By Donald Gilpin

Leading the battles — medical, economic, societal — against the coronavirus (COVID-19) epidemic have been the individual states and their governors. And one of the most powerful tools assisting the states has been the State Health and Value Strategies program (SHVS), a Robert Wood Johnson Foundation (RWJF) project based at Princeton University’s Center for Health and Wellbeing.

“We’ve pivoted to help states respond to COVID,” said SHVS Program Director Heather Howard, who is a lecturer in public affairs at Princeton University’s Woodrow Wilson School of Public and International Affairs, former New Jersey commissioner of Health and Senior Services, and a former Princeton councilwoman.

In normal times the SHVS provides technical assistance on a variety of health issues — like implementation of the Affordable Care Act, expanding the Medicaid program, and expanding access to substance abuse treatment — but the current crisis has created dire needs that the SHVS has quickly responded to.

State governments are working to develop strategies and policies to combat the virus and to address the growing needs of their constituents, and the SHVS is supporting states through webinars and a new resources website, lending advice and expert analysis.

Goals of the SHVS program include encouraging the uninsured or under-insured to seek testing and treatment for COVID-19, reducing gaps in Medicaid coverage, addressing the needs of vulnerable populations, and establishing new and effective communication channels.

“This is so hard for states,” said Howard in a phone interview on Monday. “The brunt of the response has fallen on the states, and to help them learn from each other has been valuable. We’ve had hundreds of state officials attending our webinars. The fewest states we’ve had on any webinar has been 44, so we’re getting almost all the states, which says to me they’re hungry for information tools. They’re drinking from a fire hose in their response so far.”

In an April 1 press release she stated, “States are on the front lines in responding to COVID-19. In addition to the public health measures put into place around the country, state departments of insurance, Medicaid programs, and state-based insurance marketplaces are being tasked with identifying policies and action steps that can be taken to expand coverage for treatment, reduce consumer out-of-pocket spending, increase access to telemedicine, protect vulnerable populations, and expand provider capacity.”

Howard continued, “The novel pandemic has placed unprecedented burdens on state health programs and systems. Those stresses are compounded by the economic downturn, which will starve state budgets just when states need resources the most.”

Howard pointed out that states are trying to understand what the federal stimulus and relief bills mean for them, what federal funding is available, and whether newly relaxed rules can help them in their response. “They’re hungry for information,” she said. A recent online webinar on federal stimulus bills attracted representatives from 48 different states.

A webinar coming up this Thursday, May 7, “Health Equity and COVID-19: Tracking and Taking Action to Address Disparities,” will focus on providing help to vulnerable populations that are disproportionately impacted by the pandemic.

The SHVS website (www.shvs.org), which Howard described as “a one-stop source for states to access federal guidance and to be able to see what other states are doing,” is designed to ensure that state policymakers have access to evidence-based resources for decision-making.

State officials and others are encouraged to share materials, topics of concern, and questions with other states, and the website has been expanding rapidly with a wide range of information, expert perspectives, and data analysis.

“The website is designed to support states seeking to make coverage and essential services available to all their residents, especially high-risk and vulnerable people, during the COVID-19 pandemic,” Howard said.

She went on to highlight two challenges currently facing the SHVS program in addressing the crisis. The question of how states can support their health care providers is, for Howard, a story that has not gotten enough attention. As health care providers cancel all elective procedures and people delay care for non-COVID health care issues, many health care providers face a disastrous lack of revenue.

“State officials are trying to figure out how they can help health care providers so that when things open up these providers are still there,” she said. “You need your doctors’ offices and hospitals to be there. They are facing a severe financial crisis because health care utilization has gone down.”

In addition to the tragedies of the COVID-19 crisis, Howard added, “This may be counterintuitive to people, but this health care crisis could drive a lot of health care providers into bankruptcy.”

Another focus of the SHVS program has been the financial concerns of the states, which face huge structural constraints in being required to balance their budgets each year. “They can’t print money. They can’t just bail out people,” Howard said. “They have to use federal money where they can. Helping states navigate that has been our focus.”

She pointed out that the RWJF has been a strong partner in helping the SHVS to address the coronavirus crisis. “They have supported us with additional resources to help us pivot and provide additional support to states,” she said. Howard noted that her team of five has been “all hands on deck” since the beginning of the pandemic and has quickly adapted to focus on the rapidly-changing crisis.

RWJF Senior Program Officer Tara Oakman emphasized the importance of the SHVS in the current pandemic and in the long-term effort to improve health care.

“The Robert Wood Johnson Foundation is proud to invest in the State Health and Value Strategies program because of the essential, timely, and evidence-based help that Heather Howard and her team are able to provide to state officials,” she wrote in an email. “This help has always been valuable to states in ensuring that their Medicaid and insurance programs are helping people get access to the care they need most effectively and efficiently. It is even more crucial now as states need support in their massive and fast-paced efforts to help as many people as possible have access to coverage and care that meets their needs, paying special attention to people in states most at risk.”

Howard praised Gov. Phil Murphy’s recent announcement of a recovery plan for the state, “The Road Back: Restoring Economic Health Through Public Health.” In particular she pointed out his commitment to help ensure New Jersey’s resiliency in learning from this crisis and being prepared for the next one. “We weren’t as prepared as we should have been for this one, and it would be a real tragedy if we didn’t learn from this,” she said.

Howard foresees ample material for future SHVS webinars. “Sadly, even as COVID numbers are improving, it will be a long time before we return to normal, and stresses on the health care system will continue,” she said.