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February 2022

CMS proposes adding Health Equity Index to Medicare Advantage, Part D star ratings

The annual rule governing Medicare Advantage and Part D is putting a focus on health equity, the Biden administration announced earlier this month (Source: “CMS puts focus on health equity in Medicare Advantage, Part D Advance Notice,” Fierce Healthcare, Feb. 3).

The Centers for Medicare and Medicaid Services (CMS) issued its proposed Advance Notice for Medicare Advantage and Part D in 2023, and in the regulation the agency proposes updating the MA and Part D star ratings to account for how well a plan tackles health equity.

CMS is seeking comment specifically on a potential quality measure for the star ratings that would assess how often plans are screening for common social needs such as food insecurity, housing insecurity and transportation challenges.

CMS Deputy Administrator and Center for Medicare Director Meena Seshamani, M.D., said in a statement that the proposed Heath Equity Index aims to enhance transparency around how MA plans are treating "our most vulnerable beneficiaries" as well as encourage improvements in their care.


Maternal deaths spiked during first year of pandemic, especially for women of color

Deaths during pregnancy and the first six weeks after childbirth increased during the first year of the coronavirus pandemic, especially for Black and Hispanic women, according to a new report (Source: “Maternal Deaths Rose During the First Year of the Pandemic,” New York Times, Feb. 23).

The new National Center for Health Statistics report found that the number of maternal deaths rose 14%, to 861 in 2020 from 754 in 2019. Health officials attribute the sharp increase partly to Covid and pandemic-related disruptions.

The United States already has a much higher maternal mortality rate than other developed countries, and the increase in deaths pushes the nation’s maternal mortality rate to 23.8 deaths per 100,000 live births in 2020 from 20.1 deaths in 2019. Maternal mortality rates in developed countries have in recent years ranged from fewer than two deaths per 100,000 live births in Norway and New Zealand to just below nine deaths per 100,000 live births in France and Canada.

Black women in America experienced the most deaths: One-third of the pregnant women and new mothers who died in 2020 were Black, though Black Americans make up just over 13%nof the population. Their mortality rate was nearly three times that of white women. The mortality rate for Hispanic women, which has historically been lower than for white women, also increased significantly in 2020 and is now almost on par with the rate for white women.


Experts: Little has changed 20 years after landmark report linking systemic racism, health

Twenty years after a landmark report tied systemic racism to health disparities, experts say little has changed (Source: “20 years ago, a landmark report spotlighted systemic racism in medicine. Why has so little changed?,” Stat News, Feb. 23).

Unequal Treatment” was the first major report to point to longstanding systemic racism — not poverty, lack of access to health care, or other social factors — as a major reason for the nation’s deeply entrenched health disparities. The authors, a blue-ribbon panel of the National Academies’ Institute of Medicine, hoped their work would kickstart a national discussion and lead to much-needed change.

At the time, the report sent shock waves through medicine.  But today, the disparities — poorer outcomes and higher death rates for nearly every medical condition the panel examined — and the structural racism underlying them, remain. That grim truth has been made startlingly clear by both the pandemic and by statistics that show Black Americans continue to die up to five years earlier than those who are white.

“There hasn’t been a lot of progress in 20 years,” said Brian Smedley, a health equity and policy researcher with the Urban Institute who served as the report’s lead editor. “We are still largely seeing what some would call ‘medical apartheid.’”


Ohio COVID rate lowest since August

This week, Ohio again saw a significant drop in COVID-19 cases per 100,000 residents with numbers at their lowest level since mid-August (Source: “COVID-19 rates hit lowest point since August,” (Warren) Tribune Chronicle, Feb. 18).

It was the fourth consecutive week of declines after 11 straight weeks of increases. The state saw a 46.8% reduction in cases per 100,000 residents from last week and a 371% decline from two weeks ago. 

There were 255.8 COVID-19 cases per 100,000 residents for the period between Feb. 3 and Wednesday compared to 481 cases per 100,000 last week, according to Ohio Department of Health data. The CDC defines high transmission as 100 or more cases per 100,000. Ohio's rate hasn’t been below that threshold since July 29 when 77.4 COVID-19 cases per 100,000 residents were reported by the ODH.


Ohio’s life expectancy ranks near bottom in U.S.

New federal data released last week found life expectancy in Ohio is worse than 41 other states and is the lowest-ranked of the top 10 most populated U.S. states (Source: “Ohio's life expectancy among the worst in U.S.,” Axios-Columbus, Feb 17).

The average life expectancy at birth in Ohio is 76.9, according to 2019 state-by-state data released by the CDC last week. That is down about a full year since 2010. Ohio joins neighbors Indiana, Kentucky and West Virginia in the low CDC rankings, along with most southeastern states.

The findings are consistent with those in HPIO’s 2021 Health Value Dashboard, which ranked Ohio 47th on health value, a composite measure of population health and health care spending. The Dashboard identified three key factors for Ohio’s low ranking: childhood adversity and trauma, systemic inequities and sparse spending on public health and prevention efforts.


Ohio Medicaid announces care management organizations for OhioRISE program

The Ohio Department of Medicaid announced this week the 20 organizations that would launch OhioRISE, a new Medicaid program for children with severe behavioral and mental problems (Source: “Parents have given up custody to get care for children with severe needs. Ohio Medicaid is closer to ending that,” Columbus Dispatch, Feb. 17).

OhioRISE, short for Resilience through Integrated Systems and Excellence, is scheduled to roll out in July with the goal of addressing situations where parents are at risk of giving up custody of their children to the state in order to get the required, unaffordable mental health and residential care needed by a child with severe behavioral and mental health problems. 

Aetna will be the health insurance company overseeing the program, which the department expects to cover up to 60,000 children by the end of the first year. The organizations, called care management entities, will be responsible for coordinating care for a child: Bringing together schools, behavioral health providers, juvenile services and other systems to provide help for complex needs. 

The $1 billion program is partly paid for by savings from other planned Medicaid reforms, such as centralized credentialing and billing systems. Around $19.5 million will be given to the entities to help them start up.


States brace for Medicaid redetermination following end of health emergency

The Biden administration and state officials are bracing for a great unwinding: Millions of people losing their Medicaid benefits when the pandemic health emergency ends (Source: “Why Millions on Medicaid Are at Risk of Losing Coverage in the Months Ahead,” Kaiser Health News, Feb. 14).

Before the public health crisis, states regularly reviewed whether people still qualified for the safety-net program, based on their income or perhaps their age or disability status. While those routines have been suspended for the past two years, enrollment climbed to record highs. As of July, 76.7 million people, or nearly 1 in 4 Americans, were enrolled, according to the Centers for Medicare and Medicaid Services.

When the public health emergency ends, state Medicaid officials face a huge job of reevaluating each person’s eligibility and connecting with people whose jobs, income and housing might have been upended in the pandemic. People could lose their coverage if they earn too much or don’t provide the information their state needs to verify their income or residency.

The Biden administration is giving states a year to go through the process, but officials say financial pressures will push them to go faster. Congress gave states billions of dollars to support the coverage requirement. But the money will dry up soon after the end of the public emergency — and much faster than officials can review the eligibility of millions of people, state Medicaid officials say.


New HPIO fact sheet highlights opportunities for individuals, community groups to support health, well-being of Ohioans of color

The Health Policy Institute of Ohio has released a new fact sheet that outlines actions that individuals and community groups can take to support the health and well-being of Ohioans of color.

“Every Ohioan benefits when Ohio is healthy and economically vibrant,” the fact sheet states. “Though all Ohioans deserve the opportunity to be healthy, stark differences in health outcomes signal that not every Ohioan has a fair opportunity for good health.”

This fact sheet, the final in a series of three, outlines actions individuals and community groups can take to support the health and well-being of Ohioans of color. Previous fact sheets provided action steps for state and local policymakers and private sector organizations.


COVID cases declining in Ohio, but still 'quite high,' ODH director says

COVID-19 hospitalizations and cases are continuing to decrease in Ohio after the record-setting omicron variant peaked in January (Source: “Ohio’s COVID hospitalizations, cases continue to decline but remain high,” Dayton Daily News, Feb. 10).

In the past three weeks, Ohio’s seen the number of COVID patients in the state’s hospitals and ICUs decrease by 50%.

“While I think we can all be very encouraged by the improving trends we’re seeing all across the state, let’s remember that our numbers in Ohio are really still quite high and we need to be careful not to let our guard down too soon,” said ODH Director Dr. Bruce Vanderhoff.

Despite the decrease in coronavirus cases, Ohio’s transmission rate is still nearly five times higher than the Centers for Disease Control and Prevention’s definition of a high transmission rate. In the past two weeks, Ohio is averaging 481 COVID-19 cases per 100,000 people. The CDC defines a high transmission rate as 100 cases or more per 100,000 people. None of the state’s 88 counties reported fewer than 100 COVID cases per 100,000 people.


Ohio Senate President won’t bring cannabis legalization bill to the floor

Ohio Senate President Matt Huffman, R-Lima, said this week that he doesn't support an effort to legalize cannabis and won't bring it to a vote in his chamber (Source: “Proposal to legalize marijuana in Ohio faces yet another roadblock in Senate GOP leader,” Columbus Dispatch, Feb. 9).

The Coalition to Regulate Marijuana Like Alcohol recently submitted enough valid signatures for Ohio lawmakers to consider its proposal, which would allow Ohioans age 21 and older to buy and possess up to 2.5 ounces of cannabis and 15 grams of concentrates. They could also grow up to six plants individually and no more than 12 in a household with multiple adults.

If lawmakers don't pass the bill or pass an amended version within the next four months, supporters can collect another 132,887 valid signatures to put their measure on the ballot. "I don't want anybody to misunderstand my position," Huffman said. "I'm not going to bring it to the Senate floor. And if that means people want to go put it on the ballot, have at it."

Gov. Mike DeWine already said he would veto a bill to legalize marijuana in Ohio, calling the idea "a mistake." 

HPIO recently released a fact sheet examining lessons learned from tobacco and alcohol control policies that could inform future cannabis regulation in Ohio.