Medicare beneficiaries’ out-of-pocket costs for insulin exceeded $1 billion in 2020 vs $236 million in 2007.¹ High costs lead some patients with diabetes to reduce adherence to insulin, increasing the risk of adverse health outcomes.^{2-4 [JAMA Network]}

Although efforts to cap patients’ cost sharing for insulin have existed in some states since 2020, and in certain Medicare Part D plans since 2021, in January 2023 the Inflation Reduction Act⁵ capped cost sharing for insulin at $35 for a 1-month supply for all Part D beneficiaries and, therefore, may have a greater effect on adherence. This study measures the association of this cost-sharing cap with insulin fills.

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Chicago City Council approves $2.9 million purchase of Lincoln Square hotel for transitional housing, behavioral health support

The Chicago City Council signed off Wednesday on the $2.9 million purchase of the former Diplomat Hotel in the Lincoln Square neighborhood, with the goal to turn it into a pilot program site that provides behavioral health and housing support for those experiencing homelessness. [Health News Illinois]

The program will build off the experiences of the COVID-19 pandemic, when the city offered hotel rooms to those experiencing homelessness as well as on-site healthcare workers who monitored for the virus and provided medical care for chronic health and behavioral health conditions.

Fifty-one percent of those participating in that program successfully transitioned into some type of housing, according to the Chicago Department of Public Health.

Department Commissioner Dr. Allison Arwady said the pilot program will be the first long-term city program “solely focused on stabilizing people experiencing homelessness who also have major untreated health needs.”

“It’s about breaking the cycle of homelessness by first providing transitional housing while focusing on addressing these acute health needs, with a longer-term goal of eventually moving individuals into both permanent housing and ongoing healthcare,” she said.

The Diplomat Hotel was selected based on program needs, location accessibility and support from local Alderman Andre Vasquez.

In other business, the council approved a resolution to hold a subject matter hearing on an ordinance focused on addressing behavioral health in the city. 

Along with re-opening the city’s shuttered mental health clinics, the proposal would also give the health department the ability to send out crisis response teams staffed by paramedics and social workers to address mental health crises.

“These actions taken today are a tremendous step forward in implementing our vision of supporting workers and working families and individuals in need of mental healthcare and resources, which is essential to the success of our city,” Mayor Brandon Johnson said after the meeting. “While this kind of transformational change won’t happen overnight, we are determined to chart the best path forward and create a better future for all Chicagoans.”

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In recent years, it's felt more and more like every cultural battle is a medical one. A look at how it happened and how it's changing the medical field [Medscape Medical News]

In an August 2022 survey of emergency doctors conducted by the American College of Emergency Physicians, 85% of respondents said violence against them is increasing. One in four doctors said they're being assaulted by patients and their family and friends multiple times a week, compared to just 8% of doctors who said as much in 2018. Sixty-four percent of emergency physicians reported receiving verbal assaults and threats of violence; 40% reported being hit or slapped, and 26% were kicked.

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Professional medical organizations recommend that adults receive routine postpartum care. Yet, some states restrict public insurance coverage for undocumented immigrants and recently documented immigrants (those who received legal documentation status within the past 5 years). [JAMA Network]

The objective is to examine the association between public insurance coverage and postpartum care among low-income immigrants and the difference in receipt of postpartum care among immigrants relative to nonimmigrants.

Compared with states without insurance restrictions, immigrants living in states with public insurance restrictions were less likely to receive postpartum care. Restricting public insurance coverage may be an important policy-driven barrier to receipt of recommended pregnancy care and improved maternal health among immigrants.

Read full paper here>

Download full paper here>

Sen. Tammy Duckworth, D-Ill., has proposed a plan that aims to help the U.S. Public Health Service Commissioned Corps recruit, retain and mobilize members to better respond to national and global public health crises. [Health News Illinois]

The bill would give corps members access to benefits and entitlements provided to reserve components of all other uniformed services, including leave rights and GI Bill educational benefits.

The corps is one of the nation’s eight uniformed services and has an exclusive focus on protecting the country during public health emergencies like Ebola, natural disasters and the COVID-19 pandemic, according to Duckworth.

“One of the most critical lessons we can learn from the COVID-19 pandemic is how important it is for our country to be prepared for the next public health crisis,” Duckworth said. “Supporting our Public Health Service Commissioned Corps and ensuring Ready Reserve Corps service members have the same benefits as our other uniformed service members will help create more opportunities for Americans to serve and protect our country against current and future public health emergencies.”

Despite dating back to 1798, the corps lacked an operational ready reserve component or public health emergency response strike team until the Coronavirus Aid, Relief, and Economic Security Act was signed into law in 2020, according to Duckworth. The initial authorization left gaps in personnel policy and benefits relative to other branches.

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For Star August, the birth of her first son did not go as planned. August hired an out-of-hospital midwife to guide her through the pregnancy but attended checkups in a hospital as a cost-saving measure. At one of her last checkups, the doctors told her that her amniotic fluid was low and wanted to induce labor. [Crains]

"I wasn't able to get a hold of my midwife, and I didn't know what to do," August recalls.

What happened next was a harrowing experience. After taking Pitocin, a synthetic hormone used to induce labor and speed up contractions, her son's heart rate began to drop. August was rushed to the operating room for an emergency C-section. She wasn't completely anesthetized before doctors cut into her skin, and they ignored her pleas to stop.

After awakening from a drug-induced coma, she saw her newborn son being resuscitated next to her. Once revived, the baby was taken to the neonatal intensive care unit. August couldn't experience skin-to-skin contact with her child at birth, which can decrease stress in both mother and child and help initiate breastfeeding.

August's traumatic birthing story is a familiar one, especially for Black and Brown women, who face a greater risk of trauma and death due to childbirth, compared to their white peers.

Research published earlier this month by the Journal of the American Medical Association, or JAMA, found higher maternal mortality rates in Black communities, while Native American and Alaska Native people experienced a particularly rapid rise. State median mortality rates more than tripled over the last two decades. 

Dr. Melissa Simon, MD, is a Fellow of IOMC and a member IOMC's Maternal Health and Child Workgroup. If you would like more information about this workgroup, send an email to the IOMC office at iomcstaff@iomc.org. 

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Recent research indicates efforts to improve maternal health in the U.S. have largely failed, with the maternal mortality rate more than doubling over the past two decades amid vast disparities between racial and ethnic groups. [ US News] 

Maternal mortality in the U.S. has gotten worse in recent decades, a study shows, particularly for Native and Black women.

READ: Maternal Deaths Rose During Pandemic

Findings from a novel state-by-state analysis of maternal deaths, published this month in JAMA, show the rate of death among people 10 to 54 years old who were either pregnant or had been pregnant within the past year rose from 12.7 deaths per 100,000 live births in 1999 to 32.2 deaths per 100,000 in 2019, with total maternal deaths increasing from 505 to 1,210. Between the decades of 1999 to 2009 and 2010 to 2019, the study found increases in maternal mortality rates across nearly all states and among all racial and ethnic groups.

Across the five racial and ethnic groups included, the study’s estimates show American Indian and Alaska Native females, as well as Black females, had the highest maternal mortality rates in 2019, along with the largest absolute mortality rate increases since 1999. Among American Indians and Alaska Natives, the national maternal mortality rate more than tripled over the two decades studied – from 19 deaths per 100,000 live births in 1999 to 69.3 per 100,000 in 2019 – while maternal mortality among Black women more than doubled, from 31.4 to 67.6.

Among whites, the maternal mortality rate also roughly tripled, from 9.2 to 27.9. Similar patterns were found when examining median maternal mortality rates across states.

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If you are interested in more information about IOMC's Maternal Health and Child Workgroup, please contact IOMC at iomcstaff@iomc.org

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The U.S. health care system is not set up to improve the quality of life of the most vulnerable, chronically ill, elderly people, especially those who are poor. Older poor people often face loneliness, depression, a lost sense of purpose, and an inability to live independently in their homes. They also encounter many health service hurdles, including inadequate care coordination, fee-for-service reimbursement that often reflexively encourages medical treatment over other forms of care, and a dysfunctional nursing home industry. [Harvard Business Review]

To help improve services for these patients, we analyzed the design and implementation of a national program called PACE: Program of All-Inclusive Care for the Elderly. We focused on this program because all PACE participants are vulnerable: They require nursing home–level care, and 90% are eligible for both Medicare and Medicaid. Few integrated-care programs serve this dual-eligible population, which now numbers 12.5 million Americans.

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Delivery-related maternal mortality in U.S. hospitals decreased for all racial and ethnic groups, age groups and modes of delivery during 2008 to 2021, likely due to national strategies to improve delivery-related hospital care, the Department of Health and Human Services reported. Advanced maternal age, racial or ethnic minority group status, cesarean delivery and comorbidities were associated with higher odds of mortality and severe maternal morbidity, according to the HHS study, published in JAMA Network Open. Adm. Rachel L. Levine, M.D., HHS’ assistant secretary for health, said the results “underscore the need to better manage women’s health, including identifying the most significant risk factors and supporting access to improved care.” [AHA]

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Gov. JB Pritzker's administration has applied to the federal government to extend Illinois’1115 waiver for behavioral health services, with officials saying it will help with their goal of “healthcare transformation.” The five-year extension application to the Centers for Medicare and Medicaid Services proposes 10 programs. Along with continuing four pilots originally approved by the agency in 2018 related to substance use disorder services, the waiver seeks to address food and nutrition services, employment assistance, non-medical transportation and community reintegration for previously incarcerated individuals. “The section 1115 demonstration request is an essential component of Illinois’s strategic plan to build an equitable and sustainable healthcare system,” Pritzker wrote in a letter to Health and Human Services Secretary Xavier Becerra. “This comprehensive initiative will leverage the existing transformation framework of the 1115 demonstration activities within the current program to include additional foundational innovations to address the health-related social needs of Illinoisans.” CMS originally approved the state’s 1115 waiver in 2018, granting the Department of Healthcare and Family Services the ability to implement 10 pilot programs to address the state’s behavioral health system. The initial goal, officials said, was to pilot treatments for addiction to opioids and other substances that were not directly available to Illinois Medicaid beneficiaries. But numerous factors in recent years, ranging from the COVID-19 pandemic and its challenges to Pritzker being elected after the initial waiver was submitted, have changed priorities. Officials are now seeking to rename the plan the Illinois Healthcare Transformation Section 1115 Demonstration to “better align with the state’s overall goal and current efforts to create an equitable and sustainable healthcare system for Illinoisans.” “(HFS) now seeks to leverage Section 1115 Demonstration authority to secure additional Medicaid resources to sustain the groundbreaking work already underway and seed additional innovations,” according to the application. CMS said late last month that they have extended the state’s demonstration through next June as the two sides continue negotiations over the current extension application. The federal public comment period will be open until July 28. ###