Health Innovation Highlights: August 13, 2020

Full Edition

Celebrating Carol!


Congratulations to Center Senior Advisor Carol Regan on her retirement! We are grateful for her decades of work to advance health and equity. We appreciate her deep commitment to improving the lives of older adults and caregivers. All of us have personally benefitted from her boundless energy in her roles as colleague, friend, advisor and caregiver, and we wish Carol all of the best in her next chapter.


Case Study: Lessons from Oregon’s Medicaid CCO Community Advisory Councils 

A new case study published jointly by the Milbank Memorial Fund and Community Catalyst takes a close look at the role Community Advisory Councils (CACs) are playing to foster meaningful consumer engagement for Medicaid enrollees in Oregon’s Coordinated Care Organizations. The study was authored by Center Deputy Director Renée Markus Hodin and Center Program and Policy Coordinator Madison Tallant, and is based on site visits and phone interviews with both consumer and CCO staff members of CACs, and Oregon Health Authority (OHA) staff engaged in supporting and strengthening the state’s CACs.

Following the adoption of the Affordable Care Act, the Oregon legislature passed bipartisan enabling legislation establishing coordinated care organizations (CCO) – local networks of health care providers (including physical, mental health and addiction, and dental) that serve approximately 600,000 enrollees in the Oregon Health Plan, the state’s Medicaid program. The law required each CCO to create at least one community advisory council, an advisory body made up of OHP members and community representatives. CACs are responsible for overseeing a community health assessment and developing a community health improvement plan.

In 2012, OHA was awarded a four-year, $45 million State Innovation Model grant from the Centers for Medicare and Medicaid Services. This enabled the creation of a Transformation Center within OHA that has committed staffing and other resources to CAC development that have kept Oregon in the forefront among states making ongoing and serious investments in Medicaid consumer engagement. The nature of these investments and the successes and challenges of building a strong consumer engagement infrastructure are covered in the case study.

OHA’s approach to prioritizing and supporting meaningful consumer and community engagement through CACs offers several lessons for other state agencies, health plans and accountable care entities. The “Best Practices” section of the case study covers these principles for successful engagement: Prioritize Engagment; Invest Staff Time and Financial Resources; Give Beneficiaries Meaningful Work; Measure and Communicate Outcomes; Support an Inclusive Environment; and Share “What Works.”

How Six States are Tackling Financing for Long-Term Services and Supports

One of the biggest challenges facing individuals, families, and state and federal policymakers is how to pay for the long-term services and supports (LTSS) that many of us will need as we age. Many Americans are surprised to learn that neither private health insurance nor Medicare pays for long-term services and supports. This leaves many Americans paying out of pocket for care, or trying to “spend down” their assets to qualify for Medicaid coverage.

Finding new approaches to financing LTSS is crucial to the financial security of millions of older adults and their families, and to the long-term sustainability of the Medicaid program. In recent years, a number of states have launched innovative initiatives to financing LTSS. A new report from LeadingAge LTSS Center @UMass Boston and the Center provides case studies of six states that are attempting to proactively address the issue. The study examines strategies behind LTSS financing efforts in Washington, Hawaii, Maine, California, Michigan, and Minnesota. Learning from New State Initiatives in Financing Long-Term Services and Supports, is the 48-page report detailing findings from the analysis. A 12-page Executive Summary is also available.

The study was led by Marc Cohen, LTSS Center co-director and research director at the Center for Consumer Engagement in Health Innovation; Center Director Ann Hwang; and Michael Miller, director of strategy policy at Community Catalyst.

Massachusetts Senior Action Council Hosts Virtual Discussion Series on Racism, Bias and Privilege

The grassroots, member-led Massachusetts Senior Action Council (MSAC) swiftly shifted from in-person activism to online within weeks of the shutdown due to the pandemic, meeting with elected officials and providers over Zoom to ensure that the voices of older adults are informing action on food security and facility safety standards.

MSAC has now embarked on a virtual workshop series on issues of race, and recently held the first session, a discussion examining bias and privilege. (photo above.)

Data Shows Benefits of the ACA for Middle-Aged Americans

The Affordable Care Act has reduced the number of uninsured and improved health outcomes for millions of American adults. Center Research Director and Co-Director of the LeadingAge LTSS Center @UMass Boston Marc Cohen co-authored an article on examining a timely question: has the ACA resulted in improvements in the health status of the pre-Medicare population, people ages 50-64? The authors analyzed data from the Health and Retirement Study, and tracked changes in the group’s well-being from 2010 and 2016. They found a decrease in reported levels of depression and smoking in the 2016 data. The percentage of people who say their health improved went up while the number of people who said their health worsened went down. Additionally, use of hospitals and nursing homes decreased. This group also reported lower out-of-pocket medical costs, lower rates of involuntary retirement and fewer were living below the poverty line.


A Pathway to Full Integration of Care for Medicare-Medicaid Beneficiaries

The Bipartisan Policy Center (BPC) has released recommendations for advancing integrated care for people with complex needs. The BPC’s recommendations are designed to create strong incentives to states to integrate care and proposes states choose from three models to achieve full integration: improved Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs); Programs of All-Inclusive Care for the Elderly (PACE), and a new flexible model that is built off the managed fee-for-service model used by the state of Washington. Recommendations of the report were also discussed on a recent webinar, available here.

How States Collect Data, Report, and Act on COVID-19 Racial and Ethnic Disparities

The National Academy for State Health Policy (NASHP) has added a new section to its interactive map detailing state interventions to address the disproportionate impact of COVID-19 on communities of color. Many states are tracking COVID-19 cases and deaths by race and ethnicity and 18 states have activated task forces to focus on these issues. These state task forces have given a myriad of actionable recommendations, including increased workplace protections, the incorporation of community-based organizations into decision-making processes, and an increase in public health resources and services that target communities of color.

Rethinking Long-Term Care

A new John A. Hartford Foundation blog post from foundation President Terry Fulmer and Milbank Memorial Fund President Chris Koller explores a more person-centered future for long-term care for consumers. They propose repurposing underutilized acute care capacity as extended care wings for individuals in need of skilled nursing care, and enhancing home and community-based services for individuals who need support for functional needs.

In a Health Affairs blog post, Bruce Allen Chernof, president and CEO of The SCAN Foundation, and Cindy Mann, partner at Manatt Health, describe how COVID-19 exposed the weaknesses of the long-term care system in the United States. They offer recommendations for immediate action, as well as longer term improvements, including expanding access to home and community-based services, improving integration between LTSS and the health care system, replacing aging and outdated facilities, reform oversight, and seriously explore sustainable financing models for LTSS.

Embracing Innovation Opportunities Through Pandemic Adversity

In a post on The Playbook blog, Gretchen Alkema of The SCAN Foundation, discusses how the impact of the pandemic has created a powerful opportunity for health care and long-term services and supports (LTSS) leaders in the U.S. to utilize federal and state flexibilities in order to adopt new ways of delivering services that amplify person-centeredness based on consumers’ needs, values, and preferences, while also aiming to protect them from contracting COVID-19. The author cites three recent briefs that examine actions that officials at the Centers for Medicare and Medicaid Services took that allow states and local-level providers substantial regulatory flexibilities in how care could be organized and delivered during this period.

One resource, prepared by Manatt Health, is a state resource guide that outlines new Medicaid flexibilities available to ensure access to LTSS for those populations most at risk. The Manatt brief, funded by The SCAN Foundation, provides specific examples of how states are ensuring continued access to LTSS by expanding the types of settings in which services can be delivered, bolstering pay and other supports for LTSS providers, and addressing barriers to care created by the pandemic. 

All three of the briefs the author discusses describe policy flexibilities and administrative actions across the following themes:

  • Virtual care delivery and care management
  • Access to services
  • Alternate care sites
  • Provider capacity
  • Consumer protections and safety
  • Reporting and audit requirements

Staying Connected: Telehealth at the Largest Safety-Net System in the Nation

Amid the massive shift towards telehealth over the course of the COVID-19 pandemic, it is essential to implement safeguards that ensure equity for all consumers, especially those with complex needs and limited access to technology. New commentary published in Health Affairs points to successes in the country’s largest safety-net hospital system, New York City Health + Hospitals, but also emphasizes that health systems must take further action to address equity issues of technological and language access. Importantly, the authors warn that equitable telehealth is only possible with sufficient payment, which must continue after the COVID-19 case surge subsides.



Minnesota became the first-ever state to offer housing-related services under its basic Medicaid program. The new benefits package, called Housing Stabilization Services, offers a variety of services including helping people search and apply for housing, negotiate leases and retain housing. The program launched in July 2020 and is estimated to cost $2.6 million annually.

New Jersey

Earlier this month, the New Jersey Legislature announced a package of bills addressing long-term care (LTC) in the state. COVID-19 has shed light on the shortfalls of the long-term care system and the devastating impact it has had on those who are in LTC facilities. The bills are a response to findings outlined in Manatt Health’s review of the long-term care facilities in New Jersey and their response to COVID-19. The bills address of areas, a few are:

  • requirements for the state’s preparedness and response to public health emergencies
  • revises licensure, operational and reporting requirements for long-term care facilities
  • raising the minimum wage of direct care staff in long-term care facilities to exceed the state minimum wage by $3.00, with annual COL adjustments


Last month, the state of Virginia received federal approval to offer housing and employment supports under the Medicaid program to people with significant behavioral and physical health needs. Medicaid will work with the different departments in the state that touch on behavioral health, housing and employment to implement this demonstration program. The program could launch in July 2022 if the governor and Legislature approve matching funds. Services could include interventions to prevent eviction, to move from institutional to community settings, to earn industry certifications and to receive coaching to find and keep a job.