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Author: Admin

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Employer

Value-Based Care: What Is It and Why Is It Better?

Hand arranging wood block stacking

According to the American Medical Association, health spending accounted for 18.3% of the United States GDP in 2021. This equates to $4.3 trillion or 12, 914 per capita, the highest among developed nations, as reported in a study by John Hopkins University. As an employer, the need to rein in spending while ensuring your employees are healthy and productive is also a growing problem. The solution to this problem lies in Value-Based Care, a payer model we have utilized since our inception in 1982.

In the traditional fee-for-service model, healthcare providers are paid a set amount for each medical service provided. Value-Based Care (VBC) on the other hand, pays providers on the health outcomes of their patients and the quality of services rendered. In addition to negotiated payments, providers can earn incentives for providing high-quality, efficient care. Quality care can be provided under both models, but it’s the difference in how providers are paid, paired with the way patient care is managed, that creates the environment for monetary savings to be realized.

To do this, the Live360 Health Plan value-based care model takes a much more proactive approach. Many think of the healthcare system as one that takes care of people after they’re already sick. But why would you only play defense? At Live360, we prefer to improve the health of our members and therefor reduce the cost of their healthcare overtime by also having a strong offensive game. With a team-oriented and data-driven approach working across the care continuum, we can work to engage with members and providers to help our clients better manage their total health and costs. 

Our team of triage nurses, health coaches, case managers, chronic disease managers, pharmacists, physician-led board of directors, etc. all work together to help identify and preventively address member healthcare needs. These wellness efforts and care coordination strategies help better manage chronic conditions and improve overall population health. For example, a member with a history of diabetes, hypertension, and chronic obstructive pulmonary disease (COPD), and not regularly being seen by a provider, became hospitalized with pneumonia and was discharged with supplemental oxygen. In addition, he was gaining weight and had elevated blood sugar. Through enrollment in our disease management program, which is free for our members, he has made significant lifestyle changes, lost weight, improved blood sugars, and has resumed regular visits with his primary care provider. Overall, the member is motivated to become healthier, and he feels energetic and more in control. Our case management nurse checks in with him frequently to ensure he is staying the course. 

We want to be clear that savings do not come from the denial of services. On the contrary, we average about four member appeals per quarter. The VBC model helps our clients save money through:

  • Established care standards based on best practices.
  • Proactively addressing risk factors through data and early detection.
  • Direct communication and engagement with members.
  • One-on-one management of complex cases and chronic conditions by an assigned registered nurse to better avoid late-stage interventions and hospitalizations.
  • Better pharmaceutical utilization and adherence, including encouraging the use of generics and biosimilars when appropriate with providers.
  • Enhanced care coordination and data sharing to streamline administrative processes for prior authorizations and claim payment and reduce wasted spending on things like duplicative tests

By working together to analyze data, identify gaps in care, and communicate one-on-one with patients who are currently struggling to manage a treatment plan or condition, or those who are at risk for this, Live360 can achieve considerably better outcomes for a lower cost. When evaluating plans as an employer, we challenge you to ask the other insurance carriers about their value-based care approach. Live360 utilizes this model for every single one of our commercial groups (and every Medicare member), no matter the size of your group or the type of plan you select.

Interested in learning how our value-based care model can both save you money and improve the health of your employees? Contact us today at 563-556-8070, toll free at 1-800-747-8900, or click here to request a free quote.

Sources:

American Medical Association

John Hopkins University

Categories
Member

What is burnout and what can I do to combat it?

Exhausted businesswoman

Burnout is a state of emotional, mental, and often physical exhaustion brought on by prolonged and repeated stress. Though it’s often caused by problems at work, other contributors are parenting, caretaking, or romantic relationships. If you or a loved one are feeling exhausted, sluggish, and even simple tasks feel overwhelming to complete, or you find yourself so stressed out that you’re quick to get angry or frustrated – keep reading. You might be experiencing burnout.

In addition to the mental effects, burnout can also affect your physical health. Physical signs of burnout can include fatigue, headaches, sleep changes, heartburn, and other gastrointestinal symptoms due to changes in diet, as well as increased potential for alcohol, drug, or food misuse.

Burnout is different than stress. In comparison, stress is short-lived or tied to a specific goal or event. It’s mostly likely not harmful. If the stress feels never-ending and is accompanied by feelings for emptiness, a lack of interest, or hopelessness, you may be experiencing burnout.

Burnout is also different than depression. While the symptoms can often resemble depression, clinical depression isn’t a response to a particular environment or one specific trigger. With burnout, once you detach yourself from work or have a weekend away from the kids, you have the ability to relax and enjoy your time.

What can I do about burnout?

Recognizing that you are experiencing burnout is a big first step towards finding relief. Before doing anything drastic, like quitting your job, try a few of these suggestions first. Small but smart changes might make a big difference.

1. Care for your mental health.

Seeing a therapist or licensed psychologist is a good first step in tackling burnout. Have a safe place to talk to someone that is not a family member, friend, or coworker, but someone who is impartial and trained to give you clinical feedback. Need to find a therapist or licensed psychologist in your insurance network? Use this link to log into your My eLink account and view your current provider directory.

2. Establish a daily routine and enforce boundaries.

Sticking to a daily routine as best as possible will help to maintain boundaries between your work and home life, especially when working from home. Be sure to also maintain basic health habits, like taking a lunch break, eating well at meals, and getting adequate sleep. Proper diet and sleep play a larger role than many realize on how stressed you feel.

Technology has made us accessible 24 hours a day, making our ability to disconnect from work more difficult. Communicate with your supervisor or employees to find an agreeable balance between work and the other areas of your life. Manage expectations so that you don’t become overextended. A healthy boundary is achievable. 

3. Build breaks in your schedule.

While working on that daily routine, be sure to give yourself a break when you need it. Step away from the computer or whatever your source of stress is. Give yourself a personal check-in and assess whether you need to take a five-minute walk, have a healthy snack, or listen to some music for a bit to clarify purpose and direct your efforts more effectively.

4. Exercise is important.

Activity and exercise are good for both your physical and mental health for several reasons. First, it decreases stress hormones in your body such as cortisol. It also increases endorphins – your body’s “feel good” chemicals – giving your mood a natural boost. Those same endorphins help you concentrate and sharpen your memory. (Not a bad side-effect when trying to combat stress.) Activity and exercise can also be a source of self-confidence as you challenge yourself in new ways. Increasing your heart rate several times a week will also give you more energy. Try to exercise in the morning or afternoon to help regulate your sleep patterns. 

Plus, the wonderful thing about exercise is that there are many, many ways to do it. It doesn’t necessarily mean a trip to the gym. You can exercise all sorts of ways at home, such as gentle and restorative movement through yoga, core training utilizing your body weight, or walking the neighborhood. If a social element to your exercise routine is beneficial, you can join a team or league.

5. Practice mindfulness or meditation.

There is a strong and growing evidence base for simple mindfulness exercises. There are many good apps to start some exploration and journey. Try Insight Timer app, Headspace, Calm, Mindfulness coach, or Virtual Hope Box. It’s best to start with the basics to help your regulation and enjoy a simple focus, shifting from busy/worried mind states, and interrupting those times we are pushing too hard with daily demands.

6. A little “me time” is a good thing.

Self-care is an effective weapon in the fight against burnout. Though self-care or “me time” looks different for everyone, allowing yourself this time is important. For some this might be a simple activity you can do at home like a relaxing bath, some quiet meditation, or enjoying a hobby like fantasy football. For others it might be a round of golf, grabbing lunch with a friend, or getting a massage. You are not a bad spouse or parent if you need to step away and take a break. Show yourself some compassion and take a little time to unwind.

Although it may feel overwhelming right now, burnout recovery and building routines that are restorative is possible. Once you recognize your burnout symptoms, you’re better able to try making changes. This can also help you in the future, allowing you to better recognize when the boundaries are starting to blur again. Keep lines of communication open with your support systems. Also, remember to tune into your mind-body connection and keep a sense of compassion for yourself. Help is always there if you need it. 

 

Sources:

https://health.clevelandclinic.org/

https://www.psychologytoday.com/

https://www.healthline.com/

https://www.bannerhealth.com/

Categories
Employer

Yes, You Can and Should Customize Your Health Plan Options

health plan options

According to the Bureau of Labor Statistics (BLS), average employee healthcare coverage makes up 7.3 percent of total compensation, the largest employee-related expense for U.S. private employers. But with low unemployment rates, the current job market remains very favorable to job seekers. This means benefits are not only one of your biggest expenses, they are also one of the best ways for you to stand out among the crowd, working both to attract new employees and increase retention by improving employee satisfaction. The good news is there are many ways you can customize plan options to keep both your costs and help wanted signs in check.

No matter if you are looking to revamp your existing employee healthcare coverage or start from scratch, there are many factors to consider that can ultimately affect your bottom line. At Live360 Health Plan, our experienced sales associates and licensed broker partners are experts in understanding these complex and expensive decisions. The Live360 team will work hand-in-hand with you to design a comprehensive healthcare plan that mitigates costs, improves health outcomes, and ensures the best patient experience for your employees.

As you begin to plan, it’s very helpful if you have identified your organization’s budget for benefits. It’s also great to know any specific goals you have for your benefits plan. A Live360 sales associate or licensed broker partner will then evaluate all factors to customize plan options for you. This may include:

  • The age and overall health of your current employees
  • Access/proximity to primary and specialty care
  • Tax laws and regulations
  • How the plan is structured (HMO, POS, fully insured or self-funded)

Gathering employee feedback of your benefit offerings and utilization data from current plan is also helpful. Look at employee satisfaction surveys and exit interviews to compile this feedback data. Maybe there are some benefits that are underused or not valued by employees. Could these be eliminated to save costs or afford a more desired benefit? Your current carrier should provide a utilization review for you. Knowing how often a particular benefit is used and to what extent may help you determine cost-saving design practices. Analyzing this information can help create a priority list for your new benefits plan.

Another area to look for potential savings is your prescription drug formulary. Does it encourage the use of generic drugs? In 2021, the United States health care system saved billions by utilizing generic drugs, yet they only account for 3% of all healthcare spending. As the Association for Accessible Medicine reports, generics and biosimilars made up 91% of all prescriptions in 2021, but at a fraction of the cost of name brand options, they only accounted for 18.2% of all medicine spending for the year. Imagine the savings if utilization of generics was improved? You can learn more about generic drugs here from the FDA.

As your partner, we’ll help you identify areas to look for savings and improvement to ensure your plan options feature affordable deductibles, access to a quality network of providers, and no ambiguous administration fees from third party vendors. From there, you can compare these with your priority list. Maybe you’ll find that offering vision insurance or a flexible spending account (FSA) will give you a competitive advantage for recruitment? Looking at the whole picture could reveal areas for coverage improvement and/or cost savings.

We know you’re very busy, and that choosing your employee health coverage is both overwhelming but crucial. Don’t rely on a cookie-cutter package. Having someone analyze the fine details of your health benefits package can have a large impact on your business. At Live360 Health Plan, we strive to provide unmatched customer service, and we are committed to working with you through each step of the process. From quoting to open enrollment, we’re here to offer our expertise. And once your coverage begins, you can rely on us to be a resource for both your internal benefits team and your employees. We’re here to help you manage care, answer your questions, and encourage wise use of benefits.

Contact one of our licensed Live360 Health Plan account representatives today if you would like more information. Live360 offers both fully insured HMO and POS plans for groups with as few as two employees and self-funded benefit plans for businesses with 51 or more eligible employees. We can help you determine which option is right for your business. Use this link to visit our website and request a quote. live360healthplan.com/commercial

Sources:

BLS Employer Costs for Employee Compensation – September 2022

The U.S. Generic & Biosimilar Medicines Savings Report September 2022

https://www.fda.gov/drugs/resources-you-drugs/saving-money-prescription-drugs

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Member

Updated Screening Guidelines for Colorectal Cancer

schedule colonoscopy

Last year, the American Cancer Society (ACS) updated the guidelines for colorectal cancer screenings due to a rise in cases among young and middle-aged people. For those of average risk, the ACS now recommends that screenings start at age 45 instead of the previous recommendation of 50. As we celebrate Colorectal Cancer Awareness Month, we are sharing information about colorectal cancer screenings and why it’s so important to stay current on your preventive care.

In May 2021, the U.S. Preventive Services Task Force issued new recommendations for colorectal cancer stating that people at average risk should start screening at age 45, which prompted Live360 Health Plan to change its guidance to cover testing at a younger age. 

The recommended age was lowered from 50 to 45 because colorectal cancer cases are on the rise among young and middle-aged people. Deaths of people under age 55 increased 1% per year from 2008 to 2017, even though overall colorectal cancer rates have dropped.

Colorectal cancer is most treatable when found early. Colonoscopies not only detect the disease, but also prevent cancer because precancerous polyps can be removed during
the procedure.

Guidelines for screening:

  • Starting at age 45, individuals with an average risk of colorectal cancer should undergo regular screening with one of six different tests, depending on patient preference and test availability. These tests include a FIT (Fecal Immunochemical Test) or gFOBT (Guaiac-based Fecal Occult Blood Test) every year, stool DNA test every three years, a CT colonography or flexible sigmoidoscopy every five years, or colonoscopy every 10 years. The recommendations do not prioritize any one test over another.
  • Following a positive result from a non-colonoscopy screening test, a timely follow-up colonoscopy must be performed to prevent cancer.
  • Average-risk adults in good health should continue colorectal cancer screening through age 75.
  • For patients between 76 and 85, screening decisions should be made jointly with clinicians based on patient preferences, life expectancy, health status, and prior screening history.
  • Individuals over age 85 should be discouraged from continuing screening.
  • People with a higher risk of colorectal cancer, such as a family history, should ask their physician to determine the best age to start screening.

Colorectal cancer is expected to cause about 53,000 deaths in 2023, according to the ACS. Prevention and early detection are key to staying healthy. If you have questions or are unsure when to schedule your next (or first) colonoscopy, talk to your primary care provider.

Sources:

www.uchicagomedicine.org

www.cancer.org

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Member

Ten Simple Health Resolutions Everyone Can Achieve

healthy tips

Resolutions are a popular topic of discussion at the start of each new year. And while many come out of the gate strong, the majority of resolutions are dropped after just a few months. Often times it’s because we make a big, generic goal that isn’t attainable without a realistic plan of gradual steps to achieve it. However, small changes that are sustainable over a long period of time are usually more successful. Below we break down ten easy habits you can develop this year that will make a big difference in your overall health.

1. Start with a glass of water. Really.

Proper hydration is extremely important to our diet and overall health. As we sleep, our body loses water. This is why so many of us wake up a little foggy first thing in the morning; we have become dehydrated overnight. Start an easy healthy habit this year: Wake up. Walk to the kitchen. Fill a 16 oz. cup with fresh water and drink it. Do this daily.

Congrats! Before your day has even started, you’ve accomplished something healthy for your body. Bring a full water bottle to work and carry that positive momentum with you throughout the day.

2. Add one vegetable a week into your diet.

Encourage yourself to eat healthier by committing to eating just one additional vegetable a week. Hide some spinach in a smoothie, add broccoli or asparagus to your stir-fry or pasta sauce, or eat kale chips or carrot sticks as a nighttime snack. You can get creative or mix them into your favorite dishes as a place to start.

3. Go take a walk.

It’s no secret that physical activity is a key element of good health. But it can be daunting to start. What type of exercise should I do? Do I need special equipment? A gym membership? To get started, all you really need is a good pair of supportive walking shoes, a timer (your smartphone has one), and a little motivation.

Tomorrow morning, set a timer for five minutes. Walk down the street until the timer goes off. Then turn around and walk back. You just completed a solid 10 minutes of morning cardio. Do the same thing the next day, except set the timer for six minutes. Repeat this pattern until you’ve worked your way up to a 20-30 minute walk. Do this 3-5 days a week, and guess what? You now have an exercise routine.

4. Visit your doctor.

Getting examined regularly by your healthcare practitioner is important for many reasons. Having an annual checkup and staying up to date on your vaccinations are simple ways to keep your body feeling its best. Don’t forget about preventive screenings either. These can help spot potential problems before they turn into something more serious. Whether it’s a simple blood pressure and cholesterol check or a needed mammogram or colonoscopy, make sure it’s on your calendar.

5. Take care of your teeth

Brushing and flossing your teeth regularly is another easy way to maintain optimal overall health. Just like the doctor’s office, checkups and cleanings with your dentist should not be missed. Many might not realize, but gum disease can contribute to heart disease, diabetes, and even premature, underweight births. Make great dental hygiene an easy resolution on your list, especially while pregnant.

6. Get enough sleep.

Just like exercise, sleep is something we know we need to do more. But also like exercise, it can get pushed off because we are so busy. A good night’s rest is very important for both your physical and mental health. When you haven’t had a proper night’s rest, your cognitive performance slows. You can’t remember things as well, think as critically or creatively, and your reaction time and hand-eye coordination is not as quick. This is why proper sleep is a great item to prioritize for your health this year.

Eight hours of sleep is recommended for adults each night. Create a nighttime routine to get into the habit of going to bed on time. Start by setting an alarm on your phone to remind you that it’s time for bed. Next, put the screens away. Bright lights right before bed can make you more alert. Instead, try to wind down by reading, praying, or meditating for a few minutes to put the stressors of the day away. Treat yourself to a new pillow or comfy blanket if you need it and relax as you enjoy this healthy resolution.

7. Cut back on sweetened beverages.

Consuming sugary drinks such as pop, flavored coffees and teas, and even some juices in excess is linked to an increased risk of obesity, heart disease, insulin resistance, and cavities in both children and adults. Quitting these sweetened beverages cold turkey can be a tough goal to maintain. Instead, try gradually minimizing these drinks in your diet for a better chance at success. If you consume multiple sugary beverages a day, try limiting them to just one per day or simply using a sugar-free creamer in your coffee. After you’ve got that down, maybe try one every other day, or just one per week. You can still have them occasionally, but this way they will feel more like a reward or special treat.

8. Take more “me time” and practice self-care.

Taking time for yourself is not selfish. In fact, it’s imperative for optimal mental health. This is especially true for those in caretaker roles. So how do we fit “me time” in our busy schedules? Self-care does not have to be elaborate or time consuming. Maybe it’s giving yourself time for a relaxing bath each week, enjoying a glass of wine on the deck with no interruptions for a half hour, watching your favorite TV show each week, or calling a sitter to enjoy a nice dinner with your significant other. It doesn’t matter how you choose to relax, but a little self-care is worth the investment.

9. Limit screen time.

Many people depend on their phones and computers for work and entertainment. However, spending too much time on electronic devices — particularly on social media — has been linked to depression and anxiety. Setting a resolution to cut back on the time you spend scrolling through social media, news sites, or watching TV may help boost your mood and enhance productivity.

10. Don’t self-sabotage!

If you have a slip up in your new exercise or diet goals, don’t allow a bad day to dismantle your momentum. One bad day does not mean you can’t get right back in the groove the next day. No one is perfect. We are going to have bad or stressful days where we just don’t quite meet our target. That is okay! And it certainly does not undo all the progress you have made so far. Learn to forgive yourself and start again the next day.

Though most New Year’s resolutions are only kept for a short period, the healthy habits listed above are very attainable ways to improve your physical and emotional health. They can also be followed no matter your age or body type. Choose to put your best foot forward and make 2023 healthier and happier with these simple goals.

Sources:
https://health.clevelandclinic.org/
https://www.mayoclinic.org/patient-care-and-health-information
https://www.cdc.gov/HealthyLiving/

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Member

New Member Checklist: Welcome to Live360 Health Plan!

couple on computer

Welcome! Live360 Health Plan is underwritten by Medical Associates Health Plans, a regional insurer headquartered in Iowa that celebrated 40 years of service in 2022. As a Live360 member, you are now covered by a company that has built a reputation of providing award winning healthcare coverage and excellent customer service. You may have questions as you get started and we are here to help. Below are our top five tips to help you and your family utilize your benefits in the best way.

1. Utilize our convenient member web portal, My eLink.

My eLink is a convenient, confidential web portal that offers online access to your personal health plan information 24/7. It’s free and even mobile friendly! Some actions you can accomplish through your My eLink account are:

  • View and check on claims
  • View and print EOB (Explanation of Benefits)
  • Search for a network provider
  • Submit basic questions to our staff
  • Print and request I.D. cards
  • View benefit information
  • Renew and refill prescriptions
  • Compare medication pricing
  • Check the deductible amount that you’ve paid
  • View your archived claims information
  • Change your address and other personal information
  • View authorizations
  • Grant an authorization to release information

Click here to create a My eLink account today. First-time users need to click on the Proceed to our sign up process link under the login boxes.

2. Stay in your network.

Live360 Health Plan has robust relationships with physicians in multiple communities in Illinois. Our provider networks include hundreds of primary care providers, specialty care providers, independent providers, and many hospitals. Staying in your network will mean paying less than using an out-of-network provider. The same is true for mental health professionals, chiropractors, hospitals, and labs.

You can search your provider directory through your My eLink account or by visiting the member page of our website. Click on the appropriate plan type under the heading, Find a Provider. Having a primary care provider (PCP) is a great place to start. When your doctor becomes familiar with your medical history, your habits and lifestyle, they’ll be able to better notice signs of a more serious health issue and take care of you in the long run.

3. Schedule your first appointment and take advantage of preventive care.

Live360 Health Plan believes in the importance of yearly wellness exams. These exams help find potential problems early so they can be treated early. Preventive services and immunizations are covered at no cost to you when using in-network providers.  Some covered preventive services include:

  • Adult preventive exams which include lab tests, pap smears, breast and pelvic examinations
  • Child and adolescent preventive exams for members ages 7-17 years, including preventive laboratory tests
  • Well baby and child preventive examinations for members through age 6, including preventive laboratory tests, audiometry, visual acuity and lead screening
  • Coverage for colorectal cancer screening
  • Mammography examinations

Some limits apply. Refer to your subscriber agreement for specific benefit information.

4. Explore your pharmacy benefits.

Whether you take prescription drugs regularly or use medications for specific treatments, it’s helpful to understand pharmacy benefits. It could mean getting prescriptions filled more easily and at a lower cost.

We cover both brand name drugs and generic drugs. If a drug is listed on our formulary, we will generally cover it if it is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. If you are unsure if a drug will be covered, you can use the Pharmacy Drug Lookup tool found on our member website page.

5. Keep your member I.D. cards handy.

You will receive your membership card in 10-14 days after we receive your enrollment information. Live360 Health Plan members are issued a membership identification card to be presented each time care is sought at a participating provider’s office or hospital. Take your current I.D. card with you whenever you receive care. It’s proof that you have insurance with Live360 Health Plan. Healthcare providers will use the information on the card to confirm they are a part of your network and to bill us for your care.

On the back of your card you’ll find the Live360 Health Plan website address and phone numbers you can call for help. The Member Services number is handy if you have a question on coverage, prescription drugs, authorizations, or finding a provider.

We appreciate the opportunity to assist you in getting the most out of your healthcare benefits. This information and more can be found in the Live360 Member Handbook. In addition to our online resources, you can contact us 24 hours a day, 7 days a week at 217-206-5050 or toll free at 833-728-0538.

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Member

New Year’s Resolutions: Start small and have a SMART plan

Are New Year’s resolutions on your brain? Do you swear you are going to complete your goal this year? Self-awareness and improvement are great for overall mental and physical health. But according to the New York Times, one-third of those working toward resolutions don’t make it past the end of January. So what is the problem? Studies show that many of these commitments fail because they are too vague, unrealistic, or it wasn’t your idea in the first place. The trick is to make the right goals.

It’s a wonderful idea to have goals for the New Year. They just need to be smart, or S.M.A.R.T. – the acronym devised from the journal of Management Review for Specific, Measurable, Achievable, Relevant, and Time-bound goals. Does this sound familiar? Businesses use it all over the country as an employee performance tool. But it is also a great way to set your New Year’s resolutions.

Specific. Saying something vague like, “I want to lose weight” or “get fit” isn’t going to cut it. Your resolution should be precise. How much weight do you want to lose? How are you planning to lose the weight? Do you have a deadline for yourself? Think about all the particulars and write them down to be more effective.

Measurable. While it’s easier to track things with numbers like weight or fitness, other goals can be measured by logging your progress or taking photos. Sometimes there are even apps to track different behaviors and encourage progress. Resolutions such as getting more sleep, consuming less sugar, walking so many steps in a day – these can all be measured if you set up a system to do it ahead of time.

Achievable. You can have big goals, but ease into things and start small so that you don’t become frustrated. For example if your goal is to get eight hours of sleep each night, start going to bed maybe 15 minutes earlier each week or each month. Or if you’re working on your diet, swap out one unhealthy food with a healthy one each week. Add five minutes to your walk or physical activity each day. This will help you make steady, attainable progress while you work toward your goal.

Relevant. Does this goal really matter to you? Are you doing it because your friends do this or your kids suggested it? If you are making a resolution because of peer pressure or spontaneity, you may have a harder time completing it. Think hard about your long term goals and about the support system you have to reinforce those goals when designing your resolution. This will make your chances of success that much greater.

Time-bound. Now that you have made a “specific” and “achievable” plan as suggested above, creating a timeline toward reaching your goal is the next step. Breaking your goal up to create small wins gives you more personal encouragement and also helps to create positive habits over time. For example, if your goal is to lose weight, can you break your ultimate goal out into monthly increments? This will not only help keep you on track throughout the process, but it makes the end goal seem less daunting.

Now that you have a strategy for success, do you need some ideas? Check out this article from Women’s Health for some inspiration. They’ve got great ideas that start small and build toward bigger goals and healthier habits. You can try things like eating one meal of only fruits and veggies each day, or trying to add 1,000 more steps to your daily routine each week. Maybe your goal is more about your mental health and trying to reduce stress. Try taking 30 minutes of “me time” each week. We all need it!

And if you feel like your goal is just too much for you to handle on your own, seek out help where you need it. Your primary care provider can provide plenty of tips and support for diet and exercise goals. They will also know of other resources in the community, such as the Smoking Cessation program from our Internal Medicine Department. Whether you are trying to break a vice like cigarettes, or create good habits like reading each night with your kids – you can do it by creating a SMART plan.

Sources:
https://www.womenshealthmag.com/life/a22871960/new-year-resolution-ideas/
https://www.lifehack.org/articles/communication/50-new-years-resolution-ideas-and-how-achieve-each-them.html
https://www.nytimes.com/guides/smarterliving/resolution-ideas

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Member

Gain a Better Understanding of Your Health Insurance

health insurance
Health insurance text from wooden blocks on desk

Understanding your health insurance can be intimidating. Between unfamiliar terms, puzzling acronyms, and optional coverage items, there’s a lot to unpack. By better understanding how health insurance works and key aspects of your employer sponsored plan, you can better utilize your coverage to save both time and money. Take a few minutes to review these basic insurance terms:

  1. Premium: The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly, or yearly.
  2. Deductible: An amount you could owe during a coverage period (usually one year) for covered healthcare services before your plan begins to pay. An overall deductible applies to all or almost all covered items and services. A plan with an overall deductible may also have separate deductibles that apply to specific services or groups of services. A plan may also have only separate deductibles. (For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered healthcare services subject to the deductible.)
  3. Copayment: A fixed amount (for example, $15) you pay for a covered healthcare service, usually when you receive the service. The amount can vary by the type of covered healthcare service.
  4. Coinsurance: Your share of the costs of a covered healthcare service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You generally pay coinsurance plus any deductibles you owe. (For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.)
  5. Out-of-Pocket Limit or Maximum: The most you could pay during a coverage period (usually one year) for your share of the costs of covered services. After you meet this limit, the plan will usually pay 100% of the allowed amount. This limit helps you plan for healthcare costs. It never includes your premium, balance-billed charges or healthcare your plan doesn’t cover. Some plans don’t count all of your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit.

Now that you better understand these key aspects of a health plans potential costs. Review these key terms and phrases to better understand your medical bills and how you can use your coverage in the most cost-effective way:

  1. Allowed Amount: This is the maximum payment the plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
  2. Balance Billing: When a provider bills you for the balance remaining on the bill that your plan doesn’t cover. This amount is the difference between the actual billed amount and the allowed amount. For example, if the provider’s charge is $200 and the allowed amount is $110, the provider may bill you for the remaining $90. This happens most often when you see an out-of-network provider (non-preferred provider). A network provider (preferred provider) may not bill you for covered services.
  3. Prior Authorization: A decision by your health insurer or plan that a healthcare service, treatment plan, prescription drug or durable medical equipment (DME) is medically necessary. It’s sometimes called preauthorization, prior approval, or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.
  4. Network Provider (Preferred Provider): A provider who has a contract with your health insurer or plan who has agreed to provide services to members of a plan. You will pay less if you see a provider in the network. Also called “preferred provider” or “participating provider.”
  5. Explanation of Benefits (EOB): A list that you get after you’ve received a medical service, drug, or item. This list that tells you the full price of the service, drug, or item that you received. This is not a bill.

As a member, another great way to better utilize your health insurance benefits is to utilize our secure web portal, My eLink. This convenient online tool is free and gives you access to your personal health plan information 24/7. It’s even mobile friendly! You can check on claims, search for network providers, view EOBs, benefit information, and authorizations. You can compare medication pricing, print and request I.D. cards, and submit basic questions to your Member Services team. Log in to your My eLink account here. Don’t have an account yet? No problem, use the link and click on Proceed to our sign-up process to register. 

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The Importance of Annual Physicals

annual exam
Male Patient And Doctor Have Consultation In Hospital Room

Annual physical exams are essential to your ongoing health and visiting your primary care provider for regular preventive care is one of the best ways to identify and treat health issues before they get worse. Here are some reasons why annual physical exams are so significant:

Assessing Your Overall Health

Depending on your risk factors, age, lifestyle and family history, your doctor may order a variety of blood tests and other screenings during your annual physical exam, including:

  • Blood pressure screening
  • Cholesterol screening
  • Osteoporosis screening (recommended for women age 65+ and for men 70+)
  • Body mass index (BMI) calculation

These tests can identify underlying conditions, such as heart disease and diabetes, even if you aren’t experiencing symptoms. Your test results also enable your doctor to make recommendations for follow-up testing, as well as lifestyle, exercise or diet changes that can help you improve or maintain your health.

Updating Your Vaccinations

Vaccines aren’t just for kids. Adults need to keep their vaccines up to date to prevent dangerous diseases, too. Your doctor will review your vaccination history and risk factors and may recommend immunizations, including:

  • Tdap vaccine: This vaccine is a combination of tetanus, diphtheria and acellular (contains no cells) pertussis.
  • Flu vaccine: Flu shots are recommended each year for most people age 6 months and older.
  • HPV vaccine: Recommended for teens and young adults ages 11 to 26.
  • Pneumonia vaccine: Recommended for adults age 65+.
  • Shingles vaccine: Recommended for most adults age 60+.
  • Hepatitis B vaccine: For people with diabetes or other conditions that affects the immune system.

Screening for Cancer

Keeping up with routine cancer screenings can increase your chances of detecting cancer in the earliest stages when it’s most treatable. Your doctor will consider your age and risk factors during your annual physical exam and may recommend cancer screenings including those for skin cancer, breast cancer, gynecological cancer like cervical cancer, colon cancer, prostate cancer, or lung cancer.

Since cancer screening recommendations are always being evaluated and updated, it’s best to talk with your doctor about what’s best for you.

Screening for Mental Health

Your doctor may ask if you’re experiencing symptoms of common mental health conditions, such as depression or anxiety. If you have concerns about your mental health, your doctor may refer you to a specialist.

Knowing Your Family History

Your doctor will ask if anyone in your family has developed any new health conditions. If your family history puts you at risk of developing a similar medical condition, your doctor may recommend earlier screening.

Establishing a Relationship with Your Doctor

Your primary care practitioner is your healthcare partner, and an annual physical exam is a great way to get to know your doctor—and allow your doctor to get to know you. Although you may see your primary care practitioner at other times during the year for minor illnesses and injuries, those “sick care” visits usually are focused on treating a specific problem.

During your annual physical exam, the focus is on your overall wellness and the preventive care you need to stay healthy. In addition to learning more about you and your lifestyle, your doctor will allow plenty of time to address any concerns or answer questions you may have about medications, treatment plans, or other health issues.

Scheduling your annual physical exam just might be the best thing you do for your health this year!

Sources:

www.ama-assn.org

www.virtua.org

 

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Seven Reasons Why You Need a Primary Care Provider

primary care

The term “primary care provider” is commonly used in healthcare. But what exactly is it, and why is it so important that you have one? Primary care providers are doctors, nurse practitioners, or physician assistants that serve as your main medical contact.  In fact, a primary care provider — who may come from family medicine or internal medicine, depending on your needs — specializes in diagnosing, treating, and preventing a wide variety of conditions.

Without a primary care provider, you may either ignore medical problems or visit the emergency room for an illness that doesn’t really require emergency care. Neither is an ideal choice! Having a primary care provider helps you focus more on staying healthy, instead of only seeking help when you are sick or hurt. Your practitioner becomes your health coach, showing you better ways to stay healthy and live longer. Here are seven main reasons to find a primary care provider or PCP:

1. Provide Acute Care

Primary care can diagnose and treat up to 85% of issues that present to them without a referral.  Building a trusting relationship is important in acute and ongoing medical care.

2.Better Preventive Care

One of the main responsibilities of a PCP is preventive care. A PCP can make recommendations that will help you protect your health. The practitioner can get to know you, your history, and family history. This enables them to make the best recommendations for needed screenings and to identify and treat many minor problems before they become major ones. Their office will also keep an accurate record of your vaccinations, ensuring you stay up to date on this crucial preventive tactic.

3. Continuity of Care

Having a competent PCP offers a continuity of care that long-term health maintenance requires. The practitioner can treat the “whole person,” taking into account your history and existing conditions. Timely diagnosis increases the chances that you will be able to lead a longer and more productive life.

4. A Central Point of Contact

A PCP coordinates information between other healthcare providers. All healthcare that is done by specialty providers gets funneled through the PCP’s office to assist when you have questions, or are getting multiple reports. PCP’s can also make sure there is no duplication of care and testing, and that nothing is being left out.

5. A Key Resource

A PCP should be the first person in the healthcare system that you contact when you have a question or a problem. The practitioner can provide answers and recommend an appropriate specialist if needed. They can also help you find other resources, such as support groups and classes.

6. Fewer Trips to the ER

Research has shown that regular visits to a PCP initiate more proactive healthcare measures and significantly decrease the instances of emergency room visits while also improving your quality of life.  A PCP can offer options that help prevent you from making unnecessary trips to the emergency room. For example, your doctor may be able to answer questions about a condition, call in a prescription, or suggest a course of action that can be taken at home.

7. Coordinated Care = Better Quality & Lower Costs

As the medical, specialty, and mental health fields continue to change, coordination between your PCP and other practitioners has become increasingly important. Without effective communication between different healthcare providers, you may experience delays in care, misdiagnosis, incorrect or unnecessary treatment, and potentially higher healthcare costs. Part of the task of a PCP is to help you navigate through the healthcare system.

When you put the focus of your health on primary care and prevention, a PCP can better manage chronic conditions and keep you healthy and out of the emergency room. This is great for your health and your pocketbook.

Be sure to choose a primary care provider that is in your network.

If you’re in search of a PCP, make sure they are part of your health plan’s network. Choosing an out-of-network provider may leave you responsible for the full cost of the care they provide. You can look up providers in your network through our secure, online health portal, My eLink. This convenient resource offers 24/7 access to your health plan information. You can also review your coverage, check on claims and authorizations, print and request I.D. cards and more. Haven’t created a My eLink account yet? No problem. Signing up is easy. All you need is your Live360 ID card.