Archive for 2009
CQ Roll Call Group Forum: Expanding Health Care Coverage to all Americans
Author : Janet Grant
Oct 13th, 2009 | by
CareSource is the exclusive host of the CQ/Roll Call group event on Capitol Hill titled “CQ Roll Call Group Forum: Expanding Health Care Coverage to all Americans.”
Keynote Speaker (confirmed): Senator Jay Rockefeller
Panel Moderator: Morton Kondracke, Executive Editor for Roll Call/CQ
This forum will examine how poverty impacts the way people access health care –and how providing coverage is only the first step to promoting healthy outcomes. The Roll Call Group forum will include a keynote speaker (Sen. Jay Rockefeller), a panel discussion with industry leaders, public interest groups, and leading experts on health care reform.
After the keynote address, we will be conducting an experiential learning session where attendees will participate in a “poverty simulation” which will offer a glimpse of the daily realities faced by low-income families.
Title: CQ Roll Call Group Forum: Expanding Health Care Coverage to all Americans
Place: Hyatt Regency on Capitol Hill
Description: This forum will examine how poverty impacts the way people access health care –and how providing coverage is only the first step to promoting healthy outcomes.
Date: October 26, 2009
Time: 8:00a – 11:00a
Ask your health care reform questions here
Article Tags
Congressional Quarterly • CQ • CQ Roll Call • CQ Roll Call Group • health care coverage • health care reform • Hyatt Regency • Mort Kondracke • poverty • Roll Call • Senator Jay Rockefeller • Washington DC
Dissecting the Senate Finance Committee Proposal
Author : Toni Bigby
Oct 9th, 2009 | by
Senate Finance Committee Completes Mark-up; Expected to Vote Out of Committee on Oct. 13
The Senate Finance Committee completed debate on proposed health care legislation at 2:18 am last Friday. The Finance Committee was the last congressional panel to consider a health care reform bill and plans to vote this week after the bill’s final language has been made public and the Congressional Budget Office has provided final cost figures. Democrats hold a 13-10 committee majority which clears the way for the full Senate to begin debating the measure on October 13, 2009.
The panel considered many amendments over a two-week period and voted to reduce or waive fines for people who fail to buy coverage and give states money to help insure low-income Americans.
The legislation, estimated to cost $900 billion over 10 years, mandates that Americans get insurance and provides subsidies to those who need them, creates nonprofit cooperatives to offer an alternative to private insurance companies, and prohibits insurers from denying coverage to people with pre-existing medical conditions.
Instead of approving a public option amendment, the finance panel voted 12-11 for a compromise plan offered by Sen. Maria Cantwell, D-Wash., that would give federal funds to states to negotiate with private managed care plans to buy coverage for people who would not qualify for the Medicaid program. This compromise option would be eligible to people with income between 133-200% FPL. For individuals, that means income between $14,403 annually and $21,660. For families of four, the eligibility would be $29,326 to $44,100.
Individual mandate – Lowering the Penalty & Allowing Exemptions Dismays Insurers
An amendment proposed by Senators Charles Schumer (D-NY) and Olympia Snowe (R-ME) was also approved that reduce the penalty for those who fail to comply with an individual insurance mandate to $750 per adult, from $1,900 per family as originally proposed. It also waives the penalties in 2013 and phases them in through 2017. In addition, people who would have to pay more than eight percent of their income to buy insurance would be exempt from the penalties, down from 10 percent.
This amendment is of significant concern to commercial insurers as it could allow 2 million Americans to remain uninsured without contributing to the insurance pool.
Insurers are outraged by the risk involved as they would be required to guarantee coverage for all Americans should the health reform measure pass. A strong individual mandate made this option feasible.
Other notable items:
- By a vote of 13 to 9, the committee approved an amendment by Senator Jay Rockefeller (D-WV) that would keep low-income children in the Children’s Health Insurance Program (CHIP), instead of covering them through the Exchanges. This was a key interest for CareSource as we hope to continue to provide coverage to children who qualify through CHIP in Ohio and Michigan.
- Physician groups were upset to find out that the hospital industry is exempt from a crucial cost-cutting measure related to Medicare payments included in Senate Finance Chairman’s mark. Hospitals were held exempt because they were able to negotiate a $155 billion cost-cutting agreement with Baucus and the White House.
What’s Next?
The bill that emerges from Baucus’s panel must be merged with one that passed the Senate Health, Education, Labor and Pensions (HELP) Committee for debate and vote by the full Senate and eventually reconciled with a House measure.
Across the Capitol, Democratic leaders in the House met privately with moderate members, with liberals, and then with first-termers as they struggled to achieve a consensus on legislation to bring to the floor. Majority Leader Steny Hoyer announced it would probably be at least two more weeks before House legislation was ready.
Article Tags
Charles Schumer • CHIP • co-op plan • exchange • health care reform • health insurance • Jay Rockefeller • managed care • Maria Cantwell • Max Baucus • Medicaid • Medicare • non-profit • Olympia Snowe • public plan • senator • Steny Hoyer
Paying for the Sins of Others
Author : Toni Bigby
Oct 2nd, 2009 | by
“Funny or Die”, the comedic website developed by Will Ferrell, Adam McKay and Chris Hench posted a hilarious video about the health insurance industry called “Protect Insurance Companies PSA”. Obviously satiric, the clip showcases many Hollywood personalities supporting the need for health care reform to protect Americans from the interests of greedy health insurance executives. The clip ends with a call to action to support the public option, and email your Congressman.
The only unfortunate thing about this video is that it lumps all insurance companies together. But there are some insurance companies – ours for instance – that actually support reform efforts that offer the uninsured an array of affordable health care options from which to choose. Look, the truth is we are embarking on a new era in health care. The entire health care industry – providers, hospitals and insurance companies alike – will be completely revolutionized once reform is introduced. And the legacy insurance companies who have profited unscrupulously will find it hard to adjust because they’ve operated the same way for years.
The insurance companies of the future – those that are non-profit, customer-focused first, and genuinely engaged in finding ways to decrease spending while increasing quality – are the companies ready to thrive in this new era. Do we stand to benefit? Of-course we certainly hope so. But I’d rather have a system that rewards transparency, honesty, inclusion, wellness and empathy than one that rewards profitability and size.
Public option, co-op, exchange, expanded Medicaid and/or individual mandates …whatever shape reform ends up taking, there are a handful of progressive companies ready to embrace this new world. Will Ferrell and team are funny indeed! I just hope they know there are some insurance companies out there that support his team’s ideals and don’t make us all pay for the sins of others!
Article Tags
Adam McKay • affordable health care • Chris Hench • co-op plan • exchange • health care reform • health insurance • Medicaid • Medicare • non-profit • PSA • Public Option • public plan • Will Ferrell
The Really Important Thing is Health Care for All
Author : Janet Grant
Oct 1st, 2009 | by
Last week, I sat down with the anchors at WDTN-TV, Dayton, OH. The topic of our discussion was around health care reform and how it will affect the underserved population that currently access public programs, like Medicaid.
In the TV interview, I also discussed the broad questions people have regarding health care reform. People want to know, “What does health care reform mean for me?” Will I be able to keep the coverage I have?
For health care reform to be effective, it must cover all individuals and provide those faced with poverty the supports they need to access care appropriately. Giving someone a health insurance card is only one part of the equation – albeit a considerable part. However, getting them to their regular provider on a regular basis is the essential factor for ensuring the outcomes health care reform promises.
There are still many people that do not qualify for Medicaid, and would benefit tremendously from having access to ongoing health coverage. It’s great that we are covering our children through Medicaid (one out of every five), but that coverage needs to extend to the parents and childless individuals as well.
What do you think are the biggest opportunities for health care reform? Who needs to benefit most? How do you think Americans in poverty could benefit most from health care reform?
Article Tags
health care for all • health care plan • health care reform • health insurance card • Medicaid • public-sector • underserved • underserved population • WDTN-TV
Sen. Wyden Says He Won’t Support Current Health Care Bill
Author : Janet Grant
Sep 29th, 2009 | by
CareSource was co-sponsor of the CQ/Roll Call health care reform event “Health Care – Who Pays and How”. Senator Ron Wyden (D-Ore.) was the keynote speaker, and discussed what he does and doesn’t support in the health care reform bills. Over 100 people attended the event at Charlie Palmer Steak House on Capitol Hill.
To see a clip from the event, click here.
Article Tags
Capitol Hill • Charlie Palmer • health care • health care bill • health care reform • Roll Call • Ron Wyden • town hall meeting
What Starts on the Front Lines…Stays on the Front Lines
Author : Kim Gibson
Aug 24th, 2009 | by
How many times has this happened to you: You call the customer service line for a product you purchased or a service you’ve just employed, and it becomes a fun game of basketball… you’re bounced around from service rep to service rep without resolution, only to finally declare “Can I just talk to your supervisor, please?”. And it’s then that you finally get the results you were looking for. Why can’t the front line customer service reps be more empowered to make decisions?
When it comes to a person’s health care, this doesn’t make sense on any level, especially when the end result leaves people to suffer. As a director for a large customer service center, this is a little hard to ignore. For starters, a mishandling of a call regarding a person’s health condition could easily lead to more and costlier problems. But any time a representative can’t answer a question, or doesn’t know where to get an answer, it makes the entire system that much less efficient, and more unpleasant.
This is why CareSource (the company that employs me) supports empowering our Front Line staff. We believe questions that come in to our call center should be resolved there, and shouldn’t have to trickle up to the corporate level executives in order to get the attention they deserve. By having this focus, our members and providers can get the answers they need on the very first call.
How We Empower our Front Line
At CareSource, each call center representative goes through an entire month of training to ensure they are fully prepared to answer the variety of questions that come their way. We’ve shifted our focus to think less about blanket responses and more about helping the individual we serve get what they need when they need it. Staff also has tools to help them find their answers quickly along with an assist line to get answers for questions they may not know. As an example of ensuring service representatives have the knowledge they need CareSource had customer service representatives swap jobs with claims analyst for an entire month, so their knowledge base is vast and they stand ready with answers to solve issues without the need to always refer to another department. This entire process is designed to ensure the caller’s needs are put first.
The Outcome
Motivated staff. They’re a lot more than just phone operators. They are the face of CareSource. And, they take that responsibility and the company’s mission of making a difference in the lives of underserved people to heart. You can see it each day as you listen to our members’ stories, and realize how the answers we gave and the compassion we displayed may have just saved a life.
The CareSource Front Line customer service staff is the perception that our members are left with each time they contact our office. If we treat our members with dignity and respect, that bodes well for how they perceive our health plan. It sets us apart as an insurance company that focuses on their members – not profits. A Front Line that gets the job done for members, providers and the organization. A novel concept. Probably another important concept to consider as we look at models to reform the health care system, because it means better access to care with less stress and lower costs all around.
Article Tags
Claims • Claims Questions • Customer Service • Decision Authority • health care bill • health care plan • health care reform • Prior Authorization • Provider Payments
The Heart of Health Care Reform
Author : Janet Grant
Aug 24th, 2009 | by
Title: The Heart of Health Care Reform
Location: Live taping at COSI/WOSU Studios (invite only); Airing on ONN – check cable provider for specific station
Description: CareSource is sponsoring a panel discussion with Ohio Congresspeople and State Administration delegates about health care reform. The panel discussion is being facilitated by long-time TV personality Eve Mueller, and will include Sen. Sherrod Brown, Rep. Mary Jo Kilroy, Rep. Zack Space, Rep. Betty Sutton, Director of Ohio Department of Insurance Mary Jo Hudson and Director of Ohio Department of Jobs & Family Services Doug Lumpkin. Questions for our panelists will be taken from man-on-the-street interviews from around Ohio.
The primary focus of the panel discussion will be around what our elected officials have learned from their constituents during the August recess. Our Congresspeople have been hard at work meeting with people around the state, and we believe a discussion about what they have learned from citizens, how this will affect their decisions when they go back to Washington D.C., and their overall outlook and opinions around health care reform will make an informative and insightful conversation. Ms. Hudson and Mr. Lumpkin are key panelists as they can provide a look into our own state government’s assessment of health care reform.
Air Dates:
- Sunday, 9/6/09 at 9am and 8pm
- Monday, 9/7/09 at 8pm
Article Tags
Betty Sutton • congress • Doug Lumpkin • Douglas Lumpkin • government health care • health care reform • Mary Jo Hudson • Mary Jo Kilroy • Ohio News Network • ONN • Senetor • Sherrod Brown • Zack Space
Health Care: Who Pays & How
Author : Janet Grant
Aug 19th, 2009 | by
Title: Health Care: Who Pays and How
Location: Washington DC, Charlie Palmer Steak House on Capitol Hill
Description: The Health care reform debates have made this recess one of the most eventful in recent history. As members bring the debate from the town halls to the halls of Congress, CQ-Roll Call Group presents a special live event, bringing together a panel of nationally recognized thought leaders to answer the all-important question: Who’s going to pay for health care reform?
The Policy Briefing Live breakfast event series brings together some of the nation’s most influential policy professionals for a lively panel discussion that builds on Roll Call’s monthly policy briefings.
MODERATOR: Morton Kondracke, Executive Editor, Roll Call, Inc.
KEYNOTE SPEAKER: Sen. Ron Wyden (D-Ore.) (confirmed)
Panelists:
Chris Condeluci, Senate Finance Committee, Republican Staff (confirmed)
Paul Fronstein, Employee Benefit Research Institute (confirmed)
Chip Kahn, Federation of American Hospitals (invited)
Bridget Mallon, Senate Finance Committee, Democratic Staff (invited)
Start Time: 8:30 a.m.
Date: 2009-09-23
Article Tags
Capitol Hill • Charlie Palmer • CQ • CQ Roll Call • health care costs • health care reform • Roll Call • Ron Wyden • town hall meeting
Put Your Money Where Your Mouth Is
Author : Cathy Ponitz
Aug 19th, 2009 | by
“Giving back to the community” is a pretty standard element of corporate strategy. And if it’s your mission to sell a product or service, it’s just practical to make that giving highly visible to as many people as possible.
However, when your business is to help people with poverty issues that deeply affect their lives and well-being, and your ability to serve them is challenged by the circumstances of their lives and communities, marketing is not the first consideration. You are compelled to go beyond business strategy to actually change those conditions directly. To put your money where your mouth is.
That’s the essential logic behind the CareSource Foundation.
Changing the Health Care Landscape
Our goal is to change the health care landscape for those who have the greatest challenges and the fewest resources. We know that diabetes, childhood obesity and asthma are rampant and costly…so we support programs that educate children and families on managing those conditions. We know that domestic violence and destructive behavior by young people are health issues as well as criminal issues, so we support innovative solutions for at-risk youth and help for domestic violence victims.
Mobile health and prescription access. Emergency shelters. Screenings, prenatal health, senior health, behavioral health. Investment in the health of every county in Ohio and the counties we serve in Michigan. Wherever we find an effective program that helps vulnerable populations with important health related issues, we look for ways to partner with them to find solutions.
Perhaps the greatest challenge in health care is its absence. Sadly, even with Medicaid and Medicare, about 11% of our state’s population has no health coverage at all. Although CareSource provides coverage for 765,000 Medicaid enrollees and the CareSource Foundation has invested more than $1.5 million in programs that stem the tide on significant health issues, more still needs to be done.
Taking Foundations to Another Level and Beyond
As we enter our third year as a foundation, we’ve decided that we can and should do more to support families as the nation recovers from this economic downturn. This year, we’ve developed a brand new concept called “Signature Grants” which are fundamentally inline with the programs we currently support but we’ve taken them to the next level. These large-scale grants will have numerous regional, state and/or national partners all focused on creating sustainable, high-impact change in one of two key areas: childhood obesity and/or the uninsured.
Unlike responsive grants, we actually solicit proposals that are geared toward making improvements in these predefined categories, thus offering yet another way for CareSource to impact change in the communities we serve. We believe this “outside of the box” thinking will encourage communities to work in tandem to focus on key issues that continually perpetuate the escalating costs of health care.
What We Suggest
What if all health care plans serving the underserved focused their “giving back” on the health of their own communities? Providing coverage, care and education, supporting innovations that make a difference in individual lives? What if they looked at issues that continually consume the increasingly scarce health care dollar and focus profits on impacting change?
It wouldn’t solve the structural dysfunctions in the health care system today…that’s the job of health care reform. But caring, compassionate help that empowers consumers to stay healthier and use resources well is not only the right thing to do. Long term, it will reduce costs and improve the quality of American lives. And that’s a benefit for everyone.
Article Tags
domestic violence • effects of poverty • health care landscape • health care plan • health care reform • Medicaid • philanthropy • poverty • poverty issues • senior health
People On Public Health Plans Don’t Care About Prevention
Author : Dave Mezzanotte
Author : Pam Tropiano
Aug 18th, 2009 | by
…At least that’s what some providers think. And I guess their perception is warranted given the historical challenges providers have with patients on public health programs. But the truth is that the underserved aren’t purposely making it harder for a provider to deliver preventive care. It’s just that members of public health plans often aren’t empowered to be engaged in their health care experience. The underserved simply experience the same kinds of frustrations from the health care community that they experience from many other aspects of their lives.
At CareSource, where we deal with this dynamic set of members on public health programs, we are recognizing the impact we can make when we create an environment where our members are empowered to be engaged in the health care system.
Empowerment leads to healthy lifestyles
We have learned that if we educate, create the right kinds of tools, and establish an environment where engagement and two-way decision making is encouraged, we can move our members to participate in healthy living – and that leads to lower healthcare costs.
The first step is through education
CareSource’s in-house nurses, case managers and social workers work with members to help them be empathetic to the patient-provider relationship. We help them understand the impact they have on a provider’s office when they don’t show up to a scheduled appointment. We help them see the strain they put on the system when they choose to use expensive health care means – like emergency rooms for flu symptoms. We educate them about how living a healthier lifestyle will impact their well being, and the well being of their families.
Developing tools to facilitate empowerment
Next, we are developing a number of tools to help our members be empowered. For example, we are exploring the creation of checklists and sets of questions for members to bring into their primary care physicians’ offices when they visit for an annual exam. We are in the process of developing a “pact” agreement between the patient and provider so the patient feels they have “skin in the game” relative to the provider-patient relationship ( See Dr. Craig’s blog entry about the Health Care Home pilot program ). We plan to craft materials and tools for patients with chronic care needs that make it easier for those patients to maintain an active role in their care. These tools – once rolled out – will empower our members to engage in the system in a responsible manner, and take charge of their own health.
Recognition pays off more than incentives
Lastly, CareSource is organizing a program to recognize our members for appropriate use of the system. We have tested the waters of incentive programs – discounts on services or discounts on health-related products – but have found that these programs have done little to move the needle. However, what we have learned is that our members appreciate public recognition for their efforts – a certificate of achievement for losing weight, a letter to an employer promoting a patient’s ability to quit smoking, a recipe book for a patient that has taken control of her diabetes, and elected to change their nutritional intake. We have found that actions like these do more to promote healthy lifestyle because it shows compassion, respect and dignity to our members. So we are in the process institutionalizing a recognition program the delivers on our promise to make a difference in the lives of the underserved.
There’s no doubt that a shift to healthy living will help lower the cost of health care. But the ability to make this shift lies as much in the hands of the health care user as it does with the providers. And we see our role is in helping to encourage empowerment in our members.
