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03/23/11

  06:12:18 pm, by MedBen5   , 321 words,  
Categories: News, Wellness, Health Plan Management

MedBen Wellness Partner Named Award Finalist

AWAC, a MedBen partner in the administration of iHealth Worksite Wellness and cost containment services, has been named a Finalist in the categories of Wellness/Prevention and Overall Case Management in the second annual Case In Point Platinum Awards. This is the second time that AWAC has received Finalist status.

The Case In Point Platinum Awards, sponsored by publisher Dorland Health, recognizes the most successful and innovative care management programs working to improve health care across the care continuum. The program allows medical management and care coordination programs of all sizes to share the important work they are doing to ensure each patient receives safe, quality, cost-effective care. The awards will be bestowed during a luncheon on May 10, 2011 at The National Press Club in Washington, DC.

“The Wellness/Prevention category, which recognizes the best program for ensuring members understand their specific risks and the prevention strategies to improve health and wellness, was a perfect fit for the AWAC iHealth Program,” said Debbie Tanner, RN, Vice President of Nursing Services at AWAC. “iHealth focuses on educating members about positive lifestyle change and appropriate wellness and prevention testing, as well as providing Chronic disease management through interventional nurse coaching. We are gratified to be recognized for our unique approach to wellness and prevention.”

The success of AWAC’s Case Management program is attributed to the proactive nature in which each case is pursued. Through the early detection and continuous monitoring capabilities of the AWAC claims surveillance system, the AWAC multidisciplinary team approach and the vast array of integrated resources available to our case management nurses, the AWAC team is able to conduct in-depth assessments of the case, often times addressing much more than the presenting diagnosis and ultimately staying ahead of serious cost and care issues.

For additional information about MedBen worksite wellness and claims surveillance services offered in conjunction with AWAC, please call Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.

  05:34:33 pm, by MedBen5   , 245 words,  
Categories: News, Wellness

More American Smokers Kicking The Habit

If you’ve noticed less cigarette butts getting tossed out of passing cars these days, there’s a good reason for it – heavy smoking is on the downturn, a new study finds.

HealthDay News (via MedicineNet.com) reports that the number of people who smoke a pack of cigarettes or more a day have dropped significantly – from 56% of all U.S. smokers in 1965 to a mere 7.2% in 2007. People who smoke 10-19 cigarettes have also decreased in number, from 10.5% to 5.4% over the same period.

Lead researcher John Pierce of the University of California San Diego says the drop is attributable to more people dropping the habit altogether, as well as less people picking it up. “This decline has not been accompanied by higher rates of lower-intensity smoking,” This decline in intensity of smoking has come about by a major change in the number of young people who have taken up even a half-pack per day habit,” Pierce said.

In other smoking news, the Food and Drug Administation may consider a ban on adding menthol to cigarettes, according to The New York Times. The agency’s Tobacco Products Scientific Advisory Committee said that the mint-flavored smokes make it easier to start the habit and harder to quit.

Menthol cigarettes are especially attractive to African-Americans – more than 80% of black smokers prefer methol – and teenagers. This may be due in part to the misconception that such cigarettes are healthier than their non-menthol counterparts, the FDA Advisory Committee suggests.

03/21/11

  05:44:41 pm, by MedBen5   , 335 words,  
Categories: News, Health Plan Management

Federal Government Extends Grace Period For Appeals Procedures Implementation

The Department of Labor (DOL) has extended the enforcement grace period for implementation of new appeals procedures under the Affordable Care Act (ACA), according to a DOL technical release (which you can read here).

The date for non-grandfathered plans to comply with the ACA appeals requirements has changed from July 1, 2011 to January 1, 2012. The DOL release explains that the grace period has been extended “to give [the Departments of Labor, Health & Human Services, and Treasury] time to publish new regulations necessary or appropriate to implement the internal claims and appeals provisions of PHS Act section 2719(a).” The additional time will also allow MedBen and other third party administrators to update their processes and educate clients about the new compliance requirements.

Standards affected by the extension include:

  • The reduction in the timeframe for making urgent care claims decisions
  • The requirement that the notice of adverse benefit determination be provided in a culturally and linguistically appropriate manner
  • Requiring broader context and specificity in such notices
  • Removal of the provision that allowed a plan to deviate from the specific provisions if they were in “substantial compliance”

Please note that while the most time-intensive standards do not take effect until 2012, other appeals standards will still be implemented as scheduled. Enforcement of the following will take effect on a rolling plan year basis, starting on the first day of the plan year beginning on or after July 1, 2011:

  • The disclosure of information sufficient to identify a claim (other than the diagnosis and treatment information);
  • The reasons for an adverse benefit determination;
  • The description of available internal appeals and external review processes; and
  • For plans and issuers in States in which an office of health consumer assistance program or ombudsman is operational, the disclosure of the availability of, and contact information for such a program.

MedBen is currently updating its processes and notices to reflect the ACA appeals provisions. Clients with questions regarding appeals procedures or the grace period extension are welcome to contact Vice President of Compliance Caroline Fraker at (800) 851-0907.

  05:38:38 pm, by MedBen5   , 179 words,  
Categories: News, Wellness

Americans Living Longer Than Ever

Despite myriad studies and media profiles concluding that Americans are a generally unhealthy group, there is some positive news out there: Life expectancy is on the upswing, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics.

USA Today reports that life expectancy at birth stands at 78.2 years as of 2009, a slight bump from 78 years in 2008. “What this means is that somebody born in 2009 can expect to live to an average of 78.2 years. This is a new record high for life expectancy,” says Kenneth Kochanek, a statistician with the National Center for Health Statistics.

White females have the highest life expectancy at 80.6 years. For black females, life expectancy is 77.4 years; white males 75.7 years; and black males, 70.9 years.

Equally good news is that death rates for such chronic conditions as heart disease, cancer and stroke declined from 2008 to 2009. As we noted in the previous blog entry, cancer survivors are also living for longer periods of time.

Age-adjusted death rates have fallen every year for the past decade. The 2009 rate was 741 deaths per 100,000 – an all-time low.

03/18/11

  05:22:12 pm, by MedBen5   , 170 words,  
Categories: News, Wellness

U.S. Cancer Survivor Population Continues To Grow

Early detection of the disease is among the reasons that the number of cancer survivors has increased over the past several decades, according to a report released by the Centers for Disease Control and Prevention and the National Cancer Institute.

The ACP Internist website reports that in 2007, nearly 12 million people in the U.S. were cancer survivors. That compared to 3 million survivors in 1971 and 9.8 million in 2001. Moreover, 40% of survivors have outlived their diagnoses for 10 years or more.

In addition to early detection, researchers attribute the increase to greater overall longevity, improved diagnostic methods and more effective treatment.

MedBen Worksite Wellness emphasizes early detection of chronic conditions such as cancer, diabetes and heart disease, as well as regular preventive care to reduce the risk of such conditions from developing in the first place. By focusing on both detection and prevention, employers benefits from a healthier workplace and reduced health care costs.

To learn more about MedBen’s wellness program, please call Vice President of Sales and Marketing Brian Fargus at 888-627-8683.

  04:35:59 pm, by MedBen5   , 176 words,  
Categories: News, Wellness

Man's Best Friend Makes A Good Workout Companion, Too

Dogs are great to have around the house for any number of reasons. Companionship. Security. Rubber ball retrieval. And several studies suggest you can add personal trainer to the list.

The New York Times reports that Michigan State University researchers found that 60% of dog owners who took Fido for regular walks did so at a pace consistent with moderate or vigorous exercise. Nearly half of dog walkers exercised an average of 30 minutes a day at least five days a week. By comparison, only about a third of people without dogs got as much regular exercise.

Dog walkers are also apparently more health-conscious overall – the research team also discovered that, on average, they exercise about 30 minutes more weekly than non-dog owners.

A University of Missouri study of older adults took a different approach, examining the walking pace of subjects who walked with dogs compared to those who walked with human companions. It turns out pooches make better motivators than people – the walking speed among the dog walkers increased 28%, compared with just 4% among the human walkers.

03/17/11

  05:40:50 pm, by MedBen5   , 186 words,  
Categories: News, Prescription

Brand Name, Generic Drug Costs On Different Trajectories

Here’s the bad news: Brand-name drug costs continue to go up. Here’s the good news: Generic drug costs continue to go down. Our professional advice? Whenever available, go for the generics. (No need for thanks, just doing our jobs.)

Reuters reports (via the Los Angeles Times) that the “usual and customary” price index for the top 100 commonly used drugs – 55 brand-name and 45 generic – increased by an average of 6.6% annually from 2006 through March 2010. By comparison, the consumer price index for medical goods and services rose by an annual average of 3.8% during the same period. But separating the drug by brand name and generic, the former category jumped an average of 8.3% annually, while the latter fell 2.6%.

At MedBen, we dedicate ourselves to keeping prescription costs in check, through superior discount rates for both brand name and generic drugs. And we pass through 100% of negotiated discounts and paid rebates to the client.

Additionally, our RxEOB website is an ideal source for Rx patients looking for lower-cost generic alternatives. To find out more about our pharmacy plans, contact Vice President of Sales and Marketing Brian Fargus at 888-627-8683.

  04:56:11 pm, by MedBen5   , 196 words,  
Categories: Wellness

A "Castle" That's Well Worth A Visit

There’s nothing we enjoy more on this blog than telling you about cool and informative wellness websites, being the cool and informative people that we are. We recently happened upon such a site – HealthCastle.com.

Offering “nutrition advice by registered dieticians", the site is literally packed with nutrition information, diet guidelines and advice (including food suggestions for chronic conditions like cancer and diabetes), meal tips, a calorie calculator, and so on. The phrase “one-stop shop” gets thrown around quite a bit, but looking around HealthCastle.com, we’d be hard pressed to think of anything useful you won’t find in there somewhere.

Probably our favorite feature allows you to compare brand-name foods, ranking them by serving size, fat, protein, carbohydrates, etc. We ran a check of sugar content in one of our breakfast staples, Honey Nut Cheerios, and were dismayed to find out it ranks higher on the bad side of the list than we would’ve ever imagined. (Cap’n Crunch, another favorite, isn’t represented on the list, but we have a sneaking suspicion where that would fall.)

HealthCastle.com is definitely worth a visit – and make sure you leave yourself plenty of time for exploring.

03/16/11

  03:30:40 pm, by MedBen5   , 176 words,  
Categories: News, Health Plan Management

Resolution Puts Reform-Minded Democrats On The Offensive

A flurry of legislation activity by Republican members of Congress have put Democrats on their heels a bit this year. But a new amendment suggests that Democrats may have finally realized that the best defense is a good offense.

The Hill website reports that several House Democrats have backed a resolution that would require members of Congress to publicly disclose whether they receive health insurance through the Federal Employees Health Benefits Program. The purpose for this otherwise inconsequential action? To paint Republicans who oppose the Affordable Care Act as hypocrites for accepting government-subsized health benefits.

“As Republicans continue their efforts to repeal and defund the health care law, the public has a right to know if members who are trying to take away the American people’s access to high-quality, affordable health insurance are, in turn, taking taxpayer-subsidized health benefits for themselves,” Reps. Joseph Crowley (N.Y.), Donna Edwards (Md.), Tim Ryan (Ohio) and Linda Sanchez (Calif.) wrote.

According to The Hill article, only about a dozen of the 87 House freshmen have declined congressional health insurance.

  01:54:42 pm, by MedBen5   , 177 words,  
Categories: News, Wellness

Getting Fish-Eyed (In A Good Way)

Apparently, fish oil advocates have hired a dynamic new publicist. After several recent studies challenged the virtues of Omega-3 fatty acids, earlier this month we learned that supplements may aid chemotherapy patients. And right on the heels of that comes news that Omega-3s may also help to prevent the onset of age-related macular degeneration.

NPR reports that a study of nearly 40,000 women found that women who ate fish at least once a week decreased their risk of getting the disease – a major contributor to vision loss – compared to those who ate fish just once a month. Earlier studies have shown that that Omega-3s slowed progression of the disease, but this is the first time researchers have concluded that fish may actually stop it before it develops.

The article notes that this was an observational study – and as we posted here just a couple days ago, findings from such research should hardly be taken as gospel. That said, there’s probably no harm in upping your fishy consumption if you’re all about better eyesight.

03/14/11

  09:53:18 pm, by MedBen5   , 292 words,  
Categories: News, Health Plan Management

Health Reform Simmers While Congress Shifts Focus

There hasn’t been much talk of health care reform on Capitol Hill these days as other issues have taken priority. But there’s still a couple of rather important matters bubbling under the surface, so just to keep you up to speed…

  • Last month, the House of Representatives passed an amendment that would eliminate funding for the Affordable Care Act from this year’s federal budget. The Senate has yet to vote on the budget, and party disagreements about various other cuts has put the issue on the back burner for the moment. In the interim, Congress has approved two stop-gap bills to keep the federal government running, neither of which have referenced the ACA or health care reform provisions. The latest three-week stop-gap measure proposed by the House continues the trend, to the chagrin of some of the more conservative Representatives.

    Read more about the Congressional goings-on at Politico.

  • One aspect of the ACA that appears to be on its way out is the 1099 reporting requirement, which would have required businesses to report to the IRS each purchase of goods and services from vendors of more than $600. But even though both the Senate and the House have agreed to eliminate the provision, the question remains as to how Congress will make up for the estimated $22 billion shortfall that its removal will cause.

    According to The Hill website, the House 1009 repeal measure would “requires taxpayers who receive federal health insurance subsidies to reimburse the IRS with substantial penalties if they earn more than expected, especially after qualifying for the subsidy.” House Democrats oppose the requirement, while Republicans argue that taxpayers should have to return the subsidy if they don’t need it. Surprisingly, Senate Majority Leader Harry Reid (D-Nev.) backs the House pay-for as well.

  04:47:54 pm, by MedBen5   , 325 words,  
Categories: Wellness

Coffee Study Coverage Raises Blogger's Ire

Coffee may reduce the risk of a stroke. And then again, it may not.

WebMD reports that new research in the journal Stroke – yes, there’s apparently a journal called Stroke – that women who drink at least one cup of coffee daily may lower their odds of a stroke by 22-25% compared to women who drank less coffee. The study’s authors aren’t sure why coffee apparently reduced risk, but speculate that coffee may reduce inflammation and help make the body more responsive to insulin.

So should women stock up on Maxwell House? Not so fast, says health care journalist Gary Schwitzer. On his HealthNewsReview blog, he criticizes media coverage of the findings, which were based purely on observational research. Even though the data was collected from over 34,000 women, Schwitzer stresses that the limited nature of the study makes its conclusions questionable at best. (And it’s worth mentioning that another recent study linked coffee to a higher stroke risk.)

“Observational studies have inherent limitations that should always be mentioned in stories,” Schwitzer writes. “They can show a strong statistical association, but they can’t prove cause and effect. So you can’t prove benefit or risk reduction.”

Schwitzer goes on to take the WebMD article to task, saying it was “just plain inaccurate” to claim that “1 or More Cups of Coffee a Day Reduces Stroke Risk in Women.” Conversely, he commends HealthDay’s story about the study, which emphasizes that the researchers simply asked subjects about their past coffee consumption in a questionnaire without determining if their behavior changed over time, or controlling for medication use or other health factors.

The lesson we can learn from this is that just because a news article uses language that sounds definitive, that may not necessarily be the case. An association between coffee and strokes, be it positive or negative, doesn’t prove causality. So if you’re not a java junkie, don’t feel like you have to pick up the habit now.

03/11/11

  05:44:46 pm, by MedBen5   , 191 words,  
Categories: News, Prescription, Health Plan Management

OTC Reform Provision Irritates Consumers, Inconveniences Doctors

A Wall Street Journal article examines some of the less desirous effects of health care reform. The piece focuses on the fallout from the Affordable Care Act provision that excludes over-the-counter drugs as an approved flexible spending account purchase unless the buyer has a prescription, a provision that took effect on January 1. Not surprisingly, prescription requests from FSA participants have spiked since then, adding another task to doctors’ crowded “to-do” lists.

Dr. Sandy Chung, a pediatrician, says the new rule “drives up the cost of health care as opposed to reducing it.” In addition to the extra paperwork, there’s a legal consideration – a doctor who prescribes an OTC medication over the phone could be held responsible if the patient has a negative reaction to it. Further, the provision increases the workload of pharmacists and retailers, who have to apply personalized labels onto the products.

The ACA has experienced growing pains in other areas as well. High-risk insurance pools have been a particular disappointment, with enrollment running at only 6% of expectations. And the provision requiring coverage to children with pre-existing conditions has led some insurers to drop their child-only policies altogether.

  04:37:49 pm, by MedBen5   , 126 words,  
Categories: Wellness

Set Clocks Forward, Get To Bed Earlier

Is there any single day of the year people hate more than the one where we move our clocks ahead one hour? Something about the loss of those 60 minutes really brings out our collective surly side.

Well, don’t look now, but Daylight Savings Time begins this Sunday. But rather than curse the darkness (or the light, as it were), make the best of it by laying some groundwork… specifically, by getting a little extra rest beforehand.

Speaking to HealthDay, sleep disorder specialist Dr. Aparajitha Verma recommends getting up and going to bed an hour earlier beginning several days before the time change. Alternately, take a nap on Sunday afternoon if you feel the need, but avoid doing so within a few hours of your regular bedtime.

  10:50:28 am, by MedBen5   , 191 words,  
Categories: News, Wellness

Video Games Now Cool AND Healthy!

Should parents encourage their kids to play video games? Absolutely – so long as the games offer a opportunity for better health, a new study finds.

WebMD reports that University of Massachusetts researchers monitored the metabolic rates of children playing “exergames", which require the users to move the upper or whole body to mimic dance moves or participate in a variety of virtual sports, for 10 minutes. They found the activity burned about the same number of calories as walking on a treadmill at three miles per hour – 400% to 800% over their resting metabolic rate.

Kids with higher body-mass indexes, who might be reluctant to participate in group physical activities, were found to enjoy exergames more than children of normal weight. Study researcher Kyle McInnis notes that the games offer “a kind of built-in positive reinforcement.”

But while exergames provide a decent workout, experts recommend that indoor activity be only one part of a health regimen. “These are not a substitute for being outside, riding a bike, being on the soccer field,” says Kevin R. Short, PhD, assistant professor in the department of pediatrics at the University of Oklahoma Health Sciences Center.

03/10/11

  05:55:09 pm, by MedBen5   , 171 words,  
Categories: News, Health Plan Management

Maine Gets Health Care Reform Waiver

There’s a whole lotta waiverin’ going on in the federal government these days. Over 1,000 organizations have been granted waivers that temporarily exclude them from meeting mandated coverage limits since last September. And now a whole state is off the hook from a key provision of the Affordable Care Act.

The Boston Globe reports that Maine does not have to comply with the requirement that insurers spend ar least 80% of their premiums on medical care (85% for large groups). Rather, the Department of Health and Human Services will permit the state to continue its 65% standard for the next three years. Kentucky, Nevada and New Hampshire have made similar waiver requests.

Maine Insurance Superintendent Mila Kofman requested the waiver out of concern that a major insurer – one that covers over a third of the individual policyholders in the state – would withdraw from the market.

Maine premium costs are among the highest in the nation, as insurance companies that do business in the state must approve all applicants and cover their pre-existing conditions.

  03:41:33 pm, by MedBen5   , 266 words,  
Categories: News, Wellness

Palliative Care Eases Suffering While Lowering Costs: Study

Last October on this blog, we noted a study that revealed patients who receive palliative care – which contentrates on relieving the pain and stress of chronic conditions – actually live longer on average than those who get care focused exclusively on extending life. Now another study has determined that palliative care can save money as well.

According to The Wall Street Journal Health Blog, researchers tracked palliative care teams at four New York State hospitals during the years 2004-07. By coordinating the care of seriously ill Medicaid patients, the teams reduced inpatient costs by an average of $6,900 per admission.

While patients suffered from a range of chronic conditions, not every one was at the end of their lives. Palliative care differs from hospice care, which provides physicial comfort and emotional support to the terminally ill. Study co-author R. Sean Morrison says that palliative care “focuses on improving the quality of life for patients living with serious or life-threatening illnesses and their families” while offering “all other disease-directed and life-prolonging treatments.”

The study followed 485 Medicaid patients receiving palliative care. Of those, 296 patients were discharged alive (some to hospice, others to home care) and 189 died in the hospital. Compared to patients who received standard care, the cost difference was $4,098 for the living discharges and $7,563 for those who passed away during their stay. Morrison says that savings came from heeding the wishes of the patients: “Some patients might want to pursue all treatment options, while others want to be comfortable and to minimize symptoms… In the setting of this very complex, very sick population, you’re eliminating misutilization.”

03/08/11

  02:06:26 pm, by MedBen5   , 159 words,  
Categories: News, Health Plan Management

New Website Offers Accessible Approach To Health Reform Law

In an attempt to make the Affordable Care Act (ACA) comprehensible to those of us who don’t speak government-ese, some well-known organizations – AARP, the American Cancer Society, and the American Medical Association among them – have developed the Health Care and You website.

We’ve taken a look around the site and found it to be very user-friendly. In addition to explaining the purpose of the ACA, Health Care and You breaks down the health reform law by state and other factors (i.e., people under age 65, small business owners) so users can see how ACA provisions impact specific populations.

The site also contains a ACA timeline in which the user can select a specific year to learn about future changes, and how the law affects selected groups. All in all, it’s a well-designed resource for anyone looking for intelligble reform information.

The New York Times has a story on the site’s rollout – you can find it here.

  12:13:52 pm, by MedBen5   , 140 words,  
Categories: News

1 in 5 Orthopedic Scans Performed for Defensive Reasons, Study Finds

MedPage Today recently reported on a study in which Pennsylvania orthopedic surgeons acknowledged that nearly 20% of the scans they performed were for purely defensive purposes – representing about 35% of their total imaging cost.

Robert A. Miller, MS, of Temple University in Philadelphia, ran a voluntary audit of members of Pennsylvania’s orthopedics society. The audits were prospective – doctors offered their reasons for the imaging prior to the procedure. A total of 72 orthopedic surgeons participated, and more than 2,000 imaging orders were analyzed.

Of the 19.1% of scans that were performed primarily to avoid potential malpractice suits, 70% were standard X-rays and 25% were MRIs. However, Miller estimated that the MRIs accounted for about 70% of the defensive costs.

The 1-in-5 ratio may not be reflective of defensive medicine in the country as a whole, as Pennsylvania has a high litigation rate compared to other states.

03/07/11

  10:13:07 pm, by MedBen5   , 182 words,  
Categories: Wellness, Health Plan Management

Chronic Condition Costs Highlights Need For Wellness

Spending on Patient-Centered Care Categories, 2007

A paper published in Health Services Research spotlights the cost of chronic medical conditions – and the need for a wellness approach to help control those costs.

As noted on the Healthcare Economist website, health expenditure statistics are commonly broken down by payer (such as Medicare or private insurance) or setting (inpatient or outpatient). The paper’s co-authors instead apply a “patient-centered” grouping to organize health care costs, by focusing on life events of the individual. Using data from the 2007 Medical Expenditure Panel Survey, the co-authors arrange the costs into 7 patient-centered categories.

As the chart shows, chronic conditions account for nearly half of all patient-centered care. When acute illness – which often stems from a chronic condition – is added in, the amount reaches 72.6%.

Improving individual health while managing costs is the essence of MedBen Worksite Wellness. Our program emphasizes early intervention in cancer, diabetes, heart diseases and other chronic conditions, using both primary prevention and specialty care to provide the best results possible.

For additional information about MedBen Worksite Wellness, contact Vice President of Sales and Marketing Brian Fargus at 888-627-8683.

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