Real World Health Care Blog

Cost-Savings

How to Help Sick Kids Get Better When Insurance Isn’t Enough

During the month of August, Real World Health Care will take a short break from focusing on medical breakthroughs and the researchers who are shaping the future of medicine. We will instead bring you a special series from our sponsor, the HealthWell Foundation, about what happens when families cannot afford the medical treatments their children desperately need. The families we will profile have turned to the Foundation for help, through the HealthWell Pediatric Assistance Fund®, the only fund of its kind.

Since its launch in 2013, HealthWell’s Pediatric Assistance Fund has awarded more than $850,000 in grants to help more than 400 children start or continue critical treatments covering more than 90 disease areas and conditions, including ADHD, autism, cerebral palsy, Type 1 Diabetes, epilepsy, scoliosis, seizure disorder and many more. The Fund covers family cost-shares for surgical procedures, medical devices, counseling services and prescription drug copays. This week, we’d like you to meet Karis, whose family can’t afford her type 1 diabetes testing supplies.

Imagine this: You take your child to the doctor thinking she has an infection. You discover that she has a life-altering condition and your health insurance doesn’t cover all the costs.

That’s what happened to Alicia Bell when her daughter Karis was diagnosed with type 1 diabetes. Says Bell: “There are no vacations from being a parent, and there are no vacations from being a parent of a T1D child.”

Bell was not only surprised at her daughter’s diagnosis, she was further amazed to find her insurance wouldn’t pay for all the diabetic testing supplies Karis would need.


Did You Know?

60% of bankruptcies in the U.S. are related to medical expenses.


The Bell family is far from unique. Each year, more and more Americans are forced to choose between paying for lifesaving treatments and for food, housing and utilities. People may cut pills in half, skip meals or housing payments or declare bankruptcy. An estimated 29 million Americans are underinsured and more than 60 percent of all bankruptcies in the U.S. are related to medical expenses. In the Bells’ case, Alicia would need to go into serious credit card debt just to pay for her daughter’s diabetes monitoring and testing supplies.

“I would never want money to factor into my daughter’s health care,” Bell says. “I’d sell my

Karis and her new insulin monitor

Karis and her new insulin monitor

house and everything I own if I had to.”

Fortunately, when health insurance is not enough, there is a group that helps close the gap, putting life-changing medications within reach for thousands of people in need and helping to pay for prescription drug copayments, deductibles and health insurance premiums for critical treatments.

A HealthWell Foundation Pediatric Assistance Fund grant not only pays for Karis’ supplies—including an insulin monitor, so Karis doesn’t have to have her finger stuck several times a day—it pays the co-insurance for her hospital and clinic visits and will help pay for an insulin pump if and when she needs one.

Your generous gift to the HealthWell Foundation can help kids like Karis and others afford the medical treatments they desperately need. Consider a monthly gift, a tribute or memorial donation, or an employer-sponsored fundraiser or end-of-year giving campaign to make an extraordinary and lasting difference in the lives of kids in need. Donate today.

“Not Being Able to Afford Medication for Our Child is Devastating”

During the month of August, Real World Health Care will take a short break from focusing on medical breakthroughs and the researchers who are shaping the future of medicine. We will instead bring you a special series from our sponsor, the HealthWell Foundation, about what happens when families cannot afford the medical treatments their children desperately need. The families we will profile have turned to the Foundation for help, through the HealthWell Pediatric Assistance Fund®, the only fund of its kind.


Did You Know?

Thanks to HealthWell’s Pediatric Assistance Fund, more than 400 children suffering from 90 life-altering conditions have been able to access critical medical treatments.


Since its launch in 2013, HealthWell’s Pediatric Assistance Fund has awarded more than $850,000 in grants to help more than 400 children start or continue critical treatments covering more than 90 disease areas and conditions, including ADHD, autism, cerebral palsy, Type 1 Diabetes, epilepsy, scoliosis, seizure disorder and many more. The Fund covers family cost-shares for surgical procedures, medical devices, counseling services, prescription drug copays and other out-of-pocket costs. This week, we’d like you to meet Alejandro, who was diagnosed with Cystic Fibrosis when he was six weeks old.

In the following letter, Alejandro’s parents, Ruben and Thelma, share the challenges of affording care for their child and the big difference that HealthWell’s Pediatric Assistance Fund grant made in their lives.

Aljeandro

Aljeandro

“Our son, Alejandro, was diagnosed with Cystic Fibrosis (CF) when he was six weeks old. This was a time with many mixed emotions for our family. Alejandro is a twin and we were thrilled to welcome two new babies into our family. Along with our excitement, there were many sad times because we were scared of the unknown: CF and our biggest fear as parents came true with his diagnosis. He has a chronic illness that can be managed, somewhat, but has no cure. 

CF is a disease that requires Alejandro to take many medications and breathing treatments. As part of his treatment, his doctors prescribed medication during the respiratory syncytial virus (RSV) season. Alejandro was prescribed one shot per month for a total of five shots; one for each month from November through March. Our out-of-pocket cost is $750 [$150 per shot], which is a huge financial burden. We applied to the HealthWell Foundation for financial assistance in order to be able to pay the copayment for Alejandro’s treatment. We also contacted the manufacturer of the drug. Unfortunately, having CF does not make you eligible to receive financial support. Having a child with a chronic illness has placed a lot of stress on our family, especially on my husband and me. 

Not being able to afford medication for our child is devastating and extremely frustrating for us as parents. This is why we are so thankful for the Pediatric Assistance Fund through the HealthWell Foundation. Without a grant, we would not have been able to afford this extremely important medication for Alejandro. Receiving help was heartwarming to us because, although the contributors to the Pediatric Assistance Fund do not know our son, they were willing to donate money to ensure a child who is in need of medication receives it. On behalf of Alejandro and our family, we would like to thank all of those kind people who donate their hard earned money for children like Alejandro who need extras in order to live.”

Ruben & Thelma (Alejandro’s parents)

Companies: An average Pediatric Assistance Fund grant is $2,500. With your corporate donation, you can help children like Alejandro afford the medical treatments they desperately need. Donate today to HealthWell’s Pediatric Assistance Fund.

Focusing on Recovery, Not Financial Burdens

During the month of August, Real World Health Care will take a short break from focusing on medical breakthroughs and the researchers who are shaping the future of medicine. We will instead bring you a special series from our sponsor, the HealthWell Foundation, about what happens when families cannot afford the medical treatments their children desperately need. The families we will profile have turned to the Foundation for help, through the HealthWell Pediatric Assistance Fund®, the only fund of its kind.


Did You Know?

HealthWell’s Pediatric Assistance Fund is the first of its kind. It was opened in response to families who had nowhere else to turn.


Since its launch in 2013, HealthWell’s Pediatric Assistance Fund has awarded more than $850,000 in grants to help more than 400 children start or continue critical treatments covering more than 90 disease areas and conditions, including ADHD, autism, cerebral palsy, Type 1 Diabetes, epilepsy, scoliosis, seizure disorder and many more. The Fund covers family cost-shares for surgical procedures, medical devices, counseling services, prescription drug copays and other out-of-pocket costs. This week, we’d like you to meet Anna, who was born with a rare disorder affecting the brain.

In the following letter, Anna’s mom Mary, from Delta, Pennsylvania, shares the challenges of affording care for their little girl and the big difference that HealthWell’s Pediatric Assistance Fund grant made in their lives.

Anna, after surgery, healing & growing

Anna, after surgery, healing & growing

Our daughter, Anna was born with a birthmark on her face and scalp. The doctors suspected there was more to the story. A CT scan of her head confirmed the diagnosis of Sturge-Weber Syndrome, a rare disorder affecting the brain. We spent the next few weeks as new parents trying to understand our beautiful little girl and the rare disease she had. When she was just 3 weeks old, she had her first set of seizures. It was terrifying to see her little body so out of control. She was admitted to the hospital and started on medication. The doctors were able to control the seizures, but never for too long.

Since that first seizure many years ago, we have celebrated many days without seizures and suffered through the days when they eventually returned. We changed medications, avoided activity that might over fatigue her, struggled through specialized diets and prayed for a cure. Eventually, Anna was scheduled to undergo a radical surgery to remove the diseased half of her brain. We knew this could offer her a future without seizures, but we also knew the incredible cost we faced.

With the help of the HealthWell Foundation, Anna had her surgery. She is back home, seizure free – healing and growing. Our family has been able to focus our attention on Anna’s recovery knowing the financial burden has been reduced.

We are so grateful for the financial support the HealthWell Foundation has offered to us. With their help, we are able to celebrate the wonderful little girl God has blessed us with and we look forward to her bright future.

Help kids like Anna get the medical treatments they desperately need. Ask your employer today about how your donation to HealthWell’s Pediatric Assistance Fund can go farther with a matching gift program. Donate today.

“I Don’t Know What I Would Have Done without HealthWell”

During the month of August, Real World Health Care will take a short break from focusing on medical breakthroughs and the researchers who are shaping the future of medicine. We will instead bring you a special series from our sponsor, the HealthWell Foundation, about what happens when families cannot afford the medical treatments their children desperately need. The families we will profile have turned to the Foundation for help, through the HealthWell Pediatric Assistance Fund®, the only fund of its kind.


Did You Know?

100 percent of donations to HealthWell go directly to patient grants and services.


Sophie

Sophie

Since its launch in 2013, HealthWell’s Pediatric Assistance Fund has awarded more than $850,000 in grants to help more than 400 children start or continue critical treatments covering more than 90 disease areas and conditions, including ADHD, autism, cerebral palsy, Type 1 Diabetes, epilepsy, scoliosis, seizure disorder and many more. The Fund covers family cost-shares for surgical procedures, medical devices, counseling services, prescription drug copays and other out-of-pocket costs. This week, we’d like you to meet the Ambassador of the Pediatric Assistance Fund, Sophie.

Sophie suffers from a chronic illness affecting millions of Americans: asthma. In her own words, Sophie describes what it’s like to live with asthma and how HealthWell helped her family afford the medication she needs.

“Finding HealthWell was like a breath of fresh air,” says Pat, Sophie’s father.

Sophie is one of 14 million children in the United States whose family is underinsured. You can help kids like Sophie afford the medical treatments they desperately need by donating your tax deductible gift to HealthWell’s Pediatric Assistance Fund. Donate today. Watch Sophie’s story.

Sophie TY

 

New Series: Big Data in Health Care

Welcome to 2016! The staff and sponsors of Real World Health Care wish you all a Happy & Healthy New Year. We look forward to another year of sharing ideas and insights from researchers on the forefront of real-world medical breakthroughs.

Next week, we’ll be kicking off a new blog series on implications of the use of big data in health care. From predicting disease and identifying targeted therapies and cures to improving our overall quality of life, big data is transforming the way health care decisions are made and care is delivered.

Over the next couple months, our guest bloggers will address issues including:

  • The use of analytics to identify and manage high-risk and high-cost patients.
  • How to extract clinical value from biomedical big data.
  • The use of big data to understand the human condition.
  • The role of large prospective randomized trials in the era of big data.
  • Distinctions between research and operational data within a “continuously learning” health system.
  • Implications of big data science for nurse leaders.

We look forward to sharing these expert views with all of you and hope that Real World Health Care continues to be a source of useful information throughout 2016.

Personalized Medicine & Companion Diagnostics: Speaking with Keith Stewart, Director of the Mayo Clinic Center for Individualized Medicine

Editor’s Note: This week, we sit down with Keith Stewart, director of the Mayo Clinic Center for Individualized Medicine.

Real World Health Care:  Why was the Center for Individualized Medicine formed at the Mayo Clinic? What were its initial goals and how have those goals changed?

Keith Stewart, Mayo Clinic Center for Individualized Medicine

Keith Stewart, Mayo Clinic Center for Individualized Medicine

Keith Stewart:   The Center was formed in 2012 with the idea that it would harness the power of the human genome to improve health care for our patients. It was considered to be one of three transformative initiatives for the future of the Mayo Clinic and a discipline in which Mayo Clinic should be a leader.

RWHC: How has personalized medicine and the work you’re doing at the Center for Individualized Medicine helped the Mayo Clinic to improve health outcomes?

KS:   By using the genome as a lifetime resource and not just a “one and done” test, we believe we will lower the costs of health care. For example genomic knowledge will improve the precision of diagnosis, reduce unnecessary testing, allow the right drug at the right time and ultimately improve health outcomes.

RWHC: What types of companion diagnostics are being conducted at the Center for Individualized Medicine to identify the best therapy for individual patients?

KS:          Many. One good example is pharmacogenomics where we have created 18 drug alerts in the electronic health record already. But we have many other examples: cancer gene panels in prostate cancer, glioblastoma, myeloma, sarcoma, and colorectal cancer. Panels in cardiac disease and neurology, for example in peripheral neuropathy, epilepsy, and movement disorders. And, of course, whole genome sequencing for families with rare diseases.

RWHC: In your opinion, what is the most exciting translational research being conducted at the Center for Individualized Medicine?

KS:   I am very excited about our work in the microbiome and how that will impact human health and how we might use genomic sequencing in infectious disease to identify pathogens that are hard to culture. But there are many such areas. We will be sequencing the pharmacogenomes of 10,000 of our patients and launching clinical trials in the areas of organ transplant and immune-oncology next year.

RWHC: Where do you see the future of blood cancer-related personalized medicine and companion diagnostics heading?

KS:          As an example we have built and are launching a gene panel in myeloma which identifies mutations but will also call common translocations. If successful this should replace the era of conventional cytogenetics and FISH testing. The same will be true in acute leukemias and lymphomas. A major area of interest is in immune-oncology and we will be launching trials in this area next year to understand how genomics can select for patients most likely to respond.

RWHC: When full-genome sequencing becomes routine, what sort of information do you envision healthy people obtaining and applying as a result of having their genome sequenced?

KS:          I think the answer may not be what most people expect. Yes, we will find medically actionable things such as carrier status and pharmacogenomics, but to me, the most important thing might end up being what is negative. As an example, when I had my genome sequenced, it struck me that I would never again have to have any other genetic testing done for the rest of my life. So, if I have a blood clot, cancer, or develop Parkinson’s or dementia, I already know I am negative for the currently understood genetic risk factors.

Most Americans Say They Can Afford Drugs but the Sick Still Struggle

According to an August Kaiser Health Tracking Poll, it appears that most Americans (72%) can afford their prescription drugs. However, one in four Americans surveyed indicate difficulties, including more than four in ten people who are sick. Others facing difficulties paying for their prescription drugs include those with low incomes (33%) or those taking four or more prescription drugs (38%).

KFFPollAmong those with insurance, prescription drug costs rank among a number of other health expenses, with 11 percent saying their prescription drug costs is their most burdensome health care cost, while 17 percent say it is the deductible, 14 percent say it’s their health insurance premiums, and 44 percent say that paying for health care and health insurance is not a financial burden. For those with lower incomes, paying for prescription drugs tops the list, with 17 percent reporting it is their greatest financial burden when it comes to health care costs.

Most of Americans (62%) surveyed in the poll say that prescription drugs developed in the past 20 years have made lives of people in the U.S. much better, including 42 percent who say a lot better. Do you agree? Let us know your thoughts in the comments section.

Categories: Cost-Savings, General

Rebounding from the Impact of Multiple Sclerosis: The Champlin Family’s Story

Editor’s Note: Real World Healthcare will be taking a brief hiatus during the month of August. During this time, we’d like to share with you some of the compelling stories we’ve published about patients facing both medical and financial hardships.

 

Life has not been the same for Dee Champlin, her husband Mark and their two sons since Dee was diagnosed with multiple sclerosis (MS) in 2008. The disease has imperiled Dee’s vision, severely limited her walking and weakened her memory and speech. But she and her family have always found ways to bounce back.

Dee Champlin, receiving treatment for MS

Dee Champlin, receiving treatment for MS

Symptoms such as sensitivity to hot weather, temporary numbness and joint pain had been growing more and more common for Dee beginning in 1988.  But, as with many MS patients, it was eye problems that ultimately led doctors to the MS diagnosis 20 years after her symptoms first appeared.

********************************************************************************

A Message from our Sponsor: Are you, or is someone you love, an MS patient on Medicare in Need of Financial Assistance? Click here to visit the HealthWell Foundation’s eligibility page.

********************************************************************************

In one crisis, Dee suddenly began slurring her speech and drooling. Hours later, vision in her left eye started disappearing under what she described as a dark veil. A series of three ophthalmologists assessed the problem before determining she had bleeding inside the eye. This led to MS testing. Four tests, including an MRI and a spinal tap, all came back positive for MS, revealing 14 lesions on her brain at the time.

Mark describes a moment during one of Dee’s hospitalizations when he shifted from a negative attitude to a positive one that still guides the family.

Their challenges had hit him “like a punch to the gut,” he said. “Why us?” he thought. “Everything changed so fast. But then I thought, eventually we are going to get out of this hospital and go home. Things could be so much worse. With all the bad things that are happening to Dee, I don’t want to deal with my own negative attitude.”

That outlook has allowed the Champlins to absorb many changes in their lives as they cope with Dee’s health. Mark had been a self-employed truck driver but sold his semi and changed jobs to be near home after Dee had two health emergencies while he was on the road.

The couple moved from Nebraska to Lockport, N.Y., outside Buffalo, to live closer to their family for more support. Mark began working an overnight shift so he would be available to accompany Dee to medical appointments during the day.

They have both learned that MS produces good days and bad days. And on any given day, they know their plans may change, as Dee’s physical condition may vacillate from morning to afternoon.

Their sons, ages 7 and 2 when Dee’s illness was finally diagnosed, have adapted too. They pitch in at home, help out with laundry and even endure a dreaded chore — washing dishes — when their mom needs it. Their parents are attentive to addressing the boys’ concerns about Dee. They speak openly with them, but still encourage their kids to truly be kids with as normal a life as possible.

The Champlins’ latest rebound was receiving a HealthWell grant that allowed Dee to resume treatment with the only MS medication that has ever made a difference for her. Earlier, after two years of this treatment with daily injections, she received a letter from her insurance provider saying her drug costs had already exceeded the plan’s lifetime maximum. The letter concluded with this line: The cost outweighs the benefits.  “I’ll never forget that as long as I live,” Mark said.

Despite the complex and intensive medical care Dee has been through, the family takes comfort in knowing that Dee’s form of MS is not fatal and that they can continue fighting it. Returning to a previously effective drug should give Dee a better quality of life.

“So many find out they have a disease that gives them literally weeks or months to live,” Mark said. “They don’t get the ‘opportunity’ to push their loved one around in a wheelchair for the next 30 years. Luckily, I do!”

 

Categories: Cost-Savings, General

How HealthWell Foundation’s MS Fund Helped Charlie Get His Life Back on Track

Editor’s Note: Real World Healthcare will be taking a brief hiatus during the month of August. During this time, we’d like to share with you some of the compelling stories we’ve published about patients facing both medical and financial hardships.:

Charlie Barron

Charlie Barron

Charlie Barron was raised to set goals, make plans, get things done. But setting and meeting goals has become exceptionally hard since Charlie, 46, discovered he has multiple sclerosis.

Because of his MS, Charlie is unable to work and therefore struggles to pay for the expensive treatments he has needed since he was diagnosed in 2010, a decade after his symptoms first appeared. He received HealthWell Foundation grants in 2014 and 2015.

********************************************************************************

A Note from Our Sponsor: Are you, or is someone you love, an MS patient on Medicare in Need of Financial Assistance? Click here to visit the HealthWell Foundation’s eligibility page.

*******************************************************************************

Before his diagnosis, this resident of DeKalb, Ga., had a career as a chef. On the job, he often stood 12-14 hours a day, despite a pins- and-needles sensation in his feet and numbness in his legs that went on for years. For a long time, he considered his physically demanding work the cause of his pain, yet his employer provided no health insurance.

Later, Charlie combined his cooking skills with his interest in fitness to open his own business.  As a personal trainer, he led clients in morning workouts in their homes, then cooked them a healthy breakfast in their kitchens. At that point, he bought himself health insurance.

However, his insurance policies have been unreliable in covering his medications. For instance, his first medication was covered, but when it proved ineffective for him, his insurance company declined to pay for the next prescribed treatment. Moving from private insurance, he obtained Medicare coverage through disability and thought those challenges would change. Recently his doctor recommended adding a second drug to Charlie’s treatment plan which has staved off relapses for the last two years, but the out-of-pocket expense was still unmanageable.

In a note thanking the Foundation for its financial assistance, Charlie described how he felt when he found out the cost of his care.  “Even though I was ready to physically fight to get my life back from MS, my finances were not so ready for battle,” he wrote. “I learned that the medication my doctor prescribed would cost upwards of $1,100 per month. I felt that I had been knocked down before I even had a chance to throw the first punch.”

“The HealthWell Foundation has given me the peace of mind to focus my energy on fighting MS and encouraging others to do the same,” Charlie’s letter said.  He continues learning about MS at a local MS center, takes physical therapy and has participated in activities such as a painting class with others coping with MS.

Social media connects him with additional people with the illness. Hearing about others’ experiences with MS, giving them encouragement or simply offering a kind word to lift their spirits gives Charlie strength.

Benefiting from the supportive care of his wife, brother-in-law and 13-year-old daughter, he urges other people with MS to seek support from family or a strong support group.  For caregivers, he recommends researching MS through the Internet, books or the MS Society to know what to expect.

Not comparing the present with the past is important to him as well. “It’s not about what you used to do, it’s about what you are trying to do now,” Charlie says.

Are you an MS patient like Charlie? How are you coping with the disease and its treatment costs? Let us know in the comments.

 

Rebounding from the Impact of Multiple Sclerosis: The Champlin Family’s Story

Life has not been the same for Dee Champlin, her husband Mark and their two sons since Dee was diagnosed with multiple sclerosis (MS) in 2008. The disease has imperiled Dee’s vision, severely limited her walking and weakened her memory and speech. But she and her family have always found ways to bounce back.

Dee Champlin, receiving treatment for MS

Dee Champlin, receiving treatment for MS

Symptoms such as sensitivity to hot weather, temporary numbness and joint pain had been growing more and more common for Dee beginning in 1988.  But, as with many MS patients, it was eye problems that ultimately led doctors to the MS diagnosis 20 years after her symptoms first appeared.

********************************************************************************

A Message from our Sponsor: Are you, or is someone you love, an MS patient on Medicare in Need of Financial Assistance? Click here to visit the HealthWell Foundation’s eligibility page.

********************************************************************************

In one crisis, Dee suddenly began slurring her speech and drooling. Hours later, vision in her left eye started disappearing under what she described as a dark veil. A series of three ophthalmologists assessed the problem before determining she had bleeding inside the eye. This led to MS testing. Four tests, including an MRI and a spinal tap, all came back positive for MS, revealing 14 lesions on her brain at the time.

Mark describes a moment during one of Dee’s hospitalizations when he shifted from a negative attitude to a positive one that still guides the family.

Their challenges had hit him “like a punch to the gut,” he said. “Why us?” he thought. “Everything changed so fast. But then I thought, eventually we are going to get out of this hospital and go home. Things could be so much worse. With all the bad things that are happening to Dee, I don’t want to deal with my own negative attitude.”

That outlook has allowed the Champlins to absorb many changes in their lives as they cope with Dee’s health. Mark had been a self-employed truck driver but sold his semi and changed jobs to be near home after Dee had two health emergencies while he was on the road.

The couple moved from Nebraska to Lockport, N.Y., outside Buffalo, to live closer to their family for more support. Mark began working an overnight shift so he would be available to accompany Dee to medical appointments during the day.

They have both learned that MS produces good days and bad days. And on any given day, they know their plans may change, as Dee’s physical condition may vacillate from morning to afternoon.

Their sons, ages 7 and 2 when Dee’s illness was finally diagnosed, have adapted too. They pitch in at home, help out with laundry and even endure a dreaded chore — washing dishes — when their mom needs it. Their parents are attentive to addressing the boys’ concerns about Dee. They speak openly with them, but still encourage their kids to truly be kids with as normal a life as possible.

The Champlins’ latest rebound was receiving a HealthWell grant that allowed Dee to resume treatment with the only MS medication that has ever made a difference for her. Earlier, after two years of this treatment with daily injections, she received a letter from her insurance provider saying her drug costs had already exceeded the plan’s lifetime maximum. The letter concluded with this line: The cost outweighs the benefits.  “I’ll never forget that as long as I live,” Mark said.

Despite the complex and intensive medical care Dee has been through, the family takes comfort in knowing that Dee’s form of MS is not fatal and that they can continue fighting it. Returning to a previously effective drug should give Dee a better quality of life.

“So many find out they have a disease that gives them literally weeks or months to live,” Mark said. “They don’t get the ‘opportunity’ to push their loved one around in a wheelchair for the next 30 years. Luckily, I do!”