A PUBLICATION OF
S P R I N G
2 0 1 4
It’s made me
more resilient. How type 1 diabetes has shaped Network Health member Rebecca Olson’s outlook on life.
L I F E , H E A LT H & W E L L N E S S
life
3
Eating Better on a Budget
Tips for balancing a healthy diet with a tight budget
E DITORIAL STAFF President Sheila Jenkins
4 3 Simple Steps for Better Health Care
Receiving the right health care in the most cost-effective way
03
4 Need Help Submitting a Claim?
Getting reimbursed when a medical facility makes you pay up front
Publications Sam Darcy Coordinator
he alth
5
Catching Your Breath
Understanding and managing COPD
6
Diabetes and Your Heart
Graphic Designer Debra Sutton
E DITORIAL
BOARD
Peggy Huss, Dawn Rady, Deborah Anderson, Renee Corral, Barb Gore, Chuck Rynearson, Teri Koepke
Explaining the link between diabetes and heart disease
7 10 Ways to Prevent Childhood Obesity
05
Teach your children healthy habits with 10 easy tips
FEATURE
8 Life on the Go
Type 1 diabetes has not stopped Network Health member Rebecca Olson from going wherever life takes her
08
Chief Administrative Penny Ransom Officer
Balance is published quarterly by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals. © 2014 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.
TELL US WHAT YOU THINK I f you have questions or suggestions or would like to tell us how Network Health improved your life, send us an email at balance@ networkhealth.com. You can also write to us at: Network Health Attention: Sam Darcy 1570 Midway Pl. Menasha, WI 54952
wellness 12 Surviving Spring Allergies How to relieve seasonal allergy symptoms without a trip to the doctor’s office
13 Get a Move On
Ideas for getting outside and active this spring
14 Feeling Worn Out?
Simple tips that will help you get a better night’s sleep
15 Preventive Guidelines Now
Available Online
How to use the preventive care guidelines found on networkhealth.com
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Bilingual language assistance or translation services are available for members to discuss utilization management issues. Network Health also offers TTY services for deaf, hard of hearing or speech-impaired members. Members who need these services should call 800-947-3529. networkhealth.com
life
Information to help you get the most out of your coverage
Eating Better on a Budget M
ost of us strive to eat right, but sometimes the healthy choice just costs more. It can be a challenge to balance a healthy diet with a lean budget. Here are some tips for improving your nutrition without putting a dent in your wallet.
Buy Beans – In your favorite recipes, use canned or dried beans instead of meat. Using beans instead of meat will not only save you money, but beans are typically low in fat, contain no cholesterol and are high in protein. Drink Water – Choose water instead of soda. By avoiding the sugar in soda, you’ll drastically lower your calorie intake. If you need additional flavor, try adding a slice of fruit to your water.
Shop in Season – Save money by buying fresh fruits and
vegetables that are in season. You can also buy seasonal fruits and vegetables before they ripen, making your fresh ingredients last longer.
Plan Ahead – Before you go to the grocery store, plan your meals
for the week. Try meals like stews and casseroles to stretch your portions and get more meals out of expensive ingredients.
Make the Most of Your Free Time – By making one large meal on your day off, your leftovers can last throughout the week and keep you from spending money on fast food. Grow Your Own – Even a beginning gardener can grow a variety of inexpensive vegetables for a meal.
Limit Portions – Manage the amount of food on your plate by
limiting yourself to a single serving. Also, your groceries will last longer if you avoid eating straight from the package.
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life { YOUR CARE }
3 Simple Steps for Better Health Care Do you want to receive the right health care in the most cost-effective way? These steps will lead to better coordination of care. F Let your primary doctor (often called your primary care provider, or PCP for short) know about any changes to your treatment. Your doctor needs to know if you have seen a specialist or started a new medication. F Contact your doctor after a visit to the emergency room. F If you are receiving behavioral health care services, make sure to give written consent for your behavioral health provider to share relevant health information with your doctor. Network Health’s Quality Improvement Department ensures the accuracy of the data gathered and reviewed by Network Health. To make sure we have the most up-to-date data about you, log into My Account through the member sign in on networkhealth.com or call customer service at 800-826-0940 if you change doctors. S AY W H AT ?
Coordination of Care – The process where the right kind of health care is provided at the right time, in the right setting, while avoiding unnecessary duplication of services and preventing medical errors.
Need Help Submitting a Claim?
M
ost providers will submit claims on behalf of members, but some out-of-area medical facilities may require you to pay for care at the time it is given. To arrange for reimbursement, you must send itemized bills and proof of payment within 90 days to Network Health, Attn: Claims Department, P.O. Box 568, Menasha, WI 54952. For more information, contact our customer service department at 800-826-0940 or 920-720-1300.
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Do you know your rights and responsibilities as a Network Health member? To learn more about how we provide you with service that respects your rights, go to networkhealth.com/rights or call 800-826-0940 or 920-720-1300.
networkhealth.com
health
News and tips to help you maintain a healthy and happy life
Catching Your Breath D
o you often feel as though you’re struggling for breath? Or do you have trouble with a persistent cough? You may want to talk to your doctor about chronic obstructive pulmonary disease, or COPD.
What is COPD?
It’s a condition that affects your lungs and restricts airways. People who suffer from COPD may have airways that are swollen, blocked and mucus production can increase.
How can I manage my COPD?
Once you’ve been diagnosed, it’s more important than ever to take steps to improve your health. Read the following to learn helpful management techniques. > Get
a spirometry test (also called a pulmonary function test) - This common and painless test can show you how well your lungs are working. It’s important to understand the condition of your lungs so you and your doctor can determine the best course of care.
> Prevent
infection - Flu and pneumonia are the top causes of breathing difficulty and hospitalization for people with COPD. Get vaccinated to help reduce your risk of getting infected.
> Take your medications - Make sure you understand your doctor’s medication instructions. Closely following your treatment plan can help prevent COPD flare-ups (or a worsening of symptoms). > Avoid
your triggers - Know what makes your COPD symptoms worse. Common factors include cold weather, strong fumes and smoking or secondhand smoke. Consider keeping a journal of your flare-ups to help you identify what your triggers are and how to avoid them. > Develop
a COPD action plan - It’s not always possible to avoid a
COPD flare-up, but you can identify the early warning signs and take action to keep breathing difficulty from becoming an emergency. Talk to your doctor about developing a personal plan.
TRYING TO QUIT?
One of the best things you can do for your lung health is to stop smoking. Here are some local programs to help you quit smoking. n e t w o r k h e a l t h . c o m
Where can I get extra help?
If you have COPD and would like to learn about the Network Health COPD management program, Breathe at Ease, please call Robyn West at 920-831-1498 or email her at rwest@affinityhealth.org.
> Call It Quits Program. This program, available through NurseDirect, offers phone counseling
to people who want to quit using tobacco. The program is free and available to anyone in northeast Wisconsin who wants to give up smoking. You can get a class schedule by calling NurseDirect at 800-362-9900.
> 1-800-QUITNOW. Available 24 hours a day, seven days a week, the Quit Line is free and
sponsored by the Wisconsin Department of Health Services.
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health
Diabetes and Your Heart
Most people know diabetes complications are serious. But do you understand how diabetes relates to heart disease?
C
omplications of diabetes are divided into two categories, microvascular and macrovascular. While microvascular complications can lead to blindness, kidney failure, erectile dysfunctions and even foot amputation, macrovascular complications can be serious, too.
Macrovascular complications are linked to cardiovascular disease and heart problems such as heart attacks, strokes and poor blood flow. In fact, the U.S. Department of Health and Human Services states that about 65 percent of people with diabetes die from heart attack or stroke. So, what can a person with diabetes do to prevent heart problems? > Maintain a healthy weight. Being overweight increases your risk for heart attack and stroke. > Get at least 30 minutes of exercise daily. Make a habit of taking a daily walk. It can help lower blood pressure and increase weight loss.
Improve your diet. Eat foods low in saturated fats, trans fats, cholesterol, sodium and excess sugars. >
Stay away from tobacco. Smoking is a major risk factor for heart attack and stroke. If you need help quitting, ask your doctor for help. > >
Take medications as prescribed. High blood sugar levels can cause damage to your blood vessels. Make sure to take your medications exactly as prescribed, this will help control your blood glucose levels and prevent further complications.
>
Get support. Ask your friends and family for help with your diabetes. Their support can help you reach your goals. If you have diabetes and need support with your condition, Network Health’s Condition Management Department offers information and educational resources to help you control your symptoms. To learn more, view the Condition Management section under the Health and Wellness tab of networkhealth.com.
S AY W H AT ?
Microvascular – Complications caused by damage to small blood vessels.
Macrovascular – Complications caused by damage to large blood vessels. 6 | balance • S p r i n g
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networkhealth.com
For a complete list of recent changes to our provider network, go to networkhealth.com/providerchanges.
10 Ways to Prevent Childhood Obesity C
hildhood obesity has become a major health issue across the United States. According to the Centers for Disease Control and Prevention (CDC), over 14 percent of Wisconsin children between ages 2 and 5 are obese and over 16 percent are considered overweight. The CDC also states that overweight or obese preschoolers are five times as likely as normal-weight classmates to be overweight or obese in adulthood. With obesity comes a greater risk for health issues that include heart disease, stroke, high blood pressure, diabetes and cancer. So, how can you teach children healthy habits that will prevent obesity and keep them healthy for life? Here are some tips.
1 Activity, not exercise Your child doesn’t need a strict exercise program, instead, emphasize playing games like tag, hide-and-go seek or jump rope. 2 Find interesting activities Choose activities that your child is interested in. If your child is into sports, play basketball or go swimming. If your child is into art, go on a hike to collect leaves or rocks.
7 Have healthy snacks available When you buy groceries, try to replace crackers, chips and cookies with fresh fruits and vegetables.
3 Annual well-child visits To find out how often well-child visits are covered for your child, check our preventive guidelines found under the Member’s Corner tab of networkhealth.com.
8 Limit sweetened beverages Sugary drinks provide very little nutritional value in exchange for high calories.
4 Don’t use food as motivation Don’t withhold or provide sweets as a reward or punishment. This will only create food-related power struggles with your child.
9 Serve appropriate portions Children don’t need to eat as much as adults. Your child should eat until he or she is full, even if that means there is food left on the plate.
5 Set a positive example Make sure you choose healthy foods and maintain your own weight. Also, choose activities the whole family can take part in.
10 Avoid eating out Many restaurant menus, especially fast-food restaurants, only offer options high in fat and calories.
6 Limit TV time Try to limit time spent watching television or playing video games to no more than two hours a day. Also, don’t let your child eat while watching TV, it keeps a child from being aware of how much he or she is eating.
Remember, some children grow into their extra pounds as they get taller. Focusing too intensely on your child’s eating habits can backfire and make him or her more prone to developing an eating disorder. Just try to be positive and emphasize all the great things that come with an active lifestyle.
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networkhealth.com
S T O C O V E R Y
lifeon the go Rebecca Olson is a girl with a lot on her plate.
She’s a 22-year-old college senior, majoring in nursing, graduating in May and applying for medical school. She takes honors courses, plans on working for Governor Walker’s upcoming election campaign and hopes to give the commencement speech at graduation. And Rebecca is doing all of this with type 1 diabetes.
By Sam Darcy
n e t w o r k h e a l t h . c o m
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Photographs by Shane Van Boxtel, Image Studios
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S T O C O V E R Y
W
ith a family history of diabetes, and showing abnormal signs of hunger and thirst, Rebecca was diagnosed when only 14 months old. Getting diagnosed at such a young age, diabetes has always been a part of Rebecca’s life, but she says its made it easier for her than someone diagnosed as a teen or young adult. “It’s my normal because it’s what I grew up with,” she said. “I learned how to take care of my diabetes like I learned how to brush my teeth and comb my hair.” Type 1 diabetes is usually diagnosed in children and young adults. According to the American Diabetes Association, only 5 percent of people with diabetes have this form of the condition. In type 1 diabetes, the body does not produce enough insulin to survive, and the missing insulin needs to be replaced. For diabetics like Rebecca, this means they must monitor their blood sugar levels, count carbohydrates and learn how to take daily insulin shots or use a pump. “When she was younger it was much more of a challenge because she couldn’t communicate with us. It was more observation,” said John Olson, Rebecca’s father. “But as she’s gotten older she’s taken on a lot more responsibility.” When Rebecca turned 10, she received her first insulin pump, giving her the freedom from relying only on insulin shots. “The insulin pump allowed me to be more independent,” she said. “Before, my parents had to give me shots and calculate everything.” Rebecca’s insulin pump works by a running tube into her body that gives her steady little doses of basal insulin all day long. When she eats meals, she temporarily increases the dosage so she receives one unit per six carbohydrates. This precise
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calculating has given Rebecca plenty of practice counting carbs. “When I was younger, I needed one unit for every 12 carbs,” she said. “I got really good at learning to divide by 12.” As Rebecca has grown up, she’s realized that managing her diabetes is an imperfect process, but it’s one she’s learned to control. She credits her diagnosis with teaching her a life-long lesson in responsibility. “From the time I started kindergarten, I’ve had to be able to understand my body,” she said. “I’ve needed to take responsibility to make sure I get help for myself.” Over the last decade, Network Health has been there to make sure Rebecca gets covered for everything she needs. According to her father, her coverage has been able to keep up with his busy girl. “For Rebecca it’s been wonderful,” John said. “Between changing pump manufacturers, medical supplies and appointments, she’s always been covered. We’ve been very happy with Network Health.” As Rebecca has gone through college, she’s needed to remain conscious of what goes in and out of her body. At a time in her life when of many of her peers go to bars and aren’t careful with their diets, Rebecca has had to remain steadfast. networkhealth.com
“There are times in college when I feel uncomfortable because people do stuff that I can’t,” she said. “I’m more watchful about what’s in my food because the thought of sugar freaks me out. I’m more conscious that I’m not invincible.” But Rebecca says what makes her different from other college students has also given her the direction to pursue a career in health care. While she admits that it can be hard on her to see the effects of diabetes on others, she feels that her experiences can help patients. “I was at the doctor’s office a lot growing up and I understand realistic expectations for people,” she said. “I want to help people like me, especially children, because it’s a natural extension of what I’ve been doing my whole life.” While diabetes has shaped her future pursuits, Rebecca doesn’t spend much time worrying about its future effects on her body. Long-term complications of type 1 diabetes develop gradually over years, and if blood sugar is not controlled, complications can be disabling or even life-threatening. “All I can do is take good care of myself and realize that everyone has highs and lows,” she said. “If I try my best, complications can be delayed and prevented.” When asked about the hopes for a cure of type 1 diabetes, Rebecca says that she would love to be able to eat without having to regulate her blood sugar. She acknowledges that a cure would change her life, but she doesn’t live as if she’s expecting it to happen.
“
“
Hopefully one day there is a cure, it would change my whole life, but until then, I’ll just keep on living.
“They told me when I was diagnosed that there would be a cure in 10 years, so I don’t put a lot of hope in a cure someday,” she said. “Hopefully one day there is a cure, it would change my whole life, but until then, I’ll just keep on living.” Rebecca says that she does expect for there to be an artificial pancreas someday. She hopes that all she will have to do is wear a monitor and the insulin pump will be able to take care of everything. In the meantime, Rebecca wants to focus her efforts on educating people without diabetes and helping those that have it. “I want people to know about diabetes because the more people that understand it, the easier it is for a diabetic to live,” she said. As she focuses her future on educating and helping others live with diabetes, it’s obvious that a life with type 1 diabetes has also taught Rebecca many lessons. She’s learned much more than monitoring blood sugar and counting carbs, she’s learned how to look at life. “Diabetes has made me more resilient and I don’t want it to hold me back,” she said. “I’m healthy now, so I live for today.” n e t w o r k h e a l t h . c o m
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wellness
Tools to empower your personal health
Surviving Spring Allergies F
ollowing the winter thaw, as we get further into Wisconsin’s spring, flowers bloom and trees begin to bud. Most of us can’t wait to get outside and enjoy the warmer weather. But if you have seasonal allergies, the coughing, sneezing and congestion can leave you indoors and miserable. Here are some tips to help you relieve the symptoms of spring allergies without a trip to the doctor’s office. Avoid Allergy Triggers This may seem obvious, but there are certain steps you can take to avoid allergy triggers, including: • Avoid hanging laundry on the clothesline to dry • Remove clothes and shower after coming in from outside • If possible, have someone else mow the lawn and tend to the garden • Stay indoors on dry, windy days; the best time to go outside is after it rains • Wear a dust mask when doing outdoor chores Watch Pollen Counts Make sure to watch the news for pollen forecasts. If the forecast calls for high pollen counts, try taking allergy medication before you show any symptoms. Plus, remember to close your windows and doors when pollen counts are high. If you have to go outside, avoid venturing out in the mornings, when pollen is highest. Keep Indoor Air Clean There really is no way to keep all pollens out of your home, but you can reduce their presence by running your air conditioning. Also, try to use high-efficiency filters and change them regularly. Remember, running the air conditioning in your car will help reduce your exposure to pollens, too.
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Rinse Your Sinuses For effective and inexpensive relief from congestion, rinse your nasal passages with distilled, sterile saline solution. Rinsing will flush out mucus and allergens from your nose. Try using a squeeze bottle or Neti pot, usually found at any local pharmacy. Try Over-the-Counter Medication Several nonprescription medications can help ease allergy symptoms, including antihistamines, decongestants and nasal sprays. For many people, over-the-counter medications are enough to help ease symptoms. If you can’t seem to clear up your allergies, talk to your doctor. He or she will help you find additional treatment options for your seasonal allergies. S AY W H AT ?
Neti Pot – A ceramic or plastic pot used to clear nasal passages by pouring saline solution through your nostrils.
networkhealth.com
MOVE ON
f your exercise routine went dormant over winter, take advantage of spring’s warmer weather and get outside. You don’t have to sign up for a marathon to get in shape, just do something that gets you off the couch. Here are some ideas to help you get started.
I
something to do, golf is a great way to get some walking in while competing against family and friends.
Landscaping and Gardening
Try a Pedometer
According to the Centers for Disease Control and Prevention, in just 30 minutes of gardening you can burn 150 calories. Gardening will also provide you with fresh, healthy foods that will improve your nutrition, too.
Exercise at Lunch
Even if you only get a 30-minute lunch break, try implementing a daily exercise routine. Taking a short walk can be beneficial and it can make you feel better, too.
Biking
You can get the whole family involved by taking a bike ride through the neighborhood or a local park. Biking is a great way to get aerobic exercise, even if it is only at a leisurely pace.
Participate in a Community Walk or Run If you’d like to get active and give back this spring, consider a community walk or run. Find one that supports a charity you feel passionate about and sign up. It’s a great way to get fit while supporting a good cause.
Take Up Golf
Whether you are an avid golfer or just looking for
Counting your steps can be a great way to track your daily activity level. You can find motivation by setting weekly goals or by competing against your past totals.
Walk the Dog
If you have a dog, get into a daily routine of taking your pet for a walk. Even playing fetch with your dog is an excuse to get outside and get some fresh air that will benefit you both.
Shoot Hoops
Get your competitive juices flowing with a game of basketball. You can challenge friends or get your family involved. It’s fun, and it’s great exercise. Whatever you decide to do this spring, make sure you choose an activity you like. Anything that keeps you interested and moving for at least 30 minutes a day will benefit your health.
S AY W H AT ?
Aerobic Exercise
– Constant moderate-intensity exercise that increases the rate that your body sends oxygen to
your muscles. n e t w o r k h e a l t h . c o m
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wellness Network Health’s Self-Management Workshops
Feeling
For more information or to sign up for a workshop, call us at 920-720-1655 or 800-769-3186, extension 01655. Or, visit us at networkhealth.com/workshops. Click Learn More for details about each workshop, and you’ll also find a link to where you can find dates and times for each workshop.
Worn Out?
Living Well with Chronic Conditions
Designed specifically for anyone with a chronic condition, such as arthritis, high blood pressure, heart disease, chronic pain or anxiety, this workshop teaches self-management skills and develops a step-by-step plan to achieve specific goals. The six-week class meets once a week for two and a half hours.
The solution could be a
exercise too close to bedtime; this can leave you too energized to fall asleep.
For any adult living with type 2 diabetes, this workshop is designed to help you better manage your diabetes. Classes cover topics like healthy eating choices and habits, the benefits of exercise, other techniques for dealing with symptoms and how to work with health care providers. This six-week workshop meets once a week for two and a half hours.
AVOID NAPS
Stepping On
better night’s sleep.
S
ometimes, getting some shut eye can be harder than it seems, leaving you frustrated and watching the minutes and hours tick by on your clock. Instead of counting sheep, try these tips for improving your sleep. By adopting these habits, a good night’s sleep won’t seem like such a pipedream.
SET A SCHEDULE
Just like when you were a kid, set a bedtime for yourself every night. Try to get up at the same time every day, too. Reinforcing your sleep schedule, even on weekends, will train your body and promote a better night’s sleep.
CREATE A ROUTINE
Pick an activity to do before bed every night. This could be reading a book or taking a shower. By doing the same activity every night, your body will know it’s time to wind down.
GET ACTIVE
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Healthy Living with Diabetes
Long naps can really interfere with your nighttime sleep. If you need to nap during the day, keep it between 10-30 minutes and in the middle of the day.
WATCH YOUR DIET BEFORE BED Discomfort can keep you up at night, so avoid going to bed hungry or completely stuffed. Also, avoid drinking before bed as nighttime trips to the bathroom can leave you wide awake.
Obviously, caffeine can keep you up at night, but so can alcohol. While alcohol can make you initially fall asleep, it can be disruptive to your sleep later in the night.
MANAGE STRESS
When you have too much on your mind, your sleep can suffer. No one wants to lie in bed with his or her mind racing. If you feel like you have a lot on your mind, jot down your thoughts before bed and you can reassess them in the morning.
A program for older adults who may have fallen, have a fear of falling or are at risk of falling. This program empowers older adults to step outside of their homes with the confidence to improve their quality of life. This seven-week workshop meets once a week for two hours.
Additional Local Support Groups C.O.P.E. with COPD Education and support to help those with chronic lung disease. For more information, call 920-203-8821 or 920-235-2542.
Better Breathers A community-wide support group for people with COPD and other chronic lung diseases. For more information call 920-738-2558 or 920-738-5364.
Fox Valley Diabetic Education and Support Group Open to people with type 1 or type 2 diabetes and/or their loved ones. Classes are free and no registration is needed.
networkhealth.com
Preventive Guidelines Now Available Online F
or most Network Health members, we offer free preventive services. To help you understand what services are considered preventive, you can refer to our preventive care guidelines found on networkhealth.com.
What are preventive services?
Preventive services help you identify diseases or medical problems before you show symptoms. These services include certain screenings, immunizations, lab tests and other services that help you prevent health problems.
When are preventive services free?
When you see an in-network provider for one of the services listed in this guide, we’ll pay 100 percent for most plans. However, you may be responsible for certain payments (deductible, coinsurance and copayment) if you receive the services for diagnostic reasons.
What are the preventive services guidelines?
Network Health’s guidelines list all preventive services offered for children, pregnant women and all other adults. You can print them and track the dates of doctor visits, immunizations, tests, prescriptions and physicals for you and your children. The guide also provides recommended timelines for receiving preventive services. n e t w o r k h e a l t h . c o m
How can I access the guidelines?
Find the guidelines by going to networkhealth.com/members and selecting the Preventive Care tab on the right side of the page. Then, click the Learn More button. S AY W H AT ?
In-Network Provider – Doctors we contract with to provide service to members at pre-negotiated prices. Diagnostic – Care designed to treat a specific health issue with known symptoms.
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OUR POLICY, NO HEALTH INSURANCE JARGON.
AT NETWORK HEALTH, WE SPEAK YOUR LANGUAGE. More and more people everywhere are intimidated with coordinating their health care. This leads to frustration, surprises and bad experiences. Meet Network Health, a different kind of health plan. We understand it requires more than just words and language, but also a commitment to customer service to break through industry clutter and confusion. Let us help you today. networkhealth.com
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HMO plans underwritten by Network Health Plan. POS plans underwritten by Network Health Insurance Corporation, or Network Health Insurance Corporation and Network Health Plan. Self-funded HMO and POS plans administered by Network Health Plan. SAL-194-01-3/14