GEORGIA 2016 ISSUE I Watch Your Weight, Eat Healthy and Move More More and more people are overweight and obese. Overweight people are at higher risk for: Heart disease; Diabetes; Arthritis-related conditions; High blood pressure; and Some cancers. How can you control your weight? Here are some suggestions. Exercise at least 30 minutes a day, five days a week. Try these exercises: Walking; Raking leaves; Riding a bike; Swimming; Running or jogging; or Climbing steps for 10 minutes. Eat a healthy diet: Eat a balanced breakfast. Include protein, whole grains, fruits and vegetables. Limit fast food and junk food. Drink 8 cups of water daily. Snack on fruits and vegetables. Eat low-fat and reduced-fat foods. Talk with your doctor about diet and exercise plans to fit your needs. Go for a swim. Hula-hoop with your kids. Take the stairs. Source: The National Institute of Diabetes and Digestive and Kidney Diseases, Weightcontrol Information Network, retrieved from www.niddk.nih.gov/health-information/healthcommunication-programs/win/pages/default.aspx Take a jog around your neighborhood. Buy a jump rope and have fun! WellCare proudly serves Georgia Families, PeachCare for Kids and Planning for Healthy Babies members.
What Is the Healthy Rewards Program? The Healthy Rewards Program is a rewards program. Georgia Families and PeachCare for Kids members take small steps that will help them live healthy lives. Then they get rewarded. Complete a primary care provider (PCP) visit? Get rewards placed on a reloadable Visa debit card. Prenatal visits? Get rewards. The more services members complete, the more rewards they can earn. You can also get rewards for certain health checkups. See the table on the next page. Always talk with your doctor(s) about the care that is right for you. This material does not replace your doctor s advice. It is based on third party sources. We are presenting it for your information only. It does not imply that these are benefits covered by WellCare. Also, WellCare does not guarantee any health results. You should review your plan or call Customer Service to find out if a service is covered. Call 911 or your doctor right away in a health emergency. 2 Member Newsletter
Healthy Rewards Program New Enrollees Children s Health Healthy Pregnancy Chronic Care Management Well Women Adult Health (NEW) Focus Area Initial PCP visit Diabetes and adolescent wellchild visit 0 15 months 3 6 years 7 20 years Prenatal care visits Postpartum care visit Completion of both Diabetes Cervical cancer screening Mammogram screening Annual adult health screening Activity Criteria Initial PCP visit within 90 days of enrollment Each quarter, WellCare will draw the names of four people and give each winner an ipad Complete well-child visits per well-child checkup schedule (six visits) Annual child health checkup visit Annual adolescent health checkup visit Attend six or more prenatal visits before the birth of the baby Attend one postpartum visit 21 56 days after the birth of the baby Complete prenatal and postpartum visits Complete an annual eye exam (members with diabetes ages 18 75) Complete an annual HbA1C lab test (members with diabetes ages 18 75) Complete office visit for an annual cervical cancer screening (Pap test) (ages 21 64) Complete annual mammogram screening (ages 40 65) Complete annual adult screening (wellness visit members ages 21 and older) Incentive Type Raffle Stroller or portable playpen Want more information on the Healthy Rewards Program? Call Customer Service. The number is on the back page. Incentive Value $30 ipad $10 per visit for a total of $60 $25 $30 $20 $30 Members who complete both receive the incentive plus a stroller or portable playpen $20 $20 $25 $25 $20 Member Newsletter 3
What Is the Planning for Healthy Babies Program? Planning for Healthy Babies provides family planning services. It is free to eligible women in Georgia. It can help you find the best time to have your next baby. You can enroll in: Family planning; Resource Mother helps women who deliver a baby weighing less than 3 pounds, 5 ounces; or Inter-pregnancy care (IPC) for women who deliver a baby weighing less than 3 pounds, 5 ounces; includes family planning and Resource Mother. What s Covered? Annual physical exams, including Pap tests; Contraceptives and multivitamins with folic acid; Family planning counseling; and IPC members only: Primary care and dental services, substance abuse treatment and more. How Do I Apply? You can apply online. Go to www.p4hb.org. Or pick up an application. They re at your local public health department. Or get one at the Georgia Division of Family and Children Services office. You can fax your filled-out application and required documents to 1-888-744-2102. Or mail them to: Planning for Healthy Babies P.O. Box 1810 Atlanta, GA 30301-1810 Where Can I Get More Information? Visit dch.georgia.gov/p4hb or call 1-877-379-0020. Who Is Eligible? Women ages 18 44 who meet monthly family income limits; Women who do not get Medicaid; IPC-eligible women who deliver a baby weighing less than 3 pounds, 5 ounces and do not receive or are losing Medicaid; and Women who deliver a baby weighing less than 3 pounds, 5 ounces and are only eligible for Resource Mother services. 4 Member Newsletter
Pictured: Gloria Owens Care Manager Helps Turn a Member s Life Around Gloria Owens wasn t sure what kind of help she needed. She was 72 years old. She had lost a leg due to circulation problems. She had many other medical issues, too. Then Gloria started working with a WellCare care manager. The manager knew exactly how to help. Gloria s care manager saw there was more going on than just physical issues. Gloria also had severe depression. She was isolated at home. Her care manager knew that this was a big part of Gloria s total health. Creating a Care Plan The care manager developed a care plan to treat all of Gloria s issues, including her depression. The plan included physical therapy, occupational therapy, a home health aide and a nurse. Gloria was anxious about traveling to visit certain doctors. So the care manager rode the bus with her. She also helped Gloria get some care in her own home. Making a Fresh Start These days, Gloria has her confidence back. She is enjoying life again. She s even started walking with the help of a walker. She praises her care manager for helping her. It s a job, but she went beyond that. She got to be my friend, says Gloria. At 72, I learned how to love myself. Life is a joy and I m going to have fun. Watch a video of Gloria Owens on YouTube at tinyurl.com/gloriaowens. Do you think the Care Management Program could help you? Call Customer Service. The number is on the back page. Member Newsletter 5
CAHPS : Health Care Quality From Your Point of View What is CAHPS? It stands for Consumer Assessment of Healthcare Providers and Systems. It s a survey for our adult and child members that asks what they think about the care they get. You may get a CAHPS survey by mail or over the phone. If you do, please complete it. It tells us how well we re doing and how we can improve. Survey topics may include: Access to the care you or your child need; Providers communication with you or your child; How much your and your child s primary care provider knows about care received from other providers; Our customer service; and How well you like WellCare. Do you have questions? Call Customer Service at 1-866-231-1821. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality. To learn more about CAHPS, its products and its services, visit www.cahps.ahrq.gov. Dental Care Tips for Your Child Many parents want to prevent cavities for their kids. But they don t always know how. Here are some tips: Run a damp washcloth over your baby s gums after feedings. Brush with just water and a soft toothbrush for children younger than age 2. Use a pea-sized amount of toothpaste with fluoride for children ages 2 and older. Begin using floss after your child has two teeth that touch. Ask about fluoride varnish. This is a coating that is painted on a child s teeth. It s safe. It makes teeth stronger and helps prevent or stop cavities. Source: MedlinePlus, www.nlm.nih. gov/medlineplus 6 Member Newsletter
Utilization Management: The Right Care in the Right Setting The decision making for WellCare s Utilization Management (UM) Program is based only on appropriateness of care, service and existence of coverage. WellCare does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization. If you have questions about the Utilization Management Program or coverage decisions, or need language assistance, please call Customer Service at 1-866-231-1821 (TTY 1-877-247-6272). You may also review the Utilization Management Program section of your Member Handbook. You may call to ask for materials in a different format. This includes other languages, large print and audiotapes. There is no charge for this. Click or Call for the Latest Drug Coverage Updates Want to find the latest about the drugs we cover? Stop by our website, www.wellcare.com/georgia. You ll find our Preferred Drug List (PDL). You can learn about drugs we ve added or removed. You ll also find changes to any drug requirements or coverage limits. You can also call us for updates. If you speak a different language or need something in Braille or audio, don t worry. We can provide translations and alternate formats at no cost to you. Just give us a call toll-free. Georgia Families and PeachCare for Kids members call 1-866-231-1821. Planning for Healthy Babies members call 1-877-379-0020. All TTY users call 1-877-247-6272. Si habla otro idioma o si necesita información en Braille o en audio, no se preocupe. Podemos ofrecerle traducciones y formatos alternativos sin costo para usted. Simplemente llámenos sin costo. Los miembros de Georgia Families y PeachCare for Kids llamen al 1-866-231-1821. Los miembros de Planning for Healthy Babies llamen al 1-877-379-0020. Todos los usuarios de TTY llamen al 1-877-247-6272. Member Newsletter 7
211 Perimeter Center Parkway Suite 800 Atlanta, GA 30346 PRSRT STD U.S. POSTAGE PAID WELLCARE HEALTH PLANS Para solicitar este documento en Español, llame al Servicio al Cliente al 1-866-231-1821 (TTY 1-877-247-6272). GA031924_CAD_NEW_ENG State Approved 04192016 WellCare 2016 GA_10_15 70768 In This Issue We re pleased to bring you the first issue of Member Focus for 2016. In this issue we cover ways to watch your weight, dental care tips for your child, information on the Planning for Healthy Babies program and how to take charge of your health. There s much more inside. Take a moment to explore. As always, we wish you good health. Numbers to Know We re just a phone call (or click) away! Call Customer Service: 1-866-231-1821 TTY 1-877-247-6272 Monday Friday, 7 a.m. to 7 p.m. Or visit georgia.wellcare.com Nurse Advice Line: 1-800-919-8807 24 hours a day/7 days a week 10867MF