Experts discuss telemedicine, financial navigators in health care panel

By: Tiffany Esshaki | Birmingham - Bloomfield Eagle | Published March 26, 2019

 Members of the Birmingham Bloomfield Chamber of Commerce gathered for the final installment  in the chamber’s forecast breakfast series March 22.

Members of the Birmingham Bloomfield Chamber of Commerce gathered for the final installment in the chamber’s forecast breakfast series March 22.

Photo by Deb Jacques

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WEST BLOOMFIELD — Can you imagine if, in order to properly drive your car, you had to really know how it works?

We’re talking about knowing each and every piece of the engine, where the nuts and bolts are that hold the whole thing together, and how to fix that vehicle when something isn’t working for you.

A lot more of us would have bus passes, right?

Well, that’s kind of how health care works, unfortunately. It’s a notoriously complicated system with gaps and traps that, if not navigated correctly, can leave a patient broke or with substandard care.

The future of health care in southeast Michigan and beyond depends on government, insurance companies and care providers working together to make that system easier to understand and accessible to those without fluency in legalese.

That was the running theme for the morning at the Birmingham Bloomfield Chamber of Commerce Health Care Forecast breakfast at Henry Ford West Bloomfield Hospital March 22.

The event was the third in a series of themed forecasts hosted by the chamber, and the first one for the BBCC on health care. Traditionally, a government forecast will be part of the three-event lineup, but it could be argued that, these days, we get adequate political updates each day in the media.

Speakers at the breakfast event included Sunny Connolly, a senior partner at Patterson Bryan Group; Dan Sherman, of the NaVectis Group; Steven Selinsky, from Health Alliance Plan; and Henry Ford Health System Senior Vice President and North Market CEO Denise Brooks Williams.

Presentations were geared toward business owners and administrators. BBCC President Joe Bauman said the information is intended to help employers figure out how to get their hires benefits in an industry where the target seems to keep moving.

Sherman presented some thoughts on the emerging role of financial navigation services in health care settings — basically, someone who knows private and public insurance plans like the back of their hand, and knows how to squeeze out every last benefit for a patient.

“There’s been a lot of studies done about something called financial toxicity, which is the financial consequences of being diagnosed with an illness that’s going to be fairly expensive,” he explained. “(A 2013 study) found that 42 percent of insured cancer patients expressed having significant or catastrophic financial burden. Only 4 percent of the 2,000 people they interviewed were able to articulate correctly what a copay is, what coinsurance is, what a deductible is. … There’s a huge gap here of understanding in the public as to how health insurance works.”

So, just ask your provider’s billing office to walk you through it, right? That’s definitely not the case most of the time, Sherman said, grouping insurance assistance agents into three sets: financial counselors, social workers and financial navigation experts. The counselors in most hospitals will likely refer you to Medicaid, if applicable, or a hospital’s charitable program.

Social workers will take it a step further, he said, and enroll a patient in need in copay assistance programs or organizations that can help subsidize or reduce mortgage or car payments while a patient is in treatment and their income is decreased.

Financial navigators work exclusively with insurance programs, particularly Medicare, to close payment gaps before treatment is rendered. That way, for instance, a Medicare patient — who has a one out of two chance of being below the federal poverty line, by the way — isn’t slapped with tens of thousands of dollars to receive lifesaving treatment like chemotherapy and radiation, or spend thousands each month on Medicare Part D to get the oral medications they need to treat their illness.

The American Journal of Managed Care created a report on the impact of trained oncology financial navigators on a patient’s out-of-pocket costs, and not surprisingly, hospitals that employed a financial navigator saved money themselves and spared their patients a “catastrophic financial burden” at the same time — a win-win, Sherman said.

Selinsky agreed, saying that the lack of understanding of how Medicare works is so substantial that HAP plans to roll out a Medicare 101 seminar this year for administrators and consumers alike to learn the ins and outs of the program.

That will be important, since baby boomers are aging into the system now and they’ll remain a major chunk of the health care service population for a good long while. Michigan’s population isn’t growing or getting younger, so our state will be hit harder than the rest of the nation in terms of patients aging into Medicare in the next few years.

Then there’s lots of legislation to consider when it comes to health care: the Cadillac Tax, enacted by President Barack Obama’s administration with the ACA and set to take effect in 2022, will be an excise tax levied on insurance companies for employer-sponsored health plans that exceed specified thresholds. That could apply to nearly half of all plans, and it’s likely the cost would be passed along to the consumer, according to the Tax Policy Center at the Urban Institute and Brookings Institution.

Selinsky added that there’s been more talk in Washington, D.C., about eliminating the employer tax exclusion, which makes employer-paid health care premiums exempt from federal income and payroll taxes. That means lower tax bills and reduced after-tax costs of coverage, but if that’s scrapped, Selinsky thinks employer-provided plans would dry up and workers would head to the public marketplace for plans and overload it.  

Learn about Medicare or find someone who really knows about it: Check. What else is there to consider in the near future as far as health care goes?

Keep your eyes peeled for more advances in cyber care, according to the panel. Michigan is one of the only states so far that has legalized telemedicine, though we need to catch up to other states in regulating the methodology.

As far as the internet’s role in diagnosis, particularly self-diagnosis — you know you’ve done it — Brooks Williams said it can be a useful tool for engaging patients to seek real care.

“Self-diagnosis doesn’t have to be a bad thing. People like to hone in on what their issues are,” she said. “They’re also (seeing) advertisements for pharma, so they come to their physician and say, ‘I want this specific drug.’ So at Henry Ford Health System, we’re working on using that (online component) to navigate them toward the right physician.”

Sherman added that the internet can cause a bit of panic in patients who read about what tests they should be getting to diagnose a certain condition, versus what their insurance company will and won’t pay for.

And as long as you’re web-hopping, Connolly said it would be prudent to “self-diagnose our pocketbook” and comparison shop prescriptions before they’re filled.

“Believe it or not, if you go to CVS or Walmart for a particular drug — just pretend like you don’t have health care — walk in and ask about the price, and the actual rate that you would pay will be different at every single location,” he said. “And it will be different here as opposed to Flint or Detroit or Saginaw. There are ways online that you can save 40-50 percent on prescriptions.”

On the topic of universal and single-payer health care systems, a hot topic particularly during political campaigns, the panel members understandably bit their tongues.

“From an advocacy perspective ... you see health statistics show that we are healthier when we have coverage,” Brooks Williams said. “When people have coverage, they seek care. If they have nothing, there’s the tendency to defer illnesses that could be treated at a lower threshold.”

“A lot of people have opinions on this, and very few people know everything involved,” Sherman said. “If we talk about Medicare for all, from a patient stress level they go through, we’ve already talked about how complicated it is. If we do Medicare for all, I’m going to be extremely busy. It’s extremely time-consuming to help patients understand Medicare, go through the proper enrollment process and access all different components. I don’t know if there’s anybody here who could give us a good answer.”

Connolly spoke about regulations for employee benefit plans and what businesses need to do to be compliant with the Employee Retirement Income Security Act. It’s a federal law that safeguards qualified retirement plans like 401(k), profit sharing and pensions, but also health, disability, group, life, dental and other plans. While it’s been around since 1974, the U.S. Department of Labor has only just began enforcing it with audits.

“The government has allocated $10 million in salaries to ramp this up,” Connolly said. “Once they find one little thing to poke a hole in, the whole thing is exposed.”

If a business owner doesn’t make sure their employee benefits package is compliant with ERISA, they could be penalized with hefty fees or even criminal prosecution, he explained. And the fees collected from those audits are being used to offset the costs of the Affordable Care Act, hence the sudden need since 2012 to monitor compliance.

Set aside some time and some cash to work with an ERISA expert, Connolly said, to make sure you’re compliant as a business owner, or you could be in a world of hurt.

“Ask the right questions, because any of these fees could supersede what you’re trying to do (in your business),” he added.

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