In 2014, Maryland and the Center for Medicare & Medicare Innovation (CMMI) negotiated a waiver that established a per capita expenditure rate for Medicare hospital services and a limit on the growth of inpatient and outpatient hospital costs for all payers to 3.58 percent. The waiver projects Medicare savings over five years to be $330 million. To implement the model, the state rate-setting commission will replace fee-for-service models with population-based payment models that reward providers for improving health outcomes, enhancing quality, and controlling costs. Although the new model has just been introduced, several early adoptees of the new payment models have observed significant reductions in preventable hospitalizations. With these new incentives, hospitals are expected to form more creative partnerships with public health agencies, community health organizations, and long-term care providers. To read more about this innovative program, see this brief summary [link].
State Category: Maryland
Health Leads
Health Leads, operated by lay resource specialists and college student volunteers, is a collaborative comprised of partner hospitals, health systems, community health centers, and Federally Qualified Health Centers (FQHCs) working together to integrate basic resources such as access to food, heat, and other necessities into health care delivery. Operating via clinical settings since 1996, this initiative enables providers to prescribe solutions to patients helping them manage their disease and lives. The impact of Health Leads is two-fold. The program expands clinics’ capacity to secure nonmedical resources for patients— in 2013, 92 percent of patients identified that Health Leads helped them secure at least one resource they needed to be healthy. Additionally, Health Leads is producing a pipeline of new leaders—in 2013, nearly 70 percent of Health Leads graduates entered jobs or graduate study in the fields of health or poverty. Health Leads sustainability model utilizes earned revenue, national and local philanthropy, and in-kind contributions from volunteers and health care partners to fund its operation. To read more about this innovative program, see this brief summary [link].
An Action Plan for Reducing Absences Due to Asthma
The full version of this story, published by Healthy Schools Campaign, is available at https://healthyschoolscampaign.org/policy/an-action-plan-for-reducing-absences-due-to-asthma/. Below is just an introduction.
Asthma kept Stephanie Godbolt’s grandson John home from school time and time again. John’s school, Tench Tilghman Elementary, serves 425 students, more than 95 percent of whom are black and 95 percent of whom also qualify for free or reduced price lunch. The school sits in Baltimore’s Patterson Park neighborhood on the city’s southwest side, just a few blocks away from Johns Hopkins Hospital. John’s asthma got so bad, he was missing nearly a week of school each and every month for six months. And he was losing ground academically.
Improving the Health of Communities by Increasing Access to Affordable, Locally Grown Foods
BY MICHEL NISCHAN, CEO and Founder, Wholesome Wave
When my son was diagnosed with type 1 diabetes, I became painfully aware of the direct connection between food and health. As a chef, this realization caused me to transform the way I fed my family and customers. Fresh, nutrient-dense, locally grown foods became the foundation for the type of diet that would give my son and restaurant guests the best long-term health.
Quickly, though, I recognized that not every family can afford to purchase healthy foods. As a result, I founded Wholesome Wave in 2007.
Wholesome Wave is a 501(c)(3) nonprofit dedicated to making healthy, locally and regionally grown food affordable to everyone, regardless of income. We work collaboratively with underserved communities, nonprofits, farmers, farmers’ markets, healthcare providers, and government entities to form networks that improve health, increase fruit and vegetable consumption and generate revenue for small and mid-sized farms.
Double Value Coupon Program
In 2008, we launched the Double Value Coupon Program (DVCP), a network of more than 50 nutrition incentive programs operated at 305 farmers markets in 24 states and DC. The program provides customers with a monetary incentive when they spend their federal nutrition benefits at participating farmers markets. The incentive matches the amount spent and can be used to purchase healthy, fresh, locally grown fruits and vegetables.
Farmers and farmers’ markets benefit from this approach, and have been key allies as we work towards federal and local policy change. In 2013, federal nutrition benefits and DVCP incentives accounted for $2.45 million in sales at farmers’ markets.
Communities also see an increase in economic activity. The $2.45 million spent at local farmers’ markets creates a significant ripple effect. In addition to the dollars spent at markets, almost one-third of DVCP consumers said they planned to spend an average of nearly $30 at nearby businesses on market day, resulting in more than $1 million spent at local businesses. We also see that the demographics of market participants are more diverse – our approach breaks down social barriers and allows consumers who receive federal benefits to be seen as critical participants in local economies.
Equally as important, people are eating healthier. Our 2011 Diet and Behavior Shopping Study indicated 90 percent of DVCP consumers increased or greatly increased their consumption of fresh fruit and vegetables – a behavior change that continues well after market season ends.
Today, the program reaches more than 35,800 participants and their families and impacts more than 3,500 farmers. Combined with the new Food Insecurity Nutrition Incentives Program in the latest Farm Bill, this approach is now being scaled up with $100 million allocated for nutrition incentives over five years.
Fruit and Vegetable Prescription Program
We developed the Fruit and Vegetable Prescription Program (FVRx) to measure health outcomes linked to fruit and vegetable consumption. The four to six month program is designed to provide assistance to overweight and obese children who are affected by diet-related diseases such as type 2 diabetes. In 2013, the program impacted 1,288 children and adults in 5 states and DC. Nearly two-thirds of the participants are enrolled in SNAP and roughly a quarter receive WIC benefits.
The model works within the normal doctor-patient relationship. During the visit, the doctor writes a prescription for produce that the patient’s family can redeem at participating farmers’ markets. The prescription includes at least one serving of produce per day for each patient and each family member – i.e., a family of four would receive $28 per week to spend on produce. In addition to the prescription, there are follow-up monthly meetings with the practitioner and a nutritionist to provide guidance and support for healthy eating, and to measure fruit and vegetable consumption. Other medical follow-ups are performed, including tracking body mass index (BMI).
FVRx improves the health of participants. Forty-two percent of child participants saw a decrease in their BMI and 55 percent of participants increased their fruit and vegetable consumption by an average of two cups. In addition, families reported a significant increase in household food security.
Each dollar invested in the program provides healthier foods for participants, boosts income for small and mid-sized farms and supports the overall health of the community. As with the DVCP, there are benefits for producers and communities. In 2012 alone, FVRx brought in $120,000 in additional revenue for the 26 participating markets.
In less than seven years, Wholesome Wave has extended its reach to 25 states and DC and is working with more than 60 community-based organizations, community healthcare centers in six states, two hospital systems, and many others. Our work proves that increasing access to affordable healthy food is a powerful social equalizer, health improver, economic driver and community builder.
Wholesome Wave is working to change the world we eat in. As the number of on-the-ground partners increases, we get closer to a more equitable food system for everyone. This means healthier citizens and communities, and a more vibrant economy nationwide.