IMPAQ Health News
From our experts to your inbox. Every two weeks.
In this edition, read stories related to health equity, new Medicaid studies and regulations, and the latest efforts to address the impacts of COVID-19. Don’t miss the story from IMPAQ and AIR health experts on the long-term implications of the new executive order on telehealth 
Telemental health can serve as a lifeline for those who are struggling with the far-reaching effects of COVID-19. In the latest post in our COVID-19 blog series, experts from IMPAQ and the American Institutes for Research (AIR) explore the evolution of telemental health services and how the pandemic will define their role in the continuum of care going forward.

This post features expert insights from IMPAQ authors Stevland Sonnier, Dr. Brandon Hesgrove, and Kevin Van Dyke, and AIR author Frank Rider.
As of September 13, US COVID-19 cases were growing by 5 percent or more in 11 states. With cases still on the rise, new health care utilization and reimbursement trends have begun to emerge.

  • To boost public support for a COVID-19 vaccine, the CEOs of nine drug manufacturers have pledged not to seek regulatory approval before safety and efficacy can be established in a Phase 3 Clinical Trial.

  • Preventive care in the US has declined significantly since the start of the COVID-19 pandemic, including a 60 percent decline in vaccinations in April.

  • A new Census report found that the uninsured population in America grew by 1 million people in 2019, before the COVID-19 pandemic began.
Here are some resources for following health policy trends and the latest efforts to address COVID-19: 
  • IMPAQ researchers developed a dashboard to provide a comprehensive overview of COVID-19 clinical trial data. This dashboard is updated with new data and infographics every two weeks. 

  • In a new brief, United States of Care examined the current employer-sponsored health system amid stressors caused by the COVID-19 pandemic.
Health Equity in 2020
ProPublica and the State University of New York found that COVID-19 cases can be more extreme if the patient has been exposed to hazardous air pollutants (HAPs). The study found a close correlation between HAP levels and the per-capita death rate from COVID-19 in both rural and urban settings. ProPublica (9/11)
New research indicates that the algorithm used to distribute $175 billion in hospital and community provider relief has discriminated against counties with predominately Black residents. The report found that the algorithm, which relied on costs to determine medical need, disfavored communities that spent less on their health care even though they had higher needs (e.g., more COVID-19 patients). Bloomberg (9/10)

  • An analysis from Epic Health Research Network and Kaiser Family Foundation underscores the racial disparities in hospitalizations and deaths due to COVID-19. (9/16)
According to the National Center for Health Statistics, Black women are 2.5 times more likely to die during childbirth than white women. This collection of anecdotes highlights the institutional racism and unconscious biases from medical professionals that Black women face while seeking care during pregnancy. USA Today (9/9)
A telephone survey comparing low-income adults in Arkansas and three control states assessed the policy effects of the temporary Medicaid work requirements that were implemented in 2018. The results indicated that the policy reversal made up for coverage losses during 2018, work requirements did not increase employment, and those who lost access to Medicaid experienced adverse consequences. Health Affairs (9/8)
As the US unemployment rate increased during the pandemic, Americans lost their employer-sponsored insurance coverage and turned to Medicaid programs. States are beginning to confront massive budget deficits as Medicaid enrollment continues to grow, yet states are not allowed to disenroll anyone from the program if they want to continue receiving funding through the Cares Act. The Washington Post (9/14).

The guidance encourages states to use regulatory pathways in Medicaid to adopt value-based care, such as different value-based payment arrangements. The guidance also includes innovative payment model examples that states have used to advance value-based care. CMS (9/15)
Administration Rules & Executive Orders
President Trump signed an executive order to begin demonstration projects requiring Medicare Parts B and D to offer prescription drugs at the same prices as those sold in other developed nations. The New York Times (9/13)
On September 14, CMS Administrator Seema Verma signaled the agency would withdraw the proposed Medicaid fiscal accountability (MFAR) rule, which would have increased federal oversight of how states fund their Medicaid programs and possibly led to funding cuts. The proposed rule was opposed by a wide range of stakeholders. Modern Healthcare (9/14)
Telehealth Outcomes
PCORI has released new research to determine the long-term viability and effectiveness of remote care delivery. The studies found that patients receiving follow-up care through telehealth services were less likely to return to the emergency room and phone counseling improved symptoms for patients experiencing anxiety and depression following mechanical respiratory support. NASHP (9/8)
  • FAIR Health reports that telehealth claims for private payers increased by 4,132 percent nationally from June 2019 to June 2020 but fell by 21 percent from May 2020 to June 2020. FAIR Health (9/1)
Research examining 40,000 patient encounters from Mount Sinai Hospital in New York City found that Black and Hispanic patients were more likely to use the emergency department over telehealth services compared to their white peers during the height of the COVID-19 pandemic. Patient Engagement Hit (9/3)
Controlling COVID-19:
Reopening, Testing, and Vaccines
As routine temperature checks become more commonplace, health officials warn that they are likely ineffective in screening infected individuals. Temperature checks are better for identifying those who are seriously ill, such as with a temperature of 100.4 degrees Fahrenheit, rather than those who are asymptomatic carriers of the virus. The New York Times (9/14)
The Trump Administration is seeking to help public health officials schedule COVID-19 immunizations and manage vaccine supplies through its new data system, the Vaccine Administration Management System. The platform would bypass existing state-level vaccination trackers and possibly impose new data reporting requirements. Politico (9/13)
According to a new CDC survey, adults who tested positive for COVID-19 were twice as likely to have dined at a restaurant. Although the study did not distinguish between indoor or outdoor dining, it did find that both positive and negative cases reported participating in other lifestyle activities at about the same rate. NPR (9/11)
Spotlight on IMPAQ
New measures from a recent executive order and CMS’ 2021 Medicare Physician Fee Schedule could change the landscape of Medicare telehealth benefits. In this blog post by IMPAQ and AIR experts Leah Dillard, Rachel Shapiro, and Kevin Van Dyke, learn how these new rules may impact the expansion of telehealth now and in the future, and how stakeholders are reacting to the policy shifts.
While data is a critical tool in the fight against the COVID-19 pandemic, glaring reporting disparities around race and socioeconomic status remain. In a new article published in Route Fifty, AIR experts Tamika Cowans, Ellen Schultz, Trenita Childers, Tandrea Hilliard, and Maliha Ali write about how stakeholders can use measurement equitably to inform recovery from the coronavirus health crisis.
IMPAQ researchers published six articles in a supplement to the September 2020 edition of the Journal of Patient Safety. Covering topics ranging from preventing infection spread in hospitals to supporting health care teams to promote patient safety, the articles were developed as a part of IMPAQ’s support to the Agency for Healthcare Research and Quality's Making Healthcare Safer III Report. Congratulations to IMPAQ authors Dr. Kendall Hall, Bryan GaleAnna LongElizabeth Schoyer, and Dana Costar.
Feel-Good News Stories
Cowgirl 911, a dispatch system originating on Facebook, has mobilized neighbors in Oregon to help evacuate animals from fires across the state. The group estimates that they’ve helped transport over 20,000 animals as of September 13. KGW (9/13)
Graphic of the Week
The National Institute for Health Care Management (NIHCM) Foundation examined the effects of pandemic-related stress on youth mental health. It is clear that young people need more support during this challenging time.
Upcoming Events, Trainings, & Webinars
The Interagency Working Group on Youth Programs (IWGYP) will host a free webinar to highlight Youth Participatory Action Research (YPAR), an approach in which researchers engage youth as full partners in the research process. This webinar will discuss the variety of roles youth may hold and the importance of leveraging developmental relationships while conducting YPAR. Register.
Join the Center for Health Care Strategies and Arnold Ventures as they share findings from interviews with states that operate Medicare-Medicaid integrated programs, as well as experiences from two integrated health plans. The panel will also discuss policy recommendations for better responding to the needs of dually-eligible beneficiaries in the wake of COVID-19. Register.
The National Academy of Medicine’s Leadership Consortium is hosting a webinar to explore sector-by-sector opportunities to improve US health care delivery in the wake of the COVID-19 pandemic. Register.
Join NASHP for a discussion with Maine and Pennsylvania officials on incarceration-based opioid use disorder treatment programs that link individuals to treatment upon their release. Register.
NOTE: The information, analyses, and opinions expressed in the articles, publications, or comments contained therein are those of the authors and should not be considered verified or endorsed by IMPAQ or any of our partners or clients.