1. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell Legislative Coordinator Member of the Executive Committee California Disability Alliance To insert your company logo on this slide From the Insert Menu Select “Picture” Locate your logo file Click OK To resize the logo Click anywhere inside the logo. The boxes that appear outside the logo are known as “resize handles.” Use these to resize the object. If you hold down the shift key before using the resize handles, you will maintain the proportions of the object you wish to resize. Click on arrow to start. Use Page Down to advance show, Page Up to go back. Copyright 2003 by Laura Remson Mitchell.

2. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Key Disability-Related Health-Care Issues Most problems fall into following categories : w Focus on cost-containment w Accessibility of care w Access to affordable health coverage w Delivery of covered benefits w Benefits design/definition of medical necessity

3. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Focus on cost-containment  Threatens benefits Examples: Medi-Cal benefit cuts, eligibility Medicare restrictions Restrictions/cutbacks on covered benefits in private sector

4. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Focus on cost-containment w Important Buzz Words “Cost-effectiveness” Biggest bang for health-care buck. Good if goal is best care for individual patients. Bad if goal is primarily cost-containment and based on total patient population.

5. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Focus on cost-containment w Important Buzz Words “Evidence-based medicine” Requires scientific evidence to justify treatments. If done right (allowing other standards when evidence doesn’t exist), this could improve quality of care. If goal is just cost-cutting, lack of scientific evidence could be used as excuse to deny effective care for people with disabilities as well as those with rare or unusual conditions.

6. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Accessibility of care  Physical Buildings, equipment, etc.  Programmatic Examples: Educational programs, information, grievance/appeal procedures  Communication Interpreters (ASL and other), materials in alternative formats, etc.

7. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Access to Affordable Health Coverage  Losing coverage Aging out, earning out, being priced out, etc., leaves many people with disabilities vulnerable.  Risk-avoidance by health insurers and providers Insurers, health plans, hospitals and some other health-care providers often find subtle ways to avoid people with disabilities when they can’t deny coverage outright.

8. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Access to Affordable Health Coverage  “Mitchell’s Corollary”: In the absence of a level competitive playing field, bad health plans tend to drive good plans out of business. Plans that are good for people with disabilities attract high-cost patients, while bad plans are able to reduce costs by avoiding us. Result: Bad plans can offer lower premiums and take profitable business away from good plans.

9. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Access to Affordable Health Coverage  Universal Coverage and Disability Universal health coverage could spread the risk and put an end to cost-shifting and risk-avoidance. We must evaluate specific proposals carefully, then advocate to make them disability-sensitive and to assure an ongoing role for people with disabilities in running the system.

10. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Delivery of covered benefits  Barriers to care Procedural issues (created by insurers, health plans and administrators of publicly funded plans) Accessibility issues Geographical/transportation issues  Choice of providers Access to specialty care

11. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Delivery of covered benefits w Disability stereotypes May affect willingness of some providers to deliver certain services (like preventive care). May diminish health-care provider’s ability to recognize/treat health problems unrelated to patient’s disability.  Grievance/Appeals procedures If system isn’t accessible, it’s tough to fight back!

12. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Benefit design/definition of medical necessity  Disability-insensitive benefit design Excludes or unreasonably restricts items and services that people with disabilities need to live independent lives. Reflects black-or-white thinking about disability. Example: Medicare covers durable medical equipment (DME) only if needed in the home, not if needed in the community. Example: Failure to recognize and cover so-called “maintenance therapy” as preventive care.

13. RespectAbility Conference Oct. 3-4, 2003 System-Wide Health-Care Issues for People with Disabilities Laura Remson Mitchell, California Disability Alliance Benefit design/definition of medical necessity  Medical-model view of “medical necessity” Focuses on “cure” or measurable physiological improvement.  Disability-sensitive view Recognizes “maximizing functional independence” as essential part of “medical necessity,” whether that involves improving physiological function or providing appropriate assistive items and services.