1999 - Winter by Arkansas Blue Cross and Blue Shield

~HEART Health Information Inside~

Winter 1999

Get Pumped!

â?¤

Take the road to a healthy heart

CONGRESSIONAL UPDATE

On the “Patients’ Bill of Rights” In the past several months, the U.S. Senate and the U.S. House of Representatives have passed their own versions of so-called Patients’ Bill of Rights legislation. Much of the debate in Washington has been fueled by anecdotal HMO (health maintenance organization) horror stories and accusations that the insurance industry opposes any legislation benefiting consumers. Actually, there are several matters addressed in proposed legislation with which Arkansas Blue Cross and Blue Shield agrees in concept. They include: a grievance process, mandatory Point-of-Service, direct access to certain specialists, internal and external appeals, access to emergency care, coverage for participation in clinical trials, patient access to information, prohibitions on gag clauses, and improper incentive arrangements. In general the House and Senate bills have major differences both in scope and impact. Each bill is hundreds of pages long and clearly subject to differing interpretations. Following is a short explanation of some of the highlights of each measure:

• Senate Version Many provisions contained in the Senate measure, called the Patients’ Bill of Rights Plus Act, apply to the 48 million Americans covered by plans regulated only by federal law. These are called ERISA (Employee Retirement Income Security Act) plans and are provided through employers. The Senate and House bills both require plans to have an internal appeals process. Under the Senate bill, enrollees also would have access to an independent external review of certain questions of medical necessity, experimental and investigational treatments. The decision of the independent reviewer would be binding on the insurance plan. The Senate measure does not expand the right to sue health plans, as does a controversial provision contained in the House measure.

• House Version On the House side, the Bipartisan Consensus Managed Care Improvement Act of 1999 applies to all individuals with private health insurance and expands the right to sue health plans on a wide range of issues. Patients could sue in state or federal courts for unlimited damages. If the current pre-emption for ERISA plans is removed as proposed, lawsuits could be filed in state or federal court for unlimited damages. Because ERISA plans are regulated only under federal law they currently are exempt from state actions. Employers are concerned that the cost of providing insurance for their employees may increase substantially because of the direct or indirect cost of increased legal liability. The increased costs may cause employers to stop offering such benefits and result in more uninsured workers. In addition to various access issues, both bills also would allow self-employed individuals to deduct the cost of health insurance. A new deduction for long-term care and the expansion of medical savings accounts also are among the provisions contained in both measures. Because the bills are quite different, a conference committee comprised of members appointed by the House and Senate leadership has been created. These lawmakers are charged with attempting to work out a compromise measure, a process that may not begin until after Congress returns in January. Two members of the Arkansas Congressional delegation, Republican Sen.Tim Hutchinson and Democrat Rep. Marion Berry have been selected to serve on the conference committee. If you would like further information on these important bills, please contact us at (501) 378-2131.

Customer Service Numbers Category

Little Rock Toll-free Number (501) Number

State/Public School Employees

378-2437 1-800-482-8416

e-mail: publicschoolemployees@arkbluecross.com stateemployees@arkbluecross.com Medi-Pak (Medicare supplement)

378-3062 1-800-338-2312

Medicare (for beneficiaries only): Part A (hospital benefits) Part B (physician’s benefits)

378-2173 1-800-482-5525 378-2320 1-800-482-5525

UniqueCare, UniqueCare Blue, Blue Select® (individual products) 378-2010 1-800-238-8379 Group Services

378-5579

1-800-421-1112

BlueCard®

378-2127 1-800-880-0918

Federal Employee Program (FEP)

378-2531 1-800-482-6655

Health Advantage

221-3733 1-800-843-1329

Medi-Pak HMO (Health Advantage) 954-5200 1-800-354-9904 USAble Administrators

378-3600 1-800-522-9878

Numbers to call for information about obtaining coverage: Category

Little Rock Toll-free Number (501) Number

Medi-Pak (Medicare supplement)

378-2937 1-800-392-2583

UniqueCare Blue, Blue Select® (individual products)

378-2937 1-800-392-2583

Medi-Pak HMO (Health Advantage) 378-6987 1-800-588-5706

Regional Office locations: Central Northeast Northwest South Central Southeast Southwest West Central

Little Rock Jonesboro Fayetteville Hot Springs Pine Bluff Texarkana Fort Smith

Customers who live in these regions may contact the regional offices or call the appropriate toll-free telephone number listed above.

is published four times a year by the Arkansas Blue Cross and Blue Shield Advertising and Communications Division for the company’s members, health care professionals and other persons interested in health care and wellness. Opinions expressed herein do not necessarily reflect the views of Arkansas Blue Cross and Blue Shield or any of its publics.

INSIDE THIS ISSUE

~WINTER 1999~

Risks and signs of a heart attack ................ 4 The brain attack (or stroke) ............................ 5 Heart-healthy eating .................................... 6 Exercise for your heart ................................ 7 High blood pressure/cholesterol info ........... 8 How to kick the smoking habit .................... 9 Focus on Heart Health (dental care, aspirin, congestive heart failure) ................................... 10 Children’s health tips ................................. 11 Shot Dodgers ............................................. 11 Women’s Health and Cancer Rights Act ..... 11 Preventive Health Guidelines ................ 12-13 Can we afford escalating drug costs? ....... 14 Health Advantage scores well on survey ... 15 Leading the Way (get to know some of Arkansas’ legislators) ....... 16-17 MENTOR program ....................................... 18 Hansel and Gretel ...................................... 18 Blue & Your Community ............................. 19 Clearly Blue (a guide to health insurance terminology) ............... 20 Vice President of Advertising and Communications Patrick O’Sullivan Editor Kelly Whitehorn Designer Gio Bruno Contributors Mark Carter, Damona Fisher, Kathy Luzietti and Greg Russell

4 W O M E N AND HEART DISEASE Each year, cardiovascular diseases kill more women than all forms of cancer, chronic lung disease, pneumonia, diabetes, accidents and AIDS combined. There are some risk factors you cannot control, such as increasing age, family health history and race.Your risk of heart disease is greater if close members of your family have had heart disease. AfricanAmericans have a greater risk of developing heart disease than white Americans because they typically have higher blood pressure levels. AfricanAmerican women, in fact, have a death rate from high blood pressure that is almost five times higher than the rate for white women. The risk factors you can change are smoking, high cholesterol, high blood pressure and physical inactivity.

The heart attack Y

Telltale risks and signs can help you detect this potential killer

ou are having trouble breathing. You have a shooting pain in your left arm. You feel like an elephant is sitting on your chest. Chances are, you are having a heart attack. Each year, approximately 1.5 million people in the United States have a heart attack — and 500,000 of those die. Heart attacks claim more lives than any other single cause. There are some risk factors for a heart attack that you can’t control. They are increasing age, gender (men are more at risk than women), race (African-Americans and other minority groups are more likely to have high blood pressure than white Americans), diabetes, and family medical history. Risk factors you can control include smoking, high cholesterol, high blood pressure, obesity, physical inactivity and diet. What is a heart attack? Heart attacks result from blood vessel disease in the heart. A heart attack occurs when the blood supply to part of the heart muscle itself is severely reduced or stopped. If the blood supply is cut off severely or for a long time, muscle EART TTACK ARNING IGNS cells suffer irreversible injury and die. Disability or death may result. But If you experience one or heart attacks may be stopped in more of these heart attack warning progress and muscle damage reduced if they’re treated within a signs, get help immediately. few (usually one to three) hours. • Uncomfortable pressure, To reduce your risk of a heart attack, remember the following: fullness, squeezing or pain in • Do not start smoking. If you the center of the chest lasting smoke, quit. more than a few minutes. • Recognize and treat high blood pressure and diabetes. • Pain spreading to • Don’t drink too much alcohol. the shoulders, neck or arms. • Be physically active. • Eat a healthful diet. • Chest discomfort • Have regular medical checkups. ❤

The heart health information for this issue of Blue & You was provided by the American Heart Association. For more information on heart disease — and heart health — please contact the nearest chapter of the American Heart Association or call 1-800-AHA-USA1 (1-800-242-8721) or visit them on-line at www.americanheart.org.

with lightheadedness, fainting, sweating, nausea or shortness of breath.

The brain attack A stroke can strike anyone: know your risk factors

hen considered separately from other cardiovascular diseases, stroke (or brain attack) ranks as the third-leading cause of death — behind diseases of the heart and cancer. On average, someone in the United States has a stroke every 53 seconds. While the elderly population account for the majority of stroke deaths, stroke ranks third as a cause of death among middle-aged people. However, there is some good news, thanks to improvements in medical care for stroke survivors. The age-adjusted death rate for stroke in the United States has been steadily declining, dropping from 89 per 100,000 in 1950 to 18 per 100,000 in 1990. Some risk factors for a stroke are genetically determined, others are simply a function of natural processes, but still others result from a person’s lifestyle. Factors that can’t be changed include: increasing age, gender, race, diabetes, a prior stroke and heredity. Risk factors that can be changed include: smoking, elevated blood cholesterol and lipids, physical inactivity and obesity, drinking too much alcohol and drug abuse.

STROKE WARNING SIGNS

What is a stroke? Stroke is the No. 1 cause of disability and the third leading cause • Sudden weakness or numbness of death in the United States. of the face, arm or leg on one side A stroke is similar to a heart attack, but it happens in the brain. of the body. It occurs when a blood vessel • Sudden dimness or loss of vision, bringing oxygen and nutrients to particularly in one eye. the brain bursts or is clogged by a blood clot or some other particle. • Loss of speech, or trouble talking The affected part of the brain or understanding speech. doesn’t get the blood it needs and in minutes begins to die. • Sudden severe headaches with Approximately 10 percent of no known cause. brain attacks are preceded by “temporary strokes” or transient ischemic • Unexplained dizziness, attacks (TIAs). These may occur days, unsteadiness or sudden weeks or even months before a major stroke. falls, especially TIAs result when a blood clot temporarily clogs along with any of an artery and part of the brain doesn’t get the the previously supply of blood it needs. The symptoms may occur rapidly and last a relatively short time, usually from a few mentioned minutes to several hours. The usual symptoms are like those of a symptoms. full-fledged brain attack, except that they are temporary, lasting 24 hours or less. ❤

5 Stroke is the third leading cause of death in the United States.

6 E

A “hearty” appetite

ating heart-healthy foods doesn’t have to be a chore. Taking a little effort to eat foods with less fat and cholesterol can not only make you feel better but could help you live a longer, healthier life. The American Heart Association says that a diet low in fat and cholesterol may reduce the risk of heart attack. Here are some tips to help you get started: • Use nonfat products. Eat more fruits and vegetables to help reduce your fat intake. Most fruits and vegetables are low in fat and high in vitamins and minerals. • Choose low-fat products. Compare products when shopping. For example, try baked tortilla chips instead of fried tortilla chips or pretzels and low-fat potato chips instead of regular or corn chips. • Use lean meats. The food that adds more fat to the American diet than any other is also the most popular — burgers. Try choosing fish, chicken, turkey and lean cuts of beef and pork instead of hamburger. • Switch to skim, nonfat or fat-free milk. Whole milk has up to 8 grams of fat per serving. Fatfree milk has less than half a gram per serving. Try gradually reducing the fat content of the milk you drink. If you drink whole milk now, try switching to one percent milk, then half-percent, and finally fat-free (skim) milk. • Use low-fat and nonfat cheeses and dairy products. Try nonfat and low-fat cheeses instead of regular cheeses, and low- and nonfat sour creams and yogurts. • Try nonfat and low-fat puddings and frozen desserts. Frozen fruit bars have zero grams of fat per serving, as opposed to 11-20 grams in an ice cream bar. Low-fat ice

cream has 2-3 grams per serving, as opposed to 10-18 grams in a serving of ice cream. Pudding made with skim milk has no fat; pudding made with whole milk has 5-6 fat grams per serving. • Switch to low-fat breads, cereals and pastas. A bagel has 2 grams of fat per serving. A doughnut has 14 grams of fat. Try substituting hot cereal for pastries or a Danish (2 grams of fat as opposed to 38 grams or more). Also, baked potatoes and pasta have almost no fat, but you must be sure to choose low-fat toppings. • Use egg whites or egg substitutes. You can indeed enjoy eggs as part of a heart-healthy diet, but the American Heart Association recommends no more than three to four egg yolks per week. Use egg whites or egg substitutes when scrambling eggs (try poached eggs instead of fried eggs); in nonfat cooked frostings; in making cakes, cookies and muffins, and in making bread meringues. A general guide to follow is to use two egg whites for each whole egg or use egg substitutes. • Use less fat in cooking. Try to limit the amount of fat you eat to no more than 5-8 teaspoons per day, including what is used in cooking. Helpful tips include baking, broiling, boiling, steaming, poaching, or microwaving foods instead of frying them; using nonstick vegetable oil cooking sprays; and trying to enjoy the taste of foods without sauces or gravies or using low-fat or nonfat versions. The American Heart Association recommends you limit your fat intake to less than 30 percent of your total daily calories. For example, if you consume 1,500 calories per day or less, you should eat foods with 50 grams of fat or less daily; 2,000 daily calories, 65 grams of fat or less; and 2,500 calories, 80 grams of fat or less. Remember, choices you make can help you lead a longer, heart-healthy life. ❤

Exercise: Your heart’s best friend E

xercise. The mere word makes some people cringe. But a little exercise can help make you look and feel better. Benefits of regular exercise include: • More energy. • The ability to cope better with stress. • Improved self-image. • Increased resistance to fatigue. • Stronger resistance to anxiety and depression. • More relaxation and less tension. • Improved ability to fall asleep quickly and sleep well. • Easy way to share an activity with family members and friends, and an opportunity to meet new friends. Exercise also can make you look better. It can: • Tone your muscles. • Burn off calories to help you lose extra pounds or stay at your desired weight. • Help control your appetite. You need to burn off 3,500 calories more than you take in to lose one pound. If you want to lose weight, regular physical activity can help you in two ways. First, you can eat your usual amount of calories but be more active. For example, a 200-pound man who keeps eating the same amount of calories but decides to walk briskly each day for a mile and a half will lose about 14 pounds in one year. Or, you could eat fewer calories and be more active. This is an even better, and quicker, way to lose weight.

Exercise also may help you work better. It can: • Help you be more productive at work. • Increase your capacity for physical work. • Build endurance for other physical activities. • Increase muscle strength. • Help your heart and lungs work more efficiently.

Consider the benefits of a well-conditioned heart. In one minute with 40 to 45 beats, the heart of a wellconditioned person pumps the same amount of blood as an inactive person’s heart pumps in 70 to 75 beats. Compared to the well-conditioned heart, the average heart pumps up to 36,000 more times per day, or 13 million more times per year. Feeling, looking and working better — all these benefits from regular physical activity can help you enjoy life more fully. ❤

The Silent Killer High blood pressure can kill you before you know it

t’s called the “silent killer” because there are no symptoms. You may look and feel fine while your blood pressure is rising to dangerous levels. So what can you do? Learn what causes high blood pressure and what you can do to decrease your risk of having high blood pressure.

What causes high blood pressure? In 90 to 95 percent of high blood pressure cases, the cause is unknown. You could have it for years without knowing it. In the other five percent of cases, there is usually an underlying problem such as a kidney abnormality or congenital heart defect.

What is high blood pressure? Two numbers are being measured when you have your blood pressure checked by a medical professional. The first number (systolic pressure) measures the pressure in your arteries while your heart beats. The second number (diastolic pressure) measures the pressure while your heart rests between beats. Normal blood pressure falls within a range; it’s not one set of numbers. It should be less than 140/90 if you are an adult. If your blood pressure goes above this threshold and stays there, you have high blood pressure.

What can you do about high blood pressure? • Maintain a normal, healthy weight. • Decrease salt intake. • Take medications as prescribed by your physician. • Don’t start smoking and, if you are a smoker, quit. ❤

The good, the bad and the healthy T

The chart below outlines the good and the bad about here is good news and bad news about cholesterol levels. cholesterol. If your total cholesterol or HDL levels are in the The good news is that the “good” cholesterol borderline-high risk or high-risk category, you should can actually lower cholesterol levels in your body. The talk to your family physician about: bad news is that the “bad” cholesterol is no friend to • Having your LDL cholesterol checked. your heart. • When to re-check your cholesterol levels. The “good” cholesterol is HDL (high-density • How to reduce your risk by eating less fat, saturated lipoprotein) which actually helps to clear cholesterol out fat and cholesterol; increasing your physical activity; of your system. High levels of HDL lower your risk of losing weight (if needed) or maintaining a healthy heart disease. The “bad” cholesterol is LDL (low-density weight; and avoiding tobacco smoke. lipoprotein), which deposits cholesterol on artery walls, • Taking medication, if needed. ❤ increasing plaque buildup. It is important to have Cholesterol levels Desirable (low-risk) Borderline-High risk High risk your blood levels of total Total cholesterol less than 200 200-239 240 or higher and HDL cholesterol LDL or “bad checked, especially if you or cholesterol” less than 130 130-159 160 or higher your family have a history HDL or “good cholesterol” 35 or higher less than 35 less than 35 of high cholesterol.

Where there’s smoke, there’s fire G

iving up a habit is hard. Whether you twist your hair, bite your nails or smoke cigarettes, it is hard to break a habit. Although twisting your hair may leave you with a head covered with ringlets, smoking is a habit that can damage your heart and lungs and affect your quality of life. With the year 2000 just around the corner, quitting smoking would be a great New Year’s resolution if you are trying to kick the habit. It won’t be easy, but with some willpower and planning, you can do it. Have a plan. Write down the reasons that you want to quit. Examples might be: • Smoking is bad for my health. • Smoking makes my clothes and hair smell bad. • I want to be in control of my life, not a slave to a habit. Read your list each day. Add other reasons to your list as you think of them. Your plan should include the following: commit to quit; set a target date to quit; talk to your physician about nicotine replacement therapy; and take better care of yourself by starting an exercise program, drinking more fluids and getting plenty of rest. Try to smoke fewer cigarettes. Encourage your family and friends to support your decision to quit. Switch cigarette brands to a brand you don’t like. Now put your plan into action. Do the following: • Stop smoking entirely. Throw out all your cigarettes and matches. • Buy yourself a treat or do something special to celebrate. • Go to the dentist and have your teeth cleaned. • Find a cigarette substitute (deep-breathing exercises, chewing gum, etc.) Remember to avoid those things that might trigger an urge for a cigarette. Think about when and where you prefer to smoke and avoid those situations and places. You will get the urge to smoke, so be ready to resist the temptation. Studies show that the hardest place to resist the urge to smoke is home. Other risky places are at

work and in social situations. The activities most closely linked to smoking are eating, attending parties and drinking. Most urges occur when another smoker is present. Learn to cope with the urges and resist smoking. Ways to cope include the following: • Know your triggers and avoid those situations. • Keep your hands busy (fiddle with a pencil, knit, do crossword puzzles, etc.). • Use oral substitutes (chew gum, munch carrots or apples, etc.). • Find activities that make smoking difficult (gardening, washing the car, walking the dog, meditation, etc.). • Start an exercise program. • Change your habits (if you always have a cigarette with a cup of coffee, switch to tea or water for awhile, etc.) • Choose nonsmoking environments and spend time with friends and family who do not smoke. • Avoid smokers. • Drink lots of water and fruit juices. • Keep your mouth feeling fresh and clean. • Review your reasons for quitting. • Seek social support. • Think positively. • Learn to relax. • Reward yourself for not smoking. OK, so you decided to quit, created a plan, avoided the triggers, used your new coping skills and … guess what, you had a slip and smoked a cigarette. Don’t blame yourself and don’t feel guilty. One slip is not the end of all your hard work. Identify what triggered your slip and think about how to cope with that situation the next time. As the new year approaches, make a commitment to a better, healthier non-smoking you. ❤

Dental care for adults with heart disease If you have heart disease, you need special consideration when you get dental treatment, and it is important that you establish and maintain a healthy mouth. You need to make sure your dentist knows you have a heart problem. And, you must carefully follow your physician’s and dentist’s instructions when they prescribe special medications such as antiobiotics. Several heart problems require that you and your dentist take special precautions. These include: heart attack, irregular heartbeat, heart failure, angina pectoris, heart murmur, artificial heart valve, heart pacemaker, bypass surgery and vascular surgery. Also, remember to take special care when you are taking antiobiotics to prevent bacterial endocarditis or when taking other heart medications. ❤

Aspirin and cardiovascular diseases Studies suggest that aspirin helps prevent and treat heart attack, stroke and some other blood-vessel diseases. It works by making it harder for blood clots to form. Although much has been written about taking aspirin to reduce the risk of heart attack and stroke, not everyone should use aspirin for this purpose. Data clearly shows that the vast majority of people should be treated with aspirin after a heart attack. Studies show that taking aspirin protects against later heart attacks. Taking aspirin also reduces the chance that vessels will reclog after heart bypass surgery or coronary angioplasty. Aspirin also helps in treating chest pain (angina pectoris). Despite these favorable findings, people with healthy heart and brain vessels should not take aspirin to prevent a heart attack or stroke without their doctor’s specific recommendations. Why? Because aspirin lowers the risk from clots but increases the risk of intestinal bleeding. ❤

What is congestive heart failure? It sounds pretty scary. But it doesn’t mean your heart has stopped beating or death is imminent. It means that your heart isn’t pumping as well as it should be. In cases of congestive heart failure, the heart keeps working. As a result, the body’s needs for oxygen-rich blood (both during exercise and rest) aren’t fully met. Congestive heart failure is a condition in which a weakened heart exists along with a buildup of fluid in the body. It can be caused by many forms of heart disease. Common causes of congestive heart failure are as follows: 1.Narrowed arteries that supply blood to the heart muscle. 2.Past heart attack. 3.High blood pressure. 4.Heart valve disease due to past rheumatic fever or other causes. 5.Primary disease of the heart muscle itself. 6.Defects in the heart present at birth. 7.Infection of the heart valves and/or heart muscle itself. If you are diagnosed with congestive heart failure, it can almost always be managed. With treatment and adjustments in daily life, patients usually feel a lot better. The first way to treat this disease is to limit salt intake, maintain potassium and magnesium at normal levels and control weight. Additional ways to manage congestive heart failure include prescription medications and surgical treatment. ❤ The heart health information for this issue of Blue & You was provided by the American Heart Association. For more information on heart disease — and heart health — please contact the nearest chapter of the American Heart Association or call 1-800-AHA-USA1 (1-800-242-8721) or visit them on-line at www.americanheart.org.

Good health is child’s play T

o promote the health of the approximately 78 million children and teen-agers in the United States, the Centers for Disease Control (CDC) recommends that children should do the following: • Wash hands to prevent infection. • Eat breakfast before going to school. • Not smoke and avoid the smoke of others. • Exercise and play safely and appropriately use protective gear. And parents should do the following to promote the health of their children and teen-agers: • Read to and be actively involved with their children.

• Get their children vaccinated. • Get health care insurance for their children. • Check for health hazards in their home and eliminate them. • Place children weighing less than 40 pounds in child safety seats and all other children in safety belts in the rear seats of automobiles. • Seek medical advice if their child is slow to learn. • Avoid tobacco use and limit alcohol use. In addition, women of childbearing age should take vitamins with folic acid to prevent certain birth defects.

Shot Dodgers M

ore than 29 percent of Medicare beneficiaries in the United States reported that they did not receive either the influenza or pneumococcal vaccine prior to cold and flu season, according to the 1996 Medicare Current Beneficiary Survey. When asked why they did not receive the vaccinations, most Medicare beneficiaries reported they did not know they needed the vaccine (19 percent for the flu and 57 percent for pneumonia). More than 40 percent of those who did not receive the vaccines reported that

they had concerns about the vaccine, and 13 percent of those who did not receive the pneumococcal vaccine cited the lack of a doctor’s recommendation. In the United States, the flu causes an average of 20,000 deaths per year, and 90 percent of these deaths are among persons aged 65 or older. Annual flu and pneumococcal vaccines can prevent complications from these diseases in persons aged 65 or older. Information for this article was obtained from the Centers for Disease Control.

~ Women’s Health and Cancer Rights Act reminder ~ I n accordance with the Women’s Health and Cancer Rights Act of 1998, all group and individual health plans that provide medical and surgical benefits for mastectomy cover reconstructive breast surgery, if elected by the covered individual following mastectomy, including: • Reconstructive surgery on the breast on which the mastectomy was performed. • Reconstructive surgery on the unaffected breast needed to “produce a symmetrical appearance.” • Prostheses and treatment of complications of any stage of a mastectomy, including lymphedema.

These provisions apply to all policies issued by Arkansas Blue Cross and Blue Shield, Health Advantage and to all health plans administered by USAble Administrators and are subject to the applicable co-payments, coinsurance, benefit limitations, exclusions and benefit maximums. If you have questions about your insurance coverage, contact your group benefits administrator or a customer service representative at your local Arkansas Blue Cross office.

Hearing Screening by PCP

DTP Poliovirus Hib

Hepatitis B DTP Poliovirus Hib

4 Months

2 Months

Hepatitis B DTP Poliovirus Hib

6 Months

specialists. The member version of the 1999 and 2000 guidelines is shown in this two-page chart. Arkansas physicians reviewed the schedule of services, which were adopted from national preventive health guidelines. The goal of this quality initiative is to improve the health of Health Advantage members through prevention. These

ealth Advantage recently released updated Preventive Health H Guidelines to all primary care physicians and other appropriate

Vision/Eye Screening by PCP

Urinalysis

Pap Smear

Blood Pressure

Once between birth-5 years

Hepatitis B

Immunizations

Hemoglobin & Hematocrit

X (plus head size B-2 yrs.)

Birth

Height, Weight, Physical Exam

Screenings & Immunizations

Once between ages 1-5 years

MMR Hib VZV

12 Months

DTP

15 Months

Once between ages 1-5 years

MMR DTP Poliovirus

Annually 2-5, Bi-Annually 6-20

2-6 Years

DTP - Diphtheria-tetanus-pertussis Hib - Haemophilus influenzae Type b conjugate vaccine

Immunization Legend:

Once between ages 14-20 years

At age 18

Every 2 years

Once between ages 14-20 years

Bi-Annually

13-18 Years

MMR - Measles-mumps-rubella VZV - Varicella vaccine Td - Tetanus-diphtheria

Once between ages 5-12 years

Every 2 years

Once between ages 6-12 years

Bi-Annually

7-12 Years

Birth - 18 Years

charts serve only as a guideline for care. Members should coordinate health care needs with their primary care physician.

9 Months

(for Health Advantage members)

Preventive Health Guidelines

Note: Preventive health services are covered according to the patient’s individual health care benefits with Health Advantage.

Fecal Blood Occult

Sigmoidoscopy

Mammogram

Clinical Breast Exam

Pap Smear

Visual Acuity, Hearing & Hearing Aids

Urinalysis

Non-Fasting Total Blood Cholesterol

Every 1-2 years Every 3-5 years

Periodic evaluation, annually or as appropriate

Every 1-3 years

Annually

Every 4 years

Clinical discretion

Once-booster in 5-10 years at clinical discretion

65 Years & Up

Pneumococcal Vaccine

Clinical discretion

➙

Annually

50-64 Years

Influenza Vaccine

Once between 14-20 years

➙

Once every 10 years

40-49 Years

Tetanus-diphtheria (Td)

➙ Clinical discretion

19-39 Years

Height, Weight, Physical Exam, Blood Pressure

Screenings & Immunizations

19 Years & Up

Escalating prescription costs — can we afford them? — $$$

When used appropriately, prescription medication

Pharmaceuticals cannot claim credit for these provides an effective means for reducing pain, healing stabilizing hospital and physician costs, but continuous infections and preventing hospitalizations. Historically, improvements in disease management — including medication costs have been nominal when compared to medication therapy — should produce fewer hospital and other medical costs. Approximately 20 years hospitalizations. ago, the entire charge for a prescription was $12 to $15. Pharmaceutical manufacturers have discovered the This was before prescription cards and drug co-payeffectiveness of direct-to-consumer advertising for ments; when you paid for the medication and were later prescription medications and now spend as much or reimbursed by your insurance plan. more on this than calling on physicians. This produces Physician services and hospital care traditionally higher utilization of more expensive drugs, which usually have been the high-cost areas, and pharmacy costs have are the drugs advertised. been negligible by comparison. However, this has More new drugs are being approved at a faster rate changed significantly during the past decade. Most by the federal Food and Drug Administration (FDA) than people today pay only the co-payment for name-brand ever before. Some of these new medications are firstprescriptions and do not feel the impact of the alarming generation, demonstrating marginal effectiveness but a cost of prescription medications. Today, a prescription first step toward final success. This new era of pharmaeasily may cost $100 or as much as $1,500. In recent ceuticals is producing long-awaited treatments for years, drug costs have increased to the point of becoming chronic and fearsome diseases (Alzheimer’s, multiple unaffordable for some. Compare the growth trends that sclerosis, diabetes, migraine headaches, cancer and show the annual percentage of cost increase in the more) that have troubled people for centuries. These following table: prescriptions will come at a shocking price, and everyone will be involved in sharing National Health Expenditures — Annual Percentage Growth — 1992-1998 this cost. Hospital Care Physician Services Nursing Home Prescription Drugs

1992 8.2% 8.5% 9.0% 10.6%

1993 5.8% 5.7% 6.7% 8.7%

1994 3.9% 3.8% 7.0% 9.0%

1995 3.4% 4.6% 6.2% 10.6%

Among the Best T

he A.M. Best Company has affirmed the “A-” (Excellent) rating of Arkansas Blue Cross and Blue Shield for another year, continuing the rating held since 1994. A rating from A.M. Best represents an independent opinion from the leading provider of insurer ratings of a company’s financial strength and ability to meet its obligations to policyholders. The “A-” rating reflects the enterprise’s market leadership in Arkansas, the ongoing migration of membership into a more structured managed care environment and an adequate level of capitalization, according to a news release from A.M. Best. The news release also stated that Arkansas Blue Cross and its affiliates have the largest market share in the Medicare supplement arena, group health coverage

1996 3.9% 3.3% 5.2% 13.2%

1997 2.9% 4.4% 4.3% 14.1%

1998E

18.4%E

A-, A-, A-

and HMO (health maintenance organization) markets and have been able to adapt to the health care coverage needs of their respective memberships. A.M. Best also affirmed the “A-” (Excellent) ratings of USAble Life and the First Pyramid Life Insurance Company of America. According to the A.M. Best Report, these companies continue to add value to Arkansas Blue Cross’ diverse portfolio, through the offerings of ancillary benefits. Additionally, A.M. Best rated Health Advantage at “A-” (Excellent) for the first time. This initial rating reflects Health Advantage’s strategic role in the enterprise, A.M. Best said. USAble Corporation and Baptist Health HMO, Inc. each own 50 percent of Health Advantage, the largest health maintenance organization in Arkansas.

MAKING THE GRADE Health Advantage scores well on member survey Health Advantage strives to meet the health and wellness needs of its members. According to a recent survey, Health Advantage members indicated that they are satisfied with the health maintenance organization’s (HMO) performance and very satisfied with the physicians in Health Advantage’s network. The 1999 National Committee for Quality Assurance (NCQA) Health Plan Employer Data Information Set (HEDIS) Member Satisfaction Survey results are being used to identify areas where Health Advantage and its providers could improve their services to members. The most recent survey, a new instrument used for the first time in 1999, was mailed to a random sample of 1,240 of Health Advantage’s commercial HMO members. A total of 689 respondents were certified as “valid” respondents, which gave Health Advantage a 65.3 percent response rate from the eligible sample. Health Advantage received higher-than-average scores in seven categories — when compared with national averages — on the survey. Those categories are: rating of personal doctor, courteous and helpful clinic staff, claims processing, customer service, getting care quickly, getting needed care and overall health care services. When members rated their experience with their health plan, Health Advantage received an overall rating equal to the national and regional averages.

“This was the first time that questions were asked about the physicians participating in the Health Advantage networks, and we are very pleased with the results. Survey participants indicated they are very pleased with the physicians in our network; that the physicians are listening to their needs and that they are happy with their personal physicians,” said David Bridges, president and chief executive officer of Health Advantage. “Survey participants also said they were getting care quickly and

ge Health Advanta members —

take note!

that the approval process through Health Advantage was not a problem. This survey shows that we are on the right track, and I am appreciative of all Health Advantage employees for their hard work.” According to the “effectiveness of care” categories, which are based on claims data information (not survey results), Health Advantage and its network of providers should focus on several areas. For example: members said their physicians need to increase their efforts in advising smokers to quit (see related article on Page 9). In the past few months, Health Advantage has sent out “Women’s

Health Alert” reminders for preventive tests. The wide-ranging survey asked members to characterize various aspects of their experiences in dealing with the health plan and its health care providers (doctors and hospitals). The results of a few key questions are as follows: • A total of 83.3 percent of respondents rated their specialist 8 or higher on a 10-point scale. A total of 73.7 percent of respondents rated their personal physician 8 or higher on a 10-point scale. Nine out of 10 members rated their physician and office staff communication as very good or excellent. • A total of 86.4 percent of respondents said there was no problem with delays in waiting for approval from the health plan. A total of 85.7 percent of respondents said there was no problem in getting the care they or their doctor believed necessary. • A total of 87 percent of respondents said their claims were always or usually handled correctly. A total of 85.2 percent of respondents said their claims were always or usually handled in a reasonable amount of time.

Leading s promised in the Autumn 1999 issue of Blue & You, Arkansas Blue A Cross and Blue Shield will continue to help our customers get to know the many state senators and representatives of the Arkansas General

Sen. Gunner Delay (R) (Dist. 11) Fort Smith Committee on Committees; Revenue & Taxation; Transportation, Aging & Legislative Affairs (O) 501-785-4466 (H) 501-782-4727

Rep. Gary Biggs (D) (Dist. 85) Paragould City, County & Local Affairs; Public Health, Welfare & Labor; Rules (O) 870-239-6084 (H) 870- 239-5127

Sen. Mike Everett (D) (Dist. 23) Marked Tree Vice-Chairman, Children & Youth; Agriculture, Economic & Industrial Development; Joint Budget; Joint Retirement & Social Security; Judiciary; Rules, Resolutions & Memorials (O) 870-358-5800 (H) 870-358-3560

Rep. Herschel Cleveland (D) (Dist. 26) Paris Agriculture & Economic Development; Education; Joint Performance Review (O) 501-963-8009 (H) 501-963-2418

Sen. Jon Fitch (D) (Dist.26) Hindsville Chairman,Transportation, Aging & Legislative Affairs; Vice-Chairman, Joint Retirement & Social Security; Agriculture, Economic & Industrial Development; Efficiency; Joint Budget (O/H) 501-789-2608 Sen. Gary Hunter (R) (Dist. 32) Mountain Home Agriculture, Economic & Industrial Development; Children & Youth; Joint Budget; Joint Retirement & Social Security; Revenue & Taxation; Rules, Resolutions & Memorials; Aging & Legislative Affairs (O) 870-425-6255 (H) 870-425-2220

Rep. Joyce Dees (D) (Dist. 76) Hermitage Aging, Children & Youth, Legislative & Military Affairs; Energy; Judiciary (O) 870-226-7441 (H) 870-463-8154

Rep. Dean Elliott (R) (Dist. 62) Maumelle Public Transporation; State Agencies & Governmental Affairs (O) 501-851-7783 (H) 501-851-0062

the Way Assembly who spend numerous hours working on health care issues. (Upcoming issues of Blue & You will feature additional profiles of our legislators.) Rep. Steve Faris (D) (Dist. 18) Malvern Chairman, Joint Retirement & Social Security; Joint Budget; Public Health, Welfare & Labor; State Agencies & Governmental Affairs (O) 501-865-3333 (H) 501-337-7307 Rep. Boyd Hickinbotham (D) (Dist. 66) Salem Aging, Children & Youth, Legislative & Military Affairs; Joint Performance Review; Revenue & Taxation (O/H) 870-895-2319

17 Rep. Martha Shoffner (D) (Dist. 79) Newport Joint Budget; Joint Performance Review; Public Transportation; State Agencies & Governmental Affairs (O/H) 870-523-6153

Rep. Roger Smith (R) (Dist. 32) Hot Springs Village Joint Retirement & Social Security; Revenue & Taxation; State Agencies & Governmental Affairs (O) 501-321-1781 (H) 501-922-0730

Rep. John Lewellen (D) (Dist. 58) Little Rock Aging, Children & Youth, Legislative & Military Affairs; Joint Retirement & Social Security; Public Transportation (O/H) 501-372-5612

Rep. Bobby Lee Trammell (D) (Dist. 88) Jonesboro Public Health Welfare & Labor; State Agencies & Governmental Affairs (O) 870-932-4639 (H) 870-919-3315

Rep. Sandra Rodgers (D) (Dist. 28) Hope Vice-Chairman,Aging, Chidren & Youth, Legislative & Military Affairs; Education; Energy (O) 870-777-0500 (H) 870-777-3907

Rep. Wilma Walker (D) (Dist. 65) College Station Aging, Children & Youth, Legislative & Military Affairs; Education (O) 501-490-5811 (O) 501-490-0235

Rep. Harmon Seawel (D) (Dist. 77) Pocahontas City, County & Local Affairs; Education; Joint Advanced Communications & Information Technology (O) 870-647-2051 (H) 870-647-2571

s 18 Home-grownshealth care O

The MENTOR program, through community-based awareness initiatives and events, seeks to provide resources that expose interested students to the possibilities of a career in health care, provide any needed guidance and planning, and make a case for returning home to practice. The program also targets rural schools, inviting them to open local MENTOR chapters. The centerpiece of the program is an intensive, twoweek summer medical experience program called MASH (Medical Applications of Science for Health). MASH camps, which are held throughout the state at the Area Health Education Centers and affiliates of the Rural Hospital Program, allow 10th-, 11th- and 12th-grade students to get hands-on exposure to a variety of health professions. Students apply for the camps in the spring. The MENTOR partnership also invites county Farm Bureaus, local businesses and civic organizations to provide $50 co-sponsorships. Otherwise, the MENTOR partnership pays the full $200 tuition for each student. For more information about the MENTOR partnership and/or the MASH program, contact Ken Tillman of Arkansas Farm Bureau at (501) 228-1295 or Yvonne Lewis, Ed.D., of the UAMS Area Health Education Centers Program at (501) 686-6557.

nce upon a time, Arkansas’ medical landscape was dotted with country doctors. Physicians in rural areas were depended on as integral parts of their communities. Arkansas still depends on rural physicians, but unfortunately, their numbers have been declining steadily over the past several decades. The Arkansas Medical MENTOR Partnership is seeking to reverse that trend. This innovative program, which seeks to cultivate an interest in health-related careers among rural youth, is sponsored by Arkansas Blue Cross and Blue Shield, the Area Health Education Centers (AHEC) Program and the Rural Hospital Program (both of the University of Arkansas for Medical Sciences), the Arkansas Academy of Family Physicians, Arkansas Farm Bureau, Arkansas Community Health Centers, the Electric Cooperatives of Arkansas and the Arkansas State Chamber of Commerce/Associated Industries Inc. The MENTOR program is based on the belief (supported by statistics) that health professionals who were reared in non-urban settings are more likely than their city-raised counterparts to establish long-term practices in rural regions. Sadly, though, rural junior high school and high school students often aren’t actively encouraged or counseled to seek a career in the health professions.

MENTOR, MASH initiatives seek to remedy rural plight

tory Teaching through sstory-telling F

or the fourth year, Arkansas Blue Cross and Blue Shield is teaming up with Wildwood Park for the Performing Arts in an effort to entertain and teach elementary school-aged children through a live theater experience. Performances of “Hansel and Gretel” now are being booked for the Spring Tour 2000. Through the centuries, fairy tales have taught children and adults important lessons in character, conquering fears and overcoming problems. Students today still can learn these life lessons as they experience this enchanting story, based on the Grimm Brothers fairy

tale, in a musical theater setting — complete with a tasty gingerbread house and the delightful tunes of composer Engelbert Humperdinck. The production comes with a colorful set, charming costumes and fully synthesized orchestral accompaniment. “Hansel and Gretel” is appropriate for students in grades K-6 or family-oriented community presentations, and is available February through April 2000. For performance cost, booking availability or more information, call Holly Matthews at Wildwood, (501) 821-7275, ext. 241.

19 rkansas Blue Cross and Blue Shield is a good A corporate citizen. Our employees raise money and spend many hours helping those causes near and dear to the hearts of Arkansans. Blue is in the Pink More than 300 Arkansas Blue Cross and Blue Shield, Health Advantage and USAble Administrators employees walked and ran to raise awareness and funds for the Susan G. Komen Breast Cancer Foundation in the 1999 Arkansas Race For The Cure® on Sept. 25. Employee race participants turned out in their Blue team T-shirts to join the more than 22,000 people who converged on the streets of downtown Little Rock. The company’s Three Miles of Men® team received the “Team Spirit Award” for its efforts in Blue team gets ready to race for cheering on Race the cure. participants at the “Blue Hawaii” blocks located at Arkansas Blue Cross’ headquarters at Sixth and Gaines streets. Cure for the Kids Arkansas Blue Cross participated in the Juvenile Diabetes Foundation’s “Walk to Cure Diabetes,” held Oct. 2, in Little Rock’s River Market. Employees raised $4,608, which was added to a corporate match of $5,000 and presented to JDF. Many Arkansas Blue Cross employees joined walkers from throughout the state for the second-annual event, which grew significantly from last year. A special “thanks” to Dr. David Lupo and South Arkansas Urology for donating a great door prize which was awarded as part of the event. Milestones for Mercy More than $150,000 was raised during the annual Mercy Celebrity Classic, held Oct. 1-3 in Fort Smith to benefit the Phillips Cancer Support House, the Alzheimer’s Association Western Arkansas Chapter and the Helping Hands For Children/St. Edward Mercy Auxiliary Project. As part of the festivities, Arkansas Blue Cross sponsored the Cancer Awareness Survivors’ Challenge the morning of

Oct. 2 in downtown Fort Smith. Runners and walkers got a scenic tour of historic Fort Smith and helped raise awareness of needs in the fight against cancer. Hearty Workout BlueAnn Ewe, Arkansas Blue Cross’ health-andwellness ambassador, joined several employees from the Arkansas Blue Cross Northeast Regional Office in support of the American Heart Association’s Heart Walk, held Oct. 3 in Jonesboro. Dave Ferguson of the Arkansas Blue Cross BlueAnn Ewe takes a heart-healthy Northeast Regional walk with Northeast Arkansans. Office served as assistant chair of the event, and BlueAnn helped lead the warm-up activities before the walk. Arkansas Blue Cross employees also walked in the event to help raise $30,000 in support of the agency which benefits residents in the northeast region of the state. Breast Center opens in Bentonville With hopes of becoming known as a comprehensive care program with a reputation as one of the best facilities not only in the region but in the nation, Mercy Health Center in Bentonville unveiled the new Mercy Breast Center on Oct. 10. The opening was held in conjunction with National Breast Cancer Awareness Month observed in October. The new concept in care is the vision of Douglas Friesen, M.D., who said the center will be evaluating its performance against the best breast centers in the country. Mercy Breast Center services include: mammography, ultrasound, stereotactic biopsy, physical therapy, education, support groups and pastoral care. The Mercy Breast Center will work closely with the NARTI (North Arkansas Radiation Therapy Institute) care team and the Highlands Oncology physicians. Dr. Friesen said three key components will set Mercy apart from other health care providers: a nurse coordinator; the partnerships with NARTI and Highlands; and weekly interdisciplinary conferences by all the physicians to improve the delivery of breast cancer treatment.

— a guide to health insurance terminology

f health care terminology (including abbreviations and acronyms) leaves your head spinning … don’t worry, Arkansas Blue Cross and Blue Shield wants to help you make sense of all the jargon. We want you to be an informed customer, so in each issue of this quarterly publication, Blue & You, we will explain the meaning behind those health insurance words, acronyms and abbreviations that you may encounter when reading health care-related materials. Benefit — Services provided or expenses reimbursed in a health care policy or contract. Cost sharing — A general set of financing arrangements, via deductibles, co-payments and/or co-insurance, in which a person covered by the health plan must pay some of the costs to receive care. DRG (Diagnosis Related Group) — A system of grouping medical/surgical hospital admissions according to major body systems and similar consumption of hospital resources. The grouping of conditions and procedures is statistically similar, based on resources consumed and the total cost of services. DRGs are used by Medicare and some private, third-party payers as the unit of payment. Formulary — A listing of drugs, classified by therapeutic category or disease class, that are considered preferred therapy for a given managed population and that are to be used by a health maintenance organization’s (HMO) providers in prescribing medicine.

Physician-Hospital Organization (PHO) — A communitybased affiliation of doctors and hospitals. Preferred Provider Organization (PPO) — A health plan with a network of providers whose services are available to enrollees at lower costs than the services of non-network providers. PPO enrollees may self-refer to any network provider at any time. PPO enrollees also may go out-ofnetwork at a higher cost. Preventive medicine — Care that increases knowledge of nutrition and disease with the aim of promoting health. The scope of preventive medicine has been extended beyond just warding off communicable diseases through immunizations. Today, early detection of a disease, especially during the early childhood years, as well as the ability to inhibit further deterioration of bodily functions, are among the most fruitful areas of preventive medicine. The potential for effective longterm cost-containment may be the greatest in this area of health care. Primary Care — Medical practice based on direct contact with the patient without referral from another physician. Such practice is undertaken by doctors trained in various ways including pediatricians, obstetricians, general internists, family physicians and general practitioners. In addition, many specialists engage in a significant amount of primary care.

Managed care — The integration of both the financing and delivery of health care within a system that seeks to provide information on accessibility, cost and services. Medical Management — A combination of the following: credentialing, education, information, data review, site appropriateness, policymaking, standard setting, practice guideline development, provider panel access, etc. aimed at improving the effectiveness, efficiency and affordability of services and benefits. Point-of-service (POS) — Often known as open-ended health maintenance organizations (HMOs), these plans encourage the use of network providers through benefits reimbursement, but individuals may choose providers outside the plan at the time service is rendered, but at a greater cost.

Arkansas Blue Cross and Blue Shield P.O. Box 2181 Little Rock, AR 72203-2181