Houston Medical Times

CMS Is Testing Three Models To Lower Prescription Drug Costs and Improve Access to Life-Changing Therapies

By Mark S. Armstrong, J.D. Polsinelli, PC

Americans, on average, pay two to three times as much as people in other countries for the same prescription drug. President Biden’s Executive Order 14087, directed the Secretary of the Department of Health and Human Services (“HHS”) to consider whether testing of new health care payment and delivery models by the Innovation Center would lower drug costs and promote access to innovative drug therapies for beneficiaries enrolled in the Medicare and Medicaid programs. Recently, in response to the President’s Executive Order, the Centers for Medicare & Medicaid Services (“CMS”) announced that the Secretary of the

HHS has selected three new models for testing by the CMS Innovation Center to help lower the high cost of drugs, promote accessibility to life-changing drug therapies, and improve quality of care.

The three models selected by

the Secretary for testing by the CMS Innovation Center address the themes outlined in the executive order and meet the selection criteria thresholds

San José Clinic Receives $180,000 Grant Award from Direct Relief’s Fund for Health Equity

San José Clinic today announced it is among 71 awardees that received a grant from Direct Relief’s Fund for Health Equity, which mobilizes financial resources for organizations focused on non-clinical interventions that affect a person’s health. Commonly known as the social determinants of health, these factors include an individual’s physical, social, cultural, and economic environment.

The grants, which total $22.7 million and will be disbursed over

two years, were awarded with funding from philanthropist MacKenzie Scott, the AbbVie Foundation, and Eli Lilly and Co. to support underserved communities across the United States. San José Clinic received $180,000 from the Fund for Health Equity for its work to Eliminate Barriers to Healthcare. “This critical funding from Direct Relief allows us to expand access to care around the Greater Houston Community.”

- Maureen Sanders, President & CEO of San José Clinic

“We are pleased to bolster the indispensable work of San José Clinic and other grassroots organizations striving to reduce disparities and increase equity in vulnerable populations across the United States,” said Dr. Byron Scott, MD, MBA, Co-Chair of the Fund for Health Equity and Board Director of Direct Relief and Chair of its Medical Advisory Council.

Former Congresswoman Gabby Giffords thanks TIRR Memorial Hermann

Mental Health New Breakthrough in Understanding Fentanyl Abuse

Study From Texas A&M School of Medicine Uncovers a Brain Circuit Involved in Opioid Addiction And Relapse, Paving The Way For Better Treatments

By Dee Dee Grays

The ongoing opioid epidemic continues to take a heavy toll on American communities, with more than 80,000 opioid-related deaths reported in 2021, according to the National Institutes of Health. Despite the severity of this issue, the neurological mechanisms underlying opioid addiction, withdrawal and relapse are not fully understood.

A study recently published in Cell Reports sheds light on the subject. Jun Wang, PhD, associate professor in the Department of Neuroscience and Experimental Therapeutics at the Texas A&M University School of Medicine, and members of his laboratory have

identified a specific brain circuit that characterizes how fentanyl (a synthetic opioid) affects the brain. Specifically, they looked at the striatum, which is a brain region that controls voluntary behaviors and is heavily implicated in drug relapse.

Even after a long period of abstaining from opioids, many people relapse as a result of the depression, anxiety and other negative emotions that accompany withdrawal. Suppressing these negative emotional states could greatly increase a person’s chance of overcoming opioid use disorder.

Opioid addiction is mainly mediated by mu-opioid receptors (MORs), which are expressed in the midbrain and the striatum

on a type of neuron called direct pathway medium spiny neurons (dMSNs). Previous studies from the Wang lab showed that these dMSNs control “Go” actions in the brain that promote drug-seeking behaviors. The striatum contains two distinct sub-compartments, the patch and matrix compartments. The patch compartments primarily contain MOR-expressing dMSNs and are widely studied for their roles in emotional processing and decision-making.

The study aimed to look at how withdrawal from chronic opioid exposure alters the activity of patch dMSNs and their outputs to generate the negative emotional

states which may cause relapse. The researchers discovered that fentanyl enhances the activity of dMSNs in the striatum, and during the early stages of withdrawal, inhibitory signals from these dMSNs to downstream targets, such as dopaminergic neurons, were significantly enhanced. Dopaminergic neurons play a major role in addiction as they control motivation, rewarding behavior and emotions. The enhanced suppression of dopaminergic neurons likely contributes to the negative emotions that arise during

Houston Methodist Receives $1 Million Commitment to Support Alzheimer’s Disease

Neurological Houston Methodist has received a $1 million philanthropic commitment from Susan and William “Dub” Henning, Jr. to support Alzheimer’s research at the Nantz National Alzheimer Center (NNAC) at Houston Methodist. This donation will create the Susan and William Henning Jr. Neurodegenerative Research Endowment to support research in neurodegenerative diseases at the NNAC. In recognition of the gift from the Henning family, a NNAC family room will be named in memory of Dub’s parents, Lena and William Henning, who instilled in their son a lifelong spirit of giving to their communities.

Dub and Susan Henning have a long history of generosity to various philanthropic causes in their home state of Louisiana and beyond, including research efforts at Houston

Methodist. Deeply rooted in their faith, Dub and Susan are active in their Methodist church community and have also received care at Houston Methodist, so they were compelled to support the critical work being done in Alzheimer’s, a disease that Dub has seen close friends struggle with.

“Knowing the impact that Alzheimer’s can have not only on patients, but also on the immediate and extended family members experiencing the disease inspired us to support the work being done at the Nantz National Alzheimer Center,” said Dub Henning. “We want to give hope to families struggling with this disease and contribute to ultimately finding a cure.”

A world-renowned clinical and research center, the NNAC treats thousands of patients annually — more than 4,000 patient visits in

2021 — and aims to prevent Alzheimer’s disease, slow memory loss progression and improve patients’ quality of life. The NNAC is led by Joseph C. Masdeu, M.D., PhD, a 30-year veteran clinician, researcher and leader in Alzheimer’s and neuroimaging. The gift from the Henning family bolsters his team’s many ongoing research projects at the NNAC, including more than 26 current studies, 14 of which are clinical trials and 12 studies to clarify the nature of diseases causing dementia.

“One of our clinical trials will determine the effects of exercise in preventing deposits of amyloid and tau, two of the proteins that accumulate in the brain of people living with Alzheimer’s disease, and we’re also exploring the role of proper sleep in disease development,” said Masdeu. “Among other studies, we are collaborating with Baylor College of Medicine to define genetic and

chemical factors predisposing to the accumulation of amyloid and tau in the brain of people at all stages of the Alzheimer’s spectrum. These promising developments would not be possible without the compassion and generosity of community

see Alzheimer...page 13

Susan and William “Dub” Henning, Jr.

Oncology Research Let’s Talk About It: Is It Hemorrhoids or Something More?

By Theodoros Voloyiannis, M.D., FACS, FASCRS, Texas Colon & Rectal Specialists

Who wants to discuss the topic of hemorrhoids? Almost no one. But with colon cancer rates on the rise, especially among younger people, it is critical – perhaps even life-saving – that we talk about “taboo,” awkward, bathroom behavior-related topics and symptoms. What you think is simply a hemorrhoid could be something far more serious.

That’s why being open and candid with a trusted healthcare provider is so important, particularly if you are experiencing new concerning symptoms like blood in a bowel movement, the sudden appearance of lumps at the anal opening, or

unexplained abdominal pain. It may be just a case of hemorrhoids, but it is important to involve your physician as soon as possible to confirm that or determine if it is a more serious issue like colorectal cancer, which is the third most common cause of cancer deaths in both males and females in Texas.

Similar symptoms, different diagnosis

Hemorrhoids are swollen or inflamed veins which can form inside the anal canal or swell externally near the opening of the anus. Hemorrhoids affect approximately 1 in 20 people, and while the exact cause is unknown, common factors such as chronic constipation or diarrhea, pregnancy, aging, straining during bowel movements, overuse of laxatives or enemas, and obesity can contribute to their development.

Symptoms of hemorrhoids like bleeding, itching, pain, or sensitive lumps around the anal area, are

similar to those of colorectal cancer, which may include a change in bowel habits, rectal bleeding or blood in the stool, abdominal pain, weight loss, and fatigue. Hemorrhoids tend to flare and then go away, but if the bleeding is constant and progressive or a combination of both pain and bleeding, it could be something more. It can be hard to tell the difference, so it is important to consult with a primary care physician, gastroenterologist or a colorectal surgeon, who is trained in diagnosing and treating diseases like colorectal cancer. Colorectal cancer in younger people is on the rise

In 2023, an estimated 12,220 new

cases of colon and rectal cancer and 4,350 deaths are expected in Texas. While the risk of colorectal cancer increases after the age of 45 in both men and women, over the past 25 years, colorectal cancer cases among those in their 40s have increased by 51%. Risk factors such as obesity, diets that contain large amounts of red and processed meats, lack of physical activity, certain bacteria in the gut, and smoking could be responsible for the rise in earlier onset of this disease. Why screenings for colorectal cancer are important The best way to determine if the

Liver Cancer Treatment Costly for Medicare Patients

Hepatocellular carcinoma (HCC), the most common type of liver cancer, can place a significant financial burden on patients, according to an analysis led by a researcher at UT Southwestern Medical Center.

The study, which looked at costs for patients with HCC in the first year after diagnosis, found that median Medicare payments exceeded $65,000 and out-of-pocket costs were more than $10,000 –significantly more than costs for patients with cirrhosis alone.

The study, led by Amit Singal, M.D., Professor of Internal Medicine in the Division of Digestive and Liver Diseases and a member of the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern, was published in Clinical Gastroenterology and Hepatology.

“As has been shown for other cancer types, we found patients with liver cancer suffer from high

cancer-related financial burden. Financial toxicity of cancer therapy can negatively impact patients, resulting in medical debt and even bankruptcy for some patients,” said Dr. Singal, Medical Director of UTSW’s Liver Tumor Program and a Dedman Family Scholar in Clinical Care.

The total cost of cancer treatment in the United States is expected to reach nearly $250 billion by 2030. The team chose to investigate outcomes in liver cancer given its rising incidence and mortality rate. Liver cancer mortality is accelerating, in part due to continued detection at late stages, and it is expected to be the third-leading cause of cancer deaths by 2040, according to Dr. Singal and his team.

The cost of liver cancer treatment has been little studied, the researchers said. Several treatments have become available for patients

in the past decade, including new surgeries, radiation-based therapies, and immunotherapies, making it essential to understand the financial impact of treatment. Although these therapies can be effective, they also can be quite expensive and difficult for patients to afford.

Using data from the Surveillance, Epidemiology, and End Results (SEER) Medicare database, the study looked at first-year treatment costs for 4,525 patients ages 68 and older who were diagnosed with liver cancer between 2011 and 2015. The study compared costs for patients with HCC with those for a matched set of patients with cirrhosis.

Sixty-seven percent of the patients in the study were male; 72% were white, 7.5% Black, 3.7% Hispanic, and 16.7% other ethnicities. Medication claims were not included because they were not available for all patients covered by Medicare parts A and B.

The analysis found that patients with liver cancer had significantly higher inpatient,

outpatient, and physician costs compared with the cirrhosis-only patients. Median out-of-pocket costs for the first year of treatment were more than $7,000 higher than the costs for the cirrhosis patients.

The analysis found that patients with early-stage liver cancer had lower costs. Patients with certain co-existing conditions, such as non-alcoholic fatty liver disease

Amit Singal, M.D.

Healthy Heart A Heart-Healthy Life Begins with Good Prenatal Care

By The American Heart Association

Poor heart health puts both mothers-to-be and their children at risk. Heart disease is the leading cause of pregnancy-related death causing more than 1 in 4 pregnancy-related deaths (26.5%), according to the American Heart Association Heart Disease and Stroke Statistics 2022 Update. A study published in 2022 in the Association’s flagship journal, Circulation, found that only about 40% of women in the U.S. who give birth have good heart health prior to their pregnancy with excess weight being the major driver of poor pre-pregnancy health.

According to Michelle A. Albert, M.D., M.P.H., FAHA, volunteer president of the American

on getting healthier for her baby and herself.

“Pregnancy is often a pivotal time in a woman’s life from both short- and long-term perspectives. For some, it may be their first experience with a major medical condition, for most, it’s a natural time to be more forward-thinking about their own health, as well as that of their baby,” said Albert, who is the Walter A. Haas-Lucie Stern Endowed Chair in Cardiology, a professor of medicine at the University of California at San Francisco (UCSF) and Admissions Dean for UCSF Medical School.

“Getting regular prenatal care as well as post-pregnancy cardiovascular risk factor management if appropriate along with making healthy lifestyle changes

healthier life for mom and baby.”

A 2019 study in the Journal of the American Heart Association found that improving heart health during the early stages of pregnancy can lead to a healthier pregnancy, as well as improve a woman’s long-term heart health. The study noted the importance of health care providers paying close attention to a woman’s heart health during pregnancy and promote lifestyle changes such as a healthy diet and

presented at the American Heart Association’s 2019 Scientific Sessions. The study found that children are more likely to have good cardiovascular health during adolescence and beyond if their mothers had good heart health during pregnancy.

“The role of a healthy lifestyle during pregnancy cannot be emphasized enough.” Albert said. “Healthy diet, moderate exercise including walking, smoking cessation and other healthy

The extensive trails throughout ARTAVIA® do more than just connect our neighbors to our amenities. Around the block is a path to a new way of living, set amongst lushly landscaped art

Science Master’s UNCONVENTIONAL Career Path

By Houston Medical Times

Nearly 12 years after she was discharged from TIRR Memorial Hermann, former Arizona Congresswoman Gabby Giffords joined her former care team and facility leaders for a virtual conversation and film screening of the documentary about her journey toward recovery.

“Gabby Giffords Won’t Back Down” tells the extraordinary story of her relentless fight to recover following an assassination attempt in 2011, and her new crusade as one of the most effective activists

entire care team.”

“Gabby Giffords embodies the word perseverance,” said Dr. Gerard Francisco, Chairman and Professor of Physical Medicine and Rehabilitation with McGovern Medical School at UTHealth Houston and Chief Medical Officer at TIRR Memorial Hermann.

“There was no stopping Gabby’s recovery, not with TIRR by her side. The fact that she is here today and has turned this tragedy into a fierce advocacy to help so many others

currently in the battle against gun violence.

During the virtual conversation, which preceded the screening, Giffords thanked team members at Memorial Hermann who were vital to her recovery. “Memorial Hermann will always have a special place in my heart,” said Giffords. “Following my neurosurgery at Memorial Hermann-Texas Medical Center, I spent months at TIRR Memorial Hermann recovering after I was shot, and I am so grateful for the whole team, especially Dr. Gerard Francisco and Dr. Jacob Joseph –for their expertise, patience, and dedication to my recovery. I am so excited to reunite with everyone and to share ‘Gabby Giffords Won’t Back Down’ with them. I wouldn’t be where I am today without them, and I’m forever indebted to the

shows how aligned she is with our mission. TIRR founder, William A. Spencer, MD, said ‘Man uses the tiniest strengths for the greatest of purposes.’ I believe Gabby exemplifies that statement.”

Memorial Hermann Health System operates eight TIRR Memorial Hermann facilities across the Greater Houston area, in addition to facilities which are part of the Memorial Hermann Rehabilitation Network. TIRR Memorial Hermann Hospital ranks as the best rehabilitation hospital in Texas and number two in the nation, according to the U.S. News & World Report’s Best Hospital rankings for 2022-2023. The rehabilitation hospital’s ranking marks its 31st consecutive year among the magazine’s Best Hospital rankings.

By Houston Medical Times

KelseyCare Advantage (KCA), Houston’s fastest-growing Medicare Advantage Plan, announced today the launch of a special series designed to inspire better health for adults ages 60 and older.

The first phase of the “Inspiring Health” series follows the health and fitness journey of former news anchor Art Rascon (KCA’s current advertising spokesperson) as he trains for the upcoming Ironman Triathlon taking place on April 22 in The Woodlands.

Many of you may remember Art’s long battle with COVID two years ago. He suffered from aches, pains, extreme fatigue, and fever, but it was severe breathing issues that led to his hospitalization with what

doctors called COVID pneumonia. His breathing issues continued even after he returned home, which required him to be on oxygen for eight weeks. His progress was slow and his recovery was long.

“I was lucky,” Art said about this challenging time. “There is a divine purpose for all things, and I’m confident that as we accept trials and challenges and allow them to change us for the better, we’re stronger in the end.”

Fast forward to today as we follow Art through a rigorous training schedule that includes swimming, running, and biking for three hours a day, six days a week. It is evident he’s stronger, and it is beyond inspiring.

That is just one of the reasons the KelseyCare Advantage team knew

that Art Rascon would be a natural for launching their “Inspiring Health” series.

Through emails, videos, social media posts, and other communication vehicles, Art shares his fitness, mental, nutritional, and lifestyle tips that have put him – now at 60 years old ¬– in the best shape of his life.

Art’s message is simple: Whether you want to dive into a new fitness regimen or just commit to a 30-minute walk several days a week, setting goals and remaining physically active in your 60s can have a tremendously positive impact on your quality of life.

Over the next 10 weeks, Houstonians of all ages are invited to watch videos featuring Art Rascon that cover “The Art of” topics, including The Art of Goal Setting, The Art of Commitment, The Art of Aging Well, The Art of Rest, The Art of Mental Health, The Art of Staying Healthy, and a final video that captures Art participating in the Ironman triathlon on April 22. All videos can be found at KCAInspiringHealth.com.

Financial Forecast

Helping Someone Who Isn’t Good with Money

By Grace S. Yung, CFP Midtown Financial Group, LLC

You’velikely heard, “Give a man a fish and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.” This advice holds true in many situations, including financial security. We all know someone who is down on their luck financially, and it’s a natural reaction to offer your support. But there’s a difference between giving cash and showing them how to manage money so they stay out of financial trouble for the long term.

There are times when one may be down and out financially for reasons

With little or no money management taught in schools, many people have trouble sorting out spending and saving. So, you could show them how to “pay themselves first.” This refers to setting aside a certain amount of money in a savings account before using the rest for bills. Once they have contributed to savings, they should focus on paying essential expenses, and only then spending on non-essential items.

Showing How to Negotiate and Be More Resourceful

Teaching your loved one how to negotiate and to be resourceful is another way to keep them on track for cutting expenses and building up savings. Many times, money habits can be ingrained from a young age.

If a parent keeps bailing out their children, the younger generation

beyond their control. For instance, an accident or illness could throw someone off course financially. If you want to help someone you care about for the longer term, there are important considerations, including:

Helping them create a “spending plan”

Teaching them how to save

Showing them how to negotiate and be more financially resourceful

Putting a plan in place to pay down debt and save

Educating them on good money habits

Creating a Spending Plan

While many people don’t like the term “budget,” following an income and outgo guide is essential for long-term success. It’s not only about how much income one earns, but also how much they spend.

Teaching How to Save

won’t learn how to be resourceful or responsible financially. So, while it may be hard not to “save” them in financial emergencies, doing so could end up hurting them in the long run. Putting a Plan in Place to Pay Down Debt and Increase Savings

If your loved one is in debt, they must get it paid off as soon as possible - especially high interest credit card balances where the interest charges can snowball. When paying off debts, though, savings should not be ignored.

So, it is important to find a happy medium between reducing debt balances while also adding to savings. Otherwise, if your loved one waits until debts are paid to begin their savings program, it might never start.

Educating on Establishing Good Financial Habits

see Financial Forecast ...page 13

UH Steps up Commitment to Supporting a Healthier Houston Through #Walk30

Campaign Partners UH Population Health with Fit Houston, Texas Heart Institute

By Mike Emery

Houstonians are being encouraged to take the necessary steps (no pun intended) toward living longer and healthier lives. University of Houston Population Health in collaboration with Fit Houston and the Texas Heart Institute have teamed up for #Walk30, a campaign promoting the benefits of 30 minutes of walking or exercising daily.

Experts have long advocated walking for half an hour daily for improved cardiovascular health, strengthened cognition, weight loss and reduced stress among other benefits.

and taking a 30-minute walk … or even several short walks a day … can have so many health benefits.”

Valier and other UH Population Health team members helped kick off #Walk30 on campus during a recent event in Lynn Eusan Park. In attendance were other institutional partners, including UH Human Resources POWER UP, UH Campus Recreation and UH Wellness. Representatives from Fit Houston also were on hand to encourage the commitments of 30 minutes of walk time from the Cougar community.

According to Lharissa Jacobs,

At UH, faculty, staff, students and visitors can easily satisfy this half-hour prescription for wellness by simply exploring the campus. These maps provided by UH Human Resources can serve as guides and help campus community members monitor how far they have walked.

Walking is a vastly underrated form of exercise, said Quinn Valier, director of Student Engagement for UH Population Health and research associate professor in the Honors College. Every step matters. Even more important is that people are mindful to take a mindful walk free from work, electronic devices or stress.

“We think that we need to rush between classes or meetings,” Valier said. “It is important to carve out time for walks that take our minds off the day-to-day grind. Simply paying attention to our minds and our bodies

founder and executive director of Fit Houston, the inspiration for #Walk30 came from recent data reflecting the physical activity of Houstonians. The Harris Cares report produced by Harris County Public Health mapped health conditions across the area. Physical activity also was included in the report’s data.

“Based on this data, we realized that people in Harris County are not getting the amount of exercise recommended by the Centers for Disease Control, which is 150 minutes each week,” Jacobs said. “That’s when we came up with the idea of encouraging people to walk 30 minutes a day.”

In a short time, the campaign has its fair share of influential supporters, including Houston Mayor Sylvester Turner and UH President Renu Khator.

Alzheimer

Continued from page 4 estimated 6.5 million people age 65 and older, are living with Alzheimer’s according to the Alzheimer’s Association. Since its inception, Houston Methodist’s NNAC has

scientific papers annually.

supporters like the Henning family.”

One in nine Americans, or an

Oncology Research

Continued from page 5

issue is just hemorrhoids or something more is through regular screenings such as colonoscopies. More than 20% of adults over 45 have not been screened for colorectal cancer, despite being at a higher risk due to age.

Liver Cancer

Continued from page 10

and ascites (fluid in the abdomen), experienced higher costs. These differences in costs across subgroups

Healthy Heart

Continued from page 7

healthy pregnancy for both mother and child.”

Women who have heart disease

Financial Forecast

Continued from page 11

Colorectal cancer has better outcomes when it is prevented by removal of colon polyps, or successfully identified and treated in its earliest stages. The five-year survival rate for early-stage colorectal cancer found before the cancer spreads is 91%. However, only 39% of cancers are identified in this early stage.

Colorectal cancer patients often show little to no symptoms in the early stages. As the disease

advances, more aggressive treatment may be needed. Anyone age 45 years and older at average risk should be screened. If there is a family history of colorectal cancer, physicians may suggest screening at an earlier age. Have the discussion about hemorrhoids and colorectal cancer

March is National Colorectal Cancer Awareness Month. It is an ideal time to get educated and have a conversation with a healthcare

are notable because most patients are found beyond an early stage, and non-alcoholic fatty liver disease is an increasingly common underlying factor for liver cancer.

“Our data highlight that HCC

or who experience cardiovascular complications during pregnancy should work closely with their health care clinician to monitor their health and take medications as prescribed to treat and reduce cardiovascular risk factors

care not only causes considerable financial stress on the health care system but directly for patients and their family members, who suffer from high out-of-pocket costs.

provider, no matter how uncomfortable it may be. Finding ease in talking about topics like hemorrhoids and colorectal cancer may in fact save a life. 

UH

Continued from page 12

Another critical factor in establishing good financial habits is education. Often, once people know how to move forward, they are more apt to stick with good spending and savings habits over time. In fact, financial independence and financial freedom is a result of

that could follow them through life.

“There is still much to learn about the special risks of maternal and infant health related to cardiovascular health. This is an area the American Heart Association continues to follow

deliberate habitual practice! Need Help Teaching a Loved One to “Fish” Financially?

Reaching a destination is often made possible by traveling with an experienced guide. So, if you’re in the process of assisting a loved one

There is a clear need for policy interventions and financial support systems in this patient population,” said Dr. Singal. 

the initiative. “Improved health is one of the strongest ways we can reach our goal.”

UH Population Health will continue to engage with campus partners to support this very goal and to further promote #Walk30. According to Valier,

initiatives such as this complement UH Population Health’s cross-disciplinary approach to health and wellness.

“UH Population Health touches so many areas of our campus and our external community,” Valier said. “It’s not just medicine or health care. Our

closely, devoting research dollars and other resources to ensuring the healthiest outcomes for parents and babies throughout their lifetime,” Albert said.

with good financial habits, it could help if you work with a CERTIFIED FINANCIAL PLANNER™ who can help with putting together a custom designed plan for them that is based on their specific situation and goals.

outreach impacts the arts, the social sciences, our students and so much more. We hope to reach even more stakeholders through both #Walk30 and future projects.” 

CMS Testing

Continued from page 1

of affordability, accessibility, and feasibility of implementation. The models include:

• The Medicare $2 Drug List: For chronic conditions like high blood pressure and high cholesterol, there are many relatively inexpensive generic medications that have significant clinical benefits, but cost-sharing can vary widely across insurance plans based on the specific formulation a doctor prescribes. This means that providers face uncertainty when writing prescriptions with patient out-of-pocket costs in mind because of variations in formularies and plan designs and patients may experience unexpected changes in their cost-sharing and may pay more than they have to. Under this model, Part D plans would be encouraged to offer a low, fixed co-payment across all cost-sharing phases of the Part D drug benefit for a standardized Medicare list of generic drugs that treat certain chronic conditions. The model would give pricing certainty to beneficiaries and health care providers prescribing medications, by capping the cost at a maximum of $2 per month per drug. This model will test whether a standard list of high-value drugs would improve adherence to medications and improve access to high-value prescription drugs. Ultimately, this could lead to better health

San José Clinic

Continued from page 1

“It is a privilege to promote and support these organizations that are deeply connected to the communities they serve, know best what their patients and communities need, and the most effective means of providing it.”

The organizations in the latest round of funding were chosen for their efforts to enhance workforce diversification, reduce health

Mental Health

Continued from page 3

acute fentanyl withdrawal, as the researchers found that inhibiting these dMSNs can reduce withdrawal symptoms and anxiety-like behaviors.

outcomes and lower spending for Medicare beneficiaries and, lower Medicare program costs.

• The Cell and Gene Therapy Access Model:

Cell and Gene Therapies are an emerging area of new drug development that holds significant potential to treat or even cure previously intractable diseases, such as sickle cell disease, beta thalassemia, or cancer. These drug therapies, however, can cost nearly $1 million per course of treatment. This model would create a new financing approach for patients enrolled in Medicaid to receive potentially life-changing therapies to which they may not have had access. Under this model, state Medicaid agencies would assign authority to CMS to coordinate and administer multi-state, outcomes-based agreements with manufacturers for certain cell and gene therapies. The model would seek to expand access and reduce the cost of cell and gene therapies, while also reducing the administrative and financial burden on states to administer the outcomes-based payment arrangements on their own. Medicaid beneficiaries, including those in underserved communities, could benefit from potential cures early in life or early in the course of the disease.

• The Accelerating Clinical Evidence Model:

The accelerated approval pathway expedites access to drugs that fill an unmet medical need and offer

disparities, and expand innovative models of care. A full list of winners can be found here. The awardees were selected by the Fund for Health Equity’s Advisory Council, which includes the following members:

Co-Chair Regina Benjamin, MD, MBA, 18th U.S. Surgeon General of the United States, Founder Bayou Clinic, Inc. Co-Chair Byron Scott, MD, MBA, Board Director of Direct Relief and Chair of its Medical Advisory Council Martha Dawson, DNP, MSN, RN, FACHE, President

The findings of this research provide new insights into the mechanism underlying opioid-induced negative emotional states, and pave the way for potential treatments for opioid use disorders. By reducing the negative emotional states that accompany withdrawal, it may be possible to reduce the risk of

improvements. Under this model, CMS would develop payment methods for drugs approved under accelerated approval, in consultation with the Food and Drug Administration, to encourage timely confirmatory trial completion and improve access to post-market safety and efficacy data. Giving manufacturers an incentive to expedite and complete confirmatory clinical trials may reduce the time and delays in completing confirmatory clinical trials. Faster trial completion may allow beneficiaries and prescribers to have more accurate and complete clinical information and, therefore may enable better treatment decisions. With greater confidence that drugs on the market are effective, this model would seek to improve quality of care and reduce cost, and it could help ensure patients continue to have access to the drugs they need.

In addition to the three selected models, the Secretary has identified additional areas for research with the potential to lower prescription drug costs, including: (1) accelerating biosimilar adoption, (2) data access changes to support price transparency and (3) cell and gene therapy access in Medicare Fee-For-Service. The Innovation Center will further develop and test the three referenced models with the goal of increasing availability and affordability of prescription drugs in the United States and, ultimately, improving health outcomes for all beneficiaries. 

and CEO President of the National Black Nurses Association, Associate Professor the University of Alabama at Birmingham Jane Delgado, Ph.D., MS, President and CEO of the National Alliance for Hispanic Health Gail Small, JD, Head Chief Woman, a citizen of the Northern Cheyenne Tribe Since the start of the Fund in 2021, more than $42.5 million has been provided to support 149 organizations across the U.S. 

relapse and decrease the number of lives lost to opioids.

In summary, the study provides new understanding of the brain circuits involved in opioid addiction and withdrawal and could lead to the development of new treatment for opioid use disorders.

KEEPING NEW MOMS AND MOMS-TO-BE SAFE AND HEALTHY

A healthy pregnancy is best for both mom and baby. Pregnancy and childbirth can put a woman’s health at risk, but many pregnancy-associated deaths can be avoided.

BEFORE GETTING PREGNANT

It’s important to understand your medical risks and to get as healthy as possible before pregnancy. Talk to your health care team about:

• Whether you have any signs of heart disease

• Your family health history

DURING PREGNANCY

• Visit a health care provider regularly

• Take medication as prescribed

IN AND AROUND DELIVERY

• Watch for changes and take action

• If you have concerns about your health or the health of your baby, consult your health care provider

AFTER DELIVERY

• Make your health a priority

• Get continued medical care

• Inform new health care

• Your blood pressure

• Whether you should lose or gain weight, and if so, how Getting 150 minutes of physical activity per week

• Healthy eating

• Sodium in your diet

• Whether prenatal vitamins

• Reduce stress and manage anxiety

• Monitor weight gain

• Avoid unhealthy habits such as smoking, alcohol and

immediately

• Some complications show up days after delivery

• Heart Rate and blood pressure normally decrease within 48 hours postpartum

• Blood pressure may increase

providers about the pregnancy

• Monitor your mental health

• Find ways to be active

are recommended

• Quitting any unhealthy substances, such as tobacco, alcohol, and

• marijuana or other drugs

• Safety in your home environment

illegal drugs

• Follow extra precautions if you’re older than 35

again 3-6 days later due to fluid shifts.

• During this period, you should be monitored for complications.

• Find time to sleep

• Eat nutritious food

• Rely on a support network

LEARN THE WARNING SIGNS

It’s important for you to stay on top of your own health. Many heart-related problems can happen in the days and weeks after delivery — even up to a year later. Some symptoms, such as fatigue and mild pain, are expected after childbirth. But strange or sudden changes may be a sign of stroke, heart problems or other dangerous conditions. Seek medical care right away if you have any worrisome symptoms during or after pregnancy, including:

• Severe or worsening headache

• Blurred vision or other vision changes

• Feeling dizzy, faint or disoriented

• A fever over 100.4 F

• Extreme weakness or fatigue

• Vaginal bleeding or foul discharge

• Abdominal pain

• Chest pain or racing heart

• Rapid or labored breathing

• Severe nausea or vomiting

• Unusual swelling of hands or face

• Redness, pain or swelling in arms or legs

• A slowing or stopping of fetal movement

• Severe anxiety or depression

• Thoughts of harming yourself or your child

• General ill feeling