HCAO News

Insurers shoving “advanced illness counselors” on us

Operator? Business, Insurer Take On End-of-Life Issues By Phone
By Elana Gordon, WHYY
Kaiser Health News, August 27, 2014
Forward by Don McCanne, see comments below.

Kate Schleicher, 27,  is a licensed clinical social worker, who knows almost as little about you as you do about her. Except she knows your phone number, your insurance provider and that you are pretty sick.

Schleicher is one of 50 social workers at a company called Vital Decisions. After sending a letter (people rarely respond) counselors essentially cold-call to offer what they describe as “nondirected” end-of-life counseling.

The hope of this program, she says, is to build a relationship over the phone, so (the patient) might be comfortable discussing his situation and his goals. Then he’ll be empowered to communicate those things with others, including his family and his doctors. He could also choose to allow the counselor to talk to his doctors or family directly. It’s paid for by insurers and federal privacy rules permit this for business purposes.

And when these conversations do happen, there’s can be another byproduct: reduced costs. Res

READ MORE

Oracle whistleblower figures prominently in state's lawsuit over 'shoddy' Cover Oregon work

 by Elizabeth Hayes Staff Reporter- Portland Business Journal
For Health Care Inc Aug 25, 2014,

The state revealed a secret weapon in its lawsuit against Oracle Cor p.: an unnamed former Oracle employee with first-hand knowledge of what went down at Cover Oregon.

Actually, it’s not clear if it’s one whistleblower or several, but either way, they have a few pointed things to say about Oracle’s work on the troubled website. For its part, Oracle has said the state’s account was “fictional” and that the truth would prevail both in this lawsuit and the one it filed in federal court two weeks ago.

READ MORE

Oregon health reforms threatened by new federal directive, officials say

A new federal directive has thrown a wrench into Oregon Gov. John Kitzhaber's reforms to the Oregon Health Plan. (The Oregonian/Bruce Ely)

A new federal directive has thrown a wrench into Oregon Gov. John Kitzhaber's reforms to the Oregon Health Plan. (The Oregonian/Bruce Ely)

by Nick Budnick for Oregon Live
on August 21, 2014, updated August 22, 2014

Federal officials have thrown a wrench into the state's high-stakes reforms to the Oregon Health Plan, threatening a program that serves one in four Oregonians.

A new directive could eventually even force the state to return hundreds of millions of dollars received from the federal government – money that's already largely spent.

The federal agency that holds the purse strings for care of nearly 1 million low-income Oregon Health Plan members recently harshly criticized the state's system for distributing money to regional coordinated care organizations under the reforms.

The Aug. 7 letter from the Centers for Medicare and Medicaid Services says the state is employing "high-risk practices" as well as projections that "differ greatly" from those used by the CCOs themselves.

READ MORE

Advertising Campaign Sparks Insurance Complaints

Last year, Moda Health Plan had the highest number of complaints among the major health insurers, while Regence BlueCross BlueShield followed closely behind.

by Diane Lund-Muzikant, for The Lund Report, 8-20-14

Complaints work! Just ask the Oregon Insurance Division, which has seen its complaint numbers spiral by 34 percent after launching an advertising campaign in May.

Better yet – those advertising dollars aren’t coming out of taxpayer pockets. 

After receiving around $1.9 million from multi-state settlements against insurance companies, the Division decided to put those dollars to work and is spending $833,000 on television, radio and billboards, along with print and digital advertisements -- encouraging people to file complaints after they’ve been denied care or faced delays getting their insurance company to pay the bills, according to Lisa Morawski, spokeswoman. Fish Marketing produced the segments, after receiving the $1.3 million contract.

READ MORE

Report: Racial Discrimination Severely Undermines Black Women’s Health

All too often, when women of color are concerned about things outside of what appears to be the predominant white woman’s agenda, they aren’t considered "women’s issues." But, we cannot tell women of color what issues are important to them. (StoryOfAmerica / YouTube)

All too often, when women of color are concerned about things outside of what appears to be the predominant white woman’s agenda, they aren’t considered "women’s issues." But, we cannot tell women of color what issues are important to them. (StoryOfAmerica / YouTube)

by Elizabeth Dawes Gay, Reproductive Health Technologies Project
August 13, 2014
This piece is published in collaboration with Echoing Ida, a Forward Together project.

On Wednesday, August 13, the United Nations Committee on the Elimination of Racial Discrimination begins a two-day review of the United States government’s efforts, or lack thereof, to address pervasive racial discrimination in law and practice. When the United States ratified the International Convention on the Elimination of All Forms of Racial Discrimination in 1994, it consented to a periodic review by human rights experts of its progress toward meeting the goals in the treaty. The last time such a review was conducted was 2008, when the committee expressed specific concern about persistent and worsening disparities in sexual, reproductive, and maternal health in the United States—particularly for Black women—and offered recommendations about how the country could reduce those disparities.

It’s no secret that Black women are more likely than others to experience negative maternal health outcomes, such as preterm birth or stillbirth, to suffer from conditions like preeclampsia, and to die at higher rates from pregnancy-related causes. A new shadow report, Reproductive Injustice: Racial and Gender Discrimination in U.S. Health Care, by the Center for Reproductive Rights, the National Latina Institute for Reproductive Health, and SisterSong Women of Color Reproductive Justice Collective shares some alarming data on maternal health outcomes as well as disturbing firsthand accounts of the racial discrimination experienced by Black women.

READ MORE

ACA plan renewal leads to rate shock and delayed tax refunds

An Ounce Of Prevention For The ACA’s Second Open Enrollment

gy Jon Kingsdale and Julia Lerche
Health Affairs Blog, August 4, 2014

Since recovering from its flawed rollout, the ACA has enjoyed a string of successes. By April, some eight million Americans managed to enroll.

Approximately 87 percent of Marketplace enrollees claimed premium tax credits, of which an estimated 85 percent, or six million, actually paid premiums. Many of the original six million, plus more recent enrollees, will experience their second enrollment between November 15, 2014 and February 15, 2015. They will also file with the IRS for a premium tax credit as early as January 2015.

The two events in combination represent a huge risk.

READ MORE

Our Health Care Dead Matter Less Than War Dead?

caption: "We cannot stop people from getting sick or hurt, but we can stop killing them with our lack of action to change the system that snuffs out their lives," writes Donna Smith. (Photo: Public Citizen)

caption: "We cannot stop people from getting sick or hurt, but we can stop killing them with our lack of action to change the system that snuffs out their lives," writes Donna Smith. (Photo: Public Citizen)

Published on Monday, August 11, 2014 in Common Dreams
By Donna Smith

The photos are horrific of the dead and injured from the most recent escalation of warfare in Palestine.  Seeing dead children who have their small bodies ripped apart by weapons of war forces me (and others I suspect) to confront the realities of our violent, war-prone world.  I hate war.  It hurts to see the photos, and I always have a hard time understanding why we have all had to assert our power since the beginning of recorded history by killing one another.  Will we ever advance beyond settling our differences with war?

Then I also think about the 123 people dying every day in the U.S. without access to the health care that might have saved their lives.  This is a war too.  It is a war waged by the rich and powerful against those without enough money or power.  People suffer and die needlessly and invisibly since no one takes their photos or speaks of them on the evening news.  Do their lives matter less than those of the war dead in the Middle east?  Apparently so.  Or we'd see the pictures and we'd hear the stories and we'd stop blaming these health care dead for not being rich enough or powerful enough to access care.

READ MORE

Insurers Push Back Against Growing Cost Of Cancer Treatments

Patient gets chemotherapy in North Carolina in 2003 (Photo by Chris Hondros/Getty Images).

Patient gets chemotherapy in North Carolina in 2003 (Photo by Chris Hondros/Getty Images).

by Julie Appleby KHN Staff Writer
Kaiser Health News Jun 17, 2014
This KHN story also ran in The Daily Beast

Some cancer patients and their insurers are seeing their bills for chemotherapy jump sharply, reflecting increased drug prices and hospitals’ push to buy oncologists’ practices and then bill at higher rates.

Patients say, “‘I’ve been treated with Herceptin for breast cancer for several years and it was always $5,000 for the drug and suddenly it’s $16,000 -- and I was in the same room with the same doctor same nurse and the same length of time’,” said Dr. Donald Fischer, chief medical officer for Highmark, the largest health plan in Pennsylvania.

READ MORE