Opinion: Waiting and waiting for the health care system we need

By Donna Smith.

It has been nine months since I became a “member” of a Kaiser silver insurance plan via the Colorado insurance marketplace (our state’s Affordable Care Act/Obamacare exchange).

Donna Smith photo newest version recropped

My premiums have totaled approximately $4,000. My payments to Kaiser for deductibles and co-pays have totaled approximately $1,250. My payments to other providers for out-of-pocket charges,\ and deductible portions of medical bills have totaled another $2,500 in monthly payments.

Still, I received a letter last week that explained that if I stay with the same plan, my co-pays and deductible portions of my medication costs will go up in 2015 for a plan that covers less. I will then be part of a bronze Kaiser plan. My status will have diminished to that of a person carrying essentially catastrophic coverage for my own health care.

Kaiser was one of the big winners in Colorado as people signed up for coverage on the exchange. I chose the plan that had premiums I could best afford since the small nonprofit for which I work does not cover any benefits for me. As a 59-year-old cancer survivor, I am not exactly the sort of new “member” or policyholder any insurance company hopes to capture. But Kaiser captured me and a huge percentage of the new health insurance business sold on the Colorado exchange. Believe me, I don’t really want to be captured by any insurance company either. I’d far prefer that we had an improved and expanded Medicare system that covered all of us throughout our lives.

Since January, I’ve watched as the Kaiser facility I use in East Denver has gotten busier and busier. I really like my doctor and the Kaiser model seems mostly good to me as care seems better coordinated. I especially like the access provided through the website. Getting test results and reminders via the web is great.

Pharmacy lines have gotten longer and longer as Kaiser has added more new members like me. (Photo by Donna Smith.)

Pharmacy lines have gotten longer and longer as Kaiser has added more new members like me. (Photo by Donna Smith.)

Then came the changes to the pharmacy. It was always a bit busy and growing busier at the East Denver location, but then things went crazy. Kaiser upgraded the computer system for the pharmacy.  Wait times swelled. I can get many of my meds via the mail service, but when I need an antibiotic or a medication that cannot be mailed, I must wait in the pharmacy lines. I said lines because when you get a new medication, you must first wait in the check-in line and then once you have checked in, you have to wait until your name appears on the computerized board and then get in the pick-up line and wait again.  That two-step wait has seemed odd to me from the beginning, but when the new computer system went live, that two-step process for in-person picks became positively awful.

So what could I do about it? Everyone else was waiting too, and everyone else was frustrated.  I wrote about it, took photos of the long lines, and sent my blogs out into the online world. It seemed really unnecessary to me that Kaiser could not staff up enough to handle the higher demand since the income from so many new members should have boosted revenues enough to allow for that. I joked with the pharmacy staff about it, as I knew they were not responsible for the problems. Suffice to say that one of the pharmacy techs told me about his/her most recent job, and it had nothing to do with helping with or handling patient medications. I didn’t want to get that person in trouble, but I’ll admit to thinking it less than comforting that any retail or customer service experience at all in any field is apparently enough to staff a pharmacy window.

Kaiser didn’t like the attention my writing could garner. First I heard from someone in member relations, and then from someone who heads the Kaiser pharmacy administration for several Colorado locations. I shared my concerns about Kaiser’s growing pains, including the delays in getting new meds and the potential impact on my health from waiting to start new medications. The Kaiser administrator did apologize and suggested I might try one of the less busy locations until the new computer system is functioning better. That could work, I told him, on days when I am at the office and close to another Kaiser office. I tried to be understanding. He said it was difficult to find enough people to hire to help out, as I suggested having greeters was at least reassurance that Kaiser was trying to address the problem.

I noted that Kaiser was handing out energy bars and bottles of water to those in line the past two times I was there. One of the especially bad days for waiting, my husband pulled up a chair to sit and move along with him in line as he waited for me (I was so ill I was sitting in the more general waiting area). We’ll admit to being moderately pleased when we arrived back two days later to see chairs placed strategically every few feet along the path of the line so that people with disabilities like my husband or those who feel ill (like sick people are prone to do) could sit a bit during the long waits. We felt like we had actually helped change at least part of the process for the better.

But what about the waits on phone lines for billing and financial services help? How about the burdens placed on other parts of the Kaiser system (and other providers)? Am I to believe that this very visible example of the strain on the Kaiser system is only unfolding in the pharmacy lines or would patients be concerned if we knew the pressure of our increased numbers on the whole system?

Clearly, if insurance carriers like Kaiser or going to get more premiums from more “members” like me, we need some assurance that our quality of care and our access to care will reflect a commitment to better health and not just higher revenues and profit margins for the industry.

Opinions expressed in Health News Colorado represent the views of the individual authors.

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