NHF

Hemophilia Awareness Month

In the US, this is Hemophilia Awareness Month, a chance for us to let others know who we are and what we need. Our community just did that last week on Capitol Hill, storming the hallowed halls and meeting with state representatives and senators when possible, to inform them about bleeding disorders and mostly about our funding needs.

I participated for the first time last year and loved it. An illness kept me away this year (all better now!) and how I missed it! I was so impressed with the event. It’s a chance for all of us, well known and not so well known, to share our stories. In fact, it’s most impressive when the average mom and dad, and even their children, meet with Washington folks to tell them about life with hemophilia.

Visit the NHF website (www.hemophilia.org) or HFA website (www.hemophiliafed.org) to learn more.

Speaking of HFA, what a fabulous website they have! And their annual meeting is coming up on March 27 in Tampa, Florida. While there are no scholarships left to support attending, if you can at all try to attend, please do. It’s a very different flavor than the NHF events. Both are great, but different.

What can you do for Hemophilia Awareness Month? First, learn more about the disorder yourself. It’s hard to have others appreciate what you endure if you don’t have a ready and coherent “script.” I was on Facebook most of the weekend contacting the many people who have reached our to me this past year, sorting out who is actually related to hemophilia, to keep them as friends. Some are first-time parents of a child with hemophilia and I am delighted to send them our educational materials.

Second, check in on our website (www.kelleycom.com), as well as NHF, HFA, PSI (www.youneedpsi.org) and your local hemophilia organization. Make it a habit every couple of weeks to check out a new website. There are so many!

Try to attend a hemophilia event. It might be the HFA one in March, the NHF one in Washington DC in September, or maybe a local one near you. Meet families, meet physicians, meet factor manufacturer reps. The bottom line is–get active and involved! We need you and the world needs to know about hemophilia. Help pave a great future for your child starting this month!


Welcome to the Jungle, I mean Marketplace! Part 2

At NHF’s Social Worker Insurance Workshop in Baltimore on January 16, there were some great questions asked from the audience concerning the Marketplace. Social workers know they will most likely be the first line of defense for patients with bleeding disorders facing the many challenges of the ACA. Here are some questions asked and other snippets of information from the workshop.
Q. What if you don’t like the insurance plan options in the Marketplace. How do you file a
special appeal [concerning coverage]?

Go to Healthcare.gov; there is a link for an appeal. Appeals are
worthwhile because sometimes codes are entered in wrong, and sometimes people
get approved for procedures and benefits that were originally denied.
Is there a limit to the number of appeals?
No.
Q: But after you pick a plan and don’t like it, what if you just don’t pay the next month’s
premium? Won’t you just get canceled and then you can choose another plan? Isn’t
that easier than an appeal?
There is an open enrollment time, so you can’t choose to switch outside that time period. After March 31 you can’t get into a “QHP” (an insurance plan that is certified by the Health
Insurance Marketplace, provides essential health benefits, follows established
limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum
amounts), and meets other requirements.)
Mike Bradley (Baxter), Laurie Kelly, and Derek Robertson (Apogenics, Inc.)
Joanna Gray, of CRD Associates told us that the ACA says HTCs must be included in-network. But… plans don’t have to include any specific medical procedure. They only need to cover “sufficient” providers, and they don’t say who those providers are. The ACA hasn’t come through in its promise. NHF says be careful! Don’t pick a plan that doesn’t include your HTC or product, because now it’s legal for providers to avoid HTCs. We can’t change the policy for this year. Maybe next? We need to complain to get changes made.
NICOLE of NHF said that every state has its own definition of EHB (essential health benefits). So picking a plan is harder, because there are more plans, and picking one that covers what you need is hard.
Q: To use the Marketplace, you must be a legal resident.  What happens to legal immigrants,
who are not citizens?
   In Nevada, they are currently covered under high-risk pools but will lose this soon (the pools are closing). Are there alternatives?
No. You can still get emergency medical through Medicaid; and of course, anyone can buy insurance in the commercial marketplace.

Nancy Hatcher and Ed Kuebler
JoAnn Volk of The Center on Health Insurance Reform, Georgetown University Health Policy Institute, said that six states will not enforce the ACA: Alabama, Missouri, Oklahoma, Texas, and Wyoming. The ACA gives primary responsibility to states to enforce the rules, but there are 10 state benchmarks (Essential Health Benefits) that must be followed, and will be reviewed by the feds.
If you find a QHB but it doesn’t include factor, JoAnn thinks that the appeals process will work, recommending that people get their drugs for 20 days, during the appeals process, even if they are not on formulary.
Q: How do I find the benchmark plan for my state?
All benchmarks are listed in the state insurance department website. www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/Vermont  (for example)
Q: What’s the advantage of going into the Marketplace?
The advantage of going into the Marketplace is subsidies; you can be eligible for discounts within limits. To buy into a Marketplace, you have to be physically in the state, not incarcerated and be legally present. There are no other limits.
Q: When we couldn’t find what we were looking for (was our hematologist covered), and we called the website, we couldn’t get any help.
Don’t call the health.gov website. Call the plan provider. Sometimes it’s best to work with your HTC contracting department!  They will know who is in network.
And there is so much more information! Be sure to keep reading your HemAware (from NHF), Pulse (from us), and tap into your chapter’s or your local hemophilia organization’s efforts to educate their families about insurance changes. Lots happening; don’t miss deadlines and opportunities by not staying on top!
Great Book I Just Read (Again)
Ada Blackjack: A True Story of Survival in the Arctic  by
Jennifer Niven [Kindle]
A secret exploration to Wrangle Island, in
the Behring Sea, in September 1921 goes terribly wrong when food runs low and
sea ice keeps a relief ship from rescuing the stranded four young men and one 25-year-old
Eskimo woman trapped there. The trip sets off an international crisis when
Russia, Great Britain and the US learn that the trips leader, the opportunist and
greedy explorer Vilhalmur Stefansson, who never even went, was trying to claim
the island for Canada. Only Ada survives the horrible conditions, and her
return sets off a media firestorm. Did she kill her companions? How did she survive?
Diaries are stolen, Ada is hounded and used by the press and her own sponsors.
She becomes at once a hero and a villain. Fantastic read and Ada will amaze you
with her spirit and ingenuity. Her real survival started when she returned home.
Four/five stars

Welcome to the Jungle, I mean, Marketplace

This past week I attended a useful and interesting meeting, NHF’s Social Worker Insurance Marketplace Workshop (funded by Baxter Healthcare and Pfizer Inc; thanks guys!).
Together with about 80 social workers from HTCs around the country, and some
chapter leaders, we listened to various consultants and government
representatives speak primarily about the “Marketplace,” the website of the Affordable
Care Act that allows people to choose a healthcare plan.

We’ve all heard about the difficulties in dealing with this website— healthcare.gov—such as the
crash, and various other glitches. The good news is that many of these glitches have been fixed; and now it’s time to get our bleeding disorder community on board. Healthcare insurance is mandatory now; all US citizens (with notable exceptions) must have insurance. The website is created to help people find the lowest cost insurance that also provides all their essential healthcare needs.

Crafty Posters were created to help us visualize; good idea, we needed the help!

There is plenty of assistance in navigating the website. We actually tried the website live,
and it was pretty interesting, and yes, we even got stuck once or twice! For
us, we were stuck trying to find out if our HTC hematologist was in-network.

Each website will have on-line or Internet guides, to help you live. They are called various
names: Assisters, navigators, certified application counselors, in-person assistance, marketplace call center, agents and brokers. Most people are used to calling them “Navigators.” (I can’t help but think of “Engineers,” a la Ridley Scott’s Prometheus)
Jim noted that there were still some difficulties to overcome in each state. Ed Kuebler, a social worker from Texas, slyly asked, is the difficulty level in some states… political? This garnered many laughs! Ya think?

There are many marketplaces, as each state as their own. All the marketplaces have different funding sources, based on what type of marketplace it is:

FFM: Federally facilitated marketplace

SPM: State partnered marketplace. The federal government has some role in this.

SBM: State based marketplace and the fed has no role in it.

How many people have enrolled since the site was unveiled in October?  By Dec 28: 6 million Americans gained coverage through Marketplace and Medicaid
2.2 million of those enrolled in private plans
80% received help in paying for premiums
53 million visits to healthcare.gov and state marketplace websites
11 million calls to the federal and state call centers
Different healthcare plans are designated by “metal.” The more precious the metal, the
higher priced the plan, but also the more coverage. Enrollment by Metal?
                  60%
are choosing Silver plans
20% Bronze
13% gold
7% Platinum
1% catastrophic plans

Ed Kuebler thinks we need more help than navigators (kidding–a gift from a friend)

There are still consumer problems using the Marketplace:
An inability to complete application on line

Applications get “stuck” (freeze) or lost

Info is not transmitted after the plan is submitted
If not sure you’re insured, call insurance company (not the website) to check
If you don’t pay 1st month premium by certain date, you will not get insurance!
Don’t despair! I found it actually fun to hop on Colorado’s state Marketplace and select a plan.
Michelle Rice (L), Mary Garvey (R) of NHF; Tiara of PSI (C): all great speakers and resources!
Another useful website is Marketplace.cms.gov, which has FAQs, tip sheets, paper application, and materials in Spanish. And Healthcare.gov, which does premium estimate, on line application. When you log on, you will see this banner!
Enroll by February 15 for coverage starting March 1
So contact your social worker for help if you are not yet enrolled; don’t miss the deadline!
Next week I will cover more of the NHF Social Worker Insurance Marketplace workshop.

Genotyping: Helping You, Helping Our Future Families

Laurie Kelley with Cindy Komar

I attended the excellent annual meeting of the Arizona Hemophilia Association this weekend, invited by Cindy Komar, executive director and mother of a child with hemophilia. (Cindy is an awesome exec director and lady, if you haven’t met her!) It was great to catch up with so many Arizona families I know.

I did the keynote presentation yesterday but I myself didn’t find that half as interesting as a fascinating new program for families with hemophilia: called “My Life, Our Future.” The name is a bit nebulous, but the program is important. NHF has teamed with Biogen Idec, Puget Blood Center and ATHN to create the first genotyping of families and patients with hemophilia in the US. John Indence, from NHF, and Jennifer Dumont, director of scientific affairs from Biogen Idec Hemophilia, presented.
John summed if up first: this is NHF’s most important project. One blood sample per patient will reveal vital information on the patient’s specific hemophilia type, propensity to develop inhibitors, and more. A short movie featured NHF CEO Val Bias, who stated that this will help families understand their personal genetic profile, and also help researchers learn more about the genetics of hemophilia, as the data will be pooled. Best of all, the testing will be offered at no or low cost.
John explained how ATHN currently holds the most information/data on hemophilia patients in the country. Information is supplied from HTCs, who obtain patient consent; privacy of course is key, and ATHN assures complete privacy. And Puget Sound is one of the top HTCs in the country, and one of the top genotyping centers.

Laurie with Rachel Stuart, RN

John noted that everyone in Spain and Ireland has been genotyped, and it’s time for the US too. As early as 1998, MASAC (NHF’s Medical and Scientific Committee) advocated for genotyping. IN 2008, the initiative got a boost when the Genetic Information Nondiscrimination Act (GINA) was passed, making it more reassuring for patients to share their personal health information.

In 2002, the human genome was sequenced at a cost of $3 billion; now, genotyping is much cheaper and the price per family keeps dropping. Genotyping helps uncover the causes of disorders, like hemophilia. It requires an analysis of the population, not just the individual, and the purpose of testing the individual is to aggregate the data to study the entire population. So, this new program requires the data of thousands of participants!
Jennifer Dumont then spoke and gave an excellent description of how genotyping works. She noted that 99.9% of our genetic makeup is the same! It’s the 0.1% that makes us all different. A genotype is “a description of the gene mutation that is caused by a certain condition or disorder.” A mutation is a change in the DNA sequence of a gene. It can happen in different ways: nucleic acids can be inserted, deleted or substituted in DNA, leading to a misreading of information in directing cells how to function.
There are diseases where one mutation leads to one disease, such as sickle cell anemia. Hemophilia is different: there are many possible mutations, such as missense, nonsense, frame shift, deletion and insertion. For factor VIII and hemophilia A, there are 2,513 currently identified mutations; for factor IX, there are 1,094 currently identified mutations.
Jennifer illustrated what each mutation might be like if we used a sentence as a DNA sequence (three-letter words are similar to the DNA sequence of three-letter codes): “The One Big Fly Had One Red Eye.” Each mutation makes the sentence read strangely! The body can’t figure out how to produce factor properly when the instructions are so scrambled.
After the presentation, some great questions were asked, such as will Spanish-speaking services be included in the program to help Latino families? Answer: not at the present but this is something that NHF is keenly aware of.
Another question: If HCPs (Heath Care Providers)  know the risks of inhibitors from the genotyping, what can be done to prevent them form happening? Will it affect choice of product or treatment? Jennifer replied that it shouldn’t affect choice of product since there is no difference in the incidence of inhibitor development with different products, but physicians may closely monitor people in the first several exposure days to factor and possibly change how they dose if there is a known risk of inhibitors.

With the BioRX ladies!
Deena Lapinski and Laurie Kelley
John also mentioned that if you’ve been genotyped before outside this program, you’d need to be genotyped again. And someday NHF hopes to open the program to those with VWD and other bleeding disorders.

The presentation was well done and gave rise to much discussion. The bottom line: to support NHF’s research efforts on the causes of hemophilia and its functioning, something that may help future children by our research now, ask your HTC how to participate in the genotyping program “My Life, Our Future.”

Great Book I Just Read
Gifts from Eykis by Wayne Dyer
In this fictional tale, the narrator somehow visits an identical civilization to Earth’s, in every way, though he is on Uranus. But he learns that the thought processes and psychological lifestyles of these people are strangely different. They experience positive human emotions naturally. They experience negative human emotions only through machines designed to elicit them (very creatively told!). On Earth, we create negative emotions when they don’t really exist, or don’t need to exist, because there is no external “machine” that prompts them. Jealousy on Uranus is caused artificially. The parable is that we create our own misery and can just as easily rid ourselves of it through free choice. Eykis, a beautiful Uranian inhabitant, comes to Earth to observe and then leave us her gifts of observation, in how we can take advantage of our freedom not to engage in negative thinking, such as anger, anxiety, fear, jealousy, and above all, blame. Everyone is responsible for their own emotions. Great story, simply told, easy read, powerful message. Four/five stars.

NHF’s 62nd: Carnival, Concern, Unity

The theme of the 62nd Annual Meeting of NHF was “Marching Forward,” appropriate for a place like New Orleans, where you can expect a high school marching band to turn the corner of your street at any time. Situated at the Marriott on Canal Street, just a carnival bead’s throw from the Mississippi River, the event hosted about 3,000 community members, including physicians, nurses, social workers, nonprofit staff, NHF reps, pharmaceutical and homecare reps and of course, consumers!

My week started with a five-hour workshop on Novo Nordisk’s new HERO program, the largest psychosocial research project in hemophilia history. We gathered a select group of HTC and consumer representatives to discuss ideas to bring the results of HERO to the US, to share with our community: what can we learn from the results and what to do with the results? It was a lively and challenging task, but with a great group that meshed well, it was also fun!

Opening night was heralded with a marching band and carnival characters on enormous stilts, handing out strings of beads to all. NHF Chair Stephen Bender and father of a daughter with hemophilia gave a moving opening speech recalling his daughter’s birth, and how he became an advocate for better health care as a result of their harrowing experience. Executive director Val Bias gave a motivating speech about unity in the bleeding disorders community. He also unveiled a new campaign for women with bleeding disorders, called “Victory for Women.” This will replace Project Red Flag.

Later we walked through the exhibit hall, which contains booths by all the vendors who serve our community, and all had a Mardi Gras theme. There was face painting, games and great food.

There were many sessions on a variety of topics related to bleeding disorders. Women with bleeding disorders figured prominently as a topic. I also attended a very interesting town meeting by the Committee of Ten Thousand—COTT. COTT is often referred to as our third national organization. We have NHF, HFA and COTT. This certainly doesn’t refer to third place. Each of our national organizations has a vital role to play.

This two hour meeting had two topics: blood safety, prompted by the new movie Bad Blood; and privacy issues for patients. The first topic was kicked off by Corey Dubin, a person with hemophilia and an icon in our community. Next to him was Nathan, representing the Gay Men Health Crisis organization. This year 18 senators sought to repeal the FDA ban on blood donations from gay men in light of all the safety procedures and testing performed in the US. The ban has been in place for 17 years, started during the HIV contamination of the 1980s.

A lively discussion took place but what was unique and wonderful was the mutual admiration and respect of COTT and GMHC. Each respected each other’s view about blood safety and the right to donate blood, and whether that even was a right.

The second topic unleashed a firestorm of concern: patient privacy rights. Are patients being adequately informed of how their data is being used? One patient, a well known advocate, stated that patient data is gold. People in our industry make money off of patient data, good money. How is this safeguarded? Patients are signed up for clinical studies—are they well informed? With health care reform, and anticipated countermoves by the insurance industry, patient data is needed and desired to justify decisions to restrict access to care, access to products or to protect clinical treatments. Data is everything. But do patients know who has their data?

With representatives of several different and independent organizations and patient groups—and industry—in the audience, it became clear that each group had similar questions about ethics, funding, transparency, and patient protection of any organization collecting patient data. I explained how LA Kelley Communications collects patient data through our mailing list, and how fiercely we protect it.

For other groups, it’s not as clear what the data is to be used for ultimately. Will it be sold? There’s a market for it. A big discussion ensued about bringing various groups to the table to discuss privacy and to get some questions answered. COTT has acted as a watchdog for blood safety, and now may act as a watchdog for patient privacy— a topic more vital than ever in this era of health care reform. Patient Data equals power, power to discriminate, make policy, earn money, effect government policy… the possibilities are many. This data is our data—our child’s data, our carrier daughter’s data—and we need to protect it by knowing who has it and what they plan to do with it.

After the town meeting, some people went to social events. We had a special guest—Usha Parthasarathy from India, with whom I had just finished a 16-day tour of India. She was able to promote our Save One Life program to many people, and secured more sponsorships for the 300 children who are waiting for sponsors.

On Saturday morning I facilitated a symposium hosted and funded by Baxter Healthcare, titled “Paving Your Way, Protecting Your Future.” Guest speakers included Don Molter, social worker and career counselor at the Indiana Hemophilia and Thrombosis Center, and Dr. Art Wood, vice president of Patient Services Inc. Don stressed the importance of taking the SATs or ACT, applying for scholarships and to be open to education even later in life—especially in this economy, when many people need to rethink their career choices. He introduced the Baxter Education Advantage Scholarship, which helps people with funding for college and also vocational training. This is open to anyone, not just those on Baxter’s products.

Art’s presentation included salient highlights of the ACA, the new health reform act, and how this may impact families with bleeding disorders, and how patients can take action now to get informed and learn more. It will be absolutely vital for everyone to read their insurance policy and to read updates regarding the ACA and how it impacts individual policies.

We also had two community speakers: David shared a very touching story of having hemophilia, HIV, hepatitis, losing his thumb in an accident… and losing his wife of 24 years when the marriage was overwhelmed. With a deepening of his faith and assistance from his HTC, he successfully returned to work and now is remarried. Dwight and Kathleen are parents of eight children, four with hemophilia, and shared their trials in trying to stay insured. With the help of PSI, they were able to make it. Their handsome son Patrick was in the audience, admiring his parents.

The three day event closed with a final event, also sponsored by Baxter, at a warehouse where we walked by enormous plaster of Paris statues of King Kong, Pokemon, King Neptune, the Cowardly Lion and Yoda—all Mardi Gras characters. Also we saw floats being prepared for the next Mardi Gras. It was really amazing! At the end of the walk was a large indoor room to house about 2,000 people who feasted on New Orleans cuisine, dance to an excellent band, and have their fortunes read by Tarot card readers. I caught up with my friends from California—Laurel McDonnell, Paul and Linda Clement—and enjoyed the company of our very special community.
Please visit these websites to learn more:
www.cott1.org
www.uneedpsi.org
www.thereforyou.com
www.saveonelife.net

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