• Protect Your Future Income with Disability Insurance
• Healthcare Faces Pivotal Year in 2008, Says PricewaterhouseCoopers'
• Slowing the Rise and Fall of Healthcare
• In New Jersey, a Health Plan to Cover Uninsured Children
• U.S. House passes extension of child health program
• More Health Plans Strategically Manage Diabetes
• Americans want fit finances before fit body: study
• Predicting conditions to reduce health care costs
• Exercise Corner: Got your game plan for ’08?
• Recipe Corner: Non-Alcoholic Champagne

Disability insurance insures what's extremely likely to be your biggest asset: your future income. That's the reason disability insurance is so important. It's more important than life insurance, health insurance and auto insurance.

If you depend on your income to pay your bills, you need disability insurance. And if you happen to be independently wealthy and don't need to work, you can stop listening to this episode right now. You don't need disability coverage.

The Risk of Disability Is Real

If you're unable to work because of a disability, disability insurance pays you your income. The odds of becoming disabled are surprisingly high. According to the Social Security Administration, a 20-year-old worker has a 30% chance of becoming disabled before retirement age. By way of comparison, the chances of a 20-year-old dying before age 65 are only 17%. This is the reason that disability insurance is more important than life insurance. Because the odds of becoming disabled are so high, disability insurance is expensive. Premiums can be as much as 1% to 3% of your annual income.

Source: TheStreet.com, December 26, 2007

The health industries face a pivotal year ahead as they anticipate the outcome of the 2008 presidential election and adjust to a new Medicare payment system, additional reporting requirements, pressure on Big Pharma to cut costs and innovate, the rise of retail health services and the ongoing evolution of consumer- directed healthcare. The implications of these issues are addressed in the Top Eight Health Industry Issues in 2008, an annual review of the pressing issues in healthcare, released today by PricewaterhouseCoopers' Health Research Institute.

"The future strategies of hospitals, commercial insurers, pharmaceutical companies and life sciences firms will be influenced by big changes ahead in government policies, market pressures and global trends," said R. Carter Pate, Global and U.S. health industries and government services leader, PricewaterhouseCoopers. "With healthcare costs taking a bigger bite out of the assets of individuals, businesses and the U.S. economy, there is a demand for greater accountability from the health industries and a demonstration of the value they create."
PricewaterhouseCoopers' Health Research Institute identifies the following eight issues that will dominate health industry discussions in 2008:

Retirees Will Play a Greater Role in Funding Their Healthcare Coverage

Three-quarters of executives at multi-national companies surveyed by PricewaterhouseCoopers in 2007 said that, while employers should help provide access to affordable retiree health benefits, they no longer should be expected to pay for it. Is this the bell tolling for retiree health coverage? PwC's report suggests that in 2008 employers may reexamine their approach to retiree healthcare by capping and/or eliminating traditional retiree benefits from their balance sheets and shifting toward "defined contribution" or "no contribution" approaches.

New Medicare Payment System Will Create Hospital Winners and Losers

The Centers for Medicare & Medicaid Services (CMS) has changed the way it pays hospitals, adding 200 diagnosis codes that more precisely recognize the severity of illness among patients.
As a result, hospitals that treat sicker patients will be reimbursed more for doing so, potentially leveling the playing field between general and specialty hospitals and between rural
and urban hospitals. That, combined with CMS's new stance to not pay for certain conditions
resulting from medical errors, infections and other maladies acquired in a hospital, mean some hospitals may see a decline in revenue. In 2008, watch for commercial payers to follow in CMS's footsteps and an increased demand for medical coding staff.

Retail Health Clinics Will Challenge Primary Care Models

Driven by consumer demand for convenient and lower-cost medical care, the number of retail clinics in discount chain stores, grocery stores and drugstores throughout the U.S. is expected to quadruple, from 700 today to more than 3,000 in five years. In the year ahead, U.S. states, payers and policymakers will be crafting legislation and policies applicable to this new breed of healthcare provider, which lacks uniform regulation and quality controls. The growth of retail healthcare could create opportunities for providers, or it could threaten the primary care delivery model. Pharmaceutical companies may choose to step up marketing directly to nurse practitioners who staff the clinics.

Individual Health Insurance Could Take Off

Typically more expensive than group health insurance, individual health insurance could see market growth as more states mandate health insurance such as Massachusetts has done, and if an individual mandate or additional tax incentives come to fruition from proposals by Republican and Democratic presidential candidates. Hospitals and other providers may suffer if these plans offer limited benefits, but in the long run would benefit from fewer uninsured Americans. Look for insurers to tailor products and distribution strategies to individuals in the year ahead.

Increased Merger and Acquisition Activity between Pharmaceutical and Life Sciences Companies

Revenue growth is down for Big Pharma: The pipeline of new drugs coming to market is thinning, big money-making brand drugs are coming off patent, and the cost of bringing new, innovative drugs to market is increasing. To address these woes, Big Pharma is joining forces with life sciences companies. In the first quarter of 2007, life sciences firms recorded the most deal activity and the highest dollar amounts for mergers and acquisition deals than any quarter in their history. With these collaborations, life sciences companies are now driving the industry whereas big pharmaceutical companies once had a significant advantage. To fill the pipeline and accelerate innovation, look for greater collaboration between pharmaceutical and life sciences companies through mergers, collaborative risk- sharing, joint ventures and other co-development and co-promotion arrangements.

An unknown is whether regulators will clear a path for generic versions of newer biologic drugs, which could cause disruption to pharmaceutical companies' future revenue streams.

Asia Plays Bigger Role in the Pharmaceutical Industry, but Safety Concerns Loom

Asia is poised to become one of the world's largest pharmaceutical consumers and producers.
The rising cost of drug discovery has led pharmaceutical companies to look outside the U.S.
for a less expensive workforce and to outsource both clinical development and manufacturing operations overseas. Yet there are significant concerns regarding Asia's uneven protection of intellectual property rights and Asian drug safety. If a large portion of fundamental intellectual property creation moves to Asia, the West's dominance and ownership in medical scientific breakthroughs may rapidly decline.

FDA Tightens Drug and Medical Device Safety Standards

Congress granted the U.S. Food and Drug Administration increased authority to require, not just request, increased safety standards from drug companies, and it gave the FDA increased authority over post-market drug safety. Under new FDA guidance, the pharmaceutical industry will face even more regulatory burdens, which could be costly. Physicians and hospitals will need to adhere to new restrictions in prescribing and dispensing certain prescriptions. Look for payers to track and report to the FDA insurance claims data that identify patterns of adverse reactions to certain medications, such as off-label drugs prescribed for use in ways not approved by the FDA.

IRS to Seek Full Accounting of Hospital Community Benefit

The Internal Revenue Service wants hospitals to submit a full accounting of the benefits they provide to the community, reported in a uniform manner, as part of their annual tax return to the IRS, submitted on the proposed 2008 Form 990 and available for public inspection.

Many hospitals document their community benefit, but have done so inconsistently.
In 2008, tax-exempt hospitals will need to start tracking community benefit efforts so that, when and if required, they can accurately report their activities for the year.

"The government and the public have high expectations that the health industries will deliver safe care and safe drugs and will meet consumer and patient demands for innovative products and services," said Dr.

David Chin, partner and leader of PwC's Health Research Institute. "Now there is some real accountability behind many of these expectations."

Source: InsuranceNewsNet.com, December 27, 2007

The Commonwealth Fund, a New York-based foundation, issued a report this week analyzing 15 policy options for the federal government that could reduce national spending on health care by as much as $1.5 trillion over 10 years — even after spending more than $200 billion to provide health coverage for all Americans.

The estimated savings amount to a modest 4.5 percent reduction from a projected $33 trillion in cumulative health care spending over the decade, and even these will be hard to achieve. Yet there is no choice but to try. The good news is that many of the reforms might actually improve the quality of care delivered to Americans.

The essential reform is to adopt technology that would allow information to be shared among all the doctors and institutions that care for a patient, lessening the chances of errors and duplication and encouraging better coordination of treatment. That would require an initial investment in
technology, but, according to the study, could produce a cumulative savings of $88 billion over a decade. The Commonwealth Fund also lays out a reasonable approach to pay for that initial investment: a 1 percent charge on private insurance premiums and on the government’s Medicare expenditures.

The study’s biggest projected savings — $368 billion over 10 years — would come from establishing a public-private center to evaluate which treatments work best for which patients. The goal is to deter doctors from dispensing expensive treatments and drugs that don’t work, aren’t needed or are no better than cheaper alternatives. That is a superb idea and could produce
big savings over time, although we are skeptical that the initial payback would be that high. Other savings are projected if the health system stops paying doctors for each service performed — an incentive for multiplying services — and instead pays for treating an entire episode of illness.

A few options that make good sense are sure to excite strong lobbying opposition. One would eliminate the unjustified subsidies granted to private Medicare plans. Another would allow the government to negotiate lower prescription drug prices for Medicare. More savings could be found if the government limited Medicare payments to doctors and hospitals in high-cost
areas of the country, giving them the strongest possible incentive to adopt more efficient practices.

The Commonwealth Fund stresses that it is not advocating any of these reforms but is simply examining the potential of various options to slow the rate of growth in future health care expenditures. Unfortunately, the foundation failed to assess one controversial proposal — a Medicare-like insurance program to replace private insurance — that, by some estimates,
could produce even bigger savings.

Yet the Commonwealth Fund has performed a public service by putting dollar estimates on the rather abstract proposals being discussed by many of the presidential candidates. If the United States hopes to bring health costs under control, it will need to start on these or other options as soon as possible.

Source: New York Times, December 20, 2007 

The state had reached an agreement with Horizon Blue Cross Blue Shield allowing working- and middle-class families to obtain health insurance for children at drastically reduced rates.

As many as 15,000 children who currently lack insurance could enroll in the program, which will take effect on Jan. 1. In contrast to comparable efforts in other states, the program would cost New Jersey nothing because Horizon, a nonprofit company, would absorb what Karen L. Clark, president and chief operating officer of the Horizon subsidiary Horizon NJ Health, said could be
up to a $1 million loss in the first year.

“We are going to be setting the standard in the country for how we insure those children,” Mr. Corzine said in his announcement at a shopping mall here. “We know we will get a lot more of our children insured, and you know what that will do? That will keep them out of the emergency room. That will make sure that they get their shots. That means that they will look after their health and prevent the problems from developing.” The program sets the stage for what Mr. Corzine and State Senator Joseph F. Vitale, a Democrat who is chairman of the Senate’s health committee, promised on Wednesday would be unfurled as early as January: a universal
health care plan for all residents that would be phased in over the next few years.

Several states, led by Massachusetts and Vermont, already require residents to obtain health insurance. And California took a major step in that direction on Monday, when the Democratic-controlled Assembly approved a bill that has the support of Gov. Arnold Schwarzenegger, a Republican.

Still, other states are likely to study New Jersey’s program carefully because of the involvement of a private insurance company and the state’s aggressive reputation for trying to expand health care coverage.

“There are things that states can do that are imaginative and creative, and can be effective,” said "Columbia University’s Mailman School of Public Health and president of the Children’s Health Fund, a philanthropic organization. “And any efforts made by health insurance companies, which are doing extremely well, are good and should be applauded.”

In New Jersey, those who are not insured on their own or through their employer fall into several categories for programs that receive federal and state financing. The poorest qualify for those who earn up to 350 percent of the poverty level — which, for a family of four in New Jersey, is $72,275 a year — qualify for the "State Children’s Health Insurance Program, which is also known as NJ Family Care. The new program applies to all families above that 350 percent threshold.

But there is no money from the state or federal government. Instead, families must pay monthly premiums to Horizon, at the same rate as those who qualify for the Family Care program: $137 a month for one child, $274 for a family with two children and $411 for a family with three or more children.

Mr. Corzine said that comparable private insurance would cost more than $400 per month for one child.

To ease Horizon’s concerns about possible abuses, the program stipulates that families with more than one child must enroll all of their children. In addition, families must prove that their children were not insured during the previous six months. The state has also said it will regularly monitor the effectiveness of the program.

Source: New York Times, December 20, 2007 

Ending months of deadlock with the White House, the U.S. House of Representatives on Wednesday gave final bipartisan approval to legislation that would temporarily extend the state health insurance program that covers about 6.6 million poor children.

The bill, approved by a 411-3 vote, extends the program until March 2009. It also delays a scheduled 10 percent pay cut for Medicare doctors for six months and provides a 0.5 percent increase instead.

Lawmakers have struggled for years to replace what they see as a flawed Medicare physician payment policy but have instead settled for a series of short-term fixes like this one.
The Senate on Tuesday approved the same bill and the White House has indicated that President George W. Bush will sign it. Lawmakers predicted that they would have to revisit Medicare payments early in 2008.

Bush vetoed more ambitious earlier bills that would have expanded the health program to cover about 10 million children, even though they had bipartisan support. The president said they were too costly and would push more children into government-run health care instead of private plans.

Bush also objected to raising tobacco taxes to pay for the proposed expansion of the State Children's Health Insurance Program.

Democrats had hoped for a short-term extension of the program so they would be able reopen the battle before the November 2008 presidential and congressional elections. But Republicans forced them to extend it through March 2009.

White House press secretary Dana Perino said: "We are pleased that the Congress passed legislation to extend SCHIP until March 31, 2009 -- and did so without raising taxes."

"With this bill, we can be assured that children will continue to have coverage, and Democrats won't be able to play election-year politics with children's health," Perino said.

Rep. Rahm Emanuel of Illinois, a member of the House Democratic leadership, said: "What we couldn't resolve, the American people will resolve in November."

Source: Reuters.com, December 20, 2007

Evidence is growing that effective management of diabetes can reduce complications and health care costs, while boosting employee productivity, reports the National Business Coalition on Health, which recently released a "study on health plans and diabetes performance.

Both employers and health plans have responsibilities for helping employees manage diabetes, NBCH concludes. Employers determine the benefits that are available to workers, while health plans have the clinical expertise to create incentives for patients and physicians.

NBCH determined that employers expect health plans to: help them reduce barriers to essential medications for diabetes; help patients understand their medications and take them appropriately; engage patients in self-management and preventive health behaviors; and provide disease
management programs.

Using data and information from 98 health plans, NBCH found:

• 87% of health plans offer health risk assessments online and in print. However, only 2% of members complete one per year.
• 82% offered general reminders, 71% offered members specific reminders and 37% are using the Internet for online medical consultation.
• More than 38% reduced copays for selected medications, tests or services for diabetic members, and 28% reduced deductibles.
• 77% use member reminders to support prescription compliance.

Source: EmployeeBenefitNews.com, December 20, 2007

After a year of record mortgage foreclosures and slumping home prices, Americans are more determined to shape up their flabby finances in 2008 than their bodies, according to a study released by Countrywide Bank on Tuesday.

Some 67 percent of the 1,002 adults surveyed nationwide said that becoming financially fit is a top New Year's resolution, while 57 percent are committed to becoming physically fit in 2008.
"The results of the survey are an indicator that people are finally putting financial health on par with physical health," said clinical psychologist Dr. Melody Alderman in a statement from Countrywide.

By gender, women are more insecure about their finances, with 37 percent saying they are financially fit, compared with 55 percent for men. Dads are more confident about finances than moms, and single people feel more secure than the married.

Geographically, U.S. Northeasterners felt better about their money, with 52 percent saying their are financially fit. The Midwest and South were tied at the bottom with 43 percent feeling secure about finances.

Countrywide Bank is part of Countrywide Financial Corp, the largest mortgage lender in the United States with a big stake in the troubled subprime mortgage market. It has been battered by escalating loan defaults.

Source: Reuters.com, December 18, 2007

It’s no secret that employers are at a crossroads on health care costs. Many are considering all facets of the industry to reduce expenses.
Predictive modeling is one concept that is quickly gaining traction. It involves providing a risk assessment and adjustment process that applies available data to identify employees “at risk” for high future medical costs.

Health experts gathered last week at The National Predictive Modeling Summit in Washington, D.C. to discuss the current state and challenges of the process.

“Employers should want to understand their employee population,” said Russell Robbins, principal and senior clinical consultant with Mercer. “Predictive modeling is a key toward improving productivity and health care quality and also making sure the services are in place to help those in need.”

Robbins presented a list of key predictive modeling principles. This included a focus on total population and addressing the entire health care continuum; emphasizing long-term behavior change; supporting health plan designs with strong communication and incentives; and creating data-driven programs tailored to individual risk, health status and learning.

How can employers create these intricate databases that are the foundation of predictive modeling plans? Experts urged employers to use health risk assessment surveys to get a snapshot of their employees’ overall health status.

Employers should “complement and expand opportunities to address further domains of health that they may not be concentrating on,” advised Dan Dunn, senior vice president of research and development at Ingenix, a health care IT solutions company. The hope is that comprehensive personal health records will be created, which “integrate information from a number of data sources to provide a multi-dimensional profile of an individual’s health,” he added.

One employer has created a new pharmacy model by using predictive modeling, Robbins noted. It looked at data regarding employee illness, predicted costs, and then waived copays on generic drugs and halved copays on brand-name drugs treating diabetes, asthma and heart disease. The result: first-year savings from reduced non-pharmacy medical costs were equal to the cost of the copay reductions.

“Employers should expect predictive models to provide them the ability to understand the current workforce and trends,” said Robbins, “so they can make more informed business decisions on future health care costs.”

Source: EmployeeBenefitNews.com, December 18, 2007

Every year millions of Americans make a New Year’s resolution to shape up. But for many, those good intentions are gone by the time they plop on the couch for the Super Bowl.

To really get fit in ’08, you’ll need a good game plan. Here’s how to put one together:

1. Set a goal. Don’t just say you want to exercise more. Be clear about what you want to accomplish – weight loss, more energy, better health, greater endurance, stress reduction, etc. – then get specific. Small, realistic goals (losing 10-15 pounds by swimsuit season, rather than 40, for instance) are most likely to lead to success. Write down your goal and tell it to friends and family members so they can offer support throughout the year.

2. Devise a practical strategy. Look at your work and home schedules and figure out the best time to exercise. Then set up your workouts on your calendar, writing in specific fitness appointment times.

3. Keep it simple. Don’t start off with elaborate training plans full of complicated exercises and a confusing series of sets and reps. Just get moving. Simple walking is one of the best ways to get fit; aim for 1 to 3 miles on most days of the week. Once you’ve made exercising a habit, try new things.

4. Think long-term. A New Year’s resolution can be a good motivator, but fitness is a year-round pursuit. It’s a lifestyle.

Source: TheFitList.com, December 21, 2007

2/3 cup sugar
2/3 cup water
1 cup grapefruit juice
1/2 cup orange juice
3 tablespoons grenadine
28 ounces chilled ginger ale

Combine sugar and water in a saucepan over low heat. Stir until sugar is dissolved. Bring to boil and boil ten minutes. Cool. Add sugar syrup to grapefruit and orange juices. Chill thoroughly. Add grenadine and ginger ale just before serving. Makes about 1 1/2 quarts.

Source: Mountain-Breeze.com, December 29, 2007