June 24 Update

In This Week’s Update:

  • New RWJF/Vox Medicaid Video Series
  • SHVS Webinars
  • Drivers of Health
  • State Updates: DE, MD, MN, MT, NC, TX, & WA
  • Work Requirements and Community Engagement
  • Patient Engagement Strategies

New Video Series Explains the Medicaid Program

The Robert Wood Johnson Foundation has collaborated with Vox Media to produce a series of four videos that explain the Medicaid program, which is part of the storytelling effort That’s Medicaid. The videos focus on the difference between Medicaid and Medicare, who is covered by Medicaid, the effect of Medicaid on children’s health, and an introduction to Medicaid expansion. The stories profiled by That’s Medicaid are great examples of Medicaid’s effect on the ground in various states, supplementing what data and quantitative research tells us. You can browse the first batch of stories and learn more at ThatsMedicaid.org, and share it with your lawmakers, staff and others. The effort will add more stories monthly to highlight the importance of Medicaid for people in all states; you can submit story suggestions from your state via the website.

State Health and Value Strategies Webinars

State Health and Value Strategies (SHVS) hosted three webinars for state health officials last week. SHVS launched its new webinar series for states interested in addressing disparities in health outcomes among Medicaid managed care beneficiaries. The first webinar reviewed the foundational principles of health equity, discussed the barriers to its realization, and the impact of health disparities (you can download the slide deck or watch a recording of the webinar). SHVS also hosted a webinar on leveraging Medicaid to establish meaningful health care connections for justice-involved populations, which was led by Manatt Health and spotlighted New York’s approach to continuity of care for the justice-involved. You can review the slide deck (or watch the recording) to learn about emerging state practices to enable continuity of coverage and care. Lastly, SHVS hosted a webinar to discuss the implications of the health reimbursement arrangements (HRA) rule recently issued and possible state responses. The slide deck is now posted and the recording will be up on the SHVS website today.

Drivers of Health

Last week, the Robert Wood Johnson Foundation launched a new project, Drivers of Health, a one-year research and education project aimed at improving understanding of the social determinants of health. The project kicked off with a public meeting in Princeton, New Jersey that delved into the question of what affects health, with the goal of providing a framework for the project to use in its study of the role of social determinants and health care. You can check out the project’s website, which will be updated frequently.

State Updates: DE, MD, MN, MT, NC, TX, & WA

  • Delaware — The Delaware legislature passed authorizing legislation to create a reinsurance program and funding mechanism via a Section 1332 waiver. The legislation is awaiting the governor’s signature. To stay up to date on all Section 1332 activity, check out this map from SHVS.
  • Maryland — Governor Larry Hogan, along with the Governor’s Office of Crime Control and Prevention, announced the expansion into 11 counties of the Handle With Care initiative, which encourages law enforcement and school systems to collaborate using a discrete, trauma-informed approach to address adverse childhood experiences. A Handle With Care Summit will also be held later this summer.
  • Minnesota —The MNsure Board of Directors elected former State Senator Kathy Sheran as the new chair, replacing Phil Norrgard, whose term as board chair expired this month. Peter Benner was elected vice-chair. Senator Sheran, who joined the board in January 2017, began her new role as chair on June 19, 2019.
  • Montana — The Montana Department of Public Health and Human Services, in partnership with the Montana Healthcare Foundation, released new reports that identify opportunities to cost-effectively improve health outcomes for homeless individuals with complex medical conditions by housing and assisting them in their communities. The reports specifically focus on the state’s Medicaid program and recommend ways to strengthen the state’s benefit package for the homeless and details the business case for doing so.
  • North Carolina – The North Carolina Department of Health and Human Services recently held a two-day Opioid Misuse & Overdose Prevention Summit to reflect on progress made in the state’s fight against the opioid epidemic. During the summit, Governor Cooper also unveiled the state’s new road map to combating the opioid crisis, the Opioid Action Plan 2.0
  • Texas – Governor Greg Abbott signed a SB1264 into law, which prohibits providers from sending patients “surprise” bills for out-of-network emergency services, lab work and imaging.
  • Washington – Governor Jay Inslee convened health care leaders, legislators, elected leaders and stakeholders to discuss the first steps of implementing Cascade Care, the state’s public option health plan. The effort will be led by Washington’s state-based marketplace, the Washington Health Benefit Exchange. The Exchange has created a stakeholder workgroup that will guide the development of standardized plans before they are introduced to consumers in fall 2020.

New Research on Work Requirements and Community Engagement

A new study published last week by the researcher Benjamin Sommers, M.D., and colleagues at the Harvard T.H. Chan School of Public Health, finds that Arkansas experienced an increase in the uninsured rate after establishing a work requirement as a condition of Medicaid coverage for able-bodied adults between 30 and 49 years of age. The research, supported by the Robert Wood Johnson Foundation and the Commonwealth Fund, examined how insurance coverage and employment changed following Arkansas’s implementation of the work requirement. In addition to the increase in the uninsured rate in the state, the study also found that most work requirements had no significant impact on employment or hours worked and that many beneficiaries were unaware of the policy or confused about how to report their status.

Patient Engagement Strategies and Patient Reported Outcomes

Health care practices that participate in accountable care organizations (ACOs), which are rewarded for improving patient outcomes and containing costs, have incentives to promote patient engagement strategies, such as shared decision making. A new Milbank Quarterly study, by Hector P. Rodriquez and colleagues at University of California, Berkeley’s Center for Healthcare Organizational and Innovation Research found that adoption of patient engagement strategies among ACO-affiliated practices did not improve patient-reported outcomes of physical, emotional, and social function among adult patients with diabetes and/or cardiovascular disease over one year. The authors suggest that outcomes had not yet improved because implementing these strategies requires extensive clinician and staff training, workflow redesign, and patient participation over time. Practices will need implementation support to ensure that their engagement strategies lead to benefits for patients, clinicians, and staff.