CONNECT. Member. In This. Winter HMO Medicare Member Newsletter

Transcription

1 In This Winter 2017 Member CONNECT HMO Medicare Member Newsletter 2 Medication Therapy Management (MTM) 2 Here s to Your Health! 3 Be Prepared For Your Doctors Visit 3 Always Available to Our Members 4 SilverSneakers 4 Heart Disease & Statin Medications 5 What is Your BMI? 5 Coordinating Your Care to Keep You Safe 5 Medication Reconciliation Post Discharge (MRP) 6 Get Moving: Tips to Help You Keep Walking 7 Preparing Meals the Easy Way 8 Depression: The 5 Questions 8 Initiation & Engagement of Alcohol and other Drug Dependence Treatment (IET) 9 Getting More Out of Your Doctors Appointments - Communication is Key 9 Am I Getting Close to Using up My Plan Benefits? 10 SCAM ALERT! Protect Yourself From This Scam 10 New Medical Technology 10 Have you received an Initial Health Assessment Form (HAT)? 11 Order Your Diabetes Supplies 11 Follow-Up After Hospitalization for Mental Illness (FUH) 11 Management of COPD 11 How to Receive Regular & Emergency Services 12 Flu Shots - It s That Time of Year Again! 12 Annual Election Period (AEP) 12 Laboratory Services Visit our website for updated information at your fingertips! or contact Member Services at TTY: 711

2 Medication Therapy Management (MTM) MTM programs are a requirement by the Centers for Medicare and Medicaid Services (CMS). America s 1st Choice has developed a specific program, approved by CMS, that focuses on the medications that you are currently taking. If a member meets the requirements of the program, they are automatically enrolled in the program. MTM programs have been found to improve the quality of your health by reducing problems caused by drugs. One of the most important parts of the MTM program is having a healthcare provider, such as a Pharmacist, discuss with you, the drugs you are taking. This is called a Comprehensive Medication Review or CMR. This takes place once a year, at your convenience. Our program uses a number of ways to contact you, to remind you about the importance of your annual CMR. You may be called through an automated call program, or we may have an MTM technician or Pharmacist reach out to you. We value your time and try to schedule a CMR when it is convenient for you. At any time you can decide to dis-enroll from the MTM program. PLEASE REMEMBER: Disenrollment from the MTM program does NOT dis-enroll you from your Health Plan. Here s to Your Health! Our goal at America s 1st Choice is to help our members improve their health by providing the best care and service options. In order to do this, we rely on our Quality Management (QM) program. The QM program monitors the quality of care given by Plan providers. The QM Program also looks for areas of service that need to be improved. Every year, we measure to see the progress we have made toward meeting our goals for healthy members. One of the tools we use to do this is called HEDIS, which stands for Healthcare Effectiveness Data and Information Set. HEDIS is a very common tool used by health care plans to see how well they are serving their members. We use these HEDIS results to see where we need to focus our improvement efforts. For more information on HEDIS and Quality Management, visit our website at: > Quick Links > Quality & UM > Monitoring Quality 2 America s 1st Choice of South Carolina - Member Newsletter - Winter 2017

3 Be Prepared For Your Doctors Visit You need to plan for your next doctors visit, especially after leaving the hospital. This is true for inpatient observation stays. It s a good idea to schedule your appointment within 7 days after a hospital stay. Many problems may happen during this time period with which your doctor might be able to help. Sometimes doctors appointments are stressful or you feel rushed. If you write things down ahead of time, you won t forget to ask your questions or explain how you are feeling. You need to communicate with your doctor to help bridge your treatment in the hospital with your doctor s care plan. Make sure you understand your instructions. Let the doctor know if you won t be able to do something. Here are some items to note: Appointment Information: Day: Date: Time: Doctor: Office Location: Phone: Reason for appointment: Questions about: Medications: My Test Results: My Pain: How I feel (worried about, fearful of): Other things to talk about: Always Available to Our Members The Plan offers a lot of information for our members on our website. This includes resources and programs available to our members. Please visit our website at: Click on links below for more information on the following topics: Advance Directives: Quick Links g Quality & UM g Advance Directives Clinical Health Guidelines: Providers g Clinical Healthcare Resources Fraud, Waste & Abuse: Quick Links g Fraud, Waste & Abuse Grievance & Appeals: Quick Links g Appeals & Grievances Member Rights & Responsibilities: Members g Your Rights and Responsibilities Newsletters: Members g Member Newsletters Patient Safety Programs: Quick Links g Quality & UM g Patient Safety Preventive Health Information: Quick Links g Quality & UM g Preventive Health Information Privacy: Quick Links g Privacy Practices Quality Management Programs: Quick Links g Quality & UM Quality Management Performance: Quick Links g Quality & UM g HEDIS Summary Information am - 8pm, Mon - Fri TTY:

4 The benefits of regular exercise are well known. Exercise helps physical well-being. It also improves mental and emotional well-being. Regular physical activity can help: Increase muscle strength and tone. Speed up metabolism. Reduce body fat. Improve bone mineral density. Manage body weight. Stay independent longer. Enhance social well-being. Enrich quality of life. Improve memory. Think more clearly. Living an active lifestyle helps prevent many diseases. It can also slow down many diseases. If health conditions already exist, many worry that exercise can be dangerous. Physical activity can help manage existing conditions like arthritis, heart disease and high blood pressure. 1 It also helps with balance problems or difficulty walking.1 Research has shown exercise is good for everyone! America s 1st Choice knows the importance of regular exercise. Members receive SilverSneakers at no extra cost. Members have access to more than 14,000 locations around the country. Basic services along with SilverSneakers group fitness classes* are included. If a traditional gym is not for you, SilverSneakers FLEX offers classes such as tai chi, yoga and Latin dance. SilverSneakers FLEX classes are offered at recreation centers, neighborhood parks and more. Members get so much more from using their SilverSneakers benefit. Exercise helps relieve stress. It also eases feelings of loneliness and sadness. Many SilverSneakers members feel a sense of community when they are with other participants. Members get physical activity while meeting new people. They create friendships as they workout with similar individuals. *Services vary by location. 1 Source: exerciseforolderadults/healthbenefits/01.html Tivity Health, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries Tivity Health, Inc. All rights reserved. HEART DISEASE & STATIN MEDICATIONS What are statins? Statins are a class of drugs often prescribed by doctors to help lower cholesterol levels in the blood. Common examples are: Lipitor (atorvastatin) Crestor (rosuvastatin) Zocor (simvastatin) Mevacor (lovastatin) Pravachol (pravastatin) How do statins work? Statins work by reducing the amount of bad cholesterol in your blood. This makes it less likely that the cholesterol can form blockages in the blood vessels going to your heart and brain, which in turn reduces your risk for having a heart attack. How effective are statins in preventing heart attack? Overall, statins have been shown to help reduce the risk of heart attacks and the complications of heart disease pretty significantly. A recent study published in the Journal of the American Medical Association (JAMA) found that statins are associated with a 36 percent reduction in the risk of having a heart attack. Are there side effects associated with statins? Statins have been extensively studied and all of the data collected agrees that they are very safe drugs. However, as with all medicines there are some people who will experience side effects. With statins, one of the most common side effects is muscle cramping. Typically these are mild, but some can experience painful cramps. If you experience cramping with your statin medication you should consult with your doctor. Do not stop taking the medication without discussing with your doctor first. Tell the doctor how you feel. Who should take statins? If you are between the ages of 40 and 75, and have additional risk factors for heart disease such as family history, diabetes, high blood pressure, or history of smoking, statins might be recommended for you. Have a conversation with your Primary Care Physician at your next appointment if you believe you could benefit from statins. He or she will be able to help you weigh the advantages and disadvantages of taking statins to decide if they are right for you. 4 America s 1st Choice of South Carolina - Member Newsletter

5 What is Your BMI? The Body Mass Index (BMI) is a number calculated from a person s weight and height. Knowing your BMI can assist you with understanding your weight To learn more about BMI you can visit the CDC website at assessing/bmi/index.html category. These weight categories are used in determining if you are at risk for health problems. Ask your doctor to explain your BMI, and to document your BMI in your medical records for continuous monitoring and evaluation. Coordinating Your Care to Keep You Safe We are dedicated to keeping our members safe. One way for you to stay safe is to help your doctors coordinate your care. You can help them by tracking of all of the services you receive and medications you take. This is especially important if you see a behavioral health specialist. For example, if your behavioral health provider prescribes you new or different medications, make sure they tell your primary doctor about these changes. Some combinations of medications can be dangerous. In fact, you should always make sure any doctor you see knows all of the medications you are taking. This will help you avoid dangerous medication interactions. Your behavioral health providers should ask you for consent to share your information with your primary doctor. This is to ensure your privacy. You should encourage any specialist you see to communicate with your primary doctor. This will make sure you receive only the necessary procedures. It will also help your doctors work together as a team to provide you with the best care. Taking an active role in coordinating your care will help your doctors keep you safe. Medication Reconciliation POST DISCHARGE (MRP) Health and safety for our members is top priority. Together we can prevent harm and adverse reactions from the medicine you take. You can help by scheduling a follow up visit with your PCP (Primary Care Physician). You should make an appointment soon after leaving the hospital. Your PCP will reconcile any medicine from your hospital doctor with your current medicine to ensure the safest and most effective treatment plan for you. Please bring your discharge paperwork and all new medicine from the hospital to your PCP visit am - 8pm, Mon - Fri TTY:

6 1 2 GET MOVING: Balance Training This involves doing exercises that strengthen the muscles that help you move. Such exercises can improve your stability and help prevent falls. Examples of balance exercises include: Walking while alternating knee lifts with each step Standing up and sitting down from a chair without using your hands Putting your heel right in front of your toe, like walking a tightrope Proper Shoes Invest in a good pair of shoes that support the structure of your foot. A good shoe can help you get a better feeling for the ground. Instead of looking at the ground to find your step, you can put your focus ahead of you to help with your balance. Avoid slide-on shoes which can increase your risk of falling. Tips to Help You Keep Walking Difficulty walking is common as you begin to age. This can be related to several factors, including muscle weakness, muscle tightness, balance problems, and fatigue, to name a few. Maybe you just don t have the stamina you once had. Losing the ability to walk or get around can have a negative impact on your life. Here are a few steps you can take to improve or maintain your ability to walk: 3 4 Manageable Distance Set manageable goals for yourself when it comes to walking. Start with just a few minutes and work your way up. Plan on taking breaks to sit down and rest if you get tired. Assistive Devices The use of a device such as a cane or walker can help you maintain or increase your mobility, allowing you to walk further with less fatigue. 6 America s 1st Choice of South Carolina - Member Newsletter - Winter 2017

7 PREPARING MEALS THE EASY WAY As you age tasks that used to seem like second nature can become more challenging. It is important that you maintain good nutrition, but doing so could be difficult. Whether you are having trouble holding a knife steady, or don t have the energy you once used to, the tips below might be helpful. REARRANGE THINGS IN YOUR KITCHEN This could help so that you don t have to bend down low or reach up high for tools. Keep commonly used and heavier items out on the counter for easy access. WEAR A BRACE If you have tremors, wearing a brace or splint can help steady your hand. This is especially important if you need to use a sharp knife to prepare your food. EXERCISES TO HELP STRENGTHEN YOUR MUSCLES Whether it is your wrists or legs that seem weaker, there are exercises you can do to increase your endurance. Discuss with your doctor, or consider seeing an occupational therapist. ASK A FRIEND OR FAMILY MEMBER FOR HELP Invite someone over one day a week to help you prepare several meals. If you don t like leftovers, they can help you by cutting and marinating proteins such as chicken or other meat. Chopping and portioning fruits and vegetables out for the week can make it easier for you to cook fresh daily. MAKE USE OF THE MICROWAVE There are many different options for freshly prepared and frozen meals at your local grocery store. Leftovers are great to microwave too. LOOK INTO LOCAL MEAL DELIVERY SERVICES Organizations such as Meals on Wheels specialize in delivering fully prepared meals to homebound, disabled, and elderly individuals. To learn more information, you can call the Eldercare hotline at , or for what is available in your area am - 8pm, Mon - Fri TTY:

8 Depression: The 5 Questions Change can be an exciting part of life, bringing a new point of view and surprising opportunities. But some changes can be hard to adjust to and can cause sad, angry, or guilty feelings. When these feelings last for a while, it may mean that you are depressed. If you have a chronic condition such as Diabetes or lung disease, depression can set in too. Depression is not a sign of normal aging. Is it a real illness which your doctor can treat. Sometimes depression can be hard to identify. You may not notice little changes until they add up. Take this short test and see how you stack up. 1) Do you feel grumpy, irritable or worried much of the time? yes 2) Are you having trouble concentrating or now not interested in your favorite activities? yes 3) Have you lost your appetite or found yourself eating a lot? yes no no no 4) Do you have a hard time getting going in the morning or falling asleep at night? yes 5) Do you feel sad, down or hopeless? yes no no Number of YES answers you checked: Answering the five questions may be be your first step to a happier and healthier future! If you answered Yes to any of the questions, show the quiz to your doctor. It will help figure out whether you re depressed. If so, you can talk about ways to help you feel better. Social Workers from the health plan can also assist you in determining symptoms of depression. They can also talk about what services might be helpful to you. To talk to one, call the Case and Disease Management department at A Social Worker is available during regular business hours, Monday through Friday 8am-4:30pm. Initiation & Engagement of Alcohol and other Drug Dependence Treatment (IET) Anyone can be affected by drug and alcohol addiction. Drug and alcohol addiction is a treatable disease. Treatment can help patients stop using, avoid relapse, and successfully recover their lives from alcohol and other drug dependence. Keys to success may include: - Counseling - Medication - Support groups - Residential or outpatient treatment programs If you think you may have a problem with alcohol and drug dependence please speak to your health care provider. Recovery is possible with the right treatment and support. Follow-up care is CRUCIAL TO RECOVERY 8 America s 1st Choice of South Carolina - Member Newsletter - Winter 2017

9 Getting More Out of Your Doctors Appointments- Communication is Key The doctor-patient relationship is an important one. It is built on trust and communication. It is necessary to be able to communicate well with your doctors. This is true whether it is your Primary Care Physician (PCP), a Specialist, or if you are in the hospital. When you feel you are able to openly talk to your doctor, you can have better health results. Your doctor wants to help you with your health. Better health results improve your overall well-being. ASK QUESTIONS: Talking to your doctor can be overwhelming, but questions are expected from you. Your questions can help prompt the doctor to talk about something important that may have been forgotten. You should not feel like you are bothering them. If you don t know what to say to your doctor, ask about what is important for you to know at this time. Be prepared. Try to make a list of questions ahead of time. If you are in the hospital, keep a notepad at your bedside. As you think of things, jot them down. It is always important to say I m not sure what you just said if you don t understand. You can also say, This is what I heard did I get it right? It may also be easy to forget what the doctor says, no matter your age. Bring someone with you to the appointment. They can listen to what the doctor says to you and provide support for any instructions. They can also ask questions especially if they know you well. They may also remember something the doctor said that you don t remember. It is okay to write things down so you remember or you can have someone else write things down. Keep the notes handy. Make sure you understand any instructions given before you leave. It s always helpful to repeat back what you heard. It is essential to try to ask all of your questions before you leave your appointment. Know who to call at the doctor s office in case you think of any other questions after your visit. Also, ask when to call if there are issues. For example, you doctor may say to call if you feel dizzy on the new medication or if getting more short of breath doing your usual activities. KNOW YOUR HEALTH CONDITION(S): As a patient, it is important to understand your health condition enough to talk about it. You should be able to: Spot symptoms Know what to look for if you are getting worse or better and Explain to your doctor how you are feeling. Know what to do and when to call your doctor to report changes. It is up to you to understand when to call your physician and when to get emergency treatment. Being able to communicate with your doctor is a key tool to help you monitor your health. You will get more benefit out of your doctor visits too. Am I Getting Close to Using up My Plan Benefits? What do you do when you learn you are close to using up your Medicare covered benefits? In some cases, the Health Plan may be able to help you to find other resources. This may allow you to continue to receive your present care or services. You might have worries about: Reaching the donut hole also known as the medication coverage gap. Talk to your doctor about what medications work with your conditions. Be honest and discuss what you can afford. There might be alternatives that will work for you. Running out of your skilled nursing benefits and you don t feel that you can take care of yourself at home. The Health Plan s Social Services team may be able to help. They can assist you by connecting you with available community resources and charities in your area Sometimes pharmaceutical companies have programs to help you pay for your medications if you qualify. There are also programs that can assist you with some of your care needs to support you in your home. This may include a home meal delivery program or access to other charities in your area. Many people find support programs through their Church or social network. Contact a Health Plan Social Worker at or TTY: 711 to see if resources are available to you am - 8pm, Mon - Fri TTY:

10 Beware: This is a scam!!! Don t be a victim of fraud. Protect yourself and your benefits. Unfortunately, now they have your Health Plan or Medicare number, and they can bill thousands of dollars for medically unnecessary tests or even services that you never receive. They PROTECT A SCAM YOURSlELer F FROM THIS t!cam S A booth at a local health fair, senior housing, community center or home health agency is offering free health screenings, including genetic testing. The representative falsely promises that Medicare or your Health Plan will pay for the test, and you simply need to provide a cheek swab, your ID and Medicare and/or your Health Plan information to receive your test results. They may even ask for your doctor s name, implying that they will send your results to your doctor. also have personal genetic information regarding your health. To report suspected Medicare fraud contact Never give out your Social Security, Medicare or Health Plan ID numbers or banking information to someone you don t know. Do not consent to any lab tests without your doctor s order. Do not initial or sign any documents. Protect yourself and your benefits. America s 1st Choice at Keep in mind; it is illegal to accept anything of value in exchange for medical services. NEW Medical Technology The Plan is always looking for ways to give our members the best care possible. One way we do this is by reviewing new technology for things like medical procedures, drugs, and devices. To be considered, a new technology must meet strict government rules. Our Medical Staff researches new technology by reviewing the latest scientific studies. We also talk with specialists in that area of medicine. Once the Plan approves a new technology, it is added as a covered service. Have you received an Initial Health Assessment Form (HAT) Have you received an Initial Health Assessment Form (HAT) from your Health Plan in the mail? It is important that you completely fill out and return this form. By doing this, you are helping us understand your unique healthcare needs. This helps us serve you better. By working together, we are able to better provide you with all of the necessary tools and services personalized to meet your health care goals. 10 America s 1st Choice of South Carolina - Member Newsletter - Winter 2017 To meet this obligation, we make three attempts to get a form completed by our members and returned to us. Once you return the completed HAT to the Health Plan, we will no longer need to contact you about the HAT form until the following year. Your answers to these questions WILL NOT affect your insurance coverage. Information may be shared with your primary care provider(s). If you The Centers for Medicare and Medicaid Services (CMS) requires us to have an annual have any questions, please call: HAT assessment filled out by our TTY: 711. members each year.

11 Order Your Diabetes Supplies Live a healthier life by taking an active role in your diabetic health care! If you use supplies to check your blood sugar levels, you can order them easily. Simply have your Member ID ready, and call Member Services at or TTY:711 Follow-Up After Hospitalization for Mental Illness (FUH) Your mental health care doesn t end once you leave the hospital. To continue your recovery you should engage in follow-up care within a week of your discharge. Participating in follow-up care supports your transition back home. It may also reduce the chance of you being readmitted to the hospital. Follow-up care helps you maintain the progress made during hospitalization. It s always important to keep your PCP (Primary Care Physician) informed of any health services. Management of COPD (Chronic Obstructive Pulmonary Disease) Your COPD care doesn t end once you leave the hospital. It is essential to take steps to prevent readmission by managing medications appropriately. Engaging in follow-up care with your PCP (Primary Care Physician) is very vital. To continue your recovery you should engage in follow-up care within two weeks of your discharge. It s always important to keep your PCP informed of any health services. See your health care professional at your regularly scheduled appointment even if you feel fine. How to Receive Regular Services Your PCP (Primary Care Physician) will arrange your health care needs. You will need to have your PCP send in any requests for referrals or authorizations. The Plan s Utilization Management (UM) Department makes decisions on those requests as quickly as possible. On average, a decision is made within 2 days after we have received the request from your PCP along with any supporting medical information. If you have any questions about UM decisions or the UM process, please contact Member Services. This number is located on the back of your ID card. How to Receive Emergency Services The Plan does not require any authorizations for visits to Emergency Departments or Urgent Care Centers. If you feel you have an emergency, please go to the nearest hospital or Urgent Care Center for help. After your visit it is very important that you call your PCP (Primary Care Physician) and make a follow-up appointment. This visit with your PCP is to make sure you are getting better am - 8pm, Mon - Fri TTY:

12 250 Berryhill Road, Suite 311 Columbia, SC Winter 2017 Member CONNECT HMO Medicare Member Newsletter Flu Shots-It s That Time of Year Again! Don t forget to get your flu shot this fall. There is no cost to Medicare members. Flu season begins as early as September each year. The flu, also known as influenza, can cause significant illness or even death in young adults, older adults and people with chronic illnesses. Even if you received the flu vaccine last year, you should get the flu shot again this season. Protection against the viruses begins after two weeks and will last through the flu season. It is best to get your flu shot as early as it is available for the best protection when flu activity is highest. CVS, Walgreens, Publix and many of our other participating pharmacies offer the flu vaccine. Please call the pharmacy in advance to ensure that they have a supply of the vaccine on hand. There is no co-payment for flu shots. Please bring your plan identification card with you when you go. Other pharmacies in the Health Plan network also provide flu shots at no cost to Medicare members. For a listing of other participating pharmacies, please contact our customer service department at: AFC HMO: Member Services: TTY: 711 or access our online provider directory: Additionally, many primary care providers also offer the flu vaccine. Please check with your doctor to see if they are providing the shots. You may also be able to get a flu shot at your local health department. For more information, talk with your primary care doctor or visit the Center for Disease Control website at Annual Election Period (AEP) Oct 15th Dec 7th, 2017 On October 1st, all Medicare health insurance plans began providing information on the benefits they will offer in their upcoming 2018 plans. The plan also mailed current Medicare members their Annual Notice of Change letter on or before September 30, The Annual Notice of Change letter explains any changes to your existing plan in To assist in answering your questions, our Member Services Call Center will be available 7 days a week beginning October 1, 2017 through February 14th 2018 from 8am - 8pm. Laboratory Services Your Health Plan contracts with the following lab vendors. Make sure your doctor forwards your lab orders to one of these in network vendors. Laboratory Services of America (LabCorp) Quest Laboratory Solstas