Public Health: Minding the Gaps in 2014

Vital Signs: December 2013/ January 2014

As near-universal access to health insurance expands nationwide, the public health community looks forward to the coverage for preventive services required by the new law. Services such as cancer screenings, vaccinations, chronic disease management, and mental health and substance use services will save lives and ­reduce longer-term health care costs.

As we have learned in Massachusetts, however, insurance coverage does not always mean access to care. The MMS’s most recent study on patient access to care, published earlier this year, showed significant declines in the rates of primary care physicians accepting new patients. For certain patients, disparities in access to quality, timely health care remain.

This March, the MMS will hold a leadership forum to examine health care disparities in Massachusetts, and discuss what more can be done to ensure equitable access. The forum will discuss payer issues, but will also explore opportunities and cost-effective strategies to improve care for minorities and lower income patients.

In April, the MMS will host the national Commission to End Health Care Disparities, which brings together representatives from the AMA, National Hispanic Medical Association, and other health care and academic groups. MMS leaders will share lessons learned from Massachusetts’ seven years of near-universal health care coverage, as commission members begin to experience health care reform in their own communities.

Meanwhile, the MMS will continue to promote increased diversity in the medical profession — an important factor in reducing health care disparities — through events aimed at engaging medical students, college students, and secondary school students from diverse backgrounds.

Achieving Parity for Mental Health

The Society will also focus on disparities in care for people with mental health issues in the coming year. While mental health and substance abuse issues affect almost half of Americans, mental health is not treated the same as physical health conditions in a system which faculty at MMS’s 2013 public health leadership forum called “unequivocally broken,” “confusing,” and “isolating.”

The Affordable Care Act recognizes mental health as an essential condition that insurers will be required to cover beginning in 2014. However, the different systems for referrals, authorizations, and reimbursement for mental health care make navigating the system complex, cumbersome, and restrictive for both patients and providers.

Two state commissions are examining the ability of the public and private mental health systems to meet patients’ clinical needs, as well as barriers to integration of primary care and behavioral health services. One has recommended a team-based clinical model to coordinate services, adequate reimbursement, transparency, workforce training, and modifications to prior authorization processes. The second commission, which includes representation from the MMS, is expected to issue a report soon. The MMS will continue to explore what we — and the health care community as a whole — can do to achieve the integration and parity of mental health care and physical medicine.

Ongoing Public Health Campaigns

Massachusetts has long been a national leader in public health. We had the highest flu vaccination rates in the country last season, and one of the lowest rates of adult obesity. Yet more than 40 percent of residents did not receive a flu vaccination, and 23 percent of adults are obese; obesity is one of the biggest drivers of chronic disease and health care costs.

The MMS will continue to work to improve vaccination rates and obesity prevention and treatment, as well as advocate to prevent tobacco use, particularly among young people, and keep abreast of developments as medical marijuana dispensaries open in Massachusetts. We remain committed to violence prevention efforts and our work with state officials to ensure that the health care community is prepared for disasters — natural and manmade. Physicians are the key to Massachusetts’ success in public health and prevention, and the MMS’s activities toward identifying and bridging gaps in care and prevention foster that success.

—Robyn Alie
MMS Public Health Manager

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