January 2012 will be our next open enrollment for our 401k Retirement Plan.  If you are newly eligible, you will be notified by Human Resources and receive an enrollment packet via email.  If you have previously met eligibility and did not respond or enroll, you will not receive another enrollment packet unless requested.  If you are a current plan participant and would like to make changes to your plan, you may do so at any time.

BE A SMART CONSUMER OF HEALTHCARE

STAY IN NETWORK.  It benefits you with lower out of pocket costs, your deductible is less, and your coinsurance percentage is less.  Most of the entire contracted rate that your coinsurance is applied to is substantially less; as much as 40% to 50% lower.  You cannot be balance-billed for amounts above the contracted rate if you are in network.  Sometimes you have to do your homework to find a network provider, but in doing so you can save money.  You do not have to use the provider that you are referred to.  Even physicians have to pay health insurance premiums for themselves and their staff.  They understand that you need to maximize your benefits of your own health insurance.  Speak up.  

PRE-CERTIFICATION/PRE–AUTHORIZATION.  This is not punishment.  This is to protect you against services that may or may not be necessary.  If pre-certification is required, do your homework.   Make sure that all procedures are authorized and get an estimated cost up front.  It will let you know what your financial obligation is going to be before the service.  Check with the facility before going to make sure that everything is authorized and in order before you get there. 

LABORATORY AND TESTING.  Free standing facilities will always cost less than hospital facilities.  Depending on the test, it means the difference between an office visit copay and your plan year deductible applying.  If you use a hospital for any type of test, even on an outpatient basis, your deductible will apply.  Contracted rates for free standing facilities are generally substantially less than hospital affiliated facilities.  Speak up.  Tell your provider that you want to use free standing facilities.  If they are in need of quick results, tell them to put a rush on the order at the free standing facility.  Complex Imaging is expensive and it is always subject to your deductible.  Free standing imaging centers are less expensive.  It is your right to price out these tests at different facilities.  You are the consumer and you have the right to ask what the contracted rate is at the facility.

RX DRUGS.  Ask for generic.  Specify generic when the doctor is writing the prescription.  Tell them you want the least expensive drug that will treat your condition.  It’s the difference between a $15 co-pay not subject to deductible and a $40 or $75 co-pay that is subject to a $250 plan year deductible.  Speak up.  Tell your provider to authorize the pharmacist to recommend therapeutic substitutions.  If you have a recurring need for a particular RX drug, it is in your best interest to request the lowest cost drug to manage your out-of-pocket expense.

CASE MANAGEMENT.  In the event that you or a covered family member is experiencing a serious medical condition, you may be contacted by our contracted Case Management company.  If they contact you, please cooperate with them.  They are there to help you.  They have resources for you.  They want you to get better.  They want to give you ways to get better or in some cases they want to help you live better with your condition.  They are a health advocate.  They know your health plan and they can possibly save you money.

WORKERS COMP CLAIMS.  PharmaCare Services carries worker’s compensation insurance that is separate from our healthcare plan.  If you have a work-related injury, it is imperative that you let HR know immediately.  In these situations, all medical services and RX drugs should be filed with workers comp.  Do not use your health plan ID card for workers compensation claims.  HR will provide you with a worker’s comp claim number to provide to your treating providers – this will allow you to be seen without using your group insurance.

AUTO ACCIDENTS.  Let Pharmacare know if you or a covered family member has been injured in an auto accident.  We want to let our TPA know this so they can file for reimbursement from the auto insurer. 

GET HEALTHY.  This may sound cliché, but it works.  Get a group of co-workers together and form a walking club, or get your lunch buddy to go to the gym with you.  Perhaps you can get a group together to take dancing lessons.  Bring a healthy snack to share with your co-workers.  Get creative.  You can get healthy and have fun doing it. 

Make your appointments and get your annual physicals done.  See the doctor when you need to – don’t delay until the situation becomes more difficult to treat.  Make sure your kids get their vaccinations on time and on schedule.

SPEAK UP!  ASK QUESTIONS!  BE A SMART CONSUMER OF HEALTH CARE!

These suggestions will definitely save you and the plan – our plan - money.  Being a SMART consumer of healthcare will help all of us drive down claims and drive down insurance premiums. 

INVENTORY REDUCTION IDEAS

From:  Landmark Hospital of Cape Girardeau, MO 

1.    We have really worked on trying to remember the amount of stock we have in the med-dispense instead of what we have on the shelves. Instead of ordering an item when it gets down to 40. We have now only ordered when we get down to 20. Remembering that there is always at least a couple of days worth in the med-dispense.

2.    We also work closely with our local pharmacies to borrow any non formulary drugs instead of purchasing the drug from cardinal. This helps so that we only get a week’s worth at a time instead of getting stuck with a 100 count bottle of something that we will never use.

3.    Along with working closely with our local pharmacies we also work with our sister pharmacies. For instance we have noticed that our crash cart meds usually go out of date before we get them used up. Therefore we work with our sister pharmacies and instead of both of us ordering in a case of IV fluids that will never be used we will split one case between both of us.

4.    I believe we have cut our inventory cost down by ordering in bigger bulk bottles of drugs that we are constantly loading in the machine that we know will get used before they expire.

5.    We have also cut our inventory down by having one med-dispense for controlled drugs, iv fluids, and PRN drugs and then the other med-dispense machine has all other meds. We were able to eliminate stocking both machines with the same drugs. In order for this method to work instead of having a machine on both ends of our hospital we now have both of our machines in the main med-room. This seems to be working out nicely for our nurses and it really helped with our inventory because now we don't have 2 machines with the same drugs in them.

6.    We have also been running the shelves really good at the end of the month to see if there is anything we can send back for credit to cardinal within our 30 day grace period.

Heather Illers, CPht

Landmark Hospital of Cape Girardeau

From:  Walton Rehab in Augusta, GA

1.    Worked closely with Mary to get inventory from other PharmaCare pharmacies.  This was helpful to replace slow moving items that had gone out of date. We were able to procure a small amount and reduce the amount of medication kept in the Med Dispense machines. We also keep a close watch on Zyvox… and other expensive medications and contacted Mary when needed.

2.    I have my technicians closely monitor medications that are running low and move them to a different Med Dispense machine if needed. We try really hard to let the slower stock run down to a 3-4 day supply before reordering.  After filling the Med Dispense machines, my techs review what we are out of in the pharmacy and check the quantity of those drugs in the Med Dispense machines. They run a report from Medics to see how many patients are on the drug and where the drug is located.  We then make a decision to move the drugs to another Med Dispense machine where the patients are, decide we have enough in stock or reorder the drug.

3.    I have lowered the amount of expensive drugs that were once kept in the pharmacy like Lovenox, Procrit and Fentanl patches…  I have also lowered the min/max levels for a bunch off the slow movers in the Med Dispense machines and in some cases limited them to only one or two of the machines.

4.    If we get a HIV patient that cannot provide their own medications, I am able to work with one of our local hospitals to get a supply and then we replace those meds with another med such as Lovenox.  This allows us to get only the medication that we need and are not stuck with a half opened bottle that will most likely go out of date.

5.    Toward the end of the month, I have my techs make a want list of meds that are getting low. We try to monitor those meds and try to order them the next month if possible.

Kim Morgan, Director Of Pharmacy
Walton Rehab Hosp