Health Innovation Highlights: October 31, 2018

Full Edition

FROM THE CENTER & OUR PARTNERS

Pennsylvania Advocates Score Big Win on Health and Housing

Congratulations to Center partner the Pennsylvania Health Access Project (PHAN), which has successfully advocated for a significant investment in supportive housing for people struggling with substance use disorders. Gov. Tom Wolf recently announced a new state program that will redirect $15 million to an opioid housing initiative that will fund a minimum of eight pilot projects in eligible urban and rural communities throughout the commonwealth. Advocates in Pennsylvania have been very effective in demonstrating to policy makers the connection between housing and health, and those efforts are beginning to bear fruit for consumers across the state.

The Center and Health Care For All Partner to Help Massachusetts Integrate Oral Health for Medicaid Enrollees

To help Massachusetts enhance patient care in its Medicaid and CHIP programs (MassHealth), the Center and partner Health Care For All (HCFA) have been selected to participate in the MassHealth Technical Assistance (TA) program to help the commonwealth’s Accountable Care Organizations (ACOs) and community partners integrate oral health with medical care. As a contracted TA vendor, Center and HCFA staff will now serve as a resource listed on the TA Marketplace serving ACOs and community partners.

“Oral health care is vital to health but medical providers often miss out on opportunities to address this important topic. The medical care system can play an important role in improving oral health and facilitating better access to oral health care,” said Center Director Ann Hwang, MD. “We’re excited to work with MassHealth to ensure that ACOs have the tools to integrate oral health into medical care.”

The Center brings its expertise and insight gained through years of state advocacy work through Community Catalyst’s Dental Access Project, an effort supporting state partners to promote medical-dental integration to ensure that all children and adults receive needed dental care, as well as its experience working with ACOs on program enhancements.

“Good oral health is critical to better overall health. But in many cases, deep siloes separate oral health from the medical care system,” said Amy Rosenthal, HCFA’s executive director. “HCFA is eager to work with the new MassHealth ACO program to bridge these domains and help build innovative two-way communication and care systems to lower costs, improve care and address health disparities.”

For three years, Health Care For All has been working with dental practices, community health centers and primary care providers to integrate dental care.

Center staff will work with Dr. Neetu Singh, who holds a Doctorate of Dental Medicine from Boston University and a Master of Public Health from Harvard University and currently directs the HCFA oral health policy platform, which includes providing technical assistance on integrating oral health into the broader health care delivery system in Massachusetts.

Patient Activation and Self-Determination: Two Peas in a Pod

A Health Affairs blog post co-authored by Center Research Director Marc Cohen discusses the promise of marrying the concepts of patient activation and self-determination. While a growing body of research indicates that patients more engaged in their care – or “activated” – have better health outcomes, there is little known about how this concept plays out for people with disabilities, who interact with the health system frequently and usually also have significant long-term services and supports (LTSS) needs.  Meanwhile, people with disabilities have been successfully demanding self-determination and independence in their medical and LTSS care for decades. Looking at how these two approaches to patient empowerment can work together in both the medical and LTSS realms shows great promise for empowering patients and improving health outcomes.

Dedicated Consumer Engagement in Rhode Island

In case you missed it, check out this blog post by Marjorie Waters, a community organizer with Center partner the Rhode Island Organizing Project (RIOP). RIOP has done stellar work organizing and preparing consumers to serve on the state’s Implementation Council (IC), which provides consumer input to Rhode Island’s Integrated Care Initiative, the state’s demonstration project for dually eligible individuals. The success of the IC has required both empowered consumers and a dedicated resource person from the Rhode Island Executive Office of Health and Human Services, who is committed to enhancing the impact of consumers on the demonstration. 

NOTEWORTHY NEWS & RESOURCES

Study: Community Health Workers Improve Quality of Care

In findings from a randomized clinical trial recently published in JAMA Internal Medicine, researchers found that a standardized intervention by Community Health Workers increased patient-perceived quality of care and reduced hospitalizations for a group of low-income men and women. Participants in the study were uninsured or publicly insured patients who had been diagnosed with two or more chronic diseases. Those in the experimental intervention received chronic disease management along with six months of tailored support from a community health worker. This intervention suggests that health systems may be able to use a standardized intervention to address social determinants of health.

CMS to Reevaluate Requirement to Include NEMT in Medicaid Benefits

A recently released  proposal from CMS revealed that it will reevaluate whether Non-Emergency Medical Transportation (NEMT) will be required for Medicaid beneficiaries who have no other means of accessing medical services. This reevaluation is part of the administration’s ongoing efforts to grant states more flexibility to reform their Medicaid program.

CMS Releases Data and Tools to Understand Opioid Use Among Duals and Medicare Beneficiaries

CMS has released a data brief detailing prescription opioid use among Medicare and Medicare-Medicaid beneficiaries to understand trends in opioid utilization among these two groups over the ten-year period from 2006 to 2015. This research suggests that dually eligible individuals have a disproportionately high exposure to prescribed opioids. Also released by CMS this week, are four new Chronic Conditions Data Warehouse flags to promote research on opioid use disorder.

New Survey Finds American Health System Fails People with Serious Illness

A new survey by The Commonwealth Fund, The New York times and the Harvard T.H. Chan School of Public Health reveals that our health care system is inadequately equipped to help people with serious illnesses cope with all aspects of their illnesses. In addition to fears of financial ruin, respondents reported problems with their care, medical errors during their treatment, confusion understanding what their insurance covered and emotional or psychological problems.

STATE HIGHLIGHTS

North Carolina

After a two year wait, North Carolina has obtained federal approval to transition parts of its Medicaid program to managed care. The demonstration will provide specific plans for people with behavioral health and substance use disorder needs as well as those with intellectual and developmental disabilities. . The waiver will also create a pilot program in up to four regions of the state in which managed care plans can pay for programs that address key social determinants of health including housing, food insecurity, personal safety and employment. State officials have already received bids from eight companies hoping to secure managed care contracts.            

Rhode Island

Rhode Island is seeing sizable reductions in hospital and emergency readmissions thanks to its Care Management Alert and Dashboard system, known as CurrentCare, that sends alerts to providers about patient activity and allows clinicians to track care management indicators. In 2017, the state created a pilot program with its largest integrated delivery network to measure opioid use and potential misuse. Having developed the program over the last year, integrating the alerts with electronic medical records and a state’s prescription drug management program, the state has already reduced hospital readmissions by 19 percent and emergency room readmissions by 16 percent. Overall, the state estimates that these reductions have resulted in savings of over $13 million. Approximately half the state’s population has enrolled in the program, and many patients report swift follow-up from providers after a discharge from the hospital.

Texas

A new report from the Texas Health and Human Services Commission indicates the state is making “significant progress” in transitioning acute care services and LTSS to managed care for people with intellectual and developmental disabilities. The state is designing a system that will, among other things: provide Medicaid services to more beneficiaries with greater cost efficiency; improve access and needs assessments; promote “person-centered planning” and focus on self-direction; improve care outcomes; and increase care coordination. Several managed care programs are already available to beneficiaries for the acute care needs, and the state expects to transition those with LTSS needs by Sept. 2, 2021.

KEY DATES

Tuesday, Nov. 6 (2:30-4 p.m. Eastern) - Webinar: Promising Practices for Meeting the Needs of Dually Eligible Older Adults with Schizophrenia, presented by the Centers for Medicare and Medicaid Services. Please register for the webinar.  

Wednesday, Nov. 14 (1-2 p.m. Eastern) - Webinar: Changes to the “Public Charge” Rule and the Impact on Older Adults, presented by Justice in Aging. Please register for the webinar.