By Grace Vitaglione
As a child, Gina Upchurch would sit in her grandfather’s lap and count pills at his pharmacy in Smithfield, North Carolina. He was beloved in the community, and people often asked his advice, she recalled.
When she was in high school, Upchurch watched her grandmother undergo horrible side effects from medication while in a nursing home, she said.
Those experiences inspired Upchurch to pursue a degree in pharmacy, she said.
But that degree wasn’t enough. She went on to pursue a degree in public health at UNC Chapel Hill. She took that knowledge and helped create Senior PharmAssist in Durham.
But back in the 1990s, often seniors didn’t have access to medications. That need was partly addressed in 2003, when President George W. Bush pushed the Medicare Modernization Act through Congress, which included Medicare Part D, a drug benefit.
Formed in 1994, the nonprofit started out helping seniors manage their medications to make sure the drugs were “doing more good than harm,” Upchurch said.
When that went into effect in 2006, Senior PharmAssist pivoted to helping people understand the new benefit and access the correct medications for them.
Often that can mean helping people with preventive health measures.
“What we do really helps people stay in their homes longer and stay healthier longer,” she said.
The organization — funded mostly by grants and donations — also provides financial assistance for eligible participants to afford their medications. That’s done with a Senior PharmAssist prescription card, which helps lower the cost of some drugs, Operations Director Adam Velez said.
The staff also counsel clients on Medicare and can refer them to community resources if needed.
Senior PharmAssist served more than 2,300 individuals in the fiscal year that ended on June 30. Most of them live in the City of Durham or the county, Velez said.
And now, Upchurch has taken her grassroots knowledge and advocacy to the national level. In 2023, the U.S. Government Accountability Office appointed her to MedPAC, the independent congressional agency that advises the U.S. Congress on Medicare.
Part of Senior PharmAssist’s focus is team-based care and talking with people about their needs in addition to medications, Upchurch said.
She saw that model in action during her time as a student on a UNC Chapel Hill School of Pharmacy rotation in Cherokee, North Carolina, she said.
When she arrived, Upchurch said, she stayed in a trailer on the reservation with no heat and a broken phone — and it was snowing. Fortunately, both were fixed within a few days.
The pharmacy technician there, named Pickles, took Upchurch under her wing.
The pharmacist went on rounds with doctors, Upchurch said. The experience of talking to patients and feeling as though she could contribute to their health care was influential.
“A lot of people that go through the Indian Health Service come out understanding team-based care like you really aren’t exposed to in other ways,” she said.
After that, Upchurch decided to live somewhere different and contribute while learning new things — and have some adventure too — opting for a stint in the Peace Corps as a science teacher in Botswana. She described living in a tiny room with a tin roof and no running water or electricity.
Towards the end of her tenure, two local women asked for her help in applying for a grant to start a Red Cross organization, which she did. Another Peace Corps volunteer later reached out to Upchurch and told her the women had received the grant and started the organization.
That was an important example of local community members deciding what they wanted help with and leading the charge, Upchurch said.
“That idea of having a community identify its own needs —” she said, “I feel like Senior PharmAssist facilitates that.”
In the 30 years SeniorPharmAssist has been helping people in Durham County, it’s become the envy of many across the state. Now, Upchurch is working with colleagues to help expand the model to three more communities in Buncombe County, Pitt County and Guilford County.
The model includes programs that offer medication therapy management, plus at least one of the other three services that Senior PharmAssist provides, Upchurch said. That could be Medicare counseling, referral to community resources or helping people pay for medications.
Medicare “paralysis by analysis”
Senior PharmAssist is also the Durham location for the Senior Health Insurance Information Program. SHIIP provides insurance counseling and assistance to Medicare-eligible people, their families and their caregivers.
Former SHIIP director Carla Obiol helped create the program. Now she leads the NC League of Municipalities’ effort to help municipalities with spending and reporting on money they received from the 2021 American Rescue Plan Act. She said Upchurch helped shape SHIIP into what it is today.
“She’s strong, she’s knowledgeable, and I would describe Gina as a force to be reckoned with,” Obiol said.
SHIIP started in the late 1980s, and it is now in almost all 100 counties in North Carolina, according to Melinda Munden, its director.
For example, many seniors are inundated with advertisements for particular insurance plans and Medicare products, Munden said. The program is also very complex, and seniors may feel overwhelmed.
“Gina has a great line: ‘There’s so many options, it’s almost paralysis by analysis,’” Munden said.
SHIIP provides an unbiased perspective and helps take away that stress, she said.
Munden said she and Upchurch are “Medicare nerds,” and they often discuss issues within the program. She described Upchurch as a “bulldog” in her advocacy.
From local to national
Now that Upchurch is working at a national level, she brings that grassroots knowledge and the bulldog’s sensibility to an organization — MedPAC — that’s largely been populated by policy wonks and academics.
MedPAC’s 17 members submit recommendations to Congress on how to improve Medicare, according to Mark Miller, former executive director who now directs the health care portfolio at the funding and policy organization Arnold Ventures.
Commissioners usually come from varied backgrounds in health care, such as providers or researchers, he said. Others, outliers like Upchurch, focus on the beneficiary.
While he was director, Miller said, he told the commissioners to always think about three perspectives: the taxpayer, the beneficiary and the health care provider.
The commission makes data-driven decisions, Upchurch said. She brings data about people’s lives from working at Senior PharmAssist.
“I’ve got the best of both worlds. I can deal with policy, but I have stories to tell,” she said. “You see the connection between policy and how people are able to live their lives.”
A major issue is the confusing nature of Medicare. There are many plans to choose from and factors to consider, she said. Often, too many.
Upchurch used the example of a farmer who came to Senior PharmAssist for Medicare counseling.
“He goes, ‘I like choice, but I wanted to choose between paper and plastic, not all this mess,’” she recalled.
Upchurch said she’s discussed with the commission how agents and brokers are paid more for selling Medicare Advantage plans to seniors, than they are for traditional Medicare plans. That needs to be made transparent to potential customers, she said.
Upchurch’s background and expertise in Medicare make her “uniquely qualified,” said NC SHIIP director Munden.
“What a privilege, and how fantastic, not only for the state of North Carolina, but for the nation, to have Gina on MedPAC,” Munden said.
Supporting caregivers
For years, Upchurch watched as her clients struggled with finding care, being caregivers, or getting cared for. Now she’s living it. After losing her mom in 2023, each weekend she drives to Reidsville to take care of her father, who has Parkinson’s disease.
So now she’s also bringing the experience of being a caregiver to her advocacy.
Upchurch said she’s fortunate in that her family can hire help and could afford a facility if needed, she said. The community in Rockingham County is also very supportive of her father, a retired dentist, she said.
But if that wasn’t the case, she might have had to quit her job to take care of him, she said.
That’s a decision many have to make, as Medicare doesn’t pay for many community-based long-term care services and supports, Upchurch pointed out, even as oftentimes, Medicare beneficiaries who become caregivers have their own health impacted by the stress.
Providing support for people to stay in their homes longer may also save money that Medicare and Medicaid might otherwise spend on institutional care, she said. The research backs her up, with one recent study showing that family caregivers — mostly women — provide close to a trillion dollars a year in unpaid caregiving. Much of that care enables seniors to stay out of institutions, saving billions in government spending.
Upchurch said she’s concerned that nobody is looking at “the entire picture” of how different parts of the health care system interact with each other and are linked to social care.
As for her time on MedPAC, she said the first year is like “drinking from a firehose” with all the information to learn. But it feels good to work with the other members.
“It makes me a little hopeful about our government, frankly, that there’s this group of people that are committed to making sure that we have a financially sustainable, high quality program,” she said.
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