The Impacts of the Affordable Care Act on Preparedness Resources and Programs: Workshop Summary by Megan Reeve

Author:Megan Reeve
Language: eng
Format: epub
Tags: ebook, book
Publisher: The National Academies Press
Published: 2014-09-04T00:00:00+00:00

FIGURE 6-2 Integration of models to inform plans and policies in LA County.

SOURCE: Dean presentation, November 19, 2013.

In assessing the campaign, Dean said there was no metric or a mechanism to determine how much vaccine was administered by providers. A research corporation was hired to conduct sampling for 10 weeks, and it was determined that about 3,335,000 courses of vaccine were given, just reaching the low end of the target.

The surge model was first developed in 2003 to predict the effect of an anticipated closing of several government-run hospitals on the hospital system. The model was modified in 2008 to look at the effect of an influenza pandemic on the hospital system as a whole. Using unmet need (i.e., beds) as the primary output, the results stressed the need for upstream public health intervention to alleviate the burden on the hospital system. It was also clear there would be unequal impacts in different regions, based on the size of the hospital, local population, and other factors.

Anthrax Modeling

Another example described by Dean involved medical countermeasures for anthrax exposure. Current plans require the dispensing of prophylactic medication to 10 million people within 48 hours. There are numerous PODs, he said, but more capacity is needed. Modeling was used to study the effect of additional dispensing partners, both public and private. Initial results suggested that not distributing any intervention could lead to 400,000 cases of anthrax. With LA County’s current capacity, the number of cases could be reduced to about 142,000 by dispensing within 48 hours post exposure. If dispensing capacity could be extended, through additional POD sites or engaging partners such as pharmacies, then the number of cases could be reduced to 124,000. Better planning and allocation of resources in a more systematic way could cut the number of cases further.

Prescription Drug Use

The last example shared by Dean is a pilot program to track prescription drug use by the most vulnerable residents (by both demographics and geography) prior to a catastrophic event. By 2014, about 1 million uninsured residents are expected to have acquired insurance under the ACA, the majority of them through the L.A. Care Health Plan. Using de-identified data from health records and insurance records, the goal of the tracking program is to build profiles of what these particular groups will need in an emergency and to work with the public and private providers to coordinate pharmaceutical care services for these individuals during a crisis to prevent the ad hoc provision of medications that often occurs at the local level currently at various emergency shelters. Ideally, this could help to inform real situations that Dean described in his simulations. This is useful information to inform cities’ planning, but not every city has these technologic capabilities. As the ACA progresses, and more health care systems increase EHR use and Meaningful Use requirements (enabled through the American Re-investment and Recovery Act), it may be easier and ideally more routine to have better predictive modeling at the local level that can target a range of needs.

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