Health Innovation Highlights: April 7, 2022

Full Edition

DIRECTOR’S CORNER

National Minority Health Month Boosts Us On to the Work Ahead

 

Brandon G. Wilson, DrPH, MHA,
Director, Center for Consumer Engagement in Health Innovation

It is befitting that, in this April edition, we reflect on National Minority Health Month, National Public Health Week and Black Maternal Health Week. First, thank you to every person and partner who works tirelessly for a more just world by improving and often transforming spaces in which we all live, work, worship and play. Every year, those in health services come together around one very important goal – raising consciousness about the health disparities that continue to affect people from racial and ethnic groups, and encouraging action through health education, early detection and control of health complications. In recognition of all whom we have lost, all who have sacrificed so much, all that we have accomplished and all the work that remains from the COVID-19 pandemic, this year’s National Minority Health Month theme is rightfully, “Give Your Community a Boost.” It also pays homage to the disproportionate impact that this pandemic has laid on communities of color, from workforce and supply chain shortages to increased incidence, hospitalization, morbidity and mortality rates, and the weight of the journey towards antiracism and the advancement of health equity.

As though watching a Jordan Peele horror film, we collectively lamented over Dr. Susan Moore’s self-documentary hospital-bed video, her unjust treatment, the chasm between her reality and the health system’s acknowledgments, and her untimely death. Dr. Moore’s story heightened our awareness that these structural barriers and racial inequities did not begin with the COVID-19 pandemic, but rather were exposed and in some ways exacerbated by the pandemic. Injustice did not begin with the pandemic, and it unfortunately will not end with the pandemic. If all of Dr. Moore’s education, experience and resources could not afford her equal treatment, what did this say for communities with unmet and intersecting health and social needs? For this reason, it’s important that we first reflect and then re-imagine a health care system that is responsive to us all.

In 1914, Booker T. Washington stated, "Without health, and until we reduce the high death rate, it will be impossible for us to have permanent success in business, in property getting, in acquiring education, or to show other evidence of progress." A year later, Washington started the “National Negro Health Improvement Week” [now the National Minority Health Month], circulating findings from the Tuskegee Institute. Washington made the moral and business case that the poor health status of African Americans in the U.S. was a blight against America’s values and an unnecessary drain on its economy. To combat high tuberculosis mortality disparities in the African American community, Washington called for a “community boost” of more Black health care and public health professionals. By socializing positive images of African Americans as nurses and public health professionals, this was one of our first calls to centering BIPOC leadership [acknowledging the complexity of the term] to advance the health justice movement. In memory of Dr. Moore, I’m certain that Washington’s call to action is unfinished and it is our business to see it to fruition.

In 1985, seventy years after Washington’s spotlight gazing on the health status of African Americans in the U.S., HHS Secretary Margaret Hatcher released the now famous Heckler Report – the U.S. government’s first comprehensive report on racial and ethnic minority health, elevating minority health to a national stage. Despite our nation’s progress in increasing the health status of the country – from the enactment of the Civil Rights Act of 1964, the Medicare and Medicaid Act of 1965, the Affordable Care Act and other milestones – racial and ethnic health disparities stubbornly persist. North Carolina recently highlighted a shortage of Black nurses and instructors, the AAMC stressed how Black men make up less than three percent of all physicians, and California is short on Spanish-speaking physicians.  

And these supply chain shortages do not exist in a vacuum – there are minority health outcome correlations. The CDC reports that Black women experience maternal mortality at a rate two to three times higher than that of white women. And findings suggest that when Black newborns are cared for by Black physicians, the mortality penalty they suffer, as compared with white infants, is halved. This is why we find solidarity with the Black Maternal Health Week’s theme of “Building for Liberation: Centering Black Mamas, Black Families and Black Systems of Care;” we, too, believe that the pursuit of liberation and the global fight to end maternal mortality is a revolutionary act. Therefore, we reaffirm our commitment to BIPOC leadership; as a core value, as a methodology, as a community-driven outcome, and to achieve a high-yield impact. 

At Community Catalyst, those values include race equity, health justice, collaboration and humility, amongst others.

  1. We are fighting to build a health system that is accountable to people, especially BIPOC, LGBTQ+ people, people with low incomes, women, immigrants, people with disabilities and older adults. We know that those most at risk under our current health system are people with intersecting marginalized identities and know that their active engagement and leadership are essential to a strong movement. Overall, we seek to enhance the impact and support the power-building of state and local leaders engaged in health advocacy, particularly those that represent the people most hurt by our health system today.
  2. We believe in partnership. We deeply respect the creativity and innovation of community leaders, especially BIPOC community leaders, and we approach all partnerships with an emphasis on listening and learning. With the acknowledgment that we have much to learn, we share information and resources. In working with local and state partner organizations, we seek to understand how and where we can use our strengths to be most helpful to our collective cause. Often our role is providing our partners with extra tools and support they request to make the strategic and tactical decisions necessary to achieve their goals.

As a process and methodology, we have championed community engagement from our inception. However aspirational, we also pragmatically believe that it is now time to evolve in our consumer engagement strategies. There is so much value in listening sessions, focus groups and key-informant interviews that serve as means of information extraction; but, it is also time that we employ processes that empower communities – co-designing, power building, community-based participatory, and action research. We stress the value of approaches that promote equitable partnerships that consider local social, structural and cultural factors.

The American College of Healthcare Executives demonstrate that diversity in health care leadership can enhance quality of care, quality of life in the workplace, community relations and the ability to affect community health status. The ACHE also underscores the disparities that currently exist in health care leadership. They report that in 2019, 89 percent of all hospital CEOs were white, though 60 percent of the U.S. population is white. Additionally, their research shows that white men were more likely to hold senior-level positions in health care than minority men, and the same for white women in comparison to minority women. And over the past six years, the gap has widened! Hence, during this National Minority Health Month, we recognize the need to embody Booker T. Washington’s call to action – increasing and centering BIPOC leadership in health care.

An Altarum and W. K. Kellogg Foundation national study estimates that health care disparities result in generating approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year, as well as additional economic losses due to premature deaths, and that these costs and lost productivity likely increased during the COVID-19 pandemic. Researchers have reported how racial/ethnic diversity among health care leaders galvanizes leadership toward eliminating these disparities, but the current level of diversity in leadership falls short of that necessary critical mass. So, there is indeed a business case to be made for eliminating health disparities, by promoting and centering BIPOC leadership and partnerships.

To all who have felt invisible within and to the health care system and the health justice movement, thank you for boosting your community. We at the Center at Community Catalyst see you, we hear you, we lift you.

Ashe and Amen.

FROM THE CENTER & OUR PARTNERS

The State of Person-Centered Care: 2014-2018

According to a new report published jointly by the Center and the LeadingAge LTSS Center @UMass Boston, one-third of older adults state that their preferences were never, or only sometimes, taken into account. Hispanics reported being twice as likely and African Americans three times as likely to say that the system does not account for their preferences. Why does this matter? When preferences were ignored, older adults were more likely to forgo medical care and report lower satisfaction with their health care. The report found that whether preferences are taken into account by health care providers is heavily dependent upon race, insurance and income level.

The report, “Person-Centered Care: Why Taking Individuals’ Care Preferences into Account Matters,” provides a look at how person-centered care models are working (or not) for older adults. An infographic and social media graphics are also available for download. The report was co-authored by Center Research Director Marc Cohen, Ph.D., who is also co-director of the LeadingAge LTSS Center @UMass Boston.

New Mexico Case Study Published in Medical Debt Resource Series

Recently, Community Catalyst’s Community Benefit and Economic Stability Project released a set of resources to equip advocates with important background information, lessons and strategies from successful campaigns to pass state-level policies that help mitigate the harm caused by medical debt. Included are a policy framework brief, an infographic which presents the key drivers of medical debt and case studies from Maryland, Colorado, New York and Illinois.

Now, a new case study from New Mexico is available on the resources page with more states to be added in the coming months.

Center Deputy Director Receives Women’s History Month Recognition

Center Deputy Director Leena Sharma was recently featured in Arnold Ventures' Women's History Month series "recognizing the women who are making history today by working to impact policy change." Sharma has been with Community Catalyst since 2011 and currently leads two projects in partnership with Arnold Ventures, as she works to improve policies that affect those who are dually eligible for Medicare and Medicaid. “It’s my deep belief that transformational, systemic change is possible…our voices matter when it comes to policy change," said Sharma. Read the full article here.

NOTEWORTHY NEWS & RESOURCE

NASEM Report Provides Blueprint to Transform Nursing Homes

The National Academies of Sciences, Engineering, and Medicine (NASEM) released much-anticipated nursing home recommendations in The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. The evidence-based recommendations underscore the need for critical changes to the way America finances, delivers and regulates care in nursing homes.

With support from The John A. Hartford Foundation, the report from the Committee on the Quality of Care in Nursing Homes identifies seven goals, which provide the overarching framework for a comprehensive approach to improving the quality of care in nursing homes. The committee presents an interrelated set of recommendations to achieve each of these goals, including by: bolstering nursing home staff; ensuring equitable person-centered care; and redesigning quality measures.

Forcing a Circle Into a Square: 12 Common Misconceptions About Community Engagement

As community engagement work grows in popularity, a recent blog post from Camden Coalition details common misconceptions. In this blog, Victor Murray, senior director of community engagement and capacity building, provides some best practices for effective community engagement. This piece details aspects of community engagement like empathetic and empowering storytelling, compensation for community members, and advancing health equity and DEI.

Reducing Costs for Families and States by Increasing Access to Home and Community-Based Services

A brief from the Community Living Policy Center (CLPC) highlights how increased access to home and community-based supports decreases out-of-pocket costs for indviduals in need of care, their families and state Medicaid programs. This research adds to the discussion in a recent Senate Special Committee on Aging hearing on the importance of HCBS for people who need supports to remain in the community.

Learning From COVID-19-Related Flexibilities: Moving Toward More Person-Centered Programs

This resource developed by The SCAN Foundation details learnings from the COVID-19 pandemic that have the potential to make Medicare and Medicaid more person-centered. The research found that many COVID-19-era flexibilities minimize administrative, clinical and financial barriers while significantly advancing equitable care. Among the report’s recommendations are a targeted and equitable expansion of telehealth, modifications to Medicare Advantage requirements and modifications to provider licensure, scope of practice, qualifications and payment rates.

Engaging People with Disabilities in Health Care: Lessons from the Massachusetts One Care Program

In an interview in the Playbook, Dennis Heaphy of the Disability Policy Consortium, a Center partner in Massachusetts, highlights the importance of meaningful engagement with people with disabilities in all health system decision-making, especially care planning. A 2020 report, which was created and led by people with disabilities, details member engagement in the OneCare program, which provides integrated care for dually eligible people in Massachusetts.

American Rescue Plan Act Home and Community-Based Services Funding: The Benefits and Challenges of an Infusion of Federal Support

As states begin to implement their funding from the American Rescue Plan, this brief from Milbank Memorial Fund provides an overview of the opportunities and challenges ahead. These funds average to about $250 million per state, a significant investment. The brief recommends that states focus on navigating the underlying authorities that are needed to proceed with ARPA plans, explore means of getting expert assistance with planning and implementation, focus on investments that optimize capacity, continue to promote collaboration among state agencies and meaningful stakeholder engagement, and address state staffing and HCBS sector workforce capacity together.

Applications Open: Atlantic Fellows for Health Equity

Applications are now open for the Atlantic Fellows for Health Equity program, a global fellowship that supports health care leaders. As the program describes, “Atlantic Fellows for Health Equity are passionate, experienced leaders from diverse backgrounds, deeply committed to learning from one another and finding solutions to improve the health of communities across the globe.” Applications for the next fellowship are due May 1.

STATE HIGHLIGHTS

California

In January, the Centers for Medicare and Medicaid Services approved California’s assisted living waiver amendment which will add 7,000 additional waiver slots.  The approved waiver, retroactively effective July 1, 2021, carries through until 2024.  The additional waiver slots will address the current assisted living waiver waitlist and provide eligible Med-Cal beneficiaries with alternatives to long-term nursing facility placements.  As a result, more older adults and individuals with disabilities will be able to reside in community residential care settings and public housing.

Illinois

On March 16, OSF Healthcare announced that the Medicaid Innovation Collaborative (MIC) - a public private partnership - will receive an additional $66 million in funding from the Illinois Department of Health and Family Services over the next five years.  MIC plans to use this funding to address social determinants of health in some of the most marginalized communities in the state.  Part of the plan includes equipping community health workers with technology and support to better serve individuals with complex care needs.  Specific tactics include:

  1. Tech-enabled vans to deliver care in areas where the population is at risk.
  2. Addressing connectivity and technology access in rural areas.
  3. Enhanced care communication and coordination among support teams.

New Jersey

On February 28, 2022, New Jersey submitted a renewal proposal for its section 1115 waiver - NJ FamilyCare.  Public comments for the proposal opened on March 11, 2022 and will continue through April 10, 2022.  If approved, the proposal would include:

  1. Expansion of the current MLTSS system with the intention of supporting independent living and community based services.
  2. A renewed focus on housing-related services within the MLTSS system.
  1. Further exploration of the use of Qualified Income Trusts

South Carolina

On March 29, South Carolina Department of Health and Human Services issued a provider alert announcing CMS approved a request for amendment to multiple waivers within the state’s Emergency Preparedness and Response Appendix K on January 20, 2022.  The approval is effective for six months and provides:

  1. Increased reimbursement rates for multiple HCBS services.
  2. Increased individual costs limits for community supports.
  1. Increased services limits for waiver case management.

Following the current six month approval the South Carolina Department of Health and Human Services plans to seek permanent approval.

KEY DATES