Tips for getting the right kind of care

I just saw this quick article in the Herald Health (March 2012) about when to use a Walk-in Clinic vs. the Emergency room. Here are some helpful tips on how to decide where to go when a health issue pops up that can’t wait for an appointment with your regular doctor.
Walk-in Clinic: colds, flu symptoms, sore throat, cough, ear pain, minor burns, scrapes/lacerations, sprains, possible fractures, asthma, pediatric illnesses, abdominal pain, rash/hives, stings/bites, allergies, fevers, headaches, urinary symptoms, foreign object in eye/nose, and work related injuries.
Emergency room:
chest pain, amputation of limbs or deep wounds, sudden confusion/weakness/dizziness/difficulty speaking, severe head injuries with loss of consciousness or seizures, major burns, vomiting blood, smoke or chemical inhalation, poisoning/overdoses and suicidal behavior, physical or sexual assault, and pregnancy complications over 20 weeks including labor/bleeding/decreased fetal movement.

Frequently Asked Questions on Essential Health Benefits Bulletin

On Feb. 17, the Department of Health and Human Services issued guidance on its approach to defining Essential Health Benefits. The document covers selection of benchmark plan options, coverage of service substitutions, non-dollar limits vs. annual dollar limits, and requirements for self-insured, large group market and grandfathered group health plans.
 http://www.uhc.com/live/uhc_com/Assets/Documents/EssentialHealthBenefitsFAQ.pdf

(http://www.uhc.com/united_for_reform_resource_center.htm)

New Reporting Obligation Requires Cost of Coverage on W-2s

Employers will be responsible for reporting to employees the total cost of their group health benefit plan coverage on their W-2 forms under the Patient Protection and Affordable Care Act. The reporting requirements are expected to apply to the 2012 W-2 forms, which is information employers must report to employees in January 2013.

This requirement is informational only and does not mean that employer-provided coverage will become taxable. Employers filing fewer than 250 W-2 forms in 2011 will not be required to report the cost of coverage on any forms furnished to employees before January 2014.

Some benefits are not subject to the W-2 requirement:
**HIPAA “excepted benefits” plans (accident, disability income, supplemental liability, workers’ compensation insurance).
**Stand-alone dental and vision plans.
**Coverage under an HRA, amounts contributed to an HSA or an Archer MSA, as well as salary reduction contributions to a health FSA.
**Coverage under a self-funded plan that is not subject to any federal continuation requirements (COBRA, PHSA continuation, FEHBP continuation), such as a group health benefit plan sponsored by a church.Coverage provided by the federal government, state government or agency of the government under a plan maintained primarily for members of the military and their families.
**Coverage for a specific disease or illness or hospital indemnity insurance.

The United States of Diabetes

WASHINGTON, D.C. (Nov. 23, 2010) –
New Report Shows Half the Country Could Have Diabetes or Prediabetes at a Cost of $3.35 Trillion by 2020

More than 50 percent of Americans could have diabetes or prediabetes by 2020 at a cost of $3.35 trillion over the next decade if current trends continue, according to new analysis by UnitedHealth Group’s (NYSE: UNH) Center for Health Reform & Modernization, but there are also practical solutions for slowing the trend. New estimates show diabetes and prediabetes will account for an estimated 10 percent of total health care spending by the end of the decade at an annual cost of almost $500 billion – up from an estimated $194 billion this year.The report, “The United States of Diabetes: Challenges and Opportunities in the Decade Ahead,” produced for November’s National Diabetes Awareness month, offers practical solutions that could improve health and life expectancy, while also saving up to $250 billion over the next 10 years, if programs to prevent and control diabetes are adopted broadly and scaled nationally. This figure includes $144 billion in potential savings to the federal government in Medicare, Medicaid and other public programs.Key solution steps include lifestyle interventions to combat obesity and prevent prediabetes from becoming diabetes and medication control programs and lifestyle intervention strategies to help improve diabetes control.“Our new research shows there is a diabetes time bomb ticking in America, but fortunately there are practical steps that can be taken now to defuse it,” said Simon Stevens, executive vice president, UnitedHealth Group, and chairman of the UnitedHealth Center for Health Reform & Modernization. “What is now needed is concerted, national, multi-stakeholder action. Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models. Done right, the human and economic benefits for the nation could be substantial.”The annual health care costs in 2009 for a person with diagnosed diabetes averaged approximately $11,700 compared to an average of $4,400 for the remainder of the population, according to new data drawn from 10 million UnitedHealthcare members. The average cost climbs to $20,700 for a person with complications related to diabetes. The report also provides estimates on the prevalence and costs of diabetes, based on health insurance status and payer, and evaluates the impact on worker productivity and costs to employers.Diabetes currently affects about 27 million Americans and is one of the fastest-growing diseases in the nation. Another 67 million Americans are estimated to have prediabetes. There are often no symptoms, and many people do not even know they have the disease. In fact, more than 60 million Americans do not know that they have prediabetes. Experts predict that one out of three children born in the year 2000 will develop diabetes in their lifetimes, putting them at grave risk for heart and kidney disease, nerve damage, blindness and limb amputation.Estimates in the report were calculated using the same model as the widely-cited 2007 study on the national cost burden of diabetes commissioned by the American Diabetes Association (ADA).Diabetes and ObesityThe report also focuses on obesity and its relationship to diabetes. Being overweight or obese is one of the primary risk factors for diabetes, and with more than two-thirds of American adults and 17 percent of children overweight or obese, the risk is clearly rising. In fact, over half of adults in the U.S. who are overweight or obese have either prediabetes or diabetes, and studies have shown that gaining just 11-16 pounds doubles the risk of type 2 diabetes and gaining 17-24 pounds nearly triples the risk.“Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early and prevent this devastating disease before it’s too late,” said Deneen Vojta, M.D., senior vice president of the UnitedHealth Center for Health Reform & Modernization, who helped develop UnitedHealth Group’s Diabetes Prevention and Control Alliance.SolutionsThe United States of Diabetes: Challenges and Opportunities in the Decade Ahead focuses on four categories of potential cost savings over the next 10 years:
Lifestyle Intervention to Combat Obesity: There is an opportunity to reduce the number of people who would develop prediabetes or diabetes by nearly 10 million Americans, through public health initiatives and the wider use of wellness programs to combat obesity.
Early Intervention to Prevent Prediabetes from Becoming Diabetes: Evidence from randomized controlled trials and UnitedHealth Group’s own experience demonstrates that the use of community-based intervention programs – such as the UnitedHealth Group Diabetes Prevention Program (DPP) in partnership with the Y – could reduce the number of people with prediabetes who convert to diabetes by an additional 3 million. The DPP is based on the original U.S. Diabetes Prevention Program, funded by the National Institutes of Health (NIH) and the CDC, which demonstrated that with lifestyle changes and modest weight reduction, individuals with prediabetes can prevent or delay the onset of the disease by 58 percent.
Diabetes Control through Medication and Care Compliance Programs: Better management of diabetes through improved medication and care compliance programs can help control the disease and reduce complications, such as UnitedHealth Group’s Diabetes Control Program (in partnership with community pharmacists).
Lifestyle Intervention Strategies for Diabetes Control: The wider use of public-private partnerships to develop the infrastructure to scale nationally the promising learnings of the Look AHEAD Trial.The report’s analysis draws on evidence-based, practical solutions derived from research, pilot programs and UnitedHealth Group’s own experience serving more than 75 million individuals worldwide.
(United Healthcare Group Newsroom)

Affordable Small Business Health Plans

If you have a small business and have anywhere from 2-50 employees it is in your best interest to look into a group medical plan.