2012 - Autumn

good for you events and activities saturday, october 20 Join Arkansas Blue Cross’ BlueCares Team for the Komen for a Cure walk. Our team will be handing out goodies to walkers. We look forward to supporting finding a cure for breast cancer with Central Arkansans.

saturday, december 1 City Mouse, Country Mouse, Christmas House! Arkansas Blue Cross is hosting a special showing of City Mouse, Country Mouse, Christmas House at the Arkansas Arts Center. Round up the family and enjoy a FREE night of the arts. Tickets can be picked up at ArkansasBlue, located in the Shackleford Crossing shopping center, while supplies last. Check our Web site for details.

Bringing doctors to rural Arkansas

spring 2013 saturday, november 10 Get ready for a happy, healthy

holiday season with P. Allen Smith!

Join us at the ArkansasBlue insurance store, from 9 a.m. to 1 p.m. for healthy food growing and cooking demonstrations, and activities with SilverSneakers®* instructors. *SilverSneakers® is a registered mark of Healthways, Inc. The SIlverSneakers® Fitness Program is provided by Healthways, Inc., Healthways is an independent company that operates separately from Arkansas Blue Cross and Blue Shield.

MPI 1129 9/12

Although spring is months away, now is the time to plan for the Blue & You Fitness Challenge. Start forming your team or group and plan to register for the 2013 Challenge.

The Blue & You Fitness Challenge is an exercise contest (March 1 – May 31) that encourages participants to work toward the public health recommendation of adult physical activity 30 minutes each day, most days of the week.

For more information, call toll free 1-800-686-2609, or visit blueandyoufitnesschallenge-ark.com.

Meet the first Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients ... page 4

Clinics chosen for federal initiative page 6

Health Care Reform update page 8

Teen drivers are safer now page 20

Being a primary care physician in a rural area can be challenging, but for both Lauren and Josue, that is part of the excitement of the job.

“I love the idea of treating a wide variety of medical problems, as well as taking care of patients of all ages,” Lauren said. “I feel strongly that family medicine is one of the most rewarding fields of medicine.”

The doctor is in:

Focusing on Primary Care

How Arkansas Blue Cross is bringing primary care physicians to rural communities

rkansas’ rural communities are great places to settle down, but the lack of primary health care is quickly reaching crisis proportions. Through Arkansas Blue Cross and Blue Shield, however, medical students in the University of Arkansas for Medical Sciences (UAMS) College of Medicine who are training to become primary care physicians (PCPs) are getting the help they need to set up practice and provide small communities with quality health care.

Thanks to a $1 million grant from Arkansas Blue Cross, UAMS seniors Christina “Lauren” Monteith and Josue Daniel Gutierrez are the first recipients of the Arkansas Blue Cross and Blue Shield Primary Care Scholarship. Both students will receive $20,000 from interest accrued from the grant toward the cost of medical school so they can afford to set up practice in the rural communities they love.

“Lauren and Josue exemplify the qualities we were looking for in providing dedicated physicians to serve rural Arkansans,” said Mark White, president and chief executive officer of Arkansas Blue Cross.

“We are excited for them, and we are particularly excited for the Arkansas communities that will benefit from their dedication to medicine.”

Tom South, assistant dean for medical student finance and administration in the UAMS College of Medicine, said, “With the average educational

4 Blue & You

AUTUMN 2012

Josue originally came to Arkansas to attend the University of the Ozarks in Clarksville and fell in love with the Northwest Arkansas region. “During my time in Clarksville, I was able to foster many relationships with Lauren Monteith researches individuals from the information in preparation for her career as a primary care physician. medical community A big reason for the shortage of primary care physicians is the high and am eager to return cost of medical school. The and practice there. I am Association of American Medical Colleges estimates that the average also soon to be married medical student ends up $162,000 in debt by graduation. To tackle and my fiancée and I that debt, many medical students turn their attention toward careers plan to start a family as specialists, where they are more likely to make more money. in Clarksville after Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients completing my residency, are chosen from those planning to pursue post-graduate training in family as this is the perfect medicine, general internal medicine or general pediatrics. The students, place to raise a family.”

Josue Gutierrez looks up medical information from resources in the UAMS library.

indebtedness of our medical school graduates approaching $140,000, the Arkansas Blue Cross and Blue Shield Primary Care Scholarships will have a significant impact on reducing the debt burden of students who wish to pursue primary care and practice in medically underserved areas in Arkansas.”

“Growing up in south Arkansas, I know all too well what it is like to live in a medically underserved area,” said Lauren. “As a child, my parents had to travel more than two hours to take me to specialty doctors’ appointments, which was very hard for them financially.”

Lauren grew up in a small community 10 minutes south of El Dorado and has seen first hand the decline in jobs and population. This includes a great loss in primary care physicians. Her husband also grew up in the same area.

“My husband spent part of his childhood in Huttig, one hour southeast of El Dorado, and learned that even small emergencies can be life threatening when you can’t get to medical care quickly. With the upcoming changes to health care, I believe primary care will become even more vital as the first step and possibly sole provider in rural areas.”

Josue added, “It has been my dream to become a family practitioner since I was 7 years old. There are so many benefits to practicing in a small community. The lack of specialties in rural areas provides the family practitioners a unique environment in which to perform procedures that many of their urban counterparts are not able to. The small town environment, with its tight-knit community, provides a perfect setting in which to foster rapport with patients that will ultimately translate into better health care.”

who may be in their junior or senior year, also must intend to practice primary care in Arkansas, preferably in the more rural parts of the state.

The scholarship, given in honor of the Board of Directors of Arkansas Blue Cross, will be awarded each year, beginning with the 2012-2013 academic year.

Other reasons for the primary care crisis are: • A shortage of primary care physicians, including family practice, pediatric and general internal medicine doctors.

• An aging population and an illness burden higher than the national average, which creates high patient volume for the physicians who are available.

• The potential projected influx of thousands of Arkansans to the Medicaid program in 2014 under health insurance reform.

According to the Johns Hopkins Primary Care Policy Center, adults in the United States who had a primary care physician had 33 percent lower costs of care and were 19 percent less likely to die prematurely from their conditions than those who had received care from a specialist, after adjusting for demographic and health characteristics. The center found that the availability of primary care physicians is consistently associated with improved health outcomes for conditions like cancer, heart disease, stroke, infant mortality, low birth weight, as well as increased life expectancy and self-managed care.

Sources: UAMS Center for Rural Health, Johns Hopkins Primary Care Policy Center, Association of American Medical Colleges, Arkansas Department of Health and Arkansas Center for Health Improvement

Blue & You AUTUMN 2012 5

Being a primary care physician in a rural area can be challenging, but for both Lauren and Josue, that is part of the excitement of the job.

“I love the idea of treating a wide variety of medical problems, as well as taking care of patients of all ages,” Lauren said. “I feel strongly that family medicine is one of the most rewarding fields of medicine.”

The doctor is in:

Focusing on Primary Care

How Arkansas Blue Cross is bringing primary care physicians to rural communities

rkansas’ rural communities are great places to settle down, but the lack of primary health care is quickly reaching crisis proportions. Through Arkansas Blue Cross and Blue Shield, however, medical students in the University of Arkansas for Medical Sciences (UAMS) College of Medicine who are training to become primary care physicians (PCPs) are getting the help they need to set up practice and provide small communities with quality health care.

Thanks to a $1 million grant from Arkansas Blue Cross, UAMS seniors Christina “Lauren” Monteith and Josue Daniel Gutierrez are the first recipients of the Arkansas Blue Cross and Blue Shield Primary Care Scholarship. Both students will receive $20,000 from interest accrued from the grant toward the cost of medical school so they can afford to set up practice in the rural communities they love.

“Lauren and Josue exemplify the qualities we were looking for in providing dedicated physicians to serve rural Arkansans,” said Mark White, president and chief executive officer of Arkansas Blue Cross.

“We are excited for them, and we are particularly excited for the Arkansas communities that will benefit from their dedication to medicine.”

Tom South, assistant dean for medical student finance and administration in the UAMS College of Medicine, said, “With the average educational

4 Blue & You

AUTUMN 2012

Josue originally came to Arkansas to attend the University of the Ozarks in Clarksville and fell in love with the Northwest Arkansas region. “During my time in Clarksville, I was able to foster many relationships with Lauren Monteith researches individuals from the information in preparation for her career as a primary care physician. medical community A big reason for the shortage of primary care physicians is the high and am eager to return cost of medical school. The and practice there. I am Association of American Medical Colleges estimates that the average also soon to be married medical student ends up $162,000 in debt by graduation. To tackle and my fiancée and I that debt, many medical students turn their attention toward careers plan to start a family as specialists, where they are more likely to make more money. in Clarksville after Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients completing my residency, are chosen from those planning to pursue post-graduate training in family as this is the perfect medicine, general internal medicine or general pediatrics. The students, place to raise a family.”

Josue Gutierrez looks up medical information from resources in the UAMS library.

indebtedness of our medical school graduates approaching $140,000, the Arkansas Blue Cross and Blue Shield Primary Care Scholarships will have a significant impact on reducing the debt burden of students who wish to pursue primary care and practice in medically underserved areas in Arkansas.”

“Growing up in south Arkansas, I know all too well what it is like to live in a medically underserved area,” said Lauren. “As a child, my parents had to travel more than two hours to take me to specialty doctors’ appointments, which was very hard for them financially.”

Lauren grew up in a small community 10 minutes south of El Dorado and has seen first hand the decline in jobs and population. This includes a great loss in primary care physicians. Her husband also grew up in the same area.

“My husband spent part of his childhood in Huttig, one hour southeast of El Dorado, and learned that even small emergencies can be life threatening when you can’t get to medical care quickly. With the upcoming changes to health care, I believe primary care will become even more vital as the first step and possibly sole provider in rural areas.”

Josue added, “It has been my dream to become a family practitioner since I was 7 years old. There are so many benefits to practicing in a small community. The lack of specialties in rural areas provides the family practitioners a unique environment in which to perform procedures that many of their urban counterparts are not able to. The small town environment, with its tight-knit community, provides a perfect setting in which to foster rapport with patients that will ultimately translate into better health care.”

who may be in their junior or senior year, also must intend to practice primary care in Arkansas, preferably in the more rural parts of the state.

The scholarship, given in honor of the Board of Directors of Arkansas Blue Cross, will be awarded each year, beginning with the 2012-2013 academic year.

Other reasons for the primary care crisis are: • A shortage of primary care physicians, including family practice, pediatric and general internal medicine doctors.

• An aging population and an illness burden higher than the national average, which creates high patient volume for the physicians who are available.

• The potential projected influx of thousands of Arkansans to the Medicaid program in 2014 under health insurance reform.

According to the Johns Hopkins Primary Care Policy Center, adults in the United States who had a primary care physician had 33 percent lower costs of care and were 19 percent less likely to die prematurely from their conditions than those who had received care from a specialist, after adjusting for demographic and health characteristics. The center found that the availability of primary care physicians is consistently associated with improved health outcomes for conditions like cancer, heart disease, stroke, infant mortality, low birth weight, as well as increased life expectancy and self-managed care.

Sources: UAMS Center for Rural Health, Johns Hopkins Primary Care Policy Center, Association of American Medical Colleges, Arkansas Department of Health and Arkansas Center for Health Improvement

Blue & You AUTUMN 2012 5

Medical practices chosen to participate in the CPC Initiative include: Baptist Health Family Clinic

Arkadelphia

Greenbrier Family Clinic

Greenbrier

Bradley Bibb M.D., PLLC

Ash Flat

Garner Family Medical Clinic

Hardy

Covert Clinic, P.A.

Ashdown

Harrison Family Practice Clinic

Harrison

Batesville Family Practice Clinic

Batesville

The Leslie Clinic, P.A.

Harrison

Verona T Brown, M.D.

Batesville

Cowherd Family Medical Center

Heber Springs

Beebe Family Clinic

Beebe

Cypert Ridge Family Practice Clinic

Helena

Mercy Clinic Primary Care Lancashire

Bella Vista

Fountain Lake Family Medicine

Hot Springs

Benton Family Clinic

Benton

Hamilton West Family Medicine

Hot Springs

Saline Med Peds Benton

UAMS AHEC Northeast

Jonesboro

Baptist Health Family Clinic Bryant

Bryant

West Washington County Clinic, P.A.

Lincoln

Bryant Family Practice

Bryant

Autumn Road Family Practice

Little Rock

Bryant Medical Clinic

Bryant

Baptist Health Family Clinic Baptist Health Drive Little Rock

Baptist Health Family Clinic

Cabot

Baptist Health Family Clinic Hillcrest

Little Rock

Internal Medicine Diagnostics Inc.

Cherokee Village

Baptist Health Family Clinic West

Little Rock

Ozark Internal Medicine and Pediatrics

Clinton

Barg-Gray Clinic Little Rock

B. Brooks Lawrence, M.D., P.A.

Conway

Little Rock Family Clinic - West

Little Rock

Conway Family Medical Care, P.A.

Conway

Little Rock Family Practice - Central

Little Rock

Arkansas Medicaid teamed together to apply for the initiative.

Freeman Family Medicine

Conway

St. Vincent Family Clinic - Chenal

Little Rock

Barry V. Thompson, M.D.

Crossett

St. Vincent Family Clinic - Rodney Parham Little Rock

Medical practices within Arkansas were given the opportunity to apply to participate in the CPC Initiative and 116 completed the application process. CMS chose 65 of those practices to participate in the first part of the initiative — other practices could be added later.

Family Clinic of Ashley County

Crossett

St. Vincent Medical Clinic Midtowne

Lofton Family Clinic

De Queen

St. Vincent Medical Group Longevity Center Little Rock

Randy D. Walker, M.D., PLLC

De Queen

John E Alexander Jr. M.D., P.A.

Magnolia

SAMA Healthcare Services

El Dorado

Baptist Health Family Clinic

Malvern

Washington Regional Clinic for Senior Health Fayetteville

Tilley Diagnostic Clinic

Malvern

Shipley and Sills Family Doctors

Fort Smith

Baptist Health Family Clinic

Maumelle

Glenwood Family Medicine

Glenwood

North Central Arkansas Medical Associates Mountain Home

Arkansas medical practices chosen to participate in

national initiative

This spring, Arkansas was named one of

seven markets to be part of the national Comprehensive Primary Care (CPC) Initiative, a pilot program through the Centers for Medicare & Medicaid Services (CMS) Innovation Center that fosters collaboration among public and private health plans to strengthen primary care.

Health Advantage (an affiliate of Arkansas Blue Cross and Blue Shield), QualChoice and

P rimary care physicians involved in the CPC Initiative will focus on five fundamental elements of comprehensive care: Managing care for patients with high health care needs – By engaging high-risk patients, primary care providers can create a plan of care that uniquely fits each patient’s individual circumstances and values.

Ensuring access to care – CPC Initiative primary care practices must be accessible to patients 24/7 and be able to utilize patient data tools to give real-time, personal health care information to patients.

6 Blue & You

AUTUMN 2012

Delivering preventive care – Primary care practices involved with CPC Initiative will be able to proactively assess their patients to determine their needs and provide appropriate and timely preventive care.

Engaging patients and caregivers – Primary care practices will have the ability to engage patients and their families in active participation in their care.

Coordinating care across the medical neighborhood – Under this initiative, primary care doctors and nurses will work together, and with a patient’s other health care providers and the patient, to make decisions as a team.

Little Rock

Dr. Andy’s Family Practice PLLC

Mountain View

Baptist Health Family Clinic Lakewood

North Little Rock

Burchfield Family Medicine

Paragould

Baptist Health Family Clinic

Perryville

Mercy Clinic Internal Medicine

Rogers

Sherwood Family Medical Center

Sherwood

Siloam Springs Medical Center

Siloam Springs

UAMS Family Medical Center

Springdale

UAMS AHEC Southwest

Texarkana

Foscue Medical Clinic

Warren

Michelle Weaver M.D.

Warren

Senior Health Clinic

West Memphis

Blue & You AUTUMN 2012

7

Medical practices chosen to participate in the CPC Initiative include: Baptist Health Family Clinic

Arkadelphia

Greenbrier Family Clinic

Greenbrier

Bradley Bibb M.D., PLLC

Ash Flat

Garner Family Medical Clinic

Hardy

Covert Clinic, P.A.

Ashdown

Harrison Family Practice Clinic

Harrison

Batesville Family Practice Clinic

Batesville

The Leslie Clinic, P.A.

Harrison

Verona T Brown, M.D.

Batesville

Cowherd Family Medical Center

Heber Springs

Beebe Family Clinic

Beebe

Cypert Ridge Family Practice Clinic

Helena

Mercy Clinic Primary Care Lancashire

Bella Vista

Fountain Lake Family Medicine

Hot Springs

Benton Family Clinic

Benton

Hamilton West Family Medicine

Hot Springs

Saline Med Peds Benton

UAMS AHEC Northeast

Jonesboro

Baptist Health Family Clinic Bryant

Bryant

West Washington County Clinic, P.A.

Lincoln

Bryant Family Practice

Bryant

Autumn Road Family Practice

Little Rock

Bryant Medical Clinic

Bryant

Baptist Health Family Clinic Baptist Health Drive Little Rock

Baptist Health Family Clinic

Cabot

Baptist Health Family Clinic Hillcrest

Little Rock

Internal Medicine Diagnostics Inc.

Cherokee Village

Baptist Health Family Clinic West

Little Rock

Ozark Internal Medicine and Pediatrics

Clinton

Barg-Gray Clinic Little Rock

B. Brooks Lawrence, M.D., P.A.

Conway

Little Rock Family Clinic - West

Little Rock

Conway Family Medical Care, P.A.

Conway

Little Rock Family Practice - Central

Little Rock

Arkansas Medicaid teamed together to apply for the initiative.

Freeman Family Medicine

Conway

St. Vincent Family Clinic - Chenal

Little Rock

Barry V. Thompson, M.D.

Crossett

St. Vincent Family Clinic - Rodney Parham Little Rock

Medical practices within Arkansas were given the opportunity to apply to participate in the CPC Initiative and 116 completed the application process. CMS chose 65 of those practices to participate in the first part of the initiative — other practices could be added later.

Family Clinic of Ashley County

Crossett

St. Vincent Medical Clinic Midtowne

Lofton Family Clinic

De Queen

St. Vincent Medical Group Longevity Center Little Rock

Randy D. Walker, M.D., PLLC

De Queen

John E Alexander Jr. M.D., P.A.

Magnolia

SAMA Healthcare Services

El Dorado

Baptist Health Family Clinic

Malvern

Washington Regional Clinic for Senior Health Fayetteville

Tilley Diagnostic Clinic

Malvern

Shipley and Sills Family Doctors

Fort Smith

Baptist Health Family Clinic

Maumelle

Glenwood Family Medicine

Glenwood

North Central Arkansas Medical Associates Mountain Home

Arkansas medical practices chosen to participate in

national initiative

This spring, Arkansas was named one of

seven markets to be part of the national Comprehensive Primary Care (CPC) Initiative, a pilot program through the Centers for Medicare & Medicaid Services (CMS) Innovation Center that fosters collaboration among public and private health plans to strengthen primary care.

Health Advantage (an affiliate of Arkansas Blue Cross and Blue Shield), QualChoice and

P rimary care physicians involved in the CPC Initiative will focus on five fundamental elements of comprehensive care: Managing care for patients with high health care needs – By engaging high-risk patients, primary care providers can create a plan of care that uniquely fits each patient’s individual circumstances and values.

Ensuring access to care – CPC Initiative primary care practices must be accessible to patients 24/7 and be able to utilize patient data tools to give real-time, personal health care information to patients.

6 Blue & You

AUTUMN 2012

Delivering preventive care – Primary care practices involved with CPC Initiative will be able to proactively assess their patients to determine their needs and provide appropriate and timely preventive care.

Engaging patients and caregivers – Primary care practices will have the ability to engage patients and their families in active participation in their care.

Coordinating care across the medical neighborhood – Under this initiative, primary care doctors and nurses will work together, and with a patient’s other health care providers and the patient, to make decisions as a team.

Little Rock

Dr. Andy’s Family Practice PLLC

Mountain View

Baptist Health Family Clinic Lakewood

North Little Rock

Burchfield Family Medicine

Paragould

Baptist Health Family Clinic

Perryville

Mercy Clinic Internal Medicine

Rogers

Sherwood Family Medical Center

Sherwood

Siloam Springs Medical Center

Siloam Springs

UAMS Family Medical Center

Springdale

UAMS AHEC Southwest

Texarkana

Foscue Medical Clinic

Warren

Michelle Weaver M.D.

Warren

Senior Health Clinic

West Memphis

Blue & You AUTUMN 2012

7

In June, the U.S. Supreme Court ruled that the Patient Protection and Affordable Care Act (PPACA) is constitutional. Arkansas Blue Cross and Blue Shield had been working to prepare for health care reform even before the law was signed, so we are well prepared to move forward in implementing the reforms within the law.

We know you may have questions regarding how the ruling affects your health plan. Various Web sites and e-mails circulating lately have contained misinformation about reform. We’ve been a trusted source of health care information for more than 60 years, and we want you to be well informed about health care reform so you can make the right decisions for yourself and your family.

Because we want to be available to you, we have created a new e-mail address just for your questions on health care reform. If you have questions, feel free to contact us at HCRinfo@arkbluecross.com. We will be gathering questions and responding to them on a regular basis and including the questions and answers in future issues of Blue & You magazine.

While some things still are unknown, I can tell you that Arkansas Blue Cross will continue to provide the products and services our members value and that we are expanding our involvement in health care in innovative ways to increase quality and contain costs.

We have a lot of work to do between now and late 2013 to get ready for the health insurance exchanges and the new insurance market.

The insurance exchange will be a new, online location for people to purchase insurance products. If your income is below a certain amount, you may receive significant subsidies to help cover your insurance premium, but most people still will have to pay for coverage.

If you choose not to have insurance, the penalty per person is $95 for the first year, or 1 percent of your adjusted gross income, whichever is greater, with the penalty capped at four family members. The maximum penalty in 2016 is $695 or 2.4 percent.

8 Blue & You

AUTUMN 2012

Cal Kellogg, Senior Vice President and

Chief Strategy Officer

Arkansas Blue Cross’ work toward the exchanges will focus on how our systems will interact with the federal system. We are working with the state and other stakeholders to determine the best ways to facilitate what will be a state/federal exchange partnership.

The Arkansas Insurance Department has taken on the responsibility to design the exchange and is deciding which companies can sell on it and how consumers can be assisted. Arkansas Blue Cross, however, has membership on the steering and plan management committees involved in planning for the exchange. We have been able to make recommendations on topics like essential health benefits, but ultimately it will be the Insurance Department that determines how the exchange is run.

Many employer-based insurance plans (group plans) under reform will be looking at whether they should change plans, or if it is in their best interest to drop their plan and pay the penalty. We do know that for many it will cost more to pay the fine than to keep their plan, but there still is a lot of uncertainty about pending regulations and the likely potential for continuing political debate and change. The main message we want to share is that no one has to make those decisions right now.

The next year will provide the detailed regulations and guidelines we will need to provide valuable and meaningful advice for our members ahead of the January 2014 implementation. As soon as we have information on these changes we will be sharing it with you. In the meantime, feel free to ask us your questions at HCRinfo@arkbluecross.com. We love to hear from you.

For the past eight years, I’ve had the honor of caring for hundreds of patients at Hospice Home Care who are at the end of their life. I’ve heard stories that almost made me choke with laughter and others which made my soul ache with despair. I’ve heard the most sacred confessions and witnessed love that could almost be touched.

What has never been requested include the following: more chemotherapy, more radiation, more MRIs, more biopsies, more surgeries, more blasts of electricity through the chest, more life support, more time away from home and separated from family and friends, or more time in an institution.

This serves as a wake-up call on how all members of the health care team can help patients achieve what is important for them at the end of life: quality! It’s about quality of life and ensuring patients achieve their goals with the life they have left.

This is where the growing trend of hospice is saving patients from artificial prolongation of the dying process. There are studies which show that hospice not only improves quality of life for dying patients, but helps patients live longer. Isn’t longer, happier life the entire goal of health care?

Hospice care is a team approach for supporting the

patient and family during the end of life in a variety of settings, including home, assisted living facilities, nursing homes, and hospice facilities. Sometimes events happen quickly, like a severe stroke or heart attack, and hospice care is invaluable during these times. Hospice is even more effective when patients have two to three months of hospice care.

This takes a realistic approach to life expectancies and selected treatments by the medical team. Proper channels of communication should be respected, so if one team member is not comfortable or skilled at discussing end-of-life care, utilizing other team members who are comfortable with these situations can be helpful. It is most important that the team always remember the guiding principle of medical ethics: the Principle of Autonomy.

Patients have the right to hear all information of their care in an unbiased manner. Fortunately, hospice care considerations may be started by anyone in the team, including patients, their families or friends, doctors, nurses, social workers, chaplains or case managers.

My life is going to end one day. When it is time, please, love me enough not to prolong the agony of dying. Follow these guidelines for me to honor my life:

• Make any pain nonexistent. If anyone thinks I am in pain, give me whatever it takes to keep me comfortable, even if I have to be asleep.

Don’t let me hurt!

• Make any other symptoms non existent. Don’t let me suffer!

• Treat me with dignity, respect, and unconditional love.

• Keep me clean.

• Support my friends and family while I am dying and after I am gone.

Reviewing these five goals can help health care providers recognize the beauty of hospice and how it is enriching and rewarding for patients.

Morgan Sauer, M.D., with the Longevity Center at St. Vincent Infirmary Medical Center, is board certified in family and preventive medicine, geriatric medicine, and hospice and palliative care.

He also is the medical director for Chenal Heights Memory Center and Hospice Home Care Inpatient Center and serves on the Governor’s Task Force for Alzheimer’s disease.

Blue & You AUTUMN 2012

9

In June, the U.S. Supreme Court ruled that the Patient Protection and Affordable Care Act (PPACA) is constitutional. Arkansas Blue Cross and Blue Shield had been working to prepare for health care reform even before the law was signed, so we are well prepared to move forward in implementing the reforms within the law.

We know you may have questions regarding how the ruling affects your health plan. Various Web sites and e-mails circulating lately have contained misinformation about reform. We’ve been a trusted source of health care information for more than 60 years, and we want you to be well informed about health care reform so you can make the right decisions for yourself and your family.

Because we want to be available to you, we have created a new e-mail address just for your questions on health care reform. If you have questions, feel free to contact us at HCRinfo@arkbluecross.com. We will be gathering questions and responding to them on a regular basis and including the questions and answers in future issues of Blue & You magazine.

While some things still are unknown, I can tell you that Arkansas Blue Cross will continue to provide the products and services our members value and that we are expanding our involvement in health care in innovative ways to increase quality and contain costs.

We have a lot of work to do between now and late 2013 to get ready for the health insurance exchanges and the new insurance market.

The insurance exchange will be a new, online location for people to purchase insurance products. If your income is below a certain amount, you may receive significant subsidies to help cover your insurance premium, but most people still will have to pay for coverage.

If you choose not to have insurance, the penalty per person is $95 for the first year, or 1 percent of your adjusted gross income, whichever is greater, with the penalty capped at four family members. The maximum penalty in 2016 is $695 or 2.4 percent.

8 Blue & You

AUTUMN 2012

Cal Kellogg, Senior Vice President and

Chief Strategy Officer

Arkansas Blue Cross’ work toward the exchanges will focus on how our systems will interact with the federal system. We are working with the state and other stakeholders to determine the best ways to facilitate what will be a state/federal exchange partnership.

The Arkansas Insurance Department has taken on the responsibility to design the exchange and is deciding which companies can sell on it and how consumers can be assisted. Arkansas Blue Cross, however, has membership on the steering and plan management committees involved in planning for the exchange. We have been able to make recommendations on topics like essential health benefits, but ultimately it will be the Insurance Department that determines how the exchange is run.

Many employer-based insurance plans (group plans) under reform will be looking at whether they should change plans, or if it is in their best interest to drop their plan and pay the penalty. We do know that for many it will cost more to pay the fine than to keep their plan, but there still is a lot of uncertainty about pending regulations and the likely potential for continuing political debate and change. The main message we want to share is that no one has to make those decisions right now.

The next year will provide the detailed regulations and guidelines we will need to provide valuable and meaningful advice for our members ahead of the January 2014 implementation. As soon as we have information on these changes we will be sharing it with you. In the meantime, feel free to ask us your questions at HCRinfo@arkbluecross.com. We love to hear from you.

For the past eight years, I’ve had the honor of caring for hundreds of patients at Hospice Home Care who are at the end of their life. I’ve heard stories that almost made me choke with laughter and others which made my soul ache with despair. I’ve heard the most sacred confessions and witnessed love that could almost be touched.

What has never been requested include the following: more chemotherapy, more radiation, more MRIs, more biopsies, more surgeries, more blasts of electricity through the chest, more life support, more time away from home and separated from family and friends, or more time in an institution.

This serves as a wake-up call on how all members of the health care team can help patients achieve what is important for them at the end of life: quality! It’s about quality of life and ensuring patients achieve their goals with the life they have left.

This is where the growing trend of hospice is saving patients from artificial prolongation of the dying process. There are studies which show that hospice not only improves quality of life for dying patients, but helps patients live longer. Isn’t longer, happier life the entire goal of health care?

Hospice care is a team approach for supporting the

patient and family during the end of life in a variety of settings, including home, assisted living facilities, nursing homes, and hospice facilities. Sometimes events happen quickly, like a severe stroke or heart attack, and hospice care is invaluable during these times. Hospice is even more effective when patients have two to three months of hospice care.

This takes a realistic approach to life expectancies and selected treatments by the medical team. Proper channels of communication should be respected, so if one team member is not comfortable or skilled at discussing end-of-life care, utilizing other team members who are comfortable with these situations can be helpful. It is most important that the team always remember the guiding principle of medical ethics: the Principle of Autonomy.

Patients have the right to hear all information of their care in an unbiased manner. Fortunately, hospice care considerations may be started by anyone in the team, including patients, their families or friends, doctors, nurses, social workers, chaplains or case managers.

My life is going to end one day. When it is time, please, love me enough not to prolong the agony of dying. Follow these guidelines for me to honor my life:

• Make any pain nonexistent. If anyone thinks I am in pain, give me whatever it takes to keep me comfortable, even if I have to be asleep.

Don’t let me hurt!

• Make any other symptoms non existent. Don’t let me suffer!

• Treat me with dignity, respect, and unconditional love.

• Keep me clean.

• Support my friends and family while I am dying and after I am gone.

Reviewing these five goals can help health care providers recognize the beauty of hospice and how it is enriching and rewarding for patients.

Morgan Sauer, M.D., with the Longevity Center at St. Vincent Infirmary Medical Center, is board certified in family and preventive medicine, geriatric medicine, and hospice and palliative care.

He also is the medical director for Chenal Heights Memory Center and Hospice Home Care Inpatient Center and serves on the Governor’s Task Force for Alzheimer’s disease.

Blue & You AUTUMN 2012

9

Clinical Partnership Award

Arkansas Blue

Cross and Blue Shield employees (pictured, from left: Roberta Monson, M.D., associate medical director, Connie Meeks M.D., corporate medical director, Internal Affairs, Alicia Berkemeyer, director of Enterprise Networks Special Projects, Vic Snyder, M.D., corporate medical director, External Affairs) were recently honored as the recipients of the Clinical Partnership Award given by the Community Health Centers of Arkansas, Inc. (CHCA). The award is given to a group or individual who has remained a steadfast supporter of CHCA and community health centers (CHCs), and has focused on the goal of providing quality care to all Arkansans.

Arkansas Blue Cross received the award for its dedication to the development of patientcentered medical homes throughout the state. Arkansas Blue Cross exhibited leadership in merging existing programs/projects to align with the goals and strategic plan of CHCA and the CHCs, acting as a partner, advocate, liaison and mentor.

Case management receives URAC accreditation

Arkansas Blue Cross and Blue Shield, Health Advantage

and BlueAdvantage Administrators of Arkansas, recently received reaccreditation for case management from URAC, a Washington, D.C.-based health care accrediting organization that establishes quality standards for the health care industry.

In its notification of reaccreditation, the URAC Accreditation Committee said, “Arkansas Blue Cross and Blue Shield, Health Advantage, and BlueAdvantage Administrators of Arkansas have been granted FULL accreditation,” and all three organizations are “commended for their commitment to promoting quality health services.”

URAC’s case management accreditation standards require companies to establish a process to assess, plan and implement case management interventions.

10 12 Blue & You

AUTUMN 2012

Red, White and ArkansasBlue summer family fun

Arkansas Blue Cross and Blue Shield kept kids and their families watchin’, rockin’, and

packin’ this summer with lots of family-oriented activities at ArkansasBlue, Arkansas Blue Cross’ health insurance store, located in the Shackleford Crossings shopping center.

In June, we sponsored a special showing of the new Disney/Pixar movie “Brave” on the movie’s premiere weekend. More than 100 families picked up tickets at ArkansasBlue and 330 attended the movie.

“We had lots of young moms come in to ArkansasBlue to pick up tickets to the movie,” said Sara Harris, ArkansasBlue team leader. “Many were pleasantly surprised when they walked in to the location. They said they were not aware we were here, asked about what the store was for and if we sold insurance here. It was a great opportunity to tell them about the kinds of policies we sell and that we are available to visit face-to-face to discuss any questions they have about insurance.”

BlueAnn Ewe greets two eager fans at the special Arkansas Blue Cross and Blue Shield screening of Disney/Pixar’s “Brave” held at The Rave.

In July, we rocked the parking lot with a Blue Beach Party at ArkansasBlue. Adults and kids got moving and played games with Radio Disney outside the ArkansasBlue store, received complimentary sunscreen, then cooled down with tasty shaved ice and made their own leis inside the store. Two tickets to the sold-out Justin Bieber concert in Little Rock in January were given away, compliments of Radio Disney.

In August, the Pack’n it in – Lunchbox Prep event had kids getting ready for a happy, healthy school year. Faith Anaya from Kids Cook! demonstrated two easy, economical and healthy food preparations perfect for packing a healthy lunchbox. She also discussed the importance of healthy eating and encouraged kids to try new foods. Parents were invited to participate in a nutrition label exercise designed to teach them about what kinds foods they are offering their children.

“We were thrilled to spend the summer with our members and guests, focusing on nutrition, health and family fun,” said Sara. “We look forward to even more exciting events this fall and during the holidays.”

Happy Birthday ArkansasBlue!

ArkansasBlue, Arkansas Blue Cross and Blue Shield’s health insurance store in Little Rock, celebrated its first birthday on October 1! Since opening, Arkansans’ have dropped in to speak face-to-face with our staff and learn more about health insurance. If you have questions about health insurance, stop by ArkansasBlue in the Shackleford Crossings Shopping Center. We’d love to visit with you.

Blue 13 Blue&&You You AUTUMN AUTUMN2012 2012 11

Clinical Partnership Award

Arkansas Blue

Cross and Blue Shield employees (pictured, from left: Roberta Monson, M.D., associate medical director, Connie Meeks M.D., corporate medical director, Internal Affairs, Alicia Berkemeyer, director of Enterprise Networks Special Projects, Vic Snyder, M.D., corporate medical director, External Affairs) were recently honored as the recipients of the Clinical Partnership Award given by the Community Health Centers of Arkansas, Inc. (CHCA). The award is given to a group or individual who has remained a steadfast supporter of CHCA and community health centers (CHCs), and has focused on the goal of providing quality care to all Arkansans.

Arkansas Blue Cross received the award for its dedication to the development of patientcentered medical homes throughout the state. Arkansas Blue Cross exhibited leadership in merging existing programs/projects to align with the goals and strategic plan of CHCA and the CHCs, acting as a partner, advocate, liaison and mentor.

Case management receives URAC accreditation

Arkansas Blue Cross and Blue Shield, Health Advantage

and BlueAdvantage Administrators of Arkansas, recently received reaccreditation for case management from URAC, a Washington, D.C.-based health care accrediting organization that establishes quality standards for the health care industry.

In its notification of reaccreditation, the URAC Accreditation Committee said, “Arkansas Blue Cross and Blue Shield, Health Advantage, and BlueAdvantage Administrators of Arkansas have been granted FULL accreditation,” and all three organizations are “commended for their commitment to promoting quality health services.”

URAC’s case management accreditation standards require companies to establish a process to assess, plan and implement case management interventions.

10 12 Blue & You

AUTUMN 2012

Red, White and ArkansasBlue summer family fun

Arkansas Blue Cross and Blue Shield kept kids and their families watchin’, rockin’, and

packin’ this summer with lots of family-oriented activities at ArkansasBlue, Arkansas Blue Cross’ health insurance store, located in the Shackleford Crossings shopping center.

In June, we sponsored a special showing of the new Disney/Pixar movie “Brave” on the movie’s premiere weekend. More than 100 families picked up tickets at ArkansasBlue and 330 attended the movie.

“We had lots of young moms come in to ArkansasBlue to pick up tickets to the movie,” said Sara Harris, ArkansasBlue team leader. “Many were pleasantly surprised when they walked in to the location. They said they were not aware we were here, asked about what the store was for and if we sold insurance here. It was a great opportunity to tell them about the kinds of policies we sell and that we are available to visit face-to-face to discuss any questions they have about insurance.”

BlueAnn Ewe greets two eager fans at the special Arkansas Blue Cross and Blue Shield screening of Disney/Pixar’s “Brave” held at The Rave.

In July, we rocked the parking lot with a Blue Beach Party at ArkansasBlue. Adults and kids got moving and played games with Radio Disney outside the ArkansasBlue store, received complimentary sunscreen, then cooled down with tasty shaved ice and made their own leis inside the store. Two tickets to the sold-out Justin Bieber concert in Little Rock in January were given away, compliments of Radio Disney.

In August, the Pack’n it in – Lunchbox Prep event had kids getting ready for a happy, healthy school year. Faith Anaya from Kids Cook! demonstrated two easy, economical and healthy food preparations perfect for packing a healthy lunchbox. She also discussed the importance of healthy eating and encouraged kids to try new foods. Parents were invited to participate in a nutrition label exercise designed to teach them about what kinds foods they are offering their children.

“We were thrilled to spend the summer with our members and guests, focusing on nutrition, health and family fun,” said Sara. “We look forward to even more exciting events this fall and during the holidays.”

Happy Birthday ArkansasBlue!

ArkansasBlue, Arkansas Blue Cross and Blue Shield’s health insurance store in Little Rock, celebrated its first birthday on October 1! Since opening, Arkansans’ have dropped in to speak face-to-face with our staff and learn more about health insurance. If you have questions about health insurance, stop by ArkansasBlue in the Shackleford Crossings Shopping Center. We’d love to visit with you.

Blue 13 Blue&&You You AUTUMN AUTUMN2012 2012 11

Foundation Awards 35 Mini-grants to Health Programs

New at the Blue

The Blue & You Foundation for a Healthier Arkansas has awarded $1,000 grants to 35 health improvement programs in Arkansas

New people and new positions

Mini-grant recipients in 2012 include:

• Arkansas Department of Emergency Management, North Little Rock, work-site wellness and obesity.

• Arkansas Hospice, North Little Rock, Alzheimer’s, hospice and end-of-life planning.

• Arkansas Voices for the Children Left Behind, Little Rock, healthy lifestyles and mental health.

• Arthritis Foundation Southeast Region, Little Rock, arthritis and chronic disease self-management.

• Camp Aldersgate, Little Rock, senior wellness.

• CARTI Foundation, Little Rock, patient transportation.

• Christian Health Ministry of White County, Searcy, charity clinic operation and electronic medical records.

• City of Cammack Village, swimming pool wheelchair access.

• Delta Community Based Services, Little Rock, girls’ empowerment conference.

• Delta Presents Outreach Foundation, Little Rock, aspiring college students project, addressing substance abuse.

• Donald W. Reynolds Cancer Support House, Fort Smith, skin cancer education.

• Eagle Mountain Magnet Elementary, Batesville, nutrition and obesity (nutrition and exercise).

• East Arkansas Area Agency on Aging, Jonesboro, exercise/physical activity and healthy lifestyles.

• Elizabeth Richardson Center, Springdale, disabilities and autism.

• Forrester-Davis Development Center, Clarksville, disabilities and heart health.

• Friends of the Timberwolves, Newark, nutrition, exercise and healthy lifestyles.

• Hearth, Jonesboro, nutrition, food costs and parenting.

• Hip Hop Tumblers, Harrison, nutrition and exercise.

• Historic Harrison Business Association, Harrison, physical activity and substance abuse.

• Hometown Health Coalition Network, Warren, healthy lifestyles and exercise/ physical activity.

• Hope Cancer Resources, Springdale, healthy lifestyles and cancer.

• LifeHouse Ministries, Paragould, STDs and HIV/AIDS. • Marion County Hometown Health, Inc., Yellville, prenatal/pediatrics and safety.

• Mid-Delta Health Systems, Clarendon, tobacco-related health conditions.

• Newton County Resource Council, Jasper, nutrition, exercise and parenting.

• Northwest Arkansas Community College, Bentonville, CPR/first aid /AED and medical professional education.

• Old High Middle School, Bentonville, chair-free classrooms.

• Ozark Guidance, Springdale, mental health, wellness education and prevention.

• Ozarka College, Melbourne, Australian Walkabout Fitness Challenge.

• Paragould School District, Paragould, nutrition, exercise and mental health.

• Pediatrics Plus Connections, Conway, nutrition, exercise and disabilities.

• S.W. Chance, Maumelle, obesity, nutrition, exercise and disabilities.

• University of Central Arkansas, Conway, preschoolers and the USDA MyPlate project.

• Washington Regional Medical Foundation, Fayetteville, cancer support.

• Wildwood Park for the Arts, Little Rock, healthy lifestyles and nutrition.

Nonprofit and charitable organizations, schools and government institutions in Arkansas are eligible to apply for two different programs: a $1,000 mini-grant program and a regular grant program of $5,000 to $150,000. New applications will be accepted beginning in March 2013. Grant guidelines and the online applications can be found at blueandyoufoundationarkansas.org.

The Blue & You Foundation was established in 2001 by Arkansas Blue Cross and Blue Shield to help support community organizations that are implementing programs to improve the health of Arkansans.

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AUTUMN 2012

Bryan Dorathy Bryan Dorathy has joined Arkansas Blue Cross and Blue Shield as an agency market manager for our offices in Little Rock and Pine Bluff. Bryan is responsible for Arkansas Blue Cross’ relationships with agents and partners as well as producing contracts for groups from two to 100. Bryan has more than 15 years of experience in the insurance industry.

Sam Vorderstrasse Sam Vorderstrasse recently was promoted to vice president of Actuarial Services. He is responsible for providing decision support and direction related to the pricing and development of products, actuarial management, rating programs and determining/estimating outstanding liabilities.

He is a Fellow of the Society of Actuaries and a member of the American Academy of Actuaries.

Dr. John Brineman Dr. John Brineman has accepted the position of regional medical director for our Little Rock office and associate medical director for Health Advantage.

He is a graduate of the College of William and Mary in Williamsburg, Virginia, and received his doctorate in medicine from Eastern Virginia Medical School.

He completed a residency in Anatomic and Clinical Pathology at Walter Reed Army Medical Center and is a diplomat of the American Board of Pathology in Combined Anatomic and Clinical Pathology. He had a distinguished career in the active Army and the U.S. Army Reserve, rising to the rank of Colonel, serving two tours in Iraq.

“In its first 10 years of grantmaking, the Blue & You Foundation has awarded a total of $14 million to 293 health improvement projects in Arkansas,” said Patrick O’Sullivan, executive director. “ These include programs to address obesity, diabetes, healthy lifestyles, medical and dental care for the uninsured, and dozens of other health issues that are affecting our state’s population.”

The Blue & You Foundation is an independent licensee of the Blue Cross and Blue Shield Association and serves the state of Arkansas.

Blue & You AUTUMN 2012 13

Foundation Awards 35 Mini-grants to Health Programs

New at the Blue

The Blue & You Foundation for a Healthier Arkansas has awarded $1,000 grants to 35 health improvement programs in Arkansas

New people and new positions

Mini-grant recipients in 2012 include:

• Arkansas Department of Emergency Management, North Little Rock, work-site wellness and obesity.

• Arkansas Hospice, North Little Rock, Alzheimer’s, hospice and end-of-life planning.

• Arkansas Voices for the Children Left Behind, Little Rock, healthy lifestyles and mental health.

• Arthritis Foundation Southeast Region, Little Rock, arthritis and chronic disease self-management.

• Camp Aldersgate, Little Rock, senior wellness.

• CARTI Foundation, Little Rock, patient transportation.

• Christian Health Ministry of White County, Searcy, charity clinic operation and electronic medical records.

• City of Cammack Village, swimming pool wheelchair access.

• Delta Community Based Services, Little Rock, girls’ empowerment conference.

• Delta Presents Outreach Foundation, Little Rock, aspiring college students project, addressing substance abuse.

• Donald W. Reynolds Cancer Support House, Fort Smith, skin cancer education.

• Eagle Mountain Magnet Elementary, Batesville, nutrition and obesity (nutrition and exercise).

• East Arkansas Area Agency on Aging, Jonesboro, exercise/physical activity and healthy lifestyles.

• Elizabeth Richardson Center, Springdale, disabilities and autism.

• Forrester-Davis Development Center, Clarksville, disabilities and heart health.

• Friends of the Timberwolves, Newark, nutrition, exercise and healthy lifestyles.

• Hearth, Jonesboro, nutrition, food costs and parenting.

• Hip Hop Tumblers, Harrison, nutrition and exercise.

• Historic Harrison Business Association, Harrison, physical activity and substance abuse.

• Hometown Health Coalition Network, Warren, healthy lifestyles and exercise/ physical activity.

• Hope Cancer Resources, Springdale, healthy lifestyles and cancer.

• LifeHouse Ministries, Paragould, STDs and HIV/AIDS. • Marion County Hometown Health, Inc., Yellville, prenatal/pediatrics and safety.

• Mid-Delta Health Systems, Clarendon, tobacco-related health conditions.

• Newton County Resource Council, Jasper, nutrition, exercise and parenting.

• Northwest Arkansas Community College, Bentonville, CPR/first aid /AED and medical professional education.

• Old High Middle School, Bentonville, chair-free classrooms.

• Ozark Guidance, Springdale, mental health, wellness education and prevention.

• Ozarka College, Melbourne, Australian Walkabout Fitness Challenge.

• Paragould School District, Paragould, nutrition, exercise and mental health.

• Pediatrics Plus Connections, Conway, nutrition, exercise and disabilities.

• S.W. Chance, Maumelle, obesity, nutrition, exercise and disabilities.

• University of Central Arkansas, Conway, preschoolers and the USDA MyPlate project.

• Washington Regional Medical Foundation, Fayetteville, cancer support.

• Wildwood Park for the Arts, Little Rock, healthy lifestyles and nutrition.

Nonprofit and charitable organizations, schools and government institutions in Arkansas are eligible to apply for two different programs: a $1,000 mini-grant program and a regular grant program of $5,000 to $150,000. New applications will be accepted beginning in March 2013. Grant guidelines and the online applications can be found at blueandyoufoundationarkansas.org.

The Blue & You Foundation was established in 2001 by Arkansas Blue Cross and Blue Shield to help support community organizations that are implementing programs to improve the health of Arkansans.

12 Blue & You

AUTUMN 2012

Bryan Dorathy Bryan Dorathy has joined Arkansas Blue Cross and Blue Shield as an agency market manager for our offices in Little Rock and Pine Bluff. Bryan is responsible for Arkansas Blue Cross’ relationships with agents and partners as well as producing contracts for groups from two to 100. Bryan has more than 15 years of experience in the insurance industry.

Sam Vorderstrasse Sam Vorderstrasse recently was promoted to vice president of Actuarial Services. He is responsible for providing decision support and direction related to the pricing and development of products, actuarial management, rating programs and determining/estimating outstanding liabilities.

He is a Fellow of the Society of Actuaries and a member of the American Academy of Actuaries.

Dr. John Brineman Dr. John Brineman has accepted the position of regional medical director for our Little Rock office and associate medical director for Health Advantage.

He is a graduate of the College of William and Mary in Williamsburg, Virginia, and received his doctorate in medicine from Eastern Virginia Medical School.

He completed a residency in Anatomic and Clinical Pathology at Walter Reed Army Medical Center and is a diplomat of the American Board of Pathology in Combined Anatomic and Clinical Pathology. He had a distinguished career in the active Army and the U.S. Army Reserve, rising to the rank of Colonel, serving two tours in Iraq.

“In its first 10 years of grantmaking, the Blue & You Foundation has awarded a total of $14 million to 293 health improvement projects in Arkansas,” said Patrick O’Sullivan, executive director. “ These include programs to address obesity, diabetes, healthy lifestyles, medical and dental care for the uninsured, and dozens of other health issues that are affecting our state’s population.”

The Blue & You Foundation is an independent licensee of the Blue Cross and Blue Shield Association and serves the state of Arkansas.

Blue & You AUTUMN 2012 13

Sleep and mindlessly munching Have you ever found yourself hitting the afternoon slump then reaching for a bag of chips? What about sitting on the couch watching your favorite show, yawning and feeling the urge to snack on something less than healthy? You might need to get more sleep to prevent mindless munching.

According to researchers, there may be a link between “sleep-related hunger and food cravings.” And not just any food cravings, but fatty, high-calorie foods.

Marie-Pierre St. Onge, Ph.D., suggests that when you’re tired, you gravitate towards high-calorie foods because your body is looking for energy. Additionally, sleep deprivation seems to increase activity in the areas of the brain that seek pleasure, which can include enjoyment from junk foods.

And if that’s not enough, research also suggests that being sleep deprived impairs decision-making. Therefore, you’re less likely to think through the repercussions of reaching for the junk foods. You’re literally mindlessly munching.

Source: Health.com

Diesel fumes officially declared to cause cancer The World Health Organization (WHO) recently elevated diesel to the “known carcinogen” level, officially declaring that diesel fumes cause lung cancer. Experts also concluded that the fumes were more carcinogenic than secondhand cigarette smoke.

Diesel is a type of fuel derived from crude oil, and exposure to diesel exhaust is widespread in today’s world. Health concerns about diesel exhaust relate not only to cancer, but also to other health problems such as respiratory and heart diseases.

Diesel exhaust now shares the WHO’s Group 1 carcinogen status with smoking, asbestos, ultraviolet radiation, alcohol and other elements that pose cancer risks.

14 Blue & You

AUTUMN 2012

SPECIAL NOTICE:

*Arkansas State and Public School Employees can enroll in a weightloss program administered by the Employee Assistance Program’s vendor. Call 1-877-247-4621 to enroll. **Medi-Pak Medicare supplement insurance policyholders are not eligible for The Healthy Weigh! program.

Lose weight The Healthy Weigh! Education Program is free for members of Arkansas Blue Cross and Blue Shield, Health Advantage (except ARBenefits members*), Blue Cross and Blue Shield Service Benefit Plan (Federal Employee Program), Medi-Pak® Advantage (PFFS), Medi-Pak Advantage PPO, 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 receive information through the mail, 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 Education Program’s toll-free number at 1-800-686-2609.

Simply complete, sign and return the attached enrollment form in the self-addressed, postage-paid envelope to join The Healthy Weigh!

SHINGLES Avoid the pain, get vaccinated Almost one in three people in the United States will develop shingles during their lifetime. This painful illness is a possibility for anyone who suffered with chickenpox and is more likely to occur if you are stressed or older.

The good news is you can protect yourself against shingles. Talk with your doctor about the shingles vaccine. Arkansas Blue Cross and Blue Shield covers the shingles vaccines for members age 60 or older as a one-time vaccination based on Advisory Committee for Immunization Practices (ACIP) recommendations.

Shingles, also known as herpes zoster, is caused by the varicella zoster virus (VZV). This is the same virus that causes chickenpox. The painful, blistering skin rash from shingles can last two to four weeks.

If you have had chickenpox in the past, then VZV is inside you. It never leaves your body and stays in a dormant state. For reasons that are not fully known, the virus can reactivate years later and cause shingles.

Some people may develop severe nerve pain that can last for months or even years after the rash goes away. This is called postherpetic neuralgia (PHN). Older adults are more likely to get PHN. Shingles can lead to other serious complications, including eye problems.

Pain from shingles has been described as excruciating, aching, burning, stabbing, and shock-like. It has been compared to the pain of childbirth or kidney stones.

The pain from shingles can cause depression, anxiety, difficulty concentrating, loss of appetite and weight loss. Shingles can interfere with activities of daily living like dressing, bathing, eating, cooking, shopping and travel.

The only way to reduce your risk of developing shingles and PHN is to get vaccinated. Some people should wait to get vaccinated, or they should not get vaccinated at all if they have a weakened immune system. Shingles vaccine is available in pharmacies and doctors’ offices. Talk with your doctor if you have questions about the shingles vaccine.

Blue & You AUTUMN 2012 15

Sleep and mindlessly munching Have you ever found yourself hitting the afternoon slump then reaching for a bag of chips? What about sitting on the couch watching your favorite show, yawning and feeling the urge to snack on something less than healthy? You might need to get more sleep to prevent mindless munching.

According to researchers, there may be a link between “sleep-related hunger and food cravings.” And not just any food cravings, but fatty, high-calorie foods.

Marie-Pierre St. Onge, Ph.D., suggests that when you’re tired, you gravitate towards high-calorie foods because your body is looking for energy. Additionally, sleep deprivation seems to increase activity in the areas of the brain that seek pleasure, which can include enjoyment from junk foods.

And if that’s not enough, research also suggests that being sleep deprived impairs decision-making. Therefore, you’re less likely to think through the repercussions of reaching for the junk foods. You’re literally mindlessly munching.

Source: Health.com

Diesel fumes officially declared to cause cancer The World Health Organization (WHO) recently elevated diesel to the “known carcinogen” level, officially declaring that diesel fumes cause lung cancer. Experts also concluded that the fumes were more carcinogenic than secondhand cigarette smoke.

Diesel is a type of fuel derived from crude oil, and exposure to diesel exhaust is widespread in today’s world. Health concerns about diesel exhaust relate not only to cancer, but also to other health problems such as respiratory and heart diseases.

Diesel exhaust now shares the WHO’s Group 1 carcinogen status with smoking, asbestos, ultraviolet radiation, alcohol and other elements that pose cancer risks.

14 Blue & You

AUTUMN 2012

SPECIAL NOTICE:

*Arkansas State and Public School Employees can enroll in a weightloss program administered by the Employee Assistance Program’s vendor. Call 1-877-247-4621 to enroll. **Medi-Pak Medicare supplement insurance policyholders are not eligible for The Healthy Weigh! program.

Lose weight The Healthy Weigh! Education Program is free for members of Arkansas Blue Cross and Blue Shield, Health Advantage (except ARBenefits members*), Blue Cross and Blue Shield Service Benefit Plan (Federal Employee Program), Medi-Pak® Advantage (PFFS), Medi-Pak Advantage PPO, 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 receive information through the mail, 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 Education Program’s toll-free number at 1-800-686-2609.

Simply complete, sign and return the attached enrollment form in the self-addressed, postage-paid envelope to join The Healthy Weigh!

SHINGLES Avoid the pain, get vaccinated Almost one in three people in the United States will develop shingles during their lifetime. This painful illness is a possibility for anyone who suffered with chickenpox and is more likely to occur if you are stressed or older.

The good news is you can protect yourself against shingles. Talk with your doctor about the shingles vaccine. Arkansas Blue Cross and Blue Shield covers the shingles vaccines for members age 60 or older as a one-time vaccination based on Advisory Committee for Immunization Practices (ACIP) recommendations.

Shingles, also known as herpes zoster, is caused by the varicella zoster virus (VZV). This is the same virus that causes chickenpox. The painful, blistering skin rash from shingles can last two to four weeks.

If you have had chickenpox in the past, then VZV is inside you. It never leaves your body and stays in a dormant state. For reasons that are not fully known, the virus can reactivate years later and cause shingles.

Some people may develop severe nerve pain that can last for months or even years after the rash goes away. This is called postherpetic neuralgia (PHN). Older adults are more likely to get PHN. Shingles can lead to other serious complications, including eye problems.

Pain from shingles has been described as excruciating, aching, burning, stabbing, and shock-like. It has been compared to the pain of childbirth or kidney stones.

The pain from shingles can cause depression, anxiety, difficulty concentrating, loss of appetite and weight loss. Shingles can interfere with activities of daily living like dressing, bathing, eating, cooking, shopping and travel.

The only way to reduce your risk of developing shingles and PHN is to get vaccinated. Some people should wait to get vaccinated, or they should not get vaccinated at all if they have a weakened immune system. Shingles vaccine is available in pharmacies and doctors’ offices. Talk with your doctor if you have questions about the shingles vaccine.

Blue & You AUTUMN 2012 15

October is Open Enrollment Period for individual family policies Arkansas Blue Cross and Blue Shield’s Open Enrollment Period (OEP) for individual and family health plans began October 1 and runs through Oct. 31, 2012.

During this OEP, members may apply for changes to their policy and individuals age 18 or younger may apply for a child-only policy.

Making changes to individual and family policies Members may request changes to their policy, such as: • Adding or deleting dependents.

• Increasing or decreasing the deductible.

• Adding or deleting maternity.

• Requesting the removal of surcharges or exclusions.

Change forms related to OEP must be received (not just postmarked) by Arkansas Blue Cross no later than Oct. 31, 2012. Changes to existing policies will be effective Jan. 1 or 15, 2013, depending on the policy billing cycle.

An underwriting change form is required if you are: • Adding a dependent to your policy - Dependents age 18 or younger cannot be declined coverage but will be medically underwritten and may be surcharged based on medical conditions. Children eligible for Medicaid or ARKids First are not eligible for coverage under an individual policy.

- Dependents age 19 or older will be medically underwritten and may be surcharged or denied coverage based on medical conditions.

• Increasing your policy benefits by: - Lowering the deductible.

16 Blue & You

AUTUMN 2012

- Raising the coinsurance percentage.

- Lowering the calendar-year coinsurance maximum.

- Adding the maternity rider.

• Requesting that an exclusion be removed • Requesting that a surcharge be reduced or removed.

A non-underwriting change form is required if you are: • Deleting a dependent from your policy.

• Decreasing your policy benefits by: - Raising the deductible.

- Lowering the coinsurance percentage.

- Raising the calendar-year coinsurance maximum.

- Deleting the maternity rider.

Both underwriting change forms and non-underwriting change forms are available online at arkansasbluecross.com or you can call Customer Service at 1-800-238-8379.

Applying for a child-only policy During the OEP, individuals age 18 or younger may apply for a child-only policy. Applications for child-only policies must be received (not just postmarked) by Arkansas Blue Cross no later than Oct. 31, 2012. If approved and accepted, all new child-only policies will be effective Jan. 1, 2013.

You may apply for a child-only individual policy: • Online at arkansasbluecross.com • By calling us at 1-800-392-2583; or • By contacting your independent or Farm Bureau agent.

Outside the OEP, individuals age 18 or younger can be considered for coverage only

as a dependent on a parent or guardian’s policy or as a result of a “qualifying life event.”

Qualifying life events Requesting a change to an existing policy

Changes may be made to existing policies at any time throughout the year as a result of a “qualifying life event” — such as a marriage, divorce, death, birth of a child, or loss of other health insurance coverage.

There are specific notification periods and documentation requirements associated with qualifying life event changes.

To get information, go to arkansasbluecross.com/ members/making_policy_ changes.aspx or call Customer Service at 1-800-238-8379.

Applying for a new child-only policy In addition, there are two qualifying life events that allow individuals age 18 or younger to apply for a child-only policy outside of the OEP. Those are: • The loss of employersponsored health insurance coverage; or • An involuntary loss of any other health insurance coverage.

In either case, the application must be submitted within 30 days of the loss of coverage and documentation is required to verify the loss of coverage.

Children eligible for Medicaid or ARKids First are not eligible for coverage under an individual policy.

Should you have any questions, call Customer Service at 1-800-238-8379.

Medicare Annual Election Period October 15 through December 7 Medicare’s Annual Election Period (AEP) will begin October 15, and will run through December 7. During AEP, Medicare beneficiaries can purchase a Medicare Advantage plan and/or a Medicare Part D prescription drug plan. You also may switch from your existing plans. If you join a plan during AEP, or make changes to an existing plan, your new benefits will be effective Jan. 1, 2013.

Affordable products and peace of mind Generations of Arkansans have trusted Arkansas Blue Cross and Blue Shield for peace of mind.

Our Medicare products offer members low monthly premiums.

And, in 2013 you can expect the same great selection of Medicare products you’ve come to expect from us through the years.

• $0 premiums for Medi-Pak® Advantage MA-PD Private Fee-for-Service (PFFS) (includes drug coverage) in 27 counties and affordable premiums in all Arkansas counties. Medi-Pak Advantage (PFFS) members have access to our extensive network of more than 7,000 doctors and hospitals across the state.

Attention Medicare Advantage plan members

In addition, Medi-Pak Advantage MA-PD members receive a membership in the popular SilverSneakers® Fitness Program* at no additional cost.

• $0 premiums for Medi-Pak Advantage MA (PFFS) (does not include drug coverage) in 50 counties. These plans offer all the health benefits of our Medi-Pak Advantage MA-PD plans, but do not include drug coverage. Members have the same access to our network of doctors and hospitals, and a SilverSneakers membership.

• Two Medi-Pak® Rx Prescription Drug Plans (PDP) – Basic and Premier – with competitively priced monthly premiums. More than 95 percent of Arkansas pharmacies are in our network.

• Four Medi-Pak® supplement plans including Plan F, our most comprehensive supplement plan, and Plan N, one of our lowest-priced supplement plans.

If you have a Medicare Advantage or Medicare Part D plan, during October you will receive an Annual Notice of Change (ANOC) which will explain any changes to your current plan that will become effective in January. If you are satisfied with your current plan, you are not required to change anything. Every year, the Centers for Medicare and Medicaid Services (CMS) require companies to inform members of these changes prior to AEP so they may shop their coverage.

If you would like to learn more about our Medicare plans …

Call your local Medi-Pak® Choice licensed agent or 1-800-392-2583 to learn more. You also can visit our Web site, arkansasbluecross.com/ Medicare. We’d love to hear from you. If you have a friend or family member who doesn’t have one of our Part D prescription drug plans or Medicare Advantage plans, we hope you’ll recommend Medi-Pak Rx and Medi-Pak Advantage. *See disclosure on page 28

2013 Open Enrollment for Arkansas State and Public School members October 1 through October 31

The Arkansas State and Public and School Employee and Retiree Open Enrollment Period began October 1 and run through October 31. Please refer to the Employee Benefits (EBD) newsletter, The Buzz, for plan

information or go the EBD Web site, ARBenefits.org.

This year will be a passive enrollment – meaning that if you do not wish to change plans you automatically will be enrolled

in the plan you selected for the 2012 plan year. However, if you want to change plans, add or drop dependents or update demographic information, you must complete an election form.

Blue & You AUTUMN 2012 17

October is Open Enrollment Period for individual family policies Arkansas Blue Cross and Blue Shield’s Open Enrollment Period (OEP) for individual and family health plans began October 1 and runs through Oct. 31, 2012.

During this OEP, members may apply for changes to their policy and individuals age 18 or younger may apply for a child-only policy.

Making changes to individual and family policies Members may request changes to their policy, such as: • Adding or deleting dependents.

• Increasing or decreasing the deductible.

• Adding or deleting maternity.

• Requesting the removal of surcharges or exclusions.

Change forms related to OEP must be received (not just postmarked) by Arkansas Blue Cross no later than Oct. 31, 2012. Changes to existing policies will be effective Jan. 1 or 15, 2013, depending on the policy billing cycle.

An underwriting change form is required if you are: • Adding a dependent to your policy - Dependents age 18 or younger cannot be declined coverage but will be medically underwritten and may be surcharged based on medical conditions. Children eligible for Medicaid or ARKids First are not eligible for coverage under an individual policy.

- Dependents age 19 or older will be medically underwritten and may be surcharged or denied coverage based on medical conditions.

• Increasing your policy benefits by: - Lowering the deductible.

16 Blue & You

AUTUMN 2012

- Raising the coinsurance percentage.

- Lowering the calendar-year coinsurance maximum.

- Adding the maternity rider.

• Requesting that an exclusion be removed • Requesting that a surcharge be reduced or removed.

A non-underwriting change form is required if you are: • Deleting a dependent from your policy.

• Decreasing your policy benefits by: - Raising the deductible.

- Lowering the coinsurance percentage.

- Raising the calendar-year coinsurance maximum.

- Deleting the maternity rider.

Both underwriting change forms and non-underwriting change forms are available online at arkansasbluecross.com or you can call Customer Service at 1-800-238-8379.

Applying for a child-only policy During the OEP, individuals age 18 or younger may apply for a child-only policy. Applications for child-only policies must be received (not just postmarked) by Arkansas Blue Cross no later than Oct. 31, 2012. If approved and accepted, all new child-only policies will be effective Jan. 1, 2013.

You may apply for a child-only individual policy: • Online at arkansasbluecross.com • By calling us at 1-800-392-2583; or • By contacting your independent or Farm Bureau agent.

Outside the OEP, individuals age 18 or younger can be considered for coverage only

as a dependent on a parent or guardian’s policy or as a result of a “qualifying life event.”

Qualifying life events Requesting a change to an existing policy

Changes may be made to existing policies at any time throughout the year as a result of a “qualifying life event” — such as a marriage, divorce, death, birth of a child, or loss of other health insurance coverage.

There are specific notification periods and documentation requirements associated with qualifying life event changes.

To get information, go to arkansasbluecross.com/ members/making_policy_ changes.aspx or call Customer Service at 1-800-238-8379.

Applying for a new child-only policy In addition, there are two qualifying life events that allow individuals age 18 or younger to apply for a child-only policy outside of the OEP. Those are: • The loss of employersponsored health insurance coverage; or • An involuntary loss of any other health insurance coverage.

In either case, the application must be submitted within 30 days of the loss of coverage and documentation is required to verify the loss of coverage.

Children eligible for Medicaid or ARKids First are not eligible for coverage under an individual policy.

Should you have any questions, call Customer Service at 1-800-238-8379.

Medicare Annual Election Period October 15 through December 7 Medicare’s Annual Election Period (AEP) will begin October 15, and will run through December 7. During AEP, Medicare beneficiaries can purchase a Medicare Advantage plan and/or a Medicare Part D prescription drug plan. You also may switch from your existing plans. If you join a plan during AEP, or make changes to an existing plan, your new benefits will be effective Jan. 1, 2013.

Affordable products and peace of mind Generations of Arkansans have trusted Arkansas Blue Cross and Blue Shield for peace of mind.

Our Medicare products offer members low monthly premiums.

And, in 2013 you can expect the same great selection of Medicare products you’ve come to expect from us through the years.

• $0 premiums for Medi-Pak® Advantage MA-PD Private Fee-for-Service (PFFS) (includes drug coverage) in 27 counties and affordable premiums in all Arkansas counties. Medi-Pak Advantage (PFFS) members have access to our extensive network of more than 7,000 doctors and hospitals across the state.

Attention Medicare Advantage plan members

In addition, Medi-Pak Advantage MA-PD members receive a membership in the popular SilverSneakers® Fitness Program* at no additional cost.

• $0 premiums for Medi-Pak Advantage MA (PFFS) (does not include drug coverage) in 50 counties. These plans offer all the health benefits of our Medi-Pak Advantage MA-PD plans, but do not include drug coverage. Members have the same access to our network of doctors and hospitals, and a SilverSneakers membership.

• Two Medi-Pak® Rx Prescription Drug Plans (PDP) – Basic and Premier – with competitively priced monthly premiums. More than 95 percent of Arkansas pharmacies are in our network.

• Four Medi-Pak® supplement plans including Plan F, our most comprehensive supplement plan, and Plan N, one of our lowest-priced supplement plans.

If you have a Medicare Advantage or Medicare Part D plan, during October you will receive an Annual Notice of Change (ANOC) which will explain any changes to your current plan that will become effective in January. If you are satisfied with your current plan, you are not required to change anything. Every year, the Centers for Medicare and Medicaid Services (CMS) require companies to inform members of these changes prior to AEP so they may shop their coverage.

If you would like to learn more about our Medicare plans …

Call your local Medi-Pak® Choice licensed agent or 1-800-392-2583 to learn more. You also can visit our Web site, arkansasbluecross.com/ Medicare. We’d love to hear from you. If you have a friend or family member who doesn’t have one of our Part D prescription drug plans or Medicare Advantage plans, we hope you’ll recommend Medi-Pak Rx and Medi-Pak Advantage. *See disclosure on page 28

2013 Open Enrollment for Arkansas State and Public School members October 1 through October 31

The Arkansas State and Public and School Employee and Retiree Open Enrollment Period began October 1 and run through October 31. Please refer to the Employee Benefits (EBD) newsletter, The Buzz, for plan

information or go the EBD Web site, ARBenefits.org.

This year will be a passive enrollment – meaning that if you do not wish to change plans you automatically will be enrolled

in the plan you selected for the 2012 plan year. However, if you want to change plans, add or drop dependents or update demographic information, you must complete an election form.

Blue & You AUTUMN 2012 17

with Dr. David

David A. Lipschitz, M.D., Ph.D.

You can reduce the risk of a serious fall Falls become more prevalent with age After age 65 about 30 percent of people fall at least once annually. And, if a hip fracture occurs, 25 percent will die in a year and 50 percent will become dependent, frequently requiring nursing home care.

Fortunately, much can be done to reduce the risk of a fall, the need for lengthy hospital stays or the loss of independence.

Causes of falls Increased fall risk with age frequently is due to declines in balance, mobility and gait, and a high risk of fainting caused by blood pressure drops when attempting to stand up. Visual difficulties, dizziness, inappropriate shoe choices and side effects of drugs often contribute to falls. Tripping due to environmental hazards in the home or elsewhere remains the major cause of falls at any age.

An evaluation by a physician is essential If you or a loved one is at risk of falling, an evaluation by a physician is essential. Medical conditions that contribute to falls must be identified and treated and problems with gait and balance evaluated. There are standardized tests that can be done that identify major problems with the way someone walks. First, can the patient get up from the chair without assistance? Does he have to use his hands to stand, or does someone have to help him?

Can he walk without using an assistive device such as a cane or a walker? Can he walk in a straight line?

18 Blue & You

AUTUMN 2012

How long does it take him to walk 10 meters, turn around and sit back down.

If it is longer than 20 seconds, a serious problem exists.

A careful assessment of all medications must be done. Many medications can increase the risk of falling by causing drowsiness, confusion, worsening weakness and balance difficulties and significant dizziness. This particularly occurs if a person is taking medications to lower blood pressure.

Whenever possible, keep medications to a minimum and avoid sleeping pills, tranquilizers and alcohol. Medications to treat hypertension (high blood pressure) also can lead to dangerous drops in blood pressure. If your loved one takes blood pressure medication, remind them to stand up slowly and always have something to hold on to in case he feels faint.

Exercise is the key to preventing falls No matter your health, aging is associated with a relentless loss of muscle mass, an increased proportion of weight as fat and progressive weakness that slows gait speed, affects balance and increases the risk of falls. The more we do to maintain strength the better. Physical therapy can help reduce falls.

Treatment includes balance exercises and working with weights that builds muscle, bones and most importantly strength. The older the patient, the longer the time it will take to see tangible improvements, but they will occur and the results are well worth the effort. When physical therapy ends, it

is important to keep moving and consider joining a health club to continue exercise and maintain and improve strength and balance.

Use assistive devices if needed Do not be embarrassed to use a cane, walker or a wheelchair, but walk as much as possible. The more time spent being immobile or sitting in a wheelchair, the greater the loss of muscle and the increased chance of a fall. Electric wheelchairs are great, but should only be used if needed and if walking is impossible.

of the way. Loose rugs should be removed or taped to the floor, uneven wooden floorboards or carpeting must be repaired and skid proof materials should be used for cleaning. Many falls are caused by standing on a chair or attempting to remove something from an out-of-reach cupboard. For this reason, clothing, cleaning materials, dishes, utensils and food must be accessible and stored within easy reach. Adequate lighting decreases fall risk. Assure that each room has ambient light from outside during the day, is well lit at night and night lights are used liberally. Always switch on a light before climbing the stairs and install glow-in-the-dark or illuminated light switches.

Assess your house for fall risk

Consider moving

Most serious falls occur in the bathroom.

Carefully review the bathroom to make sure slippery surfaces can be avoided, that water does not leak from the shower or tub and, if possible, install hand rails from the bed all the way into the bathroom. Often a raised toilet seat with armrests can prove helpful. A sturdy plastic seat should be placed in the tub or shower and use a hand-held shower head to bathe. If a wheelchair is needed or gait and balance are significantly impaired, a uniquely designed bathtub or shower may be needed. During the night, a bedside commode may be a good option rather than walking in the dark to a very hazardous area.

If a fall risk is too great, consider whether living alone in a large house with stairs is appropriate.

It may be time to move to a one-level home or to an assisted-living facility where help is available and people surround you. And, as you grow older, no matter your health, live as close as possible to immediate family.

Fall-proof the home by clearing walking areas of boxes and electrical phone cords. Remove low coffee tables and move magazines and plants out

Accidents due to falls are a major cause of physical disability, the need for nursing home care and a poor quality of life. The earlier precautions are taken to reduce a fall risk, the better.

David A. Lipschitz, M.D., Ph.D., is nationally recognized as a leader in the field of geriatrics.

Arkansas Blue Cross and Blue Shield is honored to have him as a contributor to Blue & You magazine.

Blue & You AUTUMN 2012 19

with Dr. David

David A. Lipschitz, M.D., Ph.D.

You can reduce the risk of a serious fall Falls become more prevalent with age After age 65 about 30 percent of people fall at least once annually. And, if a hip fracture occurs, 25 percent will die in a year and 50 percent will become dependent, frequently requiring nursing home care.

Fortunately, much can be done to reduce the risk of a fall, the need for lengthy hospital stays or the loss of independence.

Causes of falls Increased fall risk with age frequently is due to declines in balance, mobility and gait, and a high risk of fainting caused by blood pressure drops when attempting to stand up. Visual difficulties, dizziness, inappropriate shoe choices and side effects of drugs often contribute to falls. Tripping due to environmental hazards in the home or elsewhere remains the major cause of falls at any age.

An evaluation by a physician is essential If you or a loved one is at risk of falling, an evaluation by a physician is essential. Medical conditions that contribute to falls must be identified and treated and problems with gait and balance evaluated. There are standardized tests that can be done that identify major problems with the way someone walks. First, can the patient get up from the chair without assistance? Does he have to use his hands to stand, or does someone have to help him?

Can he walk without using an assistive device such as a cane or a walker? Can he walk in a straight line?

18 Blue & You

AUTUMN 2012

How long does it take him to walk 10 meters, turn around and sit back down.

If it is longer than 20 seconds, a serious problem exists.

A careful assessment of all medications must be done. Many medications can increase the risk of falling by causing drowsiness, confusion, worsening weakness and balance difficulties and significant dizziness. This particularly occurs if a person is taking medications to lower blood pressure.

Whenever possible, keep medications to a minimum and avoid sleeping pills, tranquilizers and alcohol. Medications to treat hypertension (high blood pressure) also can lead to dangerous drops in blood pressure. If your loved one takes blood pressure medication, remind them to stand up slowly and always have something to hold on to in case he feels faint.

Exercise is the key to preventing falls No matter your health, aging is associated with a relentless loss of muscle mass, an increased proportion of weight as fat and progressive weakness that slows gait speed, affects balance and increases the risk of falls. The more we do to maintain strength the better. Physical therapy can help reduce falls.

Treatment includes balance exercises and working with weights that builds muscle, bones and most importantly strength. The older the patient, the longer the time it will take to see tangible improvements, but they will occur and the results are well worth the effort. When physical therapy ends, it

is important to keep moving and consider joining a health club to continue exercise and maintain and improve strength and balance.

Use assistive devices if needed Do not be embarrassed to use a cane, walker or a wheelchair, but walk as much as possible. The more time spent being immobile or sitting in a wheelchair, the greater the loss of muscle and the increased chance of a fall. Electric wheelchairs are great, but should only be used if needed and if walking is impossible.

of the way. Loose rugs should be removed or taped to the floor, uneven wooden floorboards or carpeting must be repaired and skid proof materials should be used for cleaning. Many falls are caused by standing on a chair or attempting to remove something from an out-of-reach cupboard. For this reason, clothing, cleaning materials, dishes, utensils and food must be accessible and stored within easy reach. Adequate lighting decreases fall risk. Assure that each room has ambient light from outside during the day, is well lit at night and night lights are used liberally. Always switch on a light before climbing the stairs and install glow-in-the-dark or illuminated light switches.

Assess your house for fall risk

Consider moving

Most serious falls occur in the bathroom.

Carefully review the bathroom to make sure slippery surfaces can be avoided, that water does not leak from the shower or tub and, if possible, install hand rails from the bed all the way into the bathroom. Often a raised toilet seat with armrests can prove helpful. A sturdy plastic seat should be placed in the tub or shower and use a hand-held shower head to bathe. If a wheelchair is needed or gait and balance are significantly impaired, a uniquely designed bathtub or shower may be needed. During the night, a bedside commode may be a good option rather than walking in the dark to a very hazardous area.

If a fall risk is too great, consider whether living alone in a large house with stairs is appropriate.

It may be time to move to a one-level home or to an assisted-living facility where help is available and people surround you. And, as you grow older, no matter your health, live as close as possible to immediate family.

Fall-proof the home by clearing walking areas of boxes and electrical phone cords. Remove low coffee tables and move magazines and plants out

Accidents due to falls are a major cause of physical disability, the need for nursing home care and a poor quality of life. The earlier precautions are taken to reduce a fall risk, the better.

David A. Lipschitz, M.D., Ph.D., is nationally recognized as a leader in the field of geriatrics.

Arkansas Blue Cross and Blue Shield is honored to have him as a contributor to Blue & You magazine.

Blue & You AUTUMN 2012 19

ARKANS

AS

The Natu

DL

ral State

LEA DRIVER RNER ’S ’S LICEN

CLASS: D

SE

DLN:

9876543

21

DOB:

0000

05-30-19

97

Expires:

05-30-20 13

Issued:

9-27-201

Sex:

2

F

It is a terrifying moment for any parent —

Under 18 u ntil 05-30-2 015 Under 21 u ntil 05-30-2 018

Height:

5-02

Endors:

Eyes:

HZ

serious traffic violations or accidents on record during the previous six months. Teens with an intermediate license are allowed to drive without an adult, but they are restricted from having more than one unrelated passenger under the age of 21. Drivers with this license also may not drive unsupervised between 11 p.m. and 4 a.m., unless they are traveling to or from a school or church-related activity, work or in emergency situations. At 18, teens are eligible to apply for a regular, unrestricted, driver’s license if they have a clean driving record (i.e., there must be no major traffic violations on the applicant’s record in the previous 12 months).

ACHI studied the impact of the law using information from the Arkansas State Police Motor Vehicle Crash Data. What they found was that there was a significant reduction in crashes and crash-related fatalities among teens during that timeframe. This is especially true for the youngest drivers who obtained their intermediate license to drive for the first time

Restr: A T

your teen hops in the car with a brand new driver’s license, leaving you to worry until the car pulls back into the driveway.

without an adult. Similar reductions in crashes or fatalities were not found for the adult population during this same timeframe.

While parents always will have that nervous feeling about their teen drivers, a recent report from the Arkansas Center for Health Improvement (ACHI), a nonpartisan, independent, health policy center, shows that a 2009 Arkansas law (Act 394) is helping to save lives by allowing teens to gain driving experience through the use of restrictions based on age and their driving record.

Between 2008 and 2010, fatalities involving teen drivers were reduced by 59 percent, from about 25 fatal crashes per 10,000 drivers in 2008 to 10 in 2010. This translates to an estimated 32 actual lives that were saved.

“It’s very encouraging to see these positive trends in our teen driver statistics,” said Mary Aitken, M.D., director of the Injury Prevention Center at Arkansas Children’s Hospital (ACH) and a member of the University of Arkansas for Medical Sciences pediatrics faculty. “There is still a lot of work to be done to make sure the roads in Arkansas are safer, however. The Injury Prevention Center at ACH will continue

20 Blue & You

AUTUMN 2012

An Arkansas mom hands over the car keys to her teen daughter, now driving with a Graduated Driver’s License.

to advocate for strong policies like Graduated Driver License (GDL) and provide education for teen drivers and their parents about how they can reduce risk on the roads — everything from adhering to the GDL provisions and putting away the cell phone, to buckling up on each trip.”

The GDL provides for teen driver’s licenses in three levels: learner’s license, intermediate license and unrestricted/regular license. A learner’s license permits teens that are 14-15 years old to drive only while accompanied by an adult 21 years of age or older. To receive an intermediate license, a teen driver must have no

The most drastic change was among 16-year-old drivers. The number of crashes among this age group was reduced by 22 percent (from 1,467 per 10,000 drivers in 2008 to 1,145 in 2010).

ACHI also found that between 2008 and 2010, fatalities involving teen drivers from 11 p.m. and 4 a.m. dropped by 76 percent, from 21 fatalities in 2008 to five fatalities in 2010. Teens between the ages of 16 and 18 experienced a 19 percent reduction in single vehicle crashes, and a 52 percent reduction in single vehicle fatal crashes.

The limit on passengers in a vehicle driven by a teen also helped save lives. ACHI found a 20 percent decrease in teen driver crashes with multiple passengers from 2008 to 2010.

The most significant decrease was recognized in cars carrying five or more passengers.

Mary Aitken, M.D., speaks at a celebration of the Graduated Driver’s License at Arkansas Children’s Hospital.

Sources: Arkansas Center for Health Improvement, Arkansas Children’s Hospital

Blue & You AUTUMN 2012 21

ARKANS

AS

The Natu

DL

ral State

LEA DRIVER RNER ’S ’S LICEN

CLASS: D

SE

DLN:

9876543

21

DOB:

0000

05-30-19

97

Expires:

05-30-20 13

Issued:

9-27-201

Sex:

2

F

It is a terrifying moment for any parent —

Under 18 u ntil 05-30-2 015 Under 21 u ntil 05-30-2 018

Height:

5-02

Endors:

Eyes:

HZ

serious traffic violations or accidents on record during the previous six months. Teens with an intermediate license are allowed to drive without an adult, but they are restricted from having more than one unrelated passenger under the age of 21. Drivers with this license also may not drive unsupervised between 11 p.m. and 4 a.m., unless they are traveling to or from a school or church-related activity, work or in emergency situations. At 18, teens are eligible to apply for a regular, unrestricted, driver’s license if they have a clean driving record (i.e., there must be no major traffic violations on the applicant’s record in the previous 12 months).

ACHI studied the impact of the law using information from the Arkansas State Police Motor Vehicle Crash Data. What they found was that there was a significant reduction in crashes and crash-related fatalities among teens during that timeframe. This is especially true for the youngest drivers who obtained their intermediate license to drive for the first time

Restr: A T

your teen hops in the car with a brand new driver’s license, leaving you to worry until the car pulls back into the driveway.

without an adult. Similar reductions in crashes or fatalities were not found for the adult population during this same timeframe.

While parents always will have that nervous feeling about their teen drivers, a recent report from the Arkansas Center for Health Improvement (ACHI), a nonpartisan, independent, health policy center, shows that a 2009 Arkansas law (Act 394) is helping to save lives by allowing teens to gain driving experience through the use of restrictions based on age and their driving record.

Between 2008 and 2010, fatalities involving teen drivers were reduced by 59 percent, from about 25 fatal crashes per 10,000 drivers in 2008 to 10 in 2010. This translates to an estimated 32 actual lives that were saved.

“It’s very encouraging to see these positive trends in our teen driver statistics,” said Mary Aitken, M.D., director of the Injury Prevention Center at Arkansas Children’s Hospital (ACH) and a member of the University of Arkansas for Medical Sciences pediatrics faculty. “There is still a lot of work to be done to make sure the roads in Arkansas are safer, however. The Injury Prevention Center at ACH will continue

20 Blue & You

AUTUMN 2012

An Arkansas mom hands over the car keys to her teen daughter, now driving with a Graduated Driver’s License.

to advocate for strong policies like Graduated Driver License (GDL) and provide education for teen drivers and their parents about how they can reduce risk on the roads — everything from adhering to the GDL provisions and putting away the cell phone, to buckling up on each trip.”

The GDL provides for teen driver’s licenses in three levels: learner’s license, intermediate license and unrestricted/regular license. A learner’s license permits teens that are 14-15 years old to drive only while accompanied by an adult 21 years of age or older. To receive an intermediate license, a teen driver must have no

The most drastic change was among 16-year-old drivers. The number of crashes among this age group was reduced by 22 percent (from 1,467 per 10,000 drivers in 2008 to 1,145 in 2010).

ACHI also found that between 2008 and 2010, fatalities involving teen drivers from 11 p.m. and 4 a.m. dropped by 76 percent, from 21 fatalities in 2008 to five fatalities in 2010. Teens between the ages of 16 and 18 experienced a 19 percent reduction in single vehicle crashes, and a 52 percent reduction in single vehicle fatal crashes.

The limit on passengers in a vehicle driven by a teen also helped save lives. ACHI found a 20 percent decrease in teen driver crashes with multiple passengers from 2008 to 2010.

The most significant decrease was recognized in cars carrying five or more passengers.

Mary Aitken, M.D., speaks at a celebration of the Graduated Driver’s License at Arkansas Children’s Hospital.

Sources: Arkansas Center for Health Improvement, Arkansas Children’s Hospital

Blue & You AUTUMN 2012 21

Notice: The notice below regarding Medical Loss Ratio Information is required by the federal government.

Some readers may have received a medical loss ratio rebate because their employer’s health plan was eligible for a rebate. This notice is for members who did not receive a rebate because their segment of the market had a medical loss ratio higher than the minimum required by the Affordable Care Act.

Medical Loss Ratio Information The Affordable Care Act requires health insurers in the individual and small group markets to spend at least 80 percent of the premiums they receive on health care services and activities to improve health care quality (in the large group market, this amount is 85 percent). This is referred to as the Medical Loss Ratio (MLR) rule or the 80/20 rule. If a health insurer does not spend at least 80 percent of the premiums it receives on health care services and activities to improve health care quality, the insurer must rebate the difference.

A health insurer’s Medical Loss Ratio is determined separately for each State’s individual, small group and large group markets in which the health insurer offers health insurance.

In some States, health insurers must meet a higher or lower Medical Loss Ratio.

No later than August 1, 2012, health insurers must send any rebates due for 2011 and information to employers and individuals regarding any rebates due for 2011.

You are receiving this notice because your health insurer had a Medical Loss Ratio for 2011 that met or exceeded the required Medical Loss Ratio. For more information on Medical Loss Ratio and your health insurer’s Medical Loss Ratio, visit www.HealthCare.gov.

Congratulations to the winners of the 2012 Blue & You Fitness Challenge!

They are: Group Category 1 (2-5 participants) Jefferson County — Pine Bluff, AR Group Category 2 (6-9 participants) Arkansas Education Association — Little Rock, AR Group Category 3 (10-11 participants) Boys and Girls Club — Alma, AR Group Category 4 (12 participants) The RoArk Group — Rogers, AR Group Category 5 (13 participants) National Park Service — St. Paul, MN Group Category 6 (14 participants) - TIE Eagle Heights Elementary — Harrison, AR UAMS AHEC Northeast — Jonesboro, AR Group Category 7 (15-16 participants) SFLIC — Hot Springs, AR Group Category 8 (17-18 participants) Arkansas State Plant Board — Little Rock, AR Group Category 9 (19-20 participants) Alliance Rubber Company — Hot Springs, AR Group Category 10 (21-24 participants) Harrisburg Middle School — Harrisburg, AR Group Category 11 (25-28 participants) Ben E. Keith Foods — North Little Rock, AR Group Category 12 (29-36 participants) Northrop Grumman CEO — St. Charles, MO

22 Blue & You

AUTUMN 2012

A program of Arkansas Blue Cross and Blue Shield, Arkansas Department of Human Services and the Arkansas Department of Health

Group Category 13 (37-43 participants) - TIE Keruso — Berryville, AR Lamar Elementary School, Lamar AR Group Category 14 (44-60 participants) Lamar High School — Lamar, AR Group Category 15 (61-80 participants) Nucor Yamato Steel — Blytheville, AR Group Category 16 (81-95 participants) Administrative Office of the Courts — Little Rock, AR Group Category 17 (96-138 participants) Red River Credit Union — Texarkana, AR Group Category 18 (139-234 participants) Transportation Security Agency — Little Rock, AR Group Category 19 (235+ participants) Simmons First National Bank — Pine Bluff, AR

Student Winners: Grand-prize winner: • Wade Lambright of Harrisburg Middle School in Harrisburg won a Walmart gift card toward the purchase of a bike.

Runners-up prize winners (fitness-related gift bags and gift cards): • Dalton Parnell of Lamar High School in Lamar, • Alexis Whitten of Watson Chapel Junior High FBLA in Pine Bluff, and • Jonah Hyman of HAAS Hall Academy in Fayetteville.

Arkansas Blue Cross joins new state payment initiative Arkansas Blue Cross and Blue Shield and QualChoice have joined with Arkansas Medicaid to create the Arkansas Health Care Payment Improvement Initiative (AHCPII), which will transform the state’s payment system for doctors, hospitals and other medical facilities and put Arkansas on the leading edge of national efforts to improve health care quality and cost efficiency.

Under our current payment system medical providers are paid for each activity, regardless of value. The system is called “fee for service.” For every medical service provided, the doctor or hospital receives a pre-determined fee. There are many drawbacks to this system. For example, doctors are not motivated to coordinate patient care. You may go to your primary care doctor (PCP) and have an imaging study. Your PCP may refer you to a specialist who repeats the imaging study because he is unaware that it was previously conducted.

With the AHCPII model, health care providers are paid based on an agreed upon set of standards for the episode of care. Based on the cost of the provider’s care compared to pre-determined cost targets, they either will share in savings created, break even, or owe back money share in excess cost with to payers. By providing necessary evidence-based, high

quality, and cost-effective care and better coordinating care across a patient’s providers care team, they can actually increase their net profit payment from the plan while saving money overall. This initiative was developed with input from physician associations, hospital executives, clinicians, patients, advocacy groups and the Center for Medicare & Medicaid Services (CMS). AHCPII is not a requirement of the federal health care reform legislation, but rather a state-based initiative.

During the first phase of the new payment initiative, which began July 1, six episodes of care will be monitored.

Participation in the initiative within the six episodes will vary. Arkansas Blue Cross will participate in the new payment initiative within the episodes with an asterisk (*): • Hip and knee replacements* • Congestive heart failure* • Pregnancy* • Developmental disabilities • Upper respiratory infections • Attention-deficit/ hyper-activity disorder

During the first three to six months of the initiative, doctors and hospitals will have access to reports designed to help them understand their current practice patterns and the financial and quality outcomes they generate.

Information for those reports will be pulled from existing claims data and from a limited set of data that providers will enter into a provider portal for some of the episodes.

Arkansas Blue Cross will work with doctors and hospitals to identify ways to improve the new payment method.

After the introductory period, reimbursement changes will be implemented by the insurance companies and Arkansas Medicaid. The intent is to develop a common method for reimbursement but not to implement a common level of reimbursement.

We are all paying the price of an uncoordinated delivery system. It is essential that Arkansas Blue Cross take the lead in building a new model that will serve our members and provide the kind of high-quality, affordable care you deserve.

Source: healthcare.gov/news/factsheets/2011/09/primary-care09282011a.html

Blue & You AUTUMN 2012 23

Notice: The notice below regarding Medical Loss Ratio Information is required by the federal government.

Some readers may have received a medical loss ratio rebate because their employer’s health plan was eligible for a rebate. This notice is for members who did not receive a rebate because their segment of the market had a medical loss ratio higher than the minimum required by the Affordable Care Act.

Medical Loss Ratio Information The Affordable Care Act requires health insurers in the individual and small group markets to spend at least 80 percent of the premiums they receive on health care services and activities to improve health care quality (in the large group market, this amount is 85 percent). This is referred to as the Medical Loss Ratio (MLR) rule or the 80/20 rule. If a health insurer does not spend at least 80 percent of the premiums it receives on health care services and activities to improve health care quality, the insurer must rebate the difference.

A health insurer’s Medical Loss Ratio is determined separately for each State’s individual, small group and large group markets in which the health insurer offers health insurance.

In some States, health insurers must meet a higher or lower Medical Loss Ratio.

No later than August 1, 2012, health insurers must send any rebates due for 2011 and information to employers and individuals regarding any rebates due for 2011.

You are receiving this notice because your health insurer had a Medical Loss Ratio for 2011 that met or exceeded the required Medical Loss Ratio. For more information on Medical Loss Ratio and your health insurer’s Medical Loss Ratio, visit www.HealthCare.gov.

Congratulations to the winners of the 2012 Blue & You Fitness Challenge!

They are: Group Category 1 (2-5 participants) Jefferson County — Pine Bluff, AR Group Category 2 (6-9 participants) Arkansas Education Association — Little Rock, AR Group Category 3 (10-11 participants) Boys and Girls Club — Alma, AR Group Category 4 (12 participants) The RoArk Group — Rogers, AR Group Category 5 (13 participants) National Park Service — St. Paul, MN Group Category 6 (14 participants) - TIE Eagle Heights Elementary — Harrison, AR UAMS AHEC Northeast — Jonesboro, AR Group Category 7 (15-16 participants) SFLIC — Hot Springs, AR Group Category 8 (17-18 participants) Arkansas State Plant Board — Little Rock, AR Group Category 9 (19-20 participants) Alliance Rubber Company — Hot Springs, AR Group Category 10 (21-24 participants) Harrisburg Middle School — Harrisburg, AR Group Category 11 (25-28 participants) Ben E. Keith Foods — North Little Rock, AR Group Category 12 (29-36 participants) Northrop Grumman CEO — St. Charles, MO

22 Blue & You

AUTUMN 2012

A program of Arkansas Blue Cross and Blue Shield, Arkansas Department of Human Services and the Arkansas Department of Health

Group Category 13 (37-43 participants) - TIE Keruso — Berryville, AR Lamar Elementary School, Lamar AR Group Category 14 (44-60 participants) Lamar High School — Lamar, AR Group Category 15 (61-80 participants) Nucor Yamato Steel — Blytheville, AR Group Category 16 (81-95 participants) Administrative Office of the Courts — Little Rock, AR Group Category 17 (96-138 participants) Red River Credit Union — Texarkana, AR Group Category 18 (139-234 participants) Transportation Security Agency — Little Rock, AR Group Category 19 (235+ participants) Simmons First National Bank — Pine Bluff, AR

Student Winners: Grand-prize winner: • Wade Lambright of Harrisburg Middle School in Harrisburg won a Walmart gift card toward the purchase of a bike.

Runners-up prize winners (fitness-related gift bags and gift cards): • Dalton Parnell of Lamar High School in Lamar, • Alexis Whitten of Watson Chapel Junior High FBLA in Pine Bluff, and • Jonah Hyman of HAAS Hall Academy in Fayetteville.

Arkansas Blue Cross joins new state payment initiative Arkansas Blue Cross and Blue Shield and QualChoice have joined with Arkansas Medicaid to create the Arkansas Health Care Payment Improvement Initiative (AHCPII), which will transform the state’s payment system for doctors, hospitals and other medical facilities and put Arkansas on the leading edge of national efforts to improve health care quality and cost efficiency.

Under our current payment system medical providers are paid for each activity, regardless of value. The system is called “fee for service.” For every medical service provided, the doctor or hospital receives a pre-determined fee. There are many drawbacks to this system. For example, doctors are not motivated to coordinate patient care. You may go to your primary care doctor (PCP) and have an imaging study. Your PCP may refer you to a specialist who repeats the imaging study because he is unaware that it was previously conducted.

With the AHCPII model, health care providers are paid based on an agreed upon set of standards for the episode of care. Based on the cost of the provider’s care compared to pre-determined cost targets, they either will share in savings created, break even, or owe back money share in excess cost with to payers. By providing necessary evidence-based, high

quality, and cost-effective care and better coordinating care across a patient’s providers care team, they can actually increase their net profit payment from the plan while saving money overall. This initiative was developed with input from physician associations, hospital executives, clinicians, patients, advocacy groups and the Center for Medicare & Medicaid Services (CMS). AHCPII is not a requirement of the federal health care reform legislation, but rather a state-based initiative.

During the first phase of the new payment initiative, which began July 1, six episodes of care will be monitored.

Participation in the initiative within the six episodes will vary. Arkansas Blue Cross will participate in the new payment initiative within the episodes with an asterisk (*): • Hip and knee replacements* • Congestive heart failure* • Pregnancy* • Developmental disabilities • Upper respiratory infections • Attention-deficit/ hyper-activity disorder

During the first three to six months of the initiative, doctors and hospitals will have access to reports designed to help them understand their current practice patterns and the financial and quality outcomes they generate.

Information for those reports will be pulled from existing claims data and from a limited set of data that providers will enter into a provider portal for some of the episodes.

Arkansas Blue Cross will work with doctors and hospitals to identify ways to improve the new payment method.

After the introductory period, reimbursement changes will be implemented by the insurance companies and Arkansas Medicaid. The intent is to develop a common method for reimbursement but not to implement a common level of reimbursement.

We are all paying the price of an uncoordinated delivery system. It is essential that Arkansas Blue Cross take the lead in building a new model that will serve our members and provide the kind of high-quality, affordable care you deserve.

Source: healthcare.gov/news/factsheets/2011/09/primary-care09282011a.html

Blue & You AUTUMN 2012 23

P. Allen Smith is an awardwinning designer, gardening and lifestyle expert. Arkansas Blue Cross and Blue Shield is honored to have him as a contributor to Blue & You magazine.

Even though I am still harvesting tomatoes by and squash, it is time to start thinking about len planting my cool season favorites.

P. Al th Smi I grow certain cool season vegetables from seeds, like arugula, spinach, and various types of lettuce that germinate easily and mature quickly. Others like broccoli, cabbage, kale and days to maturity for the vegetable. Count back the collards are better started from transplants. number of days from the first average frost date and add a week or so to allow for a few extra days to If you are starting from seeds it is important harvest the mature produce. to account for the number of days it will take for a plant to mature versus the first below-freezing Another thing to keep in mind when planting fall temperatures of the season. vegetables is that the seedlings require plenty of moisture. Keep them well watered until fall rains begin.

The average date of the first killing frost in your Many of the leafy vegetables such as spinach and kale area is the most important thing to know when it are heavy feeders, so be generous with fertilizer. comes to fall vegetable gardening. To determine when to start planting, find out the number of

Plants for Your Fall Vegetable Garden Broccoli - Mulch to help keep the ground cool and moist. Feed the plants three weeks after transplanting. I blanche any extras, then freeze for eating in the winter.

Broccoli is high in vitamin C, high in folate, a good source of dietary fiber and a good source of potassium.

make my mouth water as I think about fresh cabbage. Cabbage comes in a number of varieties, but all are rich in vitamins C and E. They also contain vitamins A, B1, B2, B6, K and folic acid as well as the minerals calcium, sulfur, iron, magnesium, phosphorous and potassium.

Brussels Sprouts – Set the plants out in mid-summer. It will take about three months before the sprouts appear. Harvest when they are firm and green. Great roasted in the oven with sea salt and olive oil. Brussels sprouts are high in vitamin C and a good source of folate.

Cauliflower – Fluctuations in temperature, moisture and nutrients can cause the plant to “button,” or produce small, undersized heads. Blanch the heads by tying the outer leaves together over the heads when they are about 2 to 3 inches across.

Great when florets are roasted with olive oil and garlic in the oven!

Cauliflower is high in vitamin C and a good source of folate.

Cabbage – Heavy feeders that require fertile soil rich in organic matter and consistent moisture. I have several cole slaw recipes that

24 Blue & You

AUTUMN 2012

Kohlrabi - Shade young plants from summer sun. Delicious in stir-fry. Kohlrabi is an excellent source of vitamin C and a good source of fiber.

Lettuce – Sow seeds in late summer. Provide the seedlings with consistent moisture and shade from the afternoon sun. Clip outer leaves first for salads on the leaf and looseleaf varieties. They will produce for as long as temperatures remain cool! Lettuce is high in vitamin A and a good source of folate.

Mustard Greens – Keep the soil consistently moist to encourage rapid growth and tender greens.

I love them sautéed with chard, olive oil and garlic! Mustard greens are an excellent source of vitamin A, C and K, folate and manganese.

Annual Notice

Radish – Quick to mature, sow seeds 4 weeks before the first frost. Sow evenly so you don’t have to thin them. No feeding necessary, but soil should be fertile and well drained. Radishes are delicious sautéed in a honey glaze.

Radishes are high in vitamin C. Rutabaga – Wait to sow seeds until night time temperatures are consistently around 50 to 60 F. Keep the soil moist to prevent roots from forking. Simply toss with sea salt, pepper, olive oil and apple cider vinegar then roast. Amazing!

Rutabaga is an excellent source of vitamin C. Spinach – An established spinach crop will last well into winter and can survive temperatures down into the 20s.

Spinach prefers very fertile soil to encourage rapid growth and tender leaves. Add strawberries and a vinaigrette and there’s dinner! Spinach is an excellent source of fiber, vitamins A and C; high in iron, high in folate and a good source of magnesium.

Good to Know Root vegetables are the “storage bin” for a plant’s nutrients and are health-promoting powerhouses.

They are an excellent source of complex carbohydrates, fiber, potassium and antioxidants.

Potatoes are among the highest in potassium of any fruit or vegetable commonly eaten in this country, while orange root vegetables like carrots and sweet potatoes are an excellent source of beta-carotene.

2013 Summary of Benefits and Coverage – available November 15 for individual/family policy holders As required by the Patient Protection and Affordable Care Act (PPACA), the Summary of Benefits and Coverage (SBC) (OMB Control Numbers 1545-2229, 1210-0147 and 0938-1146) provides information regarding coverage specifications and limitations that apply to the health insurance plan you have selected.

Before the end of each year, Arkansas Blue Cross and Blue Shield provides members who are under age 65 and have individual/family health insurance policies* with an SBC. This official communication includes information about the coverage provided by your health insurance plan in a summary format for the upcoming year.

Beginning Nov. 15, 2012, you may access this information: • Online in the “Benefits” section of the Arkansas Blue Cross secure member self-service center, My Blueprint, at arkansasbluecross.com • By calling Arkansas Blue Cross Customer Service at 1-800-238-8379 to receive a printed version After that date, you also may log on to arkansasbluecross.com/sbc and enter your member number (found on your Member ID card) into the SBC locator tool to review the document online and print it.

If you make changes to your Arkansas Blue Cross health plan benefits that differ from your current coverage, a new SBC will be created for you within seven work days of our receipt of your change request. It will be available to you in the same manner described above. *These are members who do not have health insurance through an employer, a Medicare health plan, or Short-Term Blue product.

Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas members who receive health coverage through an employer group will get their SBC from their employer group plan administrator at the appropriate time.

Blue & You AUTUMN 2012 25

P. Allen Smith is an awardwinning designer, gardening and lifestyle expert. Arkansas Blue Cross and Blue Shield is honored to have him as a contributor to Blue & You magazine.

Even though I am still harvesting tomatoes by and squash, it is time to start thinking about len planting my cool season favorites.

P. Al th Smi I grow certain cool season vegetables from seeds, like arugula, spinach, and various types of lettuce that germinate easily and mature quickly. Others like broccoli, cabbage, kale and days to maturity for the vegetable. Count back the collards are better started from transplants. number of days from the first average frost date and add a week or so to allow for a few extra days to If you are starting from seeds it is important harvest the mature produce. to account for the number of days it will take for a plant to mature versus the first below-freezing Another thing to keep in mind when planting fall temperatures of the season. vegetables is that the seedlings require plenty of moisture. Keep them well watered until fall rains begin.

The average date of the first killing frost in your Many of the leafy vegetables such as spinach and kale area is the most important thing to know when it are heavy feeders, so be generous with fertilizer. comes to fall vegetable gardening. To determine when to start planting, find out the number of

Plants for Your Fall Vegetable Garden Broccoli - Mulch to help keep the ground cool and moist. Feed the plants three weeks after transplanting. I blanche any extras, then freeze for eating in the winter.

Broccoli is high in vitamin C, high in folate, a good source of dietary fiber and a good source of potassium.

make my mouth water as I think about fresh cabbage. Cabbage comes in a number of varieties, but all are rich in vitamins C and E. They also contain vitamins A, B1, B2, B6, K and folic acid as well as the minerals calcium, sulfur, iron, magnesium, phosphorous and potassium.

Brussels Sprouts – Set the plants out in mid-summer. It will take about three months before the sprouts appear. Harvest when they are firm and green. Great roasted in the oven with sea salt and olive oil. Brussels sprouts are high in vitamin C and a good source of folate.

Cauliflower – Fluctuations in temperature, moisture and nutrients can cause the plant to “button,” or produce small, undersized heads. Blanch the heads by tying the outer leaves together over the heads when they are about 2 to 3 inches across.

Great when florets are roasted with olive oil and garlic in the oven!

Cauliflower is high in vitamin C and a good source of folate.

Cabbage – Heavy feeders that require fertile soil rich in organic matter and consistent moisture. I have several cole slaw recipes that

24 Blue & You

AUTUMN 2012

Kohlrabi - Shade young plants from summer sun. Delicious in stir-fry. Kohlrabi is an excellent source of vitamin C and a good source of fiber.

Lettuce – Sow seeds in late summer. Provide the seedlings with consistent moisture and shade from the afternoon sun. Clip outer leaves first for salads on the leaf and looseleaf varieties. They will produce for as long as temperatures remain cool! Lettuce is high in vitamin A and a good source of folate.

Mustard Greens – Keep the soil consistently moist to encourage rapid growth and tender greens.

I love them sautéed with chard, olive oil and garlic! Mustard greens are an excellent source of vitamin A, C and K, folate and manganese.

Annual Notice

Radish – Quick to mature, sow seeds 4 weeks before the first frost. Sow evenly so you don’t have to thin them. No feeding necessary, but soil should be fertile and well drained. Radishes are delicious sautéed in a honey glaze.

Radishes are high in vitamin C. Rutabaga – Wait to sow seeds until night time temperatures are consistently around 50 to 60 F. Keep the soil moist to prevent roots from forking. Simply toss with sea salt, pepper, olive oil and apple cider vinegar then roast. Amazing!

Rutabaga is an excellent source of vitamin C. Spinach – An established spinach crop will last well into winter and can survive temperatures down into the 20s.

Spinach prefers very fertile soil to encourage rapid growth and tender leaves. Add strawberries and a vinaigrette and there’s dinner! Spinach is an excellent source of fiber, vitamins A and C; high in iron, high in folate and a good source of magnesium.

Good to Know Root vegetables are the “storage bin” for a plant’s nutrients and are health-promoting powerhouses.

They are an excellent source of complex carbohydrates, fiber, potassium and antioxidants.

Potatoes are among the highest in potassium of any fruit or vegetable commonly eaten in this country, while orange root vegetables like carrots and sweet potatoes are an excellent source of beta-carotene.

2013 Summary of Benefits and Coverage – available November 15 for individual/family policy holders As required by the Patient Protection and Affordable Care Act (PPACA), the Summary of Benefits and Coverage (SBC) (OMB Control Numbers 1545-2229, 1210-0147 and 0938-1146) provides information regarding coverage specifications and limitations that apply to the health insurance plan you have selected.

Before the end of each year, Arkansas Blue Cross and Blue Shield provides members who are under age 65 and have individual/family health insurance policies* with an SBC. This official communication includes information about the coverage provided by your health insurance plan in a summary format for the upcoming year.

Beginning Nov. 15, 2012, you may access this information: • Online in the “Benefits” section of the Arkansas Blue Cross secure member self-service center, My Blueprint, at arkansasbluecross.com • By calling Arkansas Blue Cross Customer Service at 1-800-238-8379 to receive a printed version After that date, you also may log on to arkansasbluecross.com/sbc and enter your member number (found on your Member ID card) into the SBC locator tool to review the document online and print it.

If you make changes to your Arkansas Blue Cross health plan benefits that differ from your current coverage, a new SBC will be created for you within seven work days of our receipt of your change request. It will be available to you in the same manner described above. *These are members who do not have health insurance through an employer, a Medicare health plan, or Short-Term Blue product.

Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas members who receive health coverage through an employer group will get their SBC from their employer group plan administrator at the appropriate time.

Blue & You AUTUMN 2012 25

Women’s Preventive Services In order to comply with the new health care reform law (PPACA or the Patient Protection and Affordable Care Act), Women’s Preventive Services will be added to many health plans.

On August 1, 2012, the change will be made to certain employer-sponsored health insurance plans. The change will take place on January 1, 2013, for certain individual health plans.

What are PPACA preventive services?

PPACA preventive services, unlike our traditional preventive services, are covered under the employer’s plan at 100 percent with no member responsibility (e.g., no copayment, coinsurance or deductible when delivered by a network provider). Effective August 1, these benefits include Women’s Preventive Services.

What are Women’s Preventive Services?

The additional Women’s Preventive Services that will be covered without copayments, coinsurance or deductibles on applicable group policies are as follows: • Well-woman visits: An annual well-woman preventive care visit for adult women to obtain the recommended preventive services, along with additional visits if the woman and her doctor determine they are necessary.

• Gestational diabetes screening: For women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes.

• HPV DNA Testing: Women who are 30 years of age or older will have access to high-risk human papillomavirus (HPV) DNA testing every three years, regardless of pap smear results.

26 Blue & You

AUTUMN 2012

Women’s Health and Cancer Rights Act The Women’s Health and Cancer Rights Act of 1998 introduced changes in insurance coverage for a mastectomy.

In accordance with the law, all group and individual health plans that provide medical and surgical benefits for a mastectomy will cover reconstructive breast surgery, including: • Reconstructive surgery on the breast on which the mastectomy was performed.

• STI counseling, and HIV screening and counseling: Sexually active women will have access to annual counseling on HIV and sexually transmitted infections (STIs).

• Contraceptives and contraception counseling: Coverage of prescription contraceptives on the drug list (brand-name contraceptives may have a copayment if a generic is available without a copayment); patient education and counseling; and Plan B (known as the morning-after pill) when prescribed for members under age 18.

Any drugs used to cause abortion (e.g., RU 486) are not covered. Over-the-counter birth control methods, even if prescribed by a doctor, are not covered.

• Breastfeeding support, supplies and counseling: Pregnant and postpartum women will have coverage for lactation counseling from applicable health care providers. Manual breast pumps are covered; electric breast pumps and supplies are not covered. NOTE: Pregnancy services including prenatal, delivery and postnatal care are subject to member copayments, deductibles and coinsurance.

• Domestic violence screening: Screening and counseling for interpersonal and domestic violence will be covered for all women.

• 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 an Arkansas Blue Cross office near you. We’d love to hear from you!

We Love to Hear From You! May we help? For customer service, please call: Little Rock Number (501)

Toll-free Number

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 1-800-863-5561 Specialty Rx pharmacy questions 1-866-295-2779 Health Advantage members 378-2363 1-800-843-1329 Pharmacy questions 1-800-863-5567 BlueAdvantage members 378-3600 1-888-872-2531 Pharmacy questions 1-888-293-3748 Federal Employee members 378-2531 1-800-482-6655 Looking for health or dental insurance? We can help!

For individuals, families

378-2937

1-800-392-2583

For employer groups*

378-3070

1-800-421-1112

*Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas

Prefer to speak with someone close to home?

Call or visit one of our offices near you:

ArkansasBlue — Little Rock 2612 S. Shackleford Rd. — Suite J

501-378-2222

Fayetteville 516 East Millsap Rd. — Suite 103

1-800-817-7726

Fort Smith 3501 Old Greenwood Rd. — Suite 5

1-866-254-9117

Hot Springs 100 Greenwood Ave. — Suite C

1-800-588-5733

Jonesboro 707 East Matthews Ave. 1-800-299-4124 Little Rock 601 Gaines Street 1-800-421-1112 Pine Bluff 1800 West 73rd St. 1-800-236-0369 Texarkana 1710 Arkansas Boulevard

1-800-470-9621

Visit our Web sites for more information: arkansasbluecross.com • healthadvantage-hmo.com blueadvantagearkansas.com • blueandyoufoundationarkansas.org

Blue & You AUTUMN 2012 27

Women’s Preventive Services In order to comply with the new health care reform law (PPACA or the Patient Protection and Affordable Care Act), Women’s Preventive Services will be added to many health plans.

On August 1, 2012, the change will be made to certain employer-sponsored health insurance plans. The change will take place on January 1, 2013, for certain individual health plans.

What are PPACA preventive services?

PPACA preventive services, unlike our traditional preventive services, are covered under the employer’s plan at 100 percent with no member responsibility (e.g., no copayment, coinsurance or deductible when delivered by a network provider). Effective August 1, these benefits include Women’s Preventive Services.

What are Women’s Preventive Services?

The additional Women’s Preventive Services that will be covered without copayments, coinsurance or deductibles on applicable group policies are as follows: • Well-woman visits: An annual well-woman preventive care visit for adult women to obtain the recommended preventive services, along with additional visits if the woman and her doctor determine they are necessary.

• Gestational diabetes screening: For women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes.

• HPV DNA Testing: Women who are 30 years of age or older will have access to high-risk human papillomavirus (HPV) DNA testing every three years, regardless of pap smear results.

26 Blue & You

AUTUMN 2012

Women’s Health and Cancer Rights Act The Women’s Health and Cancer Rights Act of 1998 introduced changes in insurance coverage for a mastectomy.

In accordance with the law, all group and individual health plans that provide medical and surgical benefits for a mastectomy will cover reconstructive breast surgery, including: • Reconstructive surgery on the breast on which the mastectomy was performed.

• STI counseling, and HIV screening and counseling: Sexually active women will have access to annual counseling on HIV and sexually transmitted infections (STIs).

• Contraceptives and contraception counseling: Coverage of prescription contraceptives on the drug list (brand-name contraceptives may have a copayment if a generic is available without a copayment); patient education and counseling; and Plan B (known as the morning-after pill) when prescribed for members under age 18.

Any drugs used to cause abortion (e.g., RU 486) are not covered. Over-the-counter birth control methods, even if prescribed by a doctor, are not covered.

• Breastfeeding support, supplies and counseling: Pregnant and postpartum women will have coverage for lactation counseling from applicable health care providers. Manual breast pumps are covered; electric breast pumps and supplies are not covered. NOTE: Pregnancy services including prenatal, delivery and postnatal care are subject to member copayments, deductibles and coinsurance.

• Domestic violence screening: Screening and counseling for interpersonal and domestic violence will be covered for all women.

• 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 an Arkansas Blue Cross office near you. We’d love to hear from you!

We Love to Hear From You! May we help? For customer service, please call: Little Rock Number (501)

Toll-free Number

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 1-800-863-5561 Specialty Rx pharmacy questions 1-866-295-2779 Health Advantage members 378-2363 1-800-843-1329 Pharmacy questions 1-800-863-5567 BlueAdvantage members 378-3600 1-888-872-2531 Pharmacy questions 1-888-293-3748 Federal Employee members 378-2531 1-800-482-6655 Looking for health or dental insurance? We can help!

For individuals, families

378-2937

1-800-392-2583

For employer groups*

378-3070

1-800-421-1112

*Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas

Prefer to speak with someone close to home?

Call or visit one of our offices near you:

ArkansasBlue — Little Rock 2612 S. Shackleford Rd. — Suite J

501-378-2222

Fayetteville 516 East Millsap Rd. — Suite 103

1-800-817-7726

Fort Smith 3501 Old Greenwood Rd. — Suite 5

1-866-254-9117

Hot Springs 100 Greenwood Ave. — Suite C

1-800-588-5733

Jonesboro 707 East Matthews Ave. 1-800-299-4124 Little Rock 601 Gaines Street 1-800-421-1112 Pine Bluff 1800 West 73rd St. 1-800-236-0369 Texarkana 1710 Arkansas Boulevard

1-800-470-9621

Visit our Web sites for more information: arkansasbluecross.com • healthadvantage-hmo.com blueadvantagearkansas.com • blueandyoufoundationarkansas.org

Blue & You AUTUMN 2012 27

good for you events and activities saturday, october 20 Join Arkansas Blue Cross’ BlueCares Team for the Komen for a Cure walk. Our team will be handing out goodies to walkers. We look forward to supporting finding a cure for breast cancer with Central Arkansans.

saturday, december 1 City Mouse, Country Mouse, Christmas House! Arkansas Blue Cross is hosting a special showing of City Mouse, Country Mouse, Christmas House at the Arkansas Arts Center. Round up the family and enjoy a FREE night of the arts. Tickets can be picked up at ArkansasBlue, located in the Shackleford Crossing shopping center, while supplies last. Check our Web site for details.

Bringing doctors to rural Arkansas

spring 2013 saturday, november 10 Get ready for a happy, healthy

holiday season with P. Allen Smith!

Join us at the ArkansasBlue insurance store, from 9 a.m. to 1 p.m. for healthy food growing and cooking demonstrations, and activities with SilverSneakers®* instructors. *SilverSneakers® is a registered mark of Healthways, Inc. The SIlverSneakers® Fitness Program is provided by Healthways, Inc., Healthways is an independent company that operates separately from Arkansas Blue Cross and Blue Shield.

MPI 1129 9/12

Although spring is months away, now is the time to plan for the Blue & You Fitness Challenge. Start forming your team or group and plan to register for the 2013 Challenge.

The Blue & You Fitness Challenge is an exercise contest (March 1 – May 31) that encourages participants to work toward the public health recommendation of adult physical activity 30 minutes each day, most days of the week.

For more information, call toll free 1-800-686-2609, or visit blueandyoufitnesschallenge-ark.com.

Meet the first Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients ... page 4

Clinics chosen for federal initiative page 6

Health Care Reform update page 8

Teen drivers are safer now page 20