Making Healthcare Affordable for Individuals

Transcription

1 Making Healthcare Affordable for Individuals Strategies to Save Money and Provide Care to Those Who Need It Published by

2 presents Strategies for Advocates in all Healthcare Settings Friday December 7, 2012 Renaissance Orlando SeaWorld Orlando, Florida In this time of advancement and of fi nding-the-way, the Professional Patient Advocate Institute invites you to an interactive conference to shed light on this emerging practice, provide education to like-minded advocates, and promote a culture of clinical and professional competence that will improve the health and welfare of your clients. Please join us for The 2012 Patient Advocate Conference and take this opportunity to build your skills and knowledge while meeting and networking with like-minded colleagues and mentors. By attending this conference, you will gain: Strategies to meet the needs of consumers by enhancing your skills as an advocate. Advice from experts on how to improve your practice, regardless of the setting. Real-world solutions for making navigating the healthcare system easy. How to utilize social media platforms and make it a part of a patient advocate s arsenal. Communication tactics and skills to achieve better outcomes. Skills to improve the quality of life for those with chronic conditions. Collaboration tactics to make it easier to gain access, information and resources from the healthcare team. New ideas and solutions to enhance patient- and family-centered care. And more! Professional Patient Advocate Institute 4 Choke Cherry Road, 2nd Floor Rockville, MD Tel:

3 7 SOURCES OF FINANCIAL ASSISTANCE FOR PATIENTS, PATIENT ADVOCATES 1 Making Healthcare Affordable for Individuals patientadvocatetraining.com 2

4 7 Sources Of Financial Assistance For Patients, Patient Advocates CancerCare s Financial Assistance Program: CancerCare offers limited assistance for cancer-related costs, and the organization s professional oncology social workers can help individuals find other resources. CancerCare can help with costs associated with transportation to and from appointments, home care, child care, pain medication and lymphedema supplies. To qualify for assistance, individuals need to meet eligibility requirements and share information about their income, savings and expenses. Healthcare professionals must also provide information about the patients diagnoses to the organization. CancerCare s financial assistance does not cover basic living expenses such as rent, mortgages, utility payments, or food. Patient advocates can help patients manage the cost of their healthcare, especially when patients are seriously ill and can t research different financial resources themselves. Certain illnesses and conditions, especially cancer, can be a huge financial burden on patients and their families. Government-sponsored programs and services supported by national nonprofit organizations are available for people who do not have health insurance and for those who have insurance but still need financial assistance to cover healthcare costs. Financial assistance programs for cancer patients include: American Society of Clinical Oncologists, Managing the Cost of Cancer Care: Provides patients and their caregivers with information on understanding the costs associated with cancer care and resources for financial assistance. The website also helps patients get organized and gives them key questions to ask healthcare providers and insurers about cancer costs. HealthWell Foundation: This non-profit organization helps address the needs of individuals with insurance who cannot afford their copayments, coinsurance, and premiums for important medical treatments. Cancer Financial Assistance Foundation: This foundation is a coalition of financial assistance organizations that has come together with the goal of helping cancer patients experience better health and wellbeing by limiting financial challenges National Foundation for Transplants: This organization provides fundraising assistance to transplant patients in all 50 states plus U.S. territories. Patients or their caregivers can request information about the fundraising assistance program by calling or ing info@transplants.org for this information. After an initial conversation with a consultant, the foundation will send patients a packet of information, including an application, policy agreement and other materials to begin the process. The Leukemia and Lymphoma Society s Patient Financial Aid Program: The Leukemia & Lymphoma Society provides a limited amount of financial assistance to help patients with significant financial need. Patients are eligible if they are under a doctor s care for a confirmed blood cancer diagnosis. This financial aid program provides $100 a year to help patients offset expenses. Receipts for expenses are not required. To apply, you must be a U.S. resident or U.S. military personnel stationed abroad and in active treatment or ongoing medical followup care for a blood cancer. Your prescribing healthcare provider must complete and sign the bottom portion of the application form. The program begins each July 1st and ends on the following June 30th. You must reapply every year after June 30th in order to receive assistance. United Way: While the United Way does not have a specific financial assistance program for cancer patient, local branches can help with individuals basic living Community hospitals, local health departments and state and local social services agencies can also be possible sources of financial assistance. Making Healthcare Affordable for Individuals patientadvocatetraining.com 3

5 4 STEPS TO REDUCE PERSONAL HEALTH SPENDING (WITHOUT REDUCING QUALITY) 2 Making Healthcare Affordable for Individuals patientadvocatetraining.com 4

6 4 Steps To Reduce Personal Health Spending (Without Reducing Quality) she doesn t have time to listen to you, or doesn t seem interested, that should be a key sign that you need to find a new doctor. Communication is a major part of a patient-physician relationship. All doctors are busy, but if they don t have time to answer your questions or talk to you about treatment options, medications and other health concerns, it s time to look for a new physician. A good place to start is references from friends, family and coworkers, but be sure to ask whether they re happy with their doctor s bedside manner. As healthcare costs and insurance premiums continue to rise, Americans are increasingly spending more on medications, doctor visits and other health services. A growing number of Americans are also in debt because of mounting medical bills, and for the uninsured, paying for healthcare is an even bigger challenge. This is where patient advocates can step in and help patients that may be struggling with how to prioritize their healthcare as well as medical payments. Dr. Angel Garcia says there are ways patients can save money without jeopardizing their health, and there are steps they should take to ensure they re getting the best value for their dollars. Garcia, an internist who has been in practice for more than 25 years, is the author of Do No Harm: Saving Our Health-Care System. Garcia offers some practical advice to help patients save money and ensure their money is well spent: For minor illnesses, try over-the-counter medications. Some minor illnesses can be resolved with nonprescription drugs. For example, Garcia recommends Zyrtec-D 12 Hour for a sinus infection or allergies, hydrocortisone cream for rashes and bug bites, Prilosec for heartburn and Imodium AD for diarrhea. But Garcia warns that if symptoms aren t resolved in three to five days, or if they go away but keep returning, you should see a doctor as soon as possible. Be prepared to talk about your medical issues so you get can get the most out of your visit. We all know how difficult it can be to get in with the doctor of your preference. The once you get an appointment, you may have a long wait at the physician s office. As the demand for healthcare grows, physicians are continually taking on new patients, and consequently, spending less time with each individual. This is why you need to prepare for your doctor s visit. Your physician will want to know the details of your chief complaint: when the problem began, how it progressed, what makes it better or worse and any associated symptoms. Your doctor will also want to know what medications you take, including the drug name, dosage, how it s administered and how often you take it. Make a list of these considerations before you go to the doctor s office, especially if you think you ll have trouble remembering them once you meet with your doctor. Don t skip the follow-up visit. When a patient sees a doctor for a medical complaint, a follow-up visit typically is scheduled. Some patients skip these because they are feeling better or their symptoms have not returned, but that just may mean the medications have temporarily relieved the symptoms. The follow-up is worth the money to ensure the problem is resolved. If a medical problem isn t resolved, it could result in a greater and more expensive issue down the road. Talk to your doctor if you can t, change doctors. Garcia says it doesn t matter whether your physician is nationally renowned or a Harvard graduate; if he or Making Healthcare Affordable for Individuals patientadvocatetraining.com 5

7 HOW TO SECURE AFFORDABLE PRESCRIPTION DRUG COVERAGE By Richard Scott 3 Making Healthcare Affordable for Individuals patientadvocatetraining.com 6

8 How To Secure Affordable Prescription Drug Coverage By Richard Scott It will take some research to locate the best resources for your particular case. Community programs are another good source for prescription needs. The city of Memphis, for example, offers a Community Service Agency Prescription Drug Program that covers up to $200 of needed drugs for an individual patient. Palm Beach County offers an assistance program that has provided more than half a million dollars in aid. A third category of help comes from the Area Agencies on Aging, which offers a toolkit for professionals. (Download key sections of the guide in the PPAI Tools & Resources area.) It can be an expensive part of treatment, but your patients will often need prescription drugs. Acquiring medications through available programs has a double benefit: better outcomes and cost savings. In your role as an advocate, you will face the dilemma of trying to secure the best care options for your patient when there are limited funds to acquire such care. In the case of prescription drugs, there are resources that can help mitigate costs and help your patient along the road to better health and medication adherence. Starting with basic insurance coverage, we look at some of the opportunities you can seize to secure prescription drugs. 1. Public and private insurance. If your patient has private insurance through an employer or through a self-bought plan, the majority, if not all, of the cost of prescription drugs will be covered. In this case, the task of the patient advocate centers around making sure the patient picks up and takes the medicine. In the case of a patient with Medicare, he or she will need to be enrolled in Medicare Part D for prescription coverage. (The link above offers a five-step process to enrolling in Part D.) 2. State and community programs. For those without private insurance or Medicare, state departments of health and local community programs can offer help. In New Jersey, for instance, the Department of Health and Senior Services offers a program called Pharmaceutical Assistance to the Aged and Disabled, which provides coverage aid to nearly 150,000 residents. The state of Washington offers a Prescription Drug Program, which provides discount cards and a prescription drug purchasing consortium to drive down costs, among other benefits. State programs vary widely, but the aid they provide can be tremendous. 3. Patient assistance programs. Created and delivered by pharmaceutical companies, patient assistance programs (PAPs) offer steep discounts, if not outright free medications, to qualifying individuals. While the criteria varies, to qualify the patient must not be eligible to obtain private insurance, Medicare or Medicaid and his or her income must fall below a certain threshold. Like state programs, PAPs require some research to find out which companies are the right fit for your patient. Here s a look at some of the largest pharmaceutical companies PAP programs. AstraZeneca Patient Prescription Assistance Programs Bristol-Myers Squibb Patient Assistance Programs GlaxoSmithKline GSK for You Merck Merck Patient Assistance Program Novartis Patient and Caregiver Resources Included here are some additional resources for your research: The Partnership for Prescription Assistance: Together Rx Access Program: NeedyMeds: Rx Hope: Rx Assist: Making Healthcare Affordable for Individuals patientadvocatetraining.com 7

9 5 STRATEGIES TO MANAGE NURSING HOME COSTS 4 Making Healthcare Affordable for Individuals patientadvocatetraining.com 8

10 5 Strategies To Manage Nursing Home Costs Protecting your home: Heiser tells seniors to make sure they protect their house when applying for Medicaid nursing home benefits. To qualify for these government benefits, individuals can have minimal assets. However, under federal law, a house is exempt from those assets when an individual applies for Medicaid. If the individual dies while receiving Medicaid nursing home benefits though, the government can take the house. Heiser advisers seniors, their families and patient advocates to make sure a patient s house is secured while they are getting government Medicaid benefits. In 2010, more than 7,000 people turned 65 years old every day, and that figure rose this year to an estimated 10,000 people every day. Alarmingly, only four in 10 of those seniors will be financially secure, according to a recent AARP report. As patients get older and need specialized care, their families and caregivers might consider placing them in a nursing home. Seniors that meet certain income and other requirements are available for Medicaid nursing home benefits. Gabriel Heiser, a lawyer in Nashville, Tenn., specializing in nursing home law, says that patients and their families, caregivers or advocates should start planning ahead even if a patient is not ready to be admitted to a nursing home yet. Ideally, Heiser said long-term care planning should begin ever before a patient turns 65. A major part of that planning includes assessing a patient s financial stability and whether the patient or other family members will be able to pay for long-term care services. Patient Advocate Report talked to Heiser, author of How to Protect Your Family s Assets from Devastating Nursing Home Costs: Medicaid Secrets, who offered patients and their caregivers some advice about applying for Medicaid nursing home services. Gifts to family members: I think the first thing that people should know is that if people make gifts to their children or grandchildren they will be subject to penalty if they apply for Medicaid within five years, Heiser says. Any large monetary or other gifts to children or grandchildren could disqualify them from receiving Medicaid nursing home benefits. Long-term care insurance: Heiser says individuals shouldn t wait to obtain long-term care insurance. Longterm care insurance, which helps provide for the cost of nursing home and other long-term care, works like other types of insurance. As Heiser says, If your house is one fire, it s too late to get home insurance. Heiser says individuals should consider buying long-term care insurance in their early 60s before they get seriously ill or injured. Long-term care insurance can help offset the cost of nursing home costs. Cash: To qualify for Medicaid nursing home benefits, individuals can possess $2,000 in cash that will not be counted as an asset in determining their eligibility for Medicaid. Other assets: If individuals and their family members or caregivers cannot afford long-term care costs and a patient applies for Medicaid, Heiser recommends setting up an asset-protection trust before the application process. With this type of trust, one person or a married couple called the settlor, or grantor transfers some type of property to another person called the trustee to hold and manage for the benefit of one or more individuals. One of the biggest myths when applying for Medicaid for nursing homes is that you can t do any planning because it s too late and you have to spend all your money until it s gone, Heiser says. But you can always protect your assets. Heiser also recommends that individuals give power of attorney to a family member or other caregiver when they are still in good health. Heiser s book is available at The Centers for Medicare and Medicaid Services have more information on applying for Medicaid nursing home benefits here: Making Healthcare Affordable for Individuals patientadvocatetraining.com 9

11 SECURING HOME MODIFICATIONS: TIPS FOR FUNDING SOURCES 5 Making Healthcare Affordable for Individuals patientadvocatetraining.com 10

12 Securing Home Modifications: Tips For Funding Sources the Massachusetts Health and Human Services Department runs a Home Modification Loan Program for individuals who are disabled or frail homeowners, those who have a household member with a disability or people who rent to individuals with a disability in a building with fewer than 10 units. The residence s owner must apply for the loan. Some landlords may be eligible for a 3 percent loan for a tenant with a disability. Pennsylvania s Access Home Modification Program offers eligible individuals loans from $1,000 to $10,000 on a first-come, firstserve basis. The program provides a deferred payment loan with no interest and no monthly payment. Most loan programs have income guidelines based on the total gross household income. While not all states Agencies on Aging may have these funds available, Pynoos says these agencies can often offer referrals to other organizations where seniors can obtain funds. State housing agencies also may provide home repair programs. Economic hardships have caused many older Americans to lose their health insurance or dip into their savings to pay for necessities like medical costs. Some seniors are finding it increasingly difficult to do certain home modifications and repairs to help them perform daily activities and help prevent falls and other injuries. Jon Pynoos, director of the National Resource Center on Supportive Housing and Home Modification at the University of Southern California, offers seniors and case managers some advice on how to find financial assistant for home modifications like installing ramps, grab bars, handrails or security systems. Funding is often hard to come by, Pynoos says. Many home modifications are low-cost and in some cases people can do it themselves, but some are more expensive and depending on people s income, they might not be able to afford it. There is money out there, Pynoos says, but it takes some resourcefulness to find it. Pynoos says case managers and care coordinators can be especially useful in this process because they can help a person navigate the various sources of funds and explain to a handyman, agency or organization what work needs to be done to a home in order to make it more accessible for an individual. Medicare does not pay home adaptations but does pay for some types of medical equipment. Medicaid may pay for home modifications and medical equipment. Many state and local governments have programs to provide loans and grants to help pay for home modifications. Medicaid programs vary by state. Some states offer Home and Community Based Services (HCBS) through a waiver program. The waiver programs permit states to use Medicaid funds for services as an alternative to institutional care. Home modifications are one of the services offered by many states under the waiver program. Pynoos suggests that seniors and their families use Elder Care Locator, at as a resource for those searching for home modification funds. On the nonprofit side, Rebuilding Together is one organization that works to preserve homeownership. The group recruits volunteers who work on homes to make them more accessible for seniors. Pynoos says there are also private loan programs like Farmers Home Loan Program that can assist seniors and their caregivers. He recommends turning to these options first before using credit cards for home modifications or taking out a reverse home mortgage, which can be complicated and often end up generating significant costs for the borrower. The Older Americans Act, passed in 1965 and reauthorized in 2006, sets aside discretionary funds through local and state Agencies on Aging for home modification loans. For example, Making Healthcare Affordable for Individuals patientadvocatetraining.com 11

13 Earn Your Certificate in Patient Advocacy The NEW Professional Patient Advocate Certificate Training Program is a comprehensive, accelerated education program aimed at enhancing training for both seasoned patient advocates and those looking to enter this emerging practice. Focusing on the concepts of patient advocacy, the program will help advocates meet the needs of individual clients with efficient, effective care, thereby improving patient education and satisfaction. Goals of the Certificate Training Program: Provide a baseline introduction to the emerging role of patient advocacy Provide structure to the practice for professionals who want to add this component to their current healthcare practice Share insights and best practices that advocates can use to assist consumers as they navigate the complex healthcare system A Certificate in Patient Advocacy Will Help You... Introduce a model of care driven by the consumer who wants to be an active participant in their own health Learn what Patient Advocacy means in today s consumer driven healthcare environment Validate your expertise Improve outcomes Advance your practice Drive business Ensure patients have a voice in their care Improve patient satisfaction rates in your organization Ensure appropriate use of healthcare resources Reduce medical risks and costs Demonstrate your qualifications, education, and skill level to other practitioners Learn new avenues to expand your business Hone your business skills For questions about this program, please contact clientservices@patientadvocatetraining.com or Find out more at

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