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Emerging Leaders Meeting
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A. Welcome, Introductions, and Overview of CHAP |
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B. Introduction to Workforce and Nursing Education States are responsible for: (1) financing and governing health professions education; (2) licensing and regulating health professions practice and private health insurance; (3) purchasing services and paying providers under the Medicaid program; and (4) designing a variety of subsidy and regulatory programs that provide incentives for health professionals to choose certain specialties and practice locations. The need for government involvement in this area persists as the private market typically fails to distribute the health workforce to medically underserved areas, provide adequate information and analysis on the nature of the workforce, improve the racial and ethnic cultural diversity and cultural competence of the workforce, promote adequate dental health of children, and assess the quality of education and practice. Compounding the problem is the fact that nursing colleges and universities across the country are struggling to find the faculty and dollars to educate an adequate number of nurses. |
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C. Introduction to Quality for People with Chronic Conditions This session will discuss the importance of quality care for those with chronic conditions. There are 125 million Americans with chronic diseases. With chronic conditions such as asthma and diabetes being the major causes of illness disability and death in the nation, the important of quality care is essential. There will be a discussion of the Chronic Care Model which identifies elements of a health care system that provide high quality care for individuals with chronic disease: community, health system, self management support, delivery system design decision support and clinical information systems.
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D. From the Neck Up: Gaps in Dental Care |
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E. Introduction to Access This session will look at who is uninsured and the many approaches states are taking to improving access, including public and private, individual and group strategies. With the addition of 800,000 uninsured Americans in 2004 the number of uninsured stands at 45.8 million, or 15.7% of the population. Through Medicaid and SCHIP –state-federal partnerships-- and many state-only or state-local initiatives, states fund coverage for many low income citizens. Medicaid waivers have gotten a great deal of attention as they leverage federal funds to expand coverage, improve care, contain state health spending or, as with Iowa’s 2005 waiver, address all three simultaneously. States expand or sustain private coverage by regulating insurance, setting standards as a purchaser, offering new pooling arrangements, and encouraging and studying innovations such as consumer driven health care. Some states, such as Maine with the Dirigo Health program, are attempting comprehensive, cross-cutting reforms that simultaneously address cost, access and quality or that integrate public and private insurance around the working poor. Disparities in health care that relate to factors such as the patient’s race, gender or nationality also factor into the issue of access. Finally, rising health care costs erode the ability of states, employers and individuals to sustain coverage.
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F. Concurrent Breakouts I There will be two sets of breakouts to meet with colleagues, NCSL staff experts, and outside experts in an informal workshop. Emerging leaders will talk about what is happening in their states, have an opportunity to follow-up with questions for the presenters , and to brainstorm the beginning of an agenda of things that the CHAP project will provide—future sessions, issues, projects. CHAP participants should come prepared to discuss…
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G. Dinner |
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A. Introduction to Addiction Prevention and Treatment This session will touch on the basics of addiction, prevention and treatment, as well as the key policy issues for state policymakers. We will start with a brief overview of addiction as a chronic, relapsing brain disease. Then we will briefly explain what is prevention and what is treatment. Finally, we will discuss key state policy issues, such as the methamphetamine epidemic, treatment in lieu of incarceration for the substance abusing offender (drug courts, diversion, sentencing reform, etc.), cost effectiveness and cost benefit of addiction treatment, pharmacotherapy (treatment with medications), screening in primary care settings (primary care physicians, pediatricians) and trauma settings (emergency rooms). |
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B. Concurrent Breakouts II CHAP participants should come prepared to discuss…
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C. Report Back, Next Steps, and Meeting Evaluation  |
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Addiction Prevention and Treatment
Reliable Information about Drugs
The federal government finances most of the scientific research that tracks the extent of the drug problem in the United States. One way to find this information quickly is via a chart prepared by the White House Office of National Drug Control Policy. The chart contains numerous links that will take you directly to the source information. http://www.whitehousedrugpolicy.gov/drugfact/sources.htmlDrug Effects
Three federal agencies finance nearly all of the biomedical research about the effects of drugs on the brain and body. The first two listed here are National Institutes of Health.Drugs http://www.nida.nih.gov/
Alcohol http://www.niaaa.nih.gov/
Tobacco http://www.cdc.gov/Prevalence
The nation's two benchmark surveys track drug use among various age groups. They are: http://monitoringthefuture.org/ and http://www.oas.samhsa.gov/nsduh.htmConsequences
The Drug Abuse Warning Network (DAWN) records hospital emergency room admissions for drug problems and drug related deaths from medical examiners' reports. The Robert Wood Johnson Foundation has released a comprehensive report on the cost of substance abuse to the nation, which is a rich resource for journalists. http://dawninfo.samhsa.gov/ and http://www.rwjf.org/publications/substanceAbuseChartbook.jhtmlTreatment
A rich body of research about effective treatment for drug addiction is available from the National
Institute on Drug Abuse. The Substance Abuse and Mental Health Services Administration houses the nation’s treatment services agency, the Center for Substance Abuse Treatment, and maintains a directory of treatment facilities, which can be searched by zip code. http://www.nida.nih.gov/PODAT/PODATIndex.html, http://csat.samhsa.gov/, and http://www.findtreatment.samhsa.gov/Prevention
A rich body of research about effective substance abuse prevention is available from the National Institute on Drug Abuse. The Substance Abuse and Mental Health Services Administration also houses the nation’s prevention services agency, the Center for Substance Abuse Prevention and maintains a registry of evidence-based effective programs. Columbia University hosts the National Center on Addiction and Substance Abuse, which conducts research on substance abuse prevention. Community Anti Drug Coalitions of America consists of local coalitions across the nation. National Families in Action helps parents prevent drug abuse in their families and communities. http://prevention.samhsa.gov/, http://www.modelprograms.samhsa.gov/, http://www.casacolumbia.org/, http://cadca.org/, and http://www.nationalfamilies.org/Policy Research
The Robert Wood Johnson Foundation has a national program office, the Substance Abuse Policy Research Program, that focuses on substance abuse policy research. http://www.saprp.org/
State Substance Abuse Policy
The Treatment Research Institute’s Center for Evidence-Based Policy and the National Conference of Legislatures are the national resources for state substance abuse policy. http://www.tresearch.org/, http://www.ncsl.org/programs/health/saldata.htm, http://www.ncsl.org/programs/health/forum/saguidebook.htm, http://www.ncsl.org/programs/health/satmeasure.htm, and http://www.addictionstudies.org/Your Critical Health Area Project (CHAP) staff on substance abuse and addiction is: Allison Colker, allison.colker@ncsl.org, 202.624.3581
Access to Coverage
The State Coverage Matrix is a deceptively simple table of state policies related to access. Click on any of the cells in the table, and you go to a page that describes the program and links to related sites, including state and national reports on the program. Click on a header and you’ll get a description of the category and a table with thumbnail sketches for each state in the category. And of course, clicking on the state will take you to links for all of its access programs. This site is part of the Robert Wood Johnson Foundation’s (RWJ) State Coverage Initiative at AcademyHealth. http://www.statecoverage.net/matrix.htm
Lots of other resources are available on this site including a database of state reports, and publications on coverage from AcademyHealth.
State Health Facts, brought to you by the Henry J Kaiser Family Foundation, is a great starting point for background information and interstate comparisons. It is very easy to use and contains a wealth of state data. You can look at information by state or nationally, and tailor comparisons using maps or tables. Information can be sorted by state name, rank or region. Public Insurance is Kaiser’s strong suite, and that shows in strong details for Medicaid, Medicare and SCHIP, but this site also has a wealth of information on demographics, health status, health costs, insurance, http://www.statehealthfacts.org/
While you are on the Kaiser site, you may also want to check out their latest reports (http://http://www.kff.org/), see what new webcasts are available at http://kaisernetwork.org/ and explore the background material they’ve created for policy students at http://www.kaiseredu.org/
The Centers for Medicare & Medicaid Services (CMS) is the federal agency concerned with these two public insurance programs. http://www.cms.hhs.gov/researchers/default.asp takes you to a variety of federal data resources related to Medicaid and Medicare. http://www.cms.hhs.gov/researchers/statsdata.asp lists available data. Note the dates. It still takes a couple of years to reconcile and clean up data for the national compilation. The Kaiser site listed above also summarizes much of their data and may be easier to use.
Center for Studying Health System Change (HSC) designs and conducts studies focused on the U.S. health care system and the national and local market forces driving change. It is an excellent source for data on current trends and policy-oriented analysis. This project is also funded by RWJ. http://www.hschange.com/
Some other sources for information on health coverage and access policies
In addition to RWJ and Kaiser, a number of foundations support coverage expansions and in some cases publish results of research and program activities. Among them:
Additional RWJF-sponsored coverage research is summarized at http://www.rwjf.org/research/researchlist.jsp?ia=132
Kaiser is particularly noteworthy for the research that it funds on Medicaid, SCHIP and the uninsured. http://www.kff.org/medicaid/index.cfm; http://www.kff.org/uninsured/index.cfm
The Commonwealth Fund supports and publishes research on private coverage approaches. http://www.cmwf.org/topics/topics.htm?attrib_id=12001&portal=yes
Kellogg Foundation projects include Community Voices http://www.wkkf.org/Programming/Overview.aspx?CID=7
A trio of other research and advocacy organizations with a focus on access: http://www.cbpp.org/ – Center for Budget and Policy Priorities focuses on publicly funded programs; http://www.ebri.org/ -- Employer Benefit Research Institute pays special attention to coverage issues that affect employers, particularly large ones. They publish annual analyses of the number of uninsured, based on the March Census survey; http://www.ncpa.org/ The National Center for Policy Analysis emphasizes market-based strategies.
More Links about the Presentations
Eric Baumgartner recommends the following links:
Communities Joined in Action http://www.cjaonline.net/
American Project Access Network http://www.apanonline.org/
A report on a 2000 conference that Eric Baumgartner organized includes links and descriptions of many of these programs. http://www.conferencereports.com/innovations/Illinois AllKids link http://www.allkidscovered.com/
Summary of AllKids program from Kaiser reports http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=3&DR_ID=33766
CMS Illinois page includes links to current Illinois waivers including Kidcare (their SCHIP program). http://www.cms.hhs.gov/medicaid/state.asp?state=IL
Some NCSL Resources
State Health Lawmakers Digest on Individual Coverage http://www.ncsl.org/programs/health/forum/54.htm
Web page on State Medicaid Reforms including recent sec. 1115 waivers http://www.ncsl.org/programs/health/1115waivers.htm; other Medicaid info at NCSL http://www.ncsl.org/programs/health/medicaid.htm; universal health—state legislation http://www.ncsl.org/programs/health/universalhealth.htm; health savings accounts (HSAs) http://www.ncsl.org/programs/health/hsa.htm
Your Critical Health Area Project (CHAP) staff on Access is: Kala Ladenheim (Kala.ladenheim@ncsl.org), 202-624-3557
Quality Care for People with Chronic Conditions
Information about chronic disease
Overview of the most common chronic diseases and their prevalence including information on costs: http://www.cdc.gov/nccdphp/overview.htm
Overview "At a Glance" reports on common chronic diseases: http://www.cdc.gov/nccdphp/publicat.htm
State profiles on chronic disease: http://www.cdc.gov/nccdphp/states/index.htm
Overview of chronic disease: http://www.partnershipforsolutions.com/DMS/files/chronicbook2004.pdf
Cost impacts
Power point presentation about the burden of chronic disease including costs: http://www.cdc.gov/nccdphp/burden_pres/
The Burden of Chronic Diseases and their risk factors,, 2004: http://www.cdc.gov/nccdphp/burdenbook2004/pdf/burden_book2004.pdf
Costs associated with obesity: http://www.cdc.gov/nccdphp/bb_nutrition/index.htm
Treatment
Evidence-based practice: http://ahrq.gov/clinic/epcix.htm
Information on effective healthcare: http://effectivehealthcare.ahrq.gov/aboutUs/index.cfm
Disease Management
Chronic Care Model: http://www.improvingchroniccare.org/change/index.html
Indiana Chronic Disease Management Program: http://www.indianacdmprogram.com/
Definition of Disease Management: http://www.dmaa.org/definition.html
Quality
The Robert Wood Johnson Foundation Quality Health care site: http://www.rwjf.org/portfolios/interestarea.jsp?iaid=142
Fact sheets on quality: http://ahrq.gov/consumer/index.html
National Quality Measures Clearinghouse: http://www.qualitymeasures.ahrq.gov/
Information on quality and patient safety: http://ahrq.gov/qual/
Institute of Medicine Health Care Quality Initiative: http://www.iom.edu/focuson.asp?id=8089
Prevention
Promising Practices in Chronic Disease Prevention and Control: A Public Health Framework For Action, 2003: http://www.cdc.gov/nccdphp/promising_practices/index.htm
Reports on prevention and wellness: http://ahrq.gov/consumer/index.html
Information on preventive services: http://ahrq.gov/clinic/prevenix.htm
Prevention Fact Sheets: http://www.cdc.gov/nccdphp/publicat.htm
Databases with information on chronic disease prevention: http://www.cdc.gov/nccdphp/publicat.htm
Research
Research Fact sheets: http://ahrq.gov/news/factix.htm
Information on chronic care: http://ahrq.gov/populations/chronix.htm
Data
Interactive databases that track chronic disease trends: http://www.cdc.gov/brfss/
The Burden of Chronic Diseases and their risk factors,, 2004, includes state profiles: http://www.cdc.gov/nccdphp/burdenbook2004/index.htm
State Programs
Information on exemplary state programs: http://www.cdc.gov/nccdphp/exemplary/index.htm
Examples of state activities: http://www.cdc.gov/nccdphp/bb_nutrition/index.htm
Presenters Resources:
Irene Fraser, Agency for Healthcare Research and Quality: http://ahrq.gov/
Nikki Highsmith, Center for Health Care Strategies, Inc. : http://www.chcs.org/
Doug Stratton, 317-877-5376 stratton@insightbb.com
NCSL Resources:
Chronic Disease Prevntion and Health promotion: http://www.ncsl.org/programs/health/chronic-new.htm
Disease Prevention and Control: http://www.ncsl.org/programs/health/chronicdisprev.htm
Disease Management: http://www.ncsl.org/programs/health/dmres.htm
NCSL Contacts:
Critical Health Area Project Staff person on Quality Care for People with Chronic Conditions--Carla Curran (carla.curran@ncsl.org) 303-856-1373
Prevention of chronic disease--Amy Winterfeld (amy.winterfeld@ncsl.org) 303-856-1544
Workforce/Nursing Resources
Helpful general resources
Kaiser Family Foundation general state health news http://statehealthfacts.org/cgi-bin/healthfacts.cgi
State level census data http://www.census.gov/acs/www/
Health, United States is an annual report on national trends in health statistics including highlights, a chartbook, and trend tables with statistics on such topics as birth and death rates, infant mortality, life expectancy, morbidity and health status, risk factors, use of ambulatory and inpatient care, health personnel and facilities, financing of health care, health insurance and managed care, drug utilization, and other health topics. http://www.cdc.gov/nchs/hus.htm
Health Professionals in general
Association of American Medical Colleges http://www.aamc.org/
The Center for the Health Professions, University of California, San Francisco http://www.futurehealth.ucsf.edu/cchws.html
HRSA Bureau of Health Professionals
National Center for Health Workforce Analysis (includes state health workforce profiles, reports such as “The Health Care Workforce: Education, Practice & Policy” and databases, etc.)http://bhpr.hrsa.gov/healthworkforce/default.htmAmerican Medical Association http://www.ama-assn.org/
Time-capsule thinking: the health care workforce, past and future at Health Affairs.
Nurses
American Nurses Association http://www.nursingworld.org/
States Tackle the Nursing Shortage by Kristine Goodwin (State Legislatures magazine) http://www.ncsl.org/programs/pubs/1002nurse.htm
Nursing workforce retention: challenging a bullying culture at Health Affairs.
Trends in the Supply of Physician Assistants and Nurse Practitioners in the United States at Health Affairs.
Arching the flood: how to bridge the gap between nursing schools and hospitals at Health Affairs.
Trends: New Signs Of A Strengthening U.S. Nurse Labor Market? http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.526v1?
Midwives
The Future of Midwifery by Catherine Dower, J. Miller and Ed O’Neil http://futurehealth.ucsf.edu/pdf_files/midwifry.pdf
Dentists
State Experience with Dental Loan Repayment Programs http://www.ncsl.org/print/health/sedlrp%20.pdf
The growing challenge of providing oral health care services to all Americans at Health Affairs.
Diversity
Racial Diversity in the Health Professions in California – presentation by Catherine Dower http://www.latinomedjournal.com/uploads/Catherine%20Dower.ppt
The case for diversity in the health care workforce at Health Affairs.
Your Critical Health Area Project (CHAP) staff on workforce is: Tara Lubin, Tara.lubin@ncsl.org, 202-624-3558
Other Background Materials for Critical Health Areas Program (CHAP)
NCSL Building Blocks: An Orientation to Health Policy for State Legislators
Frequently Asked Questions...
This set of briefing papers on important health policy topics is part of an orientation package for state legislators on the fundamentals of state health policy. Each paper provides basic, introductory information on policy and program areas in the form of most frequently asked questions (FAQs) by legislators and brief, objective and non-technical answers. Areas covered by this series include: Health Care Access, Health Care Economics, Insurance and Managed Care, Long-Term Care, Medicaid, Mental Health, Prescription Drugs, Public Health, Health Care Quality, SCHIP, Substance Abuse, and the Health Care Workforce. http://www.ncsl.org/programs/health/forum/faqpreface.htmSubscribe to State Health Notes http://www.statehealthnotes.org/
“Introduction to State Health Policy: A Seminar for New State Legislators,” March 31-April 3, 2005, Chicago, IL. The Agency for Healthcare Research and Quality (AHRQ) and the National Conference of State Legislatures (NCSL). Archived audio streams of the following sessions are available at http://www.hsrnet.net/ahrq/newleg/
Archived sessions: Roles of State Legislatures and State Government in Determining Health; State Roles in Regulating Health Care Markets: Balancing Cost, Access & Quality; Quality and Cost: Achieving Value in Today’s Health Care System; Understanding the Importance of Public Health; Providing Access to Care, Part I: The Uninsured and the Health Care Safety; Hot Issues in Health Care: Focus on Medicaid and SCHIP; Health Care Workforce Issues; The Crisis in Medical Malpractice Insurance; Prescription Drugs; and Cost Quality, and Access: Providing Long-Term Care Services to an Increasingly Elderly and Chronically Ill Population.
Other programs from the Agency for Healthcare Research and Quality on a variety of topics that may be of state interest may be found at http://www.ahrq.gov/news/ulp/ulpprwrk.htm
The Robert Wood Johnson Foundation, in addition to supporting this project at NCSL, funds projects and supports research around the country in all the policy areas covered in CHAP. Go to their website to subscribe to updates, or to see the latest findings in these and other areas. http://www.rwjf.org/index.jsp
The National Library of Medicine maintains an annotated list of sites with health data and health services research at http://www.nlm.nih.gov/hsrinfo/hsrsites.html
Duke University has attempted to identify a single gateway to health policy information for each individual state in its State Health Policy Web Portal. http://www.hpolicy.duke.edu/cyberexchange/whats_what/state/states.htm
Contact Information
For additional information please e-mail us at health.chaps@ncsl.org.
Find an expert for your issue at the Forum.
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