2005 - Spring by Arkansas Blue Cross and Blue Shield

~ THE HEALTHY WEIGH! PROGRAM INSERT INSIDE ~

Arkansas’ Big Six Are YOU at Risk?

Spring 2005

Special Bulletin: My Blueprint registration faster, easier Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas members who want to use “quick registration” for My Blueprint can enter their health plan ID number, name, date of birth and Social Security number (SSN). If we have your

Blue

Customer Service Surveys: We’re listening to you

SSN on file in our membership system, we can authenticate you immediately and let you into My Blueprint to choose your own log-in ID and password and then view your personal health plan information. (For more information, see “Blue Online” column on back cover.)

Comes Through.

As an Arkansas Blue Cross, Health Advantage or BlueAdvantage member, you may have received a “contact survey” in the mail from us after calling one of our Customer Service telephone numbers. The survey is designed to give us feedback about our customer service skills. We appreciate the input from our customers, and you will see changes based on the results of the survey. For example, the input we have received concerning My BlueLine has encouraged us to revamp the system and make it easier to use for our customers. My BlueLine is an self-service Interactive Voice Response System that recognizes speech patterns to help answer questions when you call current customer service telephone lines. We believe this is a valuable service for our customers as it is available 24 hours a day, seven days a week. However, your concerns are valid, and we are making changes accordingly. You can read about the changes in the story below. Overall, the results of our Customer Service survey have been very positive: • More than 93 percent of survey respondents felt that the customer service representative was good or excellent at “listening to your request” and “maintained professional/courteous/polite manner.” • More than 89 percent of survey respondents felt that the customer service representative was good or excellent at “answering questions to member’s under-

standing” and “willingness to help.” • Of those customers who viewed one of the Arkansas Blue Cross or affiliated-company Web sites, more than 87 percent felt that the information on the Web site was useful. Some of the comments from the Customer Service survey were as follows: • Keep up the good work. • Been with the company since Jan. 1, 2001, and have been well pleased with the way claims have been processed. • Quick service — great. • The representative was very knowledgeable and most helpful. She provided the answer before I could even ask the question. • The person who answered my call was very thorough; made sure the information she gave me was accurate. She was well-trained and was pleasant while speking with me. Keep up the good work! • Good health plan for me. I’ve recommended it to others who have changed to your plan. • I would like to thank you for a job well done. In appreciation for returning the survey, a random drawing was held from the returned surveys to award $50 Wal-Mart gift cards to nine customers. If you didn’t win, don’t worry, you’ll get another chance. The survey will be mailed out twice per year.

We’re here to meet your customer service needs

Blue comes through with improved My BlueLine Coming soon! When you call one of our Customer Service telephone numbers for Arkansas Blue Cross and Blue Shield, BlueAdvantage Administrators of Arkansas, Health Advantage or one of our regional offices, you immediately will be able to choose the option of speaking to a customer service representative (if you call during regular business hours). Additionally, you will continue to have access to the self-service Interactive Voice Response System 24 hours a day, seven days a week (see Page 25 for more information). You talked, and we listened. You let us know this new option would be a great benefit to you, and we always are working to improve our customer service for our members.

Blue & You Spring 2005

Customer Service Numbers Category

Little Rock Toll-free Number (501) Number

State/Public School Employees

378-2364 1-800-482-8416

Medi-Pak (Medicare supplement)

378-3062 1-800-338-2312

Medicare (for beneficiaries only): Part A (hospital benefits) 1-800-MEDICARE (633-4227) Part B (physician benefits) 1-800-MEDICARE (633-4227) Arkansas Blue Cross and Blue Shield health insurance plans for individuals and families 378-2010 1-800-238-8379 Arkansas Blue Cross Group Services 378-3070

1-800-421-1112

BlueCard®

378-2127 1-800-880-0918

Federal Employee Program (FEP)

312-7931 1-800-482-6655

Health Advantage

378-2363 1-800-843-1329

BlueAdvantage Administrators of Arkansas

378-3600 1-888-872-2531

Pharmacy Customer Service: Arkansas Blue Cross Health Advantage BlueAdvantage Specialty Rx

1-800-863-5561 1-800-863-5567 1-888-293-3748 1-866-295-2779

For information about obtaining coverage, call: Category

Little Rock Toll-free Number (501) Number

Medi-Pak (Medicare supplement)

378-2937 1-800-392-2583

Health insurance plans for individuals and families

378-2937 1-800-392-2583

Regional Office locations are: Central, Little Rock; Northeast, Jonesboro; Northwest, Fayetteville; South Central, Hot Springs; Southeast, Pine Bluff; Southwest, Texarkana; and West Central, Fort Smith. Customers who live in these regions may contact the regional offices or call the appropriate toll-free telephone numbers above.

Web sites:

www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com

INSIDE THIS ISSUE

~SPRING 2005~

Blue Comes Through ................................... 2 Arkansas’ Big Six: Are you at risk? .................. 4 The truth about diabetes ........................... 5-6 Diabetes Education Program ......................... 7 Help for a healthy heart ............................ 8-9 Cardiovascular Education Program.................. 9 Breathe easier .................................... 10-11 Respiratory Education Program .................... 11 Low back pain can bring you down ............ 12-13 Low Back Pain Education Program ................ 13 Lose weight? Eat smart. Exercise more. ..... 14-15 The Healthy Weigh! enrollment form .......... insert Fast facts on fat ...................................... 15 The Healthy Weigh! Education Program .......... 15 The importance of prenatal care .............. 16-17 The Special Delivery Program ...................... 17 What can case management do for you? ......... 18 Case management map .............................. 19 HealthConnect Blue has the answers ......... 20-21 The Pharmacist is in ................................. 21 Blue & You readers survey results................. 22 Let the games begin … again! ..................... 23 Top four customer needs addressed .......... 24-25 Introducing BlueSecure ............................. 26 Blue & Your Community ............................. 27 Blue Online ............................................ 28

Please note: Health Advantage’s address has changed to 320 W. Capitol Ave., Little Rock, AR, 72201. New fax number for Customer Service is (501) 212-8518.

is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, healthcare professionals and other persons interested in health care and wellness.

Blue & You Spring 2005

Vice President of Advertising and Communications: Patrick O’Sullivan Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com Designer: Gio Bruno Contributors: Chip Bayer, Tammi Bradley, Janice Drennan, Damona Fisher and Kathy Luzietti

ARKANSAS’ BIG SIX:

Diabetes Obesity Low back pain Respiratory illness Cardiovascular disease Pregnancy

Are you at risk?

o help combat six of the diseases or highrisk conditions that face Arkansans, Arkansas Blue Cross and Blue Shield and its family of companies have developed health education programs. These programs are designed to give our members the materials and help they need when they face one of what we are calling “Arkansas’ Big Six.” The six conditions that are the subject of this issue of Blue & You are diabetes, obesity, low-back pain, respiratory illness, cardiovascular disease and pregnancy. Pregnancy, of course, is not a disease but for Arkansans, it is a high-risk condition. (There are numerous other conditions that affect Arkansans, but these are the first six we have chosen to address with our health education programs). Here are some of the statistics that led Arkansas Blue Cross and its family of companies to focus on these six issues: • Diabetes — Diabetes was the seventh leading cause of death in Arkansas in 1999. In recent years, the mortality rate for diabetes in both Arkansas and the United States has risen approximately 10 percent. • Obesity — According to a study by the Washington, D.C.-based nonprofit group Trust for America’s Health, Arkansas ranks sixth in adult obesity among the 50 states. Arkansas has seen a 77 percent increase in obesity from 1991 to 2000. If you are obese, it also puts you at risk for Type 2 diabetes, coronary artery disease, stroke, sleep apnea, digestive problems, cancer and arthritis. • Low back pain — At some point, nearly everyone has low back pain that interferes with work, routine daily activities or recreation. It is the most common cause of jobrelated disability and is a leading contributor to missed work. It is the second most common neurological ailment in the United States.

• Respiratory illness — In 1998, Arkansas ranked fifth highest in age-adjusted death rate from pneumonia and flu. In 2000, the No. 1 condition among members of Arkansas Blue Cross and affiliated companies was sinusitis. • Cardiovascular disease — In 2001, 29 percent of all deaths in the United States were related to heart disease. Approximately 1.1 million Americans suffer a heart attack each year. Heart disease and stroke are the No. 1 and No. 3 causes, respectively, of death in Arkansas. According to 2001 mortality data, heart disease was the most common cause of death in Arkansas, accounting for 30 percent of all deaths. Eight percent of all Arkansas deaths are due to stroke. • Pregnancy — Preterm births are costly and high risk for both the baby and mother, and Arkansas Blue Cross and affiliated companies are dedicated to educating our members about having a healthy pregnancy to avoid preterm deliveries. Offering tips on Arkansas’ Big Six may help you, or someone you love, live a healthier life.

— Sources: Arkansas Department of Health, American Diabetes Association, American Heart Association, National Institute of Neurological Disorders and American Lung Association

Blue & You Spring 2005

The

truth

about

Diabetes in Arkansas Diabetes is a significant health problem in Arkansas. Arkansans have consistently ranked at or above the national average for diagnosed diabetes since 1995. Diabetes frequency has increased in Arkansas 15 percent between 1994 and 2000, and Arkansas ranks fifth in prevalence of diabetes among the 50 states. Given the trends in the numbers of the aging in the Arkansas population, the tendency toward obesity, and the sedentary lifestyle of the majority of Arkansans, this trend will likely increase.

Diabetes in the United States Approximately 18.2 million people, or 6.3 percent of the entire U.S. population, have diabetes. Of those, 13 million people have been diagnosed, and 5.2 million remain undiagnosed. Often diabetes goes undiagnosed because many of its symptoms seem so harmless. Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes.

The cost of diabetes The total annual economic cost of diabetes in 2002 was estimated to be $132 billion, or one out of every 10 health-care dollars spent in the United States. Nationally, direct medical expenditures totaled $92 billion and comprised $23.2 billion for diabetes care, $24.6 billion for chronic diabetes-related complications, and $44.1 billion for excess prevalence of general medical conditions. Indirect costs resulting from lost workdays, restricted activity days, mortality, and permanent disability due to diabetes totaled $40.8 billion.

Symptoms of diabetes If you have one or more of these diabetes symptoms, see your doctor right away: Blue & You Spring 2005

diabetes • • • • • • •

Frequent urination Excessive thirst Extreme hunger Unusual weight loss Increased fatigue Irritability Blurry vision

There are two different tests your doctor can use to determine whether you have pre-diabetes: the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT). The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have pre-diabetes or diabetes. With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes. In the OGTT test, a person’s blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/ dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.

What is diabetes? Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. People with diabetes have a shortage of insulin or a (Diabetes, continued on Page 6)

(Diabetes, continued from Page 5)

decreased ability to use insulin. This causes sugars to build up in your blood. When diabetes is uncontrolled, glucose and fats remain in the blood and damage vital organs over time. Diabetes is a chronic disease that has no cure. The cause of diabetes is a mystery, although both genetics and environmental factors appear to play roles. There are two main types of diabetes. Type 1 most often appears during childhood or adolescence. This type of diabetes was once called insulindependent diabetes mellitus or juvenileonset diabetes. Type 1 diabetes may account for 5-10 percent of all diagnosed cases. Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune and genetic factors are involved in the development of this type of diabetes. Type 2 diabetes affects almost 95 percent of people with the disease and most often appears after age 40 (although it is being found more in much younger ages, even children and teens). Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus or adultonset diabetes and may account for 90-95 percent of all diagnosed cases. Type 2 diabetes is linked to obesity and physical inactivity — both of which can be modified to improve health. In addition, other risk factors include older age, family history of diabetes, prior history of gestational diabetes, and impaired glucose tolerance. Gestational diabetes affects

about 4 percent of all pregnant women — about 135,000 cases in the United States each year. Pre-diabetes is a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 41 million Americans who have pre-diabetes. While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African-Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population (all races). Diabetes also contributes to higher rates of morbidity — people with diabetes are at higher risk for heart disease, blindness, kidney failure, extremity amputations, and other chronic conditions. Finding out you have diabetes is scary, but don’t panic. Diabetes is serious, but people with diabetes can live long, healthy, happy lives. To help our members with diabetes, we offer a Diabetes Health Education Program (see article on next page). To get more information about the program or enroll, call 1-800-686-2609 or visit our Web sites. Just click on the “Members” tab at www.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com or www.BlueAdvantageArkansas.com. — Sources: American Diabetes Association, The Burden of Diabetes in Arkansas (The Arkansas Diabetes Prevention and Control Network); Behavioral Risk Factor Surveillance System (BRFSS)

Blue & You Spring 2005

Diabetes Education Program

If you have diabetes, managing the disease always will be a significant part of your daily routine until there is a cure. It is a process that involves you, those close to you, your physician and other caregivers. Arkansas Blue Cross and Blue Shield, Health Advantage and eligible BlueAdvantage Administrators of Arkansas groups are pleased to offer free to their members (with diabetes) a community-based Diabetes Education Program to furnish you with information about managing this disease. Upon enrollment in the program, you will receive information about diabetes to help you: • Prevent the complications common with diabetes. • Quickly and effectively resolve acute episodes of illness associated with your diabetes. The Diabetes Education Program connects you with disease-specific health education information as well as local and national resources to keep you informed about diabetes. The program is designed to work in conjunction with you and your physician and provides a comprehensive approach to educating you about the diabetes disease process, treatments, screening and self-care techniques.* Members currently enrolled in the plan report high satisfaction rates. According to members who participated in a recent survey: • 96 percent are satisfied with the program; • 93 percent believed the material received was helpful; • 68 percent reported that some of the information received through the program was new information to them; and • 82 percent found the material useful when visiting with their physician. To get more information about the program or enroll, call 1-800-686-2609 or visit our Web sites and click on the “Members” tab. * In addition, services for diabetes selfmanagement training usually are covered at some level by most benefit plans. Check your benefit plan to determine your coverage. Blue & You Spring 2005

Lifestyle changes can help you have a healthy heart

ore than 58 million Americans have one or more types of cardiovascular disease and even more are at risk for developing it. The principal components of cardiovascular disease are heart disease and stroke. The first and third leading causes of death in the United States, these two diseases account for more than 40 percent of all deaths. Approximately 950,000 Americans die of cardiovascular disease each year. This is one death every 33 seconds. Coronary heart disease is a leading cause of premature, permanent disability among working adults. Stroke accounts for the disability of more than 1 million Americans and almost 6 million hospitalizations every year are the direct result of cardiovascular disease. Arkansas is among the 13 states with the highest rates of death due to heart disease and experiences as much as 350 deaths per 100,000 people each year. Research into cardiovascular diseases has helped us better understand the risk factors that contribute to the development of such diseases. Some of the risk factors are unchangeable, while others are directly related to lifestyle choices.

Unchangeable Risk Factors: • Heredity: Children of parents with cardiovascular diseases are more likely to develop one or more types of cardiovascular diseases themselves. • Gender: Men typically have a greater risk of heart attack than

premenopausal women and usually have them earlier in life. • Age: The older we get, the greater our risk grows. Approximately four out of five people who die from a heart attack are over 65.

Changeable Risk Factors: • Smoking: A smoker’s risk of heart attack is more than twice that of a nonsmoker and is the single biggest risk factor for sudden cardiac death. • High cholesterol: The risk of coronary artery disease rises with blood cholesterol levels. • High blood pressure: High blood pressure increases the heart’s workload causing it to weaken over time. It increases the risk of stroke, heart attack, kidney failure and congestive heart failure. • Sedentary lifestyle: Physical inactivity increases the risk of cardiovascular diseases. Even modest levels of physical activity provide health benefits if done regularly. • Obesity: An excessive amount of body fat (measured by the Body Mass Index) increases the risk of heart disease even in the absence of other risk factors. • Stress: Research has shown a direct relationship between chronic stress and coronary heart disease. • Substance abuse: A history of drug or alcohol abuse increases the risk of heart attack. The very first way to manage your risk for developing cardiovascular diseases is to amend your lifestyle to eliminate the changeable risk factors. Eating a healthy diet, getting moderate amounts of exercise, managing high blood pressure and reducing stress will significantly reduce one’s risk. Most importantly, don’t smoke. Your Blue & You Spring 2005

Cardiovascular Education Program

doctor can help you determine the best course of action for managing your risk factors. Experts agree the best first step toward minimizing your risk for cardiovascular disease is to educate yourself on the risk factors and change your lifestyle accordingly. To help our members with cardiovascular disease, we offer a Cardiovascular Health Education Program (see next column). To get more information about the program or enroll, call 1-800-6862609 or visit our Web sites and click on the “Members” tab. — Sources: American Heart Association, United States Centers for Disease Control, Yale-New Haven Hospital Web site

Blue & You Spring 2005

If you have been diagnosed with high blood pressure (hypertension) and high cholesterol (hyperlipidemia), you are aware that managing your illnesses is a process that involves you, those close to you, your physician and other caregivers. Those two conditions are major risk factors for developing heart disease, which may lead to more serious complications, such as heart attack, stroke and kidney failure. Arkansas Blue Cross and Blue Shield, Health Advantage and eligible BlueAdvantage Administrators of Arkansas groups are pleased to offer free to their members (with high blood pressure and high cholesterol) a community-based Cardiovascular Education Program. Upon enrollment in this program, you will receive information about high blood pressure and high cholesterol that will help you: • Understand your individual risk for heart disease. • Work on lowering the risk factors (within your control) for heart disease. • Communicate your needs and concerns to your health-care provider. • Prevent the complications common with these illnesses. The Cardiovascular Education Program connects you with specific information as well as local and national resources to keep you informed about high blood pressure and high cholesterol. The program is designed to work in conjunction with you and your physician by providing a comprehensive approach to teaching members about the causes of these medical conditions, treatments and self-care techniques. Members currently enrolled in the plan report high satisfaction rates. According to members who participated in a recent survey: • 96 percent are satisfied with the program; • 92 percent believed the material received was helpful; • 83 percent said that some of the information received through the program was new information to them; and • 86 percent found the material useful when visiting with their physician. To get more information about the program or enroll, call 1-800-686-2609 or visit our Web sites. Just click on the “Members” tab at www.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com or www.BlueAdvantageArkansas.com.

Respiratory illnesses and their resulting complications are a serious health concern for Arkansans. The negative impact of smoking-related diseases, asthma and allergies, colds, flu and pneumonia account for millions of dollars in health-care costs each year. Educating yourself and your family about these illnesses is a good first step in protecting your household. Know the facts, and breathe easier.

Huffing and Puffing While some health complications can’t be prevented, many problems associated with respiratory illness can be avoided, lessened or reversed by making healthier lifestyle choices. One of the most obvious and beneficial choices you can make is choosing not to smoke — or if you already are a smoker, choosing to quit. Cigarette smoking can kill you. And if you’re a smoker, you also know another awful fact — it is hard to quit smoking. But when you’re ready to kick the habit, here are six simple steps to help you on your way. 1. Identify your personal reasons for quitting. 2. Set a quit date. 3. Identify your barriers to quitting. 4. Make specific plans ahead of time for dealing with temptations. 5. Get cooperation from family and friends. 6. Utilize your smoking cessation resources. Log on to the American Lung Association Web site at www.lungusa.org and utilize the interactive “Freedom from Smoking” support group and other materials available, or visit www.stampoutsmoking.com (the Arkansas Department of Health’s Web site).

Allergies: Sniffles, Sneezing and Sensitivity Allergies are the primary cause of respiratory illness for many Arkansans. Allergic rhinitis is an inflammation of the mucous membranes that occurs when allergens touch the lining of the nose. It is characterized by sneezing, congestion, itching and dripping of the nose and itchy, watery eyes. Common allergens associated with allergic rhinitis are dust mites, pollens from weeds, grasses and trees, animal dander and molds.

Colds vs. Allergies Many people may not realize they have allergies, often attributing their congestion and runny

i i i i

Breathe nose to a cold. Left untreated, allergies can cause more serious conditions like sinusitis or ear infections. Learn the differences between allergies and colds: Allergies • Eyes, ears, nose and/or throat (especially the palate or roof of the mouth) are itchy. • Eyes may be red and watery. • Sneezing is often repetitive. • Nasal discharge is usually clear and thin. • Fever and achiness are typically absent. • Symptoms tend to be seasonal and are often at their worst during pollen season (from spring to the first frost in the fall). • Symptoms may last for weeks or months, or may be chronic, depending upon exposure to offending allergen(s). Colds • Nasal discharge is usually clear initially, but may become thick and yellow after several days. • Sneezing is usually sporadic and non-repetitive. • Fever and achiness may be present. • Eyes, ears, nose and/or throat have no or minimal itching. • Symptoms typically end within 3 to 10 days. The symptoms of the common cold, if treated vigorously, will go away in seven days. If left alone, they will disappear over the course of a week. — Popular physician witticism

When colds go bad … Influenza and Pneumonia If you have ever had influenza (better known as the flu), you know it is no fun. Flu symptoms include: fever, cough, nasal discharge, headache, muscle aches and weakness, shortness of breath, chills, sweating, fatigue and appetite loss. To prevent the flu, get a flu shot. The vaccine has a 70 to 90 percent success rate in preventing illness in a healthy person under age 65. Pneumonia can affect anyone at any age. Pneumonia symptoms include: cough, chills with shaking, fever, fatigue, chest pain, headache, loss of appetite, nausea, vomiting and general discomfort. Additional symptoms that may be associated with this illness include: shortness of breath, excessive sweating, clammy skin, rapid breathing, coughing up blood and abdominal pain. If you Blue & You Spring 2005

i i i i

Easier

are at high risk, it is important that you get vaccinated to prevent the illness and any further complications. The vaccine has a protective efficacy of approximately 60 percent. Most people will need one shot that will immunize them for the rest of their lives. However, some people may need to have another vaccine after five years.

Living with Asthma Asthma is a long-term (chronic) disease of the respiratory system that causes inflammation and spasm or tightening in the bronchial tubes, which carry air to the lungs. The inflammation causes periodic episodes of difficulty breathing, wheezing, chest tightness, and coughing. The cause of asthma is not clearly known. It often begins during childhood and may last throughout a person’s life. Asthma is more common in people who also have allergies. Although it cannot be cured, most people can control their asthma by following a plan they (Breathe, continued on Page 26)

Blue & You Spring 2005

Respiratory Education Program

The misery of a cold or flu is temporary and, in most cases, not serious. These illnesses, however, can lead to more serious respiratory infections such as sinusitis or pneumonia. People who are especially at risk are those whose resistance to infection may be low. This group includes smokers; the elderly; and those who suffer from chronic diseases such as asthma, heart disease, diabetes and kidney disease, or lung conditions such as emphysema or bronchitis. Arkansas Blue Cross and Blue Shield, Health Advantage and eligible BlueAdvantage Administrators of Arkansas groups are pleased to offer free to their members (with respiratory illness) a community-based Respiratory Education Program. Enrollment in this program will: • Help you know more about what causes different types of infections, how they are spread, and how they can be treated most effectively. • Provide information about the actions you can take to prevent or reduce your chances of acquiring respiratory infections. • Provide more specific information and resources about asthma, sinusitis and bronchitis — and how to manage them. The Respiratory Education Program connects you with respiratory disease-specific information as well as local and national resources to keep you informed about respiratory health. The program is designed to provide a comprehensive approach to educating members about respiratory health including prevention, treatment and self-care techniques. More specific information is provided about sinusitis, flu, pneumonia, asthma and smoking cessation. Members currently enrolled in the plan report high satisfaction rates. According to members who participated in a recent survey: • 93 percent are satisfied with the program; • 88 percent believed the material received was helpful; • 61 percent reported that some of the information received through the program was new information to them; and • 73 percent found the material useful when visiting their physician. To get more information about the program or enroll, call 1-800-686-2609 or visit our Web sites. Just click on the “Members” tab at www.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com or www.BlueAdvantageArkansas.com.

Low back pain can bring you

ow back pain is one of the most common conditions and one of the leading causes of physician visits in the United States. Americans spend approximately $50 billion every year battling back pain. It is the most common cause of job-related disability and a leading contributor to missed work. The only neurological ailment more common in the United States is the headache. It is estimated that four out of five Americans will experience low back pain at some point in their lives. Back pain comes in two forms, acute and chronic, and is usually in the lower back. Acute pain: This is the pain that comes on suddenly and with intensity. It is usually the result of a muscle strain that can occur with the lifting of heavy objects, sudden movements or falls. Chronic pain: This is a recurring pain that may be set off with any small movement and tends to linger for long periods of time. Ironically, the severity of back pain is often unrelated to the extent of physical damage. A muscle spasm from a simple back strain can be extremely painful while a large herniated disc may be completely painless. The lower

back is simply loaded with structures that have the potential to cause pain. Large nerve roots going to the arms and legs, smaller nerves that innervate the spine, large back muscles, and ligaments and joints are all capable of causing pain. As a result, making an accurate diagnosis of back pain is complex. In fact, many types of low back pain have no known anatomical cause. The pain is, nevertheless, quite real and needs to be treated. Common causes of low back pain are: • Lumbar strain: This is a stretching injury to the ligaments, tendons, and muscles of the lower back. • Nerve irritation: The nerves of the lumbar spine can be irritated by mechanical impingement or disease. • Lumbar radiculopathy: This refers to nerve irritation as a result of damages to the discs between the vertebrae. • Bony encroachment: Any movement or growth of a vertebra of the lumbar spine can encroach on the available space for the adjacent spinal cord and nerves. • Bone and joint conditions: This can include problems from birth, wear and tear, or injury. Other causes of back pain include kidney problems, pregnancy, ovary problems and tumors. Methods of treating back pain are as varied as the causes and can range from simple rest to surgery. Fortunately acute pain, which is usually associated with a muscle strain, can heal with time. This can be a few days or a few weeks depending on the severity of the strain. However, muscle pain, which lasts more than a couple of weeks can lead to muscle weakness which can cause the problem to become chronic. One way to reduce your risk of back pain is to exercise. As a general rule, people who are active and in shape are less likely to suffer from back pain due to muscle strains, tears or spasms. An exercise program designed to reduce your risk of low back pain should consist of a Blue & You Spring 2005

down

Low Back Pain Education Program

combination of stretching, strengthening and aerobic conditioning. To help our members with their low back pain, we offer a Low Back Pain Health Education Program (see next column). To get more information about the program or enroll, call 1-800-6862609 or visit our Web sites and click on the “Members” tab. — Sources: National Institute of Neurological Disorders, Federal Drug Administration, www.spine-health.com, www.MedicineNet.com

Blue & You Spring 2005

If you are dealing with the

effects of low back pain, managing your condition is a process that involves you, those close to you, your physician and other caregivers. You may be at risk for, or already have developed, chronic back pain. Arkansas Blue Cross and Blue Shield, Health Advantage and eligible BlueAdvantage Administrators of Arkansas groups are pleased to offer free to their members (with low back pain) a community-based Low Back Pain Education Program. The program will provide information to help you manage your condition. Upon enrollment in the program, you will receive information to help you: • Understand your individual risk factors for chronic back pain complications. • Work on decreasing pain, improving function, gaining control over your condition and returning to a normal lifestyle. • Communicate your needs and concerns to your healthcare provider. • Prevent the complications common with back pain. The Low Back Pain Education Program connects you with specific health education information as well as local and national health resources to keep you informed about managing back pain. The program is designed to work in conjunction with you and your physician by providing a comprehensive approach to teaching you about the causes of back pain, treatments and self-care techniques. Members currently enrolled in the plan report high satisfaction rates. According to members who participated in a recent survey: • 88 percent are satisfied with the program; • 82 percent believed the material received was helpful; • 70 percent reported that some of the information received through the program was new information to them; and • 73 percent found the material useful when visiting with their physician. To get more information about the program or enroll, call 1-800-686-2609 or visit our Web sites. Just click on the “Members” tab at www.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com or www.BlueAdvantageArkansas.com.

Want to lose weight?

osing weight is not easy. Just ask anyone who’s been on a diet. It takes dedication and willpower. Many people lose weight on weight-loss programs only to gain it back. So what is the answer to permanent weight loss? Eating smart and exercising more. More than 62 percent of Americans are overweight or obese. Researchers fault many things — from the prevalence of fast foods to lack of physical education classes in schools — but no matter what the cause, there is plenty of blame to go around.

Eat smart. Exercise more. journal. Write down not only what you ate, but where, when, and what you were feeling at the time. You will see what triggers your hunger and what satisfies your appetite. Eat at least 5 servings of vegetables and fruits per day. If you’re adding fruits and vegetables to your diet, try substituting them for higher calorie, less nutritious foods. Cut down on sodas and high-sugar content fruit drinks.

The Fat Facts • Americans spend $117 billion per year on obesityrelated illnesses. • Half of all obese adults have hypertension. • Two-thirds of Americans are overweight. • Arkansas ranks 15th in the nation in terms of obesity prevalence. • A child with one overweight parent has a 40 percent chance of being overweight; with two overweight parents, it’s 80 percent. • Arkansas has seen a 77 percent increase in obesity from 1991 to 2000. • Weight reduction of 10 percent can help an overweight adult reduce lifetime medical costs between $2,200 and $5,300. According to the U.S. Surgeon General, if you are overweight or obese, losing just 10 percent of your body weight can improve your health and reduce your risk for heart disease, certain types of cancer, Type 2 diabetes, stroke, arthritis, breathing problems and psychological disorders such as depression.

Tips for weight loss Make healthy choices a habit. Make a commitment to eat well, move more, and get support from family and friends. Remember to be realistic about your goals. If you try to reduce the calories, fat, saturated fat, and sugar in your diet AND, at the same time, try to make a drastic change in your physical activity level, you may be setting unachievable goals. Conduct an inventory of your meal/snack and physical activity patterns. Keep a food and activity

Eat foods that are high in fiber to help you feel full. Whole grain cereals, legumes (lentils and beans), vegetables, and fruits are good sources of fiber that may help you feel full with fewer calories. Prepare and eat meals at home. This is a great way to save money, eat healthy, and spend time with your family. Start by using a scale and measuring cup to serve your food. Read food labels to determine serving sizes. One bowl of cereal may actually be two 3⁄4-cup servings. A small frozen pizza may contain up to three servings (check the nutrition information label). This could add up to more calories than you think you’re getting. Choose snacks that are nutritious and filling. A piece of fresh fruit, cut raw vegetables, or a container of low-fat yogurt are excellent (and portable) choices to tide you over until mealtimes. Blue & You Spring 2005

Take your time! Eat only when you are hungry and enjoy the taste, texture and smell of your meal as you eat it. Remember, it takes approximately 15 minutes for your stomach to signal your brain that you are full. If you choose to eat out, remember to watch your portions. Portion sizes at restaurants (including fast food) are usually more than one serving, which can result in overeating. Choose smaller portion sizes, order an appetizer and a leafy green salad with low-fat dressing, share an entree with a friend, or get a “doggy bag” and save half for another meal. Forgive yourself. If you occasionally make mistakes, don’t give up! Forgive yourself for making that choice, and keep working on it. Remember physical activity! Aim for at least 30 minutes (adults) or 60 minutes (children) of moderate-intensity physical activity five or more days of the week. To lose weight, you must take matters into your own hands by eating smart and exercising more to help you live a longer, healthier life. To help our members with their weight loss efforts, we offer The Healthy Weigh! Education Program (see next column). To enroll in the program, complete the enrollment form, sign it and return in the self-addressed, postage-paid envelope included in this issue of Blue & You. For more information, call 1-800-686-2609. — Sources: Time, Newsweek, U.S. News and World Report, www.msnbc.com, WebMD, Arkansas Department of Health, Centers for Disease Control and Prevention, American Dietetic Association and Forbes.com

FAST FACTS ON FAT • It is estimated that 400 ,000 people die prematurely each diseases. The is 10 times more than die on our highw year from obesity-related ays and three times more than die from breast, colon and prostate cancers com bined. • Approximately one-third of all American adults are 30 pounds or more overw On average, someone 30 eight. pounds or more overweig ht will die six years earlier their normal-weight friends than . • Since 1980, the number of obe times more likely to be obe se children has tripled. These children are 11 se as adults and are much more likely to die prematur as adults. ely

Blue & You Spring 2005

15 Are you ready to make a change in your weight? Arkansas Blue Cross and Blue Shield can help! If you are an Arkansas Blue Cross, Health Advantage or BlueAdvantage Administrators of Arkansas member, you are eligible to participate in The Healthy Weigh! Education Program. The program is free to members. The information available through this program is based on the guidelines set forth by the National Institutes of Health Obesity Education Program. As a participant in this program, you will receive educational information in the mail including health tips, a BMI chart, a list of wellness discounts and much more. To enroll, simply complete, sign and return The Healthy Weigh! enrollment form in the self-addressed, postage-paid envelope inserted in Blue & You next to this article. After enrollment, you will begin to receive information through the mail, which you can read and use in the privacy of your own home, and at your own pace. The program is completely voluntary, and you may leave the program at any time. If you have already enrolled, it is not necessary to enroll again. If you have further questions about the program, call the Health Education Program toll-free at 1-800686-2609.

The importance of

O ne of the best ways to promote a healthy pregnancy is to get early and regular prenatal care (the care you receive while you’re pregnant). Prenatal care is important because, by seeing you regularly, your healthcare provider has the best chance to detect and treat any problems as soon as possible. Other problems also might be prevented. Women who see a health-care provider regularly during pregnancy have healthier babies, are less likely to deliver prematurely and are less likely to have other serious problems related to pregnancy. It doesn’t matter if this is your first, second or fifth pregnancy — it is important to see a health-care provider during your pregnancy. Many studies have shown prenatal care is as beneficial for the health of mothers as it is for their babies. Prenatal care is more than just health care, it often includes education and counseling about how to handle different aspects of pregnancy, such as nutrition and physical activity, what to expect from the birth itself and basic skills for caring for your infant. Prenatal visits also give you and your family a chance to talk to your health-care provider about any questions or concerns you have related to your pregnancy, birth or parenthood. Some health-care providers recommend that a woman who is only thinking about getting pregnant see a health-care provider about preconception health. There are steps she can take (such as taking folic acid every day) to reduce the risk of certain problems. The U.S. Public Health Service recommends that women of childbearing age get at least 400 micrograms (mcg) of folic acid each day through food sources or supplements. For women who are thinking about getting pregnant, health-care providers recommend supplementing the diet with folic acid for three months before pregnancy and then for at least the first three months of pregnancy. Prenatal vitamins are a good way to get extra folic acid into the diet. Here are some other ways to take care of yourself and the precious new life growing inside you: • Continue taking your multivitamin with 400 (mcg) of folic acid every day.

prenatal care

• Eat a healthy diet that includes fruits, vegetables, grains and calcium-rich foods. Choose foods low in saturated fat. • Unless your health-care provider advises against it, try to be physically active for 30 minutes most days of the week. If you are pressed for time, you can get your activity in 10 minute segments, three times a day. • If you smoke, drink alcohol, or use drugs, STOP. These can cause long-term damage to your baby. • Ask your health-care provider before taking any medicine, even over-the-counter medicines. Some medicines are not safe to take during pregnancy. • Avoid hot tubs, saunas and X-rays during pregnancy. • Do not empty the cat litter when you are pregnant. It may contain a parasite that causes an infection called toxoplasmosis, which can cause birth defects. Also, use gloves when working in garden areas used by cats. • Don’t eat uncooked or undercooked meats or fish. • Stay away from toxic chemicals like insecticides, solvents (like some cleaners or paint thinners), lead and mercury. Most dangerous household products will have pregnancy warnings on their labels. Ask your health-care provider about products if you are unsure. • Limit or eliminate your caffeine intake from coffee, tea, sodas, medications and chocolate. • Many women continue working through pregnancy. Staying active might help you stay healthier. If you have a question about the safety of your particular job, talk with your health-care provider. • Get informed. Read books, watch videos, go to a childbirth class and talk with experienced moms. • Ask your health-care provider about childbirth education classes for you and your partner. Classes can help you prepare for the birth of your baby. Remember the goal of prenatal care is to help you deliver a healthy, full-term baby. No one knows exactly why women who get early and regular prenatal care have healthier pregnancies and healthier babies, but we know Blue & You Spring 2005

Special Delivery Added Benefit for Expectant Mothers it works. Schedule and keep your prenatal visits. Do it for yourself — and your baby. To help our expectant mothers, Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas offers the Special Delivery Program. To get more information about the program, online enrollment is available through My BluePrint, our member selfservice center. For more information, please call 1-800-742-6457 or 501-379-4680 (Little Rock) or e-mail SpecialDelivery@arkbluecross.com. — Sources: The National Institute of Child Health and Human Development (NICHD), National Women’s Health Information Center (NWHIC) and the March of Dimes

T he Special Delivery Program is a prenatal care program offered as an additional benefit to our members. The program is designed to help our members have healthier pregnancies. It was created with three strategies in mind — education, assessment and intervention — to educate the expectant mother in the prevention of preterm births secondary to high-risk prenatal conditions. The Special Delivery program is available to Arkansas Blue Cross and Blue Shield, Health Advantage and eligible BlueAdvantage Administrators of Arkansas members regardless of their pregnancyrisk status. The program is free to expectant mothers. Once registered, each expectant mom will receive educational material and coupons by mail to encourage good health practices during pregnancy, including materials to increase her awareness of symptoms that may signal preterm labor. The Special Delivery nurse can assist in coordinating coverage of home-health care in lieu of hospitalization for the high-risk patient whose physician feels she would benefit from this alternative care. Through case management, we can provide coverage of services that are not normally offered, such as skilled-nursing assessments and nursing-assistant care in the home for conditions including pregnancy-induced hypertension, diabetes mellitus and preterm labor. How To Enroll

Expectant mothers should enroll by the 14th week of pregnancy. The expectant mother will complete a risk assessment by answering a series of basic questions. The questions are designed to identify factors that may put the mother and/or baby at risk. If risk exists, the expectant mother is followed throughout her pregnancy to determine if home health care is appropriate. Online enrollment is available through My BluePrint, our member self-service center. For more information, please call 1-800-742-6457 or 501-379-4680 (Little Rock) or e-mail SpecialDelivery@arkbluecross.com. NOTE: No member should ever rely on any advice or information from the Special Delivery nurse as a substitute for the advice of her own physician. The Special Delivery program is not a substitute for the health-care services and advice of her physician and does not assume responsibility for her medical care or advice. It is intended solely to provide general education as well as assistance in accessing healthplan benefits related to her pregnancy. You should always consult your own physician and follow his or her advice and direction with respect to all aspects of your or your child’s medical care. Blue & You Spring 2005

What can case management do for YOU?

hen you need it, case management is a powerful tool available to support members and their families as they navigate the health-care system. Case management services from Arkansas Blue Cross and Blue Shield and its affiliated companies can provide the following value-added benefits. Case management can help: • Maximize the benefits available under your health benefit plan. • Provide health education to empower you and your family to self-manage aspects of your care as deemed appropriate by your physician. • Help you to better understand and deal with the complexities of the health-care system and your health-plan benefits. • Identify cost-effective alternatives to high-cost treatment settings such as hospitalization. Case management is a cooperative process between patients, their families, their doctors and nurses, and their health insurance company. The process is to assess, plan, facilitate and advocate for options and services designed to meet the patient’s health-care needs through communication and available resources to promote costeffective outcomes. In consultation with the member’s physician, a case manager works with family members, hospitals and various home health-care providers to coordinate care. Our case managers are operating under a new, improved pro-active philosophy, which encompasses traditional case management as well as disease management. Case managers will provide educational materials and work to assist members in managing their health. The new philosophy makes case management available to all members, no matter what their healthcare needs. Members do not have to be suffering from chronic or acute conditions to be eligible for certain services — such as educational materials or guidance through the health-care system. All Arkansas Blue Cross and Blue Shield, Health Advantage and eligible BlueAdvantage Administrators of Arkansas members may receive help from case managers throughout Arkansas. They are located in all seven regions, and are, literally, at your service through a simple telephone call.

Who are the case managers?

ers. Additionally, the map outlines the counties they serve. Please call the case managers at the toll-free numbers listed with the map when you need help navigating the health-care system, have questions about your health-care needs or need health information to assist you in making good health-care decisions. An RN designation means that all of our case managers are registered nurses. A CCM designation means that those case managers are Certified Case Managers. To earn this designation, case managers must accomplish specific educational requirements, possess good moral character, meet acceptable standards of practice, hold a license that is based upon the applicant having taken an examination in the area of educational specialization and much more. All case managers employed by Arkansas Blue Cross are required to obtain their CCM designation within two years of employment. The Case Management Program at Arkansas Blue Cross is accredited by the Utilization Review Accreditation Commission (URAC). A URAC accreditation ensures our customers that our case management services are of the highest quality. The URAC standards cover several critical operational categories for any qualified management program, including staff structure and organization, staff management and development, information management, quality improvement, oversight of delegated functions, organizational ethics and complaints. — Sources: Case Management Society of America, URAC and Continuing Care News, December 2004

On the following page is a list of the Arkansas Blue Cross regional case managers and medical affairs managBlue & You Spring 2005

Need a case manager? Call us. #2 Northwest Region — 1-888-847-1900 (Fayetteville) Medical Affairs Manager Claudia Gardner, RN, CCM

#1 Central Region — 1-800-225-1891 Ext. 2-4668 (Little Rock) Medical Affairs Manager Betty Bryant, RN, CCM Case Managers Kay Beckman, RN, CCM Brenda Strange, RN, CCM Marty Usrey, RN, CCM Kelly Richards, RN, CCM JoAnn Runnells, RN, CCM Mona Davis, RN, CCM Sheila Bulloch, RN, CCM Susan Trulove, RN Veranda York, RN Dawn Staats, RN, CCM

#3 Northeast Region — 1-800-370-5861 (Jonesboro) Medical Affairs Manager Ruth Ann Harp, RN, CCM Case Managers Martye Nelson, RN Dolly Sullins, RN

Case Managers Tresha Jacky, RN, CCM Paulette Mar, RN, CCM

#7 West Central Region — 1-800-299-4060 (Fort Smith) Medical Affairs Manager Sandee Chaddock, RN, CCM Case Managers Mark Blaty, RN, CCM Sandi Cochran, RN, CCM

#4 Southeast Region — 1-800-588-5722 (Pine Bluff) Medical Affairs Manager Helen Williams, RN, CCM Case Manager Rochelle Nix, RN, CCM #5 Southwest Region – 1-800-470-9621 (Texarkana) Medical Affairs Manager Priscilla Newton, RN, CCM Case Managers Melissa Crow, RN, CCM Cheryl Loveless, RN, CCM

Blue & You Spring 2005

#6 South Central Region — 1-800-817-7924 (Hot Springs) Medical Affairs Manager Karen Bell, RN, CCM Case Manager Pat West, RN, CCM

When you have a question

HealthConnect Blue has the answer

H ealthConnect Blue is a confidential health informa-

tion service that puts members in touch with Health Coaches by telephone and offers health information online — to help members make more informed decisions about their health care. Currently, all Health Advantage, some Arkansas Blue Cross and Blue Shield and eligible BlueAdvantage Administrators of Arkansas members* have access to HealthConnect Blue. Members can call a toll-free number (1-800-3182384) to speak with a Health Coach to get the support and health information they need 24 hours a day, seven days a week. Health Coaches are specially trained health professionals such as nurses, respiratory therapists and dietitians. Members may call as often as they like at no cost. A Health Coach can help you work with your doctor to make health decisions that are right for you. Members also can access free health information online by using the HealthConnect Blue link online at www.HealthAdvantage-hmo.com, www.ArkansasBlueCross.com or www.BlueAdvantageArkansas.com.

As an member of this program, you can: • Speak one-on-one with a Health Coach 24 hours a day, seven days a week. • Receive personalized follow-up calls with a Health Coach about a chronic condition or other health concerns. • Have educational materials mailed to your home, at no charge. • Visit the Health Advantage, Arkansas Blue Cross or BlueAdvantage Web sites to review a health encyclopedia containing in-depth health information on more than 1,900 clinical topics. “When it comes to dealing with health problems, most people benefit from information to help them learn more about their conditions,” said Clement Fox, M.D., medical director of Health Advantage. “Many want support to help them take an active role in making the choices that are right for them. As always, we encourage members to talk with their physicians to discuss all of

their health-care needs. Members who participate in HealthConnect Blue may find that the information and support they receive helps them make informed decisions concerning their health care while strengthening their relationship with their physician.” HealthConnect Blue provides members the following services: • A Health Coach to talk to anytime, day or night, 24 hours a day, seven days a week Health Coaches provide health information and support so members can work more effectively with their doctors. They may also refer members to an appropriate Health Education Program or for case management. Health Coaches do not provide medical advice. Members with urgent needs that require immediate medical attention are (as always) urged to call their physician, contact their local 911 or emergency service, or go to a nearby emergency room, as the need requires. • Personalized follow-up calls with a Health Coach about a chronic condition or other health concerns A Health Coach can help provide a better understanding of how to manage members’ conditions and other topics that are important to them, as well as how they might prepare for the next visit with their healthcare provider. • Educational materials mailed to member’s home, at no charge If a member needs tips on lowering cholesterol, information about a low-salt diet, a heart condition, lung condition or diabetes, Health Coaches with HealthConnect Blue can send him or her information from nationally recognized sources on a wide variety of topics. Videotapes are available on specific topics such as breast cancer, prostate cancer and low back pain. All materials are for members to keep at no cost to them. • Easy Internet access to an “encyclopedia” of valuable health information Members may access HealthConnect Blue online by logging on to My Blueprint on our Web sites. Easy-tounderstand articles on thousands of health topics are easy to access. A Health Coach is available to ask for information to be mailed to a member’s home if the member does not have Internet access. An audio library also is available, via telephone, for members to listen to more than 470 health-care topics, from arthritis and anxiety to pneumonia and immunizations. Health Coaches are available to answer questions from the member after listening to the audio messages. Blue & You Spring 2005

The Phar macist is in Do you have any questions? Medication Compliance Making good things happen is the intended outcome when a physician establishes a medication regimen for a patient. We go to the doctor because some part of our body is in pain or is not functioning properly. The problem may be a minor discomfort or a pronounced pain that is aggravating and bothersome, but we want to know what it is, and we want it fixed. We incur an expense with this decision, but we accept that as necessary and acceptable in order to relieve the discomfort and be assured that the occurrence is nothing serious that may lead to bigger problems later. We usually expect a clear diagnosis and some medication to fix the problem. We have some anxiety, but we always hope the problem is simple and easily correctable. Prescription medications can be the answer to our problem but, they do not work well when not taken properly. Patients should receive information from their physician and their pharmacist about taking their medication properly. The following reasons lead to poor compliance: side effects may surprise a patient and sometimes interrupt therapies; feeling better too soon after starting a medication may give the impression that a patient is rid of the problem; and sometimes patients just get tired of taking pills. Taking into consideration that the doctor considered the therapy important, and we paid hard-earned money to get the diagnosis and prescription, why in the world would we decide to stop the prescribed therapy without consulting the doctor? Compliance means that the patient is continuing a prescribed treatment as intended and “By working with their health-care provider and Health Coach, we believe HealthConnect Blue will better prepare our members to manage their health and make informed, confident health-care decisions,” said Dr. Fox. Being well informed is the first step in taking charge of your health. There is no better place to start than with a HealthConnect Blue Health Coach. Call today! * Includes all Health Advantage HMO members, all public school employees and state employees covered by Arkansas Blue Cross or Health Advantage, eligible BlueAdvantage Administrators of Arkansas members, and individual and group members who have an HSA or HRA product.

directed by their doctor. To comply means we are placing our confidence in the medical professional who has prescribed the therapy, and we trust their judgment. Proper compliance usually produces good outcomes, although some prescribed therapies may need to be reevaluated and possibly modified or changed. Noncompliance usually means someone is forgetful, undisciplined or uneducated about the importance of “following the doctor’s orders.” This can then lead to wasted money, another doctor visit, and, on occasion, serious consequences due to stopping the medication too soon. Compliance is important. There is no partial compliance or interrupted compliance. We’re either compliant or noncompliant. We either take the medication as directed or we don’t. What do we say when we go back to the doctor and are asked, “Did you take the medicine?” implying “as I directed?” Do we tell the truth? If we don’t, we are posing a mystery to the person we want to treat our medical condition. If we were noncompliant and don’t admit it, the doctor has to assume the medicine was ineffective, but, in reality, we made the medication ineffective by being noncompliant. Compliance with a prescribed medication regimen is important to ensure the effectiveness of that therapy or to determine what next to do if that therapy failed. Noncompliance means we didn’t give the therapy a chance to work properly. Noncompliance usually means that we wasted our time, our money and may even be subjecting ourselves to additional harm by not doing our part. Compliance is a responsibility of the patient.

What are our members saying about HealthConnect Blue? Following are excerpts of actual comments from members: “I want to commend the Health Coach who really allayed my fears about my health condition. This is the first time I have used this service, and I really appreciate it. It has been a Godsend. Thank you very much.” “I have been working with the Health Coach. My husband and I have both called the Health Coach because I have lower back pain due to an injury. It has made a big (Comments, continued on Page 26)

Blue & You Spring 2005

Blue & You readers praise magazine, Internet services

Readership Survey Results: Members appreciate health information According to our annual Blue & You readership survey, this effort by Arkansas Blue Cross and Blue Shield (and affiliated companies) to supply its members with in-depth health-and-wellness and health insurance information is appreciated by our members. Blue & You readers sent the message that they appreciate Blue & You, and have made changes in their lifestyle due to the information they have received in Blue & You. The Autumn 2004 issue had a readership survey enclosed for members to return with comments, and customers gave Blue & You an average of 4.32 on a five-point scale (with five being the highest rating) in the “Value” category. Survey respondents gave Blue & You an average satisfaction rate of 4.53 in the “Helpful” category and a 4.49 in the “Attractive” category. For the second year in a row, we asked an additional question to our members, which required a simple “yes” or “no” response. The question was, “Have you made a healthy change in your behavior because of something you’ve read in Blue & You?,” and 81 percent of survey respondents answered “yes” to that question. More than 880 members responded to the survey, and more than 500 of the survey respondents took time to write additional comments, 98.4 percent of which were positive. Comments included: • “Unlike some health magazines, Blue & You is easy to read and easy to understand.” • “I was going to call and say how much I enjoyed it and lo and behold — here comes a survey.” • “I count my calories since Blue & You and corrected my diet.” • “It’s great! We subscribe to Prevention magazine, and honestly, Blue & You is just as good — or better!” • “I have lowered my cholesterol by 50 points. Thanks for bringing it to my attention.” • “I keep all my Blue & You magazines to refer back to. Thank you for caring about mine and my family’s health.”

Web Survey Results: Most respondents find sites useful More than 465 members participated in the 2004 Web survey by returning the card enclosed in the Autumn 2004 issue of Blue & You. About 73 percent of those who had visited the Web sites found them useful. They gave the sites a rating of 4 or 5 on a five-point scale (with 5 being the highest rating). The total number of respondents with access to the Internet increased from 64 percent in 2003 to 79 percent in 2004. Only 27 percent were not aware of the sites, compared to 56 percent in 2001, the first year the survey was done. The features respondents found most useful were “Provider Directory,” “Health Plans & Services” and My Blueprint. The three top features members said they would like to see on the sites were: 1. Review benefits. 2. Access health-and-wellness information. 3. View out-of-pocket accumulation. Benefit summaries are available now for BlueAdvantage Administrator of Arkansas and Health Advantage members. Health-and-wellness information is online for those members who have HealthConnect Blue through My Blueprint. Out-of-pocket accumulation is available through My Blueprint for BlueAdvantage members. The survey results are used to help guide Web site development to make the sites more useful and beneficial to members.

Gift card winners! From the Blue & You satisfaction survey, we randomly selected three winners who each received a $50 gift card to Wal-Mart. The winners were Sandra Jenkins of Jonesboro, Dara Bigger of Marion and Deborah Wallace of Piggott. From the Web site satisfaction survey respondents, we also randomly selected three winners who each received a $50 gift card to Wal-Mart. The winners were Mike Whitman of Hot Springs, Kristie Patton of Arkadelphia and Stacy Wharry of Bella Vista. A special thanks to all of our readers who took the time to send in your surveys and comments.

Blue & You Spring 2005

Let the games begin . . . again! F

or the second year, Arkansas Blue Cross and Blue Shield employees challenged the Arkansas Department of Health employees to a fitness “fight.” And other organizations in Arkansas also plan to battle for better health. The 2005 Arkansas Fitness Challenge officially kicked off on March 1 and runs through May 31. Sharon Allen, president and chief operating officer of Arkansas Blue Cross and reigning “Queen of Fitness,” and Fay Boozman, M.D., director of the Arkansas Department of Health, again are serving as corporate champions for their respective camps in the contest. Last year, almost 2,700 employees from the two entities participated in the competition and recorded positive fitness levels and health improvements as a result. Among the Challenge participants responding to a post-Challenge survey, 19 percent indicated that their health status had “greatly improved” during the contest, and 61 percent of the respondents said their health status had “somewhat improved.” Of the respondents, 32 percent said they reached their own personal goal to “begin exercising;” 44 percent said they reached their goal to “increase exercising;” and 31 percent to “lose weight.” Eighty-nine percent said they increased their exercise tolerance during the contest, and 98 percent said they would participate in future programs like the Arkansas Fitness Challenge. Because of the 2004 contest, a kit was developed to help other organizations construct and carry out contests of their own. Almost 400 requests for the Arkansas Fitness Challenge Employee Fitness Contest Kit have been received since it became available late last fall. “The results for our employees participating in the 2004 Challenge were better than we ever imagined,” said Allen. “And we are thrilled with the response we have received regarding the Employee Fitness Contest Kit.” For Arkansas Blue Cross and the Department of Health, our immediate goal with the Arkansas Fitness Challenge was to begin to make a difference in the physical health of Arkansans, starting at home with our own employees. Our long-term goal was to help other employers. Our hope was that the Challenge would have a ripple effect — improved fitness for our employees, spilling over into their families and friends, and then out into the state. “The Arkansas Fitness Challenge helped us get up and get moving!” Among the groups participating in the 2005 Arkansas Blue & You Spring 2005

Fitness Challenge (March through May) are: • St. Bernards Medical Center vs. Arkansas State University (Jonesboro) • Baker Elementary School employees vs. Old High Middle School employees (Bentonville) • The Booneville Human Development Center vs. the Booneville Hospital (now a countywide contest in Logan County) • Dardanelle Public School District (four-school challenge) • Hot Springs Health and Fitness vs. the Jessieville School District • Little Rock Housing Authority vs. North Little Rock Housing Authority • Stanford Insurance vs. Bismarck High School (and other clients) Groups or companies conducting internal contests, include: A-Test Consultants (North Little Rock), Cabin Rural Health Services (Hampton), CHRISTUS St. Michael’s Health Systems (Texarkana), Crystal Hill Elementary (North Little Rock), England Dryer/Elevator, Evening Shade Schools, Jiffy Print (Fort Smith), Hart Center (Fairfield Bay), Holy Angels Convent (Jonesboro), House of Prayer Church (Pine Bluff), International Paper (Pine Bluff), Ken Rash of Arkansas (Little Rock), Lions World Services for the Blind (Little Rock), Mercy Health Systems (Rogers), Navigator Telecommunications (North Little Rock), Potlatch Resource (Warren), Prestolite Wire (Paragould), Springhill Surgical Center (North Little Rock), Twin City Bank, Vera Lloyd Presbyterian Home for Children (Monticello), Central High School (West Helena School District), and Pilgrim Lutheran Church Wellness Group. The Employee Fitness Contest Kit is free and available to download at: www.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com, or www.BlueAdvantageArkansas.com. Go to the “Employers” section and click on the kit logo.

“Blue comes through” in responding

You talk. We listen.

You, our members, tell us that four things are very important to you when it comes to being satisfied customers. You want: 1. More affordable health insurance options. 2. More information about your benefits and staying healthy. 3. Your claims paid quickly and accurately. 4. Any problems resolved quickly and conveniently. Here are some of the ways that “Blue comes through” in meeting these needs.

1. New, More Affordable Plans Whatever your budget or your coverage needs, we have a plan for you. In addition to our full menu of traditional major medical, PPO, HMO and POS plans, we’ve introduced several new health plans that make health care even more affordable:

For Individuals and Families • Short-Term Blue is for individuals and their families who find themselves temporarily uninsured and in need of short-term health insurance coverage. • BasicBlue® is designed to meet the basic need for health insurance at a cost that’s easy to budget. Since you share a greater portion of your healthcare costs than you would with other health plans, your monthly premiums are significantly lower. • Blue Solution PPO is perfect for the consumer who’s looking for a doctor visit copay, prescription drug coverage and a wide range of deductibles. • HSA Blue PPO is the product you need if you’re looking for an affordable, qualified high-deductible health plan that will let you take advantage of the tax savings available through a health savings account (HSA).

For Employer Groups • Blue~by~design HSA is the product you need if you’re looking for an affordable, qualified high-deductible health plan that will allow your employees to take advantage of the tax savings available through health savings accounts (HSA). • Blue~by~design HRA is a consumer-driven health plan that gives your employees more control over how their health-care dollars are spent; more flexibility in managing out-of-pocket costs; more choice of network and out-ofnetwork providers; and the ability to roll over eligible,

unused dollars into the next year for future health-care expenses. • Open Access Point of Service is an innovative group plan from Health Advantage that is a hybrid of traditional HMO coverage and POS benefits. The plan provides coverage for preventive and routine services, in-network specialty services (without the need for a referral) and out-ofnetwork options. • MyChoice Blue enables your company to offer each employee (whether two or 200) the opportunity to select from one of four benefit plans. • Group BasicBlue® provides essential coverage for your employees at a much lower cost to your company. Each employee receives a $1 million lifetime maximum benefit for covered services and the freedom to use any health-care provider.

2. Information on Benefits & Health • Web site tools available on our Web sites (www.ArkansasBlueCross.com, www.HealthAdvantagehmo.com and www.BlueAdvantageArkansas.com) provide a variety of information resources, including: — My Blueprint: Personal Benefits and Claims Tracker, a secure, self-service center, which allows you to: ◊ Check the status of your claims and review your claims history ◊ Review copies of your Explanation of Benefits (EOB) ◊ Check eligibility for you and your covered spouse and children ◊ Review primary care physician history ◊ Order a replacement ID card — Pharmacy benefits information, a customized Web section that enables you to: ◊ Look up your specific drug coverage (formulary information and pricing) ◊ Check your prescription claims history ◊ Locate a pharmacy ◊ Access a drug information center ◊ Check drug-to-drug interactions — Provider directories, lists of physicians, dentists, hospitals and facilities participating in our networks and serving our members. — Coverage policies, a database of policies to help inform members and their physicians why certain medical procedures may or may not be covered under our health plans. Blue & You Spring 2005

to “Top Four” customer needs •

•

— Wellness discounts, a list of health clubs and fitness equipment companies that offer discounts to our members. Blue & You magazine is a quarterly publication mailed to members’ homes, containing articles on staying healthy and benefit information. Understanding Your Health Care Costs is a booklet and video about what drives health-care costs up and what you can do to help hold costs down. To read the booklet online or view the video, go to www.ArkansasBlueCross.com or www.HealthAdvantage-hmo.com, click on “Members,” then click on “Understanding Your Health Care Costs.” Brand Name or Generic Drugs? What you don’t know can cost you is a special, 16-page booklet to help Arkansans understand how and why using generic drugs is the smart choice (and why generic drugs cost less than brand-name drugs). The booklet is available on our Web sites to print. Health Education Programs, available free to eligible members, provide information and links to local, regional and national resources to help members manage disease and prevent complications of illness. Programs are available for diabetes, respiratory health, low back pain, cardiovascular health and weight management. Additionally, we offer Special Delivery, which educates expectant mothers about preterm births. Blue & Youth Health Program uses a big blue sheep, BlueAnn Ewe, to teach school-aged children the importance of practicing healthy habits. Through an elementary classroom presentation, a middleschool mentoring program (High School Heroes), a health “club” for kids, animated musical television messages and a wild and woolly Web site for kids (www.BlueAnnEwe-ark.com), the Blue & Youth programs have taken healthy lessons to more than 625,000 Arkansas youth in the past eight years.

3. Paying Claims Quickly & Accurately • Fast turnaround — After we receive your medical claims from your doctor or hospital, we process your claims in an average of six days. So, for most of the claims processed, you receive your explanation of payments within 10 days after we receive the claim. • High accuracy rate — For the 12 months of 2004, we Blue & You Spring 2005

achieved a dollar accuracy rate of 99.5 percent in paying your claims. This is impressive when you consider that we process more than 8 million claims a year. • Investment in technology — Arkansas Blue Cross has invested in technology that facilitates the electronic submission of claims from providers. As a result, more than 80 percent of all claims are submitted electronically, speeding up the process. Arkansas Blue Cross now gives doctors and hospitals free access to the Advanced Health Information Network (AHIN), giving them access to eligibility, claims, claim-status and related data. A unique feature allows direct claim submission as well as online, real-time correction of erroneous claims.

4. Resolving Any Problems Whether you prefer picking up the telephone, checking a Web site or visiting face-to-face, Arkansas Blue Cross and its family of companies are working to make customer service easy and convenient: • Personal service, close to home, is available for customers who prefer face-to-face interaction (rather than a telephone call or Web contact) by visiting any of our seven convenient locations in Arkansas. Our offices, located in Fayetteville, Fort Smith, Hot Springs, Little Rock, Jonesboro, Pine Bluff and Texarkana, offer sales, customer service, medical management and provider relations services to members in all areas of the state. • My BlueLine, our self-service Interactive Voice Response System, recognizes speech patterns to help answer questions when customers call customer service telephone lines. By simply speaking a response to the questions asked by the automated system, customers can get questions answered quickly. My BlueLine is available 24 hours a day, seven days a week. It can help customers who have questions about benefits, status of claims and premium payments, and help customers order a new ID card, provider directory or claim form. And if you prefer to speak directly to one of our 200 customer service representatives, you can do so at any time during normal business hours. • My Blueprint, our online service center, lets you check your own claims and get answers 24 hours a day, seven days a week in a customized, secure Web environment. These are some of the ways Arkansas Blue Cross and its affiliated companies are meeting the needs of our customers. When you need answers, Blue comes through … for you.

Introducing

BlueSecure,

our new Long-Term Care Insurance

ur newest product offering, a long-term care (LTC) insurance policy called BlueSecure, soon will be available in Arkansas. How Americans will pay for their long-term care needs is an important issue. In fact, in February the federal government began a public awareness campaign in five states, including Arkansas, encouraging people to plan for their financial future by investigating such things as LTC insurance. Arkansas Governor Mike Huckabee held a news conference on Jan. 28, 2005, and, in February, sent a letter to the thousands of Arkansans who are between the ages 50 and 70, stressing the need to consider some form of LTC coverage. In addition, television and radio commercials have been running in Arkansas for several months, giving people a toll-free number to call to receive more information about options available to them. What is long-term care? Long-term care includes inhome care, assisted living and nursing home care. The need for such care can deplete a lifetime of savings. Providing for it can place a substantial burden on the resources of even the most supportive family. BlueSecure from Arkansas Blue Cross is an affordable, long-term care insurance policy that can help protect your assets by helping you plan for long-term

care when you need it. Premiums are based on your age at enrollment: the younger you are when you enroll, the lower your premiums will be throughout the life of the policy. Accidents and catastrophic illness are entirely unpredictable and may strike anyone at any time of life. In fact, 40 percent of the 13 million Americans receiving long-term care services are between the ages of 18 and 64. According to estimates by the Centers for Medicare and Medicaid Services (CMS), one of every five people in the United States eventually will require some form of long-term care. As people live longer, it is likely that this figure will rise accordingly. Though these occurrences may be unforeseen, you can be prepared for them with BlueSecure LTC insurance. To be among the first to receive our BlueSecure information kit by mail when it becomes available, please call 1-800-489-0463.

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develop with their health professionals and by taking medications. Common irritants in the air, such as tobacco smoke and air pollution, can trigger asthma symptoms. Controlling tobacco smoke is important because it is a major cause of asthma symptoms. People should not smoke in a house where a person with asthma lives. To help our members with respiratory illnesses, Arkansas Blue Cross and Health Advantage offer a Respiratory Education Program (see article on Page 11). To get more information about the program or enroll, call 1-800-686-2609 or visit our Web sites and click on the “Members” tab.

difference in my approach to my treatment and getting better, and the fact that it is a long-term situation, but there are things I can do to improve it. It helps tremendously for my husband to be able to talk to the Health Coach because he was feeling very frustrated about being unable to help. It really gave us a different perspective, and it has been very, very beneficial. I really appreciate the fact Arkansas Blue Cross and Blue Shield has this available as a resource for us.”

— Sources: www.stampoutsmoking.com, www.lungusa.org, American Academy of Allergy, Asthma and Immunology www.aaaai.org, WebMD.com and Healthwise, Incorporated

“I really am appreciative of the program that you have. It has helped me a lot. I am a diabetic. I called the Health Coach, and she gave me information that really helped me to keep my sugar count where it should be. I’m really proud that you all have this program, and I hope you continue to keep it so people have a place that people can call for help when they need it. I am really proud of the program, and I thank you all very much for it.” Blue & You Spring 2005

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rkansas Blue Cross and Blue Shield strives to be a good corporate citizen. Our employees raise money and spend many hours helping those causes near and dear to the hearts of Arkansans. Texarkana for a Cure Arkansas Blue Cross and Blue Shield’s Southwest Regional Office staff turned out in full force for the Susan G. Komen Breast Cancer Foundation’s Texarkana Race For The Cure. The 22-member team walked alongside the more than 6,500 other participants in downtown Texarkana in support of those who have conquered cancer and to remember those who have died from the disease. At the finish line, participants received a brightly colored paisley scarf that represented the battle against breast cancer. The race included 375 survivors who were honored and walked triumphantly in celebration of Members of the Southwest their cancer-free status. Regional Office in Almost $375,000 was raised Texarkana gather before for the Race! the event. Capeless Crusaders BlueAnn has been “stomping” around the state with the High School Heroes once again. Capeless crusaders from Little Rock Central High (a.k.a. High School Heroes) spread the word to fourth-, fifth- and sixth-graders at Martin Luther King Elementary and Fulbright Elementary recently that smoking is not cool. These High School Heroes are specially trained high school students who present an anti-smoking program targeted to middle school students in their school district. High School Heroes serve as role models for the kids, pledging to remain smoke-free, and delivering a strong testimony about the dangers of smoking and the appeals of tobacco advertising. Using brainstorming, role-play, discussion and question-and-answer, Heroes present their message with the goal of reaching kids at an age when peer pressure and advertising might entice them to start smoking. The discussion includes information about effects of smoking on the body as well as the deceptive appeals of tobacco advertising. BlueAnn Ewe was on Blue & You Spring 2005

hand to perform the “BlueAnn Stomp” with the Heroes. The “BlueAnn Stomp” ties in the High School Heroes anti-smoking message and BlueAnn’s wellness message, which is taken statewide as well. BlueAnn poses with Heroes from Little Rock Central High.

Cleveland County Care Members of the Arkansas Blue Cross Southeast Regional Office staff, along with BlueAnn Ewe, recently participated in the Cleveland County Cancer Health Expo. The Expo emphasized cancer prevention with free prostate screenings and information about breast cancer and selfexams. Free cholesterol, blood pressure, blood sugar and hearing screenings were offered. A child identity registration program took pictures of children and placed them in the county computers. The students from Cleveland County Schools-Kingsland High School Campus Beta Club volunteered at the Expo as their community project.

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using your pharmacy benefits appears below the copayment summary. It includes helpful links to your pharmacy benefits. Member surveys (see this year’s results on Page 22) have shown that benefit summaries are one of the most desired components of the Arkansas Blue Cross, Health Advantage and BlueAdvantage Web sites. Benefit summaries also are available on www.BlueAdvantageArkansas.com and will soon be added to www.ArkansasBlueCross.com.

My Blueprint Registration Quicker, Easier It’s easier and faster now to register to use My Blueprint, the online customer self-service center for Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas members. Members who want to use “quick registration” can enter their health plan ID number, name, date of birth and Social Security number (SSN). If we have your SSN on file in our membership system, we can authenticate you immediately and let you into My Blueprint to choose your own log-in ID and password and then view your personal health plan information. If you choose not to enter your SSN, or we don’t have it on file to authenticate you, you can still register and receive your password via the U.S. Postal Service. Even if you have to wait for your password to arrive in the mail, you will be able to change it to something easy to remember after you log in the first time. Hang onto your log-in ID that appears when you register online because you will need to use the ID along with your password to enter My Blueprint. Remember that any covered person, not just the policyholder or group employee, can register now. The Arkansas Blue Cross family of companies is trying to make your Web sites more user friendly while continuing to protect the privacy of your personal health information.

Health Advantage Adds Benefit Summaries Remember when you first joined your company’s health plan, and they gave you that paperwork that contained your benefit summary? Some of us are organized enough to put our hands on that document at this moment — and some of us aren’t. Or we are the type who files every piece of paper but stores this one at the office, and we need it at home now. Or perhaps we just don’t want to dig through that file cabinet again. Now you can review your benefit summary online if you are a Health Advantage group health plan member. Go to either the “Members” or “Customer Service” page of www.HealthAdvantage-hmo.com and click on the link that says My Health Plan. If you are logged into My Blueprint, you can get to the “My Health Plan” section from the “Welcome” page menu. You will need to enter your member ID number that Blue & You Spring 2005

www.ArkansasBlueCross.com www.HealthAdvantage-hmo.com www.BlueAdvantageArkansas.com www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com appears on the front of your ID card. That number no longer contains your Social Security number. If you don’t have your ID card handy, you can find your ID number on a recent Explanation of Benefits (EOB) statement. If you have lost your ID card, you can order a new one through My Blueprint.

Benefit Summary A link to your benefit summary will appear when you open the “My Health Plan” page. The Benefit Summary link goes to a printable PDF (Adobe portable document) that shows at a glance what is covered under your health plan. It includes your deductibles and copayments, as well as covered services. To confirm coverage, you may review your eligibility information under My Blueprint or you can e-mail Customer Service from the link at the bottom of any page of the site. You also might want to review the “Coverage Policy” section for additional information about procedures and treatments covered by Health Advantage. The link to the “Coverage Policy” also is accessible from the “Members” or “Customer Service” menu page.

Prescription Drug Information A Prescription Drug Plan link will appear on the “My Health Plan” page if you have pharmacy benefits. The “My Prescription Drug Riders” page shows your copayment plan tiers. Additional information about (Blue Online, continued on Page 27)

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