Category Archives: Health Care Access
Recent data out of California has shown that close to 90,000 children go to the emergency room for dental care each year. Although the cost of those visits is tens of millions of dollars, often little more is done than prescribing antibiotics to control infections. While that is important, after such a visit a child’s teeth remain decayed, posing significant risks for adult dental health problems, which can lead to illnesses, deaths, huge out of pocket costs and reduced job opportunities if teeth are noticeably missing.
But California is now also the first state in the nation to permit dentists to take care of underserved kids and adults virtually. A law passed at the end of September vastly expands the Virtual Dental Home, a demonstration project that uses telehealth technology to bring dental services directly to patients in community settings, such as preschools, elementary schools and nursing homes.
Under the program, dental hygienists and assistants perform preventive care and provide patient information electronically for review by an off-site dentist. Under the direction of the dentist, the providers can also place temporary fillings—no drilling required—which can last for years, according to Jenny Kattlove, an oral health policy analyst for The Children’s Partnership, a children’s advocacy group. Patients who need more advanced care are referred to a dentist, and often they’re the dentist who worked with their technician.
A recent Pew study examined how the Virtual Dental Home worked at an elementary school in Sacramento, where the program provided cost-effective services to low-income children who did not have a regular source of dental care. Care under the Virtual Dental Home is paid for under California’s Medicaid program.
According to research by the University of the Pacific Arthur A. Dugoni School of Dentistry, which operates the Virtual Dental Home pilot program, more than 30 percent of Californians are unable to meet their oral health needs through the traditional dental care system. More than half of California’s Medicaid-enrolled children received no dental care in 2012 and even fewer received preventive care services.
NewPublicHealth recently spoke with Kattlove about the new law and its potential as a model for dental care for low income individuals across the country.
NewPublicHealth: What is the most significant advantage of the Virtual Dental Home?
Jenny Kattlove: The Virtual Dental Home is a way to diversify or disperse the workforce so that all the professionals are working at the top of their skills and expertise. By putting dental hygienists in a community setting and having them take care of the majority of the care that the child needs, the dentist can be in the clinic or in their dental office taking care of the more complex needs and supervising the hygienist.
The American Heart Association (AHA) is working with dozens of state legislatures this year to develop laws that would add cardiopulmonary resuscitation (CPR) classes to middle or high school curricula. Nineteen states require in-school training for high school students, and more are expected to consider or implement the training in the next few years. In Virginia, for example, Gwyneth’s Law—named for a little girl who went into cardiac arrest and died waiting for an ambulance with no one with CPR training able to step forward to try to help—goes into effect in two years and makes CPR mandatory for high school graduation, unless students are specifically exempted.
The AHA says that by graduating young adults with the knowledge to perform CPR—now taught as a hands-only skill, with no mouth-to-mouth resuscitation so as to keep the emphasis on chest compressions—they can vastly reduce the number of Americans, currently 420,000, who die of cardiac arrest outside a hospital each year. The numbers are highest among Latinos and African-Americans, according to the AHA, largely because too many members of those communities have not been taught CPR. AHA surveys find that people who live in lower-income, African-American neighborhoods are 50 percent less likely to have CPR performed.
New AHA grants are helping fund the training in underserved areas. A 2013 study in Circulation: Cardiovascular Quality and Outcomes studied several underserved, high-risk neighborhoods to learn about CPR barriers. The researchers found that the biggest challenges for minorities in urban communities are cost (including child care and travel costs), fear and lack of information.
“Our continued research shows disparities exist in learning and performing CPR, and we are ready to move beyond documenting gaps to finding solutions to fix them,” said Dianne Atkins, MD, professor of Pediatrics at the University of Iowa. “School is a great equalizer, which is why CPR in schools is an integral part of the solution and will help increase bystander CPR across all communities and save more lives.”
The AHA has received funding from Ross, the national clothing store chain, for a program called CPR in Schools, which teaches hands-free CPR to seventh and eighth graders. As a way to increase training for minority students, AHA is partnering local Ross stores with nearby public schools where at least 50 percent of students receive free or reduced lunches.
- Read a NewPublicHealth story about a pilot kiosk CPR trainer to teach hands-free CPR in the Dallas/Fort Worth Airport. The pilot program will expand to other locations in 2015.
- Watch hands-only CPR training videos from the American Heart Association. Tip: First learn to hum “Staying Alive” by the Bee Gees. The beat is almost precisely the rhythm needed for effective CPR chest compressions.
Recommended Reading: Some Drugs—Especially Oncology Medicines—Have Been in Short Supply for Too Many Years
Health Affairs and the Robert Wood Johnson Foundation recently released an issue brief on the continuing shortages of certain drugs, most frequently injectable drugs for cancer treatment. According to the issue brief, there have been fewer reports of newly unavailable drugs in the last few years, but problems remain, forcing many patients to skip some treatments or sometimes opt for a less-effective drug. U.S. Food and Drug Administration (FDA) updates on drug shortages in just the first two weeks of September found sixteen injectable drugs in short supply, two of them new to the list.
Recent Government Accountability Office reports have found several reasons for the shortages, including:
- Difficulty acquiring raw materials
- Manufacturing problems
- A loss of drug products when factories are updated and modernized
- Low reimbursement by Medicare and other government payment programs
- FDA regulations that may slow down new drug approvals
The authors of the issue brief say that it is unlikely that Congress will act, and that the industry has and will make changes likely to help bolster some supplies. Also, thorough reviews such as the current issue brief help remind policymakers that some drug shortages remain.
Read the full issue brief.
Almost every day brings reports of new cases of Ebola, the often-fatal virus now impacting multiple countries in West Africa. According to the U.S. Centers for Disease Control and Prevention (CDC), the 2014 Ebola outbreak is the largest Ebola outbreak in history. Spread of the disease to the United States is unlikely—although not impossible—and efforts are underway to find vaccines and cures, including scale-ups of drug development and manufacturing, as well as human trials for vaccines both in the United States and around the world. However, in West Africa the epidemic is impacting lives, economies, health care infrastructure and even security as countries try a variety of methods—including troop control—to get citizens to obey quarantines and other potentially life-saving instructions.
Late last week, NewPublicHealth spoke with Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. Garrett has written extensively on global health issues and was on the ground as a reporter during the Ebola outbreak in Zaire in 1995.
NewPublicHealth: What are your key concerns with respect to the current Ebola outbreak?
Laurie Garrett: My main concern has been about the nature of the international response, which could be characterized as non-response until very recently. And now that the leadership of the international global health community has finally taken the epidemic seriously, it’s too late to easily stop it. We’ve gone through the whole list of all the usual ways that we stop Ebola and every single one of them was initiated far too late with far too few resources and far too few people—and now we’re in uncharted territory. We’re now trying to tackle a problem that has never reached this stage before and we don’t know what to do. The international response is pitiful, disgusting and woeful.
NPH: How do you account for such a poor response?
Garrett: First of all, the World Health Organization (WHO) is a mere shadow of its former self. When I was involved in the Ebola epidemic in 1995 in Kikwit, Zaire, the WHO was recognized worldwide as the leader of everything associated with outbreaks and infection, and it acted aggressively. It didn’t have a huge budget, but it still was able to take the problem very seriously and the resources that were needed were available, and more importantly a very talented leadership team combining the resources of the U.S. Centers for Disease Control and Prevention; WHO; Medicin San Frontiers (Doctors Without Borders); and the University of Kinshasa, Zaire, came together. They respected each other. They were on board together. They worked very closely with the local Red Cross, and they were able to conquer the problem pretty swiftly.
A new Kaiser Health News (KHN) article describes the challenges of helping people who have never had health insurance sign up for coverage. The KHN profile looks at the Arab Community Center for Economic & Social Services (ACCESS) a nonprofit agency that is helping the large Arab-American population in Dearborn, Mich., sign up for coverage and access care.
The group has found that many of the people they are helping are immigrants who know little to nothing about health insurance concepts such as enrollment, copays and deductibles—an issue that also applies to millions of other people new to health insurance across the country. Immigrant and uninsured populations all over the country face cultural and language barriers to understanding and adopting U.S. insurance practices.
Ten million non-citizens living legally in the U.S. are expected to gain health insurance under the Affordable Care Act, according to KHN. The navigators at ACCESS are also trained to teach immigrants about free public health screenings for conditions such as breast cancer, which requires specialized training and conversations because of cultural stigmas associated with cancer.. At the ACCESS center in Dearborn, for example, women coming for free mammograms enter through an unmarked door.
Read the Kaiser Health News article.
- Kaiser Health News recently reported that, on average, premiums will decline in 16 major cities for the 2015 coverage year.
- Advertising for health insurance plans has already started across the country. Sign up for the 2015 coverage year begins October 15, 2014 and ends February 15, 2015, a period that is roughly three months shorter than last year’s enrollment period. Find information at healthcare.gov.
Recently NewPublicHealth shared an interview from AlleyWatch, a Silicon Valley technology blog about SenseHealth, a new medical technology firm that has created a text message platform that health care providers can use to communicate with patients. In May, SenseHealth was picked to be part of the New York Digital Health Accelerator, which gives up to $100,000 in funding to companies developing digital health solutions for patients and providers. The accelerator is run by the Partnership Fund for New York City and the New York eHealth Collaborative. SenseHealth engaged in a clinical trial last year that used the technology to help providers engage with patients who are Medicaid beneficiaries.
Health conditions supported by the SenseHealth platform range from diabetes to mental health diagnoses, while the messaging options include more than 20 customizable care plans, such as medicine or blood pressure monitoring reminders. There are also more than 1,000 supportive messages, such as a congratulatory text when a patient lets the provider know they’ve filled a prescription or completed lab work. The platform couples the content with a built-in algorithm that can sense when a user has logged information or responded to a provider, and providers are able to set specific messages for specific patients. Early assessments show that the technology has helped patient manage their conditions, with data showing more SenseHealth patients adhered to treatment plans and showed up for appointments than patients who didn’t receive the text program.
We received strong feedback on the post, including a question from a reader about whether Medicaid beneficiaries lose contact with their providers if they disconnect their cell phones or change their numbers, a common occurrence among low-income individuals who often have to prioritize monthly bills. To learn more about SenseHealth and its texting platform, NewPublicHealth recently spoke with the company’s CEO and founder, Stan Berkow.
NewPublicHealth: How did SenseHealth get its start?
Stan Berkow: We got started about two to two-and-a-half years ago. I met one of the other founders while I was working at the Columbia University Medical Center in New York City. We were both clinical trial coordinators and were seeing—first hand—the difficulties in getting participants in our studies to actually follow through on all the exercise and nutritional changes they needed to make in order to complete the research project. That led us to step back and look at the bigger health care picture and recognize the challenges for providers to help patients manage chronic conditions, and recognizing that there’s a huge time limitation on the providers. That pushed us toward finding a way through technology to help those providers help the patients they work with more effectively to prevent and manage chronic conditions.
It’s no secret that kids perform better in school when they are healthy and feel motivated to learn. But not all kids have access to the quality health care that can help them get healthy, stay healthy or treat any chronic health conditions they have. That’s where school-based health centers come in.
School-based health centers are partnerships between schools and community health organizations. They help students get the preventive care they need—including flu shots, annual physicals, dental exams, vision exams and mental health counseling—right where they spend most of their daytime hours: On school grounds. There are currently more than 2,000 school-based health centers across the country. Besides removing barriers to health care that many families face, school-based health centers help reduce inappropriate visits to emergency departments by up to 57 percent, research has found. They also help lower Medicaid expenditures, decrease student absences from school and do a better job of getting students with mental health issues the services they need.
Moreover, with growing recognition that health disparities affect academic achievement, school-based health clinics help close the gap by providing crucial access to health care for students who might not otherwise get it. A study by researchers at the University of Washington, Seattle, found that high school students who used school-based health centers experienced greater academic improvements over the course of five semesters than students who didn’t use these centers; the effect was especially pronounced among those who took advantage of mental-health services. Another study found that high school students who were moderate users of school-based health centers had a 33 percent lower dropout rate in an urban setting that has a high dropout rate.
The exact services offered by these centers vary by community. At Santa Maria High School in Santa Maria, Calif., the health center’s offerings include crisis intervention sessions; a grief group for students dealing with loss; and ongoing opportunities for students to build important social skills and skills that will help them maintain a healthy lifestyle. In Oakland, Calif., the Native American Health Center offered at a middle school and a high school provides medical care, dental care, mental health services and a peer health education program in one setting. At the Maranacook Health Center in central Maine, kids can get support for chronic health problems (such as asthma, diabetes, or seizures), medications they need, counseling or other mental-health evaluations and services.
The ultimate goal behind these centers is for all children to enjoy and benefit from good health and school success.
“Children and adolescents are at the heart of the mission,” said John Schlitt, president of the School-Based Health Alliance, based in Washington, D.C. But the “scope of the health center’s influence extends beyond the clinic walls to the entire school, its inhabitants, climate, curriculum, and policies. The school is transformed as a hub for community health improvement.”
Better communication means better patient engagement, and better patient engagement means better health outcomes. Understanding this, Sense Health has developed an app to promote interactive, text-message-based communications between health care professionals and high-needs patients. Stan Berkow, CEO of the New York City-based company, said in a recent interview with AlleyWatch that the focus thus far has been on Medicaid patients with chronic conditions because they represent “an underserved population with a huge unmet need both considering the human element as well as the cost-burden.”
The app allows providers to create message-based conversations tailored to the particular needs of their patients. In a two-month randomized control trial with Montefiore Medical Center, which included 67 high-needs patients and 15 care managers, providers saw a 40 percent increase in self-reported patient adherence to appointments, a 12 percent increase in adherence to medications and a 7 percent increase in adherence to care plan goals.
“Our business is built on our belief that it is not only possible, but essential to personalize healthcare through the use of technology,” said Berkow. “The prevention and management of chronic health conditions requires behavior change, something that technology alone cannot provide. Sense Health is amongst those who realize that technology in health works best when there is a human touch behind the system and patients feel supported by their providers.”
The company recently joined the New York Digital Health Accelerator, which offers up to $100,000 in funding to companies engaged in developing digital health solutions. The accelerator is run by the Partnership Fund for New York City and the New York eHealth Collaborative.
Read the full interview at AlleyWatch.
Vital Healthcare Capital (V-Cap) and the Robert Wood Johnson Foundation (RWJF) have announced a $10 million investment in Commonwealth Care Alliance (CCA), based in Boston, Mass., to help fund the organization as it rapidly expands its model of care for patients who are dually eligible for Medicare and Medicaid.
The non-profit care delivery system provides integrated health care and related social support services for people with complex health care needs covered under Medicaid and for those eligible for both Medicaid and Medicare. CCA’s expansion comes as Massachusetts continues to pioneer integrated, patient-centered care for people who are eligible for both Medicare and Medicaid though the newly created “One Care: MassHealth plus Medicare” program, one of several financial alignment initiatives for people with dual eligibility established by the Affordable Care Act (ACA) that are launching nationwide.
The loan—the first to be made by Vital Healthcare Capital, a new social impact fund based in Boston, through support from RWJF—provides funds needed by CCA for financial reserves required by the Commonwealth of Massachusetts as the agency expands the number of beneficiaries in its programs.
According to CCA Director Robert Master, the social impact goals are to:
- Scale a person-centered integrated care model for high-needs populations.
- Demonstrate what are known in public health as “triple aim” outcomes in health status, care metrics and cost effectiveness.
- Train, develop and create frontline health care workforce jobs, including health aides, drivers and translators.
- Create innovations in health care workforce engagement in coordinated care plans to better integrate into the care plan the staff members who most directly touch the lives of its members.
Over the next five years, Vital Healthcare Capital plans to establish a $100 million revolving loan fund, leveraging $500 million of total project capital for organizations working on health care reform for patients in low-income communities.
NewPublicHealth recently spoke with Steven Weingarten, CEO of Vital Healthcare Capital, about the inaugural loan and the firm’s expansion plans going forward.
NewPublicHealth: How did Vital Healthcare Capital get started and what are its overarching goals and investment criteria?
Steven Weingarten: Vital Healthcare Capital has been formed as a new non-profit financing organization to invest in quality health care and good health care jobs in low-income communities. The organization came about after a couple of years of research and development with funding from the Robert Wood Johnson Foundation, as well as from the Ford and Rockefeller Foundations and support from SEIU, the health care union. Healthcare reform is really part of a broader restructuring of health care that has enormous implications for low-income communities, and for the health care providers and plans that have been focused on these communities. Having financial capital to be able to transform health care to a better delivery model will be a critical challenge in upcoming years. So we are coming in to serve that need.
There are an estimated 7,350 homeless people living in San Francisco, yet there are only eight facilities in the city at which the homeless can shower. At each of these facilities, there are at most two shower stalls—meaning that there is at most one shower for every 460 homeless people.
Lava Mae developed a mobile approach to target this public health issue.
The refurbished San Francisco MUNI bus outfitted with two full-service bathrooms successfully made its first rounds on June 28. The bus will travel around the city providing the homeless with mobile public utilities and giving them much-needed access to clean water and sanitation. Without the limitations of stationary locations, Lava Mae is able to aide people across the city while also staying free from high real estate prices, rising rent and potential eviction.
"For at least a decade, bathrooms have stood in for the city's anxieties about homelessness, public utilities, and the changing economy," wrote Rachel Swan in a piece on public bathrooms in SF Weekly. Lava Mae founder Doniece Sandoval hopes that the program will take big steps in improving the health of the homeless and public sanitation by increasing the number and scope of available public restrooms.
The relationship between the health and wellbeing of the homeless population correlates directly with the health of the community as a whole. As the homeless population strives for a better quality of life, so does the community—one shower at a time.
Read the full story, “A Refurbished Bus Will Bring Showers to the Homeless in San Francisco.”