Health Innovation Highlights: April 18, 2018

Full Edition

DIRECTOR'S CORNER

What I’m Reading During National Minority Health Month

Ann Hwang, MD
Director, Center for Consumer Engagement in Health Innovation

April is National Minority Health Month, a fitting occasion to reflect on what is needed to improve care and achieve equitable outcomes in the United States. Sometimes on the front lines, when taking care of an individual patient, it can be hard to recognize when poor outcomes for an individual reflect a more pervasive and systemic pattern. But data collected at the national level shows that for three important indicators – infant mortalityage-adjusted death rates and life expectancy – the United States ranks lower than most peer nations and racial and ethnic disparities exist in quality and length of life among U.S. residents.

This year’s theme, “Partnering for Health Equity,” gives us a chance to celebrate the work of our partners to address health disparities, whether it’s Make the Road New York’s work with community health workers or Unite Oregon and OSPIRG’s grassroots and policy work to ensure that coordinated care organizations are responsive to community input.

Here at the Center, we are working to tackle disparities through advocacy and organizing by building the power of consumers and communities to speak up to improve health and by ensuring that policies focus on achieving high quality and equitable outcomes. To mark the month, here are a few things I’m reading:

  • Linda Villarosa’s powerful article in the New York Times Magazine examines the high rates of death among Black infants, and of death or near death among Black mothers. The article points out how racism could be contributing to worse outcomes for Black mothers and babies and looks at how doulas might be part of the solution. Community Catalyst Board Member Joia Crear-Perry’s opinion piece on rewire.com underlines the impact of racism and suggests that we list “racism as a modifiable risk factor for poor maternal health outcomes.”

  • Karen Joynt Maddox’s perspective article in the New England Journal of Medicine explores the impact of alternative payment methodologies on vulnerable populations. While some alternative payment models have helped to narrow disparities, there is also evidence that models may disproportionately penalize hospitals or clinics serving poor people. The article suggests strategies such as refining risk adjustment, evaluating improvement (not just achievement), rewarding proportional improvement and explicitly designing payment models to focus on reducing disparities.

  • The story of how Medicare forced the desegregation of every hospital in the United States shows how muscular public policy—driven by committed activists and public servants--can create powerful and lasting change. It is a story that is well worth reading, whether in David Barton Smith’s book, The Power to Heal: Civil Rights, Medicare, and the Struggle to Transform America’s Health Care System or Community Catalyst Action Fund Board Member John McDonough’s excellent review.

How are you marking National Minority Health Month? Share your work with us on Twitter.

FROM THE CENTER & OUR PARTNERS

CPEHN Releases Report on Reducing Mental Health Disparities

Center partner, the California Pan-Ethnic Health Network (CPEHN) has released a strategic plan to reduce mental health disparities. The plan is a community-driven and community-authored document that provides a roadmap for reducing mental health disparities in unserved, underserved and inappropriately served communities. It provides specific policy recommendations around five goals:

  • Increased access to mental health services;
  • Improved quality of mental health services;
  • Building on community strengths;
  • Developing, funding and demonstrating the effectiveness of population-specific programs; and
  • Developing infrastructure to support the reduction of mental health disparities.

Center Staff Author Article in Field Guide for Community-Based Organizations

Generations, the journal of the American Society on Aging (ASA), has released a Field Guide that explores the business acumen and skills community-based organizations (CBOs) need to best serve older adults and people with disabilities through managed care partnerships.  Center Strategic Policy Manager Danielle Garrett and Center Director Ann Hwang have authored an article, beginning on page 19 of the guide, entitled “CBOs and State Medicaid Programs: A Key Partnership for Patient-Centered Care.” The article discusses why partnerships between CBOs and state Medicaid programs are a natural fit for addressing the social determinants of health, and addresses the knowledge and tools that CBOs need in order to successfully participate in these partnerships.

Center Submits Comments on D-SNPs

The Center has submitted a comment letter in response to requests from the Medicare-Medicaid Coordination Office for input on developing unified grievance and appeals processes for Dual-Eligible Special Needs Plans (D-SNPs) and on establishing new standards for integration of Medicare and Medicaid benefits for D-SNPs. CMS requested this stakeholder input in response to language in the Bipartisan Budget Act of 2018 that requires further integration of D-SNPs. 

NOTEWORTHY NEWS & RESOURCE

Independence at Home a Huge Money Saver

According to an article appearing in Home Health Care News, the Independence at Home (IAH) program saves Medicare ten times more than Accountable Care Organizations. IAH, which focuses on providing care through house calls to vulnerable older adults, saved Medicare an average of $2,700 per beneficiary per year in the first two years. Initially a five-year demonstration, in February 2018 Congress extended IAH for another two years as part of the continuing resolution to fund the federal government. Congress also modestly increased the cap on participating beneficiaries from 10,000 to 15,000.

Activating Millennials in Advancing Long-Term Care

In a recent article appearing in the new aging media platform Stria, Katie Smith Sloan, CEO of LeadingAge, issues a call to action for millennials in the struggle to reform and stabilize long-term care for the baby boomer generation and for themselves. There are currently 10 million millennials in the U.S. acting as caregivers for aging relatives and their wages and wealth accumulation capabilities are suffering as a result of the high number of hours required and the high costs of this care. Sloan argues that millennials must be engaged as advocates in the fight for sustainable, systemic supports for aging populations, both because of the roles they are currently playing as caregivers and because the millennial generation is larger than the baby boomer generation, which means that the cracks in the system that are apparent now will be seismic by the time millennials require aging services. LeadingAge is kicking off a campaign to enlist millennial advocates, which will include focus groups and messaging support in an effort to harness the political capital millennials hold.

Alex Azar’s Vision for Value

In a new California Health Care Foundation blog post, authors from the Wynne Health Group dissect two recent speeches given by Health and Human Services Secretary Alex Azar about his vision for value-based care. In March, Azar delivered speeches to the Federation of American Hospitals and America’s Health Insurance Plans using both to outline his plan for conducting a “radical reorientation” of the U.S. health care system by:

  • Giving consumers greater control over health information;
  • Increasing transparency at provider and insurer points;
  • Using Medicare and Medicaid to experiment with new payment models; and
  • Removing “government burdens” including price reporting rules and restrictions on wraparound services coverage.

The authors argue that this reorientation has serious implications for providers, pharmaceutical companies, insurers, state partners and patients, but note that there are many unanswered questions on how each stakeholder group will be affected. For instance:

  • How will MACRA-driven reforms incentivize providers toward value-based care?;
  • Will price transparency ultimately have a big impact on costs?;
  • What will the introduction of short-term plans mean for health care value?;
  • Will the administration align with efforts to further cut Medicaid and privatize Medicare?; and
  • In what ways will consumers drive value under new models?

Healthy Food Playbook Now Available Online

Health Care Without Harm published an online resource for hospital community benefit professionals and advocates called "Delivering Community Benefit: Healthy Food Playbook." The Playbook offers resources and recommendations designed to address the most pressing issues communities identified in their community health needs assessments (CHNAs) including obesity, nutrition education and healthy food access. Hospital community benefit professionals and health care advocates can use the Playbook to support efforts to:

  • Conduct CHNAs, as required by the ACA;
  • Develop implementation strategies for community benefit programs; and
  • Evaluate, report and communicate the results of their CHNAs.

In addition, the Playbook offers resources including county health rankings, Center for Disease Control guidelines for increasing consumption of fruits and vegetables, and case studies of hospitals who are setting the standard for community engagement.

STATE HIGHLIGHTS

Alabama

A recent article in Health Management Associates (HMA) Weekly reviews Alabama’s Integrated Care Network (ICN) program, based on a concept paper released by the Alabama Medicaid Agency in March 2018. According to the concept paper, the ICN program will establish a new Medicaid long-term care program focusing on a person-centered approach to care delivery using the Primary Care Case Management Entity delivery model. The program is expected to launch on Oct. 1, 2018. More information on this new program is available here.

New Hampshire

In March, the New Hampshire Department of Health and Human Services (DHHS) released an implementation plan for the state’s planned transition to managed long-term services and supports (LTSS). DHHS is expected to issue a request for proposals in Spring 2018. Under the program, the state will integrate LTSS services provided by the Choices for Independence (CFI) waiver and nursing facilities into the current Medicaid Care Management program. Plans will cover acute care and non-LTSS services for Medicaid beneficiaries beginning July 2019 and expand to cover CFI and nursing home services by December 2019.

South Carolina

The South Carolina Department of Health and Human Services released a memo to all waiver case managers to provide a reminder of the appeals process for waiver services to members of Healthy Connections Prime, the state’s dual eligible demonstration project. The memo with information about the process can be found here.

KEY DATES

Monday, April 2 through April 30 – The Kresge Foundation will be accepting applications during April for its Emerging Leaders in Public Health (ELPH) initiative. ELPH is an ongoing leadership development initiative launched in 2014 as a way to equip local public health officers with knowledge and skills to lead in today’s changing health care environment. More information is available here.

Tuesday, April 24 (1-2 p.m. Eastern) – Webinar: Addressing Social Determinants of Health in Primary Care, presented by The Lewin Group in collaboration with the American Society on Aging. Please register for the webinar.

Wednesday, May 16 (12-1:30 p.m. Eastern) – Geriatric-Competent Care Webinar Series: Managing Older Adults with Substance Use Disorders, presented by The Lewin Group in collaboration with Community Catalyst and the American Geriatrics Society.  Please register for the webinar.