Health Innovation Highlights: March 10, 2022

Full Edition

FROM THE CENTER & OUR PARTNERS

New Joint Report With LeadingAge LTSS Center Lays Out National Strategy to Support Family Caregivers

A new report jointly produced by the Center at Community Catalyst, and the LeadingAge LTSS Center @UMass Boston, “Building a National Strategy to Support Family Caregivers,” draws upon findings from key informant interviews and stakeholder listening sessions to enumerate five key goals and supporting  recommendations that can begin addressing the crisis in caregiving.

The report was co-authored by Center Research Director Marc Cohen and Center Policy Analyst Siena Ruggeri, and was the basis for a February presentation to the to the RAISE Family Caregiving Advisory Council.

The research included the results of Stakeholder Strategy Sessions, Key Informant Interviews and Stakeholder Listening Sessions, which were conducted from December 2020 to October 2021 and received input from representatives of over 162 organizations from the federal, state, local, private and public sector. The recommendations are presented in the report across these five goals:

  1. Family caregivers’ physical, emotional and financial well-being will improve as a result of expanded awareness, outreach and education.
  2. Family caregivers are recognized, engaged and supported as key partners with providers of health care and long-term services and supports.
  3. Family caregivers have access to an array of flexible person- and family-centered programs, supports, goods and services that meet the diverse and dynamic needs of family caregivers and care recipients.
  4. Family caregivers’ lifetime financial and employment security is protected and enhanced.
  5. Family caregivers are engaged stakeholders in a national research and data gathering infrastructure that documents their experiences, translates evidence into best practices, develops person- and family-centered interventions, and measures progress toward the National Family Caregiver Strategy.

    The UMass Boston Gerontology Institute also has written a blog post about the report.

Webinar Recording: Centering Racial Equity and Community Voice to Improve Research Development, Execution and Anaylysis

Over the last two years, Urban Institute researchers have developed a Community Advisory Board to help identify ways to center racial equity in quantitative and qualitative research for a project focused on Medicaid and health equity. With funding from the Robert Wood Johnson Foundation and in collaboration with Community Catalyst’s Center for Consumer Engagement in Health Innovation, Urban launched this diverse board in late 2020 to support this project. The board’s goal is to improve the salience and impact of Urban’s research on this project by helping researchers incorporate the voices of people with lived experience as researchers develop, execute, analyze, and disseminate their research and policy analyses and identify solutions that can equitably improve outcomes on the ground.

On February 22, Urban Institute presented a webinar, "Centering Racial Equity and Community Voice to Improve Research Development, Execution, and Analysis" about the Community Advisory Board’s structure and evolution and the successes and lessons learned through the ongoing collaboration. This event featured researchers and members of the Community Advisory Board, highlighting the benefits to funders and researchers from supporting such partnerships. Myriam Hernandez-Jennings, Director of External Programs, Equity and Engagement at Community Catalyst was among the speakers (Beginning at time 08:45 in the recording.)

 

Center Submits Two Comment Letters to CMS on Proposed 2023 Medicare Advantage Policies

The Center at Community Catalyst recently submitted two comment letters to the Centers for Medicare and Medicaid Services (CMS) responding to 2023 proposed rules and advance notice related to Medicare Advantage and to payment policies for Medicare Part C and Part D.

In the first letter, the Center submitted comments to CMS on their 2023 Advance Notice for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. Our comments focused on the health equity sections of Potential New Measure Concepts and Methodological Enhancements for Future Years. Our comments are generally supportive and focus on the following areas:

  • Stratified Reporting
  • Health Equity Index
  • Measure of Contracts’ Assessment of Beneficiary Needs
  • Screening and Referral to Services for Social Needs
  • Beneficiary Access and Performance Problems

You can read the full letter here.

The Center at Community Catalyst also submitted comments to CMS on their 2023 Medicare Advantage and Part D proposed rule. Our comments focused on proposed changes that impact individual who are dually eligible for Medicare and Medicaid. The proposed rule seeks to incorporate many elements of the Financial Alignment Initiative into D-SNPs and the broader MA program that have improved experiences for dually eligible individuals. We were generally supportive of the changes that would potentially encourage integrated care for this population. Our comments focused on a number of areas, including:

  • Enrollee Participation in Plan Governance
  • Standardizing Housing, Food Insecurity, and Transportation Questions on Health Risk Assessment
  • Integrated Member Materials

You can read the full letter here.

Speaking Up for Making ARPA Enhanced Tax Credits Permanent

In the March 4 edition of Community Catalyst’s Health Policy Minute, a self-employed Pennsylvania mom, Jessie Green, supported President Biden's call on Congress in his State of the Union address to make the enhanced tax credits in the American Rescue Plan Act permanent. Ms. Green was contacted to share her story by Center Partner Pennsylvania Health Access Network (PHAN).

Ms. Green lives in Lebanon, PA with her husband and son. She and her husband are self-employed, so finding health coverage was difficult before the Affordable Care Act. But even after the ACA came along, Jessie was paying $1,700 a month for her family's coverage. After passage of the American Rescue Plan Act, her premiums were reduced to $0 for the rest of the year

New Application Process to Link MassHealth Enrollees to Supplemental Food Assistance

Center partner Massachusetts Senior Action Council has made it part of their mission to Close the SNAP Gap – the gap between low-income residents receiving MassHealth who are likely also eligible for the federal SNAP (food stamp) program and those who actually receive SNAP. Over 700,000 residents receiving MassHealth are missing out on this key food stamp program, including 100,000 seniors.

For many years the state has administered these food and health programs separately. This means the application process and collection of documents is duplicated for both Masshealth and SNAP which creates more work for the commonwealth and low-income households. As part of their work with the Common App Coalition, comprised of more than 150 organizations across the state committed to reducing hunger and alleviating poverty, they have successfully advocated for Gov. Charlie Baker’s administration to implement a streamlined application process between MassHealth and SNAP benefits. According to this news report, the Baker administration is hopeful that an application change set to take effect this summer will help more MassHealth recipients access food assistance benefits, targeting a gap that has affected hundreds of thousands of Bay Staters.

NOTEWORTHY NEWS & RESOURCES

A Conceptual Model to Advance Health Equity through Transformed Systems for Health

The National Academy of Medicine has introduced a new framework for community engagement that is grounded in the principle of community empowerment. Historically, community engagement and community empowerment have been inaccurately understood as separate concepts. This new framework provides an excellent way forward for stakeholders seeking to meaningfully engage with their communities. Core principles in the model include trust, bidirectional influence and information flow, inclusivity, equitable financing, multi-knowledge, shared governance, and ongoing relationships that continue beyond the project time frame that are authentic and enduring.

Age-Friendly Insights Poll: Direct Care Workers Are Underpaid, Lack Support and Oversight

The John A. Hartford Foundation has released new poll results regarding the direct care workforce and its need for improved support and oversight. The poll found that an overwhelming majority of people (73%) think direct care workers are underpaid and a majority (60%) support more training for direct care workers. It also found that 94% of people believe in the importance of government oversight of nursing homes and home care agencies as a means to help older adults protect older adults. These poll results make a clear case that the public is in favor efforts to improve supports for the direct care workforce.

What We Didn’t Hear During the Senate Hearing on Dual Eligible Beneficiaries

An ATI Advisory blog post provides a recap and analysis of the recent Senate Special Committee on Aging hearing on Medicare-Medicaid integration. While the hearing included powerful testimony from people who are enrolled in Medicare-Medicaid plans, the blog argues the Committee’s discussion did not fully capture some of the core issues dual eligible beneficiaries face. Among these unaddressed issues are the continued misaligned financing of integrated care, the fact Medicaid regulations don’t reach Medicare, and the impacts of excessively high plan choice and passive enrollment on beneficiaries.

Three Reports from CMMI’s Financial Alignment Initiative for Dual Enrollees

The Medicare-Medicaid Coordination Office and the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) created the Medicare-Medicaid Financial Alignment Initiative (FAI) to test, in partnerships with States, integrated care models for Medicare-Medicaid enrollees. CMS has posted three reports from the FAI for Medicare-Medicaid Enrollees. Reports show mixed evaluation findings across Michigan and Ohio. For example, in Michigan and Ohio, the FAI helped to increase access to physicians, resulting in more doctor visits. But, in Ohio the FAI increased the probability of preventable emergency department visits. In Michigan, although there was improved access to HCBS, there was also increased long-stay nursing facility usage. Evaluators reported a favorable integrated appeals and grievances process in New York.

Health Affairs Special Issue: Beyond Research, Taking Action Against Racism

Health Affairs dedicated its entire February issue to racism and health and included this article about how Massachusetts’ largest health system initiated a multi-year, multimillion-dollar effort to take concrete steps toward making their institution anti-racist. The article details the strategies Mass General Brigham is employing to reach its anti-racist aims, including investments in community health work, language access and a review of tools that perpetuate racialized medicine.

Talking About Complex Care: A Guide for Clear and Effective Communications

A new tool from the Center for Health Care Strategies provides guidance on how to clearly and effectively communicate about complex care issues. The resource provides audience-specific messaging and best practices that are helpful to a variety of stakeholders speaking about complex care approaches. As advocacy around complex care approaches grows, it is important to use clear and consistent language. The guide is also summarized in a three-page summary and an infographic.

STATE HIGHLIGHTS

Arkansas

Last month, the Arkansas Department of Human Services announced the availability of $112 million in funding for the Home and Community-Based Services (HCBS) Workforce Stabilization Incentive Program. The program targets HCBS providers serving individuals who are aging, have high mental health needs, or are physically or developmentally disabled. The funding is provided through a combination of state and federal funds from the American Rescue Plan Act.

Michigan

The Medicare-Medicaid Coordination Office released the Second Evaluation Report and Findings at a Glance for the Michigan capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative. Notable findings include:

  • According to the state and Prepaid Inpatient Health Plan (PIHP) representatives, access to behavioral health services and coordination of behavioral and physical health have improved under the demonstration, although the carve-out continues to pose challenges for the health plans and PIHPs.
  • In the first 3 demonstration years, Medicare costs for the eligible population increased and results for service utilization were mixed.
  • Care coordination for nursing facility residents emerged as a challenge during the public health emergency.

New York

The Medicare-Medicaid Coordination Office released the First Brief Evaluation Report for the New York Integrated Appeals and Grievances Demonstration. The goals of this demonstration are to improve beneficiary experience in appealing health plan reduction, termination or denial of Medicare and Medicaid services and to generate administrative streamlining and/or savings for plans, the state and federal agencies. The demonstration program was viewed favorably though it was not without its challenges. The state experienced some implementation challenges as it widened the scope of the integrated process to a group of enrollees that was significantly larger than under the original demonstration in New York under the financial alignment initiative.

Ohio

The Medicare-Medicaid Coordination Office released the Second Evaluation Report and Findings at a Glance for the Ohio capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative. Notable findings:

  • The percentage of members with at least one documented discussion of care goals in their care plan has been consistently high throughout the demonstration.
  • The percentage of MyCare Ohio enrollees who rated their health plan as a 9 or 10 increased from 51% to 66% between 2015 and 2018.
  • Regression analyses of the demonstration impact on Medicare Parts A and B costs, relative to a comparison group, found statistically significant increases during the overall demonstration period.

KEY DATES

Monday, March 14 - Proposal Deadline: Request for Proposals due for The Root Cause Coalition's 2022 National Summit. Please click here for full information about the summit, proposal selection criteria, and link for online proposal submissions.

Wednesday, March 16 (2-3 p.m. Eastern) - Webinar: Talking About Complex Care: Resources for Clear and Effective Messaging, presented by The National Center for Complex Health and Social Needs . Please register for the webinar.

Thursday, March 24 (1-2 p.m. Eastern) - Webinar: Roundtable on the Importance of Independent Primary Care Practices, presented by the Primary Care Collaborative. Please register for the webinar.  


Wednesday, March. 30 (12-1:30 p.m. Eastern) - Webinar: Understanding the Future of COVID-Related Medicare and Medicaid Flexibilities, presented by The Alliance for Health Policy. Please register for the webinar.  

Thursday, March 31 (2-3:30 p.m. Eastern) - Listening Session: Program Integrity, Correct Billing Concerns, Documentation and Data Requirements for NEMT Providers, presented by the Centers for Medicare & Medicaid. Please register for the session.  

Thursday, April 7,  (2-3:30 p.m. Eastern) - Listening Session: Economic Factors and Cost Containment Challenges in NEMT, presented by the Centers for Medicare & Medicaid. Please register for the session.  


Friday, April 15 - Application Deadline: Applications due for the Health & Aging Policy Fellows Program (2022-23). Please click here for an overview of the fellowship, including program tracks, eligibility and selection criteria, and application information.