Health Innovation Highlights: May 13, 2021

Full Edition

DIRECTOR’S CORNER

Resilience and Strength This Older Americans Month

 Photo Credit: Kristin Chalmers

Renée Markus Hodin
Deputy Director, Center for Consumer Engagement in Health Innovation

Just as our country is beginning to see some light at the end of the pandemic tunnel, we find ourselves in May, Older Americans Month. This year’s theme, Communities of Strength, is particularly fitting, given all that older adults and family caregivers have endured over the last 15 months.

Last Fall, prior to the approval and start of the COVID vaccine rollout, Center staff interviewed several providers, advocates and older adults in order to understand how life had changed for older adults during the pandemic. The interviews reflect what so many of us were seeing and experiencing: loss. Loss of life, loss of social interactions, loss of function. Yet, they also reflected strength: the resilience of older adults and family caregivers in the face of these losses. At a recent symposium on mental health and older adults, activist and author, Ashton Applewhite, confirmed these impressions, sharing, “new studies show that even in the midst of the pandemic, people over 50 were generally mentally better off, more resilient, maybe even happier.”

Where does this strength come from? Appleton went on to quote a researcher who studied the emotional wellbeing of older people during the pandemic: “older people are affected by terrible things, just as younger people are, but they come to that with experience and perspective, and the experience that comes with age allows us to know that bad times will pass.”

I’m seeing this in my own life. My mother-in-law, facing months alone in a remote part of Vermont, launched a “photo project” which not only helped her organize 50-plus years of photographs, but reconnected her to friends and family members who were grateful to receive  personally meaningful photos and memories from her. My father, fully vaccinated, this week overcame his trepidation borne of months in quarantine and took his first airplane flight since the start of the pandemic to attend his granddaughters’ college graduations.  

This Older Americans Month, please share your own story of strength among the older adults in your family, your work and in your community with us on Twitter!

FROM THE CENTER & OUR PARTNERS

New Report on What People with Substance Use Disorders Want from Treatment

In late April, Community Catalyst, Faces & Voices of Recovery and the American Society of Addiction Medicine (ASAM) together released “Peers Speak Out: Priority Outcomes for Substance Use Treatment and Services,” reporting findings of their “Patients Lead” project, the first national study of what outcomes people with substance use disorders want from their treatment. The partnership’s research was guided by a National Peer Council of people with lived experience of substance use disorders and was funded by the Patient-Centered Outcomes Research Institute.

More than 20 million Americans have substance use disorders, and during the COVID-19 pandemic, overdose deaths are increasing and demand for treatment has risen. In a survey conducted for this report, nearly 900 people with substance use disorders from across the country shared what matters most to them. The study found that overall, people prioritized survival and improving their quality of life and placed less priority on completely stopping all drug and alcohol use. As a result of treatment and recovery services, they also want to reduce harmful substance use, improve mental health, be able to meet their basic needs, increase self-confidence, and connect to ongoing services. This critical information from patients provides direction for reshaping research, services and policies to meet patients’ needs and to more effectively address the national epidemic of substance use disorders.

The study also found differences in priority outcomes across race and gender. To achieve these outcomes and address the continuing criminalization of addiction, especially among Black and brown communities, we need to improve cultural effectiveness of services and address systemic racism.

Both the full report and a two-page summary are available here.

Center Weighs in on the Home and Community-Based Services Access Act

Home and community-based services (HCBS) allow older adults and people with disabilities to live and age in their homes and communities rather than in institutions. Unfortunately, however, HCBS is an optional benefit under the Medicaid program. As a result, the HCBS system is woefully underfunded and inconsistent from state to state, leading to crushing emotional, physical and financial responsibilities.

The recently enacted American Rescue Plan Act and the pending American Jobs Plan seek to address the inequities and inadequacies of the HCBS system, but more must be done to build on that progress and guarantee access no matter which state a person lives in. The Home and Community Based Services Access Act (HAA) is draft legislation designed to do just that, by making HCBS a required Medicaid benefit for all who are eligible to receive it, thereby eliminating current waitlists. The Center recently weighed in with the drafters of the HAA – Sens. Brown, Casey and Hassan and Rep. Dingell. Alice Dembner, the senior policy analyst for Long-Term Services and Supports, contributed comments for the Disability and Aging Collaborative and Rachelle Brill, senior policy analyst submitted comments from the Center.

Maryland Legislation a Victory for Promoting Community-Level Health Equity Initiatives

A new grant program passed in the Maryland Legislature, and supported by Center partner Maryland Citizens Health Initiative, will fund grants in neighborhoods that have suffered from health disparities and poor health outcomes. This bill allocates $59 million in funding over the next five years for organizations in qualifying “Health Equity Resource Communities” that can demonstrate their program will reduce health disparities, improve outcomes, improve access to primary care, prevent illness, or reduce hospital use. Vincent DeMarco, president of the Maryland Citizens Health Initiative, was quoted in a Maryland Matters article and submitted a letter to the same news site after the legislation’s passage.

MCO Learning Hub Releases First-Year Findings and Resources

Center Partner, the NORC Medicaid Managed Care Organization (MCO) Learning Hub, released key findings and recommendations from its first year of work to advance health equity and reduce the racial and ethnic disparities of Medicaid members. These key findings and recommendations highlight takeaways from the three central focus areas of the project (social determinants of health, behavioral health and member engagement) as well as other timely topics, such as how MCOs responded to the COVID-19 pandemic, MCO investments in affordable housing and MCO health equity efforts. Throughout the document, the Hub identifies recommendations for MCOs, foundations, states and others.

In addition, the Hub released a batch of new materials including:

Center Staff Member Quoted in NBC News Story on Rising Medical Debt During the Pandemic

Mark Rukavina, director of the Community Benefit and Economic Sustainability Project, was quoted in an April 23 story by NBC News, on the disturbing spike in medical debt brought about by the economic stresses of the pandemic. He emphasized that the Biden administration has pushed the needle by encouraging the expansion of health care coverage and providing other consumer protections in the wake of the pandemic through the American Rescue Plan, but said there is still work to be done to mitigate the effects medical debt can have on people's lives.

Medical debt spiked during the pandemic as an estimated 7.7 million workers lost employer sponsored health insurance. There have been legislative efforts at the state level and from Congress with a bill to suspend debt collections and accrued interested during the pandemic as well as a bill to limit effects of medical debt on people's credit.

Sens. Van Hollen, Merkley and Brown introduced a bill focused just on the debt incurred during the pandemic. The bill would in essence suspend the collection of past due debt and the interest accrued on it from Feb. 1, 2020, until the end of the public health emergency. It would affect all health care providers who have accepted or applied for federal relief during that time. Similarly, Rep. Porter introduced a bill in February to limit the effects of medical debt on people's credit.

NOTEWORTHY NEWS & RESOURCES

Exploring Consumer Engagement Experiences of People Requiring Complex Care

The Camden Coalition of Healthcare Providers released a report highlighting the experiences of complex care consumers in their National Consumer Scholars program. The report details major themes from a survey of complex care consumers and project staff, including ways to strengthen consumer engagement and address common barriers to participation. The findings provide insight and guidance for how complex care organizations and others can build authentic and meaningful relationships with consumer stakeholders.

The Vulnerable Homebound Being Left Behind on Vaccination

Despite early COVID-19 vaccine eligibility for vulnerable older adults and people with disabilities, the vast majority of homebound people have not been vaccinated. An article in Kaiser Health News underscores the importance of ensuring this population is vaccinated, describes efforts made by public health agencies to address this problem and outlines the barriers to vaccination faced by the estimated 4 million Americans who are homebound by age, disability or frailty.

CHCS Tool on Strategies to Address Health-Related Social Needs

State Medicaid agencies are increasingly pursuing opportunities to address health-related social needs (HRSN) – e.g., food insecurity, housing instability, and lack of transportation – to improve health outcomes, reduce health care spending, and advance health equity. The Center for Health Care Strategies produced a tool that can guide state Medicaid agencies in developing a cohesive strategy to address HRSN supported by Medicaid managed care and value-based payment initiatives. This can not only help states achieve high-priority Medicaid goals, but can support broader state goals to improve community-level social determinants of health.

Pandemic-Driven Disruptions in Oral Health: 10 Transformative Trends in Care for Older Adults

The COVID-19 pandemic has had a severe impact on nursing homes and other long-term care facilities, with one of the many side effects being a disruption in the attention paid to oral health. A recent publication by The Gerontological Society of America (GSA) recaps two recent webinars on Geriatric Oral Health and COVID-19 and discusses ten born-of-necessity innovations that have the potential to achieve long-term positive changes. The publication concludes with five recommendations for improving oral health care for older adults during the COVID-19 pandemic.

STATE HIGHLIGHTS

Georgia

The Georgia Department of Community Health (DCH) released last month a request for proposals for potential vendors to provide non-emergency medical transportation to Medicaid beneficiaries in five regions across the state. DCH will award a contract to one provider for each of the five regions, with no more than three regions per provider. Proposals are due June 3.

Maryland

The Maryland Legislature passed a bill that would protect some residents from medical debt following a study from the state’s Health Service Cost Review Commission, which found that at least 60 percent of unpaid debt at hospitals belongs to low-income patients who should have qualified for free care. The bill is currently awaiting a decision from the governor’s office.

The bill would help those who are low-income, defined as 200 percent or less of the federal poverty level. It will extend the timeline to apply for free/reduced care to up to 240 days after receiving care, requires patients sign a form stating they have been informed of reduced cost care, prohibits an agency from filing to collect for 180 days after billing, ensures payment plans don't exceed more than 5 percent of the person's income, and prohibits liens on homes, garnishment of wages, or making arrests for nonpayment. Advocates were disappointed that the provision prohibiting hospitals from suing for low sums (under $1000) was removed. Lawmakers were also disappointed that the state's health service cost review commission will create guidelines on interest rates rather than implementing caps.

Minnesota

KSTP reports that the Minnesota governor’s office announced the publication of vaccination data by race and ethnicity, made possible through a partnership between the state and the Minnesota Electronic Health Record Consortium. The data will inform additional targeted strategies to ensure equitable distribution of vaccine to Minnesotans disproportionately impacted by COVID-19 because of systemic inequities.

New Mexico

KRWG reports that New Mexico’s governor signed the Patients’ Debt Collection Protection Act into law. This law will require hospitals and other health care facilities to screen uninsured patients for public insurance and other financial assistance programs. In addition, the law protects patients whose household income is at or below 200 percent of the federal poverty level from debt collectors or being sued by health care facilities for unpaid medical bills.

KEY DATES

Tuesday, May 18 (1-2 p.m. Eastern) - Vaccine Equity Bright Spot Briefing: Increasing Access and Readiness in Latinx Communities, presented by Health Leads. Please register for the webinar.

Wednesday, May 19 (3-4 p.m. Eastern) - Webinar: Post-COVID Strategies for Building Trauma-Informed Behavioral Health Systems, presented by Health Management Associates. Please register for the webinar.

Tuesday, May 25 (2-5:30 p.m. Eastern) - Financing that Rewards Better Health and Well-Being Workshop Series: Envisioning an Integrated Healthcare Delivery and Financing System, presented by the National Academy of Medicine. Please register for the webinar.

Thursday, May 27 (4-5 p.m. Eastern) - Webinar: Working with Older Adults with Dementia: Person Centered Care Communication Strategies, presented by Collaborative Action Team training for Community Health Older adult Network (CATCH-ON). Please register for the webinar.

Friday, May 28 (1-4:30 p.m. Eastern) - Financing that Rewards Better Health and Well-Being Workshop Series: Levers Underscored During the COVID-19 Pandemic, presented by the National Academy of Medicine. Please register for the webinar.

Wednesday, June 2 (2-5:30 p.m. Eastern) - Financing that Rewards Better Health and Well-Being Workshop Series: Roadmap for Integrated Payment Approaches to Efficiency, Effectiveness, and Equity, presented by the National Academy of Medicine. Please regis­­­­­­­­ter for the webinar.