Counties at Risk of Having No Insurer on the Marketplace (Exchange) in 2018

This map shows the counties at risk of having no insurer on the marketplace (exchange), created by the Affordable Care Act, in 2018, based on a Kaiser Family Foundation analysis of insurer rate filings and news reports

Source: Counties at Risk of Having No Insurer on the Marketplace (Exchange) in 2018 | The Henry J. Kaiser Family Foundation

Our historical analysis of insurer participation on the marketplaces from 2014-2017 can be found here.

These data are preliminary and subject to change as more information becomes public. Insurer participation in 2018 will not be finalized until the fall of 2017. It is possible that another insurer will expand into the counties that currently appear bare, and it is also possible that insurers will exit from other counties not shown on this map.

If a county has no exchange insurer, consumers would not be able to purchase marketplace plans with federal subsidies, including advanced premium tax credits (APTCs) and cost-sharing reductions (CSR). Tax credits make coverage more affordable throughout the year by lowering consumers’ monthly premium costs; cost-sharing reductions help lower out-of-pocket costs. In 2017, 8.7 million people (84% of all marketplace enrollees) received tax credits to cover a share of their premium and 5.9 million people (57% of all marketplace enrollees) received cost-sharing reductions.

This map only shows participation by on-exchange insurers. It is possible that some people in counties with no exchange insurers in 2018 will be able to purchase individual plans off-exchange, though this coverage would not qualify for financial assistance. If no exchange insurer participates in their county, people that rely on these subsidies may be unable to afford insurance off-exchange.

Pain and pain assessment in people with ID

Pain and pain assessment in people with intellectual disability: Issues and challenges in practice

Source: Pain and pain assessment in people with intellectual disability: Issues and challenges in practice – Doody – 2017 – British Journal of Learning Disabilities – Wiley Online Library

Accessible summary

  • Pain is difficult to identify when people cannot communicate.
  • If pain is not identified, it cannot be managed and causes stress.
  • Pain assessment is essential in order to identify pain.
  • Pain assessment requires a combination of knowledge, health assessments and observations.

Abstract

Background

Individuals with intellectual disability experience the same chronic diseases and conditions as the general population, but are more likely to have physical and psychological co-morbidities, resulting in a higher risk of experiencing pain and having more frequent or severe pain.

Method

This position paper aims to highlight the importance of pain assessment for people with intellectual disability.

Results

As people with intellectual disability live within the community and/or remain in the family home, they are accessing a wide range of healthcare services. This necessitates that nurses across all care settings are knowledgeable regarding appropriate/alternative pain assessment methods for people with intellectual disability. While many pain assessment tools are available for use with the intellectual disability population, they are often not well established or infrequently used to establish their validity.

Conclusion

Although self-report is the gold standard in pain assessment, pain assessment for people with intellectual disability is often challenging as they may be unable to self-report their pain due to their levels of communication or cognitive ability. Assessment requires a combination of approaches amalgamating: pain assessment, health assessment and observation of behaviours.

Waiting for health equity: A graphic novel

About the Project

Today, we can accurately predict a Coloradan’s health outcomes and access to health care based on factors like their race, income, or ZIP code. This is unacceptable, because it means that people of color, Coloradans with less economic opportunity, those living in communities with fewer resources, and others, face increased barriers to good health simply due to their life circumstances. How did this happen?

Colorado—just like the rest of the US—has a long, well-documented history of oppressive policies and practices that have led to significant, persistent, and preventable health disparities, or differences in health outcomes across certain groups. In order to tackle these injustices, we must understand their root causes, such as institutional racism (the policies and practices within institutions that, intentionally or not, produce outcomes that negatively impact people of color) and poverty. Waiting for Health Equity is a graphic novel that aims to start new conversations about the complex challenges Colorado faces in working toward health equity.

Use these supplementary materials to structure your conversations:


For more information or to request a printed copy, please contact our Director of Communications, Sarah McAfee.

The Role of Families As Caregivers & Guides for Whole Health & Wellness

Health care providers often focus on serving either children or adults. While this focus may mean more tailored approaches to care for the individual patient, it may be a missed opportunity to address the role of family on health outcomes.

Source: Multi-Generational Approach to Care Overview 

Taking a multi-generational approach involves changing the focus of how the patient is viewed within the system. Health care providers may be serving a child, but must work with the family to address any issues. Often, caregivers or parents see their child’s pediatrician more than they see their own primary care provider. Therefore, they may feel more comfortable bringing up their own health concerns or accessing community supports in this setting.

Caring for the whole family requires a system of care coordination that can support an array of services, involving a variety of health care professionals. Integrated primary care and behavioral health settings help facilitate this approach to care and leverage the community resources needed to support the whole family.

 

Plan Your Lifespan

Source: http://www.planyourlifespan.org

People are living longer. Are you prepared to turn 80, 90, or 100?

This website will help you plan for health events such as hospitalizations, falls, and memory loss that may happen as people get older. This planning differs from end of life care and wills.

Do you know…

  • What your rehabilitation options are after a hospitalization?
  • How to connect with local services and resources such as in-home care, Villages, and skilled nursing facilities?
  • What steps you can take to help prevent falls?

Plan Your Lifespan will help you learn valuable information and provide you with an easy-to-use tool that you can fill in with your plans, make updates as needed, and easily share it with family and friends.

The Impact of Health Reform Repeal on Employment

Use this interactive map to see the state-by-state impact of repeal of federal health reform on jobs.

Source: The Impact of Health Reform Repeal on Employment – The Commonwealth Fund

Contrary to a common misconception that health reform law has been a “job killer,” this study shows that repeal of these policies may cause major job losses and economic dislocation in every state -even in states that have not expanded their Medicaid programs.

While health reform repeal would dramatically increase the number of uninsured and harm access to health care, particularly for low- and moderate-income Americans, this analysis demonstrates that the consequences could be broader and extend well beyond the health care system. Repeal could trigger major reductions in employment and substantial losses in state economic activity and state and local revenues.

While health reform repeal would dramatically increase the number of uninsured and harm access to health care, particularly for low- and moderate-income Americans, this analysis demonstrates that the consequences could be broader and extend well beyond the health care system. Repeal could trigger major reductions in employment and substantial losses in state economic activity and state and local revenues.

Hover over states to see the impact of repeal of premium tax credits and Medicaid expansion on jobs.

Or click to download a state profile available under the map.

Impact of Health Reform Repeal-US Map
Impact of Health Reform Repeal-US Map

Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015 | MMWR

Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015

Source: Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015 | MMWR

Abstract

Background: Although the overall life expectancy at birth has increased for both blacks and whites and the gap between these populations has narrowed, disparities in life expectancy and the leading causes of death for blacks compared with whites in the United States remain substantial. Understanding how factors that influence these disparities vary across the life span might enhance the targeting of appropriate interventions.

Methods: Trends during 1999–2015 in mortality rates for the leading causes of death were examined by black and white race and age group. Multiple 2014 and 2015 national data sources were analyzed to compare blacks with whites in selected age groups by sociodemographic characteristics, self-reported health behaviors, health-related quality of life indicators, use of health services, and chronic conditions.

Results: During 1999–2015, age-adjusted death rates decreased significantly in both populations, with rates declining more sharply among blacks for most leading causes of death. Thus, the disparity gap in all-cause mortality rates narrowed from 33% in 1999 to 16% in 2015. However, during 2015, blacks still had higher death rates than whites for all-cause mortality in all groups aged <65 years. Compared with whites, blacks in age groups <65 years had higher levels of some self-reported risk factors and chronic diseases and mortality from cardiovascular diseases and cancer, diseases that are most common among persons aged ≥65 years.

Conclusions and Implications for Public Health Practice: To continue to reduce the gap in health disparities, these findings suggest an ongoing need for universal and targeted interventions that address the leading causes of deaths among blacks (especially cardiovascular disease and cancer and their risk factors) across the life span and create equal opportunities for health.

Lessons from High Performing Hospitals: Achieving Patient and Family-Centered Care

Source: Lessons from High Performing Hospitals

Lessons from High Performing Hospitals: Achieving Patient and Family-Centered Care

Patient-Centered Care In A Nutshell

  • Providers partner with patients to anticipate and satisfy the full range of patient needs and preferences
  • Hospitals support staff in achieving their professional aspirations and personal goals

A Consistent Finding: It’s All About Culture

  • High performing sites credited their HCAHPS success not to specific practices, but to a well-established culture of patient-centered care
  • High performing sites had implemented a comprehensive approach to patient engagement, family involvement and staff engagement
  • Improvement Guide reflects this key finding, providing guidance for implementing practices within a broader framework of organizational culture change

“Bite Sized” Exercises and Discussion Prompts to Reinforce Culture

Source: Planetree.org

“Bite Sized” Exercises and Discussion Prompts to Reinforce Culture

Below is a collection of discussion prompts and exercises designed to engage the hearts and minds of all members of the team in the practice patient-centered transformation effort. These exercises are designed to be concise enough to be incorporated into brief huddles or team meetings. Specifically, these exercises are designed to:

  • Help all members of the team reconnect to the joy of practice
  • Re-sensitize them to the patient experience.
  • Learn specific techniques for connecting with patients, remaining present and delivering care with compassion – even when it is most difficult to do so.
  • It is recommended that exercises like these be regularly incorporated into operations as a means of nurturing an understanding of patient-centered care and the responsibility and opportunity for each member of the care team to embody those values.

Exercises to Understand the Patient Experience

  • Trace the path a patient takes from arrival at the office through to registration to the waiting room to the exam room and to check-out. What do they see? What barriers may then encounter? Is the signage they encounter informative? Does the environment (including the signage) convey warmth and compassion? Trace patients’ steps using a walker and/or a wheelchair. Ask yourselves the same questions. Better yet, do this exercise alongside patient representatives.
  • Pair up with a colleague. Share a brief personal story with your partner (2-3 minutes, does not need to be overly personal). Initially, tell the story with your partner sitting down and you standing up; then both sitting at the same level. Switch roles. Together, identify specific behaviors that created a sense of connection as you shared.
  • Role play a typical patient interaction in your exam rooms. Observe how the set-up of the room either facilitates eye contact and personal connection or inhibits it, specifically in consideration of how you use the EHR. Consider placement of the computer screen, availability and height of chairs, etc. Better yet, complete this exercise alongside patient representatives.
  • Sit in an exam room on the table for 10 minutes, just as a patient would (though they wouldn’t know in advance how long they would be waiting.) Take note of the environment of the exam room. Is there anything to keep you occupied? What can you hear going on outside the room? How does it feel to sit there?

Questions to ask your doctor about patient-centered care

Source: Planetree.org

Patient-Centered Primary Care Collaborative (PCPCC)

Questions to ask your doctor about patient-centered care

Sample questions:

  1. What type of information will you provide to me about my condition and treatment options?
  2. Will you provide me with decision aids that will help me to make the best individualized care decisions?
  3. Am I able to access a patient portal to help me manage my personal health information?
  4. Am I able to update and contribute to the information in the patient portal or just review it?
  5. Am I able to review the doctor’s notes in my record? Do I have the option of adding my own information and perspectives into my record for the doctor to read and review?
  6. When my care team meets to discuss my plan of care, will I be invited to participate in those discussions?
  7. Is there a way for me to securely send questions/messages to my doctor in advance of (or outside of) a scheduled appointment?
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