Jamie Swann MSN, RN

In their new Forefront article, Gui Woolston and Amy Finkelstein of Aledade, Inc. and the Massachusetts Institute of Technology (MIT) call on Medicaid programs across the country to take advantage of opportunities to pursue test-and-learn approaches through randomized evaluations to achieve their policy goals and ultimately improve members’ health. "At the Connecticut Medicaid program that I (Gui) ran until May 2024, we believe that engaging in test-and-learn approaches based on rigorous evaluation methods such as randomized evaluations (often called randomized controlled trials or RCTs) is crucial to achieving these policy goals and ensuring that programs work for our members. Despite this, Medicaid offices across the country face a range of barriers to getting these evaluations off the ground. We propose two approaches that can overcome these challenges, along with five practical steps states can take to effectively pursue RCTs. By rigorously evaluating our programs and sharing results, we can build knowledge to help allocate resources more effectively, better serve our members, and support other Medicaid programs nationwide." Read the full article here: https://bit.ly/3VWlY9f

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📣 The Planning and Dissemination (P&D) Grants have launched! The P&D Grants are intended to provide support for planning and/or dissemination activities (either virtual or in-person). IHSPR is thrilled to support activities on the following prioritized topics: o Integration of care o Primary care and home, community, and long- term care. o Health workforce o Digital health solutions o Equitable, accessible, anti-ableist, anti-racist, anti-discriminatory, diverse and/or inclusive health care delivery systems and/or service delivery models o Advancing sustainable, climate-resilient and/or low-carbon health care systems, organizations, and service delivery models. o Advancing the theories, methods and approaches that underpin the science of HSPR Furthermore, two grants are reserved for pan-Canadian conferences that provides opportunity for the entire HSPR community to benefit from and engage in networking, research collaboration, and knowledge mobilization across a broad range of HSPR priorities. Application Deadline: August 7, 2024 Learn more: https://buff.ly/45kHj0n

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The Centers for Medicare & Medicaid Services (CMS) has announced changes to address the alarming maternal mortality rate in the U.S., which lags behind comparable nations. Starting in 2026, hospitals and Critical Access Hospitals (CAHs)—facilities serving underserved rural areas—must comply with new health and safety standards to continue offering obstetric (OB) services. Here are some of the details about the upcoming requirements: 🔹 OB services must align with national standards, with proper supervision by qualified professionals (e.g., RNs, NPs, CNMs, PAs, MDs). Privileges should be granted to all OB providers and meet hospital requirements. 🔹 Facilities must maintain basic OB equipment and implement emergency protocols for maternal care, including evidence-based post-care practices. 🔹 Staff must undergo maternal care training every two years, conduct quality assurance, and report data to Maternal Mortality Review Committees (MMRCs). 🔹 Even facilities without OB services must provide emergency care to OB patients and establish transfer policies. It's shocking that these requirements aren't already in place but the aim is to standardize care and improve outcomes for mothers moving forward. #MaternalHealth #Mothers #MothersMatter #MaternalMortality #HealthCare

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PrEP National Coverage Determination September 30, 2024: HHS Centers for Medicare and Medicaid Services finalized a National Coverage Determination for HIV PrEP — Under this NCD, CMS will cover all forms of PrEP that are approved for use by the FDA for any Medicare recipient (Medicare is coverage for older adults and people with disabilities) at risk for HIV (as determined by the person’s medical provider). The NCD means that coverage will be without cost sharing (deductibles, copays, coinsurance) and CMS will also cover medical services associated with administration of injectable PrEP, up to eight HIV tests per year, up to eight HIV counseling sessions per year, and an annual Hep B screening. This decision follows US Preventive Services Task Force’s recent Grade A recommendation for PrEP, which said that “PrEP is safe and highly effective at preventing HIV.” Read the full National Coverage Determination for HIV PrEP, here: NCA – Preexposure Prophylaxis (PrEP) Using Antiretroviral Therapy to Prevent Human Immunodeficiency Virus (HIV) Infection (CAG-00464N) – Decision Memo (cms.gov). https://lnkd.in/g8WVqcTC Read on HIV.gov here: NEW: Medicare Part B Coverage of Pre-exposure Prophylaxis (PrEP) for HIV Prevention https://lnkd.in/ggG7z-Am

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A new Vizient, Inc report found Medicaid patients were less likely to receive the same treatment services for behavioral health as compared to commercially insured patients. The variation in access and inadequate treatment, could also lead to higher utilization of the emergency department. "The results of this study demonstrate differences in access to care by payer," said Erika Johnson,VP, Vizient Strategic Research. "Providing a fair and appropriate standard of care across all patient populations means expanding provider access for mental health services across all types of payers. Some hospitals are utilizing social workers, nurse practitioners and physician assistants to close the gap in care. By expanding access earlier on, patients are less likely to need to use the emergency room for care, thereby delivering better patient care," said Stephanie Snider, consulting director, Vizient Intelligence. The Vizient Research Institute conducts research focused on broad healthcare economic trends affecting the affordability and sustainability of our healthcare delivery system. https://viz.inc/4anWvuk View Shining a light on disparities in mental health services: ➡️ https://viz.inc/44H6RUS #MentalHealthAwarenessMonth

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#Medicaid is the largest payer for #behavioralhealth (mental health and substance use disorder care) services in the United States, and almost 75 percent of Medicaid enrollees receive services through a managed care organization (MCO). Historically, physical and behavioral health benefits have been managed and financed separately to protect dedicated funding sources and established systems for behavioral health care delivery, especially for people with serious behavioral health conditions. In recent years, state Medicaid agencies have integrated mental health and substance use disorder services into existing MCO plans. This process, often referred to as carving-in behavioral health or integrated managed care, aims to support coordinated care delivery for people with both physical and behavioral health needs. #maternalmentalhealth https://lnkd.in/dYvvApNU

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Are you ready for the future of public health? THURS: Join the Public Health Accreditation Board (PHAB) and Institute for the Future (IFTF) for a webinar focused on elevating public health’s role in shaping long-term futures. IFTF will share how public health can build future-readiness to go beyond piecemeal and incremental solutions and catalyze systemic changes. We’ll learn about how to imagine bold new possibilities and create action pathways to achieve desired futures. Participants will leave with new ideas and tools to build a future-ready public health system.

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👀 Did you see? The second module for the Behavioral Health Transformation [DRAFT] Policy Manual has been released for public comment. You can find it available at the following link: https://lnkd.in/garYX33B

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Fiscal and demographic challenges threaten the financial sustainability of #Medicare, requiring a broad effort to modernize the program. Our new Solutions Brief recommends several policy reforms for decreasing the cost of Medicare and other Federal health programs while increasing the quality of care for patients: https://lnkd.in/eKbbQiiv

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As CEO's, policy makers, behavioral health leaders gather in DC for The Alignment for Progress conference, High Watch Recovery Center is proud to be part of the 150 organizations committed to reaching a bold vision outlined by The Kennedy Forum: 90% of the population is screened for MH/SUD, 90% receive quality treatments, and 90% manage symptoms and achieve recovery.   As part of the Alignment for Progress Commitment Project, we have set a unique goal that helps move us toward that future: High Watch Recovery Center, the world’s first 12-step treatment center, is committed to leading the way in ethical, evidence-based care for individuals struggling with substance use disorders. Our commitment includes utilizing evidence-based practices to deliver the highest standard of treatment, continuously improving our programs to incorporate the latest research and best practices in addiction recovery, and offering comprehensive support that addresses the physical, emotional, mental, and spiritual aspects of recovery. Our dedication to ethical, evidence-based treatment and our focus on comprehensive care aligns with the broader objectives of the Alignment for Progress initiative. Together, we strive to transform the mental health and substance use disorder treatment landscape, ensuring access and quality treatment for those in need. We’re proud to do our part and be part of this powerful coalition for change.  #Align4Progress #HighwatchRecoveryCenter #QualityTreatment #outcomes #accesstocare #mentalhealth #addiction

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Community member engagement has become an important element of Medicaid program and policy design in recent years, especially as a means of promoting health equity. New rules from the Centers for Medicare & Medicaid Services will further accelerate community engagement efforts across the nation. This new resource center, developed by the Center for Health Care Strategies, offers practical tools and guidance to help Medicaid stakeholders engage community members in policy and program design. It features best practices, as well as examples of successful community engagement strategies — from informal channels to structured approaches like community advisory committees. https://bit.ly/4c7DVrF Anna Spencer, MPH, Courtney Shahan Roman

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The Direct Care Workforce (#DCW) is essential in supporting individuals with long-term services and supports (#LTSS). The National MLTSS Health Plan Association has identified key principles for MCOs to strengthen and sustain the DCW, emphasizing collaboration, equity, and innovation. From aligning with local, state, and federal initiatives to centering the voices of DCWs in decision-making, these principles highlight the collective responsibility needed to uplift this vital workforce. Leveraging technology, flexible funding models, and person-centered planning, MCOs can drive meaningful change and improve outcomes for both DCWs and the individuals they support. Check out our framework below for more insights into the MCO role in supporting the DCW’s impact. For more information, read more in our brief where the #MLTSS Association offers priority recommendations: https://lnkd.in/e_cW-4Di   

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A new study from Humana leaders in Health Affairs provides more compelling evidence that hybrid payments provide primary care practices with the predictability they need to build out more effective care teams. Read here: https://lnkd.in/eCXbu3Tu

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Join the Region IV Public Health Training Center andTrust for America's Health for this upcoming learning opportunity: September 17: Age-Friendly Public Health Systems in Action | 12 pm EST To register: https://buff.ly/3zfy6La Over the last 10 years, the number of adults in the U.S. aged 65 and over increased by over 34%, and is expected to grow to 98 million, or 24% of the U.S. population by 2060. Healthy aging has not historically been central to the public health agenda but clearly, public health interventions are at least partly responsible for the longevity we are experiencing today. Trust for America’s Health (TFAH) is working to elevate healthy aging as a core public health function through its Age-Friendly Public Health Systems (AFPHS) movement, based on a framework of six tenets that are guiding public health efforts to improve older adult health and well-being. This web training session will introduce participants to AFPHS, including examples from one local and one state health department that have adopted and implemented APHFS principles.

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🌟 Advocating for the Future of Community Health Centers 🌟 In the latest NACHC update, we see how Congress determines CHC funding, from mandatory funding cycles to discretionary appropriations. This funding directly impacts: ✅ Expanded access to primary care ✅ Infrastructure investments ✅ Workforce retention and growth At CHC Pros LLC, we understand how funding uncertainty can disrupt planning, care delivery, and innovation. That’s why we’re here to help CHCs optimize resources, streamline operations, and improve patient outcomes, even during periods of financial ambiguity. 💡 Pro tip for CHC leaders: Stay ahead by preparing robust performance data that showcases your clinic’s impact. Demonstrating value and outcomes is key to advocating for sustained and increased funding! Let’s continue working together to secure a healthier future for all. #FQHC #CommunityHealthCenters #CHCFunding #HealthcareAdvocacy #CHCProsLLC #NACHC

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A new rule from the Centers for Medicare and Medicaid (CMS) aims to improve healthcare equity by making it easier to enroll in and retain Medicaid coverage. The rule was created to better support underserved populations most often impacted by inequities across the healthcare landscape. “With this final rule, CMS seeks to reduce coverage disruptions, further streamline Medicaid and CHIP eligibility and enrollment processes, reduce the administrative burden on states and people applying to and enrolled in Medicaid and CHIP programs, and increase enrollment and retention of eligible individuals,” per the announcement from the CMS. The new rule streamlines the application and enrollment processes by: ✅Removing unnecessary barriers to enrollment ✅Streamlining the information that people have to submit ✅Ending burdensome requirements ✅Simplifying eligibility requirements Be sure to read the full announcement at: https://lnkd.in/g9Gg__ET #CMS #HealthcareEquity #Medicaid #Medicare

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