The young man sitting on the exam table before me was breathless, pale and distressed. We had never met, but he asked for me at the clinic desk. Staff at another hospital where he had received care for nearly 20 years gave him my name when they saw he was uninsured.
Despite having a significant congenital heart condition, he had been reasonably healthy. Married, with two children, he was an independent plumber. It provided a decent living but not enough to be able to afford insurance — even if he could have qualified for coverage. With his pre-existing condition, no insurer would accept him.
For years he did what people who are uninsured do — defer regular doctor visits and hope he was lucky enough nothing bad happened. But his luck ran out. Now he was unable to work and could barely walk.
After receiving a new heart valve, he returned to his business, pledging to pay what he could for his care.
Hospitals see lots of “charity cases,” but it’s become harder and harder to balance margin with mission to care for the increasing number of uninsured. The most recent Census (2012) found 48 million Americans were effectively shut out of our health care system because they lacked basic health insurance coverage.
As the public (and political) furor over the Affordable Care Act failings dominate the headlines, it’s important to keep perspective about what this complicated health reform law is trying to accomplish. There are some real problems, but there are many things Obamacare is ...
The two day-old Health Insurance Marketplace has experienced a few newborn hiccups. The press has reported some delays and other technical glitches from people eager to complete applications for quality, affordable health insurance. Anyone involved in the launch of a new online program or website (as MeHAF has been with the recent launch of enroll207.com) knows that a new site is bound to have issues that can’t always be anticipated and corrected until the site goes live.
Such technical glitches were anticipated by many of us who are working to get people signed up for coverage. No one wants to cope with delays, but there’s another side to this story. As of this morning, HealthCare.gov, the site that operates the Marketplace in Maine and other federally-facilitated states, reported 6 million unique visitors to the site! Even Apple or Microsoft might experience issues on their sites with that volume of traffic. In Maine, organizations providing enrollment assistance, including Consumers for Affordable Health Care are reporting a similar flood of calls about the Marketplace.
The good news behind the Marketplace glitches is that people across America – and Maine – desperately want health insurance. Even in day two, the interest and response from people looking for coverage is still jamming the new website. It’s hard to ask people anxious to enroll to be patient, but the bumps and glitches will get fixed and Mainers will have time to review their options and sign up during the initial open enrollment period (which lasts through March 31 ...
In our first video blog, Dr. Jay Want, a health care consultant based in Colorado, talks with Barbara Leonard, MeHAF's Vice President for Programs, on what motivates health care professionals and their organizations to not only undertake, but persevere in long-term system change. Dr. Want was the featured speaker at the August 13th quarterly meeting of MeHAF Payment Reform grantees. A transcript of their 5-minute conversation follows.
BL: Jay, thanks for joining us to talk with our payment reform grantees today. I think it was really helpful for them to get your perspective on the work that they're doing. One of the things that you mentioned was that there are kind of three buckets of human motivation. I think you said [they were] financial, and social and ethical, and that seemed to resonate with a number of the grantees in the room. Can you talk about that a little bit?
JW: OK, I'd be happy to. I was actually taught this by a physician that I worked with several years ago. He said, you know, there really are only three big buckets of things that motivate people, and so if you're looking at the reward systems that you have for us as a practice group or whatever, you ought to think about these things. He said, they're financial, and social, and ethical. Financial is kind of self-explanatory, social is what others think of me, ethical is what I think of me. They're different, and the differences actually bear a ...
Health access, health disparities and health literacy are buzz words within our rapidly changing health care landscape. Even though one in seven Maine people are estimated to have a hearing loss, data collection efforts regarding access, disparities and literacy for people who are Deaf and hard of hearing trail far behind efforts related to other populations.
National and local health surveys - including the Center for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey which is administered annually to thousands of hearing persons in the U.S. - have not been conducted in American Sign Language (ASL). In fact, few health researchers even know ASL. Consequently, little community-based data have been collected on health risk behaviors of Deaf adults and teenagers. Even though the CDC defines deaf people as a vulnerable population, we do not know which preventable diseases are common among Deaf people, or what are effective strategies for preventing disease and improving physical and mental health among people who are Deaf or hard of hearing.
The Deaf Health Survey, conducted by researchers at the University of Rochester School of Medicine (URSOM) is a notable exception in this data desert. Rochester, New York has a large Deaf population because of the presence of area schools for the Deaf. In 2006, the county in which Rochester is located conducted a BRFSS survey using the usual approach- hearing only. The exclusion of Deaf and hard of hearing people from the survey led to the creation of the National Center ...
When the new, Affordable Care Act (ACA)-created Health Insurance Marketplace (HIM) opens on October 1 - less than 100 days from today - Maine will be the only state in New England to have a federally-facilitated (as opposed to state-run) exchange. That fact may help explain why Centers for Medicare & Medicaid Services (CMS) regional administrator Ray Hurd and colleagues visited Portland this week to participate in a training on the HIM and provide an overview of the new and improved HealthCare.gov. I had an opportunity to attend the training on behalf of MeHAF* and wanted to pass along some key takeaways from the meeting.
-HealthCare.gov has been re-launched! This is the consumer website for all ACA-related questions. It’s been redesigned for desktop and mobile devices, which will come in handy when folks begin searching for HIM information from their smart phones. It looks like a pretty impressive site. For professionals interested in helping people use the HIM, check out this page.
-The federal call center is now open as well to answer general questions on the HIM and ACA – 1-800-318-2596 – in English and Spanish. Other language interpreters will be available through a service.
-Starting on October 1, callers will be able to enroll by calling the federal toll-free number or by enrolling online. The CMS presenters expect that the vast majority of enrollees will do so online.
-The HIM will be the single point of entry where uninsured individuals and people with insurance looking for new, more affordable options can find out about their ...
I was pleased and honored to be invited to speak on behalf of MeHAF recently at the ribbon-cutting for Maine Community Health Options' (MCHO) permanent offices in the re-purposed Bates Mill Complex in Lewiston. MCHO is Maine's newest health insurer - a nonprofit "CO-OP"- ("Consumer-Operated and Oriented Plan") - authorized under the Affordable Care Act (ACA). The mission of MCHO is to increase consumer choice, competition and affordability in health insurance options for individuals, families and small businesses.
Although authorized under the ACA, MCHO did not spring into being without significant mid-wifery. The application for federal assistance and loans to launch MCHO was incubated at the Maine Primary Care Association (MPCA), with technical and financial support from MeHAF. As a health philanthropy dedicated to improving access to care and promoting care that is patient-centered, MeHAF Trustees felt that a nonprofit, consumer-directed insurer would be well-positioned to help more Maine people get quality health care in a timely fashion.
In 2012, MCHO was awarded $62 million in federal loans to design quality health plans to be offered on the federally-facilitate health insurance marketplace in Maine. MCHO's plans are currently being reviewed by Maine's Insurance Superintendent, and it fully expects to compete on the marketplace to offer Maine people and small businesses several plan options that will begin January 1, 2014. MeHAF is now providing assistance to support MCHO's marketing efforts to get the word out about their products, since the federal loans cannot be used for that purpose.
MCHO intends to work differently as an ...
Effective leadership of an organization includes being sensitive to the needs of the people it serves, the staff, and the organization's mission. The day after the Boston Marathon bombings, the Opportunity Alliance CEO Mike Tarpinian sent this email to his staff, acknowledging the impact the bombing has had on people, but also encouraging staff to speak out to correct claims inaccurately suggesting that the perpetrators of violence are violent because they have mental illness. We join Mike in recognizing that we all have opportunities to reduce stigma by sharing accurate information about persons who experience mental illness. We applaud Mike for this sensitive and balanced message, and, with his permission, wanted to share it with the MeHAF community.
From: Mike Tarpinian
Date: April 16, 2013
Subject: Tragedy of Boston Marathon
As I head out of town to spend some time with my family during school vacation, I could not let the events of yesterday go by without connecting with each of you.
Our hearts and prayers go out to the people of Boston and to the families of the victims and injured as they begin to face the realities of lost limbs and months of rehabilitation, but none so tragic as the loss of life and especially the loss of a child.
As we try to process the senseless bombing of innocent victims at the finish line of the Boston Marathon, there are many people who are trying to find quick answers to a very complex situation. To begin to explain so soon ...
I sat stunned as I listened to news reports of yet another tragedy of mass violence causing at least three deaths and over 170 injuries. This time, the horrific event was even closer to home-in Boston. Another person had shattered the social contract we expect of all people-to nurture fellow humans and not to kill them. The act of violence killed and maimed; it also diminished our trust in others.
The pain of the trauma seemed personal to me as I imagined how awful it must be for not only the victims, but also their loved ones who would be receiving phone calls telling them about the suffering or death. You see, because of my husband's death in an accident, I know what it is like to receive a call saying the person you love more than life itself has died unexpectedly and suddenly. It reopened wounds of grief and loss I thought had long ago healed.
Because most of us have experienced loss or other traumas, events such as the Newtown, CT, or the Boston tragedies can re-traumatize us. The war veteran sees images of the bomb blast on television that are too similar to what she experienced in the war zones, prompting symptoms of Post Traumatic Stress Disorder (PTSD). A first responder at the scene or an emergency health care provider at the nearby hospital is impacted by having to rescue a wounded child, recognizing how fragile his own son's life is. He has intense nightmares for weeks.
When we collectively experience ...
Mia Poliquin Pross, Esq. is the Associate Director of Consumers for Affordable Health Care.
Since shortly after passage of the Affordable Care Act (ACA) in 2010, Consumers for Affordable Health Care (CAHC) has participated in a collaborative effort with 10 other organizations supported by MeHAF to get the word out on what the ACA will mean for Maine people. As part of this effort, CAHC conducts workshops across Maine where we often ask people: How many of you have heard that you must have health insurance in 2014? Almost all raise their hands. We then follow it up with this question: How many of you know that there will be subsidies that will help you pay for health insurance?
Crickets. No hands.
Therein lies the rub, and our job as advocates during this critical year for implementation of the ACA.
I venture to guess that many people reading this blog are health advocates or are otherwise "in the know" on health reform. This year, our job as advocates is to remember that we know more than the average person, and to share what we know - as often as we possibly can. Our health care system (using that term loosely) is a complex, tangled web of laws and regulations and all sorts of variables and moving targets. Putting all the wonk-talk aside, however, from our experiences at CAHC talking to real people on our HelpLine and in communities, here are 3 basic things about the ACA that all advocates and others in the know should tell people ...
Jaime Rosenthal, a senior at Washington University in St. Louis, recently got a lot of attention for her summer research project on the availability of health care cost information. She called 122 hospitals around the country to ask the cost of hip replacement surgery for her (fictitious) uninsured grandmother who had the means to pay for the surgery. The report, published in the online version of JAMA Internal Medicine, sparked a media frenzy, including press coverage at NBC News, blogging by the New York Times, Reuters, and numerous commentaries in health care industry journals.
The bottom line was that the prices she was able to obtain varied enormously, for no discernible reason, from about $11,000 to over $125,000. It was very difficult for Ms. Rosenthal to get any kind of price estimate from a significant percentage of the providers she called. Co-authors of the report from the University of Iowa recommended that patients should put pressure on providers to be more transparent about costs and that "patients seeking elective THA (total hip replacement) may find considerable price savings through comparison shopping."
To test the researchers' recommendations, I did some savvy shopping of my own. In a quick check on the Maine Health Data Organization's (MHDO) Health Cost Calculator website, I discovered that Maine reflects the nation pretty closely: payments made for hip replacements varied from around $10,000 all the way up to nearly $100,000, with most in the $15,000 - $25,000 range. (For more detail on the cost data I ...
In the decade that has passed since the Enron collapse (yes, it really has been that long!) and the overhaul of the board governance standards we often refer to with the shorthand "Sarbanes-Oxley," it has become not only a best practice but, increasingly, a standard practice for organizations of all types - including publicly-supported 501(c)(3) non-profits and private foundations - to adopt conflict of interest policies. At the heart of every one of these policies is the core concept that board members, staff, volunteers, and their close family members should not personally benefit from the decisions in which they are involved or over which they have some influence.
Most conflict of interest policies focus on what are described as "business conflicts," which tend to be relatively easy to spot and navigate, as long as all involved openly disclose potential conflicts. Basically, if the foundation is considering a financial transaction and you, your family, or your business could benefit from that transaction, the foundation's conflict of interest policy should have guidelines that either prevent you from voting, remove you from the discussion, or disqualify you (or your family member or business) from consideration. Failing to avoid such conflicts or running amok of the IRS regulations on "self-dealing" can jeopardize the foundation's nonprofit status and have legal ramifications for all involved.
While foundations may choose to limit their conflict of interest policies to deal with business conflicts, the Maine Health Access Foundation (MeHAF) has taken its own conflict of interest policy a step further to include ...
In case you missed the announcement by the U.S. Department of Health and Human Services late last week, Maine was one of the first states to receive State Innovation Model (SIM) funding to test new ways to lower costs and improve care within the Medicaid program.
Other states in this first group of six are Arkansas, Massachusetts, Minnesota, Oregon and Vermont, which will implement plans to transform their health care delivery systems under President Barack Obama's health care reform law, the Affordable Care Act. Twenty-five states will eventually share $300 million in funding for the overall venture.
This new award advances some key initiatives that MeHAF has supported over the last decade, particularly integrated care, payment reform, and Health IT.
Exciting news for health reform in Maine!
With the rest of America, I watched in horror as details emerged on the shootings at Sandy Hook Elementary School in Newtown, Connecticut in December. Even though I know better, I’ll admit that the thought crossed my mind: “How can a sane person brutally murder so many fellow humans, especially innocent children and educators?”
I know better because I understand that violence is not associated with “insanity,” i.e., mental illness. I know it is as absurd to say, “People with mental illness are violent” as it would be to say, “People with diabetes are violent.” People without mental illness commit 96% of the violent crime in America. Research consistently shows that the two greatest risk factors for violent behavior are being male and being young.
I know better because data show that the rate of persons with mental illness who commit violence is no higher than the general population’s rate of violence. After eliminating confounding factors, the MacArthur Violence Risk Assessment study published in the June 2003 World Psychiatry concluded that the rate of violence committed by non-substance-using persons with a major mental disorder is the same as the rate for the non-substance-using general population. For some mental illness conditions, it is less. Substance abuse, however, does increase the risk of persons from both groups engaging in violent behavior.
Contrary to pop culture depictions of people with mental illness, I also know that this group is more likely to be victims of violence rather than perpetrators of it. A recent study of criminal ...
On the third day of the Policy Leaders Academy bus tour, one of the stops was the Margaret Chase Smith Library in Skowhegan, where the group ate lunch and heard several panel presentations. The library is in Margaret Chase Smith’s former home, on a knoll overlooking the Kennebec River, with downtown Skowhegan just downstream.
The two large buses pulled up to the small white house and 75 Maine legislators entered a space filled with pictures, news articles, political cartoons, and memorabilia, all highlighting Margaret Chase Smith’s remarkable life. MCS (as she is familiarly referred to in many of the exhibits), was the first woman elected to both the US House and Senate, and had her name placed in nomination for US President by the Republican party in 1964.
She was born over two decades before women even had the right to vote.
And of all of her notable accomplishments, the one that resonated with me most clearly that day was MCS’s “declaration of conscience,” which put her reputation and political career at risk by opposing the tactics of McCarthyism.
She was a bit of a renegade. She didn’t tolerate nonsense. Pretty typical for someone from Maine.
During lunch, several legislators talked about how they could take a longer-term approach to complicated issues in our state. One idea was to think differently about legislative fiscal notes so that decisions about education, health care, economic development and other crucial state-supported activities are driven by fiscal understanding that looks five or ten years into the ...
Last week, I had the chance to tour the UPM Madison paper mill as part of the Maine Development Foundation's Policy Leaders Academy (PLA) bus tour of central Maine. (See Wendy's blog from 1/15 for more on the PLA.)
The mill is located in Madison, just northeast of Skowhegan, right in the center of town along the Kennebec River. Our group of 70 legislators and guests shuffled off the buses and into the historic mill where we heard from UPM Madison's CEO, Russ Dreschel. Russ gave us a brief history of the mill, including its purchase a couple of years back by a Helsinki, Finland based company, UPM.
The international nature of UPM's business brought up a lot of questions from the group about global competitiveness, including the impact of the U.S. health care system on the ability of U.S.-based operations to stay competitive. Russ explained that it costs up to 40% more for him to employ a worker in the U.S. than it would in Germany, most of which is due to the cost of providing health insurance. Germany has a national health care system so private companies don't need to shoulder the cost of providing health insurance.
There are certainly other factors to consider in that percentage difference, but 40% is a stark figure.
The good news is that UPM Madison is taking steps to lower its health insurance costs. Michael Michaud, Madison's Director of Human Resources (not to be confused with Maine ...
As members of the 126th Legislature flocked to Augusta for the new session, about 75 members of the House and Senate kicked off their terms by boarding a tour bus for a three-day program that highlights people, places, and organizations in Maine that many had never seen before. The bus tour, which is part of the nonpartisan Maine Development Foundation's biennial Policy Leaders Academy (PLA) program, provides an opportunity for lawmakers to learn from different communities and local leaders about issues, concerns, and creative solutions to some of Maine's most challenging issues.
Since 2007, MeHAF has been a PLA sponsor. Because of our involvement, MeHAF was invited to send a staff person to ride along on the tour. From the events of the first day, I took home a few lessons from the back of the bus.
First, bus rides give you the chance to get to know your fellow travelers. It's been said that a factor driving the partisan rancor in Congress is that lawmakers rush back to their home districts at the end of the week rather than spending time in Washington getting to know each other. Developing personal relationships is an important step to understanding different points of view and establishing trust - all key factors that make lawmakers more open to compromise. On our bus there was lots of friendly conversation across the aisle (literally and figuratively) as legislators got to know new and returning colleagues.
Second, bus rides give you time for reflection between stops. The first day ...
Heather Burt is the Executive Director of FARMS (Focus on Agriculture in Rural Maine Schools). FARMS was initially awarded funding through MeHAF's Fund for the Future program in 2009, with a renewal grant awarded in 2012.
With obesity rates and related diseases on the rise and local communities struggling for independent sustainability, FARMS (Focus on Agriculture in Rural Maine Schools) offers solutions. Through hands-on education, we are building a generation of educated consumers who are relearning the art of eating locally, healthfully, and with an openness to trying new things. Although FARMS is very lucky to exist in a community where action is taking place on many levels and by many people, we find that we are increasingly being called upon to offer our expertise and team approach to incorporating local foods and garden education into the school systems, camps, and the broader community. Currently FARMS is joining individuals, farmers, medical practitioners, and several small businesses to develop the FARMS Community Kitchen and Food Learning Center, a demonstration kitchen with hands-on programming that meets the needs and interests of a broad range of people. It has become clear to us that in order to ultimately change the eating habits of children, we must simultaneously support healthier eating habits in their community. This year has marked the beginning of many new and exciting opportunities.
Since 2009, virtually free of charge to the schools, FARMS has offered our classroom and cafeteria-wide taste tests, culinary clubs, hands-on garden curriculum, staff enrichment, Healthy Local Snacks Program, and procurement support ...
Catharine Hartnett is a communications consultant based in Portland, Maine. Clients include philanthropies, nonprofits and companies. She has provided communications support to MeHAF for several years, having the opportunity to learn the ins and outs of Maine's health care systems.
"Get rid of Obamacare!" "I like that my daughter can stay on my health plan." "I don't want the government telling me what I need for health care!" "Thank Goodness I can't be denied coverage anymore because of a preexisting condition." "The Affordable Care Act will cost too much!" "I feel more secure now that the 'doughnut hole' in my drug coverage is gone."
Figuring out how to tell people what the tangible, you-may-experience-this-tomorrow benefits of the Affordable Care Act are is a budding case study in communications challenges that may eventually rank up there with the crisis management of the 1982 Tylenol scare in communications course favorites.
As someone who advises even the smallest organizations about the importance of communications strategy, I have wondered why the new reform package didn't come with clear operating instructions. Why not direct agencies to tell their constituents, clearly and concisely, how they would benefit? Rather than endure the howling and resistance that persisted in the information vacuum, why not take the guess work out of the equation immediately?
Luckily, Maine didn't wait. Eleven advocacy organizations, funded by MeHAF, together developed a comprehensive communications strategy to tell their respective stakeholders exactly how they would benefit from reform. Representing MeHAF's priority populations of uninsured Maine ...
Natalie Truesdell, author of the study, is a consultant with John Snow, Inc, which has been providing evaluation services to the MeHAF Integration Initiative since 2009.
If the goal of health care organizations is better health outcomes for their clients, then patient engagement is key. Health care providers who are engaging patients consider the patients' needs, preferences and perspectives when care decisions are being made. Patient engagement leads to higher patient satisfaction and lower costs.
Patient engagement has been a central component of the projects funded through MeHAF's Integration Initiative, which seeks to improve the integration of primary health care with behavioral health care. MeHAF believes that engaging patients means ensuring they are active participants in their own care and that patients' perspectives are contributing to decisions made at higher levels in the organization and the health care system.
Over the course of this initiative, our grant partners have collected experiences and insights into improving patient engagement. We have gathered those experiences into a case study that describes strategies used by diverse organizations to engage patients at each level of health care decision-making.
At the level of the individual patient's experience and his/her experience with the clinic, the key to patient engagement is a trusting relationship between patient and staff. The experience starts when the patient is welcomed into the office by reception staff. One program that trained front desk staff at primary care practices on how to improve their interactions with patients with mental health conditions helped everyone at the practice to ...
This is a joint blog post from Barbara Leonard, MeHAF's Vice President for Programs, and MeHAF grantee Jim Harnar, the Executive Director of The Daniel Hanley Center for Health Leadership.
Barbara: In 2009, Maine Health Access Foundation provided a grant to the Daniel Hanley Center for Health Leadership to support the Health Leadership Development Program (HLD). The Hanley Center brings current and emerging leaders from health and public health from across Maine to develop their skills and enhance their capacity to practice Values Driven Leadership: "A conscious commitment by leaders at all levels to lead with their values and create a culture that optimizes ethical practice and social contribution."
MeHAF's grant focused on providing resources to increase the diversity of participants in the HLD program, with a particular emphasis on including participants who represent or work with individuals who are uninsured or medically underserved. The grant allowed for scholarship support for individuals who otherwise might not be able to be a part of the program, and also supported creation of an advisory committee that not only helped to recruit these "MeHAF Scholars," but also focused on enhancing the program's curriculum to address issues of diversity and health disparities.
As a grantmaker, I try to support grantees in their work, serving as a sounding board, and when appropriate, helping to solve problems. Mostly, I try to help grantees develop clear work plans and then stand back and let them take the work forward. This grant to the Hanley Center went farther and reached heights ...