« Health Innovation Highlights: October 10, 2019 Issue

Full Edition

DIRECTOR’S CORNER

Building Consumer Leadership, Here, There and Everywhere

Photo credits: Renée Markus Hodin

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

This month, I’m thrilled to share several updates from our work to support the leadership of people with complex needs in improving health programs and policies.

First, please take four minutes to watch our new video highlighting the advocacy of parents of children with intellectual and developmental disabilities to improve programs in Tennessee. You’ll get to meet some amazing parents and advocates, including Leisa Hammett, whose journey from determined parent of a child with autism to grassroots organizer is featured in this accompanying blog.

We’ve enjoyed being on the road this past month, including trips to conduct an advocacy training with older adults in Rhode Island, participating in a team-building and training workshop with Medicaid consumer representatives in Alabama, and talking about aging and health on a panel in Washington D.C. organized by The John A. Hartford Foundation and Health Affairs.

We also sent in comments about a harmful Trump Administration proposal that would make it harder for millions of low-income families, older adults and people with disabilities to get food assistance. Food assistance plays a vital role in improving the health of people with complex health needs. We know that many of you also took the chance to comment (nearly 15,000 public comments were received!), and we’ll keep you updated for the Administration’s response.

Looking ahead, we’re launching two new projects focused on improving care for people who are dually eligible for Medicare and Medicaid.

And, we’re hiring! If you want to join us in our work to make sure that health care policies and programs better meet the needs of people with the most complex needs, take a look at our posting!

FROM THE CENTER & OUR PARTNERS

The Power of My Voice: Tennessee Parents and Advocates Improving Care for People with Disabilities

The Center is excited to release a new video, “The Power of My Voice: Advocating for People with Intellectual and Developmental Disabilities in Tennessee,” which features the work of longtime Community Catalyst and Center partners, the Tennessee Disability Coalition and the Tennessee Justice Center.

The video highlights the advocacy these groups and their consumer leaders did as Tennessee began expanding long-term services and supports to individuals with developmental disabilities in the state, opening new options for community-based care for this population. It touches on all the hallmarks of our work at the Center, supporting advocates on the ground who engage affected families and help them tap into the power of their voices and stories to help improve the system for the people it serves.

Please check out the video and help us spread the word by forwarding to people who may be interested.

Center Staff, Partners Conduct “Lift Up Your Voice” Advocacy Training with Older Adults in Rhode Island

On September 23, Center staff partnered with the Rhode Island Organizing Project (RIOP) to lead a Lift Up Your Voice! advocacy training session with fifteen older adults in Newport, Rhode Island. The training taught participants about health care advocacy and engagement. RIOP will continue working with these and other older adults on their ongoing campaigns to improve non-emergency medical transportation and to expand home health care options. In 2020, the Center and RIOP will be co-leading Lift Up Your Voice! advocacy training sessions with Spanish-speaking older adults.

Center Partner Changing the Care Landscape as Alabama Launches New Coordinated Health Networks

Longtime Center partner Alabama Arise is working hard to ensure the rollout of the state’s seven new Coordinated Health Networks (ACHNs) puts the voices of consumers first. Having successfully advocated for the creation of Consumer Advisory Committees (CACs) for the ACHNs, Alabama Arise is now turning its attention toward recruiting and training consumers for their new roles as leaders in Medicaid governance. In partnership with the Alabama Disabilities Advocacy Program and the Disabilities Leadership Coalition of Alabama, and with help from Center Deputy Director Renée Markus Hodin, they held a training on September 20, bringing together consumer leaders from across the state and preparing them to work together as a team. The day also featured a presentation by the state’s Medicaid Director, who underscored the importance of patient voices and urged the representatives to be actively engaged. Through these efforts, the advocates at Alabama Arise hope to bring a consumer-driven agenda for improving care to the state’s Medicaid program and improve the system’s responsiveness to consumer needs.

The Center Weighs In On Harmful SNAP Eligibility Proposal

The Center submitted a comment letter regarding the Trump administration’s recently proposed rule aimed at eliminating SNAP’s (Supplemental Nutrition Assistance Program) broad-based eligibility option, which gives states the flexibility to make the application process for food assistance accessible to families with incomes slightly higher than standard eligibility levels. More than 40 states currently use broad-based eligibility to ensure more families have access to healthy food and the better overall health benefits that come with it. The proposed change in eligibility requirements would push 3 million individuals off the SNAP program by imposing stricter income and asset limits. In addition to the 3 million people losing benefits, stricter asset limits would greatly diminish financial independence for the many older adults and people with disabilities who have relied on SNAP. Because SNAP participation is a common method to become eligible for free and reduced school lunches, those losing SNAP benefits include over 250,000 children who will lose access to healthy food at school.

The Center’s letter focused on three primary objections to the proposed rule:

  • Access to SNAP improves overall health outcomes and reduces health care costs, and therefore should be accessible to consumers;
  • The proposed rule increases administrative burdens by imposing stricter income and asset tests that would require higher levels of review than most state systems are currently designed to provide and would incur huge training and technology costs for the 40 states currently relying on broad-based eligibility processes to get their systems aligned; and
  • Impacts of the proposed rule change will fall disproportionately and negatively on the shoulders of the most vulnerable consumers including older adults, people with disabilities and children.

The Center Launches New Projects Focused on Medicare-Medicaid Enrollees

The Center is excited to announce two new projects that are focused on improving care for the Medicare-Medicaid population, also known as dual eligibles.

The 18-month projects are supported by Arnold Ventures as part of its new Complex Care portfolio, which has a strategic focus on improving care for Medicare-Medicaid beneficiaries. The portfolio’s aim is to increase integration between the two programs so that individuals receive seamless, person-centered care, to increase the availability of integrated programs to Medicare-Medicaid beneficiaries across the country, and to increase the flexibility of plans that serve these individuals to provide the services they need, whether medical, long-term services and supports, behavioral health, or social needs such as housing and nutrition.

On the first project, the Center will work in close collaboration with The LeadingAge LTSS Center @UMass Boston to explore potential opportunities for combining affordable senior housing with integrated care models, such as site-based features of the Program of All-Inclusive Care for the Elderly (PACE) to support vulnerable older adults with low incomes. Findings from this project will be summarized in a report to be shared with key stakeholders including policymakers in the hopes of informing a new demonstration model for consideration by the Center for Medicare and Medicaid Innovation.

The second project aims to identify successful person-centered strategies for enrollment into integrated care programs for Medicare-Medicaid enrollees. By studying consumer perspectives on enrollment, the Center hopes to understand the factors that increase or decrease consumer acceptance of new models of care. It will document best practices for engagement and on-boarding of consumers, as well as to develop and share practical tools to help in creating successful enrollment and retention policies. Findings from this project will be shared in a white paper and a companion toolkit that can be used by federal and state policymakers, health plans and other organizations engaging with Medicare-Medicaid enrollees.

Blog: Organizing the Old Fashioned Way

Technology has changed the way many people think about connecting with others, from pithy tweets logged forever in the annals of social media history to click-and-it’s-gone Snapchat shares, and there are certainly implications of this changing landscape for health advocates organizing grassroots consumers. In a September blog post, the Center’s State Advocacy Project Manager, Andi Mullin, explores some of the ways technology has improved organizing techniques, as well as the many ways in which good old fashioned, in-person engagement is still proving to be the most successful mechanism for sustained impact. Highlighting the work of our partners at Alabama Arise, who are focusing their efforts on building collaborative partnerships between coordinated care systems and food banks to improve regional nutrition and health, and Make the Road New York, who are working to expand their Community Health Worker Program within New York City’s public hospital system, this blog post lays out several examples of how health advocates can use technology to enhance their organizing capacity.

Both projects are funded by the Center’s Consumer Voices for Innovation (CVI 2.0) grant program. This is the third and final blog in a series about this program.

The Center is Hiring!

The Center is seeking a policy analyst to join its team working to ensure that public programs, including Medicare and Medicaid, better address the needs of consumers, particularly those with the most complex needs. The Center’s policy priorities include a strong focus on opportunities to address social determinants of health and advance consumer and community engagement in health care policies and programs. For more information about this position, please visit the job listing on the Community Catalyst website!

NOTEWORTHY NEWS & RESOURCES

New National Academies Report - Moving Upstream to Improve the Nation's Health

A new report from the National Academies of Sciences, Engineering & Medicine, Health and Medicine division, identifies and assesses current approaches to expanding and optimizing social care in the health care setting. Five key activities were found to facilitate the integration of social care into health care: awareness, assistance, adjustment, alignment and advocacy. The report also identified three keys needs for successful integration: workforce, data and digital tools and financing.

The report presents detailed recommendations under these 5 goals:

  • Design health care delivery to integrate social care into health care.
  • Build a workforce to integrate social care into health care delivery
  • Develop a digital infrastructure that is interoperable between health care and social care organizations
  • Finance the integration of health care and social care
  • Fund, conduct, and translate research and evaluation on the effectiveness and implementation of social care practices in health care settings.

 

Institute for Medicaid Innovation Releases Annual Medicaid Managed Care Survey Report

The Institute for Medicaid Innovation has released its annual Medicaid Managed Care survey report, with data covering all of 2018. This survey is one of the first comprehensive efforts to collect robust, longitudinal data on Medicaid managed care organizations (MCOs) across the country. Key findings include that approximately 95percent of Medicaid MCOs utilize a value based payment arrangement and 78 percent of plans offer targeted social determinant of health programs.

Also highlighted in this report are findings specific to critical elements of the Medicaid program, including the following:

  • High-Risk Care Coordination
  • Value-Based Purchasing
  • Pharmacy
  • Behavioral Health
  • Women’s Health
  • Child and Adolescent Health
  • Managed Long-Term Services and Supports
  • Social Determinants of Health

Root Cause Coalition Invites Participation in Two Learning Cohorts on Food and Housing Insecurity

The Root Cause Coalition is inviting leaders and graduate students interested in learning how to better address social determinants of health through cross-sector collaboration in their communities to join two new Learning Cohorts – an educational opportunity to learn and share best practices on addressing food and housing insecurity. Each month, members of the cohorts join other health equity leaders as they teach practical knowledge on how to design, implement, evaluate and sustain interventions related to food insecurity and housing. Collaborate on tactical solutions to bridge the inequity gap, help train the next generation of social determinant of health professionals and join a network of leaders dedicated to achieving health equity.

Participants may join either or both cohort. Cohort participants will meet virtually via webinar, conference call and discussion forum for 8 months and engage on topics such as building and sustaining c-suite and community buy-in; building capacity; turning theory into practice; data and evaluation; funding and sustainability.

You can sign up here for the Housing Insecurity Cohort, and here for the Food Insecurity Cohort.
 

NASHP Toolkit: State Strategies to Support Older Adults Aging in Place in Rural Areas

A new toolkit from the National Academy for State Health Policy (NASHP) highlights state initiatives that help older adults living in rural areas to age in place. The three primary types of strategies states are using to achieve this are: workforce and training, facilitating access to services in rural areas and addressing the social determinants of health. The toolkit includes key documents used to implement these strategies, as well as legislation and contracts.

Technical Assistance Tool on Information-Sharing to Improve Care Coordination for High-Risk D-SNP Enrollees

A new technical assistance tool from HCBS.org (the Home and Community Based Services clearing house) focuses on the new "information-sharing" requirement for Dual Eligible Special Needs Plans (D-SNPs) that will become effective in 2021. It offers key questions and considerations that states can review as they begin designing and implementing procedures to meet these requirements. Key questions include: how to determine the D-SNP landscape and what groups will benefit from targeted support?

STATE HIGHLIGHTS

California

Last month, the California the Department of Health Care Services) announced several policy changes that will impact all Medi-Cal (Medicaid) Managed Health Care plans. The following changes will go into effect January 1, 2021:

  • The coverage of transplants and Long-Term Care (LTC) will be carved in, to all Medi-Cal managed care health plan model types.
  • The Multipurpose Senior Services Program (MSSP) benefit from the Coordinated Care Initiative in all seven counties of operation will be carved out. MSSP will operate as a waiver benefit, as it did prior the implementation of the Coordinated Care Initiative in 2014.

Michigan

Last month, CMS released the first-ever evaluation report for the MI Health Link dual eligible demonstration project. A few highlights from the report are:

  • Home and Community Based Services were challenging to implement because the plans had difficulty meeting the state's standards for waiver applications – this was in large part due to the state's waiver unit being understaffed for a period of time, resulting in a large backlog of waiver applications in 2017 and early 2018. The backlog was eliminated by September 2018.
  • Timely completion of health risk assessments and care plans was a challenge early in the demonstration. Although the plans improved their assessment completion rates, state officials said that this challenge was an ongoing concern.
  • Focus groups conducted in 2016 and 2017 in the Detroit area found that participants were generally pleased with their plans and access to providers. The lack of co-payments for prescriptions was a big reason for satisfaction.

A separate evaluation conducted by the state focused on beneficiary experience. This evaluation focused on three target audiences: those who make use of Long-Term Services and Supports (LTSS); those who make use of Behavioral Health (BH) services; and those who have many different characteristics but do not use LTSS or BH services. Key findings include:

  • Overall, participants reported very high satisfaction with their MI Health Link plan experiences.
  • Most participants were satisfied with their care coordinator once they had one, satisfaction was particularly related to areas such as: follow-up to doctors’ appointments, emotional support, and assessment of in-home or personal care services.
  • Virtually all participants felt that being enrolled in a MI Health Link plan had positively affected their lives. Most said their quality of life had improved since enrolling, that they took better care of themselves, and that they were encouraged to do so by the plan and their care coordinators.

New York

The New York Department of Health released a draft of its Section 1115 Medicaid Redesign Team  waiver amendment request for public comment. The waiver amendment requests to extend the state’s Delivery System Reform Incentive Payment (DSRIP) program for an additional four years. The DSRIP program began in 2015 with the goals of reducing avoidable hospital use by 25 percent and increasing providers’ capacity to address the social determinants of health. The waiver amendment significantly expands efforts to address the social determinants of health through the establishment of networks that will deliver socially-focused interventions linked to value-based payment.

In other news, New York released a phase-out plan for its dual eligible demonstration project, the Fully Integrated Duals Advantage (FIDA) program. The program will be terminated as of the end of 2019. The state plans to transition FIDA enrollees to Medicaid Advantage Plus (MAP) plans fully aligned with Medicare Advantage Dual Eligible Special Needs Plans (D–SNPs). All FIDA plans currently offer a D–SNP aligned with a MAP plan owned by the same Medicare Advantage (MA) parent, which offers an opportunity for participants to continue receiving integrated care and care coordination for their Medicare and Medicaid benefits.

Last month, CMS released the first-ever evaluation report for FIDA, which included findings from focus groups of FIDA enrollees. Key findings include:

  • The demonstration struggled with low enrollment; a major reason was  the small number of providers participating.
  • The transition to FIDA had a disruptive impact on provider relationships for a number of focus group participants; nearly half the focus group participants reported having to find new primary care physicians or specialists.
  • The interdisciplinary care team process posed a number of challenges for providers (e.g., challenges of meeting the original policy of requiring real-time participation of primary care physicians in team meetings).  The state ended up revising its policy to meet a number of such provider and plan concerns.

Pennsylvania

Pennsylvania received $20 million for the Money Follows the Person (MFP) grant in federal funding. Funds will expand community-based services for older adults, veterans and people with disabilities. MFP incentivizes states to focus on transitioning individuals out of long-term care facilities and into the community. Pennsylvania has participated in this program since 2008 and has helped over 4,000 individuals transition from long-term care settings to the community. This funding will support a number of projects, such as:

  • Partnering with the Pennsylvania Department of Aging on expanding the Shared Housing and Resource Exchange (SHARE) housing pilot.
  • Supporting community-based housing opportunities for veterans experiencing homelessness or living in restrictive settings.
  • Strengthening and simplifying service delivery for people with intellectual disabilities and autism.

In other news, the Pennsylvania Medical Assistance Advisory Committee in its recent meeting announced that amendments to legislation that will enact changes to the Medical Assistance Transportation Program (MATP) required the Department of Human Services to collect information from stakeholders about the potential impact of implementing a broker MATP and the costs that come with it. An extension was granted for the implementation of the changes. The preliminary report should be completed by the end of October, with the final analysis being sent to the legislature in December.

Finally, earlier this month, the state announced an expansion of the Program of All-Inclusive Care for the Elderly (PACE), also known in Pennsylvania as Living Independence for the Elderly (LIFE). The program is being expanded to 14 additional counties. Under PACE regulations, adults 55 or older who require nursing home level of care can qualify and receive a comprehensive suite of medical and non-medical services, while remaining in their communities.

South Carolina

Last month, CMS released the first-ever evaluation report for the South Carolina dual eligible demonstration project, Health Connections Prime. Key findings include:

  • The majority of focus group participants felt they were a valued part of their care planning team, and appreciated their care manager’s regular check-ins, assistance in accessing needed services, and support in resolving issues such as improper billing.
  • Many beneficiaries opted-out of the demonstration primarily because they were satisfied with their current provider(s) and a provider was not in the network of any of the participating plans. Secondary issues for disenrollment had to do with confusion about some of the language used in marketing materials and concerns about loss of Part D benefits.
  • The majority of focus group participants were aware of, and many had used, benefits such as plan supplemental benefits (e.g., gym memberships), plan flexible or ‘waiver-like’ service benefits (e.g., home modifications), and community-based organization benefits (e.g., Meals on Wheels).

Washington

Last month, CMS released the third evaluation report for the dual eligible demonstration in Washington State. Washington is the only state among all states that have participated in the Financial Alignment Initiative that is still conducting a managed fee-for-service demonstration. Key findings from this report include:

  • Focus group participants who knew they had care coordinators generally said that care coordinators had contacted them and had mentioned or discussed goal-setting. Participants in the English-speaking groups said their care coordinators listened to them and helped them talk through issues important for goal-setting. On the other hand, most participants in the Spanish-speaking group indicated that care coordinators had visited them and only mentioned or asked about goals.
  • Many participants in the English-speaking groups were dissatisfied with access to dental and vision care because they believed the scope of coverage was too narrow. Participants in the Spanish-speaking group reported that no one had explained the scope of their benefits.
  • An indication of gross reduction in Medicare Parts A & B expenditures of approximately $150 million from 2013-2016, tied to the demonstration. In a separate report, the fourth Medicare Parts A & B cost report for the Washington demonstration, indicated a gross reduction of Medicare expenditures of $167 million from 2013-2017 (though the 2017 results are preliminary).

KEY DATES

Wednesday, Oct. 30 (3:00-4:00pm ET) -- Webinar: Social Determinants of Health, Social Risk Factors, and Social Needs: Defining Interventions and Partnership Opportunities, presented by the Health Care Transformation Task Force. Register here.

Tuesday, Nov. 5 (3-4 pm ET) – Webinar: What Matters Most in Driving Cross-Sector Partnerships for Complex Populations, presented by the Better Care Playbook and the National Center for Complex Health and Social Needs. Register here.