Neighborhood Health Plan

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Economic Abuse: Recognizing It In The Doctor’s Office And Beyond

By Dr. Paul Mendis
Guest contributor

Sarah’s husband was not only the primary earner in the household, but he also controlled the family’s finances. In addition to physically abusing her, he would withhold Sarah’s “allowance” so that she and their children could not afford the co-payment to see a doctor and get the health care they needed.

Unbeknownst to Wendy, her partner amassed hundreds of thousands of dollars in credit card debt in her name. After their breakup, she learned that she had no legal way of addressing the fraud, and became responsible for repaying the debt that he had accumulated. The stress of paying off this debt took a disproportionate toll on her health, and she developed chronic fatigue syndrome, as well as anxiety and sleep-related disorders.

Stay-at-home mom Janine (all names have been changed) was dependent on her husband’s health insurance for her own care, and the care of her young, chronically ill daughter. Janine did not have any savings, nor was she able to train for a job while taking care of a sick child. Although Janine’s husband was verbally and emotionally abusive to both of them, she was forced to stay in the relationship to ensure that her daughter had access to health care.

These are just some of the stories about Americans who experience economic abuse, a form of domestic abuse that is not just a criminal justice issue; it is very much a health care issue.

Dr Paul Mendis (NHP)

Dr Paul Mendis (NHP)

Some background: Economic abuse is a serious, and often overlooked, form of domestic violence, which can leave a partner completely dependent on an abuser to supply basic needs. An abuser will control a partner’s finances and prevent him or her from accessing resources, maintaining control of earnings, and gaining financial independence. The abuser may also interfere with a significant other’s work performance or prevent education, job training, and the ability to find and keep a job.

Typically, economic abuse goes hand-in-hand with domestic violence, which is experienced by one in four women in their lifetime. We usually associate domestic violence with physical or verbal abuse, but economic abuse is just as significant and can have long-lasting and devastating effects. The National Coalition Against Domestic Violence reports that over 1.75 million workdays are missed each year as a result of absenteeism, decreased productivity, and health and safety costs associated with domestic violence.

Economic abuse can also affect a victim’s access to health care and medicine. A victim of abuse may resist leaving an abusive partner because his or her children are dependent on that partner’s health insurance. Additionally, the victim may avoid medical care altogether because transportation options have been withheld or limited, or because he or she cannot afford co-payments while a partner controls the finances.

Victims of domestic violence may not seek out necessary health care services for fear of revealing an abusive situation to medical professionals. This is especially true when an abuser is the primary policy holder on the family’s health insurance. In most cases, the victim does not want a partner to know that he or she is accessing health care because it can escalate the violence at home.

Therefore, physicians may not always see victims with acute, trauma-related injuries, but rather, other serious health issues that require treatment. For example, victims experience toxic stress that can manifest as chronic health conditions, like heart disease or a worsening of asthma. Economic abuse can have a long-lasting impact on a victim’s health and well-being — even after an abusive relationship is over.

It is important to remember that economic abuse, like other forms of domestic violence, can happen to anyone, regardless of age, race, gender, sexual orientation, marital status, or income. Continue reading

Levy: Why Is Partners Acquiring Neighborhood Health Plan?

A day after Partners HealthCare announced it would take over Neighborhood Health Plan, the Boston-based nonprofit with 240,000 mostly low-income patients in government-subsized insurance plans, health policy insiders are abuzz with one question: Why?

Here’s a theory from Paul Levy, former CEO of Beth Isreal Deaconess Medical Center, posted on his blog:

I am speculating, of course, but there are two ways to look at this. One is that PHS is trying to lock in a set of relationships and customers for the future; but that doesn’t make sense because these patients are poorly reimbursed. Also, the company has promised that it will not use this new relationship to limit those patients’ choice of providers. So to make that work, it would have to develop new models of care that enable this group of patients to be profitable, notwithstanding Medicaid rates that are acknowledged to be too low. A worthy, but very hard row to hoe when you operate a high fixed cost network.

The other is that a trade has taken place, related to the fact that the holding company has been facing state and federal antitrust reviews. It agrees to provide some financial assurance to a financially stressed insurance company and community health centers serving mainly the indigent, in return for being allowed to keep other human resource or geographic assets that might otherwise be subject to a divestiture that would have reduced its market power.

Or maybe they just want to make sure care is accessible to everyone.

Any other theories out there? All are welcome.

Breaking: Talks Under Way For Neighborhood Health Plan To Join Partners HealthCare

WBUR’s Martha Bebinger reports:
Partners HealthCare, the state’s largest hospital network, plans to acquire a small Boston- based health insurer. Partners and Neighborhood Health Plan, a nonprofit with 240,000 mostly low and moderate income residents in government health insurance plans, have signed a letter of intent to affiliate. In Massachusetts, networks that own both hospitals and a health insurance company are unusual. And since the deal gives Partners an insurance company, regulators may raise questions about increased market clout. But CEO Gary Gottlieb says Partners does not plan to compete with other major health insurers.

“The focus here is on low income populations so doing better by those populations would seem to be both moral as well as in everybody’s interests and not related to any market issues,” Gottlieb said.

Gottlieb says he hopes an affiliation with NHP would help reduce health care disparities in the Boston area.

Partners is expected to increase investments in NHP and related community health centers, although it won’t say by how much.

Neighborhood Health began searching for an affiliation more than a year ago. Director Deborah Enos says NHP’s finances are strong now but the insurer needs to prepare for future financial pressures. Enos says NHP will not limit members to Partners’ hospitals if the deal is approved.

Partners and Neighborhood Health Plan aim to complete their due diligence process and have an agreement by the end of October. The next step is the regulatory review. While there are concerns about Partners entering the insurance market, there is also a push for hospitals to create more comprehensive health networks.

This letter just out from Partners HealthCare chief Gary Gottlieb:

Dear colleagues,

In today’s health care environment, as we know, there is an expectation that hospitals, doctors, insurance companies and other interested parties will work together to create opportunities to ensure the delivery of high quality care, improve the coordination of care, deliver value in health care benefits and in doing so will help to bend the cost curve. With that backdrop, I am writing to share the news that we are engaged in discussions with Neighborhood Health Plan (NHP), a not-for-profit Managed Care Organization, about an opportunity to form a new relationship that could yield significant benefit for our patients. Over the past few months, NHP has been seeking a strategic partner to ensure that it is in the strongest position to further its mission, provide enhanced resources to community health centers and historically underserved communities and continue on a path of sustained growth.

There are several reasons why our organizations would fit together well. Partners HealthCare and NHP share a deep commitment to provide the highest quality, highest value, culturally competent and compassionate care that is accessible to patients and their families. We are both deeply committed to Community Health Centers (CHCs) and the belief that CHCs are a cornerstone of a cost-effective health care delivery system, particularly for the underserved. Both organizations also have a long-standing history of collaboration and are strongly committed to serving the health care needs of low income and vulnerable populations in Massachusetts. The bulk of NHP’s members receive their coverage through state programs, especially Medicaid (MassHealth) and Commonwealth Care.

We both believe that combining the experience and expertise of our organizations will result in a stronger patient experience and address growing needs for care coordination and management, health equity, and the ability to help curb health care costs. Working together, our organizations will have the flexibility to develop innovative patient and family centered models of care and craft new initiatives aimed at better managing care of complex conditions.

To be clear, this is not a purchase, but rather an affiliation by which NHP becomes a member of Partners HealthCare. This is a process that will take months and will require regulatory approval. We will keep you posted on developments as we move forward.

Thank you.

Gary L. Gottlieb, M.D.
President and CEO

Here’s a fact-sheet put out by the two parties in this new relationship: Continue reading