2010 AANHPI Diabetes Coalition Conference

Opening Plenary: Advancing the Health Reform Movement - Opportunities for NCAPIP and AA and NHPI Physicians

  • Garth Graham
  • Walter Tsou
  • Elena Rios
  • Willarda Edwards
  • Melvina McCabe

Health Care Reform reflects the soul of our country and hits at the heart of what it means to be an American. With the passage of the Patient Protection and Affordable Care Act (PPACA), physicians must take this opportunity as a call to action to guide and implement this historic bill and ensure that all of our patient populations are accounted for.

This historical passage of the health care reform bill is a sign of a progress, but it is much more. It signifies the beginning of a new era in health care. As the reform promises many new benefits for patients and care providers, it is our responsibility as AANHPI leaders to use this unprecedented opportunity to make our voices heard, to address the major health concerns of our communities, and to contribute to the improvement of the overall health status of America. We must begin by speaking up to assume and solidify our positions of leadership while ensuring the path for our future leaders. We must work with leaders in Congress and government to utilize the tools available, monitor the implementation of the reform, and convert our efforts into meaningful change.

We will join this movement to eliminate racial and ethnic disparities in health by redefining health care in the following ways:
  • Define skill sets and cultural competency clearly and institute these within the health care delivery system to provide culturally competent preventative care. There needs to be an increased focus in preventative measures such as home health care, disease prevention, and education to keep patients out of the hospital.
  • Develop an interdisciplinary workforce to include physicians, community workers, nurses, and clinics, with optimal levels of core, cultural competencies.
  • Address the disparities and growing problem of Health Professions Shortage Areas (HPSA) by redistributing training, competency, and specialty choice.
  • Address existing gaps in the reform bill as they pertain to the key issues of immigration, cost control, and the uninsured.
  • Fuel change by engaging in responsible data collection, specifically by disaggregating data in Asian and other sub-populations.

As representatives of minority populations, we must approach these goals through partnership and alliances to move forward with a unity of purpose in accomplishing these universal goals.

Health Care Reform - Goals

The goal of the health care reform is to:
  • Extend coverage to address geographic location and culture competencies. Physicians will be at the front of a new, more comprehensive and efficient system of primary care, identifying high risk patients, stressing preventative care, and promoting education and health literacy.
  • Decrease bureaucracy and associated administrated costs, increase efficiency with electronic payments and more standardized systems.
  • Improve quality of care by developing a patient-centered care process, and further improve quality with personalized information focused on prevention and overall care.

Guiding HCR: Physicians as Agents of Change

By 2050, ethnic minorities will constitute 50% of the American population. With the landscape of diversity rapidly changing, it will be essential for minority physicians to work together and ensure that HCR programs benefit these growing populations that have been historically underserved. In addition to focusing on underserved areas (HPSA) and better preventative care, physicians serving and advocating for minority populations must form a strategic alliance to build a network that strengthens and sustains our minority organizations and builds a stronger public health infrastructure.

As physicians, we must address the issues that we see in our own practices by understanding the data and the needs of our communities. We must relate common areas of disparity with our fellow minority organizations to create forums for open dialogue, sharing successful programs, increasing the use of proven strategies, and developing new strategies.

We are the leaders who will serve as the voice of those who are not heard.

Plenary 2: The Future of Medical Practice - Challenges and Opportunities for Workforce and Leadership Development

  • Mirtha Beadle
  • Seiji Hayashi
  • Joan Y. Reede
  • Ignatius Bau
  • Alice Chen (NCAPIP Responder)

This panel of experts addressed the concept that being a physician in America is a privilege, and with this privilege comes a responsibility to lead and assure that a medical workforce is patient centered, and thus responsive to the people they serve. Such a workforce must reflect demographically the diverse populations that it serves, and in addition, must possess necessary core competency training.

There exists a perception that Asian Americans, in the aggregate, are overrepresented in the medical workforce. The numbers are misleading as they mask the vast disparities existing within the Asian American, Native Hawaiian, and Pacific Islander populations. Workforce and leadership diversity should not be measured simply by the numbers, but should instead be measured by representation and inclusion of different backgrounds, cultures, and experiences that will ensure health care access and equity, especially for the underserved and vulnerable populations. With the passage of the Patient Protection and Affordable Care Act, this is an opportune time for NCAPIP and its partners to shape a diverse and representative workforce and leadership through the collection and use of complete and accurate data, strong partnerships, and productive collaboration. As a result, NCAPIP and its partners will help define cultural competency in a more meaningful way and ensure understanding towards equitable access to comprehensive and affordable health care for the underserved and vulnerable populations. The panel identified the following actions:

  • Provide a clear definition of Asian American, Native Hawaiian, and Pacific Islander health providers by disaggregating data by sub-ethnic groups, language and cultural competency, and international medical graduates.
  • Develop and support a diverse and competent work force that is responsive to the communities' needs. Innovative and creative policies and partnership strategies for early engagement beginning in elementary and high school will develop a talented and diverse pool of future physicians and other healthcare practitioners. This pool will be sustained concurrently through the establishment of a youth friendly communication system designed to prepare college students with early career exploration, mentoring, and other opportunities. Minority students will be a major focus as they have been historically less able and inclined to access programs and opportunities that can place them on track for health science careers. Surveys have also found that Asian American students make up the highest percentage (48%) who are undecided if they want to be a primary care physician. The projected shortage of primary physicians in the future puts already at risk populations in an even more vulnerable health status. NCAPIP seeks to establish measures to identify and support students to pursue a primary care career through partnerships with existing programs such as Graduate Medical Education HRSA.
  • Leadership is critical in determining the policies and resources necessary to develop a diverse and representative workforce. Yet, well-qualified AANHPI and other minority health professionals are not well represented in the senior health executive ranks such as hospital administrators, division chiefs, medical school deans, and department chairs. NCAPIP and its partners need to examine the barriers to advancement that minority health professionals may face and collaborate with other concerned public and private sectors to ensure that fair and equitable leadership opportunities including mentorship and leadership education are made available to help them move up the executive and leadership ranks. Further, NCAPIP is encouraged to advocate for AANHPI representation on federal health related committees and commissions to ensure the AANHPI perspectives are articulated and addressed. Such leadership and representation is important to ensure that the needs of our AANHPI communities are adequately addressed in health care policies and practice.
  • The tools are here for NCAPIP and its partners to achieve the above objectives. The HHS' Office of Minority Health (OMH), Health Resources and Service Administration (HRSA), National Health Service Corps, and the Graduate Medical Education program of the Center of Medicare and Medicaid Services are some of the federal agencies with the resources and programs to help support a diverse pipeline of AANHPIs who will transform a patient centered medical workforce.

Plenary 3: Health Care Reform - Lessons Learned, Moving Forward

  • Jennie Chin Hansen
  • Neera Tanden
  • Robert M. Wah

This panel addressed the new health care bill, the Patient Protection and Affordable Care Act (PPACA), and how it will affect the landscape of health care provision. It is the duty of physicians to understand how PPACA affects their practices and patients. As agents of positive change within the community, physicians have the unique opportunity as well as the responsibility to monitor and impact the implementation of health care reform for AANHPI populations throughout the country.

While PPACA has been built by legislators in Washington as an improvement of the existing market-driven health care system, it is an exciting time to reframe what quality health care is and how it should be delivered, as well as to advocate for issues not addressed in the bill. As the voice of AANHPI physicians, NCAPIP has outlined the following provisions that will ensure that all Americans are the beneficiaries of the Patient Protection and Affordable Care Act.

  • Patience and Productivity - While some of the effects of the health care reform bill will become immediately apparent, many of the major policy changes will only begin to affect the public in 2014. As this long term policy process is developing, physicians should not remain as passive observers of the bill, but rather as authorities on the issues - stepping forward, engaging, and addressing specific issues lacking in the bill and ensuring proper implementation of the bill. There must be thoughtful action taking place at the same time as the bill moves steadily forward. The question must be posed: what does the ideal health provider system need to be like? With physicians taking an active role, the new HCR will be guided in a direction that ensures adequate health services for all. NCAPIP will serve as a source of information, discussion, and collaborative efforts for doctors and organizations to ensure the process includes the underserved.
  • Focus on Systems of Care - It is the responsibility of all physicians to consider all of theaspects of the community and workforce when designing the optimal health care delivery system. Groups such as the elderly require special attention, and appropriate vehicles that ensure quality, personal care while streamlining costs are paramount. If health care delivery is a vehicle, there are multiple drivers. Nurses and 'hands on' medical workforce members must be rightly considered as essential members of the system that need adequate compensation. In turn, promoting health care as a 'team' effort will improve patient - provider relations, the core strength of any health care system, and ensure quality improvement as well as prevention and wellness.
  • Reforms in the Health Bill - In addition to taking part in the discussion and monitoring of reform, NCAPIP must especially be mindful of a few key issues which are particularly relevant to the AANHPI communities:
    • 'Essential Community Providers' are referenced in PPACA; NCAPIP should take measures to ensure that the definition of these providers is a culturally and linguistically competent community caregiver.
    • Readmission rate in PPACA states that hospitals should not be compensated for readmission by a patient within 30 days of initial stay. NCAPIP should take measures to ensure that provisions are included that avoid situations where patients who do not have stable environments at home and/or have difficulty with English communication are not penalized and avoided by hospitals who may view them as financial risks.
    • Health Professional Shortage Areas lead to recruitment and placement of doctors in areas of need. These usually end up being more rural locations. ?However, the AANHPI population has lost out because they are so concentrated in urban areas which might have a higher concentration of doctors, but these populations lack the culturally competent doctors they need. HPSA should account for this oversight.
  • Reforms not in the Health Bill - There are reforms not included in the new HCR that should be advanced by a collective of physicians. The market forces at work that drive drug prices must be considered because they change the landscape of health care. SGR in its present form should be considered for change - as it stands now, Medicare fees for the last decade have been stagnant, without taking into account inflation or new treatments. Each year inadequate fees are allotted for compensation to physicians treating Medicare patients.

PPACA promises to usher in numerous positive changes to America's health care system but without the leadership and hard work of physicians helping to guide provisions of the bill, optimal progress cannot be achieved.

Plenary 4: Facing the Unique Clinical Needs of AA and NHPI Communities and Strategies to Achieve Equity

  • Moon Chen
  • George L. King
  • Samuel So
  • Joseph K. Lim
  • Henry Chung
  • Vickie Mays

This plenary session addressed four major health concerns for the AANHPI including cancer, diabetes, hepatitis, and mental health. The panel identified the unique clinical issues as they pertain to the diverse subpopulations of the AANHPI with proposed action steps to address these issues. Specific efforts fall under the categories of partnership with existing national and community organizations, responsible data collection, examination of best practices and quality measurements, and educational campaigns; all of which should be supplemented by a constant effort to increase visibility of the AANHPI on a national policy level.
  • The cancer burden is a critical issue to address for the AANHPI because they are the only demographic for which cancer is the leading cause of death with lung and liver cancer holding the highest prevalence in the population. For other less prevalent cancers, the API are particularly vulnerable with higher rates of mortality. For example, U.S. born women of Asian origin are the most likely to die from breast cancer even though they are less likely to contract the cancer. API communities continue to be at high risk because they are less likely to screen for cancers, to agree to smoking cessation, to exercise, and to see a physician in the last 12 months. Efforts must be coordinated to prevent these poor health outcomes, but the heterogeneity of the population defies a simplistic approach. NCAPIP must partner with an array of groups including the Asian American Network for Cancer Awareness, Research, and Training (AANCART) and the American Cancer Society (ACS) to reach out further into the communities with disease specific action plans. These actions should range from increasing access to HPV vaccines to launching educational campaigns for issues such as care for breast cancer and smoking and lung cancer in women. In addition, ethnically specific data collection is a priority, with more focus paid on Pacific Island numbers.
  • New data regarding diabetes in the AANHPI populations is necessary in order to re-assess the health disparities that exist within the communities. Diabetes is a serious problem for the AANHPI because it is systemic with high complications of end stage renal disease and failure. Factors such as a sedentary lifestyle, diet, urbanization, and genetics all contribute to the high risk of diabetes in our populations. In addition, the existing measures to assess risk are not good indicators as they do not reflect the risk for diabetes in Asian Americans. New standards for BMI as a measure of obesity or being overweight are necessary to account for the tendency for lower BMI and higher fat in Asian Americans.
  • A lack of awareness in the public, healthcare providers, and policy makers is the major limiting factor in the prevention and control of viral hepatitis in the AANHPI. Innovative educational campaigns such as those developed by the Jade Ribbon Campaign will educate the public to the danger of hepatitis B in our communities. In addition, it is the Institute of Medicine¡¦s recommendation to improve disease surveillance, improve health care provider and community education, promote early detection and treatment, and globally eliminate hepatitis B. New strategies must be explored to address API populations that are not concentrated on the coasts and national data should be gathered to overcome the limitations of using cohorts in large urban centers as being representative of the national population.
  • Quality measurements are the foundation that informs cultural competence and identifies gaps. When assessing the quality of care, language proficiency is only one factor in effectively administering care, especially in areas such as mental health. To ensure the highest quality of care in mental health and in all of medicine, it is imperative to adopt 5 approaches: 1) tying resources to quality measurement, 2) Health IT, 3) comparative effectiveness, 4) quality improvement collaboratives and learning networks, and 5) clinical training in practice based learning and systems based practice. Additionally, we must increase the visibility of the API as a priority population with mental health needs when discussed in the current health reform policies. We need a proposal to address changing the system by using the leadership of minority mental health service providers to act as the voice for policy planning and education in mental health. It is in this way that we can begin to provide culturally sensitive and quality care in chronic mental health treatment and in specific problems like disaster preparedness.