Third Health Care Forum Overview

Health Care Reform and the Consumer

This is the third and last forum in a series of health care reform hosted by UHCANN. You can find our overview here and here and here on this blog. The last healthcare forum, National Health Care Reform Begins: The Delivery of Care Story took place June, 20 at Cleveland State University. This forum addressed how reform will effect the general public as consumers.

Speakers included:
Cathy Levine- Executive Director of the Universal HealthCare Action network of Ohio (UHCAN Ohio).
Gary Hartman- Director of Care management program for Uninsured for the MetroHelath System.
Peter DeGolia- Director of the Center for Geriatric medicine of University Hospital Case Medical Center and the Executive Director of McGregor PACE (program of all inclusive care for the elderly).
Aaron Smith- Emergency Medicine Doctor and assistant Medical Director for External Affair organizational effectiveness for Kaiser Permanente.
John Begala- Executive Director of the Center for Community Solutions.
Scheduled but could not attend Greg Moody Director of the Governor’s Office of Health Transformation. Monica Juenger- Director of Stakeholder Relations replaced Greg Moody from the Governor’s Office of Health Transformation.

This forum began with a presentation from a consumer talking about her terrible experience with lack of coordination in the current medical system. Pat Morgan, as a result has been left blind in one eye due to misdiagnosis and lack of follow up. She suffered needlessly after receiving surgery for a cyst in her ear, she was released with no prescription for antibiotics; had to fight to get the prescription and received no follow up information from the doctor after she had the surgery. This resulted in a severe infection. Personally she feels having an accountable care facility as a standard for medical needs would have alleviated many of the miscommunications and misdiagnosis that she experienced. She believes that an accountable care facility would have resulted in fewer tests, fewer doctor visits, shorter illnesses and would have lowered her cost of health care.

Ms. Juenger replaced Director Moody, and featured a powerpoint presentation called Medicaid Hot Spots. This slide show is available online at the Ohio Governor’s Office of Health Transformation (search under reports on their website. Ms. Juenger’s presentation was the same information that has been provided in the news in regards to the Governor’s plans for healthcare. The high cost of Medicaid being absorbed by the few and changing long term care. 96% of Medicaid recipients are low cost, while 4% utilize over 50% of expenditures. Sighting that Ohio per capita has a rate 52% higher in nursing home care and 12% higher in hospital care, but 8% lower in home healthcare than the rest of the country.

Also covered by Ms. Juenger’s presentation was Ohio’s poor performance in national ranking in regards to overall health and delivery of health care. The following are few of the highlights. Ohio is ranked 42nd healthiest state in the nation, 44th in avoiding Medicare hospital admission for preventable conditions, 44th most affordable Medicaid for seniors (6th from last), 40th in avoiding Medicare hospital re-admissions. Another key highlight was that while Governor Kasich plan is designed to save money and improve a fragmented system in order to provide a coordinated, efficient and ultimately better care system. But with regard to seniors and persons with chronic disease the goal is to reduce hospitalization and nursing care facilities stays in order to save money while improving care. Ms. Juenger pointed out that savings will not take place immediately, but will take a few years to actually see cost going down.

Cathy Levine Executive Director of UCHAN of Ohio said it will be important for consumers and consumer advocates to insure that patient center care is effective during this transition. This means transparency in delivery of service, changes in how providers interact with patients and most importantly leadership provided by consumer and consumer advocates. Patients will need to have a better understanding of their insurance, specifically pertaining to cost and coverage. Providers should not receive funds for “volume but quality.” Many Medicaid providers are paid for specific services they provide, this often results in unnecessary test as well as duplication of tests.

Gwyn Hartman discussed the MetroHealth medical home model that the organization implemented in 2009, which is a comprehensive onsite coordination of care program and is available at six of their locations. This program mimics the key components of an accountable care facility as described in the law. She stated that the number of uninsured patients continues to grow. At this comprehensive care program, all health care members who relate to a patient come together on a daily basis to share information. Care coordinator nurses work with high risk patients beyond their stay in the physical facility. This includes communicating with patients on daily or weekly basis. Hartman gave examples such as the diabetic that a care coordinator also schedules the patient with an eye exam in order to reduce emergency room visits and encourage preventative care.

Peter DeGolia discussed the PACE program and their comprehensive care provided to dual eligible seniors. Dual eligible refers to people who qualify for both Medicaid and Medicare. Peter provided the average medical needs of a baby boomer in a year time span:

• 1 in 10 have a chronic illness
• 77% has more than one chronic illness
• On average they attend 37 different doctors appointments annually
• They see 14 different doctors
• They fill 50 different prescriptions annually

DeGolia explained that hospitals are not the safest places for senior, as they can find the transitions disorienting and are exposed to various illnesses. Home care saves an incredible amount of money for the State. He did point out the problem with those physicians and nurses who currently provide care coordination are often not properly reimbursed under the current system. Sharing a personal example of a house call, (yes, Dr. DeGalio still performs house calls!) he went to a gentleman’s house and he treated him for pneumonia. DeGalio arranged health care aids to properly treat him and followed up with the patient in his home. He stated it was the right thing to do because he knew the patient would become disorientated in the hospital and risk the quality of his overall health. For this house call related to pneumonia he was only reimbursed $250. Had he had the patient admitted he would of had a plethora of tests to confirm he had pneumonia, and it would have cost the state thousands. DeGalio saved Medicaid and or Medicare substantial amount of money, but in many cases the best interest of the patient is not taken into account when these health care decisions are made.

Aaron Smith from Kaiser Permanente said that patients at Kaiser also receive service that replicate an accountable care facility. The most distinct difference is that Kaiser is a for-profit corporation. Smith was asked by an audience member if Kaiser being a profit based agency had anything to do with their model of care he replied, “Yes,” and went on to point out that from a fiscal stand point healthier patients save money. Kaiser Permanente currently covers 600 Medicaid patients.

John Begala focused his presentation on how health insurance differs from other products we purchase. The buyer and the provider often do not know how much the service that they are receiving actually costs. The bulk of medical costs are paid by somebody else; consumers rely on someone else to make choices for them with regard to the amount of care as well as the costs of that care. Begalia stated that the affordable care act is “Marvelous” in regards to expanding Medicaid (32 million will receive coverage with ACT; specifically 16 million will receive coverage under Medicaid.) However he is concerned that policy makers in DC do not fully understand what an accountable care facility is and is doubtful about the federal government’s ability to guide the implementation of something they seem to know little about.

I will evaluate the forum in a follow up posting.
Holly Lyon
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