Archive for the 'Health and Wellness' Category

With BCBSNC and Rival Fusion, NC businesses will get fit in 2013

Published on February 20, 2013 in BCBSNC and Health and Wellness. 0 Comments Tags: , , .

Blue Cross and Blue Shield of North Carolina (BCBSNC) has accepted the Get Fit Challenge to begin 2013 with a healthy boost. This 60-day program, sponsored by Rival Fusion External link, will direct 85 North Carolina businesses to better health in the coming year. Fitness plans that are customized, will be administered by The Challenge to participating employees to help employees get in shape, lose weight, create healthy habits and operate together to lower company health care costs.

“BCBSNC is committed to finding new ways to rein in medical costs and make health care more affordable,” said Sean Kerns, vice president of Specialty Markets. “Businesses face the challenge of rising health care costs on a daily basis. Our Get Fit Challenge is a way to spark a little healthy competition within the business community and help companies introduce a new wellness option that can help reduce medical spending.”
Rival Health’s Rival Fusion External link software will provide a 60-day customized health and fitness program for participating employees. The program will help employees work toward their fitness goals and New Year’s resolutions with nutritious recipes, motivational tips and easy-to-use tools for monitoring progress. Employees will also receive a collection of Rival Fusion External link DVDs that will provide personalized exercise routines based on their specific profile and goals.
North Carolina businesses that are current BCBSNC customers comprising more than 50 employees qualified to participate in the Get Fit Challenge and compete against companies of comparable sizes. BCBSNC is investing in North Carolina businesses by covering the cost of the fitness program for up to 100 employees at each participating company. For every $1 invested in wellness programs, businesses can save more than $3 in medical costs[i].
The winners will be announced in March. The three companies that advance their fitness levels the most will be awarded up to $5,000 to help encourage healthy workplace habits once the challenge is over.

BCBSNC and Duke University Health System team up to improve the quality and efficiencies of knee replacement surgery

Published on February 4, 2013 in BCBSNC and Health and Wellness. 0 Comments Tags: , , , .

Durham, N.C. — Duke University Health System and Blue Cross and Blue Shield of North Carolina (BCBSNC) are teaming up in an effort to save money and enhance the standard of excellence in knee replacement surgeries under Duke’s nationally ranked orthopedic service. By seeking technological advances  in care coordination and delivery, Duke’s care teams will perfect joint replacement services while working toward decreasing the cost of care.
The intention of this project is to replace the individual costs of each of the many services provided for a successful knee replacement with a single flat-fee proposed to cover everything affiliated with this event of care. Duke and its care teams will continue to attain the high quality efforts that have made them an enduring top 10 orthopedic service by U.S. News & World Report, while also administering the entire knee replacement surgery care within the flat-fee reimbursement.
“These kinds of efforts in new care models that help drive greater efficiencies while increasing quality will become more and more prevalent and clearly represent the future of health care delivery,” said Victor J. Dzau, M.D., Chancellor for Health Affairs at Duke University and CEO of Duke University Health System. “Duke is committed to being a leader in exploring new treatment models that achieve the triple aim of better access, higher quality and lower costs.”
This “bundled payment” project will encompass the entire knee replacement care range, including the pre-surgical period of 30 days before hospitalization, the surgery itself, and most follow-up care within 90 days after discharge from the hospital. This program became effective on Jan. 1, 2013, and will be available to BCBSNC members when knee replacement procedures are performed by Duke University physicians at Duke University Hospital or Durham Regional Hospital.
“Partnerships like this one are possible when hospitals, physicians and insurers commit to new ways of putting patients first by collaborating to improve quality and reduce costs,” said Lisa Cade, BCBSNC Vice President of Network Management.
David Attarian, M.D., medical director of musculoskeletal services and vice chair for orthopedic clinical operations at Duke said “This project is a great example of collaboration between providers and a payer to advance care, but it also provides more tangible ways to engage patients directly in optimally contributing to their successful outcomes.”

Worst flu season in 10 years

Published on January 10, 2013 in Health and Wellness. 0 Comments Tags: , , , , , , .

Doctors say we’re entering the worst flu season in a decade, Boston’s mayor has, a public health emergency has been declared by Boston’s mayor and sick people are being turned away from Chicago hospitals. So we should panic, right?

ABC News’ Alex Perez reports that this is the earliest flu season onset in a ten years. This eruption of the flu has arrived a full four months earlier than 2009′s outbreak of the H1N1 “swine flu” virus, unmistakably the worst flu epidemic to hit the U.S. in recent times. That outbreak began in late April, well into spring. Most flu seasons kick in around mid-January, but this year’s flu season started snowballing towards the end of December.

This flu season brings back the H3N2 variety of influenza, a strain that brings on stronger symptoms than common flu strains and stays around longer. The strain was rampant in 2004, which had elevated death rates from the flu. Dr. William Hanage, associate professor of epidemiology at the Harvard School of Public Health, proclaims that “this is a bad year,” but also says that an H3N2 pandemic doesn’t appear to be quite as severe the threat from 2009′s H1N1 outbreak. Fortunately, the good news is that these strains are well-matched by current vaccines. That said, only 37% of Americans got a flu shot this season and it’s only effective in 60% of people.

Reports of Chicago hospitals being so overwhelmed that they’ve had to turn some flu patients away may sound scary. And admission rates are much higher than usual — four percent of Boston’s doctor visits are flu-related right now, up from the usual one percent. But it’ll take a lot more admissions to reach levels from the 2009 outbreak. CDC researchers anticipate that as many as 1 out of every 100 people visited hospital emergency wings during that pandemic.

According to the CDC, 18 children have died from the flu so far this season. However these numbers are only accurate up to December 29th. So far, it’s too soon to know whether the death toll will surpass that of the 2009 H1N1 outbreak, which took somewhere between 8,870 and 18,300 lives.

Click here to find out how you can better protect yourself from the flu!

Get in control of your health by knowing your numbers

Published on January 9, 2013 in BCBSNC and Health and Wellness. 0 Comments Tags: , , , , , .

Do you think you might be at risk for diabetes, heart disease and other chronic diseases?  How can you find out? Well fortunately there is a system of “numbers” we can use to tell us how we compare to healthier individuals. By knowing your numbers, you can take action to make positive changes that will help prevent the onset of chronic health conditions. Considering the likelihood that many individuals will develop a chronic, preventable disease resulting in poor quality of life, declining productivity, and higher health care costs has become a major concern and priority for health care providers, insurers, and employers, especially Blue Cross and Blue Shield of North Carolina.

Every person is unique and requires personalized assessment based on the best medical evidence.

Preventive screenings help you get familiar with your numbers and tackle health concerns before they become more serious—or to prevent health problems in the first place.

For example, a high waist circumference number indicates a greater level of abdominal fat which is associated with an increased risk for type 2 diabetes, high cholesterol, high blood pressure and heart disease. According to the United States Department of Health and Human Services women with a waist circumference of more than 35 inches, and men with a waist circumference of more than 40 inches are at increased disease risk.

Of course, you inherit some risk for these diseases from your family. But the majority of chronic disease risk is in the lifestyle we lead – specifically linked to smoking, poor diet and an inactive lifestyle. These are things you can change.

Before you visit your doctor for your next health checkup, try to be prepared to talk about which preventive screenings you need:

  • Blood pressure
  • Cholesterol
  • Fasting glucose (blood sugar)
  • Body mass index (BMI)
  • Blood Pressure – This is one of the strongest markers for heart disease risk. It is measured as two numbers. Systolic pressure is the first number and is the pressure when the heart is contracting. Diastolic is the second number and is the pressure when the heart is at rest between beats. Normal blood pressure is 120 / 80 or below.
  • Cholesterol Levels – Too much bad cholesterol can lead to a hardening of your arteries. This can put you at risk for a heart attack or stroke. When it comes to cholesterol, there are two important numbers you should know. LDL, is the bad cholesterol, and should be below 130 mg/dL, and lower is better. HDL, is good cholesterol, and should be above 40 mg/dL. Your total cholesterol (TC) level should be below 200 mg/dL.
  • Blood Sugar – A blood sugar test is commonly used to diagnose the presence of diabetes. A fasting blood sugar (taken when you haven’t eaten for 12 hours) should be below 100 mg/dL.
  • Body Mass Index (BMI) – This is calculated from two other numbers that you probably know – your weight and height. Your BMI will be one way to gauge if you are classified as being overweight. However, it is not a perfect measure. In people with above normal muscle mass, like bodybuilders, the BMI may indicate the individual is overweight when they are in great condition. For most of us, however, BMI is a great way to gauge how our weight compares to recommended levels. Here is an easy way to calculate your BMI.

If you know your numbers, solving the total health equation is a lot easier.

5 ton challenge helps BCBS employees lose 11,000 pounds

Published on January 2, 2013 in BCBSNC and Health and Wellness. 0 Comments Tags: , , , .

In early 2012, Blue Cross Blue Shield employees decided to make a weight loss resolution. They were actually very successful and lost more than 11,000 pounds. This loss in weight was a whopping 1,000 more pounds than their original goal.

The company began their ’5 Ton Challenge’ and kept employees on track with monthly weigh-ins, nutrition classes and even credit on their health care premiums.

To help with the motivation , BCBS also chose 25 ‘weight warriors’ and invited them to post their stories online. Stacey Royal, one of those warriors, lost 23 pounds and said she feels fantastic.

“I gained more energy because I was more active and able to keep up with my kids. For me, it didn’t mean I had to spend hours in the gym, we would go walking, we would go run. I actually completed my first 5k this year,” said Royal.

In addition, the company launched another wellness initiative called ‘Maintain Don’t Gain,’ to help employees keep the weight off as they went through the holidays.

Another ’5 Ton Challenge’ begins again in 2013.

Trans-fats may be a trigger for depression

Published on December 27, 2012 in Health and Wellness. 0 Comments Tags: , , , , , , .

Most doctors will tell you that trans-fats are the very worst type of fat. They raise our risk of developing heart disease by increasing our “bad” (LDL) cholesterol, and lowering our “good” cholesterol. Also, it has recently been discovered that reducing artery-clogging trans-fats in our diet can have a huge effect on lowering our risk for depression.

New eye-opening research done at the University of Las Palmas de Gran Canaria, in Spain, revealed that people who ingested more than 2 grams a day of this type of fat, were about 50 percent more likely to suffer from depression. This type of fat can be found in stick margarine, fast food, and packaged baked goods like cookies, crackers and cakes.

Researchers found that a diet that is high in transfats may lead to inflammatory changes inside the body. These changes seem to interfere with the brain’s neurotransmitters, such as serotonin. This interference has a negative affect on mood.

If you are not sure whether a particular food contains trans-fat, look for the words “partially hydrogenated vegetable oil”. This is simply another word for trans-fat.

Try to eat plenty of fruits, vegetables and legumes. When you want to eat meat, make sure it is baked, broiled or grilled; never fried. When you cook, use a healthier fat like olive oil. The participants of the study who consumed more than 20 grams of olive oil per day had a 30 percent lower risk for depression than those who consumed a very low amount.

BCBSNC Cardiac Disease Risk Tests Medical Policy Changes

Published on December 17, 2012 in BCBSNC and Health and Wellness. 0 Comments Tags: , , , , , , , , , , .

Effective January 1, 2013, tests listed in the policy “Cardiovascular Disease Risk Tests” will be considered investigational and non-covered services under BCBSNC.

BCBSNC will not be implementing the previously proposed changes to the Urinary Tumor Markers for Bladder Cancer medical policy on January 1, 2013, as previously advised on November 28, 2012. If this changes, members will be notified.

Nontraditional cardiovascular disease risk tests are laboratory tests ordered by physicians to assess a patient’s likelihood of developing cardiovascular disease. Traditionally, physicians use standard cholesterol and triglyceride measurements, as well as an assessment of smoking, weight and family history to determine a patient’s risk. Nontraditional cardiovascular disease risk tests include;

  1. Apolipoprotein
  2. Lipoprotein, blood; electrophoretic separation and quantitation
  3. Lipoprotein (a)
  4. Fibrinogen; activity
  5. Electrophoretic technique, not elsewhere specified
  6. Cystatin C
  7. Very long chain fatty acids

BCBSNC is changing its coverage for these cardiovascular disease risk tests because it has been receiving a higher volume of cardiovascular disease risk tests that lack clinical utility and have not been proven to improve patient management or health outcomes. BCBSNC’s decision to deny these tests as investigational is founded on evidence based research produced at a national level.

The evidence- based guideline titled “Novel Lipid Risk Factors in Risk Assessment of Cardiovascular Disease” will remain effective until December 31, 2012.The new corporate medical policy titled, “Cardiovascular Disease Risk Tests,” which lists the nontraditional tests will be effective January 1, 2013.There will still be some treatments that can be used in place of these nontraditional cardiovascular disease risk tests such as standard cholesterol measurements for LDL, HDL and triglyceride levels.

 

Prior Approval and Quantity Limitations on Medications

Published on December 11, 2012 in BCBSNC and Health and Wellness. 0 Comments Tags: , , , , , , , .
The following programs apply for members with Blue CareSM, Blue OptionsSM, Blue ChoiceSM, and Blue AdvantageSM
  • Enhanced Formulary (Open)
  • Basic Formulary (Closed)

The Enhanced Formulary (4-tier) is an open formulary, which means that almost all commercially available prescription drugs are covered. Some benefit exclusions apply.

The Basic Formulary (5-tier) is a closed formulary that covers only the drugs that are specifically listed on the formulary. Benefit exclusions apply.
If a provider recommends a drug that is not on the Basic Formulary, ask your doctor if there are any appropriate alternative medications available on the Basic Formulary.
In some circumstances, your doctor may be able to request a drug that is not on the Basic Formulary through an exception process. See below for the criteria and appropriate fax form.
Please note if the requested drug is listed below, than the additional criteria would also apply (Restricted Access / Step Therapy does not apply to the Basic Formulary).

Non-Formulary Exception Criteria Non-Formulary Exception Fax Form

Some medications require prior review from BCBSNC before the prescription can be accepted for payment.
Prior review requires that your physician contact BCBSNC at 1-800-672-7897 or fax a request form to 1-800-795-9403.

For the non-preferred prescription drugs listed below, BCBSNC requires that the member has tried a preferred drug or device. Coverage for these prescription drugs may be provided without the use of a preferred drug or device as long as the provider certifies in writing that the member has previously used a preferred drug or device and the preferred drug or device has been harmful to the member’s health or has been ineffective in treating the same condition and, in the opinion of the provider, is likely to be damaging to the member’s health or ineffective in treating the condition in the future.

BCBSNC covers certain medications up to a set amount. The purpose of quantity limitations is to make sure medications are used according to FDA regulations and to help recognize excessive use of drugs.
If a physician feels it is medically necessary to go beyond quantity limitations on your medication, he must get prior review from BCBSNC at 1-800-672-7897 before a higher quantity will be covered.

Beginning December 15, 2012, the drug Singulair will be removed from the list of drugs that require prior review, because it is now available in generic form.

Beginning February 1, 2013, the drugs, Orencia, Actemra and Rituxan, will be covered when the patient has failed to respond sufficiently or is intolerant to Remicade ® (infliximab).  This will affect new users, including State Health Plan members, since these drugs fall under the member’s medical benefit.

Diabetes Progress Report Letter sent out in November

Published on November 23, 2012 in BCBSNC and Health and Wellness. 0 Comments Tags: , , , .

During the first week of November, BCBSNC sent letters to members 18 years and older who have been diagnosed with diabetes and have one or more gaps in their care, based on available Blue Cross and Blue Shield of North Carolina (BCBSNC) claims data. A progress report in the letter outlined the most recent screening information.

The letter included the following key messages:

  • Importance of regular screening tests to control diabetes
  • A list of the most recent diabetes screening information (if available)
  • A description of the diabetes screenings and their recommended frequency
  • Instructions to complete an enclosed form, if the screening information on the letter is incorrect
  • An incentive offer to complete the screenings prior to 12/31/12: Please note that BCBSNC will not send the notifications for claiming the gift cards until April 2013, to allow time for BCBSNC to capture all of the claims for screenings completed in 2012
  • Members are encouraged to call their provider to schedule an appointment

Why is BCBSNC sending this reminder to its members?
Preventive care is one of the most important steps in controlling diabetes. Scheduling regular diabetes screening tests can help reduce the risk of future diabetes-related complications.

Members can choose whether or not to complete the screenings; this letter mainly serves as a reminder.

 

 

New Rheumatoid Arthritis Drug, Xeljanz Approved by the Food and Drug Administration

Published on November 23, 2012 in Health and Wellness. 0 Comments Tags: , , .

XeljanzThe Food and Drug Administration (FDA) recently approved the first oral medication to treat moderate to severe rheumatoid arthritis in over 10 years.  It became commercially available around November 19.

Blue Cross and Blue Shield of North Carolina (BCBSNC) will add Xeljanz to it’s utilization management programs, requiring prior review (PA) and quantity limitation (QL).

Frequently Asked Questions:

Why is Xeljanz being added to the utilization management program?
Xeljanz is not the only medication that is available to members with moderate to severe active rheumatoid arthritis.  BCBSNC wants to make sure that members are using it according to the FDA approved guidelines.  

 

Which BCBSNC members will be affected by this requirement?

 

  • Group and individual commercial members with pharmacy benefits through BCBSNC
  • Group members who have drug utilization management programs (PA/QL)

 

Which BCBSNC members are NOT affected?

 

  • Federal Employee Program
  • Blue Medicare members
  • State Health Plan

 

How will groups and members be notified?

Since this is a new to market drug, members and groups will not be directly notified other than having the information available on our website.