Bruce Butler, CEO
In my seventh month on the job as the CEO of Valley Health Plan (VHP), it’s a privilege to send a greeting to our growing membership.
I’d like to announce that VHP is celebrating our 30th Anniversary. VHP has been given great opportunities to grow over the last three decades. Since 1985, VHP has served the community with quality service and health insurance. In 2013, VHP had the honor of being selected as one of only twelve health plans in California to offer health insurance through Covered California, offering health insurance to the public and covering residents of Santa Clara County, many for the first time ever. All of our Members have access to benefits such as a 24/7 Nurse Advice line, a nationwide network of Safeway and Walgreens pharmacies, free preventive health education and disease management programs, as well as our online wellness portal to help track and self-manage your health and well-being. As the only locally based commercial health plan in Santa Clara County, we pride ourselves on having personal service and a location where Members can walk in to speak with us. We understand that Summer | Fall 2015
your health care needs are as unique as you are and I thank you for your continued membership. Thank you,
A Message from the New CEO.........1 Speaking the Language of Health in Your Preferred Language...............2 Choosing & Changing Your Primary Care Physician (PCP) .......................2 Member Information...........................3 A Guide to Emergency Department Services.............................................4 Timely Access....................................6 The Link Between Your Health & VHP HEDIS Scores .......................8 Member Grievance..........................10
The Flu Ends with U ........................ 11 Coordination of Care........................ 11 Call it Quits for Good........................12 Healthy Meals to Get You Through the Day..............................12 Health Education Wellness Programs..........................................13 Farmers’ Market Picks for Summer & Fall.................................14 Preventive Health Guidelines..........14 VHP Department Profile..................14 Pharmacy Information......................15
Table of Contents
Member Newsletter
New CEO
Perspectives
message from THE
speaking the language of health
In Your Preferred Language English
Speaking the Language of Health…in your Preferred Language As a Member, Valley Health Plan can help you in your language at no cost. If you would like to talk to us or ask for information in your language, please call 1.888.421.8444 during business hours.
Spanish Le servimos…En el idioma de su preferencia Como miembro, Valley Health Plan puede ayudarle en su idioma sin costo alguno. Si desea hablar con nosotros o recibir información en su idioma, por favor llame al 1.888.421.8444 durante horas de oficina.
Vietnamese
Chúng Tôi Chăm Sóc Sức Khỏe Cho Qúy Vị… Bằng Ngôn Ngữ của Qúy Vị Là hội viên, Valley Health Plan có thể giúp qúy vị bằng ngôn ngữ của qúy vị miễn phí. Nếu qúy vị muốn nói chuyện với chúng tôi hoặc yêu cầu thông tin bằng ngôn ngữ của qúy vị, xin vui lòng gọi 1.888.421.8444 trong giờ làm việc.
choosing & changing
Your Primary Care Physician (PCP)
Valley Health Plan (VHP) offers you several ways to choose a Primary Care Physician (PCP). You can make an informed decision and find the right provider for you and your family by: • Visiting www.valleyhealthplan.org to learn about our provider networks using our Provider Search • Talking to our knowledgeable Member Services staff about our providers As a Member, you have the right to change your Primary Care Physician at any time. The change will take effect on the first day of the next month after your request is received. During that time, a new card will be sent to you with the name of your new PCP. It is important that you wait to seek services from your new PCP until the change has become effective or you could be financially responsible. To choose or change your PCP, contact VHP Member Services at member.services@vhp.sccgov.org or by calling 1.888.421.8444 (toll-free).
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member Information
Is Your Information Up-to-Date? It is very important that Valley Health Plan (VHP) has your correct address and phone number on file. We want to make sure you receive our important mailings about additions or changes to benefits, providers/networks, or tools to help you maintain your overall health. If your information has changed, please call the number that applies to your coverage: Employer Group Plan Members Human Resources Department
Covered California Plan Members Covered California Service Center 1.800.300.1506
Individual & Family Plan Members Valley Health Plan Member Services 1.888.421.8444 (toll-free), Option 3
Member Fraud Notice Valley Health Plan (VHP) is committed to providing Members with quality care. Please notify VHP of any suspicious activity you might witness while receiving care from a Plan Provider. All complaints regarding fraud will be investigated and necessary actions will be taken to protect members from unlawful activities. If you believe you’ve experienced or are aware of any type of fraud (waste or abuse of VHP healthcare resources), please contact VHP Member Services Department at memberservices@vhp.sccgov.org or by calling 1.888.421.8444 (toll-free).
Member Updates Periodically, Valley Health Plan sends Member Updates that include information such as benefit information or changes, network additions, changes in policy, and new state regulations. Please keep these updates with your VHP Evidence of Coverage & Disclosure Form (EOC) booklet. These Member Updates along with articles in the Perspectives Newsletter will be your notification of changes related to your contract with Valley Health Plan.
New Technology Review Valley Health Plan has a rigorous process in place to evaluate new technologies that are being developed such as for drugs, medical and behavioral health procedures, and medical devices. VHP’s Utilization Management Committee and Pharmacy & Therapeutics Committee, under the supervision of the VHP Chief Medical Officer, review many areas to make sure that these are safe and effective prior to covering the new technology as a benefit. VHP uses scientific literature, peer-reviewed journal articles, information from medical societies, and government agencies such as the Food and Drug Administration (FDA) to make decisions. New technology that has not been initially approved because its safety or effectiveness has not been demonstrated can be reviewed in the future when more information becomes available.
Provider Directory Valley Health Plan or a delegated entity (such as a hospital or medical group) credentials all physicians in the network and verifies the background and education of all practitioners. The Provider Directory provides general information on all practitioners. If you would like specific information on a physician such as the medical school attended, residency completed, or board certification status, please contact Member Services at 1.888.421.8444 (toll-free).
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a guide to emergency department Services When a true emergency happens, the first thing that comes to mind is “Call 911.” But what if you are unsure whether you have a true emergency? What do you do then? The answer to this question is not always simple, but knowing the difference between going to the Emergency Department (ED) or the Urgent Care Center (UCC) may help save time while getting the services you require. UCCs are mainly designed to provide treatment of less serious conditions when a Primary Care Physician (PCP) is not available. While these UCCs operate daily and at times with extended hours, they are not equipped to handle major medical emergencies such as trauma. Many UCCs also operate on a first come, first serve basis, so you may experience shorter wait times. Emergency Departments treat all acute and potentially life-threatening conditions and are open 24 hours a day, seven days a week. In the ED, patients are treated based on the severity of the illness and this may cause congestion and longer wait times. The frequent use of EDs for inapproppriate medical treatment can also increase wait times. If you don’t have a life-threatening emergency, VHP recommends that you call your PCP office first whenever possible. Your PCP knows your health history including other underlying health problems and can help coordinate your care. During an office visit, your PCP can order tests or initiate treatments, if appropriate. Building a solid relationship with your PCP is really important since they can help you make the best decision possible. VHP also understands that medical problems can happen when your doctor’s office is closed. VHP wants to assure you that help is available to you 24 hours a day, seven days a week. VHP is here to assist you by providing the following table:
Options PCP Office
Details VHP encourages you to choose your own Primary Care Physician (PCP) who is responsible for taking care of your routine health care needs. Your PCP will coordinate your health care services including making referrals for medically necessary services.
Services Available Call your network PCP appointment number to schedule a visit. During the PCP visit, you can expect your doctor to: • Give vaccinations • Refill prescriptions • Conduct a thorough physical examination • Treat minor health problems such as fever, colds, or flu • Educate you on free VHP resources available to you e.g. Complex Case or Disease Management and Health Education programs • Order labs for diagnostic or preventive tests • Provide follow-up care after ED and UCC visits or hospitalizations • Refer you to a specialty care provider when needed
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Hours By appointment
Contact Information Use the Provider Search on our website at www. valleyhealthplan.org or call Member Services at 1.888.421.8444 (toll-free) for more information about VHP PCP’s.
Emergency Department (ED) vs Urgent Care Center (UCC) Options 24/7 Nurse Advice Line
Urgent Care Centers
Details
Services Available
Hours
The 24/7 Nurse Advice line is available to help you find the appropriate care for your medical situtation.
Speak to an experienced nurse who can answer urgent and non-urgent questions, assess symptoms, and provide care recommendations.
24/7
VHP has several network urgent care centers, many with services available on a walk-in basis.
Examples of situations that can be treated in the UCC include, but are not limited to, the following:
Days, evenings, weekends
Contact Information Employer Group Members call 1.866.682.9492 (toll-free) Covered California and Individual & Family Plan Members call 1.855.348.9119 (toll-free)
• Fever or flu • Minor cuts, injuries, or lacerations
For a complete list of UCC locations and hours of operation, visit www. valleyhealthplan.org or call Member Services at 1.888.421.8444 (toll-free).
• Eye irritation • Urinary Tract Infection (UTI) • Sore throat • Skin rashes/infection • Sprains/minor fractures (toes, fingers) • Upper Respiratory Tract infection Emergency Department
In the case of a lifethreatening situation or an emergency, call 911 or go to the nearest Emergency Department.
Examples of emergency situations include, but are not limited to, the following: • Severe bleeding • Difficulty breathing
24/7
If you have a lifethreatening emergency, call 911 or go to the nearest Emergency Department.
• Chest pain or pressure • Broken bone(s) • Trauma or injury to the head/ body • Knife or gunshot wound • Sudden dizziness • Difficulty seeing • Suspected stroke • Severe pain • Severe burns • Loss of consciousness or seizures
Remember if you have a life-threatening emergency, please call 911 or go to the nearest Emergency Department. 5
timely access
How Much Time Should it Take to Access Health Care Services? Valley Health Plan (VHP) would like to keep you informed of the important facts regarding the California Timely Access Standards. The California Department of Managed Health Care (DMHC) requires health plan members to be seen in a timely manner. The primary intent of these regulations and the underlying legislation is to ensure that the VHP network of providers have the capacity and availability to provide care to you within certain timeframes for the various levels of care. Please take time to read the following California Timely Access Standards.
Appointment Scheduling Emergency services
Maximum Waiting Time Immediately
Urgent Care appointments that do not require prior authorization from a Primary Care Practitioner (PCP)
Within 48 hours of request
Urgent Care appointments that require prior authorization
Within 96 hours of request
Non-urgent appointments for PCP Non-urgent appointments with Specialty Care Physicians (SCP) including Obstetrical Care Non-urgent appointments for Ancillary Services (for diagnosis or treatment of injury, illness, or other health condition) Office/Clinic Wait Time (From appointment registration time to when seen by the practitioner/doctor.)
Availability of Behavioral Health Care practitioners Life threatening emergency Non-life threatening emergency Urgent Care appointments
Within 10 business days of request Within 15 business days of request Within 15 business days of request
Maximum 30 minutes (VHP Standard)
Maximum Waiting Time Immediately Within 6 hours Within 48 hours of request
Non-urgent appointments with Psychiatrists
Within 10 business days
Non-urgent appointments with a non-physician Behavioral Health Care Practitioner (Psychologist, MFT, LCSW) and Psychiatrist
Within 10 business days
Office/Clinic Wait Time
After-Hours Care 24/7 Nurse Advice Line
VHP has a standard of 30 minutes maximum (The time from appointment registration until you see the practitioner/doctor) AVAILABILITY Employer Group Members: Call 1.866.682.9492 (toll-free) including holidays and weekends. Covered California and Individual & Family Plan Members: Call 1.855.348.9119 (toll-free) including holidays and weekends.
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VHP would also like to advise you that it is important for you to receive a call back from your health professionals and practitioners. If you are unable to directly reach your health care provider, the law requires you to be told, by live operator or recorded message, how long it will take to get back to you. For triage and screening services, health plans are required to provide 24/7 triage or screening services for you by telephone. Waiting times for triage or screening services may not exceed 30 minutes. However, the waiting time must be appropriate for the problem and if that problem is urgent, a plan’s screening and triage must respond more quickly. Lastly, VHP continues to provide health care advice through the 24/7 Nurse Advice Line including holidays and weekends. Employer Group Members can call 1.866.682.9492 (toll-free) and Covered California and Individual & Family Plan Members can call 1.855.348.9119 (toll-free). VHP, along with our Community Health Partners and Network Practitioners, works collaboratively to provide the utmost quality of care to meet or exceed the timely access requirements necessary to meet your health needs. VHP sincerely appreciates you for being our valued Members. Thank you for your continued confidence as we look for ways of providing you with the best available care and services possible. For more information, please visit VHP website at www.valleyhealthplan.org, review the Combined Evidence of Coverage (EOC) and Disclosure Form, call your health care provider, or contact VHP Member Services at 1.888.421.8444 (toll-free).
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the link between Your health & VHP HEDIS Scores What is HEDIS? The Healthcare Effectiveness Data and Information Set (HEDIS) is about a set of standardized performance measures generated by the National Committee for Quality Assurance (NCQA). NCQA is national, not-for-profit organization dedicated to improving and advocating on health care quality and safety. HEDIS is a tool adapted by the majority of health plans to measure performance while comparing health plans to each other. HEDIS consists of over 20 Effectiveness of Care type measures as well as Access to Care and Use of Services measures. These rates are calculated based on data sets or medical records and reported to NCQA, the Centers for Medicaid and Medicare Services (CMS), and/or state agencies as required.
Why is HEDIS important? Through HEDIS, NCQA ensures that Valley Health Plan (VHP) is accountable for the timeliness and quality of care provided for both acute and preventive medical and behavioral (mental) health services. VHP also reviews HEDIS data on an ongoing basis to identify opportunities for improvement and prioritize actions to improve rates. VHP values our relationship with you and we are committed to serving our Members. With our Member’s help, VHP can achieve our goal of improving health status through the use of HEDIS measures. We encourage you to be an active participant in your health so you can make informed health care choices or decisions.
What can you do to help? VHP strongly believes that screening saves lives. VHP would like to optimize your health outcomes by encouraging Members to participate in this year’s screening campaign. You can help by: a. Seeing your doctor at least once per year. b. Talking to your doctor about screenings and preventive health treatments that may benefit you and help you to stay in control of your health. c. Re-scheduling missed appointments as soon as possible. Follow-up is important to prevent lapse or lag in your screening or treatment.
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What needs to be done for screening? The following are recommended screenings that we encourage you to speak with your doctor about and participate when needed: 1. Breast Cancer Screening – Breast cancer is one of the most commonly diagnosed cancers; it accounts for a quarter of all new cancer diagnoses among women in the United States. Breast cancer is also the second leading cause of cancer deaths in women accounting for 40,000 deaths in 2012. Breast cancer screening measures like mammography can improve outcomes as it is known that early detection is attributed to a decline in breast cancer deaths. 2. Cervical Cancer Screening - Cervical cancer was once the most common type of cancer affecting women in the U.S. Although incidence and death rates have decreased because of cervical cancer screening, regular screening is critical to detecting precancerous stage early as rates are still high in populations with limited screening access. 3. Cholesterol Management - High cholesterol puts people at increased risk for heart disease when fat deposits stick to the walls of the artery and eventually decrease blood flow. High cholesterol has no symptoms, making screening vital to diagnosing and treating this silent indicator of heart disease. Lowering the level of bad (LDL) cholesterol in patients with coronary heart disease reduces the risk that they will suffer another cardiac event or stroke. When you get properly screened, it helps your doctor come up with a plan to improve your health and prevent future heart problems. 4. Controlling High Blood Pressure - Managing high blood pressure is an important step in preventing cardiovascular disease. High blood pressure, or hypertension, is the excess force of blood against artery walls. This increase in pressure leads to greater risk of heart disease. High blood pressure may not have symptoms, so proper screening is very important for diagnosis, treatment, and control. Approximately 69% of people who suffer a first heart attack, 74% of people with chronic heart failure, and 77% of people who have a stroke have high blood pressure. VHP advocates and supports lifestyle changes to lower blood pressure which is an effective way to improve overall wellness and reduce deterioration of health. 5. Colorectal Cancer Screening - Symptoms of colorectal cancer often do not manifest until the disease has progressed and chances of survival have decreased, which is why early screening is important. When treatment is initiated during the earliest stage of the diseases, the success rate is high, with a five-year survival rate of 74%. In addition, most colorectal cancers occur in people without a family history of colorectal cancer. 6. Chlamydia Screening in Women - Chlamydia is the most commonly reported sexually transmitted disease in the U.S., occurring most often among adolescent and young adult females. Chlamydia is often known as a “silent” disease because most infected people are asymptomatic. If a chlamydia infection is left untreated, it can lead to serious and irreversible complications, including pelvic inflammatory disease (PID), infertility, and increased risk of becoming infected with HIV. Chlamydia is easily detected and treated, but screening remains underutilized. Challenges affecting annual screening rates include lack of patient awareness and social stigma about seeking or discussing screening. It is believed that about 30,000 cases of PID could be prevented if the chlamydia screening rate for sexually active young women increased to 90%. 7. Diabetes Screening - As the seventh leading cause of death in the U.S., diabetes kills nearly 70,000 people a year. Especially when unmanaged, diabetes can cause serious health complications, including heart disease and stroke, hypertension, blindness, kidney disease, nervous system disease, amputations, dental disease, and pregnancy complications. People with diabetes can reduce their risk of serious complications by controlling their levels of blood sugar and by receiving preventive screenings in a timely manner.
Who should you contact? These are just a few of the health screenings that VHP is focused on this year. Your active participation in health screening can saves lives and by working together, VHP can help improve your health outcomes. VHP is here to help if you have any questions, comments, or concerns related to the annual HEDIS screening campaign. For assistance, contact your doctor or call VHP Member Services at 1.888.421.8444 (toll-free). Reference: National Committee on Quality Assurance (NCQA) - HEDIS and Performance Measurement. 9
member Grievance At Valley Health Plan (VHP), we take pride in being a member focused health plan. Our Member Services Department can assist you in resolving your concerns. VHP Member Services Representatives can be reached by calling 1.888.421.8444 (toll-free), Monday through Friday between 9:00am to 5:00pm. If you have a problem or concern and you would like to file a Grievance, you can contact the Member Services Department by phone, send a letter or complete a Grievance form and submit it to VHP. Grievance forms are available through VHP, at your provider’s office, and at www.valleyhealthplan.org Send your Grievance to: Valley Health Plan Atten: Grievance Manager, 2480 N. First Street, Ste. 200 San Jose, CA 95131 Alternatively, you may also submit your Grievance online at www.valleyhealthplan.org
entitled to an Expedited Review. The Grievance must initially state that you are requesting an Expedited Review. If your Grievance meets the criteria for an Expedited Review you will be notified of the outcome or status within three (3) working days of receipt of the Expedited Grievance.
If you are not satisfied with the decision of your Grievance, you may contact Please include all pertinent information the California Department of Managed Health Care (DMHC) by following the procedures outlined below. from your VHP ID Card as well as the details and circumstances surrounding DMHC Consumer Help-Line your concern or problem. Providing “The California Department of Managed Health Care is responsible for as much information as possible may regulating health care service plans. If you have a grievance against your eliminate the time required to collect health plan, you should first telephone your health plan at 1.888.421.8444 such data. Pertinent information should include any medical records or (toll-free) or visit the Web site www.valleyhealthplan.org and use your health plan’s grievance process before contacting the Department. For the physician opinions in support of your hearing and speech impaired, call the California Relay Service (CRS) by Grievance. If these are not provided, simply dialing 711 or the 800 CRS number of your modality. Utilizing this your medical records may need to be grievance procedure does not prohibit any potential legal rights or remedies obtained from your Plan Physician or that may be available to you. If you need help with a grievance involving an you may need to obtain them from a emergency, a grievance that has not been satisfactorily resolved by your Non-Plan Physician. health plan, or a grievance that has remained unresolved for more than 30 VHP will review your Grievance. You days, you may call the Department for assistance. You may also be eligible will be notified of the outcome within for an Independent Medical Review (IMR). If you are eligible for IMR, the thirty (30) calendar days of receiving IMR process will provide an impartial review of medical decisions made your Grievance. If the Grievance by a health plan related to the medical necessity of a proposed service involves an imminent and serious or treatment, coverage decisions for treatments that are experimental or threat to your health or the health of investigational in nature and payment disputes for emergency or urgent your Dependents, including but not medical services. The Department also has a toll-free telephone number limited to, severe pain, psychological (1.888-HMO.2219) and a TDD line (1.877.688.9891) for the hearing and wellbeing, potential loss of life, limb speech impaired. The Department’s Internet Web site www.hmohelp. or major bodily function, you will be ca.gov has complaint forms, IMR application forms and instructions online.” 10
the flu Ends with U
The Center for Disease Control and Prevention (www.cdc.gov/flu) recommends that anyone over the age of 6 months get the flu vaccine. It is important to get your flu vaccine early if you have a medical condition that puts you at higher risk for flu-related complications. As a VHP Member, there are many ways to get your FREE flu vaccine this year! • Schedule a flu vaccine appointment with your PCP • Ask for the vaccine at your next doctor’s visit • Walk into any Walgreens or Safeway pharmacy and show your VHP ID Card For more details and information, visit www.valleyhealthplan.org or call VHP Member Services at 1.888.421.8444 (toll-free).
coordination of Care Valley Health Plan’s (VHP) mission is to ensure you receive quality care and service at the right time, at the right place, by the right provider. As a patient, you will benefit when your doctors, health care providers, and/or hospitals coordinate care while working as a team. The goal of coordinated care is to make sure that you receive the right care at the right time, avoiding unnecessary duplication of services and the preventing medical errors. One way you can help with coordination of care is for you to review and complete an Authorization for Use and/Disclosure of Protected Health Information Form. Your health care practitioner will have a form or the one below is located on the VHP website at www.valleyhealthplan.org under Member Materials > Forms & Resources. Your physician or health care practitioner will be able to explain the importance of completing this form and receiving your information from other health care practitioners. The sharing of health information ensures your physician has all the important information about your health history which helps them understand your physical and emotional health needs, providing comprehensive coordination of care and improved health outcomes. 11
Healthy meals To Get You Through the Day Healthy Meals Made Simple!
Healthy and tasty meals don’t have to be complicated. Join our guest chef for a FREE cooking demonstration on how to prepare quick, healthy breakfast and lunch items for the entire family.
Space is limited – register to reserve your space today! Registration deadline is Monday, November 2, 2015. Wednesday, November 4, 2015 Sobrato Center for Nonprofits, Cupertino Room B, 1400 Parkmoor Avenue, San José, CA 95126 5:30 pm – 7:30 pm Free tasting, light dinner and spa water will be provided. All attendees will receive a complimentary gift. To register, visit www.valleyhealthplan.org, or contact the VHP Health Education Department at healtheducation@vhp.sccgov.org or 408.885.3490 for more information. This event is sponsored in partnership with the Santa Clara County Public Health Department.
call it quits for Good
Every year, on the third Thursday of November, smokers across the nation take part in the American Cancer Society Great American Smokeout. They may use the date to make a plan to quit, or plan in advance and then quit smoking that day. The Great American Smokeout event challenges people to stop using tobacco and helps people know about the many tools they can use to help them quit and stay quit. For more information on quitting tobacco or to find telephone counseling or other support in yoru area, visit the American Cancer Society website at cancer.org/quittobacco or call them at 1.800.227.2345 (toll-free). 12
Health educaton wellness Programs Online Wellness Portal and Your Annual PHA In just 15 minutes, you can take your annual Personal Health Assessment (PHA) and earn 1000 wellness points to go toward rewards. Visit https://vhp.mycernerwellness.com and earn your first reward today! We encourage you to take your PHA annually to compare your progress each year. While the PHA is not meant to diagnose any conditions, it will shed light on lifestyle choices and behaviors as well as provide you with the resources to start addressing your health risks.
Level 3 Reward - VHP Sling Bag
After you take your PHA, you will have access to valuable resources to help you achieve your wellness goals. Awareness and education are the first steps in taking charge of your health. Evaluate your current health status, view your health assessment report and recommendations, compare your results from last year’s report, and discover free support resources, all while earning rewards!
Wellness Classes VHP offers a variety of wellness classes for all ages. Get your heart pumping with our Total Body Condition class or relax and de-stress in one of our various yoga classes. We also offer Chronic Disease Prevention & Management classes free to Members! Visit www.valleyhealthplan.org to register. To view all classes, go to www.valleyhealthplan.org and select:
I’m a Member > Choose Your Plan > Health & Wellness > Classes
Weight Watchers Valley Health Plan offers two Weight Watchers (WW) program options. Members are eligible to receive two benefits per calendar year. Option 1: Receive ten vouchers to attend any WW meetings convenient to work or home. These vouchers can be sent to your home by certified mail or you can pick up in person at our office location. Option 2: The Weight Watchers “At Work” Program. These meetings are held at several convenient County of Santa Clara work locations. Meetings run one hour and typically run 10-17 weeks. The Health Education Department is here to help you achieve your health and wellness goals. For more information, valuable resources, or to find convenient locations near you, please contact the Health Education Department at healtheducation@vhp.sccgov.org or 408.885.3490.
5 Reasons to join Weight Watchers At Work - Convenience and flexibility - Ideas customized to the workplace to help you lose weight - Motivation with your co-worker - A healthier environment helps promote success - Can work for both men and women 13
farmers’ market Picks for Summer & Fall What’s in Season?
Take a trip to your local Farmers’ Market for in-season fruits & vegetables. Try something new or try a new healthy recipe with some of your favorite foods. You can find healthy recipes on www.valleyhealthplan.org under Health & Wellness > Healthy Eating as well as a listing of local Farmers’ Markets near you. Summer Fruits & Vegetables Apples - Asparagus - Avocados - Beets - Collard Greens Eggplant - Figs - Melon - Peppers - Spinach - Turnips Fall Fruits & Vegetables Basil - Brussels Sprouts - Cabbage - Chard - Cauliflower Grapefruit - Green Beans - Mushrooms - Persimmon Tomatillos - Yams
preventive health Guidelines
Valley Health Plan (VHP) encourages you to make an appointment with your Primary Care Physician (PCP) every year. Visit www.valleyhealthplan.org to find the recommended preventive health guidelines for screenings and immunizations. These guidelines are updated annually by the VHP Utilization Management Committee that includes practicing physicians. These guidelines are based on those from the Centers for Disease Control (CDC) and the United States Preventive Services Task Force (USPSTF). If you don’t have access to the internet and would like a copy of the guidelines, please contact Member Services at memberservices@vhp.sccgov.org or 1.888.421.8444 (toll-free).
VHP Department Profile
Finance Department
The Valley Health Plan (VHP) Finance Department is responsible for a variety of operational finance functions. In accordance with the County of Santa Clara’s financial processes, the Finance Department oversees a wide range of financial functions including, Accounts Payable, budgeting, forecasting, and rates development. The team is made up of three accounting personnel and two analysts under the Financial Manager. The entire team, and the core financial functions, fall under VHP’s Chief Financial Finance Department: Grace Kieler, Vanessa Tran, Jeannie Nguyen (Manager), Officer. The Finance Department also performs the Lindy Yeung, Emily Cai enrollment function for VHP’s individual products. VHP prides itself on being customer service-focused and the Finance Department is a good example of that. The team works frequently with Members, providers, and service providers to ensure prompt service delivery to all of VHP’s valued clients. Finance staff are available to assist in a variety of finance-related inquiries including but not limited to Member premium questions and payments, provider payments, and service contract payments. For any questions or to speak with a member of the finance team, call 1.888.421.8444 (toll-free). 14
pharmacy Information Formulary Review & Updates The Valley Health Plan (VHP) drug formulary is reviewed quarterly and updated by the VHP Pharmacy and Therapeutics (P&T) Committee. The P&T Committee uses information from many sources to determine the status of each drug. The Committee decisions include adding drugs to the formulary, requiring prior authorization for some drugs, requiring quantity limits or step therapy, the process for generic substitution, therapeutic interchange, or not adding the drug to the formulary. These decisions are based on US Food and Drug Administration (FDA) approval, scientific articles, drug safety, and whether there are other like drugs available that accomplish similar results. For information about VHP P&T Committee, please refer to your Valley Health Plan Benefits and Coverage Handbook – Combined Evidence of Coverage and Disclosure Form (EOC), including additional supplemental pharmaceutical management procedures. Occasionally, VHP will require your provider to fill out a Prescription Drug Prior Authorization Request Form for drugs that have Prior Authorization criteria or are not on the VHP Formulary. These forms will be reviewed by a pharmacist and/or a physician and approval will be based on established criteria and medical necessity. VHP posts a drug formulary and a summary of updates to the website quarterly after each VHP P&T meeting. Visit www.valleyhealthplan.org for additional
information or to view the drug Formulary, summary of updates, and the EOC online. If you do not have access to the Internet and would like a printed copy of any material, please call VHP Member Services at 1.888.421.8444 (toll-free).
Navitus Health Solutions Navitus Health Solutions is Valley Health Plan’s (VHP) Pharmacy Benefit Manager (PBM). Navitus Health Solutions administers the pharmacy benefit on behalf of VHP including customer service, formulary maintenance, Prior Authorizations, Exception to Coverage, and drug recall notifications. If you have any questions, please call VHP Member Services at 1.888.421.8444 (toll-free) to answer your pharmacy benefit questions.
Drug Recall Navitus receives notification from the US Food and Drug Administration’s (FDA) recall posting. Valley Health Plan members and prescribing practitioners affected by a Class II recall or voluntary drug withdrawals from the market for safety reasons will be identified and notified within 30 calendar days of the posting, and within two (2) business days for a Class I recall. If you would like additional information on a recent recall, please visit www.navitus.com
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Valley Health Plan 2480 N. First Street, Suite 200 San José, CA 95131 1.888.421.8444 (toll-free) www.valleyhealthplan.org
© 2015 Valley Health Plan
VHP CHIEF MEDICAL OFFICER Dolly C. Goel, MD
VHP MEDICAL ADVISORS Stephen Harris, MD Michael Meade, MD Gary Steinke, MD
BOARD OF SUPERVISORS Cindy Chavez Dave Cortese S. Joseph Simitian Mike Wasserman Ken Yeager
COUNTY EXECUTIVE Jeffrey V. Smith Location: Hellyer County Park | 985 Hellyer Avenue, San Jose, CA 95111