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As second open health enrollment begins, Kansas City groups target the hard-to-reach 

A highly regarded eating-disorder treatment center is about to make the Kansas City area its first site outside of its home state of Colorado, a development local clinicians said would help fill a critical gap in services here. The Eating Disorder Center of Denver expects to open its partial hospitalization program on Dec. 29, according to local program director Tanja Haaland. The company is renovating 5,400 square feet of space in the lower level of an office building near Shawnee Mission Medical Center in Merriam, Kan. Open to adults ages 18 and above, Haaland says the Eating Disorder Center of Kansas City will have a 12-person capacity. The program will operate eight to 10 hours a day, six days a week, with a staff of about 20 people. Haaland says the length of the program is typically six to eight weeks. “It’s a huge deal,” says Emma Wood, co-owner and clinical director of Thalia House, a transitional living facility in Fairway, Kan., that serves women with eating disorders. Established in 2001, the Eating Disorder Center of Denver, or EDC, uses a trademarked treatment program it calls CAMSA, short for Connection, Acceptance, Mindfulness, Sense of Self and Action. The EDC in Denver has become a trusted resource for local clinicians, among them Kori Hintz-Bohn, executive director of Renew Counseling Center in Olathe, Kan., which also specializes in eating disorders. “We have sent (clients) to Denver and we have been very pleased with the work they did,” Hintz-Bohn says. She says that by next year Renew, too, could have a program like the one EDC is starting. Renew has talked about a collaboration here with McCallum Place, which has locations in St. Louis and Austin, Texas. Levels of care Eating disorder treatment spans a spectrum of care, including inpatient units specializing in handling very sick patients who are severely underweight. Kansas City once had such a facility at Research Medical Center, but that program closed more than two years ago. Other options include partial hospitalization and intensive outpatient programs, known respectively as PHPs and IOPs. Intensive outpatient is generally a notch below partial hospitalization in terms of the length and frequency of weekly programming. The treatment environment also includes individual therapists and counselors, such as Mary Beth Blackwell, who runs the Eating Disorder Resource Center at Jewish Family Services of Greater Kansas City. Eating disorder experts in Kansas City say the lack of a PHP has been one of the most glaring holes in the local system. Renew and Thalia House run IOPs. Only one in 10 men and women suffering from eating disorders receive treatment, according to the National Association of Anorexia Nervosa and Associated Disorders. Relapse is common, with one study finding that more than a third of women treated for anorexia or bulimia backslide within nine years. Statistics like those, say providers, highlight the need for a range of treatment options – with patients moving up and down the continuum depending on how well they are doing in their recovery. Local clinicians say they are pleased to have a local partial hospitalization program through the Center, because the only option currently is to send patients to programs hundreds of miles away from their families and support systems. “Those that have loved ones that are friends or parents or husbands who come (to therapy) and are part of their treatment – those are the ones that have much less risk of relapse,” Hintz-Bohn says. As a licensed counselor herself, Haaland says partial hospitalization can be a better alternative to a more restrictive setting where patients are walled off from their everyday lives and don’t get to practice the coping skills they are learning in treatment. Also, she says, insurance companies are more apt to cover PHPs as a more cost-effective treatment option than inpatient care. Blackwell, the Eating Disorder Resource Center official, agrees that partial hospitalization is a valuable option for certain patients, making EDC a welcome addition to the treatment landscape here. She’s concerned, however, that insurance companies will steer patients to the partial hospitalization program when what they need is inpatient care. Blackwell hopes to resurrect an inpatient clinic to replace the one that closed at Research, which she helped staff. “There were times (at Research) when we would argue with insurance companies that this person was at a lower weight or they were chronically binging and purging and needed 24-hour care, and they just wouldn’t budge on it,” she says. “So that’s what make me nervous (about the new PHP). If insurance companies will get too used to it as an option, and then when inpatient becomes available, if it becomes available, they won’t consider that a viable option.” Another entrant? Hintz-Bohn says that Renew and McCallum Place began discussions in the spring of 2013 about collaborating on a PHP here. Those talks are on hold, however, following the recent sale of McCallum Place to Acadia Healthcare Co, a behavioral health company based in Nashville. The St. Louis Business Journal reported that the cash and stock deal with Acadia was valued at $40 million. Hintz-Bohn says the two sides have discussed starting a program with a 24-person capacity to serve both adolescents and adults. The program would be housed in a medical office building next to Menorah Medical Center in Overland Park. EDC CEO Verne Singleton declined to discuss financial aspects of the operation here. He said the new site in Kansas City is in keeping with the company’s expansion strategy that executives have discussed over the last year or so. Kansas City made sense from a geographic standpoint, Singleton said, since it’s relatively close to Denver. In addition, he said, the metropolitan area has a solid foundation of experienced clinicians. “That was really very important,” Singleton said. “You want that nucleus around to begin with.” Mike Sherry is a health reporter with Heartland Health Monitor, a reporting collaboration among KCUR Public Radio, KCPT Public Television, KHI News Service and Kansas Public Radio. Major Funding for Health coverage on KCPT provided by Assurant Employee Benefits and the Health Care Foundation of Greater Kansas City.
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As the Affordable Care Act’s second open enrollment period began Saturday, for-profit and non-profit groups ramped up efforts to assist populations that have proven hard to reach.

At events in and around Kansas City, counselors, insurance brokers and insurance companies held public education events and free health fairs to reach the uninsured and underinsured among minority populations and apprise them of their coverage options.

Nancy Kelly, program director of the Missouri Foundation for Health’s Expanding Coverage Initiative-Cover Missouri Coalition, says the coalition altered its approach in the wake of the first open enrollment period last year.

“One of the things that the group learned was that it’s really important to meet the community members where they are,” she says.

Kelly says the coalition created more outreach programs aimed at addressing the high rates of the uninsured in minority communities.

In Kansas City, 20.9% of African Americans and 34.7% of Latinos remain uninsured, compared with 11.3% of the white population, according to the coalition.

The coalition’s outreach efforts included programs aimed at African Americans and Latinos as well as the LGBT, Vietnamese and Bosnian communities.

For-profit groups offered enrollment assistance as well. John McDaniel, head of McDaniel Hazley Group, a minority-owned insurance brokerage based in Kansas City, opened MHG Enrollment Center on the northwest corner of 18th and Vine, once the cultural hub of Kansas City’s African-American community.

“He noticed that last year during open enrollment, our community – the African American community and the Hispanic community – was very underserved, so he wanted to make a difference,” says Dana McGill Brown, an account executive at McDaniel Hazley Group.

McGill-Brown says the center hoped to enroll between 2,000 and 3,000 individuals. The assistance is free of charge and underwritten by commissions provided by insurers.

Wariness among LGBT individuals

Lesbian, gay, bisexual and transgender individuals, who are also disproportionately represented among the uninsured, were also the target of outreach efforts.

The Whole Person, an organization serving individuals with disabilities, co-sponsored a health fair last weekend geared toward the LGBT community. Other sponsors were Swope Health Services and The LGBT-Affirmative Therapists Guild of Kansas City.

Dr. Matthew Heinz, who attended the fair and directs LGBT outreach for the U.S. Department of Health and Human Services (HHS), stressed the availability of financial assistance for health insurance plans purchased through the federal marketplace. He also explained the end of once-common insurance practices such as pricing decisions based on criteria like pre-existing conditions.

Getting that message across is sometimes difficult, however, because of ingrained perceptions in the LGBT community.

“It’s really hard to just turn on a dime, and say, ‘OK, you can now get insurance, and no, you won’t be charged more because your transgender 13-year-old just came out,’” Heinz says.

According to a Gallup Poll released in August, self-identified LGBT individuals are more likely than non-LGBT Americans to report they lack health insurance – although the Affordable Care Act (ACA) has helped shrink the gap.

In the fourth quarter of 2013, the last three months before the ACA required individuals to have health insurance, the percent of uninsured individuals in the LGBT community was 5.3 points higher than the rest of the population

At the start of the second quarter this year, as the initial sign-up period for health insurance through the ACA ended, the LGBT community had registered a larger drop in its uninsured population than the population at large. Yet 17.6 percent of the LGBT community remained uninsured compared with 13.2 percent of the rest of the population.

HHS report underscores advances

Earlier this month, the Department of Health and Human Services’ LGBT Issues Coordinating Committee issued its fourth annual report highlighting initiatives underway to improve the health and well-being of LGBT individuals.

Among other advances, the report cited a proposed rule that bars discriminatory practices at hospitals participating in the Medicare and Medicaid programs. And it noted that data collection efforts at HHS now include questions on gender identity and sexual orientation.

Even as outreach efforts have expanded, federal grants for health exchange enrollment assistance in Kansas and Missouri have fallen. The Centers for Medicare and Medicaid Services provided $1.59 million to health groups in Missouri, down from $1.8 million last year. Grants to Kansas groups totaled $710,145 compared with $886,085 last year.

To help fund additional enrollment assistance needs, the Cover Missouri Coalition, which consists of health organizations led by the Missouri Foundation for Health, has provided $4.5 million in grants. Those grants fund certified application counselor positions throughout the state.

Kelly, of the Cover Missouri Coalition, says she welcomes enrollment assistance from brokers and insurers like Blue Cross Blue Shield of Kansas City. But she cautions consumers to steer clear of enrollment assisters who ask for payment.

“They should not be paying a fee,” she says. “They are not required to pay a fee. There should not be a charge for the consumer. That is one of the guidelines that has been set through the marketplace.”

Kelly says consumers should also use the official healthcare.gov website to avoid scams and ensure they receive the subsidies to which they may be entitled.

Individuals lacking health coverage will be hit with larger fines this year than last year: 2 percent of their yearly household income or $325 per person for the year, whichever is higher.

Mike Sherry is a health reporter with Heartland Health Monitor, a reporting collaboration among KCUR Public Radio, KCPT Public Television, KHI News Service and Kansas Public Radio. He is based at KCPT’s Hale Center for Journalism. 

Alex Smith is a health reporter with Heartland Health Monitor, a reporting collaboration among KCUR Public Radio, KCPT Public Television, KHI News Service and Kansas Public Radio. He is based at KCUR.

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