While pre-exposure prophylaxis (PrEP) is a key tool to ending the global HIV and AIDS epidemic by 2030, recent data show that only 30 percent of the 1.2 million Americans who are candidates for the medication proven to reduce the risk of getting HIV are actually taking it.  A recent report from the Centers for Disease Control and Prevention revealed substantial differences in uptake by geography, race and ethnicity; what scientists call “PrEP deserts” are most commonly found in the rural South, where more than half of new HIV infections in the U.S continue to occur.  In this study, researchers recognize that inequity in care is likely attributed to social determinants of health and structural issues beyond individuals’ control.  They describe three approaches to potentially improve access in the South and in rural communities: 1) normalizing where providers prescribe PrEP routinely as a standard of care; 2) digitalizing, i.e., using technology, such as telehealth, as recommended in 2020 by the National Advisory Committee on Rural Health and Human Services; and 3) streamlining care using guidelines from the World Health Organization and the U.S. Public Health Service to explore different approaches, such as on-demand PrEP and HIV self-testing.  See Learning Opportunities below for upcoming event addressing stigma in the rural Southeast.

The 988 Suicide & Crisis Lifeline has expanded services and continued to answer millions of calls, texts, and chats from people experiencing mental health or substance use crises since its launch on July 16, 2022. The Department of Health and Human Services has invested nearly $1.5 billion into 988 as part of the Biden-Harris Administration’s comprehensive strategy to address the nation’s mental health and substance use crises.

988 Suicide & Crisis Lifeline crisis counselors answered more than 10 million calls, texts, and chats from people experiencing mental health or substance use crises in the two years since its launch, including almost 1.2 million calls answered by the Veterans Crisis Line (VCL) through 988’s Press 1 option, one of the ways Veterans, service members and their families can reach the VCL. Considering the full range of VCL services, Veterans and their supporters have reached VCL through phone, online chat, and text over 2 million times since July 2022. If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.

A report (PDF) from the HHS National Syphilis and Congenital Syphilis Syndemic Federal Task Force explores differences between point of care (POC) tests and laboratory-based serologic tests. It also highlights when POC testing may be the best. Visit HIV.gov to learn more. HHS will hold a webinar on the topic on July 31 from 12:00 – 1:00 pm. Registration is available.

Pennsylvania is joining the legislative bandwagon to limit noncompetition agreements for certain health care workers. In a purported effort to retain health care practitioners for the commonwealth and promote continuity of care for patients, Gov. Josh Shapiro signed the Fair Contracting for Health Care Practitioners Act into law on July 17, 2024. In addition to narrowing the scope of noncompete in certain limited instances, it imposes a separate patient notice requirement following the “departure” of a health care practitioner. The act is not effective until January 1, 2025. The act:

 

·     Prohibits noncompete covenants for more than one year in length in certain circumstances

·     Prohibits the enforcement of a noncompete covenant against a health care practitioner if the health care practitioner is “dismissed”

·     Permits an employer to recover certain reasonable expenses “related to relocation, training and establishment of a patient base” but prohibits recovery if the health care practitioner is “dismissed”

·     Permits noncompete covenants related to sales or merger of a business entity

·     Permits noncompete covenants where the health care practitioner receives by purchase, grant, award or issuance of an ownership interest in a “business entity”

·     In addition, the act requires an employer to notify “patients seen within the past year” of: (1) the “departure” of a health care practitioner, (2) how to transfer patient records to “departed health care practitioner or another health care practitioner” and (3) “that the patient may be assigned to a new health care practitioner within the existing employer if the patient chooses to continue receiving care from the employer.” An employer is required to provide these notifications within 90 days of the health care practitioner’s departure. However, the notification requirement applies only where the health care practitioner had an “ongoing outpatient relationship with the patient for two or more years.”

In 2022, the national nonprofit Build Healthy Places Network (BHPN) released “A Playbook for New Rural Healthcare Partnership Models of Investment,” a resource for addressing social determinants of health in rural communities.  In this update, BPHN reconnects with organizations featured in the original playbook to gain a deeper understanding of the partnership landscape.

Research published in the Journal of Appalachian Health reports on disasters in eight rural southeast Kentucky counties in 2021-2022, the changing nature of the disasters, and the behavioral health impact on the residents affected.

The Federal Emergency Management Agency (FEMA) indicates that disasters are occurring more frequently, often impacting communities still recovering from a previous disaster.  This timeline lays out the phases of federal response before and after a disaster.  The compendium of housing and shelter programs includes 10 cabinet-level departments, including FEMA, the U.S. Departments of Health & Human Services (HHS), Agriculture (USDA), and Housing and Urban Development (HUD).

 

Comment by September 1, 2024.  On July 10, The U.S. Department of Health and Human Services (HHS), through the Office of the National Coordinator for Health Information Technology (ONC), released the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule for public comment. The HTI-2 proposed rule has two sets of new certification criteria designed to enable health IT for public health as well as health IT for payers to be certified under the ONC Health IT Certification Program. These new certification criteria, which would improve public health response and advance the delivery of value-based care, focuses heavily on standards-based application programming interfaces to improve end-to-end interoperability between data exchange health care providers and public health organizations or payers. This rule also establishes the standards and implementation of a new, real-time prescription benefit tool certification criterion, which would empower providers and their patients to make more informed decisions with more transparent information comparing the patient-specific cost of drugs and suitable alternatives. In addition, the proposed rule also updates policy within the HTI-1 final rule published January 2024 related to the exchange of conical images and information blocking.

The Physician-Focused Payment Model Technical Advisory Committee (PTAC), an independent federal advisory committee, has transmitted a Report to the Secretary of Health and Human Services on key issues related to encouraging rural participation in population-based total cost of care (PB-TCOC) models, which are a type of alternative payment model where payment is made up of costs and utilization for all covered medical services delivered to an individual or group. This report compiles information from previous payment model proposals PTAC reviewed, literature addressing the topic, and input received during a rural-focused meeting last year.  They conclude that while value-based care often focuses on improving quality while reducing spending, achieving value in rural areas may require increasing spending.  Increasing rural provider participation in PB-TCOC models requires a sustainable glidepath to value-based care that includes a multi-payer approach and a longer glidepath for taking on risk in rural areas.  They recommend a multi-pronged approach that would improve rural infrastructure, increase and enhance sustainable funding, enhance recruitment and training of rural health physicians and providers, increase community health organization capacity, and address health disparities.