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Saturday, May 20, 2017

Taking the Time to Reconnect, It May Be Your Last Chance

   




Over the past few months, I have lost three friends. Two to cancer and one to natural causes (she was 96 years young).  The two friends with cancer were diagnosed around the time I found out I had a brain tumor. Once you are diagnosed with cancer, it seems you are put into a select group of people who you share a common bond and it brings you closer because having cancer is not something you can understand till you have it.


In this post, I share a photo of a few friends and a little story about each.

Pat Genardo, upper left photo. Pat is to my left. Pat is a case management colleague. We have been friends for over 20 years but only saw each other at the Annual Case Management Society of America Conference. Pat was active in her local chapter and had been the chair of her chapter, CMSA of Chicago, annual conference for as long as I can remember.

In January of 2017, she messaged me via Facebook and asked me to call her. I did and we talked for a while. I knew she was not doing well after battling Ovarian Cancer for several years. When she got around to why she asked me to call her, she said she wanted me to be the Keynote speaker for their conference in late April. The theme was, Rounding Up Your Passion for Case Management and she thought I would be a good person to speak on this topic. I told Pat I would love to speak, but only if she promised me she would be at the conference. Pat, true to her word, was there and looked great! We got to spend some time together and catch up. The next day, her daughter put a post on Facebook that Pat was admitted to the hospital and was on Hospice. She passed a week later with her entire family with her.
  
The next photo to the right is a group of colleagues from my time with Contexo Media which was located in SLC. I decided to go to a conference in Salt Lake City, I thought it would be great if we could bring this group together for dinner.

The main reason that this was important to me is that I wanted to be able to spend some time with one person, in particular, Jerry Okabe who is on the far right. He had contacted me a few months before and told me he was diagnosed with Pancreatic Cancer. When my plans to go to SLC were finalized, I called a friend who contacted the entire group to see who could make the dinner. Everyone knew Jerry was not doing well and wanted to come together so we had a good turnout! We had a great time and got to share some fun memories. I got to sit next to Jerry so we could talk and have a few laughs. I learned from his daughter via Facebook, a few weeks later that Jerry passed quietly with his family with him. 

The last photo is of a friend I met over 12 years ago through a volunteer group I belong, Quota International. I was contacted by one of the members that several people were driving up to West Palm Beach to take our friend, Miriam McIlvane (far left) to lunch to celebrate her 96th Birthday! I was glad I was able to attend. We had a great time and Miriam was so grateful that we all made the effort to celebrate with her. Miriam passed a few months later.

Each of these three friends were connected in various ways and touched based from time to time to catch up. With Pat and Jerry, our relationship changed once we found we had the common bond of cancer. As a result, we connected more often and took the time to share things that were personal and meaningful. We knew we each were facing a complex and scary fate causing our lives to take on a new meaning. 

As I noted, Miriam was a friend through a volunteer group (Quota International) that I am involved. She was an inspiration to many of us especially as we all aged! I always looked forward to seeing her at our District Conference (she never missed one in 50 years!) What I remember most about her, was that she always had a smile on her face!

One thing I have learned since being diagnosed with cancer is, that you have to live every minute to its fullest as you don't know when things will change and you won't have the opportunity to do the things we all put-off.  

Now I make a point of keeping in touch with people who are important to me. I try to send a note just to say hello! I take the time to make a call to someone who is on my mind and when I can, I try to visit in person.

I remember when my father was dying of lung cancer, many of our family members called our home to see how my dad was. I always encouraged them to come and visit while he was alive versus attending his funeral. Many did and although it was hard, they were grateful for having that last visit. 

I was so happy to visit each of these friends and I know my visit meant a lot to them. We got to talk, share our thoughts, laugh at our memories and take a picture that would become a lasting memory.

So in closing, my message to everyone reading this post is to stop what you are doing. Send a note, make the call and plan a visit to a friend or family member who has been on your mind! You will be glad you did! 

Sunday, May 14, 2017

Everyone needs an advocate when they are thrust into the complex world of health care





As a nurse, I was the one in our family who had healthcare experience and was looked to by family and friends when a healthcare challenge emerged.  But when I was diagnosed with a Brain Tumor in November 2014, it was my husband who stepped in as my caregiver and healthcare advocate.

Corky and I have been married for 29 years, and he has always been my biggest supporter as I moved forward in my career. He has always been the levelheaded member of our family. He also remains calm and respectful regardless of the situation. He has no healthcare experience except for the stories he has heard from me and my friends over the years. Yet, when the time came, he stepped up, took charge, and was my advocate through the most challenging time of my life.

When I got sick, he did his best to listen to the doctors and ask questions so he understood what they were telling him about my diagnosis, treatment options, and prognosis. I was cognitively not able to participate so Corky had to make decisions regarding my care and my life. Luckily we had discussed our wishes so he knew me, what my wishes were, and he advocated for me.

When my diagnosis was made, he realized this was a very serious situation. He called a good friend of mine and a fellow nurse case manager to help him understand what he was being told and what the options were at this point.  My friend, Marilyn was there to listen, support and help as she could. She was able to come to the hospital when we met with the neurosurgeon who explained the plan of care. It was at this meeting, they both realized I was not in the most appropriate hospital for the severity of my condition. As my advocate, Marilyn stepped into her case management role and took to the phones, till she found a neurosurgeon at the University of Miami who agreed to take my case. I was discharged from the small community hospital and went to see the Neurosurgeon the next day. 

I very sick when I met with the neurosurgeon at the University of Miami. He recognized this and admitted me right away so I was in a safe place and could be stabilized. He scheduled the brain biopsy for the next day so they were sure of the type of tumor I had and decide on the plan of care. Once the pathology report was back, I was referred to a hematologist who specialized in the type of tumor I had. I saw him right away and he ordered aggressive chemotherapy to be started. I truly believe this expedited care saved my life.

My husband took another piece of advice from Marilyn, that proved helpful throughout my treatment. She suggested he get a binder to keep all of my records.  Corky did this and collected reports, test, scans, lab work and notes that detailed my care and recommendations from everyone who saw me along the way. He took his own notes on what he was told by the various professionals who cared for me. He brought that binder to each appointment and when I was an inpatient in the hospital he had the binder with him every day. When the team made rounds, he listened to what they said and asked questions. Many times he was able to produce a report or a lab test that they needed but was not readily available in the chart. They would thank him and proceed with the orders.

Having Corky at my side and armed with useful information saved me from getting repeated test and experiencing medical errors. Many times the team would be talking about a direction they wanted to go and my husband would mention something my doctor had told him. He asked that they check with the head hematologist before writing the orders. Each time, they came back and said they were going to follow the current plan of care as directed by the Hematologist.

Once I improved and was able to participate and ask questions, my husband stayed involved and reminded me of various things that I was not aware of. He was always patient, respectful and willing to listen. Yet, he did not hesitate to ask a question or suggest that a resident, nurse or another member of the team check with the attending physician to ensure what they suggested was in line with my plan of care.

My experience reinforced to me, that every patient needs an advocate when they are thrust into the complex world of healthcare. It is evident to me more than every that the health care system is set up for the system and not the patient or their caregivers. Patients need to have someone by their side who is there for them. 

This is because so much information comes at you, at such a rapid pace at a time when you are least able to comprehend it. Having an advocate allows another person(s) to hear the information ask questions to help to clarify things and be able to repeat things over and over so you and other family members can make understand what is going on, so all are clear on the plan of care being designed on your behalf. 

Advocates can be a family member or friends. For most of us, this is all we need, another set of eyes and ears.  But for a complex situation, having a professional patient advocate is important.

Advocates are objective members of your healthcare team and are in place to ensure you have a voice, are able to ask questions and do research to look at alternatives that might match your plan of care so they meet your goals. Advocates address barriers and help to ensure your care needs are met. 

Independent Patient Advocates are paid privately by the patient or the family, so they are not under the restraints of the organizations which they work. There are Hospital Advocates in place who are also able to help. They are in place to represent you and ensure your needs are met when you or a loved one are in the hospital. Generally, they have the autonomy from the Hospital leadership to be your voice and to advocate for you when issues arise. In addition to Independent and Hospital Advocates, there are others such as Billing Advocates to help you review medical bills, address denials by your insurance company and negotiate bills so you can set up a payment plan that protects you. There are also Housing Advocates who can help find alternative living arrangements when needed. 

There are a number of ways you can find an advocate. Many have websites so they show up when you do a simple google search. When considering an advocate, take the time talk to them to make sure you are both clear on what they can do as well as have the experience to meet your needs. 

Keep in mind advocates do not provide hands-on care, but rather do research, meet with your health care team to understand the plan of care to ensure it meets your individual needs.  Advocates work on your behalf to break down barriers that exist in our complex system and ensure you are safe and have the information and resources to navigate the system and make decisions to address your individual needs. They ensure you have a voice in your care and are at the center of the health care system.

Here are some resources to help you learn about the emerging practice of Patient Advocacy.

Patient Advocate Certification Board: Advocates come from a variety of backgrounds. Currently, there is no national certification in place to help the consumer differentiate one advocate from another, but this is changing. Today, the Patient Advocate Certification Board is working to develop a national certification that will provide consumers and all members of the healthcare team with information they can use when choosing an advocate. You can add your email address so you can get updates on the progress of the project. 

Alliance of Professional Health Advocates (APHA) is a national/international organization designed for independent patient/health advocacy and care management professionals in the United States, Canada, and other countries around the worldAPHA provides support and resources advocates can use to start a practice or grow an existing practice.  

Aging Life Care Association: The Aging Life Care Association (ALCA), a nonprofit association with over 2,000 members. The mission of the organization is to lead the community of Aging Life Care Professionals™ through education, professional development, and the highest ethical standards.

Beryl Institute: Patient Advocacy Community: The Patient Advocate Community is a group that is your connection to other professionals who represent and advocate for consumers across the healthcare continuum.

National Association of Healthcare Advocacy Consultants: (NAHAC) is the is the professional organization for healthcare advocates dedicated to the improvement of patient outcomes through continuing education, promotion of national standards of practice, and active pursuit of policy change that lead to excellent person-centered healthcare.

Professional Patient Advocate Institute: The Professional Patient Advocate Institute exists to help professional advocates navigate the increasingly complex world of healthcare. As more advocates answer the call to aid those with complicated health and financial challenges, the Professional Patient Advocate Institute offers training to improve skills, and ultimately outcomes, for experienced and beginner advocates alike.

Today, there is a call for all of us to be active members of the healthcare team. Most of the time, we can do this for ourselves, but when you have a health care challenge that is complex and life changing, you need an advocate to be there for you! 

If you have questions on want to share how an advocate helped you during a time of needs, please leave a comment in the comment box or email me at allewellyn48@gmail.com

Have a good week!


Sunday, May 7, 2017

National Nurses Week: Reflecting on a Job Well Done



Nurses are the backbone of the healthcare system, yet many times we wonder if anyone notices. Well last week, Jimmy Kimmel, shared a personal story to millions of viewers about how an attentive nurse noticed his newborn baby boy had a problem. 

In his monolog, he noted as the nurse performed the newborn assessment, she noted that the baby had something wrong. She noted the child had a heart murmur and was a ‘little purple’. The nurse immediately took the baby out of the room to the nursery, summoned the team so that the child could be assessed and treated. Hours later, the baby was transferred to a specialty Children’s Hospital where emergency surgery was done. Today, (at the airing of the show) the baby is home and doing well. According to his Dad, he will need to be watched closely and will need additional surgeries to repair the heart defect, but… because of one nurse who noted a problem my son is alive today.

From a nurses point of view, the experience Jimmy Kimmel shared, happens every day in every corner of the healthcare system. As a father, he was grateful and humbled. But to me as a nurse, I was grateful that Jimmy Kimmel used his platform to showcase the important work that nurses play in today's healthcare system.  

I was moved by his monolog and thankful that he took the time to share his experience - it could not be a better introduction to National Nurses Week! In case you missed it, click here.

As I watched the monolog, I felt proud to be one of the 4.1 million nurses who quietly do their jobs every day in hospitals, managed care organizations, home care agencies, rehabilitation centers and other areas where care is provided for the millions of people who transition through the broad healthcare system. 

Most times our jobs are routine and matter of fact, but everyone once in a while, we recognize a problem and leap into action. Nurses are able to do this because of their training, their expertise, and their professionalism. They use the skills they have to educate and encourage their patients and their families. 

In Jimmy Kimmel’s monolog, he shared the experience intelligently and with emotion. Through his words, you could tell he knew the diagnosis, the plan of care and the severity of his son’s condition. You can tell he had been educated and empowered by the team of professionals who cared for his son and was already advocating for his newborn son. It was a wonderful example of patient empowerment and all nurses should be proud.   

This week is National Nurses Week. The theme the Amercian Nurses Association has chosen for 2017 is Nursing: The Balance of the Mind, Body, and Spirit. 

To all my nursing colleagues, take the time to celebrate the work you do and know it is appreciated even when no one tells you!  

For patients and caregivers, when you encounter a nurse this week, thank them for what they do! 

To all members of the healthcare team, make sure your nursing colleagues know they are appreciated and valued!


Have a good week! 

Sunday, April 23, 2017

Empowered Work Environments: Ensuring a Culture of Success




Today, the term empowerment is used in all aspects of the healthcare system. Before we can empower patients, healthcare teams need to ensure their workplace cultures encourage education and a forum where learning and growth are nurtured. 

In this week's post, I would like to explore the word empowerment and what it means to today's workforce. 

The term empowerment refers to the activity of the leader to give power to others to enable them to control their destiny and protect their rights.  Leaders must give the power to their subordinates in a way that they feel they have control over their destiny and therefore is the key to the road to a successful work environment.

Kanter, the most recognized theorist on structural empowerment, identified five components that must be present before participants of a workforce will be empowered. They include:


  • Opportunity (growth, mobility, promotion and recognition)
  • Knowledgebase (opportunity to learn and grow)
  • Necessary resources (having the tools and the staff to do the job safely and effectively)
  • Information (data, monitoring of improvement and technical skill to do the job)
  • Support (guidance and feedback from leaders, peers, and subordinates)


Kanter’s research has been found to demonstrate that by providing these conditions to employees, it has been shown that there is increased job satisfaction, commitment, trust and a marked decrease in job burnout. 

So how is your work environment? Take time to see if you work in an empowered workplace! If not, take the time to collaborate with your team to change the culture of your workplace. 

Do you work in an empowered workplace? If so, share how this environment has improved the outcomes you and your team have produced. Make a comment in the comment box below or email me at allewellyn48@gmail.com and share information about your work environment. I will share comments in a future post.

Resource: 


 A new book just released by an expert in Medical Improv. If you are looking for a way to improve your organizations' culture, communications and empower your teams to be the best they can be, check out Medical Improv a New Way to Improve Communications! The book explains the theory behind medical improve and also provides specific exercises you can include in staff meetings, in-services or other staff activities. Take advantage of the publication release discount.  Click here to order your copy! 



Sunday, April 9, 2017

Cost, Quality, and Access: The Three Ingredients for a Stable Health Care System






Last week’s post focused on the responsibility of having health care insurance. The purpose of health insurance is to help you pay for care whether it be preventative or diagnostic services. Insurance protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive. Having health insurance provides access to physicians, providers, and resources to enable your health and wellness.

In this week’s post, I wanted to continue the conversation and talk about two other ingredients essential for a stable health care system; improving quality and containing costs. In 2016, the United States spent $3.2 trillion on health care which comes to about $10,000 for every person. The high cost of health care spending impacts every sector of the economy. As a result, legislative leaders, employers, and the general public are asking the question ‘are we getting a good return on investment for the dollars spent’? To answer this question, I turned to a recent  Commonwealth Fund report that despite having the most expensive healthcare system in the world, the United States ranks last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity, and healthy lives.

The costs of healthcare impacts every sector of our economy. Experts say that we, as a country, cannot sustain the rising costs of health care spending. The Affordable Care Act that was passed in 2010 and put into place incremental efforts to control spending and improve the outcomes across the healthcare system. Today, a great deal of work is being undertaken to find ways to improve quality and slow health care spending. Some of the things that have been implemented include:

Implementation of Health Information Technology: Health information technology is changing the way healthcare is delivered and paid for. It has been said that over the next 8 years, we will see more innovation than we have seen in the last 18 years. Now that the healthcare industry is getting ‘wired’ we are safer, more efficient and able to use data to improve the quality of care provided. We still have a long way to go to make the system interoperable, but efforts are in place to test more and more innovative strategies in place that will revolutionize the industry so that communication is better, the system is more efficient and safer for all who transition through the care continuum.

Payment Models: Up until now, payment models for hospitals, physicians, and other providers were based on paying for products and services. Due to the rising cost of healthcare spending, changes to payment models are being tried in efforts to bend health care spending curve. Examples include; Value-Based Purchasing models that reward physicians and other providers for the quality of care they provide.  Today, due to the information technology systems in place, data is available that allows leaders to see how individual providers are caring for the populations and the outcomes achieved. As a result, new payment models are in place to reward physicians and organization who work with patients and their families in educating them about their conditions and the treatment options in place to treat them. Another payment model being implemented are Bundled Payment Models. Bundled Payment Models are designed to pay multiple providers for coordinating the total amount of services required for a single, pre-defined episode of care. Because we now have a way to collect, analyze and review data on processes and costs, experts have started to put together payment models on procedures that are repeated over and over. For example, planned hip or knee replacements, kidney transplants or care about a myocardial infarction are good examples where bundled payments can be used. By looking at overall costs, hospitals and physicians know what these procedures should cost, how many days a patient should be in the hospital and what therapies, equipment and resources are needed. Taking all the factors into account, payments are now being ‘bundled’. What this comes down to is that physicians and all members of the health care team have to work together to be efficient at every step, from diagnosis to preparing the patient for surgery, to post-op care, in preventing infections and safe discharge planning to avoid a costly setback. Educating and empowerment the consumer is also a critical part of the process, as, without their involvement, none of these models will work. Health care leaders who can operationalize these processes will do well. Those who can not/will not, will not do well under these new payment models.  

Focus on Quality Improvement Efforts: There's never been a more critical time in the history of U.S. health care system for health care professionals to turn to clinical analytics to help them survive — and thrive amidst the trials of health care reform. Overcoming the challenges of reform will ultimately result in improved quality of care delivery and decreased costs. But reaching that point will require significant changes to the way healthcare has historically operated. Health systems need to measure and report on the care they're delivering. They must also understand the financial ramifications of individual care decisions. This approach is quite a change in the traditional fee-for-service business model. But by using clinical analytics to dig into their wealth of captured data, both providers and health systems will be able to gain the critical knowledge they need to answer many questions about care delivery and how to improve it. In addition, federal regulations in the form of incentives are being put in place for providers and organizations who meet certain metrics. Disincentives are also in place for those who don’t meet metrics. National accreditation is another way quality of care can be improved and variation decreased across the broad healthcare system. Accreditation is an evaluative, rigorous, transparent, and comprehensive process in which a health care organization undergoes an examination of its systems, processes, and performance by an impartial accrediting body to ensure that it is conducting business in a manner that meets predetermined criteria and is consistent with national standards. Achieving Accreditation allows all members of the healthcare team from the payer and provider side to have a common bond that is integral to improving the delivery of care and containing costs.  

The Move to Evidenced-Based Care is a causing sea change in how medicine is practiced and delivered in hospitals, clinics and physician practices across the country. Evidence-based medicine includes three key components; research-based evidence, clinical expertise (i.e., the clinician’s accumulated experience, knowledge, and clinical skills), and the patient’s values and preferences. Practicing evidence-based medicine is important in today’s healthcare environment because this model of care offers clinicians a way to achieve the Triple Aim’s objectives of improved quality, improved patient satisfaction, and reduced costs. Payers have systems in place to ensure appropriate use of health care resources through the use of evidenced-based medicine.

Consumer Engagement: A shift is underway as more financial risk in paying for health care migrates from payers to consumers (with providers sharing the risk when individuals cannot pay) and from groups to individuals. For the consumer, this means an increasing obligation to pay a greater share of their health care costs through rising premiums, deductibles, copays, and coinsurance. As a result, consumers are demanding to be part of the decision-making process when it comes to their health and healthcare. In addition, health organizations, physicians, and others are realizing consumers are the most important, yet the most underutilized resource in the health care system. Healthcare organizations are turning to consumers to find ways to provide patient-centered that is safe, high in quality and meets the goals of the individual. If we are honest, the health care system is designed for those who work in the health care system and not the end users, the patient or their families. To re-design the system to be more patient and family centered, patient and family advisory councils are being set up as a way for patients and their families to provide input into their experience, what is important to them when they use the system and what they want to see to improve the system for THE PATIENT and the FAMILY.  Health care professionals also realize that consumers must be educated to take an active role in their health and healthcare. Efforts are being implemented to work together with consumers and their families so that care is based on their goals. Healthcare professionals are being educated in new strategies that they can use to help consumers understand the importance of adherence, behavioral change and active involvement in their health and health care.

Patient Advocacy: the practice of patient advocacy is growing to meet the needs of consumers as they strive to better understand how to use the health care system when they are thrust into the system with an injury or a complex medical or behavioral health condition. Just like a financial planner, certified public accountant or attorney are hired to assist a person with their financial or legal needs, patient advocates are being hired to help the patients and their families navigate the complex healthcare system. Advocates do not provide hands-on care but are in place to do research and advocate on behalf of the person so they have a voice in the system. Advocates come from different specialties and can be found in the hospital or in private practice. Depending on their education and area of expertise, they may specialize in areas such as medical advocacy, medical billing or assisting families when caregiving issues become complex and new living arrangements are needed. Patient Advocates work to take the burden off the patient and their families and guide them through the maze of choices that can meet their needs. Because they are in place for the patient and family, they are objective players and in place to represent the patient and family to the health care team. To learn more about Patient Advocacy, visit the Patient Advocate Certification Board. To find an advocate, visit the AdvoConnection.   

Case Management: case managers are advanced practice professionals who are in place to assist the patient in navigating the complex healthcare system. Case managers can be found at every entry point of the health care system. If a patient or the family member has a question or concern about their care, asking for a case manager can help you find the right person to answer your question, address your concerns and ensure the team is aware of barriers and challenges the patient/family are having. Case Managers are trouble shooters who understand how the system works and can break down barriers and find resources to meet the individual needs of patients and families.  Case managers, regardless of their setting follow a set of standards of practice that guide their practice. 


As you can see the health care industry is undergoing a great deal of disruption as it recalibrates to address the challenges needed to have a stable and efficient health care system in 2017. Redesigning the health care system has been put off due to its complexities of this huge task. We as a country cannot put off this job off any longer due to the rising costs of health care and the impact on our economic health. To be successful, all members of the health care team, payers, and every consumer must be part of the process as we move forward as w cross the quality chasm to build a health care system for the 21st century.  

Thank you for reading Nurse Advocate. I look forward to your comments, insights and recommendations for future comments. 

Friday, March 31, 2017

Having Health Care Insurance Might not be a Right, but it is a Responsibility




By now, I am sure you know that the Republican Plan to replace the Affordable Care Act titled The American Health Care Act was pulled before lawmakers could cast their votes by the Speaker of the House Paul Ryan and President Trump because they did not have the votes to pass the Bill. As a result, the Affordable Care Act also known as Obama Care remains the law of the land (for now).

The battle is not over as our country still needs to find solutions to growing troubles that plague our healthcare system as a country. To help YOU,  I am going to provide some insights as to how I see the situation, the difference between health care and health care insurance and why in my view you cannot have one without the other. WE the people have to speak up and share our experiences and let our legislative leaders know how we feel. We do have a voice, and we all need to use it. 
Most people following the dysfunction and rhetoric coming out of DC know that the ACA (aka Obama Care) was never a perfect plan. This was acknowledged by experts, healthcare professionals, President Obama and the legislative leaders who crafted the law and passed it in 2010. The ACA is the vehicle developed to help our country address the growing number of uninsured in our country, the escalating costs of associated with healthcare costs and the challenges the healthcare system has in providing safe, quality, effective care.
Today, with health care costs reaching 3 trillion dollars, the security and economic future of the US is at risk. All know that our country cannot continue to handle escalating health care costs and pay for the other necessary services we need to live safely. We all know something has to be done – yet our legislative leaders will not put aside their political ideologies to address the problem in a way that is palpable to all stakeholders. 
I think it is important to remember that the ACA put over 20 million people who did not have health care insurance for one reason on another onto the health insurance rolls. This was a huge lift to providers of healthcare organizations who are in place to care for the population. It was also a huge lift to insurance companies as they now had 20 million new subscribers paying premiums for the privilege of having insurance.
Despite these wins, we hear the ACA is imploding. Premiums are rising, and many insurance companies have or are planning to pull out of the market. Why? The answer is complicated. One explanation is RISK. Insurance companies do not like risk as it brings uncertainty to the market. With uncertainty there is instability and instability causes companies to find ways to cover their ‘expected' losses. To minimize risks, insurance companies are raising premiums on everyone and pulling out of markets that they view as unstable.
Another reason suggested for the failure of the ACA is that young people, healthy people, did not sign up as expected to offset the costs of those who did sign up but were sick. To help address this, the ACA put in a mandate that if someone did not obtain health care insurance, he or she would have to pay the penalty. Unfortunately, many people chose to take the penalty as they did not want ‘to be told’ they had to buy insurance, by the Government. As a result, the numbers of ‘healthy’ people in the pool was lower causing the system to be unbalanced. As a result, this led to uncertainty and caused the insurance to ‘lose' money. As a result, insurers are raising rates and in many cases, pulled out of the market. 
The other issue that has caused contentions about the Affordable Care Act is that there were incentives put in for people who made too much money to qualify for Medicaid but did not earn enough money to pay for an individual policy or an employee-sponsored policy.
In my opinion, we as a country have come to terms with the fact that to have access to health care services; you have to have health care insurance. As we know nothing is free. As a country, we need to educate everyone that it is a personal responsibility to have health care insurance as one never knows when and accident, an injury or a serious medical condition will occur. I also am of the belief that if people cannot afford to buy their own policy, the government can help. 
No one knows what the future will bring. However, from history we are aware that life can change on a dime, causing us to need healthcare services. Without healthcare insurance, sustaining an injury or being diagnosed with a serious illness becomes a financial burden that not many of us can handle.
If you have followed Nurse Advocate, you know that up until November 23, 2014, I was healthy. I pondered this question many times: "why do I need to have health insurance when I am healthy"? I took care of myself by having my preventative services done, and that is the extent of when I used the healthcare system, so why should I pay for a policy?
For me, everything changed on November 24, 2014, when I was diagnosed with a Central Nervous System Brain Tumor. Having health insurance from my employer-sponsored health plan allowed me to go to a top rated cancer center, be evaluated and treated by an expert team of professionals who saved my life. Even as a cancer survivor, I still have care needs that are costly. Today, I am on COBRA as I am unable to go back to work. The cost of COBRA is sobering; $1100.00 a month. Having this policy allows me to get the check-ups I need to have to be alerted if there is a reoccurrence allowing my doctor will find a problem early. Today, my husband and I pay our premium as not having an insurance plan would be financially devastating. I now realize the value of having health care insurance is not a choice, but my responsibility. It enables me to have access to the services and keep the doctors who saved my life.
As a nurse, a case manager and nurse advocate leader, I realize that not everyone can afford to pay this type of premium. For those who cannot afford to pay their health insurance premium, they have few choices; one being to go without care or pay privately. We all know realistically that not many people can afford to pay for health care services personally - so they go to the ED where they cannot be turned away. These people also wait till they are very sick and have to go somewhere. Most times, they are admitted to the hospital, to treat the complications and to see the specialists they need. As a result, they build up debt, lose their life's savings and are forced to claim bankruptcy. The hospitals and providers who care for people without insurance also lose. In most cases, the costs of caring for the un and underinsured are passed onto those who do have insurance causing the cycle to continue. 
As I wind Part One up, I hope you can see that having health insurance is a necessity. When one person becomes sick, the illness or injury does not just impact that person but also affects their family, the organizations they visit and the providers who care for them. So maybe having healthcare insurance is not a right. However, it is a responsibility that each of us has to come to accept. Having healthcare insurance gives you access to the healthcare industry to get the care and services needed. 
To have a stable, healthy health care system, three things are necessary: Access, Cost, and Quality. When one is not stable, the system cannot stand. I do not claim to have the answers for how to fix our health care system. However, I do believe that we as a country can and should come together to work on the problem as it is not going away.
Next week, I will look into the area of quality and what is happening in the system to ensure our health care system delivers safe, quality healthcare to all who use the system and the role we each play. 
If you have any comments, please share in the comment box or email me directly at allewellyn48@gmail.com. 
Thanks for reading Nurse Advocate! 

Sunday, March 5, 2017

Care Coordination For Those Who Serve or Have Served








Recently, I had the opportunity to present and attend a conference titled the United States Special Operations Command Warrior Care Program. The focus of the program was to look at the enduring warrior care challenges that the Department of Defense and the Veterans Administration have in meeting the needs of those injured in the line of duty.   

It was an honor to be part of this program and learn about the important work being done to assist the men and women of the US Military when they are wounded or diagnosed with a medical condition. As part of the program, Recovery Care Coordinators are assigned to the person and their family to make sure they receive the care and resources needed to meet their needs. The Recovery Care Coordinators are in place to break down barriers so that those in need can focus on recovery and when possible reintegration back to active duty. If the person cannot return to active duty, the Recovery Care Coordinators assist them with the transition out of active duty and into the VA System.

I met so many people who worked in this program and found them caring and passionate professionals who are laser focused on their duties. The Recovery Care Coordinators ranged in rank and experience, but all had a common purpose; to ensure each serviceman and women they worked with had what they needed to be the best they could be. The program is a model that all of us on the civilian side could emulate.   

As I listened to the various speakers, I learned about the history of the Recovery Care Program, some of the challenges found within the system and about various programs that are making a difference while helping service men and women re-invent themselves after a life changing injury. One such program was the Adaptive Sports Program that inspires physical and emotional recovery by focusing on the person's abilities versus their disabilities and helps those who participate set goals to strive for in a competitive yet caring environment.  There were several members of various sports teams at the conference who shared how these programs help with their physician and emotional recovery. These programs are making a difference in helping those wounded to recover and re-integrate back into life while finding their ‘new normal.'

As a leader in the field of case management and patient advocacy, I was proud to have a front role seat to learn about the important work being done to assist our men and women who serve to protect us, have a program such as the Recovery Care Coordinator Program when they need help. 

Regardless of what you read in the paper, or see on the news, please know that there is a tremendous amount of work being done for our men and women who make up our military to provide care, resources, and support for injured or ill. 

As I left the program, I felt proud to be able to impart my experience and expertise to such a dedicated group of professionals.

Here are some resources you might want to read about to learn more about this outstanding program.


 Adaptive Sports Inspire Physical, Emotional Recovery at the 2016 DoD Warrior Games: http://warriorcare.dodlive.mil/2016/06/13/adaptive-sports-inspire-physical-emotional-recovery-at-the-2016-dod-warrior-games


CMSA Today: Case Management for Those who Serve and Have Served. Military Case Management http://www.nxtbook.com/naylor/CMSQ/CMSQ1416/index.php


Thanks for reading Nurse Advocate!