Family medicine is creating and maintaining relationships with patients in order to enhance their lives.That is the definition I gave to the University of Iowa’s family-medicine residents at their resident retreat on Saturday. During my talk with this group of young physicians, I described my family-medicine team and how we help our patients to maintain their health, recover, and become healthy from an illness or improve their quality of life if diagnosed with chronic illness or a terminal disease. My team includes a head nurse, two health coaches who share a full-time position, a “roomer” nurse who seats patients in examination rooms and charts their vitals signs, and a “shot” nurse. Together, we are responsible for the family-medicine needs of 2,100 patients. I have described the use and value of health coaches in a previous entry.
Category Archives: Medicaid
Health Reform and Wrapping Up
I should wrap up this blog with this post. This was to be the last entry. I said at the beginning, two and a half years ago, that I would chronicle the first two years of progress for health-care reform and the Affordable Care Act (ACA) in Iowa. Now, at the end of the second year of the ACA, we are able — to some extent — to count the successes, some sad outcomes, and end the blog.
Health Reform and “Under Duress”
I was quoted in the Des Moines Register on Friday, November 27, regarding the Medical Assistance Advisory Council (MAAC) meeting that I attended on Wednesday, November 25. The topic is familiar in this blog: Medicaid managed care. The federally mandated council advises the state of Iowa on Medicaid issues and is one of the major overseers of the upcoming Medicaid managed-care “modernization” that is currently scheduled to begin on January 1, 2016 — four short weeks from today. The approximately 30 other members of the council and I spent two hours raising questions and concerns with the Iowa Department of Human Services and representatives from the four managed-care organizations (MCOs) that will divide 550,000 Medicaid patients and more than $3.5 billion in state and federal monies.
Health Reform and Public Service
The world became a lesser place on Friday, August 28. My mother-in-law died. I had known her for 41 years and never once heard her speak a cross word. She died three months short of her birthday. She would have been 90 years old. She worked her entire professional life in public service. Her first position was as a Head Start teacher in the first year of the Head Start Program in Alabama at the time of the Selma march. Her major role, once she returned to Iowa, was as a county home economist, initially in Kossuth County, then for more than 20 years in Crawford County. She added Ida County toward the end of her career. She taught rural families how to survive and thrive in the changing world of the 1960s, ’70s, and into the 1980s. At her retirement dinner, her supervisor said, “In many ways, Norma has been in the vanguard. When you look to see what Norma is doing and, in two or three years, all Iowa counties will be doing it.”
Health Reform and Quid Pro Quo
This week, a high-ranking politician left a phone message for me at my clinic. He asked that I call him. The purpose of his call, according to the note from my receptionist, was “politics.” I did return his call and left a message. He called me back while I was out at a movie. Stepping out of the movie to look at my phone, I found that the purpose of his call was direct and to the point: He asked for money for his political campaign fund. Another politician currently running for office has called me at various times during my work hours. He called once just as I prepared to do a knee injection for a patient and again while I was making rounds at the hospital. During each call, this politician asked for campaign money.
Health Reform and Numbers
60. I start and end this blog post with selected lines from poems. Dylan Thomas began his Poem in October with: It was my thirtieth year to heaven. Today marks my sixtieth year to heaven (I hope), and, instead of Dylan Thomas describing the beauty of Wales in October on his birthday, I am witnessing six months and thirty birthdays later the beauty of Iowa in April. April brings the brightest green grass of the year, the snow-white blossoms of the pear tree in my back yard, and the soon-to-be-red blossoms of my crabapple tree in the front yard. Colors seem to explode from every flower and bush.
Birthdays also mark time in relationship to other events, including the anniversary of the Oklahoma City bombing. Albert Einstein died 60 years ago yesterday. Sixty years ago this month, Churchill left office as the prime minister of Great Britain. The American Revolution started 240 years ago on this date. For me, dates give a sense of one’s location in both the positive and negative swings of history. Correspondingly, numbers can give us perspective and relative significance of the people, events, and details of our lives. Today, I review some numbers that I have heard over the past several months, numbers that cause me to reflect on health reform, both positively and negatively.
Health Reform and Medicaid Managed Care
I keep lists. While I do not believe there is a name for someone who keeps lists as there is for one who collects stamps — a philatelist, or a keeper of postcards, known as a deltiologist — I am simply a keeper of lists. One list is of names that are actually what the name says the object or geographic location is. For example, in the South Island of New Zealand, southeast of Queenstown, there is a range of mountains called the Remarkables. They are pristine, beautiful and truly remarkable. Another example is a swamp in northern North Carolina and Virginia called the Great Dismal Swamp, the largest remnant of a swamp habitat that once covered more than a million acres. A final example is the Trail of Tears. It was the route that more than 16,000 Cherokee Indians took from their homelands in the southern United States to Oklahoma. It is estimated that more than a third of those Cherokee people died on the Trail of Tears. Another list I keep is names that do not signify what the name indicates, such as the Big Ten Conference in collegiate sports, which has 14 teams, or the Fox News Network, whose motto is “fair and balanced.”
Iowa is currently undertaking a new program to turn its Medicaid program from a state-government-managed program of medical help for poor and disabled populations to a for-profit, private managed-care approach to administer the medical needs for these populations. The title of this program is the Iowa High Quality Health Care Initiative. I am holding judgment as to which list this program with the ambiguous name would more likely be appropriately added.
Health Reform and Aligned Incentives
In further discussing the now-dissolved CoOportunity Health, as well as Governor Branstad’s proposed plan to turn over the Iowa Medicaid program to a private managed-care company or set of companies, I was going to title this blog entry Health Reform and the Need for Nonprofit Entities, which may, in the end, be what the readers of the blog may feel is my conclusion. Instead, I chose the current title to reflect a refinement of my views over the years. To understand this refinement, I want to start this post by going back to 1993.
Health Reform and CoOportunity Health
It is with sadness that I acknowledge the takeover of the cooperative health-insurance company, CoOportunity Health, by the Iowa insurance commissioner. I have touted CoOportunity Health many times in this blog, and I have strongly felt it was a critical part of the current health-reform efforts in Iowa. My sadness is even greater for the 100,000 individuals who had insurance with CoOportunity Health. These individuals’ confidence and coverage are jeopardized because of this action. The health and peace of mind of friends, family, and patients who I know are insured by CoOportunity Health are a major concern for me at this time.
Health Reform and Drugs, Drugs, Drugs
The good news. On Wednesday, November 19, CoOportunity Health, the Iowa-Nebraska health-care-cooperative insurance entity that I have touted in several blog posts, insured its 100,000th person for health-care coverage. As I have said before, its projection for the end of this year, its first year of operation, was 15,000 policyholders.
The bad news. CoOportunity Health announced that next year, 2015, it would not participate in the Iowa Medicaid expansion for individuals whose incomes were between 100 to 133 percent of the federal poverty level (FPL). CoOportunity Health simply could not sustain the financial losses for this group of 11,000 Iowans. From my non-insurance and non-actuarial level of understanding, the major issues were 1) the federal government being unwilling to allow for a separate, more accurate actuarial premium amount for this population of newly insured individuals and instead requiring this population to be part of the entire population’s actuarial projection of CoOportunity Health’s premium holders, and 2) the high cost of drugs for treatment of diseases such as Hepatitis C and HIV. For now, this group of individuals will be part of the Medicaid program instead of utilizing the Exchange and being part of the private insurance system.
In this post I’ll discuss several incidents of how the high cost of medicines has negatively affected my patients and the health-care system. The question is: Can health reform, or for that matter the health-care system, survive the upward trajectory of the price of medications?