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Provider Perspectives
Looking Back at 2006
Tannisse Joyce is the Benefits Specialist with Lutheran Social Services of Illinois. In the early days of her advocacy position within the behavioral health network, Ms. Joyce helped consumers and staff navigate Medicaid, Social Security, and other public benefits, but that all changed with the onset Medicare Part D. As many consumers have difficulty plotting their way through this convoluted new drug benefit, much commitment and involvement is required from providers. As most of her clients were dual-eligibles, Ms. Joyce foresaw social services being forced to play an essential job in the enrollment process. She, along with another co-worker, stepped up to this task but at the expense of other organizational duties.
Now Ms. Joyce is essentially Lutheran Social Services’ Part D expert. By January 1, 2006, most of the agency’s clients in the behavioral health network were signed up for a Part D plan. Yet, this time commitment forced Ms. Joyce to ignore other tasks. She says, “I know it has impacted my job…I have really been trying to move back to my usual education efforts regarding Medicaid and Social Security. But I work out Part D problems for clients pretty much all day”. Educating beneficiaries about their options can be a difficult and time-consuming process as Ms. Joyce explains, chiefly because Part D is so complex. On top of that, consumers are constantly inundated with insurance company advertisements, auto-enrollment notices, and other Medicare-related media, which confuse them. Oftentimes, Ms. Joyce sees clients overwhelmed and “throwing their hands in the air.” She says, “If providers cannot navigate Part D, it’s absurd to think consumers can access their options”.
Once enrolled, clients return to social service providers with additional Part D problems. In fact, they are dropped on Ms. Joyce’s desk daily. She cites new co-pays, dual-enrollment mistakes, lack of outreach to individuals with disabilities, drug cards “lost” in the mail, the ambiguous donut hole, and the effects that Part D has on people trying to meet spend-down in order to receive public benefits, as even more examples of Part D’s negative consequences. And when clients are in dire situations, the social service sector steps up financially. Indeed, funding the behavioral health network maintained for prescription assistance was largely redirected towards individuals with Part D problems.
So what can be done? Ms. Joyce affirms that clients need help accessing their medications seamlessly. The government must begin listening to the problems consumers are having and make proper changes accordingly. State and Federal materials and letters sent to beneficiaries need to be accurate and in plain language to reduce confusion. Criteria and standards need to be set for prescription drug plans and help lines like 1-800-Medicare to assure proper customer service. This would relieve some of the burden and responsibility of providers in addressing clients’ problems or concerns. Ms. Joyce hopes for reform in order to benefit both consumers and the social service industry that suffers the financial and professional burdens of Part D.
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