Health Innovation Highlights: December 14, 2017

Full Edition

DIRECTOR'S CORNER

Our Year in Numbers

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

 

As we approach the end of 2017, I am filled with gratitude for our colleagues, our fellow advocates, our partners and our champions. 2017 has not been an easy year, but you inspired, challenged and accompanied us in our shared journey to create a health system that better meets the needs of vulnerable consumers and communities, even in a time of uncertainty and tumult.

A few highlights from our year:

Over 7,800 people reached by our partners in the Consumer Voices for Innovation program, which focuses on organizing consumers to engage with health systems and policymakers to improve care;

Almost 5,000 participants in total tuned in to the 9 webinars we delivered with CMS on geriatric competent care and meaningful consumer engagement;

34 hours of training we conducted with consumers and consumer leaders to improve their skills and expertise as advocates and advisory committee members;

24 health system leaders joined us in March to highlight the impact ACA repeal and Medicaid cuts would have on innovation and coverage;

10 consumers, older adults, people with disabilities and parents of special needs kids who generously shared their stories with us on our website;

8 advocacy partner organizations working to transform health care in their state through the Consumer Advocacy for Transformation program;

3 amazing Medicare-Medicaid beneficiaries who traveled to Washington, D.C. to meet with legislative and administration leaders to share their insights on improving care for duals;

2 wonderful years since our Center was established; and

1 big thing we are grateful for this year – which is YOU!

We expect that health care will be front and center in 2018, with more threats to core programs like Medicaid and Medicare. But if the last year has taught us anything, it’s that by joining together and raising our voices we can make ourselves heard.

Thank you for being part of the Center’s family. I look forward to working with you in the new year toward better health, for everyone. Happy holidays!

FROM THE CENTER & OUR PARTNERS

Center Supports Legislation to Extend Money Follows the Person Demonstration

The Center has joined other national and state organizations in signing onto a letter in support of legislation to extend the Money Follows the Person (MFP) demonstration, introduced by Sens. Cantwell (D-WA) and Portman (R-OH). State organizations wishing to sign onto the letter have until noon, Monday, Dec. 18 to do so.

The letter, addressed to the chair and ranking member of the Senate Finance Committee, Sens. Hatch (R-UT) and Wyden (D-OR), and to the legislative cosponsors, expresses strong support for extension of the program, applauds the introduction of this bipartisan legislation and urges swift passage.        

The MFP demonstration – first authorized in the Deficit Reduction Act of 2005 with strong bipartisan support and signed into law by President Bush – was designed to assist states with:

1)    Supporting Medicaid enrollees who want to transition from nursing facilities and other institutional settings back to community-based settings; and

2)    Developing infrastructure to promote and enhance access to home and community-based services.

Unfortunately, the program expired on Sept. 30, 2016. While states can continue to use remaining grant funding through 2020, they are currently scaling back their programs and reducing dedicated staff and resources. The legislation would extend the program through 2022.

Idaho Partner Organizes Consumer Turnout and Testimony at Waiver Hearings

Center partner Idaho Voices for Children generated significant consumer attendance turnout at two hearings held by the Idaho Department of Insurance and Department of Health on the state’s proposed “dual waiver” proposal, which would extend coverage to some people in the Medicaid gap. As reported in an article in the Couer d’Alene Post Falls, all the individuals who gave testimony in Pocatello supported the departments’ proposal, though many said they didn’t think it went far enough to provide care for those with chronic mental illnesses. The behavioral health talking points produced by Idaho Voices for Children were widely circulated and utilized during the hearings.

The dual waiver proposal involves submitting both a 1115 waiver request and an 1332 waiver request. Advocates would much prefer that the state close the gap by expanding Medicaid in Idaho, but are working to make this alternative approach as strong as possible in providing coverage and benefits to health care consumers in the state.

Center Director Among Roster of Health Reform Advisors for Pennsylvania-based Activist Network

A Health Affairs Blog post describes the launch of the Health Activist Network by the Jewish Healthcare Foundation and its supporting organizations, the Pittsburgh Regional Health Initiative and Health Careers Futures. The Health Activist Network empowers health professionals to create the health system they want to work in by accelerating health policy, as well as care delivery, improvements. Center Director Ann Hwang is one of the national and international health policy experts who serve as health reform advisors to the new Network.

The post shares that the program initiated a speakers’ series in April 2017 with the first event featuring Community Catalyst Executive Director Rob Restuccia, discussing the early work experiences that set  him on the career path to fight for expanded health coverage and consumer rights.

Center Submits Comments on PACE Quality Measures

On Nov. 30, the Center submitted comments on the Development, Implementation and Maintenance of Quality Measures for the Programs of All-Inclusive Care for the Elderly (PACE).

The letter expresses support for CMS’s efforts to improve PACE quality measures, while emphasizing the importance of patient-reported outcomes, including measures relating to quality of life and community inclusion. The Center points out that the proposed measures are all administrative in nature and emphasizes its belief that patient-reported outcome measures are critical to a more consumer-centered approach to quality measurement.

NOTEWORTHY NEWS & RESOURCES

Improving Healthcare Value in Rural America

The Altarum Institute’s Healthcare Value Hub recently put out a research brief detailing the challenges of – and solutions for – improving healthcare value for rural Americans. For example, among the greatest challenges is the relative scarcity of qualified medical professionals.  To address this challenge, the authors recommend strategies such as expanding the scope of practice for non-physician providers and using telemedicine. Another challenge for rural Americans is care coordination for those with chronic conditions. The research brief points to several models of care that work in rural areas and represent a shift from traditional hospital-based care to an emphasis on primary and preventive care, supported by emergency and community services.

AARP: The High Cost of Social Isolation

While many acknowledge that socially isolated older adults are at increased risk for poor health status and death, new research from AARP’s Public Policy Institute quantifies the cost of that isolation. Researchers investigated the link between social isolation — defined as a lack of meaningful contacts with others — and Medicare spending by examining claims data of over 5,000 older adults. They found that an estimated 14 percent of older adult Medicare beneficiaries were socially isolated. These beneficiaries were more likely to be male, white, live in an urban area, and have lower household income and wealth. They were also more likely to have depression, difficulty performing one or more activities of daily living, and five or more chronic illnesses. All told, researchers found that social isolation is associated with a staggering $6.7 billion in additional Medicare spending annually.

International Survey: U.S. Older Adults Sicker and Face More Financial Barriers Than Counterparts Across the Globe

An international survey published by The Commonwealth Fund finds that older adults in the United States are sicker than their counterparts in 10 other high-income countries and face greater financial barriers to health care, despite the universal coverage that Medicare provides. Among the shocking statistics:

  • Across the 11 countries, at least one of eight older adults reported having three or more chronic conditions, with rates ranging from a high of 36 percent in the U.S. to a low of 13 percent in New Zealand.
  • At least 10 percent of older adults reported having a functional limitation, like needing help with shopping or managing medications.
  • One-quarter of US older adults reported they often worry about having enough money to buy nutritious meals or pay for necessities like housing.
  • Nearly one-quarter of U.S. older adults said that, in the past year, they had not visited a doctor when sick, had skipped a recommended test or treatment, had not filled a prescription or had skipped medication doses because of the cost. Five percent or fewer of respondents in France, Norway, Sweden and the U.K. reported these barriers.
  • Nearly one of four U.S. respondents reported they had spent $2,000 or more in out-of-pocket costs for medical care in the past year.

A Wealth of Resources on Tackling Health Equity

A new publication, Perspectives on Health Equity and Social Determinants of Health, from the National Academy of Science is an edited volume of papers on a vast array of topics related to health equity and the social determinants of health. The papers are grouped into three major areas — (1) Health Equity Research and Policy; (2) A Systems Approach to Health Equity and (3) Advancing Health Equity in Communities of Color — and address topics ranging from health equity for Native Hawaiians, to violence in Black neighborhoods, to the effects of early education suspensions and expulsions on health equity. Each paper explores the topic and provides recommendations from the authors on how to promote health equity for all.

STATE HIGHLIGHTS

California

California’s Cal MediConnect (CMC) program, the state’s demonstration for dually-eligible beneficiaries that seeks to redirect care away from nursing homes and toward home- and community-based services (HCBS), is showing some promising and instructive results. A new brief by researchers from the University of California, San Francisco and Berkeley on the CMC program found that:

  • Interdisciplinary Care Teams and care coordinators improved access to HCBS, which resulted in better health outcomes for beneficiaries. 
  • Referrals to HCBS managed care benefits have improved access to services for beneficiaries.
  • Referrals to other service agencies like Meals on Wheels and housing agencies were mixed, as challenges remain in these relationships. 
  • The brokerage model was explored as a way to facilitate the partnerships between CMC health plans and HCBS agencies.
  • Data sharing continues to be a challenge due to privacy regulations and IT systems that are not integrated.

The brief also includes recommendations based on these findings that would further enhance the demonstration and improve care for dually-eligible enrollee

North Carolina

The state of North Carolina has submitted to CMS a revised 1115 waiver request seeking approval for a variety of initiatives that will invest $1.2 billion in the state’s transition to managed care in the Medicaid program. The new waiver request is focused on addressing the behavioral health and substance use disorder needs of the Medicaid population, as well as the social and economic determinants of health. Initiatives included in the waiver request include:

  • The creation of tailored plans for enrollees with complex needs
  • Allowing payment for some Medicaid services provided in so-called “institutions of mental disease”
  • Public-private pilot programs that will pursue evidence-based interventions that address housing, transportation, food, interpersonal safety and toxic stress

Unfortunately, the waiver also seeks to allow the state to charge premiums and impose work requirements on Medicaid enrollees. Such requirements are likely to be counterproductive to improving health for enrollees in the state.

KEY DATES

Tuesday, Jan. 16, 2018 (2-3 p.m. Eastern) – Webinar: Frontotemporal Degeneration: The Importance of Knowledge, Advocacy and Support to Advance Quality Care, presented by the American Society on Aging and sponsored by the Administration for Community Living.

Please register for the webinar.

 

Friday, Jan. 19, 2018 (2-3 p.m. Eastern) – Webinar: Campaign to End Medical Debt, Now and In the Future, presented by the Campaign to End Medical Debt

Please register for the webinar.

 

Thursday, Jan. 25, 2018 (12-1 p.m. Eastern) – Informational Webinar on the MIT Abdul Latif Jameel Poverty Action Lab North America (J-PAL North America) second Health Care Delivery Innovation Competition.

Please register for the webinar here.