Tuesday, April 30, 2019

Integrity Marketing Group Expands Leadership Team with the Addition of Two Seasoned Executives


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Integrity Marketing Group Expands Leadership Team with the Addition of Two Seasoned Executives






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Researchers on the Path to a Cure – Spotlight on Dr. Farshid Guilak

Friday, February 3  |  Arthritis Foundation
In July, we reported on Dr. Farshid Guilak’s remarkable breakthrough in orthopedic and osteoarthritis research. That research found a way to grow new cartilage on a hip joint shaped scaffold, using stem cells. His current Arthritis Foundation-funded project, “Engineering New Biologic Therapies for Arthritis,” is just as trailblazing.
Dr. Guilak is working on an “arthritis vaccine.” It’s a way to deliver customized drug treatment and cell repair through the use of a biologic product.
His current research has created smart stem cells. “Stem cells don’t target specific areas,” said Dr. Guilak. “We are (genetically) reprogramming stem cells to do what we want them to.”
According to Dr. Guilak, the genetically created smart stem cells identify inflamed cells. Once the inflamed cells are identified, the smart stem cells incorporate themselves, not only to repair damaged cartilage, but also to produce and deliver specific therapeutic drugs to stop the inflammation. The smart stem cells are programmed to be active only when and where inflammation is present.
He explained that this application is currently aimed at inflammatory diseases like rheumatoid arthritis (RA) and that the advantage of using smart stem cells is that they can be individually designed to deliver just the right amount of therapy, instead of a constant, long-term exposure to very strong anti-inflammatory drugs. Dr. Guilak said that the smart stem cells will stop the inflammation and repair damaged cells at the same time. For his next steps with this technology, Dr. Guilak wants to work on sciatic and JIA applications for smart stem cells. “The inflammatory processes are different for these diseases than RA,” he explained. “So we need to adjust the programming.”
Highly committed to the arthritis community and finding cures, in his spare time Dr. Guilak enjoys taking part in the foundation’s Jingle Bell Run. His team has won awards for fundraising and best team costumes in the past. A big Star Wars fan, last year he and his team took on a Star Wars theme. His humor and dedication were obvious when he played “Darth-ritis” at last year’s event!
Dr. Guilak and his team have also taken part in some of our Juvenile Arthritis conferences by teaching sessions to explain arthritis and the importance of research. They had kids of all ages use gels to create cartilage for a hands-on understanding of how things work. His team also used “Cure E. Us” the mouse to explain lab research.
Dr. Guilak is a professor at Washington University Department of Orthopedic Surgery and is Director of Research for Shriners Hospitals for Children in St. Louis. He is also the co-director of the Washington University Center of Regenerative Medicine and has appointments in the Departments of Developmental Biology and Biomedical Engineering.
We thank Dr. Guilak and all of our researchers for the amazing, innovative and truly inspiring work that they do day in and day out. To read more about our researchers, check out these past articles:
§  Researchers on the Path to a Cure – Spotlight on Dr. Markus Wimmer
§  Researchers on the Path to a Cure – Spotlight on Dr. Herb Sun
§  Researchers on the Path to a Cure – Spotlight on Dr. Hongsik J. Cho
http://blog.arthritis.org/news/arthritis-research-farshid-guilak/?utm_source=email&utm_medium=DDM&utm_campaign=research&mkt_tok=eyJpIjoiT0RFNFltUTVOVEF3Tm1FMyIsInQiOiJRNGs4cFlwOFdCUllPRGQwU0FFMUlcL0dEczhcL1wvVHp0QlZienlrQW1OeTlCaW9vWEVkN1hzeFRDR1BvUmg0MWhpU3IxWkxxR1RcLzFIdE1XTFwvRk5haVFLejBVSmc4dE94ZTVMOW42YjcrbDFyY3pXRWFxZTFZeHkyRXQ4TGZwZ0IzIn0%3D
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Glaucoma? Meet VA doctor working to improve vision

Dr. Mary Lynch receives Innovator Award for work that benefits Veterans



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Many Veterans with glaucoma have benefited from the pioneering work of Dr. Mary Lynch of the Atlanta VA medical center.
During her career, Lynch’s research has centered on innovative ways to deal with difficult problems in glaucoma.
(You may have to fire up your favorite search engine to understand…and appreciate…her remarkable achievements. There’s also a link to a video in this story which tells the story of her innovations…also in medical terminology…but very impressive!)
She wrote the first paper describing central nervous system side effects from beta-blocker eye drops. Her observations led her to work on the development of dropper tips that could produce smaller eye drops. This work has been incorporated into current dropper tip designs.
She also wrote the first paper describing the surgical treatment of pseudophakic malignant glaucoma: the creation of the unicameral eye that still is the basic principal of malignant glaucoma treatment.
Lynch also wrote the first paper describing the 360-degree suture trabeculotomy to treat congenital glaucoma. This option had a much higher success rate than other protocols and gave children a higher chance of achieving normal vision. The 360-degree trabeculotomy technique now has been expanded to include adults with glaucoma, including Veterans.
The American Glaucoma Society has named Lynch the 2019 recipient of the society’s prestigious Innovator Award. The award is given to one physician each year in recognition of his or her contributions to the field of glaucoma.
She is the first woman to receive this award.
In 1999, Lynch developed the EyePass in collaboration with her husband. The EyePass was the first trabecular bypass device for glaucoma and initiated a new category of glaucoma surgery: minimally invasive glaucoma surgery (MIGS). Last year, nearly 1500 Veterans received MIGS glaucoma surgery based on the pioneering work of Dr. Lynch.
As a physician with the Atlanta VA Medical Center, Lynch has a strong interest in improving eye care delivery and enhancing other aspects of life for aging Veterans who have poor vision.
Lynch is a professor of ophthalmology at Emory University School of Medicine/Emory Eye Center. She joined Emory and the Atlanta Veterans Affairs Medical Center in 1988.
“My husband, Reay Brown, and I were recruited to the Emory Eye Clinic in 1988 to run the glaucoma service,” Lynch says. “We were drawn to Emory’s rich tradition of clinical and bench research, the teaching opportunities afforded by Grady and VA, and the outstanding and collegial faculty.”
This video describes her distinguished career and achievements.
“Initially, I thought working at VA would be a temporary move and that I would return to Emory once the girls were grown,” Lynch says. “But VA proved to be a wonderful place to work with very grateful patients. Over time I was able to build up one of the largest sections in the hospital and expand the residency training program. I also became involved in national committees and was able to launch a number of innovative programs.”
She also established a foundation in memory of her daughter, Madeleine Jude Brown, who passed away in 2006. The MJB Foundation provides a four-year college scholarship to one or two high school students from Atlanta each year. As president of the foundation, Lynch has thus far mentored 12 students through their college journey.
The Emory Eye Center is obviously very proud of her honor.
Dr. Allen Beck, interim chair of ophthalmology and interim director of the Emory Eye Center:
“I will always remember her saying ‘We are making history!’ whenever we were performing circumferential trabeculotomy surgery. Congratulations to Mary for this outstanding award and her years of service to Emory and VA.”
Hans Petersen is senior writer-editor for Digital Media, VHA Office of Communications. An Air Force Veteran, Hans also served two years in the Peace Corps and worked for 20 years in broadcasting before joining VA.
https://www.blogs.va.gov/VAntage/59552/glaucoma-meet-va-doctor-working-improve-vision/
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WellCare's first-quarter earnings lifted by Meridian deal

SHELBY LIVINGSTON  April 30, 2019
As WellCare Health Plans prepares to combine with rival Centene Corp., the Tampa, Fla.-based insurer's first-quarter 2019 revenue and profit were helped by another acquisition.
WellCare's $2.5 billion tie-up with Meridian, which closed in September, boosted the insurer's membership rolls and premium revenue in the three months ended March 31, just as it did in the fourth quarter of 2018.
But the script is about to flip. WellCare CEO Kenneth Burdick told investment analysts Tuesday that integration planning for the Centene merger announced last month is underway and slated to close in the first half of 2020, pending approval by regulators. Medicaid membership-heavy Centene would reap the benefits of WellCare's growing Medicare membership.
"We're excited about the long-term opportunities for driving profitable growth as a combined company," Burdick said. "In the near-term, our focus continues on our commitments to our members, our partners and our shareholders."
WellCare's revenue soared 45.5% to $6.8 billion in the first quarter compared to the same period a year ago, while its net income ballooned by 48.9% to $151.4 million. The company attributed the increases in revenue and profit to the Meridian acquisition, along with organic growth across all lines of business.
WellCare's deal with Meridian, along with Medicaid contract wins in Florida and Arizona, helped boost its total membership to 6.3 million at the quarter's end, an increase of 47.4% year over year. Medicaid membership experienced the most growth, rising 52.3% to 4.1 million. Most of that membership growth was located in Illinois.
But WellCare's prescription drug plan membership also increased by more than half a million members to 1.6 million, thanks to the insurer launching a new product that "has been highly attractive in today's market," Burdick said. WellCare's Medicare health plan membership grew 10.3% to 558,000.
Membership growth lead to higher revenue across the business segments. WellCare receives the bulk of its revenue from Medicaid health plans, which brought in $4.5 billion in revenue, an increase of 59.2% over the first-quarter 2018. Medicare revenue grew 18.4% to $1.8 billion, and Medicare prescription drug plan revenue increased 11.1% to $288.8 million.
WellCare's medical loss ratio—the amount of premiums spent on medical claims and quality improvement activities—either rose or stayed flat across the business lines due to the Meridian acquisition, the company said. While the Medicaid medical loss ratio rose to 89.9% in the first quarter from 86.3% a year ago, the Medicare medical loss ratio remained at 84%. The lower the ratio, the better for the insurer.
https://www.modernhealthcare.com/insurance/wellcares-first-quarter-earnings-lifted-meridian-deal?
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RIC Resources for Culturally and Linguistically Competent Long-term Services and Supports (LTSS)


From Our Partners
April 30, 2019

RIC Resources for Culturally and Linguistically Competent Long-term Services and Supports (LTSS)

LTSS are a vital part of care for many dually eligible beneficiaries. LTSS include nursing facility services, adult day programs, home care, and personal care services. Individuals from minority groups often experience disparities in access, quality, and outcomes in LTSS. To help address these disparities, providers and plans may look for ways to meet the cultural and linguistic needs, values, and preferences of diverse individuals.
Resources for Integrated Care (RIC) invites you to explore the resources linked below that contain promising practices relevant to a wide variety of LTSS settings, and case studies demonstrating these practices in action.
This webinar describes strategies plans and providers can use to identify LTSS preferences, values, and needs of members from diverse cultural backgrounds. It addresses effective approaches for providing LTSS and training the LTSS workforce.
This webinar is also available as a set of podcasts on the SoundCloud page. A supplemental resource guide and Q&A document are also available.
This spotlight describes culturally competent LTSS programs at Keiro Northwest, including assisted living and skilled nursing facilities, and home care and adult day programs. It highlights how they incorporate architecture, décor, food, activities, and community connections to meet participants’ needs and preferences.
This resource compendium is intended for providers and health plans interested in enhancing capacity to provide and coordinate culturally competent LTSS. Resources include reports, guides, tools, and trainings applicable to a range of settings.
More than one million older adults self-identify as LGBT. Providers may not always know how to best support LGBT individuals in ways that meet their needs and preferences. This compendium offers resources to providers interested in enhancing their capacity to provide culturally competent LTSS for LGBT individuals.
Explore more resources on cultural competence
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From Ballot Initiative to Waivers: What is the Status of Medicaid Expansion in Utah?


MaryBeth Musumeci Follow @mmusumec on Twitter and Robin Rudowitz Follow @RRudowitz on Twitter
Published: Apr 30, 2019
ISSUE BRIEF  ENDNOTES
Like Idaho and Nebraska, Utah voters supported a November 2018 ballot measure to adopt the full Medicaid expansion as set out in the Affordable Care Act (ACA). Utah voters approved a full ACA expansion to cover nearly all adults with income up to 138% of the federal poverty level (FPL, $17,236/year for an individual in 2019), an April 1, 2019 implementation date, and a state sales tax increase as the funding mechanism for the state’s share of expansion costs. By implementing a full ACA expansion, Utah would qualify for the substantially enhanced (93% in 2019 and 90% in 2020 and thereafter) federal matching funds. The expansion population in Utah includes childless adults ages 19-64 with income from 0 to 138% FPL and parent/caretakers ages 19-64 with income from 60% to 138% FPL. The fiscal note from the ballot initiative estimated that approximately 150,000 newly eligible individuals would enroll in Medicaid in fiscal year 2020. However, Utah is one of 11 states (out of the 21 states that allow state laws to be adopted via a ballot initiative) that have no restrictions on how soon or with what majority state legislators can repeal or amend voter initiated statutes.
The Utah legislature significantly changed and limited the coverage expansion that was adopted by the voters. Governor Herbert signed Senate Bill 96 into law on February 11, 2019. The state released an implementation toolkit that follows the legislation in calling for multiple steps to implement an expansion of Medicaid coverage to adults in ways that differ from a full ACA expansion (Figure 1).
https://www.kff.org/wp-content/uploads/2019/04/9303-Figure-1.png?w=735&h=551&crop=1
Figure 1: State legislation calls for Utah to submit a series of waiver requests to CMS that limit the Medicaid expansion passed by voters.
Utah’s Amended Waiver
On March 29, 2019, CMS approved an amendment to Utah’s existing Section 1115 demonstration waiver to expand Medicaid to a capped number of adults with income up to 100% FPL beginning on April 1, 2019 at the state’s regular Medicaid matching rate, not the enhanced ACA matching rate.1 The authority to cover this “Adult Expansion Population” expires on January 1, 2021. The Adult Expansion Population under the waiver includes childless adults ages 19-64 with income from 0 to 100% FPL2 and parent/caretakers ages 19-64 with income from 60% FPL to 100% FPL,3 a more limited coverage expansion than the 138% FPL approved by the voters (Figure 2). The state estimates that approximately 70,000 to 90,000 people will be covered under the waiver with financial eligibility limited to 100% FPL, about 40,000 fewer compared to a full ACA expansion to 138% FPL.4
https://www.kff.org/wp-content/uploads/2019/04/9303-Figure-2.png?w=735&h=551&crop=1
Figure 2: Medicaid eligibility limits for Utah adults under S.B. 96 are lower than under the voter-passed ballot initiative.
Instead of the 90% enhanced federal matching rate tied to newly eligible adults under a full ACA expansion, Utah is receiving its current, traditional federal matching rate of 68%, which will result in higher state costs for expanding coverage to 100% FPL instead of a full expansion to 138% FPL (Figure 3). Utah refers to the March 2019 waiver amendment as the “Bridge Plan” because the state will seek further waiver amendments as required by Senate Bill 96 and described in the text below. Utah’s pre-ACA coverage expansion, authorized by its waiver prior to the Bridge Plan amendment, is described in Box 1 below.
https://www.kff.org/wp-content/uploads/2019/04/9303-Figure-3.png?w=735&h=551&crop=1
Figure 3: Under its current waiver, Utah receives its traditional match rate for coverage up to 100% FPL with an enrollment cap, but plans to seeks the ACA expansion match rate for this limited coverage group.
Utah’s amended waiver includes an enrollment cap to be imposed at state option on the Adult Expansion Population, meaning that not all eligible people may be able to enroll in coverage. The waiver allows the state to close enrollment for the Adult Expansion Population, which could limit enrollment further than the coverage estimates noted above. The waiver does not specify a pre-determined maximum number of people to be covered but instead allows the state to stop enrolling eligible people “if projected costs exceed state appropriations.” If the enrollment cap is reached, the state will not maintain a waiting list; instead, eligible individuals will have their applications denied and will have to reapply for coverage when enrollment re-opens. Consequently, individuals who apply at the beginning of a state fiscal year could be more likely to gain coverage than those who apply later in the fiscal year, even though they are otherwise eligible, if the state imposes the enrollment cap. Individuals with lower incomes or higher needs, compared to those already enrolled, might be barred from enrolling in coverage as a result of the timing of their application due to the enrollment cap. No other state currently has approval for an enrollment cap on adults who are eligible under the ACA Medicaid expansion. As explained in Box 1, enrollment caps are no longer necessary to ensure federal budget neutrality because the ACA now allows states to access federal Medicaid funds for this coverage directly through the creation of the new adult eligibility pathway and the availability of federal matching funds.
Box 1: Coverage Expansion Under Utah’s Waiver Prior to the ACA
In 2014, the ACA for the first time authorized federal Medicaid matching funds for coverage for nearly all nonelderly adults. Prior to 2014, federal Medicaid funds only could be used to cover pregnant women, parent/caretakers, children, seniors, and people with disabilities. Adults without dependent children were ineligible for Medicaid, no matter how poor they were. Before the ACA, some states used Section 1115 waivers to establish coverage expansions beyond the limits of federal law. Because federal Medicaid funds could not be accessed directly to cover these adults, these waivers included provisions to generate savings to fund coverage expansions, such as limited benefit packages, premiums, and/or mandatory managed care enrollment, and sometimes enrollment caps as a way to limit federal spending and ensure federal budget neutrality.5 However, budget neutrality is no longer a consideration for such coverage expansions under waivers now that federal Medicaid law, as amended by the ACA, includes an eligibility pathway and allows states to receive federal Medicaid matching funds to cover nearly all nonelderly adults, including those without dependent children, up to 138% FPL without the need for a waiver.
Utah’s existing Section 1115 waiver was first approved in 2002, and included a pre-ACA coverage expansion (called the Primary Care Network, PCN) to parents with income above the state plan limit (60% FPL) and childless adults (for whom no state plan coverage was available). As of March 2019, the PCN income limit was 100% FPL. The PCN coverage expansion provided a limited benefit package of primary and preventive services6 to a capped number of these adults and was funded by reduced benefits for traditional low-income (categorically and medically needy) parents. The March 2019 waiver amendment suspends authority for Utah’s pre-ACA PCN coverage expansion and moves the 17,500 parents and childless adults in the PCN group as of March 2019 to the new “Adult Expansion Population” (described in the text above) effective April 1, 2019.7
Utah’s amended waiver also includes a work requirement as a condition of eligibility for the Adult Expansion Population, beginning no sooner than January 1, 2020.8 In Utah, individuals subject to the work requirement must complete certain activities within the first three months of each 12-month eligibility period or qualify for an exemption. Those who fail to do so will lose coverage for the rest of the year or until they fulfill the requirement. Required activities include registering for work through the state’s online system, completing an online employment training needs assessment, completing online job training modules identified through the assessment, and applying for work with at least 48 potential employers.
What is Next?
Senate Bill 96 calls for Utah to submit a subsequent Section 1115 waiver amendment proposal that includes a request to receive the 90/10 ACA enhanced match for coverage up to 100% FPL subject to an enrollment cap. This “Per Capita Cap Plan” is expected to be submitted to CMS in the spring of 2019. The Per Capita Cap Plan would continue provisions in the Bridge Plan (coverage up to 100% FPL, an enrollment cap, and a work requirement), and add 12-month continuous eligibility, coverage lock-outs for unspecified program violations, housing supports, elimination of hospital presumptive eligibility, and a per capita cap on federal funds. The state legislation does not explain how such a per capita cap would operate other than to say that it would include an annual inflationary adjustment, account for “differences in cost among categories of Medicaid expansion enrollees,” and provide “greater flexibility to the state than the current Medicaid payment model.”
If CMS does not approve the Per Capita Cap Plan by January 1, 2020,9 the state will submit another waiver amendment request seeking authority for a coverage expansion up to 138% FPL with the ACA enhanced matching funds and an enrollment cap. This “Fallback Plan” also would include coverage lockouts for unspecified program violations and elimination of hospital presumptive eligibility. The Fallback Plan would continue the work requirement but would not seek a per capita cap on federal funds.
If the Fallback Plan is not approved by July 1, 2020, the state will adopt the full Medicaid expansion as set out by the ACA and approved in the ballot initiative. This would include coverage of all eligible adults up to 138% FPL at the ACA enhanced matching rate and would use a state plan amendment instead of waiver authority. It would not include a work requirement or enrollment cap as proposed in the waiver proposals described above.10
Other states will be watching for CMS’s response to Utah’s forthcoming waiver request seeking the ACA enhanced federal matching rate for a partial capped expansion. The ACA provides enhanced federal matching funds to states that expand Medicaid to nonelderly adults up to 138% FPL. To date, CMS has allowed states to receive the ACA enhanced Medicaid matching funds only if the entire expansion group is covered. Prior to Utah’s request, Arkansas and Massachusetts sought waivers to receive the ACA enhanced match while limiting coverage to individuals at 100% FPL, but CMS did not approve those waiver requests. A separate brief explains that relative to full expansion, a partial expansion with enhanced federal matching funds could result in less coverage and higher federal costs. If approved, Utah’s request for the ACA enhanced federal matching funds for a capped, limited partial expansion will open a new chapter in the debate over Medicaid in both expansion and non-expansion states.
https://www.kff.org/medicaid/issue-brief/from-ballot-initiative-to-waivers-what-is-the-status-of-medicaid-expansion-in-utah/?utm_campaign=KFF-2019-Medicaid&utm_medium=email&_hsenc=p2ANqtz--eDwV03rkdfdSOwDI2Mklogs4pT0uz8VZhTfewcBF0TL9k-SB_DqA3PF-JfQtA6WS77hDXsSEgBlE_T8Tb_dciJzo6KA&_hsmi=72219913&utm_content=72219913&utm_source=hs_email&hsCtaTracking=5ebadb07-f2b1-4bb6-9a16-a32041bdd828%7Caaf311b6-85ef-490f-8398-00f7e4d3415c

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