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1 Care Plus Blue Bulletin Member Newsletter Summer Edition What s in this issue: No one thinks about falling until it happens Three ways to save on prescription drugs SCRABBLEgrams and Jumble Y0010_MK16200 Accepted

2 Welcome Summer is here and an exciting adventure lies just outside your front door. Before you float the river or climb every mountain, we want to pass along some tips to keep you safe, healthy and wise. Page 2 is must-read material for members seeking high adventure or those enjoying a summer staycation. Learn about fall risk factors and what you can do to avoid the leading cause of serious injury in older adults. Page 5 is a wise choice if you want to keep more money in your pocket by discovering three ways to save on prescription drug costs. There s also games to keep your mind sharp. Don t turn the page without reading about phone phishing and what you can do to keep your personal information safe. Watch out for phone PHIshing PHI: Personal Health Information is data that includes your demographic information, insurance information and other medical history that medical providers collect to identify you and provide appropriate treatment. Phishing [fish-ing]: An attempt to trick you into revealing sensitive information like passwords, Medicare and Social Security numbers, or credit card and banking information. Phishing attempts usually come by and look like they re from a trusted source, like your bank. Clicking on links in the lead you to malicious websites that try to capture your information. Phone Phishing: Scam artists call impersonating reputable companies and try to make you reveal demographic information, including PHI, Medicare and Social Security numbers, or other financial information. Here are some phone phishing tips to follow: It s OK to hang up the phone if something seems wrong. Avoid providing financial information to someone you cannot verify is credible. Never provide your Medicare ID number to an unsolicited caller It s also your Social Security number. Report suspected phone phishing to the company the caller claims to work for so they can warn others. Blue Cross of Idaho Care Plus is a Medicare Advantage health plan with a Medicare and Idaho Medicaid contract. Enrollment in Blue Cross of Idaho Care Plus depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits and/or copayments/ coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

3 Dr. Rhonda Robinson Beale is the chief medical officer at Blue Cross of Idaho. Our four medical directors, along with more than 100 clinicians, nurses and medical professionals who work with them, ensure we remain at the forefront of change and innovation in the healthcare delivery system that helps improve health and lower costs. Selecting Treatment for Substance-Use Disorders By Dr. Rhonda Robinson Beale For substance-use disorders, finding the right type of care can be overwhelming and potentially costly. Fortunately, as a Blue Cross of Idaho member, you have help through our Personal Care Support Service. Our staff of behavioral health specialists can help you make informed choices that both meet your treatment needs and are cost-effective. Residential treatment centers (RTC s) are sometimes the correct option, but they are not emergency care. They must be recommended by a behavioral health professional who completes an evaluation to determine the best type of care in each case. At Blue Cross of Idaho, we can help you find a qualified provider to do an evaluation. If we find the evaluation meets our standards of medical necessity, we can then help find an in-network treatment service that best meets your needs. RTC s are typically used in severe cases that require treatment in a monitored, live-in facility. Residential care is intensive treatment, and works best when the participant is truly committed to making the necessary changes and learning how to manage his or her symptoms. Active involvement by a patient s support network is also key, so a program close to home is important. Additionally, residential care requires continued outpatient treatment after a patient is discharged so connections between the RTC and outpatient providers is also important. There are other levels of treatment, many of which do not require live-in care, including: Outpatient Intensive outpatient program Partial hospitalization program Other services involve inpatient hospitalization, but this is only for treatment requiring intensive care for medical detox, or treatment of an active medical condition. It is important to get guidance and help to find the most appropriate type and level of care covered by your insurance when seeking treatment for substanceuse disorders. Many providers and facilities advertise programs and offer incentives, but you need to be informed before responding to these ads since some facilities may ask you to sign a financial promissory note or make a large deposit before admission. We can help you get the right level of care that is covered by your insurance, making sure you aren t left with expensive out-of-pocket costs. Don t forget these important steps if you need substance-use disorder treatment: Get a behavioral health evaluation from a trained behavioral health provider. If residential treatment is recommended, have your provider submit results to Blue Cross of Idaho. Contact customer service to verify your plan covers the service. Customer service will connect you with a behavioral health clinician, who will help find in-network providers that offer treatment for the lowest out-of-pocket cost. Do not attempt to admit yourself to a RTC program without an evaluation and contacting Blue Cross of Idaho first. Do not sign promissory notes with out-of-network providers. You are protected by our contracts with in-network providers that prevent you from receiving charges for services not covered by your plan. Summer

4 No one thinks about falling until it happens You ve heard the expression salt is the silent killer. Here s another one: falls are the leading cause of fatal injuries among adults 65 and older. It sounds impossible, but it s true. Here are more facts about falls: One in 10 falls cause serious injury, like head injury or hip fracture, that require hospitalization Many people spend at least a year recovering in a long-term care facility, while others are never able to live independently again Older adults who fall once are two to three times more likely to fall again. Most falls are preventable Understanding the risk factors Fall risk factors increase with age. A fall risk factor is something that increases your chance of falling. Many times, risks are related to your environment, however, there are behavioral and biological risk factors as well: Environmental Risk Factors Clutter and tripping hazards Poor lighting Lack of stair railings Lack of grab bars inside and outside the shower Biological Risk Factors Muscle weakness or balance problems Medication side effects Chronic health conditions like arthritis or stroke Changes in vision Loss of sensation in feet Behavioral Risk Factors Inactivity Risky behaviors like standing on a chair instead of a step stool Alcohol use or improper use of prescription medications 2 BLUE CROSS OF IDAHO Care Plus Medicare MEMBER NEWSLETTER

5 Now you know the risks Let s take action Know your risk factors Take a fall risk assessment Lower your risk factors and make changes This is the first step in fall prevention. Many of the risk factors you should be aware of are listed on page two. However, you also need to know that it s usually two or more risk factors that cause a fall (like lacking a grab bar inside your shower PLUS poor balance) All members over 65 are encouraged to receive a fall risk assessment from your doctor, especially if you have fallen before or have balance problems. This is a preventive service offered to you free of charge each year. Take a fall prevention workshop online. Visit members.bcidaho.com Enter your username and password Click on WellConnected Enroll in Preventing Falls: Exercise for Strength and Balance and Preventing Falls in Older Adults Remember, it s usually two or more risk factors that contribute to a fall. It s basic arithmetic. Removing risk factors you can control reduces your risk of falling from factors you can t control. Easy, inexpensive habitat modifications include: Adding grab bars and rails where needed Updating your dull CFL fluorescent bulbs to instant-on, bright LED bulbs Keeping step stools around your home so you never use a chair to reach items. Source: Centers for Disease Control and Prevention Summer

6 Keeping an Eye on Quality We are working hard to ensure members receive high-quality, cost-effective care and services from their healthcare providers. We review all access to care or quality of care complaints, plus we closely monitor member and doctor satisfaction levels to find where we can improve. Our ongoing quality improvement plan includes: Assessing the quality and safety of services offered by in-network providers and facilities Making sure members have access to the care they need Helping members maintain their health by offering programs that coordinate care Aligning our programs and services with public health initiatives We marked some important quality improvements in 2015, including: Members can see their primary doctor within 10 days, 96 percent of the time --up from 80 percent in Additionally, timely access to behavioral health providers improved from 65 percent, to 88 percent. More members can schedule urgent appointments with primary care doctors (from 82 percent, to 91 percent) and with behavioral health providers (from 68 percent, to 82 percent). This helps reduce costly visits to the emergency room. More members completed preventive screenings, which is the key to staying healthy. We improved the level of information that s available to members in a variety of languages. We significantly increased the annual health risk assessment completion rate for our Medicare- Medicaid Coordinated Plan (MMCP) members while also improving the timeliness of completion. Member satisfaction for Medicare and Medicaid (MMCP) members was above the national average in all areas CMS measures. Our plan s strengths include: Getting appointments and care quickly Customer service Getting needed prescription drugs Member satisfaction is our top priority. That s why we ll strive to make sure you have access to high-quality healthcare you deserve. 4 BLUE CROSS OF IDAHO Care Plus Medicare MEMBER NEWSLETTER

7 Mind Games Keep your mind sharp by exercising your brain. Three Ways to Lower Your Prescription Costs If you take prescription drugs regularly, you know they can cost quite a bit. There are ways to save. Here are three tips to help: 1 Go generic. Just because a drug is generic doesn t mean it s less effective than a brand drug. Generic drugs share the same active ingredients as their brand-name counterparts. If you find a generic is not available, ask your doctor about less spendy preferred drugs that might do the trick. 2 USE CVS CAREMARK MAIL SERVICE PHARMACY. Besides saving time and fuel, you ll also save money by using mail order service. You can fill 90-day prescriptions and because coinsurance is based upon the overall cost of the drug, it is often cheaper. The overall cost of a drug (your cost PLUS the plans cost) is called the True Out-of-Pocket Cost (TrOOP) of drugs. Stay out of the Coverage Gap by reducing your TrOOP. 3 Use preferred pharmacies. If you have a plan with a preferred pharmacy network, you could save more than you think. Preferred generic drugs (Tier 1 drugs) cost $0 for a three-month supply at a preferred pharmacy versus $30 at nonpreferred pharmacies. To find preferred pharmacies, visit FindAPharmacy. Answers on back cover. Summer

8 3000 E. Pine Ave. Meridian, ID Published by Blue Cross of Idaho by Blue Cross of Idaho, an independent licensee of the Blue Cross and Blue Shield Association. All rights reserved. No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement not take the place of the recommendations of your healthcare provider. Consult your physician before making major changes in your lifestyle or healthcare regimen. Blue Cross of Idaho makes no endorsements or warranties regarding any of the products and services included in this publication or its articles. Contact Us Move recently? Don t forget to change your contact information with Blue Cross of Idaho so you continue receiving important information about your health insurance coverage. Log on to your account at members.bcidaho.com or call customer service at the number on the back of your member ID card. Have a Question? Website: MACS@bcidaho.com Call our Customer Service line at (TTY ). We are available from 8 a.m. to 8 p.m., seven days a week. Jumbles: GUMBO MINUS PRETTY BEHIND Answer: After years without striking, the picketers had a RE-UNION National Medicare Changes Centers for Medicare and Medicaid Services (CMS) occasionally makes a change or revision in Medicare coverage. We are required to notify you when a National Coverage Determination (NCD) occurs. Recent NCD s include: Screening for the Human Immunodeficiency Virus (HIV) Infection (document ID: 210.7) Screening for Cervical Cancer with Human Papillomavirus (HPV) (document ID: ) You can review these changes and others using Medicare s Coverage Database. Visit Enter the document ID in the quick search tool to get started.