Health Insurance

Intro to the U.S. Risk Pools

Hello Everyone! And Happy Holidays!!

As a final send-off before we head into 2018, I’m going to spend today giving a brief overview of the large risk pools or insurance options that we have here in the U.S. If you haven’t already checked out my prior video explaining risk pools and how they work- be sure that you do!

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So to recap: the three major ways to get health insurance in the U.S. is through:

Medicare– insurance run by the federal government for all individuals over age 65, those with disabilities, and those with two specific diseases: End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease).

Medicaid– insurance run by the government for eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by the state governments according to federal requirements.

Private Insurance: insurance run by private companies.

We can get private insurance in a few different ways:

  1. Through your employer
  2. Through the health insurance marketplaces, or exchanges (healthcare.gov)
  3. By staying on your parent’s insurance until age 26

As you can see that leaves us with a hodgepodge of insurance options which inevitably means some people fall through the cracks and don’t have health insurance in any given year.

The current estimate of uninsured individuals in the U.S. is around 30,000,000 people.

Thankfully that is much lower than in prior years because after the health insurance exchanges were built, this allowed people who own their own businesses, work freelance, or aren’t offered insurance through their employer to be able to be a part of a risk pool and purchase health insurance.

That’s all for this week, folks!

If you still haven’t purchased health insurance for 2018 be sure to check your open enrollment dates and purchase insurance.

And keep your eyes peeled in the new year because The Health Care Transformation Academy will be launching in January! I’m incredibly excited to be offering very concrete easy-to-understand lessons through The Academy that will really give you the confidence and peace of mind to understand and navigate the U.S. health care system.

Wishing you and yours the happiest of holidays and I’m so excited for all that 2018 will bring! xoxo

Cheers to Health and Happiness!

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Prevention

Get Your Flu Shot!

Hi Everyone! Welcome back to Health Care For the People.

‘Tis the season! The flu season that is! And it’s time to roll up those sleeves…

Now, what do you and your family need to know about the flu? Here’s what the Centers for Disease Control and Prevention (CDC), which is our leading agency that conducts and supports health promotion, prevention, and preparedness activities in the United States, has to say!

“Fun” Flu Facts:

  • The flu is contagious! It is spread when someone who is infected has droplets from their nose or mouth that then gets into your nose or mouth. (Think sneezing, coughing, hand-to-hand touching and then touching your face)
  • You may be able to pass on the flu to someone before you know you are sick or while you are sick. Some seemingly healthy people may be able to infect others beginning one day before symptoms develop and up to 5 to 7 days after becoming sick.
  • Typical symptoms include fever, chills, achy muscles, cough, runny or stuffy nose, headaches or a sore throat.
  • Depending on the health state of the individual, the flu can cause mild to severe illness and can even lead to death.
  • Each year, more than 200,000 people in the United States are hospitalized for respiratory and heart conditions illnesses associated with the flu virus.
  • Each year, between 12,000 and 56,000 people die from flu-related complications. These are typically patients who are already sick with a chronic condition such as heart failure or pulmonary disease.

Now let’s address all the silly myths and excuses that people make for not getting the flu shot!

Debunking “Fun” Flu Myths:

  • No, you cannot get the flu from the flu shot! The vaccine you receive is inactivated so the typical symptom you may get is soreness in the arm. And let’s be honest, any symptoms people have from the flu vaccine are much better to deal with than the symptoms caused by the actual flu illness.
  • If you do get flu-like symptoms, it wasn’t because of the vaccine! You may have already been sick when you got the flu shot. Also, you may be sick with another bacteria or virus that is not the flu or is not the strain from the vaccine.
  • The flu vaccine is safe and effective! For more than 50 years, hundreds of millions of Americans have safely received seasonal flu vaccines.

So now it’s time– I’ve gotten my flu shot. Have you gotten yours?!?

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Let me know if this article was helpful and please write any additional comments or questions below!

Cheers to Health and Happiness! 

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Primary Care

Who is your PCP? Part 2- The Primary Care Medical Home

Hi Everyone,

Welcome back to Health Care For the People for today’s post called Who is your PCP Part 2- The Primary Care Medical Home. In part 1 we talked about the importance of having a PCP and now we are going to talk about the Primary Care Medical Home, or what we call in the industry, PCMH.

The Primary Care Medical Home (PCMH) is a model whereby your PCP is the quarterback of your care for the rest of your care team.

What is a care team you ask?

Well for starters your care team is not going to look the same as someone else’s care team.

Depending on your current health state you might have only one doctor, your PCP, or you might have multiple doctors treating different diseases. You might have a mental health provider or a social worker.

If your care is very complex you might also have a care coordinator, which is an individual who is not a clinician but who works very closely with your PCP to coordinate your care between the different providers on your care team.

Potential Members of the Care Team:

  • PCP
  • Specialists
  • Care Coordinator
  • Mental Health Provider
  • Social Worker
  • Pharmacist
  • Hospital-based providers in the event of hospitalization
  • Community providers such as home health or skilled nursing facility staff

As you can see, depending on the complexity of your health situation, it can be really complex and just like anything else in this world Communication is Key! So it’s really important that your PCP (and potentially Care Coordinator) are working to optimally communicate and collaborate on improving your health outcomes.

That’s why we call the PCP your quarterback in the PCMH model. Your PCP is at the center of your healthcare world, looking at you holistically as a patient and serving as your quarterback who is fully knowledgeable in the care you are receiving from all your providers.

If you’re interested in learning more, here is a great link from the Patient-Centered Primary Care Collaborative that has some really helpful graphics:

https://www.pcpcc.org/about/medical-home 

Have any questions about the PCMH model? Feel free to write any comments or questions below and be sure to subscribe to the newsletter!

Cheers to Health and Happiness! 

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