Health Reform is a Civil Rights Issue

Author : Toni Bigby

Consumer Advocacy at CareSource Over 11 years of experience working with Ohio’s Medicaid program promoting the importance and availability of health care coverage for Ohio’s underserved populations; Responsible for working with statewide consumer advocacy groups to advance key initiatives to provide value-added benefits to CareSource members; Charged with engaging members to bring their voice to the forefront to inform internal business operations

Jan 18th, 2010 | by Toni Bigby

Martin Luther King, if he had been given the time, must eventually have tackled the health care issue as an essential civil right.  As a nation, we’ve focused so much on the tactics and details—public options, mandates, “Cadillac plans” and so on—that we may be forgetting why increasing health care accessibility is important to us as a nation.

So this is just a reminder for all of us: without health care, personal growth and success are limited indeed.  Children with sensory or behavioral problems are not treated, or whose simple illnesses are not cared for, cannot learn.  Adults with a chronic disease (like diabetes or asthma) can earn a living—but only if they have the care and medications they need.  Families that lose a parent to a disease that could have been cured if caught earlier, suffer consequences that can hardly be measured – stability, opportunity, potential.

If we are serious about equal opportunity, education, stable families, social justice at any level, we must embrace health care accessibility as an essential civil right.

The Really Important Thing is Health Care for All

Author : Janet Grant

Executive Vice President of Business Development and Regulatory Affairs, CareSource More than 25 years of leadership experience across the health care spectrum including managed care, hospital administration and geriatric services. Responsible for the development of business growth strategies and new products, in addition to regulatory and government affairs and corporate compliance, serving as the Corporate Compliance Officer

Oct 1st, 2009 | by Janet Grant

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?

Put Your Money Where Your Mouth Is

Author : Cathy Ponitz

Director, Community Relations. Executive Director, CareSource Foundation.Over 3-years with CareSource. Responsible for creating and implementing community engagement and corporate culture strategies to serve the states in which CareSource serves.

Aug 19th, 2009 | by Cathy Ponitz

“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.

People On Public Health Plans Don’t Care About Prevention

Author : Dave Mezzanotte

Vice President Sales and Marketing, CareSource 9 months with CareSource. 13 years leading growth efforts for the nationally recognized Medicare Advantage business at Tufts Health Plan. MBA from Northeastern University, Boston 2004

Author : Pam Tropiano

Vice President of Health Services, CareSource 27 years experience in nursing and 18 in health care administration; An in-depth understanding of the challenges facing Medicaid and Medicare recipients both from the provider and payer side; Responsibilities include executive leadership over care management, medical management, quality improvement, and 24 hour nurse triage; as well as designing innovative programs to help better serve the needs of Medicaid/Medicare members while driving financial efficiency

Aug 18th, 2009 | by Dave Mezzanotte & Pam Tropiano

…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.