HouseCalls: The Home Safety Issue - Spring 2013

HouseCalls Health or wellness or prevention information

Spring 2013

The

HOME SAFETY Issue

Call us 8 a.m. to 8 p.m. weekdays Toll-free 1-800-965-4022 TTY/TDD 711 or 1-800-526-0844 (Illinois Relay) HealthAllianceMedicare.org med-hchomesafety-0213 Y0034_13_7758 Accepted

What We’re Talking About

Home is Where this

‘House Calls’ is.

From the Editor

T

his issue of House Calls is all about Health Alliance Medicare coming to you. We know your home is where you’re most, well, at home. Where you relax.

Where you focus on you. Home is the theme of this issue of House Calls.

In these pages you’ll find helpful articles about: • Home safety

Also look for details about your wellness benefits, tricks to help you fall asleep and information about the Health Alliance Medicare Services “home team.”

At Health Alliance Medicare, we’re always looking for ways to give you a home field advantage. We hope House Calls does just that.

Thank you for reading. If you have any questions, please call 1-800-965-4022 weekdays, 8 a.m. to 8 p.m. TTY/TDD users, please call 711 or 1-800-526-0844 (Illinois Relay).

• Staying healthy at home • Recovering at home after a hospital stay

Sit back. Relax.

Enjoy this issue of ‘House Calls’ in the comfort of your home.

The

HOME SAFETY Issue

1

2

What We’re Talking About

Home is Where this

‘House Calls’ is.

From the Editor

T

his issue of House Calls is all about Health Alliance Medicare coming to you. We know your home is where you’re most, well, at home. Where you relax.

Where you focus on you. Home is the theme of this issue of House Calls.

In these pages you’ll find helpful articles about: • Home safety

Also look for details about your wellness benefits, tricks to help you fall asleep and information about the Health Alliance Medicare Services “home team.”

At Health Alliance Medicare, we’re always looking for ways to give you a home field advantage. We hope House Calls does just that.

Thank you for reading. If you have any questions, please call 1-800-965-4022 weekdays, 8 a.m. to 8 p.m. TTY/TDD users, please call 711 or 1-800-526-0844 (Illinois Relay).

• Staying healthy at home • Recovering at home after a hospital stay

Sit back. Relax.

Enjoy this issue of ‘House Calls’ in the comfort of your home.

The

HOME SAFETY Issue

1

2

Small Steps,

A

s we age, changes in our bodies make bouncing back from a fall a little harder. The Centers for Disease Control and Prevention (CDC) says falls cause the most injuries in people 65 and older. From head injuries to broken bones, one simple slip can cause a serious injury.

Luckily, easy ways to lower your risk of falling exist. The list here can help make you and your home safe.

Floors and Steps

In the Bedroom

• Ask someone to help move your furniture,

boxes and cords from high-traffic areas.

• Secure throw rugs with double-stick tape or non-slip backing. If you have loose floorboards, ask someone to help you fix this tripping hazard.

• Use nonskid floor wax and cleaner. Also, wear shoes with rubber soles at home.

• If your steps aren’t well lit, have an electrician install a light and a switch at both ends of the stairwell.

• Install sturdy handrails on both sides of stairwells.

In the Kitchen • Move the items you use most to lower cabinets

(about waist-level).

• If you need to use a stepstool, make sure it has a bar to hold on to. Never use a chair as a step.

In the Bathroom • Put rubber mats or non-slip strips in the shower

or tub.

• Think about adding grab bars and a sturdy plastic seat to the shower.

• Think about a raised toilet seat or one with armrests to make getting up a little easier.

• Keep a lamp and flashlight near your bed.

• Use night-lights in your bedroom, bathroom and hallways.

• Think about trading plain light switches for ones that glow in the dark.

You • Go over all the drugs you take with your doctor or pharmacist, even over-the-counter meds.

SIMON SAYS: Sometimes certain drugs, or combinations of drugs, can cause side effects, like sleepiness or dizziness, and increase your chances of falling. Some examples of these pills are: oo amitriptyline (Elavil) oo cyclobenzaprine(Flexeril) oo hydroxyzine (Vistaril, Atarax) oo methocarbamol (Robaxin) oo metaxalone (Skelaxin)

• Start a regular exercise program to help with

balance and strength. If you don’t know where to begin, ask your doctor for ideas.

• Have an eye exam at least once a year. The wrong strength glasses, certain health problems and vision loss all make falls more likely.

At-Home Healing

Might Be Just Right

R

ecovering at home can mean recovering better. “Many of our Health Alliance Medicare members recover faster at home than at a Skilled Nursing Facility.

Why? They push themselves to get up and get moving. They take care of themselves,” said Dr. Robert Parker.

The Health Alliance Medicare chief medical officer even strolled down Memory Lane.

“When I was in med school, we learned about doctors pushing women who had C-sections to get up the next day and make their own beds,” he said. “That helped women see they could get better faster if they weren’t stuck in bed.”

You need to do what’s right for you. If you recover at home, these tips can help you get well and prevent a return trip to the hospital.

• Don’t overdo. If you need help, ask. Accept help when others offer.

• Take your doctors’ advice. They know what works. If you have concerns, call.

• Take your pain meds. Be aware of how they might act with other drugs you take. They can also increase your risk of falling.

For more information about avoiding falls—and your health in general— check out our Wellness Center at HealthAlliance.org/Wellness.

3

4

A Skilled Nursing Facility stay might be right for you. For more about your Skilled Nursing Facility benefit: • Review your Evidence of Coverage. Health Alliance Medicare sends this book when you enroll and again each autumn. It’s your best source for benefit details.

• Call Health Alliance Medicare at 1-800-965-4022.

Ask for a copy of Your Skilled Nursing Facility Benefit Frequently Asked Questions. We can mail or email a copy right away.

If you want to recover at home, that might mean lining up help. You can also find out more about Home Health Care by reading your Evidence of Coverage or calling Health Alliance Medicare.

If you recover at home, you won’t be alone.

And you could feel better faster.

of our Health Alliance “ Many Medicare members recover

“

Big Difference

faster at home than at a Skilled Nursing Facility.

Small Steps,

A

s we age, changes in our bodies make bouncing back from a fall a little harder. The Centers for Disease Control and Prevention (CDC) says falls cause the most injuries in people 65 and older. From head injuries to broken bones, one simple slip can cause a serious injury.

Luckily, easy ways to lower your risk of falling exist. The list here can help make you and your home safe.

Floors and Steps

In the Bedroom

• Ask someone to help move your furniture,

boxes and cords from high-traffic areas.

• Secure throw rugs with double-stick tape or non-slip backing. If you have loose floorboards, ask someone to help you fix this tripping hazard.

• Use nonskid floor wax and cleaner. Also, wear shoes with rubber soles at home.

• If your steps aren’t well lit, have an electrician install a light and a switch at both ends of the stairwell.

• Install sturdy handrails on both sides of stairwells.

In the Kitchen • Move the items you use most to lower cabinets

(about waist-level).

• If you need to use a stepstool, make sure it has a bar to hold on to. Never use a chair as a step.

In the Bathroom • Put rubber mats or non-slip strips in the shower

or tub.

• Think about adding grab bars and a sturdy plastic seat to the shower.

• Think about a raised toilet seat or one with armrests to make getting up a little easier.

• Keep a lamp and flashlight near your bed.

• Use night-lights in your bedroom, bathroom and hallways.

• Think about trading plain light switches for ones that glow in the dark.

You • Go over all the drugs you take with your doctor or pharmacist, even over-the-counter meds.

SIMON SAYS: Sometimes certain drugs, or combinations of drugs, can cause side effects, like sleepiness or dizziness, and increase your chances of falling. Some examples of these pills are: oo amitriptyline (Elavil) oo cyclobenzaprine(Flexeril) oo hydroxyzine (Vistaril, Atarax) oo methocarbamol (Robaxin) oo metaxalone (Skelaxin)

• Start a regular exercise program to help with

balance and strength. If you don’t know where to begin, ask your doctor for ideas.

• Have an eye exam at least once a year. The wrong strength glasses, certain health problems and vision loss all make falls more likely.

At-Home Healing

Might Be Just Right

R

ecovering at home can mean recovering better. “Many of our Health Alliance Medicare members recover faster at home than at a Skilled Nursing Facility.

Why? They push themselves to get up and get moving. They take care of themselves,” said Dr. Robert Parker.

The Health Alliance Medicare chief medical officer even strolled down Memory Lane.

“When I was in med school, we learned about doctors pushing women who had C-sections to get up the next day and make their own beds,” he said. “That helped women see they could get better faster if they weren’t stuck in bed.”

You need to do what’s right for you. If you recover at home, these tips can help you get well and prevent a return trip to the hospital.

• Don’t overdo. If you need help, ask. Accept help when others offer.

• Take your doctors’ advice. They know what works. If you have concerns, call.

• Take your pain meds. Be aware of how they might act with other drugs you take. They can also increase your risk of falling.

For more information about avoiding falls—and your health in general— check out our Wellness Center at HealthAlliance.org/Wellness.

3

4

A Skilled Nursing Facility stay might be right for you. For more about your Skilled Nursing Facility benefit: • Review your Evidence of Coverage. Health Alliance Medicare sends this book when you enroll and again each autumn. It’s your best source for benefit details.

• Call Health Alliance Medicare at 1-800-965-4022.

Ask for a copy of Your Skilled Nursing Facility Benefit Frequently Asked Questions. We can mail or email a copy right away.

If you want to recover at home, that might mean lining up help. You can also find out more about Home Health Care by reading your Evidence of Coverage or calling Health Alliance Medicare.

If you recover at home, you won’t be alone.

And you could feel better faster.

of our Health Alliance “ Many Medicare members recover

“

Big Difference

faster at home than at a Skilled Nursing Facility.

Home Fire Safety Checklist KITCHEN AREA

GENERAL

Hot Problem.

Cool Answers.

T

he U.S. Fire Administration says more than 360,000 fires destroyed homes in the United States in 2010. These fires caused 2,555 deaths and more than 13,000 injuries. Clearly, we should take house fires seriously.

Taking small steps can help you stay safe.

One of the most important things you can do is make sure you have working smoke alarms in all major rooms of your home. Most of all, be sure you have one near your bedroom. Change the batteries twice a year, or ask someone to help you change them.

You should also check for possible fire starters. Make sure extension cords are not frayed, and don’t plug too many things into one outlet. In the kitchen, unplug small appliances, like your toaster, when you are not using them. Make sure the hood of your stove is clean and doesn’t have grease build-up. If you have a fireplace, put a screen up to block stray ashes and clean the chimney once a year.

Accidents can still happen. Make sure you know a couple ways to get out of your home if it catches fire.

Post emergency numbers and your address near all telephones.

Make sure your house number is visible from the street.

This helps firefighters get to you quickly.

Many fire stations will do a safety check at your home for free. Call your local fire department or senior center for details. And fill out the sample fire safety checklist from the Urbana Fire Department.

Fires can happen quickly and be deadly. Keep your home secure, and have a safety plan. Some simple steps can go a long way toward keeping you safe.

Make sure you know a couple ways to get out of your home if it catches fire.

Are your address numbers visible from the street and easy to see?

Are all fire starters kept away from the cooking area?

Are your smoke detectors in working order, batteries changed twice a year?

Is your range hood clean and are the vents working?

Do you practice an escape plan with a meeting place?

Are all unused small appliances unplugged when not in use?

Are your emergency numbers listed near all phones?

UTILITY AREA

ALL HOUSEHOLD AREAS

Are fire starters stored away from the furnace and water heater?

Are your heating ducts kept clean?

Do you keep your doors between rooms shut to reduce spread of fire?

Is your furnace filter clean?

Are you using extension cords? They can overheat and cause fires! Limit their use.

Are there any oversized fuses in the fuse box?

Check all electrical cords to be sure they are in good condition.

Do you keep your basement door closed to reduce fire spread in the event of fire?

Are your washer and dryer properly grounded?

Check to make sure outlets are not overloaded.

Check all windows to make sure they operate smoothly.

Is there a solid core door separating your garage from your home?

Do not allow waste paper or trash to collect and become a fire hazard.

Are all flammable liquids stored in the proper containers?

Provide ashtrays for all smokers. They should be disposed of properly.

Is the gasoline mower properly stored away from fire starters?

Are your household chemicals stored away from children?

OUTSIDE AREA

Are matches and lighters stored out of reach of children?

Are there any fire starters close to the house?

Don’t store items that easily burn, like an oily rag, in the attic.

Courtesy of the Urbana Fire Department

LIVING AREA

Does your fireplace have a screen and hearth to keep flying embers in?

Has your chimney been cleaned? Is it working right?

5

GARAGE/STORAGE AREA

6

Home Fire Safety Checklist KITCHEN AREA

GENERAL

Hot Problem.

Cool Answers.

T

he U.S. Fire Administration says more than 360,000 fires destroyed homes in the United States in 2010. These fires caused 2,555 deaths and more than 13,000 injuries. Clearly, we should take house fires seriously.

Taking small steps can help you stay safe.

One of the most important things you can do is make sure you have working smoke alarms in all major rooms of your home. Most of all, be sure you have one near your bedroom. Change the batteries twice a year, or ask someone to help you change them.

You should also check for possible fire starters. Make sure extension cords are not frayed, and don’t plug too many things into one outlet. In the kitchen, unplug small appliances, like your toaster, when you are not using them. Make sure the hood of your stove is clean and doesn’t have grease build-up. If you have a fireplace, put a screen up to block stray ashes and clean the chimney once a year.

Accidents can still happen. Make sure you know a couple ways to get out of your home if it catches fire.

Post emergency numbers and your address near all telephones.

Make sure your house number is visible from the street.

This helps firefighters get to you quickly.

Many fire stations will do a safety check at your home for free. Call your local fire department or senior center for details. And fill out the sample fire safety checklist from the Urbana Fire Department.

Fires can happen quickly and be deadly. Keep your home secure, and have a safety plan. Some simple steps can go a long way toward keeping you safe.

Make sure you know a couple ways to get out of your home if it catches fire.

Are your address numbers visible from the street and easy to see?

Are all fire starters kept away from the cooking area?

Are your smoke detectors in working order, batteries changed twice a year?

Is your range hood clean and are the vents working?

Do you practice an escape plan with a meeting place?

Are all unused small appliances unplugged when not in use?

Are your emergency numbers listed near all phones?

UTILITY AREA

ALL HOUSEHOLD AREAS

Are fire starters stored away from the furnace and water heater?

Are your heating ducts kept clean?

Do you keep your doors between rooms shut to reduce spread of fire?

Is your furnace filter clean?

Are you using extension cords? They can overheat and cause fires! Limit their use.

Are there any oversized fuses in the fuse box?

Check all electrical cords to be sure they are in good condition.

Do you keep your basement door closed to reduce fire spread in the event of fire?

Are your washer and dryer properly grounded?

Check to make sure outlets are not overloaded.

Check all windows to make sure they operate smoothly.

Is there a solid core door separating your garage from your home?

Do not allow waste paper or trash to collect and become a fire hazard.

Are all flammable liquids stored in the proper containers?

Provide ashtrays for all smokers. They should be disposed of properly.

Is the gasoline mower properly stored away from fire starters?

Are your household chemicals stored away from children?

OUTSIDE AREA

Are matches and lighters stored out of reach of children?

Are there any fire starters close to the house?

Don’t store items that easily burn, like an oily rag, in the attic.

Courtesy of the Urbana Fire Department

LIVING AREA

Does your fireplace have a screen and hearth to keep flying embers in?

Has your chimney been cleaned? Is it working right?

5

GARAGE/STORAGE AREA

6

Simon Says

Reducing

Readmissions

W

hen you’re in the hospital, nothing sounds better than going home to your own bed. Yet nearly one in five Medicare patients is back in the hospital in less than a month—a trend that’s being called the “revolving door of readmissions.”

Many return trips are avoidable, and with the right awareness and support, you can up your chances of staying at home.

Be Prepared Before You Leave Before you go home, you, a family member or someone on the hospital staff should call your regular doctor to schedule follow-up visits and any needed tests. Arrange rides to the doctor or to the pharmacy if you don’t drive (and keep reading for tips on programs that can help get you there).

Reba Karr, a registered nurse with Health Alliance Medicare, suggests having someone with you when the doctor or nurses give you at-home instructions.

“There can be a lot of information all at once, which can be hard to take in when you’re not feeling well,” she says.

If you’re alone, make sure you understand. Repeat the directions aloud and say, “Do I have this right?” or “Please explain again.” Don’t let them rush you out, and don’t feel bad if you don’t get it the first time.

Avoid Medication Mix-up Before you leave the hospital, tell your doctor about all the drugs you take—prescriptions, over-thecounter, even vitamins and supplements—to avoid harmful side effects with your new drugs.

7

“Read the medication list carefully,” says Karr. “Do not restart a medication you have at home if it is not on the new list. Ask questions if the list is not clear.”

Call (or have someone else call) to order your new meds before you leave the hospital. When you pick them up, ask the pharmacist questions to make sure you understand when and how to take the medicine. (see “Simon Says” for good questions to ask) If you can, have a family member or friend go to your house before you get home to clear out old drugs from cabinets and bedside tables. This helps you keep them separate from new ones. Or make a note to do it yourself before you unpack.

Make a Smooth Transition It’s normal to feel nervous about leaving the hospital, where you’ve had doctors and nurses helping with your care and medicine. But you don’t have to handle your at-home care by yourself.

Programs exist to help you make a smooth shift from hospital to home and avoid return hospital trips, when possible. An example is the CRIS Healthy-Aging Center in Danville, which offers the Bridge Care Transitions Program.

Post-hospital services from CRIS include transportation, an emergency home response plan, home-delivered meals, caregiver support and a 30-day follow-up.

To see if a home transition program serves your area, call your local senior center.

An Insider’s Perspective on Pharmaceuticals

To safely take your medicine, ask your doctor or pharmacist: • What is the name of my new medicine?

• What time of day do I take it?

• Why am I taking it?

• Do I take it with or without food?

• What should I do if I miss a dose or take too much?

• How often do I take it?

• What are possible side effects?

• How long do I have to take it?

Have someone with you when you ask these questions, if possible, and take notes. This will help you recall the answers when you get home.

Gotta Go?

You’re Not Alone

U

rinary incontinence, or poor bladder control, is a common problem. Many kinds of incontinence exist from many causes. Don’t stay silent. With the help of your doctor, you can take back control of your bladder and your life.

One of the first steps is to figure out what type of incontinence you have.

• Stress causes urine leaks when you cough or laugh.

• Urge is when you have to go to the bathroom all of a sudden and sometimes don’t make it.

• Overflow causes you to dribble urine often, even when you don’t feel like you have to go. This means your bladder does not empty all the way.

• Functional is when you know you have to go but have trouble getting to the bathroom, maybe because of a bad knee or trouble standing up.

Giving birth, being overweight and general aging can all hurt bladder control. Sometimes, though, poor bladder control can be a sign of a bigger problem like diabetes or kidney disease. This

8

is why it is so important you talk to your doctor.

Although it can be hard to talk about, your doctor can help you.

Small things, such as a diet change, can make a big difference. Doctors normally suggest the simplest treatment first, and will try other options if needed.

Bladder control problems can keep you from doing things you love. When you get the care you need, you can start feeling like you again.

Incontinence is a common problem. Don’t let it be a silent one.

About 33 million Americans suffer from bladder control problems, says the International Continence Society and SCA. Simon Says: Some medicines, such as blood pressure drugs or anti-anxiety meds, cause urinary incontinence. Have your drug names and doses on hand when you visit your doctor.

Simon Says

Reducing

Readmissions

W

hen you’re in the hospital, nothing sounds better than going home to your own bed. Yet nearly one in five Medicare patients is back in the hospital in less than a month—a trend that’s being called the “revolving door of readmissions.”

Many return trips are avoidable, and with the right awareness and support, you can up your chances of staying at home.

Be Prepared Before You Leave Before you go home, you, a family member or someone on the hospital staff should call your regular doctor to schedule follow-up visits and any needed tests. Arrange rides to the doctor or to the pharmacy if you don’t drive (and keep reading for tips on programs that can help get you there).

Reba Karr, a registered nurse with Health Alliance Medicare, suggests having someone with you when the doctor or nurses give you at-home instructions.

“There can be a lot of information all at once, which can be hard to take in when you’re not feeling well,” she says.

If you’re alone, make sure you understand. Repeat the directions aloud and say, “Do I have this right?” or “Please explain again.” Don’t let them rush you out, and don’t feel bad if you don’t get it the first time.

Avoid Medication Mix-up Before you leave the hospital, tell your doctor about all the drugs you take—prescriptions, over-thecounter, even vitamins and supplements—to avoid harmful side effects with your new drugs.

7

“Read the medication list carefully,” says Karr. “Do not restart a medication you have at home if it is not on the new list. Ask questions if the list is not clear.”

Call (or have someone else call) to order your new meds before you leave the hospital. When you pick them up, ask the pharmacist questions to make sure you understand when and how to take the medicine. (see “Simon Says” for good questions to ask) If you can, have a family member or friend go to your house before you get home to clear out old drugs from cabinets and bedside tables. This helps you keep them separate from new ones. Or make a note to do it yourself before you unpack.

Make a Smooth Transition It’s normal to feel nervous about leaving the hospital, where you’ve had doctors and nurses helping with your care and medicine. But you don’t have to handle your at-home care by yourself.

Programs exist to help you make a smooth shift from hospital to home and avoid return hospital trips, when possible. An example is the CRIS Healthy-Aging Center in Danville, which offers the Bridge Care Transitions Program.

Post-hospital services from CRIS include transportation, an emergency home response plan, home-delivered meals, caregiver support and a 30-day follow-up.

To see if a home transition program serves your area, call your local senior center.

An Insider’s Perspective on Pharmaceuticals

To safely take your medicine, ask your doctor or pharmacist: • What is the name of my new medicine?

• What time of day do I take it?

• Why am I taking it?

• Do I take it with or without food?

• What should I do if I miss a dose or take too much?

• How often do I take it?

• What are possible side effects?

• How long do I have to take it?

Have someone with you when you ask these questions, if possible, and take notes. This will help you recall the answers when you get home.

Gotta Go?

You’re Not Alone

U

rinary incontinence, or poor bladder control, is a common problem. Many kinds of incontinence exist from many causes. Don’t stay silent. With the help of your doctor, you can take back control of your bladder and your life.

One of the first steps is to figure out what type of incontinence you have.

• Stress causes urine leaks when you cough or laugh.

• Urge is when you have to go to the bathroom all of a sudden and sometimes don’t make it.

• Overflow causes you to dribble urine often, even when you don’t feel like you have to go. This means your bladder does not empty all the way.

• Functional is when you know you have to go but have trouble getting to the bathroom, maybe because of a bad knee or trouble standing up.

Giving birth, being overweight and general aging can all hurt bladder control. Sometimes, though, poor bladder control can be a sign of a bigger problem like diabetes or kidney disease. This

8

is why it is so important you talk to your doctor.

Although it can be hard to talk about, your doctor can help you.

Small things, such as a diet change, can make a big difference. Doctors normally suggest the simplest treatment first, and will try other options if needed.

Bladder control problems can keep you from doing things you love. When you get the care you need, you can start feeling like you again.

Incontinence is a common problem. Don’t let it be a silent one.

About 33 million Americans suffer from bladder control problems, says the International Continence Society and SCA. Simon Says: Some medicines, such as blood pressure drugs or anti-anxiety meds, cause urinary incontinence. Have your drug names and doses on hand when you visit your doctor.

Nurse Home Visits Give Peace of Mind

J

ack Hart of Normal is truly a “jack of all trades.”

This Health Alliance Medicare member spent 31 years in the banking business as a loan officer, salesman and marketer. He has also guided small businesses to success since the 1980s.

Once Jack helped a man who repaired and sold computers out of his home. He guided him on how to turn his side project into a full-time business at the start of the Computer Age. That man became very successful and now has several offices in the region.

That’s not all. Jack, who describes himself as “an entrepreneur the day I was born,” spent 20 years going to art shows and festivals selling wildlife art, including his own photos. (His favorite photo subject? Mushrooms. In fact, he has mushroom photos and small statues all over his house.).

It’s no surprise this always-on-the-go man was crushed when heart disease and chronic fatigue forced him to retire early. Since then, his life has a slower pace. He takes things one day at a time.

Like many people with a chronic illness, Jack often has questions. He wants to know what he can do to feel his best.

That’s where Health Alliance Medicare nurse practitioner Nancy Keith steps in. Jack was thrilled when Health Alliance Medicare offered to send a nurse to his home.

9

“I couldn’t believe that they would put forth that effort,” he says. “To me, that sets them above all the competitors out there.”

Our free home visit program connects nurses with Medicare members who need tips for managing their health. The nurses also help people adjust to being at home after leaving the hospital.

Nancy visited Jack to talk about his health—his diet, medicine and keeping pain under control—and to answer his questions. She took his blood pressure and checked his lungs and heart. They talked about heart attack and stroke warning signs.

We encourage you to use this free service. The home visits do not take the place of care or advice you get from your doctors. They are a chance for you to sit down with a nurse, discuss your health and get answers to your questions. Jack recommends this program to others living with a chronic illness and says it gave him peace of mind.

“Those of us with health problems, we’ve constantly got things on our mind that we would like to ask members of the medical profession,” he says.

“And here’s somebody making house calls, which is unheard of.”

Sleepy Side Effects What you should know about insomnia drugs

T

he National Center for Sleep Disorders Research says 30-40 percent of Americans suffer from insomnia. And as we age, insomnia becomes more common. If you take meds to help you sleep, be aware of some serious side effects.

These can include headaches, blurred vision, dizziness or drowsiness. It can happen right after taking the drug or the next day. Try to sleep at least seven or eight hours to reduce side effects the next day.

Until you know how the drug will affect you, don’t drive or use machinery.

Keep the floor clear in your house, especially around your bed, so you don’t fall or trip if you wake up and feel dizzy. (To learn more about stopping falls at home, see the article on page 3.)

If you have side effects from your insomnia drugs, talk to your pharmacist or doctor.

You might need to switch your sleep aid or lower your dosage.

10

Whether or not you have insomnia, try these tips for better sleep.

Limit caffeine, alcohol and nicotine. These stimulants can keep you awake.

Make sure your bedroom is cool, dark and quiet. Try a sleep

mask and earplugs to block out light and sound.

Start a relaxing bedtime routine. Taking a bath or playing music can help you wind down.

Keep a regular sleep schedule. Go to bed and wake up

at the same time every day, even on weekends.

Nurse Home Visits Give Peace of Mind

J

ack Hart of Normal is truly a “jack of all trades.”

This Health Alliance Medicare member spent 31 years in the banking business as a loan officer, salesman and marketer. He has also guided small businesses to success since the 1980s.

Once Jack helped a man who repaired and sold computers out of his home. He guided him on how to turn his side project into a full-time business at the start of the Computer Age. That man became very successful and now has several offices in the region.

That’s not all. Jack, who describes himself as “an entrepreneur the day I was born,” spent 20 years going to art shows and festivals selling wildlife art, including his own photos. (His favorite photo subject? Mushrooms. In fact, he has mushroom photos and small statues all over his house.).

It’s no surprise this always-on-the-go man was crushed when heart disease and chronic fatigue forced him to retire early. Since then, his life has a slower pace. He takes things one day at a time.

Like many people with a chronic illness, Jack often has questions. He wants to know what he can do to feel his best.

That’s where Health Alliance Medicare nurse practitioner Nancy Keith steps in. Jack was thrilled when Health Alliance Medicare offered to send a nurse to his home.

9

“I couldn’t believe that they would put forth that effort,” he says. “To me, that sets them above all the competitors out there.”

Our free home visit program connects nurses with Medicare members who need tips for managing their health. The nurses also help people adjust to being at home after leaving the hospital.

Nancy visited Jack to talk about his health—his diet, medicine and keeping pain under control—and to answer his questions. She took his blood pressure and checked his lungs and heart. They talked about heart attack and stroke warning signs.

We encourage you to use this free service. The home visits do not take the place of care or advice you get from your doctors. They are a chance for you to sit down with a nurse, discuss your health and get answers to your questions. Jack recommends this program to others living with a chronic illness and says it gave him peace of mind.

“Those of us with health problems, we’ve constantly got things on our mind that we would like to ask members of the medical profession,” he says.

“And here’s somebody making house calls, which is unheard of.”

Sleepy Side Effects What you should know about insomnia drugs

T

he National Center for Sleep Disorders Research says 30-40 percent of Americans suffer from insomnia. And as we age, insomnia becomes more common. If you take meds to help you sleep, be aware of some serious side effects.

These can include headaches, blurred vision, dizziness or drowsiness. It can happen right after taking the drug or the next day. Try to sleep at least seven or eight hours to reduce side effects the next day.

Until you know how the drug will affect you, don’t drive or use machinery.

Keep the floor clear in your house, especially around your bed, so you don’t fall or trip if you wake up and feel dizzy. (To learn more about stopping falls at home, see the article on page 3.)

If you have side effects from your insomnia drugs, talk to your pharmacist or doctor.

You might need to switch your sleep aid or lower your dosage.

10

Whether or not you have insomnia, try these tips for better sleep.

Limit caffeine, alcohol and nicotine. These stimulants can keep you awake.

Make sure your bedroom is cool, dark and quiet. Try a sleep

mask and earplugs to block out light and sound.

Start a relaxing bedtime routine. Taking a bath or playing music can help you wind down.

Keep a regular sleep schedule. Go to bed and wake up

at the same time every day, even on weekends.

Meet Our

Home Team

Pull In for a

A

new health resource is just a click away.

Whether you’re looking for quick tips on checking your blood pressure or wondering when your meds work best, Health Alliance has an online Wellness Center with answers, important tips and up-to-date information. All available to you at home!

These features make the Wellness Center a perfect health and wellness pit stop.

• Choose what you want to see. You can pick the

articles you see by topic. Topics include: Health and Wellness, Health and Wellness Seniors, Diabetes, Heart Health, Asthma and many more.

• Search for a subject. Pick what interests you and connect with great info.

• Join the conversation. A comments section invites

you to “Speak Your Mind.” You can read what others think about the article or topic, while also adding what you know or have questions about.

You can never know too much about your health or read too much about wellness. Check out what else the Wellness Center has just for you and your health.

Visit HealthAlliance.org/Wellness

Fraud Alerts Keep Your Personal Information Personal We all do everything we can to protect ourselves from identity theft. Yet new tricks can sneak up.

Health Alliance Medicare wants to keep you and your info safe.

address, telephone number and date of birth. The con might also ask for your bank and account number.

A new scam surfaced where people lie and say they are working for Medicare. They claim to be updating Medicare cards. The caller might ask for your name,

11

If you get a phone call like this, hang up. Never give these details out over the phone. Medicare and Health Alliance Medicare do not call to confirm personal details. Keep yourself and your identity safe by protecting your information.

Three All-Stars

Pit Stop

When you call from home with a question about your benefits or want to learn more about our added services, we have a team ready to help. Rookie or veteran, they’re always ready to step up to the plate and rarely strike out.

What do you like most about your job?

Personal

Name: Bryan Hometown: Villa Grove Position: Service rep How long have you been in the major leagues? 1 year

Stats

Average number of calls per day: 55 calls; Bryan was an MVP on a team that answered 90,737 calls for our Medicare members in 2012.

The best part of my job is when members call with a question about their policy, and I help them resolve it or explain the benefits in a way they can understand. Our members really appreciate the help.

What are your hobbies or interests?

With three boys, I’m very active in their lives.

I help coach Little League baseball and their youth basketball teams. My family likes attending sports events at U of I and Illinois State, and watching the Pittsburgh Steelers in action. My wife and I also like to visit family and friends.

What do you like most about your job?

Personal

Name: Aeja Hometown: Champaign Position: Service rep

I love the people I work with and talk to every day. I feel great about helping people.

How long have you been in the major leagues? 7 months

I love music! I love to sing and dance (not very well). I love a good book and most of all, being “Mommy.”

What are your hobbies or interests?

Stats

Average number of calls per day: 40 calls Average number of emails sent per day: 25

Personal

What do you like most about your job?

Speaking with our members and helping them work through their problems and issues.

Name: Char Hometown: St. Joseph Position: Service rep How long have you been in the major leagues? 15 years

Stats

What are your hobbies or interests?

I enjoy time with my grandchildren, and I’m very active in my church. I also enjoy scrapbooking and card making.

Average number of calls per day: 49 calls Total calls in 2012: 13,866

12

Meet Our

Home Team

Pull In for a

A

new health resource is just a click away.

Whether you’re looking for quick tips on checking your blood pressure or wondering when your meds work best, Health Alliance has an online Wellness Center with answers, important tips and up-to-date information. All available to you at home!

These features make the Wellness Center a perfect health and wellness pit stop.

• Choose what you want to see. You can pick the

articles you see by topic. Topics include: Health and Wellness, Health and Wellness Seniors, Diabetes, Heart Health, Asthma and many more.

• Search for a subject. Pick what interests you and connect with great info.

• Join the conversation. A comments section invites

you to “Speak Your Mind.” You can read what others think about the article or topic, while also adding what you know or have questions about.

You can never know too much about your health or read too much about wellness. Check out what else the Wellness Center has just for you and your health.

Visit HealthAlliance.org/Wellness

Fraud Alerts Keep Your Personal Information Personal We all do everything we can to protect ourselves from identity theft. Yet new tricks can sneak up.

Health Alliance Medicare wants to keep you and your info safe.

address, telephone number and date of birth. The con might also ask for your bank and account number.

A new scam surfaced where people lie and say they are working for Medicare. They claim to be updating Medicare cards. The caller might ask for your name,

11

If you get a phone call like this, hang up. Never give these details out over the phone. Medicare and Health Alliance Medicare do not call to confirm personal details. Keep yourself and your identity safe by protecting your information.

Three All-Stars

Pit Stop

When you call from home with a question about your benefits or want to learn more about our added services, we have a team ready to help. Rookie or veteran, they’re always ready to step up to the plate and rarely strike out.

What do you like most about your job?

Personal

Name: Bryan Hometown: Villa Grove Position: Service rep How long have you been in the major leagues? 1 year

Stats

Average number of calls per day: 55 calls; Bryan was an MVP on a team that answered 90,737 calls for our Medicare members in 2012.

The best part of my job is when members call with a question about their policy, and I help them resolve it or explain the benefits in a way they can understand. Our members really appreciate the help.

What are your hobbies or interests?

With three boys, I’m very active in their lives.

I help coach Little League baseball and their youth basketball teams. My family likes attending sports events at U of I and Illinois State, and watching the Pittsburgh Steelers in action. My wife and I also like to visit family and friends.

What do you like most about your job?

Personal

Name: Aeja Hometown: Champaign Position: Service rep

I love the people I work with and talk to every day. I feel great about helping people.

How long have you been in the major leagues? 7 months

I love music! I love to sing and dance (not very well). I love a good book and most of all, being “Mommy.”

What are your hobbies or interests?

Stats

Average number of calls per day: 40 calls Average number of emails sent per day: 25

Personal

What do you like most about your job?

Speaking with our members and helping them work through their problems and issues.

Name: Char Hometown: St. Joseph Position: Service rep How long have you been in the major leagues? 15 years

Stats

What are your hobbies or interests?

I enjoy time with my grandchildren, and I’m very active in my church. I also enjoy scrapbooking and card making.

Average number of calls per day: 49 calls Total calls in 2012: 13,866

12

Clear Care

A

s a Health Alliance Medicare member, you have access to free wellness care.

Wellness visits, vaccinations and some tests (depending on your age and gender) cost you nothing. Sometimes, though, it can be tricky to know what wellness covers versus when you have to pay.

Here are some covered services.

So What is Wellness Care?

• Heart disease screening lab tests—members qualify for coverage of blood tests to check lipid, cholesterol and triglyceride levels every five years.

Even if you are at the doctor for your wellness exam, costs could come up. For example, your doctor might notice fluid in your lungs during your visit and suggests an X-ray. That service is not considered wellness because its goal is figuring out if there is a problem. You may have to help pay for the X-ray.

• Colonoscopy—covered every 10 years for low-risk patients. If a colonoscopy leads to more testing or a procedure, it is no longer under your wellness benefit.

To stay in control of your costs, tell your doctor you are there for a wellness visit.

Ask your doctor to check with you before doing any other tests. If you would rather do the tests another time, talk to your doctor about your options.

Away from Home. Close to Care.

A medical emergency is stressful—no matter when or where. When you’re 100 miles from home or in a new country, it only adds to the worry. Where to go? Who to trust? What’s covered?

Be sure to write these important numbers down. They’ll connect you with help 24 hours a day, every day of the year.

Don’t worry. Health Alliance Medicare gives you all-the-time global emergency service with Assist America®. This provides and pays for services linked to getting quality emergency medical care while traveling. Your Health Alliance Medicare benefits kick in to cover your health care.

with Safety and Awareness

• Annual wellness exam—covered once a year with your doctor.

Wellness care’s goal is to stop a problem before it happens. A wellness visit often includes your doctor asking about your health history and a physical exam. • Pap smear, pelvic exam and breast exam—women You will also talk about lowering your health risks. with low risk factors have coverage for these services You can always call the number on the back of your once every two years.

Health Alliance Medicare card to ask questions about • Prostate cancer screenings—male members over 50 what counts as wellness care. are eligible for coverage of a prostate-specific antigen (PSA) blood test once every 12 months.

What Does Not Count as Wellness Care?

Prevent Farming Accidents

Reference number: 01-AA-HAM-031003 Within the U.S.: 1-800-872-1414 Outside the U.S.: +1-609-986-1234

A

By Patrick Harness

s children, we were lucky enough to spend time on my grandparents’ farm in Missouri. We had a lot of fun and spent the time in idle pursuits. We were vaguely aware they were taking care of business, but we never visited during the busy times like planting, harvest or slaughter. To us it was a vacation made in heaven.

Of course, youthful ignorance and our suburban background skewed our vision of farm life. Life on a farm, then and now, is a far cry from a vacation.

Agriculture can be an arduous and challenging way to earn a living. It is especially challenging for older workers, many of whom we speak with at our Health Alliance Medicare offices in Champaign.

Amy Rademaker is the farm safety specialist at Carle Hospital. She has an insider’s perspective on farm life and is an expert on the subject of farm safety. Amy stresses the importance of safe farming practices, especially for older workers.

“Agriculture is ranked as one the most dangerous occupations in the U.S., and the highest fatality rates are experienced by older farmers who may have a

Health Alliance Medicare takes care of you— no matter where or when—with Assist America.

For more information about Assist America, visit assistamerica.com.

Assist America services include: Please note: Assist America cannot honor • medical referrals • replacement prescriptions requests for reimbursement for ambulance • hospital admissions • interpreter help transport or other services arranged independently by our members.

13

14

slower reaction time, health issues impacting mobility, as well as potential medications that interfere with cognitive processes,” she says. “Therefore, we should be giving special consideration to this demographic when educating about farm safety.” Statistics show the highest agriculture fatality rate in Illinois is among those over the age of 65.

“Although some of our older generations generally try to pass down farming tasks to the next generation, many still live on the farm or continue to have an interest in day-to-day tasks.

All who work on the farm should be aware of their surroundings and take special care to look out for older farmers who may not notice they are in the path of danger,” Rademaker says.

In retrospect, it’s amazing our grandparents were able to conceal the challenges they faced as farmers from their city-bred grandchildren. On one hand, I think maybe I should temper my warm memories of life on the farm with Rademaker’s sobering perspective. On the other hand, I think I will leave my childhood memories of my grandparents exactly as they are.

For more information about community resources for seniors, contact Patrick at 1-800-965-4022 or patrick.harness@healthalliance.org.

Clear Care

A

s a Health Alliance Medicare member, you have access to free wellness care.

Wellness visits, vaccinations and some tests (depending on your age and gender) cost you nothing. Sometimes, though, it can be tricky to know what wellness covers versus when you have to pay.

Here are some covered services.

So What is Wellness Care?

• Heart disease screening lab tests—members qualify for coverage of blood tests to check lipid, cholesterol and triglyceride levels every five years.

Even if you are at the doctor for your wellness exam, costs could come up. For example, your doctor might notice fluid in your lungs during your visit and suggests an X-ray. That service is not considered wellness because its goal is figuring out if there is a problem. You may have to help pay for the X-ray.

• Colonoscopy—covered every 10 years for low-risk patients. If a colonoscopy leads to more testing or a procedure, it is no longer under your wellness benefit.

To stay in control of your costs, tell your doctor you are there for a wellness visit.

Ask your doctor to check with you before doing any other tests. If you would rather do the tests another time, talk to your doctor about your options.

Away from Home. Close to Care.

A medical emergency is stressful—no matter when or where. When you’re 100 miles from home or in a new country, it only adds to the worry. Where to go? Who to trust? What’s covered?

Be sure to write these important numbers down. They’ll connect you with help 24 hours a day, every day of the year.

Don’t worry. Health Alliance Medicare gives you all-the-time global emergency service with Assist America®. This provides and pays for services linked to getting quality emergency medical care while traveling. Your Health Alliance Medicare benefits kick in to cover your health care.

with Safety and Awareness

• Annual wellness exam—covered once a year with your doctor.

Wellness care’s goal is to stop a problem before it happens. A wellness visit often includes your doctor asking about your health history and a physical exam. • Pap smear, pelvic exam and breast exam—women You will also talk about lowering your health risks. with low risk factors have coverage for these services You can always call the number on the back of your once every two years.

Health Alliance Medicare card to ask questions about • Prostate cancer screenings—male members over 50 what counts as wellness care. are eligible for coverage of a prostate-specific antigen (PSA) blood test once every 12 months.

What Does Not Count as Wellness Care?

Prevent Farming Accidents

Reference number: 01-AA-HAM-031003 Within the U.S.: 1-800-872-1414 Outside the U.S.: +1-609-986-1234

A

By Patrick Harness

s children, we were lucky enough to spend time on my grandparents’ farm in Missouri. We had a lot of fun and spent the time in idle pursuits. We were vaguely aware they were taking care of business, but we never visited during the busy times like planting, harvest or slaughter. To us it was a vacation made in heaven.

Of course, youthful ignorance and our suburban background skewed our vision of farm life. Life on a farm, then and now, is a far cry from a vacation.

Agriculture can be an arduous and challenging way to earn a living. It is especially challenging for older workers, many of whom we speak with at our Health Alliance Medicare offices in Champaign.

Amy Rademaker is the farm safety specialist at Carle Hospital. She has an insider’s perspective on farm life and is an expert on the subject of farm safety. Amy stresses the importance of safe farming practices, especially for older workers.

“Agriculture is ranked as one the most dangerous occupations in the U.S., and the highest fatality rates are experienced by older farmers who may have a

Health Alliance Medicare takes care of you— no matter where or when—with Assist America.

For more information about Assist America, visit assistamerica.com.

Assist America services include: Please note: Assist America cannot honor • medical referrals • replacement prescriptions requests for reimbursement for ambulance • hospital admissions • interpreter help transport or other services arranged independently by our members.

13

14

slower reaction time, health issues impacting mobility, as well as potential medications that interfere with cognitive processes,” she says. “Therefore, we should be giving special consideration to this demographic when educating about farm safety.” Statistics show the highest agriculture fatality rate in Illinois is among those over the age of 65.

“Although some of our older generations generally try to pass down farming tasks to the next generation, many still live on the farm or continue to have an interest in day-to-day tasks.

All who work on the farm should be aware of their surroundings and take special care to look out for older farmers who may not notice they are in the path of danger,” Rademaker says.

In retrospect, it’s amazing our grandparents were able to conceal the challenges they faced as farmers from their city-bred grandchildren. On one hand, I think maybe I should temper my warm memories of life on the farm with Rademaker’s sobering perspective. On the other hand, I think I will leave my childhood memories of my grandparents exactly as they are.

For more information about community resources for seniors, contact Patrick at 1-800-965-4022 or patrick.harness@healthalliance.org.

Essentials

We Speak Your Language

Health Alliance Medicare Services is Here to Help We can help you with questions about claims, coverage, appeals, pharmacy issues, preauthorization, utilization management and information about the doctors, clinics and hospitals we work with. After normal business hours, leave a message, and we will return your call the next business day. Please note that all non-urgent review requests received after normal business hours will be recorded as being received the next business day.

Please call us if any of your personal information has changed, including: • Name • Other insurance • Address • Primary Care Physician (PCP) • Phone number You can call Health Alliance Medicare Services at 1-800-965-4022, Monday-Friday, 8 a.m. to 8 p.m. TTY/TDD users call 711 or 1-800-526-0844 (Illinois Relay).

Keep Your Member Materials Handy To make the most of your benefits, read your member materials, including your annual Evidence of Coverage book, and any materials you received when you became a member. These materials are a convenient source for quick information about your coverage.

If you need additional copies of your member materials, please contact Health Alliance Medicare Services at 1-800-965-4022, Monday-Friday, 8 a.m. to 8 p.m. TTY/TDD users call 711 or 1-800-526-0844 (Illinois Relay).

Take Charge Online You can often find convenient information and tools online at YourHealthAlliance.org. Simply log in* with your username and password to: • View eligibility.

• Access WorldDoc, our comprehensive online • Check the status of a medical resource. claim.

• Find copayments or • Look for a participating coinsurance. provider.

• View member rights • Order a new ID card. and responsibilities.

• View the Health Alliance • Read the Notice of Medicare Part D Privacy Practices.

Formulary.

• Evaluate drug interactions, • Review HEDIS®/ CAHPS®** results view drug claims history and other quality and see how much you’ll initiatives. pay for prescriptions.

• Pay your bill.

You’ll also find information about: • Medical and pharmaceutical management policies and procedures, including how we review new technology.

• How to submit a claim.

• Which benefits and services are included and excluded from your coverage in and out of the service area.

• How to obtain emergency care, primary care, specialty care and behavioral health services during and after normal business hours in and out of the service area.

• How to obtain information about in-network physicians and hospitals, including searching for providers.

• How to file a complaint or appeal, including your right to involve an external review organization. *To sign up for a username and password, follow these steps: 1. Go to YourHealthAlliance.org.

2. Click “Register and Get Started” under “Members.”

3. Enter the requested information and click “Register.”

4. Log in to your email account to verify your email address by following the link provided in the confirmation email.

If you are more comfortable speaking a language other than English, try our telephone translation service, Language Line. We provide access to interpreters who speak 140 different languages. Simply call Health Alliance Medicare Services and state which language you speak.

Si usted necesita un interprete para traducir esta información, por favor llamar al teléfono gratis 1-800-965-4022 y pregunte por la “Language Line.”

Documents may be available in alternate formats or languages. Please call 1-800-965-4022.

Better Service, Better Care, Safely Our Quality and Medical Management program continually strives to improve the services we provide you and the doctors and hospitals we work with. Our goal is to establish standards of care, identify opportunities and drive interventions to enhance care and measure effectiveness.

Through regular monitoring and annual evaluation, we continue to meet our goals. To view our complete program, visit HealthAllianceMedicare.org and select “Why Health Alliance” and then “Learn More” at the bottom of the page. Click the “Quality Improvement Program” link under “History and Philosophy.” Here are some examples of our initiatives.

Clinical Guidelines

Health Alliance encourages our doctors to consult nationally recognized standards, called clinical guidelines, when providing care to our members.

These evidence-based treatment suggestions have been developed to help doctors choose appropriate health care treatment for specific medical conditions. Doctors can review the guidelines on the Health Alliance website or call 1-800-851-3379, ext. 8112 (Monday-Friday, 8 a.m. to 5 p.m.) for a hard copy.

NCQA® Accreditation

We participate in a health plan accreditation program with the National Committee for Quality Assurance (NCQA®). This ensures we meet a rigorous set of nationally

recognized standards for quality and service to our members and providers. For more information, visit the NCQA® website at ncqa.org.

HEDIS® and CAHPS®

Health Alliance participates in the annual Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data collection programs through NCQA®.

HEDIS is the measurement tool used by the nation’s health plans to evaluate performance in terms of clinical quality and customer service. CAHPS® is a nationally recognized survey tool that measures members’ satisfaction with their health plan. To view the most recent HEDIS and CAHPS® scores for Health Alliance, visit HealthAlliance.org and click “About Us” at the top of the page.

Safety

Health Alliance is committed to improving health care safety so our members with medical problems do not feel worse because of an error during treatment. Our Adverse Events Committee oversees patient safety initiatives.

Patient safety suggestions and articles are also available on our website at HealthAlliance.org. Click on the Health and Wellness tab and then “Patient Safety” at the bottom of the page.

*If you don’t have Internet access, you can request printed copies of the materials on our website by calling Health Alliance Medicare Services.

Be Well—Solutions For Your Health

**HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA®).

• I Can Quit (smoking cessation)

• ChoLESSterol • Get in Check (diabetes)

• Active with Asthma

• ImmYOUnize

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ®).

Health Alliance programs help you achieve and maintain your best possible health.

• BP Beat (blood pressure) • Road to Relief (migraines)

The Case Management program serves members who need help managing a chronic health condition or navigating the health care system. For more information or to enroll in this program, members or their caregivers may call 1-800-851-3379, ext. 8112.

Essentials

We Speak Your Language

Health Alliance Medicare Services is Here to Help We can help you with questions about claims, coverage, appeals, pharmacy issues, preauthorization, utilization management and information about the doctors, clinics and hospitals we work with. After normal business hours, leave a message, and we will return your call the next business day. Please note that all non-urgent review requests received after normal business hours will be recorded as being received the next business day.

Please call us if any of your personal information has changed, including: • Name • Other insurance • Address • Primary Care Physician (PCP) • Phone number You can call Health Alliance Medicare Services at 1-800-965-4022, Monday-Friday, 8 a.m. to 8 p.m. TTY/TDD users call 711 or 1-800-526-0844 (Illinois Relay).

Keep Your Member Materials Handy To make the most of your benefits, read your member materials, including your annual Evidence of Coverage book, and any materials you received when you became a member. These materials are a convenient source for quick information about your coverage.

If you need additional copies of your member materials, please contact Health Alliance Medicare Services at 1-800-965-4022, Monday-Friday, 8 a.m. to 8 p.m. TTY/TDD users call 711 or 1-800-526-0844 (Illinois Relay).

Take Charge Online You can often find convenient information and tools online at YourHealthAlliance.org. Simply log in* with your username and password to: • View eligibility.

• Access WorldDoc, our comprehensive online • Check the status of a medical resource. claim.

• Find copayments or • Look for a participating coinsurance. provider.

• View member rights • Order a new ID card. and responsibilities.

• View the Health Alliance • Read the Notice of Medicare Part D Privacy Practices.

Formulary.

• Evaluate drug interactions, • Review HEDIS®/ CAHPS®** results view drug claims history and other quality and see how much you’ll initiatives. pay for prescriptions.

• Pay your bill.

You’ll also find information about: • Medical and pharmaceutical management policies and procedures, including how we review new technology.

• How to submit a claim.

• Which benefits and services are included and excluded from your coverage in and out of the service area.

• How to obtain emergency care, primary care, specialty care and behavioral health services during and after normal business hours in and out of the service area.

• How to obtain information about in-network physicians and hospitals, including searching for providers.

• How to file a complaint or appeal, including your right to involve an external review organization. *To sign up for a username and password, follow these steps: 1. Go to YourHealthAlliance.org.

2. Click “Register and Get Started” under “Members.”

3. Enter the requested information and click “Register.”

4. Log in to your email account to verify your email address by following the link provided in the confirmation email.

If you are more comfortable speaking a language other than English, try our telephone translation service, Language Line. We provide access to interpreters who speak 140 different languages. Simply call Health Alliance Medicare Services and state which language you speak.

Si usted necesita un interprete para traducir esta información, por favor llamar al teléfono gratis 1-800-965-4022 y pregunte por la “Language Line.”

Documents may be available in alternate formats or languages. Please call 1-800-965-4022.

Better Service, Better Care, Safely Our Quality and Medical Management program continually strives to improve the services we provide you and the doctors and hospitals we work with. Our goal is to establish standards of care, identify opportunities and drive interventions to enhance care and measure effectiveness.

Through regular monitoring and annual evaluation, we continue to meet our goals. To view our complete program, visit HealthAllianceMedicare.org and select “Why Health Alliance” and then “Learn More” at the bottom of the page. Click the “Quality Improvement Program” link under “History and Philosophy.” Here are some examples of our initiatives.

Clinical Guidelines

Health Alliance encourages our doctors to consult nationally recognized standards, called clinical guidelines, when providing care to our members.

These evidence-based treatment suggestions have been developed to help doctors choose appropriate health care treatment for specific medical conditions. Doctors can review the guidelines on the Health Alliance website or call 1-800-851-3379, ext. 8112 (Monday-Friday, 8 a.m. to 5 p.m.) for a hard copy.

NCQA® Accreditation

We participate in a health plan accreditation program with the National Committee for Quality Assurance (NCQA®). This ensures we meet a rigorous set of nationally

recognized standards for quality and service to our members and providers. For more information, visit the NCQA® website at ncqa.org.

HEDIS® and CAHPS®

Health Alliance participates in the annual Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data collection programs through NCQA®.

HEDIS is the measurement tool used by the nation’s health plans to evaluate performance in terms of clinical quality and customer service. CAHPS® is a nationally recognized survey tool that measures members’ satisfaction with their health plan. To view the most recent HEDIS and CAHPS® scores for Health Alliance, visit HealthAlliance.org and click “About Us” at the top of the page.

Safety

Health Alliance is committed to improving health care safety so our members with medical problems do not feel worse because of an error during treatment. Our Adverse Events Committee oversees patient safety initiatives.

Patient safety suggestions and articles are also available on our website at HealthAlliance.org. Click on the Health and Wellness tab and then “Patient Safety” at the bottom of the page.

*If you don’t have Internet access, you can request printed copies of the materials on our website by calling Health Alliance Medicare Services.

Be Well—Solutions For Your Health

**HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA®).

• I Can Quit (smoking cessation)

• ChoLESSterol • Get in Check (diabetes)

• Active with Asthma

• ImmYOUnize

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ®).

Health Alliance programs help you achieve and maintain your best possible health.

• BP Beat (blood pressure) • Road to Relief (migraines)

The Case Management program serves members who need help managing a chronic health condition or navigating the health care system. For more information or to enroll in this program, members or their caregivers may call 1-800-851-3379, ext. 8112.

Health Alliance Medicare members can receive discounts at various gyms, health clubs and weight loss centers. To learn more, call 1-888-382-9781.

To check out our wellness programs and other helpful health information, visit HealthAllianceMedicare.org and click on “Why Health Alliance.” Then select “Health Savings and Programs” under “Additional Services.”

Pharmacy (Part D) Programs Formulary

The Health Alliance Medicare Part D formularies were created to assist in the management of ever-increasing costs of prescription medications.

Formularies have successfully helped health insurance organizations throughout the country provide members and physicians with a reference for cost-effective medical treatment.

The Medicare Part D formularies were created under the guidance of physicians and pharmacists representing most specialties.

It is our belief that the Medicare Part D formularies can enhance the doctor’s ability to provide quality, cost-effective care to Health Alliance Medicare members. The use of products on the Medicare Part D Formularies, including generics, is encouraged as a method to ensure members are receiving quality care at a lower cost.

To view our formulary online, visit HealthAllianceMedicare.org and choose “Medicare Part D Formulary” under “Prescription Coverage.” To search within the document, choose the search function (the picture of binoculars), enter a drug name and click “Search.”

Innovative Pharmacy Initiatives

Health Alliance Medicare voluntary pharmacy programs offer convenience and savings.

• Mail-Order Convenience—home delivery of prescription drugs • Online Prescription Assistance—log in at YourHealthAlliance.org and click “My Drug Benefit” on the Member Dashboard tab to view copayments and more • DailyMed—service that sorts your medicines, making them easier to take correctly • Low-Cost Generics Program—$0 Tier 1 prescription drugs at Walmart and Sam’s Club To reach the Health Alliance Pharmacy Department, please call 1-800-851-3379, option 4, 8 a.m. to 5 p.m., weekdays.

For more information on how to use your pharmacy benefits, an explanation of limits and our processes for generic substitution and step therapy, visit HealthAllianceMedicare.org and click “Coverage Requirements” under “Prescription Coverage” near the bottom of the screen.

Health Alliance Ensures Reasonable Access to Services Health Alliance is committed to providing you with efficient, cost-effective, quality health care coverage.

Health Alliance never encourages underutilization of care. We do not give financial inducements or set quotas for denying care or coverage, nor do we keep statistics identifying individual providers and their

denial rates. The utilization decisions our medical directors, nurse coordinators, pharmacy coordinators and pharmacists make are based only on appropriateness of care and service and the existence of coverage. There are no incentives, financial or otherwise, to deny access to services.

We Partner with Physicians We regularly seek input from all doctors in our network regarding policies under development or review. Through regular (every other month) e-newsletters, we communicate with our physician

network. Practicing physicians are also involved on several of our committees to foster idea-sharing and improve the quality of our programs.

We Respect Your Privacy Protecting your medical information is a responsibility we take very seriously. Health Alliance follows Health Insurance Portability and Accountability Act (HIPAA) regulations to ensure that your information is kept confidential. This means we will only use and disclose your information in

ways that are permitted by law. For a complete copy of our website Privacy Policy or our Notice of Privacy Practices, please contact Health Alliance Medicare Services. This information is also available on our website at HealthAllianceMedicare.org.

You Have the Right to an Independent Review For members with Medicare Part C medical benefits, if we deny any part of your first appeal, the entire case, including your appeal letter, will automatically be forwarded for another review with a governmentcontracted independent review entity (IRE).

For members with Medicare Part D prescription drug benefits, if we deny any part of your first appeal, you or your appointed representative may ask for

a review by a government-contracted independent review entity (IRE).

You must file a written appeal request within 60 calendar days after the date you were notified of the decision on your first appeal to the address included in the redetermination notice you receive from us.

For more information, please read your Evidence of Coverage or call 1-800-500-3373, Monday-Friday, 8 a.m. to 5 p.m.

Planning Ahead You have a right to accept or refuse treatment and to complete an advance directive. If you’re not satisfied with how we’ve handled an advance directive, you have the right to file a complaint with the state survey and certification agency. Information on advance directives and how to file a complaint

are addressed in your Evidence of Coverage under “Your Rights to Use Advance Directives.”

For more information, contact Health Alliance Medicare Services to request a copy of the brochure “Planning Ahead.”

Health Alliance Medicare is a health plan with a Medicare contract.

Call us 8 a.m. to 8 p.m. weekdays Toll-free 1-800-965-4022 TTY/TDD 711 or 1-800-526-0844 (Illinois Relay) HealthAllianceMedicare.org med-2013Essential-0213

Health Alliance Medicare members can receive discounts at various gyms, health clubs and weight loss centers. To learn more, call 1-888-382-9781.

To check out our wellness programs and other helpful health information, visit HealthAllianceMedicare.org and click on “Why Health Alliance.” Then select “Health Savings and Programs” under “Additional Services.”

Pharmacy (Part D) Programs Formulary

The Health Alliance Medicare Part D formularies were created to assist in the management of ever-increasing costs of prescription medications.

Formularies have successfully helped health insurance organizations throughout the country provide members and physicians with a reference for cost-effective medical treatment.

The Medicare Part D formularies were created under the guidance of physicians and pharmacists representing most specialties.

It is our belief that the Medicare Part D formularies can enhance the doctor’s ability to provide quality, cost-effective care to Health Alliance Medicare members. The use of products on the Medicare Part D Formularies, including generics, is encouraged as a method to ensure members are receiving quality care at a lower cost.

To view our formulary online, visit HealthAllianceMedicare.org and choose “Medicare Part D Formulary” under “Prescription Coverage.” To search within the document, choose the search function (the picture of binoculars), enter a drug name and click “Search.”

Innovative Pharmacy Initiatives

Health Alliance Medicare voluntary pharmacy programs offer convenience and savings.

• Mail-Order Convenience—home delivery of prescription drugs • Online Prescription Assistance—log in at YourHealthAlliance.org and click “My Drug Benefit” on the Member Dashboard tab to view copayments and more • DailyMed—service that sorts your medicines, making them easier to take correctly • Low-Cost Generics Program—$0 Tier 1 prescription drugs at Walmart and Sam’s Club To reach the Health Alliance Pharmacy Department, please call 1-800-851-3379, option 4, 8 a.m. to 5 p.m., weekdays.

For more information on how to use your pharmacy benefits, an explanation of limits and our processes for generic substitution and step therapy, visit HealthAllianceMedicare.org and click “Coverage Requirements” under “Prescription Coverage” near the bottom of the screen.

Health Alliance Ensures Reasonable Access to Services Health Alliance is committed to providing you with efficient, cost-effective, quality health care coverage.

Health Alliance never encourages underutilization of care. We do not give financial inducements or set quotas for denying care or coverage, nor do we keep statistics identifying individual providers and their

denial rates. The utilization decisions our medical directors, nurse coordinators, pharmacy coordinators and pharmacists make are based only on appropriateness of care and service and the existence of coverage. There are no incentives, financial or otherwise, to deny access to services.

We Partner with Physicians We regularly seek input from all doctors in our network regarding policies under development or review. Through regular (every other month) e-newsletters, we communicate with our physician

network. Practicing physicians are also involved on several of our committees to foster idea-sharing and improve the quality of our programs.

We Respect Your Privacy Protecting your medical information is a responsibility we take very seriously. Health Alliance follows Health Insurance Portability and Accountability Act (HIPAA) regulations to ensure that your information is kept confidential. This means we will only use and disclose your information in

ways that are permitted by law. For a complete copy of our website Privacy Policy or our Notice of Privacy Practices, please contact Health Alliance Medicare Services. This information is also available on our website at HealthAllianceMedicare.org.

You Have the Right to an Independent Review For members with Medicare Part C medical benefits, if we deny any part of your first appeal, the entire case, including your appeal letter, will automatically be forwarded for another review with a governmentcontracted independent review entity (IRE).

For members with Medicare Part D prescription drug benefits, if we deny any part of your first appeal, you or your appointed representative may ask for

a review by a government-contracted independent review entity (IRE).

You must file a written appeal request within 60 calendar days after the date you were notified of the decision on your first appeal to the address included in the redetermination notice you receive from us.

For more information, please read your Evidence of Coverage or call 1-800-500-3373, Monday-Friday, 8 a.m. to 5 p.m.

Planning Ahead You have a right to accept or refuse treatment and to complete an advance directive. If you’re not satisfied with how we’ve handled an advance directive, you have the right to file a complaint with the state survey and certification agency. Information on advance directives and how to file a complaint

are addressed in your Evidence of Coverage under “Your Rights to Use Advance Directives.”

For more information, contact Health Alliance Medicare Services to request a copy of the brochure “Planning Ahead.”

Health Alliance Medicare is a health plan with a Medicare contract.

Call us 8 a.m. to 8 p.m. weekdays Toll-free 1-800-965-4022 TTY/TDD 711 or 1-800-526-0844 (Illinois Relay) HealthAllianceMedicare.org med-2013Essential-0213

HEALTH ALLIANCE 301 S VINE ST. URBANA IL 61801-3347

A Special Delivery Don’t worry if a survey from the Centers for Medicare & Medicaid Services (CMS) shows up in your mailbox. When you fill it out, you will help Health Alliance Medicare and CMS better understand your needs, your thoughts and most importantly, the quality of care you get.

CMS sends the surveys at random. They may ask you to complete one, two or no surveys at all. Your answers are private. And what you share in the survey will not change your Medicare coverage in any way.

Sometimes the questions on these surveys can be confusing or ask you to recall your medical history

from the last year. Please answer the best you can, but do not leave a question blank.

Be on the Lookout • In March—Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey • In April—Health Outcomes Survey (HOS) If you have any questions, please call Health Alliance Medicare Services or the number listed on the surveys.

It’s in the Stars Why Star Ratings Matter … to You You’ve likely heard of Medicare Star Ratings.

You might not know what they mean or why they’re important.

the Centers for Medicare & Medicaid Services (CMS). Plan performance star ratings are assessed each year, and may change from one year to the next.

A PUBLICATION OF HEALTH ALLIANCE MEDICARE

HouseCalls

Medicare Star Ratings help people choose a top-quality plan. Plan ratings show excellence. Our Star Ratings mean we partner with great It’s a five-star system, and more stars mean doctors who meet our high standards and better quality of care and customer service. those of CMS, too. It shows we have first-rate customer service and strong health plans that Health Alliance Medicare PPO and HMO meet the needs of our members. It means we plans earned 4.5 stars each for 2013 from put you first.

Chief Executive Officer Jeffrey Ingrum Chief Medical Officer Robert Parker, MD Vice President of Corp.

Communications Jane Hayes

Editorial Board James Burke, MD Patrick Harness Jennifer Marquardt Laura Mabry Reba Karr, RN

Becky Aiken Hollie Wilson Lisa Gascoigne Nancy Keith

Editor Emily Beach Graphic Design Jason Bentley 8 a.m to 8 p.m. weekdays Toll-free 1-800-965-4022 TTY/TDD 711 or 1-800-526-0844 (Illinois Relay) HealthAllianceMedicare.org