OUR PRIORITIES

ENHANCING COVERAGE

ENHANCING COVERAGE

People deserve comprehensive, high quality, affordable coverage.

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INCREASING ACCESS

INCREASING
ACCESS

All people should have equal access to healthcare with a choice of providers.

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IMPROVING OUTCOMES

IMPROVING OUTCOMES

People need the right care and supports to make them healthy.

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HEALTHIER COMMUNITIES

HEALTHIER COMMUNITIES

We are committed to reducing health disparities and improving the health of whole communities.

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Patient-centered medical homes:

They have teams you can trust to help you with:

 

Everything there is about patient-centered care:

 

In a Good Patient-Centered Medical Home…

  • You get the care you need when you need it.
  • Transportation and help with appointments make it easier to go to different doctors or places.
  • A team of professionals and anyone else you choose guides all care.
  • The team responds quickly when you ask for help.
  • The team listens, answers questions, and makes care easy to understand.
  • Face-to-face conversations are always available.
  • The team respects you by understanding your life situation and preferences.
  • The team supports your personal health goals.
  • The team asks you about the care it gives to make sure it is equal, respectful, safe, and timely.

Pennsylvania is currently working on implementing patient-centered medical homes in several different ways:

Health Homes for Opioid Treatment

Patient-Centered Medical Homes Advisory Council

Supportive Housing Services:

Our traditional model for affordable housing assumes that if you provide the physical space in which someone can live, they will overcome homelessness (i.e. “build it and they will come”). Driving this is a funding model that resources construction capital and operating costs. However, as we turn to address the issues of chronic homelessness, which are often compounded by serious and persistent mental illness, substance use disorder, co-occurring disorders, or multiple chronic physical health conditions, we know that simply having housing does not guarantee success. A new supportive housing services component needs to be added to the housing plan to ensure successful tenancy. The complexity of these populations also highlights the connection between health and housing. Safe, stable housing is a social determinant of health. A growing body of research indicates that health outcomes improve when someone has permanent supportive housing.

To fix the problem with funding, some states have already begun to turn toward using state Medicaid dollars to pay for supportive housing services for the chronically homeless who also have serious and persistent mental illness, substance use disorder, co-occurring disorders, or multiple chronic physical health conditions. States like Louisiana, Massachusetts, and Texas use their Medicaid dollars to pay for supportive housing services only. They do not pay for housing construction or rental subsidies. However, New York and California are moving toward paying directly for housing.

A campaign is currently working to press Pennsylvania to use state Medicaid dollars to fund supportive housing services. If you believe housing and health are important and interconnected, please contact Patrick Keenan for more information at patrick@pahealthaccess.org or (717) 322-5332.

You can join the campaign by completing this brief survey:

BRIEF SURVEY

Substance Use Disorder:

Passage of the Affordable Care Act (ACA) expanded insurance coverage for people with substance use disorders and improved the range of available treatment options and recovery support services. Many newly eligible individuals have enrolled in coverage since then, and countless others who already had insurance gained coverage for substance use disorders services for the first time. However, thousands more people living with substance use disorders or in recovery remain unenrolled.

To obtain comprehensive health care benefits, the uninsured must enroll in health insurance coverage. Reaching people with substance use disorders requires targeted outreach because the illness itself can create barriers to enrollment. Massachusetts’ experience with implementing a near-universal health insurance law shows the need for targeted outreach: Within four years of reforming the state’s health insurance law, 97 percent of Massachusetts residents were enrolled, but about 25 percent of those seeking treatment for substance use disorders remained uninsured.1

Impact of having a chronic illness

Addiction to drugs or alcohol is a chronic illness with symptoms that can make enrollment challenging, such as an inability to concentrate or retain information. It can also create barriers to maintaining employment, securing reliable transportation, or interacting with others.2 Many people with a substance use disorder also have a mental and/or physical illness, further complicating access to care.

Daunting application process

The length of time needed to process applications, complexity of the process, and requirements for documentation of income, citizenship, and residence can be challenging for anyone. Individuals with severe substance use disorders are vulnerable to experiencing homelessness and may have frequent changes to their mailing address or no address at all. These factors make it exceedingly difficult to get required documentation and to find a safe place to store these important papers.

Sporadic encounters with the health care system

Many people are expected to learn about ACA enrollment through their health care providers, but many individuals with substance use disorders do not have a regular health care provider, or may avoid seeking care. Health insurance is complex to navigate, particularly for people who have never before had coverage. People with substance use disorders may not know that they qualify for subsidized marketplace health plans, or that they are newly eligible for Medicaid. Many also do not know about the range of treatment options available to them, including integrated primary and behavioral health care, accountable care organizations and health homes that can help them navigate the health care system and coordinate care.

Misinformation about eligibility

Some formerly incarcerated people believe they are not eligible for coverage. In states where Medicaid eligibility is expanded, people leaving prison or jail who have low incomes will likely be eligible for Medicaid and subsidized private insurance plans. In all states, formerly incarcerated people who do not have health insurance coverage through a job and earn too much to qualify for traditional Medicaid can buy private insurance through the Marketplaces.3

Stigma

While there is movement toward treating substance use disorders as a chronic condition, many people still blame those with substance use disorders for what they see as moral failings. Stigma contributes to people with this illness feeling shame, making it difficult to seek treatment for their illness.

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Our commitment:

PHAN is partnering with PRO-ACT and the Council of Southeastern PA to help individuals and families with mental illness and substance use disorders connect with new health insurance options under the new health care law, the Affordable Care Act.

Under this partnership, we’ve developed specific outreach materials to inform the recovery community about coverage, we canvas for the uninsured at recovery events, target community locations connected to those in recovery, partner with providers of recovery supports, and host educational sessions to broaden the knowledge base of the recovery community about coverage options.

This on the groundwork teaches us about the specific barriers to care faced by those in recovery and helps us understand some of the next steps we need to take to ensure those in recovery have high-quality supports and services.

Health Systems Transformation

While the United States has some of the best medical resources (doctors, hospitals, resources), there are wide disparities in the quality of care different communities receive and we spend more on care than any other country in the world. We  need to focus on the Triple Aim: improving care, increasing health outcomes, and reducing costs. To do this, it takes a coordinated effort among consumers, providers, drug companies, medical device manufacturers, and insurers to transform our health systems. Specifically, Consumers Union groups what we need to do into several buckets:

  • Improving Population Health
  • Revealing What We Pay and What We Get
  • Changing How We Pay and What We Get
  • Organizing Care Delivery Differently

As we do these things, it’s important to ensure that consumers are engaged in the process and taken seriously, that we create a culture of care that is “person-centered,” that we incentivize person-centered care, that we ensure the proper resources and consumer protections are in place to improve outcomes, and that we address head on inequities in the system to ensure that all individuals can be healthy.

We need to tackle some key initiatives to delivers wins in each of the categories above. Some examples of work that can transform our current health system are:

  • Bundled Payments
  • Better Coordinated Care & Medical Homes
  • Health Information Technology
  • Value-Based Insurance Design
  • All Payer Claims Datasets
  • Accountable Care Organizations (ACOs)


1
Victor A. Capoccia, Kyle L. Grazier, Christopher Toal, James H. Ford II and David H. Gustafson, Massachusetts’s Experience Suggests Coverage Alone Is Insufficient To Increase Addiction Disorders Treatment. Health Affairs. 2012; 31(5): 1000-1008.
2 National Coalition for the Homeless: Substance Abuse and Homelessness. 
3 Open Society Foundation, “Affordable Care Act (ACA) 101”