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According to the Advisory Board, almost 50% of those eligible to enroll for health insurance under the Affordable Care Act this year are between 18 to 34 years old. This makes the launch of Open Enrollment 3.0 particularly important to my friends, who text me all the time with their health questions: “Hey, I chopped the tip of my finger off while cooking tonight. Should I go to the ER? Here’s a photo,” is not a strange message to receive when you’re a nurse.

 

Obamacare turned five this year, and open enrollment season, which launched November 1st, turned three. The system has come a long way from its infancy, with healthcare.gov preparing for a whopping possible 10.4 million eligible enrollees for this 2016 season.

 

Enrollment, it seems, is just the first step in creating healthy Americans – many of my friends are covered, thanks to the Affordable Care Act, but they don’t know how to use their coverage, or where to get help when they need it. Health care delivery, or how we get to the providers that facilitate our newly prized coverage, is what my friends are most concerned about.

 

Heath economist and physician-writer, Aaron Carroll, summed up our current healthcare delivery reality in his description of the arduous process that he undertakes four times a year in order to obtain medication for a chronic condition:

“The Affordable Care Act, which seems so complicated to so many, was almost entirely about getting more people in the United States health insurance. That was just a first step, arguably an easy one, and we’re still fighting about it. Reforming the ways in which we actually deliver care and try to improve outcomes? That’s so much more important, and we barely talk about that at all. But that’s what matters to the people who use the system, and it’s why so many of them are frustrated.”

What an incredible statement, considering Carroll’s vast experience with the system as a physician. How do less knowledgeable patients fare?

 

This makes the work of the non-profit The Young Invincibles (YI), especially important. YI is an organization that works to give young people – millennials, specifically – a voice in areas like political advocacy and health. Over e-mail, I interviewed the new YI Northeast division director, Kevin Stump, about his position, YI, their health initiatives, and their new app, HealthYI, which launched this fall.

Kevin Stump, Northeast Director for the organization, Young Invincibles.

Kevin Stump, Northeast Director for the organization, Young Invincibles.

 

I downloaded HealthYI to my iPhone recently. Along with my surprise at how fast it launched (woo-hoo to a low-tech app that doesn’t suck my battery dry), I found that I really liked the program’s simple, ALL CAPS html-ish layout: HEALTH CHECKLIST tops a bold list of four selection options, including MONEY-SAVING TIPS. Fitting, since Federal officials have expressed concern that cost is a reason for Healthcare.gov 3.0 being “tougher” for new-enrollees than in prior years.

 

Although each option leads to some pretty text-heavy pages, HealthYI has some great, basic content for new patients. As a nurse who has treated urban patients of all ages since before the first iPhone was created, I’ll certainly use this at work and with friends looking for a primer on health insurance. The content is welcome; Americans, especially young ones, really don’t know how to be patients, simply because they haven’t had coverage for so long.

 

The HEALTH RIGHTS menu of HealthYI is remarkably comprehensive, with sections pertaining to immigrant rights and LGBT, too. While the SCHEDULE AN ANNUAL PHYSICAL choice doesn’t include my health plan, it looks like a great start, and its platform, which zips through selections without a cinch, will likely appeal to data-restricted young folks looking for a quick and easy guide to understanding health insurance for the first time. Overall, the app is a definitive resource for pointing young people toward the information they need to gain health literacy in an unobtrusive, easily maneuvered way.

 

What stumped me, though, and will perhaps serve as a plausible impetus for launching a league of talented tech-savvy nurse YI volunteers, is the “SEND US YOUR QUESTION!” section. While YI promises to respond within two business days, it doesn’t capitalize on what all insurance companies already provide, and what my texting friends so frequently have no clue about – the oft-overlooked number on the back of every insurance card that leads directly to the 24/7 service of a preventative, available, expert nurse.

Results of a search in the HealthYI app.

Results of a search in the HealthYI app.

 

I was especially puzzled when my query for “nurse” in the search function of HealthYI came back totally empty – nurses might connect, educate on, and speak to all of the possible selections this tool has to offer – from finding providers to answering money-saving questions. In other words, would my friends stop texting me, if apps like this hooked them up with a live nurse instead?

 

Here are some October 2015 excerpts from my exchanges with Kevin, Northeast Director of Young Invincibles, who tweets @KevinStump:

 

Why YI? What, specifically, about the organization interested you?

 

Young Invincibles fills a much needed gap in advocating for and elevating the voices of Millennials, a generation that has too often been left out of today’s most critical policy and societal debates.

 

Millennials were hit the hardest by the Great Recession, and so many hardworking young adults are still facing the ripple effects. Today Millennials still face unique challenges in simply trying to gain an economic foothold – an unemployment rate that is nearly 40 percent higher than the national average, skyrocketing college costs resulting in crippling student debt, and a lack of awareness around affordable healthcare options and how how to use them.

 

In New York and across the country we are tackling these issues and beyond through research, policy, advocacy, organizing, and more. Our perspective must be heard wherever decisions about our collective futures are being made.

 

Tell me about this new YI app — What about it do you think works really well? Doesn’t?

 

The HealthYI app was designed by YI Advisors, Young Invincibles’ non-profit consulting arm, with a number of New York regional partners to bring healthcare to the fingertips of young New Yorkers.

 

This is especially relevant today because young adults are increasingly accessing services via their smartphones.  The app not only provides basic and easy-to-understand resources like a health checklist, tips on how to save money, health care rights and insurance basics, it allows users to schedule an appointment with a healthcare provider or send in a personal question and get an answer.

 

We’re also collecting feedback and watching how young adults use it, as we want to make sure we’re continually adapting and improving the app based on the real needs of its users, so there will likely be more updates and potential new features to come.

 

What’s your plan for getting YI into the hands of those it hopes to serve – young people? What barriers do you face – nationally, but regionally, too?

 

We’re working hard to get the word out there about the new app, with a special focus on reaching typically underserved and low-income communities, which historically have less experience with healthcare options.

 

We are continuing to build new partnerships, for example we’re working with the CUNY University Student Senate and School of Public Affairs to connect this tool to their students. Additionally, we are reaching Millennials where they consume information — on their mobile devices — through a paid social media campaign targeting New York City residents.

 

And we’re already hearing some great results – for example we heard from one young woman who lives in New York City and used the app to find a sports medicine physician after tearing a muscle. She has put it off for the past month because her health care provider’s website is so difficult to navigate. In less than 10 minutes, she downloaded HealthYI and was able to schedule an appointment.

 

A lot of studies are showing that young people, tech savvy ones, even, would rather pay the tax penalty than enroll in insurance because delivery is so poor. Seeing any glimmers of hope on the horizons, or any programs that YI is excited by/pairing with?

 

We know that young adults want and value coverage, and now that affordable options are available to them, they are signing up.  In New York State, 34 percent of those who enrolled in health coverage during the last open enrollment were Millennials, age 18-34.

According to the Advisory Board, almost 50% of

A bus filled with children rolls through town at eleven o’clock at night. The children are alone, have no parents, don’t speak English, and, from the looks of them, need medical attention. Most clinics are closed; the driver doesn’t even slow as he passes them. He pulls up at the local emergency department, unloads his young cargo, and drives away.

 

This is a hypothetical tale. But it isn’t far from everyday reality of some refugee children.

 

A refugee, according to the United Nations High Commissioner for Refugees, an advocacy agency, is an individual who is forced to flee their homeland against their will because of circumstances or conditions that make it unsafe to stay there. The Department of Homeland Security’s 2014 Annual Flow Report reveals that 69,909 refugees entered the United States in 2013. Of that number, 26,933 of them were children.

 

Strong opinions exist surrounding immigration and refugee support in the United States. Recent coverage of the war in Syria, particularly focused on its violent impact on children, has made the issue a more pressing one.

 

Despite their innocence, refugee children may suffer both physical and emotional consequences from their unstable lives that often lead to lack of healthcare. Many pediatric immigrants and refugees are faced with poor environmental conditions that can leave them susceptible to a host of infectious diseases, dehydration, injuries, and mental trauma.

 

While refugee children are granted health care coverage through the Affordable Care Act , is our health care system ready to meet the needs of this vulnerable population?

 

Healthcare needs from the current influx of refugee children may be larger than what the staff of the local departments of immigration can accommodate. From my experience, potential constraints range from a lack of pediatric trained health care providers, funding, and clinic operating hours. Perhaps this is why the refugee children come directly to the local emergency department.

 

Wouldn’t it be novel to apply the idea of emergency preparedness to the pediatric refugee population? Most Emergency Departments feature detailed mass casualty event protocol algorithms. A Mass Immigration/Refugee Emergency Algorithm might help unite local resources within the community, and standardize care resources for this highly variable and growing population.

 

Programs exist that assist refugees and their children, specifically with their health. The Children’s Hospital of Philadelphia boasts a Refugee Health Collaborative that offers comprehensive medical care to refugee children, and serves as an industry resource in the care of this population. But the program’s website says it can only accept 90 new primary care patients this year – another testament to why many children, who travel from surrounding states to this practice, often get their care primarily at the emergency department.

 

Where gaps in primary care exist, many faith-based program step in to serve as safety nets for cities with large refugee populations. In Buffalo, New York, where 7% of the entire population are refugees, Jericho Road Ministries offers a “culturally sensitive medical home,” a maternal-child health program called the Priscilla Project, and even legal and community acclimation services. Jericho Road served almost 11,000 patients in 2014 – 40% of which were under 18 years old, and half of which are refugees. Many of their services depend on volunteers, but since refugees are covered under Medicaid, only 3% of their patient population is uninsured.

 

The controversy continues when considering legal determinations for unaccompanied refugee children: Are they undocumented immigrants, or are they refugees? Does the path of an unaccompanied foreign minor lead towards incarceration and deportation, or acceptance and integration? Should children be made to suffer from decisions made by their parents? Is health care a basic human right or a privilege?

 

As a pediatric health care provider who often treats refugee children in the emergency department, it’s clear that a physical home isn’t all we must provide – every patient needs a medical home, too.

A bus filled with children rolls through

I noticed a big sign in my hospital’s lobby on Monday. It said, simply, “HEALTHCARE QUALITY WEEK.” Below this week’s dates, a bunch of logos and words pertaining to our institution’s quality accomplishments were displayed.

 

“Huh,” I thought. “I guess that’s nice.” But quality, which to me, quite often functions as a mechanism for tracking and preventing failures, seemed an odd thing to celebrate. Likely just another PR-opp for the tweetosphere.

 

I was curious, though. I looked up this supposedly annual celebratory event – a creation of the National Association for Healthcare Quality. The organization, which is led by a board made up largely by RNs, says of this week’s festivities: “…we are celebrating Healthcare Quality Week by recognizing the influence that healthcare quality professionals have in healthcare delivery systems and their impact on positive patient outcomes.”

 

Ranging from sentinel event tracking to improvement projects, hand hygiene assessments and fall reflection practices, the quality of a hospital is measured, very often, by the bad that we don’t do. The good that we actually accomplish for our patients is the ultimate goal, but it’s an indirect one. And besides, it’s our job. I don’t applaud my favorite restaurant for maintaining their A Grade on the window – why should I be applauded for doing my work as a nurse in a hospital?

 

But, on second thought, maybe the designation warrants a pause.

 

Quality in healthcare is changing. Remember that old ‘I Love Lucy’ episode, where Ethel and Lucy in the chocolate factory line? Bombarded with their own failures, they hide imperfect chocolates within their bulging cheeks and sagging hats, because they can’t keep up with the speed of the conveyor belt, and their assigned task.

 

www.cbs.com/shows/i_love_lucy

In contrast, the gold standard of healthcare quality, in recent years, is defined by consumer knowledge of the nitty-gritty of hospital operations. In fact, public knowledge of hospital standards is becoming common fare – and for good reason. Maybe that’s why weeks like this one matter – not so much as a celebration of my work, but as a reminder to my patients to check up on it.

 

The consumer now has many options for evaluating hospital quality choices, and experts are urging them to do so. Just this morning, Health Leaders Media posted an article on the benefits of choosing a five star hospital versus a one star hospital. According to Healthgrades, a performance and quality comparative service, patients who went to five star hospitals showed a drop in mortality by 71% from those who went to a one star hospital. That’s a lot of risk thrown out the window thanks to transparency.

 

With Hospital Compare growing in public knowledge, and the Leapfrog Group‘s similar quality comparison tools and procedure-specific trackers, like their first-ever national release of c-section rates gaining traction, quality data is now a commodity that consumers expect. Our success as healthcare providers and institutions comes with a major price these days – a very public one that we can’t just stuff under a hat.

 

But too often, we miss the goal of these quality measurements, and see them as simply punitive. When our patient falls, we frequently think of it as only a loss or a failure, instead of an opportunity to create a better system that prevents these things in the future. Shouldn’t we push aside shame, and start searching current literature for new developments, see what is best practice, and suggest an algorithmic protocol to our leaders — one that not only prevents complications, but promotes accountability and minimal harm for our patients? The Institute for Healthcare Improvement (IHI) says a an entire culture of safety is what we should be striving for — an environment where, “…people are not merely encouraged to work toward change; they take action when it is needed.”

 

We should champion accomplishments for patients, stand firm in our system’s growing transparency, and push forth a vision for the future that both providers and consumers can share. We must strive for a culture in our institutions that promotes quality, and the creation of systems that protect all involved – patients, and workers, too. This drive can only come from providers and caregivers who are willing to step up, speak clearly about processes that need refining, and work openly towards creation of safety for everyone.

 

So, yeah, we should celebrate quality this week. Not only our accomplishments, but also the regulatory agencies like Centers for Medicaid and Medicare, our local health departments, and the Joint Commission, which hold us to a standard that protects our patients and ourselves. Without safety hoops to jump through, protocols that promote prevention, and initiatives that champion innovation for more efficient care, we’d just be like Lucy and Ethel, cramming our mistakes into a hiding place that only hurts everyone in the end.

I noticed a big sign in my hospital's