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A publication for the policyholders of the
Arkansas Blue Cross and Blue Shield
family of companies
Winter 10
• New plans for individuals and families, Page 4
• 101-year-old still swimming, Page 10
• Helping UALR students compete internationally, Page 20
Long before the festivities start,
Arkansas Blue Cross and Blue Shield
employees are out in the chilly predawn air
filling hundreds of cups of water and setting the
stage for their part in the Komen for a Cure
Race in Little Rock. See the story on Page 8.
6 Eight clinics to pilot
innovative concept 8 Blue in the pink
23 Women’s Health and Cancer
Rights Act
Out of the Blue
New plans for individuals and families
Bravo Wellness to manage incentive programs for
employer groups
Eight clinics to pilot innovative concept
Your health plan information is online …
Register today!
Remembering Maudie Rogers
Blue in the pink
In the swim of things — 101 years and counting
Making healthy New Year’s resolutions and
making them stick
Lose weight The Healthy Weigh!
FDA issues consumer warning about infant
sleep positioners
Planning to have a baby? Eat more fruits, veggies
and fish!
Vitamin D supplements do not improve bone density
in healthy children
Are supplements a substitute for healthy eating?
Questions on health insurance reform?
Arkansas Blue Cross makes the grade
Lifelong Health with Dr. David
From the Pharmacist — What is step therapy?
The Doctor’s Corner
Good for you starts with …
Good for your community
Women’s Health and Cancer Rights Act
Customer Service telephone numbers
Good for you
345
67
81012
13
14
15
161819202223
24
Winter 10
is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, health care professionals and other persons interested in health care and wellness.
on Page 10
INSIDE
Editor: Kelly Whitehorn — [email protected] Editor: Jennifer GordonDesigner: Gio Bruno Photographer: Chip BayerContributors: Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming, Trey Hankins, Heather Iacobacci-Miller, Ryan Kravitz, Kathy Luzietti and Mark MoreheadVice President, Communications and Product Development: Karen Raley
101-year-old Tracy Akins, swimming at the Marvin Altman
Fitness Center in Fort Smith.
3
Blue & You Winter 2010
Out of the
BlueA message from our CEO and President,Mark White
Managing your health care budgetThe Patient Protection and Affordable Care Act
(PPACA), signed into law in March, quickly is changing
the health care landscape. There are still a lot of unan-
swered questions and concerns about how the coming
changes will affect our members. Regardless of these
changes, Arkansas Blue Cross and Blue Shield still will
continue to conduct business for our members with
three simple things in mind:
1. We want you to be healthy.
2. If you are sick, we want you to receive quality care
from excellent doctors and hospitals.
3. We don’t want you to go bankrupt in the process.
Arkansas Blue Cross always has been a careful
steward of your health care dollars. Our administrative
costs are some of the lowest in the country, and we are
always looking for ways to be more efficient without
sacrificing the quality of our customer service. Some
of the ways we save you money is by working with
doctors, hospitals and pharmacies to lower the cost
of care.
You can help add more value to your health care dol-
lar by following these simple rules:
Buy GenericGeneric medications often are a fraction of the
cost of brand-name drugs, and must meet the same
U.S. Food and Drug Administration (FDA) quality stan-
dards as their counterparts. Generic alternatives to
high-priced branded drugs help increase adherence
to prescribed drug therapies and improve health care,
while providing value to cost-conscious consumers and
businesses.
Join a Health Education ProgramDid you know Arkansas Blue Cross has programs
available to help you manage chronic illness or prepare
for a new child? All of our Health Education Programs
provide access to registered nurse case managers and
health information and education from community and
national resources. We believe that by learning more
about your condition, you can avoid problems and stay
healthier.
Use the emergency room only in emergencies
The use of emergency rooms for non-emergency
conditions results in unnecessary spending estimated
at $14 billion every year in the United States. When
insurance companies cover these costs, consumers
don’t immediately see the impact of the cost, but it’s
Budget, continued on Page 15
4
Blue & You Winter 2010
In the 60 years Arkansas Blue
Cross and Blue Shield has offered
health insurance to Arkansans, we’ve
learned what matters most to you:
cost, health plans that cover what
you need, and a choice of excellent
doctors and hospitals. Our new plans
for individuals and families, who are
not Medicaid- or Medicare-eligible,
feature all three.
Price, plans and providers
• Ourplansoffertheprotectionyou
need at prices that won’t break
the bank.
• Youhavelowcopaymentsfor
primary care doctor’s office visits
and generic prescription drugs.
And, other medical services are
covered after a deductible is met.
• Withmorethan9,300participat-
ing doctors and hospitals through-
out Arkansas, (and thousands of
doctors throughout the nation and
around the world for when
you travel).
What are you looking for in a health insurance plan?
Do you want your health plan to
start paying your medical bills
quickly? We have health plan op-
tionsfeaturing$30copaymentsfor
primary care doctor office visits and
$10 copayments for generic drugs.
Other medical services are covered
after your deductible is met.
Do you want coverage for preven-
tive care services and the option
to add benefits as your needs
change? Our health plans feature
coverage for routine physical exams,
gynecological exams, routine mam-
mograms, routine colonoscopies,
children’s immunizations and well-
patient care, and more. Also, if
you’re planning to start a family, or
add to it, our plans offer you the
flexibility of being able to add mater-
nity and obstetrical coverage to your
plan during the annual open enroll-
ment period.
Do you want a plan with tax ad-
vantages? Our “HSA-compatible”
health plans allow policyholders
to make tax-free contributions to a
health savings account (HSA) to pay
for medical expenses.
Money saved in your
HSA can be spent right
away or saved for future use.
Are you looking for dental cover-
age, too? We also offer a choice of
dental policies. These plans offer
coverage from preventive care
(including initial and periodic exams,
teeth cleanings, fluoride treatments
and X-rays) to minor restorative care
(fillings and simple extractions) to
major restorative care (root canals,
oral surgery, bridges implants and
more). Plus, you have the freedom to
use any dentist you wish — although
you can maximize your benefits by
using a dentist who participates in
the DentalBlue® network.
Whatever your need, we’ve got
the right plan for you. If you would
like more information on any of our
new plans, call toll free 1-800-392-
2583, visit us online at arkansasblue-
cross.com or contact a local indepen-
dent or Farm Bureau agent.
New plans for individuals and families
5
Blue & You Winter 2010
I f you have your health insurance through your em-
ployer (and the business has 51 or more employees),
your employer soon will be hearing about the Bravo
wellness program.
Arkansas Blue Cross and Blue Shield recently an-
nounced that Bravo Wellness will be its exclusive
incentive management partner for employer group
customers. The Bravo program, now offered exclusively
in Arkansas to customers of Arkansas Blue Cross and
its family of companies, provides employers with a tool
to control the cost of health care while encouraging
healthy behaviors among employees.
Because an estimated 75 percent of health care
costs are driven by lifestyle choices, the Bravo program
is designed to reward employees who make positive
lifestyle decisions.
In other types of insurance (like car or home), low
risk is rewarded. Good drivers pay less for car insurance
than bad drivers. Homes with swimming pools may
cost more to insure than those without pools. With the
Bravo program, these same concepts apply to health
insurance. If you make good lifestyle decisions, your
insurance will cost less.
The Bravo program will be available to Arkansas Blue
Cross, Health Advantage and BlueAdvantage Adminis-
trators of Arkansas employer customers with more than
50 employees.
“Our goal is to help our current and prospective
members live healthier lives,” said Mark White, presi-
dent and chief executive officer of Arkansas Blue Cross.
“With the help of Bravo, we can meet the needs of em-
ployers by providing a results-based incentive program
and continue to help our members reach their own
personal wellness goals.”
“We are thrilled to be selected and have given
Arkansas Blue Cross exclusive access to our products
and services in Arkansas,” said Jim Pshock, founder
and president of Bravo Wellness. “By offering Bravo’s
programs, Arkansas Blue Cross has provided employers
with a unique opportunity to control costs and improve
the health status of their employees.”
Bravo Wellness is an independent company that operates separately from Arkansas Blue Cross and Blue Shield, Health Advantage and BlueAdvantage Administrators of Arkansas. Bravo Wellness does not sell or service Arkansas Blue Cross, Health Advantage or BlueAdvantage products and is solely responsible for the incentive management services referenced in this article. This program is not available to Arkansas state employees or public school employees.
Bravo Wellness to manage incentive programs
for employer groups
6
Blue & You Winter 2010
Arkansas Blue Cross and Blue Shield has chosen
eight medical practices to serve in a pilot program:
Clinics featuring the new concept are:
Baptist Health Family Clinic; Bryant
Clopton Clinic; Jonesboro
Harrison Family Practice Clinic; Harrison
NEA Baptist Clinic, Internal Medicine; Jonesboro
Ozark Internal Medicine and Pediatrics; Clinton
UAMS-AHEC Northeast Family Medicine Residency
Program; Jonesboro
UAMS-Department of Family and Preventive
Medicine-Family Medical Center; Little Rock
Westark Diagnostic Clinic; Ft. Smith
This innovative approach to health care is another rea-
son that Arkansas Blue Cross and Blue Shield is good for
you. The eight patient-centered medical homes will be
piloted for two years and, if successful, other locations
may be added. The clinics selected to become medical
homes already are established, but will be transformed
to provide this new approach to health care.
What is a medical home?
Medical homes take the hassle out of medical care.
A medical home:
• Workstokeepyouhealthyandtakescareofyou
quickly when you are sick.
• Checkstobesureyougetthepreventivecareyou
need.
• Helpsyoumanageyourchronichealthproblems.
• Arrangesforanyspecialtycareyouneed.
• Keepsallofyourdoctorsinformedofthecareyou
receive.
• Caresforyouandaboutyou,justlikeathome.
Medical homes provide quick access for sick patients,
yet are available to patients who are taking steps to
prevent illness. By us-
ing a team approach,
medical homes can
be sure patients are
cared for by the team
member who can
best treat their needs.
This may include
advanced practice
nurses, dietitians, pharmacists and other health profes-
sionals, as well as primary care physicians (PCPs).
Keeping you well
Just like Mom reminds you to take an umbrella on a
rainy day, medical homes reach out to their patients to
make sure they are taking care of themselves. Medical
homes keep tabs on the routine screenings, vaccina-
tions, tests and check ups that can keep patients from
getting sick, and communicate reminders for them to
come in at the appropriate times. It’s just one more
thing you don’t have to remember in your busy life.
Modern Technology
The medical homes will have information at their
fingertips to be able to provide the best treatments for
specific conditions. And, information on all of the care
you are receiving, regardless of who delivers the care,
will be available to your medical home caregivers.
Maintaining good health
More than anything, the medical home concept is
about helping patients to adopt healthy lifestyles and
helping them reach their wellness goals. At Arkansas
Blue Cross, we want you to have medical care that is
good for you. And as we all know, there is no place
like home.
Copayments, deductibles and coinsurance will apply based on your coverage.
WELCOME HOME!Eight clinics to pilot innovative concept
7
Blue & You Winter 2010
Do you shop online? Pay your bills online? Catch
up with friends online?
If you spend several hours each day online, you are
not alone. Approximately 80 percent of all U.S. adults
go online for something. And, although you may not
have even thought about it, as a member of Arkan-
sas Blue Cross and Blue Shield, Health Advantage or
BlueAdvantage Administrators of Arkansas, you have a
personalized self-service Web site that allows you to go
online to:
• Check the status of a claim.
• Print a temporary ID card or order a new one.
• Contact Customer Service.
• Review your health plan benefits and other coverage
information.
• Find health and wellness information.
• Update your Personal Health Record.
• Sign up to get claims notifications by e-mail.
• And much more.
To access the self-service Web site, My Blueprint,
you’ll need to use our easy registration process by
visiting:
• arkansasbluecross.com
• healthadvantage-hmo.com
• blueadvantagearkansas.com
And, you can register if you are a:
• Policyholder
• Covered spouse
• Covered dependent
To gain immediate access to all of your personal
information, you’ll need to know the date of your last
physician office visit and the physician’s name or a claim
number or you can simply call Customer Service (see
phonenumbersonPage23).
Federal employees, Medi-Pak Rx and Medi-Pak Advan-
tage members do not have access to My Blueprint.
Your health plan information is ONLINE …
Register today!
Remembering Maudie RogersIt is with great sadness that we share that Maudie Rogers of Jonesboro, who
was featured on the cover of the Autumn 2010 Blue & You and in the Silver-
Sneaker’sarticle,diedSept.29,2010.MaudiewasamemberoftheNortheast
Arkansas Baptist Clinic Wellness Center and an inspiration to many. Even after
being diagnosed with lung cancer (she never smoked), she continued to
exercise. She will be remembered for her dedication to fitness, which chal-
lenged her friends, and even strangers, to strive for better health.
`````````
8
Blue & You Winter 2010
BLUE
8
Blue & You Winter 2010
Carl Carter, one of hundreds of Arkansas Blue Cross and Blue Shield employees who turn out each year for the Komen for the Cure® race in Little Rock, shows his spirit as he cheers on the participants.
9
Blue & You Winter 2010
In the chill pre-dawn hours, one October morning
each year, Arkansas Blue Cross and Blue Shield employ-
ees gather together at the corner of Sixth and Gaines
streets in Little Rock and transform it into a celebration
of life — a tribute to those battling breast cancer and to
those searching to cure it once and for all.
Under the glow of the blue cross and shield, hun-
dreds of Arkansas Blue Cross employees, their families
and friends, get ready to walk, run and volunteer their
time for the Komen for the Cure® race event in Little
Rock.Since1997,ArkansasBlueCrosshasbeena
financial sponsor of the race, and recently extended its
support to Komen races in Texarkana and Fayetteville.
But Arkansas Blue Cross’ sponsorship is more than
financial — it is a labor of love.
Employees in the Three Miles of Men fill thousands
of water cups and hand them out during the race. A vol-
unteer employee band fills the air with music, providing
extra encouragement to help race participants cross the
finish line. Other employees line the street to cheer on
racers and share a small gift as they pass by.
As the runners and walkers make their way through
the race route, the sea of pink takes on an undertone
of blue. Arkansas Blue Cross employees in blue T-shirts
are found throughout the race, participating in honor
or memory of women in their lives who have, or had,
breastcancer.Thisyear,morethan30ofthecompany’s
1,141-member team were breast-cancer survivors.
When the last race participant passes the Arkansas
Blue Cross building, employees gather up the decora-
tions and begin planning for next year’s race. It is a
commitment we make, not only to the Susan G. Komen
Breast Cancer Foundation, but also to the one in eight
women who will be diagnosed with breast cancer, to
the people who love them, and to our communities.
And it is one more way Arkansas Blue Cross is good
for you.
in the pink
10
Blue & You Winter 2010
In the swim
10
Blue & You Winter 2010
101 years and counting
of things
Tracy Akins, swimming at the Marvin Altman Fitness Center in
Fort Smith (left), and with Marilyn Simpson, her second cousin
and swimming partner (below).
11
Blue & You Winter 2010
In Tracy Akins’ 101 years, she
has been a school teacher, a book-
keeper, a cannery worker and a
secretary for a saw mill in Alaska, a
loving wife and a world traveler. For
the past 30 years, though, she has
been a swimmer.
Tracy swims at the Marvin Altman
Fitness Center in Fort Smith, where
she is a SilverSneakers® member.
SilverSneakers is the nation’s lead-
ing exercise program designed
exclusively for older adults. The
program offers an innovative blend
of physical activity, healthy lifestyle
and socially oriented programming.
This unique program is available to
Medi-Pak and Medi-Pak Advantage
(PFFS) members at no additional
cost at wellness centers throughout
the country.
“I just love to swim,” Tracy said
when asked about her favorite exer-
cise. “I learned to swim when I was
in the eighth grade. We had a swim-
ming pool in my hometown. For
many years, I couldn’t swim because
I didn’t have a place to go. Now I
swim five to six times a week.”
Because of macular degenera-
tion in her eyes, Tracy can no longer
drive, but that doesn’t stop her.
She and her second cousin, Marilyn
Simpson, show up around 7 a.m.
to do the sidestroke and walk laps
back and forth in the pool.
“I call her my trainer,” Marilyn
laughed. When Marilyn started
taking Tracy to the pool, at first she
would only drive, but then she said,
“that’s kind of silly,” and joined her
in the pool. Tracy keeps track of the
number of laps by reciting as many
words as she can think of starting
with each letter of the alphabet.
If she gets to the letter “J” she
knows she has done 10 laps. In that
way she exercises her mind as well
as her body.
When asked how she thinks she
managed to live so long, Tracy said
she eats regularly and keeps her
mind active. She listens to books
on tape from the library and is still
an active member at Central Pres-
byterian Church in Fort Smith. But
a big part of it, she insists, is the
swimming.
In January, Tracy fell and fractured
her pelvis. A break like that can be
devastating to an older person, but
Tracy attributes her great recovery
to her years of swimming. Still,
she was unable to swim for several
months, cooped up in rehabilita-
tion. Then, the fitness center pool
needed a face lift and she had to
wait a bit longer. The week the pool
opened back up, however, there
was Tracy, gliding through the shim-
mering water with Marilyn beside
her, thinking of words and challeng-
ing her body and mind.
When she was 94, Tracy wrote
a memoir, filled with adventures
in Missouri, Alaska and Arizona
before she and her husband, Walter,
moved to Mountainburg, Ark. Sadly,
Walter died a few years after they
moved to Arkansas and Tracy made
her home in Fort Smith. She then
became a world traveler, visiting
New Orleans, Washington D.C.,
Jerusalem, Hawaii, the Caribbean,
Germany, Switzerland, London,
Paris, Rome, Australia, New Zealand
and Ireland. Tracy will celebrate her
102nd birthday in January.
To find out if you are eligible for
SilverSneakers, please contact your
health plan provider. For more infor-
mation regarding the SilverSneakers
Fitness Program, visit silversneak-
ers.com or call 1-888-423-4632.
SilverSneakers® is a registered
mark of Healthways, Inc. The Sil-
verSneakers Fitness Program is
provided by Healthways, Inc., an
independent company that oper-
ates separately from Arkansas
Blue Cross and Blue Shield.
“I just love to swim
… For many years,
I couldn’t swim
because I didn’t
have a place to go.
Now I swim five to six times a
week.”
12
Blue & You Winter 2010
The Healthy Weigh! Education
Program is free for members of
Arkansas Blue Cross and Blue Shield,
Health Advantage (except state and
public school employees*), Blue Cross
and Blue Shield Service Benefit Plan
(Federal Employee Program), Medi-Pak
Advantage (PFFS) and eligible mem-
bers of BlueAdvantage Administrators
of Arkansas.
To enroll, complete the attached
enrollment form and return it in the
self-addressed, postage-paid envelope
included in this magazine. The pro-
gram starts when you enroll.
After enrollment, you will begin to
receive information through the mail,
which you can read in the privacy of
your own home and at your own pace.
The program is completely voluntary,
and you may leave the program at any
time. If you have further questions
about the program, call the Health
Education Program’s toll-free number
at 1-800-686-2609.
* Our state and public school members can access the “Nourish” program through LifeSynch.
Simply complete, sign and return the attached enrollment form in the self-addressed, postage-paid envelope to join The Healthy Weigh!
Lose weight
The Healthy Weigh!Each year, people start out the New Year with a list of goals and
resolutions, only to forget about them or give up on them within a few
weeks. Is it possible to make and keep healthy resolutions? It is when
you are more realistic with your resolutions. Here are some tips to help
you keep those resolutions this year, along with a few healthy resolu-
tion ideas for a happy, healthy 2011.
Tips for maintaining your resolutions:
• Berealisticwithyourresolutions;don’tmakethemallornothing.If
you want to eat healthier, start by eliminating one or two unhealthy
food items at a time.
• Setmini-goalsonyourwaytoonemaingoal.Ifyouwanttolose
weight, start with a smaller amount per month as a mini-goal.
• Paredownthelist.Stickwithafew,attainablegoalsratherthana
long list that may not be manageable.
• Makeresolutionsbasedonyourowndesiresandgoals,notwhat
others around you are doing. Don’t set up to run a marathon only
because your friends are doing it.
• Rewardyourselfwhenyoureachyourgoalsormilestones.
Healthy resolution ideas:
• Startanexerciseroutine.
• Eathealthier.
• Makeittoannualcheckups.
• Losetheextraweight.
• Challengeyourself—runa10K(or5K).
• Trysomethingnew—takeaZumba® class.
• Relax—takejust10minutesforpersonaldowntime.
• Addstepstoyourday—takethestairsandparkfartherfromthe
store entrance.
• Loweryoursugarintake.
• Addmorefruitsandveggiestoyourdiet.
With some willpower and the knowledge that the end result will be
worth it, you can make New Year’s resolutions that will stick!
Making healthy New Year’s resolutions and making them stick
12
Blue & You Winter 2010
13
Blue & You Winter 2010
The U.S. Food and Drug Administration (FDA) and the
Consumer Product Safety Commission (CPSC) recently
issued a warning to consumers not to use infant sleep
positioners.Inthepast13years,thefederalgovern-
ment has received 12 reports of babies known to have
died from suffocation associated with their sleep posi-
tioners. Most of the babies suffocated after rolling from
the side to the stomach.
The most common types of sleep positioners fea-
ture bolsters attached to each side of a thin mat and
wedges to elevate the baby’s head. The sleep position-
ers are intended to keep a baby in a desired position
while sleeping. They are often used with infants under 6
months old.
Please be careful
It’s best not to use infant positioning products. Also,
remember never to put pillows, sleep positioners, com-
forters or quilts under the baby or in the crib. Be sure
to always place a baby
on his or her back at
night and during
nap time.
Source: U.S.
Food and Drug
Administration
Eating more fruits, vegetables and fish before and
during pregnancy can reduce the risk of a baby being
undernourished or small for gestational age (SGA), ac-
cording to a recent study. SGA infants are more likely to
be stillborn and to have complications as newborns and
later in life.
The study found that a woman’s diet, prior to con-
ception, had a strong influence on the baby’s size at
birth. Women who ate a healthy amount of green leafy
vegetables (three or more portions of vegetables a
day) were found to have 50 percent fewer
SGA babies. Those who consumed
low amounts of fruit (less than one
portion a week) had a 50 percent
increase in SGA babies. Similarly, those who ate more
than three servings of fish a week had a 60 percent
reduction in SGA babies.
Researchers believe that the nutrients found in fruits
and vegetables may be protective to the pregnant
mother and the developing baby but add that women
who consume high amounts of such foods also tend to
lead healthier lifestyles. According to the researchers,
pregnancy, and the months before pregnancy, may be
the ideal time to encourage women to adopt a healthy
diet, improve their intake of important nutrients and
make lifestyle changes.
Source: Royal College of Obstetricians and
Gynaecologists
Blue & You Winter 2010
FDA issues consumer warning about infant sleep positioners
Planning to have a baby? Eat more fruits, veggies and fish!
14
Blue & You Winter 2010
A recent study revealed that vitamin D
supplements given to healthy chil-
dren who have normal vitamin D
levels, do not improve their bone
density. Building bone density
at a young age can help pro-
tect against osteoporosis later
in life and vitamin D has been shown to
help improve bone density.
Vitamin D is a fat-soluble vitamin that
helps regulate the amounts of calcium and
phosphorus in the blood and promotes the
absorption of calcium, making it easier for the body to
build bone from calcium-rich foods. Vitamin D supple-
ments previously have been shown to help build bone
density in people with a vitamin D deficiency.
In the latest study, researchers wanted
to find out if boosting levels of vitamin
D in healthy children would encour-
age bone density growth —
specifically in the hip, lumbar
spine, forearm or the body as a
whole. They discovered vitamin
D supplements had no statisti-
cally significant effect on bone
density in any of the specific body sites studied.
Vitamin supplements are meant to be just that –
supplements. Nothing beats healthy eating and whole
foods for getting the proper balance of vitamins and
minerals.
Whole foods, unlike supplements, are complex,
containing a variety of nutrients and micronutrients and
providing essential fiber necessary for a healthy diet.
They also contain other important substances for good
health, such as antioxidants.
However, sometimes supplements may be needed.
Supplements may be necessary if you:
• Donoteatawell-balanceddiet.
• Consumefewerthan1,600caloriesperday.
• Areveganorvegetarianandarenoteatingawide
variety of foods.
• Arepregnant,tryingtogetpregnantor
breastfeeding.
• Areapost-
menopausal
woman.
• Haveamedi-
cal condition
affecting
how your
body absorbs
and uses
nutrients.
If you do need to take
supplements, read the label
carefully for dosage, expiration date, active ingredients
and U.S. Pharmacopeia (USP) approval, and avoid mega
doses. As always, talk to your doctor to find out which
supplements may be best for you.
Source: mayoclinic.com
Vitamin D supplements do not improve bone density in healthy children
Are supplements a substitute for healthy eating?
14
Blue & You Winter 2010
15
Blue & You Winter 2010
Budget, continued from Page 3
still there in the form of higher premiums or reduced
benefits.
In this new health care environment, we all must look
for innovative ways to trim costs while improving health
and health care. It may be as simple as walking or bicy-
cling to a destination instead of driving, or as involved
as our new initiative to pilot several patient-centered
medical homes throughout the state of Arkansas.
Regardless, the goal is the same — to be good for your
pocketbook and good for you.
Arkansas Blue Cross and Blue Shield recently
received an “A” (Excellent) rating for financial strength
from A.M. Best Company, the world’s oldest and most
authoritative insurance rating source.
A.M. Best based this rating on the company’s signifi-
cant market share, enhanced operating flexibility and
considerable capital strength. A.M. Best noted that
Arkansas Blue Cross is well capitalized in support of its
business and insurance risk and has maintained strong
risk-based capital for the past several years.
A.M. Best also reported that Arkansas Blue Cross is
the market leader in Arkansas, has a broad network of
doctors and hospitals, offers diverse products, main-
tains a strong and attractive brand image, and is an
industry leader in coordinating member services with
other Blue Plans.
Additionally, A.M. Best recognized that Arkansas Blue
Cross emphasizes “high touch” interaction with mem-
bers with seven regional offices throughout the state
that give members easier access to sales and service.
Arkansas Blue Crossmakes the grade
A
Blue & You Winter 2010
The new changes to health insurance can be confusing,
and Arkansas Blue Cross and Blue Shield wants you to have as
much information as possible. The past two issues of Blue & You
magazinefocusedonthesechanges;ifyoumissedthem,orifyou
have questions, you can find them and other health insurance
reform information on our member Web sites, arkansasbluecross.
com and healthadvantage-hmo.com.
Questions on Health Insurance Reform?
16
Blue & You Winter 2010
Informed consent:Make sure you understand why a treatment is recommended
Whenever a patient receives surgical treatment (and
some medical treatment), he or she is required to sign
an informed consent document that describes the
treatment recommended and the potential side effects.
However, the typical informed consent document does
not tell you the benefits of having the procedure, or the
reasons for having the procedure. This could have a sig-
nificant impact on whether you are willing to undergo a
particular treatment.
A good example is the reason many patients believe
they are having coronary angiograms or angioplasties.
To explain this, I must first describe the indications for
angiograms and angioplasties.
A coronary angiogram involves inserting a plastic
catheter into the coronary artery, through which dye
is injected, so the physician can conduct a detailed ex-
amination of the inside of the coronary artery by X-ray.
Localized and generalized narrowing of the artery can
be identified, leading to the diagnosis of coronary artery
disease. An angiogram can help a physician:
• Diagnose coronary artery disease because of
suspicious symptoms such as chest pain or
shortness of breath or an abnormal EKG.
• Confirm the reason for worsening chest pain in
a patient with proven coronary artery disease
(unstable angina).
• Identify worsening heart failure.
• Indicate problems with heart valves.
A coronary angioplasty is done to open a blocked
artery. Using X-ray, the plastic catheter inserted into the
coronary artery is moved to where the vessel is blocked
or narrowed. A balloon at the tip of the catheter is in-
flated to open up the blockage. A small wire mesh (that
may be coated with medication) is then placed to keep
the artery expanded. An angioplasty is used to:
• Improve symptoms of coronary artery disease such
as chest pain or shortness of breath.
• Prevent damage to the heart muscle by opening up
an acute blockage that has led to a heart attack.
• Control symptoms in patients with proven coronary
artery disease if the symptoms are uncontrolled by
Lifelong Healthwith Dr. David
David A. Lipschitz, M.D., Ph.D.
17
Blue & You Winter 2010
medications or if the drugs cause too many side
effects.
More than a million coronary angioplasties are done
in the United States annually. In a recent study pub-
lished in the Annals of Internal Medicine, more than
88 percent of patients undergoing coronary angiograms
and angioplasties believed that the procedures were
done to prevent a heart attack. Eighty-two percent of
the patients believed the reason was to prevent death
from a heart attack.
Sadly, neither is true. Angioplasty only improves
symptoms caused by coronary artery disease (pain or
shortness of breath).
Experts now recommend using informed consent
documents that are more explanatory to better inform
patients about the benefits and risks of any procedure.
Clearly, a patient is much more likely to agree to an
angioplasty if he or she thinks that the intervention
will prolong life or prevent minor or fatal heart attacks.
But, would an asymptomatic man with proven coronary
artery disease agree to this procedure if he knew that
it had many risks with few evidence-based benefits?
Probably not, unless his cardiologist provides a compel-
ling reason why the procedure is needed. On occasion,
the patient may be persuaded, but the evidence is
undeniable that many coronary angiograms and angio-
plasties are unnecessary. Statistics indicate that more
than30percentofangioplastiesaredoneinpatients
without symptoms who have proven coronary artery
disease and whose cardiologists insist on performing
an angioplasty to clear blocked arteries.
Every patient needs to fully understand the reasons
for any medical procedure that is recommended. Make
sure you truly under-
stand what is being
recommended and the
reason for the procedure,
and make sure the following
questions are answered:
1. Why is the recommended procedure being
proposed?
2. What are the benefits of the procedure?
a. Will it prolong my life?
b. Will it improve the quality of my life?
c. What other benefits may occur?
3. Are there less invasive alternatives? Can
medications provide similar benefits?
4. What are the known side effects, and how often do
they occur in someone like me?
5. Where will the procedure be performed?
6. What is the physician’s qualification and record for
performing the procedure?
The most important message is to be fully informed,
in writing, about the potential benefits and risks of any
procedure recommended to treat any illness. While
treatment of heart disease is an easy example to un-
derstand, the same information must be provided for
the treatment of any serious disease, including cancers,
strokes and many other illnesses.
With life-threatening acute illnesses, immediate
intervention can save lives. But, if you are in a situation
where you can spend a little extra time to understand
the scope of your physician’s recommendation, it will
be time well spent.
Editor’s Note: David A. Lipschitz, M.D., Ph.D., is na-
tionally recognized as a leader in the field of geriatrics.
Arkansas Blue Cross and Blue Shield is honored to have
him as a contributor to Blue & You magazine.
The most important
message is to be fully
informed, in writing,
about the potential
benefits and risks
of any procedure
recommended to treat
any illness.
18
Blue & You Winter 2010
What is step therapy?
From the Pharmacist
Did you know that the average
cost of a brand-name medication is
$140, compared to $18 for a generic
medication? At Arkansas Blue Cross
and Blue Shield, we always are look-
ing for ways to make it easier for
you to take care of your health —
and your pocketbook.
One of the ways we look out for
you is by making generic medica-
tions even more accessible through
our list of approved medications,
which we call our “formulary.” Gener-
ic medications act exactly the same
way in your body as brand-name
medications, but they are much less
expensive. By placing generics on
the lowest copayment level, we give
you the ability to save money and
still receive quality medications.
Another way we help you save
is through step therapy. This
practice requires our members to
start a medication beginning with
the most cost-effective and safest
drug available and progressing to
other more costly therapies only
if necessary. We only do this with
medications that are very similar
with one another and can be easily
interchanged. This way, you can find
the best medication for your needs
with the least cost. If a medication
doesn’t seem to be working for
you, you can “step up” to a similar
medication in the next level in the
approved drug list, but you may end
up paying more.
Arkansas Blue Cross currently
uses step therapy in our Value For-
mulary. The Value Formulary em-
phasizes using generic medications
first. This drug list uses step therapy
on eight drug classes:
• ACEinhibitors/angiotensin
receptor blockers for high
blood pressure
• Statinsforhighcholesterol
• Non-steroidalanti-inflammatory
drugs
• Bisphosphonatesfor
osteoporosis
• Selectiveserotoninagentsfor
depression
• Triptansformigraines
• Nasalsteroids
• Sleepmedications
If you are asked to try step thera-
py the next time you are prescribed
a medication, you can be sure it
is our way of helping you find the
most cost-effective, quality treat-
ment for your condition. The use of
step therapy is based on the latest
medical findings, the U.S. Food and
Drug Administration’s medication
labeling and medication costs.
Using step therapy to guide
members toward generics and
more cost-effective medications is
another way Arkansas Blue Cross is
good for you.
This does not apply to Arkansas state employees or public school employees.
by Trey Gardner, Pharm D.,Arkansas Blue Cross and Blue Shield
19
Blue & You Winter 2010
by Ray Bredfeldt, M.D.,Regional Medical DirectorNorthwest Region, Fayetteville
TheDoctor’s Corner
What are the risks of CT scans?
Just last year, Americans received
more than 70 million CT (computer-
ized tomography) scans. According
to research, approximately half of
those scans were unnecessary and
exposed people to relatively large
doses of radiation.
Just one typical CT scan gives
a person the same amount of
radiation as 100 to 400 chest X-rays.
Total body CT scans provide as
much radiation as 1,500 to 2,000
chest X-rays.
A CT scan combines a series of
X-rays taken from many different
angles to produce cross-sectional
images of bones and tissue. For
example, a CT scan may be used
to examine people that may have
internal injuries (maybe from a car
accident) or to check for blockages
and other problems with
blood vessels.
In a study recently pub-
lished in the Archives of
Internal Medicine, research-
ers estimated that the radia-
tion people receive from CT
scans cause as many as
29,000cancercasesper
year. The younger the per-
son is, the greater the risk.
There are times when a CT scan
is absolutely necessary, however,
patients would be wise to ask their
doctors if there are alternatives that
might expose them to less radia-
tion. People also should be aware
that — although they may hear ad-
vertising for screening CT scans of
the heart, lungs (for smokers) or the
entire body — no preventive organi-
zation recommends these scans for
people without symptoms. There
is very little, if any, proof that the
potential benefits of such screen-
ings outweigh the risks from
the scans.
Flu vaccine recommended for those 6 months and older
Everyone above the age of 6
months should receive an annual
flu vaccination unless there is a
medical reason not to do so (e.g.
an allergy to eggs), according to the
Centers for Disease Control and
Prevention (CDC). Previously, the
flu vaccine has been encouraged
primarily for the elderly, pregnant
women, and people with chronic
disease. Unfortunately,
only about 50 per-
cent of those in the
high-risk categories
get the vaccine
each year. The CDC
hopes that by
making it clear
that everyone
could ben-
efit from the
vaccine,
more
high-risk
individu-
als will
get their
flu shot
each year.
20
Blue & You Winter 2010
good for you starts with …
At Arkansas Blue Cross and Blue Shield, w e recognize that every one of us is in
Customer Service, and we have a saying — “good for you starts with me.” For many
of our employees, serving others doesn’t e nd with the workday or the workplace.
20
Blue & You Winter 2010
It’s not as though the Information
Systems team at Arkansas Blue
Cross and Blue Shield doesn’t have
enoughtodo.Quitethecontrary;
just keeping up with the fast-paced
changes in the world of information
technology (IT) is a full-time job. Add
to that the responsibility of making
sure an entire company can con-
tinue to use technology to properly
function, and free time becomes
a premium. But, according to Kim
Henderson, director of Information
Systems for Arkansas Blue Cross,
it is precisely because the world of
IT is so hectic that the members of
her team are compelled to volunteer
their time and expertise.
For the past two years, Arkan-
sas Blue Cross IT employees have
worked with students at the Uni-
versity of Arkansas at Little Rock
(UALR) to help prepare them for
Microsoft’s annual “Imagine Cup”
technology competition. The world-
wide competition challenges teams
of students from colleges and
universities to apply computer tech-
nology in innovative ways to solve
real-world problems.
In2009,UALRfieldedeight
teams in the regional competition.
Two of those teams qualified for the
national competition, making UALR
the only university in the four-state
region (Arkansas, Texas, Oklahoma
and Louisiana) to have a team in
the nationals. That’s when Janet
Bailey, Ph.D., associate professor of
Management Information Systems
and coach of the UALR Imagine Cup
teams, contacted Kim for help.
“I was very proud of our team,”
Kim said. “When I first sent an e-
mail asking for volunteers I expect-
ed two or three.”
She got 12. Which is especially
commendable considering the con-
straints on their time.
“They went to the university at
night and on weekends,” said Kim.
“People spent their personal time
on this.”
And the work paid off. One of the
UALR teams won third place in the
2009nationalfinals.Team“Special
The Information Systems Team
21
Blue & You Winter 2010
good for you starts with …
At Arkansas Blue Cross and Blue Shield, w e recognize that every one of us is in
Customer Service, and we have a saying — “good for you starts with me.” For many
of our employees, serving others doesn’t e nd with the workday or the workplace.
Blue & You Winter 2010
Child” developed an application to
create a centralized database to
store information about children in
need of a permanent home and the
information about potential adop-
tive parents. Their success qualified
them to compete at the next level.
“They were the only team from
the United States that got to com-
peteinthe2009worldfinalsin
Cairo, Egypt,” said Kim.
Arkansas Blue Cross helped
UALR students prepare for the
world finals again in 2010. The finals,
which were held in Warsaw, Poland,
challenged teams to
develop a technology
that would help the
World Health Organi-
zation. The students
at UALR designed
a device that used
fingerprints to help
identify children who
had received vac-
cinations and those
who had not.
And, despite the
time-consuming nature of the work,
the Arkansas Blue Cross IT profes-
sionals seem to value the opportu-
nity to help.
“Our programmers just enjoy
helping the young people out,” said
Kim. “They remember what it felt
like to be in the students’ position.”
According to Kim, there is so
much to learn in the IT field that it is
very difficult for a university to pre-
pare students to be productive their
first day at a new job. Companies
use different software, applications
and processes, so there is no way
a student can learn them all prior to
taking a new job.
“Usually a person is on the job for
six months before they can do very
much because there is just so much
to learn,”
said Kim.
However, when
IT professionals
cooperate with
university faculties,
they can provide a
real-world context
for the students
and assist profes-
sors in reinforcing
the learning con-
cepts.
“We just want to try to help
improve the way students learn and
prepare for a field in information
technology,” said Kim. “Hopefully,
we can help them be more
productive when they get into
the workforce.”
Keith West (left) and Mike Kinnison were among a group of Arkansas Blue Cross and Blue Shield Information Systems employees who volunteered their time to help the University of Arkansas at Little Rock Imagine Cup teams prepare for their national and international competitions. “Our
programmers just
enjoy helping the
young people out.
They remember
what it felt like to
be in the students’
position.”
22
Blue & You Winter 2010
BlueAnn travels the stateBlueAnn Ewe, Arkansas Blue Cross and Blue Shield’s
health ambassador, along with the staff from Arkansas
Blue Cross’ Southeast Regional Office, attended a Back-
to-School carnival in McGehee, Ark., on August 24.
BlueAnn greeted hundreds of children and posed for
pictures while staff gave away BlueAnn coloring books
and crayons.
BlueAnn
joined Sarah
Tipton, me-
teorologist for
television station
KAIT in Jonesboro,
on September 28 to
teach children about the
weather and
its impact on
farming at a
Farm Pizza
Party hosted
by Farm
Credit Mid-
South.
More than
250 second-
grade stu-
dents from
Brookland
and Riverside
elementary
schools in
Jonesboro
attended the pizza party. The students migrated from
different weather and farm stations to learn how crucial
the weather is to growing and maintaining crops. The
different stations also taught students where the ingre-
dients for pizza come from. BlueAnn Ewe taught her
Healthy ClassAct lesson, which focuses on good health
and nutrition.
In October, BlueAnn participated in the annual Duck
Race, a fundraiser for the CHRISTUS St. Michael
Hospital Foundation in Texarkana.
BlueAnn joined several hundred families at a National
Down Syndrome Society Buddy Walk® at Bobby Fer-
gusonParkinTexarkanaonOctober30.TheNational
Buddy Walk helps raise awareness about Down syn-
drome and builds support systems, both of which last
long after the one-mile walk is over.
Arkansas Blue Cross raises nearly $10,000 for JDRF
Each year, Arkansas Blue Cross and Blue Shield
sponsors the Juvenile Diabetes Research Foundation’s
(JDRF) Walk to Cure Diabetes by forming a corporate
walk team and hosting an annual fundraiser. This year
employees raised nearly $10,000 for JDRF. Employees
also joined BlueAnn at Murray Park on September 18 to
show their support by joining the JDRF walk.
BlueAnn Ewe and friends at the Back-to-School carnival in McGehee.
23
Blue & You Winter 2010
We love to hear from you!May we help? For customer service, please call:
Little Rock Toll-free Number (501) Number
Medi-Pakmembers 378-3062 1-800-338-2312
Medi-PakAdvantagemembers 1-877-233-7022
Medi-PakRxmembers 1-866-390-3369
ArkansasBlueCrossmembers 378-2010 1-800-238-8379
Pharmacyquestions 1-800-863-5561
SpecialtyRxPharmacyquestions 1-866-295-2779
HealthAdvantagemembers 378-2363 1-800-843-1329
Pharmacyquestions 1-800-863-5567
BlueAdvantagemembers 378-3600 1-888-872-2531
Pharmacyquestions 1-888-293-3748
StateandPublicSchoolmembers 378-2364 1-800-482-8416
FederalEmployeemembers 378-2531 1-800-482-6655
Looking for health or dental insurance? We can help!
For individuals, families andthoseage65orolder 378-2937 1-800-392-2583
Foremployergroups 378-3070 1-800-421-1112 (Arkansas Blue Cross Group Services, which includes Health Advantage and BlueAdvantage Administrators of Arkansas)
Prefer to speak with someone close to home? Call or visit one of our regional offices:
PineBluff/SoutheastRegion 1-800-236-03691800West73rdSt.Jonesboro/NortheastRegion 1-800-299-4124 707 East Matthews Ave.HotSprings/SouthCentralRegion 1-800-588-5733 100 Greenwood Ave., Suite CTexarkana/SouthwestRegion 1-800-470-9621 1710 Arkansas BoulevardFayetteville/NorthwestRegion 1-800-817-7726516EastMilsapRd.,Suite103FortSmith/WestCentralRegion 1-866-254-91173501OldGreenwoodRd.,Suite5LittleRock/CentralRegion 1-800-421-1112320WestCapitolAve.,Suite900
Visit our Web sites for more information: arkansasbluecross.com
healthadvantage-hmo.comblueadvantagearkansas.com
blueandyoufoundationarkansas.org
The Women’s Health and
CancerRightsActof1998
introduced changes in
insurance coverage for
mastectomy.
In accordance with
the law, all group and
individual health plans
that provide medical and
surgical benefits for mas-
tectomy will cover recon-
structive breast surgery,
including:
• Reconstructive surgery on the breast on which the
mastectomy was performed.
• Reconstructive surgery on the unaffected breast
needed to “produce a symmetrical appearance.”
• Prostheses and treatment of complications of any
stage of a mastectomy, including lymphedema (post-
surgical fluid buildup).
The provisions of the Women’s Health and Cancer
RightsActof1998applytoallgrouphealthinsurance
coverage effective on the first day of the plan year
(which in most cases is the anniversary date of the
groupcontract)afterOct.21,1998.Thelawwentinto
effect on all individual insurance policies issued, re-
newedorineffectonorafterOct.21,1998.
These provisions apply to all policies issued by
Arkansas Blue Cross and Blue Shield and Health
Advantage and are subject to the applicable
copayments, coinsurance, benefit limitations,
exclusions and benefit maximums.
If you have questions about your insurance coverage,
contact your group benefits administrator or a customer
service representative at your regional Arkansas Blue
Cross office.
Women’s Health and Cancer Rights Act
24
Blue & You Winter 2010
At Arkansas Blue Cross and Blue Shield, we are always looking for new ways to be "Good for You." Here are some of our latest accomplishments.
Member discountsFrom contact lenses to health clubs, Arkansas Blue
Cross and Blue Shield negotiates discounts for
members for health-related services. In most cases,
your health plan ID card is all you need to obtain
the discount. Discounts include national chains like
Curves and Jenny Craig, as well as local fitness
centers. From yoga to karate to bicycling, you’ll find
an activity you enjoy! To find discounts, select the
“Member Discounts” link on the main page of our
Website(seealistofWebsitesonpage23).
DentalBlue® Web section availableWhether you are age 1 or 100, if you need afford-
able dental coverage, it is as close as the Arkansas
Blue Cross and Blue Shield Web site!
Our DentalBlue® insurance plans for individuals
offer a variety of valuable benefits — from essential
preventive services to major restorative services.
We offer three DentalBlue plans for people of
all ages.
You can find out more at arkansasbluecross.com.
Go to “Looking for Insurance” or “Individuals and
Families” and select “DentalBlue.” You also can find
out more by contacting your local independent or
Farm Bureau agent or by giving us a call, toll free,
at 1-800-392-2583.