Wednesday, July 23, 2014

Getting ready to send your child to college? Complete this health related check list before you wave good-bye.


Getting ready to send your child off to college? Take a few moments to think about how their health care needs will be met while they are away.

Ian 2008
Thanks to the ACA, children can stay on a parent's health care plan until they reach the age of 26. If you're covering your child on your plan, do a quick search to find in-network providers near where he or she will be attending school. If you don't find any, call your insurance company and ask if they have any affiliate networks available where you child will be attending school. If you have no in-network options, find out if you have an out-of-network benefit. It may have a separate deductible that needs to be met. This deductible may be high, but if your child can seek routine care at home and use the school's health clinic for primary care when they're away, it may serve as sort of catastrophic coverage if needed. If your child is uninsured, see the articles at the end of this post for some options.

The school's health clinic can be a good source of primary care for your student. If you're child seeks care at the student health clinic, it is likely that the visit will be covered free of charge. Well, not exactly free, there is probably a fee to support the student health clinic tacked onto the tuition bill or included as part of a comprehensive fee. Many schools will bill your insurance for lab work and any prescriptions your child might need. Keep in mind that the healthcare provided by the school is not a replacement for health insurance. It typically won't cover procedures, tests, prescriptions or any type of inpatient care.

If your child takes any maintenance medications, renew the prescriptions and set up mail order delivery at the school. You may need to call the school to confirm that they'll be able to accept delivery of prescriptions if you child is assigned a P.O. box.

Schedule any routine visits while your child is at home. You'll probably need to complete a pre-entrance health form and provide proof of vaccinations, so request this information from the doctor's office if you don't have records at home. It's also good to get in a routine of scheduling dental visits in December and June when your child is more likely to be home. Remember teeth cleanings generally have to be six months apart to be covered under your preventive care benefit.

Identify which hospitals are in-network and then pull up the city or town where your child will be and see which hospitals earned the highest scores for safety on Hospital Safety Score. If you don't find any in-network options, the ACA specifies out-of-network emergency services must be covered as follows:
if a group health plan or health insurance coverage provides any benefits for emergency services in an emergency department of a hospital, the plan or issuer must cover emergency services without regard to whether a particular health care provider is an in-network provider with respect to the services, and generally cannot impose any copayment or coinsurance that is greater than what would be imposed if services were provided in network. At the same time, the statute does not require plans or issuers to cover amounts that out-of-network providers may "balance bill"
If your child decides to travel abroad, consider purchasing international medical insurance for the time he or she will be out of the country. You can learn more in this post -- 10 Health Care Tips for Travel.

Your child's school should provide all the information you need on its' website, but this list should give you a head start. If you think of anything I overlooked, please leave a note in the comment section below.


Health Care Essentials -- 
A check list for college students.
Connor 2013

  • Complete any required pre-entrance health forms. This is likely to require providing proof of immunizations (see list below), but not necessarily a physical for most students. Student athletes will probably be required to have a physical and complete additional paperwork. 
  • Find in-network medical providers near the school. If none are available, find out if you have any out-of-network benefits.
  • Make sure routine dental care is up-to-date.
  • Refill any prescriptions and arrange to have maintenance medications delivered by mail-order to the school address or transfer prescriptions to the student health clinic.
  • Make sure your child has these items in his/her wallet.
    • Insurance card
    • Student ID Card
    • List of medications taken routinely
    • List of any medications he/she is allergic to
    • Primary care physician's contact information
  • Confirm your child has these apps on his/her phone.
    • Your health insurance companies' app. If you're with UnitedHealthcare, it's Health4Me. Make sure your student has the login information
    • Hospital Safety Score to find the safest hospital whenever and wherever they need it.
    • iTriage for first aid info and searching health topics by symptom
  • Put together a first aid kit (see list below.)
  • If you student wears contact lenses, it's a good idea to have a back up pair of eyeglasses and pack a copy of his or her current prescriptions.
  • Contact the student health center to notify the school of any serious pre-existing conditions your student has including any mental health issues. 
  • Pack a copy of important medical records. 
  • Pack an EpiPen if prescribed and an updated prescription for additional medication if needed.
  • Students that are diabetic should have adequate quantities of supplies for glucose monitoring and insulin administration. Check with the student health center to find out about disposal of needles and syringes.
  • If your student will be using a bicycle, be sure to pack a helmet.

    • Vaccinations:

      My youngest son attends UVA and this is what they require. I think it's fairly typical. Medical and nursing students will likely have additional requirements. You should get a list of what's required at your child's school during orientation. You should also be able to look it up on the school's website. Look for a student health section. 


      My sons always give me a hard time about getting a flu shot, but I do my best to drag them to the CVS Minute Clinic for a flu vaccine. Having the flu when you're in college is particularly miserable. Especially if you live in a dorm. The school health clinic may offer the flu vaccine. You can also check with your health insurer to see where the vaccine is covered near your child's school.

      First aid kit for college students:

      I felt better sending our sons off with a first aid kit. My oldest son sent his home fully intact after college (expired soup cans and all.) At least, I bought myself some piece of mind.

      • Adhesive bandages (assorted sizes)
      • Adhesive tape (1" wide)
      • Antacids
      • Antibiotic ointment
      • Antihistamine (diphenhydramine hydrochloride - generic for Benadryl)
      • Antiseptic wipes
      • Can or two of chicken noodle soup (pull top or be sure to include a can opener)
      • Cold Pack (disposable)
      • Cough drops
      • Cotton roll and balls
      • Cotton-tipped swabs
      • Decongestant (pseudoephedrine hydrochloride - generic for Sudafed)
      • Digital thermometer
      • Elastic bandage (3" wide) (Ace wrap)
      • Flashlight (and extra batteries)
      • Gauze pads
      • Pain relief medicine (aspirin, acetaminophen, ibuprofen)
      • Scissors
      • Tissues
      • Sunscreen
      • Hydrocortisone cream



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Thursday, July 10, 2014

Understanding Prescription Drug Pricing and Safety

According to the CDC almost half of Americans have taken at least one prescription drug in the past 30 days. Until recently, information wasn't readily available to consumers to compare the cost of prescription drugs from one pharmacy to another and to allow consumers to compare treatment options with various drugs, but those things have become much more transparent.

Lisa Roy and Eugenia Perna joined us from UnitedHealthCare to discuss prescription drug pricing, safety and the tools available to help us manage both.

Drug pricing is complicated and drug prices fluctuate like the price of gas. The same way gas may cost more on a heavily traveled holiday weekend the price of allergy medicines may be increased during allergy season. One factor in the pricing of drugs is ease of use. When drugs are going off patent, manufactures will create an extended release version or a combination drug to keep a patent. 


Azor is an example. It is a combination pill for blood pressure -- essentially two pills in one. You pay for the convenience of only needing to swallow one pill. Azore runs $280 per month. You could achieve the same effect by taking two generic pills. One at $24 per month and the other at $5 a month for a savings of $251 a month. 

Lipitor recently came off patent. In the first six months, the new generic, atorvastatin, had exclusivity. That typically means it's cheaper for consumers if they're only responsible for a copay; but three, four or maybe even five times more expensive than the brand during this time period. To make matters even more complicated Pfizer, the manufacturer of Lipitor, made a deal to provide rebates to insurers and pharmacy benefit managers (PBMs) to eliminate a lot of the cost advantage of atorvastatin. Just like many Facebook relationships, "it's complicated."


Medical advances often come in terms of new drug treatments and new treatments are often costly. We talked about Sovaldi as an example. It is a new treatment for Hepatitis C. It costs about $1,000 per pill and more than $84,000 for a course of treatment. It represents a cure for a chronic and often fatal condition, so most employers are including it in their coverage, but the cost has an impact.


Let's think safety first though. Mistakes are routinely made when dispensing medications. When you pick up a prescription, talk to the pharmacist or look up a picture of the medication to confirm you received what you expected. 

In the book, Where does it hurt? by Jonathan Bush, there is an example of a woman who had been fainting. It turned out that she had been prescribed twenty-seven different medicines by eleven different doctors, most of them specialists. Seven of these were for hypertension alone -- four of them were the exact some drug. This example is less surprising than it is appalling. Unfortunately, we can't trust the system to manage our health. Keep a record of all the medications and supplements you take and discuss possible interactions with your doctors and pharmacist. 

If you're insured with UnitedHealthCare, you have some good tools at your disposal. To use them, log into myuhc.com and select "manage my prescriptions." From there you can look up drug information which includes a picture of the pill and see what each drug will cost at a retail pharmacy and through mail order. You can see possible lower cost alternatives to a medication. You can even print out a report to show to your doctor to faciliate your discussion. See the flier below for more details. 

To save money, you may consider using a pharmacy that offers a generic discount program. Pharmacies like Target and Walmart often offer very low prices on a select list of generic drugs used to treat common conditions like diabetes, mental health, high blood pressure and infections. Their prices may be less than your copays and are likely to be less than what you would pay out-of-pocket with a high deductible plan. If you use one of these programs, the cost will not track toward your deductible though.

If you're not in our health plan, Good RX is helpful for pricing medications. Costco, Walmart and Target are generally cheaper than pharmacies like CVS and Walgreens. You may be able to negotiate with a convenient pharmacy to match a price if you find a drug cheaper at another place nearby. Giant will typically do this. It certainly doesn't hurt to ask.  

And, since were in vacation season, if you're traveling and forget your meds, go to a pharmacy and request a vacation override. Show the pharmacist your card and he or she will call UHC to obtain the override for you. You might also be interested in this post -- 10 Health Care Tips for Travel.


Learn More:

Monday, July 7, 2014

30 Day Challenges and a Green Smoothie Formula

from simplegreensmoothies.com
You may recall my initial attempts at green smoothies. Gag! So, when I heard about this 30 Day Green Smoothie Challenge, I figured I'd give it a shot. Surely I'd learn to make a decent green smoothie after 30 attempts and if I replaced one meal a day with a green smoothie, maybe I'd knock off the couple of pounds that I've gained since I fractured my foot. With luck, they might even have magical healing powers (stupid foot is taking forever to heal.) 

I find 30 day challenges educational. I did the 30 day Mediterranean Lifestyle challenge that we held here and learned  a lot from my colleagues' blog posts about the hurdles people encounter when trying to eat well. This lead me to participating in October Unprocessed with a group of staff where we tackled label reading with new vigor. During both challenges, I picked up a variety of new healthy habits that have stuck. 

It's only week two of this challenge. (Although I did get excited and start almost a week early on June 24.) I've already learned to make a decent green smoothie thanks to this simple infographic. I'm pretty sure I'd have never mixed broccoli and chocolate if I'd had this when we first got our Vitamix. Seriously, they should imprint this on the machine! Kale, coconut water, mango and banana is my current favorite. And, thanks to this infographic I can make one or two portions that fit neatly in our Klean Canteens. Before I always had too much. 

If this challenge interests you, I hope you'll join me. If not, find a challenge that helps you hone in on something you'd like to learn more about. You can always go back to our Mediterranean Diet Challenge and start with Wave 1. Or, try August Unprocessed. (I find eating well easiest in the summer when the Farmers Markets are filled with gorgeous produce.) Or, maybe you want to create your own 30 Day Challenge -- planks, squats, yoga, swimming, cold showers (no kidding, Google it) -- the options are limitless.




Sunday, July 6, 2014

ASHA Recognized as One of The Washington Post Top Workplaces


We're thrilled that ASHA has been selected as one of The Washington Post Top Workplaces. This recognition is particularly meaningful because it's based solely on employee responses to a survey conducted by WorkplaceDynamics, LLP, a leading research firm on organizational health and employee engagement. 

This recognition is wonderful, but we're even more excited that the Washington Post is helping us let everyone know that ASHA is a great place to work. Associations Now aided that cause when they did a follow up piece on What it Takes to be a Top Workplace and highlighted two of the associations that were recognized -- the American Chemistry Council and ASHA. 

Interested in working in a top workplace? Check out our job openings. We're always looking for talented folks to join our team. 

The Washington Post published the complete list of Top Workplaces on June 22nd. For more information about the Top Workplaces lists and WorkplaceDynamics, please visit www.topworkplaces.com and www.workplacedynamics.com.


Friday, June 6, 2014

My Foolish Visit

The first Friday of every month, the HR team at Motley Fool leads an office culture tour. Kay Noll at ASCO had taken it and found it interesting and thought provoking, so I went today along with the HR directors at five other associations. Sam Cicotello, Chief Rabble Rouser of the Highest Order, led our tour with admirable energy and foolish enthusiasm. I was just going to take it all in, but the geek in me won out and I took notes, so I figured I may as well share them.

I know I’m stating the obvious here, but for the record -- this is my interpretation of what I heard and saw. Like everyone else, it was filtered through my own experiences. I’m sure I misunderstood some things or read too much into them. I just hope Sam won’t want to slap me if she reads this.

The atmosphere was one of controlled chaos. All the furniture was on wheels and there was stuff everywhere -- a giant blow up shark, a pit of balls, walking desks, bike desks, giant tv screens and computer screens, white boards, Legos, books and fans. They evidently move and arrange it all depending on what they’re working on and whom they’re working with. They described their organizational chart like it’s just as fluid. As we walked around, we saw small groups of people collaborating everywhere. The Fools were welcoming and friendly and didn’t seem to mind us snapping pictures and asking questions.

Because there are essentially no rules, their supervisors have to be very skilled at giving feedback and having what most of us would perceive as difficult conversations. I had hoped to gain some insight into how they achieve this. They said they focus on getting people that demonstrate these skills into supervisory roles more than training for them, but they clearly have a lot of support. They have between 10 and 20 staff doing HR work for a staff of 300. By comparison, we have 4 people to support 265.

They said they hire for cultural fit, demonstrated passion and skill in that order and reported their average age as 35. I should have asked how diverse the staff is because I walked away thinking I’d seen mostly 20 something year old, Caucasian men (at least one of whom was barefoot.)

Here’s more of what impressed me.

The “No Policy” Policy

The crew at Motley Fool finds fun ways to communicate what’s important without relying on rules and policies. I honestly wouldn’t shed a tear if our employee handbook was burned, so this impressed the heck out of me.

Pantsing wall (i.e., caught with your pants down.) If an employee leaves their computer left unlocked (FTC compliance issue), the finder sends an all staff email that’s embarrassing. In other companies you might be written-up or even fired for this, but Motley Fool finds the public humiliation effective.

Fools errand. They pull a name out of a hat and the person selected takes two weeks off and is given some cash. They have no vacation policy and people can take whatever time they want, but this practice forces people to have contingency plans and back-ups. Obviously, an employee could be called away at any time and they don’t want to be left in a pickle.

Take what you need. People can take as much time off as they like. If it’s perceived as a problem, they have a conversation about how they’re letting their team down, not pulling their weight etc. This is how they describe it on their website:
The Fool’s vacation/sick policy is pretty straightforward: take what you need. That’s right, as long as you get your work done and consult with your supervisor in advance (if you’re going to be sick, we’d like to know in advance, but we understand it doesn’t always work that way…unfortunately…), you may take any reasonable amount of time off. With pay, of course. Huh? Flexible paid time off? What’s the catch? Well… nothing, actually. Fools treat themselves, their company and their co-workers with fairness and respect, so you will not abuse such a wonderfully Foolish benefit.
Performance Management – Measure everything and compete to win.

Key metrics include:
  •  Employee turnover (wanted ~2% / unwanted 2%
  •  Revenue per employee
  • Candidates per opening
  • Happiness score
  • Employee engagement
  • Jobs filled internally
At Motley Fool, they focus or their high performers. They suggested asking these questions: Who gets more feedback at your organization – high or low performers? Where do you spend your time? Where do you spend your money? Can you remove the low performers?

Every six months each employee picks up to 10 people to get 360 feedback from. They are trying to move away from anonymous feedback and toward face-to-face. It’s not shared with them by a manager or anyone on their team. It’s delivered by what sounded like a group of trained volunteers and used for development purposes only.

Performance management reviews are different every time. They use a 16 box performance vs potential grid. (See a traditional 9 box description from SHRM.) They don't force rank. Three times per year the leadership team discusses employees and where they are on the grid. They said approximately 10% of their staff are in the lowest quartile of the 16 quadrants at any point in time. They improve or they are put on a path to success somewhere else.  



They have what I’d call a “crossroads conversation” with those low potential/low performing folks and offer to give them some severance in lieu of putting them on a performance improvement plan. This allows them to spend more of their time investing in helping their top performers excel. And, they believe they’re ruining people’s lives if they allow them to flounder. (BTW, I agree.)

If managers don't give good feedback, they take away supervisory responsibility. They want to play to people’s strengths, so they try to create multiple career paths to advance – some that don’t require supervision. Management isn’t the only way up at Motley Fool.

The Space

Like I said, the atmosphere was one of controlled chaos and there were lots of options for people to chose from to do their work. I saw treadmill desks, bike desks and standing desks. I didn’t see anyone using the bike desk or treadmill desk, but lots of people were using the standing desks. I’ve been looking for an adjustable, standing desk option for ASHA, so I honed right in on this. They use the Varidesk.com ($275-$350). We saw a quiet work room, a mommy room, a massage room, a reading/nap room and a cool game room. There was comfortable seating scattered around throughout the office. Oh, and how could I forget to mention this, there are no offices with walls. It’s all open space.

I really liked the rolling white boards they had throughout the office (pictured above.) I could see us using those at ASHA. They could replace some of the flip charts I tend to drag around and become a sort of cubicle door for folks that want to work uninterrupted for a while.

Values and People Practices

Their advice about culture -- be intentional and model it from the top. Motley Fool's Core Values -- Be Foolish and...

  • Collaborate — Do great things together. 
  • Innovate — Search for a better solution. Then top it! 
  • Fun — Revel in your work. 
  • Honest — Make us proud. 
  • Competitive — Play fair, play hard, play to win. 
  • Motley — Make Foolishness your own. Share your core value _____________. 
Are you living your core values? 
  • Will you hire for them?
  • Will you fire for them?
  • Are they present in your office?
  • How frequently do you reference them? Are they part of your daily vocabulary/lexicon? 
They have pictures of every staff member on a wall across from their board room to serve as a reminder that the board is making real decisions that effect real people. This prompted me to think about collecting pictures of our members with brief bios and printing them on cards. We could give one to each staff member to remind us who we’re working for.

Twice a year, they do an engagement survey. They’re using an app called Culture Amp which I plan to check out. They said they ask a lot of Gallup questions, but they do it themselves.

Sam suggested thinking about what you want to fight and what you would be better off embracing. For example, they decided to embrace March Madness. They offer a bracketology class and everyone fills out their brackets, then they watch the games together.

They seemed to have a few folks to facilitate learning on their people team. They mentioned just in time learning, but said they had a curriculum built for onboarding. They respond to requests and rely on internal resources as much as possible. They look for someone outside if they don’t have expertise in house. They mentioned looking at their high performing mangers to key in on what they do well, so they can figure out how to pass it down.

The HR documentation type folks, which they described as compliance and benefits (Totally not how I would define benefits, but I understand.) report to finance not to the people team. Training, compensation, performance management, and recruiting folks are on the people team.

They value staff being in their physical environment, but 15% of their staff work remotely. They have lots of flexibility, but no set telework schedules. They said they don't hire people to work remotely, but they have made arrangements to keep some high performers. Remote workers cannot have any direct reports.

I didn’t learn much about how they compensate people. They mentioned a profit sharing type plan and being able to buy and sell shares. They also mentioned a bonus program with variable tiers (e.g., 5% and 10%), but said they all meet or miss the eligibility requirement together. They want people who invest and understand the ups and downs their customers feel, so they give all new employees $1,000 in their investment account.

They said they want Fools for life and they want it to be a long life. They employ a full time wellness person. Generally, if Motley Fool pays for it, it should be healthy, but I think I saw a cake. I liked their well-stocked kitchen area. I’d be totally into an unlimited supply of Fage plain Greek yogurt.



So, there you have it in probably my longest blog post ever. This probably goes without saying at this point, but I highly recommend taking the tour. Thanks to Kay for recommending it and thanks to my LAHRF colleagues for joining me. 





Tuesday, June 3, 2014

How to Talk with Your Doctor About the Quality and the Cost of Your Care


Savvy healthcare consumers ask questions. 
Some medical tests, treatments, and procedures provide little benefit and in some cases, they may even cause harm. Talk to your doctor to make sure you end up with the right amount of care - not too much and not too little.
But, what questions should you ask? I've looked at a lot of resources and believe the five question recommended by the Choosing Wisely campaign in the flier below are a good starting point. 

Interestingly, I've found that medical providers are very willing to engage in this conversation when I start by saying I have a high-deductible health plan (HDHP), so I'll be paying out of pocket for the services. As you can see in the photo, I've had a little first hand experience lately; and I've actually found our new HDHP very empowering.   

If you're interested in digging deeper, I found these articles interesting, The Consequences of “Over-Testing”: Doc, Am I Glowing in the Dark? and The $50,000 Physical that was just published in JAMA.  The federal Agency for Healthcare Research and Quality has some good resources. There are also lots of great specialty resources on the Choosing Wisely website.




Wednesday, May 28, 2014

Not Your Grandfather's Hearing Aids

Neil DiSarno with Matt Lauer on the Today Show
36 million American adults report some degree of hearing loss, but only one in five people who could be helped by wearing a hearing aid actually does so. Stigma often holds people back, but the new high-tech products of today aren't your grandfather's hearing aids. 

Watch ASHA's very own Neil DiSarno on the Today Show this morning with Matt Lauer talking about the latest in hearing aid technology. Neil is ASHA's Chief Staff Officer for Audiology. 



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