Tag: Affordable Care Act

The Demand for Volunteer Physicians Is Rising. The Number of Uninsured Is Too

Posted on by robbie

The class and financial borders in Bridgeport, Connecticut’s largest city, are prominent. Within a 10-minute drive, the landscape in any which way can go from tidy, two-story homes with picket fences to burned-out buildings and blighted neighborhoods.
It’s this divide that has ranked Connecticut — and specifically Fairfield County — as one of the best (or worst, rather) examples of America’s wealth gap. It’s also home to more than 83,000 people who are uninsured — the leftovers from Obamacare who are either undocumented or can’t afford private health insurance.
And it’s those residents who Dr. Ken Grossman thinks about when he volunteers once a month at the Fred Weisman Americares Free Clinic in Bridgeport, about 30 minutes south of his main practice.
“There’s this paradox where we’re the richest and the poorest county in the nation,” Grossman tells NationSwell. “The population I see, they are some of the hardest working people. Some of the poorest too, but it’s because of that they take nothing for granted.”
Grossman is one of thousands of doctors that volunteer their time at free clinics, of which there are about 1,200 across the nation serving 6 million people, according to the National Association of Free and Charitable Clinics. Their mission is simple: provide free healthcare to those who can’t afford it. These medical facilities were the lifeblood for the uninsured before the Affordable Care Act. But as Medicaid expanded in 31 states, including the District of Columbia, following the law’s passage, more people were able to get coverage, leaving free clinics fighting for survival.  
Now, with national healthcare on unsteady ground, there could be more people relying on these clinics again, but there’s a dearth of skilled and well-practiced physicians willing to volunteer.
“If you ask me what I need, I’ll always tell you dollars and docs,” says Karen Gottlieb, executive director of Americares’ four free clinics in Fairfield County. “And we desperately need docs.”

Americares Free Clinics Nurse Practitioner Mary Beth Fessler takes a patient’s blood pressure at the Boehringer Ingelheim Americares Free Clinic in Danbury, Conn.

DOCTORS’ DISAPPEARING ACT

Volunteering among professionals has seen a gradual decline over the past six years, according to data from the U.S. Bureau of Labor Statistics. The percentage of volunteers with advanced education, including doctoral degrees, dropped from 42.4 percent in 2011 to 38.8 percent in 2015.
And though more than 90 percent of physicians emphasize that volunteering or community outreach is paramount for their jobs — specifically helping the poorest patients — only 39 percent have volunteered their time, according to a 2008 survey.
“Pro bono work in law is mandated, but you don’t have that in medicine,” says Yasmin Meah, founder and program director for Mount Sinai’s East Harlem Health Outreach Program, a free clinic in New York City. “A few years ago we were really struggling as far as recruiting and maintaining volunteers. We’d have to close about four to five times per year because there were no volunteer physicians.”
The decrease in volunteers has forced clinics like Meah’s to get creative in attracting doctors to donate their services. One way they’ve done so is by offering malpractice insurance for physicians, which can cost thousands of dollars a year. Americares’ clinics, for example, provides liability coverage to its volunteer doctors — an incentive that convinced Grossman to get on board.
Still, covering malpractice isn’t the answer in every case. Free clinics affiliated with hospitals, like Mount Sinai’s for example, often prefer to work with doctors who currently practice at the hospital, because their insurance is already covered. This in turn can lead clinics to pass up the services of older, retired physicians, who otherwise have the time, experience and desire to volunteer.
It’s a conundrum that’s only become more pronounced as clinics, most of which rely on a shoestring budget and bare-bones volunteer staff, struggle to stay open. After the rollout of the ACA, many had to convince donors to keep funding their operations, says Sasha Bianchi, executive director of Volunteers in Medicine.
“The challenge was the perception more than the reality of the situation,” says Bianchi. “Everybody was thinking, ‘Oh, society solved [the uninsured] problem, so I’ll send my money somewhere else.’”

DIAGNOSIS: MORE TROUBLE AHEAD

Despite the uninsured rate dipping to 9.1 percent in 2015, a record low in the U.S., there has been a slow trend upward that has many clinic leaders worried — and fighting for funding.
According to the Gallup Health Index, the uninsured population saw an increase to 11.7 percent in the second quarter of 2017. The reasons behind the uptick are numerous: insurers leaving the ACA, higher premiums and an uncertainty of where the law will go under the current administration.
But that could all change, for the worse, as higher premiums proposed next year push more people back into the uninsured ranks. In June of this year, the two companies in Connecticut selling individual plans through the ACA — Anthem and ConnectiCare — have both proposed rate increases for 2018, ranging from 17.5 to 33.8 percent.
And Americares’ clinics won’t be able to treat everyone, says Gottlieb.
“We’re only taking care of 3,200 of them, and there are a lot more people out there who don’t have insurance,” says Gottlieb. “We could see more patients if we had more resources, but we are resource-constrained.”

‘I’M GOING TO HELP THEM’

For those clinics that didn’t close their doors, they became de facto medical homes or navigation facilities. And many were able to rise to the challenge as demand fell and patients were able to be seen faster and more frequently.
Which is all good news, as free clinics also provide a training ground for medical students. At the East Harlem Health Outreach Program, any given Saturday will see 35 volunteer med students working, all of whom get to see the troubles facing a beleaguered population whose health is sometimes made critical by lack of consistent or quality healthcare.
It’s that same population, about a quarter of which are immigrants, that Grossman, the Americares volunteer, loves to help, despite the political arguments against the undocumented and their use of the healthcare system.
“I became a physician to take care of people,” he says. “These are people. They have hearts, arms, brains and medical issues, just like everyone else. And I’m going to help them.”

The Rx for Better Birth Control

Posted on by robbie

Back in 2015, word was going around on social media claiming that Colorado — a state that battled high unwanted pregnancy rates for years — had reduced those numbers drastically by changing the way women accessed birth control.
The rumor was right.
Unwanted pregnancies among Colorado women ages 15 to 19 years old have dropped by 54 percent over the past seven years, thanks in large part to the state providing access to intrauterine devices, or IUDs, and long-lasting birth control. The move enabled another progressive bill aimed at reducing unwanted pregnancies to win universal support between Republicans and Democrats.
“I think that if I’m being really honest, we were pretty surprised at the robust bipartisan support we got on this,” says Sarah Taylor-Nanista, vice president of public affairs at Planned Parenthood of the Rocky Mountains, which oversees clinics in Nevada, Colorado, New Mexico and Wyoming. “We anticipated it to be a lot more controversial than it was, and it was really heartening to see it go through the way that it did.”
The bill, which was signed into law in June 2017 by Democratic Gov. John Hickenlooper, allows women to receive a 12-month prescription of birth control pills or patch at no-cost after an initial, one-time, three-month prescription. The bill also required the state to cover three-month vaginal rings, which also prevent pregnancy.
A note from the state’s independent governing research body, the Colorado Legislative Council Staff, found that the change in the law would result in “minimal” impacts to the fiscal budget, although it could affect insurance premiums paid by the state, assuaging conservative fears that an exorbitant amount of state funding being funneled towards contraception.
“Sometimes it’s a long ways to the pharmacy,” says Sen. Don Coram, who sponsored the Senate bill and lobbied other Republican senators to view the bill through an economic lens. “The fact is that if you want to end a cycle of poverty, you prevent unplanned pregnancy.”
The bill passed the state Senate with bipartisan support, 22-11.
Coram, a self-proclaimed “redneck Republican,” extolled the social benefits of contraceptive accessibility, something usually heard from more progressive leaders.
“It’s just a common sense thing. I’m from rural Colorado where 70 percent of my district is federally owned land. I don’t have a Walgreens around the block,” he tells NationSwell. “And the fact is, birth control only works when you take it.”

Purple support

Polls conducted in 2014 by Planned Parenthood showed contraception is a nonpartisan issue nationwide — something Colorado legislators were able to use in their advantage. According to Colorado state Rep. Lois Landgraf, a Republican who co-sponsored the bill in the House, a bit of manipulative planning was required to get bilateral support.
“I’ll tell you one thing I did when [testimonies] were heard in the Senate: I asked Planned Parenthood to stay home,” Landgraf tells NationSwell. “As soon as they come to the House, people start thinking about Planned Parenthood and all the negative connotations that it has for some Republicans. Not as if their testimony wasn’t helpful, but if it leads one mind’s astray from the actual problem, there’s no value in it.”
Landgraf says that the bill was a “good bill for women and for men,” but preconceived notions about the organization needed to be erased. In their efforts to replace the ACA, Republicans on the national stage have argued for the defunding of Planned Parenthood, but swing states and districts overwhelmingly support Planned Parenthood’s mission of providing access to contraceptives.
That’s because increased accessibility is especially good for women in rural areas, says Erika Hanson, a legal fellow at the National Women’s Law Center (NWLC).
“These types of laws disproportionately affects women in rural areas, because as with many for services in rural areas, it is very difficult for women to access healthcare,” Hanson tells NationSwell, adding that the NWLC offers a hotline specifically to provide assistance to women who have a hard time accessing contraception. “We hear from thousands of women who are having troubles getting coverage or getting access to birth control and often it is as simple as they can’t find an in-network provider that’s close enough to them. Or they’re getting the runaround from their insurance company about what pharmacy to go to, which may not be close.”
After some initial pushback from Republicans in 2015, the success of Colorado’s IUD program — including a savings of $111 million in birth-related Medicaid costs by the Colorado Department of Public Health and Environment — was enough to convince members of both parties in the state legislature that it deserved to be expanded.

Time bound coverage?

Washington’s tug-of-war over the Affordable Care Act (ACA) has caused states to be wary of future legislation changing the existing contraception mandate, which requires insurers to cover all forms of contraception (though only from one manufacturer). That aspect of the bill has been widely praised among women for eliminating costs associated with getting birth control.
In 2015, during a heated partisan debate on whether privately-held companies should be forced to offer birth control coverage, 49 congress members signed a letter urging the Secretary of Health and Human Services, Sylvia Burwell, to provide a roadmap to insurers for 12-month contraceptive coverage for women across the nation.
No federal guidelines were issued as a result of the letter.
In response, several other states have also expanded coverage beyond federal regulations.
Traditional blue states, such as Oregon and California, have also made oral contraceptives and patches available for year-long prescriptions, a move that reduces unwanted pregnancy by 30 percent. That same study, conducted by the University of California San Francisco’s Bixby Center, reports that extended contraception coverage also lowers the number of abortions by 40 percent.
California also made it a requirement that insurance plans pay for all forms and all brands of birth control. Research shows that lack of brand choice causes two-fifths of women to go without birth control.
But women in states with expanded coverage are at-risk of losing it if their employer disagrees with the use of contraceptives for religious reasons. President Trump is expected to eliminate an Obama-era rule requiring employers to provide birth control through employer-sponsored health insurance plans. The new rule, which mirrors an earlier draft and is expected to be written any day now, would allow employers to omit birth control coverage from health insurance plans completely, according to the Wall Street Journal.
Democrats say 50 million women in the U.S. will be forced to pay for birth control out of pocket.
But the win for contraceptive rights in Colorado is not lost on Planned Parenthood’s Taylor-Nanista, who wants to continue the momentum of bipartisanship within the state and hopefully the rest of the nation, especially in a time where female contraception coverage is at stake.
“Many of our activists and patients are feeling really concerned and hopeless,” she says. “But I think this bill is a great example of what we can do when we think strategically.”

Maryland’s Public Experiment to Combat Poverty and End Obesity

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In parts of Maryland, when poverty rates rise, so do healthcare costs — a correlation that’s not uncommon across the country.
In response, the Affordable Care Act carved out a portion of its budget to support communities promoting nutrition and exercise, while reducing obesity and tobacco use. Called the Prevention and Public Health Fund, it aims at not only getting Americans healthier, but also quelling healthcare and hospital costs through preventative measures.

It’s estimated that up to 40 percent of deaths each year from the five leading causes — heart disease, cancer, chronic lower respiratory diseases, stroke and unintentional injuries — are preventable, according to the Centers for Disease Control and Prevention.

MORE: These Pharmacists Are Making Affordable Medication for All a Reality

In Maryland, preventative care exploration has been underway since the 1970s, but thanks to the new funding from Obamacare, state officials have revitalized a plan to get its residents healthy.

The western Maryland city of Cumberland has one of the greatest needs for preventative care. The area, with a population of about 20,000, has notched an obesity rate of nearly 29 percent. The surrounding area of Allegany County carries a poverty rate of 16 percent, leading to poor nutrition practices, food insecurity, and often, costly hospital visits.

But Western Maryland Health Systems (WMHS) is tapping into federal funds to transition medical practices out of a traditional fee-for-service model that reimburses doctors and hospitals for each test, treatment, and medication. As critics of fee-for-service have noted, this model can lead to unnecessary treatments or substandard care which prompts further treatment. Instead, WMHS will help doctors cap and stabilize reimbursements through Medicare and Medicaid, encouraging hospitals to use more preventative care methods to keep their patients healthy, according to the American Prospect.

Perhaps the more interesting part of the state’s initiative is the community outreach teams that will visit the homes of patients with conditions like asthma or diabetes to ensure they’re taking medicine and heeding a doctor’s advice.

“If you begin to work on controlling the healthcare spending in an area, you have to be able to confront and understand some of those social determinants of health,” said John M. Colmers, chairman of the state’s Health Services Cost Review Commission and a vice president at Johns Hopkins Medicine.

A variety of organizations across the state are pitching in to help low-income families find better sources of nutrition and increase exercise. The University of Maryland’s extension office for Allegany County has implemented educational programs for families while passing out healthy recipes and helping out at local food banks. Two of its staff, Katheryn Kinsman and Eileen Morgan, have been working with local families for 26 years.

Their biggest challenge, according to Morgan, is getting inside the home.

“There is an extreme amount of pride here, and just forming any kind of rapport here is hard,” Morgan told American Prospect. “Just getting in the door is hard.”

Apart from pride, the poverty rate has directly contributed to the area’s poor health — common afflictions include obesity, asthma, and untreated mental illness. To combat obesity, Morgan and Kinsman use simple methods like teaching how to prepare nutritious meals, learning to chop and stir, and finding sources of fresh fruit and vegetables. The two recalled buying clients a pot and wooden spoon before teaching a class.

“If you’re a mom with very little resources and several kids, and you go into the market and you can get a box of 12 cupcakes for a dollar, while apples are a dollar apiece, which are you going to buy?” Kinsman said.

Even finding an area to exercise poses a problem for Cumberland, which is why the local extension office offers an exercise class at the community center.

But with renewed attention and funds to promote healthy living, state officials are hopeful to turn the tide in Cumberland and Allegany County.

Back to Basics: How One Health Nonprofit is Rethinking Clinical Care

Posted on by robbie

As Americans adjust to a new healthcare system, some providers are beginning to dig deeper into the social conditions that may lead a patient to seek medical treatment in the first place. They’re finding that sometimes, a prescribed antibiotic is simply not the answer.
That’s the thinking at Health Leads, a Boston-based organization that partners with healthcare institutions to provide non-medical assistance for vulnerable patients.
Why this new method of treatment? Too often, doctors end up prescribing medication, but instead of getting better, the patient actually worsens as he or she continues to live in poor conditions. The cyclical nature of this process leads to patients returning to seek more treatment, which then becomes a costly venture for hospitals. (For example, instead of giving medication to someone living in a car, what that patient may really need is access to proper housing or heat instead.) But what if doctors “prescribed” healthy food, housing or other basic needs?
MORE: The Checklist That Can Reform Healthcare
At Health Leads’s institutions, after seeing a doctor, patients are directed to meet with volunteer “advocates,” which typically are college students. These volunteers work with these patients to get them better access to public benefits and community resources. Their goal, according to the Stanford Social Innovation Review, is to transform the way institutions deliver health care by addressing how social factors can shape healthy living.
But the program, which connects 1,000 student volunteers with 14,000 patients and families, is keeping its focus small. Rather than expanding on a large scale, the project is partnering with just a few institutions — such as academic medical centers and for-profit hospitals — to create models for other institutions to emulate. Health Leads is also focusing on collecting data from its partnerships to further support transformation across the health care industry.
“Going small may not be glamorous,” Health Leads’s Rebecca Onie, Sarah Di Troia and Sonia Sarkar write. “But if we can couple a powerful on-the-ground demonstration with pathways to change the sector, we will have the opportunity at last to transform health care for patients, physicians, and us all.”
While addressing social conditions like public safety, economic inequality, and food security is nothing new, it’s important to see organizations like Health Leads make the connections between healthy living and health care.

Connecticut’s Health Insurance Exchange Works So Well, Officials Are Selling It to Other States

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Among the many faulty health insurance exchanges that entered the market late last year prior to the implementation of the Affordable Care Act, there is one that could soon be considered the gold standard — and is carrying the stamp of approval from the Obama administration. Connecticut has had so much success with its Access Health CT exchange that it is setting up a consulting business to help other states build websites just like it. Call it an “exchange in a box”, but the hope is that states such as Maryland, Minnesota and Oregon — all of which were plagued by problems with their insurance websites — as well as any of the three dozen states that have been relying on the glitchy federal exchange will license or franchise at least some of Connecticut’s technologies in order to help their exchanges run smoother. “We realized that we had invented a better mousetrap,” Dr. Robert E. Scalettar, a board member on the Connecticut exchange, told the New York Times. “We could package our services and expertise and make them available to other states, promoting collaboration and avoiding a duplication of effort.”
MORE: How Crowdsourcing Medical Bills Can Usher in a New Era of Healthcare Transparency
Under the plan, which was spearheaded by Kevin J. Counihan, chief executive of Access Health CT, states could set their own policies for their insurance exchanges while buying technology and other services, including eligibility determinations, enrollment assistance and call center operations, from Connecticut. “This would be an ideal solution for a state that does not like big government or does not want to hire a big new staff,” Counihan said. “You can get the benefits of a state-based marketplace without the headaches of building or staffing it yourself.” This way, states can use what’s worked for Connecticut to build a website that will work better for citizens, without needing to start from scratch. And in Connecticut, the numbers don’t lie. About 55,000 people have signed up for private health insurance through Access Health CT since October, far exceeding the goal state officials set with still a month to go before the end of open enrollment. You know what they say, if it’s not broken, then sell it.
ALSO: The Checklist That Can Reform Healthcare
 

This Clinic Is Saving Immigrants’ Lives, No Questions Asked

Posted on by robbie

Being an undocumented immigrant nearly cost Mery Martinez her life. Martinez, 38, was recently diagnosed with leukemia, but because she lacked legal status — and health insurance — she was unable to find consistent treatment to fight the disease. That is, until she relocated from New York to Philadelphia and visited Puentes de Salud, a nonprofit clinic run by volunteer doctors, nurses and med school students. Puentas de Salud, or “bridges of healing”, was created in 2006 for the sole purpose of providing health care to the area’s low-income, undocumented, and uninsured Latino community, Dr. Steve Larson, one of the organization’s cofounders, told the New York Times. The group also pinpoints social determinants of health in the community and focuses on prevention as much as treatment. “It’s not about me writing prescriptions,” Dr. Larson says. “This is an underground health system.”
So far, Puentes de Salud, which operates only two evenings a week, has treated about 3,300 patients. Initial visits to the clinic cost $20. Each follow-up visit costs $10. Since the Affordable Care Act doesn’t provide assistance to illegal immigrants, and this group is generally ineligible for Medicaid, people like Martinez are often forced to either forego medical care or take advantage of inexpensive or free clinics like Puentes de Salud. With a growing need for such operations, Dr. Larson is seeking funding to open a 7,000-square-foot clinic devoted to medical services and health education, so even more immigrants like Martinez can take control of their care.
MORE: Health Reform’s Next Crucial Step: Winning Immigrants’ Trust

How Crowdsourcing Medical Bills Can Usher in a New Era of Health Care Transparency

Posted on by robbie

Clarification appended February 10, 2014. 
Despite all the changes that the Affordable Care Act has brought to the U.S. health care industry, many patients still don’t know the up-front costs of common procedures and checkups. Enter Doctible (working title), a website that will allow patients to compare out-of-pocket costs on common procedures in their area, as well as view doctor ratings based on patient reviews. The site was conceived after Erich Graham, 27, injured himself playing hockey a few years ago. He realized that he was going to need an MRI, and because he had a high-deductible plan, he knew it was probably going to be expensive. Graham tried shopping around for the best price in his area, and found it almost impossible to learn the real costs before the imaging was performed. “It’s like looking at apartments, checking out the amenities, meeting the landlord, signing the lease, and then finding out what the rent is,” he told Fast Company.
MORE: Why House Calls Are Health Care’s Future, Not Just Its Past
Graham knew there had to be a better way, so he teamed up with a fellow graduate from Cornell Tech, Greg Tobkin, 28, and together they came up with an idea to allow consumers to crowdsource their doctor bills, in order to inform other users of their medical experiences — and most importantly, the costs of procedures and checkups. The pair is currently seeking funding and advisers to help them navigate the tricky world of health care pricing. But while there are some barriers to overcome before launch, Graham and Tobkin know that, given the success of sites like ZocDoc and Yelp, which already offer patient reviews, the ability to compare health care costs is a service that could be incredibly helpful. “This will definitely exist in five years, whether it’s us or someone else who does it,” Tobkin says. “There’s too big a need.”
Clarification: Doctible was the working title of Graham and Tobkin’s Cornell Tech project. Their idea is not related to the startup Doctible, a website that allows consumers to negotiate prices on medical bills. Graham and Tobkin are seeking a new name for their venture, and are in talks with startup accelerators to get their idea off the ground.

The Checklist That Can Reform Healthcare

Posted on by robbie

Behind the scenes, hospitals are transforming the way that doctors and nurses care for patients under the Affordable Care Act. The experiments that hospitals are trying out and small changes they’re making are less prominent parts the ACA, but Summa Akron City Hospital is showing off as an example of innovative implementation. Starting Jan. 1, the hospital will embrace a new business model. Medicare will pay the hospital one lump sum, upfront, for surgical procedures and any complications that surgery patients experience within 30 days of discharge. Currently, payments come based on procedures, not patients, so if a patient had complications and returned for another procedure, revenue grew. Under the new system, based on quality instead of quantity, the hospital could lose money if the patient needs to return, but would profit more from a successful procedure. As cardiologist Dr. Ken Berkovitz, explains it, “Everybody in the health care system gets rewarded for doing more, rather than rewarded for doing the right thing.” Meanwhile, some of the other seemingly simple changes are already making a difference; for example, did you ever think that a using checklist could be so innovative?