Posts Tagged ‘health care plan’
Reconciliation as a last resort? Yes, it should be.
Author : OurHealthCareSource.com
Feb 24th, 2010 | by
So there are some Democrats threatening to use reconciliation to get a health care plan passed (CNN article). Well, first things first. Let’s get through the President’s summit and see how it goes. Who knows what surprises may be in store? They may actually be “welcomed” surprises for a change.
This entire debate has been one surprise after another. As a result of this summit, we may actually see a few members of the minority party decide that the President’s plan (albeit not perfect) is currently the best option we have given the times. What do the Dems have to lose? Reconciliation should be used as a last resort and quite frankly, that is exactly what they seem to be doing. All we ask is – just do something – and do it soon – and don’t make it a band-aid approach.
So much debate and finger pointing and arguing and going back to the table threatens to completely dilute any meaningful reform. Despite the fact that the majority of Americans have said that reform is what they want and what America needs. Meanwhile, another $25-billion in Medicaid relief has been included in the President’s budget proposal to states that are seeing current enrollment numbers rise due to our economic environment.
The President’s plan has some really good aspects that will change the course of the health care system today and we finally have the momentum to actually make the health of our nation better. Why stop now?
Why stop when it includes a meaningful expansion of Medicaid so that our most vulnerable citizens can get the monetary relief and care they need to stay healthy? Why impede the development of an insurance exchange to make it easier for Americans to purchase health care? Why prevent important insurance reforms from taking place? Why dilute a requirement that says all of us have to buy coverage to ensure the health care system will be there when we need it and not bankrupt the nation in the process? And why in the world would we want to encumber a real focus on managing high-cost chronically ill populations?
All of these things that make a lot of sense are included in the President’s plan, and can be passed with or without reconciliation.
It will be interesting to see what plays out with the President’s health care summit. Perhaps some consensus can be met that may not address everything, but will at least garner enough votes to put something meaningful in place that we can build upon over the next decade.
A couple question to our readers – Do you think imposing reconciliation is the right way to go? Do you think the President’s health care summit will prove productive?
Insurer Fee – Reasonable Idea… Unintended Consequences
Author : Chris Whistler
Dec 10th, 2009 | by
Whenever a new concept is proposed, those at the deliberation table automatically ask “what would happen if?” before they decide to act. With health care reform for example, the driving questions are more like: “Are the changes going to result in more Americans getting coverage? Are the proposed changes budget neutral?” Given the broad scope of the proposed health care legislation, it’s easy to see how details can get overlooked. And when time is ticking, unintended consequences have a higher chance at prevailing.
One concern that should be brought to light is the $6.7B annual fee proposed on insurers. While conceptually this might make sense given the number of Americans who will be required to obtain coverage and the new revenue that insurers stand to gain, a portion of this fee would not be limited exclusively to commercial health insurance companies. Health plans that contract with federal and state governments to serve Medicaid, Medicare, and beneficiaries of the Children’s Health Insurance Plan (also known as CHIP) would also get taxed too.
Well, the challenge is that a significant portion of this fee will fall on state budgets because of the way states are required to reimburse health plans that serve its most vulnerable residents. The new fee will unintentionally require states and the federal government to ultimately come up with additional public dollars to pay for this added fee.
Also, this fee would unfortunately raise the overall costs of these government programs and place additional strains on programs that are already in extreme financial distress. For example, Ohio’s Medicaid program would have to potentially come up with an estimated $65 million annually. Subsequently, the burden of this fee will be paid for by taxpayer-funded government programs and beneficiaries that use these health plans.
Easy solution to the problem? Just exempt health plans administering government entitlement programs from the application of this fee. Problem solved; Unintentional consequence diverted.
Article Tags
Children's Health Care • Children’s Health Insurance Plans • CHIP • health care plan • health care reform • health insurance • health insurance plan • insurer fee • Medicaid • medicaid ohio eligibility • medicaid program • Ohio medicaid • Ohio medicaid program • ohio medicaid providers • SCHIP • taxes
Can We Wait Until 2014?
Author : Chris Whistler
Oct 14th, 2009 | by
The US Senate Finance Committee just approved a health care plan that includes a provision that would significantly expand Medicaid. This is great on so many levels. However, it has one flaw. That being, the full expansion wouldn’t actually start until 2014. Is it just me, or does that seem to contradict the whole idea of protecting the most vulnerable first?
Yes, it’s true that we’ve been trying to fix the health care system since at least 1948. So from one point of view, spending another few years trying to get it right doesn’t seem out of line. But imagine if all you hear around you is that health care reform is going to make a difference in the lives of the 47 million uninsured Americans right now, but then you find out that you have to wait longer than everybody else. Then, to make matters worse, your income is among the lowest in America and is the primary reason you are uninsured in the first place.
The unfortunate truth about this health care plan is that once again, those who are most in need are expected to wait longer than the rest of us. This includes hard working people with low incomes who just don’t happen to have dependent children – the current ticket for most people to qualify for Medicaid. And parents who are doing all they can to make ends meet for their children who are blocked from Medicaid coverage because their very limited income is deemed too high for them to qualify. The list goes on.
Where’s the justice in waiting to expand Medicaid until 2014? Or, maybe more pragmatically, where is the preventive care and coordination that is going to enable the right care at the right time in the right setting – you know, rather than causing the first stop to be in an emergency room after waiting until the cancer spreads, the diabetes worsens, or the heart attack occurs.
Doesn’t it make sense to have health care coverage for those that need it most first?
Ask your health care reform questions here
Article Tags
2014 • cancer • care source • diabetes • health care plan • health care reform • health care system • heart disease • Medicaid • michigan medicaid • michigan medicaid program • Ohio medicaid • Ohio medicaid program • poverty • Preventive Care • Senate Finance Committee • underserved
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?
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
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.
