Saturday, January 13, 2018

The Successful Patient: The Importance of Continuity of Care


In Minnesota during the last year we've witnessed a major medical insurance company, Blue Cross Blue Shield of Minnesota, wrangle with a major provider of medical care for children, Children's Hospitals and Clinics of Minnesota, a highly respected medical facility known for treating the toughest cases. The dispute between the two was about money. This dispute resulted in them parting ways, leaving about 60,000 BCBS patients without in-network care. Of course, they could continue to go to Children's Hospitals and Clinics and to the same physicians, but they would be required to pay more because this provider is now out of network for BCBS. Parents of sick kids now must face exorbitant medical costs alone or change providers.

There are other excellent pediatric medical providers in Minnesota. That's not the point. What is at stake here is continuity of care.

What do I mean by continuity of care? Let's look at an example. I'll use my experience. During the last four years, I've had nearly as many medical insurance plans covering my medical expenses. Every time I've been forced to change plans, I've been very careful to make certain that all my doctors, clinics, and preferred hospital are in-network providers for the new medical insurance plan. I've been going to my primary doctor for about 20 years. She knows me, knows my medical history, and because she has that knowledge I don't have to explain my medical history every time I see her. She also knows the best way to treat any medical issue I might have, and also knows the best doctors to refer me to for a specialist. It is much the same with the specialists that I see -- I've been going to them for a significant amount of time and they know my body and my health status. Keeping all these doctors in-network provides me with continuity of care.

If I were to be forced to change my doctor because a medical insurance company has that doctor out of network, then I lose that doctor's knowledge about my body and my health. I lose continuity of care. There may be other perfectly competent doctors in network for the medical insurance company, but none of them have the knowledge about me, the experience with me, and my health that my doctor has. That kind of knowledge and experience saves time and money in the long run.

Medical insurance companies look at me as a "loss" because I have one or more chronic conditions and will be making more than one or two claims during the year, as well as buying more than one medication. Medical insurance companies really don't want me on their plans because from their perspective, my claims are lost money to their bottom line. And no matter whether a medical insurance company claims they are nonprofit or not, they are all in the business of making a profit.

Because medical insurance companies only consider the financial side, they don't give a hoot about continuity of care. Has your medical insurance company dropped medications from its formulary in favor of other medications that are cheaper? One of the things pharmacy benefit managers for insurance companies will do is require that a patient use the formulary medication to see if it will be effective (and they will save money). They do not make this "suggestion" after consulting with a patient's doctor to find out if the doctor concurs. They tell the patient and the patient's doctor that this is what they must do, effectively telling the doctor how to practice medicine (although insurance companies take care to state on their websites and in the printed materials that they do not practice medicine. The way they conduct business becomes, in effect, practicing medicine -- and without a license.).


Last year, for example, my medical insurance at the time dropped one of my medications from their formulary. I'd been taking the medication for 8 years and it had been extremely effective for the condition I had. Continuity of care would say that I should remain on that same medication and not make any changes. My doctor submitted a prior authorization request for that medication, call it Med A. The pharmacy benefit manager denied the request and the reason was that I had not tried Med B, used to treat the same condition and about $150 cheaper per month. So, my doctor prescribed Med B which had a step up dosage, i.e. I took 1 pill per day the first week, 2 pills per day the second week, 3 pills the third week, and the full dose of 4 pills the fourth week and every week thereafter.

Immediately on one pill per day, I experienced severe side effects: dizziness so bad I couldn't stand up for very long, nausea, balance issues, increased pulse rate, runny nose, and frequent urination. I missed a day of work as a result. The second day, the side effects had diminished but were still with me. I powered through. When I increased to 2 pills per day the second week, that's when the allergic reaction began on top of increased severity in the side effects: itchy throat, itchy bumps in my throat, sneezing, runny nose, and increasing fatigue. After 2 days the second week, I stopped taking the Med B pills, but the reaction continued with spikey fevers. I missed 3 days of work because of this reaction. It took another week for my body to return to normal.

So, I'd tried the Med B, the cheaper drug on the medical insurance formulary. My doctor submitted a new prior authorization request, describing my body's reaction to Med B. The pharmacy benefits manager denied that request, telling my doctor that I "had not taken Med B long enough." It would be another 3 months before I was able to return to taking Med A -- during that time I was dealing with the health condition also because I was not taking Med A -- because I changed medical insurance companies. The only reason the medical insurance company wanted me on Med B was because it was cheaper not that it might be a more effective treatment. In fact, as a result of the medical insurance company's actions and the pharmacy benefit manager's actions, they were essentially practicing medicine and prescribing a treatment for my health condition in order for them to save $150 a month. They totally destroyed continuity of care and they hurt me physically.

Money is no substitute for continuity of care whether that means keeping a medical provider or a medication. Medical insurance companies are walking a very thin line right now as they do everything they can to cut "losses" and increase their profits. The Affordable Care Act (Obamacare) is in trouble not because of the legislation itself but because insurance companies have worked in every way to undermine it. As I've said to friends, ignore medical insurance companies' advertising that claims they listen to their consumers and they're only thinking of the best way to save money and pay for effective treatment. They are not.  If they truly were, they would support and work to maintain continuity of care for consumers.

Sunday, December 24, 2017

Being a Survivor During the Holidays


Let's face it: this time of year in America can be horrible, sad, painful, and the pits for some people.  How do they survive all that Christmas music, wishes of "Merry Christmas!" and the pull of family? It's really no joke, folks. This can be an excruciating time of year for many different reasons. Maybe someone is facing the first Christmas after the death of a loved one. Maybe someone has survived childhood sexual abuse which intensified during the holidays when s/he was a child and those memories make this time of year extremely painful and depressing. Maybe someone no longer has family, or children, or is sick and stuck in the hospital.  For each person, the reason is real, personal, and needs to be respected by others (who may love the holidays).

For me, the holidays are depressing, especially this year because I just lost my job. I'm not in a celebratory or Christmas mood at all.  My friends, for the most part, know that the holidays are a tough time for me. The family that I have left now are scattered all over the place, and anyway, anything that feels like family for me during the holidays makes me anxious and depressed.  It was really never fun in my family around the holidays. Over the years, I've developed some strategies to get through this time with my good humor intact and keeping the depression from getting too deep. I especially enjoy confounding traditions and customs that I grew up with in my family.

Movies

I love movies, and this time of year usually sees a bonanza of new movies in theaters. I stay away from holiday-themed movies. Going to movies on Christmas Day has been a wonderful way to enjoy the day. This is something that would never have been allowed in my family when I was growing up.  But it's surprising how many other people are thinking the same thing and head off to the movie theater. I also enjoy going with friends during December. For example, last weekend a bunch of us went to see Star Wars: The Last Jedi and then went out for dinner afterward. Relaxing, fun, and the company and conversation were great.

Not Cooking or Baking

It often astounds me just how much food -- not all of it terribly healthy -- is available and consumed during the month of December, not to mention alcoholic beverages. I used to love Christmas cookies, fudge, candy, pies, and all the rest of the food traditional to the holiday. It was a big deal for my family when I was growing up. I remember watching my mother work so hard to get all the food made and not receive acknowledgement or appreciation from the men in the family. Then I went through a period in my life when I ate pizza for Christmas dinner and nothing else because it was easy and required little time. Now, I take this holiday season as an opportunity for thinking about what a gift it is to my body to take care of her with healthy food and exercise during the year and especially during the holidays.  After all, I have only one body and it's important to take care of her.

Music

I can take only so much Christmas music before I feel depression darkening my mind. It's not really the music itself that depresses me, but the memories around the songs, or feeling bombarded with the music everywhere without relief. I love music.  I grew up playing musical instruments (piano, French horn) and singing in choirs.  I really enjoy a superb performance of Handel's Messiah early in December, and then I'm done with Christmas music for the year. What do I listen to instead? I listen to a lot of J. S. Bach's instrumental music, symphonies by Bruckner, concertos, and movie soundtracks. Or silence. We fill up the air around us with so much sound, so many loud sounds, and it's so relaxing to just have silence. The video below is J. S. Bach's French Suites for piano.



Stay out of Stores

In high school, I began to realize that Christmas was the ultimate capitalist holiday. It's now "traditional" to shop for presents, spend a lot of money at this time of year. America is the consumer paradise -- buy, buy, buy.  Don't have the latest gadget? Better get it for Christmas!  Since I joined the ranks of the Working Poor, I've come to realize how little I need to own, and that doesn't include the latest gadget. I admire people who put a real cap on their spending at this time of year and emphasize instead getting together for fun activities. So, I stay away from stores as much as possible which isn't terribly difficult when I don't have the money to spend anyway!



Books

I love to read, and one of the most wonderful gifts I could give myself is an entire day of reading, from the time I get up until I go to bed at night. This strategy for Christmas Day isn't for everyone, I realize, but it's perfect for me. I pick a novel to read for Christmas Day and then I enjoy the quiet in my apartment building (many residents have left to visit family) as I immerse myself in a good story. Over the years I've varied this somewhat by making a special meal at mid-day, or going for a walk in the afternoon through the neighborhood, or reading only until evening then watching a DVD before bed.

Being alone during the holidays can be painful, especially if well-meaning friends and/or family hound you about it. If you enjoy being alone, enjoy solitude, tell them! I'm an introvert and really enjoy my solitude, especially balanced with occasionally spending time with friends.

Whatever you do for the holiday, I hope that it is your choice. Whatever strategies you have for getting through this crazy season, I hope that you enjoy them and survive the holidays with your sanity and good cheer intact.


Saturday, November 25, 2017

The Kindness of Strangers can Happen When you Least Expect It #WATWB

Vivian Leigh as Blanche DuBois (Image via Wikimedia Commons)
There is that famous moment in Tennessee William's play, A Streetcar Named Desire, when Blanche DuBois tells her gentleman caller that she has always relied on "the kindness of strangers." Blanche DuBois was a real piece of work, of course, and her motives were completely self-centered. But the line has always stuck in my mind, along with the notion that we really never know when we will need to rely on the kindness of strangers. And it's not unusual to not expect a stranger will be kind which makes stories of the kindness of strangers so powerful to me.

For the 9th installment of the We are the World Blogfest (#WATWB), I found a story that really exemplifies the blogfest's mission of being a light in the current darkness and drawing attention to human stories of love, peace, and compassion for others.

Kate McClure, a young woman driving outside of Philadelphia, found herself in the unhappy position of running out of gas on a highway. She managed to pull over to the side of the road, and was thinking about going in search of a gas station when a homeless man approached her car.
Johnny, who is a homeless veteran of the U.S. Marine Corps, asked McClure if she was okay.

“He saw me pull over and knew something was wrong,” says McClure. “He told me to get back in the car and lock the doors.”
What happened next made my jaw drop. Read the whole story here.  This young woman also did something in response that I found unusual and heartwarming.

Kate McClure and Johnny
If you'd like to read more stories of light, please visit the blogs of our wonderful hosts this month:

 Shilpa Garg, Inderpreet Uppal, Sylvia Stein, Susan Scott, Andrea Michaels and Damyanti Biswas

Or visit this page or the #WATWB Facebook page for links to even more blogs that share stories of light with the online world.  If you'd like to join the blogfest, you can sign up here.

Saturday, October 28, 2017

A Stranger's Generosity #WATWB

For the eighth installment of the We are the World Blogfest (#WATWB), I found myself drawn to a story of generosity from a stranger. Such acts of generosity always move me because a stranger is not expected to do much but the minimum in helping someone in need. Single Mom Naomi Pruitt of Columbus, Indiana, had a different experience with a stranger.



It began with a flat bicycle tire. Pruitt, who had contracted Lyme Disease and was on disability as a result, was riding her bike to the grocery store. Symptoms of Lyme Disease make it difficult to drive a car. On the way, her bike's tire blew out in front of a home and the homeowner happened to be just driving into his driveway. He asked if he could help her. She accepted his offer and rolled her bike into his garage where she spied a trek bike hanging on the wall.  She told the homeowner her story, and about her three sons, aged 13, 12, and 8. She asked if the trek bike might be for sale.  She wanted to buy her 12-year-old son a bike for his birthday.



From there, the homeowner, unbeknownst to Pruitt, organized a special surprise for all three of Pruitt's sons. To find out what happened, read the story of his generosity and the people who helped him here.

One of the details that struck me about this story was that the generous homeowner preferred to remain anonymous.  He gave simply to give and to help, not to gain some benefit for himself through publicity.  And the Columbus, Indiana, police were more than happy to step in and play a significant role in helping that homeowner give his gift. What a wonderful example of selflessness and love!

The We are the World Blogfest strives to bring light into our dark world through stories of human compassion, love, and kindness toward other humans and animals on earth. This month's installment is hosted by the following participant bloggers: Shilpa Garg, Sylvia McGrath, Mary Giese, Belinda Witzenhausen, and Guilie Castillo.  For more stories of light, visit their blogs or those listed here.

Saturday, September 30, 2017

A Positive Attitude Changes One Mind at a Time - #WATWB


Seven months of positive news! This is the seventh installment of We are the World Blogfest which was begun to counter the negative news that pervades the internet nowadays.  Peace, love, compassion, thinking positively, we are trying to spread all of this as light in a dark world. And there is love and light in our world! Our wonderful co-hosts for this month's installment are Michelle Wallace , Shilpa GargAndrea MichaelsPeter NenaEmerald Barnes. 

For my contribution this month, I'd like to share the story of how the positive thinking of an African-American parole officer changed a White Supremacist's way of thinking about the world and himself.

"I don't want my kids to live the life I lived and live in hate."
That's a powerful statement from Michael Kent, a former Neo-Nazi who was a member of a violent white supremacist group. How did he get there?

Enter Tiffany Whittier, a parole officer who was assigned to Kent.

Tiffany Whittier
Her simple, direct, and positive approach had a profound effect on Kent. They became friends, not just parole officer and ex-con.

To read their full story, click here.  I love these types of stories in which one individual has the power to change the thinking of someone else. There are times when it's hard to believe this is possible, but this story (any many others out there) demonstrates that it is. We each, as individuals, have the power to affect other people and the world around us, either by how we live our lives, what we say, or what we do.

Help spread the word about We are the World Blogfest on social media by using the hashtag #WATWB. And if you'd like to read more positive news, check out the list of participating bloggers here. Visit their blogs and comment on their stories. Re-blog or tell your friends and family about the stories you've read. Visit the #WATWB Facebook page, too. Spread the light and love.