An urgent need to ensure universal access to healthcare

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110th World Day of Migrants and Refugees 2024

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Synod for Synodality: What We All Expect from the Catholic Church

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Be Wary and Choose the Lesser Evil

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Venezuela: “We don’t know what’s happening to us, and that is precisely what is happening to us.”

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Our Existence and Actions as Hispanics and Latinos, Here and Now.

 

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Social Care Networks Come to New York State

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Youth and Mental Illness

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A Commercial Take on PCPs

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A New Heaven on a New Earth

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Prayer at the Installation of new ABS President

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Time for Hope in American Bible Society

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The American Bible Society opens a new chapter

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Value-Based payment is the future for healthcare for the poor.

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Global Campaign Puts Spotlight on Vital Role

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Vatican conference stresses vital role of primary care doctors in care for the poor.

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Immigration Today

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Thank you Doctor!

 

“THANK YOU, DOCTOR!” Campaign 

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New Social Care Network will tackle Social Determinants of Health.

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Bread and Peace, and their Meaning for Easter

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An invitation open to all

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With Francis, 11 Years “on the High Seas”

 

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Addressing Social Needs Boosts Healthcare for the Poor

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New York State launches new phase of Medicaid innovation

Calling especially for awareness of how social factors can impact health—and insisting on tackling the Social Determinants of Health—the federal government has approved a new Medicaid 1115 Waiver for New York State, making $6B available to improve the quality of Medicaid care in the state in a variety of ways. Officially beginning in April 2024 and concluding on March 31, 2027, the new waiver program puts a premium on the delivery of Health-Related Social Needs (HRSN) services, which is allotted almost half of the budget.

The push for taking HRSN factors into account is at the heart of the waiver's vision to promote health equity, reduce health disparities, and sharply improve the quality of Medicaid-funded health care across the board—putting in place mechanisms that are designed to become a lasting part of Medicaid in New York State, including, especially, the official inclusion in Medicaid of a budget to tackle HRSN.

The program will provide funding enabling primary care providers to engage Community-Based Organizations (CBOs) to find solutions for social needs that are harming the population's health. There will be a regional approach that will single out areas that have historically seen health disparities and disengagement from the healthcare system. The waiver also calls for the integration of primary care, behavioral health, and awareness of HRSN, particularly as regards high-risk Medicaid recipients, such as youth, pregnant women, those struggling with addiction issues, and the chronically homeless. The waiver envisions Social Care Networks (SCN) to oversee the HRSN programming, working with local social care providers.

The waiver also includes more than $690M to be spent on New York State's healthcare workforce to stabilize the workforce, provide training and education, and improve access to culturally appropriate services. Training the workforce—including physician assistants, mental health counselors, and Community Health Workers—will also feature the introduction of Value-Based Payment models, even as the waiver calls for an increase in fee-for-service payments. Some doctors who sign up for a multi-year commitment to work with Medicaid patients will receive student loan repayment.

A Health Equity Regional Organization (HERO) will use data gathering and analytics to design formulas to reduce health disparities, as well as support the delivery of HRSN services. This entity will also explore different Value-Based Care models that include coverage of HRSN services. SOMOS Community Care—a network of 2500 independent physicians, most of them primary care providers serving the poorest Medicaid patients in New York City—applauds the new 1115 Waiver.

It welcomes the emphasis on integrating Health-Related Social Needs (HRSN) services in overall healthcare as key to overcoming healthcare disparities and creating health equity. In fact, SOMOS has pursued such a model of health care since it got its start in 2014 as an entity mandated by the previous 1115 Waiver. As it stands, SOMOS recognizes itself in the blueprint of the new Waiver. That is true in several key areas.

Thanks to the work of CHWs who visit patients' homes, providers have intelligence about social conditions affecting patients' lives. SOMOS doctors have already begun reaching out to CBOs, as called for by the waiver. Additional funding for the training of CHWs, as well as for physician staff, among other key positions, is much needed. The waiver's workforce investment is much needed.

While Social Care Networks (SCN) are envisioned to organize HRSN programming as delivered by local social care providers, the patients who qualify for such care must first be identified by the family doctor who knows his and her patients intimately. It is also conceivable that SOMOS doctors' practices in the Bronx, Manhattan, Queens, and Brooklyn form hubs in their networks that identify and seek help for patients needing HRSN services. It seems clear that medical providers must—alongside social care experts—participate somehow in the SCN networks.
SOMOS has also pioneered Value-Based Payment. Its experience can be fruitful for the specialists charged with exploring VBP models that will be key to statewide accountability for improving health care, patients' longer-term well-being, and health equity.

The fundamental goal of the waiver is to better serve the poor, the vulnerable, and the most disadvantaged. SOMOS doctors are community-based and accessible to their patients, and in many cases, share a cultural identity with them, which is most conducive to a strong relationship between doctor and patient—a bond that plays an important role in the quality of care. SOMOS doctors have been providing superior care—medical, behavioral, social—to their patients while saving taxpayers money in the process.

Moreover, SOMOS has operated as the only network of independent providers in the state. It has no backing from a hospital conglomerate. Instead, it has operated in the trenches. The new 1115 Waiver promises new growth as well as challenges for SOMOS—and its doctors and staff will continue to give their all, as they have done from the very start of the reinvention of Medicaid.

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Mario J. Paredes is CEO of SOMOS Community Care, a social care network of over 2,500 independent providers responsible for reaching and delivering care to over 1 million Medicaid lives across New York City.

 

 

May No Sick Person Be Alone!

On May 13, 1992, then-Pope John Paul II established February 11 as the World Day of the Sick, an annual occasion for prayer and reflection and for promoting the assistance and care that is needed – worldwide – for all those who do not enjoy good and complete health.

Every year since then, the Pope has enlivened this Day with a Message in which he encourages us to live life adopting a compassionate and merciful gaze and attitude – like Jesus himself – towards our brothers and sisters who suffer from some kind of illness, towards “all of you, brothers in trial, who are visited by suffering under a thousand forms, who search in vain for the why of human suffering and who ask anxiously when and whence will come relief.” (Closing of the Second Vatican Ecumenical Council – To the Poor, the Sick and the Suffering – 8 December 1965).

Health is a condition for personal, family, and social life. Without health, there is no full life, there is no “abundant life” (Jn 101:10). When we lack health, we are put in a situation of need, fragility, and vulnerability.

So important is health for the human being, that – theologically speaking – God’s salvation for man is synonymous with health. For this reason, the messianic times of the coming of the salvation that God offers us in his Son Jesus Christ are announced, both in the Old Testament, as times of salvation in which “the blind regain their sight, the lame walk, lepers are cleansed, the deaf hear, the dead are raised, and the poor have the good news proclaimed to them” (Mt 11:4-6).

While health care and the preferential attention that the sick must have in every society are important, the institutions and people who dedicate themselves to health care through the exercise of the medical profession are equally important.

I am the CEO of SOMOS Community Care, a network that coordinates more than 2,500 family physicians to provide primary care services to New York City’s most disadvantaged. In this medical organization, we work toward a humanistic vision and mission that views health care from a comprehensive, preventive perspective. We are aware of the importance of personal and collective health care, and we make our best efforts to ensure that our medical, human, and material resources reach those who need them most.

For this reason, among other expanded social welfare projects, the SOMOS Community Care Medical Organization and the Doctor Ramon Tallaj Foundation have implemented a scholarship system for students with academic excellence who, without this support, would not be able to achieve their academic goals of completing their studies in medical and paramedical programs.

For this 32nd World Day of the Sick, on February 11, 2024, Pope Francis’ Message is inspired by the biblical quote, “It is not good for the man to be alone.” (Gen 2:18). Because, says the Pope, “Our lives … are meant to attain fulfillment through a network of relationships, friendships, and love, both given and received. We were created to be together, not alone. Precisely because this project of communion is so deeply rooted in the human heart, we see the experience of abandonment and solitude as something frightening, painful, and even inhuman. This is even more the case at times of vulnerability, uncertainty, and insecurity, caused often by the onset of a serious illness.” For this reason, the Pope summons us all to solidarity, to a closeness with compassion and tenderness.

A society that abandons and forgets those who suffer is also a sick society, in need of health and salvation. “This grim reality is mainly a consequence of the culture of individualism that exalts productivity at all costs, cultivates the myth of efficiency, and proves indifferent, even callous, when individuals no longer have the strength needed to keep pace. It then becomes a throwaway culture in which “persons are no longer seen as a paramount value to be cared for and respected, especially when they are poor or disabled…” (Fratelli Tutti, 18). 

Thus, we are all called to live in the commandment of love, love that simultaneously heals the sick, a love that heals and saves those of us who forget our brothers and sisters in need and those who care for and soothe – from the field of medicine – those who suffer in hospitals.

Let us ask ourselves, in addition to praying, what we can do to ease the burdens of those who suffer most in our society, how we can make the loneliness of the sick and elderly more bearable, how we can lessen the pain of so many brothers and sisters who suffer and in so many ways, because “it is not good for human beings to be alone.”

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Mario J. Paredes is a member of the Board of Directors of the Latin American Academy of Catholic Leaders and a Member of the Board of the American Bible Society. He is CEO of SOMOS Community Care, a social care network of over 2,500 independent providers responsible for reaching and delivering care to over 1 million Medicaid lives across New York City.

 

A blessing from God for the Church and for our country

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The Future of Primary Care

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The Smart Way of Expanding Medicaid

A FISCAL HAWK rejects the Medicaid expansion in 40 states, saying the now ten-year-old expansion of the program under Obamacare has led to a growth in federal and state spending without improving the health of beneficiaries. Writing in The Wall Street Journal, Brian Blase, President of the Paragon Health Institute, praises Florida’s decision to resist the political push for expansion, saying that that move has already saved taxpayers almost $50B. He labels Medicaid expansion “a massive increase in public welfare.”

Blase notes that mortality rates in expansion states were higher during the first four years of Medicaid expansion. Another issue has been the payment of providers and health insurance entities, with 20 percent of payments nationwide erroneously made for the medical care of ineligible patients. Blase claims that research has found that, after expansion, Medicaid enrollees were one-third less likely to be able to make doctors’ appointments, sending program recipients to emergency rooms—and hospital beds—for costly treatment.

Blase charges that, at the same time, Medicaid spending on behalf of children, as well as people with disabilities, “stagnated.” Meanwhile, in expansion states, more was spent on “able-bodied working-age adults.” Medicaid, the argument goes, should make “those who most need it” a priority. As it stands, a “much bigger Medicaid program” has not improved health.

There is no doubt that the Medicaid program needs fixing. Traditional Medicaid only marginally improves the health of beneficiaries. A famous 2010 study in Oregon found that the health of beneficiaries showed practically no benefits compared to the health of individuals without healthcare coverage. For example, there was no difference in the prevalence or diagnosis of hypertension or high cholesterol levels or in the use of medication for this condition.

Yes, traditional Medicaid makes it challenging for beneficiaries to find doctors, from primary care physicians to specialists. In many settings, the patient faces a labyrinthine task to build even a rudimentary relationship with physicians. Moreover, a growing number of Medicaid doctors are reluctant to take on new patients, given the challenges of Medicaid payment rates, which, to begin with, are significantly lower than payments made by Medicare and private insurers. Plus, almost 20 percent of Medicaid payments due are not paid in full, a much higher share than the unpaid balances under Medicare and private insurance.

The payment issue needs urgent fixing. An additional challenge is the considerable number of fraudulent claims made by physicians.

These fundamental issues plaguing the Medicaid program and that validate critics’ opposition to Medicaid expansion—above all concerning the questionable quality of Medicaid care—are being addressed by SOMOS, a unique network of more than 2500 independent doctors in New York City. These physicians—most of whom are primary care providers—care for more than one million of the city’s most vulnerable patients, many of whom are African Americans, Asian Americans, and Hispanics.

SOMOS got its start as a participant in an innovative Medicaid initiative— Delivery System Reform Incentive Payment (DSRIP) Program—launched by the New York State Department of Health in 2014. The program stipulates that payments to doctors are linked to longer-term health outcomes for patients. The better the patients are doing, the higher the compensation for providers. Called Value-Based Care, the formula incentivizes providers to do their utmost in caring for their patients.

SOMOS enables its doctors to provide the best possible care. A cadre of Community Health Workers are providers’ eyes and ears in the community. They visit patients’ homes, reminding patients of their medical regimen and assessing the family’s social circumstances. The latter are referred to as Social Determinants of Health or Health- Related Needs, involving, among others, such factors as housing, nutrition, and transportation.

Social factors affect physical and mental health and need addressing as such, something that is only just beginning to be done in the US healthcare universe. It is decidedly not part of the traditional Medicaid approach. SOMOS doctors, by contrast, know their patients intimately, which puts them in a position to provide comprehensive care, which includes engaging Community-Based Organizations. The patient feels known and really trusts the doctor, who plays the role of the family doctor of the old, a trusted community leader. SOMOS doctors are supremely motivated!

Quality Medicaid care makes for significant taxpayer savings, which should please Mr. Blase! SOMOS saved New York State taxpayers $330M by reducing by 25 percent both unnecessary visits to the emergency room and hospitalizations. This was possible thanks to timely interventions and, for example, not letting conditions like diabetes and hypertension get out of hand.

SOMOS has demonstrated that significant Medicaid reform is possible. A program in which superior care and cost savings go hand in hand paves the way for a responsible expansion of Medicaid.

Mario J. Paredes is CEO of SOMOS Community Care, a network of more than 2.500 independent physicians—most of them primary care providers—serving more than a million of New York City’s most vulnerable Medicaid patients.

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