Changes on Tap for Managed Long Term Care Providers in NYS and Your Community Medicaid

If you receive Medicaid and/or Medicare in New York State, are chronically ill or disabled and require aides or other services in order remain safely in your home, you are likely to be enrolled with one of the state’s Managed Long Term Care (MLTC) providers. MLTCs are agencies that help manage and oversee the services that patients requiring this level of care receive.

The NYS Department of Health, the agency that oversees MLTC agencies, recently announced changes to the program. Among the new rules:

  • Those who enroll in a MLTC plan after Dec. 1, 2018 will be barred from changing plans for 9 months, after the first 90 days. This makes it imperative that the family select the most appropriate agency at the start.*
  • There will be a limit on the number of home care agencies that each MLTC is able to contract with. The result could be make it more difficult for MLTCs to place aides in the homes of patients who need them. This begins October 2018.*
  • People placed in a nursing home for three months or more will no longer be able to enroll in a MLTC. In addition, patients who are MLTC members will be dis-enrolled from MLTC after three months in a nursing home. Some consumer advocates fear that when MLTC plans are no longer responsible for the cost of nursing home care, the plans will have an incentive to place members with high needs in nursing homes, rather than approve more hours of home care needed for the member to remain in the community. The start for date this change was initially July 1, 2018 but has been postponed to an unspecified date in the future.*

Navigating this process is challenging even for savvy and experienced healthcare professionals. The implications of rapidly changing rules and regulations leave many people with unanswered questions. A professional health advocate can assist families with obtaining the appropriate level of care at the right time and in the setting that makes the most sense. Care Answered is here to help. Give us a call at (516) 584-2007.

 

*Source: New York Western Law Center-State Dept of Health Moves to Implement MLTC Changes Enacted in 2018-19 NYS Budget

How Healthcare Advocacy Can Benefit Your Employees

Our healthcare system is growing more and more complex. Medical breakthroughs create new treatment options to consider. Regulatory reforms are changing the way physicians practice, while economic factors impact on the way insurance companies pay for the services we receive. The outcomes of the choices and decisions we make can truly be life altering. These are important and complicated issues.

At the same time, healthcare costs continue to be a concern for companies and workers alike.

To help address these complicated issues, many employers have begun offering healthcare advocacy services as an employee benefit.

Healthcare advocates can save time and money for both employers and employees. They do this by:

  • Reducing stress and improving productivity for employees
  • Helping employees select lowest cost, highest quality providers and facilities
  • Providing healthcare navigation for employees and their family members, including aging relatives
  • Reviewing medical bills for accuracy
  • Answering questions that would otherwise require handling by internal human resources staff

 

Offering healthcare advocacy as an employee benefit is cost-effective. Advocacy services can be added to a benefits package for just a few dollars per employee per month.

According to a 2017 survey by consulting firm Mercer, nearly half of employers with 500 or more employees offer healthcare advocacy services as part of their benefits package. Among very large employers – those with 20,000 workers or more – 60% offer advocacy as a benefit.

The advantages are magnified for smaller employers. If even one key employee at a smaller company needs healthcare advocacy for themselves or a family member, providing the service so that the employee can focus fully on their work can mean the difference between continued success and financial devastation for a small company.

To learn more about how healthcare advocacy could benefit your workforce, contact Care Answered.

 

Telemedicine Lets You and Your Doctor Connect Without the Commute

If you’re in need of medical care, just getting out of the house can be a struggle some days. But just as technology is allowing us to connect with friends across the world in new and exciting ways every day, it’s also allowing us to connect with our care providers as well. Telehealth is the use of telecommunication technology to enhance health care in general, and telemedicine is the application of the technologies to improve the quality of health care given. Both are similar in scope, but telehealth is the overall subject name.

Telemedicine covers a wide variety of applications, so it can be used in many different situations. An example of telemedicine would be using video communications such as Skype to meet with your doctor instead of going to his or her office. Another would be if a patient uses a mobile device to take a picture of an injury and sends that to their doctor. Additionally, if two doctors use an application to send patient records between them that would also be considered telemedicine. Telemedicine has a number of different applications to help facilitate the best care possible.

Telemedicine when used properly allows practitioners and patients to connect without the commute. A patient can simply use their mobile device or personal computer to get in touch with their clinician if they have any questions, need reminders, or have a condition that they wish to have checked out but isn’t worth a trip to the office. This is especially helpful for seniors who may struggle to maintain their independence and ability to transport themselves to their care providers on their terms as they get older.

Many commercial insurance providers offer telemedicine as a covered benefit, and more and more doctors are offering some type of telemedicine services to their patients. If you would like to know more about the different ways that telemedicine can make your life easier and your healthcare more personalized, need help finding a doctor, or want to learn more about ensuring that your care is the best it can be for you, contact us at CareAnswered. We’re here to help.

Do you Need a Medicare Supplemental Insurance Policy?

Medicare supplemental insurance coverage medical charges

If you are near or past the magical age of 65, chances are you have already given a good deal of thought to Medicare, the health insurance program that covers Americans over 65 and the disabled. In addition to Medicare Part A, which covers in-hospital care, Part B, which covers doctor’s and outpatient office visits, and Part D, which covers prescription drugs, you may have heard about Supplemental Policies. These products are sold by commercial insurance companies to help you pay for additional expenses, like co-pays and deductibles, not covered by traditional Medicare. But are these policies worth buying? The answer is…it depends.

Medicare supplemental insurance – sometimes referred to as Medigap – claims to cover anything that Medicare does not. But if you read the fine print, it turns out that there isn’t much that Medicare doesn’t cover. Medicare pays for the majority of the medical procedures. The adjustors at Medicare will calculate a fair value for the services rendered, pay the provider for around 80% of the calculated cost, and the remaining 20% or so is left to you as a patient. This means that under Medicare you will be left with a considerably low out-of-pocket cost for your health care.

However, Medicare does not cover everything nor everyone, and that is where supplemental plans come into play. Deductibles and co-pays – the amount for which you are responsible if you are on Medicare – are covered by Medigap insurance. If you anticipate a high volume of hospitalizations or doctor’s visits, supplemental insurance may be a wise investment for you. If, however, you only visit the doctor a few times a year, the cost of supplemental insurance may not be offset by the amount of coverage offered.

In short, the answer really does depend on your individual needs. You can get more information by visiting the Medicare website. If you would like to know more or would like assistance with choosing a plan, reach out to us at Care Answered.

How to Find a Home Care Provider

Illness, injury or advancing age can result in the need for assistance in our day-to-day lives. When this happens, it is important to make sure that you have the appropriate provider to care for you or your loved one. The question then becomes, how do you know if your loved one is in good hands? The answer is through preparation and asking questions

The first thing you need to do is start a conversation. Include your loved ones and primary care physician in the discussion about the need for home care and the type of care needed. This will ensure that everyone can bring their concerns to the table. Step two is to start compiling lists. Make a list of daily activities with which you/your loved one need assistance. Every person is different and no two home care providers will need to perform the same exact tasks.

Building off of this, you should determine what hours of the day and how many days a week you/your loved one needs care. It is also important to create a medication list (include supplements) that contains information on why the medication is taken, what dosage, and when it is taken. Keep in mind many home care agencies can’t have their aides “administer” medications. This means the aides cannot take the medicines out of the bottle to give you, but they can give reminders. (Always ask any care provider what they are able to do based on your list of daily activities.)

After you’ve described the specific needs of you/your loved one, it is recommended that you make a list of personality traits you/your loved one would find ideal, because remember, this person will be in your home. For example, would you have a preference for someone chatty or quiet/reserved? Is there a language in which you are more comfortable communicating? Would you be more comfortable with a man or a woman? Is there a culture that you feel most at ease around? These are all important questions that should be answered before choosing an aide.

It is also helpful to establish a communication plan with the home care provider if you are a loved one. Perhaps you want to be contacted immediately if any change of behavior is noticed, or establish a protocol for any emergency situations. In addition, whether you decide to find a home care agency or choose a home care provider privately, make sure a background check is done. While it would be ideal to interview all of your prospective home care providers, sometimes it is not possible to conduct in-person or phone interviews with all of them. The lists and schedules that were made earlier can help prevent any unforeseen issues.

Of course, even after preparing as best as possible, it’s important to follow through. Try to have a loved one or advocate stop by unannounced to make sure that the home care provider is meeting all expectations.

Still have questions? Contact Care Answered for personalized help with selecting the right in-home caregiver for you.

Just What Does a Patient Advocate Do?

As healthcare evolves, doctor’s visits have only gotten more complicated. When was the last time you managed to finish an appointment without receiving a litany of things to remember: don’t eat this food; do eat this food; exercise more; take this medication at morning, noon, but not night: take this unpronounceable medication as needed, but this similarly spelled medicine can only be administered once per day. To make matters worse, you’re already under a lot of stress due to the health concern that brought you there today. At a certain point it becomes impossible to remember everything you are supposed to do to take care of your own health.

But what if you didn’t have to? What if you had someone who was there with you every step of the way to take notes, or bring up concerns you may have forgotten or just don’t feel comfortable voicing on your own? What if you had a patient advocate?

A patient advocate can be anyone you can trust. You can ask a family member or loved one to be your advocate or you can hire a professional patient advocate to stand by your side. Either way, your patient advocate will be with you for every step of treatment, making sure that you get the best care available. With a patient advocate by your side, you no longer need to divide your attention between your recovery and your care.

Your patient advocate will accompany you to all your appointments and take notes on what the doctor says. They’ll help you understand just what your doctor is talking about, and what you need to do to recover. Additionally, your patient advocate will speak up about any concerns you may have. Your patient advocate is your best ally and confidant in the doctor’s office.

A patient advocate can do all of this and more: help you select the best treatment option or facility for your care; help you untangle and understand your health insurance benefits and coverage; help create a safe discharge from the hospital, help you with decisions for yourself or a loved one.

If you do not have someone in mind to be your patient advocate, or simply have more questions, contact Care Answered and we will gladly help you through the process, at every step of the way.

Healthcare Decisions are Easier with Advance Planning

A Reminder to Have ‘The Talk’ in Honor of Healthcare Decisions Day

April 16 was Healthcare Decisions Day – a great reminder to have “the talk” with your loved ones.

Better late than never is an adage that applies to many situations – but it’s a bad policy when it comes to discussing your healthcare decisions. In fact, the best time to have those conversations is long before they are faced with making difficult decisions. The questions surrounding these discussions are important: How aggressively do you want to be treated if your medical condition is considered terminal and you lose the ability to make your own treatment decisions? Who should be responsible for making those decisions on your behalf?

The first step would be to select your health care proxy.

What is a Healthcare Proxy?

The New York Health Care Proxy Law allows you to appoint someone you trust — for example, a family member or close friend – to make health care decisions for you if you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes. Learn more here.

How do you talk about healthcare decisions?

Once you have selected your proxy, be sure to inform that person about his or her role, and let him or her know about your wishes should an illness or injury leave you unable to make your own healthcare decisions.

Talk about what you value and be as specific as you can. You might say:

“I don’t want to ever be sustained by machines,” or “I have to be able to live independently,” or “There are new health findings every day. I would like to be kept alive until they find a cure.”

Some other conversational prompts include:

“My faith is important to me and I don’t want to have….”

“I’m allergic to …. Please make sure that I don’t receive that medicine”

Why is this so important?

The discussion with your healthcare proxy can and should be ongoing. You cannot imagine every possible scenario but if the person you select as your healthcare proxy understands your values and knows the types of life-sustaining treatments that you would want, as well as those interventions that you would not want, your proxy will feel confident that they are following your wishes rather than having to decide your fate on their own.

This is not a contest of who loves you the most; rather, it’s about who will be able to carry out your wishes. It is a tremendous burden to expect your loved ones to make these decisions for you if you have not expressly told them your wishes. Help them by starting the conversation now, while you are healthy and able to share your feelings.

Health Disparities Concern All of Us

There are more than 304 million people in the United States of America, and each of us is unique. A little more than half of us are women; about a third of us identify as a racial or ethnic minority. Around 12% of us are living with a disability, while 14.5% of us live below the federal poverty level. Most of us live in urban areas (77%), but nearly a quarter of us live in rural communities. Four percent of us identify as gay, lesbian, bisexual or transgender.

These are just a few of the factors that may be used to describe, categorize, or prejudge us. Importantly, they may also contribute to differences in our health status. These differences are known as disparities, and it is important that they are recognized and addressed.

Healthy People 2020, the federal government’s prevention agenda, defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.” Disparities are often tied to social determinants of health – factors such as access to fresh food, safe places to exercise, education, income, employment and housing.

Sometimes disparities are biologically driven. For example, we know that in women, heart attack symptoms are different from symptoms in men.

Disparities may also be environmental. People who live in neighborhoods that lack grocery stores – sometimes called food deserts – may have poorer health status brought about by poor diets.

Disparities may be related to attitudes and biases. For example, for decades women were told that their symptoms were caused by their emotions, and so heart disease was largely unrecognized as a women’s health issue.

In many cases, however, disparities are the result of multiple factors that combine to create devastating outcomes. For example, African American women have similar rates of breast cancer as white women, yet they are 42% more likely to die of the disease.

How can we address health disparities?

Solving a problem with so many root causes requires collaboration by government, healthcare providers, and community-based agencies. Here are a few projects addressing disparities:

  • Medicare Advantage may begin covering air conditioners for people with asthma, healthy groceries, and rides to medical appointments under rules proposed for next year.
  • Some hospitals are hiring patient navigators to assist patients with accessing effective treatment and preventive services.
  • New York State has supported community-based programs such as “Complete Streets” that promote safe outdoor spaces for exercise.
  • The Long Island Health Collaborative’s website offers links to resources to promote health and wellness. LIHC’s own “Ready Feet” program promotes walking as a form of exercise in communities across Long Island.

What can you do?

Be your own healthcare advocate, so that your health does not suffer as a result of environmental disparities.

  • Ask questions of your doctors, and make sure you understand all diagnoses and treatment recommendations.
  • Follow up on necessary screening examinations and diagnostic tests.
  • Speak up – don’t hesitate to discuss your concerns or questions with your doctor.
  • Be proactive by adopting a healthy diet and an active lifestyle

Recognizing the existence of health disparities is the first stop toward overcoming them. Contact Care Answered for help in lifting your voice to access your best care.

For more information, contact us.

 

Call a Friend Today – Science Says Social Connections are Good for Your Health

“When ‘I’ is replaced with ‘we,’ even illness becomes wellness[1].”

Human beings have always recognized themselves as social creatures. From an evolutionary standpoint, survival depended on social structure and being part of a group.

But in recent decades, evidence regarding the link between social connections and physical health has been mounting. A 2015 meta-study linked loneliness with a 45% increased risk of dying. By contrast, obesity only accounts for a 20% increase[2]. Unfortunately, society has evolved in such a way that increasing numbers of people describe themselves as socially isolated. As we sacrifice our connections with friends and family, loneliness could become a major public health threat.

Research around this topic goes back decades. Among some of the most intriguing studies are those that have shown that social rejection triggers the same parts of the brain as physical pain[3]. A 1988 study reported that lack of social connections could have more of a negative impact on health than obesity, smoking and high blood pressure[4]. Another study, completed at UCLA in 2010, linked stress brought on by social rejection with increased inflammation in the body[5].

The problem of social isolation appears to be more significant among the elderly who are no longer in the workplace and may not live near family members. Those with dementia report even higher levels of loneliness than their peers[6].

How can you avoid or reverse social isolation and loneliness? By all indications, it is the quality rather than quantity of social connections that matters, so having just one or two friends or family members with whom you socialize can yield positive results. Face-to-face contact is preferable, but if you live apart from friends and family, try at the very least to maintain regular telephone contact.

If you are physically able to get around, consider joining a club or a gym, attend religious services, participate in your favorite hobby to meet like-minded people, volunteer, or join a support group. If you are unable to travel on your own, look for community-based and faith organizations, many of which offer resources such as friendly visitors who check up on the homebound.

The effort to remain connected to others can be challenging. But in the long run, these connections will improve your quality of life and may even help you live longer.

Here are some resources to help you get and stay involved:

www.destinationaccessible.com offers detailed accessibility descriptions of leisure locations.

https://parks.ny.gov/admission/empire-passport/ offers discounted rates to New York state parks.  Also take note that those 62+ can access at NYS parks for free and reduced rates just with their NYS ID.

 

[1] Quote attributed to Malcolm X.
[2] Brene Brown: America’s Crisis of Disconnection Runs Deeper than Politics; Fast Company, September 12, 2017. https://www.fastcompany.com/40465644/brene-brown-americas-crisis-of-disconnection-runs-deeper-than-politics
[3] Social rejection shares somatosensory representations with physical pain; Proceedings of the National Academies of Sciences, March 28, 2011. http://www.pnas.org/content/early/2011/03/22/1102693108
[4] Social relationships and health; Science Magazine, July 29, 1988. http://science.sciencemag.org/content/241/4865/540
[5] Neural sensitivity to social rejection is associated with inflammatory responses to social stress; Proceedings of the National Academies of Sciences, August 17, 2010. https://www.ncbi.nlm.nih.gov/pubmed/20679216
[6] Only the Lonely: Dealing with Loneliness and Isolation in Dementia; Unforgettable, https://www.unforgettable.org/blog/only-the-lonely-dealing-with-loneliness-and-isolation-in-dementia/

You Are What You Eat

You Are What You Eat. Choose a Diet That’s Good for Your Health.

What does diet have to do with health? Quite a bit, according to the experts. Generally speaking, it is well documented that lifestyle factors including smoking, exercise and healthy eating contribute significantly to a person’s risk of developing the most serious and common health conditions, including diabetes, heart disease and cancer. Many studies have also linked diet with the delayed onset or prevention of chronic health conditions. March is Nutrition Month, and in recognition, we have summarized some of the recent research around diet and health for you.

Mediterranean Diet

The Mediterranean Diet emphasizes fish, nuts, fruit and vegetables. A 2013 study found that women who followed the Mediterranean Diet in their 50s had fewer memory problems and fewer chronic illnesses as they aged. 

The DASH Diet

DASH stands for Dietary Approaches to Stop Hypertension. It is an eating plan developed to lower high blood pressure and reduce levels of LDL, the so-called “bad” cholesterol. Recent research has also linked the DASH diet to reduced rates of some kinds of cancer, stroke, heart disease, heart failure, kidney stones, and diabetes. The diet is centered on eating fruits, vegetables, low fat or nonfat dairy, whole grains, lean meats, fish and poultry, nuts and beans.

Preventing Diabetes

Evidence shows that lifestyle changes focusing primarily on diet and exercise can help individuals with pre-diabetes avoid the progression to diabetes. Selecting whole grains over processed grains and lean proteins such as nuts, beans and fish over red meat and processed meats are known to help prevent diabetes. Other dietary habits that can help include avoiding refined carbohydrates – think breads, cakes, white rice, pasta and potatoes – as well as sugary drinks.

The Future: Precision Nutrition

The newest breakthroughs in nutrition research concern precision nutrition. Because individual responses to dietary changes may vary from person to person, precision nutrition is focused on creating specific dietary plans based on an individual’s physical and environmental factors such as DNA, microbiome, metabolism, health history and lifestyle. Current research is exploring the use of precision nutrition in diabetes prevention.

So What Should I Eat?

Every diet wosaladn’t work for every person. Individual food preferences, convenience, access to fresh fruits and vegetables, time to prepare healthy foods, and a multitude of other factors may affect the success of a particular diet plan. If you are looking to improve your health, lose weight or just eat better, experts tend to agree on a few basic dietary guidelines.

  • Reduce your consumption of red meat
  • Eat a wide variety of vegetables and fruit
  • Choose lean protein sources
  • Limit fats, sweets and processed carbohydrates

Generally what’s good for your heart is also good for your brain. A qualified nutritionist or your primary care physician can provide additional guidance on what will constitute a healthy diet for you.

Bon appetit!