Health Innovation Highlights: October 4, 2018

Full Edition

DIRECTOR’S CORNER

Making Better Health and Health Justice a Reality: The Important Role of Advocacy

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

Last week at Community Catalyst’s Annual Advocates Convening in Atlanta, Center staff, partners and guests had the chance to celebrate the important role that advocacy plays in improving health. While there is no shortage of policy ideas and solutions for improving health – whether it is making our health care system more person-centered and effective, or addressing the underlying social and environmental factors that affect health – these policy solutions simply won’t become a reality on their own. To create change, we need more consumers and advocates who are willing to speak up, share their ideas and fight to get solutions implemented.

We were thrilled to have the opportunity to spend a few days with some of the amazing people who are making things happen in their communities, state capitols and in Washington, D.C. We would not be able to do our work without our advocacy partners fighting for policies that protect and improve care for older adults, people with disabilities and people with complex health and social needs, day in and day out. Nor would we be successful without national partners, including funders and thought leaders, who understand the importance of advocacy and push us to continue to be better, bigger and bolder.

We welcomed and celebrated three consumer leaders who work with our advocacy partners around the country and who came to share the wisdom and power of their lived experience along with their passion for improving health care:

  • Sandra Diaz, a newly trained Community Health Worker with Make the Road New York;
  • Anhora Snodgrass, a consumer advocate who grew up in Idaho’s foster care system and is working to improve behavioral health in Idaho through her work with Idaho Voices for Children; and
  • Debbie McCarthy-Arnone, a retired attorney who has been an integral part of the Pennsylvania Health Access Network’s outreach to educate and empower consumers affected by the state’s new managed long-term services and supports program.

We were also honored that the Grand Prize winner of our Speak Up For Better Health Award, Elena Hung, co-founder of Little Lobbyists, traveled to Atlanta to address the Convening. Elena recounted her journey over the past two years from a mom tirelessly advocating within the health care system for a child with complex medical needs to a powerhouse lobbyist and advocate defending Medicaid. Elena inspired every person in the convening’s Thursday morning plenary session when she proclaimed, “I speak up because there is no difference between me asking a surgeon to save my daughter’s life, and me asking a member of Congress to save my daughter’s life.”

Elena also reminded us that advocacy is often difficult. And this message was brought home during our visit to the Center for Civil and Human Rights in Atlanta. Through powerful exhibits that tell the story of those who put their lives at risk to advance civil rights and human rights, in the United States and around the world, we were vividly reminded of the courage that it can take to stand up (or sit down) for something you believe in. Despite adversity and powerful opposition, the history of the civil rights movement (as well as the disability rights movement, the women’s rights movement, the LGBTQ rights movement and the human rights movement) shows us the power that we all have to create change and make the world better. It will take both the courage and commitment of individuals, as well as a well-organized and cohesive collective movement, to protect the progress we’ve made to date on health care and to push ever forward. We are honored to be part of this talented, passionate and courageous family of advocates and know that, together, we will succeed.

FROM THE CENTER & OUR PARTNERS

We’re Hiring!

The Center is hiring a Consumer and Community Engagement Advisor. This new position will build collaborative relationships with clients including health plans and providers, hospitals, state agencies and others serving vulnerable populations. In particular, this person will assist clients in developing and implementing effective systems of community engagement in health care. The advisor will provide skill-building training and strategic guidance to support client efforts aimed at engaging consumers in order to improve health care services and the overall health of vulnerable populations. A bilingual and/or bicultural background is highly desirable. Please pass along this announcement to individuals you think might be a good fit.

Rhode Island Drops Longtime NEMT Broker

After months of protests and advocacy by Center partners in Rhode Island, the state has decided not to renew its Non-Emergency Medical Transportation (NEMT) contract with LogistiCare and has instead signed a contract with Medical Transportation Management. Rhode Island advocates will continue to push for stronger oversight from the state, including direct feedback on the service from consumers. Advocates will remain vigilant as the new broker takes over NEMT services in the state, watching for previously common issues such as late pickups, no-show drivers and discourteous service.

Massachusetts Health and Disability Advocates Weigh in on Next Generation of Programs for Dual Eligibles

Responding to a Sept. 5 Request for Information (RFI) from the Executive Office of Health and Human Services (EOHHS), Massachusetts health and disability advocates submitted responses on proposed changes to existing programs for Medicare-Medicaid enrollees (dual eligibles). The proposed changes – captured in the state’s “Duals Demonstration 2.0” submission to CMS – would affect older adults 65 and older eligible for the Senior Care Options program as well as adults 21-64 with disabilities eligible for the One Care program. Center Partners Health Care for All and Disability Advocates Advancing our Healthcare Rights submitted responses to the RFI on a wide range of topics including passive enrollment, continuity of care, quality measures, appeals, fixed enrollment periods and addressing social determinants of health. In their responses, advocates are clear about their support for the goals of ensuring access to high quality, coordinated, person-centered care for all dual eligibles and for the promotion of independent living and recovery models and rebalancing spending from institutional to community-based care for dual eligibles with disabilities. However, their responses also flag significant concerns about the impact of the proposed changes on consumers.

Maryland Health Enterprise Zone Initiative Shows Major Success

Center partner Maryland Citizens’ Health Initiative (MCHI) is seeing success in one of its longtime priority issues: the creation of “health enterprise zones.” Five years ago, Maryland created the “Health Enterprise Zone (HEZ) Initiative.” The goal of this initiative is to reduce health disparities, improve health care access and health outcomes in underserved communities, and reduce health care costs and hospital admissions and re-admissions for high-need, high-risk Medicaid enrollees. Championed by MCHI through its development and implementation and funded by MCHI's successful campaign to raise the state's alcohol tax, the state created five HEZs, recruited health care providers for each area to improve access to care and set health outcome goals based on community demographics and usage. Now, a new study conducted by researchers at Johns Hopkins Bloomberg School of Public Health found that the HEZ Initiative could be linked to more than 18,000 fewer inpatient hospital stays and about $93 million in savings. The findings are reported in a Health Affairs article [subscription required] co-authored by Darrell J. Gaskin, a MCHI Board member. The study found that while the HEZs did experience an overall increase in emergency room visits, the additional community supports and investments in these zones made it possible to send more people home, rather than admit them, saving the state millions of dollars overall and improving several outcomes.

NOTEWORTHY NEWS & RESOURCES

Medicaid Waivers May Impact State Delivery System Reform Efforts

Amidst the controversy over Medicaid waivers that impose burdensome work requirements on beneficiaries, less attention has been paid to the potential impact of these policies on state delivery system reform efforts. These impacts are outlined in a post on The Commonwealth Fund’s “To The Point” blog, authored by Community Catalyst Strategic Advisor Cindy Mann. In this post, Mann points out that Medicaid waivers with coverage restrictions could negatively impact reform efforts in three key ways. First, they could lead to a disruption of care continuity due to an increase in coverage instability. These types of waivers would also place high-need, high-cost beneficiaries at a greater risk of coverage loss. Finally, these waivers would have a considerable impact on safety-net hospitals and other providers that have a large share of Medicaid beneficiaries.

Office of Minority Health Releases Updated Connected Care/Chronic Care Management Toolkit

A newly revised toolkit from the CMS Office of Minority Health provides educational materials and resources to raise awareness about the importance of chronic care management (CCM) services and assist eligible health care professionals to successfully implement CCM services. A set of CCM Community Resources have been released alongside the toolkit to help community organizations promote this new resource. The toolkit replaces the Chronic Care Management (CCM) Health Professional toolkit and the CCM Partner toolkit, and reflects the current care coordination information for Rural Health Clinics and Federally Qualified Health Centers.

CMS Administrator Calls for Changes to the "Status Quo" for Dual Eligible Beneficiaries

CMS Administrator Seema Verma called for providers to challenge themselves to improve the standard of care for dual eligible beneficiaries in a speech to D.C. health policy leaders. At the 2018 Medicaid Managed Care Summit, she stated "the administrative burdens and inefficiencies to serving dually eligible beneficiaries are unacceptable. It's time to achieve a level of operational excellence that older Americans deserve." Verma added that CMS is planning to support additional states to test out innovative pilot projects that might better serve this population.

STATE HIGHLIGHTS

Alabama

CMS has approved the state of Alabama’s request for a Medicaid waiver that impacts beneficiaries enrolled in long-term care services, including nursing homes.  The Integrated Care Network (ICN), which will be administered by an entity known as Alabama Select, will provide case management, outreach and education with a goal of increasing the percentage of Medicaid enrollees receiving home-based rather than nursing home care. 

California

A report outlining the outcomes of California’s dual eligible demonstration project illustrates both the strengths of the program and the continued gaps in care experienced by dually eligible beneficiaries. Assessing the Experiences of Dually Eligible Beneficiaries in Cal MediConnect: Results of a Longitudinal Survey provides a detailed assessment of the California Coordinated Care Initiative (CCI), the state’s capitated managed care model. The report finds that 94 percent of Cal MediConnect beneficiaries were satisfied with their benefits; however, more than 33 percent of beneficiaries who needed help with routine needs reported not having enough help and about 25 percent of beneficiaries who needed personal care help either did not receive enough or received none at all.

Massachusetts

The Massachusetts Executive Office of Health and Human Services submitted to CMS a proposal (http://www.integratedcareresourcecenter.com/content/state-demonstration-proposals-and-public-comments) for a new “Dual Demonstration 2.0” that would include both the One Care demonstration for dually eligible individuals under age 65, and the Senior Care Options Dual Eligible Special Needs Plan (D-SNP) program for dually eligible individuals ages 65 and older.  As part of the review process, CMS is welcoming public comment on the proposal. Comments can be submitted (MMCOcomments@cms.hhs.gov) until 5:00 pm PT on October 17.

Oklahoma

The state of Oklahoma is attempting to hold pharmaceutical companies accountable with a first-in-the-nation policy to compensate drug manufacturers based on the efficacy of their products. The policy allows the state’s Medicaid program to negotiate a set price for certain medications with drug companies who voluntarily participate in the agreement. If the medications work as advertised, the state pays the full set price; if they don’t, the state pays only a portion. As an incentive, participating drug companies will have their effective products added to “preferred drug” lists, which the state says could pay off in the long run for the companies. This value-based model was praised by HHS Secretary Alex Azar, as an innovative means for bringing drug prices down.

KEY DATES

Wednesday, Oct. 10 (3-4 p.m. Eastern) - Twitter Chat: Preparing The Workforce to Address Mental Health and Substance Use in Older Adults, presented by the Eldercare Workforce Alliance. Hashtags: #TogetherWeCare #AgingMentalHealth. 

Wednesday, Oct. 24 (3-4 p.m. Eastern) - Webinar: Medical Professionals with Disabilities, presented by the Administration for Community Living. Please register for the webinar.  

Monday, Oct. 29 (1:30-3 p.m. Eastern) - Webinar: NEMT at the Crossroads: Protecting and Improving a Critical Medicaid Program, presented by The National Center for Complex Health and Social Needs in partnership with the Center for Consumer Engagement in Health Innovation. Please register for the webinar.    

Tuesday, Oct. 30 (2:30-3:30 p.m. Eastern) - Webinar: Addressing Social Determinants of Health in Medicaid Managed Care, presented by Manatt Health. Please register for the webinar.