Our spring convening series, Focus on Equity: Communities of Color in a Post-ACA California, continued today in Fresno, as health advocates gathered to discuss the most pressing health needs for communities of color in the Central Valley. Like our Oakland convening on Tuesday, this event focused on three key areas: behavioral health integration, considering equity when improving the quality of care, and Health for All efforts to expand access to coverage for everyone regardless of immigration status.
Jennifer Torres from Clinica Sierra Vista started things off by discussing ongoing efforts to integrate behavioral health services with primary care services at community health clinics in Kern and Fresno Counties. She pointed to some initial challenges with assimilating behavioral health into the culture of community health clinics, but also noted that progress has been made.
Torres: Integration of behavioral health in community health center has to assimilate with CHC culture http://t.co/qPHQNmVTjc #FocusOnEquity
— CPEHN (@CPEHN) April 23, 2015
Torres: "They don't want to tell me, and I don't want to ask" was mentality at the start for primary care physicians re behavioral health
— CPEHN (@CPEHN) April 23, 2015
Torres: But over time it became evident that some behavioral health concerns are ideal for primary care integration. http://t.co/O2YMEYfTYm
— CPEHN (@CPEHN) April 23, 2015
She also acknowledged that the behavioral health integration model only works with an adequate number of eligible providers. Severe shortages of these providers in the Central Valley have made the model more costly. But she also pointed to some actions that can be taken to ensure viability of the programs in the future.
Torres: Future work will help make integration more sustainable in region http://t.co/RFDRegJ5jV
— CPEHN (@CPEHN) April 23, 2015
Michelle Cabrera from SEIU California followed with a presentation on how equity can be considered when developing quality of care metrics. To illustrate some of the inequities in care quality, Cabrera cited recent reports that have shown that while overall quality has improved, there are not corresponding reductions in disparities.
Cabrera: National Healthcare Quality and Disparities Report shows that while overall quality is improving, disparities are persistent
— CPEHN (@CPEHN) April 23, 2015
Cabrera: Need more data to understand disparities in smaller population groups. Incl Native Hawaiians, mixed race, and LGBT populations
— CPEHN (@CPEHN) April 23, 2015
These persistent disparities are why we need to shift from the current “triple aim” of lower cost, improved quality, and population health to a “quadruple aim” including equity. However, because the discussions are driven by large purchasers like Medi-Cal, the dialogue is often about costs and there is not much incentive to focus on the fourth aim. However, Cabrera noted that progress is being made, and more voices from the community can help shift the dialogue to a more equity-focused model.
Cabrera: purchasers driving discussions which leads to focus on costs. Not a lot of incentive to shift to equity aim http://t.co/VZ4eBVGygZ
— CPEHN (@CPEHN) April 23, 2015
Cabrera: We have momentum for this, but we need more voices and we need more public outcry. #quadrupleaim #focusonequity
— CPEHN (@CPEHN) April 23, 2015
The final presentation of the day was from Betzabel Estudillo from the California Immigrant Policy Center. She focused on the current state of Health for All legislative efforts to expand access to coverage for all Californians regardless of immigration status. She started by illustrating the need for legislation like Senator Ricardo Lara’s SB 4: The Health for All Act.
Estudillo: After full implementation of ACA, 2.7-3.4m uninsured. 1.2m because of imm status http://t.co/tvHvsWJWDX @calimmigrant
— CPEHN (@CPEHN) April 23, 2015
Estudillo explains the reasons why #Health4All is necessary http://t.co/Gw2pYLiYvz
— CPEHN (@CPEHN) April 23, 2015
She closed by telling the attendees what they can do to support Health for All and join the movement to improve health in all communities, particularly among California’s large immigrant population.
Estudillo from @calimmigrant discusses how you can help #Health4All #SB4 efforts http://t.co/vFAcGNNRnk
— CPEHN (@CPEHN) April 23, 2015
We have two more Focus on Equity convenings next week: on Monday in Los Angeles and Tuesday in San Diego. There’s still room if you’re interested in attending, so please register today!