Imagine you are buying a car. Where do you start? Like many people, you’ll probably begin the process by identifying which type of car will fit your needs. If you have children, you might consider a minivan or an SUV. If you have a long commute, you may want something with good gas mileage. Once you’ve decided the make and model of the car you want, chances are you won’t buy the first one you see. Instead, you’ll likely shop around and see how prices differ among dealerships in your area before making a final decision.
You probably use a similar decision-making process when making any major purchase, but did you know you can use the same method when it comes to healthcare? People today have more choices than ever when it comes to how, when and where they receive healthcare, so to get the highest quality care at the best cost, we have to approach our healthcare the same way we would approach making any other financial decision. If you’re not sure where to start, use these tips.
#1 Understand your insurance coverage
When people think about the “cost” of healthcare, many factor in the monthly premium they pay for insurance, but that is not the only cost associated with care. Other things to consider include copays and deductibles, as well as co-insurance and out-of-pocket maximums. In addition, some treatment may not be covered by your insurance or may be considered “out of network”, which affects what you would owe for the treatment or service.
When getting healthcare services, make sure you know what is covered, what providers and facilities are in and out of network, and what costs you will owe at the time of service. If you have questions about your coverage, contact your insurance provider.
#2 Take advantage of perks and incentives
Many employers and insurance plans offer incentives for healthy choices. Some programs may reimburse the cost of your gym membership or give you discounts on wearable fitness devices. Other programs may even pay you for getting preventive screenings. Ask your insurance provider or employer if they offer similar programs and take advantage of them.
#3 Ask for pricing transparency
Before getting a procedure or other service, ask your healthcare provider about what price you can expect. Although the exact price will be different for each patient (usually depending on insurance coverage), every healthcare system has a list of charges for all of the services it provides called a “chargemaster.” Think of it like the sticker price for a healthcare service.
You most likely won’t pay the sticker price if you have insurance, but knowing the amount on the chargemaster does give you a ballpark estimate of what the service will cost. Many healthcare systems also offer discounts for patients who self-pay (meaning they do not go through insurance). In some cases, self-paying may be even more cost effective than going through your health insurance and you can request to be self-pay prior to receiving the care.
#4 Shop around for services
Hospitals often charge more for services, like laboratory testing and CT scans, compared to freestanding or outpatient clinics, so it pays to shop around for the best price. Many insurance providers offer online tools to estimate how much a service will cost with different healthcare providers. You can also use sites like Healthcare Bluebook to find what a fair price is for a service. If your provider doesn’t offer the choice of getting your imaging done at an outpatient imaging center or outpatient surgery at an ambulatory surgical center (ASC), ask them if that is an option; if it is an option, it could save you a lot.
#5 Don’t skip preventive care
Before the Affordable Care Act (Obamacare), many insurance providers did not cover routine screenings and preventive care. Now, insurers are required to cover most preventive care services in full. It’s crucial to stay up to date on your routine screenings because that is the best way to detect health problems before they become serious and expensive to treat. Plus, preventive care doesn’t cost anything extra to you or your family.
Note: If you have a history or symptoms of the condition you are getting screened for (such as colon cancer or glaucoma), your screening may no longer be covered by insurance because it would be considered “diagnostic.” Talk to your doctor about whether your routine testing is simply a screening test or a diagnostic test.
Patients are responsible for more and more of their medical costs each year, so it’s important to be aware of those costs and how to make smart healthcare decisions to not only save money but also be healthier.
[https://reverehealth.com/live-better/5-tips-to-be-a-smart-healthcare-consumer/]
🐰 Get a second opinion if you want to
The process of seeking a second opinion can be as simple as getting a referral from your current doctor and making sure your health insurance will pay for it. You will need to gather any biopsy or surgery reports, hospital discharge reports, relevant imaging tests, and information on drugs or supplements you take.
[https://www.yalemedicine.org/news/second-opinions]
It's your life; you have but only one life
I am writing this blog so people can be better equipped and educated regarding their health. It's your life. You need to care of you, whatever that means and takes. You deserve good healthcare and a doctor that listens to you. Go with your gut instinct, if something doesn't feel right then investigate why. People, too often, are too afraid to ask questions or challenge a healthcare professional. You have so many rights ... to ask questions, to be heard, to be treated correctly. Do not settle for 2nd best.
I learned that many minorities, especially the Hispanic community, are not listened to when they are in urgent care, the ER, the doctor's office. While at the bus, during a long wait, I asked a Hispanic women if she could verify this information with me. She told me that in fact, it had been her experience. She was treated poorly and felt that the doctor didn't listen nor care about her overall well-being. Jesus!
Look, we are all human beings and no one deserves to get shit on by another person, because of gender, race, age, or type of medical insurance. Unfortunately, it happens. If I were not dying I think I would be a personal health consultant; someone to go with on doctor appointments, to advocate, assist with forms and getting prescriptions. Next life, I guess. I am always available to answer questions though, while I am here. If I don't have an answer I'll find it.
The only thing regarding shitty healthcare is to check reviews on the internet and try to get a doctor of your gender preference and race. Personally, I don't put up with any shit and I use my knowledge for self-advocation.
Grandpa story, later tonight.
Do not allow healthcare workers be rude to you
I went into the CVS on Verdugo and there stood the Pharmacist and tech; both typing away. I walked up to the counter to ask about bringing in used syringes and there I stood. Neither employee acknowledged me, at all. They "should've" [YES, SHOULD'VE] at least said, Hi, give us a moment. I am old school pharmacy and my pharmacy clients were coddled. If you're in a pharmacy, chances are you're sick, tryna not get sick, or need OTC assistance. If you're a tech of pharmer and one person is standing there, then help them. smh. I had to speak firmly with the guy and tell him that I had vital question, that warranted a yes or no answer and that he could stop typing for a moment to answer for me. Jesus!
Why are you in Pharmacy? It's not Taco Bell, it's a place where people purchase life sustaining medicines, etc and prolly don't feel good.
Get up in the morning, not feeling good, long drive or battle with traffic to the doc's office, long wait in the doc's office, bad news, complicated drive to the pharmacy, and dark by now. Chances are this pharmacy client is in a testy mood. If you be pharmacy, then help them out and be kind and patient; try to anticipate their needs.
It's just common sense.
Anyway, always double check your prescription and understand the directions before you leave. If you don't want a generic substitute then ask the doctor to put that on the script [no substitutions]. It's your body and your money / insurance; you're absolutely entitled to get what you want. And don't leave the pharmacy or doc's office until your questions are answered.
Social Media & the Internet are not doctors
There is a lot of crap on the internet. Everyone seems to be an expert on something; some are though. Be careful not to believe everything you read, especially when it comes to diseases, the medical community, pharmacy, vaccines, etc Do the research for yourself before you commit to believing anything / accepting something as the gospel truth. If need be, call your doc or pharmacist.
Do not self-diagnose
Self-diagnosis is the process of diagnosing, or identifying, medical conditions in oneself. It may be assisted by medical dictionaries, books, resources on the Internet, past personal experiences, or recognizing symptoms or medical signs of a condition that a family member previously had.
Self-diagnosis is the process of diagnosing, or identifying, medical conditions in oneself. It may be assisted by medical dictionaries, books, resources on the Internet, past personal experiences, or recognizing symptoms or medical signs of a condition that a family member previously had.
Pharmacy
Take all of your prescriptions as directed
Make no changes without doctor's consent
Do not share it with anyone else
If you have expired meds call the pharmacy as what to do with them [Police have an annual "take back" event
Plan for the doctor and pharmacy trip
Have an outline of what you need to talk about
List your symptoms and onset date
Know your medical history and list of drugs you take [so important]
Don't lie!!! Docs aren't looking to arrest you, but they need to know if you drink or drug in case he needs to write you a prescription
Bring water, a snack, and something to read in case you have to wait
If you have any apprehensions, ask if someone can tag along
Ongoing Issues In The Medical Community
Medication adherence
What do suboptimal outcomes, higher rates of hospital admissions, increased morbidity and mortality, and rising healthcare costs all have in common? They're associated with medication adherence shortcomings. In fact, as the Centers for Disease Control and Prevention (CDC) notes, medication nonadherence is rampant.
In the United States, while about 4 billion prescriptions are written annually, roughly one in five new prescriptions are never filled. For those filled, only about half are taken correctly.
So, what is medication adherence, why is it so challenging, and what are ways clinicians can improve their patients' medication adherence? This blog will help answer these questions.
Learn About Medication Adherence In Our Comprehensive Guide
Defining Medication Adherence
To gain a better understanding of medication adherence, let's review how a few organizations, associations, and publications define the term.
The U.S. Food and Drug Administration (FDA) states,
"Medication adherence, or taking medications correctly, is generally defined as the extent to which patients take medication as prescribed by their doctors. This involves factors such as getting prescriptions filled, remembering to take medication on time, and understanding the directions."
The American Medical Association says,
"A patient is considered adherent if they take 80% of their prescribed medicine(s). If patients take less than 80% of their prescribed medication(s), they are considered nonadherent."
Prescriptions for a Healthy America states,
"Medication adherence occurs when a patient takes their medications according to the prescribed dosage, time, frequency, and direction."
The American Pharmacists Association says medication adherence is "… the extent to which a patient's behavior (e.g., taking medications with respect to timing, dosage, and frequency) corresponds with agreed-upon recommendations from a healthcare provider."
Finally, Pharmacy Times says medication adherence is "… the extent to which patients take medications as prescribed by their providers and agreed upon in the treatment plan."
Note: When defining medication adherence, it is essential to distinguish the term from medication compliance. Read this comparison of medication adherence and medication compliance.
Medication Adherence Challenges
Unfortunately, there are several barriers to achieving medication adherence, which all contribute to the alarming outcomes and statistics shared at the beginning of this blog. Here are four of the most significant challenges:
1. Ability to pay for medications
An ABC News report from April, citing the results of a survey by Gallup and West Health, noted that "Americans borrowed $88 billion to pay for healthcare in the past 12 months." Furthermore, the survey indicated that "… 15 million Americans deferred purchasing prescription drugs due to the costs of the medications."
Even more recent, data published in JAMA Open Network found that high-deductible health plans, which are common for employers, are creating substantial difficulty for patients to maintain adherence.
2. Low health literacy
The Center for Health Care Strategies states that "Nearly 36% of adults in the United States have low health literacy," with health literacy defined as "… the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."
Limited health literacy is associated with medication nonadherence (in addition to a slew of other wellness and financial challenges). When patients are unable to grasp critical concepts, such as how to fill a medication, how to take a medication, when to take a medication, how much of a medication to take, and when and how to refill a medication, achieving and then maintaining adherence becomes very difficult, if not impossible.
3. Side effects
When patients experience adverse side effects from taking medications, they are more inclined to stop taking medications or try to adjust their regimen on their own to counter the effects. There are many different effects likely to contribute to nonadherence. A poll conducted by Health Dialog found that weight gain, nausea/upset stomach, dizziness/fatigue, and skin irritation were all examples of such negative side effects.
4. Polypharmacy
Patients taking at least five medications — typically referred to as polypharmacy — face several challenges directly linked to this high number of prescriptions. These include the complex dosing schedule, instruction confusion, multiple side effects, and greater expenses. To learn about these and other obstacles, read our blog discussing polypharmacy challenges.
Improving Medication Adherence
The good news for clinicians is that there are steps they can take to achieve improvements in patient medication adherence. An essential step is to take the time to understand the causes of nonadherence, such as those discussed above. Learning about these causes will help clinicians better identify when such causes are likely to contribute to nonadherence.
Providing education to patients is also vital. When patients better understand issues such as the importance of following a medication regimen and risks of deviating from it, how to respond to undesirable side effects, what to do if they encounter obstacles to adherence (e.g., affording medications, filling and refilling prescriptions), and how to get questions concerning their medications answered in a timely manner, adherence will improve. As a Patient Preference and Adherence study assessing the influence of different modes of patient education on medication adherence in patients with rheumatoid arthritis stated in its conclusion, "Patient education significantly improves adherence."
Considering the significant role that cost can play in contributing to nonadherence, clinicians should know how to help patients overcome this obstacle. As we noted in a blog on patient medication management,
"Cost must always be a topic covered by clinicians when discussing mediation regimens with patients. … In addition, clinicians must be prepared to provide resources to help patients reduce their medication costs. Such resources can include information on how to obtain financial assistance, safely order medications by mail, and identify and use a preferred pharmacy."
One company that is making an impact in this area is GoodRx, which we featured in Our Favorite Healthcare Mobile Apps of 2019 post. GoodRx has been making headlines for its prescription discount app. The company reports that the app has saved 10 million-plus consumers more than $14 billion since 2011.
Finally, clinicians should explore the availability of tools and technology that can assist them in helping their patients maintain adherence. One such example is Cureatr's solution, the Meds 360° technology platform. By providing clinicians with access to real-time prescribing and pharmacy pick-up information, they gain the ability to identify potential medication avoidance behaviors and then address these issues before nonadherence takes a significant toll on a patient's wellbeing. Meds 360° is a resource clinicians and organizations nationwide are finding invaluable in their efforts to provide safe, high-quality care that also contributes to cost reduction and better achieves the objectives of value-based healthcare.
Health Literacy
The definition of health literacy was updated in August 2020 with the release of the U.S. government’s Healthy People 2030external icon initiative. The update addresses personal health literacy and organizational health literacy and provides the following definitions:
Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
These definitions are a change from the health literacy definition used in Healthy People 2010 and Healthy People 2020: “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
The new definitions:
Emphasize people’s ability to use health information rather than just understand it
Focus on the ability to make “well-informed” decisions rather than “appropriate” ones
Incorporate a public health perspective
Acknowledge that organizations have a responsibility to address health literacy
From a public health perspective, these definitions indicate that people and organizations can use their health literacy skills to improve the health of their communities and its members.
Maneuvering The Healthcare System
Barriers:
Fear
Trust
Language barriers
Travel
Work
Childcare
Money
Age ... eyesight, etc
Filling out forms
Apathy
Not following up with doctors
Not following care instructions
Not making or keeping appointments
Lying
Waiting until the last minute to refill a prescription. Please don't!! Reorder when you're down to a 7-day supply
Books
https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care
I've prolly forgotten something, so I'll give it a few days and see if more comes to mind, Maybe, tomorrow, I'll write a hypothetical-mock example to give step-by-step instructions.
***
I could've been a promotora 😭
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