Recognizing the Need for Medicaid Reform

Recommendations for Reforming Medicaid from JAMA Forum article which can be located at https://newsatjama.jama.com/2017/07/11/jama-forum-reforming-medicaid/
Summary 
Medicaid program was originally passed by Congress in 1965 and now serves more than 70 million people in 4 categories: children and mothers, seniors in nursing homes and community-based settings, people living with disabilities, and low-income people of all ages. As much as 70% of the program’s resources are devoted to people who have disabilities or live in nursing homes. However, most Medicaid beneficiaries are children and mothers and, after passage of the ACA, low-income adults and families. A state-federal partnership, Medicaid policies are driven at the state level through waivers and State Plan Amendments submitted to the federal government.
Policy Recommendations for Reforming Medicaid

Making Medicaid a more outcomes-based program. Metrics such as the early diagnosis of illness, incidence of low-birth-weight infants, maternal mortality, and the efficiency of care delivered could form the basis of such measures. 


Improving Medicaid financing. Too much funding comes from large supplemental pools (such as Medicaid disproportionate share hospital [DSH] payments and uncompensated care pools) that go to states. These pools decrease accountability because they are allocated without regard to patient care or even the numbers of people treated. Finally, we support financing strategies that would encourage investments in the social determinants of health, which are the cause of so many health disparities and undesirable outcomes.


Ensuring proper access to care.  Nationally there is appropriate concern about access to specialists and home-based and community-based services, which varies broadly by state and is of concern in rural areas and where reimbursement rates are too low. Eliminating nonaccountable pools of funding would allow states to improve their reimbursement rates to specialists and help to expand access.


Investing in a data, technology, and analytics infrastructure. For Medicaid to deliver on its potential, the program needs to use best practices in home-based and community-based care and other programs that use social workers, home care attendants, and other resources to keep families together, coordinate care, and allow people to be treated in the most comfortable, cost-efficient settings


Coordinating programs for dual-eligible beneficiaries (who qualify for both Medicaid and Medicare) and other populations. There are growing, expensive populations that do not fully benefit from investments in care coordination commonly used in the private sector.


Reducing administrative burden on states and allowing for more rapid innovation. Medicaid is a highly flexible program, with a variety of different approaches designed to serve the frail elderly, provide substance abuse treatment, create innovative payment approaches, and capitalize on mobile technology. We support the ability of states to innovate more rapidly through thoughtful reform of the waiver process and the process of submitting State Plan Amendments

GHHI’s Push for Medicaid Policy Change
After reading the JAMA Forum article summarized above it occurred to us that GHHI has been actively working to achieve these Medicaid reform recommendations from its inception. From the outset GHHI has set as one of its organizational goals to change policies within states and at the federal level to allow for Medicaid payments to reimburse for the provision of in-home environmental management services.
Along the way GHHI has learned to achieve the vision of reimbursement for comprehensive environmental management services, which combine both in-home environmental health education, comprehensive environmental assessment and remediation of triggers, requires a collective impact approach. The Collective Impact approach is premised on the belief that no single policy, government department, organization or program can tackle or solve the increasingly complex social problems that are underlying factors. The approach calls for multiple organizations or entities from housing, education, energy and health sectors, to form a common agenda, shared measurement and alignment of effort.
Our recent Pay For Success grants activities, funded by Corporation for National and Community Services the JPB Foundation, and the Robert Wood Johnson Foundation, has focused on providing business development support for asthma programs in eleven cities across the country.  Through these ongoing projects and future collaborations we are working to increase the number of in-home asthma programs that target “high utilizers” in low-income communities, and ensure they all provide comprehensive indoor environmental management services to reduce asthma triggers which are eligible for Medicaid reimbursement.
GHHI’s National Asthma Campaign Aligns with Expert Recommendations to Reform Medicaid

Making Medicaid a more outcomes-based program. GHHI is working to establish Environmental Management & Health Outcomes Metrics for Evaluation (EMHOME) which will include environmental management measures (housing characteristics, hazards identified, services provided) and outcome metrics (asthma control, quality of life, healthcare utilization and costs) to demonstrate efficacy and return on investment. 


Improving Medicaid financing. GHHI has explored numerous alternative payment methods that could allow for reimbursement including 1115 waivers, value-based payments, bundled payments, administrative billing as well as incorporating private capital through pay for success.


Ensuring proper access to care.  Medicaid service delivery reform has the potential to protect vulnerable populations with asthma by establishing effective state policies which incentivize coordination of services among traditional and non-medical providers. Use of community health workers can improve access to asthma care management services within the home.


Investing in a data, technology, and analytics infrastructure. Cost benefit analysis that relies on actuarial analysis of Medicaid claims data is key to identify the target populations and potential return on investment. Secure data sharing between sectors is necessary to identify, recruit and coordinate clinical and home-based services to “high utilizers” within asthmatic populations.


Reducing administrative burden on states and allowing for more rapid innovation. Strategic partnerships between MCOs/ACOs and service providers that facilitate innovative payment structures, such as value-based payments, can drive policy change at the state‘s direction without increasing administrative burden on states.


Coordinating programs for dual-eligible beneficiaries (who qualify for both Medicaid and Medicare) and other populations. GHHI has not directly worked on this recommendation but sees the value especially related to home interventions to prevent falls in older adults.

GHHI Travel Blog: Pittsburgh, Memphis, and Richmond

This summer has been busy and exciting for GHHI!  We have been honored to meet with elected officials and community leaders taking clear action to rid their communities of lead. Since the revelations of lead poisoning in Flint, Pittsburgh has re-committed itself to the fight to eradicate lead in the city and surrounding county. In late July, GHHI joined Pittsburgh as it became the 19th city to sign a compact to commit to improving housing in the region through a city, county and non-profit partnership. The compact is a tangible sign of support from the Pittsburgh community, local service providers, agency leaders, and local elected officials. Together, they are working on a comprehensive and streamlined program of services that will help keep homes safe and healthy for families.
One partner organization, Rebuilding Together Pittsburgh, is engaging its more than 25,000 member network of volunteers to help GHHI modify homes. GHHI also works with local nonprofits like Conservation Consultants, Inc., Habitat for Humanity, Nazareth Housing Services, the Homewood Children’s Village, and Women for a Healthier Environment.  In a press conference, Mayor Bill Peduto promised to find funding to sustain the program and said, “as we look to creating new opportunities in home ownership, we look to make sure that those homes are not only energy efficient, but healthy for the families that will be living there.”
Several cities across the country are also taking the important first step to rid their communities of lead, and earlier this summer, GHHI also met with officials in Richmond and Memphis as they learned more about programs to make homes healthy.
In Richmond, Virginia, GHHI met with Mayor Levar Stoney and partners in the Learning Network. GHHI’s Learning Network is made up of a variety of teams that help coordinate services and prepare cities for success when they sign on to GHHI’s program. Mayor Stoney expressed his enthusiasm for building a healthier and safer city and community. 
In Memphis, Tennessee, GHHI met with more than 50 people representing at least 30 organizations, including LeBonheur Children’s Hospital, Habitat for Humanity, and the Memphis Medical Legal Partnership as well as city and Shelby County officials. At the meeting, GHHI discussed how to implement its model to help decrease emergency room visits, doctor’s office visits, and hospitalizations due to asthma. The meeting also covered how to decrease the number of school days missed by children because of their asthma and save the city money through streamlining programs that address the issues caused by asthma. Director of Housing and Community Development Paul Young also met with GHHI and discussed what a partnership would look like.  Memphis is continuing to explore the best path forward based on its resources, and we look forward to building this relationship further.
GHHI’s partnerships are growing fast as we work to make sure every child can live and learn healthily, regardless of zip code.

GHHI's Work with Older Adults

Older adults are the foundation of our families and the safety and integrity of their homes is important to them aging well physically, mentally, and emotionally. Far too often many of the nation’s older adults struggle to stay in their homes simply because they are unable to afford the simple modifications necessary to avoid injuries, not to mention the major health and safety issues that need to be addressed. In Baltimore City many older adults have lived in their homes for decades, created memories, raised families or even inherited the home from a loved one, so many of these homes are in dire need of renovations that would improve the quality of life of the homeowner. Often there are issues with leaking roofs, malfunctioning plumbing, pest or rodent infestation, mold and/or lead paint concerns. On top of dealing with major housing renovations many older adults need modifications to existing structures in the home to make the home safe for day to day living. Modifications include sturdy hand rails on all stairs, safety seats and grab bars in the shower, raised toilet seats or motion sensor lighting. These modifications are simple but life changing for an aging adult and allow the adult to maintain their independence in a home they worked so hard to obtain. At Green & Healthy Homes Initative, we strive to provide older adults within the Baltimore City community a safe, healthy and clean home and most importantly a peace of mind. As an organization we provide interventions to reduce slip, trip and fall hazards common to the older adult population Coupled with the intervention GHHI provides education materials that promote good medication practices, healthy eating and regular exercise routines to ensure that the older adults we help receive a holistic approach to achieving a heathy home. This model of interventions coupled with education aligns with the organizations mission to break the link of unhealthy housing and unhealthy families. None of our efforts would be possible without our supporters from the Harry and Jeanette Weinberg Foundation, we are beyond grateful to have their support as we focus to help our older adults age gracefully in the comforts of their own homes. 

National Lead Poisoning Prevention Week 2016 Recap

National Lead Poisoning Prevention Week 2016 launched on Monday, October 24th, 2016 with a press conference in Baltimore, Maryland. Moderated by Green & Healthy Homes Initiative, President & CEO, Ruth Ann Norton, with Jeannie Haddaway-Riccio, Deputy Chief of Staff, Office of Governor Larry Hogan; Carol Bryant Payne, Field Office Director, Housing and Urban Development; Dr. Howard Haft Deputy Secretary for Public Health, Maryland Department of Health and Mental Hygiene; Ben H. Grumbles, Secretary of the Maryland Department of the Environment; Kenneth C. Holt, Secretary of Maryland Housing & Community Development; and Kristin Rzeczkowski, Chief of Staff, Baltimore City Health Department.


During the press conference at Liberty Elementary School GHHI's Derek the dinosaur and The Maryland Book Bank distributed free books from the official Ravens Bookmobile where over 200 students received free books. 

GHHI hosted a twitter chat featuring HUD Secretary Castro and GHHI, President & CEO, Ruth Ann Norton. Utilizing #LeadFreeChat the conversation addressed lead poisoning prevention and resulted in enthusiastic engagement from communities and partners with over 1.3 million impressions. Additionally, President and CEO, Ruth Ann Norton presented GHHI's Strategic Plan to End Childhood Lead Poisoning - A Five Year Blueprint for Action via live webinar.
GHHI experts visited classrooms throughout the entire week to teach students about lead poisoning prevention and executed events to build awareness. Derek the Dinosaur went on his annual school tour and visited over 200 kids teaching them about lead poisoning prevention.
GHHI partnered with the EPA, Morgan State University and Baltimore City to provide a free community fair with free trainings, food trucks, fire trucks, fun activities and lots of great services and resources available to Baltimore residents. 

  
 


 

GHHI National Lead Poisoning Prevention Week Events


Jackson, Mississippi

Thursday, October 18:  Proclamation Recognizing Lead Poisoning Prevention Week
Jackson City Hall: Mayor Tony T. Yarber will issue a proclamation recognizing Lead Poisoning Prevention Week in the City of Jackson. Mayor Yarber and staff from the Department of Planning & Development and the Green & Healthy Homes Initiative Jackson will share information about the Lead Safe Jackson Housing Program with the City Council during their regular meeting.

Wednesday, October 26:  Lead Safe Jackson Housing Program Kickoff |  Mayor Tony T. Yarber will announce the Lead Safe Jackson Housing Program, sharing information with the public about the program purpose, family eligibility, and how to apply for services. Program partners from GHHI Jackson and other agencies will be in attendance.

Wednesday, October26: Midtown Night OutMidtown Partners and Millsaps College  |  Campus 1 Community are hosting the annual Midtown Night Out and Trunk-Or-Treat at Midtown Public Charter School. GHHI Jackson and other community partners will be on site to provide information and resources to neighborhood residents and families with children enrolled in neighborhood schools.

Atlanta, Georgia

Friday, October 28 Healthy Housing Tour | City officials and stakeholders will tour homes recently rehabilitated for health and energy efficiency.  

Saturday, October 29  Lead Safe Atlanta Octoberfest  | Host activities for children complete with costumes and vendor tables on lead hazards and tips on making our homes healthier and pest free |  Blood testing at this event.

Lewiston-Auburn, Maine

Green & Healthy Homes Initiative and partners are giving away free lead dust kits for lead poisoning prevention week.  Learn More: http://bit.ly/2dnA27J

New Haven, Connecticut

 Saturday, October 20 Annual Taste of the Caribbean Fest  |  Educate community members and build awareness of the problem of lead poisoning and ways to prevent the disease.  |  Lead Inspectors will visit elementary school classrooms to read the book “Henry and Fred Learn About Lead”. | Students will receive book bags containing lead poisoning prevention materials and educational supplies.

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