Health Innovation Highlights: May 8, 2019

Full Edition

DIRECTOR’S CORNER

Welcome to the May edition of Health Innovation Highlights!

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

We have lots of news to share this month about person-centered care advocacy for people with complex health and social needs. We ended April with a bittersweet celebration of the life and legacy of Rob Restuccia, the founding executive director of Community Catalyst, that was attended by almost 800 people. Community Catalyst co-hosted the evening with our partners at Health Care for All, Massachusetts, and together we released a video that tells the story of Rob’s role in the birth and ongoing effectiveness of both organizations. The video features comments from many Center friends, including Vinny DeMarco of Maryland Citizens’ Health Initiative and Elena Hung of Little Lobbyists. It was wonderful that so many friends and colleagues were with us at the event, in person and in spirit.

We released a new report authored by Project Manager for State Advocacy Andi Mullin, called “IMPACT!,” about the ways in which consumer engagement has improved health care programs and policies. The report shows how advocates in Alabama, Maryland, Massachusetts, Pennsylvania, Rhode Island and Tennessee have improved beneficiary communications, processes for consumer engagement and health care policies. They’ve addressed everything from challenges related to an enrollment broker, making advisory committee meetings more accessible and welcoming to consumers, and improving transportation services.

We are also thrilled to announce a new program, Consumer Voices for Innovation 2.0. “CVI 2.0” supports advocacy organizations in seven states (Alabama, Colorado, Georgia, Maine, Massachusetts, New York and Pennsylvania) working to build an engaged base of consumers to advocate for policies and programs that expand how the health care sector addresses the social and economic drivers of health, specifically housing security, food security and transportation. This program connects grassroots organizing and consumer leadership development to achieving policy and program change. With this program, we aim to identify and support the development of over 125 new consumer leaders over two years. This program builds upon our highly successful original CVI program, which reached tens of thousands of individuals with complex health and social needs and engaged them to build opportunities for meaningful consumer engagement in delivery reform initiatives. 

CVI 2.0 is part of our strategy for achieving ambitious policy goals for 2019 and 2020, related to consumer engagement and social determinants of health. Thanks to our Strategic Policy Manager, Danielle Garrett, we’ve developed our policy priorities for 2019-2020, which emphasize consumer engagement, social determinants of health, better care for individuals who are dually eligible for Medicare and Medicaid, primary care and long-term care. We welcome your feedback on our goals, as well as opportunities to partner with you.

Finally, in honor of Older Americans Month, this month’s Eldercare Voices column features Byllye Avery, who partners with Community Catalyst’s Women’s Health Program to coordinate the Raising Women’s Voices national initiative, and is founder of the Black Women's Health Imperative (formerly National Black Women's Health Project). Ms. Avery discusses the health-related challenges facing older Black women in the U.S. and what it will take to make progress in addressing them. We were honored to host Ms. Avery recently in our Boston offices, where she shared her decades of insight on how to most effectively form meaningful partnerships for action with organizations of, and led by, people of color.

FROM THE CENTER & OUR PARTNERS

New Report: IMPACT! How Consumers Have Shaped the Health System

Our new report, “IMPACT! How Consumers Have Shaped Health System Delivery Reform,” shows the kind of impact that engaged, empowered consumers can have when their voices are kept front and center. The report includes examples from Alabama, Maryland, Massachusetts, Pennsylvania, Rhode Island and Tennessee.

As the health care system changes, consumers have a critical role to play in making sure that consumer needs are front and center. But the kind of consumer engagement that results in real change remains much more the exception than the rule. In particular, consumers with complex health and social needs face barriers to influencing the policies and programs that serve them. Over the last several years, the Center has partnered with state and local advocacy organizations around the country to address these exact challenges. In collaboration with these partners, we are learning how to identify, organize and support consumers with complex health and social needs so they can have a substantive impact on health policy. “IMPACT!” details just some of the successes from this work.

Center Launches Consumer Voices for Innovation 2.0 Program

The Center is excited to launch its Consumer Voices for Innovation 2.0 Program (CVI 2.0) that builds upon our highly successful original CVI program, which supported advocates in five states to use grassroots organizing strategies to build opportunities for meaningful consumer engagement in delivery reform initiatives. CVI 2.0 supports advocacy organizations in seven states to build an engaged base of consumers to advocate for policies and programs that expand how the health care sector addresses the social and economic drivers of health. Funded projects focus on one (or more) of three social determinants; housing security, food security and transportation.

All grantees will focus on organizing consumers with complex health and social needs in low-income communities, communities of color, among older adults and/or among people with disabilities. The program will run until April 30, 2021 and will ultimately provide approximately $1.4 million in funding and create over 125 new consumer leaders. We are proud to partner with the following organizations:

Alabama Arise

Together Colorado

Georgians for a Healthy Future

Maine People’s Resource Center (MPRC)

Massachusetts Senior Action Council (MSAC)

Make the Road New York (MRNY)

Pennsylvania Health Access Network (PHAN)

Center’s Policy Priorities for 2019-2020 Promote Better Health for Complex Populations

The Center has released its “Framework for Better Health for Complex Populations, 2019-2020” that focuses on five key policy areas in order to achieve the goals of maintaining a strong foundation of health coverage and access, promoting person- and community-centered models of care that will lead to better and more equitable health outcomes, and ensuring consumers and community voices are part of the discussion at all levels. Over the next two years ,these priorities will guide our advocacy for legislative and regulatory change, provide funding and technical assistance to state advocates, and conduct research and promote best practices. For each of the five priorities, the Framework document lays out steps we will be taking at both the state and federal levels. The five priorities are:

  1. Advance Policies that Enable the Health System to Better Address Patients’ and Communities’ Social Needs
  2. Incorporate Robust Consumer Engagement Into Payment and Delivery Reform Initiatives
  3. Improve Coverage and Care for Beneficiaries Who are Dually Eligible for Medicare and Medicaid
  4. Develop Sustainable Mechanisms for Financing Long-Term Care Services
  5. Promote Primary Care as the Centerpiece of a High Quality, Affordable Health System

Center Director Ann Hwang’s Blog Post on Better Care Playbook Puts Focus on Person-Centered Care

The Better Care Playbook has posted a blog from Center Director Ann Hwang framing the Center’s video series that explores the ways traditional medical systems fail people with involved disabilities, and how the values of the Independent Living model and home-based primary care can create real, meaningful improvements in quality of life. In the blog post, Ann briefly describes each of the four modules:

  • “Shifting the Paradigm” introduces learners to the barriers faced by people with involved disabilities in accessing primary care in traditional settings.
  • “Creating Culture Change” discusses the differences in the values implicit in a traditional medical model compared to an independent living model.
  • “Redesigning Primary Care” provides insights into how to design an interdisciplinary team, facilitate communication, and support clinicians.
  • “Primary Care is a Service, Not a Building” discusses the benefits of home-based primary care.

Are the Duals Demonstrations Working? A New Post from The Commonwealth Fund Weighs In

In a recent post in The Commonwealth Fund’s “To the Point” blog, Center partner Laura Keohane of Vanderbilt University analyzes the early findings from CMS’s Financial Alignment Demonstrations targeting dual eligibles. Since 2011, CMS has been working with 13 states to combine Medicare and Medicaid benefits into streamlined managed care plans that improve outcomes for patients while bringing down costs. Keohane outlines four initial takeaways from the evaluations of these demonstrations:

  • More beneficiaries opted out or disenrolled in the demonstrations than states had expected, but those stayed in the program reported higher levels of satisfaction than in previous plans
  • The benefits of care coordination are difficult to measure and directly link to improved outcomes
  • Medicare beneficiary hospitalizations decreased during the evaluation period across the board, including for those in the demonstrations
  • More time is needed to determine the benefits (if there are any) for beneficiaries utilizing long-term services and supports

The Maryland Faith Health Network Expands Partnership with Hospitals to Link Patients to Community Resources

Our partners at the Maryland Health Care for All Coalition, who lead the Maryland Faith Health Network, recently announced an innovative partnership with local hospitals to reduce readmission rates and connect patients to community services. During a 2015-2017 pilot program, the Faith Health Network reduced the 30-day readmission rates among members by 70 percent, primarily by providing pastoral care and visitation by faith community members, meals and transportation. In the next phase of this partnership, six area hospitals will work with the Faith Health Network to link patients with faith leaders and support systems to improve wrap-around services.

NOTEWORTHY NEWS & RESOURCES

CMS Announces New Opportunities to Integrate Care for Dually Eligible Individuals

In late April, CMS announced three new opportunities to test integrated care models for individuals dually eligible for Medicare and Medicaid. The three approaches discussed in the letter include the Capitated Financial Alignment Model, the Managed Fee-for-Service Model and the State-Specific Model. This new announcement is meant to complement the letter sent to State Medicaid Directors in December 2018 outlining ten opportunities to improve care for dually eligible individuals.

New Report Argues that Engagement with Community-Based Organizations is Key to Achieving Health Equity for Medicaid Populations

A new issue brief from AcademyHealth, in partnership with Health Management Associates and the Disability Policy Consortium, showcases the vital role that community-based organizations (CBOs) can play in advancing health equity and wellness for individuals and communities in Medicaid payment and care delivery system reform. Five key lessons from CBOs in New York City and the reactions to those lessons from CBOs in Massachusetts are highlighted. These lessons provide a compelling case to elevate the role of CBOs in delivery system reform.

Rush University's Geriatric Workforce Enhancement Program Releases Video on Basics of the Age-Friendly Health System Movement

Rush University's Geriatric Workforce Enhancement Program (GWEP) has released the first video in a series exploring the basics of Age-Friendly Health Systems. This video introduces the "4Ms" of Age-Friendly Health Systems (what matters, medication, mentation and mobility) and discusses how older adults can receive quality care based on what matters to them. The video is part of the Age-Friendly Health Systems initiative, which is led by The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States.

Lown Institute Report Documents Steep Rise in Adverse Affects from Overprescribing to Older Adults

A report released in April by the Lown Institute documents a steep rise in the number of medications taken by older adults and a parallel rise in serious adverse drug events that can lead to loss of mobility, falls, hospitalizations and, in some cases, death. More than four in ten older adults take five or more prescription medications a day, an increase of 300 percent over the past two decades and 750 older people living in the United States are hospitalized every day due to serious side effects from one or more medications.

ELDERCARE VOICES

Marking Older Americans Month: A Conversation With Byllye Avery on the Health Challenges Older Black Women Face

Byllye Y. Avery, interviewed by Lois Uttley

May is Older Americans Month, a perfect time to better understand some of the health-related challenges facing older Black women in the United States. Who better to talk with about this than Byllye Avery, who in 1983 founded what is now the Black Women’s Health Imperative, the only national organization dedicated solely to improving the health and well-being of the nation’s 21 million Black women and girls. Lois Uttley, director of Community Catalyst’s Women’s Health Program, did just that, interviewing Ms. Avery for this column.

Ms. Avery, who is now 81 years old, draws on a lifetime of experiences to describe the systemic health challenges facing older Black women. A major problem, she says, is cardiovascular disease, “largely due to the stresses that Black women face” throughout their lives from racism, sexism and other social determinants of health. “Black women get it from everyone on all sides.”

Diabetes is another major health issue, she says, noting that too many Black women, including those who are older, are obese. “When I come home from that job that is killing me, food becomes medicine,” she explains. “We self-medicate with food.” The Black Women’s Health Imperative has strong programs addressing diabetes for this reason.

Another stressor occurs when Black families are struck by opioid addiction, Avery said, and a lot of the impact falls on grandmothers. “You have to start taking care of a three- or four-year-old,” she explains. “That has been the reality for a lot of grandmothers that makes their older years not so golden.”

Economic disadvantages throughout life also mean that many Black women enter old age without sufficient financial resources, Avery says. “Most of us never earn the money that we could earn to be financially stable,” she explains, citing low-paying jobs, often without benefits. “We go into our senior years without being able to stash money away. Few of us are taught how to handle the money we do have.”

Avery draws on her family experiences to illustrate some of the ways individual Black women can prepare for old age. “My greatest model has been my mother, L. Alyce Ingram, [pictured at left] who lived to be 104,” she says. “What did my mother do that was important and contributed to her good health and longevity? She built up her ‘health bank’ so she could call on it as she aged.”

“My mother took really good care of herself,” Avery recalls. “Until she died, her only serious ailment was high blood pressure. Among her ‘best practices’ were no smoking and very little drinking or eating of fried foods. She was also very good about getting her checkups. Anything that appeared to be serious, she followed through with it.”

Touching upon the theme of this year’s Older Americans Month – “Connect, Create, Contribute” Avery also believes her mother’s longevity was related to her determination to stay active and be around younger people. “She was devoted to the church. The day she retired from teaching after 30 years, that following Monday she volunteered at the church and did that for the next 20 years of her life,” Avery says. “She kept herself very active and very connected. She had younger friends who helped her, which was important because friends her age all died around the same time. That kind of socialization with younger people added to her not feeling isolated or depressed.”

Avery says her mother also carefully prepared for how she could “age in place” in her house in Jacksonville, FL, by making sure the mortgage was paid off. “She taught school for 30 years, but didn’t have a pension, only Social Security, because of pension rules at that time.” When she was quite elderly, her granddaughter – Byllye Avery’s daughter, Sonja, and her husband, John – took care of her. “She was able to pay them for the care by leaving them the house,” Avery explains.

Older Black women “need to be able to pay family members to take care of us,” Avery says, voicing approval for pilot initiatives to allow use of federal or state funding streams for this purpose, as an alternative to nursing homes. She also notes that long-term care insurance is extremely expensive, and well beyond the means of many Black women thinking ahead to old age.

Providing supportive services to older Black women in their own homes is extremely important, Avery says. “Make it in the places where people are – such as in housing complexes. Don’t expect older people to catch two buses across town. Funding for improving the health of older Black women should go to community-based organizations that can best relate to them and go where they are.”

She advises all caregivers to recognize that “health is a very personal issue,” suggesting that “It’s not just the body you are treating – it’s also the head and the heart. Women are highly protective of their independence and autonomy. Caregivers need to recognize this and accommodate their wishes. Remember that this person is bringing a lot into the room.”

As Avery works to improve her own health, she has become a big proponent of walking, which she has been doing to address some knee problems. “Walking is one of the best things, and it doesn’t cost any money.” To other older Black women, she has this personal advice: “It’s never too late to try something. Don’t think you have to give up because you are in your 70s, 80s or even 90s.”

Byllye Y. Avery, founder of the Black Women's Health Imperative, has been a health care activist for over 45 years, focusing on women's needs. She is also a co-founder of Raising Women’s Voices for the Health Care We Need, along with Lois Uttley of Community Catalyst’s Women’s Health program. She is featured in the PBS program “Makers: Women Who Make America.” In the ‘70s Avery co-founded both the Gainesville Women's Health Center and Birthplace, an alternative birthing center, in Gainesville, FL. A dreamer, visionary and grassroots realist, Avery has combined reproductive justice activism and social responsibility to inspire other women to research, organize and develop effective programs for Black women. She continues to speak on women’s health experiences and rally support for Black women. Avery has been the recipient of many honors and awards.

STATE HIGHLIGHTS

California

The Centers for Medicare and Medicaid Services has approved a three-year extension requested by the California Department of Health Care Services (DHCS) for Cal MediConnect (CMC), California's dual eligible demonstration project. CMC now runs through Dec. 31, 2022. The extension allows more time to focus on quality improvement and evaluation of the program while maintaining continuity for beneficiaries. The additional time will allow for program improvement activities, some of which include:

  • Greater Emphasis on Measurable Performance
  • Enrollment Continuity Incentive
  • Increasing Shared Savings

Additionally, CMS and DHCS are moving forward with other program improvements based on a recent stakeholder engagement process and in partnership with the CMC plans. 

Michigan

The Michigan Department of Health and Human Services (MDHHS) is considering four options for implementing a Medicaid managed long-term services and supports (MLTSS) program within the next five years. MDHHS released a report earlier this year which recommends extending the MI Health Link program for another three years and outlines four different options the state is considering for global LTSS program implementation:

  1. Strengthening the existing system
  2. Moderate expansion of MLTSS options for dually eligible individuals
  3. Expansion of MLTSS options for dually eligible plus Medicaid-only individuals with nursing facility level of care
  4. Full transition to MLTSS for all populations including dual eligibles

New Jersey

The New Jersey Division of Medical Assistance and Health Services (DMAHS) gave a presentation to the Medical Assistance Advisory Council (MAAC) in April describing its review of the Centers for Medicare and Medicaid Services (CMS) State Medicaid Director Letter published December 2018 on ways to better serve individuals dually eligible for Medicaid and Medicare. DMAHS determined that it has already implemented seven of those opportunities, has one in process and is reviewing the remaining two opportunities.

New York

Because the New York duals demonstration program, Fully Integrated Duals Advantage (FIDA), closes at the end of 2019, the state’s Department of Health is currently planning for the transition of FIDA members into other forms of coverage. To inform its planning, the DOH has convened a stakeholder process which held its second session on Feb. 28. At this meeting, the DOH described its current thinking to move all FIDA enrollees into Medicaid Advantage Plus (MAP) plans, which operate in the same regions where current FIDA plans operate. The Centers for Medicare and Medicaid Services (CMS) is currently reviewing those plans’ benefits, networks and costs. The state is also considering enhancing the MAP program so that it more closely resembles FIDA. It is considering changes in the following areas:

  • Adopting FIDA’s integrated grievance and appeals process
  • Allowing MAP plans to use integrated marketing materials
  • Aligning enrollment so that members only have to complete a single enrollment
  • Exploring establishing a “default enrollment” process when Medicaid beneficiaries become Medicare-eligible

Oregon

The Oregon Health Authority (OHA) Coordinated Care Organizations 2.0 program has received nineteen applications from interested parties. The contracts are scheduled to start on Jan. 1, 2020 and go through Dec. 31, 2024. Awards for the CCO contracts are expected to be announced in July 2019.

KEY DATES

Thursday, May 16 (1:30-3:00 p.m. Eastern) - Webinar: Promising Practices for Meeting the Needs of Dually Eligible Older Adults with Substance Use Disorders, presented by The Centers for Medicare & Medicaid Services. Please register for the webinar.

Tuesday, May 21 (3:00-4:00 p.m. Eastern) - Webinar: What Are the Top Medicaid Trends to Watch? presented by Manatt. Please register for the webinar.

Sunday, June 16 - Application Deadline: The National Center for Complex Health and Social Needs is currently accepting applications for its 2019-2020 National Consumer Scholar program.