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HomeMy WebLinkAboutHSAC Forum Report 1998U��C AU1 S E RV E s A DV I S 0ram, Y C 0 M M I S S I ON FORUNNIII REPORT 1998 "Managed Care and Beyond: Fostering Health in Our Community" Prepared by Human Services Advisory Commission Prepared for Orange County Board of Commissioners and Forum Participants. BACKGROUND Roughly 105* people attended the 1998 Human Services Advisory Commission (HSAC) forum, "Managed Care and Beyond: Fostering Health in Our Community. " Participants included county and state employees, representatives from human services agencies, and local legislators. Each yearly forum informs the Orange County Board of Commissioner's decision - making process and allows local organizations to meet and plan new strategies. The 1998 forum focused on the impact managed care is having on healthcare providers, patients, and service providers in Orange County and throughout North Carolina. OVERVIEW Pamela Silberman of the Sheps Center for Health Services Research made the first presentation of the morning session. She answered the question, "What is Managed Care and How will Communities be "There are two ways that managed care tries to control costs: i 1 Keeping patients healthy 2. Making sure patients don't get unneeded care" j -from Understanding Managed Impacted ? " She defined 'managed care' as "a system which helps manage the patient's care - -to ensure that the patient is receiving the most appropriate, cost - efficient form of care, " or "any product, arrangement, or entity which integrates the financing and delivery of health services for a defined population. " She explained how patients suffer both from no care and from excess care. Some statistics claim that 20 to 40 unnecessary (and even detrimental) . However, the new forms of managed care may be providing undue financial incentives to limit care. Ms* Dr* Silberman's presentation detailed some of the pros and cons of Health Maintenance Organizations (HMOs) as shown in Table 1. She also suggested that the chronically ill and the uninsured may be at most risk from the growing shift to managed care due to reduced access to needed services. She concluded that "problems exist in any healthcare system - -the goal should be to fix the problems and improve the system. " Eleanor Kinnaird contributed the "State Perspectives on Managed Care" from her standpoint as a Senator in the North Carolina Legislature. Senator Kinnaird described the grassroots effort consisting largely of citizen appeals to legislators that led to the enactment of significant consumer protections in relation to managed care plans. More information is now readily available to both consumers and the state; out -of- network care restrictions have been 1998 HSAC Forum Table 1. HMOs: New Opportunities and Challenges Opportunities Greater emphasis on prevention and health promotion Less use of expensive tests and treatments Greater coordination of care Roughly comparable quality of care Reduced financial barriers Greater emphasis on measuring quality 2 Challenges Restricts choice of providers Reported access barriers to specialists and expensive tests and technology Shifts financial risk of caring for patients to providers More difficult for providers to act as patients' advocates loosened under special circumstances; and, appeal /grievance proceedings have been specified. Such legislation requires the support of an advocate within the legislature as well as publicity and citizen support. Insurance and small business lobbies generate a strong case. Right now, smaller human services programs such as CHIP that provide stop -gap services for many constituents are in danger from reduced funding. Counties often have to pick up the tab for inadequate programs. Ultimately, though, the legislature listens to what the people tell them. Adam Searing of the NC Health Access Coalition also enthusiastically endorsed advocacy as a method of creating change on behalf of the consumer perspective. He has found that health issues can often (although not always) elicit bipartisan support. The voice most often heard is big business: consumers must also take a stand. Broad coalitions and the media are also useful tools within politics and healthcare. He also described the differences between legislative packages that may not cover all the gaps. Allen Hamrick -UNC Student Health Services, Moses Carey- Piedmont Health Services, and Florence Soltys and Audreye Johnson with the UNC School of Social Work all made short presentations before participating in a panel discussion regarding the "Views from Service Providers: Roles and Responsibilities of Government and Non - Profit Agencies." Dr.? Hamrick endorsed the necessity of creating an infrastructure to meet the needs of the mentally ill. Managed care presents unusual challenges to psychiatric patients who need to stay with a consistent care provider. It is sometimes easier to admit a patient to a hospital than to provide preventive care. Dr.? Carey talked about the role of the "safety -net providers" in protecting the disenfranchised. Overall, the impact of managed care has been negative for "Managed Care and Beyond: Fostering Health in Our Community ".__ those organizations because of the increased competition for patients with a payment source. The competitors do not provide access to the uninsured and underinsured. He finds that a market -share approach to health care is not always in the best interest of patients and families. Florence Soltys presented the fact that there are more people over 65 than in school systems in Orange County. She brought up the need to teach interdisciplinary care that includes the home, community, and institutional resources. Audreye Johnson elaborated on the plight of children and families. Social workers are faced with the results of welfare reform, managed care, and an undereducated populace. Women often find themselves as caregivers on both ends of the spectrum, caring for children, parents, and sometimes husbands. Ms. Johnson also recommended an expanded concept of family that includes fictive kin or all people working and caring for each other. The panel discussion was moderated by Rosemary Summers, Orange County Health Director., and ranged over a wide array of topics. Katherine Leith with the Department on Aging described situations where the elderly end up in hospital situations for want of prescription coverage. Others expressed concern about the changes Triangle Hospice is going through organizationally in its affiliation with Duke. Another topic was the potential shortfall in the North Carolina Mental Health Budget. Allan Hamrick and Tom Maynard both favored a more long- sighted approach to developing a mental health infrastructure that would accept temporary budget increases in favor of long -term savings. John Link, Orange County Manager, spoke from his own experience about the difficulties in finding appropriate in -home care for seniors. Teresa Smith with Day Care Services talked about the difficulties children with Medicare are having finding dental care. An increase in Medicare payment rates might not be effective because there is already a shortage of dental providers. The forum's morning session closed as the forum participants separated into five working lunch groups after the panel discussion with different concentrations?. Each group was charged to resolve the following three questions: ♦ What are the issues? ♦ What should be done? ♦ Who will do this? The five groups' findings are summarized below. 14 � 1998 HSAC Forum MANAGED CARE STRATEGIES _._..._ Table 2. Working Lunch Results What are the issues? What should be done? Who will do this? Mental Health & Managed Care Facilitator: ? ?? ❑ Concerns for unserved and under ❑ Local priority setting and focus ❑ Local stakeholders and served populations (children, elderly, ❑ Local folks should express the need for elected officials disabled, low income, rural, and increases in state level mental health ❑ Stakeholder advocates second language) funding ❑ Orange County ❑ Financial funding system need to be Commissioners simplified, and the state needs to adopt and support a comprehensive plan for the public sector system — NC General Assembly ❑ A basic level of mental health services should be available in every county which would be state funded ❑ HSAC should launch a project to expand the number of advocates for mental wellness ❑ A rationale has to be developed for why mental health issues should be a priority Health Insurance and Managed Care Facilitator: KT &DV ? ?? ❑ Lack of providers who will meet needs ❑ Licensure requirements for service of Medicaid and uninsured children ❑ Grant reciprocity for qualified providers ❑ Information to consumers regarding provider outcomes ❑ Educate legislators /public leaders ❑ Educate local community ❑ Need for services and funding for ❑ Communicate with legislators to change undocumented children policy ❑ Collaboration amongst existing local task forces on focused issues ❑ Financial support /advocacy for existing providers /programs ❑ Learn from existing programs /states ❑ Sensitivity to racism, poverty, respect ❑ Educate legislators regarding current local standard of care issues ❑ Train and model staff regarding sensitivity ❑ Early and on -going education for everyone ❑ Develop funding for long- term /therapeutic community -based services for traumatized children (continued) "Managed Care and Beyond: Fostering Health in Our Community ".._ Table 2. Working Lunch Results (continued) What are the issues? Uninsured /Underinsured and Managed Care ❑ Mobilize local resources in an organized and coordinated way Community -Based Health Alternatives ❑ Need for better outreach ❑ Increase availability of healthcare for young children ❑ Expand community services to rural areas of Orange County ❑ Need for more community health cl to meet needs of diverse population In -home Care. Services and Managed Care ❑ Ultimate goal: home health is better than institutional care ❑ Develop infrastructure ❑ Promote easy -to -use point of entry to government and area services What should be done? Facilitator: ??? ❑ Use advocate system to help clients ❑ Resource guide to help clients ❑ Convene meeting with providers for problem solving ❑ Look at grants for funding these ideas ❑ Strategies to better deal with who shows up as uninsured ❑ Consider role of university Facilitator: ? ?? ❑ Newsletters to churches about programs ❑ Hold programs at church • Identify resources in community and partner with agencies providing services • Transportation ❑ Time ❑ Educate /motivate parent ❑ Better use of existing well -baby clinics and other clinical services ❑ Educate /motivate parent ❑ Transportation ❑ Mobile programs ❑ Understand and utilize services of agencies ❑ Mobile programs Facilitator: Who will do this? ❑ Encourage growth of numbers of trained personnel in Orange County ❑ Sponsor quantitative study to see scope of problem ❑ Outreach, media and publicity ❑ Encouragement of such services as the Department on Aging personal care list ❑ Community initiated 5 ❑ Health insurance ❑ Local community - Orange County Board of County Commissioners ❑ Orange County Health Department ❑ Health Access Coalition ❑ IRIS - make available on the web ❑ Town /Gown Committee ❑ Encourage growth of numbers of trained personnel in Orange County ❑ Sponsor quantitative study to see scope of problem ❑ Outreach, media and publicity ❑ Encouragement of such services as the Department on Aging personal care list ❑ Community initiated 5 1998 HSAC Forum (continued) Table 2. Working Lunch Results (continued) What are the issues? What should be done? Who will do this? ❑ Regulations that provide no assistance ❑ Dedicate case manager for non - Medicaid for people who do not qualify under eligible individuals who need help extreme poverty rate - it is easier for ❑ Support more staff hours for programs some to be institutionalized than receivc like adult daycare in -home care ❑ Advocate for legislative change CONCLUSIONS The explosion of managed care in the United States and in North Carolina is a result of the necessity to control the spiraling costs of health care. A surfeit of unnecessary tests and procedures has even been proven to be detrimental to patient welfare. However, recent experience has proven that balances must also be placed on the other side of the equation to ensure that individuals receive comprehensive care under all circumstances. The status of the chronically ill and the uninsured remains a critical issue in the managed care debate. Legislative action has garnered bipartisan support in North Carolina and has already established needed consumer protections. Continuing legislative action is not possible without the strong voice of the consumer and attention from the media and community leaders. Interested citizens must continue to advocate for change. 1162