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FROM THE CENTER & OUR PARNTERS

Center’s “Care That Works” Series Highlights GRACE Program

Innovations in how to best care for people with complex health and social needs are happening across the country. Our “Care That Works” series seeks to examine and elevate these successful programs and share the stories of the people they serve.

The latest brief in this series, “Care That Works: GRACE,” profiles the Geriatric Resources for Assessment and Care of Elders program (GRACE) developed and implemented more than a decade ago by the Indiana University School of Medicine’s Center for Aging Research. This home-based care program supports the office-based primary care physician in helping address the health care challenges faced by low-income seniors with multiple chronic conditions. The model utilizes a home support team consisting of a nurse practitioner and a social worker. They, in turn, collaborate with a larger interdisciplinary team (including a geriatrician, pharmacist and mental health liaison) to develop an individualized care plan including activation of the GRACE protocols for evaluating and managing common geriatric conditions. A particular focus of the model is on care transitions, which can cause serious issues for older adults with multiple chronic conditions. The brief shares the story of 81-year-old GRACE participant, Ms. Helen Carson.

Clergy Leader in Maryland Faith Health Network Exemplifies Engagement

The latest Center profile on engagement in the service of better health shares the story of Rev. Dr. Sandra Conner. As a faith leader who hears stories from her congregants, she has an important perspective on how the health care system impacts consumers. Two years ago, Rev. Dr. Conner became a leader in the Maryland Faith Health Network, a project of Center partner Maryland Citizens’ Health Initiative, which brings together faith congregations and health systems. Rev. Dr. Conner jumps at every opportunity to share her knowledge as a consumer advocate, and to learn more in order to take her advocacy to the next level.

NOTEWORTHY NEWS & RESOURCES

Ending Temporary Protected Status Impacts Both Immigrants and People Reliant on Home Caregiving  

Kaiser Health News spotlights the intensifying toll immigration crackdowns are having on older and disabled Americans who rely heavily on home-based immigrant caregivers. There are one million immigrants nationwide working as nursing assistants, personal care attendants or home health aides – fields that are already significantly understaffed because of their traditionally low wages and difficult working conditions. Since the announcement that the Trump administration will end Temporary Protected Status for Haitian immigrants – giving Haitians in the U.S. until July 2019 to leave the country – both home care agency employers and patients are raising concerns about the impact deportation will have on the growing industry. As 10,000 baby boomers turn 65 each day, the need for home health care aides and related attendants is rising much more quickly than a domestic workforce can support, which will likely mean a decrease in the availability of care for older and disabled patients in the very near future and poorer health outcomes for these populations overall.

Robert Wood Johnson Foundation Releases 2018 County Health Rankings Report

The Robert Wood Johnson Foundation released its 2018 County Health Rankings report this month, providing local data on health outcomes and indicators and identifying health inequities based on place and race. The report includes information on social determinants, as well as breakdowns based on specific state and county data for various racial/ethnic groups and marginalized communities. Findings include:

• There is a higher percentage of Black babies with low birthweight in every state in the nation;
• High school graduation rates and employment statistics are correlated with poorer health outcomes;
• Residential racial segregation is an indicator for low birthweight, infant mortality, child poverty and lower high school graduation rates;
• Child poverty rates remain higher than pre-recession levels; and
• Though teen birth rates have been declining across racial groups, with Hispanic teens seeing the greatest decline, teens in rural areas continue to have highest teen birth rates.

Individual state reports, which are then broken up by county, are available here.

Seeking to Determine the “Value” in Value-Based Care

The University of Utah has released preliminary findings from The State of Value in U.S. Health Care Survey and one important takeaway is that agreement on the definition of “value” is hard to come by as it relates to health care. For physicians, clinical outcomes – improvement in health – rank among the highest indicators of value, but less than 33 percent of surveyed patients chose health improvement as a key characteristic of high-value health care, ranking friendly and helpful medical staff higher on the list. The mismatch in defining characteristics of value between patients and physicians is one of many contributing factors in the slow progress on value-based care. Another is a lack of mutual understanding about who is responsible for improvements in health: 75 percent of physicians assigned themselves as the responsible party, while patients assigned responsibility to themselves and physicians equally. Meanwhile, employers assigned patients the most responsibility, but tended to dispense responsibility throughout the system more evenly. The authors of the survey suggest that there are straightforward, though difficult, ways to realign stakeholder expectations about value including:

• Leveraging physician and hospital review systems to gather information from consumers;
• Encouraging businesses to expand efforts to track and analyze this data;
• Organizing inter-institutional convenings to foster stakeholder dialogues; and
• Bringing leaders in corporate health benefit plans, for-profit health systems and insurers together to help lead innovation in health system transformation efforts.

STATE HIGHLIGHTS

Alabama

The Alabama Medicaid office has released a concept paper providing, for the first time, some details of its proposed approach to reforming the state’s long-term care program so that it is both affordable and allows the state to offer beneficiaries more community options. Specifically, the state is seeking to award a contract to an Integrated Care Network (ICN) to better balance institutional and home and community-based care and provide case management services to enrollees. The state is planning to announce the statewide ICN contractor in June 2018, with an eye toward having the program go live in October 2018. The state must still obtain CMS approval for the 1915 waiver applications that allow for the ICN reform.

Maryland

A recent article published by Kaiser Health News discusses the savings that the Maryland hospital global budget model has accrued since its inception, according to a new report released by the state. Implemented in 2014, the global budget model caps hospitals’ revenue each year, letting them keep the difference if they reduce inpatient and outpatient treatment while maintaining care quality. In the three years since the program began it has saved the Medicare program half a billion dollars and has been able to achieve hospital admission reductions and improve quality of care.

New York

The New York Department of Health released its Medicaid Redesign Team Structural Roadmap: Roles and Responsibilities in a Value Based Payment World. The draft document provides a structural roadmap of roles and responsibilities of various entities in a value-based payment environment. The roadmap discusses the “middle layer” of actors – Managed Care Organizations, Managed Long-Term Care Plans, Health Homes, Performing Provider Systems, Patient-Centered Medical Homes and others – that exist between the state and the direct providers of service, and seeks to clearly define how these players will interact with each other and the state in a reformed health care system.

In other news, the Greater New York Hospital Association and the New York Academy of Medicine have released a qualitative study of the relationships between New York’s health care organizations and community-based organizations within the context of the state’s delivery reform environment. The study identifies key steps to building successful partnerships and outlines some of the challenges that health care and community-based organizations have faced in working together. Despite these challenges, all parties agree that fostering successful relationships between these two sectors is critical to improving the health of New Yorkers.

Ohio

The Ohio Department of Medicaid (ODM) released a white paper outlining its strategy to transform the state’s current county-based non-emergency medical transportation (NEMT) system to a state-based brokerage model. ODM plans to contract with one or more transportation brokers to develop and maintain a provider network, verify Medicaid eligibility for NEMT services, determine and authorize the mode of transportation, and dispatch an appropriate vehicle.

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.

Wednesday, April 4 (2-3 p.m. Eastern) –Disability-Competent Care Webinar Series: Building Partnerships: Health Plans And Community-Based Organizations, presented by The CMS Medicare-Medicaid Coordination Office, in collaboration with The Lewin Group.. Please register for the webinar.

Thursday, April 12 (12-1:30 p.m. Eastern) – Webinar: Providing Culturally Competent Care: Meeting the LTSS Needs of Dually Eligible Beneficiaries, presented by The CMS Medicare-Medicaid Coordination Office, in collaboration with The Lewin Group and the Center for Consumer Engagement in Health Innovation. Please register for the webinar.
 
Monday, April 16 – Submission deadline for the 2018-2019 Health and Aging Policy Fellows program, to begin October 2018. The program aims to create a cadre of leaders who will serve as change agents in health and aging policy to ultimately improve the health care of older adults. Full program and application information here.

Wednesday, April 18 (12-1:30 p.m. Eastern) – Geriatric-Competent Care Webinar Series: Safe and Effective Use of Medications in Older Adults, presented by The Lewin Group in collaboration with Community Catalyst and the American Geriatrics Society.  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.