On December 15, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the new Transforming Maternal Health (TMaH) Model. CMS will release a Notice of Funding Opportunity (NOFO) for state Medicaid agencies in Spring 2024. Applications will be due in Summer 2024. [CMS.gov]

TMaH is the newest CMS model designed to focus exclusively on improving maternal health care for people enrolled in Medicaid and Children's Health Insurance Program (CHIP). The model will support participating state Medicaid agencies (SMAs) in the development of a whole-person approach to pregnancy, childbirth, and postpartum care that addresses the physical, mental health, and social needs experienced during pregnancy. The goal of the model is to reduce disparities in access and treatment. The model aims to improve outcomes and experiences for mothers and their newborns, while also reducing overall program expenditures.

The model is projected to run for 10 years.

Model Overview

Despite spending more per capita on maternal health care than any other nation, the U.S. has disproportionately high rates of adverse pregnancy outcomes as compared to other high-income nations. The TMaH Model provides SMAs with targeted support in the form of funding and technical assistance. The goal of this support is to improve maternal health care and birth outcomes while reducing associated health disparities.  This support also enables states to develop a value-based alternative payment model for maternity care services which will improve quality and health outcomes and promote long term sustainability of services.

TMaH’s initiatives will center on three main pillars:

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Joseph Wright, MD, MPH, and his team at the American Academy of Pediatrics (AAP) are in the midst of a herculean task—reviewing the AAP’s catalog of roughly 400 policies, guidelines, and algorithms to identify those that inappropriately use race as a proxy for biology and may exacerbate health disparities. The goal is to replace them with race-conscious approaches that explicitly aim to enhance equity. [JAMA Network]

“We cannot ignore the impact that race and ethnicity have on differential lived experiences and that those lived experiences contribute to differential health status and health outcomes,” Wright, chief equity officer and senior vice president of equity initiatives at the AAP, said in an interview.

While he and his team started with the 150 or so policies that explicitly involve race, they also plan to review policies with less obvious connections.

“What I’m concerned about is the more insidious embedding of bias into many clinical practice guidelines,” Wright said. “That’s what we are determined to ferret out.”

The AAP is among a growing number of medical societies that are systematically reviewing the way race is used in clinical guidelines or algorithms. Some have already replaced race with clinical factors or social determinants of health in their widely used clinical algorithms.

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His mother, Michelle Staten, said her son, who has autism and other conditions, reacted as many children with disabilities would when he was confined to the seclusion room at Buckhorn Creek Elementary. [KFF Health News]

“I still feel a lot of guilt about it as a parent,” said Staten, who sent the photos to the federal government in a 2022 complaint letter. “My child was traumatized.”

Documents show that restraint and seclusion were part of the special education plan the Wake County Public School System designed for Staten’s son. Starting when he was in kindergarten in 2017, Staten said, her son was repeatedly restrained or forced to stay alone in a seclusion room.

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Parents often bask in the glow of their children’s accomplishments, so if SARS-CoV-2 variants were like people, BA.2.86 would be busting its buttons right about now. [JAMA]

BA.2.86’s spawn, JN.1, has become the dominant SARS-CoV-2 variant in the US, status its parent variant never achieved. Fortunately, although COVID-19 cases have surged, hospitalizations and deaths from the disease are still considerably lower than they were the same time a year earlier.

When BA.2.86 joined the SARS-CoV-2 Omicron family last summer, it grabbed pandemic trackers’ attention because it was so different from its progenitor, BA.2. Compared with BA.2, BA.2.86’s spike protein carries more than 30 mutations, suggesting that it might spread more easily than its predecessors.

But even armed with those new mutations, BA.2.86 failed to dominate the other subvariants. Through early January of this year, BA.2.86 never exceeded much more than a 3% share of circulating SARS-CoV-2 subvariants in the US, according to Nowcast estimates from the US Centers for Disease Control and Prevention (CDC).

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Honoring Dr. Martin Luther King, Jr. - his dream, his life and his accomplishments. 

Ten books to understand Dr. M.L. King Jr's. legacy today, visit this page. . 

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The Food and Drug Administration's green light for the state of Florida to begin importing prescription drugs from Canada surfaced as a talking point for state governor and presidential hopeful Ron DeSantis in Wednesday night's two-person GOP debate ahead of the Iowa caucuses. [US News - Healthy Communities]

European countries dominate this list of nations seen by survey respondents as having well-developed public health systems.

The long-awaited federal approval followed a lawsuit to speed up the process and already had been touted by DeSantis as a triumph over “the federal bureaucracy of 2 presidential administrations,” though both President Joe Biden and former President Donald Trump had hands in creating the pathway that led to it. Regardless, it's a sentiment that fits nicely with the governor's depiction of Florida as “a refuge for freedom” and the "envy of the nation."

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A nation’s public health infrastructure serves as a pillar for the welfare and security of its population. From responding to infectious diseases and monitoring environmental health threats to addressing chronic illness and promoting general wellness, the public health system can be an important indicator of the well-being and quality of life within a nation. [US News] 

Having a well-developed public health system is one of nine attributes used to develop a quality of life subranking that factors into the 2023 Best Countries rankings from U.S. News. The overall Best Countries analysis is based on a survey of more than 17,000 global citizens, and assessed perceptions of 87 countries using 73 different attributes. Survey respondents answered whether they associated various countries with the phrase "well-developed public health system,” and such perceptions also helped develop rankings of the best countries for a comfortable retirement and the best countries for raising kids.

Countries perceived by respondents as having comprehensive public health systems tend to have attributes in common such as universal health care, longer life expectancy and substantial social spending.

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Last fall, children in China were coming down with respiratory illnesses earlier and in greater numbers than usual. [JAMA]

Ditto for respiratory syncytial virus (RSV) infections in the US and elsewhere in 2021 and 2022. And the current winter season doesn’t appear to be much different as far as higher-than-usual case numbers, according to CDC surveillance data.

The surging case numbers and their out-of-whack timing have fueled an ongoing debate about how the COVID-19 pandemic contributed to rates of other infectious diseases. No one yet knows for sure.

“Right now, this is phenomenology,” Wolfgang Leitner, PhD, chief of the Innate Immunity Section at the National Institute of Allergy and Infectious Diseases, told JAMA in an interview. “People are assuming a lot about the mechanism.”

Much of the discussion has centered around immunity debt and immunity theft, terms born of the pandemic and not found in textbooks.

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Do lockdowns work? Are masks effective? Did schools make the right decisions? {MedPage]

During the COVID-19 crisis, these questions were urgent and pervasive. Yet, clear answers were often elusive, hindered by data gaps and inefficient information exchange. 

Do lockdowns work? Are masks effective? Did schools make the right decisions?

During the COVID-19 crisis, these questions were urgent and pervasive. Yet, clear answers were often elusive, hindered by data gaps and inefficient information exchange. As we move toward a post-COVID future, we must ask ourselves: Is our healthcare data infrastructure prepared for the next health crisis? Our researchopens in a new tab or window indicates that it is alarmingly unprepared.

Two major issues became apparent early in the pandemic. First, the lack of data interoperability and effective analysis impeded the delivery of real-time insights to those making critical decisions. Second, the slow exchange of patient data severely limited treatment efforts. In a situation where a rapid response was essential, accessing comprehensive electronic records from different providers was crucial.

This significant data gap was recognized at the highest levels of government. In 2021, President Biden prioritizedopens in a new tab or window enhanced public health reporting and data sharing. The National Academy of Medicine also highlighted this issueopens in a new tab or window, calling attention to the healthcare sector's disjointed data management. These statements underscored the urgent need for a more streamlined and efficient approach to healthcare data. 

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Vaccination is one of the most highly effective public health interventions, responsible for saving millions of lives each year. In the US, authorized or approved preventive vaccines must be manufactured with high quality, and the effectiveness and favorable safety profile of vaccines must be demonstrated. Their safety over time is also closely and continuously monitored through multiple overlapping passive and active safety surveillance systems, including the Vaccine Adverse Event Reporting System, the Vaccine Safety Datalink, and the BEST Sentinel Initiative.^{1    [JAMA]}

Despite the care taken in the development and deployment of vaccines and their clear and compelling benefit of saving individual lives and improving population health outcomes, an increasing number of people in the US are now declining vaccination for a variety of reasons, ranging from safety concerns to religious beliefs. Setting aside for now the controversial issue of vaccine mandates at the federal, state, or local level in the US, which are not within the purview of the Food and Drug Administration (FDA), the situation has now deteriorated to the point that population immunity against some vaccine-preventable infectious diseases is at risk, and thousands of excess deaths are likely to occur this season due to illnesses amenable to prevention or reduction in severity of illness with vaccines.

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