Insurers Fill Gaps in Health-Law Plans

I will keep you posted on how the below news will affect my office! -- Dr. Dale

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http://online.wsj.com/articles/insurers-fill-gaps-in-health-law-plans-1402357147

By ANNA WILDE MATHEWS

Health insurers in several states are adding to the choices of doctors and hospitals in their health-law plans amid concerns among some consumers and state officials about access to care.

In states including New York, Connecticut and Ohio, insurers have bolstered their health-care provider networks in recent months. In California, three of the biggest insurers— WellPoint Inc.'s Anthem Blue Cross, Blue Shield of California and Health Net Inc. —have all added substantially to their lists.

"There have been quite a few network additions…and there are more to come," said Jeff Rideout, senior medical adviser to Covered California, the state's health-law marketplace. "We continue to ask the plans to expand their networks to meet the needs of the enrollees that we have."

CareSource, based in Dayton, Ohio, has added more than a half-dozen hospitals since the start of the year, and it hopes to roughly double the number it currently has to more than 50. Fidelis Care, a New York nonprofit focused largely on Medicaid, has added more than 4,500 providers, including 13 hospitals, since the start of the year. More hospitals and doctors have joined "as we've started to get more enrollment, and as we've shown that we are paying claims accurately and timely," said David Thomas, chief operating officer.

The insurers that are expanding their networks said they aren't responding to complaints. Instead, they said, the tweaks reflect more willingness by some health-care providers to join the new networks, which often pay them less than traditional employer plans, as well as adjustments to serve the specific populations who enrolled. CareSource, for instance, said it added a children's hospital in Cincinnati because the average age of enrollees was 41 years old and many had families.

But insurers also note that limiting the array of doctors and hospitals where services are covered can be a key tactic in keeping down costs. As a result, according to industry officials, narrow networks may expand in certain cases, but they will continue to be common among health-law plans.

A new analysis by McKinsey & Co. found that 48% of the networks in exchange plans nationwide have limited networks, which means plans with 70% or fewer of local hospitals participating as well as the tiered plans that have higher co-pays to use certain hospitals.

But among the least-expensive plans, 69% had the more-limited networks, according to the McKinsey report. In the most popular silver tier of coverage, the plans with smaller networks had premiums that were a median 17% cheaper than similar plans offering a broad hospital selection.

Because of the health law's requirements on other aspects of plan design, including how much patients could pay out of their pockets for care, networks were "certainly the biggest lever available" to affect price, said Shubham Singhal, a McKinsey director who leads the firm's health-care practice.

The relatively limited choice of doctors and hospitals in many health-law plans drew criticism from consumers and scrutiny from some regulators as the first year of plans went into effect.

In Connecticut, Access Health CT, the state insurance marketplace, had relatively stringent requirements to ensure plans offered a broad array of providers. Even so, the exchange got complaints from some consumers who wanted to see particular providers that weren't in their plans' networks.

"In the beginning, there were some holes, and the carriers have been working diligently to fill those holes" after exchange officials flagged them, said Julie E. Lyons, director of plan management. For instance, she said, they have added physicians located in bordering states.

The California Department of Managed Health Care, which regulates most of the state's marketplace plans, has gotten more than 200 complaints so far this year related to access to health-care providers. The agency has been following up with insurers, a spokeswoman said.

A San Francisco law firm has also filed a suit in state court seeking class-action status against Blue Shield of California, alleging the nonprofit misled consumers about its provider network.

Alex Talon, a San Francisco hair stylist and one of the plaintiffs, said he bought a plan from Blue Shield because he thought it used the insurer's broad network of providers, which included physicians he used.

When he got foot surgery in January, he said, it turned out the surgeon wasn't in the health-law network, so he owed "several thousand dollars out of pocket I wasn't planning on paying."

In a statement, Blue Shield said it believes "enrollees should be as informed as possible about the products they select" and is reviewing the complaint.

Blue Shield said that between April 2013, when it originally filed its plan designs with regulators, and this April, the number of hospitals grew by 19% and the number of physicians increased 70%.

Today, there are 254 hospitals and more than 36,000 physicians. Still, both totals are less than the numbers in the insurer's broader preferred-provider organization network. Blue Shield's increases represent a "strategic buildout" of a network that was already strong, said Ken Wood, a senior vice president at the insurer.

Competitors have made similar moves. Anthem Blue Cross has added more than 3,800 health-care providers to its network, as well as some prominent hospitals, since Jan. 1. In a Southern California health-maintenance organization network, Health Net's number of doctors has grown 68% since the start of the year, to more than 11,600, a spokesman said.

All three insurers said their moves reflected greater provider interest and efforts to enhance their offerings.

Best time to go to bed? Hmm.

Thank you Markham Heid for this interesting article.  I'm all about learning about sleep these days. -- Dr. Dale

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You Asked: What’s the Best Bedtime?

http://time.com/3183183/you-asked-whats-the-ideal-time-to-go-to-sleep/

The earlier the better? 11 PM? Sundown? Sleep experts say it’s not that simple. But there is a time range you should shoot for if you’re questing for a perfect night’s sleep

Every hour of sleep before midnight is worth two after midnight. Your grandparents (and great grandparents) probably adhered to that creaky adage. “The mythology is unfortunate, because there’s no pumpkin-like magic that occurs,” says Dr. Matt Walker, head of the Sleep and Neuroimaging Lab at the University of California, Berkeley. And while nothing special happens to you or the quality of your sleep at the stroke of midnight, many do wonder: What’s the best time to go to bed?

Walker says your sleep quality does change as the night wears on. “The time of night when you sleep makes a significant difference in terms of the structure and quality of your sleep,” he explains. Your slumber is composed of a series of 90-minute cycles during which your brain moves from deep, non-rapid eye movement (non-REM) sleep to REM sleep. “That 90-minute cycle is fairly stable throughout the night,” Walker explains. “But the ratio of non-REM to REM sleep changes.”

He says that non-REM sleep tends to dominate your slumber cycles in the early part of the night. But as the clock creeps toward daybreak, REM sleep muscles in. That’s significant, because some research has suggested that non-REM sleep is deeper and more restorative than lighter, dream-infused REM sleep—though Walker says both offer important benefits.

What does this have to do with the perfect bedtime? The shift from non-REM to REM sleep happens at certain times of the night regardless of when you go to bed, Walker says. So if you hit the sack very late—at, say, 3 AM—your sleep will tilt toward lighter, REM-heavy sleep. And that reduction in deep, restorative sleep may leave you groggy and blunt-minded the next day.

That’s unfortunate news for nightshift workers, bartenders, and others with unconventional sleep-wake routines, because they can’t sleep efficiently at odd hours of the day or night, Walker says. “The idea that you can learn to work at night and sleep during the day—you just can’t do that and be at your best.” Your brain and body’s circadian rhythms—which regulate everything from your sleeping patterns to your energy and hunger levels—tell your brain what kind of slumber to crave. And no matter how hard you try to reset or reschedule your circadian rhythms when it comes to bedtime, there’s just not much wiggle room. “These cycles have been established for hundreds of thousands of years,” Walker explains. “Thirty or 40 years of professional life aren’t going to change them.”

When it comes to bedtime, he says there’s a window of a several hours—roughly between 8 PM and 12 AM—during which your brain and body have the opportunity to get all the non-REM and REM shuteye they need to function optimally. And, believe it or not, your genetic makeup dictates whether you’re more comfortable going to bed earlier or later within that rough 8-to-midnight window, says Dr. Allison Siebern, associate director of the Insomnia & Behavioral Sleep Medicine Program at Stanford University.

“For people who are night owls, going to bed very early goes against their physiology,” Siebern explains. The same is true for “morning larks” who try to stay up late. For either type of person—as well as for the vast majority of sleepers who fall somewhere in between—the best bedtime is the hour of the evening when they feel most sleepy.

That means night owls shouldn’t try to force themselves to bed at 9 or 10 if they’re not tired. Of course, your work schedule or family life may dictate when you have to get up in the morning. But if you can find a way to match your sleep schedule to your biology—and get a full eight hours of Z’s—you’ll be better off, she adds.

Both she and Walker say your ideal bedtime will also change as you age. While small children tend to be most tired early in the evening, the opposite is true for college-aged adults who may be more comfortable going to bed around or after midnight. Beyond college, your best bedtime will likely creep earlier and earlier as you age, Walker says. And again, all of this is set by your biology.

Siebern suggests experimenting with different bedtimes and using sleepiness as your barometer for a best fit. Just make sure you’re rising at roughly the same time every morning—weekdays or weekends. It’s fine to sleep an extra hour on your days off. But if you’re getting up at 6:30 during the workweek and sleeping until 10 on weekends, you’re going to throw off your sleep rhythms and make bedtime more challenging, she says.

The Emotional Toll of Living with Anal Warts

Living with anal warts, caused by the human papillomavirus (HPV), can be a challenging and emotionally taxing experience. While the physical symptoms of anal warts, such as itching, discomfort, and bleeding, can be difficult to manage, the emotional impact of the condition can be just as significant. In this blog post, we'll explore the emotional toll of living with anal warts and discuss strategies for coping with the psychological effects of this common but often stigmatized condition.

The Stigma Surrounding Anal Warts

One of the primary reasons that anal warts can be so emotionally challenging is the stigma that surrounds the condition. Because anal warts are caused by a sexually transmitted virus, many people feel ashamed or embarrassed about their diagnosis, and may worry about being judged or rejected by others.

This stigma can lead to feelings of isolation and loneliness, as individuals with anal warts may be reluctant to discuss their condition with friends, family members, or even healthcare providers. This can make it difficult to access the support and resources needed to manage the physical and emotional aspects of the condition effectively.

The Impact on Self-Esteem and Body Image

Anal warts can also have a significant impact on self-esteem and body image. The presence of visible warts or lesions in the genital or anal area can cause feelings of self-consciousness and anxiety, particularly when it comes to sexual intimacy.

Many people with anal warts may feel unattractive or undesirable, and may worry about how their condition will affect their relationships or sexual experiences. This can lead to a negative self-image and a reduced quality of life.

Coping with the Emotional Challenges of Anal Warts

While the emotional challenges of living with anal warts can be significant, there are strategies that can help individuals cope with the psychological impact of the condition. These may include:

1. Seeking support: Talking to a trusted friend, family member, or mental health professional about your experiences and emotions related to anal warts can help reduce feelings of isolation and provide a valuable source of support.

2. Educating yourself: Learning more about anal warts, including how they are transmitted, treated, and managed, can help reduce anxiety and empower you to take control of your health.

3. Challenging negative self-talk: When negative thoughts or beliefs about your body or self-worth arise, try to challenge them with more balanced and compassionate perspectives.

4. Focusing on self-care: Engaging in activities that promote physical and emotional well-being, such as exercise, meditation, or hobbies you enjoy, can help boost self-esteem and reduce stress.

5. Connecting with others: Joining a support group or online community for individuals with anal warts or HPV can provide a safe space to share experiences, seek advice, and connect with others who understand what you're going through.

DON'T LET ANAL WARTS DEFINE YOU - SCHEDULE AN APPOINTMENT TODAY

If you're struggling with the emotional toll of living with anal warts, know that you don't have to face this challenge alone. As a healthcare provider specializing in the treatment of anal warts and other HPV-related conditions, I am here to provide the compassionate, non-judgmental care and support you need to manage your symptoms and improve your quality of life.

Contact me today to schedule an appointment and take the first step towards reclaiming your emotional and physical well-being. Together, we can develop a personalized treatment plan that addresses your unique needs and concerns, and helps you move forward with confidence and resilience.

Remember, living with anal warts can be difficult, but it doesn't have to define you. With the right support, resources, and mindset, you can overcome the emotional challenges of this condition and lead a fulfilling, vibrant life.