In this series on options for universal coverage, we explore elements of various reform proposals and evaluate their potential impact. Rather than examining complete proposals, we highlight specific policy elements that appear in one or more such proposals. The three we focus on in this series are: Part 1 – Eliminating Medicare Advantage (May 14,… Read More » Author information Benjamin Silver Program Manager and Research Economist at RTI International Benjamin Silver is a Research Health Economist and a program manager in the Health Care Financing and Payment Program at RTI International. His current work includes government funded health policy research designign and implementing value-based alternative payment models on behalf of the Centers for Medicare & Medicaid Services and the Medicare Payment Advisory Commission. Dr. Silver also holds faculty appointments at Brown University and at Wheaton College, where he has taught undergraduate courses in U.S. public health policy. | LinkedIn | The post Options for Universal Coverage: Part 2 – Eligibility and Enrollment appeared first on The Medical Care Blog.

We don’t always think of health insurers as communicators. However, when insurers set reimbursement rates, they provide information that directly influences service delivery. When payors reimburse for certain services, they are informing providers these services are valued and providing these services is encouraged. When payors do not reimburse for services, or reimburse at lower rates,… Read More » Author information Emily Gillen I am a PhD health services researcher, with a background in economics, and experience in the implementation and evaluation of various health care delivery and financing models. My interests include alternative payment models and delivery system reform, commercial and Medicare Advantage plans, and the employer-sponsored insurance market. I have conducted analyses on the individual market and the Affordable Care Act and studied the effect of insurance benefits on utilization and outcomes. I am passionate about how incentives can be created, and information tailored, to facilitate better decision making in the health care system. | The post Medicare Advantage and Reimbursement to Address Social Risk Factors appeared first on The Medical Care Blog.

With less than five weeks to go before welcoming a second child, the patient sat in my exam room in tears. By all accounts, this was a routine appointment at the end of a routine pregnancy. Except on this particular day, clutching family photos from their recent baby shower, the patient shared with me that… Read More » Author information Rebekah Rollston Rebekah L. Rollston, MD, MPH, is Co-Founder of Doctors For A Healthy US (@OurHealthyUS), Affiliate Editor-in-Chief of the Harvard Primary Care Blog, Family Medicine Physician at Cambridge Health Alliance, and Clinical Associate at Tufts University School of Medicine. She earned her Medical Degree from East Tennessee State University James H. Quillen College of Medicine and her Master of Public Health from The George Washington University Milken Institute School of Public Health. Her professional interests focus on social influencers of health & health disparities, gender-based violence, sexual & reproductive health, self-esteem development, addiction medicine, rural health, homelessness & supportive housing, and immigrant health. | Twitter | Facebook | The post Deportation and the Traumatizing of a Generation appeared first on The Medical Care Blog.

Nursing facilities have been in the center of the COVID-19 pandemic and experienced sweeping policy changes. The pace of change has made it difficult to keep track of each new policy, so this post summarizes the key shifts from January through May. Nursing facilities are attempting to protect residents by ramping up existing infection control… Read More » Author information Abigail Ferrell Abigail Ferrell is a Public Health Analyst in RTI International’s Aging, Disability, and Long-Term Care program. | The post The Challenge of Change: Tracking COVID-19 Policy Updates for Nursing Facilities appeared first on The Medical Care Blog.

In this post we reflect on the definition of success in a study measuring the value of peer support services administered through the HUD VASH program and discuss client-centered definitions of value. We propose designing and understanding programmatic success goals tailored to unique need categories within veteran participant groups. With stay-at-home orders lifting all across… Read More » Author information Ben King Research Scientist at UT Austin, Dell Medical School Ben King is an epidemiologist and a Clinical Assistant Professor at the University of Texas at Austin, where he teaches Environmental Health. He is also a Research Scientist at UT Austin's Dell Medical School in the Department of Neurology and President of Methods & Results, a research consulting service. His own research is often focused on the intersection between housing, homelessness, & health. Other interests include neuro-emergencies, diagnostics, and a bunch of meta-analytic methods like measurement validation & replication studies. For what it's worth he has degrees in neuroscience, community health management, and epidemiology. | LinkedIn | The post Framing Success for Supportive Housing Services appeared first on The Medical Care Blog.

In many parts of the US and Canada, physician offices have reopened and are seeing patients again. After a long 3 months in lock-down patients and physicians alike are happy to be able to have appointments again – even at reduced capacity and with new safety measures in place. Both the American Medical Association and

Blog post by Joe Babaian Hi, I exist.     ~ Said by anyone overlooked, if they could only find their voice During this ongoing pandemic, we’re all seeing the significant impacts on healthcare, including changing methods of delivery. As telehealth shows a vigorous ascendancy, in-person clinical care walks the tremulous line of reconsidering the value (or

Next week, we are teaming up with the Canadian College of Healthcare Leaders @CCHL_CCLS on a tweetchat that will explore clinical practice guidelines in a pandemic. There are two aspects that we plan to discuss. First, we will be discussing clinical practice guidelines themselves. What are these? According to the American Academy of Family Physicians

This chat was originally scheduled for Tuesday June 2nd, but in recognition of everything happening in the world right now, we decided to not go forward with it on that day. We joined many in the #hcldr community in support of #BlackOutTuesday – a time to stop pushing our own agenda/promotions on social media so

As we know, much of health and indeed healthcare happens outside the four walls of your physician office or hospital. It happens at home, while you are walking in the park, or in line at the grocery store (6ft apart of course). The space between visits is our time…but how to do we reclaim it?

An introductory meeting of WHO’s Strategic and Technical Advisory Group for Tuberculosis (STAG-TB) was held on 24-25 June 2020. STAG-TB, which is comprised of 15 eminent experts from ministries of health, national TB programmes, academic and research institutions, civil society organizations, and communities and patients affected by TB. The group is led by Dr Ariel Pablos-Méndez as Chair,  and provides strategic advice to WHO's Director-General and the Global TB Programme on its TB response.In his keynote address, WHO Director General Dr Tedros emphasized the important strategic role of STAG-TB in efforts to end TB especially in light of the current COVID-19 pandemic. He said, “Even at this difficult time, with COVID-19 threatening the world, WHO remains committed to meet the TB targets and driving high-level action and investment. Commitments must be kept to address all communicable disease threats, and reach the triple billion targets, despite the COVID-19 crisis. Doing so offers hope to end avoidable death and suffering for millions of people worldwide at risk from preventable and treatable diseases like TB.”The meeting was opened by Dr Ren Minghui, WHO Assistant Director-General, Universal Health Coverage, Communicable and Noncommunicable Diseases Division. The first day focused on briefings from the WHO Global TB Programme secretariat on ongoing WHO efforts towards ending TB, preparations underway for the development of the 2020 progress report of the UN Secretary General on TB, and the impact of the COVID-19 pandemic on the TB response. The second day included a special session of STAG-TB members with WHO Director-General Dr Tedros Adhanom Ghebreyesus. Key partners – Stop TB Partnership, Global Fund and UNITAID also participated in this session.Dr Ariel Pablos-Méndez, STAG-TB Chair highlighted the group’s commitment to guide WHO’s TB response. He emphasized, “We need to leverage existing synergies between TB and universal health coverage to save lives. This is especially critical in this time of crisis. STAG-TB is dedicated to providing strategic direction that will guide WHO in supporting countries to accelerate progress and investment to reach targets set by the UN High-level Meeting on TB.”Dr Tereza Kasaeva, Director of WHO’s Global TB Programme appreciated the role of STAG-TB, she said, “The STAG-TB provides a critical contribution to WHO, and the world, in combatting TB. We look forward to receiving strategic advice from STAG-TB during this, and coming, years on how the world can meet commitments to end the TB epidemic especially in the face of new threats”.The next meeting of the STAG-TB will be held in November 2020.

The  Generation Equality Forum—a global gathering for gender equality, convened by UN Women and co-hosted by the governments of Mexico and France in partnership with civil society—today announced the leaders of the Generation Equality Action Coalitions, to achieve gender equality and all women’s and girls’ human rights. WHO, together with The United Nations Entity for Gender Equality and the Empowerment of Women (UN Women) have been invited to co-lead the Action Coalition focusing on ending gender-based violence. The Action Coalitions will deliver concrete and transformative change for women and girls around the world in the coming five years. They will focus on six themes  that are critical for achieving gender equality. In addition to the coalition on gender-based violence there are five other coalitions on economic justice and rights, bodily autonomy and sexual and reproductive health and rights, feminist action for climate justice, technology and innovation for gender equality, and feminist movements and leadership. Adolescent girls and young women will be at the heart of each Action Coalition’s work.    The 65 initial leaders of the Action Coalitions represent Member States, diverse feminist and women’s rights organizations, youth-led organizations, philanthropic entities, UN agencies and other international organizations ( full list here).  The Action Coalitions’ leaders bring deep commitment to and experience in advancing gender equality and women’s human rights and reflect the different experiences and identities of women and girls from around the world.    Further appointments of the Action Coalitions’ leaders will be made in the next few months, including private sector companies and youth-led organizations, to ensure intersectional and intergenerational leadership.  The Action Coalitions’ leaders were selected by the Generation Equality Forum Core Group, which includes France, Mexico, Civil Society and UN Women.  Five criteria  were followed to select the leaders, including evidence of leaders’ commitment and past record of achievement in the respective Action Coalitions’ themes.   The Action Coalitions are one of the key outcomes of the Generation Equality Forum that will kick off in Mexico City, Mexico, and culminate in Paris, France, in the first half of 2021. The Generation Equality Forum, accelerated by the Action Coalitions, will mobilize urgent action to make irreversible progress towards gender equality and women’s and girls’ human rights globally.  This announcement comes as the world responds to the impacts of COVID-19, which is exacerbating gender and other inequalities and disproportionally affecting women and girls in all countries. In this context of the pandemic, the Generation Equality Forum and Action Coalitions are important and urgently needed to get through this pandemic, to recover faster, and build a more just, inclusive, and equitable future for everyone. Next stepsThe Action Coalitions’ leaders will come together in the coming months to co-design concrete, game-changing Blueprints for action to be implemented over the next five years.  Beginning in September 2020, a set of virtual public conversations will mobilize and capture women’s and young people’s voices to inform the Action Coalitions.  The Action Coalition Blueprints will then be refined at the Generation Equality Forum in Mexico City, during the first part of 2021, and officially launched at the Generation Equality Forum in Paris, later in 2021.  The Action Coalitions aim to mobilize a broad support in addition to the leadership structure. A broad set of stakeholders will be involved in the design of the Action Coalitions during the next months and will be provided with opportunities to commit to transformative actions to advance gender equality and women’s rights. Violence against women is a major threat to global public health and human rights, cutting across boundaries of age, race, religion, ethnicity, disability, geography, culture and wealth. WHO is committed to working towards a world in which all women live their lives free of violence and discrimination. Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization 

Today marks the end of the 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC). This long, complex and difficult outbreak has been overcome due to the leadership and commitment of the Government of the DRC, supported by the World Health Organization (WHO), a multitude of partners, donors, and above all, the efforts of the communities affected by the virus. WHO congratulates all those involved in the arduous and often dangerous work required to end the outbreak, but stresses the need for vigilance. Continuing to support survivors and maintaining strong surveillance and response systems in order to contain potential flare-ups is critical in the months to come."The outbreak took so much from all of us, especially from the people of DRC, but we came out of it with valuable lessons, and valuable tools. The world is now better-equipped to respond to Ebola. A vaccine has been licensed, and effective treatments identified,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.“We should celebrate this moment, but we must resist complacency. Viruses do not take breaks. Ultimately, the best defence against any outbreak is investing in a stronger health system as the foundation for universal health coverage.”The outbreak, declared in North Kivu on 1 August 2018, was the second largest in the world, and was particularly challenging as it took place an active conflict zone. There were 3470 cases, 2287 deaths and 1171 survivors. Led by the DRC Government and the Ministry of Health and supported by WHO and partners, the more than 22-month-long response involved training thousands of health workers, registering 250 000 contacts, testing 220 000 samples, providing patients with equitable access to advanced therapeutics, vaccinating over 303 000 people with the highly effective rVSV-ZEBOV-GP vaccine, and offering care for all survivors after their recovery.The response was bolstered by the engagement and leadership of the affected communities. Thanks to their efforts, this outbreak did not spread globally. More than 16 000 local frontline responders worked alongside the more than 1500 people deployed by WHO. Support from donors was essential, as was the work of UN partner agencies, national and international NGOs, research networks, and partners deployed through the Global Outbreak Alert and Response Network. Hard work to build up preparedness capacities in neighbouring countries also limited the risk of the outbreak expanding.Work will continue to build on the gains made in this response to address other health challenges, including measles and COVID-19. “During the almost two years we fought the Ebola virus, WHO and partners helped strengthen the capacity of local health authorities to manage outbreaks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.“The DRC is now better, smarter and faster at responding to Ebola and this is an enduring legacy which is supporting the response to COVID-19 and other outbreaks.” As countries around the world face the COVID-19 pandemic, the DRC Ebola response provides valuable lessons. Many of the public health measures that have been successful in stopping Ebola are the same measures that are now essential for stopping COVID-19: finding, isolating, testing, and caring for every case and relentless contact tracing. In DRC, community workers were provided with training and a smartphone data collection app that enabled them to track contacts and report in real time rather than fill in laborious paper reports. Even when violence locked down cities, the community workers, many of them local women, continued to track and trace contacts using the application, something that was crucial for ending this outbreak.While this 10th outbreak in DRC has ended, the fight against Ebola continues. On 1 June 2020, seven cases of Ebola were reported in Mbandaka city and neighbouring Bikoro Health Zone in Equateur Province and an 11th outbreak was declared. WHO is supporting the government-led response with more than 50 staff already deployed and more than 5000 vaccinations already administered.WHO salutes the thousands of heroic responders who fought one of the world’s most dangerous viruses in one of the world’s most unstable regions. Some health workers, including WHO experts, paid the ultimate price and sacrificed their lives to the Ebola response. WHO thanks the many partners who supported the Government-led responseNote to EditorsWHO thanks the donors who provided funding to WHO for the Ebola response under the Strategic Response Plans: African Development Bank, Bill & Melinda Gates Foundation, Canada, China, Denmark, ECHO, European Commission/DEVCO, Gavi, the Vaccine Alliance, Germany, Ireland, Italy, Luxembourg, Norway, Paul Allen Foundation, Republic of Korea, Sweden, Switzerland, Susan T Buffett Foundation, UK DFID, UN CERF, USAID/OFDA, US CDC, Wellcome Trust, World Bank, World Bank Pandemic Emergency Financing Facility. Several donors also provided funding to the WHO Contingency Fund for Emergencies in recognition of the critical role the fund has played in responding to the Ebola outbreak.

The World Health Organization (WHO) is urging countries to expand access to rapid molecular tests for the detection of TB and drug-resistant TB in updated consolidated guidelines, released today. The guidelines are accompanied by an operational handbook to facilitate rapid implementation and roll out of rapid molecular tests by national TB programmes, ministries of health and technical partners.“The use of rapid molecular assays as the initial test to diagnose TB is recommended instead of sputum smear microscopy as they have high diagnostic accuracy and will lead to major improvements in the early detection of TB and drug-resistant TB,” said Dr Tereza Kasaeva, Director of WHO’s Global TB Programme.  “We now need to urgently ensure universal access to these rapid molecular tests. This will impact positively on reducing transmission and enabling faster access to accurate life-saving treatment that will lead to better outcomes for those affected.”The consolidated guidelines and the associated operational handbook recommend key updates of the approaches to diagnose TB including:The use of Xpert MTB/RIF assay, Xpert Ultra assay and Truenat assay as the initial test to diagnose pulmonary TB and to detect rifampicin resistance.  This replaces smear microscopy and culture.The use of Xpert MTB/RIF assay and Xpert Ultra assay for improved diagnosis of TB and rifampicin resistance in children, in specific specimens such as sputum, stool, nasopharyngeal and gastric specimensThe use of Xpert MTB/RIF assay and Xpert Ultra assay for improved diagnosis of TB and rifampicin resistance in patients with broad range of extrapulmonary TB.The Xpert MTB Rif assay has been used worldwide since 2010, while the Xpert Ultra assay and Truenat assay are new technologies. The above updates were signaled in January 2020 through a Rapid Communication from WHO in advance of the publication of the updated guidelines. The purpose was to help national TB programmes and other stakeholders plan and prepare in advance for the rapid transition to new diagnostic tools at country level.Globally, diagnosis of TB and drug-resistant TB remains a challenge with a third of people with TB and two-thirds of people with drug-resistant TB not being detected. Accelerated efforts to diagnose TB and drug-resistance are essential to end the global TB epidemic and achieve the targets of the political declaration of the UN high-level meeting, the WHO End TB Strategy, the UN Sustainable Development Goals, universal health coverage and the triple billion targets of WHO’s General Programme of Work.

Nucleic acid amplification tests (NAAT) are promising technologies for the rapid and accurate detection of TB and resistance to selected anti-TB agents. In December 2020, the World Health Organization (WHO) will convene a Guidelines Development Group (GDG) meeting to update its diagnostic guidelines on the use of NAATs to detect TB and resistance to selected anti-TB agents. Ahead of this meeting, WHO will commission reviews of relevant evidence on diagnostic accuracy for several NAAT assays.The following NAAT assays or classes of NAAT assays will be discussed by the GDG:Centralized assays that present end-to-end solutions for detection of TB and resistance to rifampicin and isoniazid (cDST: Index test 1);Cartridge-based technology for isoniazid and second-line drug resistance detection (XDR cartridge: Index test 2);Hybridization-based technology for pyrazinamide resistance detection (PZA LPA: Index test 3).To enable this process, WHO is issuing a public call for data, appealing to industry, researchers, national TB programmes and other agencies to provide suitable evidence for the performance of these technologies. The obtained data will be essential to facilitate the process of WHO policy updates.Please send relevant data by 1st August 2020, to [email protected] For more information on the parameters of the datasets, variables, and the process see below:Annex 1: Data requirementsIndex test 1: Centralized assays that present end-to-end solutions for detection of TB and resistance to rifampicin and isoniazid (cDST platforms).Desirable characteristics of the test: (a) Sample preparation workflow included; (b) Automated DNA extraction; (c) Automated PCR preparation; (d) Automated result interpretation; (c) Capacity per run: ≥24 tests; (d) Time from sample to full MDR-TB diagnosis: <12 hours; (e) Minimal desirable drug resistance detection: at least to INH and RIF.Study type: Clinical evaluation studies to confirm diagnostic performance on clinical samples.Study population: Random sample of unselected patients with signs and symptoms of TB, requiring evaluation for TB and/or resistance to isoniazid and rifampicin in sites of intended use.Reference standard: At a minimum, result of a single sputum culture and phenotypic DST, wherever applicable (liquid or solid, with speciation) should be included for each result of Index test 1. The use of a genotypic sequencing results where available will have an added value to confirm the presence of mutations in addition to phenotypic DST results.Index test 2: Cartridge-based technology for isoniazid and second-line drug resistance detection (XDR cartridge);Desirable characteristics of the test: (a) Automated real-time PCR; (b) Automated result interpretation; (b) Capacity per run: ≥ 4 tests; (c) Time test results: <4 hours; (d) Minimal desirable drug resistance detection: at least to INH and FQ.Study type: (a) Analytical validation studies measuring accuracy, precision, and reproducibility of the test in contrived specimens or panels, covering all key mutations to isoniazid and second-line drugs. (b) Clinical evaluation studies to confirm diagnostic performance on clinical samples.Study population: Patients with detected TB, requiring evaluation for resistance to isoniazid and second-line anti-TB agents in sites of intended use.Reference standard: At a minimum, result of a single sputum phenotypic DST (liquid or solid, with speciation) should be included for each result of Index test 2. The use of a genotypic sequencing results where available will have an added value to confirm the presence of mutations in addition to phenotypic DST results.Index test 3: Hybridization-based technology for pyrazinamide resistance detection (PZA LPA).Desirable characteristics of the test: (a) Automated or manual hybridization methodology; (b) Automated or manual result interpretation (c) Time from sample to test results: <24 hours; (d) Minimal desirable drug resistance detection: at least to PZA.Study type: (a) Analytical validation studies measuring accuracy, precision, and reproducibility of the test in contrived specimens or panels, covering all key mutations to pyrazinamide; (b) Clinical evaluation studies to confirm diagnostic performance on clinical samples;Study population: Patients with detected TB and resistance to rifampicin, requiring evaluation for resistance to pyrazinamide in sites of intended use;Reference standard: At a minimum, result of a single sputum phenotypic DST (liquid or solid, with speciation) should be included for each result of Index test 3. The use of a genotypic sequencing results where available will have an added value to confirm the presence of mutations in addition to phenotypic DST results.