Monthly Archives: September 2011

Health Power-Broker Series: Congressional Black Caucus Foundation Research Director Dr. Marjorie Innocent Promises that Annual Legislative Conference Will Arm Public with Truth about Health Reform

By Talib I. Karim, Esq.
Health & Law Reporter

Dr. Marjorie Innocent, Ph.D., Congressional Black Caucus’ Senior Director of Research and Programs says the CBC ALC is very rich in content and offers those interested in health care issues useful information, contacts, and other resources to advance their work. (Courtesy of Robert Wood Johnson)

This week’s Congressional Black Caucus Foundation Annual Legislative Conference or “CBCF ALC” will be the 20th that I’ve attended/observed, and the 41st ever, the first being held in 1970, just months after my arrival, on earth that is.

It’s no coincidence that nearly 40 years to the date after the Congressional Black Caucus (CBC) itself was formed, one of its own members, Barack Obama, standing on the steps of the U.S. Capitol, would be sworn in to the nation’s highest public office.

It’s also no coincidence that two and a half years later, the ALC would focus on the center-piece of the Obama Administration’s legislative policy, health reform.

I recently discussed this year’s focus of health reform and jobs, with Dr. Marjorie Innocent, CBCF Director of Research and Programs.  A proud crisp-dressing woman of Haitian decent, raised inQueens,NY, Dr. Innocent has a B.A. in Political Science and a Ph.D. in Health Policy and Management from Columbia University and the Johns Hopkins Bloomberg School of Public Health, respectively.

Here’s what Dr. Innocent had to say:

Talib:  Dr. Innocent, first tell me, how did you get involved with championing health care issues for the CBCF?

Dr. Innocent: After finishing college, I noticed a connection between a person’s health and where they lived.  This sparked my curiosity which was quenched at Johns Hopkins where I focused on this issue as well as the benefits of school based health centers.  My work on these issues ultimately led me to the CBCF.

Talib: As people follow your lead and look to the health sector for employment opportunities, do you think it’s a good choice.

Dr. Innocent: I do.  In fact, the truth is that the Affordable Care Act provides opportunities for good paying jobs, not just for traditional health sciences professionals like doctors and nurses, but also for educators, IT specialists, and others.

Talib:  During my days as a Hill staffer helping to advance health reform, many in the CBC and Progressive Caucus argued that health care legislation was in fact a jobs bill.  So your point proves that fact.  Nonetheless, how are those seeking good paying health sector jobs helped by the President’s new $450 billion jobs stimulus package?

Dr. Innocent: While I’m still studying the President’s entire proposal, it’s clear that there are billions of dollars proposed for job training that can help the unemployed get the skills needed for them to reenter the workforce by landing the kind of good-paying jobs offered in the health sector.

Talib: With so many opportunities in the President’s health reform law, why is the public still confused?

Dr. Innocent: The CBCF is a non-partisan, non-profit organization.  Yet, it appears that certain forces might prefer to keep the public misinformed.  As a social policy think tank, it’s our role to give the public the truth, particularly the African American community.  And that’s what we’ve done with the Affordable Care Act.

Namely, we’ve published a report, Understanding Health Reform: A Community Guide for African Americans, specifically written for African Americans but designed to help all Americans understand the benefits available to them under the health reform law, as well as the law’s potential for bringing about health equity across racial/ethnic, gender, economic and geographic lines.

Talib: What are examples of some myths that your Community Guide helps to dispel?

Dr. Innocent:  First, we explain that the law does not mean that people will lose their health care or be forced to give up their family doctors, it does not impose limits on the services that people can receive, nor will it cause costs to sky rocket for businesses.  In fact, we explain that health reform is designed to give people access to care by using the latest in preventative care.  The law seeks to shift the nation’s focus from just treating people when they are sick to keeping people healthy, which will eliminate the gross burden on the nation’s limited resources.

Talib: Your Community Guide explains the many benefits of the Affordable Care Act in 50+ pages.  For our readers, what would you say is the most important opportunity for those representing underserved communities like African Americans?

Dr. Innocent: There’s really too many to quickly single out the best opportunity.  Yet, if I had to choose, I’d say the newly created National Institute on Minority Health and Health Disparities.

Talib: Right, the Institute was formerly aNationalCenter at the National Institutes of Health.  But what does this elevation mean in practical terms?

Dr. Innocent:   As a National Institute, it will have expanded research funding and will lead and evaluate NIH’s work on minority health and health disparities.  On a practical level, we now have a national resource tasked with helping health providers and organizations who have established relationships within our community to get the funding they need to better serve our community.  Some groups don’t get funding because they don’t know about the grants or cannot compete with larger applicants.  The National Institute is there to level the playing field.

The Institute can also play a pivotal role in tracking the efforts of the entire federal public health system to assess whether their efforts are effectively impacting the African American community.  If fully funded, and properly supported, over the next 15-20, we can see a dramatic change.

Talib: You’re talking about significant increases in mental and physical wellbeing, total health outcome improvements?

Dr. Innocent: Correct.

Talib: In closing, you all have several events planned next week specifically designed for those like our readers who are interested in advancing health outcomes on the local and national level.  Can you highlight them?

Dr. Innocent:   There are numerous events to attend.  I would say check out the full list to see what works for schedule.  For example, on Wednesday at 12:00, there is a Luncheon entitled “Healing Power:Community Health Centers, Prevention and Health Reform in Black Communities.”  The next day there are several other Health and Wellness events including a forum hosted by Congressman Conyers discussing what’s needed to defend and build on Healthcare Reform.  Friday also features health forums and braintrusts such as that organized by Congresswoman, Dr. Donna M. Christensen examining the Politics of Race & Health Equity.

Talib: And I’m sure we can also expect an earful on health reform from your keynote speaker for Saturday’s Phoenix Awards Dinner, President Obama. Clearly, with such probing and insightful content, the Washington Post, Huffington Post, and Wall Street Journal alike should have no problem finding hard news during the ALC to feature in the front pages of their publications.

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Health Power-Broker Series: Deputy Assistant Secretary for Minority Health Dr. Garth Graham, Prescribes Survival Plan for Urban Hospitals

By Talib I. Karim, Esq. Health& Law Reporter

Dr. Garth N. Graham M.D., M.P.H., Director of the Office of Minority Health, challenges urban hospitals to help shape new federal rules, make alliances in the community to help prevent illnesses, and invest in innovation as a prescription for survival.

During man-made and natural disasters such as the recent earthquake and hurricane, African Americans are particularly vulnerable due to their historic lack of access to quality health care.  Ending this “health-divide” or disparity in health treatments and outcomes based upon race and ethnicity is the mission of the Office of Minority Health in the U.S. Dept. of Health and Human Service (HHS) and its director Dr. Garth Graham, Deputy Assistant HHS Secretary for Minority Health.

Similar to the Surgeon General, Dr. Graham is an officer of the U.S. Public Health Service and dons a uniform to work.  The distinctively Jamaican-accented Dr.Graham was raised in the same hospital in which he was born, literally.  His mother, a nurse, would often carry the soon-to-be Dr. Graham with her to work.  Graham left Jamaica at 17 for the U.S. to follow his mother into the health field.  By 28, Graham had amassed three degrees, a B.S. from Florida International University as well as an M.D. and a M.P.H. both from Yale.  Today, the not-yet-40 Dr. Graham is the federal government’s “top doc” in tackling health issues affecting African Americans and similar vulnerable populations.

I caught up with Dr. Graham recently, and this is what he had to say.

Talib: Studies reveal African Americans still receive different health treatment from others due to no reason other than race.  What is the Obama Administration doing to defeat this disparity?

Dr. Graham: One initiative aimed at achieving this goal is our work to reduce outcomes of HIV through prevention.  We’re also working hand-in-hand with the First Lady’s “Let’s Move” initiative to reduce obesity and high blood pressure.

Today, my office’s primary focus currently is overseeing implementation of provisions of the Affordable Care Act (ACA) [the Administration’s landmark health reform law] that directly impact health disparities such as our mandate to track the government’s ethnically-targeted data collection efforts.  From our work, we know that 53% of the nation’s uninsured come from the minority communities, 1/5 African American and 1/3 Latino Americans.

This data underscores the vital role that our office plays in advancing the health care outcomes for the entire nation.  We achieve our goals through collaborations with Health Resources and Services Administration (HRSA).

Talib: How about giving us a status report on your agency’s recently released “Plan to Reduce Health Disparities.”

Dr. Graham: The plan is being fully implemented at this stage.  Ensuring quality access to care in the minority community is a priority, and HRSA is taking steps to measure and monitor the quality of care being provided to this population.  My office is charged with coordinating the work of various federal programs and fitting them under a broad umbrella to specifically target health disparities.

Yet we face a number of challenges, particularly in looking at Medicaid expenditures and resulting health outcomes.  Sicker populations account for a major reason why Medicaid dollars are not directly translating into improved health outcomes.  We can take care of people when they are sick but that’s more expensive.  When you begin shifting dollars and focus towards prevention that’s when you’ll see a better cost-outcome ratio.

For example we released $100 million dollars to stimulate prevention activities by states. Under the ACA, patients will no longer have a co-pay for preventative services.  The more you spend on prevention the better.  We have to direct more and more resources towards prevention especially if we open up avenues for care.

Talib: Grant funds can go a long way to support health providers seeking new and less expensive ways of treating vulnerable groups.  What is your office doing to increase grant dollars to hospitals and other providers who serve African American and other vulnerable communities?

Dr. Graham: Grant programs form an important component of my office’s work.  Currently, we support the activities of 44 offices of minority health at the state level, nationally.  We also fund the work of other groups such as grants to support AIDS and HIV prevention and treatment.   Yet, we must do more to ensure that other federal agencies are doing their part to increase the number of minority-serving R01 [NIH research project] grantees in the system.

To be clear, there are more grant opportunities than ever before.  However, grass roots groups should not just pay attention to identifying the grants but also to securing the technical assistance needed to win the grants and become more effective.

Talib: Some providers cite pluses and minuses in health reform.  Namely, while the Affordable Care Act expands health insurance for those who are currently without good coverage, it also calls for significant cuts in funds now paid to reimburse hospitals for care provided to the uninsured.  Many of these “Disproportional Share Hospitals (DSH)” complain that they may not be able to survive even after their patients are fully covered.  Is there a broken model here?

Dr. Graham: Many of these hospitals have unique challenges because they service a lot of very sick people who are more costly to treat.  Most costs are incurred on the end stage of treating diseases due to the significant resources required to get patients back to the baseline.  For hospitals to survive, they have to ensure that patients engage in prevention to avoid contracting conditions that are so costly to treat in the hospital.

Talib:  I note that $11 billion from the Affordable Care Act is slated to fund “Federally Qualified Community Health Centers (FQCHCs).”  Would hospitals like Howard be well served to establish such health centers to take their work in prevention outside beyond their doors?

Dr. Graham:  FQCHCs offer a unique opportunity for urban and rural hospitals alike.  Namely, HRSA just released a grant to fund early infrastructure creation [for building new FQCHCs not to just support existing facilities].  However, current guidelines require FQCHCs to be governed by boards whose majorities are made up those served by the health centers.  Thus, while hospitals may not be able to create FQCHCs [independently] they can partner with outside groups to establish these centers as satellites for their hospitals.

Talib: So in closing, if you had prescription for survival for urban hospitals such as Howard and Morehouse what would it entail?

1.  Give input on regulations being developed that affect their bottom line.  It’s critical for hospitals to submit comments when the government is proposing new rules.

2.  Make more linkages in the communities where people are getting care to avoid absorbing the total cost of treatment at the tail end of the disease.

3.  Innovation, Innovation, Innovation.  Hospitals need to be become more active in conducting cutting-edge research that leads to innovation.  Through this research, hospitals can generate revenue while also developing treatments that are more tailored to their patients, thus helping them avoid more expensive procedures.

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