Transcript Why Advocacy? Why Now? Medicare and Beyond

Why Advocacy? Why Now?
Medicare and Beyond
Lorrie McCann, LMHC, CT
Objectives
1) Answer the question: Why Advocacy? Why
Now?
2) Historical Perspective
3) Current Situation
4) Mental Health Needs for Seniors
5) Grassroots Advocacy
My goal: Heighten Your Interest and Stir Your
Passion
All Politics is Local (Tip O’Neill)
or Personal
 My Story
 The shrinking job market for LMHC’s due to
employer reluctance to hire LMHC’s in areas with
high Medicare populations
 This is particularly true in Florida which has the
highest percentage of people over 65 in the
country.
 The desire and the training to serve the Medicare
population but finding limited opportunities
We Were Young and Not Included
 Historical Background to Medicare Legislation
1933 Private hospital insurance approved by the American
Hospital Association leading to the establishment of Blue
Cross
August 14, 1935 Social Security Act signed into law – health
insurance
excluded
January, 1943 President Roosevelt in his State of the Union
calls for insurance from “ from the cradle to the grave”
Medicare History Continued
 April 1951 Social Security Annual Report recommends health insurance for beneficiaries
 August 27, 1957 Forand Bill HR 9467 to provide health insurance for social security beneficiaries
introduced
 July-August 1961 Ways and Means Committee conducts hearings on Medicare bill
 July 30, 1965 Medicare as an amendment to Social Security Act signed into law by President
Johnson under Title XVIII of the Social Security Act
 In 1984 Hospice benefit was added and 2003 prescription drug benefit
The House and Senate have twice passed legislation to include LMHC’s and MFT’s as Medicare
providers but not at the same time. Neither group was included as providers initially and this has
not changed.
Today there is a bill in the Senate SB562 and as of December, 2013 a companion bill in the House
HB 3662 to include LMHC’s and MFT’s as Medicare providers
It’s a Game Changer
Affordable Care Act
 ACA adds millions of beneficiaries through Medicaid expansion and
health exchanges
 Parity will increase those seeking care for substance abuse and mental
illness
 Shift to Accountable Care Organizations (ACO’s) an integrated care
model designed to focus on managing the healthcare of the beneficiary
with the goal of improved outcomes
 The ACO’s focus on preventing illness rather than treating the disease
creates a huge opportunity for LMHC’s but not if they’re excluded from
insurance panels
 Trial ACO’s implemented since 2011 are demonstrating cost savings!!
 Medicare exclusion will be a major barrier for LMHC’s seeking
participation in ACO’s as integrated networks become way of
managing healthcare
The Baby Boomers Are Coming
 Mental Health and Seniors
 At least 5.6 million to 8 million Americans age 65 and
over suffer from a mental health or substance abuse
disorder according to a recent report by the Institute
of Medicine (Reported by CBS News 7/11/12)
 Report co-author Dr. Peter Rabins a psychiatrist at
Johns Hopkins states that this number is sure to grow
as the senior population nearly doubles by 2030.
 Dr. Ken Duckworth of the National Alliance on Mental
Illness says,
The coming need for geriatric mental “is quite profound
for us as a nation.”
Key Senior Mental Health Issues
 Untreated depression impacts the management of
diabetes,
hypertension and many other health problems
There is a significant co-morbidity between Depression and
Heart Failure (or Congestive Heart Failure, a condition where
the heart can’t pump enough blood) research shows that
depressed people are less likely to be compliant with
treatment – depressed people with HF have poorer
outcomes including death
 Grief is a pervasive issue for the senior population as they
cope with retirement and the loss of spouse, friends and
health
Substance Abuse and the Elderly
 One third of alcoholics develop a problem later in life
 Heavy drinking is defined by 2 or more drinks/ days
 In community based study of people 60-94 years 6 % met this
criteria
 Bereavement and retirement may trigger late onset drinking in
some
 The effects of alcohol at the cellular and organ level are more
significant due to the physiological changes due to aging
 Increase fall risk
 Delirium and cognitive dysfunction
 Drug Interactions
 Immunosuppression leading to increase risk for pneumonia
Let Your Voice Be heard
 Practical Steps to Grassroots Advocacy
 Do your research – learn about the issues
 Join your professional organizations local, state
and national
 Do more than pay dues, get involved
 Be persistent, be respectful
 Use the advocacy tools provided by your
professional organizations
 Write letters, ask for a meeting with your legislator
Resources
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AMHCA Website www.amhca.org
FMHCA Website www.fmhca.org
U.S Senate www.senate.gov
US House of Representative www.house.gov
Macchio A, Monte S, Pelligrini F et al: Depression
Worsens Outcomes in Elderly with HF: European
Journal of HF, 2008;10:714-721
 Gardner A: Aging Baby Boomers Mental Health Woes
Will Swamp Health System: US News & World Report,
7/10/12
 Rigler S: Alcoholism in the Elderly: American Family
Physician; 2000 Mar 15: 170-1716