L I F E , H E A LT H & W E L L N E S S
A P U B L I C AT I O N O F
SPRING 2021
PUTTING Members
FIRST
Questions about the coronavirus vaccine? For Network Health’s latest information about the coronavirus vaccine, please visit networkhealth.com/coronavirus-vaccine. See page 16 for vaccine facts and myths.
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7 Why You Need an Annual Wellness Visit
21 Routine Eye Exam vs. Medical Eye Exam
FEATURE
22 Prevent T2 Diabetes Prevention Program
8 2020 – A Year About You
23 Do You Face Barriers to Getting Care?
13 Recommend Network Health and Earn Gift Cards
BACK COVER Convenient Access to the Care You Need
13 Access to Network Health Care Management Employees and Services
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14 Using Your Member Portal 14 How Do Health Plans Make Decisions?
3 Letter from the President and CEO 4 Quality You Can Trust
15 Where Should You Get Care? Emergency Room, Urgent Care or Virtual Visit 16 Roll Up Your Sleeve for the Vaccine
5 Updating Your Address 5 Interactive Videos for Healthy Living
18 What You Need to Know About Opioids 20 Eat Well, Age Well
6 One-on-One Support When You Need It
EDITORIAL STAFF President and CEO Chief Administrative Officer Strategic Marketing and Communications Manager Strategic Marketing and Communications Coordinator Visual Design Lead
Coreen Dicus-Johnson Penny Ransom Romi Norton Becky Pashouwer Debra Sutton
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ASK NETWORK HEALTH If you have questions about anything you read in this issue of Concierge, call member experience at 800-378-5234 (TTY 800-947-3529) Monday–Friday from 8 a.m. to 8 p.m. You can also learn more at networkhealth.com. Concierge is a biannual publication of Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals. © 2021 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.
Out-of-network/non-contracted providers are under no obligation to treat Network Health members, except in emergency situations. Please call our member experience number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Y0108_3367-01a-0321_C 2 | C oncierge
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life. health. wellness.
Letter from the President and CEO Thank you for choosing a Network Health Medicare Advantage Plan for 2021. 2020 was challenging for many reasons. Many of us were concerned about our health and the health of our loved ones. We were cautious when in public settings, we started to collect a variety of masks, kept socially distant and we disinfected and washed our hands constantly. Our communities experienced social isolation in a way society has never experienced before. Throughout the entire year, Network Health continued to focus and deliver on our mission to create healthy and strong Wisconsin communities. Our feature story reviews 2020 and shares the extra steps Network Health took to give our members the support necessary to keep them healthy and safe. We offered additional benefits and held our member events virtually to provide members an exceptional health insurance experience. Our members appreciate that we go above and beyond and it shows. Each year, we use the Net Promoter Score to ensure member experiences are positive and that members are satisfied with their Network Health Medicare Advantage Plan. A company’s Net Promoter Score can range from -100 to 100. In 2020, our score was 62, which was up 11 points from our 2019 score. And, it’s well above the health insurance industry average of 43. During a year when we faced so many challenges, having this score increase shows that Network Health is dedicated to doing what is right for our members. As we mark the one-year anniversary of our offices being closed to the public, health and safety remain our top priority. Through the coronavirus pandemic and beyond, Network Health will continue to support our members. No matter what, we are here for our members. Continue to stay safe and well. Sincerely,
Coreen Dicus-Johnson President and Chief Executive Officer
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life. health. wellness.
Quality You Can Trust By Anna Rasmussen, quality program coordinator at Network Health Network Health continues to be a top-rated health plan, because we deliver high-quality service that focuses on improving the quality of health care services you receive. The goal of our quality program is to transform the health care industry by collaborating with the highest quality health care providers to deliver innovative solutions that provide exceptional value to you. Our focus on excellence is reflected in our quality ratings, which are higher than the national average. The Centers for Medicare & Medicaid Services (CMS) gave Network Health a 4.5 Star Rating for our Medicare Advantage PPO plans.* The national average is 4 stars. Plans with higher Star Ratings receive more funding from CMS, which we put back into our plans to offer the benefits that matter most to you. Due to coronavirus, the National Committee for Quality Assurance (NCQA) did not release 2020–2021 Health Plan Ratings for any product line. NCQA awarded Network Health a 4.5 out of 5 Health Plan Rating for Medicare for 2019-2020. These scores put Network Health in the top 25 Medicare plans nationwide.
Rating of the Health Plan
Rating of Health Care Quality
Network Health
National Average
Getting Needed Care
Getting Appointments and Care Quickly
Customer Service
80.8%
86.6%
89.2%
94.6%
89.2%
97.3%
90.0%
95.0%
82.6%
91.2%
93.6%
97.2%
Medicare
Care Coordination
For more information about Network Health’s quality program, please email the quality health integration department at QI@networkhealth.com. *Every year, Medicare evaluates plans based on a 5-Star rating system. The source for data contained in this publication is NCQA CAHPS 2020 results and CMS 2019 National Benchmarks. Any analysis, interpretation or conclusion based on this data is solely that of the authors. NCQA and CMS specifically disclaims responsibility for any such analysis, interpretation or conclusion.
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Updating Your Address D
id you know that The Centers for Medicare & Medicaid Services (CMS) notifies Network Health when you make a change to your address? This happens when CMS records do not match our records. When we receive this notification from CMS, we are required to send you a letter.
You may receive one of two letters, depending on your situation.
1. If you’re still in the Network Health service area, but your zip code and/or county has changed, you will receive an address verification letter. 2. If you are a snowbird and provide CMS an out-of-state address (which is outside the Network Health service area), you will receive an out-of-area letter. This notification gives you six months to provide us your new address or confirm your physical address is still in the service area. Please confirm your address with us as quickly as possible, because if you do not, your plan will end after six months. We care about you and want you to continue receiving Network Health’s local, high-quality service, without plan disruption. When you update your address with CMS, make sure to update it with Network Health, too. By keeping your address current, you will receive your important mailings timely and you won’t risk your plan ending.
You can update your address with Network Health in three ways.
1. Complete the form you receive with one of the letters mentioned above. 2. Log in to your Network Health member portal at login.networkhealth.com. Click your name in the upper right corner. Select Change My Address. You can update your physical or mailing address or both. Once you make this change, your new address won’t appear in the member portal right away. Our system is required to confirm it matches the address CMS has on file before you’ll see the updated address. 3. Call the member experience team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m.
Interactive Videos for Healthy Living Emmi® offers free interactive videos on a variety of health topics.
You can view these animated, online programs on your computer, smartphone or tablet as many times as you like. You can find all the topics for this issue of Concierge at this link
www.my-emmi.com/SelfReg/SCONCIERGE. Note: This URL is case-sensitive.
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life. health. wellness.
Support When You Need It By Alice Parks, director of population health at Network Health
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etwork Health offers personal wellness, care management and condition management services at no cost to you. Whether you’re dealing with an unexpected medical issue, a complex diagnosis, a chronic disease or just a need a little help maintaining your health, we can help you manage your health to increase your sense of well-being and put you in control. You can be identified for these services based on specific claims and/or your responses to your health risk assessment. Your doctor may also refer you or you can refer yourself.
These programs begin with a one-on-one conversation between you and one of our health coaches, condition managers or care managers. If you choose to participate, your health coach or care or condition manager will help you manage your health conditions and meet your health goals. You may opt out of these programs at any time by calling the member experience number on your member ID card.
Health Coaching
Our health coaches focus on helping people quit smoking, eat healthy, control blood pressure and learn about ways to exercise. We also help create successful transition plans to go home when you are discharged from the hospital.
Care Management
Our care management program focuses on assisting people with complex medical and behavioral health needs
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which include cancer, end-stage renal disease and other life-threatening conditions.
Condition Management
The condition management program helps people with diabetes, heart disease, heart failure and chronic obstructive pulmonary disease (COPD). After learning more about you and your health concerns, your coach or care manager can do any of the following. • Answer any questions you have • Review your medications and treatment plans • Inform you about signs that your health condition is worsening and when to act, including when you should contact your health care provider • Work with your health care providers to ensure they are aware of any health changes • Ensure you and/or your caregivers feel included in your health care decisions • Help you set health care goals to maintain or improve your health • Help you with coordination of care with providers and community services • Provide you with educational resources, specific to your diagnosis • Work with you to meet your health goals You can learn more about our programs at networkhealth.com under Health and Wellness. If you feel you could benefit from health coaching, care or condition management support or would like to know about our programs, call 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m. Callers may leave a message 24 hours a day, seven days a week.
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Why You Need an Annual Wellness Visit By Devon Lor, MSN, RN, quality health integration clinical supervisor at Network Health
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eeing your personal doctor (also called your primary care practitioner or PCP) for an annual wellness visit early in the year is the first step to managing your health and creating healthy goals. An annual wellness visit primarily focuses on preventive care, health screenings and wellness planning.
At your annual wellness visit, your personal doctor will review your medical history, discuss medications you are taking, record your height, weight, blood pressure and other routine measurements. This visit allows you to talk with your doctor about your health and goals. He or she will work with you to create a plan to maximize your well-being throughout the year. During this visit, it’s important to let your doctor know about any health concerns you may have.* It may help to bring your My Health Journal, which you received in your member guide, to this visit. Using this tool can help you keep track of all your screenings, questions and past health issues that you can share with your doctor.
Preventive vs. Diagnostic Screenings
Preventive and diagnostic screenings are tests doctors can run to help you improve or maintain your health. Understanding the difference between these two types of tests is beneficial because it explains why you may need certain care, services or screenings. Your doctor will order preventive screenings when you have no symptoms and are generally healthy. These screenings are recommended by your personal doctor every year to keep tabs on your health and keep you healthy.
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Diagnostic screenings are used when you have symptoms or risk factors, to find and treat the problem. If your doctor finds anything abnormal during your preventive screenings, he or she may order diagnostic screenings to detect any problems. If your doctor orders tests during your annual wellness visit and you’re not sure if they’re considered preventive or diagnostic, just ask. Your doctor will let you know which screenings are considered preventive and which are diagnostic and why each test is being ordered. In general, it’s important to have an annual wellness visit each year, because it can help your doctor identify early warnings of health issues. At the beginning of the coronavirus pandemic, routine preventive care was put on hold. Since then, health care providers are taking extra precautions to stop the spread of the virus. If you did not have your annual wellness visit in 2020, call your personal doctor to discuss the best option for you. *If your doctor feels your conversation about health concerns goes beyond preventive care, he or she may charge you for an office visit.
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COVER STORY
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2020 A Year About ME G N I
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he year 2020 started the same way every year starts. People made resolutions, vowing to be more active, eat better or quit smoking. In addition, the start of a new decade meant a fresh new start. We left the 2010s behind and were looking into the future with 2020 vision. Early in the year, we began hearing about a disease called COVID-19 or coronavirus. We didn’t know much about it, just that when people were infected, they got really sick. Coronavirus started to spread globally and slowly made its way to Wisconsin. As it got closer to our homes, fear and panic set in. Then, the entire country shut down. Safer-at-home and shelter-in-place orders began. Hand sanitizer and toilet paper were impossible to find. Seeing family and friends became a thing of the past. We all hoped the virus would be eliminated quickly so everything could get back to normal. When that didn’t happen, we settled in for the long road ahead. There were some positives to shutting down. People started getting more exercise, spending more time outside and less time driving. Air pollution decreased, children spent more time with their parents and pets rejoiced as their owners stayed home. At Network Health, we didn’t miss a beat. Without any service interruption, we immediately moved all our employees to work from home to keep serving our highest priority—you.
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COVER STORY
Sharon, a Network Health Medicare member, had a transplant in 2019. To keep herself healthy and safe during the pandemic, she has been in complete isolation. Yvonne, Sharon’s nurse care manager at Network Health, checked in with her regularly to make sure she was doing OK. In a recent call, Sharon said to Yvonne, “I would like to be able to go out, see my family and get a hug. I am alone. So, it’s hard for me.” But Sharon isn’t alone. She isn’t the only person who has experienced social isolation. According to a survey done by SurveyMonkey, 70 percent of Wisconsin seniors feel more isolated because of coronavirus. As a result of the pandemic, we all had to adapt to a different way of interacting with our friends, family and Thank you other members of so much for the gifts … our community. To I’m a heart transplant limit our exposure to coronavirus, many of recipient and Network us made significant Health supported me changes to our routines.
all the way. I can’t thank you enough.
At Network Health, we adapted too. For the first time ever, we Network Health held our member events virtually to answer Medicare member member questions and in Appleton get you information about your plan updates for 2021. More than 1,700 people attended, and we received lots of feedback from you, with 93 percent event satisfaction. One member event attendee said, “I truly appreciated all the presentation planning that went into yesterday’s Zoom gathering. It was concise, clear and easy to understand … I go to the October meetings every year and this year was equal to being there [in person].” These events were so successful, we’ll be offering virtual events in 2021, too.
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My husband and mom have been receiving excellent service from Network Health. I will be in new 2021. Keeping it local and personal is important. Thank you for going #aboveandbeyond. Network Health Medicare Member
Normally, our member events are paired with our flu shot clinics. Since we did all our member events virtually, we held 33 outdoor flu shot clinics in 19 different cities throughout our service area. The response was incredible. We administered a total of 7,850 vaccinations. A member called to tell us how the flu shot clinic went. She said, “I attended the Neenah Walgreens flu shot clinic. Even with the windy conditions, they did an awesome job. It was a very welcoming experience. I was very pleased.” During the clinics, we learned that many of you hadn’t received your pneumonia and/or shingles vaccine. To keep you safe and healthy, we were able to get you these vaccines in addition to your annual flu shot.
Volunteering, Special Benefits, Gift Boxes and More
Aligned with our mission to create healthy and strong Wisconsin communities, Network Health encourages employees to get involved in our community. In fact, every year, each employee gets eight hours of paid volunteer time, to give back to the communities where we live and work. “It’s really cool that Network Health gives us paid time off to volunteer,” said one employee. “Our department usually volunteers together. It’s a fun team-bonding experience and it allows us to contribute to our community in a positive way.” In 2020, our employees supported several local organizations through donations and volunteering, including Feeding America Eastern Wisconsin, Inc., Alzheimer’s Association, Boys & Girls Club of Greater Milwaukee, Wisconsin Humane Society and many more. We also partnered with CBS58 and the Annual Hunger Task Force Food Drive to help those in need.
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As a member of a Network Health Medicare Advantage Plan, you always have access to benefits above and beyond Original Medicare. In addition to those benefits, you received additional coronavirus relief benefits in 2020. Depending on plan type, these benefits included transportation to doctor appointments, an expanded hearing aid discount program, meals after an inpatient hospital stay and $0 virtual in-network doctor visits. We also sent personal protection gift boxes to our 65,754 Medicare members to help you stay safe. We worked with a local Wisconsin vendor to create, pack and send these care packages. Each gift box included these items. • Hand sanitizer • Alcohol wipes • Digital thermometer • Pen with sanitizer • Two custom face masks • Sherpa blanket As the gift boxes started to hit homes, the feedback really started to flood in from you. Our Network Health Facebook page was inundated with hundreds of comments and messages. Some of you sent letters and others posted pictures of yourself wearing your Network Health mask. Thank you for this wonderful feedback.
As I snuggle under the fleece blanket, I am so thankful for an insurance company that truly puts its customers first. Thank you for the wellness kit. Network Health Medicare member in Neenah
For the most up-to-date information about the coronavirus vaccine, visit networkhealth.com/coronavirus-vaccine. See page 16 for vaccine facts and myths. Although our local offices remain closed to the public for the time being, know that we’re still here for you when you need us. And, we look forward to seeing you again, in person, as soon as it’s safe.
A Network Health member in De Pere said, “Each and every gift speaks loudly of your kindness, your compassion and your thoughtfulness toward all of your members. We have had many insurances over the years, and we have never had one that cares for us in such special ways … Thank you for going above and beyond.”
What’s Next?
First and foremost, we look forward to continuing to serve you as a Network Health member. It’s our pleasure to support your health and wellness journey. As 2021 continues, we have a lot more information about the coronavirus. We know about the symptoms, how and where to get tested, how the virus spreads and how to keep ourselves safe. Most importantly, we’ve taken steps to stop the spread. The biggest contribution to this is the development of the coronavirus vaccine.
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What a nice surprise to receive the #aboveandbeyond box of items … Thank you, Network Health, for looking out for your Medicare Advantage clients during these most difficult, challenging and treacherous times. Network Health Medicare member
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What a nice surprise Santa (Network Health) left on my front porch today ... I want to thank Network Health for their professional approach to the health care industry … I could not be more pleased with Network Health’s cooperative communications and support during my ongoing health adventure.
Thank you so much for the wonderful gifts you sent. Everything in your gift box is so helpful especially in this terrible pandemic. I have been quarantined since February and besides being so useful, it was wonderful getting a surprise gift in the mail.
Network Health Medicare member
Network Health Medicare member in De Pere
As we reflect on this past Christmas, we have so many things for which to be grateful. Thank you, Network Health, for sending us our first and one of our favorite, Christmas gifts. We love the beautiful box filled with goodies to help keep us safe and well. We appreciate your thoughtfulness and the reminders to stay safe during the pandemic. Network Health Medicare member in Appleton
How exciting to find a package from Network Health on my doorstep this afternoon. I never thought I’d say, ‘I love my health insurance company,’ but I do … I truly am grateful this Thanksgiving, especially for my health. Network Health Medicare member in Green Bay
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I just got home from physical therapy and it was such a nice surprise to find this care package waiting for me. My neighbor is a bit jealous because her insurance carrier hasn’t sent anything. I told her to switch companies. You are the best. Network Health Medicare member
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life. health. wellness.
Recommend Network Health and Earn Gift Cards W
hen you recommend Network Health Medicare Advantage Plans, you know your loved ones will have access to the same local, high-quality service you get as a member. As a Wisconsin-based company, we go above and beyond for our customers, because we know we’re helping our neighbors, friends and family. Our Medicare member referral program gives you the opportunity to earn gift cards for sharing Network Health with your friends and family. You can earn up to four $15 gift cards per year, and you can choose from a variety of stores, like Kohl’s and Home Depot.
How do I earn the gift card?
The people you refer to Network Health must meet these criteria.* • Have Medicare Parts A and B • Live in our service area • Are not already enrolled in a Network Health plan Simply have your friends and family members call our Medicare experts at this special number, 844-850-5284 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. When they call, our Medicare advisors will ask questions to find out which health insurance benefits are most important to them. Then, they will offer plan options to your referrals’ needs. About a week after we talk to your friend or family member, you’ll get a phone call from a Network Health employee to determine which gift card you want. Licensed agents who are appointed with Network Health are not eligible for these gift cards.
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Access to Network Health Care Management Employees and Services Network Health provides access to medical and behavioral health employees for Medicare Advantage members, providers and their office staff who are looking for information about our care or utilization management programs. If you have questions about these programs, please contact care management at 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.
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Using Your Member Portal At Network Health, we empower you to get the most out of your Medicare Advantage plan. To do this, you have a great resource right at your fingertips—your member portal. If you haven’t already, access your portal by visiting login.networkhealth.com.
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our member portal was built based on feedback we received from our members, and we continuously make updates based on additional feedback we receive. Our most recent enhancements include allowing you to easily set up recurring payments, select additional preferences for mail vs. email and to view your newly updated pharmacy Explanation of Benefits (EOB).
To select your preferences, log in to your member portal, click your name in the upper right corner and select Change My Communication Preferences. From here, you can choose email for any or all of these five available categories. • EOB statements • Medicare Annual Notice of Change • Health and wellness information • Event announcements, reminders and surveys • Member magazine Make sure to click Next to save your choices.
Accessing Plan Documents
Selecting Your Communication Preferences
In the member portal, you can choose which plan information you want to receive in the mail and which information you prefer to receive by email. Typically, when you elect to receive information through email, you will receive it more quickly, so many members choose to receive their EOBs and Annual Notice of Change by email.
You can also access many important plan materials and forms within the portal. While logged in to your portal, click My Materials. From the dropdown, you can select Plan Documents to see your member guide, Evidence of Coverage, Summary of Benefits and more. If you choose Forms, you will find any claim or reimbursement forms applicable to your plan. To access your important benefits information, click the My Benefits tab in the upper right. The dropdown that appears will contain information about the benefits that are available to you, based on your plan type.
How Do Health Plans Make Decisions? By Sarah Dencker, vice president of care services
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ecisions made about care by Network Health are based on the appropriateness of care and service. This includes medical procedures, behavioral health procedures, pharmaceuticals and devices. The decisions are based on written criteria founded on sound clinical evidence and on the benefits outlined in the various coverage documents. These written criteria are reviewed and approved annually by actively participating practitioners. Criteria are available to providers, practitioners and/or to you upon request. Requests for criteria can be submitted via telephone, fax, email or mail. Once the request is received, our utilization management team sends the information to the requestor via fax, email or mail.
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Network Health does not reward practitioners or other individuals conducting utilization reviews for denying coverage for care or service. We do not prohibit providers from advocating on behalf of members within the utilization management program. In addition, Network Health does not use incentives to encourage barriers to care and service, and we do not make decisions about hiring, promoting or terminating practitioners or other associates based on the likelihood, or the perceived likelihood, that the practitioner or associate supports, or tends to support, denial of benefits. The medical directors, associates (or designees), care management staff and supervisors of this staff receive no financial incentive to encourage decisions that result in underutilization. In addition, treating practitioners may discuss medical necessity denial determinations with our physician review medical director by contacting us. Our Medicare team can be reached Monday–Friday from 8 a.m. to 5 p.m. at 920-720-1602 or 866-709-0019 (TTY 800-947-3529). Bilingual language assistance or translation services are also available. Callers can leave a message 24 hours a day, seven days a week. All calls are returned promptly. Calls received after business hours are returned the next business day. Practitioners, providers and/or you may also send inquiries to our Medicare care management department by fax at 920-720-1916 or mail to Network Health, Attn: Utilization Management,1570 Midway Pl., Menasha, WI, 54956.
Where Should You Get Care?
Emergency Room, Urgent Care or Virtual Visit By Alice Parks, director of population health at Network Health
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f you feel you’re experiencing a life threating medical emergency, it’s important to go to the nearest emergency room or call 911. Options for non-emergency or non-life threatening conditions include an urgent care walk-in clinic, a virtual visit or a visit to your personal doctor’s office. Two questions can help you determine which type of care is right for you. What’s the difference between emergency care, urgent care and virtual visits? An emergency is an illness, injury, symptom or condition so serious that immediate medical intervention is needed to avoid serious harm. Urgent care is appropriate 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. Urgent care is available at your personal doctor’s office, a walk-in clinic or an urgent care facility. A virtual visit is another option for convenient medical care through a computer, smartphone or tablet. Many local doctors provide virtual visits to their patients as an alternative to urgent care visits for non-emergency medical conditions, so contact your personal doctor to
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find out if he/she offers this type of visit. Network Health also partners with MDLIVE® to provide virtual visits. What if I’m not sure if it’s an emergency? Being prepared and knowing what to do before an emergency can help you make the right decision quickly. For help determining if your situation is an emergency, contact your personal doctor. For more information, go to networkhealth.com and under the Health and Wellness heading, select Getting Care Quickly. Don’t forget to ask questions Anytime you visit the emergency room, a walk-in clinic, see your personal doctor or use MDLIVE, don’t be afraid to ask questions. If something doesn’t seem right or make sense, ask about it. You will be responsible for the full cost of each service you receive until you reach your $5,100 deductible. After that, you will be covered 100 percent for your emergency room, urgent care and virtual visits. If you have questions, call the member experience department at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. Whichever form of care you choose, make sure to share information about the visit with your personal doctor. C oncierge | 15
Roll Up Your Sleeve for the Vaccine By Andy Wheaton, manager of pharmacy benefits at Network Health
Immune System 101
When germs, such as bacteria or viruses, enter your body, your immune system recognizes them as foreign invaders and begins creating proteins called antibodies. These antibodies help your body identify and destroy these germs. Antibodies assist with the germ fight when you’re first exposed and protect against future infections. If your body comes in contact with the same germ, even years later, your body uses antibodies to recognize and defend itself against future infection.
diseases like polio, tetanus, measles, diphtheria, whooping cough (pertussis) and chickenpox are no longer a threat. Getting vaccinated protects you and those around you who are vulnerable to getting the disease.
How Vaccines Work
The Pfizer and Moderna vaccines are mRNA vaccines. These vaccines give your body’s cells instructions to make a harmless protein called the spike protein (which is found on the surface of the coronavirus).
Vaccines offer a way for your body to begin producing antibodies without coming in direct contact with the germs that make you sick. A vaccine teaches your body to recognize a foreign invader, alarms your immune system to activate and instructs your fighter cells and proteins to go to work against the germ. Vaccines are made using the inactive, weakened or harmless parts of the germ so they prevent disease without making you sick. Vaccines have been around for hundreds of years and play a major role in fighting disease today. Thanks to vaccines,
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Coronavirus Vaccine*
Three coronavirus vaccines have been authorized for emergency use, including the Pfizer BioNTech, Moderna and Johnson & Johnson Janssen.
The Johnson & Johnson vaccine is a viral vector vaccine. This type of vaccine uses a common cold virus that has been modified (called an adenovirus) to deliver genetic material for our cells to create the spike protein. Once your body receives the virus and creates the spike protein, your immune cells start to make antibodies to identify and destroy the virus.
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Coronavirus Vaccine Facts and Mythss Myth 1 – The coronavirus vaccine
is not safe because it was rapidly developed and tested.
The coronavirus (SARS-CoV-2) gene material was sequenced in early January 2020. This allowed the world’s best scientists to understand the importance of the spike protein and that developing antibodies against it might protect us from the disease. The partnership with the federal government provided nearly unlimited resources and allowed companies to develop vaccines faster than they normally would. For the first time in history, instead of waiting for the first study phase to be completed before starting the second phase and so forth, phases overlapped one another. So, the full duration of each study phase was completed, but in less time. Rest assured, the coronavirus vaccines were properly evaluated without cutting any corners.
Myth 2 – The Pfizer and Moderna
coronavirus vaccines will alter my genes. This is not true, because mRNA isn’t the same as genetic material (DNA), and it can’t combine with our DNA to change our genetic code. The Centers for Disease Control and Prevention (CDC) says on its website that mRNA vaccines don’t interact with our DNA in any way.
Myth 3 – If I’ve already had
coronavirus, I don’t need the vaccine.
People who have already had the coronavirus may still be at risk for re-infection. Currently, there is not enough information to say if, or for how long, people are protected from getting coronavirus after they have had it.
Myth 4 – The coronavirus vaccine is going to make me sick.
The coronavirus vaccines will not give you coronavirus and do not contain a live virus. These vaccines provide material
for your body to recognize and destroy the virus if you encounter it. As with all vaccines, side effects may occur, but that doesn’t mean they are harmful. The most commonly reported side effects, which typically last several days, are pain at the injection site, tiredness, headache, muscle pain, chills, joint pain and fever. More people experience these side effects after the second dose than after the first dose. Although these side effects may be mildly unpleasant, this is an indication the vaccine is doing its job and your body is developing antibodies against the coronavirus.
Myth 5 – If you have had the
coronavirus vaccine, you don’t need to wear a mask or social distance.
Even if you received the coronavirus vaccine, you could still pass the virus on to others. We still do not know how the vaccine effects virus transmission, and until we do, the recommendation is to wear a mask and practice social distancing.
Myth 6 – The coronavirus vaccine is
causing widespread allergic reactions.
Anaphylaxis is a severe, life-threatening allergic reaction that occurs rarely after vaccination. The CDC provided an initial analysis on January 22, 2021, which indicated 2.5 anaphylaxis cases per million (1 in 400,000) occurred in the Moderna coronavirus vaccine doses administered (CDC, 2021). Everyone who gets a coronavirus vaccine should be monitored on site after receiving the vaccine. Anyone who has had severe allergic reactions or any type of immediate allergic reaction to a vaccine or injectable therapy should be monitored for at least 30 minutes after getting the vaccine. All other people should be monitored for at least 15 minutes after getting the vaccine. Your clinic or pharmacy will have the supplies on hand to help you if this very rare reaction occurs.
NOTE: The administration fee for the vaccine will be billed directly to Medicare through the original fee-for-service Medicare program. Make sure to bring your red, white and blue Medicare card to your vaccination appointment. *Information about the coronavirus vaccine is rapidly changing. The information contained in this article is current as the publishing date. For the most up-to-date information, visit our website at networkhealth.com/coronavirus-vaccine. Centers for Disease Control and Prevention (CDC). (2021, January 22). Allergic Reactions Including Anaphylaxis ... Centers for Disease Control and Prevention. cdc.gov/mmwr/volumes/70/wr/mm7004e1.htm networkhealth.com
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What You Need to Know About Opioids By Sarah Wilczek, PharmD, pharmacist at Network Health
What are opioid pain medications?
• Tylenol® or ibuprofen for acute pain, such as an injury
Opioid pain medications are used to treat severe pain and include hydrocodone, morphine and oxycodone. These medications are also called narcotic pain medications. Opioid pain medications can help you manage pain when used correctly. However, there are some risks to them as well.
What are the risks of opioid medications?1
• Cymbalta® (duloxetine) and Neurontin® (gabapentin) are useful for chronic nerve pain • Topical patches such as SalonPas® or lidocaine patches are helpful and available without a prescription • Physical treatments, such as exercise, physical therapy or weight loss, may also be a good option
Common side effects of opioid medications are drowsiness and constipation. You can also become tolerant to the effects of the medication and need more of it to achieve the same pain relief.
•
The most dangerous side effect of opioid medications is a breathing emergency. Breathing emergencies occur when the opioid medication is taken in an amount that decreases your body’s urge to breathe.
• For acute pain, limit use to three to seven days
These are the risk factors for a breathing emergency. • A high dose of opioids • Ask your doctor or pharmacist about your risk • Combining opioids with these medications • Benzodiazepines (examples include Ativan® [lorazepam], Xanax® [alprazolam]) • Sleeping medications (examples include Ambien® [zolpidem], Lunesta® [eszopiclone]) • Alcohol • Neurontin® (gabapentin) or Lyrica® (pregabalin)
How do I use opioid medications safely? • Try other pain-relieving strategies first, including these non-opioid medications.2
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•
If opioid medications are needed, start at the lowest effective dose. This is especially important for people age 65 and older, because the response to opioid medications is less predictable as we age.
Do not use opioid pain medications at the same time as benzodiazepines, which include Xanax (alprazolam), Valium® (diazepam), Ativan (lorazepam) or sleeping medications such as Ambien (zolpidem)
• Ask your pharmacist or doctor about Narcan® (naloxone)
What is Narcan?
Narcan is a medication that can reverse the effects of opioid medications, mainly the breathing emergencies. The most commonly dispensed form is Narcan nasal spray. Think of Narcan like a fire extinguisher. You hope you never have to use it, but it is there for you in case you need it. The state of Wisconsin has a standing order that allows pharmacists to dispense Narcan to patients without a prescription from a provider.
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I have left over pain medication. What do I do with it?
After you are no longer using your pain medication, you should not leave it sitting in your cabinet. There are several options to safely dispose of pain medications. • Drop it off at your local police station—many police stations have drop boxes for unused medications. You may want to call the non-emergency line first to make sure that your local station has a drop box. • Drop off your unused medication on National Prescription Take Back Day, typically held every April and October. For more information, visit takebackday.dea.gov. • Some pharmacies offer DisposeRx®, a packet that you add along with water to the unused medication vial—it forms into a biodegradable gel which you can discard. Make sure you remove your personal information from the vial before you throw it away. If none of these options are accessible to you, place the unused medication in a plastic bag along with coffee grounds or kitty litter and throw it away. If you have questions or are concerned you may be at risk of opioid abuse, talk with your personal doctor. He or she can provide the resources you need to use your prescribed medication safely.
1 2
Marcum A.Z., Duncan N.A, Makris U.E. Pharmacotherapies in geriatric chronic pain management. Clin Geriatr Med. 2016; 32: 705-724 cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf
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life. health. wellness.
F
eeling sluggish, drowsy or down can be your body’s way of telling you to eat more nutrient-rich foods. Good nutrition is important to healthy aging, and spring is the perfect time to develop some good habits. Our bodies and nutritional needs change as we age, making it more important to make healthy choices at every meal. You can educate yourself about healthy aging and adopt lifestyle choices to make you feel better, inside and out.
Benefits of Good Nutrition
Potassium, calcium, vitamin D, vitamin B12 and fiber are micronutrients that become more important with age. They contribute to immune function, brain health and disease prevention. Eating a nutrient-rich diet can also improve your quality of life by helping you feel better overall.1
Need more reasons? • • • •
Increased energy levels More restful and restorative sleep Enhanced brain function Improved muscle mass and bone density
Eating well and staying active can help you stay strong and healthy so you can keep doing the things you love to do.
By SilverSneakers
®
Sources: 1 U.S. Department of Agriculture, choosemyplate.gov/browse-by-audience/view-allaudiences/adults/older-adults, accessed November 25, 2020 SilverSneakers is a registered trademark of Tivity Health, Inc. SilverSneakers OnDemand is a trademark of Tivity Health, Inc. © 2021 Tivity Health, Inc. All rights reserved. SSFP1072_1220
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Routine Eye Exam vs. Medical Eye Exam
P
eople age 65 and older are more than twice as likely to need glasses or contacts than people in other age groups. There are two types of eye exams. Before scheduling your next eye exam, it’s important to know the difference between each one and what your vision benefits will cover.
Routine Eye Exam – Screens for eye diseases and provides measurements for eyeglasses and/or contacts. When do you need a routine eye exam? • • • •
Your vision is blurry You have trouble reading up close You find yourself squinting to see far away Annually, even if you don’t experience issues
Is this type of exam covered by your Network Health Medicare Advantage plan? No. Routine eye exams are not a Medicare-covered service, so they are not covered by your NetworkPrime (MSA) plan. To help cover the cost of the exam, you can use the money deposited into your account by CMS.
All members will receive discounts on glasses and contact lenses with an EyeMed provider. You can find an EyeMed provider by visiting networkhealth.com/medicare/additional-benefits and clicking Find a Vision Provider. The EyeMed network of providers is different from our Network Health medical vision providers.
Medical Eye Exam – Performed to evaluate abnormalities found during your routine eye exam and to monitor
existing medical conditions. If you have an existing eye condition, you receive this type of exam every time you visit your provider. If you have questions about the type of exam you receive, contact your provider.
Why might you need a medical exam instead of a routine exam?
• • • •
You have cataracts You have diabetes You have glaucoma You have macular degeneration
Is this type of exam covered by your Network Health Medicare Advantage Plan?
Yes. Once you meet your $5,100 deductible, medical eye exams are 100 percent covered by your NetworkPrime (MSA) plan. To find a Network Health medical vision provider, visit networkhealth.com/find-a-doctor, select your plan type and search for Optometry or Ophthalmology.
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life. health. wellness.
Prevent T2 Diabetes Prevention Program P
revent T2 is a National Diabetes Prevention Program, which was created by the Centers for Disease Control and Prevention in 2010. Network Health began offering this program in 2019 and our participants have learned how to make lifestyle changes and develop healthy habits.
1570 Midway Pl Menasha, WI 54
Health or wellne
Presented by Network Health lifestyle coaches, PreventT2 is part of the National Diabetes Prevention Program, led by the Centers for Disease Control and Prevention (CDC).
This program is designed to help you make small changes that make a big difference to your health.
1570 Midway Pl. Menasha, WI 54952
Health or welln
ess or preventio
n information
Estella Lauter, professor emerita at the University of WisconsinOshkosh, participated in the Prevent T2 program. Estella holds many titles, including mother, wife, professor, writer, traveler, sailor and poet. In her retirement, she continues to use poetry to express her thoughts and feelings, and has published four books with Finishing Line press in Kentucky. Estella wrote this poem and dedicated it to her fellow Prevent T2 classmates.
Prevent T2 invitation 2278-04a-0221.indd 1
Presented by Network Heal th lifestyle coac part of the Nati hes, PreventT onal Diabetes 2 is Prevention Prog Centers for Dise ram, led by the ase Control and Prevention (CDC ).
This program is designed to help a big differenc e to your health. you make small changes that make
Prevent T2 invitation
2278-04a-0221.i
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Medicare
2/17/21 9:59 AM
These Are a Few of My Favorite Foods By Estella Lauter, Network Health Medicare member–For my Prevent T2 classmates Cottage cheese and a juicy pear for breakfast, or an orange red grapes, a Cortland apple, sprouted bread for toast and always coffee, but make it decaf. Lunch should be a slice, just one, of Provolone or Baby Swiss on a piece of sprouted bread with a ripe tomato or Bibb lettuce, Dijon mustard and maybe a bit of olive oil mayo or homemade pesto. With dinner comes variety—pork loin or flounder Florentine, chicken Marsala, shrimp curry, roasted turkey, ratatouille, delicious homemade soups, with rice and veggies too many to count. Desserts of choice are bananas pineapple, applesauce and nonfat frozen yogurt, no sugar added, 22 | C oncierge
a square or two of dark chocolate. On a hard day, dessert may come first. In between, crunchy carrots, fig newtons (just two), dried apricots or prunes, popcorn, three crackers with a thin coat of peanut butter (excess oil drained) and always decaf. For the occasional treat with friends and family, there’s chicken salad, blueberry pancakes, cherry pie, cranberry sauce, zucchini bread, hamburger or steak—more than enough, way more when I think of my parents, their lives on small farms with root cellars for winter storage and blocks of ice from the lake to keep their food fresh in warm weather. So how can I call this a “diet” when it is really a feast?
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Do You Face Barriers to Getting Care? By Alice Parks, director of population health at Network Health
You may have heard of social determinants of health, but what are they? The World Health Organization defines social determinants of health as the conditions in which people are born, live, learn, work, play, worship and age that affect health outcomes and risks, functioning and quality of life. Put simply, it means the factors in your life, outside of health care itself, that can affect your health and wellness. Some of those factors can become barriers or challenges to feeling well and being healthy.
What factors can create these barriers? Here are some examples. • • • • •
Having enough money to cover basic expenses, like food and clothing A place to live Access to transportation to get to the grocery store, the doctor, a support group or social activities you enjoy People to check in on you and support you, if needed The ability to understand information about your health—medical language can be hard to understand and sometimes we speak and understand different languages • Religious, spiritual or cultural beliefs and values that aren’t understood by your health care team
To determine which barriers you face, ask yourself two questions. • What barriers to feeling well and being healthy do I face? • What can I do to break down those barriers?
Then, you can form a plan and take action. For example, if you or a family member has a language barrier, ask for a translator. Or, if a suggested plan of care conflicts with your values, let your health care team know. They can provide alternative care plans that meet your needs and fit your values. Remember, Network Health is here to support you on your health and wellness journey. We have local nurses and social work care managers to serve you and discuss the challenges you’re experiencing. We’ll help you find resources in your community to break down some of the barriers you face. You can contact our care management department at 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.
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1570 Midway Pl. Menasha, WI 54952
Health and wellness or prevention information
MSA
Convenient Access to the Care You Need
T
hrough our partnership with Inovalon, Network Health offers convenient health assessments to review your medications and discuss any health concerns you may have. A nurse practitioner will complete a safe and comprehensive visit in the comfort of your home. If you prefer a virtual visit, Inovalon will send you a tablet to complete the visit. Both you and your personal doctor will receive a copy of the results of the assessment.
Who is eligible for an Inovalon health assessment?
All Network Health Medicare Advantage Plan members are eligible for an Inovalon health assessment at no cost. You may be contacted by mail and phone directly by Inovalon to schedule your appointment. If you aren’t contacted and would like to participate in a health assessment, call our member experience team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m.
Why should I complete this health assessment?
The Inovalon health assessment gives you the opportunity to meet with a nurse practitioner at no cost to you. This assessment is not meant to replace your visits with your personal doctor, and it can offer unique insight into your health. During the visit, the nurse practitioner will discuss your health history, perform an exam and answer any questions you may have. He or she may complete a falls assessment and ask questions about daily living activities to ensure you get the care you need, when you need it.
You can earn a $50 reward for completing a visit. Preventive Screening Kits
Inovalon also offers in-home preventive screenings. If you need a colon cancer screening or certain labs, you may receive kits in the mail to complete on your own or during an in-home visit. To find out if you are eligible or to request a kit, call our member experience team at 800-378-5234 (TTY 800-947-3529) Monday–Friday from 8 a.m. to 8 p.m. You and your personal doctor will receive a copy of your results.
You can also earn a $25 reward for each preventive screening kit you return.