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Thursday, March 28, 2013

Survey: Exchanges gain interest among employers, retirees


Health insurance exchanges are gaining favor among employers. Some 60% of those responding to a survey say they are reconsidering health coverage options for their Medicare-eligible retirees and are open to using exchanges. According to the survey, almost 20% of respondents are connected with a private insurance exchange and two-thirds are looking into the use of private exchanges in the future. Business Insurance (tiered subscription model)


Ask about our private health care exchange, Cal Choice and soon the California Exchange.  info@amsinsure.com or get a quote at www.amsminsure.com

800-334-7875

Wednesday, March 27, 2013

Hospital Prices Drive Health Care Costs

 

Inpatient Hospital prices increased 8.2% per year from 2008 to 2010 with wide variation in price levels and growth rates across states and localities. The study published in the March issue of the American Journal of Managed Care (AJMC) was conducted by researchers at America’s Health Insurance Plans (AHIP).
Taking into account the complexity of treatment and the number of procedures performed, the authors estimate that 1.3% to 1.9% of this increase could be attributed to increased intensity per admission. Thus intensity-adjusted price increases ranged from 6.2% to 6.8% annually during this period.
The price for a spinal fusion increased the most (15.2% per year) from 2008 to 2010. That was followed by bronchitis and asthma treatment (10.3% per year) and uterine laparoscopic procedure for non-malignancy (9.8% per year).
A recent report from the Health Care Cost Institute found that despite some increases in utilization, spending growth was driven primarily by increases in the prices paid. Last year, the S&P Healthcare Economic Composite Index showed the average per capita cost of hospital services in the commercial market had increased by nearly 8%.
Data show that increasing provider consolidation is one contributor to rising hospital prices. When hospitals consolidate, merging with other hospitals or buying up physician practices, they have greater negotiating strength and competition is limited. The result is higher prices for services, higher costs for patients, and often no improvement in the quality of care delivered. AHIP recently filed an amicus brief on the affect of hospital consolidation in the Court of Appeals for the Sixth Circuit in support of the Federal Trade Commission (FTC). For more information, visit www.ahip.org.

Americans Are Still in the Dark About Health Reform

 

Americans are not sure how the health reform law will affect them and few are paying attention to state-level decisions about implementation, according to the latest Kaiser Health Tracking Poll.
Though opinion on the law remains nearly evenly divided, opponents’ attacks seem to have taken a toll on the public’s expectations. Americans are now more likely to say the law will make things worse rather than better for their families. While most of the law’s individual provisions remain popular, many of the most well-liked elements are the least well-known among the public. Public knowledge of the ACA’s provisions has not increased since 2010. In fact, awareness of some key provisions has declined since the law’s passage when media attention was at its height.
The public hasn’t been paying much attention to the decisions of state and federal policymakers about Medicaid expansion and health insurance exchanges. Forty-eight percent have hear nothing about their state’s decision on whether to create a state run exchange; 15% have heard some; and 7% have heard a lot about it.
While health care cost growth has slowed in recent years, a majority of the public perceives that the country’s health costs have been going up faster than usual. While health care cost growth continues to outpace inflation, the rate of growth in national health expenditures has slowed markedly in recent years. The public’s perception is quite different, however. Fifty-eight percent say that, the cost of health care for the nation has been going up faster than usual over the past few years.
Thirty-four percent say that their own family’s health care costs have been going up faster than usual while 24% say the costs been going up about the same amount as usual, and 32% say their costs have held steady in recent years. Only 2% say their costs have been going up more slowly than usual or have come down. For more information, visit www.kff.org.

Friday, March 22, 2013

How to help a family member who develops Alzheimer's Disease

 

Question: "Help! My mother has been diagnosed with Alzheimer's Disease and my family and I have no idea how to proceed in helping her. At what point do we consider nursing home care, and how will we afford this, etc?? Please provide us with some guidance as to how we should proceed and what our options may be."
Answer:The first place to start is with your mother’s doctor. He will be in the best position to assess your mother’s need for long-term care. This could be an immediate need or one that will develop over a period of time. If the doctor feels that she needs immediate long-term care then he will complete the necessary paperwork to have your mother’s condition reviewed by the Medicaid people in your state.
Assuming that Medicaid agrees that your mother needs long-term care at this time, your next step is to sit down with an experienced Medicaid planning attorney. The Medicaid planning attorney will review your mother’s legal documents –particularly her durable power of attorney- to make sure that they comply with current law. Of course, if your mother is still married, then the attorney will review your Dad’s documents as well. If not, then he will prepare a new durable power of attorney for her (again, she must be competent at this stage to avoid a guardianship proceeding) and perhaps your Dad as well.
The Medicaid planning attorney will review your mother’s monthly income and overall wealth to determine what type of Medicaid planning tools are needed to protect her estate. If she has too much monthly income (over $2130 per month), then he will prepare a Qualified Income Trust to insure that she passes the income test. If she received less than $2130 per month, then this step will be unnecessary.
Next, the attorney will review her assets. As a Medicaid applicant she is only allowed to retain $2,000 in assets (cash or cash equivalents, stocks, bonds, etc.). If excess assets exist, the attorney will look to see what other avenues are available to protect the remaining assets. This may include a personal services contract, trusts for the benefit of a disabled adult or minor child, purchasing a pre-paid funeral contract, setting aside and designating a burial fund, purchasing a burial plot and arranging for and paying for the headstone. There may be other purchases for clothing, etc. that may come into play to get her down to the $2,000.00 limit. If Mom is married this will be somewhat easier as she can transfer property to your father without incurring a penalty.
Either your Mother’s doctor or the attorney that you pick to help you should be able to recommend the proper living environment for your mother. I would suggest that you personally visit all of the facilities that are discussed to make sure that you get the proper fit for your mother.
The Medicaid application can be completed by any number of people. Your attorney may do it, a paralegal can do it or someone at the assisted living facility or nursing home can do it for you. The attorney and the paralegal, of course, will charge you for this work. It is best to seek their help as they should have the needed experience to do it properly and to avoid the pitfalls that you might see.
As long as you put together a good team of doctor and attorney you should not find the application process to be all that difficult. The difficulty usually comes up with searching for the back-up documents that support your answers on the Medicaid application. Just remember that each application is different from the last one so do rely on the help of the individuals mentioned in this answer.

What is the difference between Continuing Care and Skilled Care?

 

Question: My sister and I are caregivers to our mother and have been for quite some time. However, we still don't understand what the difference is between Continuing Care and Skilled Care. Would you please define these two elder care terms for us?
Answer: Skilled care is ideal for patients who cannot live independently due to fairly pronounced physical or cognitive ailments. Although the level of care delivered is not the same degree as in an acute care situation that necessitates a hospital visit, a patient receiving skilled care must generally be monitored by a team of skilled nurse providers and other health team members, twenty-four hours a day. The most common location for a patient to receive skilled care is in a nursing home, which is now commonly referred to as a skilled nursing facility (“SNF”).
In contrast, the term “continuing care” generally refers to care provided in some sort of a facility that can accommodate a wide variety of capabilities in its residents – ranging from complete independence to a need for quite a bit of care and assistance. There are now many so-called continuing care retirement communities (“CCRC’s”) that offer this sort of spectrum of care to residents. In a CCRC, seniors can “age in place,” meaning the resident does not need to relocate when their deteriorating health means an increasing level of care is required. That can give residents a sense of comfort and can decrease their anxiety about what will happen in a health crisis.
Sometimes, a health issue is so pronounced there is no other option than for a brief of long-term residency in a SNF, since a CCRC may have an upper limit to the level of care they are equipped to handle. Sometimes, a CCRC may have a separate portion of the facility that is effectively its own skilled nursing facility. There, a resident may be able to stay in their original residence from full independence up until assisted living, but then relocate when skilled nursing is required. A small move to a different area within the same facility would likely be less traumatic than relocation to an entirely different, unfamiliar SNF.
What are the advantages and disadvantages of a CCRC? The obvious advantage is the desirability of living somewhere where the resident can likely receive whatever type of care they need for the near foreseeable future. Because many residents in a CCRC need little or no care, it will be easier to participate in activities to stay active and to find peers with which to socialize. The main disadvantage of a CCRC is they can be quite expensive and they do not accept residents on Medicaid.
What are the advantages and disadvantages to a skilled SNF? The main “advantage” so to speak is a SNF may be the only place in which a resident can be taken care of properly. For example, many CCRC’s simply cannot care for a resident who developed pronounced dementia, whereas many (but not all) SNF’s may be equipped for that sort of patient. A disadvantage of SNF’s is that almost all the residents will be quite frail and/or very ill. For a senior who is only moderately weak or having slight difficulties, it will probably be demoralizing to now be surrounded by the very sick.
Financially speaking, the private pay cost for SNF’s are extremely expensive, so expensive that patients are unable to bear the costs out-of-pocket for very long. However, almost all SNF’s can and do accept residents on Medicaid. For those that have the financial means, and assuming a senior’s heath conditions permit it, residency in a CCRC can be highly desirable.
The key point to bear in mind is it is undoubtedly advantageous to start planning for long-term care long before there is a health care crisis. For some seniors, their primary concern is to make sure they are well-cared for, and in the residence setting they find most desirable. Many seniors would also like to take steps to make sure the assets they have worked a lifetime to accumulate are not squandered unnecessarily. I highly recommend that a senior and/or the family of a senior consult with a competent elder law attorney as soon as they can, when they are financially sound and they are in good health. That is the ideal time to devise a good plan that addresses both health needs and financial issues, for the present and for the future, that is also flexible enough to be updated and adapted when family circumstances do change.

 


New

Habit Heroes™ experience aims to

teach families about healthy choices!

Habit Heroes™.


Everyone has the potential to be a habit hero. That’s why we’re

co-sponsoring


Habit Heroes™ in

INN OVENTI ONS at  Epcot® and Walt Disney World®


Resort. The HabitHeroes™



interactive exhibit was reviewed by health experts and is


designed to help families make healthy choices a part of everyday

life. Centers for Disease Control (CDC) research showed 17% of
 
U.S. citizens age 2-19 are obese, and nearly 80% of the kids who
 
were overweight at 10-15 years of age were obese by age

25. A CDC report said that unhealthy lifestyle choices

like poor nutrition and lack of exercise radically impact

employers’ costs. This is because they can lead to

chronic conditions, which account for 75% of U.S.

health care spending each year.* Promoting


Habit Heroes™



is one way we’re working to reverse these


trends. It’s a fun, yet effective way to help families

focus on building good habits like eating well, moving

more and staying hydrated. It’s also an extension

of how we support our members through wellness

programs and plans with 100 percent coverage for

preventive care.
What is Habit Heroes™?



 

Habit Heroes  

aims to entertain, inspire and inform



Families about the benefits of living a healthy lifestyle.

Habit Heroes™




is an interactive comic adventure that aims to teach families about
 
healthy habits and it


includes the exhibit at IN OVENI ONS at Epcot® at


Walt Disney World®




Resort as well as a cool


mobile app.


~


~ Families who experience the exhibit can


take part in hero missions alongside a

cast of


Habit Heroes™.


~


~ Each mission is focused on an important


health habit — nutrition, activity and

hydration.


~


~ And the fun continues outside of the


theme park. At home, families can take

part in the adventures with the


Habit


Heroes™



mobile


app that anyone

can download

from


habitheroes.


com




, iTunes


or GooglePlay.

The mobile app

features the


Habit


Heroes™



comic


and provides

users with fun

tools that can be

used to track and

build their hero

power.


Ready to Unlock Your Hero Potential?


Visit


anthem.com/habitheroes to learn


more about how Anthem’s health and

wellness tools can help build good habits.

We all have a role in improving our health

and


Habit Heroes™ is a terrific first step


towards helping families, especially kids,

learn about and develop good health

habits at an early age. Be a habit hero. Visit


habitheroes.com




, or iTunes or GooglePlay


to download the Mobile App.


As to Disney artwork/properties: © Disney

* Centers for Disease Control: Chronic Diseases at a Glance

Hospital care costs jump 8.2% annually over 2 years, AHIP study finds


Hospital care costs per admission across the U.S. grew from $13,016 in 2008 to $15,236 in 2010, according to an AHIP study. New York saw the greatest increase at 10.5%, while Texas and Tennessee followed at 9.3% and 8.8%, respectively, according to the report. The work was published in The American Journal of Managed Care. "The price of health care services is the major driver of overall healthcare cost growth," said AHIP President and CEO Karen Ignagni. Read the AHIP press release. HealthLeaders Media (3/20)

Monday, March 18, 2013

Good Health Can Be Fun

Become the hero of your own health story! Habit Heroes like Agent Dynamo can show you how to practice healthy habits. Eating well, exercising and having a positive attitude can turn you into a Habit Hero too — and Anthem can be your helpful sidekick. Choose one of our wellness programs to help. And be the BEST YOU that you can be!

Go To Habit Heroes
Habit Heroes

Anthem is proud to bring the message of good health to people of all ages by co-sponsoring the Habit Heroes exhibit in the INNOVENTIONS Attraction at Epcot® in the Walt Disney World® Resort. Promoting healthy habits is the goal. And you do it with healthy foods, exercising, and a positive attitude.
As to Disney artwork/properties: ©Disney.

From Anrthem and Disney, new healthy choice's app for google and iphone!


New Habit Heroes™ experience aims to teach families about healthy choices!

We collaborated with Disney to bring you Habit Heroes™. Everyone has the potential to be a habit hero. That's why we're co-sponsoring Habit Heroes™ in INNOVENTIONS at Epcot® at Walt Disney World® Resort. The Habit Heroes™ interactive exhibit was reviewed by health experts and is designed to help families make healthy choices a part of everyday life.

Centers for Disease Control (CDC) research showed 17% of U.S. citizens age 2-19 are obese, and nearly 80% of the kids who were overweight at 10-15 years of age were obese by age 25. A CDC report said that unhealthy lifestyle choices like poor nutrition and lack of exercise radically impact employers' costs. This is because they can lead to chronic conditions, which account for 75% of U.S. health care spending each year.* Promoting Habit Heroes ™ is one way we're working to reverse these trends. It's a fun, yet effective way to help families focus on building good habits like eating well, moving more and staying hydrated. It's also an extension of how we support our members through wellness programs and plans with 100 percent coverage for preventive care.

What is Habit Heroes™?

Habit Heroes™ aims to entertain, inspire and inform families about the benefits of living a healthy lifestyle. Habit Heroes™ is an interactive comic adventure that aims to teach families about healthy habits and it includes the exhibit at INNOVENTIONS at Epcot ® at Walt Disney World® Resort as well as a cool mobile app.

Visit anthem.com/habitheroes to learn more about how Anthem's health and wellness tools can help build good habits. We all have a role in improving our health and Habit Heroes ™ is a terrific first step towards helping families, especially kids, learn about and develop good health habits at an early age. Be a habit hero. Visit habitheroes.com, or iTunes or GooglePlay to download the Mobile App.

View the Habit Heroes™ article in the quarterly employer eZine My Anthem News.
As to Disney artwork/properties: © Disney
* Centers for Disease Control: Chronic Diseases at a Glance 2009

Monday, March 11, 2013

Is your health plan have ACA required benefits?

Few insurers now cover services required in 2014 under health care law
medical research - cropped
Will they be prepared for the new system? | Elizabeth Flores/Minneapolis Star Tribune/MCT
Just 2 percent of health plans available to consumers in the private insurance market offer all the coverage that will become mandatory next year under the health care overhaul, a new analysis has found.
That means that only about one in 50 plans are now in compliance with the main requirements of the Patient Protection and Affordable Care Act, according to HealthPocket Inc., a Sunnyvale, Calif., technology firm that “compares and ranks” health plans.
And consumers and the federal government might end up paying the cost of those new requirements in higher premiums.
The analysis found that basic benefits, including doctor visits, emergency room care, hospitalizations and lab tests, were standard offerings for nearly all the 11,000 plans in the study.
But only one in four offered pediatric care and only 8 percent covered dental checkups for children. About one-third covered maternity and newborn care and just over half covered services to deal with substance abuse.
These and other coverage areas are considered “essential health benefits” under the health care law. All health insurance plans in the individual and small-business market must offer them beginning next year. But “we couldn’t find a single plan that had every feature fully satisfied,” said Kev Coleman, the head of research and content at HealthPocket.
Unless a health plan is exempted from the health care law’s requirements, “It will have to change to survive,” Coleman said. “Consumers will be entitled to more health benefits in 2014 than ever before, and this will require existing health plans to expand coverage or close and be replaced by entirely new plan designs.”
The law, which critics have long labeled “Obamacare,” requires that health plans offered to individuals and small employers provide coverage in 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
Unsurprisingly, Massachusetts health plans, on average, offered more than most plans around the country, the analysis showed. The Obama administration has often cited the state’s health insurance program as the model for its own initiative.
The Bay State’s insurance plans covered 94 percent of the essential benefits, on average, followed closely by Rhode Island’s, which provided about 93 percent. Hawaii plans covered 90 percent of mandatory benefits and plans in California, Maryland and Vermont covered 89 percent.
Alaska plans had the worst showing, covering only 66 percent of essential benefits. They were followed by Wisconsin at 67 percent and Texas and New Hampshire at 68 percent.
The insurance industry said the new requirement would raise the cost of coverage for consumers.
“Anytime you add benefits to a policy, it adds to the cost of health care coverage,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a trade association for large insurers. “And many people will be getting coverage that’s more comprehensive than they have today, but it will also be far more expensive than what they pay today.”
The health care law’s requirement that all citizens have insurance or pay a fine will increase competition among insurers, which will help lower premiums for individuals, according to the Congressional Budget Office.

 

Thursday, March 07, 2013

Experts say exercise myths persist until people see results


Fitness experts say it is not always easy to separate fact from fiction in exercise science but people get a better understanding when they see results from their workouts. Two common myths are that women who lift weights will build big muscles and that low-intensity exercises burn more calories than intense workouts. Reuters

Wednesday, March 06, 2013

Today's Q&A on ElderCareMatters.com is about the legal and ethical questions surrounding the refusal of CPR to a California Independent Living Facility Resident

Question: "We have been following the story about the nurse who refused to give CPR to a dying woman at a California independent living home. The story has sparked great debate here in our Senior Living Community. Can you tell us whether she was legally right to refuse giving CPR?"

Answer: This unfortunate story is disturbing on many levels and raises important legal and ethical questions for debate and review. Whether the ‘nurse’ could legally refuse to give CPR depends on several circumstances. Was she a licensed nurse acting in that capacity? Did the resident have a DNR (Do Not Resuscitate order) in place? Was the facility an independent living facility or an assisted living facility?
Starting with the issue of the facility type first, Glenwood Gardens is an Independent Living facility. Independent living facilities may consist of fully contained apartments or even stand-alone residences and are sometimes called retirement communities. Some facilities have a communal dining rooms and provide housekeeping and laundry services, and while many have emergency call buttons in the apartments, typically there are no nurses or medical professionals on staff. The residents are presumed to be able to fully care for themselves.
In California, Independent Living facilities are not licensed and not subject to any of the Department of Social Services or Community Care Licensing regulations for assisted living. Even if Glenwood was an assisted living facility, there are no regulations that require CPR, even in assisted living. The facilities are therefore free to create their own policies regarding handling of emergencies.
There is conflicting information regarding whether the facility employee is a licensed nurse or not. If she is a licensed nurse her duties and obligations may be different than if she is not. In addition, her obligations may also depend on whether her position with the company was specifically as a nurse who was expected to render medical care to residents. Since this is an Independent Living facility it is unlikely that the course and scope of her position, even if she was a nurse, would include rendering emergency medical assistance.
California, like many states, does have “Good Samaritan” laws (California Health and Safety Code 1799.102 9)) to protect those who render emergency medical or nonmedical care at the scene of an emergency from civil liability resulting from any act or omission. However, these laws do not compel medical personnel to act in such situations, but simply provide encouragement to act.
Finally, the issue of a DNR. If there was a DNR the nurse’s actions may have been appropriate to carrying out the wishes of the resident. However, it was determined that the resident did not have a do-not-resuscitate order – thus, one would assume that she wanted to be resuscitated, but that is a big assumption, since the deceased's own daughter said she was "satisfied with the care provided."
This sad incident brings to light many ethical and legal issues. Choosing the best senior living situation can be tricky. Understanding the different types of facilities, their licensing, and the services provided is paramount to meeting the resident’s and family’s expectations. When choosing a facility it is important to understand the facility’s policies on emergency management.

Monday, March 04, 2013

Office pets may help reduce stress


More employers are letting workers bring pets to the office, as at least one study has indicated that pet-friendly policies can help reduce stress, Raygan Swan writes. Seventeen percent of workers said in a 2008 survey that their workplace allowed pets. The Indianapolis Star (tiered subscription model)

Friday, March 01, 2013

Wellness spending has doubled since 2009

 

More employees are requiring employees to undergo biometric screening or fill out a health assessment (Photo credit: Keattikorn)More employees are requiring employees to undergo biometric screening or fill out a health assessment (Photo credit: Keattikorn)
Employers have doubled their spending on wellness incentives in the last four years, new research finds.

According to a new employer survey conducted by Fidelity Investments and the National Business Group on Health out Wednesday, employers plan to spend an average of $521 this year per employee on wellness-based incentives within corporate health care programs, double the per employee average of $260 reported in 2009. That’s also a 13 percent jump from the average of $460 reported for 2011.

Growth is particularly evident in the mid-sized market, as 77 percent of employers plan to offer wellness-based incentives in 2013, more than double the 38 percent of mid-market employers that offered wellness-based incentives in 2010.

“As the cost of providing health care continues to increase, employers recognize one of the key ways to manage their company’s costs is to incent their workforce to lead a healthier lifestyle,” Adam Stavisky, senior vice president of Fidelity’s benefits consulting business, said. “Employers of all sizes have embraced wellness-based incentives to help control costs, and companies are now looking at ways to design and optimize their programs to maximize their positive impact on health for both the organization and employees.”

The survey also found that the overall use of wellness-based incentives among corporate employers continues to increase. Nearly nine out of ten employers surveyed indicated that they currently offer wellness-based incentives (86 percent), an increase from 73 percent from 2011 and 57 percent from 2009.

The most popular wellness-based incentives continue to be a decrease in premiums (61 percent), cash or gift cards (55 percent) or an employer-sponsored contribution to a health savings account or similar heath care-based savings vehicle (27 percent).
This year a majority of employers (54 percent) will expand their wellness-based incentives to include dependents, up from 45 percent in 2011. And roughly half will now include spouses/dependents in communications about wellness programs.

But employers want employees to do some of the work, too: 15 percent of employers surveyed are requiring employees to complete some sort of health activity—such as an employer-sponsored biometric screening or health risk assessment—in order to determine their eligibility for one or all of the company's health plans in 2013.

The survey results also show that 10 percent of employers will be requiring employees to complete an HRA or risk being defaulted into a less attractive subset of the company's health plan, while 7 percent of employers indicated failure to complete a biometric screening would result in being defaulted into a less attractive subset of their company's health plan. In addition, 3 percent of employers indicated that failure to complete an HRA or biometric screening would result in loss of benefits for 2013.