Archive for the 'Health Care' Category

Setting the Record Straight: Best Kept Secrets about Health Reform

Published on February 24, 2010 in Campaign for Better Care, Christine Monahan, Health Care, Quality and Reform. 0 Comments
Christine Monahan, Health Program Assistant

Christine Monahan, Health Program Assistant

Between President Obama issuing a new proposal on health insurance reform on Monday and the White House Health Care Summit Thursday, the beat marches on around this debate in Washington.

But people around the country are wondering how health reform will help them.  I think you’ll agree that the amount of misinformation and scare tactics spread by opponents over the past several months has confused just about everyone about what the health bills in Congress would really accomplish.

It’s time to set the record straight.

The National Partnership for Women & Families created a list of the top 10 best kept secrets about health reform, because people across the country need to know how meaningful reform will benefit them and their families.  That, after all, is the most important question to answer in this debate.

Here’s a look at some of the things opponents don’t want you to know about the legislation Congress has passed.

  • Better Benefits – women and families will be guaranteed coverage for the care they need, from the doctors they need.
  • Better Care – finally we will invest in innovative new ways to provide health care that will support better communication and coordination among health care providers – and between doctors and patients (and their families) – to prevent errors and duplication that disrupt your care.
  • Free Preventive Care – both private health plans and Medicare will cover the full costs of a range of preventive services and immunizations, so women and families can stay healthy without worrying about the expensive co-payments or deductibles that now often keep them from getting the care they need.
  • Coverage for Young Adults – recent high school and college graduates won’t be left without coverage as they struggle to find work and start their careers. The new legislation will let young adults stay on their parents’ insurance plans until they are 26 years old.

There’s more too.

Women and families are counting on lawmakers to get health care reform done and done right. We can’t let anyone stand in the way, or mislead the public about meaningful reform. Check out the full list: The Top Ten Best Kept Secrets about Health Insurance Reform and Why Congress Should Pass It Without Delay.

Are Workplace Wellness Programs Really as Innocuous as They Seem?

Published on January 15, 2010 in Health Care, Quality, Reform and Sabrina Corlette. 1 Comment
Sabrina Corlette

Sabrina Corlette, Director of Health Policy Programs

So, what’s wrong with the workplace wellness programs included in the Senate’s health care reform bill?  That’s a fair question, and one you may have asked yourself if you saw some of the recent coverage of the issue.

To be clear, many workplace wellness programs are innovative, effective, and help employees and their families get and stay healthy, which benefits employees and employers alike.  These workplace wellness programs should be implemented, studied, and then the best of them should be replicated (as the House health reform bill proposes.)

Unfortunately, in the name of “workplace wellness” the Senate bill creates a loophole that would allow employers and insurance companies to discriminate against people based on their health status.

Some may say, “What’s wrong with wellness? How can you be against that?”  As usual, the devil is in the details, and the language in the Senate bill is so nuanced that answering the question “what’s the problem” can stump even the top policy wonk or the most informed journalist.

Here’s my attempt at a plain English explanation.  To start, there are two important things to know in order to understand why the Senate bill would create a loophole that would allow insurance companies to continue to discriminate based on pre-existing conditions.

First, under current law employers are allowed to do some cost-shifting.   Did you think corporations would take money from their own profits to help motivate people to get healthy? Yeah, right.  No, what’s happening is that employers raise everyone’s insurance premium, and then give a “reduction” to those who meet certain health targets and call it a reward.   Those who can’t meet the health targets — for whatever reason — get charged more than their healthier co-workers.

Second, current law says a reward or penalty to an employee under these programs cannot exceed 20 percent of the cost of their health plan.  The Senate bill ups the ante and could eventually allow employers to charge an employee up to 50 percent of their health plan.   With the cost of insurance soaring – an average family policy could cost $20,000 by 2016.  This means people could be charged as much as $10,000 more for their insurance than their co-workers, simply because they have high cholesterol, high blood pressure, or weigh more than they should.   If this sounds like discrimination based on health status (something lawmakers have promised health reform would fix in our current system), that’s because it is!

Knowing that, consider the many reasons an employee may not be able to meet a health target and keep in mind that not all those reasons are within the employee’s control.   Scientists have understood for some time that some conditions like high cholesterol are often a function of genetics.  Also, certain ethnic and racial groups face genetic predispositions to conditions such as hypertension and diabetes.  Recent studies have also suggested that, because of the disruption to their body’s natural circadian rhythm, people who work the night shift are more at risk for high blood pressure, high cholesterol, and heart disease.

Women, in particular, stand to lose the most if this back-door discrimination is allowed.

Women want to make healthy lifestyle choices for themselves and their families, yet in practice they often neglect their own health because they put the needs of their children, spouses and aging relatives before their own.  And research shows that women are more likely than men to suffer from chronic conditions, meaning that women could pay disproportionately more for health insurance under these programs than their male colleagues. Such disparities are even more acute for low-income women and women of color.

This potential for discrimination is particularly troubling for the many women with lower incomes who work multiple jobs to support their families. These women often lack access to healthy food choices and have limited time or ability to access safe environments for physical activity. In effect, these programs will make health coverage less affordable to the very people who need it the most.

Employers can help everyone prioritize their health by providing a supportive environment for health and wellness in the workplace.  But, if Congress adopts the language in the Senate’s health reform bill on workplace wellness programs, we’ll see employers and insurance companies using this loophole as a way to discriminate.  That’s not good for anyone, and it undermines the promise of reform.

To learn more about workplace wellness programs under health reform, please see our recent Issue Brief:

Protect Women and Families From Discrimination: Prevent Employer “Wellness” Programs From Unfairly Increasing Health Insurance Premiums

Historic Milestone Reached! Bill Needs Improvement…

Published on December 24, 2009 in Debra Ness, Health Care, Reform and Reproductive Health. 1 Comment
Debra Ness

Debra Ness

Today, the Senate took a historic step to fix our nation’s broken health care system by passing comprehensive reform that will cover 31 million more people, prohibit insurance practices that undermine meaningful, affordable coverage, help contain costs, and put us on track to improve the quality and coordination of care.

But this flawed bill must be improved. The anti-choice provisions in the Senate and House bills are bad and worse, and represent a step the nation simply should not take.

It is a sad day when the price of reform is undermining access to a basic health service that America’s women need.

Those of us who spend our lives working to improve women’s health have been deeply shaken as lawmakers allowed reproductive health services to become a political bargaining chip, and as opponents of choice used reform to advance their extreme agenda.

Both the Senate and House bills contain anti-choice provisions that betray the promise of reform for women and would, in practical terms, cost millions of women coverage for basic reproductive health care. This should not stand.

We will work tirelessly to improve the final bill, including by urging conferees to provide more support to the low- and moderate-income families that will now have to purchase coverage.

We must strengthen the final bill by maintaining strong delivery and payment reforms, ensuring greater affordability and meaningful benefits, and guaranteeing effective market reforms that prohibit the discriminatory practices that have put affordable, quality health coverage out of reach for millions of women and families.

We see today’s vote, and the eventual enactment of this bill, as a beginning rather than an end.

The true test of reform’s success will depend on whether it delivers on the promise to expand access to high quality, affordable care; dramatically improves quality and care coordination; gives us better value for our health dollars; and puts us on track to get costs under control. We see implementation as key, and making our health care system work for the most vulnerable patients is essential.

And we look forward to the day when women’s health is no longer bargained away.

Our elected leaders’ work will not be done until those goals are achieved. And we will count on you to stand by our side.

It’s a resolution for the new year that we must all keep!

Health Care Reform Matters to Older Women

Published on December 7, 2009 in Campaign for Better Care, Debra Ness, Health Care and Reform. 0 Comments
Debra Ness

Debra Ness

Let’s be clear. As both caregivers and patients, women bear the brunt of shortcomings in our health care system – high costs, poor quality, and fragmented, uncoordinated care. 

That’s because women are the primary users of health care, and we continue to use more health services as we age.

It’s also because, in most cases, we are primary caregivers for our families.  We coordinate care for our spouses, parents and children, and often, at great cost to ourselves, we fill in the gaps when the system fails and care is poor quality or uncoordinated.

With the finish line in sight on health reform, everyone needs to take a close look at what the House and Senate bills will do, not only to expand coverage and contain costs but also to improve the way care is delivered.  We should look particularly closely at whether these bills will provide higher quality care for older women, who are more than half of Medicare beneficiaries and 70 percent of those aged 85 and older.

The good news is that the House and Senate bills both contain a number of measures that will improve the way we pay for and deliver health care.  These quality improvement measures are vital to preserving and protecting programs like Medicare for the long term, and containing costs and improving efficiencies overall.

For example, both bills move us toward a system that links payment to better quality and better coordinated care.  This means we can start paying for health care based on value and better health outcomes, rather than paying based on the number of services or tests performed. This is good news for anyone who has a loved one struggling with illness or health problems. People who navigate the health system know that their loved one needs the right test or treatment at the right time – not an abundance of repeat or erroneous services that don’t provide answers or make them better.

Earlier this year, we talked to caregivers around the country about their concerns with our health care system.  Poor care coordination and a lack of communication among doctors were foremost on their minds.  That’s because they’ve seen first-hand how these problems lead to dangers and waste from bad drug interactions, repeat tests, misdiagnoses, and more.

Both the Senate and House bills also introduce new models of delivering health care that are specifically designed to improve coordination and reduce events like preventable hospitalizations and readmissions, which are all too common now.

Because passing legislation only begins the work to fix our broken health care system, these bills allow us to test new models over time so we can find out what works best and continuously build on our success.

Recently a distinguished group of consumer advocates, economists and analysts issued a letter praising the Senate’s Patient Protection and Affordable Care Act for its payment and delivery reforms.  I was proud to coordinate and sign that letter.

Older women have a huge stake in turning our health care system around, and ensuring that it serves them and other vulnerable populations better.  If we can make the system work for them, we can make it work for everyone.

We’re closer than ever to the reforms we need, but victory is not assured.  We need to be certain the final legislation includes the key provisions that will improve care coordination and put patients first.  

Balancing the need for change with ensuring that we do change right is the key to sustainable reform.  As the Senate debates the specifics of reform, we must all fight for policies that will provide higher quality, better coordinated, and more affordable care for everyone.

A Historic Moment…But at Women’s Expense

Published on November 10, 2009 in Debra Ness, Health Care and Reproductive Health. 0 Comments
Debra Ness

Debra Ness

The health reform bill the House passed this weekend had some long-overdue advances — and an eleventh hour amendment so appalling it taints the entire bill.

The U.S. House of Representatives brought the nation one huge step closer to giving all Americans access to high quality, affordable care. We’ve been fighting for decades to get here, and it was an historic moment.

But the outrageous, reckless, and unnecessary restriction on abortion coverage — added at the eleventh hour by opponents of women’s right to choose — threatens to undermine the promise of reform and endanger women’s health and lives. It simply must not stand.

The Affordable Health Care for America Act (H.R. 3962) includes some real advances.   This bill’s greatest strengths include ending gender rating, limiting age rating and prohibiting discrimination on the basis of pre-existing conditions.  It is long past time for these disgraceful practices to end.  We are pleased that H.R. 3962 would extend these new federal rating rules to all individual and fully insured group markets.

The House bill also covers maternity care, well-woman and well-child visits, and cancer screening — and it includes no-cost language to let states expand access to Medicaid-covered family planning services without a cumbersome waiver process.�

We also applaud the provisions that will help lower-income families with the new obligation to buy health insurance, and support the expansion of the Medicaid national ‘floor’ to 150 percent of the Federal Poverty Level. But more must be done to ensure that affordable coverage is within reach for low- and moderate-income families.

But the inclusion of the Stupak-Pitts anti-choice amendment utterly taints this bill. Unless that amendment is removed, the promise of reform will ring hollow for women who will lose coverage for essential reproductive health care that we now have.

This is a historic opportunity that lawmakers must not squander by capitulating to the anti-choice extremists who would deny women coverage for basic reproductive health care.

Rx for Health Literacy

Published on October 30, 2009 in Health Care, Jennifer Sweeney and Quality. 0 Comments
Jennifer Sweeney

Jennifer Sweeney

October is health literacy month and, as Congress debates the widespread challenges in health care, we also need to address the problem of low health literacy — an obstacle people face in doctors’ offices across the country everyday and one that has a big impact on health outcomes.

According to the Institute of Medicine (IOM), 90 million people in the United States, nearly half the population, lack the ability to read, understand, and act on health care information. Low health literacy skills are often a result of limited literacy skills, generally. Consider this daunting dose of reality: One out of five American adults reads at the 5th grade level or below, and the average American reads at the 8th to 9th grade level, yet most healthcare materials are written above the 10th grade level. And while low health literacy affects people of all education and income levels, older people, non-whites, immigrants, and those with low incomes are more likely to have trouble reading and understanding health-related information.

Health literacy is defined as the degree to which someone is able to obtain, process, and understand health information in order to make the best health decisions. These are the skills that everyone needs in order to do things like fill out medical and insurance forms, follow medication instructions, and understand the doctor’s orders for before or after surgery.

Schools and hospitals around the country are raising awareness about health literacy month this October because the impact on individuals and families is considerable and, as usual, any stigma linked to a specific struggle will only exacerbate the problem. In this case, many patients are embarrassed to ask their health care providers to explain health information and, as a result, they are less likely to follow prescribed treatment, more likely to experience medication errors, and often don’t seek preventive care. Beyond the impact on individuals and families, low health literacy takes a toll on our health care system too — adding approximately $50 to $73 billion in health care costs, according to the IOM.

The good news is that positive change is within our reach. Health care providers can help by avoiding acronyms and technical medical terminology when possible. And since one of the biggest barriers to addressing the problem is actually identifying patients who are struggling to understand health information — providers should ask every patient questions to determine if they need help.

And (not that we needed another reason besides improving health to invest in tackling this problem) we’re now seeing that improving health literacy rates could also enhance people’s frame of mind. According to a recent study, researchers from the University of Alabama at Birmingham’s Center for Education and Research on Therapeutics (CERT) and the University of Oklahoma have actually found a positive correlation between health literacy and personal levels of happiness. The study revealed that happiness scores increased steadily with higher levels of health literacy even after controlling for demographic variables, poverty levels, and self-reported health.

As we’ve learned during the course of the current health care debate, the solutions we need in order to improve the health and well being of families across the country come in many shapes and sizes. Broad systemic changes, many of which we’ve seen proposed in Congress in the past year, are going to be necessary. But those changes must be underpinned by strategies — like improving health literacy — that can help ensure patients benefit from health reform. To learn more about what you can do to help tackle the problem of low health literacy, please visit the Department of Health and Human Services’ (HHS) Health Literacy Improvement page.

The Evidence is There: Better Coordinated Care Makes Sense and Saves Money. Duh.

Published on October 14, 2009 in Campaign for Better Care, Christine Bechtel and Health Care. 0 Comments
Christine Bechtel

Christine Bechtel

This just in.  What health care experts have suspected for some time has been demonstrated by a new study published in the American Journal of Managed Care: patients who can rely on a coordinated system where their providers talk to each other, their medical information is available electronically, and they have improved access to doctors and nurses – have better health outcomes.

Quick Fact: What is a Patient-Centered Medical Home?

A “medical home” — aka: “patient-centered medical home”— is a medical office or clinic where a team of health professionals work together to provide a new, expanded type of care to patients. It’s not an institution or nursing home, but a medical office or clinic that offers coordinated, comprehensive primary care that is personal and focused on making sure the patient’s health care needs are met.

The study compared four components – patient experience, quality of care, costs, and staff burnout – at a pilot patient-centered medical home (PCMH) in Seattle.  The outcome is compelling. 

Patients at the PCMH fared far better than patients at control sites in some significant ways.  After 12 months, patients at the PCMH had 29 percent fewer visits to the emergency room and 11 percent fewer hospitalizations.   These patients reported higher levels of satisfaction with their care and took a more active role in their own health care through regular communications with doctors and more participation in patient groups and self-management workshops.  These outcomes are good for patients, good for providers, and good for our nation’s pocket book. 

Another reason the medical home model is so promising?  Staff burnout (a long-time problem for primary care clinics that threatens the important role they play in preventing disease and keeping people healthy) was significantly less after one year at the PCMH.  Only 10%  of staff reported high burnout compared to 30% at the control sites.

And– because we love it when higher quality of care makes financial sense too – even though the PCMH had some significant initial start-up costs, those costs were recouped quickly (after one year).  The study estimates this is because of savings from fewer emergency visits and hospitalizations.   From the patient’s perspective, there was no detectable difference in cost between the PCMH and the control sites; meaning the PCMH was providing better care and patients were getting better outcomes and it didn’t cost them more.

But of course there’s bad news – there always is.  The problem is that all those savings generated by the PCMH didn’t actually accrue to the same people who made the wise investment in the first place.  For example, reduced hospitalizations are a worthy outcome, but those savings don’t benefit the PCMH directly; they really save health plans money.  That’s a function of the way we currently pay for health care, which promotes fragmentation over coordination and leaves patients feeling as though they’re a collection of body parts instead of the whole person they really are.

Evidence like this should play a central role in re-organizing health care payment and delivery systems in this country.  As Congress debates the future of health care, we must make sure that the way we pay for and deliver care helps every patient receives the high quality, coordinated care they deserve. 

For more information about the Patient-Centered Medical Home and how you can help advance this exciting new model of care in your area, click here.

The Costs of Family Caregiving in an Aging Society: What Is Your Experience?

Published on October 5, 2009 in Campaign for Better Care, Health Care and Lynn Feinberg. 2 Comments
Lynn Feinberg

Lynn Feinberg

Everyone I know has at least one personal story about the overwhelming stress and frustration in trying to arrange, coordinate or provide the best possible care for an aging parent, spouse, grandparent, other older relative or friend, not to mention the spiraling costs of health care.

More than three decades of research clearly show that family caregiving is a public health issue — that family members who provide care to older adults with chronic or disabling health conditions are themselves at risk — emotionally, physically and financially — particularly when the care is for a loved one with Alzheimer’s disease or another form of dementia.

Given our current economic recession, the financial aspects of family caregiving can be particularly distressing for the estimated 34 million Americans — most of whom are women — who provide care for an older (50+) family member or friend. The financial strain on this group, as they try to manage work, family, and caregiving responsibilities, was highlighted in a recent article in the New York Times. “Taking Care of Parents Also Means Taking Care of Finances” describes the growing numbers of Americans who are facing the “financial squeeze that can come from caring for elderly parents.”

The costs can be significant. Caregivers to persons age 50 and older spent an average of $5,531 per year out-of-pocket in 2007 for expenses ranging from household goods, food and meals, travel and transportation costs, to medical care co-pays and prescription medications.

According to a recent study by the National Alliance for Caregiving and Evercare, family caregivers have experienced the economic downturn in major ways. Consider these sobering statistics:

  • 50% of working caregivers (that is, those who have worked at some point while providing care in the past 12 months) said they were less comfortable taking time off from work to provide care;
  • One in three working caregivers said they had to work more hours or get another job;
  • One in six (15%) said that the economic downturn has caused them to lose their job or be laid off;
  • Six out of 10 caregivers who reported increasing their out-of-pocket spending for caregiving also reported having difficulty paying for their own basic care needs; and
  • 63% say they are saving less for their own retirement.

When it happens to you, when it becomes a personal issue in your own family, you are more likely to act.

For years at the National Partnership, we have talked about helping Americans meet the dual demands of work and family. A lot of people think about working parents when they hear those words, but millions of working people in this country are caring for frail, older relatives. The time has come to organize family caregivers as a strong and powerful force for meaningful and lasting change.

Stories about the real-life experiences of older adults and their family caregivers can help increase attention to the urgent need for better and more affordable, coordinated care.

Please take a moment to share your personal story about your caregiving experiences for an aging relative or friend.

Your story can make a difference!

President Obama has spoken. This is your moment!

Published on September 10, 2009 in Debra Ness and Health Care. 0 Comments
Debra Ness

Debra Ness

President Obama delivered a powerful and passionate speech on health insurance reform.

It was a resounding call to get it done right, and get it done right now.  

It is safe to say the silly season is officially over.

America’s families are counting on lawmakers to fix our broken health care system this year. And their need for reform is urgent and indisputable. 

The vast majority of Americans — including patients, providers, and caregivers — recognize that the status quo is unsustainable and unacceptable. 

Thousands of National Partnership supporters like you and millions of people nationwide have spoken out because they know we need meaningful reform that makes quality, affordable care a reality.

The cost of inaction to women and families across the country is too great.  

The President called for urgently-needed reforms to the insurance market so that people can count on their health care benefits when they need them the most, regardless of their age, gender, or a pre-existing condition. He also recognized the need to transform our current system into a pay-for-value rather than a pay-for-volume system in order to finally deliver comprehensive, coordinated and quality health care.

The public is counting on Congress to pass a health insurance reform package this year that will finally give them stability and security when it comes to their health and the health of their loved ones. 

And, despite a vocal minority intent on playing politics with health care, we are closer than ever before to reform that lowers costs, guarantees coverage, and provides more choice for all Americans.

Now is the time to answer the President’s call by putting politics aside and working towards a goal we all share — healthy futures for America’s families. 

There is more momentum now than ever to make it happen.

I encourage you to take action today —and demand that Congress get it done right … and get it done right NOW!

Virginia is for … Moms-to-be: New On-Line Tool Helps Expecting Parents Choose Hospitals, Doctors

Published on September 9, 2009 in Health Care and Lee Partridge. 0 Comments
Lee Partridge

Lee Partridge

You’re pregnant, your first language is Vietnamese, and you’d like to find an obstetrician who speaks your language. You had your first baby by emergency C-section, in another state, but you want to try to deliver the second vaginally, and you’d like to find a doctor who seems to use C-sections sparingly. Or you want very much to breastfeed your baby, and you’d like to deliver at a hospital with lactation consultants available.

If you live in the state of Virginia, you’re in luck, because the Virginia Health Information (VHI) organization has just released a Web-based, interactive consumer guide to obstetrical care that has just the data you need.

VHI is a private, non-profit organization that was started in 1993 and works with Virginia health care providers, the state government, and the research community to develop health-related databases that support quality health care. The obstetrics guide is the product of several years of work with a special task force and aims to give consumers a balanced picture of what they can expect, what questions they should ask, and information they would find useful in making choices of providers. It allows you to compare hospitals and compare physicians in multiple ways. It also contains a very useful short discussion of clinical issues and a glossary of terms.

Whether you live in Virginia or just want to look at it (wistfully) as a model for your own community, you can find it here. Once there, in the comparison sections, you can search by hospital, by region, and by physician name. The hospital and physician segments also include risk-adjusted performance evaluations on their c-section rates, episiotomy rates, and cost of care. And don’t miss the hospital services data under Prenatal Services tab 5. That’s where you can find the really cool tips – like which hospitals offer music therapy, birthing balls, or maternal massages to assist you during labor!

Virginia Health Information’s new consumer guide to obstetrical services is a great example of transparency in health care information. It’s exactly the type of tool we need to empower consumers in their health care decision-making and improve health care delivery and quality all across the nation.