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The Insurance Plan Makeover
Start celebrating, health insurance customers: we’ve just taken a major step towards consumer-friendly insurance. Last week, the Department of Health & Human Services announced new rules that require insurance providers to create user-friendly plan summaries so that consumers can easily compare plans.
Under the new rules, insurers will have to boil down the volumes of misleading insurance jargon that currently make up policy guides into clear, concise, 8-page summaries. These summaries will be in plain English, with a glossary to define any potentially confusing terms. Best of all, 12-point type is required – no fine print!
The summary breaks down the insurance plan, describing what will and won’t be covered. It also explains what portion of the bill the insurer will pay and what percentage the individual is responsible for. Each summary will also have to include two examples of coverage for common conditions (pregnancy and type II diabetes) so that the reader can understand the financial breakdown. One thing that isn’t required of a summary is a clear premium price.
Says Marilyn Tavenner, acting administrator of the Centers for Medicare and Medicaid Services, "For too many Americans today, choosing a health plan means reading through a human resources book usually the size of a small phone book and important information about eligibility and benefits is often buried in the fine print. With these new rules we're making it easier for consumers to find the plan that is right for them."
Consumer advocates, who were worried that the administration was going to weaken the requirements for the summaries, applauded the release of the new rules. This is one of the most popular components of the health reform law, with 84% support according to the Kaiser Family Foundation last November (PDF). Of course, insurance companies are complaining about the high costs of the new requirements – but isn’t it about time they were up front with us about our insurance?
The new summaries will roll out this September. Check out an example of a plan summary here (PDF).
Posted in Health Care | Related Topics: Health Insurance Health Care Reform
Seeking a Cure for Funding Cuts
As a biology student, I’ve been keeping an eye on the news surrounding the National Institutes of Health, which funds medical research. Because the Congressional Joint Select Committee on Deficit Reduction was unable to reach a budget proposal, Congress will be required to make $1.2 trillion in cuts across government programs, including the NIH. However, scientists aren’t the only ones who should be worried about these cuts.
NIH is the largest single funder of medical research in the world. For over 60 years, medical research made possible by NIH grants has contributed greatly to advancements in health. The Institute has been a key player in making this country a leader in medical science.
Here are some examples. Since World War II, the death rate due to heart disease is 60% lower, and the death rate due to stroke is 70% lower. In the last 15 years, cancer death rates have dropped 11.2% for women and 19.2% for men. Research funded by NIH has been significant in all of these developments. NIH has been crucial in our understanding of HIV, in genetics research, and in work with chronic diseases such as diabetes and heart disease. We’ve depended on medical research to understand yesterday’s disease, to create today’s treatment, and to find tomorrow’s cure.
If that’s not enough, NIH grant dollars affect the economy. A November 2011 Tripp Umbach study (PDF) showed that nationwide, NIH is responsible for an economic impact of $45 billion and 300,000 jobs. Minnesota is 15th on the lists of states that benefit the most, with an economic impact of $944.6 million and 6,298 jobs attributable to NIH funding.
The University of Minnesota and the Mayo Clinic are both significant draws for grants. According to Aaron L. Friedman, M.D., vice president for health sciences and dean of the U of M Medical School, “Studies show that for every dollar in funding a University takes in, we generate two dollars in economic development by purchasing supplies, hiring new staff and – in some cases – constructing new facilities or laboratories.”
Investing in medical research means investing in new drugs, new treatments, new medical devices, and new cures. It means jobs and economic growth. If funding to NIH is cut, we’ll save some money in the short term. But how can we make that choice when in the long term, we’ll lose out on important discoveries? We simply can’t afford it.
Posted in Health Care | Related Topics: Federal Government Public Health
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Elgin shows way for investing in rural development
Most small towns that are not the central city for rural counties face several problems keeping the lights on in storefronts, keeping population within the community, and in meeting human needs. The southeastern Minnesota city of Elgin, population 1,089, has overcome some such problems.
Drs. Julee Kinglsey, a dentist, and Colleen Urbain, a chiropractor, have offices in the Elgin Professional Building that the city purchased and renovated with the help of a $396,000 loan from the USDA Rural Development program. A feature on the Elgin public-private collaboration is contained in the current USDA Rural Development Newsletter from state director Colleen Landkamer.
The article can be found here. What Elgin has achieved is keeping and attracting medical professionals who serve both the surrounding area in Wabasha County and across the Mississippi River in Wisconsin. In turn, this supports residents’ decisions to live in rural areas because healthcare services are available, and it supports other merchants and services providers who gain from the traffic to the two doctors’ offices.
What the two doctors' reveal in the newsletter is that they want to live and work in Elgin, for themselves and for their families. That is a tough sell for some small towns, but not for rural communities that have progressive local leadership seeking ways to attract and support service providers, entrepreneurs and others who become community-makers.
Posted in Economic Development | Related Topics: Minnesota Cities Rural Minnesota Health Care Professionals
Bringing Health Care to the Classroom
Twenty-three percent (23.1%) of Minnesota’s school-age children are obese. So far, we’ve covered the big two program areas to prevent childhood weight gain and obesity in schools – nutrition and physical activity. But how can we help the kids who are currently facing weight problems?
Here’s one answer: School-based health clinics (SBHCs). Right now, 2,000 clinics nationwide are housed in public schools, providing care to 1.7 million students who may or may not have health insurance. Eighteen of these clinics are in Minnesota schools.
School-based health clinics come with lots of advantages. They provide easy access to health care for students who might not otherwise be able to get to the doctor’s office. Kids miss less class time if they visit the in-school clinic than if they have to travel to a community clinic. SBHCs provide comprehensive health services, from physicals to immunizations to mental health services, and are often staffed by a wide variety of practitioners to serve all of a child’s needs. The clinics already provide many benefits to students – why not also make them the center of care for overweight and obese children?
Because they’re housed in the schools themselves, school-based clinics can more easily identify and target students who are overweight or obese. This is important because obese children aged 10 to 13 are 80% more likely to become obese adults. SBHCs already have a variety of health resources at their disposal, so they’re in a great position to address weight and obesity issues in childhood from a comprehensive standpoint. Clinics can address not only nutrition and physical activity but also medical issues like type II diabetes and emotional risk factors such as depression and stress.
Clinics in St. Paul are already tackling childhood obesity. Through a program called Fit Team for Kids, overweight and obese students are given medical, physical fitness, and nutritional evaluations and are then set them up with nutrition and fitness plans. Over the 2009-2010 school year, one third of students involved in the program stabilized their weight, and one third lost weight.
We need to devote more resources to the operation of these clinics. Money is often an issue because the clinics provide care to students with and without health insurance. As a part of the Affordable Care Act, $200 million dollars are going to support SBHC programming. Some of this funding is already going to clinics in Minnesota schools. But we can do more to expand school-based clinics, especially outside of the Twin Cities where most of the clinics are currently located.
School-based health clinics already provide care for thousands of Minnesota students. They can be the helping hand students need on the path to weight control.
Posted in Health Care | Related Topics: Nutrition Children's Health
Stay CLASS-y, Washington
The US House of Representatives voted to repeal the CLASS Act. Conservatives are touting the vote as a first step into the destruction of the Affordable Care Act, which they hope to fully “repeal and replace.”
As part of the ACA, CLASS would set up a voluntary, affordable insurance program, run by the federal government, to support those in need of long-term care. The White House originally scrapped the program in October after Health & Human Services Secretary Kathleen Sebelius announced that HHS would not be able to make the program fiscally solvent due to several problems with the bill’s setup.
First, the repeal by the House is a waste of time—the Obama administration has already discontinued implementation of the CLASS Act, and the repeal is unlikely to pass the Senate anyway. Second, and more importantly, repealing the bill outright is irresponsible. Despite its problems, the CLASS Act stands as one solution to a significant issue. We should be working within the CLASS Act or investigating alternatives in order to find a workable solution.
Even though the CLASS Act in its current state isn’t viable, simple repeal is not the answer. Long-term care remains an important issue because, though 70% of those 65 and up will need long-term care, only 2.8 percent have insurance that covers it*. Medicare covers barely any of these costs, so those who need long-term care will have to pay out-of-pocket or deplete their resources until they are eligible for Medicaid. Growing numbers of retirees and rising health care costs will be a significant issue for the federal government and Medicaid in coming years,
During the debate, Sen. Charles Boustany Jr. (R-La.) said, "I believe beyond CLASS repeal, we should make it easier for disabled Americans to save for their future needs. We can expand access to affordable private long-term-care coverage, we can better educate Americans on the need for retirement planning." Retirement planning is a nice thought, but the average lifetime spending on long-term care is $47,000 – and some Americans will pay upwards of $250,000*. Most people won’t be able to plan for those figures.
Helping Americans save for long-term care is not enough. We need solutions that control costs and support people who need care, and one of these solutions should be federal long-term insurance. The CLASS Act might not be this solution, but its repeal without an attempt at amendment or a feasible alternative is thoughtless. We should all recognize that working on a viable plan for long-term care is more important than scoring political points.
*These numbers come from an October HHS memo (PDF) advising Secretary Kathleen Sebelius against continuing CLASS implementation.
Posted in Health Care | Related Topics: Health Insurance Health Care Reform Federal Government
Race to the Bottom: Minnesota’s Health Care Gap
Here's one of those Minnesota ironies highlighting yet another gap in our community: While Minnesota ranks among the best in overall health quality, we have one of the nation's largest health quality gaps by race. This is a critical issue state policymakers and key stakeholders must address when formulating Minnesota’s Health Insurance Exchange, which the Affordable Care Act requires be passed by January 2013.
As those following the Affordable Care Act will attest, we’ve already begun to see positive impacts of the ACA in Minnesota. And the Health Insurance Exchange Advisory Task Force—a Governor-appointed, 17-member conglomerate of health care providers, payers, legislators, nonprofit directors, and other key stakeholders—represents a positive method of improving how the state’s health care system serves all Minnesotans, including checking corporate interests by limiting medical companies’ control over the process.
Minnesota can pride itself on this progress, on boasting America’s Health Rankings' "Healthiest State" honor 11 times since 1990, and on the Health Care Exchange Advisory Task Forces' recent confrontation of Minnesota's worst white elephants: The facts of having both the worst achievement gap in the county, and one of the highest rates of racial disparity within its health care system, particularly among its inner-city poor.
How does this manifest?
According to the Minnesota Department of Health's most recent "Immunizations and Health Disparities" report:
- On average, African American citizens live shorter lives and have poorer health outcomes when compared with white counterparts, which reflects the national trend.
- American Indian death rates are two and a half to three and a half times higher than death rates for Whites for most age groups.
- Death rates for African Americans are more than one and a half times higher than Whites in most age groups.
- African American infants display disproportionately higher low-birth-weights and infant mortality rates than other racial groups.
- Women of color were two to three times as likely to receive no prenatal care or inadequate prenatal care, compared with only 2.3% of white women who received inadequate or no care.
- The Hispanic teen birth rate is nearly three times the white teen birth rate.
The inequalities extend vastly beyond these illustrations, and we should congratulate the Health Insurance Exchange Task Force's movement to deal with them as a stride in the right direction. As Minnesota becomes an increasingly diverse land of hundreds of cultures, policy-makers and activists must fight to ensure that initiatives combating these disparities preserve their funding this session, that the upcoming insurance exchange focuses on increasing minorities’ access and awareness around health care options, and that racial parity and cultural responsive solutions are prioritized under the new health care system.
Posted in Health Care | Related Topics: Economic Inequality Health Care Reform Minority Issues
Childhood Obesity? No Sweat
Recently, we looked at some innovations in Minnesota’s school lunch programs that are fighting childhood obesity, which looms at 23.1%. Better nutrition alone won’t improve the situation, though – healthy kids also require physical activity. Looking closer, it’s obvious that physical education in Minnesota schools could use some work.
Let’s start simple: recess. The US Department of Health and Human Services recommends at least 20 minutes of recess for children in elementary school, but Minnesota does not require recess. Aside from stimulating creativity and letting students burn off some steam, recess is a great opportunity for kids to get moving. Requiring at least one short recess period for all elementary schools is a great first step towards healthy, active students, but we haven’t invested in this simple solution.
Next step: P.E. Physical education is mandated in Minnesota, but there are few requirements for quality in these programs. The state doesn’t have Phy. Ed. standards or any required curriculum, and it doesn’t require fitness testing. So schools teach physical education, but there’s no guarantee that students are benefiting. Without dedicated teachers and strong curricula, P.E. programs won’t encourage physical activity.
We need to acknowledge that physical activity is valuable and necessary to children’s health. Let’s make a firm, statewide commitment to providing opportunities for physical activity for all of our students.
Specifically, we should start by investing in Minnesota’s Safe Routes to Schools project, which is helping kids bike or walk to school by improving pedestrian infrastructure and providing education and promotional activities. That way, it’s safe and easy for kids to get a head start on daily physical activity.
Minnesota schools should also get more involved in the First Lady’s Let’s Move! project, which encourages simple measures to encourage physical activity. Beyond recess periods and high-quality physical education programs, the project recommends active classrooms to get kids on their feet. This means engaging students in activities that require them to move, even outside of PE. Before- and after-school programs are another great opportunity for physical activity. Let’s Move! also urges changes in infrastructure and school policy to allow increased access to physical activity for all students.
Our students deserve better. Healthy food and strong physical education curricula are the first steps towards curbing the childhood obesity epidemic, and schools are the best place to encourage lifelong healthy habits. We need to invest now in a healthier future for Minnesota’s children.
Posted in Health Care | Related Topics: K-12 education Classroom Methods Youth Programs Children's Health
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That’s the Wrong Knee
Imagine that you go to the hospital for a knee implant. You enter surgery and wake up to find that your procedure went smoothly. You feel great—only the surgeon operated on the wrong knee!
This is an example of a “never event”—an adverse yet preventable incident that occurs in the hospital. This includes falls, pressure ulcers, and errors with prescription drugs, among others. The frequency of these events indicates the safety and quality of hospital care.
In 2003, Minnesota became the first state to require adverse events to be reported to the Department of Health. The 8th Annual Report on Adverse Health Events in Minnesota (PDF), released this month, has some good news and some bad news about the state of patient safety in Minnesota’s hospitals.
The bad news: The total number of adverse health events went up from 305 to 316 between 2010 and 2011. This trend can be traced back largely to a 19% increase in the number of pressure ulcers and a 63% increase in the number of wrong procedures (from 16 to 26).
While the increase in pressure ulcers may be at least partially attributable to a growing emphasis on recognizing and treating these events, the increase in wrong procedures is worrying. Wrong procedures are mistakes in the type of treatment—for example, the wrong kind of knee implant. They’re usually not serious and are corrected immediately, but these mistakes should never be made in the first place.
The good news: Though the total number of never events went up in 2011, the number of events that lead to serious injury or death decreased from 107 to 89—the lowest since 2007. In particular, there were fewer serious falls. That’s a commendable reduction in harm. A decline in wrong site surgeries (in which, for example, a surgeon operates on the wrong limb) helped improve patient outcomes. An initiative to count sponges and other objects during labor and delivery resulted in no retained foreign objects left in patients.
Minnesota hospitals are doing a good job with patient safety. But to bring down the numbers of never events, they need support for stricter safety initiatives. Procedures and checklists that encourage double-checking and errorless care are imperative for the reduction of adverse events. According to the MDH report, “this means that organizational cultures need to be transformed so that safety, efficiency, and quality are continually at the forefront. Small technical changes or one-off actions will not be sufficient; complex, ongoing, sometimes uncomfortable adaptive change is needed.”
Posted in Health Care | Related Topics: Health Care Professionals Medical Care
What’s for Lunch?
Pizza, sloppy joes, and a tiny serving of overcooked green beans. Yum?
This is standard school lunch fare—not high quality, not particularly nutritious, but appealing enough for all the picky eaters. For a long time, school lunch programs have taken the easy way out by providing junk foods that kids will like. This is no longer acceptable, because 23.1% of Minnesota children are overweight or obese. It’s a problem that we can’t ignore any more—and thankfully, not everyone is. Let’s highlight a few of the programs that are tackling nutrition in Minnesota schools:
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Great Trays Partnership: Run by the Minnesota Department of Health, this program provides the information, tools, and resources that schools need to be able to meet the USDA’s recommendations for nutritious school lunches. The Partnership holds workshops for districts looking to improve their lunch programs, and so far, representatives from 75% of the eligible districts have attended. 109 school districts have come together to create the Minnesota School Food Buying Group, a cooperative that buys affordable, nutritious foods for school lunches.
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Farm2School: Farm to school programs partner schools with local farmers to provide students with healthy, locally grown fruits and veggies. What started in 10 districts in 2006 has grown to include 811 schools in 123 districts as of 2010. Everybody wins – kids get healthy food and a chance to learn about local food production, and farmers get market opportunities by selling crops to school districts. The program reported positive or very positive feedback from 66% of students involved. Minnesota is home to one of the top ten farm to school programs - the F2S program at Native Harvest on White Earth.
- Let’s Move Salad Bars to Schools: Part of Michelle Obama’s Let’s Move! project, Salad Bars to Schools is an initiative to put a free salad bar in any school that wants one. Salad bars have been shown not only to make fresh fruits and veggies available to students, but also to reduce waste. That’s because when students serve themselves, they are more likely to take just as much as they’ll eat.
It’s great that programs like these are serving Minnesota’s students, but there’s so much more to be done. Kids at plenty of schools are purchasing sugary sodas and French fries every day. It’s our job to make sure students are getting the nutrients they need as well as learning healthy habits for the future. Expanding programs like the ones above and eliminating high fat, high sugar options from school food programs should be Minnesota’s priority.
Posted in Health Care | Related Topics: Nutrition Children's Health Education Administration
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Responsible Care Considers Cost
Americans are terrified of care rationing. We worry that we’ll be refused the care we need, that waiting lists for procedures will stretch into months and years, and that government agencies will have the power to decide what care we receive.
Because of this fear, Americans tend to conflate any mention of cost-effectiveness as a consideration in medical decision-making with rationing.
The American College of Physicians just released an updated ethics manual that emphasizes parsimonious care—health care decisions that take savings into account. Some are up in arms over this term because they believe that parsimonious care will value frugality over health benefits.
The word parsimonious does have some negative connotations. But ACP doesn’t mean that providers should withhold care merely because it’s expensive. Parsimonious care means that practitioners should critically consider costs as part of responsible decision-making. “Parsimony shouldn’t override a treatment decision that could benefit an individual patient. The real goal is to avoid wasteful, ineffective care that is not only costly, but likely to be harmful in the long run,” says journalist Naomi Freundlich.
Parsimonious care can be beneficial for patients and providers alike, saving both money and time and avoiding complications from procedures that might not be necessary.
In keeping with this principle of responsible care, HealthPartners announced recently that it is implementing a new policy for those who are considering back surgery. Now, before seeing a surgeon, patients with back problems must consult a “designated spine specialist” who will evaluate their condition and provide them with more information about their treatment options.
Mounting evidence shows that aggressive surgery is not necessarily the right option for every patient. Alternative therapies have been shown to be superior in some cases, especially for patients with lower back pain.
This policy does not mean that a system of gatekeepers will bar patients from beneficial surgery—HealthPartners still allows patients to see a surgeon if they so choose. But a consultation with a spine specialist encourages informed decision-making. This means satisfied patients as well as savings. Grand Rapids, MI-based Priority Health ran a similar program that reduced surgeries 26%, with 87% of patients saying they had better knowledge of their treatment options and almost 75% reporting satisfaction with care.
Practicing parsimonious care doesn’t mean we’ll have to forgo the treatment we need. It means that practitioners will be more responsible with care decisions, patients will be more informed about treatment options, and people will receive effective and efficient care.
Posted in Health Care | Related Topics: Health Care Reform Medical Care
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