Monday, September 30, 2019

Addressing Patients’ Social Needs Within Health Care Delivery Is Key to Improving Health Outcomes and Reducing Health Disparities, New Report Says

Sept. 25, 2019
WASHINGTON — Whether a patient has a safe place to live or healthy food to eat has an important influence on their health, but such nonmedical social needs have not traditionally been addressed in routine health care visits. A new report from the National Academies of Sciences, Engineering, and Medicine, Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health, contains five overarching goals and associated recommendations that health care systems, government agencies, and others should implement to better integrate patients’ social needs into health care delivery.

Two trends are driving a need to integrate social care with health care, the report says. Firstly, the health care system is moving toward paying care providers based on health outcomes, rather than for individual visits or services. Secondly, there is increasing recognition that addressing the social determinants of health — nonmedical factors such as housing, education, neighborhood safety, and employment — has a profound impact on one’s physical and mental health.

“Even if people get the best medical care available to them, they may still have poor health outcomes if other social needs such as housing, reliable transportation, or a strong support system at home are not addressed,” said Kirsten Bibbins-Domingo, a general internist and vice dean for population health and health equity at the University of California, San Francisco, and chair of the committee that wrote the report. “Integrating social care into health care delivery can be transformative for addressing the individual needs of patients and the collective needs of communities. However, we need the workforce, financing, and infrastructure to do this effectively.”

Industrialized nations that devote more resources to social services than health care tend to have better health outcomes, the report says. In the United States, for every $1 spent on health care, about 90 cents is spent on social services, while other industrialized countries spend $2 on social services for every $1 spent on health care. Social services constitute a variety of activities — including home-help for the elderly, rent subsidies, child allowances and credits, childcare support, job training, and disability benefits. The challenge of financing the integration of social care with health care in the U.S. is a matter of defining what activities are considered social care, and how they should be paid for, says the report.

The report recommends the following steps.

Better integrate social care into health care delivery. In order to implement social care more systematically throughout the U.S., health care organizations should:
·         Make an organizational commitment to addressing health-related social needs and disparities in individual and population health
·         Identify the most effective ways to assess and document social needs, recognizing that evidence for these practices is evolving
·         Include social care providers — such as social workers, community health workers, home health aides, and gerontologists — as an integral part of health care teams
·         Establish more formal linkages, communication, and financial referral relationships between the health care and social care sectors
Support and train an engaged, integrated care workforce. Social care professionals work in a variety of settings, including health facilities, schools, homes, and community-based organizations. However, certain federal, state, and institutional barriers limit adequate payment of social care workers and their ability to work to the full extent of their education and training, says the report. Social care workforce development efforts should aim to:
·         Develop, expand, and standardize the scopes of practice of social care workers
·         Create standards for the reimbursement of social care by public and private payers
·         Test for knowledge of social determinants of health in licensure exams, continuing education courses, and in other credentialing capacities for health professions such as medicine and nursing
·         Adopt curricula that prepare students of social work to use technology, data collection methods, and payment models that facilitate social and medical care integration

Develop an infrastructure for data sharing between health and social care.
The report calls for a national vision and defined technology standards for integrating health care and social care data, similar to the standards underpinning the adoption of electronic health records. It recommends:
·         The Office of the National Coordinator for Health Information Technology should help states and regions determine the best way to share data necessary for care coordination
·         The Federal Health Information Technology Coordinating Committee should facilitate data sharing across sectors including health care, housing, and education
·         The U.S. Department of Health and Human Services (HHS) should work with the private sector to disseminate educational tools and guidance on data security and privacy when collecting and sharing personally identifiable information
Finance the integration of health care and social care. The report recommends that the Centers for Medicare & Medicaid Services:
·         Define which aspects of social care Medicaid can cover, and make the opportunities and limitations clear to health plans and health care and social care service providers
·         Incentivize health care organizations and the managed care programs that contract with Medicaid and Medicare to collaborate with community-based social services, such as Area Agencies on Aging
·         Coordinate the coverage and benefits of dually eligible and high-need Medicare and Medicaid populations
In addition, the report says, there are few formal evaluations of the effectiveness of integrating social care needs into health care delivery. Federal and state agencies, foundations, and other funders of research should support timely, robust evaluations that help inform policy. The report also recommends that HHS establish and support a “best practices” repository, to provide stakeholders with lessons learned and examples of effective integration of social care and health care.

The study — undertaken by the Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation’s Health — was sponsored by the Archstone Foundation; the Association of Oncology Social Work; Bader Philanthropies; Chicago Community Trust; Community Memorial Foundation; the Council on Social Work Education; Episcopal Health Foundation; Health Foundation of Western and Central New York; Healthy Communities Foundation; the Helen Rehr Center for Social Work Practice; Josiah Macy Jr. Foundation; Kaiser Permanente National Community Benefit; the National Association of Social Workers and the NASW Foundation; New York Community Trust; Robert Wood Johnson Foundation; SCAN Foundation; and the Society for Social Work Leadership in Health Care.

Additional support was obtained from the Boston University Center for Innovation in Social Work and Health social work academic program matching funds campaign. For a full list of contributing academic programs, visit the report’s activity page.

The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.


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House Democrats Long-Awaited Drug Pricing Proposal Calls for Direct Price Negotiation


September 30, 2019 | Brittany McCullough
Recently, House Speaker Nancy Pelosi released her caucus’s long-awaited proposal to lower the cost of prescription drugs. The bill, entitled “Lower Drug Costs Now Act of 2019” or HR 3, includes a number of provisions aimed at reducing drug prices. These provisions include allowing for direct price negotiations, reforming rebates under Medicare Parts B and D, and redesigning Medicare Part D to, in part, limit out-of-pocket costs for Medicare beneficiaries.
The most far-reaching section of the House Democrats’ bill allows the Secretary of the Department of Health and Human Services (HHS) to directly negotiate drug prices for Medicare and the private health insurance market. While the bill was in development, there was notable infighting among more moderate Democrats and their progressive counterparts due to concerns that the Speaker wasn’t going far enough to hold big pharma accountable. In addition, Republicans have generally opposed governmental price controls, with Senate Majority Leader Mitch McConnell already stating that the upper chamber would not “be calling up a bill like that.”
Despite this initial opposition, House Speaker Pelosi appears poised to move forward with plans to potentially try to get a vote on the House floor by the end of October.
Here are some of the highlights of the House bill:
  • Empowers HHS Secretary to directly negotiate the prices of 25-250 drugs annually
    • The maximum fair price would be the upper limit of 120 percent of the Average International Market (AIM) price
      • So, what does that really mean? The AIM price is essentially the average price of a drug in Australia, Canada, France, Germany, Japan and the United Kingdom
    • HHS Secretary would take research and development costs and the availability of alternative treatments into account when negotiating
  • Imposes an excise tax on drug manufacturers’ annual gross sales if they fail to comply with negotiation requirement
    • Tax would start at 65 percent and increase by 10 percent by quarter up to a maximum of 95 percent for every quarter the manufacturer fails to comply
  • Levies a new inflation rebate on drugs in Medicare Parts B and D that would require drug manufacturers’ price increases to be tied to inflation
    • So, what does that really mean? If a drug company has increased the price of a drug beyond the rate of inflation, they must either lower it or pay a rebate to the Treasury
    • This provision has a retroactive clause dating back to 2016
  • Establishes a new annual out-of-pocket spending cap of $2,000 for Part D beneficiaries starting with plan year 2022
The President himself has not formally endorsed the Speaker’s bill but he did tweet “it’s great to see Speaker Pelosi’s bill today” after lending support to Senate Finance Committee Chair Chuck Grassley’s bipartisan bill. However, Senator Grassley’s bill is also facing opposition from within his own caucus. While it’s par for the course to see a division between Republicans and Democrats on an issue as big as drug-pricing, it is interesting that there is strong disagreement within each party. Nonetheless, I am hopeful that some type of bipartisan drug-pricing deal reaches the President’s desk since we are about to enter an election year.

7 tips for a cheaper, healthier grocery bill


Healthy eating and staying on a budget — many would argue these two ideas do not fit together. I beg to differ! My number one recommendation for making it feasible: keep it simple and delicious, or as I like to say, simplicious.
Healthy eating is not about counting calories or watching the clock to ensure you’ve waited x amount of hours since your last meal. It’s about listening to your body’s cues and fueling it with whole, real foods, ideally in their natural form. But this can become overwhelming and difficult once you start to roam the aisles at the grocery store. From confusing marketing claims to items packaged for convenience, it’s easy to get lost in all the options.
When you’re out grocery shopping, make a list and keep it simple. Focus on these key guiding principles:
·         Healthy fats (i.e. olive oil, avocado, plain nuts and seeds, olives, avocado oil, nut butter, sesame oil, ghee/butter)
·         Avoid “naked” carbs, or carbohydrates that you eat on their own (i.e. quinoa, bread or rice, as well as fruit and starchy vegetables like sweet potato and corn). Ideally, you want to pair carbs with protein, quality fat and vegetables. For example, quinoa with chicken, olive oil and a vegetable medley.
·         Stick to whole, real foods over highly processed goods.
How to save money on groceries
Raise your hand if you have ever been blindsided by your grocery total at checkout. Me too. But there’s good news! If you’re trying to be responsible with your money, feed a growing family or put some pennies toward your next vacation, these seven rules can help.
1.        Avoid packaged and convenience items. They tend to cost more.
2.       Buy from the bulk bins. You can purchase the amount Healthy eating on a budget may require changing your perspective on what makes up a meal, and it certainly will require some practice (along with trial and error), but once you have about 15+ meals to put into rotation, you’ll be set! I’ve offered some of my favorites below.
Healthy eating is not about counting calories or watching the clock to ensure you’ve waited x amount of hours since your last meal. It’s about listening to your body’s cues and fueling it with whole, real foods, ideally in their natural form.
What a registered dietitian eats in a day
Take a look at this example of a budget-friendly menu. 
Breakfast
I like to rotate two breakfasts throughout the week to keep things interesting and include a greater variety of foods.
·         Plain Greek yogurt topped with frozen thawed berries*, pecans and cinnamon
·         Homemade egg sandwich
*Pro tip: frozen berries tend to cost less and if you heat them or let them thaw, the juices are released, which creates a fruit “syrup” and adds quite a bit of flavor to plain yogurt.
Lunch and dinner
If you make extra at dinner, you can enjoy leftovers for lunch the next day, which can easily be packed and taken to work or school. (That definitely beats spending $10 on yet another salad or sandwich from that café you’re sick of.)
Here are a few meals I like to rotate through on a regular basis:
·         Spring Roll Sauté
·         Simple baked/grilled chicken topped with pesto; Quinoa tossed with olive oil, tomato, cucumber and red onion
·         Wrap with deli turkey, spinach and honey mustard; Serve with an apple and peanut butter
·         Zucchini noodles tossed with olive oil and garlic and topped with Citrus Herb Meatballs
·         Slow cooker Mexican Stew garnished with avocado
Snacks
Choose one (or more, if needed) daily and rotate throughout the week.
·         Cheese bites
·         Carrots dipped in hummus
·         Celery with peanut butter
·         Pecan-stuffed dates (because we all need a little something sweet every now and then)
See, healthy eating on a budget isn’t rocket science — it just takes a little extra thought and planning. If you need help figuring out an eating plan that works for both your health goals and your wallet, talk to a registered dietitian.

Jessica Smosna, RD, LD, is a registered dietitian at Baylor Scott & White Specialty Clinic – Westlake. She completed her undergraduate studies at Bradley University in Peoria, IL, and her dietetic internship through the University of Houston. Along with a healthy lifestyle, Jessica believes vitamins N & L (nature & laughter) are key for optimal health. She and her husband have a growing family (both in terms of babies and dogs). Get to know JessicaView all posts by Jessica Smosna, RD, LD

4 ways to build a team that believes in making an impact


Establishing an impact-driven culture creates more room for individual and team fulfillment
Sep 26, 2019 @ 3:30 pm By Ron Carson
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As more than 230 Carson Group stakeholders converge in Omaha this week for our annual two-day, companywide retreat, their presence reminds me of what it means to make an impact. It reminds me that, as advisers, we often forget the reach of our actions and underestimate the effect our businesses have on the lives around us — or better yet, the impact we could have if we were more intentional about connecting our company's culture to the community.
Think about building an impact-driven culture on three levels: locally, nationally and globally. How are you involved with friends, family and individual passion-based projects? Maybe it's donating time at your son or daughter's school, supporting your own charity or foundation or donating resources, time, and energy to a recent, local natural disaster.
Expanding your lens to a national or global level may involve serving on boards, adopting an investment philosophy that aligns with ESG initiatives or partnering with larger organizations to extend your reach.
Over the past few weeks, we've kick-started a focused effort to encourage stakeholders to volunteer for causes they believe in and want to feed. The initiative has been absolutely eye-opening. We've seen firsthand how allowing room for this time can bring more fulfillment to our stakeholders' lives while building stronger bonds as a team.
A recent UnitedHealth Group study backs this thinking up when it found 81% of employees felt more connected to their colleagues as a result of volunteering. This push to give back also lowers stress levels, improves your team's sense of purpose beyond work and makes us physically healthier individuals.
If the research teaches us anything, it's that building an impact-driven culture addresses some of the most challenging obstacles we often can't remedy through our own efforts as business owners. Increasing compensation or giving more time off only go so far in helping professionals feel good about their work.
So how can you establish an impact-driven culture and strengthen your bond as a team?
1. Give employees space to give back. This can be in the form of paid time off to volunteer each year, group-organized initiatives or gift-matching programs. Show that you support them with the gift of time and resources.
2. Lead by example. Recently, I've been quite vocal about my own mission and the causes I believe in — and this is simply to encourage our own stakeholders. Life has a way of delicately masking the things that are most important, so be the example. Show your team what it looks like to be a servant leader.
3. Make it easy. Organizations like the United Way can help your firm, however big or small, design a workplace giving program to make it easy for employees to give back with the convenience of payroll deduction. Often, the biggest roadblock to making an impact is taking the first step, so think of ways to put opportunities in front of your team so they can opt in.
4. Create a wellness program. Physical wellness is just one piece of the puzzle. We know that mental health, financial health and emotional health make just as much of a difference in work satisfaction and fulfillment.
The physiological effect of involving yourself in a cause close to your heart can reduce depression risk and lower mortality rates, so by including volunteering as part of a wellness program, you further build that holistic space for stakeholders to improve their health and happiness.
All this said, creating an impact culture is not about adding additional responsibilities or stress to your team. It's simply about creating more room for individual and team fulfillment.
Hold true to who you are and the attitudes you want to inspire. You'll be surprised by the individual talents and passions that surface, and the impact it has on your firm — an impact that not only drives your team forward but unleashes an untapped potential you could never have experienced otherwise.
Ron Carson is CEO and founder of the Carson Group, which serves advisers and investors through its businesses: Carson Group Coaching, Carson Group Partners and Carson Wealth. Follow him @RCHusker.

CMS Continues Push for Transparency and Requires Health Plan Quality Ratings for Exchanges


September 3, 2019 | Brittany McCullough
The Centers for Medicare and Medicaid Services (CMS) recently announced they will require the public display of quality ratings for health plans participating on health insurance exchanges starting with the 2020 open enrollment period (OEP) which starts on November 1, 2019. Although not directly mentioned in the President’s June executive order, this announcement is in line with the Trump Administration’s continued push for transparency. According to a CMS bulletin on the matter, “exchanges will be required to publicly report 2019 quality rating information on their websites beginning with the individual market OEP for the 2020 plan year to help consumers compare and shop for qualified health plans (QHPs).”
For background, the quality rating system (QRS) was a provision outlined in § 1311(c)(3) of the Affordable Care Act. Per CMS’s fact sheet, the purpose of the QRS is to “help consumers make informed health care decisions, facilitate oversight of health plans and provide actionable information to health plans to improve the quality of services they provide.” The QRS is often referred to as the star ratings system because health plans are rated on a scale of 1 to 5 stars with 5 indicating the highest level of quality.
As noted on CMS’s fact sheet, under the QRS, health plans are compared on the following categories:  
  1. Medical Care
  2. Member Experience
  3. Plan Administration
The Medical Care category has the greatest weight assigned in terms of calculating the overall score, but all three categories are assessed on a scale of 1 to 5. After each category has a score assigned, CMS coverts this into an overall quality rating. Issuers with over 500 enrollees that have been operating for a minimum of three consecutive years (including the current plan year) must submit quality data to CMS to have their score calculated. Furthermore, they have to submit quality data for all product types or reporting unit (i.e. – issuers will have data for both health maintenance organizations and preferred provider organizations). Healthcare.gov will display both the overall rating and the rating for each individual category for each QHP by product type. State-based exchanges will also be required to publicly display quality information on their websites starting with the 2020 OEP.
In addition to announcing that QRS reporting will now be public, CMS also released a summary of the 2019 results. Out of 185 reporting units, 175 received at least 3 stars, 124 received at least 4 stars and 36 received the highest 5-star rating. Of those that received a 5-star rating, there was an even split with 18 participating on individually state-based exchanges and 18 participating on the federally-facilitated exchange (FFE). In terms of individual categories, only eight percent of reporting units received a 5-star medical care rating. For member experience, only six percent received a 5-star rating and for plan administration, 12 percent received a 5-star rating.
URAC-accredited health plans that participate on the Exchanges, including the FFE and state-based exchanges must comply with this requirement. CMS’s August 2019 bulletin includes detailed guidance on the quality rating information that must be displayed, the form to display it in and how to account for QHPs that do not have a rating. QHPs with questions regarding the QRS should direct them to the CMS Marketplace Service Desk at CMS_FEPS@cms.hhs.gov and include Marketplace Quality Initiatives or MQI-QRS in the subject as noted on CMS’s website.
CMS will continue to make updates to the QRS in their annual QRS and QHP call letters. If you’re interested in reading the final 2019 call letter, click here.

Time to Reject Stereotypes Associated With Aging In Marketing


Henry DeVries Contributor Sep 29, 2019, 04:00pm
Are we in marketing guilty of being ageist? Two out of three old people say yes.
We all know the day we turned old. It was our 50th birthday, when the application to join AARP arrived in the mail. If you haven’t hit 50 yet, your day is coming. For full disclosure I am an old person and a member of AARP (I love the discounts).
Once known as the American Association of Retired Persons, AARP is the nation’s largest nonprofit, nonpartisan organization dedicated to advocating for people 50 and older. With nearly 38 million members, AARP is an advocacy group to be reckoned with.
So what do people 50 and older feel about marketing images? For most 50-plus people, the views are not positive.
An AARP survey announced findings in September of 2019 that, overall, 69% of consumers ages 50 and older say media images are ageist, and 62% of consumers in the same group would consider switching to a brand they feel represents people their age. Among women ages 50 and older, this openness to switching brands based on representation jumps to 70%.
Listen up all those in marketing. As part of a multi-year initiative, AARP is pressing brands, designers, ad agencies and clients to change their attitudes in order to overcome the misconceptions of aging portrayed in ads.  
“Companies seeking to improve sales and connect with consumers should produce advertising campaigns that show people of all ages,” announced AARP on its website in an article titled “Brands Are Missing a Market Opportunity in the 50-Plus.” From my experience I can tell you this 50-plus sentiment about advertising misconceptions is not new. I recall being on a team helping Marriott Corporation with a marketing campaign for a new restaurant chain in the ‘90s. One of our target audiences was seniors (for full disclosure, I am a loyal Marriott customer to this day and I even own a tiny amount of Marriott stock).
While I headed the PR agency, the Marriott advertising agency invited me to attend some focus groups with seniors. They showed the seniors a series of “humorous” (that is what we call in journalism as “scare quotes”) ads featuring people who were 50-plus. I had the safety of sitting behind the one-way mirror.
After the agency showed the ads the focus group moderator asked the group for feedback. The seniors in the room honestly thought they were being punked, that the ads shown were not real and this was some hidden-camera reality TV show trying to get a rise out of them. “Those ads can’t be real,” said one senior, “who would want to go to a restaurant that made fun of us?”
The seniors gave us an earful of what they thought of how ads portrayed them.
Later, when I was president of an ad agency, we landed an account for senior housing and assisted living. I put on our own focus group and assembled a target group of people who were 60-plus. I thought our ads were great, and the focus group attendees thought they would be great too. But not for them, for their parents. They said if the ads were for them, we shouldn’t make the people in the ads look so old.
Marketing to seniors is tricky business. According to the results of a new AARP survey, advertisers should show ads with age diversity especially if they want to target consumers ages 50-plus, who say they are eager to buy from brands that represent them.
I applaud AARP for not just pointing out the problem, but trying to be part of the solution. In collaboration with Getty Images, AARP launched The Disrupt Aging Collection at Advertising Week New York this September. AARP says this program paints a more accurate portrait of how people age in today’s society. The new collection contains more than 1,400 images that challenge stereotypes around aging, portraying the active lifestyle of consumers 50-plus, while telling a more authentic story of how people live as they age. 

Costly Specialty Drugs Put Heavy Fiscal Pressure on Pharmacies, Employers


September 19, 2019 | URAC Staff
While studies showing employers are spending 40% of their drug costs on just 1% of all prescriptions, it’s never been more important for payers to partner with high-quality pharmacies and professionals at the top of their game.
In fact, it’s only going to become more important, says Heather Bonome, Director, Pharmacy at URAC, as many studies project that the 40% drug cost figure could climb to 60% over the next several years. When it comes to handling complex, expensive prescriptions such as biologic injectables, “there is so much more to being a pharmacist than counting pills” Bonome says.
Willis Tower Watson recently published a study that found that only ten drugs accounted for a full 20% of employers’ total pharmacy spend in 2018. In the report, Nadina Rosier, Pharm.D., and Head of Pharmacy practice at WTW added, “Pharmacy represents about 20% of employers’ overall health care spend and is expected to reach 25% by 2020.”
This dynamic puts a lot of pressure on pharmacies, Bonome says. They are being asked to dispense expensive and complex injectables and help ensure the prescription is the right fit for the individual patient. “Specialty pharmacists, trained properly, can provide critical clinical, financial and educational input to ensure these complex drugs are taken properly, avoiding potential harm to the patient and waste of valuable product,” Bonome says.
However, it’s not always easy for a payer or other customer to gauge the credentials of a pharmacy. Specialty pharmacies are regulated on a state-by-state basis and state regulations focus on general operational functions that are not specific to specialty medications. URAC’s Specialty Pharmacy Accreditation Program requires adherence to several key areas in addition to the requirements set out by pharmacy regulations.
Bonome cited Patient Management as a big differentiator in the URAC program. Because it is so important that these expensive and complex medications to be taken properly, it is imperative that the pharmacy conduct an initial clinical assessment to make sure the drug is right for the patient and periodically monitor the patient for adherence, side effects and efficacy. 
Patients also need to be trained on how to effectively administer their medications; they need to understand potential side effects, and they need to understand when and how best to keep the pharmacist informed of their progress. Otherwise, “patients sometimes stop taking the medication for the wrong reason” Bonome says. In that scenario, the patient is losing out on the benefits of the treatment, and the payer is incurring a large cost for on a product that’s not being used.
URAC standards also require a clinician be available 24/7. It doesn’t mean the pharmacy itself must be open, but the accredited operation must have a qualified clinician on call to answer patient or physician questions about these complex drugs.
Another key area covered by the URAC standards is cold-chain management. Because many of these expensive drugs are sensitive to temperature fluctuations, it’s imperative that they are shipped in secure containers that preserve steady temperature integrity. URAC’s standards address specific packaging and temperature management procedures and require a validated product-delivery program backed with rigorous testing.
It’s a higher bar to clear, designed to give a high level of confidence to patients, manufacturers, payers, employers and insurers, knowing they are working with an URAC-accredited specialty pharmacy, Bonome says. “Meeting the requirements of URAC accreditation demonstrates the specialty pharmacy is providing high-quality clinical care,” she adds.
For more information or to request a quote on our specialty pharmacy accreditation program, visit our Specialty Pharmacy webpage.