Health Innovation Highlights: September 6, 2018

Full Edition

FROM THE CENTER & OUR PARTNERS

Speak Up For Better Health Award Honorees Announced!

The Center is proud to announce that Elena Hung, founder of Little Lobbyists, is the winner of the first ever Speak Up for Better Health Award! We received over 60 nominations for this award, which recognizes exceptional people who have raised their voices to improve their health and the health of their communities. Elena and our other three honorees demonstrate the power that each of us has to make better health possible for all of us. The stories that people shared are proof that health system reform is happening in communities all around us and being led by the people with the most at stake – consumers. Congratulations and thank you to everyone who submitted an entry!

Consumer Voices for Innovation Evaluation Illustrates Center’s Impact on Transformation

Engaging consumers in the design and delivery of their care is at the core of what we do at the Center. An independent evaluation of one of our grant programs, Consumer Voices for Innovation (CVI), illustrates the power of our network of advocates across the country to support consumer voices – particularly those of people with complex health needs. We set out to engage consumers from populations that have higher rates of complex health problems – people from low-income communities, people of color and older adults - as these communities are most at-risk from a dysfunctional health care system, and have the most to gain from improving care. In one year, our CVI grantees successfully connected with 13,000 consumers in six states, of whom 3,200 were added to the base of those interested in becoming involved in a delivery system reform effort. 

CVI is going strong in its second year, and is critical part of the Center’s portfolio of work that seeks to elevate the power of consumers in creating better health.

Advocates in Idaho Keep the Focus on Behavioral Health

Center partners in Idaho continue to change the conversation about the importance of behavioral health services. They’ve authored an op-ed in the Idaho Falls Post Register making clear the link between stable housing and behavioral health, particularly for Idahoans pursuing or exiting treatment. With a shortage of affordable housing units and transitional or supportive housing impossible to come by in Idaho, these individuals are at high risk of relapse. This makes emergency room visits, hospital stays and incarceration more likely – all outcomes that are both extremely expensive and ineffective at resolving chronic behavioral health conditions. 

Rhode Island Partners Continue Transportation Advocacy

Advocates in Rhode Island turned out in force to a hearing on proposed Medicaid rule changes to call attention to problems with the state’s Non-Emergency Medical Transportation (NEMT) services. Consumers in the state, especially older adults and those with disabilities, continue to experience extremely poor service at the hands of the state’s NEMT broker, LogistiCare, the largest such business in the country. Despite vigorous advocacy by consumers, LogistiCare continues to be the subject of frequent complaints of very late or no-show transportation services. Rhode Island’s contract with LogistiCare ends this year, and advocates are pushing for greater protections and more accountability from the broker under the next contract – whether that continues to be with LogistiCare or another vendor. 

NOTEWORTHY NEWS & FEATURES

Two New Resources Related to Care for Dually Eligible Individuals

Resources for Integrated Care launched a new podcast series, “Integrated Care in Action,” intended for health plans, health systems, peer support specialists, community-based organizations, and state and federal organizations that provide care to dually eligible individuals. The first episode in the series focuses on strength-based peer supervision and how to build an organizational culture to support peer supervision.

Also, the Integrated Care Resource Center released a summary of recent changes to the payment system for Medicare Skilled Nursing Facilities (SNFs). These changes are set to take effect on Oct. 1, 2019. The new system will base Medicare SNF payments primarily on patient characteristics, care needs and goals. In addition, value-based incentive payments for SNF units will begin Oct. 1, 2018. This program will make either positive or negative incentive payments to SNFs based on the program’s hospital readmissions measure.

The Bipartisan Budget Act of 2018: Implementing Changes to Improve Care for People with Multiple Chronic Conditions

The Bipartisan Policy Center has published a brief outlining the decisions that CMS, health plans and states will need to make in order to implement the provisions of the Bipartisan Budget Act of 2018. The law, passed in February 2018, made important changes to the Medicare program aimed at reducing costs while improving the quality of care for people with multiple chronic conditions. For example, the law introduces new flexibility for Medicare Advantage plans to provide additional or supplemental services to those with complex care needs. These services, which can begin in January 2020, could include non-medical benefits such as minor home modifications and home-delivered meals. The law also directs the HHS secretary to set standards for integration of Medicare and Medicaid services. In its brief, the Bipartisan Policy Center outlines key implementation decision points for these, and other, provisions of the law.

Survey on Community Benefit Practices Around Healthy Food Acess

Health Care Without Harm and Practice Greenhealth have issued a new study, supported by the Robert Wood Johnson Foundation, examining the national landscape of hospital community benefit programming to improve healthy food access and identifying opportunities and challenges for greater investment in order to improve community health.

Key findings from the study include:

  • Obesity and diet-related health needs are frequently identified in community health needs assessments.
  • Hospitals that utilize Department of Agriculture data on food-related health needs were 2.5 times more likely to have at least one community benefit program targeting food security or healthy food access.
  • Fewer than half of community benefit programs related to obesity, diet-related disease or food access were directly targeting food insecurity or healthy food access.

In addition to providing best and promising practices for programs targeting healthy food access, the report highlights three “triple win” strategies to address healthy food as a social determinant of health. The strategies include:

  • Improving access to healthy, affordable food.
  • Supporting economic and workforce development in low-income communities.
  • Strengthening local and sustainable food systems.

Homelessness as a Health Crisis: The Shocking Statistics

Evidence has increasingly shown that homelessness and inadequate housing are major factors that contribute to poor health. A new post on the Health Affairs Blog includes shocking statistics on the extent to which homelessness is a health crisis: people experiencing homelessness have shorter life expectancies, greater mortality risks, increased risk of communicable disease and higher emergency department costs. The blog post follows a June 2018 Health Affairs article  that reviewed the literature on housing and health in depth.  More health care providers and states are thinking about how they can address housing by leveraging Medicaid dollars and directing funding to housing stability services. As this issue continues to make headlines, health advocates and professionals should continue to urge policymakers to recognize and address the connection between housing and health. The Center also produced a video  on this topic, featuring the ground-breaking work of the Housing as Health coalition of advocates and housing organizations in Pennsylvania.

STATE HIGHLIGHTS

Colorado

The Denver Post reports that Colorado ranks among the top 10 states in the nation across 40 key health measures, but continues to struggle to connect at-risk patients with medical homes and routine care. There are two counties in the state without a single primary care provider, and 13 additional counties that don’t have a local hospital. Over the last five years, residents in urban centers in the state saw increases in their access to care, but rural communities - particularly those along the southern border - have seen declines over the same period. Notably, several western states, including New Mexico, Oregon and Washington, all ranked among the lowest performers for health care access in rural communities.

Massachusetts

Beginning in 2019, Massachusetts will use patient survey scores as one of several quality measures that determine payment adjustments to MassHealth (its Medicaid program) ACOs. The commonwealth has contracted with Massachusetts Health Quality Partners (MHQP), a non-profit that collects and reports quality data on physician practices, to conduct a multi-year survey targeting Medicaid consumers utilizing primary care, behavioral health and long-term services and supports. Payment adjustments will be based on a combination of factors including meeting established thresholds of care, improvements in patient health over time and performance – which will be determined in part by the MHQP scores. This model will be the first in the nation to tether consumer experience to provider payments.

North Carolina

The North Carolina Department of Health and Human Services has issued its Prepaid Health Plan RFP marking the beginning of the state’s transition to Medicaid managed care. Starting in November 2019, most North Carolina Medicaid patients will be mandatorily enrolled in a Prepaid Health Plan in one of six regions. The state is seeking proposals that focus on three distinct innovations in care delivery: behavioral health and pharmacy integration with standard primary care; the strengthening of primary care access and care coordination; and investments in social determinants of health, or what the state calls Opportunities for Health. Proposals are due Oct. 12, 2018.

Texas

Texas Health and Human Services Commission officials released a new draft of the state’s Telehealth Services policy for public comment earlier this month. The new draft clarifies provider types that can be reimbursed for services provided in schools, adds occupational and speech therapy codes to the list of reimbursable services, and provides references to existing prior authorization requirements. A state Senate panel also released a report to the full Legislature that recommended expanding telemedicine and telepsychiatry in schools to help address trauma and assist with violence prevention, noting that these services are particularly important in rural and low-income communities where access to in-person care is limited.

KEY DATES

Monday, Sept. 10 (2 – 3:30 p.m. Eastern) - Webinar: Addressing Social Determinants of Health: Connecting People with Complex Needs to Community Resources, presented by the Center for Health Care Strategies. Please register for the webinar.  

Tuesday, Sept. 11 (12:30 – 2:00 p.m. Eastern) - Webinar: Identifying and Meeting the Language Preferences of Health Plan Members, presented by The Lewin Group and The Centers for Medicare & Medicaid Services. Please register for the webinar.  

Tuesday, Sept. 18 (1:30 3 p.m. Eastern) - Webinar: Advancing Value-Based Payment in Medicaid Managed Long-Term Services and Supports: Opportunities for Community-Based Care, presented by the Center for Health Care Strategies. Please register for the webinar.