Health Innovation Highlights: July 18, 2018

Full Edition

DIRECTOR’S CORNER

We’ve Got Your Back on Your 53rd Birthday, Medicare & Medicaid! 

Medicare and Medicaid are turning 53 at the end of this month. Their importance to the health of the nation is hard to overstate: together, they provide coverage to one in three people in the United States, including many with complex health and social needs. For instance, Medicare has been critical for shouldering much of the cost of older adults’ care, forming, with Social Security, a critical economic safety net for all of us as we age. It has contributed significantly to health, as well: one analysis estimates that the Medicare program has extended life expectancy by five years. Similarly, Medicaid fills a crucial gap in health care coverage for low-income families and individuals, and provides vital long-term services and supports to people with disabilities and low-income older adults, including paying for the home-based services that enable sustained independence and better quality of life.  

To celebrate their 53rd birthday, we’re highlighting the stories of people who are served by these programs. For example:

Edna found the right combination of services to enhance quality of life for her late mother, Sally, in an innovative program integrating her Medicare and Medicaid benefits.

Teresa and Caiden illustrate the importance of Medicaid long-term services and supports for children with disabilities.

Howie, who is dually eligible for Medicare and Medicaid, has found escape from his isolation by attending a day program at a wellness and recovery center for people with mental health conditions.

Jane is a woman with disabilities who not only has autonomy in hiring her Medicaid-funded personal care attendants, but who supports others through her tireless advocacy for better Medicare and Medicaid benefits.

Because Kathy depends on the health security Medicaid and Medicare provide her, and provided her late husband, she is a stalwart advocate to preserve them. 

We’re honored to partner with Medicare and Medicaid beneficiaries, many of whom are working to improve these programs for themselves and for others. We believe that this kind of consumer input and advocacy is crucial for making these programs stronger heading into their 54th year.

Have a Medicare or Medicaid story? Share it with us on Twitter @CCEHI.

FROM THE CENTER & PARTNERS

New Case Study on Massachusetts One Care Implementation Council

On Monday, the Center and the LeadingAge LTSS Center at UMass Boston released “The One Care Implementation Council: Stakeholder Engagement Within a Duals Demonstration Initiative.” This 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 initiative. 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.

Some of the many key lessons shared in the case study include:

  • Membership and structures should be formed in partnership with community leaders and be flexible enough to grow and change over time.
  • Training and communication strategies should be multi-faceted and flexible.
  • Meaningful engagement requires you to “go where the people live, work and play.”
  • People with lived experience should be compensated for the time they invest.
  • Transparency and building of trust over time can lead to improved communication and effective decision-making among members and with state officials.

Here is “Where the Magic Happens!”

In case you missed it, take a look at this blog post by Center State Advocacy Manager Jessie Zimmerer about “Where the Magic Happens,” the Center’s new toolkit on grassroots organizing around delivery reform initiatives. Missed our webinar on the new toolkit? No problem! Watch the recording!

New Report on Health Equity Policy Options

Our national partners at Families USA have released “A Framework for Advancing Health Equity and Value: Policy Options for Reducing Health Inequities by Transforming Health Care Delivery and Payment Systems.” The report was developed by the Families’ Health Equity Task Force, which brings together state and national health equity thought leaders – including Center Project Manager Leena Sharma – to leverage health innovation initiatives for the benefit of those the health system leaves behind. After laying out a rubric for assessing the potential impact of new initiatives on equity, the report then provides a conceptual framework for thinking about delivery and payment reform and health equity and, finally, concludes with a menu of policy options.  

FEATURED NEWS & RESOURCES

Social Determinants in a Rural, Aging Context

The John A. Hartford Foundation President Terry Fulmer published an article in Next Avenue highlighting promising interventions in social determinants most impacting older adults in rural areas. The article explains that the co-dependent relationship between poverty, locality and age often compromises a patient’s access to stable, quality care. Older adults in rural areas face particularly steep obstacles including lack of access to transportation, healthy food and wrap-around services to meet their needs. She points to several community organizations, government entities and private foundations that have partnered in developing models to mitigate one or more of these obstacles, including:

  • The Arizona Age-Friendly Network created a transportation program to provide free rides to residents 60 year or older so they can access medical appointments, social events and other services;
  • Friends of Aroostook in Maine recruits volunteers to pick fresh fruits and vegetables for local senior organizations, Meals on Wheels and food banks; and
  • Senior Planet in rural New York is working to connect older adults with basic technology devices, including lap-tops, tablets and audio devices.

Dr. Fulmer also spotlights the work Saint Alphonsus Health System in Boise, Idaho is doing to provide coordinated care to older adults with complex medical needs as part of the Age-Friendly Health Systems Initiative. These innovative approaches to addressing social determinants for older adults are becoming critical aspects of effective care networks and can be used to further develop pathways to good health for older adults in every community.

JAMA Study Reveals Hopeful Trends Emerging in End-of-Life Care

The Los Angeles Times reports the findings of a new study published in the Journal of the American Medical Association (JAMA) on end-of-life care in the United States. Examining Medicare data from 2000 to 2015, researchers found a significant decrease in the number of patients who died in the hospital and an increase in the number of those who spent their final days at home, in hospice or in a community setting. While these changes cannot be attributed to a single cause, researchers point to several possible factors, including the implementation of the Affordable Care Act, the rise in palliative care integration and the incorporation of growing bodies of research on what qualifies as quality care. Also noted is a growing cultural shift in physician approaches to end-of-life care, which prioritize minimizing avoidable pain and suffering for patients and their families over the use of extraordinary medical measures. Whatever the cause, all of these factors are contributing to the trend toward less fragmented and expensive end-of-life care.

Sometimes You Wanna Go Where Everybody Feels Your Pain

A New York Times column shines a spotlight on the power of patient story-sharing as a means for building community, increasing patient satisfaction and improving health outcomes. Authors Aaron Carroll and Austin Frakt, both of whom manage chronic conditions, describe their own experiences sharing advice with other patients; talking specifically about what treatments worked for them or didn’t, checking in about reactions to medication, and bonding over the fear and pain that can accompany threats to health. This method of patient support, called “peer health advice” or “peer-to-peer health care,” when paired with expert medical care, can be an effective way to calm patient concerns and reduce isolation. In more informal settings, such as condition-specific forums or on the phone, patients describe peer-to-peer health care as cathartic. But the research on these kinds of interventions backs it up: for example, studies of diabetes management found that patients who participated in peer-to-peer health care lowered their blood sugar level more than those who didn’t. The authors are careful to caution against using online tools to diagnose or treat medical issues, but note that peer-to-peer health care is an integral part of the health system that deserves recognition.

STATE HIGHLIGHTS

Alabama

On June 29, the Alabama Medicaid Agency issued an Intent to Award Notice to Alabama Select Network, LLC for the state’s Integrated Care Network (ICN) program. The contract will be effective Oct. 1, 2018 through Sept. 30, 2020, with three optional one-year extensions. The ICN establishes a new Medicaid long-term care program focusing on a person-centered approach to care delivery using a Primary Care Case Management Entity delivery model.

California

The California Department of Health Care Services submitted a request to the Centers for Medicare and Medicaid Services to extend the Coordinated Care Initiative and Cal MediConnect program by one year. If the request is approved, the demonstration will extend through the 2020 plan year. The purpose of this extension is to align CCI and Cal MediConnect with other Medicaid Section 1115 waiver programs, which are authorized through December 2020.

Maryland

The New York Times reported on July 9, that Maryland Governor Larry Hogan signed a five-year, all-payer health care contract with the Centers for Medicare and Medicaid Services, the first in the nation in which a state is at full risk for total Medicare costs. The state has operated an all-payer model for hospitals for decades and recently shifted the model from fee-for-service to a fixed budget. This new contract aims to coordinate care across the state’s entire health care system. Maryland will need to meet benchmarks for improving health quality and access, and if successful, the new contract could provide a total of $1 billion in savings by the year 2023.

Massachusetts

MassHealth (Massachusetts Medicaid) will host three public listening sessions to hear from stakeholders about topics related to the so-called “Duals Demonstration 2.0.” The proposed demonstration would provide new federal authorities and flexibilities for One Care and Senior Care Options, the Commonwealth’s integrated care programs for dual eligible members. The draft concept paper on the 2.0 model is available here.

In related news, MassHealth is opening up a procurement process to secure new health plans to participate in the One Care demonstration effective Jan. 1, 2020. More information about the process is posted here.

Ohio

As required by the state Legislature, the Ohio Department of Medicaid released the fourth annual evaluation report of MyCare Ohio, the state’s dual eligible demonstration project. A few of the key findings are:

  • The majority of MyCare Ohio members are pleased with their care manager. Approximately 70 percent of members indicated satisfaction with their care manager and over 93 percent expressed satisfaction in their relationship with their care manager.
  • Almost all MyCare Ohio members are getting the services they need. MyCare Ohio plans have approved more than 90 percent of prior authorization requests received from providers for services during the first four years of the demonstration.
  • Ohio Medicaid now monitors timely payments by specific provider type and addresses issues with the managed care plans as needed, to better serve providers.

KEY DATES

Tuesday, July 24 (3-4 p.m. Eastern) - Webinar: Age-Friendly Health System - Action Community Info Session, presented by the Institute for Helathcare Improvement. Please register for the webinar.

Thursday, July 26 (11-12 p.m. Eastern) - Webinar: Launch of The Health Opportunity and Equity (HOPE) Initiative, presented by The National Collaborative for Health Equity. Please register for the webinar.

Thursday, July 26 (1:30-3 p.m. Eastern) - Webinar: Medicaid Work Requirements: What They Are, Who is Affected, and How You Can Engage in Advocacy, presented by The National Center for Complex Health and Social Needs in collaboration with Community Catalyst and Familes USA. Please register for the webinar.

Thursday, August 2 (2-3:30 p.m. Eastern) - Webinar: Promising Practices for Meeting the Behavioral Health Needs of Dually Eligible Older Adults, presented by The Lewin Group. Please register for the webinar.  

Tuesday, August 8 (3:30-5 p.m. Eastern) - Webinar: Demonstrating Medicaid's Value through Storytelling, presented by the Georgetown University Health Policy Institute's Center for Children and Families. Please register for the webinar.