Disclosure: Medtronic & Roche

As my readers may know, my name is Scott Strumello, and I'm the publisher, author, editor-in-chief, CEO, as well as chief cook and bottle washer of "Scott's Web Log". For those of you who were NOT aware of it, when I re-designed my blog in February 2011 (actually, the work began a while earlier, but that's when I launched the new look), I more prominently featured my "Disclosure" statement which had been around for a while, although I never exactly promoted this fact.

Note that in the right-hand margin under the heading of "Recognition" (I really should find a new heading for the items in this section, but until I do, that's where the primary link to my disclosure is found). Just look for the blue button with a red check-mark and the text "I Disclose" to read my disclosure policy (just use your mouse over that button and click on it), or for a more direct route, simply visit http://disclose.sstrumello.com/.

Transparency

In the interest of full transparency, I'd also like to disclose to my readers that tomorrow, I will be travelling from my home-base in New York the Los Angeles area to a social media event being hosted by Medtronic Diabetes Care, perhaps best known for the Medtronic Minimed brand of insulin pumps, infusion sets and continuous glucose monitors. While there, I will get to see some of the Medtronic Sensor Manufacturing area which should be a great learning experience. Medtronic Diabetes Care is headquartered in Northridge, CA. Medtronic invited me and is paying for my travel, lodging and meals during this trip. I will be joined by a number of others in the collective North American diabetes online community at this event. Kelly Kunik of Diabetesaliciousness(TM) wrote about her involvement with this event last month (see HERE for details), and I was contacted by Medtronic even before I redesigned my blog and had a tool enabling that.

Medtronic's European Social Media Conference

Now, although this is Medtronic's first such event here in North America, evidently they held a similar event in Europe a few weeks ago, and held another one a year earlier in Medtronic Diabetes Care's location in Geneva, Switzerland (or as Put Up or Shoot Up's Tim Brown referred to it "Medtronic's Swiss Lair"). My North American peers may be interested to read some of the writing about the 2010 Medtronic Europe event at the following blog links:

http://www.shootuporputup.co.uk/2011/03/medtronic-locks-diabetics-in-room/

http://www.shootuporputup.co.uk/2011/03/drowning-puppies-in-lake-geneva/

http://www.diabetesinspain.com/featured/2nd-annual-medtronic-european-internet-forum/

http://mypumpblog.com/2011/03/24/2nd-annual-medtronic-european-internet-forum/

A post from last year's event can be viewed at:
http://www.diabetesinspain.com/featured/medtronic-diabetes-internet-forum-recap/

As you might infer from these posts (including an inside joke about drowning puppies in Lake Geneva), in much the same way as many of us in North America have bonded at other meet-ups, apparently, so have our counterparts "across the pond" as more than a few UK residents are fond of saying. Maybe we can compare notes, and perhaps ... someday, someone will decide to arrange a diabetes social media event in Reykjavik, Iceland, which is about the same distance from New York as it is from London? One can wish, can't they?!

Odd-Man Out?

I should note that among my fellow North American diabetes blogger peers, I may one of a few odd-men out because I do not presently wear an insulin pump (along with Bennet Dunlap, of "Your Diabetes May Vary ['YDMV']"), who's a parent of no-longer-children with diabetes -- hey, it happens!), although I'm certainly no stranger to insulin pumps. Then, Tom Karlaya (whose children are also blessed with type 1 diabetes) will also be joining us, so not everyone there will be tethered to pumps. I don't believe they are seeking that, what they want is to gain a wider perspective for the diabetes community at large.

I can best be described as a "former pump-wearer" (I blogged a bit about that HERE) with a competitor, no less. The reasons are varied, and my d-blogging peers sometimes respond to that with disbelief. Although I don't want to make this post about why I went back to multiple daily injections, but I can say that durable medical equipment limits with my insurance played a role (at the time), but also the fact that more than 90% of my total daily dosage is prandial insulin and that my basal rates were essentially unchanged throughout the day except for the few hours before I wake up, and I can truthfully say that my glycemic management did not suffer at all since returning to MDI.

I'm not unwilling to re-consider a pump, but most likely not one of Medtronic's present line-up because I'm not a fan of pumps with tubing. That, incidentally, seems to be a family trait, as my older sister with type 1, who by-the-way, avoided a pump for longer than I did -- 41 years by my calculations, but that all changed after at Diabetes Research Institute's Diabetes 2.0 Conference my sister attended with me and a few other d-bloggers. She started wearing a pump for the first time around Chistmas 2009, and has been pretty happy with her tube-less Omnipod since then, but this conversation is digressing, so back to the point: disclosure.

As I note in my disclosure policy, unlike some bloggers, I do not now, nor have I ever, actively solicit what is euphemistically referred to in some blogging circles as "blog-ola" (various free stuff targeted towards bloggers), nor have I traditionally made it easy for commercial entities (or individuals) to reach me. The most enterprising individuals did leave comments which worked, but it wasn't as easy as clicking on my profile. In fact, even today, I still do not publish my personal e-mail address anywhere online. As I noted above, since I redesigned Scott's Web Log in February, I have added a new "e-mail me" button which utilizes a third-party contact service which can also be accessed by visiting http://kontactr.com/user/sstrumello as a way to connect with my readers without actually publishing my personal contact information online. That's been great, but don't waste your time trying to find my e-mail online because it's not out there -- and that's by design.

Beyond that, I also wish to disclose that Roche Diabetes Care has also invited me to a Conference they'll be holding in San Diego, CA from June 22 through the morning of June 24, 2011, although I have not yet determined whether I will be able to attend. That happens to be where the ADA's Annual Scientific Sessions meeting is also being held this year. In the event that I DO attend, Roche would be paying for my travel, lodging and food at this event, but it's not completely free -- I would still have to use my personal vacation days to participate in this event (although a trip to enjoy some of the awesome San Diego weather will be worth it!). Roche invited me to a similar event held last year, and also the prior summer, and I have also participated (voluntarily) in a social media advisory board that Roche seeks patient input on. Truthfully, I believe the company has listened to at least a few of our suggestions. For example, in the Accu Chek television spots, Roche now promotes the inclusion a discount card that enables patients to obtain test strips for as little as $15, which was a huge discussion at their first meeting in Indianapolis a few years ago.

Now, I have not been shy about which testing supplies I use (see HERE, although it took me a while to exhaust my OneTouch Ultra strip supply, and now I have a few left that I am trialling with a new Android application. But the reality is that few patients actually choose which meters and test strips they will use; this stuff is frequently chosen or heavily influenced by insurance company formularies and complex pricing strategies deployed, and the brand I use today could change overnight if my employer chooses a new healthcare provider (again), so consider the context that such decisions are made within.

Then again, I was previously a fan of Roche's infusion sets when I wore a pump (although at the time, Roche had not yet acquired the Swiss firm formerly known as Disetronic whose Ultraflex set was my infusion set of choice when I used to actually wear an insulin pump).

So, while I look forward to seeing at least a few of my fellow diabetes advocates/bloggers in L.A. and I hope it proves to be a productive meeting for all parties involved, just know that there's a much larger community out there as our Euro D-Bloggers out there can attest, not to mention the Australia-New Zealand (Oceania?) group, too. But with each meeting, more contacts are established which expand this virtual community in a way that online interactions cannot.

I can only hope my readers will see this perspective the same way!

Rare Compliments

I complain quite a bit about my healthcare plan (I wonder what person with a chronic disease doesn't?), but truthfully, most of my complaints should really be directed not at my insurance company or even the plan itself, but at all of the accompanying health reimbursement account/"HRA" (which although generous, still required all kinds of additional paperwork) administrative stuff that I need to deal with in order to get even the most basic medical treatment stuff paid for. My HRA pays for everything (except the first $500) until my insurance company deductible has been met, because it's much cheaper for my employer than to pay for things this way than it is to pay the higher premiums associated with a lower-deductible plan. In essence, I must file claims with both my insurance plan, and HRA to get things like doctors' appointments or even simple laboratory bloodwork paid for. Anything not covered or left over is paid for by a separate flexible spending account. All of these are tax-advantaged accounts, and whenever the IRS gets involved, there's paperwork.

It is (or I should say was) a paperwork nightmare, submitting every claim in triplicate to the insurance company first, waiting for an explanation of benefits to arrive from the insurance company indicating how much they will allow towards the deductible and that they have paid nothing until that deductible amout is met, then also submitting the same claims to various reimbursement account administrators (HRA and FSA), and then trying to keep track of all of the many, many I claims I submit for insulin, testing supplies, labwork and the like. I spent hours and hours dealing with this so-called "world-class" healthcare system just to get basic services paid for, and I hated every second of it.

My last HRA administrator would send payments (via direct deposit) with absolutely no documentation of which claims were even being reimbursed, just an adjusted dollar amount and I had to try and figure out what claims the payment was for. Last year, I had to complain to my HR person that over $1,750 in claims (which I had paid for out-of-pocket and was now incurring finance charges on from my credit card company) had not been reimbursed in over 7 weeks, in spite of a service guarantee that they would be repaid within 10 business days. Fortunately, I had return receipts for all of my claims, and they were resolved pronto once I complained about them (although I still incurred finance charges that were NOT reimbursed), but it was a royal pain-in-the-@$$ to deal with.

My employer also had problems with the reimbursement account administrator (for example, they changed the process for having claims processed using a different web host and never bothered to tell my company about it, which explains why I had $1,750 in claims that weren't processed), and fortunately, there is an entire "industry" dedicated to this. Naturally, this industry has a trade organization called the Employers Council on Flexible Compensation (ECFC).


That's why I have a very RARE compliment to make about something that actually DOES work, but it's one I felt was worth sharing because, as I learned, things really do not HAVE to be such a burden.

PWDs: PCPs, HRAs, HSAs, FSAs, even the FDA ... Do We Really NEED Any More Acronyms in this "system"?

I use the term very "system" loosely to describe the way healthcare is paid for in the U.S., because it's a euphemsim, but certainly NOT an accurate description by any stretch of the imagination. The term "system" implies that everything works together in order to provide optimal healthcare. Instead, the U.S. "system" is really a group of self-interested, for-profit providers all very eager to get paid, but with little genuine regard or even interest (unless it saves them money) for what's really in the best long-term interest of the patient.

In this "system", everyone skims something (profit) from claims yet patient outcomes seem to be at the bottom of the list in terms of how things actually work. There are a few rare exceptions: for example, a true Health Maintenance Organization (HMO), Kaiser Permanente which operates mainly in California, actually does a better job of coordinating care for a patient as a whole. Although many people covered by Kaiser still gripe endlessly about getting costly devices like new insulin pumps covered, and the formulary really does not offer much of an exception process for covering non-formulary drugs even when a person who really cannot use the chosen formulary brands. But in the grand scheme of things, this model really does provide better overall care rather than the disjointed, "everyone for themselves" business model that pretty much defines U.S. healthcare today. I was covered by Kaiser when I lived in California back in the 1990's and honestly, had no major complaints with it, unlike my mostly negative experience with WellPoint/Anthem Blue Cross-Blue Shield.

My current healthcare plan arrangement is one of the ways that smaller companies deal with runaway healthcare costs which consistently exceed the overall rate of inflation, often by quite a bit. Because smaller companies do not have the buying power and clout that large firms do, the insurance companies are anything but shy about passing costs on to their clients. While healthcare reforms slated for 2014 may help to alleviate some of these issues, that's still 3 years from now. I have to deal with this so-called world-class healthcare "system" frequently until that happens (and it assumes that recently-elected lawmakers will not be successful in changing things on a wholesale basis).

A few years ago, I wrote (see HERE) about how my employer had switched healthcare plans (and we do NOT have a choice of plans to choose from) three times over 3 years. That's due (in part) to costs that increased, on average, 27% per year. But insurance companies also play stupid games with pricing. They lure new clients in with cut-rate pricing, and then, a year later, they jack their prices to make up for the sweet deal they gave away initially. Many small companies respond by switching plans readily. My plan-year also ends June 30, compared to November 1 for most other firms.

I think have noted before that my employer offers healthcare insurance, but no choice in plans. The plan, incidentally, is a very high-deductible plan ($2,500 per person/per year) which means very little is actually covered by the insurance company until that deductible has been met (except for certain things which are required by state law, such as testing supplies, but not medicines like insulin — go figure!). However, by using plan doctors and services, I am able to enjoy the negotiated rates for doctors, labwork, pharmacy benefits, etc. that would otherwise be unavailable and unattainable to me as an individual.

My employer also generously picks up most of the cost of my insurance deductible with what is called a health reimbursement account ("HRA"), which means that once I've paid the first $500 out-of-pocket (which I can pay for using pre-tax dollars via a flexible spending account ["FSA"] which reduces my taxable income and therefore annual tax liability). After the first $500, the remainder of my healthcare claims are pretty much reimbursed via my employer's HRA, except my co-pays.

I made some adjustments to my FSA since I had more left over than I anticipated last year, and also thanks to changes in IRS guidelines some OTC (over-the-counter) things now require a doctor's prescription to be covered. Not a big deal, but it's yet another hassle from lawmakers that seem more concerned about helping industries who lobby them most than they do addressing the issue of runaway healthcare costs.

But the paperwork was an absolute freakin' disasterous nightmare. But this year, thanks to the issues I noted above, my employer dumped their former HRA/FSA administrator and selected a new firm that could also handle transit arrangements, specifically a Federally-sponsored program which enables employees to pay for mass transit using pretax dollars. They selected a firm named The Choice Care Card, administered by a rapidly-growing, Vermont-based company. What an incredible difference that has made, and I mean that in a good way!

First of all, we have a single MasterCard debit card to handle all of this, so the process is largely electronic; I have had almost no paperwork to submit aside from my signing the original enrollment form. Honestly, I still can't believe it! I was even able to authorize the HRA/FSA administrator to use my insurance company login to look up the explanations of benefits, so I don't even have to send that stuff in — they do it for me! On the rare occasion I do need to send in substantiation for something, that is easy, too. I can either upload it to their website, e-mail it to them, or mail it in the old-fashioned way.

I am also fortunate enough to have a dental plan, which although not funded by my employer, still enables me to pay for this plan, again using pre-tax income. I selected a maintenance organization largely to have access in case of dental emergencies, but have been delighted with my primary care dentist, who is a recent dental school grad with a brand new office right in my neighborhood. This year, I needed a new crown to replace one that was being uprooted by a wisdom tooth that was growing into my old crown. The co-payment cost for this was only a $200, compared to several THOUSAND dollars I paid for when I had the original crown put in a number of years ago. To pay for it, I used my healthcare debit card to pay for the co-pay, and got an e-mail a few days later asking for substantiation. I asked the dentist to fax me a copy of the procedures I had done and the charges for each (co-pay amounts), which arrives as an Adobe Acrobat file in my fax inbox. From there, I just had to upload that document to Choice Care Card's website on the particular charge/claim in question, and voila: substantiation complete. It took all of 2 minutes once I spoke to the administrative assistant at my dentist's office and received the documentation.

The difference in this system compared to the previous one is light-years ahead. These various tax-advantaged accounts (HRAs, FSA, etc.) are meant to assist U.S. residents with healthcare costs, but they DO NOT have to be an administrative nightmare, as this example has proven to me.

If you are dealing with annoying paperwork and the like, realize that there are vast differences in the capabilities of the administrator your employer hires to handle these accounts. Of course, employers are the one's to select an administrator, but enough complaints about reimbursement might prompt them to select a new vendor, as was the case with my employer starting January 1, 2011. So far, the amount of time I've spent on seeking reimbursement for claims has been just a few minutes each time, not days and days.

I call that a rare compliment!

DSMA Carnival Topic of the Week: Diabetes Summer Camps

Theme song "Are You Ready For The Summer?" from the 1979 movie "Meatballs"

The entire topic of diabetes summer camps seems to be pretty popular in the blogosphere, perhaps because the final deadlines for enrollment (and deposits) is imminent (or has passed for at least a few summer camps). See HERE and HERE for more on this subject from the Diabetes Social Media Advocacy (DSMA) blog. However, realize that residential summer camps are a big luxury for many families, perhaps a once-in-a-lifetime luxury. The cost of residential summer camps for a 2-week stay in the Northeast is now around $3,000 per child for the 2011 season. Even though many camps have scholarship programs, the reality is that even with some form of scholarship, the cost may still be out of reach for many families. For example, for a family with say 3 children (or more), the choice NOT to send all of their of children away for summer may simply be an economic decision. For 3 children to go away to summer camp, parents would need to spend approximately $10,000, while an entire family may be able to go away someplace on vacation for the same cost (or less). Simply stated, summer camps are a luxury for many families, even though it seems like it's standard operating procedure for many families in the New York City Metro area to send their kids away to camp not just for a few weeks, but for the entire summer, year-after-year.

Because of the cost, day camps are an even more popular option for many families, and growing up, I did enjoy going to a nearby day camp most days (except when the weather was lousy) where I learned how to windsurf and kayak (I already knew how to swim and row a boat), but mostly it was just a place to hang out with other kids and have fun. But I also remember my parents having to to deal with special instructions on how to deal with hypos and the like with the camp administration, even though they never needed those things while I was at camp. Fortunately, since the day camp I went to was funded (at least partially) by taxpayer dollars, the camp was in no position to say "sorry, your kid with type 1 diabetes cannot attend because we do not have a nurse on staff", but it was still a big concern for my parents.

Still, stay-away summer camp was still something that I grew up hearing about. For example, summer camp was integral to the story of the 1961 Disney film classic "The Parent Trap" starring Hayley Mills, Brian Keith and Maureen O'Hara (perhaps better known for her role in the original "Miracle on 34th Street"). I grew up watching reruns of that movie on television, and the 1979 film "Meatballs" (the theme song from that movie is above, but does require that you have Adobe Flash Player installed) that sort of launched comedian Bill Murray's film career, and that movie was all about summer camp.

But just imagine if you could send your child with type 1 diabetes away to a special diabetes camp, where the health concerns would never be an issue, plus the whole concept of good diabetes management, combined with independence from Mom & Dad, as well as hanging out with other kids who didn't need or want an explanation for why you had to inject insulin when you when you eat anything, or just because the numbers are out-of-range (which doesn't make it a crisis, or even imply you did something wrong). Basically, it's opportunity to have a great time. (Diabetes summer camp is also an excellent opportunity for mom and dad to take a break from diabetes.) While I might not have been wild about doing it as a 7 year-old kid, a few years later I might have found the idea to be very tempting.

A close friend of mine was a camp counselor at a residential camp in New Hampshire shortly after college. The experience was different as an adult, especially one with responsibility for the campers, but I recall thinking "if only there were a diabetes camp for adults!". Building on that theme, I would just answer the following questions that I probably would attend an adult diabetes camp for type 1 diabetes as long as I could fit it into my vacation schedule and it was a reasonable distance away from where I live. While an adult camp for type 2 might be worthwhile, there are enough unique needs for both two types of diabetes to have these things separately. For example, teaching Blood Glucose Awareness Training (BGAT) at diabetes camp would have almost no interest to people in the type 2 audience, while most of us in the type 1 community don't need such basics as what to do with test results or carb counting.

To address Q3: "What type of team-building activities would you like to see at an Adult Diabetes Camp?", I would respond by saying that there could be anything from advocacy and nonprofit fundraising, so such things as the things being addressed in Gary Scheiner's relatively new, online Type-1 University (T1U), to purely social events, races, competition, KP Duty ... the whole nine yards!

To respond to Q3.5: "What type of "not" so serious activities would you like to have?", I would respond by saying that some of the topics discussed during some DSMA/Twitter discussions such as a diabetes prom might also be the kind of purely "not" serious activities that would be worth having.

As for Q4: "Camp Counselors: Endo's, PCP's, PWD's or a little bit of both?", I'd say having some good endos as well as diabetes educators would be great, but they need not have such a dominant role in the way those professionals might at a kids diabetes summer camp.

What are your thoughts on this subject? I look forward to reading the feeback from my fellow diabetes bloggers out there!