Today, our nation and our region are facing a historically challenging health care environment, a still volatile economy, the uncertainties of pending health care reform, continually rising health care costs, and the aging of a huge generation of baby boomers. Against this complicated backdrop, two real and complex problems will impact the future of health care for all of us: the challenge of caring for the uninsured and underinsured and the shortage of nurses and other health care professionals trained to care for the elderly.
How can we bring about meaningful, lasting change in our region’s health care system to address these two issues and improve the quality, effectiveness, and affordability of health care for generations to come? The Independence Blue Cross Foundation, a newly formed $10 million private charitable organization dedicated to transforming the delivery of health care, is looking closely at these two pressing issues, and at new approaches to address them.
The Everyday Plight of the Uninsured
While the Patient Protection and Affordable Care Act aims to expand health care coverage to 32 million uninsured Americans starting in 2014, millions of Americans today still face the everyday anxiety of having no health insurance. In 2010, there were nearly 279,000 uninsured adults and 32,000 uninsured children in southeastern Pennsylvania. Uninsured and underinsured families are affected deeply, as every family medical crisis also becomes a stressful financial crisis. Because the uninsured do not receive preventive health care, such as tests, screenings, and health education, their health problems are more likely to spiral into acute health crises, when it is mostly likely they will rely on emergency rooms for treatment. The costs of these ER visits are borne by hospitals, which then raise the rates they request from health insurers, which increases health care premiums for those who have insurance. It’s a vicious cycle, and without alternative ways for the uninsured to get reliable, quality care, it will continue to worsen.
A Serious Shortage of Health Professionals on the Horizon
American nurses and allied health professionals, such as occupational and physical therapists, are aging, and fewer are being educated to take their places. It is projected that by 2025, our nation will experience a shortage of 260,000 registered nurses, a shortage twice as severe as any our nation has seen since the 1960s (PHMC 2010). In Pennsylvania, the nursing shortage could reach 6 percent, or about 6,000 nurses, this year, and by 2017 could be as high as 14 percent. In addition, according to U.S. Department of Labor data, Philadelphia will need to recruit more than 1,770 allied health and health information technology professionals over the next several years in order to keep pace with projected demand. While there is a shortage of nurses in most fields, of particular concern is the shortage of nurses and other health professionals who are specifically trained in geriatrics.
The shortage of nurses and other health care professionals prepared to deal with the unique problems of the elderly will impact primary care, hospital care, and long-term care in the decades to come. Research shows that by 2030, one out of every two baby boomers will have arthritis, one out of every four baby boomers will have diabetes, 615,000 new cases of Alzheimer’s will be reported each year, and more than one out of every three baby boomers will be considered obese. Who will care for this generation as more and more baby boomers require routine and acute geriatric care?
Studies of nursing education and interviews with nursing school educators show that while there are plenty of applicants for nursing programs, as many as 67,000 qualified applicants were turned away in 2010 due to a shortage of seats in nursing schools. The supply of qualified allied health professionals in our region is also limited by low levels of secondary education and a lack of proper vocational training programs. There simply are not enough faculty members available and that number continues to fall as nursing faculty retire and their positions go unfilled. Unless more nurses can be educated as teachers, nursing schools will continue to graduate only a fraction of the new nurses needed to close the ever-widening gap.
Thinking and Acting Outside the Box
To address these serious issues, the status quo is no longer acceptable. Fresh perspectives and innovative thinking are necessary. Through the Independence Blue Cross Foundation, we are looking at the future of health care through a new lens and investing in new ideas.
The IBC Foundation, launched last October, builds on Independence Blue Cross’ rich history of community leadership over nearly 75 years as the leading health insurer in our region. Our community commitment has always guided our support for a wide variety of progressive area organizations and initiatives and has served as a cornerstone for our company’s values. Now, through this new foundation, we are focusing the investment of our resources not only on improving the health and wellness of our community, but also on producing measurable results.
The Foundation focuses on four areas of impact: caring for our most vulnerable, enhancing health care delivery, leading innovative approaches to health care, and building healthy communities.
Caring for our Most Vulnerable: Blue Safety Net
Building on the success of IBC’s Charitable Medical Care Grant Program, which, from
2004-2010, contributed nearly $15 million to support nonprofit health clinics in our region, the Foundation has announced a new program called Blue Safety Net. Last year, this program provided $2 million in grants to 32 clinics that deliver quality, cost-effective care to 145,000 people who would otherwise face financial, cultural, and linguistic barriers to obtaining health care in Bucks, Chester, Delaware, and Philadelphia counties. For many of our region’s residents, these clinics are the only reliable source of health care, and play a paramount role in the everyday lives and health of many families.
Demand for such clinics may soon be on the rise. In Massachusetts, which passed a law in 2006 mandating health insurance, visits to community health centers rose 31 percent between 2005 and 2009, according to a study published in the August 8, 2011 issue of Archives of Internal Medicine (Ku 2011). With the advent of federal health care reform, the clinics in Philadelphia and its surrounding counties could see a similar rise. If so, funding from the IBC Foundation will help offset the costs to clinics of caring for more patients.
By providing more uninsured and underinsured residents in our region with preventive care, including health screenings, health education sessions, and disease management programs, and by encouraging these residents to enroll in medical assistance programs, Blue Safety Net will decrease the number of uninsured and underinsured who use emergency rooms as a primary source of care, thus helping to slow rising health care costs that drive premiums higher. Blue Safety Net will also provide support for the growing number of seniors and their caregivers in our region, a critical need given that Philadelphia is one of the top 5 cities in the country in percentage of residents older than 65, with 12 percent of its residents falling into this age group. This year, a priority of the Foundation will be the design and implementation of a new program to respond to the specific concerns of the elderly, such as transportation, prescription costs, and nutrition.
Enhancing Health Care Delivery: Nurses for Tomorrow
What will nurses and other health professionals need to know to succeed in the health care environment of the future, and who will teach them? The IBC Foundation’s Nurses for Tomorrow initiative, which builds and expands on the more than 3,000 nursing scholarships awarded from 2004-2010 through IBC’s Nurse Scholars Program, will focus on advancing and developing our region’s nursing workforce by developing the next generation of nurses, one equipped to meet the rapidly changing health care landscape.
Nurses for Tomorrow provides scholarships for nursing students pursuing nursing education and advanced and specialized fields such as primary care and geriatric care that will prepare them to deal with our aging population. The program funded $1 million in scholarships in 2011 to students in 26 undergraduate nursing programs and 12 graduate nursing programs in the Philadelphia region. In addition, the program is funding positions for well-qualified teachers in local nursing schools.
Over the next 3 years, the program will also award fellowships to 3 nursing faculty to develop innovative models of educating nursing students in primary care, geriatric care, and public health. The program’s goal is to develop the next generation of promising leaders in nursing education and to support the advancement of nursing education to meet the needs of our changing health care system. In addition, the IBC Foundation is exploring ways to work with allied health professionals to fund programs that encourage students to enter these fields and prepare them to work with the elderly.
Leading Innovative Approaches to Health Care: Innovation Grants
To encourage creative health care solutions that reduce spending, improve quality of care, and expand access to care, the IBC Foundation awards Innovation Grants, which fund promising new projects and research. In 2011, Innovation Grants totaling $1 million were awarded to organizations like the National Nursing Centers Consortium to enable nonprofit community clinics to introduce electronic medical records for safer, more efficient patient care, and to wellness centers at Philadelphia’s Belmont Charter School and Pan American Academy Charter School to provide health education programs to 1,100 students.
Among the Philadelphia region’s most vulnerable are the many impoverished children who fail to receive the health care that all of our residents need. Through its Innovation Grants, the IBC Foundation rewards new ideas for solving old problems, like providing primary care services and managing chronic illnesses among children in our region’s poorest neighborhoods who may have little or no health insurance and no regular access to health care.
The most recent recipient of an Innovation Grant is Education-Plus, Inc., a local nonprofit dedicated to bringing health care and educational support services to underserved students in area schools. In 2010, Education-Plus opened a nurse practitioner-staffed, school-based wellness center at Pan American Academy Charter School in North Philadelphia, which was featured in a recent edition of the Philadelphia Social Innovations Journal (Woods 2011). The center’s nurse practitioner served more than 450 students last year, many of whom suffer from asthma, diabetes, and other chronic diseases.
In a short amount of time, Education-Plus has created a new model of care that promises to be an easily replicated and highly effective way to enhance and transform how health care is delivered in our schools. The IBC Foundation is pleased to partner with Education-Plus on this exciting new endeavor.
With its Innovation Grant award from the IBC Foundation, Education-Plus will continue to fund the wellness center at Pan American and will open new wellness centers at two schools in West Philadelphia, Belmont Academy and Belmont Charter School, where they expect similarly positive results.
Building Healthy Communities: Programs for Children and the Homeless
The final area that the IBC Foundation has targeted is funding unique programs that reach out to those most at risk, including children and the homeless.
Programs are selected for their ability to bring about positive change in the health of our community’s most needy. AIDS Alive®/Speak Up is a program designed to educate middle and high school students about making healthy lifestyle choices and to increase awareness, promote prevention, and reduce the stigma of this disease. Back on My Feet organizes running and fitness programs that support residents of homeless shelters to promote self-sufficiency as a means to build confidence, strength, and self-esteem. The Eagles Eye Mobile visits local schools and clinics to provide free or reduced-cost eye exams to medically underserved kids.
By working together in partnership with all members of our community—physicians and hospitals, nurses and allied health professionals, schools, clinics, the uninsured, and the homeless—and by collaborating on a national level with health care leaders, the IBC Foundation will continue to help shape the health care environment of tomorrow by preparing our region’s workforce and caring for our most vulnerable. We believe that transforming health care in our region is necessary, and that, through forward thinking, strong partnerships and initiatives, we can make it happen.
The new Independence Blue Cross Foundation is taking the lead in tackling major health care issues—caring for the uninsured and developing the health care workforce of the future—with $10 million in funding and a commitment to transform health care in the Philadelphia region.
For more information on the IBC Foundation and how it is transforming health care through innovation in the communities we serve, visit www.ibxfoundation.org
Daniel J. Hilferty is the president and CEO of Independence Blue Cross.
Lorina Marshall-Blake is vice president of community affairs of Independence Blue Cross and is president of the Independence Blue Cross Foundation.
Ku, L., E. Jones, P. Shin et al. (2011, August 8). Safety-Net Providers After Health Care Reform: Lessons From Massachusetts. Arch Intern Med. 171(15):1379-1384.
Public Health Management Corporation Community Health Data Base. (2010). Southeastern Pennsylvania Household Health Survey.
K. Woods. (2011, September). A New Access Point for Primary Care: The School-Based Wellness Center at the Pan American Academy Charter School. Philadelphia Social Innovations Journal. Available at http://www.philasocialinnovations.org/site/index.php?option=com_content&view=article&id=377:a-new-access-point-for-primary-care-the-school-based-wellness-center-at-the-pan-american-academy-charter-school-&catid=21:featured-social-innovations&Itemid=35.