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Pivoting From Reactive To Proactive Innovation

Six months into the pandemic, the organizations that are thriving share one characteristic—nimble reaction to change. But the big question ahead is whether the field can move from reactive to proactive innovation.

What is the difference? With reactive innovation, executives wait for good ideas to be presented and then try to implement the ideas they believe are positive for their organization. The health and human service field has a history of reactive innovations—payers like state and county governments or Medicaid plans change what they want and release new RFPs or regulations. Provider organization executive teams react. The swift reaction of provider organizations to the pandemic—bringing up telehealth to scale—is an extreme example of this.

Proactive innovation is when executive teams identify emerging opportunities in the market and create new products and services to meet those market needs. Proactive is anticipating what customers will want and creating those future solutions. Proactive innovation is an essential part of planning for future sustainability— identifying the “the next big thing” that will be the financial anchor for their organization— whether it is home-based services, hybrid care models, primary care, new integrated care coordination approaches, or something else entirely.

Where are specialty provider organization executive teams with this pivot from reactive innovation to proactive innovation? Four executives who are making it happen on the ground offered their perspectives in the recent web briefing, Operating Behavioral Health Programs In A Pandemic: Success Stories From Arizona, New Jersey, & Ohio. The panelists included Susan Devlin, Executive Director, Comprehensive Behavioral Health Care of Bergen County; Jeff O’Neil, President and Chief Executive Officer, Greater Cincinnati Behavioral Health Services; Steven Sheets, President and Chief Executive Officer, Southwest Behavioral and Health Services; and Christy Rosado, Senior Vice President, Sales, Genoa Healthcare.

None of the three provider organizations have closed their face-to-face service delivery during the pandemic—and they found creative ways to sustain a hybrid model of virtual services with in-person outreach in the community. But all the executives acknowledged that while they were “making it up as we go” (to quote Ms. Devlin), the key to future success is look beyond the status quo with proactive planning.

Making The Shift To Virtual   

For the three provider organizations, telehealth was largely new territory as they had done little to none before the pandemic. While the pivot was quick—out of necessity and thanks to teamwork—there was a steep learning curve. To make this happen, new processes had to be developed, staff and consumers had to be trained, and technology had to be upgraded.  A key (and continuing issue) for all the provider organizations is the digital divide—many consumers either lacking access to high-speed internet, the equipment to access virtual services, or the ability to fully participate in those services. But they made virtual work over the past six months with creativity. For example, Ms. Rosado said that Genoa came up with the concept of a “virtual waiting room” where they could have conversations with consumers waiting to see clinical professionals. And Mr. Sheets noted that video visits yielded the unique advantage of letting clinical professionals see consumers “where they are” and get a sense of their living conditions that impact health.

Managing With New Operational Challenges From The Pandemic     

The pandemic brought many new operational challenges to serving consumers. Ms. Devlin said at one point, 25% of staff at Comprehensive Behavioral Health Care of Bergen County were out — quarantined, dealing with day care closures, or juggling other issues at home. She added that early on, they had to invest significantly in stocking up on personal protective equipment (the sourcing of which became a full-time job) and later had to retrofit their facilities with plexiglass shields, touchless doorknobs, and more. Mr. Sheets echoed the challenge of escalating expenses and noted that while some facility-based indirect expenses came down as they pivoted largely to virtual operations and virtual care delivery, there was a huge uptick in spending on technology—laptops, phones, a telehealth platform, etc.

For pharmacists, keeping in touch with current consumers and onboarding new consumers who needed prescriptions was no easy task, as they transitioned from onsite to online, said Ms. Rosado. Mr. O’Neil pointed out that managing a remote workforce was challenging—they quickly discovered that remote work requires “more structure, more process, and more training.” Much thought had to be invested into ensuring staff connectivity and rethinking communication and supervision protocols.

Engaging Consumers & Staff In The Midst Of Change    

The panelists pointed out that engagement—of consumers and team members—was another critical area requiring innovation and “outside the box” thinking. Ms. Devlin shared that for consumers who needed to come in for face-to-face visits, staff set up “a tent in the parking lot.” Staff also made up “activity gift baskets” with puzzles, snacks, and movies and dropped them off for consumers especially challenged by the isolation enforced by the pandemic. She said that tapping into the expertise and dedication of long-time staff and the goodwill of consumers was a key element in navigating through the crisis.

Mr. Sheets’ team sent multiple texts and emails to consumers to remind them about appointments and just to check in. They also sent staff gift cards for free lunches and “fun self-care packages” to let them know that management had not forgotten about them. “We did everything we could to let staff know that we’re here, we understand, and we’re flexible,” he said.  “Every touch point needs to be intentional.”

Mr. O’Neil said that with 10,000 people in their care management program, they needed an innovation that matched the scale of the challenge. His organization created a “COVID Work Safe” team that helped to prioritize issues, respond to the immediate situation, and engage in long-term planning. To get a better sense of consumer needs, their team conducted two assessments—the first was to evaluate basic needs and concerns of consumers and prioritize; the second was to determine the best service modality—video, telephonic, or face-to-face—for each consumer. Getting consumers their medications was also a big concern, so Greater Cincinnati Behavioral Health Services partnered with Genoa to set up a “mobile injection van” to go out and deliver medications.

Support services like onsite pharmacies had to up their game as well. Ms. Rosado said they introduced curbside pickup of prescriptions and also mailed more medications (an effort that increased 50% in volume from pre-pandemic days). And where permitted, pharmacists jumped in as staff extenders to administer long acting injections to consumers. For their staff, Genoa has done themed video calls (including a Christmas in July) and “talk while you walk” phone calls to keep the camaraderie up in the remote environment. “You can’t overcommunicate!” said Ms. Rosado.

Making The Pivot    

These creative approaches and nimble responses to the pandemic are fundamental to success in a crisis. But over the next six months, as the pandemic moves from emergency to the “next normal,” the sustainability challenge will shift to longer-term strategies—and the investment required to make them happen. Mr. Sheets said it well—that the crisis must not preclude planning for the future and service expansion. “We have to challenge the behavioral health system to think differently—to think about the long term rather than just what’s a catchy trend. Otherwise we will be part of those who fail within three years of the crisis.”

A total of 21 Medicare Advantage plans earned 5 stars, the highest, in the latest CMS release of star ratings for 2021. The 21 health plans earning 5 stars include KelseyCare Advantage, Kaiser Permanente, UnitedHealthcare, CarePlus by Humana, Tufts Health Plan, Health Partners, Capital District Physicians’ Health Plan, Quartz Medicare Advantage of Wisconsin, Cigna, Health Sun (now owned by Anthem), BlueCross Blue Shield Health Now New York, and Martins Point, to name a few.

A total of 375 plans of the 400 rated for 2021 had ratings between 3 and 4.5 stars:

  • A total of 63 plans were rated 4.5 stars.
  • A total of 110 plans were rated 4 stars.
  • A total of 141 plans were rated 3.5 stars.
  • A total of 61 plans were rated 3 stars.

Just four plans earned the lowest rating of 2.5 stars: Bright Health, AgeWell New York, Prominence Health Plan, and Virginia Premier.  Prominence HealthFirst of Texas is the only contract getting a low performance warning for consistently low-quality ratings of 2.5 or fewer stars from at least 2018 through 2021. An estimated 417 plans were rated not applicable as there was not enough data available or the plan was too new to be rated.

The average Star Rating for all Medicare Advantage plans with prescription drug coverage improved to 4.06 out of 5 stars in 2021 from 4.02 in 2017. About 49% of Medicare Advantage plans that offer prescription drug coverage will have an overall rating of four stars or higher (an increase from 45% in 2017). About 77% of Medicare beneficiaries who enroll in Medicare Advantage plans with drug coverage will be in plans with four or more stars in 2021 (compared to 69% in 2017).

For the 2021-star ratings, no new measures were introduced. However, on March 31, 2020, CMS adopted changes to the 2021-star ratings to accommodate disruption to data collection posed by coronavirus disease 2019 (COVID-19), as well as changes to the 2022-star ratings to account for expected changes in plan performance. CMS increased the weight of patient experience/complaints and access measures from 1.5 to 2 for the 2021-star ratings.

The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Part C and D Star Ratings each year to measure the quality of health and drug services received by beneficiaries enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs, or Part D plans). The Star Ratings also reflect the experiences of beneficiaries; the ratings are intended to help beneficiaries finding the best plan for them.

A link to the full text of “CMS Fact Sheet – 2021 Part C & D Star Ratings” may be found i at www.openminds.com/market-intelligence/resources/101320cms2021starratingsfactsheet.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/

Over the past decade, there has been a running disagreement with many of the non-profit organization executives and board members. One view is that non-profit organizations need to be run like for-profit organizations—that they need efficiencies that treat donor contributions and grant funding just like for-profit organizations treat their investors’ money. With great care.

And non-profit organizations need profit margins to invest in their future growth and mission-based work. “Non-profit is just a tax status,” as some have said. Non-profit organizations are granted tax exemption because they do charitable work for the communities they serve; with the margins they generate. These margins start with budgeting (yes, budgeting a profit), are delivered through efficient strategy execution, and are then available to build a portfolio of services and assets in the community.

Most non-profit organizations operate with breakeven budget expectations. So, in a conversation with Mark Mishek, President and Chief Executive Officer of Hazelden Betty Ford Foundation, Monica E. Oss, Chief Executive Officer, OPEN MINDS, was intrigued to learn why and how their organization budgets—and delivers—a margin.

As leader of the nation’s largest non-profit addiction treatment provider organization, Mr. Mishek fully espouses the mantra of “No Margin, No Mission” (conferred on health care by the late Sister Irene Kraus, founding chief executive of the $3 billion Daughters of Charity National Health System). “I grew up on the acute care side of health care where the need for capital is huge, and capital comes from margin. The purpose of margin for a non-profit is to reinvest,” Mr. Mishek said. At Hazelden, they set an Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA) target of at least 10% each year. Interestingly, they are scaling back to a 9% goal for 2021 to allow for restoration of financial stability after the pandemic.

Growth does not come with a “business as usual” mindset, elaborated Mr. Mishek. Provider organization executive teams that continue to depend on traditional revenue streams and referral sources may run out of cash and close their doors at worst, or barely survive but “not go anywhere” at best. And the pandemic is not an excuse for lack of planning. The pandemic has deferred or altered the focus of some initiatives and investments at Hazelden but has not put the lid on their growth plans. “The focus is on staying open and staying safe in all the eight states we operate in. We are rechanneling investments from brick and mortar facilities to virtual services and operations infrastructure. But growth continues to remain an imperative because there is a big unmet need out there that demands our attention,” Mr. Mishek explained. Only 1 in 10 of the nearly 20 million Americans with substance use disorders currently get the treatment they need—so it’s going to take a lot of scaling to expand access to care. “Growth is a mission mandate, not just a nice idea,” he underscored.

Executives who don’t see a path to achieve the margin needed to reinvest in growth should be thinking about new service lines, affiliations, or partnerships because “the only way to be a player in the increasingly competitive, consumer-driven market is size and scale.” Mr. Mishek offered three strategies, based on Hazelden’s own experience, for executives to employ in scaling up—follow the money, learn from the competition, and pursue win-win partnerships.

Following The Money

Executive teams need to keep their eye on where and how customers want to spend their available resources. One path is optimizing current services and customer relationships. The other is planning for their “next big thing”—the future services that will anchor their customer relationships and financial sustainability. Hazelden is looking at a seamless hybrid model of care as their “next big thing.” Mr. Mishek explained that the continuum of care for addictions will look different. “We want consumers to be able to get in and out of levels of care easily, where each level is paid for. And we want them to be able to choose virtual vs. in-person care as they prefer.” The pandemic has accelerated the adoption of virtual care, and Hazelden was well-prepared with its RecoveryGo suite piloted in 2019. RecoveryGo is a suite of virtual care tools for addictions recovery—an intensive outpatient program, a robust consumer portal for education and care management, recovery support services, and a family program. While the future is not just telehealth, the pandemic has shown how much consumers and families prefer virtual components. “Digital is a whole way of life—from consumer conveniences to the education of counselors,” said Mr. Mishek, and Hazelden is set for the transformation in care.

Mr. Mishek noted that Hazelden will always be a center of last resort for residential treatment but is also looking to expand to address the needs of those who are “further down the pyramid.” The addictions pyramid concept was made popular by Thomas McClellan, founder of the Treatment Research Institute and former deputy director of the Office of National Drug Control Policy. He explained that if all U.S. adults are placed in a pyramid, the bottom is a broad base of people who almost never use drugs, alcohol, or other substances. About halfway up are 40 million people who “misuse” substances; about three quarters of the way up are 21.4 million people with addictions; and at the top are 4.1 million people with the most chronic and severe addictions—the only group that gets any sort of substance abuse treatment. “The universe of say, problem drinkers, needs help and represents a $62 million market,” said Mr. Mishek.

Hazelden also maintains excellent relationships with health plans and offers solutions to their most pressing problems—whether that’s network expansion, geographic coverage, or clinical quality. “When a large employer in Seattle liked our quality of care but was reluctant to have their employees travel to us, we opened an outpatient facility in Seattle,” noted Mr. Mishek, as one example of expansion. They also go “all in on contracting”—Hazelden has a contract with every Blues plan in every market they’re in—and given the agreements between plans, consumers can move seamlessly from outpatient to residential, even across states. This becomes a selling point for the plans. Health plans want to stop consumers from going to out-of-network addictions treatment provider organizations that do not offer quality care and Hazelden has helped them “make the in-network providers more attractive.” Mr. Mishek added, “We’re here to play ball. We’re game for case rates and pay for performance (but not downside risk). But we have to negotiate acceptable case rates and factor in outliers—we can do all that because we have strong metrics and strong financial analysis capabilities.”

Matching The Competition

Another key to scaling up is keeping pace with the competition. Attracting customers—both payers and consumers – is about offering the “best value” when compared to other options. Mr. Mishek thinks that the growing footprint of private equity in the behavioral health market has fostered a new level of sophistication and consumerism. “We have a lot to learn from our competitors—they are investing in top-of-the-line marketing, online presence, search engine optimization, call centers, and other options to increase consumer access and convenience, and we have to catch up,” said Mr. Mishek. Hazelden is focused on excellence in care and virtual marketing to gain an edge over the competition.

Delivering convenience, education, and information may mean “doing stuff you don’t get paid for” but Hazelden sees that as part of the investment to establish its brand. They want to become a go-to source of complete online information and education on addiction disorders and treatment. “We want to be the Mayo Clinic of addictions,” Mr. Mishek asserted. Addictions treatment provider organizations that are “not doing much more than the traditional 12-step program,” are not poised for growth and success, he said.

Seeking Partnerships & Affiliations   

Changing customer expectations and more competition have sped up the product life cycle and the need for nimble innovation. For many organizations, collaboration may be the best option to remain competitive. As an example, Hazelden recently created a partnership with Emory Healthcare to create the Addiction Alliance of Georgia. With philanthropic support, the two organizations will seek community partners throughout Georgia to advance addiction-related clinical care, education, and research. Emory expects this unique public-private partnership to become a national model for promoting addictions recovery. The alliance will work with the Georgia Department of Public Health, the Georgia Department of Behavioral Health and Developmental Disabilities, Grady Health System, Morehouse School of Medicine, the Medical Association of Georgia, and federally qualified health centers throughout the state.

And Mr. Mishek gave other interesting examples of potential collaborations. Multiple provider organizations coming together and forming a management company to manage backroom operations and develop infrastructure is another good way to “scale up without losing local identity and independence,” he suggested. These coalitions bring capital to the table and enable early adoption of evidence-based practices. He also suggested looking at partnerships with health systems and with digital health start-ups. He said that capitation-based payments offer opportunities to partner with health systems on holistic treatment. “Primary care professionals don’t know substance use or mental health and they don’t want to be loaded with one more thing to do, but that’s where we can come in with strategic partnerships,” he noted. And he added that the digital-only addictions treatment companies “haven’t caught fire yet” and may need traditional provider organization partners to be successful in the long run.

At the end of the day, “The inability to produce margin and to raise capital sounds the death knell if you don’t get out there and find your kindred partners. Find nonprofits like you that share your values and understand the need to grow. Survival requires sizing up and scaling up,” summed up Mr. Mishek.

Medicaid and CHIP enrollment combined grew from almost 71 million people in February (the approximate “onset” of coronavirus disease 2019 (COVID-19)), to nearly 75 million in June, representing a 5.7% increase. Medicaid enrollment grew 6.2% during that period, with nearly 4 million more people enrolled in the program. CHIP grew about 0.5%, with enrollment increasing by more than 23,000 beneficiaries.

Overall CHIP enrollment increased in 36 of 37 states reporting. Montana was the only state that reported an enrollment decrease in 2020. However overall Medicaid and CHIP enrollment increased for all 37 states. The number of unemployed in these 37 states increased dramatically, from approximately 7.5 million individuals to approximately 23 million (about a 205.4% increase) in these states between March and April. However, unemployment then decreased 11.9% between April and June 2020.

These findings were presented in “Medicaid & CHIP Enrollment Trends Snapshot Through June 2020,” by the Centers for Medicaid & Medicare Services (CMS). Researchers for CMS tracked total Medicaid and CHIP program enrollment trends for adults and children over a 12-month period between July 2019 through June 2020. The goal was to determine recent trends in CHIP enrollment.

A link to the full text of “Medicaid & CHIP Enrollment Trends Snapshot Through June 2020” may be found at www.openminds.com/market-intelligence/resources/092920medicaidchipenrollment.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/

The incidence of acute stress, anxiety, depression, addiction, and suicidal ideation in the United States rose significantly after the coronavirus disease 2019 (COVID-19) public health emergency began in March 2020, according to three recently released studies. The studies documented prevalence three to four times higher than the same period in 2019, and proposed theories about the rise. In general, after the public health emergency began, people with pre-existing fragile mental health, financial struggles, or worries about their employment status were most likely to experience stress, anxiety, and/or depression. One of the studies proposed that elevated consumption of COVID-19-related media (print or broadcast news and social media) predicted higher acute stress and depressive symptoms.

The first study is “Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24 to 30, 2020” by researchers with the Centers for Disease Control & Prevention (CDC). They compared prevalence among 5,412 adults age 18 and older who participated in a web-based survey conducted June 24 to 30, 2020. Their responses were compared to survey responses during the same period in 2019. During June 2020 about 41% of the respondents reported an adverse mental or behavioral health condition. The prevalence was as follows:

  • 9% reported symptoms of anxiety disorder or depressive disorder.
  • 5% reported symptoms of trauma- and stressor-related disorder (TSRD) related to the pandemic.
  • 3% reported starting or increasing substance use to cope with stress or emotions related to COVID-19.
  • 7% reported having seriously considered suicide in the preceding 30 days.

The researchers found that the prevalence of behavioral health disorders was higher in 2020 than during the same period in 2019. The prevalence of anxiety disorder was three times higher, at 25.5% in 2020 compared to 8.1% in 2019. The prevalence of depression was four times higher (24.3% compared to 6.5%). The incidence of suicidal ideation was about twice as high (10.7% compared to 4.3%). A link to the full text of “Mental Health, Substance Use & Suicidal Ideation During The COVID-19 Pandemic — United States, June 24–30, 2020” may be found at www.openminds.com/market-intelligence/resources/081220covidmentalsubstancesuicide.htm.

The second study, “Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic,” by Catherine K. Ettman, BA; Salma M. Abdalla, M.D., MPH; Gregory H. Cohen, MPhil, MSW, Ph.D.; et al., found that depression prevalence was more than three times higher during the COVID-19 pandemic. The researchers compared survey responses in completed by adults ages 18 and older before and during the COVID-19 pandemic. The pre-COVID-19 survey included 5,065 participants. During the pandemic, 1,470 participants completed the COVID-19 and Life Stressors Impact on Mental Health and Well-being survey. Symptom prevalence was higher for each level of depression severity:

  • Mild, at 24.6% in 2020 compared to 16.2% in 2019.
  • Moderate, at 14.8% compared to 5.7%.
  • Moderately severe, at 7.9% compared to 2.1%
  • Severe, at 5.1% compared to 0.7%

The researchers found that the risk of depression was 2.37 times higher among those with lower income, and 1.52 times higher among those with less than $5,000 in savings. The risk was 3.05 times higher among those exposed to more life stressors. The full text of “Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic” was published September 2, 2020, by JAMA Network Open. A abstract is available online at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146?widget=personalizedcontent&previousarticle=0.

The third study, “The Unfolding COVID-19 Pandemic: A Probability-Based, Nationally Representative Study Of Mental Health In The U.S,” by E. Alison Holman, Rebecca R. Thompson, Dana Rose Garfin, and Roxane Cohen Silver focused on factors associated with higher levels of acute stress and depressive symptoms. They analyzed 6,514 survey responses from the NORC AmeriSpeak panel. The researchers found that acute stress and depressive symptoms increased significantly over time as COVID-19 deaths increased across the U.S.

Pre-existing mental and physical health diagnoses, daily hours of COVID-19-related media exposure, exposure to conflicting COVID-19 information in media, and secondary stressors were all associated with acute stress and depressive symptoms. The full text of “The Unfolding COVID-19 Pandemic: A Probability-Based, Nationally Representative Study Of Mental Health In The U.S” was published September 23, 2020, by Science Advances. A copy is available online at https://advances.sciencemag.org/content/6/42/eabd5390.

For more information about the article published in the CDC Morbidity and Mortality Weekly Report, contact:

  • National Center for Health Statistics, 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

For more information about the impact of COVID-19 on depression prevalence, contact:

  • Sandro Galea, M.D., MPH, DrPH, Dean and Robert A. Knox Professor, School of Public Health, Boston University, 715 Albany Street, Talbot 301, Boston, Massachusetts 02118; Email: sgalea@bu.edu; Website: https://www.bu.edu/sph/profile/sandro-galea/

For more information about the probability study, contact:

  • Alison Holman, Ph.D., Professor, Sue & Bill Gross School of Nursing, University of California, Irvine, 252J Berk Hall, Mail Code: 3959, Irvine, California 92697; Email: aholman@uci.edu; Website: https://www.faculty.uci.edu/profile.cfm?faculty_id=5441
  • Roxane Cohen Silver, Ph.D., Professor of Psychological Science, Medicine, and Public Health; Associate Director, ADVANCE Program, Office of Inclusive Excellence, School of Social Ecology, University of California, Irvine, 4336 Social and Behavioral Sciences Gateway, 515 Aldrich Hall, Irvine, California 92697; Email: rsilver@uci.edu; Website: https://faculty.sites.uci.edu/rsilver/

On October 1, 2020, the North Carolina Department of Health and Human Services (NCDHHS) announced it awarded a $7 million contract to United Providers of Health (UPOH) to address unmet health care needs of historically marginalized communities. The sole source contract is to provide preventative health care services, connections to mental health supports and help securing non-medical social determinants of health such as food and housing. Funding for the contract is supported by Coronavirus Relief Funds. The goal is that combining mental health services with primary care will reduce costs, increase the quality of care, reduce the burden on hospitals, and mitigate the spread of coronavirus disease 2019 (COVID-19).

UPOH will use the Hope4NC Helpline to connect with residents in the community who call or text for assistance. After receiving a Hope4NC Helpline request, UPOH will connect individuals with needs for housing, medical care, and financial counseling to services. UPOH will provide access to a statewide network of Certified Peer Support Specialists who can connect behavioral health service recipients with primary care professionals. The target population includes (but is not limited to) people living in rural counties designated by the North Carolina Office of Rural Health as being high poverty areas. The target population also includes people and communities with limited access to physical health professionals for preventive and acute care, and or behavioral health professionals.

The contract with UPOH began on September 29, 2020 and runs through December 30, 2020. NCDHHS paid UPOH half the contract value about 10 days after contract execution to support initial startup costs and to use to provide services agreed to in the contract. UPOH will work against those funds and provide documentation to support the expenditures. At the time that the first payment is exhausted, UPOH will be reimbursed for eligible expenses.

UPOH is an Independent Providers Association (IPA). Its network includes small mental health, addiction treatment, intellectual/developmental disability, provider organizations and primary care physician practices, who deliver services to underserved individuals with high health care needs. The services will be tailored to the needs of historically marginalized populations and address existing health disparities by delivering culturally competent care. UPOH will offer counseling to those dealing with the financial uncertainty posed by potential eviction or termination of utilities and by assisting community members coordinate with social services and other supports, especially those involved in the COVID-19 response.

NCDHHS did not publicly post the procurement, consistent with the procurement flexibilities granted in Executive Order declaring a state of emergency to respond to and prevent spread of COVID-19.

For more information, contact:

  • Victor Armstrong, Director, Division of Mental Health, Developmental Disabilities and Substance Abuse Services, North Carolina Department of Health and Human Services, 306 N. Wilmington Street, Bath Building, Raleigh, North Carolina 27601; 984-236-5002; Email: victor.armstrong@dhhs.nc.gov; Website: https://www.ncdhhs.gov/divisions/mhddsas
  • United Providers of Health, 9650 Strickland Road, Suite 103-189, Raleigh, North Carolina 27615; 919-701-6603; Email: info@upoh.org; Website: https://upoh.org/

Health care claims for New York City residents indicate that between March and May 2020 behavioral health care utilization dropped by 41.2% among people diagnosed with serious mental illness (SMI) compared to utilization during the same period in 2019. The March to May period was during the height of the coronavirus disease 2019 (COVID-19) outbreak in the New York City. SMI was defined as bipolar disorder, major depressive disorder, schizophrenia, and personality disorders. In 2019, about 67% of members with one of the four SMI conditions accessed behavioral health services. During 2020, only 43% accessed behavioral health services.

These findings were reported in “Mental Health Care Is Suffering During The Pandemic; New Data Shows How Much” by Urvashi Patel and A. Bartley Bryt, of Brighton Health Plan Solutions (BHPS), a health care enablement company that improves how health care is accessed and delivered. The authors compared behavioral health care claims (both in-person and telehealth) among their self-funded health plan clients’ members in New York City during the March to May 2020 period to the same period in 2019 among individuals with one of the four SMI conditions. They noted that although telehealth utilization rose by nearly 2,000% over 2019 levels, it was insufficient to fill the service gap among the population under review.

BHPS is a third-party administrator that serves self-funded health plans, offering proprietary networks, administrative services, casualty solutions, and integrated digital tools. It offers three products: MagnaCare, Create, and MagnaCare Casualty Solutions. MagnaCare offers self-insured plans and services to employers in New York and New Jersey, including commercial insurers, third-party administrators, government entities, and labor markets. Create is a new product that builds on a direct-to-professional contracting model to align the goals of provider organizations, plan sponsors, brokers, health plans, and members. Casualty Solutions is a casualty medical management and preferred provider organization vendor in the New York tri-state area (New York, New Jersey, and Connecticut).

The full text of “Mental Health Care Is Suffering During The Pandemic; New Data Shows How Much” was published September 18, 2020, by Med City News. A copy is available online at https://medcitynews.com/2020/09/mental-health-care-is-suffering-during-the-pandemic-new-data-shows-how-much/.

For more information, contact:

  • Erin George, Media Contact, Brighton Health Plan Solutions, Corporate Headquarters, One Penn Plaza, 53rdFloor, New York, New York 10119; 844-759-2477; Email: erin@lovell.com; Website: https://www.brightonhps.com/

On October 2, 2020, Pennsylvania Governor Tom Wolf signed an executive order to launch a comprehensive, whole-person health reform plan that focuses on improving affordability, access, and value for physical and behavioral health for Pennsylvanians, regardless of how they receive or purchase health care coverage. The key goals of reform are aligning the Commonwealth’s health care payment and delivery systems to provide efficient whole-person care, eliminating health inequities resulting from systemic racism, and holding health care corporations accountable.

A newly established Interagency Health Reform Council will develop proposals by December 31, 2020, to modernize and reform Pennsylvania’s health care, such as aligning programs where feasible, including the joint purchasing of medications, aligning value-based purchasing models, and using data across state agencies to promote evidence-based decisions. The Council’s report will identify all policy and legislative changes needed to adopt the proposals. In the absence of legislative action, the Council will develop initial health care cost growth benchmarks by March 31, 2021 and make accompanying recommendations for development of future year cost targets.

The Council will be composed of commonwealth agencies involved in health and the governor’s office. In addition to the work of the Council, the plan calls for establishing Regional Accountable Health Councils and a Health Value Commission, as follows:

  • Regional Accountable Health Councils (RAHCs): The Department of Human Services (DHS) will add requirements to form five RAHCs across the state into the managed care agreements. The RAHCs will be required to collectively develop regional transformation plans, based on community needs assessments, to reduce disparities, address social determinants of health, and align value-based purchasing arrangements.
  • Health Value Commission. The governor will work with the legislature to pass legislation that establishes the Health Value Commission. It will be charged with keeping all payers and providers accountable for health care cost growth, to provide the long-term affordability and sustainability of Pennsylvania’s health care system, and to promote whole-person care. The Health Value Commission would be led by up to 15 commissioners appointed by the governor and the General Assembly who have an expertise in the health care marketplace, including the heads of five state agencies. The commission would establish a statewide health care cost growth benchmark, in addition to spending targets to support primary care, behavioral health, and value-based purchasing. The commission would monitor payor and provider organization performance relative to these benchmarks. Additionally, the commission would perform public interest reviews of large provider organization mergers, acquisitions, corporate affiliations, or changes in ownership across the commonwealth, adding a new layer of transparency for Pennsylvania consumers, businesses, and communities.

A link to the full text of “Pennsylvania Governor’s Executive Order 2020-05 To Establish A Health Care Reform Council” may be found at www.openminds.com/market-intelligence/resources/100220paeohealthreformcouncil.htm.

For more information, contact:

  • Pennsylvania Office of the Governor, 508 Main Capitol Building, Harrisburg, Pennsylvania 17120; 717-787-2500; Fax: 717-772-8284; Website: https://www.governor.pa.gov/

In this presentation, the objectives are to:

  • Review the immune system and understand how it affects physical and mental health
  • Share wellness tips to improve physical and mental health
  • Explore ways to practice wellness

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 the history of mixed states in depression, focusing on conceptualization, phenomenology, and diagnostic considerations
  • Highlight the clinical relevance of correctly identifying/defining mixed states across depression
  • Discuss the impact of mixicity on the course of illness and treatment outcome

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:

  • Define the basics of patient empowerment
  • Understand the importance of patient engagement and disengagement
  • Address potential barriers to patient empowerment
  • Explore opportunities to increase patient empowerment in Psychiatry

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:

  • Behavioral Health Care as an Unmet Need Within Orange County
  • The Need for Screening in Primary Care
  • What to do After Screening
  • Integrated & Collaborative Care Models
  • The Future: Discussion/Question & Answer

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.

There has long been tension between art and science—and this has been a point of contention in health care as long as we can remember. In the article, When Should A Process Be Art, Not Science? in Harvard Business Review (HBR), the authors define art as “judgment-based work,” with variability in the process, which is valued when all customers don’t want the product or service to perform the same way. Science is about reducing variability and “creating complex rules that spell out exactly what to do in every possible circumstance….” They argue that artistic and scientific approaches need not be at odds but must be carefully harmonized.

As we move more populations and more services to managed care models of financing and service delivery, understanding how to make the art and science work together is critical. There is a need to standardize processes to support the work of clinical professionals and the operational infrastructure of provider organizations while allowing clinical judgment to thrive. Interestingly, the authors of the HBR article say that the key to managing “artistry” is performance metrics. “An artistic process has to rely on external measures of success. Artists need continual exposure to customer feedback, which prevents them from constructing their own idiosyncratic notion of quality.”

But in value-based contracts now, there are few standardized performance measures and even fewer benchmarks. The question is how to bring in the standardization we need for cost control but allow the clinical judgement that is essential for better consumer outcomes. This issue was front and center in our recent session, Navigating Health Plans: Keys To Developing Long Term Relationships, at the 2020 OPEN MINDS Management Best Practices Institute. Three payer executives—Katherine Hobbs Knutson, MD, MPH., Senior Vice President, United Health Group and Chief Executive Officer, Optum Behavioral Care; Ann O’Grady, Senior Vice President and Chief Clinical Officer, New Directions Behavioral Health; and Robert Ciaverelli, MD, Behavioral Health Medical Director, CareFirst—along with George Kolodner, MD, Founder and Chief Innovtion Officer, Kolmac Outpatient Recovery—debated the art vs. science dimension on three critical elements of payer-provider relationships—goal setting, performance measures, and communication.

Alignment On Goals

Dr. Ciaverelli pointed out that we are still in a “supply drain situation,” where there is increasing demand and inadequate supply of behavioral health services (especially on the outpatient side). So, the payer’s first goal is to give consumers what they need when they need it by expanding network access. And growing that network needs more than “a list of names in the phone book,” he said. It requires knowing provider organizations and having relationships with them, enticing them with better rates, and ensuring that they will get the payer’s consumers “at the front of the line.” He added, “I became the center of trying to recruit provider organizations into our network and having them grow, in terms of reach and geography. It is a win-win situation as payers and providers both want to grow. It takes a bit of desperation and wanting to do things differently.”

Dr. Hobbs Knutson admitted that fee-for-service structure has created a major lack of alignment on goals for payers. “We reimburse providers at higher rates for facility-based and residential care when we know the most effective care is out in the community—outside high-cost, restrictive locations. We don’t have enough access to outpatient settings, the quality of treatment is questionable, and costs are high.” The goal, she said, is to align the whole system and deliver the most effective clinical care in the most convenient location (in the community). “We get better results when we marry the priorities of people getting better with cost savings.” Provider organizations should consider alternative payment models to align on incentives, Dr. Hobbs Knutson suggested. “Practice has the risk of being shaped by payments. Provider organizations and payers must align to drive payments that support the best clinical practice,” she suggested.

Measures That Matter

Access is always the most critical measure, Ms. O’Grady emphasized. So, payers want to see measures such as time between when a consumer calls and the first appointment, especially for substance use. “Ten to twelve days later no longer works,” she said.

With access becoming increasingly important, Dr. Ciaverelli predicted that we’ll see payers moving to more “open table” type of scheduling where they allow consumers to scan (via apps and online) across the network for the earliest appointment they can get with a provider organization that offers the services they are seeking. And payers will give preference to provider organizations that offer blocks of appointments for open table scheduling.

In addition to access, payers are looking for measures that are recovery and outcomes focused, reiterated Dr. Hobbs Knutson. “We need genuine cost measures—such as reduction in emergency department visits and inpatient admissions—and need to know how they were driven by specific interventions that are evidence-based. There are lots of not so great measures out there. We get a lot of pre-post comparisons where the reasons for cost reduction are not clear,” she said. She offered a couple of examples of good measures. For a co-occurring disorders program offering prevention, education, and Screening Brief Intervention and Therapy (SBIRT), it would be important to measure how many people complete the screening, how many people who screen positive are engaged in treatment, and how many complete treatment. For evidence-based programs it is also good to extrapolate long-term health and cost outcomes, such as “when treatment is completed, the recovery rate is xx%.”

From the provider organization perspective, measurement has always been a “less comfortable area of collaboration,” in Dr. Kolodner’s opinion. But provider organizations need to be proactive and creative even if there are no defined measures. For instance, Kolmac has been measuring outcomes for the 250 consumers they’ve treated primarily through telehealth so that if telehealth relaxations are removed post-pandemic, they will be able to go to payers with evidence about why that’s not a great idea. “We know that with telehealth, 90% of consumers are completing withdrawal management and 80% are moving into follow-up treatment. And when we compare that with the decades of data we have on in-person care, we know that telehealth has the same efficacy.”

Dr. Ciaverelli—leaning more toward art than science—said, “It doesn’t matter what you are measuring as long as you can show what happened over time. Consumer self-reports are important. We want to know how they are they progressing.”

Communication & Problem-Solving

Provider organizations and payers need to have continuous dialogue, especially when there is disagreement. Ms. O’Grady noted that provider organizations may be clear on where they want to go with their programs but must stop to ask payers what they need. “Payers know where we need to improve access, we know what specialty services we need, we’re looking at data and trends to identify hot spots and needs by service or geographic area. It’s important for providers to reap the benefits of the great data payers have.” She also encouraged provider organizations to continue the conversation with payers if they are not hearing what they want to hear. “Don’t try to do end runs,” she urged.

Dr. Kolodner has the principle of “Don’t let payer treat the patient. It’s hard to dictate ‘You have 18 intensive outpatient sessions, do what you can.’ If I find that my own staff are ready to discharge a consumer who is not ready for discharge simply because their insurance has run out, I tell them the insurance company can decide what they pay, not when we discharge consumers.” If provider organizations focus on doing quality work, they can go to payers with the evidence and make the case, he suggested. And he added that it’s important to build relationships with the clinical leaders in the payer organizations as they can help those on the administrative side make better decisions based on treatment efficacy.

For provider organization executives, the implications are clear—get ready for value-based reimbursement, focus on evidence-based clinical practices, build relationships with payers, listen and align, and innovate. Helping consumers get better will continue to be an art and a science. But it’s important to show how you are moving the needle, so demonstrating outcome measures takes top priority.

On September 24, 2020, a federal district court judge denied class action status to a lawsuit filed by people in custody of the U.S. Immigration and Customs Enforcement’s (ICE) who sought release to avoid infection with coronavirus disease 2019 (COVID-19). The detainees are held in three county correctional facilities in central Pennsylvania: Clinton County Correctional Facility (CCCF), Pike County Correctional Facility (PCCF), and York County Prison (YCP). The petitioners alleged that they have health conditions putting them at high risk for more severe COVID-19 complications.

Class-action status was denied because the petitioners’ claims were not similar enough to move forward as a group. The judge noted that the petitioners as a group alleged having more than 30 health conditions, and the three facilities each have different cleaning and safety protocols. As a result, the court might have been required to certify more than 90 subclasses, without counting those petitioners with multiple health conditions.

The complaint, Thakker et al. v. Doll et al., was filed against ICE on March 24, 2020, by the American Civil Liberties Union (ACLU) of Pennsylvania, the ACLU Immigrants’ Rights Project and National Prison Project, and the law firm Dechert LLP, on behalf of 13 people in immigration detention who are at high risk of severe COVID-19 complications. The petitioners alleged that the conditions of confinement for these individuals violated their constitutional rights.

The court initially granted the motion for a temporary restraining order (TRO) and ordered that the individual petitioners be released from detention on March 31, 2020. On April 13, 2020, the TRO was extended for 14 days. On April 17, 2020, the petitioners amended their complaint to include new individual petitioners and to add class allegations, to which they appended several new declarations and exhibits. The same day the petitioners filed a motion for class certification and appointment of class counsel. On April 27, 2020, the district court issued an order granting in part ACLU-PA’s motion for a preliminary injunction and denying it in part. Plaintiffs who had been detained at PCCF could remain free, but those at YCP and CCCF were to return to detention. Those ordered to return filed a motion for a stay and reconsideration, and on April 28, 2020, the court allowed those who were sick to remain free but ordered those without symptoms to return to detention.

As of August 7, 2020, YCP housed 63 ICE detainees on the chronic care list for medical conditions listed by the Centers for Disease Control and Prevention (CDC) as associated with higher risk for COVID-19 complications. CCCF housed 37 detainees on the same list, and PCCF housed 12 such detainees.

A link to the full text of “U.S. District Court For The Middle District Of PA: Decision On Thakker et al. v. Doll et al.” may be found at www.openminds.com/market-intelligence/resources/092420thakkervdolldecision.htm.

PsychU last reported on this topic in “CDC Names Seven Conditions Most At Risk For Coronavirus; Age No Longer Considered A Risk Factor,” which published on August 10, 2020. The article is available at https://www.psychu.org/cdc-names-seven-conditions-most-at-risk-for-coronavirus-age-no-longer-considered-a-risk-factor/.

For more information, contact:

  • Harrisburg Office, American Civil Liberties Union of Pennsylvania, Post Office Box 11761, Harrisburg, Pennsylvania 17108; 717-238-2258; Email: hbginfo@aclupa.org; Website: https://www.aclupa.org
  • Clair Doll, Warden, York County Prison, 3400 Concord Road, York, Pennsylvania 17402-9007; 717-840-7580; Email: crdoll@yorkcountypa.gov; Website: https://yorkcountypa.gov/courts-criminal-justice/prison.html

To monitor the success of integrating behavioral health benefits into its Medicaid managed care system, the Washington Health Care Authority (HCA) established an “early warning system” (EWS) to monitor the access and outcomes for the first six months after the regional Medicaid managed care organization (MCO) contracts went live. The EWS was designed to be a communication tool to monitor key indicators selected by regional stakeholders. HCA began using the EWS in 2016 when the first region for fully integrated managed care launched in the Southwest Region. As each region went live, HCA established the EWS with regional stakeholders; HCA collected and reported on a set of standard indicators, and the regions could track additional measures. The last three regions (Salish, Thurston-Mason, and Great Rivers) transitioned to integrated managed care effective January 1, 2020, and EWS monitoring continued through June 30, 2020.

The EWS used the following standard indicators:

  • Behavioral health claim/encounter rejection and denial rates.
  • Behavioral health provider organization survey responses.
  • State psychiatric hospital average daily census and discharges.
  • Crisis system volume and response in terms of the number of incoming calls to the regional crisis hotline, the number of calls answered, the share answered within 30 seconds, the average response speed, and the abandonment rate.
  • Response times of designated crisis responders.
  • The number of investigations under the Involuntary Treatment Act and the outcomes of the investigations.

The EWS data is used to give the regional stakeholders data to identify and correct problems in the early phase of implementation. After the initial implementation phase, HCA partners with the Department of Social and Health Services Research and Data Analysis (RDA) Division to do ongoing evaluation and monitoring. This evaluation approach leverages tools commonly used to assess relative health plan performance, such as HEDIS (Healthcare Effectiveness Data and Information Set) and state-developed HEDIS-like measures. In early 2019, HCA reported on the first-year outcomes in the first region to go live with integrated care. In the report, “Evaluation Of Integrated Managed Care for Medicaid Beneficiaries In Southwest Washington: First Year Outcomes,” the RDA researchers examined changes in a broad set of health care performance and social outcome metrics in the first year after implementation of the model relative to beneficiary experience in the prior year.

In 2015, HCA began transitioning from a 10-region system with county-centered behavioral health care authorities to a system in which the regional Medicaid MCOs manage physical and behavioral health services for all Medicaid beneficiaries. As of July 2020, the integrated MCO contracts had been implemented statewide. In each region, the EWS was implemented one month after the MCO contracts went live. The MCO contractors are: Amerigroup; Community Health Plan of Washington; Coordinated Care of Washington; Molina Healthcare of Washington, Inc.; and UnitedHealthcare Community Plan. Each region has a choice of at least three MCOs. Crisis services and non-Medicaid behavioral health services for each region are managed by the Behavioral Health Administrative Service Organization (BH-ASO) for the region.

HCA also discussed the transitions in a June 30, 2020, report to the legislature, “Enhancement for Community Based Behavioral Health Services.” In this report, HCA presented metrics and outcomes about the transition to integrate behavioral health into Medicaid managed care. The report was required by a bill passed in 2018 that provided funding of nearly $70 million to help behavioral health provider organizations enhance local community-based behavioral health services. About 80% of the funding was built into the Medicaid per member per month payments to the MCOs. About 20% went to behavioral health organizations in areas that had not been integrated at that time, and to the BH-ASOs in the fully integrated regions.

The funding was to be used for the following:

  • Reduce the use of long-term commitment beds by placing individuals within communities.
  • Transition individuals out of state hospitals when they no longer require inpatient psychiatric treatment.
  • Improve the ability of community behavioral health agencies to recruit and retain staff.
  • Divert individuals with behavioral health issues from the criminal justice system.
  • Improve recovery service options, which includes clubhouse models.

A link to the full text of “Evaluation Of Integrated Managed Care for Medicaid Beneficiaries In Southwest Washington: First Year Outcomes” may be found at www.openminds.com/market-intelligence/resources/012419evalswwaintegratedfirstyear.htm.

A link to the full text of “Washington HCA Report To The Legislature: Enhancement For Community Based Behavioral Health Services” may be found at www.openminds.com/market-intelligence/resources/063020wahcabhenhancement.htm.

OPEN MINDS last reported on this topic in “Washington Medicaid Moving To Integrated Care,” which published on April 11, 2018. The article is available at https://www.psychu.org/washington-medicaid-moving-integrated-care/.

For more information about the EWS, contact:

  • Teresa Claycamp, LMHC, Integrated Managed Care Program Manager, Washington State Health Care Authority, Post Office Box 45502, Olympia, Washington 98504-5502; Email: teresa.claycamp@hca.wa.gov; Website: https://www.hca.wa.gov/contact-hca

For more information about the RDA reports, contact:

  • Division of Behavioral Health and Recovery, Washington Health Authority, Post Office Box 42730; Olympia, Washington 98504; 360-725-2091; Fax: 360-763-4702; Website: https://www.hca.wa.gov/billers-providers-partners/programs-and-services/behavioral-health-and-recovery

On September 24, 2020, United Airlines announced that it would partner with GoHealth Urgent Care and Color to make COVID-19 testing easy to obtain for consumers traveling between San Francisco International airport and Hawaii. Travelers will have the option to take the rapid Abbott ID NOW COVID-19 test either prior to their flight at the airport, or via a self-collected, mail-in test ahead of their trip. These tests will be available beginning October 15, 2020. The California-to-Hawaii testing is the first part of a larger implementation goal of making it easier for travelers to manage quarantine requirements and entry conditions of popular destinations around the world.

United Airlines worked closely with Hawaii officials to ensure that any person traveling between the two destinations, who tests negative on either test, would not be subjected to the Hawaii’s current 14-day quarantine requirement. The rapid Abbott ID NOW COVID-19 test is administered by GoHealth Urgent Care, and their partner Dignity Health. The on-site test provides results in approximately 15 minutes. The mail-in test option will be administered by Color. The mail-in test should be initiated at least 10 days prior to the traveler’s trip, and a sample should be provided within 72 hours of their trip.

United Airlines is a major American airline headquartered in Chicago, Illinois. United operates a large domestic and international route network, spanning several cities across the world.

GoHealth Urgent Care operates approximately 150 urgent care centers. These centers are located in the greater New York metropolitan area, the Portland, Oregon–Vancouver, Washington metropolitan area, the San Francisco Bay Area, Hartford and South Eastern Connecticut, Winston-Salem and Charlotte, North Carolina, St. Louis and Springfield, Missouri, Oklahoma City, Oklahoma, Northwest Arkansas and Delaware.

Color offers distributed health care and clinical testing. Color works with health systems, employers, and national health initiatives around the world,

For more information, contact:

  • Customer Service, United Airlines, Inc., Post Office Box 06649, Chicago, Illinois 60606-0649; 800-864-8331; Website: https://www.united.com/ual/en/us/fly/contact.html
  • GoHealth Urgent Care; 5555 Glenridge Connector, Suite 700, Atlanta, Georgia 30342; 678-774-7100; Website: https://www.gohealthuc.com/
  • Color; 600 7th Street, San Francisco, California 94103; 650-651-7116; Email: support@color.com; Website: https://www.color.com/

Consumers who used a direct scheduling function within a primary care provider organization’s online portal were more likely to obtain visits with their usual primary care professional than consumers who scheduled visits with clinic staff either in-person or over the telephone. The practice of allowing consumers to use an online portal to schedule their own office visits is called “direct scheduling.” Online consumer portals are offered by electronic health record vendors and external health care applications. Compared to usually scheduled visits, the direct scheduled visits were more likely to be for general medical examinations and were more likely to be with the consumer’s usual primary care professional.

The analysis included data for 62,080 consumers and 134,225 completed visits at 17 primary care practices within a large academic medical center. About 8.1% of the consumers used the direct scheduling option between March 2018 and March 2019. Among the direct schedulers, 36.7% made appointments for general medical examinations, compared to 21.9% of visits among those who scheduled through usual means. About 95.2% of the direct schedulers’ appointments were with their usual primary care physicians, compared to 73.5% of appointments for those scheduling through usual means. Across each practice, compared to those who did not use direct scheduling those who did were more likely to be younger, white, commercially insured, and to have more comorbidities.

These findings were reported in “Patient and Visit Characteristics Associated With Use of Direct Scheduling in Primary Care Practices” by Ishani Ganguli, M.D., MPH; E. John Orav, Ph.D.; Claire Lupo, BBA; et al. The researchers analyzed electronic health record (EHR) data from 17 adult primary care practices in a large academic medical center in the Boston, Massachusetts, area. The participants included consumers 18 years or older who were attributed in the EHR to an active primary care physician at one of the included primary care practices, were enrolled in the patient portal, and had at least one visit to one of these practices between March 1, 2018, and March 1, 2019. The goal was to identify consumer and visit characteristics associated with use of the online portal to schedule medical visits.

The full text of “Patient and Visit Characteristics Associated With Use of Direct Scheduling in Primary Care Practices” was published August 27, 2020, by JAMA Network Open. An abstract is available online at https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2769839.

For more information, contact:

  • Ishani Ganguli, M.D., MPH, Assistant Professor, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont Street, 3rdFloor, Boston, Massachusetts 02120; Email: iganguli@bwh.harvard.edu; Website: https://connects.catalyst.harvard.edu/Profiles/display/Person/231

On September 16, 2020, the Department of Labor (DOL) issued a revised temporary rule effective the same day to clarify worker eligibility for emergency paid sick leave to assist working families facing public health emergencies arising out of the coronavirus disease 2019 (COVID-19) global pandemic, and public health emergency leave under Title I of the Family and Medical Leave Act (FMLA). The DOL had issued a temporary rule on April 1, 2020. This revised rule is issued in response to an August 3, 2020, district court decision finding certain portions of that rule invalid because in an exemption for health care workers, the DOL defined “health care provider” so broadly that it included workers “who are not even arguably necessary or relevant to the health care system’s vitality.” The DOL has narrowed it definition to restrict a “health care provider” as someone employed to provide diagnostic services, preventive services, treatment services, or other services that are integrated with and necessary to the provision of care.

Both types of emergency paid leave were created by a time-limited statutory authority established under the Families First Coronavirus Response Act (FFCRA), and both are set to expire on December 31, 2020. The FFCRA and its implementing regulations, including this temporary rule, do not affect the FMLA after December 31, 2020.

The FFCRA was enacted on March 18, 2020. The provisions required job-protected paid sick leave and emergency family leave for employees unable to work due to COVID-19. Up to 61 million employees were estimated to be potentially eligible for paid sick leave or emergency family leave under the FFCRA. The provisions provide for the following:

  • Up to 80 hours of paid sick leave at the employee’s regular rate of pay where the employee is unable to work because the employee is quarantined (pursuant to federal, state, or local government order or advice of a health care provider), and/or experiencing COVID-19 symptoms and seeking a medical diagnosis.
  • Up to 80 hours of paid sick leave at two-thirds the employee’s regular rate of pay because the employee is unable to work because of a bona fide need to care for an individual subject to quarantine, including a child under age 18 whose school or child care placement is closed or unavailable for reasons related to COVID-19.
  • Up to an additional 10 weeks of paid expanded family and medical leave at two-thirds the employee’s regular rate of pay where an employee, who has been employed for at least 30 calendar days, is unable to work due to a bona fide need for leave to care for a child whose school or child care provider is closed or unavailable for reasons related to COVID-19.

A link to the full text of “Paid Leave Under The Families First Coronavirus Response Act” may be found at www.openminds.com/market-intelligence/resources/091620covidpaidleave.htm.

For more information, contact:

  • Amy DeBisschop, Director, Division of Regulations, Legislation, and Interpretation, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Avenue NW, Washington, District of Columbia 20210; 202-693-0406; Website: https://www.dol.gov/agencies/whd/ffcra

In our mapping of the post-pandemic market, one key issue is how health plans will reimburse provider organizations in the year ahead. Anecdotally, we’re seeing more health plan managers looking for provider organizations that can accept value-based reimbursement (VBR) arrangements—particularly arrangements with financial risk. And that makes sense from a macro market perspective. Most analysts predict decreased funding by payers —both government and employers— following the pandemic, and risk-based financial arrangements with provider organizations are one way to align incentives.

A recent market event confirms this general direction and should be incorporated in the 2021 planning of any provider organization that has moved consumer services to telehealth. On September 3, 2020, the Medicare Payment Advisory Commission (MedPAC) met and discussed Medicare telehealth reimbursement policy after the pandemic. The concern cited (common among all payers) was that unlimited and open use of telehealth services has the potential to increase spending under a fee-for-service payment system. A proposed policy under discussion is to permit provider organizations and clinical professionals participating in advanced alternative payment models (APMs)—such as accountable care organizations, episode-based payment models, and primary care focused models—to continue to benefit from telehealth expansions. But for the fee-for-service plan, Medicare would revert to the pre-pandemic rules. MedPAC noted, “Also, the Commission has long supported the movement of Medicare payment policy from fee-for-service to value-based payment such as advanced APMs. Allowing clinicians who participate in advanced APMs more flexibility to provide telehealth services could be another incentive for more clinicians to move into these models.”

Many think this is a likely path for Medicare reimbursement policy, and this policy is likely to be adopted by other payers and health plans as well. This development gives even more credence to the statement made by OPEN MINDS, Senior Associate, Paul Duck, at the session, How To Build Value-Based Payer Partnerships: Best Practices in Marketing, Negotiating & Contracting With Health Plans, during the 2020 OPEN MINDS Management Best Practices Institute. He said, “In the next 10 years, all payer contracts will be value based and all specialty provider organizations will be part of a risk-bearing entity.”

So where are we with value-based reimbursement? From our survey earlier this year, we learned that 58% of specialty provider organizations are participating in value-based arrangements. Of these, 42% participate in a pay-for-performance arrangement with fee-for-service, 22% in capitation for specific services, 18% in capitation for care coordination, and 24% in case or bundled rates. The same survey found that 15% of organizations had more than 20% of their revenue from VBR contracts. Our earlier survey of health plans found that 93% of health plans—including commercial plans, Medicaid, and Medicare—have implemented pay-for-performance reimbursement models. In addition, the use of episodic or bundled payments for specific acute care episodes is gaining traction, with 59% of plans using this model. While only 40% of commercial health plans use episodic payments, 71% of Medicare and 88% of Medicaid health plans use these payment arrangements for behavioral health.

And a just released report shows the continuation of this trend. VBR contracts now account for 26% of hospital revenue. The report notes that growth has been slow and the biggest factors limiting the adoption of VBR are uncertainty that there will be a return on investment and a lack of needed infrastructure.

How do provider organizations overcome their challenges and align to payer priorities? Mr. Duck suggested a focus on three elements—capitalization, population, and information. Invest in infrastructure and technologies; assume accountability for the whole health of the population you serve; and ensure that your team has the data to optimize consumer health outcomes.

The infrastructure issues are significant. There is the technology piece—care management and population health management technology, more robust analytics, network management/claims payment functionality, interoperability, consumer portals, consumer engagement capabilities, remote patient monitoring technologies, and more. But there is also the development of the organizational structure, policies and procedures, and managers with the skillsets to manage programs with downside financial risk.

On the population health side, service delivery systems and clinical programs need to be restructured in many ways. Reward for performance rather than service volume is a key piece. Building continuity of care between separate levels of care. Adopting evidence-based practices (EBP) and implementing those EBPs in a consistent way. Creating community partnerships for social service referrals. These are all part of the “whole person” approach to consumer health management that is tied to risk-based contracting.

Finally, there is moving the organization to a metrics-based management approach. There is the design of reporting systems with leading indicators and predicted modeling of consumer health conditions and resource needs. But, having the reports and having a management team that can act on the reports to improve performance are different issues.

Accepting and succeeding with some form of risk-based contracting will be increasingly important in the ability of provider organizations to develop more productive relationships with health plans and maintain market share. For executive teams, it is important to track the evolving contracting preferences of the payers in their markets. But I would argue it is also important to push health plans beyond the high-cost, low-return, pay-for-performance fee-for-service arrangements to contracting models with more financial control. It is only the latter that will allow real system transformation at the delivery system level.

President Dwight D. Eisenhower is well known for his presidency, but also known for the Eisenhower Matrix for time management. A broader view of the leadership skills of President Eisenhower has come into sharp focus over the past six months as historians profile his administration—and its parallels to challenges facing leaders today. He signed the Civil Rights Act of 1957 and sent Army troops to enforce federal court orders which integrated schools in Little Rock. He had to deal with Joseph McCarthy. He ended the Korean conflict. And, he warned the nation with regard to the corrupting influence of what he describes as the “military-industrial complex.”

So, when the new book, How Ike Led: The Principles Behind Eisenhower’s Biggest Decisions, came out a few months ago, it was at the top of many reading lists. Monica Oss, Chief Executive Officer, OPEN MINDS, had the opportunity to talk to the book’s author and President Eisenhower’s granddaughter, Susan Eisenhower, about her research and her planned keynote at the 2020 OPEN MINDS Executive Leadership Retreat. Her perspective is that positive outcomes are possible with great leadership. “These are not the most dangerous or difficult times we live in. We have been through much worse—two world wars, the Spanish flu, the Great Depression—and have emerged stronger,” she said.

As Ms. Eisenhower says in her book, “Today, tethered to smartphones and transfixed by Twitter and Instagram, we lurch from one demand to another with scarcely a moment to think. Our impulses are reactive, not considered. They are short-term rather than strategic. We have lost our capacity to act in the present while thinking into the future. We are struggling. I have always been one to look forward. Increasingly, however, it has been impossible for me to do this without looking back—at our nation’s journey since my grandfather’s years. What is profoundly striking is how far we have veered from the guiding principles of those days.”

Looking back, she recounted some instances of the crises and turbulent times through which Ike led. At 27 years of age, he was commander of the Tank Corps at Camp Colt in Gettysburg, Pennsylvania when the 1918 influenza pandemic ravaged the training camp. His plan for controlling the pandemic at Camp Colt helped mitigate the losses and establish health care protocols later adopted by the U.S. Army. He went on to serve as Supreme Commander of the Allied Expeditionary Force in Europe during World War II, leading the D-day invasion. He served two terms as President of the United States from 1953 to 1961.

We asked Ms. Eisenhower how she would describe the characteristics of President Eisenhower’s leadership style through all these crises. Three attributes that she spoke about jumped out at me as what health and human service provider organization executives most need while steering out of today’s crisis—strategic and decisive leadership, extreme accountability, and discipline with compassion.

Strategic & Decisive Leadership

Throughout his military and presidential service, Ike was a strategic rather than an operational leader. “He was a clear thinker who could strip any problem down to its essence, prioritize it, and tackle it from a big picture level,” Ms. Eisenhower told us. Her grandfather, she explained, asked for input and information across the entire enterprise, and then made informed decisions. He also thought of all problems “as human problems, grounded in human needs”—a psychological strategy central to managing controversial decisions.

In her book, Ms. Eisenhower notes that the President’s “talent for envisioning a whole, especially in the context of the long game, may explain why he did not necessarily need combat experience to be a brilliant strategic leader. It is also why he never lost the confidence of his superiors during the conduct of World War II, even if his subordinates groused about some of his decisions—many of which, not surprisingly, related to resource allocation and personal authority. Eisenhower’s subordinates simply did not have the same considerations he did.”

As the nation’s chief strategic leader, Ike “developed a process—a staff system—that would assure the collection of all possible facts and facets of any issue,” described Ms. Eisenhower. As a strategic thinker, his mantra was “Don’t sweat the small stuff” and he avoided “being drawn into second- or third-order issues that should be properly handled at a lower level.”

The President also was not inclined toward “groupthink,” says Ms. Eisenhower and was always questioning why things were done a certain way. She notes in her book that “In many ways, Eisenhower was a futurist, and he bristled at the conclusions people reached without reference to or consideration of changing circumstances that might soon make current thinking outdated.” He questioned his own thinking constantly and encouraged push-back from the “smart people” he liked to surround himself with. “In the White House, Eisenhower would elicit the views of his subordinates, referee their debates, listen for new perspectives, and then make his own decision. He was the supreme decider: the strategic leader.”

Accountability Without Caveats

The first chapter of How Ike Led: The Principles Behind Eisenhower’s Biggest Decisions is titled “Accountability Without Caveats” and Ms. Eisenhower spoke at length about this important guiding principle in Ike’s life. As a “plebe” or freshman at West Point, her grandfather quickly learned that there were four answers to a question or order from his superiors—“Yes sir,” “No sir,” “No excuses, sir” and “I’ll find that information for you, sir.” And he carried that lesson with him. “He even took responsibility for the weather forecast during the largest ever military operation (the Allied invasion of Normandy on June 6, 1944),” remarked Ms. Eisenhower.

Ike’s “in case of failure” note to himself before D-day read, “…The troops, the air and the Navy did all that bravery and devotion to duty could do. If any blame or fault attaches to the attempt, it is mine alone.” His granddaughter notes that “Eisenhower wrote such ‘communiqués’ as much for himself as for any kind of public release, should the worst happen. He was not trying to burnish his reputation in writing it, he was reminding himself, and if necessary, others, that he alone was responsible for the outcome of the mission. It was a personal and public form of accountability.”

The President was morally courageous and embodied the principle of “It starts with each of us before all of us,” said Ms. Eisenhower. He took the blame even when he was not wrong. “Ike had enormous regard for the people who were part of his team. He gave them a lot of latitude, and did not much care if they, not he, got the credit for their accomplishments. He also backed them up to the hilt—even when he did not necessarily agree with the ways they sometimes solved their department’s problems.”

Discipline With Compassion

President Eisenhower was extremely disciplined and never let his emotions take charge. The book explains that “His strength came from balance, and such psychological equilibrium required the melding of humility, determination, and human empathy.”

“As a military officer he was a disciplined, clear thinker, who did not allow himself to get pulled into emotional free-for-alls or make any consequential decisions in a noisy contentious room. Richard Nixon remembered, in fact, that Ike never made an important decision in front of others. He would go into his office alone and think about all he had heard. “[Eisenhower] was an emotional man,” Nixon recalled, “but he never made emotional decisions. He did not let his emotions control him.””

Ike believed in being extremely well prepared, for every situation. His determination to focus on and succeed at even the most mundane tasks stood him in good stead. Ike also constantly encouraged the troops in every situation and exhibited empathy for those at the receiving end of his orders. Ms. Eisenhower recounts that “Discovering the “other side” of Ike has left me, frankly, in awe of how he handled some of the most consequential decisions ever undertaken by a general or a president—all while retaining a genuine capacity for empathy and kindness, which belied or survived the hard and painful decisions he’d been compelled to make. I don’t know how he did it, but I saw firsthand that he never became callous, hard, or cynical.”

And for Ms. Eisenhower herself, it has been a process of developing “resilience through osmosis at the dinner table,” she said. As a Washington policy strategist, many decisions she has made have been influenced by her grandfather’s legacy. He taught her to be creative when the chips are down, to control fear and anxiety, and to seek support in community rather than in singular leadership. “And when you know how it’s been, you know you can ask for more—from our nation’s leadership and from those around you,” she said.

All these facets of Ike’s strategic, accountable, and disciplined leadership resonate with the advice I’ve often shared with health and human service executives, especially since March. Think beyond the immediate crisis. Surround yourself with stellar performers. Gather the facts to make informed decisions. And, always question the status quo—business as usual is a myth in the best of times.

In this companion piece to the PsychU May 21, 2020 webinar, “Managing Mental Health During & In The Aftermath Of A Pandemic,” Gaurava Agarwal, MD, Christine Moutier, MD, and Rachel Self, PhD, discuss the positive takeaways from the unprecedented COVID-19 experience, such as breaking down the stigma barrier surrounding mental health and improvements in the health care delivery system.

Gaurava Agarwal, MD, is the 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, is the Chief Medical Officer at the American Foundation for Suicide Prevention, a role she’s held since 2013, advising on evidence-based suicide-prevention strategies. Previously, she was a psychology professor and assistant dean at the University of California, San Diego School of Medicine; medical director of the Inpatient Psychiatric Unit at the VA Medical Center in La Jolla, CA; and a practicing psychiatrist.

Rachel Self, PhD, is 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.

 

Gaurava Agarwal, MD, and Christine Moutier, MD, are paid consultants to Otsuka Pharmaceutical Development & Commercialization, Inc.

Rachel Self, PhD, is a paid employee for Otsuka Pharmaceutical Development & Commercialization, Inc.

A few weeks ago, we wrote about the need for executive teams to build a culture to keep “high performers” in their organizations—the executives who can do strategy, develop the “next big thing,” make decisions quickly, and nimbly change course. It takes an “enterprising culture” to keep these team members—a culture that thrives on achievement, incentivizes productivity, values talent and intelligence, rewards great ideas, and encourages competition. But keeping the high-performing talent is a challenge in health and human services. The field is highly regulated, and change happens reactively and not proactively. The many comments about this challenge—and best practices for moving organizational culture to focus on performance—were enlightening.

The first big takeaway from these discussions came from Diane Gould, President and Chief Executive Officer, Advocates Inc. Her advice? Acknowledge the power of the existing health and human service culture—and the challenge of culture change. “There is a difference between the culture the CEO may think they have, or maybe want to believe they have, and what’s actually true on the ground in an organization.” She explained, “We found this when bringing new performers in to work alongside other executive and senior leaders who have been here for decades—the clash was painful. The very act of recruiting and hiring these folks bumps up against existing culture—so the question is not just what kind of culture attracts stellar performers, but how does a company navigate the actual transition. More attention to culture, the nature of the culture, and what happens when new leaders join is called for.”

Ms. Gould suggests that leadership teams take a hard look at what attributes of organizational culture they value most; what culture attributes are an asset for the future; and the leadership deficits of the current team—including what they avoid looking at. With that clear-eyed assessment, they can develop a plan to move to the next level. “Is it possible to preserve aspects of culture that have mattered most in relation to mission and values, while being fearless in making the changes required to recruit and retain the best possible people?” she wondered.

Building on Ms. Gould’s comments about brave leadership team self-assessment, Mario Jardon, President and Chief Executive Officer, Citrus Health Network, offers this recommendation to leaders— “Surround yourself with talent.” He said it starts with hiring the best and the most qualified team members, rooting them in the organization’s mission and outlook, and then letting them lead and train others. Citrus is accredited by the Accreditation Council for Graduate Medical Education as a sponsoring institution for the psychiatry residency program in affiliation with Florida International University’s Herbert Wertheim College of Medicine. This helps Citrus build a robust recruitment pipeline and nurture a culture of learning.

To retain the high performers, Mr. Jardon suggests, “You need to…pay well and give them a territory.” Cultures thrive when team members feel they have a stake in the outcomes and are contributing to its success. And Citrus gives executives a stake through its Total Quality Management (TQM) approach. TQM is defined as a management approach to long-term success through customer satisfaction in which all members of an organization participate in improving processes, products, services, and the culture in which they work. A performance improvement council made up of leaders from across the organization meets at least once a month to plan how they will reshape services to respond to current market trends and needs, and solve problems, Mr. Jardon explained. Involvement in how the organization achieves its goals and a strong community connection makes the job fulfilling for high performers, he said.

Debbie Reed, President and Chief Executive Officer of Chaddock, has taken this transition one step further—using the “dual operating strategy” framework developed by management guru John Kotter to move their organizational culture. In this book, Accelerate (XLR8), Dr. Kotter argues that when traditional structures hold back organizations from being creative enough and speedy enough to compete effectively, there is a need for two “operating systems.” One system conducts the everyday business, while the second system is a parallel agile network that focuses on the opportunities and demands of the future. In his model, everyone works within the hierarchy, but innovation and big ideas are assigned to enterprising employees who volunteer for the effort and work on changes across the organization. The hierarchy and the volunteer network work together as one, with constant flow of information and activity. The approach succeeds partly because the people who volunteer for the network are already working within the hierarchy.

Ms. Reed explained how they have leveraged Kotter’s dual operating system at Chaddock. “We pride ourselves on being innovative while at the same time having to accommodate the expectations of funders from multiple states. This framework also allows us to challenge and provide increased levels of autonomy for our strategic thinkers (from all levels of the organization) while providing a sense of stability to the majority of our staff,” she said. She explained that the biggest problem they have is in transitioning new programs from development to operations that are integrated with the rest of the organization. “It can be hard for owners of the program who think of it as their ‘baby’ to let the program be absorbed into the hierarchy. Still, we have found this to be an effective way to foster a culture of innovation even while providing a host of highly regulated programs and services.”

Between 2018 and 2019, Medicaid enrollment dropped by 0.7 percentage points, from 20.5% of the United States population in 2018 to 19.8% in 2019. The number of Medicaid enrollees dropped by 3%, from nearly 66 million in 2018 to 64 million in 2019. During this same time period, the share of the population with Medicare coverage decreased from 18.1% to 17.6%, and the number of Medicare beneficiaries dropped by 2.5%, from more than 58 million to nearly 57 million. The share of the population covered by the Veterans Administration declined from 2.3% to 2.2%. In total, the share of the population covered by publicly funded health insurance programs declined slightly from 35.6% in 2018 to 35.4% in 2019.

Overall, about 91% of the population was covered by public or private health coverage, and the remainder were uninsured. Of those with health coverage, about one-third had public coverage (through Medicaid, Medicare, or the VA) and two-thirds had a private insurance plan.

Among people ages 19 to 64, in 2018 about 18.3% of the 193.3 million in this population were covered by a public health insurance program. In 2019, the number of people in this age group declined to 193.0 million and the share covered by a public health insurance program declined to 17.7%.

Among people with income below 138% of the federal poverty level (FPL), the number declined by 5.3%, from 62.2 million in 2018 to 58.9 million in 2019. The share covered by a public insurance option declined from 64.6% in 2018 to 64.1% in 2019.

These findings were reported in “Health Insurance Coverage In The United States: 2019” by the United States Census Bureau. The report presents statistics on health insurance coverage in the United States based on information collected in the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and the American Community Survey (ACS). It compares health insurance estimates from each source.

A link to the full text of “Health Insurance Coverage In The United States: 2019” may be found at www.openminds.com/market-intelligence/resources/091420healthinsurancecoverage.htm.

For more information, contact:

  • Public Information Office, U.S. Census Bureau, 4600 Silver Hill Road, Washington, District of Columbia 20233; 301-763-3030; Email: pio@census.gov; Website: https://www.census.gov/en.html

 

On September 22, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that it will expand the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) nationwide. Non-emergency ambulance transportation services are covered under Medicare Part B for Medicare beneficiaries who need to ride in ambulances to certain medical appointments, most often for dialysis treatment. During 2017 and 2018, about 20% of Medicare fee-for-service (FFS) payments for non-emergency ambulance services were improper, at 22.6% in 2017 and 18.6% in 2018. The RSNAT Prior Authorization Model tests whether prior authorization before the service is furnished and before a claim is submitted for payment reduces Medicare costs while maintaining or improving the quality of care.

The RSNAT Prior Authorization Model began in New Jersey, Pennsylvania, and South Carolina in 2014. It expanded in 2016 to North Carolina, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia. The model was initially scheduled to end on December 1, 2020. However, in 2018, based on an initial evaluation, CMS determined that expanding the program nationwide would result in lower Medicare spending, even after accounting for costs of operating the model.

The second model evaluation report released in September 2020 found that the model reduced RSNAT service use by 63% and RSNAT expenditures by 72% among beneficiaries with end stage renal disease and/or severe pressure ulcers during the first four years of the model. This decrease in RSNAT service expenditures caused a total decrease of Medicare FFS expenditures of 2% (about $650 million over four years). The report did not find evidence that the model adversely affected quality of care.

For the expansion, the mode will continue past December 1, 2020, in the current states. The national expansion will follow the same design as the current model. The announcement noted that CMS is continuing to monitor the COVID-19 Public Health Emergency and will take that into account when determining the timeframe for expansion into additional states. CMS will release more information on the national expansion and implementation dates for additional states.

A link to the full text of “Evaluation Of The Medicare Prior Authorization Model For Repetitive Scheduled Non-Emergent Ambulance Transport: Second Interim Evaluation Report” may be found at www.openminds.com/market-intelligence/resources/092220evalrsnat.htm.

A link to the full text of “Certification Of The Medicare Prior Authorization Model For Repetitive Scheduled Non-Emergent Ambulance Transport” may be found at www.openminds.com/market-intelligence/resources/032818priorauthrsnat.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/

Over the past decade, the 44 states operating Medicaid Money Follows the Person (MFP) demonstrations from 2008 through the end of 2019 have transitioned more than 101,540 beneficiaries with disabilities from institutional settings to community placements paired with supportive services. The highest number of transitions were reported by Ohio (13,207 transitions) and Texas (13,114 transitions). Maine and South Carolina reported the fewest number of cumulative transitions, at 143 and 157 respectively. As of December 2019, 15 states represented about 78% of cumulative transitions, and the top five states (Connecticut, Ohio, Tennessee, Texas, and Washington) accounted for slightly less than half (45%) of all cumulative transitions.

The MFP launched in 2007 to help states rebalance their Medicaid long-term care systems, and 17 states were among the initial funding cohort. The Patient Protection and Affordable Care Act of 2010 strengthened and expanded the MFP program, allowing more states to apply. The MFP funds are for an enhanced matching rate to cover the cost of transitioning a beneficiary with disabilities from an institutional setting to a community setting, and an enhanced match rate for 12 months of home- and community-based services (HCBS). States awarded MFP funding were permitted to target beneficiaries in specific settings or with specific types of disability, such as frail elderly, individuals with physical disabilities, individuals with intellectual/developmental disability (I/DD), or individuals with serious mental illness (SMI). States are permitted to choose the populations and types of facilities on which to focus their MFP transition efforts.

During calendar year 2019, the 42 states and District of Columbia operating MFP programs transitioned a total of 4,173 Medicaid beneficiaries from institutional settings to community settings and home-and community-based supportive services (HCBS). The number of transitions in 2019 was 46% below the 2018 level of 7,671 transitions. In 2019, about 15 states accounted for 86% of transitions, and five states (Connecticut, New York, Pennsylvania, New Jersey, and Louisiana) accounted for 45% of all transitions. Six of the MFP states (Delaware, Illinois, Kansas, New Hampshire, Tennessee, and Virginia) and the District of Columbia submitted reports but reported zero transitions during 2019. In fact, all but Tennessee said they intended to end their MFP programs in 2020. Within this group of states, during 2018 Delaware, Illinois, Kansas, and New Hampshire reported no transitions. The District of Columbia, Tennessee, and Virginia represented a combined total of 443 transitions in 2018.

During 2019, about three-quarters of transitions involved frail elderly persons (38% of transitions, or 1,603 people) and people with physical disabilities (also 38% of transitions, or 1,568 people). About 12% (497) transitions were among people with I/DD; 5% (333 transitions) were among people with other types of disabilities, and 4% (172 transitions) were among people with SMI. During 2018, about 74% of transitions involved frail elderly and people with physical disabilities; 16% involved people with I/DD; 8% involved people with SMI; and 2% of people with other types of disabilities.

The highest number of I/DD transitions were in Washington (85), New Jersey (75), Texas (74), and North Carolina (70). The next highest state was Louisiana (31). The states with the highest percentage of I/DD transitions as part of the total were:

  • Texas, where its 74 I/DD transitions represented 51% of the total 146 transitions.
  • North Carolina, where its 70 transitions represented 47% of the total 148 transitions.
  • Washington, where its 85 transitions represented 37% of the total 323 transitions.
  • New Jersey, where its 75 transitions represented 26% of the total 291 transitions.

The highest number of SMI transitions were in Connecticut (77), Ohio (65), and Georgia (13); the next highest state was Colorado (7). The states with the highest number of SMI transitions as part of the state’s total transitions were:

  • Ohio, where its 65 transitions represented 29% of the total 222 transitions.
  • Connecticut, where its 77 transitions represented 15% of the total 502 transitions.
  • Colorado, where its 7 transitions represented 7% of the total 104 transitions.
  • Georgia, where its 13 transitions represented 6% of the total 216 transitions.

These findings were reported in “Money Follows the Person: State Transitions as of December 31, 2019” by Kristie Liao and Victoria Peebles for the Centers for Medicare & Medicaid Services (CMS). The report was released in August 2020.

A link to the full text of “Money Follows the Person: State Transitions as of December 31, 2019” may be found at www.openminds.com/market-intelligence/resources/081120moneyfollowsperson1219.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/

People in Florida with a past felony conviction and who have returned to the community must pay outstanding fines, legal fees, and restitution before they can register to vote, according to a legal ruling issued on September 11, 2020. Until 2018, the state did not allow people with a past felony to register to vote unless they successfully petitioned the governor to restore their voting rights. Florida was one of four states (the others are Iowa, Kentucky, and Virginia) where convicted felons did not regain their right to vote after fulfilling all requirements of their sentencing. In 2018, Florida voters approved an amendment that allowed most felons to register to vote; the amendment excluded those convicted of murder or a felony sexual offense. Voting rights were automatically restored for 1.4 million state residents starting January 8, 2019.

In June 2019, Florida Governor Rick DeSantis signed a law that added an extra requirement that anyone convicted of a felony must also pay all remaining fines and fees in full before registering to vote. A lawsuit, Jones, et al., v. Florida, challenged the law. On September 11, 2020, the U.S. Court of Appeals for the 11th Circuit in Atlanta upheld the law and agreed that payment of fines and fees by ex-felons is part of their “terms of sentence” and must be satisfied before they can register to vote.

In a court hearing during 2020, Florida elections officials said they had identified 85,000 voter-registration applications submitted by people convicted of a felony. The officials flagged the applications because the individuals may have had unpaid fines and fees related to the crime. Registration for the November 3, 2020, election closed on October 6, 2020.

The nonpartisan voting rights advocacy group Florida Rights Restoration Coalition (FRRC) said the average amount owed was about $1,000 per person. On September 12, 2020, the FRRC launched its Fines and Fees Program, an initiative that raises money to pay restitution on behalf of the past felony offender, at up to $1,500 per person. On September 22, 2020, the FRRC announced that it had raised $20 million of its $25 million goal. The FFRC has been working with local county clerks to clear fines and fees for past felony offenders since 2019. The organization is run by formerly convicted people who have returned to the community; it seeks to end the “disenfranchisement and discrimination against people with convictions” and to help create a comprehensive and humane reentry system that will enhance successful reentry, reduce recidivism, and increase public safety.

A link to the full text of “Appeals Court Ruling In Jones, et al., v. Florida” may be found at www.openminds.com/market-intelligence/resources/091120appealsrulingjonesvflorida.htm.

For more information, contact:

  • Florida Department of State, R.A. Gray Building, 500 South Bronough Street, Tallahassee, Florida 32399-0250; 850-245-6500; Email: SecretaryofState@DOS.MyFlorida.com; Website: https://dos.myflorida.com/
  • Florida Rights Restoration Coalition, Post Office Box 618147, Orlando, Florida 32861; 407-901-3749; Email: info@floridarrc.org; Website: https://floridarrc.com/

So, the Presidential debate September 29th, 2020 was full of surprises—no need to say more. But we learned a new term—the “K-shaped recovery.” The more we learned, the more it became obvious that this is a concept with big implications for any organization serving consumers with complex support needs.

So, what is the K-shaped recovery curve? When we talk about economic recovery after a crisis in terms of letters—V, U, L—we are referring to the speed of the recovery. Rapid recovery with sharp decline and sharp return, sharp decline with a period of stagnation followed by a rapid rise, and sharp decline followed by lingering economic stagnation, respectively. But what all of these descriptors assume is that the entire economy recovers at once. In a K-shaped recovery, different parts of the economy recover at different times. The challenge is that a K-shaped recovery from the current crisis would serve to reinforce the already uneven economic situation of different sociodemographic groups. Essentially, a K-shaped recovery would deepen the divide between the “haves” and the “have-nots.”

Right now, the stock market has recovered largely due to the Federal Reserve Bank keeping interest rates near zero and buying an unprecedented amount of corporate bonds. While a little over 50% of households own some stock, 84% of stocks are owned by 10% of the population. But beyond the stock market, the rest of the economy—overall employment, the flow of goods and services, and the gross domestic product—is down. Some industry sectors—like general merchandise retail, online retail, and technology-enabled services—have had a tremendous boom. Other sectors like travel and tourism, entertainment, clothing. retail, and restaurants have seen a bust.

Bloomberg columnist, Barry Ritholtz, describes it, “Once a nation of ‘Haves’ and ‘Have Nots,’ we are now a nation of ‘Haves,’ ‘Have Nots,’ and ‘Have Much More.’ The last category has left the first two in the dust.” The K-shaped recovery theory is that about a third of the economy will recover rapidly, while the rest will have a slow return with lingering unemployment.

The workers in the most negatively affected sectors are low-wage workers and more likely to be women, mothers with school-age children, Black, Hispanic, and/or without college degrees. And the worst is yet to come for these workers.  Thousands of layoffs will soon be announced—at Disney, American Airlines, United Airlines, Marriott, Hilton, Uber, and Kohls to name a few. The economic situation caused by this public health crisis is also speeding automation. Hotels, hospitals, airports, public transport, and health care entities are increasingly using robots for cleaning and other tasks. For example, the Pennsylvania Turnpike laid off 500 employees after it went with cashless tollbooths.

So, what does this have to do with serving consumers with complex support needs? The situation coming is created by the domino effect, with one event setting off a chain reaction. First, consumers most likely to be at the bottom of the K-shaped recovery have higher-than-average incidence of chronic conditions—the conditions that have a higher mortality rate from COVID. These are the same consumers who are more likely to be uninsured and/or to have limited resources for private payment for health care services.

At the same time, with the economic effects of the pandemic, we are unlikely to see government social service spending keep pace with the new level of need. In fact, social service spending in the United States has declined in real terms over the past decade. Spending on supports like income, nutrition, and housing assistance—adjusted for inflation—dropped 11% per capita, from $885 per person in 2009 to $786 in 2018.

And these two factors—more consumers with chronic conditions in dire financial situations with limited social service supports—are occurring at a time when provider organizations are going to be increasingly accepting value-based contracts with downside financial risk. With the well-documented link between social factors and health care costs, this puts provider organizations in a position of needing to provide social supports for the consumers they serve in order to “balance the books” on value-based reimbursement.

How to approach this challenge? The solution would depend on the characteristics of the consumer population and the financial risk parameters of the contract. One constant is the need to invest in the data systems that allow an understanding of the relationship between consumer health status, consumer social service needs, and consumer health care spending patterns. This allows organizations to adopt an integrated “whole life” approach to consumer care coordination. Another element is consumer engagement in managing their chronic conditions. There is the need to use technology of all types to gain efficiencies and leverage the reach of your service team. For non-profits, there is the need to rethink the criteria currently in use for allocating charitable services. But as the field moves ahead with more value-based reimbursement, with financial risk for provider reimbursement, the possibility of a K-shaped recovery is a factor to incorporate in long-term population health planning.

Florida is planning to remove low-priority consumers from its Medicaid waitlist for long-term care waiver services, as called for by House Bill No. 1373, which went into effect on July 1, 2020. The legislation directed the Florida Department of Elder Affairs (DOEA), which maintains the waiver waitlist, to include only those consumers screened as high risk of nursing home placement. On September 17, 2020, the Florida Agency for Health Care Administration (AHCA) began developing proposed rules to implement House Bill No. 1373. The laws is expected to reduce the number of people on the waitlist from the current 59,259 to 1,562.

Currently, all applicants who completed the long-term care screening process were entitled to written notice from DOEA informing them of their waitlist placement. That notice also included contact information for the Aging and Disability Resource Centers (ADRC), instructions for requesting an administrative fair hearing, instructions for requesting a copy of the completed screening tool and the priority score, and instructions for requesting a rescreening in the event of a significant change in condition.

Under the new law, individuals with low-priority risk scores will not be added to the waitlist, and the DOEA will not send a notice. Instead, the DOEA will maintain contact information for each individual with low priority score for purposes of any future rescreening. ARDC personnel shall inform individuals with low priority scores about community resources available to assist them and inform them that they may contact the ARDC for a new assessment at any time if they experience a change in circumstances. The law did not include a definition of “low priority.” However, a draft proposal is in development in which AHCA will define the “low priority” cut level.

A link to the full text of “Florida Legislature Committee Substitute for House Bill No. 1373” may be found at www.openminds.com/market-intelligence/resources/062220fllsubhb1373.htm.

AHCA’s progress on developing the proposed rules can be followed at https://www.flrules.org/gateway/ruleno.asp?id=59G-4.193.

For more information, contact:

  • Mallory McManus, Communications Director, Florida Agency for Health Care Administration, 2727 Mahan Drive, Tallahassee, Florida 32308; 850-412-3623; Email: AHCACommunications@ahca.myflorida.com; Website: http://ahca.myflorida.com
  • Rebecca Roberts, Spokesperson, Florida Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000; 850-414-2000; Fax: 850-414-2004; Email: information@elderaffairs.org; Website: http://elderaffairs.state.fl.us/

The COVID-19 pandemic has disrupted the health and human service landscape – and with it, the behavioral health delivery system. As part of their on-going commitment to the field, Otsuka America Pharmaceutical, Inc. commissioned an update to its acclaimed publication, the Trends in Behavioral Health Guide, Second Edition (The Guide) that was released in 2019. This new publication, Trends in Behavioral Health: A 2020 Update on the US Behavioral Health Financing and Delivery System (Trends in Behavioral Health 2020 Update), was released and is available for download free of charge on PsychU.org.

This new analysis of how the behavioral health field has changed as a result of the pandemic found several major shifts in financing and delivery including:

  • Positioning for new methods of digital service delivery and telehealth
  • New reimbursement models
  • Rapid consolidation
  • Increasing importance of social determinants of health
  • Challenges of dealing with the shift from fee-for-service to value-based payment

This important update represents the very latest impacts on the U.S. financing and delivery system and will inform and educate providers, payers, and all those serving the health and human services market. It is a compelling must-read that reaches beyond the pandemic and discusses the major trends and their related shifts to the behavioral health financing and care delivery system. Many of those trends were first presented and explained in The Guide but have further accelerated throughout 2020. Crucial topics covered in detail in The Guide include:

  • Accountability, integration, and risk
  • Managed care organization consolidation
  • Continued growth in accountable care organizations
  • Mergers, acquisitions, affiliations, and failures
  • Entrance of non-traditional players in the market
  • Emergence of virtual health plans
  • Bundled payments and new payment models
  • New integrated care models emerging for value-based care
  • Provider organizations and partnerships
  • Social determinants of health
  • Improving access to care

With the sweeping changes in the market landscape, the Trends in Behavioral Health 2020 Update provides decision-makers a timely update that is certain to provide key market intelligence to inform strategic planning in the upcoming year.

In 2019, health care professionals with high social-risk caseloads scored 13.4 points lower on the Merit-based Incentive Payment System (MIPS) performance, compared to MIPS clinicians with the lowest social at-risk caseloads. If qualifying clinicians received the Complex Patient Bonus in 2019, it would have increased MIPS performance scores by about 4.7%, and the likelihood of receiving exceptional performance bonus payments by about 2.8%.

The researchers concluded that health care professionals with the highest proportion of consumers dually eligible for Medicare and Medicaid had significantly lower MIPS scores compared with physicians with the lowest proportion. If risk adjustment fails to account for differences in the underlying consumer populations and their environments that influence performance on these measures, MIPS will continue to penalize health care professionals serving the neediest populations, rather than those who deliver poor-quality care. They recommend that the Centers for Medicare & Medicaid Services (CMS) consider comparing physicians within the same category of consumer social risk.

These findings were presented in “Clinicians With High Socially At-Risk Caseloads Received Reduced Merit-Based Incentive Payment System Scores,” by Kenton J. Johnston, Jason M. Hockenberry, Rishi K. Washera, and Karen E. Joynt Maddox. The researchers analyzed data from the default 2019 MIPS, and the 2019 MIPS Alternative Payment Models tracks. Clinicians from MIPS were included if they had a publicly reported 2019 MIPS final score reflecting performance during the 2017 measurement year, and a record in the 2017 Medicare Physician and Other Supplier reports database of their caseloads of Medicare consumers of any level (including dually enrolled). A total of 510,020 clinicians were included in the final study. The goal was to understand how clinicians with high caseloads of socially at-risk patients fare under Medicare’s MIPS.

The full text of “Clinicians With High Socially At-Risk Caseloads Received Reduced Merit-Based Incentive Payment System Scores, was published in September 2020 by Health Affairs. An abstract is available online at https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00350.

PsychU last reported on this topic in “2% Of Eligible Clinical Professionals Participating In MIPS In 2018 Received A Negative Rate Adjustment,” which published on March 2, 2020. The article can be found at https://www.psychu.org/2-of-eligible-clinical-professionals-participating-in-mips-in-2018-received-a-negative-rate-adjustment/.

For more information, contact:

  • Kenton J. Johnston, Assistant Professor of Health Management and Policy, College of Public Health and Social Justice, Saint Louis University, 3545 Lafayette, Salus Center, Room 362, Saint Louis, Missouri 63103; Email: johnstonkj@slu.edu; Website: https://www.slu.edu/slucor/faculty/johnston-kenton.php
  • 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

In this presentation, René Kahn, MD, PhD, PsychU Schizophrenia Section Advisor, discusses the impact of COVID-19 on long-acting injectable (LAI) antipsychotic administration, including safety and clinical considerations. Dr. Kahn will also discuss the personal protective equipment (PPE) recommendations from the Substance Abuse and Mental Health Services Administration (SAMHSA).

René Kahn, MD, PhD, is the PsychU Schizophrenia Section Advisor, as well as the Esther and Joseph Klingenstein Professor and System Chair of Psychiatry at the Icahn School of Medicine at Mount Sinai, in New York City, New York.

Jehan Marino, PharmD, BCPP, is a Senior Medical Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

 

 

René Kahn, MD, PhD, is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc.

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

In the United States, health care consumers with schizophrenia treated with long-acting injectable (LAI) antipsychotics were 38% less likely to be hospitalized compared to those treated with oral antipsychotics. Those treated with LAIs had 27% fewer hospitalizations and 16% fewer emergency room visits in the 12 months following treatment initiation. Compared to those taking oral antipsychotics, those initiated on LAIs were 79% more likely to be adherent to their medication at 12 months.

The researchers concluded that LAI versus oral antipsychotic treatment is associated with significant clinical benefit, including reduced hospitalizations and emergency room visits and improved medication adherence for the treatment of schizophrenia in the real world.

These findings were reported in “Hospitalizations, Emergency Room Visits, and Adherence Among Patients With Schizophrenia Initiated on Long-Acting Injectable Versus Oral Antipsychotics: a Systematic Review and Meta-analysis” by Dee Lin, Philippe Thompson-Leduc, Isabelle Ghelerter, Ha Nguyen, Marie-Hélène Lafeuille, Carmela Benson, Panagiotis Mavros, and Patrick Lefebvre. The researchers are affiliated with Janssen Scientific Affairs, LLC, and with Analysis Group, Inc. The researchers systematically reviewed 1,083 peer-reviewed, real-world studies published between January 1, 2010, and February 10, 2020, and identified 23 studies eligible for inclusion in meta-analyses. These studies reported hospitalizations, emergency room visits, and medication adherence comparatively among adults with schizophrenia treated with LAIs versus oral antipsychotics or in the same group of health care consumers before versus after the initiation of LAIs. The goal was to compare clinical outcomes and adherence of those with schizophrenia initiated on an LAI versus an oral antipsychotic in the United States.

The full text of “Hospitalizations, Emergency Room Visits, and Adherence Among Patients With Schizophrenia Initiated on Long-Acting Injectable Versus Oral Antipsychotics: a Systematic Review and Meta-analysis” was presented as a poster at the Psych Congress 2020 Virtual Experience from September 10-13, 2020. A copy is available online at https://www.psychcongress.com/sites/psychcongress.com/files/2020-09/162-Hospitalizations-Emergency-Room-Visits-and-Adh%20%281%29.pdf.

For more information, contact:

  • Dee Lin, PharmD, MS, Manager, US Real World Value & Evidence, Neuroscience, Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Road, Titusville, New Jersey 08560; Email: DLin@its.jnj.com; Website: https://www.jnj.com/
  • Kayla Engebretsen, Media Specialist, Syneos Health, 1030 Sync Street, Morrisville, North Carolina 27560; Email: kayla.engebretsen@syneoshealth.com; Website: https://www.syneoshealth.com/

Approximately 62% of United States physicians reported a reduction in income during the coronavirus disease 2019 (COVID-19) pandemic, according to a survey of more than 5,000 physicians. Of those who reported income reductions, about 25% said their income dropped by more than 50% during the pandemic; 28% said their income dropped by 26% to 50%; and 33% said their income dropped by 11% to 25%. About 15% said their income dropped by 1% to 10%.

In addition to asking how the COVID-19 pandemic affected income, the survey also asked about burnout and changes to stress relief behaviors. Nearly 65% said their burnout had gotten more intense during COVID-19, while 6% said their burnout had gotten less intense, and 30% said there had been no change. Approximately 33% of physicians said they were exercising more, while 31% said they were exercising less during COVID-19. Approximately 29% said they were eating more than they did before COVID-19. Approximately 19% of physicians said they were drinking alcohol more during COVID-19, and 19% said they were drinking alcohol less often. About 20% said they were using prescription stimulants or medications less during COVID-19, compared to 2% who said they were using them more.

These findings were presented in “2020 Physician COVID Experience,” by researchers for Medscape. From June 9, 2020, to July 20, 2020, the researchers surveyed more than 7,400 physician Medscape members in the United States, the United Kingdom, France, Germany, Spain, Brazil, Portugal, and Mexico. More than 5,000 of the respondents were from the U.S. The goal was to determine the impact of COVID-19 on physicians’ personal and professional lives.

The full text of “2020 Physician COVID Experience” was published in September 2020 by Medscape. The full report can be downloaded at https://www.medscape.com/slideshow/2020-physician-covid-experience-6013151#1.

For more information, contact:

  • Christine Weibe, Senior Director, Features Content, Medscape, 825 8thAvenue, New York, New York 10019; 212-301-6700; Website: https://www.medscape.com/

We appear to be entering the third phase of telehealth adoption. There was Telehealth 1.0, the pre-pandemic use of telehealth, with less than 0.01% of total visits delivered virtually. Then, there was Telehealth 2.0—the past six months—where Medicare telehealth claims rose from 13,000 to 1.4 million claims per week from March to April 2020. In the 2.0 era, 80% percent of behavioral health visits were virtual, compared to 30% of primary care visits.

And now we are slowly pivoting to the post-pandemic era, Telehealth 3.0. Surprise (or not), telehealth visits in all of health care are now on the decline. Data from MDLive found that telehealth comprised 69% of all visits in April but dropped to just 21% in July. And starting October 1, both UnitedHealthcare and Anthem will stop waiving the cost of copays, coinsurance, and deductibles for virtual visits not related to COVID-19. Other special policies for telehealth set to expire on December 31 include Cigna, Humana, and Aetna.

As the market shifts, the strategic questions are not specific to telehealth, but involve telehealth. First, as the landscape shifts, how do executive teams shift their service lines to the “next normal?” Second, what role will digital health technologies—telehealth, remote monitoring, and more—play in evolving service lines? And, third, how do executives plan to leverage the power of the virtual in their “next normal” strategies?

Service models must leverage the power of virtual. Whether services are delivered in homes, schools, community settings, residential facilities, primary care clinics, or in the emergency room—provider organization executives need to think about how each service line will leverage digital. And, the digital considerations can’t be an afterthought—something ‘added’ to an existing consumer experience. Rather, executive teams need to rethink their solution starting with digital services first. Justin Barad, an orthopedic surgeon and founder and CEO of OssoVR, said, “If we want to change the perception of health care past something that’s old-fashioned and archaic, we should take the best technology in other fields and use it to push the limits of what’s possible in health care.”

These topics were the focus of the session, Virtual Health: How To Expand Access & Build A Seamless Consumer Experience, at the 2020 OPEN MINDS Management Best Practices Institute. Three provider organization executives—Shawn Brooks, Executive Director, Special Projects at Centerstone; George Kolodner, MD, Founder and Medical Director at Kolmac Outpatient Recovery; and Diego Garza, MD, Vice President of Strategy and Innovation and Director of Telehealth at MindPath Care Centers—shared what they are doing to make digital services work in the long term. They elaborated on two elements in navigating to the digital first era—double down on convenience and access for competitive advantage, and reengineer workflows and culture for the new service landscape.

Convenience & Access Are Key Performance Measures    

Consumer expectations for “instant gratification” and extreme convenience (as defined by Netflix, GrubHub, Uber, and Amazon same-day delivery) will only grow in our increasingly virtual world. Consumers will gravitate to programs and organizations that make it easy and even “fun” to do business with them. Some organizations in the market space—Talkspace, Ginger, Heal, and others—were designed from the get-go to deliver a seamless virtual experience for consumers—from online scheduling to price transparency to the ability to be matched with a clinical professional of choice. How traditional service provider organization executive teams can reengineer their service lines to leverage the plethora of apps and social platforms with “gaming,” rewards, points, self-management tools, peer connections, and groups, is the question.

Our panelists have started with online scheduling and same day access to improve the virtual experience. “I’ve always wanted to eliminate scheduled appointments in favor of treating people as soon as they present, and telehealth made it possible. Now when a consumer in alcohol withdrawal calls us at 1 pm on Friday, we don’t have to say, ‘We’ll see you Monday morning’ but can begin treatment immediately,” said Dr. Kolodner. Since going virtual, Kolmac has seen new business from consumers in alcohol withdrawal grow from 10% to 40% of overall services because of its “ability to respond immediately.”

At MindPath Care Centers, an on-demand feature in their “virtual walk-in clinic” allows new and current consumers to get a therapy or medication management appointment with a clinical professional in 30 minutes or less, said Dr. Garza. In addition, he shared that clinical professionals who are in session with a consumer have their appointment calendar open and can schedule the next visit before the consumer “leaves”—this has helped tremendously with engagement and care continuity. And when a consumer is in crisis, the clinical professional can initiate an appointment and send a link by text.

It’s also important to address any consumer pain points. Mr. Brooks cautioned, “Never overestimate the consumer’s tech savvy.” Centerstone hosts a “tech session” for first-time consumers prior to their telehealth visit to troubleshoot ahead of time and make sure they are comfortable and know how to use the platform.

Centerstone, Kolmac, and MindPath all survey their consumers regularly and get valuable feedback. At MindPath, they found that after two to four telehealth appointments with a clinical professional—nearly three quarters of consumers said they wanted to continue with telehealth. “Putting thought into the consumer experience” is the single most important factor in taking telehealth to the next level, said Dr. Garza.

Mr. Brooks said that telehealth is about meeting consumer where they are, whether that’s at home, in a congregate or community setting, or even in a “video room” in the provider organization’s facility—if that’s what they prefer. The ability to combine virtual and in-person care, especially for high acuity consumers, is what sets specialty provider organizations apart from the competition, pointed out Dr. Garza. And Dr. Kolodner reminded us that finding out who does better in which setting is not just about what consumers like but also about efficacy and outcomes.

Workflow & Culture Need A Remake For New Service Models

New service lines—designed to leverage the power of virtual and excel on consumer convenience—will require new workflows, new technology infrastructure, and an enhanced management model and culture that embrace virtual for the long-term. Dr. Garza pointed to the importance of integration of the telehealth platform with the electronic health record system for increased efficiencies. He also commented that regardless of the platform, it’s important to establish the workflows, train staff, and break down any cultural resistance to the new ways of doing business. Every process, from appointment scheduling to documentation to billing to any supervision and peer consultation must be built into the workflow.

And Mr. Brooks mentioned how the people issues are key to making investment in technology platforms work. “Get the business processes/workflows right and everything else will fall in place. The platform is secondary, said Mr. Brooks. “It’s like if you know how to drive, you can drive a Nissan, a Cadillac, or a beamer,” he explained.

Executives need to think of telehealth not as a new service line in itself, but as one of many digital tools to leverage in the design of their next suite of service offerings. To build on the advice, below are recommend four elements for a best practice design process for the “next normal:”

  1. Keep the “true north” of customer needs (both consumer and payer) as a guide.
  2. Monitor the competition (particularly nontraditional competitors) to understand the “gaps” in the market that call for innovative new services.
  3. Use a “digital first” approach to design services to meet those customer needs.
  4. Set performance measures for new services at the start, measure them repeatedly, and adjust the service design to maximize performance on an ongoing basis.

In his presentation, Preparing For The New Normal: What’s Keeping Executives Up At Night? during the 2020 OPEN MINDS Management Best Practices Institute David Klements, Chief Executive Officer, Qualifacts, discussed the future of digital health services. His discussion centered on the issues, challenges, and opportunities facing specialty provider organizations as we move from “crisis normal” to the “new normal.”

To start, he focused on the current state of specialty provider organizations. A recent national survey conducted by Qualifacts and the National Council For Behavioral Health had some interesting findings—for example only 9% of behavioral health provider organizations said they could survive financially without some external assistance if the “crisis period” lasted a year or more. On the service side, 60% of behavioral health provider organizations are providing 80% or more care virtually (compared to just 2% of organizations pre-pandemic). Post-pandemic, 43% of provider organizations say virtual will constitute 40% to 60% of their overall service delivery.

What shifted the perspective of many executives on services in the months ahead was Klement’s discussion of service lines and product development. Mr. Klements said, “We need to accelerate product development for the new normal. We can’t use legacy systems from a time when less than 2% of services were being delivered digitally. What every provider organization needs is a remote-first product library.” He talked about the need for functionality that integrates all workflows—including digital—and allows for seamless digital communication between clinical professionals, their supervisors, and consumers. The strategic point—every service needs to be designed thinking of what can be done digitally first—not how to add digital service components later.

It appears we’ve reached another inflexion point in service delivery platforms. Instead of moving from inpatient hospital services to outpatient clinic services, the shift is from clinic-based services to digital. But the question remains the same for executive teams. If you have unlimited funding for digital services, what proportion of consumers would need clinic-based, face-to-face care? What executive teams need to do as part of the market positioning and service development is think digital first—and only use clinic-based services on an as-needed basis.

But making this transition work is about more than just designing new service lines with value-based reimbursement packages. Mr. Klements emphasized that there are operating process workflow issues and staffing challenges to address. On the workflow side, Mr. Klements discussed the difficulty in adapting 20-year old legacy EHR systems to the functionality required for virtual service delivery. The service delivery workflows of the new models require EHRs synced to the virtual care platforms for seamless scheduling, documentation, billing, follow-up, and more. And with the increasing use of remote patient monitoring technologies, robust data interoperability is key.

And the challenges of digital first service lines go beyond system design. There are staffing and culture issues involved in this shift. In their survey, only 26% of clinical professionals surveyed reported that they “preferred” to deliver service virtually. And 47% of clinical staff are concerned about maintaining connections with peers and supervisors in a virtual care environment. Executives need to plan for continuous training and establish opportunities for clinical professionals to debrief in teams, share challenges and solutions, and provide feedback. Staff working remotely need an alternative to water cooler conversations and “sticking their heads in” to consult with colleagues in order to make the digital transformation desired by consumers and health plans also work for clinical professionals.

Unpaid family caregivers are 26% more likely than non-caregivers to have physical and behavioral health conditions that reduce their overall health. According to an analysis of the Blue Cross Blue Shield (BCBS) Health Index, unpaid family caregivers had an average Health Index score of 89.6 points, which is 2.2 points lower than the benchmark population. Approximately 6.7 million commercially insured BCBS members have a spouse or child in need of caregiver support.

The health impact associated with caregiving is more pronounced for Millennials (ages 22 to 37), than for people in the Gen X (ages 38 to 53) and Baby Boomer (ages 54 to 64) generations. Compared to older generation caregiver cohorts, Millennial caregivers have a 59% higher rate of hospitalization and 33% higher rate of emergency department visits. The following health conditions are more prevalent among Millennial caregivers:

  • 82% increase in hypertension.
  • 60% increase in anxiety.
  • 64% increase in major depression.
  • 74% increase in obesity.

During the coronavirus disease 2019 (COVID-19) pandemic, demand for informal caregiving has increased. The intensity of caregiving also increased. Caregivers reported greater stress, isolation, and loneliness. A national survey found that 61% of Americans are providing some sort of informal care for a friend, neighbor, or family member due to the pandemic, and that more than half (55%) would not have identified themselves as caregivers before the pandemic. A greater share of Black (57%) and Hispanic (64%) caregivers are providing care for loved ones in their home compared to 37% of white caregivers. During the early months of the pandemic, 14% of informal caregivers reported using alcohol as a coping mechanism; 18% used medication, and 50% said they used food to ease stress.

These findings were reported in “The Impact of Caregiving on Mental and Physical Health” by researchers with the Blue Cross Blue Shield Association. The report is part of the Blue Cross Blue Shield, The Health of America Report series, and represents the 33rd study in the series. The researchers analyzed a data sample of caregivers based on BCBS commercial claims data to study the relationship between health status and caregiving. The national caregiver survey was conducted by ARCHANGELS, a national movement and platform that seeks to use data and stories to improve how caregivers are seen, honored, and supported. Additional data and support were provided by the National Opinion Research Center (NORC) at the University of Chicago, The Centers for Disease Control and Prevention (CDC), the Center to Advance Palliative Care (CAPC) and U.S. Census data.

The report noted that BCBS companies offer solutions to help support caregivers by providing education, transportation, care coordination, and care management. BCBS solutions address the following:

  • Connect caregivers to community resources.
  • Offer healthy meal delivery prescription delivery, virtual companionship, and emergency response support so that caregivers can remotely monitor.
  • Partner with digital health companies to coach caregivers and help them detect emerging health issues in care recipients with cognitive impairment.
  • Incorporate caregiver support into palliative care programs

The full text of “The Impact of Caregiving on Mental and Physical Health” was published September 9, 2020 by Blue Cross Blue Shield Association. An abstract is available online at https://www.bcbs.com/the-health-of-america/reports/the-impact-of-caregiving-on-mental-and-physical-health

For more information, contact:

  • Blue Cross Blue Shield Association, 225 North Michigan Avenue, Chicago, Illinois 60601; Website: https://www.bcbs.com/

It’s no secret—social factors affect health care spending. Last year, Bechara Choucair, MD, Senior Vice President and Chief Community Health Officer, Kaiser Permanente, provided the health plan perspective on social determinants of health in his keynote, Mind, Body, Community: Kaiser Permanente’s Unique Approach, at The 2019 OPEN MINDS Management Best Practices Institute. The message was reiterated by Andy McMahon, Vice President, Health and Human Services Policy, UnitedHealthcare Community, in his discussion of housing issues at the keynote session, Housing Is Health Care: A Post-Pandemic Look At Integrating Social Determinants Of Health. And, Allison Rizer, the former Vice President of Strategy and Health Policy, UnitedHealthcare, focused on the new opportunities for social support services in Medicare in her keynote, Emerging Models & New Benefits For Individuals Dually Eligible For Medicare & Medicaid.

There are three big issues in the nexus between health care and social supports. First, what funding is currently available to pay for social supports? Second, what are the measurable health care cost offsets for payers and health plans that underwrite social services, and what services for what consumers have a positive return? And third, how do health plans and provider organization executives design and deliver social support programs with positive financial results?

How health plans are addressing non-health issues was the focus of our recent conversation with John Lovelace, President, UPMC For You, who will keynote The 2020 OPEN MINDS Executive Leadership Retreat on October 28 with his presentation, A ‘Whole Life’ Approach To Managed Care: Emerging & Future Health Plan Models. We discussed how 80% of hospitals and health systems say they are committed to addressing social needs as part of clinical care—but more than 70% of hospitals report not having sustainable funding to address social needs. And almost 40% of hospitals report having no current capabilities to measure quantifiable improvements in health outcomes and cost savings from their strategies to address social needs.

But provider organizations claiming, “We don’t do that,” is not going to fly, said Mr. Lovelace. “Behavioral health carve-outs are out and human service carve-ins are in. We need to treat people and deal with their lives,” he asserted. And with the shift to value-based payment models, health plans are looking for provider organizations to create new initiatives that will yield shared savings. Savings on unplanned health care can then be invested right back into social services that will further help to improve health outcomes.

How is UPMC addressing social service safety net issues? The system has a number of initiatives coordinated through their new Center For Social Impact. Launched in December 2019, the Center’s role is to “coordinate, evaluate, and expand programming and innovations that address both the social needs and social determinants of the communities UPMC serves.” The Center’s mission is to translate the work of UPMC’s “unique payer-provider laboratory” to develop replicable evidence-based practices in housing, employment, and workforce training; improve service coordination with local government, expand rural health care, and address the unique needs of individuals with special needs (from consumers with intellectual and developmental disabilities, to people of color and the LGBTQI+ populations) that the UPMC Health Plan serves.

UPMC Health Plan, is owned by the University of Pittsburgh Medical Center and has eight licensed business units. UPMC For You is the government health plan, covering consumers on Medicaid, dual eligibles, and those on long-term services and supports. Community Care Behavioral Health Organization covers the Pennsylvania Medicaid carve-out for behavioral health services. “We are 50% insurance and 50% provider organization. And about 40% of our transactions are internal—our insurance division buys services from our provider organizations for our consumers. This gives us resources and leverage to engage on social determinants of health,” explained Mr. Lovelace. “We are not going to solve everything ourselves, but we are investing in partnerships to address the social determinants with the greatest impact on health. UPMC Health Plan’s priorities are to solve lack of housing for people with intellectual and developmental disabilities (I/DD), chronic unemployment, food insecurity, and institutional racism for the populations they cover.” He described a few of the initiatives that UPMC Health Plan has created to address the social needs of their members—in care coordination, housing, and employment.

Care Coordination, Including Social Services. UPMC’s Community Care Behavioral Health business unit, through its managed behavioral health programs, contracts with provider organizations to serve as “community paramedics” who go out to the homes of consumers tending to use a high volume of unplanned health care to support and stabilize them. The goal of their care management activities is to connect consumers to a full spectrum of community supports and services for “non health things.” Mr. Lovelace sees this as an opportunity for provider organizations.

Housing. UPMC has run a permanent supportive housing program for three decades because people who are homeless tend to have a lot of unplanned health care, especially if they have mental illnesses or substance use disorders, and are disabled or have chronic conditions, explained Mr. Lovelace. And they’ve seen that consumers who have housing better engage with their primary care provider organizations and take their medications. In the past, UPMC has leveraged funding from the U.S. Department of Housing and Urban Development—which traditionally supports only the chronically homeless and has many restrictions. “About 80% of those who become eligible for housing vouchers don’t use them because of the lag between application and qualifying and because of the cumbersome restrictions,” he pointed out.

So UPMC is now looking for new housing finance models and partnerships that will “lower the bar” and help more consumers get housing sooner. They’ve had conversations with Fannie Mae about low-interest loans. And they are partnering with a local non-profit, Community Human Services, that will provide housing supports while UPMC provides care management. “Consumers who get housing have to agree to talk to us, and see their primary provider,” explained Mr. Lovelace.

Employment. The Pathways to Work is a new UPMC Health Plan program serving consumers covered by the health plan who are unemployed or underemployed. The program also serves I/DD consumers seeking jobs and job training. The program hires individuals for jobs at UPMC—and in three years, the program has hired nearly 600 individuals previously on Temporary Assistance for Needy Families (TANF). UPMC Health Plan serves as a direct referral service and connects its Medicaid consumers to job supports across the state as part of the Medicaid Work Support Initiative through the Pennsylvania Department of Human Services. The health plan partners with community organizations to create an employment pipeline and also supports public policy campaigns to break down barriers to work. “It’s about more than employment, it’s about career planning,” said Mr. Lovelace. The health plan is trying to address the “benefits cliff” issue that causes individuals with disabilities to lose benefits (food stamps, housing, and heating subsidies) when they earn more than the minimum wage. With more than 2 million jobless claims filed in Pennsylvania since the pandemic began in March, the health plan is supporting consumers who have lost their jobs and connecting them to resources and opportunities. “We know that having a stable job leads to better overall health for many individuals,” said Mr. Lovelace.

Becky Stoll, LCSW, Vice President of Crisis and Disaster Management for the not-for-profit behavioral health care organization Centerstone, discusses how she utilizes PsychU in her work as a mental health professional, what she finds to be its most valuable content and resources, and what she would like to see from PsychU in the future. What does the PsychU name signify to her? “High-quality, informative” content that she often shares with others.

Featuring:

  • Becky Stoll, LCSW
    Vice President of Crisis and Disaster Management, Centerstone
  • Rachel Self, PhD, MS
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Becky Stoll, LCSW, is Vice President of Crisis & Disaster Management for Centerstone. A Licensed Clinical Social Worker with 20 years of behavioral health experience, Ms. Stoll is faculty for the Suicide Prevention Resource Center’s Zero Suicides in Health and Behavioral Healthcare initiative, she is the Crisis Service Division Board Chair for the American Association for Suicidology, and she serves on the Steering Committee for the National Suicide Prevention Lifeline.

Rachel Self, PhD, MS, is 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.

 

Becky Stoll is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc.

Rachel Self is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

For over a decade, the health and human service field has been focused on getting primary care and behavioral health services in sync. The Substance Abuse and Mental Health Services Administration (SAMHSA) has spent significantly on grants for integration and for certified community behavioral health centers. Medicare launched a new reimbursement model supporting coordinated care. But the adoption of integrated primary care/behavioral health models has been slow for many reasons. There are reimbursement issues, cultural issues in care delivery, and interoperability challenges with electronic health records (EHRs). As a result, the proportion of consumers served through delivery systems that are integrated in terms of services, finances, and information is small.

But the time has come that every specialty provider organizations needs a primary care strategy. That doesn’t mean they necessarily deliver primary care service—but that is one of the options. For payers and health plans, integration means a “whole person” approach to care coordination. The “ideal” model has medical, behavioral, and social needs addressed together in a system that has seamless consumer services, integrated data at the consumer level, and alignment of financial incentives. From the provider organization perspective, the question is to determine, even if your organization can’t be the entire solution, how to create (through new capability development, mergers, or collaboration) a system with these characteristics.

Two changes in the market over the past few months have altered the path to primary care integration for specialty provider organizations. We have seen primary care move to virtual and in-home models—eliminating the need for brick-and-mortar primary care facilities. And, primary care and specialty care coordination models are moving to non-fee for service reimbursement models.

But how have specialty organizations fared in adding primary care services to their portfolios? We heard some examples at the session, Specialty Primary Care Models That Work For Consumers With Complex Needs during the 2020 OPEN MINDS Management Best Practices Institute. The session featured Lantie Elisabeth Jorandby, MD, Chief Medical Officer, Lakeview Health; Lisa Suttle, Regional Vice President of Clinical Services, Meridian Health Services; Tracy Douglas-Wheeler, Vice President, Community Health, Meridian Health Services; and Jim Sorg, PhD, Director of Care Integration, Tarzana Treatment Centers—and was moderated by OPEN MINDS, Senior Associate, Joe Naughton-Travers.

Lakeview Health is a 200-bed residential treatment facility in Florida for adults that have a dual-diagnosis of substance use and mental health disorders. They recently embedded primary care and are staffed with psychiatrists, internists, and primary care professionals. Meridian Health Services started as a behavioral health organization in the 1970s and later added primary care, dental services, addictions treatment, intellectual and developmental disability services (I/DD), foster care, and children’s services. Today, Meridian is a Federally Qualified Health Center (FQHC) serving more than 40,000 consumers in 33 counties and 250 schools. Tarzana Treatment Centers is just a few months short of becoming a an FQHC and offers residential and outpatient mental health and addictions treatment, primary care, HIV-AIDS and Hepatitis C care. They serve about 10,000 consumers a year. Tarzana contracts with primary care physicians and employs mid-level clinical professionals in primary care at all sites. These three specialty provider organizations have two common themes in their approached to integrating primary care—comprehensive assessments and ongoing coordinated care management.

Comprehensive Assessments

All three organizations agreed that it all starts at intake—it’s important to assess the consumer for all conditions—behavioral, medical (and even social)—no matter what they present for. At Lakeview, consumers—who enter for detox initially—are assessed by an internist or psychiatrist on their first visit. After about 72 hours, when they have been stabilized, they see a mental health professional for evaluations. They administer a “battery of assessments”—PHQ-9 for depression, GAD-7 for anxiety, MoCA for cognitive dysfunction, and the MDQ for bipolar disorder. “We administer the assessments initially and throughout the 4-6-week treatment plan, and reassess where they are at the end of their stay,” said Dr. Jordanby. Lakeview also monitors other conditions that could lead to a relapse in sobriety, such as the ability to manage chronic pain and the impact of past trauma.

At Meridian, said Ms. Suttle, staff doing intake are trained to ask, “What’s going on with this consumer I am seeing today?” and to assess for all complexities. The initial assessment even includes questions about housing, employment, and other social determinants of health. “We have grant dollars to provide support services, but we won’t know what they need if we don’t ask,” she said. And often, consumers with behavioral health needs “won’t come in to see us until it’s a full-blown crisis or they are in the emergency room. So, we go out to homes, porches, garages, and schools—wherever we can assess them safely—and bring them in.”

And at Tarzana, in addition to a “self-medical,” or obtaining a full history from the consumer at intake, staff screens for substance use and other conditions. “We use motivational interviewing to engage consumers who don’t want to screen for conditions other than those they present for,” said Mr. Sorg.

Ongoing Coordinated Care Management

All three organizations have embraced a comprehensive approach to individual care coordination. Tarzana coordinates care for consumers with chronic conditions as well as for incarcerated populations, and for consumers discharged from hospitals. “From the data of one of the health plans funding this service, we saw that we helped reduce hospital admissions as well as emergency room visits by just over 5%,” said Mr. Sorg. They are now extending the care coordination beyond the health home program through case management services for all consumers with mental illness and substance use disorders. The case manager is the “human link” in the absence of an integrated EHR, said Mr. Sorg. The case manager interfaces between systems, dives into a standalone information portal that pulls consumer data from the different EHRs and manages referrals and transitions between clinical professionals. The case managers also help consumers with navigating housing assistance and other social service benefits.

Lakeview has a slightly different approach based on the same concept. “At Lakeview, we have consumers for six weeks and then they go back into the community. So, we have a strong after-care team that provides wraparound care and sets up seamless transition to outpatient primary care, occupational or vocational therapy, or other needed services. We are just the foundation, so we help integrate them back into their lives,” Dr. Jordanby explained.

And at Meridian, “referral coordinators on the primary care side look at the consumer’s medical records and push referrals to behavioral health,” said Ms. Douglas-Wheeler. Then the behavioral health team contacts the consumer proactively for follow-up care. Community health workers partner with the clinical professionals caring for a consumer to address social determinants of health. “We want to get community health workers into consumers’ homes to set up virtual visits with primary care professionals so consumers can talk about what’s going on and what’s hindering them from access to care.”

What strategic advice do the panelists have for provider organization executives that want to adopt a more holistic approach to complex care? Cross-train and educate your clinical professionals for care coordination, emphasized Dr. Jordanby. Ms. Suttle advised clinical professionals to “think out of the box, use resources across the board, and pull on other specialty areas.” And Ms. Douglas-Wheeler suggested bringing primary care or specialty clinical professionals in on a contract basis for starters—and to be sure to involve all staff at the front end, as part of the assessment process.

Clinical professionals affiliated with health systems had better performance scores on the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System (MIPS) for 2019 than non-affiliated clinical professionals. The system-affiliated clinical professionals were more likely to receive a positive payment adjustment, and bonus payments than non-affiliated professionals, and they were less likely to receive a negative payment adjustment.

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.

On a scale of 0 to 100 possible points for MIPS performance scores based on the 2017 performance year, affiliated professionals scored an average of 79 points compared to 60 for non-affiliated professionals. Higher MIPS scores represent better performance. About 97.1% system-affiliated clinical professionals and 82.6% non-affiliated professionals received a positive payment adjustment. About 73.9% of system-affiliated clinical professionals and 55.1% non-affiliated professionals received a bonus payment adjustment. About 2.8% of system-affiliated clinical professionals and 13.7% of non-affiliated professionals received a negative payment adjustment.

MIPS is one track of the Quality Payment Program (QPP) established to implement certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 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.

These findings were reported in “Association of Clinician Health System Affiliation With Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System” by Kenton J. Johnston, Ph.D.; Timothy L. Wiemken, Ph.D.; Jason M. Hockenberry, Ph.D.; et al. The researchers conducted a cross-sectional study of 636,552 clinical professionals with MIPS data for 2019, which is based on their performance in 2017. The goal was to assess whether clinical professionals who were affiliated with a health system had performance scores and value-based reimbursement under the 2019 MIPS that were different relative to their non-affiliated peers. About 48.6% of the clinical professionals were affiliated with a health system.

The full text of “Association of Clinician Health System Affiliation With Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System” was published September 8, 2020, by JAMA. An abstract is available online at https://jamanetwork.com/journals/jama/fullarticle/2770411.

PsychU last reported on this topic in “2% Of Eligible Clinical Professionals Participating In MIPS In 2018 Received A Negative Rate Adjustment,” which published on March 2, 2020. The article is available at https://www.psychu.org/2-of-eligible-clinical-professionals-participating-in-mips-in-2018-received-a-negative-rate-adjustment/.

For more information, contact:

  • Kenton Johnston, Ph.D., MPH, Associate Professor, Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Salus Center, Room 362, Saint Louis, Missouri 63104; 314-977-3236; Email: kenton.johnston@slu.edu; Website: https://www.slu.edu/public-health-social-justice/faculty/johnston-kenton.php

As of October 1, 2020, the highest rate of coronavirus disease 2019 (COVID-19) testing was in Massachusetts, at 10.2 tests per 1,000 population. It was lowest in Florida, Mississippi, and Arizona, all at 1.0 tests per 1,000 population. After Massachusetts, the next highest testing rates were Rhode Island (8.5 tests per 1,000 population), North Dakota (7.1 tests per 1,000 population), and Arkansas (5.8 tests per 1,000 population).

Also, as of October 1, 2020, Texas had the highest number of new daily cases (5,755), followed by California (3,461), and Wisconsin (2,272). Vermont had the fewest number of new cases, at just three.

South Dakota had the highest percentage of daily positive cases (25.9%), followed by Idaho (21.2%), and Wisconsin (21.1%). Maine showed the lowest percentage of daily positive cases at 0.4%. Overall, 22 states were below the 5.0% percent positive rate (as rounded up or down by tenth) recommended by the World Health Organization (WHO) in May 2020 as the threshold for considering reopening. The WHO recommended that for reopening with the lowest risk of spread, the percent positive rate should remain below 5% for at least two weeks.

These statistics were presented in “Johns Hopkins University and Medicine Coronavirus Resource Center: All State Comparison Of Testing Effort.” It is an active research project updated daily. Researchers for Johns Hopkins analyzed publicly available state COVID-19 testing data from multiple, unspecified sources. The goal is to report current trends in COVID-19 infection and deaths. Testing rates are presented as seven-day rolling averages to account for fluctuations in daily state reporting. New cases of COVID-19 are presented as daily counts, as reported by each state.

The full text of “Johns Hopkins University and Medicine Coronavirus Resource Center: All State Comparison Of Testing Efforts,” is continually updated by Johns Hopkins University and Medicine Coronavirus Resource Center. A copy may be found online at https://coronavirus.jhu.edu/testing/states-comparison. The testing trends comparison is posted at https://coronavirus.jhu.edu/testing/tracker/overview.

For more information, contact: 

  • Karen Lancaster, Assistant Vice President, External Relations, Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218; 443-997-9909; Email: klancaster@jhu.edu; Website: https://www.jhu.edu/

Home health care had a mere 3% share of the $3.6 trillion U.S. health care market in 2018. Medicare and Medicaid together made up 75% of home health spending in 2018. Home-based health care today largely comprises face-to-face care covered by Medicare, long-term services and supports funded through Medicaid home and community-based waivers, and wraparound services.

The pandemic has changed this equation. All health care (or most of it) has been home-based— though largely through telehealth. The question for executive teams developing their recovery strategies is how much of that care will remain virtual—and for face-to-face services, what proportion will move to home-based as opposed to returning to traditional office-based services. Kevin Scalia, Executive Vice President, Corporate Development, Netsmart provided some interesting perspectives on this issue of service location in the “next normal” during the session, Home-Based Services—Opportunities In The Post-Pandemic Health & Human Service System, at the recent 2020 OPEN MINDS Management Best Practices Institute.

Netsmart home care customers saw a big decrease in home-based face-to-face services at start of the pandemic, but those service levels have now rebounded. But as he looks ahead, Mr. Scalia sees the reimbursement model adopted for Medicare home care services making its way to behavioral health and other health-related services across all payers. The model, referred to as the Patient Driven Groupings Model (PDGM) is episodic payment for home care, based on diagnosis and incentives driven by outcomes. “I believe this is coming to behavioral health,” Mr. Scalia said.

There are a few reasons why episodic payments are likely to become more common. First, the possibility of “overbilling” for telehealth services is a fundamental payer concern about continuing the liberalized use of virtual care, and episodic payments would partially address that issue. And, episodic payment models can allow payers to pay for “hybrid” service models—combining virtual care, face-to-face in-home services, and face-to-face clinic-based services in a single payment mechanism.

So, what are the opportunities to deliver home-based services for provider organizations that are considering adding that service delivery model? Mr. Scalia had a number of interesting ideas. First, partnerships with existing provider organizations. He said there are twelve clinical groups in PDGM—one of them being behavioral health. PDGM base rates are adjusted for comorbidities, risk, and resource needs, with outcomes closely monitored (skilled nursing facilities have also shifted to a similar model, the Patient Driven Payment Model or PDPM). Mr. Scalia observed that most home care provider organizations don’t have the clinical resources to provide behavioral health services and would be open to partnerships. A second opportunity is for provider organizations to build their own home-based service delivery programs—specializing in particular consumer conditions and needs. Either option would prepare an organization to deliver home-based care and also to manage episodic payment arrangements with incentives based on consumer experience and outcomes.

Mr. Scalia also highlighted the opportunity for provider organizations to expand into virtual and home-based primary care. He pointed to a recent survey that found that consumers want to connect with “their own” physician rather than a “random physician”—the model of many new telehealth services. This is a big opportunity for specialty provider organizations that have relationships with consumers and can protect and extend those relationships by providing primary care services. And it was surprising to learn that this is already happening to a degree. Netsmart’s use of their primary care module by behavioral health organizations has climbed 77% over the pandemic period.

So how to prepare for a future of hybrid services? First there is expansion of the technology platform. Episodic payments require new billing systems. Electronic visit verification, workforce management, route optimization, telehealth, and mobile solutions with enhanced security were other technologies that Mr. Scalia discussed as part of the enhanced functionality needed for adding home-based service delivery to a hybrid service model.

Another surprising piece of our discussion of preparing for this shift to hybrid is the need for provider organizations to “go retail” with marketing. “Provider organizations need to build a brand for Medicare,” Mr. Scalia noted. The consumers must want to come to you. And as health plans change their network model—with a single provider network for all payers—the provider organizations with the best “consumer perception” are going to be the ones selected by payers.

What do the many opportunities in this move to hybrid models—virtual, at home, and in clinic— share? Mr. Scalia closed the session with this thought—the focus of any new provider organization service development should be on health plan partnerships. “Health plans are going to go around the hospitals directly to community-based provider organizations—behavioral health, home care, senior living, and more. They want partnerships with them to coordinate care and keep people out of the hospital.”

Before the start of the pandemic, nearly 570,000 Americans were homeless. And now, as unemployment rolls mount and moratoriums against evictions and foreclosures expire, an additional 30 to 40 million people could be at risk of homelessness in the coming months. Even before the pandemic, leaders in the health care field had started to acknowledge that housing insecure consumers are consumers who use more health care resources.

But the big question remains—what to do about it? How do health plans approach the issue of caring for housing insecure members? That was the focus of the keynote session, Housing Is Health Care: A Post-Pandemic Look At Integrating Social Determinants Of Health, by Andy McMahon, Vice President, Health & Human Services Policy, UnitedHealthcare Community & State, at The 2020 OPEN MINDS Management Best Practices Institute.

Mr. McMahon outlined a concrete plan—described as the “five levers”—to address the issue of housing among their members. The five levers? Data, policy/system reforms, investments, partnerships, and new clinical models. In each of these areas, Mr. McMahon gave an overview of the many UnitedHealthcare initiatives in each area, but a few stood out:

  • Data: Using data to track consumers and intervention outcomes—and integrating data to increase systemwide collaboration.
  • Policy/system reforms: Advocating for changes in Medicaid 1115A waivers to pay for tenancy supports and aligning HUD vouchers to connect with health care.
  • Investments: Making investments to spur affordable housing development with Stewards for Affordable Housing for the Future, pay-for-success initiatives, and low-interest loans for safety net services.
  • Partnerships: Participating in multi-system partnerships to increase Medicaid supports for housing-related services and developing value-based purchasing contracts that embrace these concepts.
  • New clinical models: Delivering intensive wraparound care onsite through the “housing + health” clinical care model with end care management, patient-centered health coaching, and goal planning, addiction recovery support, employment navigation, and non-emergency transportation assistance—transitioning medically stable and financially self-sufficient members to market-rate housing with ongoing support.

So, what are the opportunities for provider organizations in this national initiative by one of the largest health insurers?

Funding streams: Provider organizations should check if payers have special funding streams to support new or expanded health care and social service programs. For example, UnitedHealthcare has a “plan-agnostic” $150 million social impact investment fund which provides low-interest “catalytic capital” for housing and health care projects that connect more consumers to holistic services and supports.

Onsite and hybrid care models: Provider organizations that can offer face-to-face and hybrid services will be in demand, even as virtual care gains increasing traction across the board. “Many homeless people with serious mental illness don’t just have an iPad and even if they can access the technology, the remote communication may be troubling for them. You need to have case managers present with these consumers to support them in person, even if they are visiting with their clinical professional virtually,” explained Mr. McMahon. Provider organizations that can provide onsite face-to-face services at housing project sites will also have new contract opportunities.

Medical respite programs: For provider organizations offering residential services, respite care for the homeless population may present a new service line opportunity. The need for respite care has been exacerbated by the pandemic and payers are looking for care and support options for homeless consumers “who are not sick enough to stay in hospital but not well enough to go back to the streets or a shelter,” said Mr. McMahon.

Holistic health and social services: From tenancy supports to transportation, a spectrum of services is needed to care for the homeless population and Mr. McMahon advised provider organizations to “strive for end-to-end care management.” Payers are seeking provider organizations that are willing to partner across continuums of care and collaborate with other provider organizations (to offer primary care and behavioral health services), public housing authorities, health plans, state housing finance agencies, transportation sources, etc. to build holistic support frameworks for the homeless population. “With value-based payment contracts and alternative payment models, we are looking for other ways to pay for these things provider organizations are doing to help consumers,” said Mr. McMahon.

What is Mr. McMahon’s advice for provider organizations seeking new opportunities in the housing market? “Come knock on the door and ask us how you can partner,” he suggested. Do your research and focus your outreach efforts on specific functions and/or departments of the payer organization such as population health management, community partnerships, and complex care coordination. He cautioned that provider organizations need to come to the table with data on program efficacy and how they will affect outcomes and expenses. “The worst thing for an MCO to hear is that we spent all this money, and nothing happened,” said Mr. McMahon. At the end of the day, payers are looking for partners who will help them understand the “shared population,” build relationships and work across the continuums of care.

In this companion piece to the PsychU April 23, 2020 webinar, “Substance Use & The Novel Coronavirus Pandemic: A Conversation With The Experts,” Drs. Robin Nelson and Roueen Rafeyan share their perspectives on telehealth for treating individuals with a substance use disorder.

Robin Nelson, MD, is the PsychU Major Depressive Disorder Section Advisor, a psychiatrist at DGR Comprehensive Behavioral Health LLC in Wyomissing, PA, and an attending psychiatrist at the Caron Foundation Treatment Center in Wernersville, PA. Dr. Nelson received his MD from Duke University’s School of Medicine. He completed his residency in Duke University’s Psychiatric Residency Education Program. Dr. Nelson is board certified by the American Board of Psychiatry and Neurology.

Roueen Rafeyan, MD, is the Chief Medical Officer for Gateway Foundation Addiction Treatment Centers and an Assistant Professor of Psychiatry at the Feinberg School of Medicine, Northwestern University. Dr. Rafeyan was identified as the Top Psychiatrist in the Nation by Consumer Reports in 2007. He is also a Distinguished Fellow of the American Psychological Association (APA) and American Society of Addiction. Dr. Rafeyan earned his MD at Istanbul University in Turkey and completed his residency at the University of Illinois at Chicago.

Mark Tacelosky, PharmD, is a Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

 

 

Robin Nelson, MD, and Roueen Rafeyan, MD, are paid consultants to Otsuka Pharmaceutical Development & Commercialization, Inc.

Rachel Self, PhD, and Mark Tacelosky, PharmD, are paid employees for Otsuka Pharmaceutical Development & Commercialization, Inc.

Telehealth visits may be as effective as in-person visits for maintaining continuous medication-assisted treatment (MAT) for at least three months after starting MAT, according to a rapid evidence review. Further, contingency management improved treatment retention when combined with antagonist MAT, but not with agonist forms of MAT. Applicability, however, may be limited due to implementation challenges.

There were no differences in treatment retention for people using extended-release (XR) buprenorphine in either injectable or implant formulations compared with daily buprenorphine. There were conflicting results with XR-naltrexone injection compared with daily buprenorphine. The addition of psychosocial interventions did not appear to improve retention, but many of the comparison studies provided counseling to the control group, which may have masked the evidence of effectiveness. For incarcerated people, starting MAT before release improved retention in treatment after release.

The rapid evidence review included findings from two systematic reviews and 39 primary studies. The researchers observed that most studies of MAT for opioid use disorder (OUD) did not focus on retention as the primary outcome. Additionally, many studies were small and had design flaws.

These findings were reported in “Retention Strategies For Medications For Addiction Treatment In Adults With Opioid Use Disorder,” a comparative effectiveness review commissioned by the federal Agency for Healthcare Research and Quality (AHRQ). The researchers, Brian Chan, M.D., MPH; Emily Gean, Ph.D.; Irina Arkhipova-Jenkins, M.D., MBA; Jennifer Gilbert, M.D., MPH; Jennifer Hilgart, MSc; Celia Fiordalisi, MS; Kimberly Hubbard, BA; Irene Brandt, MA; Elizabeth Stoeger, BS; Robin Paynter, MLIS; P. Todd Korthuis, M.D., MPH; and Jeanne-Marie Guise, M.D., MPH, conducted a targeted literature review of systematic reviews and randomized controlled trials. They summarized evidence for six retention intervention types: care settings/services/logistical support, contingency management, health information technology, extended-release medication-based treatment, psychosocial support, and financial support. The primary outcome was retention, defined as continued medication engagement for at least three months after MAT initiation. Secondary outcomes included mortality and harm.

A link to the full text of “Retention Strategies For Medications For Addiction Treatment In Adults With Opioid Use Disorder” may be found at www.openminds.com/market-intelligence/resources/082120ahrqecmatretention.htm.

For more information, contact:

  • Farah Englert, Media Contact, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Floor 7, Rockville, Maryland 20857; 301-427-1865; Email: farah.englert@ahrq.hhs.gov; Website: https://www.ahrq.gov/

The pandemic has brought the spotlight to many inequities in the health care system. One is the access to treatment (and soon, access to vaccines) for people with disabilities. A few months ago, the shortage of ventilators was a critical issue—causing states to look at their standards for crisis care plans. As these plans were published, disability rights groups saw some states put out policies that either overtly discriminated against people with disabilities or at best, were ambiguous about protections for people with disabilities. Add to this no-visitor policy for people with disabilities admitted to hospitals and unable to communicate on their own, and instances of inaccessible COVID testing, and a troubling picture emerges.

The media reports that Washington state officials were discussing the possibility of rationing care in the event of a shortage of medical equipment and personnel caused the Arc and other disability rights groups to send a letter in March to the U.S. Department of Health and Human Services Office for Civil Rights (HHS-OCR), to ensure that any government decisions to ration treatment would be made without discriminating based on disability, according to Shira Wakschlag, Director For Legal Advocacy, Arc. But shortly thereafter, some states announced policies that the groups found to be discriminatory. They filed four complaints with HHS-OCR about disability discrimination and treatment rationing plans in Washington, Alabama, Tennessee, and Kansas. Later complaints were filed against discriminatory rationing policies announced in Utah, Oklahoma, North Carolina, Oregon, Arizona, and North Texas.

The complaints addressed a range of issues. These included categorical exclusions from treatment on the basis of disability diagnosis, quality of life assessments in place of objective medical evidence, long-term survival speculation beyond the prognosis for COVID-19 treatment, failure to provide for reasonable modifications in receiving treatment including allowing for longer time on a ventilator, reallocation of the ventilators for people with chronic conditions, and overall failure to provide for a reviews of each consumer to avoid decisions based on diagnoses and stereotypes.

In response to the complaints, the U.S. Department of Health & Human Services Office of Civil Rights (HHS-OCR) issued a bulletin in March advising entities covered by civil rights authorities keep in mind their obligations to avoid unlawful discrimination against people with disabilities when making decisions about their treatment during the COVID-19 health care emergency. HHS-OCR also conducted compliance reviews and complaint investigations. Subsequently, Alabama, Connecticut, Tennessee, Pennsylvania, Utah, and North Texas withdrew or amended their discriminatory ventilator rationing policies and instructed hospitals across the state that they cannot discriminate against people with disabilities in accessing treatment.

In Connecticut, disability rights groups filed a complaint against the state for not allowing reasonable exceptions to hospital no-visitor policies for persons with disabilities hospitalized with COVID. This denies consumers the ability to communicate, make informed decisions, and provide informed consent, the groups stated. In Nebraska, the local disability rights group complained to the state for failing to make reasonable modifications to TestNebraska, the COVID-19 testing program. The prescreening required Internet access and being tested required driving to the test site and waiting. The complaint noted that “Many people with disabilities, including people who have intellectual and developmental disabilities (I/DD), are blind, or are in institutional or congregate facilities like nursing homes and assisted living, are unable to drive and lack access to other transportation, and thus are unable to participate in TestNebraska.”

“There is a risk that decisions about rationing essential medical supplies will not be made only on the basis of how well consumers are going to respond to treatment, but may also include a judgment about which lives are more valuable than others that doesn’t have a place in a medical decision-making process,” said Ms. Wakschlag. She noted that the Arc and other groups will continue to work with hospitals and others to ensure that crisis standard of care plans take individuals with disabilities into account. Overcoming categorical exclusions from care, eliminating policies that allow for the reallocation of personal ventilators, and prohibiting long-term survivability not related to the emergent condition as a factor in care decisions will be the priorities.

On August 28, 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) began distributing the first-year funds of its two-year State Opioid Response (SOR) and Tribal Opioid Response (TOR) grant programs. The two programs ultimately will award nearly $3 billion over two years to help states and tribes provide community-level resources for people in need of prevention, treatment, and recovery support services. The awards ranged in size from $4,001,239 for South Dakota to $105,864,578 for California.

Through these existing funding streams, states, and tribes have been able to develop and utilize integral systems of comprehensive care to address their jurisdictions’ individual needs. Through SOR, states across the country are funded to develop tailored approaches to prevention, treatment, and recovery from opioid use disorders and/or stimulant use disorders. The program provides access to evidence-based medication to treat opioid use disorders, along with psychosocial services and community supports. The TOR program enables the development of these same comprehensive approaches among tribal communities.

The awards for each state and tribe are posted at https://www.samhsa.gov/sites/default/files/sor-tor-fy2020-awards.pdf.

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; 877-726-4727; Website: https://www.samhsa.gov/newsroom/press-announcements/202008270530.

In this companion piece to the PsychU April 23, 2020 webinar, “Substance Use & The Novel Coronavirus Pandemic: A Conversation With The Experts,” Dr. Roueen Rafeyan discusses patients who believe substances of abuse help them cope better with stress than prescribed psychiatric medications.

Roueen Rafeyan, MD, is the Chief Medical Officer for Gateway Foundation Addiction Treatment Centers and an Assistant Professor of Psychiatry at the Feinberg School of Medicine, Northwestern University. Dr. Rafeyan was identified as the Top Psychiatrist in the Nation by Consumer Reports in 2007. He is also a Distinguished Fellow of the American Psychological Association (APA) and American Society of Addiction. Dr. Rafeyan earned his MD at Istanbul University in Turkey and completed his residency at the University of Illinois at Chicago.

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

Mark Tacelosky, PharmD, is a Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

 

 

Roueen Rafeyan, MD, is a paid consultant to Otsuka Pharmaceutical Development & Commercialization, Inc.

Rachel Self, PhD, and Mark Tacelosky, PharmD, are paid employees for Otsuka Pharmaceutical Development & Commercialization, Inc.

Professional Disability Associates (PDA) launched a new behavioral health claim management service. PDA, a subsidiary of The Advocator Group and Brown & Brown, Inc., provides specialty risk resources and consultative solutions to the disability insurance market. The new service is intended to help disability insurance carriers improve decision making, duration management, resource utilization, and return to work outcomes of people with complex and, often, costly claims.

Utilizing innovative psychometric survey tools and the expertise of behavioral health clinical professionals, PDA will work with its insurance carrier customers to identify behavioral health claims where psychosocial issues may be affecting the claimant’s functional capacity. Claims selected will follow a prescribed process to identify and assess the claimant’s specific behavioral health issues to determine how the behavioral health issues affect the claimant’s ability to work. Claims suited for this service include those with a primary behavioral health diagnosis, co-morbid behavioral health condition, undiagnosed behavioral health, or COVID-19 impacted claims.

PDA’s proprietary process for evaluating these claims includes an evaluation of medical history and a psychometric assessment of the claimant’s ability and mindset about returning to work, combined with an in-depth interview by a seasoned behavioral health clinician. Targeted strategies for future claim management can include a multi-disciplinary discussion, outreach to a treating provider, outreach to an employer, a peer review, an independent medical exam, and/or surveillance. Where possible, the service will also serve to make recommendations as to how to safely and securely return a claimant to work.

Professional Disability Associates (PDA) is an innovative industry leader in providing specialty risk resources, including medical and vocational review services, consultative solutions and industry benchmarking, as well as full-service claim administration capabilities to major disability insurers and self-insured employers. PDA seeks to deliver customized solutions.

For more information, please contact:

About 78% of psychiatrists who participated in an online survey assessing their well-being in 2018 reported significant burnout with their careers. The following characteristics were associated with higher scores on an assessment of burnout: depressive symptoms, female gender, inability to control one’s schedule, and work setting. Age, race, number of hours worked, and hours of direct care per week were not associated with burnout.

The survey included the Patient Health Questionnaire (PHQ)-9 depression assessment and the Oldenburg Burnout Inventory (OLBI). About 16% of psychiatrists had scores of 10 or above on the PHQ-9 indicating moderate to severe depression. A total of 98% of psychiatrists who had PHQ-9 scores of 10 or higher also had scores above 35 on the OLBI, indicating burnout. Suicidal ideation was not significantly associated with higher OLBI scores. Burnout, female gender, resident or early-career stage, and nonacademic setting practice were significantly associated with higher PHQ-9 scores.

These findings were reported in “Well-Being, Burnout, and Depression Among North American Psychiatrists: The State of Our Profession” by Richard F. Summers, M.D.; Tristan Gorrindo, M.D.; Seungyoung Hwang, M.S., M.S.E.; Rashi Aggarwal, M.D.; and Constance Guille, M.D. They analyzed responses from 2,084 psychiatrists to an online survey on burnout and well-being between October 2017 and December 2018. The survey included the PHQ-9 and the OLBI. The goal was to examine the prevalence of burnout and depressive symptoms among North American psychiatrists, identify demographic and practice characteristics that increase the risk for symptoms, and assess the correlation between burnout and depression.

The full text of “Well-Being, Burnout, and Depression Among North American Psychiatrists: The State of Our Profession” was published July 14, 2020, by The American Journal of Psychiatry. An abstract is available online at https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.19090901.

For more information, contact:

  • Richard F. Summers, M.D., Senior Residency Advisor and Clinical Professor of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 950 Haverford Road, Suite 302, Bryn Mawr, Pennsylvania 19010; 610-527-4628; Website: http://www.gruenbergandsummers.com/summers

In recognition of Pharmacist Month, PsychU Pharmacist Corner Section Advisor Megan Ehret, PharmD, MS, BCPP, provides her perspective on what PsychU means to her. Dr. Ehret discusses the different perspectives and opportunities that pharmacists experience in clinics, hospitals, and public health care settings.

 

Megan Ehret, PharmD, MS, BCPP, is the PsychU Pharmacist Corner Section Advisor, as well as the Associate Professor, Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy in Baltimore, Maryland.

Patricia Rohman, PharmD, MBA, is a Senior Managed Market Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

Becky Stoll, LCSW, Vice President of Crisis and Disaster Management for the not-for-profit behavioral health care organization Centerstone, discusses her experiences in the development of the 988 National Suicide Prevention Lifeline as a member of the Action Alliance Crisis Services Task Force. Additionally, she offers her perspective on how the initiative may change the field of suicidology. As the Vice President of Crisis and Disaster Management at Centerstone, Ms. Stoll is at the forefront of programs designed to mitigate the impact of trauma in times of crisis and shares what she sees on the horizon for crisis intervention. As a current American Association of Suicidology board member, Ms. Stoll suggests special considerations that health care providers can be mindful of when interacting with populations at high risk of suicidal ideation.

Featuring:

  • Becky Stoll, LCSW
    Vice President of Crisis and Disaster Management, Centerstone
  • Rachel Self, PhD, MS
    Senior Medical Science Liaison, 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.

Becky Stoll, LCSW, is Vice President of Crisis & Disaster Management for Centerstone. A Licensed Clinical Social Worker with 20 years of behavioral health experience, Ms. Stoll is faculty for the Suicide Prevention Resource Center’s Zero Suicides in Health and Behavioral Healthcare initiative, she is the Crisis Service Division Board Chair for the American Association for Suicidology, and she serves on the Steering Committee for the National Suicide Prevention Lifeline.

Rachel Self, PhD, MS, is a Senior Medical Science Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

In her 2018 interview on mental health around 9/11, Dr. Kelly Stein-Marcus’ closing comments were on the effect of media and mental health. Today, PsychU returns to talk with Dr. Stein-Marcus to further explore the relationship between media and mental health during and after a disaster. She discusses what has been learned from events between 9/11 and COVID-19 including SARS, ebola and the Boston Marathon bombing. Dr. Stein-Marcus then identifies both concern and hope regarding the influence of media on mental health during the COVID-19 pandemic.

Featuring:

  • Kelly Stein-Marcus, PhD
    Regional Director– East, Field Medical Affairs, Otsuka Pharmaceutical Development & Commercialization, Inc.
  • Phillip Lai, PharmD, BCPP
    Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Check out the rest of the After A Natural Disaster or Tragedy series below:

 

Dr. Kelly Stein-Marcus, PhD, is a licensed psychologist and Regional Director for Otsuka Pharmaceutical Development & Commercialization, Inc. (OPDC) Field Medical Affairs.

Dr. Phillip Lai, PharmD, BCPP, is a psychiatric pharmacist and Medical Science Liaison for OPDC Field Medical Affairs.

 

Kelly Stein-Marcus, PhD, and Phillip Lai, PharmD, BCPP, are paid employees of Otsuka Pharmaceutical Development & Commercialization, Inc. 

The integration of behavioral health care into primary care is one approach to bridging the care continuum and increasing access to mental health treatment. In this webinar, speakers John Kern, MD, and Sloan Manning, MD, review the origins of behavioral health care integration, identify the role of payers, and identify the successes—and challenges—of current integration efforts. Moderated by Roland Larkin, PhD, NP, this webinar closes with an examination of technology’s role in behavioral and primary health care integration going forward.

Featuring: 

  • John Kern, MD
    Clinical Professor, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
  • Sloan Manning, MD
    Primary Care Providers Section Advisor, PsychU
    Medical Director, Novant Health Urgent Care & Occupational Medicine
  • Roland Larkin, PhD, NP
    Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

 

John Kern, MD, serves as a clinical professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine, as well as the University of Washington’s AIMS Center, the acknowledged world leader in the integration of behavioral health care services into primary care.

Sloan Manning, MD, is the PsychU Primary Care Providers Section Advisor. Dr. Manning is the Medical Director of Novant Health Urgent Care & Occupational Medicine.

Roland Larkin, PhD, NP, is a Medical Science Liaison with Otsuka Pharmaceutical Development & Commercialization, Inc.

 

 

John Kern, MD and Sloan Manning, MD are paid consultants of Otsuka Pharmaceutical Development & Commercialization, Inc.


Roland Larkin, PhD, NP, is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

Adaptive immune responses and/or effective vaccines are required to safeguard mankind from many viruses that rely on a human host for survival and propagation as a species, without which we would be vulnerable to serious illness or death. In part 3 of the Viruses, Vaccines & Inflammation: Neurological Perspectives Series, a synopsis of the vaccine-development process and some of the challenges presented therein will be provided, as well as a discussion of the promise and potential pitfalls for vaccines targeting the novel coronavirus. Neurologist, Dr. Gary Pattee, shares scientific dialogue and perspectives on these topics with psychiatric pharmacist, Dr. Jacquelyn Canning and behavioral neuroscientist, Dr. Rachel Self.

Featuring:

  • Gary L. Pattee, MD
    Clinical Neurologist, Neurology Associates, P.C.
  • Jacquelyn Canning, PharmD, BCPP
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.
  • Rachel Self, PhD, MS
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Gary L. Pattee, MD, is a clinical neurologist for Neurology Associates, P.C. Dr. Pattee is also Assistant Professor and Clinical Instructor for the Department of Neurology and Co-Medical Director for the Muscular Dystrophy Association Clinic within the University of Nebraska Medical Center (UNMC). He also serves as a Clinical Instructor in Neurology for the Lincoln Family Practice Residency Program. Dr. Pattee has extensive experience conducting preclinical and clinical trials research, as well as hundreds of scientific publications, abstracts, and oral presentations.

Jacquelyn Canning, PharmD, BCPP, is a Senior Medical Science Liaison with Otsuka Pharmaceutical Development & Commercialization, Inc.

Rachel Self, PhD, MS, is a Senior Medical Science Liaison with Otsuka Pharmaceutical Development & Commercialization, Inc.

 

 

Gary L. Pattee, MD is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc.


Jacquelyn Canning, PharmD, BCPP and Rachel Self, PhD, MS are paid employees of Otsuka Pharmaceutical Development & Commercialization, Inc.

In this interview, Paul Gionfriddo, PsychU Stigma Section Advisor, discusses the future of health care beyond the COVID-19 pandemic with Jason Carter, PharmD, Medical Science Liaison, of Otsuka Medical Affairs. Listen in to hear Gionfriddo’s perspective on the opportunities and challenges that lie ahead.

Paul Gionfriddo, is the PsychU Stigma Section Advisor, as well as the President and Chief Executive Officer of Mental Health America in Alexandria, Virginia.

Jason Carter, PharmD, is a Medical Science Liaison for Otsuka Pharmaceutical Development and Commercialization, Inc.

Dr. Charles Raison is PsychU’s Major Depressive Disorder Section Advisor; Professor, Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, WI; Professor, Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Founding Director, Center for Compassion Studies, University of Arizona, Tucson, AZ; Clinician, University Physicians Healthcare, Tucson AZ; and Clinician, University of Wisconsin Healthcare.

How has your practice changed over the past 6 months, as it relates to the COVID pandemic?

I’m primarily a researcher, although I see patients in the hospital with residents at the University of Wisconsin–Madison. For most of the last six months, I have done this via video.  It was, despite some awkwardness, very interesting. I saw telehealth’s potential.

But once COVID rates fell, we returned for the most part to in-person visits.

As for my work as a researcher at Usona Institute, it was upended for a few months. We do studies where each subject is accompanied by two clinicians for six to eight hours; three people in one room is not ideal in terms of COVID risk. So that work was disrupted for a time until we figured out how to do it safely enough to resume.

How do you think you will be seeing your patients in the future? (i.e., in person, virtual, combination)

On medical hospital units, my practice will probably return to what is was, with all in-person visits.

So many people who are stellar psychiatric clinicians tell me that their experience with televisits has been interesting, with some using it exclusively during this time and others using a combination of televisits with in-person visits. They tell me that some patients prefer video—it seems to help. For some people, having a little bit of distance from the clinician is more comfortable. And being in their own home—there’s comfort there, too.

There are a lot of pragmatic reasons as well that people prefer seeing their psychiatrist via video. They have limited time, and some have limited means. Instead of driving 45 minutes to the appointment and paying to park, perhaps missing work, their 15-minute medicine check takes about 15 minutes, as long as they have a workable internet.

Where telehealth falters is where there are more than two people in the session, such as with video group therapy. We’ve all experienced being in a Zoom meeting where people constantly interrupt one another. As humans we have so many subtle signals that cue us as to who is going to speak next. We don’t have those cues with video.

What do you think will be the main driver for the future of health care?

Insurance and reimbursement, of course, but beyond that, access and affordability.

We have so many challenges right now in the U.S. We don’t know how exactly COVID will reshape the future of health care, but it’s important to keep in mind that not all of the changes will be bad by any means.

We have had a century now where infectious diseases in the first world have been held at bay. Just some 150 years ago, half of those born were dead by their teens due to infection. We have built our entire modern world on the presumption that we can all hang out with one another without risking death from infection. What COVID has taught us is that our vista hasn’t been wide enough; we have left out our relationship with the microbial world.

There is a massive change in how we deal with this world.

One gift COVID has bequeathed us is the rapid deployment of resources and new technologies. Just like wars ramp up technological innovation, our war against the coronavirus has fueled innovation and will produce amazing medical developments, such as engineered nanobodies.

As investigators look at immune system response to COVID, some of their innovations may shape the future of cancer treatment—and the future of treatment for mental illness. As we learn more about the immune system, we see more and more its connection to mental health.

What is your biggest concern for the future of health care?

That we won’t get as lucky the next time a pandemic hits. Consider smallpox, where one-third of the afflicted died. What if one-third of those with COVID died? We’d be looking at millions dead.

COVID presents an interesting paradox where mental health is concerned. It is just deadly enough to be terrifying but not so deadly that it is almost a guaranteed death certificate. We have an innate drive to avoid infectious danger, but we also have an innate drive to be with others and socialize. This tension between opposite drives has negative mental health effects.

If COVID had a mortality rate of 10%–15%, no one would leave their home. The economy would collapse.

So COVID is our wake-up call after a century of mostly controlling the microbial world.

How has PsychU helped during this time of uncertainty?

I am just very impressed how PsychU has been operating. As the Major Depressive Disorder Section Advisor, I have found it an intellectual feast. PsychU has sparked my thinking.

How can we continue to improve mental health care… together?

On the immediate level, there is a huge need for increased access to health. We need better ideas, better treatments. I have been thinking about it this way: We have two strategies against bacterial illness. We can prevent it, or we can treat it with antibiotics once it appears.

Vaccines work by putting light stress on the immune system. It is akin to lifting weights—combatting the stressor makes the immune system stronger, just like lifting a weight makes the muscles stronger.

We need to find treatments in mental health that are like vaccines and prevent disease—treatments that stimulate the brain/body continuum to get stronger, that stimulate resistance to depression. On the horizon there are some interesting short-term interventions that provide long-term benefits.

 

On July 16, 2020, a federal appeals court upheld the administration’s plan to implement site-neutral payments for Medicare outpatient services. The ruling was in American Hospital Association, et al., v. Alex M. Azar, II. Based on this appeal ruling, the Centers for Medicare & Medicaid Services (CMS) will be permitted to reduce reimbursement for outpatient physician services provided by an off-campus provider-based hospital department (PBD) to the same rate paid to independent community-based physicians.

On July 17, 2020, the American Hospital Association (AHA) said it was reviewing the decision to determine its next steps. AHA believes that if CMS implements the site-neutral payments, it will reduce beneficiary access to care. In its response to the ruling, AHA said the CMS policy “fails to account for the fundamental differences between hospital outpatient departments and other sites of care. Hospitals are open 24/7, held to higher regulatory standards and are often the only point of access for patients with the most severe chronic conditions, all of whom receive treatment regardless of ability to pay.”

The American Hospital Association (AHA), the Association of American Medical Colleges (AAMC), and several member hospitals filed the complaint on December 4, 2018 to challenge the site-neutral provision. For regulatory purposes, PBDs are considered hospitals. As a result, under the previous Medicare Outpatient Prospective Payment System (OPPS), PBDs received reimbursement rates up to twice as high as the rates paid to a community-based physician performing the same services. The plaintiffs alleged that the site-neutral policy violates Congressional intent to protect hospital outpatient departments. They also alleged that the rule was based on faulty analysis, and that the cuts would adversely affect consumers in rural and vulnerable communities.

The appeals court ruling overturned a district court ruling that found CMS overstepped its legal authority in finalizing the site-neutral payment provisions in the OPPS final rule for 2019. The appeals court concluded that the question was whether CMS can reduce the OPPS reimbursement for a specific service and implement that cut in a non-budget-neutral manner as a method for controlling unnecessary volume increases for the service. The appeals court opinion states, “In our view, Congress did not ‘unambiguously forbid’ the agency from doing so.”

A link to the full text of “Decision: United States Court of Appeals: No. 19-5352 – American Hospital Association, et al., v. Alex M. Azar, II” may be found at www.openminds.com/market-intelligence/resources/071620ahavazardecision.htm.

A link to the full text of “Final Rule, Medicare Program: Changes To Hospital Outpatient Prospective Payment And Ambulatory Surgical Center Payment Systems And Quality Reporting Programs” may be found at www.openminds.com/market-intelligence/resources/112118frmcarehospoppschanges.htm.

For more information, contact:

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

In this interview, Kathy Day, MPA, BA, AA, PsychU Patient and Caregiver Section Advisor, discusses the future of health care beyond the COVID-19 pandemic with Elizabeth DiNapoli, PhD, Medical Science Liaison, of Otsuka Medical Affairs. Listen in to hear Day’s perspective on the opportunities and challenges that lie ahead.

Kathy Day, MPA, BA, AA, is the PsychU Patient and Caregiver Section Advisor, as well as a caregiver and mental health advocate in Sacramento, California.

Elizabeth DiNapoli, PhD, is a Medical Science Liaison for Otsuka Pharmaceutical Development and Commercialization, Inc.

In response to the COVID-19 pandemic, SuperCare Health and Optum collaborated to create a COVID-19 Telemonitoring Program that allows symptomatic individuals to be monitored and to recover in their homes, avoiding unnecessary hospitalizations. According to Curtis Sather, M.D., medical director and pulmonologist at Optum, SuperCare Health was contacted in the early stages of developing the COVID-19 monitoring program, knowing close respiratory monitoring would be vital in setting up alternative care for people who were confirmed for, or potentially had, COVID-19 but didn’t require hospitalization.

Paula Dahl, executive vice president of strategy and business development, emphasized that SuperCare Health is a respiratory disease management company that has specialized in and has developed a variety of programs for people with respiratory conditions for years, so it was a natural progression to adapt these proven clinical models to assist individuals with COVID-19 in this time of crisis. Ms. Dahl credits part of SuperCare Health’s ability to deploy a solution for individuals with COVID-19 to the fact that SuperCare already had the framework established within their iBreathe COPD readmission prevention program™. The clinical pathway included the ability to spot check SpO2 blood oxygen saturation, capture daily health monitoring question responses based on the Borg dyspnea score, and other activities of daily living to the SuperCare Health Clinical electronically. This daily tracking allows SuperCare Health teams to intervene in the individuals’ care promptly and appropriately, work with the Optum teams on escalations and ongoing communication aimed at helping this high-risk individual population get the care they need.

SuperCare Health is a comprehensive high-touch, high-tech, post-acute health care organization that manages chronic care individuals and provides a broad range of therapies including ventilation, oxygen, CPAP/BiPAP, medication optimization, and airway clearance and mobilization. Utilizing mobile technologies combined with clinical services, SuperCare Health has proven cost savings that reduce hospital readmissions and offer shared savings for payers.

Optum, part of the UnitedHealth Group family of businesses, is a health services and innovation company powering modern health care by connecting and serving the whole health system across 150 countries. Optum serves more than 100,000 physicians, practices, and other health care facilities, as well as 127 million individual consumers.

For more information, contact:

  • SuperCare Health, 8345 Firestone Blvd, Suite 210, Downey, California 90241; 888-260-2550; Website: https://supercarehealth.com
  • Optum, Corporate Headquarters, 11000 Optum Circle, Eden Prairie, Minnesota 55344; Website: www.optum.com

On May 18, 2020, Blue Cross and Blue Shield of Minnesota (Blue Cross) announced it was sending its Medicare Advantage members preventive screening kits designed for use at home. These kits are for diabetes A1C and microalbumin tests for in-home chronic disease management, as well as colorectal cancer screening kits.

The goal is to expand access to in-home wellness and preventive services during the coronavirus disease 2019 (COVID-19) public health emergency. To further reduce barriers to care, Blue Cross is waiving member cost-sharing for in-network primary care, mental health, and addiction treatment office visits for the duration of the public health emergency in 2020.

Blue Cross began making member outreach calls in June to tell its Medicare Advantage members about the expanded benefits and to ask about the members’ additional care needs. Organization President and Chief Executive Officer Craig Samitt, M.D., said Blue Cross is working closely with its provider organization network and with community agencies to “support members, keep them safe, and expand needed access to alternative care delivery methods.” Blue Cross previously announced the following coverage changes to support members during the COVID-19 pandemic emergency:

  • Waiving all member costs related to in-network COVID-19 treatment and care, including hospitalization;
  • Increasing access to prescription medications by waiving early medication refill limits on 30-day prescription maintenance medications and/or encouraging members to use 90-day mail order benefit;
  • Encouraging the use of virtual care to help members maintain social distancing standards and minimize risk of exposure;
  • Waiving costs for Doctor On Demand for members whose benefits include coverage of Doctor On Demand services (an independent company providing telehealth services);
  • Increasing the types of technology that provider organizations can use remotely, including FaceTime and Skype; and
  • Expanding the types of services that can be provided via telehealth channels, including behavioral health; physical, occupational and speech therapies; and medication management.

Blue Cross and Blue Shield of Minnesota has 2.3 million covered lives. It is a non-profit independent licensee of the Blue Cross and Blue Shield Association.

For more information, contact:

  • Jim McManus, Director of Public Relations, Blue Cross and Blue Shield of Minnesota, Inc., 3535 Blue Cross Road, Eagan, Minnesota 55122-1154; 651-662-2882; Email: jim.mcmanus@bluecrossmn.com; Website: https://www.bluecrossmn.com/coronavirus.

On July 31, 2020, Michigan Governor Gretchen Whitmer vetoed Senate Bill (SB) 956, which would have created a new facility type to house people recovering from coronavirus disease 2019 (COVID-19) and prohibit housing them in nursing homes. In her veto notice, she said that the premise behind the legislation was unsupported and that the legislation also failed to address how such facilities would operate. Going forward, people recovering after hospitalization with COVID-19 will continue to be housed in isolation units created within existing facilities.

The veto notice said that SB 956 would not protect nursing home residents. The bill would have forced hospitals and nursing homes to send people who test positive for COVID-19 to the COVID-19-only facilities without any requirement for consent, physician approval, or notification to the individuals or their families. After proposing COVID-19-only facilities, SB 956 failed to explain how such facilities staffed or paid for, or how frail nursing home residents with COVID-19 would be protected “during the potentially traumatic transfer from one facility to another.” The Michigan Senior Advocates Council had asked the governor to veto the legislation.

Initially, Governor Whitmer ordered nursing homes at less than 80% of capacity to create dedicated units for COVID-19-affected residents. The facilities were required to accept new placements, as long as the facility had appropriate personal protection equipment (PPE) for staff. In late May, the order was revised to require nursing homes to make “all reasonable efforts” to create units dedicated to residents with COVID-19; provide appropriate PPE to staff working in those units; and not accept new residents with COVID-19 unless the nursing home had dedicated isolation units.

For more information, contact:

  • Office of Michigan Governor Gretchen Whitmer, Post Office Box 30013, Lansing, Michigan 48909; 517-373-3400; Website: https://www.michigan.gov/whitmer/0,9309,7-387-90498_90663—, 00.html

About 72% of adults in the United States changed their use of traditional in-person health care services, according to a survey conducted in May 2020. The changes were due to consumer concerns about receiving health care services during the coronavirus disease 2019 (COVID-19) pandemic health emergency in 2020. About 41% said they delayed use of health care services, and 38% said they intended to delay future care, treatment, and procedures for at least six months. About 27% said they planned to delay diagnostic procedures or tests in a hospital setting. Only 31% said they felt comfortable visiting their physician’s office. About 28% received some sort of virtual care, such as a telehealth visit; the majority (89%) said they were satisfied with the experience.

Despite concerns about receiving in-person health care services, many of the respondents said they were comfortable visiting a pharmacy to pick up prescriptions or to be tested for COVID-19. About 49% said they were “very comfortable” picking up prescriptions at their local pharmacy and speaking with their pharmacists about their medications. About 39% said they felt comfortable being tested for COVID-19 at a pharmacy. About 9% said they used a local pharmacy’s home delivery service, and 24% said they used a mail-order pharmacy.

Consumers attitudes towards use of standard health care services indicated that a majority felt uncomfortable accessing health care in a variety of settings. About 42% felt uncomfortable going to a hospital for any medical treatment, and 45% felt uncomfortable using an urgent care or walk-in clinic. About 37% of consumers reported that they or someone in their household had chronic health conditions. Within this group, about 60% delayed receiving in-person care.

A majority (64%) said they wanted to be tested for COVID-19, but about 36% were concerned about their ability to access testing and treatment. Of those who want to be tested, 69% said they felt comfortable being tested at their physician’s office, and 18% said they felt comfortable being tested at their workplace.

These findings were reported in “COVID-19 Shifts Consumer Health Care Behavior.” For the report, the Alliance of Community Health Plans (ACHP) and AMCP partnered with Leede Research to survey 1,263 adults aged 18 to 74, online by invitation only, from May 1 to May 6, 2020 to examine changes in health care utilization.

ACHP represents non-profit health plans to improve affordability and outcomes in the health care system. Its member companies are provider-aligned health organizations that provide high-quality coverage and care.

AMCP is a professional organization for managed care pharmacists. Its membership includes pharmacists, physicians, nurses, biopharmaceutical professionals, and other stakeholders. The association’s work focuses on optimizing medication benefit design and population health management to help consumers access cost-effective and safe medications and other drug therapies.

The topline results from “COVID-19 Shifts Consumer Health Care Behavior” were published May 21, 2020, by the Alliance of Community Health Plans. A copy is available online at https://achp.org/release-covid-19-shifts-consumer-behavior-attitudes-toward-healthcare-services/.

For more information, contact:

  • Leah Hunter, Media Contact, Alliance of Community Health Plans, 1825 Eye Street Northwest, Suite 401, Washington, District of Columbia 20006; 202-577-5435; Fax: 202-785-4060; Email: info@achp.org; Website: https://achp.org/
  • Abigail Fredenburg, AMCP, 675 North Washington Street, Suite 220, Alexandria, Virginia 22314; 703-684-2600; Website: https://www.amcp.org/

The American Academy of Family Physicians (AAFP) and National Alliance of Healthcare Purchaser Coalitions (National Alliance) are developing a national primary care model based on a prospective payment system. They are working with regional employer coalitions and physician networks. At this stage of development, the two organizations are focused on developing a roadmap—a common framework—that will set the standard for how purchasers and physicians can work together to deliver meaningful and measurable improvements in how care is paid for and delivered. The AAFP and National Alliance believe this collaboration is the first of its kind between a primary care organization and the employer coalition community.

Michael Thompson, President and CEO of the National Alliance said regional AAFP chapters and regional employer/purchaser coalitions have started discussions. He emphasized the need to move toward the seven principles defined as advanced primary care and noted that the AAFP has been supportive of this direction. Thompson also said the advanced primary care model exists in many parts of the country and the National Alliance has found that when properly structured and reimbursed, the advanced primary care model can help reduce health care costs and improve consumer health.

The advanced primary care model features the following attributes:

  1. Enhanced access through same-day appointments, walk-in hours, virtual access, and removing financial barriers to primary care;
  2. More time with consumers to improve engagement and support, shared decision making, and understanding of the impacts of various social determinants of health;
  3. Realigned payment methods to reward focus on consumer-centered experience and outcomes, quality and efficiency metrics, and de-emphasize visit volume as the basis of payment;
  4. Use of data to support analysis, reporting and communications, and ensure continuous staff training;
  5. Integrated behavioral health screening and coordination of care;
  6. Use of analytics to focus on health improvement through risk stratification and population health management to ensure a systematic approach to reducing gaps in care; and
  7. Referral management to establish more limited, appropriate and high-quality referral practices, coordination, and reintegration of consumer care.

The National Alliance recognizes that there may be a need to have a transitional plan for some groups and some parts of the country. It will support the promotion of advanced primary care practices with regional coalitions and will work with AAFP to educate and transition more practices to an advanced primary care model. A number of employers already use advanced primary care models, and National Alliance is working to educate more employers about the model.

The AAFP is a medical society for primary care professionals. It represents 136,700 physicians and medical students nationwide. The National Alliance is a non-profit network of business coalitions, representing private and public sector, nonprofit, and Taft-Hartley organizations and 45 million Americans, spending more than $300 billion annually on health care.

For more information, contact:

  • Karlene Lucas, Director, Development and Program Management, National Alliance of Healthcare Purchaser Coalitions, 1015 18th Street, NW, Suite 730, Washington, District of Columbia 20036, , 202-775-9300; Email: klucas@nationalalliancehealth.org; Website: https://www.nationalalliancehealth.org/
  • Janelle Davis, Public Relations Strategist, American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, Kansas 66211-2680; 913-906-6000; Fax: 913-906-6075; Email: jdavis@aafp.org; Website: https://www.aafp.org/

The pandemic has increased the demand for all things delivered at home. Meals, liquor, mattresses, and more—are all now at people’s literal doorsteps. This is true in the health and human service field too. Telehealth has brought “visits” home. Humana and Blues are sending screening kits to their Medicare members’ homes. There are new services for in-home primary care and in-home hospital services.

Part of this is by mandate—non-emergency health care services have been halted in many states. But it is also a reminder that consumer confidence is just not there—consumers are afraid to get services in places where they will be in contact with the general public and exposed to the virus. This is especially true for consumer perceptions of nursing homes and other congregate care settings. The death rates in nursing homes have exceeded almost every other congregate setting and consumers are looking for alternatives.

A couple states have already responded. Rhode Island announced that it is changing the long-term care system to create more home-based care options. The state plans to invest $25 million for nursing facility supports to expand home-base care options. California is expanding a Medicaid program that allows low-income elderly and disabled people eligible for care in a nursing facility to stay in their own homes instead. By 2021, the Department of Health Care Services (DHCS) plans to expand the Home and Community-Based Alternatives (HCBA) waiver program from just under 4,000 slots to almost 9,000 slots. Currently, 4,688 people are enrolled in the HCBA program, and 836 are on a waiting list. The program covers skilled nursing care, home health aides, personal care services, and case management. DHCS is contracting with nine regional community-based organizations to provide the services.

And importantly for planning, these pandemic-induced moves to provide home-based alternatives to nursing homes are completely consistent with policy changes by many state Medicaid plans to move their long-term services and supports programs (LTSS) to some type of managed care system. Our recent national analyses of Medicaid managed long-term services and supports (MLTSS) programs found 2.8 million consumers are currently covered in those programs, more than doubling (178% increase) since 2010. There are now almost half of state Medicaid plans (24 states) operating some type of MLTSS programs. Four states—Massachusetts, North Carolina, New York, and Texas—are considering expanding MLTSS services to new populations or establishing a more comprehensive model. Three states—Nebraska, Nevada, and Oklahoma—are in the process of adopting a new MLTSS program. Currently, most states select health plans to deliver LTSS services through a competitive bid process.

The strategy question for specialty provider organizations is whether the opportunity posed by this shift in policy and consumer preference presents an opportunity for new service lines and for new relationships with health plans. The U.S. population—including the population with disabilities—is aging and the demand for these support services in on the increase. And right now, about 55% of Medicaid LTSS spending is on institutional long-term care, which includes nursing homes and intermediate care facilities for people with developmental disabilities. Moving even a small amount of nursing home spending to home-based services presents a significant new market opportunity.

It may seem like an oxymoron—spending on marketing at a time when referrals, service volume, profitability, and cash flow are all low. But marketing spend may be the key to navigating the crisis and preparing for recovery.

To determine if marketing spending—and likely virtual marketing spending—should be part of your plans right now requires answering one important question. Do you have service lines where more consumer service volume would generate more margin for your organization? If the answer to this is yes, then a well-planned marketing spend is part of the sustainability solution for your organization. The important issue is treating your marketing spend as an investment—not an expense. You would be right to insist that your marketing plan and all of its associated costs should have a positive net (after all expenses) margin.

Right now, there is more competition for consumers—and variable demand for consumer services. Primary care practices, whose consumer visits dropped to 30% of normal in March and April, have still not seen full recovery, and are at about 80% of normal volume at best. On the other hand, organizations providing home-based health care have seen a spike in demand by more than 30% during the pandemic and expect significant revenue increases this year. And we are seeing more consumers covered by commercial insurance go out of network and incur out-of-pocket costs for behavioral health services, while many insurers have expanded access to behavioral health through telehealth.

At the same time, more marketing dollars are being spent to attract consumers with changing needs and preferences. Hospitals and health systems that collectively spent $542 million on direct-to-consumer advertising in 1997 spent $2.89 billion by 2016. And in 2019, it was estimated that digital advertising for pharmaceuticals and health services would hit $10 billion in 2020. Health care advertising is increasing not only because of increased spend by marketers, but also because of greater interest from consumers. Consumers engage with health content for longer periods of time than with content from other industries. Three out of four consumers are most likely to engage with health advertising when it offers additional information and two out of three would respond to “relevant informative content.”

But marketing has changed. Virtual marketing, which includes leveraging social media, is playing a bigger role. Nine out of 10 consumers buy products and services from companies they follow on social media. Today, 75% of people spend with a brand they follow on social media (an increase of 12% over 2019). Younger consumers are increasingly drawn to social media platforms with video. Generation Z consumers report planning to use Instagram and YouTube more. And 69% of virtual marketers said that boosting brand awareness was their top goal on social media.

For health care organizations with limited budgets, now is a good time to be buying digital advertising (keywords on Google search, social media advertising, etc.). With the pandemic, the big spenders—travel, restaurants, and entertainment venues—have all cut advertising to the bone, driving down the volume, and rates, on digital advertising. Google might actually see a decline in ad revenues for the first time. Facebook and Amazon will continue to grow, but at lower rates than expected.

So, how to put together a virtual marketing plan and determine whether it will deliver the return on investment you need right now? That was the focus of the OPEN MINDS webinar, Is Your Website Designed To Get Referrals, by Tim Snyder, Executive Vice President, OPEN MINDS and Emily Korns, Senior Associate, OPEN MINDS. They offered four key elements for executives to keep in mind while developing a virtual marketing strategy and tactics.

Align to organizational objectives. Your virtual marketing goals must be closely aligned with your overall organizational objectives. If your organizational objective is to grow your consumer base, your marketing strategy should help you identify where those consumers are, what they want, and how you appeal to them. If your organizational objective is to acquire new health plan contracts, your marketing strategy must be shaped around demonstrating outcomes and showcasing your distinctive capabilities. If your objective is to attract and retain new staff, your marketing strategy should highlight why your organization is a great place to work.

Marketing objectives developed in isolation—such as growing the number of website visitors, or getting more Facebook likes—won’t do you any good. It’s imperative that marketing be geared toward the results you need for business recovery and sustainability. In short, you can’t justify the means without the ends.

Know your audience, map the journey. Once you set clear marketing objectives tied into overall organizational strategy, define the target audiences for each objective. Consumers, family members, referral sources, community organizations you can partner with, and payers—each will require a different approach and a different message.

Work to understand every one of these audiences and the typical journey they would take to find the kind of information you offer online. Think about the information they might seek, where they would look for it, and what would help them connect to you as opposed to your competitors.

Provide meaningful content. Effective marketing has always been about breaking through the noise to get people’s attention and you’re competing not only with others who provide the same services that you do but also with all the other distractions and essentials that beckon your consumers when they are online. So, a virtual marketing strategy can succeed only if your content is built on a foundation of clarity, simplicity, and transparency. Content needs to showcase thought leadership, educate, inform, and provide the basics. Tell your audience how your quality of services, and costs, compare to competitors. Let them know what consumers and caregivers are saying about you. Let them know what you are doing to ensure their safety and comfort. Provider organizations have to think like retailers selling online.

And Mr. Snyder warned that all this information will probably exist online in some format—accurate or not—whether or not you control and manage it. So, the best way to suppress any myths and misinformation is to provide accurate information and to make sure these feeds prominently on to the radar of your audiences.

In a ThinkGoogle survey, 82% of consumers said they believed that “the majority of health care providers have the same capabilities and offer similar quality services.” But 91% of those who said that also indicated that on a scale of 1 to 5, they would put forth a level 4 or 5 effort to find a health care provider organization they perceived to be better than the majority. The implication—your online content has to reveal what sets you apart.

Focus on action. In virtual marketing, the focus always has to be on what is called “conversion” or helping your audience take the next step in the journey. So, your audience reads (or watches) your great content but what next? You have to get them before you lose them. Give your online visitors a seamless way to connect more deeply with you—to take a virtual tour, talk to an expert, or best of all—schedule an appointment online. If you have great information to give away (whether that’s a fact sheet, tips for wellness, or questions to ask your clinical professional on your first visit), make sure to collect information about those who download that information. “Don’t give away good content without asking why they are interested in it. Then follow up with information that’s more specific to their needs,” advised Ms. Korns.

How about some social media Jeopardy? It was the first social media network site born in 1997 (hint: It wasn’t Facebook). What is SixDegrees.com? One million users set up profile pages, created lists of connections, and sent messages within networks. The site was shut down after three years but made a comeback and is still around today!

More than two decades later, despite a proliferation of channels that are impossible to keep track of, social media continues to be about connecting. But while many still labor under the myth that connecting is for friends and families—or for celebrities, or for the younger generations—social media has become an essential tool for business—in health care as much as in retail or entertainment.

In a 2017 study, 41% of consumers reported using social media to decide on a health care provider organization. We also know that 90% of consumers in the 18 to 24 year age group use and trust health care information on social media. Surprisingly, it’s not just the young people. Almost 90% of baby boomers and older adults (in their sixties)—a subset of the population at high risk for chronic disease, social isolation, and poor health outcomes—say they use Facebook and Twitter to locate and evaluate health information. And 60% of social media users trust social media posts by clinical professionals over any other group.

The bottom line is that if you, as a health care provider organization, don’t “hang out” where your consumers hang out, then they won’t come to you. It’s all about connecting. You want to use social media to form emotional connections with your potential consumers and stakeholders, to build trust, to establish your expertise, to inform and engage, and ultimately bring them in through your doors (virtual or physical). And the fact that more than 99% of hospitals now have (at least) a Facebook page, implies that your competitors—whether in your community or in cyberspace—are on social media talking to your consumers. Further, the increasing use of virtual services is driving the need for a strong social media presence as the “conversion” from browsing to accessing services can be seamless and instant.

Managing social media has two components. The first is monitoring and responding to the online conversations about your organization and the second is developing a push strategy for messaging. That was the focus of a recent OPEN MINDS Executive Web Forum, Social Media That Puts You In The Community – Virtually, led by OPEN MINDS Executive Vice President, Rob Hickernell. Mr. Hickernell offered best practices for both components.

With regard to monitoring and responding to online conversations, there are a number of external ratings, rankings, and review channels (payer sites, and public platforms like Healthgrades, RateMDs, Yelp, Google, Angie’s List, Nextdoor, and more), as well as reviews that people can post to your social media channels. Monitor the external and owned channels and keep track of what people are saying about you. A great “shortcut” suggested by Mr. Hickernell, is to set up “Google Alerts” for key terms, names, and services so you are notified when you are being mentioned and can respond strategically.

When consumers praise your organization, encourage them to post those comments online. When they give negative reviews, reach out to the unhappy consumer directly, or adjust your internal processes to address the complaint. Ignoring challenging comments, reviews, and ratings only heightens the negative impact they have on your online brand and reacting aggressively makes things worse. As Mr. Hickernell summarized, “You have to make sure that you keep an eye on what people are saying about you and fix any problems that are out there. Get back to people in real time and take the time to comment on both positive and negative comments. It will show that you care about your social media presence and that you care about taking care of any issues that are out there.”

As for the second component, the basics of any other marketing initiative apply to your social media push strategy. Here are five top-of-mind considerations.

Be strategic

Assess the landscape, know your audience, define your goals, form a plan, implement the plan, and measure and monitor.

Your social media goals could be defined in terms of sales, relationships, or engagement with information to a target audience. Ensure that your key performance indicators are not just “vanity metrics” (the number of followers on Facebook, the number of views on YouTube, the number of likes on a LinkedIn post, etc.) but that they encompass engagement (comments, shares, etc.) and especially conversion—seeking appointments, connecting with your experts, and making recommendations.

On a practical level, have and follow a daily schedule of posts across channels, monitor the engagement, and assign someone to respond to all questions and comments in real time.

Be relevant (not trite)

Provide information that matters and that is fresh and compelling. How do you know what matters? Mr. Hickernell emphasized that mountains of consumer data are now available to be anonymized and analyzed to identify trends and patterns that health care provider organizations can capitalize on for marketing.

Have your team take a look at what other specialty health care entities are doing on social media, see what your competition is up to, and mine the vast amounts of demographic data out there (the age of social media is also the age of data) to zero in on your target audience. What age group, gender, or economic class of consumers and family members do you want to reach? Which social media networks are they most likely to be on? What are they looking for? Who are they most likely to respond to? In short, do your homework!

Knowing your audience will help you determine the details of what you want to post, on which channels, how often, and when. And this will help you determine who should be the spokespersons—the executives, the clinical professionals, the frontline staff, consumers, community influencers, or some combination of each key group.

Be consistent with your brand

Your social media presence has to reflect your core brand and position you to showcase your “unique selling proposition.” Consider how you want to distinguish yourself from the competition.

Social media messaging needs to be reviewed and curated like any marketing messaging. The image you want to portray and the key messages you want to reiterate should drive the tone and substance of every post. You can’t be self-serving or “salesy” on social media. Your content must inform, educate, and build trust. Mr. Hickernell suggested the social media “rule of thirds.” A third of your posts could be personal stories to build your brand; a third of posts could promote your business, convert readers, and generate profits; and a third could be ideas from influencers and thought leaders in the industry and your community. The views of your clinical professionals and experts are especially valuable to your target audience.

The pandemic crisis has notably emphasized the value of social media for sharing authoritative health information and thought leader opinions. Anthony Fauci, M.D., director of The National Institute of Allergy and Infectious Diseases, has taken to YouTube to share facts, especially with the younger generation that does not watch cable news.

Be “social”

Keep your social media tone conversational and friendly, and the information you share engaging and in more visual formats. Mr. Hickernell pointed out that having video can increase conversions by as much as 80%. Live social media videos are also growing, with 50% of marketers planning to leverage them in the upcoming year.

And follow the same rules as you do in personal interactions. Acknowledge and thank those who mention you or like or share your posts. Respond to questions and comments. And share content from others that might be relevant and valuable to your audience.

Ask questions or conduct polls to engage those who see your content. And offer the opportunity for consumer or stakeholder groups you can host to allow exchange of views. More than 40% of millennials say they look for health care recommendations and advice from their peers on social media.

Be data-driven

Have a plan for what you do on social media but be prepared to adjust it as you see results. Be prepared to experiment and test. If a planned type of post is not yielding the desired results, or getting as much traction as expected, make the pivot quickly.

Most of all, said Mr. Hickernell, don’t be overwhelmed by social media and don’t try to take it all on at once. Start simple, experiment and monitor, and scale up gradually. And ask your current consumers to follow you—remind them when they come in for visits, during checkout and billing, and at every possible opportunity.

The new age of all things virtual, that has blossomed in the era of lockdowns and social distancing, is imposing new demands on all businesses, and on health care in particular. Social media marketing is at the top of the list. If you’re not on social, you’re not on the radar of your future consumers and stakeholders—and eventually even your current.

In this presentation, Melissa Mitchell, PharmD, BCPS, BCPP, BCGP, Residency Program Director, Riverside University Health System; Andrew Williams, PharmD, BCPP, BCGP, Residency Program Coordinator, Riverside University Health System; and Aneta Fornal, PharmD, Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc., discuss the pharmacist’s perspective on managing an epidemic. They will share their experiences and their approach to role changes and expansions, outpatient and inpatient best practices, and ways to keep staff calm and motivated.


Featuring:

  • Melissa Mitchell, PharmD, BCPS, BCPP, BCGP
    Mitchell received her bachelor’s degree from the University of Texas at Austin and her PharmD from the University of the Pacific Thomas J. Long School of Pharmacy. She completed her PGY1 at New York Harbor VA Medical Center and her PGY-2 at VA San Diego. Following her residency, she joined the faculty of Long Island University Brooklyn, in New York. She now practices at Riverside University Health System Medical Center as a Senior Clinical Pharmacist, overseeing both the mental health inpatient and outpatient pharmacies, as well as an offsite outpatient pharmacy. She precepts students from a variety of colleges, as well as PGY-1 and PGY-2 residents. Additionally, she is the Residency Program Director for the PGY-2 in psychiatric pharmacy.
  • Andrew Williams, PharmD, BCPP, BCGP
    Williams is a graduate of the University of Southern California School of Pharmacy. He completed his PGY-1 in acute care with psychiatry emphasis at USC and his PGY-2 in psychiatric pharmacy at USC School of Pharmacy. Following the completion of his residencies, he joined the faculty at Loma Linda University School of Pharmacy, where he taught the psychiatry, neurology, and special populations curriculum. He now practices as a Clinical Pharmacist at Riverside University Health System’s inpatient psychiatric hospital. Dr. Williams holds faculty appointments with the University of Southern California, Loma Linda University, the University of the Pacific, and Keck Graduate Institute. He serves as a PGY-1 residency preceptor and PGY-2 residency preceptor and coordinator.
  • Aneta Fornal, PharmD
    Senior Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Melissa Mitchell, PharmD, BCPS, BCPP, BCGP, and Andrew Williams, PharmD, BCPP, BCGP, are paid consultants of Otsuka Pharmaceutical Development & Commercialization, Inc.

Aneta Fornal, PharmD, is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

On August 3, 2020, WellCare, a Centene Corporation subsidiary, announced that it partnered with Shipt to provide free home grocery delivery for about 200,000 Medicare Advantage members in 23 states for the remainder of 2020. The goal is to help address food insecurity and enhance member safety during the coronavirus disease 2019 (COVID-19) pandemic. Shipt is a same-day delivery service.

WellCare is providing low-income and special needs plan members in select WellCare, WellCare TexanPlus, and ‘Ohana Medicare Advantage plans with free, monthly Shipt memberships for the remainder of 2020. With this benefit, members can have groceries and essentials delivered from a number of retailers directly to their homes through their Shipt account, which not only helps them easily obtain needed essentials, but also helps reduce possible exposure to the virus by eliminating their need to go to the grocery store.

During the COVID-19 pandemic, WellCare’s Community Connections Help Line, a toll-free, nationwide line available to anyone in need, has found increased demand for resources among seniors. The Help Line, which fielded more than 4,000 calls from Medicare members between March 1 and June 30, reports food assistance was the number-one most requested service (34%) accounting for more than one-third of all calls from this demographic. Medication assistance was the second most requested service (26%), followed by transportation (14%).

Shipt is available to more than 80% of U.S. households across 5,000 cities. The user-friendly app works with vetted, reliable Shipt Shoppers to ensure efficiency and user satisfaction. During the COVID-19 pandemic, Shipt has increased support staff, added more shoppers to help with high demand, and provides financial assistance and personal protective equipment to its shoppers.

For more information, contact:

  • Michael Polen, Senior Vice President and Chief Executive Officer of Medicare Solutions, Centene Corporate Communications, 7700 Forsyth Boulevard, St. Louis, Missouri 63105; 314-445-0790; Website: https://www.wellcare.com/
  • Rina Hurst, Chief Business Strategy Officer, Shipt, 17 20th Street N, Suite 100, Birmingham, Alabama 35203; 205-502-2500; Website: https://www.shipt.com/

In this interview, C. Brendan Montano, MD, PsychU Primary Care Provider Section Advisor, discusses the future of health care beyond the COVID-19 pandemic with Roland Larkin, PhD, NP, Medical Science Liaison, of Otsuka Medical Affairs. Listen in to hear Montano’s perspective on the opportunities and challenges that lie ahead.

C. Brendan Montano, MD, is the PsychU Primary Care Provider Section Advisor, as well as the Director and Principal Investigator for Connecticut Clinical Research in Cromwell, Connecticut.

Roland Larkin, PhD, NP, is a Medical Science Liaison for Otsuka Pharmaceutical Development and Commercialization, Inc.

In this interview, Terence Ketter, MD, PsychU Bipolar Disorder Section Advisor, discusses the future of health care beyond the COVID-19 pandemic with Dri Wang, PharmD, BCPP, Medical Science Liaison, of Otsuka Medical Affairs. Listen in to hear Ketter’s perspective on the opportunities and challenges that lie ahead.

Terence Ketter, MD, is the PsychU Bipolar Disorder Section Advisor, as well as the Founder and Founding Chief of the Stanford University Bipolar Disorder Clinic in Stanford, California.

Dri Wang, PharmD, BCPP, is a Medical Science Liaison, Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

In this interview, Sara Jones, PhD, APRN, PMHNP-BC, FAANP, PsychU Nurses Corner Section Advisor, discusses the future of health care beyond the COVID-19 pandemic with Kimberly Lonergan, RN, MSN, Senior Medical Science Liaison, of Otsuka Medical Affairs. Listen in to hear Jones’ perspective on the opportunities and challenges that lie ahead.

Sara Jones, PhD, APRN, PMHNP-BC, FAANP, is the PsychU Nurses Corner Section Advisor, as well as Associate Professor, University of Arkansas for Medical Sciences (UAMS) College of Nursing, and the owner of Journey Wellness Clinic, North Little Rock, Arkansas.

Kimberly Lonergan, RN, MSN, is a Senior Medical Science Liaison for Otsuka Pharmaceutical Development and Commercialization, Inc.

In this interview, Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC, PsychU Nurses Corner Section Advisor, discusses the future of health care beyond the COVID-19 pandemic with Kimberly Lonergan, RN, MSN, Senior Medical Science Liaison, of Otsuka Medical Affairs. Listen in to hear Amberg’s perspective on the opportunities and challenges that lie ahead.

Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC, is the PsychU Nurses Corner Section Advisor, as well as a Psychiatric Consult Liaison Psychiatric Nurse Practitioner at Northwestern Memorial Hospital in Chicago.

Kimberly Lonergan, RN, MSN, is a Senior Medical Science Liaison for Otsuka Pharmaceutical Development and Commercialization, Inc.

In this interview, Megan Ehret, PharmD, MS, BCPP, PsychU Pharmacist Corner Section Advisor, discusses the future of health care beyond the COVID-19 pandemic with Patricia Rohman, PharmD, MBA, Senior Managed Market Liaison, of Otsuka Medical Affairs. Listen in to hear Ehret’s perspective on the opportunities and challenges that lie ahead.

Megan Ehret, PharmD, MS, BCPP, is the PsychU Pharmacist Corner Section Advisor, as well as the Associate Professor, Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy in Baltimore, Maryland.

Patricia Rohman, PharmD, MBA, is a Senior Managed Market Liaison for Otsuka Pharmaceutical Development & Commercialization, Inc.

In this interview, Jim Kenney, RPh, PsychU’s Payer Section Advisor, discusses the future of health care beyond the COVID-19 pandemic with Jane Guo, PharmD, MBA, Managed Market Liaison for Otsuka Medical Affairs. Listen in to hear Kenney’s perspective on the opportunities and challenges that lie ahead.

James T. Kenney, RPh, MBA, is the PsychU Payer Section Advisor, as well as the President of the Academy of Managed Care Pharmacy, and Founder and President of JTKENNEY, LLC. Mr. Kenney also serves on the Massachusetts Pharmacists Association Government and Legislative Affairs Committee.

Jane Guo, PharmD, MBA, is a Managed Market Liaison for Otsuka Pharmaceutical Development and Commercialization, Inc.

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 novel coronavirus pandemic has had a substantial impact on mental health, as well as on its treatment. In the second part of a two-part webinar series on psychiatry perspectives in a post-pandemic world, Richard Weisler, MD, and Allan Chrisman, MD, build upon the dialogue of the pandemic’s impact on health care providers and first responders discussed in “Psychiatry Perspectives On COVID-19: Impact On Health Care Providers & First Responders And A Path Forward (Series 1 of 2)” and shift the focus to discuss the ways in which COVID-19 has affected individuals’ mental health and well-being. They also discuss new innovations and technological approaches to psychiatric patient care and identify effective treatment methods. Moderated by Phillip Lai, PharmD, BCPP, this webinar closes with Drs. Chrisman and Weisler charting a path forward out of the more lingering effects of COVID-19.

Featuring:

Allan Chrisman, MD
Associate Professor Emeritus, Duke University School of Medicine

Richard Weisler, MD
Psychiatrist, Richard H. Weisler, MD & Associates; Adjunct Professor of Psychiatry, University of North Carolina at Chapel Hill School of Medicine; Adjunct Associate Professor of Psychiatry & Behavioral Sciences, Duke University Medical Center

Phillip Lai, PharmD, BCPP
Medical Science Liaison, Otsuka Pharmaceutical Development & Commercialization, Inc.

Allan Chrisman, MD, is an Associate Professor Emeritus at Duke University School of Medicine. During his 40 years of practice in general, adult, and child psychiatry, he worked on inpatient, residential, and outpatient settings. He practiced for nearly 14 years at Harvard Community Health Plan (a health maintenance organization [HMO]), where he was a consultant to pediatric and internal medicine practices. Since retiring, he has pursued his interest in disaster mental health as an American Red Cross Disaster Health Services & Disaster Mental Health Volunteer. Dr. Chrisman received his medical degree from the George Washington University School of Medicine.

Richard Weisler, MD, has had a psychiatric practice since 1980 where he and his team follow more than 2,000 patients with a mixture of psychiatric disorders. He is an Adjunct Professor of Psychiatry at the University of North Carolina Chapel Hill School of Medicine, where he has served for many years as Chairman of the Board of Visitors for the Department of Psychiatry. Dr. Weisler also serves as an Adjunct Associate Professor of Psychiatry & Behavioral Sciences at Duke University Medical Center. He received his medical degree from the University of North Carolina at Chapel Hill and is board certified by the American Board of Psychiatry & Neurology.

Phillip Lai, PharmD, BCPP, is a Medical Science Liaison with 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 Wu 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

Navigating the health care system, particularly mental health services, is a daunting task during “normal” times. Facing the fluidity and uncertainty of a global pandemic presents many new unique challenges to accessing and utilizing health care services, but it also affords some promising advancements. Combining this environment with the current societal unrest sparked by cultural/racial disparity within our nation adds another layer of complexity to the situation.

This panel will discuss their roles within the current health care system, and detail the obstacles and opportunities presented by the coronavirus pandemic amidst the fight to end cultural, racial, and other types of disparity in our nation. Panelists will cover the good, the bad, the ugly, as well as the potential for those living with a mental health condition to thrive in our “new normal” health care landscape.


Featuring:

  • Gaurava Agarwal, MD
    • Assistant Professor in the Department of Psychiatry and the Behavioral Sciences
    • Assistant Professor of the Department of Medical Education
    • Director, Physician Well-Being for Northwestern Medical Group
    • Director, Undergraduate Medical Student Education in Psychiatry at Northwestern University Feinberg School of Medicine
  • Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC
    • PsychU Nurses Corner Section Advisor
    • Psychiatric Consult Liaison
    • Psychiatric Nurse Practitioner, Northwestern Memorial Hospital
  • Phyllis Foxworth, BS
    • Vice President of Advocacy, Depression Bipolar Support Alliance (DBSA)
  • Jonathan Singer, PhD, LCSW
    • Associate Professor, Loyola University Chicago
    • President, American Association of Suicidology
  • Rachel Self, MS, PhD
    • Senior Medical Science Liaison, Otsuka Neuroscience Medical Affairs

If you or someone you know is in crisis, call: Suicide Prevention Hotline/Lifeline 1-800-273-TALK(8255) Or text: Crisis Text Line 741-741

Gaurava Agarwal, MD, and Sloan Manning, MD, Alan “Tony” Amberg, MS, MSN, APRN, PMHNP-BC, Phyllis Foxworth, BS, and Jonathan Singer, PhD, LCSW are paid consultants of Otsuka Pharmaceutical Development & Commercialization, Inc.

Rachel Self, MS, PhD, is a paid employee of Otsuka Pharmaceutical Development & Commercialization, Inc.

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 expo