Academy Health Conference 

Academy Health, an organization promoting health policy and health systems research, held its Annual Research Meeting (#ARM24) tin July in Baltimore.  This conference brought together academics, policymakers, and stakeholders, to share research findings and ideas about health policy and health systems.  Spotlighted research topics included clinical delivery system issues such as the effects of pediatric mental health integration, and policy concerns such as the impact of Medicaid value-based payments.  

The Role of Research 

One highlight of the conference was a plenary session titled “Research During Polarized Time: How to Make Your Work Matter.” The session featured current and former government leaders and advisors including North Carolina Medicaid Director Emma Sandoe, Harvard health economist Ben Sommers, and Boston University Social Determinants of Health expert Sandro Galea. Participants discussed the pressures facing policymakers barraged with conflicting information and an evidence base that can lag behind the decisions needed in real time.  Former White House Advisor Cameron Webb discussed the challenges of responding to misinformation and described his strategy of engaging policymakers without disparaging the sources they brought to the table, but rather saying, “Let’s dig in deeper.”  

State Policy Innovation 

At the State Health Policy Interest Group, Centers for Medicare and Medicaid representatives talked about the need for more rigorous evaluations, including comparisons among states. Multiple speakers expressed the hope that Transformed Medicaid Statistical Information System (TMSIS) data will become more complete and reliable to enable rigorous cross-state analyses. State policymakers expressed their hope for more evidence on timely topics, including tribal health, home and community-based services (HCBS), Medicaid state-directed payments, and justice-involved populations.  From the state legislators’ perspective, a key question shared was what levers are available to address healthcare workforce shortages, especially in behavioral health.   

Many session presentations discussed states’ efforts to innovate through Medicaid 1115 Waivers, including to better address behavioral health needs and health-related social needs (HRSN) within Medicaid. The interface of Medicaid and community-based organizations (CBOs) is seen as key, and some research investigated whether and how to avoid shutting out smaller CBOs and those that serve disadvantaged populations. Emerging survey results found that CBOs participating in California Advancing and Innovating Medi-Cal (CalAim) say they have had positive experiences, improved financial stability, and better integration of services.  Smaller and Black, Indigenous and People of Color (BIPOC) focused CBOs may be participating at a lower rate, but it works well for them when they do. Kentucky also found that partnerships with CBOs were helpful for engaging hard to reach patients and reducing disparities. 

Dental services, and their intersection with behavioral health and HRSN, were also a big topic. Among states that provide “extensive” Medicaid dental benefits, there is still a lot of variation in what is covered and for whom. Many states are planning or considering expanding dental benefits.  

Some notable presentations included: 

• • The Arkansas Works Section 1115 Medicaid Waiver was successful in expanding access to coverage through the non-traditional approach, subsidizing Marketplace plans rather than providing traditional Medicaid coverage to the expansion population. Vanderbilt health economist Kevin Griffith noted that the positive results may depend on some specific elements of the Arkansas marketplace, such as the requirement that every plan include a federally-qualified  health center in its provider network. 

• • An Oregon Health & Science University team presented findings form a study of eight states with Section 1115 Medicaid Waivers of the Institutions for Mental Disease (IMD) coverage exclusion. They have found that outcomes improved most in states that used multiple system-wide strategies to improve access, including removing prior authorization requirements or other restrictions, and actively engaging Medicaid managed care organizations through technical assistance and incentives. 

• • Yale research Tamara Beetham presented results showing that IMD waivers have increased overall access to medications for opioid use disorder (MOUD), but the improvement was concentrated in areas with mostly White areas.  She attributed the disparity to the continued existence of “abstinence-only” treatment facilities, and recommended that state-licensed facilities be required to offer MOUD on site or through a partner as an essential standard of care.  

Health Equity 

Plenty of valuable research into health equity strategies was on display at oral and poster sessions.  Some takeaways included: 

• • Part of the disparity in pediatric outcomes after cardiac surgery can be explained by referral patterns. Black children are likely to see less experienced surgeons – even within the same surgery site.  A surgical facility’s approach to assigning surgeons to cases can reduce or exacerbate racial disparities. 

• • Doula care among higher risk women reduces cesarean section and preterm births, and increases rates of postpartum follow up visits including among Black women, reinforcing the importance of birth support to reduce disparities. 

• • Area Deprivation (socio-economic disadvantage) is associated with lower rates of well-child visits among non-White children, but not White kids. Much of the disparity is explained by provider-level fixed effects.  

• • Work requirements for the Supplemental Nutrition Assistance Program (SNAP) result in more people losing benefits, but no improvement in self-sufficiency.