1 00:00:02,720 --> 00:00:03,920 Speaker 1: Welcome to Wellness Unmass. 2 00:00:04,000 --> 00:00:07,760 Speaker 2: I'm doctor Nicole Saffire, and today's conversation is about something 3 00:00:08,039 --> 00:00:12,200 Speaker 2: every American feels, whether you're healthy, sick, young, or old. 4 00:00:12,360 --> 00:00:15,040 Speaker 2: It's essentially the cost of care and who actually gets 5 00:00:15,120 --> 00:00:19,040 Speaker 2: left behind when the system breaks healthcare it's obviously getting 6 00:00:19,040 --> 00:00:23,120 Speaker 2: more expensive, Insurance is becoming much more expensive, more confusing, 7 00:00:23,680 --> 00:00:27,080 Speaker 2: and millions of families are staring down at the expiration 8 00:00:27,200 --> 00:00:30,520 Speaker 2: of the ACA subsidies that have been propping up coverage 9 00:00:30,560 --> 00:00:33,320 Speaker 2: for years. And at the same time, we're seeing headlines 10 00:00:33,360 --> 00:00:37,600 Speaker 2: about fraud in government funded programs, including Minnesota, that raise 11 00:00:37,800 --> 00:00:43,400 Speaker 2: uncomfortable but necessary questions about oversight, accountability, and trust, especially 12 00:00:43,400 --> 00:00:46,479 Speaker 2: when it comes to some of these small businesses and 13 00:00:46,640 --> 00:00:49,240 Speaker 2: home health care. Home healthcare is one of the most 14 00:00:49,320 --> 00:00:53,000 Speaker 2: important things when it comes to caring for our patients 15 00:00:53,040 --> 00:00:54,200 Speaker 2: and also our elderly. 16 00:00:54,880 --> 00:00:55,880 Speaker 1: But I wanted to bring in. 17 00:00:55,840 --> 00:00:59,400 Speaker 2: Someone today to talk about what's available for people, why 18 00:00:59,440 --> 00:01:02,760 Speaker 2: we should consider home healthcare, but also how can we 19 00:01:02,840 --> 00:01:05,200 Speaker 2: prevent some of the fraud like we saw in Minnesota. 20 00:01:05,319 --> 00:01:09,039 Speaker 2: Joining us today is Julian Hagman, CEO of Caring Professionals, 21 00:01:09,080 --> 00:01:12,000 Speaker 2: which is an organization working directly with some of our 22 00:01:12,080 --> 00:01:13,760 Speaker 2: most vulnerable populations. 23 00:01:13,920 --> 00:01:16,080 Speaker 1: Julian, I am so glad to have you today. 24 00:01:15,840 --> 00:01:18,520 Speaker 2: Because, let me tell you, healthcare is a mess, and 25 00:01:18,680 --> 00:01:21,760 Speaker 2: heading into twenty twenty six, I would have liked to 26 00:01:21,800 --> 00:01:23,880 Speaker 2: see us get a little bit more of a handle 27 00:01:24,000 --> 00:01:27,399 Speaker 2: on healthcare in the United States, but we haven't yet. 28 00:01:27,800 --> 00:01:31,240 Speaker 2: So let's just dive right in. I want to kind 29 00:01:31,280 --> 00:01:33,720 Speaker 2: of talk to you about paint us a picture for us. 30 00:01:34,040 --> 00:01:36,800 Speaker 2: What does the healthcare system look like right now for 31 00:01:36,880 --> 00:01:39,080 Speaker 2: patients and families that you're serving every day. 32 00:01:40,400 --> 00:01:44,039 Speaker 3: So, the healthcare system currently in New York State that's 33 00:01:44,160 --> 00:01:50,040 Speaker 3: primarily my patient base, is becoming more segregated through legislature, 34 00:01:50,400 --> 00:01:54,480 Speaker 3: tearing the program part and really not offering continuity of 35 00:01:54,560 --> 00:01:58,520 Speaker 3: services by one individual provider to the end recipients, whether 36 00:01:58,560 --> 00:02:02,200 Speaker 3: they're an elderly individual who needs care or whether they're 37 00:02:02,400 --> 00:02:06,840 Speaker 3: disabled individual who needs assistance with daily living. They're really 38 00:02:06,880 --> 00:02:10,800 Speaker 3: stripping apart the home and community based models to create 39 00:02:11,200 --> 00:02:13,239 Speaker 3: fractured care across the spectrum. 40 00:02:13,320 --> 00:02:15,760 Speaker 2: So what is actually doing that You're saying health policy 41 00:02:15,800 --> 00:02:18,120 Speaker 2: does that? So what are you seeing, like why is 42 00:02:18,160 --> 00:02:19,119 Speaker 2: care being fractured? 43 00:02:20,200 --> 00:02:23,839 Speaker 3: So, for one instance, is one home care model it's 44 00:02:23,840 --> 00:02:27,560 Speaker 3: called the consumer direct and personal Assistance program in which 45 00:02:27,639 --> 00:02:32,120 Speaker 3: the legislature opted to remove the existing providers throughout the 46 00:02:32,160 --> 00:02:37,080 Speaker 3: state and consolidate it to one provider statewide, in essence 47 00:02:37,320 --> 00:02:42,400 Speaker 3: creating monopoly, a state sanctioned monopoly of that program, eliminating 48 00:02:42,520 --> 00:02:47,280 Speaker 3: choice for the consumers and creating more of a risk 49 00:02:47,680 --> 00:02:51,880 Speaker 3: for those individuals to be hospitalized or be institutionalized down 50 00:02:51,919 --> 00:02:56,080 Speaker 3: the road because they don't have other supports that would 51 00:02:56,120 --> 00:02:57,799 Speaker 3: help them service their needs. 52 00:02:58,440 --> 00:02:59,320 Speaker 1: Well, so you just. 53 00:02:59,680 --> 00:03:02,119 Speaker 2: Made buzzword that I have said a lot. You talked 54 00:03:02,120 --> 00:03:05,880 Speaker 2: about consolidating care and monopolizing healthcare industries. I mean, my 55 00:03:06,000 --> 00:03:08,519 Speaker 2: opinion is a lot of this happened under the Affordable 56 00:03:08,520 --> 00:03:09,079 Speaker 2: Care Act. 57 00:03:09,120 --> 00:03:09,880 Speaker 1: What do you make of it? 58 00:03:10,800 --> 00:03:12,880 Speaker 3: I think a lot of that. That's where it all started. 59 00:03:12,919 --> 00:03:16,800 Speaker 3: I think that's where, you know, the seeds were initially planted, 60 00:03:17,280 --> 00:03:20,000 Speaker 3: and the states then took those seeds and grew them 61 00:03:20,160 --> 00:03:23,160 Speaker 3: how they see fit through whatever model or whatever care 62 00:03:23,280 --> 00:03:26,480 Speaker 3: model that state wanted to opt to use. That In 63 00:03:26,520 --> 00:03:29,920 Speaker 3: New York, we see it through home its community based care. 64 00:03:30,160 --> 00:03:33,600 Speaker 3: In Minnesota, we see it through social adul daycares, our 65 00:03:33,720 --> 00:03:38,119 Speaker 3: children's daycares. It's you know, all the same funding source originally, 66 00:03:38,160 --> 00:03:40,520 Speaker 3: and it all stems from that initial ACA. 67 00:03:41,560 --> 00:03:43,760 Speaker 2: I'm going to get to Minnesota in a second, because 68 00:03:43,760 --> 00:03:46,000 Speaker 2: obviously the fraud that has occurred there is a hot 69 00:03:46,040 --> 00:03:48,280 Speaker 2: topic right now. But one thing I do want to 70 00:03:48,280 --> 00:03:52,200 Speaker 2: touch on is the fact that the Acaffordable Care Act 71 00:03:52,240 --> 00:03:55,480 Speaker 2: subsidies were set to expire end of twenty twenty five. 72 00:03:55,520 --> 00:03:56,320 Speaker 1: Now a lot of people. 73 00:03:56,160 --> 00:03:59,400 Speaker 2: Don't realize, especially with all the media headlines, that these 74 00:03:59,520 --> 00:04:03,560 Speaker 2: enhanced A subsidies that came out during COVID under the 75 00:04:03,600 --> 00:04:07,120 Speaker 2: Inflation Reduction Act by President Biden. These were always meant 76 00:04:07,120 --> 00:04:10,240 Speaker 2: to be temporary. It's not like Republicans or President Trump 77 00:04:10,480 --> 00:04:12,280 Speaker 2: put an end to them. They were always meant to 78 00:04:12,280 --> 00:04:16,680 Speaker 2: be temporary. But because they expired at the end of 79 00:04:16,960 --> 00:04:20,039 Speaker 2: twenty twenty five and there wasn't really a replacement planned, 80 00:04:20,080 --> 00:04:24,440 Speaker 2: or there wasn't an extension through twenty twenty six, now 81 00:04:24,440 --> 00:04:27,360 Speaker 2: they're expiring and so millions of people could actually have 82 00:04:27,440 --> 00:04:29,360 Speaker 2: a rise in their premiums. 83 00:04:29,600 --> 00:04:32,000 Speaker 1: How do you think that this is going to affect people? 84 00:04:33,360 --> 00:04:35,479 Speaker 3: Oh, it's there that I have a lot of people 85 00:04:35,560 --> 00:04:39,360 Speaker 3: that you know, we're we're seeing the benefits of this 86 00:04:39,440 --> 00:04:44,080 Speaker 3: program have a very shocking surprise when they see the 87 00:04:44,080 --> 00:04:47,760 Speaker 3: sticker price of their health insurance premium skyrocket, right, So 88 00:04:48,520 --> 00:04:50,960 Speaker 3: I'm not included in that next right, So and I 89 00:04:51,080 --> 00:04:54,479 Speaker 3: pay you know, health insurance through my employer, and it 90 00:04:54,560 --> 00:04:58,080 Speaker 3: is very expensive. You know, I hear that from my 91 00:04:58,160 --> 00:05:01,280 Speaker 3: employees also, that is very expen and you know, it 92 00:05:01,400 --> 00:05:04,000 Speaker 3: just sort of is the world that we live in today. 93 00:05:04,120 --> 00:05:06,599 Speaker 3: And then when you see these other individuals who are paying, 94 00:05:06,680 --> 00:05:08,920 Speaker 3: you know, whether it be seventy to one hundred and 95 00:05:09,000 --> 00:05:11,520 Speaker 3: forty dollars a month from their insurance, like, wow, that's 96 00:05:11,560 --> 00:05:13,920 Speaker 3: a steal. How are you on that? And then you 97 00:05:13,960 --> 00:05:16,680 Speaker 3: peel back that onion and you find out, okay, well 98 00:05:16,720 --> 00:05:19,880 Speaker 3: you're you're subsidized through here or you know, and you really, 99 00:05:20,080 --> 00:05:24,839 Speaker 3: you know, get to the root of the issue. Well, yeah, 100 00:05:24,960 --> 00:05:27,200 Speaker 3: you seem to have a good job. You probably could 101 00:05:27,200 --> 00:05:29,920 Speaker 3: be able to afford it. You know, seems like these 102 00:05:29,920 --> 00:05:33,000 Speaker 3: substances should be going away. That's my opinion on it. 103 00:05:33,480 --> 00:05:36,919 Speaker 2: Yeah, well, you're right that these premiums are going to increase. 104 00:05:37,000 --> 00:05:40,440 Speaker 2: Probably far too many people are receiving these premiums. As 105 00:05:40,560 --> 00:05:44,120 Speaker 2: you said, they probably could be affording less expensive plans. 106 00:05:44,200 --> 00:05:47,080 Speaker 2: The issue is under the Affordable Care Act, these plans 107 00:05:47,120 --> 00:05:50,840 Speaker 2: were mandated to be comprehensive. They have to cover everything 108 00:05:50,920 --> 00:05:53,840 Speaker 2: from preventative care to treatments. And you know, one of 109 00:05:53,880 --> 00:05:55,560 Speaker 2: the issues with that is that's just not really how 110 00:05:55,600 --> 00:05:58,240 Speaker 2: insurance works. I mean, if you think about car insurance, 111 00:05:58,279 --> 00:06:01,200 Speaker 2: that's like saying, well, you're car insurance has to cover 112 00:06:01,360 --> 00:06:04,159 Speaker 2: I don't know your oil changes or even your car washes. 113 00:06:04,279 --> 00:06:07,760 Speaker 2: Anything that's preventative maintenance for a car needs to be 114 00:06:07,839 --> 00:06:08,839 Speaker 2: covered by insurance. 115 00:06:08,839 --> 00:06:09,919 Speaker 1: Well, what's going to happen? 116 00:06:10,000 --> 00:06:12,440 Speaker 2: Your insurance cost is going to go up if all 117 00:06:12,480 --> 00:06:14,159 Speaker 2: of a sudden they're paying for all these things. But 118 00:06:14,720 --> 00:06:16,760 Speaker 2: this is not a conversation about affordable care ACT. I 119 00:06:16,760 --> 00:06:19,680 Speaker 2: could talk about it for hours, days, years, I wrote 120 00:06:19,680 --> 00:06:20,280 Speaker 2: a book on it. 121 00:06:20,960 --> 00:06:23,159 Speaker 1: I'm not a fan if you can't tell so. 122 00:06:23,279 --> 00:06:25,760 Speaker 2: One thing that you know I obviously worry about is 123 00:06:26,520 --> 00:06:28,799 Speaker 2: you know, we're now going to see delayed care, maybe 124 00:06:28,800 --> 00:06:32,159 Speaker 2: people not taking medications because the premiums went up so 125 00:06:32,160 --> 00:06:34,279 Speaker 2: they don't want to afford them. People are going to 126 00:06:34,360 --> 00:06:38,040 Speaker 2: use the er and urgent cares more than their primary 127 00:06:38,040 --> 00:06:41,719 Speaker 2: care doctors. But you have actually created a niche in 128 00:06:42,000 --> 00:06:45,719 Speaker 2: the healthcare movement in this sense that you know, you 129 00:06:45,839 --> 00:06:49,600 Speaker 2: want to give the support and funding to the people 130 00:06:49,600 --> 00:06:51,359 Speaker 2: who are actually doing a lot of the care, Like 131 00:06:51,440 --> 00:06:54,799 Speaker 2: I mean, families, friends actually provide a lot of care, 132 00:06:54,960 --> 00:06:57,480 Speaker 2: and in home care is one of the best things 133 00:06:57,520 --> 00:06:59,159 Speaker 2: for patients. Tell us a little bit about that. 134 00:07:00,080 --> 00:07:03,159 Speaker 3: Yeah, absolutely so. My whole philosophy is keep people in 135 00:07:03,200 --> 00:07:05,520 Speaker 3: the home, keep people in community where they want to be. 136 00:07:06,080 --> 00:07:10,560 Speaker 3: I've seen my own family friends go through with their 137 00:07:10,760 --> 00:07:15,200 Speaker 3: elderly parents, putting them in nursing homes and the disastrous 138 00:07:16,040 --> 00:07:19,120 Speaker 3: response from that from the parents being put into these 139 00:07:19,120 --> 00:07:22,920 Speaker 3: institutionalized settings. Right, everyone would prefer to stay home. I 140 00:07:22,960 --> 00:07:27,320 Speaker 3: think we can all agree. It's universal, it's bipartisan. People 141 00:07:27,360 --> 00:07:30,160 Speaker 3: want to stay home in communities, with the neighbor they know, 142 00:07:30,400 --> 00:07:33,120 Speaker 3: with the people they know in the street, and ensure 143 00:07:33,200 --> 00:07:36,120 Speaker 3: that they get the care that is given to them. 144 00:07:36,280 --> 00:07:40,440 Speaker 3: That's what I have built. I've built an all encompassing 145 00:07:40,520 --> 00:07:44,640 Speaker 3: home care service agency. We have many different services that 146 00:07:44,720 --> 00:07:47,280 Speaker 3: many different lines of business, all that are structured to 147 00:07:47,360 --> 00:07:49,880 Speaker 3: keep the individual in the home and work with the 148 00:07:49,920 --> 00:07:54,680 Speaker 3: individual to prevent those hospitalizations, prevent those times when they 149 00:07:54,720 --> 00:07:58,440 Speaker 3: miss medications that lead to another hospitalization. Right, we're the 150 00:07:58,480 --> 00:08:02,680 Speaker 3: first line of defense that really comes to try and 151 00:08:02,800 --> 00:08:07,480 Speaker 3: prevent the state from expending more money into these programs. Right, 152 00:08:07,520 --> 00:08:09,800 Speaker 3: we're in the home, we see what's going on. We're 153 00:08:09,880 --> 00:08:12,960 Speaker 3: finding these fall hazards and these trip hazards. That is 154 00:08:13,000 --> 00:08:15,720 Speaker 3: a line item on the budget. It shows how much 155 00:08:16,920 --> 00:08:21,000 Speaker 3: we are spending as a state for these preventable hospitalizations 156 00:08:21,040 --> 00:08:23,440 Speaker 3: and it's in the billions. And so if we're able 157 00:08:23,440 --> 00:08:26,360 Speaker 3: to prevent you know, even ten percent of that, that's 158 00:08:26,400 --> 00:08:31,320 Speaker 3: a job well done. And we've prevented that hospital, it's 159 00:08:31,400 --> 00:08:34,800 Speaker 3: sense to go down. That's our goal is, you know, 160 00:08:34,880 --> 00:08:39,200 Speaker 3: we want to increase and provide more supportive services in 161 00:08:39,240 --> 00:08:44,200 Speaker 3: the home to reduce unneeded hospitalization admissions as well as 162 00:08:44,280 --> 00:08:47,400 Speaker 3: nursing home admissions as well well. 163 00:08:47,440 --> 00:08:49,840 Speaker 2: From where you sit, does it feel like the healthcare 164 00:08:49,880 --> 00:08:54,040 Speaker 2: policy conversations are that they're talking about being designed like 165 00:08:54,080 --> 00:08:58,800 Speaker 2: the catastrophic plans with increased funding for HSA. You know, 166 00:08:58,920 --> 00:09:01,480 Speaker 2: is this designed to focus on patient needs? And would 167 00:09:01,480 --> 00:09:03,080 Speaker 2: this be beneficial in your opinion? 168 00:09:04,280 --> 00:09:06,800 Speaker 3: I think it is, and and I know the Trump 169 00:09:06,880 --> 00:09:09,800 Speaker 3: administration through CMS i've been coming out with different pilot 170 00:09:09,840 --> 00:09:12,720 Speaker 3: programs and then be launching this year and the following 171 00:09:12,800 --> 00:09:15,640 Speaker 3: year that is really aimed to look at these preventable 172 00:09:15,679 --> 00:09:19,440 Speaker 3: measures to ensure that people are getting the care that 173 00:09:19,920 --> 00:09:22,720 Speaker 3: they deserve in the home rather than moving to more 174 00:09:22,760 --> 00:09:27,880 Speaker 3: expensive institutionalized settings or moving into the er visits that 175 00:09:27,960 --> 00:09:29,760 Speaker 3: are extremely expensive as well. 176 00:09:30,880 --> 00:09:34,120 Speaker 2: Now you know, we're talking about these home programs, but 177 00:09:34,200 --> 00:09:37,520 Speaker 2: one of the you know, the big barriers for people 178 00:09:37,559 --> 00:09:40,640 Speaker 2: being able to be caregivers for their friends or family 179 00:09:40,760 --> 00:09:43,000 Speaker 2: is that, I mean, they have to work, They have 180 00:09:43,040 --> 00:09:44,440 Speaker 2: to go out, and they have to work, which is 181 00:09:44,480 --> 00:09:47,280 Speaker 2: why you know, it's dangerous to leave sick or elderly 182 00:09:47,400 --> 00:09:50,520 Speaker 2: people at home alone. And so that's kind of the 183 00:09:50,559 --> 00:09:53,839 Speaker 2: conundrum that people find themselves in. So you know, what 184 00:09:53,920 --> 00:09:55,920 Speaker 2: you guys do is you work with the state to 185 00:09:55,960 --> 00:10:00,760 Speaker 2: get funding for people to care for their family and friends. 186 00:10:00,840 --> 00:10:04,080 Speaker 3: Is that right, That's correct. That's exactly how the program 187 00:10:04,240 --> 00:10:08,000 Speaker 3: was started, and that has been the core values of 188 00:10:08,040 --> 00:10:12,240 Speaker 3: the consumer directed program. Right. As we enable the consumer, 189 00:10:12,520 --> 00:10:15,439 Speaker 3: the individual receiving care, to be able to go out 190 00:10:15,480 --> 00:10:18,880 Speaker 3: and find their own caregiver, it really helps in rural 191 00:10:18,960 --> 00:10:21,920 Speaker 3: areas of the state where you know, the labor force 192 00:10:22,000 --> 00:10:25,280 Speaker 3: is extremely low and it could be absolutely no labor 193 00:10:25,280 --> 00:10:28,840 Speaker 3: force in that area. Right, we empower the consumer and 194 00:10:28,880 --> 00:10:31,760 Speaker 3: their family say hey, well, do you know anybody, Do 195 00:10:31,840 --> 00:10:33,680 Speaker 3: you go to the library, do you go to a college, 196 00:10:33,720 --> 00:10:36,520 Speaker 3: You know somebody that has extra time that would be 197 00:10:36,559 --> 00:10:38,880 Speaker 3: able to get compensated, that you trust to be able 198 00:10:38,880 --> 00:10:41,320 Speaker 3: to come into your home. And that's in the rural areas. 199 00:10:41,640 --> 00:10:43,839 Speaker 3: And then you look in the cities, right, you have 200 00:10:44,000 --> 00:10:47,880 Speaker 3: people that can have other friends, neighbors, relatives come by 201 00:10:47,920 --> 00:10:49,920 Speaker 3: and take care of them. And it's better than sending 202 00:10:50,040 --> 00:10:53,040 Speaker 3: a stranger into the home. So, you know, half of 203 00:10:53,160 --> 00:10:56,280 Speaker 3: a big portion of my business, roughly half, is the 204 00:10:56,320 --> 00:10:59,440 Speaker 3: traditional home care model, where I am sending workers that 205 00:10:59,480 --> 00:11:03,280 Speaker 3: have been and trains educated by r ns into the 206 00:11:03,280 --> 00:11:06,800 Speaker 3: home to care for you. Right, with that model, we're 207 00:11:06,920 --> 00:11:12,560 Speaker 3: unable to provide medication, administer insulin, you know, even hands 208 00:11:12,559 --> 00:11:18,640 Speaker 3: pills to the recipient. The cd PAT program, they're able 209 00:11:18,679 --> 00:11:21,480 Speaker 3: to do all that. They're able to provide the insulin shots, 210 00:11:21,480 --> 00:11:24,040 Speaker 3: they're able to hand them the medication, They're able to 211 00:11:24,080 --> 00:11:28,600 Speaker 3: do more interactive and thoughtful things rather than the license side. 212 00:11:28,600 --> 00:11:31,360 Speaker 3: And this is just because you know, on the license side, 213 00:11:31,400 --> 00:11:34,640 Speaker 3: the traditional home care side, right, these aren't LPNs, these 214 00:11:34,679 --> 00:11:38,200 Speaker 3: aren't our ns, they're home home carriers, right, So they 215 00:11:38,559 --> 00:11:42,240 Speaker 3: do go through basic schooling, they go through you know, 216 00:11:42,320 --> 00:11:47,120 Speaker 3: basic courses on this. They are trained annually by nurse instructors. 217 00:11:47,480 --> 00:11:51,800 Speaker 3: But yeah, they we're held by the skilled level, right 218 00:11:52,000 --> 00:11:55,360 Speaker 3: because there not a high acuity skill like an RN 219 00:11:55,480 --> 00:11:57,560 Speaker 3: or an LPN. We can't allow them. 220 00:11:57,520 --> 00:11:59,679 Speaker 1: To be very expensive by the way, and wouldn't fit 221 00:11:59,720 --> 00:12:00,199 Speaker 1: them all all. 222 00:12:00,920 --> 00:12:02,800 Speaker 3: Yeah, it would be very expensive and it'll blow the 223 00:12:02,840 --> 00:12:05,880 Speaker 3: model way out of proportion. But they are unable to 224 00:12:05,920 --> 00:12:09,200 Speaker 3: do that stuff rather than the consumer side, the consumer 225 00:12:09,200 --> 00:12:12,520 Speaker 3: direct inside, right, they've already dealt with these. We have 226 00:12:12,720 --> 00:12:16,720 Speaker 3: families that deal with trake tubes and feeding through a 227 00:12:16,760 --> 00:12:20,160 Speaker 3: trake tubes and cleaning of those things, right, and that's 228 00:12:20,400 --> 00:12:23,360 Speaker 3: very higher skilled care that is able to be offered 229 00:12:23,440 --> 00:12:26,120 Speaker 3: rather than going in so, like I said, a nursing 230 00:12:26,120 --> 00:12:30,120 Speaker 3: home setting where that especially that high acuity skill is 231 00:12:30,160 --> 00:12:32,240 Speaker 3: going to be exasperated in costs. 232 00:12:32,520 --> 00:12:35,079 Speaker 1: You're listening to Wellness and Mass. We'll be right back 233 00:12:35,120 --> 00:12:42,360 Speaker 1: with more. Who determines Obviously, as a physician myself, I 234 00:12:42,559 --> 00:12:47,360 Speaker 1: quickly question who's determining what level of skill level the care, 235 00:12:47,480 --> 00:12:49,800 Speaker 1: what level of care that these patients need, Like you're 236 00:12:49,800 --> 00:12:54,400 Speaker 1: talking about cleaning out trakes or administering like insulin maybe 237 00:12:54,440 --> 00:12:59,040 Speaker 1: like an injectable blood thinner. We tend to want healthcare 238 00:12:59,040 --> 00:13:02,439 Speaker 1: professionals to do this, so like who determines that it's 239 00:13:02,480 --> 00:13:06,320 Speaker 1: okay for maybe like a wife or a family member 240 00:13:06,440 --> 00:13:07,880 Speaker 1: to do the trick. 241 00:13:08,679 --> 00:13:12,319 Speaker 3: So it's the primary care physician that's where it would start. 242 00:13:12,640 --> 00:13:16,480 Speaker 3: And then after from that primary care physician basically referral 243 00:13:17,040 --> 00:13:19,960 Speaker 3: or strip right, then the state would come out and 244 00:13:20,000 --> 00:13:24,160 Speaker 3: do another assessment. The managed care that your insurance is 245 00:13:24,200 --> 00:13:26,920 Speaker 3: provided through, would come out and do an additional assessment. 246 00:13:27,240 --> 00:13:30,000 Speaker 3: And then as the fourth level, I would come in 247 00:13:30,200 --> 00:13:32,720 Speaker 3: as a service provider and do an assessment as well 248 00:13:32,920 --> 00:13:36,040 Speaker 3: to ensure that nobody missed anything that we're all on 249 00:13:36,080 --> 00:13:38,719 Speaker 3: the same page with the care model. The plan of 250 00:13:38,760 --> 00:13:41,839 Speaker 3: care matches what the patient seems to need with our 251 00:13:42,040 --> 00:13:44,520 Speaker 3: nursing going in there and taking a look, and so 252 00:13:44,920 --> 00:13:48,600 Speaker 3: there are checks and balances in place to ensure that 253 00:13:48,760 --> 00:13:51,640 Speaker 3: nobody coming off the street can get into this program 254 00:13:52,120 --> 00:13:54,920 Speaker 3: and you know, be put at risk. We're ensuring by 255 00:13:54,960 --> 00:13:57,679 Speaker 3: going out there and actually physically seeing the patient that 256 00:13:57,760 --> 00:14:00,480 Speaker 3: they are in need of these services and the services 257 00:14:00,520 --> 00:14:02,959 Speaker 3: can be rendered safely well. 258 00:14:02,720 --> 00:14:03,600 Speaker 1: And home based care. 259 00:14:03,640 --> 00:14:07,560 Speaker 2: It's obviously usually less expensive more humane and truly a 260 00:14:07,559 --> 00:14:10,440 Speaker 2: better quality for life for a lot of these people. 261 00:14:10,480 --> 00:14:13,360 Speaker 2: I mean, you've seen some of the stories about the 262 00:14:13,600 --> 00:14:18,080 Speaker 2: home health aids that either verbally abusive, physically abusive, mainly 263 00:14:18,120 --> 00:14:21,960 Speaker 2: because they're overworked, underpaid. They just resentment can breed. So 264 00:14:22,280 --> 00:14:25,520 Speaker 2: I love the home health model. But shifting to Minnesota, 265 00:14:25,560 --> 00:14:29,240 Speaker 2: which has been taking over the headlines there, essentially you 266 00:14:29,320 --> 00:14:32,239 Speaker 2: saw a whole bunch of fraud, whether it was from 267 00:14:32,560 --> 00:14:35,560 Speaker 2: kind of fake child care facilities, but also on top 268 00:14:35,600 --> 00:14:38,080 Speaker 2: of that, you also saw a lot of fraudulent medical 269 00:14:38,120 --> 00:14:41,560 Speaker 2: claims for services that weren't really being rendered. Like, how 270 00:14:41,560 --> 00:14:45,000 Speaker 2: do you strike that balance between you know, strong oversight 271 00:14:45,480 --> 00:14:48,880 Speaker 2: of the program to prevent fraud and making sure legitimate, 272 00:14:49,920 --> 00:14:51,640 Speaker 2: legitimate care is actually being given. 273 00:14:52,560 --> 00:14:55,520 Speaker 3: So I love that question, and you know, I'm going 274 00:14:55,560 --> 00:14:58,080 Speaker 3: to answer that in a sort of long winded way 275 00:14:58,280 --> 00:15:01,080 Speaker 3: and what my experiences is in New York and how 276 00:15:01,160 --> 00:15:03,280 Speaker 3: I can really tie those two together. 277 00:15:03,400 --> 00:15:03,560 Speaker 1: You know. 278 00:15:03,680 --> 00:15:06,720 Speaker 3: So in addition to my role at Care Professionals, I 279 00:15:06,760 --> 00:15:09,560 Speaker 3: also sit on a few different boards. So I'm the 280 00:15:09,560 --> 00:15:12,200 Speaker 3: president of the Alliance to Protect Home Care. I'm the 281 00:15:12,240 --> 00:15:16,400 Speaker 3: executive secretary for the Consumer Directed Personal Assistance Association of 282 00:15:16,440 --> 00:15:19,400 Speaker 3: New York State. And I was also the Long Island 283 00:15:19,480 --> 00:15:22,880 Speaker 3: Chapter president for the Home Care Providers Association up until 284 00:15:22,880 --> 00:15:25,280 Speaker 3: about six months ago, but I held to that role 285 00:15:25,320 --> 00:15:28,440 Speaker 3: for three years. Also, all in all, I've held these 286 00:15:28,520 --> 00:15:31,160 Speaker 3: roles for close to six years, and so I've been 287 00:15:31,280 --> 00:15:35,080 Speaker 3: very entrenched in the politics and the policy and the 288 00:15:35,120 --> 00:15:38,560 Speaker 3: advocacy efforts that go in to these programs. And just 289 00:15:38,600 --> 00:15:42,000 Speaker 3: to rewind the clock in New York to twenty eighteen 290 00:15:42,080 --> 00:15:45,480 Speaker 3: twenty nineteen, my advocacy really switched to going up to 291 00:15:45,520 --> 00:15:50,680 Speaker 3: Albany and begging the legislature and begging the executive office 292 00:15:50,880 --> 00:15:55,200 Speaker 3: that this program is growing at an extreme amount of pace. 293 00:15:55,560 --> 00:15:58,160 Speaker 3: We need to put guardrails on to ensure that the 294 00:15:58,160 --> 00:16:01,000 Speaker 3: program stays true to the values which it was created 295 00:16:01,240 --> 00:16:04,680 Speaker 3: and ensured that only individuals coming onto the program are 296 00:16:04,720 --> 00:16:10,080 Speaker 3: individuals that are warranted to receive the benefit. For five years, 297 00:16:10,440 --> 00:16:14,480 Speaker 3: I went up there every single year, multiple times. I 298 00:16:14,520 --> 00:16:17,240 Speaker 3: mean multiple times. We're talking twelve trips to Albany. 299 00:16:17,960 --> 00:16:19,680 Speaker 2: It feels like you're banging your head against the wall. 300 00:16:19,760 --> 00:16:22,400 Speaker 2: Sometimes right when you go to the legislative, it doesn't 301 00:16:22,440 --> 00:16:22,680 Speaker 2: make it. 302 00:16:22,840 --> 00:16:25,200 Speaker 3: They want to tell you how the program works, even 303 00:16:25,240 --> 00:16:27,440 Speaker 3: though they've never worked a day in an operation of 304 00:16:27,960 --> 00:16:29,840 Speaker 3: the program. They're like, this is how it works. And 305 00:16:29,880 --> 00:16:32,280 Speaker 3: they're telling me, and I'm like, what are you the 306 00:16:32,320 --> 00:16:35,560 Speaker 3: furthest from the truth. That's not how anything works. It 307 00:16:35,680 --> 00:16:38,400 Speaker 3: might be how you write it down the legislation, but 308 00:16:38,520 --> 00:16:40,800 Speaker 3: let me show you the real world on what your 309 00:16:41,080 --> 00:16:46,760 Speaker 3: you know, penstroke really does. Right. But so for years 310 00:16:46,840 --> 00:16:49,760 Speaker 3: I've been advocating that there needs to be guardrails. There 311 00:16:49,800 --> 00:16:53,000 Speaker 3: needs to be you know, somebody that is coming in 312 00:16:53,080 --> 00:16:56,320 Speaker 3: and overlooking on the program. We've asked, oh Meg, and 313 00:16:56,400 --> 00:17:00,080 Speaker 3: all these things. Then fast forward to twenty twenty three, 314 00:17:00,360 --> 00:17:04,640 Speaker 3: and you know now that everyone had the data. You're right. 315 00:17:04,760 --> 00:17:07,560 Speaker 3: You have the Department of Labor of your statistics coming 316 00:17:07,560 --> 00:17:10,639 Speaker 3: out saying that home anthmity based care is the fastest 317 00:17:10,640 --> 00:17:13,040 Speaker 3: growing labor segment in New York. It was like, what 318 00:17:13,160 --> 00:17:15,919 Speaker 3: I've been telling you, that's four years, that is the 319 00:17:15,920 --> 00:17:19,520 Speaker 3: fastest growing segment. And you were just sitting there. And 320 00:17:19,600 --> 00:17:24,080 Speaker 3: then you know, we see the state come in and say, okay, 321 00:17:24,119 --> 00:17:26,720 Speaker 3: well there's so much fraud in this program. We need 322 00:17:26,720 --> 00:17:29,600 Speaker 3: a complete change. And we kept saying, well, show me 323 00:17:29,640 --> 00:17:32,439 Speaker 3: the instances of fraud, Show me the instances of fraud. 324 00:17:32,640 --> 00:17:34,800 Speaker 3: I believe there's fraud in the program. There's fraud in 325 00:17:34,840 --> 00:17:39,480 Speaker 3: any medicaid program under the sun, so that's not an argument. 326 00:17:39,560 --> 00:17:42,359 Speaker 3: You're not, but show me the instances of fraud so 327 00:17:42,440 --> 00:17:45,280 Speaker 3: I can help you root those out right. And they 328 00:17:45,280 --> 00:17:47,639 Speaker 3: could never show me anything. They would always point to 329 00:17:47,680 --> 00:17:51,360 Speaker 3: a case which the Department of Justice prosecuted, and I 330 00:17:51,480 --> 00:17:54,600 Speaker 3: my response to them was, well, it seems like our 331 00:17:54,760 --> 00:17:57,520 Speaker 3: justice system is working. They were caught, they were prosecuted, 332 00:17:57,680 --> 00:18:01,720 Speaker 3: they face fines, they were either arrested. Yeah, so that's good. 333 00:18:01,800 --> 00:18:04,560 Speaker 3: I'm happy that that's public and that's out there. Where 334 00:18:04,560 --> 00:18:06,879 Speaker 3: are these other cases of fraud? And they could never, 335 00:18:07,160 --> 00:18:09,639 Speaker 3: you know, show me the receipts for any of this stuff. 336 00:18:11,200 --> 00:18:14,919 Speaker 3: It's fun. So in twenty twenty three became the idea, 337 00:18:15,000 --> 00:18:19,080 Speaker 3: let's move let's consolidate six hundred providers throughout the state 338 00:18:19,119 --> 00:18:23,560 Speaker 3: to one provider, giving a state sanctioned monopoly to this provider. 339 00:18:24,760 --> 00:18:28,280 Speaker 3: That path in the twenty twenty three twenty twenty four budget. 340 00:18:28,480 --> 00:18:31,840 Speaker 1: So you're saying, there's a single private entity who received 341 00:18:31,880 --> 00:18:35,280 Speaker 1: all of the state funding for home care for. 342 00:18:35,359 --> 00:18:39,080 Speaker 3: The for this one one program, for consumer directed program, 343 00:18:39,440 --> 00:18:43,280 Speaker 3: and it's twelve billion dollars a year just as one program. 344 00:18:43,320 --> 00:18:47,440 Speaker 3: That's it. So they became the sole provider for that program, 345 00:18:47,760 --> 00:18:51,359 Speaker 3: eliminating choice, which is a federal requirement and especially in 346 00:18:51,400 --> 00:18:54,560 Speaker 3: Medicaid programs, the consumers need to have choice of providers. 347 00:18:54,960 --> 00:18:57,639 Speaker 3: Now there's only one provider. So they ignoyed all the 348 00:18:57,640 --> 00:18:58,520 Speaker 3: federal law. There. 349 00:18:58,720 --> 00:19:00,320 Speaker 1: What's the name of the provider. 350 00:19:00,200 --> 00:19:07,280 Speaker 3: Public Partnerships LLC. Additionally, in the budget language they were 351 00:19:07,320 --> 00:19:11,440 Speaker 3: moving to a request for proposal. In that language, the 352 00:19:11,480 --> 00:19:16,679 Speaker 3: governor bypassed comptroller review, so the comptroller had no chance 353 00:19:16,720 --> 00:19:20,600 Speaker 3: to review this twelve billion, five year contract. So it's 354 00:19:20,680 --> 00:19:24,159 Speaker 3: really a sixty billion dollar contract. So the controller was 355 00:19:24,240 --> 00:19:29,000 Speaker 3: excluded from reviewing this contract. They bans myself as well 356 00:19:29,040 --> 00:19:35,240 Speaker 3: as the other experienced contractors from applying to this RFP. Instead, 357 00:19:35,280 --> 00:19:39,479 Speaker 3: they chose a state, this company, Public Partnerships, who has 358 00:19:39,520 --> 00:19:42,280 Speaker 3: never worked in New York State before. It's kind of 359 00:19:42,520 --> 00:19:45,480 Speaker 3: just crazy there. I still can't get over that. And 360 00:19:46,040 --> 00:19:49,280 Speaker 3: you know, like I said, it goes against all of 361 00:19:49,280 --> 00:19:53,800 Speaker 3: the federal Medicare Medicaid regulations that govern home and community 362 00:19:53,800 --> 00:19:55,800 Speaker 3: based programs about offering choice. 363 00:19:56,080 --> 00:19:58,919 Speaker 2: I mean, honestly, that sounds like there has to be 364 00:19:58,960 --> 00:20:02,280 Speaker 2: something going on behind in the scenes. Immediately, I want 365 00:20:02,280 --> 00:20:04,800 Speaker 2: to start looking up played campaign donations. 366 00:20:05,240 --> 00:20:07,000 Speaker 3: It gets a tricky web, and I can take you 367 00:20:07,040 --> 00:20:11,440 Speaker 3: through that, you know, to to bring it to you know, 368 00:20:11,560 --> 00:20:15,159 Speaker 3: something that you'll be very familiar with. Now that this 369 00:20:15,560 --> 00:20:19,960 Speaker 3: whole workforce is monopolized under one company. Guests who's coming 370 00:20:20,000 --> 00:20:22,240 Speaker 3: to knock at the door trying to get a piece 371 00:20:22,280 --> 00:20:27,879 Speaker 3: of their pie. The eleven ninety nine SCIU, all right, 372 00:20:28,200 --> 00:20:31,200 Speaker 3: because now there's not six hundred providers that they would 373 00:20:31,200 --> 00:20:35,400 Speaker 3: have to go out to and create prece the listeners. 374 00:20:35,560 --> 00:20:37,640 Speaker 1: Just explain that just briefly. 375 00:20:38,320 --> 00:20:42,359 Speaker 3: Yeah, yeah, yeah, sure. So eleven ninety nine SCIU is 376 00:20:43,560 --> 00:20:47,119 Speaker 3: probably the largest lay labor union in the country in 377 00:20:47,160 --> 00:20:49,480 Speaker 3: New York. I call them the fourth branch of government 378 00:20:49,880 --> 00:20:53,040 Speaker 3: because that's what they are. They don't have opinions. They 379 00:20:53,119 --> 00:20:56,160 Speaker 3: just get whatever they want in writing into legislation right 380 00:20:56,160 --> 00:21:01,000 Speaker 3: away without questions. And it is beyond frustrating. And yeah, 381 00:21:01,080 --> 00:21:04,280 Speaker 3: they stand the benefit on this over two hundred million 382 00:21:04,320 --> 00:21:05,240 Speaker 3: dollars a year dues. 383 00:21:05,520 --> 00:21:06,919 Speaker 1: It sounds like it's a bit of a mess. 384 00:21:07,359 --> 00:21:09,200 Speaker 2: Do you see a lot of these program I mean, 385 00:21:09,359 --> 00:21:11,919 Speaker 2: does every state have similar programs to what you have. 386 00:21:12,880 --> 00:21:16,280 Speaker 3: Yeah, every state across the Union has a type of 387 00:21:16,720 --> 00:21:19,760 Speaker 3: consumer direction as an abbreviation, so that every state would 388 00:21:19,800 --> 00:21:21,800 Speaker 3: have a consumer direction kind of program. 389 00:21:22,640 --> 00:21:25,480 Speaker 1: But so now if the ACA SEB disease expire, which 390 00:21:25,520 --> 00:21:30,680 Speaker 1: they have, and the replacement plans do not have expanded subsidies, 391 00:21:30,840 --> 00:21:33,240 Speaker 1: and the Medicaid budgets titan, which we know that they're 392 00:21:33,240 --> 00:21:36,480 Speaker 1: going to, what happens to some of these programs. 393 00:21:37,520 --> 00:21:40,560 Speaker 3: They start going away, they start disappearing. I mean, I 394 00:21:40,600 --> 00:21:43,360 Speaker 3: would love them to look elsewhere, right, I mean when 395 00:21:43,359 --> 00:21:45,400 Speaker 3: you look at a New York State budget, I mean 396 00:21:45,480 --> 00:21:48,360 Speaker 3: without you know, the sticker shock throwing up in your 397 00:21:48,480 --> 00:21:50,360 Speaker 3: mouth the first time when you see the total bill 398 00:21:50,400 --> 00:21:52,919 Speaker 3: of it, but when you actually start going through it, 399 00:21:53,400 --> 00:21:56,000 Speaker 3: you look at all these hundreds of millions dollars being 400 00:21:56,000 --> 00:21:59,239 Speaker 3: thrown away and consulting, right, and then so you want 401 00:21:59,280 --> 00:22:01,959 Speaker 3: to peel that one back more, right, And we're paying 402 00:22:02,200 --> 00:22:04,240 Speaker 3: hundreds of millions of dollars a year for people to 403 00:22:04,280 --> 00:22:08,000 Speaker 3: consult with our Department of Health on Medicaid programs, and 404 00:22:08,040 --> 00:22:10,760 Speaker 3: it's ridiculous. The providers would be able to help you 405 00:22:11,080 --> 00:22:15,280 Speaker 3: more than a consultant, right, because we know what's happening 406 00:22:15,320 --> 00:22:17,359 Speaker 3: on the grounds, and no one ever comes and asks 407 00:22:17,400 --> 00:22:20,000 Speaker 3: providers what's the best way to do this? Right, It's 408 00:22:20,000 --> 00:22:23,520 Speaker 3: all from an office building somewhere or a zoom meeting somewhere. 409 00:22:24,200 --> 00:22:26,640 Speaker 3: So that's one portion, right, And then you can look 410 00:22:26,640 --> 00:22:30,680 Speaker 3: at hospitals. Hospitals eat up majority of the state's budget 411 00:22:30,920 --> 00:22:34,680 Speaker 3: on the Medicaid, the non pay, the readmissions and all 412 00:22:34,720 --> 00:22:38,760 Speaker 3: these items. Let's work on decreasing those and actually putting 413 00:22:38,800 --> 00:22:42,040 Speaker 3: a value based plan together. I'm sure you've heard a 414 00:22:42,040 --> 00:22:44,960 Speaker 3: lot in the past five years about value based care, 415 00:22:45,080 --> 00:22:48,399 Speaker 3: and you know that's the way everything's moving and the 416 00:22:48,520 --> 00:22:50,080 Speaker 3: realization of it humbled. 417 00:22:50,119 --> 00:22:52,439 Speaker 2: Pavements were tied to the Affordable Care Act and all 418 00:22:52,480 --> 00:22:55,520 Speaker 2: they did was drive a costs and they haven't actually 419 00:22:55,600 --> 00:22:58,880 Speaker 2: shown any improvement in outcomes. 420 00:22:59,320 --> 00:23:02,280 Speaker 3: Because they have an done anything. They had the contract, 421 00:23:02,359 --> 00:23:05,240 Speaker 3: they took the money, but they haven't done anything. You know, 422 00:23:05,640 --> 00:23:07,960 Speaker 3: they came to us with the whole big plan. This 423 00:23:08,000 --> 00:23:10,440 Speaker 3: is our what we want to do. We want to 424 00:23:10,440 --> 00:23:15,440 Speaker 3: prevent these hospitalizations but improve patient outcomes. Me, my nursing staff, 425 00:23:15,480 --> 00:23:19,399 Speaker 3: and the community. We're very excited, right because we actually 426 00:23:19,440 --> 00:23:21,800 Speaker 3: get to do more. Right, We get to go into 427 00:23:21,800 --> 00:23:25,440 Speaker 3: the patient's house once more. A month and do more 428 00:23:25,880 --> 00:23:28,760 Speaker 3: surveys and see what's going on and ask more questions, 429 00:23:29,359 --> 00:23:33,240 Speaker 3: offer more support, and instead we were met with confusion 430 00:23:33,320 --> 00:23:36,800 Speaker 3: with Okay, well, what are we supposed to do? This 431 00:23:36,840 --> 00:23:40,800 Speaker 3: is my plan, This is how I plan to reduce hostitalizations. 432 00:23:40,880 --> 00:23:42,880 Speaker 3: This is how I plan to get people who are 433 00:23:43,440 --> 00:23:46,560 Speaker 3: living alone, lonely and distressed alternate care to come in 434 00:23:46,600 --> 00:23:48,639 Speaker 3: to talk to to try and to alleviate that some 435 00:23:48,720 --> 00:23:51,879 Speaker 3: of that depression. We wrote out all the plans, but 436 00:23:52,000 --> 00:23:54,720 Speaker 3: there was nowhere to actually implement them because I wasn't 437 00:23:54,760 --> 00:23:58,639 Speaker 3: really allowed to right and on the flip side of that, 438 00:23:58,720 --> 00:24:00,800 Speaker 3: I was going to be compensated and to be able 439 00:24:00,800 --> 00:24:03,800 Speaker 3: to go out and do these kinds of additional outreach 440 00:24:03,840 --> 00:24:07,440 Speaker 3: and work to ensure that these people are receiving the care. 441 00:24:07,760 --> 00:24:10,520 Speaker 3: And so there's just been a disconnect all up and 442 00:24:10,560 --> 00:24:14,120 Speaker 3: down regarding that stuff that it never reached the end 443 00:24:14,240 --> 00:24:18,160 Speaker 3: provider myself to actually the person on the grounds who's 444 00:24:18,200 --> 00:24:18,879 Speaker 3: doing the work. 445 00:24:20,200 --> 00:24:22,840 Speaker 2: So here's my question for you, say, any of these 446 00:24:22,880 --> 00:24:27,240 Speaker 2: policy makers Resial House, Senate, I'm President Trump, We're listening 447 00:24:27,280 --> 00:24:30,000 Speaker 2: right now. What do they need to do to ensure 448 00:24:30,080 --> 00:24:32,399 Speaker 2: that there's adequate funding and access to some of these 449 00:24:32,440 --> 00:24:35,800 Speaker 2: programs because, as we have said, keeping people at home 450 00:24:35,840 --> 00:24:39,480 Speaker 2: instead of going into the nursing or nursing homes or 451 00:24:39,800 --> 00:24:42,159 Speaker 2: some of these other facilities, or even bringing strangers in 452 00:24:42,200 --> 00:24:45,520 Speaker 2: the home, they do have better outcomes and it's less expensive. 453 00:24:45,880 --> 00:24:48,560 Speaker 1: So what from a policy level needs to be done. 454 00:24:49,600 --> 00:24:51,960 Speaker 3: I think it needs to be stopped from the start, 455 00:24:51,960 --> 00:24:54,720 Speaker 3: from the top down. And I think a lot of 456 00:24:54,760 --> 00:24:58,680 Speaker 3: these programs need to be inspected and reviewed and graded, 457 00:24:58,760 --> 00:25:01,760 Speaker 3: and I think all these contracts need to be gone 458 00:25:01,800 --> 00:25:04,639 Speaker 3: through and torn through because you want to talk. You know, 459 00:25:04,680 --> 00:25:07,000 Speaker 3: you always hear about the waste, fraud, waste and abuse, 460 00:25:07,119 --> 00:25:11,280 Speaker 3: and it's always the provider or the consumer or the worker. 461 00:25:11,800 --> 00:25:14,200 Speaker 3: But what about the state officials that are making these 462 00:25:14,240 --> 00:25:16,600 Speaker 3: contracts about it and to the tunes of hundreds of 463 00:25:16,600 --> 00:25:20,760 Speaker 3: millions of dollars that don't provide any actual benefit. That's 464 00:25:20,800 --> 00:25:23,720 Speaker 3: the real fraud, that's the real miscarriage of justice here. 465 00:25:24,359 --> 00:25:28,320 Speaker 3: It's not the mom who you know got twelve hundred 466 00:25:28,359 --> 00:25:32,400 Speaker 3: dollars fraudulently. It's the company that you know is paying 467 00:25:32,800 --> 00:25:35,560 Speaker 3: some pack somewhere you know, a million dollars to get 468 00:25:35,560 --> 00:25:38,480 Speaker 3: a one hundred million dollar contracts. That's what needs to 469 00:25:38,480 --> 00:25:40,440 Speaker 3: be rooted out. And if we can root that out, 470 00:25:40,440 --> 00:25:43,359 Speaker 3: there'll be plenty of money for all these programs left over. 471 00:25:44,200 --> 00:25:44,800 Speaker 1: That's interesting. 472 00:25:44,840 --> 00:25:48,000 Speaker 2: I mean, the President is putting together a task force 473 00:25:48,040 --> 00:25:51,639 Speaker 2: to start looking at fraud when it comes to specifically medicaid, 474 00:25:51,800 --> 00:25:55,520 Speaker 2: but so putting it to the state legislative levels is 475 00:25:55,560 --> 00:25:57,720 Speaker 2: actually a pretty brilliant piece. 476 00:25:58,040 --> 00:25:59,919 Speaker 1: As we know in New Jersey. 477 00:26:00,040 --> 00:26:02,520 Speaker 2: So I practice in New York and New Jersey, the 478 00:26:02,640 --> 00:26:07,000 Speaker 2: consolidation of hospital systems and the monopolization there. We know 479 00:26:07,440 --> 00:26:13,120 Speaker 2: that these hospital sisitions, these hospitalizations, and these insurance goliaths 480 00:26:13,200 --> 00:26:18,879 Speaker 2: absolutely contribute and have open door policy with these politicians 481 00:26:18,880 --> 00:26:22,520 Speaker 2: in the state. So it's pretty interesting and upsetting, very 482 00:26:22,600 --> 00:26:23,560 Speaker 2: upsetting to see. 483 00:26:24,440 --> 00:26:27,359 Speaker 3: It's been upsetting, and you know, I've I get a 484 00:26:27,359 --> 00:26:30,600 Speaker 3: lot of support phone calls from my colleagues saying, you know, 485 00:26:30,720 --> 00:26:32,679 Speaker 3: are you coming up to albody this year? And it's like, 486 00:26:32,880 --> 00:26:35,320 Speaker 3: I really don't want to. I really don't want to. 487 00:26:36,000 --> 00:26:38,560 Speaker 3: You know, I've seen how the sausage is made and 488 00:26:38,600 --> 00:26:41,959 Speaker 3: there's no changing it. Right. Everybody is stuck and the 489 00:26:42,000 --> 00:26:45,439 Speaker 3: way that things are done, and nobody wants to change, 490 00:26:45,680 --> 00:26:49,240 Speaker 3: to improve on systems, to make things better, to move 491 00:26:49,320 --> 00:26:52,160 Speaker 3: things into the future, right. I have the same argument 492 00:26:52,240 --> 00:26:56,240 Speaker 3: for when people say, okay, well nonprofits under than for 493 00:26:56,480 --> 00:26:59,920 Speaker 3: profit and I say, okay, well hold that thought there. 494 00:27:00,160 --> 00:27:03,480 Speaker 3: Without for profit companies, there will never be efficiencies, there 495 00:27:03,480 --> 00:27:06,760 Speaker 3: will never be innovations, there would never be improvement on 496 00:27:06,800 --> 00:27:11,240 Speaker 3: a current products or a current service. Non for profits. 497 00:27:11,280 --> 00:27:14,119 Speaker 3: You know, they chugged along at the same pace. For 498 00:27:14,359 --> 00:27:17,600 Speaker 3: profits are looking for better ways to do things consistently. 499 00:27:17,760 --> 00:27:17,879 Speaker 1: Well. 500 00:27:17,920 --> 00:27:21,480 Speaker 2: Also, let'sn't mind that nonprofit is really just a tax standing. 501 00:27:21,720 --> 00:27:27,960 Speaker 2: I mean, they still function in a profitable way oftentimes. 502 00:27:28,040 --> 00:27:30,720 Speaker 1: Just look at some of the salaries of these econdives. 503 00:27:31,280 --> 00:27:34,120 Speaker 3: Not corrects, that's correct. But if you don't even want 504 00:27:34,119 --> 00:27:35,920 Speaker 3: to go down that road, right and you just want 505 00:27:35,920 --> 00:27:37,840 Speaker 3: to talk about the benefit of it, and then that 506 00:27:38,080 --> 00:27:39,400 Speaker 3: that's my argument to it. 507 00:27:39,560 --> 00:27:43,160 Speaker 2: More coming up on Wellness Unmasked with doctor Nicole Sapphire. 508 00:27:45,920 --> 00:27:48,760 Speaker 1: So I mean taking this down to the human level. 509 00:27:48,880 --> 00:27:51,639 Speaker 2: I mean, obviously this has been a policy heavy conversation, 510 00:27:51,800 --> 00:27:53,520 Speaker 2: but at the end of the day, why is it 511 00:27:53,560 --> 00:27:57,199 Speaker 2: important for people to consider home care some of the 512 00:27:57,200 --> 00:27:59,680 Speaker 2: stuff that we've been talking about, and if they want 513 00:27:59,720 --> 00:28:01,639 Speaker 2: to do it, you know, what are some resources they 514 00:28:01,640 --> 00:28:02,120 Speaker 2: can look into. 515 00:28:03,200 --> 00:28:06,720 Speaker 3: Yeah. So, like I said, every state has home care, right, 516 00:28:06,800 --> 00:28:10,000 Speaker 3: every state has a version of consumer directed care. Yeah, 517 00:28:10,160 --> 00:28:13,240 Speaker 3: it's up to every individual. I can't speak for everybody. 518 00:28:13,440 --> 00:28:15,680 Speaker 3: Some people may want to move into a nursing home 519 00:28:15,840 --> 00:28:18,719 Speaker 3: from the people that I've spoken with, the people that 520 00:28:18,760 --> 00:28:22,359 Speaker 3: we service, the employees that we employ, right, we've been 521 00:28:22,400 --> 00:28:24,680 Speaker 3: around for thirty two years. We have employees that we 522 00:28:24,720 --> 00:28:27,959 Speaker 3: are now servicing, right that we're once a home healthy. 523 00:28:28,400 --> 00:28:30,840 Speaker 3: You know, it is a much better quality of life, 524 00:28:31,119 --> 00:28:34,640 Speaker 3: the results, you know, in terms from the patient aspect 525 00:28:34,680 --> 00:28:37,639 Speaker 3: of things, in terms of staying engaged in the community, 526 00:28:38,280 --> 00:28:41,640 Speaker 3: you know, keeping their mental awareness about all those things 527 00:28:41,960 --> 00:28:45,520 Speaker 3: that you know are extremely important to a person's well 528 00:28:45,560 --> 00:28:50,280 Speaker 3: being are best treated in the home. Yeah. To find 529 00:28:50,280 --> 00:28:52,480 Speaker 3: out more about any kind of these programs, you know, 530 00:28:52,600 --> 00:28:56,760 Speaker 3: check your state's website. All the states have access and 531 00:28:56,840 --> 00:29:00,560 Speaker 3: have offerings of what the requirements are, very state by state, 532 00:29:00,720 --> 00:29:04,080 Speaker 3: but you know, it's it should be on everybody's radar, 533 00:29:04,240 --> 00:29:06,400 Speaker 3: especially you know, for the people that are aging in 534 00:29:06,440 --> 00:29:09,680 Speaker 3: place and disabled individuals across the across the country. 535 00:29:09,720 --> 00:29:12,280 Speaker 2: And all you have to do if you're really questioning 536 00:29:12,280 --> 00:29:15,160 Speaker 2: whether or not home care is a good option is 537 00:29:15,200 --> 00:29:17,760 Speaker 2: look at the blue zones all across the world. The 538 00:29:17,760 --> 00:29:20,360 Speaker 2: blue zones are where you have people are living the 539 00:29:20,400 --> 00:29:23,120 Speaker 2: longest and the healthiest. Shocking, we don't have many of 540 00:29:23,120 --> 00:29:25,920 Speaker 2: them in the United States, but if you look, there 541 00:29:25,920 --> 00:29:30,760 Speaker 2: are various places across the world that you know based 542 00:29:30,800 --> 00:29:34,680 Speaker 2: on diet activity. But one of the big pillars to 543 00:29:35,160 --> 00:29:38,720 Speaker 2: people living longer and healthier lives is that they are 544 00:29:38,960 --> 00:29:42,360 Speaker 2: maintained as part of a community. So you know, here 545 00:29:42,360 --> 00:29:44,520 Speaker 2: in the United States, when you reach a certain age, 546 00:29:44,560 --> 00:29:48,720 Speaker 2: sometimes you're you almost turn into the infant again. Everyone's 547 00:29:48,800 --> 00:29:50,560 Speaker 2: just surrounding you and caring for you and kind of 548 00:29:50,600 --> 00:29:54,240 Speaker 2: putting grandpa in the corner and not keeping them actively engaged, 549 00:29:54,280 --> 00:29:57,959 Speaker 2: whereas in some of these blue zones, grandpa still is 550 00:29:58,000 --> 00:30:00,600 Speaker 2: the patriarch of the family and he's tree that way. 551 00:30:00,760 --> 00:30:04,000 Speaker 2: And so by just having that sense of place in 552 00:30:04,160 --> 00:30:08,360 Speaker 2: the family, in the community, being at home, socialization, all 553 00:30:08,400 --> 00:30:11,720 Speaker 2: of these things contribute to better outcomes in terms of 554 00:30:11,720 --> 00:30:14,920 Speaker 2: physical but also mental health, so huge I'm a huge 555 00:30:14,920 --> 00:30:18,440 Speaker 2: supporter of home health care. I also think that we 556 00:30:18,680 --> 00:30:21,760 Speaker 2: as family members already do a lot of work. Wouldn't 557 00:30:21,760 --> 00:30:23,480 Speaker 2: it be great to be compensated for some of the 558 00:30:23,520 --> 00:30:25,560 Speaker 2: work and maybe you don't have to go and get 559 00:30:25,560 --> 00:30:28,720 Speaker 2: that third or fourth part time job just to help 560 00:30:29,040 --> 00:30:31,120 Speaker 2: care for someone to pay for a home health aid. 561 00:30:31,480 --> 00:30:33,800 Speaker 1: You can actually just be paid for the work you're 562 00:30:33,800 --> 00:30:34,360 Speaker 1: already doing. 563 00:30:34,560 --> 00:30:36,760 Speaker 3: Absolutely. I mean, you hit the now on the head 564 00:30:36,960 --> 00:30:40,120 Speaker 3: right with the blue zones. It's really about staying engaged. 565 00:30:40,560 --> 00:30:43,320 Speaker 3: You know, when people sit in a nursing home or 566 00:30:43,360 --> 00:30:45,640 Speaker 3: even at their own home and they don't have anybody 567 00:30:45,640 --> 00:30:47,959 Speaker 3: to talk to, and they don't have anybody to engage with, 568 00:30:48,040 --> 00:30:52,400 Speaker 3: and they don't, you know, you start deteriorating. Your mind, deteriorates, 569 00:30:52,400 --> 00:30:56,719 Speaker 3: your body, deteriorates, everything just starts sliding downhill real fast. 570 00:30:57,200 --> 00:30:59,800 Speaker 3: And so the goal should be to keep everybody engaged 571 00:31:00,080 --> 00:31:00,400 Speaker 3: to act. 572 00:31:01,360 --> 00:31:03,760 Speaker 2: That's right, all right, well, Julian Hagman, see you of 573 00:31:03,800 --> 00:31:08,240 Speaker 2: caring professionals and also an advocate for patients and providers. 574 00:31:08,280 --> 00:31:10,800 Speaker 1: I appreciate you. Thank you so much for coming on 575 00:31:10,840 --> 00:31:11,800 Speaker 1: Wellness Unmasked. 576 00:31:12,440 --> 00:31:14,520 Speaker 3: Thank you very much. I appreciate it. Have a great day. 577 00:31:15,080 --> 00:31:18,360 Speaker 2: This has been such an important conversation because healthcare debates 578 00:31:18,440 --> 00:31:21,920 Speaker 2: too often happen far away from the people actually affected 579 00:31:21,960 --> 00:31:26,240 Speaker 2: by them. Rising costs, the expiring subsidies, fraud, scandals. They're 580 00:31:26,240 --> 00:31:30,280 Speaker 2: not just headlines, they're stressors that determine whether someone actually 581 00:31:30,280 --> 00:31:33,440 Speaker 2: gets care or goes without it. Thank you so much 582 00:31:33,520 --> 00:31:37,360 Speaker 2: for listening to Wellness Unmasked. I'm doctor Nicole Sapphire. Until 583 00:31:37,400 --> 00:31:40,240 Speaker 2: next time, make sure you're staying informed. We'll continue asking 584 00:31:40,280 --> 00:31:44,560 Speaker 2: hard questions and never forget that behind every policy decision 585 00:31:45,000 --> 00:31:47,200 Speaker 2: is an actual person. Make sure to tune in to 586 00:31:47,280 --> 00:31:51,920 Speaker 2: Wellness Unmasked with doctor Nicole Sapfhire on iHeartRadio, app, Apple Podcasts, 587 00:31:52,000 --> 00:31:54,040 Speaker 2: or wherever you get your podcasts, and we'll see you 588 00:31:54,080 --> 00:31:54,560 Speaker 2: next time