On October 22, the Center for Consumer Engagement in Health Innovation hosted a webinar in collaboration with Services and Advocacy for GLBT Elders (SAGE) that shared information about the unique needs and concerns of Lesbian, Gay, Bi-sexual and Transgender (LGBT) older adults. A video recording of the webinar, Meeting the Health Needs of LGBT Older Adults, is now available, as are the presentation slides and an LGBT Cultural Competency Self-Reflection Questionairre.

Meeting the Health Needs of LGBT Older Adults from Community Catalyst on Vimeo.

Statistics show many older LGBT people are less likely than the general older adult population to seek needed health care and preventive services out of fear of facing discrimination from providers. Additionally, many LGBT older people engage disproportionately in behaviors that put them at health risk, such as smoking, excessive drinking and non-prescribed drug use. LGBT older adults are also more likely to be dealing with mental health concerns – a risk factor for social isolation.

The webinar presenters, including a consumer who has benefited from SAGE-sponsored services, offered information and insight on two highly successful programs that incorporate multidisciplinary interventions:

  • Elder LGBT Interprofessional Collaborative Care Program (ELINC) in New York City, affiliated with Columbia University School of Nursing, which trains a new generation of nurses to collaborate with other health professionals in providing culturally-competent care to LGBT people across the lifespan.

  • SAGECAP Baltimore, a partnership between SAGE and The LGBT Health Resource Center of Chase Brexton, which provides LGBT individuals and their families with access to expert health information and resources including one-on-one counseling, support groups, monthly workshops, assistance with financial and legal issues, referrals to aging services, and linkage to medical care for LGBT older adults and their family caregivers.

These much-needed and forward-thinking programs are demonstrating successful approaches to addressing the unique challenges that may impact the health and well-being of older LGBT adults. We are grateful to each of our webinar presenters, and share their expressed interest in looking for opportunities to replicate these promising models in other states. Please have a look at our video recording to learn more! 

Stephanie Cohen
State Advocacy Manager, Value Advocacy Project


This is the first in a series of blog posts that will share Community Catalyst’s vision for achieving health equity in the U.S. health care delivery system.

Since the introduction of the Affordable Care Act, the uninsured rate has dropped by over 50 percent for African Americans and by over 25 percent for Hispanics. These figures indicate meaningful progress in coverage, but there is much more that needs to be done to move toward truly equitable access to care and quality of care received. Here at Community Catalyst, we recently reexamined and revitalized our vision of health equity. We see health equity as the realization of a state in which everyone, regardless of their geographic location or demographic profile, can attain the best possible health outcomes. We believe that our country can attain health equity through constant and wide-ranging transformational efforts focused on the systems and institutions that have created historical and contemporary injustices in our society.

The health equity vision at Community Catalyst is based on the following five guiding principles:

  1. Reduce health inequities/disparities: Health inequities/disparities are those differences in health outcomes between population groups that are avoidable, unfair and unjust.

  2. Eliminate barriers to quality care: Advocating for adequate access and robust benefits that support culturally and linguistically competent care is necessary to break down the barriers that have prevented some groups from receiving quality care or from seeking care in the first place.

  3. Address structural injustices: Explicit recognition of the role of institutional injustices/discrimination, particularly structural racism, in driving health inequities/disparities, and taking steps to transform this dynamic within the health care system, is necessary to improve the quality of care for marginalized communities.

  4. Promote meaningful engagement from diverse consumers: A diverse consumer base must be mobilized and empowered to ensure everyone’s health needs and concerns are being acknowledged and addressed.

  5. Foster leadership: Underserved communities across the United States have pent up leadership potential that is uniquely positioned to bring together the voices of their communities and advocate for the needs, interests and concerns of their community.

These guiding principles were rolled out to the Community Catalyst staff as part of a thought exercise in which examples were solicited of the ways in which the organization strives to put these principles into practice. These examples were collected from the staff over the course of five weeks. This blog series is a culmination of the responses we received, and will consist of five posts following this one, covering one of our health equity principles in each. Each blog will include an explanation of the Health Equity principle from a Community Catalyst perspective, an example of our work within the context of that specific principle, and a brief interview with a staff member involved with the example.  In the coming weeks we welcome you to join us as we explore what more can be done advance health equity.

Shruti Shantharam
Health Equity Intern

This blog was originally posted on the Families USA website.

The uninsured rate is at an all-time low, as the Affordable Care Act (ACA) has made it possible for 20 million, and counting, to get covered and stay covered.

However, news of steeply rising premiums is causing some consumers to wonder whether they will be able to find an affordable marketplace plan when open enrollment starts on November 1. Consumers seeking health insurance on the marketplaces may have better, and more affordable, options than they think. Here’s why.

Many people in the marketplace will not have to pay large premium increases

This is true for a few reasons.

  1. Nearly 85 percent of marketplace consumers are eligible for and currently receiving financial assistance: With this assistance, consumers are protected from spending more than a set share of their income on premiums. Therefore, they will not face a price increase when a health insurance company hikes up its rates.
  2. The way premiums are changing depends on where you live: While some areas are seeing large increases in premiums, other areas are actually experiencing decreases in premiums. Premium increases are not a universal experience across the country.  
  3. Most consumers will be able to choose from multiple plans: Despite discussion of insurers pulling out of the marketplaces this year, the fact is that most marketplace enrollees have multiple plans from which to choose. Just because one insurer’s prices are unaffordable doesn’t mean that all will be. 
  4. Consumers should explore all plan options to find a better deal: Consumers should explore all marketplace plans in their area to determine which is most affordable and likely to meet their needs. Many consumers who check each year to see if a more affordable plan is available are able to save money.

Marketplace plans provide important Affordable Care Act protections

All plans that consumers buy in the marketplace provide these and other important Affordable Care Act protections and benefits to enrollees: 

  • Preventive services, like cancer screenings, check-ups, and contraception, at no cost
  • Coverage for an essential set of benefits including prescription drugs, maternity care, and mental health care, which were often excluded from coverage before the ACA
  • The right for your children to stay on your health plan until their 26th birthday
  • Protections against higher premiums based on your health or because you are a woman
  • Bans on annual and lifetime dollar caps on coverage 
  • Requirements that insurance companies spend a set share of your premium dollars on care and quality improvement instead of administrative costs and profits. Insurers who don’t meet the requirements owe you a rebate check.

Consumers can enroll in coverage starting November 1

During this critical open enrollment season, it’s important to educate consumers about the opportunity they have to get health insurance thanks to the Affordable Care Act. Insurers cannot discriminate against people because of pre-existing conditions, and most people who get coverage through the marketplaces receive financial help to pay for it. 

It is essential that above the debates about the politics and policies of the Affordable Care Act, consumers hear the most important message of all: Open Enrollment for 2017 coverage starts November 1 and goes through January 31.

Consumers can visit Healthcare.gov to enroll in health coverage and to find local help choosing and signing up for a plan.

Heather Bates, Deputy Director, Enrollment Assister Network, Families USA and Claire McAndrew, Private Insurance Program Director, Families USA

Last year, the Robert Wood Johnson Foundation launched a joint initiative with Community Catalyst called the Value Advocacy Project (VAP). The project is supporting consumer health advocacy organizations in six states in their non-lobbying advocacy efforts to pursue local and state policy and health system changes that increase the value of health care by improving health outcomes and lowering health care costs, especially for populations that have disproportionately poor outcomes. Building on the Center for Consumer Engagement in Health Innovation’s recently released Consumer Policy Platform for Health System Transformation, we will be highlighting our state partners working on issues outlined in the policy platform and encouraging them to share how their work can translate to advocates’ efforts across the country.

The Pennsylvania Health Access Network (PHAN) is teaming up with Project H.O.M.E, the Housing Alliance of Pennsylvania and the Pennsylvania Health Law Project to address the rising costs among high utilizers in Medicaid through coordinated care in patient-centered medical homes and by providing supportive housing services in Pennsylvania. We recently launched our Housing as Health Campaign to advocate for a statewide approach to patient-centered medical homes for Medicaid beneficiaries with chronic conditions and urge the state to use Medicaid dollars to establish permanent supportive housing services for Pennsylvania’s vulnerable populations. 

As more and more individuals access health care through the Affordable Care Act and Pennsylvania’s newly expanded Medicaid program, it is imperative that we focus on how to reduce costs and improve health outcomes for Pennsylvania’s most vulnerable populations. Lack of coordinated care and access to services that promote health often result in underserved populations turning to costlier forms of treatment instead of continuing the correct path of treatment for chronic conditions. 

With the expansion of Medicaid eligibility on Jan. 1, 2015, many more Pennsylvanians who have experienced chronic homelessness and who live with chronic health conditions have been able to enroll in Medicaid. Pennsylvania’s health plans and providers have an important opportunity to learn about this population’s needs and improve the quality of care and health outcomes. Many new Medicaid beneficiaries in this population have health needs complicated by substance use disorders and challenges related to mental health, trauma and other issues.  

This project is bringing together health, housing and mental health experts and leveraging consumer involvement to urge state policymakers to develop and implement new approaches to health care for vulnerable Medicaid beneficiaries, including requesting federal approval for a waiver. Strategies include engaging the existing consumer advocacy community, raising public awareness, educating policymakers and state Medicaid officials about the need for health system transformation, and working with housing advocates to lift up the benefits to vulnerable Pennsylvanians of supportive housing services. 

A big focus of our work involves engaging consumers from vulnerable populations such as those with substance use disorders, individuals experiencing homelessness and those with chronic health conditions. Through this project community health organizers are working with these targeted populations to help engage them in the campaign. We will help them share their stories about accessing health care with policy makers and the media to advance consumer friendly principles and the need for supportive housing services. Already we had a consumer forum in Philadelphia where three consumers shared their experiences with our patient-centered medical home advisory committee.

We hope our work will create a model for advocates in other states working to address both homelessness and communities with high health needs.

Antoinette Kraus, Director, Pennsylvania Health Access Network

A new report from The Commonwealth Fund demonstrates how Hennepin Health, a Medicaid Accountable Care Organization (ACO) in Minneapolis, Minn. is breaking new ground in creating partnerships to address the range of health and social needs of the most at-risk members in their community. As consumer advocates look at models that address social determinants of health and payment policies that will support such models, this case study is a must-read.

Hennepin County Medical Center has long served the low-income and uninsured community in the Twin Cities and has grappled with how to meet the needs of the most vulnerable, many of whom have needs that go far beyond medical care alone. So, in 2012 they launched a Medicaid ACO demonstration project to create a new model of care for Medicaid beneficiaries who suffer from debilitating mental health problems, chemical dependencies, and other hallmarks of poverty, trauma and social isolation. The ACO includes four partners: the county’s human services and public health department; Hennepin County Medical Center, a public teaching hospital; Metropolitan Health Plan, a county-run Medicaid managed care plan; and NorthPoint Health and Wellness Center, a federally qualified health center. 

Using a care team approach whose members may include physicians, nurses, social workers, a psychologist and a substance use specialist, Hennepin Health was able to reduce ER visits and achieve significant savings. Hennepin’s efforts to identify and engage high-risk patients are key to its success, since the ACO is financially responsible for all of its enrolled members. Patients enrolled in care coordination programs also are given a lifestyle assessment to help staff understand their social challenges.

Last year, I had the privilege of sitting in on a team meeting at the Coordinated Care Center at Hennepin. Seeing this person-centered model at work, with all medical, social and behavioral issues being discussed by team members who exhibited high mutual regard for the expertise each brings, was truly inspiring. The Commonwealth report concludes that this is a model that can be replicated elsewhere, but doing so requires: a long-term investment; that state Medicaid agencies look at risk adjustment for social determinants of health, both in quality measures and payment models; and a community-wide approach to providing compassionate care for the most vulnerable high-need populations.