Submitted by achenault on Wed, 11/18/2015 – 4:09pm
A recent survey shows that a majority of Americans believe the ACA is here to stay and value what the ACA has accomplished, as we discussed in a recent newsletter. But a strong majority also support proposals to improve the ACA by making health care more affordable. This echoes what we hear from people shopping for coverage on the Marketplace or struggling with increased cost-sharing in private insurance.
A variety of remedies exist to the problem of unaffordable health care. Each require action – by insurance companies, the Ohio Department of Insurance, and/or legislators. Here are several ways to make insurance more affordable for Ohioans.
Value Based Insurance Design: Insurance companies could stop charging high copayments for effective medications and treatments for people with serious illnesses or chronic health conditions. This is known as “Value-Based Insurance Design,” or VBID. Instead of charging the same cost-sharing (deductibles and co-pays) to every patient and every service or medication, VBID reduces financial barriers to obtaining “high value” treatments. “High value” treatments can be defined as those treatments that prevent a patient from needing more expensive care. Think about an asthma inhaler or insulin for diabetes.
VBID should apply to basic diagnostic tests and medication to promote early detection and treatment, as long as they are based on strong clinical evidence of effectiveness. For patients with such chronic conditions as diabetes, hypertension, asthma, cancer, HIV, and multiple sclerosis, reducing barriers to medications that maintain health save money on more expensive care for unmanaged disease.
Surprise medical bills: These most often occur when people obtain care from a hospital and provider in their insurance network, but then get (surprise) bills from other providers who are not in their network, such as radiologists, anesthesiologists, and laboratories they had no idea would be involved in their care. Consumers can’t avoid using out-of-network providers if they either didn’t know they would be involved or had no choice when they went with their in-network hospital and doctor. Legislation, such as a law recently passed in New York, can protect consumers from surprise bills from out-of-network providers.
Insurance rate review: The rates insurers are allowed to charge are regulated by the state department of insurance. Several regulators in other states are more aggressive than the Ohio Department of Insurance in reviewing and approving proposed rate increases. ODI could exert more pressure on hospitals and specialists around the prices they charge for services and quality of care. ODI could consider affordability of higher premiums in relation to the profits and surpluses of the insurance industry. In short, ODI could hold insurance companies more accountable.
These are just three policies organized consumers and their allies could achieve in order to bend the health care cost curve. It won’t happen overnight – few things worth winning are.
Submitted by achenault on Wed, 11/18/2015 – 5:34pm
It’s Open Enrollment Time!
Over Thanksgiving, check in with your friends and family to make sure everyone knows that health coverage is available for those who don’t have it. Here are some simple messages to share to make sure everyone knows about health coverage options available through the Marketplace and Medicaid.
See below for more information about how to get covered, and have a happy Thanksgiving!
If You Had Coverage Last Year:
If you signed up for coverage through the Marketplace last year, you need to renew or possibly change your coverage for this upcoming year.
If You Need Health Coverage:
If your employer doesn’t offer health coverage that meets federal standards or if you don’t qualify for Medicaid, you can enroll in health coverage through the Health Insurance Marketplace through January 31, 2016. If you want your coverage to start on January 1, 2016, you need to select and pay your first month’s premium by December 15, 2015. Some insurance companies might accept payment up to the end of the month. If you make around $16,000 a year as an individual or $33,000 a year as a family of 4, visit www.benefits.ohio.gov to see if you qualify for Medicaid.
UHCAN Ohio is here to help you with your enrollment needs. If you have any questions, don’t hesitate to contact us at 614-456-0060 x233.
Submitted by achenault on Wed, 11/25/2015 – 12:51pm
Every day it seems a new dimension of Ohio’s opiate crisis in Ohio appears. In September, a report released by the Ohio Department of Health showed a 17% jump in Ohio deaths due to unintentional drug overdose. Now we learn that the number of Ohio youths dying of drug overdoses has quadrupled in the past decade, putting us in the company of only four other states with such a leap (Kansas, Montana, Wisconsin and Wyoming). (See Reducing Teen Substance Misuse: What Really Works, Trust for America’s Health, November 2015.[1]) This study found that Ohioans age 12 to 25 died at a rate of 9.1 per 100,000 in 2013 compared to the national rate of 7.3.
And if one needs personal stories to bring these alarming statistics to life, look no further than the CBS Sixty Minutes Heroin in the Heartland episode aired on November 1st. Teens are experimenting with medications lifted from their parents’ medicine cabinets, or getting hooked on pain pills legitimately prescribed for them for an injury. When the expensive pills become unavailable, heroin becomes the drug of choice and is amazingly easy to get. Sixty Minutes interviewed recovering college student Hannah Morris from Worthington who said, “[i]t started with weed and it was fun, and I got to good weed. Went to– oh my gosh, I went to pills, and it was still fun. You know, Percocet, Xanax, Vicodin, all that kinda stuff. And then yeah, heroin. I started smoking it at first.” Hannah was 15 at the time, and went on to shooting up heroin in the school bathroom. Fortunately, Hannah survived. Many have not.
Prevent Use Before It Starts
“More than 90 percent of adults who develop a substance use disorder began using before they were 18,” said Jeffrey Levi, PhD, executive director of Trust for America’s Health. “Achieving any major reduction in substance misuse will require a reboot in our approach – starting with a greater emphasis on preventing use before it starts, intervening and providing support earlier and viewing treatment and recovery as a long-term commitment.”
That’s right. PREVENTION. We won’t treat or arrest our way out of this. One supplier will replace the next when the demand is great and there is lots of money to be made by providing heroin to our young people.
Fortunately, the Trust for America’s Health made some critical recommendations (quoted in part):
UHCAN Ohio has been working on the last recommendation for almost two years now. Screening, Brief Intervention and Referral to Treatment (SBIRT), which has the support of the American Academy of Pediatrics, is a preventive intervention in which a trained individual (it could be a school nurse) asks a person a few preliminary questions from a validated tool about alcohol and drug use. For adults, this is often done in the doctor’s office. For youth, a school may be a better place to capture a greater number of young people. The screening can be paired with other health screenings done in school. For those who screen positive, a few more questions are asked, and then a trained person will do a “motivational interview” with the young person. This is simply a structured conversation that provides important factual information, assesses a young person’s readiness to change behavior, and helps them devise some strategies. Where necessary a referral to treatment is made.
College-age students in recovery tell us they wished someone had asked them in middle or high school if they were using. Let’s listen to their wisdom and start asking all of our young people in schools.
The Trust for American’s Health says, “Each state should have an end-to-end network of experts and resources to support the effective community-based selection, adoption, implementation and evaluation of evidence-based programs.” We need to devote resources and we need effective community-based programs. Ohio can do this, but we need to demonstrate the political will.
Before Ohio loses more of our young people, state leaders must take a hard look at investing more resources into prevention.
[1] The study performed by Trust for American’s health was funded by the Conrad N. Hilton Foundation, who also funds UHCAN Ohio’s work on spreading youth SBIRT.
Submitted by achenault on Tue, 12/15/2015 – 3:17pm
Ohio Consumer Voice for Integrated Care (a coalition led by UHCAN Ohio) recently sent a survey to our database of over 3,000 consumers on their experience with MyCare Ohio, Ohio’s integrated managed care program for Ohioans on both Medicare and Medicaid. We received over 400 responses – a very high number for a survey! The results – including the comments – really caught the attention of Ohio’s Medicaid Director and the MyCare Ohio plans.
The survey respondents’ made their voices heard. They brought significant new attention to two major problems enrollees are experiencing in MyCare Ohio. As a result of the survey, OCVIC is in conversations with decision makers to make major improvements in appropriate care coordination and the availability of all services, supplies, and equipment that members need. We want to thank our survey respondents for helping us to bring their voice to the leaders of MyCare Ohio. OCVIC will seek feedback on any proposed improvements and will keep everyone posted on the progress.
The survey was so effective in bringing consumers’ voices to decision makers that we’d like to use it again to get additional input. One of the things we learned from the responses is that doctors are largely not involved in the enrollees’ MyCare Ohio “integrated care team,” and that makes OCVIC worry about whether enrollees’ care is well-coordinated across both medical and long-term care settings. We also want to know more about members’ experiences with medical care to see what improvements are needed.
Therefore, in the near future, we will be creating a survey asking about members’ medical experience. If the second survey is anything like the first one, it will have a big impact in improving health care for MyCare Ohio enrollees.
Again, OCVIC wants to thank our network of MyCare Ohio consumers for participating in a very successful survey. If you have questions or comments, please don’t hesitate to contact John Arnold at jarnold@uhcanohio.org or (614) 456-0060 ext. 237. If you are interested in participating in our monthly consumer calls in which we talk about enrollees’ experiences and needed improvements, let John know.
Submitted by achenault on Tue, 12/15/2015 – 3:34pm
With Ohio’s proposed Healthy Ohio waiver threatening the future effectiveness of expanded Medicaid, Ohio advocates are keeping a close watch on the outcome of Medicaid waivers in other states. UHCAN Ohio joined a coalition of Ohio advocacy organizations to submit comments to Centers for Medicare & Medicaid Services (CMS) on Arizona’s proposed waiver, which would have similar effects to Healthy Ohio.
Arizona is the first state to request a waiver after already implementing expanded Medicaid. In both Ohio and Arizona, expanded Medicaid has successfully decreased the uninsured rate and made it possible for thousands of low-income adults to get health coverage. 630,000 Ohioans have obtained coverage due to expanded eligibility since January 2014, allowing them to obtain regular care.
Like Ohio, Arizona’s proposed waiver features premiums for all adults on Medicaid, regardless of income, potential loss of coverage for missed payments, complicated “health savings accounts,” and benefit limits. These requirements create barriers that will keep people from enrolling or cause people to lose coverage and will increase the cost of administering the program.
If Arizona’s waiver is approved by CMS, it will set a precedent that will make it more likely that Ohio’s waiver will also be approved. These waivers, if approved, will cause many low income people in Ohio and Arizona to lose health coverage. That’s why Ohio advocacy organizations are calling on CMS to reject Arizona’s proposed waiver.
In the letter, the advocates state that “The Affordable Care Act is one of the most significant legislative and policy initiatives of our lifetimes. It promises all Americans access to health care. We should protect that promise and not allow it to be eroded into a shadow of itself. For all of these reasons, we request that [the Department of Health and Human Services] reject the Arizona application as submitted.”
Click here to read the full letter, and click here to read additional comments on Arizona’s waiver by Families USA.
Submitted by achenault on Tue, 12/15/2015 – 3:46pm
Advocates and experts from across the country working to improve access to dental care for underserved populations came together recently at the Dental Access Project Convening in Portland, Oregon.
Ohio’s delegation included three distinguished dental professionals: Dr. Ed Sterling. who recently retired as the dental director of the Nisonger Center, where he spent the majority of his career treating children and adults who are developmentally challenged; Ann Naber, a dental hygienist, faculty member at Sinclair’s hygiene program, and former member of the Ohio State Dental Board; and Dr. Larry Hill, a public health dental consultant and retired dental director of the Cincinnati Health Department.
The Convening, conducted by the WK Kellogg Foundation and Community Catalyst, provides an opportunity for participants to share information on progress and strategies towards creating a more cost-effective and farther-reaching dental workforce that can improve the oral health of the nation. Topics ranged from enabling legislation efforts in various states, varied strategies being employed in the states of Washington and Oregon, financing, and communications.
Each participant returned to Ohio with renewed energy and new learnings. Ms. Naber came away with an even stronger belief that our focus should be “on providing care to the Ohio population with the highest disease rates and least access to dental care.”
She noted that “Fifty-four countries already utilize dental therapists. In Alaska, twenty-five dental therapists (DHATs) provided care to 45,000 people and created 76 full time jobs. Currently there are three funded and proposed dental therapist pilot programs in Oregon and the state of Washington. The Commission on Dental Accreditation (CODA) has adopted national standards for educating dental therapists.”
Ohio representatives learned that there are several states going through the legislative process or planning to introduce legislation to add dental therapists to the oral health team. Momentum in the lower 48 states is increasing in favor of this additional dental personnel. An important component of decreasing health disparities is empowering people to make better choices and getting communities to demand health care services.
Dr. Sterling found that the biggest change from previous convenings was the progress that is occurring in the dental therapy movement. He noted that with the recognition by CODA, there is real progress in the “lower 48.” Dr. Sterling said that while “the presentations were very positive, there are still obstacles to overcome, but they seem more manageable. The reports from the states all showed progress in the establishment and acceptance of the dental therapist as a recognized member of the oral health care team.” He concluded, “It seems that efforts to make public and oral health care providers aware of dental therapy now should be more positive. Utilizing social media to a greater extent to promote the positive side of dental therapy – e.g. what therapists are doing, their commitment to oral health, and the people they serve – should be the message, rather than what is lacking in the oral health care system. With data from Minnesota, New Mexico, and the Oregon programs, along with CODA recognition, a brighter day is dawning for oral health care.”
Dr. Hill was especially impressed with the creativity in some states to create dental therapy demonstration projects. New clinical trials are beginning in Oregon; there are 3 so far and possibly more to follow. Oregon has a statute that has been on the books for some time that allows for health care workforce demonstrations but that had not previously been applied to dentistry. That law is now the foundation for developing a dental therapy demonstration, in which, over 5 years, dental therapists will be trained and deployed to communities to expand access. Almost simultaneously, the Northwest Portland Area Indian Health Board will be gearing up pilot projects in Oregon and Washington, targeting Native Americans, under the rights of Indian sovereignty.
Also of interest was a presentation by Shelly Geshen, a policy consultant and former director of the Pew Children’s Dental campaign. Ms. Geshen spoke about the workings of state workforce boards. Every state receives federal funds to create a Workforce Board. Those funds are then distributed to local workforce agencies to help underemployed populations receive training and then assistance for employment. Populations include disconnected young folks ages 16-24, people living in low-income areas, dislocated workers, adults with low literacy, unemployed veterans, etc. It was recommended that in our efforts we become acquainted with state workforce board members and even work to get a sympathetic person on the board and then to get dental therapists into the state’s workforce plan. Currently Alaska is the only state to have done so.
Finally, Dr. Hill said that he was impressed by the suggestions of Roxanne Fulcher representing the American Association of Community Colleges. Ms. Fulcher “recommended that advocates for dental therapists work not only with dental hygiene programs within community colleges, but also with the workforce development departments. Community colleges are currently facing concerns over degree inflation which is requiring nurses to get baccalaureate degrees and therefore essentially removing those programs from community colleges. Those colleges will be looking for programs and students to replace the loss of their nursing students, which may create an opportunity for dental therapy training programs.”
