Consumer 2

HSA is an ___________ to traditional health insurance: It is a savings product that offers a different way for consumers to pay for their health care. HSAs enable you to pay for current health expenses and _______ for future qualified medical and retiree health expenses on a tax free basis

Alternative Save

Despite what many might assume, the studies show that the _______ American feel is not isolated to a certain class; those at the top of the socioeconomic gradient feel the stress in ________ measure to those at the bottom

Anxiety Stress

Which race has the highest percentage of uninsured individuals?

Hispanics

Those with private insurance are _______ activated than those on Medicare or Medicaid

More

The challenge is to get young independents to recognize the _______ for healthcare products and services.

Need

Circle of ages for health care

-->Young independence--> Mature Adults--> Young Families--> Older Families --> Pre retirees--> Early retirees--> Retirees-->

**Driver of health care needs?

-Level of Responsibility - Quality of Health

Personal health care expenditures (the ratings for who pays most for what)

1. Private 2. Medicare 3. Out of Pocket 4. Medicaid (federal) 5. Medicaid (state)

Health insurance coverage among adults aged 19-25. Rate the top three

1. Private (about 60%) 2. Uninsured (About 35%) 3. Medicaid (About 15%)

Personal Health care expenditure rankings

1. Private (about 800 billion) 2. Medicare (about 500 billion) 3. Out of pocket (about 300 billion) 4. Medicaid federal (about 250 billion) 5. Medicaid state (about 150 billion)

Health Insurance coverage among children under 18 (ratings for who covers the most)

1. Private (decreasing) 2. Medicaid (increasing) 3. Uninsured (decreasing)

Health care spending/expenditures in US in 2011

1. Private health insurance= 35% 2. Medicare= 24% 3. Medicaid= 16% 4. Consumer out of pocket= 13% 5. Other private funds= 8% 6. Other Government Programs= 4% Total spending= 2.3 trillion

Rankings of how we spend health care dollars

1. Professional Procedures 2. Prescription drugs (ONLY ONE TO DECREASE) 3. Outpatient (BIGGEST INCREASE) 4. Inpatient

States with the Highest percentages uninsured under 65 for 2013 (Ranking)

1. Texas (27%) 2. Arkansas (22.5%) 3. Mississippi (22.4%) 4. Florida (22.1%- Rick Perry) 5. Louisiana (21.7%) 6. California (21.6%)

Annual Per Capita Health Care costs by age. (Countries listed from most to least)

1. US (by a lot) 2. Germany 3. UK 4. Sweden 5. Spain

Top 3 outrages of the American Health Care consumer (from consumer reports website)

1. Why do just one test when they bill for 3 2. $1000 per pill for hepatitis pill 3. Pushing the new and fleshy

Percent Increases in Health insurance Premium Rankings

1. Workers Contribution (about 180%) 2. Premiums (about 160%) 3. Workers Earning (about 40%) 4. Inflation (about 20%) They are all increasing per year due to health care increasing

QM focuses on what 5 basic principles?

1. a FOCUS on customer/supplier relationship 2. an EMPHASIS on operational and care systems and the prevention of errors; 3. The use of DATA DRIVEN decision making 4. The active involvement of leaders and empowerment of employees 5. Emphasis on CONTINUOSLY improving performance in all areas

Texas' _____ largest cities, including Houston, Dallas, San Antonia, Austin, Ft. Worth, and El Paso had a greater Percentage of their population without insurance than the collective United States

28

What does POS stand for

Point of Service

What are some reasons that people don't have health insurance?

Poor Education Poor Leadership Poor Representation Poor infrastructure of community Low activation

NCQA ____ is a widely recognized symbol of quality. Organizations must pass a rigorous, comprehensive review and must annually report on their performance. It is a reliable indicator that an organization is well managed and delivers high quality care and service.

Seal

Another way to compare quality is to use information about accreditation. Accreditation is a "_______ ____ _______". It is mainly used for health care organizations such as health plans, hospitals, and nursing homes.

Seal of Approval

Young Families:

Single, married, or divorced parents At least one child age 12 or older

Older Families:

Single, married, or divorced parents At least one dependent child, none under age 13

Point of service plans are similar to PPOs, but the introduce the ______ _____, or primary care physician. You have to choose your PCP. You can still choose to refer yourself, but it will mean more hassles and more money out of pocket

gate keeper

Quality Assurance (QA) definition:

is a systematic, departmental approach to ensuring a specified standard or level of care

Although nearly 47 million Americans are uninsured, the US spends _____ on health care than other industrialized nations, and those countries provide health insurance to ALL their citizens

more

What are the 4 stages in activation?

1. Believing the patient role is IMPORTANT 2. Having the CONFIDENCE and knowledge necessary to take action 3. actually taking action to maintain and improve one's health 4. Staying the course even under STRESS. The measure has good psychometric properties indicating that it can be used at the individual patient level to tailor intervention and assess changes.

Ranking of people in poverty in 2013 from census

1. Black=27% 2. American Indians= 27% 3. Hispanics= 24% 4. Whites= 12% 5. Asians= 10%

Health Care coverage Percentages in US in 2011

1. Employer Sponsored Insurance= 49% 2. Uninsured= 16% 3. Medicaid= 16% 4. Medicare= 13% 5. Private non group= 5% 6. Other public= 1% Total spending= 307.9 million

What are the four HOS measures in the 2012 Report?

1. FALL RISK management (65+) 2. Management of urinary incontinence in older adults 3. Osteoporosis Testing In older adults 4. PHYSICAL ACTIVITY in older adults

Table one in the website http://www.hschange.com/CONTENT/1019/

- Younger, educated, and higher income are more activated -Private health insurance tend to have higher activation than those with medicaid or those with medicare -Racial and ethnic differences in activation are also apparent with hispanics having much lower activation levels compared with other groups.

How to Protect your Medical Information:

-Be wary of "free" health services, but requires you to provide your health plan ID # - Dont share medical info by phone or email UNLESS you initiated the contact person and know who you are dealing with -Keep info in a safe place. SHRED outdated information -If you have to provide info, find out why it is needed, how it will be safe, if it will be shared, and with whom - Look for a LOCK ICON on websites if you put your info on website. Or look for URL that begins with httpS: the S is for secure.

Who qualifies for Medicaid

-Being on Welfare -Having Dependent children -Receiving supplementary security income (SSI) for elderly, blind, or disabled persons

Enrollment in Medicaid has steadily increased since_______ as people have lost jobs and health insurance. It occurred as state budgets got crunched in the recession which caused some states to cut back on medicaid benefits

2008

Because the Affordable Care Act allows young adults to stay on their parents insurance until they are _____, 3.1 million young adults gained health coverage

26

In 2011, ______ states passed laws to limit benefits or increase cost sharing, such as co payments for some children in the children's health insurance program (CHIP), according to a study by the national association of children's hospitals (Medicaid)

7

In addition to premiums, consumers spent $_____ out of pocket per person on health care in 2011-4.6% more than in 2010, out of pocket costs rose fastest for outpatient care for outpatient care but dropped for prescriptions.

735

______% of US adults own a cell phone, and more than half are smartphone users

85

Percentages of how people feel about apps that check your health.

26% are ok with an app to check for an ear infection 47% are ok with an app to check your urine 52% are ok with checking vitals Within the next 5 years, apps and mobile devices might be improved to help in healthcare.

______ of the people in Texas are the most uninsured

27%

NCQA is sustained and statistically significant that changes over ___ to ___ years

3 to 5

Engaged consumers often use more health resources, but heavy users of health care services are not necessarily _______

Engaged

Insurance companies often prefer to pay for medications, which tend to produce _______, more visible and more verifiable results, than for psychotherapy, which can last for months or years and produce results that are less objectively verifiable.

Faster

For many eligibility groups, income is calculated in relation to a percentage of the...?

Federal Poverty Level (FPL) Ex: 100% of the FPL for a family of four is $23,850 in 2014.

______ grantees provide health care to uninsured people, people living with HIV/AIDS, and pregnant women, mothers and children. They train health professionals and improve systems of care in rural communities

HRSA

________ Is the nations access agency- improving health and saving lives by making sure the right services are available in the right places at the right time. It is the primary Federal agency for improving health care services for people who are uninsured, isolated or medically vulnerable

HRSA

________ oversees organ, tissue, and blood cell donations and vaccine injury compensation programs, and maintains databases that protect against health care malpractice and health care waste, fraud, and abuse

HRSA

Young Independents are most likely to choose _______-_______ major medical policies that cover catastrophic health problems, as well as certain preventive care and wellness programs, birth control, a reasonable number of doctor visits, and dental care. They want large networks that allow them to access care whenever and wherever they find themselves in their busy lives.

High-deductible

Medicaid is _____ ______ by FEDERAL and STATE government, therefore it will look different in every state

Jointly funded

Sometimes there is suspicion that the poor's condition is their own fault, that they are simply lazy or choosing high risk __________

Lifestyles

6 basic ways HMOs, PPOs, EPOs and POS plans are different 4. Whether or not the health plan will pay for care you get outside of its provider _________

Network

To qualify for Medicaid, you must qualify based on _______ levels

Poverty

6 basic ways HMOs, PPOs, EPOs and POS plans are different 3. Whether or not you have to have health care services _____-______

Pre-Authorized

Participants of PPOs MUST USE one of the _________ providers for the majority of bills to be paid; if a patient uses non-preferred provider, they must pay a substantial fee

Preferred

Combination of the traditional fee for service health care plan and an HMO is what?

Preferred Provider Organizations (PPO)

With fee-for-services, the insurer only pays for part of your doctor an hospital bills. You pay a MONTHLY FEE, called a ________

Premium

HIPAA _______ group health plans from using past or current medical conditions, including genetic information, as a basis for denying or limiting an individual's coverage

Prohibits

How does QI differ from QA?

Scope, Focus, approach and end result -scope is organization wide rather than in select departments -The focus is on identifying COMMON causes and on processes rather than on outliers and clinical outcomes -The approach is PROACTIVE rather than reactive -QI's end result is to prevent errors and to improve rather than to inspect and repair problems and meet standards

EPOs are regulated by _______ insurance law. This is different from HMOs and PPOs.

State

Clinical performance is also called what?

Technical quality

Part C of medicare covers what?

These are medicare advantage plans (like HMO's and PPO's)

When using social media:

Think before you post- don't assume that an online forum is private or secure If you do decide to post health information, make sure privacy settings are set Be aware that information posted on the web may remain permanently

You own and control the money in your HSA. Decisions on how to spend the money are made by you without relying on a _______ party or health insurer. You will also decide what types of ___________ to make with the money in the account in order to make it grow.

Third Investment

Definition of Health Economics:

Branch of economics concerned with issues related to scarcity in the health markets

Possible strategies for those who don't have health insurance?

Building Coalitions Community Empowerment Legislative Involvement and Action Media Advocacy Grants Focus Group activities

Organizations _______ whether to participate in accreditation programs. Therefore, you will not find accreditation information on every nursing home, for example

choose

6 basic ways HMOs, PPOs, EPOs and POS plans are different 6. Whether or not you have to file insurance _________ and do paperwork

claims

6 basic ways HMOs, PPOs, EPOs and POS plans are different 5. How much _____-_____ you're responsible to pay when you use your health insurance

cost-sharing

NCQA is a private, not for profit organization dedicated to improving _____ ______ ______

health care quality

Other Americans are more kind hearted to the poor, but prefer not to ______ at them too closely; It's depressing, and they are surely not ____ people to be with

look fun

Most fee-for-service plans have a "______", the most you will have to pay for medical bills in ANY ONE YEAR (ON A YEARLY BASES). You reach this when your out of pocket expenses total a certain amount. It may be as low as $1,000 or as high as $5,000. Insurance then pays the full amount in excess of this for the items your policy says it will cover. It does not include what you pay for your monthly premium

Cap

Which age range had the highest poverty levels in 2013?

Children under 18

About Federal poverty level...

Comparing one's own income to the poverty line, as determined by the federal government. They don't usually say a percentage above or below, they just say "x percent of poverty level". If someone's income matches the poverty level, they are at 100% of poverty. If their income is only half of poverty level, the 50%, if twice as much, then 200%, and so on...

"Healthcare in America is sick..... It cost too much, wastes too much, errs too much, and _____________ too much"

Discriminates (against wealthy and poor)

Some say that american attitudes toward the poor- and perhaps not just in America- are mostly what?

Disdain and Fear

You don't have complete autonomy. Most fee-for-service medicine is _______ to a certain extent. For instance, if you're not already incapacitated, you may need to get clearance for a visit to the emergency room.

managed

HMOs and other health care organizations deliver medical services as _______ _______, a system that reduces the cost of health care

managed care

Quality health care means doing the ______ thing, at the _____ time, in the ______ way, for the _______ person- and having the BEST possible results

right right right right

Quality Improvement (QI) definition:

systematic, organization wide approach for improving the overall quality of care- one that emphasizes performance improvement as well as a standard of care

Mature adults:

Age: 30-45, single or married No kids, may own a home

CAHPS surveys have been developed with who?

Agency for Healthcare Research and Quality (AHRQ)

According to NCQA ranking, what is the ranking of the popular health plans?

#155= Scott and White Health Plan # 209= Aetna Life Insurance # 292= Human Health Plan of Texas # 293 Aetna Health

Part A of medicare covers what?

HOSPITAL SERVICES, including drugs and professional services ONLY ONE THAT IS FREE

Robert Wood Johnson Foundation report that they are having some success with improving the overall quality of health care through what three things?

(1). Collaboration- among patients can help them learn to better manage their own health (2). Transparency -of Doctor practices (3). Engaging- Engaging patients to influence health care systems or policy takes both time and resources but is critical for true culture change

Level 4 of health care

(Maintaining behaviors) -Have adopted NEW behaviors but may not be able to MAINTAIN them in the face of stress or health issues, but they are trying

Level 2 of health care

(They are building knowledge and confidence) -Individuals lack confidence and an understanding of their health or recommended health regimen

Level 3 of health care

(They are taking Action) -Individuals have the key facts are are beginning to take action but may LACK CONFIDENCE AND THE SKILL to support their behaviors

Measures of NCQA

- 11 measures (8%), Performance declines - 64 measures (64%) performance gains - 64 measures (46%) mixed results, no trends

Table two in the website http://www.hschange.com/CONTENT/1019/

- Chronic conditions, there are differences by conditions and other health characteristics. People with depression tend to be least activated while those with cancer tend to have higher activation -People with multiple chronic conditions are less activated than single conditions or healthier

Level 1 of health care

- Individuals do not feel confident enough to play an active role in their own health -Predisposed to be PASSIVE RECIPIENTS of care (like a child)

What are 2 ways Savvy shoppers can also save in several other ways:

-CONSIDER GENERICS- More than 20 of the chains in th eratings, including major retailers such as CVS, Walgreens.... sell hundreds of generics for as little as $4 for a 30 day supply, or $10 for a 90 days if you pay cash -FILL 90 DAY PRESCRIPTIONS- Filling ongoing prescriptions for tree months instead of one might save you 2 co-pays -APPLY FOR A DISCOUNT CARD- Often free. Just show your card and accrue points toward discounts, cash back, or other awards. -*ASK* FOR A BREAK- "secret shoppers" have found when they asked for a better deal, pharmacy staffers have sometimes suggested discounts and membership programs. -TALK TO HUMAN RESOURCES- ask your benefits administrator whether your company uses PHARMACY BENEFIT MANAGER- a firm that helps companies cut the cost of prescription drug coverage. PBMs have formularies (list of preferred drugs) that they make available to members, usually via mail order, at reduced rates

Different types of Federal programs for special populaitons

-Federal Employees Health Benefits Program -Tricare -Veteran Administration -Workers compensation Insurance (federal and state input)

How to correct mistakes in your medical records

-Get copies of your medical records: Federal law gives you the right to know what is in your medical files. Check for errors. Contact each doctor, clinic, hospital, pharmacy, laboratory, health plan, and location where a thief might have used your information. You have the right to know what is in your file. If a provider denies your request, you have the right to appeal. Contact the person the provider lists in its notice of privacy practices, the patient representative, or the ombudsman - Get an Accounting of disclosures -Ask for Corrections

Look for a long-term care that:

-Has been found by state agencies, accreditors, or others to provide quality care -Has the SERVICES you need -Has STAFF that meet your needs -Meets your budget

Quick Checks for Quality, Look for a plan that:

-Has been rated highly by its members on the things that are important to you. -Does a good job of helping people stay will and get better -Is accredited, if that is important to you. -Has the doctors and hospitals you want or need -Provides the BENEFITS you need - Provides services where and when you need them - MEETS YOUR BUDGET

What are the four health markets typically being analyzed?

-Health care financing market - Physician services market -Institutional services market -Professional education market

Why has Health care costs outpaced inflation and the overall consumer price index?

-Increasing use of costly high tech EQUIPMENT - High costs of treating such illnesses as AIDS and CANCER - Aging of the population - Fraudulent Practices by some providers - Large number and high cost of malpractice suits - Administration costs of complying with government regulations

Look for a hospital that:

-Is accredited by the Joint Commission on Accreditation of Healthcare Organizations -Is rated highly by State or consumer or other groups -Is one where your doctor has privileges, if that is important to you -Is covered by your health plan -Has experience with your condition -Checks and works to improve its own quality of care

Look for a doctor who:

-Is rated to give quality care - Has the training and background that meet your needs -Takes steps to prevent illness, for example, talks to you about quitting smoking -Has privileges at the hospital of your choice -Is part of your health plan, unless you can afford to pay extra -Encourages you to ASK QUESTIONS -LISTENS to you -Explains things clearly -Treats you with respect

Plan Chart

-Requires PCP: HMO, POS - Requires referrals: HMO, POS - Requires Preauthorization EPO, PPO, (Not usually for HMO and POS -Pays out of network care: POS (with PCP referral), PPO -Cost Sharing: HMO (low), POS (low in network, high for out of network), EPO (low), PPO (High, especially for out of network care. - Do you have to file claim paperwork?: POS (only for out of network claims), PPO (Only for out of network claims)

When using mobile devices:

-Research mobile apps -Read the terms of service and privacy notice of mobile app - Consider installing or using ENCRYPTION SOFTWARE (Encryption software uses an encryption scheme that encodes computer data so that it cannot be recovered without the correct key). - Install and activate remote wiping and/or remote disabling on your mobile device. Allows you to permanently delete data stored on a lost or stolen mobile device. Remote disabling enables you to lock data stored on a lost or stolen mobile device, and unlock the data if the device is recovered.

Heads up about quality for Long-term care:

-STANDARDS DIFFER for assisted living residences, which vary in size, appearance, cost, and services. Some only provide meals, basic housekeeping, and help with daily living (ADLs). Such as bathing, dressing, and grooming. -Others go beyond those services and furnish transportation and certain health services. -Facilities range from small homes with few residents to high rise apartment style building with hundreds. Living areas could be single room or full apartment with a small kitchen with prepared meals also served.

Tips for shopping for individual insurance

-Shop carefully -Make sure the policy protects you from LARGE medical costs -Read and understand the policy -Check to see that the policy states: the date that the policy will begin paying (some have a waiting period), and what is covered or excluded from coverage - Make sure there is a "free look" clause (give you some amount of time to look over your policy after you receive it, and can return it if needed) - Beware of single disease insurance policy (only offer coverage for one disease, like cancer)

Topics related to various aspects of health economics include: (If you can do all of these aspects, it does not matter where you graduate from)

-The meaning and measurement of health status -Production of health and health care -The demand for health and health services - Health economic evaluation - Health insurance - The analysis of health care markets - Health care financing - Hospital economics

Types of personal Health insurance plans

-Traditional or private insurance -Managed Care -Health Savings Accounts

What is the Vision, Mission, and Goals of HRSA?

-VISION- Envisions optimal health for all, supported by a health care system that assures access to comprehensive, culturally competent, quality care. - MISSION- Provides national leadership, program resources and services needed to improve access to culturally competent, quality health care -GOALS- focuses on uninsured, underserved, and special needs population in its goals and program activities

Other signs of medical identity theft include:

-a bill for medical services you did not receive -A call from a debt collector about a medical debt you don't owe. -Medical collection notices on your credit report that you don't recognize -A notice from your health plan saying you reached your benefit limit -A denial of insurance because your medical records show a condition you don't have

Some examples that is NOT covered by HIPAA include health information that PATIENTS:

-store in mobile apps or devices -Share over social media or online communities -Store in Personal Health Record (PHR) that is not offered through a health provider or health plan covered by HIPAA

When choosing treatment, make sure you understand:

-what your DIAGNOSIS is -Whether treatment is really needed at this time -What your treatment options are -Whether the treatment options are based on the latest scientific evidence -The BENEFITS and RISKS of each treatment -The COST of each treatment

Medications cause at least ____ death EVERY DAY and injure approx 1.3 million annually in the US

1

Sometimes people suffer from more than _____ error

1

Texas is ranked number ___ with no health insurance coverage of children 0-18 at 16%. Florida is ranked number _____ at 14%. California is ranked number _____ at 11%. New York is ranked number ______ at 6%. These are the largest states

1 2 3 4

Health care Economics ranking (How things are paid)

1. 36 cents of the health care dollar was paid for by private insurance 2. 22 cents of the health care dollar was paid for by Medicare 3. 14-18 cents of the health care dollar was paid for out of the consumers pocket 4. 15 cents of the health care dollar was paid for by Medicaid

Personal Health care spending in 2011

1. Hospitals 2. Doctors 3. Prescription Drugs

What are the 7 goals of HRSA?

1. Improve access to health care 2. Improve health outcomes 3. Improve quality of health care 4. Eliminate health disparities 5. Improve the public health care systems 6. Enhance the ability of the health care system to respond to public health emergencies 7. Achieve excellence in MANAGEMENT PRACTICES

______ of all smartphone users have downloaded a health app, and half of smartphone users seek health information from their mobile device

1/5

In the NBC news report, Postmortem exams suggest diagnostic errors contribute to ____ of patient deaths

10%

Approximately __________ deaths per year in the US result from preventable medical errors. This figure is about twice the number of people who die in car accidents and 5 times the number of murder victims annually, and 20 times the number of servicemen and women killed in Iraq and Afghanistan since the start of hostilities in 2001.

100,000

There are ____ standard plans, A-____, that vary in price and coverage for Medigap

12 L

Nation's official poverty rate in 2013 was ______ or 45.3 million people

14.5% This was down from 15% in 2012, which was the first decrease in poverty since 2006. For the third consecutive year the number of people in poverty at the national level was not statistically different from the previous year's estimate. The 2013 poverty rate was 2% higher than in 2007, the year before the most recent recession.

In the US, the gross of national product on health care is ____%. We are spending more than any other country

17.6%

In 2012, the US spent _____ percent of its gross domestic product on health care (compared to ____ percent in Switzerland). It is projected that the percentage will reach 20% by 2016

17.9% 11%

What is the importance of critical thinking:

1st: Our country faces increased global economic competition. If our higher education institutions are producing large numbers of students who are not developing 21st century skills such as thinking critically, reason complexly, and write effectively- our future economic competitiveness will potentially be undermined.

In Texas, ____ of the 254 counties account for ____ percent of the uninsured

35 80

Health care spending is approximately ___ times the amount spent on national defense

4

How many parts is medicare divided into?

4 parts. A-D (each cover different medical services and supplies)

Almost _____ of Hispanics living in Arkansas, Florida, Louisiana, Mississippi, Montana, Oklahoma, Oregon, and South Carolina also had no health insurance

40%

In Texas: _____ of hispanics under 65 have no insurance _____ of blacks have no insurance ______ of whites have no insurance

46.5% 24.3% 15.8%

States with the lowest percentages uninsured under 65 for 2013 (Ranking)

47. Minnesota (9.5%) 48. Vermont (8.9%) 49. Hawaii (7.1%) 50. Massachusetts (4.9%- Mitt Romney)

One in ____ Americans (almost ____ million) are enrolled in Medicaid

5 60

In the NBC news report, at least ____ of the US adults who seek outpatient care each year experience a diagnostic error.

5%

In the NBC news report, Medical records suggest diagnostic errors account for _____ of adverse events in hospitals

6-17%

For Medicare coverage: Americans over age ________

65

For Medicare coverage: Certain disabled Americans under age ________

65

California for example instituted enrollee co-pays ranging form $5 for an office visit to $200 for a hospitalization. Most Medicaid Enrollees are limited to ____ office visits per year.

7

To enroll in part D, you must be enrolled in Part ______ or Part _______

A or B

Pre-Retirees:

Age 45-64, working No dependent kids or under 45 with kids older than 18

Young independents:

Age: 18-29, Single Independent of parents, no kids

Activated patients fare better and ultimately cost less; therefore, policy-makers should consider encouraging health systems to find ways to _________ their patients

Activate

________ was the primary reason nearly 50 million Americans lacked health insurance before the Affordable care act and it clearly remains a top concern for people seeking coverage today.

Affordability

The __________ health care act or Obamacare's open enrollment period for 2016 health insurance coverage is when?

Affordable November 1st 2015- January 31st 2016

What failure carries a penalty for not having coverage?

Affordable health care act

Many consumer ratings of health plans are based on a survey called the Consumer Assessment of Health Plans (CAHPS) and on the Health Plan Employer Data and Information Set (HEDIS) member satisfaction survey, which includes CAHPS questions. What do both of these do?

Assure quality

The federal poverty level is updated _________

Annually

HEDIS Measures address a broad range of important health issues like:

Appropriate antibiotic use, Asthma, Breast, cervical and colorectal cancers, Care for older adults, Childhood and adolescent immunizations, cholesterol management, COPD, Diabetes, High BP, Hospital readmissions, Medication management, mental illness, prenatal and postpartum care, smoking, weight assessment, patient experience (CAHPS), and vaccinations for adults/older adults (CAHPS)

Health care coverage and personal health care expenditures in the US 2011..percentage *** He said this will be asked

Approximately 55% Private 45% Public

Under Traditional insurance (indemnity), you have more __________ when it comes to choosing doctors, hospitals and other health care providers. You can refer yourself to any specialist without getting permission, and the insurance company doesn't get to decide whether the visit was necessary.

Autonomy

________ Protection pays toward the costs of hospital room and care

Basic

Affordable Care Act also requires that _________ __________ be included as a free service, although churches and certain religiously affiliated employers, such as catholic universities and hospitals, may opt out. In those cases, insurers must provide the coverage directly to the workers at no extra cost.

Birth Control

__________ data address areas such as patient ease of obtaining information from a health plan; timeliness or service; speed and accuracy of claim processing.

CAHPS

Some widely used _______ ___________ measures are included in Health Plan Employer Data and Information Set (HEDIS)

Clinical Performance

Consumer Assessment of Healthcare Providers and Systems (CAHPS) Program is a public/private initiative to develop standardized surveys of patients experiences with ambulatory and facility-level care in ___________ and medicaid plans

Commercial

Young Independents cant be bothered with _____ policies and claims systems

Complicated

Early retirees carry over into their retired lives many of the same _______ as Pre-Retirees

Concerns

What are the 2 main types of quality measures that can help you choose quality health care. What are they both based on?

Consumer ratings & Clinical performance measures "outcome research"

Consumer ratings look at health care from the _______ point of view

Consumer's Ex: do doctors in the plan communicate well? Do members get the health services they need?

HIPAA protections apply only to ________ based and commercially issued group health insurance. No similar law exists for individuals seeking health insurance on their own.

Employer

The poor are suspected to be dangerous and _______

Different

Measurement is now in health care's ______

DNA

Both the poverty rate and the number in poverty ______ for Hispanics in 2013.

Decreased

HMOs place emphasis on early ______ and disease _______

Detection Prevention

How do you calculated federal poverty level?

Divide your income by the poverty guideline for your household size. Carry the decimal 2 places, add percent sign, and you have your answer. Ex: You are a single individual with an income of $20,000. the 2014 poverty guidline for a one person household is $11,670. $20,000/$11,670=1.71 Move decimal 2 times = 171%

If the ______ makes a referral out of the network for POS, the plan pays all or most of the bill. If you refer yourself to a provider outside the network and the service is covered by the plan, you ______ have to pay coinsurance

Doctor Will

Patients are more engaged when there is a good relationship between themselves and their _______

Doctors

Those who are younger, more _________ and have higher incomes tend to be more activated.

Educated

What are some common Communities of No insurance?

Elderly Unemployed Single Moms (white single moms) Chronic Health Problems (Cancer is high) Minority Group Geographical Challenged Group (Area with no doctors) The Uninsured!!

Under these circumstances, comprehensive major medical coverage is ____________ to early retirees, and it should cover preexisting conditions and provide decent prescription benefits.

Essential

EPO stands for....

Exclusive Provider Organizations

_______ ________ ________ are PPOs that look like HMOs. They raise the financial stakes for staying in the network. If you choose a provider outside the network, you're responsible for the entire cost of the visit

Exclusive Provider Organizations

Characteristics used to determine poverty thresholds include _____ _____, number of children whether or not those in 1 or 2 person units are _______. The same poverty thresholds apply to 50 states and the district of Columbia

Family Size Elderly

CAHPS results offer an indication of how well health care organizations meet member ___________

Expectations

HRSA has 6 bureaus and 12 offices, and provides leadership and _________ _________ to health care providers in every state and US territory.

Financial support

________ is a tool used by most HMO and PPO plans to measure performance on important dimensions of care and service

HEDIS

__________ Clinical performance measures look at how well a health care organization PREVENTS and TREATS illness

HEDIS

What are the 2 main ways poverty is measured in the US?

HHS issues poverty guidelines, which serve as an ADMINISTRATIVE function. Poverty thresholds are issued by the US census bureau for STATISTICAL purposes

Fee-for-service coverage offers ____________ in exchange for ________ out of pocket expenses, more paperwork, and higher premiums.

Flexibility Higher

Early Retirees want to lead active lives now that they are no longer working, so their health matters to them a great deal. Financial concerns can impinge on their ________. They no depend on a fixed retirement income and concerned about how to pay for increasing medical care needs.

Freedom

Preliminary poverty thresholds are released in January and final poverty thresholds are released in September the year after the year for which poverty is measured and is adjusted to the price level of the year for which poverty is measured, according to ______.

HHS

One startling finding is the fact that among those adults who said they did not enroll because they could not find an affordable plan and did not enroll through a different sources more than half (54%) had incomes that made them eligible for subsidies. It is unclear whether the subsidies are insufficient across income levels to help ll those eligible enroll or whether there is a lack of clear information about the subsidy assistance and the actual net costs of insurance to potential enrollees. What does subsidies mean?

Government helps to pay for it.

In a POS, you have _______ ________ to see out of network providers than with an HMO. But this freedom comes with a price, so every time you see an out of network provider, it costs ____. Your decision about choosing this type of plan may rest on whether this freedom is worth the extra premium price.

Greater Freedom Extra

What does HRSA stand for?

Health Resources and Services Administration

What is HSA

Health Savings Account

You must be covered by a ______ ______ ______ ______ (HDHP) to be able to take advantage of HSAs. HDHP generally costs ______ than what traditional health care coverage costs, so the money that you save on insurance can therefore be put into the health savings account

High Deductible Health Plan Less

Federal Employees Health Benefits Program is administered by the office of personnel management which is the ________ ________ department of the federal government.

Human resources

Understanding health Insurance Website 3. Which doctors and hospitals are in it?

If a doctor is not in your plan's network, the insurance company may not cover the bill, or may require you to pay a much higher share of the cost. So if you have doctors you want to continue to see, you will want them to be in the plan's network. Some state Health Insurance Marketplaces, including those operated through the federal HealthCare.gov site, have links to provider directories that you can see before you buy. But the directories are not standardized and may be hard to use or out of date. Moreover, to keep costs down, many of the plans sold through the state Health Insurance Marketplaces have smaller networks than you may be used to. That is why you should check and double-check with the health plan and your doctor's billing office to make sure your desired providers are in the network of the plan you are considering. If you are given a choice of insurance through a job, you can obtain provider lists from participating insurance companies, or from the company's employee benefits department. You can use our hospital Ratings (subscription required) to research the quality of the hospitals in your network.

Understanding health Insurance Website 1. What does the plan cover?

Insurance sold to people and small businesses must cover 10 "essential health benefits." Emergency services Hospitalization Laboratory tests Maternity and newborn care Mental health and substance-abuse treatment Outpatient care (doctors and other services you receive outside of a hospital) Pediatric services, including dental and vision care. Prescription drugs Preventive services (such as immunizations and mammograms) and management of chronic diseases such as diabetes Rehabilitation services

All managed care plans involve an arrangement between the ________ and a selected network of _______ ______ ______, and they offer policyholders significant financial incentives to use the providers in that network.

Insurer Health Care Provider

Number of uninsured has _______ from 1987 to 2012

Increased

_______________ plans are a bit like auto insurance: you pay a certain amount of your medical expenses up front, in the form of a deductible, and afterward the insurance company pays the majority of the bill. Also known as "_____-_____-_____".

Indemnity Fee-For-Service

For Medicare coverage: People with any age with permanent __________ failure

Kidney

He had dual areas of expertise in marketing and medicine. He is only one of many voices in US calling for healthcare reform.

Leonard Berry

For PPO, staying within the network means _______ money coming out of your pocket and less paperwork

Less

How engaged are consumers in their health care in the US? (According to level Percentages)

Level 1 (least activated)= 6.8% Level 2= 14.6% Level 3= 37.2% Level 4 (Most activated)= 41.4%

Eligibility for medicaid depends on where you _______. While the federal governments sets minimum eligibility levels and standards and provides more than half of the funding, each stat partially funds and runs its own program and can expand eligibility if it choses

Live

Groups that were uninsured said they _____ their jobs so they did not have insurence

Lost

Texas has the _____ Uninsured

MOST

__________ __________ (part C) takes over where your basic leaves off

Major Medical

________ ________ is supplemental insurance you might purchase to fill the holes that Part A and Part B do not cover

Medigap Plan

What are NCQA's programs and services that reflect a straightforward formula for improvement? ** He said he would ask

Measure Analyze Improve And repeat

Fortunately, health care quality CAN BE _______, and it can be improved

Measured

Being poor, or even very poor, does not necessarily qualify someone for _______. Since these plans are state run, they vary greatly from state to state.

Medicaid

The government's health insurance program for low-income people

Medicaid

If you're enrolled in Medicare, you might also be able to get __________. These seniors are known as "_______ _______"

Medicaid Dual Eligibles

The widespread tendency to rely on medicine for health solutions has been termed "_______________" which professor Paula Lantz at the George Washington School of Public Health has succinctly defined as the ______________ of health care for health.

Medicalization Mistaking

For Early Retirees, the nest egg needs to last longer and tide them over until _______ kicks in and even beyond that. Thus they are usually more risk averse than pre-retirees

Medicare

You cannot buy Medigap insurance if you are covered under a __________ __________ plan.

Medicare Advantage

Medicare Advantage for Part C of medicare (A lot of information...)

Medicare beneficiaries have the option of receiving medicare benefits through private health insurance plans, instead of the original medicare plan (A and B) These plans are called MEDICARE ADVANTAGE PLANS. Participants still pay their part B premium and possibly a premium to the medicare advantage plan. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original medicare program, but they do not have to cover every benefit in the same way. This flexibility allows medicare advantage plans to cover supplemental services like prescription drugs, dental care, vision care, and gym or heath club memberships. Other important distinctions between medicare advantage and traditional medicare are that medicare advantage health plans encourage preventive care and wellness and closely coordinate patient care. If considering a medicare advantage plan, remember that you can no longer purchase a medigap policy, so you should shop around to get a plan that covers your needs.

Does Health Insurance Portability and Accountability Act (HIPPA) protect all health information?

NO! These federal laws that set national standards for protecting the privacy and security of health information, but not all organizations have to follow these laws.

Up to 30 million 18-34 year olds with a pre-existing condition, can ______ be charged higher premiums or denied coverage under the Affordable Care act

NOT

What does NCQA stand for?

National Committee for QUALITY Assurance

Part B of medicare covers what?

OUTPATIENT (ambulatory) services including x-rays, vaccinations, and chemotherapy, durable medical equipment, such as canes, wheelchairs, and prosthetics HAS A MONTHLY FEE-AUTOMATICALLY COMES OUT OF SS CHECK

By providing ______, clinical performance data measures against a detailed set of measurement criteria, HEDIS helps purchasers and consumers compare health plans' performance

Objectives

_______ enrollment periods apply on some of the insurances

Open

What does PAM stand for?

Patient Activation Measure

Understanding health Insurance Website 2. How much does the plan cost?

Out-of-pocket expenses The terms "cost sharing" or "out-of-pocket costs" refer to the proportion of your medical bills you will be responsible for paying when you actually receive health care. Cost sharing does not include your monthly premium. -Deductible -Copay -Coinsurance -OUT-OF-POCKET LIMIT.

_______ research measures the end results of health care practices and treatments. For example, after treatment, is the pain gone? Can the patient carry out his or her daily activities? Is he/she satisfied with his or her care?

Outcome

Ted Talk: What What is the formula that will equal value in health care?

Outcomes that matter to the patients/ Cost per patient= Value When they are focused on quality, their cost will go DOWN.

Website to look at http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf411217

Pay attention that it says: 21%:Patients without the skills and confidence to manage their own health care incur costs up to 21 percent higher than patients who are highly engaged in their care 47%:Patients are stepping up to the plate. Nearly half (47 percent) of patients have brought a friend or a relative to a doctor's appointment so that they could help ask questions and understand what the doctor was saying. 3/5:Almost three in five patients have taken a list of their current medications to a doctor's appointment.

Quality reports go by DIFFERENT NAMES, including ___________ reports and ___________ cards

Perfromance Report

Understanding health Insurance Website 2. How much does the plan cost?

Premiums To make comparison easier, plans sold to individuals are grouped in standardized "metal tiers" with various combinations of premiums and cost sharing: Bronze plans cover 60 percent of the average member's total health care costs and thus have the lowest premiums but the highest out-of-pocket costs. Individual deductibles for Bronze plans in 2014 average $5,081, according to an analysis by HealthPocket, a private health insurance data-crunching firm. Silver plans cover 70 percent and have higher premiums and lower out-of-pocket costs than Bronze plans, with an average individual deductible of $2,907. Gold plans cover 80 percent and have higher premiums and lower out-of-pocket costs than Silver plans, with an average individual deductible of $1,277. Platinum plans will cover 90 percent and have the highest premiums and lowest out-of-pocket costs, with an average individual deductible of $347.

The __________ ___________ ____________ are regulated by the medicare program, but are designed and administered by private health insurance companies. These plans are not standardized and vary greatly in coverage of drugs, type of drugs covered, and level of coverage. You will generally have to pay a monthly premium and a yearly deductible. You will also pay a part of the cost of your prescription, including a copayment or coinsurance. Costs vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. However if you have limited income and resources and you qualify for extra help, you may not have to pay a premium or deductible

Prescription Drug Plans

Medicare has a ______ ______ Plan finder that will help you determine what plan is best for you

Prescription drug

Part D of medicare covers what?

Prescription drugs

__________ care services may not be covered under a PPO

Preventive

HMOs have the best reputation for covering _____ care services and health ___________ programs

Preventive Improvement

6 basic ways HMOs, PPOs, EPOs and POS plans are different 1. Whether or not you're required to have a ________ _______ physician. Also called a GATE KEEPER

Primary Care

Medigap insurance policies are standardized by the centers for medicare and medicaid services, but are sold and administered through __________ __________

Private Companies

6 basic ways HMOs, PPOs, EPOs and POS plans are different 2. Whether or not you're required to have a _______ to see a specialist or get other services. (HMO has to have one of these in your plan)

Referral

You and your spouse must buy _______ Medigap policies because your medigap policy wont cover any health care costs for him or her

Separate

Follow up Dr. visits are often _____!!

Skipped

For medicare coverage: Young people with cancer may receive medicare benefits after collecting _________ _________ benefits under the supplemental security income program for ____ years

Social Security 2

Bradley and Taylor have identified ________ _________ as the unnamed culprit behind high health care costs and poor outcomes.

Social Services

Many HMOs offer an indemnity type option known as POS. Primary care doctors in a POS plan usually make referrals to other providers in the plan. But in a POS plan, some members can refer themselves outside the plan and still get _______ coverage.

Some

With a PPO, you can refer yourself to a ____________ without getting approval and, AS LONG AS IT'S AN IN NETWORK PROVIDER, enjoy the same _________

Specialist Copay

There are usually explicit ________ for selecting providers and a formal procedure to assure quality care.

Standards

When creating a password: Create a _______ password Do ____ share your password

Strong NOT

CAHPS Report website https://www.ncqa.org/Portals/0/State%20of%20Health%20Care/2012/SOHC_Report_Web.pdf (The website on notes was not working, but this is the closest web address)

The Bottom Line Some readmissions can be prevented through improved quality of care, comprehensive discharge planning and care coordination among a patient's providers and caregivers.

What country spends the most on health care than other industrialized countries?

The US

The coverage of Medigap provided is roughly proportional to the premium paid, so more coverage will cost more True or False

True

The two main ways that people obtain health coverage are by paying into a group health insurance plan or buying individual health insurance. True or False

True

When young independents do look for health insurance, they want policies that fit their lifestyle and cover their typical concerns- Maintaining their good health and their typical concerns- maintaining their good health and their appearance. Price matters greatly to them, naturally, given their typically lower incomes, and so does flexibility: They are selective about policy features and are unlikely to purchase comprehensive. True or False

True

You do not have to have medicare coverage if you are still working past the age of 65. True or false

True

You have to apply for medicare once you turn 65 or you will become penalized. True or False

True

Department of Defense's health insurance for eligible beneficiaries in the uniformed services. Has a variety of options: HMOs, PPOs, and Fee For Service. It is a federal program as well

Tricare

2.2 million people who obtained coverage through the marketplace during the initial open enrollment period were young adults between the ages of 18-34 True or False

True

A common misconception is that the uninsured are concentrated in the counties along the Texas-Mexico Border True or False

True

Accredited health plans today face a rigorous set of more than 60 standards and must report on their performance in more than 40 areas in order to earn NCQS's seal of approval. These standards will promote the adoption of strategies that we believe will improve care, enhance service and reduce costs, such as paying providers based on performance, leveraging the web to give consumers more information, disease management and physician level measurement True or False

True

August Income in HSA is $69K/year True or False

True

Between 2010 and the first quarter of 2014, the rate of uninsured individuals between the ages of 19-25 fell by 13.2 percentage points. True or False

True

Despite the decline in the national poverty rate, the 2013 regional poverty rates were not statistically different from the 2012 rates True or false

True

Federal Employees Health Benefits program covers federal employees, families, retirees, and survivors. True or false

True

HRSA was created in 1982 when the Health Resources Administration and the Health Services Administration were merged. True or False

True

In 2012, health care spending in the US reached $2.8 trillion, and was projected to reach $4.2 trillion by 2016 True or False

True

In PPOs, there is an emphasis on prevention and health education, similar to that with an HMO, where members are encouraged to participate in programs which lead them to healthier choices and lifestyles True or false

True

Independents of medicine might be more willing to negotiate prices because they have more discretion over costs than do other types of store. Earlier studies by consumer reports suggest that prices at independent pharmacies may be much higher or much lower than those at chains or big box stores. True or False

True

Medicaid helps dual eligibles with medicare premium and cost sharing and covers important services that medicare limits or does not cover. True or False

True

NCQA has been a central figure in driving improvement throughout the health care system, helping to evaluate the issue of health care quality to the top of the national agenda True or false

True

NCQA makes this process possible in health care by developing quality standards and performance measures for a broad range of health care entities True or false

True

PAM is a valid, highly reliable, unidimensional scale that reflects a developmental model of activation. True or False

True

Research shows that Americans want and value quality health care. The problem is that the quality of health care services varies in our country, a lot! For example, some health plans and doctors simply do a better job than others of helping you stay healthy and getting you better if you are ill. True or false

True

Some of the lower income people can not afford the "affordable" health care act. True or False

True

The Affordable Health Care act which does not allow exclusion because of preexisting conditions. True or False.

True

The MAJORITY of people with private health insurance have some type of managed care. True or False

True

Early Retirees:

Under age 65 No longer working

Quality problems are reflected today in the wide variation in use of health care services, the ______ and ______ of some services, and ________ of others. Improving the quality of health care and reducing medical errors are priorities for the agency for healthcare research and quality

Underuse Overuse Misuse

**Common needs in health care?

Value Simplicity Trust

Although we would like to think that every health plan, doctor, hospital, and other provider gives higher quality care, this is not always so. Quality ________, for so many reasons

Varies

The decision by 20 states not to expand eligibility for medicaid is keeping people from gaining coverage. More than a quarter of adults who shopped for health insurance in the marketplaces and cited affordability as a reason for not enrolling likely fell into the medicaid coverage gap. For low income adults in these 20 states, the Inability to afford health insurance remains a reality. Is Texas one of these states?

YES

Is having no health insurance Economics related?

Yes! No Cash flow No health insurance (Fear and Anger)

Quality reports don't tell you which health care choices are the best. But they can help you decide which are best for _____, based on the things that are most important for you.

You

Understanding health Insurance Website 2. How much does the plan cost?

You pay for health insurance in two ways: The monthly premium that you pay to purchase your plan. The out-of-pocket expenses you pay when you receive medical care. Those are some combination of deductibles, coinsurance, and copays.

HSA makes most sense if you are _____ or middle aged and _____, and can comfortably _______ paying several thousand dollars out of your pocket for medical expenses. If you have no medical expenses in a given year or minimal ones, you will save money on premium costs and will essentially squirrel away tax deferred dollars for future use. But if the accounts require careful oversight of your medical bills and your account balances. THEY AREN'T WORTHWHILE IF YOU EXPECT MEDICAL EXPENSES CLOSE TO THE DEDUCTIBLE AMOUNT

Young Healthy Afford

There is a concern about not having ______ to health care if they do not have access to education

access

Quality Management (QM) definition

all encompassing philosophy that permeates an organization's management infrastructure, policies and practices.

Medicare Part D has helped lower out of pocket drug costs for many seniors. Still, 43% of readers recently surveyed paid $500 or more on medicine in the previous year, and 20% spent at least $1,000. We have a prescription for people who pay out of pocket: Shop ________

around

You may be able to find consumer ratings, clinical performance measures, or _____ in quality reports

both

For Traditional insurance, a certain amount of money each year, known as the ________ is paid by you before the insurance payments begin

deductible

The Affordable Care Act requires insurance companies to provide _______ _____________ care services such as flu shots, wellness visits, blood pressure and cholesterol tests.

free preventative

Another issue is the possibility of discrimination based on __________ information

genetic

Look at charts on this website

http://hschange.com/CONTENT/1019/

Those with chronic conditions are _______ activated

less

Medicare Health Outcome Survey (HOS) measures evaluate the physical and _________ health of seniors enrolled in medicare

mental

No earn accreditation, organizations must meet _______ _______, often including clinical measures

national standards

Employers or insurance companies __________ a LOWER fee for service with hospitals and health care providers in a specific geographic region for PPOs

negotiate

HIPAA states that genetic information in absence of a current diagnosis may not be considered a ________ condition

preexisting

The one area in which independent drugstores didn't do as well as chains was ___-____-_____ costs for prescription drugs. Our survey revealed that customers at independents paid a median of about $50 more each year than supermarket and drugstore chain shoppers and almost $100 more than people who buy at big box stores

out of pocket

HOS measures are the first _______ measures for elderly populations that are based on patients' self reported health status

quality

Including HOS as part of HEDIS measurement creates a broad way to evaluate the ________ of care that health plans provide to medicare beneficiaries.

quality

Currently the Health insurance Portability and Accountability Act (HIPAA), enacted in 1996, provides federal protection against GENETIC discrimination in health insurance true or false

true