Community Health Services – Choices For The Uninsured

Based on reasonable estimates from health research organizations, each year, millions of Americans lose their health care when they lose their jobs. Many of them regain coverage when they take another job. The U.S. Census Bureau reported that in 2007, 235.4 million Americans did have health insurance. This figure leaves only about 15 percent of U.S. residents without healthcare. Not many have been able to set aside money in a dedicated medical savings account to cover healthcare expenses. Those who are left to cover the costs on their own frequently turn to community health services and other health facilities to help fill the gap.

The Uphill Battle

The average cost of a doctor’s visit always depends on the part of the country where the health facility is located and the type of doctor needed to treat a condition. For example, a trip to see a general practitioner costs anywhere from $95 to $265. If the condition is serious enough to warrant a specialist, the cost rises slightly: $115 to $325. Rheumatologists seem to come in on the lower end of the scale at $91 to $137. Health care providers also tend to publish cash prices but charge a different (higher) amount when billing a patient’s insurance company.

Some of the 15 percent of the nation’s uninsured are uninsured by choice. Health statistics indicate that many of these people are under 34 years old and make over $50,000 annually. Some of them have salaries in the $75,000 range. So affordability is not the issue all the time.

Viable Options

A good number of those who do not have insurance and can be counted among the poor have used hospital emergency rooms for health treatment because they simply have nowhere else to turn. The emergency room has not only been a place for the uninsured, though. People who have Medicaid coverage are often turned away by doctor’s who do not accept this kind of insurance. It is also full of people whose regular doctors have offices that are closed.

Uninsured Americans who happen to belong to some type of professional organization, community organization or a local Chamber of Commerce could possibly get insured if they have membership in one of those organizations. It is group insurance at a discount rate and will unlikely be discontinued for the duration of the organization.

Community Programs

Those who can take advantage of community health services tend to find local nonprofit health care centers that have centralized healthcare for almost any kind of ailment. These centers either base payments on income or charge on fixed low fee to anyone who walks in the door. Patients who cannot pay anything are not often turned away. It is the ideal type of scenario because doctors who work in these facilities tend to be dedicated to patient care rather than the prestige of the job. The payment system brings together patients and capitalizes on those who have any income at all to pay. So, it achieves its goal of ensure all patients have access to care.

Sometimes, an uninsured person who is in need of care may seek more than one of these alternative healthcare paths to help heal themselves. Community health services have done much to take up the slack in the national healthcare system. Rather than leave patients hopeless, it gives them options.

Communicate Health Benefits Information More Effectively

All employers have responsibility of guiding their employees about the health benefit schemes offered by them. Even the employees on the other hand also have the right to receive information about the health benefit schemes offered to them. Therefore an employer has the right to inform the employees about certain information regarding the health benefit schemes. For this reason, organizations have created the position of Health Benefit Manager having communication as one of the responsibilities for health benefit related schemes and procedures.

Key information heads to be shared by employer

There is a plethora of information available for communication. It is the skill of the Health benefit Manager to present them in a structured manner on behalf of the employer.

– Employers need to provide a detailed list of information to the employees about what health benefit schemes are provided to them or the scheme they are entitled to.
– Providing information regarding cost sharing as well as arrangements
– To take up necessary steps to resolve problem as well as to deal with appeals.
– To provide and guide its employees about the status of accreditation, certification as well as licensure.
– Provide sufficient and necessary information about the composition of the provider network too.
– To use the emergency care services as when required by the employees of the organization.
– To obtain referrals to specialists
– Most importantly provide all the information regarding the quality, safety of the health benefit plan and the cost of the employer sponsored plan.

Regulatory directives
According to the Employer Retirement and Income Security Act of 1974, it is necessary to provide all detailed information that the employees are entitled to that includes plan rules, covered benefits, documents about the plan management and operation as well. The employees are also entitled to receive a document with the summary plan description, known as SPD. The SPD contains

– Information of the health care services that are covered in the plan.
– Description of what services are being provided by the plan and how these schemes function.
– It provides information also on how to calculate the benefits.
– Explanation on the cost that the plan covers and the cost that the beneficiary has to pay.

Tools and Methods for communicating
There are various methods by which the Health Benefit Manager, on behalf of the employers, can communicate health benefit information to the employees:

– One of the best ways is to communicate with the employees about the health coverage plan but providing too much information of it should also be avoided. The employees should be given the required time to understand the scheme and ask questions if any.

– It is best to explain the changes in simple terms to the employees to make them understand.

– Apart from the employees it is also necessary to explain the health benefit plans to the health benefit managers so that they can explain it to the employees to.

– Employers should be ready to face any questions asked by employees regarding the health benefit scheme and clear their doubts.

– It is equally important as well to be direct and honest when discussing about the coverage plan especially if employees face cost increase due to the coverage plan.

– Discussing the 5C’s too is essential with the employees. This 5C’s include cost, changes in plans, coverage of the plan, comparison of the previous year’s plan and also the current option.

– It is necessary to provide information the employees about the health care providers that are available in the revised and new plan option.

– Providing testimonials of other employees about the changes in health benefit plans can also be quite helpful for the present employees.

– Taking the help of various means like internet, face to face discussions, telephonic conversations, office intranet as well as printed materials can be helpful too. However it is also necessary to use materials that are easily understood by employees.

Using health communication campaigns

What are its advantages?

– It is important for the employers to conduct communication campaigns to educate the employees about the need of health benefit schemes and how they operate.

– The responsible manager’s aim should be to identify the objective and aim of the health care campaign.

– To develop health care message that meets the objectives and aim of the campaign.

– Setting up the criteria for evaluation of the campaign and also the degree to which it is getting conveyed among the employees.

– To implement and the campaign and make sure that the employees understand message that is being conveyed by the employer.

– It is also necessary to make sure that the employees also to address the education need of the employees with language barrier, literacy issues etc.

To conclude, an effective way to communicate about the health benefit scheme is the cornerstone of every business organization. In these schemes, employers can also guide and help its employees to select a scheme and explain every detail they should know. The authority should also explain the new health scheme option and also about the changes in the existing benefits. To improve the health plan costs the employer’s must keep in mind the factor of low health literacy. Health plans and employers should also be able to successfully communicate with employees. Lastly, employees and employers should also be able to communicate clearly about the health benefit plans.

The Many Community Mental Health Services Available to You

Well developed and well managed community mental health services are actually associated with low suicide rates. Hence, mental health services for the masses can be improved by focusing on the community based and specialized mental health services.

If ever you are in need of mental health services, you can contact your local affiliates of the national self help organizations or the local mental health center. Most of these agencies have the relevant information on the various services designed to meet the different needs of those who are suffering from different types of disorders such as anxiety conditions, panic disorders, schizophrenia, etc. Apart from these, they also provide information related to community mental health services designed specifically for children, refugees, HIV infected patients, the elderly, etc. Here are a list of various community health services available for your use.

Mental health act has provided a great opportunity in rendering different kinds of community care based upon individual needs. The provision of good residential accommodation for various groups of mentally disordered or patients with disorders who need constant care by the government aided agencies is a step towards enhancing the community health services.

Generally community health services treat or support people suffering with mental disorders in a domiciliary setting instead of placing them in a hospital or a psychiatric asylum. The various services offered by these community services usually differ from country to country. Most of the community services consist of psychiatric wards similar to that of a hospital. These services are mostly rendered by professionals and government organizations. According to the world health organization, community services are very easy to access by a wide range of people and are quite effective and even aid in reducing social exclusion.

When compared to private mental hospital, community services are less likely to have possibilities for the violation and neglect of human rights which are rarely encountered in few of the mental hospitals. These community services also play an important role in educating the people about the various common disorders and their corresponding symptoms. This way, people gain knowledge on various disorders and can easily recognize individuals who may be suffering from these disorders but might not really be aware of them. Aged and older people who require constant attention, can get benefited by these community services, instead of paying huge bills at private hospitals, they can get good care at the community services.

With the population in the older age group on the rise, there is need for the development of community mental health services in various localities. Also, with many specialists willing to volunteer at the community services, clients can gain a lot of benefits. Since, most of the mental health disorders occurrence do not have a clear reason behind them, the treatment usually is a long term one and for people who cannot afford highly expensive treatments and consultations, community mental health services is the best place to choose. With government pitching in to provide funds for them, it is time people think of visiting them when needed.

Community Health Centers and the Affordable Care Act

The Affordable Care Act (also known as Obamacare or the ACA) of 2010 garnered international attention when it famously mandated that small business owners with 50 or more full-time employees would be required to provide health insurance coverage for their full-time staff. Though the long-term effects of the law remain to be seen, the Affordable Care Act did establish the Small Business Health Options Program (SHOP), which allows small business owners to directly compare different public health insurance coverage plans. These are large-scale effects, however. How does the Affordable Care Act change how community health centers operate, if at all? What will the ACA mean for municipalities where CHC(community health center) provide the bulk of healthcare services rendered?

Since much of the Affordable Care Act is concerned with expanding access to healthcare services, community health centers have seen a large increase in the number of patients enrolled since the law was enacted. Total patients served annually have increased from 17 million in 2009 to over 20 million in 2012, and community health centers have added over 35,000 new staff positions in the same period (including over 7,500 physicians).

The ACA has also provided significant funding for centers (CHC) (as of 2013) over the next five years, designating more than $11 billion for the maintenance and renovation of existing health centers. A portion of this amount will be used to create new in medically underserved areas (MUAs). As one might expect, medically underserved areas are localities in which the physician-to-population ration is far below the national average. Residents may not have access to even very basic healthcare services, hospital procedures, or professional medical consultation, so community health centers represent their best chance at receiving the care they need.

Physicians and public health advocates alike continue to promote the development of CHC across the country, as they represent an affordable solution to the lack of hospital care for millions of residents. CHC’s are also particularly adept at addressing several different health conditions, given that they often house professional medical staff with diverse medical backgrounds. The Affordable Care Act will allow these vital community programs to expand and further evaluate local demographics and their medical needs. Should more specialized services be required, the community health center provides a gateway for policymakers to assess how future federal funding should best be spent in the area.

Productivity and Lean in the Delivery of Mental Health Services

The scale of the potential productivity challenge in mental health was highlighted in the King’s Fund report published at the end of 2010. Whilst the scale of the productivity opportunities are vast, the problems of realising them are equally vast.

Whilst it is possible to make improvements within an organisation’s own sphere of influence, the real productivity gains are only realised when organisations work together. For Mental Health this normally means working across health and social care boundaries and will often involve the third sector as well. No one should under-estimate the challenges this presents, particularly when the relationships between organisations are strained.

Shifting the setting of where care occurs, and indeed strengthening community based options, means changes to commissioning models and that affects the distribution of funding and often resources, for example moving a secondary care clinicians into a community setting to enable them to provide outreach support rather than staffing in-patient facilities causes the need for change in the funding structure of two and possibly more organisations.

Carla Bickley, Head of Specialist Mental Health Services at Wolverhampton City PCT commented, “The biggest improvements in mental health support comes when we are able to work across organisational boundaries to design the most effective pathways for service users. Increasingly service users have complex needs that require a different way of working to ensure success and by working across organisations we can minimise delays and costs whilst also improving the quality of care provided.”

Realising the productivity improvements in Mental Health needs a coordinated and strategic approach and this generally needs the application of concepts such as Transformation Mapping and Lean to bring a consistent focus to the problems. The benefits of undertaking Transformation Mapping, which is a way of bringing together all the strands of what would otherwise appear as a disjointed strategy and then putting together the requisite implementation plan, is that is allows people to coordinate activities and agree priorities.

Throwing unstructured ‘Rapid Improvement Events’ and tactical activities such as the ‘Productive’ series for Mental Health at the problem can actually make things much worse and create a legacy of bad feeling, especially when working across multiple organisations, many of whom will have different targets and objectives. You only have to annoy partners a few times before you lose their support for your improvement efforts and then the problems become significantly harder to tackle in mental health.

It is possible to make a step-change in the way mental health services are delivered but it needs coordination, consistency and the effective application of concepts such as Lean at a strategic level, linking together all the strands of improvement in mental health. Before this can be achieved there is a need to focus on creating a compelling need that spans multiple organisations, something that is easier to write than it is to achieve. Sitting above all of this is the need for effective sponsorship at a senior level. Together, this creates the right package needed to realise the productivity challenge in mental health, Without it, the challenge becomes exponentially more difficult.