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Are Opportunities Diversifying as Healthcare Payment Models Evolve?

Leigh Ann Hubbard May 14, 2018

With two promising actions, Washington has set the longevity market buzzing.

The Centers for Medicare and Medicaid Services announced that Medicare Advantage insurance policies will be allowed to cover a wider variety of services in 2019. These include certain not-strictly-medical services—such as home modification and non-skilled in-home care—that “reduce avoidable emergency and healthcare utilization.”

Just months earlier, Congress voted to pass the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act. The law expands Medicare Advantage reimbursement for telemedicine and non-medical services.

These changes mean that federal money may be available for new services and products—and the field has reacted positively. Telehealth and seniors housing sectors are optimistic and Humana announced it’s working on new plans reflecting CMS’s revised direction.

We don’t yet know how much real opportunity these adjustments in payment models will create. But it’s clear that longevity professionals should understand more about what’s behind these changes.

The growing body of research on “social determinants of health” suggests that factors such as access to nutritious food, primary health care and transportation, may strongly affect health—and health care costs. Below are some of the latest studies and reports on various social determinants of health.

As research is increasingly available, many in the longevity market are wondering whether more diverse opportunities to delve into the health sector—and its funds—will soon follow.

Note: We recommend that you click to the studies for details and to assess strengths and weaknesses in findings.

Headlines & Insights: Curated excerpts from thought-provoking articles

A Balanced Portfolio Model For Improving Health: Concept And Vermont’s Experience
Health Affairs / James Hester

[H]ealth care accounts for only 10–20 percent of the overall determinants of health. A successful strategy for improving health requires addressing a broad spectrum of policy sectors such as housing, food security, education, and transportation…

Addressing Social Determinants to Improve Patient Care and Promote Health Equity
Annals of Internal Medicine / Hilary Daniel, BS; Sue S. Bornstein, MD; Gregory C. Kane, MD; for the Health and Public Policy Committee of the American College of Physicians

In the United States, place of birth is more strongly associated with life expectancy than race or genetics. On average, there is a 15-year difference in life expectancy between the most advantaged and disadvantaged citizens. …

Neighborhoods with concentrated poverty often lack grocery stores with fresh food, adequate public transportation, access to public spaces, adequate employment prospects, and access to health care services; often have underfunded schools; and often are situated near environmental hazards.

Meal Delivery Programs Reduce The Use Of Costly Health Care In Dually Eligible Medicare And Medicaid Beneficiaries
Health Affairs / Seth A. Berkowitz, Jean Terranova, Caterina Hill, Toyin Ajayi, Todd Linsky, Lori W. Tishler, Darren A. DeWalt

[This study suggests that home-delivered meals]—in particular, those tailored to recipients’ medical needs—show promise for helping curtail the use of selected costly health services in adults dually eligible for Medicare and Medicaid, a medically and socially complex population for whom effective interventions can be hard to come by.

Colorado Healthy Eating and Active Living Cities and Towns Campaign
American Journal of Preventive Medicine / Cheryl Kelly, PhD, MPH, Julie George, MPA, Eliza R. Lanman, MSS

The [suburban] city developed a HEAL Committee to focus on increasing healthy food access by (1) expanding community gardens throughout the city; (2) working with local health department to assess foods offered in corner stores; and (3) evaluating city food concessions and vending plans. The Food Access Assessment was adopted as a policy-guiding document to ensure that recommendations to improve food access in the city are considered and integrated into other plans and projects. Two examples of recommendations that were integrated into other plans are an ordinance allowing residents to keep backyard chickens and bees and an initiative to reach 100% healthier foods and beverages in all city public vending and concessions.

Poverty Simulation: An Experiential Learning Tool for Teaching Social Determinants of Health
AEM Education and Training / Dennis T. Hsieh, MD, JD; Wendy C. Coates, MD

[T]he department of emergency medicine led a poverty simulation that placed new interns … in the shoes of low‐income patients. …

[Afterward, we] linked the learners’ insights back to the challenges that our patients face. We discussed topics such as why patients come late at night or on weekends to the ED for medication refills or other seemingly non-urgent problems, why patients may not fill their antibiotics, and how learners could engage in advocacy to address some of these challenges.

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Leigh Ann Hubbard

Leigh Ann Hubbard is a freelance journalist specializing in aging, health, the American South and Alaska.

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