Mobile App Click here to download our Mobile App for iOS or Android
Not a member? Sign up for free!

Future Of Health Care Beyond 2020 Series: Interview With Sloan Manning, M.D.

In this interview, Sloan Manning, M.D., PsychU Primary Care Provider Section Advisor, discusses the future of health care beyond the COVID-19 pandemic with Michelle Jacobs, PharmD, BCPS, BC-ADM, CDE, RPh, Senior Medical Science Liaison, of Otsuka Medical Affairs. Listen in to hear Manning’s perspective on the opportunities and challenges that lie ahead.

Sloan Manning, M.D., is the PsychU Primary Care Provider Section Advisor, as well as the Medical Director at Novant Health Urgent Care & Occupational Medicine in North Carolina.

Michelle Jacobs, PharmD, BCPS, BC-ADM, CDE, RPh, is a Senior Medical Science Liaison for Otsuka Pharmaceutical Development and Commercialization, Inc.

In this interview, Dwayne Mayes, PsychU Patient and Caregiver Section Co-Advisor, discusses the future of health care beyond the COVID-19 pandemic with Heather Davidson, PhD, Medical Science Liaison, of Otsuka Medical Affairs. Listen in to hear Mayes’ perspective on the opportunities and challenges that lie ahead.

Dwayne Mayes is the PsychU Patient and Caregiver Section Co-Advisor, as well as the Program Director of the Recovery Network and Peer Training Program at the Mental Health Association of Westchester, New York.

Heather Davidson, PhD, is a Medical Science Liaison for Otsuka Pharmaceutical Development and Commercialization, Inc.

In this presentation, the objectives are to:

  • Discuss Theories of Pathophysiology
  • Discuss Potential Role of Neurotransmitters & Treatment Considerations

Request this program for your region or organization today! This live (online or in-person) presentation, and others like it, are available for free for PsychU members. View our complete listing of presentations and programs by visiting our Request A Presentation page.

In this presentation, the objectives are to:

  • To understand the burden of behavioral health disorders on all stakeholders
  • To define behavioral health quality measures, and how they’re used
  • To describe the growing importance of value-based care in behavioral health care
  • To discuss payer and provider roles in quality improvement including challenges and strategies for success
Request this program for your region or organization today! This live (online or in-person) presentation, and others like it, are available for free for PsychU members. View our complete listing of presentations and programs by visiting our Request A Presentation page.

In this presentation, the objectives are to:

  • Explain why Motivational Interviewing can be an effective approach to engage patients
  • Discuss the spirit of Motivational Interviewing and core communications skills
  • Discuss the possible clinical effect of Motivational Interviewing and some scenarios in which it can be employed
Request this program for your region or organization today! This live (online or in-person) presentation, and others like it, are available for free for PsychU members. View our complete listing of presentations and programs by visiting our Request A Presentation page.

In this presentation, the objectives are to:

  • Provide a brief overview of Major Depressive Disorder (MDD) and measurement-based care (MBC)
  • Understand the benefits of MBC and commonly used MBC tools
  • Understand why measurement-based tools are underutilized
  • Discuss possible strategies for implementing MBC tools into clinical practice

Request this program for your region or organization today! This live (online or in-person) presentation, and others like it, are available for free for PsychU members. View our complete listing of presentations and programs by visiting our Request A Presentation page.

In this presentation, the objectives are to:

  • Examine prevalence and burden of major depressive disorder
  • Identify gaps between primary care and psychiatry
  • Discuss potential roles of nurses in collaborative care practices
  • Review examples of measurement-based care in major depressive disorder

Request this program for your region or organization today! This live (online or in-person) presentation, and others like it, are available for free for PsychU members. View our complete listing of presentations and programs by visiting our Request A Presentation page.

In this presentation, the objectives are to:

  • Review underlying mechanisms of inflammation and understand how they may affect physical and mental health
  • Discuss nonpharmacological interventions that may have  anti-inflammatory effects
  • Explore practical approaches for implementing nonpharmacological interventions

Request this program for your region or organization today! This live (online or in-person) presentation, and others like it, are available for free for PsychU members. View our complete listing of presentations and programs by visiting our Request A Presentation page.

In this presentation, the objectives are to:

  • Discuss current developments in digital health for psychiatry and consider the advantages and challenges of using digital tools
  • Examine the use of technology in promoting treatment adherence
  • Review shared decision making in psychiatry and the contribution that digital tools can make to its implementation

Request this program for your region or organization today! This live (online or in-person) presentation, and others like it, are available for free for PsychU members. View our complete listing of presentations and programs by visiting our Request A Presentation page.

In this presentation, the objectives are to:

  • Examining the neurobiology of wellness interventions and appreciating the associated clinical implications
  • Review data from a 30-day prescriptive wellness program
  • Discuss wellness strategies focusing on the importance of accountability

Request this program for your region or organization today! This live (online or in-person) presentation, and others like it, are available for free for PsychU members. View our complete listing of presentations and programs by visiting our Request A Presentation page.

Medical science relies in great part on quantifying states of health. But effective tools have not always been available to psychiatrists and other mental health care providers. In this presentation, Mark Opler, PhD, MPH, Chief Research Officer at Medavante-Prophase, discusses the evolution of the Positive and Negative Syndrome Scale (PANSS), with a focus on the PANSS-6, whose features include its brevity, practicality, and sensitivity to change. Dr. Opler goes on to discuss the Simplified Negative and Positive Symptoms Interview (SNAPSI) and the specifics of its structure.

Featuring:

  • Mark Opler, PhD, MPH
    Chief Research Officer, Medavante-Prophase
  • Stephen Murray, PharmD, MBA
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.


Mark Opler, PhD, MPH, is Chief Research Officer at Medavante-Prophase, where he directs scientific research and development. Additionally, he is an Executive Director and Board Member of the PANSS Institute and contributed to the most recent edition of the PANSS manual.

Stephen Murray, PharmD, MBA, is Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

The U.S. Department of Health and Human Services has extended the coronavirus disease 2019 (COVID-19) public health emergency declaration for an additional 90 days. Secretary Alex Azar endorsed the renewal on July 23, 2020, ahead of its expiration on July 25. With it comes several policy implications for physicians that would have disappeared over the weekend.

Mr. Azar said the administration will continue its whole-of-America response to ensure Americans can get the care they need. A number of organizations have advocated for the extension, citing several ramifications of the renewal, including continuing requirements that payers cover COVID-19 testing without cost-sharing, telehealth waivers, and the 20% add-on Medicare payment for treating coronavirus inpatients.

The mission of the U.S. Department of Health & Human Services is to enhance and protect the health and well-being of all Americans. The department seeks to fulfill that mission by providing for effective health and human services and fostering advances in medicine, public health, and social services.

For more information, please contact:

  • ASPR Press Office, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, District of Columbia 20201; 202-205-8117; Email: asprmedia@hhs.gov; Website: www.hhs.gov

About 67% of adults ages 18 to 64 enrolled in a high deductible health plan (HDHP) have a health savings account, but 55% do not contribute. About one-third of HDHP enrollees do not have a health savings account. Among HDHP enrollees with a health savings account who contributed money to it in the past 12 months, the most frequent level of contribution was $2,000 or more. People with less education and/or low health literacy were less likely to make HSA contributions. As of 2016, about 40% of privately insured adults were enrolled in an HDHP.

An HDHP is defined as a private insurance plan with a deductible of at least $1,300 for an individual or $2,600 for a family in which the plan does not pay out until the deductible is met. HSAs are special savings accounts that allow HDHP enrollees to contribute pre-tax dollars to the HSAs to save for future health care expenses.

Additional findings about the intersection of HDHP enrollment and HSAs were as follows:

  • About 70% of HDHP members who enrolled through a health insurance exchange and 36% of people whose employer offered only one option lacked an HSA.
  • 55% of HDHP members with an HSA had not contributed money to it in the past 12 months.
  • Nearly 32% of those with an HSA said they were unable to afford saving for health care.

These findings were reported in “Use of Health Savings Accounts Among US Adults Enrolled in High-Deductible Health Plans” by Jeffrey T. Kullgren, M.D., MS, MPH; Elizabeth Q. Cliff, Ph.D.; Christopher Krenz, BA; et al. The researchers analyzed survey responses from 1,637 working-age, English-speaking adults enrolled in an HDHP for at least 12 months. The survey was conducted in August and September 2016. The respondents were asked if they had an HSA, defined in the National Health Interview Survey as “a special account or fund that can be used to pay for medical expenses” that are “sometimes referred to as health savings accounts (HSAs), health reimbursement accounts (HRAs), personal care accounts, personal medical funds, or choice funds, and are different from flexible spending accounts.” The respondents were also asked if they saved for health care expenses in the last 12 months and, if so, which savings vehicles they used and how much they saved. Those who had not saved were asked to state why. Other survey questions health status and source of insurance coverage, as well as factors that could potentially influence health care savings, such as consumer engagement, financial literacy, and health insurance literacy.

The full text of “Use of Health Savings Accounts Among US Adults Enrolled in High-Deductible Health Plans” was published July 17, 2020, by JAMA Network Open. An abstract is available online at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768350.

For more information, contact:

  • Jeffrey T. Kullgren, M.D., MS, MPH, Assistant Professor, Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Post Office Box 130170, Ann Arbor, Michigan 48113; Email: jkullgre@med.umich.edu; Website: https://ihpi.umich.edu/our-experts/jkullgre

The U.S. has historically “separated” the health of an individual from their social circumstances. “Clinically appropriate” was added to the payment criteria to address level of care—the least restrictive level of care only. But social issues or supports were never in the equation.

That perspective has changed for a couple reasons. Over a decade ago, the fundamentals of health insurance underwriting changed with the Patient Protection and Affordable Care Act. The end of preexisting condition exclusions, the end of annual and lifetime care limits, parity for behavioral health services, and the requirements to accept all applicants eliminated the practice of shifting people with more expensive and complicated health conditions from private health plans to public programs. This situation prompted more investigation about the drivers of use of health care resources. What the research found—health care utilization is driven by a number of factors related to the environment (e.g., poverty), demographics (e.g., gender, insurance status), and mental and physical health (e.g., chronic conditions, serious mental illness, addiction). And the pandemic has and will continue to exacerbate the social needs of the U.S. population—more anxiety and depression, loss of housing, loss of income, interrupted education, and food insecurity.

The social supports/health connection was the focus of a recent web briefing, Population Health: Clinical & Administrative Implications, featuring OPEN MINDS Senior Associates, Sharon Hicks, Paul Duck, and OPEN MINDS Vice President, Richard Louis, III. They discussed how health plan managers have acted on this emerging body of data and are investing in social support services as a tactic for reducing member spend. A just-published survey of social service investments by Medicaid health plans in Texas and California, Comparison Of SDOH-Related Investments By Texas And California Medicaid Health Plans, confirmed this trend, finding that all of the Texas plans addressed food insecurity and transportation, while 71% of plans addressed housing issues. In California, housing instability was addressed by 84% of plans, while lack of transportation and food insecurity were addressed by 79% and 74% of plans, respectively. There are many examples of these health plan initiatives in our recent coverage:

  • Humana has a number of initiatives focused on social supports. They launched a value-based program that pays provider organizations for social determinants of health (SDOH) screenings; documentation of assessment findings; and connecting the member to appropriate resources. They have also continued their “Bold Goal” initiative, launched in 2015, with two additional cities (Cincinnati, Ohio and Detroit, Michigan) announced in May 2020.
  • CVS Health/Aetna launched a collaboration with Unite Us to develop a social determinants of health platform and connect Aetna Medicaid members with a coordinated network of local social service provider organizations.
  • Kaiser Permanente created a three-year initiative with Community Solutions to end chronic homelessness in 15 communities.
  • Horizon Blue Cross Blue Shield of New Jersey announced a demonstration project to assist community health workers in addressing SDOH through an online platform, NowPow.
  • Optum has a new partnership with Wider Circle and Helping Hands Community Partner—“Community Food Circle”—providing Optum beneficiaries in Los Angeles with healthy food amid the COVID-19 pandemic.

And, at a broader level, The Centers for Medicare & Medicaid Services (CMS) has recently allowed payment for services for “social needs” out of Medicare Advantage health plan savings. This is the first time that CMS has broadened the definition of services that can be paid with Medicare funds.

Many traditional specialty provider organizations have a long history of, and great expertise in, addressing the social needs of consumers. How do those organizations meet the emerging market need for connected health and social services and improve their market positioning? My colleagues offered some advice.

Include this expertise in your market positioning—If your organization has expertise in addressing the social support needs of consumers, do health plans managers and other payers know about that expertise? This is a matter of market positioning—understanding whether or not that expertise is a real market differentiator. And, if it is “repositioning,” how you present your organization and your brand—focusing on that expertise and attracting new referrals.

Provide linkages to social support services to all consumers—whether in fee-for-service or value-based initiatives—In your current services, providing referrals and supports for consumers to meet their social support needs is just good business. It results in better consumer outcomes and is a differentiator for health plans. As Ms. Hicks noted, a clinical social worker may not be able to find housing for a consumer, but they can easily arrange a contact with staff at a community-based organization that can. Social needs assessment and social services referrals can be built into standard clinical practices.

Develop targeted approaches to social services for value-based contracts and measure their impact—If your organization has value-based contracts, your management team (like the management teams of health plans) should be thinking about what social support services could improve performance and improve profitability. And any initiative needs a financial analysis of costs and likely returns—and a return-on-investment analysis of whether the predicted financial gains are achieved.

Evaluate the creation of new social support service lines focused on the needs of health plans and other payers—It’s clear health plans and other payers are investing in social services, but what exactly are they looking for? In the OPEN MINDS 2019 survey of health plans, Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing and Delivery System, found that 27% of health plans are investing in initiatives to improve access to affordable housing and 21% are investing in transportation initiatives. Thirteen percent are investing in food insecurity. To decide whether your organization should invest in a new service line focused on social supports requires the same process as developing any other service line- market research to determine specific needs, assessment of the competition, operational and financial feasibility analysis, and a marketing launch plan. The key, as Mr. Louis underscored, is to first understand your organization’s current ability to provide social support programs—then come together with the community to better understand the needs of consumers while aligning the strategic initiative with the goals of the health plan or payer.

The nation’s largest private funder of suicide prevention research, the American Foundation for Suicide Prevention (AFSP) announced the research priority areas for the 2020-2022 grant funding cycles. The new research priorities are suicide prevention within underrepresented racial and ethnic communities and the evaluation of technological tools for suicide prevention. Applications in these areas will be reviewed along with the general pool of grant applications, with priority given to strong grants in the designated fields.

This year’s focus on diversity is a part of AFSP’s larger commitment to addressing the disparity in mental health care access. With the vast array of technological tools for suicide prevention, the second priority area is on evaluation of technology for suicide prevention. The two-year priority period allows for resubmission of unsuccessful applications in the second year. Each application is reviewed multiple times by the top suicide prevention researchers in the world. The research grants are funded mainly through individual donors who attend the AFSP Out of the Darkness Walks and other public education events. Many of the AFSP grantees then go on to receive further funding from the National Institute of Mental Health and other large funding agencies. Last year, AFSP awarded over $5M in research grants for nearly 40 new studies.

The American Foundation for Suicide Prevention is dedicated to saving lives and bringing hope to those affected by suicide. AFSP creates a culture that’s smart about mental health through education and community programs, develops suicide prevention through research and advocacy, and provides support for those affected by suicide. Led by CEO Robert Gebbia and headquartered in New York, AFSP has local chapters in all 50 states with programs and events nationwide.

For more information, please contact:

  • American Foundation for Suicide Prevention, 120 Wall Street, 29th Floor, New York, New York 10005; 212-363-3500; Email: info@afsp.org; Website: www.afsp.org

If you or someone you know is in crisis, please contact the Suicide Prevention Hotline / Lifeline at 1-800-273-TALK (8255), or text the Crisis Text Line at 741-741.

Since the start of the pandemic, 53 million Americans have filed for unemployment, close to 16% of the adult population. For many of these people, the loss of their job also means a loss of health insurance.

Exactly how many Americans will lose their health insurance is not clear. Before the COVID-19 pandemic, 27.9 million non-elderly Americans—8.5% of the adult population—were uninsured. A third of the workers experiencing job loss have insurance through another family member’s job and a quarter have coverage through a Medicaid program prior to the pandemic. Of the estimated 10 million people who will lose employer-sponsored health insurance between April and December 2020, a third will regain employer-sponsored insurance by being added to a family member’s policy, nearly half will be eligible for Medicaid, and 10% will be eligible for marketplace subsidies. The balance will likely be uninsured and faced with either buying individual health insurance policies or remaining uninsured and paying cash for services.

This means an increase in enrollment in Medicaid health plans and commercial health plans. There will also be a likely bump in Medicare beneficiaries, with a group of consumers who will apply for coverage based on disability. And there will be an increase in uninsured, cash-paying consumers. Executive teams of provider organizations should be planning for all of the above.

Regarding Medicaid, it is likely that plans will shift a bit in the months ahead. States with stressed budgets will be looking to trim Medicaid. One way is to enroll more consumers in managed care plans and link more payments (to both health plans and provider organizations) to performance. There is financial assistance to state Medicaid plans through the Families First Coronavirus Response Act (FFCRA), with a temporary increase of Federal Medical Assistance Percentage (FMAP) by 6.2 percentage points, which will last through the end of the federal emergency period. In accepting these funds, states cannot decrease enrollment/eligibility, but can change some benefits and provider organization payments.

Now is the time to assess these likely changes in coverage and their potential impact on organizational competitiveness and sustainability in the “new normal.” It takes planning, time, and money to build a direct-to-consumer practice. And on the health plan front, it takes 18 months to go from health plan outreach to new health plan revenue. Now is the time to get started.

People who have been confirmed with mild to moderate COVID-19 can leave their isolation without receiving a negative test, according to recently revised guidance from the Centers for Disease Control and Prevention. Increasing evidence shows that most people are no longer infectious 10 days after they begin having symptoms of COVID-19. As a result, the CDC is discouraging people from getting tested a second time after they recover.

For people who have tested positive but don’t have symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive test. There are exceptions for the 10-day guidance, including people with compromised immune systems who may be infectious for a longer period of time.

The Centers for Disease Control and Prevention is the leading national public health institute of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgia.

For more information, please contact:

  • Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia, 30329-4027; 800-232-4636; Website: www.cdc.gov

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), has established a new clinical trials network that aims to enroll thousands of volunteers in large-scale clinical trials. They will be testing a variety of investigational vaccines and monoclonal antibodies intended to protect people from COVID-19.

The COVID-19 Prevention Network (CoVPN) was established by merging four existing NIAID-funded clinical trials networks: the HIV Vaccine Trials Network (HVTN), based in Seattle; the HIV Prevention Trials Network (HPTN), based in Durham, North Carolina.; the Infectious Diseases Clinical Research Consortium (IDCRC) based in Atlanta; and the AIDS Clinical Trials Group based in Los Angeles. Those individual networks will continue to perform clinical trials for HIV vaccine and prevention and other infectious diseases in addition to their new COVID roles.

The network’s vaccine testing will be led by Larry Corey, M.D., of the Fred Hutchinson Cancer Research Center in Seattle, and Kathleen M. Neuzil, M.D., MPH, of the University of Maryland School of Medicine. The network’s monoclonal antibody clinical testing efforts will be led by Myron S. Cohen, M.D., of the University of North Carolina, Chapel Hill, and David S. Stephens, M.D., of Emory University in Atlanta. The HVTN, which is based at the Fred Hutchinson Cancer Research Center, will serve as the CoVPN’s operational center.

NIAID continues to pursue progress in understanding, treating, and preventing infectious and immunologic diseases, it recognizes that new challenges to public health continue to emerge. NIAID will continue its tradition of supporting innovative scientific approaches to address the causes of these diseases and find better ways to prevent, diagnose, and treat them.

For more information, please contact:

  • NIAID Office of Communications, 5601 Fishers Lane, MSC 9806, Bethesda, Maryland 20892-9806; 301-402-1663; Email: NIAIDNews@niaid.nih.gov; Website: www.niaid.nih.gov

“If we think what we are doing today will serve us tomorrow, then we will not be here tomorrow.” This comment, made at The OPEN MINDS 2020 Strategy & Innovation Institute keynote address, Innovation By Design: Capturing Value In Health Care, by Carl Clark, M.D., Chief Executive Officer, Mental Health Center of Denver (MHCD), are words of wisdom for every executive team member of a specialty provider organization. Innovation is no longer a luxury; it is a strategic survival skill.

The pandemic has sped the need for innovation in service delivery. On one hand, it has changed “customer preference” (both consumers and health plans) for services—more virtual, more home-based, and more data-driven. On the other hand, many organizations have been busy introducing new services designed for these changing times. There are four announcements below, each an example of a game changer for specialty provider organization market positioning:

  • Optum’s purchase of AbleTo. An online behavioral health service delivery system now owned by a major health insuring organization, UnitedHealth Group.
  • Heal’s launch of “Heal Pass.” A program that offers physician house calls and next day shipping of medications for a monthly fee of $49 dollars.
  • Mayo Clinic’s expansion of nationwide acute care services at home. Through a partnership with Medically Home and a new “hospital-at-home” advanced care platform, Mayo Clinic’s physicians can deliver high-intensity services to and remotely monitor consumers at home.
  • Quartet’s arrangement with health plans to support mental health and primary care integration through its virtual care platform and coordinated network of mental health professionals, and to use its technology platform to provide virtual tele-psychiatry and tele-therapy to members.

Certainly, these new service offerings aren’t appropriate for all consumers—many consumers with chronic conditions and complex needs will need another approach. But many will prefer these new options—and will embrace the convenience and value they offer. And more importantly, it is these competitive forces that will reshape the service delivery system and force provider organization managers to change their service line portfolio to remain sustainable. Innovation is the solution to this strategic dilemma. As Dr. Clark says, “Innovation is about figuring out how to get people what they need in a new way, when you can’t do the things the way you usually would.”

But how do you nurture a mindset of innovation? How do you embed it in the way you do business? And how do you scale for success? Dr. Clark described five fundamentals that provider organization executives should think about—strategy, culture, resources, partnerships, and agility.

Innovation is strategic. Innovation must be baked into your strategic planning. Dr. Clark advises that you start by asking the key questions. What is the problem you want to solve? What value does it bring (to the organization, to the community, to the consumers you serve)? Does the innovative solution align with your strategic plan? What resources do you need, and do you have the means to obtain them? What is the tolerance for risk within your organization?

At MHCD, innovation is driven by one key question—how to expand access to care. Only two in five people who need care for mental illness and addictions can access that care, says Dr. Clark. Therefore, they are solving so the three in five can also get care. They are thinking about how to expand the capacity of clinical professionals to see more people through technology supports that act as “force multipliers.”

“We look for conflict and complaints, which are opportunities to do something new and different,” explained Dr. Clark.

Innovation is a culture. A culture of innovation must start from the top but cascade down to every level of staff and those served. Executives at MHCD describe it as human-centered design engaging the people served to develop the solutions, cutting through the red tape to solve at the line level where possible, or escalating the issues quickly to the level where they can be solved. When the pandemic enforced remote work, managers at MHCD found a way to “skip the meetings and solve the problems” through daily huddles where quick decisions could be made.

Innovation also leverages input from consumers and the community. MHCD partnered with one of its local neighborhoods to create the Dahlia Campus for Health & Well-Being to support high risk youth in the community and bought four acres of land with the idea of establishing a 20,000 square foot clinic. But when they asked the community what it needed to thrive; more urgent problems became evident. There was a food desert and food swamps, with mostly junk food. MHCD could not solve for behavioral health issues without addressing the social determinants of health. So, they transformed the area into an urban farm with community gardens, a greenhouse, a teaching kitchen, a pre-school, and a pediatrics clinic. And when the kitchens had to close during the pandemic, they still found ways to get the food out. “Getting in with the community created something we never imagined,” said Dr. Clark.

Innovation needs resources. Initially, MHCD had a whole portfolio of ideas but did not dedicate the resources to nurturing them. “We had our core business and innovation was ‘other duties as assigned.’ It was like oil and water,” said Dr. Clark. It wasn’t until they created an Innovation Lab and dedicated funding and staff that they were able to make innovation happen. Today, MHCD invests 15% of its resources in innovation initiatives.

While not every provider organization might have the ability to scale innovation at the same level, a mindset of innovation will help executives get creative about funding. From talking to payers who are eager to support innovation to “crowdfunding,” the options are many when the solutions are evident.

Innovation thrives on partnerships. The resources to support innovation can come from strategic partnerships. Public-private partnerships have proved beneficial for MHCD and the communities it serves.

In 2016, MHCD set out on an ambitious project to help address the housing crisis in Denver (approximately 400 chronically homeless individuals were costing the city $11 million each year). The city issued social impact bonds to raise funds to build a 60-unit apartment building to house the homeless. And MHCD applied the “Housing First” model principles and offered trauma-informed approach to help design the apartments with personal safety in mind. Today, previously homeless consumers are staying in the apartments and either working or attending school.

Another innovative program that thrives on a public-private partnership is MHCD’s “co-responder” program where licensed clinical social workers (LCSWs) accompany police on a first visit when there are issues involving consumers with behavioral health challenges. This intervention at the first responder level helps get people into care quickly. MHCD piloted the program with six LCSWs and was able to reduce the number of people going to jail from 97% to 7% of encounters.

“Innovation enables us to get people what they need right at the moment they need it,” said Dr. Clark and informed us that once the pilot proved successful, they added 24 LCSWs to scale up the program for impact.

Innovation demands agility. For organizations just getting started on innovation, Dr. Clark recommended a rapid-fire process, “Come up with the idea, prototype it, test it, and figure out what worked well and what didn’t.”

There are two ways of thinking when it comes to innovation. The first is exploitative; taking something you already do and improving it. The second is exploratory; starting from scratch and making broad jumps. Exploration, while it can have a big pay off in the end, is risky. So, start small and leverage the resources you already have. As Dr. Clark suggested, “The innovative solution doesn’t have to be completely thought out before you start. Being agile is key—you can modify based on feedback as you go.” He also advised focusing on “the how” rather than “the what” and developing evidence-based practices right from the get-go.

Executives who support innovation must accept that failure is often part of the process. “In health care, we don’t want to make mistakes. But for an innovative culture to work, we must challenge people to take risks and make it okay if things don’t work out.

Shatterproof, a non-profit organization dedicated to reversing the addiction crisis in the United States, announced a free, first-of-its-kind tool to connect those in need with high-quality and appropriate addiction treatment.  ATLAS™, an Addiction Treatment Locator, Assessment, and Standards Platform, will launch in six states.

ATLAS evaluates addiction treatment facilities’ use of evidence-based best practices, allows consumers to see and provide feedback on their experience, and offers an easy-to-use online interface to allow those in need and their loved ones to search for and compare facilities using criteria such as location, services offered, and insurer so they can connect with appropriate treatment. ATLAS is currently available in Delaware, Louisiana, Massachusetts, New York, North Carolina, and West Virginia. The platform lists all of the state’s addiction treatment facilities for any addiction, including opioid use disorder, with more than half voluntarily providing information on services and practices they utilize.

Shatterproof worked with RTI International, an independent research institute with expertise in quality measure development, data collection, and quality reporting, to build ATLAS using a combination of rigorous analytic approaches and data collection innovations. ATLAS was funded by Arnold Ventures, the Robert Wood Johnson Foundation, and a coalition of national health care companies: Aetna, a CVS Health Company, Anthem, Inc., Beacon Health Options, Blue Cross Blue Shield of North Carolina, Cigna, Magellan Health, and UnitedHealth Group.

Shatterproof is a national non-profit organization dedicated to reversing the course of the addiction crisis in America. Shatterproof is focused on ensuring that addiction treatment is based upon proven research and ending the stigma of addiction. The organization advocates for changes to federal and state policy, payer reform, treatment quality assessment, and provides public education through online programs.

For more information, please contact:

  • Shatterproof, 135 West 41st Street, 6th Floor, New York, New York 10036; 800-597-2557; Email: info@shatterproof.org; Website: www.shatterproof.org

Following the 2016 rollout of self-scheduling of video and phone visits at Kaiser Permanente Northern California, 14% of appointments took place via phone or video telemedicine visits during 2016, 2017, and 2018. During these years, an average of 14% of appointments were selected as phone or video visits instead of office visits by health care consumers, and 7% of the telemedicine visits were by video.

Health care consumers were most likely to choose telemedicine or telephonic care if they were aged 18 to 44 years of age: about 49.4% of this demographic scheduled video visits, and 39.8% scheduled telephone visits. Those with an office visit copayment of $35 or more were 1.5 times more likely to choose a video or telephone visit than those with a $0 to $10 copayment. Consumers who were required to pay for parking in a garage structure for their visit were about 1.7 times more likely to choose a video or telephone visit than those who did not. Those who had prior experience with a video visit within the past year were about 11.4 times more likely to choose a video or telephone visit than those who had no prior experience.

The researchers concluded that health care consumers usually chose an in-person visit when scheduling an appointment through the online portal. However, telemedicine may allow health care professionals to reach vulnerable consumer groups, and may improve access for those with transportation, parking, or cost barriers when receiving on-site care.

These findings were reported in “Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians” by Mary E. Reed, DrPH; Jie Huang, Ph.D.; Ilana Graetz, Ph.D.; et al. The researchers analyzed 2,178,440 primary care appointments scheduled by 1,131,722 health care consumers after the 2016 rollout of self-scheduling for video and phone visits at Kaiser Permanente Northern California. The goal was to determine characteristics associated with those choosing between telemedicine or office visits.

The full text of “Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians” was published June 17, 2020, by JAMA Network Open. An abstract is available online at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767244.

PsychU last reported on telemedicine in “14% Of Physicians Used Telemedicine Video Visits Weekly Pre-COVID-19,” which published on June 29, 2020. The article is available at https://www.psychu.org/14-of-physicians-used-telemedicine-video-visits-weekly-pre-covid-19/.

For more information, contact: 

  • Mary E. Reed, DrPH, Research Scientist, Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, California 94612; Email: mary.e.reed@kp.org; Website: https://divisionofresearch.kaiserpermanente.org/

As a result of the coronavirus disease 2019 (COVID-19) pandemic, Sigma Mental Health Urgent Care is expanding access to mental health care across the state of Texas through their proprietary, HIPAA complaint platform. Sigma’s platform allows a psychiatrist to conduct an appointment virtually with the same quality and efficiency as a face-to-face appointment.

Sigma will also handle prescriptions remotely through the virtual platform. According to Melissa Deuter, M.D., board-certified psychiatrist and founder of Sigma Mental Health Urgent Care, the response to the new methodology has been exceptionally well received and the transition has been seamless, as the telehealth model allows Sigma clinical professionals to obtain a full view of an individual’s mental health and well-being (e.g., weight loss or gain) for the most effective treatment.

Sigma Mental Health Urgent Care provides mental health evaluations, short-term counseling, psychopharmacological services, and referrals for longer-term care when necessary. The mission of Sigma Mental Health Urgent Care Center is to improve the lives of people living with mental health disorders by providing immediate psychiatric and therapeutic services during moments of crisis as well as creating a continuity of care between our staff members and other mental health provider organizations in the community.

For more information, please contact:

  • Sigma Mental Health Urgent Care, 18587 Sigma Road, Suite 260, San Antonio, Texas 78258; 210-314-4564; ​Email: Sigma@SigmaMHUC.com; Website: www.sigmamhuc.com

Center on Addiction has changed its name to Partnership to End Addiction. In tandem, it has launched a new brand identity and redesigned website at drugfree.org. The changes are part of an evolution following the 2019 merger of two distinguished leaders in the addiction space. They also align with the organization’s ongoing efforts to address community needs at a time of increased national uncertainty exacerbating the addiction crisis.

The new website provides critical information for families impacted by addiction, as well as policymakers, researchers, and health care professionals in the addiction space. Family members seeking guidance and information can access the organization’s educational content on treatment, recovery, and prevention in addition to one-on-one support from trained helpline specialists. They can also learn about advocating for policy changes, leading efforts in their own communities, and volunteering with the organization. Professionals in government, research, and health care can engage with the organization’s state- and federal-level policy and advocacy work, professional services, partnership opportunities, and addiction research and science.

Partnership to End Addiction’s updated logo, a combined heart and check, reflects its unique approach to ending addiction with a mix of heart and science, compassion, and expertise. Its new brand design demonstrates the broad spectrum of the non-profit’s activities and its evolution as a combined organization now working on all fronts to solve our nation’s addiction crisis.

Partnership to End Addiction is a national non-profit providing personalized support and resources for families impacted by addiction. With decades of experience in direct services, communications and partnership-building, the organization mobilize families, policymakers, researchers, and health care professionals to more effectively address addiction systemically on a national scale.

For more information, please contact:

  • Partnership to End Addiction, 485 Lexington Avenue, 3rd Floor, New York, New York 10017-6706; 212-841-5200; Email: media@toendaddiction.org; Website: https://drugfree.org

On June 18, 2020, Humana announced that its “Bold Goal” initiative focused on social determinants of health continues to show improvement in population health five years after its introduction. The program works to improve the average number of “Healthy Days” by screening for and addressing members’ upstream social needs like food insecurity (inability to obtain proper nutrition), transportation problems, and loneliness (a discrepancy between an individual’s desired and actual social relationships, whether in their quality or quantity). Under the Bold Goal initiative, Humana has provided more than 2.6 million social determinant screenings. Each member screened had an average of 3.5 health-related social needs.

Humana Medicare Advantage members across all markets improved on the Healthy Days measure between 2015 and 2019. In the seven original Bold Goal communities, Medicare Advantage members reported 2.3% fewer unhealthy days, from an average of 13.58 days per month in 2015 to an average of 13.27 days per month in 2019. In non-Bold Goal communities, the average number of unhealthy days rose by 0.2%, from 13.42 days to 13.45 days. In five of the seven original Bold Goal communities (San Antonio, Texas; Baton Rouge and New Orleans, Louisiana; Tampa, Florida; and Knoxville, Tennessee), Humana Medicare Advantage members experienced fewer unhealthy days in 2019 than in 2015. In two Bold Goal communities (Louisville, Kentucky and Broward County, Florida), the average number of unhealthy days rose, which Humana attributed in part to growth of new membership in higher-risk populations in those markets.

Humana Medicare Advantage Improvement On Healthy Days Metric, 2015 To 2019, In Bold Goal Communities
Area 2015 Average Number Of Unhealthy Days In The Past 30 Days 2019 Average Number Of Unhealthy Days In The Past 30 Days Percent Change
Non-Bold Goal Communities 13.42 13.45 +0.2%
Seven Original Bold Goal Communities 13.58 13.27 -2.3%
San Antonio, Texas 14.69 13.43 -8.6%
Baton Rouge, Louisiana 13.72 13.10 -4.5%
New Orleans, Louisiana 13.38 13.09 -2.2%
Tampa, Florida 12.93 12.44 -3.7%
Knoxville, Tennessee 14.14 13.83 -2.2%
Louisville, Kentucky 12.66 13.60 +7.4%
Broward County, Florida 14.13 14.21 +0.6%

In some Bold Goal communities, Humana monitored the effects on Medicare Advantage members with specific chronic health conditions. Members with chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), depression, congestive heart failure (CHF), and hypertension are experiencing a decrease in unhealthy days compared to the prior year. Humana believes that the decrease is due to integration of procedures to identify and address health-related social needs along with health conditions, both physical and mental, in care management. Between 2015 and 2019, the number of unhealthy days declined as follows:

  • COPD: 1.2% fewer unhealthy days
  • CAD: 1.8% fewer unhealthy days
  • Depression: 2.9% fewer unhealthy days
  • CHF: 3.1% fewer unhealthy days
  • Hypertension: 3.2% fewer unhealthy days

The Bold Goal initiative uses the Centers for Disease Control and Prevention’s (CDC’s) Healthy Days tool to measure population health-related quality of life. The method for estimating unhealthy days is supported by the actual pattern of survey responses to questions regarding self-reported physical health (physical illness and injury) and mental health (stress, depression, and problems with emotions) during the 30 days prior to the survey.

Humana Inc. is a for-profit health insurance company with more than 13 million covered lives in the United States. The “Bold Goal” initiative, which began in 2015, tracks individuals’ unhealthy days for individuals and populations. The goal of the initiative was to target these social determinants of health and, community behavioral health, to help the communities Humana serves become 20% healthier by 2020 and beyond. Having reached that goal for its associates, Humana set a further goal to achieve 500,000 more “healthy days” by the end of 2022.

Since launching the Bold Goal initiative in the seven original communities, Humana has expanded the initiative to 16 total markets. In 2018, it expanded to Chicago, Illinois; Kansas City, Missouri and Kansas; Jacksonville, Florida; and Richmond, Virginia. In 2019, it expanded to Detroit, Michigan; Cincinnati, Ohio; Charlotte, North Carolina; Atlanta, Georgia; and Houston, Texas.

The full text of “2020 Bold Goal Progress Report, Data Trends” was published in June 2020 by Humana. A copy is available online at https://mms.businesswire.com/media/20200618005224/en/799300/1/Humana_BG_data+trends_final+%28002%29.pdf.  An interactive version is posted online at https://populationhealth.humana.com/2020-bold-goal-progress-report/.

PsychU last reported on this topic in “Screening Humana Medicare Advantage Members For Social Determinants Of Health Reduced ‘Unhealthy Days’ By 2.7%,” which published on June 10, 2019. The article is available at https://www.psychu.org/screening-humana-medicare-advantage-members-for-social-determinants-of-health-reduced-unhealthy-days-by-2-7/.

For more information, contact:

  • Alex J. Kepnes, Corporate Media Relations, Humana, 500 West Main Street, Louisville, Kentucky 40202; Email: akepnes@humana.com; Website: https://www.humana.com/

The Centers for Medicare and Medicaid Services (CMS) made big news once again. On June 17, CMS issued a proposed rule to grant state Medicaid programs and other payers flexibility to enter value-based payment (VBP) arrangements with drug manufacturers. The rule’s definition of VBP is an arrangement intended to align payments to therapeutic or clinical value in a population, such as evidence-based measures. The cost should be linked to existing evidence of the effectiveness and/or outcomes-based measures. Or payment should be linked to the drug’s actual performance in a consumer or a population—such as reduction in medical expenses.

A significant change is that the proposed rule allows medication manufacturers to report multiple “Best Prices” for a medication. The current Federal reporting requirements for medication prices are byzantine in my view and an impediment to rational pricing. In short, under the current Federal reporting requirements, manufacturers must report to CMS their drug’s “Best Price”—the lowest net price a manufacturer offers for the medication in the U.S. after factoring in all rebates and discounts. Manufacturers then pay Medicaid programs a rebate equal to 23.1% of a drug’s “Average Manufacturer Price” if that amount of rebate results in a net price lower than or equal to the Best Price. This is intended to assure that the post-rebate price to Medicaid programs is no more than the Best Price available on the commercial market.

This pricing situation makes manufacturers hesitant to participate in VBP. Under the proposed rule, instead of reporting a Best Price depending on a single outcome, manufactures will be allowed to use “bundled sale” price reporting. This would permit reporting of Best Price as the average net price across all sales prices. This would change Best Price to be the lowest average price that any payer actually pays per unit, including both failures and successes. And CMS is planning an alternative to the bundled sale pricing reporting. The proposed rule would allow commercial health insurers to pay different prices for a medication based on outcomes. The manufacturer would then report the lowest price that any payer negotiates for each outcome as a Best Price, as well as the lowest available price absent a VBP arrangement.

CMS Administrator Seema Verma, in her Health Affairs blog post, CMS’s Proposed Rule On Value-Based Purchasing For Prescription Drugs: New Tools For Negotiating Prices For The Next Generation of Therapies, explained the goals of the proposed rule changes: “Value-based payment in health care involves basing payment on improvements in patient outcomes….However, value-based payment for prescription drugs is still in its infancy….Today, payment for much of health care including pharmaceuticals is based primarily on volume. Volume drives negotiations; the greater the quantity of a manufacturer’s product that a payer sells, the larger the rebate that the payer usually receives from the manufacturer….Today’s proposal would empower commercial plans to negotiate based on value while extending these discounts to Medicaid programs….All Medicaid programs in the country would immediately benefit from these private market deals without having to design the arrangements themselves, as Medicaid programs would only have to pay the lowest price offered for each outcome if they chose to participate.”

With so much happening, this is probably not a top-of-mind issue for most provider organization executives. Some would argue, however, if adopted at scale, there are many implications. Generally, there are concerns that this model of VBP will limit consumer medication choices. There is also the chance that the selected performance measures will “bend” treatment patterns, with preference for certain types of programs.

But most would still add this to the list of new opportunities. For most of these arrangements, “value” will be demonstrated through reduced emergency department use, reduced use of inpatient care, fewer inpatient admissions, cutting inpatient length of stay, and improving (or achieving) particular health status measures—all achieved through the use of the “best” medications, used in the “best” way.

Put it this way—to achieve those performance measures, consumers need to take the medication, take the medication correctly, and integrate the medication into their overall disease management plan. To make that happen, pharmaceutical companies will need provider organization partners with expertise in those disease states, consumer treatment planning and care coordination, and outreach and engagement. As these regulatory changes roll out, VBP for medications will likely open the door to a variety of solutions to achieve these best practices, such as packaging digital technologies, professional services, and support services into programmatic solutions for consumers. The key will be to find these new opportunities—likely through partnerships—to operate in yet another health care market focused on value.

Following the 2016 rollout of self-scheduling of video and phone visits at Kaiser Permanente Northern California, 14% of appointments took place via phone or video telemedicine visits during 2016, 2017, and 2018. During these years, an average of 14% of appointments were selected as phone or video visits instead of office visits by health care consumers, and 7% of the telemedicine visits were by video.

Health care consumers were most likely to choose telemedicine or telephonic care if they were aged 18 to 44 years of age: about 49.4% of this demographic scheduled video visits, and 39.8% scheduled telephone visits. Those with an office visit copayment of $35 or more were 1.5 times more likely to choose a video or telephone visit than those with a $0 to $10 copayment. Consumers who were required to pay for parking in a garage structure for their visit were about 1.7 times more likely to choose a video or telephone visit than those who did not. Those who had prior experience with a video visit within the past year were about 11.4 times more likely to choose a video or telephone visit than those who had no prior experience.

The researchers concluded that health care consumers usually chose an in-person visit when scheduling an appointment through the online portal. However, telemedicine may allow health care professionals to reach vulnerable consumer groups, and may improve access for those with transportation, parking, or cost barriers when receiving on-site care.

These findings were reported in “Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians” by Mary E. Reed, DrPH; Jie Huang, Ph.D.; Ilana Graetz, Ph.D.; et al. The researchers analyzed 2,178,440 primary care appointments scheduled by 1,131,722 health care consumers after the 2016 rollout of self-scheduling for video and phone visits at Kaiser Permanente Northern California. The goal was to determine characteristics associated with those choosing between telemedicine or office visits.

The full text of “Patient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care Clinicians” was published June 17, 2020, by JAMA Network Open. An abstract is available online at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767244.

PsychU last reported on telemedicine in “14% Of Physicians Used Telemedicine Video Visits Weekly Pre-COVID-19,” which published on June 29, 2020. The article is available at https://www.psychu.org/14-of-physicians-used-telemedicine-video-visits-weekly-pre-covid-19/.

For more information, contact: 

  • Mary E. Reed, DrPH, Research Scientist, Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, California 94612; Email: mary.e.reed@kp.org; Website: https://divisionofresearch.kaiserpermanente.org/

On June 24, 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) launched Accelerate to Value, a comprehensive program to help independent primary care practices deal with financial challenges related to coronavirus disease 2019 (COVID-19). The program provides financial stabilization payments starting in September 2020 based on the primary care practice’s 2019 revenue. In exchange for receiving the payments, the practice must commit to transitioning to value-based care by the end of 2020. Starting in 2022, the participating practices will be eligible to receive monthly population-based capitated payments, rather than fee-for-service reimbursement.

To participate in the Accelerate to Value program, applications must be submitted by July 31, 2020. Participating practices will have two options:

  • Join an existing accountable care organization through a Blue Premier clinically integrated network.
  • Join Aledade, a company that helps primary care practices move to value-based care.

Accelerate to Value is intended for independently owned and operated primary care practices, including internal medicine, family medicine, pediatrics, geriatrics, multispecialty, and/or OB-GYN. Practices owned by hospitals and health systems are not eligible. Through the duration of the program, participating practices will take steps to improve clinical quality for Blue Cross NC members, including ensuring access to care, adopting and expanding telehealth, using electronic health records, and delivering preventive care and care coordination activities responsive to the COVID-19 pandemic. Practices that meet program requirements will receive a new contract amendment from Blue Cross NC.

Blue Cross NC serves more than 3.8 million covered lives. The organization is an independent licensee of the Blue Cross and Blue Shield Association.

For more information, contact: 

  • Accelerate to Value, Blue Cross and Blue Shield of North Carolina, 1965 Ivy Creek Boulevard, Durham, North Carolina 27707; Email: AcceleratePCP@bcbsnc.com; Website: https://www.bluecrossnc.com/accelerate-value-program

There is a lot of telehealth going on. Medicare has temporarily increased access through the Medicare 1135 waiver, which covers all office visits provided via telehealth in any setting throughout the country, for any physical or mental health service; has suspended enforcement of the “established-relationship” requirement; and added 85 more physician procedure codes. All provider organizations that are eligible to bill Medicare for their professional services can now deliver telehealth.

In Medicaid, most state regulations have been relaxed to provide more telehealth services for beneficiaries, including: the health care professional’s home can serve as a distance site; new consumers (i.e., those not previously receiving telehealth) are able to receive telehealth services; new HIPAA procedures for smart phones and previously non-compliant applications are allowed for telehealth services; verbal consent can be given in lieu of written consent; and telephone-only encounters. In total, 44 states have modified their Medicaid state plans to authorize the coverage of telehealth services for Medicaid beneficiaries.

In a new OPEN MINDS survey, they looked at what has been happening in health plans. What did they find? Approximately 95% of health plans report waiving cost-sharing requirements for beneficiaries. 42% of health plans have contracted with out-of-state or out-of-network provider organizations to deliver telehealth services. They also identified that approximately 22% of health plans are reimbursing provider organizations for telehealth services at the same rate as face-to-face interactions, and 45% of health plans have modified their benefits during the COVID-19 outbreak, including eliminating co-pays, reimbursing the same as in-person, and making treatment related to COVID-19 free.

They also looked at the specialty managed behavioral health organizations (MBHOs)—approximately 46% of MBHOs have reported policy or provision changes since the COVID-19 outbreak. 21% of MBHOs have modified their service delivery to waive cost-sharing requirements and approximately 18% have contracted out-of-state or out-of-network provider organizations to deliver telehealth services. And 18% are reimbursing provider organization for telehealth services at the same rate as face-to-face interactions.

But the big planning question for provider organization management teams is what will happen after the crisis period ends? We have seen health plans set expiration dates on the expanded telehealth benefits, but those dates have been repeatedly moved—for example, Blue Cross Blue Shield of Texas has moved their cut-off date three times. Some states like Colorado and Idaho have made the telehealth expansion permanent. At the federal level, there is still no concrete plan on how long the current benefits will last, but earlier this month, 38 senators released an open letter asking U.S. Secretary of Health and Human Services Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma to provide a plan to make the expanded telehealth access permanent. And as Ms. Verma said earlier in the crisis, “the genie is out of the bottle” and there is no going back.

Yesterday, OPEN MINDS hosted a private roundtable briefing, Telehealth – What Will The Payers Change Post-COVID-19? Let’s Ask Them: An OPEN MINDS Executive Roundtable, for their Elite members of OPEN MINDS Circle on this topic. The faculty—Deborah Adler, Senior Associate at OPEN MINDS; Kathleen Mahieu, Director of Digital Product Innovation and Strategic Partnerships at Aetna Mental Wellbeing; Sean Schreiber, Executive Vice President of Network and Community Health at Alliance Health; Amy Pearlman, Vice President of Clinical Provider Strategy at Beacon Health Options; and Roberta Montemayor, Director of Telemental Health Innovation for Network Strategy Optum Behavioral Health—provided a few key takeaways about what managers can expect in the future.

Payers will continue to offer provisions to encourage telehealth but need to see the value. They need performance measures that demonstrate clinical effectiveness and engagement. They need to know if telehealth services are delivering the same quality and clinical outcomes that face-to-face services can. They need to see if consumers are staying engaged. For example, Mr. Schreiber explained, “We are seeing increased engagement for individuals already involved in care grow over time, but we aren’t seeing as much growth of new members coming into care. The focus needs to be on what the barriers are and how providers are handling bringing new members into care via telehealth, as we see a decrease in new member access and fewer new assessments.”

Payers also noted that the focus on quality and performance will likely expand from the individual-level to a programmatic level, Ms. Pearlman noted that Anthem/Beacon has been asking questions like “How are you being thoughtful in terms of standard operating procedures? How do you handle a crisis?” She noted, “These are the types of programmatic questions that will look different over telehealth than when someone is in the room with you.”

On July 17, 2020, the North Carolina Department of Health and Human Services (NCDHHS) announced it has selected 39 vendors, among them health and human service provider organizations, to conduct testing and contact tracing for coronavirus disease 2019 (COVID-19). These organizations represent the state’s initial pool of qualified vendors to support the state’s response to COVID-19. NCDHHS selected the first group of 26 organizations on June 19 and selected 13 more on July 17, 2020.

The state is using a rolling qualification process and vendors will be able to submit a response by the first of every month through December 2020. The goal is to help NCDHHS surge resources such as testing, lab capacity, and contact tracing to respond to the COVID-19 pandemic. Organizations could apply to be qualified for individual or multiple components.

The first areas of work focus on testing all residents and staff of nursing homes and significantly increasing testing for African American/Black, LatinX/Hispanic, Native American, and refugee populations in ZIP codes that lack access to testing sites. Historically marginalized populations are being disproportionately impacted by COVID-19 due to long standing health inequities that NCDHHS is addressing proactively as it responds to the pandemic.

Testing and lab capacity: The state is focusing on supporting historically marginalized populations, testing in congregate living facilities, testing in areas with outbreaks, addressing low-tested counties or communities, and supporting businesses and their workforce. Qualified vendors for testing and laboratory reserve capacity include:

  1. CW Williams Community Health Care Center
  2. EGL Genetic Diagnostics
  3. Laboratory Corporation of America Holding
  4. Omnicare, a CVS Health Company
  5. Orig3n, Inc
  6. United Providers of Health LLC
  7. University Health System of East Carolina

Qualified vendors for testing only include:

  1. Cone Health
  2. Groundwater Solutions
  3. Mako Medical
  4. North Carolina Community Health Center Association
  5. Piedmont Health Services and Sickle Cell Agency
  6. Substance Abuse Treatment Labs
  7. Visit Healthcare

Qualified vendors for lab capacity only include:

  1. Kashi Clinical Laboratories
  2. Mako Medical
  3. Substance Abuse Treatment Labs

Contact tracing: NCDHHS sought vendors who represent the communities and people impacted by COVID-19 to build on the work of local health departments. Contact tracing identifies people who have recently been in close contact with someone who has tested positive for COVID-19. Qualified vendors for contact tracing include:

  1. 22nd Century Technologies
  2. Agile Government Services, Inc.
  3. AM LLC
  4. Arbor/Res-care
  5. Atrium Staffing
  6. Automated Health Systems
  7. BizTechPeople LLC
  8. CW Williams Community Health Care Center
  9. Computer Aid Inc (CAI)
  10. Conduent State Healthcare LLC
  11. Global Contact Services
  12. Grace Federal Solutions LLC
  13. Groundwater Solutions
  14. Intellect Resources
  15. Jennifer Temps, Inc
  16. K4 Solutions Inc
  17. Keystone Peer Review
  18. Maximus Health Services
  19. Medical Edge Recruitment LLC
  20. Piedmont Health Services and Sickle Cell Agency
  21. PRC
  22. Public Consulting Group Inc
  23. ResponsePoint
  24. SouthEastern Healthcare of NC
  25. Spanish Speaking LLC
  26. SWC Group LLP dba Healthcare Solutions
  27. WellSky

From March 1, 2020 through July 20, more than 100,000 North Carolina residents have been diagnosed with COVID-19. There have been 1,642 deaths due to COVID-19. Of the more than 1.4 million tests conducted through July 20, about 7% have been positive for COVID-19.

For more information, contact:

  • Mandy Cohen, Secretary, North Carolina Department of Health and Human Services, 101 Blair Drive, Adams Building, 2001 Mail Service Center, Raleigh, North Carolina 27699-2001; 919-855-4840;  Email: news@dhhs.nc.gov; Website: https://covid19.ncdhhs.gov/.

Cases of coronavirus disease 2019 (COVID-19) were 5.5 times higher among prisoners compared to the general population from March 31 to June 6, 2020. Overall, the prison case rate was 3,251 per 100,000 prisoners, while the U.S. case rate was 587 per 100,000 individuals. The COVID-19 death rate among prisoners during this time was 1.3 times as high as the general population rate. The crude COVID-19 death rate in prisons was 39 deaths per 100,000 prisoners, while the general population COVID-19 death rate was 29 deaths per 100,000. In total, there were 42,107 total cases, and 510 total deaths, among 1,295,285 prisoners as of June 6, 2020.

The researchers concluded that COVID-19 case rates have been much higher, and escalating much more rapidly, in prisons than in the U.S. population. Although some facilities did engage in COVID-19 mitigation and control strategies, findings suggest that COVID-19 in U.S. prisons is unlikely to be contained without implementation of more effective infection control.

These findings were reported in “COVID-19 Cases and Deaths in Federal and State Prisons” by Brendan Saloner, Ph.D.; Kalind Parish, MA; Julie A. Ward, MN, RN; and colleagues. The researchers analyzed data collected by the University of California, Los Angeles (UCLA) Law COVID-19 Behind Bars Data Project from March 31, 2020, to June 6, 2020. The goal was to examine COVID-19 case rates and deaths among federal and state prisoners.

The full text of “COVID-19 Cases and Deaths in Federal and State Prisons” was published July 8, 2020, by JAMA Network. An abstract is available online at https://jamanetwork.com/journals/jama/fullarticle/2768249.

PsychU last reported on this topic in “Rate Of COVID-19 Cases & Deaths In State Prisons Over Three Times Higher Than General Population,” which published on July 27, 2020. The article is available at https://www.psychu.org/rate-of-covid-19-cases-deaths-in-state-prisons-over-three-times-higher-than-general-population/.

For more information, contact:

  • Brendan Saloner, Ph.D., Associate Faculty for Berman Institute of Bioethics, Assistant Professor, Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Room 344, Baltimore, Maryland 21205;  Email: bsaloner@jhu.edu; Website: https://bioethics.jhu.edu/people/profile/brendan-saloner/

About 17% of accountable care organizations (ACOs) are developing new home visit programs, according to topline results of a recent survey of 163 ACOs. About 26% of ACOs already have a home visit program. Another 25% conduct home visits, but do not have a formal program. About 32% said they had no plans to start a home visit program.

The majority of ACOs that have or that are developing a home visit program use it to deliver primary care. According to survey responses, other reasons for home visit programs are part of a hospital-at-home model, to support care coordination, or to support transitions from inpatient or residential settings to home care. A minority of programs are intended to address social determinants of health.

The survey was conducted from September 2019 through the start of January 2020 by the Institute for Accountable Care (IAC) and West Health Institute with members of the National Association of ACOs (NAACOS). Responses were received from 163 ACOs. The majority are participating in the Medicare Shared Savings Program; a few are participating in the Next Generation ACO program.

The survey results are being submitted to a peer-reviewed journal. Summary results were reported on July 5, 2020, in “Nearly 70% of ACOs Will Soon Offer Some Type of Home Visits” by Bailey Bryant for Home Health Care News. The article is posted at https://homehealthcarenews.com/2020/07/nearly-70-of-acos-will-soon-offer-some-type-of-home-visits/.

For more information, contact:

  • David Pittman, Health Policy and Communications Advisor, National Association of Accountable Care Organizations, 601 13th Street Northwest, Suite 900 South, Washington, District of Columbia 20005; 202-640-2689; Email: dpittman@naacos.com; Website: https://www.naacos.com/. 

On June 2, 2020, Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced it had expanded its Horizon Neighbors in Health (HNIH) demonstration project that addresses social determinants of health (SDOH). Horizon BCBSNJ partnered with six health systems to expand the program to members in 70 ZIP Codes across 11 counties (Bergen, Essex, Hudson, Mercer, Monmouth, Morris, Ocean, Passaic, Sussex, Union, and Warren). The health systems are Atlantic Health Systems, Hackensack Meridian Health, RWJ Barnabas Health, the Trenton Health Team, University Hospital, and St. Joseph’s Health. Each health system received grants to hire and train local community health workers; in total 60 will be hired. Over three years, Horizon BCBSNJ anticipates that the health systems will enroll 24,000 members covered by its commercial, Medicaid, or Medicare Advantage plans.

The community health workers use an online platform called NowPow to connect Horizon BCBSNJ members with an array of non-medical services such as food, housing, mental health support, education, or employment opportunities. The program is intended to help Horizon BCBSNJ members connect to services and resources, obtain what they need to improve their health, and maintain the connections independently. Through this program, Horizon BCBSNJ seeks to demonstrate and quantify the impact of using community health workers to help members connect to SDOH on member health and on the total cost of care.

Horizon BCBSNJ is providing $25 million to over three years to fund HNIH. The funding pays for 50% of the community health worker salaries, and half of the salaries for their managers and directors. It will cover 100% of the cost for training and certification for the community health workers, and 100% of the cost of the NowPow data platform. Horizon BCBSNJ makes quarterly payments to its partners based on the number of community health workers and management staff that are predetermined to be hired. The HNIH staffing level varies by partner depending on the number of members the partner seeks to enroll in the program.

Since April 2017, Horizon BCBSNJ has piloted a version of HNIH with Robert Wood Johnson Barnabas Health’s Newark Beth Israel Medical Center. In total, the pilot reached out to assist 1,000 Horizon members living in four ZIP Codes within the medical center’s service area. In early 2019, Horizon BCBSNJ reported that for the participating members, the pilot cut their aggregate total cost of care by 25% as of October 2018. The participants had 20% fewer hospital inpatient admissions and 24% fewer emergency department visits. Their visits to behavioral health professionals increased by 35%. In 2019, Horizon began inviting other health systems across the state to participate to expand HNIH statewide.

To identify potential HNIH participants, Horizon BCBSNJ uses advanced analytics and predictive modeling that consider individual and community factors gleaned from census data, claims data, and other data sources that provide a comprehensive profile on the target population. Using grant funds from Horizon BCBSNJ, the participating health systems hire community health workers from the same communities as the potential participants. Each community health worker is trained by the Penn Center for Community Health Works and, over two weeks, completes the Penn Health IMPaCT Training and Certification Program. After training, the community health workers engage directly with high and at-risk consumers identified by Horizon BCBSNJ. Horizon monitors the progress being made by its partners to ensure that they are achieving enrollment goals.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the HNIH program has been adapted from face-to-face engagement during in-home visits by a community health worker to telephonic engagement. Since the pandemic began, the HNIH community health workers have been helping connect members to SDOH resources and helping the members manage stresses created by the pandemic. In both the face-to-face and telephonic engagement visits, the community health workers use the NowPow online platform to connect HNIH participants to services, track utilization, and document outcomes to ensure that participants are connecting with needed assistance. The NowPow platform maintains an up-to-date inventory of services available from local social, non-profit, and community service organizations.

PsychU last reported on the HNIH pilot outcomes in “New Jersey Horizon Blues Social Determinants Pilot Cut Total Cost Of Care By 25%,” which published on April 25, 2019. The article is available at https://www.psychu.org/new-jersey-horizon-blues-social-determinants-pilot-cut-total-cost-of-care-by-25/.

For more information, contact:

  • Valerie Harr, Director, Community Health, Horizon Blue Cross Blue Shield of New Jersey, 1700 American Boulevard, Pennington, New Jersey 08534;  Email: Valerie_Harr@horizonblue.com; Website: https://www.horizonhealthnews.com/horizon-neighbors-in-health/; and https://www.horizonblue.com/.

In this presentation, Becky Wong, PharmD, MBA, provides an overview of measurement-based care, how measurement-based care may be used to improve quality in psychiatry, shares a fictional case example of measurement-based care in psychiatry, as well as provides additional mental health screening resources.


Becky Wong, PharmD, MBA, is a Senior Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

In this podcast, Dr. Pallavi Joshi discusses COVID-19’s impact on her residency training and clinical practice with Jehan Marino, PharmD, BCPP, of the Otsuka Medical Affairs team. Social distancing has affected Dr. Joshi’s training, with a move from didactic lectures to more independent reading. She has witnessed the undeniable toll it has taken on her patients, too. For instance, social distancing means that those with loved ones in the hospital cannot visit them, and those who have lost loved ones are not able to grieve them at a funeral and process their loss. Although the transition to virtual care has offered many advantages, such as the elimination of travel time and effort, for some patients, virtual care presents difficulties. This is especially the case with those who struggle with compliance, such as individuals with severe mental illness, substance use disorder, or intellectual disabilities. One personal challenge Dr. Joshi has faced in her practice, especially in the early days of the pandemic, was how to provide reassurance to patients when so much was unknown with COVID-19.

Featuring:

  • Pallavi Joshi, MD
    Geriatric Psychiatric Fellow, Yale University School of Medicine, New Haven, CT
    Former Chief Psychiatry Resident, Northwell Health, New York, NY
  • Jehan Marino, PharmD, BCPP
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

PsychU · Psychiatric Resident Perspective of the Impact of the COVID-19 Pandemic from the U.S. Epicenter

Jehan Marino, PharmD, BCPP, is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

On April 20, 2020, a lawsuit was filed against the state of Connecticut alleging that the state failed to sufficiently protect residents of two state psychiatric hospitals from contracting and dying from coronavirus disease 2019 (COVID-19). The facilities are Connecticut Valley Hospital (CVH) and Whiting Forensic Hospital (WFH). Both have had outbreaks of COVID-19, and five CVH residents died. As of the date the complaint was filed, there were 73 confirmed cases of COVID-19 among residents and another 64 cases among staff at the two facilities.

The complaint, Wilkes, et al., v. Connecticut, was filed by Bazelon Center for Mental Health Law, Connecticut Legal Rights Project, and Center for Public Representation. The plaintiffs sought a preliminary injunction, and class action status. The plaintiffs asked the court to order the Connecticut Department of Mental Health and Addiction Services (DMHAS) to do the following to protect residents of state-run facilities:

  • Conform testing protocols to standards established by the Centers for Disease Control and Prevention.
  • Take steps to ensure that staff consistently wear masks and that plaintiffs are encouraged and supported in wearing masks including through education.
  • Improve hygiene and decontamination practices.
  • Implement social distancing to the maximum extent possible including by reducing consumer census.
  • Undertake a clinical review in order to accelerate discharges.
  • Grant such other or different relief the court deems appropriate.

In response to the COVID-19 outbreak, DMHAS activated its Incident Command Structure. This structure is intended to handle emergency situations and is coordinating all aspects of the DMHAS response. In addition to the Commissioner’s Executive Group, the facility chief executive officers are participating in regular conference calls. DMHAS Commissioner Miriam Delphin-Rittmon is in regular contact with the Governor’s Office as well as the Department of Public Health regarding the impact of COVID-19.

On July 15, 2020, DMHAS released its most recent weekly update on the aggregate number of laboratory-confirmed cases of COVID-19 among residents and staff in DMHAS facilities. DMHAS operates over 760 mental health and addiction beds and employs approximately 3,300 staff throughout the state-operated service system.

Cumulative Laboratory Confirmed COVID-19 Cases In Connecticut DMHAS Facilities, As Of July 15, 2020
Facility Residents Staff
Connecticut Valley Hospital 63 45
Whiting Forensic Hospital 10 24
Capitol Regional Mental Health Center 0 4
Connecticut Mental Health Center 0 9
River Valley Services 0 3
Southeast Mental Health Authority 0 2
Southwest Connecticut Mental Health System 0 7
Western Connecticut Mental Health Network  0  3
Total 73  97

As of July 15, of the 63 CVH residents diagnosed with COVID-19, 58 have recovered. At WFH, of the 10 diagnosed with COVID-19, all have recovered. Of the 97 staff members across all facilities diagnosed with COVID-19, 92 have provided medical documentation showing they have recovered from COVID-19, allowing them to return safely to work. Over the past four weeks, four staff have newly tested positive for the virus.

A spokesperson for the plaintiffs said that because the state has made several improvements at the two hospitals the motion for preliminary injunction has been withdrawn. However, the litigation will continue because a number of significant issues remain, however, including that there are a large number of persons at the facilities who could and should be discharged to safer environments.

A link to the full text of “Wilkes, et al., v. Connecticut, Motion For Preliminary Injunction” may be found in at www.openminds.com/market-intelligence/resources/060820wilkesvctcovid.htm.

For more information about the plaintiffs’ position, contact:

  • Amy Weiss, Public Affairs, Bazelon Center for Mental Health Law, 1090 Vermont Avenue Northwest, Suite 220, Washington, District of Columbia 20005; 202-203-0448; Email: amy@weisspublicaffairs.com; Website: http://www.bazelon.org/
  • Kathy Flaherty, Connecticut Legal Rights Project, Post Office Box 351, Silver Street, Middletown, Connecticut 06457; 860-262-5030; Fax: 860-262-5035; Email: KFlaherty@clrp.org; Website: https://www.clrp.org/
  • Mark Murphy, Center for Public Representation, 1825 K Street Northwest, Suite 600, Washington, District of Columbia 20006; 202-670-1008; Email: mmurphy@cpr-ma.org; Website: https://www.centerforpublicrep.org/

For more information about the state’s efforts, contact:

  • Mary Kate Mason, Public Information Officer, Connecticut Department of Mental Health and Addiction Services, 410 Capitol Avenue, Post Office Box 341431, Hartford, Connecticut 06134; 860-418-6839; Email: mary.mason@ct.gov; Website: https://portal.ct.gov/DMHAS/Newsworthy/News-Items/DMHAS-Response-to-COVID-19
  • Jim Siemianowski, Public Information Officer, Connecticut Department of Mental Health and Addiction Services, 410 Capitol Avenue, Post Office Box 341431, Hartford, Connecticut 06134; 860-305-6810; Email: james.siemianowski@ct.gov; Website: https://portal.ct.gov/DMHAS/Newsworthy/News-Items/DMHAS-Response-to-COVID-19

Over the 2020 operating year, primary care practices in the United States could lose a total of $15.1 billion in revenue due to coronavirus disease 2019 (COVID-19). This equals a loss of $67,774 in gross revenue per full time physician, from an anticipated base gross revenue of $542,190 per physician had COVID-19 not happened.

The researchers concluded that COVID-19 will cause large, meaningful revenue reductions for primary care practices during 2020. If practices are unable to collect sufficient funding through either fee-for-service or capitated payment mechanisms, these results may threaten practice viability.

These findings were presented in “Primary Care Practice Finances In The United States Amid The COVID-19 Pandemic,” by Sanjay Basu, Russell S. Phillips, Robert Phillips, et. al. The researchers used a microsimulation model incorporating national data on primary care. The goal was to estimate the potential impact of COVID-19 on primary care practice operating expenses and revenues.

The full text of “Primary Care Practice Finances In The United States Amid The COVID-19 Pandemic” was published on June 25, 2020, by Health Affairs. A copy can be found at https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00794.

For more information, contact:

  • Sanjay Basu, M.D., Ph.D., Director of Research and Population Health at Collective Health, and Director of Research at Center for Primary Care, Harvard Medical School, 635 Huntington Avenue, Second Floor, Boston, Massachusetts 02115; 617-432-2222; Email: sanjay_basu@hms.harvard.edu; Website: https://primarycare.hms.harvard.edu/faculty-staff/sanjay-basu
  • Sue Ducat, Senior Director of Communications, Health Affairs, 7500 Old Georgetown Road, Suite 600, Bethesda, Maryland 20814; 301-841-9962; Email: sducat@projecthope.org; Website: www.healthaffairs.org/1520_staff.php

The National Committee for Quality Assurance (NCQA) collects information on the performance of health care service delivery from health plans covering more than 191 million people using its proprietary Healthcare Effectiveness Data and Information Set, or HEDIS. One of health care’s most widely used performance improvement tools, HEDIS consists of more than 90 measures over six domains of care. In the behavioral health realm, HEDIS assesses depression screening and follow-up, medication adherence, access, care coordination, opioid overuse, and more. Join NCQA speakers, Junqing Liu, PhD, MSW, and Lyndsey Nguyen, MS, BA, as they provide an update on HEDIS behavioral health measures, the expansion of telehealth inclusion in HEDIS measures, the progress of and learnings from quality improvement projects, and relevant behavioral health programs.

Junqing Liu, PhD, MSW, is a Research Scientist for NCQA. As the measure lead of NCQA’s behavioral health measures, Dr. Liu guides the re-evaluation and updates of HEDIS® behavioral health measures. Dr. Liu’s research focuses on access to mental health services, evidence-based treatment for behavioral health problems, and child welfare services. Dr. Liu was previously a Research Assistant Professor at the University of Maryland School of Social Work and conducted the evaluation of a federally funded research project on the implementation of evidence-based practices in child welfare systems in six states.

Lyndsey Nguyen, MS, BA, currently serves as a Senior Health Care Analyst in the NCQA’s Performance Measurement Department at NCQA. She manages, leads, and coordinates activities related to the development of quality metrics for U.S. health care. Her areas of focus include mental health, substance use, and pain management. Ms. Nguyen holds an MS degree in physiology (complementary and alternative medicine) from Georgetown University and a BA in cognitive science from the University of Virginia.

Hiten Patadia, PharmD, RPh, is a Managed Market Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

“You can’t cut your way to prosperity.”

One of the challenges for executive teams in managing to the end of a crisis—especially an extended crisis like this one—is addressing the loss of revenue. In more normal times, the need to replace service line revenue is a gradual one. As service lines age, demand and revenue decrease with new competition. Over time, contracts are lost to competitors. The need to create new sources of revenue is gradual.

But in this pandemic crisis, we’ve seen service lines shuttered with little notice, cost increases that have changed programs from profitable to losing propositions, and a host of new competitors. The economic forecast for the U.S. is not great—and health and human services (at 17% of the country’s gross domestic product) will inevitably be affected by the downturn. The need to find “new revenue” is more pressing.

So where to look? Right now (this could change in a month), we see a few key areas of opportunity for provider organizations serving consumers with chronic conditions and complex needs—each of which we have covered over the past two months.

  1. Expansion of telehealth—Many organizations have (whether willing or not) taken the plunge and are providing virtual care services. But, for many executive teams, the perspective is to serve “current consumers.” This is an area for expansion—new payers, new consumers, new services, and new geographies.
  2. Hybrid service models—Not all services will remain “totally virtual” in the “new normal.” The market advantage will go to the organization offering service lines that combine the depth of face-to-face services with the convenience and cost reductions of virtual care. Think of services that fit into integrated care models with reimbursement based on performance.
  3. Specialty primary care—The pandemic has had a big impact on primary care. Practice revenues are down, and it is likely that many private practices will close. Physician salaries are also down. At the same time, the demand for primary care services for consumers with complex needs has never been greater and health plans are starting to move primary care payments to capitated models.
  4. Intensive home-based services—For good reason, consumers are hesitant to consider any type of residential facility unless necessary. Nursing homes, assisted living facilities, and residential treatment facilities are experiencing falling census and revenue declines as consumers and payers look for alternatives.

5. Housing alternatives—Housing has always been an issue but expect more housing dislocation as the economic outlook sinks and rental support programs decline. Creative approaches to meet the need for stable housing will be in demand.

OPEN MINDS Senior Associate, Paul Duck pointed out that “While most provider organizations are addressing the pandemic by cutting costs, the more progressive organizations are innovating and reinventing their service delivery system and are well positioned for post-pandemic opportunities.” Mr. Duck provided a few tried-and-true tips on increasing revenue in his recent web briefing, Aggressive Business Development Strategies – Adding To The Top Line With Breakthrough Services. The first is to assess whether any of these emerging market opportunities “fit” with your organization’s longer-term vision and recovery plan. The second is to do the vetting work and “due diligence” required to evaluate specific opportunities. The third is to think creatively about expanding a revenue base in a new area. Identify at-risk competitors to form a strategic partnership or enter into new markets.

Despite the significant upset to the health and human service system caused by the pandemic crisis, the move to value-based reimbursement (VBR) seems to be moving along. On June 3, The Centers for Medicare and Medicaid Services (CMS) announced adjustments to 16 value-based care (VBC) models, with goals of accounting for COVID-19-related changes in health care delivery (and the uptick in costs), as well as allowing more time for participating provider organizations to transition to VBC. And, on June 19, CMS issued a proposed rule to grant state Medicaid programs and other payers flexibility to enter value-based payment (VBP) arrangements with drug manufacturers.

At the health plan level, most recent was the launch of Blue Cross and Blue Shield of North Carolina’s “Accelerate to Value” program to help primary care practices deal with COVID-19-related financial challenges. The program, which requires primary care practices to commit to transitioning to VBC by the end of 2020, provides financial stabilization payments based on the practice’s 2019 revenue.

Over the past few months, we’ve seen similar initiatives emerge from BlueCross BlueShield of Western New York (BCBSWNY), the Pennsylvania Clinical Network with Geisinger Health Plan, and Aetna.

What this means for provider organization recovery strategy depends on the organization’s current market positioning. The likely impact of the impending payer budget crunch (both government and employer) is more managed care and more value-based reimbursement arrangements. But that will vary by specialty, by consumer type, and by geography. Many provider organization executive teams are not waiting to see what comes their way. They are using changing reimbursement as a market positioning advantage for their post-recovery strategy.

For example, Heal announced the launch of a new “health assurance” offering called “Heal Pass”—a monthly subscription of $49 dollars where enrollees receive eight physician house calls, annual physicals, and next-day shipping on medications prescribed by a Heal clinical professional. And, Talkspace has a number of subscription options that consist of unlimited texting, live sessions, or therapy options geared toward specific populations including couples and adolescents—ranging from a rate of $260 per month to $396 per month.

The question for executive teams is to evaluate whether a proposed non-fee-for-service reimbursement model would be better for market positioning—with more revenue and/or greater profitability. To evaluate that question, executive teams need an external perspective—good customer perspectives on what they need and how they prefer to pay for those services. But equally as important, executive teams need to understand the costs of their services, not only by unit of service but by type of consumer over time.

OPEN MINDS Senior Associate, Ken Carr, believes that our traditional view of VBR—reduced costs, focus on value, and consumer outcomes—needs to take on an additional dimension with the advent of models like Heal and Talkspace. Their approach to value is to identify what is important to the consumer—immediate access, price transparency, and consistent payment, with good service and outcomes implied. For provider organization managers, fee-for-service reimbursement has driven business models—filling the schedules of clinical professionals, ensuring required levels of productivity, and shaping consumer access around available office hours. And consumers have no idea how much the service costs until they receive a statement in the mail a month later. In contrast, as Mr. Carr explained, “The new approach to value must focus on ease of access—house calls, phone calls, and virtual services.” The consumer (or the health plan) doesn’t need to worry about the cost—the subscription can be worked into a monthly spending budget like a gym fee or even a Netflix subscription.

Moving to using VBR as a proactive market strategy requires setting aside past structures and creating entirely new approaches. But how do provider organization managers begin to deal with the costs of a consumer-driven access model and set prices for these new models? Identifying the unit cost of a service and the related utilization is a starting point. But building a sustainable model will also require data on how consumers access the service, how often they use the service, and the intensity of their needs. “Provider organizations must create a structure to manage a new payment method that will lower their financial risks while better meeting consumer needs. For that, having timely data, and adjusting resource capacity is critical,” said Mr. Carr.

Mr. Carr had some more pointers for provider organizations gearing up for the shift to value in his seminar, Succeeding With Value-Based Reimbursement: An OPEN MINDS Executive Seminar On Organizational Competencies & Management Best Practices For Value-Based Contracting, at The 2020 OPEN MINDS Strategy & Innovation Institute:

  • Establish yourself as the “preferred provider” with a payer or operate exclusively within a payer system. This means demonstrating outcomes above and beyond what other provider organizations are doing (and having the data to prove it) to gain and maintain a stronger market position.
  • Realign internal operations to manage payer requirements in terms of revenue cycle—an essential process to revisit in an environment where getting paid for the services you provide is critical.
  • Deliver services that are actually valued by payers—using an integrated and holistic approach to care (behavioral health and primary care), care coordination for complex consumer populations, social supports, and medication management.

At the end of the day, VBR is here to stay. As Mr. Carr explained, “Now is the time to start the transition. VBR isn’t going to be set aside or delayed as a result of the pandemic. If anything, it’s going to be adopted as a strategy to keep costs down during a time where budgets are increasingly strained.”

The increased use of virtual therapies during this pandemic crisis will likely make a permanent change in how consumers receive services in the future. But another form of technology, also driven by the staffing challenges presented by the pandemic crisis, is gaining ground in health and human services—the robot.

Before you go to that mental place that says this is too far in the future to worry about, remember that cost pressures, fear of virus transmissions, staffing shortages, and more value-based reimbursement are going to provide market opportunities for organizations with “high value” services. And many “robotic” solutions are available now and can provide unique cost and staffing advantages.

To think about using robots, it is important to remember their simple definition—a mechanical device that can perform a variety of tasks either on command or according to instructions programmed in advance. These devices can be designed in human form (an android) or simply machines designed to perform a task with no regard to their aesthetics. And one note, robots are part of most Americans’ daily lives—Amazon has more than 200,000 mobile robots working in its warehouses, alongside thousands of human workers.

Analysts are predicting an annual growth rate of 12% of health care robots. Of the many types of robots, there are five types that executive teams serving consumers with complex needs should be considering right now.

Companion robots— We’ve covered companion robots before, but the big news, however, is that there is now a window for them to be reimbursed by Medicare. In her session, Emerging Models & New Benefits For Individuals Dually Eligible For Medicare & Medicaid, at last month’s 2020 OPEN MINDS Strategy & Innovation Institute, Allison Rizer, former Vice President of Strategy and Health Policy at UnitedHealthcare, remarked that new flexibility in the definition of services that can be purchased by Medicare D-SNP plans is now allowing the purchase of services that meet the social needs of dual eligible consumers who often suffer from isolation and diminishing emotional and cognitive function, including companion robots.

Disinfection and cleaning robots—Whether operating a residential or inpatient facility, or reopening outpatient offices, provider organization management teams need more focus on disinfecting workspaces. And there are robots for that! One of these robots is the THOR UVC robot by Finsen Technologies, used for cleaning and disinfection of consumer rooms, emergency departments, perioperative, intensive care units, progressive care units, and transitional care units.

Diagnostic temperature-taking robots—Wondering what staff person is going to take temperatures at the door of your office and who wants that job? There is a robot for that! Zorabots, developed by a Belgian software company, check people’s temperatures and if face masks are worn properly…and all in 53 different languages.

Telepresence treatment robots—Taking virtual care one step further is a whole group of telepresence treatment robots. One example is Ava Robotics’ autonomous telepresence robots, which are allowing health care professionals to treat those with COVID-19 while avoiding infection. Another example comes from OhmniLabs, which announced last month ongoing investments to offer telepresence robots to health care organizations. And in Boston, a dog-like robot named Spot is being used at Brigham and Women’s Hospital and allowing physicians to interact with individuals with COVID-19 via telemedicine. The clinical professionals managing the visit may be remote or avoid contact with the consumer and participate by video but the consumers are onsite and the telepresence robots are performing essential procedures and tests.

Siri, Alexa, and other chatbots—The use of specially programmed voice-enabled tools like Alexa or Siri offer yet another way to leverage the power of “robots” (in this case, artificial intelligence). Last year, Amazon announced the launch of a new Alexa feature that allows consumers to set medication reminders by using their pharmacy prescription information, and to request prescription refills. Another interesting application is “The Patient Is In,” a suite of apps based on Siri and the Apple Watch. With the app, consumers and clinical professionals can stream data both ways, connect in real time, and manage practice logistics and scheduling.

Staffing issues alone may drive the adoption of robotic technologies. We are reminded of the notion of “force multiplier” presented by Carl Clark, M.D., President and Chief Executive Officer of the Mental Health Center of Denver. During his keynote address, Innovation By Design: Capturing Value In Health Care, at our 2020 OPEN MINDS Strategy & Innovation Institute, Dr. Clark suggested that technology can be used as a “force multiplier” to supplement the work of clinical professionals—and the early adopters are making the case.

Imagine the possibilities, Dr. Clark pointed out—one clinical professional on a crisis line can talk to one person on the phone but could text four people at once. And scaling that up, one clinical professional can see 70 consumers a year for depression and provide cognitive behavioral therapy (CBT). But what if we use artificial intelligence to provide the mechanics of CBT—the writing, the assignments, the reviews, and the clinical professional was to talk to the consumers for higher-level interventions. Then one clinical professional can see 700 consumers a year— that’s a 10-times force multiplier! Technology is all about “how we change the way we deliver services to give more people access to care,” said Dr. Clark. Because three out of five people who need care for mental illness or addictions are not receiving that care and we just don’t have an adequate workforce to meet the need.

Passport Health Plan (Passport) announced that Molina Healthcare (Molina), Evolent Health, and Passport have entered into a definitive agreement for Molina to acquire certain assets of Passport Health Plan. Molina agreed to buy certain business lines from Passport Health Plan of Louisville, Kentucky, for $20 million. The agreement helps to provide continuity of care and coverage for Passport members while also preserving hundreds of Kentucky jobs.

The agreement calls for Molina to pay an additional amount beyond the $20 million contingent upon the results of the 2020 open-enrollment period in Kentucky. Molina will also acquire the rights to the Passport Health name. Under the terms of the agreement, which is subject to regulatory approval, Molina intends to acquire the Passport brand, operational and clinical infrastructure, and certain provider organization and vendor agreements. Molina will also offer Passport employees the opportunity to continue employment with Molina. Under a separate agreement, Molina has also agreed to purchase Passport’s real estate in west Louisville.

Passport Health Plan is a community-based health plan administering Medicaid benefits to approximately 315,000 members, as of June 30, 2020. Passport has been contracted with the Commonwealth of Kentucky to administer Medicaid benefits since 1997.

Molina Healthcare, Inc., a FORTUNE 500 company, provides managed health care services under the Medicaid and Medicare programs and through the state insurance marketplaces. Through its locally operated health plans, Molina Healthcare served approximately 3.4 million members as of March 31, 2020.

For more information, please contact:

  • Ben Jackey, Communications Director, Passport Health Plan, 5100 Commerce Crossings Drive, Louisville, Kentucky 40229; 502-457-0381; Email: ben.jackey@passporthealthplan.com; Website: https://passporthealthplan.com
  • Caroline Zubieta, Director of Public Relations, Molina Healthcare, Inc., 200 Oceangate, Suite 100, Long Beach, California 90802​​; 562-951-1588; Email: caroline.zubieta@molinahealthcare.com; Website: www.molinahealthcare.com

Research has shown that when adding measurement-based care tools to usual care, including psychiatric care, significant improvement in patient outcomes can result. In this podcast, Dwayne Mayes provides his peer support specialist perspective, and Kathy Day, MPA, BA, AA, provides her caregiver perspectives on measurement-based psychiatric care tools.

Featuring:

  • Kathy Day, MPA, BA, AA
    PsychU Patient and Caregiver Section Co-Advisor
  • Dwayne Mayes
    PsychU Patient and Caregiver Section Co-Advisor
  • Becky Wong, PharmD, MBA
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Kathy Day, MPA, BA, AA, is the Co-Advisor for PsychU’s Patient and Caregivers Section, as well as a caregiver and mental health advocate in Sacramento, CA. Ms. Day is a former member of the Sacramento County Mental Health Board and has been active in legislative reform at local and federal levels.

Dwayne Mayes is the Co-Advisor for PsychU’s Patient and Caregivers Section and a Program Director of the Recovery Network & Peer Training Program at the Mental Health Association of Westchester. He is also a former board member of the International Association of Peer Specialists. Mr. Mayes received a BA in sociology from Hunter College, CUNY.

Becky Wong, PharmD, MBA, is a Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced the adoption of the revised Confidentiality of Substance Use Disorder Patient Records regulation, 42 CFR Part 2. The adoption of this revised rule represents a historic step in expanding care coordination and quality through the Deputy Secretary’s Regulatory Sprint to Coordinated Care.

The new rule advances the integration of health care for individuals with addiction while maintaining critical privacy and confidentiality protections. Under Part 2, a federally assisted substance use disorder program may only disclose consumer identifying information with the individual’s written consent, as part of a court order, or under a few limited exceptions. Health care provider organizations, with an individuals’ consent, will be able to more easily conduct such activities as quality improvement, claims management, individual safety, training, and program integrity efforts.

The ease of sharing information, with consent, among provider organizations will enable better, higher-quality care for those with addiction. This serves as an important milestone in further aligning 42 CFR Part 2 and the Health Insurance Portability and Accountability Act of 1996 (or HIPAA) regulations.

The Substance Abuse and Mental Health Services Administration is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. Their mission is to reduce the impact of addiction and mental illness on America’s communities.

For more information, please contact:

  • Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, Maryland 20857; 800-487-4889; Website: www.samhsa.gov

Federal officials are partnering with several health systems and telehealth companies to develop a nationwide telecritical care network, including a separate telemedicine platform for the Department of Veterans Affairs (VA). The U.S. Defense Department’s Telemedicine & Advanced Technology Research Center (TATRC) and Medical Technology Enterprise Consortium (MTEC) recently launched Phase 1 of National Emergency Telecritical Care Network (NETCCN) Project, aimed at creating a network of “virtual critical care wards” to address the coronavirus pandemic.

TATRC and METC are partnering with Avera Health, the Oregon Health and Science University (OHSU), the Medical University of South Carolina (MUSC), UPMC, Philips, Deloitte Consulting, the Expressions Network, Unissant and the Geneva Foundation on the massive project. Among the projects being developed by this consortium is MUSC’s Portable Remote Operational Wireless Enabled Surge Specialist (PROWESS) ICU, a mobile telehealth platform aimed at offering remote consumer monitoring solutions for individuals who are quarantined and an in-patient telemedicine unit for provider organizations.

In a separate announcement, Philips and the VA announced a 10-year, $100 million contract to create what they’re calling the world’s largest telecritical care program. The partnership between the two longtime collaborators will build upon one of the nation’s largest connected health network, serving close to 9 million veterans a year through mHealth and telehealth platforms and more than 1,700 health care sites.

The United States Department of Veterans Affairs is a federal Cabinet-level agency that provides near-comprehensive health care services to eligible military veterans at medical centers and outpatient clinics located throughout the country. The agency also provides non-health care benefits including disability compensation, vocational rehabilitation, education assistance, home loans, and life insurance.

For more information, please contact:

  • U.S. Department of Veterans Affairs, 810 Vermont Ave NW, Washington, District of Columbia 20420; Website: www.va.gov

This presentation features Dr. Mirza I. Rahman, Senior Vice President & Chief Global Pharmacovigilance Officer, Otsuka Pharmaceutical Company, discussing the history of epidemics and pandemics, vaccines and their roles in the prevention and eradication of disease, and the ongoing public health threat posed by epidemics and pandemics. Dr. Rahman’s presentation covers smallpox, polio, tuberculosis, HIV/AIDS, and the coronavirus, and he reviews the development of the smallpox vaccine.

Featuring:

  • Mirza I. Rahman, MD, MPH, FACPM
    Senior Vice President & Chief Global Pharmacovigilance Officer, Otsuka Pharmaceutical Company

Mirza I. Rahman, MD, MPH, FACPM, is the Senior Vice President & Chief Global Pharmacovigilance Officer, Otsuka Pharmaceutical Company, responsible for leading the global pharmacovigilance function across the organization. He earned his MPH degree from Columbia University, his MD from the Stony Brook School of Medicine, and his BSc degree from the Sophie Davis School of Biomedical Education at City College of the City University of New York. A Fellow of both the American Academy of Family Physicians and the American College of Preventive Medicine (ACPM), he has been a volunteer attending physician at the Bryn Mawr Family Practice Residency Program for 16 years. Dr. Rahman has also served as a faculty member for the ACPM Board Review course since 2008. In 2014, the ACPM bestowed upon Dr. Rahman its highest honor, the ACPM Distinguished Service Award.

Julleah Johnson, PhD, and Sara Jones, PhD, APRN, PMHNP-BC, FAANP, discuss the PsychU Nurses Corner and the role of nurses in the future of health care. As the PsychU Nurses Corner Section Co-Advisor, Dr. Jones provides her perspective on what PsychU provides offers its nurse and nurse practitioner members, the most crucial needs for the nursing profession, and why she believes nurses are suited to be change agents who eliminate disparities and bias in health care.

Featuring:

  • Sara Jones, PhD, APRN, PMHNP-BC
    Associate Professor, University of Arkansas for Medical Sciences (UAMS) College of Nursing
    PsychU Nurses Corner Section Co-Advisor
  • Julleah Johnson, PHD
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.


Sara Jones, PhD, APRN, PMHNP-BC, FAANP, is Associate Professor in the College of Nursing, University of Arkansas for Medical Sciences. A Psychiatric Mental Health Nurse Practitioner (PMHNP), she also serves as the Specialty Coordinator for the PMHNP program, and is the owner of Journey Wellness Clinic, in North Little Rock, Arkansas. The Founder and former President of the Arkansas Chapter of the American Psychiatric Nurses Association, Dr. Jones is Co-Section Advisor to the PsychU Nurses Corner.

Julleah Johnson, PhD, is a Senior Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

Centene Corporation and Quartet Health announced a nationwide expansion of their existing partnership to help members quickly and easily access the behavioral health care they need. The nationwide expansion will enable members to seamlessly access quality behavioral health care from providers located in their areas who serve their unique clinical needs. To support members who want access to care from their homes during the COVID-19 pandemic, all scheduled appointments will be with provider organizations who support virtual care. Centene and Quartet first began their partnership in June 2019, launching in Illinois and Louisiana.

Quartet’s HIPAA-compliant technology platform will integrate with Centene’s population health software, allowing Care Managers and Utilization Managers to refer members to Quartet for behavioral health care, track member progress, and collaborate with the referred behavioral health provider organizations within their existing workflows. Quartet’s national network of care options includes virtual tele-psychiatry and tele-therapy, enabling members to access the care they need safely from their homes during the COVID-19 pandemic.

Centene Corporation, a Fortune 50 company, is a leading multi-national health care enterprise that is committed to helping people live healthier lives. The Company provides fully integrated and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Centene offers affordable and high-quality products to nearly 1 in 15 individuals across the nation, including Medicaid and Medicare members, as well as individuals and families served by the Health Insurance Marketplace, the TRICARE program, and individuals in correctional facilities.

Quartet Health is a health care technology and services company on a mission to improve the lives of people with mental health conditions. The collaborative technology and range of services bring together physicians, mental health providers, and insurance companies to effectively improve consumer health and drive down health care costs. Quartet is headquartered in New York City and is currently operating in several markets across the United States, including Pennsylvania, Washington, Northern California, New Jersey, North Carolina, Louisiana, and Illinois.

For more information, please contact:

  • Marcela Manjarrez-Hawn, Media Contact, Centene, 7700 Forsyth Boulevard, St. Louis, Missouri 63105; 314-445-0790; Email: mediainquiries@centene.com; Website: www.centene.com
  • Contact information: Quartet Health, Bryant Park, New York, New York 10018; 877-258-4010; Website: www.quartethealth.com

Ridesharing company Uber has rolled out a service to give public health officials quick access to user data to track coronavirus cases. The contact tracing service will be provided for free and is being introduced to public health officials in all countries where Uber operates.

The service provides health departments with data about who used Uber’s services and when and allows health agencies to urge affected drivers and users to quarantine. Uber has a protocol in place that it can disclose user information to public health agencies in an emergency involving danger of death or serious physical injury. Since COVID-19 can be transmitted through close proximity to affected individuals, public health officials have identified contact tracing as a valuable tool to help contain its spread. Uber has seen an increase in contact tracing requests from countries credited for their initial success in containing the virus, such as Australia and New Zealand.

Uber Technologies, Inc. develops, markets, and operates a ridesharing mobile app that allows consumers to submit a trip request, which is routed to crowd-sourced taxi drivers. Its smartphone application connects drivers with consumers who need a ride.

For more information, please contact:

  • Uber Technologies, Inc., 1455 Market Street, Suite 400, San Francisco, California 94103; 415-986-2715; Website: www.uber.com

Most executives are big fans of metrics-based service line analysis and the portfolio management framework that it provides for executive teams. It is one of the best ways for provider organizations to manage their present financial performance and their future market positioning.

However, portfolio management in a crisis is an essential, but completely different exercise. Service line metrics are needed to make crucial decisions. In crisis planning, there are four service line questions. First, given the newly changed environment, what service lines have a positive margin or are at least break even? Second, what service lines have a negative margin and will draw down on available cash? Third, what service lines are critical to success after the crisis and need stabilization and investment? Lastly, when you put these service lines together and look at the entirety of organizational financial performance, if no changes are made, does the organization have enough cash to make it through the crisis period?

If the answer to the last question is “no,” service line portfolio management is the key to crisis recovery strategy. Howard Snyder, Director of Business Development at ActiveDay, a provider organization offering adult day services through more than 115 centers in 12 states, explained their dilemma. As they reopen centers, they find that adhering to social distancing in the facilities and in vehicles providing transportation has limited maximum capacity to approximately 50%. While this may be close to breakeven in larger centers, programs serving 30 or fewer members are unsustainable. Mr. Snyder lamented, “We have already made the terrible decision to permanently close a number of such smaller centers. It’s crushing to walk away from these smaller communities where there are often few alternatives for members.” And he pointed out that most states have provided minimal, if any, support in the form of retainer payments, grants, or fees for remote wellness services. “Allowing vocational rehabilitation provider organizations to suddenly offer in-home care is not a viable pivot, the rates do not support a facility-based infrastructure and a transportation fleet of vehicles,” he noted.

And there is a bigger issue in portfolio management in a crisis. A crisis is the time to invest in the service lines that are key to an organization’s recovery strategy, even if this means increasing the losses in those particular service lines. Executive teams need to assure that their organization is ready to perform in the “new normal” when the crisis period is over (we’re currently using February 2021 as that likely date, based on vaccination availability information). For many organizations, that means new investments. The pain in making this decision is that it may require taking resources from other programs. As we look ahead to the continuing pandemic crisis and (hopefully) an end in the new year, executive teams can use service line analysis and portfolio management to guide their recovery plan.

The American Red Cross is launching a Virtual Family Assistance Center to support families struggling with loss and grief due to the ongoing coronavirus pandemic. People can visit redcross.org/VFAC to access a support hub with virtual programs, information, referrals, and services to support families in need. The hub will also connect people to community resources provided by partners in their area.

The Red Cross has set up a virtual team of specially trained mental health, spiritual care, and health services volunteers who are connecting with families over the phone to offer condolences, support, and access to resources that may be available. They are also providing support for virtual memorial services for families, including connecting with local faith-based community partners. Volunteers are also hosting online classes to foster resilience and facilitate coping skills. They are also sharing information and referrals to state and local agencies as well as other community organizations including legal resources for estate, custody, immigration or other issues. All Family Assistance Center support will be provided virtually and is completely confidential and free.

The American Red Cross shelters, feeds, and provides emotional support to victims of disasters; supplies about 40% of the nation’s blood; teaches skills that save lives; provides international humanitarian aid; and supports military members and their families. The Red Cross is a non-profit organization that depends on volunteers and the generosity of the American public to perform its mission.

For more information, please contact:

  • American Red Cross; 431 18th Street, NW, Washington, District of Columbia 20006; 202-303-4498; Email: media@redcross.org; Website: www.redcross.org

Torchlight, an employee-caregiver support solutions provider organization, announced the release of the first installment of its “Caregiving in Times of Crisis Toolkit.” The Toolkit is designed for organizations, businesses, individuals, parents, and caregivers in need of assistance and information during the Coronavirus/COVID-19 pandemic. With the vast majority of Americans staying at home during the pandemic, many are not only struggling with health concerns and high stress, they are also grappling with eldercare concerns, distance learning, working at home, sudden job losses/furloughs, and the death of loved ones.

The “Caregiving in Times Crisis Toolkit” contains nearly two dozen guides and tools, including articles, podcasts and webinars for eldercare and parent/child resources. Torchlight will continue to add and update resources to the Tool-kit to support individuals and families as the pandemic evolves.

Torchlight’s decision-support tools, caregiving knowledge base, and human expertise combine to reduce stress and enhance outcomes for both families and their sponsoring organizations more cost-effectively than call center or concierge-only solutions. Torchlight’s approach includes a user-friendly digital platform and a team of expert advisors.

For more information, please contact:

  • Torchlight, 25 Corporate Drive, Suite 100, Burlington, Massachusetts 01803; Website: www.torchlight.care

Headspace Inc. has added another nearly $48 million to its offerings during the coronavirus disease 2019 (COVID-19) public health crisis. The new financing was disclosed in a filing with the Securities and Exchange Commission in June 2020 under the issuer name OrangeDot Inc.

With May 27 noted as the date of first sale, Headspace raised the additional funds in the midst of the coronavirus crisis and closed quickly, selling the entire offering amount of $47.7 million and filing the documentation by June 10. Ten investors participated in the new financing. The new funding is an extension of the company’s Series C announced in February, bringing Headspace’s total funding to nearly $216 million.

Founded in 2010, Headspace is a digital meditation app for mindfulness and mental training. Headspace is headquartered in California with offices in San Francisco and London.

For more information, please contact:

  • Headspace Headquarters, 2415 Michigan Avenue, Santa Monica, Los Angeles, California 90404; Email: press@headspace.com; Website: www.headspace.com

The Illinois COVID-19 Response Fund (ICRF) has awarded Chestnut Health Systems $100,000 in its most recent round of funding. In all, ICRF awarded $6.95 million to 42 non-profit organizations around the state to help populations most burdened by the outbreak. The most vulnerable populations in downstate Illinois will be able to get help as a result of the grant award.

Chestnut will use the funding to provide mental health treatment and addiction treatment for people in Illinois impacted by the pandemic. Chestnut operates in Central Illinois, in the St. Louis Metro East area, and in Jefferson County, Missouri.

ICRF is a fund held and processed by The Chicago Community Foundation. It was created to quickly help people all over the state who are in economic, social, and health crisis due to the pandemic.

Chestnut Health Systems is a non-profit organization that has cared since 1973 for persons needing behavioral health services. Chestnut provides addiction treatment, mental health counseling, primary health care, credit counseling, and housing and supportive services. It is a leader in addiction-related research.

For more information, please contact:

  • Lori Laughlin, Director of Marketing and Communications, Chestnut Health Systems, 1003 Martin Luther King Drive, Bloomington, Illinois 61701; 309-820-3814; Email: lnlaughlin@chestnut.org; Website: www.chestnut.org

On July 8, 2020, Walgreens Boots Alliance, Inc. (WBA) and VillageMD entered a $1 billion investment agreement that will result in opening 500 to 700 in-store full-service primary care clinics in more than 30 Walgreens markets over the next five years. Walgreens and VillageMD will open “Village Medical at Walgreens” in Houston and Phoenix markets first. VillageMD will use 80% of the investment to fund the opening of the clinics and build the partnership, including integration with Walgreens digital assets. The investment gives WBA a 30% ownership stake in VillageMD.

WBA and VillageMD tested the concept in a Houston, Texas pilot with five in-store clinics, beginning in November 2019. WBA said the clinics had high consumer satisfaction, with Net Promoter Scores over 90. Tim Barry, chairman and chief executive officer (CEO) for VillageMD said the partnership will allow primary care physicians and pharmacists to work in a coordinated way to enhance the consumer experience.

The new clinics will be staffed with VillageMD primary care professionals and will integrate the Walgreens pharmacist as a key member of a multi-disciplinary team. The clinics will provide a comprehensive range of outpatient services, at-home visits, and 24/7 telehealth services. Clinic size will vary with existing store space. Most of the clinics will be about 3,300 square feet, although some may be as large as 9,000 square feet. The stores will continue to stock a broad range of retail products.

More than half of the new clinics will be located in Health Professional Shortage Areas and Medically Underserved Areas/Populations, as designated by the U.S. Department of Health and Human Services. VillageMD is in the process of recruiting more than 3,600 primary care professionals to staff the clinics. The clinics will accept a wide range of health insurance options and offer comprehensive primary care across a broad range of physician services.

VillageMD and Walgreens also recently announced the availability of Village Medical telehealth provider organizations on Walgreens Find Care™, which is an online platform that connects consumers with a wide range of health services. The rollout advances the WBA strategic priority of “Creating Neighborhood Health Destinations.” WBA runs more than 9,200 stores in the United States.

VillageMD, through its subsidiary Village Medical, provides value-based primary care services to about 600,000 people in nine markets. It partners with more than 2,800 physicians to provide tools, technology, operations, staffing support, and industry relationships. VillageMD manages $4 billion in total medical spend via value-based contracts. The Village Medical brand provides primary care for consumers at traditional free-standing clinics, Village Medical at Walgreens clinics, at home and via virtual visits.

For more information, contact:

  • Walgreens Boots Alliance Inc., 200 Wilmot Road, Deerfield, Illinois 60015; (877) 250-5823; Website: https://www.walgreensbootsalliance.com/; or VillageMD, 125 South Clark Street, Suite 900, Chicago, Illinois 60603; (312) 465-7900; Website: https://www.villagemd.com/.

Mindstrong, a healthcare company dedicated to transforming mental health through innovations in virtual care models and digital measurement, today announced it has secured $100 million in Series C fundraising. Mindstrong’s Series C raise included participation from new and existing investors, including General Catalyst, ARCH Venture Partners, Foresite Capital, 8VC, Optum Ventures, and What If Ventures, among others.

Mindstrong is unlocking an entirely new virtual care model to deliver healthcare to people living with a serious mental illness (SMI). They’re also developing technology for remote patient monitoring and mental health symptom measurement. Their in-house clinical team of therapists, psychiatrists and care coordinators use their technology platform to deliver flexible, efficient, and seamless virtual care to members through a smartphone app. Clinical services are provided by their own team of full-time clinicians on an unlimited basis and at no cost to members, thanks to Mindstrong’s value-based partnerships with national private and public insurance payers.

In addition to Mindstrong’s virtual care model, the member-facing smartphone app allows members to monitor their own mental health symptoms through AI-powered digital biomarker technology that can track changes in mental health symptoms. More importantly, the technology can also trigger alerts to a member’s clinical team when these markers indicate their mental health may be at risk or deteriorating, outside of a therapy or psychiatry session. Therapists use in-app messaging, video, and phone conversations to deliver cognitive-based therapy with members and help coordinate what is oftentimes a complex care plan for an individual living with a serious mental illness. Members can also receive telehealth medication management with a psychiatrist through the Mindstrong app.

Mindstrong is a health care innovation company, dedicated to transforming mental health through innovations in digital measurement, data science, and virtual care models. Mindstrong’s solution and health services help deliver preemptive care and improve outcomes. The company is based in Mountain View, California, and has an office in San Francisco. They are backed by ARCH Venture Partners, General Catalyst, Foresite Capital, Optum Ventures, 8VC, and others

For more information, please contact:

  • Mindstrong, 303 Bryant Street, Mountain View, California 94041; 855-944-0909; Email: info@mindstrong.com; Website: https://mindstrong.com/

Capital District Physicians’ Health Plan, Inc. (CDPHP) announced the expansion of its provider organization network to include tele-mental health services provided by Valera Health. Members can receive care in their homes through Valera’s secure telehealth platform by connecting directly through Valera’s website, or by contacting a representative at the CDPHP Behavioral Health Access Center.

The partnership expansion also addresses the need for better access to mental health services for the 370,000 plus members in the CDPHP service area. CDPHP remains committed to bringing on innovative models that focus on quality, access, and high-performing team-based care.

Established in 1984, Capital District Physicians’ Health Plan, Inc. is a physician-founded, member-focused and community-based non-profit health plan. The company offers high-quality affordable health insurance plans to members in 26 counties throughout New York.

Valera Health is a tele-mental health service company that offers team-based care across the entire spectrum of mental health needs, from behavioral health coaching and therapy, to medication management and psychiatry. Valera also offers a behavioral health engagement platform to payers, provider organizations, and health systems.

For more information, please contact:

  • Ali Skinner, Vice President, Communications Strategy, Capital District Physicians’ Health Plan, Inc., 500 Patroon Creek Boulevard, Albany, New York 12206; 518-641-5035; Email: ali.skinner@cdphp.com; Website: www.cdphp.com
  • Emma Smith, Program Manager, Valera Health, 134 North 4th Street, Brooklyn, New York 11249; Email: esmith@valerahealth.com; Website: https://valerahealth.com

Consumers with clinically significant psychological distress who used mental health services over the past 12 months reported achieving lower levels of personal recovery than a comparison group who did not receive treatment. However, those who completed treatment reported higher levels of personal recovery than those who did not complete treatment. Personal recovery encompassed four domains: the person’s perceptions of hope, empowerment, connectedness, and stigma. People with higher levels of psychological distress reported lower recovery scores. Differences according to provider organization type and adequacy of care could have been due to chance.

Significant psychological distress was defined as a score of 13 or higher on the Kessler Psychological Distress Scale (K6). The K6 asks respondents to indicate the frequency of six symptoms by answering the following questions: “During the past 30 days, how often did you feel, as follows: so sad that nothing could cheer you up; nervous; restless or fidgety; hopeless; that everything was an effort; and worthless?” The response options range from all of the time, most of the time, some of the time, a little of the time, and none of the time. Each frequency is assigned a score: 0 for “none” to 4 for “all the time,” and the individual scores are summed for an overall score, which can range from 0 to 24.

Each recovery domain was measured by participants’ responses to the set of questions. For hope, empowerment, connectedness, and life satisfaction, higher scores indicate higher levels of recovery. For internalized stigma, lower scores indicate higher levels of recovery.

Average Scores On Recovery Domains & Comparisons By Treatment Status
Domain Average Score (on a 5-point scale) Used Care Less Than 12 Months Before Survey, Compared To No Care Group Used Care More Than 12 Months Before Survey, Compared To No Care Group Completed Care Compared To Left Care
Hope 4.01 -0.31 -0.21 0.33
Empowerment 4.47 -0.14 0.14 0.29
Connectedness 3.93 -0.14 0.21 not provided
Life satisfaction 3.46 -0.24 -0.17 not provided
Internalized stigma 2.66 0.44 0.43 -0.71

If the survey respondents said they had sought treatment for a mental health problem, they were asked a series of questions about the type of services. These questions asked whether the person sought treatment from a primary care physician or some other professional such as a counselor, psychiatrist, or social worker.

These findings were reported in “Mental Health Services and Personal Recovery in California: A Population-Based Analysis” by Ryan K. McBain, Ph.D.; Rebecca L. Collins, Ph.D.; Eunice C. Wong, Ph.D.; Joshua Breslau, Ph.D.; Mathew S. Cefalu, Ph.D.; Elizabeth Roth, MA; and M. Audrey Burnam, Ph.D. The researchers obtained information about a representative cross-section of adults in California experiencing symptoms of psychological distress from the California Well-Being Survey (CWBS). The CWBS sample was drawn from participants in the 2013 and 2014 California Health Interview Surveys (CHIS), a telephone survey administered to a representative sample of over 55,000 California households. A total of 1,954 adults were recruited for the study. The goal was to examine whether utilization of mental health services as typically delivered is associated with personal recovery among adults with clinically significant psychological distress.

The full text of “Mental Health Services and Personal Recovery in California: A Population-Based Analysis” was published March 2, 2020, by Psychiatric Services. An abstract is available online at https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201900204.

For more information, contact: 

  • Ryan K. McBain, Policy Researcher, Rand Corporation, 20 Park Plaza, 9thFloor, Suite 920, Boston, Massachusetts 02116; 617-338-2059, ext. 8676; Email: Ryan_McBain@rand.org; Website: https://www.rand.org/about/people/m/mcbain_ryan.html

The volume of health care services is down. Since the start of the pandemic, in many states, non-emergency health care services other than virtual care have not been available to consumers. And it is likely that the return to a “typical” health care practice model will be slow. Health care provider organization management teams are struggling with how to reopen. Consumers are trying to weigh the risks of going outside their homes for services of any type. This drop is reflected in the financial performance of both physician practices and hospitals.

A recent Kaiser Family Foundation poll found that almost half of consumers (48%) report that they or their family members have skipped medical care, and only 11% report that the health conditions in question have worsened. PwC’s Health Research Institute (HRI) recently reported that many consumers plan to change their health care habits for medications (11%) and health care visits (16%), with 78% planning to skip at least one visit for care. Many emergency rooms have seen a dramatic drop in use—often 40% or more, and there has been a 50% to 73% drop in vaccinations for measles, mumps, rubella, diphtheria, whooping cough, and HPV. And one interesting note, on a web meeting yesterday, I listened to a health plan manager talk about how consumers were delaying even their virtual visits to primary care professionals, but that virtual visits to mental health professionals have surpassed previous face-to-face volume.

The likely effect of these delays in health services raises big strategic questions that our team considers almost daily. Will there be “pent up demand” for face-to-face services once there is a coronavirus vaccine? Will we see increases in certain conditions at some point in the future? For that reason, a recent op-ed by Sandeep Jauhar, M.D., in The New York Times caught everyone’s attention, “People Have Stopped Going To the Doctor. Most Seem Just Fine.” In his article, he said, “Perhaps Americans don’t require the volume of care that their doctors are used to providing. Most patients, on the other hand, at least those with stable chronic conditions, seem to have done OK. In a recent survey [note: the Kaiser Family Foundation poll], only one in 10 respondents said their health or a family member’s health had worsened as a result of delayed care. Eighty-six percent said their health had stayed about the same.”

One could argue that it is a little too soon to tell if the self-assessment of “health” is accurate. And the early data show that the pandemic crisis is causing excess deaths for conditions other than COVID-19. An analysis of death certificates shows that a fifth of the 24,000 excess deaths that occurred in New York City between March 11th and May 2nd were caused by factors other than COVID-19. Hospitals saw a 38% drop in serious heart-attack cases in March alone, suggesting that even people with acute, life-threatening illnesses have been avoiding medical visits. A nationwide survey conducted in April found that a quarter of individuals with cancer receiving active treatment had delays in care. The effects of delayed health screenings and the postponed management of chronic conditions are not going to be noticed by consumers—or health care professionals—in the short term.

There is a lot of inappropriate use of health care resources. We don’t use health care professionals to the top of their capabilities. We have duplication of testing because of lack of electronic health record interoperability and financial incentives to test too much. Productivity rates of health care professionals are hampered by operational process design and consumer incentives. Emergency rooms are used too often for non-urgent situations. And, our system uses highly trained professionals to do work that could be done by technology.

In the same article, Dr. Jauhar makes the point, “If beneficial routine care dropped during the past few months of the pandemic lockdown, so perhaps did its malignant counterpart, unnecessary care. If so, this has implications for how we should reopen our health care system. Doctors and hospitals will want to ramp up care to make up for lost revenue. But this will not serve our patients’ needs. The start-up should begin with a renewed commitment to promoting beneficial care and eliminating unnecessary care.”

So, what is the big takeaway from this issue for provider organizations serving consumers with chronic conditions? As we look ahead to continued rocky economic times, this pandemic-era period of health care utilization is going to be used to justify reductions in health care spending. Provider organization management teams need to go “long” on developing the ability to demonstrate value using customer-facing metrics—payers and the health plans will be asking.

Addus HomeCare Corporation (Addus), comprehensive home care provider organization, announced the acquisition of A Plus Health Care, Inc. Based in Kalispell, Montana, A Plus Health Care provides home care services, including personal care, private duty nursing, care management, and medical staffing, to approximately 1,200 clients through over 650 employees in seven office locations.

Addus closed the transaction on July 1, 2020, with funding provided by cash on hand. Financial terms of the acquisition were not disclosed. According to Dirk Allison, President and Chief Executive Officer of Addus, the acquisition represents another significant step forward in their strategy to acquire providers that strengthen their presence in their current markets.

Addus HomeCare is a home care services provider organization that primarily includes personal care services that assist with activities of daily living, as well as hospice and home health services for individuals who are at risk of hospitalization or institutionalization. Addus HomeCare’s payor clients include federal, state, and local governmental agencies, managed care organizations, commercial insurers, and private individuals. Addus HomeCare currently provides home care services to approximately 43,000 consumers through 180 locations across 25 states.

A Plus Health Care is a statewide home care and medical staffing agency for Montana with seven regional offices and over 650 employees. With almost 30 years in home care, the company is listed in the top 100 largest companies in Montana.

For more information, please contact:

  • Dru Anderson, Corporate Communications, Addus Homecare, 6801 Gaylord Parkway, Suite 110, Frisco, Texas 75034 ; 615-324-7346, Email: dru.anderson@cci-ir.com; Website: https://addus.com
  • A Plus Health Care, 926 Main Street #16, Billings, Montana 59105; 406-752-3697; Website: http://www.aplushc.com

The National Institutes of Health (NIH) is facilitating a national rapid innovation initiative to speed delivery of accurate, easy-to-use, scalable home or point-of-care tests for coronavirus disease 2019 (COVID-19) before the fall of 2020. The goal is that millions of tests will be available by September 2020, and a pipeline of more COVID-19 tests to be available in advance of the 2020 flu season. Funding of $1.5 billion for this effort was provided by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. NIH launched the Rapid Acceleration of Diagnostics (RADx) initiative on April 29, 2020.

RADx is using a competitive three-phase selection process to identify the most promising at-home or point-of-care tests for COVID-19. The finalists will share $500 million over all phases of development. Each finalist will be matched with technical, business, and manufacturing experts to increase the odds of success. If the selected technologies are relatively far along in development, they will be put into a separate track and immediately advanced to the appropriate step in the commercialization process. Projects will be assessed at each milestone and must demonstrate significant progress to receive continued support.

The NIH National Institute of Biomedical Imaging and Bioengineering (NIBIB) expanded the Point-of-Care Technologies Research Network (POCTRN) to facilitate RADx. The network will use a flexible, rapid process to infuse funding and enhance technology designs at key stages of development, with expertise from technology innovators, entrepreneurs, and business leaders across the country. The network has assembled expert review boards covering scientific, clinical, regulatory, and business domains that will rapidly evaluate technology proposals. To roll-out new products by the end of summer 2020, RADx will use a rapid, parallel process to allow quick project throughput.

Project proposals are being accepted through the online RADx portal on a rolling basis and are reviewed within a week of receipt. Each is reviewed for technical, clinical, regulatory, and commercialization feasibility. Final determinations for advancement to Phase 0 work package development are based on potential for rapid development and commercialization. For proposals advanced to Phase 0, the process is as follows:

  • Phase 0: Work Package Development. Project teams will initiate Phase 0, a “deep dive” with content and commercialization experts that produces a customized one- or two-phase work package. Awards of up to $25,000 will be provided to cover the approximately one-week participation in the RADx deep dive. Based on the results of this deep dive, a subset of projects will be selected for progression to Phase 1. More advanced approaches with higher technology readiness levels will be selected for acceleration directly to Phase 2.
  • Phase 1: Work Package #1. After NIH approves a project for entry into phase 1, funding will be provided immediately to allow work to begin. Depending on the structure of the work package, some funding may be dependent on successful achievement of interim milestones. The awarded budget will be sufficient to address barriers and risks identified in Phase 0 on a maximally accelerated timetable. In-kind support may be provided in technical, clinical, manufacturing, and regulatory domains. Depending on the milestones that must be met, project budgets are expected to range from $500,000 to millions of dollars.
  • Phase 2: Work Package #2. The awarded milestone-driven budget will be sufficient to enable full product deployment on an accelerated timeline. Additional resources will be made available through partnerships established by NIH and in-kind support provided by NIH and RADx. For projects that meet all milestones toward product distribution, budgets of tens of millions of dollars are anticipated. NIH will negotiate cost sharing with for-profit institutions as appropriate.

Project proposals for RADx can be submitted online at https://www.nih.gov/research-training/medical-research-initiatives/radx/radx-programs.

For more information, contact:

  • John T. Burklow, Director, Office of Communications and Public Liaison, National Institutes of Health, 1 Center Drive, MSC 0188, Building 1, Room 344, Bethesda, Maryland 20892-0188; 301-496-5787; Email: nmb@od.nih.gov; Website: https://www.nih.gov/

Health care has always been a stressful profession. Even before the pandemic, we knew that over half of physicians had at least one sign of burnout, including 59% of emergency physicians, 56% of obstetricians, and 55% of family and internal physicians. And burnout hasn’t been limited to physicians. Child welfare workers, nursing home aides, and many other occupational groups in health care suffer from burnout in their increasingly stressful roles.

Then comes the pandemic. The crisis has greatly exacerbated the stress of essential health care workers—the stress from fear of contracting the coronavirus or spreading it to family members; the shortage of essential health care workers during this period; and the stress of high mortality rates in emergency rooms, nursing homes, group homes, and prisons.

A report on health care workers in New York City, conducted by Columbia University Irving Medical Center and New York-Presbyterian, found that right now, half of workers have high levels of acute stress and screened positive for depressive symptoms, while one-third have anxiety. A recent survey of frontline health care workers in China treating individuals with COVID-19 found that 71% were distressed, 50% were depressed, 44% were anxious, and 34% had insomnia. Another study from Italy, currently under review, found 49.38% of health care workers reported symptoms of post-traumatic stress disorder (PTSD).

Add to this the financial instability of provider organizations—something we have reported on over the past three months. The health care sector lost 1.4 million jobs in April. And that is just the tip of the iceberg. Between May and June, dozens of large health systems announced salary reductions and layoffs. Trinity Health announced 1,000 layoffs, in addition to the 2,500 furloughs previously announced. Tower Health has announced layoffs, and Signature HealthCARE has reported layoffs at its corporate headquarters.

What should leaders do to address the growing stress levels in the health care workforce? An initiative with learning sessions with health care professionals found five common concerns—feedback, protection, preparation, support, and additional care. Health care professionals reported that, in this time of crisis, they are looking for clear communication channels and sessions with leadership; personal protection; enhanced and specific training; physical and emotional support services, and care for individuals living apart from their families.

The Royal Ottawa Hospital, in conjunction with the Phoenix Australia Centre for Posttraumatic Mental Health, has developed materials for provider organizations to reduce the impact on those susceptible to so-called moral injury, a type of PTSD. Some of the suggested measures include rotating staff between high- and low-stress roles, establishing policies to guide them through ethically tough decisions, and promoting a supportive culture. It also urges workers, including physicians, nurses, lab technicians, and social workers, to practice self-care through proper nutrition, exercise, and social connection, and to seek professional help when needed.

These issues and potential solutions were discussed by Carl E. Clark II, Chief Executive Officer of Devereux Advanced Behavioral Health, in the session The Crisis Has Changed The Key Staffing Issues For Specialty Services at The 2020 OPEN MINDS Strategy & Innovation Institute. The featured speakers, experienced managers of health care professionals, had some interesting perspectives. Their take is that there are three primary actions that leaders should take—declare crisis leadership; empower first level, direct line supervisors; and practice regular stress debriefing.

Declare crisis leadership—This strategy, like all strategies, must be a top-down endeavor with clear plans, consistent messaging, and regular reinforcement of the plan. The key is to eliminate as many stressors as possible, including any lack of clarity on process and responsibilities, inequitable workloads, or reduced staffing concerns. OPEN MINDS, Senior Associate, Ray Wolfe explained, “Increased visibility of the executive team and the verbal and nonverbal messages they convey will be critical. The leadership should speak clearly, directly, and with one voice about stress in the workplace and assure that it is defined as a community problem so that it can be discussed freely.”

OPEN MINDS, Senior Associate, Sharon Hicks, expanded on this approach, pointing out how important it is for leadership to acknowledge and remove the stigma from the “need” that staff have for support and help. Leadership must normalize the process of asking for help and help reshape how “staff vulnerability” is viewed at their organizations. She explained, “It is important to both SAY that staff should practice self-care while at the same time DOING things, like putting policies in place, that don’t oppose the need for self-care. Understanding your unspoken culture may be the first, and most important thing, that leadership can do to keep frontline staff healthy and productive.”

Empower first level, direct line supervisors—This level of leadership must understand the new strategy, their importance in implementing this strategy, and “carry the ball” when it’s time to roll it out. This will require some level of new training that at the very least requires supervisors to do weekly check-ins with staff on their emotional state and provide more consistent positive reinforcement. It might even, in some situations, require using trauma-informed principles for the benefit of staff. Mr. Wolfe noted, “We empower and provide resources to the supervisors for dealing with these concerns. They are the most trusted leader in an organization and the key to both change efforts and cultural development.”

Practice stress debriefing—The most effective response to stress is regular opportunities to talk, and realistic feedback that empowers a person to take charge of how they respond to stress. The key is to build this around a well-crafted assessment and intervention that creates opportunities for staff group sessions to discuss their concerns. OPEN MINDS, Senior Associate, George Braunstein, advised, “Wherever possible, provide staff a way to take charge of their work environment, such as designing how to maintain safety within the standards for reopening or how to ensure that any lingering organizational racism is addressed. These cannot be one-time events, but ongoing for at least the time where the stressors are still acutely active.”

Ms. Hicks summed up the situation noting, “The level of stress that direct care providers and ancillary staff who are working in hospitals is extraordinary. The stress on clinical staff in ambulatory settings has also been great. And the worst is yet to come. As the overall crisis begins to abate, staff and administrative personnel, outpatient clinics, specialty providers, and direct care staff are going to be vulnerable to experiencing significant psychological issues, including, anxiety, depression, and post-traumatic stress disorder.”

She concluded by emphasizing the importance of ongoing communication and culture building and building an approach that extends true empathy to the stresses staff face. She summarized, “Leaders and culture setters must ask employees what they need and then work to provide that for them. This is about your culture and how you express to your staff that you value them. The key to supporting staff during this unprecedented time is true empathy.”

Cedar Gate Technologies (Cedar Gate), a leading value-based care performance management company, announced its acquisition of Citra Health Solutions (Citra), a capitation management software solutions provider organization. By acquiring Citra, Cedar Gate expands its software and services capabilities across the full spectrum of value-based care. The financial terms of the acquisition were not disclosed.

By combining Cedar Gate’s existing capabilities in risk-based contract performance management, high-performance analytics, bundled payment solutions, and advisory services, the acquisition now adds capitation through Citra’s market-leading EZ-Suite platform. Citra’s EZ-Suite is a comprehensive claims, benefits, and care management software solution that delivers a highly-configurable, scalable, and flexible platform supporting multiple lines of business, including Medicare Advantage, Medicaid, Medi-Cal, carve-out and commercial populations for health plans, Independent Practice Associations (IPAs), and Management Services Organization (MSOs) accepting risk.

Cedar Gate’s enterprise platform includes the ISAAC SaaS performance management system, which enables payers, provider organizations, and self-insured employers to optimize any risk-based contract by identifying improvements in medical loss ratios, capturing lost revenues and enhancing provider network and clinical performance. Cedar Gate’s bundles and capitation administration systems also deliver high-performing, value-based centers-of-excellence programs.

Cedar Gate Technologies is a leading value-based care performance management company founded in 2014. In 2018, Ascension Ventures, a strategic healthcare venture firm, became part of the ownership group.

Citra Health Solutions provides integrated software solutions solving for the administrative, financial and clinical needs of health care payer organizations, with a highly configurable membership, authorization, capitation, claims, payment, and analytics platform. Citra Health Solutions has over 10 million members served by more than 100 Independent Practice Associations, Management Services Organization, health plans, and provider groups managing Medicare, Medicaid/Medi-Cal, specialty care, and commercial populations,

For more information, contact:

  • Julie Callahan, Cedar Gate, One Sound Shore Drive, Suite 300, Greenwich, Connecticut 06830; 469-579-8045; Email: julie.callahan@cedargate.com; Website: www.cedargate.com
  • Citrahealth, 430 Davis Drive, Suite 180, Morrisville, North Carolina 27560; 888-674-7662; Website: www.citrahealth.com

The Paul G. Allen Family Foundation announced the opening of a new housing and homeless services facility in Seattle, Washington. The Gardner House is a community center with 95 family-sized apartments, about half of which are designated as permanent supportive housing for families that need ongoing resources. The other half are rented as affordable housing to tenants experiencing or at risk of homelessness. Two units provide a third function as in-home daycare facilities designed custom for residents who wished to become childcare professionals. Gardner House has already filled 94 of the 95 units.

The Paul G. Allen Family Foundation partnered with Mercy Housing Northwest and the City of Seattle on what they call a “first of its kind” facility. The ground floor houses the Allen Family Center, an 8,000-square-foot community hub offering housing and employment assistance, childcare, other services, and events. The Paul G. Allen Family Foundation provided $30 million to develop and build the Gardner House. The facility received an additional $5 million from the City of Seattle and $10.7 million through a tax credit. Day-to-day operating funds for the resource center will come from Seattle’s Human Services Department. The Gardner House is hosting a virtual tour for its grand opening; the facility worked with local public health officials to establish safety protocols for residents and service professionals.

Founded by philanthropists Jody Allen and the late Paul G. Allen, co-founder of Microsoft, the foundation initially invested in community needs across the Pacific Northwest with a focus on regional arts, under-served populations, and the environment. The foundation supports a global portfolio of frontline partners working to preserve ocean health, protect wildlife, combat climate change, and strengthen communities. The foundation invests in grantees to leverage technology, fill data and science gaps, and drive positive public policy to advance knowledge and enable lasting change.

For more information, please contact:

  • The Paul G. Allen Family Foundation, 505 5th Avenue South, Suite 900, Seattle, WA 98104; 206-342-2000; Email: press@pgafamilyfoundation.com; Website: www.pgafamilyfoundation.org

The Pennsylvania Department of Health and Department Human Services issued updated guidance to ensure a safe return to activities, visitation, and other events for residents in nursing homes, personal care homes, assisted living residences, and private intermediate care facilities. In order to cautiously lift restrictions in long-term care facilities (LTCFs), the departments will now require all LTCFs to meet several prerequisites before proceeding into the official three-step process of reopening.

LTCFs must develop an implementation plan and post that plan to the facility’s website, if the facility has a website that specifies how the reopening and visitation requirements will be met. LTCFs must also administer tests within 24 hours of a resident showing COVID-19 symptoms and complete baseline testing as required in the Secretary’s Orders for skilled nursing facilities issued on June 8 and for personal care homes, assisted living residences, and private intermediate care facilities issued on June 26. They must also develop a plan to allow visitation that includes scheduling and other safety measures and a plan for cohorting or isolating residents diagnosed with COVID-19 in accordance with PA-HAN 509. LTCFs need to establish and adhere to written screening protocols for all staff during each shift, each resident daily, and all persons entering the facility. They must also have adequate staffing and supply of personal protective equipment for all staff and be located in a county that is either in the yellow or green phase of the Governor’s Reopening Plan. Once a facility meets the required prerequisites, the facility can proceed with the three-step process of reopening.

From the date the facility enters step one, a facility must maintain no new COVID-19 cases among staff or residents and have no spread in the facility for 14 consecutive days in order to enter step two. While in step two, facilities are required to maintain no new cases of COVID-19 among staff or residents and have no spread in the facility for 14 consecutive days to progress into the final step. The final step allows LTCFs to operate as outlined for the remainder of the Governor’s COVID-19 Disaster Declaration as long as there are no new COVID-19 cases among staff and residents for 14 consecutive days.

Governor Tom Wolf was sworn in as Pennsylvania’s 47th governor on January 20, 2015. Governor Wolf has been focused on three simple goals since taking office: jobs that pay, schools that teach, and government that works.

For more information, please contact:

  • Office of the Governor, 508 Main Capitol Building, Harrisburg, Pennsylvania 17120; 717-787-2500; www.governor.pa.gov

The PA Clinical Network and Geisinger Health Plan (GHP) announced a new, value-based contract to achieve better health outcomes and lower costs for GHP members. According to Jaan Sidorov, MD, President and Chief Executive Officer of PA Clinical Network, Geisinger Health Plan shares their interest in measurable improvements in quality with lower costs and a better member experience supported by a high performing network.

GHP is excited to partner with the PA Clinical Network to build on the success of their consumer-centered focus on their members’ health. The PA Clinical Network consists of physician-led practices seeking to increase prevention, achieve wellness and reduce avoidable complications from chronic conditions. The network uses information technology and care delivery expertise to drive measurable improvements in care delivery. It is a subsidiary of the Pennsylvania Medical Society, Pennsylvania’s largest physician advocacy organization.

The PA Clinical Network is Pennsylvania’s first and only clinically integrated network (CIN) for independent practices, led by over 150 community-based physicians. The CIN is supported by the Pennsylvania Medical Society and its Care Centered Collaborative.

Geisinger is comprised of 13 hospital campuses, two research centers, a college of medicine, and a nearly 600,000-member health plan serving more than three million residents in central, south-central and northeast Pennsylvania and beyond. Geisinger has approximately 26,500 employees, including over 1,700 employed physicians, all of whom share a commitment to quality healthcare.

For more information, please contact:

  • PA Clinical Network, 777 East Park Drive, Harrisburg, Pennsylvania 17111; 866-441-2392; Website: www.pennsylvaniacin.com
  • Mark Gilger, Media Relations Specialist Marketing and Public Relations, Giesinger Health Plan, 100 North Academy Avenue, Danville, Pennsylvania 17822; 570-214-9026; Email: mcgilger@thehealthplan.com; Website: www.geisinger.org

Health and well-being company Humana Inc. announced a pilot home-testing program that will enable at-home COVID-19 test collection for members, making Humana the first insurer to offer LabCorp’s at-home test-collection kits. Humana also announced an innovative new collaboration with Walmart and Quest Diagnostics to help members more easily get tested, becoming the first health care company to offer its members drive-thru testing at hundreds of Walmart Neighborhood Market drive-thru pharmacy locations across the country. Humana will continue to waive member costs related to COVID-19 diagnostic tests.

To create a seamless experience for members, Humana has developed a coronavirus risk-assessment tool. Members who have symptoms consistent with COVID-19 infection, or those without symptoms who may be been exposed to the virus qualify for testing and will be given the option to request an in-home test or drive-thru testing. This is part of Humana’s ongoing effort to meet members where they are and ensure that they have a wide range of options and choices for COVID-19 diagnostic testing. Humana members with Medicare Advantage, Medicare Supplement, Medicaid, or Employer Group plans through Humana are eligible for the tests, with Humana waiving member costs for the tests.

Humana Inc. is committed to helping their medical and specialty members achieve their best health. Humana’s efforts seek to lead to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

For more information, please contact:

  • Jim Turner, Corporate Communications, Humana, 500 West Main Street, Louisville, Kentucky 40202; 502-608-2897; Email: jturner2@humana.com; Website: www.humana.com

Kindred Healthcare, LLC (Kindred) announced it has completed its acquisition of the WellBridge Greater Dallas and WellBridge Fort Worth behavioral health hospitals. WellBridge Greater Dallas and WellBridge Fort Worth provide a full continuum of inpatient and outpatient behavioral health services to senior and adult populations in the Dallas-Fort Worth metropolitan area and the greater North Texas region.

Each hospital has 48 licensed beds and both are leaders in behavioral health care, with proven records of providing exceptional behavioral health services and superior clinical outcomes. Kindred plans to continue using the WellBridge name. Through Kindred Behavioral Health (KBH), Kindred is focused on addressing the unmet need for high-quality, specialized and compassionate behavioral health services, including crisis stabilization for acute mental health and addiction disorders; detoxification from alcohol, opiates, cocaine and other drugs; suicidal thoughts or actions, anxiety, depression and post-traumatic stress disorder; and many other behavioral health illnesses. Kindred also recently announced it is now managing Riverside Medical Center’s 64-bed behavioral health unit in Kankakee, Illinois.

Kindred Healthcare, LLC is a health care services company based in Louisville, Kentucky with annual revenues of approximately $3.2 billion. Kindred through its subsidiaries has approximately 31,800 employees providing health care services in 1,731 locations in 46 states, including 64 long-term acute care hospitals, 21 inpatient rehabilitation hospitals, 10 sub-acute units, 95 inpatient rehabilitation units (hospital-based), contract rehabilitation service businesses which served 1,541 non-affiliated sites of service, and behavioral health services.

For more information, contact:

  • Susan E. Moss, Kindred Healthcare, Senior Vice President, Marketing and Communications, Kindred Healthcare, 680 South Fourth Street, Louisville, Kentucky 40202; 502-596-7296; Email: susan.moss@kindred.com; Website: www.kindredhealthcare.com

On June 23, 2020, a federal district court judge upheld a federal rule that requires hospitals to publish their negotiated prices for services as part of a price transparency initiative. The American Hospital Association (AHA) and a group of hospital and trade association co-plaintiffs had challenged the rule, and filed a lawsuit alleging that the administration did not have the legal authority to require the publication of negotiated prices. The plaintiffs believe that publishing the prices would have adverse effects. On June 24, 2020, AHA and its co-plaintiffs gave notice that they intend to appeal the ruling.

On June 29, 2020, AHA urged the federal Department of Health and Human Services (HHS) to delay the effective date of the rule from January 1, 2021 until the matter is settled by the courts. AHA believes that the rule is flawed because disclosing privately negotiated rates is unlikely to help consumers understand their out-of-pocket costs. Further, the disclosure and reporting requirement imposes a burden on hospitals that are already struggling to meet consumer needs related to coronavirus disease 2019 (COVID-19).

The lawsuit was filed by AHA, the Association of American Medical Colleges, the Children’s Hospital Association, and the Federation of American Hospitals. The trade association plaintiffs were joined by AHA member hospitals Memorial Community Hospital and Health System in Blair, Nebraska; Bothwell Regional Health Center in Sedalia, Missouri; and Providence Holy Cross Medical Center in Mission Hills, California.

HHS released the final rule on hospital price transparency on November 1, 2019. The final rule established requirements for hospitals operating in the U.S. to establish, update, and make public a list of their standard charges for the items and services that they provide, effective January 1, 2021. For each hospital location, hospitals must make public all their standard charges for all items and services online in a single digital file in a machine-readable format. Standard charges include gross charges, payer-specific negotiated charges, de-identified minimum and maximum negotiated charges, and discounted cash prices.

The rule calls for hospitals to publicly disclose as follows:

  • Provide a description of each item or service (including both individual items and services and service packages) and any code used by the hospital for purposes of accounting or billing.
  • Display the file prominently and clearly identify the hospital location with which the standard charges information is associated on a publicly available website using a Centers for Medicare and Medicaid Services (CMS)-specified naming convention.
  • Ensure the data is easily accessible, without barriers, including ensuring the data is accessible free of charge, does not require a user to establish an account or password or submit personal identifying information, and is digitally searchable.
  • Update the data at least annually and clearly indicate the date of the last update.

In order to ensure that hospitals comply with the requirements, the final rule provides CMS with new enforcement tools including monitoring, auditing, and corrective action plans. CMS will be able to impose civil monetary penalties of $300 per day.

A link to the full text of “Ruling In American Hospital Association, Et Al. v. U.S. Department Of Health & Human Services” may be found at www.openminds.com/market-intelligence/resources/062320rulingahavhhspricetransparency.htm.

A link to the full text of “HHS Proposed Transparency In Coverage Rule” may be found at www.openminds.com/market-intelligence/resources/111519cmspr9915transparency.htm.

A link to the full text of “American Hospital Association, Et Al. v. U.S. Department Of Health & Human Services” may be found at www.openminds.com/market-intelligence/resources/120419ahavcmstransparency.htm.

PsychU last reported on this topic in “HHS Finalizes Hospital Price Transparency Rules & Proposes That Insurers Share Network Prices,” which published on January 6, 2020. The article is available at https://www.psychu.org/hhs-finalizes-hospital-price-transparency-rules-proposes-that-insurers-share-network-prices/.

For more information about the hospital price transparency rules, contact:

  • S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, District of Columbia 20201; 202-690-6343; Email: media@hhs.gov; Website: https://www.hhs.gov/

For more information about the hospital associations’ positions, contact:

  • Sean Barry, Senior Associate Director, American Hospital Association, 800 10th Street Nortwest, Two City Center, Suite 400, Washington, District of Columbia 20001-4956; 202-626-2306; Email: sbarry@aha.org; Website: https://www.aha.org/
  • Marie Johnson, Vice President Media Relations and Digital Media, American Hospital Association, 800 10th Street Nortwest, Two City Center, Suite 400, Washington, District of Columbia 20001-4956; 202-626-2351; Email: mjohnson@aha.org; Website: https://www.aha.org/

Summit BHC, an addiction treatment and behavioral health service provider organization, announced the acquisition of Highland Hospital, a 131-bed psychiatric facility in Charleston, West Virginia. This is Summit’s second acquisition in 2020 and its first facility in West Virginia.

According to Jon O’Shaughnessy, chief executive officer of Summit, the addition of Highland Hospital to the Summit family allows them to continue providing quality psychiatric care to their growing population of clients. Mr. O’Shaughnessy also stated Highland Hospital has a history of treating individuals in a state-of-the-art facility for all ages, and also providing specific treatment options for people with drug and alcohol addiction. Highland Hospital has 24 beds dedicated for psychiatric residential treatment with an additional 91 beds for inpatient acute psychiatric needs. Also, part of the acquisition, the Highland Health Center is a 16-bed crisis residential/detox addiction disorder facility licensed as a behavioral health center.

Headquartered in Franklin, Tennessee, and founded in June 2013, Summit was established to develop and operate a network of leading addiction treatment and behavioral health centers throughout the country. The company’s sole focus is on the provision and management of specialty Substance Use Disorder and Mental Health services within a flexible and dynamic continuum of care. The leadership team at Summit is composed of senior executives with decades of combined experience in the behavioral healthcare industry at the national level. The company currently owns and operates 20 freestanding behavioral health and addiction treatment centers in 15 states across the country.

Highland Hospital has been serving the West Virginia community for over sixty years providing quality mental health care, an educated staff, and a safe environment. Highland Hospital’s mission is to provide quality behavioral health care services to children, adolescents, and adults in a caring environment.

For more information, please contact:

  • Daniel Krasner, Executive Vice President of Business Development, Summit BHC, 389 Nichol Mill Lane, Suite 100 & 160, Franklin, Tennessee 37067; 601-906-9024; Email: dkrasner@summitbhc.com; Website: https://summitbhc.com/
  • Highland Hospital, 300 56th Street SE, Charleston, West Virginia 25304; 304-926-1600; Website: https://highlandhosp.com/

Three Medicare Advantage insurers—Highmark, Kaiser, and Humana—received member satisfaction scores higher than the industry average, as ranked by J.D. Power. Across 10 Medicare Advantage plan sponsors, member satisfaction scores averaged 800 of 1,000 possible points; the scores ranged from 773 to 830. WellCare had the lowest score. The three top-ranked plan sponsors received the following scores: Highmark received 830 points; Kaiser Foundation Health Plans received 829; and Humana received 806. Member satisfaction is based on three information and communication performance indicators (clear, helpful, and proactive communication).

Health plans included in the ranking, and their member satisfaction scores, were as follows:

  1. Highmark received a score of 830.
  2. Kaiser Foundation received a score of 829.
  3. Humana received a score of 806.
  4. UnitedHealthcare received a score of 800.
  5. Aetna received a score of 789.
  6. Cigna HealthSpring received a score of 781.
  7. Anthem received a score of 779.
  8. BlueCross BlueShield of Michigan received a score of 779.
  9. Centene received a score of 775.
  10. Wellcare received a score of 773.

More than 40% of Medicare Advantage members utilize digital means when gathering information regarding their health coverage. Overall, information gathering in general is significantly more likely among Medicare Advantage members (87%) than among those who are commercially insured (82%). Interest in telehealth has also increased since the onset of the coronavirus disease 2019 (COVID-19) pandemic, from about 5% of members who had used telehelath prior to March 2020, to 20% of Medicare plan members who say they are interested in receiving information about telehealth after March 2020.

These findings were presented in “J.D. Power 2020 Medicare Advantage Study,” by J.D. Power. The study examined satisfaction among 3,314 members of Medicare Advantage plans across the United States from January 2020 through March 2020. The study measures member satisfaction with Medicare Advantage plans (also called Medicare Part C or Part D) based on six factors: coverage and benefits; provider choice; cost; customer service; information and communication; and billing and payment. Rankings were based on a 1,000-point scale. The average of the satisfaction scores was 800 out of 1,000.

The full text of the top line findings of the 2020 Medicare Advantage Study was published on June 18, 2020, by JD Power. A copy is available online at https://www.jdpower.com/sites/default/files/file/2020-06/2020068%20U.S.%20Medicare%20Advantage%20Study.pdf.

For more information, contact: 

  • Geno Effler, Director, Corporate Communications, J.D. Power, 3200 Park Center Drive, Floor 13, Costa Mesa, California 92626; 714-621-6224; Email: media.relations@jdpa.com; Website: https://www.jdpower.com/business

On May 29, 2020, the Hawaii Department of Human Services (DHS) announced that it intended to rescind the Medicaid Med-QUEST managed care organization (MCO) contracts awarded in January 2020, and the request for proposal (RFP) released August 2019. The new RFP is slated for release in the fall of 2020. Before it is released, DHS intends to issue a request for information (RFI) to better understand the evolving needs of communities and provider organizations due to the coronavirus disease 2019 (COVID-19) public health crisis. Existing contracts with the five incumbent health plans—AlohaCare, Hawaii Medical Service Association (HMSA), UnitedHealthCare Community Plan, Ohana Health Plan/WellCare, and Kaiser—will be extended until the new contract awards are made.

The state’s action is in response to a 7.5% rise in Medicaid enrollment due to unemployment caused by the COVID-19 public health emergency. Since March 4, 2020, Med-QUEST has enrolled over 24,000 additional beneficiaries. As of June 22, 2020, Medicaid enrollment was 358,488, up from 333,321 a year ago. DHS anticipates that the number of Med-QUEST applicants will continue to climb, and that Medicaid enrollment will remain high until the state’s economic recovery begins and there is a return to pre-pandemic employment levels.

Before the pandemic, Hawaii’s unemployment rate was less than 3%. To control the spread of COVID-19, in March, Hawaii had imposed a mandatory 14-day quarantine on arriving visitors to any of the islands. The flow of visitors slowed from about 30,000 arriving per day to a few hundred. About 25% of jobs in the state are connected to tourism. In April, the state’s unemployment rate rose to 23.8%; and dipped in May to 22.6%.

DHS had awarded the QUEST Integration (QI) MCO contracts on January 22, 2020. The contracts, valued at $17 billion, were awarded to four of the five incumbents: AlohaCare, HMSA, UnitedHealthCare Community Plan, and Ohana Health Plan/WellCare. AlohaCare and WellCare were to serve Oahu, while HMSA and United was to serve statewide. Kaiser did not submit a bid. The contracts were slated to begin July 1, 2020, and run through December 31, 2025, with four optional renewal years. The contract called for the MCOs to offer a dual-eligible special needs plan for Medicare and Medicaid members in Hawaii no later than January 1, 2021.

A link to the full text of “Hawaii Med-QUEST/Medicaid Data By County, Weekly Application & Enrollment Data Update” may be found at www.openminds.com/market-intelligence/resources/062920hawaiimedqueststats.htm.

For more information, contact:

  • Public Information & Communications Officer, Hawaii Department of Human Services, Post Office Box 339, Honolulu, Hawaii 96809-0339; 808-586-4892; Fax: 808-586-4890; Email: dhs@dhs.hawaii.gov; Website: https://humanservices.hawaii.gov/

eHome Counseling Group announced the expansion of the virtual eHome post-traumatic stress disorder (PTSD) treatment program. The program combines mental health counselors with 24/7 technology to treat those impacted by post-traumatic stress completely virtually. The eHome PTSD treatment program removes the barriers many people face when seeking treatment, with minimal impact on work or family time, and the ability to have counseling sessions conveniently and confidentially on a smartphone, tablet, or computer.

The program includes an artificial intelligence app that can connect consumers to a counselor 24/7 if help is required between counseling sessions. It also has assessments and online educational resources for comprehensive care. eHome uses metrics-based treatment to rapidly diagnose mental health issues and track improvement. Through the Deep Mind Insight™ program, clients receive an online assessment that quantitatively measures anxiety, depression, PTSD, addiction disorder, and other conditions. The client gets a written report that is discussed with their therapist at the first session. The assessment is then repeated periodically to show progress and final outcomes.

eHome Counseling Group is a nationwide virtual counseling network based in Orlando, Florida that provides anytime, anywhere mental health treatment by computer, tablet or smartphone. The organization provides a convenient, confidential, highly effective alternative to traditional office-based counseling programs using a HIPAA-compliant, customer friendly, integrated platform.

Priority Health and Cigna announced they have formed a strategic alliance and will partner to make comprehensive health care coverage more affordable and accessible to Michigan employers, their employees and families. This new strategic alliance will offer a competitive network solution for employer groups in the state, leveraging the best capabilities of each organization and the strength of their provider organization relationships.

Starting January 1, 2021, Cigna clients and customers will have access to Priority Health’s comprehensive network of high-quality provider organizations, which includes 97% of primary care physicians in Michigan, a wide variety of specialists and access to the vast majority of hospitals, labs and ancillary care services in the state. Priority Health members who live, work, or travel outside of Priority Health’s service area will have access to Cigna’s national network of quality physicians, specialists, hospitals, labs and facilities around the country. The strategic alliance will make it simpler for customers to find in-network provider organizations and navigate their health care experience in Michigan and around the country. Priority Health and Cigna have worked together since 2018 to provide competitive network solutions for Michigan employers that have a national footprint, which continues to be an area of growth for Priority Health.

With over 30 years in business, Priority Health is the second largest health plan in Michigan offering a broad portfolio of health benefits options for employer groups and individuals, including Medicare and Medicaid plans. Serving more than one million members each year and offering a network that includes 97% of primary care physicians in Michigan, Priority Health focuses on quality, customer service, transparency, and product innovation.

Cigna Corporation is a global health service company. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna Life Insurance Company of New York, Connecticut General Life Insurance Company, Express Scripts companies or their affiliates, and Life Insurance Company of North America.

Contact information

  • Emily Potts, Senior Marketing Specialist, Priority Health, 1231 East Beltline Avenue, NE, Grand Rapids, Michigan 49525-4501; 616-885-6253; Email: Emily.Potts@priorityhealth.com; Website: www.priorityhealth.com
  • Holly Fussell, Business Communications Lead, Cigna, 900 Cottage Grove Road, Bloomfield, Connecticut 06002; 423-304-9128; Email: Holly.Fussell@cigna.com; Website: www.cigna.com

University of Washington Medicine (UW Medicine) announced the permanent closure of its psychiatric facility, with lay-offs of 23 staff members effective in mid-July. The announcement follows the temporary closing of the facility on UW Medicine’s Montlake campus in May and furloughed staff as part of an effort to address a $500 million shortfall due to costs and revenue losses associated with the pandemic.

UW Medicine is working to find employment opportunities within their system for those staff members. The closure will reduce the overall number of beds available to individuals in need of psychiatric care amid a growing mental health crisis. Individual populations served at the facility include UW students and high-risk pregnant women who need psychiatric care.

UW Medicine mission is to improve the health of the public through its nearly 30,000 clinical professionals. The network of health care providers, researchers, faculty, and staff includes: Airlift Northwest, Harborview Medical Center, UW Medical Center – Northwest, UW Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine, and Valley Medical Center.

Contact information:

  • University of Washington Medicine, 1959 Northeast Pacific Street, Seattle, Washington 98195; 206-744-6397; Email: mediarelations@uw.edu; Website: www.uwmedicine.org

Optum, a leading health services company, and Wider Circle, a tech-enabled community-based health care services company that drives better health for older adults and other vulnerable communities, have partnered with Helping Hands Community (HHC) to launch the “Community Food Circle” initiative to bring food to thousands of Optum consumers in Los Angeles County during the COVID-19 pandemic. The initiative supports Optum’s goal of helping people reach their health and well-being goals, including addressing social determinants of health.

Optum volunteered from its AppleCare and HealthCare Partners physician groups, Wider Circle staff, volunteered from HHC and other community partners, packed and loaded food supplies into Uber vehicles. Uber drivers then delivered the food to consumers across Los Angeles County. Since the beginning of California’s shelter-in-place order, Optum and Wider Circle have offered social support and meal delivery services free of charge to more than 20,000 Optum consumers in Los Angeles County. The recent partnerships with HHC expands the meal delivery service by offering it to an additional 60,000 individuals. Each food package provides an individual 10 days of food.

Optum California is an integrated health system that serves more than 1.4 million individuals across Southern California through its family of medical groups and provider organization networks. Optum California’s network includes OptumCare Medical Group, HealthCare Partners, AppleCare Medical Group, Monarch HealthCare, and North American Medical Management of California.

Wider Circle works with health plans nationally to deliver unique community care programs that connect neighbors for better health. Centered on trusted relationships, Wider Circle connects health plan members with familiar neighbors to inform, support and motivate one another, empowering them to be more proactive about their health. Wider Circle’s trusted delivery network has been proven to drive resilience, improve member experience and engagement, and reduce hospitalizations.

Helping Hands Community is a non-profit organization dedicated to serving those most vulnerable to COVID-19: senior citizens, the immunocompromised, and people with pre-existing medical conditions which put them at additional risk. The community of volunteers deliver groceries, medicine, and other necessary supplies, and local and national partners help the organization identify and reach those in need wherever they may be.

Contact information:

  • Brad Lotterman, Communications, Optum, 11000 Optum Circle, Eden Prairie, MN 55344; 714-445-0453; Email: brad.lotterman@optum.com; Website: www.optum.com
  • Jessy Green, Media Contact, Wider Circle, 711 Nevada St, Suite 20, Redwood City, CA 94061; 917-689-9295; Email: jessy.green@svmpr.com; Website: https://awidercircle.org/
  • Lauren Volkmann, Public Relations & Corporate Communications, Helping Hands Community, 831-331-3307; Email: lauren@helpinghands.community; Website: https://helpinghands.community/

In an unfamiliar environment, the leader with the best data has a distinct advantage. That is a frequently heard adage, but I was really struck by the concept at one of The OPEN MINDS Executive Leadership Retreats. The historian talked about how Robert E. Lee’s strategy at Gettysburg was compromised when his cavalry (the advanced surveillance unit of its time) was waylaid.

While leaders know that the right information allows better decision making, in a recent survey, 67% of U.S. corporate executives say they are not comfortable accessing or using data from their tools and resources. And shockingly, the number of companies that say they are data-driven actually declined from 37% in 2017 to 31% in 2019.

So where is your organization on the journey to a data-driven culture? One way to assess that is to look at the OPEN MINDS process for becoming a data-driven organization. Where is your team on this path?

  1. Identify a market-driven strategy

The first step on the path to becoming data-driven requires the executive team to get on the same page as to what metrics are considered important for monitoring strategy in terms of growth, quality, and finance. Specifically, what are the key actionable drivers that will give a clear indication that the strategy is working?

  1. Begin the participatory process through c-suite technical assistance

The second step in the process is to engage in a participatory discussion to start identifying the metrics desired by each member of the executive team to manage strategy. In this step of the process, you may walk away with a 10-person wish list totaling 600 measures but it will get you on the road to narrowing the list down to those metrics that matter most.

  1. Create the “wish list”

After each executive team members’ desired metrics are identified, the next step in the process is to create an inventory of potential metrics, prioritizing each by what data is available, what is actually feasible to measure, and what is the anticipated cost of measuring each.

  1. Select the C-suite base metrics set

Once the C-suite metrics are identified and prioritized, the key is to start small. Creating a very limited data set with key metrics is critical to the implementation process and to avoiding ‘data overload’.

  1. Operationalize and automate

Going from vision to production is not necessarily complicated, but it can be time consuming. In this step of the process, ensuring that the metrics are clearly defined and operationalized is critical, along with how the data will be displayed. Once defined, the reporting must be automated to ensure timeliness and limit work on the backend (if it’s not automated, put it back on the wish list to revisit in the future).

  1. Practice at the C-suite level

The next step in the process is to actually practice using the data at the C-suite level. But, it’s important to remember, initial disbelief is common particularly when turnover is reporting as especially high or productivity is especially low. Make sure the data is valid and reliable—and then turn to problem solving. Pick out the major pain points and hone in on those to guide executive team meetings rather than taking a deep dive into every data point.

  1. Add high-value metrics that require investment

As executive teams begin to master the basics, additional metrics can be added in terms of their return on investment (ROI). Whether the team desires to merge two electronic health records, pull data in from the financial system, or highlight claims data, this all comes at an increased cost and should show a clear ROI. The point to remember here is, no performance dashboard is ever static. The metrics that are important now may be overshadowed by other metrics over time as your business model or payer contracts change.

  1. Extend within the organization

The next step to becoming a data driven organization—once the executive team and board are “on board”—is to extend and distribute the data across the organization (billing department, web team, clinical staff and programs, contract managers). Consider the data that each team needs to successfully manage their own performance. While transparency in this regard is important, focus is key, because what gets measured is what gets done.

  1. Educate

While every organization may educate team members differently, it’s critical for supervisors and clinical staff to not only understand the data, but also understand why it matters—whether it’s to the consumer or payer or for financial sustainability. The more meaningful the data is, the more likely the team will learn to embrace it.

  1. Implement performance-based team compensation

Once the executive team has laid out clear, data-driven performance expectations to staff members, they can be integrated into both performance evaluations and compensation planning.

  1. Share with external stakeholders

As you begin to “know” your data (and the equivalent benchmarking data of competitors), there is a new opportunity to use performance data as a marketing advantage. As provider organizations conduct outreach to consumers or engage in discussions with health plans, knowing your performance is superior (and having the data to quantify and prove it) is essential to become an advanced data-driven organization.

  1. Share (real-time) with partners

The final (and hardest) step is data transparency. Sharing data in real-time with key stakeholders, affiliation partners, or health plans is a characteristic of a mature, strong partnership and one that will likely be more successful with shared performance metrics.

The executive teams that have the best data—and the best insights based on that data—are those that have been able to pivot quickly in our current crisis. But they will likely need to pivot again. As we enter the post-crisis normal, demonstrating your value, and having the data to back it up, will be key not only for future strategy development but also for long-term sustainability.

After the successful opening of three Walmart Health centers in Georgia, Walmart is opening the newest location in Northwest Arkansas at the Supercenter. With the new Walmart Health located at 4870 Elm Springs Road in Springdale adjacent to the Supercenter, the community will have access to transparent pricing for key health center services, regardless of insurance status.

This facility provides quality, affordable and accessible health care. In addition, Walmart Health is partnering with several on-the-ground health provider organizations to be a first-of-its-kind health center to deliver primary and urgent care, labs, x-ray and diagnostics, counseling, optical and hearing services all in one facility at affordable, transparent pricing regardless of an individual’s insurance status. Additionally, Walmart Health plans to add dental services starting in July.

Walmart Health Elm Springs is the fourth such location the retailer has opened. The first opened in September 2019 in Dallas, Georgia. Each location is unique and serves as a prototype to test and learn the right mix of health and wellness services for individual communities. Walmart Health is operated by qualified medical professionals, including physicians, nurse practitioners, dentists, behavioral health providers and optometrists. Onsite Walmart Care Hosts and Community Health Workers will help customers navigate their visit, understand resources and be a familiar presence for regular visits.

Walmart operates approximately 11,500 stores under 56 banners in 27 countries and eCommerce websites in 10 countries. They employ approximately 2.2 million associates around the world with 1.5 million in the U.S. alone.

Contact information:

  • Walmart, 702 SW 8th Street, Bentonville, Arkansas 72712; 800-925-6278; Website: https://corporate.walmart.com/

Centerstone, a national leader in behavioral health care, is introducing a zero-suicide initiative at its locations in Illinois. While Centerstone has long had a focus on crisis and suicide prevention services, the goal of this new initiative is to add further resources around the issue of suicide.

According to Jenna Farmer-Brackett, clinical manager at Centerstone, zero lives lost due to suicide has always been the goal and the Zero Suicide initiative will further support that goal. The Zero Suicide initiative will additionally help clients by providing a safe place for them to talk about suicide, help erase the stigma of talking about this issue, and will educate people to have conversations and take steps to get help. Educational training and professional development opportunities will be provided to staff to further increase comfort and knowledge around suicide, suicide screenings, and supporting clients when safety may be a concern.

Centerstone is a non-profit health system providing mental health and addiction treatment. Services are available nationally through the operation of outpatient clinics, residential programs, the use of telehealth, and an inpatient hospital. Centerstone serves over 170,000 people and families in Florida, Illinois, Indiana, Kentucky, and Tennessee.

If you or someone you know is in crisis, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Contact information

  • Centerstone of America, 44 Vantage Way, Nashville, Tennessee 37228; 615-460-4020; Email: mediainquiries@centerstone.org; Website: https://centerstone.org

A functional magnetic resonance imaging study in 2011 showed greater activation of the stress-processing pathways in study participants who hailed from urban vs. rural locales, leading study authors to propose that the greater social stress of urban environments could explain why schizophrenia is more prevalent there. The authors of a 2018 article in JAMA Psychiatry propose an alternative but not incompatible hypothesis: that people with a higher genetic risk for schizophrenia tend to live in more urbanized areas due to selective migration in either past or current generations.

In “Association Between Population Density And Genetic Risk For Schizophrenia,” Lucía Colodro-Conde, of the Berghofer Medical Research Institute at Royal Brisbane Hospital in Australia, and international colleagues explore whether adults with a higher genetic risk for schizophrenia have an increased probability to live in more populated areas than those with a lower risk for the disease.

Their key finding was that study participants living in more urban areas exhibited a higher genetic loading for schizophrenia, a genetic association that could account for 1.7% of schizophrenia risk, suggesting that the genetic liability to schizophrenia may have a causal association with the tendency to live in more urbanized environments.

Methods

Cohorts & Variables

Using a discovery cohort of 15,544 individuals who were genotyped as part of a series of studies conducted by the Genetic Epidemiology Unit at the Queensland Institute for Medical Research (QIMR) Berghofer Medical Research Institute in Australia, Colodro-Conde et al. replicated and extended their analyses by using the UK Biobank (UKB) (n=456,426), the Netherlands Twin Register (NTR) (n=16,434), and the Australian QSkin Sun and Health Study (QSKIN) sample (n=15,726).

Statistical Analysis

Variance component analysis
The study authors analyzed data from 5,894 twins in the QIMR sample to estimate the contribution of additive genetic influences (narrow sense heritability), shared/familial environment, and unique environment to the interpersonal differences in population density, remoteness, and socioeconomic status (SES) of residential area. They used the OpenMx package in R to assess the mixed models’ parameters. Likelihood ratio tests on nested models were used to test the significance of the variance components; the study authors used the same approach to replicate the results on population density in the NTR cohort. For the QIMR data, they fit a gene-environment moderator effect model that allowed the variance components—heritability, shared environment, unique environment—to vary across age, reflecting previous research that suggested that heritability of urban/rural living in Australia increases with age. Additionally, they estimated the genetic and environmental correlations between population density, remoteness, and SES using bivariate twin models.

PRS analysis
The PRS in the QIMR sample were calculated from the imputed genotype dosage scores using genome-wide association study (GWAS) summary statistics from the GWAS meta-analysis from the 2014 Psychiatric Genomics Consortium Schizophrenia Working Group. Single-nucleotide polymorphisms (SNPs) with low imputation quality or minor allele frequency were excluded. The most significant independent SNPs were selected using PLINK1.9 to correct for signal redundancy owing to linkage disequilibrium. The study authors calculated eight different PRS using different P value thresholding of the GWAS summary statistics. To test the association between neighborhood variables (population density, remoteness, and SES) and PRS, the authors employed mixed models, setting the significance threshold to 3.15 x 10–3 to account for multiple testing. The PRS analysis for the neighborhood variables in the UKB, NTR, and QSKIN samples was replicated using the same GWAS summary statistics and mixed-model approach.

Genome-wide association analyses
Colodro-Conde et al. performed GWAS of population density or SES in the largest sample, the UKB, using BOLT-LMM, on 12,272,635 SNPs with MAF greater than 0.005%. They ran additional GWAS of population density controlling for SES and of SES controlling for population density. For the QIMR, NTR, and QSKIN cohorts, they also conducted GWAS of population density. Single-nucleotide polymorphisms with MAF less than 0.5% or imputation r2<0.6 were excluded, leaving 8,495,074 SNPs for analysis. For the QSKIN cohort, they performed GWAS using PLINK, version 1.90b4.1, employing a total of 7,672,045 markers after selecting those with r2>0.6 and MAF less than 0.01%. LD score regression was used to confirm the SNP heritability and the genetic correlations between the measures of population density across samples.

Mendelian randomization
By using Mendelian randomization methods, the study authors generated hypotheses concerning the direction of causation between two heritable variables. They relied on the 2014 GWAS meta-analysis summary results from the Psychiatric Genomics Consortium for schizophrenia and the GWAS results calculated from the samples for population density and SES. MR-Base (TwoSampleMR R package) and GSMR were used to conduct Mendelian randomization using identified schizophrenia SNPs as instruments, thereby testing the selection hypothesis that having a higher propensity to schizophrenia may have a causal association with the tendency to live in more urban areas. Finally, the study authors investigated the reverse hypothesis—population density or SES inducing schizophrenia onset—using GWAS results from UKB.

Results

Variance component analysis
In all samples considered, population density, remoteness, and SES were significantly correlated at the phenotypic level, with population density and SES heritable in the QIMR sample. A highly significant proportion of the trait variance was explained by shared environment effects, highlighting that individuals tend to live with or in close proximity to their relatives. Population density was also heritable in the NTR sample, with shared environment as a source of variance.

As participants in the QIMR sample became older, population density was more heritable and less influenced by shared environmental sources; heritability increased from 9.0% to 25.6% between ages 20 and 80. Standardized estimates produced similar results, which suggests that phenotypic variance exists across age. Additionally, significant environmental correlations from twin models demonstrated that population density, remoteness, and SES shared environmental influences.

Polygenic risk scores analysis
PRS calculated from all semi-independent SNPs across the genome in the QIMR sample explained the greatest amount of variance in population density, a result that remained when accounting for SES. Schizophrenia PRS were also significantly associated with remoteness when all the independent SNPs were included, although the association disappeared when correcting for SES.

In the NTR and QSKIN samples, the association between schizophrenia risk score and population density was replicated. All correlations were in the same direction, highlighting the increased PRS for study subjects living in more densely populated locales.

Additionally, the study authors tested the association between SES and schizophrenia PRS. In the QIMR and QSKIN samples, the association did not attain statistical significance when multiple testing was taken into account. It was significant in the UKB sample, due perhaps to the gain of power owing to the very large sample size.

Genome-wide association analyses
In the UKB sample, six genomic regions reached genome-wide significance for population density, a number that increased to 12 when correcting for SES. Also in the UKB sample, the study authors identified 13 loci associated with SES when correcting for population density. In the smaller samples there were fewer significant associations with population density or remoteness, but they did not correspond to the SNP associations found in the UKB. As estimated by LD score regression, SNP heritability ranged from 0.6% to 9.3%. The genetic correlation between population density across samples ranged from 0.30 to 0.61.

Mendelian randomization
The authors selected between 88 and 94 genome-wide significant SNPs for schizophrenia as instruments to perform Mendelian randomization analyses, designating population density as the outcome variable after excluding SNPs showing evidence of pleiotropic effects by the heterogeneity in dependent instruments outlier analysis. Estimates from MR analyses performed in the UKB sample were significant and suggested that the genetic liability to schizophrenia has a causal association with the tendency to live in more urbanized environments. All other samples displayed similar effect sizes, although for the MR results were not significant.

Discussion

Using data from four studies across three countries—Australia, the United Kingdom, and The Netherlands—the study authors tested the genetic nature of the association between schizophrenia and population density and inferred the direction of causation. In all cohorts, whose combined n=504,130 participants, the genetic risk for schizophrenia was associated with greater population density, beyond that which could be explained by the locale’s SES. The study’s results show that the genetic risk for schizophrenia is not distributed uniformly but rather that participants with higher risk levels live in areas with a higher population density over what could be expected by chance. The MR results in the UKB sample suggest that schizophrenia risk could be a causal factor in the choice to live in more urban areas with lower socioeconomic status, results that are consistent with the selective migration hypothesis, which states that individuals with genetic liability for schizophrenia tend to move to or remain in urban locales.

Limitations

One limitation in Busby et al.’s study is the low power of GWAS to detect all variants associated with schizophrenia, resulting in a limited PRS instrument that explains only 11.6% of the total trait heritability in the population. That means that the variance explained by the current PRS, based on common variants, may be only one-tenth of what might be discernible with a PRS that captured the entire genetic signal. As a consequence, the small association with population density the study authors report may account for 1.7% of schizophrenia risk.

A second limitation is the potential overlap between the UKB sample and the data used in the schizophrenia GWAS, leading to an inflation of results from the PRS and MR analyses. That said, Busby et al. estimated the overlap to be negligible, and they did not observe larger effect sizes in the UKB sample compared with the other three.

Conclusions

Busby and her coauthors found that the greater prevalence of schizophrenia in urban areas is due not only to the environmental stressors of city life or other putative risk factors associated with urbanicity, such as increased risk of infection, lower vitamin D levels, or substance abuse, but also to the genetic risk for the disease. The associated PRS prediction was replicated across three different countries that differ in the availability of space, social mobility and opportunities, association of population density and SES, and historical constraints on the living environment.

Furthermore, they demonstrated that the distribution of genetic risk for schizophrenia is not uniform but rather concentrates in more populous, urban locales, which lends credence to the idea of an active gene-environment correlation due to selective migration. Prior evidence linking city living with schizophrenia is compatible with their results, reflecting that there are genetic as well as environmental risk factors for schizophrenia. What’s more, their study provides evidence that the genetic risk for schizophrenia may lead to persons now, or may have led to individuals in the past, seeking denser/urban and lower SES neighborhoods, which in turn may be risk factors for the disease.

On June 9, 2020, the federal Department of Health and Human Services (HHS) announced a $15 billion Provider Relief Fund allocation for provider organizations that participate in state Medicaid and Children’s Health Insurance Program (CHIP) programs, but that have not received a payment from earlier relief allocations. The Provider Relief Fund was created by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The initial General Distribution provided payments to approximately 62% of all provider organizations participating in state Medicaid and CHIP programs. The Medicaid and CHIP targeted distribution will make the Provider Relief Fund available to the remaining 38%. As of June 29, 2020, HHS was still determining the recipients that would receive allocations from the fund.

To be eligible for this new funding allocation, health care provider organizations must not have received payments from the $50 billion Provider Relief Fund General Distribution and must either have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for health care-related services between January 1, 2018 and May 31, 2020. HHS estimates this will provide relief to several hundred thousand more provider organizations with many considered safety net organizations.

According to the “HHS Instructions For The Medicaid Provider Distribution” released on June 26, 2020, to apply for the funds, organizations must meet all of the following six eligibility criteria:

  1. Must not have received payment from the $50 billion General Distribution
  2. Must have either directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for health care-related services during the period of January 1, 2018, to December 31, 2019, or own (on the application date) an included subsidiary that has either directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for health care-related services during the period of January 1, 2018, to December 31, 2019
  3. Must have either filed a federal income tax return for fiscal years 2017, 2018, or 2019 or be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return (e.g., a state-owned hospital or health care clinic)
  4. Must have provided consumer care after January 31, 2020
  5. Must not have permanently ceased providing consumer care directly, or indirectly through included subsidiaries
  6. If the applicant is an individual, have gross receipts or sales from providing consumer care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee

HHS will accept applications from eligible provider organizations through July 20, 2020; tardy applications submitted after that date will not be considered. The application must include gross revenue from consumer care for calendar years 2017, 2018, or 2019; the most recent federal income tax returns for 2017, 2018 or 2019; the applicant’s Employer’s Quarterly Federal Tax Return on IRS Form 941 for Q1 2020, Employer’s Annual Federal Unemployment Tax Return on IRS Form 940; and the applicant’s Full-Time Equivalent Worksheet. Some applicants may be required to submit the Gross Revenue Worksheet.

HHS partnered with UnitedHealth Group (UHG) to provide rapid payment of the Medicaid and CHIP distribution to provider organizations eligible for the distribution of the initial $30 billion in funds. The provider organizations will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS). Automatic payments will come to provider organizations via Optum Bank with “HHSPAYMENT” as the payment description. Provider organizations who normally receive a paper check for reimbursement from CMS will receive a paper check in the mail for this payment as well. Within 45 days after receiving the payment, the provider organization must attest to confirm receipt of the funds and agree to the terms and conditions. If the payment is not returned within 45 days of receipt, HHS will count the non-return as acceptance of the terms and conditions.

On June 10, 2020, HHS launched an enhanced Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP provider organizations to report their annual consumer revenue, which will be used as a factor in determining their Provider Relief Fund payment. The payment to each provider organization will be at least 2% of reported gross revenue from consumer care. The final amount each organization receives will be determined after the data is submitted, including information about the number of Medicaid beneficiaries the organizations serve.

A link to the full text of “Medicaid Provider Distribution Application Form” may be found at www.openminds.com/market-intelligence/resources/060920medicaidproviderreliefapplication.htm.

A link to the full text of “HHS Instructions For The Medicaid Provider Distribution” may be found at www.openminds.com/market-intelligence/resources/062620instmedicaidrelieffunddist.htm.

A link to the full text of “HHS Terms & Conditions For The Medicaid Provider Distribution” may be found at www.openminds.com/market-intelligence/resources/062620medicaidrelieffundterms.htm.

The National Council letter issued on June 18, 2020, is posted at https://www.thenationalcouncil.org/wp-content/uploads/2020/06/HHS_BH_Provider_Relief_Sign_On.pdf?daf=375ateTbd56.

PsychU last reported on the CARES Act Provider Relief Fund in the following articles:

For more information, contact: 

  • S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, District of Columbia 20201; 202-690-6343; Email: media@hhs.gov; Website: https://www.hhs.gov/provider-relief/index.html

“No one wants to give a significant contribution to an organization that is circling the drain.” This comment was made by a board member of a community foundation in a recent meeting. The discussion was whether they were going to provide funding for a local provider organization that has been hard hit by the pandemic crisis. The board member said there were many organizations (more than they could fund) asking for financial relief and that this particular organization didn’t appear to be sustainable going forward, even with the financial relief. As the conversation continued, the suggestion was made that the organization’s board consider a merger with another similar organization to stabilize its financial future.

This conversation illustrates the problem faced by many organizations right now (whether non-profit or for-profit, by the way). It’s not that they are going to run out of cash over the next couple months, but they don’t have a recovery plan and sustainable business model for the next year or two. And they have an urgent need for cash and capital. Using collaborations to address this very situation was the focus of the recent web briefing, Using Mergers, Acquisitions & Affiliations To Address ‘Urgent’ Cashflow Needs, by OPEN MINDS, Senior Associate, Ken Carr. His advice—recognize that it’s not enough to find cash to run the business for a couple more months. What recovery really requires is building a sustainability plan for the next 12 to 18 months.

In his briefing, Mr. Carr addressed the big questions every health and human service executive team and board member needs to answer in the recovery planning process:

  • Are we financially sustainable right now, during the crisis?
  • As the economy moves from crisis to post-crisis normal, will we be financially sustainable?
  • If yes, what are the market scenarios that would potentially harm our sustainability?
  • If no, what growth strategy do we need to become financially sustainable? And is size alone enough?

While size is an element in sustainability, size alone is not enough. Mr. Carr said, “For your specific market, in your state, you need to look where you are going and utilize this as a strategy, not to just get larger but to prepare for the future. You will need to review and assess your diversity of revenue sources, service lines, profitability, debt ratio, and cash on hand, all so that whether you are an acquiring organization or want to be acquired, you have more information to put out there with which to create a better relationship with someone who is looking to partner.”

And now is not the time for the wishful thinking that many board members engage in. The “Recovery Tracker” from Harvard University, Brown, and the Bill and Melinda Gates Foundation, presents a grim picture—consumer spending across the U.S. has decreased by 8.5% from January to June 2020. And two-thirds of the total reduction in spending came from households in the top 25 percent of the income distribution, causing businesses in the most affluent neighborhoods in America to lose more than 70% of their revenue and lay off people. As a result, household names like Virgin Airlines, General Nutrition, Chuck E. Cheese, Hertz, and Cirque de Soleil are filing for bankruptcy and likely going out of business. And health care organizations are feeling the pinch. Trinity Health announced an expected $2 billion in losses and another 1,000 layoffs, in addition to the 2,500 furloughs previously announced. Tower Health is down $212 million and cutting more jobs, and Signature HealthCARE has reported 100 layoffs at its corporate headquarters.

At the same time, there is a stream of new competitors entering the space. Walmart is planning to launch what it calls “healthcare supercenters,” tech-enabled in-home health care provider organization, DispatchHealth, announced $135.8 million in growth capital financing, and virtual mental health services provider organization, AbleTo, expanded its suite of mental health services.

This is the time to be clear-eyed about the need for affiliations and the opportunities in those affiliations. Mr. Carr noted, “As you move forward, how big you are can determine goals. Ask some questions. Why do you want to move forward? What collaboration model would work best? How do you get engagement from the board and executive team for both considering and escalating this strategy? All are critical questions.”

And maybe answers will lead us to reprise the famous lines from the Joseph Stein musical, Fiddler on the Roof, “Matchmaker, Matchmaker/make me a match/find me a find/catch me a catch.”

While the natural tendency is for every organization to “find the catch” or be the acquirer, it is important to be realistic about the limits of any organization’s cash and management talent—often assets that come from being acquired by a larger organization.

In this fluid market, executive teams need to speed up their processes for developing a recovery strategy, determining whether/how affiliations fit in that strategy, and executing the process. To do this, they must determine their goals, build a plan based on organizational needs, and maximize the return on investment in terms of finances as well as leadership time spent. Then they must review and assess their organizational potential through a “market positioning” lens that spells out exactly what their efficiencies and prospects are or are not. Next, they need to assess the current market and build a “go forward plan” to identify the structure for the ideal collaboration. Finally, they can start identifying potential collaboration partners, and due diligence beforehand will reveal if the goals, resources, and market potential of the potential partners line up or not.

Mergers are not a popular option, particularly for non-profit organizations where boards and executive team members fear loss of their positions, changing the mission, or altering the brand. Mr. Carr shared that in a recent study of non-profit mergers, 88% of participating organizations reported that they were better off after the merger.

The right affiliation executed at the right time can be like a healthy dose of vitamins for the overall health of a provider organization and can bring in an infusion of funding, staffing, services, reach, and consumers to keep the doors from closing for good.

Martin Luther King Jr. once said, “Every crisis has both its dangers and its opportunities. Each can spell either salvation or doom.” This is exactly how it has been for health and human service provider organizations of all hues during the coronavirus pandemic. And the outlook could be grim, or exciting, as we crawl back to “the new normal.” Right now, most health care provider organizations are struggling to see their way through the crisis and find a path to sustainability in the post-crisis period.

To provide a framework for executive action in the face of this crisis, The OPEN MINDS team developed the OPEN MINDS Executive Blueprint For Crisis Management. Its goal is to help executive teams optimize their performance and financial viability during and after the crisis. The framework consists of seven components—crisis management, cash management, virtual service delivery and operations, virtual revenue generation, short-term revenue maximization, short-term business development, and post-disruption sustainability.

AbleTo, Inc., a leading virtual mental health provider organization, announced an integrated suite of solutions for payers to address the growing mental health needs across their populations with AbleTo’s care model. AbleTo’s evidence-based care is found to significantly reduce mental health symptoms and improve overall health. The solution allows payers to meet the increasingly high demand for mental health services, especially teletherapy.

With the expanded product suite, AbleTo’s clinically rigorous care is available to treat mental health needs across broad populations. Each solution offers structured cognitive behavioral therapy (CBT) programs that are tailored to the participant’s unique needs for a personalized treatment experience. AbleTo uses a data-driven approach to assess needs and goals to guide individuals to a customized experience across the suite of solutions. Each participant receives up to eight weeks of treatment with a blend of human and technology support according to the severity of need and personal preference. The entire suite of solutions is integrated across a data-driven care management platform to ensure quality across programs and enable measurement-based care.

AbleTo, Inc. provides technology-enabled behavioral health care. AbleTo’s proprietary platform connects individuals and their care teams with AbleTo licensed clinical professionals who deliver weekly sessions by phone or video supported by an integrated digital experience.

Contact information:

  • Mary Mooney, Marketing Director, AbleTo, Inc., 320 West 37th Street, 7th floor, New York, New York 10018; 312-593-4280; Email: mary.mooney@ableto.com; Website: www.ableto.com

Martin Luther King Jr. once said, “Every crisis has both its dangers and its opportunities. Each can spell either salvation or doom.” This is exactly how it has been for health and human service provider organizations of all hues during the coronavirus pandemic. And the outlook could be grim, or exciting, as we crawl back to “the new normal.” Right now, most health care provider organizations are struggling to see their way through the crisis and find a path to sustainability in the post-crisis period.

To provide a framework for executive action in the face of this crisis, The OPEN MINDS team developed the OPEN MINDS Executive Blueprint For Crisis Management. Its goal is to help executive teams optimize their performance and financial viability during and after the crisis. The framework consists of seven components—crisis management, cash management, virtual service delivery and operations, virtual revenue generation, short-term revenue maximization, short-term business development, and post-disruption sustainability.

Crisis Management

At this point, most provider organizations have a crisis management plan in place. But remember, it’s important to continuously update and refresh that plan to address evolving safety threats to staff and consumers, ensure continued operations of your organization, and communicate across stakeholders. A robust crisis management plan must outline possible crisis scenarios and your likely responses. It must designate a clear chain of command—the crisis SWAT team—and the communication responsibilities of each team member. You’ll need a plan to analyze financial impact and build stability. And you must put into place new policies and procedures for conducting all business activities.

Cash Management

Cash flow has been the single biggest challenge for provider organizations in the pandemic crisis with declining volume of services and increasing expenses. And we know that 90% of small businesses that close do so because of cash problems. So, it is critical to manage cash aggressively and improve your financial strength and resilience by looking at both the revenue and expense sides. On the revenue side, you could explore how to improve the speed of billing and collections, request prepayment for services, secure additional short-term financing in the form of emergency relief funds and loans and look for quick collaboration opportunities. On the expense side, consider renegotiating payment terms with your vendors and developing financial thresholds to discontinue non-optimal service lines. You’ll also need to aggressively manage costs, streamline operations through activity-based costing, eliminate unnecessary expenses, optimize the performance of revenue-producing team members, improve the efficiency of administrative staff, and outsource non-core services.

Virtual Service Delivery & Operations

It has become clear that virtual is the new norm and here to stay, beyond the crisis. It’s time to shore up your telehealth platform, policies, and operating procedures for the long-term, factoring in regulation and reimbursement changes that will start to take effect as pandemic-related allowances are retracted. Virtual service delivery must be synced to your electronic health record, scheduling, documentation, and billing systems. And you need to determine how to measure treatment efficacy and modify performance measures, as payers will look for demonstration of value. Behind the scenes, you need to think about remote operations and what “work from home” looks like as a permanent option, even as you deal with the challenges of reopening your physical locations. You may need to re-channel investments from brick and mortar facility upgrades and maintenance to new training, equipment, and connectivity tools for staff.

Virtual Revenue Generation

The proliferation of virtual services means your current and future customers will be looking for you online. Your digital brand and reach will have a significant impact on your sustainability. You need to assess how to enhance your online presence to drive volume in virtual services. Improving the content, design, and performance of your website and social media channels must be a priority. You must optimize your website for search—so you rank at the top of the listings when consumers Google the services you provide—and then consider how to convert visitors to customers by offering quick and convenient access to appointments, information, reviews, and recommendations.

Short-Term Revenue Maximization

Despite decreases in service volume, there are ways to stabilize revenue by streamlining your processes, so you get paid for all services provided and track net collections. You can put your referral generation plan on steroids to bring in new business and address the growing need for mental health and addiction treatment that has escalated during the crisis. This is also a good time to have conversations with payers and negotiate rates and contracts— they are open if you can establish value and approach them with a concrete plan for how you will keep your doors open for the vulnerable populations you serve. And ask your payers about new reimbursement models for emergency/high-demand services.

Short-Term Business Development

While survival may seem like the only priority during a crisis and in its immediate aftermath, you don’t want to miss the opportunities for diversification and growth that any market disruption yields. Assess the urgent needs in your markets and create a rapid response model with creative and nimble service planning, pricing, staff deployment, and outreach to funders. Explore how you can maximize the revenue of current services and assets through re-purposing and repositioning in an increasingly virtual market. For example, virtual services may prime the pump for geographic expansion, and it would pay to identify replicable services and target markets.

Identify services and programs you provide today that could be repurposed for other consumer and payer markets. Look out for any competitor contracts at risk and monitor local organization “failures” that may open opportunities for you to fill the service gaps. It’s also important to develop a strategic short-term fundraising plan—identify your “critical services” to public agencies and health plans and request financial support; consider targeted appeals for specific programs; and make time for personal outreach to key donors and local charities.

Post-Disruption Sustainability

Market disruption demands fresh thinking about many things that were once untenable for most non-profits. It requires losing the “we serve; therefore, we will get paid” complacency and acknowledging the new competitors in the market. Think about how you would redesign your organization if you were starting from scratch and recalibrate frequently to keep up with market changes and needs. Strategic planning for long-term sustainability in the post-crisis market must be based on a growth mindset and include some essential elements focused on marketing, service line portfolio analysis, leverage of technology and organization-wide performance measurement.

Improving overall cost management and organizational efficiencies must be a continuous endeavor. Consider how you can become the provider organization of choice by delivering superior customer experiences. And above all, foster a culture of continuous innovation—planning, developing, and launching new service lines (while you let go of unprofitable “sacred cows”) to meet evolving needs and expectations of a market that will be in flux for a long time.

 

There is a lot we don’t know about coronavirus disease 2019 (COVID-19). The death rates, the incidence in the population, and the effect of antibodies are still big questions. But there are conclusions about one issue that seem to be emerging in almost every study—hospitalization and death rates are being driven by underlying chronic medical conditions.

Among people diagnosed with COVID-19, the most common underlying health conditions linked to hospitalization and death were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%). And last week, the Centers for Disease Control and Prevention (CDC) expanded its list of populations at highest risk, including those with chronic kidney disease, chronic lung diseases, weak immune systems from transplants, obesity, heart conditions, sickle cell disease, and diabetes.

This data is consistent with earlier findings in China and Italy. The March 2020 Italian epidemiological study found that more than 99% of Italians who died of COVID-19 had a chronic illness, including hypertension, diabetes, heart disease, cancer, dementia, or history of stroke. Of that group, 48.5% had three or more chronic illnesses, 25.6% had two chronic illnesses, and 25.1% had one chronic illness. Another study from Wuhan found that 48% of consumers who were hospitalized had a comorbidity, including hypertension (30%), diabetes (19%), and coronary heart disease (8%).

Unfortunately, almost half (45%, or 133 million) of all Americans suffer from at least one of these conditions. We also know that approximately 75% of individuals with a serious mental illness have at least one chronic health problem and half have a diagnosis of two or more chronic health problems. Chronic pulmonary illness was the most prevalent at 31%. Among consumers with an intellectual and developmental disability (I/DD), 45% have three or more chronic conditions; and among people in prison, this percentage rises to 50%.

For provider organizations serving these populations, there is an opportunity to both “do the right thing” and gain market differentiation needed for building a sustainable market position. These vulnerable populations need care management approaches that fully embrace chronic disease management and the “whole person” care approach—and that is exactly what health plan managers have been saying they want as well.

Many times, when this idea is raised, the common push back is that we are too far into the pandemic crisis for wellness and prevention programs to make a difference. But some interesting researchers have dissuaded me of that. David Katz, M.D., founding director of the Yale-Griffin Prevention Research Center, makes a great case for creating a national health promotion campaign for those at highest risk. His point is that the pandemic has turned America’s chronic health liabilities into an acute threat. As he says, “The very things we tell people to do to improve their long-term health actually do fortify your immunity. Those healthy practices can affect how your immune system functions in hours, certainly in days, and a whole lot in a span of weeks….”  In his article, he continues this train of thought, “This…is what we in Preventive Medicine call a ‘teachable moment’… The immunologic responses of generally healthy bodies are an obviously high-potency defense against the ravages of SARS-CoV-2. Why race for the extrinsic salvation of a vaccine while neglecting the rarefied, intrinsic defenses of our native immune system….?”

For provider organization executive teams looking to the future, this wellness-oriented support for our most vulnerable and high-risk consumers is also exactly what health plans are looking for. This is one of those moments in time when organizations can do well by doing good.

“The most important factor in survival is neither intelligence nor strength but adaptability”—Charles Darwin

What can we say about leadership during this pandemic crisis? We have a health crisis that is changing the health and human service field in very fundamental ways. We have an economic crisis that is just beginning with recession and likely to slide into a depression in the fourth quarter. Over 47 million Americans have already filed for unemployment and more are likely to follow in the third quarter.

But what we know about the future as leaders is limited. There will be more virtual services and there is high risk to essential workers. Unemployment will continue to increase. An estimated 25,000 retail stores are going to close this year. Government agencies will be strapped for funds.

More problematic for leaders—whose job is to assure organizational survival and recovery to continue their mission—are the big unknowns. When will the most severe part of the health crisis be over? What is the likely shape of the economic recovery—a sharp “V” or a long “L”? What is the likely timing of an economic recovery? What industry sectors, what organizations, and what individuals will have access to government financial aid? For various health and human service lines, what is a sustainable service model and business model when moving to recovery? What will be the sustainable service model and business models when recovery happens?

To manage during the crisis, we have developed a framework for executive action. And when your team gets to developing a recovery strategy, my advice to leaders is to try to let go of the anchors of the past and think creatively about your organization’s assets and opportunities. My suggestion is to ask yourself and your team a few essential questions:

  1. Why does your organization exist? What is its role in the community and in the field?
  2. If you continue at your current rate of revenue and expenses, is your organizational sustainable? And if not, how long can your organization continue to operate? And how can you reduce expenses while continuing to serve your mission?
  3. What is it that your organization does that “pays the bills?” Look at your service lines individually and in the aggregate—revenue, payers, consumers, and margins. What makes money and what does not?
  4. Based on your assessment of the most likely future, what is your vision for your organization’s role in the community and its mission a few years in the future?
  5. What are the key objectives that your organization needs to achieve over the next year?
  6. What is the best-case future scenario for your organization?
  7. What are the future scenarios that would severely damage your organization’s sustainability?
  8. What service lines have the potential for short-term revenue growth? For long-term revenue growth?
  9. What should your team do in the next month to achieve those future objectives?

These are the tough questions that shape future strategy. And with this assessment (which needs to be repeated with any shift in the market), you can develop a recovery strategy and mobilize your team to move ahead.

But, having the framework for crisis management and plan for crisis recovery is not enough. Leaders need to bring their teams with them on this new and surreal journey. There are essential executive actions that are needed, regardless of the plan, in order to assure success.

There are some specific leadership competencies that are required for success at that time. The ability to use data and the ability to manage in a virtual environment are two of many. But to be creative and develop innovative solutions requires distance. So, once you’ve thought and planned and organized and communicated, step away. No matter where you find mindfulness (whether gardening or video gaming or needlepoint or music or hiking), take a break and let it all percolate. You will likely need to do it all over again soon.

In its latest move to address mental health in the workplace, Starbucks is making mental health training available for all U.S. assistant store managers, store managers, and above, in addition to all non-retail employees. The coffee chain announced that training will be available through July and is intended to provide employees with a resource that can help them listen for, recognize and respond to signs of mental health and addiction issues and provide resources available to their teams.

The training—dubbed Starbucks Mental Health Fundamentals—is inspired by the National Council for Behavioral Health’s Mental Health First Aid and includes four 30-minute modules: effective listening; providing encouragement and reassurance; providing resources and information; and the importance of self-care. The training is the latest offering the employer has added to its roster of mental health benefits, which Starbucks leaders started examining last year. In April, Starbucks added a new therapy benefit through provider Lyra Health to provide all U.S. employees—and their eligible family members—access to 20 sessions a year with a mental health therapist or coach. Sessions can be in-person or via video-chat.

In January, the coffee chain introduced Headspace, a daily meditation and mindfulness app, as a benefit for employees. Employees can sign up for a free subscription and access hundreds of sessions and guided meditations on topics ranging from stress to anxiety to sleeplessness. Last month, Starbucks said more than 68,000 employees in the U.S. and Canada are now using Headspace.

Founded in 1971, Starbucks Coffee Company is an American coffee company that currently operates more than 30,000 stores worldwide. Starbucks was founded and is headquartered in Seattle, Washington.

Contact information

  • Starbucks, Post Office Box 34067, Seattle, Washington 98124-1067; 206-318-7100; Email: info@starbucks.com; Website: https://www.starbucks.com/

As executive teams look to diversify, there is one challenge that comes with every new service—identifying and managing new performance measures. The range of performance measures—and how to set up a system that can adapt to a wide range of measures, was the focus of a new white paper, Maximize Success With Performance And Quality Measures, that Monica E. Oss, Chief Executive Officer, OPEN MINDS wrote with Scott Green, Senior Vice President and General Manager of Human Services at Netsmart.

How different are the performance measures? It depends on your service lines. A recent analysis of performance measures found there were 558 unique mental health performance measures. This includes the “alphabet soup” of measurement systems like the Merit-Based Inventive Payment System (MIPS), Meaningful Use (MU), Certified Community Behavioral Health Clinic (CCBHC), Inpatient Psychiatric Facility Quality Reporting (IPFQR), and the Treatment Episode Data Set (TEDS) initiatives.

At the service line level, what do performance reporting requirements look like? Take just these three examples—health homes, CCBHCs, and long-term services and supports (LTSS). Medicaid health homes are required to report on eight quality measures and three utilization measures to receive payment. Some measures on the table include initiation and engagement of alcohol and other drug abuse or dependence treatment, controlling high blood pressure, screening for depression and follow-up plan, follow-up after hospitalization for mental illness, all-cause readmissions, adult Body Mass Index assessment, and the Prevention Quality Indication (PQI) 92: for chronic conditions. CCBHCs are tracking follow-up after hospitalization for mental illness, adherence to antipsychotics for individuals with schizophrenia, initiation and engagement of alcohol and other drug dependence treatment, and suicide risk assessment for major depressive disorder.

In contrast, LTSS provider organizations need to measure metrics related to assessment, care planning, and care coordination through comprehensive assessments and care plans. Some of the specifics include shared care planning with the primary care professional; reassessment/care plan update after inpatient discharge; and screening, risk assessment, and plan of care to prevent future falls.

The constant comment from provider organization executive teams is that there are too many different performance measures—with different requirements depending on the service, the consumer type, and the health plan. I don’t see that changing any time soon. Rather, management teams need to build a technology infrastructure with flexible reporting capabilities. There are six key elements to a “best practice” infrastructure: a shareable electronic health record (EHR); integrated workflows; customizable measures for each type of contract; identified gaps in care; visual dashboards; and the ability to calculate everything in real-time.

A shareable EHR—On-demand data interoperability is essential to care coordination and managing transitions of care, and for a provider organization to truly be high-functioning, it needs everyone on the care team to have access to the metrics that can build and support a whole-person approach to care. Developing a shared platform across all users equips the team to identify behavioral health concerns exposed by the data, and then to align the treatment plans.

Integrated workflows—Feeding data into the daily workflows across all clinical, financial, and operational decision making is at the heart of increasing efficiency and leveraging the potential to meet metrics requirements, increase quality, and capture the requisite outcome measurement scores. Building this “new” workflow approach should focus on clinical form consolidation, point-of-service access to health records, increased record compliance, and enhanced health record reviews and audits.

Customizable measures for each type of contract—When it comes to measures, not all contracts are created the same, and many executives will have to embrace and remain diligent in the face of “measurement fatigue.” But it’s an inescapable reality that every contract will have its own requirements and quality measures. Investing in collection methods and tools that can flexibly allow executives to target and report different data is a must.

Proactively identify gaps in care—There is no competitive advantage if provider organizations don’t have the ability to put performance measures to good use in improving consumer care. That is the key competitive advantage in a data-rich, performance-based world. Shared data and integrated workflows alone are good but run the risk of being reactive instead of proactive. A targeted investment in predictive analytics allows executives to look ahead and identify the gaps in care that threaten to keep the care team from achieving its goals.

Reporting and visual dashboards—The key to the effective use of any data is automating the data collection and analysis, and then delivering actionable information through customized reporting and dashboards for end users. These are the hands-on tools that can take large chunks of unwieldy and dense data and deliver them in a “digestible” way.

Calculate everything in real-time—Real-time data is far more valuable than lagging indicator data because it supports a proactive approach to outcomes management. It allows managers to change performance rather than just discussing why poor performance happened.

On June 12, 2020, the federal Department of Health and Human Services (HHS) finalized changes to a section of the Patient Protection and Affordable Care Act (PPACA) to eliminate protections from discrimination based on gender identity. The change affects Section 1557 referring to sex discrimination. The HHS Office of Civil Rights said it will enforce Section 1557 by returning to the government’s interpretation of “sex” discrimination based on the presence of male or female genes. HHS said this was the plain meaning of the word “sex.” The rule is effective August 18, 2020.

Section 1557 of the PPACA is a civil rights provision that prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. Congress prohibited covered health programs or activities from discriminating on any of the grounds protected by four federal civil rights statutes:

  • Title VI of the Civil Rights Act of 1964 (Title VI) (prohibiting discrimination on the basis of race, color, or national origin).
  • Title IX of the Education Amendments of 1972 (Title IX) (prohibiting discrimination on the basis of sex).
  • Section 504 of the Rehabilitation Act of 1973 (Section 504) (prohibiting discrimination on the basis of disability).
  • Age Discrimination Act of 1975 (Age Act) (prohibiting discrimination on the basis of age).

It is unknown how the HHS changes in definition regarding “sex” to enforce PPACA Section 1557 will be affected by the June 15, 2020, ruling by the United States Supreme Court in Bostock v. Clayton County, which held that federal employment discrimination law protects gay and transgender employees. The ruling means that an employer who fires an individual solely for being gay or transgender violates Title VII of the Civil Rights Act of 1964. The court said that gender identity—being gay or transgender—is “inextricably bound up with sex.”

A link to the full text of “HHS Office Of Civil Rights Final Rule: Nondiscrimination In Health & Health Education Programs Or Activities, Delegation Of Authority” may be found at www.openminds.com/market-intelligence/resources/061920hhsocraca1557rule.htm.

A link to the full text of “Fact Sheet: HHS Finalizes ACA Section 1557 Rule” may be found at www.openminds.com/market-intelligence/resources/061220hhs1557factsheet.htm.

A link to the full text of “Supreme Court Of The United States Opinion In Bostock v. Clayton County” may at www.openminds.com/market-intelligence/resources/061520scotusrulingbostockvclaytoncty.htm.

For more information, contact:

  • Luben Montoya, Supervisory Civil Rights Analyst, Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, District of Columbia 20201; 800-368-1019; Email: OCRMail@hhs.gov; Website: https://www.hhs.gov/ocr/index.html.

On June 18, 2020, Los Angeles Mayor Eric Garcetti said the city will provide 6,700 new shelter beds to clear homeless camps near freeways. The city will create 6,000 new beds over the next 10 months, which will augment 700 beds that were already planned to be built over the next 18 months. Los Angeles County will provide $300 million to fund essential supportive services at the new facilities over a five-year period. Priority for the new beds or other housing will be people currently camped within 500 feet of freeways. According to the 2020 point-in-time count in January, there were 66,433 Los Angeles County residents experiencing homelessness, up 12.7% from the previous year.

The new shelter beds are part of a settlement between the City and County of Los Angeles and the LA Alliance for Human Rights, which had sued the city and the county on March 10, 2020. On May 15, 2020, the judge overseeing the case ordered the city and the county to relocate people camped within 500 feet of freeways into a shelter or other form of housing. On June 20, 2020, the court commended the city and county for the settlement they reached regarding individuals experiencing homelessness on or near highway underpasses and overpasses and urged the parties to continue these efforts to reach a global settlement of all the remaining disputes in the matter.

The LA Alliance for Human Rights is an unincorporated association consisting of a broad coalition of Los Angeles stakeholders and taxpayers who are directly affected by the county’s homelessness crisis. They seek a legal mandate requiring the city and county to expedite provision of shelters and wraparound services as well as treatment for homeless persons.

Each of the co-plaintiffs presented evidence that their homes, businesses, and/or civil rights have been impaired by the city’s failure to maintain public property. They alleged the following:

  1. The city and county have negligently failed to control, maintain, and keep safe and clean the public and public-right-of-way areas, including parks, sidewalks, streets, public buildings, and certain undeveloped areas such as alongside freeways and other transportation routes.
  2. The city is perpetuating and facilitating nuisance violations because it fails to maintain the public property under its control and fails to enforce laws related to maintenance of public property.
  3. The city’s actions and failure to enforce laws have limited, damaged, and/or burdened the plaintiffs’ property and/or businesses so substantially that they rise to the level of a regulatory taking, yet no compensation has been provided.
  4. In their response to the homelessness crisis, the city and county have failed to comply with the California Environmental Quality Act because they have failed to assess the environmental impact of homeless encampments and cleaning up encampments and sidewalks.
  5. Failure to maintain clear sidewalks so that someone using a wheelchair or walker can walk safely violates California’s Disabled Persons Act, which provides that individuals with disabilities or medical conditions have the same right as the general public to the full and free use of the streets, highways, sidewalks, walkways, public buildings, medical facilities, including hospitals, clinics, and physicians’ offices, public facilities, and other public places.
  6. Failure to maintain clear sidewalks violates the federal Americans with Disabilities Act (ADA), which provides that people with disabilities be afforded the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation. The city and county are aware of these ADA violations through their own inspections and reports of blocked sidewalks due to encampments through its own reporting mechanisms.
  7. Failure to maintain clear sidewalks violates Section 504 of the federal Rehabilitation Act subjecting people with disabilities to discrimination regarding the benefits and services involved in utilizing public rights-of-way based solely on their disability.
  8. The city and county have failed to follow their own respective procedures, in violation of both state and federal law, because the city and county have enforced the law in some areas and declined to enforce in others. They have arbitrarily determined where homeless encampments may or may not be located and which communities should be affected, which has placed a disproportionate burden on some persons, communities, and businesses over others. The plaintiffs believe the city and county officials told or instructed homeless individuals that camps would be allowed to exist and persist in some areas (Skid Row, certain areas in Venice, or under the 405 freeway).

The LA Alliance for Human Rights began in the summer of 2019 as an informal, grassroots effort to develop creative ways to change the trajectory of the homelessness crisis on Skid Row. The organization is an unincorporated association consisting of a broad coalition of Los Angeles stakeholders who believe that homelessness in the county is a human rights crisis and are working towards solutions to address the crisis and its related impact on health and safety issues throughout the region.

A link to the full text of “LA Alliance For Human Rights v. City & County Of Los Angeles” may be found at www.openminds.com/market-intelligence/resources/031020laallianceforhrvlosangeles.htm.

For more information about the city and county response to homelessness, contact:

  • Ahmad Chapman, Director of Communications, Los Angeles Homeless Services Authority, 811 Wilshire Boulevard, 6thFloor, Los Angeles, California 90017; 213-225-8491; Email: achapman@lahsa.org; Website: https://www.lahsa.org/

For more information about the plaintiffs’ allegations, contact:

  • Daniel Conway, Media Contact, L.A. Alliance for Human Rights 916-207-6707; Email: daniel@conwaystrategies.com; Website https://www.la-alliance.org/

The Madonna hit from the ‘80s, “I am a material girl living in a material world” crept into my subconscious when I was thinking about how we are each called upon to be a digital leader because you know that “we are living in a digital world.” The pandemic sent health and human services headlong into a “digital first” world and most executives learned to adapt quickly, along with their staff, consumers, payers, and other stakeholders. And of course, we all know that lockdowns or not, digital is the way most health care—and in fact most of life—will be in the foreseeable future. Connecting with a clinical professional will be akin to ordering paper towels on Amazon, getting food delivered through GrubHub, or even watching a Broadway show on YouTube. Are we ready to deliver?

The answer is no, according to a survey of 1,200-plus executives, in which more than half (53%) of respondents said they believe the management or senior leadership at their company is unprepared to implement a successful digital strategy. Steven Nilsen, a partner at Boyden—the firm that conducted the survey—notes that for the new generation of leaders who are poised to capture the digital transformation, “…digital is not a task to be done. It is how a task gets done. It is a culture and a mindset.”

A digitally savvy leader is more than one who knows how to use their smartphone, weigh in on social media, and look cool on Zoom meetings —although those are all good skills to cultivate.

The culture and mindset for leadership in a digital world requires different approaches than it did in our previously nondigital (but evolving) world. An MITSloan Management Review research report, cautions that “time is running out for leaders who are holding on to old ways of working and leading.” This report reiterates that only 48% of executives agree that their organizations are prepared to compete in digitally driven markets and economies. While 82% believe that leaders in the new economy will need to be digitally savvy, less than 10% of respondents feel that their organizations have leaders with the right skills to thrive in the digital economy.

The authors of the MITSloan report also present emerging behaviors of digitally savvy leaders— purpose-driven, nurturing passion, making data-driven decisions, demonstrating authenticity, demonstrating empathy, employing an inclusive approach, showing humility, and working across boundaries. These would seem like enduring behaviors for all times. In addition, I would say that digitally savvy leaders in the health care world must assimilate seven truths to prepare for success in a digital world.

Digital is not a substitute for nondigital—it’s a new way of doing business.
Back in early March of 2020, most provider organizations started to provide—or ramped up capacity to provide—virtual services only because brick and mortar facilities began to close. But before long, most organizations realized that while digital can’t replicate the in-person visit, it offers other advantages. Leaders who embrace digital will recognize opportunities for new value propositions to new markets. It’s not just about telehealth. Think artificial intelligence to improve the accuracy and efficiency of routine tasks. Think telework to expand your talent pool and improve staff productivity. Think online scheduling. Think late evening appointments and even 24/7 care if clinical professionals can work shifts from home. And think about new consumers who are looking online for online services.

Digital first is not tech first, it’s people first.
Yes, today’s leaders must be tech savvy, web savvy, and social media savvy. But remember technology is only an enabler to help meet consumers wherever they are. Think about what consumers want, what they can and cannot do, and how they are willing to access and pay for care. Whether you provide services through a virtual or in-person model—or some combination of the two—the people who use your services want the same experience that they have on Amazon, Facebook, or TripAdvisor. Ease of access, instant gratification, intuitive to use, ability to connect with others who use the same services, and ability to provide feedback and have a dialogue. Digitally savvy leaders are those who can walk a mile in their customers’ shoes every day and recognize that shoe styles and sizes are changing as lifestyles and preferences evolve rapidly in a digital world.

Digital can empower deeper relationships.
Digital can empower strong face-to-face connections with consumers and stakeholders, while enabling two-way communication and the ability to obtain continuous feedback for continuous improvement. Technology also makes it easier to stay in touch with stakeholders and to engage with them often. Digitally savvy leaders use technology to listen to their audience and not just to talk at them. Digital also expands the possibilities when it comes to marketing and advertising, allowing for personalization and customization in a way that traditional channels would not allow. Just think about how Netflix, Hulu, and HBO can hold you captive with “Watch Next” or “Because you watched Tiger King, we think you’ll like…” popups, text alerts, emails, and customized home pages.

Digital demands a data-driven culture.
Google and the iPhone and social media have turned every human into a walking data cache. The “If you don’t measure it, you can’t improve it” adage in health care has been underscored by all the tools and capabilities that technology bestows on us. Digital savvy leaders are focused on data but not just for data’s sake. They seek the insights that data can provide and create a culture that “starts with why” (the phrase made legendary by Simon Sinek) and that asks the right questions before determining what data will be collected and analyzed. And digital leaders in a digital world must be prepared to deal with the skeptics who are likely to decry the data if it means they must change the way they do things.

Digital requires connecting the dots.
Leaders who “get” digital will nurture a culture where all managers will see how their work is connected to the work of others in the organization. Digital can serve as the great connector and eliminate silos by enabling transparency, faster and broader communication, and platforms for sharing information and results. Clinical professionals can’t remain oblivious to the challenges in accounting and vice versa; IT can’t live in an ivory tower; and HR is not the only problem solver. Technology can bring people together in meaningful ways and enable goals to be aligned and the big picture to remain in the spotlight.

Digital expands the competition, but also the possibilities.
Smart leaders recognize that digital ushers in more competition. A growing number of apps, e-counseling platforms, and virtual employee assistance programs are competing with traditional behavioral health organizations for consumer attention and even payer contracts. Primary care practices might consider embedding their own behavioral health services through telehealth. Assessing the competitive landscape and planning and refining the strategy to gain an edge over competitors is more critical than ever before in the digital domain. But savvy leaders also recognize that digital opens new opportunities for collaboration and partnerships. Behavioral health provider organizations may be able to embed medical care through telehealth or accept warm handoffs virtually. Digital also provides new channels for community education and engagement.

Digital divides and leaves gaps.
Discerning leaders who serve vulnerable populations recognize that the “digital divide” or the gap between the haves and the have nots in terms of tech devices and Internet bandwidth is real and growing. Even as they think about expanding services through digital channels, health care leaders must think about how to address the needs of those who cannot access such care. Digital access is increasingly being listed as a social determinant of health and is an issue that payers and policymakers know they must address.

At the end of the day, digitally savvy leaders are those who leverage the opportunities yielded by the digital world while keeping the human element front and center. “‘Cause everybody’s living in a digital world” as Madonna might say in a reprise of “Material World.”

Aegis Treatment Centers, a California-based outpatient treatment provider organization owned by Pinnacle Treatment Centers, has opened an opioid treatment program in Ceres, California. The facility is the 36th Aegis location in the state.

Aegis Ceres is providing medication assisted treatment services, including methadone and buprenorphine, as well as individual and group counseling for the treatment of opioid addiction. The facility will also incorporate cognitive behavioral therapy, motivational interviewing, relapse prevention, life skills training, contingency management, mindfulness, and stress and relaxation techniques. According to Joe Pritchard, chief executive officer of Pinnacle, the new location supports the organizations’ overarching commitment to drive affordable services into underserved communities.

Aegis Treatment Centers is a large outpatient addiction treatment center in California. The organization serves over 9,200 people through the support of over 600 staff members.

Contact information:

  • Aegis Treatment Centers, LLC., 7246 Remmet Avenue, Canoga Park, California 91303; 818-206-0360; Email: info@aegistreatmentcenters.com; Website: https://aegistreatmentcenters.com

Toledo, Ohio-based ProMedica has made a bid to assume the day-to-day operations of University of Toledo Medical Center (UTMC). Under the proposal, the University of Toledo would maintain ownership of UTMC. ProMedica would provide management and other services.

University of Toledo stated it was considering a sale of its hospital after the medical center reported more than $12 million in operating losses through the first half of fiscal year 2020, a loss of $7 million in fiscal 2019 and a $3.6 million loss in fiscal 2018. ProMedica said in its proposal it believes it can provide a unique local solution that will enable UTMC to become financially stable. ProMedica said if it wins the bid, it would work to stabilize UTMC’s finances, replace its outdated EMR and continue to offer academic and research opportunities at UTMC. A third-party advisor will review the submissions and make recommendations to the university’s board. Shortly after ProMedica announced its bid, community members voiced concerns about the potential partnership.

ProMedica is a health system serving communities in 28 states. ​The health system includes 13 hospitals, four ambulatory surgery centers, and more than 400 post-acute facilities. ProMedica has nearly 56,000 employees and more than 2,100 physicians with privileges system wide. In collaboration with educational institutions locally and regionally, ProMedica offers research, grants, and residency programs, as well as fellowship, clerkship, nursing, pharmacy, allied health, and continuing education opportunities.

Contact information:

  • ProMedica,100 Madison Avenue, Toledo, Ohio 43604; 800-774-3627; Website: www.promedica.org

The Center for Medicare and Medicaid Innovation (CMMI) will accept Letters of Intent from hospices and other provider organizations that seek to participate in the professional or global Primary Care First Direct Contracting models until July 6. The direct contracting options include three voluntary payment models that are designed to help the U.S. Centers for Medicare & Medicaid Services (CMS) and health care provider organizations reduce the cost of care and improve quality within Medicare fee-for-service programs.

The three models include the professional, global, and geographic options. The models adapt and integrate concepts from other programs such as Accountable Care Organizations, the Medicare Shared Savings Program, and Medicare Advantage, as well as strategies used in the private sector. The direct contracting program is associated with the agency’s Primary Care First Initiative, which also consists of a general payment option and a Serious Illness Population (SIP) option. All of these programs were slated to launch January 1, 2021, but CMS has pushed back the SIP and direct contracting implementation dates to April 1 of that year.

Under direct contracting professional model, provider organizations would accept the risk for 50% of shared savings or losses for all Medicare Part A or Part B services for individuals that fit the Primary Care First eligibility requirements. Organizations working in this model would receive a risk-adjusted monthly payment for primary care services equivalent to 7% of the total cost of care. Within the global model, provider organizations would also bear 100% of the risk associated with eligible individuals.

The Centers for Medicare & Medicaid Services is the agency within the U.S. Department of Health and Human Services that administers the nation’s major health care programs. The CMS oversees programs including Medicare, Medicaid, the Children’s Health Insurance Program, and the state and federal health insurance marketplaces.

Contact information:

  • Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 877-267-2323; Website: www.cms.gov

AAC Holdings Inc., the publicly traded parent of American Addiction Centers (AAC), filed for Chapter 11 bankruptcy protection. The Brentwood, Tennessee-based company listed debt of $517.4 million and assets of $449.3 million in its filing in U.S. Bankruptcy Court in Delaware.

The company stated it expects to emerge from bankruptcy in 125 days after executing on a recapitalization plan that will slash its debt. AAC lined up $62.5 million of initial financing that will allow it to maintain operations during the restructuring, according to a separate statement. The company, which operates rehab centers in seven states, has struggled with its debt load, including borrowings it took on from its acquisition of AdCare in 2018. The company defaulted on its debt obligations in 2019 and entered into a forbearance agreement with lenders. AAC operates rehab facilities in California, Florida, Texas, Nevada, Mississippi, New Jersey, and Rhode Island. The case is AAC Holdings Inc., 20-11648, U.S. Bankruptcy Court for the District of Delaware.

American Addiction Centers’ mission is to provide quality, compassionate, and innovative care to adults struggling with addiction and co-occurring mental health disorders. Through comprehensive and customized treatment plans, we instill hope that long-term recovery is possible. Their purpose and passion is to empower you, your family, and your community by helping you achieve recovery and optimal wellness of the mind, body, and spirit.

Contact information:

  • American Addiction Centers, 200 Powell PIace, Brentwood, Tennessee 37027; 888-987-1784; Website: https://americanaddictioncenters.org/

The coronavirus disease 2019 (COVID-19) pandemic could cost private health plans from $30.0 billion up to $547 billion over the next two years, according to an estimate by America’s Health Insurance Plans (AHIP), a trade association for health plans. Out-of-pocket expenses for privately insured individuals could range from $2.8 billion to $48.6 billion of the total costs.

Estimated Range Of Total COVID-19-Associated Treatment Costs
2020 & 2021 (in billions of dollars) Scenario 2020 Total Allowed Cost 2021 Total Allowed Cost 2020 & 2021 Total Allowed Cost 2020 & 2021 Total Member Cost Sharing
Low Infection Rate 10% $22.1 to $67.9 $7.9 to $24.2 $30.0 to $92.0 $2.8 to $8.1
% Cost of Care 1.3% to 3.9% 0.4% to 1.3% 0.8% to 2.5% n/a
Baseline Infection Rate 20% $44.6 to $135.2 $15.6 to $47.0 $60.2 to $182.2 $5.6 to $16.2
% Cost of Care 2.5% to 7.7% 0.8% to 2.5% 1.7% to 5.0% n/a
High Infection Rate 60% $133.6 to $404.6 $46.5 to $142.1 $180.0 to $546.6 $16.6 to $48.6
% Cost of Care 7.6% to 23.0% 2.5% to 7.6% 5.0% to 15.1% n/a

The true infection rate in the United States is unknown, although some projections as of May 18, 2020, estimate it at 3.5%. The three infection scenarios include costs of diagnostic testing in assumptions about inpatient and outpatient utilization, but do not include the potential for large-scale population testing costs. The authors did not calculate the probability that any given scenario would occur; they considered the selected scenarios to be reasonably possible outcomes.

  • The 10% infection scenario represents ongoing spread in 2020 and 2021, but without significant infection spikes. In this scenario, effective interventions mitigate exposure.
  • The 20% scenario represents ongoing spread, and a small spike that starts in the fall of 2020 and continues into 2021.
  • The 60% scenario represents ongoing spread, and a large spike in the fall of 2020, that tapers off but does affect 2021.

The scenarios assume that care would be delayed as a result of the pandemic. Some of the care delayed during 2020 would be made up in 2020, and some in 2021, and the rest would be foregone. The pattern for 2021 would be similar; some care would be delayed, with a fraction made up during the year, some made up the following year, and some foregone.

Deferred Care Assumptions For 2020
Scenario 2020 Percent Of Costs Deferred Portion Of Deferred Care Foregone Portion Of Deferred Care Made Up In 2020 Portion Of Deferred Care Made Up In 2021
Low Infection Rate 10% 5% 35% 52% 13%
Baseline Infection Rate 20% 10% 45% 33% 22%
High Infection Rate 60% 20% 55% 18% 27%

These estimates were reported in “COVID-19 Cost Scenario Modeling: Treatment” by Michael Cohen, Ph.D., and Julie Peper, FSA, MAAA of Wakely Consulting Group, LLC, for AHIP. The authors created a series of infection rate scenarios and a range of assumptions over a two-year period to model hospitalization rates, costs per utilizing member for each COVID service, and the impact of deferred care. They compiled estimates of total potential COVID-19-related treatment costs, as well as estimates of costs for U.S. private insurers operating in the commercial, Medicare Advantage, and Medicaid managed care lines of business. The estimates do not address costs outside these lines of business. The analysis of utilization and outcomes is based on data from multiple countries published during the pandemic. The hospitalization rate by line of business was adjusted to account for the higher number of health conditions among some populations.

The full text of “COVID-19 Cost Scenario Modeling: Treatment” was published on June 8, 2020, by America’s Health Insurance Plans. A copy is available online at https://www.ahip.org/covid-19-cost-scenario-modeling-update/.

For more information, contact:

  • Press Office, America’s Health Insurance Plans, 601 Pennsylvania Avenue Northwest, South Building, Suite 500, Washington, District of Columbia 20004; 202-778-3200; Email: press@ahip.org; Website: https://www.ahip.org/

While the adage “The best defense is a good offense” is typically associated with military combat and sports (and is often attributed to Michael Jordan), it was first said by George Washington in 1799, “…offensive operations, often times, is the surest, if not the only means of defense.” In the midst of the current crisis, it may appear that defense is the best choice—hunkering down and waiting it out seems safe. But defense is not the only option. Crises often present opportunities but executive teams need to plan their offense. They need a plan for how to “grow” in the midst of turbulence.

A structured approach to growth in a time of crisis was the focus of The 2020 OPEN MINDS Strategy & Innovation Institute session, Proven Methodology For Identifying Strategic Opportunities: Cultivating, Negotiating & Decision Making. The presenter, Matthew M. Dorman, Chief Executive Officer of Credible Behavioral Health, Inc. discussed his structured approach to evaluating growth choices by considering both the current and future customer base and service offerings. His three-step process—understand the market position of your current service line portfolio, set your growth targets and strategy, and use growth tools to make that strategy a reality.

Understanding market position

Traditionally, serving long-time customers with long-time products has been the “safe” thing to do for health and human service organizations. But maintaining status quo could sound the death knell in this highly disrupted market. At best, “you may be left behind” given the aggressive and growing competition in the market, Mr. Dorman warns.

It’s time to evaluate your TAM (the total demand for your product), SAM (the market based on your current business model in the context of geographic location, employee base, and internal infrastructure), and SOM (what you can do based on the practical limits of your current strategy and model).

And it’s time to take a hard look at your numbers—reimbursement rates, current market share and demand for your services, your organization’s capacity and cost to market and provide the services, and the return-on-investment.

Turning those numbers into key metrics that are tangible, understandable, and relevant is critical. As Mr. Dorman emphasized, “Make sure you are graphing numbers that are relevant to your end goal—otherwise you will get lost in the data and you’ll burn a lot of time.”

Setting growth targets and strategy

With knowledge of the market and the position of the organization’s portfolio, executive teams can set growth targets and strategy.

A low risk option is to leverage current relationships to sell new products to old customers. That’s not without challenges, especially if the new products don’t fit into the long-standing brand your old audiences are familiar with. Selling new products to new customers is the most exciting strategy—but comes with the highest risk and lowest return. The optimal growth strategy is to leverage what you already do well with current products and expand it to new consumers.

Interestingly, we’re seeing these growth strategies in play right now. The pandemic crisis has pushed us over the tipping point in terms of telehealth and we know it’s here to stay. And that has two implications—telehealth could pave the way toward better outcomes from increased consumer and family engagement and convenience. On the flip side, it could help us define our niche for service delivery that demands an in-person or blended model for efficacy. The pandemic also underscores the urgent need for integrated care so we can deliver holistic care for vulnerable populations with co-occurring, complex, and chronic conditions.

And what about new markets? Will we see increased demand for services and increased spending? Are there opportunities for more home-based services? What does the rising rate of nursing home closures mean for home and community-based services? Growth strategies that involve entering these new markets will require a keen eye on the landscape and moving in quickly where competitors fail or where gaps in care start to surface.

Making strategy a reality  

But strategy alone isn’t enough. Making the growth strategy a reality is what matters—and leveraging tools to make that happen is key.

Being transparent about your growth strategy is critical to obtaining organizational and board buy-in and ensuring long-term success. To sell the broader team on any new strategic initiatives and prepare for smooth execution, executives must clearly explain the choice of the growth strategy, communicate the roles and expectations of each team member in the process, and be clear about deadlines and timelines.

Making strategy happen also requires negotiating—whether it’s negotiating the cost of services, the ability to add employees, expand internal capacity, or expand geographically through new locations and facilities. Executive teams must know what they are bringing to the table and figure out their breakeven point in terms of costs. Mr. Dorman explained, “When you know your goals and your numbers, you also know your threshold for failure,” ultimately giving you more leverage in the negotiation process.

It’s important to realize there is more than one path to growth—and sometimes that path means being prepared to walk away for a new opportunity. Mr. Dorman discussed, “We can get so focused on a particular outcome that we don’t realize when we try to go from A to B to C, there’s another path that gets us to that same outcome. The best alternative is always a solution that gets you to your end goal with as little sacrifice as possible—you have more power than you realize.”

A sustainable strategy doesn’t have to be all-or-nothing, there are many paths to growth—the key is to make sure it’s the right path for you.

St. Luke’s University Health Network (SLUHN) will acquire Easton Hospital on July 1, 2020, including affiliated physician practices and two physician residency programs with 36 physician residents. This acquisition will preserve the 125-year-old hospital for future generations, ensuring future jobs and bringing St. Luke’s world class health care to the citizens of the greater Easton-area community. St. Luke’s and Steward Health Care of Dallas, the current owner of Easton Hospital since May 2017, recently signed an asset purchase agreement that will allow for the transfer of ownership to SLUHN effective on July 1.

The acquisition, which was approved by the St. Luke’s Board of Trustees, is subject to certain conditions, including review and approval by various regulatory agencies. Financial terms of the acquisition were not disclosed

Steward Health Care is a large private, tax-paying physician-led health care network in the United States. Headquartered in Dallas, Texas, Steward operates 35 hospitals in the United States and the country of Malta that regularly receive top awards for quality and safety. The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, over 7,200 beds under management, with more than six million annual consumer encounters.

Founded in 1872, St. Luke’s University Health Network is a fully integrated, regional, non-profit network of more than 15,000 employees providing services at 11 hospitals and 300 outpatient sites. With annual net revenue greater than $2 billion, the Network’s service area includes 11 counties: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill, and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey.

For more information, please contact:

  • Sam Kennedy, Corporate Communications Director, St. Luke’s University Health Network, 1736 Hamilton Street, Allentown, Pennsylvania 18104; 484-526-4134; Email: samuel.kennedy@sluhn.org; Website: www.slhn.org
  • Darren Grubb, Vice President Communications, Steward Health Care System Corporate Headquarters, 1900 North Pearl Street, Suite 2400, Dallas, Texas 75201; 469-341-8901; Email: darren.grubb@steward.org; Website: www.steward.org

Follow-up mental health visits, within 14 days after emergency department contact, are lower among those with substance addiction than those with other mental health diagnoses. Approximately 40.2% of 57,797 individuals who visited the emergency room for a mental health issue had a follow-up mental health visit within 14 days: just 25.2% were those with initial substance use visits.

Of those with follow-up visits that were not related to substance use, about 56.1% initially presented with bipolar disorder, 51.1% initially presented with major depressive disorder, and 46.4% initially presented with schizophrenia. Psychiatrist follow-up visits accounted for about 33.1% of those who initially presented with bipolar disorder, 26.0% for those with schizophrenia, and 21.4% for those with major depressive disorder. Primary-care follow-up visits accounted for about 29.7% of those with major depressive disorder, had primary care follow-up only (N=5,243), 23.0% for those with bipolar disorder, and 20.4% for those with schizophrenia.

The researchers concluded that successfully transitioning individuals to outpatient care following an emergency department visit for mental health reasons will require system-wide and coordinated solutions. Physicians alone are unlikely to be able to adequately care for those with complex mental health conditions without coordinated and well-resourced interprofessional teams with case management support. This is especially true in the case of those presenting with substance addiction, where time is limited to seek care before potentially rapid deterioration occurs.

These findings were presented in “Urgent Outpatient Care Following Mental Health ED Visits,” by Lucy C. Barker, M.D.; Nadiya Sunderji, M.D., M.P.H.; Paul Kurdyak, M.D.; et.al. The researchers analyzed Ontario health administrative data at ICES (was the Institute for Clinical Evaluative Sciences), an independent nonprofit health research institute. The population-level data was from Ontario, Canada’s most populated province (approximately 14 million individuals), between 2010 and 2012. The cohort was comprised of 143,662 Ontario residents ages 19 and over with an psychiatric emergency department visit, (including 31,592 presenting with substance use disorders and 112,070 whose primary presentation was not a substance use disorder). The goal was to determine the likelihood of receiving outpatient mental health care after psychiatric emergency department visits in a population-level sample.

The full text of “Urgent Outpatient Care Following Mental Health ED Visits” was published February 24, 2020, by Psychiatry Online. An abstract is available online at https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201900466.

PsychU last reported on this topic in “Following A Positive Suicide Screen In ER Visit, 42% Of Older Adults Receive A Follow-Up Mental Health Evaluation,” which published on October 16, 2017. The article can be found at https://www.psychu.org/following-positive-suicide-screen-er-visit-42-older-adults-receive-follow-mental-health-evaluation/.

For more information, contact:

  • Lucy Barker, M.D., Psychiatry Resident, Department of Psychiatry, University of Toronto, 250 College Street, 8thFloor, Toronto, Ontario M5T 1R8; 416-979-6948; Email: lucy.barker@utoronto.ca; Website: https://www.researchgate.net/profile/Lucy_Barker5

Uplift Family Services announced the receipt of a two-year $4,000,000 grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), a federal agency with a mission to reduce the impact of addiction and mental illness in the United States. As part of the grant, Uplift Family Services, in partnership with School Health Clinics of Santa Clara County and Pacific Clinics, will form a consortium to become a Certified Community Behavioral Health Clinic (CCBHC).

The CCBHC will serve 2,000 low-income individuals in Santa Clara County by offering access to and improving the quality of mental and addiction treatment in the community by integrating physical health services. The consortium is among 200 behavioral health organizations and health centers in the nation, and one of five in California, to become a CCBHC.

Uplift Family Services is one of the largest, most comprehensive mental and behavioral health treatment programs in California. Uplift Family Services takes a state-of-the-art approach to children and adolescents with complex behavioral health challenges and helps them recover from trauma such as abuse, severe neglect, addiction, and poverty.

School Health Clinics of Santa Clara County improves the health and well-being of more than 5,400 low income, medically underserved adults and children each year by providing comprehensive, easily accessible primary health care. The organizations’ six clinics are Patient Centered Medical Home certified and located on public school campuses in San José and Gilroy in the low income neighborhoods where families live and work.

Founded in 1926, Pacific Clinics is a community-based behavioral health agency that provides outpatient services to individuals of all ages at over 50 locations and 325 schools across Los Angeles, Orange, San Bernardino, and Ventura counties. Each year over 22,200 individuals benefit from comprehensive and supportive services, including case management, health navigation, early education, school-based services, housing support and employment assistance.

For more information, please contact:

  • Rachel Lepold, Editorial Contact, Uplift Family Services, 251 Llewellyn Avenue, Campbell, California 95008; 408-628-5579; Email: rachel.lepold@upliftfs.org; Website: www.upliftfs.org
  • Stephanie Kleinheinz, Chief Executive Officer, School Health Clinics of Santa Clara County, 6840 Vía Del Oro #210, San Jose, California 95119; 408-284-2288; Email: stephaniek@schoolhealthclinics.org; Website: http://www.schoolhealthclinics.org/
  • Myeisha Peguero Gamiño, Editorial Contact, Pacific Clinics, 800 South Santa Anita Avenue, Arcadia, California 91006; 626-254-5054; Email: MGamino@PacificClinics.org; Website: www.pacificclinics.org

Landmark Health and its affiliated medical groups in 46 U.S. communities announced the launch of its proprietary telemedicine app. The Landmark Health app was developed to securely connect individuals with their Landmark medical provider organizations via smartphone. The app is available to Android users as of April 27, 2020 and will soon be available to iOS users.

Telemedicine helps extend Landmark provider organizations and clinical teams into the homes of individual with higher frequency, especially those living in more rural areas. Landmark’s typical consumer is in their mid-80’s with six or more chronic conditions. The company opted to build a telemedicine app to fully customize the user experience for simplicity, while being HIPAA-compliant.

Individuals can download the Landmark Health app and go through a one-time-password (OTP) authentication registration. From there, they are brought to a home screen where they can call their local 24/7 Landmark clinical line and view their upcoming Landmark appointments. During a video call, the individual sees their provider on-screen, with a small corner video of themselves. They can flip the camera front/back if they need to show the provider a rash, swollen ankle, medication bottle, etc. The Landmark provider can call an individual directly through the app as well. The individual sees the Landmark logo and words “Incoming Call” and taps “Accept” to connect to their provider. This simplicity is critical for an older adult – it removes the need for them to remember the appointment time or find the dedicated link to connect with the provider. They simply answer a call.

Founded in 2014, Landmark Health and its affiliated medical groups deliver comprehensive in-home medical care to older adults. Specialized in complex chronic care, more than 100,000 people across 14 states and 46 metropolitan communities can access Landmark’s care at no cost.

For more information, please contact:

  • Landmark Health, 7755 Center Avenue, Suite #630, Huntington Beach, California 92647; 657-237-2450; Website: www.landmarkhealth.org

Homelessness in Los Angeles County, California increased approximately 12.7%, from 58,936 in January 2019 to 66,433 in January 2020. This increase happened despite a sustained increase in the number of people who have been rehoused after homelessness. The estimated inflow over 2019 was 82,955 individuals, with 22,769 housing placements, and an estimated 52,689 individuals finding other housing.

Figures show that 18,395 individuals experiencing homelessness in Los Angeles County were sheltered in 2019: this is a 25% increase from 14,722 during 2018. While there was a 36.8% increase in sheltered families during the year, Los Angeles County saw an 82.8% increase in unsheltered families (resulting in an overall 45.7% increase in homeless families).

According to experts, Los Angeles County needs approximately 509,000 new affordable housing units to meet the current demand. The average monthly rent is $2,182; this means that renters in Los Angeles County need to earn 2.8 times the City’s minimum wage to make rent (renters need to earn $41.96 per hour).

These statistics were reported in “2020 Greater Los Angeles Homeless Count” by the Los Angeles Homeless Services Authority. The annual report captures a picture of homelessness in Los Angeles County as it was in January 2020, the time of this year’s Homeless Count.

A link to the full text of “2020 Greater Los Angeles Homeless Count” may be found at www.openminds.com/market-intelligence/resources/061220losangelesshmlss.htm.

For more information, contact:

  • Chris Yee, Communications Specialist, Los Angeles Homeless Services Authority, 811 Wilshire Boulevard, #600, Los Angeles, California 90017; 213-219-1417; Email: cyee@lahsa.org; Website: https://www.lahsa.org/

United Us announced that Staple Health will join its growing data analytics team through the recent acquisition of the company. Founded in 2017, Staple Health combines in-house predictive analytics and comprehensive integrated care in the community. The organization was founded during a time when health care provider organizations were becoming more interested in social determinants of health (SDoH) data in the move towards value-based care. Staple Health specifically provided detailed and predictive analytics about the impact of social factors on acute care, behavioral health, addiction, and other health outcomes.

In preparation, Unite Us has worked to strengthen its data team to better analyze outcomes data and its use in communities to address and prevent the factors that negatively impact health, according to Kelly Binder, chief of staff for Unite Us. In addition, Unite Us is introducing Unite Us Insights and social risk analysis to clients nationally.

Unite Us is a technology company that builds coordinated care networks of health and social service provider organizations. With Unite Us, provider organizations across sectors can send and receive secure electronic referrals, track every person’s total health journey, and report on tangible outcomes across a full range of services in a centralized, cohesive, and collaborative ecosystem.

For more information, please contact:

  • Emily Rogan, Communications Manager, Unite Us, 217 Broadway, 8th Floor, New York, New York 10007, US; 516-381-4781; Email: Emily.rogan@uniteus.com; Website: https://uniteus.com/

Spero Health has announced plans to open a new addiction treatment clinic in Warren, Ohio as part of the organization’s quick response to the growing need for expanded services as communities continue to adjust to the COVID-19 outbreak. CARF-accredited and community based, Spero Health is a national leader in providing care for individuals struggling with addiction and will bring affordable, high quality addiction treatment services through a combination of telehealth and in-person visit options at this new clinic.

The new Warren clinic opened on June 23, joining a network of more than 35 Spero Health locations throughout Kentucky, Ohio, Tennessee, and Indiana, providing care for more than 7,200 consumers each month. To ensure access to care is not a barrier to treatment, Spero Health accepts Ohio Medicaid and most commercial insurance plans. The Warren Spero Health clinic is one of several new clinics the organization is opening over the next few months to meet the high demand for access to addiction treatment services close to home.

Spero Health, Inc., is an integrated health care services organization specializing in local and affordable outpatient care for individuals with addiction. Spero Health utilizes an innovative evidenced-based integrated care model that combines both physical and behavioral health care services to provide whole person health care.

For more information, please contact:

  • Spero Health, Inc., 2529 Maple Ave, Zanesville, Ohio 43701, 740-297-8859; Email: info@sperohealth.com; Website: https://sperohealth.com

WellCare of New Jersey, a subsidiary of Centene Corporation, announced a plan to provide additional mental health resources to New Jersey residents impacted by the COVID-19 pandemic. Through a series of local partnerships across the state, WellCare will enable provider organizations to better support communities experiencing elevated levels of stress and mental strain caused by an increase in grief, loss, economic pressure, unemployment, and social isolation.

As part of this effort WellCare, in partnership with its parent company Centene, is announcing investments to support various programs. They will support training for clinical professionals and support for frontline health care workers dealing with the COVID-19 crisis and the increase in mental health-related challenges in their practices. WellCare will support ‘Warmline’ call centers by making a donation to a local organization in New Jersey coping with an increase in demand for their ‘warmline’ services, which provide early interventions to potential mental health crises. WellCare will make an investment to help the National Council for Behavioral Health transition part of their training program to a virtual program, which will make Mental Health First Aid (MHFA) training more accessible for people in New Jersey and nationwide. WellCare will also support those impacted by domestic violence by making a $500,000 donation to the National Domestic Violence Hotline, a national service provider organization which offers service via call, chats, and texts providing support for those impacted by domestic violence in times of crisis.

WellCare of New Jersey provides government-sponsored managed care services to families, children, seniors and individuals with complex needs primarily through Medicaid, Medicare Advantage, and Medicare Prescription Drug Plans across the state. WellCare is a wholly subsidiary of Centene Corporation, a leading multi-national health care enterprise committed to helping people live healthier lives.

For more information, contact:

  • WellCare, 8725 Henderson Road Tampa, Florida 33634; 800-960-2530; Website: www.wellcare.com

Kindred Healthcare, LLC (Kindred) and Landmark Medical Center, a subsidiary of Prime Healthcare, announced a definitive agreement to create a partnership that will own and operate the Rehabilitation Hospital of Rhode Island in North Smithfield, Rhode Island. Kindred will have a 60% ownership interest in the joint venture and Landmark will own 40%. The hospital is licensed for 82 rehabilitation beds.

Under the agreement, Kindred will bring its proven rehabilitation management and services expertise to the existing hospital, which serves patients from across Rhode Island and neighboring Massachusetts. Each year, Kindred Rehabilitation Services treats nearly 50,000 consumers at its joint venture inpatient rehabilitation hospitals across the country. Kindred’s inpatient rehabilitation hospitals serve patients who are recovering from a variety of conditions, including stroke, brain injury, spinal cord injury, orthopedic injury, neurological conditions, amputation and trauma. Kindred and Prime expect to complete the transaction by the third quarter of 2020, subject to the completion of due diligence, regulatory and licensing approvals.

Kindred Healthcare, LLC is a health care services company based in Louisville, Kentucky with annual revenues of approximately $3.2 billion. At March 31, 2020, Kindred through its subsidiaries had approximately 31,800 employees providing healthcare services in 1,731 locations in 46 states, including 64 long-term acute care hospitals, 21 inpatient rehabilitation hospitals, 10 sub-acute units, 95 inpatient rehabilitation units (hospital-based) and contract rehabilitation service businesses which served 1,541 non-affiliated sites of service.

The Rehabilitation Hospital of Rhode Island is a stand-alone rehabilitation hospital with a capacity of 82-beds. Prime Healthcare Services acquired the Rehabilitation Hospital of Rhode Island in North Smithfield, Rhode Island in January 2014.

For more information, please contact:

  • Susan E. Moss, Kindred Healthcare, Senior Vice President, Marketing and Communications, 680 South Fourth Street, Louisville, Kentucky 40202; 502-596-7296; Email: susan.moss@kindred.com; Website: www.kindredhealthcare.com

During the coronavirus disease 2019 (COVID-19) pandemic emergency, Massachusetts emergency departments and outpatient settings conducted fewer psychiatric assessments per week in late March compared to January and February. The share of emergency department visit notes with mentions of depression dropped by 44%, from a mean of 1,446 visits per week in January and February to 886 visits the week of March 19 to 25. The share of outpatient visit notes with mentions of depression dropped by 81%, from 49,312 visits in January and February to 9,315 visits the week of March 19 to 25. Similar patterns were observed for other symptoms.

In emergency department settings, the odds of COVID-19 testing increased by nearly 50% in visits during which violence was referenced in the record. In outpatient settings, notes with the presence of psychiatric terms were associated with a 20% reduction in the likelihood of COVID-19 testing for anxiety, 36% reduction for depression, 37% reduction for psychosis, 27% reduction for suicide, and 60% reduction for violence.

These findings were reported in “Electronic Health Record Documentation of Psychiatric Assessments in Massachusetts Emergency Department and Outpatient Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic” by Victor M. Castro, MS; Roy H. Perlis, M.D., MSc. They sought to determine the trend in documentation of psychiatric symptoms in narrative clinical notes as COVID-19 activity increased in eastern Massachusetts. They analyzed electronic health records for all individuals seen in outpatient or emergency department visits between January 2 and March 25, 2020, from two large academic medical centers and three affiliated community hospitals in Massachusetts.

The presence of depression, anxiety, suicide, psychosis, and violence was identified by the presence of terms related to these conditions. These terms included depressed, depressive, dysphoric, dysthymic, sad, and tearful for depression; anxiety, anxious, fearful, frighten, hypervigilant, nervous, panic, phobia, phobic, scared, stress, tense, and worried for anxiety; suicide, suicidal, and suicidality for suicide; psychotic, psychosis, hallucination, delusion, paranoid, paranoia, hallucinate, hallucinated, and delusional for psychosis; and violence and violent for violence.

The full text of “Electronic Health Record Documentation of Psychiatric Assessments in Massachusetts Emergency Department and Outpatient Settings During the Coronavirus Disease 2019 (COVID-19)” was published June 8, 2020, by JAMA Network Open. An abstract is available online at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766817.

For more information, contact:

  • Roy H. Perlia, M.D., MSc, Division of Clinical Research, Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, 6thFloor, Boston, Massachusetts 02114; Email: rperlis@mgh.harvard.edu

It is not uncommon for a health care provider to experience extreme distress after medical error or after an adverse event occurs to a patient.  Dr. Albert has coined the term “second victim syndrome” for this phenomenon.  In this interview, Dr. Wu discusses what second victim syndrome is, how it can be recognized and what led him to examine this condition among health care providers.  In addition, Dr. Wu describes the development of the training program, RISE (Resilience in Stressful Events), as well as its implementation at Johns Hopkins and other medical centers.

Dr. Albert Wu, MD, MPH is a Professor of health policy and management in the Johns Hopkins Bloomberg School of Public Health, the director of the center for health services and outcomes research, with a joint appointment in Epidemiology, International Health, Medicine and Surgery at Johns Hopkins University.  His teaching and research focuses on patient outcomes and quality of care.   He has authored over 400 peer reviewed publications on the topics of patient safety and outcomes, quality of life and care, as well as his foundational work on second victim syndrome due to medical error.

Gerard Zitnik, Ph.D., is a Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

 

Dr. Albert Wu, MD, MPH, volunteered his time for this presentation.

Gerard Zitnik, Ph.D., is a paid employee for Otsuka Pharmaceutical Development & Commercialization, Inc.

Addcounsel Chief Executive Officer Paul Flynn announced a new service, Orchestrate Health, to treat clients with complex mental health needs from the comfort of their home. Mr. Flynn designed the at-home alternative for people who need mental health care but do not need or want to go into psychiatric units.

The goal of the home treatment option is to enable clients to live their lives in the least restrictive way possible, allowing them the best quality of life despite the mental health difficulties they face. Orchestrate Health offers an alternative to the mainstream and is also able to act as the continuum of care for people who may have been through treatment, and although no longer in need of complex inpatient care, require a level of support at home or for individuals who would prefer to be treated at home.

Orchestrate Health provides anonymous, private mental health services and care across the United Kingdom and internationally in the comfort of the client’s home. The services offered at Orchestrate Health are exclusive mental and behavioral health care treatment from the privacy of the client’s home and round the clock rapid response home mental health care.

For more information, please contact:

  • Addcounsel Ltd, LG, 28 Grosvenor Street Mayfair, London, United Kingdom W1K 4QR; +44 (0)203 709 3968; Email: enquiries@addcounsel.com; Website: https://addcounsel.com/

Medication adherence has proven challenging for many individuals during the coronavirus pandemic. For all the convenience offered by virtual visits, they make it more difficult to administer injections or assess how patients are responding to medication. Difficulty obtaining refills or necessary lab work can be barriers to medication adherence, as well. Care coordination is especially important now, says Dr. Ehret, who also suggests that providers consider giving patients extra refills when warranted—and check in on patients most at risk for medication nonadherence.

Featuring:

  • Megan Ehret, PharmD, MS, BCPP
    Associate Professor at the University of Maryland School of Pharmacy and PsychU Pharmacist Corner Advisor
  • Joseph Cirrincione, PharmD, MBA
    Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

PsychU · Medication Adherence During The COVID-19 Pandemic

Megan Ehret, PharmD, MS, BCPP, is Associate Professor in the Department of Pharmacy Practice & Science at the University of Maryland School of Pharmacy. A board-certified psychiatric pharmacist, she is also PsychU’s Pharmacist Corner Section Advisor.

Joseph Cirrincione, PharmD, MBA, is Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

The following is a summary of Chen, Steven W; US Pharmacists Can Now Test for Coronavirus – They Could Do More If Government Allowed It, The Conversation (April 13, 2020), which was developed independently of the article authors.

Key Messages

  • US pharmacists can now order and administer FDA-approved COVID-19 tests. Testing provides vital data to help mitigate an infectious disease outbreak.
  • As a group of highly trained and readily accessible healthcare professionals, pharmacists can play a greater role than just administering tests to help address this national crisis.

Background

  • The United States has a hospital-centered healthcare system. Italian doctors have recommended other countries should manage the novel coronavirus pandemic in the community in order to avoid overwhelming the hospital systems.
    • Testing provides vital data to help mitigate an infectious disease outbreak. On April 8th, 2020, the Public Readiness and Emergency Preparedness Act authorized US pharmacies to order and administer COVID-19 tests.

Purpose

  • Pharmacists specialize in proper use of prescription drugs and are trained alongside physicians and nurses. This editorial discusses how pharmacists can do more during the current pandemic than just offering testing.

Discussion

  • Pharmacists can provide advanced services such as comprehensive medication management and individualized evaluation. Over 90% of the US population lives a short drive away from a pharmacy. However, the Federal Government does not recognize pharmacists as healthcare providers, thus preventing reimbursement for advanced services.
  • Community pharmacists show significant value in controlling of medical conditions.
    • Los Angeles pharmacists working with barbershops helped 90% of the black patients manage their high blood pressures compared to 33% of those receiving traditional care.
    • A pharmacist outreach program in Kern County, CA reduced hospital readmission rates for recently discharged Medicaid patients by 32% and saved $2139/patient.
    • Patients showed a 3-fold increase in reaching their blood sugar targets when their diabetes medication was managed by pharmacists.
  • The 67,000 community pharmacies far exceed the number of hospitals and community health centers (5500 and 1400, respectively). During this COVID-19 pandemic, pharmacies could be an alternative to hospitals for mild-moderately ill patients.
    • Pharmacists can offer drive-up tests and evaluations, home visits for those quarantined, and provide referral for further medical care when needed.
    • Given the correlation between complications of COVID-19 with high blood pressure, diabetes and asthma, pharmacists can play a greater role during this pandemic.

Conclusions

  • A greater role for pharmacists may be needed to help address this national crisis.

Clinical Implications

Pharmacists are “the most overtrained and underutilized healthcare professionals” in part because the Federal Government does not recognize them as “healthcare providers”. If allowed, pharmacists working alongside physicians can help patients better control their chronic medical conditions and manage mild-moderately ill COVID-19 patients in the community.

 

This summation has been developed independently of the author. The following disclosures were reported in the original article: “Steven W. Chen receives or has received funding from the Center for Medicare and Medicaid Innovation and the Centers for Disease Control and Prevention.”

https://theconversation.com/us-pharmacists-can-now-test-for-coronavirus-they-could-do-more-if-government-allowed-it-135188

There are a few interesting observations about ‘reopening’ of health care service operations after the pandemic crisis closures, based on discussions during last week’s virtual 2020 OPEN MINDS Strategy & Innovation Institute. Executives are conflicted—for many reasons—about reopening their office-based operations. And, there is a real lack of clarity about the mandates and availability of testing.

The Centers for Disease Control and Prevention (CDC) guidelines for the reopening of operations of any type are ambiguous at best. I’ve read most of them. They are a combination of vague, seemingly off base, and impractical. And there is no mention of testing in any of them.

There are also variations in state and county regulations. For example, in Pennsylvania, you can hold a meeting of up to 250 people for counties in the ‘green’ phase. But, in Orange County, California, the limit is 100 people. In North Carolina, gatherings are still limited to no more than 10 people indoors, and no more than 25 people in outdoor spaces. During the Institute discussion, one executive of a multi-location provider organization discussed the complexity and cost of tracking what the requirements are—and putting them in place.

Another issue is employee perceptions of safety. During the session, Navigating The New Normal With COVID-19 Part 2: An Update On Sustainable Strategies For The Disrupted Market, David Klements, Chief Executive Officer of Qualifacts, talked about forming a cross functional team of employees to develop the guidelines that Qualifacts will use for reopening. Every team member wants to think their work environment is as safe as possible.

There are also questions about whether the delivery of many therapies will ever return to office-based practice. Not only do the majority of consumers prefer the convenience of virtual services, every executive at the 2020 OPEN MINDS Strategy & Innovation Institute who discussed their move to virtual services talked about the decrease in no-show rates, the increase in clinical professional productivity, and the elimination of the costs of office space. Therapy services weren’t profitable before the pandemic crisis occurred—and those rates are not likely to go up in the future. Many executive teams may make the decision to keep much of their therapy capacity—and those services—in a virtual delivery model. The executive commented, “We’re not going to open our offices any time soon. We’re focused on expanding our home-based services instead.”

Finally, there is the testing issue. First, none of the CDC guidelines mention testing. Yet there is a broad consensus that employee and consumer testing is a key to reopening. In testimony to Congress on June 4, Georges Benjamin, M.D., Executive Director of the American Public Health Association, told members of the U.S. Senate committee on Health, Education, Labor and Pensions that without adequate testing, universities “can’t function at all.”

There are admittedly variabilities in the accuracy of different tests. But there is widespread agreement that rapid testing—combined with sanitation measures, contact tracing, and quarantines—is an important tool for moving ahead.

One key tool for executive teams planning for recovery after this crisis period is having the metrics to make the right decisions – think of this data in three domains. There is financial data for short-term cash management strategy. There is strategic market information for planning long-term post-recovery strategy (this includes both external and internal data). And there is service performance data to optimize value.

We got a great example of service performance data in the presentation, Measurable Client Outcomes – A Provider’s Journey Continues, by Scott Zeiter, executive vice president and chief operating officer, and Jeremy Ulderich, director of educational consulting at Grafton Integrated Health Network, at The 2020 OPEN MINDS Strategy & Innovation Institute. Grafton has implemented a sophisticated approach to providing measurement-based care (MBC) in their programming for consumers with complex behavioral challenges. The program started over a year ago. Their presentation focused on what they have learned after fully implementing the MBC service model.

The model is based on a five-step process—identify the consumer behaviors that are problematic and need to change; develop a goal for behavior change; select an “intervention”;  develop a plan for integrating the intervention into a consumer care plan; and measure the effectiveness of the intervention. This sounds simple but is a complicated undertaking to determine what interventions are most effective in specific consumer groups. Mr. Zeiter explained, “We needed to come up with a response to value-based contracting. Defining value is difficult. We needed to take a step ahead of the external stakeholders. That has had a positive impact, and the payers have taken an interest in it, as a way to define true value. We wanted to root this into evidence-based practices.”

What were the key effects of this process at Grafton? Mr. Ulderich shared a few stats, showing that in their Assessment of Basic Language and Learning Skills, the overall consumer score increased from an average of 318.05 to an average of 545.62—up to 80% growth from prior assessment. And in the Assessment of Functional Living Skills Criterion, there was a 32% increase in overall consumer scores. Mr. Zeiter noted the success, saying, “Once we gave the staff that tool, it was incredibly effective, and the staff felt tremendously empowered. The message we wanted to give the staff at Grafton was, we are going to give you control of the data. It is going to emanate from you. We are going to give you that and give you the roadmap we are following in hopes that you will help us follow it.”

There were three big takeaways from the session—the importance of the tech infrastructure; the challenges of a shift in clinical culture to embrace MBC; and the possible strategic advantages of MBC in a market moving to value. The tech infrastructure discussion was interesting. The keys to success are the combination of access to “big data,” the ability to automate the compilation and reporting of that data, and the ability to customize dashboard views for Grafton teams.

Mr. Zeiter and Mr. Ulderich explained that this reveals the true promise in their work, to allow specialists to correlate variables like demographics, diagnoses, frequencies of concerning behavior, and evidence-based practices, to determine what factors were more effective in determining outcomes. The key is to begin “gathering the data pile.” Mr. Zeiter explained, “Historically we were concerned about precision when we talked about testing things. When you look at Silicon Valley, they are now less interested in precision and more interested in gathering as much as possible and then weeding through it to determine the correlations.”

And after you get the “data pile,” the key is automating the data collection and the production of customized dashboards for end users. Grafton is currently running 65 different reports to support its programs and has the potential to run as many reports as needed. Mr. Zeiter explained, “With the information, we can dashboard anything, but we are just scratching the surface of all the data we are collecting. At this point we have immediate access to data and can use it for a variety of reasons.”

But beyond getting the technology right, there is the challenge of creating a metrics-based culture, particularly among direct care staff and clinical professionals. It takes time to change the culture. As Mr. Zeiter noted, “There are many clinicians clearly still focused on relationships and process but that doesn’t exclude their interest in the data. They want to see the concrete impact of their interventions.” But it takes a lot of administrative time to ensure staff are using the tools correctly and staying on point with the treatment goals. Mr. Zeiter added, “Constantly having to follow behind to ensure the treatment goals are updated has been very work intensive. They need constant supervision.”

Most exciting was the Grafton view of the role of this information in their future strategy. Mr. Zeiter noted that by the end of this month, they will develop a data set with integration of all of their operating databases. The purpose is to use the assessment data, the behavior data, and the goal mastery to start to identify the factors that can predict the cost of care.

In 2021, health and human service budgets are going to be stressed—and all payers will be looking to get more “value” for their expenditures. The ability to tie services to outcomes and to cost will be a key competitive advantage.

As of June 9, 2020, 24 health care provider organizations each received over $100 million in relief funding from the federal Department of Health and Human Services (HHS) Provider Relief Fund created as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The New York and Presbyterian Hospital received and attested to the highest total amount—$567 million. The second largest Provider Relief Fund payments—$403 million—went to New York University Langone Hospitals.

The allocations are intended to help health care provider organizations cover lost revenue and increase costs during the public health emergency due to coronavirus disease 2019 (COVID-19). HHS has been distributing the funds since April 10, 2020. The data on relief fund allocations are available on the Centers for Disease Control and Prevention (CDC) website.

The CARES Act and the Paycheck Protection Program and Health Care Enhancement Act provided $175 billion in Provider Relief Funds to hospitals and other health care provider organizations. HHS is distributing the payments through the Health Resources and Services Administration (HRSA) for $50 billion general distribution, $12 billion targeted allocation to high impact areas, $10 billion targeted allocation to rural provider organizations, $4.9 billion to skilled nursing facilities, $500 million to Tribal Hospitals, Clinics, and Urban Health Centers.

Provider Organizations That Received More Than $100 Million In CARES Act Provider Relief Funds
Provider Organization Name State City Payment
The New York And Presbyterian Hospital New York New York $567,285,060
New York University Langone Hospitals New York New York $403,339,290
Hackensack Memorial Hospitals Corporation New Jersey Hackensack $356,441,388
Long Island Jewish Medical Center New York Westbury $326,631,509
Mount Sinai Hospital New York New York $262,819,360
Dignity Health Nevada Henderson $190,189,565
William Beaumont Hospital Michigan Southfield $179,686,440
North Shore University Hospital New York Manhasset $175,200,130
Advocate Health And Hospitals Corporation Illinois Downers Grove $160,977,911
Henry Ford Health System Michigan Detroit $157,899,088
Maimonides Medical Center New York Brooklyn $151,365,990
Ochsner Clinic Foundation Louisiana New Orleans $124,854,422
Beth Israel Medical Center New York New York $118,083,784
Regents Of The University Of Michigan Michigan Ann Arbor $116,857,156
University Hospital At Stony Brook New York Stony Brook $112,581,243
Vanderbilt University Medical Center Tennessee Nashville $108,292,719
Staten Island University Hospital New York Staten Island $106,912,606
Bronxcare Health System New York Bronx $105,345,390
New York-Presbyterian/Brooklyn Methodist New York Brooklyn $104,187,532
County Of Los Angeles California Commerce $103,853,772
Cedars-Sinai Medical Center California Los Angeles $103,347,125
The Cleveland Clinic Foundation Ohio Independence $103,289,897
St Josephs Hospital And Medical Center New Jersey Cedar Grove $102,568,689
Stanford Health Care California Palo Alto $102,405,229

HRSA released the allocations in a dataset on the CDC website that lists all provider organizations that received and attested to the Terms and Conditions for a payment from the General Distribution, High Impact Area, Skilled Nursing Facilities, Tribal, and/or the Rural Targeted Allocation of the Provider Relief Fund. Each organization listed has attested to receiving one or more payments and agreed to the terms and conditions within 90 days of payment.

HRSA released a separate dataset with payments to 395 hospitals who received a payment under the $12 billion High Impact Area Targeted Allocation. About $2 billion of the payments from the COVID-19 High-Impact Area Allocation were distributed to these hospitals based on their Medicare disproportionate share and uncompensated care payments.

Each of the 395 hospitals provided inpatient care for 100 or more people with COVID-19 through April 10, 2020. These hospitals accounted for 71% of COVID-19 inpatient admissions reported to HHS from nearly 6,000 hospitals around the country. The payments ranged in size from $7.6 million to $277 million. Twelve hospitals received payments of $100 million or more.

Hospitals Receiving Provider Relief Fund COVID-19 High-Impact Payments Of $100 Million Or More
Hospital Name State City Payment
Long Island Jewish Medical Center New York New Hyde Park $277,653,312.42
Holy Name Medical Center (AKA Holy Name Health) New Jersey Teaneck $213,428,946.86
Tisch Hospital New York New York $203,180,446.74
Montefiore Hospital – Moses Campus New York Bronx $156,708,591.59
NewYork-Presbyterian/Columbia University Irving Medical Center New York New York $152,747,325.41
NewYork-Presbyterian Queens New York Flushing $143,251,512.11
Mount Sinai Medical Center (AKA the Mount Sinai Hospital) New York New York $140,754,860.74
Sandra Atlas Bass Heart Hospital at North Shore University Hospital New York Manhasset $137,531,542.64
Maimonides Medical Center New York Brooklyn $131,500,615.31
NewYork-Presbyterian/Weill Cornell Medical Center New York New York $118,647,056.76
NYC Health and Hospitals – Elmhurst (FKA Elmhurst Hospital Center) New York Elmhurst $111,346,403.33
NYU Winthrop Hospital (FKA Winthrop University Hospital) New York Mineola $108,038,387.94

The data set of CARES Act Provider Relief Fund payments can be viewed online at https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6/data.

The data set of 395 hospitals that shared the $12 billion high impact allocation can be viewed online at https://data.cdc.gov/Administrative/Provider-Relief-Fund-COVID-19-High-Impact-Payments/b58h-s9zx.

PsychU reported on the CARES Act Provider Relief Fund on May 4, 2020, in “HHS Begins Releasing $100 Billion CARES Act Funding To Provider Organizations For Relief Assistance & Treating The Uninsured” at https://www.psychu.org/hhs-begins-releasing-100-billion-cares-act-funding-to-provider-organizations-for-relief-assistance-treating-the-uninsured/.

For more information, contact:

  • Health Resources and Services Administration, 5600 Fishers Lane, Rockville, Maryland 20857; Website: https://www.hrsa.gov/about/contact/index.html

Crises of any kind are known to increase mental health and addictive disorders. This pandemic crisis is no exception. The initial estimates are sobering.

An early April poll by the Kaiser Family Foundation shows that nearly half (45%) of all U.S. adults say the pandemic has affected their mental health, while 19% say it has had a “major impact.” Prescriptions for anti-anxiety drugs spiked 34% between February 16 and March 15, and also increased for antidepressants (18.6%) and anti-insomnia drugs (14.8%), according to a report from Express Scripts.  Companies like Ginger and TalkSpace delivering virtual mental health care have seen a massive surge in demand for services with COVID-19—with increases of 50% to 65% in February and March.

The scenario is ripe for increased addiction challenges as well. Millions of Americans with opioid use disorder who depend on face-to-face health care delivery are at increased risk. A Health Affairs blog notes that social distancing and self-quarantine are risk factors for relapse for people with addiction disorders. The fear and uncertainty associated with social and economic distress, along with mandated isolation, can aggravate anxiety and depression—and many people will self-medicate with drugs and alcohol to ease the stress. On a similar note, experts at the National Institute of Mental Health have stated that COVID-19 can be a trigger for those who already have anxiety disorder and obsessive-compulsive disorder as the “Purell is everywhere.” Rising alcohol sales maybe an early warning sign of an increase in addiction disorders—online alcohol sales increased 55% in the first two weeks of March, reported Nilesen. One alcohol delivery app, Drizy, serving 26 states and Washington D.C. said alcohol sales the week of March 16-21 were up about 300% from earlier in the year.

Trauma is another behavioral health challenge expected to be exacerbated by COVID-19. Researchers are warning that the coronavirus pandemic could inflict long-lasting emotional trauma on an unprecedented scale and leave millions wrestling with debilitating psychological disorders. The combined stressors—the global nature of the pandemic, the isolation and social distancing, unemployment, and impending recession—are taking their toll. “The scale of this outbreak as a traumatic event is almost beyond comprehension,” said Yuval Neria, the director of trauma and post-traumatic stress disorder at the New York State Psychiatric Institute and a professor of psychology at Columbia University Medical Center, talking to CNBC.

Lancet Psychiatry reports that suicide risk might increase because of stigma towards individuals with COVID-19 and their families and the increase in depression, anxiety, and post-traumatic stress among the general population and those with high levels of exposure to illness caused by COVID-19, such as essential workers. An 85% increase in gun sales in March (the highest ever sales recorded in the U.S.) also leaves experts concerned about a potential increase in gun-related suicides.

From this emerging early data, it appears that long after the acute health effects of the novel coronavirus on the population subside, we will see lasting effects in the form of increased demand for behavioral health services. For executives planning their post-recovery strategies, the unanswered questions are how the services will address these issues be delivered and how will they be funded.

While predictions are dangerous this early in the arc of the pandemic, there are a few factors that will shape the post-pandemic market. There will be increased political pressure for health benefit coverage for the entire U.S. population. But, like all things political, whether or not that happens will depend on the elections this fall. We do know that the pandemic will increase enrollment in Medicaid due to the burgeoning ranks of the unemployed—at a time when state budgets are strapped and policy suggestions like ‘state bankruptcy’ are floating around. But, like the pandemic itself drove rapid adoption of virtual care models, the financial consequences of the pandemic are likely to accelerate the use of integrated care and value-based reimbursement models for both managed care organizations and provider organizations. Regardless of the exact scenario, the successful strategy is likely to be one focused on ‘value’ defined as the low costs with a high value service to consumers.

Plans of any type—including plans for crisis management and financial recovery—are only as good as their implementation. For most organizations, success of new plans depends on the leadership team that is charged with the planning and its implementation. That was the focus of Monica Oss’ closing remarks, Strategy In A Crisis – Staying Afloat Vs. Navigating; at The 2020 OPEN MINDS Strategy & Innovation Institute.

But what do leaders need to do to make that happen? The panelists—Charles Ingoglia, chief executive officer (CEO) at the National Council for Behavioral Health; David Klements, CEO at Qualifacts Systems, Inc., and Jon Wolf, CEO at Pyramid Healthcare, Inc., discussed specific leadership “must dos” in the session, Navigating The New Normal With COVID-19 Part 2: An Update On Sustainable Strategies For The Disrupted Market. They discussed twelve essential leadership actions in the session. But the real gems were the first-hand practices and advice from this group.

Mr. Klements spoke to the importance of data in planning for success and continuously reframing recovery efforts. As an example, he cited recent survey data on the evolving virtual care landscape. “Laptops are going to be three times more important to providers than tablets…90 days ago, the data would have suggested the opposite. And it turns out that internet access and poor connectivity are the biggest challenges to providers moving to virtual service delivery.” His point? The key to navigating is to keep on top of the data—and plan and act accordingly.

Mr. Wolf described their approach to communicating during virtual operations in a crisis, saying, “Communication is so important to the staff in this crisis. But we’ve learned a lot. We’ll never go back to meeting the way we once did.”

He also spoke of recalibrating the need to meet in person and the convenience of virtual meetings for both management and all employees. He explained that they have increased the number of team meetings at Pyramid, using travel time saved to actually meet more. “We’ve tried to ramp up the way we communicate,” he explained. “Using more chat functions—Team, Jabber, and the tools in the Qualifacts system. We also do a lot of internal staff webinars; we have an intranet for our employees, and we’ve set up a function to rapidly answer employee questions. There is still a lot of fear out there and staff want to know what is going on. Our system is set up for rapid communication to answer questions.”

Mr. Ingoglia also had an interesting perspective on communication. “When this started, I assumed we would be working off site for two weeks and I started a daily email to staff,” he said. “We’re way past two weeks, but I get feedback from staff to keep my daily email. I have more touchpoints with staff now than I did and I am trying to think about how to keep that in the future.”

These new communication models aren’t the only “learning” happening from the crisis. Mr. Wolf spoke about the shift in his organization to be more engaging with consumers. “One big problem in behavioral health is engagement,” he said. “Our numbers, the percentage of people going from an assessment to admission to services was 50% pre-COVID-19. It’s now 65%. We’ve changed. We’ve become more engaging, more customer focused. That is a magnificent thing. It would be absurd for us to go back.”

Both Mr. Klements and Mr. Wolf spoke about the need for nimble decision making and operational flexibility that only comes with a system that allows decentralization of management. Mr. Klements noted specifically, “There is critical-path work that needs to happen from the top down. Conversely, bottom up communication is from the teams closest to consumers. For example, they are the team members who identified our clients’ needs for more support with virtual health. It’s an interesting dynamic to manage fewer critical things from the top down, and let the staff identify what is important to consumers.”

At Pyramid, they have accomplished decentralized decision making with a new approach. Mr. Wolf explained, “We have segmented the operations into silos, like communication, protective personal equipment (PPE), managing consumers, and then we assigned leaders for each of those segments. The change was rapid, and there is the need for short-term and long-term strategic plans. Segmenting and focusing on the communication allow us to manage the change more broadly.”

At the close of the session, the group discussed the challenges of “returning to normal.” There are the practical considerations voiced by Mr. Klements, like the additional operating costs that will be required for technology, PPE, testing, and the process for reopening offices. “Right now we’re working on how to safely reopen our offices and have set up a cross-functional committee led by our chief financial officer to evaluate all the possibilities,” he said. “Opening varies by location and market sector.”

Mr. Ingoglia spoke of these differences across the country—including navigating the different rules and COVID rates varying by geography, that make it difficult to have a single approach. Mr. Wolf agreed about the differences between states, noting, “Every market is different, every state is different. You can’t apply the same rules and timeline.”

And on top of those differences, each CEO expressed frustrations of not knowing what the federal policies and supports will be for the health and human service sector in general, and for specialty provider organizations in particular. Mr. Ingoglia explained, “The larger issue is that our system operates on the periphery of federal health care policy. The dilemma is, what exactly is a substance use provider organization, or a mental health organization? We have no definitions in federal law. We are doing our best to advocate for the sector. But having some clarity would be helpful. We need a framework for legislators.”

At the close of the session, the three CEO colleagues were in unanimous agreement about one fact—the only certainty is uncertainty.

Pharmacists, pharmacy technicians, student pharmacists, and other pharmacy staff are frontline responders to the COVID-19 pandemic. Staying protected and healthy while caring for patients is a top priority. Consider the following tips for workflow improvements that can decrease the risk of exposure to infected patients.

Provided with permission from APhA. To learn more about APhA, please visit their website at: https://www.apha.org

As an essential healthcare provider, taking appropriate steps to protect yourself, your staff, your patients, and your family is a top priority. We all do our part to provide care to patients, but it is particularly important during the COVID-19 national emergency.

Staying current with updated recommendations and guidance will help keep everyone safe and minimize the
spread of the virus.

Provided with permission from APhA. To learn more about APhA, please visit their website at: https://www.apha.org

Pharmacists and pharmacy staff working in ambulatory care/community pharmacy
settings may encounter patients who are displaying symptoms of the novel coronavirus disease, COVID-19. All pharmacies should have an action plan—and pharmacy personnel should be ready to implement that plan.

Begin by referring to any company policies and guidance that might already exist regarding patients with active respiratory symptoms or cases of tuberculosis. If no such policies exist, consider the steps below and adapt them as appropriate to your situation using your professional judgment.

Provided with permission from APhA. To learn more about APhA, please visit their website at: https://www.apha.org

As an essential healthcare provider, being informed on the most current information about the coronavirus disease (COVID-19) pandemic is critically important. There are steps you can take to make sure you have the correct information about the disease and care delivery during this current crisis.

Knowing the basics of COVID-19 symptoms and prevention as well as indispensable information for practicing pharmacy and managing well-being will help you as a healthcare worker on the front line.

Provided with permission from APhA. To learn more about APhA, please visit their website at: https://www.apha.org

Optimizing both population health and individual patient care will require major changes in how health care is delivered, starting with a systemic focus. In this webinar, three expert panelists from OPEN MINDS—Sharon Hicks, MBA, MSW; Richard Louis III; and Paul Duck—discuss the current paradoxical state of care delivery, in which providers are sometimes expected to achieve mutually incompatible goals. Their conversation covers the critical role that care management, clinical communication, and electronic interoperability must play for successful population management to occur. Additionally, the critical importance of the social determinants of health (SDoH) is considered.

Featuring:

  • Sharon Hicks, MBA, MSW
    Senior Associate, OPEN MINDS
    Former Chief Operating Officer, Community Care Behavioral Health
  • Richard Louis III
    Vice President–Western Region, OPEN MINDS
    Former Director of Development – Behavioral & Addiction Medicine, Southern California Hospitals Healthcare Systems Inc.
  • Paul Duck
    Senior Associate, OPEN MINDS
    Former Vice President–Strategy and Development, Beacon Health Options

Sharon Hicks, MBA, MSW, is a Senior Associate with OPEN MINDS and has more than 20 years of experience in the health and human services field, with expertise in health plan management, clinical operations management, and technology.

Richard Louis, III, is the Vice President–Western Region with OPEN MINDS and has extensive experience as a behavioral health care administrator, business development specialist, and innovator of new service lines for behavioral health care organizations.

Paul M. Duck has more than 30 years of experience in leadership and management, with a focus on managed care, health information technology organizations, strategy, business development, market expansion, and customer experience optimization. He serves as a Senior Associate with OPEN MINDS.

The following is a summary of Moses, Danielle and Lucido, Antonio; Best Practice Spotlight: Psychiatric Long-Acting Injectable Clinic, Missouri Society of Health-System Pharmacists, Blog number 7236202, which was developed independently of the article authors.

Key Messages

  • A psychiatric long-acting injectable (LAI) Clinic was created through a pharmacist-driven initiative at the SSM Health System to address the challenges in realizing the full benefit of LAI use.
  • The LAI Clinic improved patient care and reduced financial burden on the Health System.
    • The LAI Clinic rapidly increased patient enrollment, retained 89% of their patients, and significantly reduced rehospitalization for those retained.
    • The Clinic helped save ~ $85,000 in drug expenditure during its first 5 months.

Background

  • Long acting injectable (LAI) medications have emerged as highly valuable for managing chronic psychiatric illnesses like schizophrenia and bipolar disorder, in part because LAIs can improved compliance and quality of life.
  • However, every LAI has a unique dosing requirement, and a healthcare provider is needed for LAI administration. This can complicate transition-of-care and result in lower utilization.

Purpose

  • This article demonstrates the role of pharmacists at SSM Health DePaul Hospital in St. Louis, a large acute psychiatric care facility, to successfully address the challenges of transition-of-care for patients discharged on LAIs. Details are provided on the launch and the achievements of an outpatient LAI Clinic toward improving quality of care for patients and reducing the financial burden for the SSM Health System.

Method

  1. A psychiatric clinical pharmacy specialist (CPS) was hired to identify why LAI utilization was not yielding the expected outcomes of increased patient compliance and reduced rehospitalization.
  2. The launch of a LAI clinic was proposed by the pharmacy leadership to the hospital management to address the gaps in transition-of-care in patients discharged on LAIs.
  3. A LAI Clinic Steering Team was created, and the pilot version of the LAI Clinic was established.
  4. Following a successful pilot, a rapid improvement event (REI) was initiated to increase the clinic’s capacity and offer its services for beyond the SSM Health System.

Results

  • Challenges and Successes at each step
    • The Psychiatric CPS identifies that LAI utilization did not yield expected outcomes due to several potentially avoidable disruptions in transition-of-care at discharge.
      • Issues around suboptimal prescribing patterns were addressed by implementing a protocol that allowed pharmacists to dose LAI antipsychotics for inpatients (LAI per Pharmacy protocol).
      • Other disruptions in transition-of-care identified were patient’s inability to meet required copays/coinsurance, suboptimal coverage due to lack of prior authorization, lack of availability of psychiatrist visit for additional refills and follow-up, and patient’s lack of knowledge and/or availability of transportation to follow up at a site that provides injections.
    • The Psychiatric CPS championed the proposal for a LAI Clinic to provide a clear pathway to improve medication adherence for patients discharged on LAIs. The SSM DePaul hospital management approved a pilot LAI Clinic. A Steering Team, with representatives from inpatient and outpatient pharmacies, launched the pilot Clinic with an array of innovative services (Table below) to address the disruptions in transition-of-care.
    • The Clinic grew steadily and reached Clinic psychiatrist patient capacity within 5 months of launch. This triggered the expansion of the LAI clinic, increased the pharmacist full-time equivalents (FTEs) and led to a collaborative practice agreement between the psychiatric CPS and the LAI Clinic psychiatrist.

    • The article further describes the patient referral process, the overall workflow of patient care at the LAI Clinic, and details the timelines for the LAI Clinic launch and expansion, as well as the patient and prescription volume at the Clinic.
  • Demonstration of improvement to the healthcare system through the LAI Clinic
    • Enhancement of patient-centered transition-of-care – Patient enrollment increased from 4 to 126 between January to July 2018, with a retention rate of 89%. The Clinic improved patient access to care and improved coverage insurance through (and charity care when needed). This success was further affirmed by testimonials provided by patient and family to the hospital and to the news media.
    • Reduced recidivism – Patients retained by the LAI Clinic for over 6 months showed 74% reduction in hospitalization over 6 months following compared to the 6 months prior.
    • Self-sustaining financial benefit – The LAI Clinic helped the inpatient psychiatric wards and the hospital’s infusion centers decrease spending (or financial write-offs) on non-reimbursable medications. Simultaneously, the Clinic helped increase income at the outpatient pharmacy. Of note, although the Clinic’s financial benefits were amplified by the hospital’s participation in the federal 340B Program, the Clinic was financially viable even without the federal 340B. Over January-May 2018, approximately $85,000 was saved in drug expenditure.
  • Significance to the pharmacist profession – role as a prescribing authority and clinical provider in psychiatry
    • The LAI per pharmacy protocol established the value of pharmacists’ expertise for the appropriate initiation of LAI antipsychotics in the inpatient setting and subsequently to generate appropriate discharge orders.
    • The collaborative practice agreement between the inpatient psychiatrist and the pharmacists helped improve quality of patient care for those discharged on LAI. The pharmacist’s knowledge of patient factors and insurance coverage helped the patients achieve optimum mental health with least adverse effects, and ensure that the medications are available to the patients in the most cost-effective manner.
    • The subsequent expansion of the collaborative practice agreement to include all mental health medications (and not just LAIs) helped illustrate the value of the pharmacist as a clinical provider within the hospital.
    • The improvement in access to quality care for patients is particularly important when outpatient psychiatric care is sparse. Since discharge prescriptions do not include refills, the gap in care between inpatient and outpatient providers often contributes to the vicious cycle of rapid relapse and rehospitalization following discharge.

Conclusions

  • Pharmacists possess unique knowledge and skill sets that can be leveraged to increase availability of care for and utilization of medication by the patients. Working within a multidisciplinary team, the pharmacists’ expertise can improve patient care, decrease hospital costs and generate revenue that may have otherwise been overlooked.

Clinical Implications

The benefits of LAI utilization in psychiatric patients may be diminished by poor transition-of-care during discharge from a hospital, leading to poor quality of care for patients and increased financial burden for the hospital and the healthcare system. Pharmacists in a multidisciplinary team can mitigate these outcomes. Through collaborative practice agreements with psychiatrists, pharmacists can increase patient access to care, provide better management and utilization of LAI as well as other mental health medications in a manner that is cost-effective for both the patient and the healthcare system.

This summation has been developed independently of the authors. No disclosures were reported in the original article.

We are 13 weeks into the pandemic crisis. For executives of health and human service organizations, the question is how to make the “crisis normal” work and pivot to a new way of operating for future sustainability. One asset that is often overlooked is an on-site pharmacy that can bridge the service gaps created by the pandemic. Using this often untapped resource was the focus of the remarks by Joy Holman, Senior Director of Payer Initiatives; and Lilli Correll, Vice President, Payer Solutions Development of Genoa Healthcare, in their presentation, Building Better-Value Behavioral Health Services With On-Site Pharmacy Solutions: During The Crisis & Beyond, at The 2020 OPEN MINDS Strategy & Innovation Institute.

Ms. Correll presented an interesting snapshot of the Genoa customers—they have 520 pharmacies with 300 consumer medication coordinators, including 450 pharmacies located within behavioral health centers, community mental health centers, and federally qualified health centers. During the pandemic, Genoa saw 15% of clinics close. Of those that remain open, only 31% are allowing consumers inside. Over 80% of care is being delivered via telehealth.

The changes in service delivery among provider organizations have had a marked effect on revenue and profitability. Forty percent of hospitals report revenue declines of 50% or more; all hospitals report declines of at least 25%; 70% of primary care practices report big declines in consumer use; 68% of intellectual and developmental disabilities (I/DD) provider organizations have closed programs and lost 32% of revenue; and 62% of behavioral health provider organizations have closed at least one program.

The question for executive teams is how to leverage current assets to continue serving consumers while remaining financially sound throughout the crisis. One asset that is often underutilized is the on-site pharmacy and on-site pharmacists, according to Ms. Holman. The ability to provide injections and vaccines, flag medication adherence issues, consult with clinical professionals on drug therapies, and help consumers manage health issues are just a few of the benefits. On-site pharmacies bring five key competencies to provider organizations during this time of altered operations: medication adherence; continuity of care; care team extenders; consumer engagement; and navigating telehealth.

Medication adherence—Filling and refilling prescriptions, custom pre-filling pill organizers, medication synchronization, medication delivery, and onsite consultations are all strengths for managing consumer populations that have historically shown difficulty accessing or using medications as directed. Ms. Holman noted, “It’s important for the pharmacy to be able to fill all medications from all prescribers, both behavioral health and medical medications. This allows the pharmacist to monitor for adverse reactions. And, a pharmacist can help with medication adherence, providing high level reports to the clinic team on the days covered, medication reduction ratios, and gaps in therapy.”

Continuity of care—In addition to ready access to medications, executive teams can leverage an in-house pharmacy to maintain another reliable form of contact with consumers, to advance the quality of care over time and ensure consumer and staff safety. Continuity of care has proven extremely valuable in recent years to reliably lower the risks of drug-drug interactions. This, plus the increasing role of pharmaceuticals in disease state management, means that long-term care management can be strengthened by bringing pharmacies in-house. Ms. Correll noted, “COVID made continuity of care even more of a concern, because people were stuck at home. Provider organizations need a way to make sure consumers can get their medications and can do so safely. In our case, this let us stock more medications, increase mailing, open curbside pick-up, and administer long acting injectables in states where that is allowable.”

Care team extenders—Provider organizations increasingly want to build teams that can address the diverse needs of consumers. When pharmacists are part of the team, they can flag medication issues, collaborate directly with team members on care plans, and personally interact with the consumers. Ms. Holman explained, “Being onsite, the pharmacist can be an additional set of eyes for the team, alerting them when the consumer is late picking up medication, needs a pre-authorization, or isn’t behaving the way they normally do. A pharmacist can also add support to the clinic staff by keeping them updated on any changes in pharmacy regulations or updates with government waivers, something that is especially important during a crisis.”

Consumer engagement—Every “door” available to consumers for “entering” your organization is a valuable resource for enhancing consumer engagement. An on-site pharmacy offers an avenue to build existing relationships, proactively reach out to consumers in need of extra support, and to respond when consumers reach out for information or help. Ms. Correll explained, “We know each consumer individually, and we can develop abiding relationships with them. And we have identified opportunities, holistically, through those relationships. These consumers have other issues like social determinants, housing, transportation, and sometimes just basic needs. A partnership between the clinic and pharmacy helps identify these issues.”

Navigating telehealth—During the current crisis, as most services had to quickly pivot to virtual, on-site pharmacies helped consumers engage with and navigate virtual tools and services and stepped in with virtual prescribing and dispensing. Ms. Correll explained, “We’ve helped consumers find their way back to services when they were nervous about virtual services. Connecting an in-house pharmacy with virtual prescribing can also help set up a seamless delivery system.”

In a study by The Journal of Managed Care and Specialty Pharmacy, results showed that Genoa’s on-site pharmacies produced some interesting successes, including a 90% medication adherence rate, 18% fewer emergency room (ER) visits, and 40% fewer hospitalizations. In recent years, we’ve seen other studies that show how adding pharmacists to operations can improve service and value. One medication therapy management (MTM) program led by pharmacists raised consumer adherence rates for three drug classes by five to nine percentage points over five years, and led to higher Medicare Advantage plan quality star ratings.

There is a lot of discussion about how best to leverage the skills of pharmacists. With emergency rule changes during the pandemic, pharmacists are now permitted to order and administer COVID-19 diagnostic tests authorized by the U.S. Food and Drug Administration. In Florida, pharmacists can now perform testing, screening, and certain treatments for non-chronic diseases and certain chronic conditions.

About 81% of physicians in the United States reported a drop in consumer visit volume during the coronavirus disease 2019 (COVID-19) outbreak, according to a survey conducted from April 3 to 14, 2020. Compared to patient visit volume before the COVID-19 outbreak, about 62% reported a significant drop and 19% reported a mild drop. About 11% of physicians reported a significant increase in patient volume, and 3% reported a mild increase. The remaining 4% of physicians reported no change.

Worldwide, 53% of physicians across Asia, Europe, and the United States combined, reported a drop in patient visit volume. About 32% of physicians reported a significant drop and 21% reported a mild drop. About 24% of physicians reported a significant increase in patient volume, and 15% reported a mild increase. The remaining 8% of physicians reported no change.

These findings were reported in “COVID-19 HCP Sentiment Survey Part 1: Physician Engagement with Patients and Remote/Telehealth Experiences” by Sermo. The survey was conducted from April 3 to 14, 2020, among a convenience sample of 1,392 Sermo members in nine countries: China (111), France (167), Germany (137), Great Britain (135), Italy (323), Japan (110), Spain (181), Switzerland (7), and the United States (221). The participants were in eight specialties: general practice or internal medicine, cardiology, oncology, hematology, neurology, psychiatry, rheumatology, and dermatology. About half specialized in general practice or internal medicine. The survey topics related to the participants’ experiences with patients and remote/telemedicine.

The full results of “COVID-19 HCP Sentiment Surveys Part 1: Physician Engagement with Patients and Remote/Telehealth Experiences” were published April 2020, by Sermo. A copy is available for download at https://www.sermo.com/hcp-sentiment-study-series/.

PsychU last reported on this topic in “About 90% Of Physicians Worldwide Are Treating Consumers Remotely,” which published on June 29, 2020. The article is available at https://www.psychu.org/about-90-of-physicians-worldwide-are-treating-consumers-remotely/.

For more information, contact:

  • Joanna Molke, Marketing Director, Sermo, Inc., 200 Park Avenue South, Suite 1310, New York, New York 10003; Email: joanna.molke@SERMO.com; Website: https://www.sermo.com/.

There is some confusion about where we are—economically—in the midst of the crisis caused by the coronavirus pandemic. We are in a recession and likely on the front edge of a depression. There is wide disagreement about the “shape” of the recovery. Unfortunately, “reopening” and “recovery” are being used interchangeably.

“Reopening” is the phrase being used for an end to some of the government-imposed restrictions on organizational operations in order to prevent the spread of coronavirus. Nearly all 50 states have moved to some level of reopening— “reopening” comes in all forms.

While “reopening” is often required for the financial “recovery” of many organizations, the terms are not synonymous. To reopen physical operations does not mean the return to profitability. There are increased costs of safety measures—from personal protective equipment, to testing, to ventilation systems, and more. In addition, restrictions on capacity are widespread. Limits on the proportion of restaurant capacity that can be used. Limits on the size of gatherings. Limits on the physical distance of consumers in establishments. There are also questions about how many consumers will return to “being served.”

For the health and human service field, the reopening versus recovery issues are many. In a recent discussion, a residential treatment provider organization executive said that given the design of their facility, for the foreseeable future, they would need to operate at 80% capacity to ensure the safety of consumers. There will likely be a significant decrease in rates for virtual services as the market capacity—and competition—increases. What ‘in office’ services will consumers be comfortable receiving is another question. If consumers want more service ‘at home’, how can they be delivered profitably—since home-based services were not profitable before the pandemic crisis.

In short, the reopening is tactical, but recovery as strategic. Reopening requires a policy, an implementation plan, and a budget. Recovery for most health and human service organizations will require not only a new strategic plan—but also new business models. What services an organization delivers, the operational framework for how they deliver those services, the breakeven volume and scalable profitability of each service, the overall portfolio mix of profitable and unprofitable services—these are the types of very fundamental questions that recovery planning needs to address.

On June 5, 2020, the National Committee for Quality Assurance (NCQA) announced adjustments to 40 Healthcare Effectiveness Data and Information Set (HEDIS) measures to support the use of telehealth during the coronavirus disease 2019 (COVID-19) pandemic and after. NCQA will apply the adjustment for measurement of health care quality starting in 2020. The adjustments align with guidance from the Centers for Medicare & Medicaid Services and other federal and state regulators.

NCQA is updating the measures in “HEDIS Volume 2 Technical Specifications,” which will be published on July 1, 2020. Telehealth revisions will be outlined in each measure specification’s “Summary of Changes” section. The guidance will specify how telehealth visits can be used, what will be included in the measure denominator and numerator, and what will be excluded. It will also specify what type of telehealth (e.g., synchronous telehealth visits, telephone visits or asynchronous e-visits or virtual check-ins) is permitted to meet the measure.

Eight of the adjustments affect behavioral health measures:

  1. Antidepressant Medication Management
  2. Follow-up Care for Children Prescribed ADHD Medication
  3. Follow-up After Hospitalization for Mental Illness
  4. Follow-up After Emergency Department Visit for Mental Illness
  5. Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication
  6. Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia
  7. Diabetes Monitoring for People with Diabetes and Schizophrenia
  8. Adherence to Antipsychotic Medications for Individuals with Schizophrenia

The remaining measures with new telehealth accommodations concern prevention and screening, respiratory care, cardiovascular care, diabetes care, musculoskeletal conditions, care coordination, access and availability of care, utilization, and risk-adjusted utilization. The accommodations also affect measures reported using electronic clinical data systems. Within these remaining measures, some also affect behavioral health services.

Prevention and Screening

  1. Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
  2. Breast Cancer Screening
  3. Colorectal Cancer Screening
  4. Care for Older Adults

Respiratory

  1. Use of Spirometry Testing in the Assessment and Diagnosis of COPD
  2. Asthma Medication Ratio

Cardiovascular Conditions

  1. Controlling High Blood Pressure
  2. Persistence of Beta-Blocker Treatment After a Heart Attack
  3. Statin Therapy for Patients with Cardiovascular Disease
  4. Cardiac Rehabilitation

Diabetes

  1. Comprehensive Diabetes Care
  2. Kidney Health Evaluation for Patients with Diabetes
  3. Statin Therapy for Patients with Diabetes

Musculoskeletal Conditions

  1. Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis- Scheduled for Retirement
  2. Osteoporosis Management in Women Who Had a Fracture
  3. Osteoporosis Screening in Older Women

Care Coordination

  1. Transitions of Care
  2. Follow-up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions
  3. Access/Availability of Care

Access/Availability of Care

  1. Prenatal and Postpartum Care
  2. Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics

Utilization

  1. Well-Child Visits in the First 30 Months of Life
  2. Child and Adolescent Well Care Visits
  3. Mental Health Utilization

Risk-Adjusted Utilization

  1. Plan All-Cause Readmissions
  2. Hospitalization Following Discharge from a Skilled Nursing Facility
  3. Acute Hospital Utilization
  4. Emergency Department Utilization
  5. Hospitalization for Potentially Preventable Complications

Measures Reported Using Electronic Clinical Data Systems

  1. Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults
  2. Depression Screening and Follow-up for Adolescents and Adults
  3. Postpartum Depression Screening and Follow-up
  4. Prenatal Depression Screening and Follow-up
  5. Breast Cancer Screening
  6. Colorectal Cancer Screening
  7. Follow-up Care for Children Prescribed ADHD Medication

More information about the changes is posted at https://www.ncqa.org/covid/.

For more information, contact:

  • Andy Reynolds, Assistant Vice President, Marketing And Communications, National Committee for Quality Assurance, 1100 13th Street Northwest, 3rd Floor, Washington, District of Columbia 20005; 202-955-3518; Email: reynolds@ncqa.org; Website: https://www.ncqa.org/
  • Matt Brock, Communications Director, National Committee for Quality Assurance, 1100 13th Street Northwest, 3rd Floor, Washington, District of Columbia 20005; 202-955-1739; Fax: 202-955-3599; Email: brock@ncqa.org; Website: https://www.ncqa.org/

Our coverage of primary care physicians’ views of addiction treatment and medication assisted treatment (MAT) brought quite a few comments. A recent study found that even though two thirds of physicians believe that addiction treatment is more effective with medication than without (67.1%)—and that consumers can safely use those medications (63.7%)—only 20% of physicians reported an interest in treating opioid use disorders (OUDs).

Add to this picture a primary care landscape where physicians seldom screen for addiction of their own accord, and nurse practitioners and physician assistants feel little responsibility or comfort addressing the issue at all. Only about 57% of primary care clinical professionals report screening consumers for any kind of addiction, only 46% provide any kind of intervention, and only 47% provide a referral for treatment.

The good news is that there are a number of “change management” models to increase the success of addiction treatment services in primary care. What these models share is a two-pronged approach to changing both systems and structure while addressing leadership and staff skills at the same time. But several readers suggested that an approach that is better than educating the broad primary care community about this issue is to turn the model around and embed primary care in addictions treatment.

One suggestion from OPEN MINDS Circle member Dr. Scot Adams, former Director of Nebraska Department of Health and Human Services, Division of Behavioral Health, is to move to a “whole person” model for addiction treatment—bringing primary care into addiction treatment organizations. He wrote, “One answer to the question of addictions treatment post-COVID is found in models like the Certified Community Behavioral Health Clinics (CCBHC). The Substance Abuse and Mental Health Services Administration (SAMHSA) has had three rounds of funding for these. In short, rather than bringing addictions treatment into the primary care office, they bring primary care into the addictions treatment center.”

Some addictions treatment provider organizations are well ahead on the integration journey. Lakeview Health has multi-site adult addiction treatment programs in Florida and Texas, treating alcohol use, opioid use, and substance use disorders (SUD) as well as co-occurring disorders. Lakeview Health’s staff includes a board-certified internist and a psychiatrist who is also a family practitioner—this helps the organization easily address the medical issues faced by its SUD consumers. Lantie Jorandby, M.D., Chief Medical Officer at Lakeview Health, explained how the integrated care model helped them provide holistic care during the pandemic crisis, test consumers for COVID-19, and address all of their co-occurring disorder treatment needs.

Tarzana Treatment Centers, Inc. (TTC) has been providing primary care services integrated with behavioral health since the mid-1990’s, and serves the underserved, low-income population of Los Angeles and surrounding counties. It currently contracts with primary care physicians to operate six primary care clinics that are co-located with TTC’s SUD and mental health treatment facilities. Chief Executive Officer and President Albert M. Senella explained that TTC’s primary care services are part of their whole person care approach integrating mental health, SUD, and primary care services for adults and youth. Their full range of mental health and SUD programs include outpatient, inpatient, and residential treatment, sober living services, a primary care assessment for consumers, and access to primary care treatment when needed. TTC created a “no wrong door” model to access, ensuring that all consumers in any of TTC’s programs or levels of care have access to primary care treatment. TTC also offers follow up primary care in consumers’ homes via telehealth. TTC is accredited by the Joint Commission as a Behavioral Health Home and Patient-Centered Medical Home.

Whatever the model, a key obstacle pointed out by Dr. Adams is the cultural difference between the mindsets of “traditional” addiction treatment professionals and other health care professionals. The reality is that primary care and addiction treatment (and behavioral health care overall) are very different cultures built on different approaches to clinical professional education, management, and business administration. Learning to communicate effectively with both sides of the house is a critical issue. He explained, “Many behavioral health practitioners who ‘grew up’ on the mental health side, without immersion into addictions, think it can be as simple as adding a 12-step meeting to routine mental health programming to call it ‘co-occurring treatment.’ Thus, they don’t really ‘hear’ the content. This dynamic in culture is important because persons in recovery are often better able to relate to and connect with persons actively immersed in addictive patterns. Missing the addiction can undermine all other treatments.”

Learning the critical skill of “code switching” becomes a priority when managing teams of different disciplines. In the post-crisis period, most analysts are predicting an increase in substance abuse and addictive disorders—and with it an increase in demand for treatment and related expenses. Payers and health plan executives will be in search of the treatment model with the best clinical outcomes and total cost of care. An integrated care model is most likely to deliver.

On June 19, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to grant state Medicaid programs and other payers flexibility to enter value-based purchasing (VBP) arrangements with drug manufacturers. The proposed rule provides drug manufacturers with regulatory support to enter into VBPs with payers. VBP arrangements can be defined as “performance requirements” under the definition of a “bundled sale.” If a manufacturer is participating in a VBP arrangement, the drug manufacturer can report multiple best prices for a therapy—the prices tied to specific VBP arrangements— under the Medicaid Drug Rebate Program (MDRP).

In a fact sheet about the proposed rule, CMS said it believes providing state Medicaid programs with flexibility to enter into VBP arrangements with drug manufacturers is an important strategy to manage drug costs and promote beneficiary access to needed medications. CMS recognized that the current MDRP regulations were a barrier to medication related VBP arrangements. By changing the regulations, CMS intends to encourage states to enter into VBP arrangements for drug therapies, especially in cases when the therapy will safeguard against unnecessary utilization of other, more expensive medical services. To reach this goal, the proposed rule presented changes allowing manufacturers to do the following:

  • Report multiple “best prices” for a therapy under the MDRP if the prices are tied to a VBP arrangement.
  • Define a VBP arrangement in terms of evidence-based and outcomes-based measures.
  • Include certain VBP arrangements under the definition of “bundled sale.”
  • Revise average manufacturer’s price (AMP) and best price reporting beyond the current 36-month time limit to allow for revisions to pricing metrics as a result of VBP arrangements.

CMS also revised how a drug manufacturer must calculate the AMP of a brand-name drug that has an authorized generic, which are made by the original manufacturer of the brand-name drug. Currently, manufacturers are permitted to include the sales of the authorized generic in the AMP of the brand name drug. However, this practice lowers AMPs and reduces rebates paid for the brand name drugs. The proposed rule excludes sales of authorized generic drugs when brand manufacturers have approved, allowed, or otherwise permitted an authorized generic to be sold under the brand name drug’s new drug application (NDA).

Comments on the proposed rule, “Establishing Minimum Standards In Medicaid State Drug Utilization Review (DUR) And Supporting Value-Based Purchasing (VBP) For Drugs Covered In Medicaid, Revising Medicaid Drug Rebate And Third Party Liability,” are due by July 20, 2020. The proposed rule did not state a target implementation date.

A link to the full text of “Establishing Minimum Standards In Medicaid State Drug Utilization Review (DUR) And Supporting Value-Based Purchasing (VBP) For Drugs Covered In Medicaid, Revising Medicaid Drug Rebate And Third Party Liability” may be found at www.openminds.com/market-intelligence/resources/061920nprmcmsmedicaidpharmavbid.htm.

For more information, contact:

  • Office of Communications, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 202-690-6145; Fax: 202-260-1462; Website: https://www.cms.gov/newsroom/fact-sheets/establishing-minimum-standards-medicaid-state-drug-utilization-review-dur-and-supporting-value-based.

For more information, contact (for both Humana and Healthmap Solutions): 

  • Alissa Krinsky, Corporate Communications, Humana, Inc., 550 West Adams Street, 5thFloor, Chicago, Illinois 60661; 312-441-5576; Email: AKrinsky@humana.com; Website: https://www.humana.com/

Weekly emergency department visit volume was 42% lower in April 2020 than in April 2019; the decline was attributed to the coronavirus disease 2019 (COVID-19) pandemic in the United States. According to real-time electronic health data reported to the National Syndromic Surveillance Program (NSSP), visit volume dropped from a mean of 2.1 million per week during March 31 to April 27, 2019, to 1.2 million in March 29 to April 25, 2020. The share of visits for infectious disease was four times higher during the 2020 reporting period.

In the 2019 comparison period, 12% of all emergency department visits were among children aged 10 and under, compared with 6% during the early pandemic period. The largest proportional declines were among children under age 10 and among youth ages 11 to 14. For these age groups, the number of emergency department visits dropped by 72% and 71%, respectively.  Visit volume declined 37% among males and 45% among females across all NSSP emergency departments between the comparison and early pandemic periods.

In April 2020, the proportion of emergency department visits for exposure, encounters, screening, or contact with infectious disease compared with total visits was 3.79 times higher than during the comparison period in April 2019. The proportion of visits was 1.99 times higher for other specified and unspecified lower respiratory disease, which did not include influenza, pneumonia, asthma, or bronchitis. The proportion of visits was 1.91 times higher for pneumonia not caused by tuberculosis. Visit volume increased by more than 100 mean visits per week for eight diagnostic categories: exposure/screening/contact with infectious disease; COVID-19 symptoms; other general signs and symptoms; pneumonia not caused by tuberculosis; other specified and unspecified lower respiratory disease; respiratory failure/insufficiency/arrest; cardiac arrest and ventricular fibrillation; and socioeconomic or psychosocial factors.

Emergency department visit volume rose slightly for mental health and addiction disorders in remission and for specified encounters and counseling. The mean number of visits rose by 6 for disorders in remission, and by 22 for counseling. The visit prevalence ratio for these diagnostic categories was 1.69 times higher in April 2020 compared to April 2019. Mean weekly visits for stimulant-related disorders were 189 lower. The visit prevalence ratio was 1.65 times higher in April 2020 compared to April 2019.

Visit volume declined the most for abdominal pain and other digestive/abdomen signs and symptoms; musculoskeletal pain excluding low back pain; essential hypertension; nausea and vomiting; other specified upper respiratory infections; sprains and strains; and superficial injuries.

Visits for nonspecific chest pain were among the top 20 diagnostic categories for which visits decreased. Although not in the top 20 declining diagnoses, visits for acute myocardial infarction also declined.

These findings were reported in “Impact of the COVID-19 Pandemic on Emergency Department Visits — United States, January 1, 2019–May 30, 2020” by Kathleen P. Hartnett, Ph.D.; Aaron Kite-Powell, MS; Jourdan DeVies, MS; Michael A. Coletta, MPH; Tegan K. Boehmer, Ph.D.; Jennifer Adjemian, Ph.D.; Adi V. Gundlapalli, M.D., Ph.D.; and the National Syndromic Surveillance Program (NSSP) Community of Practice. The NSSP data captures about 73% of emergency department visits. The NSSP collects data from a subset of hospitals in 47 states (all but Hawaii, South Dakota, and Wyoming), representing 3,552 emergency departments. The researchers analyzed total weekly visit volume during January 1, 2019 through May 30, 2020. The analysis considered age, sex, region, and the reason for the visit.

A link to the full text of “Impact of the COVID-19 Pandemic On Emergency Department Visits — United States, January 1, 2019–May 30, 2020” may be found at www.openminds.com/market-intelligence/resources/061020covideffectervisits.htm.

For more information, contact:

  • S. Centers for Disease Control and Prevention, 3311 Toledo Road, #2403, Hyattsville, Maryland 20782; 800-232-4636; Email: media@cdc.gov; Website: www.cdc.gov/

Physician-led accountable care organizations (ACOs) represented approximately 45% of all ACOs (about 549 of 1,221 total ACOs included in the study), as of December 2018. During this year, hospital-led ACOs accounted for approximately 25% of all ACOs, and joint-led ACOs represented 30%. ACOs consist of health care provider organizations that accept responsibility for the cost and quality outcomes of a defined population. Physician-led ACOs are defined as organizations that are involved in ACOs that do not involve hospitals directly in the payment arrangement, or in the broader organization.

As of December 2018, an estimated 28% of existing health systems or independent hospitals were participating in an ACO of the more than 1,700 hospitals or systems that could potentially form an ACO. Only an estimated 6% of the more than 8,200 physician groups that are large enough to ultimately form an ACO, have done so.

The researchers concluded that physician-led ACOs will likely be the dominant type of ACO in the future. This is due to the greater market potential of ACOs. However, current ACO policies and strategies that have been designed for hospitals and health systems must be restructured to better support physician-led ACOs. Additionally, policies should encourage the support of physician-led ACO partnerships with other organizations.

These findings were presented in “Accountable Care Organizations Are Increasingly Led by Physician Groups Rather Than Hospital Systems,” by David Muhlestein, Ph.D., J.D.; Tianna Tu, BA; and Carrie H. Colla, Ph.D. The researchers analyzed data from the Leavitt Partners ACO database, which tracks organizations that are participating in accountable care payment arrangements and includes information on organizational structure. This database represented 1,221 of 1,334 ACOs as of the end of 2018. The goal was to determine the overall structure of ACOs, and project the future of ACOs in the marketplace.

The full text of “Accountable Care Organizations Are Increasingly Led by Physician Groups Rather Than Hospital Systems” was published May 14, 2020 by The American Journal of Managed Care. A copy is available online at https://www.ajmc.com/journals/issue/2020/2020-vol26-n5/accountable-care-organizations-are-increasingly-led-by-physician-groups-rather-than-hospital-systems.

PsychU last reported on this topic in “Physician-Led ACOs Generated Almost 7 Times More Savings Than Hospital-Led ACOs,” which published on December 2, 2019. The article can be found at https://www.psychu.org/physician-led-acos-generated-almost-7-times-more-savings-than-hospital-led-acos/.

For more information, contact: 

  • David B. Muhlestein, Ph.D., J.D., Chief Strategy and Chief Research Officer, Leavitt Partners, 299 South Main Street, Suite 2300, Lake City, Utah 84111; 801-538-5082; Email: david.muhlestein@leavittpartners.com; Website: https://leavittpartners.com/

As of June 6, 2020, about 20% of 383,159 health care personnel tested positive for coronavirus disease 2019 (COVID-19). In total, there have been 77,528 confirmed cases of COVID-19 among health care personnel. Within this group, death status was available for 49,054 people. To date, 415 health care professionals have died from COVID-19, a case fatality rate of 0.5%.

The health care worker infection and fatality statistics are based on more than 1.8 million COVID-19 test outcomes reported to the Centers for Disease Control and Prevention (CDC). Of the more than 1.8 million tests, about 21.3% of those tested identified themselves as health care workers.

The data about COVID-19 testing is being compiled by the Centers for Disease Control and Prevention (CDC). Since March 1, 2020, more than 12 million specimens have been tested. Between March 1, and June 16, 2020, there have been 2.1 million cases of COVID-19, and 116,140 deaths, for a 5.5% case fatality rate.

The CDC is reporting levels of influenza-like illness and COVID-19-like illness each week, as well as mortality rates. As of June 6, 2020, the CDC said the levels of illness continue to decline or remain stable at low levels. The percentage of specimens testing positive for SARS-CoV-2, which causes COVID-19 increased slightly from the week of May 30, 2020.

The cumulative COVID-19-associated hospitalization rate since March 1, 2020, is 89.3 per 100,000. The highest rates are among people age 65 and older, at 273.8 per 100,000, with the next highest rate among people age 50 to 64 years, at 136.1 per 100,000. The rate for adults ages 18 to 49 was 52.4 per 100,000.

Compared to comparable points in time during recent influenza seasons, for people age 65 and older, current cumulative COVID-19 hospitalization rates are within ranges of cumulative influenza hospitalization rates observed at comparable time points during recent influenza seasons. For children under age 18, cumulative COVID-19 hospitalization rates are lower than cumulative influenza hospitalization rates.

The share of deaths attributed to pneumonia, influenza, or COVID-19 (PIC) dropped from 12.4% the previous week to 7.3%. This level is still higher than baseline. The CDC noted that the percentage of deaths due to PIC has been dropping for seven weeks. However, the percentage of deaths due to PIC may change as more death certificates are processed.

A link to the full text of “COVIDview, Key Updates For Week 23, Ending June 6, 2020” may be found at www.openminds.com/market-intelligence/resources/060620cdccoviddata.htm.

For more information, contact:

  • S. Centers for Disease Control and Prevention, 3311 Toledo Road, #2403, Hyattsville, Maryland 20782; 800-232-4636; Email: media@cdc.gov; Website: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html.

So much discussion of canoes these days. Until 12 weeks ago, executives of specialty provider organizations had to balance “two canoes”—operating in a fee-for-service (FFS) or cost-based environment, with operating in a wide array of emerging performance-based and value-based reimbursement (VBR) models. But with the pandemic crisis, another layer of complexity has been added—surviving through the crisis while developing a sustainable (and innovative) post-crisis recovery strategy. This is a situation more akin to controlling four canoes.

A common question from executive teams is whether to temporarily shelve the plans for alternative payment models during this crisis period. The answer is two-fold. Certainly, putting a crisis management financial survival plan is a first-order priority. This means grappling with cash flow, maximizing revenue as much as possible, determining a temporary break-even, and reducing expenses to match. These crisis management financial survival plans are the reason we see continuing announcements of layoffs and furloughs in the press.

But one could argue that for most provider organizations, being able to accept more VBR, with more financial risk, will likely be part of any recovery plan. As of OPEN MINDS last survey in March 2020, about 74% of primary care organizations and 61% of behavioral health organizations are participating in some form of VBR, and 16% of those organizations have 20% or more of their revenue in this type of contract. If the prognostications of health plan executives we’ve recently interviewed are any indication, this will likely increase in the post-crisis period.

With that in mind, the discussion during The 2020 OPEN MINDS Strategy & Innovation Institute session, One Foot In Two Canoes: Managing Service Lines For Value-Based Reimbursement & Fee-For-Service At The Same Time, provided some great insights into navigating the transition to VBR. The session featured Friendship Community Care’s Chief Executive Officer, Cindy Mahan, and Executive Vice President of Strategy and Planning, Craig Cloud; as well as Centerstone’s Vice President of Quality, M. Brad Nunn, Ph.D., and Director of Healthcare Innovation, Mandi Ryan, and was moderated by OPEN MINDS Senior Associate, Joe Naughton-Travers.

Dr. Nunn and Ms. Ryan presented Centerstone’s work with the Tennessee Health Care Innovation Initiative Strategy, which includes patient-centered medical homes (PCMH); health homes for severe and persistent mental illness; reimbursement using episodes of care; and quality and acuity adjusted payments for long-term services and supports (LTSS). The payment structure includes case rate payments for health home services and financial incentives for high-performing provider organizations. It also includes episodes of care payments (two of 48 diagnoses are behavioral health) based on a FFS model with penalties for high costs and gainsharing payments if costs are kept below a threshold.

Friendship Community Care is participating in the Arkansas Medicaid initiative— “Provider-Led Arkansas Shared Savings Entities” (PASSEs). These are “organized care” models that are at risk for all services (physical health care services, behavioral health services, and specialized home- and community-based services) for approximately 40,000 individuals who have intensive levels of treatment or care due to mental illness, addiction, or intellectual/developmental disabilities. In this model, provider organization/health plan collaboratives assume the financial risk.

So, what should executives leading the shift toward VBR—while managing FFS reimbursements at the same time—be doing to keeping both canoes on course? Focus on three areas—staff skills and training, system integration and data management, and financial performance. While things are moving rapidly, and the crisis is shifting timelines for the transition, it is important not to rush, advised our speakers. Stop and do things right, because the transition demands care and dexterity.

  1. Staffing:Whether it’s FFS or VBR, clinical professionals are providing the same type and level of care with the goal of helping consumers get better. But it is managers who need to have two diametrically opposite perspectives. Can one person really manage two antithetical programs—one based on service volume and the other based on the right outcomes with less volume? Can they “switch from a left brain to right brain approach,” as Mr. Naughton-Travers put it? What we may need is two different managers to paddle the two canoes. Staff across the organization who have operated in a traditional FFS model will need to be trained in the new norms of VBR and will need a clear understanding of expected outcomes.
  2. Systems and data: Provider organizations collect a large volume of data but that usually happens in silos. If all systems are integrated (for example, if the electronic health records are integrated with the enterprise resource planning system) and you invest in staff skilled at business analytics—as both Friendship Community Care and Centerstone have done—executives will have the data they need to continuously monitor the variables for both FFS (productivity) and VBR (impact). Further, policies and procedures to manage each payment stream must be clearly laid out and shared with all staff.
  3. Financial performance: Balancing both canoes requires a laser focus on financial performance. Revenue cycling is critical as Ms. Mahan pointed out. Concurrent clinical documentation is key so billing can happen quickly and accurately. Billing staff must have experience in both types of billing and have access to the data that payers expect.

The pandemic crisis already calls for some exceptional navigation skills to steer through extreme market turbulence. Having one foot in the FFS canoe and the other in VBR makes it more precarious than ever before. But health plans and payers have told us that VBR is gaining traction and we can’t ignore the future even as we manage the present.

The adoption of value-based reimbursement (VBR) has been inconsistent over the past few years. But the consensus is that the recession that is upon us and the likely reduced federal/state budgets will drive more VBR and more financial risk transfers from managed care organizations to provider organizations.

OPEN MINDS does a lot of organizational assessments of ‘readiness’ for VBR—and they have developed a self-assessment tool to do just that. The tool has several key domains including provider network management; consumer access and service engagement; financial management; leadership and governance; technology and reporting; and clinical management and performance optimization. But, readiness assessments tend to focus on the organizational management infrastructure. A big question for executive teams is whether clinical programs are ready for VBR. That was the focus of the session, “Creating & Managing The Clinical Models You Need For Value-Based Reimbursement,” led by Dominick DiSalvo, MA, LPC, Corporate Director, Clinical Services, KidsPeace at The 2020 OPEN MINDS Strategy & Innovation Institute.

KidsPeace offers a full continuum of behavioral health care services for children and families, from serving youth in the foster care and child welfare system to providing residential treatment, accredited educational services, and a free-standing psychiatric hospital. Headquartered in Pennsylvania, its services span 10 states and the District of Columbia. Between 2016 and 2017, the organization followed the state of Pennsylvania in its initial journey to VBR. Since then, KidsPeace has participated in performance-based contracting, including pay-for-performance, with payments linked to a specific set of benchmarked outcomes.

But success with VBR doesn’t come without its challenges—it requires a significant shift in both leadership mindset and organizational infrastructure. As Mr. DiSalvo discussed, “The most difficult task we have is to limit risk by finding the balance between person/family-centered care and structured programs that reduce variability in services and outcomes.” His advice? Focus on trauma-informed care; synthesize evidence-based clinical models; use data to drive clinical decision-making; and engage clinical professionals to engage consumers.

Focus On Trauma-Informed Care
KidsPeace began the move to VBR by using the Trauma History Questionnaire (THQ), a 24-item self-report measure that examines an individual’s experience with possible traumatic events including crime, physical or sexual assault, and neglect. Mr. DiSalvo described this as a necessary first step in moving toward a value-based framework for care, because when trauma wasn’t factored in, the desired treatment outcomes were not being achieved. After it started to implement trauma-informed care, KidsPeace found that youth self-reported experiencing an average of 10 traumatic categories before entering the program. The new focus on trauma as an underlying cause required a considerable shift in how clinical professionals were supporting consumers—and how senior leaders were supporting clinical professionals. “This data really convinced our leadership team that we needed to have a complete change in focus—we needed to be family and youth driven, trauma-informed, and have data drive what is going on in our programs,” said Mr. DiSalvo.

Synthesize Evidence-Based Clinical Models
After understanding the “value” of becoming trauma-informed to provide more effective treatment—and ultimately—more meaningful and measurable outcomes, KidsPeace completely restructured their clinical programming by synthesizing a core set of evidence-based practices within each program. The restructure allowed each individualized treatment plan to be guided by both the youth and their family—and driven by objective and relevant data—an essential part in defining “value” for each consumer. The organization adopted four clinical practice models—including trauma focused-cognitive behavioral therapy (with all clinical leadership becoming or in the process of becoming Nationally Certified Trauma Therapists); motivational interviewing (to increase motivation and engagement among youth); community living (to prepare adolescents for young adulthood and community inclusion); and individualized treatment planning. By using these four clinical models, the organization has the flexibility to provide individualized care as well as the consistency and structure to meet the needs of all youth and families that are served.

Use Data To Drive Clinical Decision Making
Before they restructured clinical program models to focus on value, Mr. DiSalvo noted that KidsPeace had challenges with using data to drive treatment and decision making processes. “When I had conversations with our foster care program in Indiana versus conversations with our residential program in Georgia, the way they captured data and assessed youth were very different.” To ensure consistency across all programs, no matter the location or service line, the organization moved to a corporate wide electronic health record and adopted the use of a data dashboard to visually track key metrics over time. Those metrics included discharge disposition and post-discharge follow up surveys, high risk behaviors (e.g. suicidal ideation), clinical treatment benchmarks, length of stay, and individualized score cards in graph format. The data is then broken down further by day, time of day, over time, and total score. “We’ve even gotten as granular as examining if there is a particular staff member that youth are struggling more with and if we need to provide more training.” The key quality indicators (in a simple, color-coded format) are reviewed quarterly with the senior leadership team to quickly identify any pain points and make changes to maximize program efficiency. Mr. DiSalvo explained, “Not only can we track youth individually, but we are also able to track specific program progress from an aggregate level—and then make changes and help continuously improve that program.”

Engage Clinical Professionals To Engage Consumers
To truly drive optimal outcomes in value-based clinical programming, Mr. DiSalvo highlighted a final key component—engaging clinical professionals. “It’s impossible to succeed with risk-based payment models if staff aren’t engaged. If a child feels like a staff member is there simply to get a paycheck, they are not going to respond well.” Rather, a significant shift in mindset was necessary for many professionals to continuously find ways to improve the overall experience for youth, families, and staff. “Once we started to have the data inform practice, our clinicians started seeing clear, quantitative results. Once that happened, it was a ripple effect—our youth found more enjoyment in their experience. Ultimately, it’s the clinicians who then become the champions for change.”

Any significant transformation isn’t sustainable without embedding those changes within the organizational culture. Mr. DiSalvo discussed the importance of cultivating a cohesive culture to act as the foundation of any clinical program focused on providing value, “Our initiative at KidsPeace is to integrate all of our resources to improve safety, engagement, connection, clinical practice and outcomes for all staff, youth, and families but it doesn’t come naturally. It requires robust training and a strong understanding about what engagement actually looks like. Clinical professionals must move away from the mindset that ‘we are the ones who know best’ and understand that the family and youth are the experts. We are simply here to join them in their journey.”

The major takeaway from the session is that it’s not enough to have your administrative and financial infrastructure “ready” for VBR. Making clinical programs VBR-ready is a critical aspect of strategy development for sustainability.

The health care economy continues to shift from the fee-for-service model that has been in existence for decades to value-based payment. While many forms of value-based models are being trialed and implemented, there are examples of models that span slight experimentation through provider organizations partnering with payers to take on full medical risk for a population. In this webinar, our speakers discuss innovations around new payment models in a lively townhall format.

Featuring:

  • Deb Adler, CPHQ
    Senior Associate, OPEN MINDS
  • Steven Remillard, D.C.
    Senior Associate, OPEN MINDS
  • Paul Duck
    Senior Associate, OPEN MINDS


Deb Adler, CPHQ, has more than 20 years of experience in executive health care roles, serving in a variety of capacities, including network executive, quality management executive, and COO. She is the former Senior Vice President of Network Strategy for Optum, where she was responsible for behavioral health network development, contracting, and strategy for more than 185,000 providers. In this role, she developed the largest performance-tiered behavioral health network, the largest telemental health network, and the largest medication-assisted treatment (MAT) network. She was also responsible for implementing network initiatives to promote medical/behavioral integration, improve member outcomes, and reduce total cost of care through collaborative care models. Currently, she serves as a Senior Associate at OPEN MINDS. Ms. Adler earned her MA in psychology and evaluation from Catholic University of America and is a Certified Professional in Health Care Quality (CPHQ).

Steven Remillard, D.C. currently serves as a Senior Associate at OPEN MINDS. With more than 25 years of experience in the health and human services field, he leads projects related to value-based purchasing, integrated care programming, HEDIS measurement, data-driven organizational development, and the social determinants of health. Previously, Dr. Remillard served as the Special Assistant to the Secretary of the Pennsylvania Department of Human Services. In this role, Dr. Remillard directed a federal grant to promote innovation in hospital-based behavioral and physical health care integration. Dr. Remillard also supported various stakeholder groups in the implementation of integrated care planning.

Paul Duck currently serves as a Senior Associate at OPEN MINDS. He brings more than 30 years of experience in leadership and management, focusing on managed care, health information technology, strategy, business development and market expansion, and customer experience optimization to the OPEN MINDS team. Previously, Mr. Duck has served in roles such as Vice President, Strategy & Development for Beacon Health Options, the Vice President of Business Development for Netsmart Technologies, and Chief Executive Officer for Coastal Orthopedics. Mr. Duck earned his BA in business management from Case Western Reserve University. He earned his AA in electronic engineering technology from the Electronic Technology Institute.

Recovery is a treatment goal that crosscuts the care continuum. In the pursuit of this goal, payers and providers endeavor to be agile—measuring and adjusting processes, procedures, partners, and services to promote personalized, person-centered care that addresses a patient’s full spectrum of needs. Systematically focusing on evidence-based practices, performance measurement, and quality improvement allows payers and providers to convey a message of hope to patients and help them make progress on their road to recovery.

In March 2020, we asked the PsychU community three questions about patient functioning and exercise. We were interested in whether direct care providers perceive exercise as improving patient functioning, what percentage of clinicians’ patients exercise, and whether organizations incentivize physical activity. The full results of these polls are provided in the figures below.

Elizabeth DiNapoli sits down with Kathy Day to respond to unanswered questions from PsychU’s Interacting with First Responders webinar. Their conversation covers discussions among patients, family members, and law enforcement before and during a mental health crisis.

PsychU · Interacting with First Responders Webinar: Follow-Up Q&A Podcast

Kathy Day, MPA, currently serves as a caregiver and advocate for a close family member who was diagnosed with schizophrenia in 2010. She also helps to manage online support groups for families coping with mental illness like schizophrenia, bipolar disorder, and major depression. Ms. Day received her MPA from Brandman University.

Elizabeth DiNapoli, PhD, is a Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc. Dr. DiNapoli earned her PhD from the University of Alabama.

Kathy Day is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc.

Elizabeth DiNapoli is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

Prior to the coronavirus disease 2019 (COVID-19) pandemic, the average primary care physician compensation rose by 2.5%, from $237,000 in 2019 to $243,000 in 2020. Between October 4, 2019 and February 10, 2020, average specialist salaries rose by 1.5%, from $341,000 in 2019 to $346,000 in 2020. The highest average annual compensation was for orthopedics at $511,000; the lowest was for pediatrics at $232,000. Average annual compensation for psychiatrists was $268,000.

For the time period reviewed, about 58% of primary care physician practices, and 55% of specialist practices offered an incentive bonus. Examples of incentive bonuses are collections bonuses (monies collected from consumers, resulting in a net profit) and work relative value unit (productivity measure) bonuses. The average incentive bonus for all health care workers is about $26,000; however, the average incentive bonuses for specialty physicians ranges from $31,000 to $96,000. PCP physicians usually earn 64% of an incentive bonus, while specialists usually earn 69% of an incentive bonus.

These statistics were released on May 14, 2020, in the Medscape “Physician Compensation Report 2020” by Leslie Kane, MA. The findings are based on analysis of survey responses collected between October 4, 2019 and February 10, 2020, from more than 17,000 physicians working in 30 specialties. The survey examined salary, incentive bonus, and denied claims, and their attitudes about the field of medicine.

The full text of the Medscape “Physician Compensation Report 2020,” was released on May 14, 2020. A copy is available online at https://www.medscape.com/slideshow/2020-compensation-overview-6012684.

For more information, contact: 

  • Leslie Kane, MA, Business of Medicine, Medscape, 825 8thAvenue, New York, New York 10019; 212-301-6700; Email: LKane@webmd.net; Website: https://www.medscape.com/author/leslie-kane

On May 21, 2020, Texas Governor Greg Abbott directed the Texas Health and Human Services Commission (HHSC) to expand testing for coronavirus disease of 2019 (COVID-19) to the approximately 4,700 residents, and about 18,000 staff at 23 state-operated inpatient psychiatric hospitals and state-supported living centers (SSLC). This testing is part of the state’s continued effort to reduce the chances of the spread of COVID-19 at these facilities and protect these vulnerable populations.

Previously, residents at both types of facilities were tested if they displayed symptoms of COVID-19 or had possible exposure to the virus. The new round of testing will cover those who have shown no signs of COVID-19 or have not been tested within the last 30 days. Testing began May 26 and is currently ongoing. Once the results are in, HHSC will evaluate the need for further testing with the Texas Department of State Health Services.

The governor’s announcement noted that since March 13, 2020, and as of May 20, 161 residents of SSLCs and inpatient psychiatric facilities have tested positive for COVID-19 and 107 had recovered. As of June 3, 2020, across the 23 facilities there have been 178 positive cases. Currently, eight facilities have at least one positive resident. Of those 178 positive cases, 139 have recovered. Since the emergency began, there have been fewer than 10 deaths among SSLC and inpatient psychiatric facility residents.

HHSC operates 13 state supported living centers that provide 24-hour residential care, medical services, and vocational training for people with intellectual and developmental disabilities. The agency also operates 10 state hospitals that provide acute inpatient psychiatric care for adults, children, and adolescents.

For more information, contact: 

  • Scott Schalchin, Associate Commissioner, State Supported Living Centers, Texas Health and Human Services Commission, 4900 North Lamar Boulevard, Austin, Texas 78751-2316; Email: scott.schalchlin@hhsc.state.tx.us; Website: https://gov.texas.gov/news/post/governor-abbott-directs-hhsc-to-expand-covid-19-testing-to-all-state-hospitals-state-supported-living-centers

On May 29, 2020, the Kentucky Cabinet for Health and Family Services (CHFS) awarded five Medicaid managed care contracts with an aggregate value of about $8 billion. The five companies are Aetna, Humana, Molina Healthcare, UnitedHealthcare, and WellCare. Aetna will also serve children in Kentucky SKY, the Medicaid risk-based managed care delivery program for the state foster care program and the Department for Juvenile Justice. The plans are at-risk for all Medicaid physical health, behavioral health, and pharmacy services. The contracts are slated to go live on January 1, 2021 and will run through December 31, 2024. The contracts may be extended by six additional two-year periods.

The state’s current managed care contracts are with Aetna (via Coventry Cares), Anthem, Humana (via CareSource), Passport Health Plan, and WellCare. These contracts have been extended through December 31, 2020. About 1.3 million beneficiaries are enrolled in one of the five current Medicaid managed care plans.

The state issued the request for proposals (RFP 2000000202) on January 10, 2020. This was a rebid after the state cancelled contracts awarded on November 26, 2019, due to concerns about how the award process was handled. Proposals were due by February 7, 2020. Responses were also submitted by Anthem Kentucky Managed Care Plan, Inc.; and Passport Health Plan, Inc.

The proposals received the following scores:

  • Aetna received 1,653 points.
  • WellCare received 1,662 points.
  • Humana received 1,605 points.
  • UnitedHealthcare received 1,520.5 points.
  • Molina received 1,507 points.
  • Anthem received 1,491 points.
  • Passport received 1,409.5 points.

The proposals for Kentucky SKY received the following scores:

  • Aetna received 1,126.3 points.
  • WellCare received 1,120.6 points.
  • Humana received 1,066.6 points.
  • UnitedHealthcare received 1,044.2 points.
  • Molina received 1,017.4 points.

PsychU last reported on this topic in “Kentucky Announces Cancellation Of Medicaid Managed Care Contracts; To Be Rebid In January,” which published on January 5, 2020. The article is available at https://www.psychu.org/kentucky-announces-cancellation-of-medicaid-managed-care-contracts-to-be-rebid-in-january/.

For more information, contact: 

  • Susan Dunlap, Executive Director of Public Affairs, Kentucky Cabinet for Health and Family Services, 275 East Main Street, Frankfort, Kentucky 40621; 502-564-7042; Email: Susan.Dunlap@ky.gov; Website: https://chfs.ky.gov/
  • Kate Marx, Corporate Communications, Humana, 500 West Main Street, Louisville, Kentucky 40202; 502-271-9288; Email: kmarx1@humana.com; Website: https://www.humana.com/
  • Caroline Zubieta, Director of Public Relations, Molina Healthcare, Inc., 200 Oceangate, Suite 100, Long Beach, California 90802; 562-951-1588; Email: Caroline.Zubieta@molinahealthcare.com; Website: https://www.molinahealthcare.com/members/common/en-US/abtmolina/compinfo/newsmed/Pages/newsmed.aspx
  • Charles N. Talbert, Manager, External Communications, WellCare Health Plans, Inc., 211 Perimeter Center, Suite 800, Atlanta, Georgia 30346; 770-913-2181; Email: charles.talbert@wellcare.com; Website: https://www.wellcare.com/
  • Will Shanley, Director of Public Relations, United Healthcare, 5901 Lincoln Drive, Minneapolis, Minnesota 55436; 612-486-4361; Email: will.shanley@uhc.com; Website: https://www.uhc.com/
  • Leigh M. Woodward, Senior Communications Partner, Aetna Medicaid, 4630 Woodland Corporate Boulevard, Tampa, Florida 33614; 860-900-6058; Email: WoodwardL1@aetna.com; Website: https://www.aetna.com/

The Centers for Medicare & Medicaid Services (CMS) will require hospitals to adopt the Medicare Hybrid Hospital-Wide 30-Day Readmission (HWR) measure by 2023, and will begin a mandatory measurement period running from July 1, 2023 to June 30, 2024. In July 2025, the results will be posted to Medicare Hospital Compare. The HWR is based on electronic health record data and claims data for Medicare beneficiaries. CMS believes that the proliferation of EHR systems and standardization of extraction and reporting of clinical data for quality measurement provide an opportunity to integrate these data into measures of hospital performance. The HWR will replace the current Claims-Based Hospital-Wide All-Cause Readmission measure.

The new HWR measure was included in the Medicare 2020 Hospital Inpatient Prospective Payment System Final Rule, released on August 16, 2019. During 2019, 150 hospitals participated in a voluntary HWR pilot program. In preparation for the mandatory HWR reporting period that starts July 1, 2023, CMS will implement two voluntary year-long measurement periods, with the first starting on July 1, 2021 and running through June 30, 2022. The second period will start July 1, 2022, and run through June 30, 2023.

The HWR measure will be required as a part of each hospital’s inpatient quality reporting (IQR) program requirements. The Medicare Hospital IQR Program is a pay-for-reporting quality program which reduces payment to hospitals that fail to meet program requirements.

For the HWR measure, the numerator is unplanned all cause 30-day readmission. Readmission is defined as an inpatient admission to any acute care facility which occurs within 30 days of the discharge date of an earlier, eligible index admission. The denominator is admissions for Medicare fee-for-service (FFS) beneficiaries age 65 and older enrolled in Part A for the 12 months prior to admission who are matched in EHR and claims data and who are discharged alive, and not transferred to an acute care facility. The measure excludes the following populations:

  • Admitted to Prospective Payment System-exempt cancer hospitals
  • Without at least 30 days post-discharge enrollment in FFS Medicare
  • Discharged against medical advice
  • Admitted for primary psychiatric diagnoses
  • Admitted for rehabilitation
  • Admitted for medical treatment of cancer

The HWR measure uses clinical data elements from the EHR for risk adjustment in addition to claims data. The goal is to use clinical data, such as laboratory test values and vital signs, to risk adjust for consumer-level factors that influence readmission to adjust for severity of illness in hospital outcome measures.

Under the current Claims-Based Hospital-Wide All-Cause Readmission measure, CMS reports risk-standardized readmission rates for several conditions, including acute myocardial infarction, heart failure, pneumonia, and hip and knee arthroplasty. CMS has also developed hospital readmission measures for stroke and chronic obstructive pulmonary disease. In 2013, CMS began publicly reporting a hospital-wide, all-condition readmission measure that captures 92% of readmissions following eligible admissions.

For more information, contact:

  • Office of Communications, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 202-690-6145; Fax: 202-260-1462; Website: https://www.cms.gov/

During March 2020, among 305 people in Atlanta, Georgia who were hospitalized with laboratory-confirmed coronavirus disease 2019 (COVID-19), about 83% were African American, a higher than expected share based on overall hospital admissions. At a group of four affiliated hospitals, which accounted for 67% of those in the cohort, 80% of the group were African American compared with 47% of hospitalized people overall during March 2020. The hospitalized African Americans were not more likely than other races to receive invasive mechanical ventilation or to die during hospitalization.

About 61.6% of the 305 people hospitalized with COVID-19 were over age 65, and 50.5% were female. The median age was 60 years, with a range between 23 to 95 years. Data on race/ethnicity were available for 297 (97.4%), among whom, 247 (83.2%) were African American, 32 (10.8%) were non-Hispanic white, eight (2.7%) were non-Hispanic Asian or Pacific Islander, and 10 (3.4%) were Hispanic.

About 26% of those hospitalized with COVID-19 had none of the conditions associated with higher risk for severe disease, including being 65 years or older. About 6.6% of the group resided in long-term care facilities before hospitalization.

About 40.1% of the hospitalized people had private insurance; 33.4% were Medicare beneficiaries; 10.9% were Medicaid beneficiaries; and 14.9% were uninsured. The hospitalized African Americans were more likely than those of other races/ethnicity to be Medicaid beneficiaries, at 13.5% compared to 0.0%. However, those in the African American group were not more likely to be uninsured than the other groups.

These findings were reported in “Characteristics And Clinical Outcomes Of Adult Patients Hospitalized With COVID-19 — Georgia, March 2020” by Jeremy A. W. Gold, M.D.; Karen K. Wong, M.D.; Christine M. Szablewski, DVM; Priti R. Patel, M.D.; et al. They analyzed data from a convenience sample of hospitalized adults in metropolitan Atlanta and southern Georgia. The data included individuals admitted between March 1 and 30, 2020 to one of eight hospitals.

PsychU last reported on this topic in “National COVID-19 Death Statistics Show Racial Impact Disparity,” which published on May 25, 2020. The article is available at https://www.psychu.org/national-covid-19-death-statistics-show-racial-impact-disparity/.

For more information, contact:

  • Brendan Jackson, M.D., MPH, Medical Epidemiologist, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia 30333; 404-639-0536; Email: brjackson1@cdc.gov; Website: www.cdc.gov/;
  • U.S. Centers for Disease Control and Prevention, 3311 Toledo Road, #2403, Hyattsville, Maryland 20782; 800-232-4636; Email: media@cdc.gov; Website: www.cdc.gov/.

Symptom reduction for people with health anxiety who were treated with internet-delivered, text-based cognitive behavior therapy (CBT) was similar to outcomes for people who received face-to-face CBT. Health anxiety, sometimes called somatic symptom disorder or hypocondriasis, is a common mental health problem associated with distress, substantial costs, and frequent health care utilization. The internet CBT and face-to-face CBT were delivered over 12 weeks. After completing treatment, both groups had a similar reduction in their health anxiety symptoms. The internet CBT group generated lower net social costs. The researchers concluded that the online treatment format should be considered as a first-line intervention for health anxiety. The net social cost for the internet CBT treatment was $3,854 lower than face-to-face CBT.

The internet CBT program is a text-based online treatment in which the individual works with conventional CBT strategies and communicates regularly with a therapist through an email-like system. The internet CBT program could be accessed at any time of day. Therapists spent 10.0 minutes per participant per week in the online CBT versus 45.6 minutes for face-to-face CBT.

These findings were reported in “Effect of Internet vs Face-to-Face Cognitive Behavior Therapy for Health Anxiety: A Randomized Noninferiority Clinical Trial” by Erland Axelsson, Ph.D.; Erik Andersson, Ph.D.; Brjánn Ljótsson, Ph.D.; et al. The researchers conducted a randomized non-inferiority clinical trial in a primary care setting with 204 Swedish adults diagnosed with health anxiety. They compared the effects of internet-delivered CBT to conventional face-to-face CBT. Follow-up data was collected for 12 months after treatment was completed. The analysis of net social cost included costs of therapies and medications (including the cost of internet CBT or face-to-face CBT), costs of non-medical help and services, and indirect costs such as those of unemployment.

The full text of “Effect of Internet vs Face-to-Face Cognitive Behavior Therapy for Health Anxiety: A Randomized Noninferiority Clinical Trial” was published May 13, 2020 by JAMA Psychiatry. An abstract is available online at https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2765960?guestAccessKey=818cdc24-4487-4f9b-b8a9-2c4a47b571d4&utm_source.

More information about the study is posted online at https://clinicaltrials.gov/ct2/show/NCT02314065.

For more information, contact: 

  • Erik Hedman-Lagerlöf, Ph.D., Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels Väg 9, SE-171 65, Stockholm, Sweden; Email: kire.hedman@ki.se; Website: https://staff.ki.se/people/erihed

Between March 13 and April 30, 2020, 1.4 million health care workers had been laid off due to the coronavirus disease 2019 (COVID-19) pandemic, and about 17% (243,000 workers) had been employed by physician practices. The physician practice layoffs represented about 1% of the total 23.1 million job losses in April 2020.

Of the 1.4 million health care layoffs, in addition to the physician practice layoffs, about 36% (503,000) of the health care job losses were from dentist offices, and another 15% (205,000) were from offices of other health care professionals. The remaining 34% of health care jobs lost were from other health care sectors.

The 1.4 million jobs lost in the health care industry represented 6% of the total 23.1 million job losses in April 2020. The national unemployment rate in April was 14.7%. According to data tracked by the Bureau of Labor Statistics (BLS), employment fell in all major industry sectors, with the heaviest losses in leisure and hospitality.

Across all employment sectors, the number of unemployed persons who reported being on temporary layoff increased about ten-fold in April 2020, from 1.8 million to 18.1 million. The number of permanent job losses increased by 544,000 to 2.0 million. The number of people who were jobless for less than five weeks increased by 33.6%, from 10.7 million to 14.3 million,

The BLS released the April 2020 employment statistics on May 8, 2020. The statistics are from two monthly surveys. The household survey measures labor force status, including unemployment, by demographic characteristics. The establishment survey measures nonfarm employment, hours, and earnings by industry.

For more information, contact:

  • Bureau of Labor Statistics, 2 Massachusetts Avenue Northeast, Washington, District of Columbia 20212; 202-691-5200; Email: PressOffice@bls.gov; Website: https://www.bls.gov/news.release/empsit.nr0.htm

Facebook, Inc. will pay $52 million to settle a class action lawsuit filed by more than 10,000 current and former social media content moderators who allege that their task of reviewing user posts that included images of extreme and graphic violence created significant psychological trauma. As moderators, the plaintiffs reviewed posted images to ensure that they did not violate the company’s policies on “harmful content.” On May 5, 2020, the class filed a preliminary approval motion of settlement. If the court grants the motion, the class intends to file a motion for final approval. The preliminary settlement covers moderators working in California, Arizona, Texas, and Florida from 2015 going forward.

In the settlement, Facebook agreed to establish a fund to maintain a testing and treatment program for content moderators to receive ongoing medical testing and monitoring, and any necessary medical and psychiatric treatment, until determination is made that their psychological trauma is no longer a threat to their health. Additionally, moderators will be able to mute audio by default and change videos to black and white. They will be able to access on-site counseling and a 24-hour hotline staffed by mental health professionals. Facebook will conduct emotional resiliency screenings during the hiring process and will post information about psychological support.

The original complaint, Scola, et al., v. Facebook, Inc., was filed in September 2018. It became a class action to include content moderators who reviewed content for Facebook via various third-party vendors and contractors, such as Pro Unlimited, Inc., Accenture LLP, Accenture Flex LLC, and U.S. Tech Solutions, Inc.

The plaintiffs noted that in 2015, Facebook helped draft workplace safety standards to protect content moderators from this type of workplace trauma. The safeguards included providing moderators with robust and mandatory counseling and mental health supports; altering the resolution, audio, size, and color of trauma-inducing images; and training moderators to recognize the physical and psychological symptoms of post-traumatic stress disorder. However, the plaintiffs alleged that Facebook ignored the workplace safety standards.

For more information, contact:

  • For the Plaintiffs: Joseph Saveri Law Firm, 601 California Street, Suite 100, San Francisco, California 94108; 415-500-6800; Fax: 415-395-9940; Website: https://saverilawfirm.com/
  • For Facebook: Press Office, Facebook, 1 Hacker Way, Menlo Park, California 94025; Email: press@fb.com; Website: https://newsroom.fb.com/

About 14% of internal medicine physician members of the American College of Physicians (ACP) used telemedicine technologies every week to conduct video visits with consumers, according to a survey in January 2020. Video visits were more common in rural areas, and were used by 40% of rural physicians compared to 31% of those in non-rural areas.

About one-quarter of ACP members used telemedicine weekly to conduct physician-to-physician e-consultations (24%) and asynchronous evaluation (25%) of data submitted through a consumer portal or other secure system. About 30% of physicians used remote monitoring (29%) and remote care management (31%) weekly. Rural physicians used remote monitoring and remote care management (when the technology was available) significantly more than non-rural physicians.

The survey differentiated among different types of telemedicine and digital health applications, collecting usage data in the following categories:

  • Video visit.
  • Physician-to-physician electronic consultations via virtual communication tools or portals in real-time or via store-and-forward.
  • Asynchronous evaluation by a physician or other clinical professional of a consumer’s information or images provided by the consumer through a secure portal.
  • Monitoring of physiological data points. Providing remote care management and coaching via phone, text, or video technologies to discuss health status ​and lifestyle behaviors.
  • Integrated data about fitness, sleep quality, or basic heart rate from consumer-grade wearables into a consumer’s medical record.

The share of ACP members who said they had the technology available varied with the type of technology. Weekly usage among those with the technology ranged between 40% and 65%, depending on the type of technology.

Compared to the penetration rate in 2019, use of video visits, remote monitoring, and remote management increased, as measured with comparable audiences year-over-year. Use of video visits increased from 3% to 10%. Use of remote monitoring increased from 5% to 11%. Use of remote care management increased from 12% to 18%. Use of e-consultations remained flat at 21% in both 2019 and 2020. Use of wearables also remained flat at 3% in both years.

The primary barriers to telemedicine adoption were financial and structural concerns, not a lack of physician interest. Only 6% said they were not interested in offering virtual care. Only 7% doubt the need for virtual care in their practices. Variation in telehealth use by specialists reflected the institutional resources available and the nature of the various medical specialties.

These findings were reported in “2020 ACP Member Survey about Telehealth Implementation” by the ACP. The survey was conducted in December 2019 through January 2020 to explore the use of telehealth among internal medicine physicians and subspecialists who are members of ACP. This is the second year that ACP has conducted this survey. For the current survey, ACP sent surveys to 1,972 members age 65 and younger; the response rate was 11.7%. Of those who responded, 49% were in general internal medicine, 24% in hospital medicine, and 26% were subspecialists. The survey questions evaluated the availability of technology, as well as frequency of use, for six different categories of telehealth services.

The researchers identified two short-term opportunities to increase adoption of telemedicine and digital health. The first is to increase implementation of remote monitoring and remote care management technology. The second is to increase the use of video visit technology where it is already implemented.

In a press release, ACP President Robert M. McLean, M.D., MACP, noted that “The survey was conducted before the COVID-19 pandemic, which resulted in the lifting of some regulatory barriers.” He said, “At the time of this survey, telephone call visits were not covered by any insurance payers, so no physicians were formally calling them ‘visits,’ so we did not even ask the question.”

The full text of “2020 ACP Member Survey about Telehealth Implementation” was released in April 2020. An abstract is available online at https://www.acponline.org/system/files/documents/practice-resources/health-information-technology/telehealth/acp-telehealth-survey-results-2020-march.pdf.

For more information, contact:

  • Laura Baldwin, Director, Public Relations, American College of Physicians, 190 North Independence Mall West, Philadelphia, Pennsylvania 19106; 215-351-2668; Email: lbaldwin@acponline.org; Website: https://www.acponline.org/.

About 90% of physicians in nine countries, including the United States, said that they or a colleague are participating in video or telephone visits with consumers. About 47% of physicians using telemedicine for consultation during the coronavirus disease 2019 (COVID-19) outbreak are using telemedicine for the first time. About 20% of physicians using video conferencing and telemedicine tools expect to use them significantly more than before.

In the United States, 63% of physicians said they used telemedicine tools for remote treatment during the COVID-19 outbreak. About 81% reported a decline in consumer volume, with 62% reporting a significant drop and 19% reporting a mild drop. About 11% reported a significant increase in consumer volume, and 3% reported a mild increase. The remaining 4% reported no change. About 32% of calls and time were related to COVID-19, and 68% were for non-COVID-19 concerns. Additional details about their use of telemedicine were as follows:

  • About half (47%) used a consumer-facing video conferencing platform such as Skype or Zoom.
  • About one-third (32%) reported using telemedicine for mental health consultation.
  • Less than half reported using telemedicine platforms for remote learning for their nurses and practice staff (21%) or themselves (34%).
  • Few used clinical decision support tools (7%) or remote monitoring wearables and sensors (8%).

The survey respondents’ practice in eight medical specialties: general practice or internal medicine, cardiology, oncology, neurology, psychiatry, rheumatology, and dermatology. Their reported use of telemedicine before, during, and their projected use after the COVID-19 pandemic public health emergency (in their countries) varied by specialty.

These findings were reported in “COVID-19 HCP Sentiment Surveys Part 1: Physician Engagement with Patients and Remote/Telehealth Experiences” by Sermo. The poll was conducted from March 23 to 30, 2020, among a convenience sample of 1,392 Sermo members in nine countries: China (111),France (167), Germany (137), Great Britain (135), Italy (323), Japan (110), Spain (181), Switzerland (7), and the United States (221). The participants were in eight specialties: general practice or internal medicine, cardiology, oncology, hematology, neurology, psychiatry, rheumatology, and dermatology. About half specialized in general practice or internal medicine. The survey topics related to the participants’ experiences with health care consumers and remote/telemedicine.

Sermo also leveraged its social platform to conduct a poll among 1,300+ international physician members. Results revealed that about 85% said they were providing remote services, and 90% said a colleague is providing services via telehealth. About 68% believe the shift to telehealth will have a lasting impact, and 28% said office-based face-to-face visits will remain more important than telemedicine. About 77% said that given the right circumstances, they support the shift toward telemedicine.

The full results of “COVID-19 HCP Sentiment Surveys Part 1: Physician Engagement with Patients and Remote/Telehealth Experiences” were published April 2020, by Sermo. A copy is available for download at https://www.sermo.com/COVID19-HCPSentimentStudy-Part2.

The topline results of “HCP INSIGHTS: Telemedicine Explodes In These Uncertain Times” were published April 16, 2020, by Sermo. A copy is available online at https://www.sermo.com/telemedicine-explodes-in-these-uncertain-times/.

For more information, contact:

  • Joanna Molke, Marketing Director, Sermo, Inc., 200 Park Avenue South, Suite 1310, New York, New York 10003; Email: joanna.molke@SERMO.com; Website: https://www.sermo.com/.

In this presentation, Dr. Mona Sobhani, PhD, Director of Research and Operations
USC Center for Body Computing, Los Angeles, California, addresses privacy and security considerations during the Covid-19 pandemic. Dr. Sobhani gives real word considerations for clinicians to consider during this challenging time.

Mona Sobhani, PhD, is Director of Research and Operations at the USC Center for Body Computing (CBC), a digital health research and innovation center.  By training, she is a cognitive neuroscientist with behavioral, physiological, and neuroimaging research experience in psychopathic traits, mirror neurons, emotion regulation, fear conditioning, and sensory-motor feedback.  Dr. Sobhani holds a Ph.D. in Neuroscience from the University of Southern California. She also holds a B.S. in Animal Physiology and Neuroscience from the University of California, San Diego.

Fatima Sadat, PharmD, is a Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

Mona Sobhani, PhD is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc.

Fatima Sadat, PharmD, is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

The U.S. Food and Drug Administration (FDA) has posted initial validation results of 12 antibody tests for coronavirus disease 2019 (COVID-19), or SARS-CoV-2. During March and April 2020, the FDA granted the tests an Emergency Use Authorization (EUA). The validation analysis is based on information submitted by the test developers, which the FDA reviewed before granting the EUA.

The FDA summarized the expected performance of the tests, and assumed a COVID-19 population prevalence of 5% for the positive and negative predictive value (PPV and NPV) calculations. The PPV and NPV help those who are interpreting the tests understand how likely it is that a person who receives a positive result truly does have antibodies, and how likely it is that a person who receives a negative result truly does not have antibodies. PPV and NPV are calculated using a test’s sensitivity, its specificity, and a prevalence assumption.

The FDA noted that the summary results are an incomplete representation of the performance of these tests. The FDA is providing a calculator that will allow users to see the estimated performance of a single test or two independent tests based on their performance characteristics and the estimated prevalence of SARS-CoV-2 antibodies in the target population.

In addition to the 12 antibody tests authorized under an individual EUA, over 200 more antibody tests are being evaluated in a pre-EUA or EUA review. The FDA worked with National Institutes of Health, the Centers for Disease Controls and Prevention, and the Biomedical Advanced Research and Development Authority to help establish a capability at the National Cancer Institute (NCI) to independently validate certain antibody tests, including antibody tests that were not the subject of an EUA or pre-EUA, as well as those that were under FDA review. The main goal of this effort is to determine whether available antibody tests are accurate.

To validate the antibody tests, the NCI team runs a “validation panel” with a set of 110 blood samples from 30 people who had a confirmed SARS-CoV-2 infection and 80 samples taken from people before the COVID-19 pandemic started. Each sample in the validation panel was tested by at least two separate labs.

The FDA intends to use the NCI data to inform future decision making about whether to authorize the test or take other action regarding tests that fail to perform adequately. NCI has shared validation data from 13 test kits so far with the FDA. The FDA posted the results at https://www.fda.gov/medical-devices/emergency-situations-medical-devices/eua-authorized-serology-test-performance.

For more information, contact:

  • Office of Media Affairs, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Building 32, Room 5245, Silver Spring, Maryland 20993; 301-348-1956; Email: FDAOMA@fda.hhs.gov; Website: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/eua-authorized-serology-test-performance

All New York long-term care facilities must communicate coronavirus disease 2019 (COVID-19) test results and deaths to residents’ families, according to an executive order issued by New York Governor Andrew M. Cuomo. The order includes adult home and other assisted living facilities. Additionally, the Governor also announced a new directive requiring nursing homes to immediately report to the Department of Health (DOH) the actions they have taken to comply with all laws, regulations, directives, and guidance issued by the DOH based on guidance from the federal Centers for Disease Control and Prevention (CDC).

The state guidance requires nursing homes to do the following:

  • Provide personal protective equipment (PPE) and temperature checks for staff. New York State will provide PPE to nursing facilities on an emergency basis.
  • Isolate COVID residents in quarantine.
  • Separate staff and transfer COVID-positive residents within a facility to another long-term care facility or to another non-certified location.
  • Notify all residents and their family members within 24 hours if any resident tests positive for COVID or if any resident suffers a COVID-related death.
  • Readmit COVID positive residents only if they have the ability to provide adequate level of care under DOH and CDC guidelines.

The executive order, 202.18, requires any skilled nursing facility, nursing home, or adult care facility licensed and regulated by the DOH to notify a family member or next of kin within 24 hours if any resident tests positive for COVID-19, or suffers a COVID-19 related death. A related order, 202.19, sets a penalty for non-compliance at $2,000 per violation per day. On April 23, 2020, Governor Cuomo said the state DOH partnered with the state’s attorney general to investigate nursing homes that violate the executive order.

For more information, contact:

  • Jonah Bruno, Director of Communications, New York State Department of Health, Empire State Plaza, Corning Tower, Albany, New York 12237; Email: dohweb@health.ny.gov; Website: https://www.health.ny.gov/
  • New York Office of the Attorney General, The Capitol, Albany, New York 12224-0341; Website: https://ag.ny.gov/

Nurses are incredibly resilient, but the COVID-19 pandemic has imposed significant challenges to those in the profession. Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC, PsychU’s Nurses Corner Section Advisor, proposes Psychological First Aid as a means to offer emotional and practical support to nurses exposed to severe stress. It is designed to create a sense of safety and comfort, encourage contact and engagement, and connect the individual to helpful social support resources. Moderated by Rachel Self, PhD, Senior Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialize, Inc., this webcast illuminates how the coronavirus crisis may enhance nurses’ compassion, increase their courage, and strengthen their determination to bring every patient back to health.

Featuring:

  • Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC
    Nurses Corner Section Advisor; Psychiatric Consult Liaison Psychiatric Nurse Practitioner at Northwestern Memorial Hospital
  • Rachel Self, PhD
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC, is the Nurses Corner Section Advisor for PsychU. Mr. Amberg is a Psychiatric Consult Liaison Psychiatric Nurse Practitioner at Northwestern Memorial Hospital in Chicago and also does outpatient clinical work at 7 Hills Healthcare Center, also in Chicago. He is also an Emeritus Board Member and Former President of the Illinois Chapter of the American Psychiatric Nurses Association (APNA).

Rachel Self, PhD, is Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

During 2017, the total costs for outpatient prescription opioid expenses for adults were $7.7 billion for 110.4 million prescription fills. Of the $7.7 billion for prescription opioid expenses, Medicare paid 40.9%. Private insurance (including TRICARE) paid 28.6%. Individuals and family members paid 15.5% out-of-pocket. Medicaid paid 10.5%, and other sources paid 4.5%. The other sources include the Department of Veterans Affairs (but not TRICARE); the Indian Health Service; military treatment facilities; state or locally funded community and neighborhood clinics or health departments; workers’ compensation, and liability insurance.

The average annual total per-person expense was $3,693 for all outpatient prescriptions among adults with one or more prescription opioid fills in 2017. The average per-person out-of-pocket expense was $385.

These findings were reported in “Total Expenses, Total Utilization, and Sources of Payment for Outpatient Prescription Opioids in the U.S. Adult Civilian Noninstitutionalized Population, 2017” by Yao Ding, Ph.D.; and G. Edward Miller, Ph.D. The researchers analyzed the Medical Expenditure Panel Survey (MEPS) Household Component to estimate total expenses and prescription fills for all outpatient prescription opioids that are commonly used to treat pain. They ranked the top five opioid by total expenses in 2017. They also estimated annual total and out-of-pocket expense per person for all outpatient prescriptions among adults with at least one outpatient opioid fill and at least one fill of the top five opioid products in 2017.

A link to the full text of “Total Expenses, Total Utilization, and Sources of Payment for Outpatient Prescription Opioids in the U.S. Adult Civilian Noninstitutionalized Population, 2017” may be found at www.openminds.com/market-intelligence/resources/040720mepsopioidscrips.htm.

For more information, contact:

  • Bruce Seeman, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Floor 7, Rockville, Maryland 20857; 301-427-1998; Fax: 202-960-6343; Email: bruce.seeman@ahrq.hhs.gov; Website: https://www.ahrq.gov/.

About 51% of adults in North Carolina are at higher risk for severe illness from coronavirus disease 2019 (COVID-19) because they are age 65 or older and/or have an underlying health condition associated with higher risk. The estimate is based on data from the NC State Center for Health Statistics Behavioral Risk Factors Surveillance System (BRFSS) for 2018.

The underlying health conditions are based on those identified by the Centers for Disease Control and Prevention (CDC) as being associated with higher risk: chronic lung disease, cardiovascular disease, severe obesity, diabetes, kidney disease, liver disease, and immunosuppressive conditions, including cancer treatment, smoking, and other immune disorders. During 2018, the most recent year for which full data are available, about 42% of North Carolina residents had one of the high-risk underlying health conditions.

The prevalence of those with one or more health conditions increased by age. The infection rate by age group fluctuated. COVID-19 deaths were concentrated among the older age groups.

The confirmed COVID-19 case rate for specific underlying conditions and death rates varied by condition. The highest death rate was among those with pre-existing cardiovascular disease; about half died. About one-third of those with diabetes or chronic lung disease died after contracting COVID-19. About one-fifth of those with kidney disease died due to COVID-19.

The North Carolina Department of Health and Human Services reported its findings in “Risk Factors For Severe Illness From COVID-19.” The goal was to identify the share of state residents at higher risk for a serious outcome if they contracted COVID-19. The data sources do not contain every underlying health condition identified by the CDC.

For more information, contact:

  • Mandy Cohen, Secretary, North Carolina Department of Health and Human Services, 101 Blair Drive, Adams Building, 2001 Mail Service Center, Raleigh, North Carolina 27699-2001; 919-855-4840; Email: news@dhhs.nc.gov; Website: https://covid19.ncdhhs.gov/dashboard#by-age.

On April 10, 2020, a new online addiction treatment platform, Tech Together, was launched. The platform is a partnership between Google, Facebook, and Twitter, along with the Center for Safe Internet Pharmacies (CSIP). The platform addresses two key issues—treatment access and recovery support—to help consumers seeking information about addiction treatment or those in recovery find help online during the COVID-19 public health crisis.

The site provides a treatment locator that links to state behavioral health departments to help consumers find information and resources about local treatment options. It also links to the national Behavioral Health Treatment Services Locator, hosted by the Substance Abuse and Mental Health Services Administration.

To help consumers assess their need for addiction treatment, the Tech Together website provides a link to a free federal government online addiction disorder screening and assessment called the “Tobacco, Alcohol, Prescription medication, and other Substance use” (TAPS) tool. The tool consists of a combined screening component followed by a brief assessment for those who screen positive.

To help consumers in recovery access critical recovery support groups online for the duration of social distancing recommended by the Centers for Disease Control during COVID-19, the Tech Together site offers a list of online recovery support groups or virtual meetings. The list was compiled by Google through work with various non-profit addiction treatment provider organizations.

The site hosts videos featuring stories of recovery from drug addiction. The site also describes how the other Tech Together partners are supporting recovery on their platforms, as follows:

  • Facebook allows its members to offer crisis support over Facebook Messenger, host Facebook Live support sessions, and connect through Facebook Groups. In 2019, Facebook partnered with Partnership for Drug-Free Kids and the Center on Addiction, to launch the Stop Opioid Silence (SOS) campaign to reduce stigma associated with opioid use disorders.
  • Twitter provides real-time engagement for its members to share their stories of recovery, and online community building. Twitter offers hashtags for people in recovery, such as #RecoveryMovement, #OpenRecovery, and #RecoveryWorks.

Tech Together was originally launched in November 2018 with the goal of leveraging its partners’ platforms, products, and tools to help address the opioid crisis. The goal is to raise public awareness and education about addiction disorder and recovery and make it easier for people to find help and support.

CSIP is a non-profit organization chartered in 2011. The organization allows Internet industry leaders to address the problem of consumer access to illegitimate pharmaceutical products on the Internet. Its members include representatives from the Internet ecosystem and each point in the online advertising and purchase/delivery cycle, including domain name registries, registrars, shipping companies, payment processors, and advertising service provider organizations. More information is available at https://techtogether.co/.

For more information, contact:

  • Ashley Schlosser, Media Contact, Center for Safe Internet Pharmacies, 466 Cortona Cove, West Lake Hills, Texas 78746; 512-968-0562; Email: aschlosser@safemedsonline.org; Website: https://safemedsonline.org/contact-us/.

On May 12, 2020, the Virginia Attorney General’s office, the American Civil Liberties Union, and a Charlottesville attorney reached a pre-hearing stipulated settlement agreement with the Virginia Department of Corrections (DOC) about DOC’s plans to review the case for early release for eligible inmates during the coronavirus disease 2019 (COVID-19) public health emergency. DOC will ensure that inmates who are not released receive prompt medical treatment, and that facilities take all necessary precautions to prevent the spread of COVID-19.

As of May 16, 2020, the DOC had released 182 prison inmates in order to slow the spread of COVID-19. As of May 18, 2020, DOC reported that 900 offenders and 73 staff members have tested positive for the virus. Five inmates died of COVID-19.

The complaint, Whorley v. Northam, was filed on April 8, 2020, on behalf of 27 incarcerated people. The plaintiffs alleged that overcrowded prisons failed to keep them safe from contracting COVID-19. A DOC spokesperson said that after the plaintiffs reviewed DOC’s plans for addressing the COVID-19 emergency, they found little to pursue. As a result, the complaint will be dismissed.

On March 12, 2020, Virginia Governor Ralph Northam issued a state of emergency with an end date of June 10, 2020. On March 13, 2020, the Governor ordered the DOC to evaluate early release for some inmates. On April 22, 2020, the DOC released its plan for COVID-19 early release. The plan provides for the early release of eligible inmates who have a viable home plan and a low or medium risk of recidivism. Offenders convicted of a Class 1 felony or a sexually violent offense are not eligible for consideration. DOC began early releases after the General Assembly approved the Governor’s budget amendment on April 22.

Under the stipulated agreement in Whorley v. Northam, the DOC agreed to amend or otherwise clarify the release provisions in its existing Early Release Plan as follows:

  • Amend the plan to provide reference to the home plan criteria to specify that any address provided may be verified by a local probation and parole officer, rather than the re-entry counselor normally used. Suspend the requirement that home plans not be verified more than six months before the individual’s anticipated release date. The individual must still have a viable home plan, and must be able to provide an address where the individual will be able to live without violating any conditions of a court order. The individual must be able to adhere to any lease restrictions in terms of the individuals allowed to live in that residence.
  • Give priority consideration for approval of release to those individuals who have a health condition enumerated by the Centers for Disease Control and Prevention as being at higher risk of health complications if that individual were to contract COVID-19.
  • Review eligible individuals prior to the expiration of the declaration of emergency. If the DOC elects not to release an inmate potentially eligible for release under the Early Release Plan, DOC will notify the inmate of the decision.
  • Consider the review and release of eligible individuals on a rolling basis during the period of the emergency declaration.
  • Update the COVID-19 webpage to report, on a daily basis, the number of individuals who have been released. As of May 16, 2020, the DOC had released 182 offenders with a year or less left on their sentences.

For more information, contact:

  • Lisa E. Kinney, Media Contact, Virginia Department of Corrections, Post Office Box 26963, Richmond, Virginia 23261; 804-674-3275; Email: COVID19Inquiries@vadoc.virginia.gov; Website: https://vadoc.virginia.gov/
  • American Civil Liberties Union of Virginia, 701 East Franklin Street, Suite 1412, Richmond, Virginia 23219; 804-644-8022; Fax: 804-649-2733; Email: acluva@acluva.org; Website: https://acluva.org/
  • Interfaith Action For Human Rights, Post Office Box 55802, Washington, District of Columbia 20040; 240-324-9160; Email: Info@interfaithactionhr.org; Website: https://www.interfaithactionhr.org/

New York behavioral health provider organizations are delivering 82% of programs via telehealth during the COVID-19 public health emergency, according to a member survey conducted by the Coalition for Behavioral Health. About 40% of organizations reported an increase in overall demand for behavioral health services from new consumers, and 73% reported increased demand from existing consumers. About 21% of provider organizations reported that the overall current demand for services exceeds current program capacity.

Despite increased demand, individual provider organizations have lost between $45,000 and $2.4 million in revenue since the state of emergency was declared. Based on those who responded, the Coalition estimated total losses to the sector in New York of over $63 million.

Behavioral health provider organizations have had significant increased costs due to purchasing technology for staff and consumers, buying personal protective equipment (PPE), and adding additional cleanings at face-to-face sites. The additional costs averaged $311,000 per organization. The Coalition estimated a total additional cost of over $32.8 million for the survey respondents. About 21% of the organizations have furloughed or laid off staff.

These findings were reported by the Coalition for Behavioral Health. It conducted an online survey from April 15 to April 24 with chief executive officers (CEO) of its member organizations. Responses were completed by one-third of the organizations. Each of the respondents’ programs have a median of three sites open for face-to-face services, including residential and congregate care programs. The programs are also providing long-acting injectable medications and other in-person care.

The Coalition offers policy, advocacy, training, and technical assistance to more than 100 community-based behavioral health provider organizations in New York. The member organizations provide mental health and addiction prevention, treatment, and recovery services for more than 600,000 consumers annually.

For more information, contact:

  • Nadia Chait, Associate Director of Policy & Advocacy, The Coalition for Behavioral Health, 123 William Street, Suite 1901, New York, New York 10038; 212-742-1600; Email: nchait@coalitionny.org; Website: https://www.coalitionny.org/

In this webinar, psychiatrist Roger S. McIntyre discusses with Senior Medical Science Liaison Kimberly Lonergan the psychological impact of COVID-19 on those with and without psychiatric illnesses. Dr. McIntyre speaks of the “triple threat” posed by the pandemic. There is the biomedical threat, which sparks anxiety about the health of oneself as well as about that of loved ones. There is the economic uncertainty it has created for many, with employment lost and possible recession looming. And then there is physical distancing, which can increase feelings of isolation and loneliness. This webinar covers the mental health status of individuals during the pandemic, the impact of social media, and rises in suicide rates, which are sensitive to macroeconomic conditions. Dr. McIntyre closes the webinar by offering helpful resources.

Featuring:

  • Roger S. McIntyre, MD, FRCPC
    Professor, Psychiatry and Pharmacology, University of Toronto; Head, Mood Disorders Psychopharmacology Unit, University Health Network, Toronto; Executive Director, Brain & Cognition Discovery Foundation; and Director and Chair, Scientific Advisory Board, Depression and Bipolar Support Alliance (DBSA), in Chicago.
  • Kimberly Lonergan, RN, MSN
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Dr. Roger McIntyre, MD, FRCPC, is Professor of Psychiatry and Pharmacology at the University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network, Toronto. He is also Executive Director of the Brain and Cognition Discovery Foundation in Toronto; Director and Co-Chair of the Scientific Advisory Board of the Depression and Bipolar Support Alliance (DBSA) from Chicago; Professor and Nanshan Scholar at Guangzhou Medical University; Adjunct Professor at the College of Medicine in Korea University; and Clinical Professor at the State University of New York (SUNY) Upstate Medical University, in Syracuse, New York, as well as at the Department of Psychiatry and Neurosciences at the University of California School of Medicine, in Riverside, California. Dr. McIntyre completed his medical degree at Dalhousie University and received his psychiatry residence training and Fellowship in Psychiatric Pharmacology at the University of Toronto.

Kim Lonergan, RN, MSN, serves as a Senior Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

If you or someone you know is in crisis, please contact the Suicide Prevention Hotline / Lifeline at 1-800-273-TALK (8255), or text the Crisis Text Line at 741-741.

About 87% of Medicare inpatient psychiatric facility (IPF) claims with outlier payments during 2014 and 2015 failed to meet the medical necessity or documentation requirements set by Medicare. During fiscal years (FYs) 2014 and 2015, the number of IPF claims with outlier payments increased by 28%. Total Medicare payments for the IPF claims with outlier payments rose by 19%, from $450 million to $534 million. The Office of the Inspector General (OIG) for the federal Department of Health and Human Services (HHS) estimates that Medicare overpaid IPFs by $93 million for stays that resulted in outlier payments, but were non-covered or partially non-covered because inpatient treatment was not medically necessary for all or part of the stay.

An audit of a random sample of 160 claims found that 142 had missing or inadequate medical record elements. Most were missing physician certifications. Of the 142 medical records, 12 did not clearly support that the IPF had protected the individual’s right to make informed decisions regarding care. Oversight by the Centers for Medicare & Medicaid Services was not adequate to prevent or detect the IPFs’ errors.

These findings were reported in “An Estimated 87 Percent of Inpatient Psychiatric Facility Claims With Outlier Payments Did Not Meet Medicare’s Medical Necessity or Documentation Requirements” by the OIG. The audit covered 36,120 inpatient claims with nearly $1 billion in total Medicare payments. The goal was to determine whether IPFs complied with Medicare coverage, payment, and participation requirements for services provided in FYs 2014 and 2015 that resulted in outlier payments.

A link to the full text of “An Estimated 87 Percent of Inpatient Psychiatric Facility Claims With Outlier Payments Did Not Meet Medicare’s Medical Necessity or Documentation Requirements” may be found at www.openminds.com/market-intelligence/resources/040820oigiptpsychoutliers.htm.

For more information, contact:

  • Don White, Public Affairs Specialist, Office of Inspector General, U.S. Department of Health and Human Services, Federal Building, 90 7thStreet, Suite 3-650, San Francisco, California 94103; 202-528-5254; Email: Donald.white@oig.hhs.gov; Website: https://oig.hhs.gov/

One-third of primary care physicians (PCPs) doubt that medication assisted treatment (MAT) for opioid use disorder (OUD) is more effective than non-medication-based treatment; they also doubt that MAT is safe for long-term maintenance treatment. Two-thirds of PCPs believe MAT is more effective for treatment and that MAT is safe for long-term use. According to a survey of PCPs, about one-fifth (20.2%) are interested in treating consumers with OUD.

Federal efforts to expand treatment with medication have focused on PCPs who can prescribe injectable, extended-release naltrexone and, after obtaining a waiver from the Drug Enforcement Administration, buprenorphine for OUD in the office setting. Methadone for OUD can only be dispensed by specialty Opioid Treatment Programs, and cannot be dispensed by office-based outpatient physicians.

Most PCPs (81.8%) supported increasing insurance coverage of OUD medication. A majority (76.4%) supported increasing government investment in OUD medication. About 47.7% supported allowing physicians to prescribe methadone for OUD in primary care settings. Few (38.0%) supported eliminating the federal requirement that office-based physicians obtain a waiver to prescribe buprenorphine.

The researchers concluded that federal policy changes to increase the caseload limits for physicians with a buprenorphine waiver and to expand the types of health care professionals who can prescribe buprenorphine are “unlikely to lead to widespread availability of primary care-based medication treatment of OUD.” They noted that to increase medication assisted OUD treatment rates, it may be necessary to incorporate addiction medicine into physician training, and delivery system reforms, or embed addiction medicine professionals in primary care practices.

These findings were reported in “Medication for Opioid Use Disorder: A National Survey of Primary Care Physicians” by Emma E. McGinty, Ph.D., MS; Elizabeth M. Stone, MS; Alene Kennedy-Hendricks, Ph.D.; Marcus A. Bachhuber, M.D.; and Colleen L. Barry, Ph.D., MPP. The researchers conducted a national survey in February 2019 with a random sample of 1,000 primary care physicians to examine their beliefs and attitudes about the effectiveness of OUD medication treatment and policies. The survey was completed by 361 PCPs.

The full text of “Medication for Opioid Use Disorder: A National Survey of Primary Care Physicians” was published April 21, 2020 by Annals of Internal Medicine. A copy abstract is available online at https://annals.org/aim/article-abstract/2764855/medication-opioid-use-disorder-national-survey-primary-care-physicians.

For more information, contact:

  • Emma Beth McGinty, Ph.D., Associate Professor, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Hampton House 359, Baltimore, Maryland 21205; 410-614-4018; Email: bmcginty@jhu.edu; Website: https://www.jhsph.edu/faculty/directory/profile/2908/emma-beth-mcginty

According to a recent analysis, few managed long-term services and supports (MLTSS) program contracts assess or reassess the well-being of their members’ family caregivers. Of the 31 programs evaluated, seven (22.6%) specify such an assessment, as well as what an assessment should address (i.e., health, welfare, stress, burnout). These programs include those in Hawaii, New Mexico, Pennsylvania, South Carolina, Tennessee, Wisconsin Family Care, and the Wisconsin Family Care Partnership. The member is defined as the Medicaid beneficiary who is receiving the services through the managed care delivery system.

Additional findings include:

  1. The two elements most commonly found in MLTSS contracts are inclusion of the family caregiver in service planning and care coordination, and services and supports for caregivers.
  2. Contracts for all but one MLTSS program include a reference to family caregivers as part of the care team, upon the member’s consent.
  3. Contracts for all but two MLTSS programs reference coverage of services such as respite care and caregiver training.
  4. Twelve MLTSS programs in 11 states now support a program where a spouse or other family member may be paid to provide care to the member, at the member’s choice.

The researchers conclude that states have made progress in support for family caregivers in MLTSS. However, states still have opportunity to continue improving support for family caregivers in their MLTSS programs. A potential solution for this is to ensure that MLTSS contracts between states and health plans include clearly defined requirements to identify and support family caregivers.

These findings were presented in “Recognition of Family Caregivers in Managed Long-Term Services and Supports,” by AARP Public Policy Institute. Researchers for AARP studied 31 MLTSS programs in 23 states. These include the MLTSS program(s) in Arizona, California, Delaware, Florida, Hawaii, Idaho (2 programs), Illinois (2 programs), Iowa, Kansas, Massachusetts, Michigan (2 programs), Minnesota (2 programs), New Jersey, New Mexico, New York (2 programs), Ohio (2 programs), Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (2 programs), Virginia, and Wisconsin (2 programs). The goal was to examine support for family caregivers in MLTSS.

The full text of “Recognition of Family Caregivers in Managed Long-Term Services and Supports” was published by AARP. A copy is available online at https://www.aarp.org/ppi/info-2020/recognition-of-family-caregivers-in-managed-long-term-services-supports.html.

For more information, contact:

  • Media Office, AARP Public Policy Institute, 601 E Street Northwest, Washington, District of Columbia 20049; Email: media@aarp.org; Website: https://www.aarp.org/

As of mid-April 2020, about 43% of community-based addiction treatment provider organizations in North Carolina lacked sufficient cash on hand to remain in business for the next 30 days due to financial constraints created by the coronavirus disease 2019 (COVID-19) outbreak and public health emergency. According to survey responses provided by 70 community-based addiction treatment provider organizations, in addition to the 43% that reported having no more than 30 days cash on hand to fund operations without receiving reimbursements, 10% reported having 31 to 45 days cash on hand, 13% reported having 46 to 60 days cash on hand, and 16% reported having 61 to 90 days cash on hand. The remaining 18% reported having more than 90 days cash on hand.

Across the state, addiction treatment provider organizations lost revenue as demand for treatment dropped during the public health emergency, while new expenses to acquire personal protective equipment (PPE) and to implement telehealth treatment increased. To respond to the financial stress, about 27% of the organizations have laid off staff or cut positions, and another 40% were considering staff cuts. About 33% were staffing as normal. More than half, 57%, have closed at least one program. About 10% of programs cannot admit new consumers. About 19% of the organizations said they were operating as normal without service disruptions.

These statistics are the result of a survey conducted by Addiction Professionals of North Carolina (APNC). From April 13 to 20, APNC surveyed 70 of its member addiction treatment provider organizations. APNC is a network of more than 650 provider organizations and professionals. The survey was sent to executives at its member organizations statewide. The respondents are representative of provider organizations across all regions of North Carolina in terms of revenue mix and consumer volume.

For more information, contact:

  • Sarah Potter, Executive Director, Addiction Professionals of North Carolina, 3373 National Drive, Suite 225, Raleigh, North Carolina 27612; 919-630-8134; Email: spotter@apnc.org; Website: http://www.apnc.org/.

On April 14, 2020, the U.S. Food and Drug Administration (FDA) issued guidance that temporarily expands availability of digital health devices intended to aid treatment for metal heath disorders. The FDA reduced regulatory barriers on devices it believes pose low risk of harm to users. The goal is to expand the availability of these devices while reducing user and health care professional contact and potential exposure to COVID-19 during the pandemic.

The FDA defines software functions as “devices” when the functions are intended to aid diagnosis, cure, mitigation, prevention, or treatment of a disease or condition. Software intended to maintain or encourage a healthy lifestyle unrelated to diagnosis, cure, mitigation, prevention, or treatment of a disease or condition is not considered a device.

The temporary expansion policies affect two categories of digital devices:

  • Computerized behavioral therapy and other digital health therapeutic devices for psychiatric disorders; and
  • Low-risk general wellness and digital health products for mental health or psychiatric conditions.

The FDA does not intend to enforce its current requirements for the following software functions that may meet the definition of a device related to psychiatric conditions and the COVID-19 pandemic. Based on its current understanding, the FDA believes these software functions pose low risk to consumers:

  1. General wellness software functions to promote, track, and/or encourage choices, which, as part of a healthy lifestyle, have a well-established link between helping a person live well with or reduce the person’s risk of certain chronic psychiatric diseases or conditions. Chronic psychiatric conditions may include (but are not limited to): depression, anxiety, obsessive compulsive disorder, autism, and attention deficit/hyperactive disorder. The software functions could include claims that “daily motivational reminders to perform physical activity may help people with depression live well,” or that “mindfulness and medication activities may help people with chronic anxiety live well.”
  2. Software functions that help people with diagnosed psychiatric conditions maintain their behavioral coping skills by providing a “Skill of the Day” behavioral technique or audio messages that the user can access when experiencing increased anxiety related to the COVID-19 public health emergency.
  3. Software functions that help teach users to “just notice,” accept, and embrace difficult or previously unwanted thoughts and feelings during the COVID-19 public health emergency, so that the users open up to these unpleasant feelings and learn not to overreact to them or avoid situations where they are invoked.
  4. Software functions that display, at opportune times, images or other messages for a person who wants to stop addictive behavior due to increased anxiety during the COVID-19 public health emergency.
  5. Software functions that help users self-manage their disease or conditions without providing specific treatment or treatment suggestions.
  6. Software functions that use a checklist or a questionnaire of common signs and symptoms for a psychiatric disorder (e.g., anxiety due to stay-in-place orders) and to provide a list of possible medical conditions and advice on when to consult a health care professional.
  7. Software functions that guide a user through a questionnaire of signs and symptoms for a psychiatric disorder (e.g., anxiety or stress due to stay-in-place orders) and to provide a recommendation for the type of health care facility most appropriate to their needs.

In general, the FDA does not intend to object to the distribution and use of computerized behavioral therapy devices and other digital health therapeutic devices for psychiatric disorders where such devices do not create an undue risk in light of the public health emergency. The FDA believes such devices will not create such an undue risk when the following four criteria are met:

  • Software verification, validation, and hazard analysis has been performed and demonstrates that the device implements the therapy model as intended.
  • Appropriate cybersecurity protections are in place consistent with FDA pre- and post-market recommendations.
  • The labeling, including user instructions, specifically instruct the user to contact a physician before using the device, even if the device is marketed directly to the consumer.
  • The user is prompted to acknowledge the recommendation to contact a physician before use, such as by providing a standalone check-box that is separate from any end user license agreement.

The FDA emphasized that the guidance does not apply to higher risk digital health devices that include software functions for the treatment of a specific psychiatric condition, for example to support abstinence during addiction treatment. The guidance will not apply to digital health devices intended to replace face-to-face or telehealth treatment sessions or to those devices intended to treat specific psychiatric conditions where the condition may require an urgent or immediate clinical intervention, and delay may pose significant harm.

The relaxed guidance policies do not affect general wellness software functions that are not considered devices. Such functions can be unrelated to a specific disease or condition, related to sleep, related to mental health or psychiatric conditions, or provide reminders, as follows:

  1. Functions unrelated to a specific disease or condition include promoting relaxation, mindfulness, or meditation; and reducing stress, fatigue, or feelings of isolation due to the COVID-19 public health emergency.
  2. Functions related to sleep include promoting good sleep to include improving the sleep experience; having more relaxing or restful sleep; and sleeping through the night or sleeping all night.
  3. Functions related to mental health or psychiatric conditions include providing motivational tips via text and other messages intended to reduce stress related to COVID-19 or promote a positive mental outlook.
  4. Functions that provide reminders could include reminding the user to adhere to recommended physical distances from others during the current public health emergency.

The guidance was released in “Enforcement Policy for Digital Health Devices For Treating Psychiatric Disorders During the COVID-19 Public Health Emergency.” The policy will remain in effect “only for the duration of the public health emergency related to COVID-19.” The guidance does not apply to digital health devices that are intended to be solely or primarily relied upon by the health care professional or consumer to make a clinical diagnosis or treatment decision. In the document, the FDA clarified how two FDA Guidance Documents, “General Wellness: Policy for Low Risk Devices” and “Policy for Device Software Functions and Mobile Medical Applications,” apply to products that may be beneficial to individuals experiencing psychiatric conditions or have mental health concerns during this public health emergency.

Comments on the guidance can be submitted to:

  • Docket number FDA-2020-D-1138, Dockets Management, U.S. Food and Drug Administration, 5630 Fishers Lane, Room 1061, Rockville, Maryland 20852; 888-463-6332; Email: CDRH-COVID19-DigitalHealthForPsychiatricDisorders@fda.hhs.gov; Website: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/enforcement-policy-digital-health-devices-treating-psychiatric-disorders-during-coronavirus-disease.

On April 29, 2020, officials at the Montgomery County, Pennsylvania Correctional Facility (MCCF) reported that 18.7% of the facility inmates (177 of the total 948 tested) tested positive for coronavirus disease 2019 (COVID-19). Before conducting the testing, MCCF had been aware of six cases.

Of the 177 who tested positive, 3.4% were showing COVID-19 symptoms and 96.6% had no symptoms. No updated information as to the current number of the facility inmates affected by COVID-19 is available. However as of May 12, 2020, no new cases of COVID-19 were reported at the MCCF.

About 75.8% of the MCCF inmates are being held in isolation (175 individuals) or quarantine (544 individuals), depending on whether they tested positive, or came into contact with someone who did. If a prisoner or inmate tests positive, MCCF will not release the individual until after treatment and during recovery. However, if that individual is due to be released from maximum time served, that individual would be referred to a physician in the community. All released individuals are asked to follow up with an outside medical professional if they have influenza-like symptoms.

MCCF employees who test positive are directed to remain off work until they are cleared by a medical professional to return to work. Employees awaiting results are directed to self-quarantine in their homes. Employees who test negative may return to work once cleared by a medical professional.

The decision to test personnel was made solely by officials at MCCF; the Pennsylvania Department of Corrections (DOC) does not operate or have any jurisdiction over county jails. According to a spokesperson from the DOC, the DOC tests any inmate whose release is anticipated and only will be released if the test is negative.

Current information regarding COVID-19 in Montgomery County can be found at https://data-montcopa.opendata.arcgis.com/pages/covid-19.

Current information regarding COVID-19 in the Pennsylvania Department of Corrections facilities can be found at https://www.cor.pa.gov/Pages/COVID-19.aspx.

For more information, contact:

  • Teresa Harris, Public Affairs Manager, Montgomery County, Pennsylvania, Post Office Box 311, Norristown, Pennsylvania 19404-0311; 610-278-3000; Email: tharris@montcopa.org; Website: https://www.montcopa.org/
  • Maria A. Finn, Press Secretary, Pennsylvania Department of Corrections, 1920 Technology Parkway, Mechanicsburg, Pennsylvania 17050; 717-728-2573; Email: ra-contactdoc@pa.gov; Website: https://www.cor.pa.gov/

On April 27, 2020, the White House announced a plan to expand testing for coronavirus disease 2019 (COVID-19) that would increase aid to states with the goal of expanding nationwide testing capacity to about 2 million tests per week. The federal goal is to ensure that the states are able to test 2% of their populations monthly, and monitor populations at higher risk of infection and poor outcomes. Testing plans and rapid response programs will be federally supported, state managed, and locally executed.

The plan includes eight steps focused on three core elements: adequate supplies to collect samples, timely monitoring to identify new cases or clusters, and rapid contact tracing. The eight steps are as follows:

  1. Build the foundation for diagnostic testing
  2. Mobilize the private sector to develop tests
  3. Issue U.S. Food and Drug Administration (FDA) Emergency Use Authorizations (EUAs) for tests, which will allow the developers to release the tests without submitting extended validation for FDA approval
  4. Galvanize commercial and research laboratories and professional associations to ramp up testing capacity
  5. Facilitate state efforts to access and utilize all available testing capacity
  6. Identify and expand public and private sector testing infrastructure
  7. Strengthen the testing supply chain
  8. Coordinate with governors to support testing plans and rapid response programs

The administration describes the federal role as facilitating a partnership between federal, state, local, and tribal governments, along with the private sector and professional institutions. The responsibility of each sector was outlined in the “White House Opening Up America Again: Blueprint For Testing Plans & Rapid-Response Programs.” The “Blueprint” is intended to facilitate state development and implementation of robust testing plans and rapid response programs to prevent and contain local COVID-19 outbreaks.

The federal government is responsible for the following:

  1. Publish guidelines for Opening Up America Again and provide a blueprint for the testing plans and rapid response programs.
  2. Provide strategic direction and technical assistance regarding the best use of available testing technologies.
  3. In partnership with states, strategically align laboratory testing supplies and capacity with existing and anticipated laboratory needs.
  4. Provide expedited regulatory authorizations for tests and testing equipment.
  5. Publish and update procedural guidance for administering diagnostic tests (i.e., prioritization algorithms and protocols).
  6. In partnership with the private sector, accelerate research and development of innovative diagnostic tests (e.g., rapid, non-invasive Point-of-Care (POC) tests).
  7. Identify and share best practices and provide technical assistance to state, local, and tribal governments to improve their testing, surveillance, and contact tracing programs.
  8. Act as supplier of last resort.

State, local, and tribal governments are responsible for the following:

  1. Develop testing plans and rapid response programs, as called for by the President’s Guidelines.
  2. Maximize the use of all available testing platforms and venues (e.g., private, public, hospital, clinic-based laboratories).
  3. Identify and overcome barriers to efficient testing (e.g., underutilization of deployed assets, misallocation of supplies, logistical failures).
  4. Develop and implement sentinel monitoring and rapid response programs.

The role of the private sector and professional associations includes the following:

  1. Develop new technologies.
  2. Seek EUA for new technologies, as appropriate.
  3. Accelerate production of tests and materials, such as swabs.
  4. Share data and information from clinical trials with other stakeholders.
  5. Expand testing partnerships with state, local, and tribal governments.

In a press briefing on May 12, 2020, White House Press Secretary Kayleigh McEnany said that about 300,000 diagnostic tests per week are being conducted. She said that by the end of the week the administration estimates that 10 million diagnostic tests will have been conducted since the pandemic began in the United States. About 2.7% of the population has received a COVID-19 diagnostic test.

For more information, contact:

  • The White House, 1600 Pennsylvania Avenue Northwest, Washington, District of Columbia 20500; 202-456-1414; Website: https://www.whitehouse.gov/

As payers move toward population-based payment models, the National Qualify Forum (NQF) and Humana believe that the models should evaluate both social risk and clinical risk to acknowledge the interdependence of social, behavioral, and environmental factors on health outcomes. The payment models should provide incentives for addressing health-related social needs such as food access, environmental safety, and social support. Current risk-adjustment models assume that these factors exist in isolation; they include some factors while excluding others, and fail to capture social context explicitly and intentionally.

These recommendations were issued in “Clinical and Social Risk Adjustment — Reconsidering Distinctions” by William Shrank, M.D., chief medical officer of Humana, and Shantanu Agrawal, M.D., MPhil, president and chief executive officer of National Quality Forum. Their analysis builds on a recent NQF and Humana collaboration, “Food Insecurity and Health: Overcoming Food Insecurity Through Healthcare-Based Interventions” released on March 2, 2020. The guide highlights that social needs such as food insecurity and social isolation can lead to or worsen serious chronic conditions.

They said that accumulating evidence suggests that clinical and social risk factors overlap more than has been previously realized. Age is usually included in clinical risk adjustment method, and of 193 current performance measures endorsed by NQF, 89% had models that used age as a variable. However, the authors wrote that age may affect health outcomes by various biologic and non-biologic mechanisms, which among older people include higher rates of poverty, social isolation, and food insecurity. Current risk adjustment approaches may oversimplify disease processes and burden and an insufficient understanding of how social context affects disease burden.

Additionally, they said that the coronavirus disease 2019 (COVID-19) outbreak has revealed the inter-relatedness of social context and physical health. Humana’s outreach to its COVID-19-positive and highest risk members found high rates of social isolation and considerable barriers to accessing healthy food. Dr. Agrawal said, “Growing evidence indicates that socially disadvantaged people have comparatively worse health outcomes suggesting that clinical and social risk are related. To improve the health outcomes of all people, including the disadvantaged, we must consider this growing body of evidence as part of a comprehensive, 21st century approach to risk adjustment.”

The NQF and Humana collaboration, “Food Insecurity and Health: Overcoming Food Insecurity Through Healthcare-Based Interventions,” focuses on practical implementation recommendations and challenges including addressing routine screening for food insecurity, identifying appropriate clinical actions (medical and non medical), and measuring changes in rates of food insecurity in populations. It details strategies that can be tailored for organizational context, resources, and need, to facilitate and enhance food insecurity interventions and ultimately improve health outcomes.

The full text of “Clinical and Social Risk Adjustment — Reconsidering Distinctions,” was published April 23, 2020 by New England Journal of Medicine. An abstract is available online at https://www.nejm.org/doi/full/10.1056/NEJMp1913993.

The full text of “Food Insecurity and Health: Overcoming Food Insecurity Through Healthcare-Based Interventions” was released on March 2, 2020. A copy is available online at https://store.qualityforum.org/products/food-insecurity-and-health-overcoming-food-insecurity-through-healthcare-based-interventions.

For more information, contact:

  • Information Office, National Quality Forum, 1099 14th Street Northwest, Suite 500, Washington, District of Columbia 20005; 202-783-1300; Fax: 202-783-3434; Email: info@qualityforum.org; Website: http://www.qualityforum.org/

About 4.1% of the population in Los Angeles County, California, had already had coronavirus disease 2019 (COVID-19) as of April 20, 2020, based on the preliminary results of a study that tested 863 adults for antibodies to COVID-19. These results are from the first round of an ongoing study by researchers at the University of Southern California and county public health officials.

As of early April 2020, 7,994 confirmed cases of COVID-19 had been reported to the county, with more than 600 COVID-19-related deaths. However, based on the rate of positive tests within the representative sample of adults included in the antibody testing, from 221,000 to 442,000 adults in the county have had the infection. The estimated infection prevalence was 28 to 55 times higher than the rate of confirmed cases.

The testing took place on April 10 and 11 at six drive-through sites. Participants were recruited via a proprietary database that is representative of the county population. The database is maintained by LRW Group, a market research firm. The researchers used a rapid antibody test for the study. The test’s accuracy was further assessed at a lab at Stanford University using blood samples that were positive and negative for COVID-19. The researchers intend to continue conducting antibody testing over time on a series of representative samples of adults to determine the scope and spread of the pandemic across the county.

As of May 12, 2020, 33,180 confirmed COVID-19 cases have been reported to the county, with 31,670 in the county plus 953 in Long Beach and 557 in Pasadena. These confirmed cases represent 0.3% of the county’s 10.9 million residents. Two-thirds (23,833) of those with confirmed COVID-19 are adults between the ages of 18 and 65. Among the confirmed cases, 1,613 people have died representing a 4.8% death rate in the county, Long Beach, and Pasadena.

The Los Angeles Department of Public Health reported hospitalization rates only for the county. Among the 31,670 confirmed cases in Los Angeles County only, 5,508 (17.4%) were hospitalized. Of those with confirmed COVID-19, 1,503 died, representing 4.7% of all those with a confirmed case, and 27.3% of those who were hospitalized.

The USC and county study results have not yet been peer reviewed. The researchers plan to test new groups of participants every few weeks in coming months to gauge the pandemic’s trajectory in the region.

The Los Angeles County infection statistics are posted online at http://publichealth.lacounty.gov/media/Coronavirus/locations.htm.

For more information, contact:
•Paul Simon, Director of the Division of Assessment, Planning, and Quality, Los Angeles County Department of Public Health, 313 North Figueroa Street, Room 806, Los Angeles, California 90012; 213-240-8144; Email: psimon@ph.lacounty.gov; Website: http://ph.lacounty.gov/
•Communications & Public Affairs, Los Angeles County Department Of Public Health, 313 North Figueroa Street, Room 806, Los Angeles, California 90012; 213-240-8144; Fax: 213-481-1406; Email: media@ph.lacounty.gov; Website: http://publichealth.lacounty.gov/media/

On April 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued regulatory changes to further expand beneficiary access to telehealth services in their homes for the duration of the coronavirus disease 2019 (COVID-19) public health emergency. CMS is waiving limitations on the types of clinical practitioners and provider organizations that can furnish Medicare telehealth services, and is raising reimbursement rates for audio-only telephone services. CMS will reimburse for Medicare telehealth services provided by rural health clinics and federally qualified health clinics.

Prior to this change, only physicians, nurse practitioners, physician assistants, and certain others could deliver telehealth services. CMS will now allow physical therapists, occupational therapists, and speech language pathologists to provide telehealth services.

CMS will also allow hospitals to bill as the originating site for providing telehealth services to beneficiaries registered as hospital outpatients but who are staying at home. The beneficiary’s home can serve as a temporary “department of the hospital” where the beneficiary can receive counseling and educational service as well as therapy services via telehealth technology.

Reimbursement for audio-only telehealth services is increased to match the outpatient office rate, from a range of about $14 to $41 to about $46 to $110. The payments are retroactive to March 1, 2020.

In addition to raising reimbursement rates for audio-only telephone services, CMS also expanded the list of eligible audio-only telephone services to include many behavioral health and consumer education services. CMS is waiving the video requirement for certain telephone evaluation and management services, and adding them to the list of Medicare telehealth services because some Medicare beneficiaries may lack access to interactive audio-visual technology required for telehealth services. CMS also recognizes that some beneficiaries would choose not to use audio-visual telehealth services offered by their health care professionals.

For more information, contact:

  • Office of Communications, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 202-690-6145; Fax: 202-260-1462; Website: https://www.cms.gov/

At the end of March 2020, administrators from 323 hospitals and health systems responding to a federal survey about their challenges addressing the coronavirus 2019 (COVID-19) pandemic said limited testing supplies to confirm COVID-19 and delayed results led to difficulties in staffing and in discharging to post-acute care. Of the 323 hospitals and health systems that responded to the survey, 117 were treating one or more people with confirmed COVID-19, and 130 were treating one or more people with suspected COVID-19. Of the remaining 76 hospitals, 32 said they were not treating anyone with COVID-19, and 44 did not report this information. The administrators reported shortages of testing, staffing, supplies, personal protective equipment (PPE), and durable equipment.

Impact Of Testing Supply Shortages

The hospitals reported severe shortages of testing supplies. They lacked complete kits and/or the individual components and supplies needed to complete tests, such as nasal swabs, viral transfer media, and reagents used to detect the virus. As a result, the hospitals were not able to effectively test staff, people seeking care, and others in the community concerned about possible exposure.

The shortage of diagnostic testing contributed to substantial difficulties in maintaining or expanding facility capacity to care for people with suspected or diagnosed COVID-19. The hospitals reported that test results often took seven days or longer to receive. Those that relied on external laboratories reported delays due to infrequent specimen pickups, mailing delays, and labs’ restrictive business hours. Some hospitals experienced inconsistent turnaround times and were unable to predict when results would arrive, and so could not advise staff (or the community) on how long they should self-quarantine while waiting for results.

In addition to interfering with timely discharges, hospitals reported that the lack of timely test results affected staffing because staff presumed to be COVID-19 positive could resume work only after receiving the negative test results.

Impact Of Difficulties Discharging To Post-Acute Care

Many hospitals reported that post-acute facilities were requiring negative COVID-19 tests before accepting individuals discharged from hospitals. As a result, people who no longer required acute care were required to remain hospitalized while waiting for their test results.

Due to the longer stays, and the need to prepare for possible surges, the hospitals reported concerns about potential shortages of intensive care unit beds, negative pressure rooms, and isolation units. They said the limitations to bed availability created challenges in sufficiently separating COVID-19 and non-COVID-19 cases within their facilities.

Impact Of PPE Shortages

The PPE shortages (masks, including N95 masks and surgical masks; face shields; gowns; and gloves) and lack of a robust PPE supply chain contributed to the following problems:

  • Use of PPE was heavier than normal due to the slow turnaround for COVID-19 testing confirmation. People waiting for test results remained in the hospital longer, and staff were obligated to use PPE to avoid contaminating others.
  • Difficulties restocking the PPE needed to protect staff, and availability of PPE from federal and state sources was uncertain. At the time of the survey, some hospital administrators said they had not received supplies from the Strategic National Stockpile, or that the supplies they did receive were not sufficient in quantity or quality.
  • Supply chain for medical equipment was disrupted due to increased demand for PPE from health care provider organizations and others.
  • Costs for PPE increased sharply. One administrator reported that the price for masks that previously cost 50 cents rose to $6.

These statistics were reported in “Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020” by the Office of the Inspector General (OIG) for the federal Department of Health and Human Services (HHS). The survey is intended to be a national snapshot of hospital challenges and needs for responding to the COVID-19 pandemic. The OIG conducted brief telephone interviews with a random sample of administrators from 323 hospitals across 46 states, the District of Columbia, and Puerto Rico. The contact rate was 85%. The hospitals included 10 Special Pathogen Centers, 100 critical access hospitals, 24 major teaching hospitals, and a range of hospitals nationwide of various sizes and characteristics. Most were treating people with confirmed or suspected COVID-19. The interview had three questions:

  • What are your most difficult challenges in responding to COVID-19?
  • What strategies is your hospital using to address or mitigate these challenges?
  • How could government best support hospitals responding to COVID-19?

At the time the survey was conducted, the federal government, states, local, and tribal entities had taken action to help hospitals respond to COVID-19. The Coronavirus Aid, Relief, and Economic Security (CARES) Act signed on March 27, 2020, provided the basis for additional actions.

For more information, contact:

  • Don White, Public Affairs Specialist, Office of Inspector General, U.S. Department of Health and Human Services, Federal Building, 90 7thStreet, Suite 3-650, San Francisco, California 94103; 202-528-5254; Email: Donald.white@oig.hhs.gov; Website: https://oig.hhs.gov/

Between February and March 2020, median hospital operating margins fell from 4% to -8%, about 11 percentage points, in one month. Median operating margins in March were more than 170% below budget, about 15 percentage points. Median operating margins on earnings before interest, taxes, depreciation, and amortization fell 107% below budget expectations in March.

Both revenue and volume declined. Revenue was 13% below budget expectations in March 2020 compared to the previous year. Inpatient revenue was 13% below budget expectations, and outpatient revenue was 17% below budget. At the same time, expenses remained generally the same because hospitals maintained front-line caregivers and incurred added expense to maintain and expand inventories of drugs, supplies, equipment, and capacity in preparation for a surge.

Volume changes between February and March 2020 were reflected in the following data points:

  • The median hospital occupancy rate dropped from 62% to 53%.
  • The median intensive care unit occupancy rate dropped from 68% to 62%.
  • Overall discharges fell by 4% and were 13% below budget expectations.
  • Adjusted consumer days dropped by 10% and were 15% below budget expectations.
  • Operating room minutes dropped by 17% and were 26% below budget.

Year-over-year discharges dropped by 11%, and adjusted discharges fell by 13%. Emergency department visits dropped by 15% year-over-year Bad debt and charity care rose 13% year-over-year. Hospitals with 500 or more beds had a 19% year-over-year increase. At small hospitals with 25 or fewer beds, bad debt and charity care represented 15% of budget. Both bad debt and charity care are likely to continue to rise due to Coronavirus Disease (COVID) 2019-related unemployment and loss of job-based health insurance; consumers will enroll in Medicaid or be uninsured.

These findings were reported in “National Hospital Flash Report for March 2020” by Kauffman Hall. The report is based on March 2020 data reported by about 800 hospitals. Kauffman Hall issues Flash Reports monthly.

The full text of “National Hospital Flash Report” was published in April 2020. A copy is available online at https://flashreports.kaufmanhall.com/national-hospital-report-april-2020.

For more information, contact: 

  • Jim Blake, Managing Director, Kaufman, Hall & Associates, LLC, 5202 Old Orchard Road, Suite N700, Skokie, Illinois 60077; 847-441-8780; Email: flashreports@kaufmanhall.com; Website: https://www.kaufmanhall.com/

About 8.9% of Medicare beneficiaries residing in long-term care facilities during 2011 to 2013 paid for all medications out-of-pocket (OOP). Long-term care Medicare enrollees without drug coverage or with private insurance received significantly fewer prescriptions than if they had been enrolled in Medicare Part D. During 2012, beneficiaries without any drug coverage received 43.6 fewer prescriptions than those with Part D, non-low income subsidy (LIS) coverage. Beneficiaries with only temporary drug payment assistance, for example, through the Medicare hospice benefit, received 43.9 fewer prescriptions, on average. The average number of prescriptions filled among Medicare enrollees was the same whether in Veterans Administration (VA) or in Part D non-LIS.

During 2012, the majority, or 82%, of Medicare long-term care residents were covered by Medicare Part D as the main source of drug coverage, with or without a full or partial LIS. The majority of residents, 67.0% were covered by Medicare Part D and receiving full LIS. About 0.4% were covered by Medicare Part D and received partial LIS, and about 15.0% were covered by Medicare Part D, but not receiving LIS. About 8.5% were enrolled in private insurance, and 0.2% had coverage through the VA. No drug coverage was detected for 8.9%; they paid for all prescriptions OOP (0.9%) or they received only temporary drug payment assistance (8.0%), such as through the Medicare hospice benefit.

The researchers found large differences in medication use that could not be explained by differences in health status. They concluded that Medicare beneficiaries in long-term care settings who lacked reliable drug coverage received less medication than those who had reliable drug coverage. The difference remained after controlling for underlying medical conditions. The researchers said this persistent difference suggested potential underuse of medications and potential economic barriers.

These findings were reported in “Adequacy of Prescription Drug Coverage in Long-term Care” by Becky Briesacher, Ph.D.; Brianne Oliveri-Mui MPH; Bhavika Chhabra, PharmD; and Benjamin Koethe, MPH. The researchers analyzed a nationwide sample of 332,087 Medicare enrollees who spent more than 100 days in a long-term care facility from 2011 to 2013. The sample was from a nationwide long-term care database of prescription-level, resident-level, and facility-level data. The goal was to assess enrollment in prescription drug coverage, OOP payments, and medication use. Inadequate drug coverage was defined as paying OOP for more than half of medication costs. The researchers identified predictors of inadequate drug coverage and total prescription fills.

The full text of “Adequacy of Prescription Drug Coverage in Long-term Care” was published in the May 2020 issue of Medical Care. An abstract is available online at https://journals.lww.com/lww-medicalcare/Abstract/2020/05000/Adequacy_of_Prescription_Drug_Coverage_in.3.aspx.

For more information, contact:

  • Becky Briesacher, Ph.D., Associate Professor, School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, R212 TF, Boston, Massachusetts 02115; Email: b.briesacher@northeastern.edu; Website: https://web.northeastern.edu/chphr/faculty-associates/becky-briesacher/.

About 10% of adult Medicaid beneficiaries ages 18 to 64 with mental health and/or addiction disorders made telehealth visits for behavioral health services in 2017. Telehealth visits were more prevalent among beneficiaries with mental health disorders than those with addiction disorder. About 11.7% of beneficiaries in rural areas and 10.8% of those in non-rural areas made one or more telehealth visits for mental health treatment. About 2.7% of beneficiaries in rural areas and 1.5% in non-rural areas made one or more telehealth visits for addiction treatment.

Between 2012 and 2017, the prevalence of Medicaid telehealth visits for behavioral health disorder treatment increased among rural and non-rural beneficiaries. For both rural and non-rural beneficiaries, the prevalence of telehealth for mental health treatment was higher than for addiction treatment.

Among beneficiaries in rural areas, the prevalence of telehealth visits for mental health treatment rose by 5.9 percentage points, from 5.8% of rural beneficiaries in 2012 to 11.7% in 2017. The prevalence of telehealth visits for addiction treatment rose 1.8 percentage points, from 0.9% in 2012 to 2.7% in 2017.

Among beneficiaries in non-rural areas, the prevalence of telehealth visits for mental health treatment rose by 3.8 percentage points, from 7.0% in 2012 to 10.8%. The prevalence of telehealth visits for addiction treatment rose 0.1 percentage points, from 1.4% in 2012 to 1.5% in 2017.

The mean number of telemedicine visits per person increased over time for rural beneficiaries, from 1.9 visits per person in 2012 to 2.9 visits in 2017. For non-rural beneficiaries, the mean number of telemedicine visits per person decreased from 3.5 visits in 2012 to 2.3 visits in 2017. Telemedicine was associated with receipt of more in-person outpatient services by rural beneficiaries (11.2 more visits for mental disorders and 8.2 more for substance use disorders).

These findings were reported in “Rural-Nonrural Differences in Telemedicine Use for Mental and Substance Use Disorders Among Medicaid Beneficiaries” by Timothy B. Creedon, Ph.D., Kristin E. Schrader, MA, Peggy L. O’Brien, Ph.D., Janice R. Lin, BS, Christopher D. Carroll, MSc, and Norah Mulvaney-Day, Ph.D. The researchers analyzed claims data from the IBM MarketScan Multi-State Medicaid Database between 2012 and 2017 for 1.6 million adult beneficiaries ages 18 to 64 years with mental health and/or addiction disorder diagnoses. The sample was limited to a geographically diverse subset of states that contributed data to MarketScan and had any telemedicine claims during the study period. Within the group of 1.6 million unique beneficiaries, 428,697 lived in rural areas, and 1,174,369 lived in non-rural areas. The goal was to investigate recent rural-non-rural trends in the prevalence and amount of mental and addiction disorder telemedicine received by adult Medicaid beneficiaries. The unit of analysis is a beneficiary year. The 1.6 million unique beneficiaries contributed 2,986,100 beneficiary-years of data over the five-year period of analysis.

The full text of “Rural-Nonrural Differences in Telemedicine Use for Mental and Substance Use Disorders Among Medicaid Beneficiaries” was published April 15, 2020 by Psychiatric Services. An abstract is available online at https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201900444.

For more information, contact: 

  • Timothy B. Creedon, Ph.D., Research Scientist, Health Equity Research Lab, 1035 Cambridge Street, #26, Cambridge, Massachusetts 02141; 508-207-3013; Email: tbcreedon@challiance.org; Website: https://www.healthequityresearch.org/

About 35% of primary care professionals believe that a majority of independent primary care practices will have closed by the time the first wave of the coronavirus disease 2019 (COVID-19) pandemic ends, according to a survey conducted in early May 2020 by the Primary Care Collaborative (PCC). About 70% of clinical professionals said their practices have had a significant decrease in consumer volume, which is threatening the practices’ financial viability. However, slight financial improvements emerged: in early May, about 49% reported that over half of visits were reimbursable, compared to 34% the previous week. About 60% believe that policies changed to support primary care during COVID-19 will be reversed once the pandemic lessens.

Just three weeks earlier in a related survey, about 20% of primary care practices predicted that they would close by mid-May. The predictions reflect fears of market consolidation due to financial repercussions of the COVID-19 public health emergency.

Additional findings included the following:

  • Primary care professionals anticipate a rise in behavioral health problems among consumers, and 74% expect to see an increase in the number of consumers with mental health needs. About 30% anticipate that substance abuse will increase. About 24% anticipate that domestic violence will rise.
  • COVID-19 will result in serious delays in care for other illnesses, and 38% anticipate that diverted or avoided care will lead to a rise in non-COVID-19 deaths. About 60% believe consumers will experience avoidable illness due to diverted or avoided care.
  • The majority of primary care practices (54%) lack personal protective equipment (PPE) and COVID-19 testing capabilities.
  • A minority of visits take place via virtual health technologies, and 84% of clinical professionals reported that they have consumers who lack a computer or internet access.
  • About 28% of practices are conducting the majority of visits by video; 28% conduct the majority of visits by telephone; and 14% conduct the majority of visits as e-visits. About 29% of practices report no use of video visits, and 9% report no use of e-visits.

Since mid-March 2020, The Larry A. Green Center has been conducting a weekly Quick COVID-19 Primary Care Survey in partnership with PCC. The goal is to measure the impact of COVID-19 on primary care practices. The week eight survey results reflect responses from 773 primary care physicians, nurse practitioners, and physician assistants working in all states except North Dakota. The majority, 70%, are in family medicine, 11% are in internal medicine, 7% are in pediatrics, 6% are in geriatric, and 7% are in other specialties. About 25% work in rural practices, 18% at a community health center, and 9% at a convenience care setting. For about 58% of the responding primary care professionals, more than 10% of consumers are Medicaid beneficiaries.

The full text of the Primary Care Collaborative’s “Quick COVID-19 Primary Care Survey, Week Eight Executive Summary” was published May 8, 2020. A copy is available online at https://www.pcpcc.org/2020/05/06/primary-care-covid-19-week-8-survey.

The week five survey results were released April 16. They are posted online at https://www.pcpcc.org/sites/default/files/news_files/C19%20Series%205%20National%20Executive%20Summary.pdf.

For more information, contact:

  • Stephen Padre, Senior Communications Manager, Primary Care Collaborative, 601 13thStreet Northwest, #430n, Washington, District of Columbia 20005; Email: spadre@tpcpcc.org; Website: https://www.pcpcc.org/.

Editor’s note: The PCC domain is changing soon to www.thepcc.org, but as of May 11, 2020, the new domain was not live. 

On April 21, 2020, the Centers for Medicare & Medicaid Services (CMS) approved a Washington State Medicaid 1115 waiver that will allow the state to pay higher rates to home- and community-based services (HCBS) provider organizations to maintain capacity during the coronavirus disease 2019 (COVID-19) public health emergency. Most of the approved provisions affect long-term services and supports (LTSS). In particular, they extend HCBS flexibilities available under 1915 (c) to beneficiaries receiving LTSS through a state plan amendment.

Additional provisions will allow the Washington State Health Care Authority (HCA) to establish a COVID-19 Disaster Relief Fund. Under these provisions, HCA will be able to use Medicaid funds to stabilize provider organizations as they implement new and expanded care delivery sites while managing economic disruptions. The fund will help provider organizations access needed equipment, broaden access to COVID-19 testing and care, and respond to higher demand.

CMS approved the following additional provisions:

  • HCA can receive federal reimbursement for providing LTSS to beneficiaries, even if they are not timely, updated in the plan of care, or delivered in otherwise-allowable settings.
  • To reduce administrative burden on HCA and beneficiaries, individuals will be permitted to self-attest, or HCA could use an alternative verification of individuals’ income and assets, disability, and level-of-care to qualify for LTSS.
  • Delay initial assessments or annual reassessments for up to one year.
  • HCA can make retainer payments for many habilitation and personal care services provider organizations to maintain capacity during the emergency.
  • HCA can make retainer payments to those organizations that include personal care as a component.

The state had previously been approved for a 1135 Medicaid waiver on March 19, 2020. HCA submitted the 1115 waiver on March 24, 2020, two days after CMS announced the availability of such waivers.

The HCA waiver affects the independent “individual providers” who deliver personal care services but are not employed through a home care provider organization. It also affects an array of residential provider organizations, such as adult family homes, assisted living facilities, home care agencies, adult day health and adult day care programs. HCA also uses the term “provider” to refer to the clinic or hospital billing for the services delivered by an “individual provider.”

Retainer payments were available to be claimed as of May 4, 2020 for residential and adult day providers, along with the rate enhancements. They can claim retainer payments for up to 30 days at 70% of the individual consumer’s rate.

In Washington, payment and rates for residential facilities and individual providers are collectively bargained and ratified by the legislature. Any changes must be approved by SEIU 775 and the residential facility councils. As of May 11, 2020, an agreement had been reached regarding retainer payments for all residential facilities, but rate changes for “individual providers” and home care provider organizations were still pending due to Washington’s parity requirements

CMS was still evaluating HCA’s request for Medicaid expenditure authority to use the Disaster Relief Fund to cover costs associated with treatment for uninsured individuals with COVID-19, housing, nutrition supports, and other COVID related expenditures for states and individuals as well as retainer payments for more than 30 days for provider organizations. Several other requests are also under review. CMS denied HCA’s request to establish a temporary eligibility group for those with incomes 138% to 200% of the federal poverty level.

PsychU last reported on emergency waivers in “34 States Approved For Medicaid 1135 Waivers During COVID-19 Public Health Emergency,” which published on May 11, 2020. The article is available at https://www.psychu.org/34-states-approved-for-medicaid-1135-waivers-during-covid-19-public-health-emergency/ .

For more information, contact:

  • Amy Blondin, Chief Communications Officer, Washington State Health Care Authority, Post Office Box 45502, Olympia, Washington 98504-5502; 360-725-1915; Email: amy.blondin@hca.wa.gov; Website: http://www.hca.wa.gov/.

Editor’s note: this article was updated on May 12 to include clarifications from HCA about the retainer payments and rate enhancements. 

During the coronavirus disease 2019 (COVID-19) national public health emergency, behavioral health provider organizations can accept donations of mobile devices and data plans to facilitate telehealth treatment, according to the Office of the Inspector General (OIG) for the federal Department of Health and Human Services (HHS). Such an arrangement during the public health emergency would not violate federal anti-kickback regulations on providing inducements to beneficiaries. The OIG posted its opinion on April 23, 2020.

The OIG maintains an online document with its feedback on a variety of questions submitted by provider organizations seeking guidance on arrangements to facilitate provision of services during the COVID-19 public health emergency. The feedback explains the application of OIG’s administrative enforcement authorities as applied to arrangements in existence solely during the time period subject to the public health emergency. This feedback is different than an OIG advisory opinion, which is a legally binding decision between the OIG and the requesting organizations.

One or more behavioral health provider organizations asked if they could accept donations of mobile devices, data plans, or both to facilitate telehealth treatment during the COVID-19 disruption for consumers who are financially needy and who do not own their own cell phone. The OIG’s response made the following points:

  • Normally the provision of valuable technology and services to federal health care program beneficiaries for free or at a reduced cost likely implicates the federal anti-kickback statute and beneficiary inducements civil money penalty (CMP).
  • In the context of the COVID-19 outbreak and in light of flexibilities in coverage for various telehealth and other virtual services payable by federal health care programs, the provision of a mobile device, service or data plan, or both by a behavioral health provider organization to a consumer likely presents a sufficiently low risk of fraud and abuse if safeguards are implemented.
  • The safeguards include a good-faith determination that an established consumer is in financial need before the telecommunications technologies are provided and that the consumer needs the technologies to access medically necessary services related to behavioral health treatment. The services must be medically necessary to reduce the risk of overutilization or inappropriate utilization. The third-party funding must be used only for telecommunication technologies.
  • The provider organization must not market the telecommunication technologies or offer/provide free phones to generate business.
  • The devices must be returned and the data plans canceled at the end of the COVID-19 Declaration.

The OIG noted that under certain circumstances, such as the Federal Communications Commission (FCC) distributing grants to certain provider organizations to fund telecommunications technologies, the remuneration from the donor to the provider organization would not trigger federal fraud and abuse laws. However, under other circumstances, arrangements between the donor and the provider organization, or indirect financial relationships between the donor and the consumer, could present risk under the federal fraud and abuse laws. The OIG advised provider organizations to separately assess any fraud and abuse risks that may arise with respect to any direct or indirect financial relationships between the donor and the provider organization, or consumer.

The clarifications were posted at https://oig.hhs.gov/coronavirus/authorities-faq.asp.

For more information, contact:

  • Don White, Public Affairs Specialist, Office of Inspector General, U.S. Department of Health and Human Services, Federal Building, 90 7thStreet, Suite 3-650, San Francisco, California 94103; 202-528-5254; Email: Donald.white@oig.hhs.gov; Website: https://oig.hhs.gov/

In this webcast, Kent Alford discusses an initiative in which a nurse-led primary care clinic located in an underserved urban locale in the Midwest folded in behavioral health care. The initiative highlights the roles nurses can play in improving mental health care delivery by providing culturally sensitive, integrated services. Mr. Alford provides his expert insight into the nurses’ efforts, including their use of the Omaha System taxonomy to document the effects of the integration effort. One result: A 900% increase in psychosocial issues identified among individuals seen at the clinic, comparing calendar year 2018 with calendar year 2016.

Kent Alford is a nurse who serves as Systems Director for Behavioral Health for the University of Maryland Capital Regional Health Systems. Additionally, Mr. Alford serves as Chair of the Behavioral Health Consortium for the State of Maryland and is a member of the Maryland Hospital Association’s Behavioral Health Task Force. He holds the position of Adjunct Professor at Catholic University.

Christina DuVernay, PhD, is a Senior Associate for OPEN MINDS.

Speakers are paid consultants of Otsuka Pharmaceutical Development & Commercialization, Inc.

The New Jersey Medicaid program, NJFamilyCare, is creating Regional Health Hubs (RHHs) to replace its Accountable Care Organization (ACO) Demonstration Project. The four existing ACOs—the Healthy Greater Newark ACO; the Trenton Health Team; the Camden Coalition of Health Care Providers; and the Health Coalition of Passaic County—are designated as RHHs. The state’s fiscal year 2020 budget formally recognized them, and continued a $1.5 million appropriation.

The RHHs differ from the ACOs in that the RHHs will not directly coordinate care for consumers. The ACO Demonstration Project was authorized by a law passed in 2011 that directed the ACOs to coordinate care for Medicaid fee-for-service (FFS) beneficiaries in return for shared savings. Due to implementation delays, the demonstrations finally started in 2016. However, by that time, nearly all New Jersey Medicaid populations were enrolled in managed care, and the managed care organizations (MCOs) were not required to contract with the ACOs. As a result, the ACOs had few MCO contracts, and the FFS population was small. During the demonstration period, the four ACOs evolved into regional collaboratives that integrated, coordinated, and aligned disconnected programs aimed at making communities healthier.

Each RHH serves as a local expert and conduit for state health priorities. They will convene multi-sector partners in their regions to take action on the state’s most urgent health needs, and operate or use a regional health information exchange (HIE) to ensure that health and other data are accessible and useful. The RHHs will provide health care data infrastructure and analysis, support care management, and convene community stakeholders in close coordination with the Department of Human Services (DHS) Office of Medicaid Innovation.

The legislation, New Jersey Senate Bill 4282, to create the regional health hubs and expand to new regions was signed into law on January 21, 2020, and went into effect immediately. Key provisions are as follows:

  • DHS is allowed to expand the RHH model and within six months establish new RHHs in other communities statewide.
  • The RHHs will form health care partnerships to explore innovative structures and practices to integrate, coordinate, and align disconnected programs in order to make communities healthier.
  • Between 10% to 25% of funds appropriated by DHS to each RHH will be based on the hub’s attainment of predetermined goals and performance metrics. The goals and performance metrics will be specified in an annual agreement negotiated between DHS and the RHH entity.

DHS will make NJ FamilyCare claims data available for residents residing in the RHH to facilitate the RHH population health tasks. It may enter into appropriate data sharing agreements for exchange of the data. DHS will share all claims data with the RHH for beneficiaries residing in the hub geographic boundaries. The data catchment area shall include the RHH core region and may overlap with the data catchment areas for other RHHs. Each RHH will maintain a data sharing use and reciprocal support agreement, and any applicable use case agreement, with any statewide health information platform designated by DHS in order to promote interoperability.

A link to the full text of “New Jersey Senate Bill 4282” may be found at www.openminds.com/market-intelligence/resources/120919njbill4282.htm.

For more information, contact:

  • Tom Hester, Director, Office of Communications, New Jersey Department of Human Services, Post Office Box 700, Trenton, New Jersey 08625-0726; 609-292-3717; Email: Tom.Hester@dhs.state.nj.us; Website: http://www.state.nj.us/humanservices/

For centuries, the nursing profession’s overarching mission has been to make patients feel safe, heard, comfortable, and holistically cared for. But in the modern health care system, many nurses aren’t afforded time to fully commit to this mission and are instead limited to tasks driven by cost-management business policies. What’s more, nurses are sometimes siloed in their tasks and unable to work in collaborative team environments that would further benefit patients.

In a two-part position paper, Carole Orchard and colleagues make a two-fold proposal. One, they advocate for a redefinition of roles for nurse leaders; and two, they argue that a systemic shift is needed to allow for interprofessional patient- and family-centered collaborative practice. This article summarizes the key points they make in their two pieces, titled “Collaborative Leadership, Part 1: The Nurse Leader’s Role Within Interprofessional Teams” and “Collaborative Leadership, Part 2: The Role of the Nurse Leader in Interprofessional Team-Based Practice—Shifting from Task- to Collaborative Patient-/Family-Focused Care,” which together make a plea for nurses to return to their roles as person-centered care givers and collaborative leaders.

Background

To maximize their contributions both as managers and as advocates for the nursing profession, say Orchard et al., nurse leaders should be afforded the time to receive leadership training, train other nurses, work with teams of other health professionals to meet patient care goals, and advocate for health care reform.  At the same time, they would also be performing the tasks necessary for quality, comprehensive care of patients. Nurse leaders have received costly educations, which included training on ethics and theory, and they should be able to utilize all the skills in practice that they have studied.

Rising care costs also affect the care nurses can give to their patients in countries with public health care. An ever-growing population of aging and chronic-care patients has had a significant influence on these rising costs, and that has led to the creation of policies to streamline care plans for efficiency. However, these patients’ needs often do not fit perfectly into these predetermined, disease-specific care plans, and they would be better served with more personalized plans developed by their team of health professionals. In reality, since different health professionals involved in these sometimes inadequate care plans are often siloed, they don’t get the opportunity to work with each other to create better plans, and the patient can end up in a cycle of readmissions due to complications that are overlooked or unanticipated by the care plan.

Nurse leaders not only have the skills and expertise to create more tailored care plans for patients with complex conditions, but they possess the knowledge to educate patients and their families/support systems about preventative support measures they can take to minimize complications. If nurse leaders can collaborate with other involved health professionals (physicians, nurses, specialists, etc.) to create and implement these personalized plans, a patient will be better cared for and less likely to need frequent readmissions/visits. This, in turn, will save on costs more effectively than continually treating complications. This proposed model, and solution to better care at lower costs, is called interprofessional patient-centered care practice (IPPCCP).

Evidence and Discussion

The authors of these position papers gathered evidence supporting their argument that nurse leaders have a dual managerial and disciplinary role that would be supported best by interprofessional collaborative teams. They defined IPPCCP as “a partnership between a team of health providers and a patient where the person retains control over his/her care and is provided access to the knowledge and skills of team members to arrive at a realistic team shared plan of care and access to the resources to achieve the plan.” This kind of teamwork tears down silos and gives patients a voice in decision-making.

For health professionals, reports of reduced turnover, increased employee satisfaction, and higher feelings of empowerment result when IPPCCP is implemented. For patients, there have been reports of decreased medical errors, infections, negative events, and length of stays with IPPCCP (Camicia et al. 2013), all of which lead to cost savings. Furthermore, the authors cited evidence found by the World Health Organization that “stresses the importance of integrative collaborative patient-centred care to deal with the increasing population experiencing chronic diseases.”

However, the current state of health care is not necessarily set up to support interprofessional collaboration. The leadership system is hierarchical and siloed, and decisions are not made in a collaborative fashion. Also, nurses are only afforded enough time with their patients to perform necessary tasks, and not the time to collaborate with patients and other health professionals, create comprehensive plans, or educate patients and their families on preventative care. The authors found that many nurses haven’t even been trained on how to effectively collaborate with patients.

In a poll cited by Orchard et al., respondents reported the following measures as impacting the quality of care they received:

  1. Timely access to care.
  2. Respect and caring in delivery of care.
  3. Decisions made in partnership between patients and providers with a basic belief that care should be based on patients’ needs vs. their ability to pay (Montague et al. 2017).

Patients want to have a voice in the decisions being made about their care plans, but they are often not given the chance to offer input or request modifications.

Conclusion

The evidence gathered by the authors support their argument that nurse leaders should be given the opportunity to work in interprofessional, collaborative teams that include other health professionals as well as the patients and their families/communities. This practice requires a dual role in which nurse leaders embody managerial and disciplinary responsibilities. These changes will also require nurses to speak out and persuade policymakers and health care institutions that moving away from health care as a business model and back to a model that is quality-based and person-centered has the potential to not only improve patient care, but to reduce overall spending.

As of April 6, 2020, skilled nursing facilities (SNFs) and assisted living centers caring for people with COVID-19 have experienced an estimated 1,064% increase in costs for required personal protective equipment (PPE). PPE includes gloves, masks, gowns, face shields, hand sanitizer, and soap. Before the COVID-19 national public health emergency was declared on March 13, 2020, SNF and assisted living center PPE included gloves and soap. After the public health emergency went into effect, PPE guidelines were expanded to include the full range of items.

This estimate was developed by the Society for Healthcare Organization Procurement Professionals (SHOPP), an independent non-profit organization. The analysis is based on PPE needs for a 100-bed facility multiplied by 30 days for a total of 3,000 census days per month. The PPE items evaluated were:

  • Gloves: vinyl, latex, and nitryl
  • Masks: 3-ply masks, KN95 masks, N95 masks, and 3M N95 masks
  • Hand sanitizer
  • Isolation gowns
  • Face shields
  • Soap

Prior to the COVID-19 public health emergency, the per resident per day cost for pre-COVID-19 PPE requirements (vinyl gloves and soap) totaled $0.35 per day. For all items required under current COVID-19 guidelines, the total cost per day was $2.36. The cost for COVID-19-required PPE raised SNF and assisted living center costs by 674%.

Since the emergency was declared, pricing for COVID-19-required PPE has been affected by shortages and price volatility. Typical per resident per day costs using gloves and N95 masks totaled $25.10, representing an increase of 1,064% over the pre-COVID-19 cost of $2.36 per day. In the scenario that vinyl gloves would be unavailable, and nitryl gloves would be used as well as N95 masks, per resident per day costs rose to $25.58, representing a 1,084% increase in costs over the pre-COVID-19 cost of $2.36 per day.

During the national COVID-19 public health emergency, nursing homes have been required to adhere to guidelines on admitting people with confirmed and suspected COVID-19. The facilities are required to use appropriate infection control practices, including the use of PPE. The requirements often do not consider availability of staff or their qualifications, or the availability of PPE and its cost.

SHOPP is an independent, non-profit entity created to improve quality and efficiency in post-acute care. The organization represents over 100 procurement professionals representing over 1,500 post-acute care facilities.

For more information, contact:

  • Josh Silverberg, Co-Founder, Society for Healthcare Organization Procurement Professionals, 135 Chestnut Ridge Road, #100, Montvale, New Jersey 07645; 877-267-4677; Email: jsilverberg@shopp.org; Website: https://shopp.org/.

Between January 2013 and December 2016, the Iowa Medicaid program may have failed to adequately document about half of claims paid to health home provider organizations. Iowa’s health home provider organizations did not document core services, integrated health home outreach services, diagnoses, and enrollment with provider organizations. In addition, the health home provider organizations did not maintain documentation to support higher payments for intense integrated health home services and did not ensure that beneficiaries had full Medicaid benefits.

A review conducted by the Office of the Inspector General (OIG) for the federal Department of Health and Human Services (HHS) considered documentation of 130 health home payments selected at random. For each payment, the OIG reviewed the documentation submitted by the health home provider organization and the beneficiaries’ medical records. For 62 of the 130 payments, documentation was inadequate to support the claim. The OIG concluded that Iowa improperly claimed federal Medicaid reimbursement.

During this period, the state paid 795,000 health home claims totaling $107 million, with $92 million as the federal share and the remainder covered by state funds. Based on the improper payment rate in the sample, the OIG recommended that Iowa return $37.1 million. The state disagreed with most of the findings, but did say it was improving its monitoring of the health home program and that it was revising the state Medicaid plan.

These findings were reported in “Iowa Inadequately Monitored Its Medicaid Health Home Providers, Resulting In Tens Of Millions In Improperly Claimed Reimbursement” by the OIG for HHS. The goal was to determine whether Iowa’s claims for Medicaid reimbursement for payments made to health home providers complied with federal and state requirements.

During 2016, Iowa’s health home reimbursements accounted for 3% of the entire federal total nationwide, although Iowa’s population represents only 1% of the national population. For federal fiscal year 2016, nationwide, states claimed federal reimbursement of Medicaid health home services totaling $750 million, with the federal share at $431 million.

For more information, contact:

  • Don White, Public Affairs Specialist, Office of Inspector General, U.S. Department of Health and Human Services, Federal Building, 90 7th Street, Suite 3-650, San Francisco, California 94103; 202-528-5254; Email: white@oig.hhs.gov; Website: https://oig.hhs.gov/
  • Matt Highland, Public Information Officer, Iowa Department of Human Services, 1305 E Walnut Street, Hoover Building, 1st Floor, Des Moines, Iowa 50319-0114; 515-281-4848; Email: mhighla@dhs.state.ia.us; Website: https://dhs.iowa.gov/ime/providers/integrated-health-home.

In this presentation Dr. Timothy Aungst, Associate Professor of Pharmacy at the Massachusetts College of Pharmacy and Health Sciences, discusses the importance of medication optimization and digital technology. Dr. Aungst shares his insights into the cycle of digital medicine and digital endpoints and how these technologies have been used in treating various conditions, including schizophrenia and depression.

Timothy Aungst, PharmD, is an Associate Professor of Pharmacy Practice at the Massachusetts College of Pharmacy and Health Sciences, in Worcester, Massachusetts. During his post-graduate training, he began writing for multiple companies about mHealth and digital health solutions, with a focus on mobile applications. Since then, Dr. Aungst has conducted research on digital health technologies for pharmacy and published multiple peer-reviewed journal articles on the topic.

Fatima Sadat, PharmD, is a Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

Timothy Aungst is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc.

Fatima Sadat is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

Nurses are the cornerstone of health care delivery and as such are poised to take a lead role in forwarding the integration of behavioral care into primary care. This is the position taken by the International Society of Psychiatric–Mental Health Nurses (ISPN) and promoted in a recent paper in the Archives of Psychiatric Nursing. In “Quality Improvement and Models of Behavioral Healthcare Integration: Position Paper #2 from the International Society of Psychiatric–Mental Health Nurses” (2019), Lynn P. Shell of the Rutgers University School of Nursing and colleagues focus on nurses’ role in improving and integrating behavioral health care.

Integrating care is a means to improve it, Shell and colleagues write, and indeed a focus on quality is the throughline in their piece. Deficits in care quality in the United States were famously called out in Crossing the Quality Chasm (2001), from the Institute of Medicine. In response, there have been multiple initiatives launched to improve care, which Shell et al. review. One of these was the National Quality Strategy (NQS), which outlined six priorities for defining good care and advancing the Triple Aim, which famously consists of an improved experience of care, better population health, and reduced health care costs.

This table lists the six NQS priorities:

Patient safety Making care safer by reducing harm caused in the delivery of care.
Patient and family engagement Ensuring that each person and family are engaged as partners in their care.
Coordination of care Promoting effective communication and coordination of care.
Dissemination of best practices Promoting the most effective prevention and treatment practices for the leading causes of mortality.
Population health Working with communities to promote wide use of best practices to enable healthy living.
Efficient use of health care resources Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new healthcare delivery models.

The authors cite the NQS priorities in the service of their argument that nurses’ focus on quality drives improvement in pursuit of the Quadruple Aim. (As discussed, the Triple Aim was conceived a goal for health care delivery. But as provider burnout became a national issue, the Triple Aim was broadened into the Quadruple Aim, with the fourth aim being an improved provider experience.)

Why Integration

Co-occurring behavioral health and substance use disorders are common in primary care settings, particularly among those with chronic medical conditions, highlighting the need for integrated and coordinated care, write Shell and colleagues. They cite a report from the Centers for Medicare and Medicaid Services (CMS) that found that coordinated care, compared with traditional care, lowered costs in a lower-income, high-risk population with medical comorbidity. Coordinated care that includes integrated behavioral health care also has been shown to improve quality and lower costs. A study examining the economic and health benefits of a depression program integrated into diabetes treatment in primary care clinics found better outcomes and cost savings. Compared with usual care, patients in the intervention group averaged 61 additional days without depressive symptoms and had costs averaging $314 less.

The University of Washington IMPACT Study found similar results: With 1801 adults with depressive symptoms in its sample, it found that coordinated, integrated care lowered costs, decreased symptoms of depression and physical pain, and improved patient functioning.

Three Models of Integration

The authors describe several models of integration:

The Four-Quadrant Model. According to the authors, this model assumes competency-based mental health and substance abuse service integration within a primary care setting. Each quadrant considers risk and complexity along with population needs:

Quadrant I      Low to moderate behavioral health and low to moderate physical health complexity/risk

Quadrant II      Moderate to high behavioral health and low to moderate physical health complexity/risk

Quadrant III      Low to moderate behavioral health and moderate to high physical health complexity/risk

Quadrant IV      Moderate to high behavioral health and moderate to high physical health complexity/risk

Factors driving its success include consumer preference, workforce competency, organizational support, and fiscal resources.

Horizontal vs. Vertical Integration Care Models. The authors describe the horizontal model of integration as circular, with equal distribution of responsibility and power shared among providers. Examples of a horizontal integration model include the formation of multi-hospital systems, mergers, and strategic alliances with neighboring hospitals to form local networks.

Vertical models, by contrast, move patients through sequential levels of care; from community-based to acute care, and primary to specialty care. In this model, the physician directs the course of care. Shell et al. write that vertical programs feature intervention, monitoring, and evaluation.

Levels of Integrated Care. Some models feature multiple levels of integrated behavioral care with three notable features: It’s collocated, coordinated, and integrated. In some examples of this, a patient’s behavioral health needs and physical health needs are treated separately. Collaboration happens by referral. Sharing the same location facilitates communication among care providers.

Conclusion

Nursing leaders have proven their leadership in developing each part of the Quadruple Aim, and they continue to contribute to national policy. The authors close their paper by stating the ISPN’s position is that “all nurses be educated on the Quadruple Aim, behavioral health integration, and the importance of both on improving patient care and care outcomes.”

On April 24, 2020, President Trump signed the $484 billion Paycheck Protection Program and Health Care Enhancement Act, (House Resolution 266) to allocate additional funding for programs created by the Coronavirus Aid, Relief, and Economic Security (CARES) Act to provide emergency assistance and health care response for businesses affected by the 2020 coronavirus pandemic. HR 266 provides the following:

  • Approximately $370 billion to the Small Business Administration (SBA) to provide additional funding for the Paycheck Protection Program (PPP) and for emergency small business loans.
  • Approximately $100 billion to the Department of Health and Human Services (HHS) in fiscal year (FY) 2020 supplemental appropriations to HHS for the Public Health and Social Services Emergency Fund.

The SBA provisions are as follows:

  • $310 billion to refill the CARES Act PPP. The PPP can guarantee certain loans made to small businesses during the COVID-19 pandemic. The SBA must guarantee that $30 billion of paycheck protection loans are made by small financial institutions and credit unions. Eligibility for the loans is limited to businesses (including non-profit organizations) with 500 or fewer employees. All hospitals are eligible if less than half their funding, excluding Medicaid payments, is from state or local governments.
  • $60 billion for Economic Injury Disaster Loan (EIDL) loans ($50 billion) and emergency EIDL grants ($10 billion). It expands eligibility for such disaster loans and advances to include agricultural enterprises.

With more funding for the programs, on April 27, 2020, the SBA resumed accepting PPP applications from participating lenders. With the additional funding provided by the new COVID-19 relief package, SBA will resume processing EIDL Loan and Advance applications that are already in the queue on a first come, first-served basis. New applications should be filed through an existing SBA lender as soon as possible. The first round of funding was exhausted within 10 days, and this new round of funding is also expected to be quickly exhausted. There is no guarantee of additional funding through future legislation.

The HHS provisions are as follows:

  • $75 billion to reimburse hospitals and health care provider organizations for health care related expenses or lost revenues that are attributable to the coronavirus outbreak. Within this allocation, $825 million is set aside for community health centers and rural clinics.
  • $25 billion for expenses to research, develop, validate, manufacture, purchase, administer, and expand capacity for COVID-19 tests to effectively monitor and suppress COVID-19. Specified portions of this funding are allocated to states, localities, territories, and tribes; the Centers for Diseases Control and Prevention; the National Institutes of Health; the Biomedical Advanced Research and Development Authority; the Food and Drug Administration; community health centers; rural health clinics; and testing for the uninsured. Additionally, HHS must submit data on COVID-19 cases and a strategic testing plan to Congress.

A link to the full text of “House Resolution 266: Paycheck Protection Program and Health Care Enhancement Act” may be found at www.openminds.com/market-intelligence/resources/042420hr266enr.htm.

As of April 27, 2020, Congress had passed four bills that became law to address aspects of the 2020 coronavirus pandemic. The most recent is H.R. 266 – Paycheck Protection Program and Health Care Enhancement Act, which became law on April 24, 2020. It provides funding of $484 billion. The three earlier bills are as follows:

  • R. 748 – Coronavirus Aid, Relief, and Economic Security Act “CARES Act” became law on March 27, 2020. It provides funding of $2 trillion. The CARES Act provides emergency assistance and health care response for individuals, families, and businesses affected by the 2020 coronavirus pandemic. Key provisions created the Paycheck Protection Program and a Provider Relief Fund. Both are intended to address economic harm due to the COVID-19 public health emergency. A key provision will reimburse provider organizations for COVID-19 diagnosis and treatment provided to uninsured consumers. PsychU reported on the bill on May 4, 2020, in “HHS Begins Releasing $100 Billion CARES Act Funding To Provider Organizations For Relief Assistance & Treating The Uninsured” at https://www.psychu.org/hhs-begins-releasing-100-billion-cares-act-funding-to-provider-organizations-for-relief-assistance-treating-the-uninsured/.
  • R. 6201 – Families First Coronavirus Response Act became law on March 18, 2020. It provides funding of more than $3.4 billion. The bill provides for COVID-19-related paid sick leave, paid family leave tax credits, and free COVID-19 testing during the national public health emergency. It expands unemployment benefits and provides supplemental funding for a variety of food assistance programs. PsychU reported on the bill on March 31, 2020 in “Families First Coronavirus Response Act Signed With $3.47 Billion In Funding & New Mandates” at https://www.psychu.org/families-first-coronavirus-response-act-signed-with-3-47-billion-in-funding-new-mandates/?corner_id=53327.
  • R.6074– Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 became law on March 6, 2020. It provides funding of $8.3 billion. It provided $7.76 billion to federal, state, and local agencies to combat the virus and authorized an additional $500 million to pay for the waivers of Medicare telehealth restrictions. Of the funding to state and local entities, about $2.2 billion is earmarked for activities to prevent virus spread, and another $3 billion is earmarked for vaccine research. PsychU reported on the bill on March 16, 2020, in “New Federal Coronavirus Bill Waives Medicare Telehealth Restrictions” at https://www.psychu.org/new-federal-coronavirus-bill-waives-medicare-telehealth-restrictions/.

For more information, contact:

  • Press Office, Office of Communications and Public Liaison, Small Business Administration, 409 3rd Street, Southwest, Washington District of Columbia 20416; 202-205-7036; Press_Office@sba.gov; Website: https://www.sba.gov/page/coronavirus-covid-19-small-business-guidance-loan-resources and https://www.sba.gov/funding-programs/loans/coronavirus-relief-options/paycheck-protection-program and https://www.sba.gov/funding-programs/loans/coronavirus-relief-options
  • U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, District of Columbia 20201; 202-690-6343; Email: media@hhs.gov; Website: https://www.hhs.gov/provider-relief/index.html.

As of April 23, 2020, about 75% of correctional facilities in the United States report that their staff had adequate personal protective equipment (PPE) for COVID-19, up from 60% on March 30, 2020. Based on self-reports from correctional facilities participating in a survey, about 13% of inmates tested for COVID-19 have tested positive, as have 15% of correctional officers and 12% of health staff. Self-reports come from a convenience sample of a small proportion of U.S. correctional facilities and may not representative of all U.S. correctional facilities.

For this study, of 818 inmates tested, 108 have tested positive; 128 test results are pending. Among correctional officers, 795 have been tested and 122 have tested positive; 93 test results are pending. Among health staff, 156 have been tested and 19 have tested positive; 15 test results are pending.

About 96% of the facilities participating in the study screen new inmates for COVID-19. Current inmate population screening has increased from 46% to 53% between March 25 and April 23. Staff screening has increased from 79% to 90%.

The ongoing study is being conducted by the National Commission on Correctional Health Care in partnership with Marcella Alsan, M.D., Ph.D., and Crystal Yang, JD, Ph.D. of Harvard University. The goal is to gather information on how the COVID-19 pandemic is affecting correctional facilities. The number of participating facilities varies week to week, with the April 23 survey having approximately 185 respondents. The researchers are releasing testing data weekly. Only jails, prisons, and juvenile facilities in the United States are eligible to participate.

The full text of “Study of COVID-19 in Correctional Facilities” is being completed by the National Commission on Correctional Health Care. Copies of the weekly updates are available online at https://www.ncchc.org/study-of-covid-19-in-correctional-facilities.

For more information, contact:

  • National Commission on Correctional Health Care, 1145 West Diversey Parkway, Chicago, Illinois 60614; 773-880-1460; Fax: 773-880-2424; Email: info@ncchc.org; Website: https://www.ncchc.org/.

On March 17, 2020, the federal Department of Health and Human Services (HHS) Office of Civil Rights (OCR) announced that during the COVID-19 public health emergency, penalties would not be imposed on provider organizations that offer telehealth services using popular video chat applications that may not fully comply with the privacy requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The enforcement discretion will last for the COVID-19 public health emergency. It will extend to telehealth services provided for any reason regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19. A covered health care provider organization can use any non-public facing remote communication product that is available to communicate with consumers.

OCR said health care provider organizations that seek additional privacy protections should provide the services through HIPAA-compliant technology vendors that are willing to enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products. OCR listed the following vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA, including:

  • Skype for Business / Microsoft Teams
  • Updox
  • VSee
  • Zoom for Healthcare
  • me
  • Google G Suite Hangouts Meet
  • Cisco Webex Meetings / Webex Teams
  • Amazon Chime
  • GoToMeeting
  • Spruce Health Care Messenger

Covered health care provider organizations that fail to secure a BAA with video communication vendors will not be subject to a penalty for that or any other noncompliance with the HIPAA Rules that relate to the good faith provision of telehealth services during the COVID-19 nationwide public health emergency. Provider organizations are encouraged to notify consumers that these third-party applications potentially introduce privacy risks, and provider organizations should enable all available encryption and privacy modes when using such applications.

OCR warned that it considers Facebook Live, Twitch, TikTok, and similar video communication applications to be public facing. They should not be used in the provision of telehealth by covered health care provider organizations.

For more information, contact:

  • Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, District of Columbia 20201; 800-368-1019; E-mail: OCRMail@hhs.gov; Web site: www.hhs.gov/ocr/privacy

On February 21, 2020, the federal Department of Health and Human Services (HHS) Office of the National Coordinator for Information Health Technology (ONC) issued its final strategies to reduce the regulatory and administrative burden of using health information technology (IT) and electronic health records (EHRs). The strategies address clinical documentation; ease of using health IT tools and systems; federal health IT and EHR reporting requirements; and public health reporting, including coordination with prescription drug reporting programs and electronic prescribing of controlled substances. The goals are to improve EHR usability and reduce the effort and time required for clinical professionals, hospitals, and health care organizations to record information in EHRs; reduce the effort and time required to meet regulatory reporting requirements for clinicians, hospitals, and health care organizations; and improve the functionality and intuitiveness (ease of use) of EHRs.

To meet the goal, HHS developed four key strategies, each with multiple components and sub-components. The four strategies are: reduce regulatory burden around clinical documentation requirements for consumer visits, improve health IT usability, improve federal health IT and EHR reporting requirements, and improve public health reporting.

Clinical Documentation Strategies

To improve ease of clinical documentation, the strategy has three components: reducing regulatory burden around documentation requirements for consumer visits; partnering with clinical stakeholders; and leveraging health IT to standardize data and processes around ordering services and related prior authorization processes.

To reduce regulatory burden, the recommendations are as follows:

  1. HHS should continue to reduce overall regulatory burden for documenting encounters
  2. Leverage data already present in the EHR to reduce re-documentation in the clinical note
  3. Obtain ongoing stakeholder input about how to effectively implement documentation policy changes using health IT
  4. Waive documentation requirements as may be necessary for purposes of testing or administering alternative payment methodologies (APMs)

To partner with stakeholders, the recommendations are as follows:

  1. Continue to partner with clinical stakeholders to encourage adoption of best practices related to documentation requirements
  2. Advance best practices for reducing documentation burden through learning curricula included in CMS Technical Assistance and models

To leverage health IT to standardize data and processes around ordering services and related prior authorization processes, the recommendations are as follows:

  1. Evaluate other process and clinical workflow factors that contribute to burden associated with prior authorization
  2. Support automation of ordering and prior authorization processes for medical services and equipment through adoption of standardized templates, data elements, and real-time standards based electronic transactions
  3. Incentivize adoption and/or use of technology that can generate and exchange standardized data supporting documentation needs for ordering and prior authorization
  4. Work with clinical professionals, suppliers, payers, and other intermediary entities to support pilots for standardized electronic ordering of services/items
  5. Coordinate efforts to advance new standards approaches supporting prior authorization

Health IT Usability Strategies

To improve health IT usability, the strategy has four components. The components and sub-strategies address better aligning EHRs with clinical workflows; promoting health IT user interfaces that improve satisfaction, promoting alignment of the clinical content in health IT, and promoting the importance of implementation decisions.

To better align EHRs with clinical workflow; improve decision making and documentation tools, the strategies are as follows:

  1. Better align EHR system design with real-world clinical workflow
  2. Improve clinical decision support usability
  3. Improve clinical documentation functionality
  4. Improve presentation of clinical data within EHRs

To promote user interface optimization in health IT that will improve the efficiency, experience, and end user satisfaction, the strategies are as follows:

  1. Harmonize user actions for basic clinical operations across EHRs
  2. Promote and improve user interface design frameworks specific to health care delivery
  3. Improve internal consistency within health IT products
  4. Promote proper integration of the physical environment with EHR use

To promote harmonization surrounding clinical content contained in health IT to reduce burden, the strategies are as follows:

  1. Standardize medication information within health IT
  2. Standardize order entry content within health IT
  3. Promote best practice and user interface design frameworks for results display within health IT

To improve health IT usability by promoting the importance of implementation decisions for efficiency, satisfaction, and lowered burden for clinical professionals, the strategies are as follows:

  1. Better align EHR system design with real-world clinical workflow
  2. Improve clinical decision support usability
  3. Improve clinical documentation functionality
  4. Improve presentation of clinical data within EHRs

Electronic Health Record Reporting Strategies

To improve federal health IT and EHR reporting requirements, the strategy has three components. The components and sub-strategies focus on easing the burdens caused by program requirements, improving the functionality of health IT, and improving the value of electronic clinical quality measures.

To address program reporting and participation burdens, simplify program requirements, and incentivize new approaches that are both easier and provide better value to clinical professionals, the strategies are as follows:

  1. Simplify the scoring model for the Promoting Interoperability performance category and Medicare Promoting Interoperability Program
  2. Incentivize innovative uses of health IT and interoperability that reduce reporting burdens and provide greater value to physicians
  3. Reduce burden of health IT measurement by continuing to improve current health IT measures and developing new health IT measures that focus on interoperability, relevance of measure to clinical practice and consumer improvement, and electronic data collection that aligns with clinical workflow
  4. To the extent permitted by law, continue to provide states with federal Medicaid funding for health IT systems and promote interoperability among Medicaid health care provider organizations and professionals
  5. Revise program feedback reports to better support the needs of clinical professionals and to improve care

To leverage health IT functionality to reduce administrative and financial burdens associated with quality and EHR reporting programs, the strategies are as follows:

  1. Recognize industry-approved best practices for data mapping to improve data accuracy and reduce administrative and financial burdens associated with health IT reporting
  2. Adopt additional data standards that make access to data, extraction of data from health IT systems, integration of data across multiple health IT systems, and analysis of data easier and less costly for physicians and hospitals
  3. Implement a secure standards-based API approach to HHS electronic administrative systems to promote integration with existing health IT products

To improve the value and usability of electronic clinical quality measures while decreasing health care provider organization burden, the strategies are as follows:

  1. Consider the feasibility of adopting a first-year test reporting approach for the newly developed electronic clinical quality measures
  2. Continue to evaluate the current landscape and future directions of electronic quality measurement and provide a roadmap toward increased electronic reporting through the eCQM Strategy Project
  3. Explore alternate, less burdensome approaches to electronic quality measurement through pilot programs and reporting program incentives

Public Health Reporting Strategies

To improve public health reporting (including coordination with prescription drug reporting programs and electronic prescribing of controlled substances), the strategy has three components. The components and sub-strategies focus on increasing health care professional prescription drug monitoring program (PDMP) queries, increased adoption of electronic prescribing of controlled substances (EPCS), developing a process to address inconsistent data collection, and expanding privacy requirements in Health Insurance Portability and Accountability Act (HIPAA) rules.

To increase health care professional prescription drug monitoring program (PDMP) queries for the retrieval of medication history from a state PDMP, the strategies are as follows:

  1. Federal agencies, in partnership with states, should improve interoperability between health IT and PDMPs through the adoption of common industry standards consistent with ONC and CMS policies and applicable laws including HIPAA rules.
  2. Promote standards-based API emerging technologies to support improved access to and use of opioid prescription histories for opioid use disorder (OUD) prevention and treatment
  3. HHS should increase adoption of EPCS with consideration for preferences specific to health care professionals/provider organization, workflow, and use of available standards.

To develop a process to address the issue of inconsistent data collection by federal, state, and local programs, the strategies are as follows:

  1. HHS should convene key stakeholders, including state and local public health departments and community health centers, to inventory reporting requirements from federally funded public health programs.
  2. HHS should continue to work to harmonize reporting requirements across federally funded programs.

To better facilitate electronic exchange of health information for consumer care by addressing concerns about HIPAA privacy requirements as well as federal confidentiality requirements for addiction disorders, the strategies are as follows:

  1. HHS should continue to work to harmonize reporting requirements across federally funded programs.
  2. HHS should expand upon existing guidance about HIPAA privacy requirements and federal confidentiality requirements governing substance use disorder health information in order to better facilitate electronic exchange of health information for patient care.

The recommendations were presented in “Strategy On Reducing Regulatory And Administrative Burden Relating To The Use Of Health IT & EHRs.” HHS had initially released its proposals in November 2018. The final report reflects input from the more than 200 comments submitted in response to the draft strategy and recommendations.

For more information, contact:

Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, 330 C Street Southwest, Floor 7, Washington, District of Columbia 20201; 202-690-7151; Fax: 202-690-6079; Email: onc.request@hhs.gov; Website: https://www.healthit.gov/.

The COVID-19 pandemic has exerted significant effects on mental health. The prescription of anti-anxiety and antidepressant medications has increased, as have calls to the National Suicide Prevention hotline. In this webinar, Dr. Gaurava Agarwal and Dr. Christine Moutier discuss with Otsuka Senior Medical Liaison Rachel Self the dynamics of mental health and the potential impacts of a pandemic or other extreme stressor, explore a stress continuum model and sources of stress, and highlight strategies for health care professionals to establish and maintain wellness, build resilience, and engage in healthy self-care. Suicide risk and prevention are covered, as are the “Seven C’s” for Stress First Aid.

Featuring:

  • Gaurava Agarwal, MD, is Assistant Professor in the Department of Psychiatry and the Behavioral Sciences, Assistant Professor in the Department of Medical Education, and the Director of Physician Well-Being for Northwestern Medical Group
    Christine Moutier, MD,
    Chief Medical Officer at the American Foundation for Suicide Prevention and a psychiatrist
  • Rachel Self, PhD
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Gaurava Agarwal, MD, is Assistant Professor in the Department of Psychiatry and the Behavioral Sciences, Assistant Professor in the Department of Medical Education, and the Director of Physician Well-Being for Northwestern Medical Group.

Christine Moutier, MD, Chief Medical Officer at the American Foundation for Suicide Prevention and a psychiatrist.

The Food and Drug Administration (FDA) has played a critical role in protecting the United States during the COVID-19 pandemic and has provided numerous guidance documents to support rapid response efforts. One recent guidance document, “Enforcement Policy for Digital Health Devices For Treating Psychiatric Disorders During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency,” may help to expand the availability of digital health therapeutic devices for psychiatric disorders during the pandemic. Join Otsuka Medical Science Liaison Mark Tacelosky as he discusses the guidance document and how it may ultimately improve mental health during the current crisis.

Speaker is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

National Quality Forum recently endorsed four behavioral health quality measures. The measures address maximum hours of physical restraint use or seclusion, and separately address timeliness of follow-up after an emergency department visit for an alcohol or other drug abuse or dependence, and timeliness of follow-up after an emergency department visit for mental illness or intentional self-harm. The latter two measures had previously been a single measure.

The endorsed measures are:

  • 0640 HBIPS-2 Hours of Physical Restraint Use:This process measure for facilities was recommended for continued endorsement. It refers to the total number of hours that all individuals admitted to a hospital-based inpatient psychiatric setting were maintained in physical restraints. The data comes from electronic and paper medical records. The measure is reported as the number of times that physical restraints are used for more than two hours divided by the number of psychiatric inpatient days.
  • 0641 HBIPS-3 Hours of Seclusion Use: This process measure for facilities was recommended for continued endorsement. It refers to the total number of hours that all individuals admitted to a hospital-based inpatient psychiatric setting who are held in seclusion. The data comes from electronic and paper medical records. The measure is reported as the number of events divided by the number of psychiatric inpatient days.
  • 3488 Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence:This process measure for health plans was recommended for continued endorsement. It is a maintenance measure because it was previously part of an endorsed measure that combined mental health and addiction disorder emergency department follow-up visits. Data for this measure comes from claims for members ages 13 and older who have an emergency department visit with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence and who have a follow-up outpatient visit for AOD. Two rates are reported: the percentage of emergency department visits for which the member receives a follow-up visit within seven days and the percentage of follow-up visits within 30 days of the emergency department visit.
  • 3489 Follow-Up After Emergency Department Visit for Mental Illness:This process measure for health plans was recommended for continued endorsement. It is a maintenance measure because it was previously part of an endorsed measure that combined mental health and addiction disorder emergency department follow-up visits. Data for this measure comes from claims for members ages 13 and older who have an emergency department visit with a principal diagnosis of mental illness or intentional self-harm who have a follow-up visit for mental illness. Two rates are reported: the percentage of emergency department visits for which the member receives a follow-up visit within seven days and the percentage of follow-up visits within 30 days of the emergency department visit.

The recommendations were issued in “Behavioral Health and Substance Use, Spring 2019 Review Cycle: CDP Report” by National Quality Forum (NQF). During the spring 2019 project cycle, the Behavioral Health and Substance Use Standing Committee evaluated six measures. The following two measures were not endorsed during this cycle: NQF  0560 HBIPS-5 Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification; and NQF 1922 HBIPS-1 Admission Screening for Violence Risk, Substance Use, Psychological Trauma History and Patient Strengths Complete. Each Behavioral Health and Substance Use project cycle aims to endorse measures of accountability for improving the delivery of behavioral health care in the United States.

NQF is a consensus-based healthcare organization created in 1999 that works with all members of the healthcare community to drive measurable health improvements. Its mission includes promoting and ensuring consumer protections and healthcare quality through evidence-based measurement and public reporting. NQF-endorsed measures are used by the federal government (Medicare and Medicaid), states, and private-sector organizations to evaluate performance and to share information with consumers. To endorse measures, NQF committees evaluate the evidence-base for measures submitted by measure developers. NQF reconsiders endorsed measures and considers new measures during project cycles. Previously endorsed measures relevant to the project are reconsidered to assess their ongoing importance, validity, reliability, feasibility, and utility.

The full text of “Behavioral Health and Substance Use, Spring 2019 Review Cycle: CDP Report” was published in February 2020 by National Quality Forum. A copy is available online at http://www.qualityforum.org/Publications/2020/02/Behavioral_Health_and_Substance_Use_Final_Technical_Report_-_Spring_2019_Cycle.aspx.

For more information, contact:

  • Information Office, National Quality Forum, 1099 14thStreet Northwest, Suite 500, Washington, District of Columbia 20005; 202-783-1300; Fax: 202-783-3434; Email: info@qualityforum.org; Website: http://www.qualityforum.org/.

Nurses are uniquely qualified to educate and inform others, provide support, and take specific action to reduce stigmatizing practices and attitudes. In this webinar, Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC, and Hannah Phillips-Hall, MSN, PMHNP-BC, discuss the importance of the nurse in educating on stigma associated with mental health conditions and raising awareness about behavioral health.

Featuring:

  • Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC
    Psychiatric Consult Liaison Psychiatric Nurse Practitioner, Northwestern Memorial Hospital – Chicago, IL
  • Hannah Phillips-Hall, MSN, PMHNP-BC
    PNHNP, Big Bear Behavioral Health – Orlando, FL
  • Roland Larkin, PhD, NP
    Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC, is a Co-Section Advisor for the PsychU Nurses Corner, Psychiatric Consult Liaison Psychiatric Nurse Practitioner at Northwestern Memorial Hospital, in Chicago, Illinois, as well as a Psychiatric Nurse Practitioner at 7 Hills Healthcare Center, in East Dundee, Illinois. Mr. Amberg also serves as a clinical preceptor at Rush University in Chicago, Illinois, University of Illinois, and Vanderbilt University, in Nashville, Tennessee.

Hannah Phillips-Hall, MSN, PMHNP-BC, currently serves as a Psychiatric–Mental Health Nurse Practitioner at both Big Bear Behavioral Health and Grace Medical Home both located in Orlando, Florida. In addition, Ms. Phillips-Hall is a clinical preceptor at the University of South Alabama College of Nursing in Mobile, Alabama. She also serves as Co-Chair of the Central Florida Chapter of the American Psychiatric Nurses Association (APNA).

Roland Larkin, PhD, NP, is a Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

 

Disclaimers

Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC and Hannah Phillips-Hall, MSN, PMHNP-BC are paid consultants of Otsuka Pharmaceutical Development & Commercialization, Inc.

Dr. Gaurava Agarwal discusses the effect of social distancing, including loneliness, which he breaks down into three categories. He also shares his thoughts on creating a No-Corona Zone so as to preserve a sense of normalcy in conversations with family and friends. Listen in as this eminent psychiatrist looks at issues that affect everyone during the coronavirus pandemic.

Dr. Gaurava Agarwal has a double appointment at Northwestern University’s Feinberg School of Medicine: He is an Assistant Professor in the Department of Medical Education and in the Department of Psychiatry and Behavioral Sciences at Northwestern University’s Feinberg School of Medicine. He also serves as the Director of Physician Well-Being for Northwestern Medical Group. The recipient of many honors, Dr. Agarwal specializes in occupational and organizational psychiatry with an emphasis on workplace mental health.

Christina DuVernay, PhD, is a Senior Associate at OPEN MINDS. Her twenty years of experience in publishing include Harvard Business School Publishing, Health Affairs, and Johns Hopkins Medicine. She earned her PhD in English at Columbia University.

Speaker is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc.

Jim Kenney discusses how managed care organizations are impacted by the COVID-19 pandemic, in both positive and challenging ways. How are payers’ allowances and restrictions changing? What are the pros and cons of using telehealth and telepharmacy to deliver care? What are the opportunities in the midst of crisis? Rick Kegler, Managed Market Liaison for PsychU, asks for Mr. Kenney’s thoughts and projections.

James T. Kenney, RPh, MBA, is the Payer Section Advisor for PsychU. Mr. Kenney is the President of the Academy of Managed Care Pharmacy (ACMP).

Rick Kegler, PharmD, MBA, is a Managed Market Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

Speaker is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc.

Rick Kegler, PharmD, MBA, is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

In this interview, Dr. Gaurava Agarwal discusses the balancing act we all face to perform at our highest level, both personally and professionally, while avoiding the obstacle of burnout. He provides his insights and expertise into burnout among health care professionals during the coronavirus crisis and how this may change the field moving forward. Listen in and learn from one of the leading experts on preventing burnout by establishing and maintaining wellness with a special focus on the behavioral health care profession.

Dr. Agarwal is Assistant Professor for the Departments of Psychiatry and Behavioral Sciences and the Department of Medical Education at Northwestern Memorial Hospital. He also serves as the Director of Physician Well-Being for the Northwestern Medical Group. Dr. Agarwal earned his medical degree at Baylor College of Medicine in Houston, TX; he has lectured extensively at the regional, national, and international levels; and he has expertise across clinical trials and original research domains. Dr. Agarwal has numerous scientific publications to his name.

Rachel Self, PhD, is a Senior Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

 

 

Dr. Agarwal is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc.

Rachel Self, PhD, is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

The South Carolina Department of Mental Health (SCDMH) is updating its qualified provider organization list of community residential care facilities (CRCFs) available for people with mental illness who are at high risk for hospitalization. The list was created in 2011, and resubmitted following expiration in 2018. The SCDMH intends to use the new list to recommend placements for specific individuals currently served by three of its community mental health centers. SCDMH released the solicitation (5400019224) on March 23, 2020, with responses due by April 6, 2020. The initial 12-month contract term is followed by four one-year renewal options. The start date is April 20, 2020.

The state seeks to establish a fixed price contract with a source or sources to provide the services. The established maximum fixed price rate is $30.00 per resident per day.

CRCFs, unlike boarding homes, include not only room and board, but provide a degree of personal care for a period of time in excess of 24 consecutive hours for two or more persons, 18 years old or older. CRCFs are often referred to as “assisted living facilities.” They are licensed and monitored by the South Carolina Department of Health and Environmental Control’s Division of Health Licensing. A CRCF can be a transitional or a permanent placement depending on the preferences of the resident and their support networks/families for independent living settings.

Eligible CRCF residents are those who have had a serious mental illness or other behavioral health disorder and who have had a history of multiple hospitalizations and inpatient psychiatric treatment for 90 or more days, and/or who otherwise may be at significant risk of re-hospitalization. The three centers need the following number of CRCF beds:

  • Columbia Area Mental Health Center (CAMHC) needs 75 CRCF beds in Richland and Fairfield counties
  • Santee Wateree Mental Health Center needs 45 beds in Sumter and Kershaw counties
  • Coastal Empire Mental Health Center needs 45 beds across Beaufort, Hampton, Colleton, Allendale, and Jasper counties.

For more information, contact:

  • Tracy LaPointe, Public Information Director, South Carolina Department of Mental Health, Post Office Box 485, Columbia, South Carolina 29202; 803-898-8581; Email: tracy.lapointe@scdmh.org; Website:https://scdmh.net/dmh-components/community-residential-care-facilities/.

The Department of Veterans Affairs (VA) recently proposed standardizing eligibility criteria for its Program of Comprehensive Assistance for Family Caregivers (PCAFC). Specifically, the VA seeks to expand the definition of serious injury to include any service-connected disability, whether it resulted from an injury, an illness, or a disease. Further, the VA seeks refine the eligibility criteria for personal care services to capture the service needs of veterans and service members with cognitive or neurological impairment or mental health conditions. The VA also proposed changes to the PCAFC stipend payment methodology, definitions for financial planning and legal services, and procedures for revocation and discharge, to include advance notice requirements aimed at improving communication between VA and PFAFC participants. These changes are intended to ensure that the PCAFC regulations reflect changes required by the VA MISSION Act of 2018.

The proposed rule, “Program Of Comprehensive Assistance For Family Caregivers Improvements And Amendments Under The VA MISSION Act Of 2018,” was released on March 6, 2020. Comments will be accepted through May 5, 2020.

The PCAFC, established in 2011, is a component of the VA Caregiver Support Program, which provides services to family caregivers to help veterans with disabilities remain in their homes. It provides caregivers with training, peer mentoring, respite care, a telephone support line and self-care courses. The PCAFC provides additional benefits including a monthly stipend for qualifying family caregivers of eligible veterans who were seriously injured in the line of duty on or after September 11, 2001.

Under the MISSION Act, the VA will expand eligibility for PCAFC to veterans from all eras, starting with those who incurred or aggravated a serious injury in the line of duty on or before May 7, 1975. After that first expansion phase, PCAFC will be extended to eligible veterans who were seriously injured in the line of duty between May 7, 1975 and September 11, 2001. Prior to expanding, VA must fully implement an information technology system required by the MISSION Act.

PsychU last reported on this topic in “VA Expands Private Provider Options For Veterans Under MISSION Act,” which published on July 15, 2019. The article is available at https://www.psychu.org/va-expands-private-provider-options-for-veterans-under-mission-act/.

For more information, contact:

  • Elyse Kaplan, National Deputy Director, Caregiver Support Program, Care Management and Social Work, 10P4C, Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Ave. NW, Washington, District of Columbia 20420; 202-461-7337; Website: https://www.caregiver.va.gov/ and https://www.caregiver.va.gov/support/support_benefits.asp

Law enforcement requested consumer electronic health data from a software vendor in 2019 to aid investigations against physicians who had allegedly inappropriately prescribed controlled substances for alleged “pill mills.” Search warrants that have become public were issued to the same vendor, DrChrono, a digital health technology company that provides a software and billing service platform, consisting of web- and cloud-based apps for physicians and consumers.

The search warrants illustrate the tactic:

  • In January 2019, DrChrono complied with a search warrant and provided approximately 9.3 gigabytes of medical records, amounting to 8,316 files from the Gaby Medical Clinic in Fort Smith, Arkansas to the U.S. Drug Enforcement Administration (DEA). For this instance of data-sharing, DEA was investigating two physicians over claims that they were prescribing large quantities of Oxycodone and Xanax. Both physicians pleaded guilty to distributing controlled substances.
  • In July 2019, DrChrono complied with a DEA search warrant and provided records related to a Pennsylvania-based medical practice. A physician was being investigated for giving “goody bags” of drugs to consumers. The bags included analgesics, sedatives, muscle relaxants, and anti-inflammatory drugs. Data obtained from DrChrono included appointment notes that were included in the physician’s files. The physician pleaded “not guilty” to the charges of health care fraud and conspiracy to distribute controlled substances.

In September 2019, the U.S. Office of the Inspector General (OIG) for the Department of Justice released a “Review of the Drug Enforcement Administration’s Regulatory and Enforcement Efforts to Control the Diversion of Opioids.” In this document, the OIG outlined how DEA is trying to compile and use data that is required through Titles II and III of the Controlled Substances Act of 1970 (CSA), in order to combat issues with opioid prescription and abuse. The CSA requires importers, exporters, manufacturers, distributors, dispensers, and health care professionals that handle controlled substances, collectively known as “registrants,” to register with DEA. However, the OIG noted that one of the areas in which DEA’s regulatory and enforcement efforts could have been more effective in combating opioid diversion was that DEA has not taken steps to revise its regulations and require all prescribers to submit prescriptions electronically. This is one reason that the DEA has experienced a lack of information regarding these practices, and may be a reason that DEA has targeted private electronic health record and data storage vendors.

Currently, the DEA cannot access data housed in a state-operated prescription drug monitoring program (PDMP) database or in an electronic health record without a search warrant. However, according to an amicus brief filed in May 2019 by the American Civil Liberties Union (ACLU), the DEA believes that because it is a federal agency it should be able to request individual PDMP records with an administrative subpoena instead of a warrant. The brief was in response to U.S. DOJ v. Jonas. The DEA argued that people should have no reasonable expectation of privacy for their data held in the PDMP because of the “third-party doctrine.” Under that doctrine, people lose the protection from unreasonable search and seizure guaranteed under the Fourth Amendment when they voluntarily share information with a third-party, such as a company they do business with.

DrChrono provides a cloud-based electronic health record; the organization’s software manages data for about 17.8 million consumers, and has processed more than $11 billion in medical bills to date. DrChrono’s privacy policy states that it can share consumer information with partners. DrChrono also claims to not be “responsible for the privacy practices of the others who will view and use the information you disclose to others.”

For more information, contact: 

  • Michael Nusimow, Chief Executive Officer, DrChrono, 328 Gibraltar Drive, Sunnyvale, California 94089; 844-569-8628; Email: michael@drchrono.com; Website: https://www.drchrono.com/
  • Public Affairs, U.S. Drug Enforcement Administration, 8701 Morrissette Drive, Springfield, Virginia 22152; Email: DEA.Public.Affairs@usdoj.gov; Website: https://www.dea.gov/
  • Assistant Inspector General for Audit, Office of the Inspector General, U.S. Department of Justice, 950 Pennsylvania Avenue, NW, Washington, District of Columbia 20530; 202-616-4633; Website: https://oig.justice.gov/
  • American Civil Liberties Union, 125 Broad Street, 18th Floor, New York, New York 10004; 212-549-2500; Website: https://www.aclu.org/blog/privacy-technology/medical-and-genetic-privacy/government-needs-get-warrant-if-it-wants-access

The Medicaid and CHIP Payment and Access Commission (MACPAC) found that most state Medicaid programs use one or more legal authorities to use Medicaid funds to pay for residential or inpatient services provided by an institution of mental diseases (IMD). However, since 1965, the federal Medicaid program has excluded payment for IMD services to ensure that states alone fund inpatient psychiatric services. The goal of this exclusion was to encourage states to build community-based behavioral health capacity.

The federal Medicaid program defines an IMD as “a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.” The term IMD is only relevant to Medicaid; they are not singled out by other payers, state licensure agencies, or accrediting bodies. For licensing purposes, IMDs can provide inpatient or residential mental health and addiction treatment as needed.

Medicaid authorities that states use to pay for services in IMDs include:

  • Demonstration waivers under Section 1115 of the Social Security Act gives the Secretary of Health and Human Services (HHS) authority to waive provisions of major health and welfare programs authorized under the Act, including certain Medicaid requirements, and to allow a state to use federal Medicaid funds in ways that are not otherwise allowed under federal rules. This authority is provided for “experimental, pilot, or demonstration” projects which, in the view of the Secretary, are “likely to assist in promoting the objectives of” the program.
  • In-lieu-of services in managed care are alternative services in a setting that are not included in the state plan or otherwise covered by the contract but are medically appropriate, cost-effective substitutes for state plan services included within a contract.
  • Statutory exceptions to the exclusion for services provided to adults age 65 and older and children and youth under age 21.
  • A new state plan option is in effect from October 1, 2019 to September 30, 2023. This option covers IMD services for up to 30 days in a year for individuals with addiction.

MACPAC also found that state licensure agencies, accrediting bodies, and other payers do not have standards specific to IMDs, given that the designation is unique to Medicaid. Instead, states regulate inpatient and residential treatment facilities separately, and standards vary according to whether a facility provides addiction treatment or mental health care. Federal standards for IMDs are largely determined by whether or not the facilities are Medicare provider organizations; however, there is no federal certification process for these organizations because Medicare does not pay for addiction treatment services in most free-standing facilities.

These findings were presented in “MACPAC Report To Congress: Oversight of Institutions for Mental Diseases.” The report fulfills a statutory requirement in the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). The requirement is to identify and describe facilities designated as IMDs in selected states and summarize state licensure, certification, or accreditation requirements and Medicaid clinical and quality standards for these facilities. MACPAC estimated the number of IMDs accepting Medicaid in seven selected states (California, Colorado, Florida, Massachusetts, New Jersey, Ohio, and Texas) and determined the types of services these facilities offer. They also determined the roles of federal and state government agencies in the regulation and oversight of IMDs, and selected outpatient behavioral health facilities, including licensure requirements and licensure standard enforcement. Finally, they analyzed standards that select state Medicaid programs and managed care plans place on behavioral health facilities, including facilities that may be considered IMDs, how Medicaid agencies enforce these standards, and state laws governing consumer protection in IMDs.

For more information, contact: 

  • Kathryn Ceja, Director of Communications, Medicaid and Children’s Health Insurance Program Payment and Access Commission, 1800 M Street Northwest, Suite 650 South, Washington, District of Columbia 20036; 202-350-2000; Fax: 202-273-2452; Email: Kathryn.Ceja@macpac.gov; Website: https://www.macpac.gov/

On March 31, 2020, federal approval expired for the New York Medicaid Delivery System Reform Incentive Payment Program (DSRIP). The New York Department of Health (DOH) had asked the Centers for Medicare & Medicaid Services (CMS) to extend the DSRIP in two phases. The first phase would have extended the waiver through March 2021 and allowed the state to use $625 million in unspent funds from its original $7.4 billion program. The second phase, stretching into March 2024, sought $8 billion more in federal funding to continue the DSRIP. However, on February 21, 2020, CMS notified the New York Department of Health (DOH) that it would consider the first phase proposals but would not consider extending DSRIP.

CMS had approved the state’s waiver for the DSRIP on April 14, 2014. Under the current DSRIP waiver, Performing Provider Systems (PPS), regional networks of provider organizations, work in partnerships to collaborate in a regional project plan focused on improving health outcomes while reducing avoidable hospital readmissions. The projects included expanding medication assisted treatment into primary care and emergency room settings, targeting seriously mentally ill populations for enhanced supports, and addressing housing and other social determinants of health. Without the extension, the PPSs must decide whether they will continue to operate without federal support.

In its denial letter dated February 21, 2020, CMS noted that the initial DSRIP award in 2014 was intended to be a time-limited one-time investment in system transformation that could be sustained through ongoing reimbursement mechanisms and/or state and local initiatives. CMS said it intended to maintain that agreement and preserve the original expiration of the DSRIP expenditure authority. Further, the letter noted that if CMS were to approve an extension, it would be rebased consistent with new CMS policy. The rebasing would mean that the state basis would be limited to just five years of its current budget neutrality savings. As a result, CMS believes its staff would not be able to adequately assess New York’s proposal for the second phase. CMS said it was continuing to review the phase one proposal in light of the federal goal of increasing value-based care (VBC) in the Medicaid program. The state’s VBC efforts will continue beyond the planned expiration of the DSRIP program. Those plans were released in January 2020 as “New York State Roadmap For Medicaid Payment Reform, A Path Toward Value Based Payment: Annual Update June 2019: Year 5.”

The state’s Medicaid program serves more than 6 million beneficiaries. It contracts with more than 50 fully and partially capitated managed care plans. Eligible services include inpatient hospital care, outpatient hospital services, clinics, nursing homes, managed care, prescription drugs, home care and services provided in a variety of community-based settings (including mental health, addiction treatment, developmental disabilities services, school-based services, and foster care services). The proposed 2021 budget included $76.7 billion for the Medicaid program.

On March 19, 2020, the New York Medicaid Redesign Team II (MRT II) approved reforms to reduce the state’s Medicaid spending by $2.5 billion annually. The recommendations were sent to the governor and legislature for consideration in the state budget. Governor Andrew Cuomo had formed the MRT II on February 4, 2020 to develop proposals to restore financial sustainability to the Medicaid program while connecting other program initiatives that would advance core health care strategies.

On April 3, 2020, Governor Cuomo signed the state’s $177 billion fiscal year 2021 budget. It includes Medicaid changes recommended by MRT II to help close a $6 billion budget gap, but includes language to delay any provisions that might make the state ineligible for $6.7 billion in short-term federal aid to enhance Medicaid payments as part of the federal response to the COVID-19 public health emergency. On March 29, Governor Cuomo said he intended to refuse the short-term federal aid because the maintenance of effort requirements would prevent implementing the MRT II Medicaid redesign proposals, one of which would shift Medicaid costs from the state to localities.

For more information, contact:

  • Jonah Bruno, Director of Communications, New York State Department of Health, Empire State Plaza, Corning Tower, Albany, New York 12237; Email: dohweb@health.ny.gov; Website: https://www.health.ny.gov/health_care/medicaid/redesign/mrt2/.

On April 8, 2020, the Centers for Disease Control and Prevention (CDC) issued interim workplace safety practices for critical infrastructure workers with potential exposure to a person with suspected or confirmed COVID-19. Critical infrastructure workers include those working in the following sectors:

  • Federal, state, and local law enforcement
  • 911 call center employees
  • Fusion Center employees (Fusion centers are state-owned and operated centers that organize localized domestic intelligence gathering of threat-related information. The centers receive, analyze, gather, and share data between the Department of Homeland Security; federal intelligence, law enforcement at the federal, state, local, tribal and territorial levels; and private sector partners.)
  • Hazardous material responders from government and the private sector
  • Janitorial staff and other custodial staff
  • Workers, including contracted vendors, in food and agriculture, critical manufacturing, informational technology, transportation, energy, and government facilities

This guidance does not pertain to health care, first responder, or correctional facility workers for which the CDC had already issued guidelines. The federal Occupational Safety and Health Administration (OSHA) requires employers of workers in the health care industry, emergency response organizations (e.g., emergency medical, firefighting, and law enforcement services), and correctional institutions to make work-relatedness determinations for cases of COVID-19. Employers outside these industries in areas where there is ongoing community transmission of COVID-19 will not be required to make work-relatedness determinations.

The CDC defined a potential exposure as being a household contact or having been in close contact (within six feet) of an individual with confirmed or suspected COVID-19 up to 48-hours before the individual started showing symptoms. Workers who have been exposed but are not showing symptoms can work, but should have their temperatures monitored before starting their shifts, and the worker should wear a face mask. Workers who become symptomatic during the day should be sent home immediately. The work site should compile information on other workers in close contact with an exposed worker being monitored. In the case that a worker becomes sick, other workers who had close contact with that worker should be considered exposed.

In workplaces where critical infrastructure workers were exposed to COVID-19 but remain asymptomatic, the employer and worker should adhere to the following practices prior to and during their work shift:

  • Pre-screen: Employers should measure the worker’s temperature and assess symptoms prior to them starting work. Ideally, temperature checks should happen before the individual enters the facility.
  • Regular monitoring: As long as the worker is asymptomatic (no temperature or symptoms), the worker should self-monitor under the supervision of the employer’s occupational health program.
  • Wear a mask: The worker should wear a face mask at all times while in the workplace for 14 days after last exposure. Employers can issue face masks or can approve worker’s supplied cloth face coverings in the event of shortages.
  • Social distance: The worker should maintain a six-foot distance from others (social distancing) as work duties permit in the workplace.
  • Disinfect and clean work spaces: The employer should ensure that shared common areas (offices, bathrooms, break rooms) and electronic equipment are cleaned and disinfected regularly.

Generally under OSHA’s recordkeeping requirements, COVID-19 is a recordable illness, and employers are responsible for recording cases of COVID-19 if the case is confirmed, and the case is work-related. However, in a guidance memo issued on April 10, 2020, OSHA advised that in areas where there is ongoing community transmission of COVID-19, it will not require other employers (other than health care, emergency response, and corrections) to make the same work-relatedness determinations unless there is objective evidence that a COVID-19 case may be work-related. This evidence could include a cluster of COVID-19 cases without an alternate explanation that develop among workers in close proximity or who share common areas, or could include information given to the employer by employees or in the ordinary course of managing its business and employees. This loosening is because employers, other than those in health care, emergency response, and corrections may have difficulties determining whether a worker contracted COVID-19 at work. This guidance is limited to the current public health crisis.

For more information, contact:

  • Division of Public Affairs, Centers for Disease Control & Prevention, 1600 Clifton Road, Atlanta, Georgia 30329-4027; 404-639-3286; Fax: 404-639-7394; Email: media@cdc.gov; Website: https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/businesses-employers.html
  • Elizabeth Grossman, Director of the Office of Statistical Analysis, Occupational Safety and Health Administration, Department of Labor, 200 Constitution Avenue Northwest, Washington, District of Columbia 20210; 202-693-2225; Website: https://www.osha.gov/SLTC/covid-19/

On April 3, 2020, California launched Project Roomkey, an initiative to use hotel and motel rooms to isolate homeless individuals deemed extremely vulnerable to COVID-19 in an effort to limit the spread of the disease. Additionally, the state has also contracted with Chef José Andrés’s World Central Kitchen to provide three meals a day to select Project Roomkey hotels through a statewide contract to support local efforts as needed. The goals of Project Roomkey are to protect public health by isolating the medically vulnerable, reducing the shelter population for social distancing, slowing the rate of spread of COVID-19 and, in turn, flattening the curve.

The state secured approval from the Federal Emergency Management Agency (FEMA) for a 75% federal cost share for the rooms, and wraparound supports such as meals, security, and custodial services. Counties will pay the remaining 25% of the cost, as well as cover the cost of case managers and counselors. The state has distributed $150 million to counties to help pay for the rooms and other homelessness services.

Project Roomkey isolation units are intended for the following populations experiencing homelessness:

  • Individuals who are asymptomatic, but at high risk, such as people over 65 or who have certain underlying health conditions. The goal is to move them into motel or hotel units where they can more safely self-isolate and avoid exposure to COVID-19.
  • Individuals who have been exposed to COVID-19 or are COVID-19 positive (as documented by a state or local public health official, or medical health professional) who do not require hospitalization, but need isolation or quarantine to avoid further spread of COVID-19 in congregate shelter settings or homeless encampments.

The initiative targets hotels in counties with significant homeless populations that are also experiencing high concentrations of COVID-19 transmission. The state seeks to secure up to 15,000 rooms for this purpose. Some of the leases being negotiated include an option for the state or county to purchase the entire hotel/motel property to provide for permanent homeless housing. However, no information has been released about the status of these negotiations.

Local governments to date have secured 6,867 hotel and motel rooms for Project Roomkey. However, state and local health officials have not released a comprehensive list of participating hotels/motels. The local governments are responsible for identifying which shelter clients or encampment residents are selected for these hotel isolation placements and transporting them to the hotels for intake. The counties can contract with a provider organization to manage the isolation placements. As of early April, counties had moved 869 homeless individuals off the street and/or out of shelters into isolation. Essential behavioral health and health care services are being provided by the local governments and community partners, as needed.

For more information, contact: 

  • California Governor Gavin Newsom, 1303 10th Street, Suite 1173, Sacramento, California 95814; 916-445-2841; Fax: 916-558-3160; Website: https://govapps.gov.ca.gov/gov40mail/

The President’s 2021 budget proposal for the Department of Health and Human Services (HHS) includes five provisions intended to expand behavioral health services. However, overall, the HHS budget request of $94.5 billion is about 10% lower than the 2020 enacted level of funding. The HHS budget proposes $1.6 trillion in net mandatory health savings and reducing longer-term deficits by eliminating wasteful spending.

The federal budget proposal was released on February 10, 2020, as “A Budget For America’s Future, Fiscal Year 2021.” A fact sheet about the budget highlighted the following provisions affecting behavioral health:

  • Combat the opioid epidemic. The budget allocates $5 billion to fund research, surveillance, prevention, treatment, access to overdose reversal drugs, and recovery support services. This funding includes $1.6 billion, an $85 million increase from the 2020 enacted level, for State Opioid Response grants, which support prevention, treatment, and recovery support services. States are also given flexibility to use these funds to address emerging drug issues, such as the increasing number of overdoses related to psychostimulants, including methamphetamines.
  • Fund Certified Community Behavioral Health Clinics (CCBHC) expansion grants. The budget includes $225 million for the CCBHC expansion grants and extends, through 2021, the CCBHC Medicaid demonstration programs to improve community mental health services for the eight states currently in the demonstration.
  • Fund mental health prevention and screening. The budget allocates $125 million to help schools, community organizations, first responders, and other entities identify mental health issues and help affected youth and other individuals get the needed treatment.
  • Fund primary health care services for homeless individuals. The budget allocates $25 million to expand primary care services for homeless individuals in cities with high rates of homelessness.
  • Modify the Medicaid funding exclusion on Institutions of Mental Disease (IMDs) to allow states flexibility to use IMDs to provide inpatient mental health services to Medicaid beneficiaries with serious mental illness (SMI) as part of a comprehensive strategy that includes improvements to community-based treatment. In 2018, 47.6 million adults had a mental illness, of whom 11.3 million had SMI, meaning their mental illness substantially interfered with or limited major life activities.

The fact sheet and a summary of the major savings and reforms called out additional proposals affecting the health and social service field. They address Medicare, Medicaid, rural health access, public health, and child welfare.

Medicare

  • Eliminate wasteful Medicare spending, and incentivize quality and efficiency. The budget proposes to align payments for the four main post-acute care settings (skilled nursing facilities; home health provider organizations; inpatient rehabilitation facilities; and long-term care hospitals) and transition to site-neutral payments over five years (with certain exceptions for long-term care hospitals). Currently each setting uses a different prospective payment system. It revives a proposal to pay physicians the same fee whether services are provided by a hospital outpatient facility or a private practice.
  • Reform uncompensated care payments by removing the payment from the Medicare payment system, moderating the rate of growth of spending, and establishing a new process to distribute uncompensated care amounts to hospitals based on their share of charity care and non-Medicare bad debt.
  • Implement bipartisan drug pricing proposals. The budget supports legislative efforts to improve the Medicare Part D benefit by establishing an out-of-pocket maximum, improving incentives to contain costs, and reducing out-of-pocket expenses for seniors. It also calls on Congress to pass legislation to reduce the prices paid for prescription drugs. The administration also supports changes to Medicare Part D to reduce the cost of generic and biosimilar drugs. The budget proposal calls for spending $130 billion less for Medicare prescription drugs.
  • Allow people age 65 or older to opt out of Medicare entirely. Additionally, Medicare beneficiaries enrolled in a high-deductible health plan would be allowed to accumulate more tax-free savings for health expenses.

Medicaid

  • Improve consistency between work requirements in federally funded public assistance programs, such as Medicaid and Temporary Assistance for Needy Families (TANF). All able-bodied, working-age individuals, aged 18 to 65 years old and with or without children in the home, would be required to find employment or participate in individualized work activities for a minimum of 20 hours per week, in order to receive welfare and Medicaid benefits, unless they fall into an exempt category or have an individual or geographic hardship.
  • Create a permanent Money Follows the Person option, giving states flexibility to provide additional transitional services to promote care in the community. States with high rates of institutionalization would receive time-limited enhanced funding to support necessary structural changes.
  • Allow states to consider savings and other assets in determining Medicaid eligibility. The goal is to focus Medicaid spending on individuals who lack significant assets.

Rural health

  • Expand access to telemedicine services by offering increased flexibility to provider organizations who serve predominantly rural or vulnerable populations, including Indian Health Service (IHS) provider organizations and those participating in Medicare payment models requiring financial risk.
  • Modify payments to Rural Health Clinics to ensure that Medicare beneficiaries continue to benefit from primary care services in their communities.
  • To address the trend of rural hospital closures, the budget proposes to allow critical access hospitals to voluntarily convert to rural standalone emergency hospitals and remove the requirement to maintain inpatient beds.
  • Maintain funding for Rural Health Outreach grants in the Health Resources Services and Administration (HRSA).

Public health

  • Fund the initiative to end the HIV epidemic. The budget allocates $716 million for the initiative’s second year. The avocation includes $371 million for the Centers for Disease Control (CDC) and $302 million for Health Resources and Services Administration (HRSA) to deliver HIV care through the Ryan White HIV/AIDS Program and to supply testing, evaluation, prescription of PrEP, and associated medical costs through the Health Centers program; $27 million to the Indian Health Service (IHS) to tackle the epidemic in American Indian and Alaska Native communities; and $16 million for the National Institutes of Health (NIH) for evaluation activities to identify effective interventions to treat and prevent HIV.
  • Fund initiatives to improve maternal health. The budget allocates $74 million in new resources to reach the following goals: achieve healthy outcomes for women of reproductive age by improving prevention and treatment; prioritizing quality improvement for prenatal care and birth services; optimize postpartum health; and improve data and support research.

Other social services

  • Reduce the TANF block grant by 10%, and eliminate the TANF Contingency Fund, as it fails to provide well-targeted counter-cyclical funding to states. Add a requirement that states spent at least 30% of all TANF funds on activities that directly promote work. All TANF spending would be limited to families with income below 200% of the federal poverty line (FPL). All work-eligible individuals receiving TANF cash assistance would be expected to participate in individualized work activities a minimum of 20 hours per week, unless they fall into an exempt category or have individual or geographic hardship. New proposals require that TANF expenditures be directly related to achieving TANF’s purposes and by phasing out the ability for states to use TANF funds for, “activities authorized solely under prior law,” an outdated expenditure category; states would be accountable for achieving employment outcomes to incentivize cooperation and service integration between TANF and programs through the Workforce Innovation and Opportunity Act to promote work. All states
  • Eliminate funding for the Social Services Block Grant (SSBG). The budget notes that the administration believes that the SSBG lacks strong performance measures, is not well targeted, and is not a core function of the federal government. It funds services that are also funded through other federal programs, such as early childhood education.

For more information, contact:

  • The White House, 1600 Pennsylvania Avenue Northwest, Washington, District of Columbia 20500; 202-456-1414; Website: https://www.whitehouse.gov/

Anxiety, fear, and trauma can be rampant during times of natural disaster. Kimberly Lonergan, RN, MSN, interviews Tony Amberg to hear his perspectives on nurses’ role during a pandemic, including issues of self-care while caring for others.

Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC, is the Nurses Corner Section Advisor for PsychU. Mr. Amberg is a Psychiatric Consult Liaison Psychiatric Nurse Practitioner at Northwestern Memorial Hospital in Chicago, IL. He is also an Emeritus Board Member and Former President of the Illinois Chapter of the American Psychiatric Nurses Association (APNA).

Kimberly Lonergan, RN, MSN, is a Senior Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc. Ms. Lonergan covers North Texas, and her areas of expertise include critical care management, trauma medicine, and gastroenterology.

Speakers are paid consultants of Otsuka Pharmaceutical Development & Commercialization, Inc.

The federal Department of Justice (DOJ) concluded Maine’s system of services for people with intellectual/developmental disability (I/DD) violates the Americans with Disabilities Act (ADA) because it limits access to home- and community-based services (HCBS) under its Section 21 waiver. On February 10, 2020, the DOJ responded to a complaint filed in May 2018 by a Maine resident with I/DD. The DOJ concluded that Maine failed to provide necessary services in the most integrated setting appropriate to the individual’s needs. The Maine Department of Health and Human Services (DHHS) is determining how to respond.

The DOJ advised DHHS to promptly remedy the situation and prevent ADA civil right violations of people receiving Section 21 services by taking the following steps:

  1. Modify the Section 21 waiver’s 84-hour cap on Home Care Quarter Hour services by establishing and implementing a process for individuals to obtain an exception to the cap, such that individuals can receive Section 21 waiver services in the most integrated setting appropriate to their needs unless the provision of such services would constitute a fundamental alteration.
  2. Modify the Section 21 waiver’s service planning process to ensure that the services a member receives, and the setting(s) in which they are received, are determined by the member’s individual needs and preferences, rather than by provider organization preference.
  3. Inform individuals currently receiving, or who may be eligible to receive, Section 21 waiver services, including individuals currently receiving services in agency placements, those receiving Quarter Hour services, and those receiving Medicaid services in intermediate care facilities (ICFs) who may be eligible for Section 21 waiver services, about the exceptions process and providing personal planning that is sufficiently focused on the member’s individual needs and preferences.
  4. Inform state employees, agents, and contractors, including case managers, as well as others, including provider organizations, who serve on personal planning teams, and employees implementing the exceptions process, about the modifications implemented, including the exceptions process, how to apply for an exception under the process, and how the exceptions and personal planning processes should operate to ensure that individuals can receive services in the most integrated setting appropriate to their needs.
  5. Ensure that the state has sufficient provider capacity to fulfill the individual’s authorized Section 21 waiver service hours.
  6. Pay compensatory damages to the individual for injuries caused by the state’s actions.
  7. Provide the DOJ with written status reports delineating all steps taken to comply with these requirements, including the date(s) on which each step was taken, and, where applicable, information sufficient to demonstrate compliance.

Maine’s Medicaid Section 21 waiver provides comprehensive services for people with I/DD and autism who live in their own homes or in another home in the community, but not necessarily with their families. The available services include assistive communication assessment/technology, career planning, community support, counseling, crisis assessment and intervention services, employment specialist services, home accessibility upgrades, in-home support, medical equipment and supplies, therapy (occupational, physical, or speech), residential services, respite, shared living services, transportation, and work support.

The individual at the center of the DOJ complaint is an adult with several disabilities who lives with his parents. Since 2009 he has received Section 21 waiver home support services, which include personal assistance with activities of daily living and instrumental activities of daily living. In 2014, the state capped the individual’s service hours at 84 per week, citing the state’s cap on services Section 21 waiver recipients can receive while living in their own (or family) homes. The family challenged the denial. The state contested the challenge but acknowledged that the individual needed 168 hours of services per week. The DOJ noted that the state’s failure to provide needed in-home services resulted from the state’s service planning process, which determined his placement/services based on provider organization preference, rather than identifying the most integrated setting appropriate.

In February 2017, the administrative challenge was concluded, and the state cut the individual’s service hours to 84 per week. However, in March 2019, the state granted an exception to the cap during the DOJ investigation. The exception permitted the individual to receive 168 hours per week of home support services in his home; however, the 84-hour cap otherwise remained in force. Further the state failed to ensure that the licensed service provider organization actually fulfills the authorized hours, and the state failed to identify additional provider organizations to fill the gaps. Despite the exception, the individual continues to receive about 84 hours per week of in-home services.

As a result, the individual is at risk of being institutionalized to receive the needed services. The only alternative placements he has been offered are an ICF or a in a multi-person group home. An ICF is considered an institutional setting. If the individual lived in an ICF or a group home, he would not have access to the community at the same level as living at home with adequate services.

A link to the full text of “The United States’ Findings & Conclusions Based On Its Investigation Of The State Of Maine Under Title II Of The Americans With Disabilities Act” may be found at www.openminds.com/market-intelligence/resources/021020dojadaltrmaineiddhcbs.htm.

For more information, contact:

  • Jackie Farwell, Communications Director, Maine Department of Health and Human Services, 109 Capitol Street, 11 State House Station, Augusta, Maine 04333; 207-446-3319; Email: Jackie.Farwell@Maine.gov; Website: https://www.maine.gov/dhhs/.

Primary care physician (PCP) practices reporting on electronic clinical quality measures (eCQM) for an evidence-based cardiovascular care approach took a median of 8.2 months to submit data. The practices participated in EvidenceNOW Southwest, which provided nine months of coaching to improve the ABCS of heart health (Aspirin, Blood pressure control, Cholesterol management, and Smoking cessation). Practices also received support for ABCS eCQM reporting from an electronic health record, a registry, or a third-party platform.

Key findings were as follows:

  • The time needed to report differed by eCQM. Blood pressure was reported the fastest at a median of 7.8 months. Cholesterol management was reported the slowest at 10.5 months.
  • Practice characteristics were linked to how quickly the practice reported the blood pressure eCQM and the cholesterol eCQM.
  • For the blood pressure eCQM, those participating in an accountable care organization (hazard ratio 1.88) or quality demonstration programs (hazard ratio 1.58) were more able to report on the measure. Hospital-owned practices were more able to report on the measure than Federally Qualified Health Centers (hazard ratio 2.66).
  • For the cholesterol eCQM, those practices that used clinical guidelines for cardiovascular disease management reported 1.35 time more quickly. Practices owned by a clinical professional reported cholesterol eCQMs 0.52 times more slowly than Federally Qualified Health Centers.

These findings were reported in “Primary Care Practices’ Ability to Report Electronic Clinical Quality Measures in the EvidenceNOW Southwest Initiative to Improve Heart Health” by Kyle E. Knierim, M.D.; Tristen L. Hall, MPH; L. Miriam Dickinson, Ph.D.; et al. The researchers analyzed quality reporting by 211 PCPs in Colorado and New Mexico participating in EvidenceNOW Southwest between February 2015 and December 2017. The practices also received nine months of support from a practice facilitator, a clinical health information technology advisor, and the research team. The PCPs were instructed to report their baseline ABCS eCQMs as soon as possible. The researchers analyzed the association between practice characteristics and reporting speed. About 48% of the practices were owned by clinical professionals. About 71% were located in an urban or suburban area.

The full text of “Primary Care Practices’ Ability to Report Electronic Clinical Quality Measures in the EvidenceNOW Southwest Initiative to Improve Heart Health” was published on August 7, 2019, by JAMA Network Open. An abstract is available online at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2747476.

For more information, contact:

Kyle Knierim, M.D., Assistant Professor, Department of Family Medicine, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, Colorado 80045; 720-848-9000; Email: kyle.knierim@cuanschutz.edu; Website: www.linkedin.com/in/kyle-knierim.

Community reentry following incarceration is more likely to be successful if the reentry interventions address dynamic factors that affect the overall success of reentries, according to a study by The Harvard University Institute of Politics. These dynamic factors include health, employment, housing, skill development, mentorship, and social networks.

Health

Community-based organizations should prioritize providing reentering citizens with quality health care that properly addresses any mental and physical health conditions and addiction. This is especially important for female reentering citizens, who often have greater health-related needs than the general reentering population. The researchers recommend that organizations should specifically target services to women, especially in the form of trauma and counseling services.

Employment

Community-based programs are most effective when they provide training and placement services to returning citizens, using a holistic approach focused on both training and job placement. The success of these services also depends largely on the job opportunities available in the neighborhoods into which their clients are reentering. The researchers recommend that community organizations should partner with prisons to better advise incarcerated individuals on which neighborhoods to return to.

Housing

Community-based organizations that offer transitional housing, with the end goal of eventually securing an independent living situation, are effective at improving outcomes. Those programs that also provide housing in combination with other services (such as employment services, health services, and socio-emotional development) are also successful at improving outcomes. The researchers recommend that organizations and programs focus on communities with the highest risk of homelessness, namely women, Black and Hispanic individuals, and the elderly. For women, additional concern may be needed when children are involved in the reentry.

Skill Development

Assistance with both education and interpersonal skills (such as anger management, time
management, goal setting, and parenting) should be provided to those reentering the community. For education, the researchers recommend that community-based organizations should provide a variety of educational programs (such as employment training programs, college enrollment assistance and referrals, GED preparation, testing referrals, and vocational training), and these programs should be tailored to the unique education needs of different age demographics. For interpersonal skills, programs should target the skills listed above, target antisocial peer relationships, and offer appropriate cognitive behavioral programs.

Mentorship

The researchers recommend that community-based organizations that offer reentry services should also prioritize mentorship programs which match reentering citizens with mentors who share similar backgrounds. These matches could be based on gender, racial and ethnic identities, and age-related priorities.

Social Networks

The researchers also recommend programs that emphasize the role of family connection and cohesiveness, especially for young reentering individuals. Reentry programs should specifically address such needs through services that support building stronger familial ties and provide therapy, mentorship, life skills training, domestic violence education, and safe homes. They also recommend that programs subsidize or cover travel and communication costs to connect with family members when necessary.

These recommendations were presented in “Successful Reentry: A Community-Level Analysis” by researchers affiliated with the Harvard University Institute of Politics Criminal Justice Policy Group. The report focuses on how various factors significantly affect successful reentry and how existing community-based organizations tailor interventions to address those factors. The report also provides recommendations for the best practices community-based reentry programs can follow. The researchers analyzed a number of reentry case studies, social theory papers, and programs across the United States. The goal was to determine the ideal circumstances for successful outcomes for those exiting jails and prisons, and acclimating to community life.

The full text of “Successful Reentry: A Community-Level Analysis” was published in December 2019 by The Harvard University Institute of Politics’ Criminal Justice Policy Group. A copy is available online at https://iop.harvard.edu/sites/default/files/sources/program/IOP_Policy_Program_2019_Reentry_Policy.pdf.

For more information, contact: 

  • Institute of Politics, Harvard University, 79 John F. Kennedy Street, Cambridge, Massachusetts 02138; 617-495-1360; Fax: 617-496-4344; Email: ioppolicy@gmail.com; Website: https://iop.harvard.edu/

New clinical guidelines for treating attention deficit/hyperactivity disorder (ADHD) recommend psychosocial supports, in addition to medication, as essential treatment for children and adolescents with ADHD. Treatment for children with complex ADHD should focus beyond improving ADHD symptoms to improving functional outcomes in behavior, social interactions, and academics. Psychosocial interventions to improve function may include classroom-based management tools like positive reinforcement tools, a daily report card, posted expectations and consequences, parent education, organizational skills training, approaches to improve appropriate peer interactions, and school services, such as 504 plans and special education individualized education plans (IEPs).

Complex ADHD is defined as diagnosis under age 4 or over age 12, the presence of co-morbid conditions, moderate to severe functional impairments, diagnostic uncertainty, or inadequate response to treatment. ADHD and co-morbid conditions may affect children’s function across multiple settings, such as home, school, with peers, and in the community. A child with ADHD is at-risk for adverse health and psychosocial outcomes in adulthood.

To better serve children and adolescents with ADHD and complex ADHD, the guidelines recommend the following five approaches:

  1. Children under 19 with suspected or diagnosed complex ADHD should receive a comprehensive assessment by a clinical professional with specialized training or expertise, who should develop a multi-faceted treatment plan. The plan should be designed to diagnose and treat ADHD and other coexisting disorders, as well as complicating factors including other neurodevelopmental disorders, learning disorders, mental health disorders, genetic disorders, and psychosocial factors like trauma and poverty.
  2. The evaluation should verify previous diagnoses and assess for other conditions by including a psychological assessment based on a child’s functional disabilities, and intellectual and developmental level.
  3. All children with complex ADHD should receive behavioral and educational interventions addressing behavioral, educational, and social success.
  4. Treatment of complex ADHD should also include coexisting conditions, such as autism spectrum disorder or addiction, and focus on areas of impairment, rather than just reducing symptoms.
  5. Monitoring and treatment of complex ADHD should continue throughout life.

The recommendations were issued in “Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder” by William J. Barbaresi, M.D., and a panel of colleagues affiliated with the Society for Developmental and Behavioral Pediatrics. The panel developed the guidelines over three years; they conducted a literature review of research related to each action statement and approach. The goal was to facilitate integrated, interprofessional assessment and treatment of children and adolescents with complex ADHD.

The guidelines include summary diagnostic and treatment flowcharts for the following:

  • Behavioral/education treatment for children 6 years and older;
  • Medication treatment for children 6 years and older;
  • Treatment of ADHD plus a coexisting disorder including autism spectrum disorder, tics, addiction, anxiety, depression, or disruptive behavior disorders; and
  • Preschool general medication treatment for children age 3 up to 6 years.

The full text of “Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder” was published in the February/March 2020 issue of Journal of Developmental & Behavioral Pediatrics. An abstract is available online at https://journals.lww.com/jrnldbp/Citation/2020/03001/Society_for_Developmental_and_Behavioral.3.aspx.

For more information, contact:

  • William Barbaresi, M.D., Physician, Division of Developmental Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Fegan, 10thFloor, Boston, Massachusetts 02115; 617-355-7025; Email: william.barbaresi@childrens.harvard.edu; Website: http://www.childrenshospital.org/directory/physicians/b/william-barbaresi.

In 2016, suicide accounted for 30.7% of all deaths in local jails (333 of 1,071 deaths), and 6.2% of all deaths in state and federal jails (255 of 4,117 deaths). Between 2015 and 2016, the trend in overall deaths and suicide deaths differed by incarceration setting. Overall jail deaths declined as did suicide deaths. State prison deaths rose as did suicide deaths. Federal prison deaths declined while suicide deaths remained static.

Additional findings about the trends between 2015 and 2016 were as follows for each setting:

  • Overall, jail deaths due to any cause declined by 1.9% between 2015 and 2016. Jail deaths due to suicide decreased 10% from 2015 to 2016; the suicide rate declined from 52 to 46 deaths per 100,000 jail inmates.
  • State prison deaths due to any cause rose by 1.3%, from 3,682 in 2015 to 3,729 in 2016. State prison deaths due to suicide rose by 16.7% from 2015 to 2016, the rate rose from 18 to 21 deaths per 100,000 state prison inmates.
  • Federal prison deaths due to any cause declined by 15%, from 455 deaths in 2015 to 388 in 2016. Federal prison deaths due to suicide remained the same at 12 deaths per 100,00 federal inmates in 2015 and 2016.

Long-term trends by setting also varied, as follows:

  • Jails: From 2000 through 2016, there were 5,207 jail suicide deaths out of a total of 16,962 deaths, for a long-term suicide rate of 31%. The overall jail mortality rate remained similar from 2000 to 2016, with 151 deaths per 100,000 jail inmates in 2000 to 149 deaths per 100,000 in 2016. From 2000 through 2016, jail suicide rates ranged from a low of 25.4% of total deaths in 2002 to a high of 35.0% in 2011. Jail inmate suicides in general housing units accounted for 46.7% of all inmate suicides from 2000 to 2016.
  • State prisons: From 2001 through 2016, there were 3,300 suicide deaths in state prisons out of a total 53,051 deaths, for a long-term suicide rate of 6.2%. State prison suicide rates between 2001 and 2016 ranged from a low of 5.5 % of total deaths in 2011 and 2013 to a high of 7.1% in 2014.
  • Federal prisons: During the same period, in federal prisons, there were 260 suicide deaths out of a total 5,985 deaths, for a long-term suicide rate of 4.3%. Federal prison suicide rates between 2001 and 2016 ranged from a low of 6 per 100,000 inmates in 2010 to a high of 14 per 100,000 inmates in 2014.

The jail findings were reported in “Mortality in Local Jails, 2000-2016 – Statistical Tables” by E. Ann Carson, Ph.D., a statistician with the Bureau of Justice Statistics (BJS) and Mary P. Cowhig, a former BJS statistician. The state and federal prison findings were reported in “Mortality in State and Federal Prisons, 2001-2016 – Statistical Tables” by Dr. Carson and Ms. Cowhig. The researchers analyzed local jail, state prison, and federal prison data from the BJS Mortality in Correctional Institutions data collection from 2000 through 2016. The goal was to report data regarding mortality in local jails, as well as in state and federal prisons.

A link to the full text of “Mortality in Local Jails, 2000-2016 – Statistical Tables” may be found at www.openminds.com/market-intelligence/resources/021520bjsjailmortality.htm.

A link to the full text of “Mortality in State and Federal Prisons, 2001-2016 – Statistical Tables” may be found at www.openminds.com/market-intelligence/resources/021520bjsprisonmortality.htm.

For more information, contact:

  • Tannyr Denby Watkins, Public Affairs Specialist, Bureau of Justice Statistics, Office of Justice Programs, U.S. Department of Justice, 810 Seventh Street Northwest, Washington, District of Columbia 20531; Email: tannyr.m.watkins@usdoj.gov; Website: https://www.ojp.gov/

If you or someone you know is in crisis, please contact the Suicide Prevention Hotline / Lifeline at 1-800-273-TALK (8255), or text the Crisis Text Line at 741-741.

In 2018, about 46% of hospitals reported engaging in all four domains of interoperability (sending, receiving, querying and integrating data from external sources). The percentage of hospitals nationally engaging in each of these four domains varied as shown below:

  1. About 89% reported sending data electronically.
  2. About 78% reported receiving data electronically.
  3. About 65% reported electronically querying to find data.
  4. About 62% reported the ability to integrate care records from sources outside their health system.

Approximately 76% of hospitals reported using more than one electronic method to send health information, while 63% reported using more than one electronic method to receive health information. On average, hospitals used 3.3 electronic methods to send information, and 2.6 electronic methods to receive information. About 46% of hospitals used state, regional, or local health information exchange organizations (HIOs) to electronically find or query consumer health information from sources outside their health system; 38% used interface connections between electronic health records (EHR); and 34% used their EHR vendor’s network.

The most frequently reported barrier to electronic exchange was difficulty exchanging data across different EHR vendor platforms. Although 62% of hospitals used electronic patient health information received from outside sources, the top reasons for not using this information (as reported by the approximately 38% of hospitals that “seldom” or “never” used this information included:

  • Information was not always available when needed (e.g., not timely): 52%
  • Information was available but not integrated into the EHR: 50%
  • Information was not presented in a useful format (e.g., too much information, redundant, or unnecessary information): 34%

These statistics were presented in “State of Interoperability among U.S. Non-federal Acute Care Hospitals in 2018,” by Yuriy Pylypchuk, Ph.D.; Christian Johnson, MPH; and Vashali Patel, Ph.D., MPH. The researchers analyzed data from the American Hospital Association (AHA) Information Technology Supplement to the AHA Annual Survey for 2018. Sixty-four percent of all non-federal acute care hospitals responded to the survey. The total number of hospitals used in the analysis was not reported by the authors. The goal was to report the extent to which hospitals engage in interoperability, the methods they use to exchange patient health information and the top barriers to interoperability.

For more information, contact:

  • Peter Ashkenaz, Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, 330 C Street Southwest, Floor 7, Washington, District of Columbia 20201; 202-690-7151; Fax: 202-690-6079; Email: onc.request@hhs.gov; Website: https://www.healthit.gov/

The city of Rockford, Illinois is on track to end homelessness by the end of 2020 through its participation in the “Built for Zero” initiative, by Community Solutions. In 2010, the city had more than 700 homeless people. In 2018, Rockford reached “Functional Zero” in unsheltered homelessness for more than 100 homeless veterans, and for people with disabilities and chronic homelessness. “Functional Zero” is reached when the number of homeless individuals is no greater than the monthly housing placement rate for these individuals. The city now seeks to end homelessness for all remaining populations, including families, youth, and single adults who have been homeless for only a short time. If successful, Rockford will be the first city in the United States to effectively end homelessness completely.

Built for Zero works with over 80 communities across the U.S. to measurably end homelessness, beginning with veteran or chronic homelessness. Communities harness real-time, person-specific data to find and remove individual and systemic barriers that keep people trapped in homelessness. Cities that choose to work with the Built for Zero program receive support from an “improvement advisor” at Community Solutions. They also receive coaching from the Community Solutions data team and access to support data visualization software from the Tableau Foundation. Communities first work to build comprehensive, real-time, by-name data, unify local agencies around the shared goal of ending homelessness, and work to reduce homelessness in a single population at first. Once success is reached in one population, the city can then move to end homelessness for additional populations. To date, 82 cities are part of the Built for Zero network, which seeks to completely end homelessness. Twelve have reached “functional zero” for some segment of the homeless population, and 42 have reduced homelessness. More than 182,000 individuals have been housed nationally through the Built for Zero program.

Rockford began working with Built for Zero in 2015, when the city first concentrated on reaching Functional Zero for veteran homelessness. While the city had a housing voucher program (that covers housing expenses after a veteran pays 30% of their income towards housing), coordination between groups that serve homeless individuals, and those that serve veterans were put in place by local leaders in Rockford, with support from Built for Zero. Quality, real-time data was published monthly to create community accountability and involvement. After reaching “functional zero” homelessness for the city’s veteran population, Rockford translated the approach to address other populations.

Community Solutions is a New York City-based non-profit organization. It works with communities across the United States to create a lasting end to homelessness.

Additional information about the impact of the Built for Zero program can be found in “Getting to Proof Points: Key learning from the first three years of the Built for Zero initiative,” published in March 2018 by Community Solutions. The report can be found at https://community.solutions/wp-content/uploads/2019/10/bfz_impact_report_-_final.pdf. Current nationwide results of the program can be found at https://public.tableau.com/profile/esther4177#!/vizhome/BuiltforZeroResults-NewWebsite/BFZResults2.

For more information, contact: 

  • Built for Zero, Community Solutions, 60 Broad Street, Suite 2510A, New York, New York 10004; 646-797-4370; Email:communications@community.solutions; Website: https://www.joinbuiltforzero.org/

On February 17, 2020, the California Department of Health Care Services (DHCS) announced it had completed the reorganization of its Behavioral Health functions, that were formerly called Mental Health/Substance Use Disorder functions. The reorganization began on July 1, 2019. The goal was to better integrate behavioral health functions into the DHCS overall health care system, but still preserve the unique policy/program area of behavioral health. The reorganization furthers DHCS’ goal to improve consumer outcomes, and increase departmental efficiencies..

The divisions that previously fell under the former Mental Health and Substance Use Disorder Services, and their new categories, include:

  • Community Services (now under Behavioral Health) led by Marlies Perez.
  • Licensing and Certification (now under Behavioral Health) led by Janelle Ito-Orielle.
  • Medi-Cal Behavioral Health (now under Behavioral Health) led by Brenda Grealish.
  • Local Governmental Financing (now under Health Care Programs’ Health Care Financing) led by Rafael Davtian.

Kelly Pfeifer is the Deputy Director of the Behavioral Health division. Lindy Harrington is the Deputy Director of Health Care Financing. Both report to Chief Deputy Director for Health Care Programs and State Medicaid Director Jacey Cooper.

A link to the full text of “California Department Of Health Care Services Organization Chart As Of February 17, 2020” may be found at www.openminds.com/market-intelligence/resources/021720cadhcsreorgchart.htm.

For more information, contact:

  • Office of Public Affairs, California Department of Health Care Services, Post Office Box 997413, Sacramento, California 95899; 916-440-7660; Fax: FAX; Email: DHCSPress@dhcs.ca.gov; Website: http://www.dhcs.ca.gov/

On February 27, 2020, BlueCross BlueShield of Western New York (BCBSWNY) announced that it entered into a value-based reimbursement (VBR) arrangement with Value Network, LLC, IPA, a network of behavioral health provider organizations in Western New York. The contract includes an upside-risk agreement. Thomas Schenk, M.D., senior vice president and chief medical officer at BCBSWNY, said it is the organization’s “first payment model designed to directly enhance quality care for our members with mental health and/or substance use disorder diagnoses.”

The VBR arrangement with Value Network is based on the BCBSWNY “Best Practice” model, a consumer-centered, population-based care model that reimburses provider organizations based on the full scope of care management. The model uses a per member per month capitated payment along with some fee-for-service payments, specifically in preventive care. The capitation payments are based on historical claims and nontraditional consumer engagement methods such as telehealth. Provider organizations who serve consumers that require more complex care receive additional compensation. Value Network is eligible for bonus payments based on quality outcomes performance. A BCBSWNY spokesperson said the quality targets and metrics for the agreement are based on industry benchmarks around behavioral health care.

Value Network was formed in June 2017, and achieved state approval to become an Independent Practice Association (IPA) in January 2018. It is a collaborative of 23 provider organizations licensed through the New York State Office of Mental Health or New York State Office of Addiction Services and Supports, as well as designated home- and community-based service provider organizations. The network was founded by Howard Hitzel, chief executive officer (CEO) of BestSelf Behavioral Health; Anne Constantino, CEO of Horizon Health; Bruce Nisbet, CEO of Spectrum Health and Human Services; and Elizabeth Mauro, CEO at Endeavor Health Services.

The network has 65 other partners, including hospitals, primary care partners, prevention agencies, care coordination entities, and other organizations. Andrea J. Wanat, vice president of operations for Value Network, said the arrangement aligns with its mission to “design and implement a health service delivery system that improves the quality, cost effectiveness, and overall experience of care in Western New York.” Value Network serves about 70,000 people annually.

For more information, contact:

  • Amber M. Hartmann, Public Relations Manager, Marketing and Communications, BlueCross BlueShield of Western New York, 257 West Genesee Street, Buffalo, New York 14202; 716-887-8962; Fax: 716-887-7911; Email: Hartmann.Amber@bcbswny.com; Website: https://www.bcbswny.com/
  • Bruce Nisbet, Value Network Co-founder, and President and Chief Executive Officer, Spectrum Health and Human Services, 2040 Seneca Street, Buffalo, New York 14210; 716-539-5329; Email: nisbetb@shswny.org; Website: https://shswny.org/

About one-third of consumers have never used a ‘patient portal’ to view their medical records, despite provider organizations’ widespread adoption of the tools. According to an online survey by DrFirst, a health care technology company, individuals who did not use a health portal to access their records gave the following reasons for not using the technology:

  1. Do not know how to access information (37%)
  2. No health information portal offered by their health care professional (31%)
  3. No time to access (18%)
  4. Access process is too confusing (14%)

Additional findings suggest consumers and their families currently do not have satisfactory options for accessing and maintaining health records electronically. Among the findings:

  1. Approximately 59% of consumers say they’ve always been successful getting their requested medical records, either electronically or on paper.
  2. Approximately 19% of consumers report always being able to obtain documents in a digital format, while 81% of consumers report receiving records as a combination of paper and digital.
  3. Almost one-third of consumers who have received health records electronically print and keep a paper version rather than storing the documents on a computer or online.

DrFirst released the survey results in a press release. Respondents were online consumers pre-selected for having requested medical records from a physician or hospital, whether for themselves, or for a family member. The goal was to determine whether health care information portals and other technologies are meeting the needs of consumers.

For more information, contact:

  • Sofia Kosmetatos, Amendola Communications for DrFirst.com, Inc., Email: skosmetatos@acmarketingpr.com; Website: https://drfirst.com/press-releases/drfirst-survey-reveals-that-consumers-still-struggle-to-obtain-medical-records-electronically-despite-widespread-availability-of-online-solutions/

Due to a legal ruling issued on March 4, 2020, the Michigan Department of Health and Human Services (MDHHS) has ceased enforcing the state’s Medicaid Healthy Michigan community engagement participation and reporting requirements for the Medicaid expansion population. The requirement initially went live on January 1, 2020, and the state’s 674,000 non-disabled Medicaid beneficiaries ages 19 to 64 were required to report their work hours of at least 80 hours per month, participation in education, or participation in other approved activities. By the middle of February, MDHHS was preparing to issue warning notices to 80,000 people who failed to report or failed to report sufficient hours. About 90% of those who failed to report meeting the target in January did not report their hours at all. If they again failed to report or failed to meet the target for February and March, they were slated to lose Medicaid coverage on May 31, 2020.

However, on February 14, 2020, a federal circuit court in Washington, D.C., ruled that the federal Department of Health and Human Services (HHS) acted capriciously when it approved Medicaid waivers submitted by Arkansas and Kentucky to impose community engagement and work requirements as a condition of Medicaid eligibility. The Circuit Court upheld a District Court ruling that vacated HHS approval for the waivers.

Michigan’s requirements established in 2018 were very similar to the Arkansas and Kentucky requirements. Since taking office in 2018, Michigan Governor Gretchen Whitmer’s administration sought to repeal the community engagement requirements, but the legislature had refused. Michigan officials believed that the state’s requirements were illegal for the same reasons the district court stated. Given the federal circuit court ruling on February 14, on February 25, 2020, Governor Whitmer’s administration requested a quick court ruling in Michigan’s requirements. The ruling issued on March 4, 2020 means MDHHS cannot enforce the work requirements.

Recently released research had already indicated that about 60% of Michigan’s expansion population was working or enrolled in school during 2017, and would have met the reporting requirements. Additionally, the share of the expansion population participating in activities that would have met the state’s Medicaid community engagement requirements rose between 2016 and 2017, from 54% to 60%. The researchers noted that changes in employment and student status were not associated with improved health status.

The rise in community-engagement participation between 2016 and 2017 was reported in “Association of Medicaid Expansion With Enrollee Employment and Student Status in Michigan” by Renuka Tipirneni, M.D., MS; John Z. Ayanian, M.D., MPP; Minal R. Patel, Ph.D., MPH; et al. The researchers surveyed 4,090 non-elderly, adult Healthy Michigan Plan enrollees from March 1, 2017 to January 31, 2018. The initial survey response rate was 53.7%, and the follow-up survey response rate was 83.4%.

The full text of “Association of Medicaid Expansion With Enrollee Employment and Student Status in Michigan” was published January 31, 2020, by JAMA Network Open. An abstract is available online at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2759843.

A link to the full text of “D.C. Circuit Court Ruling In Gresham v. Azar” may be found at www.openminds.com/market-intelligence/resources/021420greshamvazardcruling.htm.

PsychU last reported on this topic in “Michigan Sued Over Planned Medicaid Work Requirements,” which published on January 20, 2020. The article is available at https://www.psychu.org/michigan-sued-over-planned-medicaid-work-requirements/.

For more information about the MDHHS Medicaid program, contact: 

  • Lynn Sutfin, Public Information Officer, Michigan Department of Health and Human Services, Post Office Box 30195, Lansing, Michigan 48909; 517-284-4772; Email: SutfinL1@michigan.gov; Website: https://www.michigan.gov/healthymiplan/0,5668,7-326-90904_90941—,00.html

For more information about the study findings, contact:

  • Renuka Tipirneni, M.D., MSc, Assistant Professor, Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Building 16, Room 419W, Ann Arbor, Michigan 48109-2800; Email: rtipirne@med.umich.edu; Website: https://ihpi.umich.edu/our-experts/rtipirne

How might the use of marijuana or its components affect behavioral or physical health? During this webinar, Joseph McEvoy, MD, and Heather Davidson, PhD, discuss with Nichole Neugebauer, PhD, the potential risks and purported benefits of marijuana with the goal to inform health care providers and foster open dialogue between health care providers and patients about marijuana. Also examined are the changing regulatory landscape in the United States, the effects of cannabis on the endocannabinoid system, and the benefits and risks of cannabis use for individuals with a mental health condition.

Featuring:

  • Joseph McEvoy, MD
    Professor and Case Distinguished Chair in Psychotic Disorders Augusta University Medical College of Georgia
  • Heather Davidson, PhD
    Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.
  • Nichole Neugebauer, PhD
    Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Joseph McEvoy, MD, is a Professor at Augusta University Medical College of Georgia, where he holds the Case Distinguished Chair in Psychotic Disorders. Dr. McEvoy received his MD and completed his residency in psychiatry at the Vanderbilt University School of Medicine. He is also Director of Public Psychiatry at the Georgia Department of Behavioral Health and Developmental Disabilities at Augusta University and Medical Director of Serenity Behavioral Health Services.

Heather Davidson, PhD, is Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc. Dr. Davidson received her PhD in physiology and neuroscience from the Medical University of South Carolina in Charleston, SC, and completed her postdoctoral fellowship in pharmacology and toxicology at the Medical College of Georgia in Augusta, GA. She has 20 years of experience as a neuroscientist studying the neurobiology of substance use disorders, adolescent brain development, and severe mental illnesses.

Overdose deaths in San Francisco, California, rose by 16% between 2017 and 2018. In 2017, there were 222 overdose deaths, and there were 259 overdose deaths in 2018. During the first six months of 2019, there were 182 overdose deaths. Data for the last six months of 2019 has not yet been released.

These findings were reported in “Drug Overdoses and Drug Use San Francisco Health Commission: February 18, 2020,” and “Interim Report on Poisoning Fatalities from Opioids, Cocaine, and Methamphetamine in San Francisco, 2010-2019,” both by DPH. Researchers for DPH analyzed data from the California Electronic Death Registration System (CA-EDRS) via the Vital Records Business Intelligence System (VRBIS). The goal was to present current trends in San Francisco overdose deaths.

For more information, contact:

  • Jenna Lane, Behavioral Health Communications Specialist, San Francisco Department of Public Health, 101 Grove Street, San Francisco, California 94102; 415-554-2687; Email: jenna.lane@sfdph.org; Website: https://www.sfdph.org/dph/

According to the U.S. Government Accountability Office (GAO), the Department of Veterans Affairs (VA) spending on long-term care services rose by 33%, from $6.8 in 2014 to $9.1 billion in 2018. During this period, the number of veterans using VA long-term care services rose by 14%, from 464,071 in 2014, to 530,327 veterans in 2018. Veteran eligibility for long-term care is primarily based on the extent of a service-connected disability. The VA projects that demand will continue to increase and that spending will double from about $6.9 billion in 2017, to about $14.3 billion by 2037.

VA-provided care ranges from assistance with daily activities of living, to clinical care for spinal injuries or dementia. The VA’s Geriatrics and Extended Care office (GEC) provides, or pays for, long-term care through three institutional programs, and 11 noninstitutional programs. Institutional programs typically provide more acute skilled nursing care in a residential facility. Noninstitutional programs provide care to veterans in their homes or communities. All veterans enrolled in the VA health care system are eligible for the VA’s basic medical benefits package, which includes certain institutional and noninstitutional long-term care services.

Additional findings include:

  • In fiscal years 2014 through 2018, the average daily census increased for two of VA’s three institutional programs: Community nursing homes increased by 26% (from 7,771 to 9,808); and state veterans homes increased by 1% (from 23,176 to 23,423).
  • In fiscal years 2014 through 2018, five of the 11 noninstitutional programs experienced increases in their workload over this period, ranging from 8% to 48%.
  • In fiscal years 2014 through 2018, institutional program obligations declined as a proportion of total obligations, from 74% to 67%, while the proportion of noninstitutional program obligations rose from 26% to 33%.

The GAO concluded that the VA must improve plans for providing long-term care to aging veterans. VA identified that there is not yet a consistent approach to managing the 14 long-term care programs; VA also identified an inconsistent approach in determining the amount of noninstitutional services veterans need, and has developed but not yet implemented a tool for VA medical centers to use to improve that consistency.

VA currently faces three key challenges meeting the growing demand for veteran long-term care: workforce shortages, geographic alignment of care (particularly for veterans in rural areas), and difficulty meeting veterans’ needs for specialty care. Therefore, VA must also develop measurable goals for addressing these challenges in meeting the demand for long-term care.

The GAO also recommended three executive actions to the Secretary of VA. These include:

  • Direct GEC leadership to develop measurable goals in effort to address the three key long-term care challenges listed previously.
  • Direct GEC leadership to set implementation time frames, and successfully implement a consistent GEC structure at VA Medical Centers.
  • Direct GEC leadership to set time frames for, and implement a VAMC-wide standardization of the tool for assessing the noninstitutional program needs of veterans.

These findings were reported in “VA Health Care: Veterans’ Use of Long-Term Care Is Increasing, and VA Faces Challenges in Meeting the Demand,” by the GAO. Researchers for the GAO analyzed VA data and documents on the long-term care programs that are overseen by VA’s GEC for fiscal years 2014 through 2018. VA also conducted interviews with VA officials about the programs. The goal was to describe the use of and spending for VA long-term care.

A link to the full text of “VA HEALTH CARE: Veterans’ Use Of Long-Term Care Is Increasing & VA Faces Challenges In Meeting the Demand” may be found at www.openminds.com/market-intelligence/resources/021920gaovaltc.htm.

For more information, contact:

  • Chuck Young, Managing Director, Public Affairs, U.S. Government Accountability Office, 441 G Street Northwest, Room 7149, Washington, District of Columbia 20548; 202-512-4800; Email: youngc1@gao.gov; Website: http://www.gao.gov/

From 2013 to 2016, private equity firms acquired 355 physician practices. This breaks down to 59 practices in 2013, 72 practices in 2014, 88 practices in 2015, and 136 practices in 2016. These acquisitions included 1,426 sites and 5,714 physicians. There are approximately 18,000 unique group medical practices in the U.S. Each practice has one or more sites.

Additional findings include:

  • The most commonly acquired medical groups were anesthesiology (19.4%), multispecialty (19.4%), emergency medicine (12.1%), family practice (11.0%), and dermatology (9.9%).
  • Within the acquired practices, anesthesiologists represented about 33.1% of all physicians; emergency medicine specialists represented 15.8%; family practitioners represented 9.0%, and dermatologists represented 5.8%.

The researchers concluded the results of their analysis support equity firms’ typical investment strategy of acquiring “platform” practices. These practices have large community footprints (with several sites and many physicians). Equity firms then increase the value of the acquisitions by recruiting additional physicians, acquiring smaller groups, and expanding market reach. They suggest further research to understand the effect of acquisitions by equity firms, and to mitigate unintended consequences of these acquisitions.

These findings were reported in “Private Equity Acquisitions of Physician Medical Groups Across Specialties, 2013-2016” by Jane M. Zhu, M.D., MPP, MSHP; Lynn M. Hua, BA; and Daniel Polsky, Ph.D., MPP. The researchers identified acquisitions by private equity firms through the Irving Levin Associates Health Care M&A data set, then lined those acquisitions to the SK&A data set, a commercial data set of verified physician- and practice-level characteristics for U.S. office-based practices. The goal was to report on acquisitions by private equity firms.

The full text of “Private Equity Acquisitions of Physician Medical Groups Across Specialties, 2013-2016” was published February 18, 2020 by JAMA Network. An abstract is available online at https://jamanetwork.com/journals/jama/fullarticle/2761076.

For more information, contact:

  • Jane M. Zhu, M.D., MPP, MSHP, Assistant Professor, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, Oregon, 97239; Email: zhujan@ohsu.edu; Website: https://ohsu.pure.elsevier.com/en/persons/jane-zhu

The city of Denver’s new strategic framework for improving behavioral health calls for a greater use of data to guide policy to ensure that communities promote well-being, broadly improve access to care, provide early crisis services, and provide integrated and coordinated care. The goal is to improve existing services, systems, and responses to ensure they provide consistent and comprehensive care.

The framework recommends building on the Colorado Health Observation Regional Data Service (CHORDS), a regional partnership among the metro-Denver area public health departments that uses electronic health record data to aggregate medical and behavioral health data from provider organizations. CHORDS uses the data to support public health evaluation and monitoring efforts. To further leverage data to guide behavioral health policy, the framework recommends the following:

  • Develop data collection mechanisms for behavioral health status at the population level, including positive outcomes, as well as data by race, ethnicity, and gender and for people across the lifespan, new parents, immigrants and refugees, and individuals with intellectual/developmental disabilities (I/DD).
  • Develop an official data set for Denver that captures available addiction treatment services and the demand for those services.
  • Improve care coordination by implementing a data-sharing system among providers of mental health care, physical health care, jails, and social services.
  • Enact data sharing agreements that allow multiple stakeholders, including hospitals, medical professionals, and first responders, to enable secure and timely treatment.
  • Increase family and consumer support and education for understanding health data sharing, privacy, and release of information forms.

To improve access to services, the recommendations were as follows:

  • Create a platform for Denver residents to find and access support services based on unique circumstances. Build upon existing tools such as 211 and Colorado Crisis Services.
  • Train community members (e.g., schools, religious groups, workplaces) to recognize behavioral issues in themselves and others and how to engage appropriately.
  • Collaborate with employer groups to implement workforce supports and training.
  • Expand access to supportive services such as housing assistance, food, and transportation.
  • Identify and develop care navigation and coordination plans that address the needs of specific populations.
  • Increase funding opportunities for behavioral health services and other support services to share spaces.

To increase access to integrated, coordinated care, the recommendations were as follows:

  • Expand and support Denver’s behavioral health workforce through multiple strategies, including retain existing clinical professionals; train clinical professionals to offer trauma-informed services that meet the cultural and linguistic needs of different groups; identify pathways to hire individuals with lived experience with mental health and addiction; and boost access to effective supervision models and resiliency and peer support training.
  • Develop a center to provide 24/7 care for people with behavioral health conditions, including access to treatment, social support services, legal services, and transportation.
  • Provide an accessible continuum of addiction treatment that stretches from prevention to treatment to community-based recovery.
  • Align with efforts underway through the Denver Opioid Response Strategic Plan to increase access to harm reduction services and treatment on demand.
  • Eliminate systems-level barriers to providing comprehensive care, such as reimbursement and payment structures that prioritize treating one health issue instead of the whole person, and lack of training in treating addiction and mental health issues together.
  • Promote broad adoption and use of standardized screening and processes for mental health and addiction by all health care facilities in Denver, including primary care, school-based clinics, and emergency departments.
  • Identify and fund supportive, creative strategies that build trust and strengthen relationships between city residents and service provider organizations.

To ensure that crisis behavioral health services are provided early and in appropriate settings, the recommendations were as follows:

  • Establish a first response mechanism that is distinct from law enforcement, fire, and emergency medical professionals to connect people experiencing behavioral health crises with behavioral health provider organizations directly.
  • Support legislation to allow for diversion of people in crisis to appropriate treatment and care rather than sending them to jail or the emergency room.
  • Invest in and adopt alternative crisis response models.
  • Increase the availability and integration of peer support services.
  • Expand training in trauma-informed care for law enforcement, people who work in the criminal justice system, first responders, and others who make up Denver’s behavioral health crisis response system.

The recommendations were issued in “Road To Wellness: A Strategic Framework to Improve Behavioral Health in Denver.” The goal is to provide a roadmap for stakeholders in the behavioral health community to help navigate towards shared objectives around building a healthy community. The city began developing the plan in October 2018 when the mayor convened a steering committee. The committee was charged with scanning the current state of behavioral health services in Denver, identifying gaps, examining best practices, and providing recommendations. During the process, more than 100 individuals and 50 organizations participated to provide input.

A link to the full text of “Road To Wellness: A Strategic Framework to Improve Behavioral Health in Denver” at www.openminds.com/market-intelligence/resources/011420denverroadtowellness.htm.

For more information, contact:

  • Theresa Marchetta, Director, Strategic Communications and Media Policy, City and County of Denver and the Denver Health and Hospital Authority, 1437 North Bannock Street, Room 350, Denver, Colorado 80202-5390; 720-865-9000; Email: Theresa.Marchetta@denvergov.org; Website: https://www.denvergov.org/.

Out-of-network (OON) primary care is associated with higher median quarterly costs for Medicare beneficiaries attributed to a Medicare Shared Savings Plan (MSSP) accountable care organization (ACO). Median per-beneficiary spending for ACO beneficiaries was $401 per quarter between 2012 and 2015. Each percentage point increase in OON primary care spending was associated with a $10.97 increase in total quarterly spending per beneficiary. Additionally, each percentage point increase in OON primary care was associated with quarterly per-beneficiary increases in outpatient costs, skilled nursing facility costs, and emergency department costs. Changes in OON specialty care were not significantly associated with total spending or spending in any specific setting.

About 82% of specialist care for ACO beneficiaries takes place OON. Some ACOs have focused on reducing specialty care. However, the researchers said their findings suggest that ACO administrators may have overlooked the impact of OON primary care in their efforts to reduce OON specialty care.

These findings were reported in “Out-Of-Network Primary Care Is Associated With Higher Per Beneficiary Spending In Medicare ACOs,” by Sunny C. Lin, Phyllis L. Yan, Nicholas M. Moloci, Emily J. Lawton, Andrew M. Ryan, et al. The researchers analyzed national Medicare data between 2012 and 2015 from 1,604,809 unique beneficiaries. The goal was to determine the relationship between out-of-network care and spending.

The full text of “Out-Of-Network Primary Care Is Associated With Higher Per Beneficiary Spending In Medicare ACOs” was published in the February 2020 issue of Health Affairs. An abstract is available online at https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00181.

For more information, contact:

  • John M. Hollingsworth, M.D., MS, Associate Professor of Urology, Management and Policy, School of Public Health, University of Michigan, 2800 Plymouth Road, Building 16, 1st Floor, Room 112W, Ann Arbor, Michigan 48109; 734-763-2797; Fax: 734-232-2400; Email: kinks@med.umich.edu; Website: https://sph.umich.edu/faculty-profiles/hollingsworth-john.html

To improve behavioral health in the United States, Well Being Trust recommends that policymakers adopt a new framework with five engagement points to increase the frequency of behavioral health assessments and better facilitate access to care. The framework includes recommendations to promote mental wellness, prevent and/or treat mental illness, and maintain mental wellness. The five engagement points are health systems, judicial systems, education systems, workplace and unemployment, and “the whole community.” In this framework, promotion and prevention are supported by seven community conditions that provide civic belonging, a thriving natural world, reliable transportation, lifelong learning, meaningful work and wealth, humane housing, and basic needs for health and safety. The framework identifies barriers to behavioral wellness including stigma, cost, social isolation, and problems accessing behavioral health services.

The framework recommends that the federal government take the following five actions:

  1. Ensure that hospital payment models and quality programs encourage a mental health assessment at every interaction, not only during wellness visits. This should include integrating screening and treatment into episode-based payment models for health conditions for which there are frequent mental health co-morbidities, such as cardiovascular diseases, cancers, and pulmonary diseases.
  2. Provide long-term funding for states to continue programs such as Money Follows the Person and the Balancing Incentive Program to ensure that people with intellectual/developmental disabilities (I/DD) and behavioral health conditions have consistent access to comprehensive, high-quality services and support outside of institutional settings.
  3. Increase incentives for individuals to join the mental health workforce and for training programs to actively recruit and effectively train diverse individuals to meet underserved needs and provide more culturally competent care.
  4. Create a seed fund that supports primary care provider organizations, especially Federally Qualified Health Centers and Rural Health Centers, in developing the necessary capacity to begin seeking sustainable reimbursement for integrated mental health care services.
  5. Create incentives in funding programs for municipalities that have created effective policies or strategies for ensuring access to affordable housing.

Additionally, the framework recommends that special considerations be given to focus populations, as follows:

  1. Create incentives for policy reforms that improve school culture and/or student mental health and provide additional financing for schools that implement effective strategies that reduce disparities in belonging and safety for students who identify as LGBTQ, including specialized services for suicide prevention.
  2. Make Medicaid coverage for women up to one-year postpartum a mandatory eligibility category for coverage and include measures of screening and effective coordination of care for maternal behavioral health in hospital incentive programs for care transitions and quality/safety.
  3. Ensure that the Indian Health Service and the Veteran’s Health Administration are engaged in the same reform efforts as the Centers for Medicare & Medicaid Services for mental health and increase funding to build capacity.
  4. Make it impermissible that any information related to the seeking of behavioral health treatment be used in any aspect of immigration enforcement and provide funding to disseminate this information to immigrants and for education about the availability of behavioral health services as part of immigration services.
  5. Allow Medicaid funds to reimburse for the education of housing authorities concerning the risks of housing insecurity and what resources are available to meet those needs.

These recommendations were issued in “Healing the Nation: Advancing Mental Health and Addiction Policy” by Well Being Trust. The framework focuses on multiple angles for engagement with a specific emphasis on five main entry points for policy. It also specifically highlights populations that have been impacted differently by current mental health and addiction treatment crises. In total, the report makes 50 recommendations.

Well Being Trust is a national foundation focused on advancing mental, social, and spiritual health. The organization was created to include participation from organizations across sectors and perspectives to innovate and address mental health challenges facing America, and to transform individual and community well-being.

The full text of “Healing the Nation: Advancing Mental Health and Addiction Policy” was published in January 2020 by Well Being Trust, available online at https://healingthenation.wellbeingtrust.org/.

For more information, contact:

  • Benjamin F. Miller, Psy.D., Chief Strategy Officer, Well Being Trust, 436 14thStreet, Suite 1120, Oakland, California 94612; Email: ben@wellbeingtrust.org; Website: https://healingthenation.wellbeingtrust.org/

On February 13, 2020, the Oregon Health Authority (OHA) launched Family Connects to offer universal home visiting services to all families with newborns up to six months of age, including foster and adopted babies. The state’s current home visiting programs are not designed to reach all families. By offering universal home visiting, the state seeks to make population-level change to address low birth weight, postpartum depression, and other infant and maternal health outcomes.

Through the voluntary program, families will receive one to three visits from a state-licensed registered nurse. Family Connects Oregon is based on the work of Family Connects International. The program will start in eight communities and be phased in statewide over six years. Funding for the program was made available through Oregon Senate Bill (SB) 526, passed by the Oregon legislature in 2019.

The home visiting nurses will collaborate with hospitals and birth attendants to engage parents of newborns, preferably face-to-face, to schedule a home visit prior to leaving the birthing facility. Participation is voluntary; however, evidence shows that about 70% of families offered such services, accept them. Through the program, a nurse home visitor will work with families to identify resources needed from local organizations to provide an individualized program. The support provided includes referral to other, more intensive, home visiting programs, health and social supports around the state, such as obstetric, primary care, and pediatric visits, child-care, mental health services, housing agencies, and lactation support organizations.

Family Connects Oregon will leverage federal Medicaid funding and engage commercial health plans to offer services to all families of newborns regardless of income. SB 526 requires all health plans in the state to reimburse the cost of the universal newborn nurse home visiting services. The coverage must be provided without any cost-sharing, coinsurance, or deductible applicable to the services. The health plan must notify an enrollee about the services whenever an enrollee adds a newborn to coverage. The health plan may use in-network provider organizations or may contract with local public health authorities to provide the services. The health plan can reimburse for the cost of services using any method the health plan and provider organization agree upon, including a value-based payment methodology, a claim invoicing process, capitated payments, or a payment methodology that takes into account the need for a community-based entity providing the services to expand its capacity to provide the services and address health disparities.

The following eight agencies and communities are the first to launch the program:

  1. Clatsop County Department of Public Health.
  2. Eastern Oregon Early Learning Hub, a consortium covering three counties—Baker, Malheur, and Wallowa—with members representing health, K-12 education, social services, early learning programs, and businesses.
  3. The Early Learning Hub of Central Oregon, a partnership between the Crook, Deschutes, and Jefferson counties’ public health departments, the Confederated Tribes of Warm Springs Health & Human Services, and regional early care and education stakeholders.
  4. Four Rivers Early Learning Hub, including Gilliam, Hood River, Sherman, Wasco, and Wheeler counties.
  5. Lane County Health and Human Services Department, Public Health Division.
  6. The Early Learning Hub of Linn, Benton, and Lincoln Counties.
  7. Marion & Polk Early Learning Hub, including Marion County Public Health, Polk County Public Health, Family Building Blocks/Healthy Families, Lancaster Family Medical, and Confederated Tribes of Grand Ronde.
  8. Washington County Public Health Maternal Child & Reproductive Health.

Analysis of the Family Connects International program has shown that the nurse home visiting program has helped families make more connections to community resources in the first six months of a newborn’s life; resulted in more positive parenting behaviors with infants, such as nurturing touch and reading; mothers experienced 28% less clinical anxiety at six months; and had a higher quality home environment. Specifically, the Family Connects program evaluation showed fewer emergency room visits for infants at 6, 12, and 24 months, and an estimated savings of $3.02 for every dollar invested in the program, primarily from reduced infant emergency care.

For more information, contact:

  • Jonathan Modie, Lead Communications Officer, Oregon Health Authority, 800 Oregon Street, Portland, Oregon 97232; 971-246-9139; Email: phd.communications@dhsoha.state.or.us; Website: https://www.oregon.gov/OHA/PH/HEALTHYPEOPLEFAMILIES/BABIES/HOMEVISITING/Pages/Family-Connects-Oregon.aspx.

On February 14, 2020, a federal circuit court in Washington, D.C., ruled that the federal Department of Health and Human Services (HHS) acted capriciously when it approved Medicaid waivers submitted by Arkansas and Kentucky to impose community engagement and work requirements as a condition of Medicaid eligibility. The Circuit Court upheld a District Court ruling that vacated HHS approval for the waivers.

The District Court for the District of Columbia had previously held that HHS had acted in an arbitrary and capricious manner because it failed to analyze whether the waiver demonstrations would promote Medicaid’s primary objective of furnishing medical assistance. Kentucky subsequently ended its demonstration project in late 2019. The Arkansas Works demonstration is ongoing, and requires beneficiaries to participate in at least 80 hours of work or community engagement activities monthly, and to report those hours in a timely manner. Failure to meet the threshold or to report for three continuous months results in loss of Medicaid eligibility for the rest of the year. During the first five months of Arkansas Works, about 25% of those subject to the work requirement lost coverage, representing more than 18,000 people.

The Circuit Court considered whether the HHS authorization of the Arkansas demonstration was legal, and agreed with the District Court that approval of the plan was arbitrary and capricious. The ruling noted that HHS prioritized a non-statutory objective to the exclusion of the statutory purpose of Medicaid. Because the HHS approval of the Arkansas waiver was deemed as such, the Circuit Court affirmed the district court judgment vacating HHS approval.

The Circuit Court noted that instead of analyzing whether the demonstrations would promote Medicaid’s primary objective of providing coverage for health care services, HHS identified the following three alternative objectives:

  1. Whether the demonstration as amended was likely to assist in improving health outcomes;
  2. Whether it would address behavioral and social factors that influence health outcomes; and
  3. Whether it would incentivize beneficiaries to engage in their own health care and achieve better health outcomes.

The opinion noted that while the three alternative objectives point to better health outcomes as the objective of Medicaid, the current Medicaid statutes do not mention that objective, and specifically address only coverage. Additionally, both Arkansas and HHS characterized the HHS approval letter as stating that transitioning beneficiaries away from governmental benefits through financial independence or commercial coverage as an objective promoted by the Arkansas Works demonstration. The Circuit Court said that argument misrepresents the HHS Secretary’s approval letter, which has a section for the determination that the project will assist in promoting the objectives of Medicaid. The letter cites the health outcome goals, but does not mention transitioning beneficiaries away from benefits. The letter has no reference to commercial coverage. The only reference to beneficiary financial independence is in a section summarizing public comments. The letter does not justify the approval based on a belief that the demonstration will help Medicaid-eligible people gain sufficient financial resources to be able to purchase private insurance. The Circuit Court said that while it is not arbitrary or capricious to prioritize one statutorily identified objective over another, it is an entirely different matter to prioritize non-statutory objectives to the exclusion of the statutory purpose.

PsychU last reported on this topic in “From June To November 2018, 17,000 People Lost Arkansas Medicaid Benefits Over Failure To Meet Work Requirements,” which published on February 18, 2019. The article is available at https://www.psychu.org/june-november-2018-17000-people-lost-arkansas-medicaid-benefits-failure-meet-work-requirements/.

PsychU last reported on Kentucky’s effort to implement community engagement requirements in the following articles:

  • “Under Kentucky Medicaid Work Requirements, About 15% Of Non-Exempt Beneficiaries Would Fail To Meet Criteria,” which published as a News Report on September 9, 2019, at https://www.psychu.org/under-kentucky-medicaid-work-requirements-about-15-of-non-exempt-beneficiaries-would-fail-to-meet-criteria/.
  • “Kentucky Announces Cancellation Of Medicaid Managed Care Contracts; To Be Rebid In January,” which published as a News Report on February 10, 2020, at https://www.psychu.org/kentucky-announces-cancellation-of-medicaid-managed-care-contracts-to-be-rebid-in-january/.

For more information about Gresham v. Azar, contact:

  • Andy Diantonio, Communications Associate, National Health Law Program, 1444 I Street NW, Suite 1105, Washington, District of Columbia 20005; Email: dantonio@healthlaw.org; Website: https://healthlaw.org/
  • Kevin De Liban, Attorney and Economic Justice Practice Group Leader, Legal Aid of Arkansas – West Memphis, 310 Mid-Continent Plaza, Suite 420, West Memphis, Arkansas 72301; 870-732-6370, ext. 2206; Email: kdeliban@arlegalaid.org; Website: http://arlegalaid.org/
  • Trevor Hawkins, Staff Attorney, Legal Aid of Arkansas, 714 South Main Street, Jonesboro, Arkansas 72401; 870-972-9224, ext. 6313; Email: thawkins@arlegalaid.org; Website: http://arlegalaid.org/

On February 3, 2020, the Texas Department of Family and Protective Services (DFPS) reported that turnover for its Adult Protective Services (APS) caseworker fell from 25.2% in fiscal year 2018, to 20.7% in fiscal year 2019. Based on data from the first quarter of fiscal year 2020, DFPS believes that turnover could be 17% or lower in fiscal year 2020.

DFPS believes that the decrease in turnover can be partially attributed to three events:

  • A recent legislative decision to provide APS caseworkers and front-line supervisors a raise of $750 a month.
  • More than 40 caseworkers were added to the statewide workforce, and placed in areas with the most need.
  • A mentorship program for APS caseworkers was implemented in the state.

As of August 31, 2019, APS had 512 caseworkers on staff. Of these caseworkers, 97 had been hired within the year prior, 142 had been on staff for one to three years, and 273 had been on staff for more than three years. The Arlington region had the most active caseworkers (103), followed by Houston (97), San Antonio (64), and Austin (56). During fiscal year 2019, both the Beaumont and Tyler regions had 0% turnover. El Paso region (4.8%, with just 1 turnover out of 20.8 average active caseworkers) and Lubbuck (7.1%, with just 2 turnovers out of 28.3 average active caseworkers) join these regions in the lowest turnover rates in the state.

DFPS maintains an interactive webpage with statistics at https://www.dfps.state.tx.us/About_DFPS/Data_Book/Employee_Statistics/APS/Staff_Turnover.asp.

For more information, contact: 

  • Patrick Crimmins, Media Relations Manager, Texas Department of Family and Protective Services, Post Office Box 149030, Austin, Texas 78714-9030; Email: patrick.crimmins@dfps.state.tx.us; Website: http://www.dfps.state.tx.us/

A recent report revealed that from 2010 to 2017, the number of nurse practitioners (NPs) increased from about 91,000 to 190,000, which resulted in the RN workforce contracting by as much as 80,000. RNs returning to school to become NPs is a phenomenon occurring in every region of the country. At the same time, more than one million RNs are approaching retirement.

Additional findings in the report include:

  1. Employment for NPs was concentrated in hospitals, physician offices, and outpatient care centers.
  2. The fastest growth for NP employment overall was in outpatient care centers, which also had the highest salaries.
  3. Growth of NPs was most rapid in the east south-central region of the country, which includes Alabama, Kentucky, Mississippi, and Tennessee.
  4.  It is projected that there will be two NPs for every five physicians in 2030, compared to one NP per five physicians in 2016.

The researchers concluded that hospitals must determine and test new ways to replace RNs who have left their positions to become NPs. Hospitals must also determine solutions in response to low, or fluctuating, RN staffing.

These findings were reported in “Implications Of The Rapid Growth Of The Nurse Practitioner Workforce In The US” by David Auerbach, Peter Buerhaus, and Douglas Staiger, as published in Health Affairs. The researchers analyzed occupational data from the Census Bureau’s American Community Survey (ACS).

The full text of “Implications Of The Rapid Growth Of The Nurse Practitioner Workforce In The US” was published in February 2020 by Health Affairs. An abstract is available online at https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.00686.

PsychU last reported on this topic in “Nurse Practitioners May Represent 27% Of The Family Practice Workforce By 2025,” which published on May 23, 2018. The article is available at https://www.psychu.org/nurse-practitioners-may-represent-27-family-practice-workforce-2025/.

For more information, contact: 

  • David I. Auerbach, Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Anna Pearl Sherrick Hall, Bozeman, Montana 59717; Email: davea@alum.mit.edu; Website: http://healthworkforcestudies.com/about/auerbach.html

Jane Guo, MBA, PharmD, is a Managed Market Liaison­, Northeastern Region, with Otsuka. Her career started in retail pharmacy. She then moved over to managed care at Express Scripts as a Pharmacist Supervisor in front-end operations. At Otsuka, she works on the managed care side as well, focusing on relevant products and on-demand resources. Guo graduated from the Albany College of Pharmacy and Health Sciences with a Doctor of Pharmacy degree, and she has a Master of Business Administration degree from The College of William and Mary.

Guo agreed to be interviewed by PsychU about the clinical and payer implications of the study outlined in “Telemedicine Provision: One State as Case Study,” based on research conducted in Minnesota.

The conversation has been edited for clarity and brevity.

PsychU: What is the hope of telemedicine? What do we want it to do for us?

Guo: Mostly it is the convenience factor. Individuals who live in rural areas and those who seek specialists face difficulty gaining access to services. Telemedicine allows them to connect with a medical professional able to provide quality care.

Also, we are seeing a newer generation of individuals who grew up with technology, and telemedicine may seem natural to them. You have a new mother with a baby, and she can connect with someone who will prescribe antibiotics for an ear infection. She doesn’t have to schedule an appointment and wait a day or more for it, then get in the car, or go to urgent care and sit there for an hour or two. So ease of access and convenience are definitely key.

From a payer perspective, it’s a long-term investment. You have to look at it from that vantage point because you’re seeking to improve overall health by providing better access, which hopefully will lead to lower costs because you have a healthier population.

PsychU: The research study referenced in the summary found that telemedicine was used differently in metropolitan versus rural regions. Could you speak to that?

Guo: Sure. In non-metropolitan areas, it is more about access to specialists, particularly psychiatrists and other mental health care professionals—there is a well-known shortage of them. When I am out in the field, in more rural areas, I hear, “We don’t have the clinicians we need.”

In metropolitan regions, it’s the opposite. In New York City, for instance, what I hear instead is there are plenty of providers, but sometimes it’s just difficult to schedule an appointment and then take time out of your day to go to it. In the city, telemedicine tends to be more about improving access to primary care. The convenience factor, for people on the go.

Another difference the study found was that in rural areas, telemedicine tends to be real-time provider-initiated care; in metropolitan areas, consumers are more likely to initiate the encounter.

In both metropolitan and non-metropolitan locales, I think telemedicine will play a large role in coordinating care.

PsychU: That’s interesting. As you know, our theme for 2020 is bridging the care continuum. How does telemedicine close care gaps and become part of integrated care?

Guo: Well, telemedicine allows a doctor or nurse practitioner to easily put a patient in touch with a specialist. It can be a warm handoff, as opposed to a primary care provider writing a referral to a specialist. That’s when you sometimes lose that patient. By supplementing care—rather than supplanting it—telemedicine care help bridge care gaps.

PsychU: Would you say that alternative payment models that require providers to take on financial risk, such as accountable care organizations (ACOs), foster innovative uses of telemedicine?

Guo: I don’t know if those payment models do or not, but from a quality standpoint, there is an incentive to use telemedicine to improve continuity of care, thereby improving quality of care. When you improve care and outcomes, while managing costs, you get a bigger reward in the form of a better quality ranking or bigger bonus reimbursement from the government.

PsychU: What do you see ahead?

Guo: Increasing buy-in from both patients and providers. For anyone, really, the focus is “What can this do for me?” I think clinicians will increasingly see how telemedicine can improve outcomes efficiently, while being convenient. And it is likely to increase patient satisfaction, another positive attribute. If reimbursement increased, that obviously would drive adoption.

As for individuals, convenience is key. Ease of use will encourage more individuals to try it and hopefully like it.

During 2019, merger and acquisition volume within the United States health care sector dropped by 1.5%, from 1,239 in 2018 to 1,221 in 2019. Total deal value was $91.2 billion in 2019. This is a 26.6% decrease from $66.9 billion in 2018. Health service sub-sectors analyzed include hospitals, home and hospice business, managed care plans, rehabilitation, physician medical groups labs, behavioral care, and “other services.” No definition for “other services” is provided.

Additional findings include:

  • “Hospitals” was the only sub-sector whose volumes grew on a year-over-year basis in each of the last three quarters of 2019. However, the home health and hospice, and managed care plans subsectors also finished the year with a stronger positive volume growth.
  • Three sub-sectors grew in terms of both volume and value: Managed care, long-term care, and hospitals. Additionally, Labs, MRI, and Dialysis deal value grew 503%; however, volume was flat.
  • Four sub-sectors experienced deal value declines: Physician medical groups, other services, behavioral care, and home health and hospice.

These findings were reported in “US Health Services Deals Insights Year-End 2019 Online Report” by PwC. The researchers analyzed publicly announced merger and acquisition transactions in specified sub-sectors. The goal was to compile data metrics and analysis of the announced 2019 mergers and acquisitions in the U.S. health care sector.

The full text of “US Health Services Deals Insights Year-End 2019,” was published in January 2020 by PwC. A free copy is available online at https://www.pwc.com/us/en/industries/health-industries/library/health-services-quarterly-deals-insights.html

For more information, contact:

  • Nick Donkar, Partner and West Region Health Services Deals Leader, PwC US, PricewaterhouseCoopers LLP, 300 Madison Avenue, New York, New York 10017; Website: https://www.pwc.com/us/en/industries/health-industries/health-research-institute.html. 

The number of announced behavioral health acquisitions slowed by 21% between the third and fourth quarters of 2019, from 19 in the third quarter to 15 in the fourth quarter. The fourth quarter 2019 deal volume was 46% below the 28 deals announced for the fourth quarter 2018.

Discovery Behavioral Health was the most active acquirer during the quarter, with a total of three transactions targeting companies specializing in drug and alcohol treatment programs: Authentic Recovery Center in Los Angeles, California; Casa Palmera in San Diego, California; and New Life Addiction Counseling & Mental Health Services in Pasadena, Maryland. Of the 15 announced transactions in the fourth quarter, only one disclosed a transaction price: Thomas H. Lee Partners acquired Centria Healthcare from Martis Capital and Lorient Capital for $415 million.

These findings were reported in “The Behavioral Health Care Acquisition Report 2019” by Irving Levin and Associates. The researchers analyzed publicly announced merger and acquisition transactions and pricing statistics. The goal was to compile data metrics and analysis of the 2019 mergers and acquisitions market.

For more information, contact: 

  • Irving Levin Associates, Inc., 268 ½ Main Avenue, Norwalk, Connecticut 06851; 203-846-6800; Fax: 203-846-8300; Email: info@levinassociates.com; Website: https://www.levinassociates.com/

Sarpy County, Nebraska is planning to open a new 400-bed jail in 2022 that will include space for mental health resources and programs for those about to leave jail. The current jail was designed to hold 148 individuals, and it does not have space for mental health and reentry programs, which are considered best practices. Currently, a jail employee provides case management functions, setting up services and identifying treatment options. Mental health care is currently provided by a contracted medical professional.

Preliminary plans for the new jail include space for community partners who can connect inmates to services that will get them on a path of rehabilitation, reintroduce them to society, and help them avoid recidivism. As the new jail nears completion, the county anticipates evaluating all of its contracts and moving forward with a plan for mental health care. The new jail will also offer flex space in the jail where different service provider organizations, including those offering mental health care and programming, can offer their services to the inmates during and after their time in incarceration.

The next steps are anticipated during early 2020, which include the county approving an architectural agreement, and starting formal design. The county will pay DLR Group more than $4.7 million for design and architectural services. Design of the facility is expected to take between 12 and 18 months, and the facility is slated to open in the fall of 2022. Preliminary estimates put the cost of the new jail facility near $65 million, which includes site preparation, design, and construction.

At the same time it is developing plans for the new jail, Sarpy County is also exploring a options for diverting citizens with mental health disorders from entering jail. The county hopes to establish a partnership with Nebraska Medicine to open a mental health crisis stabilization center on the Nebraska Medicine campus in the county. The center would provide short-term treatment and stabilization for those dealing with mental health crises. However, the partnership negotiations are still on-going. As a result, no firm decisions have been made about the type of facility, services, or size.

For more information, contact:

  • Megan Stubenhofer-Barrett, Sarpy County Communications, 1210 Golden Gate Drive, Papillion, Nebraska 68046; 402-593-4132; Email: mbarrett@sarpy.com; Website: https://www.sarpy.com/; or Chairman Don Kelly, District 1, Sarpy County, Nebraska, 1210 Golden Gate Drive, Papillion, Nebraska 68046; 402-593-2100; Website: https://www.sarpy.com/

A recent biennial data analysis found that approximately 14.6% of adult emergency department visitors were prescribed opioids at discharge during the 2016 to 2017 time period. This is a 6.9% decrease since the 2010 to 2011 time period. Top diagnoses associated with an opioid prescribed at discharge included dental pain, urolithiasis (stones in the kidney, bladder, or urinary tract), fracture injuries, back pain, and extremity pain.

Additional findings include:

  1. The rate of decrease was highest among visits by younger adults aged 18 to 44: from 25.5% in 2010 and 2011, to 15.3% in 2016 and 2017.

These findings were reported in “Trends In Opioids Prescribed At Discharge From Emergency Departments Among Adults: United States, 2006–2017” by Pinyao Rui, MPH, Loredana Santo, M.D., MPH, and Jill J. Ashman, Ph.D. The researchers analyzed data from the emergency department component from the National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is an annual probability sample survey of U.S. hospital emergency departments and outpatient departments, conducted by the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics. The goal was to determine current trends in opioids prescribed at discharge from emergency departments.

A link to the full text of “Trends In Opioids Prescribed At Discharge From Emergency Departments Among Adults: United States, 2006–2017” may be found at www.openminds.com/market-intelligence/resources/122619erdischargeopioidtrends.htm.

For more information, contact: 

  • National Center for Health Statistics, U.S. Centers for Disease Control and Prevention, Hyattsville, Maryland 20782; 800-232-4636; Email: paoquery@cdc.gov; Website: https://www.cdc.gov/nchs/

The Colorado legislature is considering a proposal that would have the state’s Medicaid program reimburse for behavioral health peer support professional services. The legislation, House Bill (HB) 20-1139, was introduced on January 16, 2020. HB 20-1139 intends to add definitions for “peer support professional” and “recovery support services organization” as new types of professionals and provider organizations.

The legislation defines a “peer support professional” as a peer support specialist, a recovery coach, peer and family recovery support specialist, a peer mentor, a family advocate, or a family systems navigator. A peer support professional is an adult age 18 and older who self-identifies as having experienced the process of recovery for mental illness, trauma, or addiction disorder. A “recovery support services organization” is defined as an organization led and governed by representatives of local communities of recovery. Approval from the Colorado Department of Human Services (DHS), Office of Behavioral Health (OBH) will be required to be considered a recovery support services organization. On or before January 1, 2022, recovery support services organizations with OBH approval may bill for services including:

  • Peer-delivered support services
  • Peer-run drop-in centers, recovery and wellness centers, and employment services
  • Prevention and early intervention activities
  • Peer mentoring for children and adolescents
  • Consumer and family support groups
  • Warm lines
  • Advocacy services

The legislation details the specific criteria that OBH will use to approve recovery support services organizations for billing peer support services. It gives DHS authority to establish other criteria and standards as needed.

The bill also creates a state income tax credit for eligible peer support professionals, in which each will receive a refundable tax credit of $1,000. If the amount exceeds the individual’s state income tax liability, the balance of the credit will be refunded to the individual. The credit will be available for tax years 2021 through 2030. However, the tax credit program will be limited to $100,000 per tax year, meaning that credits can be provided to only 100 people annually. OBH will issue the credit certificates in the order they were requested.

To be eligible for the credit, the peer support professional must meet one of the following requirements:

  • Employed in Colorado as a peer support professional at least part-time in the behavioral health sector for at least three years and be enrolled in a undergraduate or graduate degree from an accredited Colorado institution of higher education with at least 12 credit hours per academic year. For these individuals, the credit will be available for four years.
  • Previously employed in Colorado as a peer support professional at least part-time in the behavioral health sector for at least three years, graduated from an accredited Colorado institution of higher education, and have been subsequently employed in Colorado as a behavioral health care professional. For these individuals, the credit will be available for three years.

A link to the full text of “Colorado House Bill 20-1139: Concerning Supporting The Peer Support Professional Workforce” may be found at www.openminds.com/market-intelligence/resources/011620copeersupportbill.htm.

For more information about the legislation, contact the bill sponsors:

  • Yadira Caraveo, State Representative, House District 31, Colorado General Assembly, 200 East Colfax, Room 307, Denver, Colorado 80203; 303-866-2918; Email: caraveo.house@state.co.us; Website: https://caraveoforcolorado.com/
  • Rod Pelton, State Representative, House District 65, Colorado General Assembly, 200 East Colfax, Room 307, Denver, Colorado 80203; 303-866-3706; Email: pelton.house@state.co.us; Website: https://leg.colorado.gov/legislators/rod-pelton

For more information about Colorado Medicaid’s current provisions, contact:

  • Mark Techmeyer, Communications Director, Colorado Department of Human Services, 1575 Sherman Street, 8thFloor, Denver, Colorado 80203-1714; 303-866-5700; Fax: 303-866-5563; Email: mark.techmeyer@state.co.us; Website: https://www.colorado.gov/cdhs

On January 21, 2020, the California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS) began screening inmates at all 35 state institutions for an enhanced integrated substance use disorder treatment (ISUDT) program. The program will offer participants medicated assisted treatment (MAT), comprehensive cognitive behavioral interventions, and safe, therapeutic housing. This initiative will focus on whole-person treatment from incarceration through return to the community.

During roll out, CDCR is focusing on three priority populations; however, an individual not identified in one of these groups can request assessment and treatment. At full capacity, the program will be available to any inmate needing treatment for addiction disorder. The three priority populations are:

  • Those currently receiving MAT
  • Those leaving within 15 to 24 months
  • Those considered high risk due to previous overdose, current clinical symptoms, Hepatitis C, or infections

The ISUDT provides services within the state facilities. CCHCS and CDCR have hired new staff to administer the program, and current staff are also being trained. Contracted cognitive behavioral intervention counselors will use a standardized curriculum based on the American Society of Addiction Medicine criteria.

The CDCR’s plans for ISUDT were noted in “CDCR Vision, Mission, Values, and Goals.” The program is just one method CDCR will use to continue toward the goal of “reflecting the joint priorities of creating a prison environment that provides the incarcerated population with the tools necessary to be drug-free, healthy, and employable members of society upon their release.” Additional steps the CDCR has taken to uphold this goal include:

  • Addressing criminality: The CDCR has increased capacity in cognitive behavioral intervention (CBI) programs focused on criminal thinking, anger management, family relationships, and victim impact by almost 300% since 2015.
  • Career training: The CDCR has more than doubled the capacity of career technical education opportunities for real-world job skills. They have also launched “Microhome” initiatives at the Correctional Training Facility in Soledad, and Folsom State Prison in Sacramento, which provide training for in-demand trades and careers to help individuals succeed when they return to society.
  • College education: The CDCR offers face-to-face community college programming in 34 prisons. A total of 740 people have enrolled, with an additional 200 enrolled in distance learning courses. Face-to-face instruction at Kern Valley State Prison, offered through Bakersfield College, has served 498 individuals.
  • Restorative justice: In 2019, The CDCR awarded grants to eligible non-profit organizations to implement victim impact programs in California prisons. These programs share a common goal of giving victims the opportunity for their voices to be heard, and for incarcerated men and women to fully understand the consequences of their actions.
  • Reentry: Since 2014 and 2015, The CDCR has increased its “Transitions” reentry program capacity 753% from 2,430 to 20,734. Transitions is a five-week program, provided near the end of an individual’s incarceration, to focus on their community reentry needs (such as financial literacy, job search skills, and community resources).
  • Community partnerships: The CDCR cultivates relationships with community partners throughout the state. Through a partnership with CAL FIRE, California Conservation Corps, and the Anti-Recidivism Coalition, CDCR opened an innovative firefighter training program for recently-paroled individuals who served as firefighters while incarcerated.

The full text of “CDCR Vision, Mission, Values, and Goals” was published January 7, 2020. An online copy is available at https://www.cdcr.ca.gov/about-cdcr/vision-mission-values/.

For more information, contact:

  • Krissi Khokhobashvili, Chief, External Communications, Office of Public and Employee Communications (OPEC), California Department of Corrections and Rehabilitation, 1515 S Street, Sacramento, California 95811; 916-445-4950; Email: OPEC@cdcr.ca.gov; Website: https://www.cdcr.ca.gov/
  • Elizabeth Gransee, Communications, California Correctional Health Care Services, Post Office Box 588500, Elk Grove, California 95758; 916-691-6714; Fax: 916-691-6183; Email: Lifeline@cdcr.ca.gov; Website: https://cchcs.ca.gov/

The COVID-19 pandemic isn’t affecting physical health only; it has an impact on mental health as well. In this webinar, Paul Gionfriddo, President of Mental Health America, and Christine Moutier, MD, psychiatrist and Chief Medical Officer for American Foundation for Suicide Prevention, discuss the impact of the novel coronavirus (COVID-19) pandemic on mental health with Stephen Murray, PharmD, MBA, Senior Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

Our speakers examine the effects of social distancing, isolation, and stress of this crisis and their impact on overall health. Dr. Moutier shares her expert advice on self-care tips for providers along with her perspectives on using digital technology to engage patients. Mr. Gionfriddo discusses the effects of this crisis on individuals with underlying mental health conditions and shares some useful tips for family engagement during this period of isolation.

Featuring:

  • Paul Gionfriddo
    President and CEO of Mental Health America & PsychU Stigma Section Advisor
  • Christine Moutier, MD
    Chief Medical Officer at the American Foundation for Suicide Prevention & a Psychiatrist

Paul Gionfriddo is the President & CEO of MHA and a PsychU Stigma Section Advisor. He has worked in a variety of health and mental health-related positions during a career spanning over 30 years. He has served on many local, state, and national nonprofit boards for organizations serving individuals living with mental illness, substance use disorders, and developmental disabilities.

Christine Moutier, MD, is the Chief Medical Officer at the American Foundation for Suicide Prevention. Since earning her medical degree and training in psychiatry at the University of California San Diego, Dr. Moutier has been a practicing psychiatrist, Professor and Dean in the UCSD School of Medicine, Medical Director of the inpatient psychiatric unit at the VA Medical Center in La Jolla.

Nonadherence to medication is a serious problem in mental health care. In this webinar, Dawn Velligan, PhD, and Craig Chepke, MD, will discuss the current state of adherence and the limitations encountered. They will also introduce new technologies that are being used to measure and address adherence, as well as talk about the future state of technological adoption for treatment adherence in behavioral health.

Featuring:

  • Dawn Velligan, PhD
    Director, Division of Community Recovery, Research Training, University of Texas Health Science Center, San Antonio, TX
  • Craig Chepke, MD, FAPA
    Medical Director, Excel Psychiatric Associates, PA, Huntersville, NC

Dawn Velligan, PhD, earned her PhD in clinical psychology from the University of California in Los Angeles. She is the Director of the Division of Community Recovery, Research and Training, and is the Henry B Dielmann Chair of the Department of Psychiatry at the University of Texas Health Science Center in San Antonio. Her internationally recognized research program focuses on developing and testing psychosocial treatments to improve outcomes in patients with schizophrenia.

Craig Chepke, MD, FAPA, attended New York University School of Medicine and completed his residency at Duke University. He is a board-certified psychiatrist and has been named a Fellow of the American Psychiatric Association. He founded Excel Psychiatric Associates and is an Adjunct Assistant Professor of Psychiatry at the University of North Carolina School of Medicine. His research interests include movement disorders, neuropsychiatric conditions, and severe-persistent or treatment-resistant mental illness.

What is the ideal way to provide behavioral health care in a locale where stigma against it runs deep? Integrate behavioral health care into primary care, collocate its delivery with where primary care services are delivered, and try to make it culturally responsive to the population it serves.

That was the conclusion reached by nurse leaders at a clinic offering primary care in a low-income, urban neighborhood. Efforts to provide integrated, coordinated, and culturally responsive primary and behavioral care under one roof are detailed in an article published in the Journal of Community Health Nursing. In  “Using the Omaha System to Evaluate the Integration of Behavioral Health Services into Nurse-Led Primary Health Care” (2020), Jeana M. Holt and her colleagues, all affiliated with the College of Nursing at the University of Wisconsin–Milwaukee, evaluate the success of behavioral health integration efforts using the Omaha System taxonomy. Developed by nurse researchers and in use since 1975, the Omaha System taxonomy captures multiple elements of the patient-provider exchange and is in use across the globe. (See box.)

The Omaha System Taxonomy

Originally developed to record the practices of visiting nurses in Omaha, NE, the Omaha System taxonomy quantifies the holistic aspects of nursing, mapping environmental, psychosocial, physiological, and health-related behavior. In addition to these patient-related factors, the system captures the interventions the clinician performs under these categories:

·         Health Teaching, Guidance, and Counseling

·         Treatment and Procedures

·         Case Management

·         Surveillance

The nurse-led clinic is situated in a federally designated health provider shortage area, and it has been in operation for 30 years. Known locally as a community nursing center, it operates under the auspices of the University of Wisconsin–Milwaukee’s College of Nursing Institute for Urban Health Partnerships, whose mission is to eliminate health disparities.

In 2017 the clinic received federal funding to integrate behavioral health care into its primary care services. Operating in a lower-income African-American community, the clinic worked to normalize behavioral health care services, against which there existed considerable stigma in their patient base; the authors cite multiple studies that have found high levels of stigma about behavioral health conditions and treatment in African-American communities.

Going for the Gold: Integrated, On-Site Primary and Behavioral Care

The clinic’s aim was to provide integrated, collocated care that was:

  • Collaborative and patient centered. Integrated behavioral and primary care delivered under one roof best serves patients’ needs and suits their preferences, the nurse-led care team concluded.
  • Population based. The care team developed workflows that incorporated screening primary care patients for behavioral health needs.
  • Evidence based and measured. Individuals’ scores on behavioral health screening instruments were tracked over time in a patient registry. This data was used to assess if treatments were effective, allowing the care team to take a new approach if warranted.

To accomplish these goals, the care team needed a new balance of providers. The racially diverse care team before behavioral health integration was composed of the following roles:

  • One full-time (FTE) clinical nurse specialist/clinic director = 100% FTE
  • Two part-time family nurse practitioners = 135% FTE
  • Two part-time registered nurse case managers = 40% FTE

After the team was augmented, it looked like this in terms of roles:

  • One full-time (FTE) clinical nurse specialist/clinic director = 100% FTE
  • One full-time licensed behavioral health provider = 100% FTE
  • One consulting psychologist = 10% FTE
  • Two part-time family nurse practitioners = 65% FTE
  • Two part-time registered nurse case managers = 80% FTE

The measurement periods pre- and post-intervention were January 1–December 31, 2016, and January 1–December 31, 2018.

Achievements

The primary clinician team performed a retrospective descriptive analysis of the impact of behavioral health care service integration on the types of health problems identified, treatments provided, and patients’ ratings of several items, including psychosocial health literacy, self-management behaviors, and severity of psychosocial conditions.

The study’s authors say that the patient sample remained consistent over the study period, with about 30% of individuals uninsured and about 64% of individuals on Medicaid. Documented problems, interventions, and outcomes were assessed for a total of 189 primary care patients. From 2016 to 2018, there was an almost tenfold increase—900%—in the number of psychosocial concerns identified. In 2018, there were 50 problems with interpersonal relationships identified among patients; in 2016, none were.

All four intervention categories in the Omaha System taxonomy were used: Health Teaching, Guidance, and Counseling; Treatment and Procedures; Case Management; and Surveillance. In 2018, clinicians identified 2,326 targeted interventions in the psychosocial realm, an increase from 2016 of 266%. Case management was the most often documented intervention category. From 2016 to 2018, the number of documented case management interventions grew from 152 to 1,112, a 631% increase. In this category, the most frequent target for intervention was social work and counseling care, going from 34 in 2016 to 500 in 2018.

Also assessed were primary care patients’ psychosocial health literacy, self-management behaviors, and condition severity outcomes. For this, the clinic team used the 5-point Omaha System Problem Rating Scale for Outcomes. Eighty-seven primary care patients had at least two outcomes ratings in the psychosocial realm over the evaluation period. A paired samples t-test revealed improvement in self-management behaviors with the integrated health team approach. No significant changes were detected in either health literacy or condition severity.

Going Forward

Integrating behavioral health care into an existing primary care clinic achieved dramatic increases in the identification of psychosocial problems for care—a 900% jump. Case management was the most often prescribed intervention, write Holt and her colleagues.

The study’s limitations include the demographics of its patient base, which may limit its generalizability. Another limitation is the pervasive stigma in African-American communities against behavioral health care, which could have depressed the number of patients who accepted behavioral health care recommendations and appointments. Finally, the sample size was small.

Despite these limitations, the authors write that the integration efforts were a success. In addition to the results reported above, the authors note that the integration of behavioral health care services  enhanced the team’s whole-person, whole-health approach to care.

On January 30, 2020, Oklahoma Governor Kevin Stitt announced SoonerCare 2.0, a plan to revamp the state’s Medicaid program by implementing an alternative Medicaid expansion. The plan calls for the Oklahoma Health Care Authority (OHCA) to seek a Medicaid Healthy Adult Opportunity (HAO) waiver to implement a block grant funding structure. The state estimates that there are 220,000 in the expansion population, and that 180,000 are likely to enroll in SoonerCare 2.0.

Oklahoma intends to submit a state plan amendment to expand Medicaid to low-income adults up to 138% of the federal poverty limit, effective July 1, 2020. The state also intends to simultaneously pursue approval from the Centers for Medicare & Medicaid Services for a 1115 waiver that will be synced with health care delivery system reform in 2021. Neither of these documents had been publicly released as of February 23, 2020. Governor Stitt’s announcement said the 1115 waiver will request approval to establish new flexibility through a per person expenditure cap, to charge premiums for the expansion population and to waive retroactive coverage requirements, as well as to pursue community engagement requirements. These policy changes are only for the expansion population: core Medicaid beneficiaries (children; pregnant women; and aged, blind, and disabled) will not fall under these provisions.

Other components of the proposal are as follows:

  • Enhance rural health care access and addiction treatment programs
  • Manage non-emergency medical transportation

The HAO is a Medicaid demonstration initiative launched on January 30, 2020, that provides a range of program and benefit flexibility, including the option for block grant financing. The HAO applies to the Medicaid expansion population of low-income, non-disabled adults under age 65 who are not otherwise eligible for Medicaid. States implementing the HAO will be able to use fee-for-service, managed care, or premium assistance models without obtaining separate waivers or authorities.

For more information, contact:

  • Shelley Zumwalt, Chief of Communications, Oklahoma Health Care Authority, 4345 North Lincoln Boulevard, Oklahoma City, Oklahoma 73105; 405-522-7266; Email: shelley.zumwalt@okhca.org; Website: http://www.okhca.org/individuals.aspx?id=24454.

Residential care settings such as assisted living communities will need to fill more than 1.2 million direct care jobs between 2018 and 2028. This includes filling new jobs, as well as positions that become available as existing workers leave the field or the labor force. There are currently 720,480 positions in residential care settings, and another 500,000 will be added by 2028 to meet the expected demand of 1.2 million. Demand will also be high for in-home care settings. There are currently nearly 2.3 million home-care positions, and another 2.4 million will need to be filled by 2028 to meet expected demand of 4.7 million openings.

Additional findings include:

  1. Nursing homes will need to fill 621,000 direct care positions through 2028.
  2. A total of 720,500 residential care aide positions will need to be filled in assisted living communities, adult family homes, and other community-based residential care settings through 2028.
  3. About 86% of the total 1,203,900 positions to be filled in the direct care workforce through 2028, will be available because of workers leaving the labor force due to retirement, disability or other health-related reasons, or because they move into other occupations.
  4. The median hourly wage for direct care workers in 2018 was $12.07. This is a 2% increase since 2008.
  5. The median annual earnings for direct care workers in 2017 were $20,200.
  6. About 38% of direct care workers receive some form of public assistance.

These findings were reported in “It’s Time to Care: A Detailed Profile of America’s Direct Care Workforce,” by PHI National. Researchers for PHI analyzed data from the Bureau of Labor Statistics’s Occupational Employment Statistics program, and the American Community Survey and Current Population Survey from the U.S. Census Bureau. The goal was to determine trends in direct care worker needs, and estimate future shortages.

A link to the full text of “It’s Time to Care: A Detailed Profile of America’s Direct Care Workforce” may be found at https://phinational.org/wp-content/uploads/2020/01/Its-Time-to-Care-2020-PHI.pdf.

PsychU last reported on this topic in “States Programs To Offset Long-Term Care Costs Need To Address Direct Care Workforce Issues,” which published on September 23, 2019. The article is available at https://www.psychu.org/states-programs-to-offset-long-term-care-costs-need-to-address-direct-care-workforce-issues/.

For more information, contact: 

  • Kezia Scales, Ph.D., Director of Policy Research, PHI National, 400 East Fordham Road, 11thFloor, Bronx, New York 10458; 718-402-7766; Fax: 718-585-6852; Email: kscales@PHInational.org; Website: https://phinational.org/expert/kezia-scale

On February 6, 2020, the City of Los Angeles launched a pilot entrepreneurship program for people with insecure housing or who are homeless. The program, LA: EnterpRISE, will provide entrepreneurship and financial literacy training, as well as access to startup funding opportunities. During the first year about 200 people will be able to participate. Business startup assistance will be offered for any industry of interest to the participants.

Participants will be referred by provider organizations serving homeless and at-risk individuals. The provider organizations will identify those seeking to launch a business and refer them to LA: EnterpRISE. Each participant will receive entrepreneurship training through workshops facilitated by the Mayor’s Office of Economic Development. Upon completion, participants will be referred to one of the city’s WorkSource Centers or BusinessSource Centers. LA: EnterpRISE is a public-private partnership with the Mayor’s Office of Economic Development, the Downtown Women’s Center, Target, the Mayor’s Fund for Los Angeles, and PACE WorkSource/BusinessSource Centers.

The program will expand its long-term training capacity with a year-long “train-the-trainer” program facilitated by FreeFrom, a gender-based violence survivor advocacy organization. FreeFrom will partner with Coalition to Abolish Slavery and Trafficking (CAST) and Safe Place for Youth (SPY) to train facility case managers to function as business start-up coaches. CAST and SPY will each receive $5,000 in program support, which could be used to fund the LA: EnterpRISE participants’ business start-up costs. During the first year, this initiative aims to train 15 case managers, who can then each provide dozens of individuals with entrepreneurial skills training.

The “train-the-trainer” program will be designed and implemented by FreeFrom founder and Chief Executive Officer Sonya Passi. She will serve as the mayor’s 2020 Entrepreneur-in-Residence. In the announcement, Ms. Passi said, “Folks experiencing homelessness possess tremendous resilience, talent, and creative potential that is rarely talked about. If their case managers are equipped with the tools and knowledge to support them in building income through small business creation and self-employment, then they can create their own pathways to financial security and long-term stability.”

For more information, contact:

  • Eric Garcetti, Mayor, City of Los Angeles, 200 North Spring Street, Los Angeles, California 90012; 213-978-1028; Email: lamayornews@lacity.org; Website: https://www.lamayor.org/
  • Sonya Passi, Founder and Chief Executive Officer, FreeFrom, 12405 Venice Boulevard, Suite 422, Los Angeles, California 90066; Email: sonya.passi@freefrom.org; Website: http://www.freefrom.org/

In December 2019, officials in Vigo County, Indiana signed closing documents to allow the construction of a new 500-bed jail facility. Construction of the jail began on December 2, 2019, and is slated for completion by December 2, 2021. The new jail is part of the county’s efforts to resolve long-running litigation about overcrowding and poor conditions at the current jail, which has 268 beds. A federal court concluded the current jail is overcrowded when it exceeds 80%, or 214 inmates, and that the overall condition of the jail violates the inmates’ constitutional rights. As of September 30, 2019, the county’s jail population included 326 housed at the Vigo County Jail and another 33 housed at other county jails.

The construction of the new facility stems from a lawsuit, Jauston Huerta, et al. v. Greg Ewing, et al., filed in 2016 by past and present inmates at the Vigo County, Indiana Jail, and by the American Civil Liberties Union of Indiana. The plaintiffs alleged that the overcrowding and poor conditions violated their rights under the Eighth and Fourteenth Amendments. They sought an injunction, and asked the court to force the county Commissioners and the county Council to “appropriate sufficient funds to repair the present Jail or in the alternative, to mandate the Vigo County Commissioners, and County Council members, to alleviate the present conditions in the Jail or construct a new jail in conformity with recommendations to be made by the Indiana Department of Corrections.” The plaintiffs also requested damages.

On May 19, 2017, the court certified a class for the purposes of declaratory and injunctive relief for all inmates in the care and custody of Vigo County from October 1, 2016 to the present. The class includes current and future inmates incarcerated at the Vigo County Jail or transported to another county jail because the Vigo County Jail is overcrowded. The court found conditions at the Vigo County Jail to be unconstitutional. On October 10, 2018, the court ordered the county to remedy the “ongoing constitutional violations” at the Jail as quickly as possible, and to periodically report steps being taken to address the violations. The county agreed to open a new jail. Under the order, before the new jail opens, the county was required to commit sufficient staff and take all other steps necessary to ensure that all prisoners are offered, at a minimum, at least three hours a week of recreation outside of their cell areas and to commit sufficient staff to make sure that the health and safety of prisoners is safeguarded.

On July 21, 2018, the county released the first part of a required assessment of the jail and the county’s criminal justice system. At a hearing on November 1, 2018, the county submitted a written plan to the court that details the anticipated dates for meeting relevant construction benchmarks, and the opening date of the new jail. The county was also required to submit the population capacity of the new jail and staffing numbers for the new facility.

For more information, contact:

  • Michael Wright, Attorney, Vigo County, Indiana, 127 Oak Street, Vigo County Government Center, Terre Haute, Indiana 47807; Website: https://www.vigocounty.in.gov/
  • Ariella Sult, Media Office, American Civil Liberties Union of Indiana, 1031 East Washington Street, Indianapolis, Indiana 46202; 317-635-4059; Fax: 317-635-4105; Email: asult@aclu-in.org; Website: https://www.aclu-in.org/

Behavioral health services delivered via telemedicine now account for nearly one-third of all telemedicine visits for Excellus BlueCross BlueShield (BCBS), according to a review of the company’s 2019 claims data. In 2018, behavioral health services accounted for less than 25% of all telemedicine visits for this payer.

In late 2019, Excellus BCBS commissioned a survey of upstate New York adults. The survey was conducted by One Research. The survey found that among 2,000 respondents:

  1. The top mental health conditions for which plan members seek telemedicine treatment are generalized anxiety disorders, major depressive disorders, persistent depression (dysthymic disorders), post-traumatic stress disorders, and adjustment disorders.
  2. The top specialists seen via telemedicine for behavioral health treatment include social workers, psychologists, counselors, and nurse practitioners.
  3. About 17% are receiving counseling for a mental health condition.
  4. About 28% of adults are taking medication for a mental health condition.
  5. About 35% say they will consider using telemedicine for treatment of a mental health condition.
  6. About 58% of participants who said they take a medication or are receiving counseling for a mental health condition say they will consider using telemedicine to connect with a health care professional.
  7. Using telemedicine to access behavioral health services is most popular among younger consumers. A review of health plan claims data found that approximately 70% of users are 40 years old or younger. About 25% of users are 20 years old or younger.

Excellus BCBS is a non-profit health insurance company headquartered in Rochester, New York. It is part of the Blue Cross Blue Shield Association. Excellus BCBS serves more than 1.5 million members across 39 counties in upstate New York.

Excellus BlueCross BlueShield released the review findings on February 4, 2020. Extrapolating the health plan’s member claims data to reflect the entire statewide population, Excellus estimates that New Yorkers logged more than 80,000 telemedicine visits for behavioral health services in 2019. The findings can be viewed online at https://news.excellusbcbs.com/news-room/releases/-/asset_publisher/26WPXjKp2c3P/content/use-of-telemedicine-for-behavioral-health-increasing-year-over-year.

For more information, contact: 

  • Jim Redmond, Vice President, Communications, Excellus BlueCross BlueShield, 165 Court Street, Rochester, New York 14647; 585-238-4579; Email: jim.redmond@excellus.com; Website: https://www.excellusbcbs.com/

Seventy-eight unique programs, involving 917 hospitals nationwide, spent $2.5 billion on programs focused on social determinants of health (SDOH) between January 1, 2017 and November 30, 2019. SDOH is defined as topics concerning economic stability (employment, poverty, housing instability, food insecurity); education (early childhood education and development, high school graduation, enrollment in higher education, language, literacy); social and community context (civic participation, discrimination, incarceration, social cohesion); health and health care (access to health care, access to primary care, health literacy); and neighborhood and built environment (access to foods that support healthy eating patterns, crime and violence, environmental conditions, quality of housing). Approximately $1.6 billion was spent on 52 programs that were committed to housing-focused interventions. Additional focus areas for spending include:

  1. About $1.1 billion was spent on 28 employment-focused interventions.
  2. About $476.4 million was spent on 14 education-focused interventions.
  3. About $294.2 million was spent on 25 food security-focused interventions.
  4. About $253.1 million was spent on 13 social and community context-focused interventions.
  5. About $32 million was spent on six transportation-focused interventions.

These findings were reported in “Quantifying Health Systems’ Investment In Social Determinants Of Health, By Sector, 2017–19” by Leora I. Horwitz, Carol Chang, Harmony N. Arcilla, and James R. Knickman. The researchers analyzed public announcements given by U.S. health systems of new programs that had direct financial investments in social determinants of health between January 1, 2017 and November 30, 2019. The goal was to determine total spending on social determinant programs.

The full text of “Quantifying Health Systems’ Investment In Social Determinants Of Health, By Sector, 2017–19” was published in February 2020 by Health Affairs. An abstract is available online at https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.01246.

For more information, contact: 

  • Leora I. Horwitz, Associate Professor, Department of Population Health, New York University Grossman School of Medicine, 227 East 30thStreet, 6th Floor, New York, New York 10016; 646-501-2685; Email: leora.horwitz@nyulangone.org; Website: https://nyulangone.org/doctors/1841334810/leora-horwitz

On December 4, 2019, the New Mexico Human Services Department (HSD) announced it had settled with the last five of the 10 behavioral health provider organizations that sued the state because their Medicaid reimbursements were frozen in June 2013 due to allegations of fraud by the previous administration of Governor Susana Martinez. The five organizations are Santa Maria El Mirador (formerly Easter Seals El Mirador); Border Area Mental Health Services; Southwest Counseling Center, Inc.; Southern New Mexico Human Development, Inc.; and Families and Youth, Inc. They agreed to share a settlement of $10 million.

In 2013, the Martinez administration hired an independent auditor that estimated that 15 behavioral health provider organizations had been overpaid by $36 million over a three-year period. The state said this represented a “credible allegation of fraud” and imposed a Medicaid payhold. The payhold meant that the organizations could not bill for any new Medicaid claims and would not be paid for $11.5 million in unpaid claims submitted before the payhold was imposed. Without the state Medicaid payments, many of the organizations could not sustain operations and went out of business within a few months. In 2015, 10 of the provider organizations sued the state to protest the audit methodology. As of June 2017, HSD, the state Medicaid agency, had held fair hearings with eight of the organizations. An HSD spokesperson said these hearings “established in excess of $5 million in overpayments.” On July 7, 2017, the governor’s office alleged that at least $9.4 million in overpayments were received by the provider organizations. By July 2017, the attorney general’s investigations had cleared each of the organizations; the investigations alleged approximately $1.16 million in overbilling by the organizations, but found no evidence of fraud. The investigation findings were forwarded to HSD for further action.

In 2019, the newly-elected administration of Governor Michelle Lujan Grisham reached agreements with the behavioral health provider organizations. In the settlements, the state admitted no liability, and each organization agreed that it would not appeal or otherwise revive its lawsuit. Additionally, Governor Grisham charged HSD with fixing New Mexico’s “broken” behavioral health care system by working with the New Mexico Behavioral Health Collaborative to build a new behavioral health provider network, develop community-based mental health services for children and families, effectively address addiction disorder, and effectively address the behavioral health needs of justice-involved individuals.

The provider organizations agreed to settle their lawsuits, and to share a $10 million settlement. In addition to the settlement agreement/addendum, three of the organizations will receive additional funds. The settlements are as follows:

  • Santa Maria El Mirador (formerly Easter Seals El Mirador) will receive 29.4% of the $10 million settlement. The organization and its attorneys Davis & Gilchrist, P.C. will also receive $127,240.40.
  • Border Area Mental Health Services will receive 21.4% of the settlement. The organization and its attorneys Davis & Gilchrist, P.C. will also receive $96,201.73. Another $226.27 in fee-for-service amounts will be paid to HSD.
  • Southwest Counseling Center, Inc., will receive 21.4% of the settlement.
  • Southern New Mexico Human Development, Inc., will receive 10.4% of the settlement. The organization and its attorneys Davis & Gilchrist, P.C. will also receive $88,239.79. Another $157.21 in fee-for-service amounts will be paid to HSD.
  • Families and Youth, Inc. will receive 17.4% of the settlement.

For more information, contact:

  • Jodi McGinnis-Porter, Director, Communications, New Mexico Human Services Department, Post Office Box 2348, Santa Fe, New Mexico 87504; 505-476-7203; Email: McGinnis-Porter@state.nm.us; Website: https://www.hsd.state.nm.us/default.aspx
  • Angie Carreón, Executive Assistant, Families and Youth, Inc., 1320 South Solano Drive, Las Cruces, New Mexico 88001; 575-522-4004; Email: acarreon@fyinm.org; Website: https://www.fyinm.org/
  • Southern New Mexico Human Development, Inc., 820 Highway 478, Anthony, New Mexico 88021; 575-882-5101
  • Kathy Luzmoor, Board Chair, Southwest Counseling Center, Inc., 2300 Foothill Boulevard, Rockwell Springs, Wyoming 82901; 307-352-6677; Fax: 307-352-6614; Email: kluzmoor@swcounseling.org; Website: http://www.swcounseling.org/
  • Border Area Mental Health Services, 315 North Hudson Street, #6, Silver City, New Mexico 88061; 575-388-4497; Email: mbonacci@bamhs.com; Website: https://www.facebook.com/nmbamhs/
  • Patsy Romero, Chief Executive Officer, Santa Maria El Mirador, 10 A Van Nu Po, Santa Fe, New Mexico 87508; 505-424-7707; Email: info@eselm.org; Website: https://www.santamariaelmirador.com/

The first-known telepsychiatry-enabled model of perinatal integrated care resulted in a 100% perinatal/postpartum depression screening rate, and a higher than expected treatment engagement rate. About 19% of the mothers screened were found to have perinatal depression and/or behavioral health needs, and about 96% of them started treatment. Available data indicate that only 15% to 20% of mothers receive routine perinatal depression screening, and that of those identified, only 60% start treatment. Perinatal depression is defined as depression during pregnancy or up to one year after giving birth.

The telehealth-enabled integrated care model was implemented within a specialty obstetrics clinic serving an at-risk, socioeconomically disadvantaged population. It consisted of three components:

  • Universal depression screening: The Edinburgh Postnatal Depression Scale (EPDS) was administered at a post-natal appointment for all consumers, and the two-question Patient Health Questionnaire (PHQ-2) was administered at all other perinatal visits.
  • Virtually embedded behavioral health clinical professional (BHC): A BHC was embedded at the clinic via video conferencing to oversee the perinatal screenings, follow up on positive screens and other referrals, support coordination of virtual psychiatric consultation, provide brief intervention and treatment as needed, and refer and coordinate ongoing behavioral health and social services.
  • Virtual integration of telepsychiatry services into an evidence-based collaborative care model in primary care: The BHC served as the coordinator across the care team, consulting with the care team to make diagnostic and medication-related recommendations.

Additional findings include:

  • Under the telepsychiatry-enabled model, 12% of non-twin infants of mothers with perinatal depression were born at a low birth weight. Nationally, about 23.5% of infants of mothers with perinatal depression are born at a low birth weight.
  • Positive intervention outcomes have provided new support for the expansion of telepsychiatry-supported models of integrated care from primary care into specialty care settings.
  • There was evidence demonstrating a bidirectional relationship such that depression was associated with lower rates of breastfeeding. Among those mothers who attended their six-week postnatal visit and were able to breast feed, 85% engaged in breastfeeding.

The researchers concluded that the program improved screening and diagnosis of perinatal behavioral health issues, increased access to treatment and consumer engagement, and improved consumer outcomes. The researchers also noted that telepsychiatry is a potentially effective tool for expanding models of perinatal-integrated care.

These findings were reported in “Evaluation of Telepsychiatry-Enabled Perinatal Integrated Care” by Jay H. Shore, M.D., MPH., Maryann Waugh, M.Ed., Jacqueline Calderone, M.D., Amy Donahue, M.D., Jennifer Rodriguez, LCSW, Danielle Peters, LCSW, Marshall Thomas, M.D., and Alexis Giese, M.D. The researchers collected behavioral health screening data from 712 consumers at an urban women’s clinic, as well as in-depth process and outcome measures for 135 consumers from this same clinic. The goal was to describe the implementation of the first known telepsychiatry-enabled model of perinatal integrated care and to report initial results following implementation.

The full text of “Evaluation of Telepsychiatry-Enabled Perinatal Integrated Care” was published February 5, 2020 by Psychiatric Services. An abstract is available online at https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201900143.

For more information, contact: 

  • Jay H. Shore, M.D., Director of Telemedicine, Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, 13199 East Montview Boulevard, Suite 330, MS F550, Aurora, Colorado 80045; Email: depression.center@ucdenver.edu; Website: https://ttspsworld.com/jay-h-shore-md-mph

Federal legislation signed into law on March 6, 2020 to address national preparation and response to 2019-Novel Coronavirus (COVID-19) includes provisions that waive Medicare restrictions on telehealth for care related to COVID-19. The bill, House Resolution (HR) 6074 – Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, provides a total of $8.3 billion, with $7.76 billion to federal, state, and local agencies to combat the virus and authorizes an additional $500 million to pay for the waivers of Medicare telehealth restrictions. About $2.2 billion is earmarked for activities to prevent virus spread, and another $3 billion is earmarked for vaccine research.

COVID-19 is a new virus that presents with a fever and respiratory symptoms, similar to influenza, from two to 14 days after exposure. The symptoms range from mild to severe. It emerged in Wuhan City, Hubei Province, China. The first infections were linked to a live animal market; however, the virus is now spreading person-to-person. The Centers for Disease Control and Prevention (CDC) says that the virus seems to be spreading easily in the community, meaning that people are infected, but it is not sure how or where they were exposed. Globally, as of March 9, 2020, there had been 109,578 confirmed cases and 3,809 deaths, a death rate of 3.5%. Cases had been identified in 105 countries/territories. On March 13, 2020, the United States declared a national state of emergency due to COVID-19.

The legislation will allow Medicare fee-for-service beneficiaries living in a COVID-19 emergency area (or a portion of such an area) to receive telehealth services related to coronavirus during any portion of any emergency period. Services related to COVID-19 include a virtual check-in to discuss possible COVID-19 symptoms that the beneficiary may be experiencing. If the beneficiary shows more physical symptoms, a subsequent virtual check-in can allow a health care professional to offer recommendations about next steps and precautions that the beneficiary should take before visiting a physician office or hospital. The goal is to keep beneficiaries with mild symptoms in their homes, while increasing access to health care professionals. However, for any other services not specifically related to potential symptoms of COVID-19, Medicare’s normal telehealth restrictions apply. Medicare beneficiaries living in rural areas can continue to use communication technology to have full visits with their health care professionals.

Prior to this bill, Medicare limited payment for telehealth visits to services furnished to beneficiaries in certain types of health care facilities located in rural areas. Beneficiaries in rural areas could not receive telehealth visits in their home except under certain exceptions for the treatment of addiction or a co-occurring mental health disorder, or for monthly clinical assessments related to end-stage renal disease (ESRD).

The telehealth virtual check-ins for COVID-19 are billable services, and the Medicare coinsurance and deductible would apply to these services. The virtual check-ins must be provided by a clinical professional who has an established relationship with the beneficiary or who is in the same practice as the professional who has that relationship. Covered telehealth services can be provided via a smartphone with audio and video capabilities sufficient to provide two-way, real-time interactive communication. Physicians and other authorized clinical professionals may bill for these virtual check-in services furnished through several communication technology modalities, such as telephone (HCPCS code G2012) or captured video or image (HCPCS code G2010).

Medicare also pays for beneficiaries to communicate with their physicians by using online consumer health portals. The individual communications, like the virtual check ins, must be initiated by the beneficiary; however, health care professionals may educate beneficiaries on the availability of this kind of service prior to initiation. The communications can occur over a seven-day period. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G206, as applicable. The Medicare coinsurance and deductible would apply to these services.

For more information, contact:

  • Office of Communications, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 202-690-6145; Fax: 202-260-1462; Website: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
  • Center for the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Email: ncirddvdinquiry@cdc.gov; Website: https://www.cdc.gov/ncird/index.html; or Michelle Bonds, Director, Division of Public Affairs, Office of the Associate Director for Communication, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, MS D-25, Atlanta, Georgia 30333; Email: Media@cdc.gov; Website: https://www.cdc.gov/media/subtopic/contact.htm

On January 1, 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC), in collaboration with Quartet Health, launched a new value-based payment model called Blue Premier Behavioral Health. Behavioral health professionals who meet or exceed quality benchmarks will be able to earn higher reimbursement rates. Independent, outpatient behavioral health professionals who serve members of Blue Cross NC commercial (non-government) plans may enroll by May 31, 2020.

Behavioral health professional performance will be evaluated on a series of measures in three domains: Access, communication with primary care, and health outcomes. The participants can receive a maximum bonus payment of up to 10% of their total behavioral health service reimbursement for the year. For those with quality scores greater than 95%, Blue Cross NC will offer an additional $5,000 bonus. This new value-based payment program is part of Blue Premier, an initiative launched by Blue Cross NC in 2019 to enhance primary care services, integrate behavioral health into primary care, and move to reimbursement based on performance.

This Blue Cross NC value-based payment initiative is using the Quartet Health technology platform to measure quality of behavioral health care. Participating professionals will use Quartet’s technology to facilitate referrals and enable data collection and measurement of quality outcomes. Physicians and case managers can refer consumers for mental health care through the platform. The platform facilitates on-going communication between primary care physicians and behavioral health professionals.

In 2019, Blue Cross NC began efforts to better integrate behavioral health with physical health and to transform health care through value-based payments. This new approach also integrates with Blue Premier, the company’s value-based care program that holds network provider organizations and Blue Cross NC jointly accountable for improving care and lowering costs. As part of the integration efforts in 2019, Blue Cross NC began offering Quartet’s services to primary care and behavioral health provider organizations free of charge.

Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. It serves more than 3.9 million members, including approximately 1.1 million served on behalf of other Blue plans. Kate Hobbs Knutson, M.D., Blue Cross NC head of behavioral health said, “Blue Premier Behavioral Health will expand access, improve coordination with primary care, and help achieve better health outcomes.”

PsychU last reported on this topic in “Sutter Health Teams Up With Quartet Health To Better Integrate Mental & Physical Health Care,” which published on October 16, 2017. The article is available at https://www.psychu.org/sutter-health-teams-quartet-health-better-integrate-mental-physical-health-care/.

For more information, contact:

  • Kevin Kumler, Chief Operating Officer, Quartet Health, 119 West 40th Street, 5th Floor, New York, New York 10018; Email: help@quartethealth.com; Website: https://www.quartethealth.com/
  • Susan Foosness, Senior Business Operations Advisor, BlueCross BlueShield of North Carolina, 1965 Ivy Creek Boulevard, Durham, North Carolina 27707; 984-960-3697; Email: susan.foosness@bcbsnc.com; Website: https://www.bluecrossnc.com/

During 2019, salaries for assisted living community administrators averaged $100,622, up 3.6% over the 2018 average salary of $97,126, according to a year-to-year trend analysis for facilities that participated in salary surveys in both 2018 and 2019. Across all facilities that reported in 2019, the national average administrator salary was $76,939. Across the states, average administrator salaries ranged from $63,452 in North Carolina to $97,349 in Maryland.

At smaller facilities (74 beds or less), administrator salaries averaged $71,882. At facilities with 75 or more beds, administrator salaries averaged $80,676. At for-profit facilities, administrator salaries averaged $74,933. At non-profit facilities, administrator salaries averaged $87,380.

These statistics were reported in the 22nd annual “Assisted Living Salary & Benefits Report” by Hospital & Healthcare Compensation Service. The report was published in cooperation with LeadingAge and supported by the National Center for Assisted Living. The report covers 20 management and 29 non‐management positions. In total, 1,360 assisted living communities participated in the study and provided data for over 87,400 employees. The report includes data from communities structured as assisted living facilities (80%), personal care facilities (5%), and residential care facilities (16%). The data are reported according to for‐profit (86%) and non-profit (14%) status, revenue size, unit‐size, state, and geographic region.

The full text of “Assisted Living Salary & Benefits Report” was published by Hospital & Healthcare Compensation Service. It can be purchased at https://www.hhcsinc.com/hcs-reports.html.

For more information, contact:

  • Rich Cioffe, Client Services, Hospital Healthcare & Compensation Service, Post Office Box 376, Oakland, New Jersey 08436; 201-405-0075, ext. 10; Email: rjcioffe@hhcsinc.com; Website: https://www.hhcsinc.com/

The Arizona Health Care Cost Containment System (AHCCCS) and the three Medicaid managed care organizations (MCOs) for the Arizona Long Term Care System (ALTCS) are implementing initiatives to increase the size of the state’s Medicaid long-term care workforce. The MCO contracts require the MCOs to build a long-term care workforce within their AHCCCS networks.

The ALTCS MCOs are Mercy Care, Banner-University Family Care, and United Healthcare Community Plan. The three organizations were awarded contracts in 2017. ALTCS provides acute care, long term care, behavioral health, home- and community-based services, and case management for two Medicaid populations that are served through separate contracting arrangements. AHCCCS requires in contract that each MCO hire a Workforce Development Administrator to routinely assess the capacity and capabilities of the contracted health care workforce, produce a Workforce Development Plan, and create and support workforce development initiatives that strengthen the long-term care workforce.

The ALTCS population includes nearly 56,000 beneficiaries who are aged 65 and older, blind, or disabled and who are at risk of institutionalization. More than 30,000 ALTCS beneficiaries have developmental disabilities. Their services are provided by UnitedHealthcare Community Plan and Mercy Care under contracts with the Arizona Department of Economic Security (DES) Division of Developmental Disabilities (DDD) effective October 1, 2019. AHCCCS also requires the DDD to have a workforce development administrator to build the long-term care workforce.

The state’s goal is “to ensure that Arizona is prepared to meet the projected need for licensed and unlicensed” caregivers in the coming decades, according to AHCCCS spokeswoman Heidi Capriotti. Ms. Capriotti said the MCO initiatives include supporting innovative high school-based technical education programs, developed by the Arizona Department of Education, that prepare graduating seniors to enter the long-term-care workforce. She also added that AHCCCS supports legislation to require training and testing of direct-care workers and assisted-living caregivers to help increase career mobility and decrease training and hiring costs..

PsychU last reported on this topic in “Arizona Medicaid Announces ALTCS Managed Long-Term Care Contract Awards,” which published on April 3, 2017. The article is available at https://www.psychu.org/arizona-medicaid-announces-altcs-managed-long-term-care-contract-awards/.

For more information, contact:

  • Heidi Capriotti, Media Relations and Public Information Officer, Arizona Health Care Cost Containment System, 801 East Jefferson Street, Phoenix, Arizona 85034; 602-417-4729; Email: Heidi.Capriotti@azahcccs.gov; Website: www.azahcccs.gov.

The Texas Health and Human Services Commission (HHSC) is expanding its Texas Targeted Opioid Response (TTOR) Emergency Medical Service (EMS) Emergency Response pilot program into the Austin area. TTOR uses emergency response services to connect opioid overdose survivors to integrated services needed for long-term recovery. These services include providing individuals, their families, and supportive allies with overdose reversal medication, as well as information on how to reverse an overdose. Those served are offered same-day initiation of medications used to treat opioid use disorder and alleviate withdrawal symptoms. Paramedics and peer recovery coaches also provide ongoing support to individuals to assist in their recovery and engagement in long-term treatment. Paramedics and peer recovery coaches can refer individuals to outside services when needed.

HHSC is working with Austin-Travis County Emergency Medical Services (ATCEMS) to help provide TTOR services. On September 19, 2018, the Substance Abuse and Mental Health Administration (SAMHSA) awarded Texas $46.2 million in State Opioid Response (SOR) funds to extend and expand HHSC’s response to the opioid crisis. On May 6, 2019, the state received a $24.1 million supplemental award under this grant bringing total potential SOR funding to over $116 million over the two-year period.

Since 2018, the state has implemented TTOR in Bexar, Harris, and Williamson counties. Each site receives about $500,000 annually from the HHSC to fund the pilot services. The pilot sites are selected according to various characteristics such as overdose rates, existing community resources, existing infrastructure, and population, to test models that could be easily replicated in other counties. HHSC said in Harris County, 85% of the program’s 500 participants received and remained in treatment for more than 30 days. HHSC will select nine additional pilot sites based on community need, interest, and the ability to implement the program, however a timeline for future implementation has not been established.

The TTOR program was originally created in May 2017. TTOR funding comes to HHSC through federal grants awarded by SAMHSA. Federal grant funding covers the cost of the evidence-based prevention, treatment, and recovery support strategies. As soon as a person participating in an EMS Opioid Response pilot program transitions from the treatment induction phase into long-term treatment, a determination is made whether the cost of long-term treatment is covered by private health care insurance, Medicaid, or if the person is eligible for state-funded treatment. TTOR encompasses four grant opportunities from SAMHSA totaling more than $176 million over the expected funding periods. The funding for all grants is awarded evenly on an annual basis, with the ability to extend contingent on availability of federal funds. The grants include:

  1. State Targeted Response (STR) funds: $54,724,714. This was a two-year grant in effect from May 1, 2017 to April 30, 2019.
  2. SOR funds: $116,589,770. This is a two-year grant in effect from September 30, 2018 to September 29, 2020.
  3. The Texas Strategic Prevention Framework for Prescription Drugs (SPF-Rx) grant: $1,858,080. This is a five-year grant in effect from September 1, 2016 to August 31, 2021.
  4. The Texas First Responders – Comprehensive Addiction and Recovery Act (FR-CARA) grant: $3,200,000. This is a four-year grant in effect from September 30, 2017 to September 29, 2021.

For more information, contact: Lisa Ramirez, Director, Texas Targeted Opioid Response, Texas Health and Human Services Commission, 4900 North Lamar Boulevard, Austin, Texas 78751-2316; 512-380-4955; Email: Lisa.Ramirez@hhsc.state.tx.us; Website: https://hhs.texas.gov/

On February 3, 2020, Epic, an electronic health record (EHR) vendor, asked its health system clients to sign on to a letter urging the federal Department of Health and Human Services (HHS) to modify a pending federal interoperability rule to address concerns about consumer privacy, non-standardized data exchange, lack of protection of the intellectual property of EHR developers, and the proposed implementation timeline for fines. The letter says, “While we support HHS’ goal of empowering patients with their health data and reducing costs through the 21st Century Cures Act, we are concerned that ONC’s Proposed Rule on interoperability will be overly burdensome on our health system and will endanger patient privacy. Specifically, the scope of regulated data, the timeline for compliance, and the significant costs and penalties will make it extraordinarily difficult for us to comply.” Some 60 health systems signed the letter, which was then sent to the federal Department of Health and Human Services (HHS).

HHS is preparing to release two interoperability rules, one from the Office of the National Coordinator of Health Information Technology (ONC) and the other from the Centers for Medicare & Medicaid Services (CMS) to support the 21st Cures Act and MyHealthEData. The ONC proposed rule was released in March 2019; the final rule is expected in early 2020. It had not been released as of February 16, 2020. ONC proposed adopting Health Level Seven’s (HL7®) Fast Healthcare Interoperability Resources (FHIR®) standards as the standard to which developers must certify their application programming interfaces (APIs) and proposes language to support an ecosystem for the secure flow of information. The goal is to promote secure and more immediate access to health information for consumers and their health care professionals. Use of standardized APIs is intended to allow individuals to use smartphones and other mobile devices to easily and securely access structured and unstructured electronic health information.

In the letter, Epic and the health systems recommended that HHS make the following changes to the proposed rule:

  • Allow health systems to hold companies that seek access to consumer data to the same privacy and security standards elsewhere in the health care industry. Health information about family members should not be used or disclosed by non-HIPAA regulated organizations without family members’ knowledge and permission.
  • Standardize data exchange, and focus the rule on the medical and financial data that is most useful to the consumer and can be exchanged in a standardized format. The rule should not require exchange of non-standardized data, even if there are existing APIs.
  • Protect the intellectual property of EHR developers to allow them to continue to innovate for health systems and consumers.
  • Give organizations at least 12 months to prepare before information blocking is enforced and 36 months for development of new technology required by the rule. Further, HHS should allow a grace period for education before fines are levied.

Epic’s letter was signed by the following health systems: Access Community Health Centers; Community Health Center Network, Alameda Health Consortium; Altru Health System; Atrius Health; Adventist Health Portland; Affirmant Health Partners; Lovelace Health System; Arc; UT Health Athens; Ardent Health Services; Bay Health; Buffalo Medical Group; Christie Clinic; Deaconess Health System; Genesis Healthcare System; Catholic Health; Community Health Network; Exact Sciences, Group Health Cooperative, South Central Wisconsin; Charlotte Eye Ear Nose & Throat Associates; Confluence Health; Fresenius Medical Care; Gundersen Health System; Guthrie; HonorHealth; Institute for Family Health; Mercy; UnityPoint Health-Meriter Hospital; Hospital Sisters; HSHS Wisconsin; Iowa Specialty Hospitals & Clinics; Mercy Care; VHS; HSHS St. Clare Memorial Hospital; HSHS St Joseph’s; HSHS Illinois; Mary Washington Healthcare; Mercy Health Services; Middlesex Health; Beth Israel Lahey Health, Mt. Auburn; NYU Langone Health; PeaceHealth; Piedmont Healthcare; Northshore’s Evanston Hospital; OhioHealth; Pembia County Memorial Hospital; Pine Rest Christian Mental Health Services; Norton Healthcare; Parkview Health; Permanente Dental Associates; Prevea Health; River Valley Primary Care Services; Singing River Health System; University Health System; Vancouver Clinic; Riverside; Southcoast Health; Titus Regional Medical Center; UT Health San Antonio; Wellstar Medical Group; Self Regional Healthcare; SSM Health; UHS Inc. and UHS Hospitals; UW Health; and West Virginia University Health System.

PsychU reported on the ONC proposed rule in “HHS Issues A Proposed Rule For API Standards For Electronic Health Information,” which published on April 1, 2019. The article is available at https://www.psychu.org/hhs-issues-a-proposed-rule-for-api-standards-for-electronic-health-information/.

For more information, contact:

  • Epic Systems, 1979 Milky Way, Verona, Wisconsin 53593; 608-271-9000; Fax: 608-271-7237; Email: info@epic.com; Website: https://www.epic.com/
  • Peter Ashkenaz, Media Contact, Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, 330 C Street Southwest, Floor 7, Washington, District of Columbia 20201; 202-260-6342; Email: peter.ashkenaz@hhs.gov; Website: https://www.healthit.gov/topic/laws-regulation-and-policy/notice-proposed-rulemaking-improve-interoperability-health
  • Office of Communications, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 202-690-6145; Fax: 202-260-1462; Website: https://www.cms.gov/

On December 23, 2019, the state of Georgia submitted the Georgia Pathways 1115 Demonstration Waiver and the Georgia Access 1332 State Relief and Empowerment Waiver to the federal government. The 1115 waiver requests approval to implement a partial Medicaid expansion, and impose premiums, copayments, and requirements for community engagement of at least 80 hours per month. Although there are the approximately 408,000 adults in the state who earn less than 100% federal poverty level (FPL) and do not currently qualify for Medicaid, the state estimates first year enrollment at 25,000, and thereafter, at about 50,000 annually.

The population eligible for Georgia Pathways includes parents, caretakers, or guardians with household incomes from 35% to 100% of the FPL who are not currently eligible for Medicaid. It also includes adults ages 19 to 64 without dependent children with household incomes up to 100% of the FPL who are not currently eligible for Medicaid. The state intends to enroll the expansion population into alternative benefit managed care programs operated by its current four Medicaid Care Management Organizations: Amerigroup Community Care, CareSource, Peach State Health Plan, and WellCare.

As a precondition for coverage through Georgia Pathways, potential beneficiaries must meet the income eligibility and must meet a threshold of 80 hours per month of engagement in a qualifying activity such as employment, community service, or education, and have an income less than 100% of the FPL. Georgia Pathways beneficiaries can participate in job training for no more than six weeks during any 12-month period. Community service must be limited to projects that serve a useful community purpose in fields such as health, social service, environmental protection, education, urban or rural redevelopment, welfare, recreation, public facilities, public safety, and child care. Individuals who meet the income eligibility but not the engagement hours requirement will not be enrolled in Georgia Pathways. Short-term exceptions to the monthly hours requirement will be available in the case of a family emergency, birth or death of a family member, serious illness or hospitalization of the beneficiary or a family member, severe inclement weather, and temporary homelessness.

DCH seeks a waiver of non-emergency transportation benefits, and a waiver to retroactive and presumptive eligibility, with the goal of making the benefit package more consistent with commercial plan benefits. However, young adult beneficiaries ages 19 and 20 years will be eligible for Medicaid state plan benefits for Early and Periodic Screening, Diagnostic, and Treatment services.

Beneficiaries earning between 50% and 100% of the FPL will be required to pay premiums and copayments. The premiums, which will not exceed more than 2% of household income, will be deposited into a Member Rewards Account, which the member can use to cover copayments or purchase other health-related items. Failure to pay premiums for three months will result in disenrollment. The waiver will implement a mandatory premium assistance program for employer-sponsored insurance.

A link to the full text of “Georgia Pathways To Coverage 1115 Demonstration Waiver” may be found in at www.openminds.com/market-intelligence/resources/122319gapathwayswaiver.htm.

For more information, contact

  • Fiona Roberts, Press Secretary, Georgia Department of Community Health, 2 Peachtree Street, Atlanta, Georgia 30303; 404-651-7086; Email: fiona.roberts@dch.ga.gov; Website: https://dch.georgia.gov

Sixteen U.S. states allow home health care aides to work only 40 hours per week to avoid violating the Department of Labor (DOL) Home Care Rule. These states include Arkansas, Florida, Idaho, Kansas, Kentucky, Maine, Montana, New Hampshire, New Jersey, New Mexico, Oklahoma, Iowa, Missouri, Tennessee, Virginia, and Wyoming. Thirty-two states allow home care aides to work more than 40 hours per week, but set a cap on the number of hours that can be worked without special permission. In these states, the capped hours typically range from 45 to 50 hours. This variation comes from varied interpretations of the DOL’s rules affecting hours worked for in-home personal care aides who provide home- and community-based services.

Additional findings of a study assessing compliance with fair labor laws for home care aides include:

  • Seventeen states have an exceptions policy for individuals who need more hours of home care service than the state’s cap allows. These states include California, Connecticut, Florida, Georgia, Hawaii, Illinois, Kentucky, Massachusetts, New York, Ohio, Pennsylvania, South Carolina, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. (Specific information on the exceptions policy could not be determined.)
  • Thirteen states allow self-directing program participants exercising budget authority to authorize overtime pay if they have sufficient funds in their budgets to cover the costs. These states include Alabama, Arizona, Colorado, Florida, Georgia, Kansas, Illinois, Louisiana, Minnesota, New Jersey, North Carolina, Texas, and West Virginia.
  • Eleven states allow claiming of the live-in exemption to the overtime pay requirement. These states include Colorado, District of Columbia, Georgia, Illinois, Kansas, New Jersey, Pennsylvania, Vermont, Virginia, West Virginia, and Wisconsin.

The DOL issued the final Home Care Rule on October 1, 2013. This rule was put in place to update regulations concerning the Fair Labor Standards Act of 1938 (FLSA) domestic service employee exemptions. The Home Care Rule extended minimum wage and overtime protections to most home care workers. This ensured that these workers had the same basic wage protections as most United States workers, including those who provide similar types of assistance to people with disabilities residing in nursing homes and group homes.

The U.S. Department of Justice together with HHS’s Office of Civil Rights and, separately, the HHS Centers for Medicare & Medicaid Services issued written guidance regarding this rule. The guidance specifically counseled states to avoid imposing a 40-hour hard cap limiting the Medicaid billable hours per week that workers employed by self-directing program participants would be permitted to work, with no or only very restricted exceptions. The guidance cautioned states that if workers’ hours were limited to 40 per week without hardship exceptions, this could result in putting Medicaid program participants living at home at high risk of requiring nursing home placement or other adverse consequences associated with unmet needs for assistance with daily living tasks. This would violate the Supreme Court’s 1999 Olmstead ruling affirming the rights of people with disabilities of all ages under the 1990 Americans with Disabilities Act. The ruling stated that these people should receive Medicaid or other disability-related publicly-funded services to which they were otherwise entitled in non-institutional settings, unless medically harmful.

These findings were reported in “Analysis Of State Efforts To Comply With Fair Labor Standards Act Protections To Home Care Workers” by Pamela J. Doty, Ph.D., and Marie R. Squillace, Ph.D., of the Office Of The Assistant Secretary For Planning And Evaluation (ASPE) within the U.S. Department Of Health And Human Services, and by Edward Kako, Ph.D., of Mission Analytics Group, Inc. The researchers first conducted interviews with a home health care stakeholder group to gather information. The researchers then collected data on self-directed home care programs from the period January 2017 through July 2019. Case studies were also conducted to illustrate both state variations in FLSA implementation and adoption of promising practices. The goal was to describe and document changes states have made to their Medicaid or other publicly-funded consumer directed home care programs for seniors and individuals with disabilities to comply with the 2013 update to FLSA regulations.

A link to the full text of “Analysis Of State Efforts To Comply With Fair Labor Standards Act Protections To Home Care Workers” may be found at www.openminds.com/market-intelligence/resources/010820aspeflsahomecarestatecompliance.htm.

PsychU last reported on this topic in “DOL Opinion Allows Pay For Home Health Aides To Vary Weekly As Long As Meeting Minimum Wage Standards,” which published on February 11, 2019. The article is available at https://www.psychu.org/dol-opinion-allows-pay-home-health-aides-vary-weekly-long-meeting-minimum-wage-standards/.

For more information, contact:

  • Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health & Human Services, 200 Independence Avenue Southwest, Room 415F, Washington, District of Columbia 20201; 202-690-7858; Website: https://aspe.hhs.gov/

On November 21, 2019, the U.S. Department of Justice (DOJ) indicted four former employees of Outcome Health—including the two co-founders and two former executives—for defrauding the company’s clients, lenders, and investors of an estimated $1 billion. Prior to January 2017, the company was known as ContextMedia. It sold digital advertising in physician offices; most of its clients were pharmaceutical companies. The defendants are accused of selling millions of dollars of advertising inventory from 2011 to 2017 that did not exist, which inflated its financial statements. The DOJ alleged that the former executives used the inflated financials to raise nearly $1 billion in debt and equity financing in 2016 and 2017.

Outcome Health itself is not under indictment; it entered a Non-Prosecution Agreement (NPA) with the DOJ on October 30, 2019. After the fraud surfaced, Outcome Health engaged in “extensive remedial measures” including requiring the co-founders to give up all financial interests in the company or representation on the company’s board, and retaining a new management team. Additionally, Outcome Health provided more than $65 million in restitution to its client pharmaceutical companies.

The company provided physician practices with free waiting-room video screens, consumer-education tablets, wallboards, wi-fi access points, and free health education content. The platform provided consumers at the physician practices with health care information and advertising. The content library included assessments, 3D anatomical models, recipes for healthy living, and information about treatment options. ContextMedia/Outcome Health generated revenue by selling ads on the platform.

The DOJ alleged that Outcome sold advertising inventory—digital tablets in physician offices—that the company did not have, and then under-delivered on its advertising campaigns. Outcome allegedly invoiced its clients as if it had delivered in full. The indicted former executives and employees are accused of concealing the under-deliveries by falsifying affidavits and proofs of performance to make it appear that Outcome was meeting its contract requirements. The defendants allegedly inflated consumer engagement metrics for how frequently consumers in the physician offices engaged with Outcome’s tablets that provided health education and targeted advertising. Additionally, some of the contracts included return on investment (ROI) guarantees. One of the defendants is accused of altering studies presented to clients to make it appear that the digital campaigns were more effective than they actually were.

The under-delivery resulted in a material overstatement of Outcome’s revenue for 2015 and 2016. The company’s outside auditor signed off on the 2015 and 2016 revenue numbers because the indicted individuals fabricated data to conceal the under-deliveries from the auditor. The inflated revenue figures in Outcome’s 2015 and 2016 audited financial statements were allegedly used to raise $110 million in debt financing in April 2016, $375 million in debt financing in December 2016, and $487.5 million in equity financing in early 2017. The co-founders were allegedly paid dividends totaling $37.7 million on the $110 million debt financing. The $487.5 million equity financing allegedly resulted in a $225 million dividend to the co-founders.

On November 7, 2017, the investors sued the founders of the Company and related entities following a report that from 2014 through 2016 the company misled advertisers about the number of physician offices using the health education platform. The lawsuit, Global Private Opportunities, et al., v. Rishi Shah; Outcome Holdings, LLC; ContextMedia Health Holdings, LLC; Outcome, Inc.; Gravitas Holdings, LLC; and Shradha Agarwal, came after the company had announced on September 27, 2017 that its network included more than 140,000 installed devices, and that it had also recently received independent certification from BPA Worldwide iCompli that the platform size estimates and audience qualification complied with industry standards. On October 19, 2017, Outcome Health announced it was taking steps to ensure transparent and accurate impression measurement. On November 15, 2017, the company announced it had joined the IAB, a large trade association for digital advertising and marketing comprised of more than 650 media and technology companies that sell, deliver, and optimize digital advertising and marketing campaigns.

A link to the full text of “October 17, 2019 Letter From the DOJ Regarding Outcome Health” may be found at www.openminds.com/market-intelligence/resources/101719dojletterreoutcomehealth.htm.

A link to the full text of “Department Of Justice Indictment Of Former Outcome Health Employees” may be found at www.openminds.com/market-intelligence/resources/112119outcomehealthindictment.htm.

A link to the full text of the 2017 investor lawsuit, “Global Private Opportunities, et al., v. Outcome Health, et al.,” may be found at www.openminds.com/market-intelligence/resources/110717lawsuitoutcomehealth.htm.

For more information about Outcome Health, contact:

  • Kendall Day, Partner, Gibson, Dunn & Crutcher, LLP, 1050 Connecticut Avenue Northwest, Washington, District of Columbia 20036-5306; Email: kday@gibsondunn.com; Website: https://www.gibsondunn.com/lawyer/day-m-kendall/.

On Jan. 17, 2020, the Department of Veterans Affairs (VA) proposed a rule that will ease compliance requirements for faith-based organization social service contractors. Currently, faith-based organization contractors are required to refer potential beneficiaries who object to the provider organization’s religious character to other organizations. The faith-based organizations must also post notices about this referral procedure. However, other contractors are not required to follow similar procedures about their referral policies. The proposed rule eliminates the referral notice requirements.

Comments on the proposed rule, “Equal Participation of Faith-Based Organizations in Veterans Affairs Programs: Implementation of Executive Order 13831,” will be accepted through Feb. 18, 2020. VA says the goal is to ensure that its social service programs are implemented in a manner consistent with the requirements of federal law, including the First Amendment to the Constitution and the Religious Freedom Restoration Act.

The proposed rule language clarifies that a faith-based provider organization participating in VA-funded programs or services can retain its autonomy, right of expression, religious character and independence from government (federal, state or local). None of the guidance documents that VA or a state or local government uses to administer VA’s financial assistance shall require faith-based organizations to provide assurances or notices where similar requirements are not imposed on secular organizations. Any restrictions on the use of grant funds shall apply equally to faith-based and secular organizations.

Additionally, VA’s notices or announcements of award opportunities and notices of awards or contracts will include language clarifying the rights and obligations of faith-based organizations that apply for and receive federal funding. The language will clarify the following:

  • Faith-based organizations may apply for awards on the same basis as any other organization.
  • VA will not discriminate against an organization based on the its religious exercise or affiliation.
  • Any faith-based organization that participates in a federally funded program retains its independence from the government and may continue to carry out its mission consistent with religious freedom protections in federal law.

A link to the full text of “Equal Participation of Faith-Based Organizations in Veterans Affairs Programs: Implementation of Executive Order 13831” may be found at www.openminds.com/market-intelligence/resources/011720vaprfbo.htm, and https://www.whitehouse.gov/presidential-actions/executive-order-establishment-white-house-faith-opportunity-initiative/.

For more information, contact:

  • Conrad Washington, Acting Director, Center for Faith and Opportunity Initiative, Office of Public and Intergovernmental Affairs, Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, District of Columbia 20420; 202-461-7689; Website: https://www.va.gov/cfbnpartnerships/
  • Public Relations, U.S. Department of Veterans Affairs, 810 Vermont Avenue Northwest, Washington, District of Columbia 20420; 202-461-7600; Email: va.media.relations@va.gov; Website:https://www.va.gov/. 

For 2020, about 2% of eligible clinical professionals participating in the Medicare Merit-based Incentive Payment System (MIPS) earned a negative payment adjustment ranging from -0.01% to -5.00%. The remaining 98% of MIPS participants received a positive or neutral payment adjustment, ranging from 1.68% to 0.00%, based on their 2018 MIPS performance data. The Centers for Medicare & Medicaid Services (CMS) noted that the positive payment adjustment received in 2020 is modest because under current law, the positive and negative payment adjustments must be budget-neutral. In general, if a clinical professional is eligible for MIPS, they will choose whether to participate at the individual or group level.

CMS reported the 2018 Quality Payment Program (QPP) performance results and payment adjustments in a January 6, 2020 blog post. In total, 889,995 clinical professionals received a MIPS payment adjustment in 2018, either positive, neutral, or negative. Of the total number of clinical professionals receiving a payment adjustment, 872,148 MIPS eligible clinical professionals will receive a neutral or positive payment adjustment through their individual, group, or Alternative Payment Model (APM) participation.

In total, 183,306 eligible clinical professionals earned Qualifying APM Participant (QP) status under the Advanced APM track of the QPP. Another 47 eligible clinical professionals received partial QP status during 2018. In 2017, the number of eligible clinical professionals who met QP status was 99,076 and partial QP status was 52.

CMS noted significant successes in MIPS participation during the second year of the program. The MIPS participation rate was higher in 2018 than in 2017, which was the first year of the program. More clinical professionals avoided a negative payment adjustment, 2% in 2018 compared to 5% in 2017. The overall national average and median MIPS scores increased from 2017. Additionally, those who participated in MIPS through an APM had a mean score of 98.77 and a median score of 100.

Based on MIPS 2018 data, the payment adjustments were as follows:

  • 84% of MIPS eligible clinical professionals received an additional adjustment for exceptional performance (with scores of 70.00 to 100.00 points). The minimum payment adjustment for this group was 0.21% and the maximum was 1.68%.
  • 13% of MIPS eligible clinical professionals received a positive adjustment for earning between 15.01 and 69.99 points. The minimum payment adjustment was 0.00% and the maximum was 0.20%.
  • No MIPS eligible clinical professionals earned 15.00 points to earn a neutral payment adjustment of zero.
  • 2% of MIPS eligible clinical professionals earned 0 points to receive a negative payment adjustment ranging from -0.01% to -5.00%.
  • 97% of MIPS eligible clinical professionals in rural practices received a positive payment adjustment, compared to 93% in 2017.
  • 84% of MIPS eligible clinical professionals in small practices received a positive payment adjustment, up from 74% in 2017.

MIPS is one track of the QPP established to implement certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MIPS requires eligible clinical professionals to submit performance data on certain measures and activities in four categories: Quality, Cost, Improvement Activities, and Promoting Interoperability. Performance in the four categories determines whether participating MIPS eligible clinical professionals receive a positive, neutral, or negative adjustment to their Medicare part B allowed charges for covered professional service under the Physician Fee Schedule. Three of the four performance categories allow the MIPS eligible clinical professional to choose the measures and activities they report. In the 2017 and 2018 performance years, MIPS eligible clinical professionals included physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, osteopathic practitioners, and chiropractors who billed Medicare Part B covered professional services. MIPS eligible clinical professionals who did not participate in MIPS for the 2017 performance period were subject to a negative 4% payment adjustment in 2019.

The CMS announcement is posted online at https://www.cms.gov/blog/2018-quality-payment-program-qpp-performance-results (accessed January 22, 2020).

For more information, contact

  • Office of Communications, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 202-690-6145; Fax: 202-260-1462; Email: press@cms.hhs.gov; Website: https://www.cms.gov/.

This fact sheet provides an overview of long-acting injectable antipsychotics and the advantages/disadvantages associated with this treatment option.

Serious mental illness (SMI) is a disabling condition—and because it develops early in life, it brings with it a lifetime of costs. But while researchers have long believed that early intervention for SMI has lifelong benefits for patients, there has been little evidence that weighs whether these efforts can be considered cost effective.

This led a team of researchers and scientists to employ a simulation model to attempt to estimate the lifetime costs of SMI for patients diagnosed by age 25. In “Measuring the Lifetime Costs of Serious Mental Illness and the Mitigating Effects of Educational Attainment,” these scholars provide current outcome statistics and present their methodology and the conclusions for measuring the potential economic effect of early intervention.

SMI’s Effects and the Intervention Opportunity: A Quick Overview

As noted, serious mental illness (SMI)—including psychoses, major depressive disorder, and bipolar disorder—is disabling and costly, with an economic impact that is similar to that of cancer and diabetes. And since it is often diagnosed between the ages of 15 and 30, SMI carries other costs, too. It impacts educational attainment and dropout rates, employment status, annual earnings, and even life expectancy, with previous reports documenting anywhere from 10 to 30 years of potential life lost.

But the trend toward early diagnosis and treatment of SMI as a means to improve patient-based and economic outcomes has continued to grow. Potential strategies integrate patient-centered interventions—such as addressing substance use disorders and relationship issues—with clinical trials that demonstrate the benefits of early interventions like medication management, family involvement, and education/employment support. Indeed, a variety of studies have shown such positive early intervention outcomes as:

  • Improved quality of life
  • Reduced depression
  • Increases in academic enrollment, course completion, and employment

However, evidence that defines the economic impact of these interventions has been limited.

Research Aimed at “Filling the Gap”

Based upon findings of various studies, it might be logical to infer that intervention strategies resulting in increased educational attainment and employment could improve the quality of life and reduce the lifetime financial burden of people with SMI. In fact, policy makers in the United States have been actively exploring potential strategies.

But efforts may be hindered because long-term benefits of these strategies have not been measured—and there is limited evidence of these interventions’ long-term return on investment (ROI). Researchers Seth A. Seabury et al. have thus attempted to fill that gap by providing new data on the lifetime benefits of improving educational or employment outcomes for people who experience SMI early in life, using a research model to project the impact on health and economic outcomes.

A Brief Look at Methodology

With the growing emphasis on early identification and treatment of mental illness to help improve long-term health and economic outlooks, the research team sought to obtain evidence via simulated differences in life expectancy, quality of life, medical spending, and economic outcomes.

The research team simulated lifelong outcomes using the Future Americans Model (FAM), a dynamic microsimulation model that uses data on Americans ages 25 and older to project health, medical spending, social service use, and economic outcomes over time. FAM builds estimates based on the paths of individual health and economic outcomes rather than on average characteristics—thus allowing for more accurate estimations.

FAM combines data from several large, nationally representative surveys. As a result, it enabled the research team to:

  • Estimate transitions between health state;
  • Project health care spending; and
  • Assess quality of life.

FAM also allowed the team to compare people with a self-reported diagnosis of SMI by age twenty-five to those without a diagnosis of SMI by age twenty-five, including those diagnosed later in life.

How FAM Was Used

The model measured transition probabilities for specified health states based upon predictors such as age, gender, and health condition as derived from questions in the nationally representative Panel Study of Income Dynamics (PSID).

Detailed information on simulation scenarios, trial details, and study limitations can be found in the report referenced below.

Simulation Revealed Key Findings

While outcomes varied based upon educational attainment, the overall findings during one year of simulation showed that those with an SMI diagnosis by age 25:

  • Have lower educational attainment. In the simulation, about 23.4% had less than a high school diploma, compared to 11.3 percent for those who never developed SMI.
  • A re more likely to be female and white. They also had more restrictions to activities of daily
  • Have a lower life expectancy. The average life expectancy from age 25 was 45.7 years—10.4 years (19%) lower than those without SMI by age
  • Have substantially higher lifetime medical spending. Total lifetime medical spending was $96,500 (24%) higher, even though people with SMI are much more likely to be on Medicaid or uninsured.
  • Earn substantially less over their lifetime. Earnings were an average of $537,100 (48%) less per person, with 2 (55 %) fewer years of full-time work. This also corresponded to increased lifetime benefit payments of 500% for Social Security Disability Insurance and 809% for Supplemental Security Income (SSI).

What Comes Next?

While early intervention to improve the educational attainment of people with SMI has clear benefits, interventions can be costly. But at the same time, a significant number of Seabury et al.’s simulations also demonstrated that, at least in part, early intervention can reduce the high economic burden.

Recap: The Opportunities and the Challenges

Overall, the simulation’s findings highlight both the opportunities and the challenges to improve SMI’s economic outcomes.

The Good News

  • An estimated $1.85 million per-patient cost can be reduced by $73,600 through use of an education-based intervention. Indeed, SMI patients as a whole experience nearly a quarter of a trillion dollars in economic burden, and improvement in educational attainment would reduce that by over $8.9 billion.
  • Relatively low-cost interventions that focus on helping young SMI patients enroll in school and have accommodations from/interaction with teachers and administrators can have large impacts on school participation.

The Challenge

While intervention can flexible and implemented across a variety of geographic settings (urban, suburban, and rural), these gains would be spread across many years, which suggests:

  • The potential need for public investment or subsidy
  • The hiring and training of additional providers

Many assessments of intervention programs focus on outcomes that can’t easily measure long-term effects, but Seabury et al.’s work has provided new evidence.

And resulting from their generally optimistic findings, the Seabury et al. team urges that future interventions and evaluations should use objective and clearly defined outcome measures that can be linked to publicly available data sources.

This, in turn, could foster additional measurement of the long-term economic impact of early interventions—and, potentially, provide further evidence that supports their adoption and leads to lifelong benefits for SMI patients.

This summation was developed independently of the authors.

The year after Cascadia Behavioral Healthcare (Cascadia) implemented a certified Community Behavioral Health Clinic (CCBHC) integrated care model, the number of emergency department (ED) visits was reduced by 18% and inpatient admissions by 23% among individuals who’d previously utilized the ED or inpatient facilities. Before implementing the CCBHC integrated care model in 2017, Cascadia reported 3.74 ED visits/inpatient admissions per consumer for April 2016 through April 2017. After becoming a CCBHC, Cascadia reported 3.07 ED visits/inpatient admissions per consumer for 2018. Cascadia reported the outcomes on December 17, 2019.

Cascadia anticipates that the reduction will result in substantially lower annual health care costs. The cost savings estimates are based on data from HealthShare, one of the state’s Medicaid coordinated care organizations (CCO). The CCO tracks ER utilization for adults age 18 and older with mental illness as a quality measure to reduce disparity in outcomes. The goal is to reduce the disproportionately higher emergency department utilization among those experiencing mental illness by increasing awareness and engagement with appropriate points of primary and mental health care. ED visits for mental health and chemical dependency services are not included in the ED visit count.

As a CCBHC, Cascadia introduced care coordination and primary care services to its continuum of care. Cascadia currently serves over 3,700 consumers.

Cascadia’s Chief Medical Officer Jeffrey Eisen said “These are significant results that support the need for continued funding for the CCBHC model, which has enabled an integrated care approach for our clients. By providing preventative and proactive services, we can significantly change quality of care and health outcomes for individuals, as well as reduce financial strain on our health care system and our payers.” Cascadia is continuing to refine its integrated model through population health efforts that emphasize diabetes management, chronic pain management, decreased emergency department utilization and medical admissions, and tobacco cessation.

For more information, contact:

  • Jennifer Moffatt, Senior Director of Communications, Cascadia Behavioral Healthcare, Post Office Box 8459, Portland, Oregon 97207; 503-402-8117; Email: jennifer.moffatt@cascadiabhc.org; Website: https://cascadiabhc.org/

Cigna reports its commercial members with integrated medical, pharmacy, and behavioral benefits had annual medical costs of averaging $207 less per covered life than members enrolled in non-integrated plans. For Cigna members with health improvement opportunities (such as weight management and smoking cessation), being enrolled in a plan with integrated benefits reduced annual medical costs by an average of $850 per person.

Per-person savings were realized for members with more intensive health needs who were enrolled in a combined plan. Per-person savings attributable to the combined plan totaled $7,372 for members with conditions requiring a specialty medication. For members with an oncology diagnosis, per-person savings totaled $11,679 and their inpatient oncology costs were 24% lower.

Members of Cigna’s integrated plans also were found to have:

  • 17% higher engagement in wellness programs including counseling for conditions such as diabetes and heart disease; lifestyle or wellness coaching to help with weight management and smoking cessation; and personal case management for complex conditions such as rheumatoid arthritis or cancer.
  • 32% lower mental health readmission rates.
  • 18% fewer out-of-network behavioral claims.
  • 5% higher utilization of in-network high-performing provider organizations.
  • 4% lower out-of-network claims.
  • 15% higher treatment rate for opioid misuse, and 30% reduction in subsequent post-treatment overdoses compared to the previous year.

Cigna reported these findings as the key outcomes of its fourth annual 2019 Value of Integration report. These findings are based on a two-year internal analysis of more than 2.3 million claims from Cigna customers who receive coverage through their employer. Half of the population had comprehensive medical, behavioral, and pharmacy benefits administered by Cigna, while the other half had only medical benefits with minimal behavioral benefits administered by Cigna. Customers were matched between the two groups on key attributes, including demographics, health condition, access to health improvement services, plan design, and geographies. The study methodology was reviewed and validated by KPMG LLP in 2018. However, KPMG did not conduct an independent analysis to verify any results, and KPMG did not audit the data or the programming code used to conduct the study.

Based on the findings, Cigna asserts that with connected medical, pharmacy, and behavioral health benefits customers are more engaged in their health and well-being and are more likely to stay in-network for their care. Cigna also believes that consumers enrolled in a plan with integrated benefits are more informed about their care options.

Cigna reported the 2019 Value of Integration report findings at https://www.cigna.com/newsroom/news-releases/2020/combining-medical-pharmacy-and-behavioral-benefits-delivers-annual-savings-of-more-than-850-per-customer-with-an-identified-opportunity (accessed January 23, 2020).

For more information, contact:

  • Meaghan MacDonald, Enterprise Media Relations, External Communications, Cigna Corporation, 3 Waterside Crossing, Windsor, Connecticut 06095; 860-226-0576; Email: Meaghan.MacDonald@cigna.com; Website: https://www.cigna.com/

Despite the well-known prevalence of mental health conditions, they are woefully undertreated. Consider this: About one in five Americans has a behavioral condition, but fewer than half—only 41%—receive treatment of any kind. Among those with a serious mental illness (SMI), only 37% have care.

One barrier to treatment is stigma, and another is access to individuals trained to intercede during a mental health crisis.

Looking at surveys finding that a large segment of the public trusts their community pharmacist, the authors of a concept paper published in Pharmacy (2019) offer a proposal. They suggest training pharmacists to recognize and respond to signs of emotional distress and mental illness in their customers, absent the judgment that comes with stigma. Authors Nathaniel Rickles of the Department of Pharmacy at the University of Connecticut, Albert Wertheimer of Nova Southeastern University’s pharmacy department, and Yifan Huang—who, like Rickles, hails from the University of Connecticut’s Department of Pharmacy—explicate their proposal in “Training Community Pharmacy Staff How to Help Manage Urgent Mental Health Crises.”

Deploying pharmacists in the service of helping customers in crisis requires that pharmacists recognize signs of mental illness, they possess the capacity to intervene, and they examine and reckon with stigma—society’s stigma, individuals’ self-stigma, and their own stigmatizing attitudes to those with mental illnesses.

Need on a Continuum

The authors point out that behavioral health exists on a continuum, from mental wellness to mental illness:

Mental Wellness Struggling Mental Illness
Typified by predictable mood changes, readiness to face challenges, sense of humor, competent performance of daily work and life tasks, healthy sleep patterns, energy to get things done, and avoidance of excessive substance use and addictive behaviors. Characterized by mood fluctuations, difficulty facing challenges, little sense of humor, diminished performance of work and life obligations, irregular sleep, lower levels of energy, anxiety, and engagement in unhealthy behavior patterns. Significant mood fluctuations that may include outbursts, labile moods, intense anger or anxiety, unusual thoughts and behaviors, disrupted sleep, dysfunction in the performance of work and life tasks, substance use and/or addictive behaviors, and self-harm or harm to others.

Some individuals have behaviors that span the continuum, and some have general mental wellness but go through a period of struggle. The point is that when a crisis occurs, intervention can be very helpful—indeed, in some circumstances, lifesaving.

Why Pharmacists?

Effects of Poor Mental Health

·         Greater comorbidity compared with the general population.

·         Earlier death (average: 25 years less).

·         Diminished quality of life.

·         Significant health care costs.

·         Economic losses to the tune of $193.2 billion per year.

Pharmacists are widely accessible, serving numerous clients on any typical day. Rickles and his coauthors points to the results of a 2012 study by The College of Psychiatric and Neurological Pharmacy (CPNP) and the National Alliance on Mental Illness (NAMI). Surveying 1,031 people who either had some kind of behavioral health condition or cared for someone with such a condition, CPNP/NAMI found that 91% of respondents felt very comfortable in their community pharmacy, and 81% felt that their pharmacist respected them.

Not a bad base from which to launch outreach efforts, in other words.

The Impact of Stigma

Stigma is pernicious, infecting society such that people distrust, dislike, and even fear those with mental illness. And it creeps into the consciousness of those who are struggling with a mental health condition, poisoning them against themselves and dissuading many from seeking help that could heal them and improve their lives.

Health care professionals, including pharmacists, are by no means free of stigmatizing attitudes. The authors write that studies have generally found that while pharmacists have positive views of people with mental illness, they are often uncomfortable with those individuals. Getting beyond stigma, then, becomes part of the effort to help when there is a need.

Rx: Mental Health First Aid

Mental Health First Aid is a program that trains anyone from any walk of life how to recognize and respond to someone having a mental health crisis. The brainchild of two Australian researchers, it was launched in 2001 and it has proven effective in reducing stigma and aiding in outreach to those who are suffering. The National Council of Behavioral Health recommends the eight-hour program for anyone with frequent contact with those who may be in crisis, such as police officers, front-line care providers, and clergy. The National Community Pharmacist Association developed a version of the course specifically for pharmacists, using pharmacy-specific examples.

Mental Health First Aid consists of these steps, represented by the acronym ALGEE:

  • Assess for signs of suicide or harm.
  • Listen non-judgmentally.
  • Give reassurance and information.
  • Encourage appropriate professional help.
  • Encourage self-help and other support strategies.

Studies among different populations—among them university students, pharmacy graduate students, and pharmacists—found good results from the Mental Health First Aid program. The primary effects were these:

  • Reductions in stigma, which might prevent outreach.
  • Better recognition of signs of mental illness.
  • Greater confidence in the ability to intervene in a crisis and assist an individual in distress.

If you or someone you know is in crisis, please contact the Suicide Prevention Hotline / Lifeline at 1-800-273-TALK (8255), or text the Crisis Text Line at 741-741.

This summation was prepared independently of the authors.

The authors declare no conflicts of interest, and this research involved no external funding.

Mental health providers may detect a small portion of their patients who experience increased symptom severity.1 Implementing symptom-rating scales to monitor outcomes helps promote communication and may provide objective data which can be factored into treatment plans. During this PsychU webinar, the speakers identify four levers to optimize clinical and mental health provider performance.

Featuring:

  • Greg Downing, DO, PhD
    Founder, Innovations Horizons, LLC
  • Rebecca Plonsky, LICSW
    Corporate Director of Business Development, Fellowship Health Resources, Inc

Greg Downing, DO, PhD, currently serves as the Founder of Innovations Horizons, LLC, a Washington, DC–based consultancy focused on the applications of data in health care delivery transformation initiatives. At Innovation Horizons, LLC, Dr. Downing assists organizations by designing programs, strengthening infrastructure, and enhancing leadership capabilities that are aimed collectively at raising their innovation capacity. Dr. Downing is also Adjunct Professor of Practice at Georgetown University, where he leads the innovation in health care management track. Dr. Downing’s current research interests are in metrics and outcomes-based approaches to health care transformation, including specialty interests in behavioral entrepreneurship and social impact innovation practices. He is the author of more than 80 peer-reviewed publications, as well as multiple books and monographs on biomedical and health care research practices.

Rebecca Plonsky currently serves as Corporate Director of Business Development for Fellowship Health Resources, Inc., in addition to being a senior associate at OPEN MINDS. Prior to joining OPEN MINDS, Ms. Plonsky served as the National Vice President of Development for Prospect Integrated Behavioral Health, part of Prospect Alta Hospital Systems, LLC. Based in the Northeast, Ms. Plonsky was responsible for national growth and development of the integrated behavioral health service lines, and she was assigned to lead multiple projects to improve care quality. Ms. Plonsky also served as the Senior Behavioral Health Program Manager for the Rhode Island Executive Office of Health & Human Services. The primary leader for the division, she was responsible for behavioral health Medicaid strategy, program innovation and implementation, policy, and contracting.

On December 11, 2019, Blue Cross Blue Shield of Michigan (BCBSM) announced a new “Blueprint for Affordability” payment model. Under the model, seven preferred provider organizations (PPOs) that provide care to BCBSM members will share financial risk for consumer care and consumer outcomes.

The risk-sharing agreements became effective January 1, 2020 and cover Blue Cross Commercial PPO and Medicare Advantage PPO plans. “Blueprint for Affordability” participating organizations represent approximately 30% of the state’s total Commercial PPO and Medicare Advantage market. The seven PPOs include:

  • Ascension Michigan (Genesys Provider Health Organization physician-hospital organization (PHO), Partners in Care, St. Mary’s PHO)
  • Henry Ford Health System
  • Michigan Medicine
  • Oakland Southfield Physicians
  • The Physician Alliance
  • Trinity Health – Michigan (Saint Joseph Mercy Health System, Mercy Health, Mercy Health Physician Partners, Integrated Healthcare Associates)
  • United Physicians

The goals of the Blueprint for Affordability payment model include: improve quality of care; avoid unnecessary tests, scans, and emergency room visits; reduce complications and rehospitalizations; and better coordinate consumer care across all points of service. Under the model, health systems and physician organizations agree to annual targets for the cost of providing care to Blue Cross members. Aggregate costs that come in below those financial targets will result in financial rewards for the provider organizations involved. If costs cannot be managed within the target, the provider organization will rebate Blue Cross, and ultimately its consumers, a portion of the amount spent beyond the target. This enables costs to be predictable for Blue Cross customers, and encourages the provider organizations to improve care delivery cost, quality, efficiency, and coordination.

For more information, contact: 

  • Meghan O’Brien, Public Relations & Social Media Manager, Blue Cross Blue Shield of Michigan
    600 East Lafayette Boulevard, Detroit, Michigan 48226-2927, Phone: 313-549-9884, Email: newsroom@bcbsm.com, Website: https://bcbsm.com/

A pilot collaboration program between Georgetown Home Care (GHC) and Medstar Georgetown University Hospital reduced preventable readmissions by 44% among people who had spinal surgery. Within two months, the readmission rate dropped from 12.1% to 6.7%.

The collaboration is called the Key Program. For the program, GHC nurse practitioners trained in hospital readmission mitigation, visit recently discharged consumers in their homes. The first visit takes place within 48 hours of discharge. In the initial visit, and in subsequent visits over the next few weeks, the nurse practitioner helps coordinate the consumer’s care with the hospital staff and the consumer’s primary care physician. The goal is to ensure a smooth and safe transition home.

According to Ruth Adonizio, Director of Readmission Reduction at Medstar Georgetown University Hospital, after the pilot ended, the readmission rate returned to the previous level. Based on the pilot outcomes, GHC signed a contract with Medstar Georgetown University Hospital to continue and expand this program to more departments within the hospital for fiscal year 2020.

GHC is a non-medical home care and staffing agency in the District of Columbia metro area. It provides a wide range of in-home care services and relevant workforce solutions in the District of Columbia, Maryland, and Virginia.

For more information, contact:

  • John Bradshaw, Owner, Georgetown Home Care, 3301 New Mexico Avenue, Suite 214, Washington, District of Columbia 20016, Phone: 202-831-4536, Email: johnbradshaw@georgetownhomecare.com, Website: https://www.georgetownhomecare.com

Approximately 87.8% of workers with disabilities had health insurance in 2017. This was a 7.9 percentage point increase from 79.9% in 2009, prior to the implementation of the Patient Protection and Affordable Care Act (PPACA). Despite coverage gains, cost-related barriers to accessing medical care did not change much after the PPACA for any group. Workers with disabilities experienced an increase in structural access barriers, from 18.4% before PPACA to 24.8% after PPACA. People with disabilities are defined as those who report being limited in the type or amount of work they can perform due to a physical, mental, or emotional problem.

The increase in health insurance for workers with disabilities was the result of an 11 percentage point increase in the share of that population with Medicaid coverage between 2014 and 2017 (compared with 2001 through 2009), and a five percentage point increase in privately purchased coverage over those periods. These increases were accompanied by an 11 percentage point decline in the share with employer-sponsored coverage.

Researchers concluded that the gain in insurance coverage for workers with disabilities is an important benefit of the PPACA. However, they recommended more investigation and monitoring to understand whether PPACA coverage will translate into improvements in access to needed health care.

These findings were reported in “Insurance Coverage And Access To Care For Workers With Disabilities, 2001–2017” by Anna Hill, M.H.A., Ph.D.; and Jody Schimmel Hyde, Ph.D. The researchers analyzed data from 2007 through 2017 from the National Health Interview Survey. The goal was to determine how PPACA changed insurance coverage and access to care for workers with disabilities, and compare those changes to changes among other groups.

The full text of “Insurance Coverage And Access To Care For Workers With Disabilities, 2001–2017” was published in January 2020 by Disability and Health Journal. An abstract is available online at https://www.sciencedirect.com/science/article/pii/S1936657419301530 (accessed January 20, 2020).

For more information, contact:

  • Jody Schimmel Hyde, Ph.D., Researcher, Mathematica Policy Research, 1100 First Street Northeast, 12th Floor, Washington, District of Columbia 20002, Email: jschimmel@mathematica-mpr.com, Website: https://www.mathematica.org/

On January 1, 2020, Indiana implemented a Medicaid waiver amendment that will allow the state to receive reimbursement for short-term services for people age 19 to 64 with serious mental illness (SMI) who are treated at privately run institutions for mental disease (IMD). The waiver excludes treatment provided at Indiana’s six state-operated psychiatric hospitals. This waiver amendment augments an earlier waiver approved on February 1, 2018, that allows the Indiana Family and Social Services Administration (FSSA) to reimburse for inpatient treatment in private IMDs for Medicaid members with a primary diagnosis of an addiction disorder. FSSA implemented that waiver’s IMD provisions in early 2018, and according to an interim evaluation released in October 2019, by the end of calendar year 2018, there were 17 Medicaid-enrolled IMDs that provided addiction treatment to 4,026 beneficiaries. Without the waivers, Medicaid statutes prohibit federal reimbursement for services provided in an IMD, which is defined as any hospital, nursing facility, or other institution with more than 16 beds that provides treatment primarily for people with mental illness.

Under this new waiver amendment, the IMD services will be covered for beneficiaries with SMI who are primarily receiving withdrawal management services or short-term inpatient or residential treatment for an addiction disorder. The goal is to create consistency in treatment for the 25% of beneficiaries with SMI with a co-occurring addiction disorder.

FSSA can claim federal financial participation (FFP) for individual stays of up to 60 days, as long as by a mid-point assessment at December 31, 2022, the state can show that the average length of stay (ALOS) is 30 days or less. If the state does not meet the ALOS target by the assessment, FSSA will only be able to claim FFP for stays of up to 45 days until it meets the ALOS target.

Special terms and conditions (STCs) of the waiver require FSSA to ensure that psychiatric hospitals provide intensive pre-discharge, care coordination services to help beneficiaries transition into appropriate community-based outpatient services. The STCs include the following requirements:

  • Involve community-based provider organizations in transition efforts, such as allowing initial contact with a community-based provider organization while the beneficiary is still at the IMD, or by hiring peer support specialists to help beneficiaries connect with available community-based provider organizations and make plans for employment.
  • Assess the housing situation of a beneficiary transitioning to the community, and connect those who are homeless or who have unsuitable or unstable housing with provider organizations that coordinate housing services.
  • Require psychiatric hospitals to have protocols in place to ensure contact is made by the treatment setting with each beneficiary within 72 hours of discharge, and ensure follow-up care is accessed by those individuals by contacting them directly and by contacting the community-based provider organizations to which they were referred.
  • Implement strategies to prevent or decrease the length of stay in emergency departments (EDs) among beneficiaries with SMI/serious emotional disturbance (SED) or SED. This could include the use of peers and psychiatric consultants in EDs to help with discharge and treatment referral.
  • Develop and enhance interoperability and data sharing between disparate physical, addiction treatment, and mental health provider organizations to enhance coordination and improve clinical outcomes for beneficiaries with SMI/SED or SED

The STCs require FSSA to increase access to a continuum of care, including crisis stabilization services by doing the following:

  • Establish a process focused on crisis stabilization services to annually assess the availability of mental health services throughout the state. The assessment must provide updates on steps taken to increase availability.
  • Commit to implementing the SMI/SED financing plan included in the approved waiver.
  • Improve the state’s capacity to track available inpatient and crisis stabilization beds to help connect individuals in need with that level of care as soon as possible.
  • Require provider organizations, plans, and utilization review entities to use an evidence-based, publicly available consumer assessment tool, preferably endorsed by a mental health provider organization association to determine appropriate level of care and length of stay.

Further, FSSA must implement strategies to facilitate earlier identification and engagement in treatment for those with SMI/SED or SED, as follows:

  • Identify and engage adolescents and young adults in treatment earlier through supported employment and education programs.
  • Increase integration of behavioral health care in non-specialty care settings including schools and primary care practices, to improve early identification and improve awareness of and linkages to specialty treatment provider organizations.
  • Establish specialized settings and services, including crisis stabilization services, focused on the needs of young people.

The intent of the waiver amendment is to shift services for beneficiaries with SMI from less appropriate settings to facilities such as hospitals and larger mental health treatment facilities. As a result, FSSA anticipates that costs related to lack of access to appropriate care settings and overuse of the emergency department for mental health problems and psychiatric crises will decrease. The IMD services will be for eligible individuals with SMI who are primarily receiving short-term treatment and withdrawal management services.

FSSA had submitted the “SMI/SED Amendment Request for the Healthy Indiana Plan (HIP) Section 1115 Waiver (Project Number 11-W-00296/5)” on June 24, 2019. FSSA data indicates that in state fiscal year 2019, about half of Indiana’s traditional Medicaid members receiving inpatient psychiatric services received them at an IMD.

For more information, contact:

  • Jim Gavin, Director of Communications and Media, Indiana Family and Social Services Administration, 402 West Washington Street, W461, Indianapolis, Indiana 46204-2739, Phone: 317-234-0197, Fax: 317-233-4693, Email: Jim.Gavin@fssa.IN.gov, Website: https://www.in.gov/medicaid/

Six months after attending abstinence-based addiction treatment, 35.6% of more than 1,400 consumers reported that they had been abstinent for the past 30 days. The 35.6% includes consumers who reported an earlier relapse but current abstinence (7.9%) and continuously abstinent consumers (27.7%). About 8.5% said they were not abstinent in the past 30 days; of this group, two-thirds reported using at a lower frequency than before entering treatment. Of the remaining consumers, 0.5% had died, 0.2% were in jail, and the recent abstinence status of 2.4% was unknown. About 52.8% failed to respond to multiple contact attempts.

The percentage of consumers reporting abstinence declined between one month and six months post-treatment and then stabilized.   At one month after treatment, 42.8% said they had remained abstinent. At six months after treatment, 35.6% said they had abstained from all drugs and alcohol in the past 30 days. At 12 months, 36.2% said they had abstained from all drugs and alcohol in the past 30 days, and 25.3% had remained abstinent for the entire year.

Slightly more than half (54.8%) of the people followed up with six months after treatment had successfully completed treatment.  Among these, 43.8% were abstinent at six months after treatment.  Among those who did not complete treatment, 25.4% were abstinent.

About 23% of those who relapsed during the 12 months post-treatment did so during the first few days after leaving treatment. Half reported relapsing within the first month, and 79% of relapses happened within three months after treatment.

These findings were reported in “Learnings From Three Years Of Addiction Treatment Outcomes Research” by researchers with Vista Research Group. The report summarizes information about 23,428 people attending addiction treatment between March 1, 2016 and September 15, 2019. The individuals were receiving treatment at facilities enrolled in Vista Research Group’s INSIGHT Addiction™ and/or INSIGHT Detox™ progress monitoring research. The treatment centers are predominantly abstinence-based commercial facilities based in the United States. A small portion of these participants have also been selected to be contacted after treatment via Vista’s RECOVERY 20/20™ service to learn how they are feeling and if they have been able to remain abstinent at one month, six months, and 12 months post-treatment.

During the three-year period, there were 17 participating addiction treatment facilities for whom the researchers followed up with at least 25 patients six months post-treatment. The number of individuals who were reachable and claimed to have been abstinent for at least the last 30 days at six months post-treatment varied between 22% and 47% across these facilities.

Vista was able to contact between 49% and 56% of the participants at one month (3,163), six months (1,421), and 12 months (392) post-treatment by reaching out 10 to 15 times by text, email, and/or phone for each survey. The post-treatment results in this current report are predominantly based on responses from the 1,421 participants who Vista attempted to contact six months after they left treatment.

When the participants entered treatment, 47% reported having experienced all 11 of the DSM-5 symptoms of addiction disorder during the year prior to treatment. The majority reported moderate to severe levels of depression, anxiety, and/or post-traumatic stress symptoms. About 37% said they wished they were dead or would not wake up during the 30 days before entering treatment; 10% had some intention to commit suicide; and 6% had actively planned, prepared, or attempted suicide. In addition to having an addiction disorder, 6% were cutting or engaging in other self-harm. Some were also managing sex addiction or personality disorder. In the 30 days before they began treatment, 15% of the participants were hospitalized, 11% were arrested or jailed, 7% overdosed, and 3% were ordered into treatment by the criminal justice system.

About two-thirds of the study participants successfully completed treatment. About 80% of them said their treatment goals were met, and two-thirds said they were very satisfied with the treatment they were receiving.

Individuals who reported participating in the following activities for at least a month post-treatment were more likely to say they were abstinent at six-months post-treatment compared to those who did not report abstinence:

  1. Recovery support meetings: cited by 67% of those who were abstinent, and 34% of those who were not.
  2. Sober housing: cited by 27% of those who were abstinent, and 8% of those who were not.
  3. Alumni program involvement: cited by 17% of those who were abstinent, and 5% of those who were not.
  4. After-care monitoring: cited by 16% of those who were abstinent, and 3% of those who were not.
  5. Random drug/alcohol testing: cited by 35% of those who were abstinent, and 17% of those who were not.
  6. Seeing a therapist: cited by 39% of those who were abstinent, and 26% of those who were not.
  7. Attending additional treatment: cited by 23% of those who were abstinent, and 15% of those who were not.

For more information, contact:

  • Vista Research Group, Inc., 1330 Cape Saint Claire Road, #656, Annapolis, Maryland 21409. Phone: 800-215-3201, Email: info@Vista-Research-Group.net, Website: https://www.vista-research-group.com/ 
  • Joanna L. Conti, Founder and Chief Executive Officer, Vista Research Group, Inc., 1330 Cape Street, Claire Road, #656, Annapolis, Maryland 21409, Phone: 800-215-3201, Email: jconti@vista-research-group.com, Website: https://www.vista-research-group.com/

On December 11, 2019, PursueCare announced the launch of new telehealth addiction treatment programs for rural populations in Kentucky and in West Virginia. The programs provide telehealth counseling via a smartphone app and medication-assisted treatment. The purpose is to transition consumers with opioid use disorder (OUD) from emergency departments and rural health clinics into treatment at home. During 2020, the company plans to expand to Connecticut, Maine, Ohio, Pennsylvania, Vermont, and Virginia, with services in Connecticut and Vermont launching in early March.

PursueCare is in-network with Medicare, Medicaid, all managed care organizations (MCOs), and most commercial insurances in Kentucky and West Virginia. It also works with employee assistance programs, and participates with veterans’ plans under TRICARE. PursueCare is forming partnerships with organizations that received Kentucky Opioid Response and Education grants (KORE), which will implement and leverage PursueCare services as a resource. The company is also opening a physical clinic in Somerset, Kentucky for consumers who may need more intensive in-person assessments.

The company holds LegitScript certification for addiction treatment. LegitScript certifies companies that provide addiction treatment via any platform, including facility-based, outpatient office-based, and online via telehealth. LegitScript certification is used by Google and Facebook to verify the compliance, legality, and legitimacy of addiction treatment provider organizations marketing their products and services to consumers. PursueCare’s mail-order and specialty recovery pharmacy, CompreCare, also earned The Joint Commission’s Gold Seal of Approval Accreditation.

For more information, contact:

  • Reginald Miller, Partnership Development Coordinator PursueCare, 101 Centerpoint Drive, Suite 221, Middletown, Connecticut 06457, Phone: 860-317-0586, Email: reg.miller@pursuecare.com, Website: https://www.pursuecare.com

Despite vast improvements in diagnosis and treatment over the last half-century, mental illness is underdiagnosed and undertreated.

The reasons are many and varied. Among them: a lack of access for individuals amid a shortage of care providers, the interference of social determinants of health such as transportation problems, and social stigma. All play a role.

But technology may offer a means to address these and other barriers. Consider just a few of its more recent contributions. As a McKinsey & Company paper points out, technology applied in health care settings has helped prevent adverse drug events, including medication errors, allergic reactions, and overdoses. Technology has been deployed successfully to increase individuals’ compliance with care recommendations, such as preventive checkups and medication refill information, improving their health.

And it has served to streamline diagnostic testing and other processes, saving significant cost. 1

Why is mental illness, despite its undeniable human and societal burden, so undertreated?

Today’s advanced technology aids mental health care via disparate approaches and tools that have the capacity to:

  • Aid clinical decisions.
  • Streamline processes, both on the back end and consumer facing. Examples include blood utilization and appointment scheduling.
  • Expand access to care and increase its timeliness.
  • Enhance transparency and communication between physician and patient.
  • Collect and interpret health data in real time, complementing that recorded in the doctor’s office.
  • Reduce costs.
  • Improve outcomes.

In short, technology – from telepsychiatry to wearable health devices to artificial intelligence–aided clinical decision support may accelerate the drive toward the Triple Aim: a better care experience, improved population health, and reduced costs.

PREVALENCE OF MENTAL ILLNESS

One in five American adults lives with mental illness. That prevalence is more concerning when one considers that fewer than half of individuals with mental illness—only 43%—received any treatment for their illness in the previous year, according to a 2018 Substance Abuse and Mental Health Services

Apps that seek to alter thought patterns and improve thinking skills, using CBT principles, tend to be targeted at people with more serious mental illness.

Administration (SAMHSA) study. And about one in 25 U.S. adults has a serious mental illness (SMI), such as schizophrenia, bipolar disorder, or major depressive disorder. Among individuals aged 18–25 years with an SMI, nearly half—46%—received no treatment in the previous 12 months.2 In addition to the human cost of untreated mental illness, there is an economic one as well: lost earnings in 2002 due to SMI cost the economy around $193 billion US dollars.3

BARRIERS TO CARE

Why is mental illness, despite its undeniable human and societal burden, so undertreated? Many factors come into play, such as underdiagnosis, stigma, a worrisome shortage of psychiatrists and other mental health care providers, and individuals’ personal logistical challenges. Among these barriers, one of the most significant is wide geographical variation in the availability of mental health care providers. Countrywide there is an average of one mental health provider for every 536 individuals.

But that average disguises a dramatic difference in access: the ratio in Massachusetts is 1:200, whereas in Alabama, it is 1:1260. More than 4,000 areas across the U.S., mostly rural and low-income locales, are designated mental health care professional shortage areas.4

Technology facilitates mental health care in multiple ways:

  • Mobile health (mHealth) sensors that collect health data.
  • Digital interventions and assessments.
  • Clinical-decision support systems.
  • Mobile apps for mental health.
  • Medication adherence technology.
  • Telepsychiatry and teletherapy.

OPENING ACCESS, INCREASING TIMELY CARE

According to a 2019 Pew study, 96% of U.S. adults have a smartphone.5 The prevalence of internet usage and the ubiquity of smartphones offer individuals an abundance of mental health care sites, functions, and apps. Estimates vary widely as to number, but internet sites and mobile apps number well into the thousands.

Their advantages are plain to see. Most are low-cost or free. They overcome access barriers, both spatial and temporal. Given societal stigma, some consumers with mental illness wish for anonymity; apps can provide that. They are convenient to access and use. Some even offer games and other fun ways to address mental health.

Some examples of the types of apps available for use in managing mental wellness:

  • Self-management apps: The user inputs personal data manually, and the app provides feedback of some kind. Apps in this category can prompt consumers to practice deep breathing when their anxiety climbs or take medication on schedule. Indeed, apps that support medication adherence could be very helpful, as it is well established that poor compliance with pharmacological therapy compromises treatment and results in poorer outcomes.
  • Apps for improving thinking skills: Cognitive behavioral therapy, or CBT, relies on the recognition that thoughts, feelings, and behaviors are intertwined; change thoughts, and feelings and behaviors will follow suit. Apps that seek to alter thought patterns and improve thinking skills, using CBT principles, tend to be targeted at people with more serious mental illness.
  • Attention-Controlling Games: According to the National Institute of Mental Health, apps in this category are being tested as a treatment for post-traumatic stress disorder (PTSD).
  • Video Games: One example of a video game accessible via app features a protagonist who confronts anxiety and depression. The user can identify with the game’s central character as that person confronts challenges complicated by mental illness.
  • Experimental: A major research university is currently studying how facial recognition technology can be used to predict schizophrenia.

HEALTH INFORMATION TECHNOLOGY

Much has been written about how health information technology has impacted medical care for the better. In the wake of the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 and the Patient Protection and Affordable Care Act (PPACA) in 2010, both of which incentivized the adoption of electronic health records, or EHRs, the majority of provider practices do now have patient records in digital form.

Along with those digitized records is the capacity to automate messages to the individuals treated by a practice, such as reminders to set up appointments for preventive or specialist care. Polypharmacy review is more easily accomplished when all an individual’s medical data from different providers is collected in the same place, thereby allowing analysis.

EHRs facilitate efforts to improve population health by allowing providers to identify all individuals with a particular condition, such as diabetes type 2, and target interventions at them.

One success story with health information technology is UCLA Health, which leveraged IT across the organization to improve processes and outcomes. For example, UCLA Health increased depression screenings performed by primary care physicians via automated notices to case management.

Another project UCLA Health tackled was blood utilization. Concerted national efforts and careful research have demonstrated that blood has been routinely overused in hospitals, compromising patient outcomes. What’s more, blood is high in cost, so overuse of blood translates not only to patients receiving suboptimal care but also to increases in the cost of care without a concomitant increase in quality. Guided by clinical decision support that aided clinicians in real time, UCLA Health optimized blood utilization across its organization.

So far-reaching were its accomplishments that UCLA Health was awarded the 2018 HIMSS Davies Enterprise Award for leveraging HIT to improve outcomes, a McKinsey paper reports.6

THERAPY VIA MOBILE OR COMPUTER

Whether treatment occurs via smartphone or computer, telepsychiatry and other mental health services performed online open access to mental health care in resource-poor regions by offering consumers a way to videoconference with a psychiatrist or other mental health care professional in real time. This synchronous therapy can be augmented by asynchronous communication between consumer and care professional.

Certainly, televisits for mental health are now in wide use. Consider this graphic showing the degree to which different payers reimburse for them:7

But some question whether those with SMIs can use mHealth apps and other technologies appropriately. Does the Pew research that found widespread ownership of computers and smartphones and use of the internet mean that these individuals are comfortable with technology?

The answer would seem to be yes. One study of individuals with SMI found broad acceptance of technology-aided treatment.

Key characteristics associated with successful use of digital health tools as identified by the authors’ research:

  • Interest in using state-of-the-art technology.
  • Resources, such as a smartphone or WiFi, that facilitate access to treatment.
  • Positive expectations about using a digital health tool.
  • Supportive social network.
  • Good occupational functioning.

Substance use and chaotic living situations were two factors that worked against successful use of digital technology in this population.8

This summation has been developed independently of the authors.

Authors have declared the following: no conflicts.

Approximately 15% of men and 30% of women jailed have a serious mental illness (SMI).1 Educated first responders can potentially safely de-escalate situations involving a behavioral health crisis. Crisis Intervention Teams (CIT) are trained responders that recognize common signs and symptoms of mental illness and co-occurring disorders. An important component of the CIT model is a central designated psychiatric emergency access site with a no-refusal policy, hopefully reducing incarceration rates and increasing mental health treatment.

Featuring:

  • MSgt Corey Nooner
    Oklahoma City Police Department
  • Kathy Day, MPA, BA, AA
    Caregiver and Mental Health Advocate
  • Charlotte Anderson, BA
    9-1-1 Center and Mental Health Advocate

MSgt Corey Nooner is an Officer with the Oklahoma City Police Department. He is part of the Crisis Intervention Team Model, which is a collaborative approach to safely and effectively addressing the needs of Oklahomans with mental illness, by linking them to appropriate services within the community and diverting them from the criminal justice system if appropriate.

Kathy Day, MPA, BA, AA is a caregiver for a close family member with schizophrenia and is starting a non-profit organization for caregivers. She is an active advocate for people with serious mental illnesses by helping run online support groups, writing a blog about schizophrenia, and educating people about serious mental illnesses whenever the opportunity arises. Ms. Day is a former member of the Sacramento County Mental Health Board and has been active in legislative reform at local and federal levels.

Charlotte Anderson, BA works with the local 9-1-1 Center to address care given to callers struggling with mental health issues. She has worked with Hotline, a crisis intervention and information center, and has led a merge with Trident United way to implement 2-1-1, which responds to over 50,000 calls annually. She has served as the Crisis Division Director for the American Association of Suicidology and was part of the steering committee for the SAMHSA National Suicide Prevention Lifeline.

If you or someone you know is in crisis, please contact the Suicide Prevention Hotline / Lifeline at 1-800-273-TALK (8255), or text the Crisis Text Line at 741-741.

Smartphones are nearly ubiquitous features of modern American life. Findings from a January 2018 Core Trends Survey from the Pew Research Center illustrates this fact: 78% of the American adults surveyed (n=2,002) had access to a smartphone. Usage among individuals living with a mental illness is also high. A 2018 survey among psychiatric patients indicated that 90% of private clinic patients and 67% of Department of Mental Health (DMH) clinic patients owned a smartphone.

One feature of smartphones—the ability to run and support applications (apps)—has the potential to increase access to mental health services by providing novel outreach and service provision, reaching users with lower levels of access to traditional behavioral health providers, services, and facilities. The availability of mental health apps is on the rise, a trend that continues to hold promise for increased engagement with mental health supports.

Despite the plethora of mental health apps available, users do not download or maintain usage of these apps with the level of fervor expected. What accounts for this discrepancy? Research focused on understanding consumer preference and engagement in apps relies upon user engagement indicators (UEIs), like ease of use and satisfaction, to measure and evaluate apps like those developed for mental health. In the case of mental health apps, however, there is no true consensus on what “engagement” is, making the development, definition, selection, and interpretation of UEI study results problematic.

To shed light on the variations within the literature related to UEIs for mental health apps, a group of researchers, led by Michelle Ng of the Division of Digital Psychiatry at Harvard Medical School, recently conducted a systematic literature review. Their findings were published in “User Engagement in Mental Health Apps: A Review of Measurement, Reporting, and Validity,” which was published in 2019 by Psychiatric Services.

Study Design

The review analyzed 40 studies focused on apps for depression, bipolar disorder, schizophrenia, and anxiety in order to examine how UEIs are evaluated within the current literature. The researchers hypothesized that methods to evaluate UEIs in the readily available literature would be inconsistent. This inconsistency, they posited, would create a comparison between “apples and oranges,” causing confusion about the efficacy of mental health mobile apps. It also makes research-wide comparisons between program engagement difficult.

Researchers combed six databases in July 2018 to create their literature sample. Studies were included if they were novel, at least one week in length, involved a mobile application designed for target diagnoses (e.g., depression, bipolar disorder, schizophrenia, anxiety), and included reporting on UEIs. UEIs were designated objective or subjective. Objective UEIs included measures like frequency of use and retention rate. Subjective UEIs includes measures such as user satisfaction and perception of the app.

Results

The results of the systematic review yielded very mixed results. Multiple studies confounded their results by referring to objective and subjective UEIs interchangeably. Some studies even utilized one measure to verify another. UEI measurements in the studies examined were imprecise, as many used a blunt, universal scale across all measures. Almost half of the studies (48%) heralded positive engagement based solely on one category of UEI (either objective or subjective respectively). Scales focused on subjective measures largely developed their own measurement tools rather than utilizing readily available assessments, thereby limiting cross-sectional analysis. Finally, across the 40 studies, all posited positive results on their apps’ UEIs. The researchers discussed the possibility that these findings reflected inherent bias in the literature to present positive results for specified apps, rather than presenting objective measures of mental health app UEI.

Ng et al. concluded that establishing a priori UEI measures with distinctive and validated assessment tools and significance thresholds would further research into the rationale behind deficient user engagement with mental health apps. They also discuss the need for studies to utilize UEI measurements that cross both subjective and objective categories in order to facilitate building a body of knowledge that spans more than a single study.

This summation was developed independently from the author.

Authors declared the following conflicts: no conflicts of interest.

New technologies, changing reimbursements, and corporate consolidations are amongst the many drivers evolving the health care landscape.1 During this webinar archive, the speakers discuss strategies for future sustainability in ever-changing industry.

Featuring:

  • Kimberly Bond
    Senior Associate, OPEN MINDS
  • Paul Duck
    Senior Associate, OPEN MINDS

Kimberly Bond brings over thirty years of experience providing behavioral health treatment in the public and community settings to the OPEN MINDS team. She currently serves as the Executive Vice President of Business Development and Marketing. Prior to joining OPEN MINDS, Ms. Bond served concurrently as a Program Coordinator III and Clinical Manager of Adult Services and a Program Coordinator II and Clinical Manager of Recovery Services for the Ozark Guidance Center. In these roles, Ms. Bond was responsible for the administrative and clinical oversight of the adult outpatient and adult intensive mental health services on the Springdale Campus and the adult recovery/co-occurring services, including domestic violence and anger management treatment as well as treatment services for Drug Court.

Paul Duck currently serves as a Senior Associate at OPEN MINDS. He brings over 40 years of experience in leadership and management focusing on managed care, health information technology organizations, strategy, business development and market expansion, and customer experience optimization to the OPEN MINDS team. Previously, Mr. Duck has served in roles such as Vice President, Strategy & Development for Beacon Health Options, the Vice President of Business Development for Netsmart Technologies, and Chief Executive Officer for Coastal Orthopedics. Mr. Duck earned his Bachelor of Arts in Business Management from Case Western Reserve University.  He earned his Associate of Arts in Electronic Engineering Technology from the Electronic Technology Institute.

New technologies, changing reimbursements, and corporate consolidations are amongst the many drivers evolving the health care landscape.1 During this webinar archive, the speakers discuss strategies for future sustainability in ever-changing industry.

Featuring:

  • Kimberly Bond
    Senior Associate, OPEN MINDS
  • Paul Duck
    Senior Associate, OPEN MINDS

Kimberly Bond brings over thirty years of experience providing behavioral health treatment in the public and community settings to the OPEN MINDS team. She currently serves as the Executive Vice President of Business Development and Marketing. Prior to joining OPEN MINDS, Ms. Bond served concurrently as a Program Coordinator III and Clinical Manager of Adult Services and a Program Coordinator II and Clinical Manager of Recovery Services for the Ozark Guidance Center. In these roles, Ms. Bond was responsible for the administrative and clinical oversight of the adult outpatient and adult intensive mental health services on the Springdale Campus and the adult recovery/co-occurring services, including domestic violence and anger management treatment as well as treatment services for Drug Court.

Paul Duck currently serves as a Senior Associate at OPEN MINDS. He brings over 40 years of experience in leadership and management focusing on managed care, health information technology organizations, strategy, business development and market expansion, and customer experience optimization to the OPEN MINDS team. Previously, Mr. Duck has served in roles such as Vice President, Strategy & Development for Beacon Health Options, the Vice President of Business Development for Netsmart Technologies, and Chief Executive Officer for Coastal Orthopedics. Mr. Duck earned his Bachelor of Arts in Business Management from Case Western Reserve University.  He earned his Associate of Arts in Electronic Engineering Technology from the Electronic Technology Institute.

Dr. Mehdi Qalbani discusses his experience providing telepsychiatry in the Information Age. Topics include regulatory concerns, practice guidelines, and web-side manner when working remotely.

Mehdi Qalbani, MD, MSPH, is the Co-Founder of Integrated Behavioral Health, LLC. Dr. Qalbani received his medical degree from the Tulane University School of Medicine and completed his residency in psychiatry at the University of Illinois at Chicago.

Chip Meyer, PhD, is a Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc. Dr. Meyer received his PhD in Experimental Psychology from the University of Kentucky.

Medhi Qalbani is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc.

Chip Meyer is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

The Blue Cross Blue Shield Association (BCBSA) is creating a national provider organization network composed of health care provider organizations and professionals who routinely offer high quality care at lower prices. BCBSA announced the new network on November 13, 2019. The network will be called Blue High Performance Network (HPN); it is slated to launch in January 2021 in 55 markets.

Blue HPN is designed for large national and regional employers. It is expected to reach more than 185 million people. BCBSA represents 36 independent Blue companies. The goal is that Blue HPN will provide more consistent pricing to help large employers control medical costs and enhance care for their workers. About 16% of large employers have built a high performance network into their health plan. BCBSA predicts that Blue HPN could generate more than 10% average cost savings on top of the savings already offered by the existing BCBS preferred provider organization network.

In June 2019, BCBSA issued an infographic explaining how it defines a high-performance network. Provider organizations will be selected for Blue HPN by the independent Blue plans based on existing quality measures and relationships. About 70% of the 74 million BCBS members are already in a value-based contract. Provider organizations selected for Blue HPN will be provided with data and insights; BCBSA will also align financial incentives for the participating provider organizations.

BCBSA released the full text of “Defining High-Performance Networks” and the info graphic in June 2019. A free copy is available online at https://www.bcbs.com/smarter-better-healthcare/infographic/defining-high-performance-networks (accessed December 10, 2019).

For more information, contact: Tess Thomson, Media Contact, Blue Cross Blue Shield, 225 North Michigan Avenue, Chicago, Illinois 60601; 202-942-1082; Email: press@bcbsa.com; Website: https://www.bcbs.com/

Those with an eating disorder (ED) frequently have psychiatric comorbidities; estimates range between 56% and 98%. Such comorbidities contribute to longer periods of illness and poorer outcomes. Major depression and substance use disorder are common ones, with the former affecting 28%–95% of individuals with ED and the latter 17%–46%. Both conditions pose special risks for patients with ED: depression compromises outcomes for individuals with anorexia nervosa, and substance use disorder on top of an eating disorder has proven lethal. Both major depressive disorder and substance use disorder have been identified as increasing the risk of relapse and early death.

Most individuals eventually recover from ED. But do their comorbidities persist? A group of researchers, led by Ani C. Keshishian of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital, sought to answer that question. In “Eating Disorder Recovery Is Associated with Absence of Major Depressive Disorder and Substance Use Disorder at 22-Year Longitudinal Follow-Up,” published in Comprehensive Psychiatry (2019), the authors detail the findings from their study of ED and comorbidities.

Do Comorbidities Persist?

Between 1987 and 1991, the researchers recruited 246 women with either anorexia nervosa or bulimia nervosa. Of the 228 surviving participants, 176 (77.2%) completed the study. The average age of participants at the 22-year follow-up was 46.3. They were assessed using the Eating Disorders Longitudinal Interval Follow-up Evaluation (LIFE-EAT II) and the Psychiatric Status Rating (PSR); those whose score on the latter was 1 or 2 for at least a year were deemed recovered from their eating disorder. The women in the study were evaluated with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1) to determine presence or absence of major depressive disorder and substance use disorder.

More than a third of the participants (36%) had an active eating disorder, 28% met criteria for major depressive disorder, and 6.3% had substance use disorder. Absence of an eating disorder correlated with an absence of major depressive disorder and substance use disorder. Those who recovered from ED were 2.17 times more likely not to have major depressive disorder and 5.3 times more likely not to have substance use disorder compared with those who still had active ED. Some 22% of women recovered from ED had major depressive disorder compared with 38% of those whose ED remained active; for substance use disorder, the proportions were 3% vs. 13%.

Good News, Bad News

What is positive in the researchers’ findings is that most women in their study recovered from ED, and those who recovered were much more likely than those who did not to be free of major depression and substance use disorder. This flies in the face of psychodynamic theory that predicts symptom substitution—such as substance use—occurs after ED remission. But the study here under discussion found that the rate of substance use disorder in the recovered group was comparable to the rate in the general population.

However, the rate in the recovered group for major depressive disorder is more than double that in the population at large. This is concerning. Eating disorders in themselves may contribute to depression. And depression and substance use disorder may exacerbate eating disorders. Given that the persistence of major depressive disorder and substance use disorder in some women with ED may lengthen course of illness and contribute to premature death, those individuals with active ED and also major depression and/or substance use disorder should be considered especially vulnerable, say the study’s authors.

The authors caution that the specificity of the population studied—women seeking treatment for an eating disorder in Boston 20-plus years ago—may make the findings not generalizable. It is also possible that today’s evidence-based ED treatment may make contemporary ED populations too unlike the studied group.

The researchers suggest one avenue of further research, which is to drill down into the comorbidities associated with specific ED diagnoses.

Authors declared the following conflicts: no conflicts of interest.

This summation has been developed independently of the authors.

Individuals with schizophrenia struggle to interact with others due to impaired social cognition. Four capabilities in particular are compromised: 1.) the ability to recognize emotion in others, for instance by interpreting facial affect; 2.) the discernment to read social cues; 3.) attributional style (e.g., an individual may see hostility where none exists); and 4.) mentalizing, or inferring the mental state behind another’s behavior.

Current antipsychotic mediations do not ameliorate these social cognition impairments, which can be debilitating in social situations. In “Treatment of Social Cognition in Schizophrenia: Current Status and Future Directions,” William P. Horan of Greater Los Angeles Healthcare System and Michael F. Green from University of California–Los Angeles looked at multiple studies to see where social cognition treatment is today and where it might be headed.

The Current Landscape Is An Optimistic One

The past 20 years have seen treatment for social cognition deficits in schizophrenia steadily advance. More recent interventions that target one social cognitive domain—most often, facial affect perception—have delivered positive results. Studies have shown that remediation is possible, thereby laying the groundwork for more comprehensive intervention studies that target multiple domains of social cognition.

The findings of various analyses, including Kurtz et al. (2016), give researchers and clinicians reason for optimism:

  • A variety of interventions—for example, Social Cognition and Interaction Training (SCIT) and Social Cognitive Skills Training (SCST)—can improve at least one of the four main domains of social cognitive impairment.
  • Social cognition interventions are well tolerated by participants. What’s more, evidence shows that these studies can be conducted effectively outside their original academic setting, in a variety of languages and cultures.
  • Social cognitive improvement is not dependent on non-social neurocognition improvements; rather, evidence suggests that they can happen independently of each other. Social cognitive interventions can impact the neural systems that underlay difficulties in this area, too.

Despite Optimistic Findings, Some Caveats Remain 

The studies under review have some limitations, including limited data and varied methodology.

  • Sample sizes were generally small and some used quasi-experimental design versus trials with strict pre- and post-intervention controls.
  • A diverse range of outcome measures was employed, which can lead to considerable variation in measured results.
  • Measured success has been shown to be most consistent for facial affect perception over the other three domains; for example, attributional bias studies used the Ambiguous Intentions Hostility Questionnaire, which has been known to blur the lines between schizophrenia and healthy controls, and may apply only to those patients exhibiting paranoia.

Key Considerations In Developing Social Cognitive Treatment

While more evidence-based studies are needed, certain learnings have emerged that may serve as guideposts for further research in treating schizophrenia spectrum disorders by targeting social cognition.

Appropriate Cognitive Outcome Measures Are Needed. The lack of consensus on measures makes this aspect challenging, and psychometric properties of available instruments is either poor or unknown. But NIMH has recently sponsored initiatives—the Social Cognition Psychometric Evaluation (SCOPE) project and Social Cognition and Functioning (SCAF) in schizophrenia—to identify or develop these measures.

Long-Term Effect Must Be Studied. Thus far, there are mixed results as to whether social cognitive interventions lead to enduring improvements in social cognition after the conclusion of treatment. This is a key area to be explored in future research and treatment.

Addressing Generalization Is Key: Certainly, the goal of social cognitive interventions is to enhance daily life for people with schizophrenia. But until functional outcomes are defined more precisely and there is more agreement on which assessment tools to use, understanding outcomes will be challenging.

Timing of Interventions May Matter: Chronically ill participants were the focus of the treatment studies in the Kurtz et al. review. But experts agree that social cognitive impairments appear early after onset of psychotic disorders. Thus earlier interventions—where there is a recent diagnosis or even when there are prodromal syndromes, before full onset of illness—may be more effective than interventions after patterns become entrenched.

There Is No “One Size Fits All”: Not all patients benefit from all social cognitive interventions; there are different profiles of impairment among those with psychosis. Tailoring treatment to the individual is important.

Promising Approaches Could Enhance Efficacy & Generalizability

Although a concerted effort was made two decades ago to separate social cognitive skills training from other treatment components, it may be most effective when used in combination with other interventions. The landscape offers opportunity for improvement of social cognitive interventions, including some novel ones. Integrated strategies could include:

  • Bridging activities. Designed to help participants apply learned skills to their daily life, these activities play a key role in generalization of benefits from psychosocial skills training and cognitive remediation—and could be used to enhance the generalizability of social cognitive interventions.
  • New technologies. Three potential approaches for leveraging technology include:
    • Computerized interventions: Unlike interventions for cognitive remediation, these have rarely been tested as a treatment for social cognition.
    • Virtual reality: Simulators could allow patients to experience a wide variety of complex, dynamic, and interactive situations, and to practice social cognitive skills in a safe environment without negative repercussions.
    • Mobile devices: Services can be delivered via smartphone apps (self-initiated or automated), text message prompts (e.g., for behaviors or homework), and experience monitoring (e.g., mood or symptom monitoring with prompts for coping behaviors).
  • Combining psychopharmacology with social cognitive training. Because not all participants benefit from social cognitive training programs, the combination of psychopharmacology with social cognitive training is a promising direction that needs more exploration.

What’s Next?

Much work remains to be done before implementing social cognitive interventions in community mental health settings. But consistency in improvements and better-controlled studies are isolating treatment benefits. So despite the small number of existing studies and their limitations, the outlook is optimistic.

A key goal must be to move from small pilot studies to research that leads to new psychosocial and non-psychosocial approaches. This will include validating the endpoints for clinical trials, identifying predictors of treatment outcomes, conducting large and rigorous randomized controlled trial studies, and tackling the important challenge of generalizability.

In short: creative new approaches are needed to help link the benefits of social cognitive treatments to meaningful improvements in community functioning for people with schizophrenia.

Following-up to the 2019 Trends In Behavioral Health: A Population Health Manager’s Reference Guide On The U.S. Behavioral Health Financing & Delivery System, 2nd Edition, Deb Adler and Paul Duck discuss trends and shifts in the market and the impacts on population health management. From 2017 to 2019, specialty care coordination programs increased by 50%, behavioral health readmissions prevention programs increased by 74%, and emergency department diversion programs for behavioral emergencies increased by 43% for all health plans1. Service provider organizations are adapting to this shift by utilizing peer support specialists, adopting telehealth, and increasing consumer engagement via emails and text messages.

Featuring:

  • Deb Adler, CPHQ
    Senior Associate at OPEN MINDS
  • Paul Duck
    Senior Associate at OPEN MINDS

Deb Adler, CPHQ, has more than 20 years of experience in executive health care roles, serving in a variety of capacities, including network executive, quality management executive, and COO. She is the former Senior Vice President of Network Strategy for Optum, where she was responsible for behavioral health network development, contracting, and strategy for over 185,000 providers. In this role, she developed the largest performance-tiered behavioral health network, the largest telemental health network, and the largest medication-assisted treatment (MAT) network. She was also responsible for implementing network initiatives to promote medical/behavioral integration, improve member outcomes, and reduce total cost of care through collaborative care models. Currently, she serves as a Senior Associate at OPEN MINDS. Ms. Adler earned her MA in psychology and evaluation from Catholic University of America and is a Certified Professional in Health Care Quality (CPHQ).

Paul Duck currently serves as a Senior Associate at OPEN MINDS. He brings over 40 years of experience in leadership and management, focusing on managed care, health information technology organizations, strategy, business development and market expansion, and customer experience optimization to the OPEN MINDS team. Previously, Mr. Duck has served in roles such as Vice President, Strategy & Development for Beacon Health Options, the Vice President of Business Development for Netsmart Technologies, and Chief Executive Officer for Coastal Orthopedics. Mr. Duck earned his Bachelor of Arts in Business Management from Case Western Reserve University.  He earned his Associate of Arts in Electronic Engineering Technology from the Electronic Technology Institute.

Following-up to the