As summer comes to a close, Illinoisans are preparing for the transition into fall and winter. For many this might mean pulling out the jackets from storage, trying fun fall recipes and sending the kids back to school. While the transition can be exciting, it means shorter and darker months in Illinois are looming. 

If you have been living in Illinois for a while you might know what to expect from the weather. However, you might not know that these darker days predispose you to having a vitamin D deficiency which actually leads to many people feeling even more lackluster during these upcoming dreary days. 

Each vitamin and mineral have a unique and specific role in ensuring your body stays healthy. For example, vitamin A supports vision, the B vitamins keep up your energy and vitamin C helps your body heal. 

Vitamin D helps boost immune function, reduce inflammation, aid neuromuscular function and help absorb calcium. It is a fat soluble vitamin found in food and manufactured in the body from exposure to ultraviolet rays from the sun. That is why in northern latitudes, like Illinois, it is very common to have a deficiency. 

Even with a healthy, balanced diet with the appropriate casual exposure to the sun some people still experience deficiencies. 

Don’t worry though, deficiencies can be diagnosed by a simple blood test during a wellness check with your primary care provider (PCP). 

Wellness checks are a great time to talk to your PCP about your health, discuss changes or problems you have noticed and get ready for those long winter days. 

You don’t have to be sick to request an exam; PCPs actually recommend a wellness check at least once a year, especially in people over the age of 50. 

To make an appointment with your PCP, call your PCP’s office. If you don’t know who your PCP is, please reach out to your health insurance. Medicaid Managed Care Organizations (MCOs) are happy to assist you and help coordinate your benefits. 

This year as you fall back into your fall and winter routine make sure to maintain a balanced diet, sneak in walks in the sun on those nice days and connect with your PCP as well as your health insurance to maximize your health and get the most out of your benefits. 

The pandemic has upended every aspect of life in the United States and continues to sow a deep uncertainty into life. 

This loss of control and predictability can understandably result in stress and anxiety. 

Adults have the ability to recognize and express anxiety, but children tend to not have the tools or language to understand or communicate anxiety. 

New school years, communicating with friends and changing your routine can be exciting but stressful during ideal conditions, let alone during a global pandemic.  In light of COVID-19, children are facing additional stress related to back-to-school, fall sports, or lack thereof, and many new routines.

Managing the stress and anxiety of so much change looks different for each child within each family. However, it is important to start conversations to ensure we are supporting children’s mental health during COVID-19.

Parents can actively help kids and adolescents manage stress by:

Paying attention

Being available

Listening actively

Responding thoughtfully

Modeling 

Call your child’s or adolescent’s health care provider if stress begins to interfere with their daily activities for several days in a row.

Find additional helpful information about kids and stress by visiting the Centers for Disease Control and Prevention’s Helping Children Cope webpage at https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/for-parents.html.

Black women in the United States are four times more likely to die of a pregnancy related death than white women and on average white men live four and half years longer than black men. Black people do not receive the same quality of care as their white counterparts even when insurance status, income, age and severity of conditions are comparable. 

So why do black people receive inferior care?  Implicit bias plays a huge role. According to the National Academy of Medicine, minority persons are less likely than white persons to be given appropriate cardiac care, to receive kidney dialysis or transplants, and to receive the best treatments for stroke, cancer, or AIDS. 

Regardless of background, ethnicity or socioeconomic status, we all have attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner. 

Experts say it’s our brain’s way of trying to find patterns and organize in a way that makes sense to us. But experts also say that when addressed, our brain becomes more aware of perceptions that can lead to implicit bias, or unequal treatment of people. So simply being aware of subconscious perceptions can help prevent them. 

This is key because implicit bias is especially harmful when it comes to providing quality healthcare to all. Populations most vulnerable to implicit bias in health care include racial and ethnic minorities, LGBTQ individuals, children, women, individuals who are overweight or disabled, and those experiencing behavioral health issues. 

Currently medical doctors, nurses and other healthcare workers are offered implicit bias training. The problem is that most people, including doctors and lawmakers, don’t believe they exhibit implicit bias at all, so the issue remains unaddressed. 

That is why the Illinois Association of Medicaid Health Plans (IAMHP) is once again lobbying for HB 5522 to be reconsidered at the fall session. IAMHP realizes that not only is implicit bias far from being a non-issue, it is a public health problem that’s been begging for our attention long before the current climate to support blacks in this country ensued. 

HB 5522, sponsored by House Representative Emanuel Chris Welch, amends the Medical Practice Act of 1987, the Nurse Practice Act, and the Physician Assistant Practice Act of 1987 to require persons licensed under the Acts take a licensed continuing education course that includes implicit bias training. To satisfy the requirements of this subsection, continuing education courses shall address at least one of the following: 

1. examples of how implicit bias affects perceptions and treatment decisions, leading to disparities in health outcomes; or
   
   
2. strategies to address how unintended biases in decision making may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, physical, intellectual or developmental disabilities or other characteristics. 

At this time, IAMHP has lobbied and secured three chief co-sponsors, numerous legislative supporters from across the state of Illinois, and a diverse coalition of advocacy groups including, the American Cancer Society, Equality Illinois, Heartland Alliance, the Aids Foundation of Chicago, Access Living, 360 Youth Services, Ever Thrive Illinois, Healthy Illinois, Planned Parenthood of Illinois, Pride Action Tank, Sargent Shriver National Center on Poverty Law, and SEIU Healthcare. 

IAMHP is urging lawmakers in Springfield to recognize that implicit bias is a public health crisis that affects Medicaid members every day, putting their very lives at risk for something we can address and change. 

HB 5522 would be a huge step toward ensuring that quality healthcare will never again be subject to a person’s zip code, race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, physical, intellectual or developmental disabilities or other characteristics. We can no longer justify ignoring this public health crisis. 

As the country deals with the coronavirus pandemic there is another deadly disease that threatens to reverse our recovery gains – addiction.  For people struggling with addiction, services and treatments available to them have been disrupted by the COVID-19 epidemic.  Many community support groups are cancelled, and healthcare providers are diverted to treat COVID-19 patients making it harder for people with substance use disorders to seek help.

With in-person gatherings cancelled, people in recovery are now without a crucial lifeline and the fear is

that social isolation will increase the risk of addiction.  At the beginning on the pandemic, alcohol sales increased as anxiety and isolation rose and as more families sheltered in place they realized loved ones needed help for an addiction.  Additionally, studies show that as unemployment increases so does death from drugs, alcohol and suicide because of the psychological distress. 

Moreover, drug rehabs in Illinois and Indiana have experienced outbreaks of coronavirus or suffered COVID-related financial difficulties that have forced them to close or limit operations.  A treatment and sober living facility in Chicago recently had an outbreak of 55 coronavirus cases among clients and staff members.  The center was forced to go from double to single occupancy rooms, improve its air filtration system and change the way it serves food.  One drug rehab in Indiana which treated as many as 80 men at a time in its free, abstinence-based program is set to close its doors in September.  The next closest facility will be in Chicago, more than 30 miles away.

While addiction treatment centers have taken steps to protect their clients, they must avoid some safety strategies like keeping potentially intoxicating hand sanitizer on the premises.  Similar to nursing homes, drug rehabs have shared spaces, double occupancy rooms and group therapy which can also make social distancing difficult.  And while people struggling with addiction are generally younger, they are just as vulnerable as nursing home residents to suffer from other health conditions like diabetes and heart disease meaning they are at higher risk of succumbing to COVID-19.

Now is the time to reach out to those who are struggling with addiction and provide them with the resources and medications so that they are not alone and forgotten during this dual crisis of coronavirus and addiction.

If you need assistance locating the nearest organization providing Overdose Education and Naloxone Distribution  or Medication Assisted Recovery services in your area, contact the Illinois Helpline for Opioids and Other Substances by calling 833-2FINDHELP (234-6343), text "HELP" to 833234 or visit www.helplineil.org.

The Helpline is the only statewide, public resource for finding substance abuse treatment and recovery services in Illinois. They serve people using opioids and other substances, with or without insurance.

More information about overdose prevention and response can be found on the Drug Overdose Prevention Program (DOPP) homepage.

For Medicaid Members:  Managed Care Organization (MCOs) Care Coordinators also have special services and programs for members who need extra help managing a health program. If you are a Medicaid Member, please reach out to your Care Coordinator if you have specific questions or needs.

QUARTERLY NEWSLETTER
Texting to Improve 
Healthcare Communications
Spring 2020

COVID-19 may be having a devastating impact around the world, but it is also prompting Medicaid Health Plans in Illinois to find new ways to communicate with their members.  

During this time people need to know how to manage their health – finding testing sites, assistance with prescriptions, scheduling transportation etc.  One unique approach is a text campaign that can engage members to better manage their health while communicating important information with members. 

At a time when people can call, text or chat with their healthcare team, the value of text messaging to a person’s overall healthcare management is essential.   Texting can be used to engage and connect with member about everything from health management to billing.  It can notify Medicaid members of changes to their scheduled appointments and notify patients when they are due for routine exams, recommend specific preventive screenings, invite patients to attend community wellness events or share relevant wellness information. 

Illinois Medicaid Health Plans are constantly looking for ways to improve the overall health of their members and text messaging has seen a high engagement rate among respondents.

QUARTERLY NEWSLETTER
Ensuring Safety and Access to Medicaid During Covid-19
Spring 2020

With over 98,000 cases and more than 4,300 deaths, Illinois has been hit hard by the COVID-19 pandemic.  As federal and state officials work to flatten the curve of this disease, technical experts from IAMHP and our member plans have been working with HFS to find solutions to issues facing Illinois residents and providers.  As a result, the following changes have been enacted to mitigate the impact and spread of the COVID-19.

MITIGATING THE IMPACT OF COVID-19

As the state reinforces shelter-in-place and social distancing guidelines, measures have been taken to halt the acceleration of the virus: 

• Expanded telehealth services to allow people to continue medical services from home and free up hospital space

•  Coordinating temporary housing as a Medicaid benefit for people experiencing homelessness for the 14-day quarantine period

•  Covering home delivered meals for Medicaid members who do not have access to meals during the directed social distancing period

• Encouraging all Medicaid members to apply for or manage their coverage online at www.ABE.Illinois.gov to protect staff working in facilities.

SUPPORTING PROVIDERS:

• IAMHP trained over 1,250 providers on telehealth and grants/small business loans

• Member plans donated 150,000 KN95 masks 

• Assisted community-based providers, behavioral health and developmentally disabled providers to obtain critical PPE

• Removed prior authorization and cost sharing policies related to COVID-19

• Implemented payment advances and alternative payment models to ensure providers are paid faster

SUPPORTING MEDICAID MEMBERS:

• Expanded home delivered meal services to Medicaid members in need

• Removed restrictions on grants to give nonprofits more flexibility in utilizing donated funds

•  Provided grant support to Chicago COVID-19 response fund and the Greater Chicago Food Depository

• Worked with Chicago Public Schools to enroll families in SNAP and Medicaid

• Partnered with local laundry services to offer low-income families laundry services

QUARTERLY NEWSLETTER
Covid-19 Pandemic and Mental Health
Spring 2020

Covid-19 has galvanized global action and ushered in big changes that have shutdown our usual day-to-day activities. While these steps may be critical to stop the spread of this disease, they have and will have consequences for mental health and well-being in both the short and long term.

Worries and anxiety about COVID-19 and its impact can be overwhelming. Social distancing makes it even more challenging. But you don’t have to do it alone.  

People seeking assistance will remain anonymous and will provide only their first name and zip code, which enables the service to link you to a counselor in your area who is knowledgeable about available local resources. 

The current spread of COVID-19 has impacted all of us in multiple ways, including mental health and wellness. Remember help is here, talk to someone. 

Illinois Call4Calm Text Line Text TALK to 552020  En Español, envie HABLAR Service is free.  Available 24/7

Crisis Text Line Text HELLO to 741741 Trained crisis counselors available 24/7

MONTHLY REPORT
Implicit Bias 
March 2020

In the United States, black women are three to four times more likely to die of a pregnancy related death than white women. Black women are also more likely to experience severe birth

complications.  Why? More and more studies are now uncovering the role of implicit bias in worsening health outcomes and exacerbating health disparities.  

Implicit bias affects a variety of other health outcomes and populations such as substandard pain management for black patients, unequal cardiovascular testing for women, and inadequate services for patients with mental illness. 

Implicit bias, meaning attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner, is real and often contributes to unequal treatment of people. Populations most vulnerable to implicit bias in health care include racial and ethnic minorities, LGBTQ individuals, children, women, individuals who are overweight or disabled, and those experiencing behavioral health issues.

The American Medical Association (AMA) recognized racial and ethnic health disparities as a major public health problem creating barriers to effective medical diagnosis and treatment. As a result, the AMA has stated that the elimination of racial and ethnic disparities in health care is an issue of highest priority.

HB 5522, sponsored by House Representative Emanuel Chris Welch, amends the Medical Practice Act of 1987, the Nurse Practice Act, and the Physician Assistant Practice Act of 1987 to require persons licensed under the Acts take a continuing education course that includes implicit bias training.

To satisfy the requirements of this subsection, continuing education courses shall address at least one of the following:

• examples of how implicit bias affects perceptions and treatment decisions, leading to disparities in health outcomes; or

• strategies to address how unintended biases in decision making may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, physical, intellectual or developmental disabilities or other characteristics.

At the time of publication, IAMHP lobbied and secured three chief co-sponsors and a diverse coalition of sixteen co-sponsors:

Rep. Emanuel Chris Welch - Camille Y. Lilly - Elizabeth Hernandez, Gregory Harris, Bob Morgan, La Shawn K. Ford, Kelly M. Cassidy, Carol Ammons, Robyn Gabel, Rita Mayfield, Deb Conroy, Jennifer Gong-Gershowitz, Theresa Mah, Norine K. Hammond, Michelle Mussman, Michael J. Zalewski, Natalie A. Manley and Jonathan "Yoni" Pizer

QUARTERLY NEWSLETTER
Lowering the Cost of ComplianceUsing E-Signatures
February 2020

From grocery stores to office visits, online shopping to online banking, consumers no longer sign a carbon triplicate or receive paper copies of their receipts.  Email, signature pads, voice activation, fingerprint, and digital signatures have replaced the pen and paper.  This has paved the way for faster, more reliable commerce while lowering the cost per transaction.

So why should it be different for Illinois Medicaid members?

When it comes to individual care plans, the state of Illinois allows for a member’s signature “by hand, e-signature, or voice recording.” After researching Illinois law as to what constitutes an “e-signature” I would like to suggest that video recording could meet the same definition.  This is an area where telehealth solutions can be leveraged, not only to deliver medical interaction via video conference, but also to meet state requirements for member sign-off and engagement.

As with hand-written or digital signatures, video recordings would need to satisfy the same privacy, security, legal, and compliance requirements, such as verification of the member’s identity, retention of the video, encryption and authentication, member access to the recording, and other HIPAA safeguards.  Furthermore, the member would need to consent to the use of the video recording as a legal instrument.

In addition to compliance and cost benefits, video recording as an e-signature also results in an increase in member satisfaction, as it simplifies their care experience, leverages technology they already utilize, can be scheduled any time of the day or evening, and relieves their burden of additional steps to sign documentation by hand and/or return it via mail or fax.

As the Illinois Medicaid program continues to evolve and innovate with its partners, let’s seek creative, low-cost opportunities and policy changes to allow 21st century technology solutions to pick up much of the administrative and compliance workload.

QUARTERLY NEWSLETTER
The CMS Interoperability Challenge and You
February 2020

In 2019, CMS issued a proposed rule to require participating health actors to exchange health data elements throughout the United States using a standardized format, participate in a trusted information network, and make health information readily available for the public to consume via secure interfaces.

The government and private sector have been struggling for over a decade to solve the interoperability puzzle on a national (or even regional) level.  And while there have been some successes on local and regional levels, nation-wide interoperability doesn’t exist.  Really?? What is so hard about getting IT systems to talk to each other?  True, some of the challenges are technical in nature, like being able to exchange data in a standardized or consumable format, ensuring the integrity of the data, and the use of common definitions between systems.  But there are also major challenges on the policy side.  Privacy tops the list of concerns, such as ensuring the data stay confidential. Legal considerations are also high on the list, such as data ownership, whom to hold accountable in the event of a breach, records retention, consent, and power of attorney.  Also, let’s not forget that not all actors in healthcare have electronic health records, so requiring everyone to participate may not be feasible.  And of course, there’s the financial aspect – who is going to pay for upgrading, maintaining, and programming all systems to meet a national standard, and what’s the incentive?  Lastly, who will authoritatively govern and lead such a program, monitor for compliance, and hold all parties accountable on the federal, state, and local levels? 

Like the famous answer to how to eat an elephant, it’s clear that tackling this challenge should be in small increments.  Perhaps successful state-led Health Information Exchanges – like Colorado, Iowa, Ohio, and Wisconsin – provide a microcosmic model for scaling into a national program.  Or successful multi-state sharing of data can teach us valuable lessons learned about crossing state lines.  So, while rolling this out on a national level may still be 3-8 years away, dedicating people, process, technology, and governance within your own organization towards interoperability is a safe investment and worth the reward.