Health Innovation Highlights: June 13, 2018

Full Edition

DIRECTORS CORNER

The Importance of Housing to Health, And What We’re Doing About It

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

Watch Our New Video

Traditionally, the U.S. health care system has not directly taken on the social and environmental factors – like poverty, homelessness and hunger – that we have long understood contribute to poor health. But we at the Center believe that can and should change. This month, I’m thrilled to share with you several resources on the connection between health and housing, an area that is ripe for consumer and community advocacy.

If you have a few minutes (4:27 to be exact), please watch “Advocacy Saves Lives,” a new video produced by Community Catalyst that shows how formerly homeless individuals are part of the movement to advocate for more housing-related supports. The video features the work of Center partner the Pennsylvania Health Action Network (PHAN) in building a Housing as Health coalition in Pennsylvania along with other advocacy groups and housing organizations like Project HOME in Philadelphia. The video highlights the importance of engagement by and for consumers, particularly those with complex needs, and the powerful contributions that people sharing their lived experience can bring to these efforts.

If you have a bit more time, consider reading Lauren Taylor’s concise summary of the literature to date on housing and health, in a health policy brief for Health Affairs. The bottom line: there’s lots of good evidence on the link between health and housing, though the field would benefit from more rigorous research, particularly into the effects of healthy neighborhoods and housing issues in suburban and rural areas. There are three companion briefs in the same edition of Health Affairs that focus on specific housing policies (housing mobility programs, the low-income housing tax credit and inclusionary zoning) as strategies to improve access to affordable housing.

As health care advocates, we’re particularly interested in ways that the health care system can better support safe, affordable and stable housing as a way to improve health. We’re working with housing organizations, community-based organizations and health systems alike to identify opportunities for all parties to reap the benefits of healthier people and communities through affordable housing and housing-related services. We’ve seen great examples of health plans and hospitals that are investing in affordable housing and we’ve been encouraging implementation of the Affordable Care Act’s requirements for community benefit strategies for non-profit hospitals in a way that creates meaningful value for communities.

But the future is not necessarily rosy. A recent blog post in the JAMA forum by Community Catalyst Executive Director Robert Restuccia and Howard Koh of the Harvard T. H. Chan School of Public Health and the Harvard Kennedy School highlighted some of the opportunities, but also the threats, facing housing and health initiatives. We’ll need strong voices – like those featured in the “Advocacy Saves Lives” video - to ensure that promise becomes reality.

Do you have examples of advocacy for housing and health to share? Tweet us @CCEHI!

FROM THE CENTER & OUR PARTNERS

Center Releases Interim Evaluation Report on CVI Grant Program

The Center is pleased to release an Interim Evaluation Report on Consumer Voices for Innovation (CVI).  The CVI grant program is in its second year of providing funding to consumer health advocacy organizations in five states to engage in grassroots organizing activities in low-income communities, communities of color and/or among older adults and people with disabilities. CVI projects focus on health care innovation, particularly in the Medicaid program, with an eye toward elevating consumer voices to advocate for models of delivery reform that are person-centered, consumer-led, and responsive to the needs of the community. The Center has contracted with the Institute for Community Health to conduct an independent evaluation of the program.  

The interim report indicates that the CVI grantee cohort is successfully increasing capacity to build an engaged consumer base. Collectively, they’ve added 3,200 consumers to their base of support and grantees have made progress in developing capacities for mobilizing and organizing at the grassroots level, gaining visibility, recruiting volunteers, establishing credibility and training leaders. In just a few weeks, the Center will release a grassroots organizing guide based largely on what we have learned from the outstanding work of the CVI grantees. Stay tuned!

Alabama Arise Hires New Executive Director

Long-time Center and Community Catalyst partner Arise Citizens’ Policy Project in Alabama has named Robyn Hyden as its new executive director. Hyden will begin in her new role in July. She joins Arise from the United Way of Central Alabama and also previously worked as a North Alabama organizer for Arise. She holds a Bachelor of Arts degree in anthropology from Vanderbilt University.

All of us at Community Catalyst are excited to welcome Robyn to our family of partners even as we prepare to bid a very fond and bittersweet farewell to Kimble Forrester, who has led Arise for the past 27 years. Kimble has been an amazing leader in the consumer health advocacy movement in the South and nationally, and we will miss his leadership, strong moral compass and gentle sense of humor terribly. We wish him all the best in his retirement!

The Way Forward: Organizing Seniors to Protect Health Care

With the midterm elections looming, health care remains a top issue for voters, and particularly for older adults. In the last two years, we have seen the critical role that senior advocacy played in resisting attacks on the social safety net. Building off an article published in the Journal for Aging and Social Policy, the Center for Consumer Engagement in Health Innovation is hosting a June 19 webinar, “The Way Forward: Organizing Seniors to Protect Health Care.” Featured presenters will be Kate Villers, President and founder of Community Catalyst, Marcus Escobedo of the John A. Hartford Foundation, Carroll Estes of the University of California/San Francisco and Erin Ninehouser of the Pennsylvania Health Access Network (PHAN). Attend to learn about where we’ve been, where we are and, most importantly, where we’re going and what’s needed to get there when it comes to advocating on behalf of and organizing this important constituency. More information can be found here.

Center Director to Speak on Consumer Engagement Webinar

Center Director Ann Hwang, MD, will be a speaker on the webinar, Consumer Engagement in Health Care Governance, sponsored by the Health Care Transformation Task Force on June 20 from 2:30 – 4 p.m. EDT. Along with Dr. Hwang, the webinar will also feature Clare Pierce-Wrobel, who will discuss the results of a study conducted by the Task Force on consumer engagement structures and mechanisms used by provider organizations, Kathy Grieber from HRHCare in New York and Melinda Karp from the Commonwealth Care Alliance in Massachusetts. Register for the webinar here.   

NOTEWORTHY NEWS & RESOURCES

Rolling Out the CDC’s 6/18 Initiative

The Centers for Disease Control and Prevention (CDC) is partnering with key stakeholders in health care delivery to improve health outcomes and bring down health care costs with its new 6/18 Initiative. The initiative will target six conditions, selected based on the high-risk, high-cost burdens associated with them, including:       

  • Tobacco use;
  • High blood pressure;
  • Health care-associated infections;
  • Asthma;
  • Unintended pregnancy; and
  • Diabetes.

By offering proven interventions – an initial total of 18 – that increase coverage, access, utilization and quality, the 6/18 Initiative aims to address the biggest drivers of health care spending and provide a foundational language and process for addressing additional conditions down the road. Through the 6/18 Initiative, the CDC and other partners with provide technical assistance to state Medicaid programs, private payers and health care providers, and will disseminate best practices for intervention implementation

Housing Partnerships: The Next Frontier in Health Care

The Bipartisan Policy Center has released a report on partnerships between the Departments of Housing and Urban Development (HUD) and Health and Human

Services (HHS), describing the integration of housing and health care services as more important than ever. The report provides:

  • A description of existing collaborations between HUD and HHS, including model partnerships like Health Surveys Data linkages, departmental cross-training, the Health Homes Work Group and the Section 811 Project Rental Assistance Demonstration;
  • An exploration of the overlapping goals of the two federal agencies; and
  • The identification of opportunities to enhance collaborations between the two and improve overall outcomes for beneficiaries.

An article in Modern Healthcare reports that many hospitals have begun partnering with community-led affordable housing initiatives to stabilize the most high-risk patients in their service area.  The article’s spotlight on these partnerships illustrates how successful models help to stabilize both the community organizations working on social determinants of health and the community members they, and the hospitals, jointly serve. Funding from hospitals can help organizations scale up successful programs and can grow to include collaborations on other social determinants including hunger, unemployment and poverty.

Inspiration: Curiosity May Have Killed the Cat, But It Could Save Humanity

In the spirit of drawing inspiration from the well of commencement season wisdom, we offer this item. Surgeon, public health researcher and staff writer for The New Yorker, Atul Gawande, gave the commencement address at UCLA Medical School earlier this month, focusing his advice to new doctors on the importance of curiosity and learning in medicine. Dr. Gawande describes a patient he had in his third year of medical school whose outrageous behavior and offensive remarks made him difficult to like, but, Gawande says, not difficult to treat when considering the foundational principle of medicine: “all lives are of equal worth.” While many sectors and  individuals are siloed in their own worlds, doctors encounter the full spectrum of human conditions in the course of their daily work. This is why it is important for physicians to practice curiosity; to demonstrate concern and empathy for the issues their patients are dealing with that lead them through the hospital doors. Dr. Gawande argues that without this curiosity and openness to understanding it would be very difficult to provide good care to people and to preserve the humanity of both patients and their doctors.

STATE HIGHLIGHTS

California

UC Berkeley’s Health Research for Action and the Community Living Policy Center released a research brief examining the implementation of the Cal MediConnect (CMC) – the state’s dual eligible demonstration project – care coordination benefit. The findings reveal that care coordination activities increase collaboration between providers and could improve access to community-based services, but further clarification about roles and benefits is needed for providers to be most effective. Other key findings include:

  • Care coordination improved as health plans built internal care management capacity and connected with HCBS, but care coordination still varied in how it was implemented.
  • Individualized Care Teams (ICTs) helped promote care coordination across sites and ICT meetings proved effective at bringing all of a person’s providers, social service workers and care coordinator together. These meetings were either in-person, at regular intervals to check patient progress, or on-the-spot problem-solving teleconferences. The meetings improved communication and provider collaboration, but ICT participants found it difficult to engage members.
  • Care coordination improved care transitions at the health plan, care facility, and home- and HCBS agency level. However, the reported improvements varied and could further improve through communication about CMC plan roles.
  • Care coordination efforts improved HCBS collaboration with CMC health plans, In-Home Supportive Services (IHSS) and Community-Based Adult Services (CBAS). Some plans transitioned beneficiaries out of long-term care facilities to community-based care settings, cutting costs in the process. While some HCBS organizations reported contracts and referral relationships with CMC plans, many reported problems with a lack of plan collaboration and underuse of HCBS organizations’ established relationships.

The research brief also gave recommendations about strengthening collaboration, clarifying the care coordination process and predicting future health system workforce needs. 

Colorado

A recent article in Healthcare Informatics explains how a $65 million grant from the Center for Medicare and Medicaid Innovation (CMMI) has enabled Colorado to be one of the few states in the country to connect primary care and behavioral healthcare together in one system through telehealth technology. The four-year Colorado State Innovation Model (SIM) project, now in its third year, began with the idea to harness technology to connect primary care practices with mental health services at every patient encounter. In order to turn data into actionable information, SIM funds a dedicated advisory squad of IT professionals who go to the physician group practice sites and help staff learn more about the importance of data systems and impact it can have on their practices. The help team, called the Clinical Health Information Technology Advisors, help practices streamline revenue and improving documentation for reporting. 

New York

The Human Services Council of New York convened a group of leaders with experience and expertise spanning government, health care, philanthropy, academia and human services to examine and inform the state's health care reform efforts through a human services lens. The findings and recommendations were published in a report, "Integrating Health and Human Services: a Blueprint for Partnership and Action." The report examines the paradigm shift from volume-driven to value-driven care from a practical perspective; recognizing the operating realities that community-based human services organizations face as a result of government contracting conditions and it calls on government to take decisive action to strengthen these organizations, modernize the regulatory framework within which they operate and foster cross-sector partnerships that truly incentivize positive outcomes

KEY DATES

Thursday, June 14 (11-12 p.m. Eastern) - Webinar: Social Determinants of Health among Individuals with Functional Impairments, presented by The Association of University Centers on Disability (AUCD). Please register for the webinar.  

Thursday, June 14 (1:30-3 p.m. Eastern) – Webinar: The 1115 Impact: The Role of Medicaid Section 1115 Waivers in Complex Care, presented by the National Center for Complex Health and Social Needs. Please register for the webinar.  

Tuesday, June 19 (2:30-4 p.m. Eastern) - Webinar: The Way Forward: Organizing Seniors to Protect Health Care, presented by the Center for Consumer Engagement in Health Innovation. Please register for the webinar.  

Wednesday, June 20 (2:30-4 p.m. Eastern) - Webinar: Consumer Engagement in Health Care Governance, presented by the Health Care Transformation Task Force. Please register for the webinar. 

Tuesday, June 26 (1-2 p.m. Eastern) - Webinar: Enhancing Self-Efficacy in Persons Living with Dementia, presented by the American Society on Aging. Please register for the webinar.