Engaging extension in health reform 4 16 2013
Engaging Extension in Health Reform:
        Connecting the Dots
      at the Community Level

              Presented by:
              David Young
              Bonnie Braun
             Michelle Rodgers
              Cindy Reeves

              April 16, 2013
What Will This Seminar Cover?
• Overview of Extension’s Involvement in
  Healthy Communities
• Determining Strategic Initiatives in Health
  for Extension
• NIFA Perspective on Nutrition, Health &
  Wellness
• Health Insurance Literacy Initiative
• Connecting the Dots & Use of Social Media
Extension & Healthy Communities

 • Healthy People, Healthy Communities
   National Initiative
 • 4-H Healthy Living
 • Healthy Community Coalitions
 • eXtension ‘Creating Healthy
   Communities’ CoP
eXtension Creating Healthy
      Communities CoP
• Improve health of vulnerable populations
• Develop community engagement and
  leadership skills
• Foster improved health policy decisions
• Advance healthy community
  environments
Extension Health Stories can
    Change the World!
What would position Extension to be a
      major player in Health?
What would it take
to get that done?
ECOP Health Task Force
• Charge to Task Force
• Goals -- The ECOP National Task Force on Health will
  seek to:
• Identify priorities for Cooperative Extension health
  programs for the next 3-5 years.
• Identify outcome indicators for each priority.
• Identify potential partners, public and private,
  including non-traditional partners, to be engaged in
  resource development, program implementation, and
  outcomes reporting.
ECOP Health Task Force
        Committee Members
       Co-Chairs: Cynthia Reeves and Michelle Rodgers
1890 region                 Southern Region
Javiette Samuel             Carol Rice
Tamara Warren               Ann Vail

North Central Region        Western Region
Karen Bruns                 Roger Rennekamp
Linda Cronk                 Sonja Koukel

Northeast Region            Other
Lily Monroe Lord            Suzanne Le Menestrel
Bonnie Braun                Linda Kirk Fox
A new and unique opportunity to address the health
    and health literacy of youths and adults through
      research and theory-based programming.

Braun. B. (October, 2012). Responding to Health Care Reform: Mobilizing
Extension. Journal of Extension. http://www.joe.org/joe/2012october/comm1.php
Create New Stories –
Together we will narrate the future
Nutrition, Health and
      Wellness
• Cindy Reeves
• creeves@nifa.usda.gov
  – Encompasses a broad array of human
    science issues including health & safety,
    nutrition & health education, health literacy,
    health in the environment, access to health
    care and preventive services, and
    community health planning.
National Prevention
Strategy, America’s
Plan for Better
Health & Wellness,
June 2011




NIFA
Health
Priority
Areas
NIFA works across
all (4) Strategic
Directions
NIFA’s work on
Health Reform
Outreach &
Education
National Prevention
Strategy, America’s
Plan for Better
Health & Wellness,
June 2011
A systems framework:
Food, Nutrition & Health Security
Healthy People 2020 Leading Health
     Indicators-Health Access
Access to Health Services
   Leading Health Indicator
• Persons with Medical Insurance
  – Goal: Increase the proportion of people
    with medical insurance from 83.2% in 2008
    to 100% in 2020.
Healthy People 2020-Leading Health
   Indicators-Clinical Prev Svcs
Clinical Preventive Services
  Leading Health Indicators
• Adults receiving colorectal cancer
  screening
• Adult w/hypertension have BP under
  control
• Adult diabetics with A1c value >9%
• Children 19-35 mos who receive DTaP,
  polio, MMR, Hep B, Varicella & PCV
  vaccines
Rural Health & Safety
      Education RFA
• Broad program focus areas across
  many areas of nutrition, health & farm
  safety in rural communities
• creeves@nifa.usda.gov
• abalsano@nifa.usda.gov
CMS-Affordable Care Act
• Anticipated funding in FY13 – $875,000
• Objective
  – To provide tools and training for Extension professionals
    to educate underserved populations, in select states with
    high numbers of uninsured, about the Marketplace
    Exchanges to provide greater access to health insurance
    coverage as a result of the Affordable Care Act.
• creeves@nifa.usda.gov
CMS Prioritizes Program States
 Based on Poverty Prevalence
HealthCare.gov
Consumer Confusion
           Has Grave Consequences
• Consumers find themselves underinsured, too often
  leading to medical bankruptcy
• Under-insured consumers act like uninsured consumers
  – they delay getting care
• Inability to effectively compare plans
• Undermines the health plan marketplace
Health Insurance Literacy
The degree to which individuals have the knowledge,
ability, and confidence to find and evaluate information
about health plans, select the best plan for his or her
family’s financial and health circumstances, and
use the plan once enrolled.
Measuring health insurance literacy: A call to action and report from the health insurance literacy
expert roundtable. (2011), Washington, D.C.: Consumers Union. Available at:
http://www.consumersunion.org/pub/Health_Insurance_Literacy_Roundtable_rpt.pdf
Extension
  Multi-state Health Insurance Literacy Initiative (HILI)
                                  Launched April 2012




So what question: Given their stage of change, to what extent do
consumers increase their confidence, competence and control after
using an Extension health insurance guide?
Accomplishments

   Maryland HILI team awarded Extension funding
   Theoretical framework created
   Review of literature and curriculum completed
   Webinars conducted (5)
   eXtension Ask an Expert begun
   Multi-state task forces established
   Assessment instruments created
   Draft materials created and tested
   Evaluation plan created
   Pilot testing underway
   Website created and launched
Navigator
Fact Sheet
http://extension.umd.edu/insure
Key Questions I Need to Answer
Tasks Ahead
                   Spring-Summer
• Pilot finding used to modify materials
• Marketing Plan developed
• Funding sought

                   Late Summer-Fall
•   Revisions available to Extension
•   Training for Extension teachers & others
•   Delivery of curriculum and data collection
•   Creation of additional curriculum materials
•   Add interactivity to website

                      Winter
• Report impact results
• Release Smart Use of Health Insurance
Connecting the Dots at the
   Community Level
Connecting the Dots (con’t)
• Health Insurance Marketplaces
• Navigators, In-Person Assisters,
  Community Health Workers
• Medicaid Expansion
• Essential Health Benefits
• Healthy People 2020
  – Leading Health Indicators
  – Social Determinants of Health
• Web-Based Information Sites
Ten Essential Health Benefits
• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic
  disease management
• Pediatric services, including oral and vision care
Use of Social Media
• Know your audience
• Select the most appropriate social media
  application
  – You Tube
  – Facebook
  – Twitter
  – Blogs
  – Linkedin
http://pewinternet.org/Reports/2013/Social-media-users.aspx
INFOGRAPHIC: Survey Reveals Which
          Demographics Use What Social Media
                              By Docstoc Articles
http://premium.docstoc.com/article/151946864/INFOGRAPHIC-Survey-Reveals-Which-Demographics-
                                      Use-What-Social-Media
INFOGRAPHIC: Survey Reveals Which
          Demographics Use What Social Media
                          By Docstoc Articles (con’t)
http://premium.docstoc.com/article/151946864/INFOGRAPHIC-Survey-Reveals-Which-Demographics-
                                      Use-What-Social-Media
INFOGRAPHIC: Survey Reveals Which
          Demographics Use What Social Media
                          By Docstoc Articles (con’t)

http://premium.docstoc.com/article/151946864/INFOGRAPHIC-Survey-Reveals-Which-Demographics-
                                      Use-What-Social-Media
Summary
• The ACA is complex & changing
• The ACA mandates outreach to
  underserved, vulnerable, hard-to-reach
  populations
• 2 out of 3 uninsured do not understand
  how the ACA will impact them (March 2013)
• Extension is strategically placed to help
  connect the dots at the community level
Summary (con’t)
Questions

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Engaging extension in health reform 4 16 2013

  • 2. Engaging Extension in Health Reform: Connecting the Dots at the Community Level Presented by: David Young Bonnie Braun Michelle Rodgers Cindy Reeves April 16, 2013
  • 3. What Will This Seminar Cover? • Overview of Extension’s Involvement in Healthy Communities • Determining Strategic Initiatives in Health for Extension • NIFA Perspective on Nutrition, Health & Wellness • Health Insurance Literacy Initiative • Connecting the Dots & Use of Social Media
  • 4. Extension & Healthy Communities • Healthy People, Healthy Communities National Initiative • 4-H Healthy Living • Healthy Community Coalitions • eXtension ‘Creating Healthy Communities’ CoP
  • 5. eXtension Creating Healthy Communities CoP • Improve health of vulnerable populations • Develop community engagement and leadership skills • Foster improved health policy decisions • Advance healthy community environments
  • 6. Extension Health Stories can Change the World!
  • 7. What would position Extension to be a major player in Health?
  • 8. What would it take to get that done?
  • 9. ECOP Health Task Force • Charge to Task Force • Goals -- The ECOP National Task Force on Health will seek to: • Identify priorities for Cooperative Extension health programs for the next 3-5 years. • Identify outcome indicators for each priority. • Identify potential partners, public and private, including non-traditional partners, to be engaged in resource development, program implementation, and outcomes reporting.
  • 10. ECOP Health Task Force Committee Members Co-Chairs: Cynthia Reeves and Michelle Rodgers 1890 region Southern Region Javiette Samuel Carol Rice Tamara Warren Ann Vail North Central Region Western Region Karen Bruns Roger Rennekamp Linda Cronk Sonja Koukel Northeast Region Other Lily Monroe Lord Suzanne Le Menestrel Bonnie Braun Linda Kirk Fox
  • 11. A new and unique opportunity to address the health and health literacy of youths and adults through research and theory-based programming. Braun. B. (October, 2012). Responding to Health Care Reform: Mobilizing Extension. Journal of Extension. http://www.joe.org/joe/2012october/comm1.php
  • 12. Create New Stories – Together we will narrate the future
  • 13. Nutrition, Health and Wellness • Cindy Reeves • [email protected] – Encompasses a broad array of human science issues including health & safety, nutrition & health education, health literacy, health in the environment, access to health care and preventive services, and community health planning.
  • 14. National Prevention Strategy, America’s Plan for Better Health & Wellness, June 2011 NIFA Health Priority Areas
  • 15. NIFA works across all (4) Strategic Directions
  • 16. NIFA’s work on Health Reform Outreach & Education
  • 17. National Prevention Strategy, America’s Plan for Better Health & Wellness, June 2011
  • 18. A systems framework: Food, Nutrition & Health Security
  • 19. Healthy People 2020 Leading Health Indicators-Health Access
  • 20. Access to Health Services Leading Health Indicator • Persons with Medical Insurance – Goal: Increase the proportion of people with medical insurance from 83.2% in 2008 to 100% in 2020.
  • 21. Healthy People 2020-Leading Health Indicators-Clinical Prev Svcs
  • 22. Clinical Preventive Services Leading Health Indicators • Adults receiving colorectal cancer screening • Adult w/hypertension have BP under control • Adult diabetics with A1c value >9% • Children 19-35 mos who receive DTaP, polio, MMR, Hep B, Varicella & PCV vaccines
  • 23. Rural Health & Safety Education RFA • Broad program focus areas across many areas of nutrition, health & farm safety in rural communities • [email protected][email protected]
  • 24. CMS-Affordable Care Act • Anticipated funding in FY13 – $875,000 • Objective – To provide tools and training for Extension professionals to educate underserved populations, in select states with high numbers of uninsured, about the Marketplace Exchanges to provide greater access to health insurance coverage as a result of the Affordable Care Act. • [email protected]
  • 25. CMS Prioritizes Program States Based on Poverty Prevalence
  • 27. Consumer Confusion Has Grave Consequences • Consumers find themselves underinsured, too often leading to medical bankruptcy • Under-insured consumers act like uninsured consumers – they delay getting care • Inability to effectively compare plans • Undermines the health plan marketplace
  • 28. Health Insurance Literacy The degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for his or her family’s financial and health circumstances, and use the plan once enrolled. Measuring health insurance literacy: A call to action and report from the health insurance literacy expert roundtable. (2011), Washington, D.C.: Consumers Union. Available at: http://www.consumersunion.org/pub/Health_Insurance_Literacy_Roundtable_rpt.pdf
  • 29. Extension Multi-state Health Insurance Literacy Initiative (HILI) Launched April 2012 So what question: Given their stage of change, to what extent do consumers increase their confidence, competence and control after using an Extension health insurance guide?
  • 30. Accomplishments  Maryland HILI team awarded Extension funding  Theoretical framework created  Review of literature and curriculum completed  Webinars conducted (5)  eXtension Ask an Expert begun  Multi-state task forces established  Assessment instruments created  Draft materials created and tested  Evaluation plan created  Pilot testing underway  Website created and launched
  • 33. Key Questions I Need to Answer
  • 34. Tasks Ahead Spring-Summer • Pilot finding used to modify materials • Marketing Plan developed • Funding sought Late Summer-Fall • Revisions available to Extension • Training for Extension teachers & others • Delivery of curriculum and data collection • Creation of additional curriculum materials • Add interactivity to website Winter • Report impact results • Release Smart Use of Health Insurance
  • 35. Connecting the Dots at the Community Level
  • 36. Connecting the Dots (con’t) • Health Insurance Marketplaces • Navigators, In-Person Assisters, Community Health Workers • Medicaid Expansion • Essential Health Benefits • Healthy People 2020 – Leading Health Indicators – Social Determinants of Health • Web-Based Information Sites
  • 37. Ten Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care
  • 38. Use of Social Media • Know your audience • Select the most appropriate social media application – You Tube – Facebook – Twitter – Blogs – Linkedin
  • 40. INFOGRAPHIC: Survey Reveals Which Demographics Use What Social Media By Docstoc Articles http://premium.docstoc.com/article/151946864/INFOGRAPHIC-Survey-Reveals-Which-Demographics- Use-What-Social-Media
  • 41. INFOGRAPHIC: Survey Reveals Which Demographics Use What Social Media By Docstoc Articles (con’t) http://premium.docstoc.com/article/151946864/INFOGRAPHIC-Survey-Reveals-Which-Demographics- Use-What-Social-Media
  • 42. INFOGRAPHIC: Survey Reveals Which Demographics Use What Social Media By Docstoc Articles (con’t) http://premium.docstoc.com/article/151946864/INFOGRAPHIC-Survey-Reveals-Which-Demographics- Use-What-Social-Media
  • 43. Summary • The ACA is complex & changing • The ACA mandates outreach to underserved, vulnerable, hard-to-reach populations • 2 out of 3 uninsured do not understand how the ACA will impact them (March 2013) • Extension is strategically placed to help connect the dots at the community level

Editor's Notes

  • #4: Overview of Extension’s Involvement in Healthy Communities – Dave Y.How is Extension strategically positioned to improve health & well-being – Michelle R.NIFA Perspective on Nutrition, Health & Wellness – Cindy R.Key Elements of the ACA and Healthy People 2020 – Bonnie B.Use of Electronic Technology – Dave Y.
  • #5: Overview of Extension’s Involvement in Healthy Communities – Dave Y.How is Extension strategically positioned to improve health & well-being – Michelle R.NIFA Perspective on Nutrition, Health & Wellness – Cindy R.Key Elements of the ACA and Healthy People 2020 – Bonnie B.Use of Electronic Technology – Dave Y.
  • #6: Overview of Extension’s Involvement in Healthy Communities – Dave Y.How is Extension strategically positioned to improve health & well-being – Michelle R.NIFA Perspective on Nutrition, Health & Wellness – Cindy R.Key Elements of the ACA and Healthy People 2020 – Bonnie B.Use of Electronic Technology – Dave Y.
  • #14: Dr. Cindy Reeves is the National Program Leader for Nutrition, Health and Wellness. Cindy’s program focus is on promoting health preventing disease and disability, eliminating disparities, and improving quality of life. Her work emphasizes consumer nutrition and health and she collaborates with the Institute of Food Safety and Nutrition at NIFA. NIFAs nutrition, health and wellness programs focus on promoting health, preventing disease and disability, eliminating disparities, and improving quality of life. The health and wellness program area encompasses a broad array of human science issues including agricultural health & safety, consumer nutrition & health education, health literacy, health in relation to the environment, access to health care and preventive services and community health planning. Results are achieved through partnerships with the land-grant universities and the health community at the local, state, and federal levels.
  • #15: On a National scale, the work of NIFA in health follows the National Prevention strategy with a primary focus on the Active Living and Healthy Eating priority areas.
  • #16: NIFA works across all 4 strategic directions of Healthy & Safe Environments, Preventive Services, Empowered People and Elimination of Health Disparities.
  • #17: Our work on health reform and health literacy related to the Affordable Care Act implementation, falls primarily within the Preventive Services strategic direction.
  • #18: With the ultimate goal of increasing the number of Americans who are healthy at every stage of life.
  • #19: The nutrition and health programs of work within NIFA, as the Federal partner of the Cooperative Extension System, focuses more specifically on the systems approach outlined here, which integrates the Agri-food and Environmental systems with Health & Disease—with the central focus on Individual decision-making, resulting in individual outcomes.
  • #20: This work is also representative of the Healthy People 2020, specifically the Leading Health Indicator of Health Access
  • #21: The goal of which is to increase the proportion of people with medical insurance from 83.2% in 2008 to 100% in 2020.
  • #22: It is also related to the Leading Health Indicator of Clinical Preventive Services
  • #23: Collectively, our work on health reform and supporting the outreach of the Marketplace Exchanges will hopefully have an impact on these four goals for the Preventive Services Indicators—increasing the numbers who receive cancer screening, have their blood pressure and diabetes under control, and the number of children who are appropriately immunized.
  • #24: In terms of opportunities related to health, conference participants should check the NIFA RFAs website regularly for the Rural Health and Safety Education RFA release,which will target outreach education projects on nutrition, health and safety in rural communities. We anticipate the RFA will be published in late May or early June of this year, and this opportunity will be open to all Land-Grant Institutions. The Points of Contact are Drs. Cindy Reeves and Aida Balsano.
  • #25: In addition, NIFA has been working for the past year on developing a relationship with the Centers for Medicare and Medicaid Services (CMS) to partner with them on outreach and education related to the roll-out of the Marketplace Exchanges as a result of the Affordable Care Act. A quick shout out to Roberta Riportella for her efforts in facilitating this relationship as part of her work as a visiting scholar to NIFA last year. The Affordable Care Act puts in place strong consumer protections, provides new coverage options, including access to preventive services, and gives the tools needed to make informed choices about health. Cindy Reeves is leading this partnership effort to facilitate the development of tools and training for Extension professionals to educate people within communities about the marketplace exchanges that will provide greater access to health insurance coverage for consumers.
  • #26: While the target States for this project have yet to be determined, CMS and NIFA hope to partner with States with high numbers of uninsured people. The States with more of the dark tan to brown coloring are being considered. Stay tuned for more information as this partnership evolves. If you are not already on Cindy’s Health list serve, email her to be added, in order to receive the latest information related to this and other health issues of interest.
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