Taking Control Of Your Health
by Paul Muoio, COO

Take Control Or It Can Cost You
The most precious possession we have is our health. We cannot afford (fiscally and physically) to be passive about our health care. The most influential advocate you may have is YOU.

Advances in medicine and technology enable us to live longer, healthier and more productive lives. Unfortunately, most Americans do not understand the value of taking advantage of the health care system and taking personal control of their health. Why does it typically take the escalating “cost of care” to motivate us to take a pro-active approach? We expect the health care system to deliver quality of care but why don’t we demand better care from ourselves, for ourselves?

Here are some suggestions for taking control and making a difference.

Be A Better Consumer
Understand your type of insurance coverage. Some issues to address include:

• Is your benefit package a PPO, HMO, POS, Consumer Driven Health Plan or one of the various other products available in the market?
• Is your plan community rated, experience rated, or self-funded?
• What are the specific benefits of your coverage? Do the benefits cover your specific current health condition? Do the benefits address concerns you may have for future conditions?
• Does the provider, hospital, lab and pharmacy network meet your specific needs?
• Can you stay in-network and get the quality of care to meet your needs?
• Do you have out-of-network benefits?
• What are the specifics of the pharmacy benefit? Examine the formulary and the drugs that have prior-authorization restrictions. What can you do to save your expense within the pharmacy benefit and still obtain quality care? Buying generic, pill splitting, and taking advantage of the mail order program can help curb expenses.
• Does your employer offer voluntary or supplemental products to complement the gaps in your coverage to ensure your specific needs are covered?

Be A Detective
Due to the complexity of health care and increased cost shifting of the premium to be paid by employees you may be forced to make more and more health care decisions. Educate yourself to make better and more informed decisions. Learn to probe. Ask questions. Do your homework about yourself and the industry. What does health care cost? What should it cost?

Be In Control

• Consider what environmental and lifestyle changes would enhance your overall health level.
• Take risk assessment tests periodically. In most cases, taking control of your health now will reduce the chance of long-term care requirements and expenses.
• Be a good patient and take your medications.
• Keep adequate records and notes to share with your health care provider. Keep a record of test results and be sure to take the time to understand your test results.
• Study your family history and get involved in the various Disease Management, Wellness Programs, and Preventive Care Programs that may be available from your company and/or insurance carrier.

Be Informed
The amount of information available can be overwhelming but this is an advantage to you. Resources include:

• The internet;
• Your company Human Resources Department;
• The industry professional that services your company (broker, consultant);
• The member services/customer service department at the insurance carrier;
• Hospital medical libraries;
• A second opinion from a health care provider; Ask for a case manager to be assigned from your insurance carrier if you are experiencing a serious condition.

Engage A Mentor
Mentors can help you through the various stages of your journey back to health. You may have different mentors at the various stages of your condition. A mentor is:

• Informed and experienced. Previously dealt with similar medical issues;
• Trustworthy. Privacy is paramount;
• Available. Willingly and easily reachable almost anytime;
• A good, gentle listener. Understands the patient’s vulnerability and mind-set;
• Empathetic but objective. Keeps own emotions in check;
• Never domineering. Guides, not steers;
• Free. Expects nothing in return.

From U.S. News & World Report, November 8, 2004

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