Category Archives: Health

Understanding Pharmacy Benefit Management: How Do PBMs Generate Money?

Pharmacy Benefit ManagementPharmacy benefit managers (PBMs) help self-insured companies and health plan providers in reducing pharmacy expenditures. PBMs, for the most part, function to lower the cost of prescription drugs using different methods like drug utilization management. They also negotiate discounts, contract with pharmacies, and automate administrative services.

While these managers help clients reduce pharmacy costs, some of them generate a sizeable revenue. This is why it is important to understand how PBMs make money. Pharmacy benefit consulting companies note that this is a great help for effective negotiation and PBM cost control.

Cost of Generic Ingredients

PBMs generate money from generic ingredient expenses by charging extra amount per prescription. This is possible through Maximum Allowable Cost or Average Wholesale Price. These are the main revenue sources of PBMs and there is a significant gap between these pricing elements. It is best for clients to ask PBMs a list of generic drugs used last year to know if the pricing is reasonable.

Electronic Processing

They also make money through administrative fees for the electronic processing of the claim. This is common in pass-through models, with fees that can range from $1.25 to $3.50. PBMs also generate extra revenue through transaction fees that they charge retail pharmacies.

Rebate Amount

PBMs earn more by offering a not-so-fair rebate amount on retail pricing elements. They offer this in different ways such as on fixed amount, on percentage, on per script basis, or on per formulary brand basis. This is why it is best to ask for a fixed dollar amount or a percentage, with negotiation on per script basis.

Other Revenue Sources

They also make money through mail order pricing elements, dispensing fees, and specialty pharmacy rebates. Many of them also offer value added program that promises guaranteed savings. It is of utmost importance to evaluate if such programs can offer a good return on investment.

Effective auditing techniques, according to Government Finance Review, can help ensure that clients or plan sponsors pay competitive market prices for drugs and eliminate excessive PBM profits. It is also advisable to work with pharmacy benefit consulting company to negotiate better and understand pharmacy benefit cost.

Do Your Genes Make You Look Fat?

Weight Problems in Pembury

Weight Problems in PemburyWeight does not define a person, but it certainly affects how we perceive ourselves. It does not help that overweight people are often stereotyped as overeaters living a lazy lifestyle.

About 62.1% of adults in the UK are overweight or obese, says a 2013 data from the Health Survey for England. That means more than half of the population are suffering from the health risks and stigma associated with obesity.

Carrying that excess weight affects both the self-esteem and physical health, says TheWellsSuite.co.uk, exposing you to risks of heart disease, stroke, and hypertension. Just when we think there is nothing good about obesity, experts argue that being overweight is more natural than being thin in revolutionary terms.

This raises the question of whether we should blame obesity to genetics or learned lifestyle. Is obesity nature or nurture?

For Nature

To argue the stance of nature and genetics, the key term is ‘predisposition’. Experts believe that about 80% of people have inherited genes that predispose them to storing fat for any foreseen danger, like a famine. Looking at the numbers (62.1%), this premise clearly has some merit.

Paul Zimmet, a professor and obesity expert from Australia says at least 50% of all obesity cases are caused by genetics. Healthcare professionals should address obesity as they would other genetic conditions, like high-blood pressure and depression.

For Nurture

The role of genetics in obesity was challenged when a British research argued that an active lifestyle can significantly reduce someone’s propensity to obesity. When trying to gain and maintain a healthy weight, they advise focusing on exercise, not genetics.

On the other hand, it is the ones prone to obesity who take more effort to burn fat and to control their appetites. Some genes prevent people from realising they are full while other genes mean an overweight person can exercise as much as a thin person, but burn less fat.

Regardless of whether obesity is an act of nature or nurture, experts urge the public to avoid fat-shaming. Society should stop judging an overweight person without knowing their background and health conditions, says Professor Zimmet. ‘Assuming someone is fat because they’re lazy or eat too much is just plain nasty.’

Surgery to the rescue

When dealing with serious weight problems, exercise and diet may not be enough. Some professionals consider bariatric surgery (weight-loss surgery) to help the morbidly obese, especially those at risk of developing type II diabetes. The person can lose about 50% of their excess weight and live on to leading a healthier, stricter lifestyle.

Health Issues That Prolonged Inhalation of Asbestos May Cause

Inhaling Asbestos Cases in Salt Lake CityIf you live in an old house, it’s important to inspect it regularly for natural minerals like asbestos that build-up with age. Although asbestos fibers are useful in tile flooring, building materials, and pipe insulation, being overly exposed to it could cause serious health problems.

Asbestos contains mineral fibers such as tremolite, amosite, chrysolite, actinolite, and crocidolite that might cause several health complications over time. It’s not easy to detect the presence of asbestos in your house without performing certain tests. Aerolite Group and other experts say that it’s advisable to perform asbestos testing in your Salt Lake City home, especially if it’s more than 30 years old.

Here are some health conditions you might get if you don’t do something:

Lung Cancer

The risk of developing lung cancer is higher in people who breathe large quantities of asbestos, like smokers. They may quickly develop this cancerous condition along with their inhaling of cigarette smoke. Although the tumor may first develop in the lung, it could spread to other vital organs if not treated early. Persistent coughing is among the symptoms a victim could show.

Asbestosis

Unlike what many people assume, asbestosis is not a cancerous condition. It’s simply a progressive and chronic lung disease that people develop once they inhale asbestos fibers for many years. The inhaled asbestos accumulate in the lungs and cause lung scarring (fibrosis), which causes the lung to stiffen and to look like a honeycomb. Symptoms include persistent coughing, tight chest, breathlessness, and bluish skin tinge due to inadequate oxygen in the circulation system. If not diagnosed early, asbestosis may cause respiratory failure or even death.

Pleural Disorders

The tissue that covers the lung surface and lines the chest cavity is known as pleura. Inhaling asbestos for a long period may cause the production and accumulation of pleural plaques (thickened patches) on the pleura. The inhaled asbestos could also cause the pleura to produce pleural effusions (chest cavity fluid) or a widespread fibrosis. Although pleural disorders are not cancerous, they reduce lung capacity as most lung function tests and chest x-rays reveal.

Don’t let these happen to you. Know how old your house is and have it tested before it’s too late.

Start Young: Caring for Your Toddlers’ Teeth

Dental Care

Dental Care in ArizonaTeeth erupt in different stages. The first set of teeth, often called baby teeth, are completed before a child turns three years old. The second set of teeth, called permanent teeth, start erupting at age seven. This means that your children’s teeth will all be replaced starting age seven.

While teeth eruption happens at a specific time, Scott Dentistry and other dental professionals say that this does not mean you should not take care of your child’s teeth. The habits they form as a child are more difficult to change. It’s best to let your children learn proper dental care at an early age. Here are some ways you can do this:

  1. Ease them through the process – Children begin teething six months after birth. For most babies, this may cause mild to severe discomfort and fever. Rubbing their gums with your fingers can help relieve irritation. Going to your family dentist for medications may also be an option if your child suffers from extreme discomfort.
  2. Teach them to brush properly – While this is a phrase repeated by many people, not everyone actually understands what it means. Supervise your children while they brush their teeth and remind them to cover all surfaces. Use soft bristles to minimize gum bleeding.
  3. Go for regular check-ups – Dental check-ups at least twice a year is important to diagnose dental problems, to know if there’s a need for braces, or to clean the teeth. While brushing everyday helps, nothing cleans better than a professionally done prophylaxis.
  4. Control their diet – Start teaching your children what to eat to avoid sugary food and carbonated drinks, which are the culprits for tooth decay. If they are not used to eating sweets, they won’t have problems resisting sweet cravings in the future.
  5. Commit to a dentist – Prioritize family dental care and find a family dentist to take care of everybody’s your teeth. Choose a dental clinic that is accessible and within your immediate vicinity, and a dentist you can trust completely to cater to your needs.

Form your children’s habits early with the tips mentioned above. It is but one more way to show your love and concern for your little ones.

PPO Negotiation: Maximizing your Dental PPO Insurance Revenue

Dental Insurance

Dental InsuranceContracts with insurance firms vary year to year and from one firm to another, some firms having fixed fee structures while you can negotiate for friendly fees with other firms. For dental insurance, these fees also depend on your local competition, and the value your dental practice adds to these firms’ insurance plans. When signing up with a Participating Provider Organization (PPO), for example, you choose to be a preferred provider and agree to a lower fee structure than you would have charged.

Nevertheless, PPOs are beneficial in marketing your dental practice and services you offer, which, in the long run, will help you maximize your PPO insurance revenue.

What are PPOs?

PPOs are insurance programs in dental practice in which patients choose a dentist of their preference from a pool of providers that have a contractual agreement to discount their fees. When reviewing these PPO plans, you should consider the amount of discounts that make patients change their dentists, the employers’ liability — should the plan influence provider selection — and the criteria for provider selection while maintaining the ADA’s code of ethics.

The Dynamics of Reimbursement PPO

From a patient’s viewpoint, the benefits of PPO are very clear. But for providers, while the benefits will help you drive patient flow, reimbursements from PPOs change over time as your practice matures. When participating in multiple PPOs, you should consider ditching low reimbursement PPOs after comparing the fees paid and the plans’ market share with the associated administrative hassles. In some cases, you can add better PPOs to maintain modest PPO insurance revenue.

It is important that you also involve a professional hand to assist in negotiating with insurance providers to discuss the insurance fee structure for better dental insurance reimbursement rates, and to help you cut overhead for optimum practice profitability.

Negotiating with insurance providers will demand more than just you contacting them for better rates. These insurance firms are also on the run to maximize their profits, so you require sane reasons for deserving these high rates. But do you really have extra hours to keep chasing down insurance representatives to negotiate your reimbursements, or to analyze your PPO structure at the expense of pursuing your dental practice?

Contact professionals with a consistent service record in PPO insurance revenue negotiation to help you secure the best dental PPO reimbursement rates in the market.

Dental Basics: What Exactly Your Dentist Wants You to Know

Oral Health Talk

Oral Health Talk Whilst dental services are easily accessible these days, dentists are still encouraging people to be responsible for taking care of their oral health. The message is simple: maintain good oral health, and if problems do occur, help is within reach.

Dentists are more than just problem solvers. They were trained to provide treatments and most importantly, educate. So what exactly does your dentist want you to know?

You are Responsible for Your Oral Health

You are responsible for whatever happens to your mouth. The current condition of your teeth and gums, whether good or bad, is a result of your decisions and actions in the past. Dental care should start in you. Your dentist, however, is there to remind you of your responsibilities and to provide treatments whenever necessary.

You Should Not Wait for Bad Things to Happen Before You Act

When was the last time you visit a dental practice? If you are doing this regularly since you were a child, then you probably have healthy teeth and gums. If regular dental check up was not your priority, chances are you experience many oral problems. Your dentist wants you to realise that prevention is always a better option. Do not wait for problems to occur and worsen – avoid them in the first place.

It is Never Too Late to Save Your Oral Health

Your dentist is always ready to save your oral health. He is just waiting for your call or appointment request. It is never too late to improve the condition of your mouth. A cosmetic dentist in Surrey, for example, will provide the best treatment options if restoring the health and beauty of your teeth and gums is possible.

There is Hope for Your Damaged or Missing Teeth

A range of cosmetic dental treatments is available to restore the appearance and function of your teeth. Let your dentist know about your problem and you will get the treatment that is right for you.

You are responsible for taking care of your oral health, but a dentist will guide you on the right track to help you achieve the best results. Be informed, watch what you eat, maintain proper oral hygiene, and visit your dentist regularly.

Athletics and Fitness: The Fundamental Training Trio

Sports Massage in Wellington

Physiotherapist in WellingtonGetting fit and aspiring to become the image of health is perhaps one of the noblest pursuits in life. Health and fitness trends and fads aside, living strong is its own reward. When you are healthy and strong, you get more out of life. You get to do more things some people cannot. If you are one of those people in Wellington who place value in well-being and have decided to adopt a healthy lifestyle, here are three constant anchors to help you reach your fitness goals.

Proper Exercise

Exercise is a key component of fitness. Working your body from mediocrity to athletic superiority is the way to achieve your fullest physical potential. Think, if you were bestowed a healthy and properly functioning body upon them without disabilities do not squander it. It is your responsibility to nurture it and unlock its potential. Go running, start lifting weights or learn sports. Exercise kick-starts your metabolism, activating more energy in your body. This energy turns you livelier and lifts your mood. Start working out and you will soon feel that a good sweating does wonders to your brain.

Proper Nutrition

A developing physique needs nutrients to fuel its development. They say you are what you eat. So if you want to be the best version of yourself, you had best better start eating right. Cut the junk food and eat ‘real’ food. Whole grain food such as bread and oats, and lean protein beef up your physique. To help accelerate your progress, you can always take supplements to complement your food intake.

Proper Rest

Working hard is one thing, but working without rest is quite another. For those who are trying to get a healthy body, they must never forget the third ingredient that makes everything come together: rest. In any training program, you need rest to give your body the time to recover and rebuild. So do not cheat yourself of sleep. Have a Wellington sports massage if you are sore. It is in resting that the body’s systems take over to repair all the damage you took and make you stronger.

Making a commitment to yourself to live strong is the first step towards your goal. See it through and you will be winning in due time.

Oral Decision: The Search for a Reliable Dentist

Dentist in Layton

Dentist in LaytonMany advise to always take your time when choosing a dentist or any professional you wish to provide you services. The last thing you want to happen is to think that you are doing your part in maintaining your oral health and then end up dealing with unwanted and unnecessary emergencies.

When choosing a dentist, Hillfield Pediatric & Family Dentistry and other dental professionals suggest taking note of the following factors and use them as basis:

Qualifications

This is your priority: you want to make sure that the oral health care provider you choose has the qualifications that make them worthy of their job title. A dentist in Layton or anywhere in Utah should have completed a doctoral degree in dental medicine or dental surgery and should carry a certification and licensure. Length of experience and practice also indicate their abilities and qualifications.

Facilities and Amenities

The dental clinic can tell you a lot about their training and reputation. You want to choose an oral health care provider who maintains a sanitary, organized, and clutter-free clinic. This includes those who follow strict and rigorous infection control policies.

The equipment and facilities also signifies the trustworthiness of a dentist, as only the most dependable dental care professionals understand the need and value of investing in these latest technologies.

Location and Payment Options

It pays to have a good working relationship with a dentist near your home or office. This makes it easier for you not only to schedule visits, but to always be present during your appointments. When talking to prospective dentists, ask them what their accepted payment options are. Having a dentist who accepts your insurance plan will do your finances a lot of good.

Personal Comfort

How comfortable you feel when you are around a dentist can impact your overall dental visit. Fear and discomfort are two of the biggest factors why many people rarely pay their visits, contributing to the decline of good oral health.

As long as you take these factors into consideration, you have greater chances of choosing the right dentist.

Dental Treatments: When You Need Them

Endodontics in Santaquin

Endodontics in SantaquinThere are dental conditions that might not give you the confidence you need. These include discolored teeth, crowding, or a protruding tooth. Various treatments may be employed to help change these conditions.

Gingivitis

Gingivitis is a periodontic diseases that causes the inflammation of the gums. When one brushes the teeth, a particular area of the gum may bleed. The disease might be painless, and even though blood may be seen, you are encouraged to continue brushing your teeth. Also, mouthwash that contains Chlorhexidine is effective in treating gum diseases.

Braces

If you’re not happy with that protruding tooth, you may visit a dentist to have braces. Braces not only change the way your teeth appear; they may also improve the long term health of your teeth. This is because braces spread the biting pressure of the teeth. Some braces are metallic and can be seen, while others are invisible.

Tooth Extractions and Endodontics

Extractions involve removing a tooth because of crowding or because it’s decaying. The affected area is usually numbed to reduce the pain and discomfort. A little bleeding may also be experienced during the treatment.

Myspanishforkdentist.com says endodontics services in Santaquin also handle root canal treatment. Endodontics deals with the treatment of root canal. It involves getting rid of a damaged area of the tooth, filling a tooth, or disinfecting an infected tooth. A tooth infection may be the result of a crack or a deep cavity. Endodontics offer endodontic and periodontic treatments for gum disease. The most common gum disease is gingivitis.

Teeth Whitening

There are several factors that may lead to the discoloring of teeth. These include smoking, drinking, or eating certain foods. Very few people have that perfect smile with a white set of teeth.

A perfect smile may be all you need to give you the confidence to face the day — or life, for that matter. Root canal treatment, oral cancer examinations, and gum surgery may also determine how your health is generally.

Common Teeth Problems: What You Should Do

Dental Care

Dental Care in Utah A visit to the dentist may result in the identification of dental problems that need quick solutions. To have an idea, here are some of the most common problems and their solutions.

  • Tartar build-up – The build-up of tartar causes teeth discoloration and stains on the surface of the teeth. Eventually, tartar hardens into plaque. Proper cleansing of the teeth through regular brushing, flossing, and cleaning administered by the dentist at least twice a year helps prevent the build-up.
  • Plaque – The combination of saliva, food particulates, and fluids produce a sticky deposit called plaque. It is the primary cause of gum disease and the development of dental cavities which further break down and weaken the teeth. Flossing and brushing daily is primarily the way to combat this build-up. Having the dentist perform cleaning also makes sure existing plaque is removed before other problems begin to develop.
  • Teeth stains – Teeth stains are discolorations at the surface of the teeth caused by a variety of things such usage of certain drugs, smoking cigarettes, drinking coffee and tea and consumption of dark-colored food, among others. Toothpastes containing pyrophosphates help prevent stains. Lessening the consumption of said items and brushing teeth regularly can also help. When the stain is already there, the process of whitening or bleaching is also an alternative.
  • Gum disease – Also known as periodontal disease, gum disease can cause tissue loss when left neglected. The use of toothpaste with sodium fluoride as well as good oral hygiene addresses the problem.
  • Tooth decay – Cavities, when not dealt with early, may lead to serious tooth decay. Too much sugar from food and drinks that get trapped between teeth and some of it is not removed by ordinary brushing and losing. In these occasions, the bacteria from the by-products of food eat away at the tooth enamel, making it weaker. When you neglect tooth decay, it may result to tooth loss. In those cases, dental professional myspanishforkdentist.com recommends consulting an endodontist may be advisable to go over options on replacing lost teeth. Cosmetic dentistry has provided a lot of choices to restore the mouth’s natural beauty through intact teeth.

Taking care of your teeth pays off in many ways. This is the reason consulting with your dentist should be a part of your daily habits to avoid lifelong regrets.