A publication for the policyholders of the Arkansas Blue Cross and Blue Shield family of companies Autumn 09 • Read our CEO’s editorial about health care reform, Page 3 • Enroll now in one of our Medicare plans, Page 5 • Dr. David offers healthy eating tips, Page 16 Dan Peterson of Little Rock, Ark., is a survivor of pancreatic cancer. See his story on Page 6.
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A publication for the policyholders of the Arkansas
Blue Cross and Blue Shield family of companies
Autumn 09
• Read our CEO’s editorial about health care reform, Page 3
• Enroll now in one of our Medicare plans, Page 5
• Dr. David offers healthy eating tips, Page 16
Dan Peterson of Little Rock, Ark., is a survivor of pancreatic cancer. See his story on Page 6.
5 Medicare enrollment information
12 SilverSneakers adds to active lifestyle
19 Yarnell’s & Arkansas Blue Cross
Out of the Blue
Great options for members 65 and over
Beating the odds: Dan Peterson’s journey
with pancreatic cancer
Can Zicam damage your sense of smell?
Caffeine may reduce Alzheimer’s memory loss
Beware: Tanning beds cause cancer
Prepare for two flus this fall
SilverSneakers adds to active lifestyle
Prediabetes? Take the warning seriously!
Lose weight The Healthy Weigh!
Taking calcium supplements for weight loss?
What not to feed Junior
Senior Moments with Dr. David
Where does your health-care dollar go?
A sweet relationship:
Yarnell’s and Arkansas Blue Cross
From the Pharmacist —
Are you an unintentional drug dealer?
Curves offers discount to members
What is a formulary?
The Doctor’s Corner
Three benefits added to group DentalBlue plans
Mental Health Parity: What it means for you
Women’s Health and Cancer Rights Act
Blue & You Fitness Challengers win with
better health
Customer Service telephone numbers
Good for you
Vice President, Communications and Product Development: Karen RaleyEditor: Kelly Whitehorn — [email protected]: Gio Bruno Photographer: Chip BayerContributors: Chip Bayer, Matthew Creasman, Damona Fisher, Kristy Fleming, Jennifer Gordon, Trey Hankins, Heather Iacobacci-Miller, Ryan Kravitz, Kathy Luzietti and Mark Morehead
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Autumn 09
is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, health-care professionals and other persons interested in health care and wellness.
on Page 12
INSIDE
A special thank you to Stacy Harter, a University of Arkansas at Little Rock graduate student, who contributed the article on chiropractic medicine in the Summer 09 edition of Blue & You.
3
Blue & You Autumn 2009
Our stance on health care reformIn the ever-changing environment around health care
reform, there are a few constants. At Arkansas Blue
Cross and Blue Shield, our position on health care re-
form has not changed.
• We support health care reform. We believe chang-
ing our current system is important to Americans
individually and collectively. The rate of growth in
health-care costs today is not sustainable for the
long term. The impact of these costs on our na-
tion’s ability to compete in a global economy and
on hard-working Americans will be unbearable. We
believe so strongly in the need for change that we
will support responsible changes even if they require
that we as a health insurance company significantly
change the way we do business.
• We believe that every American should have ac-
cess to high-quality, affordable health care, and
that any reform enacted should address the problem
of the uninsured by providing financial assistance to
those who cannot afford coverage on their own.
• We believe that the most significant issue we
face in health care today is cost. To be success-
ful, any reform enacted must address cost as the
primary issue. It is cost that has created a situation
in which many Americans lack health coverage. It is
the cost of health care that makes our current sys-
tem unsustainable. We must first address the cost in
order to reform health care without bankrupting the
country in the process.
As an industry, we must be — and are — prepared to
make radical changes in the way we do business. One
much-maligned insurance company practice is denying
coverage or payment for those with pre-existing medi-
cal conditions. Early in the health-care discussions, our
industry pledged to support guaranteeing coverage for
everyone despite any pre-existing health condition
they might have. But to make this proposal affordable,
we must have laws that require everyone who can
afford it to purchase insurance and stiff penalties for
those who fail to do so. Without these laws, people
would not buy insurance until they got sick. And we all
know you don’t wait until after you’ve burned dinner to
turn off the oven.
But other changes are needed to make health care
Out of the
BlueA message from our CEO and President, Mark White
4
Blue & You Autumn 2009
available and affordable for all Americans. Remember
that the problem is the cost of health-care services,
which directly impacts your health insurance costs.
Health-care costs drive health insurance costs — not
the other way around. There are a number of reform ini-
tiatives that hold promise for addressing our cost prob-
lem. The most important has not been part of the public
debate. Payment reform is an important first step if we
are serious about controlling the cost of health care.
We must change how we pay health-care providers,
not necessarily how much we pay them. Today, doc-
tors, hospitals and other health-service
providers are paid for each service
they provide, even if that service isn’t
helpful or already has been done. This
method of payment is called “fee-for-
service.” In this environment, patients
often see specialists and undergo
many tests and procedures with no
one coordinating the care they receive
from one doctor to the next. We need
a system in which doctors and hospi-
tals are paid to treat a patient’s “medi-
cal episode” rather than each medical
service provided. An episode might be a hysterectomy
or a heart attack or any other condition for which a
patient might seek medical care. When we pay doctors
and hospitals to treat a patient’s medical episode, they
are incented to coordinate the care the patient receives,
avoid duplicate and unnecessary testing and provide
care that has been proven effective and necessary.
Another important initiative that will contribute to a
more efficient system is the expansion of health infor-
mation technology (IT) in the health-care delivery sys-
tem. This initiative already is included in many reform
proposals and is part of the American Recovery and
Reinvestment Act (ARRA) of 2009. We need a system
that links the health plan, the doctor, the hospital and
the patient together so that everyone has access to the
information they need to best treat each patient and get
their claims paid. This means when you see your doctor
or visit the emergency room, the physician or nurse
should be able to enter your name and other identifi-
able information in a computer and review your medical
records. This will help avoid delays in care and unneces-
sary tests, as well as give the health-care providers a
clear understanding of your medical history.
Let me give an example: your 80-year-old mother
goes to the emergency room and the doctor doesn’t
have any experience treating her. He
has no access to her medical records.
He may have to order more tests, pre-
scribe more medicines and take more
time trying to diagnosis the problem.
Some of these procedures are prob-
ably not necessary and may actually be
harmful. The doctor won’t know if the
same tests or procedures were con-
ducted just a few months before. He
could save time and money if he had
access to her medical history, and he
would be more effective in treating her
with the appropriate information at his fingertips. That is
the promise of improved health IT.
As you listen to all the discussion surrounding the
current health-care debate, I encourage you to keep
one question in mind. How will this particular proposal
or plan help control cost? Responsible health care
reform will build on our current employer-based system
in ways that make it more affordable. Will huge, new
government bureaucracies control costs? How about in-
creasing taxes or placing new demands on employers?
I hope that each of you will take the time to consider all
the proposals out there and make an educated decision
about what is best for you and those you love. That’s
the American way.
We need a system in which doctors and hospitals are
paid to treat a patient’s
“medical episode”
rather than each medical service
provided.
5
Blue & You Autumn 2009
GREAT OPTIONSfor members 65 and over
If you are eligible for Medicare, November 15 is an
important date to remember. From November 15 until
December 31, you can purchase a Part D prescription
drug plan or Medicare Advantage plan. You also can
change the plan you have. The federal government’s
Centers for Medicare and Medicaid Services (CMS)
calls this time period the Annual Election Period (AEP).
If you join a plan during the AEP, or make changes to
an existing plan, your new benefits will be effective
Jan. 1, 2010.
Medi-Pak Choice plans offer peace of mind
Arkansas Blue Cross and Blue Shield’s Medi-Pak
Choice plans provide the same affordability, conve-
nience and peace of mind you’ve come to expect
from us.
For 2010, Arkansas Blue Cross will offer:
• ThreeMedi-Pak Rx Prescription Drug Plans (PDP)
with competitively priced monthly premiums – Basic
at $25.90, Classic at $57.20 and Premier at $86.50.
Our Medi-Pak Rx (PDP) plans cover all Medicare-
approved generic drugs plus an extensive list of
brand-name prescription drugs. In addition, more
than 95 percent of the pharmacies in Arkansas are in
our network.
• $0premiumsforMedi-Pak Advantage MA-PD
Private Fee-for-Service (PFFS) plans (includes drug
coverage) in 27 counties and affordable premiums
in all Arkansas counties. Medi-Pak Advantage MA-
PD (PFFS) plans are Medicare PFFS plans, which
combine all the benefits of original Medicare (Part A
hospital and Part B medical) with valuable extras.
Beginning Jan. 1, 2010, our Medi-Pak Advan-
tage (PFFS) customers have a great new benefit!
Arkansas Blue Cross has contracted with more than
6,000 doctors and hospitals all over the state that
have agreed to accept our Medi-Pak Advantage
members as valued patients. No more searching for
a doctor who will accept your health plan. You will
know in advance the doctors and hospitals that will
accept your plan. And when you use these doctors
and hospitals, you’ll have lower out-of-pocket costs.
Plus, our Medi-Pak Advantage members will contin-
ue to receive a membership in the SilverSneakers®
Fitness Program at no additional cost.
• $0premiumsforMedi-Pak Advantage MA (PFFS)
(does not include drug coverage) in 52 counties. These
plans offer all the health benefits of our Medi-Pak
Advantage MA-PD plans, but do not include drug cov-
erage. Members have access to a network of 6,000
doctors and hospitals that have agreed to accept their
plan and receive a SilverSneakers membership.
Great options, continued on Page 18
6
Blue & You Autumn 2009
Miracles can happen. Dan
Peterson is living proof.
In late 2002, Dan began having
severe pain in his upper abdomen.
After a few days with no relief, he
and his wife, Donna, went to the
emergency room at a local hospital.
Dan endured several tests, includ-
ing a CAT scan, and was diagnosed
with pancreatitis — inflammation of
the pancreas. One of the medical
professionals noted that there was
“something” on the CAT scan re-
sults but did not suggest any follow
up, and Dan was sent home.
Two days later Dan returned
to the hospital, still in pain, and
was admitted. After a few more
tests, Dan’s doctor walked into
the room and told his family he had
bad news.
“It was like the air was sucked
out of the room,” Donna said, still
fighting back tears from that pain-
ful memory. “He said that Dan had
stage-four pancreatic cancer and he
needed to go home and settle his
affairs because he only had a few
months to live.”
Dan’s pancreas had an adeno-
carcinoma, a cancer originating in
glandular tissue, and it had spread
to two locations in his liver. There
was no talk of oncologists, surgery
or other treatments. The doctor sug-
gested that Dan and his family start
saying goodbye.
Donna said that the only thing
keeping her together at that point
was that she had to be strong for
their five children. “I couldn’t eat;
I couldn’t take a deep breath; I
couldn’t imagine life without him.”
Dan went back to his job as a
human resources director for the
Central Arkansas Veterans Health-
care System and contacted his
friend, Nick Lang, M.D., a surgical
oncologist who was chief of staff for
the Department of Veteran’s Affairs
Beating the odds:
Dan and Donna Peterson enjoy the view from their front porch.
7
Blue & You Autumn 2009
(DVA) hospital at the time and who
now is chief medical officer for the
University of Arkansas for Medical
Sciences (UAMS). Lang contacted
Laura Hutchins, M.D., director of
the UAMS division of Hematology/
Oncology and director of clinical
research for the UAMS Winthrop P.
Rockefeller Cancer Institute.
The Cancer Institute has a tight-
knit group of physicians and re-
searchers who focus on specific
types of cancer, one of the reasons
it’s been named a Blue Distinc-
tion Center of Excellence for Rare
Cancers by the Blue Cross and Blue
Shield Association. Dr. Hutchins
quickly paired Dan up with Issam
Makhoul, M.D., associate professor
of medicine in the division of Hema-
tology/Oncology.
The first person to talk with Dan
and Donna at Dr. Makhoul’s office
was Michelle Welch, R.N., Dr. Mak-
houl’s nurse. Donna remembers her
shock when Michelle said, “It’s not
over — we have lots of things we’re
going to throw at you.” Michelle
confirmed that it is true that the
prognosis for pancreatic cancer
is not good for anyone, but given
Dan’s relatively young age of 57, and
his excellent health otherwise (at
the time he also was a warrant offi-
cer in the Arkansas National Guard),
she felt he had a better chance than
many people.
“I will always be grateful to her
for that,” Donna said. “She gave me
my world back.”
That glimmer of hope shone
even brighter as they visited with
Dr. Makhoul himself. His warm
demeanor and positive attitude
allowed them to think toward the
future for the first time in weeks.
He told Dan that he believed he had
at least a year to live, if not longer,
and that his team would try several
of the latest therapies to shrink
the tumor and look into ongoing
research to see if new treatments
were available.
“We had considered going out of
state for Dan’s treatment,” Donna
said, “but after that first visit we
realized how blessed we were to
live in Little Rock, so close to such a
renowned medical center.” She said
she and Dan visited with people
from throughout the country in the
waiting rooms of the Cancer Insti-
tute who had come for the excel-
lent, state-of-the-art treatment.
Part of the reason UAMS is rec-
ognized nationally for its treatment
of rare cancers is that its missions
of teaching, healing, searching and
serving are interwoven into the
daily activities of its employees. Dr.
Makhoul said he originally planned
to only stay a short time at UAMS,
but found he enjoyed the balance
of treating patients, heading the
fellowship program, interacting with
the residents and working on his
own research.
As a Blue Distinction Center of
Excellence for Rare Cancers, the
Cancer Institute must meet high
quality standards established by an
expert panel of physicians, surgeons
and other health-care professionals.
When a hospital has been desig-
nated a Blue Distinction Center, you
know they have expertise in that
specialty, that they focus on quality,
and that they have a history of pa-
tients with
positive
outcomes.
Hospitals
provide
care differ-
ently, and
the Blue
Cross and
Dan Peterson’s journey with pancreatic cancer
Dan and Donna before he was diagnosed with cancer.
Issam Makhoul, M.D.
8
Blue & You Autumn 2009
Blue Shield Association has created
a process where hospitals can dem-
onstrate their expertise.
If you are looking for a hospital
with a Blue Distinction designation,
go to our Web sites and visit our
“Members” section. We do the work
for you, so you can be assured you
are receiving the best care possible.
The Petersons also were grateful
to have Arkansas Blue Cross and
Blue Shield as their health insur-
ance provider. “Arkansas Blue Cross
has just been fantastic,” Dan said,
remembering the ease of getting
his expensive treatments covered.
When Dan retired from the National
Guard he qualified for Tricare, a
program for retired military mem-
bers. Still, he insisted on keeping
Arkansas Blue Cross as his second-
ary insurance because he knew the
importance of having good health-
care coverage.
A few days after Dan’s diagnosis,
Donna listened to a voicemail from
Brenda Strange, R.N., C.C.M., case
management coordinator for Arkan-
sas Blue Cross. Donna dismissed
the first call, but Brenda was insis-
tent and, through one of the visiting
nurses, got Donna to call her back.
Brenda explained that case manag-
ers don’t direct member’s care, as
some often think. “As a case man-
ager, I help coordinate the plan of
care already in place, work with the
member and health-care
team to maximize the
benefits available and help
them return to self-manag-
ing their care.”
“I had no idea in the be-
ginning that there would
be that kind of help, but
any time I had a question I
knew I could call Brenda,”
Donna said. Part of Dan’s
treatment still includes a
nightly infusion of IV flu-
ids, and the port must be
changed weekly. For sev-
eral months, nurses came
out to change the port, but then the
Petersons received a notice that the
number of visits was running out.
Donna immediately called Brenda
for help.
“We were able to offer an alterna-
tive benefit plan that would allow for
an extension of Dan’s skilled nursing
visits to support Donna,” Brenda
remembered. “This allowed Dan to
receive some of his treatments at
home, which would have otherwise
caused him to return to the hospital
during acute episodes of his ill-
ness.” For more about case manag-
ers at Arkansas Blue Cross, visit
our Web site at arkansasbluecross.
com and select “Case Management
Services” under the “Members”
section.
Dan’s treatment included visits
to the Central Arkansas Radiation
Therapy Institute (CARTI) along with
If you are looking for
a hospital with a Blue
Distinction designation, go
to our Web sites and visit
our “Members” section.
We do the work for you, so
you can be assured you are
receiving the best
care possible.
9
Blue & You Autumn 2009
powerful doses of chemotherapy
that thinned his hair but not his spir-
it. At one point Dan asked Brenda,
“Why do you think I’m still here?”
and her answer was, “Because you
make everyone better.”
By September 2003, Dan’s tumor
had shrunk enough that the doc-
tors decided to try to remove it.
With the waiting room packed with
family members, Ralph Broadwater,
M.D., chief of Surgical Oncology for
UAMS, started the operation, only
to stop three hours later in frustra-
tion. The tumor was too close to a
main artery. He was, however, able
to remove one of the tumors on
the liver; the other had disappeared
from the treatments.
While the operation wasn’t suc-
cessful, Dan continued to keep a
positive outlook and to “live in the
moment.” During a long wait to
see Dr. Makhoul, Dan and Donna
decided to have some fun. Using a
marker,
they
drew a
face on
Dan’s
belly,
using the scar from the operation as
a frown. They tried to keep straight
faces as Dr. Makhoul lifted Dan’s
shirt, but it was no use and they
burst out laughing. As time went
by Dr. Makhoul and his staff found
quirky notes on the door of the ex-
amination room, silver nail polish on
Dan’s toes when they became dis-
colored from the medication — any-
thing to make light of the situation.
“We relied a lot on humor and just
staying in the moment,” Dan said.
By 2005, the chemotherapy had
taken a toll on Dan’s bone marrow.
Dr. Makhoul found information
regarding a medication not yet ap-
proved for pancreatic cancer, but
one that sounded promising. Arkan-
Peterson, continued on Page 21
sas Blue Cross approved the “de-
signer” drug for Dan, which is now
an accepted medication for certain
types of pancreatic cancer.
One of the misunderstandings
people have about cancer is that
they consider it all to be the same
thing. Dr. Makhoul said he often
hears people ask, “Why can’t you
cure cancer?” but in reality there
are many subsets of cancers, some
much more easily treatable than
others.
Research began about 25 years
ago into the link between genetics
and certain forms of cancer. “We
now are harvesting the fruits of this
work,” Dr. Makhoul said, through
medications focused on specific hu-
man genes that may contribute to a
person’s predisposition for a type of
cancer. In Dan’s case, even though
pancreatic cancer in general is dif-
ficult to treat, his specific cancer
responded extremely well to the
medications, and his excellent over-
all physical health allowed him to
endure treatments that many other
patients couldn’t have tolerated.
“There is no question in my mind
that he is cured at this point,” Dr.
Makhoul said of Dan.
Almost seven years after his jour-
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