Over the past several years, many health care organizations — especially in response to the Black Lives Matter movement and the murders of George Floyd, Breonna Taylor, and others — made strong public declarations of their commitment to advance equity and racial justice. [ Beckers]

This attention was long overdue. Some have described this as the largest groundswell of energy focused on racial justice in decades.

This racial reckoning touched every industry, and health care systems were no exception. Yet, while many companies rushed to hire chief diversity officers, chief equity officers, and similar positions several years ago, the Wall Street Journal recently reported that many organizations are now shedding these positions or rolling back their initial commitments. In too many cases, positions created to advance equity were neither adequately resourced nor given clear and specific objectives. As a result, the top-tier talent who filled these roles were not set up to achieve the results that people have hoped for, leading to much frustration.

This is a troubling development and should be seen as a call to recommit ourselves to advancing equity, diversity, and inclusion. Some organizations may simply be recalibrating or rethinking how they want to do this work. But others may be abandoning these equity leadership roles and initiatives because the effort is more difficult, more complex, and takes longer than they expected. Instead of pulling back, individual organizations should consider how taking part in coordinated and collective action could strengthen their anti-racism and equity efforts.

Don’t Go It Alone

The Institute for Healthcare Improvement (IHI), the organization that I lead, has joined with the American Medical Association (AMA), in collaboration with Race Forward and a growing list of organizations, to create the Rise to Health Coalition. The Coalition brings together individuals and organizations committed to equity and justice within the health ecosystem to build, lead, and advance shared solutions and collective actions to transform and strengthen health care. We have invited a coalition of individual practitioners, health care organizations, professional societies, payers, and pharmaceutical, research, and biotechnology organizations to deliver more equitable care outcomes to patients, families, and entire communities. 

The theory behind the Rise to Health Coalition is that no individual or single organization can advance equity and justice alone, and three years into our equity commitments, many organizations are now at an inflection point. This is neither the first nor the last time we will face such a moment. But, as we have in the past, we must now commit ourselves anew to taking action with colleagues and communities to build a future where health and care are better, fairer, and more equitable. 

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A summer COVID-19 wave may have already crested in Illinois. [Health News Illinois] 

Dr. Arti Barnes, chief medical officer for the Department of Public Health, told officials late last week that hospital admissions for COVID-19 are falling, and that while pediatric intensive care unit capacity is down, it’s not being driven by COVID-19.

“I'm not going to go as far as to say that we're not going to see another second wave coming up deeper into the winter, but at least it looks like this is one slightly reassuring piece of news,” Barnes said at a State Board of Health meeting.

Low takeup of COVID-19 booster shots this fall, coupled with inequitable access to treatments, could lead to a higher rate of hospitalizations for high-risk groups, according to Barnes. But, she expects that the booster shots will be effective against the mix of variants they’ve recently seen in Illinois. 

“No one variant is dominating any more in this new COVID era,” Barnes said. “Which, again, means we're heading towards endemicity to some part.”

Meanwhile, Barnes is hopeful that new vaccines and treatments will mitigate respiratory syncytial virus cases this fall and that the flu season will be more moderate than last year, based on a gentler and faster than expected peak in the Southern Hemisphere. 

 “Of course, you know all predictions come back to bite you, so hopefully this will hold true,” she said.

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The COVID-19 pandemic has led to unprecedented mental health disturbances, burnout, and moral distress among health care workers, affecting their ability to care for themselves and their patients. [Science Direct]

RESEARCH QUESTION: In health care workers, what are key systemic factors and interventions impacting mental health and burnout?

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Download PDF of white paper here>

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Addressing the Mental Health Crisis in Youth—Sick Individuals or Sick Societies? | The prevalence of anxiety and depression has been increasing in the US as well as in many other parts of the world. This trend, beginning in the 2010s, has largely been concentrated among adolescents and youth.1 [JAMA Network]

At least 2 broad sets of characterizations have been proposed in the scientific literature and lay press, the first viewing this increase as an epidemic of psychiatric disorders2 while the other seeing the increase in psychological distress in youth as reflective of sociopolitical adversity and disorganization.3

At the risk of oversimplification, this contrast may be viewed as a sick individuals vs sick society polarity. Such explanatory dualities present clinicians with the challenge of how to navigate concerns about excessive medicalization and address complex social determinants of health in clinical settings. Moving past conceptual binary constructs fueling this polarization can be an important first step in addressing the mental health crisis in youth. Herein, we discuss the reasons for this polarization, strategies to overcome it, and how these insights should inform clinical practice.

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The Department of Healthcare and Family Services said Tuesday it will delay implementation of copays for healthcare services provided to those in the state program that provides Medicaid-like coverage for undocumented individuals. [Health News Illinois] 

Medicaid Administrator Kelly Cunningham said in a notice that providers should not charge cost-sharing for the population “until further notice.” Any cost-sharing that providers may have already collected must be returned.

“HFS will issue a provider notice with implementation guidance when the necessary provider reimbursement programming is in place,” she said.

The department did not return a request for additional comment.

The rules, unveiled earlier this summer, include a pause on new enrollees between 42 and 64 and copays for hospital services not eligible for a federal match. Seniors can still join the program until their enrollment reaches 16,500, a threshold that officials recently said has yet to be reached.

Tovia Seigel, director of the Healthy Illinois Campaign, said in a statement they are relieved by Tuesday’s decision as copays significantly burden individuals seeking care.

“We stand ready to work with (the department) to find fiscally responsible ways to make this delay a permanent policy and protect the … programs that thousands of immigrants rely on for critically important healthcare services,” she said.

HFS’ announcement comes as advocates for the program renewed their call for the Pritzker administration to reverse its decision to place restrictions on the program.

Nadeen Israel, senior vice president of policy and advocacy at AIDS Foundation Chicago, said at a public hearing that they understand the state faces financial challenges, but ensuring access to healthcare services is a necessity for the undocumented population.

“Investing in this care now will help save the state money in the long run,” she said, noting her organization is also part of the Healthy Illinois Campaign that has advocated for the expansion of the program. “We are ready to work with you to calculate and identify those cost savings.”

Advocates said Tuesday that the copays for hospital services not eligible for a federal match, such as $250 for inpatient hospitalizations and $100 for emergency room visits, could drive immigrants away from receiving healthcare.

“Therefore, immigrants will be less likely to even seek preventive care, which ultimately drives up the cost of emergency room visits,” said Edith Avila Olea, policy manager at the Illinois Coalition for Immigrant and Refugee Rights.

Additionally, she said several questions remain unanswered, such as whether enrollment will reopen after the planned transfer of members to Medicaid managed care occurs next year.

Others remain concerned that the agency has yet to provide a customer notice for individuals enrolled in the program as well as a provider notice to better clarify the copay process, specifically to aid individuals for whom English may not be a first language.

Andrea Kovach, an attorney at the Shriver Center for Poverty Law, said the current language does not ensure enrollees are informed if they will incur cost-sharing before receiving services, nor which services will be covered.

If the department will not pull the language related to cost-sharing, Kovach suggested they amend it to include an annual cap on the amount incurred by an enrollee.

 HFS Chief of Staff Ben Winick said the goal of Tuesday’s hearing is to take public feedback before the filing of a second notice of the rules to the Joint Committee on Administrative Rules.

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Drug overdose deaths are continuing to rise in Illinois, specifically among Black and older residents, according to a newly published database by Northwestern University. [ Health News Illinois] 

Per the data, 729 adults between 55 and 64 died from overdose in 2021, compared to 473 in 2019. Of those, about 80 percent were opioid-related. 

Meanwhile, 610 Black Illinoisans died from overdose in 2021, compared to 357 in 2019.

Comparably, 426 white Illinoisans died from overdose in 2021, compared to 347 in 2019.

Maryann Mason, an associate professor of emergency medicine at Northwestern University Feinberg School of Medicine and lead faculty member behind the dashboard, said it's a “call for all hands on deck.”

“The dashboard gives a 10,000-foot view of how the illicit drug market has changed in Illinois,” she said. 

Additionally, the data show that heroin-related deaths dropped, while those related to fentanyl, cocaine and xylazine increased.

The Centers for Disease Control and Prevention and the Illinois Department of Public Health are funding the dashboard. 

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Bicycle Health is partnering with Albertsons to allow its patients with an opioid addiction to receive a buprenorphine injection from pharmacists at more than 700 of the grocery and pharmacy chain's locations. [Modern Healthcare]  

Opioid use disorder patients of the telehealth company in 17 states must first have a virtual visit with Bicycle Health before being prescribed the medication, which helps reduce people's dependence on opiates. Previously, the company's patients were only able to get prescriptions for oral buprenorphine at pharmacies including Albertsons.

The partnership does not include any financial agreement, a Bicycle Health spokesperson said.

 A study published in JAMA Network in June 2021 found patients prefer injectable buprenorphine to oral buprenorphine medication. 

“In the past, if a patient was a better fit for injectable medication, we would have to refer them to a local provider," said Bicycle Health CEO Ankit Gupta. "And it was almost impossible to find a local provider who was an expert in injectable buprenorphine, could administer it and manage all of the logistics required [around receiving the medication]." 

The move comes as the Drug Enforcement Agency scrutinizes the virtual prescribing of controlled substances. In May, the DEA extended until November flexibilities that allow telehealth companies to remotely prescribe certain controlled substances without an in-person visit. Earlier this year, the agency proposed that Schedule III-V substances like buprenorphine could only be prescribed via telehealth for an initial 30-day dose.

As the DEA figures out next steps, virtual companies like Bicycle and Talkiatry are pushing the agency for permanent flexibilities around remote prescribing. They’re also working on contingency plans. 

“A lot of our work does take into account what the DEA might or might not do,” Gupta said. “We’re always planning for contingencies because of the regulatory uncertainty we live in now." 

Albertsons did not respond to an interview request.

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Illinois Attorney General Kwame Raoul joined more than 30 colleagues this week to urge the Food and Drug Administration to take further steps to protect minors from e-cigarettes. [Health News Illinois]

Thirty-two attorneys general and one deputy attorney general wrote a letter commenting on a five-year strategic plan by the FDA’s Center for Tobacco Products. They recommended prohibiting all non-tobacco flavors in e-cigarettes, enacting limits on nicotine in e-cigarettes, restricting marketing and closing a “loophole” where disposable e-cigarettes are not subject to the same, existing enforcement guidance as cartridge e-cigarettes.

“The FDA is a critical partner in this effort, but it can and must do more,” Raoul said in a statement. “That is why we are urging the FDA to take additional steps to protect young people from nicotine addiction through e-cigarette usage.”

A spokesman for the FDA said they will respond directly to the attorneys general.

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Elected officials and advocates called for empathy Monday toward people with substance abuse disorders and increased options for treating and preventing opioid overdoses. [Chicago Tribune]

In his address to the crowd of volunteers, supporters and onlookers in Chicago’s Federal Plaza ahead of International Overdose Awareness Day on Thursday, Mayor Brandon Johnson repeated his campaign promise on so-called Treatment Not Trauma and called for a “public health approach” to reduce opioid deaths in Chicago.

“We must not criminalize and further harm our brothers and sisters in need,” Johnson said before dozens of volunteers and bystanders. “Substance use and abuse ... creates a ripple effect of devastation in our families and neighborhoods.”

“We must extend care,” he added, “not judgment.”

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Chicagoans with confirmed and probable cases of mpox have a high rate of co-infections with other sexually transmitted infections, according to an analysis by the Chicago Department of Public Health. [Health News Illinois]

The analysis also found racial disparities, with Black individuals being twice as likely than white individuals to have mpox and HIV co-infections. Latinx individuals had a 34 percent increase and Asian individuals had a 90 percent increase in HIV co-infection compared to white people.

Kara Herrera, an epidemiologist at the department, said the analysis highlights their ability to leverage surveillance and case management data to identify vulnerable populations that may need additional care. 

She said that at the time of mpox diagnoses, “we strongly encourage HIV-negative individuals to get on PreP for HIV and encourage healthcare providers to utilize the syndemic approaches by offering testing and prevention (for) STIs, HIV and infections such as mpox.”

Additionally, the agency suggested further investigation into the association between positive syphilis serology and HIV co-infection among people with mpox.

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