Welcome to 2020! We’re kicking it off right by bringing you 20 voices germaine to the California Broker world. Of course, this is not a ranking or top 20 list. We do think our contributors are tops, but we’ve merely arranged the pieces in alphabetical order by last name. You’ll see that we have some longer contributions and some short Q&As and conversations. Our aim was to mix it up—and invite a few fresh faces to contribute along with a few regulars. Read on for what’s on these folks’ minds for 2020….
Food and Shelter: The Foundation of Wellbeing
Seeing through the eyes of CHCF Engagement Specialist Xenia Shih Bion
For the California Health Care Foundation (CHCF), making more progress towards universal coverage, improving care access and quality in Medi-Cal, and improving access to quality mental healthcare are top priorities in 2020. Supporting the health care system in addressing the social determinants of health is also important. CHCF communicates about initiatives addressing these issues to its primary audiences of policy makers and health care leaders, and funds certain efforts through grants.
I’m encouraged that some health care systems are recognizing stable housing as fundamental to health. This is important for the industry AND the community to address. UnitedHealth Group started MyConnections, a program in selected cities that invests in housing and support services for UnitedHealth Medicaid members who are homeless. Oakland-based Kaiser Permanente invested a generous $200 million into the Thriving Communities Fund. This stable housing initiative for Kaiser members and the broader community was championed by the late Bernard Tyson, chairman and CEO. He looked at patients holistically and pushed the organization to address social determinants of health, including stable housing. This exciting initiative is reaching 15 communities across America, seven of those in California.
Both programs recognize that getting patients off the streets is one of the most important steps to helping them heal, both physically and mentally. The healthcare system is designed to treat people once they’re already sick but historically has not been designed to help prevent sickness. Living on the streets can lead to overuse and overcrowding of emergency rooms, with the health care system constantly treating surface issues and not causes.
It’s also important to recognize the role of good nutrition for health. Medi-Cal is halfway through a pilot project that provides medically tailored meals to adults with chronic diseases. We can keep treating illnesses and injuries, but to really invest in people’s long-term wellbeing, we need to treat the underlying social determinants of health—like food insecurity.
What do you see as the role of brokers?
Brokers play a vital role by providing consumers with accurate information about health plan choices. It’s really important to steer clients away from short-term plans that are meant only as stop-gap coverage. These plans can lead to unexpected medical debts because they have a lot of holes. They can exclude essential benefits like emergency services and maternity care, and can charge higher prices for pre-existing conditions if they cover them at all.
Brokers also play an important role in removing barriers to enrollment, especially in the face of the Trump administration’s changes to the “public charge rule” to favor wealthier immigrants who do not use public programs. Even though federal courts have blocked the final rule from taking effect, it’s had a chilling effect on immigrant families that are legally in this country and are eligible for but avoiding or disenrolling in public programs like Medicaid, supplemental nutrition programs and housing assistance. Brokers can communicate to immigrant families that they can continue to use these services without fear. There’s a campaign called Protecting Immigrant Families that has helpful resources that they can refer to.
Part of my interest in social determinants of health stems from me being the child of Taiwanese immigrants. I personally benefited from the Women, Infants and Children (WIC) program when I was an infant. Another experience that got me interested in public health nutrition was my time as a running coach for 9 to 10-year-old girls for the non-profit Girls on the Run. One of the units was on nutrition and how what you eat can impact how you run. It struck me as ironic that we were teaching them about eating highly nutritious foods when most lived in a community that historically was ‘food insecure.’ Here was a challenge. I became keenly interested in the concept of food deserts, and grassroots movements to improve community nutrition, and went on to earn my Master of Public Health. I feel really fortunate to work at CHCF where I can make an impact. I still write about food issues in the context of the many factors that contribute to health and can even help lower health care costs.
I think my family’s immigrant background motivates me to seek out stories that maybe other writers might not. One of my passion projects is a series of articles about the importance of listening in health care. Each explores an organization in California that proactively engages their patients and uses their feedback to improve the design and delivery of care.
The first article highlighted the Trust Health Center in Oakland that serves adult residents of Alameda county who are homeless or at risk of becoming homeless. To combat the stigma of homelessness, the clinic is committed to creating a safe, welcoming space with continuous feedback from the staff and patients. Another will explore the California Healthy Nail Salon Collaborative, which is dedicated to increasing awareness by salon owners, workers and patrons of the effect of the toxic chemicals in nail products. There’s a push to ban harmful chemicals, and to alert the public which salons to patronize. A true ‘vote with your money’ initiative, it’s a great example of how policy can have an impact at the worker level.
Normal People by Sally Rooney
- “Tradeoffs” by Dan Gorenstein on health policy issues (CHCF is one of the funders).
- “Reply All” a clever take on all the oddities of the internet.
Xenia Shih Bion, CHCF Engagement Specialist, serves on the External Engagement Team, handles social media and writes the Essential Coverage weekly column and more.
— Linda Lalande