We at LA Kelley Communications thank all of you for reading this blog all year long, and for subscribing to our services. We look forward to serving you in the new year.
Wishing you all a Merry Christmas on this Christmas eve… and may you all have a successful, healthy and happy new year!
So what is going on out there? I have gotten more emails this past week about home care switching than ever.
Tom wrote in to ask if all Anthem Blue Cross patients with hemophilia will be required to use Precision Rx as their factor provider? He is livid, if this is true. Another mom wrote in to report that she is hearing that Anthem in Ohio is forcing a switch in home care companies. She heard that Anthem’s doses may be +2%, not the current industry of dose +10%. She is concerned that this means fiddling around with the vial sizes and number of vials we get.
Still another mom, employed by a home care company herself (so she buys factor from her employer) is being forced to switch to another home care company–a competitor!– that she doesn’t like and has not heard good things about. She is very concerned. I would be too: if my son is a source of revenue for my employer and then no longer supplies revenues, will my job be on the line? A lot of parents and patients are employed in the homecare industry.
I had a long conversation with Bob Robinson, the executive director of the Illinois chapter, and he tells me now that Blue Cross Blue Shield is doing the same thing in their state. This trend is gaining speed, and this will be happening more and more. Bob and I talked about how our community is going to have to start accepting that some change is inevitable and that we are going to have to learn to compromise. There is just no way we can have “our way” any more. Most disturbing is that the insurance companies are setting up their own in-house specialty pharmacies. So they are paying for factor and getting the profits at the same time. Can they can charge whatever they want? Who is monitoring this practice?
It seems shocking, but you know, this at first seemed like much more of a market correction than an out-of-the-blue change. Health costs have risen astronomically, so payers are naturally going to do something to lower costs, as long as this does not put the patients in danger. This is what managed care is all about, and it is here to stay, whether we like it or not. Best we can do immediately is to document everything, carefully, every call, every EOB, every charge. We do pay good money, but the payers can simply say “Then go find another plan.” Harsh reality but it is the reality.
But the scary part is this: it’s not just about lowering health care costs, but control. Insurers are definitely wrestling control of our health care management. Competition is dwindling. When insurers have their own in-house specialty pharmacy (to allegedly control costs) and see the profits rolling in, who will authorize cost control then? They will be fixing the reimbursement price, and reimbursing themselves. Conflict of interest? Big time. The questions become: what is competition, how is it defined and what is fair?
I’ve been predicting this trend for three years now, since the November issue of PEN in 2004. If you’ve been reading our work this should not be such a surprise. Only the speed at which it is happening is quickening. Keep those letters and emails coming to us; let us know your insurance and home care switching story so we can pass it along to NHF, HFA… we are all working to preserve care and control, at fair cost.
The return trip from Africa required some 30+ hours in transit, and flying coach on these long trips sometimes leaves me with a very stiff back. Yoga helps, but so does a visit to one of my favorite people, my chiropractor. However, I just received notice from my insurance company that it is only covering 12 visits. Any more and I need referrals, certifications, x-rays, passport, a note from my mother and proof of my existence.
Okay, so I’m kidding–just a little. But seriously, in keeping with the current health expenditure cutting trends by the insurance companies, things are changing rapidly. If I am not careful, do not read the fine print, and keep track of my visits, I could end up with a whopper of a medical bill. This happened to someone I know who also went to her chiropractor, whose office was less than forthcoming about what was and was not covered under her insurance. $1,000 is a lot to be hit with during the holidays.
The end of the year is a good time to review all your insurance policies. Call your insurance company and double-check on any changes for the New Year. You could have changes in co-pays, coverage, and deductibles. Call your human resource department at your place of employment and also check to see what has changed. We are also getting notices from Kevin’s employer about such changes for 2008. Try to stay one step ahead, so you don’t get left behind!
If you need any insurance help or have any questions, call the new toll free Bleeding Disorders Insurance Hotline — 800-520-6154, sponsored by Baxter BioScience. This innovative service is just what we need in these changing times.
Great Book I am Reading: Into Africa: The Epic Adventures of Stanley and Livingstone, by the exceptional writer Martin Dugard. This book tells the true story of the last amazing African exploration of Dr. David Livingstone in the mid-nineteenth century, and is one of my all-time favorites. Livingstone was a Scotsman, physician and missionary, and considered the greatest explorer of his time. Following the upheaval and accusations between fellow British explorers Richard Burton and John Hanning Speake, Livingstone decides to take his last voyage to Africa at the age of 53 to find the true source of the Nile. He encounters hardships and disease, and at his advanced age, is unable to return. He awaits his fate at an African village. Enter Henry Morton Stanley, a shrewd journalist upstart who is out to make a name for himself. As brash and arrogant as Livingstone is humble and tolerant, he sets out to rescue Livingstone and earn world fame. Of course, you know the outcome when they meet: “Dr. Livingstone, I presume?” is one of the world’s most famous questions. But the outcome is far from certain. Read this book for adventure, history and an insight into the minds of two amazing but very different men. Dugard has researched his subjects thoroughly, and most interesting are the descriptions of what these men endured, and how differently they perceive Africans and their respective missions. Four stars!
My trip to Zimbabwe has come to a close. I am preparing to leave today, with mixed feelings. There is so much hardship here, but so much potential!
Friday was spent mostly in transit. Peter and I traveled together with his family: Laureen, his lovely wife, who shares the same name as me; Prince, his 11-year-old son; and Nkosi, his active and mischievous 3-year-old son. The trip was over 4 hours north to Victoria Falls. We traveled mostly in the evening, which is risky as there are animals in this very rural and wild land. We arrived safely and settled in.
Saturday we had quite the day! We began with a helicopter ride over Victoria Falls, the longest waterfall in the world, which creates a natural border between Zambia and Zimbabwe. Laureen and the boys had never flown before, and this was amazing! The boys were just fascinated and so excited!
Then we had a hike through Victoria Falls itself to see this stunning natural wonder of the world. Shadowing us were a troop of monkeys who were quite bold. We also saw deer along the path. The views were many and just indescribable. Vic Falls was discovered in the mid-1800s by British explorer David Livingston.The tremendous water power from the Falls kicks up spray and creates a rain forest all along the length of the Falls.It was hot that day so the “rain” felt great.
Finally we had a night safari through the Vic Falls game reserve. Safari means “journey” in Swahili, and was introduced into the English language by Richard Burton, the famed Irish explorer who charted interior Africa in the mid-1880s. On this journey, we saw elephant, rhino, hippo, impala, zebra, wart hog, water buffalo and tons of bugs. Our guide Mike was fantastic and taught us a lot about each animal, more than you would ever learn on a TV show, and the delicate eco-system that keeps all things alive in their symbiotic relationship. We didn’t feel so symbiotic, however, particularly when we stumbled upon a 100+ herd of water buffalo, who stared at us menacingly. Water buffalo are considered the most dangerous animal in Africa. And they stood only a few feet away!
As wonderful as the day was, Peter and I couldn’t help but continue to brainstorm ways to help the Zimbabwe Haemophilia Association get organized, raise awareness of hemophilia in the country, secure funds and most immediately, help the children in dire need. Top of our list? Elton, the 17-year-old with the hideously swollen knee. He needs to go to South Africa at once for testing to try to save his leg. We have a massive to-do list when we each return home.
I must end my trip now. But let me thank Peter Dhalamini for his superb assistance all throughout my trip. Peter organized every aspect of it and is well respected and beloved by the hemophilia community here. He has hemophilia, has laboratory training, and is a born politician! He knows everyone and can enlist just about anyone’s help. I cannot thank him enough for making this trip so safe, effective and enjoyable. Thanks also to his family for sharing the last leg of our trip together.
Thanks also to so many others: Lenox, Dr. Mvere, the ZHA, Collin Zhuwao, Simba… and everyone who assisted. Zimbabwe is a tough place to live. Food, cash, fuel, foreign exchange, medicine and basic necessities are all hard to come by. But its people persevere with grace and dignity. Gentle and patient as they are, Zimbabweans don’t have the luxury of waiting out the ravages of hemophilia, and that is something we are about to change. Help is coming.
(Photos: Victoria Falls; Impala; One of Big Five; How the other half lives)
