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Nov. 1st Convening drew diverse health leaders

 

From left to right: Barbara Webber, Joe Martinez, Danielle Boudreau, Melanie Herrera Bortz, Kate Doehring & Erik Lujan at Health Action NM's Central NM Regional Convening, 11/1/2013.
 

On November 1st we held our first-ever regional convening on health care Outreach & Enrollment. It was a great success! With over 80 health leaders from a diverse set of backgrounds, we had a wide range of representation from various players in the enrollment field.

One of the most exciting outcomes from the convening was participants' interest in continuing the dialogue. There are so many groups doing great work surrounding outreach and enrollment in our state, it is time that we join together to work towards the same goal: enrolling New Mexicans in health coverage.

Health Action NM two more convenings during open enrollment - one for southern NM in December 2013, and one for northern NM in January 2014. Stay tuned for details!

Health Action

Once Is Chance, Twice is Coincidence, Third Time Is a Trend

This post was originally posted on the Health Policy Hub Blog.

- - -

Rowena Ventura, director of We Are the Uninsured in Cleveland, knows firsthand the horrific effects that the lack of affordable dental care can have. She tells of how a woman she knew died on the streets after losing her job because she was unable to see a dentist and of how her own son, a roofer, wound up pulling his own tooth and losing three more after he got an infection.

Every day, millions of Americans, like those in Rowena’s life, suffer and struggle because they can’t get dental care. In 2010, 181 million children and adults went without any dental care at all.

With glaring gaps in the delivery system preventing people from getting affordable care in their community, policymakers, researchers and the media are increasingly focusing on the use of dental therapists – an evidence-based solution that can address this crisis, one that expands the ability of the dental team to treat underserved populations. In the last few weeks, we have seen a trend of independent research and support from policymakers and dentists emerge.

First, Senators Max Baucus and Charles Grassley issued a Joint Staff Report in which they note that access to dental services is a concern and empowering mid-level providers is a common-sense solution.

Dr. Richard Katz, a California dentist and business owner, raised mid-level dental providers again, in an op-ed published Aug. 6 in the Huffington Post, where he asserted that mid-levels known as dental therapists “can improve the lack of access to many Americans, as one in seven live in an area where there is very little availability. These mid-level practitioners would be able to serve more people at a lower cost.”

And, on Aug. 9, the Washington Post’s Wonkblog carried a piece by Harold Pollack that shed light on the severe problems in our dental delivery and financing system. Some 85 million Americans lack dental insurance; Pollack notes that while raising Medicaid rates for dental services is important, money alone won’t solve this problem. One important way to bring dental care to Medicaid patients, he says, is to “expand services provided by mid-level providers known as dental therapists.” Which, as a recent report released by Community Catalyst demonstrates, is exactly what dental therapists in Minnesota and Alaska are doing: increasing the capacity of safety-net providers to treat underserved populations in their communities.

Taken together, these articles and studies bring to mind the old saying, “Once is chance, twice is coincidence, third time is a trend.” Dental therapists are catching on.

Someday, the practice of dental therapists in the United States will be the norm – in much the same way that the practice of medical mid-levels such as nurse and physician practitioners is the norm today. Demographic realities and market changes will continue drive this trend. The tipping point for dental therapists will happen sooner rather than later because from a cost and access perspective, we simply can’t afford to wait.

Stay tuned for part II of this post, which will detail how dental costs are driving this issue.

- David Jordan, Dental Access Project Director, Community Catalyst

Word of Mouth

Lemons to Lemonade: NM declared dental provider shortage is a job creation opportunity

I see facts and statistics all the time that put New Mexico at the bottom of the national list in health, education and other socioeconomic indicators. There is plenty of work to be done in our state on high school dropout rates, teenage pregnancy, children in poverty, and other areas of socioeconomic wellbeing. Oral health is no different.

The number of dental providers in New Mexico is not enough to meet current demand for dental services let alone the additional demand brought about through newly insured New Mexicans under Medicaid Expansion and the Affordable Care Act (ACA), according to a May 2013 report to the state Legislative Finance Committee.

This is not news for many of us working to bring access to dental services to all New Mexicans.  And it’s certainly not news for over 1.31 million New Mexicans, 63% of our population, who according to the report, don’t have access to a dental provider because they live in dental provider shortage areas or underserved areas of our state. 

New Mexico has a choice:

  1. We can either be depressed by the shortage of dental providers and stand frozen in a state of worsening status quo, OR
  2. We can embrace an innovative, evidence-based solution that creates jobs in NM for NM.

The Solution:  Add mid-level dental providers called “Dental Therapists” to NM’s dental team. 

In fact, one of the key findings of the report was the NM Legislature should “revisit the concept of dental therapists as an additional way to provide care to underserved areas under the supervision of dentists…" 

Dental therapists come from underserved communities and return to serve their home communities.  Dental therapists mean: 

  • Careers and livable wage jobs for all NM communities. 
  • Serving the oral health needs of their home community.
  • Keeping money in the community rather community members taking their dollars to other towns and cities.
  • Increased worker and student productivity, fewer school and work days missed because the dental therapist is in town.
  • Job opportunities at NM educational institutions with dental therapy education programs.

This makes sense for our communities. People want dental care; and they want jobs for the next generation. Schools are on board, also: at least four NM education institutions are interested in having dental therapy education programs.  (Southwestern Indian Polytechnic Institute, Northern NM College, Eastern NM University – Roswell, and Dona Ana Community College).  They see dental therapists as a viable solution both to serve their community’s oral health needs and to create new work opportunities. We can turn what is currently a sour situation into better care and increased opportunities for New Mexico communities. 

- Pamela

Word of Mouth

Notes from the field: CMS Call discussing NM Behavioral Health

Some highlights from the Aug. 28, 2013 CMS listening call to hear from behavioral health consumers on the disruption of service due to HSD process of Medicaid funding freeze and bringing in AZ takeover companies.

  • 27 callers were heard.
  • Callers were told not to discuss the “fraud” issue.
  • Many consumers noted that the timing and method of the call was not accessible to most consumers of behavioral health services (working parents, non-English speakers, children, homeless persons, persons in jail or in the juvenile justice system.  Others complained about the lack of outreach to let people know about the call other than email or facebook postings.
  • Callers noted that a quarter of the time for consumers to give their input was taken by HSD defending their actions or countering with their actions to resolve issues.
  • Stories from across the state painted some of the vivid picture of the disruption of services that has taken place, including not being able to get appointments and medications. Many parents reporting disruptions of service for their children.  Lack of contracts by new AZ provider agencies with psychologists who can prescribe medications.
  • Many consumers noted that consumers and their communities were “scared”, “frightened and threatened" by the type of actions taken by HSD. Some described the HSD action as a dangerous future precedent.
  • Consumers complained they received no notification or explanation of changes either from HSD or the new providers. Had to learn about it word of mouth or in the media.
  • One therapist whose takeover situation is down from 12 to 3 therapists for several thousand clients says they now have to do new intake forms which take up to 2 hours.  This results in long waits until this process is completed.
  • Various callers discussed behavioral health professionals either leaving rural areas or the state because of the HSD takeover process.  Two referred to the “ripple effect” across NM and its communities.
  • Callers from Native American communities noted that their communities would be hardest hit both by the disruption of service and the decrease in providers in NM.
  • Various callers called for HSD to “change direction,” restore previous provider agencies, etc.
  • Several callers outlined impact on frontier communities where services are already precarious.
  • Several callers discussed the lack of contracts with BMS workers so children who needed these services couldn’t be in school.
  • An attorney noted that assessments for infants in state care were not happening in her affected area so parents couldn’t start the process to get their children back - with a disastrous effect on family.
  • Callers talked about disruption leading to potential hospitalization and reliance on ER services that didn’t resolve issue. One caller talked of dual diagnosis person who is in a nursing home because of lack of services – this is not an appropriate place for care.
  • A psychologist from one of the pueblos discussed cultural competency and that NM was very different from AZ in cultures and poverty despite the AZ takeover entities’ claims to the contrary. Gave clear examples from tribal and Hispanic traditional societies where it takes extended time of years in these communities to gain real insight into the cultural issues.  Said that bringing in AZ agencies was in fact saying culture doesn’t matter. 
  • One caller called on HSD to put boots on the ground in the affected communities and hold community forums.  When HSD said they would do so with 6 months, the caller deemed that was not acceptable.
  • One caller: “Government has failed consumers and I don’t know how you can sleep at night.”

  

If people have crisis situations, they should call:  855-662-7474

If people have care coordination issues, they should call 866-660-7185

 

Also, active Facebook groups for this issue can be found here:

1) New Mexico Rising Up - https://www.facebook.com/nmrising 

2) Save Behavioral Health https://www.facebook.com/SaveBehavioralHealthNM

 

- Notes by Barbara

Health Action

Mission of Mercy: A Well-Meaning Public Relations Event, Not a Solution to NM Dental Health Crisis

 

MOM 2012 Line-up
Albuquerque, 2010: Mission Of Mercy line outside of patients waiting to be seen (Source: Only in New Mexico blog)
 

“Are you in pain?” I asked a young man who was waiting in line to see a dentist at the New Mexico Mission of Mercy (MOM) weekend dental clinic in 2010. 

“Only when I eat,” he answered.

The patient intake form I was filling out for him gave me only two ways to answer the question “Are you in pain?”: “yes” or “no.”  I wasn’t sure which answer to choose. Did the question mean “Are you in pain right now as you are standing here?” or was it the more general “Do you have pain?”  This man clearly needed to eat to live, so even if he is only in pain when he eats, he is in pain in a way that impacts his life in a big way. Right? I marked “yes.” 

As I found in my few hours volunteering at the patient intake station, this man wasn’t the only person who was in pain only when he or she ate. He stood in line with over 2,000 other New Mexicans for the chance to see a dentist, to try to have at least one of their dental problems resolved.  Hundreds camped outside overnight and traveled hundreds of miles for this chance.  Others may not have traveled so far in miles, but because they are Medicaid patients, don’t have insurance coverage, or can’t afford dental services the distance to see a dentist is just as great. 

MOM 2012
Albuquerque, 2010: Mission Of Mercy clinic inside (Source: Only in New Mexico blog)
 

The MOM is good for generating positive public relations, awareness, and good feelings every year and a half.  But just as the “Are you in pain” question failed to accurately represent this man’s dental condition and the day-to-day realities his pain, the MOM fails to understand the nature of NM’s dental health and access crisis. More importantly, the MOM fails to provide a meaningful long-term solution.   

The MOM is a well-orchestrated event, and the people in line do get to see a dentist. But because it is only a weekend clinic, most people are limited to getting only one of the many dental services they actually need.  Then what happens if these individuals need follow-up care after the weekend is over?  There is nowhere – or in some cases very few places – that these patients can go. They are already so outside the healthcare system, there is no avenue of access to dental services beyond these MOM events. Reportedly, for weeks after the MOM event, safety net clinics like Community Dental Services in Albuquerque received a flood of follow-up calls from MOM patients. They received calls from more patients than they could possibly see. 

Clearly there is a demand for dental services and a shortage of dentists who can provide these services.  Rather than investing in MOM clinics we should invest in a long-term workforce solution that can help meet our dental health and access crisis; adding mid-level dental providers called “dental therapists” to NM’s dental team will strengthen the workforce and increase access for consumers. 

Dental therapists practice in rural, tribal and underserved communities, under the off-site supervision of dentists providing routine and preventative dental services to the community.  With a dental therapist people won’t have to camp out to see a MOM dentist every year and a half, and they won’t have to travel long distances missing school or work.  Most importantly, with the guidance of their dental therapist New Mexicans would be able to prevent the dental decay that leads to extractions, and other serious dental health and overall health problems.

NM has had 3 MOM’s.  The next MOM is in September 2013 in Farmington.  How much longer and how many more MOM’s will New Mexicans have to stand in line for?  Let’s work to make the need for Mission of Mercy events obsolete by bringing the long-term workforce solution of dental therapists to NM.  

- Pamela

Word of Mouth

You are not invincible! (Sorry.... but true.)

Young Invincibles Video Contest, by USGOVHHS
 

This fall, many young Americans will have more health insurance options available to them than ever before as the Affordable Care Act (ACA) begins allowing individuals to enroll in new subsidized health insurance plans. Young Invincibles and the U.S. Department of Health & Human Services have created a competition that will tap into the creativity and energy of young Americans while raising awareness about the new law and encouraging young people to take advantage of the benefits of health insurance.

With a prize pool worth up to $30,000, and over 100 prizes to be won, this is your opportunity to shine! Cash prizes will be awarded to the creators of the best videos in three distinct categories; so whether you’ve got a talent for short films, writing a great song, or designing an entertaining video infographic, you can be a winner! Click the links above to learn more about each of the categories and how you can participate.

Videos can be submitted during the five-week period starting on Monday, August 19th. A public voting period will follow to help determine the Finalists in each category, and a final round of voting and judging will determine who takes home the Grand Prize. The Young Invincibles website has all the juicy details.

Health Action

Let us not abandon our own

 

La Llorona
La Llorona, source here
 

With increasing amazement and sorrow, I’ve watched unfold the behavioral health saga in New Mexico with the Arizona takeover of 15 long standing New Mexico provider non-profits. Last week, I sat in a meeting where some of the targeted providers provided a very different story than has surfaced in public coverage of these events. Affected consumers also shared their stories.

I came away with the sense that we have only seen the tip of the iceberg the impact this misadventure has and will have for many decades on communities and people’s lives across New Mexico. One person described it as the tsunami that will touch every corner of New Mexico. 

Even if we reversed everything tomorrow, our fragile support system for vulnerable children and adults touched by mental health issues, their families, their schools, workplaces, etc. can never be the same.  Skilled providers in our rural communities have already begun leaving the state.  Providers seeking certification in the new health plans and MCO’s are withdrawing their applications saying they don’t want to work in such a climate of uncertainty and lack of loyalty to patients and employees. Charges of intentional criminality have shattered both providers and clients.   

Those of us who know New Mexico’s deeply rooted communities whose fabric goes back centuries and, in the case of tribal communities, millennia, wonder how it was conceivable to bring in entities from another state.  Others ask where was the state and their oversight vendor in providing training and management guidance. Still others ask what agendas are at play.

But what stills the heart are the stories, the people’s stories – the grandmother of an eight-year old who has lost her BMS worker just before school starts and as her behavior escalates, puts her fist through a wall; the anguished mother who watches the increasing anxiety and regression of her 23 year old son with schizophrenia as his provider non-profit changes are happening… the stories go on.

New Mexico must act quickly to create opportunities for state and federal decision makers to hear from those affected by this surging crisis and investigate the process that brought us this crisis and learn from it.  Brakes need to be placed on a process that has ignored due process, respect and client safety.   

The basic therapeutic relationship as well as public stewardship is one of trust.  Trust has been broken at many levels and action needs to be taken immediately. Because if not, we are all doomed in New Mexico to collectively become La Llorona: condemned to wander New Mexico forever asking, donde estan mis hijos, where is the mother with postpartum depression, the father on the road to recovery, the young teens without hope, the veterans who could not forget? Where are those we are pledged to protect?  Like La Llorona, we have abandoned our own for the promises and resources of outsiders.  New Mexico, New Mexico, can we change our looming fate of becoming La Llorona?

 

- Barbara Webber, HANM Executive Director

Health Action

Communications 101: Make it Make Sense

There are as many explanations of the Affordable Care Act these days as there are types of eggs in a natural foods store. While I am thrilled to see so many people working to spread the word, often the information varies depending on who is producing the content. And sometimes not all information out there is very user-friendly.

There is one simple solution that I think would immediately make most ACA content easier to read: replace the word "Exchange" with the word "Marketplace."

The reason is this.

What comes to mind when you hear the term “Exchange”? I think of stock markets or trading beads in the Trobriand Islands. Unfortunately, neither of these are close to what the new health insurance option will look like. So it's understandable when people are confused after hearing about the new "Exchange" that is starting in October.

Now try the word “Marketplace.” What images does this word bring to mind? Are farmer's markets, grocery stores, or craft fairs high on your list? NOW you're getting closer to what the new health insurance Exchange - ahem, Marketplace - will be like.

So read on to this infographic, but keep in mind that what we're actually talking about is a consumer-friendly, easy-to-use marketplace where you can shop for health insurance. 

Health Action

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