Tag: Health Insurance

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.”

Getting Real About Golden Years

Posted on by robbie

Getting old isn’t for the faint of heart. Healthcare is expensive. Extra services are needed. There’s pressure on your adult children to take care of you. (And from their perspective, they’ve got to deal with the mental anguish of watching you try to cope!)
Yes, it’s joyous to lead a long, healthy life, but the operative word is “healthy.” If you’re lingering, not living, I don’t see an upside.
Making it to 100 — or beyond — only makes sense, to me, if you have a high quality of life. If you’re confined to a wheelchair, if someone has to clean you, bathe you and dress you, and if you’re not even aware of your surroundings, living to such a ripe old age doesn’t feel like much of a victory. To enjoy longevity, it’s crucial that we can still give back to others, feel well enough to participate in activities, and enjoy our family and friends.
When my father was 69, he had a stroke. A medevac helicopter rushed him to the hospital, where doctors told us there was a possibility that he’d recover. As a family, we decided to put in a feeding tube.
Had I understood the magnitude of my father’s stroke and been given more clear medical information, I would have made a different decision.
My father lived 14 more years, but he was confined to a wheelchair and had minimal speech capabilities. He suffered. Despite my parents’ long-term health insurance policy, his illness also ate away at their financial resources.
Three years ago, my father finally passed.

Afterward, I thought my mother would have a chance to be healthier and happier, as she was no longer a primary caregiver. Unfortunately, that didn’t happen. Last year, she fell and broke her hip. At the same time her physical health declined, so did her mental health. Now she, too, requires 24-7 care.
Today, my mother resides in a senior living facility. It’s clean and safe. She’s treated with kindness. A nurse visits her once a week and calls me with any problems. But since my mother’s finances were drained from my father’s illness and her long-term insurance doesn’t cover much, I support her. At first, I was optimistic that Medicare would help, but at the end of the day, when someone needs around-the-clock care, the cost is too considerable.
I’m not complaining; many others are in a similar situation. As people live longer, they need to be cared for. That’s the concern with an aging population, and it’s one that should be addressed more seriously.
I think the healthcare crisis we’re in is substantial. It’s a tragedy to see people lose their Medicare while drug prices rise, and to hear about terrible nursing home situations in the news. The longer people live, the more needs they have, and the greater the burden on our entire system.
I doubt that I’m alone in these thoughts. There’s a movement in our country toward hospice services. People want compassionate solutions, not 911 drama. As we have the opportunity to live longer, it will become critical for people in the medical field to come clean with families so that appropriate choices can be made. Hopefully, those decisions will be guided by love.
On the other hand, exactly when the “best” years are in your life depends on you, your career and your interests. Each individual’s journey is different. There’s no prescription for success or happiness.
If I were to live to 100 and still had a good quality of life, I’d continue to engage in enriching, cultural activities. I’d spend my days going to the theater, watching old movies and reading fiction. I’d surround myself with interesting stories, and would hopefully be reading them to my great-grandchildren.
Although I officially retired as president of the Brooklyn Academy of Music in 2015, I recently completed a two-year senior fellowship at The Andrew W. Mellon Foundation. Now, I’m serving as a senior advisor to the Onassis Foundation’s cultural centers in New York and Athens, Greece.
I love what I do, but it’s hard to know if I’ll still be working at the age of 100. Younger people will call the shots at that point, but hopefully I’ll be interesting enough to stick around and contribute to their shining moments.
If so, I’d try to illuminate and educate younger generations without always saying, “In my day…” I’d try not to hold on to the same level of professional intensity I had in my 40s, 50s and 60s.
In return, I’ll hopefully be seen as a visionary in my day — someone who worked hard, did well and added more vitality to the field.
As humans, we can’t go backward. We have to move forward. If it’s intimidating to think about that in big chunks, then we can break it down day by day. To me, that means if I can wake up and feel good, continue to work and be with the people I care about, then I’m lucky.

Karen Brooks Hopkins served as President of the Brooklyn Academy of Music from 1999 until her retirement in 2015 and was an employee of the institution since 1979. She has worked with the Cultural Institutions Group, the Mayor’s Cultural Affairs Advisory Commission and as the Brooklyn Regent for the New York State Education Department. In 2013, Crain’s named her one of the “50 Most Powerful Women in New York.” Karen currently serves on the boards of the Jerome L. Greene and Alexander Onassis Foundations, as Senior Fellow in Residence at the Andrew W. Mellon Foundation and Fellow of the National Center for Arts Research at Southern Methodist University.
This post is paid for by AARP.

In Connecticut, Saving Lives Comes With an Unexpected Perk: Saving Money

Posted on by robbie

Across much of the U.S., a person who’s poor, overweight and a candidate for obesity-related diseases might not visit a doctor until they’ve already contracted diabetes — that is, if they can even find a physician who will accept Medicaid, the federal health insurance program aimed at the neediest Americans.
But in Connecticut, they’re doing things differently. There, state employees actually reach out to those at the greatest risk before they’ve exhibited any noticeable symptoms, then work diligently to connect them with the right care. Doctors are paid a bonus for getting a patient to see the appropriate specialists, and out-of-the-box arrangements are made when other solutions prove necessary; a low-income senior facing eviction, for example, might be given a “prescription” of a rental voucher so that she can remain in her own neighborhood.
In treating poverty as an ailment in and of itself, Connecticut has adopted a proactive approach to improving the health of its poorest residents — and it’s saving money in the process. After switching to a rarely used Medicaid payment model, known as fee-for-service (FFS), the state faced a daunting challenge: Keep those unable to pay out of the emergency room, or see its budget eaten up by soaring medical costs.
Here’s how it works: Using the extensive data collected from all Medicaid patients, the state’s predictive modeling identifies those most in danger of expensive, chronic ailments like diabetes. Then, says Dr. Robert Zavoski, a former pediatrician who now serves as the state’s medical director, “We make sure they’re getting preventive care so that, 10 years from now, we’re not paying for dialysis for renal dysfunction and amputations for limbs that would have been better left where they were.”
After Connecticut dropped three private companies who administered its Medicaid program and decided to run the massive entitlement on its own, other states practically took bets on when the system would implode.
“They patted us on the head and said, ‘Good luck with that,’” Kate McEvoy, who oversees all of Connecticut’s public health services, recalls of the 2010 decision.
In booting private insurance companies off the job (in Hartford, a city that’s known as the insurance capital of the world, no less), Connecticut was bucking a trend. Thirty-nine other states, representing nearly three-quarters of the nation’s enrollees, have hired managed-care organizations, or MCOs, to oversee Medicaid, with even more governors pondering following suit. Of the rest, only Alaska and Wyoming have a system like Connecticut’s.
Without relying on MCOs to set standards and manage the process, Connecticut’s been on the hook for whatever care its Medicaid population requires, which can include check-ups, specialist visits and hospital drop-ins. The looming receipts have created an incentive for Connecticut to keep its poor healthy.
The tactic has already paid off in the short term and promises to deliver even bigger dividends in the future.
According to a recent analysis of federal payment data published in the journal Health Affairs, Connecticut led the nation in reducing Medicaid costs. The state’s per-patient spending on Medicaid dropped by an average of 5.7 percent each year between 2010 and 2014. One explanation is simple. “We got rid of [the MCOs’] profit and overhead,” says Ellen Andrews, the head of Connecticut Health Policy Project, a nonpartisan analyst. But officials also believe, financially and morally, they’ll do better by paying upfront.
“The old adage went, ‘If you can predict something, you can prevent it.’ And yet as a practitioner, when we look at the population of inner-city children, a lot of stuff was happening that you could predict but nobody was preventing anything,” Zavoski says. “Standing in the capital city in the richest state in the richest country in the world, that’s not acceptable.”
Under Connecticut’s FFS system, primary care doctors are given bonuses for coordinating their Medicaid patients’ care. “They don’t just say, ‘You have a heart problem.’ They’ll make an appointment with a cardiologist and follow-up,” Andrews says.
Paying out doctor bonuses won’t break the bank, but other preventive measures do involve five-figure decisions. Previously, under managed care, insurers denied coverage of top-dollar treatments — exclusions the state has now reversed. For example, Connecticut will pay $94,500 for a prescription that cures Hepatitis C, with the confidence that it will lower costs in the long run. Zavoski reasons that a one-time course of drugs, paired with education about reinfection, might be cheaper than a lifetime supply of the older pills, which put the patient at risk of severe liver and kidney damage.
Of course, the resources might not always be there. As Connecticut’s legislature faces a massive budget deficit that could slash health programs and congressional Republicans attempt to dismantle Obamacare’s expansion, Medicaid is under constant assault. But if the Nutmeg State has one lesson for the rest of the country, it’s that deferring treatment will cost us later — in dollars and in lives.
Homepage photo courtesy of Joe Raedle/Getty Images.
Continue reading “In Connecticut, Saving Lives Comes With an Unexpected Perk: Saving Money”

Meet the Couple Caring for Uninsured Families

Posted on by robbie

New York City has long been the final destination for incoming immigrant families. Today, that population totals over 3 million people, and nearly 35 percent of them lack access to health insurance. Now one married couple is aiming to provide these families with the pediatric care they otherwise can’t afford.
Dynasty Pediatrics is a private practice with an office in Brooklyn’s Kensington neighborhood. Its founders, Dr. Marina Klotsman and her husband, Schmeil, provide affordable healthcare services for the borough’s newly settled immigrants, many of whom lack health insurance. As a result, the Klotsmans often end up waiving co-pays and other medical fees for those families struggling to make ends meet.
“We put a lot of effort, a lot of time, a lot of our own energy into this place,” says Marina. “It’s not even for business; it’s for the feelings we have. We want to help everybody.”
Schmeil agrees, adding, “The money’s not the main subject in this office.”
Dynasty Pediatrics is open Sunday through Friday, with hours late into the evening. The goal is to make it easier for working-class parents — many of whom support family members living outside the US — to bring in their children without disrupting their work schedules. The Klotsmans also help families explore insurance plans as well as local services like NYC’s universal pre-K program.
That sense of duty goes back to the husband-and-wife team’s own journey to the US from Kyrgyzstan. Schmeil left his home country in 1989 during the dissolution of the USSR, a period he remembers as marred by “chaos.” Marina left eight years later, in 1997, to further her medical career. They would eventually meet in Brooklyn through Marina’s uncle and marry soon after.
Learn more about the Klotsmans’ passion for helping others in the video above.

Meet The Woman Putting a Personal Touch on Health Insurance Enrollment

Posted on by robbie

With all the intricate details of the health care system, it’s easy to get bogged down and overwhelmed, making it next to impossible to choose the best insurance option. Which is why King County, Wash. is taking a different approach — they’re letting the people that know the community take the lead.
So instead of residents hearing about health care options in a general format, a representative of the community presents information catered to the individual area’s needs.
The woman behind the idea? Daphne Pie, King County’s manager of access and outreach at the Public Health Department for Seattle and King County. Her group of workers consists of 24 community leaders, including representatives from Cierra Sisters, Arms Perinatal Doula Program, Gay City health project and the Asian Counseling and Referral Service.
All of this began about four years when the County Council put forth their ‘equity and social justice’ strategic plan, according to National Journal. The measure has each county department focus on reaching the communities where there is the greatest inequity in their respective area of expertise.
For Pie, that meant finding a way to reach diverse groups about their health insurance choices. Her solution? For every community that had above average rates of uninsured citizens, a leader that spreads the message: “you can have health care insurance for free or at a very low cost.”
Communities in King County are quite diverse, featuring African-Americans, Native American tribes, Latinas and homosexuals, among others. Therefore, it’s useful to have a member of that community who can understand and address each group’s specific needs — whether it be HIV medication or natural childbirth.
The County’s commitment to this project isn’t just on paper, either. In 2013, out of the $1.6 million of federal grants King County received, $1.3 million of it went to community partners.
“You have to reach the uninsured where they live,” Pie tells National Journal. “We can’t expect these people to always come to us.”
MORE: Step Right Up, the Barber Will See You Now

How Price Tags in Hospitals Can Help Patients Avoid Huge Medical Bills

Posted on by robbie

The Affordable Healthcare Act created marketplaces to expand affordable healthcare and to underscore that promise, Massachusetts is now requiring private health insurance companies to use price tags on anything from an MRI to a general check-up.
Beginning Oct. 1, all heath insurers in the Bay State are required to list prices in real-time, outlining the otherwise hidden costs of healthcare, much like an online shopping site. While it’s unclear if every insurer met the deadline, there is no penalty if they failed to do so, according to 90.9 WBUR. 
By using an online calculator on their insurer’s website, users can find out how much they’ve spent this year toward their deductible. If coverage does not include a deductible, the calculator will add up the balance toward the out-of-pocket maximum. Blue Cross customers can find the calculator under “Find a Doctor,” Tufts is under “Empower Me” and Harvard Pilgrim’s is under “Now iKnow.”
While the mandate underscores a sea change in health care practices, Massachusetts first began the process two years ago when the state passed a law to increase transparency among hospitals and health insurers.

“This is a very big deal,” says Undersecretary for Consumer Affairs and Business Regulation Barbara Anthony. “Let the light shine in on health care prices.”

But the new law has its flaws, and though it’s still early, WBUR points out a few glaring issues with the new health care price tags.

No standard price: There is no standard price and no list of priced tests and procedures. Pricing out a visit depends on the insurer and can range in price drastically. For instance, an MRI for the upper back can cost between $614 and $1,800 on the Harvard Pilgrim “Now I Know” tool. The prices are also listed in real-time, which means they can change day-to-day.

Prices are ambiguous: Since insurers negotiate their rates with hospitals and physicians, they may entail hidden costs. For example, a listed price tag may not include the cost of reading a test or a facility fee.

Prices focus on outpatient care: The information is not comprehensive and encompasses few prices outlining what it would cost for inpatient care or an overnight stay at the hospital.

However, as Tufts Health Plan Director of Commercial Product Strategy Athelstan Bellerand notes, the new prices “are a major step in the right direction.”
By adding price tags, state officials are forcing us to think more about our health spending and how much a procedure actually costs, rather than leaving it to our private insurance. Anthony is also hoping by illuminating the price difference, more physicians will become sensitive to where they fall on the scale and ultimately encourage more competition and drive down costs.
“I’m just talking about sensible rational pricing, which health prices are anything but,” she adds.
MORE: The Checklist That Can Reform Healthcare