CH Allegheny PRO

It’s EdLogical | 10

Rewards for Wellness | 14 Love Your Heart | 18

COMMUNITYHEALTHMAGAZINE.COM | WINTER 2021

Sticking to your preventive care schedule puts you in the driver’s seat | PAGE 36 On Time, Every Time

ALLEGHENY COUNTY SCHOOLS HEALTH INSURANCE CONSORTIUM

PERMIT 335

ST. JOSEPH, MI

PAID

PRSRT STD US POSTAGE

Scrub as much as you scroll.

Do it right. Get back to life.

Our practice is committed to providing state-of-the-art care to our patients, treating all gastrointestinal problems and screenings through a full range of diagnostic and therapeutic options. All of our physicians are board certified in Gastroenterology. Colorectal cancer is the secondmost deadly cancer and screening for colorectal cancer can save your life. The South Hills Endoscopy Center is a state-of-the-art facility providing colonoscopy and upper endoscopy screenings and services. Our medical staff and office personnel strive to work as a team to provide you with quality medical services in a pleasant and professional atmosphere. THISWINTER TAKE CARE OF YOURSELF

COLON CANCER AWARENESS MONTH

March

is just around the corner!

NO REFERRALS NECESSARY. MAKE YOUR APPOINTMENT TODAY.

(412)

232-8104

Pictured clockwise from top right: David V. Glorioso, M.D.; Mark A. Cedar, D.O.; Robert J. Pagano, M.D., Lisa A. Oliva, D.O.; Nicholas A. Bellicini, D.O.; Xuong Lu, M.D.; Theresa Schuerle, D.O.; David L. Limauro, M.D.; Jungman Leo Lee, M.D.

2589 BOYCE PLAZA ROAD • UPPER ST CLAIR South Hills Endoscopy Center is an independently owned and operated facility, which may lower your out-of-pocket health care costs.

Compassionate, personalized Anesthesia Care delivered by our partnering Nurse Anesthetist team

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2589 Boyce Plaza Road, Upper St. Clair - 412-838-0400 • 100 Stoops Drive, Suite 320, Monongahela - 412-232-8104 ALSO VISIT US AT:

Get care in minutes without leaving your house.

Stay in bed instead. Use your smartphone, tablet, or computer to connect with a health pro. Video visits are a great way to safely connect with a health professional and get care for mild coronavirus symptoms, cold or flu symptoms, back pain, cough, diarrhea, eye irritation, rash, and urinary problems. The doctor or nurse can even send any necessary prescriptions to the pharmacy of your choice. IT’S CONVENIENT AND AFFORDABLE Video visits are available 24/7 for anyone in Pennsylvania, Maryland, New York, Ohio, or West Virginia. Plus, they’re a covered benefit under many insurance plans — including most Highmark plans. So check with your insurance company to see if there’s any cost to you.

Book your video visit at MyChart.AHN.org, or download the MyChart app to your smartphone or tablet. Certain terms and conditions as well as additional fees, messaging, and data rates may apply.

Allegheny Health Network (AHN) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex in its health programs and services. In order to treat individuals in a nondiscriminatorymanner, AHN provides free communication aids and language assistance services.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. (412) 469-5017 ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (412) 469-5017 ⌞ᝅφྸ᷒ᛞֵ⭞㑷儊ѣᮽθᛞਥԛ ރ 䋱⦨ᗍ䃔䀶ᨪࣟ ᵃएȾ䄁㠪䴱 (412) 469-5017

The of POWER PARTNERSHIP

Since 1998, Aon has been proud to partner with ACSHIC to provide health and insurance solutions to consortium members. With deep experience in the education sector, we help consortium members by providing fact-based insights to guide insurance purchasing decisions.

For more information contact: Michael Garofalo | 412.263.6353 | michael.garofalo@aon.com Sherri Grasak | 412.594.7576 | sherri.grasak@aon.com Diana Gregorakis | 412.263.6365 | diana.gregorakis@aon.com Jeff Snyder | 412.263.6375 | jeff.snyder@aon.com Aon is a leading global professional services firm providing a broad range of risk, retirement, and health solutions.

IN-NETWORK Dentist’s charge Discounted cost SAVINGS EXAMPLE: CROWN* You pay discounted prices at dentists in your Concordia Advantage network. But out-of- network dentists can charge full price for the same care, so you’ll spend more. Plus most in- network dentists offer discounts on services above your annual maximum. Use the Find a Dentist tool on UnitedConcordia.com and look for this mark. SAVE MONEY ON DENTAL CARE Spend less at dentists in your Concordia Advantage network

Plan pays 80% Your cost

$700

$560

$140

$1,100

OUT-OF-NETWORK Dentist’s charge

No discount

Plan pays same 80% Your cost**

$1,100

$1,100

$560

$540

FIND IN-NETWORK DENTISTS UnitedConcordia.com/find-a-dentist • 866-604-8512

*For illustrative purposes only. Savings shown do not account for premium cost. Savings will vary by dentist, service, patient history, geographic region and provider net- work associated with your plan. Sample charges based ZIP Code 16601 as of November 2020, and rounded up to even dollar amounts for ease of explanation. **Non-network dentists may bill the member for any difference between our allowance and their fee (also known as balance billing).

MEM-0585-1120

WINTER 2021 | VOLUME 13 | ISSUE 4 Allegheny County Schools Health Insurance Consortium

COMMUNITY

10 BY JACKSON A. THOMAS EdLogics offers online games and other interactive assets that can earn you rewards — and keep you on the path to better wellness. Healthy Fun

COVER STORY

Don’t Defer Regular visits to your primary care physician, dentist, eye doctor and — for some people — specialists are the front line of defense against illness, including chronic and potentially lethal diseases.

36

INSIDE

8 HAPPY NEW YEAR!

12 WEBINAR EASES STRESS

14 WELLNESS REWARDS

Listen to Your Heart 18 BY JACKSON A. THOMAS February is National Heart Health Month. Take care of your ticker by staying active, eating right and effectively coping with stress.

15 DIABETES PREVENTION

16 LEGAL CHALLENGES TO THE ACA

20 COVID VACCINES ARE COMING

28 MORE COVID: WHAT WE’VE LEARNED

6

WINTER 2021

COMMU N I T Y H E A LT H

We’re here to help.

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ALLEGHENY COUNTY SCHOOLS HEALTH INSURANCE CONSORTIUM

To Better Times Ahead

WINTER 2021 | VOLUME 13 | ISSUE 4

BOARD OF TRUSTEES AFT PENNSYLVANIA Donald Alexander Christine Armbruster Jo Ann Hunter Walt Michalski AIU Joseph Lucarelli BUSINESS MANAGERS

F inally, the last welcome letter for the 2020 magazines. Like all of you, the Allegheny County Schools Health Insurance Consortium Board of Trustees has faced the challenges brought about by the COVID-19 pandemic. Like you, we have worked around day-to-day changes in rules, sudden notifications of implemented and revised government-imposed guidelines, and the availability of our various health care provid- ers and vendors. Like you, we have done all of that while main- taining our duties to you in a “business as usual” manner. Also, like you, we have been working on the needed effort to continue our duties in the future. Trustees made a fortunate decision at the 2019 development sem- inar: Because of the growth of ACSHIC and the need to use our time wisely, an initiative spawned at the event was to revisit the need for and use of our subcommittees.

Dana Kirk | PINE-RICHLAND SD Doug McCausland | AMBRIDGE SD HIGHER EDUCATION Michael Swartzendruber | CCAC PSEA Barbara Bell Alisa Murray Marylou Stefanko Robert Tuite Jr. David Wyatt SCHOOL BOARD MEMBERS

David Wyatt ACSHIC Chair

Jamie Evans | SOUTHEASTERN REGION Peter Moniodes | WESTERN REGION Debra Raubenstrauch | EASTERN REGION Gary Shingleton | NORTHERN REGION SEIU Helen Spade Pete Schmidt Joseph Wysocki SUPERINTENDENTS Dr. Amy Burch | BRENTWOOD BOROUGH SD Dr. Caroline Johns | NORTHGATE SD Dr. William Short | GATEWAY SD Dr. William Stropkaj | KEYSTONE OAKS SD

Over the years of growth, ACSHIC has beenmuchmore that a “mom-and-pop” consortium. To maintain the excellence we have striven to maintain and that you have come to expect, com- mittees were consolidated, redefined and empowered to do particular work. DougMcCausland andWalt Michalski have done an unbelievably helpful job leading the pharmaceutical group. TheWellness Committee has done a masterful amount of work withMike Swartzendruber at its head. Budget and finance is being covered by Joe Lucarelli, a move that will streamline that committee. Joanne Hunter is leading us with a strategic planning process, and has constructed a format that each of our vendors must follow in the future. This will allow us to track vendor costs, income, contract details, product and advertisement requirements, and other valuable infor- mation. Trustees will be able to share the needs of our members with the vendors contracted to meet those needs. The trustees who serve on these committees have made things a little easier for the Board, and the committees’ reports have provided the Boardmore time to focus onmeeting our goals. Trustees have been using their time with our vendors to focus on what we can offer members to help alleviate problems caused by the pandemic. Trustees have worked tirelessly with our health provider’s liaison, Susan Ballengee of High- mark. With daily updates when available, texts and emails, Sue has been a valuable and reliable source of information from local, state and federal agencies. She has also assisted with the day- to-day functioning of the consortium. Our EAP provider, Lytle, and their representative, Bev Brem, have reached out to our school districts, community colleges and others to offer assistance to people who are experiencing stress. While physical well-being is obviously crucial, members are no doubt under pressure because of the challenges presented by e-learning and hybrid teaching models, and uncertainty about which they’ll be using and when; all while trying to maintain as normal an existence as possible, both personally and professionally. Our consultants, Mike Garofalo and Diana Gregorakis, have seen to it that the trustees are as well-informed as our members. Because of the uncertainties of our situation, the financial reports we receive fromCarleen Burns of AMCA are not only informative, they help us focus on areas where costs can be contained or reduced. We are now approaching our end-of-the-year tradition: setting the rates for the next year, in this case 2021-22 We want our members to take care of themselves, so stick to the maintenance schedule you may be following; get flu shots and, if necessary, pneumonia shots; and take care of your regular doctor and dental appointments and procedures. And as you try to stay well, we will continue to function as well as we can, and provide the level of health care you expect at the most affordable cost possible. With the Board consisting of superintendents, school boardmembers, business managers, teachers, librarians and education- al support staff, ACSHIC is very aware of what you face every day. Being that this is my final welcome of the year, I will take some personal privilege and extend to all our members greetings of the season, and the sincere hope that 2021 will be as hopeful as 2020 was chaotic. As I write this, the potential vaccines are being touted by the media. I am hopeful that in the next issue of our magazine, we’ll be able to share pertinent information or even some success stories. Stay well and stay safe, and here’s to a Happier New Year.

BUSINESS OFFICE Michael Garofalo Diana L. Gregorakis

c/o Aon Consulting 625 Liberty Ave., 27th Floor, Suite 2700 Pittsburgh, PA 15222 (412) 263-6365 | (412) 765-3022 Fax

COMMUNITY MAGAZINE GROUP Larry Perrotto | CHAIRMAN Mark Hornung | MANAGING DIRECTOR Jason Maholy | EDITOR Caitlyn Bettenhausen | PROJECT MANAGER

Shannon Mashek | ART DIRECTOR Joe Zannelli | GRAPHIC DESIGNER Dee Edington| WELLNESS EDITOR Jeff Mercer | REGIONAL SALES REP

1550 S. Indiana Ave., Chicago, IL 60605 (312) 880-0370 | jason@communityhealthmagazine.com ADVERTISING | Call Jeff Mercer at (412) 596-3727, or email jeff@communityhealthmagazine.com

LETTERS TO THE EDITOR | Send comments, letters, story sugges- tions and photos relating to your local health news to jason@communityhealthmagazine.com . This magazine and its content are for general consumer educa- tional use only. Nothing contained in this magazine is or should be considered or used as a substitute for medical advice, diagno- sis or treatment by a licensed medical practitioner. Nor does the Allegheny County Schools Health Insurance Consortium endorse any products or services marketed by advertisers in this issue. As always, please consult your physician. Community Health magazine content is published to educate consumers about health care and medical issues that may affect their daily lives. As always, please con- sult your physician. COMMUNITY HEALTH ACSHIC is published quarterly by Community Magazine Group, 1550 S. Indiana Avenue, Chicago, IL 60605.

Postmaster: Send address changes to COMMUNITY HEALTH ACSHIC, 1550 S. Indiana Avenue, 2nd Floor, Chicago, IL 60605.

CommunityHealthMagazine.com Facebook.com/CommunityHealthMagazine

8

WINTER 2021

COMMU N I T Y H E A LT H

Knowyour care options andwhen to use them

Family doctor For annual exams and ongoingmedical conditions that need regularmonitoring.

Urgent care For in-person conditions like earaches, sprains, orminor cuts.

ER For emergencymedical care including severe chest pain, burns, or broken bones.

Set up your Teladoc account today Call 1-800-TELADOC | Visit Teladoc.com/Enter Download the app

© 2020 Teladoc Health, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc Health, Inc., and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA-controlled substances, non- therapeutic drugs, and certain other drugs that may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.

ACSHIC

YOUR COMMUNITY

Healthy Gaming EdLogics makes well-being interactive Information about the vendors available to Allegheny County School Health Insurance Consortium (ACSHIC) members can be accessed in a fun way at myedlogics.com, thanks to an online game. EdLogics CEO TomChamberlain, Vice President of Product Development and Client Services Brooke Chamberlain, and Executive Vice President of Business Development Kirk Woodruff say the concept is about making learning fun. Judging by the responses from clients, that goal has been attained. By Steve Metsch

“We know that people forget about 80 percent of what their doctor says by the time they get to the parking lot,” Woodruff says. Words from a doctor about health care sometimes seems like a lecture to a patient. “That’s why you tend to not remember some of the most important things you probably should,” Woodruff says. “So, what we did, we built an interactive, multimedia — and most importantly, gamified — health education and engagement platform,” Woodruff says. Through the use of online games, clients can earn points to become eligible for gift card prizes. En route, they also learn more about each of the following vendors that have links on the EdLogics page:

Lytle EAP Teladoc Healthcare Bluebook

“What we did was build these games to teach the employ- ees about what these vendors are all about,” Chamberlain says. “We became the virtual front door of ACSHIC.” Brooke Chamberlain says the games have proven popular. The “Fact or Myth” game has questions from seven vendors about services offered. Users can answer questions about services that are offered. After answering, they learn if they are correct or not, and in the process learn more about the topic in each question. “We’ve become a knowledge center for the employee on any product, any company or their own company,” Tom Chamberlain says. “You learn something about your bene- fits by playing.” Clients can also access information about the Highmark program, ShareCare. “ShareCare wasn’t being used often because it wasn’t engaging,” Tom Chamberlain says. “So, we built it on behalf of Highmark because they wanted to make ShareCare stay as a product. We wanted it more exciting and more useful and more used.” Brooke Chamberlain, notes that a link to ShareCare is on

United Concordia Dental ACSHIC Health Options Program Advance Medical Davis Vision Highmark (member portal and FAQs) Social Security Administration (retirement) VBA (vision) Medicare

10

WINTER 2021

COMMU N I T Y H E A LT H

The COVID-19 pandemic has increased use by clients. “When we went to the COVID marathon — I think when that reality hit — our numbers went even higher,” Brem says. Lytle EAP started recording webinars in March, when the pandemic began to take its grip on the nation. “They’re recorded and are on our website,” Brem says “They’re on adjusting the new normal, resilience, self-care, talking to your kids about the pandemic, all different topics related to the pandemic, to be as supportive as we can and be responsive to everyone’s needs.” “None of us have every dealt with anything like this before,” she adds. “We want to be there for our customers as they’re there for their employees.” EdLogics offers a “Coronavirus Center” where clients can learn more about a wide range of issues regarding the pandemic. Included are risk factors, prevention and tips about how to stop the spread. There are infographics about the pan- demic, and special features including current news about the virus, with updates from the CDC. “We really are a communications platform,” Tom Cham- berlain says. “Ultimately, we’re really good at engaging con- sumers. That’s kind of what ACSHIC really likes. There are lot of vendors they use. ... We all have a thousand opportu- nities to do different things.”

the EdLogics website, as are links to all the other vendors for ACSHIC clients. Tom Chamberlain, who has worked as a pharmacist, says asking people to read pamphlets about vendors wasn’t working. “I knew there had to be a better way,” he says. “When gamification starting coming into corporate America – starting to use points and leader boards and badges – that kind of gave us the idea.” The games aren’t just a gimmick. “They’re not just a way to get people to come back to the site,” Woodruff adds. “They’re incredibly important and also really powerful educational tools.” Clients can earn points to increase the number of entries they have in drawings for gift cards, and they can receive a $50 one-time award if five colleagues who they invite actually register. Lytle EAP Executive Director Beverly Brem and notes that many services are offered to members, such as short- term counseling, medical advocacy and work-life issues. Mental health counseling is available by calling (800) 237-7272 around the clock. Lytle EAP also offers legal and financial resources, health and lifestyle assessments, and interactive checklists for family, health and other life situations. Checklists can be saved for future use.

WINTER 2021 11

COMMU N I T Y H E A LT H

ACSHIC

YOUR COMMUNITY

Webinar helps educators and staff de-stress By Steve Metsch A webinar for teachers, support staff and administrators in the Allegheny County School Health Insurance Consortium was intended to help them cope with stress and anxiety during the pandemic. The online event in November was hosted by Highmark’s Director of Behavioral Health Demetrios Marousis and Alicia Kaplan, an associate professor of psychiatry at Drexel University and a psychiatrist for the Allegheny Health Network. “Stress and anxiety, it’s not something we talk about often,” Marousis says. Uncertainty is prevalent because teachers are not familiar with teaching online, he says. “As teachers, you were trained to teach, and part of that training puts you in class- rooms in a multisensory experience, and that is now not available,” Marousis says. “Teachers fulfill many community roles. It’s not just the education of children. Some- times it’s a safe place for children, a respite of tumultuous family life.” Teachers miss the interacting in the same roomwith students. So do students. Marousis notes that students learn in different ways, and getting through to students virtually is another challenge that contributes to stress. “You have the impact that COVID has on our entire lives, our entire community, our family, our connectivity to everyone around us,” he says. “That’s important to recognize that we are in such extraordinary times.” “We’ve all been effected by the stress,” Kaplan says. “This is a collective experience that was abrupt on all of us.” Continued uncertainty can create an overwhelming sense of anxiety. Anxiety and stress can hit people in different ways. “Not one of us is exactly alike, so by understanding some of the symptoms of stress and anxiety, we can not only help ourselves but help those around us,” Kaplan says. Some signs and symptoms of anxiety may include feeling nervous, irritable or on edge; having a sense of impending panic, danger or doom; an increased heart rate; breathing rapidly, sweating or trembling; feeling weak or tired; difficulty concentrating; having trouble sleeping; and experiencing gastrointestinal problems. “We tend to overestimate the probability of something bad happening in the future,” Kaplan said. “And we also tend to underestimate our ability to cope.” The first step in the right direction is recognizing stress and talking about it, Marousis says. “The other piece is we have to go beyond ‘Hey, how’s your day?” he says. “Leadership has to have a plan. Some of that is mutual recognition. Some of it is ‘I hear you and we’re going to work on it’.” “The things we avoid tend to build upmore anxiety,” Kaplan adds. “If I haven’t been to my place of work in a while, it’s only normal that I’ll start having feelings of anxiety going back in. Avoidance can create anxiety.” Amore relaxed body, she says, can help achieve relaxation in the mind, and, hopefully, lessen the strain of stress and anxiety. Given the ever-changing news about COVID-19, it’s smart for people to try for a good sleep pattern, good diet and regular exercise. “Relaxation techniques can be very helpful,” she says, suggesting breathing with abdominal muscles and progressive muscle relaxation. “When someone comes to see me, I want to make sure none of the symptoms are related to another medical condition,” she says. Kaplan strongly suggests not overloading on news about the virus. She says it’s okay to watch the news, but advises limiting viewing to perhaps 15 minutes each day. “There are plenty of ways to help ourselves at home,” Kaplan says. “It’s important to be kind to each other and to also know there’s help available.” Virtual chill pill

12

WINTER 2021

COMMU N I T Y H E A LT H

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ACSHIC ACSHIC

YOUR COMMUNITY YOUR COMMUNITY

Be proactive to keep health problems at bay By Steve Metsch Playing prevent defense

The sweeping 2021 ACSHIC well- ness rewards program features both Sharecare and EdLogics, and is designed to be preventive of future health problems. It gives clients personalized guid- ance for a healthier lifestyle through nutrition, exercise, getting the right amount of sleep, stress reduction and more. And they get rewards for participat- ing with a $100 e-gift card adminis- tered by EdLogics. Highmark Health Management Specialist Jody Balko hopes clients are excited about the wellness program. “This is building on the program they had in 2020,” Balko says. “In 2020, it was only four months long. In 2021, it’s going to be six months long. There’s also new activities.” In 2020, clients had to complete the Sharecare RealAge test, register on

pared to your calendar age, and find out what you can do to improve your health. That is worth an additional 250 points. Another 250 points comes from completing a preventive exam or can- cer screening. This can be for breast, colorectal or cervical cancer. Each exam may be completed in-person or virtually, if allowed by one’s health care provider. That leaves another 250 needed points, which can be earned by com- pleting one of five additional activities: Engage in Health Coaching: Call (877) 258-3123 to get started. Engage in RealAge Program: To earn credit for this, track one life- style category a minimum of four days per week, for three weeks, in ShareCare.

EdLogics and undergo a preventive exam or cancer screening, then regis- ter with Healthcare Bluebook. This year, the members have more options. Instead of simply registering for EdLogics, they have to participate in a game — a list of 30 true-or-false questions to provide more insight to the health history. “This is a cool game because not only does it educate members on the rewards and the benefit, but also some of the features that they have available to them within ShareCare,” Balko says. “It is all questions about the rewards program or on ShareCare.” Completing the game scores 250 points and is one of the required activities. The others are completing a Real- Age Test on ShareCare, which helps you understand your RealAge com-

14

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COMMU N I T Y H E A LT H

Halt diabetes in its tracks Adjust diet, improve exercise habits and reduce stress with Livongo By Steve Metsch Highmark Clinical Strategy Consultant Rebekah Beil, a Registered Nurse, says the Diabetes Prevention Program aims to help those who have prediabetes from developing diabetes. An online eligibility quiz has questions about family history and one’s blood sugar. “In 2010, the CDC saw diabetes exploding,” Beil says. “They came up with kind of the foundation for what an effective DPP program is.” The year-long program teaches people how to eat right, the importance of exercise, and how to handle stress. “It will be something like tracking your food for a week (and asks) what do you feel like when you eat that food,” Beil says. “Small steps that aggregate make huge, huge differences.” The goal is to make behavioral changes that have a lasting impact, rather than a quick fix. “The ultimate goal of this is they want you to lose 5 percent of our starting weight,” she says. “That seems much more manageable than saying, ‘I weigh 200 pounds. I need to lose 50 pounds in six months.’” She says that losing 5 percent of weight is often enough to take people out of the risk for developing diabetes. Commitment, she notes, may get harder with age. But it’s something one needs to consider, especially with the many health problems and risks associated with diabetes. “It just makes you think about taking care of yourself,” she says of the prevention program. “This kind of helps guide them for the support they need.”

Achieve 60 Green Days Challenge: You join the ACSHIC Green Day Challenge in ShareCare to get started. Engage in the Livongo Diabetes Prevention Program: This entails enrolling and activating your ac- count at www.well360.livongo.com to start tracking your blood sugar. Complete four sessions of the Dia- betes Prevention Program: Visit Highmarkbcbs.com and select Diabetes Prevention to determine if you are eligible and to enroll. “I’m expecting a good breakout in the five,” Balko says. “The good thing with these options is that we do sort of tailor it for the person, how they best want to work on their wellness.” You must pre-qualify for either of the diabetes-related programs. “If they have prediabetes they can take a questionnaire to see if they qualify for the diabetes prevention program,” she says. “The first three programs anyone can do.” Balko likes the RealAge program be- cause people can choose between diet, sleep, stress and physical activity. “They pick which one they want to work on and just have to track at least four times a week for three weeks,” she

that day in order to get them thinking about their health. To start earning reward points, users must create an account at mycare.sharecare.com. Be sure to enter your information exactly as it appears on your Highmark member ID card. If you have an existing ShareCare account, you can sign in with that user- name and password. Once you have an account, you can access rewards on the Sharecare website or by downloading the Sharecare app. If you are new to EdLogics, you may register at myedlogics.com. You may register on or after Jan. 1 to start earning wellness rewards points through June 30, 2020.

says. “What’s great about the RealAge program is when a member picks a lifestyle category of their choice, they’ ll start to get information based on that topic in their timeline.” The 60 Green Days Challenge tries to get people focused on their health. Once you reach “green” status in at least eight of the 13 categories, you’ ll earn a Green Day and be one step clos- er to lowering your RealAge. “For me, I just have to answer four or five questions a day, and I get a Green Day (reward),” Balko says. “It’s based on your lifestyle already. It’s a short questionnaire each day.” Questions are broad, such as what level of stress a person may be feeling

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ACSHIC

YOUR COMMUNITY

Legal challenges to ACA could put millions of Americans at risk of losing health insurance A potentially profound impact

By Steve Metsch

Legal challenges to the Affordable Care Act, or ACA, could have a devastating impact on the health and well-being of millions of Americans, according to studies by Highmark. Citing a report by the Urban Institute/New York Times, if the ACA is struck down in court — as the Trump administration has been attempting for the past four years — 21 million Americans could lose their health insurance. The study said that 12 million adults who gained access to Medicaid through state expansion could lose coverage, and some 133 million Americans with pre-existing conditions — or roughly half the population younger than 65 —would lose protections. In addition, the study reports that 2 million young adults would be forced off their parents plans if the ACA is struck down. The study found that if the ACA is repealed, states that ex- panded Medicaid and/or had a high marketplace participation would feel the largest relative increase in uninsured population. Pennsylvania is among those states. According to Highmark, a variety of health programs would lose authorization with repeal of the ACA. Some of those include: limiting customers’ financial protec- tions; changing the formula used to calculate providers’ Medicare payments; eliminating the provision requiring pharmaceutical companies to disclose gifts and payments to physicians; ending the requirement of chain restaurants to publish calorie informa- tion on menus; invalidating insurance coverage of breast pumps and not requiring rooms for nursing mothers; and increasing drug costs for Medicare users. According to The Commonwealth Fund, the ACA faces a re- newed threat, as a Texas federal court judge is hearing arguments in a case that seeks to invalidate the law’s pre-existing condition protections, and potentially the law itself. This latest lawsuit asserts that Congress’s repeal of the individ- ual mandate penalty has rendered the mandate unconstitutional.

Further, it states that the mandate is an essential feature of the ACA and that without it the rest of the lawmust be struck down, too. Should this argument prevail, an estimated 17 mil- lion people could become uninsured, a number slightly lower than the previous estimates, but still very large. However, even with a new 6-3 conservative majority on the Supreme Court, usnews.com reported on Nov. 10 that the ACA may not be endangered after all. Two conservative justices, including Chief Justice John Rob- erts, indicated that they were unlikely to scrap the entire law, even if the individual mandate is deemed unconstitutional. Lisa Hagen of usnews.com reported: “During two hours of oral arguments in the landmark case, the justices, including newly installed Justice Amy Coney Barrett, weighed the constitutionality of the individual mandate – the requirement that people purchase health insurance or pay a penalty that Congress eliminated in 2017. “Republican Attorneys General, supported by the Trump ad- ministration, believe the mandate should be struck down and, because it was once seen as a critical part of the law, the rest of the ACA cannot stand and should be entirely invalidated. “Democratic-led states and an attorney for the U.S. House, meanwhile, argued that Congress “made a single surgical change” when reducing the penalty to zero while the rest of the law’s provisions were kept intact. “California Solicitor General Michael Mongan asked the court not to ‘tear down’ the law and asserted that there is a ‘strong presumption in favor of severability,’ meaning that a provision like the mandate can be removed from the law and the rest of the statute could still stand on its own,” the story states. A decision on the challenges to the ACA is expected from the Supreme Court no later than June 2021, according to High- mark.

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Don’t Get the Flu or Overpay for Care if You Do

In the middle of a pandemic, flu season approaches and experts warn we could be in for a double whammy.

The flu alone can lead to serious complications and the potential for multiple lab tests and diagnostic imaging, resulting in substantial medical costs. Did you know that costs for labs and diagnostic tests can vary by hundreds, even thousands, of dollars depending on where you go? The flu is bad enough! Don’t overpay for medical care, too. Use Healthcare Bluebook to find providers in your area that charge a Fair Price ™ for common shoppable services.

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YOUR COMMUNITY

The Heart of Winter Be active, find balance and keep your ticker going strong

By Jackson A. Thomas

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February isn’t just reserved for celebrating Valentine’s Day, Random Act of Kindness Day and National Chocolate Mint Day. The second month of the year is also the time to recognize American Heart Month, which raises awareness about heart health and urges people to incorporate healthy practices into their lifestyles to prevent heart disease. Heart disease is the leading cause of death for American men and women, according to the Heart Foundation. It’s also one of the most preventable diseases. “Often, the conditions we treat can lurk silently for years before causing heart attacks and strokes,” says Dr. Eli Fried- man, medical director of sports cardiology at the Miami Cardiac & Vascular Institute, part of Baptist Health South Florida. “These include high blood pressure, high cholesterol, diabetes and abnormal heart rhythms. Going for checkups, getting recommended screenings and being aware of the conditions that run in one’s family provides an opportunity to catch these conditions before it’s too late.” “Being aware of the foods we put into our bodies can have significant impacts on our long-term health,” he says. “The most accessible diet for most people consists of what we call the Mediterranean diet. This consists of chicken and fish; lots of fresh or frozen vegetables; whole grains, like brown rice or whole wheat pasta. It is better to bake our foods and avoid frying. We also want to try to limit red meat, like beef and dairy products. Of course, it is still important to cheat once in a while.” This diet is based on the traditional eating habits in the countries bordering the Mediterranean Sea, according to the American Heart Association. Dr. Susan Zhao, a cardiologist with the Santa Clara Valley Medical Center in San Jose, California, adds that exercise is also vital for a healthy ticker, but it’s not necessary to go overboard. “You don’t need to train for a triathlon to stay cardiovascularly healthy,” she says. “Health experts recommend at least 150 minutes of moderate aerobic activities per week — that is about 30 minutes of moderate-paced walking for five days per week — to maintain CV health. Not a very high bar to clear. Key is to stay consistent and make it part of your routine.” The COVID-19 pandemic may also impact a person’s heart health, and Zhao has some advice. “My recommendation to my patients during COVID-19 is to stay active, go out and exercise —while socially distancing, of course,” she says. “Exercise is instrumental for cardiovascular health, mental health and may even lower your risk for COVID susceptibility.” Stress can also impact heart health, Friedman says, but it can be mitigated. “Stress is something we all experience,” he says. “Prolonged exposure to stress can weaken the immune system, raise blood pressure and raise blood sugars. All of these can impact heart health negatively. Stress can be managed through dietary choices, exercise, improved sleep, less interaction with our smart devices and, of course, discussing withmental health professionals.” Tips for a strong ticker The effects of heart disease can come in many different forms — heart attack, heart failure, sudden cardiac death, hyperten- sion and arrhythmias, Zhao says. “With aging of the population, heart disease prevalence and burden are surely to rise,” she says. “For those without heart disease and who are at risk, the key is to prevent it from ever occurring. For those who have already had manifestations of heart disease, it is never too late to implement measures to prevent recurrence — something we call secondary prevention, which is a sweeping array of changes in mindset and habits.” She and Friedman offer some tips for heart health: “If someone has been diagnosed with cardiovascular disease, certainly taking prescribed medications is important, and monitoring those medications and their desired effects with the prescribing physician,” Friedman says. “The fundamentals of cardiovascular health are good dietary choices, a consistent commitment to exercise, and being aware of risk factors,” includ- ing blood pressure, cholesterol numbers, blood sugar control and family history of heart disease. Zhao says good practices include cooking at home, reading food labels and being mindful of portion sizes. Intermittent fasting also has gained a lot of attention in recent years, she adds. “What it does is to narrow the feeding time window per day to eight or 10 hours, and allow the body not to be metabolical- ly overrun,” Zhao says. “Do not go ultra-restrictive or punitive, which may backfire and cause binge eating. The key is balance and moderation.” Diet, exercise and stress Dietary choices are a very important part of cardiovascular health, according to Friedman.

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ACSHIC

YOUR COMMUNITY

The end in sight?

COVID-19 vaccines are coming but challenges lie ahead, health experts caution

By Jackson A. Thomas

As of December, the United States reached grim milestones in the number of COVID-19 cases and deaths. Nearly 300,000 Americans have died from the virus, and more than 15 million cases of infections have been reported in the country. An end to the pandemic may, however, be on the horizon. Pharmaceutical companies Pzifer, AstraZeneca and Moderna have each announced they have made substantial progress in their developments of COVID-19 vaccines. But the good news might be met with some skepticism from doctors and consumers alike.

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Vaccine front-runners The Moderna vaccine was found to be 94.5% effective against the coronavirus, according to early data released by the company, which made it the second vaccine in the Unit- ed States to have a high success rate. The first, from Pfizer, was found to be 90% effective and then 95% effective. Both vaccines were in the third phase of their respective studies. Dr. Andrea Amalfitano, dean of Michigan State Univer- sity’s College of Osteopathic Medicine, says he’s cautiously optimistic about the interim vaccine results. “We do not know yet whether (these vaccines) will elicit similar levels of protection when delivered to large popu- lations,” he says. “However, I am hopeful these early results are very promising.” Amalfitano stresses that it’s “very important” to have a vaccine for this particular virus for two major reasons. “The first being it is highly transmissible from individual to individual, increasing the likelihood it can spread across large populations and eventually to vulnerable populations rapidly,” he says. “This is coupled with the second reason, that being that once infected, the subsequent symptoms, morbidity and mortality are higher than for the common flu. “While one can dispute how high those numbers will be — we will eventually learn full infection rates and not just cases vs. mortality rates — it is clear that older individuals and the immunocompromised will be predictably more vulnerable, and those same individuals are at risk due to annual flu epidemics. This is why we justify annual flu vac- cines and vaccination campaigns, and therefore must even more vigorously pursue COVID-19 targeted vaccines and COVID-19 vaccination campaigns.” Challenges and concerns Medical experts and health department officials were hopeful that a successful coronavirus vaccine was going to be out by the end of 2020. If it gets emergency use autho- rization from the Food and Drug Administration, experts say it would likely be prioritized for essential workers such as doctors and nurses, and those most at risk, including people with underlying conditions and older adults. Wider distribution for all Americans still likely wouldn’t come until later in 2021. Data from early COVID-19 vaccine trials, including Mod- erna and Pfizer, has also suggested that consumers will have to be prepared for side effects that, while technically mild,

could disrupt their daily lives. “The side effects which have been reported in the first few clinical trials include fever, body aches, chills and symptoms consistent with the flu,” says Quincy Byrdsong, vice provost for health affairs and a profes- sor at Lipscomb University in Nashville. “Additionally, the longevity of the symptoms seems to vary from a few hours to a few days.” Byrdsong says he sees some challenges ahead when a COVID-19 vaccine is available. “The biggest challenge is the perception that the vac- cine will have an immediate impact on the pandemic,” Byrdsong says. “It is still being determined how long it takes these vaccines to take effect in an individual or in a population.The biggest challenge is ensuring the pre- vention measures are not relaxed because the vaccine is being distributed.” Like Amalfitano, Byrdsong is also optimistic about Moderna’s and Pfizer’s interim vaccine results, but he also has his own concerns. “I am optimistic with the technology because it does not involve the introduction of the virus into humans as a way to produce protective antibodies,” Byrdsong says. “My major concern surrounds the push to release the vaccine under an FDA Emergency Use Authoriza- tion. ... I worry if we use the vaccine before the FDA has approved it, it may hinder the ability of the clinical trials to carry out their regulatory responsibilities of ensuring safety and efficacy. I feel we have to get this right out the gate. It would be better to stress con- tinued preventive measures — social distancing and masks — and nail down the FDA approval of the vac- cine when it has gone through the appropriate checks and balances than to release it prematurely and cause more damage from a public health prospective.” Amalfitano adds that the timetable for delivery and distribution are important concerns because the Pfizer vaccine has to be kept extremely cold — at minus 94 degrees (colder than winter in Antarctica). The Mod- erna vaccine has to be frozen, too, but “only” at minus 4 degrees. “That may well limit the distribution ... to large or distant populations,” he says, and emphasizes he is still hopeful, given that early studies show this formulation can elicit protection from natural COVID-19 infection, as compared to subjects receiving a placebo.

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our open

sign works

overtime

MedExpress is committed to serving our neighbors in Allegheny County. Our warm, welcoming centers are open 8-8 every day with a full medical team, so you can take comfort in knowing great care is there when you need it. feel better about feeling better

Illness & Injury • colds, flu & infections • breaks, sprains & cuts • minor surgery • X-rays, IVs & labs Wellness & Prevention • physicals • immunizations • medical evaluations • health risk assessments Employer Health Services • occupational health & safety • workers’ compensation • worksite solutions • workplace health & wellness

emergency room or urgent care?

If you have an unexpected illness or injury, do you visit the emergency room or an urgent care center? Here’s a helpful guide to help you decide.

EMERGENCY ROOM For life-threatening conditions of all types, such as trauma or chest pains, you should always choose the ER.

URGENT CARE

For everyday illnesses and injuries that require timely attention, there is urgent care.

trauma or serious head injury

chest pain

respiratory distress

cuts and scrapes

fractures and sprains

colds, bronchitis and pneumonia

stroke symptoms

uncontrollable bleeding

unconsciousness

rashes and allergic reactions

vomiting and dehydration

asthma and wheezing

VISIT TIMES

Average Visit at MedExpress

Average Emergency Room Visit HOURS 1 OVER 4

HOUR 1

UNDER

AFFORDABLE

Average Cost of an Emergency Room Visit

$ 1,423 2

$ 155 3

Average Cost of an Urgent Care Visit

This information is not intended to replace the advice of a physician. It is information that is generally available. Each person has unique medical needs based on several factors including age, genetics, body type and build, medications, exposures to illness and medical history, to name a few. Always seek the advice of a physician or other qualified healthcare provider with any questions you may have regarding a medical condition that you are experiencing. If you are suffering from a non-emergent medical situation, it is suggested that you visit the nearest MedExpress center or your family physician. If you believe you are experiencing a medical emergency, call 911.

2 Emergency Department Pulse Report, 2010, 2 Agency for Healthcare Research and Quality Medical Expenditure Panel Survey, 2013, 3 UCAOA Benchmarking Survey, 2011