CalCPA ProtectPlus

On September 13, 2011, a national initiative was announced by Million Hearts to prevent 1 million heart attacks and strokes over the next 5 years. Since one in three deaths occur in the United States due to heart disease, it is vital that we educate ourselves on the terrible disease. Over the next few months we will feature articles that will help educate readers on what heart disease is, as well as what cardiovascular disease and strokes are. We hope our readers will be able to learn what causes these conditions and what they can do to help prevent them.

The following is taken from http://millionhearts.hhs.gov.

Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over the next five years. The Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services are the co-leaders of Million Hearts within the U.S. Department of Health and Human Services, working alongside other federal agencies including the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Food and Drug Administration. Key private-sector partners include the American Heart Association, and YMCA, among others.

Heart disease and stroke are two of the leading causes of death in the United States. Million Hearts aims to improve heart disease and stroke prevention by:

• Improving access to effective care.
• Improving the quality of care.
• Focusing more clinical attention on heart attack and stroke prevention.
• Increasing public awareness of how to lead a heart-healthy lifestyle.
• Increasing the consistent use of high blood pressure and cholesterol medications.

Million Hearts brings together existing efforts and new programs to improve health across communities and help Americans live longer, healthier, more productive lives.

• Learn more about the science of Million Hearts in CDC’s Morbidity and Mortality Weekly Report
• Check out Million Hearts in Circulation, [PDF-286K] a journal of the American Heart Association
• See the Million Hearts perspective in the New England Journal of Medicine
• See the Million Hearts press release issued on Tuesday, September 13, 2011 [PDF-132K]

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The following is from womenshealth.gov – a project of the U.S. Department of Health and Human Services Office on Women’s Health.

National Women’s Health Week is a weeklong health observance coordinated by the U.S. Department of Health and Human Services’ Office on Women’s Health. It brings together communities, businesses, government, health organizations, and other groups in an effort to promote women’s health. The theme for 2011 is “It’s Your Time.” National Women’s Health Week empowers women to make their health a top priority. It also encourages them to take steps to improve their physical and mental health and lower their risks of certain diseases. Those steps include:

• Getting at least 2 hours and 30 minutes of moderate physical activity, 1 hour and 15 minutes of vigorous physical activity, or a combination of both, each week 
• Eating a nutritious diet
• Visiting a health care professional to receive regular checkups and preventive screenings
• Avoiding risky behaviors, such as smoking and not wearing a seatbelt
• Paying attention to mental health, including getting enough sleep and managing stress

Learn more about National Women’s Health Week.

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The Department of Health and Human Services (HHS) released proposed new rules late last week to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). An ACO is a network of doctors and other health care providers and suppliers that shares responsibility for providing care to patients.

The latest release from the HHS states that,

ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower health care costs while meeting performance standards on quality of care and putting patients first.  Patient and provider participation in an ACO is purely voluntary.

You or someone you know, may have a serious illness and have more than one doctor and taking more than one medication. If so, you have more than likely witnessed how disorganized your doctor’s office is when it comes to your medical information. No one likes to have to repeat the same information at each visit or watching doctors fumble through unsystematic files. It shows just how much our health care system needs to form accurate coordination of information and better communication between health care providers.

Medicare beneficiaries who have five or more chronic conditions suffer the most – and more than have of the Medicare beneficiaries fall into this category. With such serious conditions as diabetes, heart disease and kidney disease, these beneficiaries are very likely to have multiple physicians. These patients are at risk when doctors have failed to coordinate information in their files – so each physician is not sure what the last doctor did or they may not know which medication or dosage was prescribed. This can inevitably lead to the patient not getting the right care they need and there is an increased risk of being prescribed a medication that should not be taken with a medication prescribed by another doctor. It can also lead to complications that require hospitalization – which could have  easily been prevented. A study was conducted on nearly 12 million Medicare beneficiaries which showed that 1 in 5 patients discharged from the hospital was readmitted within 30 days which means if hospitals and doctors were better organized and coordinated with files and communication ”across care settings” , readmission may have been avoided. (continue reading…)

Among the features of the Patient Protection and Affordable Care Act (Health Care Reform) recently implemented, is the requirement that insurers cover a number of specific preventive health services without any additional cost-sharing requirements.

The law is designed to encourage individuals to get exams, screenings, and tests that detect health problems in their early stages. And while the law can’t get people to go get the recommended check-ups and tests, it is meant to remove their hesitations over cost by disallowing deductibles, co-payments, or co-insurance for the specified services.

At the time of passage, the legislation left blank the list of services and governing rules. Since then, the departments of Health and Human Services (HHS), Labor and the Treasury have issued regulations and a detailed description of covered services that must now be part of every plan begun after September 23, 2010. Already existing plans, where benefits and costs remain substantially unchanged from previous years, may be grandfathered and exempt.

Under the new rules, a list of routine recommended immunizations for both adults and children was adopted from the Centers for Disease Control and Prevention. The immunization list includes hepatitis A; hepatitis B; herpes zoster; human papillomavirus; influenza; measles, mumps and rubella; meningococcal; pneumococcal; diptheria, pertussis, and tetanus; and varicella.

Health care reform guidelines also include preventive care screenings for depression, alcohol misuse, high blood pressure, colorectal cancer, Type 2 diabetes, HIV, cholesterol, obesity, and syphilis. Adult men who smoke or have smoked can also receive a one-time screening for abdominal aortic aneurysms.

Women are eligible for free screenings for osteoporosis; breast cancer through mammograms; anemia; cervical cancer; hepatitis B; chlamydia and gonorrhea. Women who are pregnant can also receive screenings for Rh incompatibility and urinary tract infections.

In addition to the screenings and tests listed here, still others appear in the HHS guidelines. A complete list that was generated by the U.S. Preventive Services Task Force is available online by clicking here.

When clarifying its rules, the HHS declared that when these services are accessed through out-of-network providers, insurers may apply their usual out-of-network charges. In a related ruling, the agency determined that if a medical appointment is made for care not included in the covered list but covered care is given during the appointment, the co-payment or co-insurance may still be charged for the appointment. However, the insurer can not add an extra charge for the preventive care given during that appointment.

Finally, ProtectPlus subscribers should take note that all the preventive services newly mandated by health care reform were already covered by their plans. Though subject to some cost sharing in the past, these services are now 100% plan paid when obtained through in-network providers.