Stakeholders want to increase access and support efforts to address social determinants of health.
The Association for Community Affiliated Plans is calling on the federal government to strengthen support for efforts to address social determinants of health for the nation’s poor and underserved.
The push is part of a new initiative by ACAP and its 74 member nonprofit plans across the nation that provides a framework for stakeholders and policymakers to reduce health disparities and improve health outcomes.
Pathway to Improve Health Equity uses a three-pronged approach to increase equity among plan beneficiaries, who have low incomes, are disproportionately from communities of color, and may live with disabilities.
ACAP CEO Margaret A. Murray says the initiative will rely on robust data collection to support improvement on equity measures, pursuing public policies that improve equity, and listening and learning from the experiences of other plans.
"Increasing health equity requires a shared commitment from policymakers and health plans," Murray says in a media release.
"With an intentional focus on measuring and reporting data, and more support for policies that improve health care coverage, Safety Net Health Plans will continue to lead the way in meaningful, innovative progress on health equity," she says. "Policymakers can support these important efforts by backing policies that allow plans to address social determinants of health as an essential element of healthcare."
ACAP wants federal policymakers to fund more benefits that address SDOH, including food, transportation, and housing programs, and to promote healthcare access by establishing continuous eligibility for people covered by Medicaid and the Children’s Health Insurance Program and extending postpartum Medicaid coverage to 12 months.
ACAP is also pushing a learning collaborative to help Safety Net Health Plans advance equity across their members. The two-year program partners with the Center for Health Care Strategies to address health disparities and help nonprofit health plans develop and vet health equity strategic plans.
"There are no silver bullets to solve the widespread, systemic disparities that plague America's health care system, but there are concrete actions that can move the needle," says Christopher D. Palmieri, president and CEO of Massachusetts-based Commonwealth Care Alliance and chair of ACAP’s board of directors. "Health equity can progress from an aspiration to a reality, but it requires policymakers to work with health plans and others in new and deliberate ways. The Pathway fuels that process."
The mega-health system cites its 'unique position' to address the epidemic of gun violence.
Kaiser Permanente wants to "amplify" the opening of its Center for Gun Violence Research and Education by doling out $1.3 million to nonprofits with a shared interest in gun violence prevention.
"It is increasingly and distressingly clear that gun violence is a public health crisis in the U.S., claiming lives and creating trauma with untold, long-lasting consequences for countless people," said Bechara Choucair, MD, chief health officer and senior vice president for Community Health at Kaiser Permanente.
"As a major health care organization caring for 12.6 million people, we are in a unique position to expand, amplify, and implement promising work underway by healthcare and public health leaders to prevent future gun-related injuries and deaths, starting with a series of grants to organizations focused on addressing gun violence," Choucair said.
Grant partners include:
UC Davis — To provide core support for the Violence Prevention Research Program;
The Ad Council — To scale the End Family Fire campaign, which promotes safe gun storage in order to prevent shootings involving unsecured or misused firearms;
Association of State and Territorial Health Officials — To develop materials on evidence-based public health approaches to gun violence and suicide prevention, as well as to plan a national summit and develop collateral materials for broad use;
Big Cities Health Coalition — For public education on public health approaches to gun violence prevention:
Health Alliance for Violence Intervention — To convene researchers and experts to study the effectiveness of hospital violence intervention programs and their ability to break and prevent the cyclical nature of gun violence;
Johns Hopkins Bloomberg School of Public Health - To support the Johns Hopkins Center for Gun Violence Solutions, including efforts to study the implementation of extreme risk protective orders and the role clinicians can play in raising awareness of these measures:
National Institute for Criminal Justice Reform (NICJR) — To provide core support for NICJR violence reduction initiatives in states impacted by increased rates of gun violence;
California hospitals were reminded that they must provide written notice to patients – in their native language – of the availability of "charity care" and how to apply.
California Attorney General Rob Bonta has issued a consumer alert after receiving reports that the state's hospitals are ignoring the state’s charity care law obligation to tell patients about free and cheaper care options.
Bonta also sent letters to California hospitals warning them that they must provide written notice to patients – in their native language – of the availability of "charity care" and how to apply.
"When hospitals fail to inform patients of the availability of free or reduced-cost medical care, they force patients and their families to make impossible choices and confront financial hardship," Bonta said. "No family should ever have to think twice about getting their loved one's necessary medical care because they're afraid of high medical costs. Hospitals have a responsibility to inform Californians about their charity care options."
Bonta said the California Department of Justice has received complaints, particularly from rural and farm-working communities across the state, that hospitals are not providing charity care policy notices in a language that patients understand as required by state law.
A media release by CDOJ points to a 2021 survey from Gallup and West Health, showing that one-third of Americans have skipped medical treatment because of the high cost of care.
"As patients continue to face high out-of-pocket costs, they have the right to know that charity care programs exist to help families avoid financial catastrophe," Bonta said.
Those eligible for charity or reduced cost care include:
Uninsured patients: California law requires hospitals to provide free or discounted care to uninsured patients who earn up to 400% of the federal poverty level.
Insured patients: Californians with health insurance may qualify for discounts if they: (1) earn up to 400% of the federal poverty level, and (2) have faced out-of-pocket medical expenses in the preceding 12 months that exceed 10% of their income.
Immigrants: Californians’ immigration status does not affect eligibility for charity care. Hospitals may request proof of their financial situation — such as pay stubs or documentation from a local social services agency — but only to assess financial eligibility.
Bonta said Californians have the right to: request payment assistance even if they have health insurance or are undocumented; receive information about charity care and an application for charity care in their native language; receive a written estimate of the out-of-pocket cost they will be expected to pay if they are uninsured; negotiate an extended payment plan to pay for their treatment if they qualify for charity care.
Patients who believe a hospital is violating the law can file a complaint with the California Department of Public Health here.
The unanimous ruling in American Hospital Association v. Becerra sets up the potential for hospitals to collect billions of dollars in 340B back payments.
Hospital stakeholders offered a collective booyah on Wednesday after learning that the U.S. Supreme Court struck down the federal government's 28.5% cuts to drug reimbursements under the 340B program.
The unanimous ruling in American Hospital Association v. Becerra – written by Justice Brett Kavanaugh -- sets up the potential for hospitals to claw back some of the $3.2 billion in 340B payments owed to them in 2018 and 2019.
The high court said that the cuts, which took effect during the Trump administration, were illegal because the U.S. Department of Health and Human Services did not first survey the hospitals' drug acquisition costs before making the cuts, which the justices said violates protections against varying payment rates for some hospitals.
Wednesday's ruling overturns a federal appeals court ruling in favor of HHS and sends the case back to the lower court for further review. However, SCOTUS offered no potential remedies for the dispute.
The American Hospital Association, America's Essential Hospitals, and the Association of American Medical Colleges issued a joint statement shortly after Wednesday's ruling praising the decision and saying they were "looking forward to working with the Administration and the courts to develop a plan to reimburse 340B hospitals affected by these unlawful cuts while ensuring the remainder of the hospital field is not disadvantaged as they also continue to serve their communities."
Legal Scholars React
Stephanie Kennan, a senior member of the Federal Public Affairs group at McGuireWoods Consulting, said the ruling could greatly affect hospital reimbursements, with SCOTUS pushing HHS to compile the correct data to determine a reasonable reimbursement rate.
"This opinion calls out HHS for not surveying hospital acquisition costs before making decisions about 340B reimbursement rates," Kennan said. "It is important that the program be available for those who need it -- but it is as important to get the data correct to determine reasonable reimbursement and achieve the goals of the program."
Allison Hoffman, a professor at the University of Pennsylvania Carey Law School, called the ruling "a straightforward reading of the statute."
"The implication of this decision is that HHS will have to repay the 340B hospitals the difference between their lower rate and a higher rate paid other hospital for the two years at issue (2018 and 2019)," Hoffman said. "After that point, HHS collected survey data that will justify lower rates consistent with the Medicare statute."
"The larger policy issue, which this case leaves unresolved, is how to tailor federal support for hospitals that disproportionally care for underserved populations," she said.
Cary Coglianese, director of the Penn Program on Regulation at Carey Law School, said the high court "dodged entirely the question of the status of its longstanding precedent in Chevron v. NRDC."
"The question was teed up by the litigants and received sustained consideration by the justices during oral argument. In fact, the very first question following the petitioner's opening statement—asked by the otherwise long-quiet Justice Thomas— directly raised the issue of whether the Court should overturn Chevron," Coglianese said. "But in the end, the court did not even cite to Chevron in its unanimous decision today in;Becerra, let alone give any discussion to it."
"But perhaps the mere fact that the court says simply that it 'does not agree' with HHS means that Chevron is actually dead," Coglianese said. "Perhaps in the future judges are supposed to conduct their own interpretation of statutes without ever any regard or deference given to the agency's role under a statute authorizing it to implement its terms."
"We simply do not know. It is conceivable still that the court will provide further clarity about Chevron’s status in another case remaining to be decided this term, such as Becerra v. Empire Health or West Virginia v. EPA. Both these other cases involve disputes involving agencies' interpretations of statutes."
"Of course, it is also possible that the court will in these cases again simply give Chevron the silent treatment. If so, the silence we saw in today's decision may be part of a deliberate strategy of allowing Chevron to wither on the jurisprudential vine and ultimately die from desuetude. We will have to wait and see."
UC San Diego Health borrows strategies from the restaurant and airline industries and text messages patients when their providers are available.
Staring at a blank computer screen while awaiting a telehealth consultation is not the best way to endear patients to virtual care.
With that in mind, providers at UC San Diego Health borrowed strategies used by the restaurant and airline industries and launched a 10-week pilot project that text messaged patients when their provider were available. The "telemedicine untethered" program proved so successful that the health system is expanding the option into various high-volume primary and surgical care clinics this summer.
Brett C. Meyer, MD, a neurologist and clinical director of telehealth at UC San Diego Health, led the pilot and said "the goal of the feasibility study was to determine if this flexibility lead to improved perception of waiting time and an enhanced experience, while assessing for time saving for both patients and providers."
Nearly two dozen patients from a stroke clinic participated in the study and were given the option of either getting a text with a visit link when their provider was ready or logging in at a scheduled time and waiting in front of a camera in a virtual waiting room.
After the 10-week pilot, the researchers found that no patients were seen late, while 55% were seen early, with an average 55-minute time savings in clinic operations due to patients being seen early. Study metrics also included demographics, visit rates, and satisfaction surveys. The results were published in Quality Management in Health Care.
"Providers are extremely interested in making clinic visits better and easier for our patients — especially in the event we are running late," Meyer said. “Our old patient-communication strategy was complicated by the fact that the device that we would call to inform of a delay was often the same device they were actively using for their video visit."
UC San Diego Health saw a 1000-fold increase in the rate of telemedicine visits during the pandemic, and telehealth volumes remain high, with more than 550,000 ambulatory telehealth visits seen at the health system since the start of the pandemic for all types of medical and surgical care needs.
Emily S. Perrinez, RN, MSN, MPH, study co-author and director of telehealth operations at UC San Diego Health, said the rise in the use of telehealth is prompting a re-evaluation of standard operating procedure.
"We stepped back and asked, 'Do we need a virtual waiting room at all? Can we let patients know when their provider is available instead of making them wait online?'" she said. "The reality is that wait times and lack of timely communication both correlate with patient experience. Real-time text notification that the provider is ready improved patient satisfaction, and this experience is the kind of feedback we love to see."
The bottom line for Meyer is about making life easier for patients and providers.
"As long as a patient has a smartphone handy, they can go about their day rather than waiting for the provider to join the video visit," he said. "For the provider, it definitely increases flexibility and may even increase throughput. Additionally, texting decreases the anxiety of a provider who may be running late. Knowing that we are not keeping a patient waiting is, in my mind, the most important thing. We respect that patients have obligations and their time is precious as well, and we don’t want to keep them waiting."
The money, a gift from the David and Lucile Packard Foundation, will pay for renovations to the hospital’s West building, which opened in 1991, and which is the only pediatric care venue in the Bay Area to offer obstetric, neonatal, and developmental medicine services in one place.
"It's vital that more mothers and babies have access to Packard Children's Hospital, in an enhanced environment that supports optimal physical and mental well-being," says Yasser El-Sayed, MD, obstetrician-in-chief at Stanford Children’s Health. "This reimagined space will also facilitate impactful scientific research studies, which will accelerate our commitment to advance maternal and infant health in California and beyond."
Nearly two-thirds of expectant mothers at Lucile Packard are high-risk, with patients coming from across the state, the nation, and the world for treatment. The renovations will expand the labor and delivery unit, adding capacity for up to 20% more births. The building will also house the hospital’s first-ever dedicated and physically separate unit for high-risk moms who need to be hospitalized for days, weeks, or months before they deliver, ensuring rapid access to a state-of-the-art obstetric delivery suite.
The neonatal intensive care units will transition from large, open rooms—which typically hold up to 10 babies, their parents and care teams, and medical equipment—to private rooms where parents can stay with their babies.
Key upgrades include:
14 private labor rooms in a new labor and delivery unit
9 private antepartum rooms in a specially designed unit
51 private postpartum rooms
64 private NICU rooms
3 new and state-of-the-art obstetric operating rooms
A streamlined, family-centered experience, starting with a welcoming lobby
The David and Lucile Packard Foundation has donated $614 million to Lucille Packard over the years, making the Bay Area foundation the single largest philanthropic supporter of Lucile Packard Children's Hospital Stanford and one of the biggest funders of children's hospitals in the nation.
Affected staff have received 60-days' notice for the lay-offs, which will take effect on July 24.
Borrego Community Health Foundation has launched "a series of strategic initiatives" – including systemwide layoffs of 218 staff -- to protect its long-term financial viability and ensure access to safety-net care Riverside and San Diego counties.
The Borrego Springs-based nonprofit Federally Qualified Health Center filed a federal Worker Adjustment and Retraining Notification Act, and the affected staff have received 60-days' notice for the lay-offs, which will take effect on July 24.
The layoffs include 11 in nursing, 14 in nursing support, 70 in clinic support, 37 in the call center, 18 phlebotomists and eight dental staff. No physicians or advanced practitioner providers will be laid off.
Borrego Health CEO Edgar Bulloch, MD, says that – like many providers across the nation – the Borrego Springs-based FQHC has been rocked by the financial ill-effects of the COVID-19 pandemic.
"Without question, the past 18 months have been significantly challenging for Borrego Health," Bulloch says. "As we work to navigate our financial and legal issues, we are driven forward by our mission to provide primary care to the underserved."
"Indeed, our patients in Riverside and San Diego counties need Borrego Health. That's why we’re doing everything we can to overcome our challenges, even though it means making difficult decisions regarding the size of our workforce and our operational structure."
Bulloch says that Borrego will work to align with industry benchmark data and best practices from other regional FQHCs to trim administrative and clinical teams.
The CEO stressed that the changes are needed to ensure Borrego Health's ability to meet the needs of patients, do not alter clinic hours or scheduled appointments.
In 2021, Borrego Health served more than 120,500 patients and had more than 463,000 visits.
Survey finds Americans will need 7x more than they expect to pay for healthcare in retirement.
A 65-year-old couple retiring this year will spend on average $315,000 for healthcare expenses throughout retirement, about seven times more than they expect to pay, according to a new study from Fidelity Workplace Consulting.
Fidelity's 21st Annual Retiree Health Care Cost Estimate for single retirees is $150,000 for men and $165,000 for women. The estimate assumes both members of the couple are enrolled in traditional Medicare and Medicare Part D.
The 2022 estimate is up 5% from 2021 ($300,000) and has nearly doubled from its original $160,000 in 2002, the first year the estimate was published.
"Even as many Americans look to turn the page on the events of the last two years, staying informed on potential future healthcare costs should remain a top factor when planning for retirement," said Hope Manion, senior vice president, Fidelity Workplace Consulting.
A March survey of 2,022 adults commissioned by Fidelity found that most are clueless about the cost of healthcare in retirement, estimating that a couple retiring this year will spend $41,000 on healthcare expenses in retirement -- $274,000 less than Fidelity's estimate. Additionally, 68% think associated costs will remain under $25,000.
Fidelity is using the survey to plug health savings accounts, which Manion said "are also a great way to cover current qualified medical expenses."
Among the misconceptions harbored by many American adults ages 58-76, the survey found that:
* 57% of respondents incorrectly think a person can elect to enroll in Medicare at age 62 and receive reduced benefits. Medicare gives people a 7-month time frame to sign up/enroll. For those who are eligible when they turn 65, that 7 months begins 3 months before the month they turn 65 and ends 3 months after the month they turn 65.
* 41% assume incorrectly that there are out-of-pocket caps for Medicare coverage. In reality, retirees must enroll in Medigap to limit their out-of-pocket expenses.
* 40% believe incorrectly that Medicare will pay for them to stay in a nursing home when they can no longer take of themselves.
A study looked at spending by Medi-Cal associated with malpractice cases from "never events."
California's cap on noneconomic losses in malpractice cases is lagging far behind current values and, perversely, could be linked to a rise in malpractice cases over the past 50 years, new research suggests.
"The lack of adjustment to reflect inflation or the growth of household incomes is inequitable, because it lowers the real value of the reward — which in current dollars, could be as much as $1.5 million – six times the 1975 value," says Prof. Jack Needleman, chair of the UCLA Fielding School of Public Health's Department of Health Policy and Management. "The second issue is that the cap, by lowering the risk of suit for malpractice, has also weakened the deterrent effect of risk of being sued on physician’s efforts to avoid malpractice."
"The best available research suggests imposing caps is associated with a 16% increase in adverse events," Needleman says. "Given this, it is likely that the repeal of a cap on noneconomic damages would increase attention to patient safety and lead to reduction of adverse patient events. These changes would be associated with cost savings to payers and patients and reduced economic and noneconomic damages that improve the life and health of patients."
Needleman's review looked at spending by Medi-Cal associated with malpractice cases from "never events," such as objects left in patients after surgery, mismatched blood transfusions, or hospital-acquired pressure ulcers. In 2018, more than 250,000 Medi-Cal patients experienced a never event and the state paid $1.5 billion on these cases.
Needleman says that many of these costs could be avoided if California’s malpractice cap was lifted or substantially raised. A 16% reduction in adverse events could mean savings to the state as much as $245 million annually.
The cap was adopted by California in the mid-1970s when state legislators believed rising malpractice premiums and risk of lawsuit would nudge some physicians into retirement or stop practicing medicine and increase care delivery costs through defensive medicine. No provision was made for indexing the cap level for inflation.
Federal statistics show that, between November 1975 and November 2021, the Consumer Price Index increased by a factor of 5.03. If the cap had been adjusted based on CPI to maintain its purchasing power, its current value would be $1.257 million.
Needleman suggests that a better measure of the value of the cap would be the ratio of the cap to household income. In 1975, the cap of $250,000 was 19.5 times the median California household income of $12,778. If the cap had been adjusted to maintain the ratio of value to household income, its current value would be $1.5 million.
"That is six times the difference," Needleman says. "In effect, someone who suffered in a malpractice case in the 1970s received much, much more in compensation, in a relative sense, than someone suffering the same injury today."
Proponents for caps on malpractice awards argue that the caps lower malpractice risk and premiums. The lower premiums and lower risk reduce practice costs, reduce the incentive for defensive medicine such as unneeded diagnostic testing — which increases overall health care costs — and reduce the incentive for physicians to leave practice.
"Imposing a cap on awards also reduces the incentive to avoid malpractice," Needleman says. "If the incentive to reduce malpractice is weakened, and malpractice rates increase, this raises the potential costs to patients and insurers, as well as increasing potential noneconomic losses for patients."
Needleman says research suggests that state adoption of caps on noneconomic damages in medical malpractice lawsuits is associated with higher rates of preventable adverse patient safety events in hospitals, estimated as a 16% increase in these adverse events.
"The economic and noneconomic losses for patients and their families from malpractice can be significant," he says. "Beyond these, there are substantial costs to the state in Medi-Cal and medical payment for state and local government employees that would be reduced by raising or eliminating the cap on non-economic losses in malpractice."
Burnout and need for better benefits, pay, and/or family time are adversely affecting workers' plans for the future.
More than two-thirds (64%) of California's behavioral health workforce is comprised of women, most of whom have a bachelor's degree or higher and a decade or more in the field, a new analysis from the Department of Health Care Services shows.
More than 1,600 members of the workforce responded to the Fall 2021 California Behavioral Health Workforce Assessment survey, which collected information about respondents' demographics, educational and professional backgrounds, employment, communities served and use of telehealth services.
The survey also included questions related to peer support services and providers in the context of California’s current initiative to establish Peer Specialist as a provider type under DMC-ODS and SMHS programs.
The survey found that:
64% of behavioral health workers are cisgender women.
32% of respondents are Hispanic or Latino.
76% of respondents have a college or graduate degree, and 42% of respondents have been in behavioral health for more than 10 years.
35% of respondents identify as a family or caregiver of a person with behavioral health needs, and 32% have experienced a personal mental health challenge.
Burnout and need for better benefits, pay, and/or family time are adversely affecting workers' plans for the future.
The survey assessment offers seven recommendations to support, strengthen, and expand California's behavioral health workforce:
Support data-driven decision-making and policy by collecting nuanced behavioral health workforce data.
Create, expand and strengthen career pathways for racially, ethnically, linguistically and culturally diverse behavioral health providers.
Increase pay and benefits for the behavioral health workforce. Address disparities between peer and non-peer staff.
Address provider burnout and compassion fatigue. Support parents and caregivers.
Prioritize supports for unserved, underserved and inappropriately served communities. Invest in equity-driven strategies and wraparound supports
Provide additional training and technical assistance to expand telehealth.
Invest in training initiatives and programs that support integration of peers. Include and promote peer voice and leadership.
