The Wolf Administration announced this week that, under the guidance of the Department of Human Services (DHS), it is expanding home visiting supports to first-time mothers and mothers of children with special needs covered by Medicaid. The expansion, made possible in collaboration with physical health Medicaid managed care organizations (MCOs), will guarantee at least two home visits to new parents and families with children with additional risk factors across Pennsylvania, expanding access to evidence-based models that promote and support healthy child and family development. The home visiting expansion is effective Jan. 1, 2020 through the MCOs’ 2020 agreement. Read more.

The Philadelphia Inquirer reported on Oct. 9, that the Department of Human Services (DHS) will implement a single preferred prescription drug list for all companies that manage pharmacy benefits under Medicaid, starting Jan. 1, 2020. DHS estimates the change will save the state $85 million per year, at least in part by allowing the state to take full advantage of federal Medicaid drug rebates. Managed care organizations (MCOs) are not eligible for federal rebates. The companies affected, loosely organized as the Pennsylvania Coalition of Medical Assistance MCOs, assert the proposed change would cost the state $81 million more in the first year and make life harder for doctors. Read More.

This toolkit from the National Academy for State Health Policy highlights state initiatives to help older rural adults age in place by increasing services that help people remain in their homes, expanding and professionalizing the caregiver workforce, and making delivery system reforms within Medicaid programs.  According to research referenced in the toolkit, more than 85 percent of older adults prefer to remain in their own homes and communities, and serving older adults in their homes is usually less expensive than housing people in facilities. This resource was funded by the Geriatrics Program in the Bureau of Health Workforce at the Health Resources and Services Administration.   The Toolkit can be accessed here.

The U.S. Department of Health & Human Services is seeking input from the public on a 10-year national strategy for addressing vaccine-preventable diseases.  The plan will update all aspects of vaccine research and development, supply, financing, distribution, and safety, and address causes of an increased reluctance to vaccinate that led to recent outbreaks of pertussis, hepatitis B and measles.  Last year, the Centers for Disease Control and Prevention released research showing a lower rate of vaccination for rural teenagers and made recommendations for making it a routine part of clinical care.   Click here to access the Federal Register notice.  Comments are due on October 24, 2019.

In 2017, the Health Resources and Services Administration (HRSA) launched its Strategy to Address Intimate Partner Violence, with targets and projects that involve each of the agency’s bureaus and offices.  This month, HRSA’s Office of Women’s Health released the first progress report for that initiative, describing its achievements between 2017 and 2018.  Victims in rural areas may be reluctant to report intimate partner violent abuse, and unaddressed abuse has an impact that goes beyond the individual and into communities.

As urbanization increases, an older, sicker and poorer population remains in rural America. New infographics from the National Institute for Health Care Management (NIHCM) Foundation depict the population shifts driving these changes, the corresponding health care challenges, and promising tools to improve rural health. In rural areas, 18.4 percent of the population is over 65 years of age compared to 14.5 percent in urban areas, and rates of obesity, diabetes and smoking are higher.   The infographics can be accessed here.

Depression is on the rise. So is suicide, particularly among young people and military veterans. And Pennsylvania recently concluded that addressing mental health needs is the best defense against school shootings.

Yet, because of a shortage of psychiatrists, people commonly wait six months for an appointment in central Pennsylvania. That means some people badly in need of help continue suffering, and may become dangerous to themselves or others, before they can begin getting better.

“It’s terrible,” says Marge Chapman, executive director of the Dauphin County chapter of the National Alliance on Mental Illness, or NAMI.

Kathleen Zwierzyna, head of the NAMI chapter for Cumberland and Perry counties, tells of a relative who waited more than five months for an appointment with a psychiatrist. “We know many families who have lived through it,” she says.

Long waits extend to young people who show signs of mental illness at school and are referred by school staff, says Dan Daniels, executive director of the NAMI organization serving York and Adams counties.

Nearly half of Pennsylvania counties have no psychiatrist, says Christine Michaels, CEO of NAMI Keystone Pennsylvania.

“Yet there’s a crisis with suicide,” she says, noting areas that lack psychiatrists tend to be economically-depressed and have higher rates of depression among residents.

Psychiatrists, who are medical doctors, play a key role in diagnosing mental illness and deciding what treatment and medication should be used. Sometimes, symptoms return in patients who have been doing well, putting them in need of a psychiatrist to change or adjust their medication.

When people experiencing mental illness have to wait to be diagnosed, or begin medication or have it adjusted, it can disrupt their ability to work, attend school or care for their family, says Dr. Erika Saunders, chair of psychiatry at Penn State Health Milton S. Hershey Medical Center. Worse, it can put them at high risk of having to be hospitalized, ending up in jail or committing suicide, she says

Beyond that, delays can trigger other health problems and cause harrowing and destabilizing times for families. “There is a huge burden on families who are trying to care for their loved one,” Saunders says.

One central Pennsylvania resident who doesn’t want his name published experienced a return of a condition that had been well-controlled for years with medication. He learned his Harrisburg-area psychiatrist had retired. He says he contacted the area’s three major health systems: Penn State Health, UPMC Pinnacle and Geisinger Holy Spirit.

None could offer a near-term appointment, he says. One provided a list of private psychiatrists, but none were available. One suggested he try again in fall.  “We have a severe shortage of mental health professionals,” Saunders says. “We’re doing our best to care for [the sickest] patients, but we need to expand access for all patients.”

The shortage is severe not only in Pennsylvania but in much of the United States.

Read the entire article here.

She started having suicidal thoughts at 11 or 12. She didn’t know the words to name it. She had no idea what it was, but she consistently had these urges to end her life.  “I just wanted to be dead,” she says.

One night when she was 24, and already long diagnosed with clinical depression, she succumbed to the feelings.  “I couldn’t suppress these thoughts anymore,” she recalls. “I had thought about ending my life for eight straight months.  “I texted a friend and said, ‘It would be better if I wasn’t here.’ That friend did not know that I had already taken substances in the hope that I would go to sleep and not wake up. And while I was waiting to die, the police showed up.”

T-Kea Blackman, now 29, survived that attempt and dedicated her life to helping others navigate the darkness of depression and mental health crises.

Read the entire article here.

Updated Oct 04, 2019; Posted Oct 04, 2019

ECRI Institute this week released its annual list of the 10 biggest patient-safety concerns in 2020, with misuse of surgical staplers ranking No. 1. Marcus Schabacker, president and CEO of ECRI, said, “Injuries and deaths from the misuse of surgical staplers” were found to be “substantial and preventable.” (Source: HealthLeaders Media, 10/8)