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Greetings!
In the articles
below, we've included important and
interesting information on topics
that you've surely been hearing about
in the news, like National Health
Care and the Swine Flue. Also included
in this edition of the monthly newsletter,
you'll find information on recent
PBG media coverage, a cost saving
Blue Cross prescription option, and
a PBG sponsored charity golf event.
As always, please contact our office
for additional information.
A Blue Cross
Blue Shield Q & A:
August 21, 2009 - Blue Cross
released the following Q & A to
try to help their members understand
the issues at hand and the their position
on national health care reform.
Q: President Obama recently unveiled
eight consumer protections that he
says are necessary to protect consumers
from the practices of health plans.
What does Blue Cross Blue Shield of
Massachusetts think about this?
A: First, it's important to note that
the health insurance industry has
already agreed to end the practices
to which the president is referring.
(See America's Health Insurance Plans'
press release, "AHIP Proposal
Includes Guarantee Issue, Rating Reform,
and Coverage Requirement.") Second,
most, if not all, of the insurance
reforms the president is speaking
about already exist in Massachusetts.
For example, no health plan in Massachusetts
can refuse to enroll a member based
on a pre-existing health condition.
And lastly, without more specifics,
it's hard to say whether Massachusetts
will be fully compliant with the president's
consumer protections for "annual
caps on out-of-pocket expenses, deductibles
or co-pays," "no annual
or lifetime caps on coverage,"
and "no cost-sharing for preventive
care." These protections are
defined by minimum creditable coverage
(MCC) requirement in Massachusetts,
which does include some cost-sharing
on preventive care services and other
limits.
Q: Does Blue
Cross Blue Shield of Massachusetts
support national health care reform?
A: Absolutely, yes.
And we believe the 2006 Massachusetts
health care reform law should serve
as an important model. Also, the Massachusetts
law focused on expanding coverage
to the uninsured but did not adequately
address the rising cost of health
care. As you know, the state has since
begun taking steps to slow rising
costs, including the recent recommendations
by the state's payment reform commission
to reform the way we pay for health
care. We believe it's imperative for
any meaningful national health care
reform to address both expanded coverage
and cost containment.
Q: What does
Blue Cross Blue Shield of Massachusetts
think about a so-called "government
option" that would have a government
health plan compete with private health
insurers?
A: We oppose a government
option because we do not believe it
is necessary. Massachusetts has been
able to cover 97.5 percent of Massachusetts
residents without a government plan.
We are also very concerned that the
government would underpay providers
who would seek to recapture losses
on public coverage from private insurers.
This cost-shift trend already exists
in Medicare and Medicaid today and
would only be exacerbated by the introduction
of a government option. Additionally,
the government is often slow to innovate
and implement changes due to the complex
legislative and regulatory process.
On the other hand, the private sector
is free to innovate and has initiated
programs to improve quality of care
and slow rising costs, such as recognizing
medical centers of excellence and
promoting quality through provider
incentives.
We also believe that a government
health plan would have an unfair competitive
advantage because it wouldn't necessarily
be required to do all of the things
private health plans have to do, such
as:
- Comply with state mandates
- Make a margin to fund reserves
- Maintain sufficient reserves
- Potentially be able to negotiate
lower rates with providers, which
would lead to more cost-shifting
to the private sector resulting
in higher premiums
Q: What does
Blue Cross Blue Shield of Massachusetts
most want to see included in national
health care reform legislation?
A: We believe that
any meaningful reform legislation
must address the waste and ineffectiveness
in the health care delivery system.
Study after study documents that as
much as 30 percent of all health care
spending is unnecessary and potentially
harmful to patients. These studies
also suggest that eliminating the
overuse, underuse, and misuse of health
care services will reduce harm and
lower costs. In fact, eliminating
the unwanted variation in clinical
care could save $690 billion a year.
We believe the most
effective way to improve the delivery
system is to change the way we pay
for health care. In Massachusetts,
we are already moving away from the
current fee-for-service system that
rewards the quantity, not quality,
of care. We believe a system of global
payments with outcome-oriented incentives
will both improve quality and slow
rising costs. As the nation expands
coverage, its progress toward affordable,
high-quality care would be greatly
advanced if Medicare embraced a global
payment system, like our Alternative
Quality Contract.
H1N1 Vaccine
Q & A and Employer Communication
Toolkit:
Partners Benefit Group has begun to
receive questions surrounding a vaccine
for the H1N1 virus. In an effort to
answer these questions with information
from a qualified source, a Q &
A that the CDC recently released is
below. Additional information regarding
the H1N1 flu can also be found on
their website.
Additionally, the CDC has released
an employer communication kit for
their employees. For a link to the
kit, click
here.
Q. What are the plans for developing
novel H1N1 vaccine?
A. Vaccines are
the most powerful public health tool
for control of influenza, and the
U.S. government is working closely
with manufacturers to take steps in
the process to manufacture a novel
H1N1 vaccine. Working together with
scientists in the public and private
sector, CDC has isolated the new H1N1
virus and modified the virus so that
it can be used to make hundreds of
millions of doses of vaccine. Vaccine
manufacturers are now using these
materials to begin vaccine production.
Making vaccine is a multi-step process
which takes several months to complete.
Candidate vaccines will be tested
in clinical trials over the few months.
Q. When is it
expected that the novel H1N1 vaccine
will be available?
A. The novel H1N1
vaccine is expected to be available
in the fall. More specific dates cannot
be provided at this time as vaccine
availability depends on several factors
including manufacturing time and time
needed to conduct clinical trials
Q. Will the seasonal
flu vaccine also protect against the
novel H1N1 flu?
A. The seasonal
flu vaccine is not expected to protect
against the novel H1N1 flu.
Q. Can the seasonal
vaccine and the novel H1N1 vaccine
be given at the same time?
A. It is anticipated
that seasonal flu and novel H1N1 vaccines
may be administered on the same day.
However, we expect the seasonal vaccine
to be available earlier than the H1N1
vaccine. The usual seasonal influenza
viruses are still expected to cause
illness this fall and winter. Individuals
are encouraged to get their seasonal
flu vaccine as soon as it is available.
Q. Who will be
recommended as priority groups to
receive the novel H1N1 vaccine?
A. CDC's Advisory
Committee on Immunization Practices
(ACIP) has recommended that certain
groups of the population receive the
novel H1N1 vaccine when it first becomes
available. These key populations include
pregnant women, people who live with
or care for children younger than
6 months of age, healthcare and emergency
medical services personnel, persons
between the ages of 6 months and 24
years old, and people ages of 25 through
64 years of age who are at higher
risk for novel H1N1 because of chronic
health disorders or compromised immune
systems.
We do not expect
that there will be a shortage of novel
H1N1 vaccine, but availability and
demand can be unpredictable. There
is some possibility that initially
the vaccine will be available in limited
quantities. In this setting, the committee
recommended that the following groups
receive the vaccine before others:
pregnant women, people who live with
or care for children younger than
6 months of age, health care and emergency
medical services personnel with direct
patient contact, children 6 months
through 4 years of age, and children
5 through 18 years of age who have
chronic medical conditions.
The committee recognized
the need to assess supply and demand
issues at the local level. The committee
further recommended that once the
demand for vaccine for these prioritized
groups has been met at the local level,
programs and providers should begin
vaccinating everyone from ages 25
through 64 years. Current studies
indicate the risk for infection among
persons age 65 or older is less than
the risk for younger age groups. Therefore,
as vaccine supply and demand for vaccine
among younger age groups is being
met, programs and providers should
offer vaccination to people over the
age of 65.
Q. Where will
the vaccine be available?
A. Every state is
developing a vaccine delivery plan.
Vaccine will be available in a combination
of settings such as vaccination clinics
organized by local health departments,
healthcare provider offices, schools,
and other private settings, such as
pharmacies and workplaces.
Q. Are there
other ways to prevent the spread of
illness?
A. Take everyday
actions to stay healthy.
- Cover your nose and mouth with
a tissue when you cough or sneeze.
- Throw the tissue in the trash
after you use it.
- Wash your hands often with soap
and water, especially after you
cough or sneeze. Alcohol-based hands
cleaners are also effective.
- Avoid touching your eyes, nose
or mouth. Germs spread that way.
- Stay home if you get sick. CDC
recommends that you stay home from
work or school and limit contact
with others to keep from infecting
them.
- Follow public health advice regarding
school closures, avoiding crowds
and other social distancing measures.
These measures will continue to
be important after a novel H1N1
vaccine is available because they
can prevent the spread of other
viruses that cause respiratory infections.
Q. What about
the use of antivirals to treat novel
H1N1 infection?
A. Antiviral drugs
are prescription medicines (pills,
liquid or an inhaled powder) that
fight against the flu by keeping flu
viruses from reproducing in your body.
If you get sick, antiviral drugs can
make your illness milder and make
you feel better faster. They may also
prevent serious flu complications.
This fall, antivirals may be prioritized
for persons with severe illness or
those at higher risk for flu complications.
National Dental
Benefits Conference
Mike McKenna, President of Partners
Benefit Group, has been invited to
the American Dental Association (ADA)
National Dental Benefits Conference
August 28-29, 2009. The conference
will be held at the ADA Headquarters
in Chicago. Topics of interest to
PBG clients will be:
- Direct Reimbursement (DR) dental
plans: This session will discuss
and debate the advantages and disadvantages
of DR dental plans. They are the
only dental plans endorsed by the
ADA. Partners Benefit Group is a
leading provider of DR plans in
the New England Market.
- Administrative Cost Reductions:
How dental insurance companies are
cutting administrative costs.
- Real-Time Claims Adjudication:
The potential use of debit card
technology in dental claims processing.
Blue Value RX
Several years ago, Blue Cross introduced
a new formulary option, Blue Value
RX. This formulary is included in
several medical options that Blue
Cross currently offers. It consists
of a generic based formulary, but
also includes certain brand name drugs
if there is not a lower costing alternative
available that is as safe and effective.
Compared to the traditional Blue Cross
formulary of over 4,000 covered drugs,
the Blue Value RX covers approximately
2,000. Due to the high demand of brand
name drugs, options with this formulary
have not been popular in the past.
However, due to the rising cost of
providing healthcare, we are encouraging
clients to take a closer look at plans
with the Blue Value RX prescription
design. Plans with the Blue Value
RX formulary can save 2-3% off of
the total premium of a medical plan.
Under the Blue Value RX, generic medications
are covered with a $15 copay ($30
for mail order) and no deductible
applies. For brand name drugs. typically
the member is responsible for a $250
annual deductible ($500 max per family)
and then 50% coinsurance.
The goal of the Blue Value RX formulary
is to engage members so that they
understand the cost of their medications
and try to utilize the generics when
possible.
Southborough
company puts health care to work...
Partners Benefit Group was recently
featured in an article in the Metrowest
Daily News. To read the complete article,
click
here.
Sincerely,
Brittany Powers
Partners Benefit Group, Inc.
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