Last month, this blog discussed the managed care organization (MCO) scorecards created with review data collected by MetaStar. These scorecards enable enrollees in Wisconsin’s Home and Community-Based Services (HCBS) programs to easily compare MCOs and select one that has been fairly and impartially reviewed. There is another program that falls under Medicaid HCBS in Wisconsin: Include, Respect, I Self-Direct (IRIS). Since 2008, the IRIS program has operated as a self-directed program by the enrollee. “That means you will have the freedom to decide how you want to live your life,” says the WI DHS website. That freedom and independence is important to those who enroll in the program.

Preserving independence can be crucial for older individuals and people with disabilities. According to an article in the International Journal for Equity in Health, “Preservation of independence is among the most important health priorities cited by older adults” (Enogela, Buchanan, et al 2022). Additionally, less independence can lead to increased depressive symptoms in patients with spinal cord injuries and vice versa (Monin, Schulz, et al 2015). We all want to keep our independence and ability to care for ourselves as long as possible. The IRIS program provides more control for enrollees over their care and decisions affecting their bodies, homes, and lives.

Studies have also shown that aging-in-place, or allowing individuals to age at home, provides many benefits, including routine, comfort, and reduced physical and mental strain. The same holds true for those with disabilities. However, most healthcare insurance companies don’t cover the services and needs of older individuals or persons with a disability living in their home. The HCBS waiver allows IRIS enrollees to remain in their home and receive the necessary healthcare and other services, reducing hospitalizations and assisted living fees and preserving their independence.

The IRIS Difference

HCBS programs, such as Family Care (FC), Family Care Partnership (FCP) and the Program of All-Inclusive Care for the Elderly (PACE), use MCOs to coordinate care for enrollees. However, the IRIS program empowers enrollees by allowing them to manage their own care. They are given a budget based on their current needs and long-term goals, and they can spend that money however they see fit within the program’s rules and regulations. IRIS covers a variety of services and commodities, including in-home medical care, house cleaning, errands, assistive devices, and more.

WI DHS’s IRIS website points out, “Joining IRIS does not mean doing things all by yourself. Others will help you along your way.” Others include an IRIS consultant and a fiscal agent, who can advise the enrollee on how to use the budget for current needs and adjust it when future needs arise.

Wisconsin’s IRIS program has over 25,000 people enrolled as of January 1, 2024 (WI DHS). Each individual selects an IRIS consultant agency (ICA) to work with—an important decision essential to smooth and safe service. How can enrollees effectively compare these organizations to determine which one is right for them? Enter MetaStar. MetaStar is essential in upholding IRIS program standards and providing user-friendly scorecards for each ICA, helping enrollees easily determine which ICA to work with.

MetaStar’s ICA Review Process

ICAs have different responsibilities to their participants than MCOs, resulting in different review processes. The IRIS program review focuses on the interactions between the enrollee, consultant, and ICA.

The MetaStar IRIS Record Review team, part of the External Quality Review Department, evaluates the six IRIS consultant agencies in Wisconsin. As noted in the previous blog post, this team is populated by former care workers, including social workers, nurses, and therapists who “come with direct experience in the field and really understand how the system works,” said Alicia Stensberg, MetaStar Project Manager.

The MetaStar IRIS Record Review team reviews over 400 ICA participant files quarterly, looking for a comprehensive care plan, monthly contact by the IRIS consultant with the participant, incident documentation, and other quality indicators. Data collected is converted into scorecards by WI DHS. “It’s a lot of oversight at the participant level to make sure their needs are getting met.” explains Stensberg. The MetaStar IRIS Record Review team helps to make sure the ICAs understand the metrics and requirements. They also provide technical assistance and help solve problems during the review process.

MetaStar’s team helps organizations address “not met” requirements by clarifying requirements, monitoring follow-ups, and documenting improvements. “We have a lot of contact with these organizations,” Stensberg said. “We also work closely with the state to make sure the ICAs are improving, and they are.”  She notes that while immediate improvements may not be evident each quarter, significant long-term enhancements in the performance of the ICAs have been seen, which she attributes, in part, to the ongoing reviews.

Hotline for IRIS Participants

MetaStar also operates a hotline for IRIS participants to report grievances or complaints regarding the IRIS program. MetaStar employees staff the hotline during business hours. The MetaStar employee works with the participants and the agencies to find acceptable resolutions. “From a statewide perspective, the [number of] grievances is relatively low, less than 1% of the membership,” Stensberg said. “It’s a healthy amount. No grievances mean people aren’t exercising their rights.” The grievances reported during these calls do not affect the scorecard results.

The IRIS program supports Medicaid enrollees’ dignity and independence. MetaStar provides clear evaluations of the ICAs and a grievance hotline, ensuring enrollees’ care is taken seriously. It’s crucial to consider future medical and personal care—for oneself and loved ones. “Anyone can end up needing Medicaid benefits at any time,” Stensberg explains. She also reminds us that “one of the most important things that we can do as a society is take care of the people who are marginalized. It is our duty, and frankly, it would cost us a heck of a lot more if we didn’t.” Scorecards created by WI DHS with data from MetaStar’s experienced review team enable clear decision-making during difficult times and offer a way for WI DHS and MetaStar to help Wisconsin’s marginalized populations.

“Do not regret growing older,” said Mark Twain. “It is a privilege denied to many.” While we’re not entirely sure Mark Twain is the author of this adage, the truth in the statement still rings clear: aging is not a disease to be fought, but a stage of life to appreciate and possibly even enjoy. However, aging can also bring health issues, loss of ability, financial struggles, and lack of a support system. By 2040, the number of Americans age 65 and older will reach 21.6%, according to the Administration for Community Living (ACL), up from 16% in 2000. Additionally, people who are disabled—who make up almost 27% of the population according to the United States Centers for Disease Control and Prevention—experience similar challenges.

These groups of people often face challenges caring for themselves. While some lucky people can self-fund care in aging years or disability, many others lack the financial resources for these situations. While Medicare and private insurance can alleviate medical costs and replace lost wages, medical care isn’t the only need to arise when a person becomes unable to care for themself.

Medicaid enrollees receive medical care, but they also require support in their homes and communities for various tasks, including at-home medical tasks, personal care, home care, pet care, errands, and much more. However, most health insurances won’t cover these services outside of a medical setting. Older adults or people with a disability are then caught in a web of problems: Can they self-pay for care? Is there a friend or relative who can help them? Should they move to a nursing home or assisted living facility? Depending on the extent of needs, some of these options aren’t possible. Fortunately, Wisconsin offers various ways to meet the long-term care needs of older adults and people with disabilities while allowing them to stay in their own homes.

The Wisconsin Way of Meeting Long-Term Care (LTC) Needs

Wisconsin provides LTC services through Medicaid Managed Care programs, including Home- and Community-Based Services (HCBS), through the following programs: Family Care (FC), Family Care Partnership (FCP), and the Program of All-Inclusive Care for the Elderly (PACE). FC is offered statewide while FCP and PACE are only offered in certain counties. These programs, operated by managed care organizations (MCOs), provide a variety of healthcare and other services that allow people to remain in their homes. When a person enrolls in one of the HCBS programs, they need to choose an MCO to work with as care is coordinated through the enrollee’s team at the MCO.

Wisconsin has four MCOs. When an MCO plays such an important part in a person’s life, choosing the right one becomes essential. How can anyone compare such large and varied organizations? MetaStar helps maintain program standards and contributes data to user-friendly scorecards for each MCO. Potential enrollees can easily compare options and select the most suitable one based on impartial data that has been collected and reviewed by MetaStar.

MCO Scorecards—MetaStar Makes the Difference with Data

MetaStar’s Quality Compliance Review team conducts reviews annually to gather data for the MCO scorecards. The team reviews each MCO in the state. “It’s a comprehensive system-level evaluation to determine that they are meeting requirements and hopefully exceeding them,” said Alicia Stensberg, project manager for the External Quality Review Department at MetaStar. Data for the scorecard comes from program enrollee surveys, an extensive document review, and employee interviews, with the latter two completed by MetaStar’s team.

The MetaStar team reviews documents such as policies and procedures, monitoring data, training information, contracts, correspondence, and much, much more to ensure these documents meet the metrics set by the state and federal governments. Employee interviews conducted over two or three days, involving various groups of staff members—everyone from information technology to care team members to leadership to support and supervision staff gets interviewed. The interviews are done to corroborate the findings from document review, but Stensberg finds them interesting for another reason: “It’s neat to hear [the staff] talk about their passions for supporting members and helping people live full and safe lives. I hear about the different initiatives that they have and the ways that they’re being collaborative with different organizations and different resources, all in the name of supporting members. It’s a cool experience.” She cites an example of another state’s Medicaid program addressing gun violence, highlighting the importance of caring for enrollees’ needs beyond direct medical care. Stensberg continues: “If you’re looking at caring for the whole patient, gun violence is very, very real for so many of the Medicaid recipients. The amount of impact Medicaid has amazes me.”

Data from the review process helps reviewers identify a requirement as “met” or “not met.” If something is found to be deficient, Stensberg explains, the Wisconsin Department of Health Services (WI DHS) can implement a corrective action plan for the organization to make improvements.

The hundreds of pages of MetaStar’s technical review are distilled into key areas for MCOs, such as such as satisfaction, responsiveness, communication, care delivery, quality standard, staff turnover and staff ratios. The WI DHS compiles this data into easy-to-compare scorecards.

Additionally, the review data is reported to the Centers for Medicare & Medicaid Services (CMS) as an Annual Technical Report, which is hundreds of pages long (and available online for anyone who is interested.)

The MetaStar Quality Review Team

The Quality Reviewers are part of the MetaStar External Quality Review Department. Stensberg calls them “some of the most amazing people I’ve ever worked with. All of them are such strong advocates for the individuals receiving services and really understand how the systems operate.” They all have 10 years or more of experience in LTC or a related field, such as nursing, counseling, social work; they’ve worked with children’s programs and family care organizations. Stensberg herself previously worked with adults with disabilities, and, like the rest of her team, she thinks it helps her in her current work. While she misses the job, “I’m glad to be here because I’m still part of the field. I think I’m having an impact on a broader scale.” This all-star team ensures regular assessment of the MCOs so participants can be assured that the scorecards are a carefully considered collaboration between WI DHS and caring, patient-focused MetaStar reviewers.

In addition to the MCO reviews and scorecards, the External Quality Review Department is involved with another HCBS-waiver program: Include, Respect, I Self-Direct (IRIS). This unique program allows enrollees to have more control over what care they receive, where they receive it, and when. Be sure to check in next month when we discuss the IRIS program and its formula for giving enrollees more influence in the direction of their healthcare as well as more choice and more independence.

May is the American Stroke Association’s (ASA) American Stroke Month. Often unrecognized and untreated, strokes can have devastating consequences:

• Each year, nearly 800,000 stroke patients join the 9.4 million adults (20 years old or older) in the United States who have had a stroke and are living with its effects. Of those 800,000 patients, over 160,000 will die.
• One American has a stroke every 40 seconds, and one American dies of a stroke every 3.25 minutes.
• 40% of strokes in the United States occur in males, and 60% occur in females.
• The risk of having a first stroke is nearly twice as high for non-Hispanic Black adults as for White adults. Non-Hispanic Black adults and Pacific Islander adults have the highest rates of death due to stroke.
• Strokes rank fifth among all causes of death in the United States.
• In 2020 (the latest year for which data is available), 2,091 people in Wisconsin died of strokes.
  • Strokes are the leading cause of disability in Wisconsin.
  • About 25% of people who recover from their first stroke will have another one within five years.
  • Up to 80% of strokes are preventable.

(Sources: Wisconsin Environment Public Health Tracking Program, The Centers for Disease Control and Prevention, Wisconsin Department of Health Services Coverdell Program, Stroke Awareness Foundation)

The cost of strokes in human lives and resources continues to grow each year. There’s no better way to mark this important awareness month than to discover the ways the Wisconsin Department of Health Services (WI DHS) and MetaStar are enhancing the continuum of care for stroke patients across the state.

The Quest for Better Stroke Care

Paul Coverdell was a Georgia Senator who died from an intracerebral hemorrhage in July 2000 while serving in Congress. He served the people of Georgia for nearly 17 years before his death at age 61.

This tragedy led to the creation of a new stroke care program. In 2004, the Centers for Disease Control and Prevention (CDC) established the Paul Coverdell National Acute Stroke Program in response to Senator Coverdell’s death and a three-year study on stroke care in the United States. The program provides funding to state health departments that are committed to improving stroke care.

Wisconsin’s community-based organizations, emergency medical services (EMS), hospitals, professional organizations (like the ASA and the American Heart Association [AHA]), academic institutions, public health, and industry partners work together to “ensure that all patients in Wisconsin receive timely, high-quality acute stroke care” (WI DHS).

MetaStar Meets Coverdell

Dot Bluma, BSN, RN, CPHQ, is MetaStar’s stroke project specialist. She provides invaluable support to the program. Bluma currently works with hospitals to analyze data, finding areas where more focus or education is needed. “I’m our data geek on this program,” she said with a laugh. “I’m a nurse, but I’ve become a data nerd.” She has three colleagues on the Coverdell team, one who works with EMS, and two others who work with community partners, all with the same goal of improving stroke care in Wisconsin.

Wisconsin Coverdell in Action

Though the broad focus of a Coverdell program is decided by the CDC, the awardee states can choose to work on specific areas anywhere along the stroke-care continuum that fit within the broader focus. Wisconsin has chosen several areas to focus on for the current program’s focus on disparities.

“We always start with educating the community,” said Bluma. “How can we prevent a stroke from happening?” Educational materials created by the Coverdell team addressed that question. “Risk Factor Rick,” created in 2023, explains stroke risks and how to combat them. “BE FAST Bella,” created in 2017, educates about the signs of a stroke, using an acronym adapted from the ASA’s FAST acronym. With the most recent Coverdell program, the materials were translated into Spanish, Hmong, Somali, and Russian, which, along with English, are the languages most frequently spoken by stroke patients in Wisconsin. “We want to meet people where they are and be cognizant of everybody’s diversity,” Bluma said.

Equally important is ensuring that when the patient goes home, their individual needs are met. In addition to medication, regular blood tests, and follow-up appointments, the Coverdell program provided the opportunity to begin including community resources in stroke recovery. Bluma described an integrated health program between the Milwaukee Fire Department (MFD) and Froedtert Hospital that refers certain high-risk stroke patients to the MFD Mobile Integrated Health Program (MIH). MFD performs home visits, assesses and addresses safety concerns, provides education, and more. MIH then sends a report back to Froedtert who enters the information into the database so outcomes can be studied. “It’s been a phenomenal connection,” Bluma said. ” Clients say it’s been worth its weight in gold.”

Decoding Coverdell Data

With so many areas that could be the focus of this much-needed program, how does Coverdell identify which areas should and could be targeted for improvement? They use data from the AHA’s Get With The Guidelines^®-Stroke database. According to the registry, over 9.5 million patient records from over 3,400 hospitals have been entered. The database provides a rich data set for analyzing stroke care at the hospital, Wisconsin, and national levels. Factors like bed size, hospital certification, sex, and more can be analyzed and interpreted to improve the quality of stroke care. Bluma spends part of her time working in the database and helping hospitals with their data. EMS data can also be integrated into the Get With The Guidelines^®-Stroke database to provide a fuller picture of patient care and transitions.

Additionally, Coverdell creates hospital report cards based on the Get With The Guidelines^®-Stroke database. Hospitals can now easily compare their data and benchmarks with all Coverdell hospitals in Wisconsin and hospitals nationally. Similar report cards have been created for EMS as well.

The Future of Stroke Care

Bluma isn’t one to rest on her laurels. She continues to sift through data to identify ways to improve stroke care in Wisconsin. “Addressing disparities in stroke care is an area we need to have a bigger focus on,” explained Bluma. Through continued work by implementing evidence-based stroke care education and protocols to reduce geographic, racial, and ethnic disparities, MetaStar aims to pave the way for targeted approaches that address individual patient needs. Continuing to leverage the relationships between community-based organizations, emergency medical services, hospitals, and patients and families are crucial in successful pre and post stroke care. The ongoing approach is to continue to build on prior work, provide equitable and inclusive care to diverse communities, and leverage data and technology, to ensure the future of stroke care will be more equitable and effective.

In the ongoing battle against the opioid epidemic, National Drug Take Back Day stands as a beacon of hope, fostering community engagement, and promoting responsible disposal of prescription drugs. This biannual event, held across the United States, serves as a vital initiative in combating the opioid epidemic and ensuring the safety of our communities.

How National Drug Take Back Day Started

The inception of National Drug Take Back Day is resultant of Drug Enforcement Administration’s (DEA) realization of the pressing need for proper disposal of prescription medications.

Recognizing unused prescription drugs as hazards, the DEA, in collaboration with community members and other partners, launched the first Prescription Drug Take Back Day in September 2010.

Since its start, this initiative has garnered widespread support and participation from individuals, pharmacies, law enforcement agencies, and community organizations. The event’s success hinges on its simple yet impactful premise: to provide a safe, convenient, and anonymous method for individuals to dispose of unwanted prescription drugs.

A Biannual Event

National Drug Take Back Day typically occurs twice a year, in the spring and fall, with designated collection sites nationwide. (The next event is set for April 27, 2024.) These sites are often located in pharmacies, police stations, and community centers. The drugs collected are securely transported and incinerated, ensuring they do not end up in the wrong hands or harm the environment.

Participation in National Drug Take Back Day is crucial in addressing the multifaceted challenges posed by prescription drug misuse. By removing unused medications from homes, individuals reduce the likelihood of accidental ingestion, diversion to non-prescribed users, and environmental contamination through improper disposal methods like flushing down the toilet or throwing them in the trash.

Wisconsin’s Leadership in Take Back Efforts

Among the states leading the charge in drug take back efforts, Wisconsin has emerged as a trailblazer. Through strategic partnerships between state agencies, law enforcement, healthcare providers, and community organizations, Wisconsin has established a robust infrastructure for prescription drug disposal and education.

One key factor contributing to Wisconsin’s success is its extensive network of disposal sites. The state boasts a diverse array of collection locations, providing widespread access for residents across urban and rural areas.

Wisconsin community members have also implemented innovative ways to raise awareness and promote participation in drug take back programs. Public awareness campaigns, educational workshops, and outreach events are organized to educate residents on the importance of safe medication disposal and the risks associated with prescription drug misuse.

By fostering partnerships and leveraging resources, Wisconsin maximizes the impact of its drug take back initiatives and creates a united front against the opioid epidemic.

National Drug Take Back Day demonstrates the joint effort to protect communities from prescription misuse. For over a decade, it has made progress in promoting safe medication disposal. Do your part, access the Wisconsin Department of Health’s Dose of Reality: Drug Take Back Day page to find a local drop off location near you.

On the Mission page of the Utilization Review Accreditation Commission (URAC) website, President and CEO, Shawn Griffin, MD, declares “At URAC, we seek to inspire health organizations and communities to deliver a higher level of care.” The page goes on to say that URAC knows “equity and inclusion can be improved. It’s our intention to continually define and write standards that elevate health care for each individual. Every person matters. Every person deserves the best care.” Figuring out how to get to that higher level of care can be a complex and challenging endeavor for most healthcare organizations. That’s why, in 1990, the newly incorporated URAC created standards and metrics that allow organizations to receive URAC accreditation. The accreditation shows that, through careful data collection and validation, an organization has reached an elevated level of healthcare delivery. Today, URAC offers dozens of accreditation programs to help healthcare organizations provide the best, most efficient health care at the lowest cost.

Steps to URAC Accreditation

URAC accreditation is a multi-step process of data collection and validation. In healthcare, where it’s difficult to consistently measure outcomes between and within organizations, having a third-party organization—like URAC—allows healthcare providers and administrators to see how their organizations are performing using a set of predetermined metrics. Like the shiny gold star atop a school test, the URAC accreditation gold star lets everyone who sees it know that this organization has met the high standards set by URAC’s various panels of experts.

Accreditation happens in three steps: first, the organization applies to URAC to be accredited. For the remainder of that year, the organization reviews the required metrics for their area and adjusts their workflows, data tracking, and data storage systems to ensure they are tracking and collecting the required data. Next, the organization collects data for an entire calendar year for all mandatory metrics. The final step includes data validation by a URAC-approved validating organization such as MetaStar and the submission of that data to URAC. For example: if an organization applies to URAC in 2024, they collect their first year of data in 2025, and they would have their data validated for URAC submission in 2026. Data submission is required each year the organization wishes to be URAC-accredited.

Each URAC accreditation program has mandatory metrics used to evaluate their organizations. For example, mail service pharmacies will report on their prescription dispensing accuracy, such as the number of labels with incorrect patient addresses. This will be reported as a numerator (number of prescription labels with incorrect addresses) and a denominator (total number of prescriptions) to create a percentage of prescriptions with incorrect addresses. Measurement rates can then be assessed to find areas of improvement or areas of exceptional competence.

The Data Validation Process

During the validation process, MetaStar helps “confirm that the pharmacies/organizations are collecting the appropriate data and calculating the measure rates correctly,” said Ross Gatzke, the URAC data validation lead at MetaStar, during a recent interview. This means providing the organization with documentation to help them through the validation process, confirming they are collecting the correct data, and ensuring the organization is ready to report the required information to URAC. “For most of the mandatory measures that URAC has, organizations typically already have a data collection process in place,” Gatzke continued. “A lot of times, they just have to make some updates to meet the technical specifications [set by URAC.]”

MetaStar provides top-tier data validation services for pharmacies, which are the only organizations that require data validation for URAC accreditation. MetaStar validators continuously review submitted data and measure rates through the validation process. “It helps the organization feel at ease and get confirmation that they are reporting the measures accurately to URAC,” Gatzke explained. If any issues are found, the organization has time to adjust and run more data checks to ensure the final submission to URAC accurately portrays what happens at their organization.

The MetaStar Difference

MetaStar is one of the five URAC-approved data validation vendors. When deciding which vendor to choose, consider the following:

• MetaStar’s three-year retention rate (2022-2024) is 98.73%.
• MetaStar has the experience and consistency that organizations who are serious about URAC accreditation look for:
  • Ten unique data validators. Each data validator has at least two years of experience, while most have five or more years of data validation experience. “They are subject matter experts in their own rights,” Gatzke said.
  • A consistent, reliable relationship between MetaStar data validators and organizations.
    • Year over year, the same validator will work with an organization, building a relationship on familiarity, trust, and knowledge.
    • In subsequent years, data validation becomes a familiar process as the data validator will have experience and expertise working with the specific organization.
  • MetaStar hosts three webinars twice each year that provide education and guidance regarding URAC data validation.
  • MetaStar has outstanding customer service, and their data validators are among the best in the business.

Organizations praise MetaStar’s work, data validators, and customer service. Here’s what they say:

• [MetaStar is] dependable, quick to respond and extremely helpful. Everyone has been amazing and very friendly.
• The experience with MetaStar and our current reviewer is excellent. We have been customers for 5 years, and we enjoy the bi-directional learning that comes along with these audits and reviews.
• Our overall experience with MetaStar was excellent; our validator was very easy to work with and was very helpful every step of the way.
• We have been working with MetaStar for several years and continue to appreciate the quality and efficiency shown during the validation and reporting process!
• [MetaStar is] extremely professional and diligent. Working with our validator was a very positive experience where any question or concern we had was met with professional insight and remediation.
• Overall experience was fantastic. [MetaStar data validators are] extremely knowledgeable and helpful throughout the process.

If your organization wants top-of-the-line URAC data validation from a leader in the industry with proven, positive results, MetaStar URAC data validation services is the obvious choice. Contact Manny Martin, Vice President of Commercial Services at MetaStar, at 608-441-8264 or mmartin@metastar.com for more information or to get the contracting process started today.

 

MetaStar has a grant from the Health Resources and Services Administration, or HRSA, to work with a coalition in Sauk County to reduce opioid overdoses. As part of MetaStar’s grant funding, the team worked with a local agency to create a position for a jail re-entry coordinator. This position was created because for people with substance use disorder, one of the times that is considered high risk for overdose is immediately after leaving jail. The re-entry coordinator meets with people while they are in jail and connects them to treatment and other supportive services, to help reduce the risk of overdose after release.

One re-entry coordinator shared this story:

Frank, a program participant, was interested in support for the sobriety he found while in jail. He also needed housing. The re-entry coordinator connected him with The Harbor Recovery Center in Portage for peer and group support.

Frank and the re-entry coordinator worked together to complete a prescreen for a housing program. He was given his former employer’s contact information and wrote them a letter inquiring about employment after release. He was also given information on how to renew his certifications for work and how to activate his FoodShare card.

Before his release, Frank spoke about how he felt like everything was coming together for him to be successful. On his first day out of jail, Frank went to the housing program office to meet the staff, moved into his temporary living placement, got his FoodShare activated, and started working with his previous employer that same afternoon.

After being released for less than three weeks, Frank was accepted into the housing program, which can provide up to 12 months of rental assistance and/or security deposit assistance. He continues working and receiving services to support his recovery from substance use disorder through The Harbor Recovery Center.

As of October 2023, the jail re-entry coordinator has served 128 individuals like Frank.

 

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Grant # GA1RH42910
Program #: HRSA-21-088; CFDA 93.912
Award: $1,000,000 (over three years) 9/1/21 through 8/31/24
Project: HRSA Rural Communities Opioid Response Program (RCORP) Implementation Grant
Grantee/Applicant: MetaStar, Inc.
Supporting: Sauk County Continuum of Care Consortium (S4C)
Focus County: Sauk
Period of Performance: 9/1/2021 through 8/31/2024 (36 mos.)

2023 marked MetaStar’s 50th anniversary, a significant milestone that we celebrated with gratitude and a commitment to giving back. As we reflect on five decades of pursuing our vision of optimal health for all, our dedication to the well-being of our communities takes center stage. This anniversary year has been more than a celebration – it’s been a year of meaningful contributions. Throughout the year, our team members gave back in a variety of ways.

Virtual Blood Drive with the American Red Cross

We partnered with the American Red Cross for a virtual blood drive. Aligning with our anniversary theme, our goal was to recruit and secure 50 donors. We’re thrilled to announce that we exceeded this goal! These donations help ensure a crucial supply of life-saving blood is available for community members in need.

Fall Donation Drive Supporting United Way and Community Shares

In the spirit of the season of giving, we organized a fall donation drive for United Way of Dane County and Community Shares of Wisconsin. The entire MetaStar team heard directly from individuals from Safe Communities of Madison and Dane County (supported by the United Way) and Disability Rights Wisconsin (supported by Community Shares) and learned about the important work both groups are doing to support our communities and help them thrive.

Empowering Team Members to Volunteer

As part of our commitment to community engagement, MetaStar empowered our team members to contribute their time through volunteer opportunities in their own communities. Our team rose to this opportunity by providing over 100 volunteer hours to support mission-aligned organizations. Below is a list of some of the organizations our team supported in 2023:

• Madison Street Medicine in Madison
• Ronald McDonald House Charities in Madison
• Safe Shelter in Green Bay
• Kinship Community Food Center in Milwaukee
• Second Harvest Food Bank in Madison
• SOAR Fox Cities in Appleton
• The Stoughton Wellness Coalition in Stoughton
• H.E.L.P. (Help Excite Little People) in Sauk City
• Meals on Wheels in Madison
• Project Christmas of Jackson County in Black River Falls
• Allied Family Center Boys and Girls Club in Fitchburg

As we celebrate our 50-year legacy, we remain committed to “walking the talk” by giving back to the communities we serve – now and in the years to come.

How we can improve health equity with culturally and linguistically appropriate services (CLAS)

Everyone deserves quality healthcare services. CLAS standards can help tailor care to the patient’s unique needs and help them feel included in their care. If we all do our part, we can move health equity straight to the head of the CLAS!

The CDC defines health equity as “the state in which everyone has a fair and just opportunity to attain their highest level of health.”* Health equity is a tenant of high-quality care and should remain a commitment for the entire healthcare community, as outlined in the overarching goals of Healthy People 2030.

Dr. Kedar Mate, the Institute for Healthcare Improvement president and CEO, challenges that there can be no progress on quality without equity. And yet, our data continues to highlight the gaps in care by characteristics such as race, ethnicity, socio-economic status, and geography. Commitment exists to provide equitable care and reduce disparities across healthcare organizations, requiring changes in policies and practices.  Guidance is available to help build such policies and procedures and assist with staff education to get us closer to providing culturally and linguistically appropriate services (CLAS).

CLAS sets forth standards and guidelines to help healthcare organizations deliver culturally aware care, encompassing many aspects of healthcare delivery, including communication, language assistance, and organizational culture. Health services that are respectful of and responsive to the health beliefs, practices, and needs of diverse patients can help understand and break down barriers to ultimately close the gap in health outcomes.

Bias Is a Barrier

While many healthcare professionals are well-intentioned and dedicated to offering high-quality care, explicit or conscious bias as well as implicit bias—an unconscious association, belief, or attitude toward any social group—can be a barrier for building trust with patients.

How might incorporating CLAS standards improve the implicit bias in the following examples leading to improved care?

• A doctor diagnoses a Black patient with diabetes and focuses initial treatment efforts on nutritional changes—without first exploring if nutrition is a central factor in the patient’s condition; making assumptions about what the patient is eating due to their race.
• A nurse practitioner is surprised when a Hmong patient seems hesitant to try a treatment plan, not knowing that the patient is afraid to say they want to first try traditional healing practices.
• A nursing home administrator assumes they are being inclusive by putting up LGBTQIA+ posters throughout the facility but does not consider talking to the residents who are members of the LGBTQ+ population about what would make their care and stay respectful and inclusive.

Sadly, bias too often leads to inferior care that is not personalized or equitable. Without incorporating CLAS, providers may miss opportunities to provide even better care for their patients. The CLAS standards are a blueprint of 15 standards for individuals and organizations, providing simple, effective ways to address health equity, improve quality, and eliminate disparities.

Breaking Down Barriers

• Be intentional and involve your intended audience. When creating CLAS materials, it’s important to both identify the needs of your intended audience and validate those needs by involving those most impacted in the development and design of services. For example, when creating materials for a Spanish-speaking audience, it’s not always enough to rely on a translation firm’s expertise. Instead, involve people whose native language is of the Spanish dialect for the patients being served. Ask them to help you understand nuances among differing dialects. This can go a long way in creating materials that help patients feel welcome, heard, and understood.
• Educate your staff. Healthcare providers earn trust by showing they are knowledgeable and empathetic. Incorporate training, across the organization, to build cultural competency and reduce explicit and implicit bias. Our reach extends beyond our internal employees. We’re proud to partner with the University of Wisconsin-Madison effort on Community-Academic Aging Research Network (CAARN), which brings together community and health system partners with academic researchers to conduct research to improve the health of older adults and decrease health disparities.
• Understanding, and using, Z-codes. Z codes, which are a category of ICD-10 codes, represent reasons for healthcare encounters that are not related to disease, injury, or external cause. Instead, Z codes describe social, economic, and environmental factors that influence a person’s health. These codes include issues related to education and literacy, housing and economic challenges, and difficult family circumstances. By using Z codes, instead of merely identifying a patient as having diabetes or other ailment, patient files alert the physician to potential problems that may be affecting the patient such as poverty, homelessness, food insecurity, or other personal challenges that can shape the physician-patient conversation. By having this information at hand, healthcare providers may better avoid biases and misconceptions that stand in the way of the most effective care. It allows the provider to have the necessary information to focus on the unique patient in front them.

Providing equitable care is essential to improving the health of the communities we serve.  Through a commitment to the CLAS standards, we can support cultural humility across the continuum of healthcare and move closer to the ultimate goal of health equity for all.

*What is Health Equity? | Health Equity | CDC

 

 

 

 

 

September is National Recovery Month, an annual observance to educate Americans that appropriate treatment and mental health services can help those with substance use disorder (SUD) live healthier lives. Sadly, this ideal remains difficult to achieve because of bias in how we view addiction in this country.

At MetaStar, we’ve identified stigma as a primary major public health challenge. Stigma can prevent people with SUD from seeking help, even if they desperately want it. Educational programs and policy innovations have helped, but there is still work to be done to help eliminate stigma and help those struggling with SUD.

Systemic issues work against those fighting addiction

Imagine SUD as a very large boulder a patient carries with them every day. Should this person also have a mental health disorder—which often is the case—this adds a second boulder. If they happen to be a person of color, they’re weighed down by three boulders. If they’re a woman, by four, and if they’re living in poverty, five, and so on.

Despite good intentions, the healthcare community struggles with systemic issues in deploying appropriate, evidence-based treatment to those who most need it for SUD, as well as additional challenges. We know there are effective treatment options, but the question remains: How do we get the right treatment, to the right patient, at the right time?

Too often, the healthcare community chases the latest “solutions,” such as smartphone apps, telehealth, and AI-supported tools without reflecting on a root cause—stigma—and how overcoming that can help pave a smoother road to recovery.

Overcoming stigma

Stigma continues to cast a shadow over efforts to provide effective treatment for those grappling with SUD. This pervasive, societal shaming creates barriers at every stage of the recovery journey:

• Structural stigma leads to discriminatory policies and practices, such as a devaluing of treatment care providers, treatment entry procedures designed to present hurdles to those who are seeking care, and limited insurance coverage.
• Continued stigma on the part of healthcare providers can lead to mistreatment of those seeking help.
• And lastly, as people internalize negative stereotypes, it leads to feelings of shame and worthlessness, making a person feel as if they aren’t even worthy of getting better.

The Shine a Light podcast, which focuses on reducing stigma, recently featured a guest from a rural area who described her experience when seeking help. After finding herself at rock bottom, she made the brave decision to go to the hospital emergency department for help. After waiting for six hours, she received a curt response from the first doctor she saw: “I know what you’re here for, and I know what you’re all about. You’re not getting any drugs from me, so you should just leave.” This devastating experience kept her from seeking help again for a long time.

Shine a Light on Stigma

MetaStar’s two tenets related to the reduction of stigma are simple:

1. Knowing, understanding, and empathizing with those with SUD helps defuse the negative impact of stigma.
2. Words matter.

Not everyone has the opportunity or comfort level to get to know someone who has experienced SUD. Through our work with the Superior Health Quality Alliance’s Shine a Light on Stigma campaign, we’re able to bridge that gap. We offer informative, frank and action-oriented videos and podcasts to help people recognize their own prejudices and learn how to change them, humanize those struggling with SUD, and evolve the language we all use in discussing SUD.

Words matter. Using patient-friendly, person-centered language is a critical step in reducing stigma. For example, referring to “a person with substance abuse disorder” conveys an entirely different message and tone than labeling this same individual an “alcoholic,” “addict,” or “drug abuser.” The former suggests the person has a problem that can be addressed; the latter implies the person is the problem. By using person-centered language, you can show respect and kindness to people who may need it the most.

Take the pledge to reduce stigma

Because stigma is public health challenge, it requires community support to change it. That’s why we ask people and organizations to pledge to use appropriate, empathetic language and encourage others to do so, as well. We’re proud that people from across the nation have joined us, and the number continues to grow. We’ll continue our efforts throughout National Recovery Month and throughout the year, because changing stigma happens one conversation at a time.