Today in Oakland, health advocates from across the Bay Area gathered at CPEHN’s spring convening, Focus on Equity: Communities of Color in Post-ACA California, to discuss efforts to reduce health inequities in California. The event focused on three priority areas: efforts to expand access to health care to all Californians regardless of immigration status (Health for All), including equity in efforts to improve quality of care, and the integration of behavioral and primary health care services.
After an introductory presentation from CPEHN’s Cary Sanders on the current state of coverage, quality, and behavioral health integration, we shifted to local speakers. The first, Jazmin Segura from Educators for Fair Consideration, spoke about the importance of expanding health care to all Californians, regardless of immigration status. She noted that thanks to the recent executive order by President Barack Obama, many immigrants receiving Deferred Action for Childhood Arrivals (DACA) status are now considered Permanent Residents Under Color of Law (PRUCOL) and are thus eligible for full-scope Medi-Cal if they meet the income requirements. However, years of distrust in the system has combined with pervasive misinformation to keep DACA-eligible immigrants from signing up for Medi-Cal, either because they don’t know they are eligible or because they are afraid of future repercussions.
Segura then discussed current efforts to extend health coverage to all Californians, regardless of immigration status. She noted that Senator Ricardo Lara’s SB 4 Health for All Act is “the next great fight for immigrant rights organizations” and noted that for it to pass through the legislature, it will need help from advocates across the state.
Segura @e4fc: Overview of what SB 4 #Health4All legislation will do. http://t.co/QieQfX5NLh #FocusOnEquity
— CPEHN (@CPEHN) April 21, 2015
Sarah Muller from the California Association of Public Hospitals and Health Systems followed with a presentation on the importance of considering equity when evaluating quality measures and making improvements to health care quality. She discussed the Delivery System Reform Incentive Program (DSRIP) and how it focuses on outcomes, improvements, and patient experience measures. She pointed to several equity-related measures, too:
Muller @CaPubHospitals: Some examples of equity related measures in DSRIP http://t.co/etZGHgRMHA
— CPEHN (@CPEHN) April 21, 2015
As well as several examples of innovative practices at local public health services aimed at reducing inequities:
Muller @CaPubHospitals: many local public health systems have done equity efforts outside of DSRIP http://t.co/Uit5X9sQi2 #FocusOnEquity
— CPEHN (@CPEHN) April 21, 2015
The final local presentation was by Esther Lucero from the California Consortium for Urban Indian Health (CCUIH), discussing the importance of integrating behavioral and physical health care. The presentation, which sparked a lively discussion, focused on how traditional native healing practices, and models of care in other cultures such as promotoras in the Latino community, have long considered the whole person when offering care. Lucero cautioned that while it is great that we are finally working to integrate behavioral and physical care, we need to move away from a “top-down” incentive model where a set of priorities is instilled at the state level and then communities are forced to fit into those priorities. In particular, integration is already going on in many communities, but it is informal and as a result is not billable. For example, substance abuse sponsors and mentors are not seen as a billable service by Medi-Cal and other types of health coverage and therefore cannot be compensated for their time despite providing a vital service. There are many other culturally specific treatment models that also fall outside of what is considered a billable service. Lucero summed up the concerns with a question: “Are we thinking about meeting the best needs of our community or are we working to meet the top-down requirements?”
The event was just the first of four convenings, with the next coming this Thursday, April 23rd in Fresno. Next week we will also be in Los Angeles (April 27th) and San Diego (April 28th). There is still space available, so please register today if you’d like to attend!