Universal Child Healthcare, Essay Example

A Case Study of St. James Parish, Louisiana

At present, there are approximately 9 million children without medical insurance in the United States. A sketch of the population demographic drawn from Profile for St. James Parish, Louisiana (2010) situates this study of healthcare insurance access and its relation to community providers in the region, and makes a strong case for President Obama’s social welfare policies toward allocation of universal healthcare. The Parish of 21,000 is predominantly comprised of African American (Black) residents at 53% which is substantially higher than the 32% of total population in the State of Louisiana contributed to a portion of the 26% of the state population without medical insurance. Age breakdown of youth constituents is at 15% under 5 years of age, and 27% under 18 years of age. Despite the relatively high index for poverty which was reported to be 21-23% in Louisiana in 2010, the apportionment to Medicare in state impacted uninsured children to a reported 7.6% in 2009 from 11% in 2003. The foregoing analysis looks at the role of Louisiana Medicaid in patient care in St. James Parish through an examination of  the Women’s Healthcare Access Project (WHAP) and the organization’s work as a provider network to Medicaid for the mitigation of risk to primary, secondary and tertiary health implications in patient care (WHAP, 2010).

Review of demographic information on St. James Parish population shows that children are especially implicated in the extended alternative and public healthcare network, with most African American residents rely upon local outpatient clinics for infant care and treatment (Profile for St. James Parish, 2010). Systemic influence on clinic based care provision is largely due to the fact that the those family patient clients are designated low income Women Infant Children (WIC) program recipients which includes provision for nutrition for themselves during pregnancy, and post birth feeding of infant children. Part of the national allocation  under oversight of the U.S. Administration on Children of Families (ACH) in the Department of Health and Human Services (DHHS), WIC is typically aligned with other services in state healthcare support, and especially Medicaid status. Clients seeking care at clinics then, are often referrals through the Regional Center’s network, with the clinics obtaining ‘vendor’ status for the provision of those services responsive to low income, and especially prolonged chronic care clients with developmental disabilities. Even in cases of short term provision, where women determined to qualify for low income assisted Medicaid insurance, the resource is the most frequent form of sustaining pregnancy related healthcare, including pre-natal visits during pregnancy and childbirth delivery. Post-partum, mothers often participate in the Wellness Programs offered by Medicaid to ensure infant immunizations and nutritional care continues. Other particularities to healthcare in the Parish are related to chronic Sickle Cell Anemia and other high risk patient care for prevention of diseases most common to African Americans.

The WHAP network offers online assistance to the Medicare Access Network of Louisiana and linked referral to member providers (WHAP, 2010). The mission of the Project is to no other ends than to serve as a guided assistance resource for Medicaid in the State of Louisiana and is accessed by community health agencies, government administration and physician sponsors. The Medicaid process of application and follow-up on claims is fairly complicated, yet as cited by WHAP and other regional community health organizations, there is increased access to competent processing assistance.  The core competency of WHAP’s outreach prospectus is to leave no pregnant mother or no child without medical, dental and vision coverage. Mother’s are covered for the duration of pregnancy, and after the delivery, the child. Beneficiaries are offered assistance in each step of the application through billing process, with a range of programmatic training and other knowledge sharing opportunities scheduled for healthcare providers in the network. Part of a current trend in comprehensive patient care, WHAP’s ‘patient-centric’ assistance network is readily accessible through the organization’s web based information sharing referral and after-care portal.

In addition to the internet interface, WHAP offers telecare sponsored by peers, specialist nurses, and medical technicians for review and revision of existing Medicaid issues. Louisiana based public health programs are also directed through the organization’s Medicaid interface (Dale, 2009). For instance KidMed a special program to ensure no child that the parents meet the income guidelines is denied free medical services is subject to annual qualification for renewal according to guardian income reporting guidelines. Most consideration of children’s programs however is fairly consistent, and children are assessed for qualification based on household, so that if one child is qualified for Medicaid assistance all residing minors under the age of 18 also fall under the scope of that protocol. As indicated in WHAP’s literature, some restrictions apply to community health providers and other referral services in the network, and prescriptions from participating physicians, dentists and optometrists sometimes may only be filled by stipulated Medicaid listed pharmacies.

In my research I found that in some urgent cases, where child patients are not quite poor enough to fit the ‘low income’ criteria to qualify for the Medicaid Card, yet the family cannot afford medical insurance, local doctors in the St. James Parish area are known to have contributed “compassionate care” to patients who are in need with pro bono services. Those who are in need are often referred to the local St. Vincent DePaul’s for medical financial assistance with doctor bill payment and medical prescription payment. In general, families from low income, non-qualifying applications that are not recipients of insurance benefits at work, or simply do not have sufficient means to pay out of pocket, are forced to either take on high premiums on minimum service plans, or even still left with astronomical bills after just one major surgery or illness such as heart disease and cancer. To this end, some Louisiana healthcare organizations have begun to work with Blue Shield and other primary insurance providers toward bundled care options for patients seeking more than one service (Healthcare Finance News, 2010). I would argue that the bundled care concept is an especially effective method of systemic managed patient care for Medicaid patients, in that many of the services sought by those patients are consistent due to WIC and other ‘model program’ based recommendations where clients receive all or almost all the same services over a standard timeframe according to the gestation cycle, for example.

From a channel management perspective, clinical institutions now employ healthcare management information systems (HMIS) for advancement of ‘patient-centric’ connectivity models toward administrative oversight of the various database records systems (Tan and Payton, 2010). Impetus for investment in integrated IT HMIS is two-fold: 1) optimizing patient care and operations flows; and 2) attendant mitigation of risk to patients and therefore institutions. Recommendation of HMIS architecture as a solution to change management in Medicaid processing by healthcare organizations with a high density of constituent patients in St. James Parish and elsewhere in Louisiana, streamlines the insurance management interface with partners in the referral network, and with clients from point of application to account management by way of a single portal. An applications based capacity building instrument, the impact of IT systems integration on healthcare management promises to enhance organizational response to potential shifts within Medicaid policies that might affect the WHAP network. Clients will also benefit from better knowledge sharing systemization, as parents are able to access free assessment and after-care information. Studying the ‘gaps’ in child healthcare ultimately leads back to access. For low income patients, those opportunities are exponential once direct conduits are established.

References

Blue Shield of California extends contract for MedeAnalytics’ claims transparency solution (2010 12 February). Healthcare Finance News. Retrieved from: http://www.healthcarefinancenews.com

Cannon, M. (2010) Does Barrack Obama Support Socialized Medicine Retrieved from: http://www.cato.org/pubs/bp/bp108.pdf

Dale, J. et al. (2009). Telephone peer-delivered intervention for diabetes motivation and support: the telecare exploratory RCT. Patient Education and Counseling, 75, 91-98.

Profile for St. James Parish, Louisiana (2010) Retrieved from: http://www.epodunk.com/cgi-bin/genInfo.php?locIndex=3572

Louisiana Medicaid (2010) Retrieved July 8, 2010 from, http://www.lamedicaid.com/provweb1/default.htm

Medicare Access Network of Louisiana (2010).Women’s Healthcare Access Project. Retrieved from: http://www.womenshealthaccess.com/medicareflyer.pdf

Monegain, B. (2010). N.C. health system to launch bundled payment pilot. Healthcare Finance News, 22 June 2010. Retrieved from: http://www.healthcarefinancenews.com

Tan, J. and Payton, F.C. (2010). Adaptive Health Management Information Systems: Concepts, Cases, & Practical Applications, Third Edition. Sudbury, MA: Jones & Bartlett Learning.

Women Infant Children (2010). Administration on Children of Families. Washington, D.C.: U.S. Department of Health and Human Services (DHHS).