Communities Creating Opportunities
LISTEN, LEARN, ACT
Organizing Orientation CCO (Communities Creating Opportunities) is a grassroots community organizing effort to bring together our Congregation and make systemic change in what matters most to our congregants.
As we work with St. Luke’s South to explore ways to build a pilot program to improve health outcomes and reduce costs for Beth Torah members, we learned about activities and resources already available at SLS, which are available to us now. Many of you are aware that SLS is the official health care partner at the JCC, offering the Health and Wellness Center. Did you know they will send their doctors to speak directly to Beth Torah members, on topics of interest to us? They will meet us at SLS, or come to us at Beth Torah. What topics would we like to learn more about? A cardiologist could speak to us about heart related issues. A nutritionist could speak to us about diet. Their talks on memory loss always fill up – but they will come here to speak on that subject if we want. Tell us what interests you, and we will organize one session, or a series of talks.
If you are interested, please join us to help bring this important work to life. The next CCO meeting will be on Wednesday, December 5th, 7:00 p.m. at Beth Torah. Contact Linda Zappulla at firstname.lastname@example.org
A note from Rabbi Levin: End-of-life issues are of increasing interest for our entire community. The advances in palliative care make it possible for us to anticipate maximizing living and the meaning of our lives even as we face the inevitable. A member of Beth Torah, Dr. Jay Riseman, in this article below answers some standard questions about how care has changed in the last 20 years, and what is possible today.
End-Of-Life Care :
End of life care has been changing in America over the past few decades. In the early 1970s, before hospice and palliative care were available, a patient’s own doctor was responsible for care at the end of life. Unfortunately, sometimes this meant no care and doctors just quit seeing their dying patients. Then, in 1974, a new science came across the pond from England. Dame Cecily Saunders noted poor treatment of the dying patient as a nurse, so she went back to school and became a doctor and founded the first hospice in London. A nurse in the northeast trained with her and brought it to America and it has grown like wild fire ever since. Other innovations changed the medical scene: The invention of ventilators, heart lung machines, balloon pumps, artificial nutrition, transplants and other discoveries made it possible for people to exist in the ICU and no longer be aware. Finally in the last 15-20 years, patients and families have started to demand more control of their symptoms and decisions as the end got closer. Hospice and Palliative Care has only been a board-certified specialty since 2008, but many practitioners in the field now have 25-30 years experience helping families and patients make hard decisions.
There are some startling facts recently described by the Robert Wood Foundation and the American College of Surgeons. 25% of Medicare patients have a surgical procedure in the last year of life, and 33% of these surgeries are in the LAST MONTH of life. Furthermore, chronically ill patients in 2007 were much more likely than patients in 2003 to be treated by 10 or more doctors in the last 6 months of life. So many patients and their families are choosing not to die in the ICU, hands tied down, on the ventilator with tubes and wires in and out of every orifice as well as some newly created ones, but to die in a peaceful environment instead.
Hospice and palliative medicine is a team specialty involving physicians, nurses, care partners (nurses aides), social workers, chaplains, art and music specialists and other experts as needed by family and patient. Interdisciplinary teams (IDT’s) meet every two weeks to discuss every patient in their group. No one person’s opinion is any more valuable than another’s on the team. Patients and their families get the added benefit of multiple opinions, not just their doctor’s.
Many people ask what the difference is between hospice and palliative care. Palliative care is when you are diagnosed with a serious illness, but still pursuing curative care, and need help with symptom management. Palliative care and hospice are both about helping patients and their families make difficult decisions and providing excellent symptom management. Symptoms can include pain, nausea, breathlessness, diarrhea, constipation and a host of others. The team develops an individual plan for each and every patient involved. To be admitted as a hospice patient means that your doctor and the hospice medical director have to agree that the chance of living more than six more months is not likely. So, hospice and palliative care are not at all about withdrawing care, providing death panels or helping patients die. It is all about helping people live as long as they can, but be comfortable, safe and be able to remain close to family, either at home or in an in-patient facility.
If needed near the end of life, only about 20% of patients chose specialty places of peace that are called in-patient hospices. Here, patients are treated with intensive care for symptoms the last days or weeks of life, again in a quiet peaceful place with family around.
Jay Riseman MD, FACS
2012 Health Care Dialogue Video:
The 4 CEOs of health institutions used most often by CBT members have
many ideas on how to save money on prescriptions. Listen to their
thoughts, and see which ones might save you money.
In September, the CCO team met with Jani L. Johnson, the new CEO of St. Luke’s South. (Kathy Howell, who many of you met when she spoke on our Health Care Panel in April, was promoted to Chief Nursing Executive for St. Luke’s Health System.) Working with Jani and several of her staff, the CCO team is exploring ways to build a pilot program to improve health outcomes and reduce costs for Beth Torah members. You will hear more about this as we identify what such a program might look like, and what skills from our members we will need to make it happen.
If you are interested, please join us to help bring this important work to life. The CCO team meets monthly at Beth Torah on the 2nd Wednesday of each month. Next CCO meeting will be on Wednesday, October 10th, at 7:00 p.m.
Important actions coming out of the Health Care Panel Discussion:
-Yom Kippur Study Session (more information will follow in the High Holy Day mailing)
-Education – look for experts speaking on these topics Sunday mornings throughout the year:
• Maximizing your health insurance – choosing the best plan for your family and getting the most out of it
• Medicare – how to be your own best health care advocate
• Patient centered medical home: learn more
• Prescription drugs - what to ask your doctor and your pharmacist
-Patient compliance – how Beth Torah can be an even more supportive caring community, helping members better manage their chronic or convalescent health needs
-The next stage in life – it’s more than ‘end of life’
Join us to help bring these important topics to life. Next CCO meetings will be on Wednesday, October 10th. For CCO information, or to get involved in the CCO process, contact Linda Zappulla at: email@example.com.
THANK YOU FOR THE SUCCESS OF THE
“2012 Health Care Dialogue:
A panel discussion with local health care executives”
Thank you to the panelists: the CEOs from St. Luke’s South, Menorah Medical Center, United Healthcare and Blue Cross/Blue Shield spent two hours with our congregation members, plus additional hours planning and preparing with the CCO program team.
Thank you to more than 140 Beth Torah members who attended the April 25th panel discussion, hearing first hand what the panelist organizations are doing to reduce health care costs, and ways we can work together for mutual benefit.
Most of all, thank you to the CCO team of more than a dozen members and staff who spent countless hours developing the health care survey, tallying and interpreting the results, strategizing how to pull together the most powerful group of local health care leaders to partner with us, inviting and working with them to prepare for the event, and finally thanks to more Beth Torah members who helped turn out a big, interested and attentive crowd.
Look for a follow-up survey to provide feedback on the event and to let us know areas in which you would like to work. Join the team at our next LOC meeting, where we will begin to plan actions that came out of the panel discussion – Thursday, May 24th, 7:00 p.m.
Click here to read an article from the Local Health Care Foundation on the event.
CCO is working on the next steps following the April 25th
Panel Discussion with Local Health Care Executives.
The goal of the panel was to start a relationship and dialogue with the CEOs of the health care institutions used most by Beth Torah members. This panel discussion was focused and narrow – a small portion of a large and complex topic. Members told us they learned from the conversation, and were inspired with things we could do together to reduce health care costs. They also said the conversation raised more questions for them. We will compile these questions and continue to ask for answers from our panelists. So please send in questions to the office, and we will work to get answers, and to share them with the congregation.
For those who missed the event, or would like to listen again, you will find a video at the CCO page on the Beth Torah web site at www.beth-torah.org (under Social Justice).
Next LOC meeting will be on Thursday, June 28th. For CCO information, or to get involved in the CCO process, contact Linda Zappulla at: firstname.lastname@example.org.
CCO Update (February Tekiah)
“2012 Health Care Dialogue: A panel discussion with local health care executives “
Featuring CEOs from St. Luke’s and Blue Cross/Blue Shield - Date to be announced shortly
Kathy Howell, CEO of St. Luke’s South, and David Gentile, president and CEO of Blue Cross/Blue Shield of Kansas City, are confirmed, and others invited, to address important strategic questions about affordable, accessible health care, a primary concern of many members at Beth Torah. St. Luke’s, BlueKC and others were identified in our survey as key health care resources for our members.
Our vision for this facilitated panel discussion with select health care executives in Kansas City is to learn from one another and build long- term relationships with the goal of taking action together for change.
What exactly is the event? Eric Morgenstern will moderate the discussion around the following strategic questions: 1) What are panelists’ organizations doing to reduce health care costs? 2) What can we at Beth Torah do to support those efforts? and, 3) What can we do that perhaps they cannot? Send in your questions and comments, and we will work to incorporate them into the discussion. Contact Linda Zappulla at email@example.com for information about CCO at CBT. The next CCO Local Organizing Committee meeting will be on Thursday, February 23rd, 7:00 p.m. at CBT. We welcome your involvement.
CCO on Health Care (January Tekiah)
Working Toward the CBT Health Care Town Hall (December Tekiah)
Responding to 75% of survey respondents (about 150 Beth Torah members) who say they are concerned about the cost of health care, the CCO team at Beth Torah continues to research this issue, and look for systemic solutions.
How much of your monthly income do you think is reasonable to spend on your family’s health care costs? 2 percent? 5 percent? 10 percent? Slightly more than 100 Beth Torah congregants responded to this item on our recent health care survey.
• Fifty-one of them say that at least 10 percent of their families’ monthly income is spent on health care.
• Twenty-four say they are spending at least 20 and as much as 40 percent each month on health care.
Can we do anything to bring down the cost of health care?
CCO@CBT is planning a Health Care Town Hall to explore this important question. Our original plan was to hold this action in December. However, we are now aiming for early February. We envision a powerful panel of speakers: from the hospitals and insurers that serve many of our congregants, to a representative from the state insurance commission. We are taking the extra time to ensure the participation of these decision makers, and to involve more Beth Torah members in the planning of our event. We will be scheduling focus groups to get input from Beth Torah doctors and from congregants who work in the insurance industry.
Are you ready to join CCO@CBT to help plan our Health Care Town Hall? Contact Linda Zappulla at firstname.lastname@example.org
so that she can give you the schedule of our upcoming planning meetings. We welcome your involvement.
CCO: Community-Wide Action (November TEkiah)
Annoucing the CBT Health Care Town Hall
In early December, CCO at CBT will host the CBT Health Care Town Hall, with invited panelists including executives from the health care providers serving most of the CBT community, industry executives and elected officials. Look for details on the date, the speakers, and your opportunities to participate.
At this event we will share results of the recently completed health care survey, a few highlights of which are shared below:
1. 200 families representing 591 persons completed the survey.
2. 76% say they are concerned about the cost of their health care.
3. Approximately ¾ are always able to pay their deductible, co-pays and prescription costs. This means that ¼ (that’s 40-50 families) sometimes or always cannot!
4. Approximately ½ never forgo or delay doctor visits and treatment, and ¾ never forgo or delay medications. This means ½ (that’s 100 families) may delay or forgo doctor visits and treatment, and ¼ may forgo or delay medications.
5. 24 CBT families are spending 20% to 50% of their income on health care.
6. Right now, Eight CBT families do not have health insurance for at least one of their members.
CCO at CBT invites you to help plan our Health Care Town Hall. We welcome your involvement. We meet monthly on Wednesday evenings at Beth Torah. For more information, contact Linda Zappulla at email@example.com.
CCO Update at Beth Torah - (September Tekiah)
Working Toward Action
At the writing of this article, 162 Beth Torah members had completed the health care affordability questionnaire. By the time the survey has closed on September 18th, we hope to have more than 200 responses, to give us a detailed view of how health care costs are affecting our members.
The research and exploration around health care costs has led us to envision possible solutions to our health care concerns. We considered new ways of educating ourselves, finding consultation and support from others in our community that have learned before us, providing critical answers to urgent health care questions before we slip into crisis mode. We also explored reducing all health care costs by re-directing “super-users” of emergency rooms to convenient local clinics for non-emergency needs, and by focusing on hospital re-admission rates as an opportunity for change.
This CCO work is a new form of social justice: Our power rests in ALL OF US speaking out on an issue. Our work in the prior months, building relationships and sharing our concerns, is bearing fruit with real solutions on the horizon! We’re excited about the shape our work is taking and look forward to sharing our learnings and proposed action at an event to be scheduled this fall.
CCO at CBT welcomes your involvement. We meet monthly on Wednesdays at Beth Torah. For more information, contact Linda Zappulla at (913) 685-3521 or firstname.lastname@example.org.
Join us at two October opportunities to participate;
1. Attend our interactive Yom Kippur study session on Saturday, October 8th. Hear first-hand of our progress in the last year, get the preliminary results of our health care survey, and develop relationships with your fellow members at Beth Torah, by learning and then participating in a one-to-one relational conversation.
2. Attend the city wide CCO action on Tuesday, October 18th, at 6:30 p.m. at Union Station - Communities Creating Opportunity Now: It’s On. More than 1,000 members of CCO congregations across the Kansas City metro will advocate for specific changes that will make Kansas City a better place. CCO congregations will call on elected officials and other leaders to help create economic security, and safe and healthy environments for families by taking specific action to:
• Reduce interest rates on payday loans and prevent unnecessary home foreclosures.
• Improve access to health care while lowering costs.
• Provide quality public education and restore the safety of neighborhoods blighted by crime.
CCO at Beth Torah hopes you will join us on this journey. Our next CCO/LOC Meeting will be held on Wednesday, October 5th, 7:00 p.m.
CCO Update at Beth Torah - (July/August Tekiah)
Working Toward Action
Members of the CCO Local Organizing Committee at Beth Torah recently met with experts on various aspects of health care, continuing the ‘learn’ aspect of the CCO process.
1. Team members had a conference call with a member of a congregation in Boston, who shared her experience in gathering cost information from the community. Her group was able to demonstrate that assuming consumers could pay a given percent of their income for health insurance didn’t take into consideration the realities of financial responsibilities (such as previous debt, care of parents, tuition, etc.) This data turned out to be the baseline the state government used in establishing cost thresholds for state-wide health care when it was established.
2. The CCO Group met at Beth Torah to learn from Chuck Wells, a consultant to hospitals and health care providers and former chairman of the Kansas Health Institute. He expressed concern that consumers are disengaged from their true health care costs, due to negotiated rates with insurance companies, a cost structure based on Medicare, and employer coverage plans typically built into payroll deductions. He felt transparency of costs would be the most effective tool for change. Chuck was the most pessimistic of those we spoke with, concerned that the increasing costs of health care reform will fall back on those of us who are actually paying for our health insurance, and that we can’t anticipate the unintended consequences of massive reform like the Affordable Care Act (ACA).
3. A small group met to begin to identify needs and possible resources to help community members navigate the many entities they may have to deal with as they face major health insurance questions, including coverage for individuals and for children over or under age 26, Cobra, negotiating costs with providers, Medicare and Medigap, high risk pools and others. The first goal would be to understand existing resources, and then consider the cost/benefit of filling in potential gaps.
4. Two CCO members attended a Train the Trainer session at UMKC, where the group – primarily social workers - was given tools to educate their various constituents about health care reform. This meeting was the most optimistic of those we attended, noting that the ACA increased funding to primary care providers, community health centers and nursing faculties, and represents the first major change to health care since Medicare was introduced in 1965. Most inspirational was learning that better care can be achieved at lower costs, by reducing hospital-acquired conditions, preventable injuries, and hospital readmissions by better coordination among doctors, nurses, specialists and labs.
Much of our learning has been focused on the subject of costs - we believe this is a place where we can make a difference. We want to address this complicated issue in a way that fits the needs of Beth Torah members, and is specific to the time and place in which we live. We plan to host a meeting at the end of the summer/beginning of the fall to share what we’ve learned about the opportunities to impact health care and insurance in the KC metro area. We will also ask participants to share their needs (or the needs of their friends and family members) and we will consider possible action steps that intersect Beth Torah needs and external opportunities— conducting our own cost survey to determine what Beth Torah (and possibly Kansas community) members can actually afford to pay; further exploration of a community risk pool, and making it easier for Beth Torah members (and possibly the community) to gather the information that might be needed for contending with health care struggles. Expect to hear more details in the next few months.
We invite the CBT community to continue to listen, learn and act with us. Our next meeting is Thursday, August 30th, 7:00 to 9:00 p.m. Whether you have been involved before, or want to see what’s going on, you are welcome.
Please contact Linda Zappulla (email@example.com
) for information and to get involved.
CCO Update at Beth Torah - Working Toward Action
On April 27th, 2011, 20 Congregation Beth Torah members attended a Q&A Research Action to learn more about the Kansas implementation of the Affordable Health Care Act. Linda Sheppard, Director of the Accident and Health Division of the Kansas Insurance Department, led the session. The following are highlights of her responses to our questions:
There are two high-risk pools available in Kansas, especially for people with pre-existing conditions:
1. The existing state pool. This has 1,600 members who pay up to 128% of market rate for coverage. To qualify, you must be a state resident for 6 months and denied, or facing premiums higher than 128%. The Medical Loss Ratio (MLR) for this pool is 200% - two dollars paid out for care for every dollar paid in for premium.
2. The new federal pool. It has 170 members since it started less than a year ago, paying 100% of market rate. To qualify, you must be a US citizen, without coverage for 6 months, have a pre-existing condition certified by a doctor, and cannot move over from the state risk pool. MLR was projected at 400%, but is actually at 1,000%, based on actual costs and the composition of the pool - very small enrollment and very high cost of care delivered.
Linda described the eight working groups initiated to develop Kansas Health Care Exchange required for 2014. In an attempt to be transparent and inclusive in the process, these groups are open to all interested parties, with conference call lines that would allow us to listen and maybe even participate.
We also discussed the concept of creating a risk pool for the Jewish community. She educated us that the rate-setting methodology already combines individual purchasers into virtual pools with all the other individual purchasers. From an actuarial point of view, a pool needs to be very large to cover the risks. Historical groups (chambers of commerce and individual business associations) that have offered such pools have shut them down - only 2 remain in Kansas. Even 1 high cost individual can bring down an entire pool. When one of our members offered up the idea of a new risk pool proposal from the Jewish community, supported by an actuarial study, Linda thought it a good way to approach the request. A consideration here is that the time and cost it would take to fund and prepare the study (and get various groups involved) could take up most, if not all of the time between now and 2014, when all the rules will change to an unknown state with the next stage of implementation of the Affordable Care Act.
CCO team members left the discussion shocked that the Affordable Care Act appears to be more about access than affordability. We were surprised to learn the working groups are not about cost; they are focused on implementation of the Kansas Health Exchange by the 2014 date.
With the goal of affordable health care for all, the CCO team plans to do the following:
1. Assess the viability of pursuing a risk pool for the Jewish community.
2. Pursue information about costs so that we can influence the implementation of the Affordable Care Act to include consideration of the cost to consumers, as so many CBT stories have addressed.
3. Assess the challenges individuals face in researching their options, as well as the ‘simple’ task of filling out insurance applications, where a single answer could re-direct one into a risk pool. A potential resource could be services offered by JFS.
Next CCO Meetings:
June 15, 2011, 6:30 to 9:00 p.m. at CBT (in lieu of the previously announced May 26th meeting)
June 30, 2011, 7:00 to 9:00 p.m. at CBT
For those who are interested in planning a citywide action with all CCO member congregations,
contact Joy Friedman about the upcoming CCO Metropolitan Leadership Assembly
June 2, 2011, 6:30 to 8:30 p.m.; St. Therese Parish Center, 5814 Euclid Ave, Kansas City MO 64130
For CCO information, or to get involved in the CCO process, contact Linda Zappulla at: firstname.lastname@example.org
Click here to download our 1-to-1 Conversation Form
CCO Update at Beth Torah - Working Toward Action
• On January 30th Beth Torah held its first research action. Members of the CBT Local Organizing Committee (LOC) met with Anna Lambertson, Executive Director of the Kansas Health Consumer Coalition. Led by Barry Daneman, the group began to learn about how the Affordable Care Act (ACA) affects the accessibility and affordability of health care for Kansans who are uninsured, high-risk, have pre-existing conditions and/or special health needs, as well as how CCO/CBT can influence implementation of the act locally.
• As we understand more about the ACA, we begin to identify people we should reach out to – legislators, regulators, insurance department, Medicaid team - and additional questions we need to ask.
• The ACA is complex and changes over time. As we explore the implications of this act, one of the questions we’ll be exploring is the potential cost of health insurance to Kansas residents as implementation continues.
1. The group will continue research to understand the political landscape and possible areas of action, while holding 1-to-1 meetings to better understand the healthcare needs of, and to build relationships with CBT members.
2. Additional 1-to-1 training was conducted, and the CCO team will reach out to the congregation to conduct health-related meetings with CBT members to hear our stories and learn more about our specific concerns. You may be invited into a conversation, or feel free to call to share your story.
For CCO information, or to get involved in the CCO process, contact Linda Zappulla at: email@example.com
In December and January the CBT Employment group conducted an employment survey of members and met with Jewish Employment Service (JES) to learn more about its services and how CBT can work more closely with the agency, to assist CBT members seeking new employment. About 70 CBT members responded to the survey, 30 of whom are looking for new employment. While many members are willing or able to share job openings or network with CBT members, it seems that JES has a process and provides a broader resource, including a Job Club, with which CBT members could become more involved, both as job seekers and as resources. Please feel free to continue to contact CBT member Steve Becker at firstname.lastname@example.org and he will help put you in touch with Gayl Reinsch at JES, or you may contact Gayl directly at email@example.com. JES is a joint program of Jewish Family Services and Jewish Vocational Services whose goal is helping unemployed persons in the Jewish community become employed.
JES services available (There is a small charge for career counseling sessions for those able to pay):
- Career assessment
- Resume assistance
- Networking skills
- Interviewing preparation
- Job search strategies
- Guidance and connection to jobs
JES has a Job Club that presents speakers and interactive sessions on topics of interest to job seekers. Job Club meetings are held the 2nd and 4th Mondays from 4:00 to 5:30 p.m. at the JCC (room varies). Everyone is encouraged to attend these free sessions!
What’s keeping Beth Torah members up at night? Throughout this year, CBT held a listening campaign, primarily in House Meetings, where more than 100 members of the congregation shared their personal stories. On September 12th, over 200 members met in the sanctuary for the CCO Call to Action at CBT, where they heard a selection of stories that illustrated the predominant threads that emerged from all the stories:
• Congregation members are worried their life or that of a loved one is not what they expected, due to health, financial and/or employment concerns. “I am one crisis away from disaster.”
• Congregation members want Beth Torah to be a place they can engage meaningfully with others, and a community that welcomes, supports and honors the full range of their life’s experiences. “I thought I was the only one who felt this loneliness.”
CCO (Communities Creating Opportunity) is teaching us organizing - new ways to come together, to listen and to be heard, and to build the Power of Community. In our culture, we tend to face our challenges alone. Through organizing we have found a vehicle to connect people, to share our difficulties, and to harness our collective energy to exert power for change.
More than 130 members of the congregation signed up to get involved. We met on Thursday, October 21th at 7:00 p.m. at Beth Torah to take the next step in the process – beginning to research one or several topics to learn more about the issue, identify the people or entities that might have the power to change things, and what kind of action Beth Torah members could take to make change happen.
Listening to the stories of our fellow members connects us to each other – we begin to feel heard and to feel known and to feel accepted. Acting on what we learn makes our community a better place. Acting together reminds us we are not alone, as we build the Power of Community.
For CCO information, or to get involved in the CCO process, contact Linda Zappulla at: firstname.lastname@example.org