Thursday, 22 May 2014

Health insurance coverage now costs $23,215 for a typical family

The typical cost of health care for a family of four with employer-based insurance this year is $23,215, according to a new report from the Milliman actuarial firm.

The bad news first: That amount has more than doubled in the past 10 years. The goodish news: That cost grew just 5.4 percent between 2013 and 2014, the slowest growth rate since Milliman started keeping track in 2002.

That $23,215 figure isn’t what the employee pays, though. Employers pay about 60 percent of those costs ($13,520), while workers pay the rest through payroll deductions ($5,908) and out-of-pocket costs ($3,787).

The employee share of the costs have been rising faster — increasing 73 percent since 2007 – than the employer contribution, which has grown 52 percent over the same period. The Milliman numbers are for family coverage under preferred provider plans, so it excludes the increasing prevalence of consumer-driven health plans, in which employees handle a higher share of the costs.

Don’t blame the four-year-old Affordable Care Act for these changes, though. Milliman says Obamacare has barely had any impact so far on these large employer plans, but that’s about to change.

The actuarial firm cites Obamacare's impending excise tax on “Cadillac” plans – valued at at least $27,500 for family coverage starting in 2018 – as a factor that will force employers to scale back health plans.

Milliman points to other factors that will push down cost increases. Higher out-of-pocket costs are fueling efforts around health-care price transparency, and that's making consumers become better health-care shoppers. Conversely, an improving economy and an increase in expensive specialty drugs will pressure costs to rise.
Employer health plans have been undergoing a major transition and will continue to. They're increasingly looking at things like "reference pricing" and private health insurance exchanges, which put more responsibility on employees to control their health-care costs.

That's all to say that the strategies large employers ultimately adopt to keep down costs — and what employees can bear — are still evolving.


Wednesday, 21 May 2014

NICB Says Stop SCAMS Act Will Help Fight Insurance Fraud

National Insurance Crime Bureau (NICB) says a bill introduced in the Senate yesterday provides much needed support for fighting healthcare fraud. The Stop Schemes and Crimes Against Medicare and Seniors (Stop SCAMS) Act, was introduced by Sen. Bill Nelson (D-FL), and is co-sponsored by Sens. Susan Collins (R-ME), Tom Carper (D-DE) and Chuck Grassley (R-IA).]

The bill contains important provisions to strengthen the Healthcare Fraud Prevention Partnership (HFPP). The Partnership was established last year to focus on joint efforts to fight fraud by both the public and private sectors.

"NICB is particularly focused on the bill's carefully crafted provisions relating to the sharing of fraud-related information and investigative activities among the HFPP's partners," said NICB President and CEO Joe Wehrle.

This language is consistent with the HFPP's anti-fraud program and with laws already in effect in many states governing anti-fraud insurance investigations.

"The same fraudsters who prey on government healthcare programs and private health insurance also target the medical component of auto and workers' compensation insurance," said Wehrle. "The HFPP is the most comprehensive effort ever undertaken to bring the nation's public and private resources together to protect the integrity of medical care and insurance. The Stop SCAMS Act's support for the HFPP will strengthen it and the anti-fraud program overall."

About the National Insurance Crime Bureau: headquartered in Des Plaines, Ill., the NICB is the nation's leading not-for-profit organization exclusively dedicated to preventing, detecting and defeating insurance fraud and vehicle theft through data analytics, investigations, training, legislative advocacy and public awareness. The NICB is supported by more than 1,100 property and casualty insurance companies and self-insured organizations. NICB member companies wrote $371 billion in insurance premiums in 2013, or more than 78 percent of the nation's property/casualty insurance. That includes more than 93 percent ($168 billion) of the nation's personal auto insurance.


Tuesday, 20 May 2014

6 Tips To Reduce Your Medical Costs

According to the Centers for Medicare and Medicaid Services, healthcare costs are expected to rise by 5.8% each year until 2022, which is going to make for a pretty serious hike in your expenses. Instead of getting frustrated and giving in, though, put your thinking cap on. If you’re willing to roll your sleeves up and do a little research, you can find plenty of ways to reduce your medical costs. Here are six of them.

1. Use Urgent Care Facilities Instead of the Emergency Room
It’s a pretty decent bet that there’s an urgent care facility near where you live that you can use in lieu of the emergency room. It won’t cost you as much, and many such facilities offer extended hours. Don’t wait for the next time an emergency occurs – do an Internet search now to find suitable locations and note their hours of operation.

2. Improve Your Health
One of the simplest ways to decrease your medical costs is to improve your health. If you’re overweight, join a gym or create a home workout program and adjust your diet to include more fresh fruits and vegetables.
Still smoking cigarettes? Buy a patch or join a support group and quit. Got friends who encourage you to party it up on the weekends? Find yourself some new ones or convince them to participate in healthier activities. Concrete steps like these can get you more fit and less likely to need medical attention.

3. Get Generic Prescription Medication
Whenever your doctor prescribes any medication, be sure to ask for a generic option. You can save as much as 85%, according to the 
Food and Drug Administration, which also points out that you don’t sacrifice anything in quality by avoiding brand name meds.

4. Pay Your Bill Upfront
If you have the means to do so, offer to pay your medical bill upfront for a negotiated discount. This is a shrewd and under-used method to reduce your medical costs. See the billing department at the hospital or your doctor’s office for details.

5. Use Your Smartphone
A variety of mobile apps can help you save on medical bills and healthcare. There’s the Patient Army app which helps identify medical billing errors, and your employer and insurance provider may be able to provide other mobile apps that can help you reduce costs. If you need an app to stay on track with your fitness goals, try My Fitness Pal or CalorieKing.

6. Review Bills for Errors
It’s easy to say “review your bills for errors” to save on medical costs, but when you get right down to it, the process can seem almost impossible. Medical bills are generally filled with codes and data that are virtually impossible for the layperson to decipher, and the process can easily lead to frustration.
Don’t give in. Review your bill to the best of your ability and if you notice any obvious errors, question them. Then get in touch with your medical provider’s billing department and ask for a detailed explanation. This can take some time, but if you’re addressing a charge of $100 or more, a few minutes is certainly time well-spent. If you don’t find a satisfying resolution, visit the website Medical Billing Advocates of America where a representative can review your bills and tell you what’s in error.

Final Thoughts
Whenever you do save money on your medical costs, note them in a journal. Then, every few months, contribute that amount to whatever area of your finances needs the most attention. You might want to send in an extra payment toward your credit card balances, beef up your emergency fund, or start a 529 college savings plan for your kids. Conserving money on medical and healthcare costs is great, but putting that money to its best use is even better.


Monday, 19 May 2014

Evidence of HIPAA compliance tips for healthcare providers

According to healthcare attorney Susan Miller, detailed evidence of HIPAA compliance and going beyond just the black letter HIPAA rules will be important factors when the Office for Civil Rights (OCR) makes its HIPAA audit rounds this fall. Miller said that OCR has been talking about evidence of compliance since 2009, when it first released the HIPAA Omnibus Rule Notice of Proposed Rule Making (NPRM).

Evidence of compliance, in my view, goes beyond what the rule asks of an organization, such as where its policies and procedures are. This includes the Notice of Privacy Practices (NPPs), business associate agreements (BAAs), but they’ve also [made it clear] that organizations must have a breach plan. In no place in the regulation does it say that an organization has to have a breach plan or process. It does makes sense to have a breach plan to know what the organization will do when it has a breach event. I would suggest that organizations have a breach plan that they look at and update yearly.

OCR will be looking for specific things in the plans, Miller said, including communication tactics within a breach plan. And Miller tells her clients that they need a detailed training plan, as well as the training materials and sign-in sheet or even some way to know when staff completes computer based training (CBT) modules, depending on how they do training. The important thing is knowing the training was completed. And organizations need something similar to a contingency plan, which is in the Security Rule but the larger organizations name as business continuity and disaster recovery plans. “Think of [the Boston Marathon bombings] – you need something that’s going to help you continue to function during these events that are out of the control of the covered entity or business associate (BA),” Miller said.

In Miller’s estimation, evidence of HIPAA compliance includes the following documentation:

- HIPAA Privacy, Security and Breach policies, procedures and related documents, updated to the Omnibus Rule additions and changes; reviewed yearly; updated as necessary

- Breach Plan, plus yearly role playing and update

- Training Plan, plus training and training material

- Communications Plan, plus meeting agenda, minutes

- Disaster Recovery Plan, plus yearly role playing, and update

- Audit and Monitoring Plan, reviewed yearly

- Governance documentation

- Yearly, internal HIPAA audit, documentation

- Yearly Security Risk Analysis/Assessment, documentation

How the HHS Security Risk Analysis (SRA) Tool factors into compliance
Because, in part, OCR discovered during its previous round of audits that many organizations had not done a thorough or complete risk analysis, it recently released its SRA tool to help organizations with risk analysis. Miller said that the tool is a step in the right direction, but it doesn’t explain what a risk or vulnerability is, let alone a risk assessment or analysis for smaller providers that may not understand NIST language.

If I was designing a tool for the smaller providers, I would use common language, such as what the industry thinks a risk is, but I would not use the NIST definition in the glossary. [And] it’s more than 150 questions and 400 pages long which seems too much too long to a small practice. Any medical practice is a fast-paced environment and I don’t know who would be doing this, but the security language is still the same language that only the security experts who work with security on a daily basis would understand.

Miller added that regardless of whether organizations have used either the ONC Security Risk Analysis Tool, the NIST Tool or self-audits, OCR is going to be looking for documents and will take them as evidence of the security compliance.


Sunday, 18 May 2014

Tips on How to Save Money on Health Insurance

Health insurance protects you from any unexpected and costly medical emergencies. However, the situation today is different than 20 years ago where healthcare is now rather cheap and affordable for all Americans.

Choosing a reliable insurance company can be complicated, as you will have to deal with several insurers and their various healthcare policies. Individuals who want to enroll themselves to a good health insurance policy must take their time in choosing a good company that offers the right coverage at an affordable cost.

Saving money on health insurance is not an easy goal to achieve but with some thorough research, you’ll have an understanding of each of the policies available. First and foremost, you should check out the company’s credentials and past achievements before you consider it as the one to get your policy from. Don’t get confused by the different policies they offer; just choose the one that suits your budget with the coverage you need. Having good customer service that will answer your concerns in case the situation gets complicated is also a must for all health insurance companies.

Comparing health insurance quotes is another good thing to consider, as it will give you the opportunity to choose the right policy that fits your needs. A cheap insurance policy is always an attractive deal for anyone to consider, but you must also check for the benefits it provides. It does appear like you save money in choosing an inexpensive plan, but with limited medical coverage you will end up spending more. Going through the terms and conditions before signing up with any plan is one way to find out if your insurance policy will take care of you until its validity ends.

Joining various discount clubs for a lesser monthly payment is also a good idea. Some companies even provide up to 60 percent discount as long as you show them your discount cards. However, it will help you choose the right club to join if you check each plan’s coverage as some regions only have few participating providers.

Most people will agree that the best way to avoid the rising health care costs is having a healthy lifestyle. As the great Benjamin Franklin once said, “an ounce of prevention is better than a pound of cure." Health care does secure your future in case of emergency,but the best way to save money on health insurance is not using them at all by staying healthy as possible.


Thursday, 15 May 2014

One Reason Health Insurance Premiums Vary So Much

A 27-year-old in Jackson pays $336 a month for the second-cheapest silver health plan on Mississippi’s s federally run insurance marketplace. That is more than twice as much as the $154 a 27-year-old in Nashville would pay for the same type of policy, and the $138 for a similar person in Tucson.

Across all 34 insurance marketplaces run by the federal government, the average is $287, about 25 percent cheaper. The reason for the higher prices in some markets? Paltry competition, say Leemore Dafny and Christopher Ody from Northwestern University, and Jonathan Gruber of the Massachusetts Institute of Technology. Jackson has only two insurers on the marketplace: Humana and Centene. By contrast, four insurance companies slug it out on Nashville’s exchange. In Tucson, there are eight.

Jackson’s over-the-top premiums underscore one of the least-heralded shortcomings of the rollout of the Affordable Care Act: the scarcity of insurers on health plan exchanges, which is driving up the price of policies across the country.

The research by Ms. Dafny, Mr. Gruber and Mr. Ody, to be published by the National Bureau of Economic Research next week, concludes that premiums on the exchanges are 11 percent higher than they would be if all the health insurance companies that sell policies in each state had participated in the new markets for health plans.

More competition not only would lower premiums, but would also save the federal government money. It would spend $1.7 billion less in subsidies to low- and middle-income Americans buying policies on the health care insurance exchanges.

“Half of the population in the states with health exchanges facilitated by the federal government is served by three insurers or fewer,” Ms. Dafny said. “To have competition on the exchanges you need competitors.”

The findings are somewhat perplexing, though. By law, 80 to 85 percent of premiums must be devoted to medical spending. Insurers don’t have particularly large profit margins. They have no great incentive to charge customers through the nose.

Still, as Ms. Dafny explains, in markets where there are few insurers competing for business, premiums could rise simply because insurers wouldn’t drive as hard a bargain with hospitals to reduce costs. They could raise premiums to meet hospitals’ demands, without losing customers to the competition.

“A concentrated provider market may be a factor underlying the high premiums,” Ms. Dafny noted.

Of course, you also need competition among providers.

Consider Albany, Ga., which has the highest premiums of all the federally assisted markets, where the 27-year-old would pay $395. It has only one insurer, but also only one hospital. In 2011, the Federal Trade Commission failed to stop the merger of Phoebe-Putney Health System and Palmyra Park Hospital, creating a local monopoly. No matter how many insurers there were, the premiums would probably remain high.


Wednesday, 14 May 2014

Health Insurance Giants To Unveil Price Information In 2015

A nonprofit organization the three work with known as Health Care Cost Institute, a nonpartisan research organization, said the insurance companies will develop and provide consumers “free access to an online tool that will offer consumers the most comprehensive information about the price and quality of health care services.” Additional health plans could soon join Aetna, Humana and UnitedHealth in the effort.

The move by the insurance companies comes as more Americans gain health care coverage under the Affordable Care Act. Meanwhile, these newly insured Americans and those already with coverage are demanding more information about the cost of care as deductibles and co-payments rise and they pay more out of their own pockets for medical services and treatments.

“This unprecedented initiative is testament to our belief that educated consumers benefit the entire health care system,” UnitedHealth Group said in a statement to Forbes.

The information on prices will also include information about quality and other information in an effort to help health care become more transparent.

“Consumers, employers and regulatory agencies  will now have a single source of consistent, transparent health care information based on the most reliable data available, including actual costs, which only insurers currently have,” David Newman,  the Health Care Cost Institute’s executive director said in a statement issued this morning.

There will be three tiers of information provided. In one tier, any consumer will get average price information for an “episode of care” such as a knee replacement or heart surgery based on complex coding and claims data submitted to and analyzed by the Institute.

In another tier, consumers with coverage from Aetna, Humana or UnitedHealth Group will get more detailed price information given the health plan subscribers in their plans already have a relationship with the companies and therefore more specific information on their network of medical care providers that are part of the data set used by the Institute. Meanwhile, employers will have access to even more “granular” information to help them customize information for employees, Newman said.

“Voluntarily making this information available will be of immeasurable value to consumers and other health system participants as they seek to manage the cost and quality of care,” Newman said.

Humana said the online tool will “satisfy consumer, employer and regulator demand for an easy and consistent way to compare prices by providing a free, single source of information on health care services, price and quality.”

Meanwhile, Aetna said its executives “believe that the health care system should be redesigned around the consumer.”

“Delivering reliable, transparent cost and quality information to consumers is a major part of that process,” Aetna said. “This initiative is a step in the right direction and will provide all consumers with access to comprehensive information about the price and quality of health care services.”


Tuesday, 13 May 2014

Wearable Technology: The Coming Revolution in Healthcare

The year 2014 may well go down as the year of wearable technology. The impact of wearables is already being felt in education, communication, navigating, and entertainment; but perhaps the greatest potential lies in healthcare. Wearable technology has started to revolutionize healthcare by assisting doctors in the operating room and providing real time access to electronic health records.

The full potential of wearable technology in healthcare, though, goes well beyond directly assisting doctors. Patients can now continuously monitor their own health. At the 2014 Consumer Electronics Show in Las Vegas, Sony, LG and Garmin introduced devices that track everything from heart rate and blood pressure to a patient's O2 saturation. By 2018, the overall number of wearable devices shipped to consumers is expected to reach 130 million. With such acceptance on the part of the public, wearables are perhaps the perfect application for healthcare.

To learn more about wearables in healthcare, I spoke with David Peterson, Chief Marketing Officer for Emdeon, a company well-experienced in linking healthcare payers, providers and vendors. David believes that the adoption of wearable healthcare-related devices could indeed be a significant step in patient engagement and improving population health -- two critical success factors driving today's increasingly complex healthcare environment. Specifically, wearable health technology brings three distinctly beneficial trends to the table -- connected information, community, and gamification. By harnessing this trifecta, healthcare leaders have new ways to build engagement and create accurate, far-reaching views of both personal and population health.

David Peterson - CMO Emdeon Inc.

Connected Information

Healthcare information has traditionally been extremely siloed. Finding ways to integrate, aggregate, and analyze disparate data can be difficult and costly, but is needed to move healthcare toward cost-effective, evidence-based treatments. Furthermore, privacy and security considerations, like HIPAA regulations, have presented technical challenges related to the exchange of healthcare data.
To successfully employ wearable health technologies, the industry must find a way to develop networks that allow information access and provide support on the back end. This is already being done on a small scale: think about users of Fitbit® and similar health and wellness tracking gear who view their personal data and compare it against data from other users.

Having a network or backbone that a much broader population base can seamlessly connect to will fuel more meaningful data comparisons and analysis and distill useful information. This may spur wearable health technology vendors to partner with organizations that have extensive national networks and access to a large volume of health claims and other patient data. Companies like Emdeon, which processes more than seven billion U.S. healthcare transactions annually, and programs like the Department of Veterans Affairs Blue Button initiative or the Health Data Consortium can play a key role. Such a network could then aggregate data from wearables with other health information -- data from across a certain geography or specific diagnosis, for example -- to create a more complete picture of group health.


Creating healthcare communities from which to collect data is a way to crowd source valuable healthcare information. By bringing together people with a common interest such as weight loss, wearables serve as a mechanism to build engagement and at the same time compile information. It is a logical approach: The more you know about a population's health, the more steps you can take to keep them healthy.

For instance, patient data entered into electronic health records at practices and hospitals could reveal allergies, health histories, and medication use. Combined with information collected through wearables, providers will have more complete and essentially real-time data to treat and manage the health of individual patients, as well as patient populations.

Gathering data this way is somewhat like microphilanthropy, where individual donors give small amounts to charity over a period of time. The real power comes from the cumulative sum of the donations from many individuals. In healthcare, the exponentially larger pool of data about a health condition or population could prove tremendously powerful.


With information networked and communities built, participation in wearable groups can be driven by gamifying healthcare and fitness apps. Most of us are competitors at heart, and we love a good game. Imagine the interest in competing not against three or four friends who are trying to lose weight or lower cholesterol levels, but rather against a larger group of individuals who are members of your health plan or who share a similar health condition.

Health plans might offer incentives to members willing to sign up for designated wearable health programs and join in the "game." The incentives build participation by making the competition more engaging for participants. Growing the volume of data collected has the potential to broadly improve population health.

The Future

Surprisingly enough, wearable technology dates back to the 1200s, when the first eyeglasses were made out of crystal. Fast forward a few hundred years, when Chinese artisans of the Qing Dynasty created an abacus worn as a finger ring. Today, wearable health technology comes in the form of smart clothes, including sneakers, glasses, watches, rings, and more. Regardless of what they look like or how they are worn, wearables will play an pivitol role in the future of healthcare.

As the accuracy and scope of data improve, wearables hold the potential to reduce healthcare costs by identifying trends and commonalities among certain populations -- thereby enabling better preventive care. In addition to engaging patients and aiding personal wellness, they can move healthcare beyond individual monitoring and treatment toward more effective population health management.

By engaging and empowering patients to take an active role in data collection, wearables can change the way data and analytics are used to improve health. It is fascinating to think about, just as the abacus ring must have captivated the ancient Chinese. Consider how this can become the healthcare equivalent of how Google Maps displays traffic; showing healthcare patterns based on real time reporting of anonymous data from healthcare wearable devices.

While technology may never completely replace the all-inclusive health record, a detailed diagnosis or a one-on-one dialogue between patient and provider; the data collected from these devices can provide a broader scope of information. Healthcare organizations can tap the power of that data to engage patients and develop more effective and more personalized approaches to care, thereby lowering the overall cost of care.


Stateline Health Insurance Death Rates

health care
Felue Chang, who is newly insured under an insurance plan through the Affordable Care Act, receives a checkup from Dr. Peria Del Pino-White at the South Broward Community Health Services clinic on April 15 in Hollywood, Fla.

The mortality rate in Massachusetts declined substantially in the four years after the state enacted a law in 2006 mandating universal health care coverage, providing the model for the Affordable Care Act.­

In a study released last week, Harvard School of Public Health professors Benjamin Sommers, Sharon Long and Katherine Baicker conclude that "health reform in Massachusetts was associated with a significant decrease in all-cause mortality."

The authors caution that their conclusions, published in Annals of Internal Medicine, may not apply to all states, and other studies have shown little correlation between having insurance and living longer. Nevertheless, the Harvard study adds to a growing body of evidence that having health insurance increases a person's life expectancy.

Mortality rates – in this case, the number of deaths per 100,000 adults between the ages of 20 and 64 that occur in a given year – vary widely among states. Mississippi, Alabama, West Virginia, Oklahoma, Kentucky and Louisiana have the highest age-adjusted rates (which recognize that some states have older or younger populations). Hawaii, California, Connecticut, Minnesota, New York and Massachusetts have the lowest mortality rates, according to 2010 data (the most recent available) from the U.S. Centers for Disease Control and Prevention (CDC).

Uninsured rates also vary widely. Between 2011 and 2012 Massachusetts had the lowest uninsured rate in the nation at 4 percent of its population, compared to a national average of 15 percent, according to a Kaiser Family Foundation analysis of U.S. Census data. Texas had the highest rate at 25 percent, followed by Nevada (24 percent) and New Mexico and Florida (both 22 percent).
Massachusetts is also among the most affluent states in the nation, and it has one of the highest average education levels and ratios of physicians to residents, all of which lower mortality rates. Many other factors also affect the death rate of a state or regional population, including the prevalence of chronic diseases, obesity, climate and environmental hazards, smoking and drug and alcohol abuse, gun violence and occupational safety.

"It is difficult to compare one state to another when it comes to mortality rates," said Alison Cuellar, a health economist at George Mason University. "All the evidence points in the direction of health insurance increasing longevity," she said. "We just don't know the magnitude of the effect."
In 2002, the Institute of Medicine estimated that the death rate of the uninsured is 25 percent higher than for otherwise similar people who have health insurance. According to the study, 18,000 excess deaths occurred each year because 40 million Americans lacked insurance.

But a 2009 rebuttal study by Richard Kronick of the Health Research and Education Trust found that when adjusted for health status and other factors, the risk of subsequent mortality is no different for people who lack insurance than for those who are covered by employer-sponsored plans. Kronick's conclusion: "There is little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States."

The Harvard researchers compared Massachusetts death rates from 2001 to 2005 to the four-year period after the new health care law was enacted, and found that the mortality rate decreased by 3 percent between 2006 and 2010. Using county-level mortality rates from the CDC, they compared 4 million Massachusetts residents (the entire population from age 20 to 64) to a control group with similar demographics in counties in other New England states.

Greater access to health care may have prevented as many as 320 deaths per year, the authors estimated. Changes were most pronounced in Massachusetts counties with lower household incomes and higher uninsured rates. According to the authors, providing health coverage to 830 uninsured adults prevented one death per year.

Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.


Monday, 12 May 2014

Hep C Cure Costs Pose Challenge for Medicare

By Richard Knox NPR 

Walter Bianco has had hepatitis C for 40 years, and his time is running out. "The liver is at the stage next to becoming cirrhotic," the 65-year-old Arizona contractor says. Cirrhosis is severe scarring, whether from alcoholism or a chronic viral infection. It's a fateful step closer to liver failure or liver cancer.

If he develops one of these complications, the only possible solution would be a hard-to-get liver transplant. "The alternative," Bianco says, "is death."

Previous drug treatments didn't clear the virus from Bianco's system. But it's almost certain that potent new drugs for hep C could cure him. However, the private insurer that handles his medication coverage for the federal Medicare program has twice refused to pay for the drugs his doctor has prescribed.

Doctors are seeing more and more patients approaching the end-stage of hep C infection. "There isn't day that goes by when I don't have a story very similar to Mr. Bianco's," says Dr. Hugo Vargas of Mayo Clinic in Scottsdale, Ariz., his liver specialist. Researchers estimate that 3 to 5 million Americans carry the insidious hep C virus. The biggest concentration is among those born between 1945 and 1965.

Many, like Bianco, got hep C from injecting street drugs in their youth. He says he's been drug- and alcohol-free for 32 years, but the infection was permanent.

Other baby boomers got the virus from transfusions before 1992, a period when blood wasn't screened. Some got it from sharing razors or toothbrushes, or from contaminated tattoo needles or hospital equipment. For some, transmission was sexual, although fortunately this isn't the highest-risk route.

The timing of these infections spells trouble for Medicare, which insures Americans over 65.
Hepatitis C is a slow-acting virus. Over a period of 20 to 40 years, it causes liver damage in about 70% of people it infects. A growing number of people who got infected in the 1960s through the 1990s have now "used up" the infection's latency period, notes Dr. Camilla Graham of Beth Israel Deaconess Hospital in Boston, "which is why we're now seeing this dramatic increase in the number of people developing complications and dying of hepatitis. And we expect this to continue to increase for the next 10 years."

Is A Cure Worth $84,000?

Another part of Medicare's problem is that new hep C medications are among the priciest of any drugs. One called Sovaldi, federally approved last December, costs $1,000 a pill -- or $84,000 for a typical 12-week treatment course. The other recently approved drug, Olysio, costs around $66,000. Others in the pipeline are expected to be similarly expensive.

"People were very shocked about the price because it hit a psychological barrier in terms of 'this is too expensive,'" Graham says. She has a patient like Walter Bianco -- a 65-year-old woman whose severe liver damage puts her on the edge of liver failure. Graham believes her patient's best chance at cure lies in the use of both Sovaldi and Olysio. "We have about 160 people who were studied in a clinical trial called COSMOS that showed a very high cure rate -- 90% to 100% -- for even the most difficult-to-treat patients with this combination," she says.

But, as in Bianco's case, the Medicare drug-benefit contractor that covers this patient has refused to approve payment. The apparent reason is that the FDA has not yet approved use of the two drugs in combination. (On May 7, Olysio's maker, Janssen Therapeutics, asked the agency for such approval.

But Graham notes that in the early days of successful antiviral drug treatment for HIV, payers allowed doctors to "mix and match" medications in "off-label" or unapproved combinations as they thought best. "Medicare has been slower to adopt off-label combinations than most of the other insurance plans," Graham says.

Accelerating Demand

Medicare officials wouldn't comment on coverage of new help C drugs. A spokesman wrote in an email that the federal program turns such decisions over to private insurers that administer its drug plan, called Medicare Part D.

However, advocates say Medicare officials are well aware of the program's looming exposure to the enormous costs of treating hep C. Some say it could run in the tens or hundreds of billions of dollars, though it's not clear over what period of time.

One thing likely to accelerate demand for treatment: Medicare is expected to approve payment for routine blood tests for hep C infection soon. That will reveal many people who don't yet know they're infected -- and spark difficult conversations between patients and doctors on when to use the expensive new medications to clear the virus from their blood.

Many hepatitis specialists and patient advocates are worried that the cost of the drugs will lead payers to limit access to patients who already have advanced liver disease, or even more narrowly, those who are on transplant waiting lists. "We're very scared that these programs to limit access to treatment could interfere with our goals of trying to find people with hepatitis C," Graham says.
Ryan Clary of the National Viral Hepatitis Roundtable, a patient advocacy group, says public health may be on a collision course with treatment and reimbursement policy.

"On the one hand, we're saying 'Now is the time to be tested for hep C. There are these promising treatments,'" Clary says. "But on the other hand, we're saying 'You can't have access to these cures. It'll bankrupt the country.' So where's the incentive to test?" Apart from expensive drug treatment aimed at cure, doctors say there are other good reasons for identifying infected patients. They can be counseled to stay away from alcohol, which accelerates hep C-related liver damage. They can also be told about steps to take to avoid infecting others.

There are other implications of delaying treatment until liver damage is advanced. Once a patient has developed cirrhosis, he'll need to be monitored every 6 months for the rest of his life for signs of liver cancer.

And if a patient tips into liver failure or cancer before getting cured, treatment will cost an estimated $50,000 a year -- possibly over several years. "Hepatitis C is a ticking time bomb," Graham says. "We have a very limited amount of time to get in here and alter the course of the disease for a good number of people. And we either do that, and we do it well now, or we face a whole lot more people suffering severe complications of this disease."

While the cost and treatment implications get sorted out, patients like Walter Bianco are in an agonizing limbo. He says he can't possibly afford the $150,000 it would cost to buy Sovaldi and Olysio on his own. "It is a lot of money and there are a lot of help C sufferers out there," he says. "I think Medicare's probably thinking 'If we can hold off for a year or two, some of these following drugs will be cheaper.'"

But Hugo Vargas, Bianco's doctor, says it's urgent to cure his infection now. "If he were my father," the Mayo specialist says, "I would want Mr. Bianco to be treated now -- not in a year, not in a year-and-a-half."

This article, which first appeared May 12, 2014, was produced in collaboration with NPR and had support from The SCAN Foundation. It was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.


Sunday, 11 May 2014

Practical Saver : Tips for saving money on healthcare - Westhill Consulting Insurance

Practical Saver: Tips for saving money on healthcare


Courier Columnist 

Changes in the health insurance arena have many consumers scrambling for affordable options. Don't despair; there are still ways to save significant money on healthcare. Below are a few medical resources that Prescott has to offer, as well as tips on how to pay less at the doctor's office, and an alternative to health insurance.

To save money on premiums, many families opt for higher-deductible health insurance policies. High deductibles generally equate to lower monthly insurance premiums. However, in exchange, the majority of the medical expenses are paid out of pocket. In the case where doctor's visits and medical treatment are paid out-of-pocket, you can save money by asking the medical office if there is a cash pay discount. When a patient pays cash and the business doesn't need to submit the claim to the insurance company, it saves the office time. In fact, many establishments offer a 20 percent discount for cash payment. Last year paying cash saved our household $1,000 by allowing us to pay $400 for an MRI versus paying the insurance rate of $1,400.

If you have children enrolled in the Humboldt, Prescott or Chino Valley school districts, free health care checks are available to them through the YRMC's Partners for Healthy Students Program. Children and/or their siblings who have no health insurance or ones that have a deductible over $2,500 (and no co-pay before the insurance will cover medical expenses) are eligible for this free school-based clinic. Yes, the service is free! The clinic offices are located on school campuses on various days of the week, as well as in a Mobile Kid's Clinic that visits the outlying areas of Mayer, Kirkland and Yarnell. Clinic visits are by appointment only and they offer well exams, sports physicals and ill childcare. The check-up is provided by certified nurse pediatric practitioners. Many of our friends have used this service and rave about the care and thorough treatment received. Call 771-5662 for more information.

Money can also be saved on childhood immunizations at the Yavapai County Health Department. The Arizona Partnership for Immunization (TAPI) provides affordable immunizations for uninsured children under age 18, and those whose insurance does not cover the cost of all vaccines.

There is a $20 administrative fee and the program covers the cost of the vaccines. For more information, call 583-1000.

Fortunately, adults in Prescott have options to save on routine health care as well. Prescott Health Clinic at 1003 Division, Suite #2 in Prescott, offers routine medical visits for $38. They do not accept any medical insurance, and payment is required at the time of the visit. Some of the routine conditions they treat are: sore throats, cough, sinusitis, bronchitis, urinary tract infections, skin infections, and minor injuries such as sprains, strains and lacerations. They provide general, CDL, sports, employment and school physicals, women's exams, Pap Smears and STD testing. Some conditions that they DO NOT treat are: Workman's Comp injuries, motor vehicle injuries, chronic back pain, pregnancy/prenatal care, infant or toddler care or vaccines for minors. You can learn more at

In the world of transitioning health insurance, people are looking for cost effective alternatives. The Christian organization MediShare offers a medical bill sharing program which is an alternative to traditional health insurance. This is not insurance, but rather a pooling of funds that pays for the medical expenses of its policy holders. As far as the legality of the organization, the Affordable Care Act contains a provision making members of these medical sharing programs exempt from the mandatory insurance requirement. Medishare acts similar to insurance in that medical expenses are submitted for payment and the pool of funds pays the bills. To be included in the program, the participants must sign a Christian statement of faith. The cost of the program is significantly less than traditional insurance. For more information, visit

I am not an insurance or medical expert, but I do enjoy researching ways to save money. If you have more information on the topic of saving on healthcare, I would love to hear from you at

Kara Rozendaal, a financial planner, wife and homeschool mother of three, has lived in Prescott Valley for 17 years. Kara's website helps make shopping simple and savings possible.