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Article source: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm352948.htm
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Note: If you need help accessing information in different file formats, see Instructions for Downloading Viewers and Players.
Article source: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm352948.htm
When Maria and Vadim Brodsky’s then-7-year-old daughter needed an MRI two years ago to examine a tumor in her head, they took her to a hospital in their health plan’s network and were dismayed to receive a $4,500 bill.
The couple had a $6,000 deductible on their family plan. And even though the bill was reduced to $3,000 – the price the provider and insurer had agreed to by contract – the Brodskys had to cover all of it.
The next year, when their daughter needed another MRI, the Huntingdon Valley couple took her to a stand-alone facility and put the procedure on a credit card. The total bill: $600.
So it goes in the new world of health insurance, where high-deductible plans are growing more widespread and the consumers in those plans often have an incentive to haggle with providers.
Health insurance still protects people from high out-of-pocket costs for care. But these days, more people have cheaper, high-deductible plans in which they must cover the first $1,000, $5,000, or even $10,000 of care before insurance kicks in.
For that group, it pays to shop around, experts say.
“It’s definitely worth it to look at different hospitals or outpatient services, because prices can vary dramatically,” says Carrie McLean, senior manager of customer care at eHealthInsurance.com, an online vendor.
Five years ago, 12 percent of workers faced a deductible of at least $1,000 for single coverage. Today, more than a third do, according to the Kaiser Family Foundation’s 2012 survey of employer-sponsored plans.
Increasingly, a high-deductible plan, often linked to a tax-advantaged health savings account, is the only insurance offered on the job, even at big companies that have long offered generous coverage.
Proponents of high-deductible plans say consumers will make more cost-conscious health-care choices if they have to spend more of their own money. According to an analysis by the Robert Wood Johnson Foundation, consumers in such plans cut their medical spending by between 5 percent and 14 percent. But results were mixed on whether they cut back only on unnecessary care or on treatment that was needed.
As patients increasingly owe a bigger share of the bill, “providers and patients have gotten creative about paying out-of-pocket costs,” says Mark Rukavina, a principal at Community Health Advisors in Boston who consults for nonprofit hospitals. “The price that appears on an invoice may be fluid.”
Insurers in recent years have helped ease the burden by billing consumers only for the companies’ lower contracted rates.
And the Affordable Care Act takes some pressure off by requiring many health plans to cover preventive services without applying those charges to the deductible.
Still, high bills are a fact of life.
One way patients can cut costs is by agreeing to pay cash at the time service is provided. Many doctors and hospitals offer such “prompt pay discounts.”
“If they’re willing to pay in cash and I don’t have to wait six weeks for reimbursement [from the insurer], I’ll reduce the bill by 10 to 25 percent,” says Joseph Mambu, a family physician in Lower Gwynedd.
Patients who pay hospitals within 30 to 60 days of billing – the time frames vary – can often get up to a 30 percent discount, adds Rukavina.
It’s also worth asking hospitals about financial-assistance policies, says Rukavina. They’re not necessarily only for uninsured patients. “Many have policies for the uninsured as well as underinsurance and might provide relief for the amounts due after insurance has paid,” he says.
Paying directly, however, can have downsides because it bypasses the insurance claims process, advocates warn. For one thing, those immediate payments won’t be applied to the deductible, so if the patient has more medical expenses later in the year, he or she won’t get “credit” for the amount spent. And, if there’s an error in the bill, you may not find out about it.
“If you don’t use your insurance, the bill won’t be reviewed [by the insurer] for errors,” says Pat Palmer, founder of Medical Billing Advocates of America, which helps consumers resolve medical billing problems.
Some patients are willing to take those chances to get a cash discount.
Typically, consumers’ medical bills are adjusted to reflect the contracted rate the provider has agreed to accept from the insurer. This lower rate is applied even when consumers are paying 100 percent of the bill because they haven’t yet satisfied their deductible.
That’s how the Brodsky family’s first bill was reduced.
Among other tips:
You are more likely to succeed in negotiating a lower price for care that’s not covered by insurance or that’s done by an out-of-network provider, say experts. “Usually, patients are very successful in appealing [higher charges for] any out-of-network providers that took care of them while at an in-network facility,” says Palmer.
Insurers often have different discount deals with different types of facilities, says Palmer. At a standard radiology practice, the discount for an MRI may be only 20 percent, she says, but it can be 40 percent at a stand-alone imaging facility. Charges at teaching hospitals are often higher than at other facilities, she says. “Look to have the service done outside the hospital or hospital-owned facility,” says Palmer. “It’s often going to be less expensive.”
Drug prices vary widely, even for generic drugs. A recent Consumer Reports analysis compared prices at 200 pharmacies for five common generic drugs. The variation between the highest- and lowest-priced stores was a hefty $749 for the five drugs. The takeaway: shop around.
Dawn Herbert, 41, of Philadelphia, saves a $14 copayment each month by filling her prescription for generic birth control meds at Walmart instead of CVS. “Whatever the insurance is paying for that drug, Walmart is considering it payment in full,” she says.
Kaiser Health News at www.kaiserhealthnews.org is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
Article source: http://www.philly.com/philly/health/healthcare-exchange/20130519_You_better_shop_around.html
When Maria and Vadim Brodsky’s then-7-year-old daughter needed an MRI two years ago to examine a tumor in her head, they took her to a hospital in their health plan’s network and were dismayed to receive a $4,500 bill.
The couple had a $6,000 deductible on their family plan. And even though the bill was reduced to $3,000 – the price the provider and insurer had agreed to by contract – the Brodskys had to cover all of it.
The next year, when their daughter needed another MRI, the Huntingdon Valley couple took her to a stand-alone facility and put the procedure on a credit card. The total bill: $600.
So it goes in the new world of health insurance, where high-deductible plans are growing more widespread and the consumers in those plans often have an incentive to haggle with providers.
Health insurance still protects people from high out-of-pocket costs for care. But these days, more people have cheaper, high-deductible plans in which they must cover the first $1,000, $5,000, or even $10,000 of care before insurance kicks in.
For that group, it pays to shop around, experts say.
“It’s definitely worth it to look at different hospitals or outpatient services, because prices can vary dramatically,” says Carrie McLean, senior manager of customer care at eHealthInsurance.com, an online vendor.
Five years ago, 12 percent of workers faced a deductible of at least $1,000 for single coverage. Today, more than a third do, according to the Kaiser Family Foundation’s 2012 survey of employer-sponsored plans.
Increasingly, a high-deductible plan, often linked to a tax-advantaged health savings account, is the only insurance offered on the job, even at big companies that have long offered generous coverage.
Proponents of high-deductible plans say consumers will make more cost-conscious health-care choices if they have to spend more of their own money. According to an analysis by the Robert Wood Johnson Foundation, consumers in such plans cut their medical spending by between 5 percent and 14 percent. But results were mixed on whether they cut back only on unnecessary care or on treatment that was needed.
As patients increasingly owe a bigger share of the bill, “providers and patients have gotten creative about paying out-of-pocket costs,” says Mark Rukavina, a principal at Community Health Advisors in Boston who consults for nonprofit hospitals. “The price that appears on an invoice may be fluid.”
Insurers in recent years have helped ease the burden by billing consumers only for the companies’ lower contracted rates.
And the Affordable Care Act takes some pressure off by requiring many health plans to cover preventive services without applying those charges to the deductible.
Still, high bills are a fact of life.
One way patients can cut costs is by agreeing to pay cash at the time service is provided. Many doctors and hospitals offer such “prompt pay discounts.”
“If they’re willing to pay in cash and I don’t have to wait six weeks for reimbursement [from the insurer], I’ll reduce the bill by 10 to 25 percent,” says Joseph Mambu, a family physician in Lower Gwynedd.
Patients who pay hospitals within 30 to 60 days of billing – the time frames vary – can often get up to a 30 percent discount, adds Rukavina.
It’s also worth asking hospitals about financial-assistance policies, says Rukavina. They’re not necessarily only for uninsured patients. “Many have policies for the uninsured as well as underinsurance and might provide relief for the amounts due after insurance has paid,” he says.
Paying directly, however, can have downsides because it bypasses the insurance claims process, advocates warn. For one thing, those immediate payments won’t be applied to the deductible, so if the patient has more medical expenses later in the year, he or she won’t get “credit” for the amount spent. And, if there’s an error in the bill, you may not find out about it.
“If you don’t use your insurance, the bill won’t be reviewed [by the insurer] for errors,” says Pat Palmer, founder of Medical Billing Advocates of America, which helps consumers resolve medical billing problems.
Some patients are willing to take those chances to get a cash discount.
Typically, consumers’ medical bills are adjusted to reflect the contracted rate the provider has agreed to accept from the insurer. This lower rate is applied even when consumers are paying 100 percent of the bill because they haven’t yet satisfied their deductible.
That’s how the Brodsky family’s first bill was reduced.
Among other tips:
You are more likely to succeed in negotiating a lower price for care that’s not covered by insurance or that’s done by an out-of-network provider, say experts. “Usually, patients are very successful in appealing [higher charges for] any out-of-network providers that took care of them while at an in-network facility,” says Palmer.
Insurers often have different discount deals with different types of facilities, says Palmer. At a standard radiology practice, the discount for an MRI may be only 20 percent, she says, but it can be 40 percent at a stand-alone imaging facility. Charges at teaching hospitals are often higher than at other facilities, she says. “Look to have the service done outside the hospital or hospital-owned facility,” says Palmer. “It’s often going to be less expensive.”
Drug prices vary widely, even for generic drugs. A recent Consumer Reports analysis compared prices at 200 pharmacies for five common generic drugs. The variation between the highest- and lowest-priced stores was a hefty $749 for the five drugs. The takeaway: shop around.
Dawn Herbert, 41, of Philadelphia, saves a $14 copayment each month by filling her prescription for generic birth control meds at Walmart instead of CVS. “Whatever the insurance is paying for that drug, Walmart is considering it payment in full,” she says.
Kaiser Health News at www.kaiserhealthnews.org is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
Article source: http://www.philly.com/philly/health/healthcare-exchange/20130519_You_better_shop_around.html
Last year, many health insurers were predicting huge premium increases of up to 70 percent for new individual health plans created under “Obamacare” rules.
But when insurers filed their requests for rates last week with the Washington State Office of the Insurance Commissioner, something very different happened: Requested premiums were not much higher than current plans.
“Considering the dire situation the companies predicted, we’re extremely surprised,” said Stephanie Marquis, spokeswoman for state Insurance Commissioner Mike Kreidler.
Previously, the insurers blamed changes under Obamacare for their bleak forecast.
The law requires everyone to buy insurance or pay a penalty beginning in 2014, and insurers will be required to take any paying customer.
The insurer’ predictions were based on an expectation of a flood of people with “pre-existing conditions,” including those insured by the state’s high-risk pool for people so sick that private companies had turned them away.
The insurers also worried that people who hadn’t had insurance for some time would rush out and get complex, expensive health care they’d been putting off for years, pushing insurers’ costs upward.
For a number of reasons, insurers have revised their calculations.
However, the insurance commissioner’s office hasn’t begun to review the rates, which it could challenge as too high — or too low, if it appears insurers have artificially lowballed rates to gain market share.
Both insurers and regulators cautioned that an apples-to-apples comparison with current rates is difficult, at best. These are entirely new plans, most with more benefits and different out-of-pocket amounts and limits than the old plans.
And whether an individual will pay more or less than they pay now, or than plans now on the market, will depend on many factors, including the makeup of their previous plan, their age and whether their income qualifies them for a federal subsidy.
Individuals making up to $45,960 and families of four making up to $94,200 a year will be eligible for subsidies if they buy their plans through the new online marketplace exchange created by the federal law.
These new individual plans, which will be available this fall and take effect in 2014, cover a much wider range of benefits than most current individual plans.
The new plans must cover 10 “essential health benefits,” including items rarely covered now by individual plans, such as prescription drugs and maternity and newborn care.
The new rules limit out-of-pocket costs in most plans to $6,350 for individuals and $12,700 for families, including deductibles but not premiums. The plans can no longer have annual or lifetime coverage caps for essential health services.
In an attempt to quantify the changes, the insurance commissioner’s office looked at the most popular two plans now offered by LifeWise Health Plans of Washington, a Premera Blue Cross subsidiary that offers the top-selling individual plans in Washington.
To compare current and new plans, the insurance office considered not just premiums, but deductibles and cost-sharing.
It concluded that for most adults who are now either uninsured or who hold an individual plan, the out-of-pocket costs with similar new plans would be about the same as plans now offered.
Young adults, though, may get hit with significantly higher premiums.
But state planners estimate that over 50 percent of 18-24-year-olds will qualify for tax credit subsidies or state Medicaid under the law, which would reduce the premium for plans they buy inside the exchange. In addition, those under 30 will still be able to buy high-deductible, catastrophic-coverage plans.
Inside the exchange, insurers offer three levels of plans with different cost-sharing arrangements: “gold” plans pay 80 percent of medical costs, “silver” plans 70 percent, and “bronze,” 60 percent.
For plans offered by four major insurers, here is the range of monthly premiums in King County filed by four major insurers:
• $166-$279 for a 21-year-old, single non-tobacco user;
• $212-$356 for a 40-year-old single non-tobacco user;
• $451-$757 for a 60-year-old single non-tobacco user.
The highest premium rate level requested was $997 per month for a 60-year-old smoker in a “gold” level Regence BlueShield plan with dental and vision care and an individual-assistance component.
To compare current plans with these new plans, analyst Jim Keogh with the insurance office compared the two current LifeWise plans with two new plans at the silver and bronze level the company said it expected to be the two most popular.
Keogh compared not just premiums, but all out-of-pocket costs from deductibles and cost-sharing that would be expected, on average. The insurance commissioner’s office notes that many individual plans today cover only 40 percent to 50 percent of costs overall, with the purchaser picking up the rest.
For a 40- to 44-year-old in very good to excellent health, the popular LifeWise WiseEssentials 6 ($1,970 deductible) plan now costs $3,680 per year in premiums. Average out-of-pocket costs of $1,170, Keogh calculated, would bring that person’s total annual cost of health care to $4,850 per year.
For the roughly comparable new LifeWise silver plan, while the annual premiums are slightly more ($3,972 per year), the out-of-pocket costs would be considerably less ($743), making the total $4,715.
The current Lifewise plan with a $3,500 deductible is about $140 per year more expensive in total costs than the most comparable new bronze plan.
Seniors in good health would actually save a small amount of money on new
silver plans, compared to similar current plans.
But for 21-25-year-olds in good health, both levels of the new plans were more expensive — the silver plan was $60 per month higher, while the bronze level was $48 per month higher.
What made the insurers change their tune?
In a nutshell, said Premera spokesman Eric Earling, changes and clarifications in federal rules and new actuarial figures showed Obamacare wasn’t going to raise costs as drastically as insurers had predicted.
In addition, changes in risk-sharing arrangements among health plans helped “level the playing field a bit,” by lessening the financial risk to any one company of taking on less-than-healthy people, he said.
Earling and other insurers cautioned, however, that individual people may see their rates rise.
“The rate impact varies,” he said. “And whether you are eligible for a federal subsidy is going to have a huge impact.”
Some analysts predict that premiums will rapidly rise in the future after insurers readjust rates based on costs incurred in 2014.
Insurers, Earling said, want to make sure insurance is affordable. But when medical costs rise, so will premiums.
“The ultimate issue in addressing cost is addressing the rising cost of medical services,” he said.
Carol M. Ostrom: costrom@seattletimes.com or 206-464-2249. On Twitter @costrom
Article source: http://seattletimes.com/html/localnews/2021013487_insuranceratesxml.html
Last year, many health insurers were predicting huge premium increases of up to 70 percent for new individual health plans created under “Obamacare” rules.
But when insurers filed their requests for rates last week with the Washington State Office of the Insurance Commissioner, something very different happened: Requested premiums were not much higher than current plans.
“Considering the dire situation the companies predicted, we’re extremely surprised,” said Stephanie Marquis, spokeswoman for state Insurance Commissioner Mike Kreidler.
Previously, the insurers blamed changes under Obamacare for their bleak forecast.
The law requires everyone to buy insurance or pay a penalty beginning in 2014, and insurers will be required to take any paying customer.
The insurer’ predictions were based on an expectation of a flood of people with “pre-existing conditions,” including those insured by the state’s high-risk pool for people so sick that private companies had turned them away.
The insurers also worried that people who hadn’t had insurance for some time would rush out and get complex, expensive health care they’d been putting off for years, pushing insurers’ costs upward.
For a number of reasons, insurers have revised their calculations.
However, the insurance commissioner’s office hasn’t begun to review the rates, which it could challenge as too high — or too low, if it appears insurers have artificially lowballed rates to gain market share.
Both insurers and regulators cautioned that an apples-to-apples comparison with current rates is difficult, at best. These are entirely new plans, most with more benefits and different out-of-pocket amounts and limits than the old plans.
And whether an individual will pay more or less than they pay now, or than plans now on the market, will depend on many factors, including the makeup of their previous plan, their age and whether their income qualifies them for a federal subsidy.
Individuals making up to $45,960 and families of four making up to $94,200 a year will be eligible for subsidies if they buy their plans through the new online marketplace exchange created by the federal law.
These new individual plans, which will be available this fall and take effect in 2014, cover a much wider range of benefits than most current individual plans.
The new plans must cover 10 “essential health benefits,” including items rarely covered now by individual plans, such as prescription drugs and maternity and newborn care.
The new rules limit out-of-pocket costs in most plans to $6,350 for individuals and $12,700 for families, including deductibles but not premiums. The plans can no longer have annual or lifetime coverage caps for essential health services.
In an attempt to quantify the changes, the insurance commissioner’s office looked at the most popular two plans now offered by LifeWise Health Plans of Washington, a Premera Blue Cross subsidiary that offers the top-selling individual plans in Washington.
To compare current and new plans, the insurance office considered not just premiums, but deductibles and cost-sharing.
It concluded that for most adults who are now either uninsured or who hold an individual plan, the out-of-pocket costs with similar new plans would be about the same as plans now offered.
Young adults, though, may get hit with significantly higher premiums.
But state planners estimate that over 50 percent of 18-24-year-olds will qualify for tax credit subsidies or state Medicaid under the law, which would reduce the premium for plans they buy inside the exchange. In addition, those under 30 will still be able to buy high-deductible, catastrophic-coverage plans.
Inside the exchange, insurers offer three levels of plans with different cost-sharing arrangements: “gold” plans pay 80 percent of medical costs, “silver” plans 70 percent, and “bronze,” 60 percent.
For plans offered by four major insurers, here is the range of monthly premiums in King County filed by four major insurers:
• $166-$279 for a 21-year-old, single non-tobacco user;
• $212-$356 for a 40-year-old single non-tobacco user;
• $451-$757 for a 60-year-old single non-tobacco user.
The highest premium rate level requested was $997 per month for a 60-year-old smoker in a “gold” level Regence BlueShield plan with dental and vision care and an individual-assistance component.
To compare current plans with these new plans, analyst Jim Keogh with the insurance office compared the two current LifeWise plans with two new plans at the silver and bronze level the company said it expected to be the two most popular.
Keogh compared not just premiums, but all out-of-pocket costs from deductibles and cost-sharing that would be expected, on average. The insurance commissioner’s office notes that many individual plans today cover only 40 percent to 50 percent of costs overall, with the purchaser picking up the rest.
For a 40- to 44-year-old in very good to excellent health, the popular LifeWise WiseEssentials 6 ($1,970 deductible) plan now costs $3,680 per year in premiums. Average out-of-pocket costs of $1,170, Keogh calculated, would bring that person’s total annual cost of health care to $4,850 per year.
For the roughly comparable new LifeWise silver plan, while the annual premiums are slightly more ($3,972 per year), the out-of-pocket costs would be considerably less ($743), making the total $4,715.
The current Lifewise plan with a $3,500 deductible is about $140 per year more expensive in total costs than the most comparable new bronze plan.
Seniors in good health would actually save a small amount of money on new
silver plans, compared to similar current plans.
But for 21-25-year-olds in good health, both levels of the new plans were more expensive — the silver plan was $60 per month higher, while the bronze level was $48 per month higher.
What made the insurers change their tune?
In a nutshell, said Premera spokesman Eric Earling, changes and clarifications in federal rules and new actuarial figures showed Obamacare wasn’t going to raise costs as drastically as insurers had predicted.
In addition, changes in risk-sharing arrangements among health plans helped “level the playing field a bit,” by lessening the financial risk to any one company of taking on less-than-healthy people, he said.
Earling and other insurers cautioned, however, that individual people may see their rates rise.
“The rate impact varies,” he said. “And whether you are eligible for a federal subsidy is going to have a huge impact.”
Some analysts predict that premiums will rapidly rise in the future after insurers readjust rates based on costs incurred in 2014.
Insurers, Earling said, want to make sure insurance is affordable. But when medical costs rise, so will premiums.
“The ultimate issue in addressing cost is addressing the rising cost of medical services,” he said.
Carol M. Ostrom: costrom@seattletimes.com or 206-464-2249. On Twitter @costrom
Article source: http://seattletimes.com/html/localnews/2021013487_insuranceratesxml.html
“I probably would have been dead now,” said Mr. Gutierrez, 61, a recovering alcoholic. “I was helpless.”
Haven for Hope of Bexar County, is a 20-acre community that provides services, shelter and safety for people who are homeless or nearly so. Working with dozens of government agencies, nonprofit organizations, mental and medical health providers and religious groups, Haven helps people like Mr. Gutierrez make the transition from the street to a healthy home and a job.
For the first time since state lawmakers made historic budget cuts a decade ago, they are dedicating hundreds of millions of dollars more to mental health care. Haven serves as a model of the kind of services and success legislators aim to accomplish.
“It is a place of hope and new beginnings,” said Ms. Morin, the social worker who is now Haven’s assistant vice president for community and external affairs.
As Republicans and Democrats in the Texas House and Senate hash out the details of the state’s 2014-15 budget — there are fights over water, roads and education — one issue they are not arguing about is support for mental health.
“One thing we could all agree on was mental health was, to a large extent, a driver of crime,” said Representative John Zerwas, Republican of Richmond.
In the wake of mass shootings like the one at an elementary school in Newtown, Conn., in December, lawmakers disagreed vehemently about addressing gun laws. But legislators in both parties acknowledged that Texas should raise itself from its position at the bottom of the heap in spending for mental health services.
From 2006 to 2009, Texas ranked last in the nation in per-capita spending on mental health services, according to the Henry J. Kaiser Family Foundation. In fiscal year 2010, Texas spent $39 per capita and moved up a couple of spots from the bottom of the list. By comparison, Maine, near the top of the list, spent more than $300 per capita.
For years, mental health advocates have urged lawmakers to spend more on mental health care to prevent people with psychiatric illnesses like bipolar disorder and schizophrenia from winding up homeless or in jail or a public hospital. In 2011, sheriffs across the state asked legislators to finance community-based treatment programs to keep mentally ill Texans out of their jails. Houston’s Harris County Jail has become a de facto state hospital where psychotropic medication is needed for 2,000 inmates a day, Sheriff Adrian Garcia has said.
Senator Joan Huffman, a Republican from Southside Place and a former prosecutor and criminal court judge, said lawmakers in both parties realized this year that the state had reached a critical juncture.
“At some point it’s really inexcusable,” she said, “and you have to do something about it.”
This year, lawmakers had money to do something about it, said Dr. Zerwas, an anesthesiologist who sits on the House Appropriations Committee. In 2011, lawmakers faced a budget shortfall that some estimated to be as high as $27 billion. Now, budget writers are working with a surplus estimated at $12 billion.
Lawmakers have agreed to put $1.77 billion into mental health care, an increase of $259 million over the previous biennial budget. “It’s been a truly transformational amount of money,” Dr. Zerwas said.
Among the allocations, lawmakers are setting aside $57 million more to eliminate waiting lists for mental health services for children and adults. An additional $25 million will finance grants to local mental health authorities and crisis programs. Roughly $10 million more will go to substance abuse treatment.
To get a better idea about how state dollars should be invested, Dr. Zerwas and a bipartisan group of lawmakers toured Haven for Hope this year. The visit had a dramatic impact, he said.
Brightly colored butterflies on murals that decorate the buildings leading into the gated Haven campus represent its mission of transformation.
Haven opened in 2010 after an infusion of money and a fund-raising effort by a local business leader and a push from former Mayor Phil Hardberger of San Antonio to address the city’s homeless population. It has annual revenue of about $15.5 million, and nearly $1.6 million of that comes from state financing.
“You need to have some investment from your community,” said Mark Carmona, Haven’s chief executive. “It can’t be completely government-backed.”
bgrissom@texastribune.org
arocha@texastribune.org
Article source: http://www.nytimes.com/2013/05/19/us/with-consensus-and-money-state-takes-on-mental-health-care.html?pagewanted=all
“I probably would have been dead now,” said Mr. Gutierrez, 61, a recovering alcoholic. “I was helpless.”
Haven for Hope of Bexar County, is a 20-acre community that provides services, shelter and safety for people who are homeless or nearly so. Working with dozens of government agencies, nonprofit organizations, mental and medical health providers and religious groups, Haven helps people like Mr. Gutierrez make the transition from the street to a healthy home and a job.
For the first time since state lawmakers made historic budget cuts a decade ago, they are dedicating hundreds of millions of dollars more to mental health care. Haven serves as a model of the kind of services and success legislators aim to accomplish.
“It is a place of hope and new beginnings,” said Ms. Morin, the social worker who is now Haven’s assistant vice president for community and external affairs.
As Republicans and Democrats in the Texas House and Senate hash out the details of the state’s 2014-15 budget — there are fights over water, roads and education — one issue they are not arguing about is support for mental health.
“One thing we could all agree on was mental health was, to a large extent, a driver of crime,” said Representative John Zerwas, Republican of Richmond.
In the wake of mass shootings like the one at an elementary school in Newtown, Conn., in December, lawmakers disagreed vehemently about addressing gun laws. But legislators in both parties acknowledged that Texas should raise itself from its position at the bottom of the heap in spending for mental health services.
From 2006 to 2009, Texas ranked last in the nation in per-capita spending on mental health services, according to the Henry J. Kaiser Family Foundation. In fiscal year 2010, Texas spent $39 per capita and moved up a couple of spots from the bottom of the list. By comparison, Maine, near the top of the list, spent more than $300 per capita.
For years, mental health advocates have urged lawmakers to spend more on mental health care to prevent people with psychiatric illnesses like bipolar disorder and schizophrenia from winding up homeless or in jail or a public hospital. In 2011, sheriffs across the state asked legislators to finance community-based treatment programs to keep mentally ill Texans out of their jails. Houston’s Harris County Jail has become a de facto state hospital where psychotropic medication is needed for 2,000 inmates a day, Sheriff Adrian Garcia has said.
Senator Joan Huffman, a Republican from Southside Place and a former prosecutor and criminal court judge, said lawmakers in both parties realized this year that the state had reached a critical juncture.
“At some point it’s really inexcusable,” she said, “and you have to do something about it.”
This year, lawmakers had money to do something about it, said Dr. Zerwas, an anesthesiologist who sits on the House Appropriations Committee. In 2011, lawmakers faced a budget shortfall that some estimated to be as high as $27 billion. Now, budget writers are working with a surplus estimated at $12 billion.
Lawmakers have agreed to put $1.77 billion into mental health care, an increase of $259 million over the previous biennial budget. “It’s been a truly transformational amount of money,” Dr. Zerwas said.
Among the allocations, lawmakers are setting aside $57 million more to eliminate waiting lists for mental health services for children and adults. An additional $25 million will finance grants to local mental health authorities and crisis programs. Roughly $10 million more will go to substance abuse treatment.
To get a better idea about how state dollars should be invested, Dr. Zerwas and a bipartisan group of lawmakers toured Haven for Hope this year. The visit had a dramatic impact, he said.
Brightly colored butterflies on murals that decorate the buildings leading into the gated Haven campus represent its mission of transformation.
Haven opened in 2010 after an infusion of money and a fund-raising effort by a local business leader and a push from former Mayor Phil Hardberger of San Antonio to address the city’s homeless population. It has annual revenue of about $15.5 million, and nearly $1.6 million of that comes from state financing.
“You need to have some investment from your community,” said Mark Carmona, Haven’s chief executive. “It can’t be completely government-backed.”
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Article source: http://www.nytimes.com/2013/05/19/us/with-consensus-and-money-state-takes-on-mental-health-care.html?pagewanted=all
By Sarah Richards
Can’t sleep? Got the PMS blues? Before you open your medicine cabinet, step into your kitchen. “Real, whole, fresh food is the most powerful drug on the planet,” says Mark Hyman, M.D., author of The Blood Sugar Solution. “It regulates every biological function of your body.” In fact, recent research suggests not only what to eat but when to eat it for maximum benefit. Check out the latest smart food fixes.
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Problem: I’m Bloated
Food Fix 1: Dig In To Juicy Fruits And Vegetables
When you’re feeling puffy, you may not want to chow down on watery produce, but consuming foods like melon, cucumber and celery is an excellent way to flush out your system, says Elizabeth Somer, RD, author of Food Mood. “We need sodium to survive,” she explains, “but because we often eat too much of it, our bodies retain water to dilute the blood down to a sodium concentration it can handle. Eating produce with high water content helps the dilution process, so your body can excrete excess sodium and water.”
Food Fix 2: Load Up On Enzymes
Bloating can also be a sign that your intestines are out of whack. “If you’re irregular or experience gas right after eating, papaya can help,” explains Dharma Singh Khalsa, M.D., author of Food As Medicine. “Eating 1 cup several times a week helps rejuvenate the gastrointestinal system, thanks to papaya’s digestive enzyme papain, which breaks down protein.” The fiber also helps push food through your intestines, improving regularity. Try a smoothie with papaya, pineapple (it also contains digestive enzymes), protein powder, ice and almond milk.
Problem: I’m On An Emotional Roller Coaster
Food Fix 1: Say Yes To Breakfast
“People who eat within an hour or two of waking up have a more even mood throughout the rest of the day and perform better at work,” Somer says. British researchers found that study participants who skipped their morning meal did worse on memory tests and were more tired by midday than those who had eaten. The optimal breakfast includes a whole grain to supply glucose for your brain to run on, protein to satisfy hunger and keep your blood sugar levels steady and one or two antioxidant-rich fruits or vegetables. Somer’s suggestion: a 100 percent whole-grain cereal that contains at least 4 grams of fiber and no more than 5 grams of sugar, eaten with fruit and low-fat milk.
Food Fix 2: Stock Up On Selenium
A lesser-known trace mineral, selenium — found in Brazil nuts, tuna, eggs and turkey — helps keep you on an even keel. Women whose diets are deficient in the mineral are more prone to feeling depressed. Why? Selenium is crucial for the production of thyroid hormones, which govern metabolism and mood. You don’t need much, though: The recommended daily allowance for selenium is 55 micrograms, and you can get that amount by eating one 3-ounce can of tuna.
Problem: My Skin Is Acting Up
The Food Fix: Eat Your Onions
Battling breakouts? The antioxidants in onions and other sulfur-rich veggies tamp down the inflammation that leads to acne, says Valori Treloar, M.D., a dermatologist in Newton, Mass., and co-author of The Clear Skin Diet. The sulfur in onions, leeks and scallions helps produce a detoxifying molecule called glutathione, which a 2011 study found to be lower in the skin of people who were prone to breakouts.
This antioxidant is most potent when eaten in raw or lightly cooked foods. Try adding chopped scallions to your salad or stirring diced onions into your salsa or stir-fry. Taking folate and vitamin B6 and B12 supplements may also boost glutathione levels.
Problem: I Get Crazy-Bad Jet Lag
The Food Fix: Don’t Snack On The Plane
It’s no fun spending the first days of your vacation trying to acclimate. One surprising secret to avoiding the headaches, irritability and upset stomach of jet lag is to fast for several hours before arriving at your destination. That’s because when you eat influences your circadian rhythms, in much the same way that exposure to light and dark does.
Let’s say you’re headed to France. On the plane, steer clear of most food (but drink plenty of water), set your watch to Paris time and eat a high-protein breakfast at 7 a.m., no matter where you are on your trip. “The fast depletes your body’s energy stores, so when you eat protein the next morning, you get an extra kick and help your body produce waking-up chemicals,” explains Dave Baurac, spokesperson for the Argonne National Laboratory, a research institute based in Illinois.
Problem: I’m Tossing And Turning
Food Fix 1: Have A Late-Night Morsel
We’ve all been told to avoid eating too close to bedtime, but applying this rule too strictly could actually contribute to sleep woes. As anyone who has tried a fast knows, hunger can make you feel edgy, and animal studies confirm this. “You need to be relaxed to fall asleep, and having a grumbling stomach is a distraction,” explains Kelly Glazer Baron, Ph.D., an instructor of neurology at Northwestern University and spokesperson for the American Academy of Sleep Medicine. “It makes it hard to get to sleep and wakes you up at night.”
The trick is to tame the munchies 30 minutes to an hour before bed with a small snack that includes complex carbohydrates. “Since you metabolize sugars more slowly at night, a complex carb like whole wheat is a better choice,” Baron says. “It keeps your blood sugar levels even.” Try cheese and whole-wheat crackers or almonds and a banana.
Food Fix 2: Add Cherries
You can boost your snack’s snooze power by washing it down with a glass of tart cherry juice. A recent study of folks with chronic insomnia found that those who downed 8 ounces of juice made from tart Montmorency cherries (available in most grocery stores) one to two hours before bedtime stayed asleep longer than those who drank a placebo juice.
These sour powerhouses — which you can eat fresh, dried or juiced — possess anti-inflammatory properties that may stimulate the production of cytokines, a type of immune-system molecule that helps regulate sleep. Tart cherries are also high in melatonin, a hormone that signals the body to go to sleep and stay that way.
Problem: I Have Wicked PMS
The Food Fix: Keep An Eye On Iron
You might be more susceptible to the monthly blahs if you have low levels of iron, according to a new study.
Researchers looked at the diets of 3,000 women over 10 years and found that those who consumed more than 20 milligrams of the mineral daily had about a 40 percent lower risk of PMS than those who ingested less than 10 milligrams.
You can get almost your full daily dose by eating 1 cup of an iron-fortified cereal; other great sources include white beans (4 milligrams per one-half cup) and sautéed fresh spinach (3 milligrams per one-half cup).
Problem: I’m So Sensitive To The Sun
The Food Fix: Pile On Protective Produce
While you still need the usual sun protection (SPF 30 sunscreen as well as a wide-brimmed hat), you may be able to bolster your skin’s own resistance to UV rays with what you eat. The details: Micronutrients called carotenoids in fruits and vegetables protect the skin against sunburn, recent science shows. “Most topical sunscreens work by filtering out the UV component from the solar light that reaches the skin,” explains researcher Wilhelm Stahl, Ph.D., a professor of biochemistry at Heinrich Heine University in Düsseldorf, Germany. “But these micronutrients, if you have enough in your system, actually absorb UV light and prevent damage.”
The most potent carotenoids are the beta-carotene found in carrots, endive and spinach, and the lycopene in watermelon and tomatoes. Keep in mind that the effect isn’t instantaneous; you would need to eat a carotenoid-rich diet for at least 10 to 12 weeks in order to get the full benefit, says Stahl. Still, there is a reward for your patience: skin fortified to fend off sun damage and wrinkles.
“Fix Your Health Problems With Food” originally appeared on Health.com
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Article source: http://www.huffingtonpost.com/2013/05/18/fix-health-problems-food_n_3288398.html
Check out a great new resource on the Massachusetts health care system from the Blue Cross Blue Shield Foundation of Massachusetts: the Massachusetts Health Care Delivery System Map. As the state’s new Health Policy Commission seeks to get its mind and arms around the issue of market concentration, the Foundation’s new site boils the issue down to the key factors in an impressively accessible and compelling way.
For example, if you want to begin to understand why Partners Healthcare is so dominant in the state’s healthcare market, don’t go to this page, Hospital Systems by Size, on which Partners is #2 after Steward Health Care System. Go this this page: Physician Networks and Major Medical Groups, where the size of Partners’ physician network (called Partners Community Healthcare Inc., PCHI, or “peachy”) is larger than #2 (Steward) or #3 (Atrius), combined.
Or look at hospitals by Net Patient Service Revenue, and see that Partners total NPSR in 2010 ($4.2 billion) was the same as #s 2 (UMass Memorial), 3 (Steward), and 4 (Beth Israel Deaconess) combined.
Don’t forget this helpful page of Recent Changes in the Massachusetts health care market.
I found the page on Inpatient Capacity helpful as well. Yes, Partners dominates the Boston market, but no other, not even in the Greater Boston market. Pretty much every region (except for Northeast Mass.) has a single dominant player. The biggest is UMass Memorial which owns 54% of the inpatient capacity in Central Mass. If anything, this page helps to understand why inpatient hospital capacity is no longer the essential feature of market dominance that it used to be. It’s about the docs.
So much more to explore in this highly useful and accessible tool as the state debate over cost and market dominance continues. Kudos to Massachusetts Health Quality Partners which did the legwork on this terrific resource.
And congratulations to the Foundation on choosing a new Executive Director to succeed Sarah Iselin. Their choice is Audrey Shelto who has been a highly respected professional in government and non-profit health care in Massachusetts for three decades. An excellent choice to ensure that the Foundation continues its useful and important work for the Massachusetts health system.
Article source: http://www.boston.com/lifestyle/health/health_stew/2013/05/how_concentrated_is_mass_healt.html