Physicians Plus MEMBER NEWSLETTER

Transcription

1 Physicians Plus MEMBER NEWSLETTER FALL 2016 Inside This Issue Ten Reasons Why You Need a Primary Care Doctor...p. 2 How can I confirm my Primary Care Physician (PCP) selection?...p. 2 Who s the Right Doctor for Your Teen?...p. 3 Physicians Plus Care Management...p. 4 Genetic Testing Reminder...p. 4 Immunizations: Timing Is Essential...p. 5 Protect Yourself From the Flu...p. 5 For Your Information...p. 6 Formulary Update...insert Nondiscrimination Notice...insert Welcome our new Medical Director...p. 4 The Persistent Value of Generics The use of brand-name medications, when clinically-equivalent generics are available, results in billions of dollars in pharmacy waste each year in the U.S. The average price of brand-name drugs increased 16.2% in 2015 and 98.2% since For this reason, it is important to note that more than half of the prescription drugs available today have a generic option for consumers. A generic drug is a chemically equivalent, lower-cost version of a brand-name drug. Each generic medication dispensed in the U.S. must meet the same strict standards of the U.S. Food and Drug Administration (FDA) for quality and therapeutic efficacy to ensure bioequivalence to brand-name medications, prior to approval. In other words, generic medications, by law, must contain the same active ingredients and work the same way in the human body. While it s true that the price for some generics have increased, on the whole, generic medications continue to deliver significant cost savings by providing cost-effective alternatives to brand-name medications. Generic prices for the most commonly used drugs decreased 20.7% from 2014 to Physicians Plus members are encouraged to speak with their primary care physicians and pharmacists to learn about generic alternatives. Additionally, the Express Scripts Mobile App offers even more alternatives to lower drug costs and increased convenience. Express Scripts Mobile App features: $ $ View lower-cost Rx options. Compare drug prices for home delivery and local pharmacies. View your medications and set reminders. $ Member Service Contacts: (608) (800) ppicinfo@pplusic.com Web site: pplusic.com

2 Ten Reasons Why You Need a Primary Care Doctor Holistic Health Care Better Manage Chronic Diseases Higher Level of Comfort Transparency of Entire Health History How can I confirm my Primary Care Physician (PCP) selection? Lower Overall Health Costs Routine Screenings Catch Health Issues Early Physicians Plus requires that you select a P CP. Please choose one of the following methods to select a PCP from the Physicians Plus network, using our online directory at pplusic.com: your PCP selection to Member Services at Referrals to Other Medical Specialists ppicinfo@pplusic.com. Include your member information and your PCP selection in your . Decrease in Hospital and ER Visits MyChart users may send a PCP selection to Member Services via secure message on MyChart, our password-protected online health plan manager (accessible through pplusic.com). Better Patient-Provider Communication If you do not have access to the internet or would like assistance, call Member Services at (608) or (800) , Monday Friday, 7 a.m. 5 p.m. (To help us serve you better, please have your member number ready.) State and local government employees should also inform their payroll office of a PCP change. You may change to another PCP at any time by contacting Physicians Plus. 02

3 Who s the Right Doctor for Your Teen You want the best for your children, but where do you go for care when your teen seems too old for the pediatrician and too young for a general practitioner? The decision to transition your teen from pediatrics to adult or family care depends on your teen s stage of personal growth and should be a collaborative process involving parents, the pediatrician, the new primary care provider and your teen. This transition is typically slower for youth with special needs and/or chronic health conditions. It is important to empower your teen to begin managing and advocating for their health care needs as they move towards greater independence in other aspects of their life. The Differences Between Pediatric and Family Medicine Pediatric Care Pediatricians specialize in child care and medicine from when a child is born all the way up until their patients reach the age of 18 or sometimes 21. They help manage the physical, mental and emotional needs of their patients as they grow and develop. Family Care While family care doctors can treat babies and young children, not all do. Family doctors care for their patients into adulthood, not just until the age of 18 or 21. It is normal for patients seeing a pediatrician to transition to a family care doctor after the age of 18. Develop a Transition Plan A transition plan should include input from all parties and lay out action items with goal dates. This measure will help families to think through future health care needs and any complications, such as: Moving away from home or traveling Maintenance medications Vaccination history and schedule Behavioral health maintenance (therapy, counseling) Use of health savings accounts For more guidance on this transition, write out a list of questions with your teen, schedule a well-child visit and discuss options with your pediatrician. Questions related to health insurance coverage can be answered by calling Physicians Plus Member Services at (608) or (800) Physicians Plus Insurance Corporation PHYSICIANS PLUS MEMBER NEWSLETTER: FALL

4 Immunizations: Timing Is Essential The fall is a great time to ensure that your family is up-to-date on their immunizations. If you have a child who is 11 or 12, you should consider starting the three-shot series for the human papillomavirus (HPV) vaccination. HPV is one of the most common viruses in the country, with over 79 million people in the United States currently infected. HPV can cause major health problems, including cervical, anal, vulvar, mouth and throat cancer. Unfortunately, many people carrying HPV never show symptoms and can spread the virus to others without knowing it for many years. In fact, each year over 33,000 people in the United States are diagnosed with cancers directly caused by HPV. For these reasons, it is important for your child to receive the HPV vaccine before becoming infected with this virus. Fortunately, the likelihood of getting HPV can be reduced by up to 99% when your son or daughter completes the three-shot series of the HPV vaccine. Remember, the HPV vaccine is most effective when given within the recommended age range of years. Many families aim to begin the series at the annual well child exam around their child s eleventh birthday. At this visit, be sure to ask your child s doctor about the Tdap (tetanus, diphtheria and pertussis), meningococcal and flu vaccines, as well. Please contact your child s primary care physician (PCP) to schedule a visit in which your child can receive the recommended vaccinations. If your child does not have a PCP, please contact Physicians Plus Member Services at (608) or (800) for assistance or visit pplusic.com for more information. Protect Yourself From the Flu Get the flu vaccine Wash your hands with soap and water Cover your nose and mouth with a tissue if you cough or sneeze Disinfect hard surfaces Don t touch your eyes, nose or mouth Exercise more often Avoid contact with sick people Exercise more often Get more sleep Drink enough water Quit smoking Anyone with the flu is contagious one day before they begin to show symptoms and will continue to be contagious for five to seven more days. Flu vaccines will be available in clinics beginning September 30. Avoid the flu! Schedule your vaccine appointment today! 04

5 Physicians Plus Care Management is Here for You Physicians Plus is committed to our members health and wellness. We offer our care management services in true partnership with your physician and health care team. If you need help managing a condition like asthma, diabetes, high blood pressure or a heart condition, please reach out to us for more information. You may refer yourself to our care management programs or opt out at any time by calling us at (608) or (800) Genetic Testing Reminder Genetic testing requires prior authorization (PA) before testing occurs and testing must meet Physicians Plus guidelines for coverage. Your ordering physician should submit the PA with appropriate clinical information. To request a specific medical policy guideline used in making prior authorization decisions, please contact Member and Provider Services at (608) or (800) Why do I need prior authorization? Prior authorization acknowledges that a meaningful medical decision has been thoroughly analyzed by a healthcare provider in line with best practices. This process is a way of ensuring that our members are not tested for conditions without medical necessity and that appropriate, consistent steps are always taken for diagnosis and treatment. Furthermore, prior authorizations help to control costs and avoid unexpected medical bills. Remember that your primary care physician (PCP) and Physicians Plus Member Services, available at (608) or (800) , are valuable resources that will help you through the prior authorization process. Welcome our new Medical Director Dr. Jason Yelk, Medical Director Physicians Plus Rachel Hill Smith, Editor rachel.hill-smith@pplusic.com 2016 Physicians Plus Insurance Corp. P Dr. Jason Yelk, a hospitalist for UnityPoint Health Meriter, comes to Physicians Plus with over 15 years of experience as a Doctor of Osteopathic Medicine (DO). He enjoys working in a team setting at UnityPoint Health Meriter, in order to provide high quality, comprehensive care to his patients. His commitment to creating the best possible health care experience is also reflected in his role as the Director of Quality & Safety for the Division of Hospital Medicine at UnityPoint Health Meriter. Dr. Yelk looks forward to applying his expertise at Physicians Plus to help our organization stay in line with our mission to deliver excellent products, services and quality care to our members. He will continue his medical practice part-time, in conjunction with his new role as the Medical Director of Physicians Plus. UnityHealth Point Meriter is an affiliate of Iowa Health System, which does business as UnityPoint Health. The Physicians Plus Member Newsletter is published as a c ommunity service for the members of Physicians Plus Insurance Corporation, 2650 Novation Parkway, Madison, WI 53713, (608) If you have any concerns or questions about specific content that may affect your health, please contact your health care provider b-4 09/16 CS Physicians Plus Insurance Corporation PHYSICIANS PLUS MEMBER NEWSLETTER: FALL

6 2650 Novation Parkway Madison, WI Presorted Standard U.S. Postage PAID Madison, WI Permit #2675 For Your Information MEDICAL MANAGEMENT NOTICE Medical Management and Pharmacy staff are available by phone 8 a.m. 5 p.m. Monday Friday (excluding holidays), to discuss medical management or pharmacy issues. You may obtain information on the medical management process or authorization of care during normal business hours by calling Care Management at (608) or (800) , options 2, 3, 1 or leave a message after normal business hours. You may contact Pharmacy Services for medication questions or information at (608) or via your Physicians Plus MyChart account. Please Note: Medical management decision-making is based only on appropriateness of care and service and existence of your current benefit coverage. Physicians Plus does not specifically reward practitioners or other individuals for issuing denials of coverage or care. Financial incentives are not provided to medical management decision makers to encourage decisions that would result in underutilization of your services. WTRS & AT&T LANGUAGE LINE SERVICES AVAILABLE Services for Physicians Plus members with hearing impairment are available via the Wisconsin Telecommunications Relay System (WTRS). You can use WTRS for all telephonic communications with Physicians Plus, including those related to prior authorizations. Physicians Plus provides access to over-the-phone language interpretation resources for over 170 languages via AT&T s Language Line Services, which operates 24 hours per day, 365 days per year. You can find contact information for WTRS and the AT&T Language Line services in your Physicians Plus Member Handbook or on the Physicians Plus website at pplusic.com. APPEAL AND INDEPENDENT REVIEW PROCESS NOTICE Members have the right to file complaints or appeals about Physicians Plus on the care we provide. A copy of our Appeal and Independent Review Process is available at pplusic.com/members/ member-materials or upon request by calling Member Services at (608) or (800) COLLABORATION UnityPoint Health - Meriter, UnityPoint Health, UW Health, Physicians Plus Insurance Corp., Unity Health Plans Insurance Corp., and Gundersen Health Plan are exploring the potential benefits we can deliver to patients and members in Madison and the broader region through a collaboration. Our goal is to build a smart, efficient delivery system that optimizes the best of our organizations. If you would like to learn more about this potential collaboration, please visit collaborationforcare.org.