Less expensive coverage comes with more risks “The administration’s rule change is dangerous for Georgia consumers,’’ said Laura Colbert of Georgians for a Healthy Future
Blog (October 2014)
Georgians for a Healthy Future and the Georgia Council on Substance Abuse are teaming up to launch a new public health advocacy campaign — Somebody finally asked me! — to prevent addiction and its harmful effects among Georgia’s youth…
More than 300,000 Georgians have enrolled in health insurance since last October, when new coverage opportunities became available through the Health Insurance Marketplace. These big coverage gains present an opportunity to raise awareness about the importance of prevention, both among consumers and policymakers. We are already seeing the lifesaving impact that services like cancer screening, blood pressure checks, and mammograms are having. One screening tool not broadly talked about is Screening, Brief Intervention, and Referral to Treatment (SBIRT).
SBIRT is a cost-effective, evidence based way to identify individuals who are at risk of developing a substance use disorder and can often prevent the development of addiction or refer those in need to treatment. Studies have shown every $1 invested in SBIRT yields $4 in savings. This important set of preventive tools should be available to all Georgians, particularly to our state’s youth.
This important set of preventive tools should be available to all Georgians, particularly to our state’s youth. The rise in heroin use among Georgia adolescents has gained widespread attention in recent months, but the problems goes beyond just heroin. By the time a student reaches ninth grade, 1 in 5 will display signs of alcohol use, a rate which rises to 2 in 5 by the twelfth grade. Approximately 20 percent of twelfth-graders are also engaging in drug use. We know that drug and alcohol use that starts in adolescence all too often becomes a lifelong habit some people even find themselves to purchase Melatonan 2. In fact, 90% of adults with a substance use disorder began using alcohol and/or drugs before the age of 18 and half under the age of 15. With an increased awareness and use of SBIRT, we can work together to prevent drug and substance use disorders among Georgia’s youth and help them lead healthier and more productive lives by doing a drug intervention and informing them about the non 12 step rehab and how they could end up if they don’t stop on time. To raise awareness about substance use disorders among Georgia’s youth as a public health challenge that can be addressed through prevention, Georgians for a Healthy Future and the Georgia Council on Substance Abuse (GCSA) have teamed up to raise awareness of and advocate for widespread use of SBIRT.
To do this, we have created palm cards and book marks to aid those who regularly interact with youth to become better acquainted with SBIRT.
If you are interested in these or other SBIRT materials from our campaign, please contact Laura Colbert, at email@example.com
This education and advocacy campaign is in partnership with Community Catalyst and supported by a grant from the Conrad N. Hilton Foundation, alongside similar initiatives in Wisconsin, Ohio, New Jersey, and Massachusetts.
Georgians for a Healthy Future partnered with Seedco at a briefing in Atlanta on October 16 to present and discuss findings from a comprehensive evaluation of the impact of health insurance navigators on consumer experiences during the first open enrollment period. The evaluation was conducted by a team of researchers at the University of Georgia, and its key findings include:
-Navigators succeeded in assisting consumers from diverse communities and in reaching those in need of affordable health services
-Rates of achieving enrollment or application success with navigators differed by region, by demographics, and by consumer financial status
-Navigator interpersonal communications, and especially follow-up, was the biggest factor in consumer satisfaction
As we gear up for the next open enrollment period, which begins on November 15, 2014, the findings from this report can inform the work of enrollment assistance personnel and community-based organizations in Georgia and across the country. Selected recommendations from the report include:
-Continue partnering with community agencies that serve diverse populations
-Publicize the navigator role and concrete ways to access free in-person assistance
-Follow up with consumers after they receive in-person assistance
Georgians for a Healthy Future is excited to welcome Nykita Howell, our new Health Insurance Navigator, who joined us this week! In this role, Nykita provides Marketplace enrollment assistance to Georgia health care consumers. Prior to joining Georgians for a Healthy Future, Nykita worked in the fields of clinical and community based research and as a navigator for the first open enrollment period of the Health Insurance Marketplace. Her research efforts have been on studies focused on retention strategies for an NIH-funded cohort based at Umass Medical School, and a church-based diabetes project housed at Mercer University. Her work as a navigator prior to joining Georgians for a Healthy Future included building community partnerships and educating consumers over a seven county area. She holds an MPH from Mercer University School of Medicine and is a Certified Health Education Specialist. Prior to her graduate studies, Nykita received her B.S. in Biology from Clark Atlanta University, in Atlanta, GA. If you or anyone you know needs assistance navigating the health care system, please contact Nykita at firstname.lastname@example.org or 404-567-5016. Remember, open enrollment begins Nov. 15th—just one month away!
When consumers enroll in a health insurance plan, they gain access to a network of medical providers. Insurance companies contract with a range of providers, including both primary care and specialty physicians, to deliver health care services included within the plan’s benefit package. This network of providers must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. This is what is meant by network adequacy. More specifically, to be considered adequate, a network must provide adequate numbers, types, and geographic distribution of providers; must ensure that access to care is timely; and must include essential community providers that serve predominantly low-income, medically underserved individuals. Additionally, accurate information about providers must be made available to consumers.
Network adequacy has become a hot topic over the past several months because many consumers who enrolled in new health plans through the Health Insurance Marketplace found that their plan came with a narrow network of providers. Provider directories weren’t always accurate or up-to-date, and consumers expressed a fair amount of confusion over which providers were in their plan’s network.
At the same time, the National Association of Insurance Commissioners (NAIC), which develops model laws and rules that states often adopt, has been working to update its network adequacy model law. Stakeholders ranging from insurers to medical providers to patient and consumer advocates are weighing in on this process, making network adequacy a hot topic in the policy arena too. Georgians for a Healthy Future has been monitoring this process through the participation of our executive director as one of the consumer representatives to the NAIC. Earlier this summer, the consumer representatives submitted comments to the NAIC focusing on developing a stronger standard and better oversight of network adequacy, an end to “balance billing” by out-of-network providers in in-network facilities, and greater transparency of provider networks.
Georgians for a Healthy Future will continue to monitor this process and will advocate at all levels, in conjunction with state and national partners, to ensure consumers have meaningful access to care.
If you are an individual consumer enrolled in a commercial health plan and the provider directory you were given was incorrect or if you have concerns about your ability to access covered services under your plan, please contact the Georgia Office of Insurance & Fire Safety, Consumer Services Division by calling (800) 656-2298 or use the Consumer Complaint Portal at www.oci.ga.gov/ConsumerService. Please also consider sharing your story with Georgians for a Healthy Future so we can get a better picture of what is happening in our state.
For more information on network adequacy, please see the following reports and resources:
From Georgetown Center on Health Insurance Reforms: Reforming State Regulation of Provider Networks: Efforts at the NAIC to Re-Draft a Model State Law
From Robert Wood Johnson Foundation and Georgetown University Health Policy Institute: ACA Implications for State Network Adequacy Standards