Will Humble Medicaid, Social Determinants, Wills Blog

AHCCCS Tackling Housing Instability with Their New ‘H2O’ Program

October 1 marks the beginning of the federal fiscal year – and with it comes one of the most exciting initiatives coming out of AHCCCS in a long time – their new Housing and Health Opportunities (H2O) program.

So, what’s H2O about? It’s about tackling one of the most pressing issues for individuals with serious mental illness and other high-risk groups: stable housing.

Addressing Healthcare & Housing Infographic

AHCCCS leadership recognized that without a safe and stable place to live, keeping up with treatment plans is impossible, especially for persons with a serious mental illness. H2O aims to provide housing services such as rental aid, home modifications, and case management to support individuals in securing and keeping a home for this key population.

AHCCCS Housing and Health Opportunities (H2O) Demonstration

There’s solid evidence that housing is a key social determinant of health, especially for those with serious mental illness. When people are stably housed, they’re more likely to stick to their treatment plans, attend medical appointments, and experience fewer crises.

The AHCCCS Housing Program follows a ‘Permanent Supportive Housing Model an evidence-based and cost-effective strategy for addressing & improving health outcomes for persons with a serious mental illness. Data shows it is effective in reducing health care use and costs directly translating to improved member health outcomes

Permanent Supportive Housing Evidence-Based Practices (EBP KIT) | SAMHSA Publications and Digital Products

The benefits don’t end with better health outcomes. Providing stable housing also saves taxpayer money. When people have homes, they need fewer emergency room visits, fewer inpatient stays, and less crisis intervention—all of which are expensive.

In their waiver request to CMS, AHCCCS provided evidence that their plan likely to significantly reduce the overall costs of healthcare, benefiting not only AHCCCS but taxpayers too.

H2O is a demonstration waiver, meaning it’s a pilot effort to test new ways of improving health and stability for vulnerable populations—and it comes with a requirement for AHCCCS to measure the program’s impact – both in terms of patient care and cost containment (see AHCCCS’ Evaluation Design)

Kudos to the new leadership at AHCCCS who have prioritized this initiative over the last couple of years to build this out, get CMS’ approval and begin their implementation via their contracted Accountable Care organizations – especially given the fraud and human trafficking scandal they inherited from the previous administration.

AHCCCS Housing and Health Opportunities (H2O) Demonstration

…  and yes. That is AHCCCS’ new logo. Good idea to change the logo especially considering the damage to their brand that occurred during the previous administration due to the horrible human trafficking and fraud scandal.

Will Humble Public Health, Vaccination, Wills Blog

RFK Jr. as HHS Secretary? Why It Could Mean the End of Evidence-Based Public Health Policy

If you’re reading this, you’ve no doubt heard the word on the street that Robert F. Kennedy Jr. will be appointed the Secretary of Health and Human Services if Mr. Trump wins the presidency. HHS is a super-agency which includes CDC, CMS, FDA, HRSA., NIH all important health and human services agencies. The very agencies who oversee protecting public health and the most vulnerable persons in the country.

What would a Kennedy-run HHS look like? Given Kennedy’s longstanding skepticism of evidence-based health policy, his leadership of HHS would likely prioritize his personal beliefs over solid science.

Kennedy’s vocal stance on vaccines provides a glimpse into his priorities. For years, he’s argued that vaccines are neither safe nor effective, claiming, without evidence, that they’re tied to a laundry list of health issues, including autism, autoimmune disorders, infertility, and obesity.

His assertions have been widely debunked by researchers and public health agencies, but Kennedy has doubled down, continuing to spread misinformation that contributes to vaccine hesitancy and compromises public health. His leadership at HHS could shift resources and policies away from promoting vaccines—an essential tool in fighting preventable diseases—and instead, focus on unsubstantiated theories that put lives at risk.

Besides vaccines, Kennedy has pushed other unproven therapies, including ivermectin, hydroxychloroquine, and chelation therapy, none of which are supported by scientific evidence for the uses he promotes. During the COVID-19 pandemic, Kennedy advocated for these treatments, despite a lack of credible data backing their effectiveness.

If appointed to HHS, his influence could result in funding for these non-evidence-based treatments while sidelining effective, science-backed interventions. Under Kennedy’s leadership, we might see the federal government actively endorsing and funding unproven therapies, wasting taxpayer dollars and eroding trust in the department.

Another alarming aspect of Kennedy’s approach is his disdain for agencies like the CDC and FDA, both essential parts of the HHS. He’s called for “slashing” their budgets and has suggested that leadership within these agencies should be investigated and potentially jailed, accusing them of engaging in conspiracies and misinformation.

This rhetoric is not only unfounded but is also deeply damaging to public trust in institutions meant to safeguard health. Should Kennedy gain control of these agencies, it’s likely he would try to implement his agenda by weakening their funding and influence, leaving FDA and CDC ill-equipped to regulate food and drug safety, and provide reliable guidance.

Kennedy’s leadership would likely align with Project 2025, a right-wing policy blueprint that proposes drastic rollbacks of federal public health initiatives. This project, which Trump has vowed to implement if re-elected, calls for shrinking the federal government’s role in health policy, reducing the power of public health agencies, and limiting their ability to issue health recommendations.

The Dangers of Implementing Project 2025s’ Public Health Proposals – AZ Public Health Association

The HHS under Kennedy could very well fast-track these proposals, potentially dismantling key public health protections. For instance, Project 2025 advocates for removing the CDC’s authority to issue public health guidelines, a move that would be disastrous during health emergencies and diminish the role of science in policy decisions.

Kennedy’s approach to health policy is often rooted in personal beliefs rather than evidence, a dangerous quality for the head of an agency responsible for regulating food, drugs, and public health guidance.

Public health leaders are tasked with protecting and improving lives through science, not ideology. If Kennedy’s history is any indication, his appointment would mean prioritizing fringe theories over established science, weakening the agencies that Americans rely on to keep them safe.

At a time when public health faces multiple challenges, from pandemics to chronic disease, having an HHS Secretary who dismisses scientific consensus could be catastrophic. Health policy requires leaders who understand and respect evidence; Robert F. Kennedy Jr. has shown time and again that he does not.

Will Humble Suicide Prevention, Wills Blog

View the Webinar: Suicide Surveillance & Evidence-Based Intervention Summary in Pima County Arizona

‘Suicide Surveillance & Evidence-Based Intervention Summary in Pima County Arizona’

Passcode: 6+zDds4q

Speaker

Mark Person – Pima County Health Department

This presentation provides an overview of suicide rates and key trends identified in Pima County, in addition to discussing some of the most recent key findings revealed by the suicide mortality review committee.

Throughout the presentation the discussion will also focus on suicide prevention recommendations, risk factors, and populations disproportionately impacted by high suicide rates.

View the PowerPoint
Will Humble Health Insurance, Wills Blog

The Future of Telehealth in Medicare: Why Congress Needs to Act to Preserve Access & Improve Care

The COVID-19 pandemic forced the US to rethink how care could be delivered safely and effectively, especially for older and underserved populations. One of the most significant developments was the expanded use of telehealth services within the Medicare program.

As the country shifted to remote care, telehealth became a lifeline for millions of Medicare members. It let people get care without the risks associated with in-person visits, especially for high-risk populations. It also really helped out in rural reals that have weak networks for behavioral health, psychiatric and other critical care.

However, now that the public health emergency is over – the benefits of telehealth for Medicare members is also expiring at the end of 2024 (telehealth was temporarily extended when the PH emergency ended).

In order for Medicare to be able to continue to provide telehealth for certain things Congress will need to act before the end of the year.

The question before congress isn’t just whether telehealth should remain a part of Medicare – but how it can be structured to improve care and ensure long-term sustainability.

The Pandemic’s Lessons:
Improved Access Through Telehealth

The expansion of telehealth during the pandemic showed remarkable improvements in access to care. As documented in a Kaiser Family Foundation report, before the pandemic, Medicare’s telehealth coverage was limited.

Only patients in rural areas or specific settings had access, and visits had to be conducted via real-time audiovisual technology. The public health emergency lifted these barriers, enabling all Medicare beneficiaries to use telehealth for a broad range of services, including behavioral health, chronic disease management, and primary care visits.

A study published in Health Affairs highlighted how these changes improved care access for members who had struggled to see their doctors regularly. Older adults, those living in rural & underserved areas, and patients managing multiple chronic conditions benefitted the most.

Telehealth made it easier for patients to stay connected with their providers, avoiding travel, and waiting times. Patient and provider satisfaction surveys showed a high level of approval for telehealth, with many beneficiaries preferring virtual visits for routine care.

A Crucial Moment for Telehealth Policy

Before the end of the telehealth extension is here (12/31/24) Congress will need to decide whether to again temporarily extend telehealth or make permanent the telehealth flexibilities enacted during the pandemic.

There’s a current proposal for a two-year extension of these flexibilities, which would provide a temporary solution but falls short of addressing long-term needs.

A two-year extension is better than allowing the COVID-era policies to expire altogether, but it’s only a stopgap.

But… the bipartisan CONNECT for Health Act offers a more comprehensive and forward-looking solution. This bill proposes permanent expansions of telehealth in Medicare (including the removal of geographic site requirements that restrict telehealth to rural areas) and eliminates in-person visit rules for behavioral health.

Importantly, it also includes critical measures to reduce potential fraud and abuse, something sorely needed to prevent fraud and make telehealth services sustainable over time. Those measures include setting stricter guidelines for billing and ensuring better auditing of services.

The CONNECT Act also addresses concerns about overuse of telehealth by focusing on finding high-value services that are proper for virtual care.

Not all medical issues are suited for telehealth, but many conditions—particularly in behavioral health—benefit greatly from continued virtual access. The CONNECT Act emphasizes this distinction, ensuring that telehealth is used where it can be most effective without undermining the need for in-person care.

The Stakes: What Happens If Congress Fails to Act

If Congress doesn’t at least extend the current Medicare telehealth policies seniors could lose access to a vital service -especially for behavioral health services and in rural areas, erasing the gains in access achieved in the last 4 years.

While a two-year extension would temporarily keep access, it doesn’t provide the certainty needed to build sustainable, long-term solutions for telehealth in Medicare.

A Call to Action

Congress needs to act by December 31 to prevent the rollback of important Medicare telehealth services. While a two-year extension is a start, it really just kicks the can down the road.

Passing the CONNECT for Health Act would ensure that telehealth stays a permanent and sustainable part of the Medicare program.

Will Humble Public Health, Social Determinants, Wills Blog

Take Back Our Homes Initiative: Working to Balance of Power for Tenants by Helping Them Access Legal Counsel

The Take Back Our Homes collaborative (part of the Organized Power in Numbers organization) is working to improve health outcomes and reduce health disparities by attempting to improve the balance the power between landlords and tenants during eviction procedures – right in line with good public health practice!  

Last week they hosted a press conference launching a campaign to advocate for the city of Phoenix to adopt a Renters’ Right to Counsel’ policy – and important intervention to balance the scales between landlords and tenants in Arizona.

In essence – the initiative is trying to help balance the legal scales by providing legal counsel for tenants during the eviction process. As it stands – next to no tenants have legal representation during eviction procedures in Arizona while most or virtually all landlords have legal representation

As you’ll recall, we wrote a two-part series last week pointing out that Arizona’s antiquated Residential Landlord and Tenant Act is highly tilted in favor of landlords.

In those pieces I advocated for changes to the balance of power between landlords and tenants by urging key reforms should include:

  1. Just Cause Eviction Protections: Require landlords to provide a valid reason for eviction, preventing arbitrary and retaliatory actions.
  2. Extended Eviction Timelines: Lengthen the notice period for evictions to give tenants more time to find alternative housing, reducing the likelihood of homelessness.
  3. Mandatory Mediation: Implement a mandatory mediation program for eviction cases, encouraging dispute resolution and keeping more Arizonans in their homes.
  4. Heat Season Eviction Moratorium: Prohibit evictions during the hottest months of the year to protect tenants from the dangers of extreme heat.

What I forgot to mention was that providing legal counsel for tenants during the eviction process! What an oversight on my part!  

Here are the key components of their Right to Counsel initiative: 

  • The collaborative has contracted for an independently produced cost-benefit analysis of a Right to Counsel policy for the city of Phoenix, and essential piece of the puzzle to inform city council members’ decisions on the proposal.
  • Phoenix is currently participating in this Results for America Right to Counsel Policy Sprint, with a team composed of legal aid providers, tenant organizers, city staff, elected officials, and a member of the Maricopa County Bench. The purpose of this program is to bring together relevant stakeholders and build knowledge, relationships, and skills to advance a Right to Counsel policy.
  • Here are several political education training sessions we have hosted over the past 6 months:  Right to Counsel Political Education Part 1 and Part 2 for tenants which builds understanding of this policy. They’ve also gathered over 400 surveys from community members, hosted several leadership training events, and recently held a large day-long forum with over 100 tenants to talk about tenants’ experiences in Phoenix and what change is needed.
  • Finally, they’ve built a community coalition composed of direct service providers, legal aid providers, policy advocates, members of the Arizona State Bar, faith-based organizations, and labor organizations who support Right to Counsel policies. 

You can see some of the media coverage that was earned by the Take Back Our Homes collaborative last week.

What’s the evidence based for this initiative you ask? Good question. Here are some resources that connect the dots between eviction and eviction prevention to public health outcomes: 

This Right to Counsel Initiative is in direct alignment with AZPHA’s commitment to improving health disparities and I’m currently in contact with their organization to see how AZPHA might be of help with this evidence-based intervention. Stay tuned.

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