Archive | August, 2013

A New Approach To Care: Health Incentives In The Affordable Care Act (Guest Post)

Preventative Care is a key aspect of the Affordable Care Act that stands to benefit millions of Americans, in ways that you might not expect.

The term describes an array of services, programs, and incentives that are funded by the government in order to make people healthier. Contrary to what you might think, however, the funds are not limited to impacting care on the individual level.

Rather, the reforms will include everything from building public health centers to creating bike lanes and walking paths. Not to mention, free immunizations for individuals and families.

It’s important for consumers to understand what these changes could mean for them, in every respect. With this thought in mind, let’s explore the ways in which individuals, families, and communities will be impacted by these new reforms.

Individual and Family Health

Individuals and families will benefit tremendously from a host of preventative services that will be offered free of charge by insurance providers, regardless of pre-existing conditions.

Offered services will include: Breast cancer screenings, wellness checkups, domestic violence screenings, contraception, and breast-feeding supplies. Immunizations, counseling services, and depression screenings will also be made available as a result of the new legislation.

For many Americas, this change will mean first time access to potentially life-saving services that work in turn to promote further wellness among individuals, families, local and regional communities.

Public Health and Prevention

Without funding, reforms are simply laws on the books that don’t have any real-world import.

In 2010, The Prevention and Public Health Fund was created in order to ensure that care actually gets to the people who need it, through the development of programs that mobilize entire communities toward the goal of better health.

The fund’s initial budget has been compromised since 2010, but local governments have already received an estimated $290 million to put towards the development of healthy eating programs that are aimed at some of our nation’s deadliest health issues, such as child obesity and diabetes. Funding has also been put to work through infrastructure development to create sidewalks and bike paths, in an effort to encourage daily exercise.

Although the Prevention and Public Health Fund has met some opposition from congressional republicans, the potential for positive impact is clear.

Smoker’s Penalty: Two Sides Of The Same Coin

The Affordable Care Act takes a bold stance on smoking.

The Smoker’s Penalty, as it’s come to be known, has to do specifically with plans offered in the state health insurance marketplaces, which will open for business this October.

Under the ACA, insurance providers are allowed to charge smokers up to 50% more for their coverage than non-smokers, due to the associated health risks.

However a recent, highly publicized computer error has delayed this possibility. This is due to the fact that the computational system in place cannot differentiate between price inputs for smokers of differing ages. The glitch may take up to a year to fix.

Although this may seem like good news to smokers, no one knows how insurance companies will respond to the penalty issue come October.

Some view the smoker’s penalty as discriminatory, while others see the benefit in a hard-nosed incentive to get people to quit.

The good news is that the ACA will provide access to quitting services and products at no charge to consumers, and you can’t be denied coverage for having been a smoker.

All of these incentives, controversial or otherwise, are clear indicators of a much needed change in government thinking. Healthcare reform is doing more to help Americans avoid potential problems altogether. Let’s hope this is just the beginning.

Michael Cahill is the Editor of the Vista Health Solutions Blog. He writes about the health care system, health insurance industry and the Affordable Care Act. Follow him on Twitter @VistaHealth and @VistaHealthMike 

94% of Cancer Doctors Say Patients Affected by Drug Shortages

This seems like the type of headline you’d expect to see in a 3rd world country not the US.  But, we’ve been talking about drug shortages for years, and while it may be better in a few areas, cancer isn’t one of them.

I was recently reminded of this in an AJMC article which was discussed at ASCO and had this data point about 94% of oncologists and hematologists from a University of Pennsylvania study.  

Looking back a few years, I think IMS did one of the best studies on this topic.  Here’s a few of the items they highlight from the study (with links to their charts).

It can be a little mind-boggling.

  • Is it an issue of planning and forecasting demand?
  • Is it an economic issue of not enough profit in these drugs?
  • Is it an issue of quality where these get shut down due to manufacturing issues?
  • Is it a structural issue of too few suppliers?
  • Is it a raw materials issue?

Diet Soda Versus Regular Soda – Ongoing Confusion

I view this as one more example of how the average consumer gets confused by all the information out there.


Should I focus on calories?

Should I focus on the ingredients?

Should I just drink water?  (of course)

Now, “new” research shows that the artificial sweeteners in the Diet drink can actually fool your body making it worse for you over time.  This isn’t completely new if you look at this blog from a few years ago.

But, we often wonder about why consumers don’t take responsibility for their actions and then get upset when more aggressive measures have to be taken.  (See the recent Penn State uproar.)

Consumers don’t know who or what to trust.

Should I drink alcohol?  Is it good for me in moderation?

How much exercise is needed?  New research shows that it can’t all be done at once.

Extreme Weather Isn’t Good For Our Health

After moving to Charlotte, it’s been raining and flooding here all summer.  It reminds me of 1993 when I moved to St. Louis, and they had their 100-year flood.


All I ever hear from everyone is that this isn’t normal weather for Charlotte.  It begs the question of whether any weather is normal.  [I’ll avoid going down the global warming path here.]

So, I found it interesting that there was a recent article says that this will essentially be part of a new normal which will be more weather extremes.  Drought.  Flooding.  Hurricanes.  Extreme Heat.

So, what does this have to do with health?  A lot.

When these extreme weather scenarios come up, people are less likely to leave the house.  Kids don’t go outside and play.  And, as you can see on the CDC website, they’re focused on analyzing these trends to understand the impact.  On the NC HHS site, here’s what it says about this weather change.

“Some of the health impacts of climate change may include illness, injuries or deaths due to heat, air pollution, extreme weather, and water-borne pathogens.”

Weather has an impact.  Just look at SAD (Seasonal Affective Disorder).

Or, just think about childhood obesity.  Our kids are supposed to get 60 minutes of activity a day.  While we assume that happens with sports, it doesn’t always as I blogged about before.  With many of them over-scheduled to begin with and schools dropping recess, weather may be the last straw.  As recent research shows, a structured recess program is important for academic success.

Some days, I think our kids work harder then us parents.  Let’s look at a kid playing a serious sport.

  • 7:50-2:55 school for 5 days a week
  • 1-2 hours of homework per day
  • 2 hours of sports practice 5 days a week
  • Homework on the weekend
  • Games / tournaments on the weekend

Now, add a second sport which many kids do.  Or a part-time job as they get older.  (I know I’m getting off on a tangent, but it’s been so long since I’ve had time to blog…I need to get back into a pattern.)

Only 15% Of Workers Leave The Office Every Day

Have you noticed that you eat lunch more at your desk every day?  I certainly have.

With 7 hours of meetings (at least) every day plus 300+ emails every day, we’re busy.  I’d argue that most companies these days are busier than they were historically.  At the same time, everyone is focused on wellness and healthier choices.  When sleep, diet, exercise, and stress are all related to health, it’s hard to separate those from the workplace.

That being said, I wasn’t too surprised by this recent poll I saw which highlights this.

Exercise at work

How Bank Of America Messed Up My Account At Citibank


To say I’m frustrated would be an understatement. This scenario seems like something from a movie in which the evil bank blatantly abuses their power over the financial system to push people into economic hardship.


I write about this here for two reasons:

  1. Maybe this will bring it to someone’s attention that will help and
  2. All we generally hear about is the bad customer service in healthcare which pales in comparison to this.

Here’s the scenario:

  • On 6/3/13, we paid off our Bank of America mortgage when we sold our house in St. Louis.
  • On 6/17/13, BofA sent us a payoff check for our overpayment of our escrow.
  • On 7/5/13, that money was deposited into our Citibank account.
  • On 7/18/13, BofA confirmed that the check cleared.
  • On 7/23/13, Citibank removed the funds from our account and stated that BofA had rejected the check.
  • After several calls, Citibank could not explain the reason for the funds being removed other than to say the check wasn’t paid by the institution. Here’s some of the reasons that they’ve made up to try to tell me why:
    • First they told me that we both didn’t sign the check. That was wrong.
    • Then they told me that it was made out to a business. Which it wasn’t.
    • Then they told me that BofA rejected it. Which they didn’t.
    • Then they told me that it was because I used an ATM. Which I didn’t.
    • Then they told me to go into the branch office where I made the deposit. I used the same lock-box that I’ve used for years. There are no branches in St. Louis or Charlotte.
  • On 7/30/13, we had a 3-way call with Citibank and BofA to confirm the check was paid.
  • On 8/1/13, BofA faxed proof of payment to Citibank.
  • As of 8/5/13 after more calls with the 3rd supervisor at Citibank, they still couldn’t prove that the check was paid or find the BofA proof even after they had selected the location for the proof to be faxed.
  • I then got all fired up:
    • Followed the @AskCiti Twitter account and asked them to direct message me contact information for someone who could help me…with no response.
    • E-mailed the CEO of Citibank with no response.
    • E-mailed 3 members of the Committee on Financial Services with no response.
    • E-mailed the Ombudsman at the CFPB with no response.
    • E-mailed 3 members of the Citibank Board of Directors with no response.
    • E-mailed the WSJ reporter who wrote the article about Citibank’s use of Twitter for customer service.
    • E-mailed 6 other members of the Citibank executive team with no response yet.
    • Wrote my original blog post here throwing Citibank under the bus
    • Tweeted again to @AskCiti for help linking to the blog post

FINALLY, there was some action on 8/6:

  • The 3rd supervisor at Citibank called me back several times to see if he could help.
  • The @AskCiti people direct messaged me and called me several times.
  • The Executive response team at Citibank stepped in to help.  They even called the Bank of America CEO’s office to get them involved.
  • I’ve now had a direct person in both offices to call several times a day to try to get resolution.

In a surprise turn of events, it was Bank of America that screwed this up.  While they swore on 5 different calls that they paid the check, in the end, they showed it as cleared, but they never actually sent the money to Citibank causing the issues.  There’s some customer service issues to blame on both sides, but fortunately, the Citibank team could listen to the recorded three way call where B of A swore that they paid Citibank getting me all riled up.  I’m not sure how this happens or why me, but this has been a frustrating experience.  After 11 years with Citibank and different accounts with B of A for years, you want more.

In the end, they’ve been helpful, but I shouldn’t have to go so far to get resolution.  (Of course, B of A still hasn’t paid Citibank although they have provisionally credited my account the money…not that I’m willing to spend it yet.)


Do you ever feel like no one can help you with your issue in a company? It’s not like I have hours of free time to play games with the bank. Why can’t big companies ever actually resolve something themselves?

Walgreens and Express Scripts Collaborate To Compete With CVS Caremark

The recent press from Walgreens and Express Scripts is interesting on several fronts:

  1. We worked for years even when I was there to try to figure out a win-win around 90-day with Walgreens.  It wasn’t easy.
  2. Walgreens and Express Scripts have a “colorful” past regarding working together.
  3. This is definitely in the best interest of the patient which we don’t always see everyday in healthcare.
  4. This is a definite recognition of the success of the Maintenance Choice program by CVS Caremark.

Here’s some language from the Walgreens’ press release.

Under the new option, plan sponsors that choose to include Walgreens as part of the Smart90 program for their pharmacy benefit will provide their members who have chronic conditions such as high cholesterol, high blood pressure and diabetes, the choice to receive 90-day supplies of maintenance medications through home delivery from Express Scripts or directly at a Walgreens retail pharmacy for the same copayment. Pending adoption by benefit plan sponsors, plan members could access Smart90 Walgreens as early as January 2014.

“Working together with Express Scripts, Smart90 Walgreens will offer more pharmacy locations and better member access coverage than any single retail chain 90-day maintenance medication solution in the nation,” said Kermit Crawford, President of Walgreens Pharmacy, Health and Wellness. “Through Smart90 Walgreens, our more than 8,000 Walgreens retail pharmacies will provide plan sponsors with cost savings and will offer their members safe, easy and convenient access to important in-person pharmacist consultations and a wide-range of health and wellness services that can further improve medication adherence and lower overall healthcare costs.”

“Members will be able to continue to receive the safety, convenience, cost savings and care offered from Express Scripts home delivery pharmacies,” said Glen Stettin, M.D., senior vice president of research and new solutions at Express Scripts. “Our data are clear: 90-day prescriptions delivered to a member’s home improve medication adherence and health outcomes, lower the cost of care and add convenience when compared to 30-day prescriptions. Over the past few years, our Smart90 program has driven more 90-day prescriptions for participating clients, and we’re pleased to now offer this additional option.”

Why Use RunKeeper?

I’ve been a longtime user of Garmin for my running.  They provide easy to use GPS watches that provide you with all the details and history you want.  I also now have my FitBit as another tracking device when I run.

So, while several people encouraged me to try RunKeeper, I was hesitant.  How many trackers for the same activity do I need?  But, I started carrying my iPhone for music while I ran so I decided to give it a try.

I like it.


So, the question is why?

  1. It talks to you.  While looking at my Garmin is pretty easy, the RunKeeper app speaks into my headphones while I’m running to tell me when I’ve completed a half-mile, what my total time is, what my average mile pace is, and what my last split was.  I can certainly calculate all that and see it on my Garmin, but this is very easy.
  2. It gives you reinforcement and now some badges (through Foursquare which I don’t use).  But, I do like the reinforcement – i.e., that was your longest run, that was your fastest run.  Simple but positive.
  3. It has a nice GUI (graphical user interface) or app.  It tracks my data.  It’s easy to read.


So, if you’re like I was, I’d recommend trying it.


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