Will Humble Health Insurance, Prevention, Public Health, Wills Blog

Merger of CVS & Aetna Finalized

Last week CVS Health completed their acquisition of Aetna. You know CVS through their pharmacy stores- and Aetna through their health insurance businesses (in AZ that includes Mercy Care and Mercy Maricopa Integrated Care). 

Aetna will be a stand-alone unit within CVS and led by members of its current management team.  It’s essentially a vertical integration- as it combines Aetna (primarily a health care insurer) with CVS (primarily a retailer).

The US Justice Department required Aetna to divest its Medicare prescription drug business to WellCare Health Plans before approving the merger.

One of the goals of the merger is to integrate Aetna’s medical information and analytics into CVS Health’s pharmacy data- creating a new model of care delivery.

The new company says they’ll be introducing new programs to target more efficient management of chronic disease with services focusing on self-management for patients with chronic conditions, expansion of chronic care management services at MinuteClinic, nutritional and behavioral counseling and benefit navigation support.  The plan includes expanded preventive health screenings to better manage high cholesterol, high blood pressure and diabetes.

A major focus will be on better managing five chronic conditions: diabetes, cardiovascular disease, high blood pressure, asthma and behavioral health.

There are some academics and other analysts that suggest the merger is anticompetitive and won’t result in better care or outcomes- but it looks to me like it has a pretty good chance of improving outcomes- especially if they focus on better management of chronic medical conditions combined with more convenient and numerous service sites.

CVS has been moving their mission from its traditional pharmacy business model for some time- bringing it more in line with providing health care and other services.  Several years ago- as this new model was emerging, CVS decided to stop selling cigarettes etc. as they rightly saw those sales as inconsistent with that of a business focusing on improving health outcomes.

Will Humble Affordable Care Act, Health Insurance, Wills Blog

Marketplace Open Enrollment Ends December 15

December 15 is the last day to apply for Marketplace health insurance.  Most people get health insurance through their employer, Medicare or Medicaid, but about 87,000 Arizonans get their insurance though the Federally Facilitated Marketplace.  Nearly 9 out of 10 people in Arizona that get coverage from www.healthcare.gov receive tax credits – financial help – to make coverage more affordable. 

Each year many Arizonans meet with an Assister, thinking they will buy a www.HealthCare.gov plan, but find out they are in fact eligible for AHCCCS (Medicaid). Some learn their children are eligible for very low cost KidsCare (Children’s Health Insurance Program). 

To find out what a comprehensive plan may cost go to www.healthcare.gov/see-plans. By simply entering your zip code, age, number of family members and projected 2019 income, you can look at available plans and find out if you qualify for a discount.  If a single person earns less than $48,560 they may qualify for financial help.  A family of four can earn up to $100,400 and qualify for financial help.

No matter where you live in Arizona, help is available. You can call 1-800-377-3536 or go to www.CoverAZ.org  and click on “Send a Message” to get your questions answered, or visit www.CoverAZ.org/Connector and make an appointment to meet with a local Assister.

Will Humble Affordable Care Act, Health Insurance, Wills Blog

Feds Open Door to Subsidizing non-ACA Plans

Last week CMS released new guidance urging states for states to start offering federal subsidies to people buying plans that don’t comply with the ACA.  Their objective is to provide subsidy options for short-term and association health plans, which offer fewer benefits and consumer protections but at a lower cost.  They’ve branded the new subsidy system “State Empowerment and Relief Waivers. 

If the program stands up to a judicial review, states will be able to who is eligible for health insurance subsidies. Under the ACA, anyone with an income 400% of the federal poverty line is eligible for subsidies on the insurance marketplace. This new guidance would allow states to add to that regulation, like prioritizing younger, healthier populations over lower-income residents.  Importantly, any waiver request would still need to meet the ACA standard that it ensures the waiver plan meets the four statutory standards relating to comprehensiveness, affordability, coverage, and federal deficit neutrality.

Included in last week’s announcement is a provision giving states a way to better manage risk in their Marketplace plans. The Risk Stabilization Strategy that they announced gives states a way to implement reinsurance programs or high-risk pools. Reinsurance programs can lower premiums by providing some protection from expensive risk pools.  Examples are a “claims cost-based model”, a “conditions-based model”, and a hybrid conditions and claims cost-based model.

Will Humble Climate Change, Public Health, Wills Blog

Global Climate Change Research Program Report

Profound Public Health Impacts Identified

The Global Change Research Act of 1990 mandates that the U.S Global Change Research Program deliver a report every 4 years to analyze the effects of global change on the natural environment, agriculture, energy demand, land and water resources, transportation, human health and welfare, human social systems, and biological diversity.  The statutory charge for the report is to “… inform decision-makers, utility and natural resource managers, public health officials, emergency planners, and other stakeholders by providing a thorough examination of the effects of climate change on the United States”.  The 2018 report was issued on the day after Thanksgiving. 

The Report issued last week focuses on the elements in their statutory mandate for 10 regions and 18 topics.  Chapter 14 focuses on public health.  Many of the public health challenges and impacts in the report are things readily observable today.  For example, one of the acute is the public health and policy struggles this year will be surrounding prioritization, use and conservation of increasingly limited water supplies here in Arizona.   As the Colorado River basin continues to have less snow pack and earlier melting- there’s no doubt that allocating a permanently reduced water supply.  We’re likely to see these negotiations play out at the national and state level in the coming months.

At first, I was planning to write my own summary of the public health chapter- but the Executive Summary of that chapter does a pretty good job- so I’ll paste that section for you instead:

Climate-related changes in weather patterns and associated changes in air, water, food, and the environment are affecting the health and well-being of the American people, causing injuries, illnesses, and death. Increasing temperatures, increases in the frequency and intensity of heat waves (since the 1960s), changes in precipitation patterns (especially increases in heavy precipitation), and sea level rise can affect our health through multiple pathways. Changes in weather and climate can degrade air and water quality; affect the geographic range, seasonality, and intensity of transmission of infectious diseases through food, water, and disease-carrying vectors (such as mosquitoes and ticks); and increase stresses that affect mental health and well-being.

Changing weather patterns also interact with demographic and socioeconomic factors, as well as underlying health trends, to influence the extent of the consequences of climate change for individuals and communities. While all Americans are at risk of experiencing adverse climate-related health outcomes, some populations are disproportionately vulnerable.

The risks of climate change for human health are expected to increase in the future, with the extent of the resulting impacts dependent on the effectiveness of adaptation efforts and on the magnitude and pattern of future climate change. 

Obviously, there is allot more in the report that really requires a deeper dive.  The report is certainly worth book marking in your Favorites section for reference as you conduct your public health work.

Will Humble Oral Health, Wills Blog

Approaches for Improving Oral Health

Poor oral health is a health disparity for low-income people and people with disabilities.  Dental illnesses significantly increase the risk of chronic health conditions, result in missed days of work and school, and negatively affect employability. According to an American Dental Association survey, approximately 33% of Americans who have income lower than 138% of federal poverty level struggle to get employed because of the condition of their mouth and teeth. 

Poor oral health can easily compound the effects of preexisting conditions and aggravate already fragile socioeconomic well-being, both at the individual and population levels. However, oral health care delivery and services can be improved through innovations in programming, financing, and workforce training. Using the population health framework, states can make significant strides towards improving their population’s overall health by improving dental care access and delivery.

Below are some examples of public health policy interventions underway in the U.S in various states to address this important health disparity.

Impact of Medicaid on Access to Oral Health Services

State Medicaid programs including AHCCCS are mandated to provide comprehensive dental coverage for Medicaid-enrolled kids – but aren’t required to offer dental coverage to Medicaid‐enrolled adults. Nationally there’s an uneven patchwork of dental care coverage that impacts access to dental services. 

Arizona provides emergency dental services to all enrolled adults up to a $1,000 annual cap. But coverage alone isn’t enough to actually get care.  Many dental providers don’t  accept Medicaid coverage and nearly 49 million people are living in dental health professional shortage areas (HPSAs) across the country (HPSAs are geographic regions, populations, or facilities that are lacking sufficient healthcare providers).

Many states have used Medicaid waivers demonstrations to improve dental care. For example, California developed a Dental Transformation Initiative to increase dental care access and address the specific oral health needs of children by providing incentive payments to dental providers for achieving state-defined targets.  Here are some examples that are being implemented across the country:

Alignment with Population Specific Services

Oral health programs or pilots can also be aligned with current services provided by the state for increasing access to oral health services for specific populations.  For example, New Hampshire created a pilot program held at local WIC sites to integrate preventative oral health care for low-income women and children into existing safety net programs. It included a weekly dental clinic at each WIC site at which dental hygienists and dental assistants provided preventative care and referred participants to local Medicaid-enrolled dental providers for follow-up care.

Workforce Innovation

Last legislative session Arizona lawmakers approved a new class of dental professionals called Dental Therapists who, over time, will be about to meet some of the workforce demands in Arizona’s rural and underserved areas.  The Board of Dental Examiners still needs to develop the Administrative Code (Rules), but dental therapists will be practicing on the horizon, providing a potentially important access point in rural and other underserved areas.

Care Delivery Innovations

Advances in telehealth can also be promising avenues for improving access to oral health care too. For example, Alaska used telehealth to address its oral health needs. Given the lack of access to oral healthcare that affects their rural residents, they established the practice of mid-level oral health providers known as dental health aide therapists. Telehealth (specifically live videoconferencing) allows these aides to connect with supervising dentists in hub locations who are then able to provide professional oversight and supervision virtually. 

Will Humble Physical Activity, Prevention, Wills Blog

New Physical Activity Guidelines

It’s no secret that obesity is a core public health challenge of our time- largely as a result of the lack of physical activity and poor nutrition.  In fact, 80% of US adults and adolescents aren’t getting enough physical activity.  Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases.

A couple of weeks ago JAMA’s 2018 Physical Activity Guidelines Advisory Committee published a systematic review of the science supporting physical activity and health in HHS’ 2018 Physical Activity Guidelines Advisory Committee Scientific Report.  The HHS Physical Activity Guidelines for Americans Report (2nd edition) recommended the following:

  • Preschool-aged children (3 through 5 years) should be physically active throughout the day to enhance growth and development.

  • Children and adolescents aged 6 through 17 should do 60 minutes or more of moderate-to-vigorous physical activity daily.

  • Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity. They should also do muscle-strengthening activities 2 days a week.

  • Pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic activity a week.

The 2018 recommendations emphasize that moving more and sitting less will benefit nearly everyone. Individuals performing the least physical activity benefit most by even modest increases in moderate-to-vigorous physical activity. Additional benefits occur with more physical activity. Both aerobic and muscle-strengthening physical activity are beneficial.

The JAMA Committee concluded that the  Physical Activity Guidelines for Americans Report (2nd edition)   provides information and guidance on the types and amounts of physical activity that provide substantial health benefits. Health professionals and policy makers should facilitate awareness of the guidelines and promote the health benefits of physical activity and support efforts to implement programs, practices, and policies to facilitate increased physical activity and to improve the health of the US population. 

You can dive into the systematic review on the JAMA site. Their review largely validates the 2018 guidelines.

Will Humble Professional Development, Wills Blog

Sign Up for Our Professional Learning Communities

Over the next month, we’ll be setting up some Professional Learning Communities in our Basecamp where members with similar interests can share information with one another, update each other about actions that state and federal agencies are taking (or not taking), and share best practices that influence public health.

Lauren Savaglio (our Board Member for Professional Development and Academic Relations) has set up a tool so you can sign up to participate on one of 5 pilot Professional Learning Communities.  In order to sign up, simply go to our Survey Monkey Link and ask to sign up for one of our initial Communities in Basecamp.  Our pilot PLC’s will be in the areas of:

  • Behavioral Health

  • Public Health Nursing

  • Maternal and Child Health 

  • Oral Health

  • Nutrition & Physical Activities 

Also, let me know if you’d like to be added to our Public Health Policy Committee Basecamp site and I can get you all set up.  We have about 50 folks already set up on that site.

Will Humble Professional Development, Wills Blog

Participate in our Volunteer Event!

Please consider participating in our December Volunteer Event to hand-pack meals specially formulated for malnourished children! We still need 5 more people to help us hand-pack meals that will be sent around the world where they feed orphanages, schools, and clinics to break the cycle of poverty. 

When: Monday, December 10. 2018, 8:30 PM – 10:00 PM

Where: 1345 S. Alma School Rd, Mesa, AZ 85210

Register: https://www.fmsc.org/join-group?joincode=1931W2 

Group Name: Professional Development AZPHA  Join Code: 1931W2

For questions and/or an outlook calendar invite, please contact Lauren Savaglio-Battles at professionaldevelopment@azpha.org. 

Will Humble State Legislature, Wills Blog

2019 Legislative Session

The 2019 Legislative Session will begin on January 14.  The Session usually starts with a State of the State address by the Governor followed by a proposed executive branch budget. 

Here’s a PowerPoint RE 2019 Legislative Priorities that I put together.  Like other years, lots of things will come up during the session that we will support or be opposed to.  Our Public Health Policy Committee will share information and meet during the session as we prepare our positions and conduct our public health advocacy.

The party balance in the State Senate will remain 17-13; while the balance in the House will be 31-29 (a much closer party balance than there has been in recent years).

The President of the Senate will be  Karen Fann (R) LD-1 and House Speaker will be  Rusty Bowers (R) LD-25.  There will be 12 Senate committees and 20 House committees starting in January.  The Senate Health and Human Service Committee will be chaired by Senator Kate Brophy-McGee (Sen. Heather Carter will be Co-chair).  The House Health Committee will be chaired by Representative Nancy Barto (Rep Jay Lawrence as Vice Chair)

Senate Committees:

Appropriations: Sen. David Gowan (LD14), Chair

Commerce: Sen. Michelle Ugenti-Rita (LD23), Chair

Education: Sen. Sylvia Allen (LD6), Chair and Sen. Paul Boyer (LD20), Co-chair

Finance: Sen. J.D. Mesnard (LD17), Chair

Government: Sen. David Farnsworth (LD16), Chair and Sen. Sonny Borrelli (LD5), Co-chair

Health and Human Services; Kate Brophy McGee (LD28), Chair & Heather Carter, Co-chair

Higher Ed. & Workforce Dev: Heather Carter (LD15), Chair and Sen. J.D. Mesnard, Co-chair  

Judiciary: Sen. Eddie Farnsworth (LD12), Chair

Natural Resources and Energy: Sen. Frank Pratt (LD8), Chair

Rules: President-Elect Karen Fann (LD1), Chair  

Transportation and Public Safety: Sen. David Livingston (LD22), Chair  

Committee on Water and Agriculture:  Sen. Sine Kerr (LD13), Chair Sen. Frank Pratt (LD8), Co-chair

House Committees:  

Appropriations: Rep. Regina Cobb (LD5), Chair and Rep. Kavanagh (LD23), Vice Chair

Commerce: Rep. Jeff Weninger (LD17), Chair

County Infrastructure: Rep. David Cook (LD8), Chair

Education: Rep. Michelle Udall (LD25), Chair

Elections: Rep. Kelly Townsend (LD16), Chair

Federal Relations: Rep. Mark Finchem (LD11), Chair

Government: Rep. John Kavanagh (LD23), Chair

Health & Human Services  Nancy Barto (LD15), Chair and Jay Lawrence (LD23), Vice Chair

Judiciary: Rep. John Allen (LD15), Chair

Land & Agriculture: Rep. Tim Dunn (LD13), Chair

Military & Veterans Affairs: Rep. Jay Lawrence (LD23), Chair

Natural Resources, Energy & Water: Rep. Gail Griffin (LD14), Chair

Public Safety: Rep. Kevin Payne (LD21), Chair

Regulatory Affairs: Rep. Travis Grantham (LD12), Chair

Rules: Rep. Anthony Kern (LD20), Chair

Sentencing & Recidivism Reform: Rep. David Stringer (LD1), Chair

State & International Affairs: Rep. Tony Rivero (LD21), Chair

Technology:  Rep. Bob Thorpe (LD6), Chair

Transportation: Rep. Noel Campbell (LD1), Chair

Ways & Means: Rep. Ben Toma (LD22), Chair

Will Humble Behavioral Health, Early Childhood, Public Health, State Legislature, Wills Blog

2018 Child Fatality Review Report Published

The death of any child is a tragedy – for the family and for the community. Everybody wants to prevent childhood deaths. But making policy interventions to prevent childhood deaths requires information in order to develop effective policy interventions.  That’s where the Arizona Child Fatality Review State Team comes in.

More than 25 years ago the state legislature passed a law establishing the Arizona Child Fatality Review Program (A.R.S. § 36-342, 36-3501-4).  It’s a great example of establishing public policy designed to build data and evidence so policy makers can use evidence to build future interventions.

The State Team includes representatives from the Academy of Pediatrics and from the ADES Divisions of Developmental Disabilities and Children and Family Services, as well as from law enforcement and the ADHS. The team’s role is to review all childhood deaths in AZ and produce an annual report to the Governor and legislature with a summary of findings and recommendations based on promising and proven strategies regarding the prevention of child deaths.

In past years this focus has raised the awareness about child drowning and the importance of putting babies to sleep on their backs or making sure all children are always secured in car seats. Other recommendations included taking action to reduce the number of uninsured, decrease medical complications of pregnancy and increase safe sleep practices.

The 2018 Child Fatality Review Report was published last week- and as usual it provides a host of data and recommendations that are directly tied to evidence. Here are some examples from this year’s report.

Child suicides increased an astonishing 32% and accounted for 6% percent of all child deaths. A history of family discord was the most commonly identified preventable factor in suicides followed closely by a history of recent break-up, drug/alcohol use and an argument with a parent. 

Firearm deaths increased 19% from the previous report.  Suicides and homicides accounted for 88% of firearm-related deaths in 2017. Fifty-one percent of firearm related deaths were a result of suicide (n=22) and 37% of firearm related deaths were homicides (n=16).

Injury deaths increased 4% from the previous reporting period and comprised 23% of all child deaths. The leading cause was car crashes and 31% of the injury deaths were among kids less than 1 year old… and important piece of data considering Arizona has yet to adopt a law requiring kids under 2 years old to be in a rear facing car seat.

The number of unsafe sleep deaths increased 5% from the previous year.  60% were bed sharing with adults and/or other children. Child fatalities due to maltreatment decreased 4% and accounted for 10% of all child deaths in Arizona.   Substance use was a factor in 65% of maltreatment deaths.

Drowning deaths increased 30% over the period and accounted for 4% of all child deaths. 63% occurred in a pool or hot tub. Lack of supervision was a factor in 69% of drowning deaths.

Substance use was a factor in 17% of all child fatalities (n=136).  The majority of substance use related deaths involved the child or the child’s parent as the main user contributing to the death of the child. In 49% of substance use related deaths, the parent was misusing or abusing alcohol or drugs.

The full report covers each of these areas including some recommendations for policy and program interventions in each area.  Sometimes the recommendations are more related to increasing awareness but many are more policy based.

Lots of work went into this report- so if you’re somebody in a position to influence either lawmakers or agency officials to implement preventative policies in these areas- please get familiar with this   important research product – it will really help inform your advocacy efforts.

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