Will Humble Public Health, Public Health Law, Return on Investment, Vaccination, Wills Blog

Using Public Health Policy to Boost Vaccine Coverage

Measles across the country have deteriorated to a level not seen in 30 years, and several states have recently taken direct action to implement policies to boost immunization coverage.

At the beginning of 2019, only California, Mississippi, and West Virginia had state laws that only allowed medical exemptions from their school attendance requirements. Now there are 3 more states like that.  This year Maine and New York passed laws that limit school vaccine exemptions to medical reasons.

 The Maine legislation (which will take effect on September 1, 2021) repeals the state’s religious and philosophical (personal belief) exemptions – but grandfathers in kids that have a non-medical exemption if the parents show that a healthcare provider was consulted about the benefits and risks of vaccinations.

The New York legislation (which took effect immediately) repealed their religious exemption (and has no grandfather clause). NY didn’t have a persona exemption, so all they have now is a medical exemption for school attendance requirements.

Washington state removed their former philosophical exemption for the measles, mumps, and rubella vaccine.

I’ve heard through the grapevine that Arizona state government will be working on a “Breakthrough Project” in the coming year that will have a core goal of improving Arizona’s decreasing immunization rates. 

“Breakthrough Projects” are something in the “Arizona Management System” (a Governor’s Office Initiative) that is also a state agency scorecard metric.  Breakthrough Projects are supposed to: 1) align with an agency performance measure; 2) result in a sustainable success that addresses a stakeholder concern; and 3) require “a substantial design or re-design of a work process documented with an A3 project plan”.

I’ll stay tuned to get more information about what the ADHS has planned for the Breakthrough Project and include it in a future Policy Update.

Will Humble Environmental Health, Public Health, Public Health Law, Tobacco, Wills Blog

Flagstaff City Council Approves Tobacco 21 Ordinance

The Flagstaff City Council approved a Tobacco 21 ordinance last week! Here’s a copy of their ordinance, which follows the national best practices model for Tobacco 21.

The ordinance is a few pages long- but essentially it will limit the sale of tobacco including electronic cigarettes to only people over 21.  It’ll require retailers that sell tobacco and e-cigs to get a license (the city will do compliance checks). 

Fines for retailers who violate the ordinance will begin with a $500 fine.  A 2nd violation within 36 days will be a $750 fine (and a loss of the ability to sell tobacco products for a week).  A 3rd violation within 36 days increases the punishment to $1,000 and 30 days of no-sell.  A 4th violation is a $1,000 and the retailer won’t be able to sell tobacco products for 3 years.

Perhaps next legislative session a bill will move forward that establishes a statewide Tobacco 21 law.

Will Humble Nutrition, Public Health, Wills Blog

SNAP: An Underused Lever to Address the Obesity Epidemic

One of the bigger policy levers to improve the nutrition decisions that people make lies with the Supplemental Nutrition Assistance Program or SNAP. By making some policy changes within the program, we could hard-wire better nutrition decisions among program participants.

The thing is that the federal government (congress and USDA) would need to take the lead to implement evidence-based policy decisions – policy changes that would have a profound impact on nutrition and obesity in the US.

To help make the case, the ADHS contracted with the ASU School of Nutrition & Health Promotion back in 2012 to write a White Paper that outlined evidence-based strategies to improve the effectiveness and efficiency of SNAP including: 1) improving access to healthy foods to provide better choices; 2) incentivizing the purchase of healthy foods; 3) restricting access to unhealthy foods; and 4) maximizing education to more effectively reach a larger population of SNAP participants.

That paper, entitled Policy Considerations for Improving the Supplemental Nutrition Assistance Program (SNAP): Making a Case for Decreasing the Burden of Obesity. Back in 2012 the ADHS team presented the recommendations and evidence at the American Public Health Association Annual Meeting that year.

This month the American Journal of Public Health published a paper on a similar topic entitled Support for Supplemental Nutrition Assistance Program (SNAP) Policy Alternatives Among US Adults. 

The article measures public and participant support regarding some important policy options like removing sugary drinks and candy from the allowable products for purchase list and providing SNAP participants with a supplemental benefit that could only be used for fruits and vegetables. The authors found that most respondents approved of both the restrictive policies (e.g. removing sugar drinks and candy from the buy list) and the supplemental policies tested.

Important information for Congress and the USDA to consider when the Farm Bill comes up for re-authorization next time- which will be in a few years. Honestly, with the obesity epidemic we’re facing- we really should be using all the policy levers we can to dial back obesity- but congress and the USDA have consistently resisted these policy options- perhaps out of fear of the junk food lobby?

Will Humble Community Health Workers, Wills Blog

Arizona’s Community Health Worker Workforce:

Assessment of the Integration and Financing of Community Health Workers within Arizona Medicaid Health Plans

Now that the process is under way to provide voluntary certification of community health workers (via the ADHS Rulemaking), an important next is to engage Arizona health plan leadership in conversations about the integration and sustainability of the CHW workforce within Arizona’s Medicaid contracted health plans and provider networks. 

To that end, the Center for Health Equity Research at NAU through funding from the ADHS and in collaboration with the UA Prevention Research Center (AzPRC) wrote a report that was released this week which provides insight into innovative strategies for integrating, sustaining and scaling of the CHW workforce within AHCCCS.

The new report provides direct insight to this pathway via conversations with health plan leadership including topics on:

1. Current and Projected Utilization

2. Roles, Competencies and Skills

3. Recruitment and Training

4. Financing and Payment Models

5. Healthcare and Workforce Policy

The report found that Arizona health plan leaders recognize that Community Health Workers can play a significant role in improving patient outcomes and reducing system costs for health care. Many health plan leaders already actively support their contracted provider networks to better integrate and finance CHWs to meet HEDIS measures.

In fact, 4 AHCCCS Health Plans and 10 of 22 Federally Qualified Community Health Centers currently employ CHWs to link patients to community resources to promote self-management.

The research team found that health plan leadership expects that the new Arizona Complete Care Contracts will fundamentally expand the need for CHWs and the core competencies, roles and skills as plans expand their services and seek creative approaches to meeting membership medical and non-medical needs.

This week’s report sheds light on important next steps toward building CHWs into the care network.

Congratulations and thanks to AzPHA member Dr. Samantha Sabo, Louisa O’Meara, and Katie Castro for their work on this important roadmap document.

Will Humble Medicaid, Wills Blog

Arizona Medicaid Members Get a Lyft

Non emergency medical transportation for doctor appoints can be a covered benefit for Medicaid members that qualify. The benefit is aimed at members that need assistance to get to medical appointments but may not have a drivers license or car etc.

AHCCCS recently became the 1st Medicaid agency to take advantage of the new efficiencies provided by ridesharing services.  AHCCCS Director Jami Snyder was quoted in media report this week as saying  “We are proud to be the first Medicaid program in the country to establish an innovative regulatory approach that seamlessly offers rideshare as a non-emergency medical transportation option for Medicaid beneficiaries.” 

This policy change will help more people get to consultations without having to rely on public transportation. Here’s the statement on the AHCCCS website about the new policy: 

Adding rideshare companies as providers of non-emergency medical transportation can add flexibility to the health care delivery system and increase transportation options for Medicaid members. Under the new AHCCCS provider category, rideshare companies are eligible to serve Medicaid members who do not require personal assistance during medically necessary transportation. As such, the training required of these providers is reduced as compared to traditional non-emergency transportation providers.

AHCCCS members will not need to change how they request non-emergency medical transportation, and should continue to contact their health care plan to request service. The health care plan and/or their transportation broker will assess the member’s need and determine whether a Transportation Network Company is a viable option for that particular transportation need.

Non-emergency medical transportation is a covered benefit for AHCCCS members when: the physical or behavioral health service for which the transportation is needed is a covered AHCCCS service; the member is not able to provide, secure or pay for their own transportation, and free transportation is not available; and the transportation is provided to and from the nearest appropriate AHCCCS registered provider. The complete transportation policy is published in the AHCCCS Medical Policy Manual, Chapter 300-BB and available on the AHCCCS website.

Will Humble Affordable Care Act, Medicaid, Public Health, Wills Blog

Tools to Align Public Health & Medicaid Polices

The Center for Healthcare Strategies has been partnering with the CDC, CMS, ASTHO, and the National Association of Medicaid Directors on a really interesting policy development partnership that aligns and accelerates the adoption of evidence-based prevention strategies between public health and Medicaid for high-cost health conditions like tobacco use, high blood pressure, inappropriate antibiotic use, asthma, unintended pregnancies, and type 2 diabetes.

It’s called the 6|18 Initiative and it’s supporting Medicaid-public health partnerships in 34 states to accelerate adoption of proven prevention strategies (the “18” refers to a set of evidence-based interventions that address the “6” conditions above).  The collaborative has developed practical tools to help Medicaid agencies, state and local health departments, and other payers and purchasers plan, design, implement, and assess CDC’s 6|18 Initiative prevention activities.

The tools are designed to help the collaborative teams (Medicaid and public health officials and managed care organizations) to implement high-opportunity prevention interventions.  Here’s a link to those entity specific tools.

Arizona and many other states are aggressively adopting new value-based payment models to improve health care quality and stabilize or reduce healthcare costs.  CDC’s 6|18 Initiative offers some evidence-based preventive practices and payment and delivery models that offer opportunities for state and local agencies to collaborate on enhancing the coverage, access, utilization, and quality of cost-effective prevention practices.

Will Humble Tobacco, Wills Blog

Flagstaff City Council Voting on a Tobacco 21 Ordinance Tuesday (2/2/19)

The Flagstaff City Council has a Tobacco 21 ordinance up for a final vote at their Tuesday, July 2nd 4:30 PM council meeting.  Here’s a copy of their ordinance, which follows the national best practices model for Tobacco 21.  

The ordinance is a few pages long- but essentially it would limit the sale of tobacco including electronic cigarettes to only people over 21, requires retailers that sell tobacco and e-cigs to get a license (the city will do compliance checks), and includes fines for violations.  I couldn’t tell exactly what the effective date for the ordinance would be (should it pass).  More to come.

Will Humble Social Determinants, Wills Blog

Great News for Arizona Kids & Families

As a part of the state budget recently passed, the legislature finally granted the Department of Economic Security the authority to expend $56 million in new annual federal childcare money. ADES moved swiftly to begin using these new dollars to increase scholarship rates and to serve more children.

The ADES has already implemented a provider rate increase with the funds (the first since the since before the recession). The childcare wait list has also been suspended, meaning that families that are eligible for childcare assistance will be able to begin services immediately (this is the first time since 2009 there has been no wait list).

Thank you to all the parents, champions, and partners who called for investment of these funds in these three changes. Advocacy works!

Will Humble Disease Control, HIV Prevention, Prevention, Public Health Law, Return on Investment, Wills Blog

New USPSTF Recommendations for HIV Will Have a Powerful Public Health Impact

Ever since the passage of the Affordable Care Act, a prevention model of health has been increasingly weaving its way into the fabric of traditional models of care.  That’s because the ACA expanded the role of preventive services in the US health care delivery system via various incentives. 

For example, the “Category A & B” preventive services that are recommended by the United States Preventive Services Task Force (USPSTF) are now included (at no cost to consumers) in all Qualified Health Plans. In addition, many employer-based and state Medicaid programs routinely cover Category A & B services once they’re recommended by the USPSTF. 

The USPSTF is an independent, volunteer panel of experts in prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

The Task Force analyzes priority preventive health services and assigns the a letter grade (an A, B, C, or D grade or an “I Statement”) based on the strength of the evidence and the balance of benefits and harms of the preventive service.

Currently, the USPSTF recommends 51 Category A & B Preventive Health Services – which include things like screening tests, counseling, immunizations, and preventive medications for adults, adolescents, and children. 

The preventive services that have an A or B grade are presented in alphabetical order and by the date they were recommended on the Task Force website.

This month they added 2 new recommendations related to HIV: 

You can browse the USPHS website and check out the preventive services that they have evaluated but got a lower grade. Most of the services are broken down by age, gender and other risk factors.

Will Humble Disease Control, HIV Prevention, Wills Blog

Should Pharmacists Prescribe PrEP as Part of the Solution for HIV Prevention

As I mentioned above, the U.S. Preventive Services Task Force this week put out their final recommendation statement on preexposure prophylaxis (PrEP) for the prevention of HIV infection. The Task Force found that clinicians should offer PrEP to persons at high risk for HIV.
The task force found convincing evidence that PrEP is of substantial benefit in decreasing the risk of HIV infection in persons at high risk of HIV acquisition.  They conclude that PrEP is associated with small harms, including kidney and gastrointestinal adverse effects and that (with high certainty) the benefit of PrEP (with oral tenofovir disoproxil fumarate–based therapy) is substantial. They classified it as a Category A intervention.

The final recommendation statement can also be found in the June 11 issue of JAMA. The impact of the Category A recommendation is important because PrEP will now be included (at no cost to consumers) in Qualified Health Plans offered on the Marketplace.  In addition, many employer-based and state Medicaid programs routinely cover Category A & B services once they’re recommended by the USPSTF. 

This week there was an article in the American Journal of Public Health that makes an argument that pharmacists should have a role in HIV prevention related to preexposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and HIV testing and harm reduction.

The authors make a compelling case that, because PrEP and PEP require a prescription, control of the epidemic face hurdles like limited network capacity, physician shortages, and other access to care barriers. They argue that pharmacists are an untapped resource that are more easily accessible and available without appointment. Also, because pharmacies and pharmacists aren’t linked to specific health conditions, the setting is considered largely free of HIV-related stigma.

Of course, expanding into this role would require pharmacists to work within each jurisdiction’s scope of practice laws and policies, ensure HIV literacy through pharmacist training programs and continuing education courses and building infrastructures for billing and reimbursement, and health information technology.

Interesting idea for sure.

1 … 138 139 140 141 142 … 167