Home Care Companies

Switching Time

Insurance challenges was the topic of my talk in Pleasanton, California at a Herndon Pharmacy sponsored event Saturday evening. We had a great turn out with about 50+ patients and parents attending. We all enjoyed a delicious dinner at the Pleasanton Hilton, followed by my presentation on “The Current Storm.” The hour-long presentation covers what’s happening with hemophilia reimbursement, why it’s happening, how it all got started, and what families shoudl do to protect their insurance and choice. California is facing two major challenges: sudden switching of homecare companies by insurance companies, and a 10% reduction across the board on reimbursement by MediCal. Both measures hurt factor providers (340Bs and homecare) and parents are not very happy with the home care switching. For many parents, they don’t even know what questions to ask. Insurance is complex, ever changing… and necessary.

It was really great to meet some new parents like Christina and Colleen, patients like Art and Stanley, and families I’ve known for a long time, like Vicky and Burt, and Betty. All the attendees really enjoyed meeting each other: everyone knew somebody and it was like a big reunion. You could see the comraderie and joy everyone was feeling. Before everyone left we all sang happy birthday to Mark Helm, president of Herndon, who just had his 50th birthday.

Thanks to Zuiho Taniguchi of Herndon Pharmacy for inviting me and handling all the logistics, and to Mark Helm, for sponsoring this enjoyable event. And please see www.herndonpharmacy.com for more information on Herndon Pharmacy, a contributor of factor to Project SHARE for patients in the developing world, and provider of hemophilia services in the US.

(Photos: 1) Colleen, Laurie, Christina 2) Brochure 

Book I Just Read

Enough About You, Let’s Talk About Me: How to Recognize and Manage the Narcissists in Your Life
Les Carter

We all know people who love to talk about themselves. And we all know bores. But these are not necessarily people with bona fide narcissistic personality disorder (NPD). Carter explains very simply and easily what sets these people apart from people who just love talking about themselves. People with NPD can make your life miserable especially if you are married to them, have one as a sibling or parent, or as a boss. They lack the ability to be empathic and are notoriously difficult if not impossible to get into therapy or even get to see your side of a situation. Being with them is positively exhausting and narcissists are great at making you feel guilty and responsible for all that is wrong in a relationship. Carter offers excellent scenarios and great tips for dealing with those with NPD. Carter has a fundamentalist Christian background, and I did not like or agree with his view of children, despite that he is a popular author and therapist, and you may not agree with his linking original sin to this disorder. I also found the book very light, mostly anecdotal, with dialogues from his sessions with patients. This is a good book if you are new to psychology or narcissism. Two out of four stars.

Homecare Switching Heats Up

So what is going on out there? I have gotten more emails this past week about home care switching than ever.

Tom wrote in to ask if all Anthem Blue Cross patients with hemophilia will be required to use Precision Rx as their factor provider? He is livid, if this is true. Another mom wrote in to report that she is hearing that Anthem in Ohio is forcing a switch in home care companies. She heard that Anthem’s doses may be +2%, not the current industry of dose +10%. She is concerned that this means fiddling around with the vial sizes and number of vials we get.

Still another mom, employed by a home care company herself (so she buys factor from her employer) is being forced to switch to another home care company–a competitor!– that she doesn’t like and has not heard good things about. She is very concerned. I would be too: if my son is a source of revenue for my employer and then no longer supplies revenues, will my job be on the line? A lot of parents and patients are employed in the homecare industry.

I had a long conversation with Bob Robinson, the executive director of the Illinois chapter, and he tells me now that Blue Cross Blue Shield is doing the same thing in their state. This trend is gaining speed, and this will be happening more and more. Bob and I talked about how our community is going to have to start accepting that some change is inevitable and that we are going to have to learn to compromise. There is just no way we can have “our way” any more. Most disturbing is that the insurance companies are setting up their own in-house specialty pharmacies. So they are paying for factor and getting the profits at the same time. Can they can charge whatever they want? Who is monitoring this practice?

It seems shocking, but you know, this at first seemed like much more of a market correction than an out-of-the-blue change. Health costs have risen astronomically, so payers are naturally going to do something to lower costs, as long as this does not put the patients in danger. This is what managed care is all about, and it is here to stay, whether we like it or not. Best we can do immediately is to document everything, carefully, every call, every EOB, every charge. We do pay good money, but the payers can simply say “Then go find another plan.” Harsh reality but it is the reality.

But the scary part is this: it’s not just about lowering health care costs, but control. Insurers are definitely wrestling control of our health care management. Competition is dwindling. When insurers have their own in-house specialty pharmacy (to allegedly control costs) and see the profits rolling in, who will authorize cost control then? They will be fixing the reimbursement price, and reimbursing themselves. Conflict of interest? Big time. The questions become: what is competition, how is it defined and what is fair?

I’ve been predicting this trend for three years now, since the November issue of PEN in 2004. If you’ve been reading our work this should not be such a surprise. Only the speed at which it is happening is quickening. Keep those letters and emails coming to us; let us know your insurance and home care switching story so we can pass it along to NHF, HFA… we are all working to preserve care and control, at fair cost.

Acquisition Time Again

Those hungry home care companies are at it again. This time, Apria Healthcare Group Inc. announced on October 15 it has purchased Coram Healthcare, a privately-held national provider of home infusion and specialty pharmaceutical services, for $350 million. Coram is a home healthcare company that provides factor, but is best known for its top notch home nursing services. Indeed, this shining reputation was one of many qualities which attracted Apria. The acquisition will create the leading, nationwide home infusion provider. A bigger attraction? Apria can now enter the specialty pharmacy market, which seems to be attracting everyone these days. This means they can benefit from Coram’s position as seller of factor in the hemophilia marketplace. Even insurance companies themselves are opening up their own specialty pharmacies, the very entities they reimburse!

As we’ve been predicting for the three years, there have been continued acquisitions as hemophilia home healthcare companies, whose profits are being squeezed by shrinking government and private insurance budgets, struggle to survive.

But both Coram and Apria view the acquisition positively. From the Coram website: “This is a transformative event for Apria Healthcare,” said Lawrence M. Higby, Chief Executive Officer of Apria Healthcare. “The transaction supports our strategy of diversifying our service offering by adding and expanding complementary product lines that fit well with our core competencies. In addition, this expansion makes Apria significantly less reliant on government reimbursement policies, since government payors will represent a smaller percentage of our overall business. As a leading provider in the home infusion industry, Coram has long been known for its patient care-focused reputation, clinical leadership and innovative programs which benefit patients, manufacturers, physicians and payors alike. We believe the combination will enable us to serve our combined patient and customer base even better.”

Good news for hemophilia patients of Coram: Coram’s current management team will stay in place to coordinate the integration of the two companies’ infusion businesses. This should ensure that the special needs of hemophilia patients are not left in inexperienced hands.

For more information, visit www.apria.com and www.coramhealthcare.com. And stay tuned for more mergers, which are sure to continue.

Great Book I just read: The Ghost Map, by Steven Johnson. This is the fascinating account of the cholera epidemic that hit London in 1854. The simple tossing of a soiled diaper by the mother of an infected infant into a local cesspool used by neighbors led to an epidemic that wiped out whole families in hours, hundreds in a matter of days, and thousands as the weeks dragged on. More than just a recording of this horrible event, author Johnson has the reader accompany Dr. John Snow, a physician of incredible brilliance and courage, as he bucks tremendous professional pressure and traditional medical wisdom that cholera is transmitted via air, and seeks to finds its true source, at a time in history when microbes were not even known.

Johnson skillfully shows how the explosive growth of cities reaped an environment ripe for bacterial disaster; London had 2 million people, and no public sewer system. With citizens emptying human waste directly into the Thames, the city’s water supply was tainted. But it took an incredible convergence of truth seekers, including John Snow, to fight the public health bureau, and discover the true source: the Broad Street pump.

Snow’s groundbreaking research and methods are still used today, and brought about a permanent change in our understanding of how infectious disease is spread. This is an amazing book! I learned so much, and can see that major cities in the developing world are not unlike London only 150 years ago. This simultaneously disturbs me, in this day and age, but also gives me hope for the exploding cities of the world like Mexico City, Delhi, and Dhaka. Johnson’s otherwise perfect book is marred only in his conclusion/epilogue, which gets unfocused as he tries to relate the story to every single contemporary event, in a preachy lecture. A+ content, B+ style.

Would You Rather Fight Than Switch?

The ongoing insurance cost-cutting has impacted hemophilia deeply, particularly since we are flashing beacon on payers’ radar. One of the most prominent impacts has been forced home care switching. Reactions by families include irritation at being switched without forewarning; anger at being switched without any say in the matter; and fear at being switched to a company that has no experience with hemophilia.

Read the current issue of PEN, which delves deeply into what is happening, why, and how this could impact you. We interview 17 patients and opinion leaders to see how forced switching is impacting lives. What we do know is this: forced switching is not something that can easily be reversed, and it is definitely a cost-cutting tactic that is here to stay. Tims are changing–read PEN to learn about all the changes and how to adapt while best protecting your loved ones with bleeding disorders. If you are not on our mailing list, please contact us to sign up! It’s free to patients, HTCs and nonprofits.

Which Suitor is More Attractive?

Far more interesting than watching Pamela Anderson and Kid Rock or Britney Spears and what’s-his-name marry and divorce is the romance going on between PBMs and certain homecare companies. Express Scripts is one suitor that doesn’t give up easily. Last week I told you that Express Scripts made a hostile bid for Caremark; Caremark jilted it this past week. It prefers the attentions of CVS, which has also bid for its hand. Those of you who use Caremark for your homecare needs better pay attention; and those of you who don’t better pay attention. The marriage of any of these giants is going to continue to impact our community, directly and indirectly. Although allegedly all this wedded bliss is supposed to lower prices of drugs, it remains to be seen in the hemophilia bottom line. What it will do for certain is consolidate power— and squeeze out the market share of smaller homecare companies who are not owned by large specialty pharmacies or PBMs.

Caremark shareholder approval of CVS or Express Script (most analysts are betting on CVS) is the next thing to watch. Tune in—

Book I read this week: “Thunderstruck,” by Erik Larson. **** Four stars
Fascinating true account of a murder mystery in London that riveted the world, and the parallel invention and development of the wireless by Marconi— and how these two events eventually crossed paths with explosive and fateful consequences. Great reading!

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