Winter 10
A publication for the policyholders of the Arkansas Blue Cross and Blue Shield family of companies
• New plans for individuals and families, Page 4 • 101-year-old still swimming, Page 10 • Helping UALR students compete internationally, Page 20
Long before the festivities start, Arkansas Blue Cross and Blue Shield employees are out in the chilly predawn air filling hundreds of cups of water and setting the stage for their part in the Komen for a Cure Race in Little Rock. See the story on Page 8.
101-year-old Tracy Akins, swimming at the Marvin Altman Fitness Center in Fort Smith.
INSIDE 3 Out of the Blue 4 New plans for individuals and families 5 Bravo Wellness to manage incentive programs for 6 7
8 10 12
13
14
on Page 10 6 Eight clinics to pilot 8 23
innovative concept Blue in the pink Women’s Health and Cancer Rights Act
Winter 10
is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, health care professionals and other persons interested in health care and wellness.
15 16 18 19 20 22 23 24
employer groups Eight clinics to pilot innovative concept Your health plan information is online … Register today! Remembering Maudie Rogers Blue in the pink In the swim of things — 101 years and counting Making healthy New Year’s resolutions and making them stick Lose weight The Healthy Weigh! FDA issues consumer warning about infant sleep positioners Planning to have a baby? Eat more fruits, veggies and fish! Vitamin D supplements do not improve bone density in healthy children Are supplements a substitute for healthy eating? Questions on health insurance reform? Arkansas Blue Cross makes the grade Lifelong Health with Dr. David From the Pharmacist — What is step therapy? The Doctor’s Corner Good for you starts with … Good for your community Women’s Health and Cancer Rights Act Customer Service telephone numbers Good for you
Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com Assistant Editor: Jennifer Gordon Designer: Gio Bruno Photographer: Chip Bayer Contributors: Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming, Trey Hankins, Heather Iacobacci-Miller, Ryan Kravitz, Kathy Luzietti and Mark Morehead Vice President, Communications and Product Development: Karen Raley
Out of the
Blue
A message from our CEO and President, Mark White You can help add more value to your health care dollar by following these simple rules:
Buy Generic Generic medications often are a fraction of the cost of brand-name drugs, and must meet the same U.S. Food and Drug Administration (FDA) quality standards as their counterparts. Generic alternatives to high-priced branded drugs help increase adherence
Managing your health care budget The Patient Protection and Affordable Care Act (PPACA), signed into law in March, quickly is changing the health care landscape. There are still a lot of unan-
to prescribed drug therapies and improve health care, while providing value to cost-conscious consumers and businesses.
Join a Health Education Program
swered questions and concerns about how the coming
Did you know Arkansas Blue Cross has programs
changes will affect our members. Regardless of these
available to help you manage chronic illness or prepare
changes, Arkansas Blue Cross and Blue Shield still will
for a new child? All of our Health Education Programs
continue to conduct business for our members with
provide access to registered nurse case managers and
three simple things in mind:
health information and education from community and
1. We want you to be healthy.
national resources. We believe that by learning more
2. If you are sick, we want you to receive quality care
about your condition, you can avoid problems and stay
from excellent doctors and hospitals. 3. We don’t want you to go bankrupt in the process. Arkansas Blue Cross always has been a careful steward of your health care dollars. Our administrative costs are some of the lowest in the country, and we are always looking for ways to be more efficient without sacrificing the quality of our customer service. Some of the ways we save you money is by working with doctors, hospitals and pharmacies to lower the cost of care.
healthier.
Use the emergency room only in emergencies The use of emergency rooms for non-emergency conditions results in unnecessary spending estimated at $14 billion every year in the United States. When insurance companies cover these costs, consumers don’t immediately see the impact of the cost, but it’s Budget, continued on Page 15
Blue & You Winter 2010
3
flexibility of being able to add maternity and obstetrical coverage to your plan during the annual open enrollment period. Do you want a plan with tax advantages? Our “HSA-compatible” health plans allow policyholders to make tax-free contributions to a
New plans
health savings account (HSA) to pay
for individuals and families 4
I n the 60 years Arkansas Blue
Cross and Blue Shield has offered health insurance to Arkansans, we’ve
around the world for when you travel).
What are you looking for in a learned what matters most to you: health insurance plan? cost, health plans that cover what Do you want your health plan to you need, and a choice of excellent start paying your medical bills doctors and hospitals. Our new plans quickly? We have health plan opfor individuals and families, who are tions featuring $30 copayments for not Medicaid- or Medicare-eligible, primary care doctor office visits and feature all three. $10 copayments for generic drugs. Other medical services are covered Price, plans and providers • Our plans offer the protection you after your deductible is met. need at prices that won’t break Do you want coverage for preventhe bank. tive care services and the option • You have low copayments for to add benefits as your needs primary care doctor’s office visits change? Our health plans feature and generic prescription drugs. coverage for routine physical exams, And, other medical services are gynecological exams, routine mamcovered after a deductible is met. mograms, routine colonoscopies, • With more than 9,300 participatchildren’s immunizations and welling doctors and hospitals through- patient care, and more. Also, if out Arkansas, (and thousands of you’re planning to start a family, or doctors throughout the nation and add to it, our plans offer you the Blue & You Winter 2010
for medical expenses. Money saved in your HSA can be spent right
away or saved for future use. Are you looking for dental coverage, too? We also offer a choice of dental policies. These plans offer coverage from preventive care (including initial and periodic exams, teeth cleanings, fluoride treatments and X-rays) to minor restorative care (fillings and simple extractions) to major restorative care (root canals, oral surgery, bridges implants and more). Plus, you have the freedom to use any dentist you wish — although you can maximize your benefits by using a dentist who participates in the DentalBlue® network. Whatever your need, we’ve got the right plan for you. If you would like more information on any of our new plans, call toll free 1-800-3922583, visit us online at arkansasbluecross.com or contact a local independent or Farm Bureau agent.
Bravo Wellness
to manage incentive programs for employer groups I f you have your health insurance through your em-
The Bravo program will be available to Arkansas Blue
ployer (and the business has 51 or more employees),
Cross, Health Advantage and BlueAdvantage Adminis-
your employer soon will be hearing about the Bravo
trators of Arkansas employer customers with more than
wellness program.
50 employees.
Arkansas Blue Cross and Blue Shield recently an-
“Our goal is to help our current and prospective
nounced that Bravo Wellness will be its exclusive
members live healthier lives,” said Mark White, presi-
incentive management partner for employer group
dent and chief executive officer of Arkansas Blue Cross.
customers. The Bravo program, now offered exclusively
“With the help of Bravo, we can meet the needs of em-
in Arkansas to customers of Arkansas Blue Cross and
ployers by providing a results-based incentive program
its family of companies, provides employers with a tool
and continue to help our members reach their own
to control the cost of health care while encouraging
personal wellness goals.”
healthy behaviors among employees. Because an estimated 75 percent of health care
“We are thrilled to be selected and have given Arkansas Blue Cross exclusive access to our products
costs are driven by lifestyle choices, the Bravo program
and services in Arkansas,” said Jim Pshock, founder
is designed to reward employees who make positive
and president of Bravo Wellness. “By offering Bravo’s
lifestyle decisions.
programs, Arkansas Blue Cross has provided employers
In other types of insurance (like car or home), low risk is rewarded. Good drivers pay less for car insurance than bad drivers. Homes with swimming pools may cost more to insure than those without pools. With the Bravo program, these same concepts apply to health insurance. If you make good lifestyle decisions, your insurance will cost less.
with a unique opportunity to control costs and improve the health status of their employees.” Bravo Wellness is an independent company that operates separately from Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas. Bravo Wellness does not sell or service Arkansas Blue Cross, Health Advantage or BlueAdvantage products and is solely responsible for the incentive management services referenced in this article. This program is not available to Arkansas state employees or public school employees.
Blue & You Winter 2010
5
WELCOME HOME!
Eight clinics to pilot innovative concept
Arkansas Blue Cross and Blue Shield has chosen eight medical practices to serve in a pilot program:
ing a team approach,
Clinics featuring the new concept are:
medical homes can
Baptist Health Family Clinic; Bryant Clopton Clinic; Jonesboro Harrison Family Practice Clinic; Harrison NEA Baptist Clinic, Internal Medicine; Jonesboro Ozark Internal Medicine and Pediatrics; Clinton UAMS-AHEC Northeast Family Medicine Residency Program; Jonesboro UAMS-Department of Family and Preventive Medicine-Family Medical Center; Little Rock Westark Diagnostic Clinic; Ft. Smith
6
prevent illness. By us-
This innovative approach to health care is another reason that Arkansas Blue Cross and Blue Shield is good for you. The eight patient-centered medical homes will be piloted for two years and, if successful, other locations may be added. The clinics selected to become medical homes already are established, but will be transformed to provide this new approach to health care.
What is a medical home? Medical homes take the hassle out of medical care. A medical home: • Works to keep you healthy and takes care of you quickly when you are sick. • Checks to be sure you get the preventive care you need. • Helps you manage your chronic health problems. • Arranges for any specialty care you need. • Keeps all of your doctors informed of the care you receive. • Cares for you and about you, just like at home. Medical homes provide quick access for sick patients, yet are available to patients who are taking steps to Blue & You Winter 2010
be sure patients are cared for by the team member who can best treat their needs. This may include advanced practice nurses, dietitians, pharmacists and other health professionals, as well as primary care physicians (PCPs).
Keeping you well Just like Mom reminds you to take an umbrella on a rainy day, medical homes reach out to their patients to make sure they are taking care of themselves. Medical homes keep tabs on the routine screenings, vaccinations, tests and check ups that can keep patients from getting sick, and communicate reminders for them to come in at the appropriate times. It’s just one more thing you don’t have to remember in your busy life. Modern Technology The medical homes will have information at their fingertips to be able to provide the best treatments for specific conditions. And, information on all of the care you are receiving, regardless of who delivers the care, will be available to your medical home caregivers. Maintaining good health More than anything, the medical home concept is about helping patients to adopt healthy lifestyles and helping them reach their wellness goals. At Arkansas Blue Cross, we want you to have medical care that is good for you. And as we all know, there is no place like home. Copayments, deductibles and coinsurance will apply based on your coverage.
Your health plan information is ONLINE …
Register today!
• Review your health plan benefits and other coverage information. • Find health and wellness information. • Update your Personal Health Record. • Sign up to get claims notifications by e-mail. • And much more. To access the self-service Web site, My Blueprint, you’ll need to use our easy registration process by visiting:
Do you shop online? Pay your bills online? Catch
up with friends online?
If you spend several hours each day online, you are not alone. Approximately 80 percent of all U.S. adults go online for something. And, although you may not have even thought about it, as a member of Arkansas Blue Cross and Blue Shield, Health Advantage or BlueAdvantage Administrators of Arkansas, you have a personalized self-service Web site that allows you to go online to: • Check the status of a claim. • Print a temporary ID card or order a new one. • Contact Customer Service.
• arkansasbluecross.com • healthadvantage-hmo.com • blueadvantagearkansas.com And, you can register if you are a: • Policyholder • Covered spouse • Covered dependent To gain immediate access to all of your personal information, you’ll need to know the date of your last physician office visit and the physician’s name or a claim number or you can simply call Customer Service (see phone numbers on Page 23). Federal employees, Medi-Pak Rx and Medi-Pak Advantage members do not have access to My Blueprint.
Remembering Maudie Rogers ````````` It is with great sadness that we share that Maudie Rogers of Jonesboro, who was featured on the cover of the Autumn 2010 Blue & You and in the SilverSneaker’s article, died Sept. 29, 2010. Maudie was a member of the Northeast Arkansas Baptist Clinic Wellness Center and an inspiration to many. Even after being diagnosed with lung cancer (she never smoked), she continued to exercise. She will be remembered for her dedication to fitness, which challenged her friends, and even strangers, to strive for better health. Blue & You Winter 2010
7
BLUE 8
Carl Carter, one of hundreds of Arkansas Blue Cross and Blue Shield employees who turn out each year for the Komen for the Cure速 race in Little Rock, shows his spirit as he cheers on the participants.
Blue & You Winter 2010
In the chill pre-dawn hours, one October morning
each year, Arkansas Blue Cross and Blue Shield employees gather together at the corner of Sixth and Gaines streets in Little Rock and transform it into a celebration of life — a tribute to those battling breast cancer and to those searching to cure it once and for all. Under the glow of the blue cross and shield, hundreds of Arkansas Blue Cross employees, their families and friends, get ready to walk, run and volunteer their time for the Komen for the Cure® race event in Little Rock. Since 1997, Arkansas Blue Cross has been a financial sponsor of the race, and recently extended its support to Komen races in Texarkana and Fayetteville. But Arkansas Blue Cross’ sponsorship is more than financial — it is a labor of love. Employees in the Three Miles of Men fill thousands of water cups and hand them out during the race. A volunteer employee band fills the air with music, providing extra encouragement to help race participants cross the finish line. Other employees line the street to cheer on racers and share a small gift as they pass by. As the runners and walkers make their way through the race route, the sea of pink takes on an undertone of blue. Arkansas Blue Cross employees in blue T-shirts
in the pink
are found throughout the race, participating in honor or memory of women in their lives who have, or had, breast cancer. This year, more than 30 of the company’s 1,141-member team were breast-cancer survivors. When the last race participant passes the Arkansas Blue Cross building, employees gather up the decorations and begin planning for next year’s race. It is a commitment we make, not only to the Susan G. Komen Breast Cancer Foundation, but also to the one in eight women who will be diagnosed with breast cancer, to the people who love them, and to our communities. And it is one more way Arkansas Blue Cross is good for you.
Blue & You Winter 2010
9
In the swim of things 10
Tracy Akins, swimming at the Marvin Altman Fitness Center in Fort Smith (left), and with Marilyn Simpson, her second cousin and swimming partner (below).
101 years and counting Blue & You Winter 2010
In Tracy Akins’ 101 years, she
would only drive, but then she said,
months, cooped up in rehabilita-
has been a school teacher, a book-
“that’s kind of silly,” and joined her
tion. Then, the fitness center pool
keeper, a cannery worker and a
in the pool. Tracy keeps track of the
needed a face lift and she had to
secretary for a saw mill in Alaska, a
number of laps by reciting as many
wait a bit longer. The week the pool
loving wife and a world traveler. For
words as she can think of starting
opened back up, however, there
the past 30 years, though, she has
with each letter of the alphabet.
was Tracy, gliding through the shim-
been a swimmer.
If she gets to the letter “J” she
mering water with Marilyn beside
Tracy swims at the Marvin Altman
knows she has done 10 laps. In that
her, thinking of words and challeng-
Fitness Center in Fort Smith, where
way she exercises her mind as well
ing her body and mind.
she is a SilverSneakers member.
as her body.
®
SilverSneakers is the nation’s lead-
When asked how she thinks she
When she was 94, Tracy wrote a memoir, filled with adventures
ing exercise program designed
managed to live so long, Tracy said
in Missouri, Alaska and Arizona
exclusively for older adults. The
she eats regularly and keeps her
before she and her husband, Walter,
program offers an innovative blend
mind active. She listens to books
moved to Mountainburg, Ark. Sadly,
of physical activity, healthy lifestyle
Walter died a few years after they
and socially oriented programming.
“I just love to swim
This unique program is available to
… For many years,
Medi-Pak and Medi-Pak Advantage (PFFS) members at no additional cost at wellness centers throughout the country. “I just love to swim,” Tracy said when asked about her favorite exercise. “I learned to swim when I was in the eighth grade. We had a swimming pool in my hometown. For many years, I couldn’t swim because
moved to Arkansas and Tracy made her home in Fort Smith. She then became a world traveler, visiting
I couldn’t swim
New Orleans, Washington D.C.,
because I didn’t
Germany, Switzerland, London,
have a place to go.
Now I swim five to six times a week.”
Jerusalem, Hawaii, the Caribbean, Paris, Rome, Australia, New Zealand and Ireland. Tracy will celebrate her 102nd birthday in January. To find out if you are eligible for SilverSneakers, please contact your health plan provider. For more information regarding the SilverSneakers
I didn’t have a place to go. Now I on tape from the library and is still
Fitness Program, visit silversneak-
Because of macular degenera-
an active member at Central Pres-
ers.com or call 1-888-423-4632.
tion in her eyes, Tracy can no longer
byterian Church in Fort Smith. But
drive, but that doesn’t stop her.
a big part of it, she insists, is the
She and her second cousin, Marilyn
swimming.
swim five to six times a week.”
Simpson, show up around 7 a.m.
In January, Tracy fell and fractured
to do the sidestroke and walk laps
her pelvis. A break like that can be
back and forth in the pool.
devastating to an older person, but
“I call her my trainer,” Marilyn
Tracy attributes her great recovery
laughed. When Marilyn started
to her years of swimming. Still,
taking Tracy to the pool, at first she
she was unable to swim for several
SilverSneakers® is a registered mark of Healthways, Inc. The SilverSneakers Fitness Program is provided by Healthways, Inc., an independent company that operates separately from Arkansas Blue Cross and Blue Shield.
Blue & You Winter 2010
11
Making healthy
New Year’s resolutions and making them stick
Each year, people start out the New Year with a list of goals and resolutions, only to forget about them or give up on them within a few weeks. Is it possible to make and keep healthy resolutions? It is when you are more realistic with your resolutions. Here are some tips to help you keep those resolutions this year, along with a few healthy resolution ideas for a happy, healthy 2011.
12
Lose weight The Healthy Weigh! The Healthy Weigh! Education Program is free for members of Arkansas Blue Cross and Blue Shield, Health Advantage (except state and
Tips for maintaining your resolutions: • Be realistic with your resolutions; don’t make them all or nothing. If you want to eat healthier, start by eliminating one or two unhealthy food items at a time. • Set mini-goals on your way to one main goal. If you want to lose weight, start with a smaller amount per month as a mini-goal. • Pare down the list. Stick with a few, attainable goals rather than a long list that may not be manageable. • Make resolutions based on your own desires and goals, not what others around you are doing. Don’t set up to run a marathon only because your friends are doing it. • Reward yourself when you reach your goals or milestones.
public school employees*), Blue Cross
Healthy resolution ideas: • Start an exercise routine. • Eat healthier. • Make it to annual checkups. • Lose the extra weight. • Challenge yourself — run a 10K (or 5K). • Try something new — take a Zumba® class.
receive information through the mail,
• Relax — take just 10 minutes for personal down time.
Education Program’s toll-free number
• Add steps to your day — take the stairs and park farther from the
at 1-800-686-2609.
store entrance. • Lower your sugar intake. • Add more fruits and veggies to your diet. With some willpower and the knowledge that the end result will be worth it, you can make New Year’s resolutions that will stick! Blue & You Winter 2010
and Blue Shield Service Benefit Plan (Federal Employee Program), Medi-Pak Advantage (PFFS) and eligible members of BlueAdvantage Administrators of Arkansas. To enroll, complete the attached enrollment form and return it in the self-addressed, postage-paid envelope included in this magazine. The program starts when you enroll. After enrollment, you will begin to which you can read 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 further questions about the program, call the Health
* Our state and public school members can access the “Nourish” program through LifeSynch.
Simply complete, sign and return the attached enrollment form in the selfaddressed, postage-paid envelope to join The Healthy Weigh!
FDA issues consumer warning about infant sleep positioners The U.S. Food and Drug Administration (FDA) and the Consumer Product Safety Commission (CPSC) recently issued a warning to consumers not to use infant sleep positioners. In the past 13 years, the federal government has received 12 reports of babies known to have died from suffocation associated with their sleep positioners. Most of the babies suffocated after rolling from the side to the stomach.
Please be careful It’s best not to use infant positioning products. Also, remember never to put pillows, sleep positioners, comforters or quilts under the baby or in the crib. Be sure to always place a baby on his or her back at night and during nap time.
The most common types of sleep positioners feature bolsters attached to each side of a thin mat and
Source: U.S.
wedges to elevate the baby’s head. The sleep position-
Food and Drug
ers are intended to keep a baby in a desired position
Administration
while sleeping. They are often used with infants under 6
13
months old.
Planning to have a baby?
Eat more fruits, veggies and fish! Eating more fruits, vegetables and fish before and
increase in SGA babies. Similarly, those who ate more
during pregnancy can reduce the risk of a baby being
than three servings of fish a week had a 60 percent
undernourished or small for gestational age (SGA), ac-
reduction in SGA babies.
cording to a recent study. SGA infants are more likely to
Researchers believe that the nutrients found in fruits
be stillborn and to have complications as newborns and
and vegetables may be protective to the pregnant
later in life.
mother and the developing baby but add that women
The study found that a woman’s diet, prior to con-
who consume high amounts of such foods also tend to
ception, had a strong influence on the baby’s size at
lead healthier lifestyles. According to the researchers,
birth. Women who ate a healthy amount of green leafy
pregnancy, and the months before pregnancy, may be
vegetables (three or more portions of vegetables a
the ideal time to encourage women to adopt a healthy
day) were found to have 50 percent fewer SGA babies. Those who consumed low amounts of fruit (less than one portion a week) had a 50 percent
diet, improve their intake of important nutrients and make lifestyle changes. Source: Royal College of Obstetricians and Gynaecologists Blue & You Winter 2010
Vitamin D supplements do not improve bone density in healthy children A recent study revealed that vitamin D supplements given to healthy children who have normal vitamin D
build bone from calcium-rich foods. Vitamin D supplements previously have been shown to help build bone density in people with a vitamin D deficiency. In the latest study, researchers wanted
levels, do not improve their bone
to find out if boosting levels of vitamin
density. Building bone density
D in healthy children would encour-
at a young age can help pro-
age bone density growth —
tect against osteoporosis later in life and vitamin D has been shown to
specifically in the hip, lumbar
help improve bone density.
spine, forearm or the body as a
Vitamin D is a fat-soluble vitamin that
whole. They discovered vitamin
helps regulate the amounts of calcium and
D supplements had no statisti-
phosphorus in the blood and promotes the
cally significant effect on bone
absorption of calcium, making it easier for the body to
14
density in any of the specific body sites studied.
Are supplements a substitute for healthy eating? Vitamin supplements are meant to be just that –
• Are a post-
supplements. Nothing beats healthy eating and whole
menopausal
foods for getting the proper balance of vitamins and
woman.
minerals. Whole foods, unlike supplements, are complex,
• Have a medical condition
containing a variety of nutrients and micronutrients and
affecting
providing essential fiber necessary for a healthy diet.
how your
They also contain other important substances for good
body absorbs
health, such as antioxidants.
and uses
However, sometimes supplements may be needed. Supplements may be necessary if you:
nutrients. If you do need to take
• Do not eat a well-balanced diet.
supplements, read the label
• Consume fewer than 1,600 calories per day.
carefully for dosage, expiration date, active ingredients
• Are vegan or vegetarian and are not eating a wide
and U.S. Pharmacopeia (USP) approval, and avoid mega
variety of foods. • Are pregnant, trying to get pregnant or breastfeeding. Blue & You Winter 2010
doses. As always, talk to your doctor to find out which supplements may be best for you. Source: mayoclinic.com
Questions on
Health Insurance Reform? The new changes to health insurance can be confusing,
and Arkansas Blue Cross and Blue Shield wants you to have as much information as possible. The past two issues of Blue & You magazine focused on these changes; if you missed them, or if you have questions, you can find them and other health insurance reform information on our member Web sites, arkansasbluecross. com and healthadvantage-hmo.com.
A.M. Best based this rating on the company’s signifi-
Arkansas Blue Cross
makes the grade
A
Arkansas Blue Cross and Blue Shield recently
cant market share, enhanced operating flexibility and considerable capital strength. A.M. Best noted that Arkansas Blue Cross is well capitalized in support of its business and insurance risk and has maintained strong risk-based capital for the past several years. A.M. Best also reported that Arkansas Blue Cross is the market leader in Arkansas, has a broad network of doctors and hospitals, offers diverse products, maintains a strong and attractive brand image, and is an industry leader in coordinating member services with other Blue Plans. Additionally, A.M. Best recognized that Arkansas Blue
received an “A” (Excellent) rating for financial strength
Cross emphasizes “high touch” interaction with mem-
from A.M. Best Company, the world’s oldest and most
bers with seven regional offices throughout the state
authoritative insurance rating source.
that give members easier access to sales and service.
Budget, continued from Page 3
still there in the form of higher premiums or reduced
cling to a destination instead of driving, or as involved
benefits.
as our new initiative to pilot several patient-centered
In this new health care environment, we all must look
medical homes throughout the state of Arkansas.
for innovative ways to trim costs while improving health
Regardless, the goal is the same — to be good for your
and health care. It may be as simple as walking or bicy-
pocketbook and good for you. Blue & You Winter 2010
15
Lifelong Health
with Dr. David
particular treatment. A good example is the reason many patients believe they are having coronary angiograms or angioplasties. To explain this, I must first describe the indications for David A. Lipschitz, M.D., Ph.D.
angiograms and angioplasties. A coronary angiogram involves inserting a plastic catheter into the coronary artery, through which dye is injected, so the physician can conduct a detailed examination of the inside of the coronary artery by X-ray. Localized and generalized narrowing of the artery can be identified, leading to the diagnosis of coronary artery disease. An angiogram can help a physician:
16
• Diagnose coronary artery disease because of suspicious symptoms such as chest pain or shortness of breath or an abnormal EKG. • Confirm the reason for worsening chest pain in a patient with proven coronary artery disease (unstable angina). • Identify worsening heart failure. • Indicate problems with heart valves. A coronary angioplasty is done to open a blocked artery. Using X-ray, the plastic catheter inserted into the
Informed consent:
coronary artery is moved to where the vessel is blocked
Make sure you understand why a treatment is recommended
flated to open up the blockage. A small wire mesh (that
Whenever a patient receives surgical treatment (and some medical treatment), he or she is required to sign an informed consent document that describes the treatment recommended and the potential side effects. However, the typical informed consent document does not tell you the benefits of having the procedure, or the reasons for having the procedure. This could have a significant impact on whether you are willing to undergo a Blue & You Winter 2010
or narrowed. A balloon at the tip of the catheter is inmay be coated with medication) is then placed to keep the artery expanded. An angioplasty is used to: • Improve symptoms of coronary artery disease such as chest pain or shortness of breath. • Prevent damage to the heart muscle by opening up an acute blockage that has led to a heart attack. • Control symptoms in patients with proven coronary artery disease if the symptoms are uncontrolled by
Editor’s Note: David A. Lipschitz, M.D., Ph.D., is nationally recognized as a leader in the field of geriatrics.
The most important message is to be fully
Arkansas Blue Cross and Blue Shield is honored to have him as a contributor to Blue & You magazine.
medications or if the drugs cause too many side
sure you truly under-
effects.
stand what is being
More than a million coronary angioplasties are done
recommended and the
informed, in writing, about the potential benefits and risks of any procedure recommended to treat any illness.
in the United States annually. In a recent study pub-
reason for the procedure,
lished in the Annals of Internal Medicine, more than
and make sure the following
88 percent of patients undergoing coronary angiograms
questions are answered:
and angioplasties believed that the procedures were
1. Why is the recommended procedure being
done to prevent a heart attack. Eighty-two percent of the patients believed the reason was to prevent death from a heart attack. Sadly, neither is true. Angioplasty only improves symptoms caused by coronary artery disease (pain or shortness of breath). Experts now recommend using informed consent documents that are more explanatory to better inform patients about the benefits and risks of any procedure.
proposed? 2. What are the benefits of the procedure? a. Will it prolong my life? b. Will it improve the quality of my life? c. What other benefits may occur? 3. Are there less invasive alternatives? Can medications provide similar benefits? 4. What are the known side effects, and how often do they occur in someone like me?
Clearly, a patient is much more likely to agree to an
5. Where will the procedure be performed?
angioplasty if he or she thinks that the intervention
6. What is the physician’s qualification and record for
will prolong life or prevent minor or fatal heart attacks.
performing the procedure?
But, would an asymptomatic man with proven coronary
The most important message is to be fully informed,
artery disease agree to this procedure if he knew that
in writing, about the potential benefits and risks of any
it had many risks with few evidence-based benefits?
procedure recommended to treat any illness. While
Probably not, unless his cardiologist provides a compel-
treatment of heart disease is an easy example to un-
ling reason why the procedure is needed. On occasion,
derstand, the same information must be provided for
the patient may be persuaded, but the evidence is
the treatment of any serious disease, including cancers,
undeniable that many coronary angiograms and angio-
strokes and many other illnesses.
plasties are unnecessary. Statistics indicate that more
With life-threatening acute illnesses, immediate
than 30 percent of angioplasties are done in patients
intervention can save lives. But, if you are in a situation
without symptoms who have proven coronary artery
where you can spend a little extra time to understand
disease and whose cardiologists insist on performing
the scope of your physician’s recommendation, it will
an angioplasty to clear blocked arteries.
be time well spent.
Every patient needs to fully understand the reasons for any medical procedure that is recommended. Make
Blue & You Winter 2010
17
What is step
therapy?
you the ability to save money and still receive quality medications. Another way we help you save is through step therapy. This practice requires our members to start a medication beginning with the most cost-effective and safest drug available and progressing to
Did you know that the average
18
blood pressure • Statins for high cholesterol • Non-steroidal anti-inflammatory drugs • Bisphosphonates for osteoporosis • Selective serotonin agents for depression
other more costly therapies only
• Triptans for migraines
if necessary. We only do this with
• Nasal steroids
medications that are very similar
• Sleep medications If you are asked to try step thera-
cost of a brand-name medication is
with one another and can be easily
$140, compared to $18 for a generic
interchanged. This way, you can find
py the next time you are prescribed
medication? At Arkansas Blue Cross
the best medication for your needs
a medication, you can be sure it
and Blue Shield, we always are look-
with the least cost. If a medication
is our way of helping you find the
ing for ways to make it easier for
doesn’t seem to be working for
most cost-effective, quality treat-
you to take care of your health —
you, you can “step up” to a similar
ment for your condition. The use of
and your pocketbook.
medication in the next level in the
step therapy is based on the latest
approved drug list, but you may end
medical findings, the U.S. Food and
up paying more.
Drug Administration’s medication
One of the ways we look out for you is by making generic medications even more accessible through
Arkansas Blue Cross currently
labeling and medication costs. Using step therapy to guide
our list of approved medications,
uses step therapy in our Value For-
which we call our “formulary.” Gener-
mulary. The Value Formulary em-
members toward generics and
ic medications act exactly the same
phasizes using generic medications
more cost-effective medications is
way in your body as brand-name
first. This drug list uses step therapy
another way Arkansas Blue Cross is
medications, but they are much less
on eight drug classes:
good for you.
expensive. By placing generics on
• ACE inhibitors/angiotensin
the lowest copayment level, we give
receptor blockers for high
This does not apply to Arkansas state employees or public school employees.
From the
Pharmacist
by Trey Gardner, Pharm D., Arkansas Blue Cross and Blue Shield
Blue & You Winter 2010
The
Doctor’s
Corner and other problems with blood vessels. In a study recently published in the Archives of Internal Medicine, researchers estimated that the radiation people receive from CT scans cause as many as 29,000 cancer cases per
What are the risks of CT scans? Just last year, Americans received more than 70 million CT (computerized tomography) scans. According to research, approximately half of those scans were unnecessary and exposed people to relatively large doses of radiation. Just one typical CT scan gives a person the same amount of radiation as 100 to 400 chest X-rays. Total body CT scans provide as much radiation as 1,500 to 2,000 chest X-rays. A CT scan combines a series of X-rays taken from many different angles to produce cross-sectional images of bones and tissue. For example, a CT scan may be used to examine people that may have
year. The younger the person is, the greater the risk. There are times when a CT scan is absolutely necessary, however, patients would be wise to ask their doctors if there are alternatives that might expose them to less radiation. People also should be aware that — although they may hear advertising for screening CT scans of the heart, lungs (for smokers) or the entire body — no preventive organization recommends these scans for people without symptoms. There is very little, if any, proof that the potential benefits of such screenings outweigh the risks from the scans.
Flu vaccine recommended for those 6 months and older
internal injuries (maybe from a car
Everyone above the age of 6
accident) or to check for blockages
months should receive an annual
by Ray Bredfeldt, M.D., Regional Medical Director Northwest Region, Fayetteville
flu vaccination unless there is a medical reason not to do so (e.g. an allergy to eggs), according to the Centers for Disease Control and Prevention (CDC). Previously, the flu vaccine has been encouraged primarily for the elderly, pregnant women, and people with chronic disease. Unfortunately, only about 50 percent of those in the high-risk categories get the vaccine each year. The CDC hopes that by making it clear that everyone could benefit from the vaccine, more high-risk individuals will get their flu shot each year.
Blue & You Winter 2010
19
good for you
starts with …
The Information Systems Team It’s not as though the Information Systems team at Arkansas Blue Cross and Blue Shield doesn’t have
20
nology in innovative ways to solve real-world problems. In 2009, UALR fielded eight
enough to do. Quite the contrary;
teams in the regional competition.
just keeping up with the fast-paced
Two of those teams qualified for the
changes in the world of information
national competition, making UALR
technology (IT) is a full-time job. Add
the only university in the four-state
to that the responsibility of making
region (Arkansas, Texas, Oklahoma
sure an entire company can con-
and Louisiana) to have a team in
tinue to use technology to properly
the nationals. That’s when Janet
function, and free time becomes
Bailey, Ph.D., associate professor of
a premium. But, according to Kim
Management Information Systems
Henderson, director of Information
and coach of the UALR Imagine Cup
Systems for Arkansas Blue Cross,
teams, contacted Kim for help.
it is precisely because the world of
“I was very proud of our team,”
IT is so hectic that the members of
Kim said. “When I first sent an e-
her team are compelled to volunteer
mail asking for volunteers I expect-
their time and expertise.
ed two or three.”
For the past two years, Arkan-
She got 12. Which is especially
sas Blue Cross IT employees have
commendable considering the con-
worked with students at the Uni-
straints on their time.
versity of Arkansas at Little Rock
“They went to the university at
(UALR) to help prepare them for
night and on weekends,” said Kim.
Microsoft’s annual “Imagine Cup”
“People spent their personal time
technology competition. The world-
on this.”
wide competition challenges teams
And the work paid off. One of the
of students from colleges and
UALR teams won third place in the
universities to apply computer tech-
2009 national finals. Team “Special
Blue & You Winter 2010
At Arkansas Blue Cross and Blue Shield, w
Customer Service, and we have a saying — of our employees, serving others doesn’t e
Child” developed an application to
tive parents. Their success qualified
very difficult for a university to pre-
create a centralized database to
them to compete at the next level.
pare students to be productive their
store information about children in
“They were the only team from
first day at a new job. Companies
need of a permanent home and the
the United States that got to com-
use different software, applications
information about potential adop-
pete in the 2009 world finals in
and processes, so there is no way
Cairo, Egypt,” said Kim.
a student can learn them all prior to taking a new job.
Arkansas Blue Cross helped Keith West (left) and Mike Kinnison were among a group of Arkansas Blue Cross and Blue Shield Information Systems employees who volunteered their time to help the University of Arkansas at Little Rock Imagine Cup teams prepare for their national and international competitions.
“Usually a person is on the job for
UALR students prepare for the world finals again in 2010. The finals,
six months before they can do very
which were held in Warsaw, Poland,
much because there is just so much
challenged teams to
“Our
develop a technology that would help the World Health Organi-
programmers just enjoy helping the
at UALR designed
young people out.
fingerprints to help identify children who had received vaccinations and those who had not. And, despite the
They remember what it felt like to be in the students’
However, when IT professionals cooperate with university faculties, they can provide a real-world context for the students and assist professors in reinforcing the learning concepts.
“We just want to try to help
the Arkansas Blue Cross IT profes-
improve the way students learn and
sionals seem to value the opportu-
prepare for a field in information
nity to help.
technology,” said Kim. “Hopefully,
“Our programmers just enjoy
nd with the workday or the workplace.
”
position.
time-consuming nature of the work,
— “good for you starts with me.” For many
said Kim.
zation. The students a device that used
e recognize that every one of us is in
to learn,”
we can help them be more
helping the young people out,” said
productive when they get into
Kim. “They remember what it felt
the workforce.”
like to be in the students’ position.” According to Kim, there is so much to learn in the IT field that it is
Blue & You Winter 2010
21
attended the pizza party. The students migrated from different weather and farm stations to learn how crucial the weather is to growing and maintaining crops. The different stations also taught students where the ingredients for pizza come from. BlueAnn Ewe taught her Healthy ClassAct lesson, which focuses on good health
BlueAnn travels the state BlueAnn Ewe, Arkansas Blue Cross and Blue Shield’s health ambassador, along with the staff from Arkansas Blue Cross’ Southeast Regional Office, attended a Backto-School carnival in McGehee, Ark., on August 24. BlueAnn greeted hundreds of children and posed for pictures while staff gave away BlueAnn coloring books and crayons. BlueAnn joined Sarah
and nutrition. In October, BlueAnn participated in the annual Duck Race, a fundraiser for the CHRISTUS St. Michael Hospital Foundation in Texarkana. BlueAnn joined several hundred families at a National Down Syndrome Society Buddy Walk® at Bobby Ferguson Park in Texarkana on October 30. The National Buddy Walk helps raise awareness about Down syndrome and builds support systems, both of which last long after the one-mile walk is over.
Tipton, me-
22
teorologist for television station KAIT in Jonesboro, on September 28 to teach children about the weather and its impact on farming at a Farm Pizza Party hosted by Farm Credit MidSouth. More than 250 secondBlueAnn Ewe and friends at the Backto-School carnival in McGehee.
Blue & You Winter 2010
grade students from
Arkansas Blue Cross raises nearly $10,000 for JDRF Each year, Arkansas Blue Cross and Blue Shield sponsors the Juvenile Diabetes Research Foundation’s
Brookland
(JDRF) Walk to Cure Diabetes by forming a corporate
and Riverside
walk team and hosting an annual fundraiser. This year
elementary
employees raised nearly $10,000 for JDRF. Employees
schools in
also joined BlueAnn at Murray Park on September 18 to
Jonesboro
show their support by joining the JDRF walk.
Women’s Health and Cancer Rights Act T he Women’s Health and
Cancer Rights Act of 1998 introduced changes in insurance coverage for mastectomy.
We love to hear from you! May we help? For customer service, please call:
Little Rock Number (501)
Medi-Pak members
378-3062 1-800-338-2312
Medi-Pak Advantage members
1-877-233-7022
Medi-Pak Rx members
1-866-390-3369
Arkansas Blue Cross members
378-2010 1-800-238-8379
Pharmacy questions
In accordance with
Toll-free Number
1-800-863-5561
Specialty Rx Pharmacy questions
1-866-295-2779
the law, all group and
Health Advantage members
individual health plans
Pharmacy questions
that provide medical and
BlueAdvantage members
surgical benefits for mas-
Pharmacy questions
378-2363 1-800-843-1329
1-800-863-5567
378-3600 1-888-872-2531
1-888-293-3748
tectomy will cover recon-
State and Public School members 378-2364 1-800-482-8416
structive breast surgery,
Federal Employee members
including: • Reconstructive surgery on the breast on which the mastectomy was performed. • Reconstructive surgery on the unaffected breast needed to “produce a symmetrical appearance.” • Prostheses and treatment of complications of any stage of a mastectomy, including lymphedema (postsurgical fluid buildup). The provisions of the Women’s Health and Cancer Rights Act of 1998 apply to all group health insurance coverage effective on the first day of the plan year (which in most cases is the anniversary date of the group contract) after Oct. 21, 1998. The law went into effect on all individual insurance policies issued, renewed or in effect on or after Oct. 21, 1998. These provisions apply to all policies issued by Arkansas Blue Cross and Blue Shield and Health Advantage and are subject to the applicable copayments, coinsurance, benefit limitations, exclusions and benefit maximums. If you have questions about your insurance coverage, contact your group benefits administrator or a customer service representative at your regional Arkansas Blue
378-2531 1-800-482-6655
Looking for health or dental insurance? We can help! For individuals, families and those age 65 or older
378-2937 1-800-392-2583
For employer groups 378-3070 1-800-421-1112 (Arkansas Blue Cross Group Services, which includes Health Advantage and BlueAdvantage Administrators of Arkansas) Prefer to speak with someone close to home? Call or visit one of our regional offices: Pine Bluff/Southeast Region 1800 West 73rd St. Jonesboro/Northeast Region 707 East Matthews Ave. Hot Springs/South Central Region 100 Greenwood Ave., Suite C Texarkana/Southwest Region 1710 Arkansas Boulevard Fayetteville/Northwest Region 516 East Milsap Rd., Suite 103 Fort Smith/West Central Region 3501 Old Greenwood Rd., Suite 5 Little Rock/Central Region 320 West Capitol Ave., Suite 900
1-800-236-0369
1-800-299-4124
1-800-588-5733
1-800-470-9621
1-800-817-7726
1-866-254-9117
1-800-421-1112
Visit our Web sites for more information:
arkansasbluecross.com healthadvantage-hmo.com blueadvantagearkansas.com blueandyoufoundationarkansas.org
Cross office. Blue & You Winter 2010
23
At Arkansas Blue Cross and Blue Shield, we are always looking for new ways to be "Good for You." Here are some of our latest accomplishments.
24 Member discounts
DentalBlue® Web section available
From contact lenses to health clubs, Arkansas Blue
Whether you are age 1 or 100, if you need afford-
Cross and Blue Shield negotiates discounts for
able dental coverage, it is as close as the Arkansas
members for health-related services. In most cases,
Blue Cross and Blue Shield Web site!
your health plan ID card is all you need to obtain
Our DentalBlue® insurance plans for individuals
the discount. Discounts include national chains like
offer a variety of valuable benefits — from essential
Curves and Jenny Craig, as well as local fitness
preventive services to major restorative services.
centers. From yoga to karate to bicycling, you’ll find
We offer three DentalBlue plans for people of
an activity you enjoy! To find discounts, select the
all ages.
“Member Discounts” link on the main page of our Web site (see a list of Web sites on page 23).
You can find out more at arkansasbluecross.com. Go to “Looking for Insurance” or “Individuals and Families” and select “DentalBlue.” You also can find out more by contacting your local independent or Farm Bureau agent or by giving us a call, toll free, at 1-800-392-2583.
Blue & You Winter 2010