Wellpoint


Bloomberg recently reported a story that highlighted the recommendations of the U.S. Preventive Service Task Force on yearly mammograms for women aged 40 and above. According to the story, the guidelines released by the task force suggested that annual mammograms for most women in their 40s have more drawbacks than benefits and therefore, women should wait until age 50 to start getting breast cancer screening tests every two years.

Here is the story:

November 17, 2009

Annual mammograms for most women in their 40s have more drawbacks than benefits, said a panel of U.S. doctors that recommended women wait until age 50 to start getting breast cancer screening tests every two years.

The change in guidelines released by the U.S. Preventive Service Task Force, a government-backed physician group, said women in their 40s are more likely to get false-positive tests that can lead to unnecessary biopsies and anxiety. The recommendations, which also said that self-examinations were unnecessary, don’t apply to women who carry a high risk for breast cancer. Those women should talk to their doctors about when to get screening, the panel said.

The new guidelines, published yesterday in the Annals of Internal Medicine, pit the task force against the American Cancer Society, which insisted doctors should still advise women to undergo routine annual screening starting at age 40. About 64 percent of women ages 40 to 49 had an X-ray of their breasts during the past two years, the panel’s report said.

“This is not a blanket recommendation not to worry until age 50,” said Diana Petitti, a disease epidemiologist at Arizona State University in Tempe, Arizona, and vice chair of the panel. “It’s a recommendation to have a discussion with your physician to better understand the trade-offs between starting exams now and starting later.”

Imaging machines for mammograms, and related supplies, are marketed by Fairfield, Connecticut-based General Electric Co., Bedford, Massachusetts-based Hologic Inc. and Munich-based Siemens AG.

Insurer Coverage

J. Leonard Lichtenfeld, the American Cancer Society’s deputy chief medical officer, said the panel’s guidelines may affect insurance payouts. ‘Our hope is that insurers will not make any change in coverage,” Lichtenfeld said.

WellPoint Inc., the top U.S. health insurer by enrollment with 34 million members, pays for annual mammograms for women age 40 in the majority of its health plans. The Indianapolis- based company periodically reviews its reimbursement policies and “doesn’t adhere to any one source” for guidance, said Jill Becher, a company spokeswoman in Milwaukee.

The new guidelines, if widely adopted by physicians and insurers, could reduce the number of U.S. mammogram screenings by 58 percent, from the current 37.2 million annually to 15.6 million under a “worst-case scenario,” Junaid Husain, a Boston-based analyst at Soleil Securities, wrote in a note to investors today.

Detecting Cancer

Mammograms, self-breast examinations, and doctor’s exams are the three main forms of detecting breast cancer. The task force said there was no evidence that self-exams reduce breast- cancer deaths, and insufficient information exists to recommend that doctors do routine physical exams.

The mammograms are used to check for breast cancer in women who have no signs or symptoms of the disease, and also to check for breast cancer after a lump or other signs of cancer have been found, according to the National Cancer Institute.

Breast cancer is the second-leading cause of cancer-related deaths among U.S. women, after lung cancer, killing 40,480 women in 2008, according to the task force report.

The task force analyzed published research and developed computer-simulation models to evaluate the likely health outcomes if mammograms were begun at certain ages and done every one or two years.

Deaths, False Positive Tests

The study confirmed earlier research that women who have mammograms die less frequently of breast cancer than those who don’t have the tests. About two deaths per 1,000 women are averted if women begin annual screenings rather than exams every two years starting at age 40, the task force estimated.

It also estimated that women who begin getting mammograms at 40 will have about 60 percent more false positive results per 1,000 exams than women who start screenings at age 50. A false positive, in which an abnormality is seen that proves not to be cancer, typically leads to additional screenings and tissue biopsies, the panel’s researchers said.

The cancer society challenged the reliability of the task force study’s methods.

“We are reluctant to recommend changing a proven program that has helped to save lives,” Lichtenfeld said. The society questions whether the task’s force computer modeling “is sufficiently sophisticated and accurate enough,” he said.

High-Risk Women

The recommendations aren’t intended for women older than 40 who have a higher risk for breast cancer. Increased risk can come from having a gene mutation linked to breast cancer or having been exposed often to chest radiation, which can raise the probability of breast cancer.

The task force said it didn’t make recommendations for these higher-risk groups because it lacked sufficient data to know the benefits of more frequent screening tests.

Women’s health groups varied in their responses to the new guidelines.

Susan G. Komen for the Cure, the Dallas-based breast cancer advocacy group, said it won’t change its recommendation that women ages 40 to 49 get annual mammograms. “We would not want to see a change in policy or reimbursement for screening mammography at this time,” said Eric Winer, the group’s chief scientific adviser, in a statement.

The task force’s recommendations were applauded by the National Breast Cancer Coalition, a Washington-based advocacy group, which said the guidelines support its position.

‘Deserve the Truth’

“Women deserve the truth even when it is complicated,” said Fran Visco, the coalition’s president, in a statement. “They can accept it.”

The American College of Obstetricians and Gynecologists rejected the task force’s recommendations, maintaining its guidelines that women in their 40s be screened every one to two years and women age 50 and older get annual exams, according to a statement issued by the group on Monday.

Researchers and physicians know that results from the X- rays aren’t as reliable in younger women as in older women. Women in their 40s typically have denser breast tissue, making it more difficult for technicians to determine if an image is normal or cancerous.

After women enter menopause, typically about age 50, the breast tissue becomes less dense and more fat, and the X-rays can be more accurately interpreted, said Susan Love, president and medical director of the Dr. Susan Love Research Foundation in Santa Monica, California.

‘Long Overdue’

The panel’s suggestions for women ages 40 to 49 are “long overdue,” said Love in a telephone interview. “Most countries in the world do not do mammography screening until age 50.”

“There is a lot of anxiety created when someone tells you that there is something that showed up in a test,” said Karla Kerlikowske, an epidemiologist at the University of California, San Francisco, Medical Center who wrote an editorial accompanying the task force report.

Subsequent exams expose women to more radiation, and although biopsies are “low risk,” some patients develop infections or experience pain and bruises, she said.

Screening women ages 50 to 74 every two years “achieves most of the benefit of annual screening with less harm,” the task force said. Now women in the older age group get a mammogram, on average, every 14 months, according to the report.

In forming its guidelines, the task force’s “biggest concern” was that women would be confused by conflicting advice from health experts or wrongly interpret the panel’s message as a blanket recommendation for those ages 40 to 49 to forego screening until they turn 50, Petitti said.

Risks, Preferences

Instead, decisions by women younger than 50 and their doctors should be based on “the risk for breast cancer and preferences about the benefits and harms” the task force wrote in the study.

Although the recommendations are “very clear and thoughtful,” women are likely to be confused by the different advice of health experts, Kerlikowske said.

It may be difficult to persuade many women in their 40s who have been told by their doctors for years that annual screenings are beneficial to accept the panel’s recommendations, said the cancer society’s Lichtenfeld.

“The task force is saying you can get 70 percent of the benefit if you get a mammogram every two years compared with every year,” Lichtenfeld said. “There will be women who say, ‘I want 100 percent of the benefit.’”

Source: Bloomberg

FREE cost estimate for surgery in any of the 18 countries supported by Healthbase

Like it? Share it or save it!!

blinklistblinklist blogmarksblogmarks del.icio.usdel.icio.us diggdigg furlfurl/diigo

googlegoogle netscapenetscape/propeller redditreddit spurlspurl

stumbleuponstumbleupon technoratitechnorati yahoo mywebyahoo myweb

Advertisements

By Victoria Knight, Dow Jones Newswires

A post recently appeared in the Wall Street Journal Blog which talked about Healthbase, Healthbase’s customers and the latest trend in medical tourism or global healthcare – traveling from one state to another within the United States in search for cheaper prices for major surgeries. Healthbase is one company that has been helping American patients connect to affordable hospitals in the US for major surgeries. The author writes,

Uninsured Americans also are shopping around for surgery in the U.S. in record numbers, and using new services such as Healthbase Online Inc. , a Boston-based medical brokerage that arranges treatments for patients at health-care facilities worldwide. Rodney Larson, a self-employed electrician from Minnesota, used Healthbase Online to arrange a triple heart bypass at Galichia Heart Hospital in Wichita, Kansas. He paid $13,000 flat fee for the surgery, about $90,000 dollars less than the rate for uninsured patients in Minnesota.

The current economic conditions…

Worsening economic conditions have made employers and workers more inventive in dealing with ever-rising health-care costs. Some are taking advantage of new health services that offer fixed rates for surgery to patients willing to travel to get care.

The financial benefits of domestic and international medical tourism cannot be overlooked and some insurers have taken active steps to reduce the health care costs for their clients in this slowing economy by offering them medical tourism options. The author mentions about the forward thinking by some health insurers and writes,

It’s a strategy that giving some insurers food for thought. WellPoint Inc., the nation’s largest health insurer, is currently evaluating programs and benefits where customers can “elect to seek certain services at designated facilities for a fixed per-case rate ,” according to a spokeswoman, Jill Becher.

Others insurers aren’t sold on asking customers to travel for health care. Aetna Inc. says it already negotiates significant discounts with medical providers. Typically, it pays physicians within three days of submitting a claim, so up-front cash payments aren’t a strong incentive for achieving additional discounts, according to a company spokesperson.

Request FREE quote for affordable major surgery within US or overseas

More at: Wall Street Journal Blog

Like it? Share it or save it!!

blinklistblinklist blogmarksblogmarks del.icio.usdel.icio.us diggdigg furlfurl

googlegoogle ma.gnoliama.gnolia netscapenetscape redditreddit spurlspurl

stumbleuponstumbleupon technoratitechnorati yahoo mywebyahoo myweb

Healthbase Collaborates with WellPoint to Bring Affordable Medical Tourism Solutions

Healthbase collaborates with WellPoint to bring affordable healthcare benefits to Americans through an international medical tourism pilot program. Members will now have more choices regarding where to receive care and a greater involvement in the care they receive

BOSTON, Jan. 5 /PRNewswire/ — Healthbase Online Inc., a Boston-based award-winning medical tourism facilitator, has collaborated on a pilot basis with WellPoint, Inc., an Indianapolis-based health benefits company to provide global health care coverage to members of WellPoint’s affiliated health plan in Wisconsin. Healthbase will handle all the medical travel logistics and arrangements for WellPoint members.

According to Saroja Mohanasundaram, CEO of Healthbase (http://www.healthbase.com), “Healthbase is committed to providing high quality medical travel services at affordable cost. Healthbase will assist WellPoint members with coordination of the trip, medical appointment scheduling, digital medical records transfer, and concierge travel service.”

Under this program, effective from January 2009, members who travel for certain non-emergency elective procedures like joint replacement and spinal fusion, will have access to Joint Commission International accredited healthcare providers in India. This will result to lower out-of-pocket costs for members translating into thousands of dollars in total savings. A hip replacement surgery, for example, costing over $60,000 in the US, costs less than $8,000 at an accredited hospital in India.

“We are pleased to work collectively with Healthbase to deliver an international medical tourism pilot product to our clients who are interested in exploring a medical tourism solution,” said Dr. Razia Hashmi, vice president and medical director for WellPoint’s national accounts division. “Medical tourism is a promising option for improving access to affordable, quality health care. Working with Healthbase, our case managers will coordinate all steps of the medical tourism process for members interested in receiving care overseas.”

About Healthbase:

Healthbase is a one-stop source for global medical and dental choices, connecting patients to internationally accredited providers in 14 countries including India, Thailand, Singapore, South Korea, Turkey, Panama, Costa Rica and Mexico. Healthbase caters to individual consumers, self-funded businesses, insurers, benefit consultants, third party administrators and those using Consumer Directed Healthcare Plans (CDHPs) or voluntary benefit plans. More information at http://www.healthbase.com.

About WellPoint, Inc.:

WellPoint, Inc. is the largest health benefits company in terms of medical membership in the United States. WellPoint is an independent licensee of the Blue Cross and Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at http://www.wellpoint.com.

Like it? Share it or save it!!

blinklistblinklist blogmarksblogmarks del.icio.usdel.icio.us diggdigg furlfurl

googlegoogle ma.gnoliama.gnolia netscapenetscape redditreddit spurlspurl

stumbleuponstumbleupon technoratitechnorati yahoo mywebyahoo myweb

The health insurer Wellpoint is testing a new program that gives covered patients the option of going to India for elective surgery, with no out-of-pocket medical costs and free travel for both the patient and a companion.

The program is being tested at Serigraph, a printing company in Wisconsin whose managers have been looking for ways to curb rising health care costs, said Dr. Razia Hashmi, chief medical officer for national accounts for Anthem Blue Cross and Blue Shield, which is affiliated with Wellpoint.

“This is a first for us,” Dr. Hashmi said. “We will be monitoring every aspect of this very closely, to make sure everyone is satisfied and there are good clinical outcomes.”

By the year 2010, more than 6 million Americans annually will be seeking medical treatment abroad , according to the Deloitte Center for Health Solutions, a consultancy. The potential savings are significant. Knee surgery that costs $70,000 to $80,000 in the United States can be performed in India for $8,000 to $10,000, including follow-up care and rehabilitation, Dr. Hashmi said. Similar savings could be achieved for such common procedures as hip replacements and spine surgery .

If other insurers follow Wellpoint, Dr. Hashmi said, the trend ultimately may pressure on United States hospitals to be more competitive in their pricing.

Critics say that’s unlikely.

“There have been some reports of hospitals that have been willing to match the prices, but I don’t know how they’re doing that,” said Howard Berliner, a professor of health policy and management at State University of New York Downstate Medical Center in Brooklyn. “The reality is there’s just no way that most hospitals can respond to this. It’s just like any service that’s outsourced – the price is so cheap abroad that there isn’t much an American company can do about it.”

At the same time, he said, the program could potentially siphon off the healthiest, most profitable patients from a local hospital.

Dr. Hashmi predicted that the program would appeal primarily to people who have traveled abroad. Many employees of Serigraph, which has offices in India, are familiar with the country.

“The quality is comparable” to care provided in the United States, Dr. Hashmi said. All the physicians speak English, and patients can share their medical records and consult with a surgeon in India before making the trip, she said.

The pilot program arranges for patients to be picked up at the airport and provides special meals to prevent food-borne illnesses. The program complies with the American Medical Association guidelines on medical tourism and uses hospitals accredited by the Joint Commission International.

Dr. Hashmi said it had actually been easier to evaluate the quality of medical care abroad than in the United States. “There is a lot more willingness to share data about complication rates, the total number of procedures and the outcomes,” Dr. Hashmi said. “We’re able to get detail per hospital and per physician.”

In addition to saving out-of-pocket costs for surgery for patients, the program could potentially help keep insurance premiums affordable, Dr. Hashmi said.

More at: NY Times

For information about affordable surgery overseas, visit Healthbase.