Crushing Deductibles Affect RI Families

Many employer group plans today have higher than normal deductibles. In my experience (and under past employment), benefit plans generally did not have an in network deductible, and my out-of-pocket costs included either copayments of flat dollar fees, or coinsurance, percentages of a total. Deductibles were saved for out of network benefits, and even then we were talking only $500 or $1000, on a generous plan. Nowadays, a family has to meet so many out of pocket costs.  I have two anecdotes to provide in this regard.

A family member experienced a glitch, and was not able to change her plan as of January 1 of this year. A new plan with a new deductible was in effect February 1.  Unfortunately, her out-of-pocket costs incurred in January do not offset her February plan with a new organization. She has filed appeals requesting exceptions, which hopefully will be approved because the Summary of Benefits and Coverage (SBC) has been arguably watered down to incompletion. This is a great difficulty for someone self-employed and raising a family.

A close friend has been helping her sister financially as she undergoes treatment for a serious illness. Her sister was diagnosed a few months ago, and has a plan your benefit which includes a $6000 deductible starting June 1. She works for a major pharmacy benefit manager in a warehouse position, and has so for years, but barely makes a living wage considering she is single, taking care of her disabled son as well as a granddaughter. My friend is self employed herself and is now hustling as best she can to help her sister pay participating physicians who are demanding cash upfront.

These anecdotes illustrate a couple examples of how our current system is causing great financial harm to working families. More refinement is needed to make sure people don’t delay care and providers do not refuse care due to cost.

Passed the Test!

This past week I completed and passed the exam to be a Certified Compliance & Ethics Professional, or CCEP. This certification is administered by the Compliance Certification Board.  Continued education is something I personally value and in all instances of my professional activities, it enhances not only my client work but also my decision-making as a manager of staff and as a board member of a health center. I recommend anyone in this field to pursue this or a similar certification.

In other news, 2018 seems to be flying by. I am keeping busy not only with career obligations but also with my volunteer efforts. We are seeking a new CEO for our health center, as our current leader is retiring. He has some pretty big shoes to fill, so if you know anyone with some HRSA experience and a penchant for New England living, don’t hesitate to send them my way. Really, is it almost March?

 

January Imperatives

A few thoughts during this quiet Sunday in a temperate January come to mind that I hope all readers consider:

  • Yes everyone has their feelings about the flu shot. I’m not here to preach about the vaccination as it’s a personal decision you make with your medical professional. However, as a human, it’s not only flu season we are dealing with but also a very miserable virus. It’s scary the number of reported casualties this season. If you or a family member is under the weather, get checked out. Here are some helpful tips on choosing the right setting for your medical care.
  • The first State of the Union Address delivered by President Trump will be this coming Tuesday, January 30. Anticipated themes include tax reform, border security, immigration, and the stock market. Tune in at 9PM Eastern.
  • On the local front, while Q4 2017 data is not finalized, I am hoping that accidental drug-related overdose deaths are on the decrease for our tiny state. Every live saved is a blessing and a gift that has slipped through another family’s fingers. Continue educating yourself and promoting recovery options for all.

Looking forward to a prosperous and healthy 2018 for everyone.

New Year, What is Next?

…one of my favorite phrases that I picked up during Spiritual Exercises in college is so fitting for a new year.

It’s the first Saturday of  2018, truly one of the first days with some time to breathe after the planning and excitement of the last month.

There’s not much to love in the news lately but there are glimmers of hope if you can find them. Sarah Silverman has done an act of kindness instead of choosing escalation and inflammation. On the same platform there are bullies and moms and reporters and megalomaniacs, so it is nice when something so positive gets attention.

And then?

  • Spent the end of the year in a chilly city; kept warm with great people.
  • Reading a book that is totally outside my wheelhouse but my brain is thanking me for it.
  • Planning work travel and sharpening those time management skills.
  • Getting involved in community events and sharing the intel forward.

Be Antibiotics Aware

Far be it from me to provide medical advice. This place is about my personal perspective and experience, and this topic includes an important message for our community, especially now that the holiday season is coming. Families will be getting together, and oftentimes, someone at the dinner table feels under the weather.

The Rhode Island Department of Health (RIDOH) issued a press release today to remind Rhode Islanders to be “antibiotics aware”. It seems there is a special week for everything!  Last week was Corporate Compliance and Ethics week, but this week, apparently, is U.S. Antibiotic Awareness Week and World Antibiotic Awareness Week (November 13th -19th). These drugs are super helpful in the treatment of bacterial infections. However, according to the press release, the overuse of antibiotics and the use of these drugs when not appropriate have contributed to 2 million+ people falling ill with antibiotic-resistant bacteria.

Remember: antibiotics do not work on viruses. There is a distinction between viruses and bacteria that make us ill. Take it from an experienced patient: Let your physician properly diagnose your illness. Finish your prescription medication as directed. Alert your physician if you experience any significant side effects of antibiotics (as I have done; some of them pack quite a punch!) and safely discard any unused medication.

www.health.ri.gov/antibiotics

www.cdc.gov/antibiotic-use

The End of Oklahoma’s In-Home Support Waiver

Buried in my newsfeed today is an article from earlier this month regarding the state of Oklahoma’s decision to cut funding for a significantly needy population.  Families who care for developmentally disabled adults often require additional support, otherwise, working a full-time job would be difficult.

The Oklahoma Health Care Authority describes the In-Home Support Waiver as follows: In-Home Supports for Adults serves the needs of individuals 18 years of age and older with intellectual disabilities who would otherwise require placement in an ICF/IID [Intermediate Care Facilities for Individuals with Intellectual Disabilities].

According to the OHCA website,  services include: Respite, Nursing Services, Adaptive Equipment, Nutritional Services, Audiology, Occupational, Physical, & Speech Therapies, Habilitation Training Specialists (in-home care), Psychological Counseling, Medical Supplies and Services, Employment Services, and Transportation. Funding for these and more services will end December 1, forcing families to make some key decisions in the next few weeks.

I hope state lawmakers responsible for informing the budget can find something else to cut besides these valuable sevices. Parents and caretakers may need to choose between caring for these loved ones or keeping their jobs. From the article:

“We are still hopeful, still optimistic that the legislature will not allow these cuts to take place,” said DHS spokeswoman Sheree Powell. “There’s still time to pass funding bills, to make sure that the funding is available for these services. But come December 1, these programs will end and there will be nothing DHS can do about it.”

Give Memorial Hospital New Life

This past month, it was announced that Memorial Hospital in Pawtucket, RI will close. While it appears the low utilization and financial state of the facility support this clear choice, it is always disappointing to the local community that has depended on Memorial for generations.

Dr. Michael Fine notes in his article that we are healthier than we used to be, But he also provides a compelling alternative, which is to use the facility as a treatment center for those battling drug and alcohol addiction. There is such a great demand for these services, and having additional local access to high-quality treatment would be welcome in any community.

Now all we have to do is make it affordable and accessible. Who can come in and turn this Brewster St. facility into a place of treatment and recovery? Any takers?

Joy

This past week was one of the best of my life. Looking forward to more bright days ahead.

Autumn is my favorite season; enjoy every moment.

#OpioidEpidemic

My brother died of a Fentanyl overdose this year. Next year, he will be included in all the charts and bar graphs showing the thousands of overdose deaths. You won’t see his name, but I will see it, and so will his mother and father and brother, burned on every chart, graph, and state map.

The top story on my bookmarked news page earlier today  was about President Trump declaring the opioid crisis a Public Health Emergency. It is now a mere hours later and the headline is now regarding talks of a major pharmacy player that may potentially puchase the nation’s third largest health insurer. It seems to me this crisis is reduced to the fleeting hashtag level of awareness – here today, gone tomorrow.

According to the Centers for Disease Control and Prevention, an average of one hundred and seventy five people in the United States died every day last year due to overdose. One hundred and seventy five families devastated a day.

Stats and colorful maps are fantastic eye-catching tools to raise visibility, but we are all Davids and this crisis is the Goliath. When do we stop the bleeding? Who should be held accountable for immediate changes? In my work, it is all about identifying root causes and Corrective Action Plans. We create a Beneficiary Impact Analysis when there is the hint of risk to plan enrollees. When can the collective Davids join up and bring this epidemic to the ground? When will Goliath collapse?

I close this with a link to Virginia Recovery Foundation. These good people educate family members on how to get loved ones the help they need, and your donation will honor my brother. Or, please give to your local community resources.

Find Yourself in Service to Others

If you think about the great expanse that is the United States, there are about 35,000 cities and towns, and of that number, only about 4,000 of those are considered “cities” as defined by a population of 10,000 or more permanent residents. Definitions vary depending where you go, but using this figure as a measure, the majority, like my town, don’t have a high population.

When you support local businesses with your time or your money, you are supporting your neighbors. You are investing in your local economy and helping the community thrive. Local businesses provide alternative options to large chains. No, you might not be able to pick up your favorite flavor of Jell-O at the local mom-and-pop shop, but keeping your neighbors in business benefits you.

Since October 2015, I have served on the Board of Directors at Wood River Health Services in Hope Valley, RI. When I was seeking volunteer opportunities within my small community, this seemed like a natural fit based on my professional experience. Our mission at WRHS is “to improve the health and well-being of our community by assuring access to affordable high quality healthcare, coordinated services, and health related information.”

Giving of your time takes you out of yourself, at the same time provides a window in to yourself. Placing focus on an issue or cause that is important to you not only benefits that cause but also benefits you in your own personal growth. Suze Orman has spoken about volunteering. You should choose wisely where to place your focus. Identify the benefits you get from volunteering. Does it support your career? Does it help you advance your own skill development, all the while making a difference? I like to think WRHS gains from my experience and in return I learn from my peers on the Board.

Regardless of how you spend your time, professionally or personally, make sure it is something you are passionate about. People can tell when you love what you do.