NAVIGATING THE HEALTH CARE SYSTEM Floyd Shewmake, MD Senior Medical Director Coventry Health Care
Topics of Discussion Choosing the right doctor Communications Managing your pharmacy benefits Compliance
CHOOSING THE RIGHT DOCTOR ASK QUESTIONS FAMILY, FRIENDS, NEIGHBORS TALK TO PEOPLE WHO KNOW --PATIENTS OF DOCTOR --NURSES AVOID HOSPITAL REFERRAL LINES
CHOOSING THE RIGHT DOCTOR TRAINING AND BACKGROUND MEETS YOUR NEEDS PRIVILEGES AT HOSPITALYOU PREFER BOARD CERTIFICATION MEMBER OF INSURANCE NETWORK - COVENTRY NETWORK - TAKES MEDICARE
CHOOSING THE RIGHT DOCTOR TRAINING AND BACKGROUND SPECIALTY - FAMILY PRACTICE - INTERNAL MEDICINE - GERIATRICS
CHOOSING THE RIGHT DOCTOR CONVENIENCE OFFICE LOCATION OFFICE HOURS WAIT TIME FOR APPOINTMENT COVERAGE WHEN OFF CHARGES FOR MISSED/CANCELLED APPOINTMENTS ANCILLARY PROVIDERS
COMMUNICATIONS IF YOU LISTEN CAREFULLY TO THE PATIENT THEY WILL TELL YOU THE DIAGNOSIS -Sir William Osler
COMMUNICATIONS BE PRO-ACTIVE PROVIDE INFORMATION DOCTORS NOT TELEPATHIC YOU KNOW YOUR PROBLEM THE BEST..TELL YOUR DOCTOR ABOUT IT
COMMUNICATIONS BRING LISTS. ESPECIALLY FOR FIRST APPOINTMENT PREVIOUS ILLNESS & SURGERY FAMILY HISTORY MEDICATIONS...DOSE & FREQUENCY NATURAL & OTC PRODUCTS
COMMUNICATIONS ASK QUESTIONS
TO UNDERSTAND THE PROBLEM YOU VE GOT TO ASK THE RIGHT QUESTIONS. - SENATOR DANIEL PATRICK MOYNIHAN
COMMUNICATIONS ASK QUESTIONS NOT ASKING IS TELLING DOCTOR YOU UNDERSTAND WRITE DOWN SPECIFIC QUESTIONS TAKE NOTES.IT S OK ASK ABOUT ALTERNATIVES
COMMUNICATION ASK ABOUT RADIOLOGY TESTS: CT SCAN A MAJOR SOURCE OF RADIATION EXPOSURE ASK ABOUT ALTERNATIVES SUCH AS MRI OR ULTRASOUND NO RADIATION INVOLVED ASK HOW TEST RESULT WILL AFFECT CARE
COMMUNICATIONS RADIATION DOSES: CT OF CHEST OR ABDOMEN = 10 MILLISIEVERT MAMMOGRAM = 1 MILLISIEVERT CHEST X-RAY = 0.1 MILLISIEVERT DENTAL X-RAY = 0.005 MILLISIEVERT ATOMIC BOMB = 150 MILLISIEVERT
PHARMACY BENEFITS PHARMACY COSTS ARE THE FASTEST RISING SECTOR IN HEALTH CARE PRUDENT MANAGEMENT OF YOUR PHARMACY BENEFIT SAVES YOU $$$
PHARMACY BENEFITS HOW TO GET THE MOST FROM YOUR PBM PHARMACY COSTS THE FASTEST RISING MOST PEOPLE OVER 50 ARE ON MEDICATION DOCTORS DON T REMEMBER FORMULARIES KNOW YOUR PLAN S FORMULARY BRING A COPY TO DOCTOR VISITS SAVES TIME FOR YOU SAVES TIME FOR DOCTOR
PHARMACY BENEFITS FORMULARIES USUALLY 3 OR 4 TIERS THE HIGHER THE TIER THE MORE YOUR CO-PAY GENERICS USUALLY ON TIER 1 ALWAYS ASK IF NEW PRESCRIPTION COMES AS A GENERIC
PHARMACY BENEFITS FORMULARY TIERS 1. GENERIC DRUGS 2. PREFERRED BRAND NAME DRUGS 3. NON-PREFERRED BRAND NAME DRUGS 4. SPECIALTY/BIOLOGICS
PHARMACY BENEFITS BIOLOGICS & NEW CANCER DRUGS SPECIFICALLY TARGET CERTAIN TUMORS OR FACTORS WHICH CAUSE INFLAMMATION HIGHLY EFFECTIVE FOR MANY AMONG THE MOST COSTLY DRUGS NOW BEING PRODUCED
PHARMACY BENEFITS SPECIALTY PHARMACY PRODUCTS BIOTECH IN NATURE TYPICALLY INJECTABLE OR INFUSION HIGH COST THERAPIES USED MAINLY BY MEDICAL SPECIALISTS CLOSE MONITORING NEEDED BY PHYSICIAN PATIENT COMPLIANCE IMPORTANT
COMPLIANCE THERE IS NO CURE FOR PATIENT NONCOMPLIANCE
COMPLIANCE BEHAVIORS MEDICATIONS SCREENING TESTS
COMPLIANCE BEHAVIORS DIET RESTRICTIONS EXERCISE WEIGHT LOSS TOBACCO USE ALCOHOL USE
COMPLIANCE MEDICATIONS FREQUENCY OF DOSES LIMITATIONS OF SIDE EFFECTS PERCEIVED BENEFITS COST OBTAINING REFILLS
COMPLIANCE FACTORS AFFECTING AGE SOCIO-ECONOMIC GROUP PATIENT S PERECPTION OF ILLNESS ASYMPTOMATIC OR SYMPTOMATIC PATIENT S PERCEPTION OF BENEFITS PSYCHOLOGICAL
COMPLIANCE CHRONIC DISEASES DIABETES CONGESTIVE HEART FAILURE HYPERTENSION HYPERCHOLESTEROLEMIA ASTHMA
COMPLIANCE SCREENING TESTS COLON CANCER PROSTATE CANCER BREAST CANCER CERVICAL & OVARIAN CANCER
COMPLIANCE BENEFITS IMPROVES HEALTH OUTCOMES SAVES HEALTH CARE DOLLARS IMPROVES QUALITY OF LIFE
THE END Questions Comments?