Category Archives: Medicaid
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.
While behavioral and physical health have generally been separate entities in the United States, new rules under the Affordable Care Act are bringing them together—both to reduce costs and to integrate care in millions of people who face behavioral and physical health issues.
Experts at last week’s Healthy Communities Initiative forum, convened by the National Association of Counties (NACo), and this week’s AcademyHealth National Policy Conference, meeting in Washington D.C., presented strategies for combining the two. Some pilot projects are beginning. The pace is picking up largely because many people now covered under the states that have created Medicaid expansion have a range of behavioral and physical health needs. They will benefit from integration because the two are often connected—for example, diabetes has been linked to depression—and because connecting the two can reduce health care costs and reduce the number of provider visits a patient has to make.
“Behavioral health is a driving force in why people don’t get where they want to be,” said Donna Skoda, Assistant Health Commissioner of Summit County, Ohio, who spoke at the NACo forum.
Several public health officers at the forum presented ideas of what works in their communities, including:
- Hiring nurses to be care providers to assess both behavioral and physical health needs
- Retraining behavioral health specialists, including psychiatrists, to use blood pressure cuffs and other medical equipment
- Integrating patient files with information on mental and physical health baselines and changes
- Opting, when possible, to deliver care in physical health offices rather than counseling offices, since physical practitioner clinics already have devices needed such as scales
Presenters at the AcademyHealth policy conference stressed cost savings. For example, Washington state will participate in a federal demonstration project for beneficiaries dually eligible for Medicare and Medicaid. Under the demonstration, the health plans will be responsible for a full range of services—including mental health; chemical dependency; long-term services and supports; and medical care—under a single capped rate.
“Integrated care needs to be the rule, not the exception,” said Charlene Le Fauve, a deputy director of the National Institute of Mental Health.
Le Fauve said new technologies can be an important factor in delivering care including mobile devices and internet tools, which can be used at provider offices, clinics, and in homes if communities provide those services.
Other ideas being funded include training community workers for brief interventions which may be able to keep many people with mental illness out of both the emergency room and the hospital. Phone intervention is also being studied, said Le Fauve.
A key session at the National Association of Counties (NACo) Health Initiatives Forum held last week in San Diego focused on the opportunities and implementation challenges of the Affordable Care Act for inmates of county jails.
Most county jail inmates are there awaiting trial because they can’t afford bail, and a large percentage have physical and/or mental health problems. While in jail, the cost for their health care falls to the county; Medicaid and other benefits inmates have in the community end once they enter the jail system, and many have no benefits. Typically, the care inmates received in jail ends on release since there is generally no entity to help them transition to community benefits and care.
And benefits under the Affordable Care Act are generally elusive for inmates—and counties—desperate for care and a break on the high cost of health care for inmates. While just about all inmates would qualify for coverage under the Affordable Care Act either through health insurance marketplaces or Medicaid expansions in those states that have changed their Medicaid rules under the health law—expanding Medicaid benefits to those without children who qualify financially because of low incomes—current laws do not permit inmates to be covered for health care costs under Medicaid while in jail, except for hospitalizations while they’re incarcerated.
Many counties in states that have expanded Medicaid to include low-income adults without children have petitioned their state Medicaid offices to amend current rules and allow coverage for health care under Medicaid during incarceration.
However, counties are taking initiative to help inmates sign up for coverage that will kick in on their release, reducing the chance for recidivism and improving the chance for healthier and more productive lives. For example, last week in San Francisco the city sheriff sent a bill to the city’s Board of Supervisors that would make the sheriff’s office responsible for helping inmates sign up for the Affordable Care Act.
At the NACo meeting, Farrah McDaid Ting, Associate Legislative Representative for Health and Human Services at the California State Association of Counties, said a key issue both for county budgets and for the health of people released from jail into the community is that without benefits and a transition to care, often care was only sought afterward and delivered when there is a crisis. Ting says among the requests being made in California is to have Medicaid suspended rather than terminated for people in jail under a year, which would allow a person to transition back to care immediately on release.
Another critical need in jail is technology infrastructure to allow inmates to be signed up. Some counties in California, according to Ting, are using outside nonprofit groups to sign up eligible inmates before release.
“What we want to reduce is that person ending up back in jail,” said Ting.
GUEST POST by Virgie Townsend, JD, associate editor at the Association of State and Territorial Health Officials (ASTHO)
About 40 percent of the health care dollars spent in New York State come from Medicaid. Realizing that the rate was climbing far too fast, the state brought together health care advocates, physician representatives, elected officials, management and unions to solve the growing financial issue by addressing the social determinants.
And they were effective. Last year the state saved $4 billion while adding approximately 154,000 people to its Medicaid program.
One of the key figures behind the public health improvements was New York State Health Commissioner Nirav R. Shah, MD, MPH, who last week moderated the panel discussion âMedicaid and Public Health: Improving Partnershipsâ at the Association of State and Territorial Health Officialsâ (ASTHO) 2013 Annual Meeting.
>>Read more in a NewPublicHealth Q&A with Shah.
>>Read more on New York Stateâs Health Improvement Plan.
>>Follow continued ASTHO Annual Meeting coverage on NewPublicHealth.org.
In addition to Shah, the panel included Vermont Department of Health Commissioner Harry Chen, MD; Executive Director of the National Association of Medicaid Directors Matt Salo; and Chief Medical Officer for Center for Medicaid and CHIP Services Stephen Cha, MD, MHS. Shah and Chen discussed how their states are improving population health through greater integration with Medicaid, while Cha and Salo presented their views from the Medicaid perspective.