Benefits of sponsoring out of state trips for policymakers

A new Health Affairs blog highlights the benefits of learning trips for state health policymakers working on systemic change. The author, President of New Jersey’s Nicholson Foundation, notes that out-of-state trips are very effective in fostering new perspectives on problems and finding innovative solutions.

“The Nicholson Foundation is dedicated to addressing the complex needs of vulnerable populations in New Jersey’s urban and other underserved communities. Over the years, we have sponsored many trips that have sent hundreds of New Jersey health leaders beyond the Garden State to study approaches used and innovations practiced elsewhere. The knowledge these leaders have brought back has helped transform how care is delivered at home.”

We couldn’t agree more. A delegation from CSG/ERC’s health committee visited New Jersey in October for a conference sponsored by the Nicholson Foundation, to hear more about New Jersey’s success with high-cost, high-need Medicaid members. It’s great to hear others who appreciate the value of travel and policymakers learning from each other; at CSG/ERC we’ve been doing this for 83 years.

Next CEPAC meeting taking a deep dive into effectiveness of palliative care

The March meeting of CEPAC, New England’s comparative effectiveness council, will be in Hartford, CT on the 31st. CEPAC is an independent council of clinicians, academics and consumer advocates across the region who take a deep dive into research around treatments for specific conditions, sorting out and voting on clinical effectiveness, but also which are worth the money specifically for New England. Previous meetings have addressed opiod addiction, breast cancer screening and depression treatments. The March 31st meeting will address Palliative Care: Barriers, Opportunities and Considerations for Quality Improvement. Very smart, independent people discussing how to do the best thing for patients and pocketbooks on the issues vexing the health system. We are lucky to have them in our region. Click here to register for the free meeting.

Survey of state laws on Epi-Pen use in schools; ERC states split on policies

The Network for Public Health Law has just published a survey across all 50 states of laws addressing epi-pen use in schools. Food allergies affect six to eight percent of US children and that number is growing. Children are at greater risk than adults of life-threatening anaphylactic reactions to trigger foods, too often with tragic consequences. A prompt injection of epinephrine is the first choice for treatment. Almost all states have laws allowing competent students to carry and self-administer their own epi-pen at school. But consensus is growing that this may not be enough. One in four anaphylaxis reactions in schools afflict a child with no previous food allergy diagnosis. According to the new survey, 27 states and the District of Columbia have laws allowing schools to maintain non-student specific epinephrine for emergencies to be administered by appropriate personnel. ERC states are split on the issue. Maryland, Massachusetts, Rhode Island and Vermont have laws allowing, and in some cases requiring, non-student specific epinephrine access in schools. Connecticut, Delaware, Maine, New Hampshire, New Jersey, New York, and Pennsylvania do not, but some have caveats. For more on state laws regarding epinephrine in schools, go to the survey.

Medicaid and free care – Public Health Law Webinar

Join our partners at the Network for Public Health Law for a webinar Jan. 21st at 1pm on how Medicaid can now cover community services that are usually provided for free. The new rule, published by HHS a year ago, replaces guidance that prohibited Medicaid paying for “free care”. This webinar will be helpful for policymakers interested in expanding community health such as school health, local public health and services for people with disabilities.

Health care is expensive for American households, but less than housing or transportation

In 2013 Americans of all ages devoted more of total household spending to housing and transportation than health care, according to the Bureau of Labor Statistics. For most age groups that year, health care spending was also behind food and pensions/Social Security. Spending on health care peaked for ages 65 to 74 at $5,188/person; children spent the least at $943. Americans under age 34 spent more on entertainment than health care on average and children under age 25 and seniors age 75 and older spent more on clothing than health care.

New Health Affairs issue focuses on high-cost, high-need patients, ACA and Medicaid expansion impacts

CSG-ERC policymakers will find a wealth of helpful information in this month’s Health Affairs issue. Several papers address the challenge of caring for high-cost, high-need patients, a significant problem for state budgets that we tackled in an ERC webinar with Clemons Hong last year. Issues and findings in Health Affairs include substance use, supportive housing for the homeless, mental illness, and lessons from a successful California program of care coordination and home visiting. Papers on ACA Medicaid expansions include a study finding no impact on employment in states that expanded the program and another finding similar improvements in access to care in states with either traditional or private insurance-based Medicaid expansions over states that chose not to expand coverage. Other articles include a study finding that the ACA has reduced uninsured hospital admissions, little evidence of a feared increase in part time employment, and that the law has improved access to care and affordability but much remains to be done. The issue also includes an important article about variation in the effectiveness in Medicaid tobacco cessation care between states, reviewed in more depth in our last blog.

Medicaid tobacco cessation effectiveness varies between states

An article in this month’s Health Affairs finds that while all state Medicaid programs cover smoking cessation services, there are significant gaps between states. Smoking is the leading preventable cause of disease and Medicaid members are almost twice as likely to smoke as the average American. The Surgeon General estimates that 15% of Medicaid spending results from smoking and a study found that each dollar invested in tobacco cessation returns three dollars in lower health costs. The Affordable Care Act requires Medicaid programs to offer smoking cessation treatment, but the extent and effectiveness of those programs vary considerably. The study estimates that 10% of all US Medicaid smokers are getting cessation medications but that rate varies from 27% in Minnesota to 2% in Rhode Island. The article outlines some differences between more and less effective states.

% adult Medicaid smokers Number of adult Medicaid smokers (1,000s) Estimated % of Medicaid smokers using medications
CT 31 102 15
DE 34 43 4
ME 39 61 6
MD 36 182 8
MA 30 260 18
NH 38 18 25
NJ 28 114 11
NY 29 966 12
PA 39 445 14
RI 36 38 2
VT 38 33 13