CMS releases Care Coordination Toolkit and series of ACO Case Studies. The Centers for Medicare & Medicaid Services (CMS) has released a public Accountable Care Organization (ACO) Care Coordination Toolkit highlighting innovative strategies that ACOs and End-Stage Renal Disease Care (ESRD) Seamless Care Organizations (ESCOs) use to collaborate with beneficiaries, clinicians, and post-acute care partners to ensure high-quality, effective care is provided at the right time and in the right setting. CMS has also released seven case studies to describe innovative initiatives from ACOs and ESRD ESCOs on a variety of topics including engaging beneficiaries, coordinating care in rural settings, and promoting health literacy. Each case study includes detailed results and lessons learned.

Dying Too Soon: Disparities in Death By Rurality, Race, and Ethnicity.  A recently released brief by the Rural Health Research Gateway finds rural counties had higher rates of premature death (defined as years of potential life lost before age 75) than urban counties.  Researchers analyzed data from the 2017 County Health Rankings, and found that counties with a majority of residents identifying as non-Hispanic Black or American Indian/Alaska Native had significantly higher rates of premature death.

Increasing Number of Grandparents Raising Grandchildren.  An analysis from the U.S. Census Bureau shows that, in 2016, there were over 7.2 million grandparents nationwide living with grandchildren under the age of 18.  Reports from media outlets and nonprofit organizations suggested that a recent rise in these arrangements is due in part to the opioid crisis.  To get an accurate and better understanding of what is happening, the Census Bureau examined data from its American Community Survey and data on opioid prescribing from the Centers for Disease Control and Prevention (CDC).  Previous research focused on the national or state level, but levels of opioid prescriptions vary widely within states, and county level data allow for a more localized analysis.  Data analysis showed a rural-urban divide in grandparents caring for grandchildren that is similar to the higher rates of overdose deaths in rural areas.  In 2016, 32 percent of grandparents were responsible for grandchildren in urban areas, compared to 46 percent of grandparents in rural areas.  The Census Bureau created an overview of their analysis, with methods, maps and data.  See frequently asked questions answered by the Administration for Children and Families on this topic and the Funding Opportunities section below for related resources.

The U.S. Census Bureau has released estimates of the total population of counties in the nation and Pennsylvania as of July 1, 2018. The estimates show that the Southeast and South Central regions of Pennsylvania continue their growth since 2010 with Cumberland County in the lead as the fastest growing county. Click here to read the Penn State Data Center brief.

Ambulatory care refers to medical services performed same day on an outpatient basis, without admission to a hospital or other facility, and includes services ranging from wellness and disease management to surgical treatment and rehabilitation.  Not much is known, however, about the ambulatory care that rural Medicare patients typically receive.  This chartbook from the North Carolina Rural Health Research and Policy Analysis Center uses available Medicare claims data to describe costs and common diagnoses for Medicare beneficiaries at rural ambulatory care facilities (excluding private practitioners).

The Centers for Disease Control and Prevention (CDC) recently released the latest figures on drug poisoning deaths at the national, state, and county levels from the years 1999 through 2017.  Updated data collection and methodology over that time period allows researchers to capture death rates in counties with small population sizes or small numbers of deaths, permitting reports on urban/rural trends by state (see pull-down menu under the heading “Options”).

Abigail Barker, PhD; Lindsey Nienstedt, BA; Leah Kemper, MPH; Timothy McBride, PhD; and Keith Mueller, PhD

This brief uses data from the 2012–13 Medicare Current Beneficiary Survey (MCBS) to describe rural and urban differences in the populations that enroll in the Medicare Advantage (MA) program. Combined with county-level data on MA issuer participation, this dataset also allows us to assess the degree to which issuers may engage in selective MA market entry on the basis of observed demographic characteristics. Rural and urban MA and fee-for-service populations did not differ much by any characteristics reported in the data, including age, self-reported health status, cancer diagnosis, smoking status, Medicaid status, or by other variables assessing frailty and presence of chronic conditions. Most measures of access were similar across rural and urban respondents. While rurality on its own was often a significant predictor of lower issuer participation in a county’s MA market, the addition of other demographic characteristics did not influence the prediction. In other words, we found no evidence, based upon MCBS data, that issuers exclude rural counties due to other demographics. These findings suggest that poor health – as approximated by the demographic characteristics captured in MCBS data – is also captured similarly in risk adjustment formulas, meaning that MA issuers are compensated for this observed risk.

Click to download a copy: Comparing Rural and Urban Medicare Advantage Beneficiary Characteristics

The Flex Monitoring Team’s latest briefing paper is a report on our evaluation of projects implemented under Flex Program Area 5: Integration of Innovative Health Care, which is a new program area in the current funding cycle.

We describe the initiatives of seven states in the areas of telehealth, care coordination, and quality improvement, and discuss their implementation and their early results. We also examine the role and impact of Program Area 5 in the Flex Program, and highlight key lessons learned from this first round of implementation.

Click through to access the paper.

Please click here to view full PDF.

Tackling HPV Cancers.  The Human Papillomavirus (HPV) vaccine can prevent 30,000 Americans from getting cancer each year, but data from 2017 show that fewer than half of adolescents completed the HPV vaccination series.  In rural communities, adolescents are less likely than their urban peers to be aware of the HPV vaccine and its importance in cancer prevention.  Monday, March 4^th is International HPV Awareness Day and the U.S. Department of Health & Human Services (HHS) asks you to join the #EndHPVCancers Twitter Chat on that day at 3:00 pm ET.  And to help others understand the risks and ways to prevent HPV, share resources from the HHS HPV Promotional Toolkit, the National HPV Roundtable, and Centers for Disease Control and Prevention.