Express Scripts, Other PBMs Go Data-Diving to Predict Health Problems

Pharmacy benefit managers and insurers are going all “Minority Report” — they’re attempting to predict when people will stop taking their meds or develop medical problems before they even do so.

As the WSJ reports, Express Scripts is announcing a new initiative that will analyze factors including prescription history, whether the patient has kids living at home, the amount of the co-pay and disease-specific issues to predict who’s likely to skip doses or stop taking their meds. (No word on whether, like Tom Cruise’s crime-predicting team in the movie, they’ve also got three psychics in a swimming pool helping them out.)

Once those folks are identified, the PBM will reach out to them via phone or letter to offer them ways to stick to the medication plan, say, by ordering via mail.

And other PBMs and insurers are also data-diving in order to figure out who’s likely to skip meds or develop complications or new problems down the line, the paper says. UnitedHealth’s Ingenix unit sells a diabetes-prediction service; among other things, it uses mole-removal stats to pinpoint people who spend time outdoors and therefore who aren’t likely sedentary. CVS Caremark is preparing to launch its own predictive prescription adherence efforts.

On a similar note, we wrote recently about a study suggesting that offering care-management services to a broader swath of the patient population — not only to those facing a big treatment decision or chronic-disease patients, but also “chaotic users of the health-care system” — may save money.

A bioethicist tells the WSJ companies must tread lightly because of privacy concerns; insurers and PBMs say they would never share the info with outside parties.

Further reading:

Image: iStockphoto

View the original article here

Reader Story: How I Purchased Private Health Insurance

This guest post from Jaime Tardy is part of the “reader stories” feature at Get Rich Slowly. Some stories contain general advice; others are examples of how a GRS reader achieved financial success — or failure. These stories feature folks from all levels of financial maturity and with all sorts of incomes. Jaime writes about her financial journey at Eventual Millionaire. This piece is a follow-up to her first reader story from June, in which she described how she paid off $70,000 and quit her job.

Finding affordable health insurance was one of the biggest obstacles we faced when I quit my job. My husband is a self-employed performing artist (juggler/musician). We had always relied on my job to pay for our insurance.

Health Insurance is a complicated issue. We knew we needed to have health insurance, because without it we could face financial ruin; but I didn’t want health insurance to stop me from quitting a job I hated to pursue my dream of working for myself.

Before I quit, I spent hours researching different health care options. This post is about what I learned.

Note: This post is not about what we should do with our health care system; it’s about my experience in finding health insurance. Everyone’s experience will be different!

Finding the Right Health Insurance Plan
There were so many plans with so many options it was hard to keep everything straight. Our best option was to keep my newborn son on a separate plan. It would allow him to have much better coverage and let my husband and me purchase a cheaper plan for us, to save money.

At that point we lived in the state of New Hampshire. There was a program through the state that allowed you to buy in to their insurance program for kids. The coverage was excellent. At the time the payment was about $100 per month for just my son.

The plans for my husband and me were limited and expensive. I spoke to a few qualified agents. I researched and found reviews on the internet. I needed to make sure the plan fit our budget, had benefits that fit us, and had a good reputation.

It seemed like we had two options:

A PPO/HMO plan which had a lot of benefits and a high monthly cost. A high-deductible plan that didn’t have a lot of benefits but was less expensive.

With the high deductible plan, we could also sign up for a Health Savings Account. An HSA is a savings account that allows individuals to save for medical expenses tax-deferred.

We seemed like perfect candidates for the high-deductible plan. We were 25 years old and very healthy. We rarely went to the doctors. We were frugal and could pay attention to the cost of our health care.

In 2007, a high-deductible plan for two adults was $192 per month with a $5,000 deductible. We had over $20,000 in our emergency fund, so we figured we could pay for most health emergencies. Our total cost per month for health insurance for our family would be $292.

After thinking about it more, I realized I had to take into account the possible loss of income too. If my husband injured his hand, he couldn’t juggle. If either of us had a serious injury and couldn’t work, we’d need our emergency fund to pay for bills. We decided to save an additional $5,000 to put in our HSA to help with that risk.

A Problem with the Plan
We had the plan for a year before I realized we were losing money. I had signed up for the preventative option, so we could have regular health check-ups covered for my son. It turned out that the option had a cap of $200 per year. I was paying an extra $22 per month. That meant I was losing at least $64 per year.

I thought I had inspected every inch of that plan. There were just too many options and rules. Needless to say, I canceled the preventive option.

New State, New Insurance
When we moved to Maine, we had to find new insurance. I had to spend hours researching again. There are only three health insurance companies here, and the premiums are a lot more expensive because Maine doesn’t discriminate. Everyone has the ability to get coverage.

The high-deductible plan and HSA seemed to work well before. Since the prices were so much higher here (our previous plan would have been almost $600 per month), we increased our deductible to $10,000. To avoid more risk, we increased the amount of money in our HSA to $10,000. Our current plan costs $483 for a family of four. (We welcomed a new little girl last year!)

Paying for Visits
Having a high deductible means we have to pay for doctors visits. Many people I talk with have no idea what a doctor’s visit costs. A normal doctor visit costs us $92. If we pay within 21 days, we receive a 10% discount.

I’ve realized how great it is to pay attention to costs. I feel so much more involved in the process of our health. My daughter’s doctor wanted to do a test, so I asked how much it would cost. She said that she never looks at the cost of the procedures. The test was $2,000 and it wasn’t medically necessary. If a procedure is important to your health, you need to spend money on it; but I was able to save $2,000 because I did my due diligence to research and ask for second opinions about my daughters care.

Last year we spent about $2,800 on medical expenses. That included all wellness visits for my one-year-old daughter, about seven appointments for illnesses, and two emergency room visits.

J.D.’s note: This is one of my pet peeves with the modern medical system. Nobody seems to know how much anything costs. Back when I started Get Rich Slowly, I posted a rant about how ridiculous it is that doctors don’t know how much their services cost, but it’s not just doctors. It’s the entire system.

A Learning Process
Figuring out what fit for us has been a learning process. Since I can’t predict the future, I don’t know if this plan will fit us 100%. If I have a big disaster come up and my plan lacks adequate coverage, I’ll have to learn from it and adjust.

There’s a delicate balance of living the life you want and mitigating risk. I’m still finding the balance, but I do my best to keep my family debt-free, healthy and living the life we want.

Do you have any ideas or suggestions for my plan? What has worked for you, and what hasn’t?

Reminder: This is a story from one of your fellow readers. Please be nice. After more than a decade of blogging, I have a thick skin, but it can be scary to put your story out in public for the first time. Remember that this guest author isn’t a professional writer, and is just learning about money like you are. Henceforth, unduly nasty comments on readers stories will be removed or edited.

This article is about Health & Fitness, Insurance, Reader Stories  Sunday, 26th September 2010 (by J.D. Roth)  

View the original article here

Reader Story: How I Purchased Private Health Insurance

This guest post from Jaime Tardy is part of the “reader stories” feature at Get Rich Slowly. Some stories contain general advice; others are examples of how a GRS reader achieved financial success — or failure. These stories feature folks from all levels of financial maturity and with all sorts of incomes. Jaime writes about her financial journey at Eventual Millionaire. This piece is a follow-up to her first reader story from June, in which she described how she paid off $70,000 and quit her job.

Finding affordable health insurance was one of the biggest obstacles we faced when I quit my job. My husband is a self-employed performing artist (juggler/musician). We had always relied on my job to pay for our insurance.

Health Insurance is a complicated issue. We knew we needed to have health insurance, because without it we could face financial ruin; but I didn’t want health insurance to stop me from quitting a job I hated to pursue my dream of working for myself.

Before I quit, I spent hours researching different health care options. This post is about what I learned.

Note: This post is not about what we should do with our health care system; it’s about my experience in finding health insurance. Everyone’s experience will be different!

Finding the Right Health Insurance Plan
There were so many plans with so many options it was hard to keep everything straight. Our best option was to keep my newborn son on a separate plan. It would allow him to have much better coverage and let my husband and me purchase a cheaper plan for us, to save money.

At that point we lived in the state of New Hampshire. There was a program through the state that allowed you to buy in to their insurance program for kids. The coverage was excellent. At the time the payment was about $100 per month for just my son.

The plans for my husband and me were limited and expensive. I spoke to a few qualified agents. I researched and found reviews on the internet. I needed to make sure the plan fit our budget, had benefits that fit us, and had a good reputation.

It seemed like we had two options:

A PPO/HMO plan which had a lot of benefits and a high monthly cost. A high-deductible plan that didn’t have a lot of benefits but was less expensive.

With the high deductible plan, we could also sign up for a Health Savings Account. An HSA is a savings account that allows individuals to save for medical expenses tax-deferred.

We seemed like perfect candidates for the high-deductible plan. We were 25 years old and very healthy. We rarely went to the doctors. We were frugal and could pay attention to the cost of our health care.

In 2007, a high-deductible plan for two adults was $192 per month with a $5,000 deductible. We had over $20,000 in our emergency fund, so we figured we could pay for most health emergencies. Our total cost per month for health insurance for our family would be $292.

After thinking about it more, I realized I had to take into account the possible loss of income too. If my husband injured his hand, he couldn’t juggle. If either of us had a serious injury and couldn’t work, we’d need our emergency fund to pay for bills. We decided to save an additional $5,000 to put in our HSA to help with that risk.

A Problem with the Plan
We had the plan for a year before I realized we were losing money. I had signed up for the preventative option, so we could have regular health check-ups covered for my son. It turned out that the option had a cap of $200 per year. I was paying an extra $22 per month. That meant I was losing at least $64 per year.

I thought I had inspected every inch of that plan. There were just too many options and rules. Needless to say, I canceled the preventive option.

New State, New Insurance
When we moved to Maine, we had to find new insurance. I had to spend hours researching again. There are only three health insurance companies here, and the premiums are a lot more expensive because Maine doesn’t discriminate. Everyone has the ability to get coverage.

The high-deductible plan and HSA seemed to work well before. Since the prices were so much higher here (our previous plan would have been almost $600 per month), we increased our deductible to $10,000. To avoid more risk, we increased the amount of money in our HSA to $10,000. Our current plan costs $483 for a family of four. (We welcomed a new little girl last year!)

Paying for Visits
Having a high deductible means we have to pay for doctors visits. Many people I talk with have no idea what a doctor’s visit costs. A normal doctor visit costs us $92. If we pay within 21 days, we receive a 10% discount.

I’ve realized how great it is to pay attention to costs. I feel so much more involved in the process of our health. My daughter’s doctor wanted to do a test, so I asked how much it would cost. She said that she never looks at the cost of the procedures. The test was $2,000 and it wasn’t medically necessary. If a procedure is important to your health, you need to spend money on it; but I was able to save $2,000 because I did my due diligence to research and ask for second opinions about my daughters care.

Last year we spent about $2,800 on medical expenses. That included all wellness visits for my one-year-old daughter, about seven appointments for illnesses, and two emergency room visits.

J.D.’s note: This is one of my pet peeves with the modern medical system. Nobody seems to know how much anything costs. Back when I started Get Rich Slowly, I posted a rant about how ridiculous it is that doctors don’t know how much their services cost, but it’s not just doctors. It’s the entire system.

A Learning Process
Figuring out what fit for us has been a learning process. Since I can’t predict the future, I don’t know if this plan will fit us 100%. If I have a big disaster come up and my plan lacks adequate coverage, I’ll have to learn from it and adjust.

There’s a delicate balance of living the life you want and mitigating risk. I’m still finding the balance, but I do my best to keep my family debt-free, healthy and living the life we want.

Do you have any ideas or suggestions for my plan? What has worked for you, and what hasn’t?

Reminder: This is a story from one of your fellow readers. Please be nice. After more than a decade of blogging, I have a thick skin, but it can be scary to put your story out in public for the first time. Remember that this guest author isn’t a professional writer, and is just learning about money like you are. Henceforth, unduly nasty comments on readers stories will be removed or edited.

This article is about Health & Fitness, Insurance, Reader Stories  Sunday, 26th September 2010 (by J.D. Roth)  

View the original article here

Affordable Individual Health Insurance Is An Achievable Actuality

If you have not enough mony to buy health insurance,you have to consider buying affordable  individual health insurance.Affordable  individual health insurance plan can be an achievable actuality and there are without a doubt a lot of methods by which this may be secured. The rule to retain in thoughts in conditions of this sort of matters would be to generally keep in mind that programs with probably the most folks is heading to be in a location to afford much better cost savings for that members. Some states allow it to be feasible for a person to buy guidelines as a person group.

Self employed individuals can utilize for protection to affordable  individual health insurance.The programs that include the nationwide Association for that Self-Employed (NASE). via 1 of the organization’s applications recognised since the 105 HFR, do it yourself employed individuals are permitted the selection to subtract their whole non insured healthcare costs and healthcare premiums from their do it yourself employment, federal, and suggest taxes.

Employees also can safe affordable  individual health insurance merely by getting people of agencies like alumni or business associations. the most beneficial strategy right here would be to subscribe to an association that is appropriate for your duty description. Journalists, for example, is heading to be finest positioned if they subscribe to an association such as the American community of Journalists and Authors (AJSA). There are a lot of associations in as much since the different occupations that exist in thiscountry. The association require not be job-related only; there are associations which will be appropriate in your case merely for the reason that you certainly are a pregnant mom for example.

The cause why associations are inside a location to provide these affordable  individual health insurance plan programs is for the reason that they are not subjected towards the exact same intense scrutiny that is suggest regulated, as opposed to the set well being plans. like a potential applicant it is prudent to remember how the well being insurance plan provided via the association will seldom provide every single member uniform premiums as opposed to the situation with the set well being plans.

Related posts: The way to shop for Individual Health InsuranceGet Affordable Health Insurance For Self EmployedThink 0ver Purchasing An Individual Health Insurance For YourselfWhat are some factors to considering when deciding on individual health insuranceHealth Insurance – Are You need?

View the original article here

Affordable Individual Health Insurance Is An Achievable Actuality

If you have not enough mony to buy health insurance,you have to consider buying affordable  individual health insurance.Affordable  individual health insurance plan can be an achievable actuality and there are without a doubt a lot of methods by which this may be secured. The rule to retain in thoughts in conditions of this sort of matters would be to generally keep in mind that programs with probably the most folks is heading to be in a location to afford much better cost savings for that members. Some states allow it to be feasible for a person to buy guidelines as a person group.

Self employed individuals can utilize for protection to affordable  individual health insurance.The programs that include the nationwide Association for that Self-Employed (NASE). via 1 of the organization’s applications recognised since the 105 HFR, do it yourself employed individuals are permitted the selection to subtract their whole non insured healthcare costs and healthcare premiums from their do it yourself employment, federal, and suggest taxes.

Employees also can safe affordable  individual health insurance merely by getting people of agencies like alumni or business associations. the most beneficial strategy right here would be to subscribe to an association that is appropriate for your duty description. Journalists, for example, is heading to be finest positioned if they subscribe to an association such as the American community of Journalists and Authors (AJSA). There are a lot of associations in as much since the different occupations that exist in thiscountry. The association require not be job-related only; there are associations which will be appropriate in your case merely for the reason that you certainly are a pregnant mom for example.

The cause why associations are inside a location to provide these affordable  individual health insurance plan programs is for the reason that they are not subjected towards the exact same intense scrutiny that is suggest regulated, as opposed to the set well being plans. like a potential applicant it is prudent to remember how the well being insurance plan provided via the association will seldom provide every single member uniform premiums as opposed to the situation with the set well being plans.

Related posts: The way to shop for Individual Health InsuranceGet Affordable Health Insurance For Self EmployedThink 0ver Purchasing An Individual Health Insurance For YourselfWhat are some factors to considering when deciding on individual health insuranceHealth Insurance – Are You need?

View the original article here