F amily. She quit smoking Thanks to Tank and her health coach. Do s and don ts for a peaceful holiday season

Transcription

1 F amily Health tips She quit smoking Thanks to Tank and her health coach Page 2 Do s and don ts for a peaceful holiday season Page 6 Nonprofit Organization U.S. Postage Paid Security Health Plan of Wisconsin, INC. Security Health Plan of Wisconsin, Inc. PO Box 8000 Marshfield, WI Julie Brussow Chief Executive Officer Member experience Changes with members in mind Page 3

2 Smoke free, thanks to Tank and health coach Terry Child and Tank Sara Nordbeck Health Educator Terry Child was inspired to quit smoking by a rescue dog named Tank. And help to stay motivated came from health educator Sara Nordbeck. Child is a devoted animal lover. She figured that if she could quit smoking cigarettes, she could save enough money to add a new dog to the family. Once she had quit smoking, Terry began looking for a rescue dog. Her friend let her know about Tank. I could say we found him, but maybe he found us, she joked. Either way, a Fairy Dog Mother was involved. Child s best guess is that Tank is a cross between a Whippet and a Cavalier King Charles Spaniel. Setting breed aside, Tank is a bundle of fast-paced energy. He has brightened life for Terry and her husband Rodger. I was never a chain smoker and never found myself out of breath. But I knew that I wanted to stop, Child said. Call it a crutch or call it whatever, there were some times that I needed a cigarette. With Rodger s encouragement, Child called Security Health Plan. She asked to speak with a health educator about our tobacco cessation program. Tobacco Free is open to BadgerCare members at no additional cost. Quitting tobacco isn t easy. When you have a plan, it increases your chances of success, said Nordbeck. Terry did all the right things. She sought support from her husband. She talked to her doctor. She applied the tips she learned in our Tobacco Free program. And she found the inspiration to stay on track. Terry was able to quit tobacco for good. I knew I needed to quit and Sara was a big part of that, Child said. She was never intrusive, never judgmental, never condescending. I knew she was going to call me each week and we were going to talk about how I was doing. Security Health Plan available through the Marketplace Security Health Plan has again been approved as a Qualified Health Plan on the Health Insurance Marketplace. This means we can offer individual and family plans through the Marketplace. The open enrollment period for the Marketplace lasts until January 31, If you lose your BadgerCare plan, you will need to look at options through the Marketplace. You will have 60 days to buy a plan through the Marketplace. Security Health Plan can help you get a high-quality plan with a low premium. And chances are good that you will qualify for a tax subsidy. The Affordable Care Act requires most people to have health insurance. They can get it through their employer. Or they can buy it directly from a company such as Security Health Plan. The penalty for not having insurance goes up in It will be $695 for an adult. For each child under age 18 it will be $ Or it will be 2.5 percent of household income if that is greater. The maximum penalty for a family is $2,085. You can compare plan options on our website at www. securityhealth.org/myplans. You can also figure out your tax subsidy and enroll in a plan. If you would like to talk with someone in person you can call Family Health Tips Fall 2015

3 We are doing more for you Perfection is not attainable. But if we chase perfection, we can catch excellence. ~ Vince Lombardi Julie Brussow Chief Executive Officer Child has now been smoke free for nearly a year. And rather than fall back into a bad habit, all she needs to do is hand Tank a doggie treat and pet him on the head. His smile is enough to keep her from temptation. You have to find the key that unlocks the door, Child said. For me it was Tank and support I received from Rodger and Sara. Connecting with a Health Educator Are you looking to quit smoking? Do you want to lose weight or get back in shape with a fitness plan? Talk to a health educator to get information and support to help you meet your goals. To connect with a health educator call Remember to renew your benefits Once you are enrolled in Medicaid, BadgerCare Plus or Family Planning Only Services, you must renew at least once each year. The renewal is to make sure you still meet all program rules and are getting the correct benefit. If the renewal is not done, your benefits will end. There are many ways to renew. You can do your renewal online at ACCESS.wi.gov. You can also renew by phone, mail or in-person. The month before your renewal is due you will be notified by mail. If your renewal is due in April, a letter will be sent to you in March. This letter will tell you how you can renew. Recently, Security Health Plan s family of health care products was reviewed. We rated high marks for all our plans including BadgerCare. The ratings came from the National Committee for Quality Assurance. These ratings prove that we are taking steps to help you live a healthier life. We are happy with these good marks. Yet we want to do even better. I want to share with you some of the steps we are taking to improve. We will change an already great member experience into an even better one. We ve recently opened nine Answer Centers at Marshfield Clinic sites throughout the region. You can meet face-toface with an insurance specialist. We will talk about your options and answer your questions about claims and coverage. You can find the list of Answer Centers and hours they are open on our website. Of course, you can still phone our Customer Service Department and get timely answers to your questions. But we know members will also like the convenience of the Answer Center. We recently hired a firm to survey our members who call Customer Service. This survey will be used to gauge how well you like the services we provide. You may be asked to be part of this survey. If so, I hope you will respond. Your comments help guide us to improve our service to you. Here s something new starting in January. You will be able to tap into the resources of WebMD. WebMD is one of the nation s leading sources for online health information. We think we will be great partners on your behalf. Much of the health information you receive from us will have the WebMD name behind it. We will have many new service enhancements in Keep an eye on this newsletter and your mailbox to learn how we re helping to serve your needs. It s our business to serve our members. We want to do more than you even expect from us. We ll continue to take steps to do so. Fall 2015 Family Health Tips 3

4 High marks mean healthier lives for our members Every fall Security Health Plan receives two report cards that tell how well we re serving our members. We have again been named one of the best health insurance plans in the U.S. by the National Committee for Quality Assurance. This is for all of our plans including BadgerCare Plus. Each of our plans was rated in the top 10 percent of the entire nation. These ratings mean you can know you chose a high-quality health plan. The other report card comes from the Centers for Medicare and Medicaid Services (CMS). For 2016 our Medicare Advantage plans received an overall rating from CMS of 4.5 out of 5 stars. CMS uses this star rating to rank Medicare Advantage and Part D Drug plans. CMS adjusts its scoring system every year. This means insurance plans must adapt. Few Medicare health plans in the nation receive an overall rating this high. So once again this score has real meaning to our members. Security Health Plan partners with first-rate doctors and health care specialists. We know they use the best treatments to produce good results for our members. We also have a team of nurse and social work care managers and health educators. They reach out to make sure our members know how to stay as healthy as possible. These report cards affirm that we are on the right track. We are making a healthy difference in the lives of our members and the communities we serve. *Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next. Advance directives: Let your wishes be known You have the right to accept or refuse treatment. You have the right to complete an advance directive. It will let others know your wishes should you ever be unable to speak for yourself. An advance directive can lessen the burden on your loved ones, said Penney Dupee, social worker care manager at Security Health Plan. It keeps you in control of your health care decisions. It makes sure your wishes are honored. Penney Dupee Social Work - Care Manager In Wisconsin if you are at least 18 years old and of sound mind you can complete an advance directive. Three kinds of health care advance directives are available: Power of attorney for health care (used for health decisions) Living will (declaration to doctors) Do Not Resuscitate Order and Bracelet (used for terminal illness) This is really about planning and choices, Dupee said. It allows you to sit down with those you love. You can talk about things that are really important but aren t always easy. Discuss your wishes with those who will be around you. This includes your health care agents and your primary care provider. When you travel, carry a card to alert emergency responders that you have completed an advance directive, she said. Questions? Call Customer Service at We are open Monday through Friday from 7 a.m. to 5:30 p.m. We can mail an Advance Directives packet to you at no charge. You can also learn more in more Member Document Library at Eligible for Medicare soon? Learn about your options Are you turning 65 soon? For any other reason will you be eligible for Medicare? Security Health Plan offers options you can afford. We will help you get the best value to fit your budget and lifestyle. Two options are a Medicare Supplement and Medical Savings Account. These are great choices to protect you from high out-of-pocket costs. You can have these plans no matter where you live in Wisconsin. Our Medicare Advantage plans are sold in 41 counties. They will save you money on health costs not covered by Medicare alone. Learn more at: 4 Family Health Tips Fall 2015

5 Stay current with your preventive care Have you had your flu shot yet? As a Security Health Plan member your flu shot is 100% covered with any provider. The Centers for Disease Control recommends a yearly flu vaccine for everyone 6 months of age and older. This is the first and most important step in prevention against this serious disease. Here are other recommended preventive guidelines: Preventive guidelines These recommendations are for adults at normal risk. Your health care provider may want you to start screening earlier. You may need screening more often if you are at higher risk. Adults Service 19 to 39 years 40 to 64 years 65 and older Abdominal aortic aneurysm screening Blood pressure At each visit One time for men ages who have ever smoked Breast cancer screening Mammogram every 1-2 years for women ages 40 to 75 Pap smear every 3 years for women Cervical cancer screening ages 21 to 65 Every year for all sexually active Chlamydia screening women age 24 years and younger Cholesterol test Every 5 years for men beginning at age 35, and for women beginning at age 45 Age 50 until age 75 (age 45 for African Americans, American Indians and Alaska natives). Colonoscopy is the recommended screening test. Other Colorectal cancer screening screening options are available. Frequency varies based on the screening test chosen. Influenza immunization (flu shot) Every year during flu season for all individuals Height, weight and body mass index Osteoporosis screening Physical exam At least once a year Yearly exam for all ages Screening for women age 65 and older Pneumococcal immunization Immunize if at high risk Immunize starting at age 65 if not done previously Vision screening Every 3-5 years Every 2 years Every 1-2 years Zoster (shingles) vaccine Age 60 and over Children and Adolescents Service 2 to 6 years 7 to 12 years 13 to 18 years Chlamydia screening Every year for all sexually active women age 24 years and younger Human papillomavirus (HPV) vaccine 3 doses by 13 th birthday Influenza immunization Every year during flu season Meningococcal vaccine Tetanus-diphtheriaacellular pertussis (Tdap) vaccine Well child visit Every year By 13 th birthday By 13 th birthday Service Blood lead screening Birth to 6 months 6 to 18 months By 12 months of age, if at risk See immunization schedule at Well-child visit Infants and Children Birth to 24 months At 2 weeks of age, and at 2, 4, 6, 9, 12, 15 and 18 months of age 19 to 24 months By 24 months of age, if at risk At age 2 To request a paper copy of any preventive guideline, call Fall 2015 Family Health Tips 5

6 Do s and don ts for a peaceful, not-too-stressful holiday season Tara Erickson-Bartsch Social Work - Care Manager For some of us the holidays aren t joyful. Just thinking about the holidays can trigger a wave of anxiety. Tara Erickson-Bartsch is a social work care manager at Security Health Plan. She says there are keys to coping with a hectic holiday season. One is to start with a firm idea of what is (and what isn t) a priority during the upcoming months. Some people get stressed just thinking about all the things that might create stress. There are obligations. To our children, to our work, to our church, to our friends, to our extended and sometimes blended families, she said. Now, before we get too close to the holidays, is the time to look at the calendar. We need to decide what is absolutely necessary. And don t be wishy-washy. Maybe this is the year you don t pile everyone into the car. You don t drive four hours through snow and cold. You put off that visit that always stirs harsh words and hurt feelings. Instead you schedule that visit in January or February, when seasonal demands and emotions have slackened. Does someone in your circle have a drinking problem or an eating disorder? Then plan holiday events that don t involve food and drink. If money is tight, you re not alone. Set limits for holiday presents. Be aware of topics that might trigger anxiety in others. Is this the first holiday season following divorce? Or the death of a loved-one? If so, you ll want to keep that in mind as you make your holiday plans. My heart tells me that women feel more stress during the holidays than men, Erickson-Bartsch said. We hold ourselves to such high expectations. We want the holidays to be the perfect Norman Rockwell moment. What we need to do is reset our expectations to something more reasonable. Talk with a social work care manager Do you find yourself overwhelmed during the holidays? Do others demand and expect too much of you? You can get help from a Security Health Plan social work care manager. Just call: Whatever is causing your challenges, we will help. We will connect you with community resources. We will support you and help you learn how you can achieve a better quality of life. Your care manager will: Assess your needs Help you understand all facets of your condition Help you find community resources to provide ongoing support you may need for your condition Know the standards for receiving care from your providers Security Health Plan members should receive timely access to health care services. Here are some guidelines on how quickly you should be able to get health care. These standards are for primary care and behavioral health. Primary Care Providers Routine, non-urgent problems, focused primary care appointments (Examples include joint or muscle pain, blood pressure checks) Urgent needs (Examples include persistent fever, sore throat, vomiting) Life-threatening emergencies (Examples include chest pain, severe bleeding, traumatic injury) Members should be able to get care within: 14 calendar days 24 hours Immediate access Behavioral Health Providers Routine office visits (Examples include life stressors, mild depression) Urgent needs (An example would be medication reactions) Non life-threatening emergencies (Examples include psychosis, delirium) Life-threatening emergencies (Examples include potential for suicide, homicide) Follow-up after hospitalization for mental health illness Members should be able to get care within: 10 business days 48 hours 6 hours Immediate access Within 7 calendar days 6 Family Health Tips Fall 2015

7 Women s Health and Cancer Rights Act Security Health Plan provides benefits for mastectomy-related services. This is required by the Women s Health and Cancer Rights Act of It includes all stages of surgery so the breasts look the same. It includes breast forms or pads. It also includes complications that may result from breast surgery. A common one is swelling in the arms. To learn more or if you have any questions, please call Customer Service at Note: The above law generally applies to group health plans. Coverage under other Security Health Plan policies or plans may be different than described above. Is your child becoming an adult? Your child has always seen a doctor who specializes in children. Now your child is age 18 or 19. It may be time to transfer to a primary care provider who sees adults. How do you find the right adult doctor for your child? Ask your current doctor to recommend one. Your doctor may be able to refer your child to an adult doctor. You can also search for a doctor on our website: We can help if you need it. Call Customer Service at (TTY 711). Want more information about health insurance topics? A: Our website is a great source of information about health insurance. Check it out at Learn the Basics How does health insurance work? Find a Doctor Select BadgerCare Plus to find a provider near you Notice of Privacy Practices Learn how we protect your privacy Live Healthier We can help you manage your health If you have questions or want a paper copy of any topic in this newsletter, call us at (TTY 711). We will help you get a second opinion Security Health Plan does not require second opinions. But we know that you may want a second opinion. You have the right to get one. Talk to your primary care provider or call our customer service at if you want a second opinion. We will help you get one from a provider who is part of the Security Health Plan network. In a rare instance there may be no network provider who can give the opinion. If this occurs we will arrange for you to get a second opinion from a provider who is not in our network at no additional cost to you. F amily Health tips Family Health Tips is published for members of Security Health Plan. Information comes from a wide range of medical experts. Models may be used in photos and illustrations. If you have any concerns or questions about specific content that may affect your health, please contact your health care provider. How to reach us: Customer Service: (TTY: 711) 7 a.m. to 5:30 p.m., Monday - Friday Website: shpcsweb@securityhealth.org New address? Update your information by calling our Customer Service Department. Copyright 2015 Security Health Plan of Wisconsin, Inc. HP Fall 2015 Family Health Tips 7

8 Steve Bartig Pharmacist Marshfield Clinic pharmacies encourage proper use of medications Are you taking your prescription drugs as instructed? Unfortunately, many people don t take their drugs correctly. When this happens they don t get the full benefit of those drugs. They may not even realize that they may be getting sicker. Marshfield Clinic pharmacists and pharmacy technicians are working to help people take medicines properly. That is, taking them at the right time and in the right dosage. A doctor may see a patient once or twice a year. On the other hand, the pharmacy may see that patient once or twice a month when medications have to be refilled, said Steve Bartig, Marshfield Clinic pharmacist. The Pharmacy is in a good spot to help patients. We can help make sure they are properly taking their $5 blood pressure pills. This may prevent them having to be in the hospital. That s certainly better for their health and less expensive, too. Here s one way Marshfield Clinic pharmacists promote proper use of medications. They work with doctors and patients to arrange for refills to all occur on the same day rather than randomly. This is more convenient for patients. It also helps doctors make sure medication is being taken properly. We re trying to set aside the barriers that keep people from properly taking their medicines, Bartig said. Sometimes people are confused about how and when to take medicine. Sometimes they don t think the medicine is needed or helping. Here are some examples. A pharmacist sees that a patient with asthma has refilled a rescue inhaler six times. Rescue inhalers offer quick relief in an asthma attack. But the patient has not refilled his controller medicines. These medicines are needed for longterm benefits. The pharmacist will talk to the patient or alert his doctor. They will make sure the patient knows how to take the medicines properly. It s also common that a patient with diabetes or high cholesterol has doubts about the value of medicines, Bartig said. There may be no outward signs of the disease, and the patient may think the medicine is not needed. And yet, not taking the medicine could be harmful. With married couples it s common that one spouse is handling the medications for both. The other spouse may know nothing about the medications they take regularly. And what happens if the first spouse becomes ill? It might mean that neither gets the correct medicines. In all of these examples, pharmacists have a role in helping patients take the right medicines at the right time. The most important factor is the buy-in by the patient, Bartig said. And the entire health care team doctors, nurses and pharmacists should have a common goal to improve the outcomes for patients.