Despite decades of federal and state efforts to bolster the healthcare workforce in some of North Carolina’s most remote areas, many rural counties in the state still face provider shortages, reports North Carolina Health News. Among the strategies to combat provider shortages is loan repayment, whereby state and federal programs forgive a portion of school loans of health professionals in exchange for service in areas of high need, but assessing the success of this strategy is difficult. Theoretically, the state’s rural areas should have gained more than 250 new providers in the last year, but the actual number is far lower. Cities also have pockets of high need and providers can choose placement there. All in all, advocates for rural health believe there needs to be a more coordinated plan for increasing rural healthcare access.
Primary care associations and Health Center Controlled Networks are uniquely situated to serve as a bridge between individual health centers and prospective legal partners, as well as help plan for the financing, operation and sustainability of medical-legal partnership activities, according to a case study by the National Center for Medical-Legal Partnership and the Montana Primary Care Association. The case study focuses on how the Montana Primary Care Association helped develop a statewide subscription model for medical-legal partner services, which integrate lawyers as part of the health center team to support addressing social determinants of health for patients. This new model allows health centers to “subscribe” to MLP services, creating a sustainable mechanism for supporting ongoing civil legal aid access for patients. Previously, geographic clusters of health centers would collectively contract and share a dedicated legal intake specialist and a lawyer from Montana Legal Services Association (MLSA) but ran into issues stemming from Montana’s limited resources and rural landscape. The success of the pilot is attributed to a few factors: partners defined shared values early on; legal services were integrated into the health center’s existing workflows; screening and data tracking were streamlined; and medical-legal partnership outcomes were tied to health center priorities in order to advance sustainability.
Prior to the COVID-19 pandemic, telehealth use was already increasing, reports State of Reform. Using the Colorado all-payer claims database, the Center for Improving Value in Health Care report shows telehealth utilization increased 33 percent among commercially insured patients, 91 percent for Medicaid beneficiaries and 13 percent for Medicare Advantage patients between January 2018 and February 2020. Telehealth utilization is especially high among females and young adults aged 18-22, as well as in some (but not all) rural counties.
People who lost Medicaid coverage when Arkansas’ Medicaid program implemented work requirements experienced significant trouble affording care, according to a study in Health Affairs. Fifty percent of people had serious problems paying off medical debt, 56 percent delayed care because of cost and 64 percent delayed taking medications because of cost. These rates were significantly higher than among people who remained on Medicaid during the entire year. The study also found that most coverage losses were reversed after the work requirements were stopped, that the requirements did not increase employment rates and that awareness of the policy change remained poor—potentially hindering people from accessing Medicaid coverage even after the work requirements were no longer in effect.
A study to understand perceptions of how medical students and institutions can meet the needs of the self-identified houseless community found that people who are houseless want medical students to 1) listen to and believe them, 2) work to destigmatize houselessness, 3) engage in diverse clinical experiences, and 4) advocate for change at the institutional level, according to the Social Interventions Research & Evaluation Network at the University of California, San Francisco. Authors concluded that medical students, and the institutions they are a part of, should seek to reduce stigma against people who are houseless in medical systems and institutions should change their approaches to healthcare delivery and advocacy.
Uninsured New York City residents in all five boroughs can now enroll in a city program that gives them access to a physician and other health services, reports Patch. The program, NYC Care, expanded into Manhattan and Queens four months ahead of schedule. Regardless of immigration status or ability to pay, residents can enroll in the program and receive a card that helps them connect with guaranteed low or no-cost services. New Yorkers who are eligible for health insurance will be directed to the city’s public choice health plan, MetroPlus. About 30,000 New Yorkers have enrolled in the program since its launch last year and have used it for 85,000 provider visits and to fill 30,000 prescriptions.
The federal Health Resources & Services Administration (HRSA) has ranked Idaho the fourth best state in the nation for the quality and performance efforts of its critical access hospitals, reports Idaho County Free Press. HRSA’s measures are from its Medicare Beneficiary Quality Improvement Project, which includes more than 1,350 hospitals across 45 states. The program is intended to reduce hospital closures in rural areas, promote a process for improving rural healthcare and focus on community needs.
At the height of the coronavirus pandemic, a majority of Connecticut residents worried they would not be able to cover their medical bills if a family member were to contract COVID-19, reports the Hartford Courant. Additionally, a survey of nearly 1,000 Connecticut adults revealed that most had experienced one or more healthcare affordability burdens—such as delaying or canceling medical appointments because of high costs, opting to go without insurance entirely or struggling to pay medical bills after receiving care—in the past year. Respondents strongly supported state and federal action on healthcare affordability problems; 92 percent said the government should expand health insurance options so that everyone can afford quality coverage.
Tennessee state officials said that while a private data firm's initial findings that state health plans erroneously paid $17.58 million in medical bill overcharges were "helpful," a planned "deep dive" is necessary before drawing firm conclusions, according to Chattanooga Times Free Press. In its preliminary report in June, Connecticut-based ClaimInformatics says it found state health plans' third-party administrators BlueCross BlueShield of Tennessee and Cigna overpaid at least $17.58 million over a three-year period in bill claims by professional providers such as physicians.
Across Massachusetts’ cities and towns, Latino and Black communities are experiencing higher rates of COVID-19 cases, and a recent study in Health Affairs identifies important factors that are independently associated with higher COVID-19 case rates in the state. The proportion of foreign-born, non-citizens was the strongest predictor of the burden of COVID-19 cases within a community, while household size and food service occupation were also strongly associated with the risk of developing COVID-19. Some factors, however, such as occupation in an essential service field, did not affect Black and Latino communities in a similar matter. The authors posit that other factors not examined in the study, such as structural inequities like disproportionately high incarceration rates, residence in areas with a higher concentration of multi-unit buildings and defacto neighborhood segregation, may contribute to the spread of COVID-19 in Black communities.