Health Innovation Highlights: July 16, 2020

Full Edition

DIRECTOR’S CORNER

A World Transformed

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

As I’ve returned to clinical practice after maternity leave, I’ve found a world transformed. I find myself often turning to colleagues to fill me in on constantly changing information about what is open or closed, and how to arrange specialty appointments, radiology studies, laboratory tests and in-home services for patients. I’m navigating shortages of supplies and medications. Catching up on new procedures for clinic visits, and new routines that involve donning and doffing masks, face shields, gowns and gloves. Using new platforms for videoconferencing. And learning new clinical information about diagnosing, treating and preventing the spread of COVID-19. In some ways, I’m impressed with how much we have adapted and learned over the last four months. In other ways, I’m angry that despite all of the sacrifices and suffering of so many, including by so many health care and other essential workers, as well as patients and their families, COVID-19 is still surging in so much of the country.

The COVID-19 pandemic is changing from a natural disaster to a man-made one. And as this disease exposes daily the weaknesses of our political system, our policies, and our health care and public health infrastructure, the role of advocacy to achieve a system for health and health care that actually works feels more important than ever.

As we mark the 55th anniversary of Medicare and Medicaid later this month, I reflect on how powerfully these two programs have shaped the fabric of our lives, and the advocacy and activism, particularly by older adults, that was essential to getting these programs enacted. These programs have improved the health and security of hundreds of millions. They have contributed to a more just society, through the desegregation of hospitals. And there is so much more that these programs can and must do, especially in these times, to improve health and health equity.

In this month’s Health Innovation Highlights, we share materials to guide health care organizations in engaging consumers, an important component of making health systems – and health care – better meet the needs of the people and communities they serve. We also highlight a new paper by the National Academy of Medicine that highlights how patient- and family-engaged care is absolutely foundational to health equity.

In case you missed it, please take a look at our ideas for actions health systems should take to advance racial justice, and share your feedback with us.

And finally, this is the time of year that we usually launch our Speak Up for Better Health award contest, by which we recognize community members who are using their voices to improve the health of their communities. This year, in light of the pandemic, we will not be holding our usual contest and award ceremony. However, we will be taking time at the end of the year to recognize how consumers and advocates have innovated and continued the critically important fight for more person-centered health policies and programs, even in this time of physical distancing. We look forward to sharing this work with you. In the meantime, all of us at the Center thank you for all that you are doing to address the immediate threats facing the people and communities we serve, and to advocate for creating the system for health and health care that we all need.

FROM THE CENTER & OUR PARTNERS

The Hows and Whys of Person-Centered Consumer Engagement

Now more than ever, it is crucial that health systems find meaningful ways to stay connected to the people they serve, while also prioritizing person-centered care. To that end, the Center and the Health Care Transformation Task Force (HCTTF) have developed a new web-based change package to guide health systems toward meaningful person-centered engagement structures at the organizational level.

The online tool, Organizational-Level Consumer Engagement: A Guide to Implementing and Sustaining Successful Strategies, provides a blueprint for planning and implementing organization-level consumer engagement strategies. It also includes key considerations for scaling and spreading engagement efforts across departments, service lines, or delivery sites, allowing for variances in culture, patient populations and policies.

This is part of an ongoing, collaborative project between the Center and the HCTTF funded by the Robert Wood Johnson Foundation.

Georgia Partners Launches NEMT Initiative

Medicaid non-emergency medical transportation (NEMT) is a critical benefit for millions of Americans, ensuring access to medical appointments, substance use disorder/behavioral health care, preventive care, specialist visits, physical therapy/rehabilitation, dialysis and adult day health care. This is especially particularly important for those with disabilities, seniors and people in rural areas. Center partner The Arc Georgia has collaborated with Georgians for a Healthy Future to launch an initiative, “Georgians in the Driver’s Seat.” This effort aims to ensure transportation is eliminated as a barrier to health care for all Georgians, with a focus on people with disabilities. The webpage also includes a customer satisfaction survey, offering consumers an opportunity to share their feedback and stories.

New York Partner, Plaintiff in DACA Case, Celebrates SCOTUS Ruling

Immigration has been a core issue for Center partner Make the Road New York (MRNY), and they were plaintiffs in the first federal lawsuit in the country to challenge the termination of DACA, the Deferred Action for Childhood Arrivals program, that provides protection to more than 700,000 young people in this country.

Last month's United States Supreme Court decision affirming this program was an immense and emotional victory for MRNY, which held an online celebration and discussed the work that lies ahead. Lead organizer Eliana Fernandez wrote a poignant response op-ed in the New York Daily News, and MRNY wasted no time in establishing NYDACA.org as a resource for DACA recipients and potential new applicants.

Tennesseans with Disabilities Protected from Discrimination in Health Care Rationing

In April, we reported on an emerging threat to the more than 7 million Americans with cognitive disabilities and how some states were developing triage criteria that would ration care for this population in disaster preparedness plans. In response, Center partner the Tennessee Disability Coalition joined with Disability Rights Tennessee and others to file  a complaint with the Office of Civil Rights for the U.S. Department of Health and Human Services, alleging Tennessee guidelines for allocation of health care violated the ADA and similar laws. As a result, in late June Tennessee comprehensively revised their guidelines to create crisis standards of care that better protect people with cognitive disabilities.

Maine Partners Push for Expanded Rental Relief and Lend Support to BLM Advocates


Rent relief and eviction moratorium event in Bethel, ME that drew over 200 people

As previously reported, our partners at Maine People's Alliance (MPA) established a robust mutual aid network since the onset of the Coronavirus pandemic, "Mainers Together." This work led directly to the establishment of a rental relief program and eviction moratorium. There were limitations to Maine Housing's COVID rental assistance program, so, along with coalition partners, MPA helped organize a virtual press conference for tenants to speak out about their need for stable, affordable housing and the restrictions of Maine Housing’s COVID rental assistance program. The day after the press conference, the director of Maine Housing, Dan Brennan, announced that emergency rental assistance would extend through June.

Additionally, MPA staff and volunteer leaders have worked to support the incredible organizing across Maine in response to George Floyd’s murder. For example, MPA has assisted Black Mainers with rallies across the state and has educated young Black leaders organized by Maine Youth Action Network on opportunities for advancing racial justice priorities in the state Legislature.

NOTEWORTHY NEWS & RESOURCES

New Hospital Index Includes Support of Communities in Rankings

The Lown Institute has released the Lown Institute Hospitals Index, a new ranking project that has been two years in the making. The Index shows how nearly 3,300 U.S. hospitals compare on 42 performance measures that fall under three categories: Civic Leadership, Value of Care and Patient Outcomes.

This new index is the first to measure Civic Leadership, which includes how well hospitals serve people of color and people with lower incomes, how well a hospital’s staff are paid compared to executives, and how nonprofit hospitals are spending their community benefit dollars.

As a web-based resource, the Index provides full rankings listed and searchable by hospital name, location, type and metric. The website also provides white papers describing the methodology and findings for each of the metrics reported on, as well as featured insights, like this one addressing disparities in patient outcomes at safety-net hospitals.

Older Adults and COVID-19

A recent blog post from the John A. Hartford Foundation highlights a potential improvement brought to the health system by the pandemic – telehealth for older adults. A recent survey found that the majority of older adults reported their telehealth appointments to be the same or even better quality than an in-person office visit. Telehealth has the potential to mitigate risk at nursing homes and assisted living facilities, and could help address built-up demand for care. While there’s plenty of potential, the blog cautions that many older adults were not satisfied with their telehealth experience. As telehealth gains popularity, the health care ecosystem must ensure all older adults have equitable access to technology and that quality of care is not diminished.

Also, a new fact sheet from Justice in Aging details how the Affordable Care Act helps older adults who are most impacted by the coronavirus pandemic. The ACA has expanded coverage to older adults with preexisting conditions and  provided protections that make treatment more affordable, which protects a group at high risk for COVID-19 complications. It also includes initiatives that allow older adults to remain in their homes, shielding them from congregate living situations that allow for rapid spread of COVID-19. As the Trump administration continues its legal battle to dismantle the ACA, advocates must emphasize the ACA’s importance in saving the lives of older adults during the pandemic.

Measuring Complexity

The National Center for Complex Health and Social Needs recently released a report with recommendations for the complex care field to develop a standard set of quality measures. The report includes four areas of findings: defining the population, data availability and potential sources, measurement domains, and measures and measure concepts. The standardization of these measures will help the complex care field show its value and evaluate program outcomes and impacts, leading to better care for consumers.

Patient and Family Engaged Care: An Essential Element of Health Equity

A new discussion paper from the National Academy of Medicine explores the important role of patient, family and community engagement in achieving health equity. Taking a population health approach, the paper includes examples from organizations that have innovated strategies for consumer engagement, as well as action steps to better orient organizational culture and policies to engaging consumers and their communities.

SENATORS: COVID-19 in Nursing Homes: How the Trump Administration Failed Residents and Workers

A new report by Sens. Casey, Peters and Wyden details the federal government’s failure to adequately protect older adults and people with complex needs living in nursing homes, as well as their caregivers. Its findings point to a lack of preparation, data collection, resource distribution, testing strategy and oversight as some of the main reasons nursing homes suffered an overwhelming amount of COVID-19 deaths and cases. The report recommends a significant investment in home and community-based services, PPE, and testing, as well as strong data collection, to prevent more unnecessary deaths in nursing facilities.

STATE HIGHLIGHTS

New Jersey

Horizon Blue Cross Blue Shield of New Jersey recently launched Horizon Neighbors in Health, a $25 million program to address social determinants of health (SDoH) in 11 counties. Under the new program, Horizon plans to work with community partners in areas hardest hit by COVID-19. The program aims to establish a data set that will demonstrate the health and financial benefits of addressing SDoH under a Community Health Worker model developed by the University of Pennsylvania.

Oregon

The Oregon Office of Diversity, Equity, and Inclusion released a new framework to help state agencies increase attention on equity and racial justice in response to the coronavirus pandemic, as reported by My Oregon News. The core elements of the framework include: using inclusive communications; forming community-informed policy and partnerships; ensuring safety for communities by protecting against discrimination, racism, xenophobia, violence and hate crimes; collecting, analyzing and reporting data in a culturally- and linguistically-responsive way; and making investments in community resilience.

Texas

Last month, the Centers for Medicare & Medicaid Services (CMS) approved Texas’ request to update its Section 1915(c) Home and Community-Based Services (HCBS) waivers with the Emergency Preparedness and Response Appendix K in order to respond to the coronavirus pandemic. Key items approved are:

  • Allow extensions for reassessments and reevaluations
  • Allow for remote delivery of case management and orientations for financial management services agencies
  • Allow for virtual evaluation assessments and person-centered service planning meetings

The full Appendix K can be found here.

KEY DATES

Monday, July 20 (3-4 pm Eastern) - Webinar: Alone Together: Understanding Social Isolation in Caregiving in the U.S. 2020, presented by the National Association of Area Agencies on Aging (n4a). Please register for the webinar.

Tuesday, July 21 (1-2 pm Eastern) - Webinar: Social Determinants and Health Equity: What Has COVID-19 Taught Us and Where Do We Go From Here?, presented by Manatt Health. Please register for the webinar.

Wednesday, July 22 (2-3 pm Eastern) - Webinar: Health Inequities & COVID-19, presented by National Hispanic Council on Aging (NHCOA). Please register for the webinar.

Wednesday, July 22 (2-3 pm Eastern) - Webinar: Engaging People with Complex Health and Social Needs in Advocacy (and Beyond!), presented by the National Center for Complex Health and Social Needs. Please register for the webinar.

Thursday, July 23 (2-3 pm Eastern) - Webinar: How Is COVID-19 Transforming Value-Based Payment?, presented by Manatt Health. Please register for the webinar.

Wednesday, July 29 (1-2 pm Eastern) - Webinar: Health Care Contracting in the Age of COVID-19, presented by the Aging and Disability Business Institute. Please register for the webinar.