Inside How to lower your blood pressure Make Health HAPPEN Quarter 3, 2017 www.myamerigroup.com/medicare Prepare now to stay healthy during flu season Influenza, also known as the flu, can make you feel terrible. But there are things you can do now to help keep the flu away. Some basic tips: Get a flu vaccine, or shot, each year. Wash your hands often. Stay away from people who have the flu. Eat more foods like fruits and vegetables that can help protect you from the flu. Drink more water. Get more rest. When should you get a flu shot? Even though the flu season usually peaks in January or later, try to get a flu shot as soon as the vaccine becomes available before the flu season even begins and reaches your community. This will give your body time to develop the antibodies needed to protect against the flu. Where can you get a flu shot or more information? Your primary care provider (PCP) or case manager Any of our network pharmacies if you re age 21 or older Your local health department The Centers for Disease Control and Prevention (CDC) recommends everyone 6 months and older, especially those at high risk of serious complications from the flu, get a flu shot every year. If you re age 65 or older, the CDC suggests getting a pneumonia vaccine as needed. How active is the flu in your state or city? Visit cdc.gov/flu/weekly for more details. Member Services 1-866-805-4589 (TTY 711) 8 a.m.-8 p.m. local time 7 days a week 24-hour Nurse HelpLine 1-866-805-4589 (TTY 711) HMM-NL-0010-17 69258MUSENAGP
Be a nutrition detective to help keep your blood pressure in check It s normal to feel overwhelmed when you ve been told you have hypertension, or high blood pressure. But there are small changes you can make to help lower your blood pressure and improve your quality of life. Question: The diet for lowering blood pressure seems so complicated. What can I do to make it simpler? Answer: First, take a look at your eating habits. Keep a food journal for a few days and then be a detective: Look for foods you know are high in sodium and consider changing them to lower sodium items. If you re not sure of the sodium content, take a look at the nutrition labels on the foods you eat. What are some of your favorite fruits and vegetables? What are some ways you could increase the amount you eat? Consider eating smaller portions of the foods you eat. Diane, a registered dietitian nutritionist at Amerigroup, shares how being a nutrition detective can help you control your blood pressure.
Next, consider eating the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension. It began as a way to help manage hypertension but also helps prevent heart disease, diabetes and some cancers. The DASH diet: Is low in saturated fat, cholesterol and total fat Focuses on fruits, vegetables and fat-free or low-fat dairy products Is rich in whole grains, fish, poultry, beans, seeds and nuts Contains fewer sweets, added sugars, sugary beverages, red meats and less sodium (salt) For more information on the DASH diet, visit nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf. Question: How do I cut sodium from my diet? Answer: Most sodium comes from processed foods like hot dogs, luncheon meats, boxed macaroni and cheese, pizza, fast food, restaurant foods, frozen dinners and snack foods such as chips and crackers. Try using roasted meats for sandwiches, preparing foods from fresh ingredients, eating at home more often and using less salt to season food. When eating out, choose lean fish and seafood that s not fried or with sauces, grilled meats and vegetables without sauce or with sauce on the side. Another good tip is to split your meal with someone. Or at the beginning of your meal, put half your food in a to-go container to take home for another meal. Question: Won t the food be tasteless? Answer: You re not alone if you feel this way. Consider using herbs and spices to take the place of salt. Most cookbooks have charts that show which herbs and spices will work best for certain foods. You can also look online for charts and recipes, find low-sodium cookbooks and check a restaurant s menu for low-sodium dishes. Remember, you can still eat some of your favorite foods by limiting the amount and how often you eat them.
Committed to excellence Our team s focus is on you at Amerigroup. We want to help you get and stay healthy. We do this through the following programs: Clinical Quality Improvement Program, which consists of the following: Coordination of Care to help you and your providers work together as a team to help you get the care you need when you need it. Improved access and affordability to offer a large network of providers and hospitals to meet all your health care needs. We can help you find who and what you need when you need them. Preventive care to remind you about health screenings and services that can help you get and stay healthy. At times, you may get calls or mail from us to help set up appointments, yearly checkups, and other screenings such as mammograms or a bone density test if you recently broke a bone. We can also send a provider to your home for some routine screenings. Treatment for chronic conditions to provide you with extra help from our nurses who can help you manage your condition at home, including support after a hospital stay that can help reduce your risk of having to go back to the hospital. Clinical Practice Guidelines (CPGs) and Preventive Health Guidelines (PHGs) are recommendations for your providers to help them give you the best possible care for certain health conditions and preventive care. We have a special committee of board-certified and credentialed providers who review the guidelines to help make sure they re up-to-date. If you d like a copy of any CPG or PHG, please call Member Services. Pharmacy programs such as reviewing medications with a pharmacist help make sure the medications you take are safe and effective. A team member may call you to talk about why you may not be taking a drug you were prescribed, send you a letter to offer services and support, or contact your provider to talk about possible changes to your medication. Healthcare Effectiveness Data and Information Set (HEDIS ) is a program developed by the National Committee for Quality Assurance (NCQA) to measure performance on different types of care and service.
Consumer Assessment of Healthcare Providers & Systems (CAHPS ) is a survey that asks members how happy they are with their health care, health insurance plan, and providers so the Medicare program can rate the quality and performance of all health insurance and prescription drug plans each year. Some of the areas on the survey that Medicare reviews include how: You rate our plan's services and care Our doctors find illnesses and keep members healthy Our plan helps you use prescribed medications safely Star Ratings also use CAHPS measures. In 2016, more members said: They got appointments and care quickly Their doctors made it easy for them to manage their care It was easy to get services they needed, such as specialist care, lab tests and X-rays They were very happy with the quality of health care they received through the plan They could easily get the prescription drugs they needed using the plan HEDIS and CAHPS results help identify areas of strength and areas where we can improve. For more information about our plan and how it compares to others, visit the website medicare.gov. Quality Improvement Goals to help make sure we re: Getting our members quality health care and services Helping you see your provider for prompt follow-up care after being in the hospital Working to help you improve your health Helping you stay well and manage your health care needs Special Needs Plan (SNP) programs are designed to meet your unique health care needs. Shortly after you enroll in our SNP and every year after you enroll, you ll get a call to complete a health risk assessment (HRA) so we know your health care needs. A nurse will work with you to create a care plan and discuss it with your health care team to help make sure you get the care you need. Case management is just one of the many ways we can help you if you: Have a serious health problem Go to the emergency room a lot See multiple providers Have to go into the hospital often For more information about case management, call the customer service number on your member ID card. Evaluating our program each year is another way to help us improve. We have goals for our SNPs that we monitor and measure often. They include: Having enough providers to meet your needs Effectively reaching out to you to complete an HRA Working with you to create a care plan and health care team that meets your needs Knowing how many members are getting certain preventive care services Getting you follow-up care after you go home from the hospital Making sure you re going to your primary care provider (PCP) While we have met many of the goals, we re currently working to find better ways to: Reach you to complete the HRA Reach you and your provider to participate in care team meetings Help you get the care you need, including vaccinations and other preventive testing Contact you after a hospital stay to help with follow-up care and ways to stay at home Offer case management services and home care providers
We report the following HEDIS and other measures on our Special Needs Plans (SNP) every month: Controlling High Blood Pressure (CBP) Care for Older Adults (COA) Medication Review Care for Older Adults (COA) Functional Status Care for Older Adults (COA) Pain Screening Colorectal Cancer Screening (COL) Follow up after hospitalization for mental illness 7 days (FUH-7) Follow up after hospitalization for mental illness 30 days (FUH-30) Osteoporosis Management in Women Who had a Fracture (OMW) Plan All-Cause Readmission (PCR) In 2016, we had overall improvement in seven of nine SNP measures listed above. We have more work to do on two of the measures Controlling High Blood Pressure and Medication Review for Older Adults. We ll keep working to improve these results. The Medicare HEDIS measures we track are listed below: Comprehensive Diabetes Care (CDC) HbA1c testing Breast Cancer Screening (BCS) Colorectal Cancer Screening (COL) Controlling High Blood Pressure (CBP) High Risk Medications (HRM) Medication Adherence for Blood Pressure, Cholesterol and Diabetes Plan All-Cause Readmission (PCR) Medicare health plans get Star Ratings based on how well they perform on these HEDIS measures. The number of stars indicates how well of a job our plan is doing: 5 stars Excellent 4 stars Above average 3 stars Average 2 stars Below average 1 star Poor In 2016, more than 50 percent of our Medicare members were enrolled in health plans with four or more stars. Overall improvement in six out of seven Medicare HEDIS measures listed to the left helped our star rating, but we have more work to do on Controlling High Blood Pressure. We ll continue to check these results often to help improve your care.
What can you do to stay as healthy as possible? You may feel overwhelmed at the thought of going to your provider regularly or getting regular tests and screenings, but there are a few things you can do. And our team members are here to help you every step of the way. Put a check beside the things you already do or are willing to start doing. I will: See my PCP if I m not having a medical emergency. He or she is my main doctor and can help coordinate my care with other providers I may have. Complete the HRA when a nurse case manager calls me. Get preventive health care such as flu and pneumonia shots, mammograms, colon cancer screenings, diabetic testing and glaucoma tests. Keep a health journal, write down questions for my provider and take them with me to my appointments. Take a list of my medications to my appointments and go over it with my providers. Take my medicines as my provider prescribed. Be more active but talk to my PCP first about what activities are safe for me. Control my blood pressure and cholesterol. What questions do you have? If you need help, call the toll-free customer service or 24-hour nurse help line numbers listed on your member ID card.
P.O. Box 62509 Virginia Beach, VA 23466-2509 Our Notice of Privacy Practices This type of notice explains how medical information about you may be used and disclosed by Amerigroup. It also tells you how to access this information. The notice follows the privacy regulations set by the Health Insurance Portability and Accountability Act (HIPAA). If you would like a copy of our Notice of Privacy Practices, please call Member Services at the phone number listed on your ID card or visit www.myamerigroup.com/medicare. Make Health HAPPEN newsletter Health and wellness or prevention information Making decisions on care and services Sometimes, we need to make decisions about how we cover care and services. This is called Utilization Management (UM). Our UM process is based on the standards of the National Committee for Quality Assurance (NCQA). All UM decisions are based on medical needs and current benefits only. We do this for the best possible health outcomes for our members. We also don t tell or encourage providers to underuse services. And we don t create barriers to getting health care. Providers do not get any reward for limiting or denying care. And when we decide to hire, promote or fire providers or staff, we don t base it on whether or not we think they might deny or would be likely to deny benefits. Make Health Happen is published by Amerigroup to give information. It is not a way to give personal medical advice. Get medical advice directly from your physician. 2017. All rights reserved. Printed in the USA. Amerigroup is a Medicare Advantage Organization with a Medicare contract. For Dual-Eligible Special Needs Plans: Amerigroup is a D-SNP with a Medicare Contract and a contract with the state Medicaid program. Enrollment in Amerigroup depends on contract renewal. In New Mexico, Amerigroup is Amerigroup Community Care of New Mexico, Inc. In New Jersey, Amerigroup is Amerivantage Specialty + Rx (HMO SNP). Y0114_17_33299_I_ 10/25/2017 AMV NL-PC-1017 E