« Health Innovation Highlights: May 12, 2022 Issue

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DIRECTOR’S CORNER

Reflections During Older Americans Month

 

Brandon G. Wilson, DrPH, MHA,
Director, Center for Consumer Engagement in Health Innovation

From the Post-War Generation to Generation X, from Selma to Stonewall, Women’s Rights and Disability Rights, Civil Rights to the enactment of Medicare and Medicaid – this month we pay tribute to all older Americans and their contributions to pressing our nation towards its north star. Along with our national, state and local partners, every year we lift up the many contributions that older adults make to our nation and society. They volunteer, provide childcare, educate, continue to strengthen the workforce, and constantly outpour love and wisdom.

This is why we join hands with the Administration for Community Living by observing Older Americans Month. Befittingly, this year’s theme is Age My Way.

Age My Way allows us to consider the diversity of older Americans, the individual and collective actions we all can take to ensure that they can participate and remain in our lives and communities. May I share just a few of the many resources that we’ve developed to achieve this aim:

  • The Center at Community Catalyst continues to bring the voice of communities into health systems decision-making, particularly for vulnerable and underserved populations, which includes older adults. For this reason, we recently applauded efforts of the Biden/Harris administration for breaking down silos with a federal investment in housing and supportive services – Housing and Services Resource Center – between HHS and HUD, two agencies that both serve older Americans. Correspondingly, with generous support from Arnold Ventures, and in partnership with the Leading Age LTSS Center @UMass Boston, we embarked on research to understand the barriers to successfully link affordable housing and health care and to chart potential solutions. Through focus groups with low-income older adults and stakeholder interviews, our research surfaced five key building blocks for success and a three-pronged strategy for advancing the role of affordable housing as hubs for addressing the health and social needs of low-income older adults.
  • With our partners at the LeadingAge LTSS Center @UMass Boston and with support from The SCAN Foundation, we explored the state of person-centered care for older adults and found that one-third of people 50 and older report rarely or never having their care preferences considered by their clinicians, with more people of color and lower-income individuals saying that is their experience.
  • We also partnered with Rush University Medical Center’s Geriatric Workforce Enhancement Program (GWEP), CATCH-ON (Collaborative Action Team training for Community Health – Older Adult Network), to co-develop a suite of person-centered age-friendly “4M” materials, with older adults and family caregivers.

We also continue to collaborate with our partners, because we recognize that our work is not complete. LGBTQ older adults continue to face discrimination due to their sexual orientation and gender identity. We can collectively commit to continuing to advance equity and expand inclusion in elder care networks.

There is greater recognition that persons living with HIV/AIDS are now aging and this is associated with further health complications. The Centers for Medicare and Medicaid Services (Medicare) should update HIV/STD screening coverage from once annually to once quarterly. This would align with CDC’s Preexposure Prophylaxis for the Treatment of HIV guidelines and allow more older adults to benefit from effective biomedical prevention intervention and continue to enjoy sexual health and wellness.

In addition, evidence is now mounting that long-term COVID-19 poses serious challenges for older adults and emerging evidence suggests there are racial/ethnic disparities in the incidence of Long COVID. And, while we applaud the Biden/Harris administration for a whole-of government approach to addressing Long COVID, our evolving understanding of its impacts underscores the need for greater federal investments into home and community-based services (HCBS) so that all Americans can remain in their communities with dignity. Research also notes racial/ethnic disparities in HCBS utilization. We can and we must do better by co-developing solutions with those most impacted.

Just as older Americans dared to dream by bringing humankind to the cosmos, we can dare to develop person-centered policies that would allow them to age in place.

May we remain faithful and untiring in service.

FROM THE CENTER & OUR PARTNERS

Matching Patients to Primary Care to Drive Better Health

When patients are matched to a primary care practice or individual, preventive and pro-active care, care coordination and trusted relationships are possible. Matching patients to an individual or team is also necessary in value-based payment models. In an April 26 webinar presented by the Primary Care Collaborative, "Matching Patients to Primary Care to Drive Better Health," an expert panel, including Center director Brandon Wilson, discussed proven strategies for increasing patient matching to primary care practices and how purchasers and payers can increase the share of enrollees with a usual source of care.

Center Director Featured on NLIHC Podcast on Housing and Health Care Intersectionality

Center Director Brandon Wilson was the featured guest on an early May episode of “The Home Front” podcast from the National Low Income Housing Coalition, discussing the intersectionality of housing and health care.

Connected to this topic, a resource from the Better Care Playbook is complementary to the Center's work to provide recommendations on integrating housing and health, particularly for older adults and those with disabilities. Complex care stakeholders can use this Better Care Playbook Collection to explore evidence, tools and case studies related to housing programs. Interventions highlighted include permanent supportive housing, medical respite care, affordable housing development, and other housing support services designed to improve the health of people experiencing homelessness and other populations with complex health needs with unstable housing.

Too Healthy for the Hospital, Too Sick for the Streets is a recent podcast episode from the national health policy podcast Tradeoffs. The episode explores what goes on in medical respite facilities, the help it offers, the evidence behind it, what is fueling its recent growth and what barriers remain in its way.

Webinar Recording Available: Health Equity Impacts of Hospital Consolidation

On April 21, Center Director Brandon Wilson and Senior Director of Equity and Engagement at Community Catalyst Stacey Wright co-facilitated a webinar conversation on what can be done to protect access to care for medically-underserved people and promote health equity through government oversight of health industry consolidations. Also presenting on the webinar, “Addressing the Impact of Hospital Consolidation through Health Equity Assessment,” was Lois Uttley, senior advisor for the Hospital Equity and Accountability Project at Community Catalyst. Speakers discussed the strategies recently used to secure the enactment of new laws in New York and Oregon aimed at ensuring health equity is a consideration when state regulators are reviewing proposed consolidations. Facilitator and speaker bios are here.

Decades of market-driven hospital consolidation have seen health systems abandoning urban communities of color and rural areas while shifting resources into facilities in middle-class white suburban areas and expanding academic medical centers to provide highly-reimbursed services. The people most affected by hospital downsizing and closings or relocation of services have been Black, Latinx, Indigenous and other people of color, as well as those who are uninsured, immigrants, women, LGBTQ+ people, people with disabilities, vulnerable older adults and rural residents.

Comment Letter and Blog Roundup

The Center, in collaboration with U.S. PIRG, submitted a No Surprises Act (NSA) recommendation letter to HHS Sec. Xavier Becerra, Treasury Sec. Janet Yellen, Labor Sec. Martin Walsh and CMS Administrator Chiquita Brooks-LaSure. The act is designed to strengthen patient protections and the letter provided recommendations in five areas of concern.  

Additionally, the Center, in partnership with the State & Community Health Advocacy Program and the Hospital Equity and Accountability Project at Community Catalyst, submitted this letter to U.S. Federal Trade Commission (FTC), which urges the agency to use a health equity access framework when considering hospital and health system consolidation. The issue is discussed in this May 2 blog post by Community Catalyst Senior Advisor for the Hospital Equity and Accountability Project Lois Uttley and Senior Policy Analyst for the Community Benefit & Economic Stability Program Quynh Chi Nguyen.

Two other blog posts in late April by Center staff members delved into aspects of the crisis in medical debt in the United States, focusing on the widely disproportionate impact of such debt on communities of color: “A CFPB Report Sounds the Alarm on the Volume and Inequities of Medical Debt,” by Program Associate Sheila Philips, and “Medical Debt Implications in Native American Communities,” by State Advocacy Manager Jenny Chiang. 

NOTEWORTHY NEWS & RESOURCES

PHI Report Lays Out Strategies for Strengthening the Direct Care Workforce

Recognizing the urgency of the crisis in direct care, states are taking action – collaborating with diverse stakeholders to tackle entrenched workforce challenges in bold, innovative ways. To leverage this historic moment, PHI has compiled 24 specific policy strategies – with concrete examples – for improving direct care job quality and stabilizing the workforce in the new report, “State Policy Strategies for Strengthening the Direct Care Workforce.” The report highlights how state leaders around the country are taking action to tackle entrenched workforce challenges in direct care.

What Will the End of the Public Health Emergency Mean For Dually Eligible Individuals?

This Health Affairs article discusses how states can prepare for the end of the COVID-19 public health emergency (PHE), discussing policy and operational decisions that promote continuity of coverage for dually eligible individuals, as they could be disproportionately harmed by unnecessary disruptions in Medicaid coverage.

In response to the PHE, states have used a variety of federal policy flexibilities to stabilize their health care systems and maintain continuity of coverage for people. To comply with the Families First Coronavirus Response Act’s “continuous coverage” requirement and receive a temporary increase of 6.2 percentage points in their federal medical assistance percentage, states have had to maintain continuous Medicaid enrollment for nearly all program enrollees. This requirement has been largely responsible for a 20 percent increase in Medicaid and CHIP enrollment between February 2020 and September 2021.

Alliance for Health Policy Series on the Future of Medicare

The Future of Medicare Series from the Alliance for Health Policy focuses on Medicare sustainability/solvency, consumer affordability, understanding the Medicare population and enrollment trends. Center Director Brandon Wilson recently moderated Part II of the series, Understanding the Medicare Population and Consumer Affordability.

More COVID-19 Fallout: Social Isolation Associated with Poor Health and Emotional Distress

A Commonwealth Fund blog post examines the growing body of data confirming the severe impacts of social distancing and other interventions in response to the COVID-19 pandemic that cut many people off from their emotional and social support systems. For older adults, this may have exacerbated feelings of isolation; the percentage of those who reported feeling isolated jumped from 27 percent in 2018 to 56 percent after the start of the pandemic. This is particularly concerning for older adults with high health care needs — that is, people with multiple chronic conditions or functional limitations who require assistance with daily activities. Feelings of isolation not only create emotional distress but also have the potential to further exacerbate their already complicated health problems and even contribute to early mortality.

Policy Roadmap for Advancing Medicare-Medicaid Integration through Medicaid Programs

In partnership with Arnold Ventures, ATI Advisory evaluates Medicaid regulations and catalogues opportunities to promote Medicare integration in Medicaid program approvals in this policy roadmap. This resource identifies these opportunities for the Center for Medicaid and CHIP Services (CMCS) to consider to increase the Medicaid program’s integration with Medicare across two unexplored pathways: managed care programs and underlying HCBS approvals.

STATE HIGHLIGHTS

Nebraska

On April 28, the Nebraska Department of Health and Human Services (DHHS) announced the formation of a Medical Care Advisory Committee (MCAC). The MCAC will consist of beneficiaries, advocates and providers who will advise DHHS on issues related to Nebraska’s Medicaid program. Membership will consist of 17 voting members, nine of which are required to be either beneficiaries or advocates.  DHHS is currently seeking applicants via their MCAC website.

North Carolina

A study published on April 1 revealed alarming disparities in access to intellectual and developmental disability (I/DD) waivers in North Carolina. Inequities exist by race, ethnicity, age, gender and geographic location. The team of researchers from Duke University who completed the study, led by Michelle Franklin, call for additional resources and investigation to understand practical, cultural, and systemic barriers to access and to explore this issue on a national level.

Minnesota

On April 8, Minnesota submitted an amendment request to CMS for its section 1115 waiver demonstration - Minnesota Reform 2020.  The personal care amendment seeks to replace Minnesota’s Personal Care Assistance (PCA) program by phasing in its Community First Services and Supports (CFSS) program statewide over time. CFSS covers the same services as the PCA program, but seeks to add additional flexibilities and options for self-determination. Federal public comment is open until May 25.

KEY DATES

Monday, May 16 (time TBD) - Virtual Symposium: 5th Annual Older Adult Mental Health Awareness Day Symposium, presented by the National Council on Aging. Please register for the symposium.  

Tuesday, May 17 (2-3:30 p.m. Eastern) - Virtual Briefing: Fulfilling the Promise of the CHRONIC Care Act: The Future of New Supplemental Benefits in Medicare Advantage, presented by The National Center for Complex Health and Social Needs. Please register for the briefing.


Tuesday, May 24 (2-3 p.m. Eastern) - Webinar: Accountable Care Organizations (ACOs): What the Research Tells Us, presented by the Primary Care Collaborative. Please register for the webinar.