Sunday, July 31, 2016

Healthcare in the Age of Accountability

By Scott Rollett, M.B.A., C.M.P.E

As they say, we live in interesting times.  As anyone who works in the healthcare industry can attest too, nowhere is this more true today than in healthcare.  Probably unbeknownst to most healthcare consumers (i.e. patients!), there is a quiet revolution underway to transform the United State’s costly healthcare system into one that is both more effective in terms of health outcomes and less expensive to deliver.  It goes by many names and has many parts and pieces, but all are designed to work together with those ultimate goals in mind.  Perhaps you have heard of some of the latest “buzzwords”.  The Triple Aim.  Value-Based Care.  Accountable Care.  Outcomes-Driven Care.  Or one of the most popular, the Patient-Centered Medical Home.    

Many of these are not new concepts and have been around for decades.  I began my career in healthcare in the early 1990’s when Managed Care and HMO’s first came upon the scene in Indiana.  You may remember how your Family Doctor was your “gatekeeper” and how your access to specialty care and diagnostic tests was directed by him or her.  It was seen as an efficient model of care and there are many studies that do report a “slowing” in the growth of health care costs during the 1990’s. 

Then things kind of got crazy again.  Patients pushed back against some of the restrictions that limited their access to care.  New technologies came into existence.  More effective drugs and treatment options became available.  More specialists came onto the scene and some specialists became sub-specialists.  All of these things and more created the most advanced level of healthcare available to anyone in the world - - but also the most expensive.  The harsh reality is that American healthcare has become so expensive that it is breaking budgets.  But not just your budget and mine!  Also State and Federal budgets as well the budgets of third party insurers which likely trickles down to the budget of your employer if they offer health coverage as a benefit.  The bottom line is that health care costs are skyrocketing at an alarming rate for all of us and no one can stand idly by anymore and do nothing.  As consumers, as employers, as taxpayers, we can no longer afford it.         

So this latest permutation of “managed care” is back and it needs to succeed more than ever before.  One of the key differences this time, however, is that Primary Care Providers (PCP’s) are no longer asked to be simply “gatekeepers” for your health care.  Instead, governmental payers and third-party insurers are requiring PCP’s to be “accountable” for your health outcomes.  They want PCP’s to make sure your health is either improving (or at least not deteriorating!).  They want us to make sure you are getting recommended preventative health care services.  They want us to use evidenced-based medicine and hit certain quality metrics.  They want to make sure that we address any “care gaps” that might exist.  They want us to screen you for depression and substance abuse.  If you are elderly, they want us to asses the probability of you falling in your home.  If you’ve been recently discharged from the hospital, they want to make sure that you understand your discharge plan and also make sure that you follow up with your PCP at the appropriate time.           

These all seem like good things and, when done right, they do, indeed, meet the goals of the Triple Aim (Better Care, Better Health, Lower Costs).  But in today’s healthcare environment, this can present some unique challenges.  One of the biggest challenges, of course, is:  Is this what the patient wants?

It seems like a silly question, right?  What patient would not want better health, better care, and lower costs?  Everyone does want that, right?  But the real question remains, do they want it enough to do anything different?  Do they want it enough to get that colonoscopy once they turn 50?  Or their annual mammogram or PAP test?  Do they want it enough to stop smoking?  Do they want it enough to try to lose weight?  Do they want our offices calling them every few months to remind them of things they need to come in and have done? 

What we are finding at Windrose Health Network is mixed.  Some patients like the reminders and really appreciate that someone is looking out for their health.  But others don’t like it one bit!  They want to be in control of their health-care decision-making and resent the fact that we are calling to remind them about things they don’t want and have no intention of pursuing.  Further, since some of these things will cost patients money out of their pocket, we’re asking them to spend money that they may have set aside for other things.     

Such exists the dichotomy of Healthcare in the Accountable Age.  Whether patients want it or not, commercial and governmental payers are beginning to hold Primary Care Providers accountable for positive health outcomes for their patients.  For many years now, medical practices and other healthcare organizations have been incentivized to take proactive steps to ensure good health for their patients.  Beginning in 2017, however, reimbursement mechanisms will begin penalizing medical providers who are not able to demonstrate that they are effectively influencing the health of their assigned patients.

So, as 2017 approaches, Windrose Health Network will continue to operate as we always have: by helping patients become active participants in their care and creating a partnership in which the patient remains firmly in the driver’s seat.        

Tuesday, July 19, 2016

Healthy Indiana Plan-HIP 2.0

By Beth Sullivan, CIC, CAC, SHIP Counselor

Healthy Indiana Plan (HIP) was expanded in 2015.  HIP is health insurance for Hoosiers age 19-64.  There are two HIP plans: HIP Basic and HIP Plus.

HIP Basic

HIP Basic is a fee for service plan.  This means the patient pays a copayment at every visit to a medical facility.  There is also a copayment for any medications prescribed.  There is NO monthly Power Account Payment.

HIP Plus

HIP Plus patients pay a monthly Power Account Payment (PAP) which is 2% of their household income.  By paying their contribution, the member does not have a copay at the time of service.  Covered services include: doctor visits, emergency room services, hospitalization, maternity, mental health, laboratory, pharmacy, preventative and adult vision and dental.

Power Accounts cover the first $2500 of covered services.  The patient makes their contribution and the state contributes the rest.  This does not mean that after the first $2500 the patient is no longer covered.  The member continues to be insured.  The purpose of the power account is to help educate the members on the cost of health care.  If the member does not use all of the $2500 it can be rolled over to the next year to reduce the Power Account Payment for the next year.

If you would like assistance, you can schedule an appointment with one of our Eligibility Navigators. Visit for our locations. 

Tuesday, July 12, 2016

Bicycling Safety

By Staci Brandenburg, RN

Bicycling is good exercise and is a green form of transportation. Anyone who wants to enjoy bicycling should follow some basic safety:

  • The bike should be the right size for the rider.
  • It should be in good working order. 
  • Wear the right equipment:         
    • A well-fitting helmet.
    • Bright clothing during the day.  
    • Reflective clothing with a white front light and red rear light at night. 

  • Practice riding somewhere safe, like a park or an empty parking lot. 
  • Do not goof around when riding in traffic. 
  • Do not ride with anyone on the handlebars. 
  • Keep your shoe laces tied and your pant legs out of the way. 
  • Stay alert, using your eyes and ears at all times. 
  • Look left-right-left before entering traffic and behind before entering traffic. 
  • Ride the same direction the traffic is going. 
  • Follow the traffic rules: 

    • Stop at "STOP" signs and red traffic lights.
    • Use hand signals for turning and stopping. 
    • No texting. 

  • Ride your bike where it is supposed to be, avoiding the sidewalk unless marked for bicycles: 

    • Watch for people walking on the sidewalk. 
    • Tell the walkers when you are going to pass them, by saying "Passing on your left," or something similar. (Caution: Some people who are hard of hearing or have earbuds with music playing may not hear this!) 

Stay safe and have fun bicycling!

Wednesday, July 6, 2016

Learning To Manage Anxiety

By Donna Vaughan, Anxiety Sufferer, LMHC, DBH

Anxiety in America is a growing health issue.  Just turn on the evening news as you are bombarded with horrible news and yet another thing to worry about.  Our society has become so fast pace that it is difficult to find time throughout our work day to even visit the restroom!!  We learn every day of another “danger,” whether it is our food supply, a new disease, a mass shooting, or __________ (you fill in the blank).  As a Licensed Mental Health Counselor (Behavioral Health Provider), I work with patients daily who are experiencing high levels of anxiety.   The good news (and there is some) is that I work with patients within a primary care setting.  This means that the medical doctor AND the Behavioral Health Provider can see the patient in the same exam room. The medical doctor will assess the physical symptoms and if anxiety is suspected then I will be called in to meet with the patient and offer brief interventions to help manage the anxiety.  The news gets even better from here! I once suffered from anxiety (panic disorder) myself and learned to manage my symptoms and beat it. So why is THIS good news?  Because I can truly understand when someone else is suffering from anxiety and people will listen to someone who has “been there”.  If you have never had a panic attack, please do NOT tell me you understand what it is like…..and PLEASE do not tell me it is ALL in my head!!

Anxiety is the most common behavioral health disorder and is also the most treatable!  It is estimated that more than 40 million American adults suffer from anxiety.   However, only one-third of these 40 million will seek treatment (Anxiety and Depression Association of America).  Anxiety presents itself with a variety of physical symptoms and these physical symptoms are what brings people in to their primary care clinic for treatment.  Most individuals know they are “uncomfortable” and that “something is wrong” but are totally unaware that anxiety is the issue and how easily it can be treated.


Worry, stress, and anxiety can trigger physical symptoms such as the following:
·       Sweating
·       Stomach ache
·       Dizziness
·       Shortness of breath
·       Headaches
·       Pounding heart
·       Muscle tension
·       Stomach upset
·       Numbness
·       Tingling

For me, it was a matter of regaining control.  I would experience these physical symptoms that would feel like I was dying (literally)!  I was not a trained Mental Health Counselor at the time.  I was a 19 year-old college student experiencing my first panic attack out in public, which triggered catastrophic thoughts in my mind that EVERY TIME I would even think about going out, I would have a panic attack.  In my mind I was the ONLY person on earth that experienced this horror.  Much to my surprise about ten years later I was having a conversation with my father and he shared with me his experience with panic attacks at about the same age!!  Thanks, Dad, you could have told me sooner!!  It turns out that anxiety tends to run in families.  Our brains (anxiety sufferers, that is) are wired so that we are hypersensitive to physical sensations in our bodies and quick to start the cycle of anxiety between the mind and the body.  Our body goes in to the “on guard” mode pretty quickly.  Learning to STOP that cycle is HUGE!  I call it “catching the uh-oh thoughts”.  No, that is not a clinical term at all but it is the best way to describe the thought just prior to the cycle of anxiety beginning.  Once I learned to stop that cycle with "catching my thought" that triggers and doing some deep breathing that would slow down my pulse, I was good to go. I can honestly say that I have not had a panic attack in about 33 years!  Now that is not to say that I never get anxious because I do, but I can MANAGE it and not let it (anxiety) MANAGE me. Don't be afraid to ask for help from your medical provider.  Yes, medication can help (SSRI antidepressants) but you must know that learning these techniques to manage your thoughts and your behaviors ALONG with an antidepressant medication, has the BEST results for treating anxiety.  Medication alone WILL NOT treat it.  However, I am living proof that changing my thoughts and my behaviors WITHOUT medication worked!!