DIRECTOR’S CORNER

Speaking Up: Celebrating Advocacy in 2020

Photo credit: Center for Health Progress

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

Since 2018, the Center’s annual Speak Up for Better Health Award has recognized extraordinary people working to improve the health of their communities, and demonstrated the power that each of us has to make better health possible for all of us.

In this unprecedented year, we are pleased to honor nine organizations that have shown incredible creativity, resilience and agility in transforming their work to remain effective amidst the many challenges posed by the COVID-19 crisis with our 2020 Speak Up for Better Health Award.

Read more about our honorees from Alabama, Colorado, Georgia, Maine, Massachusetts, New York, Oregon, Pennsylvania, and Wisconsin.

In these challenging times, now more than ever, our nation needs advocacy, activism and community-mindedness. We appreciate the chance to reflect on and celebrate the tremendous work that has been done this year.

In this holiday season, we wish you peace and joy, and rest and renewal for the journey ahead.

FROM THE CENTER & OUR PARTNERS

Community Catalyst “Undoing the Harm” Brief: Policy Priorities for the Incoming Administration

Last week, Community Catalyst released the first brief in a three-part series outlining policy priorities for the incoming Biden-Harris administration to undertake to undo the harm the Trump administration has inflicted in terms of health care access and health equity. This brief lays out specific actions the new administration should urgently undertake, broken down in “Day One” and “Within the First 100 Days” sections.

The brief lays out a detailed list of goals and  specific actions needed, that are directly related to securing the progress in health system transformation and health equity for the populations that Center works to empower that follow from this key stated goal: "The administration must unwind the harmful policies of the Trump administration that target people of color, LGBTQ+ people, immigrants, women, older adults, people with disabilities and other excluded and harmed populations."

The brief enumerates many specific actions needed to protect and strengthen the Medicaid program, as well as specifying actions need to provide housing and nutritional assistance during the pandemic emergency.

California Partners Release Reports on Health Equity and Delivery Reform, Telehealth

Center partner the California Pan-Ethnic Health Network (CPEHN) has released two new reports that we are excited to share. The first publication, “Centering Equity in Health Care Delivery and Payment Reform: A Guide for California Policymakers” is the culmination of nearly two years of work, during which time CPEHN conducted six consumer focus groups, facilitated an advisory workgroup with statewide stakeholders, and held state and national responder panels with policymakers and others. This guide will help to shape California’s health equity efforts over the next several years. You can also read the corresponding editorial in CalMatters.

CPEHN also released a short brief, “Equity in the Age of Telehealth: Considerations for California Policymakers.” This brief details the findings of their consumer survey related to telehealth and provides policy recommendations for ensuring that equity considerations are addressed as California continues to expand the use of telehealth.

Comments Submitted on Proposed Rule on Arbitrary Expiration of HHS Regulations

Last week, Community Catalyst submitted comments in response to the U.S. Department of Health and Human Services' (HHS) proposed “SUNSET” rule (the Securing Updated and Necessary Statutory Evaluations Timely rule). This rule would impose on every HHS regulation an arbitrary expiration date of 10 years from when it was issued unless the agency undertakes an assessment and review of the rule within two years of its expiration. If it doesn't undertake the review, the rule will expire, and if it does conduct a review, the 10-year expiration will reset to 10 years after the review is conducted. Given that the Affordable Care Act was signed into law 10 years ago, many of its implementing regulations, along with many recent regulations pertaining to Medicaid and Medicare, are at risk of arbitrarily expiring. Community Catalyst opposed the SUNSET rule noting that it would jeopardize many policies that are important to the Center, including those impacting low-income older adults and people with disabilities.

Center Submits Recommendations and Comments on HCBS Quality Measures

Community Catalyst has long advocated for robust, meaningful, publicly reported home-and community-based services (HCBS) quality measures in Medicaid. From our work with consumers directly and with state and local partners, we know these measures are essential to ensure consumers are receiving services that meet their needs, goals and preferences and help them thrive in the community.

Recently the Centers for Medicare and Medicaid Services (CMS) requested comments on a draft set of HCBS measures that are intended to raise expectations for states and health plans to prioritize HCBS measurement. As importantly, it is meant to help improve HCBS and will provide consumers with data they can use to choose health plans (and eventually providers). The Center submitted a comment letter  in response to CMS’ “Request for Information: Recommended Measure Set for Medicaid-Funded Home-and-Community-Based-Services,” which included five critical changes needed to the measure set.

Center Research Director Weighs in on COVID-19, Long-Term Care and Workforce

Center Research Director Marc Cohen is a featured presenter in a new video from the Jewish Healthcare Foundation, entitled, “What COVID-19 Exposed in Long-Term Care.” Other voices in this documentary are those of Dr. Ashish Jha, dean of the Brown University School of Public Health, Terry Fulmer, president of The John A. Hartford Foundation, Katie Smith Sloan, president of LeadingAge, and several relatives of older adults who have died of COVID-19 in long-term care residences sharing their personal stories of loss.

As the foundation writes, “...this horrific crisis [is] still crushing our long-term care system. We hope this film can serve as a launching point for the critical conversation in our national discourse as we prepare for a new administration and the needs of a broken system…We as a nation are responsible for the failure to prepare LTC facilities for the onslaught of COVID-19. Even worse, we did not respond swiftly when it was clear that all LTC facilities faced incredible risk. It is time to look at long-term solutions to what COVID-19 has expose.

In a related post on the Health Affairs blog, titled “Making Care Work Pay: How A Living Wage For LTSS Workers Benefits All,” Marc and three co-authors point to the chronically low pay for workers providing long-term services and supports, both in facilities and in the community, as paving the way for the staffing shortages that were a key factor in the disastrous inability to adequately prepare for and respond to the COVID-19 crisis. The post summarizes research by LeadingAge and the LeadingAge Center @ UMass Boston showing that several states that have implemented higher wages for LTSS workers are already seeing the benefits, and outlines a wide range of effective policy solutions to raise wages and professionalize the role of direct care workers.

New Resources on Medicaid Managed Care, Homelessness During the Pandemic

Funded by the Robert Wood Johnson Foundation, the NORC Medicaid MCO Learning Hub, a Center partner, is committed to providing information on ways to address health equity and transform health care to key MCO leadership, consumer groups, state Medicaid leaders and other stakeholders. A number of new resources are now available from the Hub, dealing with Medicaid managed care broadly, and homelessness among Medicaid enrollees, more specifically.

A key social determinant of health is an individual’s neighborhood and built environment, which includes their type and quality of housing. Individuals experiencing homelessness or inadequate shelter frequently have chronic mental or physical health conditions and a lower quality of life. Due to the COVID-19 pandemic, an increasing number of individuals are experiencing homelessness and job loss and, therefore, are more vulnerable to negative health outcomes and health inequities. Medicaid programs and MCOs have an increasing role in supporting Medicaid beneficiaries’ housing needs and key insights and innovations are highlighted in the materials below.

• MCOs’ Role in Combatting Homelessness in the Wake of COVID-19: This issue brief reviews the impact of homelessness on health outcomes, what state Medicaid programs and MCOs have done for this population pre-COVID-19, what they are doing now and strategies they can consider in the future.
• Spotlight: Circle the City: NORC spoke with Linda Ross, CEO of Circle the City, to discuss how the federally-qualified health center works with MCOs and other service organizations to provide medical and other social services to individuals experiencing homelessness in Maricopa County, Arizona. This spotlight highlights the conversation about Circle the City’s mission, how COVID-19 has impacted the organization’s work, how it partners with MCOs and other community-based organizations, and what lessons learned can be derived from the Circle the City model and experiences.

The learning Hub also recently conducted two national webinars of interest.

The first webinar provided an overview of Medicaid managed care, including the use of Medicaid managed care across states and state contracting strategies, as well as cost growth, rate setting and the use of managed care reserves. The webinar recording is available here. The second webinar covered Medicaid managed care federal authorities and how these authorities are both defined and used by managed care plans, as well as promising approaches and strategies for community-based organizations to partner with Medicaid managed care plans. The recording and resources from this session will be posted here once they are available.

Sign-On to Show Your Support for Evidence-Based, Community-Focused Dental Providers

Too many Americans lack access to affordable, high-quality dental care but Community Catalyst’s Dental Access Project works to change that, in part by supporting state-level efforts to authorize dental therapists. Dental therapists are licensed dental care providers that work under the supervision of dentists to provide routine care like exams and fillings. Authorizing dental therapists is shown to improve access to dental care and create pathways for people from underserved communities to become the dental care providers their communities need. Community Catalyst co-chairs the National Partnership for Dental Therapy, which is asking organizations that support dental therapists to add their name to a list of supporters. Please consider lending your support to this evidence-based, community-focused dental provider.

NOTEWORTHY NEWS & RESOURCES

CHCS Blog Series Explores Impact of COVID-19 on Duals

The Center for Health Care Strategies (CHCS) has launched a blog series on the impact of COVID-19 on different sub-populations of dually eligible individuals. This post focuses on the more than one-third of dually eligible individuals who use home- and community-based services (HCBS). As a population with high rates of chronic conditions and functional limitations, it is especially difficult for HCBS users to leave home during the pandemic for essential activities such as filling prescriptions and getting groceries.

Another post in the series outlines the challenges faced by dually eligible individuals with intellectual and developmental disabilities (I/DD) during the pandemic. Many people with I/DD have co-occurring physical and behavioral health conditions that put them at greater risk for contracting COVID-19 and make navigating the health care system and advocating for themselves particularly difficult. The blog highlights the importance of integrated care programs in helping address the comprehensive medical and social needs of these individuals.

A third post explores the impact of COVID-19 on dually eligible individuals who are residents of skilled nursing facilities.

States Work to Improve Long-Term Care in the Age of COVID-19

The National Academy for State Health Policy (NASHP) published a blog post describing how states are rethinking and restructuring their long-term services and supports (LTSS) programs in light of the disproportionate impact of COVID-19 on nursing home residents. For instance, Washington state and Wisconsin have maximized the flexibility of home- and community-based waiver services to ensure access to LTSS without wait times and administrative burdens. In Ohio, state and hospital leaders coordinated efforts and resources to prevent and contain outbreaks for high-risk individuals.

New Tool Helps States Assess Hospital Community Benefit Spending on Health Equity

The National Academy for State Health Policy developed a tool that helps states gather detailed information from hospitals about their community benefit expenditures and activities during the pandemic. The tool gives states the ability to assess how hospitals are identifying shifting community needs during COVID-19 and how community benefit spending is shifting to meet those needs, as well to address disparities and promote equity.

Commonwealth Fund Task Force on Payment and Delivery System Reform

The Commonwealth Fund’s Taskforce on Payment and Delivery System Reform released their recommendations on ways to improve quality, advance equity and increase affordability. The recommendations include six policy imperatives – (1) increase health system preparedness, (2) increase health system accountability, (3) strengthen primary care, (4) support patient engagement, (5) reduce administrative burden, and (6) balance regulatory and competitive approaches.

The Impact of Federal Value-Based Primary Care Programs on Participating Oregon Practices: A Snapshot

An issue brief by the Milbank Memorial Fund examines the impact of a federal value-based care program, the Comprehensive Primary Care Initiative (CPC), on Oregon primary care practices. According to the brief, the practices that participated in the CPC program performed better across all payer types than practices who did not participate. Among the other findings was that participating practices showed positive trends in emergency department utilization. These positive results lend continued support for value-based payment programs in Oregon.

CMS’ Geographic Direct Contracting Model

Last week, the Centers for Medicare & Medicaid Services (CMS) unveiled a new Medicare Accountable Care Organization (ACO) model, entitled the Geographic Direct Contracting Model, or “Geo.” This model will test whether health care providers can improve quality while also lowering costs by managing care for Medicare enrollees in a particular geographic region. CMS plans to test out the model beginning in January 2022, and asked the Center for feedback on how to best engage Medicare consumers in the design and implementation of the model prior to its rollout. We look forward to ongoing discussions with CMS as they further develop Geo.

STATE HIGHLIGHTS

Illinois

Modern Healthcare reports that the Blue Cross & Blue Shield of Illinois will be piloting new programs to improve health outcomes for minority populations and increase racial and ethnic diversity among medical professionals. The Health Equity Hospital Quality Incentive Program’s goal is to work closely with hospitals serving a large number of Blue Cross members in communities with people most at risk of contracting COVID-19 and, ultimately, reduce racial and ethnic disparities in care. The three-year pilot program will pay doctors more for achieving certain metrics, such as meeting maternal health care requirements and equitably implementing telehealth.

Massachusetts

Massachusetts Attorney General’s office published a report on racial justice and equity in health care. The report highlights longstanding disparities, as well as the disproportionate effect that COVID-19 has had on Black, Hispanic and Latinx communities. The report calls for action in five domains: data to identify and address health disparities; equitable distribution of health care resources; telehealth as a tool for expanding equitable access to care; health care workforce diversity; and social determinants of health and root causes of health inequities.  

Michigan

The Michigan Department of Health and Human Services recently posted two consumer stories highlighting the benefits of person-centered care coordination received through the MI Health Link duals demonstration program. The stories and more information of the demonstration can be found here.

Ohio

Ohio’s Medicaid Managed Care plans announced last month that they will offer their members free transportation services to and from food banks, food pantries, food clinics and grocery stores as part of the benefit plan. Ohio’s five Medicaid plans are Centene/Buckeye Health Plan, CareSource, Molina Healthcare, Paramount Advantage and United Healthcare Community Plan.

Rhode Island

GoLocalProv reported on Nov. 9, that Neighborhood Health Plan of Rhode Island (NHPRI) has signed a three-year contract extension to continue its participation financial alignment dual eligible demonstration. NHPRI is the only plan in Rhode Island participating in the federal-state demonstration program to improve care delivery and align financing of Medicare and Medicaid. They currently have 13,000 Medicare-Medicaid enrollees in the program.

KEY DATES

Tuesday, Dec. 15 (2-3 p.m. Eastern) - Webinar: Ensuring Value in Telehealth (Session 2), presented by Altarum Healthcare Value Hub. Please register for the webinar.  

Wednesday, Dec. 16 (12-1 p.m. Eastern) - Webinar: Emerging trends in the 2021 Medicare Advantage market: Benefit trends, D-SNP expansion, and SSBCI, presented by Milliman. Please register for the webinar.  

Wednesday, Dec. 16 (2-3 p.m. Eastern) - Webinar: Pathways to Homelessness among Older Adults with Mental Illness, presented by the National Coalition on Mental Health and Aging. Please register for the webinar.  

Thursday, Jan.14 (11 a.m.-12 p.m. Eastern) - Webinar: Building the Research Pipeline: Home and Community-based Services and the Dual Eligible Population, presented by the Administration for Community Living and CMS in collaboration with Arnold Ventures. Please register for the webinar.

Thursday, Jan. 14 (3-4:30 p.m. Eastern) - Webinar: Reducing Food Insecurity and Nutrition-Related Chronic Diseases During COVID Among Medicaid HCBS Beneficiaries, presented by presented by the Administration for Community Living and CMS. Please register for the webinar.