Pooja Mittal

What’s the HEC? Following a long period of advocacy and supported by a trust fund of $1 billion, the Agency for Healthcare Quality and Research (AHRQ) has signaled they will soon release a Notice of Funding  Opportunities (NOFO) for state-based Health Extension Cooperatives. The intention of this NOFO is to demonstrate the effectiveness of state-based healthcare practice transformation support systems. This is similar to the way in which the Dept. of Agriculture has shown decades of success in the Regional Extension Cooperatives (RECs) to support rural farmers. This program comes at a very opportune time as 20+ states are actively engaged in transforming the payments and delivery to primary care. CMMI is promoting state-based payment and primary care delivery reform in their Making Care Primary Program, the AHEAD state-based model, and the recent ACO Flex model. All of these programs require providers to undergo major changes in the way they deliver care, expanding their focus to population health while delivering patient centered comprehensive care. The programs also compel states to look carefully at how the health of their diverse, rural and underserved communities can be maintained and improved over time. Change does not occur spontaneously and none of the hopeful changes in these programs are easy to accomplish. The introduction of HEC resources, regionally distributed within a state, is a powerful way to meet the educational and resource needs of the states and providers as they begin the journey of transformation to high value, whole person equity focused care.  There are a few good examples of the effectiveness of "HEC-like" programs in Vermont’s Blueprint for Health and New Mexico’s Health Extension Regional Organizations. My experience in the Maryland Primary Care Program also demonstrated the essential role of the State Health Department's Program Management Office and regional Care Transformation Organizations providing technical assistance and resources to primary care practices to successfully integrate behavioral health, care management and advanced health information technology in primary care practices across the state. Please take a moment to read the AHRQ notice below: https://lnkd.in/eSTqRpN5 Yours in health- Howard

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Patients confront different barriers in healthcare, everything from long waits for appointments and follow-ups to stress and financial strain. These “patient-facing” administrative burdens can discourage many from seeking care in the first place. Many healthcare professionals are prioritizing patient care, however, transforming how staff engage with patients and improving the patient experience by: -Simplifying the administrative process -Enhancing the patient experience through technology -Adopting holistic and equitable care models #PatientExperience #PatientCare #PatientCenteredApproach

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Healthcare is a complex space. Not easy to understand, design to, or operate in.

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Patients want more convenient accessibility in healthcare and are shifting to consumerism in healthcare as a more affordable and modern option. As they become more vocal about what they need and want in healthcare options/platforms, these are the top factors motivating patients' mindset: ➡️ Consumerism in healthcare ➡️ Digital transformation ➡️ Generational shifts ➡️ Time constraints #Healthcare #DigitalTransformation #HealthcareStrategy #PatientExperience

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Excited to share our insights on recent research uncovering racial disparities in readmission rates from Medicare data! From hospital segregation to community-level disparities, there's much to unpack. Let's work towards targeted interventions and policy changes for a more equitable healthcare system. #HealthcareDisparities #StructuralFactors #ResearchInsights https://lnkd.in/gMT-dFDk

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In the biggest maternal health news you haven’t heard of: this September, applications will close for a new maternal health Medicaid pilot that will give funding to 15 states. The first-of-its-kind experiment will run for a decade, and could be applied to the rest of the country. This experiment represents the collision of two national movements: the fight for maternal health, and the fight for Medicaid payment reform. Neither happened overnight. In my latest Preprint, I trace how we got here—from Medicaid’s original passage in 1965, to the Affordable Care Act in 2010, to the CMS Innovation Center’s first pilots in 2013, and gumshoe maternal health journalism in 2018 that sounded the alarm. Forty percent of all births in this country are covered by Medicaid. Where the program goes, the rest of health care follows. The promise of the latest set of Medicaid innovation experiments is the opportunity to tackle how we pay for care, and how we deliver it. The challenge, experts told me, is bringing federal, state, and private programs into alignment, and making sure these experiments don’t just stay experiments. At Maven Clinic, we currently assume risk for members in six Medicaid markets, with more to come soon. We have the political attention, the business momentum, and the tech to truly forge that alignment...which is what we plan to do. You can read more about how we’re meeting the moment here. https://lnkd.in/eE2a-bxD

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True health equity can only be achieved through strong community and ecosystem partnerships. Collaborations are growing, with 81% of government entities building alliances to drive health equity. Let’s reflect on how partnerships can become a force multiplier in your health equity initiatives, and by extension, in your population health aspirations https://lnkd.in/ej7fYagG #CommunityHealth #HealthCollaboration

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In medicine everybody has good intuition, however, intuitions don’t necessarily agree with each other, and even if they did, they might not be right. Thusly why we advise so heavily on evidence base and best practices to guide medicine and medical approaches and treatments. In the digital age, healthcare is being transformed by AI and NLP. As clinicians, we’re at the forefront, utilizing health sensors and digital tools to enhance patient care. Part of the backbone of nurses striking at Kaiser, is the promotion of best practice paring with AI and not practice only with AI. Recent studies show that while AI can improve diagnostic accuracy, it doesn’t benefit all equally. https://lnkd.in/gvFSvAtJ Factors such as experience, clinical care area use, patient population and cohort, and decision-making styles play a role, suggesting a need for personalized AI integration. This means placing clinicians at the helm. ✨As we adopt these technologies our responsibility to our patients and community heath is to optimize new tools and solutions that are appropriate, validated, and verified. 💡Always optimize patient outcomes. 💡Provider and clinician experience and burden cannot be overlooked. 💡Ensure its ethical. 💡Embrace continuous learning. #HealthcareInnovation #DigitalHealth #AI #EthicsInAI #nursesonlinkedin

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Advancing Health Equity in a Primary Care Practice The 2021 NASEM report “Implementing High Quality Primary Care” posed the research question, “By what mechanism does primary care achieve health equity?” In response to that question, I was honored to do a presentation at the “Inaugural Meritus Health Equity Summit” hosted by the visionary Dr Maulik Joshi (CEO) and Dr Chante Richardson, Associate Dean of Equity, Diversity and Inclusion at the Meritus School of Osteopathic Medicine. The presentation described a program that achieved equity in a primary care practice serving a largely Hispanic and African American population (Menocal Family Practice). The purpose of the presentation was to provide a model for others to establish scalable and sustainable equity focused programs in primary care that produce measurable equity results. The following is a brief summary of the key elements and a few representative results: 1. Begin with standardized social needs screening tools. Use the screen for all patients to avoid bias and to normalize the process. The PRAPARE screen is a good example of a widely used tool that is readily incorporated into EMRs. 2. Employ and support a Community Health Worker (CHW) team to assist patients in addressing social determinant barriers by linking to Community Based Organizations, government programs, navigating the healthcare system and developing longitudinal support relationships.   The CHW services are reimbursable by many insurance companies including Medicare and Medicaid (in most states). 3. Provide a simple provider to CHW referral workflow for consenting patients facing social challenges. Encourage first contact for the CHW at the time of the visit. 4. Provide a framework for consistent communication between providers and CHWs. 5. Maintain a registry of patients in the CHW program in order to track health quality, outcomes and resource utilization. 6. Track and analyze health quality measures (eCQMs) and outcomes through an equity lens for the overall practice population. Disaggregating quality measures into distinct demographic groups reveals insights that are not apparent from the average practice performance and provides opportunities for tailored equity initiatives. The presentation also included an example of primary care equity in action. Disaggregated eCQM quality data revealed a significantly worse diabetes control in the Hispanic patients compared to whites. In response the CHW team focused attention on 100+ Hispanic diabetic patients with defined social needs and implemented culturally and linguistically relevant programs in nutrition, diabetes education, and assisted with medication access. Within the span of one year the good control eCQM measure for this group improved by 6% and the average sugar (A-1-C) control improved from 9.6% to 8.2%, (lower is better). This is an example of the Health Equity return on investments through primary care. Yours in health equity Howard

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Once a pipe dream to many in medicine, preventing transmission of intergenerational trauma is now the vanguard of evidence-based care. Many thanks to Nadine, Edward Machtinger, Alicia Lieberman, Alex Briscoe and so many others who’ve made this reality in California. #mentalhealthishealth. #traumainformedcare is primary #prevention for the next generation.

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Recently attended the M8 Alliance Executive Committee meeting, where we engaged in in-depth discussions on various agendas on how global health can be improved. As the backbone of the World Health Summit, the M8 Alliance is unwavering in its commitment to driving impactful initiatives, fostering international collaboration, and advocating for robust health policies. Our collective efforts are focused on enhancing health outcomes and addressing pressing health challenges worldwide. Together, we are making a significant impact on global health. #GlobalHealth #M8Alliance #WorldHealthSummit #HealthPolicy #Collaboration #ImpactfulInitiatives Axel Radlach Pries Linda Sebbas

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On a recent podcast, I spoke in favor of a focus for our #healthcare system to address #health equity: that #primarycare provides the foundation for accountability and right-sized resources to improve #health for individuals and communities facing health inequities. “As Barbara Starfield so eloquently states, “The focus of primary care on recognizing and meeting patients’ needs (including but not limited to ‘diagnoses’) is the reason primary care–oriented services are associated with greater equity in distribution of health in populations. Different populations differ in the kind and extent of their health problems, with more socially deprived populations having a greater number, greater severity and greater variability in their health needs than is the case in more socially advantaged populations. Primary care, the place where needs are best recognized, is the venue by which equity in health services and, hence, equity in those aspects of health responsive to health services, is attained. Person-centered services are the essential hallmark of primary care.”” A great supplement this month from the Journal of the American Board of #FamilyMedicine. #healthcareonlinkedin

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Book Reading Chapter 17. In the pandemic we were led by public health leaders who were hardworking but ignorant. We should do a course correction else we are headed for future mishandling of "pandemics" if we do not put the right leaders at the top. https://lnkd.in/dC9mrGUZ

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Health Policy and Muscle Memory What is muscle memory and what does it have to do with health policy? I had the enlightening pleasure of attending the Duke Margolis Annual Health Policy Conference in Washington, DC. The presenters were an all-star cast including, but not limited to, the Directors of the CDC, NIH, CMS and past HHS and state Health Secretary’s. The overall outlook they presented, particularly for primary care, was very optimistic. The discussion that really caught my attention was about the need for the healthcare industry to develop muscle memory for value-based strategies in order for sustainability. Their premise and corresponding concern were that the industry has had a lot of value-based programs introduced over the past decade but there has not been the degree of sustainable and broad-based value delivery cemented into the day-to-day delivery of care. This is a really intriguing point. Edward Deming proposed that “Every system is perfectly designed to get the result that it does” Webster defines muscle memory as “the ability to repeat a specific muscular movement with improved efficiency and accuracy that is acquired through practice and repetition”. With these definitions in mind, has the past decade of innovation in healthcare payment and delivery been designed to train that muscle memory that allows healthcare organizations and providers to function at peak performance in value-based care? I think the results, so far, provide a somewhat disappointing answer. As noted in the conference, there have been a lot of amazing innovations, but they have not yet been incorporated into muscle memory. In the early days of healthcare transformation, it was necessary to experiment with a variety of innovative models in order to get the basic elements of value-based care nailed down. The confounding issue over the past decade may have been the continued changes and tinkering at the policy and program level and the lack of consistency across payers that continually shifted the implementers and healthcare providers from settling into patterns that would allow that muscle memory to develop. As was said many times; “That was then, and this is now”. I heard a strong commitment from many of the important policy makers, leaders and influencers at this important gathering, to restrain the pace of new modeling (there was a recent bevy of models from CMMI, many of which are promising) over the next decade and allow the industry to settle into stable patterns. The innovation will not stop, but it will come from the training of that healthcare industry muscle to perform at a peak level, always improving and always competitive in the best sense of the word. More about the conference here:   https://lnkd.in/eSyUVEVx Yours in Health Howard

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💊How green are your prescriptions? 🧐After looking at the fabulous ‘The 4 Pillar Plan*’ by Dr. Rangan Chatterjee and a talk by Hamaad K. on #healthcreation I made these little prescription library cards! 🎯Patients choose a prescription that will help them with their goal: -losing weight -thriving through menopause -improving their mood -sleeping better …and many more, common problems! We put their first initial (only) and date in the left box, then at 3 month r/v with me, they complete the right box with a tip for the next ‘borrower’. 🏆By far the most popular cards out currently are ‘drink a glass of water at the start of a meal’ and ‘eat all your food in a 12-hr window’ (📚*And of course I have a poster explaining the book with a QR code next to my desk, for folks to scan and find out more!) #nhs #susQI #prevention #doctors #climateaction #greenprescriptions #generalpractice

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Indeed a turning point for women's health. I am not a political person, but this is something I can proudly support. Very proud of my friends Liz Powell, Jodi Neuhauser, and Candace McDonald for launching this Women's Health PAC who have the support of thousands of women in the healthcare industry. With more money, research, information, innovation, funding, and focus on women's health... everyone wins. Including men. This is not exclusive, this ensures inclusion of all people, especially women who have been excluded from most of the above including in healthcare. Equity ensures equality, and without a focus on women's health there will be not achievement of equity. #healthequity #healthequityforwomen #womenshealth #women #equality #womeninhealth #womenleaders #womeninleadership #womeninmedtech #PAC #womenshealthPAC

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