Carenet Trenches - In Healthcare Now

What Slow Down?

2012-02-08T13:54:00.000-08:00

Carenet Healthcare Services has enjoyed positive growth since 2009 which has been the catalyst for the company’s expansion in both people and facilities.

We are continuing to hire for a variety of positions now and this trend does not show signs of abating. Currently, we are recruiting for:

Clinical Services
Clinical Services, Supervisor (RN)
Care Adviser (RN) Weekends – Full Time
Care Adviser (RN) Weekends – Part Time

Client Services
Account Executive
Associate Account Executive

Member Services
Inside Sales – Medical
Care Coordinator
Engagement Specialist

Information Technology
Programmer
Applications System Analyst
Software Developer
Interactive Intelligence Engineer

Admin Services
Administrative Assistant – Sales Department

If you are interested in learning more about these positions, please visit www.carenetjobs.com.

Carenet is an award winning company having appeared on the Inc. 500II5000 list of “Fasting Growing Private Companies” for the last three years, as well as being recognized with multiple awards from the San Antonio Business Journal for its steady growth.

Carenet Healthcare Services delivers measurable value through our cost-effective and efficient solutions, which provide personalized member support and medical assistance exclusively to America’s leading healthcare organizations. We help our clients build and strengthen their vital relationships with their members/patients. Founded in 1988 and headquartered in San Antonio, Texas, Carenet supports 15 million members nationwide. Learn more about our customized solutions at www.callcarenet.com.

Winning RX Solutions

2012-01-30T10:05:00.000-08:00

Case In Point
One of the nation’s largest pharmacy benefit managers (PBM) partnered with Carenet to inform their members of the value and convenience of prescription drug mail-order service.

Situation & Opportunity
Millions of consumers use maintenance medications, such as drugs to control blood pressure or cholesterol. PBM’s can supply these medications with great accuracy, speed and safety via home-mail delivery for substantially less money than retail pharmacies. Enrolling members into a mail order and automatic refill prescription service saves them time and money by providing access to less-expensive drugs, multiple-month supplies, and lower co-payments while eliminating inconvenient monthly trips to their local pharmacy. Health plans also benefit as this highly efficient option reduces their plan’s cost and thus their members’ premiums. The PBM identified a key sector of its member population to target based on current medication regimen and potential cost savings. They turned to Carenet to provide the personalized support required to convert this valuable audience to their home-delivery service.

Success Strategy
A customized communication and conversion strategy was developed by Carenet to encourage members to enroll all their maintenance medications into the PBM’s mail order and automatic refill services. Carenet’s knowledgeable engagement specialists contacted more than 100,000 members to inform them of the program’s benefits. By leveraging the engagement team’s ability to build one-to-one relationships and the PBM’s customer data, Carenet was able to tailor each conversation to a member’s specific needs and medications, and advise them of the potential cost savings and convenience factors associated with the service.

Performance Delivered
By combining expert engagement specialists with finely tuned customer relationship management (CRM) technology and skills, Carenet converted 45 percent of the contacted target audience from retail to mail service and enrolled over 75 percent of their eligible prescriptions into the mail program—an average of five drugs per member. Of the enrolled prescriptions, 95 percent were registered for automatic refill service. This high conversion rate far exceeded the PBM’s expectations and has led to many more successful programs.

Become a Success Story
As drug costs and chronic-disease management needs grow, both payers and members seek strategies for lowering costs without compromising quality. Carenet’s pharmaceutical engagement programs can help. By personally reaching out to members and informing them of their options from generic drugs to mail order service, Carenet’s engagement specialists save everyone time and money. With nearly 25 years in the healthcare arena, Carenet knows how to deliver measurable results. Learn how you too can become a success story; contact Carenet today.

Innovative Healthcare, what does that mean?

2011-06-08T10:03:00.000-07:00

In a recent article by Laura Landro that appeared in The Wall Street Journal, the author explores the necessity of innovation in healthcare. Much of the new legislation that is shaping the future of our healthcare system will require those who operate within its confines to transform the way they do business.

Carenet Healthcare Services is uniquely positioned to be a driver of innovation for many of these companies. With a long list of clients in markets that include health plans, government programs, U.S. military system, employer groups and hospital systems, our solutions address a host of opportunities to better serve the member population.

Read how our program assisted an MA Plan in setting mammogram appointments.

One of our recent programs helped to successfully increase appointment setting for an MA Plan's member population by 165 percent.

The Time to Innovate Is Now

The Wall Street Journal
By LAURA LANDRO

Finding innovative ways to deliver health care has never been more important than it is today.

Read the complete Innovations in Health Care report.

With the passage of sweeping health-care legislation last year, 32 million more people are expected to flood into a health-care system already strained by rising costs and a short supply of physicians, nurses and other clinicians.

At the same time, reining in health-care costs is crucial if the government is going to deal with a long-term budget deficit that is spiraling out of control.

How will an increasing number of people get quality care at a cost that the nation can afford? The answer isn't hard to figure out. It's innovation.

Easier said than done, of course. Unlike many other industries, health care has remained highly fragmented, with a hierarchical culture resistant to change, and a payment system that rewards providers for quantity rather than quality of care. It has been slow to adopt technologies like electronic medical records that have the potential to make care more efficient and safer for patients. Even when new practices have been shown to improve care and reduce error, hospitals and doctors have been slow to adopt them.

The government is determined to be part of that solution. The new health-care law also created a Center for Medicare and Medicaid Innovation charged with identifying, testing and spreading new ways of delivering and paying for care. In introducing the new innovation center, Donald Berwick, head of the Center for Medicare and Medicaid Services, promised that it will work with caregivers, insurers, and employers to replicate successful innovations in communities across the country.

But, he warned, "none of this will be easy. Government cannot and should not do this alone."

In fact, as you'll see in this report, government is far from doing this alone. You'll read of doctors, hospitals, insurers, researchers and cities that are all experimenting with novel methods to improve the quality, safety and effectiveness of care at a reasonable cost. Some are pioneering new delivery systems that encourage providers to coordinate patient care, rather than work at cross-purposes with little communication. Others are rigorously testing safety practices to determine how teams of caregivers can reduce adverse events and errors. Still others are mining medical records to identify patients who aren't taking their medications or might benefit from enrollment in a clinical trial.

And then there are all those attempts to give consumers the resources they need to stay healthier in the first place. That can mean things as simple as building more sidewalks and bike paths, or getting schools to bring back exercise at recess. Sometimes innovation means getting back to the basics.

Finding Healthcare's Funny Bone

2011-05-27T08:37:00.000-07:00

Healthcare is a serious issue, more serious for some than others? An article recently published in HealthLeaders Media looks at the role of humor in this sacred space. Is there a right time or place to inject a slightly skewed view of the issues facing us today?

At Carenet Healthcare Services we try to find the most appropriate way to tell our story everyday. It's a struggle because as a team we are different from the traditional healthcare company, but we still want to be respectful of the space. Do our recent ads reflect this for you?

Humor's Role in Healthcare Marketing
Anna Webster, for HealthLeaders Media , May 18, 2011

Can humor be used to address serious healthcare problems? Many ads and marketing campaigns for healthcare services tend to take the safe (and more serious) route when discussing the quality or reliability of an organization. But some healthcare marketers are walking the line between funny "haha" and the type of funny that raises eyebrows.

Mixing healthcare and humor can be a risk – is it one that pays off?

HealthLeaders recently featured a campaign spotlight centering on a marketing campaign from Blue Cross Blue Shield of North Carolina. The BCBSNC website, features goats dressed in shirts with the tag line, "let's stop looking for scapegoats" in reference to escalating healthcare costs.

"If we're going to make a difference and address out-of-control costs, we have to start somewhere. The campaign we've launched featuring the scapegoats was a way for us to do that," said Kathy Higgins, VP of Corporate Affairs for BCBSNC, in response to a blog critique of the website.

My question: is Blue Cross making light of the situation of rising medical costs? The point of the website is that everyone (consumers, doctors, hospitals, and insurers) can be seen as a scapegoat – we are all in the same boat and thus no one should be offended. This type of satire works well on shows like Family Guy but in healthcare, it's less common and may ruffle a few feathers.

Using farm animals could be taking the point past humor and toward mockery.

BCBSNC doesn't see it that way. "We used goats to emphasize that no one group is to blame, but to make it clear that everyone, including us, has a role to play," added Higgins. "The humor in these ads helps us make our point and address the complexity of the issue, but we are serious about the need to control medical costs."

I applaud BCBSNC for starting the conversation and looking for solutions to an escalating problem. The payoff for Blue Cross may be measured in audience participation on the website. Site visitors may post questions and receive answers from other patients or members or BCBSNC employees. But as far as a monetary payoff goes, BCBSNC has not disclosed how much was spent on the campaign, so ROI remains unknown.

"This is not to make light of a serious issue," Brad Wilson, CEO of BCBSNC, said in a recent News & Observer article. "We made a conscious choice to use humor in this campaign as a way of opening the door to a conversation that can be complex and, at times, uncomfortable. Finding solutions to rein in medical costs is in the best interest of our company, our customers and everyone in North Carolina."

Humor is tough because it can be mistaken for downplaying the issue at hand. Lexington Medical Center in West Columbia, South Carolina has also used humor to highlight selected healthcare services or departments. Its television campaign features scenarios of people injuring themselves during the holidays. The tagline is: "We see some crazy things during the holidays. Please try and take it easy this year, have a safe and merry Christmas."

The physical comedy of holiday accidents in the Christmas commercial of 2010 won Lexington Medical Center an Aster Award in Healthcare Advertising, a national healthcare marketing award competition based on creativity, quality, message effectiveness, consumer appeal, graphic design, and overall impact.

In the Lexington Medical Center campaign, the acting is over-the-top and makes the point that the ad is meant to be taken light-heartedly. In the BCBSNC campaign, though the ad is meant to be humorous, the issue at hand is a serious one.

I can see laughing at hanging a wreath or tripping down the stairs, but escalating healthcare costs…? Not so funny to me.

2011-05-17T07:54:00.000-07:00

A recent story in the Chicago Tribune does a great job of exploring the upcoming patent expiration on some of the top drugs in the U.S. The report also explores and reinforces the safety of generics and why patented drugs are so expensive when they come to market.

Health plans and pharmacies will look for ways to effectively market the patent expirations and provide savings information to members and customers, helping bring their annual drug spends down.

Carenet Healthcare Services understands the engagement opportunities available with the upcoming status changes for these drugs. Carenet designed and rapidly deployed an engagement program for a health plan that encouraged its members to try at least one generic equivalent for three brand name statins. Within a six-week period the engagement team achieved a 440 percent lift in savings over the health plan’s prior direct mail campaign.

Big savings coming from emerging generic drugs, patent expirations

Some of the top-selling drugs in the U.S. — including Lipitor, Plavix and Actos — will lose patent protection in the coming years, promising big savings for consumers

By Bruce Japsen, Tribune reporter

10:16 PM CDT, May 4, 2011

Lipitor. Actos. Plavix.

These are some of the most-prescribed medicines in the U.S., drugs that are so commonplace they are responsible for a huge chunk of the $300 billion spent on brand-name pharmaceuticals each year.

That is about to change as patents on these pricey pills begin to expire, opening the door for generic competition. And that can translate to savings of up to 90 percent, analysts say, making these drugs affordable to more consumers.

Americans will see cheaper copies of some of the biggest drug names starting this fall. Out-of-pocket costs of the generic form of Lipitor, a widely used and advertised cholesterol drug that loses its patent protection in November, will be reduced to as little as $4 for a month's supply. Even for a person with health insurance, Lipitor can cost $25 to $40 — or more — each month.

In the next two years, six of the nation's 10 best-selling drugs are expected to be available in generic form. They include Lipitor, which lowers levels of the bad (LDL) cholesterol; Actos, a blockbuster diabetes drug; and Plavix, which reduces the risk of deadly blood clots after surgery.

"The human scale of all this is unprecedented," said Michael Kleinrock, director of research development at IMS Health, a market research and information firm that tracks the health care industry. "For most of the last two decades, many of the most popular drugs were for large populations in the primary setting. When those drugs go off patent and become available, there are going to be big savings coming for patients."

More than $100 billion in annual brand-name drug sales will be at risk for generic competition from 2011 to 2015. That's about one-third of the annual spending on all prescription drugs in the U.S., according to IMS data.

Pharmacies and health insurance plans are expected to step up marketing and education to get consumers to use generics.

"You are going to see more and more people being pushed to generics," said Linda Bannister, health care analyst with Edward Jones in St. Louis. "For patients, I see a big dividend for the research the drug companies put in in the late 1980s and 1990s."

As for consumers' concerns about the effectiveness of generic drugs, doctors say the cheaper versions have the same active ingredients as their brand-name counterparts. Also, the Food and Drug Administration requires that these cheaper copies be as safe and effective as the patented versions.

The primary reason generics are cheaper is because the companies that make them don't have the expenses tied to bringing a drug to the market.

"The medical profession has struggled to dispel the perception that generics are somehow inferior, but it is simply bogus," said Dr. Caleb Alexander, an internist at the University of Chicago Medical Center and a pharmacoepidemiologist who studies the quality of prescription drugs as well as pharmaceutical cost issues. "(Generics) are the same."

Many of the brand-name drugs were launched in the 1990s, a golden age for the pharmaceutical industry when breakthrough treatments for some of the most chronic health conditions such as diabetes, high cholesterol and hypertension became available to the masses.

They have been credited with helping to reduce deaths as well as the need for expensive surgeries. The volume of open-heart surgery, for example, has dropped nationally since 1998, according to statistics from the American Heart Association.

But these expensive medications also have been blamed for a spike in health care costs. And their price has made them prohibitive for many Americans.

Certain brands cost $3 to $5 a pill, which quickly adds up for consumers who need to take them daily to manage their health conditions.

Pharmaceutical companies say they have to charge a premium to recoup their investment for research and development, which can reach into the hundreds of millions of dollars for just one drug. Patents are granted for 20 years, but drug companies have argued they have 10 years or less to market the product exclusively due to the many years it takes to discover, research and develop the drug before it is approved by the FDA.

The biggest impact for consumers will come from generic competition for Pfizer Inc.'s Lipitor, which has grown to be the top-selling drug of all time, generating more than $9 billion in U.S. sales at one point in its history. Competition from other statin drugs has started to make a dent in Lipitor's sales, which slowed to about $7 billion last year — an early sign of what Pfizer faces when its drug loses patent protection in November.

"Recognizing the significant role Lipitor has played in the cardiovascular health of millions of people with heart disease or risk factors for heart disease around the world, Pfizer is actively exploring how the Lipitor brand can continue to improve cardiovascular health following its loss of market exclusivity," Pfizer said in a statement to the Tribune.

Analysts note that drug companies typically find ways to fend off generic competition for as long as possible. There's the widespread tactic of creating "patent extenders," which involves slightly altering a brand-name drug by developing extended-release versions or prescriptions that require different dosages.

Some also try to protect their patents by taking makers of generic drugs to court, which can delay the release of cheaper copies by months. "The dates are a movable feast because there is always patent litigation, so the dates (of patent expiration) may move a little bit," Kleinrock said.

Meanwhile, makers of generic drugs eagerly await the opportunity to make cheaper copies, a business worth tens of billions of dollars around the world. The generic drug business has become a fast-growing industry, particularly in emerging economies such as India and China where consumers don't have as much money to spend on medical care and generics are a way to provide more affordable treatments.

Drugmakers have seen their sales take a hit after their generic versions are launched, often forcing them to cut thousands of jobs. To find other ways to make a profit, many companies have turned their attention to biotechnology drugs, specialized treatments derived from animal or human cells. Such therapies are booming as the medical industry sees biotech drugs to be more effective than older treatments, but they come with a higher price tag.

While biotech drugs are complex to develop and manufacture, making them very expensive for consumers, they can pay off for drug companies.

Take Abbott Laboratories, which bought Knoll Pharmaceuticals in 2001 for $6.9 billion largely to get a single drug.

In that deal, the North Chicago-based drug giant obtained Humira, a drug derived from human cells used to treat a variety of autoimmune diseases such as rheumatoid arthritis and Crohn's disease. Today, Humira is on pace to generate more than $7 billion in annual worldwide sales for Abbott.

Analysts see future drug development moving toward biotechnology as scientists look for ways to treat diseases and conditions that include cancer, multiple sclerosis and Alzheimer's disease.

"A lot of people think drug development is cyclical," Bannister said. "There are a lot of innovative medicines on the horizon. Hopefully, there will be new products."

Accountable Care Organization (ACO), just a phrase or a workable solution?

2011-05-06T09:07:00.000-07:00

The Wall Street Journal published an article taking a closer look at the Accountable Care Organization (ACO) model. ACO's have become the "solar power" of health care, the idea seems to address major pain points of the industry, but putting them into use large scale is proving difficult.

Carenet Healthcare Services offers integrated solutions for physicians and hospital systems that helps distill the costs, time and management of patient care. Our engagement model, clinical services and care coordinators assist healthcare professionals in providing the best care and experience to their patients.

The Model of the Future?
The health-care law promoted accountable-care organizations. But it's hard to know what they are.

By AVERY JOHNSON

The 2010 health-care law encourages the development of accountable-care organizations as a way to improve care and reduce costs.

So what exactly are accountable-care organizations, anyway?
In broad outline, these entities propose to unite doctors and clinics or hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care. When the group can show that it is improving care and delivers it for less than the cost projected—arrived at by crunching historical patient data for that market—a share of the savings goes to the ACO's bottom line.

ACOs exist more on paper than in reality, for now. But a few organizations up and running for decades do closely resemble how the concept can work. One of the most prominent is Atrius Health of Newton, Mass., an alliance of five medical groups comprising more than 800 physicians, about 700,000 patients and 30-plus care centers in eastern Massachusetts.

"An ACO is like a unicorn; everyone thinks they know what one is, but no one has ever seen one," says Gene Lindsey, president and chief executive of Atrius Health. "A few months ago, I announced to our organization, 'We are an ACO.' "

The term was invented only in 2006 and was just recently worked into the 2010 health-care reform law. Regulations for ACOs from the Department of Health and Human Services are pending, and the National Committee for Quality Assurance, a nonprofit that accredits health-care organizations, is in the process of developing ways to accredit the groups.

Roots in the '60s
Doctors, nurses and technicians at Atrius Health, part of Harvard Community Health Plan back in the 1960s, constantly strive to shave costs and improve quality. The group saved $62 million in 2010 from improvements that lowered costs.

A committee of doctors and other employees reviews operations looking for specific ways to make them more efficient. A few months ago, for example, the panel noted it was taking MRI technicians and nurses 10 minutes to turn over exam rooms between patients. After making some adjustments, such as removing cabinet doors so technicians could get at supplies more easily, it now takes five minutes. The result: an increase of two MRI patients a day, or 700 scans a year. Atrius Health recorded roughly $3.5 million in savings last year from this change alone.
Other innovations adopted include an electronic medical records system that helps measure quality and identify problems in patient care. Atrius Health also uses case managers, who help patients with chronic conditions coordinate care using multiple doctors and medicines; and pharmacists who review patient records to identify problematic drug interactions or cheaper alternatives for persons on multiple medications.

Two years ago, the group's doctors started a monthly process of sharing and discussing patient records. Physicians performing near the bottom of the pack thus can learn from peers who are seeing better results. Atrius Health executives say the practice has improved quality of care across the organization.

Quality measures are showing improvements, too. Atrius Health reports it has been able to boost the number of patients receiving cholesterol screenings to 88% from 80% and the number of diabetics getting a certain blood test to 79% from 68%.

An Adoptable Model?
Still, some critics argue that the ACO concept is not widely adoptable.

The health-care law calls for paying providers for the services they use and for rewarding them for any savings, initially in the Medicare program.

Atrius Health is paid by health plans with traditional fee-for-service deals for about 50% of patients. For the rest, when cost of a patient's care exceeds the limit set by the payor, Atrius Health has to cover the difference. The group has enough scale that it is able to improve quality, wring out waste and absorb losses on certain cases.

But smaller ACOs might not be able to get to that scale.

"It's so much like the old managed care that people really didn't want," says Jeff Goldsmith, a professor at the University of Virginia. That model, tried extensively in the 1990s, led to outcry over care rationing and caused some providers to lose money. Mr. Goldsmith worries that patients could find themselves in ACOs without being given a choice.

Organizations can try to limit their risk, as Atrius Health does, by accepting pay from some insurers for total care, and pay for services as performed from others. But critics say it also could be confusing for doctors in an ACO if they're paid different ways by different insurers.

Payor Problems
Atrius Health admits having multiple payor sources can be a problem, as it can create conflicting agendas for care. For instance, the group's global payments cover care coordinators for patients, while its fee-for-service payments do not. It has resolved this problem, it says, by allowing the global payments to subsidize the fee-for-service patients. But Chief Physician Executive Rick Lopez acknowledges that not every group would be able to do that.

Another concern: "Hospitals and doctors don't work together well," says Mr. Goldsmith. Hospitals' incentive is to maximize revenue through admissions, Mr. Goldsmith says, while doctors aim to keep their patients at home or in outpatient facilities.

Dr. Lopez agrees: "It absolutely is a tension that underlies the concept." Atrius Health has ended preferred relationships with hospitals when they didn't share its collaborative approach, he says. But the group has saved roughly $5 million in 2010 from its hospital partnerships.
Atrius Health is unique in some ways. It's a large and sophisticated group that is able to pull off care coordination because it can afford to invest in information technology and other costly improvements.

By contrast, so many mom-and-pop medical groups and small hospitals lack these kinds of resources, Mr. Goldsmith says, "the idea that this could scale to the rest of the health system is seriously flawed."

Elliott Fisher, the Dartmouth Medical School professor who helped coin the term ACO, and who worked with members of Congress to draft the ACO concept into the health-care law, concedes that "there are some really important questions about whether this will work."
But, Dr. Fisher adds: "I think it's the best hope we have."

Ms. Johnson is a reporter for The Wall Street Journal in New York. She can be reached at avery.johnson@wsj.com.

Interesting Statistics

2011-03-31T07:55:00.000-07:00

We found the statistics below at www.healthcareproblems.org. Carenet Healthcare Services faces these numbers each day as we help our partners accomplish their initiatives. By delivering performance driven results in Member Engagement, ER Diversion, Disease Management, Health Coaching as well as many other areas of opportunity. Our markets, which include Health Plans, Government Programs, Employers, US Military and Hospital Systems, are working to meet the demands of their member populations by offering the best possible services and an ongoing effort to contain costs. While Carenet does not endorse the extrapolations written in the piece we did find the statistical information compelling.

Health Care Statistics

Healthcare is one of the top social and economic problems facing Americans today. The rising cost of medical care and health insurance is impacting the livelihood of many Americans in one way or another. The inability to pay for necessary medical care is no longer a problem affecting only the uninsured, but is increasingly becoming a problem for those with health insurance as well.

In 2007, nearly 50 million Americans did not have health insurance, while another 25 million were underinsured. (Source: Commonwealth Fund Biennial Health Insurance Survey 2007)
The amount people pay for health insurance increased 30 percent from 2001 to 2005, while income for the same period of time only increased 3 percent. (Source: Robert Wood Johnson Foundation)
The total annual premium for a typical family health insurance plan offered by employers was $12,680 in 2008. (Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2008)
Healthcare expenditures in the United States exceed $2 trillion a year. (SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group;) In comparison, the federal budget is $3 trillion a year.

The underinsured are those who have health insurance but still struggle to pay their healthcare bills. Many of them are faced with rising health care premiums, deductibles, and copayments, as well as limits on coverage for various services or other limits and excluded services that can increase out-of-pocket expenses.

The following statistics were part of a study conducted by the Commonwealth Fund and recently published in the online version of the Health Affairs journal:

The number of people who are underinsured has grown 60 percent to 25 million over the past four years.
The fastest growing segment of the underinsured are middle and upper income families. The rate of underinsured for those with incomes of $40,000 or more nearly tripled, to 11 percent.
The highest rate of underinsurance is in families with incomes under the poverty level (about $20,000), at 31 percent.

To consider an individual underinsured is a somewhat general concept which can vary depending on individual circumstances. The researchers at the Commonwealth Fund, however, define the underinsured as “people who spent 10 percent or more of their income on medical expenses (or 5 percent if they were low income), or people who had deductibles that equaled at least 5 percent of the family annual income.”

As part of the study, researchers found that the underinsured behave a lot like the uninsured when it comes to medical care. That is, they often don’t visit the doctor, don’t fill prescriptions, and don’t undergo preventive checkups and lab tests. Even when they go without preventive care and necessary prescriptions, many of the undersinsured are still unable to cover all their medical expenses.

In a study completed by the Commonwealth Fund, 45 percent of the adults in the survey reported that they had a hard time paying their bills, even with health insurance, and had been contacted by a collection agency or had to change their way of life in an effort to pay their medical bills.
Approximately 50 percent of personal bankruptcies are due to medical expenses. (Source: Health Affairs)
According to a Kaiser Family Foundation poll, 28 percent of middle income families (annual family income between $30,000 and $75,000) stated that they were currently having a serious problem paying for healthcare or health insurance.

Most Americans would agree that health care reform needs to happen, but the disagreement is on how a new health care system should be structured and funded. What doesn’t work is a health care system administered by profit-driven corporations and health insurance benefits that are primarily tied to employment.

Health care benefits are an important factor in either taking a new job or staying with a current job. Approximately 25 percent of employed individuals choose employment based on better health benefits. (Source: Kaiser Family Foundation)
Many co-habitating couples are getting married in order to provide their new spouse with access to health care benefits. (Source: Kaiser Family Foundation)
Retirees will need an estimated $635,000 (per couple over age 65) to cover healthcare costs in retirement. This amount is estimated to give a retired couple a 90 percent chance of having enough money to pay for their health expenses beyond what Medicare covers. (Source: Employee Benefit Research Institute)

The United States is fast becoming one of the worst health care systems in the world. Not only are they the only industrialized nation that does not provide some form of universal health care to it’s citizens, they have one of the highest rates for health care expenditures.

Health care expenditures in the United States are the highest of any developed country, at 15.3% of GDP. The country with the next highest spending is Switzerland, at 11.6% of GDP. (Source: Organisation for Economic Co-operation and Development)
The United States does not spend health care money efficiently. An estimated one-third of 2006 health care expenditures, about $700 billion or nearly 5% of GDP, did not improve health outcomes. (Source: Congressional Budget Office)
Prescription prices for drugs still under patent protections (as opposed to generic medications) are about 35% to 55% higher in the United States than they are in other countries. (Source: Congressional Budget Office)

One of the biggest and most costly aspects of health care is the treatment of chronic diseases. It will be hard to make insurance affordable without changing how chronic disease is treated.

75% percent of total health care spending in the United States in 2007 went towards the treatment of chronic diseases, such as diabetes and asthma. (Source: CMS)
Approximately half of all chronic diseases are linked to preventable problems including smoking, obesity, and physical inactivity. (Source: CDC)
Numerous studies have shown that when patients with chronic diseases focus on their health and get involved in their own care, their health improves and health expenses decrease.

The problems with health care are affecting many Americans: the uninsured and insured, the unemployed and working, children and retirees, single individuals and families. From lack of access to preventative care and the high cost of medical treatment, there are many health care problems facing Americans. By sharing our experiences and problems in regards to health care issues, hopefully we can find a better solution for fixing our health care system.

An Emergency Room Visit, Should I or Shouldn't I?

2011-03-07T13:56:00.000-08:00

Fevers often strike at the most inconvenient times, especially when they belong to our children. There are a lot of questions surrounding how fevers affect children and when you should intervene.

In a recent USA Today article, "Parents shouldn't fret over kids' fevers," explores a report by the American Academy of Pediatrics to highlight how parents and caretakers often approach fevers more aggressively than necessary.

This report brings to light one of the biggest pain points facing some of our clients, Emergency Room utilization. When a child has a high fever, many parents seek to take immediate action to stave off what they fear will cause permanent damage or even lead to death. When fevers are detected late at night or on the weekends many people turn to emergency rooms for diagnosis and treatment.

Carenet Healthcare Services, offers plan members several expert solutions to turn to when these situations arise. The 24-7 Nurse Triage line offers support by informing members on varying degrees of care from at home treatment options that require no medical attention, unless symptoms worsen in a given period, to directing them to an urgent care facility in the area. And, when the situation demands it, having the members go to an ER or call for emergency medical support.

Other solutions that also deter the use of the ER as a treatment center are Post Discharge Follow up, Device Monitoring, Decision Support and Patient Advocacy.

Health Care Advocacy

2011-03-02T10:11:00.000-08:00

A recent Wall Street Journal article titled Working the System: One Cancer Patient's Story did a fantastic job of highlighting the frustration and pitfalls or trying to navigate the health care system alone.

Carenet Healthcare Services can answer much of the irritation that meet members in their journey through the system with its Care Advocates. Studies show that 80% of all medical bills contain errors and often contain confusing codes and language which make it difficult for members to review bills for accuracy.

Most people pay their medical bills when they are received without question. It’s unfortunate that it takes something life changing like the patient in the WSJ article experienced for a person to take the time to really understand their benefits coverage. The writer, Anna Wilde Mathews reports that her subject spent somewhere along the lines of $600,000, including travel and other expenses, with about $100,000 coming from his own pocket. This is a perfect example of the types of cases Carenet's Care Advocate encounter on a daily basis.

Advocates are able to educate and empower members, who have been diagnosed with chronic illnesses, in their journey through the healthcare system. They fill in any gaps that a client's members may experience with treatment, testing, transportation, lodging, and even financial assistance. Carenet's Advocates have resources nationwide that enable them to partner with and refer patients and help minimize any gaps in care or the accumulation of excessive expenses. By acting as advisers as well, they help patients understand the need to stay within their covered network of benefits to prevent higher out of pocket costs.

If out-of-network services are required, the advocates are able to assist with obtaining authorization for the services at in-network rates depending on the circumstances. The team can also help a client's member understand the advantage of waiting until explanation of benefits are received and at that point can review them together to ensure accuracy. If something needs to be disputed it is dealt with directly via the provider’s office and the insurance company to resolve any issues.

Another benefit of working with an Advocate is their ability to assist with making payment arrangements, obtaining discounts on medical bills usually ranging from 10-70%, and sometimes even having the balance forgiven.

Healthcare advocacy is one of the most valuable services provided in the industry as it bridges the crucial gap between benefits and care, provider and patient, and hospital and home. It is the support needed for a healthy journey.

Flu Season

2011-03-02T10:01:00.000-08:00

USA TODAY reports Flu Season is picking up. Our nurses are certainly getting an influx of calls from members with symptoms. What advice do the experienced clinicians at Carenet Healthcare Services have to offer (the information below is not a diagnosis, if you think you have the flu, follow up with your personal physician or nurse advice line for their treatment suggestions)?

1)Use a cool mist humidifier to moisten air. Be sure to clean according to manufacturer's instructions.

Consider use of a saline nasal spray per package directions to help relieve nasal congestion.

2)Sore Throat Relief:

Use warm salt water gargles 3 to 4 times/day, as needed (1/2 tsp. salt in 8 oz. [.2 liters] water).
Suck on hard candy, OTC or herbal throat lozenges (sugar-free if diabetic)
Eat soothing, soft food/fluids (broths, soups, or honey and lemon juice in hot tea, Popsicles, frozen yogurt or sherbet, scrambled eggs, cooked cereals, Jell-O or puddings) whichever is most comforting.
Avoid eating salty, spicy or acidic foods.

3) Over-the-counter medicine relieve the symptoms only. They do not treat the virus. Antibiotics do NOT treat flu or cold symptoms, but may be prescribed by the provider for other indications.

4) If you can, stop smoking now and avoid all secondhand smoke.

5) Coughing up mucus or phlegm helps to get rid of an infection. A productive cough should not be stopped. A cough medicine with guaifenesin (Robitussin, Mucinex) can help loosen the mucus. Cough medicine with dextromethorphan (DM) should be avoided.

Drinking lots of fluids can help loosen the mucus too, especially warm fluids.

6) Respiratory Hygiene:

Cover the nose/mouth tightly with a tissue when coughing or sneezing.
Use tissue 1 time and discard in the nearest waste receptacle.
Wash hands with soap and water or alcohol-based hand rub after coming into contact with respiratory secretions and contaminated objects/materials.
Alternatively when no tissue is available, cough into the bend of the elbow.
Avoid touching your eyes, nose or mouth.

7) Over-the-counter Medications:

Be very cautious and always read the label on over-the-counter medicines such as "flu and cold" remedies. They often contain combination of pain/fever relieving medicines, decongestants, or antihistamines.
An overdose of medication can occur when over-the-counter combination remedies are taken with other medicines that duplicate the ingredients.

8) Consider nonprescription decongestant (Sudafed, Drixoral) for relief of symptoms after checking with a provider, especially if there is a history of hypertension, hyperthyroidism, heart disease, diabetes, glaucoma, urinary retention caused by prostatic hypertrophy.

9) Rest until symptoms improve.

10) Expected Course - Influenza:

Symptoms start to improve in 3 to 7 days.
Cough and feeling tired (malaise) may continue for more than several weeks.
Symptoms for longer than 7 days require an evaluation by a provider.
Cough and feeling tired (malaise) lasting more than 2 weeks require a medical evaluation.

This information is not intended as a diagnosis, if you think you have the flu, follow up with your personal physician or nurse advice line for their treatment suggestions.

Medical Device Monitoring

2011-02-28T07:48:00.000-08:00

We may be a few years away from a Tricorder (my first Star Trek reference of the day) but, medical devices and the capabilities to monitor them are making amazing advancements. A recent USA Today article "Tiny sensor keeps heart patient out of hospital" explores how this technology is helping monitor heart patients and alert their doctors when adjustments in medications are necessary.

Carenet Healthcare Services works with leading medical device companies across the country to assist them with the implementation and monitoring of Medical Device programs. Responsive in-home patient care is the goal of these programs. Ensuring patients are given the attention they need to remain healthy, without frequent trips to the hospital or physician's office.

Chronic-Disease management requires vigilance for patients to remain healthy, and as technology evolves treatment options will expand. Carenet Healthcare Services is poised to adapt its technology and services to answer the needs of clients and their members.