Keep Your Dollars in Your Pocket- Managing a Chronic Illness

Save money on your healthcare by properly managing chronic conditions. Yes, I’m going to suggest that you actually spend some healthcare dollars. Let’s look at some statistics first:

1. More than 40% of Americans have one or more chronic conditions and people with chronic conditions account for 75% of healthcare spending in this country according to a recent study published in Health Affairs.
2. About 58 million non-elderly adults have at least one chronic condition.
3. About 65% of people with chronic diseases are working age adults.
4. Unfortunately, Americans with chronic conditions get the recommended care only 50% of the time and less than 50% have their disease satisfactorily controlled
5. Only 50% of those with chronic conditions take their prescribed medication, and the cost of poor medication adherence is more than $100 billion annually in the US.
   
   Let’s talk about these numbers for a minute. 58 million Americans have at least one chronic condition and we are not, or choose not to receive the recommended treatment. We will talk more about that recommended treatment at another time, but once again, the medication issue has surfaced. Over $100 billion is WOW! A lot of money! I can’t really comprehend that amount of money. But, once again it is critical that we take our medications as prescribed.
   
   Let’s use the example of Congestive Heart Failure. There are multiple specific interventions crucial to managing heart failure in a controlled manner. One of those interventions will likely be to take medications that will keep excess fluid from building (a diuretic) and a medication to help the workload your heart must endure. If you wait until you are short of breath to take your diuretic, it then increases the workload on your already failing heart. It will likely contribute to a needed trip to the doctor or worse to the hospital ER. Do you get my point? By spending the money to buy your diuretic and then take it as prescribed, you are reducing the likelihood of a more expensive intervention. An additional benefit is you feel better and can enjoy more of life. If you cannot afford to purchase your medication, refer to one of my previous posts on that topic.
   
   I hope you choose to live life to the fullest and not let a chronic illness take you down. Most of the time, it is a conscious decision. Until next time, stay happy and healthy. You can contact me at alice@EZHealthCareOnline.com
   

Some are Stopping Their Medications Due to the Economic DownTurn

A NY Times Headline reads: “Some Cut Back on Prescription Drugs in Sour Economy”. In the US, we have become a society of treating any ailment with a drug. A drug will fix anything. Consequently, the US is highest in the world on prescription drug spending which last year was estimated at nearly $286.5 billion. Now, for the first time in quite some time, people are trying to reduce the amount of prescription drugs utilized. The economic downturn has caused more people to choose between gasoline, food and medications.

I believe it is reasonable that expenses could be lowered by cutting out some medications…I don’t believe it should be undertaken lightly and certainly not without a joint plan with your physician. People are apparently stopping medications for high cholesterol, high blood pressure, etc. It seems to be primarily the drugs that do not produce a noticable affect such as that of pain pills. If you stop your pain pills you will feel bad therefore those will not likely be on your list to cut. If you stop your cholesterol medication, you probably don’t really notice a difference (at first).

Let’s talk about the consequences. Which is more cost effective: paying for the pill to keep your blood pressure under control or having a stroke, putting you in the hospital probably paralyzed, needing rehab and thus not being able to provide for your family or yourself. Sorry, but this is the harsh reality. If people stop taking the medications that are having a long-term benefit for your health, it will ultimately result in more severe illness and even higher medical expenses.

Below are my suggestions for approaching this dilemma:

1. Refer back to my previous post of ways to reduce the cost of your medications

2. Talk to your doctor about weaning from some of your medications

3. Many of the conditions being treated with pills can be controlled with diet and exercise. Examples are hypertension, diabetes (Type II) and high cholesterol.

4. DO NOT CHANGE YOUR PILLS WITHOUT TALKING TO YOUR DOCTOR!!!

5. Do not spread them out over a longer period or break them in half to take only half the prescribed treatment.

Please consider the longer term effects of your medications on yourself and your family. You do have options, please try them. Until next time, stay happy and healthy. alice@EZHealthCareOnline.com www.EZHealthCareOnline.com

Keep Your Dollars in Your Pocket (Part 2)

In this post, we will discuss how to save healthcare costs on your medications. Since it is the medication costs that are usually the portion of your care that is most likely to be an ongoing expense, we will start there. Many times people with chronic conditions can be on 6 or more medications. Due to the costs, there are often times when there is a decision between purchasing medications and putting food on the table. I have seen it many times that the medications will not be taken, the condition becomes worse and the person ends up in the hospital.Only recently have we begun to see ways to save on your healthcare costs. Most of the literature that suggests ways to lower you medication costs, generally cover the topic fairly well. However, I do usually have one or two items to add.
1. Generic drugs: When your doctor gives you a prescription, always ask to be sure there is a generic equivalent available. These are the same chemical structure, only much cheaper. Most meds that have been on the market for a while will have a generic counterpart. Beware of new medications on the market, they will usually be very pricey and no generic will be available.
2. Home delivery: For medications taken regularly, you can usually access your health plan's pharmacy benefit in which it can be delivered right to your front door. Besides saving on gas to frequent your favorite drug store, you can usually get three months at a time. To make it easier to switch to home delivery, call your doctor's office and ask the fax a prescription directly to home delivery pharmacy. They can then be scheduled on a regular basis so you will no longer have to remember to order your refill.
3. Drug List: Each health plan will usually have a list of drugs that are categorized into groups of which designate how much you will pay or how much the health plan will cover. It may be a difference in co-payment or some will not be covered at all. Take the list with you to your doctor and make sure any medications ordered are in the best category for your benefit i.e. your lowest cost.
4. Non-prescription drugs: Many medications that were once only available by prescription are now available without. They are usually less expensive than the same kind of drug by prescription. An example is the heartburn drug Prilosec. When purchased with a prescription it costs about $116 per month. The cost of a similar amount of the over-the-counter version is about $25. Be sure and check with your doctor if this could work for you.
5: Samples: One of the big ways that drug companies advertise their new drugs is directly with the physicians. In most doctor offices, there are frequent visits from drug salesmen. Most of the time, they will leave samples so the doctor can "try the drug" to see if it serves the purpose. Really, it keeps their drug in “top-of-mind” for prescribing. In some doctor offices, I have seen extensive amounts of sample medication...actual sample closets. If the doctor gives you a new prescription and there is not a generic ask if they have samples. I have been able to get a patient’s entire set of medications from samples. Unfortunately, with the economic situation of the past few years, even the drug companies have felt the pinch so it is somewhat more difficult to obtain samples in that quantity.
6. Different Drug: One of the things I usually include in suggestions for cost savings is to ask if there is a different medication that will accomplish the same thing, but be less expensive. There are times when the physician may not think about the cost of the drug. They will order the latest and greatest, or the one that the drug salesman recently spoke with them about. Whatever the reason, it does happen. Always ask if there is a less expensive drug. You can also talk to your pharmacist about alternative medications. Then your doctor will need to change your prescription.Hopefully these have been helpful tips to help you reduce your healthcare costs. Until next time, stay happy and healthy.www.EZHealthCareOnline.com alice@ezhealthcareonline.com

Keep Your Dollars in Your Pocket (Part 1)

As of late, there has been several articles addressing measures to reduce your healthcare costs. Recent health population studies indicate that our "senior" (>55) population is better equipped to do that than young adults (25-34). While 3 in 4 adults expressed concern about the cost of healthcare. What is ironic about the results of this study indicate that the seniors are more savvy at finding savings on healthcare costs than the young adults. Seventy percent of young adults stated that the economy has made it significantly harder to pay for healthcare expenses. Here's the kicker...more than half of those >55 stated the economic downturn had not impacted the ability to pay for healthcare at all. This is the opposite of what most people would have thought. It seems that the seniors are more experienced at reducing their costs.
The most prominate area of expense is with medication costs. The study indicated that while those <35 are in fact looking for ways to cut their medication costs but 1 in 5 say they do not know where to start. Only 3% of those over 55 answered the same.
In short, it appears there is an apathetic view of healthcare cost pervading the population...people either don't know where to start or simply feel it is a futile effort.
Well...let me tell you, it is not a futile effort! There are ways to cut your costs and streamline your care. Over the next few posts, I will be discussing some of those methods. Until then, stay healthy and happy.

Can You Obtain Health Insurance?

As statistics continue to indicate the increasing numbers of uninsured in the US, it is (or should be) of utmost concern to every American that the team we elect into the presidency as of January has a firm plan to reform health care. In my opinion, the health care system is in a state of turmoil akin to the economic crisis. They are going to go hand-in-hand. Today, WebMD published articles related to the uninsured which did reinforce what we have been told all along of the number of uninsured. Along with these statistics, a recent study by Consumer Reports was highlighted that indicated it has become increasingly more difficult for individuals to obtain insurance coverage.

Here's the link to the article: http://www.webmd.com/news/20071203/buying-health-insurance-on-your-own

In other words, if they do not have group coverage through the employer, it is difficult or near impossible to obtain it unless you are completely healthy. They told the story of a woman with Rheumatoid arthritis who lost her group insurance when her employer discontinued the plan. With her arthritis, the only thing that was keeping her from being completely disabled was a monthly injection of a medication costing $1400-$1700 per month. She has been turned down for most policy coverage or when accepted, it was to exclude any costs related to the rheumatoid arthritis.

I restate parts of the story to make a point. This situation is not an isolated one. I am fairly sure if I lost my group coverage, I would not be able to obtain coverage, or at least not anything I consider comprehensive and or affordable. In the above situation, she is actually considering not taking her injections (because of cost) until she is completely disabled again, then file for disability through the government systems. Now, is this what we want or need in a health care system? I think not, but it is not the fault of the insurance companies. I believe the insurance situation is a by-product of ever increasing costs of technology, drug research and development as well as the increase in the human life span. The attached link is to another article published on WebMD of items to consider and look for if you find yourself in the position of searching for health policy coverage.

It is extremely important that we demand of our legislators and the upcoming President of the US to implement a plan that will ensure every American is able to obtain health coverage regardless of current health conditions. We need to hold them responsible to first, implement a committee of health personnel and non-health care persons to identify what we actually do expect from our health care system. Then, do whatever it takes to find funding that will provide at least that basic requirement for every American. Now, I don't mean to imply that there is no personal financial responsibility.

As you can see, I am somewhat passionate about this topic. Due to that passion, I have provided some helpful resources on my web site (http://www.ezhealthcareonline.com/ ). I would also like to recommend a book recently published by a colleague. The book is "Healing Health Care" by Dr. Roger Howe. His analysis does give an interesting perspective of approaching a solution to this crisis...and yes, it is a crisis. That is my opinion.

National Case Management Week

It is National Case Management Week. EZHealthCare wants to acknowledge all the Case Managers in the various areas of care provision. We see and use Case Managers in virtually every aspect of the health care system. We see them in Acute Care Hospitals, Long term care facilities, home health services, physician offices as well as Rehab facilities. They can be found in clinics, managed care organizations (health insurance companies) and even on the internet. My entire web site and business is based on a community based case management model. In this sense, I can function as your case manager.

The Case Managers are the ones who act as a central point of care coordination along with your physician. In cases where your primary physician cannot or does not act as a central coordination the Case Manager can assist in this manner. The basis of Case Management is to “manage” the case/care…your case. This does not mean we provide hands-on-care for your illnesses…your doctor should do that. We can assist you in pulling the different pieces of the healthcare puzzle together. This helps eliminate gaps in care, duplication in care by more than one physician and to help you understand your conditions to better self-manage. This is usually a Case Manager’s goal with you…to assist you to become more independent with your care and that includes providing education and resources. There are times when you may need the services of a case manager for a prolonged or extended amount of time.

My services at EZHealthCare include that of Community Based Case Management. If you would like to know more about how I can help YOU, please contact me at alice@EZHealthCareOnline.com or check my web site: www.EZHealthCareOnline.com

Maintain Care Information Flow

Let's talk about coordination of care. In the last post, I mentioned how your primary care physician (PCP) is the one who serves as the central point of coordination for your care. He/she should have any information from specialist visits and from any testing that may have been ordered by another doctor. You have a role in maintaining this flow of information. One opportunity for this occurs when you have a test such as a CT scan or a x-ray ordered by another physician. The ordering physician is the one who will receive the report findings of the test. At the time you are providing your history and giving consent for the ordered procedure, there will be a place on the forms asking if the test results should be sent to any other physicians. This is your opportunity and responsibility to facilitate the flow of information to your PCP. Always add your PCP to this list of recipients assuring that not only the specialist will get the results but also to your central point of coordination. By doing this consistently, your doctor has the ability and information to adequately identify any patterns that may need to be addressed.

Your consciousness of this is more important now than ever in the past. Most insurance plans today do not require a referral from a PCP for a specialist visit. All you need to do is make an appointment. If the specialist does not include your PCP with the findings of the examination and any tests, your PCP may never know of the specialist visit. There will be a gap in information and potentially in care. Ask the specialist to send a copy of the assessment and findings to your PCP. You may want to ask for a copy also. The days of the patient not being knowledgeable of the doctor's records are gone. You can then make sure your PCP does indeed have copies of your information.

Another area that needs your action to assure information flow is with your preventive care tests. An example is a mammogram. There is often no need for a physician referral for a yearly screening mammogram. If you do not identify the physicians to receive a report, your PCP may never know you had it done. Consider this aspect of your coordination of care any time you have a health care experience. You can always check with alice@ezhealthcareonline.com if you need assistance with any aspect of care flow.

Do You Need a Family Doctor?

I read an article yesterday advocating for Family Practice Physicians as a critical piece of the healthcare reform puzzle. I happen to agree. We all need a central coordination point for our healthcare. In the medical community, this is known as the "Medical Home". Your family practice doctor, also called primary care physician should be the one you see first for any condition, and more importantly for preventive care. Your physician is not to be seen only when you become ill. One of the main issues with today's healthcare system is that it is fragmented. We see a specialist for every different illness we have. In this case, you are the only central point of coordination, potentially leaving gaps in care or missed issues. The family physician needs to evaluate your conditions, assure you are being cared for according to national practice standards and make referrals IF necessary. All information obtained through a specialist referral should be channeled back to your primary care physician. This assures someone has "The Big Picture" of your care and can put together the puzzle.