TORONTO, Nov. 30, 2020 (GLOBE NEWSWIRE) — Braingrid Limited (CSE: BGRD) (“Braingrid” or the “Company”) is pleased to announce that it will be pursuing a change of business to an investment company (the “Proposed COB”) under the rules of the Canadian Securities Exchange (the “CSE”).
After an evaluation of the Company’s existing resources and a review of strategic options available to the Company, the Company determined to refocus its business operations from a “technology issuer” to an “investment issuer”. The board of directors of the Company (the “Board”) believes that its network of business contacts, the depth of experience of its management team and its overall entrepreneurial approach will enable it to identify and capitalize upon investment opportunities as an investment issuer.
It is anticipated that the Company’s name will be changed to “Tony G Co-Investment Holdings Ltd.” in conjunction with the completion of the Proposed COB. Although Antanas Guoga (commonly known as “Tony G”) has consented to the use of the name “Tony G Co-Investment Holdings Ltd.” by the Company, Tony G is not currently part of the Board or management of the Company and will not be appointed to the Board or management following the completion of the Proposed COB. In contrast, the new name reflects the intention of the Company to direct its investments towards companies in which Tony G has a significant equity interest and/or in which Tony G played a material role in developing the business.
In accordance with the policies of the CSE, trading in the shares of Braingrid have been halted pending review and approval by the CSE of the Proposed COB. The Company plans to shut down or dispose of its current assets in connection with the Proposed COB.
The completion of the Proposed COB is subject to the receipt of all necessary approvals, including without limitation shareholder and CSE approval of the Proposed COB.
In connection with the Proposed COB, the Company intends to adopt an investment policy (the “Investment Policy”) to govern its investment activities and investment strategy. A summary of the material terms of the Investment Policy will be disclosed in due course and, upon the completion of the Proposed COB, a copy of the Investment Policy will be posted on the Company’s profile at www.sedar.com.
As an investment issuer, the Company will look at multiple investment opportunities, with a particular focus on the blockchain technology, cryptocurrency, payment processing services, syndicated credit opportunities, online commerce and online gambling industries, as well as ancillary industries thereto. The Company will maintain a flexible position with respect to the form of investment taken and may employ a wide range of investment instruments. The Company may take an active role in management of its investee companies where its experience and contacts would be beneficial.
In connection with the Proposed COB, the Company has entered into a letter of intent on November 30, 2020 with all of the shareholders of News 3.0 Limited (“Cryptonews”), pursuant to which the Company shall purchase 51,000 shares of Cryptonews (representing a 51% interest) from existing shareholders for an aggregate purchase price of $3,600,000, payable by way of the issuance of a new class of preferred shares (the “Preferred Shares”) of the Company to be designated as Series “1” Preferred Shares (the “Cryptonews Investment”).
Cryptonews is a crypto-focused online media outlet that delivers original international news coverage on digital assets, blockchain, cryptocurrencies, and related content, including, but not limited to, market information, research, educational guides, product reviews, expert opinions, videos, and events. The key addressable audience includes cryptocurrency investors, enthusiasts, traders, industry professionals, and the general public interested in learning more about blockchain, investing, trading, and digital asset technologies. Cryptonews delivers content in English, French, Russian, German, Italian, Dutch, Persian (Farsi), Arabic, Chinese, and Turkish languages with the aim to expand its coverage to more local markets. Cryptonews’ current main revenue streams include the sale of advertisements, affiliate deals, and sponsored content such as press releases, sponsored articles, guides, reviews, and community events.
The completion of the Cryptonews Investment is subject to certain conditions, including but not limited to shareholder and CSE approval of the Proposed COB.
Tony G is contemplated to remain a substantial shareholder of Cryptonews following the completion of the Cryptonews Investment. Tony G is a founding shareholder of Cryptonews and has played an active role in the development of its business.
The Company has also entered into a letter of intent with a shareholder of Sportsclothes UAB (“Sportsclothes”) on November 29, 2020, pursuant to which the Company shall purchase shares of Sportsclothes (the “Sportsclothes Shares”) representing 20% of the issued and outstanding Sportsclothes Shares, for an aggregate purchase price of EUR 1,400,000 (One Million, Four Hundred Thousand Euros) (the “Sportsclothes Investment”). The purchase price will be payable by way of the issuance of Preferred Shares.
Sportsclothes is a Lithuanian online retailer of high-end basketball, leisure, football and tennis shoes, clothing and accessories. Sportsclothes has one wholly-owned subsidiary, Krepsininkams, UAB, a private company incorporated under the laws of Lithuania. Sportsclothes’ sales are placed through Amazon and eBay to customers in the United States and the European Union, and through its websites use https://shop.lympo.com/ and https://www.sil.lt/. Sportsclothes also maintains one physical store location in Kaunas, Lithuania. Sportsclothes’ integrated and unique e-commerce platform allows Sportsclothes to manage real time large amounts of products between different sales platforms, including Amazon, Ebay, its own retail shop and other websites.
Key distributors of Sportsclothes include Nike/Jordan, Adidas, Reebok, Puma and New Balance. As Sportsclothes has a fully automated warehouse and excellent relationships with top international couriers, Sportsclothes has the ability to deliver parcels to customers in Europe and the United States within two to three days of purchase orders. Sportsclothes has integrated and intends to expand integration via Paypal solution cryptocurrency technology into its websites and other sales channels allowing its customers to pay for products using various forms of cryptocurrencies.
The completion of the Sportsclothes Investment is subject to certain conditions, including but not limited to shareholder and CSE approval of the Proposed COB.
Tony G is contemplated to remain a substantial shareholder of Sportsclothes following the completion of the Sportsclothes Investment. Tony G is a founding shareholder of Sportsclothes and has played an active role in the development of its business.
Board and Management
In connection with the Proposed COB, it is anticipated that Andrew Parks will resign as Interim Chief Executive Officer of the Company and Gediminas Klepackas will be appointed as the Chief Executive Officer and a director. Douglas Harris will remain as the Company’s Chief Financial Officer and Andrew Parks, Ronald McKenna and Gregory Pepin will continue to act as directors.
Gediminas Klepackas is currently the Chief Executive Officer of Cryptonews. Mr. Klepackas is a professional manager with over 10 years of experience in international affiliate marketing. Out of those, he spent 8 years at Pokernews, helping with the expansion of franchise partners and managing the entire Lithuanian operations company. Aside from that, he has two years of experience in active sales within the fintech sector. He became immersed in the crypto market in early 2018 when he became Chief Operating Officer at Blockchain Centre Vilnius. For the past 2.5 years, he has been the Chief Executive Officer of Cryptonews and has grown it into a top 10 cryptocurrency news website globally.
Braingrid is a global technology company committed to the best interests of the precision agriculture industry for the long term. We provide valuable grow analytics by capturing real-time data using our technology platform to increase revenues, reduce costs, risks and improve yield – making it easier for the grower to operate efficiently and effectively. Braingrid is listed on the CSE under the symbol BGRD.
The Canadian Securities Exchange has not reviewed, approved or disapproved the content of this news release.
Certain information set forth in this news release may contain forward-looking statements that involve substantial known and unknown risks and uncertainties. All statements other than statements of historical fact are forward-looking statements, including, without limitation, statements regarding the Proposed COB, the ability of the Company to complete the Proposed COB, the Sportsclothes Investment and the Cryptonews Investment and the terms thereof, anticipated changes to the board and management of the Company, the anticipated name change of the Company, the anticipated new objective of the Company, including the industries it intends to focus on as an investment issuer and its intent to direct its efforts towards companies Tony G is involved in, plans for the current assets of the Company, Sportsclothes’ plans to integrate cryptocurrency technology into its business, the expected benefits of the Proposed COB to the Company and its shareholders and the future plans or prospects of the Company. Such forward-looking information reflects management’s current beliefs and is based on information currently available to management. Often, but not always, forward-looking statements can be identified by the use of words such as “plans”, “expects”, “is expected”, “budget”, “scheduled”, “estimates”, “forecasts”, “predicts”, “intends”, “targets”, “aims”, “anticipates” or “believes” or variations (including negative variations) of such words and phrases or may be identified by statements to the effect that certain actions “may”, “could”, “should”, “would”, “might” or “will” be taken, occur or be achieved. A number of known and unknown risks, uncertainties and other factors may cause the actual results or performance to materially differ from any future results or performance expressed or implied by the forward-looking information. These forward-looking statements are subject to numerous risks and uncertainties, certain of which are beyond the control of the Company including, but not limited to, the impact of general economic conditions, industry conditions and dependence upon regulatory approvals. Readers are cautioned that the assumptions used in the preparation of such information, although considered reasonable at the time of preparation, may prove to be imprecise and, as such, undue reliance should not be placed on forward-looking statements. The Company does not assume any obligation to update or revise its forward-looking statements, whether as a result of new information, future events, or otherwise, except as required by securities laws.
With the Covid-19 pandemic, telehealth use has exploded with consequences for clinicians already overburdened by the demands health IT (EHRs in particular) is making. Future telehealth capability must be designed with practitioners’ needs in mind, assuring that the technology improves patient care without contributing further to burnout.
The medical field is in the midst of a major transformation, fueled by a combination of legislation and rapid adaptation. This trend has been most apparent in the rapid expansion of telehealth. A review of 16.7 million medical visits conducted from January to June 2020 revealed a staggering 2,000% increase in telemedicine visits. For some of my patients, this ability to conduct a visit through their computer or smartphone has been life changing. It is clear that the Covid-19 pandemic, despite providing some of the toughest challenges, has also brought out some of the best traits in healthcare organizations: agility, adaptability, and innovativeness.
However, we still do not know the full impact of telehealth. Will it be good for patients? For some, it will mean access to care that would otherwise be impossible because of limited transportation, excessive distance, and other prohibitive costs. But the risks, including potential for missed diagnoses and physical exam findings, remain a concern. Will it be good for providers? For some, it will mean the convenience of not commuting into the office and the peace of mind of working remotely during a pandemic. But a study over a million e-visits revealed that the adoption of telehealth nearly doubles the number of work hours per week, with the bulk of work occurring on nights and weekends, while questions about telehealth’s implications for malpractice claims remain. Of course, the telehealth explosion was born out of extreme necessity. But if necessity is the mother of invention, is all invention good? The answer may depend on how we envision success.
Path of least resistance
This tension can be seen in the evolution of the electronic health record (EHRs). Despite their promise, early adoption of EHRs was limited due to the technology’s high costs and low usability. The Health Information Technology for Economic and Clinical Health (HITECH) Act set out to fix low utilization through legislation. And, it succeeded — by 2017, 96% of U.S. Hospitals had adopted certified EHRs. But an unintended consequence of this rapid adoption was that EHRs, which were originally conceived as catalysts for improved patient care and physician wellness, instead became a major source of physician distress. This phenomenon was described in a recent study assessing the usability of EHRs through the System Usability Scale (SUS) — a validated instrument designed to measure the effectiveness, efficiency, and satisfaction with an electronic system. Google’s search engine has an A rating; a microwave or an ATM has a B rating. But 10 years after the passing of HITECH, EHRs are still being given an F grade by the primary end users — physicians.
More importantly, EHR usability is highly correlated with physician burnout. “It is no accident we are where we are now,” says Dr. Ted Melnick, director of the Yale Clinical Informatics Fellowship and lead author of the study. “The HITECH Act incentivized rapid adoption of EHRs. In order to qualify for federal incentives, EHR vendors rushed products to market. There was no time for health IT to organically address usability and the user experience. Now, here we are with powerful yet clunky systems that have digitized healthcare at the expense of the clinician-patient relationship.”
Over time, EHRs have also become increasingly complex. With each additional need (e.g., compliance with billing requirements, increased patient access), the EHRs have expanded to include new capabilities. But the design of the tool has consistently lacked one key component: a cohesive understanding of how it would impact providers. Absent that focus, the evolution of these systems has followed the path of least resistance — the added responsibilities defaulted to become the burden of the providers. In this way, the issue is not that EHRs are imperfect; it’s that their imperfections disproportionally affects providers.
Ten years after the passage of the HITECH act, work at home and on the weekends — dubbed “pajama time” — has become an industry standard while physician burnout associated with EHRs is the industry’s worst-kept secret. Indeed, 70% of physicians who use EHRs report health information technology (HIT)-related distress. And if the intention was to improve satisfaction with the physician-patient interaction, then those results have yet to materialize. In fact, time motions studies reveal that physicians spend twice as much time with their screens as with their patients. Essentially, by rushing to implement a solution, healthcare was opening a digital Pandora’s box, spending the next decade in an attempt to put the plagues back in the vault.
The digital communication revolution
Recently, the digital communication revolution has been kicked into high gear in healthcare, driven by attempts to increase patients’ access to their providers and medical information. The most widespread example is the patient portal and the in-basket — a tool through which a patient can send a message directly to a provider’s inbox. The emergence of patient portals and direct-to-provider messaging has exacerbated the expectation of instantaneous availability, making it increasingly difficult for providers to truly “log off.” It is no surprise that receiving an above-average number of in-basket messages has been associated with a 40% higher probability of provider burnout. Dr. Christine Sinsky, VP for Professional Satisfaction for the American Medical Association, explains that the in-basket puts two strains on physicians by creating “expectations that they be available 24/7 to their patients and the requirement to work after hours simply to get work done.”
She proposes a radical redesign of our current processes by concentrating on several key factors: setting clear expectations about when and how providers must be available; and team management of the inbox. EHRs are a powerful, but novel, tool. Developing cultural norms around their use is key to managing expectations. Meanwhile, engaging nurses and medical assistants in managing the inbox can be vital in helping triage questions that need to involve the provider versus those can be managed without them (for example, forwarding a prescription from one pharmacy to another). This step requires a well-resourced and stable team and continuous training. But as before, we are finding ourselves playing catch-up and trying to undo the conceptual design flaws inherent in both legislation and the EHRs themselves.
From chatbots to intelligent EHRs, promising new technology could help alleviate some of providers’ workloads. But even as we work to decrease the inbox load the central question lingers: should we continue to rush products and legislation to implementation without putting measures in place that protect our most valuable, and often most fragile asset — healthcare workers themselves. Dr. Ratwani, Director of the MedStar Health National Center for Human Factors, sees this as one of the central questions of innovation in healthcare: “New digital health technologies offer tremendous potential. However, in order for these technologies to lead to the patient outcomes we all desire they have to be designed, developed, and implemented with patient and clinician needs in mind.”
In healthcare, the coming years will be defined by ever-more sophisticated EHRs, increasing digital access by patients, the explosion of personalized medicine, and widespread adaptation of artificial intelligence. All will be indispensable tools in the new era and all still carry many unknowns. Ensuring that these tools serve their intended purpose will require us to think beyond the path of least resistance. Instead, new interventions must involve deliberate design that considers the impact of innovation on all the main stakeholders, including providers. Ted Melnick points to six core tenets of HIT design that can help ensure its success:
- Put patient care first: Remembering this core goal of HIT can help ensure it remains safe, effective, and efficient.
- Assemble a team with the right skills: Successful design will require the input of a variety of perspective and skillsets. A careful interplay of experts in human factors, finance, population health, and provider wellbeing, among others, will be needed to ensure that innovation is functional, sustainable, and supports various stakeholders.
- Relentlessly ask why: Asking why things are done a certain way can help ensure that HIT does not get stuck in a cycle of “we do it this way because that’s how we’ve always done it.”
- Keep it simple: Using human factors principles can help lead to intuitive and user-friendly design.
- Be Darwinian: Test innovation and only keep the best features at every stage.
- Don’t lose the forest for the trees: Assess the potential unintended consequences of human and technological interactions with each design modification.
To this I would add one more:
- Troubleshoot problems, not solutions: Often, healthcare design fixates on bolstering solutions before identifying the real problems. At each step of process design, it is important to reassess what fundamental issues the proposed solutions aim to solve. This can help avoid the pitfall of solutions for solutions’ sake
Finally, it is essential to remember that healthcare technology does not exist in a vacuum. As such, it should look to other industries that have successfully implemented user-centered design. After all, with over 40% of physicians experiencing burnout, too much hinges on getting it right.
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BROWNWOOD — Women come from more than one hundred miles away to Building 35 in a red brick public housing project in rural Brown County, a housing unit turned health clinic where virtually every item, even the beige exam tables, is donated.
The clinic is walk-in only — no appointments — a better bet for patients with unreliable transportation or unpredictable schedules. Without federal funds, Midway Family Planning in Central Texas would have shut its doors long ago, its director says, as state budget cuts dried up family planning dollars from the Gulf Coast to the Texas Panhandle.
Instead, the nonprofit clinic has endured as a small health care lifeline, where low-income and uninsured Texans — far from busy cities with many doctors — can get free or low-cost contraceptives, cancer screenings and treatment for sexually transmitted diseases.
This is what women’s health care looks like in the rural heart of Texas, a state routinely ranked among the worst nationwide in health care access and where three-quarters of counties lack enough medical professionals.
Lawmakers have increased funding for women’s health in recent years, but there remain large swaths of the state where medical professionals are scarce and reliable internet is spotty — and the gap between these health care havenots and their urban counterparts has widened during the coronavirus pandemic.
From the rural Panhandle to the U.S.-Mexico border, financial pressures and safety concerns have shuttered doctors‘ offices, inundated health departments and pushed people living on slim margins into ever more precarious living situations.
Some clinics have seen their office visits plummet, leaving experts to wonder if women are missing opportunities to catch potential health problems before they need serious treatment. Elsewhere, safety net providers like Midway have scrambled to see patients traveling further to get time-sensitive care, like birth control.
While clinics in cities like Dallas and Houston easily pivoted to telehealth visits to minimize face-to-face contact when the pandemic hit, that prospect makes Midway’s director, Carole Parker, laugh: Most of her patients don’t have access to stable internet connections.
“It’s just not feasible. We don’t do anything online,” she said. “Where we are, that is just not an option for us.”
Midway runs a three-exam-room clinic on an annual budget of roughly $198,000, at least half coming from the federal government. It’s staffed three days a week, with two contracted nurses, an administrator and Parker. A nurse practitioner and a local obstetrician-gynecologist with a busy private practice drop in.
Nearly all the 1,100 patients they served last year lacked insurance. Many don’t have permanent homes, and though the state has a health program for low-income women, it has limited use here. Parker knows of just one other health center and an obstetrician-gynecologist’s office around Brownwood that accept payment through the program.
After a lull during the spring, the Midway clinic became “run over” with demand this summer, Parker said, as the coronavirus has devastated parts of the state’s economy and sent unemployment claims skyrocketing. Some patients describe desperate challenges to find reliable housing and work.
Some patients are newly unemployed, have just lost job-based insurance or are driving more than an hour to Midway. Parker says the clinic has gone from serving people in three counties to about a dozen, and believes people are commuting further because nearby clinics and doctor’s offices scaled back their services or succumbed to the loss of revenue that accompanied the delay of nonessential procedures this spring. Others have diverted staff to focus on the coronavirus or have personnel out quarantining after being possibly exposed.
It’s “just become a greater burden on the people that are still able to provide services,” said Parker, whose clinic also treats homeless women and those in the local shelter for people fleeing abusive relationships.
In September and October, there was a marked increase — 27% more than the same period last year — in undocumented people coming to the clinic after cross-border traffic was restricted, she said. Several women had serious conditions, like a mass in their breasts, when they arrived, a problem for Parker because she said there are few places to refer them for advanced care if they cannot pay.
“I don’t know if they thought it would be over so they let their condition ride through the summer, but by the time they got here, it was almost an emergency situation,” she said. “There was apparently nowhere they could go if they had no money to be treated.”
A health care lifeline
On a summer Monday, the raps on the Midway clinic’s door come often. Down the street from a bail bonds center, the clinic is in the predominantly white city of Brownwood, which counts manufacturers like 3M and Kohler as major employers. The city’s median household income is far lower than the state’s overall, and about a fifth of its 18,500 residents live in poverty.
Judy Guinn, the clinic’s manager, slips on a plastic face shield and opens the clinic door. In a small community like Brownwood, many of the faces are familiar.
“All I see is your eyes, I can’t see your pretty face,” she tells the masked woman outside, a high school senior whose parents were incarcerated while she was growing up.
The woman, a minor, is here to get a birth control shot, which prevents pregnancy for three months. The next woman who walks in — with “Midway Family Planning” scrawled on a pink sticky note stuck to her finger — says she’s there for contraception and doesn’t have insurance. She lives a nearly hour drive away. Another walks in to pick up a pack of birth control pills.
Most of the clinic’s patients are between ages 14 and 30. Parker said many of the teenagers that come have absent parents or an unstable home life, and some are comforted by the nonjudgmental approach taken by the clinic staff.
Bethany Wigham started coming to Midway Family Planning when she entered her first relationship in high school. She didn’t feel like she could talk to her family and wanted to get medical advice and birth control without her parents knowing.
Clinic staff helped her apply to the state’s health program for low- and middle-income women once she turned 18 and once kept the clinic open late for her to pick up medication after coming back into town from school, she said.
“It was the only place I could find in the area that would let me go at 17 without my parents,” said Wigham, who is now studying pre-clinical psychology at Tarleton State University. “I was able to go [see] them and have a talk with all these questions, that I didn’t have anybody at home to really help me.”
When the pandemic hit, closing the town’s only movie theater, the clinic closed for several days. Its staff knew they couldn’t rely on unstable Internet connections for telehealth visits, and instead found a low-tech alternative: They popped open a window and began dispensing birth control pills through the opening and curbside.
Women coming for contraceptive shots or for a preventive screening were told to enter through the back door of the clinic, see the nurse and exit through another door to minimize face-to-face contact from two-way foot traffic. One person was permitted to enter the clinic at a time. Parker and her staff sometimes held babies so mothers unable to find child care could go in for treatment alone.
The clinic is eccentrically decorated, though it bears the unmistakable hallmarks of a small one-story house. Guinn perches at a counter right next to the refrigerator — in what would be the unit’s kitchen — where she calls patients and reminds them they are due to come in for their birth control shots. A crate of patient files sits on a narrow counter behind her next to the kitchen sink.
The bedrooms have been converted into offices and exam rooms and have colorful gauze hung from the window blinds. The patients’ bathroom has a large potted plant in the bathtub. Medications are stocked in locked wood and glass armoires— a small pharmacy the clinic operates thanks to a federal drug program that offers medications at a reduced cost.
Many of the clinic’s patients come from the housing authority that houses it, subsidizing its rent and utilities. The rest of the clinic’s funding is cobbled together from grants, government programs and donations. Packs of condoms were a gift from the county health department and a state infertility project. Prescriptions and long-acting reversible contraceptives are subsidized by a federal program that provides affordable birth control and reproductive health care to poor people.
Parker relies heavily on federal funds rather than state appropriations, which she’s found to be too volatile a funding stream in Texas, where lawmakers have been tight-fisted with women’s health funding in the past.
The clinic used to receive a significant amount of money from the state in the early 2000s, but as anti-abortion sentiment swelled, the funds dried up, she said. In 2011, the Texas Legislature slashed funding for family planning by two-thirds and restructured it to starve clinics like Planned Parenthood. Midway’s funding was decimated. For a few years, the clinic “survived on donations,” Parker said.
Women’s health providers around Brownwood — in San Saba, San Angelo and Abilene — closed under the financial stress. It was a blow for Parker, who used to send patients to those areas to receive long-acting reversible contraceptives, which are highly effective, expensive and require specialized training to insert.
In the years that immediately followed the cuts, more than 82 clinics closed or stopped providing family planning services, and those that remained served about half the patients they had before, according to researchers at the University of Texas at Austin’s Texas Policy Evaluation Project. Fewer lower-income women were able to receive family planning and reproductive health care, and those that did had less access to the most effective birth control methods, like intrauterine devices and implants, the researchers found.
Without insurance or the federal subsidy, the cost of long-acting reversible contraceptives like an intrauterine device or a matchstick-sized implant in the arm can cost more than $1,000.
That kind of expense is prohibitive for a patient like Marissa Villalpando, 22, who used to pay $200 to $300 out of pocket to get birth control from a nearby gynecologist. She’d been taking pills that were cheaper, even though they gave her side effects like sweats and cramps.
“I don’t have that kind of money,” said Villalpando, who began coming to Midway Family Planning about four years ago, while pregnant with her daughter.
When she stopped by the clinic on a Tuesday, with a stethoscope around her neck, she told the staff that she was studying nursing and said she might want to be a doctor.
“Well good for you!” Guinn said.
Villalpando was also “between houses,” she said — her small family had been kicked out of a family member’s home — and both her and her partner’s cars had broken down over the summer. She had borrowed a vehicle from a family member to drive to the clinic after class and was grateful Midway was open because other offices had been closing midday due to COVID-19, she said.
“Now would not be the time to get pregnant … This is something small, but at the same time, it could be so, so big. It could be another baby,” said Villalpando.
John Sommer, a licensed clinical social worker in Brownwood who counsels children and adults and works with the region’s probation departments, said it’s an understatement that poor women in the county are “underserved.”
They use the hospital for “everything,” even a terrible sore throat, because they lack insurance, and “there are virtually no places to be able to get help.” He typically refers poor patients he works with to AccelHealth, a federally qualified health center that also offers contraceptives and cancer screenings. Medical professionals tend to leave for bigger cities after a “stop-off” in Brownwood, he said.
In addition to specialized family planning clinics like Midway, local health departments, academic health centers, federally qualified health centers and other broad-service providers offer contraceptives and cancer screenings to low-income women, funded by the state or through the federal Title X program, said Stacey Pogue, a women’s health policy expert at the left-leaning Every Texan think tank.
The state programs are generally more limited — one excludes undocumented immigrants and younger teens seeking reproductive health services. But a challenge for women is just finding which clinics nearby participate in the programs, Pogue said — an exercise that often involves cross-referencing maps on different websites and calling the providers listed.
“There’s stretches of rural Texas that might be pretty underserved — where you’d have to go pretty far to get to a provider,” Pogue said, and it could be the same in certain pockets of urban and suburban areas.
Back at Midway, Parker herself recently went hunting for a women’s health provider. Two of her young patients had returned to college in San Angelo and were looking for a place to get their birth control shots. But “between here and there, no doctor, no clinic, nobody” in the state’s health program seemed to be available, Parker said.
Ultimately, Parker and a nurse met them at the clinic on a Sunday in October, more than a month after their shots were due.
Doctors and hospitals across the state have struggled to survive the financial hit of limiting nonessential procedures and face-to-face contact that was recommended in the early months of the pandemic. Some doctors stopped seeing new patients and even hospitals preparing for the virus were forced to furlough or lay off staff employees during the spring.
Coupled with patients’ own financial challenges, the results spell trouble in some rural areas, where people have to travel long distances to see a nurse or doctor, or lack access to broadband, said Jane Bolin, deputy director of the Southwest Rural Health Research Center at Texas A&M University, and an associate dean at the college of nursing.
Texas has had the most rural hospital closures of any state in the last decade, according to one analysis, and some 30 counties don’t have a primary care doctor. The state has the highest rate of people uninsured of any nationwide, and one of the highest teen pregnancy rates.
“For rural individuals, they may go five years in between a simple clinical breast exam and it’s not because they intend to — it’s just, they have to choose: ‘Do I put milk on the table? Do I feed my family or do I go in and pay $300 per screening?’” Bolin said. “And then, if something is diagnosed as being suspicious … Well, then it may mean a trip into inner city Houston” for treatment and finding transportation and time off from work.
Parker has sometimes arranged for a government-funded van to transport her patients 80 miles to Abilene to get no-cost mammograms or other diagnostic screenings that require specialized equipment. If the patient can’t cover the $1.25 to $4 fare, the clinic will.
Women’s health providers in other parts of the state face challenges similar to Midway’s.
Consider the situation at Amarillo’s Haven Health, which regularly sees patients from Lubbock, Dalhart and Perryton, all a one- to two-hour drive away.
Located in a one-story beige building, Haven is the only family planning clinic in 41 counties and the area’s sole provider in Title X — a federal program offering reproductive health care to low-income people, according to chief executive officer Carolena Cogdill. Before a massive state budget cut in 2011, Cogdill said there were a half-dozen or so clinics spread throughout the Panhandle.
“It’s not like a metropolitan area where there might be four or five different clinics,” she said. “You kind of have to plan your day because it might take you two hours to get here, you’re here for an hour and then two hours to go home … If you have kids, you need to think about child care.”
The Amarillo clinic has seen more new patients as the local health department began referring STD cases to them, and the money the clinic receives from the state for family planning has been depleted faster than normal because of their rising numbers, she said.
“With COVID, particularly in Amarillo, a lot of people are employed by small businesses and small businesses were hurt,” she said. “We still have a lot of people who are unemployed and who are struggling to make ends meet, so Haven is the only place they can come to get assistance.”
It’s a similar story in the Corpus Christi area, where Martha Zuniga, executive director of a network of family planning clinics, has seen patients coming in with less income compared to before the pandemic. More are asking for long-acting reversible contraceptives.
Many of the general providers redirected their services to focus on the coronavirus, leaving patients wanting medical care without access to short-term appointments, Zuniga said. The clinics absorbed the overflow of patients coming from nearby health facilities and took on treatment of sexually transmitted diseases when the public health department limited its operations to handle the virus.
“Where do you think those patients went? They couldn’t pay a private provider,” she said. “They were asking us to refill their diabetes medications, to refill their hypertension medications they were getting” from other health centers or to remove long-acting reversible contraceptives they received from providers who curtailed in-clinic visits.
Elsewhere, along the Texas-Mexico border, Access Esperanza Clinics in Hidalgo County has seen a decrease in patients because the area was a coronavirus hot spot with rampant community spread. Between 30% and 40% of the population in the region are uninsured, living in poverty and don’t have access to reliable WiFi or computers, said Patricio Gonzales, the clinics’ chief executive officer.
“A lot of women are now losing their employment or their child care resources because of the pandemic,” he said in a September interview. “We’re expecting a lot of those women to start coming in as soon as things start to stabilize.”
Disclosure: Every Texan, Planned Parenthood, Texas A&M University and University of Texas at Austin have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
The co-founders of luxury candy boutique Sugarfina, Rosie O’Neill and Josh Resnick, have invested an undisclosed amount in free-from baked goods company Bougie Bakes through the couple’s recently launched Pure Imagination Brands.
The early-stage investment fund was set up in 2019 to support disruptive brands across sectors, such as fashion, beauty, as well as health and wellness, and it has so far helped scale a number of high-growth companies, including cannabis-infused social tonic brand CANN, banana-based snacks Barnana, and Asian meals startup Omsom.
Upon joining as strategic advisors by taking a minority share of Bougie Bakes, O’Neill and Resnick are expected to support the company’s efforts in marketing, sales, and operations, to help it expand distributions both domestically and internationally.
O’Neill told me via a recent Zoom call about how she made the acquaintance of Bougie Bakes’ co-founder Meghan Quinn when the two were working together at Mattel MAT , a firm that develops products for children and licenses by partnering with entertainment companies.
“When you look at the better-for-you desserts space, [Bougie Bakes] really stands out as they are using very high-quality ingredients and hitting on all the dietary trends,” O’Neill said.
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“One of the things that really impresses me is how quickly they have grown in such a short period of time, and particularly how they accelerated during the pandemic in a way that I believe sets them up for success going forward.”
Ryan Quinn, Meghan Quinn’s husband who helped launch Bougie Bakes, notes how fundraising became necessary after they moved to a new manufacturing facility and has grown eight folds in capacity from 2019.
“We’ve already reached our eight-figure valuation range,” he said. “We expect our sales [next year] to be five times greater than our 2020 sales through a combination of direct-to-consumer growth, as well as retail partnership expansion.”
Indulgence with free-from ingredients
The idea of Bougie Bakes was created when Meghan and Ryan Quinn were preparing for their wedding a few years ago, as the couple describes themselves “a big sweet tooth”, yet firmly believe in how “abs are made in the kitchen”.
“We started by making healthy cookies and brownies,” Ryan Quinn said. “So from a global market perspective, whether it’s snacks category in general, or the cookies category, or even the gluten-free food category, we’re looking at a $30 billion industry that’s growing 5% [in revenues] year-over-year.
“If we even take a percentage of one of those categories, we’d be in good shape.”
The couple has tested various sugar replacements prior to launching their business, and found erythritol delivers the best flavor profile through combining with the sweetness from peanut butter and cocoa powder.
“We also put collagen powder in [our baked goods], which is very good for skin, nails, and brain,” Meghan Quinn added.
Bougie Bakes has expanded its offerings over time to also include scones, mini muffins, and bundles that are all made without gluten, sugar, or dairy, to mainly target the gifting market. The company bakes throughout the week, and ships its products via priority across the U.S.
Expansion in the natural and specialty channels
While Bougie Bakes will remain primarily an e-commerce business, its recent partnership with Los Angeles-based Erewhon Market, through which the company has customized a grab-and-go pack size for its six locations, is expected to pave the way for the bakery’s further retail expansion.
“Ryan and I are doing the deliveries ourselves, meeting with the store manager on a regular basis to really understand how our products are selling,” Meghan Quinn told me. “We want to ensure the sell-through is strong… before we’re just putting our baked goods anywhere and everywhere.”
She said: “We want to make sure every single move we make is strategic, and [we’ll] take learnings from Erewhon and apply them to the natural and specialty markets [such as Whole Foods WFM and Sprouts] in a bigger way in 2021.”
In this article you are going to find out whether hedge funds think Brookfield Business Partners L.P. (NYSE:BBU) is a good investment right now. We like to check what the smart money thinks first before doing extensive research on a given stock. Although there have been several high profile failed hedge fund picks, the consensus picks among hedge fund investors have historically outperformed the market after adjusting for known risk attributes. It’s not surprising given that hedge funds have access to better information and more resources to predict the winners in the stock market.
Brookfield Business Partners L.P. (NYSE:BBU) has seen an increase in support from the world’s most elite money managers of late. Brookfield Business Partners L.P. (NYSE:BBU) was in 4 hedge funds’ portfolios at the end of September. The all time high for this statistics is 7. Our calculations also showed that BBU isn’t among the 30 most popular stocks among hedge funds (click for Q3 rankings and see the video for a quick look at the top 5 stocks). Video: Watch our video about the top 5 most popular hedge fund stocks.
So, why do we pay attention to hedge fund sentiment before making any investment decisions? Our research has shown that hedge funds’ small-cap stock picks managed to beat the market by double digits annually between 1999 and 2016, but the margin of outperformance has been declining in recent years. Nevertheless, we were still able to identify in advance a select group of hedge fund holdings that outperformed the S&P 500 ETFs by more than 66 percentage points since March 2017 (see the details here). We were also able to identify in advance a select group of hedge fund holdings that underperformed the market by 10 percentage points annually between 2006 and 2017. Interestingly the margin of underperformance of these stocks has been increasing in recent years. Investors who are long the market and short these stocks would have returned more than 27% annually between 2015 and 2017. We have been tracking and sharing the list of these stocks since February 2017 in our quarterly newsletter. Even if you aren’t comfortable with shorting stocks, you should at least avoid initiating long positions in stocks that are in our short portfolio.
Ian Wace of Marshall Wace
At Insider Monkey we scour multiple sources to uncover the next great investment idea. For example, Federal Reserve has been creating trillions of dollars electronically to keep the interest rates near zero. We believe this will lead to inflation and boost real estate prices. So, we recommended this real estate stock to our monthly premium newsletter subscribers. We go through lists like the 10 most profitable companies in the world to pick the best large-cap stocks to buy. Even though we recommend positions in only a tiny fraction of the companies we analyze, we check out as many stocks as we can. With all of this in mind let’s take a look at the key hedge fund action regarding Brookfield Business Partners L.P. (NYSE:BBU).
Hedge fund activity in Brookfield Business Partners L.P. (NYSE:BBU)
At the end of September, a total of 4 of the hedge funds tracked by Insider Monkey were bullish on this stock, a change of 33% from the previous quarter. Below, you can check out the change in hedge fund sentiment towards BBU over the last 21 quarters. So, let’s review which hedge funds were among the top holders of the stock and which hedge funds were making big moves.
Of the funds tracked by Insider Monkey, Citadel Investment Group, managed by Ken Griffin, holds the most valuable position in Brookfield Business Partners L.P. (NYSE:BBU). Citadel Investment Group has a $1.8 million position in the stock, comprising less than 0.1%% of its 13F portfolio. The second largest stake is held by Arrowstreet Capital, led by Peter Rathjens, Bruce Clarke and John Campbell, holding a $1.4 million position; the fund has less than 0.1%% of its 13F portfolio invested in the stock. Some other hedge funds and institutional investors with similar optimism encompass Renaissance Technologies, Paul Marshall and Ian Wace’s Marshall Wace LLP and Matthew Hulsizer’s PEAK6 Capital Management. In terms of the portfolio weights assigned to each position Arrowstreet Capital allocated the biggest weight to Brookfield Business Partners L.P. (NYSE:BBU), around 0.0022% of its 13F portfolio. Marshall Wace LLP is also relatively very bullish on the stock, designating 0.0021 percent of its 13F equity portfolio to BBU.
As aggregate interest increased, key money managers were leading the bulls’ herd. Arrowstreet Capital, managed by Peter Rathjens, Bruce Clarke and John Campbell, initiated the most valuable position in Brookfield Business Partners L.P. (NYSE:BBU). Arrowstreet Capital had $1.4 million invested in the company at the end of the quarter. Jim Simons (founder)’s Renaissance Technologies also initiated a $0.8 million position during the quarter. The only other fund with a new position in the stock is Paul Marshall and Ian Wace’s Marshall Wace LLP.
Let’s now review hedge fund activity in other stocks – not necessarily in the same industry as Brookfield Business Partners L.P. (NYSE:BBU) but similarly valued. These stocks are Avient Corporation (NYSE:AVNT), Agios Pharmaceuticals Inc (NASDAQ:AGIO), White Mountains Insurance Group Ltd (NYSE:WTM), Merit Medical Systems, Inc. (NASDAQ:MMSI), Advanced Energy Industries, Inc. (NASDAQ:AEIS), Masonite International Corp (NYSE:DOOR), and Kennametal Inc. (NYSE:KMT). This group of stocks’ market valuations match BBU’s market valuation.
[table] Ticker, No of HFs with positions, Total Value of HF Positions (x1000), Change in HF Position AVNT,20,221331,-2 AGIO,31,330249,1 WTM,17,115000,6 MMSI,20,289828,4 AEIS,21,87181,0 DOOR,29,495473,2 KMT,16,225704,6 Average,22,252109,2.4 [/table]
View table here if you experience formatting issues.
As you can see these stocks had an average of 22 hedge funds with bullish positions and the average amount invested in these stocks was $252 million. That figure was $4 million in BBU’s case. Agios Pharmaceuticals Inc (NASDAQ:AGIO) is the most popular stock in this table. On the other hand Kennametal Inc. (NYSE:KMT) is the least popular one with only 16 bullish hedge fund positions. Compared to these stocks Brookfield Business Partners L.P. (NYSE:BBU) is even less popular than KMT. Our overall hedge fund sentiment score for BBU is 23.1. Stocks with higher number of hedge fund positions relative to other stocks as well as relative to their historical range receive a higher sentiment score. Hedge funds clearly dropped the ball on BBU as the stock delivered strong returns, though hedge funds’ consensus picks still generated respectable returns. Our calculations showed that top 20 most popular stocks among hedge funds returned 41.3% in 2019 and outperformed the S&P 500 ETF (SPY) by 10 percentage points. These stocks gained 30.7% in 2020 through November 27th and still beat the market by 16.1 percentage points. A small number of hedge funds were also right about betting on BBU as the stock returned 19.2% since Q3 (through November 27th) and outperformed the market by an even larger margin.
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Disclosure: None. This article was originally published at Insider Monkey.
| The Detroit News
A west Michigan Christian school fighting the state in federal court over its mask mandate and contact-tracing provisions has been warned that its parents and the school’s associated church will suffer fines if COVID-19 rules aren’t followed.
The Ottawa County Health Department issued the warning to Libertas Christian School earlier this month, but it will be put to its first real test on Monday as students return to the Hudsonville school for the first time in almost three weeks.
The health department’s order threatened parents with a $250-per-day fine for sending their children to the school if the school failed to follow COVID-19 orders. The department levied the same fine on Beaverdam Christian Reformed Church if, as landlord to the school, it failed to prohibit the school from being used in a way that “facilitates the spread of disease.”
The church is liable to the fines, despite a carve-out in state law for religious services, because “it is acting as landlord, not church holding religious services,” said Douglas Van Essen, a lawyer for the health department.
As for the parents: “Libertas sometimes hides behind its parents, claiming it cannot control parents. There is shared responsibility here, and that is what the order recognizes,” Van Essen said.
Lansen Perron enrolled three of his children at Libertas in August, in large part because of the school’s Christian worldview but also because of the school’s emphasis on parents’ ability to make decisions for their children.
When the state issued a mask mandate that applied to students, each family was still able to decide whether their children would wear them. The school did emphasize mask usage was not to be looked down upon, Perron said.
When weighing the risks of the virus, Perron said he believes protective policies should be more focused on at-risk populations. The data, he said, showed many kids had less serious cases.
“For us, that was the main driver,” Perron said. “The data doesn’t show that our kids are at a risk. We felt very comfortable sending our kids to Libertas without a mask.”
When the school was closed in late October, Perron was frustrated by the decision given the school’s case rate at the time.
“They seemed like they cared more about compliance than the actual outcomes,” Perron said. “It does seem to me that they are targeting or singling out Libertas.”
Libertas Headmaster Bob Davis agreed, arguing other Christian schools across the state aren’t enforcing the mask mandate but encounter a fraction of the same punitive measures employed in Ottawa County.
“We feel that we’re being unequally treated under the order,” Davis said.
The school has asserted “a good-faith effort” to remind parents of state and local mask mandates, but state law allows schools to accept “a verbal representation” from students who are unable medically to wear a mask, said Ian Northon, a lawyer for Libertas whose bills are being paid by the Thomas More Society, a conservative nonprofit law firm based in Chicago.
“What the county is doing is unprecedented,” he said. “I’ve never seen any other county be so aggressive in the enforcement of these emergency orders.
“This is vindictive. This is retaliatory. It is unfortunate.”
Besides that medical exemption, the school should be excluded from the order because of constitutional religious protections and out of respect for parents’ rights, Northon said. And public school code prohibits a school from disciplining a student in such a way that restricts their breathing, he said.
“I’ve got a statute that says one thing, an emergency order that says another, and parents’ heads are on a swivel trying to figure it out,” Northon said. “They did what civilized people do and took it to court to figure it out.”
No relief in courts yet
The school filed suit against the state in October as the health department issued orders and threatened the school’s closure because students weren’t wearing masks and two teachers tested positive for the virus but wouldn’t release the names of their students.
The school argued it had a religious exemption because each class had a spiritual element to it and it argued that the two teachers at issue had not exposed students to the virus prior to testing positive.
Libertas Christian School grew from a home school group in a church basement to more than 250 students in a separate building in Hudsonville. Some home school families still attend part-time through a partnership program at the school. The school views itself as assisting parents in education and faith formation.
The curriculum centers around faith-based learning, with praise and worship at the beginning of each day, each class and sporting events.
The health department closed the school a few days after the federal lawsuit was filed and the school was denied immediate relief in early November from federal Judge Paul Maloney, a Republican-appointed judge in Michigan’s Western District court.
In a separate case, Maloney also denied immediate relief in October to a Lansing Catholic school, called Resurrection School, that sought an exemption to the requirement for kids over the age of 5 to wear masks. That case still is pending.
Libertas reopened Nov. 9 after the quarantine period had lifted for students allegedly exposed to the COVID-positive teachers but closed again on Nov. 11 when several families and teachers were forced to quarantine because of exposure outside the school. The health department said in its order that a Libertas teacher also tested positive around that time.
On Nov. 20, the 6th Circuit Court of Appeals again denied the school’s request for immediate relief from the state mandates.
The school plans to amend its complaint in federal district court to reflect the changes that have been made to the state’s epidemic orders, one of the issues prompting denial in the 6th Circuit, Northon said.
One of the challenges of filing suit against the state’s orders is the fact that they have changed every few weeks so that the order listed in a court filing one week isn’t the same on appeal, Northon said. Essentially, he said, it allows the state and local health laws to “evade review.”
“I expect at some point we’re going to be back in front of the 6th Circuit,” Northon said.
On Nov. 12, the county issued its fifth order to the school, noting that students continued to attend classes between Nov. 9 and Nov. 11 without masks.
The county ordered the school to require students to wear masks unless they have a “written medical mask waiver” from a physician, post signs informing people of the mask mandate, warn people upon entry of the order and hand out face masks to students without them.
If the school does not comply, it must close, the order said. If it submits a plan to the county indicating compliance, it must allow a health department employee on site to “spot check” the school’s compliance.
“The point is to ‘encourage’ Libertas from all angles to obey the mask mandate to protect the safety of their children and teachers, and of course the broader community which is experiencing a surge undoubtedly due in large part to gatherings without masks,” health department lawyer Van Essen said.
Case raises ‘key issue’
There aren’t many cases similar to Libertas’ throughout the United States, but not all of the actions taken are unique to the west Michigan school, said Peter Jacobson, professor emeritus of health law and policy at the University of Michigan’s School of Public Health.
Jacobson also is director of the Mid-states Region of the Network for Public Health and collaborates with the Michigan Department of Health and Human Services.
The action threatened against the parents has been employed in different instances throughout the country, Jacobson said, but there are few, if any, instances of a health department pursuing fines against a landlord.
That’s not to say Michigan’s public health code doesn’t allow for such action.
“The department has wide authority to confront the virus, and if there’s a scientifically valid reason, a public health rationale for holding landlords accountable, then yes,” he said.
“But we are skeptical that the church will be held responsible for this. It will be up to the state courts to decide if that goes too far.”
He also noted the state public health code does allow for “verbal representations” of medical conditions preventing mask usage in a school setting. It’s possible Ottawa County employs stricter standards though, he said.
“It’s going to be a key issue, whether the school should be expected to do more,” Jacobson said. “What I think the court is going to do is balance the need to comply with the order with not making compliance too burdensome.”
With the school planning to reopen Monday, Northon said administrators have communicated the COVID-19 orders to parents but argued state law allowed the school to continue to accept “verbal representations” of medical issues that conflict with mask usage.
“They’ve communicated to the parents that the county and state are demanding they comply with the rules,” Northon said. “They’ve informed them of the risks.”
The county’s cease and desist order, which expires Monday, “will have to be renewed,” Van Essen said.
“We are still a land where the rule of law needs to mean something,” Van Essen said.
(Bloomberg) — Swiss voters rejected two proposals that had the potential to alter the corporate landscape of a country known for low taxes and light-touch regulation.
An initiative that would’ve banned the Swiss National Bank from investing in defense companies was opposed by almost 60% in a ballot on Sunday.
A second measure, the Responsible Business Initiative, was also unsuccessful. It would’ve held multinational corporations responsible for human rights and environmental lapses abroad but failed to get the requisite majority among the country’s cantons, or states.
While activists pushed for the two initiatives in a bid to force businesses and investors to adhere to higher moral standards, Switzerland’s government argued they’d hurt the economy.
Multinational corporations also campaigned against the RBI, saying it would’ve saddled them with additional bureaucracy and had the potential to cause a flood of lawsuits.
“Of course I’m disappointed,” lawmaker Mattea Meyer, who supported the RBI, told broadcaster SRF.
For the SNB, the vote result means it escapes having to offload stocks valued at almost 20 billion francs ($22 billion). The central bank holds the equities as part of its mammoth 870 billion francs in reserves, built up during a decade of currency interventions.
“The SNB can continue to pursue its tried-and-tested investment policy,” which is designed to support monetary policy, the central bank said in a statement.
The initiative would also have stopped pension funds from providing both debt and equity financing to companies that derive more than 5% of their revenue from arms sales.
The failure of the RBI paves the way for the adoption of the government’s less stringent counterproposal. It’ll institute new reporting and due-diligence for firms.
Initiatives require 100,000 signatures to make the national ballot in Switzerland. To be successful, they must get a majority of votes, as well as a majority of cantons.
Stefan Brupbacher, director of machine industry group Swissmem, said he was “relieved” that damage to the Swiss economy and employment was averted.
(Updates with SNB reaction in eighth paragraph.)
For more articles like this, please visit us at bloomberg.com
©2020 Bloomberg L.P.
In the early stages of this pandemic, I don’t think any of us knew what we would face over the coming months. All of us have been changed and affected in some way over the course of the last year.
Our community’s nonprofit organizations are no different. At the American Heart Association, we mobilized our full organizational strength quickly to address the coronavirus. Our work is more important now than ever as we work relentlessly for a world of longer, healthier lives in a world where lives are threatened by a dangerous virus.
The American Heart Association had to quickly pivot to help combat the spread of the coronavirus and address the vulnerability of heart and stroke patients, caregivers, and health care professionals. Here’s how:
Focusing on healthy schools, families and worksites: When schools closed, we quickly provided resources to schools, youth and families. Our “Kick Cabin Fever to the Curb” tools provided healthy living resources and fun activities for teachers and parents working through the new home-school environment. We also held the first ever online STEM Goes Red event in Eastern Iowa, educating young women and men about possible careers in the STEM fields and connecting them to mentors and professionals working in those fields. Through our healthy living channels and worksite health relationships, we also provided resources on self-care, mental health and physical activity to individuals and companies faced with our new work-from-home reality.
Focusing on health care: For those working on the front lines of the pandemic, we quickly worked to provide job aids and training for oxygenation and ventilation of COVID-19 patients. We developed guidance to help health care rescuers treat victims of cardiac arrest who have COVID-19, giving victims the best possible chance for survival without compromising rescuers’ safety. The AHA supported its nearly 400,000 CPR Training Network instructors with training resources that incorporate social distancing.
Public health education: In the early stages of the pandemic, hospitals across the country saw a nearly 40 percent decline in heart attack and stroke patients reporting to their emergency rooms. We know that cardiac emergencies don’t stop for a pandemic, so the AHA worked with hospital partners across the country to educate the public about the continued importance of calling 9-1-1 for cardiac and stroke emergencies. The “Don’t Die of Doubt” campaign is credited with saving lives by helping people understand that the hospital still is the safest place to be if you or a loved one is experiencing a cardiac event.
Advancing science: As researchers desperately try to understand COVID-19 and find treatments, they’re racing against time and working through mountains of data. To help, the AHA launched a patient data registry to help professionals on the front lines better understand treatment patterns and variations. The registry collects data from more than 140 hospitals, and 35,000-plus lab reports — work that typically takes years. But we’ve been able to accelerate this work significantly during the pandemic.
In addition, many mysteries remain about how COVID-19 affects the heart and brain. The AHA invested $2.5 million earlier this summer to fast-track scientific research to better understand this. The grants were awarded to teams at 12 institutions, with initial investigative reports expected in less than six to nine months for most of the studies.
As I look toward the future, I am alarmed by the potential future effects of COVID-19 and it’s potential to drastically change the health and well-being of people in our community for many years to come. The American Heart Association is working hard to create a better future and reduce these impacts. Your help is needed now, more than ever.
Those at greatest risk of COVID-19 are counting on us, and we’re counting on you. Your support is essential in the fight to save and improve lives, especially in the age of COVID-19. We hope this holiday season you considering supporting our many efforts with a donation at heart.org.
Ani Snyder is regional vice president for Eastern Iowa at the American Heart Association.
Document: Missouri’s Certified Behavioral Health Clinics Impact Report
Data show a program intended to improve access to mental health and addiction care in Missouri is effective.
In the first three years in which Certified Community Behavioral Health Clinics have offered care to Missourians through a federally created program, access to and effectiveness of mental health services have greatly improved, according to a report from the Missouri Coalition for Community Behavioral Healthcare.
The CCBHC program is intended to help deal with the shortage of mental health services offered in rural communities. Clinics are required to provide mental health crisis services, screenings and assessments, patient-centered treatment planning, outpatient mental health and substance use services, peer and family support, and intensive community-based mental health care for veterans and members of the Armed Forces.
It started out as a federal demonstration project. Missouri was among 20 states that applied for the planning grant and was one of eight chosen for the original Medicaid demonstration program, with Minnesota, Nevada, New Jersey, New York, Oklahoma, Oregon and Pennsylvania, according to Dorn Schuffman, project director for the CCBHC initiative for Missouri.
“Missouri has been the leading, and an outstanding state, in the program,” Schuffman said. “Missouri was the only state that participated in the demonstration whose plan was to include the whole state.”
That includes urban and suburban areas.
The state had done a number of things like the project and knew it could be effective, Schuffman said.
What organizers of the project wanted to see was whether changing the way the government pays for services could improve access and outcomes.
Instead of paying providers for face-to-face visits with patients, which encourage multiple visits, the program pays for a continuum of care through the course of the day. Providers are paid the same whether they are seeing patients or not. The program allows providers to have staff available for when they are needed.
Providers, Schuffman said, create cost reports, which take all their costs and divide them by the number of visits they anticipate.
Medicaid paid poorly for mental health services, he said, so providers couldn’t afford to offer psychiatry. Through a prospective payment system, they can.
The clinics recently produced a report showing year-over-year improvements in access and outcomes.
Data collected four years ago, before the project started, show 119,002 Missourians had access to CCBHCs. The report shows that number has increased to 146,665 — a 23 percent increase.
The project had a focus on veterans, Schuffman said, and veterans served increased by 19 percent to 2,993.
Another goal was to decrease unnecessary and repetitive use of emergency rooms and hospital services for mental health. The data show emergency rooms have had 36 percent fewer visits, and there have been 20 percent fewer hospitalizations.
Before the project started, 3,128 patients received medication-assisted treatments. Through the program that number has increased to 6,292.
“One of the key treatments for opioid disorders is medication-assisted treatment,” he said. “Medication-assisted treatments more than doubled during the demonstration, which saves money and saves lives.”
Another major component of the project is to relieve law enforcement of the burden placed on it to offer mental health services. From July 2017 through September 2020, law enforcement officers have referred 76,451 people with whom they’ve had encounters to mental health providers, rather than taking them to emergency rooms or arresting them.
“If we get them into treatment, we get them out of jails,” Schuffman said. Among the greatest supporters of the program are local law enforcement agencies and police chiefs.”
And several CCBHCs have expanded outreach to schools, he said.
“They engage people, engage families and get them into treatment,” he said.
The report shows 74 percent of adults and 78 percent of youths sought and received follow-up care within 30 days after hospitalization.
“One of the best predictors of being re-hospitalized is whether you follow up after being released from the hospital,” Schuffman said. “(Follow-ups) divert people from further hospitalization.”