Health, Wellness, & Healthcare Coverage
BCBSNC has made changes to their prior review/certification requirements for certain prescription drugs. The change will take effect on April 1, 2011.
Members who have filled prescriptions for oxymetholone (Anadrol-50), oxandrolone (Oxandrin) or doxepin (Silenor) within the past three months will be receiving letters from BCBSNC this week beginning March 14, 2011.
Recently, European scientists found that they could accurately diagnose Down syndrome through a blood test given to pregnant women. This new procedure gives hope that in the future pregnant women could evade the more invasive procedure that is currently used to test for Down syndrome.
The journal Nature Medicine published the online preliminary report on March 6. It is the most recent of many current studies that indicate that scientists can now pinpoint Down syndrome through fetal DNA found in the mother’s bloodstream.
Having an extra specific chromosome constitutes Down syndrome. Presently, pregnant women have a blood test and an ultrasound to see if the fetus is at risk for Down syndrome. To make absolutely sure of an accurate diagnosis, doctors extract a sample of amniotic fluid or the placenta. This procedure, called an amniocentesis, can cause some uncomfortable pressure, pain and even a risk of miscarriage.
A middle-aged person with Type 2 diabetes will lose about six years of their life due to the disease. According to researchers, this is just one year less than a smoker would lose of the same age. Additionally, he or she has more than double the chance of dying from cardiovascular disease as someone who does not have diabetes and the report also says that they are 25 percent more prone to die of cancer. The report was based on an international study of more than 820,000 people that was published in the New England Journal of Medicine.
There is more bad news for people with Type 2 diabetes. The study indicates that they are also more likely to die from kidney disease, pneumonia, liver disease, infectious diseases and even intentional self-harm.
This study was run by the Emerging Risk Factors Collaboration at the University of Cambridge in England. The data collected is particularly upsetting because of the speedy incidence of diabetes cases in the United States, most likely from the increase in obesity. There is currently an estimated 25.8 million Americans with diabetes, which is 10 million more than just 20 years ago.
Dr. David Kendall of the American Diabetes Association said that researchers already knew that diabetes could cut short one’s lifespan but this recent study shows just how many years of life could be lost and to what causes.
Also shown in the report was the fact that people with pre-diabetes, having blood glucose levels higher than normal but not yet diabetic, are at risk from many of the same causes of death. There is an estimated 79 million Americans who have pre-diabetes.
Kendall said that even though diabetes is frequently seen as just a condition instead of an illness, as something one can just live with. He said, “well, in fact, this shows that it is associated with a significant risk of both morbidity and mortality.”
The report from the Emerging Risk Factors Collaboration found that diabetics were 2.32 times as likely as non-diabetics to die from cardiovascular disease and 25 percent more likely to die from cancer. Also diabetes was somewhat related to death from cancers of the pancreas, ovary, colon, liver, rectum, lung, bladder and breast.
The study did not have enough proof on whether Type 1 diabetes, when the pancreas stops producing insulin, is associated with a risk for cancer.
Bariatric surgery, also called “weight-loss” surgery, is performed to help extremely overweight people to lose weight, attain better health and heighten their quality of life. In the United States alone, morbid obesity has almost risen to epidemic proportions, causing around 11 million to suffer from its crippling effects.
Morbid obesity is defined by a body mass index (BMI) of more than 40 kg/m2 or 35 kg/m2 with related complications such as diabetes, hypertension or obstructive sleep apnea. Those who suffer from morbid obesity are at a substantially higher risk for different types of cancers and even a shortened life span.
For the Corporate Medical Policy on morbid obesity with Blue Cross Blue Shield of North Carolina, click http://docs.healthplansofnorthcarolina.com/page7/files/Surgery%20for%20Morbid%20Obesity.pdf
Here is some good news for those of you who cringe at the thought of getting a colonoscopy: new research indicates that most colonoscopies will not be necessary in the future. Why is this? Well there have been two new DNA-based tests that claim to be able to detect colon cancer early. If this holds to be true, this will have a huge impact on reducing colon cancer. Colon cancer is a devastating disease that affects around 150,000 people a year in the U.S. and costs and astounding $14 billion to treat.
These new tests could allow the majority of people to bypass colonoscopies, which are currently recommended for people who are 50 and older. Instead of screening everyone, doctors may refer people for a colonoscopy only in cases where they have tested positive in one of the DNA tests.
It is believed that more people will go and get one of these DNA tests, because they are noninvasive in comparison to a colonoscopy, which uses a seeing tube that is fed threw the colon. These new tests could be available within the next two years.
In one of the test, created by Exact Sciences of Madison, Wisconsin, stool samples are examined to see if they contain the four altered genes that are characteristic of colon cancer. This test could find cancerous and precancerous tumors at an early curable stage that can be removed quickly.
The other test searches for changes in a single gene, called Septin 9, which is not one of the Exact Sciences’ panel of four genes. Epigenomics AG in Germany developed this test.
The good news is that both of these tests would be less costly than a colonoscopy and perhaps even more effective. The first test, which examines stools, will cost around $300. The current average cost of a colonoscopy is around $2000. A lot of people tend to avoid colonoscopies because they are invasive, and the general cost per detection is high since most people are in pretty good health. They also miss many tumors in the upper part of the intestine.
Exact Sciences has decided to sign up several thousand patients in a future trial that they hope the FDA will approve. The trial will be finished in 2012 and the test will be available soon after that, as long as it is approved.
Dr. David Ahlquist from the Mayo Clinic, who is an adviser to Exact Sciences, said “If widely used, and regularly, this test really does have the opportunity to eliminate colon cancer.”
Of course, the value of the tests depend heavily on details such as their sensitivity, which means the proportion of detected tumors and their specificity, or how many of the positive results are false alarms. In July, Exact Sciences claimed that its test was extremely sensitive and specific when applied directly to cells taken from tumors. In reality, the tumor DNA has to be detected in stool samples. This is a much harder to accomplish, because almost all the DNA comes from the bacteria of the gut, and only 0.01 percent of the DNA in feces is human. In October, the company revealed at a meeting of the American Association for Cancer Research that in a trial of 1,100 patients, the test detected 64 percent of polyps, larger than 1 centimeter in diameter, and 85 percent of cancers, as judged by the colonoscopies that were also performed on the patients.
Dr. Ahlquist is happy with the results, particularly the 64 percent detection rate for precancerous polyps.
Even though this detection rate seems less than perfect, it will be highly effective is the test is performed on a regular basis. Ahlquist said that “The pap smear detects only 50 percent of cervical cancers, but applied over time it virtually eliminates the disease.”
The Exact Sciences test specificity is 88 percent. This means that 12 percent of the time a patient will be given a false alarm. This may not be so bad, since the worst that will occur is that the patient will have to undergo an unnecessary colonoscopy.
BCBSNC is currently embarking on creating a customer market research panel. This panel will supply an organized, cost-efficient system for getting in contact with customers directly to perform research on health care and health insurance matters.
Members from three different divisions were sent invitations to participate during the last week of January 2011. The process of enrolling members will continue through the end of February. If members desire, they will have the opportunity to cancel any e-mail communications associated with this program.
The minimum amount of members that they hope to enroll in the program are:
BCBSNC employees, Federal Employee Program members, and State Health Plan members will not be summoned to participate in this program.
In early March, panel members will start to receive surveys. These surveys will be directed to members who are picked by customer segment and /or demographics as needed. Every time a member finishes a survey, they will get the chance to enter a drawing for a gift card. These gift cards will differ in value, depending on the survey.
Those with questions concerning the customer market research panel are asked to call the Agent Contact Center.
Things may be looking up for a long overlooked epidemic. There will be two very powerful drugs available soon that may help cure many people of the hepatitis C disease which attacks the liver. This said, most people who have the infection are not even aware of it yet.
Remarkably, around two-thirds of hepatitis C sufferers are believed to be baby boomers who may have acquired this disease in their carefree youth. The virus can take twenty to thirty years to complete its damage.
Perhaps it is time to consider if the government should suggest that baby boomers be checked for hepatitis C like they are for cancer.
This two-drug treatment for hepatitis C will cure about 40 percent of people who have the common variety of the virus, but can cause some unwelcome side effects. Major studies reveal that adding a new drug – either Vertex Pharmaceuticals’ telaprevir or Merck & Co.’s boceprevir – can lift those cure rates to as high as 75 percent. They also allow people to cut treatment time in half, about six months, which will reduce how long they have to endure those terrible side effects.
If the FDA approves the drugs, they would be the first to directly target the hepatitis C virus. The decision is expected to be announced sometime this summer.
The most significance could come if more people would get tested for hepatitis C, which is a blood-borne virus. Most people think that it is a only a risk for those who inject illegal drugs. The virus could also have begun from blood transfusions before 1992. Testing of the blood supply was not performed until then.
People are still exposed today in health care facilities due to errors in infection control. Even a one-time experiment with drugs, perhaps in college, could also expose someone. Many doctors are hesitant to ask a middle-aged conservative patient to reveal, according to Dr. John Ward.
Scientists have recently found that whether you drink too much or not at all, you may increase your risk for developing dementia.
In the December issue of the Journal of Alzheimer’s Disease, a Finnish study found that people who either didn’t drink at all or those who drank heavily, are at increased risk for dementia later in life.
Led by Jyri Virta from the University of Turku in Finland, scientists discovered that the pattern of drinking and the amount of alcohol consumed were both crucial factors in the risk for dementia.
For example, people who drank the quantity of a bottle of wine at one sitting only once a month but controlled their drinking the rest of the time, still increased their risk for dementia according to the researchers. The study found that binge drinking actually doubled the risk.
Even more scary was the fact that the study claims that passing out from heavy drinking just once was enough to increase one’s risk for cognitive impairment.
The research depended on a study group established in 1974 called the Finnish twin cohort. It explored links between the environment and chronic diseases.
In a statement the scientist Jyri Virta said, “Our finding is significant as the changes typical of Alzheimer’s disease – the most common dementia syndrome – are thought to start appearing two to three decades before clinical manifestation and therefore identification of early risk factors is imperative.”
Surprisingly, people who never drank alcohol were found to be at more risk for cognitive impairment than moderate drinkers. This finding provides even more proof that totally staying away from alcohol can increase some health risks. In earlier research, non-drinkers were four times more likely to get rheumatoid arthritis than moderate drinkers.
The researchers used questionnaires on which people rated their own drinking, possibly distorting the results.
Virta said that one explanation for moderate drinkers showing some health benefits could be that they are more likely to live healthier in general.
On January 11, 2011 BCBSNC and UNC Health Care announced their partnership to work together and form a totally new type of medical practice where patients will be the main focus of care. This cutting-edge type of medical practice will reach beyond what is known as the ‘medical home’ and will allow teams of health care providers to work together with patients and families to provide excellent coordinated care.
This new type of practice is expected to open sometime in the fourth quarter of 2011 and will most likely be located in Orange or Durham county. This practice will be the first product of an ongoing team effort for BCBSNC and UNC Health Care. They will be working with each other to improve health care quality, efficiency and effectiveness and bring down health-care costs.
BCBSNC President and CEO Brad Wilson said that “the team approach to care emphasizes patient involvement and allows more time for clinical interaction and patient education and support. We believe this approach will result in improved health and fewer complications – both of which will help control rising health care costs.”
Around 5,000 BCBSNC members will be able to use this new practice. It will focus on patients with chronic conditions such as hypertension, diabetes, obstructive lung disease, coronary artery disease, major depression and asthma.
Continuous care will be available with the new practice, because coordinated care will extend across a variety of settings and provider types. The practice was created to allow more effective patient-provider interactions, resulting in increased patient satisfaction and better health. Also, this practice will supply an extended set of services and better access to these services which include:
BCBSNC and UNC Health Care will share the cost of leasing and equipping the practice.