NBfC Endorses NEPA Breastfeeding Center at Pediatric Associates of Kingston, PA

NBFC-Endorsement-SealThe National Breastfeeding Center (NBfC) is pleased to announce the endorsement of The NEPA Breastfeeding Center at Pediatric Associates of Kingston, effective July 14, 2017. This endorsement builds on the more than 30 years of experience that Pediatric Associates of Kingston has in offering breastfeeding support to mothers and babies in our community.

“Our Breastfeeding Center is the only nationally certified breastfeeding program in Northeastern Pennsylvania. Through this national certification, mothers, babies – and employers with workplace lactation programs – can trust that we provide comprehensive, top quality lactation services” says Jeffery R. Kile MD, owner of Pediatric Associates of Kingston.

The NEPA Breastfeeding Center was established to provide private lactation services for all breastfeeding mothers and babies in our communities. The center provides breastfeeding support and counseling by international board-certified lactation consultants (IBCLCs) led by Darnetta Yukso, CRNP, IBCLC. The consultants work with the family’s obstetricians, pediatricians and family doctors to provide a structure of care continuity. “Our goal is to be a resource to all that need sound, evidence based breast feeding advice and care,” says Darnetta Yusko, CRNP, IBCLC.

The National Breastfeeding Center seal of endorsement is given to medical practices that have a proven track record of supporting breastfeeding mothers and infants at a significant level of quality.  These practices are able to work with the most difficult and challenging breastfeeding problems, provide education on a wide range of lactation issues, coordinate care between families and their employers, insurance companies and doctors, and offer high quality pumps and supplies to help support breastfeeding duration.

To earn the NBfC endorsement, medical offices must go through a comprehensive audit and review of their practices and policies by the NBfC, including compling with the WHO Code and demonstrating how they surpass the stringent criteria set forth in the application process.

NEPA Breastfeeding Center provides superior outpatient lactation services and we are delighted to recognize this center through our official NBfC endorsement,” says Susanne Madden, chief operating officer of the NBfC.  “They are constantly innovating the services they provide to the pediatric community and have consistently invested in on-going training and education of their staff and providers. We look forward to assisting them expand their breastfeeding services and resources to employers that are interested in developing workplace lactation programs.”

NEPA Breast Feeding Center is part of Pediatric Associates of Kingston, LLC, an independent pediatric practice.  You can find out more here: http://nepabreastfeeding.com/

Questions? Please reach us here: inquiry@nbfcenter.com / 855-777-NBFC

 

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Fourth Year of Ranking Healthcare Insurers on Support for Breastfeeding Moms: Asuris Zooms to the Top, Most Grades Remained Consistent

New York, NY, March 8, 2017 – International Women’s Day:

Asuris rose in its ranking by the National Breastfeeding Center (NBfC) this year, upgrading from a D- to an A due to greater transparency in its policies and for its overall coverage for pumps and services.

The National Breastfeeding Center (NBfC) reviews insurers’ publicly posted benefits for members and evaluates how well insurers are living up to their obligations to meet the intent of the law. They publish the results in an annual Scorecard. Most of the payers’ scores this year have remained fairly consistent with last year’s grades. However, there have been a few standouts.

In addition to Asuris zooming to the top of the list, securing an A grade overall, United Healthcare Community Plan made a significant leap, moving from a failed grade to a B+, due to publishing its policies and providing improved coverage. Blue Cross Blue Shield of Florida upgraded from a C to a B+ due to improvements in benefits and Anthem Blue Cross Blue Shield (across all states) upgraded marginally from a B- to a B. Other insurers that showed improvement include Health Partners, which moved from a C+ to a B, and MedMutual, which moved from a D to a C+. Qualcare was newly added to the list and scored a B.

It’s not all good news though. “There have been a couple of downgrades, which we are sorry to see” said Susanne Madden, NBfC’s Cofounder and COO. “We have two insurers that inexplicitly decided to stop publishing information about coverage – Peach State/Centene and Total Healthcare – dropping them both into the ‘fail’ category”. Part of securing a grade requires that Payers make their information publicly available. Policies vary from covering the bare minimum as required by law to offering fully qualified lactation care providers and the purchases of efficacious pumps. “We did not expect to see much change this year due to the fact that it was an election year with the very real possibility of a dismantling of the Affordable Care Act” said Madden. “The ACA specifically made a deliberately, though not clear, attempt to address and expand breastfeeding support and coverage. The potential repeal or replacement of the ACA potentially puts at risk the breastfeeding support/coverage insurance coverage gains made from 2013-present, as reflected in our NBfC Scorecards*” stated Todd Wolynn, MD, MMM, IBCLC and CEO of the NBfC.

“Given the strong current federal legislative proposals to modify or entirely replace the ACA, the NBfC remains ideally positioned to continue to measure, publish and reveal trends/changes to health insurance coverage and support of breastfeeding and breastmilk use.” said Wolynn. Madden further states “We call upon the healthcare insurance industry to at least maintain the current level of breastfeeding benefits, in the face of challenges to the Affordable Care Act. The population health benefits that breastfeeding affords society may take some time to bear fruit in the form of lower healthcare care costs, but one thing is for certain – putting women’s health issues on the chopping block is a guaranteed way to ensure that future costs spiral.”

*NBfC researches and measures publicly communicated insurance policy points, which are scored based on the Model Payer Policy – Payer Coverage of Breastfeeding Support and Counseling Services, Pumps and Suppliesan evidence-based, “best practices” resource demonstrating optimal breastfeeding coverage and support, which health insurers could provide to their applicable members.

Scoring Methodology

NBfC assesses commercial insurance companies’ published policies and guidelines and assigns a grade based on the adequacy of coverage provided, using The Verden Group’s Policy Search tool to locate official Medical Policies, Google to search insurers’ member and public domains for guidelines, and newsletters that contained information about each company’s breastfeeding coverage.

Questions? Please reach us here: inquiry@nbfcenter.com / 855-777-NBFC

www.nbfcenter.com

Third Year of Ranking Healthcare Insurers on Support for Breastfeeding Moms: Neighborhood Health Plan Shoots To The Top, Premera Makes Great Strides

New York, December 8, 2015: Neighborhood Health Plan receives the highest grade out of 117 healthcare insurance plans nationally ranked by the National Breastfeeding Center (NBfC) on the provision of breastfeeding benefits to those insurers’ members.

Initial research was conducted in 2013 to see how the insurance industry was responding to the Patient Protection and Affordable Health Care Act (PPACA), which went into effect on August 1, 2012. This marks the third year that NBfC has scored these policies.

“I wish we could say that coverage is steadily improving every year, but it isn’t,” says Susanne Madden, COO, of the National Breastfeeding Center. “While gains have been made, the majority of insurers continue to skirt around the intent of the law and many continue to provide the least amount of benefit in order to comply with the law.”

That said, “there are some standouts this year that really should be looked to for emulation by the rest” said Madden. Neighborhood Health Plan zoomed up from a score of D+ last year, mostly due to greater transparency and a revamping of its policy, and Premera Blue Cross Blue Shield lifted its scores from C+ to A- thanks to offering greater choice in pumps and covering counseling.

“As parents become more educated health care consumers, this type of information can help them make more informed decisions about the value they get for their dollar,” says Albert Wolf, Chief Financial Officer of the NBfC.  “Every insurer will tell mothers that they cover breastfeeding services, but most consumers don’t have the ability to see and compare how well those services are actually covered.  Armed with these grades, they can have a better idea about how well breastfeeding services will be supported by various insurers when they’re shopping for insurance companies.”

As with every year, those companies covering home visits, offering a variety of pumps that are able to be dispensed from both providers and medical supply companies, and utilizing trained lactation consultants are the ones that scored the highest.

View the 2015 Scorecard here

Download a pdf of this release here.

Scoring Methodology

NBfC assesses commercial insurance companies’ published policies and guidelines and assigns a grade based on the adequacy of coverage provided, using The Verden Group’s Policy Search tool to locate official Medical Policies, Google to search insurers’ member and public domains for guidelines, and newsletters that contained information about each company’s breastfeeding coverage.

Questions? Please reach us here: inquiry@nbfcenter.com / 855-777-NBFC

www.nbfcenter.com

National Breastfeeding Center Announces Endorsement of The Lehigh Valley Breastfeeding Center, Allentown, PA

The National Breastfeeding Center (NBfC) is very pleased to announce that The Lehigh Valley Breastfeeding Center has been awarded the NBfC Endorsement for Excellence in providing breastfeeding services, effective November 1, 2015.

Located in Allentown, Pennsylvania, The Lehigh Valley Breastfeeding Center’s primary goal is to provide compassionate, evidenced-based care and education to breastfeeding families. It is located inside The Children’s HealthCare Center and staffed by passionate physicians and staff that are experts in breastfeeding medicine. The Center is designed to both service Children’s HealthCare’s own patients and as an additional specialized resource for other breastfeeding mothers and their babies in conjunction with their existing healthcare professionals.

The National Breastfeeding Center seal of endorsement is given to medical practices that have proven able to support breastfeeding mothers and infants at a significant level of quality. These practices are able to work with the most difficult and challenging breastfeeding problems, provide education on a wide range of lactation issues, coordinate care between families and their jobs, insurance companies and doctors, and offer efficacious pumps and accessories to help support breastfeeding duration.

To earn the NBfC endorsement, medical offices must go through a comprehensive audit and review of their practices and policies by the NBfC, including compliance with the WHO Code and demonstrate how they surpass the stringent criteria set forth in the application process.

You can visit the Lehigh Valley Breastfeeding Center at http://www.lvbreastfeeding.com and meet their specialists:

  • Kenneth Toff, DO FAAP IBCLC
  • Rima Strassman, MD FAAP FABM
  • Anna Linderman, MD FAAP CBS
  • Lora Steffie, RN BSN IBCLC CCE
  • Tracy Kramer, MSN CRNP CLC
  • Laurie Cohen, DO FAAP CLC

Questions? Please reach us here: inquiry@nbfcenter.com / 855-777-NBFC

Milk Money

NBfC’s very own Todd Wolynn recently gave a compelling presentation on the history and importance of breastfeeding. This enlightening and engaging talk ends with a call to action for the future. If the applause from the audience is any indicator, change is coming but there is still work to be done.

Todd takes us back 250 thousand years to a time when the dinosaurs became extinct and “warm-blooded creatures who gave birth to live young and nursed their young with milk” became the dominant species.

“What were they called? Mammals, because of these… it’s not all about the mammary glands. It’s about what came out of them.”

For 250 thousand years, humans “were literally grown on this stuff. It nourished our life force.” Todd goes on to ask what could possibly change such a perfect system? In the 1900s, big business got the idea to take breast milk from one species and feed it to another. Suddenly, cows milk becomes known simply as “milk” and the move away from drinking our own milk began. Baby formula was only a few steps behind.

Dr. Wolynn makes it clear that he is not trying to “demonize cows” or “bash formula”. He recognizes that formula can indeed be medically necessary in some cases. He points out that doctors study for 8 to 9 years in Medical School. Countless hours, even entire courses, are dedicated to learning about another precious human fluid: blood. How many hours are dedicated to breastfeeding education? 2 hours or less.

Compare that with the amount of time that doctors are directly or indirectly faced with positive marketing messages from the formula industry. A recent survey shows that 40% of physicians think breast milk and formula are equivalent. They’re not.

“Millions of years of mammalian evolution designed this complex dynamic, species-specific design ensured to keep infants survive and thrive.”

Formula may have the most basic building blocks of breast milk: fats, sugars, and proteins, but it doesn’t have these: antimicrobial factors, growth factors, cytokines and anti-inflammatory factors, digestive enzymes, hormones and transporters. Many of these components simply cannot be made outside of the human body.

Just some of the components of breast milk, with more being discovered each year.

Just some of the components of breast milk, with more being discovered each year.

With nothing to stop the marketing machine of formula, breastfeeding rates dropped dramatically. By 1971 only 1 in 5 women even attempted to breastfeed, resulting in striking feeding changes in our society.

“In less than 100 years, the art, the knowledge, and the teaching of breastfeeding from grandmother to mother to daughter was gone.”

The US formula market is valued at $4 billion dollars. New mothers are flooded with freebies, samples and special offers to entice them into using formula. The motive is clear: every baby who doesn’t breastfeed is a potential formula customer.

If it all comes down to economics in the end, Wolynn expertly argues that breasts make more money than formula, “thanks to what comes out of them.” He’s not talking about milk here; he’s talking about savings.

A recent report from the federal government shows employers that every $1 spent on comprehensive breastfeeding support programs results in a $3 savings. That’s a huge return on investment! That’s just in the workplace; the savings for us as a nation are even greater. A recent Harvard study shows that if 90% of women in the US exclusively breastfed for the first 6 months, we as a nation would recognize 3 billion in savings.

Breast milk offers benefits far beyond complete nutrition. In terms of preventative medicine, the long-term benefits of breastfeeding are impossible to ignore. Take a look at just some of the chronic diseases and conditions that we could be fighting on the front end of the healthcare system, instead of the back end:

With breastfeeding, the risk of these diseases goes down; with formula feeding, they go up.

With breastfeeding, the risk of these diseases goes down; with formula feeding, they go up.

When Dr. Wolynn was in Medical School they didn’t know the risks of not breastfeeding, but we do now. Now is the time for action. Now is the time for change.

What can be done?

  • Training and education of physicians and healthcare workers on how to support breastfeeding
  • We need to inform and educate moms and families about the benefits of breastfeeding
  • We need to demand that the healthcare services, support, equipment and donor milk are covered health benefits.
  • Consider the strong case for 3-6 months paid maternity leave.

In closing, Wolynn’s message is simple. “Let’s got back to the beginning and let mammals be mammals and see what comes out of that mix.”

Watch the video presentation here: www.youtube.com/watch?v=gqB44IYKRvs#t=15

not equal

Dr. Todd Wolynn (MD, MMM, IBCLC) is the CEO of the National Breastfeeding Center and the President of Kids Plus Pediatrics. He has been named one of America’s Top Doctors by US News & World Report.  Growing and developing pediatric and breastfeeding medicine services into national models has been a key accomplishment for him. Dr. Wolynn advises and presents nationally on a range of topics and is regularly acknowledged for his powerful, engaging and effective communication.

 

Healthcare Insurers Graded on Support for Breastfeeding Moms: Emblem Stands Above the Rest with an A+

New York, November 3, 2014: Emblem receives the highest grade out of 106 healthcare insurance plans nationally ranked by the National Breastfeeding Center (NBfC) on the provision of breastfeeding benefits to those insurers’ members. Research was initially conducted in 2013 to see how the insurance industry was responding to the Patient Protection and Affordable Health Care Act (PPACA), which went into effect on August 1, 2012, and has been refreshed to see how these policies have changed in the year since their first scoring.

“We are two years into this benefit provision now,” says Susanne Madden, COO, of the National Breastfeeding Center, “and we wanted to see if insurers were doing a better job of meeting the intent of the law.” Madden went on to say, “We still see insurers that only provide the bare minimum required by law, such as a manual hand-operated breastpump and advice given during a well care exam by providers that may have little lactation care experience, but overall the results show that the trend is toward improvement, in many cases significantly.”

“This year we also added in a new measure for assessing if insurers were covering the cost of premature babies receiving donor human milk,” says Beverly Curtis, the Executive Director of NBfC. “While we only found that benefit in a handful of policies, we thought it significant enough to warrant inclusion. Our hope is that insurers will begin to more fully utilize the Model Payer Policy (released last year in conjunction with the USBC) in an effort to better understand coverage needs and ways to see a return on those investments in better population health in the future.”

Madden said that Emblem topped the list this year “primarily because they aligned their benefits with the New York State Department of Health’s comprehensive breastfeeding recommendations. Furthermore, they fully support the use of qualified, trained lactation consultants rather than relying on its existing network of physicians, most of whom have no understanding of lactation issues.” Companies covering home visits, offering a variety of pumps that are able to be dispensed from both providers and medical supply companies, and utilizing trained consultants are the ones that scored highest.

“Companies should see our score card as a helpful tool for evaluating their breastfeeding support policies,” Curtis says, “and like Emblem, Aetna and Anthem, aspire to be the best in this critical area of mother and infant healthcare insurance coverage.”

NBfC assessed commercial insurance companies’ published policies and guidelines and assigned a grade based on the adequacy of coverage provided. Using The Verden Group’s Policy Search tool to locate official Medical Policies, Google to search insurers’ member and public domains for guidelines, and newsletters that contained information about each company’s breastfeeding coverage, “we’re confident we’ve conducted a comprehensive review of the information available,” says Madden.

That review also included talking to trained lactation consultants, who are specifically referenced as the providers required by the law to be paid. “We were very disappointed to hear how difficult it is for trained consultants to be paid for rendering these services,” said Madden. “We viewed two United Healthcare policies that actually conflict with one another, making payment to lactation providers impossible. As a result, we have had to downgrade United’s score from A- to a D until this issue is resolved.” The issue is that their payment policy specifically prevents payment of the most frequently used lactation codes from being paid to non-licensed providers. However, there is no licensure for lactation consultants available.

Why grade insurance companies on their breastfeeding support policies at all?   “The purpose of the law is to improve breastfeeding initiation and duration rates,” Curtis replies. “It follows that mothers should receive lactation counseling support from a provider educated in lactation care.” Madden agrees and says “This year we dug further than ever into assessing these benefits,” Madden concludes, “and we want insurers to do even better going forward.”

View the 2014 Scorecard here

Download a pdf of this release here.

Questions? Please reach us here: inquiry@nbfcenter.com / 855-777-NBFC

www.nbfcenter.com

Misinterpretation of the Affordable Care Act’s Directive for Payment for Lactation Support and Other ‘Trends’

We are deeply concerned to see the continuing misinterpretation of the Affordable Care Act’s guideline to cover breastfeeding services, most recently posted on HealthConnectOne.org’s site advertising a tweetfest on the topic ‘Breastfeeding Support – Who Gets Paid?’. On that page it states “The Affordable Care Act requires insurance companies to reimburse providers of breastfeeding support”.  But the ACA says no such thing. . .

So what does the ACA actually say?

Breastfeeding support, supplies, and counseling. Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment. In conjunction with each birth.

There is an enormous difference between requiring insurance companies to “reimburse providers of breastfeeding support” stated on the HealthConnect One site, and the actual law which states that “comprehensive lactation support and counseling, by a trained provider” needs to be a covered benefit.

Let’s examine the difference in the statements. The manner in which HealthConnect One’s statement is written could have people believing that ANYONE providing ANY support to a breastfeeding mom could be paid by an insurance company for that service.  We certainly do not disagree that breastfeeding support is a most valuable service and deserves to be financially supported; what we are concerned with is a statement that implies that insurance companies could pay anyone for that service.

Here’s the problem. Regulations prevent insurance companies from deciding who should get paid and who should not. It is not an arbitrary process. In order to be recognized as a “trained” provider, the usual standard is a medical license. In order to participate in an insurance company’s network of providers, you must go through a rigorous credentialing process, by regulation, standard and law. In order to ‘pass’ the credentialing process, you must have an identified credential.

So therein lies the problem. By suggesting that insurance companies are supposed to, by law, pay ANY provider of breastfeeding services, this is not only misinterpreting the law, it is also ignoring the regulations and standards under which insurance companies must operate. We are greatly concerned that a lack of care around stating precisely what the law mandates is misleading many providers of these valuable services into thinking that it is possible to be paid by insurance companies for their commendable work.

Further, with regard to there being “a trend in the breastfeeding community to recommend that ONLY licensed providers or individuals with credentials should  be permitted to receive reimbursement for lactation services”, we must correct that statement. What is completely overlooked is that insurance companies can ONLY pay professionals that have credentials and that is not a “trend”. It is a statement of fact.

Why can insurers only pay credential-carrying providers? Well, think about it this way. Without these credentialing standards, how would an insurance company determine who is a professional able to meet a defined standard of care? Would it be okay to list a doctor that simply says that they meet a standard of care but who doesn’t possess a medical license validating that they actually do? Of course not. In the same way, it is impossible for insurers to determine whether a person providing breastfeeding services is someone who simply read a book or is someone with years of experience, unless they have some third-party credential to indicate that they have achieved – or are recognized for – a standard of care in this regard.

So let’s get the record straight once and for all. The National Breastfeeding Center is supportive of everyone that supports and helps breastfeeding moms. Our role has been to identify what is POSSIBLE under the law, at this point, and in doing so, it has led some organizations – namely  @HealthConnctOne, @MomsRising and @Support_ROSE – to unwisely and falsely proclaim a “trend” to exclude some providers.

This is a basic fact – insurance companies cannot, rather than will not, pay for services provided by those that they cannot credential or identify as having achieved some standard of care. This simple realization should help to free up the enormous resources (time, energy and expense) that has been expended to date on chasing trends.

We sincerely hope that by understanding the nature under which commercial insurance company payments are currently made, and recognizing that insurance companies are only ONE source of support in providing these most necessary of services, these organizations will turn their resources toward helping their members achieve funding through many avenues – securing federal and state funding, attracting sponsorship or achieving credentialing standards that can help to get many providers the commercial payments sought that the ACA has helped to champion. At a time when the market is wide open for exploration, it is imperative that we see what is possible, what is doable under the law, and what other avenues of funding may be available for ALL types of support.

While we certainly do not speak for the insurance industry, we are happy to answer any insurance related questions that we can shed light upon and will continue to work toward achieving fairness in payment for professional services rendered under the law.

Most sincerely,

Susanne Madden

COO, National Breastfeeding Center