Capsules

The Metropolitan Area Agency on Aging is now Trellis

The Metropolitan Area Agency on Aging, one of seven agencies authorized under the federal Older Americans Act (OAA) and designated in Minnesota by the Minnesota Board on Aging, has changed its name to Trellis. Minnesota Area Agencies on Aging (AAAs) are seven regional organizations (one represents Minnesota Indian Tribes) that provides services, supports and information for a wide range of services for older adults. The Metropolitan Area Agency had grown beyond its original mission as the area agency and now provide services, information and innovations that connect and improve the lives of people across Minnesota and in ten other states. “I am proud of the work that we have done as Metropolitan Area Agency on Aging over the past 26 years,” said Dawn Simonson, president and CEO of Trellis. “We have provided trusted and responsive support for individuals and organizations in our community and have developed strong, resilient networks. Trellis—with the imagery of life, growth and a structure for support—will take our work to new heights, helping people optimize well being as they age. I am particularly encouraged by the progress we are making in developing partnerships with healthcare organizations to provide whole-person care to older adults in our communities. Trellis serves the older population with many innovative partnerships that integrate health and social care to produce better life and health outcomes while containing costs. They create and support community-wide efforts to address complex issues, such as building age-friendly and dementia-friendly communities, the Volunteer Driver Coalition, the Juniper Project, assistance with Medicaid-certified nursing facility preadmission screening, working with the Senior Linkage Line and much more. Trellis awards and manages Older Americans Act funding to support older adults in living healthy and connected lives. The funding provides services such as home-delivered and congregate-dining meals; caregiver support and respite care services, assisted transportation, health promotion, and chore and homemaker services. In 2020, Trellis awarded $13+ million to 37 organizations. 

Mayo Study Finds Genomic Research Disparities

Low representation of minority groups in public genomic databases may affect therapy selection for Black patients with cancer, according to a new a Mayo Clinic report. Researchers investigated the use of genomic databases and found that tumor mutation burden (TMB) was significantly inflated in Black patients compared to White patients. As a result of the study, clinicians who are using public genomic databases need to be aware of the potential for these inflated values and how that may affect therapy selection and outcomes, especially for patients from underrepresented groups. Most of the time TMB is calculated, normal cells are not used, and genomic databases of mutations or algorithms are used to filter results. The Mayo team collected data from 701 patients who were newly diagnosed with multiple myeloma, including 575 self-reported White patients and 126 self-reported Black patients. They analyzed DNA from patients’ tumor cells and healthy cells to determine the differences. Since autoimmune toxicities can be severe, it is critical to have accurate TMB data which improves the ability to predict optimal treatment for patients. “Determining tumor mutation burden becomes difficult when you do not have DNA from a patient’s normal cells,” says Aaron Mansfield, M.D., a Mayo Clinic medical oncologist and an author of the paper. “For this reason, reference genomes are used for comparisons to tumors to estimate the burden.” He added, “It needs to be recognized that we performed this proof-of-principle study in patients with multiple myeloma”. Accurate TMB is also important in treating other cancers including breast, bladder, cervical, colon, head and neck, liver, lung, renal cell, stomach and recta, as well as Hodgkin lymphoma, melanoma and any other solid tumor that is not able to repair errors during DNA replication. Based on Dr. Mansfield’s experience, the current approach to determining TMB is inaccurate, especially in patients with ancestral backgrounds that are not well-represented in the reference genome databases. The lack of representation of diverse backgrounds in genomic research is well-known. Of more than 60,000 people genotyped and sequenced, only 8.6% are of African ancestry, while 54.9% are of non-Finnish European ancestry “At the level of an individual patient, our findings suggest that when we sequence tumors, it is also important to sequence paired normal tissues to accurately identify differences,” says Dr. Mansfield. “At the level of the research community, we need to continue to improve the representation of patients with diverse ancestral backgrounds in reference genome databases.”

HealthPartners and Allina Announce Partnership

Recently two of Minnesota’s largest health care insurance companies announced a five-year partnership that implements value-based care across both organizations with the goal of providing better outcomes, better access to care and lower premiums for members and patients. The partnership builds on the non-profit organizations’ collaborative approach, including their work together over the past 10 years on the Northwest Metro Alliance, an accountable care organization (ACO). The Northwest Metro Alliance has improved patient experience and resulted in medical cost trends that are 6 percent lower than the metro area – a savings of $40 million over the last decade. Prior to the work of the alliance, the cost trend was consistently higher than the metro average. The new value-based care partnership elevates the quality of care delivered over the quantity of care provided. Reimbursement structures are directly connected to patient outcomes and improving quality of care based on specific measures, such as reducing hospital readmissions, improving coordination of care using electronic exchange of documents, and improving preventive care, ultimately leading to the improvement of both individual and community health. Additionally, the length of the partnership is longer than previous partnerships to allow for a longer-term focus on population health strategies. “This partnership is an extension of what is possible when health care organizations work together to improve the physical, mental and financial health of patients,” said Penny Wheeler, MD, Allina Health CEO. “We are proud to build on our partnership with HealthPartners – a partnership that has proven that by working together, we can better improve the lives of those we collectively serve and change health care for the better.” “Today, we are expanding the strong partnership between our organizations,” said Andrea Walsh, HealthPartners President and CEO. “Our shared commitment to deliver high quality, affordable care and coverage has translated into better health and cost savings through the Northwest Metro Alliance. We are excited to bring that same spirit of innovation to build better health in all of the communities we serve.”

Medical Liability Premium Show Highest Increases in 15 Years

New analysis from the American Medical Association shows professional liability insurance premiums have begun an upward trend after holding more or less steady during the past decade. In 2020, during the height of the COVID-19 pandemic, more than 30% of premiums reported on a survey of liability insurers increased from the previous year, the highest percentage since 2005. For a second consecutive year there has been an exceptional surge in the percentage of premiums with a year-to-year increase. Between 2010 and 2018, the share of premiums that increased maintained a somewhat stable pattern, ranging from 12% to 17%. In 2019, that proportion almost doubled to 26.5% and went up again in 2020 to 31.1%. Increases varies by state, county, specialty and provider. Some Minnesota practices have reported increases. According to the AMA analysis the responsiveness of premiums to changes in their determinants and external factors takes considerable time in the medical liability insurance market. Therefore, although some 2020 premiums may have been set after the onset of the COVID-19 pandemic, it was still too early for them to be affected by it. “Increases in medical liability premiums compound the economic stress on medical practices as the COVID-19 pandemic resulted in significant reductions to patient volume and revenue, and higher expenses for scarce medical supplies,” said AMA President Susan R. Bailey, M.D. “Practice revenue has not fully recovered as the pandemic has stretched on and a protracted upward trend in medical liability premiums will threaten the viability of many practices that already face a difficult road to recovery. Keeping medical liability premium growth in-check is imperative to ensure patient access to care is not jeopardized by unaffordable liability insurance costs that make it impossible for physicians to remain in practice,” said Dr. Bailey. “This concern is particularly pressing given the negative impact that the COVID-19 pandemic has had on access and practice viability, as many physicians have had to suspend patient visits or elective procedures, and some have had to close their practices.”

Studies Find Tear Gas Producing Delayed Health Problems

In troubled times nationwide, and between the George Floyd and Duante Wright killings especially in Minnesota, street protests and police use of tear gas have increased dramatically. This has lead to a growing body of health care data that suggests long-term negative consequences from tear gas exposure and a redefinition of its use from non-lethal force to chemical weapon. Medical professionals at HennepinHealth have seen many patients in the ER treated for tear gas effects where the most serious reactions have occurred in people with breathing disorders like asthma or emphysema. Some however have been exposed at least 10 times and mounting evidence raises serious concern. Medical research on the long-term health impact of repeated exposure to chemical irritants like tear gas has just started and includes work by Kaiser Permenta based on over two thousand people from Portland, Oregon and an article currently under peer review co-authored by Asha Hassan, a public health doctorate student at the University of Minnesota. The Kaiser study showed 80 percent of respondents reported ongoing physical health problems. Erika Kaske, a third-year medical student at the University of Minnesota who led a recent New England Journal of Medicine report examining non-lethal weapons used in Minneapolis last summer during the Floyd protests, said such examples underscore the public health problems that come with police using tear gas. Beyond the immediate effects research reports delayed physical health issues after exposure at a rate of over 80%, many of which were severe and lasted for weeks. The Hassan report showed these concerns ranged from diarrhea, with blood in some persons, to menstrual cycle problems, to being exhausted and unable to carry out their regular work, to worsening of an existing health condition. In addition there were numerous behavioral health-related concerns. Another factor drawing concern is the use chemical irritants and its proximity to nearby homes, apartments and schools. Thought to dissipate rapidly and not penetrate closed windows and doors recent anecdotal evidence from Brooklyn Park suggests otherwise. Direct links of tear gas use to negative health effects are yet to be scientifically established however such evidence is growing. 

Children’s Minnesota Challenges Ban of Transgender Student Athletes

Dr. Goepferd and Dr. Chris Dunne, clinical lead of the Gender Health Program at Children’s Minnesota have recently added their voices in opposition to a recently introduced bill at the Minnesota state capitol bill seeking to ban transgender athletes from competing in girls’ sports.  This proposed legislation, like over 20 others nationwide, some already passed, would prevent transgender or gender non-conforming kids who want to play sports at school. While some bills penalize transgender student athletes who participate on a team that aligns with their gender identity the Minnesota bill is the first to propose criminal penalties for these students. For example, a transgender girl using a girl’s locker room would be guilty of a petty misdemeanor, which could show up in future background checks and carry a fine of hundreds of dollars. Dr. Angela Goepferd, Medical Director of the Gender Health Program at Children’s Minnesota points out that there is no scientific justification behind the bill and, further, that there are very few transgender or gender non-conforming kids who choose to play sports in middle or high school. Stating that the bill could not only impact student athletes who are transgender or gender non-conforming, but all kids and teens who identify as transgender. Dr. Goepferd points out that transgender children tend to struggle with self-esteem more than peers who identify with the sex they were born with, and sports are one way that kids can work toward overcoming self-esteem issues. Whether or not they play sports, this type of legislation can have a negative impact on kids because it singles out and “others” transgender and gender non-conforming kids. Excluding transgender youth hurts everyone, because it encourages gender policing, potentially leading to accusations of girls being “too masculine” or “unreasonably good” at their sport. Including trans athletes benefits everyone, as it promotes non-discrimination and inclusivity. 

IBM Recognizes HealthPartners As National Leader

For the fifth consecutive year IBM Watson Health as named HealthPartners as one of the top 15 health systems in the country. The annual study from IBM Watson Health evaluates more than 300 health systems and 2,500 hospitals within those systems to determine the top performing organizations in the nation. Compared to other health systems, top performers had fewer patient deaths, fewer infections and complications, lower readmission rates, shorter length of stay, higher patient satisfaction and lower costs.