Every Year, Every Fall…Medicare Drug Plans

by Joanna Smith on Aug 25, 2010

In the California County that I live in, there are 52 separate drug (Part D) plans available to people on Medicare.  I receive frequent calls—especially in the fall, which is open enrollment time for drug plans–about selecting a Medicare drug plan.  Callers are incredulous:  how can there be 52 choices?  How can anyone choose?

Under newly released Medicare rules, the choices (which will be announced at the end of September 2010) for 2011 will be significantly reduced.  Insurance companies have already been notified by Medicare that they will only be able to offer one basic plan (rather than several) and will have to show that other plans are significantly different from each other.  According to today’s Chicago Tribune, more than 3.7 million people may change plans because of plan eliminations.

The advantage of this reduction in the number of plans is that selection will be less confusing for people.  The disadvantage is that co-pays and premiums may be quite different in the new plans, so careful consideration should be given to each plan.

With all of the drug plans, it is important to remember that every year the plan should be reviewed.  Each year insurers may change what drugs they offer in a plan as well as the co-pays and deductibles.  Since consumers can change plan each year from Nov. 15-December 31, they should review their particular plan each fall to see if it is the best one for their needs.

If you need help selecting a drug plan, or know someone who does, you can contact your local HICAP (Health Insurance Counseling and Advocacy) Program by searching on the internet for the HICAP office nearest you.  If you know someone who needs assistance with paying for medications, check with www.pparx.org.


by Joanna Smith on Aug 10, 2010

When I listen to clients that I work with–of almost any age–they all say the same thing:  “I want to maintain my independence” .  The other description you may hear more frequently these days is “aging in place”, the ability of an older person to remain in their own home with appropriate services and maintain their independence.   Their families say the same thing :  “we want them to stay as independent as possible. “ This last month, I have heard these words on at least six separate occasions.  What does it mean to be independent?

For many people, as they age, they fear “losing their independence”.  For some that means not being able to drive any longer; for others it means having to live with a family member who provides care for them; for still others it means having a “stranger”, a caregiver outside their family, assist them with care at home.  Frequently clients may say to me “I’m doing ok, I manage to stay independent with the help of friends and family.”

Family and friends  can be very puzzled by this comment, because they see the situation so differently.  This last week one of the members of the Healthcare Liaison Credentialing program  put it succinctly:  “If someone is living at home and relying on friends and family to provide care, are they really “living independently”?

It’s an interesting question.  The difficulty here is that friends and families—with their myriad responsibilities and activities—frequently feel pushed—by themselves or guilt or another family member– to provide care that taxes their emotional and economic resources to the limit.  Their family member may be living independently, but at an enormous cost to others in the family system.  There is a delicate balance of needs that must be accommodated.  It frequently takes a healthcare advocate with an  unbiased set of eyes to identify where the balance is and see if it can be shifted so everyone’s needs are taken into account.

Perhaps the ultimate goal as we age should be to look at our entire community of support–our friends and family–address their needs as a whole, and reach a compromise plan.  So then the goal is not independence, but interdependence.

Six Sigma and Healthcare

by Joanna Smith on Aug 4, 2010

In the world of  manufacturing, the term “six sigma” refers to the ability to produce items that are 99.9996%  free from defects.  As we step into the next levels of healthcare technology, the desire for six sigma in healthcare will increase.  Is that realistic?

What would six sigma look like in healthcare?  Surgeries would be successful, with only a few exceptions; diseases would be cured, except for a very few people; equipment would function with almost no failure; professionals would  make very few mistakes.  We would have working models of treatment for complex medical conditions, and these models would be successful.  What stops us from achieving these goals?

One factor is the unpredictability of both medical conditions and human beings.  While, from a technical standpoint, we could produce equipment and technology that reaches six sigma, people do not function in the same way, and by “people” I mean providers as well as the people they care for.    If three people are diagnosed with a leukemia, factors such as age, access to healthcare, insurance coverage, available economic resources,  geographic area of the country,  family dynamics, religious and spiritual values—all  will affect their decisions about the course of treatment they wish.  Providers are affected by training, experience, ability to work with diverse populations, persistence, curiosity, and compassion.  Providers have good days and bad days, just like everyone.  Is every day a “six sigma” day without mistakes?  No.  Is every day a “six sigma” day for people trying to decide about their healthcare?  Also no.

So we are left in a medical world with imperfect people, complex decisions and limited resources.  What, then, becomes important in healthcare?

  • That we use technology in the best ways we can to increase the likelihood of six sigma outcomes. A good example is the bar coding that is appearing on medications in hospital:  those codes are matched to the patient’s wristband so the likelihood of the wrong medication being given to a patient is greatly reduced.  Or drug interaction applications for the smart phones:  for every client I work with, I check their medications in Epocrates, a program on my phone that will alert me to possible interactions.  It’s my signal to consult with a pharmacist and the physician to double check, especially when many different physicians are writing prescriptions for my client.  You can do this kind of check yourself.
  • That we realize that people’s decisions about their healthcare will not fall into “six sigma” thinking. Many subjective factors—quality of life being one of them—drive people’s decisions about what treatments they want.  My job as a healthcare advocate is to help people create the decisions that work for them, based on their personal beliefs and goals.
  • That we accept that our capacity to create solutions in healthcare does not mean those solutions are appropriate for everyone. Value-based decision-making in healthcare will play an increasingly important role in how and what care is provided.
  • Six Sigma may not be possible, but attentive, effective healthcare is.