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New Report from Altarum and the National PACE Association Highlights the PACE Model of Care’s Flexibility and Resiliency in Response to Covid-19

October 22, 2020 | Press Release

A new report details how Programs of All-Inclusive Care for the Elderly (PACE) have been effective at keeping nursing home-eligible enrollees safer in the community during the Covid-19 pandemic.

Survey of Nursing Home Residents Reveals Deep Emotional Toll of Social Isolation Under Covid-19

October 01, 2020 | Press Release

A new survey of nursing home residents by Altarum provides a rare glimpse into how Covid-19 restrictions of nursing facilities have impacted nearly every aspect of resident life and led to the unintended consequence of drastically reducing frail elders’ connection to community and family, a fundamental human need.

Altarum and the University of Michigan Team Up to Help Primary Care Providers Prevent Opioid Misuse in Older Adults

September 29, 2020 | Press Release

In a new initiative funded by the Agency for Health Research and Quality, Altarum and the University of Michigan are partnering to develop, implement, evaluate, and disseminate strategies to improve the management of opioid use, misuse, and opioid use disorder in older adults in primary care, including those in diverse populations.

Altarum Releases Policy Roadmap for Making Insulin Affordable

September 10, 2020 | Press Release

How did insulin become unaffordable for millions of Americans and what can policymakers do about it? Our new report answers this question and provides a detailed set of policy proposals to rein in the cost.

Altarum’s Innovative Value-based Payment Solution—PROMETHEUS Analytics®—is Acquired by Change Healthcare

August 26, 2020 | Press Release

Altarum is pleased to announce that Change Healthcare has acquired PROMETHEUS Analytics®, an Altarum software application that supports episode analytics, health care payment, and value-based initiatives.

Rural Mothers with Substance Use Disorders Often Struggle to Access Care. Wider Adoption of Tailored Telehealth Can Help

August 14, 2020 | Perspective

How can we ensure rural women navigating motherhood in these difficult times are getting the care they need? The answer may lie with tailored patient-centered telehealth services.

HRSA Selects Altarum to Lead Innovations in Newborn Screening Interoperability Resource Center

August 12, 2020 | Press Release

Altarum has been selected by the Health Resources and Services Administration (HRSA) to lead the Innovations in Newborn Screening Interoperability Resource Center, a $3.8 million initiative over three years.

Livingston County Catholic Charities and Altarum Release Toolkit on How to Create and Operate a Volunteer Caregiver Corps

August 07, 2020 | Press Release

To address a growing need for reliable long-term care supports in communities and neighborhoods across the country, Altarum and Livingston County Catholic Charities have developed a customizable toolkit on how to create and operate a corps of community volunteers who can safely provide non-medical services to older adults and people with disabilities living at home.

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The survey—the first known to directly poll nursing home residents about their pandemic experience—comes at a critical time as nursing homes grapple with balancing infection control measures with maintaining quality of life for their residents, often the most frail and vulnerable members of our society.

365 nursing home residents in 36 states responded to the survey, which was conducted from early July to August 31, 2020. The survey asked residents how often they engaged in various common social and other activities after the Covid-19 restrictions were imposed compared to before the outbreak.

The findings show that residents’ ability to move freely around their homes, leave the facility, have outside visitors, or even socialize with fellow residents has declined sharply since March and that those restrictions have taken a toll on their emotional health.

Below are highlights from the survey:

Social interactions outside the nursing home have dropped sharply

Only 5 percent of respondents reported having visitors three or more times per week, compared to 56 percent before the outbreak.
93 percent of respondents reported that they did not leave their nursing home in a given week for routine activities such as shopping and visiting family, compared to 42 percent before the outbreak.
Only 28 percent reported they went outside to enjoy fresh air one or more times a week, compared to 83 percent before the outbreak.

Social interactions and activities within the nursing home have also dropped sharply

54 percent reported they are not participating in any in-home organized activities (such as exercise classes, art classes, resident meetings, and religious services), compared to 14 percent before the outbreak.
Only 13 percent reported eating their meals in the dining room, compared to 69 percent before the outbreak.

Additionally, 76 percent of respondents reported that they felt lonelier under the restrictions, an unsurprising finding given that 64 percent also indicated they no longer even leave their rooms to socialize with other residents.

Previous research has demonstrated that social isolation, an already common reality for many older adults pre-pandemic, can accelerate declines in physical and mental health. The findings of Altarum’s survey add to this body of evidence by capturing how the current health crisis has exacerbated this further.

The open-ended question in the survey asking residents how they are coping provides additional insight into the emotional toll of these restrictions, including candid comments about feeling more depressed, anxious, sad, and lonely.

“Hearing the residents’ own words about how restricted and lonely they feel really hit home,” said Sarah Slocum, co-director of Altarum’s Program to Improve Eldercare. “Hearing an elder say they feel like they are in prison is heartbreaking. We need to change this.”

The report also includes survey responses to questions about how safe residents feel, their access to technology that can connect them to people and activities, advance care plans and bereavement, and changes in basic quality of nursing home care and support.

Finally, the report provides a detailed set of recommendations on ways nursing homes and policymakers can reduce social isolation and loneliness while still limiting the spread of the virus, largely through measures that improve distance socializing, access to technology, individualized plans to head off loneliness, and nursing home staff support.

“This survey shows that it’s not enough to try to keep residents from being infected; frail elders must have something to live for,” said Anne Montgomery, co-director of the Program to Improve Eldercare. “For many, that means seeing their family and friends, going outside and socializing—all of which can be arranged while social distancing and taking other precautions recommended by CMS. We hope that some of the ideas and resources offered in the report will help with that.”

Read the report:
Experiences of Nursing Home Residents During the Pandemic: What we learned from residents about life under Covid-19 restrictions and what we can do about it

While opioid use disorder afflicts a larger share of younger Americans, it is also a problem among people older than 65. Between 2002 and 2014, the rate of opioid misuse among older Americans nearly doubled. And while many initiatives have been developed to curb the opioid crisis, few have targeted the growing toll among older adults.

When prescribing opioids to older adults, it is important to balance pain relief and quality of life with the risk of opioid dependency, along with other factors including polypharmacy, cognitive and physical function, caregivers, social supportive services, and end-of-life preferences.

There also are areas for improvement when it comes to prescribing—according to AHRQ, it has not been uncommon in recent years for providers to prescribe more opioids to seniors than is recommended.

A key part of this project is integrating these practices so they are sustained over the long term, including assessing patient risk for opioid misuse, following-up with patients who have been prescribed opioids, using prescription drug monitoring databases to identify patients with multiple opioid prescriptions, and prescribing the recommended drugs and doses to manage pain in older adults effectively.

Altarum achieves sustained improvement in prescribing practices through a strategy that combines in-depth physician education with academic detailing and practice facilitators who provide direct technical assistance. We also extract and analyze data to provide feedback that further motivates physician behavior change. After delivering a similar program with the University of Michigan funded by the Health and Human Services Office of Minority Health, we saw substantial improvement in prescribing practices six months after the program concluded.

Daniel Berland, MD, of the University of Michigan, and Emily Ehrlich, MPH, director of Altarum’s Center for Behavioral Health, are co-principal investigators of the program. Dr. Berland is a clinical associate professor in the Departments of Medicine and Anesthesiology at the University of Michigan. He is also Board Certified in Internal Medicine and Addiction Medicine. Emily Ehrlich has led and participated in several nationally funded programs aimed at reducing opioid misuse. Altarum’s Joanne Lynne, MD, a former geriatrician and nationally recognized expert on issues related to palliative and end-of-life care, also will inform the program design.

Learn more about our continuing medical education offerings, clinical quality improvement services, and solutions to help states coordinate a comprehensive opioid response.

How did insulin, a life-saving therapy for patients with diabetes, become unaffordable for millions of Americans and what can policymakers do about it?

A new report from Altarum answers this question and provides a detailed set of policy proposals to make insulins affordable to patients and payers through federal regulation, market reforms, and direct government action.

The need for affordable insulin is clear—US insulin prices are the highest in the world and have grown dramatically over the last 20 years, leading to one in four diabetic patients’ rationing insulin and taking less than their doctor prescribes.

Concern about affordability has even pushed insulin to the national political stage, figuring prominently in the Democratic presidential primary earlier this year and emerging again last spring when the White House pivoted from the Covid-19 response to announce a plan to reduce insulin co-payments for Medicare beneficiaries. Yet despite this attention, little has been implemented to fully address affordability for patients and overall costs.

To guide policymakers in addressing the problem in the near and long term, Altarum has developed a policy roadmap around three objectives:

Making insulin affordable to patients. Because insulin therapy is a form of high-value care that should be encouraged and that patients are unlikely to overuse, cost-sharing for insulin should be eliminated for insured patients by modifying Medicare Part D and Medicaid and by requiring private insurers to eliminate cost-sharing for at least one insulin of each type. The additional costs to insurers could be offset by reducing coverage of non-value-added or l ow-value care services according to the principles of value-based insurance design.

Reducing prices of the current generation of insulins by increasing market competition. The FDA should continue to define and implement the regulatory pathway to ease market entry of biosimilars and finalize guidance on interchangeability to allow pharmacists to substitute higher-priced insulin prescriptions with more affordable biosimilars. Policymakers should also pass federal legislation to prevent the patent system from being used to inhibit the introduction of biosimilar insulins, and to encourage more manufacturing of off-patent drugs in the US.

Maintaining affordability and addressing systemic issues through direct government action. Until market reforms increase competition for biologics, and for future innovations, a more direct government role is needed to advance affordability. Longer-term reforms include a federal role in setting prices or negotiating drugs purchased with public funding, setting reasonable limits for launch prices and price increases, and requiring manufacturers to submit an accounting of research and development and manufacturing costs.

In addition to policy proposals, the report includes an in-depth examination of the drivers of the dramatic growth in prices over the last 20 years, including 1) lack of competition in the US market, 2) rapid adoption of new technologies without weighing benefit versus cost, 3) patents and market exclusivity periods, 4) lack of government negotiation of drug prices, 5) the rebate system and its impact on list prices, and 6) distortions in the health insurance market.

The report also includes background information that is critical for a fuller understanding of the cost of insulin, including the science, history, evolution, and future of insulin therapy, along with an examination of domestic insulin prices and how they compare to prices internationally.

Altarum economist Ani Turner co-authored the report with Dr. Rena Conti of Boston University, a nationally recognized economist and expert on drug pricing, and Altarum economist Paul Hughes-Cromwick. The report was funded by the National Institute for Health Care Reform, a nonprofit health care policy research organization established by the International Union, UAW; Chrysler Group; Ford Motor Company; and General Motors.

Read the report Strategies to Advance Insulin Affordability in the United States

Altarum has leveraged PROMETHEUS Analytics to help Colorado, Maryland, Michigan, Minnesota, and New York advance value-based payment by supporting the transition from Medicaid fee-for-service payments to value-based payments, identifying potentially avoidable complications, and producing episode-based spending estimates.

PROMETHEUS Analytics was originally developed by the Health Care Incentives Improvement Institute (HCI3) with funding from the Robert Wood Johnson Foundation. In 2017, Altarum integrated HCI3 into its operations and launched a subsidiary—Payformance Solutions. Over the past three years, the Payformance team built TrustHub, an alternative payment model contracting platform that is powered by PROMETHEUS Analytics. TrustHub also moves to Change Healthcare as part of the transaction.

“Altarum has played an important role in maturing value-based payment models, and Change Healthcare is well positioned to expand this work at scale, enabling Altarum to focus on our mission of advancing health of at-risk and disenfranchised populations through clinical quality improvement and public health interventions,” said Altarum President and CEO Lincoln Smith.

Altarum will continue advancing health care value through a variety of initiatives that empower people and the providers that serve them so that they may lead healthier, happier lives.

A young mother comforts her crying baby with a kiss.

Women in rural areas often struggle to access care during and after pregnancy for a variety of reasons—from a shortage of hospitals and obstetric providers to poor transportation and socioeconomic disparities. COVID-19 is adding to that struggle, as women navigate uncertainty over how to safely access prenatal care and other health care services. At the same time, another health crisis in rural America—opioid misuse and overdoses—continues to claim lives, adding yet another risk.

How can we ensure rural women navigating motherhood in these difficult times are getting the care they need? The answer may lie with tailored patient-centered telehealth services. While we know many health systems adopted some form of telehealth in response to the Covid-19 pandemic, there are still many that have lagged behind on implementation and expansion of their services. Yet there are good reasons to continue expanding telehealth over the long term to perinatal women. Virtual services can be effective in delivering routine perinatal health services, such as lactation support, postpartum mental health, contraceptive care, and substance use disorders.

There are many examples of promising practices to reach rural pregnant women and new mothers, including Text4baby and Pacify. However, for women with substance use disorders, these types of virtual care delivery innovations have not been widely developed or evaluated.

To broaden our understanding of the issue, Altarum conducted qualitative research in West Virginia on the needs of perinatal women with substance use disorders. Women in our focus groups explained that they wanted to access support services and resources through multiple avenues such as text, phone calls, and video. They also wanted in-person and virtual provider and peer support.

There are opportunities to improve and expand telehealth in rural areas that combine these various options and preferences. We must invest in telehealth, not only because of the special challenges that rural mothers face in accessing treatment, but that all new mothers face in balancing their health needs with the all-consuming job of caring for a newborn. In many cases, new mothers just don’t have time to drive more than 30 minutes to access perinatal services.

How do we expand such services? It’s important to remember when creating a telehealth operation that rural communities are not monolithic in structure or makeup, so evaluation research is key to ensuring that virtual health care services are tailored to meet the needs of pregnant and parenting women, including those with substance use disorders. When researching, designing, and evaluating telehealth, it’s also important to assess patient experience, quality, cost, access, and efficiency and gain provider and patient input to understand how easily a program can be implemented, how well a program works, and how well a program will be accepted and widely used by its target populations.

Current telehealth measures tend to focus on compliance rates, retention, and patient satisfaction. While these metrics are important, it is also critical that we take a deeper look at the user experience among specific sub-groups to understand the extent to which currently available telehealth services are not only meeting their expectations but truly meeting their needs. We can then translate this research into practical, concrete recommendations for health care providers and organizations.

To learn more about our solutions for rural perinatal women and virtual care and telehealth, contact one of our experts below.

The goal of the program is to reduce morbidity and mortality associated with heritable disorders in newborns and children by enhancing connectivity between state public health newborn screening programs and health care providers. The connectivity will improve the ability of states to conduct screening and report results in a timely manner, which increases the likelihood that infants with one of these newborn screening conditions will receive timely diagnoses and treatment.

Altarum and its partners—OZ Systems, the University of Michigan’s Susan B. Meister Child Health Evaluation and Research Center, and the American Academy of Pediatrics—will provide technical assistance to states to advance their newborn screening interoperability, from building a program portal and assessing state readiness to providing direct technical assistance and creating customized roadmaps for enhancing interoperability.

In leading the initiative, Altarum brings two decades of experience advancing states’ health information exchange and interoperability, which includes developing Fast Healthcare Interoperability Resources (FHIR) solutions; building applications that support information exchange for disease surveillance and care coordination; and helping to create national standards for electronic birth defect reporting, newborn screening early hearing detection and intervention, and critical congenital heart defects/disease.

Altarum’s partners in the Newborn Screening Interoperability Resource Center also bring deep subject matter expertise in interoperability and childhood disease and prevention:

OZ Systems, an organization with extensive experience creating and providing information management and technical assistance to newborn screening programs, will recruit states to participate in the program, conduct environmental scans and readiness assessments, and deliver technical assistance.

The University of Michigan’s Susan B. Meister Child Health Evaluation and Research Center, a national leader in pediatric health services research at Michigan Medicine, will conduct the assessment of the adoption and implementation of existing newborn screening standards and lead the program performance evaluation.

The American Academy of Pediatrics, a nonprofit professional membership association representing more than 67,000 pediatricians and related specialists, will help recruit their members to participate on state planning teams and help disseminate materials.

Newborn screening programs are a vital public health resource that enable millions of infants to benefit from early detection and intervention of genetic, endocrine, metabolic, hearing, and critical congenital heart conditions. Yet in many jurisdictions across the country newborn screening data can be fragmented, siloed, and subject to different screening procedures, methods, turnaround times, and approaches for interpreting results.

Altarum and its partners will help states and jurisdictions address these gaps, creating a more streamlined and uniform system of newborn screening and reporting.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $3,798,209 with 100 percent funded by HRSA/HHS. For more information, visit HRSA.gov.

To address a growing need for reliable long-term care supports in communities and neighborhoods across the country, Altarum and Livingston County Catholic Charities (LCCC) are releasing an online, customizable toolkit on how to create and operate a corps of community volunteers who can safely provide non-medical services to older adults and people with disabilities living at home.

Developed with funding from the Michigan Health Endowment Fund, the comprehensive 340-page toolkit provides community leaders, program directors, and managers with a step-by-step guide to create a volunteer corps of community residents—from recruiting, screening, training, and retaining volunteers to conducting community outreach and marketing.

This toolkit is the first of its kind developed for community-based organizations seeking to organize volunteers to assist aging adults that are largely homebound and in need of basic supports to remain safe and socially connected. The growing aging population and now the Covid-19 crisis are driving demand for these services.

“The Health Fund is proud to have supported LCCC in developing this resource, as their expertise and experience can benefit residents in Michigan and beyond. We've recently seen how people will come together to care for one another, and a volunteer caregiving corps can help communities build that kind of culture. The toolkit provides organizations with the blueprints for action, and is an important part of nationwide caregiver volunteer efforts," said Tim Niyonsenga, program officer at the Michigan Health Endowment Fund.

The toolkit is informed by LCCC’s 30-years of experience running a volunteer caregiver program in Livingston County, Michigan, and Altarum’s decades of leadership advancing eldercare policy, including expanding the Program of All-Inclusive Care for the Elderly, improving nursing home quality through culture change, and monitoring and evaluating a national community care corps initiative funded by the Administration for Community Living.

“LCCC’s Volunteer Caregiver Program has been an essential service in our community for many years,” said Suzanne Snyder, director of senior services at Livingston County Catholic Charities. “There are many benefits to using caring, local volunteers to provide support and assistance to individuals that may be invisible in the community. We are honored to share our knowledge and material with other organizations that serve their communities.”

Any state or local organization interested in improving care of homebound older adults will benefit from using the toolkit to launch a new volunteer caregiver program or to improve upon an existing one. While the toolkit is shaped by LCCC’s work in Livingston County, a blend of rural and suburban communities 58 miles northeast of Detroit, its detailed policies and communication materials can be easily adapted to the needs of different localities. The toolkit also includes guidance on modifying program policies and services to ensure compliance with public health guidance on Covid-19.

“Everyone at LCCC—our Board of Directors and our Senior Services Team—is grateful to the Michigan Health Endowment Fund for supporting this project. Their funding, along with the partnership with Altarum, provides us the opportunity to strengthen our services and to share our work with others,” said Mark Robinson, executive director of the Livingston County Catholic Charities. “Altarum is proud to have played a role in assembling this toolkit, which we hope will be widely copied and used, ” said Co-Directors of Altarum’s Program to Improve Eldercare, Sarah Slocum and Anne Montgomery.

Download Create Your Own Caregiver Corps: A Toolkit from the Livingston County Catholic Charities

About Altarum

Altarum is a nonprofit organization that works with public and private insurers, provider organizations, and foundations to improve health of vulnerable and publicly insured populations. Altarum achieves measurable results by combining public health and health care delivery domain expertise with applied research and analytics, technology, continuing education, advisory services, and program implementation. Our innovative solutions lead to better value and better health for all. Learn more at Altarum.org.

About Livingston County Catholic Charities

Livingston County Catholic Charities is a community-based organization that seeks to respond to social service needs in Livingston County that are otherwise unmet or insufficiently served. Agency programs are diverse, including both prevention and direct service and are responsive to everyone. Learn more at LivingstonCatholicCharities.org.