Rate increases in the Health Insurance Marketplace: Should we freak out or chill out?
By Ken Janda, for the Houston Chronicle
August 15, 2016
August 15, 2016
In a vacation season when many of us want a break from alarming news, the world seems not to be cooperating. And that includes the health care industry. (A shame, that: “Health” and “care” could be such soothing words.)
We hear that we should be alarmed about proposed rate hikes in the subsidized Health Insurance Marketplace created by the Affordable Care Act (“ObamaCare”). But before we freak out, let’s take a deep collective breath and remember a couple of things.
First, proposed Marketplace rate increases probably don’t apply to you. Out of the 26.7 million Texans, slightly more than half of us — 52 percent, about 14 million — have employer-sponsored insurance. Another 13 percent are retirees covered under Medicare, and 17 percent are low-income children and pregnant mothers covered by Medicaid.
Just over a million Texans are insured via the federal Marketplace, and it’s only to them that the proposed rate increases may apply. (Most of the remaining 4 million-plus Texans are uninsured; they fall into the coverage gap.)
Read more in the Houston Chronicle: http://www.houstonchronicle.com/local/gray-matters/article/2016-the-summer-of-ObamaCare-9134773.php?t=4b3abc52d0
BACK-TO-SCHOOL HEALTH FAIRS WILL TAKE PLACE ACROSS EL PASO.
El Paso, TX: El Paso First Health Plans will provide backpacks to 1,500 children in the area by hosting a series of Back-to-School Health Fairs throughout the El Paso region. The campaign was launched on July 16, 2016, with the first health fair where 400 backpacks were distributed to children in the Horizon area. The health fair took place at Mission Ridge Elementary School.
The Back-to-School Health Fairs are family-friendly events open to the public. Backpacks will be distributed on a first-come basis at each health fair. School supplies donated by Kool Smiles dental clinics will also be distributed at the events.
“At El Paso First Health Plans, we believe in giving back to our community through grassroots efforts that improve the lives and wellbeing of all El Pasoans,” stated Frank Dominguez, President & CEO of El Paso First Health Plans. “This year, we decided to go beyond our Annual Back-to-School Health Fair and take on an unprecedented effort to distribute backpacks in every corner of El Paso because we know that families in every area have needs. And, what better way to help than to provide them with backpacks for their children.”
The Back-to-School Health Fairs will offer information and resources by over 30 community agencies and free health screenings. Attendees will enjoy entertainment and a special appearance by Super Heroes.
El Paso First Back-to-School Health Fairs
Super Heroes Appearance at 9:30am
Lower Valley
Saturday, August 6 ● 9:00 am- 1:00 pm
Presa Elementary School, 128 Presa Place, El Paso, TX 79907
Westside
Saturday, August 13 ● 9:00 am – 12:00 pm
Harvest Christian Center, 1345 New Harvest Place. El Paso, TX 79912
Northeast
Saturday, August 20 ● 9:00 am – 1:00 pm
Newman Elementary School, 10275 Alcan St. El Paso, TX 79924
For more information, contact El Paso First at 915-532-3778.
About: El Paso First Health Plans, Inc. is a non-profit, local health plan serving Medicaid and CHIP recipients. El Paso First Health Plans strives to be your trusted community health plan by providing access to quality healthcare.
Parkland Community Health Plan – Care Management for Behavioral Health
We would like to tell you about our Care Management program. We have trained staff who can help you with any special health care needs. They will give you information about ways to take care of your health.
Here are some special needs that we can help you with:
• Mental health concerns
• Long-term illness, like asthma or diabetes
• Other special needs
We are here to help as much or as little as you want us to The service does not replace any care you are currently receiving. It is part of your health plan benefit at no cost to you. If you enroll in the program, you will workwith a team of people.
Your team may include the following people:
• Case manager
• Care Management associate
Your team may include both. They will work with you and your doctor to create a plan of care just for you. The goal is to help you get the services you need. They will help you meet the health goals that are important to you.
If you are our member and you would like to enroll in this program, please call Member Services.
Parkland Health first 1-888-672-2277 Parkland Kids first 1-888-814-2352
Doctors, family members or caregivers can also refer a member for the program.
Some people choose not to get regular checkups, shots, and other important health tests. Sadly, they also do not go to the doctor until they are very sick. The truth is that the earlier you start treating an illness, the better chance you have to get and stay well.
Here are a few examples of doctor visits that are important for your family:
• Get a Texas Health Steps checkup within 90 days after joining DHP.
• Women should get a prenatal exam either within the first three months of pregnancy or within 42 days after joining DHP.
• New moms should have a post-partum exam within 21 to 56 days after their baby is born.
• Regular annual Texas Health Steps/well-child checkup to be done before your child’s birthday.
Talk with your doctor. Learn about ALL of the checkups, shots and regular tests that are important for your wellbeing. Also, try to live a healthier lifestyle. This includes exercise, eating healthy, getting enough sleep, and other ways to take better care of yourself. Preventative healthcare and living a healthy lifestyle may take more of your energy. The payoff is that you will live a longer and happier life.
Take care of your body, and your body will take care of you. You are worth it!
Let’s obliterate a serious health care threat: Zombies. Yes, zombies. They have become a recognized peril. Even the U. S. Centers for Disease Control website instructs us how to prepare for a Zombie Apocalypse. Join the CDC task force, and you might earn a zombie T-shirt.
The zombie I’m hunting is an undead political idea, one that threatens health care. It is the Obamacare Job-Killer Zombie.
Unlike garden-variety zombies, who simply hunger for good gray matters, the Obamacare Job-Killer Zombie comes to life during political campaigns. Fed mostly by politicians, the OJK Zombie roars threats from our television screens. As I have written before, the Affordable Care Act is far from perfect, and there is a long list of things I would change if we could ever talk about ACA 2.0. But “Obamacare is a job-killer!” is the lie that won’t die.
Originally published in the Houston Chronicle: http://www.houstonchronicle.com/local/gray-matters/article/The-lie-that-won-t-die-No-Obamacare-doesn-t-6771684.php
Community Health Workers-This Promotora or Community Health Worker (CHW is a lay Hispanic/Latino community member who received specialized training to provide basic health education in the community without being a professional health care worker. Ours are certified by the TX Department of State Health Services as CHWs and Diabetes Empowerment Education Program (DEEP) educators. The CHW is culturally competent, identifies barriers to care, and assists member to gain access to needed services while increasing health knowledge and self-sufficiency. Specifically for the Sendero OB Pathway – A Tu Lado, Sendero By Your Side program – the CHW will work with the member to overcome any barriers to care, which includes assisting with scheduling prenatal appointments and transportation needs. The CHW will facilitate at expanded group prenatal care classes which includes education, Life Steps Family Training, and support. Sendero sponsored educational baby showers will include a tour of hospital delivery rooms. The CHW will conduct a post-partum home visit to screen the mom and newborn to identify postpartum depression and any medical or social needs. Any needs will be referred to the Sendero Case Management team. The CHW will ensure mom has a post partum appointment and baby has a pediatrician appointment scheduled. The CHW will provide educational resource material including TX Health Steps check up list, when to call the doctor, and the 24/7 nurse advise line.
Reaching out to mother, child
By Mary Dale Peterson
Each year, nearly 9,500 moms-to-be in South Texas attend Driscoll Health System-sponsored Cadena de Madres (Network of Mothers) community baby showers. The free showers are open to any pregnant woman. We provide essential health information on how to prevent premature births, which can lead to infant deaths or long-term, costly care, in a fun, supportive environment.
Since 2009, Cadena de Madres and other innovative Medicaid programs in South Texas have helped Driscoll Health System reduce the premature birthrate by a remarkable 29 percent. The Texas premature birthrate is 10.4 percent (2013 data). In Nueces County, the premature birthrate — including for mothers with private health insurance — is 13 percent. In contrast, the premature birthrate for higher-risk Medicaid women enrolled in the Driscoll Health System is 10.2 percent. Our goal is to bring that rate down to 6 percent, far below the current national rate of 9.6 percent.
Nearly 10 years ago, 1 in 5 local babies required treatment in a neonatal intensive care unit. To change that, medical leaders from Driscoll Health System went into the community to meet with obstetricians and pregnant women, spreading the word about the importance of regular prenatal medical exams and full-term pregnancy (at least 39 weeks) for the health of the baby as well as the mother. A baby’s brain, lungs, and other important organs are not completely developed until 39 weeks. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recommend that C-sections and induced labor be performed only when medically necessary — never for convenience.
In addition, Driscoll Health System offers nutritional counseling for pregnant women; resources to help pregnant women stop using tobacco, alcohol, and illicit drugs; and health counseling for pregnant women who have chronic health conditions such as diabetes, high blood pressure, and obesity that can cause miscarriage, early birth, or other serious complications.
Driscoll Health System has maternal-fetal medicine specialists that provide care to low-income women enrolled in Medicaid. We hired five of these specialized physicians who travel throughout South Texas, often treating 30 to 40 pregnant women a day. They concentrate on high-risk pregnancies to control early labor, prevent miscarriages, and manage other health problems. The five circuit-riding doctors collaborate with obstetricians, pediatric cardiologists, geneticists, nurses, and ultrasound professionals, among others.
The community baby showers sponsored by Driscoll Health System complement the efforts of medical teams. The mother-to-mother peer network created at these prenatal education events is a powerful force for behavioral change. Pregnant women listen and learn from other pregnant women who understand the importance of healthy habits. At one recent shower, a young pregnant woman said she saw no danger in drinking. “My mother drank alcohol when she was pregnant with me, so I don’t know why that would cause any problems,” she said. The other expectant moms disagreed. A health care educator explained that alcohol can pass from a pregnant mother to her baby and cause brain damage as well as other permanent disabilities and developmental problems.
The health of mothers and babies is a priority for Driscoll Health System. We focus not only on medical needs, but also on social, educational, and support network needs. We also partner with Texas A&M Health Science Center’s Coastal Bend Health Education Center in Corpus Christi to help pregnant women manage their diabetes.
Women with stable support systems have healthier pregnancies and healthier babies, making our communities stronger and more economically sound. Our Medicaid-supported programs have a significant and positive impact on the health of South Texans. We are proud of that achievement. Healthy babies mean a healthy future for us all.
We continue to work with beneficial Medicaid programs and educational opportunities to improve the health of mothers and babies. We’ve learned that even a baby shower can help provide the best baby gift of all: good health.
Local Nonprofit Selected as STAR Kids Program Managed Care Organization
San Antonio’s only nonprofit health plan to serve local children on Medicaid
San Antonio—Community First Health Plans, San Antonio’s only local nonprofit health plan provider, has been chosen to serve as a managed care organization for the STAR Kids Program in the Bexar County service delivery area.
“We are excited with the announcement. As the largest Medicaid and CHIP health plan in the Bexar service delivery area, this allows us to serve even more of the San Antonio community,” said Greg Gieseman, president and CEO of Community First Health Plans. “We want to ensure that all children in our community have their health taken care of and help ease parents’ worries about paying for a child who may have disabilities.”
STAR Kids will be the first Medicaid managed care program tailored to the needs of youth and children with disabilities. The program provides benefits such as prescription drugs, hospital care, primary and specialty care, medical equipment and supplies and more to qualified children and youth.
Through STAR Kids, families are provided with coordinated care to help identify their child’s needs and connect members to services and qualified providers. Community First Health Plans will be one of San Antonio’s health plans to assess families’ service needs and create their individual service plans.
“Being able to serve our member families through the STAR Kids program allows us better care for children and families who may not know where to turn for their healthcare needs,” Gieseman said. “Community First wants to ensure that all children in our community have access to quality medical care they need.”
The STAR Kids program is set to begin in the Fall of 2016. Interested families wanting to look into Community First Health Plans services can visit www.communityfirsthealth.org or call 210-227-2347.
Our mission is to engage our membership in collective efforts promoting quality healthcare and administrative efficiency, particularly for services to Texans at low to moderate incomes. Over 2 million people receive healthcare through our member health plans, covering most counties in the state.