in This issue: MEMBER NEWSLETTER spring 2016 Utilization Management (UM) Department Behavioral Health Services Can Help Member Portal!

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1 spring 2016 MEMBER NEWSLETTER in This issue: Utilization Management (UM) Department Behavioral Health Services Can Help Member Portal Patient Safety Corner: Preventing Injuries in your Home Cholesterol - How Does Your Diet Stack Up? Communication and Preparation for Appointments Always Available to Our Members Spring Eye Issue: Dry Eye Syndrome Do Your Part: Learn How to Protect Yourself! Contacts for Home Services Pharmacy - Medication Adherence Get Healthy - Stay Healthy Concierge Service Locations Case and Disease Management Our Member Portal will assist you in getting updated information on Plan Providers and much more! Do More Online With Our Member Portal! It s Easy and Convenient! See inside for details...

2 Utilization Management (UM) Department The Plan has a UM Department that makes sure you are getting safe and appropriate care. UM evaluates services your doctor has requested based only on appropriateness of care and service and the existence of coverage. UM uses the following information when looking at a service your doctor has asked for: Medicare and/or Medicaid Rules State and Federal Government Rules lnterqual Criteria Hayes Medical Technology When your doctor asks for a service and it is approved, the Plan will notify both you and your doctor of it being approved. Your doctor will then let you know when the service is going to start. When your doctor asks for a service and it is not approved, you will receive a Medicare required denial letter. This letter will tell you: Why it was not approved. How you can ask for a copy of the information used to make the decision if you would like. How to file an appeal if you want it looked at again. How your doctor can call and talk with our doctor if needed. UM tries to help you get the right care and checks to make sure your Plan covers what is being asked for. The Plan does not give bonuses or rewards or incentivize anyone for saying no to your care, stopping care you are getting, or giving you less care than your doctor asked for. Behavioral Health Services Can Help Most people can benefit from behavioral health services at some time in their lives. A therapist is not needed for every stressor life throws your way. Family and friends can offer support to help you deal with struggles. Sometimes that support is not enough or not available. While mental health screening and treatment can dramatically improve someone s quality of life, there is often a resistance to the idea. Getting help can get you back on track to enjoying your life. Your Plan does offer behavioral health services if you need it. So, what types of things should you consider behavioral health for? Depression - feeling sad, blue, hopeless or just not yourself Anxiety impacting your daily life You have lost someone or something important to you - Grief Family or marriage problems Drug use or alcohol issues Information is available for a number of services including: Psychiatrists Therapists or counselors in your area Information on Support Groups Help with drug or alcohol addictions Other You can get services that you are comfortable with to help you. The type of services needed depends on you and your situation. You can call the Behavioral Health number on the back of your Member ID card. The Plan social workers can assist in linking you to services as well. Call if they can help you. 2 SPRING 2016 Optimum HealthCare - Member Newsletter

3 Register & Do More Online with our Member Portal! Here are some of the benefits you will receive: Place & track orders Find a Plan Doctor, for your over-the- Pharmacy, Hospital counter medication and covered drug. and diabetic supplies. Print and order your ID CARD, provider directory, formulary and other Plan materials. Gain access to health & wellness information. View your claims activity and benefit information. Access important Plan forms and documents from a central location. Track your out-ofpocket expenses. (MOOP) NEW! Complete your Health Assessment Form NEW! Personal Health Tracker TTY/TDD:

4 You may think your home is your safety zone, but there can be many hidden dangers that can cause an injury even within your home. Use these tips to make your home safer: Make sure there is a clear path from room to room without furniture or other obstructions. There s no need to rush for the phone- if it is important, they will call back. Keep frequently used items low and close-by so you can reach them without using a step stool or reaching over your head. Patient Safety Corner: Preventing Injuries in your Home Make sure area rugs are secure. Install grab bars next to your toilet and in your shower. Improve the lighting in your home. Install night lights so you can see better at night. Wear shoes to improve your traction on slippery surfaces. Falls are the most common cause of injury in senior citizens. In fact, the CDC states that one out of every three adults 65 years or older fall each year, resulting in a great deal of preventable injuries and hospitalizations. However, there are many precautions you can take to prevent falling. Exercise regularly to increase your strength and improve your balance. Cholesterol - How Does Your Diet Stack Up? You ve heard about good and bad cholesterol. Your doctor might have told you that your cholesterol levels are good or bad. You should be tested regularly if you have risk factors. Diet is a big factor that can affect your cholesterol numbers. Cholesterol is found in foods. How does your diet stack up to your cholesterol levels? Let s look at what influences cholesterol: Saturated fat raises your bad cholesterol (LDL) and is found in some meats, dairy products, chocolate, baked goods and deep-fried and processed foods, such as canned goods. Trans fatty acids lower your good (LDL) cholesterol. It is found in vegetable shortenings, some margarines, crackers, cookies and snack foods. Talk to your doctor about prescriptions you take that may have side effects such as dizziness or drowsiness. Have your vision checked at least once a year, and make sure your eyeglasses or contacts match your most updated prescription. Consider using some of the following helpful products that can make your life easier, more enjoyable and safer: - Canes and walkers with proper rubber tips - Bath seats and hand-held shower heads - Raised toilet seats - Grab bars and poles mounted properly throughout the home - Non-skid bathmats and non-slip surfaces in the shower or bath tub - Grabbers with suction cups, grips, or magnets on the end Limiting foods with cholesterol, saturated fats and trans fat can help you control your cholesterol levels. Look at the highlighted items on the sample food label below for macaroni and cheese. Combine the grams (g) of saturated fat and trans fat and look for the lowest combined amount. Also, look for the lowest percent (%) Daily Value for cholesterol. Check all three nutrients to make the best choice for a healthful diet. Since macaroni and cheese is a processed food, see how this label adds up for you. When you shop, look at the label. It can help you make better choices for your health. When making a food selection, pay attention to the lowest combined amount of saturated fat and trans fat grams. The Food and Drug Administration (FDA) offers good information on cholesterol and food. Other labels and educational materials can be found on the FDA website at 4 SPRING 2016 Optimum HealthCare - Member Newsletter

5 Communication andpreparation for The doctor and patient bond is an important one. It is built on trust and communication. It is essential to have good communication with your doctors. This is important when talking to your Primary Care Provider (PCP) or Specialist. It also includes doctors you may see in the hospital. When you are able to talk to your doctor, you can have healthier results. Better results improve your overall health. You can also increase your total well-being. We expect that our doctors are prepared for our visits. It is important that we are ready too. This may take a little organization before seeing your doctor. This little bit of preparation is worth it in the long run. This helps ensure enhanced quality health results. There are some tips to help you be prepared. Show up at least 15 minutes early to fill out any paperwork. Some offices may ask for more time if it is your first visit. Write down a list of questions you may have. Be sure to take that list with you to your appointment. You may also bring a friend or family member. Get the doctor s contact information to keep for future reference. This includes name, phone number, and address. Take your most up-to-date list of medicines. You can also bring pill bottles or pill boxes. Pack any treatment plans or discharge instructions. Also, take any lab or test results with you. Keep a file folder of your test results. Save them with your other health information. You should keep lab results and paperwork in order by date. This will help you see changes in your health. It will also save time. You can look at this folder when talking to your doctor. 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 the links below for more information on the following topics: Advance Directives: About Us -> Utilization & Quality -> Advance Directives Case & Disease Management Programs: About Us -> Utilization & Quality -> Case Management or Disease Management Clinical Health Guidelines: About Us -> Utilization & Quality-> Clinical Practice Guidelines Fraud, Waste, and Abuse: Quick Links -> Fraud, Waste, and Abuse Grievance & Appeals: Quick Links-> Appeals & Grievance Medical Record Standards: About Us -> Utilization & Quality -> Medical Record Standards Member Rights and Responsibilities: About Us -> Utilization & Quality -> Member Rights and Responsibilities Appointments This will help you see changes in your health. It will also save time. You can look at this folder when talking to your doctor. T his helps you to be more informed about your health condition. By being prepared, you become an active partner in your health care! Always Available to Our Members Newsletters: Quick Links -> Member Newsletters Patient Safety Programs: About Us -> Utilization & Quality -> Quality Management Preventive Health Guidelines: About Us-> Utilization & Quality -> Quality Management -> Preventive Health Information Privacy: Quick Link-> Privacy Policy & Legal Quality Management Programs: About Us-> Utilization & Quality-> Quality Management Quality Management Performance: About Us -> Utilization & Quality-> Quality Management -> Monitoring Quality Utilization Management Programs: About Us-> Utilization & Quality-> Utilization Management UM Decisions: About Us-> Utilization & Quality-> Utilization Management TTY/TDD:

6 Spring Eye Issue: Dry Eye Syndrome Are your eyes watery? Itchy? Blurry? Do they sting or burn? Just generally icky? It could be that you have allergies or you may have Dry Eye Syndrome. Dry Eye Syndrome is a wide-spread condition that unfortunately comes with aging. Tear ducts that are used to produce enough tears to keep our eyes wet, clear, and comfortable may now make less or poorer quality tears. If the tears don t wet the eye properly, the eyes may sting and result in an overproduction of tears causing watery eyes and blurry vision. Dry Eye Syndrome can t be cured, but the symptoms can be managed so your eyes are clean and clear. Here s what you can do on your own to help: The first step is to make sure you drink plenty of water to make sure you are well hydrated. Smoking and caffeine consumption also lead to lower production of tears, so eliminating these may help. Next, you can use over the-counter lubricating drops for comfort, but not the ones that get the red out. Artificial tears should be used at least 4-5 times a day to be effective, by re-wetting the eyes and balancing the tears before symptoms begin. Clean lids are a must. Use a commercial eyelid scrub or a small amount of baby shampoo diluted with warm water on a cotton wash cloth to remove debris buildup from the base of the eyelashes. If a crust has formed on your lashes, soften it with warm, moist compresses first and then gently wipe it away. Keep your hands away from your eyes. No rubbing please! Your eye doctor can provide more information about additional treatments that may help keep the uncomfortable symptoms of Dry Eye Syndrome under control. *Dr Mark Sarno, an optometrist in the Florida -Tampa Bay Area, for over 20 years and a member of the American Optometric Association, practices in Seminole, FL. You can learn more about Dry Eye on their website at: glossary-of-eye-and-vision-conditions/dry-eye Do Your Part: Learn How to Protect Yourself! Fraud can harm you and costs the Medicare and Medicaid programs. To protect yourself and save these programs for generations to come: Only make changes that are right for you. Understand the differences between your current plan and new coverage options. Do not change your coverage if someone calls or visits your home without permission. Review your plan statements and other mailings to make sure no one changed your plan without you knowing. Do not give out your coverage information. To report suspected Medicare fraud contact Optimum Health at SPRING 2016 Optimum HealthCare - Member Newsletter

7 Contacts for Home Services Additional Services Members have asked about extra services that might be available to them. This includes help with rides and home chores. In general, services vary by your location. This includes what resources your County offers. It might be worth you exploring what is available to you. Here are some resources for Florida residents: If you need RIDES Most Counties offer public transit. This includes for the disabled. Ride fees vary ($10, $5 or Free) Call your County phone number Ask for information Sometimes an application has to be filled out ahead of time. If you want HOUSEKEEPING or Home Help Call the Florida elder Helpline (Toll-Free) Ask what is available in your area. Sometimes Local Senior Centers and Church groups can help as well. County Phone Citrus Hernando (352) Hillsborough (813) or (813) Lee (239) Manatee (941) Marion (352) orange (407) Select Option 6 Palm Beach (561) or (toll-free) Pasco West: (727) Central: (813) East: (352) Pinellas (727) and ask for DART. Polk (863) Saint Lucie Ft. Pierce: (772) Port St. Lucie: (772) Sarasota (941) Sumter (352) Feeling better can be as simple as filling your prescription and taking your medicine as prescribed. A Few Tips: Many prescriptions are generic and most are covered in the 1st tier. All participating pharmacies can fill the majority of your prescriptions for 90 days or you can have them mailed to you using our mail order pharmacy. Call AssuredRx at for more details! Over 90% of the medications our members take to keep them healthy are generic. Staying healthy may be as easy as taking your medication on time. Pharmacy Medication Adherence Get Healthy- Stay Healthy TTY/TDD:

8 P.O. Box , Tampa, FL ConCierge service Locations Living Wellness Member Newsletter spring 2016 Health & Information Hillsborough/Pinellas/Polk 5403 N. Church Ave. Tampa, FL (813) ext Hernando/Pasco/Citrus 8373 Northcliffe Blvd. Spring Hill, FL (352) Orange/Osceola/Seminole/Brevard 950 S. Winter Park Dr., Suite 340 Casselberry, FL (407) Marion/Lake/Sumter/Volusia 2102 SW 20th Place, Building 200, Ste 201 Ocala, FL (352) Sarasota/Manatee/Charlotte/Desoto 3874 E. SR 64 Bradenton, FL (941) Lee/Collier 6831 Palisades Park Ct., Suite 1 Ft. Myers, FL (239) Indian River/St. Lucie/ Martin 1187 S. US Hwy. 1 Vero Beach, FL (772) If you have questions about your Health Plan or Health Plan coverage, please contact Member Services tollfree at or TTY/TDD at 711. If you have questions about your individual health, your doctor or PCP is most qualified to answer these questions. As always, if you feel you need emergency assistance please dial 911. Case and Disease Management As a Plan member, you are eligible for Case and/or Disease Management services. Case Managers are nurses. They can help you with your health needs. Our nurses work with your Doctor to help you. You can call and ask for a nurse case manager. You can also stop services at any time. This will not affect your benefits. We can be reached Monday Friday from 8:00AM to 4:30PM. Our phone number is Depending on your health needs, we may call you and offer case or disease management services.