H.R. 7038 The CHILD Act – Incenting Communities to Improve the Health of Their Medicaid Beneficiaries

This past week on PopHealth Week Gregg and I discussed the Annual Medicare Wellness Visit and how it came to be.  I have always dabbled in policy and was fortunate enough to participate in the creation of that piece of legislation.

More recently,  a small group including Reyn Archer, MD, the former Commissioner of Health for the State of Texas and current Chief of Staff to Congressman Jeff Fortenberry, Doug Goldstein and I have been exploring ideas on community health improvement. One of the key gaps we identified was that if a person or community works to improve their health, the financial benefit accrues to the payer or providers. At the same time, sustainable financing has been a fundamental problem with many of the community health improvement initiatives, such as Blue Zones, The Way to Wellville, the Clinton Health Matters Initiative, Humana’s Bold Goal initiative, which typically have the funds to get started, but after a few years have no source of revenue to continue. We sought to solve these two issues.

While I have been working on a concept I call Havens of Health, a Medicare /Medicaid  Health Plan owned by its members;  Reyn had come up with the concept of creating Community Shared Savings Accounts as the vehicle to distribute/share funds and provide incentives.

For the past three years we have been working on legislation to do just that, and I am excited to announce that we now have a Bill, H.R. 7038 the “Community Health Improvement, Leadership, and Development Act of 2018” or the “CHILD” Act.   The purpose of the bill is:

To give communities the tools to improve their own health outcomes through community-relevant health information and new health supporting incentives and programs funded without further appropriations.

The idea is simple:

  • it tasks HHS/CMS with putting together data sets of relevant Medicaid epidemiological and claims health information,
  • provides grants to states to carry out localized Community Health Improvement programs which includes the creation of dashboards for the community
  • The Community puts together a program to target one or more of these conditions and
  • if the program reduces the rates of illness in the  community’s Medicaid beneficiaries and/or lowers costs, 70% of the savings would go back to the community.
  • These savings would be placed in the Community Savings Account to be overseen by a local board, and “used for promoting the health and wellness of residents of the community.”

This bill has bipartisan support, being co-sponsored by Congressman Jeff Fortenberry (R) and Congresswoman Eddie Bernice Johnson (D), and establishes an incentive for communities to work to improve the health of their residents while also creating a sustainable source of funding for communities to begin to work together on both the clinical and social determinants of health, as some have been doing for a while.

If you’d like more information on H.R. 7038 please contact me.

Advertisements

Leave a comment

Filed under #SDOH, PopHealth Week

PopHealth Week – Annual Medicare Wellness Visit,Value Based Care and Employers

Gregg and I had an interesting discussion on this week’s episode of PopHealth Week. We covered the Annual Medicare Wellness Visit and how it came to be, as well as value based care and some interesting moves by employers (Walmart and the Utah State Employee Health Plan) and providers (Oschner and their ACO).  Listen in:

PopHealthWeek-logo-TWTTR-sq PopHealth Week – The Medicare Annual Wellness Visit, Oschner and Walmart, Utah Employees and high Cost Pharmaceuticals, a new approach.

Leave a comment

Filed under Health Innovation Media, PopHealth Week

The Continuing Errors of the Wellbeing/Wellness Industry: Notes from a recent conference.

At some point the industry needs to come up with some way to police itself. Why?  I recently attended a meeting of the key companies and leaders in the wellbeing industry. Here were some statistics presented by a large corporation during a panel that included one of the Senior Executive’s of the company offering the employer their wellness service:

Incentives Associated with the Company Wellness Program

Annual Physician Visit –  $100

So why are they incenting employees to get an annual visit? Amongst the many screenings recommended by the USPSTF it gives it an A Grade to annual screening for adults aged 40 years or older and for those who are at increased risk for high blood pressure. Adults aged 18 to 39 years with normal blood pressure (<130/85 mm Hg) who do not have other risk factors should be re-screened every 3 to 5 years.

Health Risk Appraisal (HRA) $100

I believe this one is fine.

Annual Biometric Screenings $300

Again this is over-testing and not recommended annually. Per the USPSTF various biometric screens such as abnormal blood glucose a typical screening included in these gets a B Grade. The USPSTF recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese.

Both the annual physician office visit and the annual biometric screening are not recommended for many in the younger age categoris or those with no known risk factors.  So why would the conference, the company and the senior population health executive offer up this information as an example of an excellent program?

Then they presented a slide on outcomes:

82% of all continuously enrolled maintained or improved their health continuum status.

This one is just bogus as presented, but let’s go through it.

  1. Selection bias, by only measuring those who enrolled and then were continuously enrolled (2 out of 3 strikes) selection bias is all over this one. See the Illinois Workplace Wellness Study.
  2. How many didn’t enroll at all?
  3. How many enrolled, but quit?
  4. What was the definition of maintain or improved health?
    1. Might it have been one measure and others got worse?
  5. What was the net overall change in risk a la Dee Edington (Natural Flow) or perhaps the movements for each of the individual health measures?

Again as a Wellbeing expert why would the vendor allow their client to put this slide up?

The weight loss program they ran offered by one of the well-recognized national vendors had 2,600 participants who lost 9,226 lbs during the year.  Wow an average of 3 lbs! Was that at 12 months? How many gained versus lost weight during the period? How many dropped out?

And the next line showed a weight loss challenge at 12 weeks. In which over 1,300 participants had lost about 12,000 lbs or about 10 lbs each.  Again these weight loss challenges have not been shown to create sustainable weight loss.   How did they look at the end of the year?

But to add insult to injury, this presentation was the final one of the day that began with a nationally recognized academic who when asked which is the best weight loss program, gave this answer:

“any weight loss program can show weight loss over 3-6 months, but a year or two later they gain it back and often gain back more.”

So they started the day honestly and finished it a little less so, to put it nicely. But the bigger issue is:

Isn’t part of our job as experts to inform and educate clients to do what works, what is evidence based and report on what’s meaningful and real? ”

Why would you let one of your clients present this at a major national conference. And then while you are on the stage, tout it as success and look the other way. And, if this is a reflection on your program, one allowing excess testing, inappropriate visits and the reporting of meaningless results what does it say about your program?

Come on, we can and must do better.

 

 

Leave a comment

Filed under Uncategorized

John D. Bower School of Population Health

JDB LogoI’m honored to have been appointed as Graduate Faculty at the John D. Bower School of Population Health at the University of Mississippi Medical Center.

The School is one of the few schools of Population Health in the nation and “their mission is to educate leaders who will transform health care delivery and the health of Mississippians.

This really resonated with me as I had previously done work in Mississippi when Specialty Disease Management Services Inc. (SDM) was involved in the Medicaid disease management initiative as a subcontractor to McKesson Health Solutions.  SDM provided on the ground RNs and community care coordinators located throughout the state seeking to improve the health and care for Medicaid beneficiaries with asthma, diabetes heart failure and COPD. I also have in-laws in Leland, Mississippi in the heart of the Delta.

beech,-bettina1The school is led by Dr. Bettina Beech, their Dean, who is a dynamo building the school and truly working to embed the schools expertise into the state by getting involved in programs to leverage population health in an effort to improve the health of all Mississippians.  Her areas of scientific inquiry focus on the role of nutritional factors in the primary and secondary prevention of obesity and type 2 diabetes, with a particular focus on child health disparities.

The School has three departments, Continue reading

Leave a comment

Filed under Uncategorized

PopHealth Week Interview with Dr. Anthony Slonim of Renown Health

This week’s episode of PopHealth Week had a broad ranging and fascinating interview with Anthony Slonim, MD the President and CEO of Renown Health. We cover their community efforts, ACO, the Healthy Nevada Genetic Testing initiative which already has 35,000 people enrolled, value based care and other topics.

delivery models focused on improving health within the community. He is board-certified in Internal Medicine, Pediatrics, Internal Medicine Critical Care and Pediatric Critical Care and is an academic leader with faculty appointments as Clinical Professor in the Departments of Internal Medicine and Pediatrics at the University of Nevada, Reno School of Medicine. He also holds a master’s degree and a doctorate in Administrative Medicine and Health Policy from George Washington University Center for Health Policy Studies and has more than 100 publications and 15 textbooks to his name.

Since joining Renown Health in July 2014, Dr. Slonim has reoriented northern Nevada’s largest locally governed, not-for-profit healthcare network. He launched a five-year strategic plan that is focused on the community’s overall health while embracing the national triple aim initiatives of improving quality care and patient satisfaction — all while reducing costs. Dr. Slonim also ushered in a new era of national collaboration to establish a medical training campus at Renown and expanded the region’s quaternary care services in collaboration with Stanford Medicine.”

PopHealthWeek-logo-TWTTR-sq

Listen to Anthony Slonim, MD on PopHealth Week

Dr. Slonim is an innovator and proven leader in healthcare at both the regional and downloadnational levels. During his notable career, Dr. Slonim has developed a profile as an expert in patient safety, accountable care, healthcare quality and innovative care

Leave a comment

Filed under Uncategorized