Health-Care Transition



Shaindle Braunstein, Project Chessed director, goes over Affordable Care Act paperwork with client Peggy Berman.
Shaindle Braunstein, Project Chessed director, goes over Affordable Care Act paperwork with client Peggy Berman.

I was Divorced, recovering from a closed head injury and post-concussive disorder from a recent auto accident, not working and my group health coverage ran out from my last job,” said Peggy Berman of SOuthfield. “I needed help!”

While looking for possible resources at Jewish Family Service (JFS) three years ago, Berman discovered she was a candidate for Project Chessed. She had never heard of the JFS program, now 10 years old and being phased out with the advent of the Affordable Care Act (ACA), also known as “Obamacare.”

Project Chessed, an innovative health care program that became a model for others across the coun- try, served nearly 10,000 individu- als in the Jewish community by providing services, medication and even surgery from local volunteer physicians, hospitals, pharmacies and companies.

“I feel blessed that the people at Project Chessed helped me regain my health and become a whole per- son,” Berman said. “They found out what services I needed, assigned a case worker to me and recommend- ed a new doctor. They helped man- age my prescription costs, some- times paying when I had no funds. With the doctor’s help, I lost weight and changed to a healthier lifestyle. I’m not completely without pain, but I can work with what I’ve got.”

Today, Berman works as a job coach in community-based services at JVS, helping individuals explore and achieve career goals and opportunities.

Last August, the Lansing-based Michigan Consumers for Healthcare (MCH), a broad coalition of health care nonprofits, received $1.6 million in federal grants to help Michiganders navigate the acquisition of health insurance. Project Chessed received $35,000 of that grant to train its staff and two full-time ACA navigators for Oakland and Macomb county residents over the six-month enrollment period.

“They came to us because we were familiar with much of the process in our own work,” said Shaindle Braunstein, Project Chessed director. “A major difference is that physician care was entirely vol- unteers in our program and that portion is now insured under the ACA.”

“When Peggy called for help to register online for the Affordable Care Act, I invited her to attend the Dec. 22 [registration] event at the Jewish Community Center,” said Megan Pudlik, ACA-trained navigator and Project Chessed case coordinator.

The event was open to all who needed help registering. Scheduled for 10 a.m. to 4 p.m., the last person left at 6:30 p.m.

“Peggy was one of the first to walk in the door,” Pudik said. “She had already completed some of the work; once we figured out her subsidies and tax credit, several available plans popped up. Peggy wanted to stay with her current physician so we found providers who accepted that doctor.”

Berman said, “It was confusing figuring out which bracket I belonged in and what coverage I needed. The navigators patiently made everything very clear. You can tell it’s not just their job; they really care.”

Pudik said, “I was blown away by the number of phone calls we received outside the Jewish community asking for help. One woman arrived with no health insurance for six years. She was raising her 13-year-old son and was extremely skeptical about finding a plan. We ended up finding a plan that met her needs for 11 cents a month.”

Jewish Uninsured

Perry Ohren
Perry Ohren

“Throughout its history, Jewish Family Service has been in the business of helping members of the Jewish community sur- vive, whether the issue is housing, healthcare or making ends meet,” said Perry Ohren, CEO of JFS. “About 12 years ago, we realized many in the Jewish community were going without health care because they couldn’t afford to pay for it. Following some discussion, the Jewish Fund [established with the 1997 proceeds from the sale of Sinai Hospital] provided funding for a feasibility study to determine if this was a legitimate problem in our community and health care assis- tance was needed.”

Megan Pudlik, ACA navigator and Project Chessed case manager
Megan Pudlik, ACA navigator and Project Chessed case manager

The need was real. Project Chessed (Hebrew for “acts of lovingkindness”) was established to cover the large number of Jewish adults in Metro Detroit not covered by health insurance. Part of the problem was that many low-income individuals without private health insurance did not have an income low enough to qualify for Medicaid.
“The result was a col- laborative effort among JFS, Federation and other community organiza- tions to find a solution to this problem,” said Margo Pernick, direc- tor of the Jewish Fund. “The goal was to find a respectful approach to health care that kept clients healthy and independent.”

Margo Pernick
Margo Pernick

Ohren explained, “JFS never thought of itself as a resource for access to health care, but rather as a service agency often used as a safety net when there were no other resources. We figured out an eloquent solution that only worked if we could cobble together volunteer hospitals, physicians and pharmacies. Our efforts resulted in more than 1,000 volunteer Jewish doctors providing pro-bono services to our clients, leveraging millions of dollars in free care.”

Project Chessed also partnered with several local hospitals that were compensated by the state for providing care to a disproportionate number of uninsured patients as regulated by the Disproportionate Share Hospital (DSH) program. Commonly referred to as safety net hospitals, they included public and private hospitals, children’s hospitals and university hospital systems.

“Project Chessed established good partnerships with these hospitals because we did all of the required paperwork for our clients, making sure they were eligible for the program and any document required was on file,” Ohren said. “Obtaining pharmaceuticals at the lowest cost possible was the third major part of our solution.”

The Prescription Solution

Mindi Fynke, founder and CEO of Employee Health Insurance Management (EHIM) in Southfield, was honored by Jewish Family Service as the 2013 Community Partner of the Year for her work in support of Project Chessed.

Due to the escalating costs of prescription drugs, Project Chessed started working with EHIM in 2006. EHIM excels in negotiating rates for medications with pharmacies and established a formulary listing medications to treat Chessed clients. Doctors prescribed medications for many conditions from this list and Chessed patients obtained them at local pharmacies that partnered with Chessed.

Mindi Fynke
Mindi Fynke

“We established a formulary of drugs that helped promote generics whenever possible,” Fynke said. “Reaching a 90 percent generic utilization rate permitted Project Chessed to stretch its dollars and reach more people in need. We were also able to use our systems and technology to make the administration of the program much easier.”

Providing every Chessed participant with his or her own ID card, which resembled an insurance card, was one key to the overall mission.

“Our goal was to ensure that Project Chessed members were treated with dignity,” Fynke said. “While an ID card may sound like a simple thing, it allowed clients to know they were part of a community in which doctors, pharmacies and other medical care providers treated them with respect.

“Our goal was to service as many individuals as possible in the most cost-effective way,” Fynke said. “For me, Project Chessed redefined caring.”

There were fundraising events and individual donors, but primary support for Project Chessed came from the Jewish Fund and the Jewish Federation of Metropolitan Detroit.

“Project Chessed was a huge success story because it fulfilled an enormous need without having to create new institutions, and we were happy to be part of it.” Pernick said. “The services were already out there; it was a matter of bringing them together. JFS opened more partnerships and helped other communities develop the same types of support systems that were working so well for the Jewish community.”

Doctors Pleased To Help

“I was impressed with the quality of questions my Chessed patients asked when discussing their health,” said Dr. Joel Kahn, director of cardiac wellness and professor of medicine at Wayne State University School of Medicine. “I’ve worked with a couple dozen over the past seven years, including office vis- its, hospital care and follow-through care.

Dr. Joel Kahn
Dr. Joel Kahn

“Other doctors and I also served on their pharmacy management com- mittee to lower prescription costs,” Kahn said. “Today I’m working with Shaindle Braunstein, adding a wellness element to the program to again lower the costs of health care.”

Dr. Jeffrey Forman, oncologist and professor of radiation oncology at WSU, initially worked with Project Chessed as a board member and later provided health care services for clients.

“My practice is not elective,” Forman said. “People come to me because they need treatment and often that treatment is complicated and expensive. One of my Chessed patients, for example, had breast cancer. She was unemployed and her family was very supportive as she underwent surgery and chemo- therapy, but no one could afford the more than $100,000 in health-care costs.

Dr. Jeffrey Forman
Dr. Jeffrey Forman

“The beauty of Project Chessed is that patients maintain their dignity during their care, presenting their Chessed insurance cards just as other patients present their Blue Cross insurance cards. Clients visited their doctors in the privacy of their offices and physicians fitted pro bono patients in between the appointments of their regular patients. I’m convinced this patient is alive today because of all the physicians who worked with her.”

None of this would have been possible without Rachel Yoskowitz, formerly with Jewish Family Service and currently with Oakland University William Beaumont School of Medicine.

With her nursing degree and strong background in public health, Yoskowitz was the first to identify the needs of uninsured individuals in the Detroit Jewish community. She then produced a feasibility study to define the issue and created a model program to fix the problem — Project Chessed.

“In one year, our Jewish physicians had given away $4 million dollars in healthcare services,” says Forman.

“We took care of a vulnerable population with quality care, but now that type of need is greatly reduced with the Affordable Care Act (ACA). That’s the way it should be: a vulnerable population has its needs resolved and their need for support disappears and other needs take its place.”

Phasing Out

“Project Chessed began planning for its phasing out when the Supreme Court upheld the ACA,” Braunstein said. “For instance, I have a split role at JFS, one as Project Chessed director and the other as JFS’s chief information officer. I will continue full time at JFS in IT.

“One or two staff members may be placed permanently as ACA navigators helping individuals who lost their coverage find health insurance programs. That will continue at a much smaller degree. In addition, JFS has been very successful finding positions for others within its organization.

Recently, the Jewish Fund pro- vided Project Chessed with a one-year “bridge grant” to help their clients successfully enroll in a viable health insurance program provided by the ACA.

“Our first group of about 400 cli- ents is now enrolled successfully in a health insurance plan with significant subsidies,” Braunstein said. “Some are paying as little as $22 a month for insurance that includes prescription medication. The second group, about 250 clients, will be enrolled April 1 fol- lowing expansion of Medicaid by the Michigan legislature.

Ruthan Brodsky | Contributing Writer

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