Health Innovation Highlights: November 29, 2017

Full Edition

DIRECTOR'S CORNER

On Giving Care and Giving Thanks

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

 

In my clinical work, I get to meet and work with an incredibly devoted set of family caregivers. These are parents caring for their special needs child, often while also caring for an aging parent. Or a spouse, sibling or friend who helps out with care coordination for someone with a mental illness or cognitive impairment. Or the friend who steps in with last-minute transportation help for someone who might be mobility impaired. My clinical colleagues and I rely every day on the proverbial “village” of caregivers as we work to maintain or improve health. 

In my own family, I’m grateful for my mom and her siblings, who lovingly cared for my grandfather at the end of his life, and who continue to care for my grandmother. Our Center team is a team of caregivers too, and we pause during National Family Caregivers Month (#NFCMonth) and in this season of gratitude to share our thanks for the caregivers in our own families and our wider communities. Here is a sampling of reflections on caregiving from members of our team:

  • “As I watch my dad look after my 96 year old grandmother, I really am in awe. He has done such a good job of making sure she’s safe and well cared for while still maintaining his own life and not drowning in her needs. I hope I can do as well when he is 96!”
  • “My mother is 80 years old and doesn’t speak English. She needs my help at her medical appointments as she prefers to have a family member translate from Spanish for her. She doesn’t like strangers hearing about her medical conditions, so even when a provider offers a staff translator, she is uncomfortable without me accompanying her.”
  • “I’m grateful for my father, who was a gentle, loving and committed caregiver for my mother during her many illnesses and, in particular, over the last year of her life. He navigated appointments with a dizzying array of doctors, nurses, social workers and home health aides, all the while managing most of the responsibilities at home. The physical and emotional toll it took on him was enormous, but he remained steadfast by her side throughout.”
  • “Having an engaged and responsive local pharmacist who prepared a weekly bubble-packed card for all my mother’s daily medications – organized by morning, noon, evening and bedtime – relieved a great deal of stress for me about her safety, and allowed my mom to remain in charge of taking her own pills for as long as was possible, which was very important to her sense of autonomy.”
  • “An important aspect of caregiving I’ve experienced is to be at the bedside when my mother has been hospitalized, both to provide comfort and to observe and advocate for her. Recently, after she fractured her leg in a fall, she had a truly alarming episode of post-operative delirium following the repair surgery. While the nursing staff were attentive, they reacted to this as fairly routine. My family and I pushed ourselves to be assertive, requesting steps to manage and quiet her room, to help speed the resolution of my mother’s delirium. She’s doing much better now.”

But in addition to our gratitude, there’s much we can do to support caregivers. Let’s make sure that the health care system: recognizes their importance and includes them in care teams; addresses caregiver burnout, including the provision of respite care; ensures caregivers have peace of mind that their loved ones will ALWAYS have access to the health care coverage they need; and is a system that is easy to navigate so we can spend less time sorting out the bureaucracy of health care and instead be able to spend time together celebrating what matters most in our families’ lives.

Happy holidays, and thank you to all of the caregivers out there.

FROM THE CENTER & OUR PARTNERS

Center Submits Comments on Proposed “New Direction” for CMMI

In September, the Center for Medicare and Medicaid Innovation (CMMI) put out a “Request for Information” (RFI) asking for stakeholder input on their direction and priorities. The Center submitted comments in response, asking CMMI to move forward with a vision that puts patients at the center, as full partners in their care, and that holds advancing health equity and reducing disparities as a central goal. To accomplish this, we asked that CMMI:

  • Advance models of care that include strong, sustainable mechanisms for consumer engagement, including robust consumer protections.
  • Promote innovations that value primary care, address the social determinants of health, meet the needs of patients with complex health conditions, and integrate mental, behavioral and oral health services.
  • Refrain from implementing models that increase costs for consumers, create barriers to accessing needed service, or have disproportionately negative impacts on low-income or complex patients.

Center Research Director Appointed Co-Chair of Study Panel on LTSS and Family Care Issues

The Center’s research director, Marc Cohen, has been appointed co-chair of a study panel which is part of a new project of the National Academy of Social Insurance, “Designing State-Based Social Insurance Programs for Paid Leave, Affordable Child Care, and Long-Term Services and Supports.” The Academy is forming the study panel to shed light on the design challenges states face in developing programs to meet these needs. Heidi Hartmann, President and CEO of the Institute for Women’s Policy Research is the other co-chair of the study panel.

Most Americans at some point in their lives have a child through birth or adoption, need to provide care for a family member or loved one, stop working temporarily to care for their own serious health condition, and/or require long-term services and supports (LTSS), either due to a disability, illness or the natural process of getting older. When workers seek to balance work and family without adequate supporting infrastructure in place, both families and the economy face significant costs. In the absence of a sufficient care infrastructure, workers are often driven to reduce or abandon their labor market participation, which in turn can lead to forgone household income and retirement savings, inadequate care and lower GDP more broadly. In an effort to address the lack of access to paid leave, affordable child care and long-term services and supports, some states are in the process of developing social insurance programs to meet these needs. The Academy’s study panel will inform these debates by studying options for funding and administering such programs.

Rob Restuccia Co-authors JAMA Forum Post on Housing as Health

Community Catalyst Executive Director Rob Restuccia, MPA, and Howard K. Koh, MD, MPH, former Massachusetts commissioner of public health and former assistant secretary for health for the U.S. Department of Health and Human Services, co-authored a Nov. 29 post in JAMA Forum on the relationships between Health and Housing. The post begins: “Envision a society that fully connects the usually disparate worlds of health and housing.” It then goes on to survey the growing awareness of the intimate relationship between people’s homes and their health, discussing innovative models, programs and funding streams that have begun to address this field, and pointing out that wide disparities in quality of housing generally track with disparities in health equity.

The authors also look toward the future, taking into account the repeated congressional attempts to repeal the ACA and deeply cut Medicaid. They conclude, “In this context, housing and health care stakeholders must plan strategically for the future. Groups like the National League of Cities, the Root Cause Coalition, and the Democracy Collaborative have committed to heightening, not diminishing, cross-sector collaboration. Clinicians can serve as vital colleagues to protect gains to date and renew commitment to housing and health as a vision for the future.”

Center Staff and Partners Present Panel at “Putting Care at the Center” Conference

On Nov. 16, Center Senior Advisor Carol Regan moderated a session, “Politics, Policy and Progress: What’s at Stake for the Care of Complex Populations,” at the second annual conference of the National Center for Complex Health and Social Needs held in Los Angeles, CA. Participating as panelists for the session were Center consumer advocate partner Jane Hash, Community Catalyst Strategic Advisor Cindy Mann and Manan Trevdi, President of the National Physicians Alliance. The panelists discussed the current policy and political landscape as it pertains to care for those with complex health and social needs and reviewed recent legislative and executive actions, describing the current political context.

NOTEWORTHY NEWS & RESOURCES

CMS Changes to 1915 and State Plan Amendment Processes

CMS issued a letter to state Medicaid directors earlier this month announcing changes to the 1915 application review and approval process, as well as the State Plan Amendment (SPA) review process. To streamline the 1915 and SPA review process going forward, CMS will:

  • Host a phone call with states within 15 days of receiving their 1915 or SPA submission
  • Develop a package of tools to help states complete their 1915 or SPA submissions, including templates, preprints and checklists that are available on a new page on Medicaid.gov
  • To reduce SPA backlog, CMS will summarize and send states a complete list of any outstanding requests for additional information (RAIs). If states don’t respond within 90 days to the RAI, CMS may reject the SPA request
  • Expand the use of MACPro, a websystem for submitting SPAs that’s currently only used for Health Home SPAs but will now be used for MAGI-based SPAs, with plans to expand to others in the future
  • Eliminate the process of “same page reviews,” or reviewing of each page of an SPA for non-compliant language in addition to the proposed change itself. Going forward, CMS will only review the language of the proposed change

Accountable Communities of Health: A Promising Approach

The National Academy of Medicine has released a new study about Accountable Communities of Health (ACHs). While models vary, ACHs are best known for their cross-sector approach to addressing population health disparities. These cross-sector interventions are carried out with financial, technical and planning support from health care delivery systems; philanthropic organizations; local, regional and state-based public health departments; community-based organizations; consumers of health care; and others. Through an extensive literature review, the authors sought to identify common characteristics, major challenges and variations in stakeholder engagement to address identified community needs. Although they found that ACHs are too new to make definitive conclusions, the authors identify a common set of principles behind the promising ACH models. Specifically, they work to improve population and community health through (1) growing investments by public and private funders for pioneering accountable health initiatives; (2) focused dialogue among these investors through the Funders Forum on Accountable Health, to assure that there is cross-initiative learning and coordination; and (3) ongoing movement building through entities such as the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Population Health Improvement.

Emerging Innovations in Managed Long-Term Services and Supports for Family Caregivers

Just in time for National Family Caregivers Month, a new paper from the AARP’s Public Policy Institute, “Emerging Innovations in Managed Long-Term Services and Supports for Family Caregivers,” provides insights from managed care leaders about the increasing number of supports available to their members’ family caregivers. Among the innovations featured in the paper are:

  • The use of formal family caregiver assessment tools to identify risk of caregiver burnout, to encourage caregivers to identify their own needs, and to help care managers recognize the need for additional instruction or supports
  • Plan flexibility to go beyond state benefit limits, when needed, to sustain effective family caregiver arrangements
  • More focused engagement of family caregivers to provide input to plan operations and to identify areas of needed supports and culturally appropriate services through focus groups, surveys and family advisory councils
  • Plans going beyond linkage and referral of existing resources to creating or expanding the availability of effective family caregiver services and supports
  • Plan initiatives to improve supports for those caring for someone living with dementia, behavioral health conditions or challenging behaviors
  • Effective partnerships among health plans, community-based organizations and universities to provide targeted education and support groups.

Caring for High-Need Populations                                                                                                                                                

“The right provider team delivering the right care for the right patient, employing the right data.” This is the key takeaway in a new paper from the Peterson Center on Healthcare on strategies in caring for people with complex health care and social needs. “Improving Healthcare for High-Need Patients” examines the key attributes of specific sub-populations—under-65 people with disabilities, frail older adults, people with multiple complex and/or chronic conditions—and points to promising approaches to care for each. The paper also names the essential attributes of promising care delivery models as well as the policy reforms that would create the fertile ground in which these models could thrive.  

New Report Details Strategies of High-Performing ACOs

The Health Care Transformation Task Force, a consortium of patients, payers, providers and purchasers, issued a new report, “Levers of Successful ACOs,” which details the findings of the Task Force’s study analyzing the elements of ACO success. According to the report’s authors, the key elements are:

  • Developing a culture conducive to value
  • Dedication to proactive population health management
  • A strong supporting infrastructure.

The report’s findings will be discussed on a Dec. 5 webinar.

STATE HIGHLIGHTS

Massachusetts

The One Care Implementation Council is hosting regional listening sessions on Dec. 8 to give members and their caregivers a chance to share their experiences with the One Care  program, the state’s dual eligible demonstration project.

New York

The Citizens Budget Commission (CBC), with support from the New York Community Trust, published a report exploring issues around integrating community based providers and organizations in the state’s Delivery System Reform Incentive Payment Program (DSRIP). Despite the DSRIP emphasis on population health and the state’s emphasis on social determinants of health as keys to improving health outcomes, community-based organizations (CBOs) were not integrated into most activities in the participating performing provider systems (PPSs) and only a small number received financial compensation for their efforts. The report identifies four challenges that the PPS’s have encountered that help explain these findings:

  1. Limited evidence for selecting appropriate roles for CBOs in addressing health delivery needs;
  2. Difficulties designing suitable business models for contracting for non-clinical services from CBOs;
  3. Uncertainty about the future governance and sustainability of PPS entities; and
  4. Leadership skepticism among some CBOs and some lead organizations

South Carolina

The South Carolina Department of Health and Human Services and the Medicare-Medicaid Coordination office posted the new 2018 signed three-way contract. Among the changes are (1) the elimination of co-pays for Medicare Part D drugs; and (2) an update to the Multidisciplinary Team (MT). MT members may now include the enrollee and the Care Coordinator and, at the enrollee’s choice, additional members may participate in any or all MT meetings to review or approve the Individual Care Plan.

KEY DATES

Tuesday, Dec. 5 (3-4 p.m. Eastern) – Webinar: Levers of Successful ACOs, presented by The Health Care Transformation Task Force.

Please register for the webinar.

Thursday, Dec. 7 (12-1:30 p.m. Eastern) – Webinar: Interdisciplinary Care Teams for Older Adults, presented by The CMS Medicare-Medicaid Coordination Office, in collaboration with The Lewin Group and the Center for Consumer Engagement in Health Innovation.

Please register for the webinar.

Wednesday, Dec. 13 (2-3 p.m. Eastern) – Webinar: A Disability Competence Resource: DCCAT, presented by The Lewin Group. The DCCAT is a free resource designed to assist health plans and health systems in evaluating their current ability to meet the needs of adults with functional limitations.

Please register for the webinar.

Thursday, Dec. 14 (12-12:45 p.m. Eastern) – Webinar: Elevating State Progress: The SCAN Foundation’s Pacesetter Prize, presented by The SCAN Foundation.

Please register for the webinar.