today A Newsletter for Freedom Health s Special Needs Plan Members

Transcription

1 SNP today A Newsletter for Freedom Health s Special Needs Plan Members This Issue In This Issue In Page # About Special Needs Plan Nurse Case Managers What is a Care Plan? The Doctor, the Emergency Room or the Urgent Care Clinic Health & Wellness on the Member Portal Dual Eligible Members Completing Your Health Assessment Tool When You Leave The Hospital Disease Tips: Simple Tips to Get More Exercise Breathing Problems Bloom with Spring Season Diabetes and Your Skin Understanding Heart Failure Commit to your Heart and your Health Your Health Goals, Your Doctor and You Using Your Benefits to Achieve Your Health Goals Concierge Locations TTY: Spring 2017 Welcome to Freedom Special Needs Plan. In this newsletter, we will give you some general information about your Plan. 1

2 Welcome to Freedom Special Needs Plan! What is a Special Needs Plan? Special Needs Plans were developed by Medicare so that people with certain diseases would receive certain services that would help them better take care of their disease in order to stay healthier and more active. How did I qualify to be part of a Special Needs Plan? You became a part of a Special Needs Plan when you enrolled and said that you had a certain disease or that you had both Medicare and Medicaid. The Plan then verified this with your doctor or Medicaid and you became eligible to enroll. What is my Primary Care Physician responsible for when I am a part of this Plan? Your Primary Care Physician (PCP) is your Medical Home and is responsible for managing all of your health and to make certain you are getting all the medically necessary services you need to better take care of yourself. Your PCP is responsible in making sure that your care follows certain accepted guidelines or medical practices that have been developed by specialists in the field of your disease. Your PCP is responsible for making certain that your care follows a Care Plan that has been developed to better manage your healthcare. It is important to see your PCP regularly and at least annually, even if you have no changes in your health status. This will help your PCP to better manage your care. 2 Nurse Case Managers can Help Nurses, called Case Managers, can assist you with managing your care. When the situation becomes too much for you, they can help. Maybe you need a transplant, cancer treatment, or have a wound that isn t getting better. Perhaps you notice that you are starting to fall more often. Our goal is to assist you in managing your treatment plan. Nurses can also help when questions arise about your chronic conditions. This could be about diabetes or heart disease. These nurses help you manage your condition in your everyday life. Their goal for you is to prevent further complications from happening. If you believe you could benefit from speaking with a Nurse Case Manager, contact the Case Management Department directly, Monday through Friday, 8:00AM to 4:30PM toll free at or TTY/TDD: 711. Freedom Health - SNP Member Newsletter Spring 2017

3 What is a Care Plan? A Care Plan is an established plan that helps everyone who is involved in your care make certain that everything that needs to be done to improve your health is done. These Care Plans are developed using information from nationally accepted guidelines that were developed by leading experts on how to manage certain diseases. These Care Plans are different depending on how much help you may need to reach your health goals. Members are placed into one of three levels of care that are determined from the answers you gave on the Disease Specific Health Assessment you filled out when you enrolled. These Care Plans are sent to your PCP for his/her review and agreement with the plan of care. For those members participating in our case or Disease Management Program, a more detailed care plan is developed by the nurse. Working with a nurse is voluntary although you might find the assistance helpful. What information will I receive? Educational Material This will be sent to you within the first three months of coming on the Plan. This will include information about your specific disease and suggestions on how to best manage your healthcare. Please read this and take it with you to your PCP appointment if you have any questions. These suggestions, if followed, may help keep you out of the hospital. Quarterly Educational Information About every three months, you will receive another educational mailing with pertinent tips on helping you stay healthy. Newsletter Twice a year you will receive a Special Needs Plan Member Newsletter that will have even more helpful information for you to manage your care TTY:

4 4 The Doctor, the Emergency Room or the Urgent Care Clinic? How do you decide? How can you take care of yourself and avoid the emergency room? Doctor or Primary Care Office What it is: Primary care doctors are available during regular office hours. Sometimes they offer evening appointments and some allow walk-in visits. You will have better care if you see the same doctor regularly since your doctor will know you and your health conditions. It also helps if your medical records are readily available. When to go: For preventive care, or when you have a medical problem or concern. When a minor illness or injury strikes, you should first seek treatment from your primary care doctor at his or her office. Most doctors offices offer same day visits when you are sick. When you call for an urgent visit, make sure you explain your medical situation or how it has changed since you last were seen in the office. Don t wait until you feel really bad to call. You might feel better sooner. Your primary care doctor s name and phone number is on your Plan ID Card. Consider the cost: All Special Needs Plans have a $0 PCP office copay. Emergency Room What it is: An Emergency Department is there to save lives. An emergency is any medical problem that could cause death or permanent injury if not treated quickly. An emergency department is open 24 hours a day, seven days a week, 365 days a year. When to go: During a health episode that can lead to death or permanent injury. Some examples of medical emergencies are: Chest pain with sweating, nausea, vomiting, shortness of breath, radiating pain that moves to the arm or neck, dizziness, or feeling that your heart is beating irregularly or too fast Choking Severe bleeding that doesn t stop after 15 minutes of direct pressure Fainting Broken or displaced bones Swallowing poison Burns Suddenly not being able to walk, speak, or move a portion of your body Shortness of breath or difficulty in breathing Many visits to the emergency room aren t true emergencies. An Emergency Department is there to treat the critically ill and injured first. Patients seeking treatment of minor illnesses and injuries will wait longer to be seen by a doctor. Some examples of non-emergencies are: Cold or flu symptoms Sore throat Earache A fever that is relieved with over-the-counter medication Toothaches Minor cuts, scrapes and abrasions Muscle sprains Sunburn Consider the cost: The copay alone may be costly. Other costs may be included depending on the care you need. Urgent Care Center What it is: These are clinics with doctors where you can walk-in without an appointment. They are open during the day, have evening hours and can see you on weekends. When to go: Urgent Care centers are set up to help with an illness or injury that does not appear to be life threatening, but also can t wait until the next day, or for the primary care doctor to see them. Urgent medical conditions are not considered emergencies but still require care within 24 hours. Some examples are: Accidents and falls Sprains and strains Moderate back problems Breathing difficulties (i.e. mild to moderate asthma) Bleeding/cuts -- not bleeding a lot but requiring stitches Diagnostic services, including X-rays and laboratory tests Eye irritation and redness Fever or flu Vomiting, diarrhea or dehydration Severe sore throat or cough Minor broken bones and fractures (i.e. fingers, toes) Skin rashes and infections Urinary tract infections Consider the cost: It will cost a little more than the doctor s office but much less than emergency room care. Other costs may be included depending on the care you need. Freedom Health - SNP Member Newsletter Spring 2017

5 Health & Wellness on the Member Portal We would like to remind you about the Member Portal that is available to you to help you stay informed about your Health Plan information. The Member Portal is also a great tool to help you achieve health and wellness. With some newly added features in the Health Education section, you are able to access interactive quizzes and learn about some of the following topics: At-Risk Drinking Breast and Colorectal Cancer Calculating your weight-to-height ratio, also known as Body Mass Index (BMI) Depression Diabetes-Related Health Fitness & Exercise Healthy Eating Heart Health Quitting Smoking Stress Management Wellness Visits We encourage you to frequently visit our member portal at We are actively working to add new features and tools to help you to achieve your health goals. If you need any of these self-management tools in print or by telephone, please call us at or TTY/TDD TTY:

6 Medicare/Medicaid (Dual Eligible) Members Make sure you keep all your paperwork current with the State about your Medicaid benefits. If you have any questions about how to re-apply for your benefits, you can call Medicaid at (866) or Member Services at (800) Being in a Dual Eligible SNP helps you with the following: Your healthcare claims are paid for by Freedom, which means there is no confusion about what part is paid by Freedom and what part is paid by State Medicaid. You receive all your health benefits from Freedom and do not need to coordinate any care services with State Medicaid. You are able to see any of the participating doctors with the Plan and do not need to worry if they take Medicare or Medicaid. Your plan provides limited cost-sharing which is determined by how much assistance you receive from State Medicaid. This keeps your health care costs affordable. If you have a complaint, grievance or appeal, you can contact Freedom Member Services. It is not necessary to contact State Medicaid. Completing Your Health Assessment Tool It can sometimes feel like a challenge working on goals to improve your health or to stay healthy. The Health Plan would like to help you achieve your goals. One way we can work together to improve your health is by assessing your health and your needs through our Plan Health Assessment Tool. This tool allows us to detect any needs you may have or added services that we can offer you. The sooner you can complete and return the Health Assessment Tool to the Health Plan, the sooner we can determine if we can help you. Additionally, you may also receive a tool that focuses on a particular condition such as Diabetes, Asthma or Cardiovascular Disease. These tools are another great way for the Health Plan to detect whether you might benefit from a telephone call from one of our qualified nurses to further assess your needs and ability to manage your condition. The Health Assessment Tool was mailed to you as soon as you enrolled with the Health Plan and we also send it to you annually. If the Plan does not receive a completed Assessment Tool from you soon after it is mailed, we will give you a call to help you complete it over the phone. The goal is to update your health record at least annually. Your health may change throughout the year and we want to make sure to help you as soon as you need us or your condition changes. By reviewing your responses on the Health Assessment Tool, the Health Plan may offer you case management services to help you with your condition. A social worker may also give you a call if it appears that you may benefit from some community resources. We hope you will consider completing the tool promptly, even if you believe you do not need any help. You never know with what the Health Plan might be able to assist you. 6 Freedom Health - SNP Member Newsletter Spring 2017

7 When You Leave the Hospital You may need support after discharge. While in the hospital your case manager or discharge planner helps you plan for going home. You and your home care giver need to take part in the planning process. Everyone involved needs to know the discharge plan so it can work. This includes what to expect. Don t hesitate to speak up and ask questions. You need to know what help will be provided to you once you are home, if any. This could be a home health nurse visit or wound supplies. It could also be a walker or the delivery of Meals on Wheels. Make sure to ask questions before you leave the hospital. Your understanding of the instructions can affect how well you do at home. It could also help you to avoid problems once you are home. Things to know before you leave the hospital: 1. The date when you are expecting to leave the facility. Plan ahead for that date. Do you have a ride? 2. What to expect when you get home. What will you be able to do? It s great to have a second person there when the nurse reviews the instructions with you. 3. Who will support you at home? 4. How will you manage grocery shopping, cooking and getting medications filled. 5. What type of problems should you call for? The nurse or doctor will review this with you before you leave as well. 6. The name and phone number of who you should get in touch with in case there is a problem with what was planned. Your PCP will want to know too. 7. Understand your medicines before you leave the facility. This includes understanding why they changed, why you are taking them, when to take them and side effects of which to be aware. If you can t pay for your medicine or can t get to the pharmacy, let the hospital nurse or discharge planner know before you go home. Call your doctor if you stop taking medicines for any reason. The PCP will want to know if you are nauseous or they make you dizzy. 8. Any discharge tasks for you or your caregiver. This could be dressing changes or weighing yourself daily. Know how to do them. Make sure you can do the task. Let the hospital nurse know if you don t think you can do it. 9. Make a follow-up appointment with your PCP within 7 days of going home. Your PCP will want to see you. The PCP will want to review your plan of care too and review your medications with you. It is very important for your doctor to review the medications with which you were discharged. They may need to be adjusted. You should know when to call to report problems TTY:

8 Disease Tips SIMPLE TIPS TO GET MORE EXERCISE Life is busy, and fitting in exercise is tough, especially if you think of it as something that requires special clothing or a trip to the gym. It is time to change your mindset though, because exercise can make you happier, protect you from illness, and manage symptoms of chronic conditions such as diabetes, asthma, or heart disease. Here are some tips for getting more activity: Tune into fitness during TV time. Instead of sitting on the couch, try walking in place or lift a few weights while you watch your favorite show. Better yet, watch an exercise show and follow along. There are fitness shows for all levels on television. Park and walk. Rather than circling the parking lot to find the closest spot to the store, park farther away and enjoy the walk. See how the extra distance adds up in steps. Take the stairs. Try taking the stairs if you have to go up one flight or down two. To be safe, take one flight at a time until you gain strength. Join a class. Exercising with a group can be fun while keeping you motivated and on track. Set a schedule. Ask a friend to walk with you daily. If you set a specific time each day, you are more likely to stick with it. Create a weekly plan such as Monday-walking, Tuesday-bicycling, Wednesday-walking/ weights, etc. Go for a swim. This low impact activity is easier on the body. Start with a lap or two and work up to longer swims. Try water aerobics for both fun and exercise. You might even treat yourself to a few minutes in the sauna after. Make sure to talk to your doctor about what exercise or activity is right for you. Think about something that you enjoy and get going. Maybe its gardening, mowing the lawn or golfing for you. Even little activities add up to a healthier you. 8 BREATHING PROBLEMS BLOOM WITH SPRING SEASON Most people with respiratory diseases can tell whether the weather is changing. It doesn t matter what date on the calendar says. Spring also may be a time of COPD flare-ups or feeling tired more often. Spring is a beautiful time when flowers come into bloom. So do unwanted allergies. In addition to your COPD medications, your doctor might want you to add some additional ones if you are uncomfortable. Maybe something for your runny nose, sneezing or joint pain might work. Try taking your allergy medications at night so you will be ready to go in the morning. Pollen counts are highest in the morning. Plan on going out late morning or early afternoon. Talk to your doctor if you don t feel better. Watch the weather reports. Spring can bring weather that s warm and cold as well as rainy and sunny. Don t be caught unprepared. Carry a light jacket with you. Try to keep your body temperature balanced. Are you still Spring cleaning? If so, the dust could magnify your respiratory problems. Certain cleaning products can, too. Some have really strong odors so avoid those. See if you can get help with cleaning the oven or other tough tasks. Make sure there is good ventilation in the area you are cleaning. Take a nap if you re tired to recharge and boost your energy afterward. As usual, see your doctor regularly and take your medications on schedule. Spring can be a fun time if you are careful. Freedom Health - SNP Member Newsletter Spring 2017

9 DIABETES AND YOUR SKIN It is noted that up to 33 percent of diabetics will have a skin disorder at some time in their lives. Managing your diabetes helps prevent complications such as skin issues. Higher glucose levels in the body have been associated with an increased risk of infection. It also can make it harder for you to fight off bacteria and can cause dry skin. You should monitor your skin regularly. Let your doctor know if something changes so it can be treated earlier versus later when it might get worse. What about the parts of your body that you may not see? If you are not too flexible, use a wall or hand mirror to check your backside or behind your feet. Looks for cuts or open areas. Scratchy, itchy areas could become infected if irritated or scraped. Good foot care is really important. Check them every day. Wear shoes and ones that are comfortable for you. Socks are helpful too. Even a lose pebble stuck in your shoe can break the skin and cause problems. Make sure your doctor looks at your feet during each visit and at least once a year. Take off your socks and shoes to make it easier. Look for changes in color, shape or feeling such as loss of sensitivity. If you use lotion, don t use it between your toes. That s because fungus can grow because it is moist there. Keep your foot circulation going. Try not to cross your legs. When sitting, wiggle your toes and move your feet around. Elevate your legs when sitting for a longer period of time. Your doctor may recommend a foot specialist for trimming calluses or those hard to reach toe nails. Call your doctor if you notice any changes or you have a cut or burn that you can t handle. Managing your diabetes can help your feet and your skin too. UNDERSTANDING HEART FAILURE Heart failure has been compared to a car engine that is losing its power. If you have heart failure, you want to make sure that your engine, or heart, can still keep your body going. Maybe it won t run the same as it used to, but by taking care of your engine, you can still enjoy life. Heart failure is a progressive condition but you can slow it down and ease its symptoms. Know Your Treatment Plan Your doctor will follow guidelines for your medication choices and developing your plan of care. Ask questions such as: How bad is my heart failure (mild, moderate, severe)? How do you know my treatment is working? What can I do to improve my symptoms? What should I watch out for? What changes should I notify you about? (These can include weight gain, feet or ankle swelling, chest pain, cough, feeling tired all the time, dizziness) Focus on Quality of Life What types of activities can you routinely do? What changes are affecting your lifestyle? Think about what you do every day: Walk up 1-2 flights of stairs. Walk to the mailbox and back, around the block, to the store. Garden or golf. Have a conversation without being short of breath. Prepare meals. Get together with friends, go to club. Take a shower or bath on your own. Focus on Being Healthy Commit to making some personal changes. Exercise regularly. Write it down in a notebook or online to track your progress. Reduce salt or sodium in your diet. Eat more fresh fruits and vegetables. Limit processed foods such as canned goods and sweets. Determine what amount of calories you need each day and try to stick with it. It will help you lose weight if you need to do so TTY:

10 Disease Tips COMMIT TO YOUR HEART AND YOUR HEALTH A new year brings new commitments. Commit to your heart and you will be pledging to your overall health as well. What new habits are you willing to commit to? 1. Diet and Nutrition Think about what you can do to improve your diet and commit to it. Maybe you are watching your cholesterol or your blood sugar levels. You improve your health by pledging to: Eat fish twice a week. Drink more water. Check food cans for sodium or sugar content. Reduce your alcohol intake. Fill half your plate with fruits and vegetables. Say goodbye to fast food. Eat whole grains versus white bread or rice Reduce trans and saturated fats. Eat more unsaturated fats. Compare product labels. 2. Exercise and Activity Commit to what you are willing to do each week to fitness. Get a pedometer and track your steps each day. Write down your daily activities in a log. Walking Swimming or ware aerobics Chair exercises Stationary or road biking Stretching Gardening or lawn care Taking the stairs Parking farther away from the store Yoga, Pilates, Tai Chi or some other exercise class. 3. Health Monitoring Weigh yourself daily. Monitor your blood pressure as often as the doctor suggests. Stay away from people who are sick or have the flu. Get your annual flu shot. Ask about the pneumonia shot. Use your walker or cane if you need help with balance. Avoid fall hazards such as throw rugs or pet toys. Monitor your mental fitness. If you are feeling down a lot or anxious, let your doctor know about it. 4. Reduce Stress Fit in time for you! What helps you relax should be a priority each day. Meditate or pray Read Lunch with a friend. Work on your hobby whether it s woodworking or sewing. Get out of the house and watch the birds. Set up a bird feeder for fun. 10 YOUR HEALTH GOALS, YOUR DOCTOR AND YOU Do you get anxious or nervous during your doctor s appointments? A lot of people do. It has been said that 80 percent of what patients are told during office visits are forgotten right away. As an active participant in your health care, you want to make sure that you get the most out of every appointment. Both you and your doctor have a responsibility to communicate your health goals and how to go about meeting them. To do this, you have to be prepared. Preparation - Write down what you want to make sure you talk about during the visit.keep a notebook handy at home or have a sheet of paper that you keep on your refrigerator. As you think of things in between visits, write them down. These could be both questions and goals. For example, you might write down that you want to increase your exercise or that you feel more tired from the water pill. Medicines - Bring all your medicines from all your doctors in a bag. Bring medicines you buy without a prescription too like cold medicine or Tylenol. It also includes vitamins and herbals. Even those you don t use regularly like ointments or creams. Know why you are taking each one. Ask the doctor or staff to write down the reasons for you if you don t know. Ask for your medicine list from the doctor. Know what to look for if it isn t working or you feel bad while taking it. When should you call the doctor and tell him about changes you feel? During the Appointment Bring your notebook or sheet of questions and goals with you. Or, you can always ask your doctor for a sheet of paper and a pen. You will want to make sure you understand what the doctor told you. What did the doctor tell me? What tests do I need? What were my test results? What do I need to do next? Medicine instructions Did we discuss all my questions/goals? When do you need to come back? Write down your next appointment. Be an active member of your health care team. It can only benefit you! Freedom Health - SNP Member Newsletter Spring 2016

11 USING YOUR BENEFITS TO ACHIEVE YOUR HEALTH GOALS Taking care of your health is not always easy. It takes time and work to achieve certain goals like maintaining a healthy weight. Keeping all your doctor appointments and sticking to a recommended diet plan takes effort. Freedom Health can help you achieve your goals. As a Special Needs Plan member, you have added benefits to help keep you on track with your goals. The following benefits are free to you: Transportation to medical appointments & pharmacy. Depending on your specific plan, you are eligible to receive 4 or more free transportation rides per year to Plan-approved locations. Please use your rides wisely. Use this benefit for the more important appointments first so that you don t run out of rides before then. This benefit will help you keep your doctor s appointments and pick up your prescriptions. All you have to do is call Access2Care, the Plan s contracted transportation company at to schedule a ride. To ensure availability, please call 3 business days in advance of your appointment date. Gym access. Get a SilverSneakers Fitness Membership at no cost to you! With access to thousands of locations, you will have use of the equipment, pools, saunas and other amenities. You can also order a SilverSneakers Home Fitness Kit if that is more convenient! With SilverSneakers Steps, you can get fit at home or when you travel. Designed for your lifestyle and fitness level, Steps includes a choice of four kits stress release, strength, walking and yoga. Each comes with its own topic-specific instructions and exercise tool. For the most current directory of participating gyms, please visit the SilverSneakers website at www. silversneakers.com or contact customer service at , Monday through Friday, 8 a.m. - 8 p.m. Freedom Health cares about its members well-being and we hope these added services prove to be helpful to you. If you have any questions, please contact member services at Toll Free: or TTY/TDD: 711. Meals delivered after a hospital stay. If you have an inpatient admission to the hospital overnight or longer, you are eligible to have 10 free meals delivered to your home. This benefit gives you the peace of mind in knowing that you won t have to cook when you first get home. These meals are also available with certain dietary restrictions (low sodium, fat and sugar etc). For more information or to place an order after being discharged home, please contact member services at or TTY/TDD: TTY:

12 P.O. Box , Tampa, FL Spring 2017 Member Newsletter H e a l t h & W e l l n e s s I n f o r m a t i o n Concierge Service Visit one of our Locations Hillsborough/Pinellas/Polk 5403 N. Church Ave Tampa, FL Phone: (813) ext Our Local Concierge Centers Offer: Staff to help expedite general issues (replacement cards, PCP changes, etc.) Licensed agents One-hour resolution time and more. 812 Hernando/Pasco/Citrus 8373 Northcliffe Blvd Spring Hill, FL Phone: (352) Orange/Osceola/Seminole/Brevard 950 S. Winter Park Dr, Ste.340 Casselberry, FL Phone: (407) Marion/Lake/Sumter/Volusia 2102 SW 20th Place, Building 200, Suite 201 Ocala, FL Phone: (352) Sarasota/Manatee/Charlotte/Desoto 3870 E SR 64 Bradenton, FL Phone: (941) Lee/Collier 6831 Palisades Park Ct., Suite 1 Ft. Myers, FL Phone: (239) Indian River/St.Lucie/Martin 1187 S US Hwy 1 Vero Beach, FL Phone: (772) Freedom Health - SNP Member Newsletter Spring 2017