Question: Have you identified or prioritized the top services needed to deliver independent living? If so, have you built pro forma financial models to accomplish these goals?
Response: No – we have not done so. It seems to us that priorities need to be determined on a case-by-case basis, which is why we are concentrating on promoting the notion of individual choice. The NAB believes that individuals with disabilities can achieve independence with the right service and support systems. The first priority is to allow individuals to choose when and where they receive services. We must incorporate personal preferences in the long-term services decision making process. This is the first step in achieving independence.
Q: What collaboration is occurring with Vocational Rehabilitation professionals? Many individuals with disabilities want to work but often health care professionals do not know about division of Vocational Rehabilitation Services in their areas or the Ticket to Work program through the Social Security Administration.
R: In our opinion, more collaboration needs to occur between health care providers and service professionals. Berthy de La Rosa Aponte, NAB board member, served as chairperson of the Ticket To Work and Work Incentives Advisory Panel and continues to remind the members how important it is to incorporate work opportunities as part of the supports and services for which we are advocating. We are making every effort to collaborate with organizations to help educate communities, consumers, and professionals about what services and programs are available to individuals with disabilities.
Q: Is the board working to improve work incentives for people with disabilities and access to benefits counseling to ensure proper health care and employment decisionmaking?
R: Yes. As highlighted in principle five (5) of our Declaration for Independence white paper, we recommend empowering people to participate in the economic mainstream, and encouraging employment of people with disabilities and seniors by removing disincentives for people to work. The board recommends investing resources to educate, train and support employment of people with disabilities. This will ensure we no longer elude an entire population of people who can further contribute to our nation’s social and economic welfare. Furthermore, expanding our labor pool would create significantly more eligible candidates who could fill job vacancies created by retiring baby boomers. We want to work with individuals and community-based organizations to help develop a health care infrastructure that supports work incentives for people with disabilities who want to work and take an active role in their whole health. It is imperative that we work together to eliminate work place and benefit structure barriers. Continued communication with benefit counselors within Vocational Rehabilitation is important.
Q: Do the board and Amerigroup support the designation of specialists as PCPs in managed care?
R: It seems only reasonable that the people who best understand certain types of disabilities would be eligible to serve as PCPs as long as they are qualified and willing to provide basic care for day-to-day medical problems. The board would like very much to hear the opinions about this topic from both providers and consumers who may be reading these posts.
Q: How can we nationally engage insurance companies to support new in home care services and technology? What will it take to accomplish national funding from all payors – private insurance, government (Medicare/Medicaid) and Veterans Administration?
R: Consumers must let healthcare companies, regulators and legislators know the importance of including new in-home care services and technology in long-term supports and services in health care benefits. Nothing is more important than helping people live full, independent and dignified lives within the comfort of their own homes. It is important to communicate with Washington based associations addressing this issue, such as AHIP, NASMD and NASUA. With respect to accomplishing national funding from all payors to ensure comprehensive long term supports and services, this will require policy changes, legislation and funding. It is also important to communicate with MCOs in this process. We must call on legislators at the national and state levels to work with insurance companies, and invest in technology to empower individuals to remain in their home, in the workforce and engaged in the community.
Comment: In addressing technology, I would like to see the Board address technology on two levels: technology for administrative purposes and personal use technology. While technology can be viewed as a potential cost savings for personal care I would encourage you to focus on technology as a means to improve quality of care, independence, and prevention of disabilities for caregivers. The cost savings or cost containment for reduced personal care costs is a value add, but one that is on the fiscal end.
R: Thank you for your comments and for participating in the National Day of Dialogue. The board shares your views entirely. For reference, you may wish to review principle six (6): Invest in Improved Technology, pages 28-30 of the white paper/Call to Action. We also believe that technology continues to eliminate barriers to independence and increase personal preference opportunities and participation in the community.
Q: Seems to me that most COPD problems are ignored.
R: COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard for people to breathe. We have met people with other complex health-related conditions who feel the same as you about their unique problems. Thank you for your comments and for participating in the Day of Dialogue.
Q: Much of the high-level care to the home has no payment structure from CMS. Only the managed care organizations have this opportunity, not the remote physician who wants to help his patient stay home. I am hopeful that this committee can help with the transition that will be needed. Sensors for the smart medical home exist now, as well as new FDA approved devices for the home.
R: Thank you for your comments and for participating in the Day of Dialogue. If you have documented evidence of the cost-efficiencies created by the use of these technologies, we would be grateful to you for sharing such documentation with us and would encourage you to share it with others that are engaged in the health reform process. We agree that technology offers much hope for reducing costs and increasing the quality of life for individuals who wish to live independently in their own home.
Q: We are a small high-tech company called iVisit. We have developed several assistance solutions under NEI and NIA sponsorship. These solutions allow use of mobile phones for automated recognition of objects or landmarks for visually impaired and elderly as well as remote assistance or telehealth for visually impaired and chronically ill patients through their PDA phones. What are some ways that a small company like us could get such solutions to qualify for Medicaid/ Medicare coverage?
R: While the importance of venture capital and other means to sponsor development and production of technological innovations are undeniably important and will cut costs and improve outcomes, the nuances involved in obtaining such sponsorships have thus far been beyond the scope of the NAB’s discussion.
Q: Are you hearing when proposals are expected? How can we ensure that states implement community choice for all? States move incrementally.
R: We believe health care reform is imminent and the time to contact legislators is now. Please go to the Speak Up for Independence section on our web page to contact your elected officials at http://www.declarationforindependence.org/site/page/speak-up. You can also access other web sites, such as AAPD (www.aapd.com) and ADAPT (www.adapt.org) to get CCA updates, and be sure to check our web site at www.declarationforindependence.org or www.mydfi.org for regular news updates. We suspect the most up-to-date information about legislative progress will come from the offices of members of Congress, advocacy organizations like those noted above and your daily news.
Q: How about the quality safeguards that needs to be in place and the potential for exploitation by family members of individuals who are not able to make informed choice?
R: Education is the key to informed decision-making. Families should reach out to caregiver organizations such as the National Family Caregivers Association (NFCA) and service coordinators to gain a better understanding of eligibility requirements, availability and access to supports and services for family members and caregivers. The issue of oversight on behalf of plan beneficiaries or healthcare consumers is a delicate and complex one in that many consumers wish to be responsible for “oversight” of their own programs, without the involvement of regulators, overseers, quality checkers, or other third parties. At the same time, the board is clearly aware of instances where people with certain disabilities may require or wish to have external oversight in order to assure that they are receiving the most appropriate and best quality services available to help them live as independently as possible.
Q: I have little confidence that this congress will change health care. Until we change the flow of money, change cannot happen. We cannot sustain spending 40 percent of Medicare dollars for people in the last month of life as we do today. Can this congress step up and truly provide a new system?
R: We believe it is possible to affect health care reform… we all must get involved! Please speak up via our blog (www.mydfi.org) or by contacting your legislators.