Home Care Hospitalization: An Experiment with Promise

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November 11, 2016; Forbes

As the cost of healthcare, particularly in hospitals, continues to skyrocket, a few are exploring alternative methods of providing high quality care for lesser costs. One nonprofit in particular is reintroducing a method of care from decades ago: home visits from doctors.

When Dr. William Terry arrived at Boston’s Brigham and Women’s Hospital with violent chills and a high fever, emergency room staff determined he needed hospital care. Instead of being admitted, however, Dr. Terry became part of a study where he would receive the same care at home, including at least one home visit from his doctor plus two nurse visits every day.

The Brigham and Mass. General studies are limited to patients living within five miles from the hospital who present with heart failure, pneumonia, chronic obstructive pulmonary disease, or infections. (Terry’s chest x-ray showed a “suspicious spot.”) The study is focusing on these conditions because patients do not normally require intensive care or major procedures.

The preliminary results of the Brigham study were published in a recent issue of JAMA Internal Medicine. Patients were found to suffer from lower infection and readmission rates. The cost savings was an average of $2,000 per patient as compared to a hospital stay. More importantly, patients receiving care at home reported feeling happier. Perhaps that is not surprising, given hospitals’ reputations for awful food, harsh lighting, loss of privacy, snoring roommates disturbing sleep, and nurses on a schedule that works for the hospital system rather than the patient. The list goes on.

The study is part of a larger movement led by Hospital at Home, a program created by the Johns Hopkins School of Medicine and Public Health. Their research found the model lowered costs by almost a third and reduced complications of hospital stays. Surprisingly, the first study of these types of programs was conducted in 1997, leaving a supporter to describe the treatment plan as the “most studied innovation in health care.”

Although common in England, France, and Australia, in-home care is not widespread in the U.S., mainly because most insurance companies and Medicare do not cover it. Many of the treatment providers, such as Brigham and Women’s Hospital, are picking up program costs. New York City’s Mount Sinai Hospital is part of a $9.6 million, three-year similar study funded by the Centers for Medicare and Medicaid Services.

Overall, due to technology and revolutionary research, plus the emerging population health and wellness reimbursement structure of the Affordable Care Act, medical care is shifting. As research and technology has disrupted once-deadly diseases like HIV-AIDS and we continue to live longer and healthier, some are describing the hospital of the future as a “NASCAR pit-stop.”—Gayle Nelson

Original cite: https://nonprofitquarterly.org/2016/11/16/home-care-hospitalization-experiment-promise/

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New England Sees 900% Increase in Organ Donations Tied to Opioid Epidemic

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October 14, 2016; NPR, “Shots”

This year, some hospitals in Massachusetts, like Lahey Hospital and Medical Center in Burlington, have dramatically increased the number of organ transplants they perform. The sources of these lifesaving gifts are the victims of the opioid epidemic. Although the increase in available organs represents hope for some and brings a small degree of comfort to the families of those lost to deaths from drug abuse, the wait continues for many more on the transplant list as well as families of addicts seeking services.

On June 30, 2015, Colin LePage found his thirty-year-old son, Chris, unresponsive after an apparent drug overdose. Over the next 24 hours, medical personnel from one of Boston’s largest medical centers revived Chris’s heart but struggled to stabilize his blood pressure and temperature. After two rounds of tests displayed no sign of brain activity, LePage listened to his son’s beating heart one last time before Chris was wheeled away. Although Chris died that day, his liver continues to function in a new body, that of a 62-year-old pastor.

The liver represents just part of the dramatic increase in New England organ donations since 2010, according to the New England Organ Bank, the organization responsible for gathering the organs in the six New England states. The expansion is due to the growing number of organ donors who fell victims to the growing epidemic of opioid abuse. Since the beginning of the year, more than one in four organ transplants in the New England area originated from people suffering a drug overdose. Nationwide, organs from deceased drug users accounted for 12 percent of all donations this year. Traffic accidents used to be the fourth-largest source of organ donation, behind deaths from strokes, blunt injuries, and cardiovascular disease, but drug overdoses, now the fastest growing category of organ donor, eclipsed them in 2014.

Before the epidemic took hold, organs from drug users were considered too risky for transplant. Drug users have long been associated with HIV, hepatitis C and other diseases. Although contraction from transplants is rare, tests have sometimes failed to detect infectious diseases, leading to donors contracting the diseases. (For example, in 2007, one donor transmitted both HIV and hepatitis C to four organ recipients.)

But as the shortage of organs continues to grow, the number of opioid overdose victims rises, and testing procedures improve, more people are receiving these donated organs. “We know now that the mortality rate of being on the waiting list for several years is higher than that of getting an organ with an infection that is treatable,” said Dr. Robert Veatch, a professor emeritus of medical ethics at Georgetown University, who has authored numerous articles on organ transplants. At the same time, recipients with HIV can receive organs from donors with HIV without additional risk. Earlier this year, surgeons from Johns Hopkins University Medical Center performed the first transplant of this kind.

“It’s an unexpected silver lining to what is otherwise a pretty horrendous situation,” said Alexandra K. Glazier, chief executive of the New England Organ Bank.—Gayle Nelson

Original cite: https://nonprofitquarterly.org/2016/10/26/new-englands-900-increase-organ-donation-tied-depth-opioid-epidemic/

Health Conversion Foundations: How to Make Them Relevant

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June 2, 2016; Becker’s Hospital Review

Experts estimate there are about 400 foundations across the U.S. created due to the consolidation or conversion of a nonprofit hospital or health system into a for-profit. These foundations, known as legacy or health conversion foundations, maintain missions similar to their source organization: to support the health of the community the organization once served. In this age of limited government funds and great need, returning these resources in an effective and efficient method is essential.

Health organization conversions began in the 1980s as for-profit health corporations expanded their market by purchasing nonprofit hospitals, often associated with religious denominations. In the 1990s, this trend continued as Blue Cross Blue Shield plans in California and other states were transformed into for-profit entities.

In the 2000s, hospitals, healthcare systems, and health plans grew even larger, serving increasing geographic areas. (The Nonprofit Quarterly has written extensively on thedeath of the rural health organizations.) At the same time, hospital systems located in strong urban and suburban markets tend to be conversion targets. Other characteristics of converted health organizations are: small or medium in size, located in the South, and not or only rarely connected to a medical school or other teaching institution.

In 2010, the IRS identified 306 conversion foundations with assets of $26.2 billion. In the six years since then, the number of organizations in the healthcare industry has continued to decrease and conversions continued as hospitals and health care systems’ revenue sources shifted due to the Affordable Care Act (ACA). For example, in 2012 alone105 hospitals were acquired. Although there are no comprehensive reports for this period, experts estimate an additional one hundred legacy foundations were formed.

Similar to a community foundation, these legacy foundations are connected to specific places or geographic areas. The assets held by health conversion foundations range from less than $10 million to more than $3 billion. The larger organizations often make annual grants of $5 million or more and include some of the country’s most influential health supporters such as the California Endowment, the California Wellness Foundation, and the Colorado Health Foundation.

Due to the size of these foundations and the vast needs of the communities they serve, it is not surprising many conversion foundation leaders feel immense pressure. One expert,Wayne Luke, managing partner of the nonprofit practice at executive search firm Witt/Kieffer, provides advice that can be broadened to any new foundation. First, develop a well-thought-out plan before beginning grant distribution. Second, enlarge the mission beyond health to include social determinants such as education, housing, economic development, and access to healthy foods. (We would add transportation to this list, as it is often mentioned as a barrier to health care in nonprofit hospitals’ community health needs assessments, or CHNAs.) Third, since new legacy foundation boards and staff often contain leaders from the source health care organization, foundations should promptly broaden leadership to increase credibility and organization knowledge. Fourth, build collaborations across the community to expand impact and outcomes.

It is clear the healthcare industry will continue to shift as new healthcare laws and regulations take effect. Communities depend on leaders of conversion foundations to develop strong partnerships and effectively distribute the essential resources they are responsible for.—Gayle Nelson

 

Original Cite: https://nonprofitquarterly.org/2016/06/07/health-conversion-foundations-how-to-make-them-relevant/

The Promise of Partnerships between Mental and Physical Health Services

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February 23, 2016; CNN (Kaiser Health News)

Serious mental illness (SMI), including schizophrenia, bipolar disorder, and major depression, affects more than 9.5 million adults, almost four percent of adults living in the United States. A 2006 report from the National Association of State Mental Health Programs revealed adults suffering from SMI die an average of twenty-five years earlier than those without these conditions, and that the rate is rising. Grants funded through the federal Substance Abuse and Mental Health Services Administration (SAMHSA) indicate locating physicians and other physical medical partners in mental health clinics improves physical health in this needy population.

Although Tracy Young has to take two buses to San Fernando Mental Health Center, she never misses an appointment. The fifty-year-old describes these appointments as key to controlling her depression and schizophrenia.

Unfortunately, like many people suffering from mental illness, Young did not always receive regular medical care. The lack of essential care leads to a higher percentage of people with severe mental illness dying prematurely, often from treatable chronic diseases such as hypertension, diabetes, and obesity. It also leads to an increase in the cost of care and gaps in the care received.

Frequently, the barriers low income individuals suffering from mental illness face are due to transportation and lack of integrated care between the mental and physical health care systems. Increasing cooperation and communication between providers is a goal of the Affordable Care Act.

In the past, leaders focused on adding mental health services to physical health offices. Recent grants are focused on offering physical health services in mental health clinics, as is the case at San Fernando Mental Health Center. Joint clinics are in development in many states, including California, New York, Washington, and Florida. Many are funded by grants administered under the Primary and Behavioral Health Care Integration (PBHCI) program of SAMHSA. Since 2009, the department has awarded $150 million in grants for this purpose.

Clinics funded under the program received up to $500,000 annually to integrate physical and mental services. In 2014, The RAND Corporation evaluated fifty-six of these programs around the country. Their study revealed patients receiving primary care at their mental health clinic increased their control of their diabetes and hypertension. Results were not as positive for patients who smoked or suffered from obesity.

The clinics also reported early enrollment success measured by over half of patients using integrated services in the first year they were offered. But care specialists found it difficult to target those most likely to benefit from integrated care.

Although many of these clinics successfully developed models of co-locating behavioral and primary care services, they struggled to develop a joint culture and long-term funding.

Original cite: https://nonprofitquarterly.org/2016/03/01/creating-partnerships-between-mental-and-physical-health-services/

Using Technology to Improve Healthcare in Rural Maine

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September 23, 2015; Portland Press Herald

Rural Washington County is located on the Maine coastline. The county contains some of the most majestic landscape as well as the highest childhood poverty rate in the state. Close to 60 percent of school children in the county are eligible for free or reduced lunch. As a whole, Maine has more residents over the age of 65 than any other state, and Washington County has the second-oldest Maine county. Not surprisingly, this population has substantial health needs.

Recently, the Nonprofit Quarterly examined the issues people living in rural areas experience particularly in their ability to access to healthcare. And these issues are growing to crisis levels: 57 rural hospitals have closed in the last year. Only ten percent of America’s doctors practice in the rural areas where one quarter of the country’s population lives. This lack of access to medical care leads to a disproportionately high rate of deaths from things like unintentional injuries and motor vehicle accidents among rural residents compared to those living in urban areas.

Harrington Family Health Center is at the center of the health crisis in Maine. Patients depend on the nonprofit to provide medical, dental, and mental health services. Many of the patients served at the Center suffer from multiple conditions requiring a complex medical regimen. According to its CEO, Lee Umphrey, its patients have the highest instances of diabetes, heart disease, and cancer in the state. In 2014, the Center provided over 14,000 medical visits treating about 3,500 patients.

Brock Slabach, senior vice president of member services for the National Rural Health Association (based in Kansas), describes helping patients manage chronic conditions as “imperative” as the number and types of medical services baby boomers require continues to grow. Better management means fewer hospital stays and less expensive treatment in the patient’s home community.

As nonprofits providing these services struggle to serve, a new pilot program offers medical staff technology to bridge the gap between resources and need. In July, the Harrington Center’s healthcare providers began utilizing tablets loaded with medical apps to deliver more effective services as part of a pilot project. The tablets were developed in Haiti by Health eVillages, a collaboration between Physicians Interactive and the Robert F. Kennedy Center for Justice & Human Rights. They are used in some of the “most challenging clinical environments around the world.”

Although the tablets were developed millions of miles away, the apps they are loaded with are tailored to the needs of rural Maine. The list begins with searchable medical encyclopedias, a dosage calculator, lists of dangerous drug combinations and interactions, and a pill identifier, as well as a symptom checker listing potential conditions after the provider enters a patient’s symptoms. The tablet’s apps supportdiabetes care, too.

The founder of Physicians Interactive, Donato Tramuto, created the pilot because he knows firsthand the challenges rural areas face. After all, rural Maine is the area he calls home. “You’d be surprised in our country how technology is behind the eight ball in terms of healthcare,” he said.

Funders are focused on using technology to bridge the gap in other countries. The Bill & Melinda Gates Foundation is funding projects using apps loaded onto mobile devices to improve healthcare for people living in poverty in Africa. Among their interests areprojects in Nairobi to decrease the number of women dying in childbirth, fighting malaria in Mozambique, and supporting overall rural healthcare in Kenya.

One of the challenges is pinpointing the apps that best support medical care in the community from the thousands of apps available. Projects like the one in Harrington have the potential to begin to identify how medical providers can use these resources to better serve.

http://nonprofitquarterly.org/2015/09/29/using-technology-to-improve-healthcare-in-rural-maine/

The Next Recycling Frontier: Prescription Drugs

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A 2012 study by the Commonwealth Fund entitled Insuring the Future discusses the link between poverty and healthcare coverage. It found, among many other things, that about one in four American adults, or about 50 million people, have neglected to fill a prescription due to cost. Many experience dangerous conditions due to their inability to afford these essential drugs. Thirty-eight states have laws allowing prescription drugs left over after a person dies or is otherwise unable to use the drugs to be provided to low-income people who cannot afford medicine. These programs cost a few thousand dollars, but recycle millions of dollars worth of lifesaving medications.

Tulsa County in Oklahoma began its drug-recycling program in September 2004. The state was one of the first to develop a program to capture unopened previously prescribed drugs from large institutions including nursing homes. It utilizes twenty-two retired doctors to travel to sixty-eight long-term care facilities collecting the medications for the county run pharmacy. The prescription drugs picked up are dispersed free of charge to low-income citizens of the county. Over the past eleven years the program has filed 172,149 prescriptions worth $16.8 million dollars. Incredibly, the cost of the program over the same period was less than $6,000.

In 1997, Georgia was the first state to create a prescription drug recycling program. In the eighteen years since that time, thirty-seven other states have created similar programs. These programs are lifelines for low-income residents, especially seniors. Seniors take an average of four to five medications a week, and one in five report cutting back on food, heat, or other necessities to afford their prescription drugs. Those that cut back on their medications, including those with cardiovascular disease, can experience serious conditions—for example, strokes or non-fatal heart attacks.

While some states and counties created their own programs, others utilize nonprofit organizations to deliver and provide the medications. SIRUM (Supporting Initiatives to Redistribute Unused Medicine), located in California, has a staff of five and a budget of less than $200,000. The nonprofit was started by three Stanford graduates in 2005; in 2014, they won the prestigious Grinnell prize for work related to social justice. SIRUM uses a patent-pending computer program to match 200 organizations with unused prescriptions to a dozen county-owned and federally-qualified health centers andclinics around the nation. The donating organizations pay nothing to access the program, letting them save the funds they once used to destroy the drugs. Recipient programs with means pay a membership fee equal to twenty-five percent of the value of the medications received. In the years since it opened, the program has expedited the transfer of $3.7 million worth of prescription drugs to 35,000 patients.

Lincoln-Glen, a nursing home in California, takes part in the program. Once a quarter, Deane Kirchner, the director of nursing, spends less than an hour logging and packaging the prescriptions for shipping. Throughout the year, the 50–75 bed facilitytypically donates about $6,000 in medications at a cost of $40. The recipient is the Santa Clara County Public Health Pharmacy, who distributes the prescriptions countywide based on need.

The largest state-run program is the Iowa Prescription Drug Corporation. In Iowa, the drugs come from the drug manufacturers and pharmacies themselves. They maintain prescription safety stocks to avoid shortfalls. About three percent of drugs worth 270 billion reach their expiration dates and are destroyed. The budget of the nonprofit organization’s program distributing the drugs is $500,000. In the eight years it has been in existence, it has delivered $13 million worth of drugs to 52,000 low-income patients.

Original cite: http://nonprofitquarterly.org/2015/05/26/the-next-recycling-frontier-prescription-drugs/

Gates Foundation Invests in Corporation to Fight Disease

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The Bill & Melinda Gates Foundation is investing $52 million in CureVac, to fund a new factory in Germany. The factory will make drug products using mRNA. This represents the foundation’s largest ever investment in a corporation. It is also a symbol of what the world learned since the Ebola outbreak, diseases in poor countries affects health across the world.

The Gates Foundation’s majority equity investment will be used to build a $76 million factory developing products using mRNA, a messenger chemical that provides information from the gene into cell parts making proteins. It is believed that mRNA can be used as a platform for rapidly producing low-cost drugs and vaccines. These products are “thermostable,” meaning they do not need cold-chain storage, a major hurdle in supplying vaccines in developing countries.

Additionally, the two organizations are forging a larger partnership as part of the foundation’s focus on vaccines that fight global diseases that disproportionally affect people in the poorest countries. The Gates Foundation’s mission is “guided by the belief that every life has equal value….[The] Foundation works to help all people lead healthy, productive lives. In developing countries, the emphasis on vaccines leads to better health thereby increasing individuals’ ability to lift themselves out of extreme poverty.” This initial project is part of a larger plan to invest billions to develop vaccines for viral, bacterial, and parasitic infectious diseases including rotavirus and HIV.

This investment is part of the trend of foundations turning to corporations rather than nonprofits or other foundations to solve the world’s inequities. These partnerships are part of socially responsible investing, or SRI. SRI includes impact investing, shareholder advocacy, and community investing, and is designed to encourage corporations to act in a socially respectable manner in addition to making a profit.

Because the majority of medical research is driven by the desire to make a profit, corporations and the world’s scientists are focused on drugs and vaccines that will make the largest monetary return on investment. These are rarely realized in medicine that’s focused on outbreaks in the world’s poorest countries. World NGOs have described this as “the 10/90 gap”; ten percent of global health research is focused on ninety percent of the world’s diseases. Ignoring these diseases leads to epidemics like the recent Ebola outbreak.

While there are clearly questions embedded in such tight relationships between nonprofit and for-profit organizations, these types of partnerships are gaining support with conservatives as well as liberals. Prime Minister Stephen Harper of Canada recently met with Bill Gates to discuss their shared goal of improving the lives of women and child around the world. Canada is funding twenty research teams of African and Canadian scientists to expand immunizations in order to eradicate polio and eliminate tetanus.

The CureVac factory is expected to produce additional products funded by the foundation. The corporation will hold the licenses created by the partnership and sell the products at an affordable price in poor countries.

Original cite: https://nonprofitquarterly.org/philanthropy/25738-gates-foundation-invests-in-corporation-to-fight-disease.html