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: 
Image from www.scottinsurance.com

  • 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 Medicare.gov 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. 

Update October 15, 2020:

Question: One of our colleague’s husband is turning 65 this month. She is under 65 and covers both of them on our plan. They’ve elected the HDHP with HSA. The question is will she still be able to make a full family contribution if her husband enrolls in Medicare? 

Answer: If she maintains family HDHP coverage, she can continue to contribute up to the family HSA limit, even if her spouse enrolls in Medicare.  The person who enrolls in Medicare is not eligible to contribute to an HSA (which is why the rule is different for employees who enroll in Medicare).  If she were to switch to single HDHP coverage, then her maximum contribution would be reduced for the remainder of the year.

Monday, November 17, 2014

In the News: a new heart health calculator and a study on the value of cooking at home

Just a quick post to share two newsworthy items. First, the Harvard School for Public Health released a new online calculator to estimate your risk of cardiovascular disease. I like that it focuses on lifestyle choices and modifiable risks. It's easy to complete and you don't need to know your blood pressure or cholesterol to get your results. 

Despite being one of the leading causes of mortality and morbidity in the U.S. and worldwide, people seem to be less fearful of cardiovascular disease than cancer or Ebola. And, unlike some diseases almost all cardiovascular disease is preventable. The recommendations you receive after completing the survey include practical tips for improving your health. It's been so popular that the site sometimes gets overwhelmed (an encouraging sign), but keep trying. It's worth doing! 

Second, a new study from Johns Hopkins University Bloomberg School of Public Health revealed that:

"People who frequently cook meals at home eat healthier and consume fewer calories than those who cook less, according to new research. The findings also suggest that those who frequently cooked at home -- six-to-seven nights a week -- also consumed fewer calories on the occasions when they ate out."
Certainly, not surprising, but it does confirm again that we're on the right track in planning a series of cooking classes for ASHA staff.

Friday, November 14, 2014

Mediterranean Diet and Workplace Health -- The Evidence Behind the Recommendations

One final post about the the Mediterranean Diet and Workplace Health Conference at the Harvard School of Public Health. The conference organizers prepared the review paper below. It clearly indicates the health benefits of following a Mediterranean diet and the evidence that supports the recommendation. I particularly like this chart at the top of page three that provides clear instruction for following a Mediterranean diet. Please take a few minutes to peruse the paper. 

Thursday, November 13, 2014

Health Plan Changes for 2015

When I announced that ASHA will be self-insuring the medical coverage for staff next year, I mentioned that one of the advantages is that we have more flexibility in the plan design. This has allowed us to enhance benefits in a number of areas. Below is a summary of the changes our plan participants should expect for 2015.

1. You’ll receive a new card. Our administrator will be listed as UMR, but we’ll be using the same Choice networks through UnitedHealthcare that we have now. Your id number, the mailing addresses, phone numbers, and the website will all be new. We’re doing everything we can to assure you will have your new cards in hand before January 1, 2015. And, we will make sure you have all the up-to-date contact information for the 2015 calendar year.

2. To get a 90 day supply of a prescription medication, you will have to use mail order. Through mail order, you will receive 90 days of medication for two copays. (The cost of procuring the medication through mail order is less, so we’re passing along some of that cost savings to you if you chose this option.) If you chose to have your prescriptions filled at your local pharmacy, you will get a 30 day supply for one copay. Our copays will continue to be $10 for a generic (Level 1), $35 for a preferred brand name (Level 2) and $60 for a non-preferred brand name (Level 3.) If you are in the Choice Plus with HSA plan, you will continue to pay the cost of the medication until you hit your deductible. Then, the copays will apply.

All mail order prescriptions will be transferred from 2014. You will have to call OptumRX the first time you need a refill in 2015. After a prescription has been filled once, you’ll be able to order refills online at the UMR site. Your prescription number will stay the same. At a local pharmacy, you’ll just need to present your new insurance card. If you have a specialty medication, call and talk with your advocate. You’ll just need to provide your new id number and your prescription will be transferred.

Some of the tiers that drugs are in may change. The 2015 prescription drug list has been posted on the Healthcare Savvy ASHAnet site for you. Diabetic supplies will now be covered at the generic copay level of $10.

Learn more about prescription drug pricing and safety by reading the summary of the session we hosted here in July.

3. Out-of-network services will be reimbursed at 90% of UCR (usual customary and reasonable) in 2015 instead of 80% as they are now. This enhances the benefit for staff that seek services outside the network.

4. The in and out-of-network deductibles in the Choice Plus with HSA will now cross accumulate. This means that whatever you spend out-of-pocket for in-network services will also count towards your deductible for out-of-network services. This softens the hit of the out-of-network deductible.

5. Your pre-colonoscopy doctor’s visit and the “prep” kit will now be covered as preventive services if they’re billed as preventive. (They are currently subject to the deductible and copays, so this is an enhancement.)

6. Chiropractic services will no longer be limited to 30 visits per calendar year. They will be reviewed for medical necessity after 25 visits and an unlimited number of visits may be approved if they’re medically necessary.

7. Replacement batteries on durable medical equipment will be covered in 2015 enhancing your coverage.

8. A number of exclusions for mental health disorders have been eliminated for 2015 enhancing your coverage.

We will talk about these changes during our open enrollment meetings. The HR team will also be happy to answer your questions.

Sunday, October 19, 2014

Mediterranean Diet and Workplace Health -- Best Practices from the Field

2014 Initiative for Productivity and Health Management Conference at the Harvard School of Public Health

I came back from the Mediterranean Diet and Workplace Health Conference at the Harvard School of Public Health with so many notes, I decided to break them up into two posts. You can read my earlier post about Day 1 where they defined a Mediterranean diet and shared the scientific evidence about the health benefits. Day 2 focused on effective real world initiatives to help people eat a Mediterranean diet. Here’s some of what stood out to me…

Chef Psilakis is a big proponent of teaching kids to cook. That was actually a theme that was thread throughout the two days. Dr. Gianluca Tognon talked about how they improved the diet of school children in Sweden. They empowered children by involving students in the meal planning and offering them choices. They exchanged information by inviting school chefs into the classrooms. And, they evaluated the effects of what they were doing by keeping track of foods that were not well accepted and collecting feedback from students and teachers. He suggested food tastings, having specially themed food days, creating "smarter lunchrooms" by carefully considering food placement and having school gardens as ways to improve dietary habits of children. Dr. Tognon has a free e-book that I look forward to reading. 

UMass shared what they did at the university level and it really didn't sound all that different. Ken Toong the Executive Director did add a mention of "stealth health" for example making sliders with a meat blend that's 30% mushrooms. At UMass they've found a way to make healthy affordable. They have 12% waste and the US average is 40%. He also reported that they consumed 22% less soda from 2013 to 2014. They encourage students to drink water by offering sparkling water and water infused with fruit. (I'm already requesting that we do that in our office.) I loved the UMass tagline -- Come for the food, stay for the education. I sure didn't have lobster when I was in college. 

In general it sounds like it is much easier to get children and college students to make healthy choices than adults. Although the effective strategies for adults were much the same as those used for young people -- samplings, tasting tables, talking with chefs -- with the addition of distributing recipe cards. A few other poignant points:
  • Many people know they should change what they eat and move more, but feel "stuck" and lack the skills to change.
  • Nutritional knowledge is not enough. Culinary literacy is at an all time low. Hands-on training is essential. 
  • Each 30 minute reduction in time spent cooking in the US has been associated with an increase in BMI of 0.5.
This made me recall reading, Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies which concluded,
"Across socioeconomic groups, people consume the majority of daily energy from the home food supply, yet only slightly more than half spend any time cooking on a given day. Efforts to boost the healthfulness of the US diet should focus on promoting the preparation of healthy foods at home while incorporating limits on time available for cooking."
I had a chance to observe this first hand when we did our Mediterranean Challenge. Many people really struggled with the cooking. Grocery shopping took a long time because they were looking for items that were unfamiliar to them. The kitchen prep work took a long time because they weren't set up for it and their knife skills weren't good. And, they often picked meals that were too ambitious for a week night because they didn't have enough experience judging what could be prepared quickly. I've been planning to organize a knife skills class and a series of cooking classes at ASHA since I learned this. From what I learned at the conference, I'm on the right track with this idea. 

The experience of Todd LeDuc at the Boston Fire Service affirmed something I believe, money is not the best motivator for improving healthy. They started out with some incentive programs that they later eliminated. He shared an example of a communication that I liked, if you eat x you'll have to run x miles to work it off. How much more useful would that kind of message be than our current food labels?

One of the most exciting presentations was David Eisenberg, MD, he hit on many things that I'd been discussing during the breaks with other attendees. He has a program that teaches physicians too cook -- Health Kitchen, Healthy Lives. You can read about it in this New York Times article. I'm wondering how many of the program objectives we could incorporate in our workplace wellness program. Dr. Eisenberg was the first to mention mindfulness. I emailed him and asked if he'd share his slides. I'll definitely be spending some more time reflecting on what he shared. 

As a Blue Zones fan, I enjoyed hearing from Diane Kochilas. I especially liked her take on seasonal foods, 

"Eating foods in their season, when nature intended, brings anticipation, which in turn teaches us to savor and enjoy the moment, a notion obscured by the 24/7 availability of almost everything in American supermarkets and the erroneous -- and, ultimately, unsustainable -- belief that it's our right to have it all in endless choice."
Chef Michael Psilakis described the Mediterranean as the “have your cake and eat it to diet” and they practiced what they preached.  Breakfast was served both days of the conference – Fage plain greek yogurt, fruit, honey, pistachios and veggie filled filo pastries. Lunch was 90 minutes long. It included chicken, farrow, eggplant, salad and wine (no dessert.) Snacks and appetizers were fruits, roasted vegetables, hummus and more filo pastries. I’ve never eaten so well at a conference and all in the name of health. What’s not to love? They also closed the conference with a Greek Food Expo that gave us a chance to try wines, olive oils and other treats imported from Greece. 

With the focus on diet, I don't want to neglect the fact that activity and sleep were mentioned. I sat next to Voula Manousos, a registered dietitian, and she described our need for sleep in an enlightening way. She suggested you imagine your bedroom with everything pulled out of the closet and drawers heaped in the middle of the floor. While you sleep, everything is neatly put away where you can find it the next day. That's why sleep is such a critical component of memory and recall. On that note, I think I'll say good night. 

I recommend trying the oils from Flying Olive Farms. They're available in Whole Foods in the Raleigh, NC area and I'm begging the Wine Cabinet in Reston, VA to carry them. I loved their balsamic too. 

I recommend the series of Huffington Post articles written by the conference organizers and faculty. 

Friday, October 17, 2014

From Passive Patient to Savvy Healthcare Consumer: How to Seek and Find the Best Care

Dr. Gourdine met with us yesterday to teach us how to seek and find the best medical care. This was Dr. Gourdine's second visit to ASHA. I shared a little about her impressive background when I summarized her last presentation How to Be the CEO of Your Health

Yesterday, we walked away away better equipped to:
  • Distinguish among an empowered patient, an engaged patient, and a savvy healthcare consumer.
  • Define quality healthcare.
  • Identify and use reliable sources for choosing the best doctor.
  • Talk to our providers about safe care.
  • Identify and use reliable sources for choosing a safe hospital.
  • Define the role of a hospitalist.

An empowered patient is informed, speaks up, asks questions, and makes sure he/she fully understands all aspects of his/her care. To be empowered, you must first be an engaged patient and have the knowledge, skills and tools to take charge of your health. Engaged patients have fewer hospital admissions, fewer ER visits, better preventive care and lower medical costs. But, what does it mean to be a savvy healthcare consumer? Savvy consumers:

  1. Select quality providers
  2. Seek care from the highest quality hospitals and facilities when they need it.
  3. Are educated about procedures and alternatives.
  4. Estimate the total cost and out-of-pocket costs of their care.

So, what is quality healthcare? There are two main types of quality measures -- consumer ratings that tell you what people think about the care they received and performance measure that evaluate how well a doctor, health plan or hospital prevents and treats illness. Many of the resources we first think of like publications that list top doctors are more popularity contest or paid advertising than an indication of quality. Dr. Gourdine provided us a number of reliable resources to help us select top quality doctors and hospitals. 

So, how do you chose a doctor? 

  • First, identify your own health priorities. AHRQ has a nice tool
  • Look at the Unitedhealthcare website to find providers that are in-network. Look for providers that are designated as Tier 1 which indicates that they have received a premium designation for quality and cost efficiency.
  • Review information on the AMA website. Many doctors are not AMA members. You can still find them in the directory, but there is limited information about them available.
  • Check out the doctor on Health Grades to learn more about their background and read reviews from patients. 
  • You can also look at the Medicare physician compare website
  • And, Rate MDs

What reliable resources are available for choosing a hospital?

Dr. Gourdine has compiled a more comprehensive list of resources in the last few slides of her presentation. I encourage you to take a few minutes to view it. 

We look forward to having her back at ASHA next year. If there is a particular topic you'd like to have her speak about, please let me know. We feel very fortunate to have someone with her expertise available to help us. 

Thursday, October 16, 2014

Oh Hell No: What to do when your flex vendor sells you out

These white boards that I
saw at Motley Fool are the greatest!
When we implemented EBIX as our online benefits enrollment system two years ago, we switched flex vendors to FlexCorp because they were business partners. Flexcorp had already been acquired by TASC (Total Administrative Services Corporation) at that time, but they operated independently. Because Flexcorp was fully integrated with EBIX, we had a single sign-on. Our staff were happy with FlexCorp. They appreciated the single sign-on and the requested levels of substantiation seemed reasonable. From the admin side of things, Flexcorp was ok. Their responsiveness wasn't great, but it wasn't causing many problems. We planned to continue our relationship with them into 2015.

In August, our staff started letting us know they couldn't log on to their accounts and we couldn't get an explanation of the problem from FlexCorp or an expected time frame for fixing it. On August 11, we received an email that FlexCorp had joined forces with TASC and they would be transitioning our account. TASC had actually acquired Flexcorp in December of 2011. For reasons unknown to us, they decided to move our account to TASC midway through our plan year. I didn't know much about TASC when we received this notice, but I contacted our broker, Mark Sager at Alliant, immediately and asked him to help us look at other providers. I figured if we were going to have to change vendors, why not look at all our options. We had a call with TASC on September 12. It didn't go well. They couldn't answer any of the questions we asked. I called Mark again and told him we needed to find a new vendor FAST.

Our team got busy and mapped out the plan you see in this image. I sent out an SOS to the HR directors at other large associations and made note of who they had experience with and who they liked and didn't. The feedback about TASC was not good. (Evidently they've acquired a lot of other flex vendors recently.) Connie Castrogiovanni, our payroll guru, set up a meeting for us with ADP. I posted questions on LinkedIn and got a few responses that helped me hone the list a bit more. On September 16, Mark Sager brought Bridget Holt from Benefit Resource, Inc. out to meet with us. They're a small firm in Rochester, New York that seemed to be a good fit for us. At the end of the meeting, we asked Connie to hold the next transfer of funds to FlexCorp. We figured there was no sense giving them funds that we would just have to collect back. 

Benefit Resources' references stressed the quality of their customer service. We like their app that allows participants to submit claims or receipts necessary to substantiate a claim right from their phone. And, they could meet our ambitious timeline for making the transition, so our staff had access to their funds in less time than they would have if we'd made the transition to TASC. We quickly executed the contract and they had us up and running in record time. 

What we couldn't do is shut down the process with TASC. Of course we informed them we would not be making the move -- verbally and in writing. But, they didn't seem to get the message. They continued to email our FSA participants, so we blocked incoming email from TASC. They even sent debit cards to our staff. We did a pretty good job of keeping the staff informed about what was going on, but TASC certainly did everything possible to confuse matters. 

It was a real scramble and certainly a lot of work that we had not planned on at a particularly busy time for us, but we got it done. Most employers would have just gone along with the transition to TASC, but there is no reason to be a victim if you have a good network of people that will help you when you're in a pickle. 

Thursday, October 9, 2014

Mediterranean Diet and Workplace Health -- Challenges in Contemporary America and Scientific Evidence

2014 Initiative for Productivity and Health Management Conference at the Harvard School of Public Health

I had the good fortune to attend the Mediterranean Diet and Workplace Health Conference at the Harvard School of Public Health. Someone there evidently Googled “Mediterranean diet workplace wellness,” stumbled across my blog, and sent me an invitation. (Now that's an incentive to keep blogging.) I’m pretty confident I was the only HR person in attendance, so this was a pretty unique learning opportunity for me.  

The first day was entitled Challenges: Diabesity and Contemporary American Nutrition and Value of the Mediterranean Diet. Day 2 was Promoting Dietary Change: Workplace/School Solutions and Other Best Practices from the Field. I walked away with a lot of notes, so I'm breaking them up into two posts. This post will cover Day 1 and a second post will share what I learned Day 2. 

Here’s some of what I made note of the first day…

They clearly defined what it means to eat Mediterranean. I've plunked the main points into the box above. 

I actually learned a lot about olive oil. Look for EVOO, extra virgin olive oil. It should be labeled cold pressed and first pressed. Then, check the ingredient list. A lot of what is sold as olive oil in the U.S. is a blend of oils. Interestingly, in Greece they never mix their olives. Each bottle of olive oil is made from olives from one of three regions Kalamata, Crete, etc... It was suggested that we use a good, but less expensive olive oil for roasting vegetables and other cooking and then have some really nice oils for finishing dishes. Olive oil does have a low smoking point, so if you're making a dish that involves high heat, it was suggested that we use canola or grape seed oil. 

Interestingly, there is no relationship between milk consumption and fracture risk. It was pointed out that the highest rates of fractures are in milk drinking countries.  We were told that calcium needs are overstated in the U.S. (Guess we can thank the dairy lobbyists for that.) Yogurt and cheese are the healthiest way to consume calcium. It was pointed out that in Greece, they don't eat much cows milk cheese, it is usually made from goats milk. 

They defined a moderately high intake of fish as two to three servings a week. I was also happy to hear some definition around "moderate consumption of wine." It was defined as one drink per day for women and two drinks per day for men. A drink can be 12 oz of beer, 5 oz of wine or 1.5 oz of spirits. (There were no special health benefits noted with red wine, so choose what you like.) You should consume your drink slowly. They also clarified a question I'd heard asked on a number of occasions. Most people can safely have up to three drinks in one day as long as they don't exceed the weekly limit of 7 for women and 14 for men. 

They talked about the health benefits of eating nuts. All nuts, which was refreshing. I've so often heard we she eat this nut or that nut, but all nuts have health benefits and I guess you're sort of splitting hairs by picking one over another. 

Nutrition experts at Harvard School of Public Health developed this Healthy Eating Plate to address key flaws in the U.S. Department of Agriculture’s MyPlate.

I found the graph below rather shocking. Of the 20 leading causes of death worldwide, 14 are linked in some way to food, diet and nutrition. Notice how high a diet low in fruits ranks. We were told that each additional serving of fruit a day results in 5% reduction in the risk of diabetes. Volume is more important than variety. Juice doesn't count. Click on the link in the caption if you'd like to learn more about the graph. 

Low Fruits and Vegetables and Mortality Burden

recent article in JAMA stated, "inadequate intakes of minimally processed foods such as fruits, nuts, vegetables, fish and whole grains together are associated with larger proportions of global death and disability than excess intakes of started fat, trans fat, and sodium." This reinforced that what we eat matters more than what we refrain from eating. I certainly find eating healthy easier when I focus on what I "do" eat rather than on what I "don't." 

There was a presentation by Frank Sacks, MD on randomized clinical trials that was interesting. He was the perfect speaker for after lunch delivering what could have been a dry and complex topic in easy to understand terms with plenty of humor. He said you get the best results lowering blood pressure by combining a low salt and Mediterranean diet. EVOO matters and all nuts have a similar benefits. (Chef Diane Kochilas said olive oil makes vegetables craveable. She has a new cookbook coming out on October 14 that I can't wait to receive.) He showed a slide that summarized the benefits of a Mediterranean diet that have been documented in clinical trials. I recreated that info in this image.  

A few times, the cost of eating well was mentioned, but it was never really explored. In the September 3, 2014 issue of JAMA there is an article on The Real Cost of Food. It states that, “Higher-quality diets typically costs more than lower-quality diets – on average, about $1.50 more per person day.” Obviously this can pose a barrier for many people. It reminded me of the work that Dr. Mary Flynn, a research dietician, is doing in Rhode Island. She partnered with food pantries and provided participants six weeks of cooking classes where they were taught the cooking techniques needed to execute simple healthy recipes. After each class, participants were given a bag of groceries to recreate the recipes at home for their families. Six months after completing the program – they cut their spending on groceries in half and most lost weight (although that was not the focus of the study.) I’ve had this in the back of my mind for at least a year and a half. This weekend inspired me to get in touch with the Embry Rucker Shelter in Reston and see if there is a similar initiative where I could volunteer. If not, maybe I can start one. Anyway, this was one perspective I thought was missing in the conference. (You can learn more about Dr. Flynn's initiative in this post, Eating Mediterranean on a Budget.)

That pretty well summarizes Day 1. During Day 2, the focus shifted to how we help people eat a Mediterranean diet. I'll summarize what I learned the second day in my next post

If I've peaked your interest in olive oils, read Tips on Finding the Best Olive Oil With Eataly Expert Nicholas Coleman. I recommend trying the oils from Flying Olive Farms. They're available in Whole Foods in the Raleigh, NC area and I'm begging the Wine Cabinet in Reston, VA to carry them. I loved their balsamic too. 

I also recommend the series of Huffington Post articles written by the conference organizers and faculty. 

Friday, October 3, 2014

How to Choose a Health Plan

Open enrollment is just around the corner and ASHA staff will be selecting which of our three health plans are the best fit for themselves and their families for 2015. To make the decision process a bit easier and more transparent, we created this decision making tree. 

We've also revamped our plan for open enrollment meetings to follow along the same lines as the decision tree. We'll be holding a brief overview meeting and then staff members can chose to attend any combination of the following sessions. They'll each be offered more than once and include a presentation and a panel discussion with representatives from our insurers and staff. 
  • Securing Your Financial Future with an HSA
  • Caring for Your Children
  • Planning for Medical Expenses in Your Retirement 
  • Receiving Care from Providers Outside the Network
  • Protecting Your Income When You Can't Work
We'll also hold a separate meeting for retirees. Staff nearing retirement are welcome to attend. We hope everyone will seize this opportunity to make a well-informed decision. 

Thursday, October 2, 2014

ASHA Moves to Self-Insure Medical Coverage for N.O. Staff

Many employers move to self-insure the medical plans for their employees once they reach a certain size. With a large enough group, it becomes less expensive to pay the actual medical claims and an administrative fee than to pay premiums to an insurance company to assume the risks associated with fluctuations in claims. Self-insuring also allows an employer more flexibility in the plan design and allows an employer to avoid some of the taxes imposed on fully-insured plans. 

How a plan is funded is largely invisible to the staff. For example, ASHA has been self-insuring dental coverage for years and I doubt most staff have given it any thought. In 2015, staff will notice a few changes though. Our coverage will still be with UnitedHeathcare, but UMR (a different group within the company) will be handling our account. Therefore, we will all be issued new cards with new contact information. 

We'll be explaining all this and more during our open-enrollment meetings in November. Please plan to attend. As always, spouses are welcome. 

Thursday, September 25, 2014

Flu Shot Clinic at ASHA October 8

If 92% of our staff are vaccinated, we could basically stop the spread of the flu within our workplace. Please consider getting a flu shot to protect yourself and those around you. 

Our clinic will be held on October 8 from 10:00 - 1:00. Shots for staff members are free and come complete with a Tootsie Pop. Family members can receive a shot for $26. This flyer from LifeWork Strategies explains what you should expect.

If you have coverage through our health plan, you have additional options for obtaining a flu vaccination for free. Please see the second flyer below.

Sunday, September 21, 2014

How to Be the CEO of Your Health

Rources for Empowered Patients

Last week, we had the good fortune of having Dr. Michelle Gourdine come talk to the ASHA staff. She delivered a presentation titled You're the Boss: How to be the CEO of Your Health. Dr. Gourdine is a physician and CEO of Michelle Gourdine and Associates. She is a Clinical Assistant Professor in the Departments of Epidemiology and Preventive Medicine and Pediatrics at the University of Maryland School of Medicine, and a Senior Associate in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. She served as Deputy Secretary for Public Health Services for the Maryland Department of Health and Mental Hygiene (DHMH) from 2005 - 2008. So, she knows both the medical and policy sides of health care. She is a nationally-sought-after speaker and author of the book, Reclaiming Our Health:  A Guide to African American Wellness. We have a few copies in HR if you're interested in checking it out.

She began by showing us slides that demonstrate how we spend too much on healthcare in the US and get results that pale in comparison to other countries. (The one to the left was my favorite.) She pointed out that chronic disease is driving a lot of our spending and that there is an inverse relationship to what we spend to improve our health and what really makes us healthier. She stressed that 90% of Type 2 diabetes, 80% of heart disease and 60% of all cancers can be prevented by basic healthy lifestyle choices. People manage their health through day-to-day decisions. She suggested we start by asking ourselves these questions.

She shared some practical approaches for accomplishing each and added a 5.1 How well am I managing my stress? She also mentioned the importance getting 7 to 9 hours of sleep each night. You can see her recommendations by flipping through the slide show below. I also recommend reading Eat, Move, Sleep by Tom Rath. It's full of compelling reasons to do all of the above and practical tips that will improve your health.

Dr. Gourdine moved on with tips to help us get the most out of relationship with our doctors. She recommended that we ask these five questions any time a doctor recommends that we take a medication or have a test or procedure.

She explained when seeking a second opinion is valuable and outlined which screenings she recommends. It seems these recommendations are changing all the time and I was grateful that she outlined everything clearly. She cautioned against chasing test results rather than treating a patient and cited The $50,000 Physical that was in JAMA last June as a cautionary tale. 

Here are her screening recommendations:
  • Blood pressure check every 2 years…more frequent if high 
  • Cholesterol test every 5 years 
  • Diabetes test every 3 years 
  • Colonoscopy every 10 years starting at age 50 
  • Dental exam and cleaning yearly 
  • Eye exam every 1 to 3 years 
  • Height, weight, BMI every year or 2 
  • Flu shot yearly 
  • Tetanus booster every 10 years 
  • Prostate cancer screening and PSA -- Discuss with provider starting at age 50…age 45 if African American 
  • Annual lung cancer screening (low dose CT scan) for smokers 55 – 80 with: 30 pack year smoking history AND currently smoke or have quit within past 15 years
  • Mammogram every 2 years starting at age 50
  • Pap smear (and HPV) -- Every 3 years starting at age 21 and every 5 years starting at age 40
She also shared 5 resources for empowered patients:
  1. choosingwisely.org
  2. costhelper.com
  3. mayoclinic.com
  4. webmd.com
  5. nlm.nih.gov
Again, I recommend flipping through the presentation and don't forget to mark your calendar for October 16 at 1:00 when Dr. Gourdine will be back. She'll be talking to us about where to seek care.