A decade of value-based payment policy has done little to reduce health inequity in the US. Despite modest successes in improving quality and cost efficiency, value-based models and alternative payment models can also unintentionally exacerbate inequities encountered by historically marginalized communities. [JAMA Network]

Although consensus about the need to reform payment policy around equity has grown, effective reforms must reconcile existing tensions between financial incentives and equity goals.1 For instance, holding clinicians accountable for total spending (a core mechanism for achieving cost-efficiency through value-based payment) could inadvertently discourage clinicians from caring for historically marginalized populations for whom spending can be more challenging to control.

Policymakers must systematically address such issues to translate moral imperative into policy reform. This Viewpoint presents a potential guiding framework of strategies that align payment model components with equity goals (eTable in the Supplement).

Full article> https://lnkd.in/e3ZDdcyd

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Mental healthcare in Chicago must improve. Many of the Chicagoans most in need of quality mental health services haven’t been able to access them when and where they need them. About 178,000 Chicago adults needed mental health treatment at some point in the previous year but didn’t get it.1 This lack of services can be devastating for vulnerable residents—including our young people and communities of color, mainly on the south and west sides. [City of Chicago -Department of Public Health} 

This is unacceptable and demands urgent and well-coordinated action. We can and must do better. That’s why Mayor Lightfoot believes it’s time to transform Chicago’s mental health system. When she took office, she directed the Chicago Department of Public Health (CDPH) to work with advocates, experts, community providers, patients, and public officials to assess Chicago’s mental healthcare system to identify gaps and how they can best be filled, especially when it comes to addressing trauma.

The result of those efforts is the Framework for Mental Health Equity. Grounded in data, the framework is a roadmap to a better network of mental health services in Chicago. The Framework begins with a $9.3 million investment in the 2020 City budget to ensure a coordinated, comprehensive system of mental healthcare. This system must provide access to high-quality, trauma-informed services for the populations and communities most in need. COVID- 19 pademic impacted progress and exacerbated wellbeing. How are we doing?  Share your comments on IOMC's Linked page.

Review the Framework of Mental Health here>

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The Joint Commission, an independent accrediting body for hospitals, will introduce new standards on Jan. 1 aimed at reducing healthcare disparities, calling the effort a quality and safety priority. [Healthcare Dive 8.15.2022]

• Targeted interventions to detect and address differences in care among racial, ethnic and other historically marginalized groups should be integrated into providers’ quality improvement programs, alongside efforts to prevent healthcare-acquired infections, medication errors and workplace violence, the commission said in a report out this summer.  Full article here>
• The commission’s new accreditation requirements will apply to organizations in its ambulatory care, behavioral healthcare and human services, critical access hospital and hospital accreditation programs.

• Despite extensive research into the problem, disparities in access to healthcare and quality of care persist. The issue is a priority for the Biden administration, which has directed federal agencies including the HHS to advance racial equity initiatives. The CMS announced in its final inpatient rule that it was going to update its measurement and reporting methods to identify potential gaps in care between groups of patients.

  The pandemic has widened disparity gaps. In November 2021, the Joint Commission published a report that showed that Black and Hispanic people with COVID-19 infections experienced nearly three times the rate of hospitalization as White patients.

  While racial care disparities have been documented in published research, studies have also shown disparities in care for women, older adults, people with disabilities and other historically marginalized groups, according to the report.

  “Although health care disparities are often viewed through the lens of social injustice, they are first and foremost a quality of care problem,” the commission said.

  More> 

CDC Reports 90 Illinois Counties at High or Medium Community Level; Public Health Officials Urge Illinoisans to Get Up to date on Vaccines and Boosters

CHICAGO – The Illinois Department of Public Health (IDPH) today reported 26,462 new confirmed and probable cases of coronavirus disease (COVID-19) in Illinois, including 123 deaths since August 5, 2022. [IDPH 8.12.2022]

According to the CDC, 42 counties are now rated at High Community Level for COVID-19. An additional 48 counties in Illinois are now rated at Medium Community Level.

Currently, IDPH is reporting a total of 3,620,877 cases, including 34,539 deaths, in 102 counties in Illinois since the beginning of the pandemic.

As of last night, 1,471 individuals in Illinois were reported to be in the hospital with COVID-19.  Of those, 181 patients were in the ICU and 67 patients with COVID-19 were on ventilators.  The preliminary seven-day statewide case rate is 208 COVID-19 cases per 100,000 Illinoisans.

IDPH Director Sameer Vohra urges parents and guardians to take the steps necessary to get children vaccinated, especially small children under 5 for whom COVID-19 vaccines were recommended by the CDC on June 18.  IDPH is supporting an education and outreach campaign by the Illinois Chapter of the American Academy of Pediatrics to educate healthcare providers and parents about the effectiveness and safety of the newly authorized vaccines for children under 5. Click HERE to view the resources for families

The counties listed at High Community Level are Adams, Calhoun, Champaign, Clark, Clinton, Coles, Crawford, Cumberland, DeKalb, Douglas, DuPage, Edgar, Fayette, Ford, Franklin, Henderson, Jackson, Johnson, Kane, Kendall, Knox, Lake, LaSalle, Lawrence, Lee, Madison, Marion, Mason, Massac, Monroe, Ogle, Perry, Pike, Randolph, St. Clair, Stephenson, Vermilion, Warren, Whiteside, Will, Williamson, and Winnebago.

The CDC recommends the following measures for people in areas that are rated at High Community Level for COVID-19 transmission:

• Wear a well-fitting mask indoors in public, regardless of vaccination status (including in K-12 schools and other indoor community settings)
• If you are immunocompromised or high risk for severe disease
  
  • Wear a mask or respirator that provides you with greater protection
    
  • Consider avoiding non-essential indoor activities in public where you could be exposed
    
  • Talk to your healthcare provider about whether you need to take other precautions
    
  • Have a plan for rapid testing if needed (e.g., having home tests or access to testing)
    
  • IF YOU TEST POSITIVE: Talk to your healthcare provider about whether you are a candidate for treatments like oral antivirals, and monoclonal antibodies
    
• If you have household or social contact with someone at high risk for severe disease
  
  • consider self-testing to detect infection before contact
    
  • consider wearing a mask when indoors with them
    
• Stay up to date with COVID-19 vaccines and boosters
  
• Maintain improved ventilation throughout indoor spaces when possible
  
• Follow CDC recommendations for isolation and quarantine, including getting tested if you are exposed to COVID-19 or have symptoms of COVID-19
  

At the Medium Community Level, persons who are elderly or immunocompromised (at risk of severe outcomes) are advised to wear a mask in indoor public places. In addition, they should make sure to get up to date on their COVID-19 vaccines or get their 2nd booster, if eligible.

IDPH has been supporting pharmacies and healthcare providers in efforts to increase their inventories of the various FDA-authorized treatments. There are over 1,200 treatment locations in Illinois - including all the major retail pharmacies. More than 96.7% of the state’s population is within a 10-mile radius of one of these locations.

A total of 23,114,591 vaccines have been administered in Illinois. The seven-day rolling average of vaccines administered daily is 8,829 doses.  Since August 5, 61,805 doses were reported administered in Illinois. Of Illinois’ total population, more than 77% has received at least one COVID-19 vaccine dose, more than 69% of Illinois’ total population is fully vaccinated, and more than 54% of the vaccinated population has an initial booster according to data from the Centers for Disease Control and Prevention. Data indicates that the risk of hospitalization and severe outcomes from COVID-19 is much higher for unvaccinated people than for those who are up to date on their vaccinations.  All data are provisional and are subject to change.  Additional information and COVID-19 data can be found at https://dph.illinois.gov/covid19.html.  

Vaccination is the key to ending this pandemic.  To find a COVID-19 vaccination location near you, go to www.vaccines.gov.  The federal government has established a new website that provides an all-purpose toolkit with information on how to obtain masks, treatment, vaccines and testing resources for all areas of the country at: https://www.covid.gov/.

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Numbers are in... Managed care rolls decline in June

The state’s Medicaid managed care rolls saw a slight dip in June, according to recent data from the Department of Healthcare and Family Services. [Health News Illinois]

Enrollment in HealthChoice Illinois was 2,800,420 as of July 1, down 0.4 percent from the 2,810,482 enrolled on June 1.

Blue Cross and Blue Shield of Illinois saw a small increase in its enrollment, while the other four health plans saw their enrollment decline.

As of July 1, enrollment totals were:

·    Aetna Better Health – 424,677 (2.1 percent decrease from June 1)

·    Blue Cross and Blue Shield of Illinois – 696,745 (0.1 percent increase)

·    Molina Healthcare – 334,546 (0.3 percent decrease)

·    CountyCare Health Plan (Cook County only) – 435,299 (0.1 percent decrease)

• Meridian Health Plan – 872,738 (no percent change)

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If Congress could put its effort behind only one important goal on the domestic policy front in the remainder of the year, it should focus on continuation of healthcare coverage for tens of millions of Americans. [MedPageToday]

Medicaid eligibility rules have been effectively suspended for existing enrollees since the passage of a 2020 COVID-19 relief bill that provided a 6.2 percentage point federal matching grant (FMAP) bump if states allowed Americans to stay on the Medicaid rolls once qualified. The bump is effective until the end of the COVID-19 public health emergency (PHE), now through October 13, 2022.

With the potential end of the PHE in the U.S. sometime later this year or early next, Medicaid eligibility rules will begin to kick in again and studies suggest that between 5.3 and 14.2 million current enrollees could lose coverage. More>

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Monica Mitchell has lived in South Shore for two decades, and in that time, she’s had to change pharmacies three times.

The 48-year-old registered nurse said when a Walgreens five minutes from her house was closed, she switched to one a few blocks over, but it didn’t carry all the items she needed. So she started going to one in Hyde Park.

Then came the murder of George Floyd by a Minneapolis police officer in the summer of 2020, which sparked days of protests, civil unrest and looting across the city and the nation.

In the aftermath, hundreds of businesses in Chicago shut their doors either temporarily or permanently, including many pharmacies, and Mitchell was forced to change drugstores once again. By then, the closest Walgreens was in southwest suburban Evergreen Park, 30 minutes away.

While Mitchell now gets most of what she needs via mail order, that convenience is not widely used by those who are more comfortable with brick-and-mortar stores or lack internet access, she said.

A few miles southwest of Mitchell, 68-year-old Renita Johnson said over the decades she has lived in Roseland, she has seen a number of nearby pharmacies close.

She can’t imagine how her older neighbors without cars and limited mobility even get to a drugstore these days.

“I would see it as a total nightmare,” she said.

The experiences of the two women are not unusual in many parts of Chicago.

Even as drugstores are providing more vital services — including COVID-19 tests and vaccinations, contraceptive counseling and wellness visits — a recent study shows communities on the city’s South and West sides have fewer pharmacy locations than other parts of the city. More>

More on this topic here>

And here> 

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A person who works at a day care in Illinois has tested positive for monkeypox and potentially exposed children, who are at higher risk for severe outcomes from the virus, state officials announced Friday. [Washington Post 8.5.2022]

Officials are screening children and others who were potentially exposed for symptoms, and the Food and Drug Administration is allowing the children to receive the Jynneos vaccine, which is authorized only for adults. The vaccine can prevent infection or reduce the severity of symptoms after exposure.

What to know about monkeypox symptoms, treatments and protection

Authorities said no one else has tested positive. Illinois health officials had determined that between 40 and 50 people, many of whom are children, had been potentially exposed to the day-care worker directly or to items that had been handled by the person, officials said.

“We are casting a wide net,” Julie Pryde, administrator of the Champaign-Urbana Public Health District, wrote in a text message Friday night. Pryde said that several dozen children had been offered vaccines, pending their guardians’ approval.

Full article here>

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The Department of Public Health will receive $5.3 million in federal funds to support efforts to improve maternal health, the state’s two senators announced last week. [Health News Illinois] 

The dollars from the Department of Health and Human Services will help the state agency identify, review and characterize maternal deaths. They will also go toward prevention opportunities and the development of new treatments for pregnancy and postpartum complications.

“Despite being one of the richest and most advanced nations, the United States is facing a dire crisis when it comes to maternal health, particularly for women and babies of color,” said Sen. Dick Durbin, D-Ill.

 An IDPH report released last year found that Black women in Illinois were three times as likely to die from pregnancy-related conditions as white women between 2016 and 2017. The number of white women likely to die from pregnancy-related mental health conditions grew during that same time. 

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Gov. JB Pritzker on Monday declared monkeypox a public health emergency.

The declaration will allow the Department of Public Health to better coordinate logistics across state agencies when it comes to vaccine distribution and working with the federal government on a response to the virus, he said. [Health News Illinois]

IDPH and the Illinois Emergency Management Agency will also be able to access state and federal recovery and assistance funds to expand vaccine and testing capacities.

“(Monkeypox) is a rare, but potentially serious disease that requires the full mobilization of all available public health resources to prevent the spread," Pritzker said in a statement.

Monday’s declaration, effective for 30 days, also allows for emergency procurements to aid the state's response.

IDPH on Tuesday reported 533 probable and confirmed cases in Illinois, making it the state with the third highest case count.

Illinois has received more than 7,000 doses of vaccine from the federal government, with IDPH saying an additional 13,000 doses are expected in the “near future.”

Chicago Mayor Lori Lightfoot and Chicago Department of Public Health Commissioner Dr. Allison Arwady praised Pritzker's action in a joint statement, adding the city will not issue its own declaration.

They said more needs to be done at the federal level to address the outbreak.

 "It is our hope that this declaration joins a chorus of others across the nation and encourages the rapid increase and distribution of vaccines," they said.

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