Health Innovation Highlights: May 31, 2018

Full Edition


Center Staff Co-Author Health Affairs Blog Post on Harms of Medicaid Work Requirements

Since the beginning of the year, the Trump administration has ramped up its attacks on Medicaid, a vital health safety net program for vulnerable Americans. Allowing states to impose work requirements on beneficiaries through state Medicaid waivers has been a centerpiece of this effort. Center Strategic Policy Director Danielle Garrett, Director Ann Hwang, and Clare Pierce-Wrobel, adjunct professor at the George Washington University Milken School of Public Health, co-authored a blog in Health Affairs explaining why work requirements won’t work in Medicaid, and to the contrary, will result in depriving coverage to many lower-income adults, including many within our most high-need populations.

The authors also note how the administration is co-opting the term “social determinants of health” – an idea in good standing among progressive advocates – to advance these harmful measures. They write: “While truly addressing the social determinants of health involves removing barriers that prevent people from making healthy decisions, punitive policies such as work requirements create an environment where people face more barriers to making healthy decisions.” The administration’s cynical argument not only supports a wrong-headed policy, it undermines the necessary work already underway to address social determinants and create a more just and equitable health care system, one that works for all of us.

The Way Forward: Organizing Seniors to Protect Health Care

With the midterm elections looming, health care remains a top issue for voters, and particularly for older adults. In the last two years, we have seen the critical role that senior advocacy played in resisting attacks on the social safety net. Building off an article published in theJournal for Aging and Social Policy, the Center is hosting a June 19 webinar featuring Marcus Escobedo of The John A. Hartford Foundation, Carroll Estes of the University of California/San Francisco and consumer advocates who, respectively, are funding, advocating for and organizing older adults on a variety of health care issues. Attend to learn about where we’ve been, where we are and, most importantly, where we’re going and what’s needed to get there when it comes to advocating on behalf of and organizing this important constituency. More information can be found here.

Center Submits Comments to CMMI on Direct Provider Contracting

On May 25, the Center submitted comments to the Center for Medicare and Medicaid Innovation (CMMI) in response to a Request for Information (RFI) on direct provider contracting models. Direct provider contracting (DPC) arrangements, which are often utilized in a primary care setting, involve providing a certain set of services for a fixed monthly fee. These models aim to improve value and strengthen the patient and provider relationship. With this RFI, CMMI is exploring the possibility of extending DPC arrangements to Medicare fee-for-services and even potentially Medicaid.

In its comments, the Center points out that the lack of details provided in this RFI regarding what the model will actually look like makes it difficult to evaluate potential impacts on beneficiaries. Despite the vague nature of the RFI, the Center provided extensive comments that detail the key consumer protections that must be included in any expansion of the model to Medicare and Medicaid.

Center Partners in Rhode Island Present on Older Adult Topics

Center partner Maureen Maigret, consultant to the Rhode Island Senior Agenda Coalition, joined with RI College faculty toco-author four research articles on issues important to helping older adults remain living in the community. The articles’ topics are: Information and Access Services, Housing, Transportation and Senior Centers. A summary of the research, which was supported by the RI Collaborative, was presented at a forum at the Rhode Island State House attended by state agency staff, legislators and providers.

Maureen Maigret, at left, and Rachel Filinson, PhD, Director of the RI College Gerontology Program.

In other Rhode Island partner news, Geriatric Provider Advocate Martha Watson, MS, APRN, GCNS-BC, presented at the spring session of the Women's Health Council of RI which was focused on older women's health. The event was very well attended with many nurses and physicians participating, including those in geriatrics. Martha’s presentation was on Sensory Awareness and changes in the communication process with aging.

Center Director to Speak on Consumer Engagement Webinar

Center Director Ann Hwang, MD, will be a speaker on the  webinar, Consumer Engagement in Health Care Governance, sponsored by theHealth Care Transformation Task Force on June 20 from 2:30 – 4:00 p.m. EDT. Along with Dr. Hwang, the webinar will also feature Clare Pierce-Wrobel, who will discuss the results of astudy 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.  

PHAN Op-ed in Philadelphia Inquirer Highlights the Work of Housing as Health Coalition

Antoinette Kraus, executive director of Center partner the Pennsylvania Health Access Network (PHAN), recentlyauthored an op-ed in The Philadelphia Inquirer on the connection between health and housing. PHAN is the founding member of the Housing as Health coalition, which brings together a wide range of housing and consumer health advocates to push for affordable housing supportive services through Medicaid, among other issues in the housing sphere. 


Are Health Systems Sacrificing Relationship for Efficiency?

The Health Issue of the New York Times Magazine, published May 20, features a series of articles about the relationship (or lack thereof) between doctors and patients. For instance, author Abraham Verghese writes that electronic health records have had a complicated impact on the provision of health care in the U.S.: on one hand, the technology allows for greater sharing of health information and more precise monitoring of vital statistics; on the other, there has been a marked shift in the focus of providers’ attention away from patient bodies and towards the devices used to monitor them. This shift costs physicians time, and patients care. Similarly, Kim Tingley describes the ways assembly line health systems, designed to create specialization and maximize profit, also tends to result in significant losses in value – and more specifically, meaning – for patients with chronic conditions and for doctors whose own purpose and satisfaction is sacrificed for “efficiency.” Tingley concludes that  purpose and meaning, for both patients and providers, must be identified criteria in the development of quality measures, particularly as health systems move away from fee-for-service payment models and toward value focused care.

Introducing a Behavioral Health Integration Capacity Assessment Tool

The Lewin Group and the Institute for Healthcare Improvement have released the Behavioral Health Integration Capacity Assessment (BHICA) tool designed to help behavioral health provider organizations evaluate their current and future capacity for integrating primary care services into their models. Integration capacity is measured in three approaches:

  • Coordinated care;
  • Co-located care; or
  • In-house primary care.

For the purposes of the assessment, integrated care is defined as, “the care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic health conditions), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization.” The assessment is self-administered and allows behavioral health organizations to break down the process of integration into manageable evaluation areas including:

  • The population served by the organization;
  • The operational and cultural infrastructure of the organization;
  • Matching the population served with appropriate services;
  • The integration approach(es) best suited for the organization; and
  • Financial considerations for the organization pursuing integrated care.

The Costs of Treating Immigrants Unequally

NPR and Side Effects Public Media collaborated on apiece discussing the ways health systems that discriminate against undocumented immigrants contribute to provider burnout. The author focuses on providers who have struggled to treat undocumented patients with kidney failure who cannot access routine dialysis because of discriminatory Medicaid requirements or lack of access to private insurance. In such cases, patients can only receive dialysis treatments in an emergency setting, which carries a risk of death 14 times higher than standard, outpatient dialysis and is significantly less effective at treating disease.

Discrimination against immigrants creates perverse incentives for patients, who may put themselves at greater risk in order to become eligible for emergency services, while straining hospital resources and creating an “emotionally exhausting” environment for providers who are powerless to help. Physicians experiencing high levels of distress because they are unable to provide necessary care may eventually leave their positions, contributing to even more dysfunction in the system. In an effort to prevent these scenarios, several states, including Arizona, New York and Washington, have modified their emergency Medicaid programs to include standard dialysis for undocumented immigrants, which provides system wide benefits—helping patients access the care they need, offering providers a reprieve from participation in mandatory discrimination, stabilizing hospital resources and lowering the costs of state Medicaid programs overall.



The California Department of Health Care Services (DHCS) is completing a systemic assessment of care coordination across the Medi-Cal (Medicaid) delivery system for members enrolled in Medi-Cal managed care. Given the changes that the Medi-Cal managed care program has experienced over the last 10 years (e.g. new populations, benefits, etc.), DHCS plans to assess the full spectrum of care coordination, including screenings, health assessments, case management, care management (provider and plan driven), data, transitions in care, communication, governance, training, monitoring through meaningful metrics and other issues. The purpose of the assessment is to inform an external workgroup and eventual concept paper about how to improve the coordination of all care for members in Medi-Cal managed care. DHCS will convene three workgroups over the summer: (1) Plan, County and Provider Association Meeting (2) Medi-Cal Member Advocate Meeting and (3) Care Coordination Advisory Group. Adialogue question document developed by DHCS provides examples of the type of feedback they will be soliciting from stakeholders in the Plan, County and Provider Association and Medi-Cal Member Advocate meetings.

New Jersey

The New Jersey Department of Human Services, Division of Medical Assistance and Health Services published an updated set of Frequently Asked Questions (FAQs) for providers serving individuals in NJ FamilyCare, the state’s Medicaid managed long-term services and supports program. The updated FAQ is availablehere.


The Pennsylvania Department of Human Services released aQuestions & Answers document for Community HealthChoices (CHC) program. The CHC is the Commonwealth’s managed long-term services and supports program, which has been implemented in the southwest region of the state and is scheduled to be rolled out in the southeast in January 2019, followed by the rest of the state in January 2020. The Q&A document is a product of multiple stakeholder events and previous FAQs put together for both providers and participants.

Rhode Island

The proposal in the state budget to charge Medicaid beneficiaries a co-pay was removed by Rhode Island Governor Gina Raimondo. The prospects of passing this policy in the budget were bleak. Beneficiaries and advocacy organizations, like the Economic Progress Institute, came out strongly against co-pays. The co-pays would have ranged from $2.50 for a generic-drug prescription to $8 for a “non-emergency” visit to an emergency room.


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 (11-12 pm Eastern) - Webinar: Social Determinants of Health among Individuals with Functional Impairments, presented by The Association of University Centers on Disability (AUCD). Please register for the webinar.  
Thursday, June 14 (1:30-3 pm 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 (2:30-4 pm Eastern) - Webinar: Consumer Engagement in Health Care Governance, presented by the Health Care Transformation Task Force. Please register for the webinar.  

Tuesday, June 26 (1-2 pm Eastern) - Webinar: Enhancing Self-Efficacy in Persons Living with Dementia, presented by the American Society on Aging. Please register for the webinar.