IMPAQ Health News
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This edition of IMPAQ Health News highlights reports on racial and ethnic health disparities and the impact of COVID-19 on the LGBTQ community, along with relevant rules and insights, including an  interview with IMPAQ HIV expert Valerie Betley  in advance of National HIV Testing Day.
How will the effects of COVID-19 impact the future of Medicaid? In the latest post in IMPAQ’s COVID-19 blog series , IMPAQ Medicaid experts Tim Hill and Melissa Hafner explore how the factors of pent-up health care demand, a swell in Medicaid enrollment, decreasing state revenue, and limited budget flexibility will combine to present immense challenges for the Medicaid system.
Government Response
The United States is experiencing a surge in coronavirus cases , particularly in the West and South. On June 24, the US set a record for new infections since the start of the pandemic. States continue to ease lockdown restrictions and public health officials worry about building testing capacity for a fall outbreak , lack of adherence to social distancing guidelines , and overall lack of consistent messaging concerning the virus at the federal level . While the US recently reached an important testing milestone by conducting 500,000 daily COVID-19 tests, testing levels vary greatly by state . Meanwhile, a recently released Government Accountability Office report sheds light on the shortcomings of the Trump Administration’s coronavirus response, including failure to ramp up testing and release pertinent data. CMS released new Medicare claims data that supports the finding that COVID-19 is disproportionately affecting racial and ethnic minorities and low-income Americans. To combat these disparities and enhance the delivery of COVID-19 information to minority, rural, and socially vulnerable communities, HHS announced a $40 million initiative with the Morehouse School of Medicine. Additionally, CMS created the Office of Burden Reduction and Health Informatics to reduce providers’ administrative and paperwork burden as they respond to the COVID-19 pandemic.
Here are some resources for following the latest COVID-19 news:
  • Johns Hopkins developed a frequently updated worldwide map of confirmed COVID-19 cases and deaths.

  • The New York Times has compiled a tracker outlining the progress of more than 140 COVID-19 vaccines currently in development around the world.

  • Using data from the APM Research lab, the Color of COVID tracker on Tableau Public visualizes the disproportionate COVID-19 death rate among Black Americans.
COVID-19 Amplifies Racial & Ethnic Health Inequities across the Country
CMS released new Medicare claims data on June 23 that confirmed the racial and ethnic disparities of COVID-19. The data reveals that Black and Latino Medicare patients are hospitalized at rates nearly four and two times higher, respectively, than white Medicare patients. CMS Administrator Seema Verma called for a renewed commitment to value-based care in Medicare based on the findings. NPR (6/22)
Over the past two months, coronavirus infection rates among Latinos has outpaced other racial and ethnic minorities. Health experts note that the spike in cases poses unique threats to minority communities due to increased exposure, underlying health problems, and less access to health care. Politico (6/18)
A study published in the New England Journal of Medicine found racial bias in decision aids that US physicians utilize to guide patient care across multiple specialties. Implicit racial biases, whether known or unknown by the algorithm’s creators, adversely affected the quality of care among African Americans for conditions ranging from heart disease, kidney disease, certain types of cancer, and giving birth. STAT News (6/17)

Racial & Ethnic Inequities and
Newborn Health Outcomes
Research published in JAMA Network Open found a relationship between exposure to heat or air pollution and birth outcomes in the United States, particularly for Black mothers. As minority communities tend to be located in hotter areas that are in close proximity to polluting industries, the report underscores the disproportionate effect of pollution and global warming on ethnic and racial minorities. The New York Times (6/18)
As the enrollment of pregnant women in Medicaid grows amid the COVID-19 pandemic, it is important to learn from recent evaluations to inform care. Results from the Strong Start model indicate that birth centers are an appropriate alternative to hospitals for those who are at lower medical risk, given that they were associated with less negative birth outcomes as compared to group prenatal care and maternity care homes. Health Affairs (6/23)
Impact of COVID-19 on the LGBTQ Community
A report by the Human Rights Campaign and PSB Research explores multiple health and economic risk factors affecting the LGBTQ community during the COVID-19 pandemic. Key findings highlight that compared to the general population, the LGTBQ community is more likely to work in jobs in that were negatively impacted by the pandemic and less likely to have health insurance. Human Rights Campaign (3/2020)
On the 50 th anniversary of the first Pride march, this article reflects on the similarities between the COVID-19 pandemic and the AIDS crisis, including availability of testing, alarming death rates, the call for health care as a human right, and Dr. Anthony Fauci on the TV screen.  The New York Times (6/18)
Read more about the innovative ways Pride celebrations are moving online to reduce the risks of COVID-19 transmission, creating an unprecedented event for an unprecedented time. Time (5/7)
Spotlight on IMPAQ
June 27 is National HIV Testing Day , a day to raise awareness about the importance of HIV testing and early diagnosis. In this interview with Valerie Betley , IMPAQ Research Associate and HIV subject matter expert, learn how IMPAQ is working with the CDC to identify and understand barriers and facilitators to HIV prevention, care, and treatment.
On June 25, IMPAQ President Dr. Adaeze Enekwechi led a panel discussion on health equity with national health care leaders at the Virtual Summit on Health System Recovery from the COVID-19 Pandemic .  “We can’t sidestep social justice issues,” Dr. Enekwechi remarked during the event. “It might have been convenient or possible to do before, but for those of us in health, even in labor and education where you have gross injustices and inequities playing out every day—it is the issue of our time and we have more tackling to do.” In addition to Dr. Enekwechi, other notable keynote speakers at the summit included Dr. Anthony Fauci, NIAID Director, and Brad Smith, Director of CMMI. Additionally, on June 16, Dr. Enekwechi was a speaker at the Alliance for Health Policy webinar, Health Inequities: Addressing the Disease Burden in Black, Indigenous, and People of Color Communities .
The COVID-19 pandemic has so over-burdened critical infrastructures that there is a need to understand how Community Based Organizations (CBOs) and related groups have been affected. AIR and the  Community-Campus Partnerships for Health  have developed a survey to assess the effects of the coronavirus on these groups.
Beyond the Headlines
Workers with employer-sponsored health insurance are at increased pressure to return to potentially unsafe working conditions. Many with pre-existing conditions whose health insurance is tied to their employment will be the first back on the job as state economies gradually reopen. The New York Times (6/18)
In an open letter to Acting ICE Director Matthew Albence, public health and medical professionals raised concerns over the often-cramped and unsanitary conditions in ICE facilities and the spread of COVID-19. The group of experts encouraged ICE to dramatically increase screening and mass testing, improve access to medical care outside of facilities for positive detainees, and investigate facilities violating official guidelines. Health Affairs (6/17)
According to a new survey conducted by NPR, based on The George Washington University’s Contract Tracing Workforce Estimator , seven states and the District of Columbia are staffed with the necessary contact tracers required to contain the spread of COVID-19. While the national contact tracing workforce has tripled to over 37,000 in the last six weeks, the total falls short of the 100,000 contact tracers recommended by public health experts. NPR (6/18)
Good News
On June 15, the Supreme Court ruled in a 6-3 decision that Title VII of the Civil Rights Act of 1964 prohibits workplace discrimination against people identifying as LGBTQ. Health Affairs (6/16)
A 60-year-old steroid, dexamethasone, reduced COVID-19 deaths according to a recent British clinical trial. Despite the need for reproducible trials and additional details of the researchers’ findings, investigators found that dexamethasone could prevent one death in about eight ventilated patients. The Washington Post (6/16)
Rules & Reports
A federal judge ruled that hospitals and health insurers must adhere to the Trump Administration rule to publish their negotiated prices for health services. With limited research on price transparency in health care, it is unknown whether the rule will empower patients and employers to make informed decisions or create market pressure to lower costs. The New York Times (6/23)
A proposed rule would allow drug manufacturers and insurers to enter pricing deals that would not contradict Medicaid “best price” rules, which direct drug manufacturers to offer the lowest negotiated price with insurers to state Medicaid plans. The rule would allow manufactures to offer multiple “best prices” if they were tied to value-based purchasing agreements and allow insurers to incorporate positive health outcomes into payments for pharmaceuticals. Politico (6/19)
In its June Report to Congress , the Medicare Payment Advisory Commission (MedPAC) recommended that Medicare rapidly move from fee-for-service payments to value-based payments. The report also recommended eliminating loopholes to accountable care organizations (ACOs) shared savings programs and new strategies for determining prescription drug payments in the hospital outpatient prospective payment system (OPPS). MedPage Today (6/16)
In its June report to Congress , the Medicaid and CHIP Payment and Access Commission (MACPAC) supported increasing integration and loosening enrollment restrictions for the dual Medicaid-Medicare eligible enrollees and improving coordination between Medicaid and Tricare. MACPAC also had concerns regarding determining eligibility for the Medicare Savings Program without standard definitions across states. Modern Healthcare (6/15)
Graphic of the Week
After the cancellation of Pride events around the world, Global Pride is happening this Saturday, June 27 with the slogan “Exist. Persist. Resist.” and a focus on Black Lives Matter. AFAR (6/19)
Upcoming Events, Trainings, & Webinars
Organizations using the Program for All-Inclusive Care for the Elderly (PACE) utilize a care delivery model that blends Medicare and Medicaid funding and integrates preventive, acute, and long-term care for older adults. This webinar will highlight innovations from PACE organizations across the country, as leaders will describe their experiences implementing new approaches to care for patients with complex health needs during the coronavirus pandemic. Register.
This discussion will highlight the federal policy barriers, including low reimbursement, provider shortages, and access to health insurance, that inhibit the provision of comprehensive primary care in Medicaid. This webinar will walk through the Bipartisan Policy Center’s policy recommendations to eliminate these barriers as well as COVID-19’s impact on primary care providers and state Medicaid programs. Register.
Social determinants outside of the health system play a significant role in health and health equity. This webinar will feature a selection of state and local government leaders and authors who contributed to the July 2020 issue of Health Affairs as they discuss how find effective and equitable solutions to service delivery during COVID-19. Register.
Virtual care and digital health have become increasingly popular as a result of COVID-19. This webinar, sponsored by Stat News, will discuss the benefits and challenges of the increased use of virtual and digital care, as well as how virtual care will shift in a post-pandemic world. Register.
NOTE: The information, analyses, and opinions expressed in the articles, publications, or comments contained therein are those of the authors and should not be considered verified or endorsed by IMPAQ or any of our partners or clients.