Policy in Plainer English

The second half our of episode on screening for hunger and food insecurity. . . and you can probably guess what these show notes are going to say: start with the first half! 

In this episode, our original guests (Kristen Bigelow-Talbert and Katy Davis) are joined by Christina Quinlan from Islands Community Medical Services, Inc. in Maine.

The subtitle of this episode may be "in which Helen learns that three guest interviews is one guest too many for amateur podcasting." On the plus side, there's a lot of good information here about implementing hunger screening.  Maybe be prepared to take notes.  . .and definitely peruse what was covered in the first half of this two-parter before diving into the action-packed second half.

Looking for more on screening? Check out our episode on Help Me Grow for programs involving educators and child care providers in food insecurity screening and our background one-pager on the evolution of the most common screening tools. 

Kristen Bigelow-Talbert, from Bi-State Primary Care Association, and Katy Davis, from Hunger Free Vermont, discuss screening for hunger and food insecurity. If poor diet leads to poor health, and health care providers want their patients to stay well, then it makes sense that we would screen for poor diet just like we screen for high blood pressure, cholesterol, BMI, etc. - simple, right? Clearly not simple or we wouldn't be podcasting about it.

This episode provides background on the interest in screening for hunger / other social factors in our overall health, and some considerations for selecting screening tools. The second installment (linked here) looks at implementation, including lessons we might learn from trying new models during COVID-19. 

Some references from this episode:

• Community Health Needs Assessments - Definitely helpful as a prelude to this episode, in fact if you have a moment, start here.
• EHRs - This will be more important in Part 2, but you might as well get ahead.
• Hunger Vital Sign - One thing that didn't make it into the finished episode was Katy praising Children's HealthWatch on their work with this screening tool. Children's HealthWatch has a lot of excellent resources.
• PRAPARE - Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences. The Community Health Centers screening tool.  
• SBINS from Blueprint for Health - Screening, Brief Intervention, and Navigation to Services (acronym or to-do list? This sent me down a rabbit hole of looking up the precise definition of 'mnemonic' and I'm no closer to knowing what to call SBINS)
• Examples of other screening tools can be found in this toolkit from the Rural Health Information Hub. 
• Confused by the number of different tools? Here's a backgrounder on how they fit together.

This season of the Policy in Plainer English podcast is made possible through a grant from the Federal Office of Rural Health Policy to plan for a rural health network that increases communication around the intersection of food and health care in Vermont.

This episode gives a short introduction to our topic for Season Three. If you want more background information on food access in general here are some good starting places:

• Feeding America - includes Hunger and Health exploring health connections and the Map the Gap site for statistics
• Food Research and Action Center 
• USDA Food Security - includes definitions of commonly used terms like "food insecurity"
• Food is Medicine Coalition - this is for a very specific area of food work, but it's useful to know as an example of food prescribed to treat particular diseases
• NFACT - A UVM led project that uses survey data to capture food insecurity and concerns during COVID-19 response, including stay at home orders

And a few other items of interest referenced in the episode:

• If We All Ate Enough Fruit and Vegetables, There'd Be Big Shortages - NPR, 2019
• The Great Nutrient Collapse - Politico, 2017
• Behind Belle Gibson's Cancer Con - The Guardian, 2017 - I keep reading these stories because what I really want to know is, are the recipes any good? They didn't cure cancer, but how did they taste? It's not easy to write a cookbook you know. 
• Columbia and the Problem of Dr. Oz - The New Yorker, 2015

One topic we won't cover, but one where Vermont is particularly awesome, is food literally in health care - what food we serve at our hospitals. There's a whole movement around that (Healthy Food in Health Care) and a Vermont network. "Healthy" food in this context includes environmental health along with nutrition. It's a great set of initiatives, but beyond the scope of this series, so we're mentioning it now and for more details you'll have to follow the links above to learn more. 

This season of the Policy in Plainer English podcast is made possible through a grant from the Federal Office of Rural Health Policy to plan for a rural health network that increases communication around the intersection of food and health care in Vermont.

Update: The program described in this podcast is now live and accepting applications from Vermont practices until Oct 5: www.vpqhc.org/ccptelehealthvt

In a follow up to our telehealth series from this spring, we check in with Hillary Wolfley, Associate Director at the Vermont Program for Quality in Health Care on a new program designed to help patients cross the digital divide and access telehealth.

Some additional links referenced in this episode:

• Our earlier episode on Broadband for Telehealth (May 14, 2020).
  
  
• Bi-State's Vermont Telehealth Resources Guide, which we update regularly. 
  
  
• Recordings of (most of) the VPQHC telehealth office hours. At the beginning of the public health emergency the rules were changing so quickly that we didn't want to record and post things that were no longer true (that was also the time when we were not just date stamping the resource guide, we were hour stamping it). 
  
  
• Hillary references Telehealth Access for Seniors as a program VPQHC is working with, you might recognize some of their materials from the Telehealth Resources Guide in the section on patient communications. 

We're leaving telehealth and entering the world of food . . . food and health care (although, as former director of a restaurant and farmer association, I'm happy to talk about any element of food that might be of interest).

Before we completely exit the telehealth realm, I'm doing a few more quick updates and also reminding everyone that Bi-State Primary Care Association does track telehealth developments in a non-podcast format. Just hop over to our telehealth resource guide for all the updates and details you might ever want.

https://televermont.atavist.com/telehealth-in-vermont

We're wrapping up our special series on telehealth with a conversation with Georgia Maheras of Bi-State Primary Care Association, where we hit on some of the highlights of what we discussed over the season.

A few items referenced in this conversation that we have not previously linked are: VPQHC Twice-Weekly Telehealth Office Hours, I reference some early data which we discussed in a 2-part webinar series with VPQHC that will be posted here (June 11 & June 18), and we refer to the Milbank study on eConsults.

For current federal guidelines, we recommend the Center for Connected Health Policy.

About the same time we recorded this episode, the Freakonomics podcast came out with their summary of telehealth and the economics of telehealth. That would be a nice geeky prelude to browsing our full series:

• Telehealth Special Series - Intro
• Telemedicine vs. Telehealth (previously recorded)
• Telehealth Reimbursement & COVID-19 (note that specific rules change frequently, and for the most up to date version check this update page). 
• Telehealth and the Telephone
• Telehealth and the Telephone - Chronic Care Management (not everything fit in the first episode)
• Broadband for Telehealth
• Telehealth Reimbursement & COVID-19 Part Two (same caveat as above, check our update page if you want specific guidance)
• Teledentistry
• Telehealth and Provider Consultations
• Telehealth and Global Budgets (can't get enough of this topic? We recommend our Season One: Welcome to Payment Reform)
• Transportation and Telehealth 
• Final Episode 
• Bonus: VPQHC Connectivity Care Packages Pilot

For more telehealth information, check out our resource guide. 

This episode starts where we probably would have started a telehealth series in normal, non-COVID-19 times . . . looking at telehealth as one of the tools available to help overcome transportation-based barriers to accessing health care. Chris Towne, of Northern Counties Health Care*, and Dr. Brian Bates, of Mountain Health Center, join us to discuss this issue.

If you want to read more about options for public transit, including the state's plan for connecting patients to medical appointments, the Vermont Agency of Transportation released their Public Transit Policy Plan earlier this year.

Slide 9 in this presentation shows travel hours and miles saved in a telehealth pilot at UVMMC. 

If you want to read more about MAT programs in Vermont and their COVID-19 adjustments, UVMMC has this April 17 blog post. Also, the Rural Health Information Hub has this toolkit on using telehealth as part of MAT programs (in non-COVID-19 times). 

*Northern Counties Health Care was an original sponsor of this series - and if you feel it's totally unfair that a sponsor got a coveted interview spot then please, by all means, contact us and volunteer to be interviewed to even things out, we would love that. 

Here we check back in on a topic from Season One - global budgets. You may remember this as the final phase of our journey into value-based payment reform. But if this is the first time you've heard that phrase, never fear - we give a quick recap at the beginning. And an even shorter one here: 

A global budget means that instead of getting a fee for every service performed, health care providers or a network of health care providers (aka an Accountable Care Organization or ACO) get an annual budget designed to cover the costs of keeping all their patients well. 

Obviously it gets more complicated than that, hence Season One, but that's all you need to know to understand this discussion with Lawrence Miller of Five Vine Consulting. 

In this episode we're joined by Katie Marvin, MD, from Community Health Services of Lamoille Valley (CHSLV) and Jennifer Fenn, NP, from Northern Tier Center for Health (NOTCH) to talk about provider-to-provider connections through telehealth.

One thing this episode doesn't touch on is what is reimbursable in these systems, which use specialist input to keep treatment in primary care. There's a mixture of reimbursable and non-reimbursable items in this conversation.

eConsults are one form of "store and forward" telehealth - asynchronous connections that happen not in real time. In Vermont these were previously only reimbursable for dermatology and ophthalmology but recent legislation is opening them up to a range of specialties. As this episode describes, the hope is that this gets us to the much-sought-after health care moment of both improving access to care and saving significant money within the system. It also makes programs like the one at NOTCH (currently funded through a grant) sustainable and replicable. A very exciting telehealth moment. And, in full disclosure, one that Bi-State lobbied for - you can read our testimony on this topic here.

Thank you to Northern Counties Health Care for making this series possible.

At the end of last week, Governor Scott and the Vermont Department of Health authorized dental practices to start accepting non-emergency patients for the first time since the COVID-19 emergency began. Because of its aerosol generating procedures and the creation of droplets when performing work in mouths, dentistry has been particularly hard hit by this pandemic. Here we discuss some of the options available for remote work.

This episode features Dr. Rachel Rivard, Dental Director at Community Health in Rutland, and Dr. Joe Errante, Vice President for Network and Clinical Strategies at Northeast Delta Dental. Thank you to Northern Counties Health Care for sponsoring this special series on telehealth.

A few additional resources on this topic, taken from the Bi-State guide to telehealth implementation during COVID-19: 

• DentaQuest Partnership COVID-19 Response
  • Teledentistry in COVID-19 Webinar (April 6)
  • “Fast Track to Teledentistry” White Paper
• Mouthwatch COVID-19 Resource Hub
  • Mouthwatch - Adapting Teledentistry for COVID-19 with Dr. Paul Glassman
• NNOHA Collection of COVID-19 Resources
  • NNOHA Implementing Teldentistry During COVID-19 Webinar & Resources links (May 12)
• ADA Billing & Coding During COVID-19 Sheet (regularly updated)
  • Includes lists of policies by payer
• Memo from Northeast Delta Dental on Teledentistry & COVID-19
  • Northeast Delta Dental Teledentistry Presentation (4/30)
• Vermont Medicaid Teledentistry Reimbursement Memo