Health Innovation Highlights: October 26, 2017

Full Edition

Director’s Corner

 

Reflections from Atlanta

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

I was thrilled to be in Atlanta last week for Community Catalyst’s Annual Advocates’ Convening. While there, the Center team and I had the chance to meet with and learn from consumer and community advocates from around the country and to reflect on our work together to date.

For example, for the past six months our state advocacy partners in the Consumer Voices for Innovation (CVI) program have focused on engaging consumers on a variety of initiatives to improve the delivery of health care. A unifying theme in these grants is the importance of grounding policy improvements in a strong base of consumer and community input. This requires getting out and talking to, and more importantly, listening to, community members. I’m pleased to report that in the first six months of the grant, the CVI grantees conducted outreach to nearly 8,000 community members, added 2,000 people to their databases and supported over 200 consumer leaders.

I think it’s fair to say that doing this kind of engagement isn’t always an easy task. Over the past half year, our partners have tried strategies including door knocking, phone banking, trainings, house meetings, one-on-one conversations and outreach through faith-based organizations. We’ve heard about how hard it is to identify people with the stories we wish to lift up and the need to build relationships of trust that enable people to open up and share how the health system is or is not working for them.

We’ve learned that it’s important to think strategically about how to find the constituency you are most interested in, whether it is at senior housing facilities, through Meals on Wheels, in community clinics, or through collaboration with community health workers or navigators. We’ve heard about how outreach is more effective if it connects directly to a clear and imminent threat, such as efforts to take away a “no fare” bus pass for seniors. And we’ve learned that building relationships of trust takes time.

Although the CVI program is still young, our partners have begun to develop terrific resources and strategies for reaching and engaging consumers generally, and hard-to-reach populations specifically.

The work done by our state and local partners is even more impressive given the tumultuous political environment in health care that requires organizations to simultaneously defend health care coverage while working proactively to improve health care delivery. We heard loud and clear that even in these trying times, we need to continue to advance our positive vision of better health — one that is grounded in strong communities and a powerful consumer voice, and one that addresses the serious and persistent disparities in health in our country. We look forward to being part of this effort and lifting up what works so that it can spread.

What are some unique ways you use to engage consumers on health innovation? Tweet us @CCEHI to let us know!

From the Center & Our Partners

Eye on the Upcoming Launch of MLTSS Program in Southwestern Pennsylvania

The Pennsylvania Health Access Network (PHAN) hosted its 9th Annual Health Conference on October 23-24 in Harrisburg, PA. The conference focused on the future road of health care in these uncertain times. PHAN, a Center partner and part of the Consumer Voices for Innovation grant program, hosted two workshops on the roll out of Community HealthChoices, the state's Medicaid Managed Long-Term Services and Supports program, which will launch in 14 counties in the southwestern part of the state on Jan. 1, 2018. Speaking on the first workshop was Center Senior Leader, Judy Feder, and Health and Aging Policy Fellow, Pam Cacchione. The workshop examined the risks and rewards of managed care, and discussed strategies for making managed care work for, and not against, the people it’s intended to serve. The second workshop session was focused entirely on how consumers were feeling about this coming change. Did they know what was happening? Did they have enough information to make a choice between one of the three new managed care plans? What were they worried about? What did they want the state, and advocates to understand about how this would affect them?

Consumer perspectives on the Consumer HealthChoices have also been in the news. Alice Dembner, Senior Policy Analyst for Long-Term Services and Supports at the Center, was was among several advocates quoted in an article in the Pittsburgh Post-Gazette on how beneficiaries are being prepared for the coming changes. Up to 80,000 older adults and people with disabilities will be affected by the move to the new program and are being asked to select one of three new managed care organizations by Nov. 13. The article states that multiple mailings were sent by the state in recent months to those automatically enrolled in Community HealthChoices, but many remain either unaware of the new program, confused about it or fearful that it’s going to disrupt services to which they have become accustomed.

Alice shared the view that implementation of MLTSS programs in other states has been a “mixed bag” of benefits and harm for consumers, but that Pennsylvania in many ways has learned from mistakes made elsewhere. For example, the provision of a 180-day transition period during which no one will have to change services is a positive feature, but she noted Pennsylvania could do more to protect consumers’ rights, such as giving them independent ombudsmen to turn to for help with problems.

Maryland Faith Health Network Leads Classes on End-of-Life Planning

An article in The Baltimore Sun profiles the work of Center partner Maryland Faith Health Network as it launches a series of classes to share resources available to help in creating advance directives and other end-of-life documents with congregants at local places of worship. The initiative is run in partnership with the Maryland Volunteer Lawyers Service, with funding from the Maryland State Department of Health.

Seeing congregations as an ideal place to reach consumers in a place of trust where they can explore such personal topics, the initiative plans to continue holding sessions until they have reached 500 congregants. The talks emphasize that medical directives should be done in consultation with family members and that one can always change one’s mind about end-of-life care and revise documents. 

Center Partner Presents at Hill Briefing on Person-Centered Accountable Care

On Oct. 12, RoAnne Chaney of the Michigan Disability Rights Coalition spoke on a panel about what it really means for a health care system to be person-centered, as part of a Hill Briefing on Measuring Quality for Person-Centered Accountable Care organized by the Alliance for Health Policy. 

Rhode Island Center Partner Honors Volunteer of the Year

The Senior Agenda Coalition of Rhode Island, a statewide advocacy and community organizing group and a Center partner, honored Sherman Pines as Volunteer of the Year at its October 20 Annual Conference. He was recognized for his leadership as the elected chair of the Integrated Care Initiative Implementation (ICI) Council, an entity which includes consumer representatives and which provides oversight to Rhode Island’s dual eligible demonstration project. The Council was created at the urging of consumer advocates who work to amplify the voices of seniors and people with disabilities in the ICI. Honored at the same event were Rhode Island’s Speaker of the House, Nicholas Mattiello, and Senate President Dominick Ruggerio for their restoration of free bus passes for low-income seniors and persons living with disabilities. The conference theme: Building Senior Power was well attended, with 220 people, including 25 state legislators, in attendance. 

Noteworthy News & Resources

Commonwealth Fund Brief Examines Payment and Delivery Reforms in Medicaid Expansion States

A new issue brief from The Commonwealth Fund highlights the findings of a study that examined the evolution of payment and delivery system reform in ten ACA Medicaid expansion states which have made health system reform a core element of their expansions, with the aim of improving access, quality, efficiency, and population health. The issue brief identifies common characteristics of these reforms, challenges states faced and factors that promote success. Findings include:

  • States primarily focused on populations that can benefit from better-managed care, including adults with chronic physical and mental health conditions, people with addiction and substance use disorders, and children.
  • Seven of the ten states are directly engaged in provider payment and delivery system reform.
  • Most of the states use targeted performance improvement measures, like linking payment incentives to the fulfillment of specific quality improvement goals.
  • Provider networks experienced in addressing complex health and social needs are essential to these reforms.
  • Stability of both coverage and the underlying federal policy environment are fundamental to delivery and payment reforms.

Featured Resources: The Intersection of Community Development and Health

The National Alliance of Community Economic Development Associations (NACEDA), has published a useful list of 2017 events hosted by its member organizations across the country focused on the intersection of community development and health. While most of the events have already taken place, conference descriptions (and, in some instances, links to presentations) provide a useful overview of the widely growing awareness and activism related to the interrelation of housing, community development, health and equity.

Supporting Partnerships Between Health Organizations and Community-Based Organizations

The Center for Health Care Strategies (CHCS) released a suite of tools to help Medicaid stakeholders, community-based organizations (CBOs) and health care organizations (HCOs) create and maintain effective partnerships. The first tool is a fact sheet on Medicaid options for supporting these partnerships. For example, it explains how states can: (1) provide financial support to build and sustain program capacity; (2) offer assistance in identifying metrics for evaluation; (3) provide incentives to providers to address SDOH; and (4) use policy levers, including value-based contracts, managed care organization regulations, and state plan amendments. The second tool, the Partnership Assessment Tool for Health (PATH), is intended to help CBOs and HCOs in existing partnerships, work together more effectively and maximize their impact. Third, CHCS released a series of four case studies that illustrate how successful collaborations deliver services, share information, secure funding, engage communities, and evaluate success. The case studies are from Louisville, KY (vulnerable children), Spokane, WA (homeless); Eastern Virginia (older adults); Detroit, MI (High-Risk LGBTQ Youth).

State Highlights

Colorado

The Medicare-Medicaid Coordination Office released the Medicare savings report for Year 1 (September 2014-December 2015) of the Accountable Care Collaborative: Medicare-Medicaid Program, the state’s Managed Fee-for-Service dual eligible demonstration project. The report finds that in Demonstration Year 1, Medicare incurred additional costs for the Colorado demonstration of $10,253,047. Almost all of the estimated Medicare cost increases were driven by users of home and community-based services (HCBS), while the demonstration achieved small savings among nursing facility residents and non-HCBS community residents, collectively. Given these results, CMS has determined that the state of Colorado is not eligible for a Demonstration Year 1 performance payment under the managed fee-for-service financial alignment model. The Colorado demonstration is scheduled to end on Dec. 31, 2017. CMS will retroactively determine whether the state is eligible for performance payments for Demonstration Years 2 and 3 based on the results of cost analyses for those years, when they become available.  

New York

Health Management Associates (HMA) reports that four plans are withdrawing from the state’s dual eligible demonstration project, the Fully Integrated Duals Advantage (FIDA), as of January 2018. HMA points to Crain’s HealthPulse (subscription required) which reports that Independence Care System, North Shore–LIJ Health Plan, Aetna and Fidelis Care will no longer participate in FIDA. In addition, GuildNet has indicated it will end operations in Nassau County but maintain coverage in New York City. These plan exits bring the number of participating plans in 2018 down to fourteen (from the original twenty-three). As of September 2017, 4,566 dual-eligibles were enrolled in FIDA.

In other news, the New York Department of Health has posted an exciting new video that highlights best practices from Performing Provider Systems (PPS) participating in the state’s Delivery System Reform Incentive Payment (DSRIP) program. Among the replicable (and creative) best practices:

  • establishing a $6 million innovation fund
  • adopting best practices with data to make it more actionable
  • addressing social determinants of health with a anti-poverty effort
  • adopting a cross-PPS approach to build a crisis intervention center
  • mobilizing around high-priority community health needs, especially the opioid crisis.

Finally, the governor of New York announced 169 conditional awards to agencies in 47 counties across New York that will provide support services and operating funding for at least 1,200 units of supportive housing for homeless persons with special needs, conditions or other challenges. The target homeless populations include veterans, victims of domestic violence, frail or disabled older adults, young adults with histories of incarceration, homelessness or foster care, chronically homeless individuals and families, individuals eligible for Medicaid Redesign Team funds, as well as individuals with health, mental health and/or substance use disorders.

 KEY DATES

Thursday, Nov. 2 (3:30-5 p.m. Eastern) Webinar: Preventive Care and Health Screenings for Persons with Disabilities, presented by the CMS Medicare-Medicaid Coordination Office (MMCO), in collaboration with The Lewin Group. 

Please register for the webinar.

Thursday, Nov. 2 (4-5 p.m. Eastern) Webinar: Transformation to Value: A Payer Perspective presented by the Health Care Transformation Task Force.

Please register for the webinar.

Wednesday, Nov. 8 (1-2 p.m. Eastern) Webinar: Support for the Working Family Caregiver presented by the American Society on Aging, in collaboration with The Lewin Group. 

Please register for the webinar.

Thursday, Nov. 16 (3-4 p.m. Eastern) Webinar: Building Int Infrastructure to Advance Health Equity, presented by the National Collaborative for Health Equity, as the first in a four-part series. 

Please register for the webinar.

Tuesday, Nov. 21 (1-2 p.m. Eastern) – Webinar: Depression and Parkinson’s Disease - Treatment Options, presented by The Parkinson’s Foundation in collaboration with The Lewin Group.

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.