Health Innovation Highlights: May 16, 2018

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DIRECTOR’S CORNER

Engage at Every Age!

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

Older Americans Month celebrates the difference that older adults make in our communities and this year’s theme is “Engage at Every Age.” Working with older adults to improve the quality of care and quality of life is central to the Center’s mission. Older adults bring a powerful and essential voice for improving health care programs and policies, and ensuring better health for all.

Here are some suggestions for ways to honor the month:

  • Learn about ways in which the health care system can and should be “age-friendly,” by focusing on the “4Ms”: what matters to patients, medication, mental activity and mobility. If you’re interested in working with your hospital or doctor’s office to make it more “age-friendly,” please let us know – we’d love to hear from you.

  • Read this article by Center Senior Advisor Carol Regan, Project Manager and Senior Policy Analyst Leena Sharma and Community Catalyst Founder and President Kate Villers on how older adults have organized over the decades to bring about important safety net policies. The article describes the challenges and possibilities today for organizing older adults to advance progressive social policy.

  • Sign up for POLITICO and AARP’s new series, “The Deciders.” This series promises to bring polling, data and journalism to help understand American voters 50 and older and their potential impact on the 2018 midterm elections.

  • Go see the documentary about Supreme Court Justice Ruth Bader Ginsburg (the Notorious R.B.G), who at age 85 is enjoying her newfound role as cultural icon. And, if you dare, give her workout a try.

  • Need a little more motivation? Read my article about how volunteering and engaging in your community can be good for your health.
  • Finally, do you know an older adult who deserves to be recognized for his or her efforts to improve their own health and the health of others? Nominate an older adult for our Speak Up For Better Health Award! 

How are you honoring Older Americans Month (#OAM18)? Tweet us at @CCEHI.

FROM THE CENTER & OUR PARTNERS

Bella and Cassie: Two Older Americans Speaking Up for Better Health

Recently, we had the pleasure of hearing from two people who embody the spirit and power of consumer engagement. Bella Zuzel and Cassie Adams of Pennsylvania have traveled difficult but inspirational journeys from homelessness to becoming powerful health care and housing advocates with the help of Center partner the Pennsylvania Health Access Network (PHAN) and the recently-formed Housing as Health coalition. Bella and Cassie embody the type of consumer engagement and activism we’re looking to celebrate with our Speak Up For Better Health Award. If you know someone who is raising their voice and working to improve their health and the health of their community, consider nominating them for the Award!

Center Director to Speak on Consumer Engagement Webinar

Center Director Ann Hwang, MD, will be part of a webinar panel with the Health Care Transformation Task Force on June 20 from 2:30 – 4:00 p.m. EDT. The webinar is entitled Consumer Engagement in Health Care Governance. 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.   

New Jersey Partners Comment on NEMT

Our partners at the Camden Coalition of Healthcare Providers have submitted comments to the New Jersey Legislature’s Human Services Committee about the long-standing struggles consumers and providers in the state have experienced with the state’s Non-Emergency Medical Transportation (NEMT) broker, LogistiCare. In 2017, after years of advocacy by the Coalition and other consumer advocates in New Jersey, the state developed a new contract for LogistiCare designed to improve the service. While some improvements have materialized, the Coalition reports that many problems remain. The Camden Coalition is part of a Community Catalyst work group of advocates from about a dozen states that seeks to defend and improve NEMT services across the country by sharing information among states, developing policy recommendations and advocating for improved services at both the state and federal level.

Massachusetts Partners to Hold Forum on Consumer Experience in ACOs

Center partner Disability Advocates Advancing our Healthcare Rights (DAAHR) is hosting a public forum on May 31 to hear directly from enrollees in the recently-launched MassHealth Accountable Care Organization (ACO) program. With nearly 100,000 people with disabilities now in ACOs, DAAHR is interested in hearing about these enrollees’ experience thus far. 

NOTEWORTHY NEWS & RESOURCES

Check Out the 2018 Scorecard on State Health System Performance

The Commonwealth Fund released its 2018 state-by-state scorecard measuring health care access, quality, efficiency, outcomes and disparities across all 50 states and the District of Columbia, and comparing states to one another. Key takeaways outlined in the report include:

  • The five highest performing states in order are Hawaii, Massachusetts, Minnesota, Vermont and Utah;
  • Arkansas, Florida, Louisiana, Oklahoma and Mississippi are the bottom ranking states;
  • Several states improved their overall ranking from last year, including New York, which improved on 18 indicators, and Arkansas, Louisiana, Oklahoma and West Virginia, which all improved on 17 indicators;
  • The most pressing challenges for states overall include rising death rates, obesity levels and gaps in care;
  • Disparities in performance exist both regionally and within states;
  • Quality of care is out of sync with spending overall; and
  • Widespread gains have been made in access including improvements in home care and patient mobility and a decline in tobacco use and avoidable hospitalizations.

The scorecard emphasizes the important role investments in public programs, like the ACA’s Medicaid expansion, have had in improving overall outcomes and recommends that states continue to establish innovative stakeholder partnerships to address those measures that are not resolved by coverage alone.

MLTSS Done Right

The National Association of States United for Aging and Disabilities (NASUAD) and the National Association of State Directors of Developmental Disabilities Services (NASDDDS) have released a report describing indicators of success and best practices for Medicaid managed long-term services and supports (MLTSS) for people with intellectual and developmental disabilities (I/DD). CMS has primarily steered states toward models for home and community-based health services for people with I/DD that connect patients with their neighbors and communities. The most effective of these models follows a lifecycle that includes:

  • Goal setting;
  • Program design;
  • State infrastructure alignment;
  • Procurement and contracting;
  • Policies and procedure development; and
  • Quality management and oversight.

The report recommends that each phase in the lifecycle be given adequate time and deliberative planning. Consumer and family engagement also plays a critical role in successful MLTSS models for I/DD populations.

Care Navigators: The Next Frontier iIn Addressing Social Determinants of Health

Systems for Action’s webinar Testing an Integrated Delivery and Financing System for Older Adults with Health and Social Needs is now available online. The webinar provides a deep dive into ongoing research on how a program in Greater Rochester, New York integrates “care navigators” into the health care delivery setting to connect patients with support services for chronic health conditions and to manage social determinants negatively impacting their overall health. While physicians in clinical care settings widely understand the importance of addressing social determinants, few feel they have the time and resources to address them, according to recently released results from a 2017 Leavitt Partners physician survey. Developing integrated delivery research and reforms that identify medical and economic benefits of care navigator programs, as well as the public-private partnerships that can develop in successful models, could be an important step in improving patient outcomes, without overburdening physicians. The Systems for Action research aims to chronicle best practices for the successful implementation of additional care navigator programs, as well as strengthening existing programs through evaluation.

STATE HIGHLIGHTS

California

The California Department of Health Care Services finalized the Duals Plan Letter that provides clarification and guidance about changes to Medi-Cal Non-Emergency Medical Transportation (NEMT) and Non-Medical Transportation (NMT) services. Beneficiaries now have access to NMT rides beyond the 30 rides originally covered. And, Cal MediConnect plans, like Medi-Cal plans, must now ensure that members have unlimited access to NEMT.

In other news, researchers at the University of California, San Francisco and Berkeley, supported by The SCAN Foundation, published a research brief based on their evaluation of the implementation and impact of the Cal-MediConnect (CMC) dual eligible demonstration project on health systems and beneficiaries. This research brief focuses on the implementation of the new CMC care coordination benefit, including the progress made and challenges that remain in coordinating care for dual eligibles. Key findings from the report on the care coordination benefit include:

  • State and federal policies recognize that care coordination is an essential part of integrating care for duals;
  • The CMC care coordination benefit encourages collaboration across health system stakeholders, could improve care transitions across health care settings, and could improve access to HCBS;
  • There is great variation in how CMC plans are organizing and delivering care coordination benefits;
  • The CMC care coordination benefit has impacted California’s health care workforce;
  • Awareness about the CMC care coordination benefit varies among CMC plans, providers and members;
  • Data sharing barriers remain a significant challenge to successful, non-duplicative care coordination efforts.

Maryland

The state of Maryland announced this week the federal approval of a new contract for the state’s unique all-payer health care modelfirstFirst approved in 2014 with a focus on hospitals, the new model will now include community providers such as nursing homes to focus on comprehensive care coordination. It will include hospital and non-hospital settings, including mental health and long-term care. The new model will take effect Jan. 1, 2019 and last through 2023. The contract can be extended for an additional five years, pending a review of the terms. Maryland’s current model already has saved Medicare more than $586 million through 2016, compared to national spending, and the new model is expected to provide an additional $300 million in savings per year by 2023 and a total of $1 billion over five years.

New York

The New York State Health Foundation released two reports addressing progress to date on its “Building Healthy Communities” initiative. The grantees in this initiative are partnering with community-based organizations, government agencies, local businesses, advocacy groups and other stakeholders on a range of neighborhood-based efforts to help New Yorkers lead healthier, more active lives. “Building Healthy Communities: One Funder’s Place-Based Approach to Help Neighborhoods Transform,” explores the start-up and early phase of its work in this area. “One Size Doesn’t Fit All: The Need for Local Approaches to Improve Neighborhood Health” takes an in-depth look at the commonalities and differences of the six communities that are part of this initiative, examining the characteristics of these communities, including demographic, as well as health status and health care utilization attributes. It has a particular focus on the Medicaid population within these communities.

KEY DATES

Thursday, May 24 (3-4 p.m. Eastern) – Webinar: Redefining Care Management in Medicaid Managed Care, presented by Manatt Health. Please register for the webinar.
 
Wednesday, May 30 (1-2 p.m. Eastern) – Webinar: The CHRONIC CARE Act: New Opportunities to Advance Complex Care Through Community-Clinical Partnerships, presented by the American Society on Aging. Please register for the webinar.
 
Thursday, June 7 (1-2 pm Eastern) – Webinar: Partnership Opportunities for Payers, Providers and States: Supportive Housing for High Utilizers, presented by Health Management Associates. 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.  

Wednesday, June 20 (2:30-34pm Eastern) - Webinar: Consumer Engagement in Health Care Governance, presented by the Health Care Transformation Task Force. Please register for the webinar.