Health Innovation Highlights: September 13, 2017

Full Edition

DIRECTOR'S CORNER

Research Roundup: Patient Engagement Pitfalls and Possibilities

Ann Hwang, MD

I’m pleased to share two recent articles by our team that were published in the latest issue of The Journal of Ambulatory Care Management.

The first article, “Perspectives on How to Engage Consumers in Health System Transformation,” suggests that consumers and their health advocates can be valuable sources of expertise for policy makers and health care organizations looking to improve health care delivery. This article breaks out the steps in engagement, including tactics for recruiting consumers, tools for soliciting input from consumers on issues of health system transformation, and examples of supporting consumers in deepening their involvement. The work of Medicare Rights Center, Ohio Consumer Voice for Integrated Care, Pennsylvania Health Access Network, and Rhode Island Organizing Project are mentioned.

The second article, “Competing Visions for Consumer Engagement in the Dawn of the Trump Administration,” explores two distinct models of consumer engagement – one which sees patients as partners in health care decision-making and a second that focuses on financial incentives and penalties for patients. These two models use overlapping language to describe very different things. While the models could potentially co-exist in some circumstances, for patients with complex health and social needs these models are in direct conflict. For example, high cost-sharing has been demonstrated to result in underutilization of high-value services, particularly for low-income patients. Furthermore, a paradigm in which patients are asked to “shop” for low prices is problematic when patients have complex needs that benefit from coordinated care and longitudinal follow-up with a care team.

We are especially honored that this article was published with five commentaries from thought leaders in the field, namely:

  • Judith Hibbard, DrPH, who suggests patient activation as a way of assessing the effectiveness of engagement, and who reminds us that we must work to reach patients wherever they are on the spectrum of activation.
  • David Lansky, PhD, who discusses the forces that have impeded progress in consumerism, and suggests value-based insurance design (VBID) as a bridge between the two paradigms.
  • John Rother, JD and Larry McNeely, MPA, who also discuss the opportunities of VBID and highlight the critical importance of protecting health care coverage to any conversation about consumer engagement.
  • Jessica Mittler, PhD, who provides valuable historical context and deepens our understanding of the different frameworks in which consumer engagement is situated.

  • Lynn Quincy, MA, who reminds us that these two paradigms are not equal when it comes to evidence, noting the lack of evidence that high-deductible health plans improve health outcomes, patient satisfaction, or the use of high-value care.

We appreciate the Journal’s focus on consumer engagement for its 40th anniversary edition. We echo the call of the Journal’s editor, Dr. Norbert Goldfield, for “a relentless focus on improving consumer engagement” and hope these articles help to advance the conversation around this this critical set of issues.

FROM THE CENTER & OUR PARTNERS

PHAN Launches Online Campaign to Build a Network of Older Adult Consumer Leaders

The Pennsylvania Health Access Network (PHAN), a grantee in the Center’s Consumer Voices for Innovation program, is conducting an online "Pledge to Make Senior Voices Heard" campaign to collect stories and recruit older adults to engage in the work of improving the health care system, with an initial focus on long-term services and supports. PHAN began building their new Senior Voice Leadership Network by conducting a survey over the summer to collect stories from older adults and invite them to become involved in the project. As a recent blog post from PHAN relates, the next step is using the online pledge tool to build a larger base of engaged individuals. The goal is to assemble “a dynamic network of senior leaders in every county to make sure our health care system is delivering high-quality, coordinated, patient-centered care.”

NOTEWORTHY NEWS & RESOURCES

Spotlight on the Direct Care Workforce

Several recent articles and publications provide both data and perspective on the millions of individuals providing long-term services and supports to older adults and people with disabilities. PHI released its annual research briefs on the direct care workforce, which in 2016 included about 2.4 million home care workers and more than 600,000 nursing assistants working in nursing homes. Data from this brief indicates that a significant number of these essential workers –mostly women of color or immigrants – live below the federal poverty line and rely on public assistance. Home care workers were also in the news this week as the Trump administration announced plans to end the Deferred Action for Childhood Arrivals program (DACA). A New York Times article discusses the risk to older adults and people with disabilities if DACA beneficiaries, known as “Dreamers,” are deported. Tens of thousands of Dreamers currently are employed as home care workers and their loss would create a major workforce supply problem in an industry already rife with shortages. Finally, another New Yok Times article covers the many current challenges faced by home care workers from low wages to a lack of training.

A How-To Guide to Improving Care for High-Need Patients While Balancing Costs

A new National Academy of Medicine publication, Effective Care for High-Need Patients, summarizes discussions, analyses and learning from a series workshops held with an array of experts between July 2015 and October 2016. The major sections of the publication are: (1) key characteristics of high-need patients; (2) the use of a patient categorization scheme – or a taxonomy – as a tool to inform and target care; (3) promising care models and attributes to better serve this patient population, as well as insights on “matching” these models to specific patient groups; and (4) areas of opportunity for policy-level action to support the spread and scale of evidence-based programs. Peter Long, President and CEO of the Blue Shield of California Foundation, who chaired the Planning Committee responsible for the NAM efforts, authored a Health Affairs blog post on the common features of successful models of care for the high-need population.

Medicaid the Key to Addressing Social Determinants of Health

At a time when there is growing evidence that social and economic circumstances have a bigger impact than health care services on people’s health, functioning and quality of life, Abt Associates researcher Katharine Witgert makes the case in a new Health Affairs blog post that Medicaid is the ideal platform for addressing these circumstances. In the post, Weigart points to several states (Pennsylvania, Colorado, Louisiana and Oregon) that implemented innovative approaches to address issues such as housing, food insecurity and other social determinants of health. She then discusses how the Medicaid program’s size, breadth, state-federal partnership and experience with diverse populations make it well-suited to integrate health care and social services.

Case Studies: Health and Housing Partnerships

A new report prepared by Mercy Housing and The Low Income Investment Fund features nine case studies of collaborations between the health and housing sectors. The case studies, which emerge from Arizona, California, Minnesota, Ohio and Oregon, illustrate the breadth of approaches to these partnerships and include:

  • The use of health care funding as a catalyst to expand housing stock;
  • Investments from managed care organizations to build housing alternatives for people living in institutions and suffering from homelessness;
  • The use of hospital community benefit dollars to expand housing;
  • Providing community alternatives to institutional care; and
  • The combination of resources and political will to expand both scattered site and project-based housing targeting chronically homeless adults who are high users of the health care system.

Each case study describes how the project developed and details the housing and financial systems that supported the health/housing partnership.

STATE HIGHLIGHTS

Maryland

A newly approved waiver in Maryland will allow hospitals and doctors to enter into care-coordination partnerships and share in savings resulting from treatment that is more efficient. As reported in Modern Healthcare, 16 hospitals will participate in the Care Redesign Program, and more will be able to join next year. In addition to allowing hospitals and doctors to share in savings, providers will easily be able to access patients’ data, ensuring that all providers responsible for that person's care are aware of the care that person is receiving.

In related news, the state is also seeking federal approval to expand an existing hospital cost-savings program to include doctors, rehabilitation facilities, skilled-nursing centers and others who treat Medicare beneficiaries. The Baltimore Sun reports that the 10-year program, which would start in 2019, is aimed at incentivizing health care providers to work more closely with hospitals to improve quality and reduce Medicare costs. The plan projects savings of $300 million in annual Medicare costs by the end of 2023.

Massachusetts

Last month, Massachusetts announced it would collaborate with 17 health care organizations as part of major restructuring of MassHealth, the commonwealth’s Medicaid program. Effective March 1, 2018, Accountable Care Organizations (ACOs) - networks of physicians, hospitals and other community-based health care providers - will be financially accountable for cost, quality and member experience for over 850,000 MassHealth members. The ACO program is a major component in the state’s innovative five-year 1115 Medicaid waiver, bringing in $1.8 billion in new federal investments to restructure the current MassHealth system. ACOs will receive more than $100 million in new investments throughout the remainder of 2017 to support the transition of health care providers providing value-based care.

South Carolina

South Carolina’s dual eligible demonstration project, Health Connections Prime, released its latest stakeholder update. Some of the key updates provided are:

KEY DATES

Thursday, Sept. 14 (12-1:30 p.m. Eastern) – Webinar: Involving and Supporting Family Caregivers in Care Planning and Delivery, presented by The CMS Medicare-Medicaid Coordination Office, in collaboration with the American Geriatrics Society and the Center for Consumer Engagement in Health Innovation,

Please register for the webinar.

Sunday, Oct. 1 – 
Early Bird Registration Deadline for Putting Care at the Center 2017, the second annual conference presented by The National Center for Complex Health and Social Need. The conference will be held Nov. 15-17 in Los Angeles, with pre-conference workshops taking place Nov. 13-15. This year’s conference is co-hosted by Kaiser Permanente.