Blue & You - Autumn 2012
Bringing doctors to rural Arkansas; Clinics chosen for federal initiative; Health Care Reform update; Teen drivers are safer now; Meet the first Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients
Bringing doctors to rural Arkansas;
Clinics chosen for federal initiative;
Health Care Reform update;
Teen drivers are safer now;
Meet the first Arkansas Blue Cross and Blue Shield Primary Care Scholarship recipients
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Bringing doctors<br />
to rural Arkansas<br />
Meet the first Arkansas <strong>Blue</strong> Cross<br />
and <strong>Blue</strong> Shield Primary Care<br />
Scholarship recipients ... page 4<br />
Clinics chosen for<br />
federal initiative<br />
page 6<br />
Health Care<br />
Reform update<br />
page 8<br />
Teen drivers<br />
are safer now<br />
page 20
The doctor is in:<br />
How Arkansas <strong>Blue</strong> Cross<br />
is bringing primary<br />
care physicians to<br />
rural communities<br />
rkansas’ rural communities are great places<br />
to settle down, but the lack of primary health<br />
care is quickly reaching crisis proportions. Through<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield, however,<br />
medical students in the University of Arkansas for<br />
Medical Sciences (UAMS) College of Medicine who are<br />
training to become primary care physicians (PCPs)<br />
are getting the help they need to set up practice and<br />
provide small communities with quality health care.<br />
Thanks to a $1 million grant from Arkansas <strong>Blue</strong><br />
Cross, UAMS seniors Christina “Lauren” Monteith<br />
and Josue Daniel Gutierrez are the first recipients<br />
of the Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield Primary<br />
Care Scholarship. Both students will receive $20,000<br />
from interest accrued from the grant toward the<br />
cost of medical school so they can afford to set up<br />
practice in the rural communities they love.<br />
“Lauren and Josue exemplify the qualities we were<br />
looking for in providing dedicated physicians to<br />
serve rural Arkansans,” said Mark White, president<br />
and chief executive officer of Arkansas <strong>Blue</strong> Cross.<br />
“We are excited for them, and we are particularly<br />
excited for the Arkansas communities that will<br />
benefit from their dedication to medicine.”<br />
Tom South, assistant dean for medical student<br />
finance and administration in the UAMS College of<br />
Medicine, said, “With the average educational<br />
Josue Gutierrez looks up medical information<br />
from resources in the UAMS library.<br />
indebtedness of our medical school graduates<br />
approaching $140,000, the Arkansas <strong>Blue</strong> Cross<br />
and <strong>Blue</strong> Shield Primary Care Scholarships will have<br />
a significant impact on reducing the debt burden<br />
of students who wish to pursue primary care and<br />
practice in medically underserved areas in Arkansas.”<br />
“Growing up in south Arkansas, I know all too<br />
well what it is like to live in a medically underserved<br />
area,” said Lauren. “As a child, my parents had to<br />
travel more than two hours to take me to specialty<br />
doctors’ appointments, which was very hard for<br />
them financially.”<br />
Lauren grew up in a small community 10 minutes<br />
south of El Dorado and has seen first hand the<br />
decline in jobs and population. This includes a great<br />
loss in primary care physicians. Her husband also<br />
grew up in the same area.<br />
“My husband spent part of his childhood in Huttig,<br />
one hour southeast of El Dorado, and learned that<br />
even small emergencies can be life threatening<br />
when you can’t get to medical care quickly. With the<br />
upcoming changes to health care, I believe primary<br />
care will become even more vital as the first step and<br />
possibly sole provider in rural areas.”<br />
4 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>
Being a primary care physician in a rural area can be challenging, but<br />
for both Lauren and Josue, that is part of the excitement of the job.<br />
“I love the idea of treating a wide variety of medical problems, as<br />
well as taking care of patients of all ages,” Lauren said. “I feel strongly<br />
that family medicine is one of the most rewarding fields of medicine.”<br />
Josue originally came to Arkansas to attend the University of the<br />
Ozarks in Clarksville and fell in love with the Northwest Arkansas<br />
region. “During my<br />
time in Clarksville, I<br />
was able to foster many<br />
relationships with<br />
individuals from the<br />
medical community<br />
and am eager to return<br />
and practice there. I am<br />
also soon to be married<br />
and my fiancée and I<br />
plan to start a family<br />
in Clarksville after<br />
completing my residency,<br />
as this is the perfect<br />
place to raise a family.”<br />
Josue added, “It<br />
has been my dream<br />
to become a family<br />
practitioner since I was<br />
7 years old. There are<br />
so many benefits to<br />
practicing in a small<br />
community. The lack of<br />
specialties in rural areas<br />
provides the family<br />
practitioners a unique<br />
environment in which<br />
to perform procedures<br />
that many of their<br />
urban counterparts are<br />
not able to. The small<br />
town environment,<br />
with its tight-knit<br />
community, provides<br />
a perfect setting in<br />
which to foster rapport<br />
with patients that will<br />
ultimately translate into<br />
better health care.”<br />
Focusing on<br />
Primary Care<br />
A big reason for the shortage of<br />
primary care physicians is the high<br />
cost of medical school. The<br />
Association of American Medical Colleges estimates that the average<br />
medical student ends up $162,000 in debt by graduation. To tackle<br />
that debt, many medical students turn their attention toward careers<br />
as specialists, where they are more likely to make more money.<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield Primary Care Scholarship recipients<br />
are chosen from those planning to pursue post-graduate training in family<br />
medicine, general internal medicine or general pediatrics. The students,<br />
who may be in their junior or senior year, also must intend to practice<br />
primary care in Arkansas, preferably in the more rural parts of the state.<br />
The scholarship, given in honor of the Board of Directors of Arkansas <strong>Blue</strong><br />
Cross, will be awarded each year, beginning with the <strong>2012</strong>-2013 academic year.<br />
Other reasons for the primary care crisis are:<br />
Lauren Monteith researches<br />
information in preparation for her<br />
career as a primary care physician.<br />
• A shortage of primary care physicians, including family practice,<br />
pediatric and general internal medicine doctors.<br />
• An aging population and an illness burden higher than the national<br />
average, which creates high patient volume for the physicians who<br />
are available.<br />
• The potential projected influx of thousands of Arkansans to the<br />
Medicaid program in 2014 under health insurance reform.<br />
According to the Johns Hopkins Primary Care Policy Center, adults in<br />
the United States who had a primary care physician had 33 percent lower<br />
costs of care and were 19 percent less likely to die prematurely from<br />
their conditions than those who had received care from a specialist, after<br />
adjusting for demographic and health characteristics. The center found that<br />
the availability of primary care physicians is consistently associated with<br />
improved health outcomes for conditions like cancer, heart disease, stroke,<br />
infant mortality, low birth weight, as well as increased life expectancy and<br />
self-managed care.<br />
Sources: UAMS Center for Rural Health, Johns Hopkins Primary Care Policy<br />
Center, Association of American Medical Colleges, Arkansas Department of<br />
Health and Arkansas Center for Health Improvement<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
5
Arkansas medical practices<br />
chosen to participate<br />
in<br />
national initiative<br />
T<br />
his spring, Arkansas was named one of<br />
seven markets to be part of the national<br />
Comprehensive Primary Care (CPC)<br />
Initiative, a pilot program through the<br />
Centers for Medicare & Medicaid Services<br />
(CMS) Innovation Center that fosters<br />
collaboration among public and private<br />
health plans to strengthen primary care.<br />
Health Advantage (an affiliate of Arkansas<br />
<strong>Blue</strong> Cross and <strong>Blue</strong> Shield), QualChoice and<br />
P rimary care physicians involved in the CPC Initiative will focus<br />
on five fundamental elements of comprehensive care:<br />
Managing care for patients with high<br />
health care needs – By engaging high-risk<br />
patients, primary care providers can create a<br />
plan of care that uniquely fits each patient’s<br />
individual circumstances and values.<br />
Ensuring access to care – CPC Initiative<br />
primary care practices must be accessible to<br />
patients 24/7 and be able to utilize patient<br />
data tools to give real-time, personal health<br />
care information to patients.<br />
Arkansas Medicaid teamed together<br />
to apply for the initiative.<br />
Medical practices within Arkansas<br />
were given the opportunity to apply to<br />
participate in the CPC Initiative and 116<br />
completed the application process. CMS<br />
chose 65 of those practices to participate<br />
in the first part of the initiative — other<br />
practices could be added later.<br />
Delivering preventive care – Primary<br />
care practices involved with CPC<br />
Initiative will be able to proactively<br />
assess their patients to determine their<br />
needs and provide appropriate and<br />
timely preventive care.<br />
Engaging patients and caregivers<br />
– Primary care practices will have<br />
the ability to engage patients and<br />
their families in active participation<br />
in their care.<br />
6 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>
Medical practices chosen to participate in the CPC Initiative include:<br />
Baptist Health Family Clinic<br />
Arkadelphia<br />
Bradley Bibb M.D., PLLC<br />
Ash Flat<br />
Covert Clinic, P.A.<br />
Ashdown<br />
Batesville Family Practice Clinic<br />
Batesville<br />
Verona T Brown, M.D.<br />
Batesville<br />
Beebe Family Clinic<br />
Beebe<br />
Mercy Clinic Primary Care Lancashire Bella Vista<br />
Benton Family Clinic<br />
Benton<br />
Saline Med Peds<br />
Benton<br />
Baptist Health Family Clinic Bryant Bryant<br />
Bryant Family Practice<br />
Bryant<br />
Bryant Medical Clinic<br />
Bryant<br />
Baptist Health Family Clinic<br />
Cabot<br />
Internal Medicine Diagnostics Inc. Cherokee Village<br />
Ozark Internal Medicine and Pediatrics Clinton<br />
B. Brooks Lawrence, M.D., P.A. Conway<br />
Conway Family Medical Care, P.A. Conway<br />
Freeman Family Medicine<br />
Conway<br />
Barry V. Thompson, M.D.<br />
Crossett<br />
Family Clinic of Ashley County<br />
Crossett<br />
Lofton Family Clinic<br />
De Queen<br />
Randy D. Walker, M.D., PLLC<br />
De Queen<br />
SAMA Healthcare Services<br />
El Dorado<br />
Washington Regional Clinic for Senior Health Fayetteville<br />
Shipley and Sills Family Doctors<br />
Fort Smith<br />
Glenwood Family Medicine<br />
Glenwood<br />
Coordinating care across<br />
the medical neighborhood –<br />
Under this initiative, primary<br />
care doctors and nurses will<br />
work together, and with a<br />
patient’s other health care<br />
providers and the patient, to<br />
make decisions as a team.<br />
Greenbrier Family Clinic<br />
Greenbrier<br />
Garner Family Medical Clinic<br />
Hardy<br />
Harrison Family Practice Clinic<br />
Harrison<br />
The Leslie Clinic, P.A.<br />
Harrison<br />
Cowherd Family Medical Center<br />
Heber Springs<br />
Cypert Ridge Family Practice Clinic Helena<br />
Fountain Lake Family Medicine<br />
Hot Springs<br />
Hamilton West Family Medicine<br />
Hot Springs<br />
UAMS AHEC Northeast<br />
Jonesboro<br />
West Washington County Clinic, P.A. Lincoln<br />
<strong>Autumn</strong> Road Family Practice<br />
Little Rock<br />
Baptist Health Family Clinic Baptist Health Drive Little Rock<br />
Baptist Health Family Clinic Hillcrest Little Rock<br />
Baptist Health Family Clinic West Little Rock<br />
Barg-Gray Clinic<br />
Little Rock<br />
Little Rock Family Clinic - West<br />
Little Rock<br />
Little Rock Family Practice - Central Little Rock<br />
St. Vincent Family Clinic - Chenal Little Rock<br />
St. Vincent Family Clinic - Rodney Parham Little Rock<br />
St. Vincent Medical Clinic Midtowne Little Rock<br />
St. Vincent Medical Group Longevity Center Little Rock<br />
John E Alexander Jr. M.D., P.A.<br />
Magnolia<br />
Baptist Health Family Clinic<br />
Malvern<br />
Tilley Diagnostic Clinic<br />
Malvern<br />
Baptist Health Family Clinic<br />
Maumelle<br />
North Central Arkansas Medical Associates Mountain Home<br />
Dr. Andy’s Family Practice PLLC<br />
Mountain View<br />
Baptist Health Family Clinic Lakewood North Little Rock<br />
Burchfield Family Medicine<br />
Paragould<br />
Baptist Health Family Clinic<br />
Perryville<br />
Mercy Clinic Internal Medicine<br />
Rogers<br />
Sherwood Family Medical Center<br />
Sherwood<br />
Siloam Springs Medical Center<br />
Siloam Springs<br />
UAMS Family Medical Center<br />
Springdale<br />
UAMS AHEC Southwest<br />
Texarkana<br />
Foscue Medical Clinic<br />
Warren<br />
Michelle Weaver M.D.<br />
Warren<br />
Senior Health Clinic<br />
West Memphis<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
7
In June, the U.S. Supreme Court ruled that the<br />
Patient Protection and Affordable Care Act (PPACA)<br />
is constitutional. Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />
Shield had been working to prepare for health care<br />
reform even before the law was signed, so we are<br />
well prepared to move forward in implementing the<br />
reforms within the law.<br />
We know you may have questions regarding how<br />
the ruling affects your health plan. Various Web<br />
sites and e-mails circulating lately have contained<br />
misinformation about reform. We’ve been a trusted<br />
source of health care information for more than<br />
60 years, and we want you to be well informed<br />
about health care reform so you can make the<br />
right decisions for yourself and your family.<br />
Because we want to be available to you, we have<br />
created a new e-mail address just for your questions<br />
on health care reform. If you have questions, feel free<br />
to contact us at HCRinfo@arkbluecross.com. We will<br />
be gathering questions and responding to them on a<br />
regular basis and including the questions and answers<br />
in future issues of <strong>Blue</strong> & <strong>You</strong> magazine.<br />
While some things still are unknown, I can tell you<br />
that Arkansas <strong>Blue</strong> Cross will continue to provide the<br />
products and services our members value and that<br />
we are expanding our involvement in health care in<br />
innovative ways to increase quality and contain costs.<br />
We have a lot of work to do between now and late<br />
2013 to get ready for the health insurance exchanges<br />
and the new insurance market.<br />
The insurance exchange will be a new, online location<br />
for people to purchase insurance products. If your<br />
income is below a certain amount, you may receive<br />
significant subsidies to help cover your insurance<br />
premium, but most people still will have to pay<br />
for coverage.<br />
If you choose not to have insurance, the penalty per<br />
person is $95 for the first year, or 1 percent of your<br />
adjusted gross income, whichever is greater, with the<br />
penalty capped at four family members. The maximum<br />
penalty in 2016 is $695 or 2.4 percent.<br />
Cal Kellogg,<br />
Senior Vice President<br />
and<br />
Chief Strategy Officer<br />
Arkansas <strong>Blue</strong> Cross’ work toward the exchanges will<br />
focus on how our systems will interact with the federal<br />
system. We are working with the state and other<br />
stakeholders to determine the best ways to facilitate<br />
what will be a state/federal exchange partnership.<br />
The Arkansas Insurance Department has taken<br />
on the responsibility to design the exchange and<br />
is deciding which companies can sell on it and how<br />
consumers can be assisted. Arkansas <strong>Blue</strong> Cross,<br />
however, has membership on the steering and plan<br />
management committees involved in planning<br />
for the exchange. We have been able to make<br />
recommendations on topics like essential health<br />
benefits, but ultimately it will be the Insurance<br />
Department that determines how the exchange is run.<br />
Many employer-based insurance plans (group<br />
plans) under reform will be looking at whether they<br />
should change plans, or if it is in their best interest<br />
to drop their plan and pay the penalty. We do know<br />
that for many it will cost more to pay the fine than to<br />
keep their plan, but there still is a lot of uncertainty<br />
about pending regulations and the likely potential<br />
for continuing political debate and change. The main<br />
message we want to share is that no one has to make<br />
those decisions right now.<br />
The next year will provide the detailed regulations<br />
and guidelines we will need to provide valuable and<br />
meaningful advice for our members ahead of the<br />
January 2014 implementation. As soon as we have<br />
information on these changes we will be sharing it<br />
with you. In the meantime, feel free to ask us your<br />
questions at HCRinfo@arkbluecross.com. We love<br />
to hear from you.<br />
8 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>
For the past eight years,<br />
I’ve had the honor of caring<br />
for hundreds of patients at<br />
Hospice Home Care who are at<br />
the end of their life. I’ve heard<br />
stories that almost made<br />
me choke with laughter and<br />
others which made my soul<br />
ache with despair. I’ve heard<br />
the most sacred confessions<br />
and witnessed love that could<br />
almost be touched.<br />
What has never been<br />
requested include the<br />
following: more chemotherapy,<br />
more radiation, more<br />
MRIs, more biopsies, more<br />
surgeries, more blasts of<br />
electricity through the chest,<br />
more life support, more time<br />
away from home and separated<br />
from family and friends, or<br />
more time in an institution.<br />
This serves as a wake-up<br />
call on how all members of<br />
the health care team can<br />
help patients achieve what<br />
is important for them at the<br />
end of life: quality! It’s about<br />
quality of life and ensuring<br />
patients achieve their goals<br />
with the life they have left.<br />
This is where the growing<br />
trend of hospice is saving<br />
patients from artificial<br />
prolongation of the dying<br />
process. There are studies<br />
which show that hospice not<br />
only improves quality of life<br />
for dying patients, but helps<br />
patients live longer. Isn’t<br />
longer, happier life the entire<br />
goal of health care?<br />
Hospice care is a team<br />
approach for supporting the<br />
patient and family during<br />
the end of life in a variety<br />
of settings, including home,<br />
assisted living facilities,<br />
nursing homes, and hospice<br />
facilities. Sometimes events<br />
happen quickly, like a severe<br />
stroke or heart attack, and<br />
hospice care is invaluable<br />
during these times. Hospice<br />
is even more effective when<br />
patients have two to three<br />
months of hospice care.<br />
This takes a realistic<br />
approach to life expectancies<br />
and selected treatments by<br />
the medical team. Proper<br />
channels of communication<br />
should be respected, so if<br />
one team member is not<br />
comfortable or skilled at<br />
discussing end-of-life care,<br />
utilizing other team members<br />
who are comfortable with<br />
these situations can be<br />
helpful. It is most important<br />
that the team always<br />
remember the guiding<br />
principle of medical ethics:<br />
the Principle of Autonomy.<br />
Patients have the right to<br />
hear all information of<br />
their care in an unbiased<br />
manner. Fortunately, hospice<br />
care considerations may<br />
be started by anyone in the<br />
team, including patients, their<br />
families or friends, doctors,<br />
nurses, social workers,<br />
chaplains or case managers.<br />
My life is going to end one<br />
day. When it is time, please,<br />
love me enough not to prolong<br />
the agony of dying. Follow<br />
these guidelines for me to<br />
honor my life:<br />
• Make any pain nonexistent.<br />
If anyone thinks<br />
I am in pain, give me<br />
whatever it takes to keep<br />
me comfortable, even if<br />
I have to be asleep.<br />
Don’t let me hurt!<br />
• Make any other symptoms<br />
non existent. Don’t let<br />
me suffer!<br />
• Treat me with dignity,<br />
respect, and<br />
unconditional love.<br />
• Keep me clean.<br />
• Support my friends and<br />
family while I am dying<br />
and after I am gone.<br />
Reviewing these five goals<br />
can help health care providers<br />
recognize the beauty of<br />
hospice and how it is enriching<br />
and rewarding for patients.<br />
Morgan Sauer, M.D., with the<br />
Longevity Center at St. Vincent<br />
Infirmary Medical Center,<br />
is board certified in<br />
family and preventive<br />
medicine, geriatric<br />
medicine, and<br />
hospice and<br />
palliative care.<br />
He also is the<br />
medical director<br />
for Chenal Heights<br />
Memory Center and<br />
Hospice Home Care<br />
Inpatient Center and<br />
serves on the<br />
Governor’s<br />
Task Force for<br />
Alzheimer’s<br />
disease.<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
9
Clinical<br />
Partnership<br />
Award<br />
Arkansas <strong>Blue</strong><br />
Cross and <strong>Blue</strong> Shield<br />
employees (pictured,<br />
from left: Roberta<br />
Monson, M.D.,<br />
associate medical<br />
director, Connie<br />
Meeks M.D., corporate<br />
medical director,<br />
Internal Affairs,<br />
Alicia Berkemeyer,<br />
director of Enterprise<br />
Networks Special<br />
Projects, Vic Snyder,<br />
M.D., corporate medical<br />
director, External<br />
Affairs) were recently honored as the recipients of the Clinical Partnership Award given by<br />
the Community Health Centers of Arkansas, Inc. (CHCA). The award is given to a group<br />
or individual who has remained a steadfast supporter of CHCA and community health<br />
centers (CHCs), and has focused on the goal of providing quality care to all Arkansans.<br />
Arkansas <strong>Blue</strong> Cross received the award for its dedication to the development of patientcentered<br />
medical homes throughout the state. Arkansas <strong>Blue</strong> Cross exhibited leadership<br />
in merging existing programs/projects to align with the goals and strategic plan of CHCA<br />
and the CHCs, acting as a partner, advocate, liaison and mentor.<br />
Case management receives<br />
URAC accreditation<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield, Health Advantage<br />
and <strong>Blue</strong>Advantage Administrators of Arkansas, recently<br />
received reaccreditation for case management from<br />
URAC, a Washington, D.C.-based health care accrediting<br />
organization that establishes quality standards for the<br />
health care industry.<br />
In its notification of reaccreditation, the URAC<br />
Accreditation Committee said, “Arkansas <strong>Blue</strong><br />
Cross and <strong>Blue</strong> Shield, Health Advantage, and<br />
<strong>Blue</strong>Advantage Administrators of Arkansas have been granted FULL accreditation,”<br />
and all three organizations are “commended for their commitment to promoting quality<br />
health services.”<br />
URAC’s case management accreditation standards require companies to establish<br />
a process to assess, plan and implement case management interventions.<br />
10 12 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>
Red, White and Arkansas<strong>Blue</strong> summer family fun<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield kept kids and their families watchin’, rockin’, and<br />
packin’ this summer with lots of family-oriented activities at Arkansas<strong>Blue</strong>, Arkansas<br />
<strong>Blue</strong> Cross’ health insurance store, located in the Shackleford Crossings shopping center.<br />
In June, we sponsored a special showing of the<br />
new Disney/Pixar movie “Brave” on the movie’s<br />
premiere weekend. More than 100 families<br />
picked up tickets at Arkansas<strong>Blue</strong> and 330<br />
attended the movie.<br />
“We had lots of young moms come in to<br />
Arkansas<strong>Blue</strong> to pick up tickets to the movie,” said<br />
Sara Harris, Arkansas<strong>Blue</strong> team leader. “Many were<br />
pleasantly surprised when they walked in to the<br />
location. They said they were not aware we were<br />
here, asked about what the store was for and if we<br />
sold insurance here. It was a great opportunity to<br />
tell them about the kinds of policies we sell and<br />
that we are available to visit face-to-face to discuss<br />
any questions they have about insurance.”<br />
<strong>Blue</strong>Ann Ewe greets two eager fans at<br />
the special Arkansas <strong>Blue</strong> Cross and<br />
<strong>Blue</strong> Shield screening of Disney/Pixar’s<br />
“Brave” held at The Rave.<br />
In July, we rocked the parking lot with a <strong>Blue</strong><br />
Beach Party at Arkansas<strong>Blue</strong>. Adults and kids<br />
got moving and played games with Radio Disney outside the Arkansas<strong>Blue</strong> store, received<br />
complimentary sunscreen, then cooled down with tasty shaved ice and made their own leis<br />
inside the store. Two tickets to the sold-out Justin Bieber concert in Little Rock in January<br />
were given away, compliments of Radio Disney.<br />
In August, the Pack’n it in – Lunchbox Prep event had kids getting ready for a happy,<br />
healthy school year. Faith Anaya from Kids Cook! demonstrated two easy, economical<br />
and healthy food preparations perfect for packing a healthy lunchbox. She also discussed<br />
the importance of healthy eating and encouraged kids to try new foods. Parents were<br />
invited to participate in a nutrition label exercise designed to teach them about what<br />
kinds foods they are offering their children.<br />
“We were thrilled to spend the summer with our members and guests, focusing<br />
on nutrition, health and family fun,” said Sara. “We look forward to even<br />
more exciting events this fall and during the holidays.”<br />
Happy Birthday Arkansas<strong>Blue</strong>!<br />
Arkansas<strong>Blue</strong>, Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield’s<br />
health insurance store in Little Rock, celebrated its first<br />
birthday on October 1! Since opening, Arkansans’ have<br />
dropped in to speak face-to-face with our staff and learn<br />
more about health insurance. If you have questions about<br />
health insurance, stop by Arkansas<strong>Blue</strong> in the Shackleford<br />
Crossings Shopping Center. We’d love to visit with you.<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
11 13
12 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
Foundation Awards 35 Mini-grants to Health Programs<br />
The <strong>Blue</strong> & <strong>You</strong> Foundation for a Healthier Arkansas has awarded<br />
$1,000 grants to 35 health improvement programs in Arkansas<br />
Mini-grant recipients in <strong>2012</strong> include:<br />
• Arkansas Department of Emergency<br />
Management, North Little Rock,<br />
work-site wellness and obesity.<br />
• Arkansas Hospice, North Little Rock,<br />
Alzheimer’s, hospice and end-of-life planning.<br />
• Arkansas Voices for the Children Left<br />
Behind, Little Rock, healthy lifestyles<br />
and mental health.<br />
• Arthritis Foundation Southeast Region,<br />
Little Rock, arthritis and chronic disease<br />
self-management.<br />
• Camp Aldersgate, Little Rock, senior wellness.<br />
• CARTI Foundation, Little Rock, patient<br />
transportation.<br />
• Christian Health Ministry of White<br />
County, Searcy, charity clinic operation<br />
and electronic medical records.<br />
• City of Cammack Village, swimming pool<br />
wheelchair access.<br />
• Delta Community Based Services,<br />
Little Rock, girls’ empowerment conference.<br />
• Delta Presents Outreach Foundation,<br />
Little Rock, aspiring college students project,<br />
addressing substance abuse.<br />
• Donald W. Reynolds Cancer Support<br />
House, Fort Smith, skin cancer education.<br />
• Eagle Mountain Magnet Elementary,<br />
Batesville, nutrition and obesity (nutrition<br />
and exercise).<br />
• East Arkansas Area Agency on Aging,<br />
Jonesboro, exercise/physical activity and<br />
healthy lifestyles.<br />
• Elizabeth Richardson Center, Springdale,<br />
disabilities and autism.<br />
• Forrester-Davis Development Center,<br />
Clarksville, disabilities and heart health.<br />
• Friends of the Timberwolves, Newark,<br />
nutrition, exercise and healthy lifestyles.<br />
• Hearth, Jonesboro, nutrition, food costs<br />
and parenting.<br />
• Hip Hop Tumblers, Harrison, nutrition<br />
and exercise.<br />
• Historic Harrison Business Association,<br />
Harrison, physical activity and substance<br />
abuse.<br />
• Hometown Health Coalition Network,<br />
Warren, healthy lifestyles and exercise/<br />
physical activity.<br />
• Hope Cancer Resources, Springdale,<br />
healthy lifestyles and cancer.<br />
• LifeHouse Ministries, Paragould,<br />
STDs and HIV/AIDS.<br />
• Marion County Hometown Health, Inc.,<br />
Yellville, prenatal/pediatrics and safety.<br />
• Mid-Delta Health Systems, Clarendon,<br />
tobacco-related health conditions.<br />
• Newton County Resource Council,<br />
Jasper, nutrition, exercise and parenting.<br />
• Northwest Arkansas Community College,<br />
Bentonville, CPR/first aid/AED and medical<br />
professional education.<br />
• Old High Middle School, Bentonville,<br />
chair-free classrooms.<br />
• Ozark Guidance, Springdale, mental<br />
health, wellness education and prevention.<br />
• Ozarka College, Melbourne, Australian<br />
Walkabout Fitness Challenge.<br />
• Paragould School District, Paragould,<br />
nutrition, exercise and mental health.<br />
• Pediatrics Plus Connections, Conway,<br />
nutrition, exercise and disabilities.<br />
• S.W. Chance, Maumelle, obesity, nutrition,<br />
exercise and disabilities.<br />
• University of Central Arkansas, Conway,<br />
preschoolers and the USDA MyPlate project.<br />
• Washington Regional Medical Foundation,<br />
Fayetteville, cancer support.<br />
• Wildwood Park for the Arts, Little Rock,<br />
healthy lifestyles and nutrition.<br />
Nonprofit and charitable organizations, schools and government institutions in<br />
Arkansas are eligible to apply for two different programs: a $1,000 mini-grant program<br />
and a regular grant program of $5,000 to $150,000. New applications will be accepted<br />
beginning in March 2013. Grant guidelines and the online applications can be found at<br />
blueandyoufoundationarkansas.org.<br />
The <strong>Blue</strong> & <strong>You</strong> Foundation was established in 2001 by Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />
Shield to help support community organizations that are implementing programs to<br />
improve the health of Arkansans.
New at the <strong>Blue</strong><br />
New people and new positions<br />
Bryan Dorathy<br />
Bryan Dorathy has joined Arkansas <strong>Blue</strong> Cross<br />
and <strong>Blue</strong> Shield as an agency market manager for<br />
our offices in Little Rock and Pine Bluff. Bryan is<br />
responsible for Arkansas <strong>Blue</strong> Cross’ relationships<br />
with agents and partners as well as producing<br />
contracts for groups from two to 100. Bryan has<br />
more than 15 years of experience in the insurance<br />
industry.<br />
Sam Vorderstrasse<br />
Sam Vorderstrasse recently was promoted to vice<br />
president of Actuarial Services. He is responsible<br />
for providing decision support and direction<br />
related to the pricing and development of products,<br />
actuarial management, rating programs and<br />
determining/estimating outstanding liabilities.<br />
He is a Fellow of the Society of Actuaries and a<br />
member of the American Academy of Actuaries.<br />
Dr. John Brineman<br />
Dr. John Brineman has accepted the position of<br />
regional medical director for our Little Rock office<br />
and associate medical director for Health Advantage.<br />
He is a graduate of the College of William and Mary<br />
in Williamsburg, Virginia, and received his doctorate<br />
in medicine from Eastern Virginia Medical School.<br />
He completed a residency in Anatomic and Clinical<br />
Pathology at Walter Reed Army Medical Center and<br />
is a diplomat of the American Board of Pathology<br />
in Combined Anatomic and Clinical Pathology. He<br />
had a distinguished career in the active Army and<br />
the U.S. Army Reserve, rising to the rank of Colonel,<br />
serving two tours in Iraq.<br />
“In its first 10 years of grantmaking, the <strong>Blue</strong> & <strong>You</strong> Foundation has awarded<br />
a total of $14 million to 293 health improvement projects in Arkansas,” said<br />
Patrick O’Sullivan, executive director. “ These include programs to address<br />
obesity, diabetes, healthy lifestyles, medical and dental care for the uninsured,<br />
and dozens of other health issues that are affecting our state’s population.”<br />
The <strong>Blue</strong> & <strong>You</strong> Foundation is an independent licensee of the <strong>Blue</strong> Cross and<br />
<strong>Blue</strong> Shield Association and serves the state of Arkansas.<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong> 13
Sleep and mindlessly munching<br />
Have you ever found yourself hitting the afternoon<br />
slump then reaching for a bag of chips? What about<br />
sitting on the couch watching your favorite show,<br />
yawning and feeling the urge to snack on something<br />
less than healthy? <strong>You</strong> might need to get more sleep<br />
to prevent mindless munching.<br />
According to researchers, there may be a link between<br />
“sleep-related hunger and food cravings.” And not just<br />
any food cravings, but fatty, high-calorie foods.<br />
Marie-Pierre St. Onge, Ph.D., suggests that when you’re<br />
tired, you gravitate towards high-calorie foods because<br />
your body is looking for energy. Additionally, sleep<br />
deprivation seems to increase activity in the areas of the<br />
brain that seek pleasure, which can include enjoyment<br />
from junk foods.<br />
And if that’s not enough, research also suggests that being<br />
sleep deprived impairs decision-making. Therefore, you’re<br />
less likely to think through the repercussions of reaching for<br />
the junk foods. <strong>You</strong>’re literally mindlessly munching.<br />
Source: Health.com<br />
Diesel fumes officially declared<br />
to cause cancer<br />
The World Health Organization (WHO) recently<br />
elevated diesel to the “known carcinogen” level,<br />
officially declaring that diesel fumes cause lung<br />
cancer. Experts also concluded that the fumes were<br />
more carcinogenic than secondhand cigarette smoke.<br />
Diesel is a type of fuel derived from crude oil, and<br />
exposure to diesel exhaust is widespread in today’s<br />
world. Health concerns about diesel exhaust relate<br />
not only to cancer, but also to other health problems<br />
such as respiratory and heart diseases.<br />
Diesel exhaust now shares the WHO’s Group 1<br />
carcinogen status with smoking, asbestos, ultraviolet<br />
radiation, alcohol and other elements that pose<br />
cancer risks.<br />
14 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
SPECIAL NOTICE:<br />
*Arkansas State and Public School<br />
Employees can enroll in a weightloss<br />
program administered by the<br />
Employee Assistance Program’s<br />
vendor. Call 1-877-247-4621 to enroll.<br />
**Medi-Pak Medicare supplement<br />
insurance policyholders are not eligible<br />
for The Healthy Weigh! program.<br />
Lose weight<br />
The Healthy Weigh! Education<br />
Program is free for members of<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield,<br />
Health Advantage (except ARBenefits<br />
members*), <strong>Blue</strong> Cross and <strong>Blue</strong> Shield<br />
Service Benefit Plan (Federal Employee<br />
Program), Medi-Pak® Advantage<br />
(PFFS), Medi-Pak Advantage PPO, and<br />
eligible members of <strong>Blue</strong>Advantage<br />
Administrators of Arkansas.**<br />
To enroll, complete the attached<br />
enrollment form and return it in the<br />
self-addressed, postage-paid envelope<br />
included in this magazine. The<br />
program starts when you enroll.<br />
After enrollment, you will begin to<br />
receive information through the mail,<br />
which you can read in the privacy of<br />
your own home and at your own pace.<br />
The program is completely voluntary,<br />
and you may leave the program at any<br />
time. If you have further questions<br />
about the program, call the Health<br />
Education Program’s toll-free number<br />
at 1-800-686-2609.<br />
Simply complete, sign and return<br />
the attached enrollment form in the<br />
self-addressed, postage-paid envelope<br />
to join The Healthy Weigh!
SHINGLES<br />
Avoid the pain, get vaccinated<br />
Almost one in three people in the United<br />
States will develop shingles during their<br />
lifetime. This painful illness is a possibility<br />
for anyone who suffered with chickenpox<br />
and is more likely to occur if you are stressed<br />
or older.<br />
The good news is you can protect yourself<br />
against shingles. Talk with your doctor about<br />
the shingles vaccine. Arkansas <strong>Blue</strong> Cross<br />
and <strong>Blue</strong> Shield covers the shingles<br />
vaccines for members age 60 or older<br />
as a one-time vaccination based on<br />
Advisory Committee for Immunization<br />
Practices (ACIP) recommendations.<br />
Shingles, also known as herpes zoster,<br />
is caused by the varicella zoster virus<br />
(VZV). This is the same virus that causes<br />
chickenpox. The painful, blistering skin rash<br />
from shingles can last two to four weeks.<br />
If you have had chickenpox in the past,<br />
then VZV is inside you. It never leaves your<br />
body and stays in a dormant state. For<br />
reasons that are not fully known, the virus<br />
can reactivate years later and cause shingles.<br />
Some people may develop severe nerve<br />
pain that can last for months or even years<br />
after the rash goes away. This is called postherpetic<br />
neuralgia (PHN). Older adults are<br />
more likely to get PHN. Shingles can lead<br />
to other serious complications, including<br />
eye problems.<br />
Pain from shingles has been described<br />
as excruciating, aching, burning, stabbing,<br />
and shock-like. It has been compared to<br />
the pain of childbirth or kidney stones.<br />
The pain from shingles can cause depression,<br />
anxiety, difficulty concentrating, loss of<br />
appetite and weight loss. Shingles can<br />
interfere with activities of daily living<br />
like dressing, bathing, eating, cooking,<br />
shopping and travel.<br />
The only way to reduce your risk of<br />
developing shingles and PHN is to get<br />
vaccinated. Some people should wait to<br />
get vaccinated, or they should not get<br />
vaccinated at all if they have a weakened<br />
immune system. Shingles vaccine is available<br />
in pharmacies and doctors’ offices. Talk with<br />
your doctor if you have questions about the<br />
shingles vaccine.<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
15
October is Open Enrollment Period for individual family policies<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />
Shield’s Open Enrollment Period<br />
(OEP) for individual and family<br />
health plans began October 1 and<br />
runs through Oct. 31, <strong>2012</strong>.<br />
During this OEP, members may<br />
apply for changes to their policy<br />
and individuals age 18 or younger<br />
may apply for a child-only policy.<br />
Making changes to<br />
individual and<br />
family policies<br />
Members may request changes to<br />
their policy, such as:<br />
• Adding or deleting dependents.<br />
• Increasing or decreasing<br />
the deductible.<br />
• Adding or deleting maternity.<br />
• Requesting the removal of<br />
surcharges or exclusions.<br />
Change forms related to<br />
OEP must be received (not<br />
just postmarked) by Arkansas<br />
<strong>Blue</strong> Cross no later than Oct. 31,<br />
<strong>2012</strong>. Changes to existing<br />
policies will be effective Jan. 1<br />
or 15, 2013, depending on the<br />
policy billing cycle.<br />
An underwriting change form<br />
is required if you are:<br />
• Adding a dependent<br />
to your policy<br />
- Dependents age 18<br />
or younger cannot be<br />
declined coverage but will be<br />
medically underwritten and<br />
may be surcharged based on<br />
medical conditions. Children<br />
eligible for Medicaid or<br />
ARKids First are not eligible<br />
for coverage under an<br />
individual policy.<br />
- Dependents age 19 or<br />
older will be medically<br />
underwritten and may<br />
be surcharged or denied<br />
coverage based on medical<br />
conditions.<br />
• Increasing your<br />
policy benefits by:<br />
- Lowering the deductible.<br />
- Raising the coinsurance<br />
percentage.<br />
- Lowering the calendar-year<br />
coinsurance maximum.<br />
- Adding the maternity rider.<br />
• Requesting that an<br />
exclusion be removed<br />
• Requesting that a surcharge<br />
be reduced or removed.<br />
A non-underwriting change<br />
form is required if you are:<br />
• Deleting a dependent<br />
from your policy.<br />
• Decreasing your policy<br />
benefits by:<br />
- Raising the deductible.<br />
- Lowering the coinsurance<br />
percentage.<br />
- Raising the calendar-year<br />
coinsurance maximum.<br />
- Deleting the<br />
maternity rider.<br />
Both underwriting change<br />
forms and non-underwriting<br />
change forms are available online<br />
at arkansasbluecross.com or<br />
you can call Customer Service at<br />
1-800-238-8379.<br />
Applying for a<br />
child-only policy<br />
During the OEP, individuals age<br />
18 or younger may apply for a<br />
child-only policy. Applications for<br />
child-only policies must be received<br />
(not just postmarked) by Arkansas<br />
<strong>Blue</strong> Cross no later than Oct. 31,<br />
<strong>2012</strong>. If approved and accepted,<br />
all new child-only policies will be<br />
effective Jan. 1, 2013.<br />
<strong>You</strong> may apply for a child-only<br />
individual policy:<br />
• Online at<br />
arkansasbluecross.com<br />
• By calling us at<br />
1-800-392-2583; or<br />
• By contacting your<br />
independent or<br />
Farm Bureau agent.<br />
Outside the OEP, individuals<br />
age 18 or younger can be<br />
considered for coverage only<br />
as a dependent on a parent or<br />
guardian’s policy or as a result<br />
of a “qualifying life event.”<br />
Qualifying life events<br />
Requesting a change<br />
to an existing policy<br />
Changes may be made to<br />
existing policies at any time<br />
throughout the year as a result<br />
of a “qualifying life event” —<br />
such as a marriage, divorce,<br />
death, birth of a child, or loss of<br />
other health insurance coverage.<br />
There are specific notification<br />
periods and documentation<br />
requirements associated with<br />
qualifying life event changes.<br />
To get information, go to<br />
arkansasbluecross.com/<br />
members/making_policy_<br />
changes.aspx or call Customer<br />
Service at 1-800-238-8379.<br />
Applying for a new<br />
child-only policy<br />
In addition, there are two<br />
qualifying life events that allow<br />
individuals age 18 or younger<br />
to apply for a child-only policy<br />
outside of the OEP.<br />
Those are:<br />
• The loss of employersponsored<br />
health<br />
insurance coverage; or<br />
• An involuntary loss<br />
of any other health<br />
insurance coverage.<br />
In either case, the application<br />
must be submitted within 30<br />
days of the loss of coverage<br />
and documentation is required<br />
to verify the loss of coverage.<br />
Children eligible for Medicaid<br />
or ARKids First are not eligible<br />
for coverage under an individual<br />
policy.<br />
Should you have any questions,<br />
call Customer Service at<br />
1-800-238-8379.<br />
16 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>
Medicare Annual Election Period<br />
October 15 through December 7<br />
Medicare’s Annual Election<br />
Period (AEP) will begin October<br />
15, and will run through<br />
December 7. During AEP,<br />
Medicare beneficiaries can<br />
purchase a Medicare Advantage<br />
plan and/or a Medicare Part D<br />
prescription drug plan. <strong>You</strong> also<br />
may switch from your existing<br />
plans. If you join a plan during<br />
AEP, or make changes to an<br />
existing plan, your new benefits<br />
will be effective Jan. 1, 2013.<br />
Affordable products<br />
and peace of mind<br />
Generations of Arkansans have<br />
trusted Arkansas <strong>Blue</strong> Cross and<br />
<strong>Blue</strong> Shield for peace of mind.<br />
Our Medicare products offer<br />
members low monthly premiums.<br />
And, in 2013 you can expect the<br />
same great selection of Medicare<br />
products you’ve come to expect<br />
from us through the years.<br />
• $0 premiums for Medi-Pak®<br />
Advantage MA-PD Private<br />
Fee-for-Service (PFFS)<br />
(includes drug coverage) in<br />
27 counties and affordable<br />
premiums in all Arkansas<br />
counties. Medi-Pak Advantage<br />
(PFFS) members have access<br />
to our extensive network of<br />
more than 7,000 doctors and<br />
hospitals across the state.<br />
In addition, Medi-Pak<br />
Advantage MA-PD members<br />
receive a membership in<br />
the popular SilverSneakers®<br />
Fitness Program* at no<br />
additional cost.<br />
• $0 premiums for Medi-Pak<br />
Advantage MA (PFFS) (does<br />
not include drug coverage) in<br />
50 counties. These plans offer<br />
all the health benefits of our<br />
Medi-Pak Advantage MA-PD<br />
plans, but do not include drug<br />
coverage. Members have the<br />
same access to our network of<br />
doctors and hospitals, and a<br />
SilverSneakers membership.<br />
• Two Medi-Pak® Rx<br />
Prescription Drug Plans<br />
(PDP) – Basic and Premier<br />
– with competitively priced<br />
monthly premiums. More<br />
than 95 percent of Arkansas<br />
pharmacies are in our<br />
network.<br />
• Four Medi-Pak® supplement<br />
plans including Plan F,<br />
our most comprehensive<br />
supplement plan, and Plan<br />
N, one of our lowest-priced<br />
supplement plans.<br />
Attention Medicare<br />
Advantage plan members<br />
If you have a Medicare<br />
Advantage or Medicare Part D<br />
plan, during October you will<br />
receive an Annual Notice of<br />
Change (ANOC) which will explain<br />
any changes to your current plan<br />
that will become effective in<br />
January. If you are satisfied<br />
with your current plan, you<br />
are not required to change<br />
anything. Every year, the Centers<br />
for Medicare and Medicaid<br />
Services (CMS) require companies<br />
to inform members of these<br />
changes prior to AEP so they may<br />
shop their coverage.<br />
If you would like to<br />
learn more about our<br />
Medicare plans …<br />
Call your local Medi-Pak®<br />
Choice licensed agent or<br />
1-800-392-2583 to learn<br />
more. <strong>You</strong> also can visit our Web<br />
site, arkansasbluecross.com/<br />
Medicare. We’d love to hear from<br />
you. If you have a friend or family<br />
member who doesn’t have one of<br />
our Part D prescription drug plans<br />
or Medicare Advantage plans, we<br />
hope you’ll recommend Medi-Pak<br />
Rx and Medi-Pak Advantage.<br />
*See disclosure on page 28<br />
2013 Open Enrollment for Arkansas State and Public School members<br />
October 1 through October 31<br />
The Arkansas State and Public and<br />
School Employee and Retiree Open<br />
Enrollment Period began October 1<br />
and run through October 31. Please<br />
refer to the Employee Benefits<br />
(EBD) newsletter, The Buzz, for plan<br />
information or go the EBD Web site,<br />
ARBenefits.org.<br />
This year will be a passive<br />
enrollment – meaning that if you<br />
do not wish to change plans you<br />
automatically will be enrolled<br />
in the plan you selected for the<br />
<strong>2012</strong> plan year. However, if you<br />
want to change plans, add or drop<br />
dependents or update demographic<br />
information, you must complete an<br />
election form.<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
17
with Dr. David<br />
David A. Lipschitz,<br />
M.D., Ph.D.<br />
<strong>You</strong> can reduce the risk of a serious fall<br />
Falls become more prevalent with age<br />
After age 65 about 30 percent of people fall at<br />
least once annually. And, if a hip fracture occurs, 25<br />
percent will die in a year and 50 percent will become<br />
dependent, frequently requiring nursing home care.<br />
Fortunately, much can be done to reduce the risk of<br />
a fall, the need for lengthy hospital stays or the loss<br />
of independence.<br />
Causes of falls<br />
Increased fall risk with age frequently is due to<br />
declines in balance, mobility and gait, and a high<br />
risk of fainting caused by blood pressure drops<br />
when attempting to stand up. Visual difficulties,<br />
dizziness, inappropriate shoe choices and side effects<br />
of drugs often contribute to falls. Tripping due to<br />
environmental hazards in the home or elsewhere<br />
remains the major cause of falls at any age.<br />
An evaluation by a physician is<br />
essential<br />
If you or a loved one is at risk of falling, an<br />
evaluation by a physician is essential. Medical<br />
conditions that contribute to falls must be identified<br />
and treated and problems with gait and balance<br />
evaluated. There are standardized tests that can<br />
be done that identify major problems with the way<br />
someone walks. First, can the patient get up from<br />
the chair without assistance? Does he have to use his<br />
hands to stand, or does someone have to help him?<br />
Can he walk without using an assistive device such<br />
as a cane or a walker? Can he walk in a straight line?<br />
How long does it take him to walk<br />
10 meters, turn around and sit back down.<br />
If it is longer than 20 seconds, a serious<br />
problem exists.<br />
A careful assessment of all medications<br />
must be done. Many medications can<br />
increase the risk of falling by causing<br />
drowsiness, confusion, worsening weakness<br />
and balance difficulties and significant<br />
dizziness. This particularly occurs if a person<br />
is taking medications to lower blood pressure.<br />
Whenever possible, keep medications to a<br />
minimum and avoid sleeping pills, tranquilizers<br />
and alcohol. Medications to treat hypertension<br />
(high blood pressure) also can lead to dangerous<br />
drops in blood pressure. If your loved one takes<br />
blood pressure medication, remind them to stand<br />
up slowly and always have something to hold on to<br />
in case he feels faint.<br />
Exercise is the key to preventing falls<br />
No matter your health, aging is associated with<br />
a relentless loss of muscle mass, an increased<br />
proportion of weight as fat and progressive weakness<br />
that slows gait speed, affects balance and increases<br />
the risk of falls. The more we do to maintain strength<br />
the better. Physical therapy can help reduce falls.<br />
Treatment includes balance exercises and working<br />
with weights that builds muscle, bones and most<br />
importantly strength. The older the patient,<br />
the longer the time it will take to see tangible<br />
improvements, but they will occur and the results are<br />
well worth the effort. When physical therapy ends, it<br />
18 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>
is important to keep moving and consider<br />
joining a health club to continue exercise<br />
and maintain and improve strength<br />
and balance.<br />
Use assistive devices if needed<br />
Do not be embarrassed to use a cane,<br />
walker or a wheelchair, but walk as much as<br />
possible. The more time spent being immobile<br />
or sitting in a wheelchair, the greater the loss of<br />
muscle and the increased chance of a fall. Electric<br />
wheelchairs are great, but should only be used if<br />
needed and if walking is impossible.<br />
Assess your house for fall risk<br />
Most serious falls occur in the bathroom.<br />
Carefully review the bathroom to make sure<br />
slippery surfaces can be avoided, that water does<br />
not leak from the shower or tub and, if possible,<br />
install hand rails from the bed all the way into the<br />
bathroom. Often a raised toilet seat with armrests<br />
can prove helpful. A sturdy plastic seat should be<br />
placed in the tub or shower and use a hand-held<br />
shower head to bathe. If a wheelchair is needed<br />
or gait and balance are significantly impaired,<br />
a uniquely designed bathtub or shower may be<br />
needed. During the night, a bedside commode may<br />
be a good option rather than walking in the dark to<br />
a very hazardous area.<br />
Fall-proof the home by clearing walking areas<br />
of boxes and electrical phone cords. Remove low<br />
coffee tables and move magazines and plants out<br />
of the way. Loose rugs should be removed or<br />
taped to the floor, uneven wooden floorboards or<br />
carpeting must be repaired and skid proof materials<br />
should be used for cleaning. Many falls are caused<br />
by standing on a chair or attempting to remove<br />
something from an out-of-reach cupboard. For this<br />
reason, clothing, cleaning materials, dishes, utensils<br />
and food must be accessible and stored within easy<br />
reach. Adequate lighting decreases fall risk. Assure<br />
that each room has ambient light from outside<br />
during the day, is well lit at night and night lights<br />
are used liberally. Always switch on a light before<br />
climbing the stairs and install glow-in-the-dark or<br />
illuminated light switches.<br />
Consider moving<br />
If a fall risk is too great, consider whether living<br />
alone in a large house with stairs is appropriate.<br />
It may be time to move to a one-level home or to<br />
an assisted-living facility where help is available<br />
and people surround you. And, as you grow older,<br />
no matter your health, live as close as possible to<br />
immediate family.<br />
Accidents due to falls are a major cause of physical<br />
disability, the need for nursing home care and a<br />
poor quality of life. The earlier precautions are<br />
taken to reduce a fall risk, the better.<br />
David A. Lipschitz, M.D., Ph.D., is nationally<br />
recognized as a leader in the field of geriatrics.<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield is<br />
honored to have him as a contributor to<br />
<strong>Blue</strong> & <strong>You</strong> magazine.<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
19
ARKANSAS<br />
The Natural State<br />
LEARNER’S<br />
DRIVER’S LICENSE<br />
DL<br />
CLASS:<br />
D<br />
0000<br />
DLN:<br />
987654321<br />
DOB:<br />
05-30-1997<br />
Expires:<br />
05-30-2013<br />
Issued:<br />
9-27-<strong>2012</strong><br />
Sex:<br />
F<br />
It is a terrifying moment for any parent —<br />
your teen hops in the car with a brand new<br />
driver’s license, leaving you to worry until the<br />
car pulls back into the driveway.<br />
Under 18 until 05-30-2015<br />
Under 21 until 05-30-2018<br />
Height: Eyes:<br />
5-02 HZ<br />
Endors: Restr:<br />
A T<br />
While parents always will have that<br />
nervous feeling about their teen drivers, a<br />
recent report from the Arkansas Center for<br />
Health Improvement (ACHI), a nonpartisan,<br />
independent, health policy center, shows that<br />
a 2009 Arkansas law (Act 394) is helping to<br />
save lives by allowing teens to gain driving<br />
experience through the use of restrictions<br />
based on age and their driving record.<br />
“It’s very encouraging to see these positive<br />
trends in our teen driver statistics,” said Mary<br />
Aitken, M.D., director of the Injury Prevention<br />
Center at Arkansas Children’s Hospital (ACH)<br />
and a member of the University of Arkansas for<br />
Medical Sciences pediatrics faculty. “There is<br />
still a lot of work to be done to make sure the<br />
roads in Arkansas are safer, however. The Injury<br />
Prevention Center at ACH will continue<br />
to advocate for<br />
strong policies like Graduated<br />
Driver License (GDL) and provide education<br />
for teen drivers and their parents about how<br />
they can reduce risk on the roads — everything<br />
from adhering to the GDL provisions and<br />
putting away the cell phone, to buckling<br />
up on each trip.”<br />
The GDL provides for teen driver’s licenses<br />
in three levels: learner’s license, intermediate<br />
license and unrestricted/regular license. A<br />
learner’s license permits teens that are 14-15<br />
years old to drive only while accompanied by<br />
an adult 21 years of age or older. To receive an<br />
intermediate license, a teen driver must have no<br />
20 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>
serious traffic violations or accidents on record<br />
during the previous six months. Teens with an<br />
intermediate license are allowed to drive without<br />
an adult, but they are restricted from having<br />
more than one unrelated passenger under the<br />
age of 21. Drivers with this license also may not<br />
drive unsupervised between 11 p.m. and 4 a.m.,<br />
unless they are traveling to or from a school or<br />
church-related activity, work or in emergency<br />
situations. At 18, teens are eligible to apply for<br />
a regular, unrestricted, driver’s license if they<br />
have a clean driving record (i.e., there must be<br />
no major traffic violations on the applicant’s<br />
record in the previous 12 months).<br />
ACHI studied the impact of the law using<br />
information from the Arkansas State Police<br />
Motor Vehicle Crash Data. What they found was<br />
that there was a significant reduction in crashes<br />
and crash-related fatalities among teens during<br />
that timeframe. This is especially true for<br />
the youngest drivers who obtained their<br />
intermediate license to drive for the first time<br />
An Arkansas mom hands over the<br />
car keys to her teen daughter, now driving<br />
with a Graduated Driver’s License.<br />
without an adult. Similar reductions in crashes<br />
or fatalities were not found for the adult<br />
population during this same timeframe.<br />
Between 2008 and 2010, fatalities involving<br />
teen drivers were reduced by 59 percent, from<br />
about 25 fatal crashes per 10,000 drivers<br />
in 2008 to 10 in 2010. This translates to an<br />
estimated 32 actual lives that were saved.<br />
The most drastic change was among<br />
16-year-old drivers. The number of crashes<br />
among this age group was reduced by 22<br />
percent (from 1,467 per 10,000 drivers in<br />
2008 to 1,145 in 2010).<br />
ACHI also found that between 2008 and<br />
2010, fatalities involving teen drivers from<br />
11 p.m. and 4 a.m. dropped by 76 percent,<br />
from 21 fatalities in 2008 to five fatalities in<br />
2010. Teens between the ages of 16 and 18<br />
experienced a 19 percent reduction in single<br />
vehicle crashes, and a 52 percent reduction<br />
in single vehicle fatal crashes.<br />
Mary Aitken, M.D., speaks at a celebration<br />
of the Graduated Driver’s License at<br />
Arkansas Children’s Hospital.<br />
The limit on passengers in a vehicle driven<br />
by a teen also helped save lives. ACHI found<br />
a 20 percent decrease in teen driver crashes<br />
with multiple passengers from 2008 to 2010.<br />
The most significant decrease was recognized<br />
in cars carrying five or more passengers.<br />
Sources: Arkansas Center for Health Improvement,<br />
Arkansas Children’s Hospital<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
21
Notice: The notice below regarding Medical Loss Ratio Information is required by the federal government.<br />
Some readers may have received a medical loss ratio rebate because their employer’s health plan was eligible<br />
for a rebate. This notice is for members who did not receive a rebate because their segment of the market had<br />
a medical loss ratio higher than the minimum required by the Affordable Care Act.<br />
Medical Loss Ratio Information<br />
The Affordable Care Act requires health insurers in the individual and small group markets to<br />
spend at least 80 percent of the premiums they receive on health care services and activities<br />
to improve health care quality (in the large group market, this amount is 85 percent). This<br />
is referred to as the Medical Loss Ratio (MLR) rule or the 80/20 rule. If a health insurer<br />
does not spend at least 80 percent of the premiums it receives on health care services and<br />
activities to improve health care quality, the insurer must rebate the difference.<br />
A health insurer’s Medical Loss Ratio is determined separately for each State’s individual,<br />
small group and large group markets in which the health insurer offers health insurance.<br />
In some States, health insurers must meet a higher or lower Medical Loss Ratio.<br />
No later than August 1, <strong>2012</strong>, health insurers must send any rebates due for 2011<br />
and information to employers and individuals regarding any rebates due for 2011.<br />
<strong>You</strong> are receiving this notice because your health insurer had a Medical Loss Ratio for<br />
2011 that met or exceeded the required Medical Loss Ratio. For more information on<br />
Medical Loss Ratio and your health insurer’s Medical Loss Ratio, visit www.HealthCare.gov.<br />
Congratulations to the<br />
winners of the <strong>2012</strong><br />
<strong>Blue</strong> & <strong>You</strong> Fitness Challenge!<br />
They are:<br />
A program of Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong> Shield,<br />
Arkansas Department of Human Services<br />
and the Arkansas Department of Health<br />
Group Category 1 (2-5 participants)<br />
Jefferson County — Pine Bluff, AR<br />
Group Category 2 (6-9 participants)<br />
Arkansas Education Association — Little Rock, AR<br />
Group Category 3 (10-11 participants)<br />
Boys and Girls Club — Alma, AR<br />
Group Category 4 (12 participants)<br />
The RoArk Group — Rogers, AR<br />
Group Category 5 (13 participants)<br />
National Park Service — St. Paul, MN<br />
Group Category 6 (14 participants) - TIE<br />
Eagle Heights Elementary — Harrison, AR<br />
UAMS AHEC Northeast — Jonesboro, AR<br />
Group Category 7 (15-16 participants)<br />
SFLIC — Hot Springs, AR<br />
Group Category 8 (17-18 participants)<br />
Arkansas State Plant Board — Little Rock, AR<br />
Group Category 9 (19-20 participants)<br />
Alliance Rubber Company — Hot Springs, AR<br />
Group Category 10 (21-24 participants)<br />
Harrisburg Middle School — Harrisburg, AR<br />
Group Category 11 (25-28 participants)<br />
Ben E. Keith Foods — North Little Rock, AR<br />
Group Category 12 (29-36 participants)<br />
Northrop Grumman CEO — St. Charles, MO<br />
22 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
Group Category 13 (37-43 participants) - TIE<br />
Keruso — Berryville, AR<br />
Lamar Elementary School, Lamar AR<br />
Group Category 14 (44-60 participants)<br />
Lamar High School — Lamar, AR<br />
Group Category 15 (61-80 participants)<br />
Nucor Yamato Steel — Blytheville, AR<br />
Group Category 16 (81-95 participants)<br />
Administrative Office of the Courts — Little Rock, AR<br />
Group Category 17 (96-138 participants)<br />
Red River Credit Union — Texarkana, AR<br />
Group Category 18 (139-234 participants)<br />
Transportation Security Agency — Little Rock, AR<br />
Group Category 19 (235+ participants)<br />
Simmons First National Bank — Pine Bluff, AR<br />
Student Winners:<br />
Grand-prize winner:<br />
• Wade Lambright of Harrisburg Middle School in Harrisburg<br />
won a Walmart gift card toward the purchase of a bike.<br />
Runners-up prize winners<br />
(fitness-related gift bags and gift cards):<br />
• Dalton Parnell of Lamar High School in Lamar,<br />
• Alexis Whitten of Watson Chapel Junior High FBLA in Pine Bluff,<br />
and<br />
• Jonah Hyman of HAAS Hall Academy in Fayetteville.
Arkansas <strong>Blue</strong> Cross joins<br />
new state payment initiative<br />
Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />
Shield and QualChoice have<br />
joined with Arkansas Medicaid<br />
to create the Arkansas Health<br />
Care Payment Improvement<br />
Initiative (AHCPII), which will<br />
transform the state’s payment<br />
system for doctors, hospitals and<br />
other medical facilities and put<br />
Arkansas on the leading edge of<br />
national efforts to improve health<br />
care quality and cost efficiency.<br />
Under our current payment<br />
system medical providers are<br />
paid for each activity, regardless<br />
of value. The system is called<br />
“fee for service.” For every<br />
medical service provided, the<br />
doctor or hospital receives<br />
a pre-determined fee. There<br />
are many drawbacks to this<br />
system. For example, doctors<br />
are not motivated to coordinate<br />
patient care. <strong>You</strong> may go to your<br />
primary care doctor (PCP) and<br />
have an imaging study. <strong>You</strong>r<br />
PCP may refer you to a specialist<br />
who repeats the imaging study<br />
because he is unaware that it<br />
was previously conducted.<br />
With the AHCPII model,<br />
health care providers are paid<br />
based on an agreed upon set<br />
of standards for the episode of<br />
care. Based on the cost of the<br />
provider’s care compared to<br />
pre-determined cost targets,<br />
they either will share in savings<br />
created, break even, or owe<br />
back money share in excess cost<br />
with to payers. By providing<br />
necessary evidence-based, high<br />
quality, and cost-effective care<br />
and better coordinating care<br />
across a patient’s providers care<br />
team, they can actually increase<br />
their net profit payment from<br />
the plan while saving money<br />
overall. This initiative was<br />
developed with input from<br />
physician associations, hospital<br />
executives, clinicians, patients,<br />
advocacy groups and the Center<br />
for Medicare & Medicaid<br />
Services (CMS). AHCPII is not a<br />
requirement of the federal health<br />
care reform legislation, but<br />
rather a state-based initiative.<br />
During the first phase of the<br />
new payment initiative, which<br />
began July 1, six episodes<br />
of care will be monitored.<br />
Participation in the initiative<br />
within the six episodes will<br />
vary. Arkansas <strong>Blue</strong> Cross will<br />
participate in the new payment<br />
initiative within the episodes<br />
with an asterisk (*):<br />
• Hip and knee replacements*<br />
• Congestive heart failure*<br />
• Pregnancy*<br />
• Developmental disabilities<br />
• Upper respiratory<br />
infections<br />
• Attention-deficit/<br />
hyper-activity disorder<br />
During the first three to<br />
six months of the initiative,<br />
doctors and hospitals will have<br />
access to reports designed to<br />
help them understand their<br />
current practice patterns<br />
and the financial and quality<br />
outcomes they generate.<br />
Information for those reports<br />
will be pulled from existing<br />
claims data and from a limited<br />
set of data that providers will<br />
enter into a provider portal for<br />
some of the episodes.<br />
Arkansas <strong>Blue</strong> Cross will<br />
work with doctors and hospitals<br />
to identify ways to improve<br />
the new payment method.<br />
After the introductory period,<br />
reimbursement changes will be<br />
implemented by the insurance<br />
companies and Arkansas<br />
Medicaid. The intent is to<br />
develop a common method<br />
for reimbursement but not to<br />
implement a common level<br />
of reimbursement.<br />
We are all paying the price<br />
of an uncoordinated delivery<br />
system. It is essential that<br />
Arkansas <strong>Blue</strong> Cross take the<br />
lead in building a new model<br />
that will serve our members and<br />
provide the kind of high-quality,<br />
affordable care you deserve.<br />
Source: healthcare.gov/news/factsheets/2011/09/primary-care09282011a.html<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
23
P. Allen Smith is an awardwinning<br />
designer, gardening and<br />
lifestyle expert. Arkansas <strong>Blue</strong><br />
Cross and <strong>Blue</strong> Shield is honored<br />
to have him as a contributor to<br />
<strong>Blue</strong> & <strong>You</strong> magazine.<br />
Even though I am still harvesting tomatoes<br />
and squash, it is time to start thinking about<br />
planting my cool season favorites.<br />
I grow certain cool season vegetables<br />
from seeds, like arugula, spinach, and various<br />
types of lettuce that germinate easily and mature<br />
quickly. Others like broccoli, cabbage, kale and<br />
collards are better started from transplants.<br />
If you are starting from seeds it is important<br />
to account for the number of days it will take for<br />
a plant to mature versus the first below-freezing<br />
temperatures of the season.<br />
The average date of the first killing frost in your<br />
area is the most important thing to know when it<br />
comes to fall vegetable gardening. To determine<br />
when to start planting, find out the number of<br />
by<br />
P. Allen<br />
Smith<br />
days to maturity for the vegetable. Count back the<br />
number of days from the first average frost date<br />
and add a week or so to allow for a few extra days to<br />
harvest the mature produce.<br />
Another thing to keep in mind when planting fall<br />
vegetables is that the seedlings require plenty of<br />
moisture. Keep them well watered until fall rains begin.<br />
Many of the leafy vegetables such as spinach and kale<br />
are heavy feeders, so be generous with fertilizer.<br />
Plants for <strong>You</strong>r Fall Vegetable Garden<br />
Broccoli - Mulch to help keep<br />
the ground cool and moist. Feed<br />
the plants three weeks after<br />
transplanting. I blanche any extras,<br />
then freeze for eating in the winter.<br />
Broccoli is high in vitamin C, high in<br />
folate, a good source of dietary fiber<br />
and a good source of potassium.<br />
Brussels Sprouts – Set the<br />
plants out in mid-summer. It will<br />
take about three months before<br />
the sprouts appear. Harvest when<br />
they are firm and green. Great<br />
roasted in the oven with sea salt<br />
and olive oil. Brussels sprouts<br />
are high in vitamin C and a good<br />
source of folate.<br />
Cabbage – Heavy feeders that<br />
require fertile soil rich in organic<br />
matter and consistent moisture. I<br />
have several cole slaw recipes that<br />
make my mouth water as I think<br />
about fresh cabbage. Cabbage comes<br />
in a number of varieties, but all are<br />
rich in vitamins C and E. They also<br />
contain vitamins A, B1, B2, B6, K<br />
and folic acid as well as the minerals<br />
calcium, sulfur, iron, magnesium,<br />
phosphorous and potassium.<br />
Cauliflower – Fluctuations<br />
in temperature, moisture and<br />
nutrients can cause the plant<br />
to “button,” or produce small,<br />
undersized heads. Blanch the<br />
heads by tying the outer leaves<br />
together over the heads when they<br />
are about 2 to 3 inches across.<br />
Great when florets are roasted with<br />
olive oil and garlic in the oven!<br />
Cauliflower is high in vitamin C<br />
and a good source of folate.<br />
Kohlrabi - Shade young plants<br />
from summer sun. Delicious in<br />
stir-fry. Kohlrabi is an excellent<br />
source of vitamin C and a good<br />
source of fiber.<br />
Lettuce – Sow seeds in late<br />
summer. Provide the seedlings with<br />
consistent moisture and shade from<br />
the afternoon sun. Clip outer leaves<br />
first for salads on the leaf and looseleaf<br />
varieties. They will produce for<br />
as long as temperatures remain<br />
cool! Lettuce is high in vitamin A<br />
and a good source of folate.<br />
Mustard Greens – Keep the soil<br />
consistently moist to encourage<br />
rapid growth and tender greens.<br />
I love them sautéed with chard,<br />
olive oil and garlic! Mustard greens<br />
are an excellent source of vitamin<br />
A, C and K, folate and manganese.<br />
24 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>
Radish – Quick to mature, sow<br />
seeds 4 weeks before the first<br />
frost. Sow evenly so you don’t<br />
have to thin them. No feeding<br />
necessary, but soil should be fertile<br />
and well drained. Radishes are<br />
delicious sautéed in a honey glaze.<br />
Radishes are high in vitamin C.<br />
Rutabaga – Wait to sow seeds<br />
until night time temperatures are<br />
consistently around 50 to 60 F. Keep<br />
the soil moist to prevent roots<br />
from forking. Simply toss with sea<br />
salt, pepper, olive oil and apple<br />
cider vinegar then roast. Amazing!<br />
Rutabaga is an excellent source of<br />
vitamin C.<br />
Spinach – An established<br />
spinach crop will last well<br />
into winter and can survive<br />
temperatures down into the 20s.<br />
Spinach prefers very fertile soil<br />
to encourage rapid growth and<br />
tender leaves. Add strawberries<br />
and a vinaigrette and there’s<br />
dinner! Spinach is an excellent<br />
source of fiber, vitamins A and C;<br />
high in iron, high in folate and a<br />
good source of magnesium.<br />
Good to Know<br />
Root vegetables are the “storage<br />
bin” for a plant’s nutrients and are<br />
health-promoting powerhouses.<br />
They are an excellent source of<br />
complex carbohydrates, fiber,<br />
potassium and antioxidants.<br />
Potatoes are among the highest<br />
in potassium of any fruit or<br />
vegetable commonly eaten in<br />
this country, while orange root<br />
vegetables like carrots and sweet<br />
potatoes are an excellent source<br />
of beta-carotene.<br />
Annual Notice<br />
2013 Summary of Benefits and<br />
Coverage – available November 15<br />
for individual/family policy holders<br />
As required by the Patient Protection and Affordable<br />
Care Act (PPACA), the Summary of Benefits and<br />
Coverage (SBC) (OMB Control Numbers 1545-2229,<br />
1210-0147 and 0938-1146) provides information<br />
regarding coverage specifications and limitations that<br />
apply to the health insurance plan you have selected.<br />
Before the end of each year, Arkansas <strong>Blue</strong> Cross<br />
and <strong>Blue</strong> Shield provides members who are under<br />
age 65 and have individual/family health insurance<br />
policies* with an SBC.<br />
This official communication includes information<br />
about the coverage provided by your health insurance<br />
plan in a summary format for the upcoming year.<br />
Beginning Nov. 15, <strong>2012</strong>, you may access this<br />
information:<br />
• Online in the “Benefits” section of the Arkansas<br />
<strong>Blue</strong> Cross secure member self-service center,<br />
My <strong>Blue</strong>print, at arkansasbluecross.com<br />
• By calling Arkansas <strong>Blue</strong> Cross Customer Service at<br />
1-800-238-8379 to receive a printed version<br />
After that date, you also may log on to<br />
arkansasbluecross.com/sbc and enter your member<br />
number (found on your Member ID card) into the SBC<br />
locator tool to review the document online and print it.<br />
If you make changes to your Arkansas <strong>Blue</strong> Cross<br />
health plan benefits that differ from your current<br />
coverage, a new SBC will be created for you within seven<br />
work days of our receipt of your change request. It will be<br />
available to you in the same manner described above.<br />
*These are members who do not have health insurance<br />
through an employer, a Medicare health plan, or<br />
Short-Term <strong>Blue</strong> product.<br />
Arkansas <strong>Blue</strong> Cross, Health Advantage and<br />
<strong>Blue</strong>Advantage Administrators of Arkansas members<br />
who receive health coverage through an employer<br />
group will get their SBC from their employer group<br />
plan administrator at the appropriate time.<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
25
Women’s Preventive<br />
Services<br />
In order to comply with the new health care<br />
reform law (PPACA or the Patient Protection<br />
and Affordable Care Act), Women’s Preventive<br />
Services will be added to many health plans.<br />
On August 1, <strong>2012</strong>, the change will be made to<br />
certain employer-sponsored health insurance<br />
plans. The change will take place on January 1,<br />
2013, for certain individual health plans.<br />
What are PPACA preventive services?<br />
PPACA preventive services, unlike our<br />
traditional preventive services, are covered<br />
under the employer’s plan at 100 percent with<br />
no member responsibility (e.g., no copayment,<br />
coinsurance or deductible when delivered by<br />
a network provider). Effective August 1, these<br />
benefits include Women’s Preventive Services.<br />
What are Women’s Preventive Services?<br />
The additional Women’s Preventive Services<br />
that will be covered without copayments,<br />
coinsurance or deductibles on applicable<br />
group policies are as follows:<br />
• Well-woman visits: An annual well-woman<br />
preventive care visit for adult women<br />
to obtain the recommended preventive<br />
services, along with additional visits if the<br />
woman and her doctor determine they are<br />
necessary.<br />
• Gestational diabetes screening: For women<br />
24 to 28 weeks pregnant, and those at high<br />
risk of developing gestational diabetes.<br />
• HPV DNA Testing: Women who are 30 years<br />
of age or older will have access to high-risk<br />
human papillomavirus (HPV) DNA testing<br />
every three years, regardless of pap<br />
smear results.<br />
• STI counseling, and HIV screening<br />
and counseling: Sexually active women will<br />
have access to annual counseling on HIV<br />
and sexually transmitted infections (STIs).<br />
• Contraceptives and contraception counseling:<br />
Coverage of prescription contraceptives on the<br />
drug list (brand-name contraceptives may have<br />
a copayment if a generic is available without a<br />
copayment); patient education and counseling;<br />
and Plan B (known as the morning-after pill)<br />
when prescribed for members under age 18.<br />
Any drugs used to cause abortion (e.g., RU<br />
486) are not covered. Over-the-counter birth<br />
control methods, even if prescribed by a<br />
doctor, are not covered.<br />
• Breastfeeding support, supplies and<br />
counseling: Pregnant and postpartum<br />
women will have coverage for lactation<br />
counseling from applicable health care<br />
providers. Manual breast pumps are<br />
covered; electric breast pumps and supplies<br />
are not covered. NOTE: Pregnancy services<br />
including prenatal, delivery and postnatal<br />
care are subject to member copayments,<br />
deductibles and coinsurance.<br />
• Domestic violence screening: Screening<br />
and counseling for interpersonal and domestic<br />
violence will be covered for all women.<br />
26 <strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong>
Women’s Health<br />
and Cancer Rights Act<br />
The Women’s Health and Cancer<br />
Rights Act of 1998 introduced changes<br />
in insurance coverage for a mastectomy.<br />
In accordance with the law, all group<br />
and individual health plans that provide<br />
medical and surgical benefits for a<br />
mastectomy will cover reconstructive<br />
breast surgery, including:<br />
• Reconstructive surgery on the<br />
breast on which the mastectomy<br />
was performed.<br />
• Reconstructive surgery on<br />
the unaffected breast needed<br />
to “produce a symmetrical<br />
appearance.”<br />
• Prostheses and treatment of<br />
complications of any stage of a<br />
mastectomy, including lymphedema<br />
(postsurgical fluid buildup).<br />
The provisions of the Women’s Health<br />
and Cancer Rights Act of 1998 apply to all<br />
group health insurance coverage effective<br />
on the first day of the plan year (which<br />
in most cases is the anniversary date of<br />
the group contract) after Oct. 21, 1998.<br />
The law went into effect on all individual<br />
insurance policies issued, renewed or in<br />
effect on or after Oct. 21, 1998.<br />
These provisions apply to all policies<br />
issued by Arkansas <strong>Blue</strong> Cross and <strong>Blue</strong><br />
Shield and Health Advantage and are<br />
subject to the applicable copayments,<br />
coinsurance, benefit limitations,<br />
exclusions and benefit maximums.<br />
If you have questions about your<br />
insurance coverage, contact your group<br />
benefits administrator or a customer<br />
service representative at an Arkansas<br />
<strong>Blue</strong> Cross office near you. We’d love<br />
to hear from you!<br />
We Love to Hear From <strong>You</strong>!<br />
May we help? For customer service, please call:<br />
Little Rock<br />
Number (501)<br />
Toll-free<br />
Number<br />
Medi-Pak ® members 378-3062 1-800-338-2312<br />
Medi-Pak Advantage members 1-877-233-7022<br />
Medi-Pak Rx members 1-866-390-3369<br />
Arkansas <strong>Blue</strong> Cross members 378-2010 1-800-238-8379<br />
Pharmacy questions 1-800-863-5561<br />
Specialty Rx pharmacy questions 1-866-295-2779<br />
Health Advantage members 378-2363 1-800-843-1329<br />
Pharmacy questions 1-800-863-5567<br />
<strong>Blue</strong>Advantage members 378-3600 1-888-872-2531<br />
Pharmacy questions 1-888-293-3748<br />
Federal Employee members 378-2531 1-800-482-6655<br />
Looking for health or dental insurance? We can help!<br />
For individuals, families 378-2937 1-800-392-2583<br />
For employer groups* 378-3070 1-800-421-1112<br />
*Arkansas <strong>Blue</strong> Cross, Health Advantage and <strong>Blue</strong>Advantage Administrators of Arkansas<br />
Prefer to speak with someone close to home?<br />
Call or visit one of our offices near you:<br />
Arkansas<strong>Blue</strong> — Little Rock<br />
2612 S. Shackleford Rd. — Suite J 501-378-2222<br />
Fayetteville<br />
516 East Millsap Rd. — Suite 103 1-800-817-7726<br />
Fort Smith<br />
3501 Old Greenwood Rd. — Suite 5 1-866-254-9117<br />
Hot Springs<br />
100 Greenwood Ave. — Suite C 1-800-588-5733<br />
Jonesboro<br />
707 East Matthews Ave. 1-800-299-4124<br />
Little Rock<br />
601 Gaines Street 1-800-421-1112<br />
Pine Bluff<br />
1800 West 73rd St. 1-800-236-0369<br />
Texarkana<br />
1710 Arkansas Boulevard 1-800-470-9621<br />
Visit our Web sites for more information:<br />
arkansasbluecross.com • healthadvantage-hmo.com<br />
blueadvantagearkansas.com • blueandyoufoundationarkansas.org<br />
<strong>Blue</strong> & <strong>You</strong> AUTUMN <strong>2012</strong><br />
27
good for you<br />
events and<br />
activities<br />
saturday, october 20<br />
Join Arkansas <strong>Blue</strong> Cross’ <strong>Blue</strong>Cares<br />
Team for the Komen for a Cure<br />
walk. Our team will be handing out<br />
goodies to walkers. We look forward<br />
to supporting finding a cure for breast<br />
cancer with Central Arkansans.<br />
saturday, november 10<br />
Get ready for a happy, healthy<br />
holiday season with P. Allen Smith!<br />
Join us at the Arkansas<strong>Blue</strong><br />
insurance store, from 9 a.m.<br />
to 1 p.m. for healthy food<br />
growing and cooking<br />
demonstrations, and activities<br />
with SilverSneakers ® * instructors.<br />
*SilverSneakers ® is a registered mark of<br />
Healthways, Inc. The SIlverSneakers ® Fitness<br />
Program is provided by Healthways, Inc.,<br />
Healthways is an independent company<br />
that operates separately from Arkansas<br />
<strong>Blue</strong> Cross and <strong>Blue</strong> Shield.<br />
MPI 1129 9/12<br />
saturday, december 1<br />
City Mouse, Country Mouse, Christmas<br />
House! Arkansas <strong>Blue</strong> Cross is hosting<br />
a special showing of City Mouse,<br />
Country Mouse, Christmas House at<br />
the Arkansas Arts Center. Round up<br />
the family and enjoy a FREE night<br />
of the arts. Tickets can be picked<br />
up at Arkansas<strong>Blue</strong>, located in the<br />
Shackleford Crossing shopping center,<br />
while supplies last. Check our Web<br />
site for details.<br />
spring 2013<br />
Although spring is months away, now<br />
is the time to plan for the <strong>Blue</strong> & <strong>You</strong><br />
Fitness Challenge. Start forming your<br />
team or group and plan to register<br />
for the 2013 Challenge.<br />
The <strong>Blue</strong> & <strong>You</strong> Fitness Challenge<br />
is an exercise contest (March 1 –<br />
May 31) that encourages participants<br />
to work toward the public health<br />
recommendation of adult physical<br />
activity 30 minutes each day, most<br />
days of the week.<br />
For more information, call toll<br />
free 1-800-686-2609, or visit<br />
blueandyoufitnesschallenge-ark.com.