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How do wellness programs save lives? May 9, 2013

Posted by medvision in Cancer Care, Employee Wellness, health data, Insurance Plans, Risk Management, Uncategorized.
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Employee wellness programs and screenings can provide early detection and better outcomes for patients.  Just watch this cancer survival story of a teacher working for our client Manatee County School District.

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Cancer is about patients and the community May 5, 2012

Posted by medvision in Cancer Care, Healthcare Costs, Uncategorized.
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America is blessed with wonderful physicians. This oncologist’s article moved me by his description of cancer’s broad impact on care givers, family and loved ones. I took this cancer-care journey with my Mom. From a healthcare perspective, my experience highlighted the importance individual members/patients.

http://www.kevinmd.com/blog/2012/04/stop-someones-oncologist.html

Wellness screenings covered at 100%–read the small print! December 28, 2011

Posted by medvision in Cancer Care, Chronic Disease, Employee Wellness, health data, Healthcare Costs, Insurance Plans, Risk Management, Uncategorized.
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Here’s an egregious practice unfortunately common in the managed care industry. A member, trying to maintain health, participates in a “no cost” wellness procedure. While sedated, or undergoing the procedure, the physician identifies a minor medical issue and fixes it. Then “whack” the member wakes up facing a fat charge due to a diagnostic in place of a screening code.  One could argue it’s a “technical event” allowing insurance companies a manner to collect additional revenue. http://tinyurl.com/7lxz32l

Here’s the work place problem. For example, colon cancer is the 2nd leading cause of cancer death in the US. The main weapon to fight this cancer is early detection by colonoscopy. It’s hard to imagine this procedure being abused by members, recreational colonoscopies? Due to these hidden charges, one has to wonder how many colon cancer deaths result? If a plan is self-funded, the plan managers need to prevent ASO claims payors from implementing these processes. If fully insured, employers should pick up/pay for the additional fees.

High deductible plans not working? Here’s what works, 0 deductible! December 10, 2011

Posted by medvision in Cancer Care, Chronic Disease, Employee Wellness, health data, Healthcare Costs, Healthcare Reform, Insurance Plans, Rx Costs, Uncategorized.
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My initial introduction to consumer driven plans, HDHPs, was presented in a group setting by a national carrier, or, “industry speak” a BUCA. We were first told the reason for explosive trend is a combination of easy physician access due to low copays, better technology, our legal environment and expensive drugs. Then came the HSA regulatory part. (I used to think the 401K regs were somewhat complex)! Today, from my years of data experience, I know explosive health inflation is driven by a small percentage of members suffering worsening states of chronic disease.

Anyway, a troubling thing is sneaking up on the disciples of HDHPs and their concept of member consumerism. It’s the rapid adoption of on/near site clinics by 20%+ of employers with a thousand or more employees.

Hmm. In one corner we have plans requiring members to spend the 1st $1,000 – $10,000 before plan benefits start, And, in the other corner, all-inclusive primary care benefits with no, 0, member dollars needed. If fact, a few BUCAs are big proponents of both plans! Sort of an AC/DC strategy.

The clear winner is immediate and easy access to primary care, preferably in scenarios in which the physicians are significantly rewarded for “great” member health. A great plan discount occurs when large claims don’t occur due to prevention/early disease identification. Guess how many $70 primary care visits can be purchased for the cost of a $250K annual claim paid on behalf of a member facing end-stage renal failure? A great physician can he hired for $200K annually. So, how many members can a physician see in 12 months? Here’s a good opinion article on employer clinics! http://tinyurl.com/7rvm7sm

Accountable patients. What patients with heart disease need to learn from cancer patients. November 18, 2011

Posted by medvision in Cancer Care, Employee Wellness, Healthcare Costs, Uncategorized.
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My personal experiences in providing care for, and knowing the journey faced by, cancer sufferers is truly humbling. Under the term “courage” in the dictionary, an example should describe challenges faced by cancer patients undergoing cycles of chemotherapy and radiation therapy. Cancer patients exhibit amazing courage in battling cancer.

Many times we see an exact opposite behavior exhibited by heart disease patients so clearly stated by this doctor.

http://tinyurl.com/79fywck

A Physician’s View about Medical Necessity May 6, 2011

Posted by medvision in Cancer Care, Employee Wellness, Risk Management, Uncategorized.
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Very insightful thoughts when we question our doc’s instructions. Maybe we should always ask, what are the probable outcomes if I don’t do what you suggest?

http://tinyurl.com/3gxmr2k

Study: Many don’t take drugs because of cost March 31, 2011

Posted by medvision in Cancer Care, Chronic Disease, Employee Wellness, health data, Healthcare Costs, Healthcare Reform, Insurance Plans, Risk Management, Rx Costs, Uncategorized.
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Some have heard my negative thoughts concerning High Deductible Health Plans (HDHPs) as a strategy to control health cost and quality. I won’t go into a diatribe, but I argue  relate to lower cost and high quality in the manner “dynamite” relates to sturdy hillsides.  Here’s another study looking at “cost” as a member barrier to preventative/lower cost care management. http://tinyurl.com/4gjjfc7

A relevant risk management question: If a member with advanced type 2 diabetes cannot afford plan-dictated prescription drug co-pays of $300 per month, and becomes non-compliant, is the plan sponsor at higher risk of a “shock” claim?  My thoughts are: The risk bearer/employer is “short-sighted” in trying to manage Rx and medical risk in separate silos.

Hmmm? $300 per month Vs. potential vascular events, renal failure, blindness, renal transplant and potential multiple amputations? I’ll take the $300/month, please!

Take your medicine! March 28, 2011

Posted by medvision in Cancer Care, Chronic Disease, Employee Wellness, health data, Healthcare Costs, Insurance Plans, Risk Management, Rx Costs, Uncategorized.
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Some elements responsible for our national out-of-control healthcare inflation are amazingly simple. Maybe plan managers, government policy makers and clinicians should stop–and take a few deep breaths: 50% of Americans fail to follow their doctor’s instructions concerning prescription drugs”  The short form is: We aren’t taking our medicine. This fact lines up with a dated Rand study finding 50% of Americans fail to receive recommended care. http://tinyurl.com/4ev7dbc

Does this have a large impact on our healthcare inflation? As a splinter of evidence the attached WSJ article indicates up to 90,000 Americans die annually from the failure to take blood-pressure medication. Med-Vision’s experience shows (3) factors responsible for poor Rx adherence:

(1) COST–Today large health plan managers have virtually “unlimited liability” associated with the total cost of adverse health events. Where’s the logic in assigning co-payment/co-insurance cost responsibility to the members, in today’s economy, who cannot afford and thus guaranteeing the (low-cost compared to hospital stay) medicine necessary to prevent a catastrophic medical event are not taken? Imagine if physicians medication orders were ignored by nurses in the inpatient acute care hospital setting? The next time a consultant offers advice to increase drug co-pays across-the-board, as a cost control strategy, maybe it’s time to suggest for him/her look for a new client.

(2) Untreated/under-treated DEPRESSION: Depression is classified as a mental illness and carries a significant social stigma. Many doctors will prescribe antidepressants, and due to concern of the patient’s medical records, fail to record a depression diagnosis. Today’s ramped up levels of anxiety coupled with the absence of free time and worries about the economy are pushing depressive symptoms to higher levels. Why not change the name “depression” to emotional wellness, make it known to the workplace the prevalence of this disabling condition and relay it’s ok to seek help. Depression is one of the most “curable” conditions. Why do people suffering from depression fail to take medicine? Feelings of lack of self worth, even suicide, are benchmark symptoms.

(3) Lack of education: Plan managers cannot simply provide plan members with a carrier web address and expect them to study the importance of taking their prescribed medications. Rx therapy compliance must be a central point with respect to wellness programs and other population based health education. Here’s an example of workforce perceptions concerning blood pressure medications. Today physicians have a large group of antihypertensive drug classes to help patients control blood pressure. One type, Beta Blockers, are sometimes contraindicated for men concerning sexual performance. Absent any clinical education, imagine the impact of one police officer’s story concerning “this” performance could have on 100s of male police officer’s adherence Rx therapy for any blood pressure class? Locker room discussions are the “grape-vine” of many employer organizations. The “grape-vine” should not be the information super-highway of critical health information to your employees!

Plan manager’s–part of  “taking your medicine” is to determine critical Rx compliance ratios for your own plans. The data are available. Don’t let anyone keep it from you!

Frightening WSJ article-2/28/11– February 28, 2011

Posted by medvision in Cancer Care, Chronic Disease, Employee Wellness, health data, Healthcare Costs, Uncategorized.
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“The FDA and Slower Cures: The bureaucratic assault on cancer treatments.”

http://tinyurl.com/4jzgyh9

 

You are enjoying the beach on a pacific island and you see the ocean quickly recede? What danger is likely coming? October 12, 2010

Posted by medvision in Cancer Care, Employee Wellness, health data, Healthcare Costs, Healthcare Reform, Insurance Plans, Risk Management, Uncategorized.
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Tsunami–This blog is about healthcare and we face many health tsunamis’–Shortage of physicians, fragmented data, obesity leading to diabetes, government regulations formulated by “aliens”, so what else? How about the phenomenon of sick Americans failing to pick up prescriptions written to prevent the worsening of disease? Here’s a “brain teaser” for all the experts recommending high drug co-payments: What event costs more for employer plan sponsors/taxpayers? (1) a $1,000 initial dosage of Lovonox preventing pulmonary embolism (2) 15 day  hospital intensive care unit visit struggling to prevent death from pulmonary embolism.

http://tinyurl.com/28xr4r5

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