Tuesday, November 29, 2016

Flu Vaccines: Get Yours Today!

By Laura Pryor, RN, MSN

The Centers for Disease Control and Prevention, also known as the CDC, reports that the single best way to protect against influenza (flu) is to get vaccinated each year.

Many people believe the flu is no more serious than a cold; however, influenza is a serious viral disease that can lead to hospitalization and sometimes even death. This is especially true for the very young, those over the age of 65 years, as well as people with other chronic health issues. Even healthy people can get very sick from the flu and spread it to others. Several years ago, I skipped the flu vaccine, thinking I was a young mom that had a healthy immune system. I got the flu that season and was very ill. I had to have my young daughter phone her grandmother to come over because I was too sick to care for myself or my two young children. That experience made me seriously re-think the importance of the flu vaccine! I have not missed a vaccine since that year.

Flu season can begin as early as October and can last as late as May. During this time, flu viruses are circulating at higher levels in the U.S. population. Flu is usually at it’s peak in January or February each year. Because it can take 2 weeks for your body to develop flu antibodies, it’s best to get your flu vaccine as early in the season as it is available (usually around September or October). For those who didn’t get their vaccine yet, it is still a good idea to get one. Vaccines can be given throughout the flu season.

Everyone 6 months of age and older should get a flu vaccine every season. This recommendation has been in place since February 24, 2010 when CDC’s Advisory Committee on Immunization Practices (ACIP) voted for “universal” flu vaccination in the United States to expand protection against the flu to more people.

Vaccination to prevent influenza is particularly important for people who are at high risk of serious complications from influenza. More information is available at Who Should Get Vaccinated Against Influenza.

I’ve heard many people say that the flu vaccine “gave them the flu”. It is quite common for a person to have a mild fever, feel tired, and even have some muscle aches or headache as part of the natural process the body goes through while developing antibodies from a vaccine. Experiencing this does not mean a person got the flu from their vaccine.

There are different forms of flu vaccine available. The following link will take you to the CDC website, where you can learn more about the different types of flu vaccine: http://www.cdc.gov/flu/protect/keyfacts.htm

The CDC recommends use of injectable influenza vaccines (including inactivated influenza vaccines and recombinant influenza vaccines) during 2016-2017. The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017.

Both trivalent (three-component) and quadrivalent (four-component) flu vaccines will be available.

Trivalent flu vaccines include:

  • Standard-dose trivalent shots (IIV3) that are manufactured using virus grown in eggs. Different flu shots are approved for different age groups. Most flu shots are given in the arm (muscle) with a needle. One trivalent vaccine formulation can be given with a jet injector, for persons aged 18 through 64 years. 
  • A high-dose trivalent shot, approved for people 65 and older. 
  • A recombinant trivalent shot that is egg-free, approved for people 18 years and older. 
  • A trivalent flu shot made with adjuvant (an ingredient of a vaccine that helps create a stronger immune response in the patient’s body), approved for people 65 years of age and older (new this season). 

Quadrivalent flu vaccines include:

  • Quadrivalent flu shots approved for use in different age groups. 
  • An intradermal quadrivalent flu shot, which is injected into the skin instead of the muscle and uses a much smaller needle than the regular flu shot. It is approved for people 18 through 64 years of age.
  • A quadrivalent flu shot containing virus grown in cell culture, which is approved for people 4 years of age and older (new this season). 

If you have questions about which vaccine is best for you, talk to your doctor or other health care professional.

Sources: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD)

Monday, November 14, 2016

"Steady As She Goes"

By Scott Rollett, MBA, C.M.P.E.

If you were like me, you went to bed late Tuesday night simply stunned by the election results.  Being a healthcare administrator who has worked for a Community Health Center for more than twelve years, my first initial thought was one of panic:  the GOP finally has the power to repeal the Affordable Care Act (ACA) - - an act the GOP-led Congress brought to a vote more than 60 times since the ACA was signed into law but each were defeated either by Congressional Democrats or vetoed by President Obama.    

My thoughts turned immediately to the possible impact on Windrose Health Network, its patients, and its employees if that were to occur.  Regardless of what anyone thinks about the overall impact of the legislation, the fact of the matter is that Windrose Health Network has grown significantly as the result of the ACA.  Below is a brief comparison of some common statistics for WHN in 2010 (the year the ACA was signed into law) and projected figures for 2016.    
# of Patients Served
70% ↑
# of Patient Visits
92% ↑
% of Uninsured Pts.
21% ↓
# of Employees
96% ↑
WHN Annual Budget   
142% ↑

Additionally, WHN was poised for even more growth in 2017, with as many as (3) new Health Centers planned to come online throughout the year.  With these facts in mind, one can understand my initial, fearful  reaction.  Simply repealing the ACA - - without a replacement plan - - would do significant damage to WHN and the people and the communities that it serves.  Further, the GOP has already identified this as Priority #1 for the Trump Administration and the 115th Congress.

However, as the days and hours after the election passed, my outlook began to change.  The more that I thought about things and the more that I began to talk with other healthcare leaders and read thoughtful analysis by industry experts, the more that I realized that simply overturning / reversing the ACA  is likely not possible.  The healthcare environment has shifted significantly in the past six years and - - like it or not - - the ACA is already well-entrenched into society.  Below are a few thoughts that give me solace, even in the midst of an uncertain future.

Popular Components of the ACA:
Most critics of the ACA focus on some of the unpopular components of the ACA, like the Individual Mandate, the economic impact on Small Businesses, or the overall lack of affordability for Marketplace Exchange products.  But critics rarely focus on the positive components of the ACA which consumers have already begun to appreciate and use.  Some of these things are:
·       Free preventative care - - especially for pricey items like colonoscopies and mammograms
·       Continued coverage for adult children up to Age 26 (regardless of college status)
·       The removal of Annual or Lifetime Coverage Limits
·       No denial of coverage for pre-existing conditions
·       The establishment of Marketplace Exchanges and Medicaid Expansion to create additional access to coverage for early retirees, the self-employed, the unemployed, or those whose employers do not offer affordable coverage (through which an additional 20M people now have coverage)    
·       Healthcare premium subsidies based on Household Income and Size

These are all popular components of the ACA and ones which will be difficult to "walk back" without having serious implications for the 2018 Mid-Term Elections. 

 The Impact on the Economy:
One of the strongest arguments against a swift repeal of the ACA is the overall negative impact it would have on the economy.  To start with, states who have already expanded Medicaid have seen an influx of Federal Dollars that they would not otherwise have access to.  These Federal Dollars have bolstered state budgets and created tens of thousands of new jobs in government, in healthcare, and in healthcare-related industries like Pharmaceuticals and Medical Device Manufacturers.  A January 20, 2017 rollback would instantly imperil those jobs and I do not think any of our elected officials are eager to let that happen. 

Secondly, the ACA was signed into law in March 2010 and while some of its components took effect immediately, other parts of it took years to be implemented as State Governments and Insurance Companies worked to incorporate the changes into their business models.  Yes, there has been a lot of negative publicity in the past six months about some large insurance companies dropping out of specific Marketplace Exchange networks.  But they are not telling the whole story.  The ACA has many positive attributes to it that Insurance Companies have incorporated into their conglomerate organizations.  For example, Medicaid Expansion has been a boon to many private insurance companies because they manage risk for many Medicaid Members on behalf of state governments.  In fact, United Health Care, of which a lot of focus was put on this past summer as they announced they were dropping out of many Marketplace Exchanges was one of several insurance companies that submitted a bid to try to get INTO Medicaid Expansion / HIP 2.0 in Indiana in 2017.  Clearly, their leaders saw this part of the ACA as a business opportunity, even as they were abandoning the less-profitable Marketplace Exchange market.  Additionally, the creation of Accountable Care Organizations and Shared Savings Plans put Medicare and private insurers on a pathway that already has created hundreds of millions of dollars in cost savings and fraud prevention.  Last but not least, the taxpayer premium subsidies have been incorporated into the revenue streams of nearly every major health insurance company in America.  Ending those on January 20, 2017 would throw the insurance industry into immediate turmoil.  I do not think any of our elected officials would be eager to let that happen either.         

HIP 2.0:
Initially, the Healthy Indiana Plan (HIP 2.0) - - Indiana's version of Medicaid Expansion - - was highly political.  Governor (and Vice-President Elect) Mike Pence's Administration negotiated with President Obama's Administration and Health and Human Services (HHS)to develop a plan that both sides could live with.  The result of HIP 2.0, more than a year and a half after its implementation, is that it not only works, it is also widely seen by conservative leaders as a successful model that can be duplicated in other states that have yet to implement Medicaid Expansion.  Furthermore, specific components of  HIP 2.0, like Presumptive Eligibility, have been not only a financial "shot-in-the-arm" for hospitals, specialty physicians, pharmacies, and other healthcare providers, it has also been a blessing to many previously-uninsured patients who need healthcare services NOW and not in 45-60 days when their applications can be approved.  The fact that Indiana - - a fiscally-conservative state - - has implemented such a program to great success gives me hope that President-Elect Trump's campaign promise to "repeal and replace the ACA" with something that "covers everyone" might be legitimate.       
We Still Have a Voice:
Last but not least, as advocates of the poor, the working poor, the medically-underserved, and the middle class, we still have a voice.  The elections are over, and our newly-elected Senators and House Reps have a job to do - - to serve the people that elected them.  Lobbyists will soon begin their descent on Washington and will be making their case for their clients' best interests.  We must continue to do the same and we must not become complacent.  Americans everywhere must continue to let their government reps know how their decisions will impact their lives, the lives of their family members, and the communities in which they live.  The good news is that the Health Center Program enjoys bipartisan support and as Tom Van Coverden, President & CEO of the National Association of Community Health Centers (NACHC), said in a statement issued last Thursday, Congress and Presidential Administrations on both sides of the aisle have made investments in Health Center expansion over the last 16 years.  WHN has seen this bipartisan support demonstrated at a local level.  In 2015, House Representative (and Senator-elect) Todd Young visited our Countyline Health Center.  He was both supportive of our mission and inquisitive as to the people that we serve.  Finally, last summer, when WHN put in an application to serve the community of Bloomington with a new Health Center, both Mr. Young and Democratic Senator Joe Donnelly gave us a Letter of Support towards that endeavor.            

In conclusion, at this point in time, there are likely more questions than answers about what  a Donald J. Trump Presidency and a GOP-controlled Congress will mean for the healthcare industry.  The reality is that none of us can predict exactly what will happen after January 20.  So as we look down towards this unknown path and ponder the journey that we are all about to embark on, the words that Captain James T. Kirk ended many Star Trek episodes with echo in my head, "Steady as she goes, Mr. Sulu.  Steady as she goes."  

Thursday, November 3, 2016

This November, Be Thankful For Open Enrollment

By Beth Sullivan, CIN, CAC, SHIP Counsellor

November is the month that we pay attention to being thankful. This year, I am thankful for all of the opportunities we have as a nation to obtain healthcare. It seems appropriate that November is also the month that Open Enrollment for health insurance is going strong. 

Some people have access to employer sponsored insurance and the employer decides when they will hold Open Enrollment. During this time, employees can change their coverage, depending on their personal family needs. This is usually around November and December. 

For people who get their health insurance through Medicare, Open Enrollment ends on December 7. From now until then, those with Medicare may change their coverage and drug plans for the coming year. Plans and medicines change, so this is the time to make them match up to get the best coverage for your needs. 

The Federal Marketplace is also open during November and ends December 31. In order for coverage to start on January 1, 2017, applications need to be submitted by December 15, 2016. Everyone who has Marketplace insurance needs to update their application for 2017 and shop for plans. There are many changes in the companies on the Marketplace and in the coverage. 

For the first time, there is an Open Enrollment for Hoosier Healthwise (HHW). It is from November 15 to December 15. There are now four companies that have contracted with Indiana to oversee HHW: Joining Anthem, MDWise, and MHS, is Care Source. 

All of these health insurance options allow an individual to shop for plans that meet their needs. 

So, if you are "shopping" around, call a Windrose Health Network Eligibility Navigator to assist you!