Archive for the ‘Medicaid’ Category

From Last Place, Bronx Communities Now Prize Culture of Health

December 7th, 2017 by Patricia Donovan

Barely eight years ago, the Bronx landed at the very bottom of the first county health rankings issued by the Robert Wood Johnson Foundation (RWJF) —the least healthy of 62 New York counties, to be exact.

It didn’t help that as a borough, the Bronx topped a few other lists compiled by New York officials, including the highest prevalence of obesity and diabetes and the top consumers of sugary drinks.

Rather than discourage this diverse borough, however, these rankings galvanized residents and a number of Bronx organizations, including the Bronx Institute of Health, to partner and examine facets of community life to see where health might be improved. Under the hash tag and rallying cry of #Not62, the coalition’s reach has extended into Bronx schools, housing and even local food stores known as bodegas as it attempts to reimagine and enhance community health.

During Innovative Community-Clinical Partnerships: Reducing Racial and Ethnic Health Disparities through Community Transformation, a November 2017 webcast now available for rebroadcast, Charmaine Ruddock, project director, Bronx Health REACH, charted the path to some of the innovative community health partnerships forged by her organization.

Formed in 1999 with a grant from the Centers for Disease Control and Prevention (CDC), Bronx Health REACH (shorthand for “racial and ethnic approaches to community health”) is charged with eliminating racial and ethnic disparities in health outcomes, particularly those related to diabetes and heart disease, in Bronx populations. Since its inception, Bronx Health REACH has grown from five to more than 70 community-based organizations, schools, healthcare providers, faith-based institutions, housing, social service agencies and others.

“Those founding partners were particularly concerned that Bronx Health REACH not be seen as a program per se, but as a catalyst for creating a movement around health and well-being in the community,” explained Ms. Ruddock.

From early focus groups, Bronx Health REACH determined that community members not only felt disrespected by the healthcare system, but also powerless to advocate on their own behalf for better services. Those findings helped to shape the Bronx Health REACH mission and subsequent efforts.

Outreach began at the organizational level, such as examining the way a local church provided meals at church events. The coalition brainstormed ways to prepare those meals in a healthier manner, supplementing the church’s work with nutrition training that quickly spread throughout the faith community. From there, the program applied that approach to the food offered during school meals and via vending machines, and eventually within the local food retail environment, which consists principally of bodegas.

Today, the scope of Bronx Health REACH is broad, encompassing street safety, physical activity and overall wellness, among other areas. Its early work with bodegas has grown from demonstrations and tastings of healthy foods to the formation of a Bronx bodega work group and a new Healthy Bodegas marketing initiative. It has engaged farmers’ markets in its objective of increasing healthier food options. To that end, healthcare providers now issue “prescriptions” for fruits and vegetables that are accompanied by ten-dollar coupons.

The transformation is visible in the community, Ms. Ruddock notes. Today, some previously padlocked playgrounds are open; murals by visiting artists that adorn the walls of local housing are left alone for all to enjoy.

However, a great deal of work remains. “We have given ourselves as a goal that by 2020, we will establish a multi-sector infrastructure working with housing groups, economic development groups, and others as the first step in addressing many of the health-related factors and issues,” explained Ms. Ruddock.

But for now, the enthusiasm and contributions of Bronx residents have not gone unrewarded. In 2015, just five years after receiving its disappointing health ranking, the Bronx was one of eight recipients of the RWJF’s Culture of Health prize. The prize is awarded to communities that work to ensure residents have the opportunity to live longer, healthier and more productive lives.

Listen to Charmaine Ruddock explain how early findings from focus groups helped to shape Bronx Health REACH initiatives.

Healthcare Hotwire: Medicaid Trends

December 2nd, 2017 by Melanie Matthews

Medicaid Trends

Medicaid has moved to the forefront of the national healthcare debate even as states continue to innovate.

2017 marked the year that Medicaid moved to the forefront of the national conversation, as perception—and politics—caught up with the reality that no other social welfare program touches more Americans. While the robust debate remains unsettled, it’s clear that the future of Medicaid coverage, and resulting expenditure impacts, will remain in the spotlight for the foreseeable future, dominating the headlines and permeating the nation’s debate, according to a new report by PwC.

Despite uncertainty about potential federal Medicaid legislative changes, many states are continuing efforts to expand managed care, move ahead with payment and delivery system reforms, increase provider payment rates, and expand benefits as well as community-based long-term services and supports. Emerging trends include proposals to restrict eligibility (e.g., work requirements) and impose premiums through Section 1115 waivers, movement to include value-based purchasing requirements in MCO contracts, and efforts to combat the growing opioid epidemic, according to a Kaiser Family Foundation report.

In the new edition of Healthcare Hotwire, you’ll learn more about Medicaid collaborations, the role of community partners in serving Medicaid beneficiaries and the potential impact of Medicaid cuts.

HIN’s Healthcare Hotwire tracks trending topics in the industry for strategic planning. Subscribe today.

Infographic: The ACA’s Innovation Waiver Program

November 10th, 2017 by Melanie Matthews

Under the Affordable Care Act (ACA), states can pursue “innovation waivers,” sometimes known as 1332 waivers, as of 2017. These waivers allow states to modify key parts of the law, so long as they stay true to its goals and consumer protections, according to a new infographic by the Commonwealth Fund.

The infographic provides a state-by-state look at innovation wavers.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

The Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Cityblock Health to Open First ‘Neighborhood Health Hub’ for Underserved Urban Populations in NYC

October 6th, 2017 by Patricia Donovan

Cityblock Health neighborhood health hubs for underserved urban populations: “Where health and community converge.”

Cityblock Health expects to open its first community-based clinic for underserved urban populations, known as a neighborhood health hub, in New York City in 2018, according to a Medium post this week by Cityblock Health Co-Founder and CEO Iyah Romm.

Cityblock Health is a spinout of Sidewalk Labs focused on the root causes of health for underserved urban populations. Sidewalk Labs is an Alphabet company focused on accelerating urban innovation.

The neighborhood health hub, where members can connect with care teams and access services, is one of several key member benefits outlined on the Cityblock Health web site. Other advantages include a personalized care team available 24/7, a personalized technology-supported Member Action Plan (MAP), and a designated Community Health Partner to help members navigate all aspects of their care.

According to Romm, who brings a decade of healthcare experience to the initiative, the neighborhood hubs will be designed as visible, physical meeting spaces where health and community converge. Caregivers, members, and local organizations will use the hubs to engage with each other and address the many factors that affect health at the local level, Romm said.

For example, Cityblock Health states it will offer members rides to the hub if needed. Transportation, care access, and finances are among multiple social determinants of health that drive health outcomes, particularly for populations in urban areas.

Where possible, the hubs will be built within existing, trusted spaces operated by its partners and staffed with local hires, he added. Cityblock envisions offering a range health, educational, and social events, including support groups and fitness classes.

The hubs are part of Cityblock Health’s larger vision to provide Medicaid and lower-income Medicare beneficiaries access to high-value, readily available personalized health services in a collaborative, team-based model, Romm explained in his post. The organization will partner with community-based organizations, health plans, and provider organizations to reconfigure the delivery of health and social services and apply “leading-edge care models that fully integrate primary care, behavioral health, and social services.”

Three key health inequities related to underserved urban populations motivated the formation of Cityblock Health: disproportionately poor health outcomes, interventions coming much later in the care continuum, and the significantly higher cost of interventions in urban areas as compared to other populations.

Cityblock Health will use its custom-built technology to enhance strong relationships between members and care teams, while simultaneously empowering and incentivizing the health system to do better, he added.

Infographic: Food Insecurity Among Medicaid Seniors

October 2nd, 2017 by Melanie Matthews

There’s an estimated 5.2 million seniors who are eligible for the Supplemental Nutrition Assistance Program (SNAP) but are not enrolled, according to a new infographic by Benefits Data Trust.

The infographic examines the impact of food insecurity on seniors’ health and healthcare costs and quality.

2017 Healthcare Benchmarks: Social Determinants of HealthInitiatives such as CMS’ Accountable Health Communities Model and other population health platforms encourage healthcare organizations to tackle the broad range of social, economic and environmental factors that shape an individual’s health. To underscore the need to address social determinants of health, Healthy People 2020 included “Create social and physical environments that promote good health for all” among its four overarching goals for the decade.

In one measure of their impact, 2015 research by Brigham Young University found that the social determinants of loneliness and social isolation are just as much a threat to longevity as obesity.

2017 Healthcare Benchmarks: Social Determinants of Health documents the efforts of more than 140 healthcare organizations to assess social, economic and environmental factors in patients and to begin to redesign care management to account for these factors.

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Chronic Care Plus for the Chronically Homeless: ‘Recuperative Care on Steroids’

September 28th, 2017 by Patricia Donovan

Chronic Care Plus is designed for ‘Joe,’ a prototypical vulnerable client and frequent hospital user who for some reason has not connected to either his community or healthcare system.

Illumination Foundation’s joint venture pilot, which began as an ER diversion project, now offers community-based stabilization following a hospital stay for medically vulnerable chronically homeless patients. Here, Illumination Foundation CEO Paul Leon describes the origins of Chronic Care Plus (CCP), which has been associated with a $7 million annual medical cost avoidance at all hospitals visited by the 38 CCP clients.

Back in 2008 when we first started, we began to realize that housing was healthcare. With many of the patients we were seeing, although we experienced great success, we ended up discharging them many times back into a shelter or into an assisted living or sober living situation. And although these options were better than being in the hospital or being discharged to the street, we knew we could improve on this.

So, in 2013, we implemented the Chronic Care Plus (CCP) program. Basically, CCP was recuperative care on steroids. It was recuperative care with more tightly wrapped social services and a longer length of stay. At that time, we began a pilot program in conjunction with UniHealth and St. Joseph’s Hospital in which we took the 28 most frequent users and kept them in housing for two years. We also brought these individuals through recuperative care, and wrapped them tightly with social services.

These efforts would eventually lead us to create our ‘Street2Home’ program, which we’re working on now. It implements more bridge housing and permanent supportive housing that is supplied not only by us but by collaboratives in the community. We are able to link to these collaboratives to take our individual, our ‘Joe,’ from a street to eventual permanent housing.

Source: Homelessness and Healthcare: Creating a Safety Net for Super Utilizers with Medical Bridge Housing

home visits

Homelessness and Healthcare: Creating a Safety Net for Super Utilizers with Medical Bridge Housing spotlights a California partnership that provides medical ‘bridge’ housing to homeless patients following hospitalization. This recuperative care initiative reduced avoidable hospital readmissions and ER visits and significantly lowered costs for the collaborating organizations.

SDOH Video: Tackling the Social, Economic and Environmental Factors That Shape Health

September 7th, 2017 by Patricia Donovan

Initiatives such as CMS’ Accountable Health Communities Model and other population health platforms encourage healthcare organizations to tackle the broad range of social, economic and environmental factors known as social determinants of health (SDOH) that shape an individual’s health.

This video from the Healthcare Intelligence Network highlights how healthcare organizations address SDOH factors, based on benchmarks from HIN’s 2017 Social Determinants of Health Survey.

 

 

Source: 2017 Healthcare Benchmarks: Social Determinants of Health

SDOH benchmarks

2017 Healthcare Benchmarks: Social Determinants of Health documents the efforts of more than 140 healthcare organizations to assess social, economic and environmental factors in patients and to begin to redesign care management to account for these factors. These metrics are compiled from responses to the February 2017 Social Determinants of Health survey by the Healthcare Intelligence Network.

Infographic: Opioid Overdose Characteristics in Medicaid Members

August 28th, 2017 by Melanie Matthews

Medicaid members are prescribed opioids twice as often as other patients—and are six times more likely to overdose, according to a new infographic by Conduent.

Conduent examined drug use patterns, care coordination issues (number of prescribing physicians seen and pharmacies used), substance abuse history and pain-related diagnoses.

The infographic summarizes the results by highlighting factors that both increase prescription opioid overdose risks and can define management strategies.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve OutcomesAs the critical role of an engaged, activated healthcare consumer becomes more apparent in a value-based healthcare system, healthcare organizations are focusing on patient engagement and activation programs.

In a recent industry survey on trends in patient engagement, healthcare organizations reported that behavioral health conditions presented a particular challenge to patient engagement initiatives. However, there is robust evidence that motivational interviewing is a powerful approach for treating substance abuse, anxiety and depression.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve Outcomes, a 45-minute webinar now available for replay, Mia Croyle with the University of Wisconsin School of Medicine and Public Health shares key learnings from patient engagement initiatives targeted at patients with behavioral health conditions.

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Montefiore SDOH Screenings Leverage Learnings from Existing Pilots

August 3rd, 2017 by Patricia Donovan

Montefiore Health Systems screens patients for social determinants of health, which drive 85 percent of a person’s well-being.

Montefiore Health System’s two-tiered assessment screening program to measure social determinants of health (SDOH) positivity in its predominantly high-risk, government-insured population is inspired by existing initiatives within its own organization. Here, Amanda Parsons, MD, MBA, vice president of community and population health at Montefiore Health System, describes the planning that preceded Montefiore’s SDOH screening rollout.

I’d like to explain how we came to implement the social determinants of health screening. Many of us in New York State participate in the delivery system or full-on incentive program. It is that program that has enabled us to step back and think about using Medicaid waiver dollars to invest in the things that make a difference.

I need not tell anybody in this industry: many studies have looked at what contributes to health. We know that clinical health in and of itself contributes somewhere between 10 to 15 percent of a person’s well-being; however, so much more of their health and well-being is driven by other factors, like their environment and patient behaviors. And yet, we had not had a chance in the healthcare system to really think about what we wanted to do about that. It was really the Delivery System Reform Incentive Payment (DSRIP) program that has allowed us to start exploring these new areas and think about how we want to collectively address them in our practices.

The way we structured our program was quite simple. We said, “If we’re going to do something about social determinants of health, let’s recognize that they are important and must be addressed, and that we have many different community-based organizations that surround or are embedded in our community that stand poised and ready to help our patients. We’re just not doing a very good job of connecting them to those organizations, so let’s backtrack and say, ‘First, we have to screen our patients using a validated survey instrument.’”

There were different sites at Montefiore that had already launched various pilots. We said, “Let’s make sure we leverage the experience and the learnings from these pilots. Then let’s think about who’s going to deal with those patients, which means we have to triage them.” For example, if somebody screens positive for domestic violence that is occurring in their home right now in the presence of children, that might require a different response from us than someone who says, “I have some difficulty paying my utilities.”

Source: Assessing Social Determinants of Health: Screening Tools, Triage and Workflows to Link High-Risk Patients to Community Services

sdoh high risk patients

Assessing Social Determinants of Health: Screening Tools, Triage and Workflows to Link High-Risk Patients to Community Services outlines Montefiore’s approach to identifying SDOH markers such as housing, finances, healthcare access and violence that drive 85 percent of patients’ well-being, and then connecting high-need individuals to community-based services.

In Montefiore Social Determinants of Health Screening, Patients’ Needs Shape SDOH Workflow

July 11th, 2017 by Patricia Donovan
 Clinical factors drive 15 percent of a patient's well-being; social determinants of health like finances drive the rest.


Clinical factors drive 15 percent of a patient’s well-being; social determinants of health like finances drive the rest.

In Dr. Amanda Parsons’ twenty-something years in healthcare, she has never implemented a program as widely embraced as Montefiore Health System’s Social Determinants of Health (SDOH) screening.

“It was one of the few times in my career that I didn’t encounter physician resistance,” said Dr. Parsons, Montefiore’s vice president of community and population health. The health system’s screening assesses patients for a host of SDOH factors that drive 85 percent of their well-being, including housing, food security, access to care or medications, finances, transportation and violence.

Following assessment, the goal is to connect individuals who screen positively for SDOHs with assistance from the area’s robust network of community organizations.

Dr. Parsons outlined her organization’s SDOH screening process, findings, challenges, and future plans during Assessing Social Determinants of Health: Collecting and Responding to Data in the Primary Care Setting, a June 2017 webcast by the Healthcare Intelligence Network now available for rebroadcast.

To get started, Montefiore piggybacked on the efforts of a few provider sites already screening for SDOHs. It then offered providers a choice of two validated screening tools, the first developed at a fifth-grade reading level, the second a more sophisticated “stressor” screen. Thirdly, it built a two-tiered triage system that leveraged social workers for individuals with very high SDOH needs, and community health workers to assist with lower-level needs.

Referrals would come from existing data banks or a host of new online referral tools, many of which Dr. Parsons mentioned during the webcast.

Interestingly, while Montefiore is fully live on an EPIC® electronic health record, SDOH screenings are currently conducted on paper, noted Dr. Parsons. This decision was one of multiple considerations in workflow creation, including respect for patient privacy.

For the time being, each Montefiore provider site selects a unique population to screen—or opts not to screen at all, if staffing is lacking. For example, one site screens all patients scheduled for annual physicals, while another screens patients recently discharged from the hospital.

In an initial readout of both screens, SDOH positivity was highest for housing and finances.

By the end of 2017, Montefiore expects to have completed more than 10,000 screenings. The health system, which serves some 700,000 patients, also plans to boost its ranks of community health workers, broadening its referral network.

Looking ahead, Montefiore will address a number of key administrative and emotional barriers. Some patient issues, like overcoming the stigma of seeing a social worker, can be minimized with a simple scripting change. Others, like alleviating an individual’s financial pain or putting a roof over a family’s head, are much more complicated.

Also needed is a process to confirm a patient has “gone that last mile” and obtained the recommended support, Dr. Parsons added.

As it expands SDOH screening, Montefiore is banking on that swell of engaged providers. As part of its mission to provide comprehensive, ‘cradle-to-grave’ care for its mostly Medicaid and otherwise government-insured population, Montefiore “intervenes even when there is no payment structure for that work,” said Dr. Parsons.

Falling into that category is SDOH screening. “Much of the Social Determinants of Health work is not very billable in the traditional paper service model, but it is incredibly important to do, regardless.”

Listen to an interview with Dr. Parsons on adapting SDOH screenings for different populations.
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