Health Innovation Highlights: February 13, 2020

Full Edition

DIRECTOR’S CORNER

A Spark of Sun

Photo credit: Bigstockphoto.com

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

In “January,” John Updike writes,

“The days are short,
The sun a spark,
Hung thin between
The dark and dark.”

Indeed, the past month has had its share of “the dark and dark” for those of us working to improve the health of those with the most complex needs. For example, on Jan. 27, the Supreme Court allowed the Trump administration to move forward with plans to deny green cards to immigrants who might possibly make even occasional and minor use of public benefits like Medicaid, food stamps or housing vouchers. This policy on “public charge” will cause many individuals and households to forego essential benefits out of fear and confusion about the consequences for their immigration status. Legal challenges to the program will continue to wend their way through the courts as the administration moves forward with implementation.

The same week, the Social Security Administration closed the comment period for its proposed policy to increase the frequency of reviews for individuals who receive Social Security Disability payments, imposing burdensome new requirements. This proposed policy will reduce the number of people who receive disability benefits and will particularly affect older adults and people with disabilities. Our comments, asking the Administration to withdraw these proposed changes, can be found here. Thanks to the many others who also submitted comments on this rule.

But even amidst the dark and dark, we do find a thin spark of sun. I’m particularly proud to highlight our new case studies and findings, developed in partnership with the Health Care Transformation Task Force, that profile three health care organizations that are leaders in embedding patient and family engagement into their work. The case studies lay out the nuts and bolts of what it takes to build meaningful consumer engagement and I hope they will encourage other health care organizations to adopt similar strategies.

We also have just produced two new resources that examine some best practices for identifying and addressing patients’ social needs, such as healthy food or stable housing – an issue brief on programs in North Carolina and Oregon that are working to address social determinants of health through Medicaid, and a two-page resource that can help health advocates identify workable policy solutions and health system levers they can employ in their community.

And finally, I’m thrilled that Becca Telzak, director of health programs at Make the Road New York, received the Joan H. Tisch Community Health Prize! This prize honors one individual and one organization for outstanding accomplishments in urban public health. Becca has built Make the Road's health department into a powerhouse that directly serves 8,000 immigrant New Yorkers every year with health insurance enrollment, food stamp enrollment, asthma home visits and more. Please join me in congratulating Becca!

FROM THE CENTER & OUR PARTNERS

New Case Studies Examine “What It Takes” for Effective Organizational-Level Consumer Engagement

The Center and the Health Care Transformation Task Force, with support from the Robert Wood Johnson Foundation, released “Organizational-Level Consumer Engagement: What It Takes” – a set of three case studies along with an overview and findings document. The case studies take an in-depth look at consumer engagement strategies at three different health care organizations – Children’s Mercy Kansas City, Hudson River Health Care and Trinity Health.

Patients, families and caregivers bring valued and critical insights to health care organizations eager to provide the best possible care and experience for the patients and communities they serve. But health care organizations don’t always have the resources or know-how to do the hands-on work necessary to ensure the voice of the patient is both meaningful and influential throughout the organization.

The case studies examine and share lessons learned on:

  • the array of engagement structures each organization employs
  • what it takes (staff, dollars and time) for them to implement and sustain these structures, and, most importantly
  • the impact of engagement structures on the organizations and the people and communities they serve.

Two New Center Resources Focus on Addressing Social Determinants of Health 

The Center released two resources that frame effective policy and programmatic approaches to connect people to social services and meet some of their immediate social needs. Our issue brief, “Addressing Social Needs Through Medicaid: What Consumer Advocates Can Learn from North Carolina and Oregon,” presents the efforts of two very different states that are at the forefront of finding innovative approaches to address Medicaid beneficiaries’ social needs.

While there is widespread agreement that the social and economic conditions of a community play a
large role in determining the health outcomes of residents, it is not always as clear how the health care system can most effectively address these issues. Our brief resource, “Community Solutions for Addressing the Social Determinants of Health: Choosing the Right Policy Levers,” is  a tool to help health advocates identify the policy solutions and health system levers they can employ to address social needs in their own communities.

Center Partner Becca Telzak of Make the Road New York Receives Prestigious Health Prize

A big congratulations to Becca Telzak, director of health programs for Make the Road New York, who received this year's Joan H. Tisch Community Health Prize on Feb. 6. This prestigious prize honors one individual and one organization for outstanding accomplishments in urban public health.

Becca has built Make the Road's health department into a powerhouse that directly serves 8,000 immigrant New Yorkers every year with health insurance enrollment, food stamp enrollment, asthma home visits and more, ensuring that those who are least likely to have access to mainstream providers get quality care. New York City has replicated aspects of these programs and relied on Becca for help designing services that are intended to reach low-income immigrant families.

And, like all great leaders, Becca works constantly to develop the leadership of those around her, hiring staff who are from the communities they serve, supporting them in learning new skills and enabling them to raise through the ranks of their organization. Indeed, she shared the honor in her acceptance speech - “This award is a testament to the work and accomplishments of Make the Road New York’s health team over the years to improve the health of immigrant and working-class communities in New York. Thank you to everyone who made this award possible and to Make the Road New York and our members for providing the support, perseverance and creativity to move our work forward.”

Congratulations, Becca!

Rebecca Telzak, center, with (from left to right): Harold Holzer, Jonathan F. Fanton director, Roosevelt House Public Policy Institute at Hunter College; Lilliam Barrios-Paoli, senior advisor to president of Hunter College; Laurie M. Tisch, founder and president of the Laurie M. Tisch Illumination Fund; and Jennifer J. Raab, Hunter College president.

 

 

 

 

Maine People’s Alliance Works to Improve Medicaid-Funded Transportation Services for Seniors and People with Disabilities

Center partner Maine People’s Alliance (MPA) is actively engaged in a wide-ranging campaign to reform Maine’s Medicaid transportation system. In December, MPA met with state Rep. Chloe Maxmin, the Maine Council on Aging, and senior staff at Maine’s Department of Health and Human Services to discuss the path for Rep. Maxmin’s  bill, LD1142, which would restore coverage of non-medical transportation services to seniors and people with disabilities, and convene a stakeholder group to study how to improve Maine’s Medicaid-funded transportation system as a whole.

MPA also convened a meeting of Sanford, ME residents to discuss the issue and MPA Deputy Director Ben Chin did a site visit with transportation provider LogistiCare to witness the service being provided in Portland. They also recruited another transportation company owner to their campaign to reform Maine’s Medicaid transportation system and talked about the issue on the recent Beacon podcast (minute 22:11).

Rhode Island Coalition Weighs in on Future of Health System Models for Duals

Center partners the Rhode Island Organizing Project, Senior Agenda Coalition and the Economic Progress Institute responded to last month’s request for information (RFI) from the Rhode Island Executive Office of Health & Human Services regarding the development of a payment and delivery system model that coordinates care for dual eligible Medicare and Medicaid members. ( The state is considering issuing a request for proposals to serve dual eligibles under a Medicare-Medicaid Plan (MMP) or a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) model. The Rhode Island coalition made the following points in their letter:

  • The state should “stay the course” with the MMP model rather than disrupt care by moving to a FIDE-SNP. Consumers are satisfied with their care under this program and there are many lessons learned to help improve the program.
  • The state should continue to push for strong stakeholder engagement at both the health plan and state levels, regardless of which model is ultimately chosen. This includes continuing the existing state-level consumer-driven Implementation Council.
  • Ongoing outreach and education to both consumers and providers is essential.

Center Opposes Proposed Trump Administration Rule on Reviews for Disability Benefits

On Nov. 18, 2019, the Social Security Administration proposed a worrisome regulation that would increase the frequency of disability reviews, imposing burdensome new requirements.

The comment period for this rule change ended Jan. 31, 2020, and the Center submitted a comment letter to vigorously oppose the burdensome new process of increasing the frequency in which people are subjected to increased scrutiny to justify their benefits. Center Program Associate Siena Ruggeri explains in more detail the risks involved, starting with, “A disability review requires extensive documentation and medical evidence. If there is any mistake at any point in the process, people are at risk of completely losing their benefits.” Please read her blog post to learn more!

Center Partner Massachusetts Senior Action Council Works to “Close the SNAP Gap”

On February 11, 2020, Center Partner Massachusetts Senior Action Council (MSAC) participated in the “Close the SNAP Gap” Lobby Day at the Statehouse. The SNAP Gap is the difference between the number of low-income Massachusetts residents receiving MassHealth (Medicaid) who are likely SNAP-eligible and the number of people actually receiving SNAP. In Massachusetts, the size of this gap is over 700,000 residents, many of whom are older adults. At the Lobby Day, MSAC member and SNAP beneficiary Jeanne Cronin represented the consumer voice on a panel of SNAP Gap experts. Kudos to MSAC for lifting up the voices of those who are directly impacted by food insecurity!

FEATURED NEWS & RESOURCES

MACPAC Public Meeting Tackles Integrated Care for Duals

MACPAC’s January public meeting included a briefing on a new anysis of the availability of integrated care at the county level and a presentation of policy options for improving integration. The two presentations provide helpful insights into the policy landscape for dually eligible beneficiaries at the local, state and national level.

It’s Time to Care: A Detailed Profile of America’s Direct Care Workforce

The Paraprofessional Healthcare Institute (PHI) has released its first installment in a series of reports focused on the prospects for the nation’s direct care workforce. This first report details, and offers solutions to, the growing complexity of direct care in all settings and the diverse technical, interpersonal, and linguistic and cultural competencies direct care workers must develop. Importantly, it also highlights the wage disparities within the already-underpaid direct care workforce by race, ethnicity and gender. Finally, PHI offers clear solutions to this growing paradox between the increasing complexity of direct care and the marginalization of its workforce.

CBPP Papers on Advancing the Health Sector’s Role in Housing

The Center on Budget and Policy Priorities released two white papers, with an accompanying Health Affairs blog post, that provide insight on how to integrate the health and housing sectors to address social needs that affect health outcomes. These resources outline ways Medicaid can fund services that help people find and maintain housing. It also calls upon health care providers to invest deeply in affordable housing projects and community-wide social needs. The resources are an important tool for health care advocates looking to promote adequate funding for under-resourced public housing programs. 

Expanding Access to Community-Based Substance Use Disorder Treatment

The Center for Health Care Strategies’ PRomoting Integrated Care for Dual Eligibles (PRIDE) project, supported by The Commonwealth Fund, has released a series of resources for improving access to community-based substance use disorder (SUD) treatment. The PRIDE project is a learning collaborative of nine health plans advancing innovative approaches to integrating and enhancing care delivery for dually-eligible consumers.

The new resources include:

STATE HIGHLIGHTS

California

Last September, the California Department of Health Care Services (DHCS) announced that they will carve in coverage of institutional Long-Term Care (LTC) services into all Medi-Cal managed care health plan (MCP) model types. Late last month, the state released a Frequently Asked Questions document to address questions regarding the LTC carve-in.  

Oregon

A  recently published study in the Journal of Health Politics, Policy and Law examined the utilization of “flexible services” which were included as part of the 2012 Medicaid waiver that created the coordinated care organization (CCO) initiative. The study looks at these services and the challenges providers faced in delivering them. A key finding was the need to provide managed care organizations (MCOs), such as CCOs, with detailed definitions and guidance up-front on health-related services they are expected to coordinate and pay for. While flexibility to pay for a variety of services may help MCOs respond to their patients’ unique health-related needs, many CCO informants described clarification and certainty provided by new rules as helpful. 

Washington

A recent blog post authored by the National Academy for State Health Policy (NASHP) discusses some of the lessons learned through Washington state’s collaborative regional Accountable Communities of Health (ACH). These lessons are from a recent evaluation conducted by the Center for Community Health and Evaluation, which found that the ACH model has largely succeeded in building robust regional coalitions to improve the health of their communities.

KEY DATES

Thursday, Feb. 20 (2-3 p.m. Eastern) - Webinar: Family Caregiving Policies and Innovations, presented by the National Academy for State Health Policy (NASHP). Please register for the webinar.  

Thursday, Feb. 20 (2-3 p.m. Eastern) - Webinar: Rooted in Oral Health Equity: Beyond the Clinic Walls: Social Determinants of Oral Health, presented by Community Catalyst and the Morehouse School of Medicine. Please register for the webinar.

Wednesday, Feb. 26 (2:30-3:30 pm Eastern) - Webinar: Medicare Advantage and Flexible Supplemental Benefits: New Data and Principles for Implementation, presented by tthe Long-Term Quality Alliance (LTQA). Please register for the webinar.

Wednesday, Mar. 4 (1:30-2:30 pm Eastern) - Webinar: Redlining & Health Equity: How Health Systems Can Help Dismantle Structural Racisms, presented by HealthBegins. Please register for the webinar.

Monday, Mar. 9 (2-3 pm Eastern - Webinar:  Understanding and Respecting What Matters Most to Patients and Family Caregivers, presented by the Coalition to Transform Advanced Care (C-TAC). Please register for the webinar.

Wednesday, Apr. 15 - Application Deadline: Applications due for the Health & Aging Policy Fellows Program (2020-21). Please click here for an overview of the fellowship, including program tracks and eligibility and selection criteria.