Welcome to the March 2020 newsletter. You can find past newsletters with additional background materials, and different stories and initiatives in my LinkedIn articles and on my website. Join me in improving and coordinating initiatives that advance health, health equity and community and healthcare redesign.
Shannah’s Insights and Reflections
Nothing in March is business as usual and this newsletter is no exception. I gather my intel on living conditions and health from google alerts. The first Coronavirus online story that surfaced (based on my search terms) was on March 8th about the first case in Kansas and that she was isolating at home. Just this statement underscores how living conditions or social determinants will be part of the fabric in which people manage through this pandemic. “Isolating” and “home” are two fundamental factors for how individuals who test positive will fair. Do they have a support network, albeit remote, that will help them through this challenge? Do they have a home in which they can isolate/self-quarantine, manage needed services and resources and avoid infecting others?
There was no further mention in my alerts until a COVID-19 Q&A on the 20th and an article identifying protection for rideshare drivers. This article discussed helping drivers know if they have been exposed to the virus, particularly medical rideshare drivers who are critical for patients needing rides. Drivers are at greater risk for exposure from patients and in turn are potentially exposing others. The drivers may also want riders to wear protective gear that is increasingly difficult for even healthcare workers to get. Since that story the intersection of the pandemic and living conditions was regularly reported.
Meanwhile the shelter in place requirements and changes in restriction on telehealth and virtual visits can help many, but likely not the most vulnerable and uninsured since they are less likely to have a provider with virtual visits, less likely to have a smart phone or tablet and sometimes least tech savvy or tech literate. Drive thru testing is gearing up, but only for communities who have access to test kits and the demand far exceeds the supply for now.
State governments and federal programs are working to make state and local services and support more readily available. CMS’ release of four Medicaid’s waiver templates is a great example of facilitating exceptions and expansions in the midst of the pandemic.
Job loss, particularly for low wage workers can be devastating and will make health disparities worse. The stimulus package is a good start, but likely not enough for the many hourly wage workers. The abandoned debate about getting people back to work as a tradeoff for accepting more deaths, particularly for our aging population, was very scary and not a decision to make hastily.
Healthcare shortages – personal protective equipment (PPE), test kits, beds, and ventilators, are dangerous. The shortages are fostering fast development but still putting the healthcare workforce and their patients at risk. It could be worth discussing the presumption that in the absence of documentation (no DNR) people want extraordinary measures to avoid death when we’re on the other side of the pandemic.
I hope my next newsletter will occur at a time when we have turned the corner and know the end is in sight. There could be many silver linings as we enable more care and services delivery in people’s homes and create flexibility for delivering at a time of need in more creative ways.
This month I’ve noted a few activities across all sectors, most of which relate to the pandemic with a few new items of interest: overview of the new services being offered by Medicare Advantage plans and the final non-blocking rules.
Share your personal or community stories by connecting via LinkedIn or email firstname.lastname@example.org I welcome suggestions in all topic areas, particularly community driven models.
A personal or individual story
My personal COVID story is my adult children had their trip to Ireland and Scotland cut short. They came back to a furlough and closed businesses along with self-quarantining away from their 57- & 61-year-old parents. 3 days left for their quarantine!
Perhaps the most heartening events are the many state and local responses. The local stories and initiatives that are seeking to help everyone with social distancing, self-quarantining and shelter in place. The outpouring, likely on every neighborhood listserv or as we pass each other 6 feet apart, of what we can do to stay busy, how we can help each other and stay connected in this unprecedented time is absolutely reassuring.
A growing practice across the country to help seniors continue to do their grocery shopping while reducing the risk is senior hours for shopping. National chains and local stores are all trying to accommodate the need and help reduce the risk of COVID19 exposure for more vulnerable populations. Do senior hours help? Sometimes, if the senior population constitutes are a large portion of the grocery stores customer base, then it can actually be more crowded not less.
Background on community investments and initiatives outside of healthcare
The far-reaching effects of this pandemic break the mold on how local, state and national businesses and organizations of almost every flavor are getting involved to help flatten the curve (slowing down and limiting the spread of the virus). Let’s hope this is a sustained trend post pandemic.
Government Initiatives Federal and State (national initiatives)
CMS issued guidance supporting fast track Medicaid Waivers that include expanding community-based services such as meal delivery. CMS has quickly eliminated barriers and added flexibility to allow for virtual visits, provide for alternative settings to increase bed capacity, and postpone or waive reporting requirements as providers, particularly hospitals, are being overwhelmed.
The stimulus package has more funding for home meal deliveries to older adults. The infusion of funding for the millions of workers who have lost their jobs, in addition to unemployment, will hopefully hold people over until the economy regains some normalcy.
Coverage under the new Medicare Advantage plans with flexibility to cover more community based social services and supports have begun and an early analysis of the number and scope of these plans can be found here. ATI Advisory breaks down the number of plans offering non-health services. The top 3 categories are: pest control, food and produce and transport for non-medical needs. The top 2 parent organizations with the most plans are Anthem and Geisinger Health.
Final Fast Cures non-blocking rule finally published. When implemented the ONC and CMS rules will facilitate patient access to their own automated health records. Unfortunately, the deadlines for compliance will likely be pushed out because of the pandemic. Crowell Moring provided a nice summary and eHealth Initiative hosted a good nuts and bolts webinar.
Health System and Community-based Services
Hospitals across the country are doing a heroic job with inadequate resources. Companies of off all kinds are stepping in to help fill needs — distilleries, perfumeries, fashion designers, culinary cloth – sanitizer and masks or Ford helping to make ventilators.
Rapid response and change are the norm for today’s healthcare delivery and community-based services. Rapid movement to telehealth/virtual visit services, postponement of non-essential surgery, transportation limitations and rapid alternatives to in-person services including groceries.
Challenges also keep surfacing, such as: Can you have safe transportation? Can you keep drivers and passengers safe? Meanwhile there are critical populations that need non-emergency transportation to medical facilities e.g., dialysis, chemo treatment.
Research, Metrics & Technology
Jvion offers new COVI-19 community vulnerability map that uses SDoH to identify at-risk populations
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CURRENT & UPCOMING EVENTS
Interview with Bruce Chernoff, MD CEO of the SCAN foundation, by Healthcare Strategies podcast. Discusses leveraging community-based partnerships to address senior SDOH
Nationwide all large in-person gatherings are canceled or postponed, but many are maintaining a virtual program.
NEW DATES: RISE National Summit on Social Determinants, June 28-30, 2020 Nashville there is a virtual attendance option.
Background and Definition
I have chosen the phrase “Living Conditions” rather than social determinants of health (SDOH) to make the concept more accessible. This focus tracks with the Centers for Disease Control and Prevention’s SDOH definition “as conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
Go here for more information from CDC on its organizing SDOH framework in Healthy People 2020