Balance winter 2017 by Network Health

W I N T E R

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People have to know their own body. If thereâ&#x20AC;&#x2122;s something wrong or suspicious, you do need to get to the doctor.

With the help of a health screening, Network Health member Sandy Thurber is now a cancer survivor.

P U B L I C A T I O N

O F

L I F E , H E A LT H & W E L L N E S S

3 Knowledge at Your Fingertips

3 Exchange of Information

4 The Effect of Changing Seasons

5 Your Right to Request an

Independent Review

6 Stressed, Anxious or Depressed?

COVER STORY

President Coreen and CEO Dicus-Johnson

Chief Administrative Penny Ransom Officer

Marketing Lisa Endl Manager

Lead Designer Debra Sutton

BOARD

Lisa Endl, Melanie Draheim, Stacy Schwandner, Alice Parks, Theodore Regalia, Kimberly Swanson, Kacey Werner, Angela Keenan

Balance is published by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals.

Clinical Practice Guidelines

E DITORIAL

Find Out Your Behavioral Health Index

7 Breaking Down Obstacles to Care

E DITORIAL STAFF

g n i n e ife l scre a s

g, er enin scre dy Thurb h t l hea er San of a b help lth memivor. e h t a v h r e t i u H W work cer s Net w a can is no

e v a s

15 Know Your Numbers

Breathe at Ease

12 One-on-One Help to Live Better

16 Ensuring the Service You Deserve

17 Healthy Habits During Flu Season

TELL US WHAT YOU THINK 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: Network Health Attention: Lisa Endl 1570 Midway Pl. Menasha, WI 54952

13 Emergency Room, Urgent Care or 17 Good Questions for Your Virtual Visit

HAVE A QUESTION?

14 Update on Asthma Medication

HOURS Monday, Wednesday–Friday: 8 a.m. to 5 p.m. Tuesday: 8 a.m. to 4 p.m.

14 CVS Launches New Drug

Price Comparison Tool

Good Health

18 A Focus on Quality Health Care 19 Schedule and Track Your

Preventive Screenings

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. 2 | balance • W i n t e r 2 017

Call our highly rated customer service team.

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 6 p.m. Friday: 7:30 a.m. to 5 p.m.

WANT MORE HEALTH TIPS? Check out our blog at copilotwi.com.

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life. health. wellness.

Knowledge at Your Fingertips

mmi® is a series of free, animated, interactive online programs that walk you through important information about a health topic, condition or procedure.

Maybe your doctor clearly explained what you need to know during your last office visit, and after you left the clinic, some of those details got a little fuzzy. Emmi programs can help answer your questions and make you feel more at ease about your health condition. The most important member of your health care team is you, so it’s essential you have the information you need. Even if you feel confident managing your health, visit GoEmmi.com to verify you’re on the right track or maybe even learn some new helpful tips. Using Emmi is easy. Watch for the icon above at the end of articles throughout this edition of Balance, to know what article topics are covered by Emmi. By visiting the links provided, or viewing Balance online, you can interactively experience a variety of health topics. Watch them on your computer, smartphone or tablet as many times as you like.

Exchange of Information M

any medical conditions can be related to another condition, or result from the treatment of another condition. Effective coordination of care depends upon clear and timely communication among providers and facilities caring for you. 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 of your personal doctor’s organization or from community organizations, your personal doctor may not be aware of all services, tests or treatments you have received. Whenever you receive a service outside of your personal doctor’s office, ask whether that 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 had with other providers since your last office visit. It is important to keep your personal doctor informed so he or she can see the complete picture of your health care, and be alert for possible interactions. It also helps avoid unnecessarily repeating tests, leads to improved outcomes and increases patient safety. Think of your personal doctor as your copilot, helping you navigate the way to a healthier you.

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The Effect of Changing Seasons

How to know when it’s more than just the blues

he stress of the holidays, paired with cold weather forcing us to spend more time indoors, makes maintaining good mental health a challenge as the seasons change. While the holiday blues and Seasonal Affective Disorder (SAD) are different issues with their own triggers, both are likely to hit during the winter months. To avoid long-term health conditions, learn to recognize and address the symptoms of these seasonal illnesses.

The Holiday Blues

It’s easy to find oversimplified tips for dealing with the holiday blues. However, maintaining your mental health during this time is not always easy. According to the National Alliance on Mental Illness (NAMI), 64 percent of people say they are affected by the holiday blues, and 24 percent say they are greatly affected. Symptoms are usually temporary, but should be taken seriously. Symptoms may include fatigue, tension, frustration and feelings of loneliness and/or sadness. Speak with your doctor if symptoms are persistent or worsening.

Looking to avoid the holiday blues? These tips can help. Stick to normal routines, including sleep and exercise Spend time with supportive, caring people Drink in moderation Avoid overeating Set reasonable expectations and stick to a spending budget Make time for yourself to relax Volunteer in your community

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Did You Know?

Research shows that volunteering and giving back to your community can help fight depression. Many people report a “high” from volunteering, similar to the feelings that come after exercise.

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Seasonal Affective Disorder

The amount of people who report feeling depressed increases during the winter months. This can be a normal response to cold days with fewer daylight hours or a form of depression called SAD. Although SAD can also occur in warmer months, it is more likely to occur in the winter. Those who suffer from SAD often experience a relief from symptoms in the spring and summer months. Diagnosis of SAD requires symptoms of major depression occurring during a specific season for at least two years.

Symptoms of SAD may include the following. n n n n n n n

Decrease in energy Difficulty sleeping or oversleeping Overeating Weight gain Difficulty concentrating Isolating yourself from friends and family Thoughts of death or suicide

SAD occurs more often in women than in men, and more frequently in those living in climates with harsher winters. Younger adults, and those with a history or family history of depression, are more at risk of developing SAD. Causes are unknown, but may be linked to an increased production of the hormone melatonin or the decreased production of Vitamin D, both of which are impacted by the decreased amount of sunlight available during the shorter days of winter.

Learn about free online assessments you can take to determine the state of your behavioral health on page six.

The following treatments or a combination of these treatments may be recommended. n Medication n Light

therapy

n Psychotherapy n Vitamin

It is not uncommon to find yourself feeling overwhelmed by the holiday season, but thankfully the holiday blues are temporary and much of the accompanying stress usually resolves as our routines get back to normal. SAD, on the other hand, is a serious mental health problem that should not be self-diagnosed or self-treated. Speak with your doctor if you struggle with the changing seasons, experience the symptoms mentioned above or have difficulty functioning or interacting with others during the winter months. By partnering with your doctor, you can find the solution that’s right for you.

Visit goemmi.com/NHPM17DEPRESSION for free, interactive programs on depression.

Your Right to Request an Independent Review We work hard to ensure your satisfaction, but it’s important to know you have the right to have an independent organization examine certain final decisions made by Network Health. Reviews are completed at no cost to you, including any filing fees. Decisions eligible for review are those where Network Health determined the requested care or services did not meet our requirements for the following. n Medical

necessity (care that is reasonable, necessary or appropriate based on proven clinical standards) n Effectiveness n Cancellation of a policy or a certificate

n Appropriateness n Health care setting n Level of care n Experimental treatment n Coverage denial determination

based on preexisting condition exclusion

For more information on the independent review process at Network Health, refer to your certificate of coverage or policy, or contact our customer service department at the phone number on page two.

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life. health. wellness.

Stressed? ANXIOUS? Depressed?

Find out your behavioral health index with a free online assessment.

rouble at home, stress in the workplace, low self-esteem, financial trouble and grief are just some of the situations we are bombarded with every day that can affect our behavioral health. Many times we can cope with what the world throws at us. Other times we may need a professional to help us make it through the hard times or rough patches. The trick is knowing when it’s time to ask for that help, before it affects your physical well-being.

MDLIVE® offers free online assessments that can help you determine the state of your behavioral health. These two or three minute assessments ask questions about current symptoms, feelings, relationships and recent life changes. The results can provide insight into conditions you may already be experiencing, or those that could be on the horizon, such as depression, anxiety or stress.

There are two assessments available. DASS-21

Holmes-Rahe

A measurement of depression, anxiety and stress

Assesses risk of stress-related illness based on recent life changes

Take these no-cost, no-obligation assessments at MDLIVE.com/assessments Diagnosing and treating behavioral health issues can be challenging, but it’s easier than ever to get help right in the comfort of your own home. Network Health members have access to MDLIVE’s behavioral health therapy services. Just create an account, or sign in if you’ve already activated your account, and choose a therapist that fits your needs to make a secure video appointment. Whether you’re looking for long-term therapy or simply need a one-time check-in on your health and wellness, MDLIVE’s behavioral health therapy services are safe, confidential and convenient. There’s no travel time, no office visit and no chance of running into anyone in the waiting room. Virtual visits are a new, convenient and affordable way to receive behavioral health care. Through your phone or computer, you can connect with a licensed therapist from the comfort of your home using MDLIVE behavioral health services. Access MDLIVE by logging in to the Network Health member portal at networkhealth.com/MyAccount and clicking on the MDIVE Virtual Visits link. Or visit MDLIVE.com/networkhealth.

Copyright © 2017 MDLIVE Inc. All Rights Reserved. MDLIVE does not replace the primary care physician and is not an insurance product. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit mdlive.com/terms-of-use.

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I Breaking Down Obstacles to Care W

e understand there may be religious, financial or cultural obstacles that keep you from following or understanding a treatment plan prescribed by your personal doctor. These obstacles may include the following. n n n n

Beliefs and concerns about a condition and treatment Perceived barriers to meeting treatment requirements Access, transportation and financial barriers to obtaining treatment Cultural, religious and ethnic beliefs

All of these factors play into a person’s ability to follow their doctor’s treatment plan. If you are unable to follow your treatment plan because of one or more of these barriers, and need additional support, call our care management department at 920-720-1600 or 800-236-0208. We will assist you with finding ways to work through these barriers.

Clinical Practice Guidelines

etwork Health provides clinical practice guidelines to help you and your health care team make decisions regarding appropriate care for specific clinical circumstances. These circumstances may be medically acute or chronic in nature, such as low back pain or diabetes, or behavioral health like depression. These evidence-based guidelines are available to both you and your provider on Network Health’s website. Go to networkhealth.com and access the guidelines by selecting Member’s Corner. Select Resources and click on the Learn More button. Here you will find a link for Clinical and Preventive Guidelines. If you would prefer a printed copy of these guidelines, call our customer service department at the phone number listed on page two. S AY W H AT ?

Acute – Symptoms appear, change or worsen suddenly Chronic – Symptoms develop and worsen over time n e t w o r k h e a l t h . c o m

f you’ve been diagnosed with chronic bronchitis, emphysema or chronic obstructive pulmonary disease (COPD), let us help. Breathe at Ease is Network Health’s proactive condition management program designed to help members avoid flare-ups, control symptoms and potentially improve their lung conditions. It’s intended to supplement a physician’s care with one-on-one support from a respiratory therapist. Breathe at Ease received the 2016 Innovation Award from the Wisconsin Society of Cardiovascular and Pulmonary Health & Rehabilitation. To learn more, visit networkhealth.com/Breathe. Breathe at Ease is available at the following locations. St. Elizabeth Hospital Attention: Robyn West, RRT 1506 S. Oneida St., Appleton, WI 54915 Phone 920-831-1498, Fax 920-831-1281 robyn.west@ascension.org Mercy Medical Center Attention: Robyn West, RRT 500 S. Oakwood Rd., Oshkosh, WI 54904 Phone 920-831-1498, Fax 920-831-1281 robyn.west@ascension.org Affinity Medical Group New London Attention: Robyn West, RRT 1420 Algoma St., New London, WI 54961 Phone 920-831-1498, Fax 920-831-1281 robyn.west@ascension.org Holy Family Memorial Attention: Sandy Bauman, CRT and Lori Newberg, CRT 2300 Western Ave., Manitowoc, WI 54220 Phone 920-320-4247(4AIR), Fax 920-320-3043 sbauman@hfmhealth.org or lnewberg@hfmhealth.org

Visit goemmi.com/NHPM17ASTHMA or goemmi.com/NHPM17COPD for free, interactive programs on asthma and COPD. W i n t e r 2 017

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S T O C O V E R Y

ual n n lar a l. I felt u g y re hysica m n ht o gular p g u a e n’t c of the r s a his w a part t y t wh sted as u o find isn’t te o t ctor globin . o d wn t hemo ing o h y t y m u call found o ck or an d i i Id al. I ’t feel s c i s phy , I didn t grea

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hat’s exactly what happened to Network Health member Sandra (Sandy) Thurber, from Neenah, WI. Sandy participated in her annual, employer-offered wellness program, as she has done for years. Only, in 2016, when the doctors came back to follow-up, she was immediately scheduled with her personal doctor to be seen the next day. From there, they sent her to an oncologist at St. Elizabeth’s Hospital for a bone marrow biopsy, which confirmed Sandy had multiple myeloma. Sandy explained, “I still can’t believe it. When I had my hemoglobin tested, it was way low. I think it was at a six.” (Generally, a low hemoglobin count is defined as less than 12 grams of hemoglobin per deciliter, 120 grams per liter, for women.) The timeframe from completing the lab test to receiving a diagnosis was very quick. “It went very fast. They wanted me to get in to see the oncologist right away,” Sandy said. When asked if she had any symptoms, Sandy stated “I was working at the time, so I was a lot more active. I kept getting a sinus thing and went to the ear, nose and throat doctor and was treated for that. I kept getting a cold sore. It was very different and it wouldn’t go away. I get cold sores once in a while but when I think back to the color if it, it should have been a sign to me that something was up. But at the time, I didn’t really think anything of it. “I did call my own doctor to find out why this wasn’t caught on my regular annual physical. I found out hemoglobin isn’t tested as a part of the regular physical. I felt great, I didn’t feel sick or anything.” In summer of 2016, Sandy started treatment. She was on REVLIMID® and steroids and also did bone strengthening. She went through four months of treatment to prepare for a stem cell transplant. In October of 2016, Sandy had an autologous stem cell transplant to induce a remission of her cancer. They gave her shots of Neupogen® to stimulate the white cells before they were harvested. “When they collect stem cells, they’re looking for a certain number,” Sandy said. “It’s nothing to have it done. It’s just trying to get the right amount. They take it from your blood. There’s this machine that separates it and puts the rest back. It took a couple hours each time. It wasn’t uncomfortable. Then after that, I had to make the appointment to have the stem cells put back.” After the stem cell harvest, Sandy underwent a high dose of chemotherapy to destroy the cancer. Her immune system was hit hard by the chemotherapy. “Of course that’s what caused me to lose all of my hair. To tell you the truth, I really didn’t care. I adjusted to everything, it wasn’t a big deal for me. Being in the hospital for three weeks, that was rough. I had no energy and they want you to walk around, and you’re tired. There were a lot of side effects from the chemo,” said Sandy. After the chemotherapy wiped everything out, she was able to have the stem cell transplant. Originally, she was going to wait to have the transplant. But with everything that was going on with her son, Jamie, she decided to proceed so she could be there for him. Jamie was diagnosed with melanoma in 2015. What began with a suspicious mole, turned into a two-year-long battle with cancer, that he ultimately lost. “Jamie knew something was different about this mole. It changed in shape and color and was all the way up in the inner thigh.” This wasn’t caused by the sun.

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Health checks are extremely important. Go by your gut feeling and really advocate for your own health. “I was supposed to spend two weeks at Kathy’s House in Milwaukee [Kathy’s House is a place where patients and their family members can stay in Milwaukee if they have far to travel for treatment] because I had to have daily labs, following the stem cell transplant, but that’s when things for Jamie started to go bad. I had to go home. His cancer had spread. I was able to get home and take care of what I needed to with lab testing here.” “I’ve learned so much from Jamie. Now I tell everyone, get tested. Listen to your gut. Our whole family went in for mole checks and some of us even had to have things removed,” Sandy said. Jamie may have already saved one life by encouraging another family member to get a second opinion. Melanoma was diagnosed and he’s currently undergoing treatment, grateful they caught it early. “People have to know their own body. If there’s something wrong or suspicious, you do need to get to the doctor,” Sandy said. Throughout her medical journey, Sandy has been grateful for her Network Health coverage. “My insurance covered everything. I didn’t have any bills, other than the copayments,” Sandy explained. “I have had Network Health for years and years and have never had a problem with my insurance.” When asked about any notable practitioners she encountered, she said, “Dr. Brian Burnette was the best. He has a great bedside manner and is very funny. He was my favorite,” Sandy shared. It turns out Dr. Burnette studied at the Mayo Clinic with Dr. Anita D’souza, the doctor who was treating Sandy at Froedtert for the stem cell transplant. Today, Sandy is in remission. She has been surrounded with cancer; from family to friends, and is looking ahead to a fresh start in 2018. As she embarks on a new year, she’s looking forward to following a good diet, exercising and keeping busy with some volunteer work. When asked what is the most important takeaway from her health lesson, she said “It’s important to take advantage of any screening options you have. The wellness program was exceptional. If it wasn’t for that, this wouldn’t have been caught. I was so grateful they caught it and were right on top of it.” As for how she wants to honor her son Jamie, she said, “Get your moles checked. Health checks are extremely important. Go by your gut feeling and really advocate for your own health.”

S AY W H AT ?

Multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Plasma cells help you fight infections by making antibodies that recognize and attack germs. Visit mayoclinic.org/diseases-conditions/multiple-myeloma for more information.

Autologous is cells or tissues obtained from the same individual.

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One-on-One Help to Live Better

id you know Network Health offers case management services to members at no cost? Through this voluntary program, experienced nurses and social workers, also known as care management coordinators, support individuals in improving their overall health, navigating the health care system and getting needed services in an optimal, cost-effective setting. Those who are eligible and agree to participate are enrolled into the program. When enrolled, a care management coordinator works with you to identify your health care needs, develop goals based on your values and assists you in meeting those goals. If you have complex chronic conditions or illnesses that could lead to high-risk conditions or an increased use of health care services, you could benefit from case management. These conditions can include any of the following. n Complex chronic diseases, such as metastatic cancer or end-stage renal disease n Catastrophic or rare conditions, such as premature infancy, high-risk pregnancy, trauma or spinal cord injury n Conditions requiring an organ or stem cell transplant n Major complications from a surgery or an extended hospital stay n Multiple physician specialists involved in care n Multiple specialty equipment needs at home Those who might benefit from case management can be referred by a personal doctor or caregiver, you can refer yourself, or Network Health may identify you through claims or utilization processes. Care management coordinators are available by calling 800-236-0208 from 8 a.m. to 5 p.m., Monday–Friday.

“

I’m working with individuals to make things easier all the way around. Yvonne M., RN Avid runner, single mom and oncology care manager at Network Health View Yvonne’s story at networkhealth.com/Yvonne

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For a complete list of recent changes to our provider network, go to networkhealth.com/providerchanges.

Emergency Which Is Right for You Right Now? Room, Urgent Care I or Virtual Visit

f you or a loved one are hurt or become very ill, panic and confusion can make it difficult to know what to do. If you feel you’re experiencing a medical emergency, it’s important to get to the nearest emergency room or call 911. But, sometimes you might not be sure if it’s an emergency. If it’s not, many times your personal doctor, a virtual visit or an urgent care walk-in clinic can help. Here are the answers to two of the most common questions we get about knowing what type of care you need.

What’s the difference between emergency care, urgent care and virtual visits?

Emergency care and urgent care are not the same. An emergency is an illness, injury, symptom or condition so serious, that a reasonable person would seek care right away to avoid serious harm. Urgent care is for an unexpected injury or illness that is not life threatening, but still needs attention quickly so it doesn’t develop into a serious problem. You typically receive emergency care at the emergency room. You may get urgent care at your personal doctor’s office, a walk-in clinic or an urgent care facility. Another option for care is virtual visits, a convenient way to get care for covered health services that include the diagnosis and treatment of medical conditions through electronic means. MDLIVE®, offered through most Network Health plans, was designed as an alternative to urgent care visits for non-emergency medical conditions. Learn more about virtual visits on page six.

What if I’m not sure if it’s an emergency?

Knowing what to do before an emergency can help you make the right decision quickly. You can call your personal doctor or our 24-hour hotline to speak with a nurse for advice.

Call the Network Health Nurse Line at 888-879-8960 (TTY 888-833-4271) for advice about symptoms and when to seek care.

Don’t forget to ask questions

Anytime you visit the emergency room, a walk-in clinic or see your personal doctor, don’t be afraid to ask questions. Asking questions about your care is the best thing you can do to ensure your safety. If something doesn’t seem right or make sense, ask about it. There’s no such thing as a dumb question, especially when it comes to your health. Your coverage for each of these services may be slightly different depending on your plan. Be sure to call customer service to verify your benefits. Hours and contact information can be found on page two of this publication. Whichever form of care you choose, make sure to share information about the visit with your personal doctor. n e t w o r k h e a l t h . c o m

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Update On Asthma Medication New Generic Controller Inhaler Available

ontroller inhalers are used daily to help with asthma, even when there are no symptoms. The goal of a controller inhaler is to prevent future asthma attacks by decreasing the swelling and sensitivity of airways. Recently, Teva Pharmaceuticals launched a new generic fluticasone/salmeterol metered-dose inhaler (MDI) for asthma. Fluticasone/salmeterol MDI has a full cost of only about $100 per inhaler and could be as low as a Tier 1 medication depending on your plan. Advair®, which also contains fluticasone/salmeterol, compares at $325 to $400 at full cost. It’s important to note the new generic inhaler fluticasone/salmeterol MDI is not interchangeable with Advair, meaning the prescription would need to be reordered by your prescriber, if the prescriber deems appropriate. Fluticasone/salmeterol MDI is available in the following strengths: 55mcg/14mcg, 113mcg/14mcg, 232mcg/14mcg. Usual instructions are one puff twice a day. Teva claims that due to the new and improved delivery system in the generic, less overall medication is needed for asthma benefit.1 Contact your Network Health pharmacist or visit myAirDuo.com for more information. Members who are part of the State of Wisconsin Group Health Insurance Program receive their prescription drug coverage through Navitus Health Solutions. Please contact Navitus at 1-866-333-2757 with questions about your prescription drug benefits. Teva Launches AirDuo™ RespiClick® and its Authorized Generic, Two Inhalers Containing Fluticasone Propionate and Salmeterol http://www.tevapharm.com/news/teva_launches_airduo_respiclick_and_its_authorized_generic_two_inhalers_containing_fluticasone_propionate_ and_salmeterol_04_17.aspx 1

Visit goemmi.com/NHPC17ASTHMA for free, interactive programs on asthma.

Launches New Drug Price Comparison Tool CVS/caremark is streamlining their drug pricing tool. These enhancements will include the following. n Enhanced results highlighting searched drug costs and savings opportunities n The ability to search for multiple drugs at multiple pharmacies (past searches will also be available on the same screen) n “Request a New Prescription” functionality, which will enable you to request new prescriptions for selected mail-order drugs right from the results page n Functionality to trigger searches from your search history and previously filled prescription list n The Price a past search feature will allow you to reprice a medication from your searches in the last 360 days (only desktop applicable) n The Price a previously filled prescription feature will allow you to price drugs from your prescription history (applicable to both desktop and mobile) This feature also includes enhanced messaging capabilities that will provide the ability to view messages in an expanded and collapsed format. The main enhancement under the Plan Summary accumulation display is the graphs for deductible and maximum out-of-pocket costs. These graphs are designed to help you understand how your health care costs change during different phases of coverage. Check out these new enhancements by logging in to our member portal at networkhealth.com/MyAccount and click on the CVS link. (Not available for members who are part of the State of Wisconsin Group Health Insurance Program.) 14 | balance • W i n t e r 2 017

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BLOOD PRESSURE H

igh blood pressure is common among Americans—nearly half of U.S. adults have high blood pressure, according to the American Heart Association. Unfortunately, this leads to an increased risk for developing serious health conditions. The American Heart Association recently released new blood pressure guidelines. However, your target blood pressure is dependent on a few variables, including your age and whether you have a condition like diabetes or kidney disease. It’s always best to talk with your personal doctor about your specific blood pressure goals. Knowing your numbers and being informed can help you manage risk factors and bring blood pressure under control. The new guidelines from the American Heart Association recommend earlier intervention to prevent an increase in blood pressure or the chance of complications tied to hypertension.

WHAT SHOULD I DO IF I HAVE HIGH BLOOD PRESSURE?

Talk to your personal doctor. Together, you can decide your target blood pressure and what steps you need to take to achieve your target. If your initial blood pressure taken at your doctor’s office is higher than usual, be sure to have it rechecked before you leave.

HOW TO CONTROL YOUR RISK FACTORS

n Lose weight. If you’re overweight, losing even five pounds can help lower your blood pressure. n Get active. Regular physical activity can help lower your blood pressure and keep your weight under control. n Don’t use tobacco and limit alcohol. Smoking or chewing tobacco can raise blood pressure. If you smoke, quit. And, only consume alcohol in moderation because too much is a contributing factor of high blood pressure. n n

Eat a healthy diet. A diet rich in whole grains, fruits, vegetables, low-fat dairy and low in sodium has been shown to help lower blood pressure. Reduce stress. Stress can raise blood pressure temporarily and may lead to overeating and tobacco or alcohol use. If you often feel overwhelmed or stressed, it’s important to identify it and take steps to reduce it.

Visit goemmi.com/NHPM17HTN for free, interactive programs on hypertension.

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life. health. wellness.

Ensuring the Service You Deserve

f you have a concern about any services provided by Network Health, contact our customer service department at the phone number on page two and a representative will review your situation and help resolve the issue. We are focused on one-call resolution. It’s very important to us that you receive the service you need and deserve. We ensure you are always treated with courtesy and respect. We believe it’s a big part of the reason our customers rate us higher than the Wisconsin and national averages in customer service. If your complaint or appeal cannot be addressed immediately, the representative will offer to explain the complaint process to you. If you choose to file a formal complaint, it will be forwarded to a member advocate for a complete investigation that typically involves requesting medical records (if needed) and speaking with the individuals or facilities involved. The member advocate will contact you with the outcome.

“

It’s my job to make sure both the member and Network Health are following guidelines in the claims process. I’m usually the member’s last step in the appeals process, and for me and Network Health, it’s important that I educate the member on their current situation. I also help them understand what they need to know going forward to make sure their claims are submitted and handled properly.

Danelle Member advocate at Network Health

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Healthy Habits During Flu Season

etting a flu vaccine is always the best way to avoid the flu each year, but adopting good health habits can also stop the spread of germs and illnesses. What everyday actions can you take to avoid illnesses like the flu? According to the Centers for Disease Control and Prevention, these healthy suggestions can help fight harmful germs. n Wash your hands often with soap and water. If not available, use an alcohol-based hand rub. n Avoid close contact with sick people. Remember, when you are sick you should also keep your distance from others. n Stay home when sick for at least 24 hours after your fever goes away without the use of medications. You should only leave your home to get medical care, or if absolutely necessary. n Cover your mouth and nose with a tissue when you sneeze or cough. Do not reuse the tissue, immediately throw it in the trash. n Avoid touching your eyes, nose and mouth. Germs are most commonly spread by coming into contact with something contaminated and then touching your eyes, nose or mouth. n Clean and disinfect surfaces, especially when someone is, or has recently been ill. These surfaces include areas at home, work or school. During the flu season, it’s also important to practice other good health habits like getting plenty of sleep, staying physically active, drinking plenty of fluids and eating a nutritious diet. For most people, getting the flu results in a mild illness and they do not need medical care or drugs. However, certain people (young children, elderly persons, pregnant women and people with certain long-term medical conditions) face a higher risk of serious flu-related complications. If you fall into one of these groups and show flu symptoms, contact your personal doctor immediately.

Thank you for getting your flu shot.

Visit goemmi.com/NHPC17FLU for free, interactive programs about flu shots.

Good Questions for Your Good Health D

id you know studies show that people who understand health instructions make fewer mistakes when they take their medicine or prepare for a medical procedure? It’s true. Informed patients can even manage a chronic health condition more effectively.

Open and honest communication with your personal doctor is key. And, many health care professionals recommend Ask Me 3™, a patient education program designed to promote communication and improve health outcomes. The program encourages patients to understand the answers to three simple questions. 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

Ask questions when— • You see a doctor, nurse or pharmacist. • You prepare for a medical test or procedure. • You get your medicine.

Make sure to ask these three questions next time you discuss your care with your doctor. It can help you be better informed and understand what you need to do to take care of your health. n e t w o r k h e a l t h . c o m

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A Focus on Quality Health Care N

etwork Health evaluates the quality of care and services provided using two nationally recognized tests, the Healthcare Effectiveness Data and Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®). Each test scores our services in a different way. HEDIS measures preventive care and care for chronic diseases. CAHPS evaluates customer satisfaction with services provided by customer service, claims and physicians. The tables below show Network Health’s excellent ranking on both state and national levels.

How We’re Doing

2017 Reporting Year Network Health HMO/POS (Commercial) HEDIS Results Category/Measure

Network Health Combined Results

Wisconsin Health National Average Plans Average Results Results

Colorectal Cancer Screening

74.09%

68.14%

60.11%

Controlling High Blood Pressure

77.87%

70.90%

58.71%

Comprehensive Diabetes Care – Eye Exams 74.45%

58.77%

50.52%

Comprehensive Diabetes Care – Controlled HbA1c (<8.0%)

70.99%

56.38%

51.28%

Prenatal Care

97.96%

79.78%

80.64%

Post Partum Care

91.16%

79.36%

69.90%

Childhood Immunization Status – Combo 10

64.84%

59.48%

48.10%

Immunizations for Adolescents – Meningococcal Conjugate and Tdap

81.27%

76.52%

73.54%

How You Rate Us

2017 Reporting Year Network Health HMO (Commercial) CAHPS Results Network Health Category/Measure Combined Results

Wisconsin Health National Average Plans Average Results Results

How often did your health plan handle your claims correctly?

96.21%

91.66%

89.95%

How often did your health plan handle your claims quickly?

87.44%

86.55%

86.82%

How often did your personal doctor explain things in a way that was easy to understand?

98.18%

97.48%

96.42%

How often did your personal doctor listen carefully to you?

96.06%

95.22%

96.38%

How often did you get an appointment to see a specialist as soon as you needed?

84.94%

84.79%

84.44%

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Quality Program Information Our quality department focuses on improving the quality of health care services our members receive. The program and structure is evaluated and revised annually to remain responsive to our members and the changing requirements of the health care environment.

The quality program helps to ensure Network Health does the following. n n n n

Uses an integrated health management model to ensure members receive high-quality, safe and cost-effective care Improves member access, availability and experience Enhances member personal health and wellness, including behavioral health Works collaboratively with the provider network to ensure coordination of care

The quality program structure is accountable to the Board of Directors and includes the following elements. n n n n

n n

A designated physician who has substantial involvement in the quality improvement program A designated behavioral health care professional who is involved in behavioral health care aspects of the program A quality committee that oversees the function of the organization The specific role, structure and function of the quality improvement committee and other connected committees, including how often they meet An annual quality work plan, including progress toward accomplishing goals A description of resources the organization devotes to the quality program

For more information on Network Health’s Quality Program, please call customer service at the number listed on page two or email the quality department at QI@networkhealth.com. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Schedule and Track Your Preventive Screenings

o help you live the healthiest life possible, certain preventive services are offered at no cost for most Network Health members. Preventive services help you identify diseases or medical problems before you show symptoms. These services include screenings, immunizations, lab tests and other services that help you prevent health problems. When you see an in-network doctor for one of the preventive services listed in our Preventive Services Guide, most plans cover preventive services at 100 percent. However, you may be responsible for certain payments (deductible, coinsurance and copayment) if you receive the services for diagnostic reasons. If you are part of a selfinsured plan, refer to your Summary Plan Description for coverage details. Any follow-up tests, tests to monitor a chronic disease and any tests not listed in this guide are considered diagnostic. Our Preventive Services Guide will help you understand when certain common services are considered preventive or diagnostic. To view our Preventive Services Guide online, visit networkhealth.com/members. Select the Resources button on the right side of the screen and then click Learn More.

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1570 Midway Pl. Menasha, WI 54952

MAILED ON 12/29/17

“ I love being a part of something bigger than

“

myself.

My name is Chris, and I work at Network Health. We have members who rely on us to take good care of them, and that’s got to be in the forefront of everything we do. We need to be able to make the right decisions, and not just from a business standpoint, but from the member’s standpoint. It boils down to really one thing, and that’s helping people.

networkhealth.com | 800-276-8004

MO plans underwritten by Network Health Plan. POS plans underwritten by Network Health Insurance H Corporation, or Network Health Insurance Corporation and Network Health Plan. Self-insured plans administered by Network Health Administrative Services, LLC.