our work continues 2009 update - healthy summithealthysummit.org/pdfs/hcnreport_fullcolor pdf...

Healthy Connections Network

Our Work Continues 2009 Update

Table of Contents

Evolution of Healthy Connections Network 3 About Access to Care 4 An Access to Care Client Story 6 Confronting Health Care Issues Health Disparities 8

The Uninsured 10 The Medicaid Program 12 Medicare Eligibility 13 Underinsurance 14

A Public Health Perspective 16 How can you help eliminate health disparities? 18 Help with Health Care in Summit County 20 Healthy Connections Network Members 22 Healthy Connections Network Executive Committee 23 Contributors, References, and Contact Information 24

Publication Date: June 2009

HEALTHY CONNECTIONS NETWORK

Evolution of Healthy Connections Network

Healthy Connections Network (HCN) began in 1995 when representatives of Summit County’s public

and private health and social service organizations convened to discuss an urgent and common concern:

the rising number of working poor adults without health care insurance for themselves or their children.

In 1999, HCN incorporated as a 501 (c )(3) organization with a Board of Directors representing 38 public

and private health, social service, and business organizations. HCN is governed by a 9-member Executive

Committee, led by the Chair of the HCN Board of Directors. The work of HCN is conducted with

volunteered resources and funding from Akron Children’s Hospital, Akron General Medical Center,

Summa Health System and other HCN member organizations.

In 2001, HCN joined the "100% Access/Zero Disparities Campaign" initiated by the Bureau of Primary

Health Care (BPHC). A Town Hall Meeting was held where consumers and providers of health care in

Summit County identified a need for improved access to health care for the uninsured. HCN completed a

proposal and business plan to develop the Access to Care (ATC) program and continued efforts to

develop community support for a local health care access program.

In 2004, HCN received a $1,682,256 federal grant from the Healthy Communities Access Program

(HCAP) to initiate ATC. In 2005, ATC began enrolling clients, linking them to a volunteer network of

local health care providers.

Numerous local philanthropies (GAR, Knight Foundation, Akron Community Foundation, OMNOVA,

Brennan Foundation, and Sisler McFawn Foundation) along with United Way of Summit County, Kaiser

Permanente, Centene Foundation, Summit County General Health District, Akron Children’s Hospital,

Akron General Medical Center, Summa Health System and City of Akron), have since provided support

to help ATC remain in operation. Through ATC, private physicians, local hospitals and other community

safety net organizations such as OPEN-M, The University of Akron Nursing Center for Community

Health, and Akron Community Health Resources have contributed significant services at no charge to

those most in need of health care.

In 2007, ATC received the “Making A Difference” Award at the Summit County Human

Services Forum.


The Access to Care program is the Healthy Connections Network’s flagship

program. Its goal is to mobilize community resources to connect uninsured adult

community members to a regular source of healthcare. The program was initiated in

2005 after receipt of a three year, $1,682,256 grant from the Bureau of Primary

Health Care (BPHC)/Health Resources and Services Administration (HRSA). Within

the first 18 months of operation, the program returned $5 in value for every $1 spent

to operate it.

As of April 2009, the Access to Care provider network has grown to over

300. Since its inception in 2005, Access to Care has served 3,299 individuals and lev-

eraged over $1.2 million in pharmaceuticals and $30 million in donated care.

Access to Care has made a major impact in the lives of its participants. Forty

percent received care for hypertension, 20% for diabetes or a related condition, and

an additional 15% for chronic obstructive pulmonary disease (COPD). Left un-

treated, these conditions often lead to more serious complications and an overflow in

our emergency rooms.

Overall, the benefits of the Access to Care program are

between 4.9 and 5.2 times greater than its cost. The Access to

Care program has resulted in numerous benefits, not just for

participants, but for the dedicated volunteer providers and our

entire community!

PAGE 4

Access to Care has returned $5 in value for every $1 spent to operate it.

HEALTHY CONNECTIONS NETWORK PAGE 5

The majority of Access to Care participants are single

white females, age 45 or older, living in the city of Akron.

Together, direct and indirect cost savings of the Access

to Care program, medication donations, additional Medicaid

funding, and increased personal income due to increased pro-

ductivity and reduced rates of illness and mortality total between

$4 million and $4.2 million. Moreover, emergency department

usage by Access to Care participants was reduced by 7.8 visits

per 100 people as compared to a national comparison group.

Healthy Connections Network recognizes that the

Access to Care program cannot fully solve the challenges of the

uninsured in Summit County and continues planning to move

beyond the limited goal of access to health care toward a

broader goal of creating a forum for community organizations

to work together toward improved community health and

reduced health disparities in Summit County. Still, the Access

to Care program represents a working example of the great

accomplishments that can be made when a community comes

together to make better use of existing resources and to take

local ownership of its problems.

Over 45

62%

29 and

Under

15%

30-44

23%

White

Non-

Hispanic

64%

Black

Non-

Hispanic

32%

Hispanic

or other

Races

4%

City of

Akron

73%

Suburbs

27%

Where do Access to Care participants live? (2007 Data)

What is the racial makeup of ATC participants? (2007 Data)

How old are Access to Care participants? (2007 Data)

Christine is a 57 year old single female who owns her own business. As a self-employed individual, she contacted many insurance companies over the years about purchasing health insurance, but the quotes were “astronomical.” In December 2006, her primary care physician of 20 years, as a “Christmas gift,” shared with Christine a brochure about the Access to Care program. Christine immediately called the number on the brochure and got enrolled in the program. Christine has arthritis and, prior to enrolling in Access to Care, paid for all of her medical expenses out of pocket. She often had to set up payment plans with her medical providers. She was in an automobile accident in 1995 during which she injured her knee. For the past 14 years she has suffered with a permanent limp as a result of the knee injury, as well as back and foot problems related to her limp. Thanks to the Access to Care program, Christine was able to have a knee replacement. Christine loves her primary care physician and feels she provides excellent, thorough care. She was grate-ful for the referral to Access to Care.


“How do I find the right words to thank the Access to Care program for providing me the opportunity to get the care I have so desperately needed? I am a very small busi-ness owner who could not afford monthly health insurance. For the past 14 years after a car accident that totaled my delivery van, I have needed knee surgery on both knees. Without this program, I would be in a wheelchair, permanently, until I was old enough for Medicare. The Access to Care program has

given my life back to me, as well as my family.” Christine

“People don’t realize how fortunate they are to have insurance through

their employer.”


“An important lesson learned in the Access to Care model is that health care alone is not enough

to significantly shift the public's health. As a consortium or network, HCN can help support and

expand health promotion, disease prevention and healthy community efforts that will help keep

families healthy. Equally important as unmet health needs, HCN is seeking to promote models of

care management, access to pharmaceuticals and expanded oral health care services. The

demonstrated collaborative capacity of the Network makes possible the opportunity to truly affect

health status and well being in Summit County.”

-Gene Nixon, Summit County Health Commissioner

Confronting Health Care Issues

Health Disparities The Uninsured Medicaid Gaps Medicare Eligibility The Underinsured


What are health disparities and why do they exist?

Social determinants of health are just as important to one’s overall health as are genetics or health behavior choices. This is because the health

choices one makes are determined by the circumstances of their life, from the time they are young through adulthood. Behaviors like eating healthy, exercising, and visiting the doctor regularly are a direct result of a person’s access to fresh, healthy food, the availability of safe places to walk, run or jog, and the affordability of health insurance. In addition, chronic stressors such as lack of reliable transportation or child care, limited or inconsistent income, unsafe living conditions, lack of knowledge about health, and a weak social support system can also negatively affect

a person’s health. Unfortunately, these factors are often overlooked when addressing a person’s health care needs.

Health disparities (also called health inequities) occur when the health of an individual or group is unnecessarily or unfairly worse than another group. Often, these differences in health status are due to social factors, called social determinants of health, which include things like a person’s race, ethnicity, income, education level, job or profession, social support system, and even the neighborhood in which they live.

Health disparities are prevalent in Summit County and throughout the United States today. There are differences in health status between Caucasian individuals and other minority groups, the insured and the uninsured, people of low-income and those of greater wealth, and individuals living in rural, urban, or suburban areas.


What are the effects of health disparities?

One of the biggest concerns with health disparities is that they are not only an individual issue, but a

problem for society as a whole. As Americans, we each pick up the bill for health inequities through the

high costs of health insurance and a strained health care system. Businesses are affected by health

disparities as well, both directly through high insurance premiums, and indirectly through lost productivity

in their workforce. With the percentage of racial and ethnic minorities and the number of uninsured

Americans increasing, health disparities experienced by these groups have the potential to further strain

our healthcare system.

One of the most common health disparities exists

between those with and without insurance. When

examining health disparities in the uninsured popula-

tion, we find that uninsured individuals are more likely

to be diagnosed with more severe health conditions, in

later stages, which are harder and more expensive to

treat. This is because the uninsured often put off

much-needed preventative medical care like routine

doctor’s visits. When they do receive care, uninsured

individuals pay 2.5 times more for their health care than

those with insurance. This is because they cannot

negotiate for deals and lower prices with hospitals and

doctors like large health insurance plans can. In addi-

tion, many of these individuals end up finding care in

hospital emergency departments, which places yet

another strain on our health care system.


Is it true that anyone who needs health care can get it?

Some may think the answer to this question is yes because individuals who are

insured or uninsured often use the emergency room to receive medical care.

Unfortunately for all of us, this is a very costly approach which leads to unnecessary

overcrowding in our hospital emergency rooms. Most importantly, patients receive

no preventive care or regular check-ups resulting in patients being treated at very

late stages of diseases. By receiving regular check-ups, individuals can help prevent

problems before they start. Also, early detection results in individuals having a

better chance of receiving treatment and cures. It is imperative that uninsured indi-

viduals have access and resources to allow them to be healthy.

As of 2006, 47 million Americans reported having no

health insurance. This is a major problem because un-

insured adults are 25 percent more likely to die prema-

turely than those who have private health insurance.

Specifically in Ohio, between 2000 and 2006 over

5,100 deaths of adults age 25-64 occurred due to lack

of health insurance. These are alarming numbers for

deaths that may have easily been prevented with

proper access and treatment from our health care sys-

tem. To help prevent these unnecessary deaths, we

must investigate who the uninsured populations are, as

well as their barriers to accessing proper health care

and health insurance.

The Uninsured in Ohio and the United States

Preventive care “can dramatically reduce the long-term burden and health care de-

mands of chronic conditions”

World Health Organization

In 2008, Ohio's 18-64 uninsured rate increased from 15.0% in 2004 to 17.0%. In Summit County the rate rose to 19.6%

Also, the percent of 18-64 Ohioans who got coverage through job-based coverage fell

from 63.5% in 2004 to 61.7%


18-29 Years48%

30-44 Years29%

45-64 Years23%

Summit County Uninsured Adults (Age 18-64) by Age

Rate Percent

Does Where I Live Within Summit County Make a Difference?

You may not have thought so but, YES. Those

who live in urban areas, as opposed to the

county’s suburbs are more likely to be uninsured.

Akron made up over half of Summit County’s

uninsured population. Much of this disparity

between suburban and urban areas and lack of

insurance can be accounted for by differences in

employment rates, income, and educational

attainment.

The Uninsured in Summit County, Ohio

Does My Job or Education Level Make a Difference?

Having a job, as well as one’s level of education, make a big

difference when it comes to getting health insurance. This is

because many people cannot afford health insurance without

a well-paying job or one that provides health insurance

benefits to their employees. Educational level adds to this

dilemma because higher education attainment usually trans-

lates into high paying jobs with potentially better benefits.

Unemployed

42%

Employed

Full-time

20%

Employed

P art-time

38%

Employment Status* (Age 18-64)

Summit County Uninsured Adults* (Age 18-64)

*

*2005 Data

*2005 Data

*2005 Data

Who is eligible for Medicaid?

Medicaid, the joint federal-state health insurance program for low income

Americans, is an appropriate option for many people. Unfortunately, many individu-

als do not meet eligibility requirements, leaving them without health care.

Eligibility for Medicaid in the state of Ohio is based on income as well as age.

Pregnant women, children, families, adults 65 and older, and individuals of any age

with disabilities, may qualify for Medicaid. Low-income adults without dependent

children do not qualify for Medicaid under existing eligibility categories.

If a state covers a low income person who is not in one of these categories,

the state cannot get federal matching funds for that person. Medicaid does not cover

the majority of low income in the U.S. This includes adults without children, and also “empty nesters” whose chil-

dren are grown. As a result, more than half of all low income uninsured people are adults who are not categori-

cally eligible for Medicaid.

Who is eligible for Medicare?

Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than

age 65 can qualify for Medicare, too, including those who have disabilities and those who have permanent kidney

failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). The program helps with the cost of health care, but

it does not cover all medical expenses or the cost of most long-term care.


The Medicaid and Medicare Programs

Medicaid does not cover

the majority of

low-income Americans 69,000 individuals in Summit County are not eligible for

Medicaid


Many people who do not meet the eligibility requirements under their employers and under the government have

many eligibility factors to consider if they need health care assistance. Also again resulting in individuals being

without health care. In order to receive health care under the government you have

to be:

• A low-income parent

• Pregnant

• Have limited income

• A person with disabilities

• A teenager up to the age of 21 who is living on their own

• A child between ages 6-19 with a family income at or below the federal poverty level

• An adult who takes care of a child/children under the age of 18 receiving Social Security Income (SSI)

If you do not fall under one of these categories you are not considered eligible to receive Medicaid.

Who is Eligible for Medicaid in Ohio?

Who’s covered?Who’s covered?Who’s covered?Who’s covered? Income GuidelineIncome GuidelineIncome GuidelineIncome Guideline

Children up to 19

200% FPL

Pregnant Women

150% FPL

Parents

90% FPL

Disabled Persons

~64% FPL

Persons 65 and over

~64% FPL

Who is Covered by Medicaid in Ohio? Federal Poverty Guidelines*

*Federal Poverty Level (FPL)— refers to the minimum income level the government deems as necessary for basic necessities of life, deductions and exceptions apply– this is an approximate guide.

Persons in FamilyPersons in FamilyPersons in FamilyPersons in Family Poverty GuidelinePoverty GuidelinePoverty GuidelinePoverty Guideline

1 2

$10,830 $14,570

3 4

$18,310 $22,050

5 6

$25,790 $29,530

7 8

$33,270 $37,010


Underinsurance, or not having appropriate coverage

to fulfill your medical needs, is a very serious and

growing problem. If medical expenses equal 10%

or more of one’s income (5% of income for

those earning below 200% of the federal poverty

level) or if 5% or more of one’s income is spent

on health coverage deductibles, that person is

considered to be underinsured. Using this

standard, it is estimated that 15.6 million people

are underinsured in America.

High Prices and the Resulting Medical Debt

Being underinsured for health care can very quickly lead someone into medical debt. Due to the high

deductibles, co-pays and cost sharing, individuals must pay before their insurance plan will cover their

medical services. Other plans put caps on the dollar amount of coverage they provide. This can be a huge

problem for people with catastrophic or chronic medical needs who need frequent care or prescription

medication that their insurance won’t cover.

A survey by the Henry J. Kaiser Foundation has found that 24% of families that were insured for health

care spent $2000 or more in out-of-pocket expenses. Those with chronic conditions spent even more to

keep up with expensive prescription drugs for their conditions. Other major expenses can occur when

certain conditions are excluded from coverage, such as a pre-existing condition. When individuals can only

afford the lowest premium health care plan they are more likely to face these problems and are therefore

more vulnerable to these major out-of-pocket expenses.

What Is Underinsurance?

15.6 Million Americans are Underinsured


Gaps in coverage

A change in a work status, such as being fired or laid off, changing from full time to part time, being self-employed,

getting divorced, or even retiring can cause a change in coverage or one’s ability to afford health care.

Pre-existing Conditions

Having an existing health condition or illness can make it

difficult for a person to qualify for new health insurance. Often these individuals are uncovered during

the required waiting period between plans.

Examples

of

Underinsurance

Pharmaceutical Expenses

Prescription costs are a large portion of out of pocket medical expenses. While free and low cost

prescription programs exist, meeting eligibility requirements

and completing necessary enrollment forms can be difficult.

Large Deductibles

Payment Caps

Catastrophic Conditions

Underinsurance contributes to many people not being able to access or afford appropriate care.


Healthy Connections Network (HCN) brought together a

critical mass of agencies and interested individuals dedicated to addressing the need to

expand access to health care in our community. The most important step we took as a

consortium was to clearly identify the state of the uninsured in our community; collect-

ing the data, interpreting the information and reporting back to the community. The

establishment of Access to Care as a locally born means of addressing the growing bur-

den of the uninsured put Summit County in a small group of communities from

throughout the nation motivated enough to confront this problem.

HCN has broadened the availability of health care to a critical slice of vulnerable

individuals and families in the community. The Network also meets on a regular basis

which offers opportunities to interpret and share data on the status of health care in our

community. This common understanding of the status of the uninsured and

representation of efforts to address these problems work to leverage our community's

combined and coordinated capacity to addressing these inequities.

In closing, HCN aims to continue to support and expand health promotion,

disease prevention and healthy community efforts that will keep

Summit County families healthy.

A Public Health Perspective from the Summit County Health

Commissioner, Gene Nixon

What is Healthy Connections Network’s role in addressing these health care issues?

PAGE 16

“To have a healthy community with accessible health care for all in

Summit County”

Healthy Connections Network Mission Statement


Healthy Connections Network has worked diligently to

assure that someday, all people in the county will have

access to comprehensive and coordinated health care

services of good quality. HCN provides a forum where

community organizations can continue to work

together toward the goal of a healthy community with

reduced health disparities.

Susan Gerberich, PhD Healthy Connections Network

Project Consultant


• Volunteer at free clinics, community health centers and in programs like

Access to Care.

• Learn about the types of health disparities that exist in Summit County

and in the United States and seek training on how to eliminate or reduce

these inequalities.

• Educate others in your practice and the community about health disparities

and what they can do to help.

• Take steps to reduce health disparities by

incorporating culturally sensitive methods into your

daily practice.

• Advocate for the rights of minorities (including the

uninsured) by making your voice heard and

communicating with local, state and national

policymakers about the effects these disparities have

in your neighborhood.

There are many things you can do to help eliminate or reduce the problem of

health disparities in your community and for all Americans.

According to the American Medical Association,

medical professionals and public health workers can:

How can you help eliminate health disparities in Summit County?

PAGE 18


• Learning about the health issues that exist in your community

and in your family.

• Taking steps to improve your health and your family’s health by

becoming actively involved in your own preventive care.

• Becoming an educated consumer of health care.

• Utilizing and supporting the services of community health

agencies like those offered by the Healthy Connections Network.

• Educating others in your community about the health issues

you and your neighbors face.

• Advocating for yourself and for the rights of those who

experience health inequities in your community by contacting

your local, state, and national policymakers to voice

your concerns.

There are many things individual citizens and

community groups can do to help lessen the

burden of health disparities. These include:

You do not have to be a medical professional or public

health worker to make a difference!


Healthy Connections Network Members

Akron Children’s Hospital Akron Community Health Resources (ACHR)

Akron General Medical Center Akron Health Department

Akron Metropolitan Housing Authority Akron Regional Hospital Association

Akron Summit Community Action American Cancer Society

American Medical Response Asian Services in Action, Inc.

Barberton Health District Buckeye Community Health Plan

Caler & Company Caresource

Community Health Center County of Summit, Alcohol, Drug Addiction & Mental Health Services Board

Department of Insurance East Akron Community House

Family and Children First Council Hispanic Development Project, St. Bernard’s Church Parish Nursing

Info Line, Inc. Kaiser Foundation Health Plan of Ohio

METRO Regional Transit Authority Minority Health Roundtable

Northeastern Ohio Universities College of Medicine and Pharmacy Opportunity Parish Ecumenical Neighborhood Ministry (OPEN-M)

Planned Parenthood Seibert Keck Insurance Company

Summa Health System Summit County Department of Job and Family Services

Summit County Combined General Health District The University of Akron, College of Nursing, Nursing Center for Community Health

Unison Health Plan United Way of Summit County

Visiting Nurse Service & Affiliates

PAGE 22


Healthy Connections Network Executive Committee

Seated: Joan Picone – American Cancer Society

Thomas Quade – Akron Health Department Gene Nixon – Summit County General Health District

Susan Gerberich – Healthy Connections Network

Standing: Suzanne Hobson – Akron General Health System

Robert M. Howard, Chair – Akron Children’s Hospital Roxia Boykin – Summa Health System

Roberta Aber – Planned Parenthood of Northeast Ohio Marsha Schofield – Access to Care

Not Pictured: Dr. Deborah Plate – AGMC Not Pictured: Richard Stahl - Info Line, Inc.

If you are interested in participating in the work of HCN visit our website at: http://www.healthysummit.org/HCN/HCN_About.cfm

Or contact

Susan Gerberich, Ph.D., R.N., CNS Healthy Connections Network

P.O. Box 2734 Akron, Ohio 44309-2734

330-972-7894, e-mail: [email protected]

References

Susan Gerberich– Healthy Connections Network Robert M. Howard- Akron Children’s Hospital

Gene Nixon- Summit County General Health District

Lead Contributors: Lead Contributors: Lead Contributors: Lead Contributors: Manuella Crawley, Megan Wise &

Mayra J. Porrata Kent State University

Additional Contributors:Additional Contributors:Additional Contributors:Additional Contributors:

Christin Seher Suzanne Kirby Gina Ross

Tiffany Greene Kent State University

Contributors

• Centers for Medicare and Medicaid Services, www.cms.hhs.gov/medicaideligibility/.

• Department of Job and Family Services online: http://jfs.ohio.gov

• Families USA. Dying for Coverage in Ohio. March 2008

• Healthy Connections Network online http://www.healthysummit.org/HCN/HCN_About.cfm

• Healthy Connections Network Summit County’s Access to Care Program; A Report to the Community November 2007

• Hoady, J. The Prescription Drug Safety Net: Access to Pharmaceuticals for the Uninsured

• Institute of Medicine, Insuring America’s Health (Washington: National Academy Press, 2002)

• Pryon, Carol, Cohen, Andrew, & Prottas, Jeffrey. The Illusion of Coverage: How Health Insurance Fails People When They Get Sick.

The Access Project (March 2007)

• Schoen, C. et al., Insured but Not Protected: How Many Adults Are Underinsured? Health Affairs Web Exclusive (June 14, 2005)

• Social Security online: http://www.socialsecurity.gov

• The Center for Community Solutions. Summit County’s Uninsured and the Problems that they Face (June 2005) Retrieved from

http://www.communitysolutions.com/images/upload/resources/summit-report.pdf

• The Henry J. Kaiser Foundation : Underinsured in America: Is Health Coverage Adequate?

(July 2002) Retrieved from http://www.kff.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=14136

• United States Department of Labor, FAQs For Employees About COBRA Continuation Health Coverage Retrieved from

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

• United States Department of Labor, FAQs About Portability Of Health Coverage And HIPAA Retrieved from

http://www.dol.gov/ebsa/faqs/faq_consumer_cobra. HTML

• Unnatural Causes unnaturalcauses.org

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