Is it Possible to Find Out What Surgery Will Cost Before the Surgery?

by Martin Trussell on February 6, 2010

in Consumer-driven Health Care, Hospitals, Payments

Healthcarebluebook.com, a leader in helping patients obtain fair prices for medical procedures, surgeries and treatments, wants to know if it is possible for patients to find out what surgery will cost before the surgery.  So, as part of Healthcare Blue Book’s ongoing effort to learn more about how patients can obtain pricing before agreeing to a surgery, their researchers regularly conduct pricing studies with medical providers.

In a recently published white paper, Surgery Pricing Secrets: The Challenges Patients Face, Healthcare Blue Book queried hospitals and Ambulatory Surgery Centers (ASCs) in three demographically disperse markets. These were Raleigh-Durham, North Carolina; Denver, Colorado; and Portland, Oregon. Researchers sought to obtain prices for self-pay patients, who did not intend to use insurance to pay for the procedure.

Healthcare Blue Book research focused on the ease of obtaining a price quote from a facility prior to receiving treatment. The evaluation included several categories, including how to:

  • Find someone who could answer pricing questions
  • Get a price quote within a reasonable amount of time
  • Obtain a complete price quote for all parts of a surgery
  • Ask for and obtain a cash discount
  • Get a guaranteed price estimate

The researchers found that while many hospitals attempt to help patients figure out what surgeries will cost, it’s still uncommon to obtain guaranteed prices from them before a surgery. Although many hospitals have created a staff position called “patient financial counselor,” patients frequently have a frustrating and unproductive experience. In contrast, ambulatory surgery centers (ASCs) provide far greater pricing transparency to patients and do so in a patient friendly manner in most cases.

The primary conclusion reached from the research is that healthcare pricing transparency is not possible under the current practices and pricing policies of most hospitals and some ASCs.

Healthcare Blue Book suggests six steps consumers can take to make sure they get a fair price for their surgery:

1. Ask your surgeon for the CPT code for your procedure before researching surgery pricing.

2. Call multiple providers from different types of facilities.

3. Ask for all costs associated with a surgery (surgeon, facility, anesthesia, hardware, etc).

4. Get pricing estimates in writing.

5. Consider out-patient alternatives to hospitals whenever possible.

6. Be patient and persistent when conducting pricing research.

The Healthcare Blue Book is provided free to consumers. The Healthcare Blue Book price represents a fair price to pay for a service or product when the patient is paying cash at the time of treatment. It represents a payment amount that many high-quality providers accept from insurance companies as payment in full, and it is usually less than the stated “billed charges” amount. Visit www.healthcarebluebook.com.

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UnitedHealthcare’s ”Refill and Save Program” Rewards Prescription Drug Compliance with Discounts.

by Martin Trussell on February 1, 2010

in Consumer-driven Health Care, Innovation, Pharma

UnitedHealthcare has launched a health plan innovation  that offers $20 discounts off certain prescription drug co-payments for plan participants who refill their medications on a timely basis.

The Refill and Save Program, which includes asthma drugs Advair and Symbicort, and antidepressants Cymbalta, Effexor XR and Pristiq, reduces a customer’s co-payment for refills of these drugs by $20 – a 40-percent savings on a typical co-payment plan. Health plan participants who refill their prescriptions via mail order will receive a $50 discount on a 90-day supply of medicine, with a refill deadline of approximately 120 days. Initial prescriptions of the medicines will not be eligible for the discounted co-pay as the program is focused on encouraging timely refills of needed medications.

The Refill and Save Program is reportedly available to most of UnitedHealthcare’s fully insured commercial health plan participants and is said to be the first of its kind.

“Patients with chronic diseases such as asthma and depression who take their medicines regularly and who comply with prescribed treatments are likely to stay healthier. They not only feel better, they can potentially avoid costly medical problems that could result from delaying appropriate therapy,” said Tim Heady, CEO of UnitedHealth Pharmaceutical Solutions. “The Refill and Save Program is another example of UnitedHealthcare’s focus on helping people enhance their overall health and well-being while helping to reduce health care costs.”

Asthma drugs and antidepressants were selected for the program because the health benefits realized from increased adherence are often seen relatively quickly, according to Heady. “We anticipate that increased pharmacy costs that result from wider utilization will be offset by savings in medical costs,” he added.

UnitedHealthcare estimates that approximately 50 percent of its customers who take asthma medicines and 20 percent of its customers who take antidepressants are not compliant with their prescriptions. To ensure eligible plan participants are aware of this new opportunity to save money and improve their health, UnitedHealthcare is alerting eligible customers through a mailing, providing details of the program online at www.myuhc.com, and encouraging pharmacists to talk to their customers.

“Research has clearly shown that individuals are more sensitive than ever to the cost of their medications given the current economy,” said Dr. Mark Fendrick, director of the Center for Value Based Insurance Design at the University of Michigan. “I was excited to learn UnitedHealthcare is offering such an innovative program that rewards patients for being adherent to their medication by reducing their co-pay when they are compliant, which improves adherence and ultimately their health.”

About UnitedHealthcare
UnitedHealthcare (www.unitedhealthcare.com) provides a full spectrum of consumer-oriented health benefit plans and services to individuals, public sector employers and businesses of all sizes, including more than half of the Fortune 100 companies. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.

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Hacker Attacks Targeting Healthcare Organizations Doubled in the 4th Quarter of 2009.

by Martin Trussell on January 26, 2010

in HIPAA, Health IT

SecureWorks®, Inc., a global provider of information security services , reported today that attempted hacker attacks launched at its healthcare clients doubled in the fourth quarter of 2009. Attempted attacks increased from an average of 6,500 per healthcare client per day in the first nine months of 2009 to an average of 13,400 per client per day in the last three months of 2009. Attempted attacks against other types of organizations, protected by SecureWorks, did not increase in the fourth quarter.

“From October through December of 2009, we blocked hundreds of SQL Injection and Butterfly/Mariposa Bot malware attacks launched at our healthcare clients. These attempted attacks were responsible for the increase in our attack statistics,” said Hunter King, security researcher with SecureWorks’ Counter Threat Unit(SM) (CTU).

In the Fall of 2009, SecureWorks and the security community began tracking a new wave of attacks involving the latest version of the Butterfly/Mariposa Bot malware, according to King. If a computer is infected with the Butterfly malware, it can be used to steal data stored by the victim’s browser (including passwords), launch Distributed Denial of Service attacks, spread via USB devices or peer to peer, and download additional malware onto the infected computer.

Factors Contributing to Healthcare Attacks

SecureWorks noted that there are tow mini reasons that Heathcare entities are targeted:

1. Valuable Data Stores – Healthcare organizations often store valuabledata such as a patient’s Social Security number, insurance and/or financial account data, birth date, name, billing address, and phone, making them a desirable target to cyber criminals.

2. Large Attack Landscape – Because of the nature of their business, healthcare organizations have large attack surfaces. Healthcare entities have to provide access to many external networks and web applications so as to stay connected with their patients, employees, insurers and business partners. This increases their risk to cyber attacks.

“In order for healthcare organizations to effectively protect their sensitive patient data, they should consider employing a defense-in-depth strategy. This approach involves implementing multiple layers of protection to shield the organization from current and emerging threats,” said Jon Ramsey, CTO for SecureWorks.

SecureWorks has outlined a set of information security guidelines to assist the healthcare industry in protecting their patient data from cyber attacks and other data breaches. Adopting these security measures will also assist organizations in demonstrating their adherence to the HIPAA regulations and the requirements outlined in the new Health Information Technology for Economic and Clinical Health (HITECH) Act.

About SecureWorks

SecureWorks is a market leading provider of world-class information security services with over 2,700 clients worldwide spanning North America, Latin America, Europe, the Middle East and the Pacific Rim. Organizations of all sizes, including more than ten percent of the Fortune 500, rely on SecureWorks to protect their assets, improve compliance and reduce costs. The combination of strong client service, award-winning security technology and experienced security professionals makes SecureWorks the premier provider of information security services for any organization. Positioned in the Leader’s Quadrant of Gartner’s Magic Quadrant for MSSPs, SecureWorks has also won SC Magazine’s “Best Managed Security Service” award for 2006, 2007, 2008 & 2009. www.secureworks.com

Source: SecureWorks, Inc.

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Aetna Launches Team-Based Fitness and Nutrition Program that Uses Online Social Networking.

by Martin Trussell on January 22, 2010

in Health, Innovation, Social media, wellness

Aetna (NYSE: AET) today announced a new team-based fitness and nutrition program for employers nationwide that uses online social networking to encourage people of all health and fitness levels to work together with their colleagues to achieve their optimal health. Powered by Shape Up The Nation, Aetna Health Connections Get Active!SM is modeled after Aetna’s own Get Active Aetna employee program. The program has been exceptionally successful among Aetna’s own employees, with 57 percent of employees participating in the program in 2009.

“We all know the health benefits of losing weight, being more active, quitting smoking, eating a healthier diet and more, but many people don’t know where to begin and the thought of doing it alone is often daunting,” said Lonny Reisman, M.D., Aetna’s chief medical officer. “Introducing a program to employees that includes a group dynamic has proven effective for motivating Aetna’s own employees to get healthy. In fact, many Aetna employees have shared amazing success stories about how the program helped them achieve and sustain healthy lifestyles. Now, Aetna is bringing this program to our customers so that other companies can enjoy the success that Aetna has had with its own employees.”

Kip Hill, an Aetna employee in Arlington, Texas, credits the program with helping him lose 120 pounds by eating better and exercising regularly. Hill has participated for three years and says, “It is such an important program. I’m a competitive person, so this makes exercise fun because you have teams and you are rooting each other on.” Now, just 40 pounds away from his goal weight, he’s already met another important health goal – quitting smoking. “I love the program because it makes you think about how to fit exercise into your busy schedule and if you continue to do it all year long, you really see a difference.” Now, Hill is even more active, leading his son’s Cub Scout pack and once he reaches his goal weight, Hill says he hopes to enjoy a whole range of activities with his two sons, like karate, kickboxing and hiking.

Aetna Health Connections Get Active!
Powered by Shape Up The Nation, a wellness company focused on leveraging the power of trusted social networks to promote healthy living, Aetna Health Connections Get Active! is being offered to large- and medium-sized employers who want to help employees of all health and fitness levels improve their overall health. The social networking platform is designed to unite employees to schedule group exercise opportunities, find colleagues with similar health interests, use online fitness and nutrition trackers and participate in team competitions. Participants can invite, challenge, track and motivate each other throughout the year. Aetna Health Connections Get Active! joins Aetna’s full suite of health and wellness programs aimed at helping people achieve their optimal health.

“We are proud to partner with Aetna to bring our employee wellness platform to their customers,” said Mike Zani, Shape Up The Nation’s chief executive officer. “Research shows that trusted social networks can be harnessed to encourage healthy behaviors and increase the likelihood for success through peer motivation, support, and accountability. Aetna members will benefit greatly from this powerful new tool for improving their health.”

Get Active Aetna results
Aetna has used a variety of wellness programs, including its own Get Active Aetna program, now in its third year. More than 20,000 Aetna employees actively participated in the program in 2009. In 2008, nearly 60 percent of employees participated and as a whole, participants walked the equivalent of 132 times around the earth’s equator. This year, Aetna employees walked 3.9 million miles or the equivalent of circling the equator 156 times.

About Aetna
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.

About Shape Up The Nation
Shape Up The Nation is the first wellness company focused on leveraging the power of trusted social networks to promote healthy living. Founded in 2006, Shape Up The Nation has pioneered an innovative approach to behavior change that uses social networking to reduce health care costs by improving the health of large populations through peer motivation, support, and accountability. Shape Up The Nation’s evidence-based online platform is used by more than 100 leading self-insured employers and health plans. Headquartered in Providence, Rhode Island, Shape Up The Nation is online at www.shapeupthenation.com.

Source: Aetna

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Innovative Value-Based Health Insurance Plan Designs Can Improve Member Health at No Added Cost, Study Says.

January 21, 2010

The financial impact of behaviors resulting in improved health can be measured in terms of savings on both medical [such as fewer emergency room visits and hospitalizations] and non-medical [such as fewer disability days, less absenteeism and greater worker productivity] spending, Fendrick says.

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What Do Employers Want from Health Insurers in 2010.

January 20, 2010

“Hit by a major recession and thrust into the teeth of a national debate on health reform, employers are taking a critical look at their health benefits strategy and the value they derive from it.”

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CSA Travel Protection Enhances Travel Insurance Plan With Consult A Doctor.

January 19, 2010

Consult A Doctor offers 24/7 access to physicians for phone and secure email medical consultations. Its proprietary nationwide cross-coverage network of U.S. licensed primary care physicians and specialists provide specific answers to medical questions and advice regarding non-emergency, routine medical conditions.

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Programs Fight Obestity and Encourage Kids to Get Active.

January 18, 2010

“More than half of the United States is affected by excess weight; however, many Americans, both young and old, do not realize they are overweight or obese until they are faced with a serious health risk, such as diabetes or high blood pressure.”

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Cisco and Molina Healthcare Pilot a Telemedicine Program for Underserved and Underinsured Communities.

January 16, 2010

Through the use of high-definition cameras and electronic scopes, patients will also be able to see and listen to the medical examination in the same way as the clinician, allowing for more informed interactions with physicians.

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Health Plans React to Earthquake Crisis in Haiti.

January 15, 2010

The company is also reaching out to its customers with employees in Haiti to offer medical evacuation for those injured and other assistance.

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