Transcription of Accessing Health #163
Speaker 1: You’re listening to the Dr. Lisa Radio Hour and Podcast recorded at the studio of Maine magazine at 75 Market Street, Portland, Maine. Dr. Lisa Belisle is a physician trained in family and preventative medicine, acupuncture, and public health. She offers medical care and acupuncture at Brunswick Family Medicine. Read more about her integrative approach to wellness in Maine magazine. Here are some highlights from this week’s program.
Dr. Wolf: We have to have a health system that works better for people where we take care of individuals no matter what the need is and no matter what their payment source is.
Vanessa: Who’s counting on you to stay healthy? Is it your family? Is it your friends? Is it your co-workers? Or is it much larger than that? What is your role in the state? I think that that’s a message that we’re trying to get out there and I hope as people are weighing the decisions about what plan to sign up for or whether to sign up at all, I think they should take that into consideration. I certainly am going to be.
Lisa L: I say to people, “It just doesn’t hurt to see what your options are,” and I’d be happy to go over some plans with you, and at least you know what your options are, what your choices are, and then you can make an informed decision. It doesn’t cost anything.
Dr Nesin: I hope that we’ll be able to, at some point, expand Maine Cure because there’s a big population that the marketplace doesn’t serve, and that’s exactly what the expansion of Maine Cure was designed to address. Hopefully someday we’ll get to that so that we really can reach all people in Maine.
Speaker 1: The Dr. Lisa Radio Hour and Podcast is made possible with the support of the following generous sponsors: Maine magazine, Marci Booth of Booth Maine, Apothecary by Design, Mike LePage and Beth Franklin of RE/MAX Heritage, Tom Shepherd of Shepherd Financial, Harding Lee Smith of The Rooms, and Bangor Savings Bank.
Dr. Lisa: This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and Podcast show number 163, “Accessing Health,” airing for the first time on Sunday, October 26, 2014.
It is critical for people to have access to healthcare. Far too many families become devastated by unexpected healthcare costs and far too many individuals are unable to seek the medical assistance they need often delaying diagnosis and treatment for serious problems. Today, we address this issue with Dr. Wendy Wolf, founding president of the Maine Health Access Foundation; Vanessa Santarelli, CEO of the Maine Primary Care Association; patient outreach and enrollment specialist and licensed social worker, Lisa Lemieux; and Penobscot Community Health Care Chief Medical Officer, Dr. Noah Nesin. If you or someone you know does not currently have access to healthcare, listen in and learn how you can remedy this situation. Thank you for joining us.
Today on the Dr. Lisa Radio Hour and Podcast, we have the opportunity to speak about something that I think many people would love to learn more about and it’s something that influences all of us, really. We have, as guests, Dr. Wendy Wolf who is the Maine Health Access Foundation’s founding president and CEO, and also Vanessa Santarelli who is the Maine Primary Care Association’s Chief Executive Officer. Couple of big names coming in and spending time with us; obviously this is a pretty important topic that you want to discuss. Thanks for coming in.
Dr. Wolf: Yeah, it’s our pleasure.
Vanessa: Thank you for having us.
Dr. Lisa: First, for people who are listening, what is the Maine Health Access Foundation, Dr. Wolf?
Dr. Wolf: We’re the largest private healthcare foundation in the State of Maine. People may have heard of the Robert Wood Johnson Foundation which is the largest health foundation in the United States. We actually are statewide organization. We have a mission to provide access to high-quality care and improve the health of everyone in Maine. Fortunately, we have an endowment that helps fund our work and we give out grants and other program support to organizations across the state including the Maine Primary Care Association to really try and make sure that everyone in Maine has the healthcare that they need so they can have better health.
Dr. Lisa: Then, I guess, we would also like to know what is the Maine Primary Care Association and why do people need to know about this?
Vanessa: The Maine Primary Care Association is also a statewide non-profit organization. We have the pleasure of representing and having among our members all of the state’s federally qualified health centers. Federally qualified health center is a community health center. We have 19 FQHCs in the state. They serve approximately 200,000 individuals for their primary care needs, primary and preventive care and they integrate behavioral health and oral health services. The community health centers have over 71 sites throughout the state and are really integral in providing patient-directed primary care services. When I say patient-directed, each one of our health center’s boards have a requirement to have at least 51% of their governing boards represented by patients of the health center. It’s a really unique model in which health center patients have a direct say and direct influence on the healthcare that’s provided not just to them but to several other services available in their community.
Dr. Lisa: Tell me where some of the sites are.
Vanessa: Sure. Our member sites range all over the state from up in Aroostook County and places like Eagle Lake, Presque Isle, Caribou, down to Eastport, Lubbock, Harrington and Washington County through to Bangor and across the state over to Bethel. We have sites all the way as far down as Springvale and cities like Portland, but we are recognized for being primary care providers in some of the most medically underserved communities throughout the state. We, in fact, have sites in pioneer destinations like on Vinalhaven out in the islands. We are in almost every single county in the state and are proud to be serving people locally in their communities.
Dr. Lisa: There is a chance that people who are at one of these centers may not realize that they’re actually at one of these centers. They just may be thinking, “I’m going to my family doctor. I’m going to my nurse practitioner,” or maybe, “I’m getting some counseling or I’m going to see a dental hygienist.” They may be going to one of these sites you’re talking about.
Vanessa: Exactly right, yes.
Dr. Lisa: Dr. Wolf, why do we care about health access? What is this that we’ve been talking about for such a long time and the Affordable Care Act has been addressing? What is the public health impact of not having access to care?
Dr. Wolf: Let’s have your listeners think for a moment. Of all the things that we have in our life, probably the most valuable thing is our health. If you ask people, “What do you value most?” Probably my health and my family. One of the things that helps keep us healthy and makes us feel more secure about our health is having health insurance. We know this for seniors. They really value their Medicare coverage and it has really introduced for seniors a degree of security and support that didn’t exist before the 1960s when the Medicare program started.
For you and me, we probably have health insurance through our employer and I know a lot of people in Maine who are of working age, health insurance is a very important benefit because it really helps you feel secure to be cushioned from say any medical illness, hospitalization, things that basically people are afraid might really, frankly, bankrupt them or really cost more than they could afford to spend to remain healthy.
When you talk about access to healthcare, there are two things that we need to think about. First of all is everyone in Maine should have access to affordable health insurance, whether it’s through public health insurance like Medicare or Medicaid or private insurance like you and I may have through one of the local insurers here in town. Then the second component of that is when you have health insurance is can I get in and see a primary care doctor and have a relationship with someone who I trust, who listens to me, who takes care of everything that’s going on in my life, not just my physical issues but mental health, hopefully your oral health also, and really wants to take care of me, me and my family.
I know you’re a physician, I’m a physician, so I think one of the things that we know is that people really want to have a relationship with their healthcare provider because we ought to be in a partnership to make sure people are staying healthy or, if they have an issue, they can return to health as quickly as possible. The access equation is two things: coverage and then being able to get into the healthcare setting whether you live in Rural Maine, Portland, Lewiston, whatever. That’s why the Primary Care Association is a really important partner because they are the backbone of healthcare providers particularly in rural areas in our state where a lot of people still continue to live.
Vanessa: The beauty of the community health centers, just to put on what Dr. Wolf was saying, serve anyone who walks through their doors. We don’t discriminate based on different types of insurance status or ability to pay. We essentially are there to provide care to everyone. Not only are we providers of choice for people who have health insurance because they recognize that the community health centers provide some of the highest quality primary and preventive care services, but we also serve a very high percentage of folks on Medicare; actually, one of the highest percentages in the country, and folks on MaineCare, but also for folks who don’t have health insurance. We provide those healthcare services just as equally to them and we try to tear down barriers to access.
We provide transportation and interpretation services if individuals need those services as well as chronic diseases management and care management services. It’s really like going to your doctor’s office but a whole host of things more, and we’re really proud of our model of care.
Dr. Lisa: One of the things that has gained recognition is this idea of the patient-centered medical home. This is something that we wrote about for our Maine magazine article in which we interviewed Bill Caron in MaineHealth. This is something that you’ve been doing and the Maine Primary Care Association has been doing for a very long time.
Vanessa: Yes, thank you for bringing it up. Actually, we are really proud because, nationally, if you look at federally qualified health centers throughout the country, patient-centered medical home recognized sites nationally are about 54% of all FQHCs. In Maine, I think we’re at 95% and will likely be higher than that probably next year. Almost every single one of our federally qualified health centers has at least one and most have more than one site that’s been designated by the National Centers on Quality Assurance, which is a nationally recognized designation for sites that are providing some of the highest quality integrated primary care services.
I think it’s a huge honor that our members are way outpacing what’s going on nationally as it relates to patients and in medical home recognition. It’s something that Maine should be very proud of. We wouldn’t be able to do that without the support of organizations like the Maine Health Access Foundation, Maine Quality Counts and others. It’s really been a partnership and also with the state and federal government.
Dr. Wolf: Yeah. In fact, one thing you may not know is that Maine is a role leader in the patient-centered medical home. One very important aspect, we have actually a statewide effort to bring patient-centered medical care to every place in Maine that’s being spearheaded by a group called Quality Counts. As one of the core attributes of Maine’s patient center medical home is the fact that mental and behavioral health services and physical health care services or primary care health services are brought together to work hand in hand so that patients receive all the care that they need.
This is so important because if you think about taking care of people with chronic illness, say with diabetes, many times people with diabetes feel overwhelmed and they may feel depressed about their illness. If you just try in to help them get better insulin and take care of their diet, but don’t address the underlying issues that they may have suffering from depression, then probably they won’t get the optimal diabetes care. In Maine’s patient center medical home, we try and bring and join the mind and the body so that optimal health is really achieved and we aren’t ignoring the really powerful thing that stress, depression, and mental health plays in optimizing health and it’s unique among the nation.
Others actually are now catching up and the national standards for patient-centered medical home are now saying, “Oops, we need to include integrating mental and behavioral health as part of our core competencies for this sort of model.” Maine’s a real leader in that regard, and I think we need to acknowledge that.
Dr. Lisa: Here on the Dr. Lisa Radio Hour and Podcast, we’ve long recognized the link between health and wealth. Here to speak more in the topic is Tom Shepherd of Shepherd Financial.
Tom: Sometimes I meet with married or partnered clients and when we get to talking about their financial lives, a cultural divide bubbles to the surface. One person feels one way about their money, and the other seems to be on their own financial island where their set of beliefs and rules that have created unnecessary borders and boundaries. It’s not an uncommon thing.
When I hit those situations, I do my best to help both people understand that neither is a 100% right or wrong, that they simply have to take a step back and look at their own financial life in a new light. It is also true in politics and economics. What we need to do is see money as a living thing that can be used to grow our lives together without disagreement or so-called border issues. It’s a great feeling for me. It’s like I’m helping people negotiate peace treaties with their money.
Be in touch if you want to know more: tom@shepherdfinancialmaine. We’ll help you evolve with your money.
Speaker 1: Securities offered through LPL Financial, member of FINRA/SIPC. Investment advice offered through Flagship Harbor Advisors, a registered investment advisor. Flagship Harbor Advisors and Shepherd Financial are separate entities from LPL Financial.
The Dr. Lisa Radio Hour and Podcast is brought to you by Bangor Savings Bank. For over 150 years, Bangor Savings has believed at the innate ability of the people of Maine to achieve their goals and dreams. Whether it’s personal finance, business banking, or wealth management assistance you’re looking for, at Bangor Savings Bank, you matter more. For more information, visit www.bangor.com.
Dr. Lisa: In my practice in Brunswick, we see a lot of patients who are self-employed. We see patients whoa re lobstermen, fishermen, people who work in the woods, people who are craftspeople, entrepreneurs, and I think this is true around the state. Being self-employed, that offers its own unique challenges as far as healthcare access and insurance is concerned.
Dr. Wolf: Yes, and actually the Affordable Care Act or Obama Care, some of your listeners may know it better by that name, provides a real opportunity for folks who are self-employed, say also young entrepreneurs, sole proprietors to finally have the availability of affordable health insurance probably for the first time in their careers through the way that the health insurance marketplace is structured. One of the things that people may not know is that part of the Affordable Care Act is to make health insurance not only available, but also make it affordable based on your income and when you apply for health insurance through the marketplace, they will ask you for information about your income, and if you’re a young person starting off or a sole proprietor or self-employed person, you probably meet the income eligibility to receive a lot of assistance that can lower your monthly premiums and finally make health insurance affordable for lots of people in Maine.
In fact, last year, in the first sign up period for the health insurance marketplace, out of 44,000 people that signed up, 90% of people, 9 out of 10 people received financial help that lowered their monthly premiums. Vanessa can tell you, at the health centers where they were helping people sign up, people would break into tears. They would say, “I’ve never been able to afford health insurance in 20 years. This will be the first time I’ve ever been able to feel insured and have that security that knowing if I get sick, I can be taken cared of.”
It’s really a tremendous game changer for people in Maine, particularly who are working really, really hard, sometimes at multiple jobs to have that security and have affordable health insurance finally for the first time.
Vanessa: Absolutely. In our health centers, through grants, through the federal government, through the Health Resources and Services Administration, we’re fortunate enough to get outreach and enrollment grants to hire certified application counselors, so each one of our community health center members has on staff a certified application counselor to help individuals. Our next open enrollment period is starting November 15th, and all of our health centers have these folks ready to go to sign people up, and as Dr. Wolf said, Maine was one of the leading states in the nation during the last period. We well exceeded the expectations for Maine in terms of the number of folks that we enrolled.
Our health center alone assisted over 25,000 people and enrolled well over, I think, it was 4,000 people. Even some of those folks that we assisted, the 25,000, they might have asked some questions, but then we’re able to successfully apply and get an insurance plan in their own home I would say that for your listeners, if they know anyone who’s interested in signing up or re-enrolling this time, they don’t have to be a patient of their community health center. They can be anyone. Come in, setup an appointment. Call one of our federally qualified health centers and we can set up an appointment and our folks are ready to help walk them through the process and answer any questions at any stage in that process that they have.
There is staff at the health centers but there are also navigators that are out at the community action program agencies. The Lobstermen’s Association has folks ready to assist people as well, and Dr. Wolf, I’m sure, can you tell you about their wonderful website, enroll207, which has been a tremendous resource for folks here.
Dr. Wolf: Yeah, and in fact, if you need help and you want to find out where somebody in your local community can help you sign up for health insurance or just review your options, not necessarily even sign you up, go to Enroll207.com. There is a little place that says, “Need Help?” and you can click on that. The map of Maine will come up. Just enter your zip code and it will pull up who is in your local area, who is certified assister or an application assister who can sit down with you and really walk you through your options. We think it’s this neighbor helping neighbor and people in your own community helping others who I think really helped us achieve the enrollment numbers that we got last year with really extraordinary enrollment of 44,000 people.
Enroll207.com, check it out. Again, I will say, I don’t know about you, but I run a small business. I know Vanessa does too and when we come to our annual health insurance enrollment, I’m a doctor and this stuff is complicated. I have to sit down with my insurance broker and go over all our options. I ask lots of questions. I know for individuals who are thinking about health insurance, these are complicated issues to try and work out and figure out what’s the best plan for you. It really is great to sit down with somebody and just say, “I just need to understand my options. Can we walk through this and help me understand the best plan, what I need to do for me or my family,” and these folks are ready and trained to be able to do this.
In fact, when we talk to the assisters, they really enjoy doing this. They really feel that this is helping their neighbors and friends in their community and it is a great feeling, again, to provide that sense of security to your friends and neighbors that they won’t have to worry about a catastrophic illness or an event that might wipe them out financially, so check it out.
Vanessa: I would like to mention that despite the fact that our health centers and other organizations had a great deal of success in enrolling people, I think we had a missed opportunity in not passing the … Allowing Maine to accept the federal funds to expand Maine care coverage for approximately 70,000 individuals in our state. A number of them are actually served by community health centers and other types of practices throughout the state but they just don’t have the insurance coverage, and so those providers are not getting reimbursement for the full cost to care to cover their services.
We found that a number of our assisters, the folks that were helping people fill out applications would either find … there were a gap, there was this hole, so that in the Affordable Care Act, it was envisioned that the states would expand Medicaid coverage, and so either you would because of your income be deemed eligible for coverage under Medicaid which in Maine is called the Maine Care Program, or that you might be eligible for subsidies through the health insurance marketplace.
Because Maine and Maine is the only state in the entire northeast that did not choose to expand, we fell short by a couple of votes in the legislature to expand Maine Care coverage, we found that a number of people would go to try to sign up and either couldn’t afford it, didn’t have any ability to get the subsidies, and weren’t eligible for Maine Care. In addition, we had about 25,000 people drop for Maine Care eligibility on January 1st. the good thing is that we’ve stayed connected to these folks and if they don’t have a medical home or a health home, they don’t have a primary care provider and that relationship established, our health centers wouldn’t just say, “Geez, we’re sorry, we can’t help you out this time.” They would offer to provide healthcare services to them through the health centers.
For folks who are uninsured, they could sign up to be patients at the health centers but I think that we really need to pass this coverage so that more people can have the access that Dr. Wolf spoke eloquently about earlier in the program.
Dr. Lisa: Dr. Wolf, your background is in pediatric cardiology.
Dr. Wolf: Yes.
Dr. Lisa: I guess, I’m wondering and I’m sure other people might be wondering too, why is this so important to you? Why is health access the thing that you have chosen to focus on?
Dr. Wolf: Okay, I’ll tell you a quick story. I used to practice out in the Texas medical school system, and as a pediatric cardiologist, I took care of children with inborn heart problems mostly. I had a child who had a heart valve replacement and was doing very well, went home, and I got a call a couple of weeks later and she was not feeling well. She has fever. She came in to see me. The long and short of it is she had developed a toothache. Her mother had tried to get her in to see a dentist. The dentist did not take Medicaid and her toothache went on to become a tooth abscess and the bacteria in the abscess got in her bloodstream and infected her brand new heart valve and she was deathly ill, all because she cannot get dental care.
That just frankly enraged me, both morally and personally, and I said, “We have to have a health system that works better for people where we take care of individuals no matter what the need is and no matter what their payment source is.” I know you as a physician and me, when you see someone who is uninsured, it’s one of the hardest things in the world to try and take care of someone when you know they are weighing every potential test, every therapy, every prescription of saying, “Can I afford this? Maybe I can cut these pills in half.” You and I know we can’t provide the care that we want to provide because when someone does not have health insurance, they are hamstrung financially from getting the care that you and I know they deserve. That’s just wrong.
I changed my orientation and go into health policy and end up running the foundation. There is the short version of it.
Dr. Lisa: We were lucky enough too to have Dr. Lisa Letourneau from Maine Quality Counts and my sister, Dr. Amy Belisle, who also works with Quality Counts. Dr. Letourneau is an emergency room physician with public health training and my sister is a pediatrician. I think that there are physicians around the state who are working with individuals like Vanessa because we know that this is an issue, this is a bigger issue that we can’t just do it one-on-one in the doctor-patient relationship setting.
Vanessa: The example, the story, a really heartbreaking story that Dr. Wolf just shared about dental and oral health issues. I mean those issues are being seen every single day in our health centers and in emergency departments unfortunately because we don’t have adequate coverage for dental, especially for adults. That’s one of the issues that our health centers will be trying to push this session as well through the legislature and working collaboratively with a number of other organizations as to try to get some … create Maine Care benefit for adult preventive and restorative services.
Our health centers throughout the sate, for the ones that provide integrated dental, they don’t just provide it to children, they get reimbursed for most children’s services, but they also provide it to adults. That’s huge. They do oral health cleanings. They provide fillings. They do the preventive and restorative work to try to keep folks from getting to that stage where they just have to have their teeth pulled in order to get rid of that terrible pain.
We are spending, at our health centers, hundreds and hundreds of thousands, actually millions of dollars each year, in essentially subsidizing the cost of providing oral health care to those adults because we know it’s so important and we believe that integrated health also includes the mouth, not just the head and not just the body but also the mouth. I just applaud our health centers for prioritizing that and the voter approved dental bonds a couple of years ago means that towns like Porter, Maine at Sacopee Valley Health Care Services, they’re going to have four new dental operatories and folks down in the southwestern part of the state will be able to go and sign their kids up and sign themselves up to get some oral health care. We provide those types of oral health services throughout the state in places like Houlton and at Fish River Rural Health up in Eagle Lake in Fort Kent and actually at Penobscot Community Health Care in Bangor. I believe it’s the largest dental care practice among federally qualifier health centers, certainly I think on the east coast, if not in the country.
Dr. Wolf: Sometimes doctors and nurses don’t realize how potent they are in helping patients understand the importance of health insurance and why should we care about people having coverage. Many people don’t realize that medical illness is one of the leading cause of bankruptcies. When I talk to young people starting off on their careers, particularly in Maine where we have lots of really entrepreneurial individuals or artists starting off, saying, “You realize you’re just at the point of starting off your business right now. You’ve put plenty of investments in. What would happen if you get appendicitis, something that could just happen out of the blue and all of a sudden end up with a $15,000 or a $20,000 bill because you had to have your appendix out? It would really pretty much functionally wipe out all the investments that you made starting your own business or starting out your art career or whatever.”
People sometimes don’t realize how important it is to have that cushion or safety and security that keeps you from having financially catastrophic event and the benefit is also when you have health insurance, there are plenty of things that are in the health insurance package now that can encourage wellness. Free preventive screening, annual wellness visit with your doctor, things that allow us the opportunity not only to deal say with an acute problem, but really sit down with patients and say, “Let’s talk about how we keep you health and maybe keep you out of my office and how I can be a helper in doing that?”
I think there are lots of benefits that doctors and nurses can help talk about that you all can help educate patients about “Why is this a really good thing?” You’re very trusted and we ought to be telling them the truth about these things.
Dr. Lisa: How do people, Vanessa, find out about the Maine Primary Care Association and the work that your centers are doing?
Vanessa: Sure. People can go to our website, www.mepca.org, or Google Maine Primary Care Association and our organization will show folks how they can locate their local community health center, also by going to enroll207 if they’re interested not only in how to find their local community health centers but assisters and how they can get information to help sign up for the next open enrollment period on the health insurance marketplace. We have information available at our office in Augusta. We’re in Winthrop Street, Augusta, but we also have community health centers like I said in over 71 locations throughout the state, and I think any of our health center sites would be more than happy to help folks get whatever information they need about enrolling and staying healthy.
One of the key message too, and I know that we have limited time, that we’re putting out there this session is “Who’s counting on you to stay healthy?” That’s one of the big messages we’re going to be putting out there for this next open enrollment period. For me, it’s my dog and it’s also my staff at the organization that I work for, but I think that that’s a key message for people to keep in mind. Who’s counting on you to stay healthy? Just like Dr. Wolf is referencing a small business owner and working and staying healthy for purposes of their own employee and business success, I think that folks need to think about that.
Who’s counting on you to stay healthy? Is it your family? Is it your friends? Is it your co-workers? Or is it much larger than that? What is your role in the state? I think that that’s a message that we’re trying to get out there and I hope as people are weighing the decisions about what plan to sign up for or whether to sign up at all, I think they should take that into consideration. I certainly am going to be.
Dr. Lisa: Dr. Wolf, how do people find out about the Maine Health Access Foundation?
Dr. Wolf: They can go to our website also and that’s www.mehaf … It’s called MEHAF.org. They can call me. They can visit our office in Augusta and also go to enroll207. It’s not about the foundation but we’re the sponsor for enroll207. It’s providing basic information about the health insurance marketplace and as I said, it has that great help locator where you can put in your zip code, find lots of people in your area and all different sorts of agencies: community health centers, community action agencies, brokers. We have brokers who are Affordable Care Act certified on our website. It’s really just a host of individuals who are ready and really want to help people get signed up for affordable coverage.
Go there first. I’d rather you check that out than even come and learn about the foundation. You can learn about us after you get coverage.
Dr. Lisa: The open enrollment period begins November 15th.
Vanessa: Yes, and it’s shorter this year, so it’s more critical that people make appointments to sign up if they’re interested with their health centers or with the navigators. The period runs from November- … yeah.
Dr. Wolf: November 15th to February 15th.
Vanessa: I’m sorry.
Dr. Wolf: Yes, but if you want coverage, January 1. You need to sign up by December 15th, but coverage for 2015, you can still enroll up to February 15th. After that, people need to realize you cannot sign up for coverage after February 15th for the year 2015 unless you have a life-changing event. You have a baby or you lose a job or things like that. There is a limited window to sign up and people need to realize now is the time to start thinking about it and review your options.
Vanessa: There will be fines associated if people don’t sign up, and so, I think that that’s also a factor that folks should consider as they’re weighing their options come November.
Dr. Lisa: I appreciate the work that you’re both doing in this area. We’ve been speaking with Vanessa Santarelli is who is the Maine Primary Care Association’s Chief Executive Office and also with Dr. Wendy Wolf who is the Maine Health Access Foundation’s founding president and CEO. I encourage people to look into enrollment if this is something that they need, look into the health centers you’ve described, Vanessa, and really consider who it is that is counting on you to stay healthy. Thank you so much for coming in today.
Dr. Wolf: Thanks. It’s a pleasure.
Vanessa: Thank you very much.
Dr. Lisa: As a physician and small business owner, I rely on Marci Booth from Booth Maine to help me with my own business and to help me live my own life fully. Here are a few thoughts from Marci.
Marci: When asked, most of my clients say the same thing about what keeps them up at night: money. Making certain cash flow is there to meet day-to-day operational needs. “Oh my gosh, is payroll going to be able to make it?” When we dig deeper, we understand that those sleepless nights are symptoms of poor planning and forecasting. More often than not, the reasons for not doing it are a lack of time and a lack of resources. Here’s a suggestion: Instead of living in fear of the numbers and losing sleep over them, make peace with them by paying closer attention to the financials and creating positive cash flow. I’m Marci Booth. Let’s talk about the changes you need, boothmaine.com.
Speaker 1: This segment of the Dr. Lisa Radio Hour is brought to you by the following generous sponsors: Mike LePage and Beth Franklin of RE/MAX Heritage in Yarmouth, Maine. Honesty and integrity can take you home. With RE/MAX Heritage, it’s your move. Learn more at ourheritage.com.
Dr. Lisa: As a family physician for many years, it has been an interesting experience to see how access to healthcare has changed. When I have patients who come in who tell me that they now have health insurance after many years of not having had health insurance, it’s a good thing. It makes me happy. Today, we speak with two individuals who are going to help us understand why it is that we now are able to give patients access to healthcare when we weren’t before and also what that process entails and why it’s important.
Today we have with us Dr. Noah Nesin who is the Chief Medical Officer for Penobscot Community Health Care which serves approximately 60,000 patients for their primary medical, behavioral health, and dental care needs. We also have with us Lisa Lemieux who is a licensed social worker and the patient outreach and enrollment specialist at all three Daniel Frank David Russell Medical Center facilities. Lisa is a certified application counselor who works with both patients and community members to educate and assist them in knowing the options available to them through the Affordable Care Act.
Thank you so much for coming in.
Dr. Nesin: It’s great to be here, thank you.
Lisa L: Thanks for having us.
Dr. Lisa: This is an interesting topic, as I mentioned, for me because as a family doctor, I’ve cared for patients across the spectrum. I have cared for patients who are in jail and patients who are students in college and patients who are living in suburban, urban, and rural Maine. I’ve seen a lot of different people coming through my doors and the one thing that unites all of them is the need for basic healthcare services. This is something that you both have quite a lot of experience with.
Dr. Nesin: Yes, there’s no question. I grew up in a household in rural Maine where my dad was the doctor for the community in the old style family doctor mode and saw that model and then my own career as a family doctor like you. I tried to mimic that the best I could although as medicine became more sophisticated with more resources, more tests, more and more I bumped into the barriers of the finances of people who are uninsured and couldn’t afford some of the care that they needed or delay it or deferred their care because of the cost. It is very gratifying to have more people covered and able to access care.
Lisa L: Right. My role, it’s a fairly new role here as in many states, is to educate consumers about what their options are. For the first time, people are really understanding what the healthcare can offer them, what plan is best for them, and know there’s no pressure, there’s no pressure to choose a plan. It’s up to them. That’s my role is to guide them through that.
Dr. Lisa: When we think about healthcare, often we think about things like vaccinations and preventive care, but what I find fascinating is that you are also talking about behavioral healthcare in the work that you do and dental care and you’re also using the word “client” as opposed to patient. You’re actually talking about somebody who has a choice, who is making a decision to access services.
Dr. Nesin: One of the catchphrases in healthcare these days is population health. I’ve heard a number of definitions of population health, some of which I understand and some of which I don’t. Fundamentally, it’s about the wellness of the community in which we live, and we can think of a community in a number of ways, but I think that’s much more tangible for people. Really, that kind of integrated model and the patient or consumer or client as a partner in that model is really the best way to approach that. Until people have the kind of coverage that allows them to participate in that model, there are outsiders who are intermittent users of this system and therefore can’t fully partner with us.
Dr. Lisa: Lisa, as a social worker, I suspect you spend some time with individuals who maybe have financial difficulties, who maybe have problems emotionally. How does healthcare become more important for people who maybe are dealing with issues of unemployment or poverty or grief or loss?
Lisa L: I think that’s the interesting factor about this position is when health centers look to hire people to talk to consumers about health insurance. They didn’t look for people that had had health insurance experience, sales experience. The goal is to get people and who could just sit down and have a conversation and really understand where they’re coming from, what their needs were, and how they were best going to be served. That helped us go through the different plans, to talk to somebody and say, “What are your needs and let’s find something that can meet those needs?”
Financial issues play a big part in this Affordable Care Act. Here in Maine, you need to be between 100 or 400 percent of the federal poverty level in order to qualify for a subsidy and it’s those subsidies that help define affordability. There’s two things I always say to people is affordable means different things to different people and it’s about their own health needs. That’s the two bottom inner lines that we’re going to look at when we look at the plans for them.
Dr. Lisa: If I am listening to the show and maybe say I’m an entrepreneur and I’m working on a startup or I’m an artist perhaps, define for me what that looks like financially. You said 100 and 400 percent of the federal poverty level.
Lisa L: For a household of one, I usually tell people, “It’s like 11,600 is what you need to claim on your federal income taxes.” In Maine, it’s a little difficult. One of the whole things is that you have to project your income for 2014. People in January are going “I don’t know what I’m going to make in 2014.” Here in Maine, we have a lot of self-employed people, we have a lot of seasonal, part-time, so it’s helping them figure out what their bottom line is going to be and changing it during the year if we need to because that’s what their subsidy is based on. Again, a person of one, it’d be like 11,600 is what I say.
Dr. Lisa: That’s not a lot of money.
Lisa L: It’s not a lot of money. That’s the 100%.
Dr. Nesin: One hundred, right.
Lisa L: Right.
Dr. Lisa: Okay, so you can make between that amount and four times that amount-
Lisa L: Exactly.
Dr. Lisa: Which is still not a lot of money really.
Lisa L: Right.
Dr. Lisa: If you’re one of the individuals who qualifies in that range, what can you expect to pay for health insurance?
Lisa L: If you’re right at that 100%, the majority of people I saw were paying 3 to 5 dollars right at that 100% and the higher up you go in income. It’s based on your income and how many are in your household and where you live. It’s broken down into four districts here in Maine.
Dr. Nesin: Age also factors into it,
Lisa L: Age, yes, thank you, yeah.
Dr. Nesin: A young person who’s single, the only member of the household and low income can get a very significant subsidy and pay very little for insurance whereas a couple who has a combined income that’s at the upper levels of that who might be a little bit older will pay a little bit more. One of the phenomena that I have experienced in this is people who haven’t accessed the insurance market previously, it takes a little bit for them to understand the value of that purchase because it’s still a fair amount of money especially if you’re closer to the 400% and knowing what that is relative to what they’d pay if they were in the private insurance market as opposed from the marketplace is helpful in aiding people in understanding the value of what they’re getting in that subsidy.
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Dr. Lisa: Lisa, I think it’s interesting that we are now at a place that’s people who in the social work field have arguably been in for generations, the need to marry logistical concerns and priorities with emotional and social concerns and priorities. This is something that people who are social workers know. You know that you have to help somebody feed their children as well as help them deal with the loss of a parent. That’s a broad range of things, but it’s all part of the hierarchy of needs.
Lisa L: It is, absolutely, and I think that was one of the reasons for hiring us to talk to people. Again, the first thing I say to somebody when I meet them is “Hey, I’m just here to show you what your options are.” I’ve had people not even choose a plan because of that, what we thought was going to be affordable really isn’t affordable when we’re looking at them trying to put food on their table and then we look for other alternatives for them. It’s all about education and understanding what their choices are. I think for the first time, people are understanding the different plans that are available to them and what the consequence is if they choose not to take the plan at this time, because there is.
There will be a financial penalty for some people and for others, we can certainly do a hardship waiver. Again, it’s tied into education and trying to meet their needs and what feels good to them.
Dr. Nesin: I think also for the previously uninsured, I’d be interested to know if this is your experience as well, but I hear people a lot talking about the cost of whatever their share of their premium is compared to no cost as opposed to comparing that to the cost of having a healthcare need unmet or having to pay for an emergency healthcare need. That’s a discussion I’ve had with lots of friends and family who are interested in this but wonder if there’s value in it.
Lisa L: I think that’s sometimes a cultural thing of growing up maybe. People that have never had insurance, it’s that education piece about what is now offered to you. I do think the word is getting out. I think last year, I certainly had people say, “Well, I’m going to wait and see,” because there was a lot of “Let’s wait and see how this goes.”
Dr. Nesin: Especially with the way the marketplace rolled out last fall.
Lisa L: It really was.
Dr. Nesin: Many people hesitate.
Lisa L: Yeah, and a lot of people are like, “Is this going to work?” There’s no guarantees at anything, so some people really step back and they wait but I think they’re talking to people tat took that bold step and said sign me up. I’m sure you probably had the same and you’ve also said you’ve met with patients who are really excited to have health insurance. I think the exciting thing is that they understand it and what they can get for that health insurance as well, so really meeting the need of education.
Dr. Lisa: I also think that there is a sense of fear associated with not having health insurance because it’s all fine when you’re healthy, when you didn’t break a leg or your child didn’t have appendicitis, or you haven’t had a diagnosis of cancer. If you can stay healthy and you can avoid all accidents, then that’s great. We know that one of the major problems associated with financial struggle is medical debt, and this is becoming increasingly challenging because our costs are much higher than they used to be.
Dr. Nesin: People lose homes, people become homeless, families break up over some of the financial stresses that are caused by medical debt, and they can be devastating. There was a Time magazien article in the last year, I think, that detailed some of the variabilities and cost from facility to facility and state to state and things that one might not think would cost a tremendous amount like a simple appendectomy or hip replacement which are not cheap but the cost of variability is so dramatic that without health insurance and with the requirement that you pay that, it could end your ability to retire, for instance, at a minimum or make it impossible for you to pay your mortgage or pay off your car payment.
Lisa L: I think that’s one of the things with this new marketplace plans is that there’s actually an out of pocket cap on all of them, and that was really appealing to a lot of people. Six thousand five hundred, you’re covered at a 100% after that. You talk to somebody and you say, “What happens if you’re in the hospital for 2, 3, 4, days?” That debt is accumulating, but once you hit that out of pocket and it can actually be actually lower than that depending on your subsidy and your cost sharing reduction. The 100% federal poverty level, typically their out of pocket maximum is $500 and then they’re covered at a 100% for the rest of the year after that. Those are big pieces to talk ton people about.
Dr. Lisa: I’ve also seen in my practice that people will actually verbalize, they will say, “Well, Dr. Belisle, I know that I need to keep my self healthier because it will cost me more if I don’t.” This is something that is relatively new, that people are actually understanding that if they can’t lose the weight that they’ve gained or if they don’t take care of their diet, then they’ll have problems, let’s say for joint pain, because they’ve become obese or heart attacks because they can’t control their cholesterol levels. They’re now knowing that there’s something I can do about this, like I can take some control over my life so that whatever I can control, I can control and what I can’t, it will be covered by insurance, which is I think really great. It’s really nice to know that people are that engaged.
Dr. Nesin: I do think there’s an increasing level of sophistication both among patients and providers about exactly that kind of engagement and certainly among purchasers, especially employers who pay for health insurance for their employees that you see more and more wellness programs but not just more wellness programs, more involved wellness programs that really do promote health and important ways and they’re constantly refining them. In addition, some of the payers like Maine Community Health Options, one of the marketplace plans, really has been pioneering value-based benefits which really do get at trying to motivate people to do the things for themselves that will keep them in better health and therefore limit their cost, the cost to the insurer, the cost to the employer, the cost to the entire healthcare system.
Because, as you know, we’re in a system that spends 40% of the world’s healthcare dollars on 5% of the world’s population and has something like the 35th or the 36th best outcomes. We don’t have an efficient system right now. Part of what’s been missing is exactly that kind of engagement that you just spoke about.
Dr. Lisa: Because I’m thinking about what the healthcare educational system and recruiting system has been and you were describing type A personalities, medical students who are able to put their noses to the grindstone and just plow through all the work, and that really was, I believe, your father’s practice model. I think there are still medical students who go in with that idea in mind. What I’m understanding is that the ability to be collaborative is so much more critical, and in fact, as a physician, I feel better because I now know that there are people with me who can offer some of the things that traditionally I had been asked to do all by myself.
There are people who can help me in the areas of behavioral health and dental health and my team in Brunswick, the nurses do so much more because they’re able to do so much more. I love working as a team because it makes my job actually much easier.
Dr. Nesin: It is easier and we know it’s better care. That the more delegation that goes on within the care team, the better the outcomes for the patients that we serve. You’re exactly right. That transformation from … it relies on my memory, my good intentions, my knowledge base, and my energy on a day-to-day basis and my need to control everything that goes on with the people that I serve to my team’s commitment to this, how elegant the delegation model is, how well people understand their roles and the parameters of their roles, the amount of autonomy in that team for people to act in ways that serve the patient’s best and all of that supported by the kind of data that helps us adjust our work systems so that we really are providing care as efficiently and as effectively as we can to people.
That is a different mindset for those of us who were trained in the control freak model, to be a collaborator, team leader, to delegate responsibility, and to accept responsibility for that team’s performance.
Dr. Lisa: Lisa, do you have any final thoughts for people who are in the marketplace now and who are looking for options that are available to them through the Affordable Care Act?
Lisa L: Open enrollment starts November 15th and people have from November 15th to February 15th to shop for a plan and purchase a plan, and then after that, it closes except for special enrollment situations like having a baby, getting married, moving, something like that. There’s a 3 month window that … I say to people that it just doesn’t hurt to see what your options are. Give any certified application counselor or navigator, you can find them listed on enroll207 and find one in your area and they’d be happy to go over some plans with you, and at least, you know what your options are, what your choices are, and then you can make an informed decision. It doesn’t cost anything.
Dr. Lisa: How about you Dr. Nesin? Do you have any final thoughts?
Dr. Nesin: I do. Just that I’m so pleased to be able to work in a community health center the way that Lisa does. There’s partnership, there’s team approach that you described. It’s fundamental to what we do and the commitment to serve all of the population of Maine regardless of their ability to pay. I hope that we’ll be able to, at some point, expand Maine Cure because there’s a big population that the marketplace doesn’t serve, and that’s exactly what the expansion of Maine Cure was designed to address. Hopefully someday we’ll get to that so that we really can reach all people in Maine.
Dr. Lisa: That is a lot of a goal and I’m going to put my energy behind that, that intention as well. We’ve been speaking with Dr. Noah Nesin, the Chief Medical Officer for the Penobscot Community Health Care System and also Lisa Lemieux, a licensed social worker and patient outreach and enrollment specialist with the Daniel Frank David Russell Medical Center facilities. Thanks so much for coming in and talking to us today.
Dr. Nesin: Thanks for having us.
Lisa L: Thank you.
Dr. Lisa: You have been listening to the Dr. Lisa Radio Hour and Podcast, Show Number 163, “Accessing Health.” Our guests have included Dr. Wendy Wolf, Vanessa Santarelli, Lisa Lemieux, and Dr. Noah Nesin. For more information on our guests and extended interviews, visit doctorlisa.org. The Dr. Lisa Radio Hour and Podcast is downloadable for free on iTunes. For a preview of each week’s show, sign up for our e-newsletter and like our Dr. Lisa Facebook page. Follow me on Twitter as @doctorlisa and see my daily running photos as Bountiful One on Instagram.
We’d love to hear from you so please let us know what you think of the Dr. Lisa Radio Hour. We welcome your suggestions for future shows. Also, let our sponsors know that you’ve heard about them here. We are privileged that they enable us to bring the Dr. Lisa Radio Hour to you each week. This is Dr. Lisa Belisle. I hope that you have enjoyed our “Accessing Health” show. Thank you for allowing me to be a part of your day. May you have a bountiful life.
Speaker 1: The Dr. Lisa Radio Hour and Podcast is made possible with the support of the following generous sponsors: Maine magazine, Marci Booth of Booth Maine, Apothecary by Design, Mike LePage and Beth Franklin of RE/MAX Heritage, Tom Shepherd of Shepherd Financial, Harding Lee Smith of The Rooms, and Bangor Savings Bank.
Dr. Lisa Belisle is a physician trained in family and preventative medicine, acupuncture, and public health. She offers medical care and acupuncture at Brunswick Family Medicine. Read more about her integrative approach to wellness in Maine magazine.
The Dr. Lisa Radio Hour and Podcast is recorded in the studio of Maine magazine at 75 Market Street, Portland, Maine. Our executive producers are Kevin Thomas, Susan Grisanti, and Dr. Lisa Belisle. Our assistant producer is Leanne Ouimet. Audio production and original music by John C. McCain. Our online producer is Kelly Clinton.
The Dr. Lisa Radio Hour and Podcast is available for download, free on iTunes. See the Dr. Lisa website or Facebook page for details.