News from Community Clinic Voice

"High Dose" school-based physical activity and nutrition programs prove effective

Community-based efforts to change the environment are proving to be an effective way of encouraging more physical activity and nutrition among school-age children, according to findings from Kaiser Permanente.

Researchers examined a series of Kaiser Permanente community-based obesity prevention interventions in adults and children and found that the more effective obesity prevention interventions were those that were “high dose” — reaching large populations with greater strength — and those that focused specifically on changing child behaviors within the school environment.

Kaiser Permanente has been tracking the success of obesity-prevention efforts as part of its Community Health Initiatives to improve population health. The recent findings confirm that the high-dose interventions in and around school settings can make positive, measurable impacts on health behavior.

Read more.

And see a study in the American Journal of Evaluation, which provides a definition and examples of measuring population dose and how the concept has been used in the Kaiser Permanente Community Health Initiative.

The latest issue of OSHPD’s Healthcare Workforce Development Division (HWDD) News announces the launch of CalREACH in February, a new e-application for OSHPD’s financial incentive programs that allows registered users to search and apply for any Health Professions Education Foundation and/or Healthcare Workforce Development Division scholarships, loan repayments, and grants online.

Health Careers Training Program (HCTP) Mini Grants Coming Soon!

To develop a more culturally and linguistically competent healthcare workforce for Californians, HCTP funds programs encouraging economically/educationally disadvantaged and/or underrepresented groups pursuing health careers. HCTP Mini-Grants fund programs that encourage diversity in the health professions through an annual Request for Application (RFA) process. This year $120,000 total is available to fund approximately 11 applications of $12,000 or $15,000 each. This year’s funding will be based on two categories: Health Career Conferences and/or Workshops; and Health Career Exploration...

Launched in 2011 by Robert Wood Johnson Foundation, Care About Your Care focuses attention on what people can do to provide and receive better health care. This year, the conversation focuses on improving care transitions to reduce avoidable hospital readmissions, and how nurses, care coordinators, doctors, consumers, caregivers, patients, and others can work together to achieve this.

A February 13 webcast will focus on how hospitals and communities are working together to reduce avoidable hospital readmissions.

Families USA provides this summary of important information newly released by the administration:

Drafts of the Single, Streamlined Application for Coverage Available for Comment

On January 25, the Centers for Medicare and Medicaid Services (CMS) released drafts of the online and paper versions of the single, streamlined application for health coverage. This application will be used to determine eligibility for Medicaid, CHIP, and the premium tax credits available to help consumers purchase insurance in the exchange. Comments are due on February 28, and can be emailed to: OIRA_submission@omb.eop.gov

CMS offers a webinar on February 11 at 10:00 AM PT, that will walk through and explain the draft single, streamlined application. The call-in number is 877-267-1577; passcode “5620.” Listen to the webinar at: https://webinar.cms.hhs.gov/learnmoressapp2/

Also, please consider signing on to a letter being circulated by the Asian & Pacific Islander American Health Forum and the National Health Law Program urging CMS to translate the single, streamlined application into at least 15 languages. To sign, please complete this form by 3 pm PT on Tuesday, February 12...

The theme of the journal Health Affairs February 2013 issue is the “New Era of Patient Engagement.” Lead articles include "Bringing The Patient Into Health System Change," "What The Evidence Shows About Patient Activation" and a survey of what foundations are funding in the areas of patient engagement, patient safety, and quality of care.

The issue was funded by the Robert Wood Johnson Foundation (RWJF), the Gordon and Betty Moore Foundation, the Patient-Centered Outcomes Research Institute, and the California HealthCare Foundation.

Read more.

The Obama administration announced that implementation of the Basic Health Program -- created by the Affordable Care Act to help low- and moderate-income families who do not qualify for Medicaid gain coverage -- has been delayed until 2015. HHS said it does not have enough time to issue the guidelines necessary to launch the program in 2014, as scheduled under the ACA. Read FAQs from HHS.

On February 6, CMS posted a set of frequently asked questions discussing a range of issues including the Basic Health Program, the new FMAPs and how states qualify, MAGI issues, and the coverage of pregnant women and children.

The latest CPCA Weekly Update of 2/7/13 reports on:

CaliforniaHealth+ Campaign Launch - See the print ad!

腹OSHPD Stakeholder 2/6 Meeting Summary - CPCA and health center representatives expressed the need to adopt revised building standards in order to allow CCHCs to expand. OSHPD will send out proposed standards this Friday, February 8th, in order to meet the 45 day comment period.

腹Workforce Updates - The Healthcare Workforce Development Division of OSHPD is launching CalREACH, a new e-application for OSHPD痴 financial incentive programs and a great resource for clinicians.

HRSA Program Assistance Letter (PAL) 2013-04: Look-Alike Program Update

腹Webinar Series on Migrant Health Begins Feb 13

腹NO CPCA Advocacy Call on Feb 13...

In a recent New York Times column, Nicholas Kristof wrote about young children in some poor communities who face greatly diminished opportunities by the time they池e just two years old.

In a letter to the editor in the New York Times, Center on Budget and Policy Priorities President Robert Greenstein, opens a dialogue about how best to fight poverty:

"Unfortunately, Kristof痴 otherwise excellent column also contains a significant misjudgment. He says that despite the growth of various social programs over recent decades, the poverty rate is no lower today than it was in the late 1960s, and he seems to conclude that the current system of anti-poverty programs largely addresses only symptoms of poverty and doesn稚 reduce poverty itself."

However, the comparison of today痴 poverty rate to the rate in the 1960s isn稚 valid, writes Greenstein, and Kristof overlooks recent research showing that safety-net programs lift millions of people out of poverty and, in a number of cases, have positive long-term effects on children痴 outcomes: the poverty rate would have been nearly twice as high in 2010 without the safety net, according to the National Academy of Sciences poverty definition. The safety net keeps or lifts one of every seven Americans out of poverty.

As we look to identify and institute effective interventions, we should be careful not to lose sight of the safety net痴 considerable accomplishments or the progress that has been made, Greenstein concludes...

Newly updated data from Kidsdata.org show that although some pollution measures in California have declined since the early 2000s, certain regions across California continue to face significant challenges with polluted air, contaminated drinking water, and dangerous toxins, such as lead.

Poor air quality, polluted water and exposure to lead have a particularly negative impact on children because their developing bodies are more fragile and their skin is more permeable. High levels of toxic substances in the environment put children at risk of developing serious chronic illnesses.

Pollution also can affect families and communities in other ways, increasing costs for health care and basic needs like clean water. Research has shown that low-income families and communities of color are disproportionately exposed to pollution...

As health care delivery systems take greater responsibility for the costs and quality of care they provide, they should be aware that a patient's ability and willingness to manage their health care is crucial to maximizing outcomes and minimizing costs.

According to a Commonwealth Fund穆upported study in Health Affairs, patients at a large care delivery system in Minnesota who were identified as the most "activated"―that is, participated in treatment decisions and took part in managing their own care―had significantly lower costs than those who were the least activated.

Researchers note that the finding held even after controlling for variables like demographics and severity of condition, indicating that 兎ven sicker patients can make a difference in their costs of care through their own actions and choices.

Read more.

Former President Clinton opened the Health Matters Conference, held recently in La Quinta, CA, with a warning about obesity, heart disease and diabetes, citing a Columbia University study that found the cost of treating preventable diseases will rise by $48-66 billion a year if current trends continue.

One overarching theme emerged: regular people have the power to fix most of what ails the health-care system and the economy by embracing a healthier lifestyle, HealthyCal.org reports.

Clinton said his foundation has worked with dozens of companies and non-profits to make best-practices a reality. 典oday there will be pledges that amount to 100 million dollars that will help more than 25 million people across America,he said.

Thirty one pledges made at the conference, including formation of a new national nonprofit to improve prevention and treatment of addiction, aim at getting individuals and communities to take action to improve health and bring down costs.

In one example, General Electric is putting six million dollars into a 滴ealthymaginationprivate/public health program that gives people online tools to improve their health...

The James Irvine Foundation announced its 2013 Leadership Award Recipients, six extraordinary Californians who are successfully addressing some of the state’s most critical challenges.

Now in its eighth year, the James Irvine Foundation Leadership Awards recognize and support individuals who are advancing innovative and effective solutions to significant state issues. Nominees may be working in any field — such as education, health, housing, economic development or the environment — in the public, private or nonprofit sector.

Nominations for the 2014 awards are now open and are due Friday, April 5, 2013. Recipients receive $125,000 to support their work benefiting the people of California...

Congress is about to make some critical budget and funding decisions in the next few weeks that will have real implications for health centers and our patients. It is certain that federal spending will be reduced, the question is how it will be done and what programs will suffer the most. This is one of those times when strong, convincing grassroots action can make a difference, writes NACHC's Campaign for America's Health Centers.

There are two key dates to be aware of in the next two months: March 1st and March 27th.

March 1st: "Sequestration" -- Significant cuts to the entire government. Unless Congress acts, on March 1st, $1.2 Trillion in "sequestration" or across the board cuts will occur across virtually every federal program...

Last week, top HHS and White House advisors publicly committed to protecting the Medicaid program and providing stable, predictable future funding for the program, NACHC reports. Gene Sperling, the top White House economic advisor, said that the President would oppose any major cuts to the Medicaid program for the rest of his administration. He did leave open the possibility of minor administrative cuts to Medicaid, but we have no firm details on what exactly those would be.

In advance of another round of negotiations on sequestration and the fiscal cliff, this sends an explicit signal to Members of Congress that large-scale Medicaid cuts are off the table for the White House, and that any deal should not include such cuts. This also further reiterates that the Blended FMAP proposal, which the White House had formerly put ON the table, is definitively now OFF the table as far as they are concerned...

According to Bill Finerfrock, Executive Director of the National Association of Rural Health Clinics:

 

"On Friday, February 1, the Centers for Medicare and Medicaid Services (CMS) released a revised RHC/FQHC Policy Manual.  The purpose of these revisions is to clear up areas where there was confusion over CMS policy or where CMS had been silent on a policy that now required a clear statement. 

 

In most instances, these clarifications are vast improvements in the document and should help to avoid commonly recurring questions.  In other instances, we believe CMS has incorrectly stated the policy and we will be working with them to make further refinements/corrections.

 

NARHC would like to generally congratulate CMS on the completion of this revised manual and we look forward to working with them to make some additional changes to properly reflect both the RHC statute and regulations.

 

Should you see areas in this document that you think are incorrect, please contact me and identify those areas so we can work with you to get them addressed.  You are not required to work with us and everyone should certainly feel free to contact CMS directly and raise your questions/concerns with them...

A report from Lucien Wulsin of Insure the Uninsured Project (ITUP) focuses on the challenges for California health reform and a status report for the progress we’ve made. California has not yet begun an educational campaign or agreed on any major improvements in the enrollment process for Medi-Cal.

ITUP urges California to set a high bar for anticipated enrollment, suggesting a target of 96% enrollment, equivalent to Medicare, with robust outreach and extensive simplification of enrollment. Download the full report.

And see "Thoughts on the Medicaid Expansion in CA" and related resources from ITUP at: http://itup.org

ITUP's 17 Annual Conference Statewide Conference, ACA: The Final Countdown, is Feb 5, 2013 in Sacramento. Follow on Twitter #itup

HHS' Health Resources and Services Administration is seeking input on how to disseminate text messages that promote wellness, nutrition and exercise to parents of children under age five

In a 1/29/13 Federal Register notice, HRSA asked for input on ways to leverage its new text messaging program -- called Text for Tots, or TXT4T. The program is modeled after a similar initiative called Text4Baby, which reaches more than half a million participants.

The TXT4T program will provide weekly text messages in both English and Spanish, based on the Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents, a HRSA-funded project launched in collaboration with the American Academy of Pediatrics.

First Update in More Than 30 Years

On 2/1/13, the U.S. Department of Agriculture (USDA) proposed updated nutrition standards for school snack foods and beverages. The first update since 1979, the proposed standards aim to help schools provide healthier fare in vending machines, cafeteria à la carte lines, and other places where foods and beverages are offered outside of the school meals program, Robert Wood Johnson Foundation reports.

Notably, the proposed standards call for schools to offer more snacks with whole grains, low-fat dairy, fruits, or vegetables as their main ingredient. If implemented, the proposed standards would improve the nutritional quality of the snacks and beverages available to tens of millions of students before, during, and after the school day. USDA will seek public comment on the proposal for 60 days...

Congress should consider increased payments and other ways to bolster the primary care physician workforce before next year's expansion of health care insurance coverage, witnesses told a Senate panel on 1/29/13.

The hearing, entitled 30 Million New Patients and 11 Months to Go: Who Will Provide Their Primary Care, focused on primary care access in the face of expansion of health insurance coverage under the Affordable Care Act. More than 52,000 additional primary care physicians will be needed by 2025 to meet the needs of the growing population and the expanded insured population, according to Sen. Bernard Sanders, chairman of the Senate Health, Education, Labor, and Pensions Subcommittee on Primary Health and Aging. See coverage from The Commonwealth Fund.

Written testimony is now available on NACHC’s website.

California's acute care hospitals saw capacity changes between 2001 and 2010, and overall have adjusted to stresses, while many have improved their financial status, according to a new report from California HealthCare Foundation.

The state's 393 general acute care (GAC) hospitals saw 46 million outpatients and discharged 3.5 million inpatients in 2010, when the number of beds available had declined to the lowest level in a decade. The report examines the state's GAC hospital facilities, including their bed supply and capacity, use of services, financial health, and selected quality measures.

Some key findings:

- The number of hospitals declined 5% and licensed beds dropped 3% from 2001 to 2010, while the population increased 8%.

- Emergency department beds increased steadily during the same period.

- Use of EDs increased 12%; nevertheless, California had significantly fewer ED visits per 1,000 population than the US as a whole in 2010...