Wednesday, March 11, 2015

Couponing for Prescription Drugs -- Guest Post by Reed Racette

Reed Racette published this article on LinkedIn and I'm sharing it here with his permission. Reed described his take on an experience he had from a customer service perspective, but it's just as illustrative from the perspective of managing prescription drug costs. In Reed's case, their pharmacist lead them through the process which is where the exceptional customer service came in. However, it's something you can do for yourself or a family member. I work with Reed's wife, Kellie, at ASHA and she told me the coupon they found covered the entire cost of the medication saving them more than $2,000. Many thanks to Reed and Kellie for sharing their story.

Customer Care - the Acceptable, the Expect-able and the Exceptional

Usually we only hear about customer care when something has gone horribly wrong. We have all been left in awe after hearing horror stories about frustrating experiences with cable companies, call centers, or DMV's. As consumers it's easy to criticize or complain, but as managers or service providers it's much more productive to find good examples to emulate. Recently I had a health issue that helped remind me of the value of truly exceptional care.

Background - Bear with me, this is relevant.

I’m pretty fortunate in that I am generally healthy and my family has excellent health insurance. But even with great coverage you don't always get great care.
Without going overboard with the details, last month I had severe swelling in my left calf. It had persisted for a while so I went to a doctor - expecting to be told to take aspirin. Long story short, I ended up in the ER. I felt fine, but fortunately the hospital took it seriously because as it turned out, it was deep vein thrombosis (DVT). Essentially I had a big clot in my leg, part which had broken off and made its way to my lungs, resulting in a pulmonary embolism. I stayed in the hospital for two nights while they ran many, many tests, and started me on blood thinners which probably saved my life. Upon discharge from the hospital, they gave me a four month prescription for an anticoagulant called Xarelto (from Janssen Pharmaceuticals). We left the hospital and went to the pharmacy for the meds. This is where the real story begins, because the customer care I received from my pharmacy - the Harris Teeter Pharmacy in Columbia, Maryland - is a textbook example of how customer care should be delivered.

The Problem

We have good health insurance but Xarelto is a very expensive drug. We (my wife and I) went to fill the initial prescription and found that our out-of-pocket expense for a two-week supply would be a little more than $500. The four-month prescription was going to cost thousands of dollars.


Before I go any further, please note that this is not a knock on pharmaceutical companies. They take huge risks and incur big losses on drugs that never make it to market, but they are helping us beat more diseases than ever before. So while Xarelto is expensive, it's better than not having it as an option.

The Point

Here is how the Harris Teeter pharmacy team demonstrated how to move from "Acceptable" to "Exceptional." When the Pharmacist and the Technician (Faithe and Brandon) realized how much the medicine was going to cost, they were concerned. They know me, my wife, and our kids and they care about us. The situation was sub-optimal and Brandon and Faithe were empathetic. But they don’t set the drug prices, so it was outside of their control. If the story ended there, I’d say I received an “acceptable” level of care.
Then they suggested calling the insurance company and the doctor to check on other possible alternatives - maybe a lower cost option was available. This was smart, kind, and also a good business practice. As a valued customer I would expect this of my pharmacy, and my expectations were met. So I checked. I learned that other options were available for less money, but for several reasons I chose to stick with Xarelto as the doctor had suggested. We would just have to deal with the cost. We asked Faithe to fill the prescription, and said we would pick it up later.
When we got home, Faithe called with an idea. She suggested that we look at the Xarelto and Janssen websites because drug companies often have special offers and coupons (I had no idea) so we might be able to save some money. This was an exceptional act of patient care. The pharmacy is very busy, but Faithe wanted to look out for us. She didn’t have to take the extra step. She went out of her way to try to help because she cares. Regardless of the result, this level of care is on a higher plane.
My wife found that there was a special offer on the web site. It was a re-usable coupon that saved us more than two thousand dollars. This was great news for us, and I couldn't help thinking how it would affect patients who have to take this drug for years, or for life. When Brandon saw the new price of the prescription he was so happy for us that it was almost as if he had saved thousands. Again, this was exceptional. It is not often that a vendor or service provider - even in the health care industry - sincerely expresses concern for a client. This is a team that really cares about me and my family.

Lesson Learned

After this experience, I started thinking about the level of service we provide for our customers - I work as an IT consultant at GovernmentCIO. We want the best for our customers and the folks on my team go out of their way to meet high expectations. I like to think we are providing the same level of care that I receive from Brandon and Faithe, but do our customers know how important they are to us? How have I shown them?
Companies don’t win customers and form long-term client relationships by providing “acceptable” service or by “meeting expectations.” They build and keep relationships by being exceptional. One way to be exceptional is to show your clients that you sincerely care about them.
Do you?
I am interested in your thoughts on what makes customer service exceptional. Please comment or contact me at rracette@governmentCIO,com
My 25 years of experience includes service as a military officer as well as time with large corporations, national non-profits, and small companies.
My Alphabet Soup includes: PMP, CSM, ITIL V3, Six Sigma
Thank you for reading.

Tuesday, February 10, 2015

We're Taking a Stand

When I toured Motley Fool last year, I was impressed by the number of people I saw using standing desks. The treadmill desks and cycling desks they had weren't being used when I was there, but a lot of folks were standing. After my visit, I talked with our facilities director about offering a standing desk to ASHA staff and he agreed to pitch the idea to our CEO with me. 

I really had no idea how many people would want to stand while they work. We conducted a little survey to see how many folks would be interested and 150 people responded that they would. That's over half of our staff of 280. 

We plan to start by purchasing 100 units. I hope to eventually accommodate everyone who wants one. We set up a demo model and we have people coming by to kick the tires and take it for a test drive to affirm their interest. (You can see Paul, one of ASHA's audiologists, testing it out in the picture.) Zack Koutsandreas, the ergonomics expert that works with us, recommended an Ergotron desk mounted product. We like the way it attaches to our desks and how easy it is to raise and lower.

It's fun to hear how excited people are about using a standing desk. We plan to use a lottery to distribute the first 100 giving priority to people that work five days each week in the office. (40% of our staff telecommute one or more days each week.)

Interested in trying a standing desk? Maybe you can use these articles to make your case. 

Wednesday, January 7, 2015

Test Your Flu IQ

The CDC is projecting a severe flu season and it is now widespread in Maryland and Virginia. Experts recommend getting a flu shot (It's still not too late.) and following these six steps to stop the spread of germs.
  1. Wash your hands often with soap and water or an alcohol-based hand rub.
  2. Avoid touching your eyes, nose, or mouth. Germs spread this way.
  3. Try to avoid close contact with sick people.
  4. Practice good health habits. Get plenty of sleep and exercise, manage your stress, drink plenty of fluids, and eat healthy food.
  5. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  6. If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone without the use of fever-reducing medicine.
I also recommend taking a few minutes to complete the Well Flu Quiz from the New York Times. You can learn the answers to these questions, "What surface is the most friendly to the flu virus? Where’s the best place to stand when you’re talking to a sick person? And how are Australians curbing germs in schools?" and more....

* Precautions taken from

Tuesday, December 2, 2014

Help a First Responder Help You -- Set Up an Emergency Medical ID on Your Phone

A group of us spent yesterday afternoon running through disaster recovery scenarios at ASHA. This lead us to talking about emergency contact information and the new emergency Medical ID in iOS8's new health app. I'd never actually tapped "emergency" in the lower left corner of the passcode screen. (I was afraid it would dial 911.) It actually leads you to a screen with your Medical ID. 

Open the health app and tap Medical ID in the lower right corner to set it up. This apple insider article explains how to set it up if you need help. You can include medical conditions, allergies and reactions, blood type, organ donor status, and who you would like to have contacted in the event of an emergency. A first responder can see this information without unlocking your phone. 

If you don't have an iPhone or the current operating system, download an app called ICE and use it. I'm also a big fan of the low tech, Road ID


Monday, December 1, 2014

Can I Have a Health Savings Account if I'm Eligible for Medicare?

During our open enrollment period a lot of questions came up about Medicare. I reached out to our attorneys to confirm my understanding of some key issues. I'll share that information here, but first let's make sure we're on the same page in discussing the parts of Medicare. In the simplest terms: 
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  • Medicare Part A covers hospitalization. It's free to those who enroll.
  • Medicare Part B covers physician care. Participants pay for it. 
  • Medicare Part D covers prescription drugs. Participants pay for it. 
Obviously, there are a lot more nuances to Medicare, but the above should suffice for this discussion. (You can read more about the different parts of Medicare on the site.) 

It's a common misunderstanding that you have to apply for Medicare Part A when you turn 65. If you are an active employee and enrolled in health coverage, it's not necessary for you to enroll in Medicare Part A or Part B. It's enrollment in Medicare that precludes you from contributing to an Health Savings Account (HSA), not your age. So, you can contribute to an HSA if you have a high deductible health plan and you're Medicare eligible as long as you do not enroll in Medicare. If you start receiving social security benefits, you will be automatically enrolled in Medicare Part A. If you work for an employer with 20 or fewer employees, you may be required to enroll in Medicare when you become eligible. Check with your plan administrator.

Once you are no longer working, you must enroll in Medicare Part A and Medicare becomes primary. Most retiree health plans also require you to enroll in Part B by reducing the benefits as if Part B was elected. If you didn't enroll in Part B, you'd be left responsible for the part of the bills it would have paid. This is how ASHA's plan works. If you retire from ASHA and keep our retiree coverage, you should enroll in Part A and Part B. You should also not wait to enroll in Part B, once you are no longer working. If you wait to enroll in Part B, you may have to pay a penalty for late enrollment, which will last for as long as you are enrolled in Part B. 

Medicare Part D is different. It's completely voluntary and if you already have broad based prescription drug coverage (like what ASHA provides) you should not enroll in Part D. Many retiree plans state that if a person does enroll in Part D that the retiree coverage will terminate because the coordination of benefits provisions between Part D and a retiree plan are too cumbersome. ASHA provides a creditable coverage notice to our retirees each year. Because our coverage is creditable, our retirees can use ASHA's coverage and not pay a higher premium (a penalty) if they later decide to join a Medicare drug plan. 

Pretty straight forward so far, but now it gets tricky. I stumbled upon this warning at the end of this AARP Article
Warning for when you retire: You cannot contribute to an HSA in any month that you are enrolled in Medicare.  And there’s a pitfall inherent in that rule that you need to be aware of.  When you finally sign up for Social Security retirement benefits—probably when you’re on the point of retirement—and if you’re already at least six months beyond your full retirement age (currently 66)—Social Security will give you six months of “back pay” in retirement benefits.  It’s a generous gesture, but it means that your enrollment in Part A will also be backdated by six months.  Under IRS rules, that leaves you liable to pay six months’ of tax penalties on your HSA.  To avoid the penalties, you need to stop contributing to your account six months before you apply for Social Security retirement benefits.

When applying for social security, a person may be entitled to monthly benefits retroactively for up to six months for full retirement age claims. When social security benefits are paid retroactively, typically the Medicare Part A enrollment is also made retroactively to the same effective date. There is little information available about this. It may be possible to inform the social security administration that you had other coverage and you do not want to start Part A retroactively. If you were able to do this, there would be no problems contributing to an HSA while you're employed. Here's what we recommend: 
  1. Stop your HSA contributions six months prior to applying for social security benefits. When you do apply, ask the social security administration not to backdate your Part A enrollment. If they honor your request, you can make an additional contribution equal to what you would have contributed in the six months prior to applying for social security benefits. You'd make this contribution directly to the HSA trustee before December 31 or before you file your tax return for the relevant year. Then, you'd deduct the "missed" contribution from your income taxes. 
  2. If you do not stop your HSA contributions six months before applying for social security benefits and you are enrolled in Part A retroactively, contact the HSA trustee and request that your contributions during that time period be removed from your account and refunded to you. You should do this before December 31 of the year you became ineligible. (You may be able to do it up to the point when you file your tax return for that year, but that's more complicated.) If you do not have the ineligible contributions refunded, a special penalty tax applies to that contribution for the year and for each future year that the contribution is not withdrawn. 
So, the answer to the question posed in the title of this post is "Yes", but it can get complicated. We're hoping to have a Medicare expert come in and talk with ASHA staff next year.