Community Catalyst: In The News

Consumer Group Says Stronger Federal Measures Needed to Ensure Vulnerable Patients Get High Quality Care

Mon, 30 Jun 2008 00:00:00 -0700

Boston, MA - Amid growing concerns over the rising costs and declining quality of health care, a national consumer advocacy organization today stressed the need for health plans that serve the sickest and frailest Medicare beneficiaries to adhere to enforceable quality standards. The organization’s briefing paper points to standards that, if implemented, would both improve care and contain costs.

The briefing paper released today by Community Catalyst coincides with the first time Medicare Special Needs Plans (SNPs) must submit data to the National Committee for Quality Assurance (NCQA) as part of a new evaluation of the plans. NCQA will use the data to assess plan performance in a number of specific clinical areas, such as glaucoma screening in adults, as well as against a number of structure and process measures, such as the steps the plan takes to manage care for those with the most complex health care needs. This is phase one of a three phase approach to developing SNP-specific quality measures. The NCQA will deliver an assessment report to the Center for Medicare and Medicaid Services on September 30th. It is unclear how that report will be used or whether it will be made public.

In 2003, Congress created SNPs to address the needs of Medicare beneficiaries with complex health issues by improving quality of care to reduce avoidable emergency room visits and nursing home admissions, resulting in cost savings. There are now 769 approved SNPs. Last year, Congress imposed a moratorium on the approval of new SNPs due to concerns about rapid program growth and uncertainty whether the program has achieved improved health outcomes for its beneficiaries.

“Medicare beneficiaries with complex health care needs require health care delivery systems that coordinate their care and their benefits,” said Renée Markus Hodin, director of Community Catalyst’s Special Needs Plan Consumer Education Project. “While the SNP program presents an opportunity to provide exactly this sort of care, we’ve seen that plans provide dramatically varied levels of coordination, integration, and consumer involvement. The NCQA evaluation represents a positive step forward, but is not enough. Enforceable federal quality standards must be implemented in order to ensure that the promise of the SNP program is met.”

The Community Catalyst paper discusses the risk that exists to beneficiaries without a comprehensive set of federal quality guidelines for SNPs and suggests standards to ensure that SNP enrollees receive coordinated, integrated care.

“Developing strong quality standards for the SNP program may also provide a blueprint for re-designing our ailing, fragmented health care system,” added Hodin.

View the report, Medicare Special Needs Plans: A Critical Need for Quality Standards of Care.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization working to build the consumer and community leadership that is required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst has provided leadership and support to state and local consumer organizations, policymakers, and foundations working to change the health care system so it serves everyone – especially vulnerable members of society – since 1997. For more information, visit www.communitycatalyst.org.

About the Special Needs Plan (SNP) Consumer Education Project
The Special Needs Plan Consumer Education Project seeks to educate state and federal payers, advocates, health care providers and the public on the opportunities and risks that come with SNPs. Along with education, this project promotes best practices that enhance patient care. Funded by the Retirement Research Foundation, the SNP Consumer Education Project is an initiative of Community Catalyst.

New Efforts to Combat Underinsurance as Numbers Nationwide Increase Dramatically

Tue, 17 Jun 2008 00:00:00 -0700

Boston, MA - As the number of people across the nation who are “underinsured” reaches epidemic proportions, Community Catalyst today awarded grants to advocate-led collaboratives in Arkansas, Florida, Mississippi and North Carolina to improve access to health care and reduce medical debt for the underinsured.

An estimated 25 million people, although they have insurance, are not protected from high medical expenses, according to a recent report from the Commonwealth Fund. This figure represents a 60 percent increase from 2003 to 2007. Middle-income families experienced the biggest growth, with the number of underinsured nearly tripling over that four year period.

The grant program, an initiative of Community Catalyst’s Hospital Accountability Project, promotes changes in policies and practices of individual hospitals and hospital systems and works for reform at local and state levels. Each state collaborative will embark on campaigns and activities aimed at improving health access and reducing medical debt for low- and moderate-income underinsured individuals and families.

“In spite of paying ever-rising premiums and co-payments, too many Americans are shocked to learn that their insurance fails them when they need it most. While we work to eliminate the causes of underinsurance, we must also provide a safety net that protects people from financial ruin and gives them access to timely medical services,” said Renée Markus Hodin, Project Director at Community Catalyst, a national consumer health advocacy organization. “We’re pleased to support these state and local groups who are working to create a more transparent, accountable and fair health care system for everyone.”

This grant is the third phase of a project funded by the settlement of a class action lawsuit against the Tenet Healthcare Corporation, a national for-profit hospital company. The suit alleged illegal billing and collection tactics against the uninsured and underinsured. As part of the settlement, the court awarded Community Catalyst funds to provide grants in 15 states to attack the problems that gave rise to the original litigation. Advocacy groups in California, Massachusetts, Nebraska, Pennsylvania, Tennessee and Texas received grants earlier this year. The remaining five grants for Alabama, Georgia, Indiana, Nevada and South Carolina will be awarded later in 2008 and in 2009.

New Community Catalyst Hospital Accountability Project Grant Recipients:

Arkansas: The Arkansas Hospital Accountability Project will work to create a partnership between nonprofit hospitals and their communities to expand coverage for the underinsured. The project will also work with local hospitals, particularly those in Central Arkansas, to create local hospital policies that end aggressive debt collection and discriminatory pricing, allow patients to make reasonable payment plans, and publicize the availability of patient financial assistance. The Project is being led by Arkansas ACORN, a community organization of low- to moderate-income families.

Florida: The Florida Hospital Accountability Project seeks to increase underinsured and uninsured consumers’ access to hospital financial assistance while decreasing medical debt and aggressive collections practices. The Project will focus on educating consumers about available patient financial assistance and on improving hospital notification about these programs. It will also focus on evaluating and monitoring the distribution of funds in Florida’s Low Income Pool to ensure that the program places priorities on the needs of the underinsured. The Project is being led by Florida CHAIN, a statewide consumer health care advocacy network organization dedicated to improving the health of all Floridians by promoting sustainable access to affordable, effective health care.

Mississippi: The Mississippi Hospital Accountability Project will focus on creating better access to health care for the underinsured. The Project will research hospital practices with regard to the underinsured in the Jackson area, and use the findings to promote improved hospital financial assistance policies and practices. It will also campaign for future legislative reforms in Mississippi. The Project is being led by Mississippi ACORN, a community organization of low- to moderate-income families.

North Carolina: The North Carolina Hospital Accountability Project is aimed at improving North Carolina’s hospital financial assistance policies and collection practices for all of the State’s underinsured. The Project will use a combination of education and outreach activities, the development of “best practices” standards for the State’s hospitals, and the identification and implementation of state law and policy changes to protect patients from the consequences of medical debt. The Project is being led by the North Carolina Justice Center, North Carolina’s leading private, nonprofit anti-poverty organization.

About Community Catalyst:

Community Catalyst is a national non-profit advocacy organization dedicated to making quality, affordable health care accessible to everyone. Since 1997, Community Catalyst has worked to build consumer and community leadership to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

AMSA, RxP release PharmFree Scorecard

Fri, 06 Jun 2008 00:00:00 -0700

Most of the 150 U.S. medical schools are failing when it comes to building strong conflict of interest policies to limit pharmaceutical marketing on campus, according to the American Medical Student Association (AMSA) PharmFree Scorecard released today. Only seven institutions received 'A's for their conflict of interest policies.

“The schools that earned ‘A’ and ‘B’ scores are to be commended for setting a high bar and aggressively moving forward to ensure medical education, training and patient care is free of commercial bias,” says RxP executive director Robert Restuccia. “While we still have a long way to go, we are optimistic that the growing momentum for reform will change the landscape and there will be great improvement next year.”

To check out the Scorecard, go to www.amsascorecard.org

Community Catalyst Announces Request for Proposals in 3 States to Support Improved Health Care Access for the Underinsured

Tue, 03 Jun 2008 00:00:00 -0700

Boston, MA - Community Catalyst, a national consumer health advocacy organization, announces funding opportunities in Alabama, Georgia, and Nevada in an ongoing effort to improve health care access for the underinsured. Through an initiative of the Hospital Accountability Project, Community Catalyst seeks to fund advocate-led collaboratives to work on a range of policy, organizing, and education activities that benefit the underinsured in these states.

“As health care prices continue to rise, more families than ever are finding that their insurance fails them when they need it most,” said Renée Markus Hodin, Project Director. “Insurance premiums, copays, and deductibles are on the rise. As a result, fewer employers are able to offer health insurance. The result is that consumers, even those who have coverage, are bearing more of the financial burden for their care than ever before—a burden that many of them cannot afford in these challenging economic times.”

The funding opportunities come as hospitals face deeper scrutiny from a wide array of sources—the IRS, members of Congress, and the national media among them—for engaging in egregious practices that push families into financial ruin. These practices include selling off patient’s medical bills to third parties that charge exorbitant rates of interest or requiring sick patients to make upfront payments for necessary services, such as chemotherapy. Aside from the financial consequences, these practices dissuade many patients from seeking necessary medical care in an effective, timely fashion.

The Hospital Accountability Project works with health care advocates to remove these barriers to care for the underinsured. The Project currently focuses on 15 states that were part of a lawsuit against the Tenet Healthcare Corporation, a national for-profit hospital company. The lawsuit alleged illegal billing and collection tactics against the uninsured and underinsured. As part of the settlement, the court awarded Community Catalyst funds to provide grants in each state to attack the problems facing the underinsured that gave rise to the original litigation.

The Hospital Accountability Project promotes changes in policies and practices of individual hospitals and hospital systems as well as in local and state-level public policy. These activities are aimed at addressing the issues of medical debt for the underinsured in the states where Tenet hospitals were located. To date, Community Catalyst has awarded grants in California, Massachusetts, Nebraska, Pennsylvania, Tennessee and Texas and is working with collaboratives in Arkansas, Florida, Indiana, Mississippi, North Carolina, and South Carolina to launch projects in those states. Proposals to engage in this work are now being accepted for Alabama, Georgia and Nevada.

For details on the Project and to view the Request for Preliminary Proposals, please click here.

About Community Catalyst:

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Generics Are Powerful Medicine Announces National Grant Recipients

Tue, 20 May 2008 00:00:00 -0700

Boston, MA -- Generics are Powerful Medicine (GPM), a program of Community Catalyst and the Alosa Foundation, is pleased announce grants to eleven nonprofit organizations to educate consumers about the value, safety and effectiveness of generic prescription drugs. The recipients will use consumer education materials developed by GPM, and will employ a very broad set of strategies, targeting a diverse set of audiences, ranging from seniors to parents of young children, in large cities, small towns and rural communities.

The recipients were selected for their innovative approaches, their previous consumer education experience, their relationships with the target populations and their geographic diversity. They will work closely with GPM and with each other over the next year and a half to implement, refine and document a set of best practices and model approaches for how to encourage consumers to switch to generic drugs.

The recipients of the grants are:

GPM’s team of medical experts and health care advocates are developing a set of printed, electronic and video materials on generic drugs. An electronic copy of these materials will available on our website to any interested organizations or individuals.

These materials will include:

Factsheets and brochures about what generic drugs are, how they are inspected and approved, and how to save money on prescription drugs
A wallet-sized card for patients to bring to medical appointments and pharmacies, reminding them of questions to ask about their medications and obtain generics, when appropriate
Template public service advertisements for consumer publications
An online search tool where patients can look up whether there are generics available for their medications
A 10-minute video documentary on generics, featuring a physician, a pharmacist and several consumers

All these materials will be consumer-friendly, written in easily-understood, readable language, with a minimum of jargon. Many of the materials will be translated into Spanish.

Initial funding for GPM came from residual settlement funds in two class action lawsuits that alleged that a pharmaceutical company illegally kept generic versions of two prescription drugs off the market. GPM is seeking additional funding for the program and hope to make additional grants available in the future.

Generic drugs have become a vital tool for consumers to save money on their prescription medications. Generic drugs use the same active ingredient as brand-name drugs and are approved by the FDA. Generic drugs are as safe as the brand-name equivalent, yet much less expensive (often only 20-30% of the brand-name price). 65% of prescriptions in the US in 2007 were filled with generics, yet they accounted for only 20% of spending on prescription drugs.

Despite the huge savings possible with generics, they are still underutilized. American consumers and the health care system could save billions of dollars more by increasing the usage of generic drugs. With a recent study by Medco showing that more than 50% of Americans now routinely take one or more prescription drugs for a chronic condition, generics will become increasingly important. Unfortunately, many consumers have been deceived by myths about generics that have been perpetuated by the brand-name pharmaceutical industry. Brand-name drug companies now spend more than $5 billion a year marketing to consumers and more than $20 billion a year marketing to physicians. In addition to the message about any particular drug, there is an underlying set of myths in all such advertising – the inaccurate ideas that “newer is better,” that brand-name name drugs are superior to generic drugs , and that the more expensive a drug is, the more effective it must be. GPM aims to expose and confront these myths head-on, to provide consumers with the truth about generics, and to give them the tools to make smart choices about prescription drugs.

Increasingly, health plans and pharmacies urge consumers to switch to generics. Yet consumers sometimes view these messages skeptically, seeing them as self-serving. What makes GPM unique is that its materials and messages come from sources with no such self-interest, and will be delivered by well-trusted organizations with established relationships in their communities. This will help overcome the skepticism that some consumers have about generics messages delivered by other entities.

More information about Generics are Powerful Medicine is available at our website. The GPM materials will be made available on that website this summer.

About The Alosa Foundation

The Alosa Foundation is a non-profit organization dedicated to the dissemination of accurate, unbiased, evidence-based and non-commercial information about medications for prescribers and patients. It sponsors the Independent Drug Information Service which provides educational research to prescribers and is funded by the Commonwealth of Pennsylvania Department of Aging. Alosa is not affiliated with any pharmaceutical company in any way.

About Community Catalyst

Community Catalyst is a national advocacy organization that builds consumer and community participation in the shaping of our health system to ensure quality, affordable healthcare for all. Community Catalyst believes that health care is a basic human right and that all people–including children, the poor, the elderly, minority communities, and others who are vulnerable–should have access to quality health care. Community Catalyst works in partnership with consumer and community groups around the country to promote health care justice. http://communitycatalyst.org//

Newly-unsealed documents shed light on Abbott Labs' 400% Norvir price hike

Mon, 12 May 2008 00:00:00 -0700

Boston, MA – In an ongoing nationwide class action lawsuit against Abbott Laboratories, Inc. (NYSE: ABT), the Court in the case recently ordered the unsealing of documents regarding Abbott’s four-hundred percent price increase of the HIV/AIDS drug Norvir®.

Abbott fought to keep these documents sealed, arguing that they contain ‘business strategies’ important to Abbott’s competitive position in the HIV pharmaceutical market. But Judge Claudia Wilken of the U.S. District Court for Northern California ruled that because the price increase related to the “allegations that are central to Plaintiff’s anti-trust claims” the documents should be unsealed. (Order, p. 3).

The ongoing lawsuit, brought by SEIU Health and Welfare Fund and others, alleges that Abbott violated federal antitrust laws when it increased the price of Norvir (ritonavir), a drug used in combination with other protease inhibitors (PIs), by 400%. It did not raise the price of Kaletra, another Abbott pill which combines Norvir and Abbott’s own protease inhibitor, lopinavir. Plaintiffs allege that this price increase was engineered in order to force patients and insurers to switch from using Norvir (which is taken with several other competitors’ PI drugs) to Kaletra.

Kaletra is one of Abbott’s best-selling drugs, grossing $400 million in 2003, $682 to 900 million in 2004, and $1.14 billion in 2006. Norvir has become a key weapon in the fight against the progression of HIV in patients, as it “boosts” the effectiveness of protease inhibitors.

The unsealed documents revealed how Abbott Labs dismissed patient considerations from their pricing considerations.

One document shows that Abbott considered making Norvir available at its original price only in a foul-tasting liquid form that Abbott executives acknowledged tastes like “someone else’s vomit.” Abbott also considered completely halting Norvir production, while continuing to make only Kaletra. This would have forced millions of patients to switch to Kaletra, despite the fact that it would have exposed them to Kaletra’s side effects, and would have deprived them of vitally important treatment options to preserve for future stages of the disease.

Other documents show that Abbott executives planned to justify a price increase by stating that it was “no longer feasible for Abbott to continue manufacturing Norvir capsules” at their original price. Abbott executive Jesus Leal noted that this plan and rationale had a significant weakness -- “exposure on price if forced to open books.”

“We're appalled by the callous disregard for HIV/AIDS patients that Abbott displayed in the documents they tried to keep secret,” said Steve Abrecht, Executive Director of the SEIU Health and Welfare Fund. “We plan to continue pushing the class action lawsuit against Abbott forward, to hold them accountable for this unconscionable and cynical price gouging."

“These documents show that Abbott put profits ahead of the needs of seriously ill HIV/AIDS patients in quintupling Norvir’s price” said Alex Sugerman-Brozan, director of Prescription Access Litigation, a national coalition of which plaintiff SEIU Health and Welfare Fund is a member. “This information would never have come to light if not for this lawsuit, demonstrating that litigation is sometimes the only means to uncover such schemes and hold drug companies accountable.”

One of the unsealed documents contained a chart summarizing a proposed slide presentation discussing the price increase. One column in that chart described a slide titled “Public Relations and Activist slide,” which tellingly contained nothing but a question mark “(?)”, suggesting that Abbott was aware of the outcry that would ensue following the price increase but had no convincing explanation for it.

In the months following Abbott’s price hike in December 2003, Abbott was the target of numerous protests and widespread public condemnation, shareholder resolutions, government investigations, physician boycotts, and an unsuccessful petition to the NIH and FDA to force Abbott to permit a generic version of Norvir onto the market. The class action lawsuit is the only significant challenge to the Norvir price increase that is still ongoing.

The class action lawsuit, originally filed in October 2004, has cleared numerous hurdles. The case is scheduled to go to trial in August 2008. The Court has already denied Abbott’s motion to dismiss the case and has certified the case as a national class action. Abbott’s request that the 9th Circuit Court of Appeals review the decision certifying the case as a class action was denied, and Abbott now also faces lawsuits brought by chain pharmacies and GlaxoSmithKline, a competitor in the HIV/AIDS drug market.

On May 1, the Court held a hearing on Abbott’s Motion for Summary Judgment. The case is part of In re Abbott Laboratories Norvir Anti-Trust Litigation, 04-CV-1511, U.S. District Court for the Northern District of California. The Judge’s ruling, and copies of the unsealed documents can be found here.

About SEIU Health and Welfare Fund:
The SEIU Health and Welfare Fund is a multi-employer fund managed by a joint board of trustees comprised of union and employer representatives and sponsored by the Service Employees International Union, a 1.9 million member labor union headquartered in Washington, D.C. More information can be found on its website.

About Prescription Access Litigation:
Prescription Access Litigation (PAL) is a nationwide coalition of over 130 state, local, and national senior, labor and consumer health advocacy groups fighting to make prescription drugs affordable. The organizations in the PAL coalition have a combined membership of over 13 million people. PAL, a project of the national nonprofit health care advocacy group Community Catalyst, works to end illegal drug industry practices that increase the price of prescription drugs beyond the reach of the American consumer, using class action litigation and public education. PAL members have filed more than 30 lawsuits targeting such practices. News about PAL’s cases and public education efforts can be found on its website or on the PAL Blog.

The Prescription Project collects signatures for petition regarding the Physician Payments Sunshine Act

Mon, 05 May 2008 00:00:00 -0700

Recently, the Prescription Project, an affiliate of Community Catalyst, has focused its federal work on the Physician Payments Sunshine Act – a bill that would require public disclosure of industry payments to doctors.

Drug companies spend at least $25 billion each year marketing to doctors. We pay for that with every drug we buy. And studies prove that marketing causes doctors to prescribe higher-cost drugs. Some new drugs also have safety risks (like Vioxx). By increasing transparency, the Sunshine Act will help protect patients and help counter the skyrocketing costs of drugs.

Please sign the petition today to ask your members of Congress to support these bills. Shine a light on undue influence by the drug industry.

Community Catalyst Uses Class Action Settlement Funds to Support State Efforts to Improve Health Care for the Underinsured

Wed, 23 Apr 2008 00:00:00 -0700

Boston, MA - As hospitals face increasing scrutiny for egregious policies and practices, Community Catalyst today announced a set of grants awarded to advocate-led collaboratives in Massachusetts and Texas to increase health access and reduce medical debt to benefit the underinsured.

Many hospitals routinely engage in financial practices that push patients into debt by charging uninsured patients nearly three times the rate of insured patients for the same procedures or by selling patients’ bills to third-party lenders that charge up to 27% interest. Some patients penalized through such practices are later found to be eligible for financial assistance.

In addition, national media is examining the tax breaks received by nonprofit hospitals and insufficient regulation of the services they provide to their most vulnerable patients. The IRS recently released the redesigned Form 990, filed annually by nonprofit institutions, and a new “Schedule H” to be completed by hospitals with new requirements designed to promote greater transparency among nonprofit hospitals.

“As debate over health care heats up nationally, we are continuing our efforts to support heath care reform at the state level, where real changes are happening.” said Renée Markus Hodin, Project Director. “We’re proud to support local advocates who are working to change egregious hospital policies and practices that bankrupt their patient’s futures and deter them from seeking preventive, less-costly care. This kind of change is a key ingredient in creating a more transparent, accountable and fair health care system for everyone.”

The grants in Massachusetts and Texas are the second phase of a 15-state project funded by the settlement of a class action lawsuit against the Tenet Healthcare Corporation, a national for-profit hospital company. The suit alleged illegal billing and collection tactics against the uninsured and underinsured.

The grant program, an initiative of Community Catalyst’s Hospital Accountability Project, supports efforts to change hospital practices by reforming state and local policy. As part of the settlement with Tenet Healthcare Corporation, the court awarded Community Catalyst funds to provide grants in Alabama, Arkansas, California, Florida, Georgia, Indiana, Massachusetts, Mississippi, Nebraska, Nevada, North Carolina, Pennsylvania, South Carolina, Tennessee, and Texas to attack the problems that gave rise to the original litigation. Advocacy groups in California, Nebraska, Pennsylvania, and Tennessee received grants in January 2008. The remaining nine state grants will be awarded later in 2008 and 2009.

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Community Catalyst is a national non-profit advocacy organization dedicated to making quality, affordable health care accessible to everyone. Since 1997, Community Catalyst has worked to build consumer and community leadership to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

New Community Catalyst Hospital Accountability Project Grant Recipients:
Massachusetts: The Massachusetts Project for Hospital Fair Debt Collection and Amelioration Guidelines will collaborate with local consumer groups and hospitals to develop and implement a model hospital policies and practices that improve health access, restructure medical debt and establish fair debt collection and credit counseling services. The Project is being led by Health Care For All, the premiere consumer health advocacy organization in Massachusetts.

Texas: The Texas Hospital Accountability Project seeks to improve health access and reduce medical debt in Texas for the underinsured, specifically for people living in Dallas, Houston, El Paso and Brownsville. The Texas collaborative will work to improve hospital financial assistance and collection practices. It will also advocate for insurance reforms as the Texas Sunset Advisory Commission reviews the policies and programs of the Department of Insurance. The Project is being led by Texas ACORN, a community organization of low to moderate income families.

For information about other Hospital Accountability Project Grant recipients, visit the Community Catalyst website.

Community Catalyst Executive Director Wins Prestigious Public Health Award

Mon, 21 Apr 2008 00:00:00 -0700

Rob Restuccia, Executive Director of Community Catalyst and Director of The Prescription Project, has been awarded the 3rd Annual Gail Douglas Award of Public Health Practice from the Boston University School of Public Health. Rob was recognized for his sustained efforts and achievements in the Boston public health community, first as a hospital worker, union organizer, director of the Committee of Interns and Residents, and more recently as Executive Director of Health Care for All and then Community Catalyst. Rob is also an adjunct professor of Health Policy and Management at BUSPH. The $1000 prize, given to a community member who has made outstanding contributions to public heath in education, research, and/or service, was begun in 2006 to honor retired nurse and faculty member Gail Douglas, RN, MPH.

New Report to Aid Consumer Advocates in Navigating Individual Mandates

Wed, 26 Mar 2008 00:00:00 -0700

Boston, MA - Community Catalyst, a national consumer health advocacy organization, released a guide that will help consumer advocates navigate the difficult waters stirred up by proposals that require people purchase health coverage. As these individual mandates gain popularity with policymakers across the nation, the guide poses critical questions to determine whether the proposals will result in quality, affordable health care for everyone.

Since Massachusetts enacted an individual mandate in 2006, a number of other states including Maine, California and Maryland have begun considering an individual mandate, a law that requires all residents to enroll in health insurance. While mandates can create harmful effects of a mandate, Community Catalyst offers suggestions to guard against overburdening the people who should benefit from health care reform.

A Guide to Protecting Consumers Under an Individual Mandate highlights the need for adequate consumer protections in designing mandates, and engages stakeholders and encourages shared responsibility by employers, insurers and providers. Some of the recommendations include:

• Creating a standard of affordability for health insurance
• Establishing private market reforms such as guaranteeing that insurers cannot deny coverage based on medical history or limiting the variations of premiums based on individual’s health status
• Requiring efficiency in insurance, such as defining the amount insurers must dedicate to patient care while limiting administrative cost
• Ensuring proportional responsibility for financing between employers and individuals

In addition, the report examines Massachusetts’ individual mandate and California’s recent bill that would have created a mandate. Under the best-case scenario, an individual mandate can be a tool to expand coverage and ensure shared responsibility. However, unless implemented with sufficient care, an individual mandate can adversely affect the people who struggle under the current system.

To view the complete report, click A Guide to Protecting Consumers Under an Individual Mandate.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst provides leadership and support to state and local consumer organizations, policymakers, and foundations working to change the health care system so it serves everyone—especially vulnerable members of society. www.communitycatalyst.org

Community Catalyst helps Consumers Union collect signatures for petition regarding TV drug ads

Tue, 18 Mar 2008 00:00:00 -0700

Consumers Union is collecting signatures for a petition that calls on the FDA to require TV drug ads to include a 1-800 number for reporting side effects (as print ads already do). Please take a moment to sign.

Drug companies often fail to clearly present the benefits and risks of the products they advertise, and it often isn’t until a drug is on the market and taken by millions of patients that safety problems emerge. The easier it is for us to report side effects, the earlier the FDA will be able to detect safety hazards with medications and take action. That’s why we support including a 1-800 number and web address in all TV drug ads.

Help us hit our goal of 50,000 signatures so the FDA hears our voices over drug industry lobbyists. Add your name to the petition now, and help build support by sending this on to your family and friends.

Consumer Group Guide Highlights Benefits and Risks of Medicare Advantage Special Needs Plans

Fri, 29 Feb 2008 00:00:00 -0800

Boston, MA, February 29, 2008 - In a fragmented health care system where the sickest, frailest and most disabled individuals often receive inadequate care, well-designed and regulated Special Needs Plans (SNPs) offer the potential to deliver high-quality, coordinated services that address consumer needs, according to Community Catalyst, a national non-profit consumer advocacy organization.

In a guide released today, Community Catalyst’s SNP Consumer Education Project highlighted the SNP program’s promise: that specialized care for Medicare’s most vulnerable beneficiaries, many of whom also qualify for Medicaid, will also help to contain Medicare and Medicaid costs, By providing comprehensive appropriate care, SNPs can help enrollees with complex or chronic health care needs avoid unnecessary hospital or nursing home stays.

SNPs, a subset of Medicare Advantage (MA) plans, were established by the Medicare Modernization Act of 2003 to improve the quality of care for high-risk Medicare beneficiaries with multiple or chronic health needs. Most SNPs focus on individuals dually eligible for Medicare and Medicaid; about 7 million people currently qualify.

Community Catalyst also stressed the importance of appropriately designed benefits and health delivery structures, strong oversight, and enforcement capability. “Without these key elements, SNPs may come to represent a lost opportunity to address one of the thorniest issues in health
care policymaking: how to meet the needs of the minority of individuals who account for the majority of the nation’s health care expenditures,” cautioned Project Director Renée Markus Hodin.

The guide comes as state officials express growing concern about increasingly burdened state economies and federal rules that would add to states’ Medicaid costs. “The federal government should not look to shift additional costs to states. Instead, it should work with states to promote innovative, improved, coordinated care for the most vulnerable populations and share in resulting savings,” Hodin added.

Prepared with support from the Henry J. Kaiser Family Foundation and the Retirement Research Foundation, the guide is meant to inform health access advocates, policymakers and SNPs themselves as they work to improve quality for SNP enrollees. The guide includes promising practices for coordinating care and models for integrating Medicare and Medicaid benefits.

View the Medicare Special Needs Plans: A Consumer Advocate’s Guide to Opportunities, Risks, and Promising Practices.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization working to build the consumer and community leadership that is required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst has provided leadership and support to state and local consumer organizations, policymakers, and foundations working to change the health care system so it serves everyone – especially vulnerable members of society since 1997. For more information, visit www.communitycatalyst.org.

About the Special Needs Plan (SNP) Consumer Education Project
The Special Needs Plan Consumer Education Project seeks to educate state and federal payers, advocates, health care providers and the public on the opportunities and risks that come with SNPs. Along with education, this project promotes best practices that enhance patient care within a state’s health care framework. Funded by the Retirement Research Foundation, the SNP Consumer Education Project is an initiative of Community Catalyst.

Foundations to Strengthen State Health Care Reform Advocacy

Sat, 09 Feb 2008 00:00:00 -0800

WASHINGTON -- The Robert Wood Johnson Foundation (RWJF) and the David and Lucile Packard Foundation (Packard) each announced grant projects today that will considerably strengthen state health reforms.

Effective solutions to some of the nation's most pressing health care problems are being actively developed and implemented in the states. All together, Packard's Finish Line Project and RWJF's Consumer Voices for Coverage will provide 18 advocacy organizations in 14 states with significant technical and financial resources. Consumer Voices for Coverage will concentrate broadly on state health care reform initiatives, and the Finish Line Project will focus on providing coverage for all children.

"There is tremendous momentum in the states for implementing effective health care reform. We know from experience that the voices of consumers - the men and women who work hard each day to support their families - are often the most effective in driving necessary change," said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. "As states launch ambitious health care reform efforts to ensure that more Americans have health insurance, advocates for consumers will be able to make their voices heard."

"States are leading the charge to cover America's uninsured children and with effective leadership from committed policymakers, advocates, and community leaders, they can finish the job and cover every child," said Carol S. Larson, president and CEO of the David and Lucile Packard Foundation. "As private health insurance has grown less available and more expensive, children are in danger of being left behind, but some states are building a future where every child has the opportunity to grow up healthy."

Finish Line Project

Funded by the Packard Foundation, the Finish Line Project is a $15 million, five-year grantmaking strategy providing financial and technical support to advocacy organizations in selected states that are best positioned to make significant advances in children's coverage. The Center for Children and Families, an independent, non-partisan policy institute based at Georgetown University's Health Policy Institute, will provide policy and communication support to each of the Finish Line state grantees.

Organizations receiving Finish Line Project grants include:

-- Arkansas - Arkansas Advocates for Children and Families

-- Colorado - Colorado Children's Campaign

-- Iowa - Child and Family Policy Center

-- Ohio - Voices for Ohio's Children

-- Rhode Island - Rhode Island KIDS COUNT

-- Texas - Children's Defense Fund of Texas

-- Washington - Children's Alliance

In addition to funding in those seven states, Packard will also expand its multi-year, multi-million dollar investment in support of children's coverage work in California.

Consumer Voices for Coverage

Initiated by RWJF, Consumer Voices for Coverage will enhance the critical role that advocates play in shaping and promoting comprehensive health reform. The $15 million, three-year initiative will strengthen existing advocacy networks in 12 states. Community Catalyst, a national, non-profit consumer health advocacy organization headquartered in Boston, will coordinate the effort nationwide.

Organizations chosen to lead Consumer Voices for Coverage networks in select states include:

-- California - Health Access Foundation

-- Colorado - Colorado Consumer Health Initiative

-- Illinois - Campaign for Better Health Care

-- Maine - Consumers for Affordable Health Care Foundation

-- Maryland - Maryland Citizens' Health Initiative Education Fund, Inc.

-- Minnesota - TakeAction Minnesota Education Fund

-- New Jersey - New Jersey Citizen Action Education Fund

-- New York - The Community Service Society

-- Ohio - Universal Health Care Action Network of Ohio, Inc.

-- Oregon - Oregon Health Action Campaign

-- Pennsylvania - Philadelphia Unemployment Project/Unemployment Information Center

-- Washington - Washington Community Action Network Education and Research Fund

Reform efforts in California, Colorado, Ohio and Washington will receive support from both RWJF and Packard.

"Effective consumer advocacy can increase the momentum in the states leading to action," said Susan T. Sherry, deputy director of Community Catalyst, who directs Consumer Voices for Coverage. "Creating networks that bring the views of real people to policy-makers and key thought leaders in the states about the need for coverage expansion can be a powerful inducement for reform."

"States are moving forward in addressing the pressing health care needs of children," said Cindy Mann, executive director of the Center for Children and Families. "States are learning from each other what works and which policy reforms are most efficient and effective at getting more kids covered. As they do so, state leaders and advocates are able to ensure best practices are adopted in additional states to improve coverage for children and families."

For more information about the Finish Line Project, visit http://www.packard.org/finishlineproject.

Additional information on Consumer Voices for Coverage can be found at http://www.voicesforcoverage.org.

About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. By helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.

About the David and Lucile Packard Foundation
The David and Lucile Packard Foundation is a private family foundation created in 1964 by David Packard (1912-1996), cofounder of the Hewlett-Packard Company, and Lucile Salter Packard (1914-1987). The Foundation provides grants to nonprofit organizations in the following program areas: Conservation and Science; Population; and Children, Families, and Communities. The Foundation makes national and international grants and also has a special focus on the Northern California Counties of San Mateo, Santa Clara, Santa Cruz, and Monterey. Foundation grantmaking includes support for a wide variety of activities including direct services, research and policy development, and public information and education. The Foundation does not fund attempts to influence specific legislation or ballot measures.

Website: http://www.packard.org/
Website: http://www.rwjf.org/
Website: http://www.voicesforcoverage.org/

Consumers Act to Address Health Care Crisis in New Orleans

Thu, 17 Jan 2008 00:00:00 -0800

January 17, 2008. Community Catalyst, a national consumer health advocacy organization, today lauded consumers in New Orleans for seeking to restore access to health care services on behalf of more than 100,000 uninsured individuals who lost these vital services in the aftermath of Hurricane Katrina.

For the past two years and half years, the residents of New Orleans have experienced an unprecedented health crisis. Today, consumers took the bold step of filing a class action lawsuit challenging the 2005 closing of Charity Hospital in New Orleans, a state-funded hospital run by Louisiana State University. This lawsuit charges that closure of Charity Hospital has resulted in the termination of the plaintiffs’ entitlement to health care without the availability of viable alternatives within the hospital’s service area. The basis of the lawsuit is a state law that requires legislative approval prior to the closure of any state hospitals. The suit argues that services and funding equivalent to their level prior to the hospital’s closure must be provided.

Prior to its closure in October 2005, Charity Hospital provided free care to thousands of low-income patients suffering from serious medical conditions. The lawsuit documents a number of problems facing consumer who previously were cared for at Charity Hospital, such as long-time New Orleans residents with chronic conditions who can no longer manage their illness because they don’t have the transportation or funds to get treated at private clinics farther afield. There are also cases of former free-care qualified Charity patients who have since been taken to private hospitals after emergency medical events, then held responsible for the enormous costs incurred at these involuntary visits.

“This lawsuit gives voice to tens of thousands of consumers whose lives were turned upside down by the impact of Hurricane Katrina,” said Susan Sherry, the Deputy Director of Community Catalyst, which hopes to work with consumer advocates in Louisiana to ensure a strong consumer voice in any effort to address health care issues in the state.

Community Catalyst has led an effort to build consumer voices in health care across the country and is currently working with consumer organizations in over 30 states. Indeed, consumers in many states are taking the lead in advocating for a health care system that responds to the needs of all residents. In Vermont, consumer organizations have led recent efforts to expand insurance to the uninsured. In Missouri, consumer advocates played a critical role in restoring Medicaid benefits to disabled.

“The election of a new Governor and new legislature provides an opportunity for consumers, state government and LSU to come together to address the complaints of consumers in a way that makes the health care system work better for everyone,” Sherry added. “It is our hope that this effort will result in a short-term solution that ensures those who require immediate treatment receive it, while developing a long-term plan to rebuild a health care system that better addresses the needs of all Louisiana’s residents, particularly those who cannot afford care.”

View the court petition, exhibits, and a brief fact sheet on the lawsuit that was filed.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

Community Catalyst and Families USA Announce the Release of a New Web-Based Guide to State Health Reform for Advocates

Wed, 16 Jan 2008 00:00:00 -0800

January 16, 2008. As health care reform gains more of the spotlight in both national and state agendas, Community Catalyst and Families USA today announced the joint release of a unique web-based guide to state health reform for consumer advocates working on expanding health care coverage in their states. The Consumer Guide to State Health Reform provides a detailed look at the basic building blocks of comprehensive health care coverage.

More and more states are prioritizing health care access reform to address the coverage gaps that exist and the affordability crisis in the health care system that continues to worsen, while also working to find ways to rein in health care costs. Community Catalyst and Families USA work together with health care advocates in states across the country, providing policy and technical assistance on the many dynamic components that should be considered in any health reform effort.

“States are leading the movement toward meaningful health care reform, but every one of them has to evaluate its starting point and the paths available to get them to expanded coverage for everyone,” said Michael Miller, Policy Director at Community Catalyst. “This guide is a significant resource that state advocates can use to explore the multitude of variables and policy options out there and learn from case studies where those decisions have been put into practice. We hope this is valuable tool for advocates on-the-ground working to make the health care system accountable to everyone and that state and federal lawmakers are paying attention to the progress that is being made.”

”This collaboration between Families USA and Community Catalyst has produced a terrific resource for consumer health advocates,” said Ron Pollack, Executive Director of Families USA. “States across the nation are moving in the right direction to reduce the number of uninsured and contain rising health care costs. This online tool walks through the menu of opportunities for consumer-friendly reform in a state and makes the ambitious endeavor of expanding coverage a little easier to undertake. We hope this will enable advocates to dive into the process of expanding coverage in their state.”

The policy guide serves to help advocates design health coverage expansions that build upon the current system of public programs, employer-sponsored insurance and private market options. It walks the user through the steps of laying a strong foundation of Medicaid and State Children’s Health Insurance Program (SCHIP) coverage, regulating the private market, building subsidy programs and pooling mechanisms, ensuring adequate benefits and access to services, and finding sustainable financing. Under each topic, the guide provides links to more in-depth descriptions and examples from states that have used these strategies. Additionally, a comprehensive glossary of terms is available and integrated as links throughout the online resource.

Begin using the Consumer Guide to State Health Reform.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

About Families USA
Families USA is a national nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable health care for all Americans. Working at the national, state, and community levels, we have earned a national reputation as an effective voice for health care consumers for 25 years.

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Prescription Project lauds D.C. City Council for reining in pharmaceutical marketing with Safe Rx Act

Fri, 11 Jan 2008 00:00:00 -0800

BOSTON – The Prescription Project applauds the District of Columbia City Council, which passed the Safe Rx Act this week by a vote of 7-6. Among its provisions, SafeRx will require pharmaceutical representatives in the district to be licensed and adhere to a code of conduct, and penalize those who convey knowingly false information in their sales pitches. Sponsored by Councilmember David Catania (I-At-large), the act is an important step to regulating the runaway sales force of pharmaceutical companies, which send nearly 100,000 detailers into doctors’ offices and hospitals each year.

“At a time when a lot of eyes are on the pharmaceutical industry’s questionable conduct and rising costs, SafeRx provides a great example of putting science on level ground with a powerful and unregulated sales force,” said Robert Restuccia, executive director of the Prescription Project in Boston, which aims to reduce the influence of marketing on medical practice. “D.C.’s law creates accountability for the reps and what they are telling our doctors, and sends the pharmaceutical industry the message that their aggressive sales tactics have not gone unnoticed.”

The new law also provides for an academic detailing program in the District, which will offer physicians sales-free meetings and materials on pharmaceuticals, and will establish required educational credentials for sales reps.

About The Prescription Project
The Prescription Project is led by Community Catalyst in partnership with the Institute on Medicine as a Profession. Created with The Pew Charitable Trusts, the Project promotes evidence-based prescribing and seeks to eliminate conflicts of interest in medicine caused by pharmaceutical marketing to physicians by working with academic medical centers, professional medical societies, public and private payers, and state and federal policymakers. For more information, please visit www.prescriptionproject.org.

Community Catalyst Announces First Round of Grant Awards to Support Improved Health Care Access for the Underinsured

Tue, 08 Jan 2008 00:00:00 -0800

Boston, MA, January 8, 2008. Community Catalyst, a national consumer health advocacy organization, today announced that it has awarded an initial round of grants to advocate-led collaboratives in California, Nebraska, Pennsylvania, and Tennessee to work on policy and organizing activities to benefit the underinsured in each state.

The grant program, an initiative of Community Catalyst’s Hospital Accountability Project, will promote changes in policies and practices of individual hospitals and hospital systems as well as at the local and state public policy levels. Each funded state collaborative will embark on campaigns and activities aimed at improving health access and reducing medical debt for low- and moderate-income underinsured individuals and families.

“Medical debt is the leading cause of bankruptcy in the nation,” said Renée Markus Hodin, Project Director. “Clearly, this is a serious problem for those with no health insurance, but, increasingly it is a problem for those with insurance who discover their coverage falls short at the times they need it most. We’re pleased to award these grants to advocate-led collaboratives that are at the forefront of the fight for a more transparent, accountable and fair health care system.”

The four state grant awards are the first phase of the 15-state Project whose funding is derived from the settlement of a class action lawsuit against the Tenet Healthcare Corporation, a national for-profit hospital company, alleging illegal billing and collection tactics against the uninsured and underinsured (brief descriptions of each of the four state projects are available below). As part of the settlement, the court awarded Community Catalyst funds to provide grants in Alabama, Arkansas, California, Florida, Georgia, Indiana, Massachusetts, Mississippi, North Carolina, Nebraska, Nevada, Pennsylvania, South Carolina, Tennessee, and Texas to attack the problems that gave rise to the original litigation. The remaining 11 state grant awards will be made later in 2008 and in 2009.

Community Catalyst awards these grants at the same time that federal policymakers are increasingly turning their attention to nonprofit hospital accountability. Last month, the IRS released stronger and more uniform reporting requirements for hospital community benefits. In October, Senate Finance Committee staff members also convened a roundtable discussion on the issue of setting minimum federal standards for nonprofit hospital community benefit programs.

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About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

About Community Catalyst Hospital Accountability Project Grant Recipients
California: The California Health Initiative on Overcharging and Underinsurance, or “Health I.O.U.,” will seek to build on the framework established by the 2006 passage of AB774, publicly known as the Hospital Payers’ Bill of Rights, to prevent hospital and medical overcharging and to improve hospitals’ financial assistance policies in both state and local arenas. Led by the Health Access Foundation and the Western Center for Law and Poverty, Health I.O.U. will also focus its efforts on advocating for strong standards that limit consumers’ out-of-pocket costs while providing them with comprehensive, affordable health care coverage.

Nebraska: In Nebraska, legislative reforms intended to contain the state’s Medicaid costs are expected to increase costs for Medicaid recipients, thereby increasing the number of underinsured in the state. Led by Nebraska’s Appleseed Center for Law in the Public Interest (“Appleseed”), the Nebraska collaborative will work to strengthen the existing advocacy structures as they prepare for potential reforms, educate state legislators on Medicaid’s importance to the state’s overall healthcare system and the effects of those reforms, and propose positive alternatives for increasing efficiency within the Medicaid program.

Pennsylvania: The Pennsylvania Health Law Project (“PHLP”) is leading a collaborative that will work to establish standards for charity care in Pennsylvania; to ensure greater access to timely and appropriate care; to create consumer-friendly, standardized hospital billing procedures; and finally, to establish standards regarding hospital debt collection practices.

Tennessee: Led by the Tennessee Health Care Campaign (“THCC”), the Tennessee collaborative will seek to improve consumers’ ability to afford and get timely access to health care by highlighting the inadequacies of current hospital charity care policies and billing and debt collection practices across the state. Its ultimate goal will be to develop recommendations for improvement, promote state policy changes that will establish fair standards in each of these areas, and monitor implementation of these policies throughout Tennessee.

National Consumer Health Organization Responds to Special Needs Plans Provisions Contained in Congress's Medicare Legislation

Fri, 21 Dec 2007 00:00:00 -0800

Boston, MA, December 21, 2007. Community Catalyst, a national nonprofit consumer health organization, today offered a mixed reaction to the minor policy changes for Special Needs Plans (SNPs) contained in the Medicare legislation approved by Congress this week, urging congressional leaders to do more in the coming year. SNPs are a subset of Medicare Advantage plans that serve people with chronic, severe health conditions. Community Catalyst launched the SNP Consumer Education Project earlier this year.

The legislation, which is expected to receive the President’s signature, extended the authority of SNPs for one-year and imposed a moratorium on new SNPs and expanded service areas for existing plans. Unlike a bill approved last summer by the House, the changes in yesterday’s bill did not seek to create SNP-specific quality measures or promote much-needed coordination between Medicare and Medicaid for dually eligible beneficiaries.

“The bill didn’t include most of the reforms essential to making the Special Needs Plans program work,” said Project Director Renée Markus Hodin. “We are pleased with the increased level of congressional scrutiny that the moratorium implies, but we believe that additional quality standards are necessary in order for the program to live up to its potential and, in fact, improve care for the most vulnerable Medicare beneficiaries.”

Community Catalyst also emphasized the importance of promoting improved coordination between Medicare and Medicaid for the over 700,000 beneficiaries dually eligible for both and enrolled in SNPs. “Dually eligible beneficiaries often have multiple health needs that are poorly served in today’s health care system. Establishing formal mechanisms for coordination of the two programs through SNPs is fundamental to providing seamless care for those who need it the most, and we hope this will be a priority for Congress in the coming year as well,” added Hodin.

Community Catalyst recently released a briefing paper for consumer advocates in states across the country to highlight the value of increased coordination of care between Medicare and Medicaid. Integration provides benefits to both the individual beneficiaries of the program and offers the potential for cost savings in state budgets.

SNPs, which were established in the Medicare Modernization Act of 2003 for high-risk Medicare beneficiaries, were created as a way to improve the quality of care for individuals with multiple or chronic health needs where traditional Medicare fee-for-service programs often led to unnecessary hospitalizations or lengthy nursing home stays.

View the paper on Medicare Advantage Special Needs Plans or for more information, visit the Community Catalyst website at www.communitycatalyst.org.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

About the Special Needs Plan (SNP) Consumer Education Project
The Special Needs Plan Consumer Education Project seeks to educate state and federal payers, advocates, health care providers and the public on the opportunities and risks that come with SNPs. Along with education, this project promotes best practices that enhance patient care within a state’s health care framework. Funded by the Retirement Research Foundation, the SNP Consumer Education Project is an initiative of Community Catalyst.

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Consumer Group Applauds IRS Steps Toward Improving Community Accountability for Nonprofit Hospitals

Thu, 20 Dec 2007 00:00:00 -0800

Urges Firm Federal Standards for Free Care and Other Community Benefits

Boston, MA, December 20, 2007. Community Catalyst, a national consumer health advocacy organization, reacted to today’s release of the new tax form 990, calling the development a “positive step in the right direction.” The Internal Revenue Service (IRS) released the redesigned Form 990, which is filed annually by nonprofit institutions, and a new “Schedule H” to be completed by hospitals. Community Catalyst has historically backed efforts to hold hospitals more responsible for reporting on and providing care to un- and underinsured individuals.

In September, the group, along with twenty state and national organizations, issued comments to the IRS citing the importance of the new reporting requirements for nonprofit institutions and called for additional transparency so that the public can fully understand whether nonprofit hospitals are living up to the high standards their tax-exempt status merits.

“Nonprofit hospitals receive over $12 billion each year in tax breaks. We believe that they should be straightforward about the specific financial assistance programs and community benefits provided in exchange for these breaks,” said Renée Markus Hodin, Project Director at Community Catalyst. “Though it does not include all that we and other advocates asked for, the new Schedule H goes a long way toward shining some light on nonprofit hospitals’ activities.”

Community Catalyst pointed to a number of new requirements that may be particularly valuable in promoting greater transparency among nonprofit hospitals, including:

A greater level of detail about a hospital’s financial assistance policies and eligibility criteria;
Standardized reporting for free care and community benefits, as well as bad debt and Medicare shortfalls;
A description of the ways in which hospitals notifies patients about the hospital’s free care policies and public programs such as Medicaid;
A connection between a hospital’s community-building activities and the promotion of health; and
Detail about the community the hospital intends to serve and how it assesses the needs of that community.

However, the group also criticized several very significant aspects of the new Schedule that they maintain are key factors in determining whether a hospital is fulfilling its obligations as a tax-exempt organization. These include:

Allowing hospitals the opportunity to mischaracterize bad debt as a community benefit;
Eliminating important billing information that would allow communities to assess how hospitals serve all classes of patients, including the uninsured, who are often billed at a rate three times of other payers; and
Delaying of the reporting requirements until 2009 (filed in 2010).

In addition, Community Catalyst raised a fundamental and longstanding concern about the continuing lack of standards to which hospitals are held. “While the new reporting requirements are welcome news, there is still much more to be done.” added Hodin. “At the end of the day, there are still no firm standards on the level of community benefits a hospital must actually provide in order to earn its federal tax exemptions. It is our hope that that the IRS and Congress will soon come up with a long overdue remedy to this glaring omission.”

View the complete comments submitted to the IRS in September.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

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New Analysis of Massachusetts Health Reform Shows Initial Success, But Challenges Remain

Thu, 13 Dec 2007 00:00:00 -0800

Boston, MA, December 13, 2007. Community Catalyst, a national consumer health advocacy organization, has released an analysis of the first year-and-a-half of Massachusetts’ comprehensive health reform package. The report finds early success in the program due to robust enrollment, largely in subsidized programs for people with the lowest incomes. However, the study also stresses that certain uncertainties and challenges remain in future implementation phases for the law, particularly regarding the individual mandate and long-term financing of reform.

“Massachusetts has made great strides in the last 18 months to cover low-income, uninsured individuals,” said Michael Miller, Policy Director at Community Catalyst. “A laudable consumer voice and significant outreach and public education efforts have helped lay the groundwork, but in order to sustain this effort and close the gap of uninsurance and underinsurance, difficult decisions will need to be made to secure funding in coming years and to guarantee that a healthcare option is truly affordable for every person in the state.”

Since health care reform passed in April 2006, hundreds of thousands of individuals have been covered in Massachusetts. In fact, the most recent press reports indicate that enrollment is approaching 300,000. While it is still too soon to know the results of every aspect of reform, the Community Catalyst report outlines several promising policies that have emerged, including:

Fully subsidized, comprehensive coverage for the lowest income adults;
Expanded Medicaid coverage for children; and
Determination of the “floor” of insurance coverage for all residents of the Commonwealth.

Other features of the health reform law have not yet proven successful; time will tell their impact. A low threshold for employers to either provide insurance or pay an assessment for uninsured workers is not likely to produce adequate revenue, and Massachusetts may face future financial distress without adequate funding from both the state and federal government for health reform. In addition, it is too early to tell the repercussions of the impending individual mandate, especially whether penalties and the exemption process will prove fair and reasonable.

“Implementation of Massachusetts health reform has faced a number of challenges in its first year and a half, and it’s clear that there will be many more uncertainties to address as we move ahead,” said Brian Rosman, Research Director for Health Care for All, Massachusetts’ consumer health advocacy organization. “Advocates have worked with the political leaders and stakeholders across the state to ensure that consumer voices have been part of the critical decisions to date and we’ll continue to participate in the implementation efforts make sure that health care coverage and access is a reality for all residents of the Commonwealth.”

In addition to findings on health reform policies, Community Catalyst’s report emphasizes the importance of consumer advocacy in making the law work. In each major decision faced in implementation so far, advocates led by the ACT!! (Affordable Care Today) Coalition and Health Care for All have played a critical role. The study cites this lesson for state advocacy groups: campaigns do not end with enactment; implementation is just as important.

View the complete report Revisiting Massachusetts Health Reform: 18 Months Later.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

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National Consumer Health Organization Releases Analysis of State Standards for Nonprofit Hospital Community Benefits

Wed, 05 Dec 2007 00:00:00 -0800

Boston, MA, December 5, 2007. Community Catalyst, a national consumer health advocacy organization, today released an updated compilation and analysis of all state hospital community benefit laws and guidelines. Only 17 states currently have any form of standards in place requiring nonprofit hospital compliance with obligations tied to their tax-exempt legal status. (A community benefits law for an 18th state, Oregon, will become effective on January 1, 2008.)

Community benefits, including free care and other services that address the unmet health needs of a community, are provided by hospitals in exchange for the lucrative federal, state, and local tax exemptions they receive. It is estimated that the total value of all tax exemptions enjoyed by nonprofit hospitals is over $12 billion each year.

“It’s a shame that more states haven’t set firm standards about the kinds of services their nonprofit hospitals must provide to meet the needs of the uninsured and underinsured in their communities,” said Renée Markus Hodin, project director at Community Catalyst. “And, our analysis shows that the standards in even this small number of states vary dramatically from state to state. This finding underscores the need for uniform benchmarks and transparency requirements both at the state and the federal level.”

Community Catalyst offers this updated analysis of state community benefits standards at the same time that federal policymakers are increasingly turning their attention to nonprofit hospital accountability. Recently, Senate Finance Committee staff members convened a roundtable discussion on the issue of setting minimum federal standards for nonprofit hospital community benefit programs. The IRS has also proposed stronger and more uniform reporting requirements for hospital community benefits.

Hospital free care, an essential component of community benefits, has also been a focus of Community Catalyst’s recent efforts. In October, for instance, Community Catalyst launched a custom-designed web-based software solution that allows users to “build” their own state legislation aimed at setting standards for patient financial assistance and free care laws.

Try the Patient Financial Assistance Act web tool or view the complete report Health Care Community Benefits: A Compendium of State Laws.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

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Community Catalyst and the Alosa Foundation Announce the Generics Are Powerful Medicine Program Aimed at Educating Consumers About Generic Drugs

Mon, 26 Nov 2007 00:00:00 -0800

Boston, MA, November 26, 2007. Community Catalyst and the Alosa Foundation are proud to announce a new program, Generics Are Powerful Medicine (GPM). Aiming to educate consumers about the safety, value and effectiveness of generic drugs, GPM will award up to 20 sub-grants of $10,000-$20,000 to eligible nonprofit organizations who are able to demonstrate both a commitment to consumer education and the ability to reach underserved and under-insured populations.

With support of faculty from Harvard Medical School and the Brigham and Women’s Hospital, GPM will create high-quality consumer education materials which sub-grantees will use to educate their networks and consumer populations. For details regarding eligibility requirements and selection criteria, please view the Request for Proposals which can be found on the Generics are Powerful Medicine website, www.genericsarepowerful.org.

Funding for GPM was obtained through the settlement of two lawsuits which alleged that drug-makers conspired to keep more affordable generic alternatives off the market. Generics are often priced at 70-80 percent less than their brand-name drugs counterparts. Generic drugs contain the same medication (active ingredient) as brand-name drugs, but generics usually only become available after the brand-name drug’s patent has expired.

Over the next five years, numerous patents on expensive blockbuster brand name drugs will expire, making less costly generic medicines available to millions of consumers. Yet, studies show that many Americans opt for more expensive, brand-name drugs, rather than switching to equally effective, FDA-approved, lower-cost generics as they become available. The GPM program seeks to work with organizations to counteract this trend by addressing the following concerns:

1) Consumers are often simply not aware that generic versions of brand-name drugs are available. In stark contrast to the $5 billion spent advertising brand-name drugs to consumers, it is not feasible for generic drug manufacturers to advertise.

2) Brand-name drug companies work hard to convince doctors to prescribe a brand-name drug even when a less expensive and equally effective generic is known to be available.

3) Many consumers incorrectly believe that generic drugs are not as effective as their brand-name counterparts, an impression often fostered by the brand name manufacturers.

Hard-to-afford drugs make it difficult for patients to stay on the regimens their doctors prescribe. Consumers, and the health care system generally, could save billions of dollars more every year by increasing use of generic drugs. Increasing appropriate use of generics is an important strategy to reduce the burden of medical costs to consumers. The Generics are Powerful Medicine (GPM) campaign seeks to increase generic drug usage by providing consumers the truth about generic drugs.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

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Community Catalyst Launches Unique Web-Based Tool to Help Advocates Improve Hospital Policies for the Uninsured and Underinsured

Wed, 31 Oct 2007 00:00:00 -0700

Resource comes on the heels of national attention to nonprofit hospital patient assistance programs

Boston, MA, October 31, 2007. Community Catalyst, a national consumer health advocacy organization, has launched a custom-designed web-based software solution that allows users to “build” their own state legislation aimed at setting standards for patient financial assistance and free care laws. The introduction of the Patient Financial Assistance Act tool comes on the heels of a roundtable discussion sponsored by the Senate Finance Committee on the issue of nonprofit hospital community benefits.

Hospital free care is the ultimate safety net for millions of uninsured people. Unfortunately, hospital standards for providing free or reduced care are vague, in particular for nonprofit hospitals who seek tax-exempt status as charities. Community Catalyst offered comments before Congress this week, along other consumer groups, hospital associations, academics and various stakeholders debating the extent of the obligation of nonprofit hospitals to provide services to their communities, in exchange for tax exemptions.

But as the discussion continues at the federal level, Community Catalyst and advocates across the country are also working at the state level to set adequate standards. The Patient Financial Assistance Act tool helps advocates understand the various components of financial assistance laws and provides important model language for strong state legislation.

“While the spotlight recently has been on the federal community benefit obligations of nonprofit hospitals, we don’t want state advocates to forget that they still hold a lot of power for making a change at the state level,” said Renée Markus Hodin, project director at Community Catalyst. “We envision this resource to be extensively useful, not only for consumer advocates across the country, but also for state policymakers looking to enact meaningful hospital financial assistance measures and protections for patients in their state.”

The “build-a-bill” web tool allows users to select standards for various key components: from reporting and eligibility standards to publicity and billing and collections practices. Users can select among three different Model Acts or they can customize their own legislation based on their own state circumstances.

Try it now—build your own Patient Financial Assistance Act.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

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The Prescription Project report shows industry spends $50 million-a-year marketing cough and cold medicines for children despite evidence of risks

Thu, 18 Oct 2007 00:00:00 -0700

BOSTON – The Prescription Project today released a report showing that companies producing over-the-counter (OTC) cough and cold medicines spent more than $50 million marketing these widely used products for children under the age of 6 despite evidence of risks and lack of effectiveness in treating children. The report, titled Risk With No Benefit: The Marketing of Over-the-Counter Cough and Cold Medications for Children, was released to coincide with today’s Federal Drug Administration’s Nonprescription Drug Advisory Committee hearing on the potential dangers of these products for children under the age of 6.

The Prescription Project report, which analyzed FDA, industry, and epidemiological documents on OTC remedies, shows a lack of efficacy data but a significant number of reported injuries and deaths associated with overdosing of these products. Manufacturers have heavily marketed this class of OTC preparations for many years based on their FDA classification as “safe and effective,” yet the FDA has not conducted or brought forward a single study or review to prove the safety or effectiveness of these products for use in small children in the last three decades. The full report is available at www.prescriptionproject.org.

“Especially when it comes to over-the-counter drugs, physicians and patients rely on the FDA to ‘calculate’ the benefits versus risks and communicate this to the public,” said John Santa, MD, MPH, a consultant to the Prescription Project and former medical director of the Drug Effectiveness Review Project (DERP). “In this case, it appears the benefits are close to zero while the risks are significant."

Last week, in response to growing questions and pressure from pediatricians and the FDA, major manufacturers of the popular cold remedies announced that they were voluntarily withdrawing from the shelves OTC infant cold and cough products marketed for children age 2 and under. As of yet, there has been no action on drugs marketed for children 2-6 years old.

Prescription Project-National Physicians Alliance join forces to stem negative influence of drug industry marketing on health care

Tue, 16 Oct 2007 00:00:00 -0700

BOSTON – The Prescription Project and the National Physicians Alliance (NPA) today announced a partnership to engage physicians in a nationwide campaign to eliminate the harmful influence of pharmaceutical marketing on the cost, quality, and safety of health care.

Last spring, the Prescription Project and the NPA began a collaboration around their united opposition to prescription data mining—the sale of physician prescribing data for use in pharmaceutical marketing. Building on those efforts, the two organizations will work in partnership to develop a national physician network to educate doctors about how pharmaceutical marketing to physicians creates conflicts of interest in the profession; generate support among physicians for reforms that limit industry influence on medical practice; and promote evidence-based prescribing. The NPA will also develop professional ethical guidelines for physician-industry relationships and provide practical advice on cutting ties to the industry.

“As the prime targets of a well-funded drug industry marketing machine, physicians must play a leadership role in promoting medical care that is guided by independent, evidence-based science, not by propaganda,” said Rob Restuccia, executive director of the Prescription Project. “Given the NPA’s firm stance against the influence of pharmaceutical dollars on the profession and its strong organizational capabilities, it will be a very powerful, effective voice driving reform from within the profession.”

The pharmaceutical industry spends more than $7 billion per year in direct-to-physician marketing that includes free gifts, meals, travel, speaking fees and other inducements—all to persuade physicians to prescribe new, expensive, largely unproven brand-name drugs that lack a significant record of safety. As recently reported in the New York Times, pre-marketing clinical trials have lacked adequate oversight and the dangers of new drugs are often revealed during their first few years on the market.

An April 2007 survey published in New England Journal of Medicine found that 94 percent of physicians reported some type of relationship with industry, with 83 percent reporting they accept free food and drinks from drug company representatives. The prescribing of brand-name drugs over equivalent generics results in an estimated $8.8 billion in excess expenditures per year in the United States.

"Pharmaceutical marketing has infiltrated every level of medical education, publishing, research, and practice,” said NPA executive director Dr. Jean Silver-Isenstadt. “Physicians want to prescribe what is best for patients, and want data they can trust. Today, ads look like articles, educational lectures are industry-funded, and patients must practically compete with drug reps for seats in office waiting rooms. The safety of patients, the cost of health care, and the independence of our profession are all at stake here, and physicians are ready to push back.”

Other components of the Prescription Project-NPA partnership include development of:

• an online toolkit to provide physicians with industry-free resources, such as information sheets for patients about why the office is refusing to display pharmaceutical marketing materials, advice on how to change practice habits and replace pharmaceutical-branded items, and evidence-based prescribing resources such as CR Best Buy Drugs and The Medical Letter

• an “Industry-Free Speakers Bureau” of NPA members who have no financial conflicts of interest and who will give presentations on pharmaceutical policy reform at medical institutions, professional meetings, and to the general public; and

• a database of physician stories that document industry-influence experiences to be shared with legislators and the public to bolster arguments for reform.

About the National Physicians Alliance
United across medical specialties, the National Physicians Alliance was founded to restore physicians' primary emphasis on the core values of the medical profession: service, integrity, and advocacy. The NPA works to improve health and well being, and to ensure equitable, affordable, high quality health care for all people. For more information, please visit www.npalliance.org.

Consumer Groups Weigh In on Community Benefit Standards for Nonprofit, Tax-Exempt Hospitals

Thu, 27 Sep 2007 00:00:00 -0700

Boston, MA, September 27, 2007. Consumer groups nationwide joined Community Catalyst, a national consumer health advocacy organization, in an appeal to Congressional leaders to take action in setting better community benefit standards for nonprofit hospitals.

In comments issued to the office of Senator Chuck Grassley (R-IA), ranking member of the Senate Finance Committee, the groups assert that the legal obligations that nonprofit hospitals must meet to obtain federal tax exemption are vague and have no connection to the reality of today’s health care system. As a result, many hospitals are failing to adequately serve millions of consumers in the U.S. who depend upon full or partial free care for their health needs.

Comments were submitted in response to a Discussion Draft on Tax-Exempt Hospitals, which was released by Grassley’s office. The groups’ comments come on the heels of those provided to the IRS on its proposed re-design of Form 990 and introduction of Schedule H, which seeks additional reporting of tax-exempt hospitals’ community benefit activity.

“The reality today is that more and more people need assistance when faced with a health care crisis or even a just a doctor’s appointment. A study released this week indicates that over half of low-income families make too much money for Medicaid assistance, yet don’t have other health insurance options,” said Susan T. Sherry, Deputy Director of Community Catalyst. “Nonprofit hospitals that seek and gain tax-exempt status need to be accountable for helping to serve the needs of the uninsured and underinsured in their communities.”

Supporting many of the proposals in Sen. Grassley’s Discussion Draft, consumer groups particularly praised the attention to the full breadth of concerns related to free care and community benefit standards, from setting a minimum level of free care that each hospital must provide to addressing egregious hospital billing and collection practices.

Community Catalyst and 24 other national and state-based organizations supported and recommended the following points related to free care and community benefit standards for nonprofit hospitals:

Set minimum free care requirements at five percent of revenues or operating expenses, whichever is greater;
Limit the amount that self-payers (uninsured and underinsured) can be billed for hospital services;
Require clearly defined and publicized free care policies;
Provide free care for all patients up to 200% of the Federal Poverty Level (FPL) and partial free care for all patients between 200% and 400% of the FPL;
Regulate collection practices, ban the selling of accounts to third parties, require publicly available debt collection policies and greater hospital administration approval of those policies;
Conduct community needs assessments at least once every three years;
Improve transparency and better reporting of community benefits and free care policies;
Establish sanctions for failing to meet obligations based on clear standards and with appropriate penalties.

The groups also emphasized the fact that many nonprofit hospitals already provide meaningful community benefits for the people they serve. “There are many exemplary hospitals out there. But without firm standards, too many hospitals are shirking their responsibilities to their communities. It’s clear the system needs changing,” added Sherry.

View the complete comments submitted to Sen. Grassley’s office.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.

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