WEDNESDAY, OCTOBER 7, 2020

2:00 PM ET / 1:00 PM CT / NOON MT / 11:00 AM PT

CHRONIC DISEASE MANAGEMENT DURING COVID-19

Bipartisan membership organization

All 50 states and the territories

7,383 state legislators

All state legislative staff (30,000+)

Mission:

To improve the quality and effectiveness of state legislatures

To promote policy innovation and communication among state legislatures

To ensure states a strong, cohesive voice in the federal system

NATIONAL CONFERENCE OF STATE LEGISLATURES

CHRONIC DISEASE MANAGEMENT DURING COVID-19: AGENDA

COVID-19 Impact on Chronic Disease Susan Kansagra, MD, MBA, section chief, Chronic Disease and Injury, Division of Public Health, North

Carolina Department of Health and Human Services

Cardiovascular Disease Management Keith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLA, professor of medicine, Tulane University School of

Medicine

State Legislative Actions and Policy Options Jack Pitsor, research analyst, NCSL

Discussion and Q&A

COVID-19 Impact on Chronic Disease

Susan Kansagra, MD, MBA

Section Chief, Chronic Disease and InjuryNC Division of Public HealthNC Dept of Health and Human Services

Board PresidentNational Association of Chronic Disease Directors

5► https://www.cdc.gov/chronicdisease/pdf/infographics/chronic-disease-H.pdf

6► https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-underlying-medical-conditions.html

7► https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

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Prevalence of Chronic Disease Condition that Impact COVID Outcomes (NC)

51% 42%of adults in North Carolina are at higher risk for severe illness from COVID-19 based on being 65 or older, having at least one of the underlying health conditions, or both

of people in North Carolina have one of the health conditions that increases risk for a severe illness from COVID-19

https://files.nc.gov/covid/documents/dashboard/Risk-Factors-for-Severe-Illness-from-COVID-19.pdf

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Impacts of COVID on Delayed Care for Chronic Diseases

Overall, 41% of US adults have avoided medical care during the pandemic because of concerns about COVID-19; 12% avoided urgent/emergency care and 31.5% avoided routine care.

• 55% of with 2 or more underlying conditions compared avoided care• 42% of people without insurance compared to 25% with insurance avoided care• 55% Hispanic; 48% Black, non-Hispanic; 36% White, non-Hispanic avoided care• 49% believed to be in a group at high risk for COVID-19 compared to 39% who were not• Impact of delays in care:

Heart Disease• Lasting damage to heart muscle from

delayed care for heart attack• Increased risk of heart failure and death

Cancer• Tumor progression• Delays early detection• Lowers rate of cancer survival

Diabetes• Poorer diabetes control• Increase complications like kidney

and eye disease

https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a4.htm

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Prevention on Chronic Diseases – NC Resources

https://www.diabetesfreenc.com/

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NC Medicaid Telehealth Provisions Implemented for COVID-19

NC DHHS Medicaid implemented 125 telehealth flexibilities, which spanned 482 codes, during the public health emergency. Some of the provisions implemented were:

• 56 flexibilities for behavioral health, I/DD and TBI

• 15 flexibilities for CDSAs to bill for telehealth across multiple clinical services

• 6 flexibilities for pregnant and post partum services

• 6 flexibilities for DME prior authorizations

• 5 flexibilities for LEAs to bill across multiple therapies

• 4 flexibilities for teledentistry

• 4 flexibilities for outpatient specialized therapies (PT, OT, and Speech Audiology)

• 3 flexibilities for Well Child visits

• 3 flexibilities for optometry

• 2 flexibilities for respiratory therapy

• 2 flexibilities for physiological monitoring

• 2 flexibilities for dialysis services (ESRD and training)

• 2 flexibilities for consultants

There were 15 other general telehealth flexibilities implemented

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Deaths attributable to individual risk factors (in thousands), by disease

Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009) The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLOS Medicine 6(4): e1000058. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000058c

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A Healthier Population Increases Resiliency Against Health Threats

Creating a healthy, resilient population requires upstream policy, systems, and environmental changes

RIDOH Health Equity Framework adopted from Frieden T. A framework for public health action. AJPH. 2010.

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Other Resources

https://chronicdisease.org/resource/resmgr/website-2020/covid/factsheet_covid19cd.pdf https://mcusercontent.com/f5eb710db3/files/5afc0b37-6559-43e1-8664-ec5ae0e13a6d/FS_CDpolicymakers2020FINALv3.pdf

POLL

Impact of COVID-19 on Cardiovascular Disease

ManagementKeith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLAGerald S. Berenson Endowed Chair in Preventive Cardiology Professor of MedicineTulane University School of Medicine LA COVID-19 Health Equity Task Force Member

COVID-19: Cardiovascular Viewpoint

• Cardiovascular complications of COVID-19• Implications of delayed care on long term health and health care

systems• Disparities in cases and outcomes • Insights from the LA COVID-19 Health Equity Task Force

usaheartfacts.org

Coronavirus means Crown in Latin

Name of this Disease for Coronavirus :COVID-19

COVID-19:• 'CO' stands for 'corona,’• 'VI' for 'virus,’ • 'D' for disease• 2019

Visualizing What

COVID-19 Does to the

Body

https://www.neurodiem.com/

Mechanisms of New or Worsening Heart Failure With COVID-19

JACC HF online, 3 June 2020 https://doi.org/10.1016/j.jchf.2020.05.006

Numerous Variables Making African Americans More Vulnerable to COVID-19

…. “a mixture of the many difficulties faced by African Americans which may compound or even extend the burden for the coronavirus risk factors,” …Ferdinand, KC April 2020

https://www.nationalgeographic.com/history/2020/04/coronavirus-disproportionately-impacts-african-americans/

MMWR Early Release - Vol. 69, August 17, 2020

Numerous Variables Making African Americans More Vulnerable to COVID-19

• Working in service industries or “essential jobs” exposing themselves to infection;

• Using public transportation to get to work; • Lack of access to early testing; and • A historical distrust of the health-care system because of

previous bias.

https://www.nationalgeographic.com/history/2020/04/coronavirus-disproportionately-impacts-african-americans/

“…….sentinel event as an unexpected occurrence resulting in death or serious physical or psychological injury, or the risk thereof. Conventionally identified sentinel events, such as unintended retention of foreign objects and fall-related events, are used to evaluate quality in hospital care…”

Keith C. Ferdinand, Samar A. Nasser J Am Coll Cardiol. 2020 Jun, 75 (21) 2746-2748.

Remote Monitoring for Cardiovascular Risk Reduction: The Impact of COVID-19

https://www.keckmedicine.org/

Telehealth = Improved Healthcare?Flexibilities allow providers to:

• Conduct telehealth with patients in their homes and rural areas

• Deliver care to both established and (new?) patients • Bill for telehealth services (both video and audio-only) as if

provided in person• Educate patients in face-to-face visit• Loan (automated blood pressure cuff)

Thank You!

POLL

JACK PITSOR, RESEARCH ANALYST

TELEHEALTH STATE ACTIONS DURING COVID-19

All 50 states, D.C. and Puerto Rico modified their telehealth policies due to COVID-19.

35 states, D.C. and Puerto Rico enacted over 72 bills since March.

OVERVIEW OF STATE ACTIONS

Private Insurance Twenty states now maintain payment

parity requirements for private insurers (either permanently or temporarily).

Fifteen states and D.C. enacted other private insurance requirements during the pandemic.

ENHANCING PRIVATE INSURANCE AND MEDICAID COVERAGE

Medicaid Ten states enacted legislation extending

Medicaid coverage for telehealth. MD HB 1208—Chronic conditions case

management via telehealth

INCREASING PROVIDER AND PATIENT ACCESS TO TELEHEALTH

Out-of-State Providers & Provider-Patient Relationship

Originating Site Requirements

KY SB 150—Authorizes health practitioners licensed in another state or territory to deliver services via telehealth and waives in-person visit requirements

MN SF 4334—Expands the definition of originating site to include a patient’s home

Broadband Connectivity MS SB 3046—Establishes the COVID-19 Broadband

Provider Grant Program Fund

TEMPORARY VS. PERMANENT CHANGES

Extend beyond the declared emergency: CT HB 6001—Extends COVID-19

telehealth coverage requirements until March 2021

Enact permanent changes: NH HB 1623—Codifies the governor’s

telehealth emergency order into state law

ADDITIONAL RESOURCES—AND THANK YOU!

COVID-19 Resources

State Action on Coronavirus (COVID-19)

COVID-19: State Health Actions

Rural Health Care and COVID-19

The Health Workforce and COVID-19

Other Resources

Health Innovations State Law Database

Jack Pitsor, Research AnalystJack.Pitsor@ncsl.org | 303.856.1343

DISCUSSION AND Q&A

Please type your questions into the chat box in the lower left-hand corner of your

screen.

Thank you!Questions?

Contactkate.bradford@ncsl.org