Notice on yet another scam that is proliferating; a company under the name of Senior Alertline has framed itself to look like Philips Lifeline, a medical alert service for elders, and is basically out to collect seniors’ credit card information. Below is an alert letter from the senior director of Philips Lifeline describing the scam in more detail and what to watch out for. Please contact our Senior Medicare Patrol office if you come across any such scam at 1-855-613-7080.

Dear Lifeline Program partner,

I wanted to alert you of a fraudulent situation that has recently been identified that could impact your subscribers or seniors in your community. A company referring to itself as Senior Alertline has been calling large numbers of seniors using an automated dialing technology. The company had created a website that essentially copied the Philips Lifeline website. The design and photography was the same as the Lifeline website, and some of the phone numbers in their website actually pointed to Lifeline. When asked, the fraudulent call center indicated they were based out of Framingham, MA (though our investigation has identified the call center as existing in Florida). This appears to be a fast moving outfit, as they have already changed their website (www.senioralertline.com) and they are now copying another PERS provider’s website. Obviously, there are severe legal implications with this fraudulent company’s activities. Apparently, this enterprise is also being pursued by a state attorney general in the mid-west, as hundreds of senior related scams have already been reported. This company is only interested in gaining access to a senior’s credit cards. A variety of tactics are being used including the promise of a free gift, inexpensive PERS service, free PERS equipment etc.

Our privacy people and legal team are actively pursuing a variety of means in order to shut this scam down as quickly as possible. However, because Senior Alertline is using automated dialing, they are reaching many consumers very quickly. To compound this situation, LifeAlert and other PERs providers have also begun investing in these automated dialing methods. This may make it challenging for seniors to understand and differentiate between a legally acceptable marketing approach and a scam.

We wanted you to be aware of this situation, in case any of your subscribers or seniors in your community contact you with regard to PERS related calls they may have received or any unusual charges showing up on their credit card bill. If a subscriber does report an unusual charge, they should contact the bank that issued their credit card to stop the fraudulent charge. If your subscriber contacts you, we would encourage you to inform them that there are a number of PERS related scams going on. They should not give out their credit card to anyone and simply tell the inquiring caller they are not interested.

Unfortunately, this is not the first industry related scam, and it will likely not be the last. Rest assured we will work to hastily resolve any fraudulent activities that come to our attention. I will keep you apprised should the situation warrant further communication. Should you have any questions or should you be contacted by any subscribers reporting unusual activity, please email us at healthcaresegment@lifelinesys.com.

Thank You,

Mark Rutherford, Senior Director, Healthcare, Philips Lifeline

Oral health problems can hinder a person’s ability to be free of pain and discomfort, to be able to maintain a satisfying and nutritious diet, and to enjoy interpersonal relationships and a have positive self-image.

Oral and dental health problems are more frequently found in an older adult population for whom other health problems are often more of a priority. However studies show links to poor oral health and over all health care issues and therefore should not be seen as not important, since oral health is connected to your overall health care.

The 2013 quality ratings for Medicare Advantage and Part D prescription drug plans were posted on Medicare.gov in early October. The Centers for Medicare and Medicaid Services (CMS) rates plans on a variety of quality care measures with 1 star being the lowest rating and 5 stars the highest. As Medicare’s fall Open Enrollment (also called Annual Election Period) is now through December 7, this is a good tool for beneficiaries to use when choosing whether to change their health coverage for the new year. This rating system is also one way CMS is encouraging and rewarding plans that provide quality care.

In addition, beneficiaries who are in a low-rated plan, one that has received less than 3 stars for 3 consecutive years, now have the right to switch to another, higher rated plan. CMS has sent out over 500,000 notices to such beneficiaries in October, encouraging them to consider switching plans. Beneficiaries in low-rated plans who do not make a change within the Annual Election Period (Oct 15- Dec 7), and decide later that they would like to, can call 1-800-MEDICARE to do so.

Also, if beneficiaries live in an area with a 5 star rated plan, they have the right to switch to that 5 star plan anytime between December 8 and November 30. Their coverage will begin on the first of the following month. Note that not all areas have 5 star rated plans. In fact, there are very few plans with such high ratings. In 2013, only 9 out of 555 Medicare Advantage contracts are with 5 star plans, and only 4 out of 74 Part D contract are with 5 star plans. California does have some MA 5 star plans but no Part D 5 star plans for 2013.

Patients with Type 2 Diabetes may face an increased risk for Barrett’s Esophagus (BE), regardless of other risk factors including smoking, alcohol consumption, obesity and gastroesophageal reflux disease (GERD), according to research unveiled at the American College of Gastroenterology’s (ACG) 77th Annual Scientific meeting in Las Vegas.

With more and more studies showing links to poor oral health and over all health care issue it is important to maintain your oral and dental care health.  Seniors may need to see their dentist more then just twice a year if advised by their dentist in order to properly maintain their dental healthcare needs.

However with the rising cost of dental care many seniors tend to put off their dental care needs.  One why to address the cost factor is by having dental insurance.  There are many different types of dental insurance plans that can address different needs. One this website we offer Affordable low cost dental insurance plans such as HMO and or dental discount plans. Both of these plan types will make dental care much more affordable at a low month cost.

For people that wish to stay with or choose their own dental provider we also offer dental PPO plans such as Dental Dental, NationWide StandardLife Dental and AlwaysCare to name a few.  Take a moment to review our dental insurance and plan options and see which may be the best fit for your dental needs and your budget.

In a prior posted dated we talked about what periodontitis is and how it affects your dental health.  However you can avoid getting periodontitis simple by having good at home dental care habits, and seeing your dentist at least twice a year or as often as advised by your dentist.  By having dental insurance it help keep your dental care cost low. One main factor as to why people do not see a dentist regularly was cost factors. However with insurance most dental plans benefits provide free preventive care. Thus helping you maintain your regular dental visits and  your dental health care.

Several beneficiaries from 6 California counties have been calling their local Health Insurance Counseling and Advocacy Program (HICAP) about their plan’s termination notice. These beneficiaries are enrolled in the Anthem Blue local PPO plan called Anthem Medicare Preferred Standard. They received a letter in late October letting them know that their plan is terminating as of December 31; it is not renewing their contract with Medicare for 2013. Yet this letter arrived 3 weeks past the October 2 deadline for plans to notify their enrollees of any non-renewal for next year. Furthermore, what makes this situation confusing for beneficiaries is that Anthem Blue is offering a new local PPO plan in 2013 with the exact same name (different plan ID number) but with much higher premiums and maximum out-of-pocket (MOOP) amounts.

If you know of affected beneficiaries in these counties (Sacramento, San Diego, San Francisco, San Mateo, Sonoma and Ventura), please help let them know that they need to actively choose their new coverage for the coming year. Because Anthem Blue’s 2012 local PPO is not renewing, plan members have a Special Election Period (SEP) to join a different Medicare Advantage plan (between December 8 and February 28) AND a guaranteed issue right to by a Medigap policy.

Below is a brief summary of their options:

Change to a different Medicare Advantage plan. Beneficiaries can make this change during the Annual Election Period (October 15 – December 7), or during their SEP (December 8 – February 28). Again, beneficiaries should be reminded that the new Anthem Blue local PPO is a different plan even though it has the same name. If a beneficiary wants the new Anthem Blue local PPO plan, they need to affirmatively enroll, understanding that the premium and maximum out-of-pocket (MOOP) amounts are higher. They will not be passively enrolled (or cross-walked) into the new Anthem Blue PPO.

Return to Original Medicare. Beneficiaries can go back to Original Medicare by enrolling in a stand-alone Part D plan during the Annual Election Period (AEP) or SEP. If they do nothing, they will be automatically enrolled in Original Medicare and not have prescription drug coverage as of January 1, 2013. Those who return to Original Medicare can also use their guaranteed issue right to buy a Medigap policy.

Improvements in health care are slow, in part because doctors and nurses lack skills in quality improvement, patient safety, and interprofessional teamwork. This article reports on the Retooling for Quality and Safety initiative of the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement, which sought to integrate improvement and patient safety into medical and nursing school curricula.

In one academic year, 2009–10, the initiative supported new learning activities (87 percent of which were interprofessional, involving both medical and nursing students) in classrooms, simulation centers, and clinical care settings that involved 1,374 student encounters at six universities. The work generated insights—described in this article—into which learning goals require interprofessional education; how to create clinically based improvement learning for all students; and how to demonstrate the effects on students’ behavior, organizational practice, and benefits to patients. A commonly encountered limiting factor for the programs was the lack of a critical mass of clinically based faculty members who were ready to teach about the improvement of care. What’s more, the paucity of robust evaluation strategies for such programs suggests a future research agenda that deserves to be funded.

The Coordinated-Transitional Care (C-TraC) Program was designed to improve care coordination and outcomes among veterans with high-risk conditions discharged to community settings from the William S. Middleton Memorial Veterans Hospital, in Madison, Wisconsin. Under the program, patients work with nurse case managers on care and health issues, including medication reconciliation, before and after hospital discharge, with all contacts made by phone once the patient is at home.

Patients who received the C-TraC protocol experienced one-third fewer re-hospitalizations than those in a baseline comparison group, producing an estimated savings of $1,225 per patient net of programmatic costs. This model requires a relatively small amount of resources to operate and may represent a viable alternative for hospitals seeking to offer improved transitional care as encouraged by the Affordable Care Act. In particular, the model may be attractive for providers in rural areas or other care settings challenged by wide geographic dispersion of patients or by constrained resources.

Even though most seniors understand that their dental care is important many do not see a dentist regularly due to increasing dental care cost.  However seniors seeking to reduce the cost of their dental care services should give thought into buying dental insurance.  There are many good low cost HMO dental insurance plan that are affordable under tight budgets and can make a big difference in the cost of dental care.  Stop putting off your dental care needs and look into buying dental insurance to make dental care more affordable

Consumer-directed health plans are plans with high deductibles that typically require patients to bear no out-of-pocket costs for preventive care, such as annual physicals or screening tests, in order to ease financial barriers and encourage patients to seek such care.

People surveyed  in California who had a consumer-directed health plan and found that fewer than one in five understood that their plan exempted preventive office visits, medical tests, and screenings from their deductible, meaning that this care was free or had a modest co-payment. Roughly one in five said that they had delayed or avoided a preventive office visit, test, or screening because of cost. Those who were confused about the exemption were significantly more likely to report avoiding preventive visits because of cost concerns. Special efforts to educate consumers about preventive care cost-sharing exemptions may be necessary as more health plans, including Medicare, adopt this model.

15 million people in the U.S. have food allergies, and  pesticides and tap water may be responsible.  According to the researchers, high levels of dichlorophenols, a chemical used to chlorinate water and also used in pesticides, is linked to food allergies when it is found in a person’s body.  The finding was published in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), and came from a team of experts led by Elina Jerschow, M.D., M.Sc., ACAAI fellow and allergist.

Periodontitis is an inflammatory disease that affects the periodontium, which is the group of all the tissues that surround and support your teeth. Among these tissues, the periodontium is made of the alveolar bone, the gums, the periodontal ligament and the cementum.

Periodontitis is a progressive loss of alveolar bone around teeth. If periodontitis is not treated, teeth begin to move, shift and eventually fall out.  This disease is mainly caused by harmful bacteria and protozoa, and an aggressive response of the immune system against these microorganisms. The dentist makes the diagnosis by detecting the presence of periodontal pockets (spaces created between the gums and the teeth) and the analysis of X-rays to evaluate bone loss.

Health plans participating in the Medicare managed care program, called Medicare Advantage since 2003, have historically attracted healthier enrollees than has the traditional fee-for-service program. Medicare Advantage plans have gained financially from this favorable risk selection since their payments have traditionally been adjusted only minimally for clinical characteristics of enrollees, causing overpayment for healthier enrollees and underpayment for sicker ones.

As a result, a new risk-adjustment system was phased in from 2004 to 2007, and a lock-in provision instituted to limit midyear dis-enrollment by enrollees experiencing health declines whose exodus could benefit plans financially. To determine whether these reforms were associated with intended reductions in risk selection, we compared differences in self-reported health care use and health between Medicare Advantage and traditional Medicare beneficiaries before versus after these reforms were implemented. We similarly compared differences between those who switched into or out of Medicare Advantage and non-switchers. Most differences in 2001–03 were substantially narrowed by 2006–07, suggesting reduced selection. Similar risk-adjustment methods may help reduce incentives for plans competing in health insurance exchanges and accountable care organizations to select patients with favorable clinical risks.

Within Medicare, the Medicare Advantage program has historically attracted better risks—healthier, lower-cost patients—than has traditional Medicare. The disproportionate enrollment of lower-cost patients and avoidance of higher-cost ones during the 1990s—known as favorable selection—resulted in Medicare’s spending more per beneficiary who enrolled in Medicare Advantage than if the enrollee had remained in traditional Medicare.

A looked at the two measures that can indicate whether favorable selection is taking place—predicted spending on beneficiaries and mortality—and studied whether policies that Medicare implemented in the past decade succeeded in reducing favorable selection in Medicare Advantage. We found that these policies—an improved risk adjustment formula and a prohibition on monthly disenrollment by beneficiaries—largely succeeded.

Differences in predicted spending between those switching from traditional Medicare to Medicare Advantage relative to those who remained in traditional Medicare markedly narrowed, as did adjusted mortality rates. Because insurance exchanges set up under the Affordable Care Act will employ similar policies to combat risk selection, our results give reason for optimism about managing competition among health plans.

Enrollment in Medicare Advantage, the managed care program for Medicare beneficiaries, has grown rapidly, from 4.6 million enrollees in 2003 to 12.8 million by 2012, or 27 percent of all current Medicare beneficiaries. We analyzed utilization patterns of enrollees in Medicare Advantage health maintenance organization (HMO) plans compared to matched samples of people in traditional Medicare during 2003–09, to ascertain whether the HMO enrollees demonstrated different levels of use of services, which can be a hallmark of more integrated care.

It was found that utilization rates in some major categories, including emergency departments and ambulatory surgery or procedures, generally were 20–30 percent lower in Medicare Advantage HMOs in all years. Medicare Advantage HMO enrollees initially had lower rates of ambulatory visits and hospitalizations, although these rates converged by 2008; they also received about 10 percent fewer hip or knee replacements. In contrast, HMO enrollees underwent more coronary bypass surgery than patients in traditional Medicare. These findings suggest that overall, Medicare Advantage HMO enrollees might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.