Health Innovation Highlights: October 14, 2021

Full Edition

DIRECTOR’S CORNER

Dignity. Aren’t We All Worthy of It?

 
Photo credit: Kristin Chalmers

Renée Markus Hodin
Deputy Director, Center for Consumer Engagement in Health Innovation

I'vebeen thinking a lot about dignity recently. Merriam-Webster defines dignity as the “quality or state of being worthy of honor and respect.” Not to throw shade at such a pillar of American language, but as human beings, aren’t we all worthy of honor and respect?

Isn’t Jane, a wheelchair-using business owner, advocate and subject of a new documentary, worthy of honor and respect?

Aren’t Caiden, a boy with profound autism, an intellectual disability, epilepsy, asthma and chronic allergies, and his mom, Theresa, worthy of honor and respect?

Isn’t Bernice, an octogenarian Medicare-Medicaid enrollee whose health problems require help with some activities of daily living in her home worthy of honor and respect?

And yet, every day across this country, people like Jane, Caiden, Theresa and Bernice wait to get the help they need to live with dignity. This help, known as home and community-based services (HCBS), includes an array of supports – personal care attendants, transportation, meal preparation and the like – many older adults and people with disabilities need because of their age, functional limitation and/or health condition. While these supports are the key to people living independently and safely, maintaining their relationships and pursuing their passions, they are in short supply. Over 800,000 people are currently on HCBS wait lists. Too many more go without an adequate number of hours or services. 

Currently, Congress is hashing out a legislative package that could make unprecedented (and long overdue) investments in the human infrastructure of our country. And, thankfully, among these proposed investments are hundreds of billions of dollars for HCBS. Fully funding HCBS would not only help those who rely on these supports and their families, but also the workers who provide these vital services. These workers, part of the so-called “care economy,” have been devalued and underpaid for decades. Infusing significant funds into the care economy will help raise their wages, recruit new workers to the profession and begin to address the critical shortage in the caregiving workforce. Notably, these investments would also

It’s also worth mentioning that Americans want to see these investments! In fact, new polling from SEIU shows overwhelming support for including significant HCBS funding in any legislative package.

Members of Congress are currently on recess, so it’s a good time to raise up the need to fully invest in HCBS. To help, we have collected a set of communications and policy materials for you to use in your advocacy efforts. This includes sample talking points, op-eds and letters to the editor as well as background and state-specific HCBS information from our partners at The Arc and Justice in Aging.

This is our moment. By raising our voices in favor of full investment in HCBS, we can move closer to a society that deems everyone worthy of dignity. 

FROM THE CENTER & OUR PARTNERS

Center Report Featured in Better Care Playbook

This summer, the Center released the report “Listening to Dually Eligible Individuals: Person-Centered Enrollment Strategies for Integrated Care” based on research conducted to better understand enrollment policies and practices that take into consideration dually eligible individuals’ perspectives. The three-pronged research project aimed at understanding whether integrated care plans, specifically Medicare-Medicaid plans offered through the Financial Alignment Initiative and Fully Integrated Special Needs Plans, meet the needs of dually eligible individuals. This report is now also a resource in The Better Care Playbook, which was created to help busy complex care stakeholders find the latest information about what works to improve care for people with complex health and social needs. It offers a valuable outlet to share your work with others and also learn about the latest evidence-based research and promising practices in the field of complex care.

Rhode Island Organizing Project Fights to Preserve Bus Access

Center partner, Rhode Island Organizing Project (RIOP), has been working with low-income older adults and people with disabilities to preserve Kennedy Plaza in Providence as the central bus hub for the Rhode Island Public Transit Authority. There are efforts to eliminate it by the state, which RIOP suggests may be a poorly disguised attempt to clear Kennedy Plaza of low-income and homeless people. In this interview, Ray Gagne and Marjorie Waters of RIOP talk about what is happening with Kennedy Plaza, why this is happening, and most importantly, who this will affect.

Centering Racial Justice in Hospital Community Benefit: Webinar Recording Available

Community Catalyst’s Community Benefit and Economic Stability Project is partnering with organizations in Georgia, Illinois and New Mexico to strengthen consumer health advocacy capacity to promote economic justice policy proposals which may occur at the local, state or federal level. As part of this initiative, the Center recently hosted a webinar, “Centering Racial Justice in Hospital Community Benefit,” focused on building authentic community-hospital partnerships and fostering community engagement. The conversation featured speakers from A Vision of Change-University Hospitals in Cleveland, OH and the Cultural Wellness Center-Allina Health in Minneapolis, MN. Recordings of the webinar are available in both English and Spanish.

Looking Toward a Broader Approach to Dementia Care Advocacy

In an editorial in the Journal of the American Geriatrics Society, Center partner Robyn Stone, co-director of the Leading Age LTSS Center @UMass Boston, and Christopher Callahan, MD, map out creative ways that advocates for improvements in care for people with dementia can “re-imagine the playbook.” The authors draw on advocacy models and techniques that have been successful in other health care and public health campaigns in the past.

NOTEWORTHY NEWS & RESOURCES

Reimagining Care for Older Adults

A new report from the Convergence Center for Policy Resolution, with support from The John A. Hartford Foundation and The SCAN Foundation, highlights long-term care experts’ views on rethinking care for older adults in light of COVID-19, and identifies key issues to transform the long-term care system. This report offers an outline to help frame discussions that are part of the Convergence Center’s national dialogue aimed at reaching an agreement on restructuring long-term care for older adults.

Congressional Council Calls for Financial and Workplace Security for Family Caregivers

The congressionally mandated RAISE Family Caregiving Advisory Council has delivered key recommendations to support family caregivers, including a call for financial and workplace security and expanding home and community-based services. The recommendations emerged from a two-year, multifaceted effort in which the council gathered information from family caregivers across the country. Their recommendations fall under five goals: (1) Increasing Awareness of Family Caregivers, (2) Engaging Family Caregivers as Partners in Healthcare and Long-Term Services and Supports, (3) Improving Access to Services and Supports for Family Caregivers, (4) Supporting Financial and Workplace Security for Family Caregivers, (5) Generating Research, Data, and Evidence-Informed Practices.

In related news, NASHP, which supports RAISE Family Caregiving Advisory Council, recently released resources that outline how states are proposing to spend American Rescue Plan Act (ARPA) funds. Among those resources is a description of how 25 states have proposed using these dollars to support family caregivers. Proposals have included spending ARPA funds on respite, training and education, and payment to family caregivers.

Strategic Approaches to State Utilization of ARPA Funds to Support Older Adults

A new issue brief released by the Milbank Memorial Fund provides an overview of direct and indirect provisions of the American Rescue Plan Act that can help state government officials address both long-standing and emerging needs of older adults. States could leverage the temporary 10 percentage point increase in the federal match for certain Medicaid home and community-based services (HCBS) spending, as well as funding for health-related social needs and workforce supports that will bolster traditional programs and services delivered through Medicaid and the aging network.

Principles for Person-Centered Care in Value-Based Payment

The Health Care Transformation Task Force (Task Force) released a new resource, “Person-Centered Care as a Cornerstone of Value-Based Payment: Five Guiding Principles,” which serves as an update to the 2016 Consumer Priorities Framework. Developed in coordination with the Task Force’s Patient-Centered Priorities Work Group, the five principles are designed to provide a framework for how health care organizations can assess their current practices and strategically plan effective, person-centered care programs and policies that advance health equity.

COVID-19’s Toll Underscores Need to Address Health and Social Needs of Dual-Eligibles

In a letter to the Congressional Social Determinants of Health Caucus, Arnold Ventures emphasized the urgent need to improve care for those who are dually eligible for Medicare and Medicaid. Dual-eligible individuals have particularly high levels of social determinants of health needs and were among those hardest hit by the COVID-19 pandemic. To address this, Arnold Ventures outlined the specific social needs that affect care and outcomes for dual-eligible individuals and identified opportunities for policy change.

STATE HIGHLIGHTS

California

The CMS Medicare-Medicaid Coordination office released the Second (Preliminary) Evaluation Report and associated Findings At-a-Glance for California’s capitated duals demonstration program. Highlights include:

  • Medicare expenditures were significantly higher for demonstration-eligible beneficiaries than for the comparison group cumulatively across the three years, as well as in each year individually.
  • Focus group participants reported that enrollment in the demonstration has had a positive impact on their lives.
  • Competition from Medicare Advantage plans impacted enrollment, and interruptions in Medicaid eligibility were also reported as playing a role.

Colorado

Last month, Colorado Politics reported that the state began scaling back its Medicaid non-emergency medical transportation (NEMT) contract with IntelliRide. This comes as a result of an audit that revealed a number of issues with the state’s oversight of the NEMT contract. The report can be found here.

The Colorado Department of Health Care Policy & Financing announced last month, that it will use $530 million in American Rescue Plan Act funding to enhance home and community-based services over the next three years. The plan categorizes 72 potential initiatives into eight focus areas as prioritized by stakeholders:

  • Strengthen the Workforce & Enhance Rural Sustainability
  • Improve Crisis & Acute Services
  • Improve Access to HCBS For Underserved Populations
  • Support Post-COVID Recovery & HCBS Innovation
  • Strengthen Case Management Redesign
  • Invest in Tools & Technology
  • Expand Emergency Preparedness
  • Enhance Quality Outcomes

Illinois

The CMS Medicare-Medicaid Coordination Office released the Second Evaluation Report and associated Findings At-a-Glance for the Illinois capitated duals demonstration program.  Highlights include:

  • Health Risk Assessment completion rates improved in 2019 but remain a challenge.
  • Enrollees, state officials, and stakeholders generally viewed care coordination as a positive feature of the program.
  • Enrollees continued to report difficulties contacting care coordinators, and care coordinator turnover created challenges.
  • The program had mixed results on service utilization and there was no statistically significant impact on Medicare costs over the first three years.

Massachusetts

The CMS Medicare-Medicaid Coordination Office released the Fourth (Preliminary) Annual Report for the Massachusetts One Care duals demonstration program. Highlights include:

  • Over the course of the first four demonstration years, the number of monthly physician evaluation and management visits increased and the probability of long-stay nursing facility use decreased among all demonstration-eligible beneficiaries, relative to the comparison group.
  • The probability of an inpatient admission, a skilled nursing facility admission, an ambulatory care sensitive condition admission (chronic), and the number of 30-day all-cause readmissions increased, relative to the comparison group.
  • Relative to the comparison group, the first two years of the demonstration were not associated with statistically significant savings or increased costs to the Medicare program. The third and fourth demonstration years were associated with increased costs (statistically significant) to the Medicare program. However, the cumulative impact over all four demonstration years was not statistically significant.
  • Robust stakeholder involvement continued to be a distinguishing characteristic of the demonstration. Several of the changes reflected in the three-way contract amendment, effective April 1, 2019, were attributable to feedback from the Implementation Council.

Ohio

Last month, The Columbus Dispatch reported that the state of Ohio will increase provider rates for Medicaid home and community based services (HCBS) by 6.1 percent beginning in November. There are approximately 200,000 Ohio Medicaid members enrolled in an HCBS program. The state also expects to receive additional funding for HCBS through the American Rescue Plan Act.

Washington

The CMS Medicare-Medicaid Coordination Office released the Demonstration Year 5 Final and Demonstration Year 6 Preliminary Medicare Cost Savings Report for the Washington managed fee-for-service model demonstration program. Highlights include:

  • Over the first five years, the Washington demonstration has resulted in a $278 million reduction in gross Medicare Parts A and B expenditures. With performance payments included, the net savings to Medicare is about $208 million.
  • Service utilization showed some positive findings, and demonstration cost impacts seemed to be driven by targeting high-cost enrollees with focused, intensive care coordination.
  • Finding and engaging beneficiaries in care coordination activities is time-consuming and labor intensive.

KEY DATES

Monday, Oct. 18 (10-11 a.m. Eastern) - Webinar: Primary Care and COVID-19: It’s Complicated—Leveraging Primary Care, Public Health, and Social Assets, presented by the Primary Care Collaborative. Please register for the webinar.  

Monday, Oct. 18 (3-4 p.m. Eastern) - Webinar: Accounting for Health Equity in Medicaid Managed Care, presented by the National Health Law Program. Please register for the webinar.  

Wednesday, Oct. 20 (4-5 p.m. Eastern) - Webinar: TFAH Age-Friendly Public Health Systems Team Office Hours - Best Practices for Vaccinating Older Adults that are Homebound, presented by the Trust for America's Health Age-Friendly Public Health
Systems Team. Please register for the webinar.  


Wednesday, Oct. 27 (4-5 p.m. Eastern) - Webinar: NIHB Webinar Series: Enhancing Tribal Environmental Health Program Capabilities and Engagement in COVID-19 Responses, presented by the National Indian Health Board. Please register for the webinar.  

Thursday, Oct. 28 (2-3:15 p.m. Eastern) - Webinar: Advancing Equity for Older Adults, Part 1: An Introduction to Advancing Equity in Legal and Aging Services, presented by National Center on Law & Elder Rights. Please register for the webinar.