Local Strategies Helping Move ACA Forward in West Virginia

rahul-guptaThis post was originally published on the Public Health Newswire as part of a series on the impact of the Affordable Care Act written by contributing authors with varying public health perspectives. This piece comes from NACCHO board member Rahul Gupta, health officer and executive director of Kanawha-Charleston Health Department in West Virginia. Gupta offers his thoughts on how the Affordable Care Act has impacted local health initiatives in West Virginia. 

Einstein once said that the world we have created is a product of our thinking; it cannot be changed without changing our thinking. At the very foundation of the Affordable Care Act (ACA) lies an attempt to change our way of thinking when it comes to the health of Americans. While the central thrust of ACA is healthcare insurance coverage expansion, it is also an imperative first step in understanding population health challenges and raising the profile of public health.

There is no doubt that local health department (LHD) leadership must take advantage of the advancements in federal policy reflected in ACA that recognize and emphasize the significance of prevention and population health. As the largest LHD in our state, the Kanawha-Charleston Health Department (KCHD) collaborates with West Virginians for Affordable Health Care—the most influential  nonprofit group in West Virginia advancing healthcare reform—to bring together various sectors impacted by ACA, such as the hospital association, health departments, legislators, state insurance commission, primary care and federally qualified health centers, free clinics, academic institutions, various voluntary associations, and others.

Parallel to efforts in Camden, NJ, we have also established a countywide task force on healthcare reform whose focus is to create local innovative approaches in reducing healthcare costs in our community. By evaluating data such as unnecessary hospital readmissions, we are working to create an integrated patient care approach beyond the medical home model. In our community, for almost two decades now, we have combined our collective efforts between local hospitals, health department, primary care, school system, behavioral health, wellness council, and community agencies such as the United Way to create a unified community health needs assessment every three years, which is utilized by all parties. Similar requirements in the ACA for 501(c)(3) nonprofit hospitals were embraced by our community and helped reaffirm our belief that working in partnership accomplishes leveraging limited resources while not sacrificing effectiveness.

Anticipating that some in Congress would argue that the expansion of insurance coverage justifies curtailing federal support for programs such as immunizations, we have been involved in adopting proactive innovative strategies to address such challenges. KCHD developed an in-school influenza vaccination program for the county school system (30,000 students) that bills insurers for services. In its third year, this effort has not only received extensive local and state accolades but has been self-sustaining without any local, state, or federal funding. It has also recently been recognized as a model practice by NACCHO.

In policy advocacy, KCHD has been actively engaged in supporting state Medicaid expansion. During the 2011 legislative session, we worked to ensure that a state health benefits exchange was established and a local health officer would be eligible to serve on its board. During this year’s session, we are supporting legislation to allow LHDs across the state to become sustainable by having the ability to bill insurers for services for STD/HIV screening, testing, and treatment.

Finally, West Virginia is utilizing Community Transformation Grant funds as a statewide opportunity to develop a framework for sustainable programs and resources throughout local communities to reduce the impact of obesity and tobacco. LHDs from all 55 counties in West Virginia are playing a pivotal role in bringing various stakeholders and institutions together to transform state and local communities.

While much work remains to assure that health reform efforts truly bring a change in our way of thinking, we believe the public health work being conducted in local communities across West Virginia and the country through the provisions of ACA has the potential to bring a significant and sustaining change for our nation.

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