The Centers for Disease Control and Prevention (CDC) released new data this week that finds that one in seven individuals with diabetes did not take their medication as prescribed because of the cost. The survey found that 13.2% of diabetics either skipped a dose, took less medicine or delayed filling a prescription because of cost. The high cost of insulin has been at the epicenter of discussions on how to make prescription drugs more affordable in the U.S.
The National Alliance to End Homelessness has released a new report, Understanding Encampments of People Experiencing Homelessness and Community Responses: Emerging Evidence as of Late 2018, to discuss different models to assist people living in encampments by removing barriers to accessing services and housing through the use of navigation centers, such as those used in San Francisco. Evidence shows that clearing out encampments without follow-up support services does nothing to solve the actual problem but instead creates unnecessary trauma for inhabitants. More research on the demographic characteristics of people living in encampments would better inform policy and program initiatives.
The Pennsylvania Data Advisory Committee (DAC) is pleased to announce the availability of the 2019 Burden of Cancer in Pennsylvania Report. This report provides a comprehensive analysis of the burden of cancer in Pennsylvania and lists disparities and the harms of cancer for policy makers, program administrators, business and industry leaders, and the citizens of the commonwealth.
Eight cancers were selected for study: cervix uteri, colon and rectum, female breast, leukemia, lung and bronchus, melanoma of the skin, ovary, and prostate. These selections were based on a survey from cancer control partners in Pennsylvania, each cancer’s impact on the overall burden of cancer, and the fact that screenings and preventive measures exist for most of them. This report shows different aspects each cancer including incidence, mortality, comparison by sex, race and ethnicity, US and PA trends, age of diagnosis, stage and 5-year net survival.
The DAC is a committee of the Pennsylvania Cancer Control, Prevention and Research Advisory Board with members representing the Pennsylvania Cancer Registry, the Bureau of Epidemiology, Bureau of Health Statistics and Research and the Division of Cancer Prevention and Control within the Department of Health and selected external organizations.
The report can be accessed on the Pennsylvania Department of Health website at https://www.health.pa.gov/topics/disease/Cancer/Pages/Cancer.aspx
A new report from the Rural and Minority Health Research Center provides the results of a web-based survey disseminated to a geographically diverse sample of nurses throughout the U.S. to assess perceived barriers and facilitators to nursing practice; job satisfaction; and self-identified challenges in nursing work environments and patient care. Of particular interest were nurses in ambulatory care practices. The full report can be accessed here.
The Rural & Minority Health Research Center (RMHRC) is one of ten HRSA/FORHP-supported centers for research and policy analysis. In this series of policy briefs, the RMHRC provides data on social determinants of health (SDOH) for four minority groups living in rural areas: African American, Hispanic, American Indian/Alaska Native, and Asian and Pacific Islander. For each of these groups, researchers used several national data resources such as the U.S. Census to determine rates for educational attainment, poverty status, disability, veteran status, nativity, access to computers and broadband, and access to health care.
The reports can be accessed here.
As part of the transition to value-based care, Medicare Shared Savings Program Accountable Care Organizations (ACOs) have developed a number of strategies to reduce Medicare spending and improve quality of care. This report describes the strategies that selected ACOs have found successful in reducing spending and improving quality of care. These strategies involve working to increase cost awareness in ACO physicians, engaging beneficiaries to improve their own health, and managing beneficiaries with costly or complex care needs to improve their health outcomes. Other strategies that ACOs found successful involve reducing avoidable hospitalizations, controlling costs and improving quality in skilled nursing and home healthcare, addressing behavioral health needs and social determinants of health, and using technology to increase information sharing among providers. ACOs also report challenges in each of these areas and describe the ways they overcame them.
The Centers for Medicare & Medicaid Services (CMS) recently made changes to the Shared Savings Program. As CMS carries out this and other ACO programs and develops new alternative payment models, it should support the use of these strategies and other successful strategies that emerge. These strategies can apply not only to ACOs but also to other providers committed to transforming the healthcare system toward value.
The OIG recommend that CMS take the following actions to support efforts to reduce unnecessary spending and improve quality of care for patients: (1) review the impact of programmatic changes on ACOs’ ability to promote value-based care; (2) expand efforts to share information about strategies that reduce spending and improve quality among ACOs and more widely with the public; (3) adopt outcome-based measures and better align measures across programs; (4) assess and share information about ACOs’ use of the skilled nursing facility (SNF) 3-day rule waiver and apply these results when making changes to the Shared Savings Program or other programs; (5) identify and share information about strategies that integrate physical and behavioral health services and address social determinants of health; (6) identify and share information about strategies that encourage patients to share behavioral health data; and (7) prioritize ACO referrals of potential fraud, waste, and abuse. CMS concurred with all of our recommendations.
The full report can be found at oig.hhs.gov/oei/reports/oei-02-15-00451.asp.
U.S. Department of Health and Human Services
Office of Inspector General
The Flex Monitoring Team has released a new report on the community impact and benefit activities of Critical Access Hospitals (CAHs), rural non-CAHs, and urban hospitals. The report enables State Flex Programs and CAH administrators to compare the community impact and benefit profiles of CAHs nationally to the performance of CAHs in their state.
The report may be found in the link below. Pages 1–5 provide national data with key findings and pages 6–95 provide state-specific tables. Shortcut links to each state’s tables are on the bottom of page 5. The report can be accessed here.
New Data on HIV Diagnoses; Disproportionate in Rural Areas. The Centers for Disease Control and Prevention (CDC) recently released a new Morbidity and Mortality Weekly Report (MMWR) on HIV testing. The CDC data show that less than 40% of people in the U.S. have ever been tested for HIV; in the seven states with rural areas that are particularly affected by HIV, just 26% of people recommended for annual HIV testing were tested in the past year. The proposed HHS-wide initiative, “Ending the HIV Epidemic – A Plan for America,” is multiyear initiative designed to end the HIV epidemic over 10 years by significantly increasing public health resources, technology, and expertise on the ground in the hardest-impacted areas. The plan, if funded, will focus first on the geographic areas with the greatest HIV burden, including the 50 local jurisdictions and seven states highlighted in the MMWR report, before expanding to reach all areas of the nation affected by HIV.
A new report finds that during a 12-month period, about 1,800 babies entered this world dependent on addictive drugs, or about 14 of every 1,000 babies born in the state. The report from the Pennsylvania Health Care Cost Containment Council (PHC4) focuses on a one-year period ending in late 2018. If there is any good news in the report, it is that the data show a leveling off after rising each of the last 15 years. The report shows wide variation by county with, for example, rural Elk County with the highest rate of 63 per 1,000 births, Philadelphia County at about 14 per 1000 births, and Bradford County with only six addicted babies per 1000. Neonatal abstinence syndrome (NAS) results in higher rates of respiratory distress and premature birth compared to other babies, with NAS babies averaging 16 days in the hospital, compared to 3.4 for other births. The report also found that the highest rate of NAS babies involved whites (18 out of 1,000 babies), and rates of 9.5 per 1,000 among blacks and 6.2 per 1,000 among Hispanics. About 90% of the hospital costs of NAS babies are borne by Medicaid. Read more.
The Pennsylvania State Data Center has released a Child Diversity Dashboard and report in collaboration with their affiliate, Pennsylvania Partnerships for Children. The report highlights state level trends relating to the increase in children of color while the dashboard allows users to get data at the school district level.
Some key findings include that one-in-three Pennsylvania children are children of color and that over 80 percent of school districts had a higher share of children of color in 2017 than 2009.
To view the dashboard and report, visit: https://pasdc.hbg.psu.edu/Data/Visualizations/ChildDiversity