How to Find the Right Doctor

The majority of the content in this blog post is from Trig’s Healthcare Navigation Module 8: Selecting a Healthcare Professional.

couple with doctor

Finding the right doctor can be a difficult task. Not only do you want a provider who’s in your area, in your insurance network and in your price range, but you also want to feel comfortable with them and feel confident that they are meeting your needs and wishes. This is a tall order, but it can be done.

Many people don’t take the time to search for the right doctor – or don’t know how – and end up going to see whichever doctor is available. This isn’t a good plan, either, because you’ll want a doctor with whom you can develop a relationship and establish trust. Whether you’re seeking a general practitioner or a specialist, if you’re entrusting your health to this person, you should probably make sure they’re the right fit by doing your research and meeting with them ahead of time.

Here are some steps to follow to find the right doctor for you:

  1. Research your condition
  2. Search for doctors in your area and insurance network
  3. Research quality
  4. Set up an informational consultation
  5. Make a decision
  6. Ensure you are getting good quality care

Step 1: Research Your Condition

Before you even schedule an appointment, it’s a good idea to conduct some simple research on your own to learn more about your condition and symptoms using resources like WebMDthe Mayo Clinicthe National Cancer Institute and the National Institutes of Health. Doing your own research may help you understand and answer your doctor’s questions more completely when you go in. However, beware of diagnosing yourself based solely on your web research; visiting a healthcare professional is always the best way to receive an accurate diagnosis.

Step 2: Search for Doctors in Your Area and Insurance Network

Oftentimes, the best place to start your search is your insurance company’s website. Most insurance companies have online provider directories that allow you to search for in-network physicians or facilities by zip code, specialty, etc. Trig members can use our Provider Search for quick access to these directories.

Step 3: Research Quality

Once you have narrowed down your list of potential doctors, you should research each of them to find out the following information:

  • Certifications
  • Years practicing (experience)
  • Specialties
  • Reviews/ratings
  • Complaints from patients

Some of this information you can get from your insurance company’s directory, but some of it you may have to get elsewhere. You can contact your state’s Board of Medical Practice to find out if any complaints have been filed against a doctor. Certificationmatters.org has a search feature that allows you to find out if a doctor/specialist is certified by the American Board of Medical Specialties. And you can access reviews and/or ratings of healthcare professionals on the following sites:

Step 4: Set Up an Informational Consultation

After conducting your research, set up an informational consultation with a doctor (or doctors) you are interested in. You can do this by calling the the physician’s office and setting up the consultation over the phone. During your appointment, be sure to do the following:

  • Confirm that they are covered by your insurance.
  • Ask questions about their experience.
  • Assess your comfort level.
  • Ask how they expect your treatment plan to work (if applicable).
  • Ask if you can contact them after hours when needed.

You should also ask yourself the following questions after the appointment to determine whether or not the doctor is a good fit:

  • Do I trust this person? Do I feel respected and heard?
  • Does the doctor explain critical information clearly so that I understand it?
  • Are the facilities up to my standards, and are they located a convenient distance from my home?

Step 5: Make a Decision

Once you’ve gone through steps 1-4, it’s time to choose a doctor. Remember that ultimately you’ll want to select a doctor or specialist that you feel comfortable with. Trust your instincts when you make your decision.

Step 6: Ensure You are Getting Good Quality Care 

You want your healthcare providers to be skilled and knowledgeable, of course. But that’s not enough – they should also be good at communicating with you. Do they listen carefully and explain things in a way that you can understand? Do they take your values and preferences into account and involve you in making decisions that affect your health? Do they spend enough time with you and make you feel comfortable about asking questions?

If the answer to these questions is ‘no,’ perhaps you should reevaluate your decision. If the doctor you choose doesn’t turn out to be a good fit, don’t be afraid to change doctors. Your health matters too much for you to stay with a provider who isn’t meeting your needs.

For more information about finding the right doctor or specialist, Trig members can read or watch Healthcare Navigation Module 8: Selecting a Healthcare Professional. 

Additional Resources:

Image Credit: Rhoda Baer

Circuit Training: 30-Minute Workouts You Can Do at Home

The following is a guest post by Nancy Biber. Nancy is a certified personal trainer and is the Quality Assurance Specialist for Trig.

As George Washington once said, “He that is good for making excuses is seldom good at anything else.”

For 20+ years I worked in a gym, so I really had no excuse not to get my workouts in. Since joining the “desk job” work force, I’ve had to get a little more creative. I don’t always have time to get to the gym, and I definitely don’t have all day to work out. That’s why I’ve started doing circuit training. It’s easy to find 30 minutes in my day to work out, and these short workouts pack a punch. Now I lead circuit training classes at the Trig office at least twice a week and fill in other workouts with running, Zumba class and/or Yoga.

Circuit training is a form of high-intensity interval training that combines multiple small workouts into one comprehensive session. The combination of weight training and cardiovascular effort makes circuit training a beneficial type of cross-training and a great way to burn calories. You’ll gain muscle through the resistance training, and you’ll increase your cardiovascular endurance through the elevated heart rate that you maintain throughout the program. You’ll also burn lots of calories during the high exertion periods of your sets - on average, a person weighing 150 pounds will burn about 10 calories per minute. For a 30-minute circuit training workout, that’s 300 calories burned! 

I’ve listed two of my favorite 30-minute circuit training workouts below. The great thing about these workouts (in addition to being short) is that you can do them at home! You don’t have to have a gym membership or much equipment to do these exercises.

Workout #1: Ladder Training

The idea of ladder training is to gradually increase the amount of reps you do up to a certain number, and then count back down again to 1. For this workout, start by doing one rep of each exercise listed below, then do two reps of each exercise, then three, and so on until you reach 10 reps per exercise. Then count back down to 9 reps per exercise, 8 reps, and so on all the way back down to 1.

Refer to the photos and their corresponding descriptions below.

circuit training workout 1

  1. Two-legged squat: Start in a standing position with your feet shoulder-width apart. Squat down as if you’re sitting on an invisible chair – move the hips back and bend the knees and hips to 90 degrees, then return to the upright position. Keep your back straight.
  2. Push-ups: You can do these on the floor (regular, or modified with your knees touching the ground), against the wall (stand facing the wall and push against the wall), on an elevated platform (such as a desk) or using an exercise ball (with your legs balanced on the ball and your hands on the floor). The standard floor push-up is the most challenging of these.
  3. Abdominal crunch: To isolate your abdominal muscles, lie on your back with your knees slightly bent. Make sure your feet are planted firmly on the floor and about hip-width apart. Keep your knees comfortably apart. Fold your arms on your chest or cradle your head/neck and tighten your abdominal muscles. Raise your head and shoulders off of the floor. Hold for three seconds and lower yourself back down.
  4. Standing lunges: Step back into the lunge. Keep your back straight and keep your knees behind your toes as you lower to a 90 degree bend at your hips and knees. Alternate legs.
  5. Tricep dips: Start on all fours with your stomach facing up. Keep your back straight and your elbows in, finger tips facing forward. Lower yourself with your arms and then life back up. Make it easier or harder by placing your feet closer to your body (easier) or further from your body (harder).
  6. Single-leg squat: Start by standing with your feet shoulder-width apart. Completely lift one leg or raise one foot so just the toe touches the floor. Lower into squat position and keep the one leg/foot raised. Alternate legs.
  7. Burpee: Begin in a standing position. Drop down into a full squat with your hands touching the ground. Kick your feet back into plank position, keeping your elbows extended. Then jump your feet back to squat and jump back up into the standing position. 
  8. Superman lifts: Lie face down on your stomach with arms and legs extended. Keep your neck in a neutral position. With your arms and legs straight (but not locked) and torso stationary, simultaneously lift all of your arms and legs up toward the ceiling to form an elongated “u” shape with your body — the back arches, and your arms and legs lift several inches off the floor. Hold for 2-5 seconds and lower back down.
  9. Side plank, each side: Lay on your side so that only your forearm and the side of your foot are touching the ground. Make your body into a straight line (side plank position). Bend at the waist and lower your hip towards the ground and then back up again. Repeat for the desired amount of repetitions and then switch sides.

Workout #2: 1-Minute Reps

For this routine, you will need a stop watch and a pair of dumbbells or soup cans.  Perform each exercise for 1 minute. After you’ve finished all 9 exercises, do 1 minute of cardio – run in place, do jumping jacks or run up and down stairs. Repeat the entire set 2 more times for 30 minutes of activity.

Refer to the photos and their corresponding descriptions below.

circuit training workout 2

  1. Plank: Hold yourself up in plank position with only your forearms and toes touching the mat. Keep your body in a straight line from head to heels (avoiding hip sag), and keep your abdominals tight for the duration.
  2. Plie squat jump: Stand with your legs about two feet apart, toes turned out. Bend your knees and squat down until your thighs are parallel to the floor. Then jump off the ground, bringing your feet to hip-width apart and land softly on your toes. 
  3. Rows: Hold one dumbbell in each hand. From standing position, bend over at the hips, keeping your back straight and parallel and a slight bend in your knees. Be sure your elbows stay at your sides as you raise your elbows to the ceiling and lower the weight back down.
  4. Bridge: Lay on your back with your hands by your sides, your knees bent and feet flat on the floor. Make sure your feet are under your knees – you should be able to touch your heel with your fingers. Tighten your abdominal and butt muscles, and raise your hips up to create a straight line from your knees to shoulders. Squeeze your core and try to pull your belly button back toward your spine.  The goal is to maintain a straight line from your shoulders to your knees and hold for 20-30 seconds.
  5. Mountain climbers: Begin in a push-up position on the hands and toes. Bring the right knee into the chest toward the left shoulder and resting the right foot on the floor. Jump up and switch feet in the air, bringing the left knee in and the right leg back. You can also run the knees in and out without touching the toes to the floor.
  6. Shoulder press with bicep curl: Hold a dumbbell in your right hand. Keep your back straight and your abdominals tight. Do a bicep curl and then raise the dumbbell to the ceiling for a shoulder press before lowering back down. Maintain a slight bend in your elbows at the top of each repetition, about 90 degrees when you lower the weight. Keep your elbows close to your body and turn your palm inward as you lower the weight toward the floor, then squeeze the biceps as you lift the weight back up and press overhead. After 30 seconds, switch to your left hand.
  7. Skater lunges: Cross your right leg behind your left leg as you bend your left knee into a half-squat position. Extend your left arm out to the side, and swing your right arm across your hips. Hop a few feet directly to the right, switching the position of your legs and arms, and bend down. Keep repeating side to side for 1 minute.
  8. Side bends: Hold a pair of dumbbells at your sides, arms straight and core engaged. Without twisting your upper body, slowly bend to the left as far as you can, lowering the weight toward your left knee. Pause, and then slowly return to an upright position. Repeat, bending to the right side.
  9. Wall sit with goal post arms: Squat with your back against a wall – form a right angle at your hips and your knees, your back flat against the wall and your heels on the ground. Extend your arms out to your sides at shoulder height, elbows bent 90 degrees, palms facing forward. The back of your arms should be touching the wall. To make this more challenging, slowly move your arms up the wall. 

Remember: due to the lack of rest that circuit training demands, you will maintain elevated heart rates for the entire period of exercise. If you have a history or family history of heart issues, make sure you talk to your doctor before starting a new physical activity program.

Good luck, and happy exercising!

– Nancy

Shopping for Medical Services: A How-To Guide

surgeons operatingIn a recent article on The Atlantic, Dr. Helen Ouyang discusses the difficulty she experienced as a patient in the healthcare system. Even with all of her “insider knowledge,” she still had trouble finding the right doctor and understanding how pricing worked. This is becoming an increasingly common issue as high-deductible, self-pay and other insurance plans with high out-of-pocket costs become the norm. We are expected to make our own decisions about our healthcare, and yet we have no idea where to start or how to get the best value for our dollar.

This post is meant to be a “how-to” guide to shopping for medical services. We’ll address some important questions, offer tips and list some helpful websites to use for comparison shopping.

Why is it important to shop around for medical services?

1. Healthcare is a commodity, and you are a consumer.

Do you buy the first house you see because your realtor recommends it? Do you buy the first car the salesman points to? Do you send your children to whichever daycare is closest to your house? Of course not. You don’t make blind decisions about other large purchases, nor do you entrust the lives of your loved ones to just anyone, so why would you do the same with the most important and often the most expensive commodity you’ll buy?

The main incentive for shopping around first is to ensure that you’re doing everything you can to get the best possible medical care for the best possible price.

2. Prices are not the same everywhere.

Prices can vary drastically for the same test, procedure or service at different locations. Here’s an example: in a recent Wall Street Journal article entitled “How to Bring the Price of Health Care Into the Open,” five hospitals in the greater Los Angeles area were profiled on the prices they charge for certain treatments. Amongst these hospitals – which are all within a few miles of each other – the cost of treating a brain hemorrhage ranges from $31,668 to $178,435. That’s a cost difference of $146,767 between two different hospitals in the same zip code for the same treatment.

It’s up to you to educate yourself about the cost of your medical services and find the best value.

When should I shop around for medical services?

  • Less complex services or situations: When services are less complex, comparison shopping will be more effective because you have a better idea of exactly what you are shopping for. Less complex situations also require less customization of care. When services are more complex, it’s harder to find useful price quotes without substantial costs in time, money and treatment delay. Examples of less complex services include: dental cleanings, preventive care (screenings, immunizations etc.), prescription medications and standard tests or procedures.
  • No Urgency or Emergency: Shopping around is easier in situations where you have time to consider price and quality. A good example of this would be any procedure or test that is scheduled in advance, such as a hip replacement surgery. This allows you time to go home and do your research before scheduling the appointment. Examples of urgent situations would be any type of emergency medical situation that requires immediate action, such as a heart attack. However, you can still plan ahead for emergencies by choosing the hospital you want to go to and outlining your medical wishes in an advance directive or similar document.
  • Diagnosis is Given: Price shopping is more effective when you have a diagnosis and treatment plan from your doctor, because you know exactly which services you need and can then compare prices for those services at various locations.
  • High Out-of-Pocket Costs: The more you have to pay out of pocket, the more time you should spend shopping around to try and save yourself money.

What do I do when my doctor recommends a medical service?

Here are some rules of thumb to follow:

  1. First, ask yourself if you’re comfortable with your doctor’s diagnosis and/or recommendations. If not, consider getting a second opinion from a different doctor before moving forward with the recommended test, treatment or procedure.
  2. For smaller services (e.g. lab tests, x-rays and other “protocol” services) – ask your doctor why the test or service is necessary and what will happen if you choose not to have the service done. You can also ask what it will cost.
  3. For larger outpatient services (e.g. surgery, MRI, etc.) – don’t feel pressure to schedule these right away with your provider, even if they ask. If it’s not an urgent situation, you can go home and comparison shop first to find the best value, which may not be at your current clinic or hospital.

girl using laptop

How do I shop around for medical services?

  • Check With Your Insurer: Some insurance companies post provider prices on their websites. This allows you to compare prices among network providers for the tests, treatments and other services they offer. See below for links to this search feature on some major insurance company websites.
  • Search the Web:
    • HealthInReach.com: Search by specialty and location for a list of providers in your area and their prices.
    • HealthcareBlueBook.com: This site compiles prices paid for specific treatments and procedures by zip code and lists a range of fair prices. You can use these as a starting point for negotiations.
    • MediBid.com: This is an online marketplace for patients to request bids from physicians in their area based on their medical needs.
    • OkCoPay.com: Search for doctors by location and medical specialty to view and compare prices.
  • Browse State Data: Many states require hospitals to make their prices public. When you’re researching hospitals, check your state government’s website for pricing information about the hospitals in your area. A few things to keep in mind, however:
    • Often, only the most expensive, non-discounted prices are listed.
    • Some states offer more information than others.
    • On most sites, the costs are not bundled, meaning they don’t include added fees in the listed price.
  • Talk to Your Doctor: Did you know that the prices for most medical services are negotiable? When you talk to your doctor about money, it can often lead to discounts. You should feel comfortable asking your doctor what a service will cost and if it’s possible to reduce the price. If your doctor doesn’t want to discuss money or can’t answer your questions, ask to talk with someone in charge of billing. This person will know the prices your doctor charges and can estimate what you will pay. Then you can do some comparison shopping and contact the billing person again to try and negotiate a better price.

Below are links to some of the major health insurance companies’ websites. These links will take you to their online provider directories or price comparison tools that you can use to find network doctors and facilities near you and possibly compare prices. Choose your insurer from the list to get started:

For more information about shopping for medical services, getting second opinions and understanding your treatment options, Trig members can watch or read Healthcare Navigation Module 6: Verifying My Illness and Module 7: Selecting Treatment Options. 

Sources:

Photo Credits: Phalinn Ooi, Ed Yourdon

Empowering the Healthcare Consumer

Couple smiling

With all of the past and current efforts to impact the health of individuals, organizations and communities and reduce healthcare costs, it should come as no surprise that there are differing opinions as to what works and what doesn’t.

Recently, RAND and PepsiCo released results of a study they conducted on Pepsi’s wellness program that contradicted what most of us have heard or assumed about the cost impact of wellness programs. The study states that while there are positive effects from wellness programs, “employers and policy makers should not take for granted that the lifestyle management components of such programs can reduce health care costs or even lead to net savings.” In other words, the ROI of wellness programs is still murky at best.

While I don’t want to get mired in this debate, it seems to me like it may be time to take the focus off of lifestyle management programs and place more of an emphasis on programs that will have a direct impact on costs — programs that train people on the healthcare system. While there is still intrinsic value in improving a population’s health, there is measurable, quantifiable value in teaching people how to use healthcare more effectively and empowering them to make their own decisions.

In other words, I believe in the power of the individual healthcare consumer. As consumers, we have the power to make a real and profound impact on the system as a whole. We can and should have a say in the quality, safety and cost of the medical care we receive. There are few other businesses or services in this country in which people don’t advocate for themselves or for others — whether that’s with their shoes (by walking out when needed) or their wallet (by making decisions based on cost). Right now healthcare is an exception to this rule, but it should not stay this way. People have a voice, and they deserve to be heard.

The design of the healthcare system is very complex, and this can lead to negative outcomes for patients whose care is not being managed properly. So far, the response to this issue has been to reform the system itself with a goal of quality improvement. There is nothing wrong with that approach, but it isn’t enough. I stand firmly on the side of the consumers and the important role they play. Instead of putting more pressure on overburdened healthcare providers, it is time to arm the individual consumer with the knowledge, skills and resources to make the most of every medical appointment, improve interactions with their providers and look to themselves to impact quality and cost whenever and wherever they can.

Let’s work together for better costs, better care and a better healthcare system.

Click here to learn more about Trig’s Healthcare Navigation services and membership options. You can also watch our YouTube video to learn about our vision to change healthcare, one person at a time.

Image Credit: Rhoda Baer, National Cancer Institute 

How to Organize Your Health Information

The majority of content in this post is borrowed from Trig’s Healthcare Navigation Module 4: Managing My Health Information.

medical charts

Most of us don’t give too much thought to our health information. Our doctors keep our medical records on file for us and update them whenever we come in. So we shouldn’t have to worry about it, right?

Wrong.

It’s very important for you to keep track of your own health information. Of course your records will be stored for you at the clinic or hospital, but what if you start seeing a new doctor or specialist? What if you are seeing multiple doctors? Or worse – what if your records are incorrect?

When you keep track of your own health information, you enhance your healthcare experience by providing your physicians with up-to-date information, learning more about your health and taking a more active role in your medical care.

In this post, we’ll cover ways for you to safely organize, store and keep track of your health information at home, starting with the information you’ll want to collect.

What information should I keep track of?
The items in bold represent information you should definitely include in your personal records:

  • Personal identification information (full name and birth date)
  • People to contact in case of an emergency
  • Names, addresses and phone numbers of your primary care physician, dentist and specialists
  • Your health insurance information (carrier name, policy number, etc.)
  • Living will, advance directives or medical power of attorney
  • Current medications and dosages
  • Allergies and drug sensitivities
  • Herbal medications, supplements, etc.
  • Organ donor authorization (if applicable)
  • Chronic or ongoing health issues (e.g. asthma, diabetes, etc.)
  • Your medical history with dates (e.g. major illnesses, surgeries, etc.)
  • Your immunizations and their dates
  • Family history and hereditary conditions present in your family
  • Results from your most recent physical exam
  • Important test results
  • Medical bills
  • EOBs (Explanation of Benefits) from your insurance
  • Opinions from specialists
  • Dietary practices (especially if they have impacted your health)
  • Dental/vision records
  • Current educational materials relating to your health
  • Other information you want to include relating to your health (e.g. exercise frequently, non-smoker, etc.)

How can I organize and store my health information safely?
You have a few different options when it comes to organizing and storing your health information, depending on your preference between paper and electronic records.

1. Paper Records (hard copies):
If you prefer storing hard copies of your medical records and information, you should keep it organized in a binder with dividers, an accordion file, or something similar. If you are organizing health information for your entire family, consider creating a separate binder/folder for each person in order to avoid mixing up information. It may be helpful to separate your information into the following categories:

  • Personal information and contacts
  • Current/ongoing conditions (e.g. asthma, diabetes, other chronic diseases)
  • Current medications and allergies
  • Past medical history and important test results
  • Family medical history
  • Bills and EOBs

Some of this information you will need to type up yourself, whereas some can be pulled from your medical records or other documents. If you have an official copy of your medical records from your doctor, be sure to store that here as well.

Tips for Safe Storage:
Your health information should be stored in a secure place that is easily accessible in case of emergency. These records contain personal confidential information and should therefore be treated like any other important paper document, such as a birth certificate or social security card. Records should be kept in a locked, fire-resistant file cabinet or safe, and you should decide carefully who has access to these documents.

HealthVault

2. Electronic Records:

a. Offline
You can store your records electronically by either saving them directly to your computer (in a folder) or on a CD or thumb drive. You may find it helpful to create sub-folders on your computer or device to help organize your information.

Tips for Safe Storage:
Make sure that any health information you store on a computer is password-protected and backed up on a hard drive in case the computer is broken, stolen or hacked. If you choose to load your records onto an electronic device (CD, thumb drive, hard drive, etc.), make sure to store the device in a secure location as you would paper records or other important documents.

b. Online (PHRs)
Websites that store your health information electronically are called Personal Health Records, or PHRs. You choose the information that goes in your PHR and you are responsible for managing it and keeping it updated. Some PHRs will also connect to your provider network and pull information from your doctor’s records. Some healthcare providers actually offer PHRs now in order to communicate directly with patients, show test results, remind about appointments, etc. If your provider doesn’t have a PHR, you can find one online. Here are a couple examples:

  • HealthVault: Microsoft HealthVault is a popular PHR website. It’s also available as an app you can download to your smartphone or tablet. It lets you store your health information (allergies, medications, insurance, etc.); your measurements (blood pressure, cholesterol, weight, etc.); trackers (dietary intake, exercise, sleep, etc.); and important contacts. It can also potentially pull your records directly from your doctors and pharmacy, if they are partnered with HealthVault.
  • iTriage: iTriage is a PHR website and app. It lets you store health information (“My iTriage”), symptoms, doctors, conditions, medications and procedures. It also provides information on healthcare facilities that are close to you. You can download iTriage from the App Store or Google Play.

Tips for Safe Storage:
If your health information is stored online – whether it’s through your provider, insurance company or other website/app – make sure that the site is secure and password-protected.

To learn more about medical records, Personal Health Records and your rights to your information, Trig members can read or watch Healthcare Navigation Module 4: Managing My Health Information.

If you’re interested in exploring or discussing topics like this, we invite you to check out our discussion forum, which is free and open to the public.

Additional PHR Resources:

Image Credits: Wikimedia Commons, Healthvault.com 

Do You Know Your Preventive Care Benefits?

The content in this post is borrowed from Trig’s Healthcare Navigation Module 5: Staying Healthy.

physical exam

As we begin the new year, now is the perfect time to review your preventive care benefits under your health insurance plan and schedule an appointment to go in and see your doctor. And here’s the good news: it should cost you nothing!

As of September 23, 2010, preventive care services provided in-network are required to be covered by most health insurance plans according to the provisions of the Affordable Care Act (ACA). This means that medical services classified as “preventive” (see below for examples) should be provided to you at NO COST from your doctor. You should not be charged at all for these services, even if you have a high deductible health plan and you haven’t met your deductible yet. Keep in mind that you must see an in-network provider in order for these services to be covered by your insurance; if you go out of network, you will likely be charged. Contact your insurance company or visit their website for a list of in-network providers in your area and to verify that certain preventive care services are covered under your plan.

The purpose for offering these services free of charge is to encourage you to go in for your preventive visits on a regular basis. This helps you:

  • Maintain your health
  • Get to know your healthcare provider to establish trust and open communication
  • Catch early warning signs of a possible serious illness or condition

Listed below are the preventive care services that are covered by all health plans on Healthcare.gov as well as most other health insurance policies, although the ages at which certain screenings are covered will vary between plans. Make sure to talk with your doctor to determine which of the screenings or services listed below are appropriate for you.

  • Abdominal aortic aneurysm screening for people who smoke or have ever smoked
  • Alcohol abuse screenings and counseling
  • Aspirin use in men and women
  • Blood pressure screenings in adults
  • Cholesterol screenings for adults in certain age ranges or at high risk
  • Colorectal cancer screenings for men and women over 50 years of age
  • Depression screenings in adults
  • Diet counseling for those who are at high risk for a variety of chronic conditions
  • HIV screenings for adults at high risk
  • Immunizations for adults:
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster
    • Human Papillomavirus (HPV)
    • Influenza (Flu)
    • Measles, Mumps, Rubella (MMR)
    • Meningococcal
    • Pneumococcal
    • Tetanus, Diptheria, Pertussis
    • Varicella
  • Obesity screenings and counseling
  • STI (sexually transmitted infections) prevention counseling
  • Syphilis screenings
  • Tobacco use screenings and cessation interventions
  • Type 2 diabetes screenings for men and women with high blood pressure

The following preventive services for women only should also be covered as of August 1, 2012:

  • Anemia screening for pregnant women
  • Breast cancer chemoprevention or chemotherapy counseling for women at high risk
  • Breastfeeding support and counseling
  • Cervical cancer screening for women who are sexually active
  • Chlamydia screening
  • Contraception (birth control)
  • Counseling for the BRCA (breast cancer) gene for those at high risk
  • Domestic violence screening and counseling
  • Folic acid supplements for women who might become pregnant
  • Gestational diabetes screening for pregnant women (24-28 weeks)
  • Gonorrhea screening
  • Hepatitis B screening for pregnant women as part of their first prenatal visits
  • HIV screening and counseling for sexually active women
  • HPV (Human Papillomavirus) DNA test every 3 years for women over 30
  • Mammograms every one to two years for women over 40
  • Osteoporosis screening for women over 60
  • Rh incompatibility screening for pregnant women
  • STI (sexually transmitted infections) counseling
  • Syphilis screening for pregnant and high-risk women
  • Tobacco use screening and interventions
  • Urinary tract or other infection screening for pregnant women
  • Well woman visits for women under 65 to get recommended services

Savvy Consumer Tip #1: Check with your health insurance provider before scheduling a preventive care visit with your doctor. Make sure the services or screenings you plan to get are covered under your plan, and if not, find out how much they will cost you. Also, don’t be afraid to ask why a service isn’t covered. The solution might be as simple as scheduling with a different doctor. Click here to learn about plans that are not required to offer free preventive care.

Savvy Consumer Tip #2: Keep in mind that preventive care coverage only extends to the services and screenings listed above, even if your health plan was purchased through an exchange. If you ask a question about a separate issue during your physical exam, for example, you may be charged a co-payment or other fee since the appointment is no longer classified as “preventive.” Please don’t let this discourage you from asking important questions, but you can consider scheduling a separate appointment to discuss your concerns with your doctor if they are not urgent.

Savvy Consumer Tip #3: After completing a screening or test, make sure to ask your doctor how and when you can expect to receive your results. Some test results are immediate, whereas others may take a few days to process. You should also ask your doctor how to get in touch with him/her to discuss your results once you have them. It’s important for you to understand what your results mean and find out what your next steps should be.

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To learn more about preventive care and other general health tips, Trig members can read or watch Healthcare Navigation Module 5: Staying Healthy.

If you’re interested in exploring or discussing topics like this, we invite you to check out our discussion forum, which is free and open to the public.

Additional Resources:

Image Credit: University of Michigan MSIS

Five Tips for a Healthy Holiday Season

The following is a guest post by Nancy Biber. Nancy is a Quality Assurance Specialist with Trig and a certified personal trainer.

Holiday houseI have worked in the health and fitness industry over the course of about 20-something Decembers. Managing your weight during this time of year is difficult, but it can certainly be done. Here are the best tips I have learned from those who have done it successfully year after year:

  1. If maintaining your weight over the holidays is important to you, start by asking yourself why. That reason better hold up against all your favorite holiday goodies. The best motivators I have found from successful maintainers are those that are health-related versus those that are vanity-related (e.g. get off my blood pressure medication versus fitting into last year’s holiday attire). Dig deep to find what will motivate you not to let the scale creep up in December.
  2. Remember this is not the last time you will ever get to eat your favorite holiday treats, whether it’s Christmas cookies, chocolate Hanukkah gelt or HoneyBaked Ham. Rate the typical holiday foods you’ll encounter on a scale of 1-10, with 10 being the best and 1 being the worst. If you want to treat yourself without overdoing it, try sticking just to the foods you rank high (9 or 10) on this scale. Then practice mindful eating behaviors — savor every bite, chew slowly, take in the aroma and truly enjoy quality over quantity.
  3. Don’t arrive at holiday gatherings famished. Eat a small snack before you go. You don’t have to be hungry to eat homemade desserts, but if you are hungry, controlling your portions will be much more difficult. Drink a full glass of water before you go and alternate water with holiday beverages throughout the event.
  4. Holidays are a stressful time, and physical activity can be one of the best ways to combat stress. Dance around the house to your favorite holiday music classics, sign up for a holiday walk/run event and train for it throughout the month or take a yoga class to help quiet your mind during this busy time. You will feel better both physically and mentally.
  5. Finally, remember what this time is truly about. Focus on being together with your friends and family, and take the focus off of the food. Use the buddy system to remain accountable throughout the month for both your diet and your physical activity. And keep this in mind: “When you feel like quitting, go back to #1 and remember why you started.”

Good luck to you, and enjoy the holiday season!

Now tell us: what are your healthy holiday goals? Share them with us in the comment section below.

– Nancy

Photo Credit: dfbphotos, Flickr.com

Announcing: New Partnership with MVNA

MVNA logoWe are very excited to announce a new partnership with MVNA! MVNA is a non-profit health and human service provider in the Twin Cities and surrounding areas that has been caring for the community since 1902. For over a century, MVNA has used its compassion and ingenuity to profoundly impact the health and independence of individuals, families and communities. Among their many programs and services, MVNA is one of the premier providers of flu shots and nurse-led biometric screenings for employers.

This partnership has been created with the purpose of educating more people about healthcare, providing expanded access to clinical services and improving the health and well-being of the people of Minnesota. According to Jen Van Liew, CEO of MVNA, “The work we do cannot be done in a silo; it requires every one of us.”

Though it’s rare to see non-profit and for-profit companies working in collaboration, Trig and MVNA share a common vision of raising awareness, enhancing the community and ultimately, saving lives. In addition, both companies truly believe that we are better together than apart. Not only do our services complement each other, but by working in collaboration, we’re actually able to offer our clients a more robust and integrated strategy for health and wellness that is unlike anything else in the market today.

MVNA’s wellness services include:

  • Flu/immunization clinics
  • Health screenings
  • CPR, AED and first aid training

These wellness services – all of which are provided by registered nurses – offer important preventive measures and assessments that identify potential health issues. But instead of leaving it there, Trig will then step in and design a customized strategy for the client to resolve or prevent these issues through training, consulting and onsite programming. In essence, MVNA will get people to start asking questions and thinking differently, and Trig will get people to start behaving differently. Both elements of the process are necessary in order to start seeing real change in a population as well as in the healthcare system as a whole. Mick Hawton, Vice President of Business Development & Operations for Trig, sums it up: “Put simply: if we’re saving lives, then we’re succeeding.”

To learn more about MVNA, visit their website at www.mvna.org.

Your Questions Answered: MNsure & Health Exchanges

The enrollment period begins today for the health exchanges, or insurance marketplaces, that have been created in conjunction with the Affordable Care Act (ACA). The enrollment period for the exchanges will last through March 31st. All Americans are required to have health insurance coverage by January 1, 2014, but ACA officials have said that those who get coverage by April 1 will not face a penalty. Minnesota is one of 16 U.S. states that opted to create and operate a state-run exchange — called MNsure — as opposed to “defaulting” to a federal-run exchange.

The exchanges are confusing to many of us — businesses included — so I decided to sit down with a couple experts to try and get some answers about the exchanges in general and MNsure in particular. I spoke with Mick Hawton, Vice President of Operations here at Trig Life Services, and Al Hofstede, Vice President of Sales and Consulting at Corporate Health Systems (CHS). CHS is a benefits administration and consulting firm that has been in business for over 25 years. These are their responses.

ACA health exchanges

General exchange questions

Q: What are the health exchanges?

The health exchange is a new marketplace through which small businesses and individuals can find and purchase health insurance plans.

Q: Who runs the exchanges?

That depends. In some states, it’s the federal government (Affordable Care Act). In states with their own exchanges, it is typically run by the state’s Department of Commerce. Some insurance carriers have also set up their own private exchanges separate from the state and federal exchanges.

Q: What will be the biggest change that individuals can expect with the start of these exchanges?

Rates and plans are expected to change. Rates may go up or down and the benefits offered within the plans may change. Also, individuals will see an expanded number of choices for plans, whereas small businesses may see fewer options.

Q: Who stands to benefit most from the exchanges?

The people who will benefit most from the exchanges are the uninsured and “uninsurable,” (unhealthy, in other words) who will gain access to a market to purchase health coverage without facing rejection for pre-existing conditions. In Minnesota, specifically, this will cause some changes to existing programs. For example, the MCHA (Minnesota Comprehensive Health Association) was a pool of uninsured Minnesotans that most people either didn’t know existed, didn’t know how to access or perceived to be unaffordable. MCHA is being phased out and replaced by MNsure. Minnesota General Assistance Medical Care is another public program that will be replaced by MNsure.

Q: Who is most likely to participate in the exchanges?

Small business owners who don’t offer coverage to their employees and individuals without health coverage.

Q: Who is the target market for the exchanges?

The young and healthy. If they enroll, they will help stabilize the premiums for coverage in the exchange by supporting the high claims from the unhealthy.

Q: What factors will cause the exchanges to be successful?

If the young and healthy sign up and pay premiums. This allows the insurance companies to have stable (though not necessarily low) rates.

Q: What factors will cause the exchanges to be unsuccessful?

The young and healthy DON’T sign up or the carrier rates were set too low at the beginning and don’t cover the cost of claims. If rates are set too low, insurance carriers may increase their rates too rapidly over time (making the exchange unaffordable) or even drop out of the exchange altogether.

Q: What do you think will happen if the exchanges don’t hit their expected numbers?

Potentially, “the sky falls,” to put it simply and dramatically. And if the sky falls, then the sky’s also the limit on cost shifting options that may come into play to keep the exchange viable and running. In other words, the funding to the exchanges could be shifted elsewhere. However, programs that were eliminated for the exchange (such as MCHA in Minnesota) can’t just be started back up, so there is a potential for a real loss to long-standing safety nets.

Q: A recent Gallup poll revealed that 2 out of 3 uninsured Americans plan to purchase insurance, but less than half of those plan to use the exchange to do so. Why do you think that is?

It shows a potential lack of trust in the exchange program and possibly the Affordable Care Act in general. However, there are some people who simply prefer to purchase their insurance directly from insurance companies still (and insurance companies prefer that, too).

Q: How integral are the exchanges to the overall success of the Affordable Care Act?

In the political sense, if the exchanges fail, it would be a big blow to the public view of the ACA and would give ammunition to those who would like to see the law repealed or changed drastically. In a  more literal sense, the success of the exchanges is critical to the perceived overall success of the Affordable Care Act because part of the law’s success will be measured by how many people gain access to health coverage who were either uninsured or didn’t have access to it previously.

Q: How will the exchange impact employers (small businesses & large businesses)?

Small businesses (less than 50 full-time equivalents) have the option to purchase a group plan through the exchange (or directly from an insurance carrier) or dissolve their plan entirely; they are not required to provide coverage to employees and will not be charged penalties.

Large businesses, on the other hand, are required to provide coverage to employees working 30 or more hours per week. Right now, their only penalty-free option is to continue their current coverage. If they dissolve their plan, offer a plan that is considered “unaffordable” or offer a plan below the minimum value outlined in the Affordable Care Act, they will owe a penalty. Eventually, large businesses will also have the option to purchase plans through the exchange.

Q: How will MNsure and other exchanges impact employer-sponsored health coverage for employees?

Outside of the ACA imposing fees on employer-sponsored plans to support the law, employees may or may not see any changes to their benefits. There are significant opportunities for change at some point, but right now it depends on the size of the employer. Small businesses have the option to purchase health coverage through the exchange and may begin doing so. Large businesses don’t have this option and will likely continue their current coverage for the time-being.

Q: What are the conditions for a Qualified Health Plan (QHP) offered through the exchanges?

Qualified health plans have to include coverage for the essential health benefits and meet other requirements outlined in the Affordable Care Act (no exclusion for pre-existing conditions, preventive care coverage, etc.). Also, plans offered outside of exchanges have to be similar to plans offered through the exchanges.

MNsure logo

Questions about MNsure

Q: What is MNsure, and how is it different from other exchanges?

MNsure is a state-run exchange rather than a federal-run exchange or partnership. There are only 15 other states currently offering state-run exchanges. MNsure also has lower rates than the other exchanges.

Q: Who is coordinating MNsure?

MNsure staff, ACA staff, Minnesota Department of Commerce, insurance carriers, etc. MNsure staff handles the day-to-day operations.

Q: Why did Minnesota decide to create its own exchange rather than go through the federal exchange?

Minnesota has a long history of providing diverse health insurance options and being a thought leader in the healthcare industry. In many cases, Minnesota has opted to work on healthcare projects independently at the state level, sometimes before they were even happening at the federal level. So, it isn’t surprising to see Minnesota take an independent course to make decisions and plans in an effort to meet our state’s needs.

Q: What will be considered a “success” for MNsure?

If MNsure is funded appropriately in order to cover all claims and create stable rates starting in year one, that would definitely be considered a success for the program.

Q: What are the pros and cons of MNsure?

There are many perceived pros and cons, but it’s all conjecture at this point; time will tell how everything plays out. However, one “pro” that we can see for individual consumers is that MNsure provides them with a centralized location to view insurance options.

Q: How do individuals and employers access MNsure?

Through MNsure’s website (mnsure.org) or over the phone: 1-855-3MNSURE (1-855-366-7873).

Q: Are all possible insurance plans offered through MNsure?

No. Insurance carriers have the choice to participate or not. If a carrier submits their rates to the MN Department of Commerce and the DOC either rejects their plan rates or does not receive them by the deadline, that carrier is not allowed to participate in MNsure. On the other hand, some carriers have elected not to participate or are waiting to see how the exchange does before deciding whether or not to participate. The motivation for carriers to participate in the exchange is the potential for higher enrollment, but they do have to pay a percentage of the premiums they receive through the exchange back to MNsure.

Q: What is the role of the “navigator” with MNsure?

Navigators are access points or resources to help individuals and employers navigate their options in the exchange. They can’t make recommendations — only licensed agents can do that — but they are certified with MNsure and can answer questions about plans (eligibility, coverage etc.).

Q: What is the question you get asked the most from employers regarding MNsure?

“Is it really going to be cheaper and lower costs?” The answer to this really depends on the individual circumstances; there are multiple sources of funding that have to be considered in order to compare cost savings. Regardless, there are both short-term and long-term consequences for decisions that are made now, and we don’t yet know the future costs associated with MNsure.

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To learn more about MNsure or begin enrollment, go to mnsure.org. To learn more about the Affordable Care Act, visit their website at healthcare.gov. You can also use this helpful tool to determine your options and help you decide whether or not to enroll in an exchange.

If you’re an employer with 50 or more employees, we encourage you to attend an upcoming ACA seminar for large businesses on October 10th sponsored by Corporate Health Systems to learn more about how MNsure will impact your organization. Click here to register for this event on Trig’s website.

Photo sources: mn.gov, Wikimedia Commons