Coordinated care plans can hold down costs, improve quality of care for poor elderly
Health care for the poor elderly in this nation is in dire straits. For every state in this nation, Medicaid — the federal/state health insurance program for the indigent — is growing faster than the rate of inflation. That cost is being driven by an aging population of poor people, who consume an enormous amount of resources with end-of-life medical care and long-term nursing home care. At the heart of the issue is the fact that 15 percent of the people who qualify for Medicaid are over 65, yet they use 45 percent of all the Medicaid dollars.
To be eligible for Medicaid, an individual’s annual income can’t exceed $10,000 and their personal assets must be less than $1,000. They are, by definition, known as “dual eligibles” because they are enrolled in both Medicare and Medicaid and, since 2006, Medicaid Part D for prescription drugs. Sounds like comprehensive coverage, and it is. But on the other hand, it’s also incomprehensible because it’s administered by three separate entities. The federal government processes Medicare claims, individual states handle Medicaid claims, while private drug plans pay for prescription drugs.
To further compound the confusion, consumers have three sets of documents, triplicate customer service contacts and almost always need assistance from family or friends to get the three plans to work in unison. In recent years a new approach has been launched to hold down costs and improve the quality of care received by dual eligibles.
Each of the three government insurance plans (Medicare, Medicaid and Medicaid Part D) are being consolidated with one private health plan entity that pays all claims, handles all customer service issues and contracts with all the providers. One of the major benefits of these “coordinated care plans” is that each beneficiary is assigned a nurse care manger to:
u Assess the member’s health status upon enrollment and develop an individual care plan
u Become the member’s advocate in implementing the plan by anticipating each person’s health and social service needs
u Work with each member’s primary care physician, family and social services to keep them as independent as possible until the end of life, thereby avoiding nursing home admissions
u Align social services for food stamps, meals on wheels or courier services to deliver food ordered from a local grocer
The cost of the nurse care manager is paid for out of the savings from the elimination of unnecessary hospitalizations — something that is extremely prevalent among the elderly.
By keeping New York’s poor, elderly well at home and avoiding institutional care and frequent hospital stays, there is a model that can reduce medical inflation and improve their overall quality of life.
The writer is the CEO of Senior Whole Health, a voluntary health care benefits plan for low-income seniors in Albany, Rensselaer, Schenectady, Saratoga, Dutchess and Ulster counties. For more information, go to seniorwholehealth.com.
‘Intelligent design’ isn’t a science that can be proven or disproven
In response to William Hartman’s Mar. 3 letter, “More evidence than ever of “intelligent design”: Like Darwin: I, too, once “believed that the universe was too beautiful to not have some kind of intelligent origin.” Since Darwin’s time, however, the evidence for evolution has stacked up in the form of fossil records, advances in medicine, and laboratory experiments that demonstrate evolution at work. I needed only to find them in the books and papers provided by the scientists who discovered them.
Recent discoveries of the beauty and complexity of the universe isn’t “evidence” of intelligent design. It’s simply a self-serving interpretation that further justifies a reasoning for the belief in design.
To answer your question, Mr. Hartman: “intelligent design” simply isn’t science. It can neither be proven (unless the designer reveals him/her self) nor disproven. Academia is less afraid of religion in the classroom than of something that is far from empirical being passed off as science.
General attitude of the candidates — maybe a crown should replace oval office
I was watching the Channel 10 program, “20/20 — the Royals” and I had a vision — Barack Obama, Hillary Clinton and John McCain with a crown! Imagine! Who would it suit best?
Carol A. McArdle