Health Care Reform Boon for Cancer Prevention, Wellness

Experts at University of Texas MD Anderson Cancer Center say health care reform will lead to early cancer detection and prevention. Eliminating co-payments for preventive screening and expanding coverage for services will remove financial barriers for cancer screening exams. Affordable health care also will improve vaccination rates.
For individuals with private insurance plans that started after September 2010, healthcare reform madates preventive cancer prevention services that include colorectal cancer screening, diet counseling for those at high risk, obesity counseling and screening, help with smoking cessation, PAP tests, HPV vaccine, genetic counseling and chemoprevention, mammograms and well baby and child visits.
For Medicare participants; beginning January 1, 2011, covered preventative services include mammogram, colonoscopy and flexible sigmoidoscopy, PAP tests, smoking cessation, personal risk assessment, body mass index and waist circumference measurements to find the risk for cancers fueled by obesity, and family and medical history review.
In 2013, states that offer free or low cost preventive services through Medicaid will receive incentives and are also already receiving funding to provide care at community health centers for vaccines, cancer screening and other preventive services.
According to Ernest Hawk, M.D., M.P.H., vice president and division head for Cancer Prevention and Population Sciences at MD Anderson. “We’re optimistic that more cancers may be prevented or detected early when they can be treated most effectively." Healthcare reform mandates better coverage and expanded services for disease prevention - something that Hawk says “promises to reduce some of the barriers to cancer screening exams and improve vaccination rates.”

Prevention Services Expand in Response to Health Care Reform

To meet the anticipated need of increasing number of individuals seeking cancer screening, MD Anderson plans to expand their facilities. Included in their services are individualized cancer risk assessments, assistance with diet improvement, stop smoking programs that can reduce risk of various types of cancer.
Dr. Hawk explains, "The good news is that health care reform makes wellness and prevention top priorities. These are very promising and important developments for all Americans, and particularly for the most vulnerable among us — underserved communities, who often forgo regular screenings because they’re too expensive or inaccessible.”
Heath Care reform is expected to lead to the need for a different type of service from health care providers with more emphasis on prevention. More preventive services are being covered by insurance companies with zero co-pay, co-insurance or deductible. The affordable healthcare act should be a boon for cancer and prevention and welllness. Speak with your insurance provider for details about prevention and wellness services associated with your individual plan.

New Mexico Bill Would Establish Health Care Authority

The NewMexico House on Tuesday voted 56-6 to approve a bill (HB 147) that would createa Health Care Authority to develop a plan by January 2009 for "accessibleand affordable" health care for all state residents, the AP/Santa Fe New Mexican reports. The measure now moves tothe state Senate.

The bill, sponsored by State Rep. Danice Picraux (D), would create the11-member Health Care Authority, comprising the state insurance superintendent,five members appointed by the governor and five members appointed by theLegislature. All decisions by the committee would need to be supported by atleast seven of the authority's members. If the bill is approved by the stateSenate, the Health Care Authority would take over the New Mexico Health Policy Commission and its budget in July. The commission'sexecutive director would serve as the interim head of the authority.
According to the AP/New Mexican, "Lawmakers have beenreluctant to make major decisions about the health care system during thesession that ends Feb. 14, and it appeared the bill approved ... on Tuesday mayhave the brightest prospects for passage." State Rep. Luciano Varela (D)said, "My concern is, if we take too much on this session, we will not dojustice to the health care system in New Mexico." Supporters of the measure say itprovides the framework for fundamental health care system changes.
Gov. Bill Richardson (D) has asked lawmakers to pass separate legislation thatwould require all state residents to obtain health insurance, expand governmentprograms and require businesses to contribute to the cost of health care. Thatbill remains in committee. Richardsonspokesperson Gilbert Gallegos said that "another study is unacceptable tothe 400,000 New Mexicans who need access to quality health care now"(Baker, AP/Santa Fe New Mexican, 2/5).

Some Health Insurance Providers Don't Include Sports Physicals

Many of the major health insurance carriers in the United States allow for a Physical each year, but you need to check with your carrier to see if that includes Sports Physicals. Often times sports physicals are not covered since the doctor may bill them differently than the regular physical.

Who pays for physical health insurance

It is good practice to get a physical, you just need to understand who is paying for it. Like many billable insurance services you should always compare your out of pocket expense with what the doctor calls the cash option.
Many doctors have a insurance rate and a cash rate. In fact, if you have a prescription next time you are at the pharmacy before you present your health insurance card ask what the cash rate is. You will find that some cash rates are less than you would have spent out of pocket using your insurance deductible. You will also want to ask about the 90 day supply vs. the 30 day supply. I have found on prescription I take had a $25.00 co-pay that I would pay every 30 days. I asked how much it would be if I did not use my insurance and paid cash they said $15.00. Better than that I asked about the 90 day supply and they said $21.00. So over a 90 day period I was able to save $54.00 by paying cash vs. using my insurance card. Paying cash also saved my insurance company too, and did not go against my plan benefits when I really needed them.
You will find the same thing holds true with maternity. My first baby was born underinsurance and I paid $400 total but the insurance company paid close to $18,000 for that expense. My second child we did not have insurance so we ended up paying $5500.00 cash for everything, including the OB visits. We were able to make payments to the hospital and the OB over 24 months . We had insurance for the 3rd and 4th child, but we opted out of the maternity benefit that was over $150.00 additional each month saving over $18000.00 and working out payment plans for a fraction of the cost paying with cash.
We are in the middle of a health care crisis, but we the users of the system are partly to blame. If everyone questioned the cost of their medical expenses line they do their car repair, or grocery bill things would not be so out of control.
You can be a smart consumer, and save yourself money if you take the time to understand the system.

Illinois Highlights Young Adult Dependent Health Insurance Option

The Illinois Department of Insurance highlighted the new Young Adult Dependent Coverage Law, effective June 1st, that allows dependent young adults up to age 26—and age 30 for military veterans—to be added to a parent’s health insurance coverage.
“Young adults, working through college or even with steady employment, often lack access to health insurance. This coverage option offers families a fair alternative, ultimately improving the long-term health and financial security of our young adults,” said Michael T. McRaith, Director of the Illinois Department of Insurance.
The new law permits unmarried young adults to remain on or be added to their parents’ health insurance plans up to age 26, or up to age 30 for military veterans.
Eligibility
Health insurance policies and HMO contracts that offer dependent coverage must include unmarried young adults up to age 26, or age 30 for military veterans, and regardless of the young adult’s enrollment in an educational institution.
Enrollment
All policies must offer an initial 90-day enrollment period to eligible dependents. New policies issued after June 1, 2009, must provide the initial 90-day enrollment period immediately upon issuance or delivery. For existing policies, the initial enrollment period will vary depending on the date the policy is issued, amended or renewed.
Pre-existing conditions
For group policies, dependents added during the initial 90-day enrollment, annual enrollment, or special enrollment periods may not be declined coverage due to health status.
For parents seeking to purchase an individual policy, the parent must first meet the insurance company’s underwriting guidelines in order to receive an offer of coverage. If the individual policy provides dependent coverage, eligible dependents must be offered coverage regardless of health status.

Study takes first steps to improve the quality of health care for chronically ill children

Children with chronic health conditions such as cystic fibrosis, type 1 diabetes, sickle cell diseases and cerebral palsy represent less than two percent of the population but can consume more than 50 percent of resources at children's hospitals throughout the country. Coordinating care for these children has historically been difficult because hospitals have varying methods to identify them in their systems. In a new study led by John Neff, MD, of Seattle Children's Research Institute, researchers developed a unique method to identify children with serious lifelong chronic conditions using hospital discharge data that will enable children's hospitals to improve the quality of care for these patients and reduce costs. The study, "Identifying Children with Lifelong Chronic Conditions for Care Coordination Using Hospital Discharge Data," published online November 15 in Academic Pediatrics. (For a full copy of the study, please contact the media contact listed below or Academic Pediatrics.) "In the long run, if we can identify these children, their cost patterns and needs, hospitals can then work with the state and health plans to provide support for the care coordination that they need. This should result in better quality of care and hopefully lower costs for these children," said Dr. Neff, clinical director at The Center for Children with Special Needs at Seattle Children's Hospital.
"One of the big barriers in the past is that hospitals have not known who their patient population is and have not been able to systematically identify them," added Neff. "Categorizing children with complex or multiple chronic conditions is particularly difficult because of the general infrequency and variable nature of their conditions. Because hospitals haven't had a reliable method to identify these patients, they haven't been able to effectively coordinate their care or know the cost implications to their own hospital."
Findings suggest that children with lifelong chronic conditions require a disproportionate share of resources in children's hospitals and when measured over several years are likely to accrue a high percentage of health costs. The study reviewed one hospital's records from 2007; these children represented 41.1 percent of Seattle Children's Hospital total patients and 71.4 percent of patient days.
Neff and co-investigators combined the use of hospital discharge data from Seattle Children's Hospital and its primary care clinic, Odessa Brown Children's Clinic (OBCC) over seven years from 2001 through 2007. They selected patients whose primary care occurred at OBCC and hospitalization and emergency department care were likely to be at Children's. Using Clinical Risk Groups (CRGs) software to analyze the data - CRGs is a risk adjustment method that has been used with health plan data to identify and stratify individuals into condition and severity groups, but has not previously been used to analyze patients in hospital discharge data - patient information was classified according to complexity of diseases and primary chronic conditions. That data was merged with hospital discharge data to identify what hospital services those patients used.
As a result of this data and methodology, Seattle Children's Hospital is launching a study that will examine how to improve the coordination of care for patients with lifelong chronic conditions, decrease their need for hospitalization and improve their quality of life. The study will follow approximately 600 of these medically complex patients for two years in a clinic that will work with patients' primary care providers to develop care plans and other interventions to improve their care and reduce the need for hospitalization.
"This will be the most comprehensive study of its kind," said Mark Del Beccaro, MD, pediatrician-in-chief at Seattle Children's Hospital. "If we succeed in showing we can improve care and lower costs for the patients and their families, this will also have tremendous implications nationally as these most complex and fragile of patients utilize a significant portion of health care expenditures in every community and state."