ADVOCATING & NEGOTIATING
PRIVATE HEALTH PLAN COVERAGE
STEVEN C. WHITE, PhD, CCC-A
Director of Healthcare Economics and Advocacy, ASHA
GRETCHEN BEBB, M.A., CCC-SLP, STAR-TX
LYNNE F. HARMON, M.A., CCC-SLP, STAR-TN
MARIE NOPLOCK, M.Ed., CCC-SLP, STAR-MD
KATRINA ZEIT, M.H.A., M.A., CCC-SLP, STAR-OH
November 22, 2008
8:00 – 10:00 am
1
2008…
Strategic Objective
Reimbursement
+ Richard Shell’s negotiating approach
2
Pathway to Success
• Goal?: Improve private plan coverage & reimbursement
for speech-language pathology & audiology services and
devices
• How? Through negotiating with or persuading decisionmakers:
‹ Managed care plan executives
‹ Employers that self-insure: employees-benefits
managers, human resource manager
‹ Other employers
‹ Labor
‹ State legislators
‹ Clients
3
Pathway to Success
Pathway:
• Identify issue(s)
• Prepare
• Develop strategy
• Educate
• Negotiate
Strategic Objectives Process
• Board of Directors– selects issues using member input
& determines desired outcomes
• Committees and networks – advise Board of Directors
• National Office Staff - develop and implement work
plans and strategies with State Advocates for
Reimbursement (STAR) Network
• Multi-year span for strategic objectives
5
2008 Strategic Objectives
Negotiating Private Health Plan Coverage –
Negotiation, persuasion and advocacy seminar
presented at State Association conventions and
meetings
State actuarial data from Milliman National data available in Negotiating Health Care
Contracts and Calculating Fees
Purpose: For use by State Speech-Language Hearing Associations, especially STARs
6
2008 Strategic Objectives, cont’d
State Advocates for Reimbursement (STARs)
• Educational programs for the STARs
• Collaborating with ASHA on Strategic Objectives
• Listserv and member community forum
• Monthly conference calls
• Annual meeting at ASHA Convention
7
2008 Strategies
National Business Group on Health
International Foundation of Employee
Benefits
Private and Public Employers
State Grants
8
FEHB
Federal Employees Health Benefits
Program (FEHB)
Covers 8 million lives
ASHA seeks more comprehensive speechlanguage and hearing services
Contacts with Congress and Office of
Personnel Management (OPM)
9
FEHB
¾
¾
FEHB is a leader for modeling benefits
Improvements in FEHB coverage for
SLP and AUD services can lead to
changes in other public and private health
care plans
¾Annual Call Letter
10
Prepare
¾Understand the perspective of the
other party
Federal & State Laws
Federal: Employee Retirement Income Security Act
(ERISA)
Exempts employers who self-insure from some state
mandates
Any Willing Provider (AWP) Laws (21 states)
Private health plan must accept any provider willing
to meet participation terms.
‹
‹
‹
‹
‹
‹
Georgia: The two laws apply only to Blue Cross Blue Shield
contracts or rural health care providers; defines qualifying
counties.
Idaho: All qualified health care providers.
Illinois: Limited to participating providers with public aide.
Indiana, Kentucky (not limited)
Minnesota: Any qualified independent health care provider.
Wyoming: Any qualified Wyoming provider.
12
State Laws and Regulations
Investigate health insurance statutes and
regulations
Determine if your state currently mandates
benefits
Locate relevant laws with the help of your state
association’s lobbyist and the state Insurance
Department
13
Current Attitude in State Capital
Determine the current climate for amending
state law
Discuss issues with colleagues in human
resource departments
Determine reactions with state legislators
14
Insurance Commissioner
Elected OR appointed
Party affiliation AND bias
Public statements regarding state law and health
insurance
Local Insurance Commissioner’s web page
National Association of Insurance Commissioners
(www.naic.org)
15
Attitude of Insurance Companies
Check BC/BS Assn. and other insurers’ websites for
news and information (www.bcbs.com)
Expect insurers to firmly oppose any mandates
Success of recent legislation
16
Trends in Employer
Health Benefits
™
Employers increasingly look for ways to
cut health care insurance costs.
™ Major Strategy: Drop or reduce scope of
benefits.
17
Employer Strategies
¾ Employees share more cost of health plan
¾ Co-pay
¾ MSA, FSA, HRA
¾ Association plan or some form of joint
coverage
18
New Approaches
Flexible Spending Accounts (FSAs)
Health Reimbursement Arrangements (HRAs)
Health Savings Accounts (HSAs)
19
Trend to Watch
Health Savings Accounts
HSAs are savings accounts into which individuals
deposit money and then withdraw it tax-free
for eligible medical expenses.
HSAs implemented in 2004 through a change in
the Internal Revenue Code to allow an
individual to deduct HSA contributions.
HSAs require a high-deductible health plan
(HDHP)—a plan that features higher annual
deductibles than other traditional health plans.
Those who hold HSAs are responsible for
researching health coverage options and
keeping careful track of their financial and
medical records.
20
HSA
Covered expenditures include
medical costs that may not be
included in some standard health
insurance contracts but are
considered tax deductible medical
expenses by the Internal Revenue
Service (IRS).
21
HSA
The IRS has specifically deemed the
following expenses to be included
in their definition:
• Therapy received as a medical
treatment
• Special education expenses paid on a
doctor’s recommendation for a child’s
tutoring by a teacher who is specially
trained and qualified to work with
children who have learning disabilities
caused by mental or physical
22
impairments
Health Savings
Accounts
●Must be paired with high deductible health plan
(HDHP)
● Maximum contributions are $2,600 annually
for singles and $5,150 for families
● Contributions can be made by employer or
the employee’s family members
● Employer contributions are voluntary
● Ownership may transfer to spouse
upon death of employee
● Allow rollover of unused funds from year to
year
23
Employer Trends
¾ Providers need to continually justify
the cost of their services by
demonstrating a return on investment
(RoI).
¾ ASHA had Milliman include new data in
the most recent report
¾ Large employers continue to provide
health insurance benefits to their
employees
24
Our Message
Prevention and treatment of communication disorders are cost
effective services that should be included in all private health
plans because…
Nearly 50 million in U.S. have speech, language or hearing
disorders;
30 million have hearing loss
One million per year suffer brain damage from strokes,
tumors or trauma with residual disorders of speech, hearing
or swallowing
Anything else?
25
Part of Our Message
9Untreated…
9Swallowing problems (dysphagia) can lead to
respiratory complications such as aspiration
pneumonia and/or malnutrition
9Hearing loss can lead to depression, anxiety,
paranoia and decreased social activities
9 (National Council on the Aging survey 5/1999)
26
Determine Who is DecisionMaker
After preparing you want to
communicate with the decisionmaker
Who’s Who-Know the Players
State Legislators
State Regulators (Department of Insurance)
Benefits Managers
Health Plan Medical Directors
Union Representatives
STAR Representative
28
Initiating Contact
IDENTIFY a health plan, employer, or other entity
REVIEW the current health plan or employer
‰
‰
What is covered?
What are the limits?
TARGET the decision maker
‰
‰
‰
Human Resources Director
Benefits specialist
Union representative
29
Initiating Contact
ARRANGE a meeting and discuss:
The issue – if better coverage is needed:
Examples of problems created
Incidence and prevalence
Services provided by audiologists and
speech-language pathologists
Coverage issues
Costs to add services
Consumer satisfaction surveys
30
Initiating Contact
At your meeting, discuss:
Credentials held by audiologists and speech-language
pathologists
Medical necessity of your services
Treatment effectiveness: ASHA’s National Center for
Treatment Effectiveness in Communication Disorders
31
Initiating Contact
¾Your needs and interests
¾Their needs and interests
¾Which ones are shared
Initiating Contact
PREPARE for the meeting
¾ Benefits administrators and medical directors
pose very direct questions – can you anticipate
their questions?
¾ Preparation is the only aspect of negotiation
over which you have complete control
FOLLOW UP IS ESSENTIAL!
33
Our Advocacy
Convince third parties that health plans should
have comprehensive coverage of SLP and
audiology services
AND
that our services should have appropriate
payment levels
34
Your Style
¾Hard nose negotiator
¾Collaborative and helpful
¾Willing to build on first contact
More style – will they be…
¾Competitive?
¾Problem solving?
¾Compromise?
¾Avoiding?
¾Accommodating?
Advocacy Plan
5- Step Professional Advocacy Plan:
¾
Define goal(s) best case and bottom line
¾
Identify target(s)
¾
Analyze the message/issue Do you have any
leverage?
¾
Choose advocacy tools
¾
Evaluate
¾think about the results
¾be realistic
37
Step 1: Identify Goals
¾ What do you want to accomplish?
¾ Best case and bottom line
¾ Why?
¾ What resources do you have for this?
¾ Who will gain what, if you succeed?
¾ Who will lose what, if you do not succeed?
¾ How does the goal fit into your long-range plan?
38
Step 2: Target(s) of Influence
Identify whom you need to persuade
Specifically describe target
Learn about target audience
39
Step 3: Analyze the Issue
“The
inability to understand the world from
another’s perspective is one of four root causes
of business failure and ineffectiveness.”
40
Step 3: Analyze the Issue
IDENTIFY THE TARGET’S:
- Understanding of speech-language pathology and
audiology
- Interests: Financial, practical, political?
- Current position: Why was it chosen and kept?
- Benefits and Drawbacks with your desired outcome
- Arguments against your position
- Reasons to find your Arguments and Evidence persuasive
41
Step 3: Analyze the Issue
¾
Role play
¾
Story boards
¾
Devil’s advocate
“Don’t ask for power.
Seek influence.
It lasts longer.”
E.M. Forster, Howard’s End
42
Step 4: Advocacy Tools
Message
Knowledge
Image
Allies
Public Relations and Marketing
Techniques
43
How does the message relate to your issue?
¾ The Message: Identify a problem and solution.
¾ Communication disorders are a major problem that costs
money:
lost productivity, medical fees, special education expenses.
¾ SLP and AUD services enable: employees to be more
productive, children to learn better, and all persons to enjoy
a better quality of life.
¾ SLP and AUD services are a “need” not a luxury
¾ ASHA Model Benefits Plan
44
Step 4: Advocacy Tools
Messages are most persuasive when they are:
Personalized
Concise
Evoke emotion
Delivered by a trusted, respected source
45
Step 4: Advocacy Tools
Knowledge:
¾ Find relevant information that already exists
¾ Create information that you need
¾Image:
¾ Establish yourself as a respected source, with
helpful ideas
46
Step 4: Advocacy Tools
Allies:
¾Who has similar interests?
¾Which authorities endorse your
point of view?
47
Step 4: Advocacy Tools
Public Relations and Marketing Techniques:
‰Brochures
‰Newsletters
‰Fact sheets (e.g., efficacy papers)
‰Letter writing campaigns
‰Report cards
48
Step 5: Evaluate
™ Monitor progress toward outcome
™ Review and revise tools as necessary
™ Set new goals and start again
49
ASHA & Other Publications
1.Negotiating Health Care Contracts and Calculating
Fees
2.Getting Your Services Covered
3.Health Plan Coding and Claims Guide
4.Business Matters: A guide for SLPs
Other:
Bargaining for Advantage: Negotiating Strategies for
Reasonable People by Richard Shell
50
Action Needed
You are an expert in speech, language and hearing
disorders and how to treat them.
Consider advocating for your profession and those
you serve – work with the STAR Network
Assist in identifying focus of advocacy in your state
Prepare, prepare, prepare
51
ASHA Contacts
[email protected]
www.asha.org
Click on “ASHA & NSSLHA Members”
Go to “Billing & Reimbursement”
Steven White, PhD [email protected]
Director, H.C. Economics & Advocacy
Angela Foehl, JD, MPH [email protected]
Director, Private Health Plans Advocacy
Mark Kander, M.H.A. [email protected]
Director, Health Care Regulatory Analysis
Neela Swanson [email protected]
H.C. Financing Communication Coordinator
52
Advocacy Efforts in
Tennessee
Partnering
¾Tennessee Association of
Audiologists and SpeechLanguage Pathologists
¾Tennessee Disability Coalition
¾Families
¾Key Legislators
Advisors
¾Lobbyist
¾Key Legislators
¾Clinicians specializing in Autism
¾Researchers from Johns Hopkins and
Vanderbilt University
¾Families
¾Other states (e.g., Connecticut, California,
Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky,
Louisiana, Maine, Maryland, Montana, New Hampshire,
New Jersey, New York, and Virginia)
Education
¾Get the facts
Decide on the approach and educate
¾Supporters
¾Legislators
¾The media
Be persistent!
¾Tennessee’s Autism Equity
Act
¾Passed May 2006 unanimously in the
House and Senate
CELEBRATE!
¾With
¾With
¾With
¾With
¾With
¾With
partners
legislators
the Governor
the media
clinicians state-wide
families
Continue to educate…
¾Medical Directors
Autism Equity Act Manuals distributed
¾Families
Consumer advocacy packets
¾Companies – Self Insured
More information….
www.taaslp.org
Autism Equity Act Manual
Consumer Packets
“We Speak So That Others Can”
Maryland’s Partnering for Success through
Grassroots Legislative Advocacy
Chicago ASHA Convention
November 22, 2008
Marie L. Noplock, M.Ed., CCC-SLP, President
The Maryland Therapy Network, Inc.
Maryland Rep. to STAR NETWORK
60
MARYLAND’S STAR GRANT-2007
¾ MSHA AND STAR Committee used grant:
¾ -To Sponsor public relations campaign with motto
“WE SPEAK SO THAT OTHERS CAN”
¾ -To Educate fellow MSHA members, healthcare consumers
as well as providers and key legislators of the Maryland
General Assembly
¾ -To Conduct focus groups and meetings with state
legislators
¾ -To Draft House Bill 1505 Health Services-Reimbursement
61
for Pre-Authorized or Approved Healthcare Services
House Bill 1505-Health InsuranceReimbursement for Preauthorized or Approved
Health Care Services
For the purpose of prohibiting certain health insurance
carriers from altering the amount of reimbursement to
health care providers for preauthorized or approved
health care services delivered to a patient except under
certain circumstances; requiring certain carriers to
establish a mechanism for providers to submit certain
fees to the carriers; requiring certain carriers or the
carriers’ private review agents to provide certain
notification to providers or patients at a certain time;
and generally relating to reimbursement for
preauthorized or approved health care services under
health insurance.
62
Grassroots Advocacy
MSHA’s Actions – Activities – Fun!
1. Set agenda for Legislative Session.
2. Reviewed legislation with help of lobbyists.
3. Developed key contact network.
4. Strategized for the most effective way to
communicate (e.g. listserv, e-mail, telephone, in
person contacts.)
5. Scheduled, planned, and participated in annual
Legislative Advocacy Days in State Capitol.
6. Time the use of Legislative Alerts and distributed
as often as needed.
63
MSHA’s Governmental Affairs
Committee’s Mission
To continuously improve services provided by Audiologists
and Speech-Language Pathologists through professional
education, communication and recognition of excellence.
To enhance opportunity to Maryland’s Speech-Language
Pathologists, Audiologists, and the clients we serve
through group advocacy and involvement in the
legislative process.
To educate the public regarding communication sciences and
disorders and the professions of Audiology and SpeechLanguage Pathology.
64
MSHA’s Governmental Affairs Committee’s
2008 Strategic Plan Objectives
FOCUS AREA: ADVOCACY
Issue: An organized concerted effort by the Association to advocate for the
professions and for the individuals they serve will result in policies and
procedures that improve access to quality programs and service in
speech-language pathology and audiology.
OUTCOMES: Maintain legislative and regulatory advocacy activities related to
the professions and the individuals they serve. Increased visibility of the
professions and the quality services provided by audiologists and speech
language pathologists with policymakers.
INDICATORS OF SUCCESS: At least one event per year for state legislators to
promote MSHA legislative issues to take place in Annapolis and/or in
local districts Advance the MSHA public policy agenda and prevent
passage of legislation that may have a negative impact on the
professions.
STRATEGIES: The Director of Public Policy will work with the Maryland STAR
and the Maryland SEAL to develop plans aligned with the MSHA
legislative/regulatory agenda to use the STAR and SEAL networks to
promote increased coverage for speech-language pathology and
65
audiology services in employee health insurance programs and
education/special education related issues.
Maryland
Speech-Language-Hearing
Association
Public Policy Advocacy Day
Join your colleagues from around the state as they meet their
legislators. Learn about the legislative issues and how to advocate
for our professions and consumers.
Public Policy Day offers MSHA leaders and members the
opportunity to discuss current developments in legislative action,
become informed about pending policy issues and decisions, meet
one-on-one with your elected representatives and their aides, and
learn techniques for advocacy and self empowerment.
66
Agenda
8:00-8:45 Registration and Breakfast
8:45-9:00 Welcome – MSHA Legislative Committee Chair and
Lobbyists Mike Johansen and Geraldine Valentino
9:00-9:30 Meet our Senate and House Sponsors
9:30-10:05 Remarks from other invited legislators as well as
representatives from MSDE/MSTA, the Governor's
Office,
and ASHA
10:00-11:30 Advocacy Training: How to Effectively
Communicate with Elected Representatives
11:30-12:00 Update on MSHA’s Policy Agenda and Strategies for
Action Tour of Legislative Buildings
12:00-1:00 Visits to Your State Senators’ and Delegates’ Offices
1:10-2:15 Luncheon and Meeting at the Historic Maryland Inn
Participants’ Forum
Discussion: Future Legislative Issues
67
Coalition Building
Comprised of individuals or organizations with common interests who
pool resources and collaborate to advocate for a common outcome.
Also may be composed of professional organizations and/or
consumers.
Agencies/Legislators Participating in Past
Advocacy Days
Md Academy of pediatrics
Md State Teachers Assoc.
Md. State Dept. of Ed
Governor’s Office
Md
Coalition for Hearing Impaired
Infant and Toddler Directors
State Senators
State Delegates
Md OT Assoc.
PT Assoc.
Md Hospital Assoc.
68
Maryland Speech-LanguageHearing Association:
Legislative Actions and Victories
1999 Carve-out for Speech/OT/PT/Audio, Hearing Aids
2000 Universal Newborn Hearing Screening
2001 Hearing Aid Loaner Bank
2001 Mandated Insurance Coverage of Hearing Aids for
Children
2001 Mandated Insurance Coverage for Habilitative
Services for Children
2002 Modification and Clarification of Habilitative
Services Bill
2002 Funding Increase for Maryland Infants and
Toddlers
69
Maryland Speech-LanguageHearing Association:
Legislative Actions and Victories
(cont.)
2003 Task Force to Study Availability of
Audiology and Speech-Language Services in
Maryland Public Schools
2005 Higher Education Scholarship
2006 Licensure Fee Reimbursement for School
Based
Speech Language Pathologists and
Audiologists
2007 Comprehensive Licensure for Speech
Language Pathologists and Speech Pathology
Assistants
2008 Introduced HB 1505 Health ServicesReimbursement for Pre-Authorized or Approved
Healthcare Services
70
71
72
73
Advocacy
Maryland’s Key to Success
1. Kept it simple. Did not assume
legislators knew the facts.
2. We were specific. Had small and focused
agendas.
3. Found allied legislators to champion our
issues
4. Developed quality relationships. Supported,
encouraged and rewarded legislators.
74
Advocacy is the Key
5. Had members, parents, supporters send
letters, email and make phone calls.
6. Made in person contacts
7. Annual Public Policy Advocacy Days in
Annapolis
8. Follow-up was critical
9. Formed strong coalitions and alliances with other
organizations.
75
Lobbyists as Mentors
• Need knowledge about the professions of speechlanguage pathology and audiology.
• Capability to communicate the issues with
legislators
• Negotiation skills
• Solid understanding of the political climate
• Awareness of allies and opponents
• Past success with passing legislation
76
Developed Key Contact Network
1. Identified association members who had
relationships or were willing to establish
relationships with their state legislators.
2. Developed a list of legislators we wanted to
contact.
3. Identified geographic districts of key legislators
on important committees.
4. Recruited members who live in the appropriate
districts.
5. Developed a means of communicating quickly
with all members of our network.
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79
80
81
82
Questions and Answers
Group Discussion
Contact information:
Marie L. Noplock, President
The Maryland Therapy Network, Inc.
2225 Old Emmorton Road, Suite 210
Bel Air, Maryland 21015
Office: 410-515-4900, Fax: 410-515-0777
[email protected]
83
TSHA Task Force Initiative
Regulatory, Consumer and
Practice Management
Reform
Working Together
¾My request for assistance
¾Executive Board interest
¾Linda Barbee
¾Judith Keller
¾Private practice task force
¾Barbara Samfield
¾Develop a core group of interested
practitioners
¾Work within the TSHA system
Creating an Action Plan
360 degree advocacy approach
¾Identified stakeholders: SLPs,
policyholders. employers, insurance
companies, DOL, TDI, legislature,
lobbyists, TSHA, ASHA
¾Identified level of involvement: make
laws, determine policy coverage/rates,
purchase policy, enforce laws, educate,
advocate
¾Goals
¾Budget
Goals
¾ Identify consumer and SLP provider issues
related to self-funded health plans
¾ Promote a 360 degree awareness of
focused initiatives through advocacy to
stakeholder groups
¾ Educate TSHA members and other paying
participants about business management
practices and advocacy
¾ Inform TF, TSHA EB and EC about
progress of task force and core group
representative activities
Goal Support Information
¾Developed rationales for each goal
¾Described the benefit to TSHA
¾Developed objectives
¾Developed a budget
Objectives: Goal 1
Knowledge of SLP issues
¾Developed survey forms
¾Demographics
¾Practice management
¾University training
¾Budget
Objectives: Goal 2
Promote 360 degree advocacy
¾Reassigned to Reimbursement Task
Force
¾Four primary target groups
¾Insurance company medical
directors
¾Employers
¾Consumers
¾Legislature
¾TSHA legal council
Objectives: Goal 3
Educate TSHA members and other
paying participants
¾Survey university programs
¾Private practice strand at TSHA
convention
¾Business institute
¾Additional objective:
¾Certified Private Practitioner
¾ASHA
Objectives: Goal 4
Monitor progress and budget
¾TF
¾TF subcommittee
¾Core group
Budget
Developed and revised
¾$70K initially
¾Requested $22,535
¾Received $5000
¾Normal award was $900
Keeping Up
¾Core group meetings
¾Monthly task force meetings
¾Tireless efforts and passion of
those involved
To Date…
¾First year
¾Business institute
¾Demographic survey
¾University survey
¾Second year
¾Business institute planned for April
2009
¾Practice survey
¾Insurance company advocacy
¾Employer advocacy (develop flash
drive)
Just do it!
Develop a cooperative
model that works for
your state!
Advocacy through:
Partnering with
Clients
&
Improving Public and Employer
Awareness
Katrina Zeit, M.H.A., M.A.
ASHA Convention 2008
Where We’ve Been
Negotiating with private
health plans
Baby steps
One step forward, two
steps back
ASHA Meeting with
Medical Director of PA
BCBS
Budget dust
PR Principals that
Support Partnering with Clients
1. PR is …being in the strategic position …
that others come to know, believe in,
and support you and your efforts
2. Marketing is what you say about
yourself; PR is what others say about
you
3. Successful PR requires taking many
small steps over and over again
**Joseph Cerquone, ASHA Director of PR, CSAP pres
Partnering to Improve
Public Awareness
Testimonial Video &
Commercials
Channel 9, ABC
in Cincinnati
www.wcpo.com
WCPO
Jackie commercial
WCPO
Missy commercial
OLSHA
You’ve Made A Difference Award
Anthem
Partnering with Clients
Dr. Rick Strother
and Ampacet
Award at
Convention &
Legislative
Breakfast
Quotes for
brochure
Improving Employer
Awareness
Division Brochure
Speech Therapy for Children: A
Smart Investment in Your
Business
Client Testimonials
“I have seen the monumental sacrifices made by
so many parents to get their children the
therapies they so desperately need. I was
prepared to leave the state where I was born
and grew up, to leave the support of my family
and friends to secure speech therapy for my
sons. I know of parents who have taken out
second mortgages on their homes to pay for
therapies their insurance wouldn’t cover.”
Rick Strother, parent of two sons with autism
Improving Employer
Awareness
“One of our employees informed us that
pediatric speech therapy was not being
covered. He gave us research that
explained that early intervention for
speech and language disorders is critical.
We found that it was not a significant
cost for the company to cover it.
Comparing the costs to the benefits made
our decision to cover pediatric speech
therapy a ‘no-brainer.’”
Bob Oakes, Senior Director of Human
Resources, Ampacet
Highlighting Quality Plans
From Employers
“We expanded our speech therapy
benefit to include speech dysfunction
that occurs as a result of learning
disabilities and developmental
delays—and the rewards far exceed
the minimal cost.”
Jennifer Mueller, Director of Benefits
and Compensation, Cintas
Highlighting Quality
Health Plans
“Anthem realized that many problems
arose from the stipulations in place for
members with developmental delays. As
a result, we made the decision to remove
the pre-certification requirement and the
exclusion. This decision brought many
benefits: It eased the administrative
burden on members and providers,
streamlined internal processes and led to
more cost-effective care.” (Zeit, K.
Advocating for Insurance for Young
Patients. The ASHA Leader. 2004 Feb 17:
2, 23.)
Testimonials from Physicians
“Speech and language impairments in children
are most often caused by neurological
disorders. If left untreated, they are strong
indicators of future learning disabilities. For
the best outcome, they should be diagnosed
and treated as early as possible with speech
therapy.”
Ton deGrauw, MD, PhD, Professor of Pediatrics
and Neurology, University of Cincinnati
Medical Center and Director of Neurology,
Cincinnati Children’s Hospital Medical Center
Speech Therapy for Children: A
Smart Investment in Your Business
¾Policy Language
Can be Misleading
and Confusing
¾Early Access to
Speech Therapy is
Critically Important
¾The Risks of
Inadequate Coverage
¾Low Cost: 8 cents
per member per
month (Milliman,
2007)
¾Investing in
Pediatric Speech
Therapy can Benefit
Bottom Line (NBGH
2008 report)
¾What You Can Do
Current Public Awareness
Initiatives
¾Making speech
therapy and audiology
a household name
¾Media focus
¾Newspaper
¾TV
¾Radio
Sponsored Silence 2008
¾ Two radio announcers
for University of
Cincinnati (UC)
basketball
¾ “Voices” of UC will use
AAC devices at halftime
¾ Game is December 6,
2008: UC vs. UAB
Sponsored Silence 2008
Televised by Fox
Sports Network
12,000 fans
expected to
attend
Professional sports
videographer to
film entire event
Potential radio shows