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I think a lot of guys are like me—they push themselves to the limit and think sickness will go away. Network Health member, Jim Totzke, finds comfort in care management support.
P U B L I C A T I O N
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L I F E , H E A LT H & W E L L N E S S
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3 Letter from the President and CEO
3 Member Rights and Responsibilities
E DITORIAL STAFF
Chief Administrative Penny Ransom Officer
4 Exchange of Information
4 Pharmacy Network Changes
Insurance Program Vaccine Update
6 Men – Keep Yourself Healthy
COVER STORY
College Student Coverage
08
06
KNOWING YOUR LIMITS
Medical Director
12 Does My Child Have
Seasonal Allergies?
12 Quality and Performance
Improvement Program Information
Phone Call Away with MDLIVE®
17 Medical and Behavioral
Health Access
17 New Behavioral Health Options
for Children at Ascension NE Wisconsin St. Elizabeth Hospital
Teens and Young Adults
14 Safety with Opioids:
© 2019 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.
Is Naloxone Right for You?
If you have questions or suggestions or would like to tell us how Network Health improved your life, send us an email at
marketing@networkhealth.com. You can also write to us at:
19 Make Your Health a Priority 19 Join All of Us, a Precision
HAVE A QUESTION?
18 Lifecycle of a Claim
Medicine Research Program
Screenings are Considered Preventive?
20 Network Health for Life
Network Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. If you, or someone you’re helping, has questions about Network Health, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 800-826-0940. Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Network Health, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 800-826-0940. Hmong: Yog koj, los yog tej tus neeg uas koj pab ntawd, muaj lus nug txog Network Health, koj muaj cai kom lawv muab cov ntshiab lus qhia uas tau muab sau ua koj hom lus pub dawb rau koj. Yog koj xav nrog ib tug neeg txhais lus tham, hu rau 800-826-0940. 1746-02-0619 2 | balance • S u m m e r 2 01 9
TELL US YOUR STORY
Network Health Attention: Katie Sharratt 1570 Midway Pl. Menasha, WI 54952
13 Heat-Related Illnesses Affect 19 Which Labs and Health
Balance is published by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals.
16 Feeling Down? Help Is a
11 Meet a Network Health
BOARD
Melanie Draheim, Angela Keenan, Joan Merwin, Mallory Mueller, Alice Parks, Stacy Schwandner, Katie Sharratt, Kimberly Swanson, Theodore Regalia, Kacey Werner, Hannah Zillmer
Lead Designer Debra Sutton
E DITORIAL
5 Safe Summer Grilling 7
President Coreen and CEO Dicus-Johnson
Marketing Becky Pashouwer Coordinator
4 State of Wisconsin Group Health
Call our highly-rated customer service team. HOURS Monday, Wednesday–Friday: 8 a.m. to 5 p.m. Tuesday: 8 a.m. to 4 p.m. PLANS THROUGH AN EMPLOYER 800-826-0940 PLANS FOR INDIVIDUALS AND FAMILIES 855-275-1400 STATE OF WISCONSIN EMPLOYEES/MEMBERS 844-625-2208 Monday–Thursday: 7:30 a.m. to 5 p.m. Friday: 7:30 a.m. to 4:30 p.m.
WANT MORE HEALTH TIPS? Check out our blog at copilotwi.com.
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life. health. wellness.
Letter from the President and CEO Choosing health insurance is a big decision, and Network Health values the trust you place in us. Network Health works collaboratively with our Wisconsin-based owners, Froedtert Health and Ministry Health Care, a part of Ascension Wisconsin, toward health care advancements and provider accessibility to give you the best care possible. Our mission is to continue to create healthy and strong Wisconsin communities. We are happy to provide you with resources to guide your health care decisions with this edition of Balance. This issue includes educational articles about health care topics such as men’s health, summertime safety and behavioral health. Thank you for your membership, and enjoy your summer. Sincerely,
Coreen Dicus-Johnson President and Chief Executive Officer
Member Rights and Responsibilities As a Network Health member, you have certain rights and responsibilities. To learn more about how we provide you with service that respects your rights, visit our website at networkhealth.com. If you get coverage through your employer, select Employer Plans, then choose Member Resources. At the bottom of this page, you’ll find Member Rights and Responsibilities. You can also call customer service at 800-826-0940 (TTY 800-947-3529) Monday, Wednesday – Friday, from 8 a.m. to 5 p.m. and Tuesday from 8 a.m. to 4 p.m. to request a hard copy. If you buy insurance on your own, select Individual and Family Plans and choose Member Resources. At the bottom of this page, you’ll find Member Rights and Responsibilities. You can also call customer service at 855-275-1400 (TTY 800-947-3529) Monday, Wednesday – Friday, from 8 a.m. to 5 p.m. and Tuesday from 8 a.m. to 4 p.m. to request a hard copy.
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Exchange of Information
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any medical conditions can be related to, or the result of, another condition. Effective coordination of care depends on clear and timely communication among providers and facilities caring for an individual. This communication allows better decision-making regarding treatments and decreases the potential for unwanted medication interactions. When your personal doctor refers you to a specialist, information is often shared as allowed by privacy laws. However, if you choose to seek services outside your personal doctor’s organization or from community organizations, your doctor may not be aware of all services, tests or treatments you receive. Whenever you receive a service outside your personal doctor’s office, ask whether the information is being sent to your doctor, or ask for a copy that you can send. When you see your personal doctor, discuss all visits and treatments you have received from other providers since your last visit. It is important to keep your personal doctor informed so he or she can see the complete picture of your health and be alert for possible interactions. It also helps avoid unnecessary repeat tests, leads to improved outcomes and increases your safety. Think of your personal doctor as your copilot, helping you navigate the way to a healthier you.
Pharmacy Network Changes
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n January 1, 2020, Network Health will transition to Express Scripts® (ESI) as the pharmacy benefits manager. For your convenience, Network Health will provide access to Walgreens pharmacies beginning August 1, 2019, and the networkhealth.com Find a Pharmacy tool will be updated to reflect this change. This early access gives you time to work with a Walgreens pharmacist to transition your pharmacy files. The other pharmacies within the ESI network will be in-network on January 1, 2020. CVS/caremark™ will continue to be in-network until December 31, 2019. ESI has provided pharmacy benefits management for Network Health Medicare members since 2005, saving members money and providing excellent customer service.
If you decide not to participate in the early transition, we recommend refilling your prescriptions the last week of December 2019 to cover your medication needs until you can transfer your pharmacy files. Beginning January 1, 2020, you can request that your new pharmacy contact your old pharmacy to transfer your files. If you are currently using CVS/caremark for mail order, you will need to contact ESI starting January 1, 2020, to establish your mail order services. You can search the entire updated pharmacy network, both retail and mail order, on networkhealth.com starting November 1, 2019. Network Health pharmacy benefits do not apply to State of Wisconsin Group Health Insurance Program employees and members.
State of Wisconsin Group Health Insurance Program Vaccine Update By: Anna Peterson Sanders, Pharmacist at Network Health
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eginning January 1, 2020, Network Health members of the State of Wisconsin Group Health Insurance Program can get a vaccine at any pharmacy in the Navitus network. While the Group Insurance Board approved expanding vaccine coverage to your pharmacy benefit, you will still have the option to be vaccinated by your personal doctor under the medical benefit in 2020. For the remainder of 2019, vaccines can still be obtained at your personal doctor’s office under your medical benefit. In addition, you can receive vaccines at Walgreens pharmacies using your medical benefit starting August 1, 2019. Network Health has contracted with Walgreens to provide this service, through the end of 2019.
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networkhealth.com
Safe Summer Grilling
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rilling is a favorite summer pastime in Wisconsin. It’s fun to grill for your family and friends, at home or tailgating. No matter where you’re grilling, you should take certain steps to keep your food safe before and after you cook. According to the Centers for Disease Control and Prevention, these are the steps to keeping your food safe.
Separate
Keep raw meat, poultry and/or seafood separate from other foods—this includes in your shopping cart, grocery bags and the refrigerator. If you elect to freeze your meat before cooking, make sure to thaw it in the refrigerator, cold water or in the microwave. Never thaw food on the counter or in the sink because bacteria can spread easily onto your cooking surfaces.
Chill
Keep raw meat, poultry and seafood refrigerated until you’re ready to cook them. Make sure to keep your refrigerator below 40⁰F.
Clean
Wash your hands before and after handling raw meat, poultry and/or seafood. Keep your cooking surfaces clean by thoroughly disinfecting before and after preparation. Even if you use a wire brush to clean the grill, wipe down the surface with a damp cloth or paper towel before cooking. This will ensure the grill is clean and no wire bristles will end up in your food.
Don’t cross-contaminate
Anything that comes in contact with raw meat (or raw meat juices) should be cleaned thoroughly before reuse. Discard used marinades or sauces and always use clean utensils and a clean plate to remove meat from the grill.
Cook thoroughly
Use a food thermometer to confirm the meat is hot enough to kill harmful bacteria and germs. These are the recommended temperatures to cook different meats.
• 145°F for whole cuts of beef, pork and lamb (then allow the meat to rest for three minutes before carving or eating) • 160°F for ground meats, such as beef and pork • 165°F for all poultry, including ground chicken and turkey • 165°F for leftovers and casseroles • 145°F for fresh ham (raw) • 145°F for finfish or cook until flesh is opaque
Store promptly
Refrigerate any uneaten food within two hours of cooking it; one hour if it’s hot outside. n e t w o r k h e a l t h . c o m
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Men – Keep Yourself Healthy By: Jennifer Stubbe, Health Coach at Network Health
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ne of the biggest health challenges men face is their reluctance to seek care. Studies suggest men are 24 percent less likely to visit a doctor than women and only 40 percent of men go to the doctor if they fear they have a serious medical condition. These numbers are surprising, considering men have a higher instance of heart disease and chronic liver disease. The good news is many of these potential health risks can be prevented or treated with early detection. Take care of yourself by making the following healthy lifestyle choices. Take advantage of your annual visit with your personal doctor, to stay up-to-date on age-appropriate preventive screenings, like a prostate exam and colonoscopy. Some conditions don’t show early symptoms, so preventive screenings can lead to the early detection of diseases, which provides better outcomes. Maintain a well-balanced diet rich in a variety of whole foods. This includes reliable sources of protein and healthy fats, like wild-caught fish, grass-fed beef, wild game, free-range eggs, avocados, nuts and seeds—such as walnuts, almonds, chia and flaxseed. Consume plenty of fruits and vegetables, which are full of vitamins and minerals your body needs to maintain your immune system, minimize inflammation and maintain prostate health. Make sure to limit added sugar as much as possible. Limit alcohol consumption and avoid tobacco use. This is better for your health and your quality of sleep. Sleep is important because it serves as a protective measure for your physical and emotional health. While sleeping, your body self-regulates.
Improve your sleep by addressing following these lifestyle habits. 1. Maintain a regular sleep routine. Follow your natural sleep cycle by going to bed and waking up at the same time every day. Strive for seven to nine hours of sleep nightly. 2. Ensure adequate exposure to natural light during the day and darkness at night. During the day, spend time outside or open the blinds to allow natural light into your home. Consider a seasonal affective disorder (SAD) light box during the winter. In the evening, make the room dark and non-stimulating. Avoid blue light exposure from electronics two to three hours before bedtime. 3. Stay active. Integrate cardiovascular exercise four to five days a week for at least 30 minutes, and strength train at least two times a week. Exercise can help you maintain a healthy weight, manage stress, promote restful sleep and boost hormones. 4. Limit daytime naps to less than 30 minutes. Naps don’t make up for inadequate nighttime sleep, but can be a short-term solution to improve mood, alertness and performance. 5. Identify and manage stress. Stress often impacts sleep, which negatively impacts your hormones and energy levels. It’s important to identify stressors and make necessary lifestyle changes to the stressors you can control. For example, make a to-do list, meal prep for the upcoming week, schedule your exercise time on your calendar and don’t be afraid to ask for help. 6 | balance • S u m m e r 2 01 9
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College Student A
COVERAGE
s you prepare to send your child to college, you may have questions about health insurance coverage. It’s important to understand the coverage options your child has available. If your child is covered under a Point-of-Service (POS) plan, he or she has benefits outside the Network Health service area. If your child is covered under a Health Maintenance Organization (HMO) plan, he or she has coverage for emergency care received in a hospital-based emergency room outside the Network Health service area, until he or she can be safely moved to a Network Health participating facility. A Network Health participating provider must provide any follow-up care or regularly scheduled office visits. If that isn’t possible and your child must visit a doctor or hospital outside our network, the provider must call our utilization management team at 800-236-0208 or 920-720-1600 for prior authorization before the appointment. One of our nurses or doctors will review the request and determine if your child can receive care from an out-of-network provider. It’s important to remember, if you plan to follow up on behalf of your child, you must be identified as an authorized representative. We have Personal Health Information forms available at networkhealth.com, select Employer Plans and Member Resources from the dropdown. Under Forms, you will find the Personal Health Information Form to complete and return to Network Health. This allows you to call and discuss your child’s coverage and plan information if it’s ever needed. Another option for non-emergency care is a virtual visit using MDLIVE®. Check your plan documents to confirm your coverage includes MDLIVE virtual visits and set up your child’s account so he or she is prepared for an unexpected illness. You can sign up for MDLIVE in one of four ways. 1. Log in to your member portal at login.networkhealth.com and click Virtual Visits. Once you’ve set up your MDLIVE account, you’ll be able to seamlessly access it from your member portal. 2. Text NETWORK to 635483 to be walked through step-by-step registration on your phone. 3. Download the MDLIVE app on your smartphone or tablet. Open the application and follow the instructions to create an account. 4. Call 877-958-5455 and an MDLIVE customer service representative will walk you through the process of setting up an account. n e t w o r k h e a l t h . c o m
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K NOWING YOUR
>>>
LIMITS
N
etwork Health member, Jim T., rarely went to the doctor. Once a year, he would have his annual wellness visit and screenings, but he wouldn’t go to the doctor if he was sick.
“Anytime I didn’t feel well, I would try to ride it out,” Jim said—and he isn’t alone. A study by the Cleveland Clinic shows that 40 percent of men only see a doctor when they believe they have a serious health problem. In 1997, Jim was in a snowmobile accident and hurt his shoulder. The doctor gave him a sling for two weeks and sent him back to work. Jim lived in pain for almost nine years until he pinched a nerve in his shoulder and his personal doctor took a closer look. Upon further examination, Jim’s doctor told him that in addition to his pinched nerve, he had arthritis, an overgrown bone and bone fragments that were the result of a broken shoulder that didn’t heal properly. Jim said, “I think a lot of guys are like me—they push themselves to the limit and think sickness will go away.” By Becky Pashouwer Photographs by Carlene Jahnke
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In November of 2018, Jim began feeling tired and rundown. He was surrounded by people who had the flu, so he assumed he had the flu. After that, Jim began sleeping later into the day and feeling weaker. “I just didn’t feel right,” he said, but he carried on with his life. He worked, went to California for his niece’s wedding and went to a Styx concert with friends. On December 30, Jim went to his parents’ house to watch the Packers/Lions game. During the game, he mentioned that he was very tired and worn out, so he planned to make a doctor’s appointment the next day. After the game, he was too tired to go home, so he spent the night at his parents’ house. The next morning, Jim’s mom woke him up and drove him to the hospital. On the way, he decided, “I’m going to see what’s going on and I’m staying home from work until I feel better.”
Yvonne Morrow, RN oncology care manager at Network Health
Jim and his brother are fourth-generation painters. They each own their own business, but they work together most of the time. The tradition of painting started with Jim’s great-grandpa, who worked for the power company and painted the trolley cars by hand. His grandpa and dad also worked for the power company and took painting jobs on the side. At 10 years old, Jim would go on painting jobs to help his dad and grandpa and he enjoyed it so much, he turned it into a career.
She came [to the corporate office] and somebody helped her out—went through everything. It gave her piece of mind. When she left, she knew exactly where she stood—what money she owed to who. That stuck in my mind and I’ve heard from a few other people that they were really satisfied. That means a lot, when you’re hearing it about an insurance company. Because a lot of times, that isn’t the case.
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Because Jim doesn’t have health insurance through an employer, he purchased his Network Health insurance through the Health Insurance Exchange. He chose Network Health because his daughter had previously been insured by Network Health and received help when she had questions. Jim said “She came [to the corporate office] and somebody helped her out—went through everything. It gave her peace of mind. When she left, she knew exactly where she stood—what money she owed to who. That stuck in my mind and
“[Yvonne] has been wonderful. She explains things to me the doctors didn’t explain, and she gives me advice. It’s been very helpful. I’ve heard from a few other people that they were really satisfied. That means a lot, when you’re hearing it about an insurance company. Because a lot of times, that isn’t the case.” On January 1, 2019, Jim got the results of his bloodwork from the day before. He remembers the doctor coming in and saying he had life-changing news. Jim had Acute Myeloid Leukemia (AML), which is a type of cancer that starts in the bone marrow, moves into the blood and can spread to the lymph nodes, liver, spleen and brain. He was immediately admitted to Ascension NE Wisconsin St. Elizabeth Hospital where he met his oncologist, Dr. Kamal Abbi and two other doctors—Dr. J. Mitchell Winkler and Dr. Bradley Heraly. Jim spent 32 days in the Cancer Center at St. Elizabeth Hospital, undergoing chemotherapy treatments for AML. Jim’s thankful for the care he received while he was there. “[Abbi’s] whole team was very helpful. They know you’re in pain and help you as much as they can. They’re excellent.” During that time, Jim received a phone call from Yvonne Morrow, an oncology nurse care manager at Network Health. Yvonne said “It’s such a hard time in a person’s life—to learn about a cancer diagnosis. I wanted Jim to know that I’m here to support him and answer any questions he may have.” Jim explained how much he appreciates Yvonne’s guidance. “[Yvonne] has been wonderful. She explains things to me the doctors didn’t explain, and she gives me advice. It’s been very helpful.” He also appreciates that Yvonne doesn’t make him feel like a patient. “Whenever we get on the phone, we talk for about an hour. It doesn’t always pertain to my treatment. We talk about life and our personal experiences.” In 2016, Jim was diagnosed with a serious retinal eye infection. His doctors were concerned that the chemotherapy would compromise his
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immune system and cause the infection to come back. When Jim left the hospital, he saw his eye doctor who referred him to a specialist at Northeast Wisconsin Retina Associates. He was introduced to Dr. John Rosculet, a retinal specialist. He said ,“I went in to see Dr. Rosculet on a Tuesday. At that appointment, I had 20/20 vision, and everything was fine. I woke up on Friday morning and I was completely blind in my left eye.” Jim was impressed; Rosculet came in on a Saturday to give him an injection. Abbi and Rosculet worked together on Jim’s treatment plan. They wanted to make sure his eye was healed before he continued his AML treatments. Abbi’s team recommended an outpatient procedure that consisted of 24 chemotherapy injections over seven days. After this round of chemotherapy, Jim had a blood test and a bone marrow biopsy to determine the state of his AML. The results of this biopsy confirmed that Jim was cancer-free. Despite this wonderful news, his treatment plan still called for three rounds of consolidated chemotherapy, which would make sure the cancer cells were completely gone. In late May 2019, Jim went through a consolidated chemotherapy treatment. A few days later, Jim began feeling ill. “I’m glad I was at my mom’s house, because if I was at my house and didn’t feel well, I would have tried fight it. I would have thought, ‘I’ll be fine. This will pass.’” His mom handed him a thermometer, and it’s a good thing she did— he had a fever of 104.8 degrees. She brought him right to the hospital. Jim had some tests done and learned he had a severe infection that caused his white blood cell count to drop to dangerously low levels and he was admitted to the hospital. Jim said, “I was in bed for the first five days. Just standing up made me winded. Once I was finally able to move, I made a deal with the nurses—usually they give shots
Don’t be stubborn. Just because there’s a sickness going around, don’t assume that it’s what you have. Get in and get checked if you feel like you have a flu or something that’s dragging on. The earlier you get checked, the better off you’re going to be. in the stomach to reduce the risk of blood clots—I promised to walk three or four times a day if they wouldn’t give me the shots.” After a seven-day stay, Jim was finally well enough to go home. Today, Jim is still in treatment for his AML. His next step is to see Rosculet and have his eye checked. “If it isn’t cured, [Rosculet] has done everything he possibly can. I feel like I owe him a lot,” said Jim. After he’s cleared by Rosculet, he’ll undergo two more rounds of consolidated chemotherapy, about four to six weeks apart. After everything he’s been through, Jim is looking forward to getting back to work. He said, “Abbi doesn’t want me working, but I’m planning to work between treatments. I need to keep money in the bank and I need make enough money to keep up my health insurance.” Jim has some simple advice for other men. “At a minimum, always go in for your annual physical.” He adds, “Don’t be stubborn. Just because there’s a sickness going around, don’t assume that it’s what you have. Get in and get checked if you feel like you have a flu or something that’s dragging on. The earlier you get checked, the better off you’re going to be.”
Meet a Network Health Medical Director A
t Network Health, we have a team of medical doctors that manages our programs to ensure you receive the care you need when you need it. The doctors, called medical directors, provide their expertise to our health coaches, care managers and condition managers, and they receive medical cases and consult with providers to ensure members receive appropriate care. Dr. Thomas Heinrich, Associate Medical Director at Network Health, is a professor of psychiatry and family medicine at the Medical College of Wisconsin (MCW) and practices psychiatric consultation at Froedtert Hospital in Milwaukee. He is board-certified in family medicine and general adult psychiatry and holds certifications in consultation-liaison psychiatry and neuropsychiatry. Network Health: You have a unique perspective—you are a doctor, an educator and you work for an insurance company. How have your professional experiences influenced your role at Network Health?
Dr. Heinrich: I was unfamiliar with the role insurance companies play in driving quality initiatives. It was reassuring to learn how much effort goes into ensuring quality of care for members and patients.
Dr. Heinrich: As an educator, I realized we don’t teach medical students or residents about how insurance companies work. It’s important for providers and payers to work together to provide the best care for the patients.
Network Health: What has been your most rewarding experience as a Network Health Medical Director?
As a clinician, I have interacted with insurance companies for decades. Now I can represent the insurance company and work peer-to-peer with other providers, helping them understand the resources available to their patients. Network Health: What have you learned as a medical director at Network Health that was surprising?
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Dr. Heinrich: I am especially proud of the innovative approach Network Health has taken toward increasing access to behavioral health care. The telehealth options [like MDLIVE®] allow us to help more members find the care they need when they need it. Network Health: Do you have any advice for our members? Dr. Heinrich: Be your own advocate. If something doesn’t feel right, whether it be physical or emotional, don’t hesitate to get the help you need to be your healthiest self.
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life. health. wellness.
Does My Child Have Seasonal Allergies?
Jelena Shadick MD, MBA, Pediatrician with Ascension Wisconsin easonal allergies—allergic rhinitis—also known as hay fever, impacts more than 50 million Americans every year and about 30 percent of children. Seasonal allergies are responsible for almost two million missed school days in the U.S. and account for about three percent of all pediatric visits. Seasonal allergies are often caused by trees, weeds and grasses. Some children experience allergies all year, which are usually related to dust mites, cockroaches, animal dander and mold spores. Children with family members who have allergies have an increased risk of seasonal allergies.
S
Diagnosing seasonal allergies usually does not require any clinical testing and is based on symptoms. These are the most common seasonal allergy symptoms in children. • Sneezing • Runny and itchy nose • Congestion • Watery, itchy eyes • Darkening or swelling around the eyes • Clear nasal discharge Your child’s pediatrician is an excellent resource to help control his or her symptoms. If your child has severe allergies, an allergist can do a skin test and/or give allergy shots geared toward specific allergens. In addition, these over-the-counter remedies can ease seasonal allergy symptoms.
• Cetirizine (Zyrtec®) • Loratadine (Claritin®) • Fexofenadine (Allegra®) • Fluticasone (Flonase®) • Friamcinolone (Nasacort®)
Quality and Performance Improvement Program Information A
t Network Health, we have an internal department focused on improving the quality of the services our members receive from us and our participating providers. Quality Health Integration (QHI) ensures we provide one-on-one service to meet your individual health needs and help you live a better life.
Each year, QHI reviews and updates their program structure, which includes the following. • • • • • • • •
Written description of the program, including behavioral health care and patient safety, which are both specifically addressed The specific role, structure and function of the QHI committee and other committees including frequency, are addressed in the program description Accountability to the Board of Directors A designated physician who has substantial involvement A designated behavioral health care practitioner who is involved in behavioral health care aspects QHI committee that oversees the function of the Network Health organization An annual work plan including progress toward goals A description of resources devoted to the QHI program
For more information about Network Health’s Quality Health Integration Program, email QI@networkhealth.com. 12 | balance • S u m m e r 2 01 9
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Heat-Related Illnesses Affect Teens and Young Adults T
he Wisconsin Department of Health Services and Minnesota Department of Health performed a study to determine who is at risk during extreme heat. Epidemiologists reviewed data from 2006-2015 about heat-related illness—such as heat exhaustion, heat cramps and heat stroke—in Wisconsin and Minnesota. The study revealed that teens and young adults from 15–34 years old are the most likely to seek emergency care for heat-related illnesses. This was surprising, because most public health alerts focus on the very young and very old.
Extreme heat can affect anyone. Follow these steps to keep yourself safe Stay in air conditioning. If you don’t have air conditioning, go to the library, mall or other public locations to keep yourself cool. Check on loved ones. Make sure to check on friends and neighbors who live alone or don’t have air conditioning. Avoid the hottest part of the day. If you must be outside, stick to the morning and evening hours. Follow the shadow rule—if your shadow is shorter than you, head inside. Beware of hot cars. Never leave a person or pet in a parked car. On an 80 degree day, a car can reach 100 degrees in less than 10 minutes.
During hot summer months, we are still concerned about the very young and very old. But what we learned from this project is that we can do better to reach other populations who may not be aware of their risk, Tess Koen, an epidemiologist and project lead at Minnesota Department of Health.
Keep yourself hydrated. Drink plenty of water on hot days. Avoid alcohol because it leads to dehydration. Stay informed. Watch your local weather forecast and pay attention to extreme heat alerts.
S AY W H AT ?
Epidemiologist – Scientist who studies patterns and causes of diseases n e t w o r k h e a l t h . c o m
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Safety with Opioids:
Is Naloxone Right for You? By: Anna Peterson Sanders, Pharmacist at Network Health
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pioid use has been in the spotlight as the crisis has grown over the years. Communities, prescribers and insurance providers are working together to find ways to make opioid use safer. Awareness is key.
These painkillers are some of the most commonly used opioids • oxycodone • hydrocodone • morphine • codeine • fentanyl • hydromorphone • methadone • tramadol
Who should have naloxone on hand? Those at high risk of opioid overdose and anyone who can help a person at risk should have naloxone available. High-risk individuals include, but are not limited to, the following.
• Those on long-term opioids for treatment of chronic pain • Those on extended-release or long-acting opioid medications • Those who have been discharged from medical care following an opioid overdose • Those currently in opioid rehabilitation programs Opioids can affect the central nervous system by slowing or stopping breathing, which is the primary concern when dealing with opioid overdoses. Fortunately, a reversal agent called naloxone, is available to have on hand if there is the chance for opioid overdose. If you or a loved one is on an opioid medication, you may need to be trained to use naloxone.
How is naloxone administered?
• Your pharmacist will explain how to identify an opioid overdose and how to use naloxone. If you are an individual at risk of opioid overdose, it is important that your friends and family know you are considered at risk and should learn how to administer naloxone. For additional instructions or reminders, access How to Give Naloxone at www.dhs.wisconsin.gov/publications/p01576.pdf • In general, giving naloxone will not harm anyone who is not experiencing a true opioid overdose.
Where can I get naloxone?
• Your personal doctor - Speak with your doctor about sending a prescription for naloxone to your local pharmacy. • Without a prescription – Wisconsin has a Statewide Standing Order for Naloxone, which allows certain pharmacies to dispense naloxone without a prescription. This can be given to anyone at risk of an opioid overdose and any family, friend or individual who may witness an opioid overdose. To find a pharmacy near you that is part of this program, visit www.dhs.wisconsin.gov/opioids/naloxone-pharmacies.htm
How much does naloxone cost for Network Health members? For those who get coverage through their employer ... • Narcan® nasal spray - Tier 2 medication • Evzio® auto-injector – Tier 5 with prior authorization • Naloxone for injection – Not covered
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For those who buy insurance on their own ... • Narcan nasal spray – Tier 3 medication • Naloxone for injection – Tier 2 medication • Evzio auto-injector – not covered
State of Wisconsin employees/members ... • Narcan nasal spray – Tier 2 medication • Naloxone for injection – Tier 2 medication • Evzio auto-injector – not covered
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life. health. wellness.
Feeling Down?
Help Is a Phone Call Away with MDLIVE
®
By: Alice Parks, Director of Population Health at Network Health
A
lmost all of us experience depression and stress sometime in our lives. When working through the curve balls life throws at you, like stress, anxiety, depression, or sudden loss, it can help to talk to someone. You can always schedule a visit and talk with your personal doctor (also referred to as your primary care provider or PCP) if you have concerns about your mental health. In addition, Network Health has behavioral health specialists within our network who are available for an office visit. You can find a behavioral health provider at networkhealth.com/finda-doctor. Your employer may have an Employee Assistance Program (EAP) to help you deal with a mental health issue. If you’re uncomfortable speaking with your personal doctor, are out of the service area, or you can’t make it to an office visit for other reasons, Network Health offers counseling and behavioral health appointments any time of the day or night, over the phone or virtually through MDLIVE.
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MDLIVE has board-certified psychiatrists and licensed therapists who treat depression and other behavioral health diagnoses. Virtual visits are private and secure, done over your phone, mobile app or online. If needed, the psychiatrists can send certain prescriptions to a pharmacy near you. You can use MDLIVE for yourself, your spouse or your children if they are Network Health members. Usually a parent or legal guardian must be present during the MDLIVE visit with a minor dependent. Many Network Health plans cover MDLIVE virtual visits at no additional cost to you, however some plans may have a required copayment, coinsurance or deductible. Check your summary of benefits to confirm your coverage. Call the customer service number listed on the back of your member ID card if you have questions about your benefits.
networkhealth.com
Set up your Network Health MDLIVE account in one of four ways
Log in to your member portal at login.networkhealth.com and click Virtual Visits. Once you’ve set up your MDLIVE account, you’ll be able to seamlessly access it from your member portal.
Text NETWORK to 635483 to be walked through step-by-step registration on your phone.
Download the MDLIVE app on your smartphone or tablet. Open the application and follow the instructions to create an account.
Call 877-958-5455 and an MDLIVE customer service representative will walk you through the process of setting up an account.
MDLIVE’s licensed therapists and psychiatrists can help with the following conditions. Bipolar disorders Grief and loss Postpartum depression
Child and adolescent issues LGBTQ support Relationship and marriage issues
Depression Panic disorders Stress
Eating disorders Parenting issues Trauma and PTSD
Medical and Behavioral New Behavioral Health Health Access Options for Children at Ascension NE Wisconsin St. Elizabeth Hospital Network Health assures access to medical and behavioral health care management employees for you, your personal doctor and provider office staff seeking information about our care management and utilization management programs. If you have questions about the utilization or care management process, or to request a copy of specific utilization criteria, please contact care management at 920-720-1600 or 800-236-0208 (TTY 800-947-3529). For questions specific to behavioral health utilization, call 920-720-1340 or 800-555-3616 (TTY 800-947-3529).
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The Ascension NE Wisconsin St. Elizabeth campus is adding a partial hospitalization program (PHP) to their children’s behavioral health options. This program is for children 12-18 years old who are struggling to manage their moods. A PHP is less intensive than inpatient treatments and more intensive than community-based outpatient programs. Over a two-week period, the children engage in group, individual and family therapy sessions and practice health coping and communication techniques.
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Lifecycle of a Claim
STEP
1
After you go to the doctor, his or her office will file a claim for the service(s) provided. Each service has a procedure and diagnosis code. The procedure code tells us what was done during the visit and the diagnosis code tells us why. It’s important to ask your doctor about the procedures they are performing and how they are being coded. This can help you avoid surprises when your Explanation of Benefits (EOB) arrives.
H
ave you ever wondered what happens to your claim between the time you go to the doctor and the time you receive your bill?
Each claim has its own lifecycle, containing several steps to confirm accuracy.
STEP
4
STEP
2
STEP
Claim Filed Your claim is filed with Network Health, either electronically or through the mail. Claims that are received electronically automatically load into our system. Paper claims are dated when they are received and converted into electronic files or manually entered into our claims processing system.
3
Claim Processed
The Network Health claims processing system is set up to coincide with your benefits, and your claim is either processed automatically or reviewed by a claims analyst. This process ensures accuracy of the claim.
STEP
5
Verified When your claim is processed, we ensure your insurance coverage was effective on the date you received the service. Our processing system automatically verifies the service is covered and the doctor you saw is in network.
STEP
6
Reviewed
Your claim and benefits are reviewed. If your doctor is in the Network Health provider network, we pass discounts on to you, meaning you owe less than if you saw an out-ofnetwork provider. This review also determines if you owe out-of-pocket costs, like a deductible. Then, our system applies your deductible to your claim, if applicable, and notifies your doctor what you owe.
Explanation of Benefits (EOB)
We pay the eligible amount—less any out-of-pocket costs, such as coinsurance or copayments—directly to the provider. You receive the EOB, explaining how your claim was processed. The EOB is not a bill—it’s a breakdown of how your claim was processed.
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Doctor Visit
STEP
7
Billing
Once Network Health pays your doctor, it’s posted to your record, which you can view from the member portal at login.networkhealth.com. Your doctor’s office sends you a statement showing the remaining amount you owe—if anything. It’s important to compare the provider bill to your EOB to ensure you are being billed the correct amount.
networkhealth.com
life. health. wellness.
Make Your Health a Priority By: Mark Geiger, Quality Health Integration Supervisor at Network Health
N
etwork Health is on a mission to create healthy and strong Wisconsin communities. To help us achieve our mission, we recommend you schedule an annual wellness visit with your personal doctor and take the health risk assessment (HRA). Annual wellness visits and HRAs can lead to the early detection of diseases and common risk factors. Early detection provides better outcomes and ultimately saves you money. An annual wellness visit consists of a physical examination, preventive screenings and immunizations, if applicable. Some conditions don’t show early symptoms, so staying up-to-date on your annual wellness visit is important to maintain your health. By completing an HRA, you can be identified as a candidate for our no cost, one-on-one health management services, including care management, condition management and health coaching. Our team of nurses, social workers and health coaches assist thousands of members annually. Complete your HRA by logging into the member portal at login.networkhealth.com and clicking Health Questionnaire under Wellness.
Join
T
a Precision Medicine Research Program By: Froedtert Health
he National Institutes of Health All of Us Research Program has a simple mission—to speed up health research breakthroughs. To do this, All of Us is asking one million or more people from diverse backgrounds to share their health information.
Froedtert and the Medical College of Wisconsin, along with Versiti Wisconsin, Inc., are part of the All of Us Wisconsin cooperative, which includes Marshfield Clinic Research Institute and the University of Wisconsin School of Medicine and Public Health. The goal of All of Us is to advance precision medicine or health care based on you as an individual. It considers factors like where you live, what you do and family health history. Precision medicine outlines the best ways for you to stay healthy and may help health care teams find the best treatment if you get sick. Participants will share information about their health over time. Researchers will then study this data to determine how to improve health for future generations.
To learn more, visit Participant.JoinAllofUs.org, email allofus@mcw.edu, or call (833) 629-2638. To start your journey right away, go to Participant.JoinAllofUs.org and follow these steps. 1. Create an account 2. Give your consent 3. Agree to share your electronic health records 4. Answer health surveys 5. If requested, have your measurements taken (height, weight, blood pressure, waist and hip size) and give blood and urine samples Participants completing all registration steps not only have a chance to personally support medical research but will also receive a $25 gift card in appreciation for their time and commitment. Consider joining today.
Which Labs and Health Screenings are Considered Preventive? Preventive health care aids in the early detection of diseases or other medical problems before you show symptoms. This care includes screenings, immunizations, lab tests and other services that can help prevent health problems. When you see an in-network doctor for the preventive services listed in our Preventive Services Guide, they will be covered at 100 percent.
Our recommendations for preventive care are based on medical research from nationwide organizations like the U.S. Preventive Services Task Force. These guidelines can change from year to year depending on new research. For a full list of preventive care services covered by Network Health, visit the member portal at login.networkhealth.com. Under My Materials, click the Preventive Services Guide.
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PRESORT STD US POSTAGE PAID PERMIT 1033 GREEN BAY, WI
1570 Midway Pl. Menasha, WI 54952
MAILED ON 7/19/19
Network Health for Life
N
etwork Health offers insurance options for all stages of your life. Whether you have insurance through your employer or you purchase it through the Health Insurance Exchange (also known as the Marketplace), you can continue receiving high quality medical coverage from Network Health after you turn 65 and become eligible for Medicare.
When am I eligible for Medicare?
3 months before turning 65
There is a seven-month window when you can enroll in Medicare.
your birthday month
3 months after your birthday
You may have a lifetime penalty if you don’t enroll during the initial enrollment period, depending on your current coverage.
What’s the difference between Original Medicare and a Medicare Advantage plan? Original Medicare is federal health insurance for people 65 and older, people with disabilities and/or people with certain conditions. Original Medicare is broken into two parts. Medicare Advantage plans cover everything Original Medicare covers, and more.
Original Medicare Part A Hospital Insurance
You can add
Medicare Advantage Plan
Part B Medical Insurance
A
Medicare Supplement Insurance Policy
Part D Prescription Drug Coverage
C
Part C Combines Part A and Part B
or
May include, or you may be able to add Part D Prescription Drug Coverage (Most Part C plans cover prescription drugs. You may be able to add drug coverage to some plan types if it’s not already included.)
Sometimes, Medicare Supplement plans look like a great deal because of what you’ve been paying for health insurance coverage. When you compare the coverage of a Network Health Medicare Advantage Plan to a Medicare Supplement plan, you’ll be surprised how much you get for the premium. Some Medicare Advantage Plans even offer extra benefits like drug coverage, vision, hearing or dental.
Call the Network Health sales team at 800-983-7587 for answers to your Medicare questions.