Now Viewing: Health Care Coverage and Access

A Free Clinic Builds “Bridges to Health” by Treating the Whole Patient

Dec 5, 2018, 11:00 AM, Posted by Catherine Malone

How one rural clinic addressed its patients’ complex health and social needs successfully—and cut emergency room use and costs drastically.

Dr. Steven Crane discusses a patient with a nurse.

There’s no bus service in his small town in rural North Carolina, so Dean* drives 10 miles to The Free Clinics ("Clinics") in Hendersonville every couple of weeks whenever he has money for gas.

Staff there helped him find affordable medications and treatments for cancer and for his shoulder, which he injured by falling 20 feet on a construction site. He’s unable to read due to learning disabilities, so they’ve also helped him find lawyers to file disability claims.

Dean is also one of the patients who attends the Clinics’ Bridges to Health ("Bridges") program, a drop-in group session where patients can discuss their social and emotional concerns as well as medical problems. He has battled depression since the age of five after enduring early childhood trauma. He credits the Bridges sessions, along with the Clinics’ holistic care, with easing his depression and improving his physical health, as well as “opening up avenues for me to get help.”

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Don’t Try to Fit Rural Health Into an Urban Box

Nov 12, 2018, 2:00 PM, Posted by Melissa Bosworth

In rural areas, lack of access to adequate care can be a matter of life and death. Transforming rural health requires creative, place-based solutions and a commitment to fostering local leadership.

A corn production farm.

The amputation was scheduled for that day. John’s* uncontrolled diabetes had stopped blood flow to his lower leg. With the tissue starting to die, it seemed inevitable that his foot would have to be removed to save his life.

Thankfully, a team I work with had recently helped bring telehealth services to the rural Colorado hospital where John had been admitted. A cloud-based video system connected to electronic health records enabled his doctor to consult with an infectious disease specialist hundreds of miles away in Denver. The specialist suggested one last “cocktail” of antibiotics, to be administered by I.V. The protocol worked. John kept not only his foot, but also his livelihood as a rancher: his ability to graze cattle, grow wheat, and provide for his family.

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How States Can Better Engage Medicaid Patients

Oct 29, 2018, 2:00 PM, Posted by Andrea Ducas, Tricia McGinnis

Experts weigh in on practical approaches for engaging Medicaid beneficiaries to ensure that services are designed to meet their needs.

People walking in a hallway of a government building.

Medicaid is the largest health care program in the United States and impacts the lives of more than 76 million Americans, nearly one-quarter of the nation’s population. The program can play a powerful role in influencing the health and well-being of individuals and families.

State Medicaid programs can only be truly successful, however, if they are responsive to the needs and priorities of the clients they serve—not providers, but patients and their families. Medicaid officials understand this. However, in the resource- and time-constrained environments in which Medicaid staff operate, finding the right avenues for gathering meaningful consumer input can be a challenge.

The Robert Wood Johnson Foundation has been trying to address these challenges through its work to transform health and health care systems. As part of these efforts, the Foundation along with the Center for Health Care Strategies recently engaged experts, including representatives from across the patient advocacy world, around this issue. These experts include leaders from Altarum, American Cancer Society Cancer Action Network, Community Catalyst, Georgetown Center for Children and Families, Nonprofit Finance Fund, and the Patient Advocate Foundation.

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To Improve Health Disparities, Focus on Oral Health

Aug 9, 2018, 3:00 PM, Posted by Charles Moore

A team from our Clinical Scholars program believes that addressing oral health disparities can improve overall health and well-being, and help end cycles of poverty. They are bringing oral health to the community through school clinics, an app and an oral health protocol development for nurses, physicians, dentists and dental hygienists.

HEALing Community Center Atlanta

In January 2018, the Hollis Innovation Academy, a K-8 school, opened a dental exam room. Though it may seem unusual to see a dentist’s chair in a school, its presence reflects years of learning within this Atlanta community. Hollis's students live in English Avenue/Vine City, an area with one of the highest poverty rates in Atlanta. They also reside in one of three zip codes with the highest oral cancer rates in the city.

Early in my career as an ear, nose and throat specialist, I witnessed a deeply troubling pattern: on my first visit with a patient, I would diagnose him or her with advanced head and neck cancers. There would have been good treatment options if these patients had been seen much earlier. But time and time again, all we could do was rush the patient into an operating room, put in a tracheotomy to control the airway, and set up end-of-life care. I kept thinking that someone needed to get to this issue much sooner so that people wouldn’t die from something that could be treated effectively if caught sooner.

Eventually, I decided that person was me.

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Honoring Andy Hyman: A Passionate Advocate for Health Equity

Aug 4, 2016, 9:37 AM, Posted by Brian C. Quinn

A new award celebrates and pays tribute to the life and work of Andy Hyman by recognizing a champion in the field of health advocacy.

The sunrise acts as a backdrop to the Capitol Building in D.C.

My boss and mentor Andy Hyman was the kind of visionary leader who instilled a deep sense of hope in everyone he came into contact with. He inspired in us a feeling that anything was possible. It’s this kind of unwavering hope that is needed when pursuing seemingly insurmountable goals—like the goal of ensuring that everyone in America has access to affordable, quality health care coverage.

Andy led the Robert Wood Johnson Foundation’s (RWJF) work on health insurance coverage from 2006 until shortly before his untimely death in 2015. One of the things I vividly remember was his deep conviction—even when progress seemed elusive—that we could make major strides toward improving coverage for those who needed it the most. 

Among his many wonderful qualities, Andy had keen political foresight that revealed itself when I started working with him back in 2006. He predicted a window to put the spotlight on health reform in 2008, regardless of who was elected president. In preparation, he led our team in building evidence to make the case for health reform and in bolstering the capacity of community of advocates nationwide who could work on state-level reform. Once the Affordable Care Act (ACA) was enacted, Andy worked tirelessly to help implement it in the states.

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How Health Insurers Can Help Kids Reach a Healthy Weight

Jun 1, 2016, 12:30 PM, Posted by Katherine Hempstead, Victoria Brown

Innovative approaches in health insurance can help support youth development and prevent chronic diseases.

Attendees visit tables at a health and enrollment fair.

While research shows that access to safe neighborhood spaces for physical activity along with affordable healthy foods help families and kids maintain a healthy weight, it’s often not enough.

Health care economist Mike Bertaut illustrated this reality through a deeply personal and passionate post last month. He opened up about his lifelong struggle with obesity and shared some important lessons about how the health care sector can help children maintain a healthy weight. It’s a moving piece worth reading.

As Mike shows us, health care providers—and health insurers—have a critical role to play, especially for children and families at highest risk for obesity and obesity-related disease.

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SHOP: Can it Boost Health Coverage for Small Business Employees?

Dec 14, 2015, 6:04 PM, Posted by Katherine Hempstead

A new report shows that small business owners care about the health insurance coverage they offer their employees, yet the Small Business Health Option Program (SHOP) remains an untapped resource with the potential to help employers find affordable plans.

In 1942, Ken Wilson’s grandfather started Bonnie Brae Conoco, a full-service gas station and neighborhood garage in Denver. Today, Ken is the third generation to manage the business. They’ve offered their employees health insurance since 1970, paying 100 percent of the costs for those who work full-time. Although it’s their largest expense, the Wilsons believe offering coverage is essential. They want to take care of their employees and attract and retain the best people.  

Small businesses, like all businesses, have struggled to keep up with the rising cost of health insurance. But unlike larger companies that can leverage their purchasing power to negotiate lower premiums and more comprehensive benefits, small businesses often have a choice of costlier plans with skimpier benefits. A recent study found small firms are far less likely than larger firms to offer health coverage. In 2012 and 2013, the percentage of small employers offering health insurance was 35 percent, while the percentage of large employers offering insurance was 95.8 percent.  

The Affordable Care Act (ACA) has several implications for small businesses. Under the ACA, small business health plans are subject to the marketplace regulations similar to those in the individual market. Depending on the state in which the business is located and the characteristics of the work force, these changes could make premiums change a lot or a little. Many small businesses are still offering pre-ACA plans, and many of them will need to transition to ACA-compliant coverage in 2017.

One new opportunity is the Small Business Health Options Program or SHOP, which is an online marketplace where small business owners with 50 or fewer full-time employees can purchase health insurance for their workers. Features of SHOP attempt to provide flexibility for both employers and employees. Business owners can set their contribution and their employees can choose the plan and benefits they want. Small business owners with 25 or fewer full-time employees can also qualify for a tax credit to put toward the cost of coverage.

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Open Enrollment: One Step Closer to Coverage for All

Nov 2, 2015, 9:00 AM, Posted by John Lumpkin

Let’s build upon the success of the Affordable Care Act with this year’s open enrollment.

A pediatrician makes a home visit to check on an infant patient.

Open enrollment is here again—the annual opportunity for Americans to find and enroll in a health plan through HealthCare.gov or their state-based health insurance marketplace. In three short years, millions of Americans have gained access to health plans that cover important services like doctor’s visits, prescriptions, hospital stays, preventive care, and more. As a doctor, I’ve seen the difference health coverage can make in the lives of families. Quality, affordable health insurance means new access to care—care that can have a huge impact on health, equity, financial security, and a better quality of life. It moves us closer to a Culture of Health, where people can access care when they’re sick and when they’re well, making prevention the priority.

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Expanding Opportunities for Rural Communities to Get Quality Care

Jun 9, 2015, 4:58 PM, Posted by Susan Hassmiller

Initiatives like the Future of Nursing and Project ECHO are expanding opportunities for more communities to get quality health care and lead healthier lives regardless of ZIP code.

Two children play in a toy tractor on a farm.

I read recently in The New York Times about Murlene Osburn, a cattle rancher and psychiatric nurse, who will finally be able to start seeing patients now that Nebraska has passed legislation enabling advanced practice nurses to practice without a doctor’s oversight.

Osburn earned her graduate degree to become a psychiatric nurse after becoming convinced of the need in her rural community, but she found it impossible to practice. That’s because a state law requiring advanced practice nurses to have a doctor’s approval before they performed tasks—tasks they were certified to do. The closest psychiatrist was seven hours away by car (thus the need for a psychiatric nurse), and he wanted to charge her $500 a month. She got discouraged and set aside her dream of helping her community.

I lived in Nebraska for seven years, and I know firsthand that many rural communities lack adequate health services. As a public health nurse supervisor responsible for the entire state, I regularly traveled to small, isolated communities. Some of these communities did not have a physician or dentist, let alone a psychiatric nurse. People are forced to drive long distances to attain care, and they often delay necessary medical treatment as a result—putting them at risk of becoming even sicker, with more complex medical conditions.

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Retail Clinics Are Expanding Their Role Within the Health Care System

May 6, 2015, 3:38 PM, Posted by Tara Oakman

With convenient weekend and after-hours care, retail clinics have the potential to expand access to basic primary care and help address some non-clinical needs underlying the social determinants of health.

A CVS Retail Clinic at the corner of a street.

My husband had been suffering from a very painful sore throat for a couple of days when he finally decided to call his doctor. Just one problem: It was a Friday morning and the office was booked for the day. The doctor called back later in the afternoon and told my husband it sounded like a virus and he should simply “wait it out.” With the weekend approaching, the next available appointment—if needed—was on Monday. Rather than suffer all weekend with a raw throat, my husband followed the advice of a relative (who also happens to be a physician) and went to a clinic at our local CVS. Less than an hour later he was diagnosed with strep throat and started on antibiotic therapy he picked up at the pharmacy. By Saturday evening he was feeling a lot better.

Access to quick, convenient care on nights and weekends is one of the prime selling points of “retail clinics” based in pharmacies, groceries, and big-box retailers. With longer operating hours and no need for an appointment, these clinics, sometimes called “doc-in-a-box,” give patients more flexibility to avoid time away from work and family. Plus, a trip to a retail clinic costs about one-third less than a visit to a doctor’s office, and is far cheaper than an emergency room. Retail clinics usually accept private insurance, Medicare, and, in many cases, Medicaid; yet people without insurance or a personal physician also are using them for treatment of routine illnesses, basic health screenings, and low-level acute problems like cuts, sprains, and rashes.

New shopping list: Pick up milk, breakfast cereal, and toilet paper; get a flu shot and that weird rash checked out.

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