The Affordable Care Act — What SBHCs Need to Know

Robin Turner

Wow!!  I can’t believe its been almost two years since the passage of the Affordable Care Act (ACA) .  I remember watching it on a television in Washington DC when I was attending the National Association of Community Health Centers.  I was just down the road from the momentous vote!  Needless to say, the people attending the conference were mostly ecstatic that it finally happened.  It had been years of fits and starts, trying to move the country forward together to provide health care to all people.

You might be wondering exactly what the status is.  So, here are just a few critical pieces to keep on your radar:

1. The Supreme Court will hear the states (Michigan among them) case against mandatory coverage.  This is supposed to be heard in March 2012, and decided by June 2012.   The decision could repeal all or just some of the ACA.
2.  State Insurance Exchanges – the (Michigan Health Marketplace): Legislature is waiting to work on this until the ACA case is determined in June.
3. Many parts of the ACA have already been rolled in; for example, children staying on parents insurance until age 26 (without having to live with them, nor be in school).  Co-pays on prevention services have been removed already on most plans.  Small business and non-profit tax credits for providing insurance were phased in 2010, just to name a few.

SCHA-MI received a grant to do some grass-roots outreach through our school-based/linked health centers, providing presentations on ACA 101.  Contact SCHA-MI if you are interested in a short presentation to your community group, advisory board, or others.

For more information on the ACA, please see our state partner,  Michigan Consumers for Healthcare or the federal website for information.

You probably realize that the number one determinant of better health is simply HAVING insurance.  Finally, we have a vehicle to move things forward.  There will be changes, compromises, and struggles, but it’s a start, and I’m happy for it.   Are you?

Healthy Students Graduate from High School: Reframing How We Talk About SBHCs

Michele Strasz

With Michigan’s statewide drop-out rate holding steady at 15% annually, and the Detroit graduation rate of 21.7%,  dead last in the country,  this is not just a school problem!

Economists know that graduation rates are a predictor of a person’s future economic status.  According to a 2006 Princeton study, Michigan drop outs stand to lose $11 billion in total lifetime income by foregoing the diploma.

Graduation rates also impact health disparities.  Jocelyn Elders, former U.S. Surgeon General, stated that, “You cannot educate people who are not healthy.  But you certainly cannot keep them healthy if they are not educated.”

Last week, our friend and colleague, Terri Wright spoke at the State Capitol about the impact that school-based health care has on the children and youth served in school-based and linked health centers across the country.  Terri is the Director of Center for School, Health, and Education, and co-editor of School-Based Health Care: Advancing Educational Success and Public Health, published by the American Public Health Association.

The research Terri highlighted in the book illustrates that users of SBHCs have:

• Decreased absenteeism (50%)

• Decreased tardiness (25%)

• Increased grade point average

Did you know that African American males who used SBHCs were three times more likely to stay in school? Yes, 3x!

School-based health centers have a proven track record improving health and educational outcomes for Michigan’s children and youth. Michigan State University’s recent study, the Michigan Evaluation of School-based Health (MESH), reviewed the impact of Child and Adolescent Health Centers  (CAHC) on the health and health behaviors of the children and youth of Michigan. Findings from the study document that CAHCs are associated with a wide-range of health benefits for the entire student population, including greater self-esteem, less physical and emotional discomfort, and eating more healthy foods. CAHCs are an important component of school environments that support student health and achievement, whether students directly use CAHC services or not.

For years, SCHA-MI and our national partners have pitched school-based health using the tagline, Healthy Students are Better Learners.  Terri challenged us to take that one step further by reframing the message- Healthy Students Graduate from High School.

If Michigan wants true school reform, we must link school achievement to health, and vice versa.  School-based and linked health centers are a key to improving graduation rates in Michigan.  Advocates for school-based health care must join with school-boards, teachers, parents and students to take this message to policy-makers.

Practice your elevator speech and join us on March 13 for SCHA-MI’s annual advocacy day at the state capitol! Registration will open this week.

February 2012: A Month to Celebrate

Keri Bennett

In line with the national effort, Governor Rick Snyder is proclaiming February as School-Based Health Center Awareness Month in Michigan.  Today, there are approximately 100 centers and programs in Michigan serving more than 200,000 children and adolescents in urban, rural, and suburban schools and communities across the state.

Every year, SCHA-MI invites youth advisory councils from local health centers to participate in an Awareness Month Contest.  The 2012 theme, “School-based and school-linked health centers are the ‘key’ to academic success,” brought entries showcasing photography, videos, posters, and interviews.  Entries have been showcased in the Capitol Rotunda this week, garnering media and public attention.

I am amazed every year we do this and never underestimate the power of youth voice.  But, this year, I was impressed and proud of the program I serve more than usual.  As many of us are bogged down by the winter blues and mundane paperwork, this is a ray of sunshine that reminds me why I’m so invested in our program.  Our youth are talented, intelligent, and when given high expectations – always rise to the occasion.  Michigan health centers give youth a forum to exercise meaningful engagement, stay healthy, and in school!

Even though February 2012 is a designated month to celebrate our health centers, why not celebrate them year round?  Here are some great activities for youth advisory councils to try:

• Plan for a legislative visit to your health center.  Experience the legislative process in action!
• Inundate school functions and pass our fliers, postcards, or have meaningful conversations about the services and programs offered in your centers.
• Hold an after school exercise forum – challenge the teachers and adults in your building as well!
• Create a videotape encouraging others to support your health center.
• Write your school or local newspaper highlighting your health center.
• Find a list of “months” to celebrate and highlight National Health Observances throughout the year to raise awareness.
• Hold a cooking demonstration or distribute health recipes in your clinic.
• Make a PSA or announcement once a week or month to highlight a new service or program offered at the health center.
• Engage your art, physical education, health teachers in projects throughout the year to get the word out about your health center!

Congrats to our youth that has entered their projects!  Winners will be announced on our March 13^th Youth/Adult Advocacy Day.

Practice Management Tools: Keeping Your Patients Happy!

Brenda McLean

I expect good customer service, everywhere I go. I take notice when people are not shown respect, especially at my doctor’s office.  When I am sick, I certainly expect to encounter caring and compassionate staff when I go to see my medical provider, or when I call their office with a question – whether it is about my health, my bill, or a refill on a prescription.

I recently attended a workshop put on by the Michigan Medical Billers Association that spent a good portion of the day discussing why it is so important to provide “WOW Customer Service” in a medical setting. Providing quality care, capturing our services with the appropriate codes, and making sure we meet the reporting standards of our funders are all very important aspects of medical practices. But without good customer service, why would your patients want to continue to utilize your services? And with a population that is already left without much choice, we certainly don’t want them feeling like they would rather go without than return to you!

Here are some tips I learned about how we can all do a better job at keeping our customers happy and feeling like they matter. What better way to keep them engaged than in the management of their own health!

 Here are a few tips for dealing with an unhappy patient:

1.  Don’t take it personally – A patient’s anger is likely not with you personally.
2. Let the patient vent – Let them get it all out and to a more positive note before jumping in with a solution or recommendation.
3. Acknowledge feelings – Listen and then paraphrase how the person is feeling, a technique called mirroring feelings.
4. Separate the person from the situation – Always try to avoid the blame game and keep the problem in focus.
5. Refer the patient – If you are getting nowhere, refer the patient to another colleague who may be better able to assist the patient.
6. Avoid deadly phrases – “I disagree”, “Let’s compromise” and “You have to” tend to only provoke more anger. Try using “I understand”, “Let’s work together to find a solution”, or “You may wish to try” as other options.
7. Follow up – Do what you say you are going to do!
8. Take a break – At the end, take a moment to mentally and physically regroup. If you were able to come to a positive solution, congratulate yourself and share your success with others!

The Alliance PDM team not only provides billing and reporting services, a big part of what we provide revolves around managing your practice. We feel that it is important that your practice has the tools to keep your patients happy, and we believe our clients (YOU) should receive “WOW Customer Service” as well.

To review the full MMBA presentation (thanks to the great speaker, Barb Szkotnicki), and a number of other tools to assist you in managing your practice, check out the APDM Wikispace.

Health Inequities Among Our Youth

Deborah Riddick

The current national debt crisis has been at the forefront of recent political debate.  And as a result, there have been events and protests that draw attention to financial inequities that exist all across America.  It is a conversation long overdue, but there is an equally important back story that deserves to share center stage; America’s ever-present and rapidly increasing health inequities, particularly among our youth.

Did you know that…

• Approximately 23% of Michigan youth live in poverty
• Over 32,000 Michigan youth are victims of abuse and neglect
• More than 127,000 Michigan youth have no insurance at all
• Nearly 1/3 of Michigan’s youth are without a regular medical home

It has been well-documented that poverty, violence, and access to quality care impact a child’s physical, mental and emotional well-being.  It is also been established that health status and educational success are interrelated; healthy students make better learners.  It should then be a no-brainer that investment in our greatest resource, our children, is an investment in our long-term economic success and is essential if we are to address inequalities of the future.

We recently celebrated the life and accomplishments of Rev. Dr. Martin Luther King Jr.  For many, it was a day of service.  It is only proper, then, that we celebrate the accomplishments and service of all who work to consistently decrease health inequities among Michigan’s youth; all of you who in one way or another help to keep our school-based and school-linked centers running.  From our providers and support staff, to our educators and school districts, to our administrators, health systems and fiduciaries, to our legislative champions, state departments and partners in advocacy.  We have come together to proactively tackle inequity, in spite of the spreadsheets and limited resources.  We have demonstrated that human capital and collective will can make up the difference when financial capital wanes.  We have found a way to make it happen!

However, adequate funding is essential to the existence of our centers.  And so we must soon prepare to make the case, once again, to keep our children healthy…and protected…and thriving.  Their lives and future depend upon it because Dr. King’s words are more relevant today than they were in 1966…

“Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.” Rev. Martin Luther King, Jr., at the Second Annual Convention of the Medical Committee for Human Rights, Chicago, March 25, 1966

A Super Way to Renew YOU in the New Year – Part 2

C. Leslie Charles - Guest Blogger

(This is part 2of a 2 part guest blog series from C. Leslie Charles, Speaker and Author.  Leslie provided keynote remarks for the 2011 SCHA-MI Annual Meeting.)

THOUGHTS WORTH REMEMBERING

1. The traits and qualities that got us into trouble as kids are the ones that make us successful as adults. In time, early childhood imperfections can be transformed from misfit to major asset. Think about how your once-annoying early vices have become your sustaining assets or virtues.

2. Every experience, good or bad, has the potential of leaving us with a lesson—or a lesion. There are times when bad things happen but later we find the lesson we needed to learn; the lesson that helped transform us. I call these BLESSONS. The permanence or impermanence of a negative experience is up to us. Perceptions / thoughts = feelings = actions (choices).

3. Life works best when we lighten up, let go, laugh more, and let our sense of humor replace everyday sources of irritation or annoyance in “clutch” moments. It’s doable. Try it; you’ll like it! Laughter is a tonic for the spirit and a salve for an aching heart.

4. When things fall apart, remember that adversity and opportunity are constant companions. Some of your most profound insights are most likely connected to a challenge or difficulty; possible even a catastrophe you met head on, survived, and later, once again thrived.

5. Despite your minor flaws or imperfections, you have many excellent parts: cultivate your innate strengths, grow them and polish them. Apply your best skills in every attempt to truly connect with others.

6. When you keep your heart open it’s easier to be patient and kind. Never underestimate how little it takes to help someone else to feel good about him/herself. Keep the “kind” in humankind, especially with those who are recalcitrant or resistant (they’re the ones who need your kindness the most).

7. Remember that blame is a trap; whenever we blame, we end up sacrificing our ability to change a situation, we give up our power. Resentment is equally toxic. Resentment is like taking poison and expecting the other person to die.

Your work isn’t easy. Sometimes it feels thankless; sometimes it’s misunderstood. But you help instill the essentials upon which a healthy life is built; you never know the lasting impact you can have on another. Keep modeling your message and showing that you care.

STAY SUPER WITH:

 Sustained effort: even when you feel like giving up, give it one more try instead.

Understanding and empathy: disarm or neutralize your biases when met with resistance or recalcitrance.

Patience and perspective: don’t panic till you know you need to, cultivate “wait and see.”

Effective communication: smile, be open, listen, refrain from judgment, and look for common ground.

Rapport and teamwork: keep thinking “partnerships” even when others are being uncooperative.

Life is precious: let your every day be rich with gratitude. Give yourself credit for your contributions. Add as much texture, color, shape, and size as you can to your existence. Accept life’s imperfections and irregularities, for they are the source of your growth.

When you take the high road with what life brings, you live the metaphor of the pearl. When faced with irritations or annoyances remind yourself that with grit and determination, you can consciously reduce life’s glitches to the size of a grain of sand. I call it “blessing your stress.” A heroic option, and it works!

“People don’t care how much you know until they know how much you care.”

Chick here to learn more about C. Leslie Charles. For 17 years Leslie has embraced the life-changing practice of having an annual theme and she provides plenty of examples as to how this practice has altered the course of her life. If you’re interested in the potential of adding more meaning to your life or deepening your purpose as one year flows into the next, click here.

A Super Way to Renew YOU in the New Year – Part 1

C. Leslie Charles - Guest Blogger

(This is part 1 of a 2 part guest blog series from C. Leslie Charles, Speaker and Author.  Leslie provided keynote remarks for the 2011 SCHA-MI Annual Meeting.)

A friend of mine often facilitates a two-day training called “Crucial Conversations,” based on the book of the same title. One of her favorite moments in the class is when participants proclaim that they know a lot of people who need the training (acting as if they are exempt from the good ideas presented). She says it happens every time and it always prompts a knowing smile.

The wise and witty Edwin Newman once said, “The obscure we see eventually, the completely obvious takes longer.” Maybe, if you’ve been ever greeted with one of those embarrassing “blinding flashes of the obvious,” (as we all have), you can relate to his words. I certainly can.

We all know it’s easier to see someone else’s flaws than our own. Similarly, it’s often easier to spot someone else’s unconscious habits or tics than our own, from absent-minded gum snapping, unchecked fidgeting, excessive head nodding, or unmindful throat clearing, we all have habits that may not register with us but they certainly do with others. The above are physical habits of which we may be clueless but there are also mental habits that evade us as well.

Take your thoughts for example. How often do you think about what you’re thinking? And what do you suppose is the percentage of negative thoughts you have? Some experts suggest that 90% of what we think about is of a negative vein; just think about the cumulative effect that can have on our mental and physical health!

We talk a lot about stress these days but a lot of people act as if stress is just something you have to learn to live with, like height, eye color, or the presence of a pesky relative you’d rather not claim as part of your gene pool.

Well, guess again: thinking habits, like physical ones (no matter how firmly entrenched they may be) are learned behaviors, and whatever has been learned can be unlearned and relearned. You may be thinking that while the learning, unlearning, and relearning may sound simple, it’s way more complicated than that and you’re right.

 A POINT WORTH STRESSING

And here is an important point: though it takes some work, the process of giving up a habit (physical or mental) and replacing it with something else, something more positive or healthy, is doable. Considering the amount of stress in our society (hint: think about your own life, your own stress level, for example) when it comes to the habits that affect our everyday attitude or outlook, making some positive changes is often advisable and sometimes essential!

Stress isn’t something you catch (though unwanted events or the antics and demands of other people can prompt feelings of frustration, threat, or other unsavory emotions). Stress is something you create, whether you know it or not. Forgive me for asking, but how many unconscious stressors do you trigger on a daily basis in your own life? This a subject I touched on in my keynote at SCHA-MI’s Annual Meeting in Mount Pleasant on October 28, 2011 (I loved the theme “Heroes of Healthcare: Celebrating the Hero in You”) and considered it well deserved.

Having visited both a school based and community Center I was taken aback at the little-known, highly unrecognized work you do. Just like fantasy super heroes (and sheroes) you don’t dominate the main or center stage in your work to improve the mental and physical health care to those who need it. Your work is done deftly, quietly, competently, and without fanfare, off in the wings.

But to those whose lives you touch in a formative moment of their lives you are The Force and I hope you never forget that. Your work is critical to populations that often overlooked, under acknowledged, and under treated. Truth be told, it doesn’t really take a super hero to do your job, but it can take a super effort to unite diverse professionals through persuasive partnerships and a common purpose.

I encourage you to acknowledge that when you take super care of yourself and make a super effort to connect with others you need to work with (even if they aren’t completely convinced) the more prepared you are to take care of others in the long term.

If you ever get overwhelmed with the challenges of your job (or life), or frustrated with the social imperfections or inconsistencies in your community, consider the lot of the freshwater pearl. Born of adversity, pearls, like each of us, are irregular in size, shape, color, and texture, and they often have minor flaws. Yet each pearl is unique, just like you or me, just like the populations you serve.

Thanks to your efforts, you strive for a safer, healthier future for those who might otherwise be bereft and vulnerable. Perhaps the pearl’s inspiring metaphor can help you consistently sustain your best efforts mentally, physically, and spiritually, even in less than ideal circumstances. By helping others smooth out life’s rough edges, one day, they may do the same in turn: we both touch and are touched by others and never know when we leave a legacy to be passed along.

2011: A Year in Review

School-Community Health Alliance Staff

2011 marked a successful year for the School-Community Health Alliance of Michigan.  Help us in celebrating “11″ of our top accomplishments!

• Our advocacy efforts allowed child and adolescent health centers to remain included in the state’s 2 year budget cycle at $3.5 million!
• Our annual advocacy day, held in March 2011, included youth and adults!  Almost 40 visits were made and all 148 legislators received materials! (Don’t forget to SAVE THE DATE for our 2012 Advocacy Day:  March 13th)
• HRSA released the construction and equipment funds grants.  14 centers in Michigan received funding totaling almost $4 million dollars.
• Project Voice: A Dynamic Approach to Youth Empowerment was bigger and better!  All workshops were led by youth, for youth.  Over 175 youth attended, accompanied by 76 adults.  SCHA-MI solicited 10 exhibitors, including many colleges for youth to converse with.
• Our Alliance Practice and Data Management service contracted with the state of Delaware to provide billing and data services!
• Our advocacy reach was stronger on the state and federal level by providing leadership and insight on Health Exchanges, Health Information, bullying, ACA regulations, oral health, and the Nurse Practitioner Bill.
• SCHA-MI unveiled many new communication tools including: digests, an E-Bulletin, updated website, blog, Facebook and Twitter.  Have you signed on yet?  Contact SCHA-MI for more information.
• SCHA-MI has expanded our continuing education process and look to do more of this for our 2012 trainings.
• An endowment fund was established for opportunities for donors who want to support the legacy funding for SCHA-MI.
• SCHA-MI’s 2nd Annual Golf Outing was held and was a major success.
• Finally, SCHA-MI welcomed talented new Board Members and sadly saw many veterans step down.  Special thanks for their continued support for our mission and vision.

Here is to a productive 2012!  Take a moment today to celebrate at least one of your 2011 accomplishments and strive to make 2012 successful. 

Holiday STRESSSSSSSS alert!

Michele Strasz

I have been so busy the past month that I have hardly had time to do my holiday shopping, write my cards, or decorate my house. I even asked my sons if they were ok if we did not put up our Christmas tree because we are going to be out of town most of the holidays.

I gave up being the perfect holiday mom a long time ago.  I haven’t made cookies in years.  I have resorted to buying way too many gift cards instead of the thoughtful presents I used to get for people all year long and hide in my basement.

What does that say about creating traditions for my boys???  I know the guilt is setting in especially since my oldest is coming home from his first year at college and I want him to feel special. Something has got to give!

I have been thinking about the children and youth we serve and what kind of holidays they will have.  Because they get gifts and time off from school, we assume that things are good.  But holidays can be stressful for children as well.  Maybe they are coping with a divorce or military deployment in their family; maybe they are hungry; maybe there is violence in their home.

Here are some tips from the American Psychiatric Association to share with your patients and their families to help them cope with holiday stress.

• Discuss holiday plans in advance, and include the children and youth in the planning.  Constantly changing plans or last minute decisions can increase stress.
• Get plenty of rest.  Allow teens to stay up a little later and sleep in a bit, but try and keep on a regular sleeping schedule.
• Encourage physical activity and interaction with their peers.
• Give children of all ages your time and attention.
• Uphold and maintain family traditions even if a family member is absent.  Traditions have a grounding effect by letting children know that even though something has changed, other things remain the same.
• Make sure to eat something healthy before you go off to a party. Enjoy a little treat, but don’t overdo it.
• As adults, take care of yourself too.  If you feel stressed, it increases the pressure and tension on your children.

The holidays are not about the stuff.  It’s about spending time together, relaxing, talking, enjoying a family outing, and sharing a family meal.  Guess I better take this advice!

Happy Holidays to you and your families!  Thanks for a great first year.

~ Michele Strasz

Have a Healthy Holiday Season by Preventing the Flu

Mary-Kate Bosworth

Happy Holidays!  I would like to take a minute to introduce myself.  My name is Mary-Kate Bosworth and I am the Practice Management & Billing Specialist for SCHA-MI.

With the upcoming holiday season, we need to do our best to avoid the seasonal flu. Vaccination is the single best way in prevention!  In my work, I have seen a rise in the number of vaccinations from children and adolescents served in our health centers.  It’s not too late – you should consider doing the same!

In addition to getting a flu vaccination, other ways to avoid catching and spreading the flu include:

• Washing your hands often!  It will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.

• Cough and sneeze into your arm our sleeve, not your hands. Sneezing and coughing into your hands actually helps spread the flu the virus, as we touch many things with our hands like door knobs, pens, etc.

• If you are sick, please stay home!  CDC has some valuable resources for “I had to take a flu break” to hang in your centers stressing this message.

• Working out is part of prevention!  There are not only cardiovascular benefits, but staying fit boosts your immunity and helps you manage your stress levels, which is important for staying healthy in flu season.

• On the off chance that you have come in contact with an infected object or person, avoid touching your eyes, nose and mouth until you have properly cleaned your hands.  SCHA-MI has a host of materials that you can post in your health centers, including PSAs and videos to showcase this technique to students in your health center.

• Make sure that you are getting plenty of sleep, maintain a healthy diet, managing stress appropriately and drinking plenty of Vitamin C.
• Check out more tips and free resources from the CDC.

Have a healthy holiday season!