« Health Innovation Highlights: September 16, 2021 Issue

Full Edition

2021 Speak Up for Better Health Award

Nominations Now Open

This year marks the fourth time the Center’s Speak Up for Better Health Award will be given and the nomination window is now open! We are seeking nominations that lift up individuals and advocates who are using their voices to make the health system more just and equitable. We are particularly interested in the work of people most hurt by our health system today, including people of color, individuals with disabilities, LGBTQ+ people, women, immigrants and older adults. Learn more about the awards, our past honorees and honoraria for winners.

FROM THE CENTER & OUR PARTNERS

Advocacy Success! CVI 2.0 Program Evaluation Report Released

A final evaluation report prepared for the Center by the Institute for Community Health on the Consumer Voices for Innovation 2.0 program (CVI 2.0), describes how advocates in seven states engaged their communities to win a total of 43 policy victories. Policy wins were achieved at the state and local level, as well as within health systems.

CVI 2.0 supported seven state health advocacy organizations in building an engaged base of community members to advocate for policies and programs that expand how the health care sector addresses the social determinants of health. The program focused on food security, housing security and non-emergency medical transportation (NEMT) for communities that have been traditionally left out of policy conversations including: people from low-income communities, people of color, and/or older adults.

House Committee’s Proposed Legislation Would Increase Funding for Home-Based Long-Term Care

Congress took a major step last week toward increasing access to Medicaid home and community based services (HCBS), which help older adults and people with disabilities thrive in their communities. A key House committee proposed adding $190 billion to reduce waiting lists, improve the quality of services and strengthen the long-term care workforce. This increased funding would implement a portion of President Biden’s Build Back Better agenda and allow states to make long overdue and needed investments in their HCBS programs, such as expanding services as well as strengthening and expanding the critical home care and direct care workforce. The House committee proposal also requires states to adopt and report on HCBS quality measures and create an HCBS Ombudsman Program, which will both help improve and provide oversight over the quality of the program.

The Center for Consumer Engagement in Health Innovation is excited by and supportive of these proposals and we will continue to track them as they move through the Congressional budget reconciliation process. We will also continue to advocate for the greatest amount of HCBS funding achievable toward President’s Biden’s original $400 billion proposal as the House and Senate move toward final legislative language. To help our advocacy partners elevate their support for investing in and improving HCBS, we developed an HCBS Advocacy Toolkit, including communications materials and policy materials.

Center Releases Toolkit for Creating Person-Centered Care and Service Plans

Older adults and people with disabilities who receive home-based care report how important a care plan is, and the challenges faced in working with a care team to develop and implement a plan that meets their needs. A care plan becomes even more important when life brings unexpected challenges, such as the COVID-19 pandemic or natural disasters, like floods and fires. To that end, the Center created a Toolkit for Creating Person-Centered Care and Service Plans to assist professional caregivers in preparing care plans that put the individual’s needs at the center.

The toolkit includes Making Care Plans Person-Centered: Policy and Practice Recommendations, which provides our recommendations geared toward policymakers and health sector leaders. Also included is the Person-Centered Planning and Disaster Preparedness Guide, a set of practice-oriented resources for professionals who develop and write care and service plans. The guide includes checklists for departure and disaster preparedness. In addition to these resources, two videos share the insights of individuals with a care plan, providing perspectives on the care planning process and the impact a care plan has on a person’s life. 

Center Applauds CMMI’s New Vision on Equity, Offers Recommendations for Achieving It

In a recent Health Affairs blog post new leaders at the Centers for Medicare and Medicaid Services laid out their strategic vision for the Center for Medicare and Medicaid Innovation (“CMMI” or “the Innovation Center”), with a new focus on equity. The mission of CMMI is to “test innovative payment and service delivery models” within Medicare and Medicaid “while preserving or enhancing the quality of care.” The post announced that CMMI’s vision for the next decade is to make equity the centerpiece of every new innovative payment/delivery model (frequently referred to as a “value-based” payment model – a model that pays health care providers based on the quality of care they provide, rather than the quantity).

The Center is excited to see this new strategic direction for CMMI, and in a Community Catalyst blog post, Center Senior Policy Analyst Rachelle Brill offers three recommendations for ways CMMI can build on this commitment to further advance health equity and justice.

Community Catalyst Submits Comments on Proposed Changes to the Medicare Home Health Rule

Community Catalyst submitted comments to the Centers for Medicare & Medicaid Services in response to its Medicare Home Health rule, a lengthy regulation proposing to make changes to how the Medicare home health benefit is paid for and delivered. Our comments discussed our concerns about the current state of access to, and quality of, the benefit, and pointed out how some of the proposed changes may exacerbate these issues, and therefore adversely affect the health of the individuals who rely on this benefit. 

Health Affairs Blog Post on the WISH Act

Center Research Director Marc Cohen recently co-wrote a post published on the Health Affairs Blog about a revolutionary bill designed to repair our broken system for financing long-term services and supports (LTSS). Sponsored by Rep. Thomas Suozzi (D-NY),  the “WISH Act” – Well-Being Insurance for Seniors to be at Home – seeks to address the growing, financially devastating costs of LTSS, especially for those residing in nursing homes.  

The WISH Act relies on payroll taxes to establish a trust fund to pay for future catastrophic LTSS needs, recognizing that not all LTSS needs are the same. It places value on family caregivers, aids in stabilizing the private insurance market, reduces Medicaid spending, advances health equity and would help achieve fiscal sustainability. While no solution solves all problems, the WISH Act represents a very pragmatic approach that promises to revolutionize the financing system. Click here to read the full blog post.

NOTEWORTHY NEWS & RESOURCES

State Medicaid HCBS Programs Respond to COVID-19: Early Findings from a 50-State KFF Survey

An issue brief from the Kaiser Family Foundation presents early findings from a recent 50-state survey of Medicaid home and community-based services (HCBS) programs. It focuses on state policies adopted in response to challenges posed by the COVID-19 pandemic, the pandemic’s impact on Medicaid HCBS enrollees and providers, and states’ early plans for utilizing the new American Rescue Plan Act 10-percentage-point temporary increase in federal Medicaid matching funds for HCBS. The overall findings from states show that expanding HCBS access and increasing funding to strengthen the direct care workforce would most effectively help to improve care as pandemic recovery efforts continue and beyond.

Inequities in COVID-19 Vaccination Rates in the Nine Largest US Cities

According to a research letter in the JAMA Health Forum, COVID-19 vaccination rates in the nine largest U.S. cities were disproportionately high in communities with lower burdens of the disease. Results from the research also showed that neighborhoods with the highest vaccination rates had a greater share of White and Asian people and a lower share of Black and Hispanic or Latino people, higher mean incomes, lower poverty rates and higher 4-year college completion rates. These inequities likely reflect several root causes, including systematic underinvestment in public health in segregated communities, unequal access to health care information and services, and medical racism that drives mistrust among members of marginalized groups.

More Information Needed: How CMS Can Best Partner with State Medicaid Agencies

A blog post by the Milbank Memorial Fund reflects on a recent Health Affairs blog in which the leaders of the Centers for Medicare and Medicaid Services shared their vision and objectives for the country’s health care system through setting forth guideposts for the next 10 years of value-based care. Acknowledging CMS’ unwavering focus on equity and serving low- and modest-income, racially diverse, and/or rural populations, authors of the Milbank blog post call attention to the support and tools that state Medicaid agencies will need to be full partners in this effort. Most importantly, they highlight the need to increase state Medicaid agencies’ ability to collect and store data necessary to advancing health equity.

Past Racist Redlining Policies Still Having an Impact on Health

An article by the Lown Institute highlights findings from a recent study on health disparities among residents of formerly “redlined” communities, emphasizing the importance of taking a historical view of health equity issues. The study found that patients in neighborhoods formerly labeled “hazardous” had significantly higher rates of post-operative mortality and complications, adding to the evidence of the impact of structural racism on health. The article also points out the role of hospital quality in leading to poorer health outcomes, particularly for patients served by safety net hospitals, and the need to provide greater support for hospitals caring for communities of color.

Sunshine Works: Study Finds Hospitals Stopped Suing Patients for Unpaid Medical Debt after Media Exposure

A study published in JAMA Network Open study found that published studies and unfavorable press about hospitals that pursue medical debt lawsuits have led to a decline in the number of collections against patients. An initial study in Virginia in 2017 found more than 20,000 warrants in debt lawsuits and 9,200 wage garnishment cases filed by 46 percent of Virginia’s hospitals. This study was cited by at least 82 local and national news outlets and many of these singled out specific organizations as major offenders. Researchers found a 59 percent  decrease in the number of medical debt lawsuits filed by hospitals when comparing the 12-month period before the reporting and the 12 months that followed. Eleven of the 67 hospitals that were found to be suing patients halted the practice entirely after the study's publication. Researchers acknowledged the analysis had some limitations. For example, certain debt collection practices may not be found in court records and the decline in cases could have also resulted from external factors. However, the findings seem to suggest that patients benefit from a feedback model of public accountability.

STATE HIGHLIGHTS

Massachusetts

Last month, the Massachusetts Executive Office of Health and Human Services (EOHHS) announced that they intend to request an extension for their Medicaid 1115 waiver. The waiver will focus on five main goals: (1) increase expectations on Medicaid ACOs (2) invest in primary care, behavioral health and pediatric care (3) advance equity (4) support the safety net and (5) maintain coverage through eligibility updates. EOHHS is accepting public comments until Sept. 20.

New York

The New York State Department of Health announced last month that it submitted an 1115 waiver requesting $17 billion in new Medicaid funding over five years to address health disparities and systemic delivery systems issues highlighted by the COVID-19 pandemic. The new waiver would focus on four goals: building a more resilient, flexible and integrated delivery system; developing supportive housing and alternatives to institutions for the long-term care population; redesigning and strengthening health and behavioral health system capabilities; and creating statewide digital health and telehealth infrastructure.

Pennsylvania

The Pennsylvania Departments of Health and Human Services recently introduced the PA Health Equity Analysis Tool, an interactive map that synthesizes Medical Assistance and population health data to show opportunities for intervention to promote better health and promote health equity. This tool provides state, county, zip code and census-tract-level data on a number of population health measures and how they affect local communities and the state as a whole. The purpose is to help providers, partners and the public better understand opportunities to address population health across the state.

KEY DATES

Friday, Sept. 17 (12:30-1 p.m. Eastern) - National Stakeholder Call: CMS Administrator Chiquita Brooks-LaSure and her leadership team will share key updates from her first 100 days in office, presented by the Centers for Medicare & Medicaid Services. Click here to join the call at the scheduled start time.  

Friday, Sept. 17 (2-3 p.m. Eastern) - Webinar: How Racism and Discrimination Impact Latino/Hispanic Health, presented by the U.S. Food and Drug Administration. Please register for the webinar.  

Tuesday, Sept. 21 (2-3 p.m. Eastern) - Webinar: CHWs as Community Connectors and Care Team Supervisors, presented by the Camden Coalition of Healthcare Providers and the National Center for Complex Health & Social Needs. Please register for the webinar.  

Wednesday, Sept. 22 (4-5 p.m. Eastern) - Webinar: NIHB Webinar Series: Enhancing Tribal Environmental Health Program Capabilities and Engagement in COVID-19 Responses, presented by the National Indian Health Board. Please register for the webinar.

Tuesday, Sept. 28 (2-3 p.m. Eastern) - Webinar: Transform Your Engagement Practices, presented by the Camden Coalition of Healthcare Providers and the National Center for Complex Health & Social Needs. Please register for the webinar.  

Wednesday, Sept. 29 (2-3 p.m. Eastern) - Webinar: Partnerships and Strategies for COVID-19 Vaccines: Migratory & Seasonal Agricultural Workers, presented by the Farmworker Health Network. Please register for the webinar.

Thursday, Sept. 30 (2-3 p.m. Eastern) - Webinar: Primary Care: A Team Sport?, presented by the Primary Care Collaborative. Please register for the webinar.

Wednesday, Oct. 6 (4-5 p.m. Eastern) - Webinar: TFAH Age-Friendly Public Health Systems Team Office Hours - Best Practices for Vaccinating Older Adults that are Homebound, presented by the Trust for America's Health Age-Friendly Public Health Systems Team. Please register for the webinar.  


Wednesday, Oct. 20 (4-5 p.m. Eastern) - Webinar: TFAH Age-Friendly Public Health Systems Team Office Hours - Best Practices for Vaccinating Older Adults that are Homebound, presented by the Trust for America's Health Age-Friendly Public Health Systems Team. Please register for the webinar.  

Wednesday, Oct. 27 (4-5 p.m. Eastern) - Webinar: NIHB Webinar Series: Enhancing Tribal Environmental Health Program Capabilities and Engagement in COVID-19 Responses, presented by the National Indian Health Board. Please register for the webinar.