Health Innovation Highlights: August 8, 2018

Full Edition

FROM THE CENTER & OUR PARTNERS

Center’s “Care That Works” Series Highlights Vermont’s SASH 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 third brief in this series, “Care That Works: SASH,” profiles the Support and Services at Home (SASH) program based in Burlington, Vermont. Founded in 2009, SASH coordinates the resources of social service agencies, community health providers and nonprofit housing organizations to support Vermonters who choose to live independently at home. Individualized, on-site support is provided by a wellness nurse and a SASH care coordinator based in housing facilities. SASH serves older adults as well as people with disabilities who are enrolled in Medicare.

SASH participants report having significantly less difficulty with common medication management tasks compared to Medicare beneficiaries who are not in the SASH program. As one result of this, 76 percent of SASH participants with hypertension have it under control, compared with the U.S. average among older adults of 30 percent.

The brief shares the story of Ms. Regina Fournier, a SASH participant since 2015.

Rhode Island Advocates Pass Law Creating Home Health Care Worker Registry

Center partners in Rhode Island, including the Rhode Island Organizing Project, the Senior Agenda Coalition and the Economic Progress Institute have successfully achieved passage of a law that provides for an Individual Provider (IP) program. The program will allow people eligible for Medicaid-funded home care to hire their own personal care attendants via a registry. This victory gives consumers an important new option for home-based care, and will help make it possible for more Rhode Islanders to live independently in their homes.

Connecticut Advocates Push for Better Transportation Services for Low-income People

Center partners at the Connecticut Children’s Advocacy Center brought consumer concerns forward with the state, in order to push for better non-emergency medical transportation (NEMT) services from the state’s new transportation broker, Veyo. Despite moving to a different broker in January, consumers in the state are still experiencing a familiar complaint: vehicles arriving to transport a client without appropriate wheelchair access. Across the country, inaccessible vehicles along with very late or no-show drivers plague NEMT programs and prevent consumers from getting necessary medical care. Advocates in Connecticut have been national leaders in pushing aggressively for improvements to the service.

Massachusetts One Care Implementation Council Case Study

In case you missed it, the case study of the Massachusetts One Care Implementation Council jointly published last month by the Center and the LeadingAge LTSS Center @UMass Boston is now available on the LeadingAge website, and highlighted in this news item. The case study examines the establishment and impact of the One Care Implementation Council, a state-level body that provides input into Massachusetts’ dual-eligible demonstration. The Council, created through the advocacy of Massachusetts disability advocates, provides a powerful example of effectively engaging consumers and their advocates in the design and oversight of health care programs. It also provides important lessons for consumer engagement that have relevance for advocates, public officials, and health plan and provider leaders.

NOTEWORTHY NEWS & RESOURCES

Aging Is Harder on LGBTQ People

A federally funded, ongoing study by the National LGBT Health and Aging Center found that older LGBTQ people have higher rates of disability and mental distress compared to their straight counterparts. The report also shows that many older LGBTQ people lack access to care and have faced serious adversity including verbal harassment and threats of violence, and 21% of respondents did not disclose their sexual or gender identity to their doctor.  

These findings highlight the importance of culturally competent care for LGBTQ older adults.

In related news, Massachusetts recently passed legislation which requires providers of elder services to receive training on caring for LGBTQ elders.

For a closer look at the importance of culturally competent care for LGBTQ older adults, see our video, “The Main Thing: Respect,” produced last year.

Reimbursement Rates for Primary Care Services: Evidence of Spillover Effects to Behavioral Health

A new working paper from the National Bureau of Economic Research illustrates the impact of a federally mandated Medicaid primary care reimbursement rate increase (the “Medicaid fee bump”) between 2013 and 2014 as part of the Affordable Care Act. The findings show that the Medicaid fee bump improved behavioral health outcomes among Medicaid enrollees, without altering utilization of behavioral health services. This suggests that primary care providers are efficient in improving behavioral health outcomes among Medicaid enrollees.

Curtailing Medicaid's Transportation Benefit is 'Penny-Wise And Pound-Foolish’

Stat reports on a recent study that shows that non-emergency medical transportation (NEMT) has a sizeable return on investment for two relatively common and expensive diseases. Findings suggest NEMT could produce significant savings in the care of individuals with end-stage kidney disease or diabetes-related wounds. Estimated savings associated with NEMT for individuals on dialysis is $3,423 per member per month. NEMT services for individuals with diabetes wound care needs is estimated to save $792 per member per month.

An Economic Argument for Treating Spending on Social Determinants as Public Goods

In a new HealthAffairs article, authors Len M. Nichols and Lauren A. Taylor argue that upstream spending on social determinants of health has the economic properties of a public good, as opposed to a private good, and that “a pragmatic approach for creating long-run financing mechanisms for historically underfunded services is needed.” They continue, “The theory of and experience with public goods such as national defense and transportation infrastructure suggest that public goods will be undersupplied by self-interested actors in a free market, even in cases where the market is dominated by nonprofit health care provider organizations, nonprofit health plans, and governments at every level.”

The authors identify “a financing model that enables each stakeholder to recognize that revealing its true willingness to pay for a social determinants intervention is in its own self-interest. This self-interest is what makes the intervention an investment, rather than a donation.” The authors conclude that this pursuit of health care organizations investing to benefit their self-interests is “reasonably sustainable under the current norms of US health care.”

STATE HIGHLIGHTS

California

The California Department of Health Care Services (DHCS) has released a set of recommendations on how Cal MediConnect plans serving Medicare-Medicaid enrollees can share data to promote continuity of care when members transfer between plans. These new recommendations come after a recent revision of the three-way contract between the participating Cal MediConnect plans, DHCS and the Centers for Medicare & Medicaid Services (CMS) which created a new requirement to improve continuity of care as members transition between plans.

New York

The state of New York will impose enrollment lock-in periods beginning Dec. 1, 2018, for those who enroll in Managed Long-Term Care (MLTC) Partial Capitation plans. This applies to those who are newly enrolled or who are transferring to a new plan . These individuals will have a 90-day grace period to elect a plan transfer and then experience a lock-in period for nine months after the end of their grace period (for a total period of one year from the date of enrollment). This will not apply to enrollees who were enrolled in an MLTC partial capitation plan prior to Dec. 1, 2018, unless they elect to transfer to a new MLTC partial capitation plan. This change does not impact a consumer's ability to enroll in any of the integrated plans: Fully Integrated Duals Advantage (FIDA), Medicaid Advantage Plus (MAP), and the Program of All-Inclusive Care for the Elderly (PACE). Enrollees will have the ability to enroll into an integrated plan at any time, and the integrated plans do not have a lock-in period.

Oregon

The Oregon Health Authority released a report that lays out the progress of Oregon’s coordinated care organizations (CCOs) on quality measures in 2017. While the report gives the CCOs a glowing report, a recent Lund Report questions how many of the metrics CCOs are being graded on actually reflect meaningful improvements. The state will pay out $178.3 million to reward these Medicaid providers for making the grade. Incentives clearly work, but experts are divided on whether the annual report card reflects the overall goal of keeping prices in check and improving the health of patients. 

KEY DATES

Thursday, August 23 (1:30-3 p.m. Eastern) - Webinar: Comparing the Quality of Managed Long-Term Services and Supports (MLTSS) Plans: New Measures of Person-Centered Assessment and Care Planning, presented by The Centers for Medicare & Medicaid Services. Please register for the webinar.