The Flex Monitoring Team (FMT) has released a new policy brief: Critical Access Hospitals’ Initial Response to the COVID-19 Pandemic: Use of Federal Funding and Regulatory Flexibilities. This brief uses survey data collected by the FMT about Critical Access Hospitals’ response during the first seven months of the COVID-19 pandemic and describes key findings from the survey including:

• How many participating CAHs received federal funding and from which sources
• Which regulatory waivers and flexibilities were most commonly used by participating CAHs

On our website, you can read more about other FMT work assessing the impact of the COVID-19 pandemic on Critical Access Hospitals.

Counties with greater primary care access, more robust public health and fewer social vulnerabilities had fewer COVID-19 infections and deaths, according to a report from the Primary Care Collaborative (PCC) and Robert Graham Center. “As we emerge from the current pandemic and re-imagine and rebuild primary care, we also need to look at other factors, such as investment in public health and community-based services,” PCC President and CEO Ann Greiner said in a statement. “It is beyond time for us all to reach beyond our silos and join forces to address the widening health inequities that the pandemic laid bare.”

More than 2 in 5 children in PA now rely on publicly funded or supported health insurance

Pennsylvania Partnerships for Children (PPC), the only statewide advocacy organization with a public policy agenda that spans a child’s life prenatally through adulthood, released its 2021 State of Children’s Health Care in Pennsylvania: Health Insurance During the COVID-19 Pandemic. Due to the unique circumstances of the COVID-19 pandemic and the limited data available as a result, this year’s report takes a different approach by using alternate data sources.

The report highlights steps to connect Pennsylvania children to health insurance better and reduce known racial disparities that will continue to deepen if not directly addressed.

“We found that families have weathered the pandemic storm under the umbrella of public health coverage because enrollment increased in the last year,” said Kari King, President and CEO of Pennsylvania Partnerships for Children.

Together, Medicaid, the Children’s Health Insurance Program, and Pennie™, the state-based marketplace, account for 45.9% of children covered in Pennsylvania. Statewide, Medicaid and CHIP have enrolled 10% more children since the beginning of the pandemic, and every county has seen an increase.

King said a key factor affecting the increase is the disenrollment freeze implemented in the Families First Coronavirus Response Act in March of 2020, which will be in place for as long as the federal public health emergency (PHE) is in effect.

However, an estimated 500,000 individuals stand to lose coverage once the PHE expires and routine Medicaid operations resume if Pennsylvania does not carefully plan.

“Threats to safety net programs existed before the pandemic,” said King. “We cannot understate the importance of ensuring that every eligible child and pregnant or postpartum individual does not unnecessarily lose coverage.

“Keeping eligible people connected to Medicaid once the public health emergency ends is avoidable,” she continued. “In partnership with other Pennsylvania health advocates, we offer best practices to assist DHS, the state’s Medicaid agency, in its planning efforts for the enormous task ahead, some of which can start now, before the PHE ends.”

Those recommendations include ensuring those with existing coverage stay connected without unnecessary gaps in coverage through auto-renewal strategies, updating current mailing addresses and more extended time frames for continuous coverage.

In addition, data shows disproportional impacts of the pandemic by race and ethnicity on Pennsylvania households with children, causing economic hardship, food insufficiency and delayed medical care. Larger percentages of children of color enrolled in Medicaid during the pandemic than their White counterparts, which would appear consistent with existing health disparities that have become exacerbated over the past nearly two years.

“We acknowledge that we do not have all of the pieces of the puzzle. What we do know is that these disparities will continue to deepen if not directly addressed. Using data disaggregated by race and ethnicity coupled with feedback from impacted communities can help achieve equitable outcomes,” said King.

The report also covers the impact of the pandemic on routine immunizations that protect from 17 childhood diseases. Overall, Pennsylvania had a 5% decline in vaccination coverage. The early part of 2021 shows vaccination gaps continued among children, particularly preschool and young school-age children ages 4-10. Ensuring kids are up to date on routine immunizations is necessary for community health and helps keep them healthy enough to stay in school.

Health literacy is more than just words. In a new study, Weert and colleagues examined graphical format preference and tested understanding of risk information in younger and older adults. Learn more:  Visual Displays of Risk

A new study by the WWAMI Rural Health Research Center, led by David Evans, MD, found that patients from rural areas have lower breast cancer screening rates than urban patients.

The researchers found that a greater proportion of rural patients received an initial breast cancer diagnosis at a late stage compared with urban patients and that patients living in remote small rural counties had the highest rate of late-stage breast cancer at diagnosis. Breast cancer survival is known to be worse for rural patients compared to urban, and late stage at diagnosis may be a contributing factor. These disparities are longstanding and suggest areas for further research, advocacy, policy changes, and patient education.  Further study is needed to identify appropriate screening availability in rural areas and the burdens that travel presents for patients where screening is not available.

Read more about rural breast cancer screening and a companion study of rural colorectal cancer screening.

The Flex Monitoring Team has released a new policy brief summarizing characteristics of Critical Access Hospital (CAH) initiatives addressing the social needs of individuals in their communities. The brief, How Critical Access Hospitals Are Addressing the Social Needs of Rural Populations, highlights the importance of partnerships in rural communities, as well as the need for support of hospital leadership, ample funding, and dedicated staff to make these programs effective.

In tandem with the previously published report, Rural Initiatives Addressing Community Social Needs, this work can provide additional knowledge for developing population health initiatives in rural areas.

ECRI and the Institute for Safe Medication Practices (ISMP), a Patient Safety Organization (PSO), recognizing the ubiquity of racial and ethnic disparities in health and health care and their far-reaching consequences, will be using data they receive, detailed research and expert evaluation for their upcoming 2022 Deep Dive. It will identify why addressing racial and ethnic disparities is important and what you can do to reduce them. They have also released Deep Dive: Racial and Ethnic Disparities in Health and Healthcare Executive Brief, key strategies for understanding, detecting, and reducing disparities that impact every area of health care.

The 2021 Technical Assistance Outcomes Report issued by the HRSA Bureau of Primary Health Care (BPHC) is an annual report highlighting the significant resources, impacts and outcomes achieved by the BPHC awardees between June 2020 and June 2021. This report, broken down by categories, includes a publication by Health Outreach Partners on the role of value-based care as a primer for outreach and enabling services staff. Enabling services are non-clinical services that do not include direct patient services that enable individuals to access health care and improve health outcomes. Enabling services include case management, referrals, translation/interpretation, transportation, eligibility assistance, health education, environmental health risk reduction, health literacy, and outreach.

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