Health Innovation Highlights: November 14, 2019

Full Edition

DIRECTOR’S CORNER

Consumer and Community Leadership: It's the Key!

 

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

In less than a week, we’ll be hosting many health care, health advocacy and consumer leaders in Washington, D.C. at a morning event, “Consumer and Community Leadership: The Key to Better Health.” At the Nov. 20 event, we’ll be announcing the winner and honorees of the 2019 Speak Up for Better Health Award and releasing the findings from focus groups the Center commissioned that show how consumers reimagine a better, holistic and person-centered primary care system. I hope to see many of you there! If you can’t join us, follow us on twitter at #BetterHealth19 (or check our website on Nov. 20) to meet the winner and read the focus group results!

This month, I'm thrilled to share a number of new publications with you that continue our focus on person-centered care for people with complex needs:

  • A new report on how people with intellectual and developmental disabilities are faring under managed care programs, and what state officials and consumer advocates can do to improve their care.
  • An issue brief assessing the impact of integrated managed care programs for people dually eligible for Medicare and Medicaid, including on care coordination and health care spending.
  • A new poster on the challenges and opportunities that result when Medicaid pushes health plans and providers to do more to address the social and economic factors that affect health.

And finally, a video we released last year about health and housing was selected to be screened at the 2019 Global Public Health Film Festival at the American Public Health Association’s annual meeting earlier this month! The video, "Advocacy Saves Lives: Housing as Health," showcases how consumer health and housing advocates worked together with people who have experienced homelessness to increase supportive housing services in Pennsylvania, and features the work of Center partner, the Pennsylvania Health Access Network.

I hope to see you Washington, D.C .next week!

FROM THE CENTER & OUR PARTNERS

Join us in Washington, D.C. on Nov. 20!

On Nov. 20, the Center is hosting "Consumer & Community Leadership: The Key to Better Health" in Washington, D.C. At the event, we will release a report on new focus group findings on how consumers with complex needs view primary care and opportunities to address social determinants of health in health care settings. To help put the report findings in context, we will host a panel discussion about opportunities and challenges for the health care system to address social determinants of health, featuring Damon Francis, Chief Clinical Officer at Health Leads; Hoangmai (Mai) Pham, Vice President at Anthem; Tara Oakman, Senior Program Officer at the Robert Wood Johnson Foundation; Marjorie Waters, Community Organizer and Wendy Thomas, Consumer Leader from the Rhode Island Organizing Project. We will also be presenting the 2019 Speak Up for Better Health Award to a consumer leader who has worked to improve the health of their community. The award will be presented by 2018 winner Elena Hung, Executive Director and Co-founder of Little Lobbyists. Attendees will also hear from new Community Catalyst Executive Director Emily Stewart. Please click here to learn more or to register to join us in D.C.

New Report Focuses on Improving Medicaid Managed Care for People with Intellectual and Developmental Disabilities

Increasingly, adults with intellectual and developmental disabilities (IDD) are being enrolled in Medicaid managed care. These consumers need a well-coordinated and broad range of home and community based long-term services and supports. Our new report assesses how these consumers are faring in managed long-term services and supports (MLTSS) programs in eight states (Arizona, Arkansas, Iowa, Kansas, Michigan, North Carolina, Tennessee and Wisconsin). While results ran the gamut, no consumers have gained better access to the full range of high-quality, coordinated services they need in any state. The problems of MLTSS programs for people with IDD have caused some states to rethink the viability of managed care as the model for IDD service system reform. This opens up space for advocates to introduce other ideas on how to improve and strengthen the IDD service delivery system. Our report identifies promising practices, and offers action steps for state officials and consumer advocates.

New Issue Brief Explores the Impact of the Duals Demonstrations

In collaboration with the Commonwealth Fund, the Center is excited to share a new issue brief, "Improving Care for Individuals Dually Eligible for Medicare and Medicaid: Preliminary Findings from Recent Evaluations of the Financial Alignment Initiative." The brief was co-authored by Center Director Ann Hwang, Center Senior Policy Analyst Leena Sharma and Laura M. Keohane of the Vanderbilt University School of Medicine.

Nearly 12 million older adults and people with disabilities qualify for both Medicare and Medicaid. Compared to Medicare beneficiaries overall, these individuals have greater needs for both health care and functional support services, and their overall care requires a higher level of coordination.

Launched in 2013, the Financial Alignment Initiative (FAI) aims to improve care for dually eligible individuals by combining Medicare and Medicaid benefits into one managed care plan.

In the issue brief, we review key findings from recent evaluations from five states pursuing the FAI. We find that there is more work to do to make sure that these demonstrations improve coordination of care for beneficiaries, and highlight considerations for future integrated care initiative.

New Poster Resource on How Medicaid Can Address Social Determinants of Health

The Center team recently presented a poster at the Root Cause Coalition Meeting in San Diego. The poster describes opportunities and risks to addressing social determinants of health through Medicaid and gives examples of how advocates are building strong consumer and community voices in shaping how social determinants of health are being addressed through Medicaid programs in Colorado and Alabama.

Community Catalyst Video Screened at 2019 Global Public Health Film Festival

Our video, "Advocacy Saves Lives: Housing as Health" was selected to be screened at the 2019 Global Public Health Film Festival during the American Public Health Association's 2019 Annual Meeting and Expo in Philadelphia last week. The video showcases how consumer health and housing advocates work together with people who have experienced homelessness to increase supportive housing services. The video features the work of the Pennsylvania Health Access Network and can be viewed here.

NOTEWORTHY NEWS & FEATURES

Barriers to Person-Centered Care

A recent Health Affairs blog post discusses new research investigating the barriers standing in the way of person-centered care. The four key barriers identified by the researchers are: (1) missing information on a patient’s broader context and life circumstances; (2) inadequate patient trust in health care providers and the health care system emerging from systemic issues such as racism and gender bias as well as a lack of power; (3) a pervasive culture within medicine that fails to prioritize patient centeredness; and (4) a misalignment of financial incentives that prevents providers from being able to spend the time and other resources necessary to meet patients’ goals and needs. Finally, the blog post author underscored the importance of routinely partnering with patients in order to overcoming these barriers.

Health Systems, Viewed as Anchor Institutions, Invest in Local Communities

A New York Times Business Section article reports on nonprofit medical systems and government providers that have formed the Healthcare Anchor Network, with the mission of “doing more business with local companies in the communities they serve.” This coalition is part of a movement pushing health care systems to invest in their local communities, for example, by employing local community members and contracting with local companies. Investments in local economies create jobs in communities experiencing poverty – by addressing economic and social needs, these investments have the potential to improve health outcomes. According to the article, over the last two years, members of the Healthcare Anchor Network have pledged more than $300 million toward local investments,

Older Adults and Caregivers Unaware of Age-Friendly Care Options

WebMD and The John A. Hartford Foundation recently released the results of a national survey of older adults and family caregivers evaluating the “4Ms” of age-friendly care – the essential set of elements that systems need to address for older adults: what matters, medication, mentation and mobility. Among the findings:

  • Older adults with a greater number of conditions are much more likely to rate their overall quality of life as fair or poor.
  • Different racial and ethnic groups had different views of age-friendly health care
  • Caregivers were much more likely to rate quality of care more negatively.
  • 3 in 4 older adults were not aware that they have the right to ask for, and receive, health care tailored especially to their needs and wants
  • There was significant misinformation among respondents, e.g. nearly 40 percent didn’t know that certain prescription medications can impact cognition; over 40 percent incorrectly thought that depression is an inevitable part of aging.

State Policy Innovations to Support Family Caregivers

The National Academy for State Health Policy (NASHP) released a blog post detailing new state innovations supporting the needs of family caregivers of older adults. Because Medicare does not provide long-term services and supports, many older adults rely on family members to provide these supports, adding up to an estimated $470 billion in unpaid services per year. This post reports on a state officials-only roundtable at NASHP’s 2019 annual conference in August that explored this issue in-depth. Minnesota, Washington and Hawaii have implemented innovative programs to better support caregivers who help their loved ones age in place.

STATE HIGHLIGHTS

California

The California Department of Health Care Services (DHCS) released its proposal for revamping Medi-Cal (Medicaid) over the next few years. The proposal, “Advancing and Innovating Medi-Cal” (CalAIM), outlines the state’s interest in streamlining and reducing variation across delivery systems. As part of the proposal, DHCS would require all Medicaid managed care plans to offer Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs); concurrently, the state would require dually eligible beneficiaries to be enrolled in Medicaid managed care plans. Under the proposal, the state’s Financial Alignment Initiative demonstration, called Cal MediConnect, would fold into D-SNPs and affiliated Medicaid managed care plans.

Illinois

The Illinois Department of Healthcare and Family Services submitted a formal request to the Centers for Medicare & Medicaid Services (CMS) to expand its demonstration under the Financial Alignment Initiative, known as the Medicare-Medicaid Alignment Initiative (MMAI), to be implemented statewide beginning in January 2021. In July, the state also rolled out a statewide Managed Long-Term Services and Supports (MLTSS) program. The expansion of the MMAI to be statewide will allow for greater coordination between the MLTSS program and the MMAI. Illinois has invited Medicare-Medicaid Plan (MMP) applications from all existing Illinois MMPs, as well as from organizations that do not currently have MMPs, but that offer existing Medicaid managed care plans (including MLTSS) in the state. 

Oregon

Two of Oregon’s Medicaid Coordinated Care Organizations (CCO) have notified the state of their closure at the end of 2019. The two CCOs have started to notify Medicaid and dual eligible Medicare-Medicaid members in those CCOs. PrimaryHealth did not win a new CCO contract in the state’s latest procurement process and Willamette Valley Community Health did not seek a new contract. For more information about how the state will transition members to a new CCO, please see this FAQ.

KEY DATES

Wednesday, Dec. 4 (1-2 p.m. Eastern) - Webinar: Mental and Behavioral Health and Aging, presented by the American Society on Aging. Please register for the webinar.

Tuesday, Dec. 10 (1-2 p.m. Eastern) - Webinar: Leveraging Medicaid MCOs as Agents of Change in Payment Reform, presented by Catalyst for Payment Reform. Please register for the webinar.