Boston Business Journal: Harvard Law School study seeks to prove health insurance should fund food as medicine

Boston Business Journal
June 26, 2014

Harvard Law School study seeks to prove health insurance should fund food as medicine

Imagine that you are a diabetic. Except you can’t speak English, don’t read, and don’t have any food in the cupboard. It’s a scenario likely to end in an emergency room visit, and is a predicament that Massachusetts-based Community Servings, and more recently Harvard Law’s Center for Health Law and Policy Innovation, is seeking to alleviate. The two organizations have partnered together in a recently released study to prove why food is medicine, and to encourage insurance providers and hospitals to help pay for medically tailored meals.

 

Read the full news story.

National Journal: Is Obamacare Living Up to Its Preexisting-Conditions Promise?

National Journal
June 23, 2014

Is Obamacare Living Up to Its Preexisting-Conditions Promise?

Insurance companies may have found a way to skirt one of Obamacare’s most popular promises: equal access to insurance coverage for patients with preexisting conditions…”Insurance companies have a long history of undertaking practices designed to restrict [high-risk pools]—through preexisting-protection preclusions, and higher premiums,” said Robert Greenwald, director of the Center for Health Law and Policy Innovation at Harvard Law School. “All those options are now off the table clearly and explicitly. So what we’re seeing instead are other practices—lack of transparency, failing to cover other medications, refusing to accept third-party payments, or the tiering of medicines.”

 

Read the full news story.

Bridging the Gap between Cultural Communities and Health Providers

Bridging the Gap between Cultural Communities and Health Providers: Peers for Progress Consolidates Research Findings, Discussions, and Directions

On June 17 and 18, doctors, health researchers, and other medical leaders convened at the Omni Hotel in downtown San Francisco with a common goal: presenting and promoting the evidence for the medical, social, and financial contributions of community health workers (CHWs) in diabetes prevention and management. Collectively, the attendees presented research that has been conducted across several countries in addition to the United States: Cameroon, Canada, China, Thailand, and the United Kingdom. The conference provided a productive platform for attendees to exchange ideas, discuss diabetes management methods within different cultural contexts, and identify how to best institutionalize CHWs within the health system without compromising their unique, localized contributions to their communities.

Peers for Progress and The National Council of La Raza (NCLR) jointly coordinated the conference as part of the National Peer Support Collaborative Learning Network. The Center for Health Law and Policy Innovation (CHLPI) contributed to the research by generating two white papers regarding CHWs and other non-licensed providers. The first paper, Affordable Care Act (ACA) Opportunities for Community Health Workers, generally explores the policy and legal framework underlying the ACA, which increases the role of CHWs within the US healthcare system. The second paper, Community Health Worker Credentialing, more specifically discusses different state approaches to recognizing and reimbursing their CHWs through both public and private insurance. While CHLPI has traditionally referred to non-licensed providers as CHWs, Peers for Progress applies the terminology generally as “peer supporters.”

The two-day program was divided into two structures of activity. On the first day, attendees broke into two groups in order to learn more about topics for which they had less prior knowledge. Two CHLPI students, Nina Souliopoulos and Qing Qing Miao, had the privilege to present CHLPI’s papers to conference participants. The day concluded with a dinner and rich panel presentation from CHWs of the Bay Area peer support programs who have applied their personal experiences from managing disease to helping other patients manage their illnesses.

The second day was a marathon event that alternated between presentations by Peers for Progress research grantees and discussions of the research, all of which were divided among three topics: (1) outcomes of applying peer support education and interventions in diabetes self-management; (2) challenges in peer supporters program development; and (3) the technological and cultural methods for diabetes management.

Personal highlights came from the introduction given by Ed Fisher, the Global Director of Peers for Progress. Mr. Fisher set the attitude for the conference, directing our attention to the very basic human function that peer supporters (including CHWs) serve within their respective communities. Patients with diabetes and other chronic illnesses might be able to access medication for disease self-management; however, without the support, guidance, and care of individuals with similar conditions to whom they can relate, patients cannot achieve a level of recovery as they would otherwise. “We like to be with, be around, have contact with, and engage with other people,” Fisher stated in reference to Harlow’s famous Reesus Monkey study that he presented along with his point about the human need for social interaction.

Another presenter was Justin M. Nash, Ph.D. in the Departments of Family Medicine and Psychiatry & Human Behavior at Brown University, who discussed an issue raised in CHLPI’s white paper, Community Health Worker Credentialing. “We need to be sure we don’t lose the uniqueness of the peer supporter and what the peer supporter brings to the community,” he emphasized, driving home the point that policymakers need to be careful to avoid setting standards and competency thresholds that exclude many effective peer supporters.

Lastly, Charlie Alfero, representing the Hidalgo Medical Center, honed in on the systemic dilemma underlying the previous presentations. “From what I have observed, the common theme across all the presentations is that the basic healthcare system – even…the stronger ones…lack adequate support.” Across different continents, the medical infrastructure for diabetes management will continue to operate inefficient and unsustainable models of healthcare until we collectively shift our model of care and support for patients. Community health workers, or peer supporters, seem to be one of the most promising avenues for this shift.

FLPC Releases Farm & Food Law Guide for Legal Services Food Hub Launch

On Monday, June 23, 2014, the Conservation Law Foundation (CLF) officially launched the Legal Services Food Hub (LSFH), a free legal services clearinghouse for farmers, food entrepreneurs, and food-related organizations. The Harvard Food Law & Policy Clinic (FLPC) collaborated with CLF to create Farm & Food Law: A Guide for Lawyers in the Legal Services Food Hub Network. Alli Condra, Clinical Fellow at FLPC, presented the content of the first version of the Farm & Food Law Guide with the help of two summer interns, Graham Downey and Kate Giessel.

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A recent survey found that only 10% of farmers seek out legal services, as compared to 70% of small business owners in other industries. The LSFH seeks to increase this percentage by training attorneys on agriculture- and food-specific issues, and then connecting them to small-scale farmers and food entrepreneurs who could benefit from pro bono transactional legal services. The Farm & Food Law Guide is meant to be a resource for attorneys in the LSFH network, providing some context for their work with LSFH clients. The first version of the Farm & Food Law Guide includes four chapters: Massachusetts Farming and Local Food Economy; Business Structures; Food Safety; and, Farm Transitions. The Farm & Food Law Guide itself is a work in progress; additional chapters are forthcoming and will take a more in-depth look at the legal issues that small-scale farmers and food entrepreneurs in Massachusetts face.

In addition to an introduction to the substance of the Farm & Food Law Guide, those in attendance were given an overview of agriculture in Massachusetts, with a focus on some of its more unique aspects. For example, Massachusetts ranks number one in the nation in the percentage of farms that operate a CSA.

Also presenting at the launch were representatives from CLF, New England Farmers Union, Stonyfield Farms, and Nixon Peabody. Nearly 75 attorneys and other professionals attended the event, which was held at the Nixon Peabody offices in downtown Boston.

Version one of the Farm & Food Law Guide is available online at: www.bit.ly.lsfhguide.

For more information on the LSFH, visit www.legalservicesfoodhub.org.

“Isn’t Incarceration Better than Death?”

Katherine L. Record, JD, MPH, MA

Shortly after criticizing Massachusetts for incarcerating innocent individuals with substance use disorder (SUD) when drug rehab facilities are full, I received an email from a woman who lost her son to a heroin overdose just four months ago.

“Is preventing an overdose by detaining the SUD sufferer not a better alternative than leaving them to languish?” she asked.

She had found her 24 year-old son cold and blue, just hours after kissing him goodnight.  He had been evicted from his sober living home for testing positive for drugs, but his mother did not know he had relapsed when he arrived at her front door.  He was, in hindsight, a clear danger to himself – so why did his step-down house let him wander away?  Why didn’t anyone call the authorities?  Is jail not better than death?

Her question captures the crux of our warped approach to SUD.  In what other scenario would a grieving family member have to ponder whether a deceased patient would’ve been better off dead or incarcerated?  Cancer?  Cardiovascular disease?  Diabetes?  The comparison would be ludicrous.

Unfortunately, her inquiry is not absurd.  Her son would probably still be alive had he been committed (in Massachusetts, incarcerated) for his relapse.  To a mother who has lost her child, that is undeniably the better option.  Yet it is neither Constitutional nor humane.

Those with SUD need healthcare just like all others.  But more often than not, it is not available.  Instead there is death or jail.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the Center for Health Law & Policy Innovation or Harvard Law School. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

Groundbreaking Article about Food Law & Policy, Co-authored by FLPC Director Emily Broad Leib, Published in Wisconsin Law Review

The Wisconsin Law Review has just published Food Law & Policy: The Fertile Field’s Origins & First Decade–an article co-authored by FLPC Director Emily Broad Leib and Baylen Linnekin, Executive Director of Keep Food Legal, a national nonprofit devoted to food freedom. The article is the first to describe the history and development of the ten-year-old field of Food Law & Policy. That field, as the authors define it, “is the study of the basis and impact of those laws and regulations that govern the entire ‘food system’”–including not just federal laws and regulations but those at the state and local levels.

In what is likely a first for legal scholarship, the article also features a 7-minute video companion, which is directed by American University Prof. Leena Jayaswal and co-produced by Linnekin, Broad Leib, and Jayaswal. It features Linnekin, Broad Leib, and several of the key players in the development of Food Law & Policy–including Harvard Law Prof. Peter Barton Hutt; Drake Law Prof. Neil Hamilton, Arkansas Law Prof. Susan Schneider, and UCLA Law Prof. Michael Roberts.

“When I was in law school, no one talked about food law and policy in the sense of the courses that are taught now,” says Broad Leib. “The field of Food Law & Policy covers obesity, food safety, social justice, and food waste, and the body of laws spans various federal agencies as well as state and local laws and policies. The importance of examining the law and policies impacting our food system cannot be overstated—this system touches all individuals and communities in terms of our health, our environment, and our economy.”

As Linnekin and Broad Leib detail in the article, Food Law & Policy has been a growing and welcome addition at law schools around the country. A recent Harvard Law School publication noted, for example, that there is “no hotter topic in law schools right now than food law and policy.” With this groundbreaking new article and video companion and the spread of law school courses focused on Food Law & Policy, we are confident this field will only continue to grow in scope and importance over the next decade.

To read the full article in the Wisconsin Law Review, see Baylen J. Linnekin & Emily M. Broad Leib, “Food Law & Policy: The Fertile Field’s Origins and First Decade,” 2014 Wis. L. Rev. 557 (2014).

CHLPI Hosts the Western North Carolina Diabetes Strategy Forum at UNC-Asheville

by Katerina Souliopoulos, 2014 Summer Intern, Health Law and Policy Clinic

Clinical Fellow Maggie Morgan presents on the importance of integrated, whole-person care for people living with Type 2 Diabetes.

Clinical Fellow Maggie Morgan presents on the importance of integrated, whole-person care for people living with Type 2 Diabetes.

On June 9th, the Center for Health Law and Policy Innovation (CHLPI) hosted the Western North Carolina Diabetes Strategy Forum at UNC – Asheville in order to address diabetes prevention and management throughout the Western region of the state. The population of Western North Carolina has a particularly high rate of diabetes at 12%. Western North Carolina faces particular regional challenges in preventing and managing type 2 diabetes, such as a lack of public transportation to medical services, low access to healthy food, and a shortage of medical providers. The strategy forum convened local diabetes leaders from a range of disciplines including endocrinologists, clinical pharmacists, certified diabetes educators, and community health workers for an in-depth conversation about the current state of the disease in Western North Carolina and how to best move forward.

Harvard Law Professor and Director of CHLPI, Robert Greenwald, kicked off the event along with Patti Doykos, Director of the Bristol-Myers Squibb Foundation. The introductions highlighted the importance of the recommendations within CHLPI’s comprehensive 2014 North Carolina State Report Providing Access to Healthy Solutions (PATHS) – The Diabetes Epidemic in North Carolina: Policies for Moving Forward. Both Greenwald and Doykos emphasized that the Forum is only the first step in identifying opportunities for policy reform and eexpressed commitment to transforming the report’s research into advocacy and reform efforts.

Participants in the Strategy Forum heard from Dr. Wendy S. Lane of the  Mountain Diabetes and Endocrine Center in Asheville about the gaps in care for people living with diabetes. Dr. Lane explained that a combination of providers having little time to spend with patients and a lack of diabetes-specific training and education often resulted in delayed referrals from primary care doctors to specialists, putting patients at risk of developing complications. For example, Dr. Lane related an experience in which a patient came to her that had been living with diabetes for over 18 years. By the time Dr. Lane saw the patient, he had bleeding in his right eye and nerve damage in his legs. During those eighteen years, just one mile from Dr. Lane’s office, his primary care physician had attempted to manage his treatment with a kind of insulin that had been disfavored for at least a decade. Dr. Lane’s anecdote highlights the need for better diabetes-specific training incorporated into medical school curricula, and timely referrals to specialists. Dr. Lane recommended that medical residents spend at least four weeks practicing under trained endocrinologists, especially as diabetes is one of the most common conditions they’ll see as primary care providers practicing in Western North Carolina.

The Forum also included a panel discussing diabetes prevention and management initiatives throughout Western North Carolina. The panel included:

  • · Rick Davis, Executive Director, Graham Revitalization Economic Action Team (GREAT)
    • Presenting on Graham County’s Greenway Project and the Reimagining Robbinsville project. Each project will revitalize Robbinsville’s downtown, while increasing sidewalk connectivity and cultivating a community of walking and biking.
  • · Suzanne Landis, MD, MPH, Director, Division of Healthcare Innovation; Director, Center for Healthy Aging, Mountain Area Health Education Center
    • Presenting on the potential benefits of Accountable Care Organizations (ACOs) within the Western North Carolina hospital network. ACOs are groups of various medical providers who join together to deliver coordinated care to patients in the hopes of increasing quality of care while decreasing cost.
  • · Katie Souris, Coordinator of Preventive Health & Diabetes Wellness and Prevention Program, YWCA of Asheville and WNC
    • Presenting on the YWCA’s Diabetes Wellness and Prevention Program. Participants in the program receive personal fitness training, diabetes education from medical providers and other health professionals, and access to support groups and cooking classes.
  • · Wendy S. Lane, MD, Clinical Endocrinologist & Director of Research, Mountain Diabetes and Endocrine Center

The forum concluded with a roundtable discussion in which participants identified priorities for improving diabetes prevention and management within Western North Carolina in the coming years. Community leaders addressed several themes, such as increasing collaboration and communication among providers and community health resources, educating patients on proper diabetes self-management techniques, and increasing insurance coverage for prevention and management programs. They also learned of one another’s great work within the region and forged new connections that will advance the goal of improving access and quality of diabetes healthcare in Western North Carolina.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the Center for Health Law & Policy Innovation or Harvard Law School. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

A Drug Epidemic’s Silver Lining

by Katherine L. Record, JD, MPH, MA

Heroin Seized in Boston, 2013

Heroin Seized in Boston, 2013

Can there be a silver lining to a drug epidemic that is so extreme it is deemed a public health emergency?  As prescription opioid (painkiller) addictions drive individuals to heroin, there just might be.

Heroin use has surged recently – seizures of supply increased by nearly 70% over the last few years in New York (the epicenter for imports into the United States).  In Boston, overdoses increased by nearly 80% between 2010 and 2012.  This has followed a rising trend in prescription opioid addictions – 4 out of 5 users are addicted to prescription painkillers when they first try heroin.  Turning to the street opioid is often a move of desperation; prescription opioids are now harder to abuse, more expensive, and harder to obtain than heroin.  In other words, heroin provides a cheaper, easier to score, and stronger high.

This surge in use is changing the face of heroin; the Office of National Drug Control Policy’s director recently described the drug as a former “inner city problem” that has become classless, affecting “all populations and all ages.”  To be blunt, white people – many with high paying jobs and fancy apartments – are now doing 8 to 10 bags a day.

This has the nation’s attention.  With a changing demographic, our perceptions of drug abuse are shifting – from viewing addiction no longer as a crime implicating incarceration, but as an illness implicating treatment.

The response here in Massachusetts paints the clearest picture of this 180 degree turn on drug policy:

The Commonwealth is heralded as a beacon of hope for healthcare reform.  Since enacting an Affordable Care Act-like law in 2006, Massachusetts saw death rates fall by up to 4.5% in just four years, particularly in counties where many were newly insured.  The state now has the lowest rate of uninsured residents in the country.

Yet Massachusetts left one set of patients out to dry – those with substance use disorder (SUD).  In fact, Massachusetts is the only state in the nation that incarcerates innocent individuals when inpatient beds are unavailable (i.e., those who have committed no crime but are deemed to be a danger to themselves or others).

Let’s imagine you are a Massachusetts resident with an alcohol or drug addiction.  You are likely insured, but cannot or have not obtained treatment.  Anyone who suspects you to be suffering from SUD can file a petition to have you committed (e.g., police officer, physician, spouse, relative) – thus triggering a summons to appear in court.  A failure to appear before a judge results in automatic issue of a warrant for your arrest – not for a crime, but for suffering from an untreated illness.

We know that incarceration does not treat, and may well exacerbate, SUD.  In fact, substance abuse is disproportionately prevalent in prisons, affecting 80% of inmates.

Now, eight years after Massachusetts’s healthcare overhaul – legislators are starting to take notice.  Once again, healthcare is following the money.

In Massachusetts, the methadone business is booming.  After prescription opioid manufacturers raked in $11 billion in profits in 2010, the largest line of methadone clinics saw an increase in net income of over $4 million between 2011 and 2012, up from a deficit of $46 million in 2010.  The company’s deputy chief clinical officer attributes profits to healthcare reform: “We’ve pretty much convinced the country now that this is a health care issue.  This isn’t about bad people trying to become good.  This is about ill people trying to get well.”

Perhaps not coincidently, Massachusetts legislators are viewing SUD in a new light.  Governor Patrick recently approved $20 million in treatment funding – a tiny, but significant, step towards keeping the innocent out of jail.  The state’s House and Senate are addressing the issue as well.  For example, pending bills propose limiting incarceration for SUD to 10 days (currently a patient can be jailed for up to 90) and increasing insurance coverage of SUD treatment by both public and private plans.

Lawmakers are acting in accordance with public support; 83% of those polled in 2013 agreed that treating, rather than criminalizing, SUD would reduce crime.  Budgetary constraints are also at play; the Commonwealth spends over $47,000 per year on each inmate.

Perhaps, as heroin addiction becomes a (very public) white person problem, Massachusetts will lead the nation not just in healthcare reform, but also in recognizing SUD as an illness just like any other.  That, indeed, would be a silver lining to a devastating public health problem.

*This blog post originally appeared on Harvard Law School’s Petrie-Flom Center Bill of Health.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the Center for Health Law & Policy Innovation or Harvard Law School. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

CHLPI Releases National Report on Opportunities to Improve Health and Lower Costs Through Reimbursement of “Food is Medicine” Interventions in Health Care

6.5.2014 Food is Medicine Report - Cover ImageThe Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School released the report Food is Medicine: Opportunities in Public and Private Health Care for Supporting Nutritional Counseling and Medically Tailored, Home-Delivered Meals. The report, funded in part by the M·A·C AIDS Fund, examines ways in which public and private health care programs like Medicaid, Medicare and new marketplace health insurance plans can support access to nutritional counseling and medically tailored home-delivered meals within their systems.

“We are at a unique point in time, when new health policy reforms, both within and outside of the Affordable Care Act, have opened the door for the inclusion of innovative services that both improve health outcomes and ultimately reduce health care costs,” said Robert Greenwald, Director of the Center.

“Through legal and policy analysis, our report identifies opportunities within our health care systems for integrating and reimbursing specific food and nutrition service interventions that can help move us toward reducing health disparities, promoting health, and reducing costs.”

For critically and chronically ill individuals, food is medicine. With adequate amounts of nutritious food, people who are sick have a better response to medication, maintain and gain strength, and have improved chances of recovery.

Despite this connection, support for these services has been largely divorced from our health care systems, limiting access in many cases to individuals who are elderly and disabled.

“Unfortunately, restricting access in this way only serves to perpetuate a cycle of increased costs and hospitalizations.” said Greenwald. “Providing these services for individuals, before they are home-bound and disabled or in need of hospitalization, would prevent such declines in health from happening in the first place.”

The nonprofit organization Community Servings in Boston, Massachusetts, has long understood this relationship between food and medicine, and has been providing nutritional counseling and medically-tailored home-delivered meals to individuals living with HIV and other chronic and critical illnesses for many years.

Yet, Community Servings and similar organizations across the country have traditionally been reliant exclusively on support from private charitable donations and periodic grants, in addition to the federal Ryan White AIDS Program (serving people living with HIV), a model that is ultimately unsustainable and forces many organizations to limit the numbers of individuals they can serve.

“This report assists organizations like ours in understanding how different kinds of health care systems work. It also makes recommendations for how we can form partnerships with public and private health insurance programs and work towards integration of our services into new models of care,” said David Waters, CEO of Community Servings.

“Ultimately, we all have the same goal: to keep critically and chronically ill individuals healthy and out of the hospital: it costs $20 a day for us to provide a person with medically tailored home-delivered meals, as compared to a hospitalization which can cost up to $4,000 a day.”

The Food is Medicine report is available for download on the Center for Health Law and Policy Innovation website at www.chlpi.org.

North Carolina Launch for Phase II of the PATHS Project

by Qing Qing Miao, 2014 Summer Intern, Health Law and Policy Clinic

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Dr. Ann Albright, Director of the CDC’s Division of Diabetes Translation, presents on the efficacy and importance of the Diabetes Prevention Program.

In continuation of its efforts to provide comprehensive policy recommendations for the prevention and management of type 2 diabetes, the Harvard Law School Center for Health Law and Policy Innovation (CHLPI) recently launched its 2014 North Carolina State Report: Providing Access to Healthy Solutions (PATHS) – The Diabetes Epidemic in North Carolina: Policies for Moving Forward. The launch took place in Raleigh, North Carolina and began with a Diabetes Leadership Dinner on May 29th followed by a Strategy Forum on May 30th. Similar to its counterpart New Jersey report released earlier in March, the North Carolina report provides detailed coverage of the current landscape of diabetes care and offers both broad and specific policy initiatives to strength federal, state and local efforts to improve type 2 diabetes care.

Funded by the Bristol-Myers Squibb Foundation through the organization’s Together on Diabetes Initiative, the report comprises the second phase of PATHS’ state-level policy reform initiatives in New Jersey and North Carolina. Selected for their opportunities to receive and implement federal-level recommendations, these pilot states possess both the momentum and infrastructure to sustainably implement findings from the report.

The North Carolina report is the final product of the efforts of the CHLPI Clinical Fellows, Maggie Morgan and Sarah Downer and the clinical student Tiffany Lopinsky. Developed over the course of 18 months, the report incorporates extensive interviews with over 90 key stakeholders and community partners, who shared insights into the barriers involved in mitigating the health impacts of diabetes.

The PATHS report provides both the contextual and structural analysis of institutional systems currently installed within North Carolina and recommends policy to help the state move forward with its health initiatives. Touching upon the social, legal, environmental, and financial dimensions of diabetes care, the report underscores two broad areas of policy: disease prevention and disease management. Detailed recommendations spanned the following topics: increasing economic access to healthy foods for the underserved; improving the food retail and transportation infrastructure to help individuals access healthy foods; implementing early childhood interventions through school food and wellness programs; embracing community resources to build a social support network for patients; implementing a coordinated system of whole-person care involving primary and special care, self-management education, community health workers; and increasing access to health care providers.

CHLPI initiated its launch with a Diabetes Leadership Dinner, inviting key interviewees and other notable partners such as Patti Doykos, the Director of the Bristol-Myers Squibb Foundation. Opening the event with warm introductions was Robert Greenwald, the Director & Clinical Professor of Law at CHLPI. Greenwald introduced the mission of the Center to improve health outcomes and reduce health disparities, highlighted the strategic legal moves and actionable recommendations underlying the report, and put forth the “whole-person patient centered” treatment approach that PATHS advocates. In closing, he emphasized the imperative for community and state support in steering the trajectory of diabetes care as it changes within a rapidly transforming health landscape.

Following Greenwald’s introduction was a keynote address presented by Dr. John Buse, Chair of the National Diabetes Education program. In his presentation titled “A Clinician’s Perspective of Diabetes Priorities in North Carolina,” Dr. Buse underscored studies supporting the efficacy of lifestyle interventions on decreasing the incidence of comorbid diseases. Unfortunately, the populations most vulnerable to diabetes complications are minority groups, which are disproportionately affected by the disease. In North Carolina, diabetes is twice as likely to affect minorities. According to Dr. Buse, segregation and income are the two most prominent factors for health disparities. To eliminate this health gap, he proposed a three-pronged approach of expanding insurance coverage, helping individuals access diabetes self-management education, and developing community health workers & peer support.

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Over 75 participants in the Diabetes Strategy Forum rose to their feet and vowed to continue the fight against Type 2 Diabetes in North Carolina.

The Strategy Forum hosted on May 30th allowed CHLPI to present its report to the North Carolina Diabetes Advisory Council (NCDAC), which directly advises the state government on diabetes prevention and management. The forum served a dual function as a platform for the attendees – public health officials, health care professionals, community health workers, and other stakeholders of the state – to prioritize action items surrounding diabetes prevention and management.

Formal events started with the CHLPI team’s presentation of its report before the Diabetes Advisory Council (DAC). Afterwards, the team welcomed the arrival of significant contributors to the Strategy Forum. Patti Doykos and Robert Greenwald led the introductions and directed the audience attention to the final iteration of CHLPI’s presentation. Following the PATHS presentation was the keynote speech given by Dr. Ann Albright, the Director of the Division of Diabetes Translation for the Centers for Disease Control and Prevention. Detailing the trends of diabetes within the last few decades and the trajectory of the disease in the future, Dr. Albright emphasized the importance of evidence-based Diabetes Prevention Programs (DPP) implemented at the state level and scaled at the national level. After presenting the CDC’s own DPP research trial, she made a forceful case for lifestyle change interventions – mediated by the installation of trained health workers – in helping to prevent diabetes and managing pre-diabetes.

The full breadth of current state efforts to prevent and manage diabetes was encapsulated by the four panelist presentations given after the keynote. The last of the panelists, L’Tanya Gilchrist, shared a compelling story of her motivations for working as a clinical assistant health provider at the Durham County Health Center. She recounted her father’s experience with diabetes: at the height of his disease, his complications had necessitated that he receive several amputations. At the climax of her story, Gilchrist determinedly asserted that no patient should ever have to experience what her father had. She described her role as a community health coach – how she is able to assist patients with literacy barriers in providing diabetes self-care and how she connects them to their healthcare providers.

The Forum culminated with a strategy session, an incubator exercise for the different health and policy professionals to distill their ideas about moving forward with diabetes prevention and management. A sense of excitement and reserved optimism characterized the tone of the collaborative work as each group detailed their priorities for diabetes-related policy reform. Themes pervading the exercise ranged from improving the built environment, community zoning involving the partnership of urban planners, and methods to increase community social support. Although conversations about diabetes prevention and management touched on various subjects, the issue of reimbursement for pre-diabetes care was especially prominent, as Medicaid currently does not reimburse for the identification and management of pre-diabetes. This issue guided the forum’s final discussion as multiple attendees highlighted the imperative to expand the health focus to include pre-diabetes.

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the Center for Health Law & Policy Innovation or Harvard Law School. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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