Health Innovation Highlights: March 13, 2019

Full Edition

DIRECTOR’S CORNER

Remembering Rob

Rob Restuccia speaking at the Center’s launch event at the National Press Club, Washington, D.C., Jan. 15, 2016.

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

Rob Restuccia was the reason I came to Community Catalyst.

I met Rob when I was working in the Executive Office of Health and Human Services in Massachusetts. In the aftermath of the challenging rollout of our state’s health insurance exchange, Rob was one of a handful of people we turned to as we navigated through that difficult time.

In a room of health care executives and state government leaders, Rob stood out. He seemed to know everyone and be trusted by all parties. He listened more than he spoke, and when he spoke, it was quietly and with purpose – to share vital information from the national scene, to offer connections to others that might be useful, to help navigate a group to consensus.

Here at Community Catalyst, it was Rob’s vision that made the Center possible. He was always encouraging us to look ahead, think about what was around the corner and plan for that future. Even while our organization was fully deployed in the challenging and urgent fight to defend Medicaid and the Affordable Care Act, Rob emphasized the importance of thinking long-term and acting proactively, to craft the positive vision of health care that we know is possible.

Rob did this better than anyone. Starting in 2003, he worked with Robert Master, MD to create what ultimately became Commonwealth Care Alliance, a health plan for people with complex medical, social and behavioral needs. In doing so, he broke new ground for a consumer advocacy organization and also broke with a common mindset among some consumer organizations, which tended to view health systems and health plans as adversaries rather than potential collaborators.

In the op-ed Rob wrote for the The Boston Globe in the last weeks of his life, he identified what he saw as the keys to success. He believed: “…change happens when ordinary people become empowered advocates who can eloquently articulate their stories of hardships and then translate their experiences into compelling arguments for changing the system;” and, “rather than view those in power as adversaries, it is far more effective to see them as partners with advocates and consumers.”

We all miss Rob dearly. But it is my hope that the Center carries on these tenets of Rob’s vision and continues the march toward universal, affordable, equitable, quality health care that was his life’s work.

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Thank you for your kind notes of support during this time. We list below links to some additional stories about Rob's lifetime of work fighting for health justice.

The Boston Globe published this appreciation of Rob’s life on March 5, 2019.

WBUR radio, Boston, CommonHealth Feb. 25, 2019 audio profile and interview with Rob.

A remembrance by Health Affairs Editor-in-Chief, Alan Weil

POLITICO Pulse “Names in the News”

 

FROM THE CENTER & OUR PARTNERS

New Report: Building a Case for Advancing Health Justice

We’re excited to share Community Catalyst’s new report, “Advancing Health Justice: Building a Health System that Works for Everyone,” that makes the case for an agenda to improve the health of all Americans. It recommends building a more diverse health justice movement as an essential step to delivering transformational change; focusing on proactive advocacy and engagement with state and local governments; and strengthening the three-legged stool (coverage, quality, social determinants of health) to support a health system that works for everyone. It then details how Community Catalyst will contribute to advancing this agenda..

Center Staff’s Health Affairs Blog Post on Link Between D-SNP Disenrollment and Plan Quality

A new Health Affairs blog post by Marc Cohen, Ann Hwang and Leena Sharma explores the relationship between annual disenrollment rates and performance on a set of quality measures – the Medicare Star Rating Systems – for plans serving dually eligible consumers. Findings from this study suggest that high disenrollment rates reflect inferior health plan quality, especially on person-centered measures of quality. These findings have troubling implications for the new, increasingly restrictive disenrollment policies faced by Medicare-Medicaid beneficiaries. While the CMS policy on lock-ins is in effect, the authors urge CMS to shore up consumer protections, including ensuring access to unbiased enrollment assistance; expanding access to ombudsmen programs; strengthening beneficiary outreach and engagement; and allowing waivers of the lock-in rules. Ultimately, however, the Center would like to see CMS and states turn away from restrictive disenrollment policies.

...And More Center-Related Blog Posts

Center Project Manager/Senior Policy Analyst Leena Sharma penned a Feb. 19 post for the Institute for Healthcare Improvement’s Better Care Playbook blog summarizing the key findings from the Center’s November 2018 Duals Symposium, as laid out in our publication, “Findings from the Duals Symposium.” Also in February, the National Center for Complex Health and Social Needs posted a blog in which Center Director Ann Hwang shared her perspective on the value of the new series of educational video modules released by the Center in February on “Re-envisioning Care for People With Involved Disabilities.

The Case for Culturally Competent Care for LGBTQ Older Adults

LGBTQ older adults face significant barriers to accessing needed health care services, including outright discrimination and systems ill-equipped to provide culturally competent care. To help aging services providers understand and meet the needs of LGBTQ older adults, the Center has published a new issue brief, authored by staff members at SAGE, that defines terms, provides a case study and offers a vision for culturally competent care for this increasingly diverse community of older adults. The issue brief is the Center’s second collaboration with SAGE, following the 2017 video, "The Main Thing: Respect."

Center Submits Comments on Draft Medicare 2020 Call Letter

The Center submitted comments to CMS regarding the 2020 Advance Notice and Call Letter for Calendar Year 2020 for Medicare Advantage Capitation Rates, Part C and Part D Payment Policies. Our comments focusing primarily on the sections that impact Medicare-Medicaid beneficiaries, including:

  • CMS-HCC Risk Adjustment Model for CY 2020;
  • Frailty Adjustment for PACE Organizations and FIDE SNPs;
  • Star Ratings, Risk Adjustment and Future Measurement Concepts;
  • Medicare-covered Opioid Treatment Program Services Beginning in CY 2020;
  • Special Supplemental Benefits for the Chronically Ill (SSBCI);
  • D-SNP Administrative Alignment Opportunities;
  • D-SNP “Look-alikes”;
  • Parts A and B Cost-sharing for Individuals Enrolled in the QMB Program; and
  • Medicare Advantage Organizations Crossing Claims over to Medicaid Agencies.

NOTEWORTHY NEWS & RESOURCES

SIREN Releases Report On Funding SDoH Programming in Community Health Centers

The Social Interventions Research and Evaluation Network (SIREN) at UCSF has released a new report that highlights the diverse funding sources community health centers use to initiate and sustain programs that target the social determinants of health (SDoH). The report also highlights the looming challenges of each funding strategy and circumstances that strongly limit sustainability. For community health centers, this will spark ideas about how to support new or existing SDoH programs and for policy-makers and advocates, it will shed light on ways to change the system to support community health centers in this work.

CMMI Unveils New Payment Model for Emergency Ambulance Services

The new Emergency Triage, Treat and Transport (ET3) model from the Center for Medicare and Medicaid Innovation (CMMI) for emergency ambulance services will create a new set of incentives for emergency transport and care. This model allows ambulance providers to collaborate with qualified health care practitioners to deliver treatment on-the-scene or through telehealth and with alternative destination sites (such as primary care offices or urgent-care clinics) for Medicare beneficiaries. ET3 will have a five-year performance period, with an anticipated start date in early 2020. CMS hopes this new model will incentivize transporting beneficiaries to lower-cost and more appropriate settings for care than emergency departments.

NASHP Highlights Lessons from Oregon’s Accountable Care Initiative

The National Academy for State Health Policy (NASHP) posted a blog offering lessons learned from the first five years of Oregon’s Coordinated Care Organizations (CCOs). CCOs, established in 2012, are local networks of all types of health care providers — including physical, behavioral, and oral health providers — that the state pays a global capitated rate to provide integrated care to Medicaid beneficiaries. The state is currently accepting bids for organizations that want to serve as CCOs for the next five years — a program known as “CCO 2.0” — which will have increased responsibility for improving health equity, addressing the social determinants of health and meaningfully engaging the community.

AMA Journal of Ethics Offers Lessons for More Ethical Hospital-Community Development Work

As outlined in this overview of the March 6 edition of the AMA Journal of Ethics, a key tension in public health engagement has been how to reconcile public health improvement with local autonomy in decision-making to express respect for community members’ lived experience. This article uses a case study to illustrate how health systems can more ethically engage communities. Lessons include taking an asset-based approach, centering ethical critiques as the focus of collaboration and being aware that the interests of the community and of the hospital may not always align.

ELDERCARE VOICES

Health and Aging Policy Fellows: Training Future Leaders to Address Health Care Needs of Older Americans 

Harold A. Pincus, MD

While Americans are living longer, healthier lives, many of them face mounting health care and other challenges with advancing age. In the light of profound demographic changes, many of the issues confronting older Americans cannot be solved by research and education alone but require large-scale policy changes at the federal, state, local and even global levels. The Health and Aging Policy Fellows (HAPF) Program was established in 2008 to contribute actively to solutions in the policy arena by educating the next generation of health and aging policy ‘change agents.’ The program is funded by The John A. Hartford Foundation, The Atlantic Philanthropies and the West Health Policy Center. In its eleventh year, the Fellowship Program has had 128 Fellows to date, and is accepting applications through April 15 for the 2019-2020 program year.

The year-long fellowship offers an extensive and unique training and enrichment program to create a cadre of leaders with the skills, experience and networks necessary to influence policies and improve the lives of older Americans. The cornerstone of the fellowship is the hands-on experience Fellows obtain through a placement (residential or non-residential) with federal and state agencies and organizations, congressional offices, consumer advocacy groups and think tanks. The Residential Track includes a full-time placement of up to a year while the Non-Residential Track allows Fellows to remain at their home institution, dedicating at least 20 percent of their time to a project related to health policy and aging in collaboration with a government agency or a non-governmental policy organization, including Community Catalyst. The project can have a global, federal, state or community focus. A newly established Behavioral Health Track provides an additional opportunity for both residential and non-residential Fellows to influence policy at the intersection of aging and mental health and substance use disorders.

All Fellows participate in a series of seminars and workshops throughout the fellowship year, including a five-week orientation in Washington, D.C., organized with AcademyHealth, the National Program Office of the HAPF Program, American Political Science Association (APSA), The Centers for Medicare and Medicaid Services (CMS) and the Veterans Health Administration. The program’s reach and the lasting success of our fellows is further expanded through a broad range of strong partnerships (e.g., Veterans Health Administration, CMS, Administration for Community Living, Substance Abuse and Mental Health Services Administration, Health Resources and Services Administration, National Institutes of Health, Centers for Disease Control and Prevention) and many other agencies, Senate and House congressional offices, think tanks and advocacy groups. Throughout the course of the Fellowship, Community Catalyst has been an important partner in terms of mentorship and placement opportunities

Alignment of the Fellows’ interest and ongoing mentoring throughout the fellowship are essential factors for a successful experience. Many of our Fellows and alumni are and have been at the forefront of addressing major policy issues including geriatric work force shortages, elder abuse, integration of mental health care, age discrimination in organ transplantation, value-based care, quality and patient safety, guardianship, end-of-life care, as well as housing, transportation and nutrition policies.

Our 15 2018-19 Health and Aging Policy Fellows are following in the footsteps of their peers, working on a diverse range of aging-related issues at the national, state and community level. Six of our current fellows have placements in Congress (House of Representatives and Senate committees, leadership and member offices) addressing wide-ranging issues, including long-term care benefits under Medicare, rural hospital needs, state Medicaid expansion, Social Security, health information technology, prescription drug pricing and protecting the ACA. One of our Fellows is focusing on policies at the state level while another one will be working with Community Catalyst. Many of our Fellows are working on initiatives in executive branch agencies, including the Administration for Community Living, Substance Abuse and Mental Health Services Administration, Centers for Medicaid/Medicare Services and Agency for Healthcare Research and Quality. Areas of focus at the executive branch level include palliative care, eCare health planning, family caregiving and development of healthy aging resources.

The leaders emerging from the HAPF Program possess the knowledge, experience and skills to positively impact health and aging policymaking and have demonstrated that impact both during and after the Fellowship. Many of our alumni have become actively involved in health policy at national and local levels. Many have assumed leadership roles in health care organizations and policy settings inside and outside of government at local, state and national levels, including serving as congressional staff, becoming spokespersons, publishing key papers on major policy issues, and taking on policy and advocacy roles in professional organizations.

Health and Aging Policy Fellows constitute a network of individuals who, individually and collectively, are poised to help shape policies that address the complex health needs of an aging American society. Recent funding from the West Health Institute has enabled us to establish an Alumni Program to support Fellows in collaborating on critical policy issues and continue to make an impact beyond their fellowship year.

The Health and Aging Policy Fellows Program has recently received funding from The John A. Hartford Foundation for another four years of program support. We invite interested individuals to apply for the 2019-2020 class to continue this legacy of excellence! The deadline for applications is April 15, 2019.

For more information about the Health and Aging Policy Fellows Program, please contact the National Program Office: hapfell@nyspi.columbia.edu or 646-774-5495. 

Harold Alan Pincus, MD, is Professor and Vice Chair of the Department of Psychiatry, Co-Director of the Irving Institute for Clinical and Translational Research at Columbia University and the New York State Psychiatric Institute. Dr. Pincus also serves as a Senior Scientist at the RAND Corporation. Previously, he was Director of the RAND-University of Pittsburgh Health Institute and Executive Vice Chairman of the Department of Psychiatry at the University of Pittsburgh. He is the National Director of the Health and Aging Policy Fellowship, supported by West Health Institute, The John A. Hartford Foundation and Atlantic Philanthropies. Earlier, Dr. Pincus was Deputy Medical Director of the American Psychiatric Association and founding director of APA’s Office of Research, was the Special Assistant to the Director of the National Institute of Mental Health, and served on White House and Congressional staffs as a Robert Wood Johnson Foundation Clinical Scholar. Dr. Pincus has been appointed to the editorial boards of 12 scientific journals and published over 500 scientific publications in health services research, science policy, research career development, quality of care and the diagnosis, classification and treatment of mental disorders. Dr. Pincus was the 2017 recipient of the C. Charles Burlingame Award by the Institute of Living for outstanding contributions to the field of psychiatry and has received the Menninger Award from the American College of Physicians, among other honors. He worked one evening a week for twenty-two years at a public mental health clinic caring for patients with severe mental illnesses.

STATE HIGHLIGHTS

California

Hospitals in California are now required to establish plans for discharging homeless patients and provide resources that might keep them from returning to the street, according to KPBS. For example, hospitals must provide meals and weather-appropriate clothing to homeless patients when needed and offer them transportation to their destination after discharge if it is within 30 miles or 30 minutes of the hospital. Left out of the law is the requirement that housing services also be provided, which has prompted numerous conversations among stakeholders on how to better address homelessness in California communities.

Maryland

CMS and the state of Maryland signed an agreement to implement the Maryland Total Cost of Care Model. This is the first time that CMS will hold a state accountable for total cost of care incurred by resident Medicare fee-for-service beneficiaries, according to JAMA.  This new model, which took effect in January and will go on for eight years, builds on the state’s All-Payer Model providing incentives for hospitals to increase high-value care for patients seeking care from their institutions and their community services by centering improved population health as the foundation for the model to achieve savings.

Massachusetts

The Massachusetts Executive Office of Health and Human Services (EOHHS) issued a Request for Responses (RFR) for plans to participate in the state’s “One Care Dual Demonstration 2.0.” One Care is for Medicare-Medicaid beneficiaries ages 21 through 64 with disabilities. Currently, the program covers medical, behavioral, Long-term Services and Supports (LTSS), community supports, and care management services for over 22,000 people enrolled in two plans in nine counties. Responses are due on May 24, 2019 with an expected start date of Jan. 1, 2021. EOHHS expects to award contracts to three, but no more than five, plans.  

Minnesota

As reported in the HMA Weekly Roundup, the Minnesota Department of Human Services has issued requests for proposals (RFPs) for its Medicaid managed care programs: (1) Families and Children Medical Assistance and MinnesotaCare; (2) Minnesota Senior Health Options and Minnesota Senior Care Plus. The two RFPs were released by the Minnesota Department of Human Services on February 25, 2019, with implementation scheduled to begin on January 1, 2020 for all programs. The HMA article provides an overview of each program, including eligibility and anticipated enrollment.  

New Jersey

The New Jersey Department of Human Services, Division of Medical Assistance and Health Services posted the amended Medicaid managed care organization contract, effective July 2018, to its website. HMA published a description of relevant amendments, which include:

  • Alignment of behavioral health benefits
  • Requirement that MCOs use a community services screening tool for people receiving long-term services and supports

KEY DATES

Thursday, March 14 (1-2 p.m. Eastern) - Webinar: The Role of Medicaid Managed Care Plans in Addressing the Opioid Crisis, presented by Health Management Associates. Please register for the webinar.    

Friday, March 22 (1-2 p.m. Eastern) - Webinar: The Many Ways Community Health Centers Finance Social Care Programs, presented by the Social Innovations Research & Evaluation Network (SIREN). Please register for the webinar.

Friday, March 22 (2-3 p.m. Eastern) - Webinar: Consumer-Focused Health System Transformation: What are the Policy Priorities?, presented by Health Care Value Hub. Please register for the webinar.    

Wednesday, March 27 (12:30-2 p.m. Eastern) - Webinar: Gathering and Using Member Feedback in Plan Governance, presented by The Lewin Group in collaboration with the Center for Consumer Engagement in Health Innovation. Please register for the webinar.