Greeners Working for Better Health
As national health care reform was being debated, North Dakota Senator Kent Conrad suggested non-profit insurance cooperatives such as Group Health, based in Seattle, as one option for universal care.
Pam MacEwan ’76, Group Health’s executive vice president for public affairs and governance, found herself in the national spotlight, featured on National Public Radio as well as radio and newspaper reports across the country.
Greeners like MacEwan are working throughout the health care system to provide better access to care, help doctors and patients work better together, and raise awareness of multiple ways people can get and stay healthy. Although she appreciates the attention Group Health is receiving, MacEwan warns that the co-op model is not the only answer to the health care issues we’re facing. “It’s exciting to have the spotlight on Group Health, especially in these momentous times,” she explains. “But this is not an easy debate to influence.”
The most important thing about the Group Health model is not that it is governed by members—a board of directors who are all GHC patients. “The most important thing is that we integrate care and coverage,” she says. “In the fee-for-service model that dominates current health care, the incentive is to do more—more tests, more visits, more prescriptions. The incentives at Group Health are for doctors to keep patients healthy—to be patient centered, and that’s the difference.”
This isn’t the first time MacEwan has been involved in health care access reform. In 1993, Governor Mike Lowry signed a new Health Services Act, which gave access to health care coverage to almost all Washington residents. Governor Lowry tapped MacEwan to serve as one of five commissioners in charge of making sure the Health Services Act was implemented effectively.
But the law was repealed in 1995. “We had to start all over,” MacEwan says. “The consequences for not changing health care in America are worse than changing it. People need to ask themselves ‘how would you pay for health care without your job?’” MacEwan serves on the state’s Joint Select Committee on Health Reform Implementation, and has worked with the state and the county to expand access to health care for children in King County and in the state. She now finds herself working to keep programs for low-income people going. “The state of Washington has been committed to these programs until very recently, when they have had to cut programs because of reduced budgets,” she explains. “We can’t continue the health care cost trend we’re on. And we can’t continue to justify that more and more people have no coverage at all.”
From children to seniors, bridging the coverage gap is always a challenge.
Roger Moore ’86, executive director of Woodmark at Steel Lake, an assisted living facility in Federal Way, Wash., has worked with the elderly and their families for 20 years, and says funding has always been an issue, especially as people expect more and more from the health care system. “We know that the Baby Boomers are coming,” he says. “People are living longer, and the elder population is the fastest growing in the country. How do we house and care for these people as they grow older?”
Woodmark is Moore’s first experience at an assisted living facility, after running skilled nursing homes for most of his career, and they are running at almost 100% capacity. Demand for their services has increased as acuity levels—the measure of the intensity of a patient’s medical condition—have changed. “More hospital patients go home to recover now,” Moore explains. “So many more people are ending up in nursing homes for a while, doing physical and occupational therapy so they can remain in their homes.”
In the Seattle area, there have been many resources available for older people, although Moore agrees with MacEwan that the budget deficits of the last two legislative sessions mean that without new revenue sources, many programs face being cut. Moore, a licensed nursing home administrator, serves on the board of the Washington Health Care Association, a nonprofit organization of assisted living and skilled nursing facilities, and is the Washington state representative for the American Health Care Association’s National Center for Assisted Living.
He has spent significant time in Olympia working to ensure funding is available for long term care. “We are asked to do more at the same time they’re cutting funding,” he explains. “With every new regulation, there are new costs associated with that. But it has to be done in a way that optimizes quality of care, as well as quality of life.”
Helping people enhance their quality of life requires different ways of thinking about patient care and the doctor-patient relationship. Naturopathic doctor Justin Pollack ’90, who co-founded the Mountain River Naturopathic Clinic in Frisco, Colo. with his wife, Dr. Kimberly Nearpass, agrees that incentives should be more toward family and overall care. They chose to found their clinic in Summit County after falling in love with the beauty of the mountain town, and for a simple reason—the residents said “We need you here.”
Since 2003, they’ve added an acupuncturist, massage therapists and counselors, and developed an integrated center, with an herbal apothecary. But because licensing and standards for N.D.s vary widely among states, they are still fighting to become a part of the health care solution.
“The politics of medicine is very messy—there is pressure to see as many patients as possible and malpractice insurance is high,” Pollack says. “As N.D.s, we have the luxury of spending time with our patients, which makes for great care. The goal is to get to the cause of health issues and treat them with lifestyle changes. But since in many states we’re not part of the system, we aren’t seen as a viable option.”
Pollack and Nearpass, both licensed N.D.s in Oregon, have been at the forefront of the fight for N.D. licensure in Colorado, setting standards and regulations for practitioners in the state. As many insurance companies will only cover “licensed/certified” health practitioners, this would increase access to naturopathic medicine in Colorado, as well as ensure that only trained and educated N.D.s could offer this care.
Currently 15 states, the District of Columbia, and five Canadian provinces have licensure for naturopathic doctors. “If health care reform is modeled after Medicare/Medicaid, N.D.s are not yet part of that, although we hope to be,” Pollack explains. In Oregon and Washington, N.D.s are classified as primary care physicians, and their scope of practice includes minor surgery and prescribing medication. “Insurers, including Medicare and Medicaid, should not have to pay for an emergency room visit for a cold.”
Educating patients on their own health care needs, and helping doctors, nurses and other health care providers best use their knowledge is critical to making health care patient-focused and affordable. New technologies are important, but simply talking with patients and their families about their options can help prevent health care crises.
For elderly patients, families are critical, as adult children are often called on to help them stay healthy. In 1994, Seattle Mayor Norm Rice started the Mayor’s Council on African American Elders, made up of community members, doctors, activists, University of Washington faculty members and other professionals. In 2005, Roger Moore was asked to join the council, and he served as chair for a year. One of his concerns was that older people were not aware of resources available to them—not just in health care, but also in financial issues, housing and other challenges. He implemented a campaign to educate seniors and their adult children. “We need to advocate for and educate our elders, as well as their adult children who are often the decision makers,” Moore says. “People want to know that their loved one is receiving the best of care.”
Pam MacEwan agrees. She is frustrated with the tone of the conversation around health care reform. “We need to discuss issues like end-of-life care in a caring and patient-centered way,” she says. “People want to have conversations with their own families so that they make choices that are right for you. Politicians and pundits creating fears about ‘death panels’ are not helpful.”
All of us have a vested interest in a healthy population, and more personally, in our own and our families’ health care needs. It’s a daunting task for those working with doctors and patients to solve these issues. MacEwan, Moore and Pollack, along with hundreds of other Greeners working in the business of health, understand it is critical to find ways for Americans to get and stay healthy. “An Evergreen education teaches you to be self-reliant and independent in judgment and thinking,” says MacEwan. “You’re able to think differently to solve seemingly intractable problems.”
That kind of thinking is necessary as the health care debate continues. “Although I’m not a physician, I am very passionate about this particular piece of health care,” says Moore. “I’m lucky to be able to be at the forefront in state and national associations so I can really advocate for this industry. We need to take care of our folks.”