Preparedness, Response, and Recovery Considerations for Children and Families Workshop Summary (2014) / Chapter Skim
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5 Financing Health Care for Children in Emergencies
5 Financing Health Care for Children in Emergencies
Pages 49-58
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From page 49... ...
As for-profit entities, private practice providers are not eligible for grant money from the Department of Health and Human Services or for Federal Emergency Management Agency assistance. In this section of the report, panelists representing a health system, an insurer, a hospital, and community practice offer their perspectives on the challenges of funding preparedness activities and response.
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From page 50... ...
to help load the Disproportionate Share Hospital formula in favor of hospitals that join a regional disaster compact would be a good effort that could benefit from advocacy. The rest of this section gives varying financial perspectives of preparedness financing related to children, including the federal level, private insurer, hospital association, and private practice provider.
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health care system, beyond the emergency care system, critical care, and emergency medical services? Margolis suggested that a successful business case for emergency preparedness involves decreasing the cost and increasing the value of preparedness.
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The task moving forward, Margolis reiterated, is to think not only about how to build a financially sustainable health care system, but how to ensure that emergency preparedness is an integral part of the entire evolving health care system. PRIVATE INSURERS Robert Smith, senior medical director for the central region of United Healthcare Clinical Services, began by clarifying that UnitedHealth Group is both an insurer, through its UnitedHealthcare division, and a health and wellness company, through its Optum division.
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From page 53... ...
In a disaster, the majority of children may be covered by employer or individual insurance; however, they may become separated from their parents. These children are not likely to have identification or a health insurance card in their pocket, and may not be able to provide accurate health histories.
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The UnitedHealth Group business continuity plans focus on critical business functions and planning for the worst-case scenario so that the organization can react quickly and efficiently, even in the face of loss of its own critical systems, resources, or facilities. Because private insurers control a significant portion of health care dollars as the fiduciary representatives of employers of parents, they can have significant involvement in disaster preparedness and response.
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INDEPENDENT PRIVATE PRACTICE PROVIDERS The majority of pediatric care is primary care provided by pediatricians, as well as family practitioners, nurse practitioners, and physician assistants, said Scott Needle, a pediatrician in the Healthcare Network of Southwest Florida (Phillips et al., 2005)
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From page 56... ...
After Hurricane Katrina, for example, Medicare incentive payments were made available for some of the affected providers and institutions. Any kind of comparable proactive change to Medicaid is much more difficult to effect because four agencies are involved in the decisions (CMS, Congress, the state legislature, and the state Medicaid authority)
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Needle added that officebased providers are key partners in a disaster for the management of children with special health care needs. Opportunities for Preparedness Involving private practice pediatricians in preparedness, response, and recovery will require financial and material assistance.
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From page 58... ...
Other opportunities include community coalitions, and networks to share resources and create economies of scale. Needle also suggested recovery memoranda of understanding or contracts that could pass on Stafford Act disaster recovery funds to office-based practices, perhaps similar to how for-profit debris removal services are contracted by the state for disaster services.
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