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MN2020: Health Care http://www.mn2020.org/issues-that-matter/health-care Affordable healthcare creates opportunity and prosperity. Tue, 21 Nov 2017 08:53:31 -0600 VIDEO: TC Mobile Market http://mn2020.org/issues-that-matter/health-care/video-tc-mobile-market http://mn2020.org/8727 <p> By Briana Johnson, {related_entries id="article_author_blogger"}Briana Johnson, Video Production Specialist </p> <p> Minnesota 2020 headed out for a sneak peek of the retro fitting for the TC Mobile Market Bus. A program funded by the Wilder Foundation, the TC Mobile Market was created to bring healthy, affordable food to food deserts in Minnesota. Launching in September, the TC mobile market plans to sell fresh produce, as well as dairy and meat on the bus for 20 percent off regular retail groceries. The Mobile Market plans to begin their journey in St. Paul, and eventually expand to the North Minneapolis area. Once up and running the, TC mobile market is expected to run year round.&nbsp;</p> <p> &nbsp;</p> <p style="text-align: center;"> </p> Thu, 28 Aug 2014 18:00:12 +0000 Home care workers stand up, fight back http://mn2020.org/issues-that-matter/health-care/home-care-workers-stand-up-fight-back http://mn2020.org/8553 <p> By Steve Fletcher, {related_entries id="article_author_blogger"}Steve Fletcher, Executive Director </p> <p> The wrong-headed Supreme Court decision in Harris v. Quinn deserved a response. Tuesday, Minnesota home care workers delivered it, presenting&nbsp; union election filing cards to the State Bureau of Mediation Services, triggering an organizing vote. The action reminds us that, contrary to some of last week&rsquo;s misleading spin, nothing in Harris v Quinn prevents home care workers from organizing and forming a union. In fact, it affirms their right to do so. It was also a bold statement, to stand and announce the largest union election in Minnesota history in a week when pundits were fretting about labor's future or celebrating labor&rsquo;s demise.</p> <p> Yesterday, surrounded by a large, supportive crowd, caregivers and care recipients shared their stories about work, and struggle, and health, and love. We heard from Tyler, a young man whose partner needs constant care, and who often has to rearrange his life because of the constant turnover among caregivers working for such low wages. We heard from Shaquonica Johnson, who became a nurse because of her own family&rsquo;s struggles getting access to adequate healthcare, and sees a clear connection between her poor working conditions and her own family&rsquo;s health problems. We heard from Nikki Villavicencio, a care recipient who testified about the turmoil caused by inadequate wages and support for her caregivers. She asked a question we should all be wrestling with: &ldquo;Why is this field so undervalued?&rdquo;</p> <p> As I <a href="http://mn2020hindsight.org/view/the-verdict-misogyny-wins-in-court" target="_blank">argued last week</a>, one reason home care work is undervalued is because it&rsquo;s performed almost entirely by women and, disproportionately, by people of color. The invisibility and devaluation of work performed in the home is nothing new and certainly not an invention of Harris v. Quinn. In fact, workers launched the organizing drive last fall with union SEIU Healthcare MN, choosing the slogan &ldquo;Invisible No More.&quot; These workers understood, long before Justice Alito reminded them last week, that their work was valued differently, less than, other labor.</p> <p> Shaquonica Johnson drew a clear connection between race, gender, and healthcare injustice. She told the cheering crowd she was there to represent the thousands of workers who had signed cards expressing their intent to form a union and also to represent her ancestors, whose labor had been systematically erased by society. In her telling, the &ldquo;Invisible no more&rdquo; campaign resonated across time and space, offering the power of collective bargaining as a redemptive alternative to a legacy of discrimination and neglect.</p> <p> Home care work is rendered invisible because we as a society don&rsquo;t seem to want to know about the work they do. The elderly and disabled among us are often hidden away in their homes or in nursing homes, segregated, out of sight and out of mind, from the young and non-disabled. Our fear of mortality and fetishization of youth leads us to turn away from aging neighbors even as we maintain affection for the elderly and differently-abled in our own families. Yet, we all know in the back of our minds that someday, we or the people we love will need care, and may want the option to stay in our home. As the baby boom ages, demand for home care workers will only increase. <a href="http://www.mn2020.org/issues-that-matter/economic-development/organized-cooperative-home-care-shortage-solution" target="_blank">Experts anticipate a shortage of home care workers</a>. Fixing that shortage is especially important because quality home care <a href="http://www.npr.org/2010/12/10/131755491/home-care-might-be-cheaper-but-states-still-fear-it" target="_blank">saves our state healthcare system money</a> compared to nursing homes. &nbsp;Home care is smart state fiscal policy but only if we make it sustainable.</p> <p> Home care workers are fighting for their patients&rsquo; health and well being, for their own health and well being, and for the quality of care we all deserve when we all eventually need it. They&rsquo;re fighting for us all, and their collective strength offers hope that we might yet create a system of care for Minnesotans that sustains patients and workers together, and lets us all live with dignity. &nbsp;&nbsp;</p> Wed, 09 Jul 2014 13:30:34 +0000 Video: Nurses Picket for Patient Care http://mn2020.org/issues-that-matter/health-care/video-nurses-picket-for-patient-care http://mn2020.org/8501 <p> By Briana Johnson, {related_entries id="article_author_blogger"}Briana Johnson, Video Production Specialist </p> <p> Twin Cities nurses wore red as they picketed outside of North Memorial Medical Center to protest the unsafe working conditions. The informational picket called attention to the increasing ratio of patients to staff, which nurses say is diminishing the quality of patient care. Patients are experiencing delays with medications, feedings, restroom assistance and other critical services due to over-worked staff being spread too thin. The nurses called on the hospital to restore staffing levels to make sure patients get the care they deserve.</p> <p> &nbsp;</p> <p style="text-align: center;"> </p> Thu, 26 Jun 2014 11:00:12 +0000 Shortsighted Cuts Could Hurt Community Health Advancements http://mn2020.org/issues-that-matter/health-care/shortsighted-cuts-could-hurt-community-health-advancements http://mn2020.org/8074 <p> By Nicole Simms, Fellow </p> <p> The Community Transformation Grant (CTG) program was initiated in 2011 by the Centers for Disease Control and Prevention (CDC) in an attempt to address health disparities, help control health care spending, and create a healthier future. To this end, federal funds from the Affordable Care Act were allocated to select communities across the U.S. to help <a href="http://www.health.state.mn.us/divs/oshii/docs/CTGfactsheet2.pdf ">support community-level efforts</a> to reduce chronic diseases by expanding efforts in &ldquo;tobacco-free living, active living and healthy eating, and quality clinical and other preventative services.&rdquo; Minnesota fared well in the selection process: the state was awarded $4.7 million per year (including $1.1 million for Hennepin County) for what was supposed to be a five-year program.</p> <p> Congress, however, decided to eliminate funding for the CTG after year three &ndash; a move Martha Roberts of the Minnesota Department of Health (MDH) characterizes as a &ldquo;terrible blow to Minnesota.&rdquo;</p> <p> According to Roberts, who oversees the implementation of the CTG for the MDH, CTG funding in Minnesota was specifically dedicated to addressing health inequities in northern rural Minnesota communities, which are home to some of the <a href="http://www.health.state.mn.us/divs/orhpc/pubs/workforce/status.pdf ">worst socio-economic conditions and health outcomes</a> in the state. She notes that northern Minnesota has &ldquo;higher poverty rates, more children living in poverty and receiving free-and-reduced lunch, more residents being served by the Supplemental Nutrition Assistance Program (SNAP), higher rates of tobacco use among youth and greater mortality from heart disease and stroke.&rdquo; Roberts also points out that northern Minnesota has a significant Native American population &ndash; a group facing some of the worst health disparities and inequities in the state, including high rates of smoking, infant mortality, suicide, obesity, and diabetes incidence.</p> <p> The five northern communities granted CTG funding were already participants in the <a href="http://mn.gov/health-reform/topics/prevention/statewide-health-improvement/ ">Statewide Health Improvement Program (SHIP)</a>, a prevention program aimed at addressing preventable causes of illness and death, such as tobacco use/exposure, physical inactivity, and poor nutrition. Since the CTG has a similar mandate, using SHIP&rsquo;s existing structure and capacity to implement the funds was seen as the best way to maximize them. The factors which indicated an elevated need for CTG funding included poverty, smoking and obesity rates, chronic disease burden (including mental health), and poor <a href="http://www.countyhealthrankings.org/app/minnesota/2013/rankings/outcomes/overall/by-rank">county health rankings</a>.</p> <p style="text-align: center;"> <a href="/assets/uploads/article/CTGfactsheet.jpg" target="_blank"><img alt="" src="/assets/uploads/article/CTGfactsheet.jpg" style="width: 550px; height: 525px;" /></a></p> <p> Within these communities, Roberts says CTG funding has been focused on &ldquo;creating healthy and safe physical environments that promote good health for all and improve community health by reducing obesity and overweight and tobacco use and exposure, with the goal to reduce key risk factors of hypertension and high cholesterol.&rdquo; An array of community-led initiatives have been executed under the auspices of the program, geared toward healthy eating in schools and hospitals, active living, tobacco cessation, and the strengthening of community-clinic linkages. The CTG in Minnesota was also designed to operate at the regional and state levels, and has funded a variety of larger-scale initiatives aimed at chronic disease prevention, including the development of a <a href="http://mnfoodcharter.com/">Minnesota Food Charter</a>.</p> <p> According to Roberts, many of these efforts have seen success, and CTG funding in Minnesota has been &ldquo;making great strides in engaging a broad range of partners statewide to take action to improve community health. In combination with the Minnesota SHIP, CTG is providing vital resources to rural northern Minnesota, where some of our greatest social and health challenges exist.&rdquo;</p> <p> This makes the loss of CTG funding all the more striking - especially given the MDH&rsquo;s <a href="http://www.health.state.mn.us/divs/chs/healthequity/ahe_leg_report_020114.pdf ">recent emphasis</a> on the importance of confronting Minnesota&rsquo;s significant health disparities (and the accompanying assertion that structural racism has played an integral role in their persistence). Since the CTG was <a href="http://www.cdc.gov/nccdphp/dch/programs/communitytransformation/">designed</a> to enable &quot;communities to implement broad, sustainable strategies that will reduce health disparities and expand clinical and community preventive services,&quot; it ostensibly offered a path toward greater health equity in the state.</p> <p> Roberts emphasizes the importance of community-led health initiatives to any strategy aimed at reducing health disparities:</p> <p> &ldquo;There is no better way to improve health than to build the capacity of communities to engage their citizens in identifying the challenges they face and defining the actions they can take collectively to improve the well-being and health of their own communities. Combine this with regional and state-level public health improvement action strategies, and you can develop a highly effective and systematic way to improve the health of the entire state of Minnesota.&rdquo;</p> <p> Without CTG funding, Roberts says local health departments and tribes will face significant challenges in undertaking their community health work. Ultimately, she notes that &ldquo;the loss of CTG funding is a tremendous loss for Minnesota and especially for the people living in rural communities in northern Minnesota, who clearly do not have the same opportunities or access to resources that can help them thrive and live in health.&rdquo;</p> <p> Both the MDH and the CDC were caught off guard by the CTG cut, for which Congress has offered no explanation. Congress did increase CDC funding for diabetes, heart disease, and stroke prevention programs, and also created a new grant program to support community coalitions in their efforts to prevent chronic disease, but disrupting the CTG mid-stream compromises the gains that have been made in northern Minnesota as a result of the program.</p> <p> Roberts suspects the decision may be related to the desire to see funding produce rapid, targeted health improvements that are easily quantifiable &ndash; a challenge for prevention efforts that address the key factors that cause disease within communities. She situates the cut within a broader pattern of behavior with highly negative implications:</p> <p> &ldquo;Congress&rsquo; increased practice of starting and then unexpectedly stopping federally funded programs not only wastes a tremendous amount of work and resources, but ultimately interrupts crucial community health efforts, as well as Minnesota&rsquo;s overall ability to make progress on reducing health disparities and inequities in rural parts of the state. And growing inequities are one of the most serious long term threats to Minnesota&rsquo;s economy and to the social well-being and health of our families and communities.&rdquo;</p> <p> The elimination of CTG funding will result in a total loss in community health funding of about $7.2 million through September 2016. The funding also supported 32 jobs in the state &ndash; 13 at MDH and the rest held by grantees and contractors serving northern Minnesota.</p> <p> At present, the MDH is assessing the extent to which it might be able to salvage the CTG program work and evaluation efforts through a contingency plan that would leverage other resources.</p> Mon, 14 Apr 2014 11:00:03 +0000 The 5% Campaign Makes Headway http://mn2020.org/issues-that-matter/health-care/the-5-campaign-makes-headway http://mn2020.org/8094 <p> By Nicole Simms, Fellow </p> <p> Last year, the Minnesota House passed a health and social programs budget that allowed for the first wage increase nursing home and long-term care workers had seen since 2008. While this represented an important step in ensuring care workers are fairly compensated, the bulk of the increase was directed toward nursing homes, leaving only a very small amount for the many services that aim to assist people with disabilities and older adults within their own communities.</p> <p> This session, a broad coalition of advocates are working on the <a href="http://www.arrm.org/news/docs/5_Percent_Campaign_Fact_Sheet_2014.pdf">5% Campaign</a> &ndash; an initiative to secure a 5% rate increase for Home and Community Based Services (HCBS) during the 2014 legislative session.</p> <p> The Campaign is based on the <a href="http://www.arrm.org/news/5percentcampaign.html">premise</a> that &ldquo;life in the community is the first and best option for people with disabilities and older Minnesotans, as well as their families, workers and our state as a whole.&rdquo; This assertion reflects the changing nature of care in Minnesota &ndash; while nursing homes once served as a long-term care option for many Minnesotans, they are increasingly being used only for recuperation, rehabilitation, and end of life care. In 2002, the average length of stay in a nursing home in Minnesota was <a href="http://www.health.state.mn.us/divs/fpc/profinfo/nhlengthofstay.pdf">502</a> days; by 2006, it was 298 days, and by 2012, it had fallen to <a href="http://www.longtermscorecard.org/~/media/Files/Scorecard%20site/Report/Case%20Studies/AARP758_Minnesota_May8_FINAL.pdf">150 days</a>. At the same time, the number of HCBS participants has steadily increased: there were <a href="http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2012/across-the-states-2012-minnesota-AARP-ppi-ltc.pdf">30,174</a> Medicaid HCBS waivers in 2003; in 2013, there were approximately <a href="http://www.house.leg.state.mn.us/hrd/pubs/waiver.pdf">71,597</a>. Relative to the U.S. as a whole, Minnesota has a <a href="http://www.pascenter.org/state_based_stats/medicaid/medicaid_hcbs.php?state=minnesota">high proportion</a> of HCBS participants.</p> <p> This shift from segregated, institutional settings to integrated, community settings is no accident&ndash;the state has played a <a href="http://www.longtermscorecard.org/~/media/Files/Scorecard%20site/Report/Case%20Studies/AARP758_Minnesota_May8_FINAL.pdf">key role</a> in facilitating it in recognition of the personal and statewide benefits associated with community-based care. Minnesota&rsquo;s <a href="http://www.dhs.state.mn.us/main/groups/olmstead/documents/pub/dhs16_180147.pdf">Olmstead Plan</a>, which arose in response to the U.S. Supreme Court&rsquo;s ruling that states must offer services to people with disabilities in the most integrated setting possible, is a recent example. The Olmstead Subcabinet &ldquo;strives to ensure that Minnesotans with disabilities will have the opportunity, both now and in the future, to live close to their families and friends, to live more independently, to engage in productive employment and to participate in community life.&rdquo;</p> <p> Home and Community Based Services are central to achieving this mandate. Such <a href="http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&amp;RevisionSelectionMethod=LatestReleased&amp;dDocName=id_000852">services</a> include the Elderly Waiver Program, the Community Alternatives for Disabled Individuals, the Brain Injury waiver, the Community Alternative Care waiver, and a state-funded Alternative Care Program. These programs serve a significant portion of the population. In 2011, <a href="http://www.dhs.state.mn.us/main/groups/olmstead/documents/pub/dhs16_180147.pdf ">10.1%</a> of Minnesotans had disabilities, with some regional variations: the highest rates of disability (14%) were in the northern and western parts of the state, while the lowest rate (8%) was in the Twin Cities.</p> <p> And in Minnesota, as in many other parts of the world, a significant demographic shift is underway that will ultimately leave us with a higher proportion of elderly people than ever before. By 2030, <a href="http://www.health.state.mn.us/divs/orhpc/pubs/profiles/rhprofilenursing.pdf">25% of Minnesotans</a> will be over the age of 65, and many of them will live alone. In particular, the number of people 85 and over will increase dramatically.</p> <p style="text-align: center;"> <img alt="" src="/assets/uploads/article/statewide_age_comparison.png" style="width: 600px; height: 353px;" /><br /> <a href="http://www.demography.state.mn.us/PopulationPyramids2015-2040/Projecxtions2012Paper.pdf" target="_blank">Source: Minnesota Population Projections MN State Demographic Center</a><br /> <br /> &nbsp;&nbsp;</p> <p> This &ldquo;graying&rdquo; of the population has significant policy implications; chief among them is the need to ensure that effective long-term care programs are in place. Programs that keep older Minnesotans in their own communities allow these individuals to retain a sense of independence and maintain a higher quality of life. This not only enriches the diversity of our communities &ndash; it also decreases the cost of care: in 2011, the <a href="http://swroc.cfans.umn.edu/prod/groups/cfans/@pub/@cfans/@swroc/documents/asset/cfans_asset_366305.pdf">cost</a> of a Home Health Aid ranged from $44,000 to $68,000, while a private room in a nursing home cost $70,000 to $102,000.</p> <p> But the individual, communal, and statewide benefits of long term-care in integrated community settings simply can&rsquo;t be achieved without the contributions of care workers. There are currently approximately <a href="http://www.arrm.org/news/docs/5_Percent_Infographic_2014.pdf">90,880</a> caregivers and staff who serve 67,000 people with disabilities and 24,900 older adults in assisted living facilities, developmental achievement centers, group homes, and their own homes. These workers make an average of $10.50/hr &ndash; such low salaries make it difficult to attract and retain workers, and the sector is currently characterized by high turnover rates, which aren&rsquo;t good for workers or the people they care for. Increasing wages will make it possible for more workers to consider care work a viable, long-term career. The 5% rate increase for HCBS the Campaign is working for would cost about $83 million, and would translate into approximately $0.40 more per hour for each worker.</p> <p> Sarah Lewerenz, the Political &amp; Legislative Coordinator at AFSCME Council 65, stresses the importance of the 5% Campaign in noting that &ldquo;many of the non-nursing home direct care employees are paid out of the state budget and are paid incredibly poorly.&rdquo; Current wages are so low that some full-time employees are unable to afford basic necessities, including food and housing. &ldquo;It is an outrage that we as a state think it is OK to compensate these workers at such poverty rates,&rdquo; says Lewerenz. She says the legislative leadership has an obligation to ameliorate conditions for long-term care workers &ndash; one she hopes they will honor this session.</p> <p> And so far, there is every indication they will. According to Arc Minnesota&rsquo;s Senior Policy Director Steve Larson, who is one of the co-chairs of the 5% Campaign, the initiative&rsquo;s bill has broad-based bipartisan support, and has been faring very well during the legislative session. The Governor recently released a supplemental budget proposal that includes a 4% increase for community-based care services. Larson says the campaign&rsquo;s supporters are grateful to the Governor for making this the one area in Health and Human Services that will receive a funding increase this year, but they remain hopeful legislators will be willing to grant the full 5% increase.</p> <p> Larson characterizes the 5% Campaign and efforts to raise the minimum wage to $9.50 as &ldquo;parallel campaigns,&rdquo; but emphasizes that the 5% Campaign is a distinct endeavor. If an overall wage increase is approved, it won&rsquo;t be funded from whatever increase ends up being secured through the Campaign. There has been good news on this front as well: the Health and Human Services Committee recently approved an amendment to the bill that would provide the funding necessary to bump long-term care facility employees up to the new minimum wage.</p> <p> These are welcome developments, as they indicate lawmakers are beginning to acknowledge and value the work of long-term caregivers &ndash; work that will only increase in importance as our population ages. As Lewerenz says, the state has been providing needed services to the most vulnerable members of our communities on the backs of care workers for far too long. It&rsquo;s time for that to change. A 4% increase is a good start, but let&rsquo;s make it 5%.</p> Wed, 19 Mar 2014 11:00:49 +0000 Raising the Minimum Wage Won’t Shut Down Nursing Homes http://mn2020.org/issues-that-matter/health-care/raising-the-minimum-wage-wont-shut-down-nursing-homes http://mn2020.org/7986 <p> By Nicole Simms, Fellow </p> <p> Those hesitant or opposed to raising the minimum wage claim it will result in job loss and business failure; in particular, they frequently express concern it will have an <a href="http://hometownsource.com/2014/02/19/legislatures-minority-leaders-give-session-preview/ ">adverse effect on nursing homes</a>, causing some to go out of business. These accounts fail to consider that raising the minimum wage to $9.50 will only increase the wages of a small proportion of nursing home workers, and that such an increase may actually help nursing homes stay in business by attracting workers to understaffed facilities &ndash; especially those in rural areas.</p> <p> Since some nursing home workers do make under $9.50/hr, it is indeed the case that raising the minimum wage to $9.50 would require nursing homes to pay out more in wages. But what kind of an impact would this have on workers, nursing homes, and the elderly residents and people with disabilities who depend on them?</p> <p> Minnesota 2020 visited the relationship between nursing homes and minimum wage a few months ago with a guest commentary from SEIU Healthcare Minnesota&rsquo;s <a href="http://www.mn2020.org/issues-that-matter/health-care/nursing-home-workers-need-support">Lisa Weed</a>. I wanted to build on Weed&rsquo;s analysis to consider how an increase in the minimum wage to $9.50 might impact nursing home workers in different parts of the state. Using information from 2012 kindly provided by the Minnesota Department of Employment and Economic Development (DEED), I was able to determine significant regional disparities in the numbers of nursing home workers making under $9.50.</p> <p> First, some notes on my analysis are called for. The 2012 numbers Lisa Weed used from DEED to calculate the number of nursing home workers currently making under $9.50 come from the UI Wage Records, which are continually updated as information is added by employers. I have therefore based my calculations on the newest numbers for 2012.</p> <p> Also, DEED provides a wage breakdown that makes it impossible to precisely determine the numbers of people making under $9.50/hr. Wages are&nbsp;categorized in $0.50 increments.</p> <p> Of the 53,470 people working in Minnesota nursing homes, at least 2,579 make up to $9.00/hr. These 2,579 individuals constitute approximately 4.8% of all nursing home workers. When we include those making up to $9.50/hr, we get 4,240 individuals &ndash; 7.9% of all nursing home workers.</p> <p> A closer look reveals that of these individuals, approximately 16% make $7.50 or less, 7% make between $7.51 and $8.00, 13% make between $8.01 and $8.50, 25% make between $8.51 and $9.00, and 39% make between $9.01 and $9.50.</p> <p> Increasing the minimum wage to $9.50/hr will therefore result in a $0.00 - $1.50 raise for the majority of nursing home workers who qualify &ndash; about 3,264 individuals (only 1,604 workers would definitely get a wage increase, since some of the rest already make $9.50). The other 975 individuals who make $8.00 or less will receive marginally larger raises. It&rsquo;s important to note that some of the individuals in this latter category are trainees who currently make a training wage of $4.90. While their wages will likely increase with an increase to the minimum wage, trainees wouldn&rsquo;t be eligible to receive $9.50/hr &ndash; an increase to<a href="http://www.jobsnowcoalition.org/reports/2013/raise-for-mn_jobsnow2013.pdf"> $8.00/hr for trainees</a> is being advocated.</p> <p> All told, these modest increases won&rsquo;t drain the finances of nursing homes, but they will give workers more money to put towards things like rent and groceries. And every dollar more they have to spend is a boost to their local economies.</p> <p> Speaking of local economies, let&rsquo;s consider some of the regional differences in wages for nursing home workers. Back in the 1990s, Minnesota was divided into six Planning Areas based on things like industry distribution and commuting patterns: Northeast, Northwest, Central, Southwest, Southeast, and the Twin Cities 7-County Metro Area.</p> <p style="text-align: center;"> <img alt="" src="/assets/uploads/article/MN_Planning_Areas.gif" style="width: 210px; height: 205px;" /></p> <p> Data on nursing home worker wages for these six Planning Areas is the most detailed level available. Based on the 2012 data, Central has the highest percentage of nursing home workers making $9.00 or under/hour at 8.4%; the Twin Cities Metro Area has the lowest at 1.7%. The percentage of nursing home workers making up to $9.00/hour in the other four Planning Areas ranges from 6.1%-6.8%. If we include the group making up to $9.50, Central continues to see the highest percentage at 12.9%, and the Twin Cities the lowest at 3.2%. Some of the Planning Areas from that middle group (which range from 8.7%-12%) swap places, but those in the top three and bottom three remain the same under both scenarios.</p> <p style="text-align: center;"> <a href="/assets/uploads/article/nursing_home_9.png" target="_blank"><img alt="" src="/assets/uploads/article/nursing_home_9.png" style="width: 600px; height: 232px;" /></a></p> <p style="text-align: center;"> <a href="/assets/uploads/article/nursing_home_950.png" target="_blank"><img alt="" src="/assets/uploads/article/nursing_home_950.png" style="width: 600px; height: 244px;" /></a></p> <p> I looked at a number of variables and determined that Planning Areas with higher percentages of nursing home workers making under $9.50/hr have lower per capita and household incomes, higher poverty and unemployment rates, are more rural, and have a larger percentage of individuals in all fields making under $9.50/hr. These are areas that stand to <a href="http://www.mn2020.org/issues-that-matter/economic-development/weak-economy-hitting-hard-in-central-minnesota">benefit the most</a> from a boost in wages.</p> <p> But the kind of modest wage boost we&rsquo;re talking about simply won&rsquo;t shut down nursing homes. Nursing homes shut down because they can&rsquo;t keep up with infrastructure improvements, huge state or federal funding cuts make it impossible for them to carry out their operations, or they have difficulty attracting and retaining staff. This latter problem recently resulted in a nursing home being shut down in <a href="http://blogs.mprnews.org/ground-level/2013/11/nursing-home-closure-rocks-small-town-of-hoffman/">Hoffman, MN</a> &ndash; despite spending thousands on advertising, administrator Bill Brewer could not draw enough staff to be able to fill the home to capacity, which made it difficult to balance finances.&nbsp;Increasing wages may actually help prevent shut-downs by attracting workers to jobs in nursing homes (a particular challenge for rural facilities).&nbsp;And at least some of the money to pay for increased wages is already in place: a recently passed <a href="http://www.mprnews.org/story/2013/05/18/politics/hhs-bill-gives-increase-to-nursing-homes">health and human services budget bill</a> increases funding for nursing homes and other long-term care facilities over a two year period. A portion of that is dedicated to helping increase salaries.</p> <p> Let&rsquo;s put a human face on all these numbers. Who are the people working in nursing homes who may be making less than $9.50/hr? They are the nursing aides, orderlies, and attendants, the custodians, the groundskeepers, the cleaners, the laundry workers, the food makers and servers. They are the people that keep nursing homes running; the people who make it possible for our loved ones to receive care when they need it most.</p> <p> Research indicates care for the elderly is changing. More and more elderly Minnesotans are staying in their homes, or residing in assisted living facilities. Nursing homes are being increasingly used on a temporary basis, for <a href="http://www.health.state.mn.us/divs/orhpc/pubs/profiles/rhprofilenursing.pdf ">rehabilitation, recuperation, or end of life care</a>. This means our loved ones need nursing homes and their workers in some of their hardest moments. They take care of us; taking care of them means supporting an increase in the minimum wage.</p> Wed, 26 Feb 2014 12:00:55 +0000 Report Blames Structural Racism for MN Health Disparities http://mn2020.org/issues-that-matter/health-care/report-blames-structural-racism-for-mn-health-disparities http://mn2020.org/7886 <p> By Nicole Simms, Fellow </p> <p> In a bold move by the Minnesota Department of Health (MDH), state officials are blaming structural racism for Minnesota&rsquo;s significant health disparities, which have been a point of concern in the state for decades. The accusation is front and center in a new report to the Legislature called &ldquo;<a href="http://www.health.state.mn.us/divs/chs/healthequity/ahe_leg_report_020114.pdf">Advancing Health Equity</a>,&rdquo; which was released Monday. In it, the MDH attempts to identify and explain the persistence of poor health outcomes among certain groups in Minnesota, which are expressed most starkly along racial lines.</p> <p> Of course, other segments of the population experience persistent health inequities, including women, children, LGBT people, people with disabilities, people with mental illness, those who live in rural areas, and those who live in certain urban or suburban neighborhoods. Yet in composing the new report, the MDH decided to &ldquo;lead with race&rdquo; to meet the challenge of health equity, because &ldquo;disparities by race/ethnicity in Minnesota persist across socio-economic factors, environmental conditions, health behaviors, and health outcomes; in many cases these disparities are growing.&rdquo;</p> <p> The report explores several areas in which structural racism contributes to poor health outcomes &ndash; even in areas where a connection to health may not seem immediately evident. One example is the racial disparity in homeownership rates between whites and people of color that are largely attributed to discriminatory practices (such as redlining). Those who don&rsquo;t own homes because they can&rsquo;t afford to often live in older housing as renters &ndash; and older homes can present threats to health (such as lead based paint, mold, and asbestos). The homeownership rate among whites in Minnesota is 75%; in comparison, the homeownership rate for Native Americans is 47%, Asians 54%, Hispanics 45%, and blacks 21%.</p> <p> Housing is only one example of the kind of &ldquo;persistent, significant, and socially-determined differences in the conditions that create health and the opportunity to be healthy for certain populations in Minnesota.&rdquo; Other factors explored in the report include the frequency with which 9th graders change schools, high school graduation rates, poverty, unemployment, incarceration, and per capita income, along with more intuitively-related markers such as a lack of health insurance or underinsurance.</p> <p> The documented disparities in these areas along racial lines are significant, as are several related disparities in health outcomes. Particularly illustrative are two examples: mortality rates for African-Americans and Native Americans in Minnesota are two to three times higher, respectively, than for whites at earlier ages, and African American women have a 24% higher breast cancer mortality rate than white women &ndash; despite the fact that the incidence of breast cancer among the former is 18% lower than the latter.</p> <p> Taking into account the range of &ldquo;social determinants of health&rdquo; &ndash; the living and working conditions that influence individual and population health &ndash; the MDH argues for a systems-based approach to advancing health equity, wherein systems are in place that ensure every person has:</p> <p style="margin-left: 40px;"> 1) access to political, economic and educational opportunity;<br /> 2) the capacity to make decisions and effect change for themselves, their families and their communities;<br /> 3) social and environmental safety in the places they live, learn, work, worship and play; and<br /> 4) culturally competent health care available when the need arises (MDH, 2014: 3)</p> <p> Identifying deficiencies in all of these areas may help to explain the disproportionately higher rates of autism spectrum disorder (ASD) accompanied by intellectual disability within Minneapolis&rsquo; Somali community that were documented in a <a href="http://rtc.umn.edu/autism/doc/Autism_report.pdf">University of Minnesota study</a> last month. That study was prompted out of concern that there seemed to be a disproportionate percentage of Somali children enrolled in Minneapolis Public Schools&rsquo; preschool special education program for ASD. While researchers found no overall difference in the number of Somali and white children diagnosed with ASD (rates were found to be lower among black and Hispanic children), the likelihood that ASD will be accompanied by an intellectual disability in Somali children is significantly higher. The study&rsquo;s authors did not offer an explanation for the discrepancy, but their recommendations for addressing it include adopting the kind of systems-based approach the MDH advocates.</p> <p> Because it purports to address the socially-determined conditions that lead to disparities in health outcomes (and thereby produce health inequities), an authentic systems-based approach to health will require that Minnesotans confront the many racial disparities that have plagued the state. Talking about structural racism &ndash; let alone actually doing anything about it &ndash; is often a challenge. However, the authors of the new MDH report rightly point out that &ldquo;having explicit conversations and creating clear intention to talk about race and racism and the relationship of race to the structural inequities that contribute to health disparities is necessary to advance health equity in Minnesota.&rdquo; The authors note that all Minnesotans should take an interest in overcoming these disparities, because in societies with significant population-based inequities that result in compromised health outcomes, everyone&rsquo;s health is diminished through &ldquo;generalized tension and a diminished sense of overall security.&rdquo;</p> <p> A systems-based approach to health requires <a href="http://www.iom.edu/Global/Perspectives/2013/~/media/Files/Perspectives-Files/2013/Discussion-Papers/VSRT-SAHIC-Overview.pdf ">substantial leadership support and cultural shifts</a>. The MDH has taken an important step in highlighting the way structural racism produces system-wide inequities that translate into poor health outcomes. Health care providers must also show a willingness to overcome an organizational culture that is often fragmented, driven by profit, and focused on individual rather than collective health if there is any hope of achieving more comprehensive, collaborative, and culturally-competent health care delivery in Minnesota.</p> Wed, 12 Feb 2014 12:00:34 +0000 Video: Community Pharmacy http://mn2020.org/issues-that-matter/health-care/video-community-pharmacy http://mn2020.org/7805 <p> By Tim Blodgett, Undergraduate Research Fellow </p> <p> Small business owner Tom Sangupta speaks to Minnesota 2020 about the joys of being a part of a community and the struggles of owning an independent drug store. Sangupta's Schneider Drug located on University Avenue in Minneapolis prides it self on medical know-how and has become a integral part of the community after 42 years in business.&nbsp; He says costs and complexity of modern medicine are putting a lot of pressure on business, but he works hard to keep up and build strong relations with customers.</p> <p> &nbsp;</p> <p style="text-align: center;"> </p> Wed, 15 Jan 2014 11:59:33 +0000 Organized, Cooperative Home Care Shortage Solution http://mn2020.org/issues-that-matter/health-care/organized-cooperative-home-care-shortage-solution http://mn2020.org/7641 <p> By Lee Egerstrom, Economic Development Fellow </p> <p> Minnesota is projecting a shortage of as many as 53,000 home health care workers by the end of this decade. In order to avoid forcing older Minnesotans and people with disabilities into nursing homes because of worker shortages, there are several steps we must take to professionalize the industry, raise wages, and provide better benefits.</p> <p> Two models that can work in tandem involve unionizing home care workers, which is currently underway, and forming worker-owned cooperatives.</p> <p> Changing demographics with aging populations in many communities, especially in rural areas, should be a driving force for little-used worker co-op development, said Margaret Bau, a USDA Rural Development co-op specialist in Wisconsin.</p> <p> Despite need for creative developments, and despite Upper Midwest experience with cooperatives and related mutual insurances and credit unions, worker-owned enterprises remain an under-utilized tool for development, said Kevin Edberg, director of Cooperative Development Services in St. Paul.</p> <p> Bau and Edberg were among co-op developers, financiers and community organizers participating in a Cooperatives = Community Development conference in Minneapolis. Minnesota and Wisconsin are leading states in co-op development, various speakers noted, but there has been less success with workers owning and operating their own businesses.</p> <p> One major area for potential development is the growing need for home health care services. A leading co-op model is Cooperative Care based at Wautoma, Wis., where 60 home care workers provide services for about 150 clients in Waushara, Winnebago, Green Lake, Adams, Fond du Lac and Marquette counties.</p> <p> Tracy Dudzinski, who describes herself cooperatively as &ldquo;a caregiver, administrative coordinator, and the board chair,&rdquo; said Cooperative Care is owned by 40 of the caregiver members while 20 caregivers are employees. Together, they supply workers in categories of home health care, personal care and certified nursing assistants.</p> <p> The anticipated shortfall of caregivers in Minnesota &ldquo;is already here (central Wisconsin),&rdquo; she said. &ldquo;We have trouble meeting needs for our services, and we&rsquo;re paying a lot of overtime.&rdquo;</p> <p> These needs are expected to increase. Gail MacInnes and Dorie Seavey, in a 2012 Paraprofessional Healthcare Institute (PHI) study, projected a 53,000 shortfall of Minnesota home care workers by the end of this decade.</p> <p> Their report, &ldquo;Home Care at a Crossroads: Minnesota&rsquo;s Impending Long-Term Care Gap,&rdquo; attributes some of the gap to the aging population. But other factors plague the industry - not the least of being the lack of compensation and benefits. This means home care workers can&rsquo;t adequately care for their families while caring for other people.</p> <p> Minnesotans over age 65 are expected to increase from 670,429 in 2010 to more than 1,193,100 in 2030 &ndash; an 80 percent increase, according to U.S. Administration on Aging projections in the report.</p> <p> The authors cited Minnesota Department of Employment and Economic Development (DEED) estimates that an additional 53,224 direct-care workers would be needed between 2010 and 2020, while the number of women between ages 25 and 54 &ndash; the core pool for these workers, is projected to decline by about 2,000 in this decade.</p> <p> Direct-care workers include home health aides and personal care aides that account for 72 percent of all workers in the sector. Different nursing aides, orderlies and attendants account for the other positions.</p> <p> At the same time, personal care aides and home health aides are projected to be the two fastest growing occupations in the current decade, with increases of 62 percent and 54 percent (27,579 jobs and 20,594 jobs) by 2020. Overall Minnesota job growth is projected at 13 percent.</p> <p> What home health care represents in Minnesota is a neglected growth service industry. Two public policy events of the past year should help.</p> <p> For starters, the Minnesota Legislature passed a law earlier this year allowing health care workers the right to vote for unionization, which would provide collective bargaining rights. Rules and regulations are being adjusted for the change, and elections are anticipated by next spring.</p> <p> Secondly, President Obama approved rules on Sept. 16 extending federal minimum wage protection and overtime pay for home health care workers who help elderly and disabled. The rule changes affected an estimated 2 million workers nationally.</p> <p> &ldquo;Home care workers are no longer treated like teenage babysitters performing casual employment under this final rule,&rdquo; the Associated Press quoted Labor Secretary Thomas Perez as saying. Babysitters and home care workers were exempted from the federal minimum wage law in 1974.</p> <p> Despite the predictable claims such a boost will ruin the industry and force elderly and disabled to move into institutional care facilities, the Labor Department said the median wage for home care workers is $9.70 per hour &ndash; well above the current $7.25 per hour federal minimum wage. But that still means at least half the industry&rsquo;s workers are paid less than the median, and untold thousands are making less than the minimum wage.</p> <p> A SEIU spokesman in Minnesota said the federal minimum wage coverage is mostly &ldquo;a correction&rdquo; of an oversight from the 1970s.</p> <p> At the same time, building sustainable home health care systems aren&rsquo;t &ldquo;either-or situations&rdquo; between collective bargaining and co-op development, said Wisconsin&rsquo;s Bau. Both are important for attracting&nbsp; newcomers and keeping current caregivers in these important jobs. Throughout Europe, many cooperative enterprises are highly unionized.</p> <p> Benefits that Cooperative Care achieved are like union contracts. Owner-member-workers qualify as a pool for negotiating health care benefits, meaning health care workers can afford health care for their own families; and being employees of a company they also own, rather than freelance care providers, they have predictable employment that qualify them for home mortgages.</p> <p> Minnesota may still face a shortage of home care providers, but there are tools to help these workers care for their families while they care for others.</p> Wed, 13 Nov 2013 12:00:07 +0000 Video: What Causes Cancer? http://mn2020.org/issues-that-matter/health-care/video-what-causes-cancer http://mn2020.org/7625 <p> By Briana Johnson, {related_entries id="article_author_blogger"}Briana Johnson, Video Production Specialist </p> <p> Besides the obvious causes, such as tobacco use, too much sun, and excessive drinking, what causes cancer in an otherwise healthy person? The American Cancer Society is looking in the Twin Cities for healthy volunteers between the ages of 30-65 willing to commit to long-term participation in the third of an ongoing series of studies aimed at preventing cancer. Preliminary steps to participate are minimal -- a waist measurement and a blood sample starts the research off. Find out why people are signing up.&nbsp;</p> <p> &nbsp;</p> <p style="text-align: center; "> </p> Thu, 07 Nov 2013 12:00:53 +0000 Video: The time to plan for your future is now http://mn2020.org/issues-that-matter/health-care/video-the-time-to-plan-for-your-future-is-now http://mn2020.org/7560 <p> By Briana Johnson, {related_entries id="article_author_blogger"}Briana Johnson, Video Production Specialist </p> <p> The Own Your Future project held a public discussion to make people aware of the many different options and strategies they can use in order to make sure they have a clear plan for life after 65. The majority of people do not save or make a solid financial plan for themselves until it is too late. Talking with family and friends early about your plan before any issues arise is the best way to get a head start on planning for your future.</p> <p> &nbsp;</p> <p style="text-align: center; "> </p> Mon, 21 Oct 2013 11:00:33 +0000 Nursing Home Workers Need Support http://mn2020.org/issues-that-matter/health-care/nursing-home-workers-need-support http://mn2020.org/7517 <p> By Lisa Weed, Guest Commentary </p> <p> Recently some legislators, Senate Majority Leader Tom Bakk more prominently, who support the idea of raising the minimum wage, have expressed concern that a $9.50 minimum wage would hurt Minnesota nursing homes. They have expressed fears that if homes were forced to pay all workers $9.50 an hour, many would close.</p> <p> SEIU Healthcare Minnesota strongly supports H.F. 92 which would raise the wage to $9.50 and index it to inflation. Since, however, our union includes over 4,000 nursing home workers, we share Senator Bakk&rsquo;s concern. We wanted to be sure we did not do anything that would cause workers to lose their jobs.</p> <p> As a first step, we checked our own membership database. Of the 4,208 members we represent who work in Minnesota nursing homes, just 236 or 5.6% made less than $9.50 as of about January 2013. Next I checked with the Minnesota DEED and got similar results. According to DEED, in 2012 out of 44,300 people who work in Minnesota nursing homes 3,372 or 7.6% were paid less than $9.50. Surely, Minnesota nursing homes could afford this small group a little bit more without shutting down or compromising care.</p> <p> Yet even these numbers overstate the impact of a minimum wage of $9.50. For starters, the $9.50 wage would not go into effect until August 1, 2015, so natural wage increases will have already lifted many nursing home works above the minimum. In fact, Senator Bakk and other DFL legislators have passed for this year a 5% average increase in nursing home funding so that homes can increase wages. A smaller 3.2% increase has been scheduled for 2015. That state has already provided funds for homes to meet most if not all of their costs under a higher minimum wage. In fact, a higher minimum wage would help make sure that those increases in nursing home funding went to workers who care for our vulnerable seniors.</p> <p> In addition, many nursing home workers would not be covered by the $9.50 minimum wage. The law allows a lower training wage for workers under 20 in the first 90 days of employment. The current training wage is $4.90 and H.F. 92 would raise it to $8.00 by 2015. Industry experts know that nursing homes have a very high turnover, so at any given period a significant percentage on their workers are likely to be only eligible for the lower training wage.</p> <p> If despite all of this, nursing homes cannot pay a $9.50 minimum wage, then Minnesota legislators need to provide an additional funding increase. If you have ever had a loved one in a nursing home, you know that the overworked and understaffed caregivers put in more than $9.50 of effort in an hour. Does anyone want to say that McDonald&rsquo;s should pay a cook $9.50 to flip a burger, but Minnesota should get away with paying less to the professionals who takes care of our loved ones?</p> <p> The nursing home industry is a tough business with lean margins, but there is enough money in the system to pay workers a decent minimum wage. Minnesota legislators, like all employers, can and should pay workers at least $9.50.</p> <p> <em>Lisa Weed Executive Vice President Director LTC Sector SEIU Healthcare Minnesota.</em></p> Wed, 09 Oct 2013 11:00:24 +0000 Video: Run for your life http://mn2020.org/issues-that-matter/health-care/video-run-for-your-life http://mn2020.org/7507 <p> By Briana Johnson, {related_entries id="article_author_blogger"}Briana Johnson, Video Production Specialist </p> <p> Even if you didn't run the Medtronic Twin Cities Marathon Sunday, this annual event still represents a great opportunity and reminder about why staying active is important. Getting outdoors, whether&nbsp;you run or walk, helps keep your stress level down and is great for your heart. The marathon provides a numbers of ways to engage in running as a sport or just for fun. Here's how. &nbsp;</p> <p> &nbsp;</p> <p style="text-align: center; "> </p> <img class="UMSRatingIcon" id="ums_img_tooltip" /> Mon, 07 Oct 2013 10:59:49 +0000 A Health Care Cost Cutter with Promise http://mn2020.org/issues-that-matter/health-care/a-health-care-cost-cutter-with-promise http://mn2020.org/7307 <p> By Annalise McGrail, Undergraduate Research Fellow </p> <p> America <a href="http://kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-states-selected-oecd-countries/ " target="_blank">spends</a> more on health care than any other country in the world, yet there is little evidence proving these costs yield quality care. When compared to sixteen other developed nations, the US <a href="http://www.theatlantic.com/health/archive/2013/01/new-health-rankings-of-17-nations-us-is-dead-last/267045/ " target="_blank">ranked</a> dead last in health outcomes.</p> <p> Luckily, there is ample room to generate savings. Dartmouth University researchers estimate that approximately <a href="http://www.dartmouthatlas.org/tools/faq/" target="_blank">30%</a> of health care spending is wasted. The key to rein in health care spending is to uncover the sources of waste and proactively discover solutions to minimize it.</p> <p> In the status quo the majority of hospitals use a fee-for-service model. Critics argue that this payment system is the crux of wasteful spending. Doctors are paid for the number of services performed rather than the quality of care they provide. This incentivizes a <a href="http://mn2020hindsight.org/view/rejecting-more-is-better-medicine " target="_blank">&ldquo;more is better&rdquo;</a> approach to medicine. Bob Wachter, M.D., chair of the American Board of Internal Medicine explained in the <a href="http://stream.wsj.com/story/experts-health-care/SS-2-135539/" target="_blank">Wall Street Journal&rsquo;s <em>The Experts</em></a>, &ldquo;much of medicine involves decision-making under uncertainty, and when the incentive system favors doing more, that&rsquo;s what we end up doing. &rdquo;</p> <p> We need to adjust incentives so that they are truly in line with cost effective quality care.</p> <p> In response to the fee-for-service model, the Federal government included forty-five provisions to the Affordable Care Act intended to cut costs.&nbsp;</p> <p> One of the most promising provisions includes the implementation of Accountable Care Organizations. According to the Centers for Medicare &amp; Medicaid Services (CMS):</p> <p style="margin-left: 40px;"> &quot;Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients&hellip;When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.&quot;</p> <p> There are now well over <a href="http://leavittpartners.com/wp-content/uploads/2013/03/Accountable-Care-Paradigm.pdf" target="_blank">400</a> ACOs nationwide, currently serving about <a href="http://blogs.wsj.com/experts/2013/07/19/elliott-fisher-shift-to-accountable-care-organizations/" target="_blank">10% </a>of Americans.&nbsp;</p> <p> Minnesota pursued the ACO initiative aggressively. The state&rsquo;s already <a href="http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2013/Mar/1667_Edwards_Medicaid_Minnesota_case_study_FINAL_v2.pdf" target="_blank">highly integrated delivery system and extensive networks</a> put them in a unique position to adopt the ACO model. In 2011, three Minnesota based health care organizations&mdash;Allina, Fairview, and Park Nicollet&mdash;signed on to be one of the thirty-two Pioneer ACOs. The project intends to successfully accomplish the <a href="http://www.ihi.org/knowledge/Pages/IHIWhitePapers/AGuidetoMeasuringTripleAim.aspx" target="_blank">Triple Aim</a> of improving population health and experience of care, while simultaneously reducing per capita cost.</p> <p> However, this is significantly easier said than done. Last month the CMS published a <a href="http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-07-16.html" target="_blank">press release</a>&nbsp;explaining the status of Pioneer ACOs, and the results were mixed.</p> <p> The Pioneers served a total of 669,000 Medicare beneficiaries. All Pioneers exceeded fifteen of the thirty-three quality performance benchmarks. Eighteen of the ACOs performed below budget and thirteen of those performed well enough to receive bonus payments. Medicare costs in the ACO system increased by a smaller amount&mdash;0.3% in comparison to the 0.8% experienced by non-ACO Medicare beneficiaries. Over a one-year period, savings amounted to $87 million with $33 million going to Medicare.</p> <p> While the savings are impressive, they do not account for the high input costs of creating an ACO. Therefore, as Dr. Kavita Patel and Steven Lieberman from the Brookings Institute <a href="http://www.brookings.edu/research/opinions/2013/07/25-assessing-pioneer-acos-patel" target="_blank">point out</a>, the majority of Pioneer ACOs likely did not break even.</p> <p> In Minnesota, Allina was 0.8% over budget. Fairview and Park Nicollet did not report. All three have decided to remain within the ACO Pioneer program.</p> <p> These results demonstrate that it is possible to generate significant savings under the ACO model, but it is not easy. And the necessity to continually generate savings from one year to the next in order to qualify for bonus payments does not make it any easier. For relatively efficient organizations, continually cutting costs year after year while simultaneously improving care may not be feasible, and could undermine the ACO.</p> <p> Discovering how to reach the Triple Aim&rsquo;s third pillar of cost savings is not the only concern confronting ACOs either. The ACO model measures organizations based on several quality benchmarks. Hospital performance is empirically <a href="http://online.wsj.com/article/SB10001424127887323528404578454432476458370.html?mod=wsj_valettop_email " target="_blank">difficult to measure</a>. For example, determining something as seemingly simple as hospital death rates has proven very challenging. Depending on the algorithm used, a hospital&rsquo;s ratings can range from outstanding to dangerous.</p> <p> There is also widespread <a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/06/hospitals-want-to-delay-a-key-obamacare-program/" target="_blank">disagreement</a> pertaining to what benchmarks ACOs ought to strive for.&nbsp;Should they use a flat rate target? Or would it be better to base standards on comparative improvements from the previous year? Just this past March, thirty of the Pioneers&mdash;including all three Minnesota based ACOs&mdash; <a href="http://www.washingtonpost.com/blogs/wonkblog/files/2013/03/2013-Quality-Benchmarks.pdf" target="_blank">threatened to quit</a> the program unless the quality benchmarks were postponed and adjusted.&nbsp;While the Center for Medicare &amp; Medicaid Innovation (CMMI) and the Pioneers were able to come to a <a href="http://www.modernhealthcare.com/assets/pdf/CH88183424.PDF" target="_blank">compromise</a>, the request demonstrates the need to further reevaluate benchmark standards.</p> <p> However, these concerns are far from game over for ACOs. The ACO initiative has accomplished a lot by way of payment reform, and the recent Pioneer results offer a framework for organizations to move forward with appropriate adjustments. All in all, ACOs hold a lot of promise, but the health care payment system will not change over night. The process will be lengthy and difficult.</p> <p> In order to cut costs in the meantime, there is a comparatively simple approach of increasing transparency through&nbsp;<a href="http://www.economist.com/blogs/democracyinamerica/2013/07/high-cost-health-care-0?zid=318&amp;ah=ac379c09c1c3fb67e0e8fd1964d5247f " target="_blank">publishing insurance negotiated rates</a>. Health care costs vary greatly not only by region, but by hospital, and by doctor groups too, according to a recent <a href="http://books.nap.edu/openbook.php?record_id=18393" target="_blank">report</a> from America&rsquo;s Institute of Medicine. 70% of price variation in commercial health care spending is due to price mark-ups; therefore, increasing transparency could increase competition thereby driving down costs. Small measures such as this one could help quell anxiety and ease the payment reform transition.</p> <p> Payment reform is necessary, though as a stand alone insufficient. At this point, ACOs appear to be a viable option and Minnesota should continue to pursue the initiative. However, we do not need to stop there. While looking for ways to make ACOs more effective we can implement additional policies to supplement health care cost cutting.</p> Tue, 13 Aug 2013 11:00:41 +0000 Despite Regressivity, Tobacco Tax Increase was Good Policy http://mn2020.org/issues-that-matter/health-care/despite-regressivity-tobacco-tax-increase-was-good-policy http://mn2020.org/7232 <p> By Jeff Van Wychen, Fellow and Director of Tax Policy & Analysis </p> <p> In an <a href="http://www.mn2020.org/issues-that-matter/fiscal-policy/flawed-conservative-tax-incidence-analysis">article published last week</a>, Minnesota 2020 revealed the error in a conservative claim made in a <a href="http://www.postbulletin.com/opinion/rep-mike-benson-dfl-and-dayton-didn-t-merely-tax/article_cfd912f1-8618-56f9-bf56-6541f668a59a.html" target="_blank">Rochester Post Bulletin commentary</a> that &ldquo;each and every Minnesotan&rdquo; is going to pay higher taxes as a result of the 2013 tax act. The preponderance of middle income Minnesotans will actually pay lower&mdash;not higher&mdash;taxes as a result of the tax changes made during the last 2013 session.</p> <p> The flaw in the conservative analysis of the 2013 tax act was in assuming that the tobacco tax increase* will apply uniformly to all Minnesota taxpayers, which is not the case. Approximately <a href="http://mntobacco.nonprofitoffice.com/vertical/Sites/%7B988CF811-1678-459A-A9CE-34BD4C0D8B40%7D/uploads/%7B7CA6AA41-89A6-4701-BB43-C54E32FA157B%7D.PDF" target="_blank">84 percent</a> of Minnesota adults do not smoke and will not be affected by the tobacco tax increase. After factoring out the impact of tobacco tax increases, it is likely that the majority of non-smoking middle income Minnesotans will see a tax reduction. In fact, as noted in last week&rsquo;s article, only 0.1 percent of the net increase in non-tobacco taxes will be borne by Minnesota households with annual income below $146,400, which averages out to 29 cents per household per year.&dagger;</p> <p> However, the impact of the 2013 tax act will obviously be much steeper for Minnesota smokers. The impact of the cigarette tax increase will hit low income smokers particularly hard, since tobacco taxes are more regressive than any other state tax according to the <a href="http://www.revenue.state.mn.us/research_stats/research_reports/2013_tax_incidence_study_links.pdf">2013 Minnesota Tax Incidence Study</a>.</p> <p> Minnesota 2020 has generally favored increased dependence on progressive taxes and reduced dependence on regressive taxes, but we have always recognized that regressivity/progressivity is only one of several criteria by which a tax can be evaluated. A tax can also be evaluated based on its ability to defray public costs associated with harmful activities and as a way of discouraging those same activities. On both these criteria, the tobacco tax increase in the 2013 tax act scores highly.</p> <p> According to <a href="http://www.preventionminnesota.com/objects/pdfs/X18121_A_HCC_and_Smoking.pdf" target="_blank">a 2010 report</a> from Blue Cross and Blue Shield of Minnesota, &ldquo;In Minnesota, smoking was responsible for $2.87 billion in excess medical expenditures in 2007&mdash;a per capita expense of $554 for every man, woman and child in the state.&rdquo; The excess medical expenses associated with smoking include costs for physician and other professional health services, hospital and nursing home care, and prescription drugs.</p> <p> <a href="http://www.lung.org/stop-smoking/tobacco-control-advocacy/reports-resources/cessation-economic-benefits/reports/MN.pdf" target="_blank">Another 2010 study</a> conducted by researchers at Penn State University looked beyond the direct medical expenses of smoking to include costs associated with workplace productivity and premature death losses. After factoring in these costs, the Penn State study concluded that &ldquo;in Minnesota the annual direct costs to the economy attributable to smoking were in excess of $5 billion.&rdquo; The study went on to note that &ldquo;the combined medical costs and productivity losses attributable to each pack of cigarettes sold [in Minnesota] are approximately $20.83 per pack.&rdquo;</p> <p> Undoubtedly, a significant portion of these direct losses translate into increased public expenses and reduced public revenue. The state tax per pack of cigarettes&mdash;$2.83 after the 2013 increase&Dagger;&mdash;is not excessive relative to the cost that cigarette smoking imposes on society.</p> <p> In addition to helping defray the costs associated with tobacco usage, it is an established fact that increases in tobacco taxes lead to a reduced consumption of tobacco products. This is especially true among lower income households and teens, who are especially price sensitive. Thus, the increase in tobacco taxes has the additional benefit of not only defraying the societal costs of tobacco usage, but reducing these costs in future years, as well as improving health and saving lives&mdash;especially among lower income households where cigarette usage is most prevalent, according to the <a href="http://clearwaymn.org/wp-content/uploads/2012/11/MATS2010-FULL.pdf" target="_blank">2010 Minnesota Adult Tobacco Survey</a>.</p> <p> It is refreshing to see conservative legislators finally taking an interest in reducing tax regressivity, as revealed in the Post Bulletin commentary. Certainly such attitudes among right wing policymakers were rare over the last ten years, as recurring state budget deficits were resolved through repeated <a href="http://mn2020.org/issues-that-matter/fiscal-policy/restoring-property-tax-relief" target="_blank">slashing </a>of property tax relief programs, leading to increases in regressive property taxes. Hopefully the newfound conservative interest in tax regressivity will be more than a temporary and politically expedient fad.</p> <p> However, the regressivity of the tobacco tax increase in the 2013 tax act is justified on the grounds of other societal benefits that it advances, such as increased revenue, improved health, and saved lives. After all, as a state and as a society, we can do more for low income people than simply giving them access to cheap carcinogens.</p> <p> Furthermore, the revenue generated by 2013 tax act will benefit all Minnesotans&mdash;especially low and moderate income families&mdash;by helping increase state funding for:</p> Minnesota public schools, which will reduce class sizes, improve course offerings, and partially offset the sharp decline in real per pupil state aid over the last decade. This includes new investments designed to close <a href="http://www.mn2020.org/issues-that-matter/education/it-s-time-to-tackle-minnesota-s-achievement-gap" target="_blank">Minnesota&rsquo;s achievement gap</a>. All-day kindergarten, which will reduce expenses for parents and help kids enter grade school with the skills they need to succeed. Early Learning Scholarships, which will allow young children from low-income families to benefit from early childhood education. MnSCU and the University of Minnesota, which will stabilize tuition costs and replace a portion of the state funding decline that occurred over the last ten years. The Minnesota Job Creation Fund, the Minnesota Investment Fund, and other business development and adult workforce training programs, which will create a skilled workforce and grow Minnesota businesses. This includes funding for initiatives specifically designed to help economically distressed regions of the state. Programs to provide job training for at-risk youth and improve employment opportunities for people with physical and mental disabilities. Housing initiatives, which will increase the supply of affordable housing, reduce family homelessness, improve housing stability for people with mental illnesses, and rehabilitate residential properties. The renters property tax refund and a <a href="http://www.mn2020.org/issues-that-matter/fiscal-policy/targeted-powerful-property-tax-relief">new homestead credit refund</a>, which will provide targeted property tax relief for low and moderate income households. Civil legal services and the Board of Public Defense, which will reduce caseloads and help low income families and individuals get legal assistance. The Department of Veterans Affairs to improve access to health care for Minnesota veterans. A variety of measures to improve access to insurance and health care for a wide variety of Minnesotans. <p> These and other benefits of legislation passed during the 2013 session are described in more detail in a <a href="http://www.mnbudgetproject.org/research-analysis/minnesota-budget/proposals-budget-outcomes/Budget-Choices-in-2013-Legislative-Session.pdf" target="_blank">recent Minnesota Budget Project publication</a>.</p> <p> Conservative gripes about the 2013 tax act are based on a flawed interpretation of Revenue Department information and a failure to take into account the numerous benefits that increased state revenue will make possible. Many of these benefits will accrue to the middle and lower income families and are well worth the additional 29 cents per year that the average non-smoking Minnesota household with income below $146,400 will pay. Households with smokers will pay more, but this is entirely justified based on the increased societal costs resulting from tobacco use and the increased incentive to quit smoking that the tobacco tax increase will produce.</p> <p> In 2013, progressive public policymakers delivered on their promise to make Minnesota&rsquo;s tax system <a href="http://www.mn2020hindsight.org/view/new-report-reveals-2013-tax-act-is-powerfully-progressive">less regressive</a>, improve Minnesotans&rsquo; quality of life by restoring public investments in education and other important public assets, and balance the state budget without shifts and gimmicks. Furthermore, progressives accomplished this while at the same time reducing taxes for most middle income families. Despite conservative naysaying, the 2013 Legislature made great strides toward tax fairness, revenue adequacy, and sound fiscal management.</p> <p> &nbsp;</p> <p> <em>*As used here, the term &ldquo;tobacco tax increase&rdquo; will refer to the cigarette and tobacco tax increases in the 2013 tax act. The cigarette and tobacco tax results presented in the Department of Revenue (DOR) <a href="http://www.revenue.state.mn.us/research_stats/revenue_analyses/2013_2014/Final_Incidence_Analysis_2013.pdf" target="_blank">incidence analysis of the tax act</a> includes a tax reduction resulting from an increase in the small brewers&rsquo; credit, which DOR staff characterize as negligible.</em></p> <p> <em>&dagger;Given the margin of error in the DOR incidence analysis, it would be appropriate to characterize this tiny increase as approximately zero.</em></p> <p> <em>&Dagger;After the 2013 tobacco tax increase, the total average retail price for a <a href="http://www.tobaccofreekids.org/research/factsheets/pdf/0202.pdf" target="_blank">pack of cigarettes in Minnesota</a> including taxes is $6.44.</em><br /> &nbsp;</p> Mon, 29 Jul 2013 11:00:16 +0000 The Mental Health Discussion: a Mixed Bag http://mn2020.org/issues-that-matter/health-care/the-mental-health-discussion-a-mixed-bag http://mn2020.org/7213 <p> By Annalise McGrail, Undergraduate Research Fellow </p> <p> Few medical issues are as widely misunderstood as mental illness. As many as <a href="http://www.startribune.com/opinion/editorials/211123061.html" target="_blank">1 in 4</a> Americans experience a mental illness or substance abuse disorder each year, yet we still approach the topic with fear and confusion.</p> <p> This year&rsquo;s tragic shootings have given unprecedented attention to mental health. While the state of mental health has long been in desperate need of this focus, the reason for the spotlight is troublesome. Highlighting mental health in context of the shootings gives the impression that individuals with mental illness are by in large dangerous. This is false. &quot;Only about <a href="http://www.nytimes.com/2013/02/01/us/focus-on-mental-health-laws-to-curb-violence-is-unfair-some-say.html?pagewanted=all&amp;_r=0">4 percent of violence</a> in the United States can be attributed to people with mental illness,&quot; according to a New York Times commentary quoting an <a href="http://ajp.psychiatryonline.org/article.aspx?articleid=96905" target="_blank">American Journal of Psychiatry article</a>. In these cases, weapons are used only 2 percent of the time, according to another <a href="http://www.nytimes.com/2013/02/01/us/focus-on-mental-health-laws-to-curb-violence-is-unfair-some-say.html?pagewanted=all&amp;_r=1&amp;" target="_blank">Times article</a> published after the Sandy Hook shooting. Furthermore, individuals with mental illness are 11 times more likely than the general population to have violent crimes perpetrated on them.</p> <p> Mental health care is broken in more ways than one. That is why last month President Obama called for a new national conversation about mental health. We need improved access to care, more research, and a national dialogue that seeks to understand the issues.</p> <p> One of the most complicated components to mental health is the stigma accompanying it.</p> <p> One <a href="http://www.huffingtonpost.co.uk/2013/06/10/depression-university-mental-health-stigma_n_3415641.html?utm_hp_ref=uk" target="_blank">survey</a> found that 90% of young adults with a mental health concern report experiencing negative treatment as a result of their illness; and as many as 40% of those experience that treatment on a daily basis.&nbsp;Lisa Lambert, executive director for the Parent/ Professional Advocacy League and mother to a child with a mental illness, explains:</p> <p style="margin-left: 40px;"> &quot;We all live in a society where the stigma around mental illness can stop us in our tracks. It&rsquo;s far more serious than a lack of understanding. People repeat things to you that cut you to the quick and you learn not to tell them what you are going through.&quot;</p> <p> This stigmatization is a major barrier to accessible care. Mary Brainerd, the CEO and president of HealthPartners explains in a <a href="http://finance.yahoo.com/news/campaign-seeks-end-silence-mental-154900358.html" target="_blank">May press release</a>, &ldquo;most people live with the symptoms of a mental illness for up to 10 years before seeking treatment, largely due to stigma.&rdquo; A significant portion of the American population goes without care, because society has not created a safe enough environment for accessible care.</p> <p> Minnesota has set out to change this. A little over a month ago a collaboration between the Minnesota chapter of the National Alliance on Mental Illness (NAMI-MN), HealthPartners, Regions Hospital, and many metro community organizations launched the Make it OK campaign, seeking to normalize the mental health discussion, create understanding, and make it easier for individuals to access necessary care.</p> <p> Sue Abderholden, executive director for NAMI-MN explains, &ldquo;'This is really about &hellip; how do we <a href="http://www.startribune.com/opinion/editorials/211123061.html" target="_blank">create empathy and respect for somebody</a> who is going through this, how do we make people more comfortable? What we&rsquo;re talking about is different than raising awareness. It&rsquo;s the next step.'&rdquo;</p> <p> In addition to the Make it OK campaign, Abderholden explains how the legislature recently passes <a href="http://www.minnpost.com/community-voices/2013/07/2013-has-been-banner-year-minnesota-childrens-mental-health" target="_blank">17 new measures</a> to improve children&rsquo;s mental health services in the state, which includes doubling funding for school-based mental health grants.&nbsp;</p> <p> What makes these new initiatives different than their predecessors is the much needed inclusion of individuals with mental illness in the discussion. Instead of enacting programs for individuals with mental illness, the reforms are made with them.&nbsp;</p> <p> No individual should go without proper medical care, especially on account of fear. &ldquo;Like any other medical condition, mental illnesses are biological in nature, and should be treated with the same urgency as diabetes or heart disease,&rdquo; says Abderholden.</p> <p> In addition, mental illness has severe affects on general health. <a href="http://theincidentaleconomist.com/wordpress/the-physical-reality-of-mental-illness/" target="_blank">A 20-year study</a> examining people in Western Australia found men with mental illness die on average 16 years earlier, and women die 12 years earlier, a mortality difference on par with life-long smoking.</p> <p> Lastly, current mental health care, or lack there of, creates&nbsp;<a href="http://www.nytimes.com/2013/07/02/magazine/the-half-trillion-dollar-depression.html?_r=0" target="_blank">inequality</a>. Individuals with serious mental illness on average earn $16,000 less and are at a greater risk for poverty. This affects us all, as it costs the country a $193 billion annual loss of earnings, $150 billion on direct care that is ineffective or incorrect for their condition up to half of the time, and over $140 billion on indirect public safety-net services, according to a NY Times article citing a 2008 American Journal of Psychiatry study. By continuing research and implementing effective policies that highlight outreach, a cost effective solution that betters the livelihood of individuals with mental illness and improves society as a whole could be found.</p> <p> Minnesota has a&nbsp;mental health care <a href="http://www.duluthnewstribune.com/event/article/id/271429/" target="_blank">shortage</a> in all but the counties surrounding the Twin Cities and Rochester, with many of these areas having little to no psychiatry care for youth. Many of the changes in the state will certainly have substantial effects for those in the metro, but will still leave those in rural communities underserved.</p> <p> Minnesota is most certainly on the right track, but more needs to be done to help all citizens.</p> Wed, 17 Jul 2013 11:00:48 +0000 Obamacare is Coming http://mn2020.org/issues-that-matter/health-care/obamacare-is-coming http://mn2020.org/7169 <p> By Kevin George, Policy Associate </p> <p> Arguments about health insurance rate shocks when Obamacare kicks in willfully disregard key facts behind the policy.</p> <p> Claims regarding rate shock are based on the premise that the cheap plans on the market today are no longer going to be available, and the new plans will be incredibly expensive. To get there, many conservatives go to eHealthInsurance.com, a private insurance marketplace, and compare the cost of the cheapest rates on the private market to the cost of plans on health insurance exchanges.</p> <p> As <a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/01/the-shocking-truth-about-obamacares-rate-shock/" target="_blank">Ezra Klein states</a>, however, comparing <a href="http://www.forbes.com/sites/theapothecary/2013/05/30/rate-shock-in-california-obamacare-to-increase-individual-insurance-premiums-by-64-146/" target="_top">eHealthInsurance.com rates</a> with Obamacare rates is &ldquo;not just comparing apples to oranges. It&rsquo;s comparing apples to oranges that the fruit guy may not even let you buy.&rdquo;</p> <p> Many of those who are uninsured right now would not be eligible for the $60/month plans available on the market. That&rsquo;s because these prices assume you have no risk factors, and are a young, healthy individual. After filling out the health forms, most uninsured folks would find themselves on the hook for considerably more than $60/month, for the same coverage.</p> <p> Think of it as one of those car commercials with a rock bottom interest rate. In reality, most people don&rsquo;t actually have the credit score to qualify for that rate. Exchange plans will show the price you'll pay up front, so the price you see is the price you pay. Furthermore, the new plans are required to offer more than just the bare bones coverage, which contributes to a higher average cost. But, in the long-term, patients&rsquo; out-of-pocket costs will be less with the new plans.</p> <p> Those ginning up fear about rate shocks only refer to the monthly premium, which is a pretty shoddy cost-measurement tool. Monthly premiums aren&rsquo;t the limit of what you&rsquo;ll be spending on any plan. Think about the current system&rsquo;s co-pays, deductibles, and procedures insurance doesn&rsquo;t cover.</p> <p> Using the median household income ($28,693) for Minnesotans younger 25, I went to eHealthInsurance.com and found myself a plan based on my age, location (a 23-year-old St. Paul resident) and a couple of basic health questions. Medica&rsquo;s Solo plan with a $12,600 annual deductible was one of the cheapest, with a monthly premium of $69.39. This comes with a total out-of-pocket expense limit of $13,600 in a calendar year. (Excluding the monthly premium, that&rsquo;s the most you&rsquo;d have to fork over for one year.)</p> <p> The most stripped down coverage level for Obamacare plans is <a href="http://www.healthpocket.com/individual-health-insurance/bronze-health-plans#.Ucsb-PlZiSo" target="_blank">the Bronze coverage,</a> which is expected to have a total out-of-pocket expense limit of $6,400.</p> <p> Since Minnesota's exchange is still in development, so it's not possible to make an exact comparison. However, one state that can possibly act as a guide is <a href="http://www.cahba.com/assets_c/2013/02/Standardized%20Benefits%20Overview-406.htm" target="_top">California</a>, which has the first official Obamacare plans on a exchange. It shows I would pay a $137 monthly premium for my plan, and would have that $6,400 out-of-pocket limit. What it boils down to is that I would pay an extra $67/month to reduce my total liability by $7,200/year.</p> <p> I know what people are thinking, I&rsquo;m a healthy young person. Why should I pay that much extra to lower my out-of-pocket, when I&rsquo;ll likely never need it?</p> <p> Consier this: Medica estimates the average <a href="http://www.mainstreetmedica.com/pdc-detail.html?pdc=154&amp;sort=2,0" target="_blank">price of an appendectomy</a> in St. Paul (a procedure two of my closest friends had at 22), to be between $6,881 and $10,500. Even on the lower end, say $8,000, you're already well above the out-of-pocket threshold for the Obamacare plan, but still well below the cheaper plan.</p> <p> Add in a second emergency, and you&rsquo;re looking at a pretty painful year on the pocketbook under the cheap plan.</p> <p> All right, maybe you can stay healthy over a few years, but let&rsquo;s consider what could happen over a decade. Reaching that $13,600 out-of-pocket threshold while on the Bronze plan from Obamacare instead of the Medica plan would pay for 107 months of the additional $67 premium, or nearly 9 years&rsquo; worth.&nbsp;</p> <p> Finally, conservative claims about rate shock tend to ignore the premium subsidies included in the Affordable Care Act. Individuals and families making up to 400% of the federal poverty line &ndash; $45,960 for an individual and $94,200 for a family of four &ndash; are eligible for tax subsidies on their health care premiums. Considering that the vast majority of uninsured Minnesotans live under the 400% of poverty level, nearly all of them would be eligible for some measure of subsidy.</p> <p> In the recently released California plans, a 21-year old making 150% of the <a href="http://www.familiesusa.org/resources/tools-for-advocates/guides/federal-poverty-guidelines.html" target="_blank">federal poverty line</a>, or $17,235/year, or less would pay nothing for the most affordable Bronze-level health care. That&rsquo;s a $0/month premium. And while that might be a shocking rate, it&rsquo;s sure not going to be bankrupting anyone.</p> <p> <a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/23/california-obamacare-premiums-no-rate-shock-here/" target="_blank">Rate shock is a myth</a>, designed only to scare the public into believing that the most meaningful health care reform in recent history will bankrupt people everywhere. What I&rsquo;ve written above is only the immediate dispelling of the fear mongering. A number of factors will better control costs across the system over time, as the total cost of health care decreases due to everyone having insurance.</p> <p> We need facts, not rhetoric, to prevail in order to make the transition to the Affordable Care Act as smooth as possible. That starts with not allowing the myth of rate shock to continue. People are going to save money on health care with minimum-standard plans. We&rsquo;ll all be richer, and healthier, for it.</p> Tue, 09 Jul 2013 11:00:20 +0000 Preparing for the Medical App Revolution http://mn2020.org/issues-that-matter/health-care/preparing-for-the-medical-app-revolution http://mn2020.org/7129 <p> By Annalise McGrail, Undergraduate Research Fellow </p> <p> Smart phones and the apps that help them run have become so mainstream, the medical community is tapping into the technology to help lower access barriers, deliver higher quality care and hopefully drive down medical costs. Mobile health, or mHealth, is incorporating a wide range of apps, from a device called <a href="https://www.cellscope.com/ " target="_blank">CellScope</a>, that can record and transmit images of the middle ear, to a personalized diagnosis program partnered with the Mayo Clinic, called <a href="http://allthingsd.com/20130416/can-a-247-medical-app-save-your-life-better-thinks-so/" target="_blank">Better</a>.</p> <p> By 2010, 50% of physicians were already using smartphones on a daily basis, according to a Putzer and Park study. The industry is estimated to be highly lucrative with revenues predicted to reach $23 billion by 2017, according to the consulting firm PricewaterhouseCoopers. If the trend continues, the shift appears to be mutually beneficial with a Benton Foundation study estimating that the industry will reach gains in medical productivity of $305.1 billion by 2022.</p> <p> Therefore, it is not a question of whether mHealth technology should be utilized, but rather how we appropriately implement it. While mHealth may be inevitable, its medical benefit is not a guarantee. The industry depends on individuals thoroughly understanding the potential problems, actively seeking solutions, and preceding forward with caution.</p> <p> Regulation has been a key government concern. We currently lack effective means to determine which of tens of thousands of health care apps currently in the market are legitimate. The FDA began drafting regulatory guidelines in July 2011, but probably won't finalize and release them until October of this year. The industry's rapidly transforming nature is likely to blame for this <a href="http://www.healthcaretechnologyonline.com/Doc/taking-the-pulse-of-mobile-health-0001" target="_blank">delay</a>. And there's no sign the industry is slowing down. A recent FDA <a href="http://www.fda.gov/NewsEvents/Testimony/ucm344395.htm " target="_blank">statement</a> explains that &ldquo;[health care apps] are being adopted almost as quickly as they can be developed.&rdquo; Therefore, individuals ought to be cautious of which apps they choose to trust and should verify results with their doctors.</p> <p> It is also not yet clear how effective privacy protection will be. Joe Santilli, the CEO of SafeApp explains, &ldquo;an app is like giving somebody the keys to the house.&rdquo; App producers gain access to a breadth of sensitive information about their users. David Kotz, Computer Science professor at Dartmouth agrees, &ldquo;[his] concern is that most producers of new hardware and software won&rsquo;t be worried about your privacy or about the security of your data.&rdquo;</p> <p> In order to combat security issues Congressman Hank Johnson from Georgia introduced the <a href="http://www.govtrack.us/congress/bills/113/hr1913" target="_blank">Application Privacy, Protection, and Security Act</a>. Johnson explains that the law &ldquo;would require that app developers provide transparency through consented terms and conditions, reasonable data security of collected data, and users with control to cease data collection by opting out of the service or deleting the user&rsquo;s personal data to the greatest extent possible.&rdquo;&nbsp; The bill faces an uphill battle on the Hill.</p> <p> Cyber security presents another problem. Although uncommon, hackers can access personal information available on smartphones, and in extreme cases researchers have <a href="http://now.dartmouth.edu/2011/09/cybersecurity-health-care-and-mobile-devices/ " target="_blank">discovered a means</a> that would enable a hacker to induce a heart attack from a pacemaker or inject a lethal overdose from a mobile insulin pump. Kotz explains that these &ldquo;examples have awakened people to the realization that medical device makers must focus on issues they&rsquo;ve previously ignored, namely wireless network and computer security.&rdquo;&nbsp;</p> <p> Ultimately, there's little consensus on how much apps' can improve care. Telemedicine initiatives like HealthPartners&rsquo; 24/7 online clinic <a href="https://www.virtuwell.com/?s_kwcid=TC|15670|virtuwell||S|e|27117589423&amp;gclid=CPavtd_k8rcCFSJqMgodMCEAig" target="_blank">Virtuwell</a> have been successful because they are <a href="http://www.minnpost.com/twin-cities-business/2013/06/telemedicine-tourniquet " target="_blank">effective means</a> to treat minor problems. It improves accuracy and efficiency, all while providing physicians the time they need to spend with patients suffering from more serious conditions. However, many other apps intend to address chronic conditions. App developers often lack a medical background and consequently they are often dangerously inaccurate. Dr. Laura Ferris ran a <a href="http://archderm.jamanetwork.com/article.aspx?articleid=1557488#qundefined " target="_blank">study</a> of apps claiming to detect skin cancer from a picture of a mole. One app had a 98% success rate, but the others failed to detect melanoma as much as 90% of the time. As a result, individuals ought to be careful when choosing to defer to the ease of a smartphone health care app.</p> <p> Smartphone apps have the potential to revolutionize the health care industry by improving physician-patient communication, increasing access to care, and cutting costs. However, the industry presents a complicated range of problems that we are only beginning to fully understand. Resolving these concerns will require a responsive government, dedicated physicians, and diligent patients.</p> Tue, 25 Jun 2013 11:00:46 +0000 Forget Florida, MN Tops for Retiree Health http://mn2020.org/issues-that-matter/health-care/forget-florida-mn-tops-for-retiree-health http://mn2020.org/7069 <p> By Annalise McGrail, Undergraduate Research Fellow </p> <p> Much of the nation is frightfully unprepared for the dramatic demographic shift happening as a result of the aging baby boomer population, according to a United Health Foundation <a href="http://www.americashealthrankings.org/senior/all/2013 " target="_blank">study</a>. In this much needed wake up call to the national healthcare system, researchers indicate that between 2015 and 2030 the American population 65 and older will increase by 53%, and will comprise <a href="http://www.census.gov/prod/2010pubs/p25-1138.pdf" target="_blank">1/5 of the entire American population</a>.</p> <p> Americans are living longer than ever before, but are facing increased health problems in the form of high rates of diabetes, obesity, and other chronic diseases. The Centers for Disease Control and Prevention (CDC) indicates that healthcare costs are 3 to 5 times more for adults 65 and over than for adults under 65. With healthcare spending already accounting for <a href="http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS" target="_blank">17.9% of GDP</a>, these changing demographics will present a financial challenge for many states and will result in lower levels of care for many seniors.</p> <p> Minnesotans in contrast are comparatively well prepared. It looks like enduring all those bitter cold winters have paid off after all; Minnesota ranked #1 as the healthiest state for adults 65 and older. It was in the top five for home health care worker rates, low percentage of food insecurity, prescription drug coverage, percentage of seniors who report very good or excellent health, and mental health, just to name a few. This is very good news for the <a href="http://www.health.state.mn.us/divs/orhpc/pubs/healthyaging/demoage.pdf" target="_blank">1.5 million baby boomers in Minnesota</a>.&nbsp;</p> <p> Minnesota&rsquo;s work is far from over, however. The study also gave light to some issues that need to be addressed in senior care. The study indicates that Minnesota faces challenges with 200,000 inactive adults of ages 65 and older, comparatively lower percentage of dedicated health care providers, limited community support expenditures, and prevalence of chronic drinking.</p> <p> Excessive drinking, an area Minnesota ranks below average in, is of particular concern. Adults 65 and older <a href="http://www.cdc.gov/vitalsigns/BingeDrinking/index.html" target="_blank">binge drink more often</a> than any other age group. In addition, a <a href="http://ajp.psychiatryonline.org/article.aspx?articleID=101223&amp;RelatedWidgetArticles=true" target="_blank">study </a>in the American Journal of Psychiatry&nbsp;indicates that a larger percentage of baby boomers drink in excess than the generation before them. For adults 65 and older binge drinking just twice a month <a href="http://www.cnn.com/2012/07/19/health/alzheimers-caregivers" target="_blank">doubles the rate of cognitive function decline and increases the rate of memory decline more than fivefold</a>.&nbsp;This is particularly troublesome, as a decline in cognitive function is empirically linked to Alzheimer's.&nbsp;Policy changes will be important in addressing current health care gaps, but alone will be insufficient; individuals must be diligent to ensure their own future health.</p> <p> As demographics continue to shift, states will be forced to make changes, and will inevitably look to Minnesota&rsquo;s example when doing so. Therefore, there is a great level of responsibility that comes with our #1 spot. Lucky for us, Minnesota has historically been responsive to studies in the past, even when already ranking highly. In 2011 Minnesota ranked <a href="http://www.longtermscorecard.org/~/media/Files/Scorecard%20site/Report/Case%20Studies/AARP758_Minnesota_May8_FINAL.pdf" target="_blank">#1 for long-term services and supports</a>, but ranked low on two categories of home care. However, Minnesota promptly established a health care task force to effectively address the problem.</p> <p> In the case of health care directed towards seniors, the government even began to address problems with status quo care before the study was released. <a href="http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&amp;RevisionSelectionMethod=LatestReleased&amp;dDocName=dhs16_166654" target="_blank">Reform 2020</a>, an initiative supported by many <a href="http://mn2020.org/issues-that-matter/health-care/empowering-individuals-meeting-unmet-needs">disability advocates</a> will soon make some much needed adjustments to senior care. Reform 2020 will <a href="http://www.accesspress.org/2012/07/medicaid-reform-2020-pathways-to-independence/" target="_blank">improve home and community based support, engage consumers more directly, and facilitate direct contracting with providers</a> to improve care for seniors as well as individuals with disabilities.</p> <p> While improving care, Reform 2020 is simultaneously projected to save Minnesota tax payers <a href="http://www.mn.gov/governor/images/Reform_2020_Delivering_Care_More%20Efficiently.pdf" target="_blank">$151 million</a> over the next five years. In addition, if other states adopted Minnesota&rsquo;s model, approximately <a href="http://www.echopress.com/event/article/id/104870/group/News/" target="_blank">200,000 people</a> could be kept out of the nursing home system, and instead experience more <a href="http://www.npr.org/2011/07/18/138158827/at-88-a-chance-to-be-independent-again" target="_blank">freedom and independence</a>&nbsp;in the comforts of their own home and community.</p> <p> In a nutshell, for those of you contemplating retiring along the beach in the Sunshine State or desiring to escape those pesky mosquitoes in the Land of Enchantment, I recommend reconsidering the benefits of living amongst <a href="http://www.startribune.com/lifestyle/184723611.html" target="_blank">Minnesota- nice folks</a>, having access to more shoreline than California, Florida, and Hawaii combined, and having access to the # 1 senior healthcare system in America that is pro-active and responsive to boot.</p> Thu, 06 Jun 2013 11:00:44 +0000 VIDEO: Insurance Exchange Coming to Minnesota http://mn2020.org/issues-that-matter/health-care/video-insurance-exchange-coming-to-minnesota http://mn2020.org/7027 <p> By Tom Niemisto, {related_entries id="article_author_blogger"}Tom Niemisto, Video Production Specialist </p> <p> Three years after the Affordable Care Act passed in congress, Minnesota and&nbsp;<a href="http://kff.org/health-reform/state-indicator/health-insurance-exchanges/#map" target="_blank">fifteen other states</a> have opted to shape their own healthcare exchange system. Going into effect in October,&nbsp;<a href="http://www.mn.gov/hix/how-work/overview.jsp">MNsure</a> will be an online marketplace for individuals, small businesses, and larger companies to compare plans that work for them.</p> <p> We checked in with <a href="http://www.mnbudgetproject.org/" target="_blank">Minnesota Budget Project</a>, and <a href="http://www.smallbusinessmn.org/" target="_blank">Small Business Minnesota</a>, two leading voices in shaping the policy, to find out what to expect in the progress to new health care policy in Minnesota.</p> <p> &nbsp;</p> <p style="text-align: center;"> </p> Thu, 30 May 2013 11:00:40 +0000