Studies suggest that whole-person health care isn't limited to physical health but also includes mental and spiritual well-being. So why is spiritual care more difficult to find coverage for?
Studies suggest that whole-person health care isn't limited to physical health but also includes mental and spiritual well-being. So why is spiritual care more difficult to find coverage for?
Lisa Eisenhauer, Editor of Catholic Health World, joins the show to discuss an article she wrote for the paper featuring Dennis Heaphy, Health Justice Advocate and Researcher at the Massachusetts Disability Policy Consortium, and Sasha Shenk, Sr. Research Technician at Tufts University. Heaphy and Shenk talk about their article and the benefits of offering Medicaid for spiritual care, and Teresa Anderson, Mission Leader at Trinity Health PACE and Trinity Health at Home, describes how Trinity Health tries to implement extended coverage into their work.
Brian Reardon (00:00):
Hey Lisa, how you doing?
Lisa Eisenhauer (00:01):
Good. How are you Brian?
Brian Reardon (00:03):
Very good. So you've been now editor at CHW officially for what, two months?
Lisa Eisenhauer (00:07):
That's about right.
Brian Reardon (00:08):
And this is your first time on Health Call. So welcome!
Lisa Eisenhauer (00:11):
Thank you. Happy to be here.
Brian Reardon (00:12):
Do you want to give a shout out to Judy Vandewater? She was the longtime editor of Catholic Health World, just retired. So if you're still listening, again, congratulations on your retirement, but I think we're in good hands with Lisa now, heading up the editorial responsibilities for CHW. So Lisa, we're going to talk about a topic that appeared a couple of issues ago, but one, and we'll get into this in a moment that I think will be of interest from a couple of perspectives, both from a policy perspective and from the services we provide around spiritual care. So are you ready to get started?
Lisa Eisenhauer (00:45):
I think so, let's go.
Brian Reardon (00:51):
This is Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host Brian Reardon, and as you just heard, we have with us in studio Lisa Eisenhauer. She's editor of Catholic Health World. And Lisa, this topic is on Medicaid coverage for spiritual care. And I think the reason we wanted to talk more in depth about this topic is because again, our advocacy on behalf of Medicaid and the work we do with our members on really strengthening spiritual care services. So I think we wrote a really in depth piece on this, which I thought was great and that's why I wanted to bring you in and talk to you and the guests that I'm going to introduce in a moment. But what kind of attracted you to this? I know there's a Health Affairs article that was written, so give us a little bit of context about how this story came together.
Lisa Eisenhauer (01:35):
This story was actually assigned by my predecessor, Judy Vanderwater. You mentioned. She spotted it in Health Affairs and realized how well the proposal that Dennis and Sasha put forward in this article aligned with the mission of Catholic health care.
Brian Reardon (01:50):
And I think again, the coverage appeared. It was in the April issue of Catholic Health World. And you not only talked to Dennis and Sasha who are going to have join us in a moment, but you also talked to a colleague from Trinity. In your reporting on this really kind of what was the main thing that stood out to you?
Lisa Eisenhauer (02:05):
I think what stood out to me was how they talk about how it's not just about addressing isolation, loneliness, but they talk about it as a health equity, a racial justice issue. And they also emphasize that spiritual care is not about proselytizing, rather it's about, it's an important part of holistic care,
Brian Reardon (02:22):
Our emotional and mental health wellbeing, which is something again, fits into a lot of what we've been talking about with our members, particularly over the last year. So least I'm going to bring you back at the very end of this discussion just as part of the wrap up. But let me now move to introducing the three guests that were featured prominently in your coverage. And that would be first, Terry Anderson, she's mission leader, Trinity Health PACE , and Trinity Health at home. Welcome, Terry.
Teresa Anderson (02:48):
Thanks so much. It's great to be with you today.
Brian Reardon (02:50):
And we also have with us the two co-authors of that Health Affairs article that we mentioned. We have Dennis Heaphy, he's health justice advocate and researcher with the Massachusetts Disability Policy Consortium. Welcome Dennis. And we have Sasha Shenk, she's senior research technician at Tufts University. Hi Sasha.
Sasha Shenk (03:07):
Hi. Thank you for having me on.
Brian Reardon (03:09):
Well, let me start with Dennis and Sasha, if you would just provide some, again, we kind of jumped into this and we talked about Medicaid coverage for spiritual care, but really it's a lot more precise than that. And I think we probably need to start off with having you, if you would recap the piece you wrote in Health Affairs, just to give our listeners kind of an overview of the policy change that you are recommending.
Dennis Heaphy (03:31):
Sure. It'd be helpful for folks to understand that the CDC and CMS recognize spirituality as an important domain of health and that having a healthy spiritual life is important to one's health outcomes. There's a recent article in the Journal of the American Heart Association that talks about the importance of cardio of spiritual care or spirit, healthy spirituality for African Americans. And so it's something that we all recognize is important in the lives of people. And CMS already pays for services that impact people's determinants health, whether it's housing increasingly now there's housing, they pay for it, they pay for service that support folks to remain in housing, they pay for food, they pay for other aspects of services that are important to health care even though they're not considered directly medical services. And so spiritual care would be a piece of that.
(04:38):
And spiritual care is already being provided throughout the country, primarily in hospital settings, palliative care settings, hospice settings, or our PACE programs that do provide as well. But until 2021 or 2022, there were no codes to actually cover the provision of spiritual care to people. Actually this was done by CMS for folks in Veterans for Veterans. And so now that we actually have codes, there's an opportunity to have those codes implemented and put in place within Medicaid. And the reason why we started with dual eligibles is because there's a lot more flexibility in the care that can be provided to dual eligibles, and there are to folks who aren't straight in Medicaid in the country. And that's where we started with this population. And then in addition to that, as a person with a disability that does research on and with people with disabilities, it's also important that we look at a population that's disproportionate experience, disproportionately isolation and loneliness and look at what the role spiritual care can play in reducing isolation and loneliness in this population.
Sasha Shenk (05:51):
I'll add that I come from a very different background than Dennis. So as it was in the introduction, I am a research technician at Tufts University working in the lab actually researching a rare disease called scleroderma, the most fatal rheumatic disease. And something that I really noticed in Dennis and I have separately connected initially through a health policy course at Northeastern and then continue to collaborate onwards. Something that I noticed actually in my research that also really highlighted the importance of a spiritual care aspect for health care is that in this disease that I study, scleroderma it due to its rareness, there's really not many community kind of places for people to connect. And without that spiritual aspect, especially to do, due to how debilitating this disease can be for patients, many patients with scleroderma have actually independently formed scleroderma support groups all across the United States.
(06:55):
And something that was extremely interesting to me and when Dennis and I really connected about this was that there, there's certainly a need there and people are kind of informally creating those sPACEs that a spiritual care aspect in the health system could also provide. And there's sort of a vacuum there of connectivity, mutual support, speaking outside of the medical context and more in a spiritual personal context that is not being provided for patients that I work with on a regular basis. And so they've created this separate entity. And so I really do think that it represents that vacuum and also that need that's been shown that people are creating these systems because there is a shortcoming in the, there's a vacuum medical system right now.
Brian Reardon (07:50):
And so by having direct reimbursement for, again, dual eligible patients that are provided spiritual care services, Sasha is the point that that policy change could then increase the availability of spiritual care for these patients?
Sasha Shenk (08:06):
Well I think having the opportunity I think can give patients a chance to, within their medical context include this spiritual care element. And this was only kind of one dimension that I'm sharing where I noticed that connectivity and reducing isolation and loneliness is so important for patients. But beyond that, for patients with disabilities, as Dennis was sharing, the spiritual aspect is sort of left behind and you're left when you are in the medical system with either needing to go outside of that or simply suffering with increased rates of isolation, loneliness and depression.
Dennis Heaphy (08:53):
And as folks who deal with Medicaid know or with Medicare, if it doesn't have a code, it's not paid for. And so when the CMS finally OK'd codes for services provided by chaplains to veterans, we saw that as an opportunity. Not that means that translates into payment necessarily, but it does translate into tracking of those services. And once those services begin to be tracked and we can understand the level of services that are being provided, then there's opportunity to engage in conversation about payment for those services. And we know that there are programs in the community that already paid for and cover spiritual care, including PACE and other programs, and they have to do a lot of work, they have to do a lot of workarounds to actually pay for the care. So it's through a lot, through grants, a lot through bundle payments, just a lot of workaround that are really unnecessary, make it difficult for health providers to deliver spiritual care through chaplaincy services in the community as well as opposed to in a hospital setting.
(10:06):
And so for us, we think there's a tremendous opportunity here to say let's look at the duals population and particularly folks who might be nursing home eligible or at high risk of institutionalization in general and provide spiritual care and put codes in place so we can actually track the impact of spiritual care on the lives of these folks and look at at that impact over time and pay for those services. Because we know that spiritual care is important in the lives of people and we know that and we know that researchers, there's, there's enough research that shows out there that having a healthy spirituality, that having spiritual interventions, having a spiritual practice actually improves people's health outcomes and their overall quality of life.
Brian Reardon (10:58):
And Sasha, if I could follow up on Terry, I do want to bring the conversation to you. You did mention in the article that by having those codes, there's some really valuable data that someone like you as a researcher could look at and be able to get a better sense of health outcomes and how spiritual care contributes to better outcomes.
Sasha Shenk (11:19):
Oh, definitely. I mean, I think that, as Dennis stated, there is programs that exist, but I think what is lacking is a consistent infrastructure. And so, you know, could go into, there are of course so many different organizations, external, outside Medicaid or community-based organizations that are doing this work, but without the data, it's very hard to justify one spending money on it, which of course is, there's so many different resources that are competing for things that when you want to implement a novel program, it's really important that you have that justification. And also, yes, coming from a research background, if you can really contextualize beyond, it's really important that you bring together all of these pieces to sort of, it's not just that you are seeking to have a more whole care team that you are the knock on effects of that can become measurable of lower incidents of isolation, depression, fewer health disparities, reduction in health costs due to better health outcomes. And it's really important to actually, to be able to say those that you have the data and the tracking that's backing that up. And so I think that that's a hugely important justification as Dennis shared, to make sure that the infrastructure that is tracking these things is very robust and thorough to ensure that long-term progress can be measured.
Dennis Heaphy (13:04):
And beyond that, I think it's important to say it's the right thing to do. No, definitely, definitely that people are, speak specifically to folks with disabilities are really medicalized, don't necessarily view themselves as people view themselves as patients and lack meaning in life. And that lacking of meaning in life is something that health care providers can't give or necessarily give. They don't have the training, they don't have the skills, but that spiritual care providers can really support folks in their journeys to develop meaning in life and understand their value and their purpose. And they do that because they're the only person on the care team that does, that's totally confidential. That whatever the person shares, they share with that chaplain and confidence and that chaplain can provide a listening ear that others on the care team are not trained to provide and provide a respect that others on the care team are not trained to provide. And so it, it's the right thing to do. We're spending a lot of money on a variety of services and this is one that we feel its time has come to really to implement perhaps piloting, piloting it through SNPs or through PACE programs, but to find a way to provide these services is vitally important because the data shows that people are isolated, they're lonely, they're lacking in meaning, and spiritual care is a way to address that unmet need.
Brian Reardon (14:49):
And we heard from the surgeon general just a couple of months ago about the exactly epidemic of isolation and loneliness. Let me bring in Terry now again, Terry Anderson is with Trinity. She works with the PACE and their health at home. So Terry, I guess the question to you is, if as you've heard Dennis and Sasha provide an overview of what they wrote in Health Affairs, you contributed to the article from on the ground perspective, why would this policy change? Why is it so important from your perspective?
Teresa Anderson (15:18):
No, thanks so much for inviting me to be part of the conversation. From the perspective of PACE, I think to the point that both Dennis and Sasha had mentioned, there's incredible value and I think a richness in terms of even being able to look at if we could, HIPAA protected ways, some of the data that's available already, looking for example at Trinity Health PACE nationally in our organization, I served as a chaplain for 10 years before becoming the mission leader nationally for our PACE programs. And spiritual care is something that we are really believe in as part of holistic care and are really attuned into the limitations and challenges for our participants who may struggle with isolation on the ground. Some of the things that we do, it was mentioned, Sasha mentioned to find support groups perhaps separate from medical care or Dennis talking about the importance of spiritual care in the medical setting in PACE, our chaplains who are with our programs and they're trained chaplains, they have masters in theology or pastoral ministry or divinity, additional units.
(16:29):
We want all of our chaplains to be board-certified, but at least have accomplished a couple of units of clinical pastoral education, which is the formal professional training before they're working in the PACE setting. But they're journeying along with our participants in our programs and also the interdisciplinary team in partnership. And I think one of the things Dennis mentioned, those who may be struggling with disability or isolation may be identified through the course of their life as patients and really lack a sense of meaning and agency. And we call all of our individuals who are in our program, our participants, because we're really working towards shared decision making. So when we're looking at together individual participants, perhaps their family members, the care team, the chaplain, looking at the challenges, not just from a medical perspective and not over medicalizing issues, challenges and problems, but looking at the the psychosocial, the biological, and also the spiritual issues that provide the complexity of what the person might be experiencing going through in their experience of illness and aging.
Dennis Heaphy (17:42):
And if I could just build on what Terry was saying.
Brian Reardon (17:46):
Go ahead, Dennis.
Dennis Heaphy (17:47):
I was actually on my way to becoming a certified supervisor, HCP supervisor when I went the public health route. And for me, what I find missing in public health is a spiritual dimension and that recognition of everything that Terry was saying of in trauma-informed care, recognizing that the many multi-dimensions of what it means to be a person, and that if we only treat people as a medical outcome and we only treat their presented diagnoses and don't really treat the whole person and look at all these other dimensions of what of an individual's life. And it may be that the person's been harmed by a faith community or they had a deep spirituality and they've lost it over the course of years because of other illness or bad experiences with faith communities that chaplains can food can provide some spiritual healing or support spiritual healing for folks as they're go, they're going through whatever it is within the medical system. And so it's really about a holistic way of providing care. And right now, bill NTUs says you can't have Whole Person care without having spiritual care.
Brian Reardon (19:09):
Completely. Yeah, completely agree.
Dennis Heaphy (19:10):
So what we're asking for is assurance is that people who desire it can have a spiritual care plan as part of their care planning process.
Brian Reardon (19:19):
No, and I think all your comments really underscore what we talk about all the time and at Catholic health care is that union of body, mind and spirit and Whole Person Care. So really good conversation. Before we wrap up, I do want to bring Lisa back in and see if she has any final thoughts or maybe a quick question for all of you.
Lisa Eisenhauer (19:38):
I wanted to say thanks very much to all the insight you all three of you shared, and I guess my only comment was that you really started a rich conversation and I hope it continues. I hope your article is widely read and that it brings this issue to the forefront and brings about change.
Dennis Heaphy (19:58):
Thank you.
Brian Reardon (19:58):
Yeah, thank you. And thanks Lisa. Thank you. Terry Anderson again. She's mission leader with Trinity Health PACE and Trinity Health at home. We also want to thank Dennis Heaphy from the Health Justice Advocate and researcher with the Massachusetts Disability Policy Consortium and Sasha Shenk, she's a senior research technician with Tufts University. Thanks to all of you for joining us for this conversation and for your contributions to the article, which again, you can read in the April issue of Catholic Health World. You can find that on our website at chausa.org. And that's also where you can find episodes of Health Calls, the podcast of the Catholic Health Association of the United States. As always, I'm your host, Brian Reardon. I'm joined by Josh Matejka, our producer. And Health Calls is engineered by Brian Hartmann at Clayton Studios just outside of St. Louis. Thanks for listening.