Stakeholder Analysis: Medicare Diabetes Prevention Program Awareness and Implementation

Study Design: We conducted a qualitative stakeholder analysis project with suppliers of the MDPP and health care providers. Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points More than 5 years after CMS enacted coverage of the CDC-approved Medicare Diabetes Prevention Program (MDPP) in 2018, little is known about why MDPP uptake is so limited. * Findings of our stakeholder analysis with program suppliers and health care providers reinforced existing evidence on insufficient reimbursement and low awareness of the program. * Newer insights include recommendations about lagged payments, ongoing virtual delivery, and formally diagnosing prediabetes among MDPP participants. * Our findings on barriers and facilitators can inform policy to refine the MDPP and research on the MDPP, particularly within the field of implementation science. _____ Population-level strategies to prevent type 2 diabetes are urgently needed for the more than 24 million older adults with prediabetes in the United States.1 Evidence-based lifestyle interventions can prevent diabetes onset, per evidence from the landmark Diabetes Prevention Program trial.2 Thus, the CDC launched the National Diabetes Prevention Program (NDPP) in 2010.3 Significant reductions in weight and medical spending were observed among Medicare beneficiaries who participated in the NDPP,4 prompting CMS to fully cover the Medicare Diabetes Prevention Program (MDPP) starting in 2018.5 Despite unprecedented Medicare coverage for a disease prevention program, MDPP uptake is limited. Regarding awareness, national guidelines recommend referral to lifestyle intervention for adults aged 40 to 70 years with prediabetes.9 Yet less than 5% of adults eligible for a NDPP reported receiving a referral,10 which may stem from limited awareness among health care providers.11 Thus, we conducted a qualitative stakeholder analysis to learn about regional awareness of, referral to, facilitators of, and barriers to the MDPP. The 8 interviewees included 5 program directors (3 from YMCAs, 1 from a private organization, and 1 from a hospital system) and 3 health care providers (2 family physicians and 1 dietitian).

Screening for Social Determinants of Health Among Medicare Beneficiaries in Primary Care During the Covid-19 Pandemic in Prince George's County, Maryland.

Primary care providers in Prince George's County, Maryland reported inconsistencies in their ability to identify and refer patients with social care needs. This project aimed to improve health outcomes of Medicare beneficiaries by implementing social determinant of health (SDOH) screening to identify unmet needs and improve rates of referral to appropriate services. Buy-in was achieved from providers and frontline staff via stakeholder meetings at a private primary care group practice. The Health Leads questionnaire was modified and integrated into the electronic health record. Medical assistants (MA) were trained to conduct screening and initiate care plan referrals prior to visits with the medical provider. During implementation, 96.25% of patients (n = 231) agreed to screening. Of these, 13.42% (n = 31) screened positive for at least one SDOH need, and 48.39% (n = 15) reported multiple social needs. Top needs included social isolation (26.23%), literacy (16.39%), and financial concerns (14.75%). All patients screening positive for one or more social needs were provided referral resources. Patients who identified as being of Mixed or Other race had significantly higher rates of positive screens (p = 0.032) compared to Caucasians, African Americans, and Asians. Patients were more likely to report SDOH needs during in-person visits (17.22%) compared to telehealth visits (p = 0.020). Screening for SDOH needs is feasible and sustainable and can improve the identification of SDOH needs and resource referrals. A limitation of this project was the lack of follow-up to determine whether patients with positive SDOH screens had been successfully linked to resources after initial referral.

Physical to virtual: challenges and opportunities for a neighbourhood-based employment support initiative

PurposeThis paper aims to explore challenges and opportunities of shifting from physical to virtual employment support delivery prompted by the Covid-19 pandemic. It investigates associated changes in the nature and balance of support and implications for beneficiary engagement with programmes and job search.Design/methodology/approachThe study draws on longitudinal interviews conducted with beneficiaries and delivery providers from a neighbourhood-based employment support initiative in an English region with a strong manufacturing heritage between 2019 and 2021. The initiative established prior to the Covid-19 pandemic involved a strong physical presence locally but switched to virtual delivery during Covid-19 lockdowns.FindingsMoving long-term to an entirely virtual model would likely benefit some beneficiaries closer to or already in employment. Conversely, others, particularly lone parents, those further from employment, some older people and those without computer/Internet access and/or digital skills are likely to struggle to navigate virtual systems. The study emphasises the importance of blending the benefits of virtual delivery with aspects of place-based physical support.Originality/valuePrevious studies of neighbourhood-based employment policies indicate the benefits of localised face-to-face support for transforming communities. These were conducted prior to the Covid-19 pandemic and the more widespread growth of virtual employment support. This study fills a gap regarding understanding the challenges and opportunities for different groups of beneficiaries when opportunities for physical encounters decline abruptly and support moves virtually.

Experiences of Female-headed Households in the ADRA Cash Transfer Programme in Zvishavane, Zimbabwe

The social, economic, and political crises in Zimbabwe have resulted in extreme poverty and the female-headed families are no exception. The COVID-19 pandemic exacerbated poverty and food insecurity in rural households. This sudden shock was not anticipated, and many governments failed to sustain livelihoods for smallholder farmers who relied solely on farming activities and selling of farm produce. The state has failed to fulfil its basic mandate of social service provision to the most vulnerable sections of society. Consequently, the Basic Agricultural Assistance programme was introduced as a microeconomic stability tool to buffer income risks faced by the poor. The article aimed to discuss the experiences of female-headed households in the Adventist Development and Relief Agency cash transfer Programme in Nganunu Village in Zvishavane. A phenomenological research approach through an exploratory qualitative research design was used to get in-depth insights on the experiences of female-headed households. In-depth interviews and focus group discussions were used to collect data. Content thematic analysis was used to analyse data. Findings indicated that despite health, political and economic crises, the implementation of the Adventist Development and Relief Agency cash transfer was a success in bridging the gap left by the collapse of the social welfare system. The cash transfer programme empowered female-headed households to access agricultural inputs timeously. Female-headed households were capacitated to make decisions and improve food security in and to initiate social cohesion with other beneficiaries. The study recommended inter-sectoral collaborations between state and non-state actors for more effective programmes that cushion female-headed households from poverty.

Psychosocial Programming in Uganda: Adaptations during COVID-19

The COVID-19 pandemic brought concerns about mental health to the fore. While more and more people struggle with the mental health effects of experiencing a global pandemic, people in humanitarian settings may be even more at risk. In humanitarian settings, it may be more challenging to ensure accessible to mental health services and support staff who are implementing essential programmes amidst concerns for their own health. We present a report of programme adaptations during COVID-19, including measures to support staff wellbeing, communicate with donors to support protective measures, and adapt programmes to be safer and more accessible for beneficiaries. Lessons learned from adaptations during COVID-19 can inform additional programming in humanitarian settings, especially in sub-Saharan Africa.

Dual-Eligible Beneficiaries and Inadequate Access to Primary Care Providers

Known as "dual-eligible beneficiaries," they account for 20% of Medicare beneficiaries and 15% of those receiving Medicaid, but account for one-third of total expenditures for each program.1 Most qualify for Medicare on the basis of age or a disability, and all dual-eligible beneficiaries have incomes below or near the federal poverty level. AHRF data were also used to identify PAs in each county. Because the HPSA designation only considers PCPs, to identify primary care NPs (PCNPs) we used methods previously developed, based on National Provider Identifier numbers from CMS.4 We calculated the county-level number of PCNPs and PAs per 1000 population and categorized them into the highest (ie, ≥ 75th percentile) and lowest (ie, < 25th percentile) supply density quartiles. [...]in the face of the competing challenge of the coronavirus disease 2019 (COVID-19) pandemic, we observed the prevalence of infection rates in counties with a high density of dual-eligible beneficiaries to understand the challenge of coordinating care for these beneficiaries. The quality of care provided to vulnerable populations, such as dual-eligible beneficiaries, by PCNPs and PAs has been proved to be comparable with that delivered by PCPs.11-13 However, at the state level, scope-of-practice regulations often restrain the flexibility of having care furnished by nonphysician providers.

Examining the re-territorialisation of beneficiary accountability: Digitising nonprofit services in response to COVID-19

This research explores change in accountability toward beneficiaries within nonprofit organisations (NPO) during the first wave of COVID-19;specifically, through the digitalisation of NPOs' services. COVID-19 was a time of great change, where chaos replaced a level of order and routine in organisations' established structures and systems. Accordingly, this research uses understandings from Deleuze and Guattari to explore territorial changes within two NPOs' regimes of beneficiary accountability as a result of COVID-19 and their actions in attempting to restore order. Findings suggest that although disruption was produced by COVID-19, responses by the NPOs resulted in digitised changes to service provision that predominantly saw positive experiences for beneficiaries in each NPO. Findings demonstrate how organisational responses to unanticipated change, through the digitalisation of service provision, impacted upon the beneficiary accountability regimes in ways that both expanded and restricted their territories. Here consideration is given to shifts in territory and emphasis on accounting for-the-self versus accounting for-the-other. A theoretical contribution is made toward understanding how NPOs might work to produce order in times of chaos through considering their territories of accountability. © 2023 British Accounting Association

CHALLENGES EXPERIENCED BY FEMALE HEADED HOUSEHOLDS IN UTILISING CASH TRANSFERS: CASE OF ZVISHAVANE, ZIMBABWE

The Adventist Development and Relief Agency- Zimbabwe (ADRAZimbabwe) is one of the non-governmental organizations that has been conducting a cash transfer programme to help alleviate poverty in Zvishavane District, Zimbabwe. The unexpected Covid-19 outbreak posed significant socio-economic shocks on female headed households, further exacerbated by a crippling state support for vulnerable groups. The objective of the study was to explore the challenges faced by female headed households in the Basic Agricultural Assistance, a cash transfer programme in Zvishavane, Zimbabwe. In-depth and Focus group discussions were used to gather data on the challenges that women face in the cash transfer program. Findings indicated that although the Basic Agricultural Assistance programme was introduced as a micro economic stability tool to buffer income risks faced by the poor, external factors like the political and economic crises have deterred the cash program to comprehensively reduce poverty in female-headed households. The constraining cultural and patriarchal norms deterred most women in achieving autonomy. Furthermore, cash transfers only targeted a portion of the female-headed households. Most of these women experienced difficulty in accessing markets to purchase farm implements amidst the Covid-19 pandemic. This paper recommends that the Basic Agriculture Assistance Programme should consider grassroots approaches in project initiation and implementation. In other words, the beneficiaries themselves should be consulted and should have a say on projects to be initiated in their communities and these projects should be line with their needs.

Women Suffering from Multiple Sources of Oppression in Upper Egypt: A Case Study of Intersectional Targeting and Integrated Development Interventions as the Way Out

Scholars in the field of gender and development are strong advocates of the concept of "intersectionality," first coined by Crenshaw in 1989, as a way of thinking about how marginalized groups may be subjected to oppression from various sources. The main purpose of this research is to make a case for how intersectional targeting, together with integrated development interventions, can be useful in helping vulnerable individuals, specifically women, suffering from multiple sources of poverty and oppression. A case study, coupled with in-depth field interviews, was the method employed for assessing the application of an intersectional lens by a nonprofit development organization (ENID) that targets vulnerable poor, illiterate, and unemployed women living in marginalized rural communities in South Egypt and employs integrated development interventions to get them out of poverty. Working on upgrading basic services, promoting small and micro enterprises, fostering sustainable agricultural development, initiating a program for knowledge dissemination and policy advocacy were some of the features of the integrated development approach utilized by ENID. The research findings indicated that ENID activities may have had a positive impact on reducing poverty and empowering women in the rural villages of South Egypt. Many challenges were faced related to government bureaucracy, restrictive cultural norms, and the COVID-19 pandemic. However, on the positive side, poverty was reported to have declined by 14.5% in absolute terms from 2015-2018 in Qena governorate where ENID works. More investments are being directed to the region, and the women beneficiaries attest to lifechanging experiences, enhanced self-confidence, and empowerment.

Applying Nurse Practitioner Student Reflections in Design of Telehealth Curricula

Telehealth demand increased precipitously among all populations, particularly Medicare beneficiaries with complex care needs, during the coronavirus disease 2019 pandemic. Current nurse practitioner (NP) graduates require practice readiness in telehealth when transitioning to advanced practice. Competency-based education models integrate progressive, multimodal evaluation of core practice competencies, including telehealth. Self-reflection supports student acquisition of new competencies. Thematic analysis of guided reflections after a pilot gerontologic robot-enabled telehealth simulation identified curricular opportunities in a primary care NP program. NP students' perceived challenges in communication and adaptation to virtual patient presence were considered in building integrated telehealth curricula in clinical courses applying the 4Ps of Telehealth Education (Planning, Preparing;Providing;and Performance Improvement) framework.

Association between broadband capacity and telehealth utilization among Medicare Fee-for-service beneficiaries during the COVID-19 pandemic.

BACKGROUND: Telehealth is a rapidly growing modality for expanding healthcare access, especially in the post-COVID-19 era. However, telehealth requires high-quality broadband, thus making broadband a social determinant of health. The objective of this study was to evaluate the association between broadband access and telehealth utilization across the United States during the COVID-19 pandemic. METHODS: Using a cross-sectional, ecological study design, we merged county-level data on broadband capacity (Microsoft's Rural Broadband Initiative), telehealth utilization among Medicare Fee-for-Service beneficiaries from January through September 2020 (CareJourney), and county-level socioeconomic characteristics (Area Health Resources Files). Multivariable linear regression was used to estimate the association between broadband capacity, county-level characteristics, and telehealth utilization. RESULTS: Among the 3107 counties, those with the greatest broadband availability (quintile 5) had 47% higher telehealth utilization compared to counties with the least broadband availability (quintile 1). In the adjusted model, a 1 standard deviation (SD) increase in broadband access was associated with a 1.54 percentage point (pp) increase in telehealth utilization (P < 0.001). Rural county designation (-1.96 pp; P < 0.001) and 1 SD increases in average Medicare beneficiary age (-1.34 pp; P = 0.001), number of nursing home beds per 1000 individuals (-0.38 pp; P = 0.002), and proportion of Native Americans/Pacific Islanders (-0.59 pp; P < 0.001) were associated with decreased telehealth utilization. CONCLUSION: The association between broadband access and telehealth utilization and the decreased telehealth utilization in rural areas highlight the importance of broadband access for healthcare access and the need to continue investing in broadband infrastructure to promote equitable healthcare access across populations.

Factors Associated with Mental Health of Medicare Beneficiaries During the COVID-19 Pandemic.

OBJECTIVES: This study examined factors associated with the mental health of Medicare beneficiaries during the COVID-19 pandemic. METHODS: The Medicare Current Beneficiary Survey COVID-19 Supplement administered in the Fall of 2020 of beneficiaries aged ≥65 years was analyzed (n = 6,173). A survey-weighted logistic model, adjusted for socio-demographics and comorbidities, was performed to examine factors (e.g., accessibility of medical/daily needs, financial security, and social connectivity) associated with stress/anxiety. RESULTS: Of Medicare beneficiaries, 40.8% reported feeling more stressed/anxious during the pandemic. Factors that were associated with this increased stress/anxiety include the inability to get home supplies (95% CI [3.4%, 16.5%]) or a doctor's appointment (95% CI [1.7%, 20.7%]), feeling less financially secure (95% CI [23.1%, 33.2%]) or socially connected (95% CI [19.1%, 25.6%]), and being female (95% CI [7.2%, 12.2%]), when compared with their respective counterparts. Non-Hispanic blacks were less likely to report feeling more stressed/anxious than non-Hispanic whites (95% CI [-19.9%, -9.0%]). CONCLUSIONS: Our findings highlight that beneficiaries' mental health was adversely influenced by the pandemic, particularly in those who felt financially insecure and socially disconnected. CLINICAL IMPLICATIONS: It is warranted to screen at risk beneficiaries for stress/anxiety during Medicare wellness visits and advocate for programs to reduce those risk factors.

COVID-19 Vaccine Hesitancy Among Medicare Beneficiaries with and Without Cancer History: A US Population-based Study.

Understanding COVID-19 vaccine hesitancy among Medicare beneficiaries is critical for increasing COVID-19 vaccine uptake in the US. This study aimed to estimate and compare the vaccine hesitancy rate among community-dwelling Medicare beneficiaries with and without cancer history, also to investigate factors associated with vaccine hesitancy during the first four months after COVID-19 vaccine became available. We used population-based, cross-sectional data on 3,034 community-living Medicare beneficiaries from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 Supplement. Sample weights were applied to account for the complex survey design with results generalizable to 16.4 million Medicare beneficiaries. Weighted multivariable logistic regression model was conducted to investigate the association between cancer history and vaccine hesitancy adjusting for covariates. A total of 39.6% were hesitant about getting COVID-19 vaccine. Those with cancer history were significantly less likely to be hesitant to get vaccinated than those without cancer history (adjusted odds ratio = 0.80, 95% confidence interval: 0.64, 0.99, p = .050). The most common reason for being hesitant to get COVID-19 vaccine was that the vaccine could have side effects or was viewed as not safe (19.2%), followed by not trusting what government says about vaccine (11.4%). Those with cancer history were more likely to report ongoing health conditions, lack of recommendation from a doctor, and doctor recommending against COVID-19 vaccination as reasons for not getting the vaccine compared to participants without cancer history. Increasing the confidence and knowledge about vaccine benefits among high-risk and more hesitant individuals are urgently needed to increase the vaccine uptake.

Association between social connectedness and stress or anxiety among older cancer survivors during the 2020-2021 winter surge of the COVID-19 pandemic.

INTRODUCTION: Our goal was to estimate a relative decreased rate of social connectedness to family and friends, increased rate of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic, and investigate the association between social connectedness and stress or anxiety among a nationally representative sample of older adults with cancer history. MATERIALS AND METHODS: We used population-based, nationally representative cross-sectional data from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 Community Supplement. The study cohort included community-living Medicare beneficiaries aged 65 years and older who self-reported cancer history (other than skin cancer) (n = 1650). Sample weights were applied to account for the complex survey design, with results generalizable to 8.5 million Medicare beneficiaries with cancer history. The outcome was self-reported feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. The independent variable was social connectedness, defined as feeling less socially connected to family and friends during the 2020-2021 winter surge of the COVID-19 pandemic. We conducted weighted descriptive statistics and multivariable logistic regression analyses. RESULTS: Overall, 42.5% of beneficiaries reported decreased social connectedness to family and friends, and 37.8% reported increased feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. After adjusting for all covariates, participants who reported decreased social connectedness had 154% higher odds of increased feelings of stress or anxiety (adjusted odds ratio [AOD] = 2.54, 95% confidence interval [CI] = 2.00-3.20, p ≤0.001) compared to those who reported more or about the same social connectedness to family and friends. The odds of increased feelings of stress or anxiety were also higher for those who self-reported as Hispanic vs. non-Hispanic White beneficiaries (AOR = 1.35, 95% CI = 1.10-1.73, p = .016), women vs. men (AOR = 1.85, 95%CI = 1.43-2.38, p ≤0.001), and those who reported depression history vs. not reporting depression history (AOR = 2.55, 95% CI = 1.86-3.48, p ≤0.000). DISCUSSION: An estimated 3.6 million older adults with cancer history reported decreased social connectedness to family and friends, and 3.2 million reported increased feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. Identifying these adults and referring them to appropriate supportive care resources and services are essential to help them cope with negative feelings.

SOCIAL ASSISTANCE FOR THE ELDERLY AND LEGISLATIVE CHALLENGES DURING COVID 19

The proliferation of clandestine homes for elderly people is encouraged by the underfunding of the establishment of such centres by central or local public administration authorities and the small number of places available at already existing centres or the poor conditions that are provided. The elderly represents a vulnerable category, most of the people who live in such centres have a precarious financial or family situation or various chronic diseases that require constant medical care. Through this study, we want to analyse the causes and possible legislative solutions that can lead to the improvement of the lives of these people.

BEING SOCIAL WORKER DURING THE COVID-19 PANDEMIC

This paper presents the results of qualitative research on the work of social workers during the COVID-19 pandemic. Data were collected by applying an interview guide, to which 18 social workers responded. The results of the research, interpreted through storytelling, refer to how social workers perceived the measures taken by the government during the pandemic and its influence on their work with the beneficiaries. Difficulties during the pandemic, Positive aspects of the pandemic and Roles of social workers in the pandemic are also presented.

An Assessment of Coping Mechanism for Reducing Unemployment Syndrome among Graduates in Nigeria

This study was conducted to access the impact of coping mechanism on unemployment syndrome reduction among the graduate youths in Osun state, Nigeria. Survey method was used in this study and purposive sampling technique was adopted to collect data through administration of questionnaire. Two set of groups were involved. Four hundred and seven copies of questionnaire were administered on graduate benefiaries of N power in Osun State and 60 copies of questionnaire were also administered on the supervisors in each of the 30 local government areas of Osun State. (2 per local government). Linear Regression analysis was used to achieve the formulated hypotheses and objectives. The findings showed that Hypothesis 1 R2= 0.620, sig= 0.000, p < 0.05), for Hypothesis 2 (R2=0.455, sig =0.000, p < 0.05). The study established that individual commitment, self assiduous, focus and goal oriented are keen to self sustainability in this current situation in Nigeria today. The study concluded that individual determination (individual commitment, Focus, goal oriented and self assiduous) as coping mechanisms have significant impact on unemployment syndrome reduction among graduates in Osun State. Therefore, the study recommended that government should intervene and practically involve in the activities of the beneficiaries of any fund release to reduce unemployment in this era of ongoing COVID 19 pandemic in Nigeria to reduce economic wastage of fund.

Providing social services in Romania, during the pandemic generated by Coronavirus

The purpose of this paper is to analyze the influence of the pandemic on the provision of social services in Romania that have experienced a development only in recent years, so the institutional organization at central level contributed to the elaboration of the first legislative regulations that took into account a number of beneficiaries such as: children in difficulty, the elderly, people with disabilities, users of banned substances and victims of domestic violence. Social services are mainly aimed at people who are in an unfavorable social situation and who cannot have a basic basis for their lives or who urgently need help for other serious reasons. The COVID-19 pandemic has had a negative impact on social services, with massive outbreaks being reported in all care facilities around the world, affecting not only residents, but also caregivers and visitors. [ FROM AUTHOR]

Ayushman Bharat Mission: Protect the Health of Families in Uttar Pradesh, India

According to the 2011 Socioeconomic and Caste Census Database (Ayushman Bharat for a New India -2022, Announced, nd.), it aims to cover about 40% of India's population divided into rural and urban areas. For implementation of Ayushman Bharat scheme states are free to choose either their own health insurance model or PMJAY. Because it is noted that states are at different levels of development and have varying capacity to manage such schemes. The medical insurance under Pradhan Mantri Jan Arogya Yojan incorporates hospitalization expenses of beneficiaries and also incorporates elements likes health checkups, advice and treatment;services before hospitalization;non-intensive care and critical care services;medicine and medical consumables;diagnosis and inspection services;accommodation;medical implant service as much as possible;diet expenses;complications that occur during treatment;up to 15 days follow-up treatment costs and treatment of Coronavirus. Beggar, Domestic helpers, Worker related to collection and sells of rags, Cobbler/Street Vendor/Hawker/Other street service providers, Plumber/Constructor/ Brickman/Painter/Worker/ Welder/Security Guard/Coolie, Sweeper/Gardener/Sanitation Worker, Artisan/Handicrafts Worker/Tailor/Home-based Worker, Driver/Transport Worker/Conductor/Cart or Rickshaw Pullers/ Driver or Conductor's assistant, Workers in shops/ Peon in Small enterprises/Assistant/workers/Attendant/Delivery Agents/ Waiter, Assembler/Mechanic/Electrician/Repair Worker and Watchman/Washer-man [12].

When a request turn is segmented: Managing the deontic authority via early compliance

By drawing on service encounter data in Japanese, this paper analyzes a previously undocumented request action initiated by a service provider to a client as a necessary step to provide the service. The service provider and their client, both exercising respective deontic rights, collaboratively construct a request turn in particular ways. In this case, due to the Japanese SOV word order, the service provider takes advantage of segmenting their request turn to allow the recipient clients to begin compliance, who thereby acquiesce to the service provider's deontic authority at the earliest point. By bringing the request turn to completion after the client's compliance while reflexively showing their deontic and beneficiary stances in the turn final component, the service provider displays commitment to balancing out their relative deontic status to the client. [ FROM AUTHOR]