DIRECTOR’S CORNER

Fighting for What We Care About

Photo credit: Flickr.com creative commons license

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

When asked how she would like to be remembered, Justice Ruth Bader Ginsburg said, "Someone who used whatever talent she had to do her work to the very best of her ability. And to help repair tears in her society, to make things a little better through the use of whatever ability she has.”

These are the words on my mind as I reflect on the work of consumer and community advocacy. While our work in these challenging times sometimes feels like a long and difficult road (uphill both ways!), each tear that is repaired matters.

This month, I was delighted to hear Jim Carnes, policy director of our partner Alabama Arise, interviewed on National Public Radio, talking about Medicaid and food security. And to read a report from the Pennsylvania Health Access Network, who have been working tirelessly to ensure that the voice of Medicaid beneficiaries is heard in the effort to improve the critical non-emergency medical transportation (NEMT) services that they rely on to get to their medical appointments. Our Colorado-based partner, the Center for Health Progress, produced a video explaining why these Medicaid NEMT services are so important. And in a step forward in strengthening NEMT benefits that reflect such collective nationwide activism, the House of Representatives in late September passed H.R. 3935, a bill that codifies Medicaid non-emergency medical transportation as a mandatory benefit within the Medicaid statute. That legislation now requires Senate action.

Center Research Director Marc Cohen and colleagues released a report on how paying a living wage for direct care workers would have significant benefits, both for the workers and the broader economy. And Center Deputy Director Renée Markus Hodin and Joshua Traylor of the Health Care Transformation Task Force (HCTTF) joined Hala Durrah, Founder of Patient Advocates Transforming Healthcare (PATH), in an online discussion of the Center/HCTTF jointly produced change package and case studies to support health systems in deepening their patient and family engagement.

Together, each of us working in persistent and creative ways to repair the many tears that need mending moves us forward in ensuring that consumers and communities have a central role in shaping health care programs and policies. With this voice, we can create systems for health that support and care for the whole person and strengthen the communities they serve. 

Without question, we are living through some unprecedented times. But the power of communities pulling together to express their collective voice has brought about change time and again in the most daunting of situations. I’d like to give RBG the last uplifting word as we look ahead to navigating the coming weeks and years together; “Fight for the things that you care about, but do it in a way that will lead others to join you.”

FROM THE CENTER & OUR PARTNERS

Center Partners in Pennsylvania and Colorado Push for Higher Quality NEMT Services

Center partners the Center for Health Progress in Colorado and Pennsylvania Health Access Network (PHAN) have each been working to improve accessibility to and the quality of Non-Emergency Medical Transportation (NEMT) for Medicaid beneficiaries in their states.

The Center for Health Progress has been working on expanding access to Medicaid NEMT services throughout the state. They created an NEMT explainer video (in both Spanish and English) and carried out a customer satisfaction survey among NEMT users. Data collected from consumers will help improve the service for everyone.

PHAN’s consumer-focused report on the state’s Medical Assistance Transportation Program (MATP) (featured in the September edition of HIH) has spurred the state to partner with PHAN to convene a series of stakeholder feedback sessions with the counties.

Living Wage for Direct Care Workers Would Benefit the Economy Along with the Workers

Direct care workers are a critical foundation of the U.S. health care system; some 3.5 million go to work in residential care settings and homes to provide care for some of society’s most vulnerable members. Despite the importance of these workers to our nation’s health and economy, direct care work remains undervalued and poorly compensated.

A report on economic and productivity benefits of better pay for direct care workers from the LeadingAge LTSS Center @UMass Boston, co-authored by Center Research Director Marc Cohen, was featured in McKnight's Senior Living. The full report, Making Care Work: How Paying at Least a Living Wage to Direct Care Workers Could Benefit Care Recipients, Workers, and Communities, uses publicly available data and standard economic simulation techniques to illustrate the benefits of direct care workers being paid at least a living wage. It goes on to discuss how paying living wages to direct care workers can lead to not just individual stability, but translate into faster economic growth, more jobs in other sectors, and lower costs for public assistance programs and tax credits.

PHAN Report Gives Recommendations to Improve Care for Rural Pennsylvanians with Disabilities

The Pennsylvania Health Access Network (PHAN) released a report compiled from over 300 conversations with people with disabilities, their family members and caregivers, and local organizations in rural Pennsylvania. This report is part of the Rural Healthcare Access Project, an initiative intended to improve access to health care for people with disabilities in rural Pennsylvania.

The report’s recommendations for improvement are:

• Increase funding to rural health systems.
• Use consumer experiences as a roadmap for policy shifts.
• Provide education and support to consumers in navigating the healthcare system.
• Increase provider education & competency.
• Make information about the healthcare system more accessible by consolidating, better publicizing, and utilizing various accessible formats that can be easily understood.
• Create opportunities for direct communication between consumers, providers, insurance companies, and officials.

Alabama Arise Policy Director Talks Medicaid and Its Connection to Food Security on NPR

Jim Carnes, policy director of Center partner Alabama Arise, was interviewed by National Public Radio’s Michelle Martin on All Things Considered. Jim laid out the many interwoven connections between, poverty, lack of insurance coverage, poor health care and how they all are related to food insecurity. He highlighted the fact that these problems are further exacerbated in those states that have not expanded Medicaid.

Center’s Person-Centered Engagement Change Package Highlighted in Online Presentation

Center Deputy Director Renée Markus Hodin and Joshua Traylor of the Health Care Transformation Task Force (HCTTF) joined Hala Durrah, Founder of Patient Advocates Transforming Healthcare (PATH) in an online discussion of the Center/HCTTF jointly produced change package and case studies to support health systems in deepening their patient and family engagement.

UCAHN Ohio Urges CARE Act Housing Assistance to Help Struggling Families Stay Healthy

Access to safe and affordable housing is key to helping prevent the spread of COVID-19 and reduce its disparate impact on low-income populations and communities of color. The Minority Health Strike Force in Ohio has issued a report recommending increased access to safe and affordable housing and policies to prevent eviction. In this Columbus Dispatch opinion column, Steven Wagner – executive director of the Universal Health Care Action Network (UCAHN Ohio) – urges Ohio’s government to use its CARES Act dollars to invest in testing and stabilize housing for struggling families to contain the spread of coronavirus.

A Survey From Community Catalyst’s Substance Use Disorders Team:

Community Catalyst and Faces & Voices of Recovery are looking for people with lived experiences of substance use challenges, including addiction, to complete this survey to improve addiction treatment and recovery services nationwide. By substance use, we mean alcohol or drugs. Please share this opportunity with your networks and read more about the project here! The deadline for survey submissions is Oct. 27, 2020.

This survey is part of the Patients Lead project to amplify the voices of people with lived experience of substance use disorders in shaping research and treatment to improve recovery outcomes. Too often, people with lived experiences of substance use disorders are left out of important policy decisions that affect their lives, including how treatment and recovery programs are designed and what outcomes those programs seek to achieve. People who have experience with substance use disorders treatment and services know what works and doesn’t work for them. By completing this short survey, people with substance use disorders and in recovery can share their experiences to help make treatment and services work better, and improve recovery outcomes. Contact the project team with questions: TreatmentResults@communitycatalyst.org

Patients Lead is funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Eugene Washington PCORI Engagement Award (12786-CC)

NOTEWORTHY NEWS

Prospective Payment for Primary Care: Lessons for Future Models

The Milbank Memorial Fund released a report offering lessons and insights for shifting primary care payment away from fee-for-service to a prospective payment model. The report outlines how prospective payment arrangements provide greater financial predictability and control and allow for flexibility in allocating resources to communicate with and care for patients. The authors of the report conclude that adopting prospective payment models can facilitate the delivery of comprehensive, coordinated and patient-centered primary care.

Eight Recommendations for Health Plans Serving Dually Eligible Individuals to Center Equity

Justice in Aging has released an issue brief with recommendations for how health plans serving dually eligible individuals can actively fight the racial inequities COVID-19 has laid bare. The issue brief notes that individuals dually eligible for Medicare and Medicaid are almost four times more likely to be infected with COVID-19 compared to Medicare-only enrollees. Black dually eligible individuals face an even higher risk. It also provides immediate actions health plans can take to minimize this disproportionate risk for older adults of color.

State Scorecard on LTSS for Older Adults, People with Physical Disabilities and Family Caregivers

The latest edition of the Long-Term Services and Supports (LTSS) State Scorecard provides an updated tool for state policymakers, advocates and family caregivers to use in improving the lives of older adults, people with physical disabilities and their family caregivers. This edition places special emphasis on how the COVID-19 pandemic has brought about new LTSS challenges, especially in residential settings such as nursing homes. The Scorecard benchmarks and compares LTSS performance across states and identifies innovative and promising LTSS practices and offers policy ideas and best practices that can help states achieve high performance as they rebuild and reimagine LTSS systems in the wake of the pandemic.

Health Disparities in COVID-19 Telehealth Access and Use

Inequities in telehealth use and access for older adults and Black and Hispanic patients have emerged during the COVID-19 pandemic. Research reported in the Journal of the American Medical Informatics Association found that white and Asian individuals were more likely to use telehealth than their Black and Hispanic peers. Furthermore, Black patients were four times more likely to access the emergency department over telehealth than white patients. As the telehealth industry continues to grow, these findings emphasize the importance of implementing policies that promote equitable access to telehealth service.

States Explore Requiring Hospitals to Devote Community Benefits to Address Inequities

This blog post by the National Academy for State Health Policy (NASHP) highlights the opportunity for state policymakers to require hospitals to address health inequities through their community benefit investments. The post provides examples of hospital community health improvement initiatives aimed at addressing the inequities that have led to poor health outcomes, including in COVID-19. Importantly, the authors note that the initiatives have proven to be most effective when there is authentic and meaningful community engagement throughout the process.

STATE HIGHLIGHTS

Massachusetts

The Commonwealth of Massachusetts announced last month a new nursing home reform package aimed at improving standards of care. The Nursing Facility Accountability and Supports Package 2.0 includes requirements to strengthen staffing and the direct care workforce, ensure adequate spacing in congregate rooms, and improve standards of care. The package contains a long-term $82 million investment through MassHealth rate restructuring, up to $60 million in COVID-19 funding, and oversight and monitoring measures.

Michigan

The Medicare-Medicaid Coordination Office extended the three-way contract for MI Health Link, the state’s duals demonstration program, to Dec. 31, 2021. A summary of key changes can be found here.

Pennsylvania

Last month, the Pennsylvania Department of Human Services published updated guidance for personal care homes, assisted living residences and private intermediate care facilities. The updated guidance covers screening plans in facilities not experiencing an outbreak, expanding visitation, and circumstances when and how facilities can safely relax mitigation tactics. 

Rhode Island

The Medicare-Medicaid Coordination Office extended the three-way contract for the Integrated Care Initiative, the state’s duals demonstration program, to Dec. 31, 2023. A summary of key changes can be found here.

KEY DATES