Elizabeth Stawicki, Minnesota Public Radio, Author at �鶹Ů�� Health News

Obamacare Credited For Big Drop In Minnesota’s Uninsured Rate

Elizabeth Stawicki, Minnesota Public Radio — Mon, 16 Jun 2014 12:10:42 +0000

This story is part of a partnership that includes , and Kaiser Health News. It can be republished for free. ()

The website malfunctioned. The exchange chief was fired. And many people had to sign up the old fashioned way: pen, paper, with a person. So, Minnesota’s launch of the Affordable Care Act was a clear failure, right? Not so much.

A less modest state might call it the Minnesota Miracle: The rate of uninsured people in Minnesota tumbled to less than 5 percent, despite with its Obamacare website, a new .

How did Minnesota do it? It wasn’t miraculous. The state started out ahead with a rate of uninsurance roughly half the national average. Then it used the health law to strengthen and publicize a health care safety net that was already more complete and generous than most other states.

The number of uninsured Minnesotans fell by nearly 41 percent since September and the rate of uninsurance in the state fell from 8.2 percent to 4.9 percent, according to the study from the University of Minnesota’s .
The university crunched the numbers at the request of the state’s troubled health insurance marketplace.��“This is a pretty historic change in insurance coverage in Minnesota,” said Julie Sonier, the report’s lead researcher.��“We have never seen anything like the change that we have seen between last fall and May 1st of this year.”

Some 180,500 people gained health insurance, mainly through enrollments in the state’s : Medical Assistance and MinnesotaCare. Here are the details on those two programs:

— Medical Assistance is the state’s Medicaid program. It covers people who make up to 133 percent of the federal poverty level, or $15,500 for a single person this year.

— ��MinnesotaCare is a program that predates the health law. It is��funded by a state tax on Minnesota hospitals and health care providers, federal Medicaid funds and enrollee premiums.��Under the health law, the state adapted MinnesotaCare to be a “basic health plan,” a new category that only Minnesota set up. People qualify if they make up to 200 percent of the federal poverty level, or $22,980 for a single person this year. Congress offered this option to help people who earn too much to qualify for Medicaid, but not enough to afford the out-of-pocket costs of a commercial health plan, even with the benefit of federal subsidies.

Before the health law went into effect, about two-thirds of uninsured Minnesotans qualified for one of these two public health programs but hadn’t signed up. The federal law’s combination of a mandate to buy insurance and funding for outreach and navigators likely boosted enrollment in the two programs.

The study by SHADAC, as the organization is known, goes further than those in other states, other researchers say.

“What’s unique about this Minnesota report is it’s the first I’ve seen that really looks at what’s happening across the whole coverage spectrum.�� So not just looking at what’s happening with enrollment but also pulling in what that means for the uninsured,” said Rachel Garfield, Senior Researcher at the non-profit Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Still, the picture of who signed up for private insurance under the ACA in Minnesota is somewhat murkier, critics point out.��State Rep. Joe Hoppe, R-Chaska, questioned the report’s findings that tied a big drop in uninsured Minnesotans to the federal health care law. Officials, he said, weren’t initially asking people who were signing up for MNsure if they’d previously had coverage.

Sonier acknowledged that her organization didn’t calculate who was previously insured, but the study did get a measure of increases in the private market by asking the insurance plans themselves for enrollment numbers.

“We don’t know who came in or out during the time, whether they came from group coverage or uninsured, we are still pretty confident that overall shift that we calculated, the 180,000, is in the right ball park,” said Sonier, a former Minnesota state health economist.

The study showed that the number of people buying their own plan jumped about 12 percent, and it��also suggests employers didn’t dump their health plans and force workers to buy their own.

Most Minnesotans get their insurance through work. The study found the number of people in employer-sponsored plans went down by about 6,000, a decline of two tenths of 1 percent.

Even as officials applauded the drop in uninsured since September, they wanted to know more about the 4.9 percent of Minnesota’s population that still lacks health coverage.

“That’s something we need more research in — who are we still missing?” state Human Services Commissioner Lucinda Jesson said. “That’s going to be an important thing to find out the future because we need to continue to target our outreach effort.”

The University of Minnesota expects to release further analysis late this fall or in early winter. The study was requested by MNsure and funded by the Robert Wood Johnson Foundation.

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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Minnesota, Not Florida, Not Hawaii, Is Healthiest State For Seniors

Elizabeth Stawicki, Minnesota Public Radio — Thu, 22 May 2014 09:00:49 +0000

“Minnesota Nice” might be the key to good health for seniors.

Massachusetts Unions Shape Compromise For State’s Municipal Health Insurance Law

rated Minnesota the healthiest state in the nation for adults aged 65 and over — beating out Hawaii. And that retiree and��snowbird haven, Florida? It came in 28th.

What could put Minnesota, which just weathered arguably the harshest winter in the country, ahead of those sunny climes? Volunteering is one factor. Minnesotans do more of it and it plays a major role in senior vitality,��according to��Dr. Reed Tuckson, senior medical adviser to the UnitedHealth foundation, which funds the annual rankings.

“There’s a much better chance to be active, to be engaged, to be alive, to feel excited, to be inspired,” said Tuckson, “and therefore to have a good mental attitude.”

The report grades states on 34 individual measures ranging from the amount of physical activity to prescription drug coverage to flu vaccinations. New Hampshire, Vermont and Massachusetts round out the top 5 states.

Tuckson said Minnesota stands out in a number of key indicators beyond volunteering. Seniors in the state have the lowest prevalence of cognitive problems, and they visit the dentist often.

Seth Boffeli, spokesman for AARP Minnesota said the report underscores that decades of proactive efforts have paid off.�� He says Minnesota was ahead of the curve in moving towards community-based living for seniors and away from institutionalized nursing home care, when possible.

“We saw early on that you could treat three people in the community for the same amount that it costs to put one person in nursing home,” Boffeli said.

But, when needed, the state’s nursing home quality also scored high, according to the report.

Another key indicator for Minnesota was a low rate of seniors facing “food insecurity” — a lack of access to sufficient and nutritious food.�� “We have made real efforts to increase the number of seniors who are eligible … for the state’s food assistance program to actually enroll,” said Lucinda Jesson, state Human Services Commissioner.

The research is an effort to understand the major health problems that will arise as the senior population balloons due to the aging of baby boom generation.

The report ranked Mississippi the least healthy state for seniors preceded��by Louisiana, Kentucky, Oklahoma and Arkansas.

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Minnesota’s MNsure Exchange Weighs What To Do Next

Elizabeth Stawicki, Minnesota Public Radio — Fri, 24 Jan 2014 19:10:25 +0000

Officials with Minnesota’s troubled online insurance marketplace heard from the authors of a scathing independent report and began weighing the crucial question of what do do next.

Minnesota Gov. Mark Dayton (at podium clapping) at a signing ceremony creating MNsure, Minnesota’s health insurance exchange in March 2013 (Photo by Gov. Dayton’s office via Flickr).

“Is it irreparably broke?” ‘s chairman of the board Brian Beutner asked during the insurance marketplace’s board meeting on Thursday.

, a subsidiary of , prepared the report as an end-to-end review requested by MNsure board members. It found that MNsure is unlikely to meet its enrollment goals this year and fixing the site completely could take up to two years.

Calling the current program management structure and process “non-existent,” the Optum report says management has been making decisions in crisis mode since MNsure went live Oct. 1.

Optum’s , told the MNsure board that’s not unusual when a project starts to unravel.

“It’s not�� uncommon, in heat of all that was going on in short-term needs versus long-term needs to take your resources, to go after the fires,” Eppel said.

The report lists numerous problems with MNsure, among them:

A lack of clear communication between MNsure and its vendors and stakeholders.
A call center, notorious for hour-long waits, that needs to nearly double its staff.
Software that contains more than 200 defects, with IBM Curam software accounting for more than half of them.�� The governor blasted IBM in December for providing a defective product.

Optum’s Laura Groschen said MNsure has three options:�� Two involved fixing the current system, which could take up to two years to complete; A third option involved getting the system minimally functional for 2015 enrollment while building a new system from scratch.

In that scenario the report said the “existing asset may need to be written off — sunk costs.”

Optum did not provide cost estimates. And when asked to pick a favorite option, Groschen wouldn’t commit.

“I know it feels unsurmountable but all three options have their pros and cons to them, but we wouldn’t have recommended them if we didn’t think it would get you to an endpoint,” Groschen said.

What is clear from the options is that end point — a working MNsure website — won’t happen before the March 31 deadline this year when most Americans must obtain health coverage or pay a penalty.�� As a result, MNsure staff will have to conduct manual workarounds to get Minnesotans enrolled.

But missing from Optum’s report was just how MNsure reached this point, something board member and Human Services Commissioner asked about:

“Could you just help the board understand what was it that was working?” Jesson said. “Because I think as we’re really looking to make sure that we have the governance and oversight that’s in place, we want to understand what worked in the past.”

Groschen said she wasn’t sure Optum could comment on that: “What we decided to do was not spend a ton of time on the past.”

Jesson floated the idea of hiring a new prime contractor. Board Chairman Brian Beutner was open to that suggestion.

“Everything should be on the table,” Beutner said. “I don’t think we should rule anything out.”

Meanwhile MNsure’s interim CEO says MNsure will act on the recommendations and decide which option to pursue to get the website working properly within the next several weeks.

Geoff Bartsh, vice president of public policy, government relations at insurer says the report’s findings and MNsure’s response give him renewed confidence.

“That whatever process or path MNsure takes, there’ll be more collaboration between all of the vendors and the partners including the health plans in terms of how we build this,” Bartsh said.

MNsure also released new enrollment numbers as of Jan. 18: a total of about 80,000 enrollments with government programs running 2 to 1 over enrollments in commercial insurance.

This story is part of a reporting partnership that includes MPRnews, NPR and Kaiser Health News.

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After Exposure, Security Holes Sealed In Minnesota’s Health Exchange

Elizabeth Stawicki, Minnesota Public Radio — Thu, 19 Dec 2013 20:46:38 +0000

A security flaw has been fixed on , Minnesota’s health insurance marketplace — one that had left users vulnerable to data interception by hackers.

The fix follows an��and a��between forensic analyst Mark Lanterman and the state’s chief information security officer, Chris Buse. At the meeting, Lanterman explained how he discovered the flaw and how the state could resolve the problem.

Lanterman tested for the flaw again Tuesday.��“I’m happy to report that MNsure is no longer vulnerable to this attack,” he said.

The problem was complex, but it came down to this:�� MNsure’s flaw allowed private data to be transmitted unencrypted, leaving consumers’ personal information unprotected.

As people access a website, there’s a lot of communication between their computers or smartphones and the site’s servers. When sensitive information, such as a credit card number, is involved, websites typically��offer a secure, encrypted connection so no one can eavesdrop and steal the information.��Many websites protect users by severing connections to other computers if encryption is not working correctly.

But that was not true in this case.

Here’s one way this flaw could be exploited: A hacking device can offer up what appears to be a standard Wi-Fi connection to the Internet. But when a user connects to a website through that device’s Internet connection, it attempts to strip away security measures. In the case of the MNsure site, that would allow a hacker to see the�� users’ log-ins.

Since that tool works like a standard Wi-Fi router, it can capture information coming from computers or smartphones within a range of as much as 150 yards, according to Lanterman. This would allow a hacker to set up near libraries, coffee shops or other locations where computer users expect to find safe Wi-Fi connections.

But in those instances, MNsure’s website continued to permit users to send sensitive data.

The flaw in the site is now fixed.

Forensic professionals legally use devices like these to detect security weaknesses in wireless networks.�� But in the wrong hands, they are a hacker’s best friend.

Buse said the MNsure site is safe and always has been. Still, he called website security an ongoing journey. He said that although new threats appear daily, chances are slim that a hacker could use a device to convince a computer that it is connected to MNsure. He said a successful attack requires several elements, among them a high level of sophistication, the right tools and close proximity to the user.

“So when you think of all these things happening in the real world, this type of attack has a pretty low probability of actually occurring to anybody that’s planning to go to the MNsure��site,” Buse said.

But Lanterman disagreed.�� He said there’s no way to know how widespread an attack could be, because using it leaves no trace.

The security problems at MNsure are just one aspect of a rocky rollout of the Affordable Care Act in Minnesota. On Tuesday the executive director of the exchange April Todd-Malmlov resigned��about an ill-timed tropical vacation and various problems with the site.

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Minnesota Marketplace’s Latino Outreach Events Get Off To A Slow Start

Elizabeth Stawicki, Minnesota Public Radio — Tue, 29 Oct 2013 15:34:00 +0000

ST. PAUL, Minn. — Minnesota’s new online health insurance marketplace, MNsure has been open for four weeks. But efforts to inform hard-to-reach populations about how they can sign up for health care coverage are only now getting underway.

That’s what brought employees of Southside Community Health Services on Saturday to Karina’s Beauty Salon in the heart of the city’s Latino community. The organization has received part of a $4 million federal grant to help explain what MNsure is about and help people sign up for coverage, and the Latino community is an important target for MNsure outreach efforts.��

With that mind, a beauty salon in St. Paul’s West Side neighborhood was the perfect place to start, said Clarence Jones, the health organization’s outreach director.

“Barber shops and beauty shops are really one of the places where people come and they talk to trusted messengers,” Jones said. “So we know that people are concerned about their health, and so we wanted to establish kinds of relationships with barber shops and beauty shops that we can give them information on how to access medical care, which is an issue in many communities.”

The Southside Community Health Services’ white bus is parked outside Karina’s Beauty Salon in St. Paul, Minn. (MPR Photo/Elizabeth Stawicki)

But when Jones and several colleagues visited the salon, they had no takers, even though the state’s Latinos are three-times as likely as white residents to lack health insurance.

They set up shop in a big white bus parked outside and squeezed into available niches in the salon to screen customers for health problems, give flu shots, and spread the word about MNsure. They call it the clipper clinic.

Salon owner Karina Cardoso said 90 percent of her customers are Latino. She said most are like her, self-employed with no health insurance.

“When I talk to the clients, there is a huge thing now with Obamacare,” she said. “And I don’t think that a lot of us know exactly what Obamacare is.”

Southside community worker, Miguel Rivera, who is MNsure-certified to provide help as a so-called “navigator” said that confusion about the health care law championed by the president is common among the people he sees.

“They’re totally confused,” he said. “The client has to get into it and navigate the system, but people can do it.”

As a MNsure navigator, Rivera can help if clients can’t manage alone. But when the five-hour clinic ended, he hadn’t signed up anyone for a plan on MNsure.

On board the bus, Southside Community health worker, Heidi Benson wasn’t discouraged. She said up to 40 percent of Latino patients at Southside’s health clinics are undocumented immigrants. Even people who are legal immigrants and qualify for coverage may not sign up to protect a family member who is in the country without authorization.

Benson said the “clipper clinic” at Karina’s is only the first step in a continuing conversation about MNsure.

“I think it opens up… the ability for the conversation to broaden,” she said. “So people who’ve been afraid or don’t know what questions to ask, when they hear more information start to understand that it’s OK to ask any questions and hopefully get the answers they need to go forward and take care of themselves.”

Outreach efforts have been slow to get off the ground due to delays in training, background checks, and finalizing MNsure’s contracts with organizations that provide one-on-one help.

Mollyann Brodie, who directs Kaiser Family Foundation’s tracking poll on the federal health care law, said it’s too early to tell of hard-to-reach populations. She said research confirms that people who lack insurance are confused about what the federal law means for them.

“I think it’s one of the reasons why there’s a six-month enrollment period, because they knew that some of these groups were going to take some time,” Brodie said. “There’s also a perception that it’s going to take not just one year but multiple years until all those who are eligible for these programs and these benefits actually know about it.”

The “clipper clinic” may yet produce at least one new health plan enrollment. Cardoso, the salon owner, said she plans to sign up with navigator Miguel Rivera in the next week.

This story is part of a reporting partnership that includes , and Kaiser Health News.

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Minn. Reports 3,700 Enrollments Underway, But A Rocky Road For Consumers

Elizabeth Stawicki, Minnesota Public Radio — Thu, 17 Oct 2013 13:03:00 +0000

Officials from MNsure, the online health insurance marketplace in Minnesota, provided the first public glimpse into how many Minnesotans have not only created accounts on the new health insurance site, but also committed to choosing a plan and paying for coverage.

MNsure officials say about 3,700 visitors to the site are in the enrollment process — they’ve taken the step of selecting coverage through MNsure and are in the payment process if their plans require payment. That’s about 30 percent of the total number of accounts opened. The majority of those in the enrollment process are qualified for government programs such as Medicaid or MinnesotaCare, the state’s plan for low-income people. About 400 accounts are enrolling in individual or family commercial plans. Four small businesses have completed setting up an employee health plan through MNsure.

The opening of the MNSure website was plagued with technical problems. It appears largely to have recovered, though wait times for the call center are still longer than projected.

The reviews from many organizations trying to enroll consumers in MNsure are still mixed. Elana Gravitz, Program Manager at Hennepin County Human Services Department sums up how many community organizations view the new marketplace, with a quick assessment: “Sometimes it works,” she said. “Sometimes it doesn’t work.”

MNsure officials say the on-again, off-again problems stem from the federal data hub that insurance marketplaces such as MNsure must use to verify a person’s income through the IRS. In recent weeks, the hub has been overwhelmed. But when it is working, Gravitz said, it automates the otherwise cumbersome enrollment process in Medicaid.

“It’s a great thing for the county,” she said. “What it means is that eventually as the system gets smoother and smoother, we’ll be able to have the workers spend the time with clients that have more complex issues and questions, rather than the folks who have more straightforward cases who might be able to take care of things on their own.”

Open Cities Health Center in St. Paul, which has a large clientele of non-English-speaking patients, has also had mixed results.

Duachi Her, who is certified by MNsure to help people enroll in health plans, said the site seems pretty straightforward. But so far, she hasn’t been able to enroll anyone because of problems with the MNsure site in creating accounts.��On the other hand, Her said, there hasn’t been a lot of interest. She said not many of the organization’s clients even know about MNsure.

“I haven’t heard much about it in the community,” Her said. “Not a lot of people know about it, especially the Hmong community or the Somali community. We haven’t had much education on it.”

Some people were pleasantly surprised because they really didn’t expect MNsure to work.

James Albrecht, a community health worker at Portico Healthnet, a nonprofit that helps Minnesotans find health coverage, hasn’t enrolled anyone on MNsure yet. But he said the system has surpassed his expectations anyway.

“I expected to have more tech problems. I was thinking that we’d get too many people using the system and that the system would crash and we’d be down for a couple of weeks,” Albrecht said. “So I’m actually surprised that it’s working as effectively as it is.”

MPR News reporter Catharine Richert contributed to this report.

This story is part of a reporting partnership that includes��, NPR and Kaiser Health News.

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Problems Continue For Some Users On Minnesota’s Health Insurance Exchange

Elizabeth Stawicki, Minnesota Public Radio — Tue, 08 Oct 2013 13:00:09 +0000

ST. PAUL, MINN. — Days after Minnesota’s online insurance marketplace had a less-than-trouble-free launch, MNsure officials are betting that consumers will have a smoother experience this week. But the site is not in the clear yet.��

Intermittent problems with account creation continue for users of the online health insurance marketplace, and weekend fixes to a key federal component of the system appeared to trigger a new set of problems.��

“This is having a little bit of an impact on us,” MNsure executive director April Todd-Malmlov. “We are working with the federal government right now to evaluate that. This issue appears to be minor so we do anticipate that we will be able to get this fixed with them quickly.

Todd-Malmlov says the MNsure site will include notice of the problems while they’re ongoing. She said consumers who are unable to get through on the site should try again in a couple of hours.��

Despite the ongoing troubles, MNsure officials say the��website – which is run by the state, not the federal government – performed well compared some in other states, in part because MNsure delayed its start until the afternoon of the first day.��

“I think we were the only exchange in the country that didn’t have a major crash on the first day,” said MNsure chairman Brian Beutner, who is thrilled with the rollout. “That enabled people to come in and see what they could find and then quite frankly be able to completely access the system.”��

That’s not a universally held assessment, particularly among those who had to use the system. Last week, frustration levels ran high as some users reported getting booted off the system while trying to create accounts.

Common Complaints

“It would get so far and then freeze — and then it would log me off,” said Mike Corbin, an attorney in Medford, Minn. “You just kept having to redo it and redo it and redo it. And then you’d come to what I call a ‘death screen’ where there’s just a bunch of gibberish… and it would just keep kicking you off the system.”

Corbin said he was able to create an account, but got no further. After waiting on hold with the MNsure call center, he gave up and made an appointment with an agent to get help.��

That was a common complaint in MNsure’s first days as exasperated consumers vented on news and social media sites about difficulties creating the accounts needed to enroll in a health plan.��

Consumers have until Dec. 15 to sign up for insurance that will be effective Jan. 1. A three-month grace period early next year will allow consumers to buy insurance by the end of March without incurring a federal tax penalty for lacking coverage.��

The flood of criticism on the site’s start earned MNsure’s mixed reviews from the board’s vice chairman, Pete Benner, a former state employee union leader who for decades has advocated affordable health care.��

Benner said the good news is that MNsure is up and running, which in his words, is “a big deal.” The not-so good news, he said, is the rollout was rockier than he would’ve liked.��

“[It] sounds at this point that most of that is due to connections to the feds, not to the design here in Minnesota,” he said. “But to the end user that doesn’t matter, right? If the experience was not good, the experience was not good.”��

Dan Schuyler, who served as an information technology director for Utah’s health exchange when it began several years ago, agreed that bad experiences by users can hamper any system’s chances of success.

Schuyler said consumers who are desperate for health coverage will keep trying to create accounts. But the people who the exchanges desperately need to participate if they are to succeed financially — uninsured young people — may be ambivalent about whether they need coverage. They also may lose interest:��

“We’re trying to market to a very tough segment of the population,” Schuyler said. “They don’t have insurance now because they don’t feel like they need it for whatever reason. And if you can’t provide a seamless, intuitive experience for these individuals, you could quickly lose them.”��

There is time for the exchanges to gain a foothold, said Joel Ario, former director of the federal Office of Health Insurance Exchanges.��

Ario, who now works as a consultant, said the time to start worrying about problems impeding enrollment is in November.��

“Here in October, most people are just going to want to browse, see what their options are, think about it,” he said. “Because even if they were tempted to purchase already…I don’t know how many people want to pay in early October for coverage that’s not going to be effective until January.”��

MNsure board member Thompson Aderinkomi, an entrepreneur who has started health data businesses from scratch, thinks MNsure is off to a great start.��

“This is an extremely fast and large roll-out and most start-ups would only dream of things going this smoothly with such a large number of users trying to get a product or service that means so much to them,” he said.

This story is part of a collaboration that includes , and Kaiser Health News.

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Farzad Mostashari To Leave Federal Health IT Office

Elizabeth Stawicki, Minnesota Public Radio — Tue, 06 Aug 2013 20:04:32 +0000

The charismatic head of health information technology at the Department of Health and Human Services will step down this fall.�� In an e-mail to staff, Dr. Farzad Mostashari didn’t divulge why he was departing after serving for ��and four years at the agency.

Mostashari (Photo by Mark Finkenstaedt for KHN)

“It is difficult for me to announce that I am leaving. I don’t know what I will be doing after I leave public service, but be assured that I will be by your side as we continue to battle for healthcare transformation,” Mostashari wrote in an email to the staff of the Office of the National Coordinator for Health Information Technology.

A source close to the situation said that it was Mostashari’s decision to leave.

His email was very personal at times. He wrote about his mother’s 2009 “life-threatening heart arrhythmia” and being frustrated at the time that there were no electronic records for him to see. Problems after her discharge led her to need emergency surgery. “The complications, which weren’t supposed to happen, indecently increased the hospital’s revenue,” Mostashari wrote.

Health and Human Services Secretary Kathleen Sebelius shed no light on Mostashari’s departure. In an email to colleagues, she called Mostashari’s tenure as National Coordinator a time of “great accomplishment” and that his “expertise, enthusiasm and commitment to innovation and health IT will surely be�� missed.”�� She said: “This critical work has not only brought about important improvements in the business of health care, but also has helped providers better coordinate care, which can improve patients’ health while saving money at the same time.”

Mostashari, known in D.C. circles for his bow tie and his enthusiasm for wonky topics, is the second person to serve as the National Coordinator for health IT. He followed into the job after serving as his deputy.

Mostashari played a pivotal role in pushing the American foot-dragging health care system to go digital.�� In a 2012 he proclaimed: “Data is power.”

Mostashari encouraged health care systems to install electronic medical records and to demonstrate that they’re “meaningfully using” them.�� In his email to staff, he reminisced about how 32 staff members took on the “daunting task” of establishing a new certification program, endorsing national standards, designing and setting up new grant programs to assist in health IT adoption, exchange, workforce, research and privacy. The pace of the work earned them�� “‘The Office of No Christmas’ moniker … for yuletide rulemaking,” he wrote.

Mostashari has also been a champion of patients taking control of their health care and using technology to do so.�� As he did with his e-mail, he frequently brought in examples to demonstrate the need for electronic records. He spearheaded the “Blue Button” concept that would allow patients to download their electronic health records into a simple text file onto personal computers and smart phones.�� Now, third-party apps are available to help consumers use that data in easy to understand way.�� The Blue Button service is available from the federal government for veterans as well as Medicare beneficiaries.

But not everybody followed Mostashari onto the electronic-record bandwagon. Many doctors to EHRs is too expensive and cumbersome. Critics claimed he exaggerated EHRs’ benefits and downplayed evidence . So far the use of computerized records the promised cost savings, the RAND Corp. said in a January report.

The health technology community “should re-examine whether and how regulation of electronic health applications could foster improved care, public health, and patient safety,” a group of skeptical experts two years ago.

In December Mostashari’s office of recommending that EHR vendors be required to report computer mistakes that put patients at risk.

Sebelius said Mostashari would continue to serve in his role while a search for his replacement is underway.

In his email, Mostshari praised staff for a litany of accomplishments and said that it should provide hope that “we can still do big things as a country.”�� He wrote, “We have been pioneers in a new landscape, but that landscape is one changed forever, and for better.”

Jay Hancock contributed to this report.

This story is part of a reporting partnership that includes , NPR and Kaiser Health News.

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Connecting Minnesota’s Latino Community To Health Care

Elizabeth Stawicki, Minnesota Public Radio — Fri, 12 Jul 2013 05:48:15 +0000

When Samuel Alcocer arrived at the reception desk of a North Minneapolis clinic with a swollen cheek in 1996, he was desperate for relief.

Spanish-language interpreter Samuel Alcocer, right, helps a patient communicate with diabetic nurse educator Michele Kimber at NorthPoint Health and Wellness Center in Minneapolis (Photo by Jennifer Simonson/MPR News).

One of his wisdom teeth had erupted into a throbbing, painful ache.

At the time, Alcocer, a native of Santa Cruz in the Mexican state of Guanajuato, spoke no English. No one at the clinic spoke Spanish. So he and the receptionist resorted to gestures, to little avail.

“[I was] pointing hands to my face,” said Alcocer, who remembers the day vividly. “And the lady at the front desk [was] just moving her arms, like ‘What do you want me to do?'”

Seventeen years later, Alcocer helps to make sure others don’t have a similar experience, working as a Spanish interpreter at the same clinic in Minneapolis, now called NorthPoint Health and Wellness Center.

While Latinos comprise only about five percent of Minnesotans, they are a big part of the state’s uninsured population. One in eight Minnesota Latinos lacks health insurance.

That makes Latino communities a likely focus for efforts prompted by the federal health law to reduce the number of people lacking health coverage. NorthPoint, which is a federally qualified health center, received a $151,000 grant this week to hire workers who will help people sign up for insurance coverage in the state’s new exchange, MNsure.

For Acolcer, interpreting for Spanish-speaking patients and English-speaking health care workers has been a calling.

“To me,” he said, “it was like, ‘Why cannot I go over there and open the doors that [were once] shut in my face?'”

Alcocer’s tenure as a NorthPoint interpreter began 10 years ago as temporary project with funding for six months. On his first day, he was given an office, a desk, a computer, and a phone and was told he’d get a call if needed. But instead of sitting in his office and waiting, Alcocer did what he wished someone else had been doing when he arrived there the first time.

“I went and sat in the lobby waiting for anybody to show up and say, ‘Welcome. Thank you for coming.��How can I help you?'” said Alcocer.

In the first month, 25 Spanish-speaking patients arrived.��Their family members and friends followed in subsequent weeks.��By the sixth month, Alcocer was translating for 700 patients. Today, NorthPoint sees close to 1,000 Spanish-speaking patients each month.��Alcocer attributes that growth to word-of-mouth, not advertising or marketing.

The funding for his position was extended, and after eight months, Alcocer needed help, so the staff expanded. There are now eight full-time and five part-time Spanish-speaking interpreters at NorthPoint, as well as interpreters who speak Hmong, Laotian and Thai.

Alcocer said that kind of one-to-one interaction is what many people will need to understand the new federal health care law’s requirements and benefits. Radio, TV or newspaper ads in English, he said, won’t be enough.

Eva Sanchez of Portico Healthnet agrees. Sanchez, a native of Morelos, Mexico, has been working in Minneapolis helping Spanish-speaking families navigate the health insurance landscape for more than five years. She has an office in the Andersen United Community School located in the heart of one of Minneapolis’ most vibrant Latino communities.

Sanchez said health insurance itself can be a foreign concept for Latino immigrants, particularly if they grew up in a small town as she did.��People may have no experience filling out health insurance forms because there was no health insurance. Patients pay the doctor at the visit.

“If it’s already difficult for people from here,” Sanchez said. “Imagine how hard it will be for other people.”

Other immigrant advocates say the new federal health care law has a mixed message for immigrants that makes it harder to convince some Latinos to enroll in health plans.

The law includes . Even people who are legally entitled to be in the United States are subject to a five-year waiting period before they’re eligible to enroll in Medicaid. In addition, the law bars anyone who entered the country without authorization from receiving the health care law’s benefits.

People who work with immigrants say the law’s mingling of health and immigration policy can stoke fears about being deported.

“There’s no question that the politics that has mixed immigration policy with what I think should be public health policy has made the job much harder,” said Daniel Zingale, senior vice president of the Los Angeles-based private health care foundation, The California Endowment.

California, which has more uninsured residents than many states have people, started trying to navigate those crosscurrents before most states. Latinos make up .

The California Endowment has partnered with Spanish-language media giants such as the Telemundo and Univision networks to explain the new law. According to two polls, Latino support for the federal health care law in California rose from to .��

Officials with , Minnesota’s new health insurance marketplace, say they will be advertising in ethnic newspapers, translating their educational materials into Spanish, Hmong, and Somali and sending staff members to events in diverse communities to explain insurance.

This story is part of a reporting partnership that includes , and Kaiser Health News.

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Your Smartphone Might Hold Key To Your Medical Records

Elizabeth Stawicki, Minnesota Public Radio — Mon, 17 Jun 2013 05:57:41 +0000

It’s one of those unhappy holiday surprises — a visiting family member gets sick. That happened to Dr. Farzad Mostashari last Thanksgiving.

“My dad comes downstairs and he has acute pain in his eye where he had cataract surgery. And I said, ‘What’s the matter, what’s the story?'” recalled Mostashari, who lives in Bethesda, Md. “And he said, ‘Well, I think they put the wrong lens in my eye, I’d gone back to the doctor and…'” His father didn’t remember exactly what had happened at his last doctor’s appointment and the office was closed anyway.

How could a local doctor in Maryland access his dad’s medical record in Boston? Through , a computer program that allows patients to download their medical history into a simple text file on their smartphones and personal computers. Then third-party applications that you download help organize this information.

Mostashari certainly knew how to handle his dad’s problem. After all, he’s the coordinator for health information technology at the U.S. Department of Health and Human Services, and it’s his passion and profession to promote electronic health records.

And, he had signed his dad up for Blue Button, which downloads three years of a patient’s medical history, as well as the Humetrix , a smartphone app that translates and displays the information in a simple-to-understand way. The file includes names, phone numbers and addresses of physicians as well as diagnoses, lab tests, imaging studies, and medications.

So when Mostashari took his father to a local doctor, his dad was able to hand over his iPhone and say, “Here’s my history.”

Mostashari predicts that soon everyone will have that kind of information at their fingertips: “Within the next 12 months if people want to, they will be able to get the same data that your doctors would send to each other to have it come to you.”

The Blue Button service is available from the federal government as well as Medicare beneficiaries.

Before a patient can download medical information to a computer or a smartphone, the files must first be stored electronically. And while electronic health record advocates note that there has been a sharp increase in the number of hospitals and doctors using EHRs, they acknowledge that a complete electronic system is a long way off. According to a 2012 , while 72 percent of office-based physicians are using some sort of electronic system in their practice, only 40 percent of practices meet the definition of a “basic” system.

Power In The Hands Of The Patients?

The federal health law is designed to encourage patients to be more involved in managing their own health. Making medical records and test results accessible to smartphones is in line with those policy goals.

The floodgates have opened for patients to use technology to manage their own care particularly those that have chronic, and expensive, diseases, said Jennifer Lundblad, CEO of , a nonprofit organization based in Minnesota, which aims to improve health care by translating research into practice.

Lundblad said smartphones and health-related applications can become powerful tools to help people monitor and improve their health.

“Some parts of health care are so complex that we need complex solutions,” she said. “But some parts of health care can be simplified and with the prevalence of smartphones, let’s use the smartphone tool that that patient already has.”

But there are also risks that Lundblad and others worry about, among them the possibility that a company storing the health data could go out of business or that some patients may lose smartphones containing their medical information.

Protecting Your Data

To address privacy concerns, in February the Federal Trade Commission to companies that build and sell mobile apps, not just those related to health care. Those recommendations followed a major report the FTC released about

But even its most recent report noted that “many questions remain” about the applications. Among them: What information should be included in application developer’s privacy policies? What might a model short privacy notice look like? Can a single system of icons be developed to avoid consumer confusion?

Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology, notes that when doctors and health plans store electronic medical information, that information is covered by federal privacy and security rules. But those rules don’t extend to medical information on a smartphone.

“When you take possession of it and share it, stick it in an app, share it on the web, a social networking site, it’s not going to be protected beyond what’s in the privacy policy for the app or what’s the privacy policy for the social networking site. And you need to read that,” McGraw said. “Be aware before you share.”

McGraw provides some tips for consumers who want to protect themselves:

• Determine if cellphone app makers claim rights to patients’ data for marketing purposes.

• Look for very clear statements about how the data is used. Language such as “from time to time we will use your data…in order to improve the services we provide for you” may warrant further investigation.

• Look for who owns the data, if the company will disclose it. Do you own your data? Or do you merely have the right to use the service, but that is the extent of your rights?

• Look for commitments on security of the data. Is the data stored on your phone or on a server?

• What are your rights to retrieve data if they cancel service? Are you permitted to have a copy of the data? What is the app provider’s right to use the data after service is canceled? Ideally, McGraw said, companies should return all your data and not have the right to subsequently use it.

• You should use unusual passwords that employ varied symbols and numbers.

• If possible, you should be able to remotely delete data from the device if it is stolen.

And Medicare Blue Button has these security recommendations:

• Download your data to a secure location. You may want to download your information to a CD or flash drive. Consider purchasing an encrypted flash drive for your information. You may also encrypt or require a password to access a CD.

• If you want to send your information via email, you should encrypt the message.

• Keep paper copies in a safe and secure place that you can control.

Another problem with smartphone medical records – not related to security – is that some physicians may not know whether the records stored there are complete, said Scott Edelstein, co-chair of Squire Sanders’ Healthcare & Life Sciences Industry Group in Washington, D.C.

“There may be some data that the patient doesn’t want to keep on their smartphone,” said Edelstein, who specializes in mobile health applications. “Maybe there’s very sensitive health information. Maybe there’s information that they don’t want other providers to know but it could be very important information for a provider to know, for example, in the event of an emergency.”

Edelstein said errors or omissions could be disastrous.

But in the case of Dr. Farzad Mostashari’s father, the records on the phone had pointed to the problem: “He had dry eye; that was the diagnosis.”

Then, it was an easy treatment that salvaged the Thanksgiving weekend.

This story is part of a collaboration that includes ,�� and Kaiser Health News.

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