~ You Can Track Your Claims On-Line â€” P. 25 ~
A new year, a new you
Mak in g Heal thy Ch oic es
“BLUE” products offer more affordable CHOICES New —————————————————————————— A
rkansas Blue Cross and Blue Shield recently created six new products for members. The products are designed to offer more choices for the budget-conscious consumer. “For more than 50 years, Arkansas Blue Cross has been driven by the insurance needs of Arkansans,” said Sharon Allen, president and chief operating officer of Arkansas Blue Cross. “Understanding those needs requires listening to our customers — employers, members and agents. Employers have told us they need more predictability to be able to budget for health insurance, and our members have told us they need more choices, more flexibility. Everyone wants more affordable health insurance coverage. These new products are a direct result of our being responsive to the marketplace and our customers.” The new products are:
MyChoice Blue — This product allows employers of any size — from 2 to 2,000 employees — more predictable premium contributions while offering each employee the freedom to choose from among four separate benefit designs. The four distinct plans all include a comprehensive Preferred Provider Organization (PPO) network, office visit copayments for both primary care physicians and specialists, preventive care, prescription drug card, inpatient and outpatient services, full range of ancillary services, and treatment for emergency medical conditions at the innetwork benefit level. BlueFlex® PPO — This product is designed for companies with 2 to 50 employees. Members can visit any physician they choose, but they receive a higher level of covered benefits when they visit providers in the Arkansas’ FirstSource PPO network. Members have the flexibility to choose the deductible that best suits their needs. Plan highlights include wellness benefits, physician services, laboratory and X-ray services, inpatient and outpatient services, emergency care, durable medical equipment, and mental illness, alcohol and drug treatment.
BasicBlue® & Group BasicBlue® — These lower-cost health plans for individuals (BasicBlue) and groups (Group BasicBlue) are designed to provide
essential health insurance at a more affordable price. Members have the freedom to use any health care provider, but can save money by selecting a physician in the Blue Book network. Plan highlights include inpatient and outpatient care, physician services, catastrophic major medical coverage, and ambulance and emergency services.
MSA Blue® — A highdeductible health plan that allows you to set up a companion medical savings account (MSA). The employer-sponsored health plan pays covered medical and prescription claims at 80 percent. It offers deductibles of $2,500 (individual) and $4,500 (family), and members receive the benefit of negotiated provider discounts with unrestricted choice of providers, and a lower, more affordable premium. The medical savings account may be used to pay certain non-reimbursed medical expenses, and the amount in the fund can build up year to year. (No “use it” or “lose it.”)
Consumer-Driven Health Plan — This product gives consumers more control over how their health care dollars are spent. It offers more flexibility in managing out-of-pocket costs and more choices of in-network and out-of-network providers. The plan allows consumers to roll over eligible unused dollars into the next plan year for future health care expenses. It also offers consumers Web-based tools to guide the best use of their health care dollars, find physicians and hospitals and answer questions.
Open Access POS (OAPOS) — This plan combines the characteristics of a traditional health maintenance organization (HMO) coverage with the extra provider options of a point-of-service (POS) plan. OAPOS provides preventive and routine services with co-payments for visits to primary care physicians (PCPs). Members of the OAPOS plan also may visit their in-network specialty physicians without a PCP referral; this is where the lower-priced health plan becomes apparent with benefit choices of deductibles, co-payments and co-insurance for specialty and hospital services.
Customer Service Numbers Little Rock Toll-free Number (501) Number
State/Public School Employees 378-2437 1-800-482-8416 e-mail: email@example.com firstname.lastname@example.org Medi-Pak (Medicare supplement)
Medicare (for beneficiaries only): Part A (hospital benefits) Part B (physician benefits)
378-3151 1-877-356-2368 378-2320 1-800-482-5525
UniqueCare, UniqueCare Blue, Blue Select®, BlueCare PPO & PPO Plus (individual products) 378-2010 1-800-238-8379 Group Services
Federal Employee Program (FEP)
For information about obtaining coverage, call: Category
Little Rock Toll-free Number (501) Number
Medi-Pak (Medicare supplement)
Blue Select®, BlueCare PPO & PPO Plus (individual products) 378-2937 1-800-392-2583
Regional Office locations: Central Northeast Northwest South Central Southeast Southwest West Central
Little Rock Jonesboro Fayetteville Hot Springs Pine Bluff Texarkana Fort Smith
Customers who live in these regions may contact the regional offices or call the appropriate toll-free telephone numbers above.
www.ArkansasBlueCross.com, www.HealthAdvantage-hmo.com, www.BlueAdvantageArkansas.com, www.BlueAndYouFoundationArkansas.org www.BlueAnnEwe-ark.com
is published four times a year by Arkansas Blue Cross and Blue Shield for the company’s members, health care professionals and other persons interested in health care and wellness.
INSIDE THIS ISSUE
New “Blue” products ................................... 2 Obesity: an alarming health trend ............. 4-5 Why are our children overweight? ............ 6-7 Guidelines for physical activity ................... 7 Hooked on chocolate or caffiene? ............... 8 Alcohol — friend or foe? ............................. 9 Preventive health for children ................... 10 Practicing good breast health ................... 11 Men: remember your TSE ........................... 11 Club drugs ............................................ 12-13 Can you kick the smoking habit? .......... 14-15 Household chemical disposal ............... 14-15 Carpal tunnel syndrome ............................. 16 Driving safety tips ..................................... 16 Health information on the Web ............. 18-19 Changes to third-tier formulary ................. 20 Health Advantage survey results .......... 20-21 AHIN: no more access fee .......................... 21 Standards for privacy, Making a move ............. 22 The pharmacist is in .................................. 23 Shoptaw named Association chairman ...... 24 On-line self-service with My Blueprint ...... 25 New medical director, New ad campaign .......... 26 ScriptSave drug discount program ............. 27 New ID card for Medi-Pak Plan I members . 27 Blue & Your Community ............................. 28 Vice President of Advertising and Communications: Patrick O’Sullivan Editor: Kelly Whitehorn — BNYou-Ed@arkbluecross.com Designer: Gio Bruno Contributors: Tammi Bradley, Janice Drennan, Damona Fisher and Kathy Luzietti Guest Contributor: Joseph A. Banken, Ph.D., UAMS
4 O b e s i t y
an alarming health trend T
oday, more than 38 million American adults are considered obese. This trend is alarming because obesity is linked to an increased risk for illnesses such as high blood pressure, diabetes, coronary artery disease, congestive heart failure, stroke, osteoarthritis, respiratory disorders and much more. The percentage of women who are overweight and obese is higher among members of racial and ethnic minority populations than in non-Hispanic white women. There is a higher percentage of Mexican-American men who are overweight and obese when compared to nonHispanic whites or non-Hispanic blacks. For all racial and ethnic groups combined, women of lower socioeconomic status are approximately 50 percent more likely to be obese than those of higher socioeconomic status. What has caused this trend? The reasons include behavior (simply eating too much and not getting enough exercise), environment (home, work, school or community can create barriers to an active lifestyle), and genetics (heredity plays a large role in determining how susceptible people are to being overweight or obese). Although behavior and environment are the main contributors to weight problems, they all offer the greatest opportunities for prevention and treatment. They are factors that can be controlled. Obesity is defined as having a BMI (body mass index) of 30 or greater. According to surveys, 26 percent of women are obese, while 20.6 percent of men are considered obese. What are the costs of obesity? In 2000, the cost of obesity in the United States was more than $117 billion. Poor nutrition and physical inactivity account for approximately 300,000 premature deaths in the United States each year.
How do we define overweight and obesity? Overweight is defined as a Body Mass Index (BMI) of 25.0-29.0, and obesity is defined as a BMI greater than or equal to 30.0. Overweight refers to increased weight in relation to height, when compared to some standard of acceptable or desirable weight. Obesity is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass. Desirable weight standards are found in several ways: 1) By using a mathematical formula known as BMI, which represents weight levels associated with the lowest overall risk to health. Desirable BMI levels may vary with age. 2) By using actual weights and heights measured and collected on people who are representative of the U.S. population by the National Center for Health Statistics. According to the National Institutes of Health Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, all adults (18 and older), who have a BMI of 25 or more are considered at risk for premature death and disability as a consequence of being overweight or obese. These health risks increase as the severity of the obesity increases. What can be done to change the trend? The Surgeon General recently called for a broad approach to avoid and reduce obesity. He challenged people to work together through communication and education, to take action by helping Americans balance healthy eating with exercise, and to conduct research to evaluate the publicâ€™s understanding of the causes, prevention and treatment.
… Reasons include behavior and environment … factors that can be controlled. According to the Surgeon General, losing just 10 percent of your body weight can improve your health. The Surgeon General also recommends that gradual weight loss is the best way to go — losing just 1 to 2 pounds per week is recommended. Additionally, the Surgeon General recommends physical activity at least 30 minutes per day most days of the week (60 minutes for children) and limit TV watching to two hours per day. Americans should eat sensible portions based on the Dietary Guidelines for Americans (www.health.gov/dietaryguidelines). The Centers for Disease Control and Prevention’s Division of Nutrition and Physical Activity recommends that the easiest and safest way to lose weight is to reduce calories and increase physical activity. Government research and recommendations can provide the facts based on science so that people can make informed choices about appropriate weight loss. The fact is that the majority of people who are attempting weight loss are not using the correct methods to maintain or achieve positive results. — Sources: American Obesity Association, Centers for Disease Control and Prevention, WebMD, American Dietetic Association and the University of New Hampshire Cooperative Extension
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Why are our children overweight? And what can we do about it?
n 1972, approximately 12 percent of America’s youth were considered overweight. Today 25 percent of U.S. children and adolescents are considered overweight. African American, Hispanic American and Native American children and adolescents have particularly high obesity rates (30.9 percent, 30.4 percent and 38.5 percent, respectively). There are numerous health risks associated with childhood obesity. Diabetes — Type 2 diabetes in children has increased dramatically in the last 20 years. The parallel increase in obesity is reported to be the most significant factor for the increase in diabetes. Sleep disorders — Apnea, hypopnea, excessive nighttime arousals or abnormalities in gas exchange have been associated with obesity. Hypertension — High blood pressure is nine times more prevalent among obese children. Approximately 20-30 percent of obese children have high blood pressure. Menstrual abnormalities — Early menarche is observed in obese girls. Late or absent menstruation also is associated with obesity. Orthopedic complications — When children are growing, bone and cartilage are in the process of development and are not strong enough to bear excess weight. Obesity can cause numerous orthopedic complications. In a study of Blount’s Disease (severe bowing of the legs), approximately 80 percent of patients were obese. Eating disorders (anorexia nervosa, bulimia, binge eating) — Everywhere you look, there is an emphasis on weight in American society. There are numerous weight loss products on the market, and most people have dieted at one time or another. In a recent study of elementary school students (third through sixth grade), 70 percent believed they were fat, 45 percent wanted to be thinner, and 37 percent had tried to lose weight. Psychosocial effects and stigma — Obesity may cause inappropriate expectations and adverse socialization because the child looks older for their age. Overweight children and adolescents often receive negative feedback from their peers and parents. Why are children more overweight than ever before? Genetics, overeating and lack of physical activity all can contribute to obesity.
Experts believe there are two main reasons for the alarming rate in childhood obesity: the food they eat and their lack of exercise. The good news is that parents can reverse this trend by helping their children make healthy choices and encouraging exercise. By making these changes fun and nonthreatening, children will not feel deprived or different. Because families are so busy, many times moms and dads turn to fast food to feed their children. Fast foods usually are high in fat and sugar. Additionally, fast foods put children at risk for nutritional deficiencies that contribute to a lack of energy, mood swings, sleep difficulties, poor school performance and more illnesses. Children also get less exercise than they used to get. The average American child spends 24 hours a week watching television. And that doesn’t include time spent playing video games, watching movies or working on the computer. For children who are overweight, there are things parents can do to help him or her trim down. It is up to the parent to help children make healthy choices. Additionally, by modeling healthy habits themselves, parents set powerful examples for their children. Studies show that children whose parents are overweight are more likely to become overweight adults themselves.
Focus on healthy choices Do not limit the amount of food your child eats. Limiting food is not the answer and is not the healthy choice. Limiting food can lead to eating disorders and can cause other health problems. Instead of focusing on deprivation, focus on replacing unhealthy food choices with healthy food choices. Instead of chips, offer grapes as a snack. Instead of a candy bar, offer yogurt or a banana. Keep healthier food choices visible — a bowl of fruit on the counter or carrot sticks in the refrigerator. If eating in front of the television is a problem, do not allow your child to eat while watching TV or sitting at the computer. When your family does eat out, choose the smaller portions (no super sizing) and choose grilled
items rather than fried. Stay away from buffets and all-you-can-eat specials.
Get children moving Children need more physical activity. With plenty of physical activity, children will lose weight or avoid the weight gain in the first place. Choose activities that are fun and be sensitive to the child’s needs. Do not pick activities that may be difficult. Plan fun family outings such as bike rides, swimming at the pool and hikes. Take a family walk after dinner; play tag and hopscotch; set
up a volleyball net in the backyard; shoot the basketball; and play Frisbee. Instead of focusing on losing weight, focus on increasing physical activity and making healthier food choices. Develop healthy habits now to last a lifetime. — Sources: University of New Hampshire Cooperative Extension Program, American Dietetic Association, American Obesity Association and The American Academy of Child and Adolescent Psychiatry
Guidelines for physical activity levels Are you really exercising? Here are a few guidelines as to how to classify your own physical activity.
healthy, you need at least 20 to 40 minutes of this type of exercise three times a week.
Playing the piano Floating on a river Golfing with a cart Playing pool Walking at a pace of two miles per hour
Strength exercises build your muscles. These exercises involve the use of progressively heavier resistance in the form of weights, bands or exercise machines. Without regular strength training, you will lose muscle mass after age 25. If you are new to weight training, find someone professionally trained to help you get started. Using weights improperly can cause injury to muscles and joints. A community fitness center is a good place to find an advisor. Once you learn the basic techniques, you can do weight training on your own. You don’t need fancy equipment. Soup cans or milk jugs filled with water or sand will work. Your goal is to increase gradually the number of repetitions you can do and the amount of weight you can handle. About 30 to 40 minutes two to three times a week is enough to maintain muscle tone.
Moderate Leisurely bicycling Golfing without a cart Walking at a pace of three or four miles per hour Playing Frisbee Badminton Gardening
Vigorous Chopping wood Climbing hills Cycling Dancing Jogging 10-minute miles Swimming Tennis Walking at a pace of five miles per hour
Nothing but the truth To maintain good health, both men and women need three kinds of exercise: aerobic, strength training and flexibility.
Aerobic exercise Aerobic exercise helps to keep your lungs, heart and circulatory system healthy. Aerobic exercise increases your breathing and heart rate and builds endurance. It should be rhythmic and continuous. Walking, jogging, cycling, dancing, stair climbing, cross-country skiing, rowing and swimming are examples. To keep your heart
Flexibility Stretching increases your physical performance and decreases your risk of injury. It helps keep your body limber. Flexibility exercises also increase blood flow to your joints, improve balance, decrease your risk of lower back pain and reduce stress in muscles. Stretching is a good way to relax mentally and physically. You should do five to 10 minutes of stretching before and after a workout. — Sources: http:// www.healthfinder.gov, WebMD, American Dietetic Association, and Centers for Disease Control and Prevention
Hooked on chocolate
“I’m a chocoholic.”
“I can’t wake up without three cups of coffee in the morning.” “I need my caffeine fix . . . my chocolate fix.” We’ve all heard these snippets in American society, but are some people really addicted to these common substances; and is this “addiction” harmful to their health?
Chocolate Through the ages, chocolate has been considered a mood enhancer, an aphrodisiac and even “food of the gods.” People crave its flavor, smell and texture. They use it for self-medication when they are “feeling down.” Chocolate affects the chemistry of the brain as cocoa fats stimulate the production of natural opiates and cause a feeling of well-being. Chocolate also contains cannabinoids, chemicals similar to those found in marijuana, which may cause a pleasurable feeling. Another substance found in chocolate, phenylethylamine, is the same chemical that produces the “rush” felt by a person who is “in love” and that is used in medications to relieve depression. The pleasurable effects of chocolate may be rooted more in myth than reality. The amount of phenylethylamine in chocolate is so small that you could get nine times more by eating salami sausage. And you certainly don’t get the same kind of “high” from eating chocolate as you would from smoking marijuana. There is some truth, however, that eating chocolate may actually be good for your health. Chocolate contains flavonoids, a type of antioxidant beneficial to cardiovascular health. Flavonoids help reduce the vesselclogging effects of cholesterol. They have antiviral, antiallergic, anti-inflammatory, antithrombogenic and anticarcinogenic effects. A University of California at Davis research team has found that eating chocolate also promotes relaxation of the blood vessels, which enhances blood flow. There is no scientific evidence that chocolate triggers migraines or causes acne. The beneficial effects of chocolate, however, are not an excuse to substitute bon bons for fruits and vegetables. On the negative
side, those creamy confections contain fat, sugar and caffeine. The caffeine in an ounce of chocolate, however, is low (10 to 20 mg.) in comparison to a six-ounce cup of coffee (105 mg.) Chocolate comes from the seeds (beans) of the cacao tree, Theobroma cacao, native to the American tropics. The heart of the beans (nibs) are ground into “chocolate liquor,” which contains cocoa solids and cocoa butter, which is a fat. The nonfat component gives chocolate its dark, rich color and contains the flavonoids and moodenhancing chemicals. Dark chocolate contains more of the cocoa solids, as well as cocoa butter and sugar. Milk chocolate contains cocoa solids, sugar, cocoa butter and milk. White chocolate contains only the cocoa butter, sugar, milk fats and milk solids. The Mayans began cocoa cultivation in Central America about 1500 B.C. Mayans and Aztecs thought that the god Quetzacoatl gave them the cocoa tree. The precious cocoa beans were used as currency. The sacred beverage called “chocolatl” was consumed from golden cups. People may crave chocolate, but they aren’t really physically addicted to it. If they stopped eating chocolate on any given day, they wouldn’t suffer physical withdrawal or ill effects. It appears that craving for chocolate is linked to its flavor and other sensory properties rather than the bioactive compounds it contains. The danger comes when you replace foods that have a higher nutritional value with chocolate. Like anything else, moderation is the key.
Tea and Coffee Like chocolate, tea and coffee may be habit forming but are not truly addictive. You will suffer withdrawal symptoms (headache, fatigue, drowsiness) if you stop your caffeine intake suddenly; but these will disappear in a day or two. The danger comes when you go overboard and ingest too much caffeine. The question is, how much is too much? How much is harmful to your health? Caffeine is a central nervous system stimulant and diuretic (increases the flow of urine). It exists naturally in plants and can be produced synthetically. It is found in tea leaves, coffee and cocoa beans. Caffeine is added
to carbonated beverages. It is a frequent ingredient in over-the-counter medications, such as pain relievers, cold medicines and appetite suppressants. Caffeine increases alertness and enhances the senses. Moderate caffeine intake is not associated with any health risk. Three eight-ounce cups of coffee (300 mg. of caffeine) is considered moderate intake. Ten cups is considered excessive. Excessive caffeine intake can lead to a fast heart rate, excessive urination, nausea and vomiting, restlessness, anxiety, depression, tremors and difficulty sleeping. Some studies have shown that excessive caffeine intake in older women may lead to osteoporosis (bone loss). However, other studies indicate that caffeine does not actually cause bone loss but does increase urinary excretion of calcium, which is necessary for bone health. No scientific evidence indicates that caffeine affects blood cholesterol, increases blood pressure or causes chronic hypertension. Moderate intake is not associated with any increase in cardiovascular disease risk. Caffeine is not associated with fibrocystic breast disease. Pregnant women might choose to limit their caffeine intake as a precaution. Caffeine easily passes from the mother to the unborn child through the placenta. Studies of the effects of caffeine intake on miscarriages, birth defects and low birth weight, however, have been inconclusive. Your favorite caffeine source may have some positive effects on your health. Tea, like chocolate, contains flavonoids, which promote cardiovascular health. Tea also has been shown to decrease inflammation within blood vessel walls. If you don’t add sugar or cream to your tea, moderate amounts are good for you. Again, moderation is the key. — Sources: American Chemical Society; American Cocoa Research Institute; Center for the Evaluation of Risks to Human Reproduction; National Institutes of Health; International Cocoa Organization; International Food Information Council Foundation; Medline Plus Health Information; National Institutes of Health; Radio Netherlands; Science News Online; University of Louisiana, Lafayette; U.S. Food and Drug Administration; www.discover.com and www.healthfinder.gov
friend or foe?
T o drink or not to drink? For the majority of people, moderate drinking is not harmful to your health and may even have some health benefits. For people who are genetically or environmentally at risk for alcoholism or who abuse alcohol (one in every 13 adults), drinking can lead to poor health, personal relationship problems and even death. Moderate alcohol use means no more than two drinks per day for men and one for women. For older people, it’s one drink per day. A drink is: • One 12-ounce bottle or can of beer or a wine cooler, • One 5-ounce glass of wine, or • 1.5 ounces of 80-proof distilled spirits. Alcoholism is a disease for which there is no cure. It has four symptoms: • Craving: A strong need or compulsion to drink. • Loss of control: The inability to limit one’s drinking on any given occasion. • Physical dependence: Withdrawal symptoms, such as nausea, sweating, shakiness and anxiety, occur when alcohol use is stopped after a period of heavy drinking. • Tolerance: The need to drink greater amounts of alcohol in order to “get high.” The cause of alcoholism is not fully understood. Alcoholics have a powerful craving or uncontrollable need similar to the need for food and water. This craving has little to do with willpower. Genetics plays a role. Studies show that children of alcoholics are more likely to become alcoholics if they choose to drink. Environmental factors, such as where and how you live, family, friends, culture and peer pressure also play a role. Although there is no cure, alcoholism is treatable. Medications and counseling usually go hand in hand to keep alcoholism under control. Alcoholics may have relapses, but they can go years without “falling off the wagon.” Some people who are not alcoholics may suffer from problem drinking (alcohol abuse). Alcohol abuse differs from alcoholism in that it does not include an extremely strong craving for (Alcohol, continued on Page 17)
the kiddos healthy Keeping ---------------
ll children should have the opportunity to reach their full potential. Practicing good disease prevention starts before birth and lasts a lifetime. Some of the best
ways for parents to make sure their kids get off to a good, healthy start is through immunizations, proper health screenings and well-child checkups.
PREVENTIVE HEALTH 2002 GUIDELINES Screening for Children – Normal Risk Infancy AGE
Early Childhood 6m 9m 12m 15m 18m 24m 3y
History & Physical Exam, Hearing & Vision, Immunization Status At birth
After 24 hours After 24 hours Infant by history and exam
10y 12y 14y 16y 18y 9-21y
Urinalysis Blood Pressure Height & Weight or BMI Head Circumference Anemia Screen
Once in age range
Vision for Amblyopia & Strabismus Tuberculosis
Once in age range High-Risk Populations
Lead Risk Assessment Chlamydia (sexually active females) Pap with pelvic (sexually active every 1-3 years) Active screen for Problem Drinking & Tobacco use
If sexually active If sexually active
Always check your health benefits plan to see which preventive services are covered and to what extent. All referenced health services may not be covered under a health plan. Check the terms of your health plan or policy for coverage of services. Practice healthy lifestyles yourself and teach your children — good nutrition, exercise, dental hygiene, safety, proper sleep, and avoiding tobacco, alcohol and drug abuse — to help stay ahead of illness and disease. Please Note: These guidelines are evidence-based and provide the basics of preventive care for average patients. These guidelines are for normal risk. High-risk populations are not addressed in this guideline. They do not replace clinical judgement. You should always consult your physician for medical advice.
P lan to practice good breast health T
he two primary risk factors for developing breast cancer are being female and getting older. Obviously, these factors cannot be controlled. While there is no cure at this time, practicing good breast health habits is a woman’s best assurance of detecting and beating this disease. Make a promise to yourself to practice good breast health and a plan on how to do so. Breast cancer is the leading cause of death in women 40-59. Education and a personal commitment to put the education to work are essential for the early detection and treatment of breast cancer, which lead to better chances of survival. There are three steps to follow: 1) Monthly Breast Self-Exams (BSE), 2) Annual clinical exams by a physician or nurse practitioner, and 3) Annual mammograms starting at age 40. The Breast Self-Exam (BSE) is a commitment women make to themselves and to the ones who love them to perform a monthly breast self-exam (BSE). Starting at age 20, the monthly exam should be done approximately one week following the start of the menstrual period. For women who have reached menopause, the BSE should be done on the same day each month. It is suggested that women select a day that has meaning, such as a birth date or anniversary date, so that the day is easily remembered. This must be a life-long commitment. The next step is an annual physical examination by a physician or nurse practitioner. Women do not need to see a gynecologist if their family physicians are including
B S E
breast and cervical exams in the annual physical. If a physician or nurse practitioner does not include a breast exam in the physical, it is perfectly acceptable — in fact, it is encouraged — for women to request a breast exam. Finally, don’t forget to have a baseline screening mammogram which should be done sometime before the age of 40. Then, once a woman reaches 40, screening mammograms should be done on an annual basis. Mammograms are non-invasive, low-dose radiological exams of the breast tissue and are safely done with special radiology equipment. Mammography is about 90 percent effective and can detect tiny lumps before they can be felt. It is important that the mammogram be done in a qualified mammogram facility (whether located in a permanent building or a mobile unit), because the qualified facility must follow very strict standards administered by the Food and Drug Administration (FDA). It is also recommended that the same facility be used each year to facilitate consistency and comparison of the films from one year to the next. Alone, each step is important. Together, these three steps are powerful and offer the best package women have today to protect themselves and to detect breast cancer early enough to have successful outcomes. The sooner a breast health program is begun and consistently followed, the greater the chances of survival. — Sources: American Cancer Society and the Susan G. Komen Breast Cancer Foundation
Men: remember your TSE Testicular cancer is the most common type of cancer in men between ages 18 and 34. When detected early, it is one of the easiest to cure. That’s why it’s important for men to practice testicular self-exams (TSE). If testicular cancer goes undetected at its earliest stages, it may spread throughout the lymph node system into the lungs and other parts of the body. Testicular cancer is particularly dangerous because there are usually no symptoms associated with it. However, several predisposing factors may place some men at higher risk: past medical history of undescended testicle, mumps orchitis, inguinal hernia during childhood, or previous testicular cancer. So how can a man detect testicular cancer? All men
should perform monthly testicular selfexaminations (TSE) just as women are encouraged to do monthly breast selfexaminations. Testicular cancer usually starts as a small pea-sized lump within the testicle. It probably would not be noticed unless self-exams are routinely performed. Treatment of testicular cancer includes surgery (removal of the testicle and associated lymph nodes), radiation therapy and chemotherapy. If symptoms of testicular cancer occur, call your physician for an appointment. If you are a male (15 or older), your physician should be performing routine testicular screenings during routine physician examinations, and teaching you to perform TSE.
Club Drugs: by Joseph A. Banken, Ph.D., Assistant Professor; Director, Behavioral Sciences, Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences
any parents, school officials and law enforcement authorities are concerned about the increased numbers of youth using so called “club and recreational drugs.” These drugs are more commonly used in connection with all-night dance parties, known as Raves. Although not all people who attend and participate in Raves use drugs, available research shows that a significant percentage of people attending Raves are using drugs. Additionally, club and recreational drugs also are used outside the Rave environment. Raves are all-night dance parties that often feature loud, “techno” music and elaborate light shows. The Rave, as a venue for dancing and partying, originally developed in England and more recently has gained considerable popularity among youth in the United States. A recent study suggests the growing popularity of Raves is contributing to an increased number of participants using club and recreational drugs. It is believed that the use of drugs at Raves greatly intensifies the sensation of the music, light shows, the feeling of psychologically connecting with others and a euphoria that is part of the Rave culture. Although there is no official description of a “club” or “recreational” drug, there are several common drugs that are known as such. This overview highlights the most common club and recreational drugs. These so-called club and recreational drugs commonly include Ecstasy, also known as MDMA, (3, 4Methylenedioxymethamphetamine) Rollies, X, XTC, and a variety of other names. GHB (Gammahydroxybutyrate) is also known as Georgia Home Boy and EZ-lay. Methamphetamine often is referred to as meth, and its more powerful forms may go by terms such as Glass and Ice. LSD (lysergic acid diethylamide), considered one of the drugs from the decade of the 1960s, is often recognized as acid. These drugs have no known medical use and are believed to have a high potential for abuse. Ketamine, sometimes used as a surgical anesthetic, is more commonly used as a
veterinary anesthetic and is referred to as Special K, KitKat, Vitamin K, and Cat Valium among other names. Although other drugs also are used in the party setting, these drugs generally are considered among the most popular. The most well-known club drug is Ecstasy. Ecstasy is both an hallucinogenic and amphetamine drug, so it produces strong hallucinations and energizes the user to a high level of activity for hours — in frenetic dancing, for example. Many who use Ecstasy report feeling an onset of serious depression 2-3 days after using this drug. This depression can last for several days. In the drug-use culture, this has been referred to as “suicidal Tuesdays,” and sometimes has warranted the involvement of a mental health professional. Sometimes the quantity of the Ecstasy, or other dangerous substances added to Ecstasylike drugs, and a high level of activity by the user can increase body temperature to a fatal level. There have been deaths in Arkansas related to reactions to the use of Ecstasy and other club drugs. Recent scientific research suggests possible brain damage that can result from the use of Ecstasy. GHB and its chemical cousin GBL (Gammabutyrolactone), are other club drugs common in the Rave culture. Both GHB and GHL and other related drugs can be lethal when combined with alcohol or other drugs that depress the brain and nervous system. Methamphetamine and its derivatives are known to cause a significant increase in energy and activity of the user. In addition, dangerous increases in heart rate and blood pressure also can develop. Following the use of methamphetamine, the user often experiences powerful feelings of depression and cognitive problems. Sometimes these experiences are accompanied by violent behavior. Almost everyone has heard of the large number of meth labs that have cropped up in Arkansas and the Midwestern part of the United States. LSD is a strong hallucinogenic drug that was popularized in the 1960s, and has made a comeback in the Rave culture. LSD is a powerful hallucinogenic substance that creates strong hallucinations and generally lasts for several hours more than other commonly used club drugs. Some persons who have used LSD have developed “flashbacks” of disturbing images and hallucinations
A QUESTION OF SAFE OR SORRY? long after they have stopped using LSD. In some cases these flashbacks have resulted in the person seeking mental health treatment. Current research clearly indicates there is no safe use of any of these powerful drugs. There is no scientific measure for so-called safe recreational use. Unlike medicine regulated by the Food and Drug Administration (FDA) and standardized by the pharmaceutical industry, common club drugs are neither regulated nor subject to exact dosage formulas or quality control. The person who uses club and recreational drugs has no assurance of what he/she is putting in his/her system and affecting his/her brain. As if club drugs by themselves are not enough, some people further increase their risk of harm by combining different club and recreational drugs with other drugs in an effort to “fine tune” their drug experience and reduce unpleasant effects of certain drugs. One of the more recent drug combinations has been Ecstasy and Sildenafil citrate (Viagra ®), referred to by the street name of “Sextasy’. This combination can result in a dangerous cocktail that could have serious physical and brain chemical consequences. Using club and recreational drugs can have serious consequences of which many users and even some medical professionals may not be aware. An increased number of studies from research universities are suggesting that XTC may cause brain damage and can place the user at significant risk for serious and sometimes fatal increases in body temperature and dehydration. GHB, and its chemical cousin, GHL have been implicated in the victimization of users, due to profound loss of control of their mental and physical capabilities while under the effects of this drug. The use of Methamphetamine and its derivatives have been clearly associated with incidence of physical damage to the body. It is important to know that there is no “quality control” of club and recreational drugs. This is most clearly an example of “buyer beware.” In fact, some of the most popular club drugs are not drugs at all, but rather “bum” substances, some of which carry hidden
and sometimes lethal dangers. In summary, club drugs are powerful and dangerous drugs that dramatically change the brain and body of the user. Many users of these drugs say it makes them “feel good,” and that it is difficult for them to believe the drugs can hurt them or cause serious problems now or later. Little is known about how these drugs affect the brain and body of the user. Even less is known about possible long-term and permanent effects of these drugs. Many young people are tempted to experiment “just once” based on the testimony of a friend who is a user or from ‘information’ they have read over the Internet. Some may falsely believe these drugs are natural products and therefore safe, although there are many natural products and herbs that are unsafe. Others may think Ecstasy and other popular club drugs are unquestionably different from illegal “street drugs”. Myths about these drugs are plentiful. There is much to be learned about these powerful drugs. Clearly the safest decision is NOT TO USE club and recreational drugs. As more young people, parents and professionals get the straight facts about these dangerous drugs, better and safer decisions will follow. A club and recreational drug may be the most powerful drug that you can NOT get with any prescription. In a final comparison with Russian roulette, it is a deadly fact that some people die the first time they experiment with these drugs. This is clearly one risk that is not worth taking with your brain or with your body. A lot rests on this decision. Here are some helpful Internet sites with information about club and recreational drugs. The more you KNOW about club and recreational drugs, the more you will SAY NO to using them. www.adfy.com www.clubdrugs.org www.nida.nih.gov
CAN YOU KICK
mokers have heard it time and time again — smoking causes lung cancer and emphysema, smoking is bad for you, smoking can kill you. But, despite those dire warnings, 25 million men (25.7 percent) and 22.6 million women (21.5 percent) in the United States still continue to light up their cigarettes. The relationship between tobacco use and cancers of the lung and head and neck has been established for almost 50 years. Of the estimated 53,000 cases of head and neck cancer diagnosed each year, 85 percent are associated with tobacco use. The relative attributable risk for morbidity from smoking for lung cancer is more than 90 percent; it is between 60 and 70 percent for other smoking-related cancers (larynx, oral cavity, esophagus, bladder, kidney, pancreas and other urinary cancers). Cigarette smoking can kill you. And if you’re a smoker, you also know another awful fact — it is hard to quit smoking. When you’re ready to kick the habit, here are six simple steps to help you on your way. 1. Identify your personal reasons for quitting. Smoking is bad for my health. Smoking makes my clothes, breath and hair smell bad. I want to be in control of my life, not a slave to a habit.
2. Set a quit date. If you smoke more at work, try quitting on a weekend. If you smoke more when relaxing or socializing, quit on a weekday. 3. Identify your barriers to quitting. What’s stopping you? Do the people around you also smoke? Become more aware of the situations that lead you to want to smoke. 4. Make specific plans ahead of time for dealing with temptations. Identify two or three coping strategies (from the list below) that work for you. 5. Get cooperation from family and friends. They can’t quit for you, but they can help by not smoking around you, providing a sympathetic ear and encouragement when you need it, and leaving you alone when you need some space. 6. Utilize your smoking cessation resources. Log on to the American Lung Association Web site at www.lungusa.org and utilize the interactive “Freedom from Smoking” support group and other materials available. Identifying your triggers and developing a plan for dealing with them helps give you the control needed to overcome them. Here are some possible triggers:
Household chemicals: W hether they are under your sink, above your washing machine or in your garage — there are probably products in your house that are labeled with words of caution such as “poison” or “keep away from children.” Household chemicals are made for specific purposes and pose no danger if they’re used and disposed of properly. The labels will use words like caution, poison and danger to show potential hazards. Proper disposal of household chemicals is especially important for our children, pets and sanitation and emergency response workers. It’s also important to store chemicals safely at home; children and pets might eat or drink chemicals that look edible to them. Chemicals tossed into the garbage may explode when mixed with
other chemicals or compacted in a garbage truck, injuring the workers operating the truck and anyone nearby. Gasoline, oil-based paint or other flammable material placed too close to a pilot light or any open flame can ignite. Those same materials will explode in a fire and injure firefighters. One way to reduce the amount of household chemicals you need to store is to only buy the amount of material needed for the job you have (even if you find a great sale). If you don’t use the entire amount of the chemical, it can become a problem. Share household chemicals with a friend or relative. Don’t store them for future uses. Regularly check your household chemical storage areas, and remove old products. In Arkansas, the Pulaski County
THE SMOKING HABIT ?
• When I wake up in the morning • With my morning coffee or tea • In my car on the way to work • At work during breaks • After each meal • When socializing, especially drinking or eating with friends • When I talk on the phone • When I watch TV • When I am feeling stressed or tense • When I am upset or have had an argument with someone • When I am bored • When I feel anxious or scared If you need help developing strategies for how to cope with your smoking triggers, try some of these suggestions and then come up with some of your own. Instead of lighting up when you’re:
Talking on the phone Driving Being around other smokers
Holding a straw or doodle. Chewing sugarless gum or munch on carrot sticks. Staying in a smoke-free environment as much as possible. Spending time with nonsmoking friends. Exercising, taking deep breaths or calling a friend. Going for a walk first thing in the morning. Changing the order of activities in the morning. Taking up a new hobby or playing with a child or pet.
Feeling tense or stressed Waking up in the morning Feeling sad or depressed
“You are in the best position to keep yourself healthy. If you will not smoke cigarettes, not overeat, exercise regularly, wear seat belts, and use alcohol only in moderation, you will do more good for your own health than can all of medical science.” — C. Everett Koop, M.D., Surgeon General of the U.S., 1981 to 1989
get rid of them the right way Regional Solid Waste Management District offers a monthly collection service for old, worn-out household chemicals. These collections are for individual households only; no businesses are allowed. Pulaski County residents may bring household quantities of latex and oilbased paint and paint solvents; motor oil, gasoline and antifreeze; common household cleaners such as ammonia, bleach, disinfectants and liquid and powder cleansers; household and car batteries; pesticides, herbicides and insecticides to the collection sites. Limits for each car are twenty 5-gallon cans of paint and five 5-gallon containers of any other material. Locations throughout the county
feature Saturday morning collections, including a reuse center where usable chemicals received at that collection site are stored and made available to Pulaski County residents for their use at no charge. Electronics such as televisions, VCRs, printer and computer components also are accepted at the collections. Remember … household chemicals are safe when used for their intended purpose and stored properly. Make healthy decisions in your house by making sure household chemicals are kept in their proper spots and disposed of in a safe and timely manner. This information is provided as a public service by Blue & You and the Pulaski County Regional Solid Waste Management District. Check the District’s Web site at www.pulaskiswdistrict.org for the latest collection schedule, or call the Recycling Hotline at (501) 340-8790.
Again…and again…and again
Carpal Tunnel Syndrome — a repetitive motion disorder
f, on any given day, you repeat the same hand movements over and over again, the result could be carpal tunnel syndrome. By doing the same activities with the same finger or hand movements (whether it be work, a hobby or sports) the result could be this disorder. Carpal tunnel syndrome accounts for more than 40 percent of all repetitive motion disorders. It is one of the most common causes for absenteeism from work. Stopping or reducing the activity that caused the injury, or changing the way in which a person does the activity can prevent carpal tunnel syndrome. Symptoms include tingling, numbing, weakness or pain in the fingers, hand and sometimes lower arm and elbow. The symptoms are a result of pressure on the median nerve within the wrist (carpal tunnel). Mild cases may be treated at home. The earlier the condition is diagnosed, the better the chances are for relief. Nonsurgical treatment is usually helpful. In most
cases, surgery is not needed. Home treatment for mild symptoms of carpal tunnel syndrome includes resting your fingers, hand and wrist (stop activities that cause numbness and pain); icing your wrist for 10 to 15 minutes at a time, as often as once or twice per hour; wearing a wrist splint to relieve pressure; and doing simple range-of-motion exercises to prevent stiffening. You should call your physician if you continue to have pain, numbness or tingling in your fingers or hand that lasts for more than two weeks; have little or no feeling in your fingers or hand; cannot do simple hand movements; cannot pinch your thumb and first finger together, or your pinch is weak; cannot use your thumb; or have problems at work because of pain in your fingers or hand. — Source: WebMD
Eyes on the road Driving safety tips I
f someone asked you to name the last time you did something risky, what would you say? You might tell them about the last time you went mountain climbing or the time you went sky diving. But did you mention the last time you drove your car? According to statistics collected by the Federal Highway Administration in 2000, there were approximately 6,356,000 car accidents in the U.S. In relation to the accidents, there were 3.2 million injuries and 41,821 deaths. Remember, when driving — be prepared and follow the rules of the road. Here are a few tips to help you be a safer driver.
Allow Enough Time. Leave in plenty of time to get to your destination. Always allow for traffic jams or other emergencies along the way. If you’re relaxed, you’ll be more patient and more likely to avoid aggressive driving behavior such as tailgating, excessive speeding and lane-changing that can lead to road rage (or collisions).
Plan Ahead. Adjust rearview mirrors, read directions, study maps, find sunglasses, change tapes or compact disks, etc., before you begin driving to avoid distractions while driving. Don’t Talk On the Phone. If you need to use your cell phone while driving, pull over to a safe location to place the call.
Fasten Your Seat Belt. You and all of your passengers need to buckle up before you start driving. If traveling with small children, make sure they are secured in the appropriate safety seat or restraint and that you follow directions for use. Children aged 12 and under always should be buckled up in the back seat because it is the safest place to ride.
Don’t Drink and Drive. Alcohol is one of the leading causes of fatal car accidents resulting from human error. Even small amounts of alcohol can impair judgment and reflexes when driving. Know the Signs of Fatigue. Be aware of medications that might make you drowsy. Try to eat light when (Tips, continued on Page 23)
(Alcohol, continued from Page 9)
alcohol, loss of control over drinking or physical dependence. Alcohol abuse is defined as a pattern of drinking that results in one or more of the following situations within a 12-month period: women after menopause. Long-term heavy drinking • Failure to fulfill major work, school or home increases the risk for high blood pressure, heart disease responsibilities; and some kinds of stroke. • Drinking in situations that are physically dangerous, such as while driving a car or operating machinery; Cancer — Long-term heavy drinking increases the risk of • Having recurring alcohol-related legal problems, such developing certain forms of cancer, especially cancer of as being arrested for driving under the influence of the esophagus, mouth, throat and voice box. Women are alcohol or for physically hurting someone while at slightly increased risk of developing breast cancer if drunk; and they drink two or more drinks per day. Drinking may • Continued drinking despite having ongoing also increase the risk for developing cancer of the colon relationship problems that are caused or worsened by and rectum. the drinking. Pancreatitis — The pancreas helps to regulate the Like alcoholism, alcohol abuse can result in body’s blood-sugar levels by producing insulin and has a numerous health problems and death. Long-term, heavy role in digesting the food we eat. Long-term heavy drinking can cause liver disease, heart disease, cancer drinking can lead to pancreatitis (inflammation of the and pancreatitis. Women develop health problems over a pancreas). This condition is shorter period of time after associated with severe consuming less alcohol abdominal pain and weight than men. Al-Anon Family Group Headquarters, Inc. loss and can be fatal. The most serious Phone: (757) 563–1600; Fax: (757) 563–1655 health effects of heavy E-mail: WSO@al-anon.org Besides these physical drinking are: Internet address: http://www.al-anon.alateen.org problems, the more heavily you drink, the more likely Alcohol-related liver Alcoholics Anonymous (AA) World Services, Inc. you are to have personal disease — Some drinkers Phone: (212) 870–3400; Fax: (212) 870–3003 problems at home and work develop alcoholic hepatitis E-mail: via AA’s Web site and in social settings. (inflammation of the liver). Internet address: http://www.aa.org Even moderate drinking Symptoms include fever, National Council on Alcoholism and Drug can have serious jaundice (abnormal Dependence, Inc. (NCADD) consequences. A bloodyellowing of the skin, Phone: (212) 269–7797; Fax: (212) 269–7510 alcohol level as low as 0.02 eyeballs and urine) and E-mail: email@example.com percent affects driving abdominal pain. Alcoholic HOPE LINE: (800) NCA–CALL (24-hour Affiliate referral) skills, such as steering and hepatitis can cause death if Internet address: http://www.ncadd.org responding to changes in drinking continues. If traffic. Alcohol interacts drinking stops, this National Institute on Alcohol Abuse and Alcoholism negatively with more than condition often is Phone: (301) 443–3860; Fax: (301) 480–1726 150 medications. These reversible. E-mail: firstname.lastname@example.org interactions can range from About 10 to 20 percent Internet address: http://www.niaaa.nih.gov increasing drowsiness to of heavy drinkers develop causing liver damage. Consult your physician or alcoholic cirrhosis (scarring of the liver). Alcoholic pharmacist before drinking alcohol while taking over-thecirrhosis can cause death if drinking continues. Although counter or prescription medications. cirrhosis is not reversible, if drinking stops, one’s If you are pregnant, don’t drink alcohol at all. chances of survival improve considerably. If they stop Alcohol causes a range of birth defects, including fetal drinking, those with cirrhosis often feel better, and the alcohol syndrome (FAS), which can lead to a lifetime of liver function may improve. Liver transplantation may be learning and behavioral problems for the child. needed as a last resort.
Where to go for help:
Heart disease — Moderate drinking can have beneficial effects on the heart, especially among those at greatest risk for heart attacks, such as men over the age of 45 and
— Source: National Institute on Alcohol Abuse and Alcoholism (NIAAA)
18 Health information on the Web: C
onsumers are looking for health information on the Web in growing numbers. In a survey of Arkansas Blue Cross members conducted last year to determine what type of information they wanted to see on our family of companies’ Web sites, health information rated number 3. The problem is in evaluating the quality of the health information available on the Internet. Who do you trust when your health is at stake?
Specific Guidelines for Evaluating Health Information Sites
For health information sites, you also can check to see if the site is endorsed by a credentialing body, such as the Health on the Net Foundation, or a professional organization, such as a medical society. The Health on the Net Foundation (HON), created in 1995, is a notfor-profit international Swiss organization. HON’s mission is to guide lay persons or nonmedical users and medical practitioners to useful and reliable on-line medical and health information. HON provides leadership in setting ethical standards for Web site developers. Any health or medical site endorsed by HON must adhere to the HON Code of Conduct. The HON code aims to raise the quality of health care information available on the Net. It is a self-regulatory, voluntary certification system based on an “active seal” concept. While primarily intended for health care site developers and publishers, the blueand-red HON code seal on subscribing sites also helps users identify sources of reliable information. The code addresses, among other things, the authority of the information provided, data confidentiality and privacy, proper attribution of sources, transparency of financial sponsorship and the importance of clearly separating advertising from editorial content. A total of 2,800 sites now adhere to the code. In formally submitting an application for certification, the Webmasters of these sites commit themselves strictly to observe all the HON code principles. They are held to this commitment by the entire Internet community and through verification by the HON team.
HON Code of Conduct: Authority 1. Any medical or health advice provided and hosted on this site only will be given by medically trained and qualified professionals unless a clear statement is made that a piece of advice offered is from a nonmedically qualified individual or organization.
Is it reliable ???? Complementary 2. The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Confidentiality 3. Confidentiality of data relating to individual patients and visitors to a medical/health Web site, including their identity, is respected by this Web site. The Web site owners undertake to honor or exceed the legal requirements of medical/health information privacy that apply in the country and state where the Web site and mirror sites are located. Attribution 4. Where appropriate, information contained on this site will be supported by clear references to source data and, where possible, have specific HTML links to that data. The date when a clinical page was last modified will be clearly displayed (e.g., at the bottom of the page). Justifiability 5. Any claims relating to the benefits/performance of a specific treatment, commercial product or service will be supported by appropriate, balanced evidence in the manner outlined above in Principle 4. Transparency of authorship 6. The designers of this Web site will seek to provide information in the clearest possible manner and provide contact addresses for visitors that seek further information or support. The Webmaster will display his/her e-mail address clearly throughout the Web site.
Transparency of sponsorship 7. Support for this Web site will be clearly identified, including the identities of commercial and noncommercial organizations that have contributed funding, services or material for the site.
Honesty in advertising and editorial policy 8. If advertising is a source of funding, it will be clearly stated. A brief description of the advertising policy adopted by the Web site owners will be displayed on the site. Advertising and other promotional material will be presented to viewers in a manner and context that facilitates differentiation between it and the original material created by the institution operating the site.
Arkansas Blue Cross Health Education Programs Resource Lists Arkansas Blue Cross has posted resource lists that contain links to health information sites for specific chronic diseases as part of its “Health Information Programs” Web content. This section resides under “Health Plans and Services: Value Added Services” on the www.ArkansasBlueCross.com site. The address of the “Health Information Programs” section is http:// www.arkansasbluecross.com/health_plans/ value_added_services/health_education.asp.
Arkansas Blue Cross announces changes to third-tier formulary
M any Arkansas Blue Cross and Blue Shield and Health Advantage groups use a three-tier co-payment benefit plan.
Tier 3 is for brand-name prescription drugs that have the highest co-payment, Tier 2 is for brand-name prescription drugs with the mid-range co-payment, and Tier 1 is for generic prescription drugs which have the lowest co-payment. Annual changes to the tiers normally occur each October. Effectiveness and safety are primary considerations. If a less expensive medication becomes available, which is just as safe and effective as a more expensive medication, the more expensive medication may move to a higher tier. High-cost medications are covered under the third-tier co-payment.
How changes will affect members As of Oct. 15, 2002, several medications moved to Tier 3. Members using one of the medications were notified earlier and may continue to use these medications at a higher co-payment, or the member may request from their physician a generic medication or a medication in the second tier.
Three-Tier Formulary Changes Medications moved from Tier 2 to Tier 3 on Oct. 15, 2002 Aggrenox Albenza Aldara Ancobon Asacol Avinza Biaxin/Biaxin XL Cortenema Declomycin Depakote/Depakote ER
D.H.E. 45 Dovonex Duoneb Duragesic Famvir Gabitril Glucophage XR Hexalen Lamictal Mirapex
Mycobutin Neurontin Nolvadex Oxycontin Pancrease MT Patanol Pentasa Potaba Prandin Risperdal
Roxicodone Suprax Tambocor Trizivir Urecholine Vesanoid Winstrol
Health Advantage scores well with members H ealth Advantage continues to perform well with its commercial HMO population according to the results of the 2002 Health Plan Employer Data Information Set (HEDIS) member satisfaction survey. In a repeat performance from the 2001 survey, members who responded to the survey gave Health Advantage excellent ratings in several categories, including rating of personal doctor, rating of specialist, rating of all health care services and rating of health plan. Health Advantageâ€™s health care services, in general, received almost identical marks to 2001. The percentage of members highly satisfied with all health care services at Health Advantage came in at 78 percent (the same score as in 2001 marking an 8 or higher). Additionally, 61
percent of members indicated a satisfaction rate of 8 or higher with their health plan, down from 62 percent in 2001 but up from 60 percent in 2000. Respondents expressed an overall satisfaction rate with their personal physician of 75 percent (a rating of 8 or above on a 10-point scale), while giving their specialist a satisfaction rate of 80 percent. Only 2 percent marked that it was a big problem to get the care that the member or their doctor believed necessary, and 96 percent did not have big problems getting the referrals to specialists that they believed were needed. Also, only 3 percent experienced big problems with delays awaiting approval from Health Advantage. The survey, required by the National Committee for
Access Fees Waived for
Advanced Health Information Network A rkansas Blue Cross and Blue Shield now is offering health care providers free access to its Advanced Health Information Network (AHIN). AHIN allows providers on-line access to a variety of information, which in turn accelerates financial payments and has the potential to impact health care delivery by reducing administrative costs. With AHIN, providers are linked to Arkansas Blue Cross information systems to gain access to eligibility, claims, claim-status and related data. A unique feature allows direct claim submission as well as on-line, real-time correction of erroneous claims regardless of how they were submitted. AHIN is an on-line system that allows physicians as well as hospital providers to manage their business functions more efficiently. It was one of the first health information networks in the United States to offer advanced real-time functionality and continues to offer capabilities that are unique within the industry. Previously, hospitals and physician offices paid monthly user fees to connect to the network. However, AHIN has allowed Arkansas Blue Cross to gain numerous efficiencies since introducing the network in 1998 which offset the cost of providing the network to providers. “For several years now, AHIN has been empowering health care professionals with information at the point of service,” said Jerry Bradshaw, director of AHIN. “More than 3,000 physicians and 50 hospitals in Arkansas have gotten ‘connected’ and have taken advantage of this seamless integrated health care network.
Quality Assurance, also revealed the following results: • 91 percent of members were satisfied that their claims were handled in a reasonable amount of time. • 93 percent were satisfied that their claims were handled correctly. • 95 percent of those surveyed felt they were treated with courtesy and respect by office staff. • 91 percent felt that the office staff was as helpful as they thought they should be. • A mere 9 percent felt they had any problems with paperwork. • Almost nine out of 10 patients reported that they usually or always get the help or advice that they need, get the appointment for regular or routine care
“One of the biggest advantages in utilizing AHIN is the processing of claims,” said Bradshaw. “Claims, which traditionally required 24 hours or more to be accepted into the payment system for adjudication, can take as little as 15 minutes to process electronically. Errors are identified and corrected more quickly, which results in faster payment. Ultimately, our providers and our members (their patients) are looking at a significant improvement in timeliness and accuracy of claims payments, which should result in lowering administrative costs for health care delivery. That should translate into lower health care costs for all involved.” AHIN is a browser-based system utilizing Netscape Navigator or Internet Explorer, which simplifies installation and maintenance. With the exception of a small software program to handle security, which AHIN supplies free of charge, everything necessary to access the system already is present on most personal computers. Hospital or physician office representatives interested in finding out more about AHIN or “getting connected” may contact their Arkansas Blue Cross regional network development representative or visit the Arkansas Blue Cross Web site at www.ArkansasBlueCross.com for more information and to download a contract. Contracts will be processed on a first-come, first-served basis. Training will be provided statewide and coordinated through the Arkansas Blue Cross regional offices.
they need or treatment for illness or injury as soon as they want it. • More than nine out of 10 doctors or other health care providers are perceived usually or always to listen carefully to their patients, explain things in a way that the patient could understand and show respect for what the patient had to say. • Almost nine out of 10 doctors or other health care providers are reported to usually or always spend enough time with their patients. • Overall, on a scale of 1 to 10 where 10 is the best possible health care, 96 percent of respondents gave their health care a 6 or higher. (Scores, continued on Page 23)
HOW THE “STANDARDS
WILL PROTECT YOUR HEALTH CARE INFORMATION
Privacy — we’ve all heard the horror stories associated with an individual’s personal health information accidentally being released to the wrong person and the harm caused by that disclosure. While this is the exception rather than the rule, the Department of Health and Human Services, a division of the U.S. government, has implemented a set of regulations to prevent these accidents. The Standards for Privacy of Individually Identifiable Health Information took effect April 14, 2001, with compliance required by April 14, 2003. As required by the Health Insurance Portability and Accountability Act (HIPAA), the Privacy Rule covers health plans, health care clearinghouses, and health care providers. These are considered “Covered Entities” by the law. This means they are responsible for complying with the laws that protect your information. The Privacy Rule creates national standards to protect individuals’ personal health information and gives individuals increased access to their own medical records. Information protected under the new law must meet certain criteria. The information must: • Be created by or received from a covered entity. • Relate to the past, present, or future physical or mental health condition of an individual; the provision of health care to an individual; or the payment for health care services. • Identifies or could be used to identify the person who is the subject of the information. • Be able to be transmitted or maintained in any format. It is the responsibility of those who create, maintain or distribute personal health information (the Covered Entities) to safeguard this information. As the consumer, the new law gives you certain rights and access to your information. These provisions
P R I V A T E
provide you the right to: • Receive a Privacy Notice from covered entities that maintain your personal health information. This notice will provide examples of how your information is used and give instructions on how to exercise your rights. You’ll receive a notice from Arkansas Blue Cross and Blue Shield between January and March of 2003. • Request to inspect and copy your personal health information that was used to make a decision about you. Information such as medical records, claims information, reports or other personal health information identified as being used to make a decision about you are contained in a record set. • Request an amendment be placed on a record set. This request must be made to the creator of the record. • Request that all communications with you be handled confidentially to prevent personal harm to you. This means that we will make all contacts with you to an alternative address or phone number you specify. • Receive an accounting of all disclosures of your personal health information that have been made in the prior six years (starting with April 14, 2003) that were for purposes other than treatment, payment or health care operations, and for which you did not sign an authorization. • Request that certain portions of your personal health information be restricted. The entity to whom you make this request is not required to comply. The Spring 2003 issue of Blue & You will provide information on the changes you can expect when you contact Arkansas Blue Cross, Health Advantage and BlueAdvantage Administrators of Arkansas. Blue & You also will provide instructions on the methods members may use to make requests or file complaints concerning Privacy issues.
Making a move I n mid-January, the Central Region Division of Arkansas Blue Cross and Blue Shield (which includes Marketing and Medical Management) will move from 26 Corporate Hill Drive in West Little Rock to the USAble Corporate Center, located at 320 W. Capitol, in downtown Little Rock. Telephone numbers for the Central Region will change in mid-January. Health Advantage Customer Service remains at 26 Corporate Hill Drive. The Health Advantage Claims, Customer Accounts and Information Systems divisions moved to the USAble Corporate Center in 1998.
The Phar macist is in Do you have any questions? P harmacists often hear the following question —
“Why does my insurance co-payment for my prescription keep increasing?” Many people who have pharmacy coverage included with their medical insurance don’t realize how much prescription prices have increased in the past few years and don’t really know the prices of the medications they are taking. The patient’s focus is on the co-payment because that is the amount the patient has to pay. The balance is billed by the pharmacist directly to a claims processor who then reimburses the pharmacist. The patient, in most cases, never realizes the full price of the prescription. It would be shocking to most consumers if they paid the entire amount. Prescription costs have increased at an alarming rate during the past seven or eight years because of the staggering increases in the cost of brand name drugs. These rising costs were slow to be included into the copayment structure until employers and other contract purchasers began to see their premiums increase more than usual.
The member co-insurance/co-payment part of the prescription benefit will likely continue to rise in proportion to future increases in drug costs. This rising drug cost also is adversely affecting your pharmacist as their drug inventories are skyrocketing while their margins are continually being squeezed. Everything is not about cost. There are values and benefits to some of the new medications on the market. Some of the new drugs are giving people an improved quality of life and preventing other expensive medical costs. Regrettably, this does come at a cost. It is difficult to separate cost and value, but people can obtain value with prescription medication without exaggerated costs. Prescription co-payments probably will become increasingly indexed to the rising drug costs. Arkansas Blue Cross and Blue Shield recommends that our members continue discussions with their doctor concerning ways to reduce the costs of prescription medication co-payments.
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traveling since heavy meals can cause drowsiness. If you’re feeling tired, pull over as soon as possible to a safe area and let someone else drive or, if you’re alone, take a short nap or get out of your car and walk around.
• On a scale of 1 to 10 where 10 is the best possible health plan, 86 percent of respondents gave their health plan a rating of 6 or higher. • On a scale of 1 to 10 where 10 is the best doctor or nurse possible, 94 percent gave their personal doctor or nurse a 6 or higher. Based upon additional analysis of the survey results, the following service factors were determined to be the biggest predictors and drivers of members’ overall satisfaction with the health plan: • Claims processed in a reasonable time. • Claims handled correctly. • Before care, the Plan makes clear how much each member will have to pay. • Understanding written material from Plan. • Ease of getting help from Customer Service to solve problems.
Be Considerate Of Other Drivers. Give proper signals, keep a safe distance from the car ahead of you, don’t weave in and out of traffic and give the right-of-way to emergency vehicles. A safe driver is also a responsible driver. When you drive, you not only take responsibility for your own safety, but the safety of others. So, please … be prepared the next time you get behind the wheel of your car. Your life and the lives of others may depend on it. — Source: www.auto.indiamart.com and www.car-accidents.com
Blue Cross and Blue Shield Association Elects Robert L. Shoptaw Chairman of the Board
he Blue Cross and Blue Shield Association (BCBSA) Founded in 1948, Arkansas Blue Cross and Blue Board of Directors recently elected Robert L. Shoptaw Shield is the largest health insurer in Arkansas, serving chairman of the board at its meeting in Chicago. more than 860,000 Arkansans. Arkansas Blue Cross and Shoptaw, 55, chief executive officer of Arkansas Blue its USAble family of companies have more than 2,300 Cross and Blue Shield, succeeds Michael B. Unhjem, employees. Arkansas Blue Cross and its affiliates provide president and CEO of Blue Cross Blue health care financing for more than Shield of North Dakota. one-third of Arkansans. “Bob Shoptaw will provide Arkansas Blue Cross administers strategic leadership to the nation’s Medicare Part A and Part B programs Blue Cross and Blue Shield Plans in Arkansas, and administers Part B during a critical time,” said Scott P. claims in Louisiana, Oklahoma, New Serota, president and chief executive Mexico and eastern Missouri. officer of BCBSA. “With health care Arkansas Blue Cross is also the sole costs rising dramatically, we need national maintenance contractor people with Bob’s breadth and depth (“maintainer”) for the Fiscal Interof experience leading our efforts to mediary Standard System (FISS) and keep health care affordable for all the Arkansas Part A Standard System Americans.” (APASS), the two computer software As chairman of the board, systems used to process all of the Shoptaw assumes leadership of 160 million Medicare Part A claims BCBSA’s governing body. The nationwide. Arkansas Blue Cross also group meets quarterly to set BCBSA serves as the Data Center for contracmembership policies for the 42 tors who process Medicare Part A independent Blue Cross and Blue claims for Alabama, Alaska, Maine, Shield companies and provides Maryland, Massachusetts, MissisRobert L. Shoptaw strategic guidance and oversight for sippi, New Hampshire, North Carothe Association. lina, Rhode Island and Washington. Shoptaw joined Arkansas Blue Cross and Blue Shield in 1970, and became vice president of claims and profesThe Blue Cross and Blue Shield Association is comprised of 42 sional services in 1975. He was promoted to executive independent locally-operated Blue Cross and Blue Shield Plans vice president in 1979, chief operating officer in 1987, that collectively provide health care coverage to 84.7 million president and chief executive officer in 1993, and CEO in people — 30 percent of all Americans. For more information on 2002. Shoptaw also serves on the board of the National BCBSA and its Plans, visit www.bcbs.com. Institute for Health Care Management (NIHCM), headquartered in Washington, D.C. In Arkansas, Shoptaw serves on the board of directors for Arkansas Blue Cross and Blue Shield and two of its affiliated “Blue” companies, Health Advantage and USAble Corporation. A civic and business leader in Arkansas, Shoptaw is a board member of the Arkansas Center for Health Improvement, Arkansas Executive Forum, Downtown Partnership, Metrocentre Improvement District, Governor’s Rural Health Advisory Council, Regions Bank, Fifty for the Future, Philander Smith College and An Association of Independent BlueCross BlueShield Companies Easter Seals.
On-line self-service center allows members to check claim status, eligibility
he Arkansas Blue Cross and Blue Shield family of companies is striving to meet customer expectations by providing members with convenient, self-help access to their health plan information 24 hours a day, seven days a week. Members of Arkansas Blue Cross and Health Advantage now are able to check their claim status and eligibility on-line and perform other self-service functions with My Blueprint: Personal Benefits and Claims Tracker. A button on the home page or a link on the “Members” page of www.ArkansasBlueCross.com and www.HealthAdvantage-hmo.com directs Arkansas Blue Cross and Health Advantage members to the new section. Programming for www.BlueAdvantageArkansas.com is under way and should be complete in January. When a member logs in to My Blueprint, a “welcome” page, containing a menu of self-service links, appears. Current selections include: • Check member eligibility; • Check claim status; • Check primary care physician (PCP) history (Health Advantage only); • Order replacement ID card; • Update My Blueprint registration information. “My Blueprint is part of our commitment to provide members with the information they need in a convenient, private and confidential manner,” said Robert L. Shoptaw, chief executive officer of Arkansas Blue Cross.
Secure Registration Members must register on-line and receive a password by U.S. Mail before they can enter My Blueprint. This level of security is necessary to protect personal information and meet federal privacy regulations. Only the policyholder (subscriber or contract holder) can register, but the policyholder can see a covered spouse or dependent’s information. The policyholder must enter some basic information from his or her ID card to complete the registration form: • Member ID number; • First and last name and middle name or initial; • Date of birth. The only other information the form requires is the selection of two secret questions and answers to be used if the member forgets his or her password. Entering an email address is optional. Once the form is submitted, the member receives a log-in ID on-line and must verify the information, verify the address to which the password will be mailed and
accept the “Security and Privacy Notice.” After the member receives a password by U.S. mail, the member can return to the site and log in. The account must be activated using the computer-generated ID and password. After the initial log-in, the member may change the password to something easier to remember but cannot change the log-in ID.
Self-Service Features The “Check Member Eligibility” section allows the policyholder to see who is eligible for coverage under the registered health plan. The member name, date of birth, member number, relationship to policyholder, effective date and termination date will be displayed for each covered member. “Check Medical Claim Status” allows the policyholder to select the member and a time range for the claims to be viewed. Selection of “all claims” pulls the member’s claims history as far back as the data is stored on-line. The “Claims Summary” returned after the form is submitted provides: • Service date; • Service provider; • Claim number; • Date received; • Date completed; • Total charge; • Status. Initially, the status will be either “complete” or “in process.” The member soon will be able to click on “complete” and pull up the Explanation of Benefits (EOB). “Check Primary Care Physician (PCP)” is available for members who must select a PCP for their health plan. “Check Primary Care Physician” allows the policyholder to select a member to see each PCP that member has chosen, the provider number, date selected and date terminated. Members should find this useful if they have recently contacted Customer Service to change their PCP and need to verify that a change has been made. Lost ID cards will be no problem. “Order Replacement ID Card” will allow the policyholder to order ID cards. Finally, members can update their password, secret questions, secret answers or e-mail address by going to “Update My Blueprint Registration Information.” For each page, a “Help” section offers an overview, keyword definitions and answers to questions. Members may submit an on-line form to receive help.
PETER MARVIN, M.D., NAMED ASSOCIATE MEDICAL DIRECTOR ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
rkansas Blue Cross and Blue Shield has named Peter M. Marvin, M.D., F.C.C.P.*, a pulmonary medicine physician from North Little Rock, as associate medical director for Arkansas Blue Cross. As associate medical director, Marvin will assist the medical director in providing professional and technical counsel designed to promote effective operation of existing and future services. The associate medical director also contributes to improved services for members and health care providers. Marvin will review and advise on coverage policies, provider profiling methodology, quality and outcome measurement, and provider communication issues. Prior to joining Arkansas Blue Cross in August, Marvin was in private practice in Pulmonary Medicine in North Pulaski County. At BAPTIST HEALTH North Little Rock (formerly Baptist Memorial Medical Center), he served as medical director for the Intensive Care Unit, the Respiratory Therapy Department, Clinical Effectiveness and Sleep Laboratory; served as co-director of
Nutritional Support Services; as a member of the Ethics Committee; and as chief of staff. Marvin also is a former chest clinician with the Arkansas Department of Health. A native of Arkansas, Marvin received his bachelor’s degree from Brown University in Providence, R.I., and a master’s degree in Pharmacology from the University of Arkansas for Medical Sciences. Marvin completed his medical degree and internship in General Medicine at UAMS. He completed his residency in Internal Medicine at UAMS and the John McClellan Veterans Hospital in Little Rock, and a fellowship in Pulmonary and Critical Care Medicine at UAMS and the VA. Marvin is certified in Internal Medicine with a subspecialty certification in Pulmonary Disease. He is a member of the Alpha Omega Alpha Medical Honor Society, a fellow of the American College of Chest Physicians, a member of the Arkansas Medical Society, the Southern Medical Association and American Academy of Sleep Medicine. *Fellow of the College of Chest Physicians
More choices, more information and more service mean more freedom for you, our customer. That’s the message of Arkansas Blue Cross and Blue Shield’s newest advertising campaign. Using two television commercials and three newspaper ads, the campaign shows three Arkansas Blue Cross members (as portrayed by actors) enjoying a moment of freedom — making a run on a water slide, riding a shopping cart and gliding across a waxed floor. The More Choices ad (featuring “water slide man”) talks about our new plans that make health care even more affordable (see inside front cover). The More Information ad (with “shopping cart woman”) mentions new information technology that gives our members more freedom to control their own health care. These include our new 24-hour, on-line customer self-service function, My Blueprint, (see page
25) and the Advanced Health Information Network (AHIN) for providers (see page 21). The More Service ad (with “gliding businessman”) shows how getting good customer service can be a liberating experience. The newspaper ad talks about the variety of ways we serve our customers — at seven regional offices, with 120 customer service representatives, in person, by telephone or on-line. “Although health insurance can be a serious subject, we felt it was OK to have a little fun with these commercials, to break through the clutter,” said Patrick O’Sullivan, vice president of Advertising & Communications. “No actors were injured in the filming of these commercials,” O’Sullivan said, “and I know all of our members practice safe sliding, riding and gliding.” The campaign ran through December, and will reappear in spring 2003.
ScriptSave drug discount program saves Medi-Pak members money S
criptSave, a national prescription drug discount program offered to Medi-Pak members by Arkansas Blue Cross and Blue Shield, helps participating seniors save money on prescription drugs. To date in 2002, Arkansas Blue Cross Medi-Pak members have saved $2,384,188 by participating in ScriptSave. “With so many seniors needing prescription drugs to remain active and healthy, we are dedicated to helping our members better meet the high costs of their prescription drug expenses. We are pleased to be able to provide a ready solution for our seniors that have no or limited coverage for their prescription medicines. Very simply, our program helps our seniors save on their medications at the pharmacy with no waiting and no paperwork,” said Ron DeBerry, vice president of Statewide Business. So far this year, Arkansas Blue Cross Medi-Pak members have filled more than 406,978 prescriptions,
and have saved an average of $7.94 per discounted prescription (or 16.32 percent). According to DeBerry, “Our goal is to help our seniors work with their physicians and health care providers to make the most costeffective and health-effective decisions possible on prescription drugs.” The savings on prescription drugs through the ScriptSave discount program may be from 5 percent up to 35 percent. Additionally, the ScriptSave card covers all brand-name and generic drugs, offers instant discounts and can be used over and over again. If you have a ScriptSave card, call the toll-free number on the card to receive more information on which pharmacies in your area participate in the program. The ScriptSave discount drug card is a free, value-added service from Arkansas Blue Cross. It is not an insurance policy and does not provide insurance coverage. For more information, call (501) 378-5695 or toll-free 1-888-847-2300.
Medi-Pak Plan I members receive new ID card Card eliminates paper claims, saves money for Medi-Pak Plan I members
ffective Jan. 1, 2003, Medi-Pak Plan I members will no longer have to file a paper claim to take advantage of prescription benefits. Medi-Pak Plan I benefits have not changed. Medi-Pak Plan I members must meet a $250 prescription drug deductible; and then Medi-Pak Plan I plays 50 percent of the next $2,500 in prescription drugs, for a maximum annual benefit of $1,250. Medi-Pak Plan I members should have received a new ID card in mid-December. Medi-Pak Plan I members should present the card to their pharmacist each time a prescription is filled. The new Medi-Pak Plan I card also will save Medi-Pak Plan I members money. The prescription drug benefits now will be administered by AdvancePCS, and because of Arkansas Blue Cross and
Blue Shield’s contractual relationship with AdvancePCS, members now can benefit from negotiated discounts. Medi-Pak Plan I members no longer need to use their ScriptSave card. To process a prescription claim, all the pharmacist needs is the new Medi-Pak Plan I ID card. With the new Medi-Pak Plan I ID card, members can take their prescriptions to any pharmacist. Medi-Pak Plan I is the only Medi-Pak Plan that includes prescription benefits. Therefore, Medi-Pak Plan I members are the only Medi-Pak members that have received or will receive the new ID card. The monthly premium for Medi-Pak Plan I is $244.50. If you’re a Medi-Pak Plan I member and have questions about your new ID card, call Customer Service at (501) 378-5695 or 1-888-847-2300.
rkansas Blue Cross and Blue Shield strives to be a good corporate citizen. Our employees raise money and spend many hours helping those causes near and dear to the hearts of Arkansans. Light the Night BlueAnn Ewe got in on the fun of three “Light the Night” events this fall — in Fayetteville, Maumelle and Russellville — to support the Leukemia & Lymphoma Society. The “Light the Night” Walk is the Society’s nationwide evening walk to celebrate and commemorate lives touched by cancer. Walkers carried illuminated balloons — red for participants and white for cancer survivors — to light their paths, all in an effort to raise money and awareness for these blood diseases. All funds raised support the Society’s mission to cure leukemia, lymphoma, Hodgkin’s BlueAnn makes new friends. disease and myeloma and improve the quality of life of patients and their families. The Leukemia & Lymphoma Society leads the fight against the number-one disease killer of children and also serves as a source of hope for the 640,000 people currently living with blood-related cancers. Contributions help fund medical research, patient assistance programs, advance medical education, advocacy, and provide critical information to the general public. And, they’re off Almost 200 people circled the track at Oaklawn Park in June … but on foot rather than horseback … for the first A.I.R. (Asthma Is Resolvable) Walk held in Hot Springs by the American Lung Association of Arkansas and sponsored by Arkansas Blue Cross and Blue Shield’s South Central Regional Office. BlueAnn Ewe, along with Barbara Mitchell and Steve Spaulding of the regional office, attended the event to support the A.I.R. mission, which is to empower children to manage their asthma. Project A.I.R. is a free program for asthmatic children in need of education and/or resources. Project A.I.R. provides educational materials and equipment for those who qualify. The A.I.R. Walk helped raise money for and
awareness of the needs of children in Garland, Hot Spring, Clark, Pike, Montgomery and Howard counties. Wild About Wellness The Wild About Wellness Back-to-School BlueAnn Ewe poses with Health Fair in Texarkana tracksters. welcomed kids back to the classroom, fit and ready to learn. Our Southwest Regional Office staff manned a great booth exhibit and helped kids get their heights and weights measured for their health charts for school. More than 4,000 little folks came through the two-day event for their immunizations and other health screenings, such as vision, hearing and speech. There were 79 businesses and agencies participating in the event to make it fun and educational for kids who came from Arkansas, Louisiana, Oklahoma and Texas. In August, BlueAnn joined parents and students at the Back-to-School Jamboree at Southeast Middle School in Pine Bluff. She had a blast meeting new kids and playing with a parachute and hula-hoops! Several hundred kids came through the event, which was held to allow kids to get their school schedules, meet some of their teachers and enjoy grilled burgers for lunch. Arkansas Blue Cross and Blue Shield P.O. Box 2181 Little Rock, AR 72203-2181
PRSRT STD U.S. POSTAGE PAID Arkansas Blue Cross and Blue Shield