The Pulse WHAT'S INSIDE. MEMBER NEWSLETTER Winter 2016 WEBSITE PRIMARY CARE OFFICES. Check out our new website

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1 The Pulse MEMBER NEWSLETTER Winter 2016 WHAT'S INSIDE PAGE 4 WEBSITE Check out our new website PAGE 7 PRIMARY CARE OFFICES Getting the most out of your health care PAGE 9 SCHOOL SUCCESS System development for success

2 TABLE OF CONTENTS Message from COO/CFO...4 Website Update...4 Health Guide...5 Winter Health Focus...6 Primary Care Offices...7 School Success...9 Important Contact Information If you have questions, comments, or concerns, we want to hear from you! Member RIghts...10 Online Resources...11 Health Offerings...12 Privacy...13 MEMBER SERVICES (855) PRIOR AUTHORIZATION (FAX) (844) CONNECT WITH US: The Pulse is published twice a year. Visit Us Online: PHARMACY BENEFITS (855) Evergreen Health Care Primary Care Offices Rotunda (443) EvergreenHealthCoop White Marsh (410) Columbia (301) Greenbelt (240) The Pulse Winter

3 A Message from CEO: Dr. Peter Beilenson, MD Evergreen Health wishes you a happy holiday! As 2016 comes to a close, I want to thank you for your support of Evergreen Health. We established Evergreen to be the best option in Maryland for high quality, comprehensive, affordable health insurance for you and your family. We remain steadfast and dedicated to that mission and to innovating for the future so that you not only have excellent health care, but also a lifetime of wellness. To me, Evergreen has always been about more than just health insurance. We want to help our members become smart healthcare consumers. This is one of the biggest expenses for people so it s very important to understand an overly complicated topic. This year we wrote a book called, The Worlds Easiest Health Insurance Guide (Ever) to arm you with the best information when you need it. The book is free and you can download it from our website. Finally, on behalf of everyone at Evergreen Health, I wish you peace, prosperity, health, and great happiness during this joyous holiday season, and I want to thank you for being a member. We look forward to serving you now and in the future. Please feel free to contact me directly at peter@evergreenmd.org. Peter Beilenson, MD, MPH Founder & CEO, Evergreen Health The Pulse Winter

4 VISIT OUR ENHANCED WEBSITE We recently launched our newly redesigned website with improved navigation in response to your feedback. Everything has been rearranged to help you find what you need quickly and easily. The new site is also more responsive, allowing you to use it effortlessly from any device. Looking for important news and highlights? Simply scroll down the home page or click the dots along the right side of the page to jump from one section to the next. As always, if you have questions or concerns about your coverage, contact Member Services at or submit a help request ticket through your member portal. New features include a drop down menu in the upper right hand corner of each page to get you where you need to go right away. Select Member to go directly to the Member page, bypassing other information you don t need. Navigate to Help and Resources for tools, documents, forms and frequently accessed links broken out by type of information and group. Links at the bottom of the Member page offer faster access to frequently needed information. This includes details on benefit types, how to file claims, provider search, member resources, and how to request your health record. Need to access the member portal? Click on Member Login from the top right of any page and enter your username and password to go to your personal account. The Pulse Winter

5 We are working to make every Marylander a healthcare expert. CONFUSED ABOUT HEALTH INSURANCE? ANNOUNCING The World s Easiest Health Insurance Guide (Ever) We re excited to announce our new book, The World s Easiest Health Insurance Guide (Ever). It was created to help you understand how health insurance works. Find out whether you re paying too much or getting the wrong coverage. Look for details on: Common plan types Choosing the right health insurance for individuals and families Understanding the terminology and paperwork of health insurance Accessing health insurance benefits, including preventive care The World s Easiest Health Insurance Guide (Ever) is available as a free download at evergreenmd.org/guide or at one of Evergreen Health Care s four primary care offices. DOWNLOAD YOUR COPY TODAY AT: evergreenmd.org/guide The Pulse Winter

6 WINTER HEALTH FOCUS Vaccinations for Adults Many adults may think that they are fully immunized against all diseases because they received their shots when they were children. However, that s not the case. We need booster vaccines to remind our body s immune system to keep making protective immune cells. For example, a one-time booster shot of the measles, mumps and rubella (MMR) vaccine is recommended in adulthood, occasionally alongside a chicken pox booster for some adults. This is especially important for young women. If a woman contracts one of these illnesses during pregnancy, it can pose a critical threat to the health of both herself and her unborn child. Other booster shots you should get on a recurring basis are tetanus and whooping cough (Tdap), which are recommended every ten years. Tetanus can enter through cuts and scrapes that are exposed to the tetanus bacteria in the soil. Spare yourself a trip to the emergency room after minor small cuts by staying on top of your vaccine schedule with your primary care doctor. Some vaccinations are recommended specifically for adults only. Pneumonia shots are recommended for all individuals aged 65 and older, as well as individuals of any age who suffer with heart or lung disease. A shingles vaccine is recommended for those aged 50 and older to prevent this painful disease which is a reactivation of the chicken pox virus. Depending on a person s travel plans or individual risk factors, additional protection against hepatitis, yellow fever, rabies and other illnesses may be necessary. It can be confusing keeping track of all the recommend vaccinations available, so please talk with your doctor to be sure that you are up to date on your shots. However, there is one vaccine that doctors recommend for almost everyone: the flu shot. This annual shot protects against influenza, which is different than your typical cold; it is a very severe illness that takes the lives of 23,000 individuals every year. Furthermore, this disease is constantly evolving, so just because you got a flu shot last year does not mean that your body is ready to tackle this year s new strains. The flu shot provides protection against getting the flu virus and despite common misbeliefs, the flu shot or influenza vaccine cannot cause someone to contract flu. The number one way to protect yourself against this serious illness is to get a flu shot every year. Talk with your doctor if you re due for vaccinations or have any questions about vaccines. Vaccines not only protect you, but others around you by reducing or even eliminating the spread of life threatening illnesses. Remember, physicians are a trusted resource to treat you when you are sick -- but we also want to keep you healthy in the first place! The Pulse Winter

7 PRIMARY CARE OFFICE NEWS Group Programs at Evergreen Health PCOs At our Primary Care Offices (PCOs), we know that patient education doesn t end in the exam room. Our Behavioral Health Specialists and Care Coordinators work together to bring you top quality group programming so that you can work with fellow PCO patients on shedding those last few pounds, or sharing your experiences living with a chronic disease. We are constantly rolling out new group programs year-round, but here s a snapshot of some classes we ve offered in the past Smoking Cessation Quitting is hard. Don t do it alone! An intensive six-week course designed to help participants quit smoking. Included health coaching that explored effective quitting methods, motivational activities, and social support. Yoga A month long series of classes for all levels, taught by a licensed yoga instructor. Classes also included a meditative focus. Our most popular group program yet! Sharing experiences within a group and learning how other people cope with the disease is great. I have learned that I am not alone. Patient participant Relaxing and fun, much needed relaxation time! Yoga Patient Managing Your Diabetes Conversational tools designed to help you discover what you want and need to know about managing your diabetes or that of a loved one. Best of all, these classes are FREE for Evergreen Health Members. Keep an eye out for our 2017 group programming calendar! NEW OFFICE HOURS In response to your requests, we are glad to announce new, extended hours at Evergreen Health Care Primary Care Offices (PCOs). Our Rotunda and White Marsh offices are now open five days a week. Did you know? All locations offer: On-site bloodwork Care for all ages, including kids! Same-day appointments To make an appointment, call your closest Primary Care Office or for more information, visit us at: evergreenmd.org/primary-care-offices/ BALTIMORE The Rotunda 733 W. 40th St., Suite 200 Baltimore, MD (443) WHITE MARSH Across from White Marsh Mall 7939 Honeygo Blvd. Building 3, Suite 127 White Marsh, MD (410) COLUMBIA Corner of Broken Land and Snowden River Parkways 9710 Patuxent Woods Dr. Suite 200 Columbia, MD (301) GREENBELT Maryland Trade Center Building Greenway Center Dr. Suite 600 Greenbelt, MD (240) The Pulse Winter

8 PCO STAFF HIGHLIGHT Top Notch Doctors Committed to your Health Dr. Adanma Ndubuizu, MD is a family medicine physician whose lifelong passion for learning has earned her, among other things, a prestigious Meyerhoff scholarship, a Masters of Public Health, and of course those two letters at the end of her last name. However, most strikingly, this academic yearning left her with one of the most important traits that a doctor can have the enthusiasm to educate her patients. It s always great to help connect the dots for patients, admits Adanma. The teaching aspect of medicine is something that I really enjoy. After graduating from Duke Medical School, Adanma s first major experience in a clinical setting was in emergency medicine at the Duke University Medical Center. However, Adanma s urge to help in emergency situations was soon eclipsed by a deeper need to care for her patients beyond the ER. I had numerous patients who would ask me what clinic I worked in because they wanted to see me once they got discharged, recalled Adanma, of the patients who she saw in the emergency department who often did not have insurance or a source for primary care. Many times I d ask patients, What are you on this med for? And this one and this one? [and the response would be] I don t know, my doctor just would write them for me, no one ever would explain anything, said Adanma. During the little time she spent with patients in the emergency department, Adanma attempted to educate them about their medications or care plans. But, she knew that if she truly wanted to make a sustained change, she would have to make some changes of her own. There are aspects of emergency medicine that kind of left me yearning for more I realized family medicine would be a better fit, because it deals with everything, reflected Adanma. You get to see the full spectrum of life from babies to geriatric patients. There s more of the continuity of care. Adanma has been a physician at Evergreen Health Care s Primary Care Offices (PCOs) for over a year, but she is thrilled every time she connects with a patient. It gives you a good deal of satisfaction when you see that light bulb go on for patients in the middle of a visit, said Adanma, explaining that a lot of her patients don t understand the connection between poor sleep habits and the fatigue that they may be experiencing during the day. Some of that extra care that we re able to give patients can be very rewarding. That care is what sets Evergreen PCOs apart from the typical doctor s office. Many doctor s offices will give you a survey, like five sheets, to fill out at the beginning. You check off things, you get through it as quickly as you can, and no one ever talks to you about it ever again, said Adanma, describing the typical waiting room experience. It s nice that there s a human aspect to the health coaching portion [at Evergreen PCOs] where we can uncover issues that need to be further addressed. A lot of patients have been pleasantly surprised by the model of care here. I think initially when [one patient] first started coming here, he was worried that we wouldn t see him because he smokes, said Adanma incredulously. And we had to say No, of course we are going see you. That s just something for us to work on. How do you want to stay connected? Connect with Evergreen Health online so you can stay up to date on the new programs and services we will be launching later this year. Prefer to receive updates instead of a printed newsletter? Visit your member portal to update your communication preferences: facebook.com/ EvergreenHealthCooperative twitter.com/ evergreenmdcoop The Pulse Winter

9 WHAT TO KNOW SCHOOL SUCCESS School Success As easy as ABC! At this point in the year, some families may notice things that need to be tweaked to make the morning rush or after-school routine go more smoothly. Here are some tips to help support your child s success at school this year it s as easy as ABC! A is for After School System. Craft an after-school routine that your family can stick to. Creating designated spaces for hanging backpacks, a spot for keeping folders or papers and routines for unpacking lunch boxes, can help your child stay organized. Systems such as these foster your child s independence, make your life easier as a parent and avoid that early morning scramble looking for a lost lunch box or permission slip. Discuss your family s system with your children, get their input, and expect to give some gentle reminders at first. B is for Be Prepared. Getting things ready the night before is helpful in avoiding the frantic search for a lost water bottle or homework in the morning. Pack lunches, check folders, and zip up backpacks as part of the after-school routine. Having everything ready in the same spot near the front door will help to reduce forgotten items in the morning. C is for Create a Homework Space. Organization is a learned skill that comes naturally to some and is more challenging for others. Creating a specific space and time for your children to complete their homework is a great way to teach organization and create a structure that will help them be successful. Think through a routine and place for completing homework. To ward off power struggles and help children know what to expect, designate a time and place for completing assignments. Any place that is quiet and has somewhere for the child to sit and write will do. For younger children, it s helpful to have an adult nearby to answer questions, monitor progress, and help when needed. The kitchen table works great! D is for Daily Routine. An established morning routine is one of the best ways to reduce your child s (and your!) stress when getting out the door. If you haven t already, establish a daily routine for school day mornings. Make sure you have enough time for the child to successfully complete the routine. Even rising five to ten minutes earlier in the morning can reduce some of the stress caused by the last-minute rush for the door. For younger children, visual aids can be helpful and reduce nagging by parents. For example, create a simple poster that shows each step of the morning routine (e.g., brush teeth, get dressed, and so on). Children can visit the poster for the next step. You can even build in a small incentive for completing all the steps by a certain time. E is for Emotional Wellness. It is normal for children, particularly Kindergarteners or those transitioning to a new school, to have some anxiety around the start of school. However, if your children are still experiencing worries or anxiety about going to school at this point in the year, or if they are having trouble speaking at school, it may be time to reach out for help. Your child s primary care provider is a great place to start. All the Evergreen Health Care Primary Care Offices have an on-site Behavioral Health Specialist who can address these types of concerns and help get your child back on track! Had a claim denied? If you have a claim that is denied, please contact Member Services at the phone number on your Member ID Card or call and an Evergreen Health representative will help you. We ll try to identify why the claim was denied and resolve the problem if possible. Learn more about the appeal and grievance process in your member handbook. You can access your handbook in the member portal. You have the right to an external review of appeals. Learn more at evergreenmd.org/appeal The Pulse Winter

10 MEMBER RIGHTS AND RESPONSIBILITIES Your Member Rights & Responsibilities As a member of Evergreen Health, you should be aware of your rights and responsibilities. They are listed below and can be found in your member handbook. A right to receive information about Evergreen Health, its services, practitioners, and providers A right to be treated with respect and recognition of a member s dignity, as well as a right to security and privacy A right to participate with providers in decisionmaking regarding their health care A right to candid discussions of appropriate or medically-necessary treatment options for a member s conditions, regardless of their cost or benefit coverage A right to voice appeals and complaints about Evergreen Health or the care provided, without fear of retaliation A right to make recommendations about Evergreen Health's member s rights and responsibilities provisions A right to more information regarding member rights and responsibilities A responsibility to provide, to the fullest extent possible, information that Evergreen Health and its practitioners or providers need in order to care for a member A responsibility to follow the plans and instructions for care that a member has agreed to with their practitioners and providers A responsibility to understand a member s health problems and participate in developing mutually agreed upon treatment goals to the degree possible A responsibility to pay co-payments, and/or deductibles You can download a copy of your handbook online at: The Pulse Summer

11 TAKE ADVANTAGE OF YOUR ONLINE RESOURCES evergreenmd.org You can find the answers to many of your questions online. You can also contact member services at (855) with any questions or concerns about your coverage. We make it easy to find out information about your plan online in the secure member portal. Go to to create your account today. Once you have registered, you can login to access: SECURE MEMBER PORTAL your specific benefits and coverage how to submit claims and check claim status charges for copayments or coinsurance appeals & complaint procedures prescription drug coverage make a premium payment (if you don't have coverage through your employer) PRESCRIPTION DRUG COVERAGE We make it easy to learn about your pharmacy benefits online. Visit us online at to view a list of your covered prescriptions and learn about prior authorization, quantity limits, and generic drugs. If you don t have access to the internet, you can also call (855) to speak with a pharmacy benefit specialist. ONLINE PROVIDER DIRECTORY All of our plans include broad access to all hospitals and a majority of physicians and other healthcare practitioners in Maryland. Outside of Maryland, members have in-network benefits through a national provider network called PHCS (owned by MultiPlan). Whenever you receive care, be sure to use our online provider directory to search for in-network providers, or call member services at (855) to ensure your provider is in-network. MEMBER HANDBOOK You can access your member handbook at If you don t have access to the internet, call member services at (855) FIND A FORM Need a document such as a claim form, PHI authorization, or continuity of care request? Visit our new form library at to download commonly requested forms and documents. UPDATE YOUR INFORMATION Have an address change? Login to the secure member portal at memberportal or contact member services at (855) If you purchased your coverage through Maryland Health Connection you must update your information with them by calling (855) The Pulse Winter

12 HEALTH AND WELLNESS DinnerTime New Meal Planning Tool for Evergreen Health Members During 2016, we are offering members access to DinnerTime.com a powerful, convenient solution to your everyday. What s for Dinner? challenge. DinnerTime helps you plan, save, shop and share all while saving time and money on groceries. SIGN UP TODAY: STEP 1: Go to DinnerTime.com. STEP 2: Create an account through your member portal using your Employee Code/ID. STEP 3: Create a profile and get a highly personalized meal plan based on your schedule, budget, dietary preferences and much more. DinnerTime will generate a highly personalized meal plan based on your schedule, budget, dietary preferences and more. You ll get delicious recipes using ingredients on sale at your grocery store. Automated meal preparation reminders help you plan and mobile-friendly shopping lists bring the convenience of DinnerTime to your mobile device. It doesn t get more convenient then that! DinnerTime membership costs $89 per year for non-evergreen Health members. BRICK BODIES, LYNN BRICK & PLANET FITNESS We are excited to partner with Brick Bodies and Planet Fitness to offer an exclusive new wellness option. From state of the art facilities and expert fitness training to comprehensive seminars on health and nutrition, you can enjoy special discounted offers at any Brick Bodies or Planet Fitness club location including reduced joining fees and memberships. Want to get in shape, but not sure how? Try First Step, a 30-day trial offer for $24 that gives you a chance to try it out. A fitness instructor will work with you on cardiovascular exercise and strength training to help you see results. You can also choose from a series of health and wellness seminars, even without a membership. To learn more, go to evergreenhealthmd.org/healthclub The Pulse Winter

13 PROTECTING YOUR PRIVACY PROTECTING YOUR PRIVACY Evergreen Health is committed to the protection of your personal health information (PHI). We know that we have a lot of information about you, and we want you to know that we make sure we use it in the right way. You have the right to request restrictions on the use of your PHI and the right to designate a third party to receive information on your behalf. To learn more, visit us online at You can also request a copy of our privacy policy by calling member services at (855) You can also download a PHI request form, or third party authorization at members/requesting-your-health-record. Evergreen Health's Quality Improvement Program WHAT YOU NEED TO KNOW Evergreen Health is committed to providing access to quality health care for all members through continuous planning, implementation, and assessment to improve the quality of care and services delivered to our members. Our goal is to provide you with affordable and high quality health care choices that emphasize keeping you healthy, with a strong focus on prevention, wellness, and continuity of care and application of evidence-based medical practice. In 2015, Evergreen Health achieved a three-year full Health Plan Accreditation from the National Committee for Quality Assurance. In 2016, Evergreen Health will be reporting QRS/HEDIS measures for the first time for continued participation on the exchange. Learn more about our quality improvement program at or by calling member services at (855) Evergreen Health is proud to announce that we received interim accreditation from the National Committee for Quality Assurance (NCQA), the health insurance industry s most widely-recognized accreditation organization. TO OUR PLEDGE M E M B E R S Evergreen Health continually strives to ensure you receive necessary services at the appropriate time and in the appropriate setting. This is done through several utilization management processes under the direction of qualified clinical staff. All utilization management decisions are based only on the appropriateness of care and service and the existence of coverage. We do not specifically reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service. Evergreen Health does not offer financial incentives to encourage inappropriate underutilization of covered services. OUR PLEDGE TO YOU HOW DECISIONS ARE MADE ABOUT YOUR CARE AT EVERGREEN HEALTH If you have questions about the review processes or utilization management, please contact us at (855) (language interpretation services are available). TDD/TTY services for the hearing impaired can be assessed by calling (800) or 711. The Pulse Winter

14 The Pulse MEMBER NEWSLETTER Winter 2016 EHAMN Falls Road, Suite 1 Baltimore, MD