Balance winter 2020

A

W I N T E R

2 0 2 0

P U B L I C A T I O N

O F

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

Inside Page 7 Text4baby – Keeping You and Your Baby Healthy Page 16 Antibiotics: Avoid Overuse Page 26 Mental Health and Staying Positive

You never imagine one of your kids is going to be born with medical challenges.

- Hannah N., Network Health member

3 Letter from the President and CEO 4 Handling Winter and the Coronavirus 5 Don’t Hibernate During the Winter Months

07

EDITORIAL STAFF

6 Evaluating New Technologies

President Coreen and CEO Dicus-Johnson

6 The Importance of Exchanging Information

Chief Administrative Penny Ransom Officer

7 Text4baby – Keeping You and Your Baby Healthy

08

COVER STORY

Cleft, Heart Valves and COVID: A Story of Strength and Optimism 20 Where Should You Go Emergency Room, Urgent Care or Virtual Visit?

12 How Do Health Plans Make Decisions 13 Preventive Care to Manage Your Health

21 Welcome to MDLIVE® 22 Achieving a Balanced Work-Life Balance 23 Let’s Stay Socially Distant ... Together

Strategic Marketing Jon Race and Communications Coordinator Visual Design Lead Debra Sutton

EDITORIAL BOARD

Melanie Draheim, Angela Keenan, Mallory Mueller, Alice Parks, Stacy Schwandner, Romi Norton, Kimberly Swanson, Theodore Regalia, Kacey Werner, Hannah Neylon Balance is published by Network Health.

The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals. © 2020 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.

TELL US YOUR STORY

14 Ensuring You Receive the Service You Deserve

24 What Happens When We Focus on Quality

If you have questions or suggestions or would like to tell us how Network Health improved your life, send us an email at marketing@networkhealth.com.

15 Customer Service is Now Member Experience

24 Do You Get Too Much Mail?

You can also write to us at:

16 Antibiotics: Avoid Overuse

25 What Is Population Health Management?

Network Health Attention: Jon Race 1570 Midway Pl. Menasha, WI 54952

17 The Opioid Crisis – How We All Pitch In

26 Mental Health and Staying Positive

HAVE A QUESTION?

18 Keep Your Children’s Immunizations Current

27 New Behavioral Health App SilverCloud Available for State of Wisconsin Employee Members

19 One-on-One Care Management

BACK COVER Know Someone Turning 65?

19 Partners in Care and Quality Network Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. If you, or someone you’re helping, has questions about Network Health, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 800-826-0940.

Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Network Health, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 800-826-0940.

Hmong: Yog koj, los yog tej tus neeg uas koj pab ntawd, muaj lus nug txog Network Health, koj muaj cai kom lawv muab cov ntshiab lus qhia uas tau muab sau ua koj hom lus pub dawb rau koj. Yog koj xav nrog ib tug neeg txhais lus tham, hu rau 800-826-0940.

2776-02-1120 2 | balance • W i n t e r 2 0 2 0

Call our member experience team.

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

Tuesday: 8 a.m. to 4 p.m.

PLANS THROUGH AN EMPLOYER 800-826-0940 PLANS FOR INDIVIDUALS AND FAMILIES 855-275-1400 STATE OF WISCONSIN EMPLOYEES/MEMBERS 844-625-2208 Monday, Wednesday–Friday: 8 a.m. to 5 p.m.

Tuesday: 8 a.m. to 4 p.m.

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

networkhealth.com

Letter from the President and CEO 2020 was a challenging year of unprecedented events. As we step into 2021, it is a time to look forward at what the future may bring. It is a new year. A time for renewal. A time to start again … in all things. Your health. Your wellness. Your everyday lifestyle.

Network Health remains dedicated to creating healthy and strong Wisconsin communities, and our resolve to do so has only strengthened. This new year presents us with the opportunity to embrace our Hometown Advantage™. To embrace our community, our friends, our family. I am talking about you, our members. The small-business owner. The parent. The husband. The wife. The fellow Wisconsinite.

Network Health is dedicated and determined to go above and beyond and to continue to move forward. Just like you and just like Hannah Neylon in our feature story in this issue of Balance.

Along with her story, you will find resources to guide your future health care decisions and awareness. Inside these pages are a variety of information, tips and valuable articles I believe you will find informative.

Thank you for being a Network Health member and for providing us the opportunity to share our Hometown Advantage with you.

Wishing you a safe and healthy 2021.

Sincerely,

Coreen Dicus-Johnson President and Chief Executive Officer

HMO and POS plans underwritten by Network Health Plan. Self-insured plans administered by Network Health Administrative Services, LLC.

n e t w o r k h e a l t h . c o m

W i n t e r 2 0 2 0 • balance

|3

life. health. wellness.

Handling Winter and the Coronavirus

By Katie Normington, MSSW, LCSW, social work care manager at Network Health

W

inter is here, and for many people, it brings with it concern and anxiety.

With efforts to stay home to avoid the spread of the coronavirus, many are envisioning spending more time inside, away from family and friends.

Potential changes to holiday traditions may also trigger feelings of sadness and uneasiness. It is more important than ever to consider and create an action plan for your emotional wellness. While so many things are outside of our control, there are a number of things we can do now for self-care.

• Create an environment of peace. How do you feel when you walk into your home? Creating a space that is peaceful and relaxing is the goal. When things within the home are in a state of disarray, research shows our mood is often negatively impacted. Organizing, getting rid of clutter and completing unfinished projects can all contribute to an improved state of well-being.

• Soothe your soul. Mental health counselors routinely help individuals handle feelings of distress, especially when things cannot be avoided or changed. In doing so, they often encourage their clients to consider, “What soothes you?”

This is not something many think of, but it is worthy of some conscious effort, especially as winter can challenge our mood. To do this, consider your five senses. What, when you look at it, makes you happy or inspires a sense of awe? Is there a smell that calms you? What relaxes you when it contacts your skin? Are there any sounds that bring you joy, perk up your mood or help you feel calm? Is there anything you gravitate toward regarding taste that contributes to those same feelings? Take the time to really think about this and create a space in your home to incorporate these things.

A word of caution to consider—using alcohol and/or food as coping strategies can be unhealthy and counterproductive. Be mindful of your habits and seek help if you notice a change in your behavior.

• Change how you think. It is well understood that one’s thoughts directly impact one’s mood and behaviors. Thoughts like, “This winter is going to be terrible,” are likely to trigger feelings of stress. It is important to recognize when such thoughts are negatively impacting your mood. If you find yourself in a difficult thought spiral, stop and ask yourself, “Is this helpful?” If not, try to change it to something more positive.

• “I’m not sure what this winter will bring.”

• “There will be challenges and I’ve survived tough challenges before.”

If you find you cannot detach from thoughts that cause worsening depression or anxiety, call a friend and ask him or her to help you consider things differently. A counselor who specializes in cognitive behavioral therapy can also be of great assistance when struggling with difficult thoughts.

• Stay in the present and live life according to your values. Focus on the daily routines you will build into your winter days. What are the most important things in your life? If it is your family, make a point to reach out and connect. If it is spirituality, set aside time to engage in spiritual practices. If you value creativity, ensure you have a creative outlet. If you embrace the things you value every day, you will be much more likely to achieve and experience joy despite all that is happening around you.

• Focus on gratitude and helping others. On a daily basis, take some time to recognize and document things that bring you joy and for which you are grateful. Research shows that doing this and engaging in a regular gratitude practice, can contribute to feelings of happiness and improve your health. You can train your brain to find and focus on what makes you happy more often. Also, find opportunities to express your gratitude to others. This can also have significant benefits to your own physical and emotional health.

4 | balance • W i n t e r 2 0 2 0

networkhealth.com

• Give yourself, and others, grace. When you have a difficult day, feel down or are not proud of the way you expressed your feelings, try to respond with compassion. Take a moment to talk to yourself in a way that is supportive, understanding and forgiving. Surround yourself (if not physically) with the emotional support of a few special people who can be there for you when the going gets tough. It is more important to consciously reach out to others, even if you have not heard from them in a while.

The last year has made many people feel stressed and uneasy.

Winter brings with it the possibility that such feelings may take a deeper hold. If you embrace these suggestions and the people in your life, you can help ensure you stay mentally healthy. If you think you could use some additional help, reach out to your friends, family or your personal doctor to get the support you need.

Don’t Hibernate During the Winter Months T

he cold weather and early sunsets of winter may seem like good excuses to hibernate on the couch in front of your fireplace or TV and avoid physical activity. Don’t let yourself fall into that trap.

You can, and should, be just as active in winter as any other season.

Forget about the cold temperatures (bundle up if you have to) and get yourself moving. Here are some tips and ideas for alternatives to hibernating this winter.

Join a gym or fitness class. Most gyms and fitness centers are operating under the Centers for Disease Control and Prevention (CDC) guidelines to help keep people safe. It’s a personal decision and if you are comfortable with the idea, start working out. Be sure to choose a conveniently located facility so driving in winter won’t be an issue.

Play some winter sports. Try outdoor sports like skiing, snowboarding, ice skating, snowshoeing, hockey, even ice fishing.

Okay, these aren’t all technically sports, but they are winter activities that will get you up and moving. Plus, all of these are easy to enjoy while you take some well-earned time off.

Exercise at home. It’s relatively easy and inexpensive to set up a home gym. All you need is a yoga mat and/or some hand weights to get started. A variety of workout videos are available for free on YouTube. Your favorite App store also has numerous options for workout routines and trackers.

Go outside with your kids. A great way to get the blood flowing is to go outside and play with your kids. Don’t have kids? Then play around with your dog. Sledding, building a snowman, having a snowball fight and throwing a ball around with your favorite fuzzy friend are all ways to exercise while having fun.

Get outside in general. Not every winter day is unbearable.

Embrace the milder days and go for a walk. Of course, you have to be careful around ice, but if you dress appropriately, you can still soak up the sun and get some fresh air during a pleasurable walk.

Join/start a step challenge. You can challenge your family, friends or coworkers. This could be a long-term challenge (months) or shortterm (one week). n e t w o r k h e a l t h . c o m

W i n t e r 2 0 2 0 • balance

|5

life. health. wellness.

Evaluating New Technologies N

etwork Health’s Medical Policy Committee (MPC) evaluates new technology or new application of existing technologies. The evaluation process considers effectiveness of the technology, its appropriate use and evidence base. In addition, Network Health follows the Centers of Medicare and Medicaid Services (CMS) coverage determinations and technology assessments, if available, for its Medicare Advantage membership. Decision-making on technologies is based on, but not limited to the following.

• Scientific evidence demonstrated in well-designed and well-controlled investigations published in peer-reviewed literature • Information from appropriate government regulatory bodies like the FDA and CMS • Risk/benefit analysis as compared to current modalities • Manufacturer information • Assessments done by agencies specializing in technology assessments such as BCBS TEC Hayes • Opinion of provider experts When a new technology or application is found to be safe and effective, the MPC develops necessary criteria for its application. If not otherwise covered, our strategic committees consider the technology for inclusion in coverage documents.

Requests for technology assessments may be submitted by MPC members, Network Health’s providers and/ or health plan associates. If you have a question about a technology assessment, contact our utilization management department at 920-720-1602 or 866-709-0019, Monday – Friday, 8 a.m. to 5 p.m.

The Importance of Exchanging Information M

any medical conditions can be related to, or affected by, other health conditions and/or medications. Communication between patients, providers and health care facilities allows for clear and coordinated treatment. This also lessens the possibility of unwanted medication interactions and additional testing, increases safety and helps control medical costs.

Steps you can take to help coordinate your health care.

Communicate with your personal doctor. Notify your personal doctor about any other health care provider visits you have, including specialists and behavioral health visits.

This will help provide important health care information and can aid in avoiding duplicate testing.

Keep your doctors up to date on your medications. Being aware of all medications you take helps your personal doctor and other providers see the complete picture.

Keeping updated lists of all your medications and doses and giving them to your doctor helps avoid any medication interactions. This will help improve your outcome and safety.

Release of information. When your see a specialist or other care providers in the same health care system as your personal doctor, information is usually shared as allowed by privacy laws. However, if you see a provider outside of your doctor’s system, ask if a signed consent to release information is needed to have information sent to your personal doctor.

Open communication and exchange of information between all providers involved in your care allows your personal doctor to develop and follow a complete, safe and successful overall plan of care for your health and well-being.

6 | balance • W i n t e r 2 0 2 0

networkhealth.com

Text4baby – Keeping You and Your Baby Healthy

By Karlyn Raddatz, , MPA, BSN, RN, manager of care management at Network Health

A

re you expecting or do you have a baby under the age of one? Network Health partners with Text4baby to provide you with support throughout your pregnancy and your baby’s first year with free text messages on topics relevant to you during this special time.

How does Text4baby work?

Receive weekly text messages Text BABY (or BEBE for Spanish) to 511411 to receive three free text messages a week. These messages will coincide with the baby’s due date or birth date. The messages are sent throughout pregnancy and until the baby’s first birthday. These messages cover a variety of topics, including the following and more.

• • • •

Labor signs and symptoms Prenatal care Urgent alerts Developmental milestones

• • • •

Immunizations Nutrition Birth defect prevention Safe sleep

Just text STOP to discontinue messages or HELP for help at any time.

Set Up Free Appointment Reminders

1

Text REMIND (or CITA for Spanish) to 511411.

2

Enter appointment date.

Dates should be entered as eightdigit numbers. For example, July 7, 2020 should be entered as 07072020. No spaces, dashes or slashes.

3

Enter appointment description with time, place and purpose.

For example, 3 p.m. appt w/Dr. Parker. Enter whatever makes sense to you.

4

A reminder text will be sent three days before and the morning of the appointment.

You can set up as many reminders as you need, at any time.

Text4baby also has a free add-on tool for the text messaging service. Download Text4baby from your App store onto your smartphone to access the below additional content and interactive features.

• A weekly planning list of medical, developmental and lifestyle calendar items • Polls that allow participants to see how other moms respond to topics like pregnancy symptoms, infant development and emotional experiences • Appointment reminders scheduled via the app that will be sent through the text message service • Helpful health hotlines and community resources Your health care provider is your primary source of care to meet your individual needs. However, Text4baby can help you through a healthy pregnancy and your child’s first year.

For more information, visit text4baby.org.

n e t w o r k h e a l t h . c o m

Yvonne, RN Nurse Care Manager at Network Health

W i n t e r 2 0 2 0 • balance

|7

8 | balance • W i n t e r 2 0 2 0

Cleft, Heart Valves and COVID: A Story of Strength and Optimism Invariably, the question would come up. “Are you hoping for a boy or a girl?”

Hannah and Adam would answer the question the same way they always did.

“We don’t care. As along as the baby is healthy.”

Unlike a lot of parents, however, Hannah and Adam were not secretly wishing for a boy or a girl. They truly meant what they said. They did not care what gender their third child was. All that mattered was that he or she was healthy.

That, above all, was their only concern.

By Jon Race Photography by Melissa Morgan Photography

W i n t e r 2 0 2 0 • balance

|9

As soon as we could, we made the switch to Network Health because we knew how important it was.

- Hannah N.

Hannah and Adam

H

annah and Adam Neylon live in Pewaukee. Hannah is the government programs manager at Network Health. Adam is a member of the Wisconsin State Assembly, representing District 98.

He also owns a commercial window cleaning business and is part owner of a health and fitness company.

Their job responsibilities don’t end there. They are also parents of three children—Elizabeth (4), Tommy (2) and Henry (8 months).

Three kids under five … that’s a full-time job in and of itself.

Though definitely busy, outwardly, their life doesn’t seem to be any different than anyone else you may know. When you go a little deeper and hear their story, you realize their journey has been a bit different than a lot of other parents. Maybe you even start to think, “Wow. I guess what I have going on isn’t all that challenging.”

And, that’s when you understand why they really didn’t care whether their third child was a boy or a girl.

Tommy

In 2017, while pregnant with their second child Tommy, the Neylons were at Hannah’s 20-week ultrasound appointment. This was the appointment where they would find out the baby’s gender. The ultrasound revealed the baby was a boy. However, it also revealed the baby would be born with a cleft lip and a cleft palate.

“I had heard of cleft, but I really didn’t know what it was,” said Adam. “I had to Google it to find out what it meant. It was kind of jarring to see what he was going to be born like and what he was going to have to go through in life.”

Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. They result when facial structures

10 | balance • W i n t e r 2 0 2 0

developing in an unborn baby don’t close completely. They are also among the most common birth defects, occurring about once in every 700 children.

“You never imagine one of your kids is going to be born with medical challenges,” Hannah said. “It’s not really something you ever think about.”

At the time Tommy was born, the Neylons were getting insurance through Adam’s place of work, the State of Wisconsin. The state offers a group health insurance program that allows its members to choose from several health plans sponsored by a variety companies.

Network Health’s insurance plans are available through that program; however, Hannah and Adam were with a different provider.

“When Tommy was born, we didn’t have Network Health as our insurance through the state,” Hannah explained. “The insurance company we were with did not have Children’s Hospital in their network.”

Adam continued, “It was a nightmare to get approval. Our insurance declined it. They said there was a plastic surgeon in-network we had to see. So we did. And he said, ‘I can’t do this. You need to see a specialist at Children’s Hospital.’ There was a lot of stress, a lot of hours on the phone trying to get authorization for our child to see the proper doctors.”

Hannah and Adam were eventually able to obtain prior authorization, but they had to put off Tommy’s first surgery longer than was recommended. They vowed to make a change in the future.

“When open enrollment started that year, we said we’d never make that mistake again and we switched to Network Health. They are the only health plan in the State of Wisconsin Group Health Insurance Program that has both Children’s Hospital and Froedtert in-network,” Adam said. net workhealth.com

“As soon as we could, we made the switch to Network Health because we knew how important it was,” Hannah added. “For our kids’ sake, we knew Network Health is where we had to be.”

Tommy had two surgeries by the time he was 18 months old. The first was to repair his lip by sewing it together. The other was a palate repair where doctors sewed together the roof of his mouth. Hannah and Adam are unsure exactly how many more surgeries Tommy will need. Doctors have said at least four more, but probably more because he had a very large cleft. His next surgery will be when he is four or five years old, and his last will be when he is 18.

prior authorization or any of the stuff we went through with Tommy.

We got to skip those ‘steps.’ So she was able to see the specialists she needed to and, more importantly, we were confident we could get her the care she needed.”

Henry

Fast forward to May 2020. Along came child number three. Boy or girl didn’t matter. As long as he or she was healthy.

When they found out Hannah was pregnant, the Neylons went to the Genetic Counseling Office at Froedtert’s Maternal Fetal Concern Center. Because the birth defects Tommy and Elizabeth had are

We talk a lot in our family about the special things you are born with. How people are born special - Hannah N. instead of how they are born different.

According to Hannah, Tommy is in excellent spirits and he is handling his ordeal well. In fact, his sister gets jealous because he gets to go to so many more appointments than she does, so he gets more stickers.

Elizabeth

Elizabeth, the oldest of the Neylon children at four, was born in 2016.

When she went for her three-year check-up, her pediatrician heard a heart murmur. He didn’t think it was anything to be concerned about, as many children have them, but he recommend getting an electrocardiogram (EKG).

The results of the EKG showed Elizabeth had a bicuspid aortic valve (BAV). BAV is a birth defect in which the aortic valve—located between the lower left heart chamber and the main artery that leads to the body (aorta)—has only two leaves, or cusps, instead of three.

Most people with BAV experience no impact to their quality of life when they’re young. However, it is something that will affect them as adults. So, for now, there is not much to be too concerned about for Elizabeth. But they will definitely have to pay attention to it as she gets older.

We appreciate how happy and healthy our children are. We feel very blessed.

- Adam N. “At that point, we were with Network Health,” explained Hannah.

“So right away we were able to get her in to see a cardiologist, able to get her the testing she needed right away. We didn’t need to wait for a

n e t w o r k h e a l t h . c o m

generally considered genetic, Hannah and Adam decided to get genetic testing done.

“Because of Tommy and Elizabeth’s history, we got special ultrasounds to look at Henry’s heart and his cranial facial structure,” Hannah said. “And, because Children’s and Froedtert are so connected, when we had Henry, we had him at Froedtert, and they were able to just ‘take him down the hall’ to Children’s to check everything out. They work so well together. It was super easy.”

Henry was born an average, healthy baby boy. But his arrival brought with it its own set of unique circumstances.

“You never plan on getting pregnant and having a baby in the middle of a pandemic,” Adam said. “Overall, COVID wasn’t too much of an issue. I was still able to be there. Things were a bit more isolated.

A benefit was, because only I was allowed in, we were allowed a privacy and intimacy we otherwise might not have had. It was nice.”

Sheila

It was during her pregnancy with Henry that Hannah connected with Sheila, a registered nurse care manager at Network Health. Sheila was able to provide the Neylons with emotional support and help them navigate medical care during a pandemic. She answered their questions, provided updates, checked in on the family and learned about the concerns and worries they were facing.

“She helped out a lot,” said Hannah. “She called to let us know about things. Reminders. She’d recommend things we should do because she knew we had other kids who had medical issues. She was as concerned about Henry as we were and made sure we had everything we needed for him.”

To anyone who is facing a medical issue, whether their own or a family member’s, Hannah and Adam recommend using the resources available like a Network Health care manager. Care managers have a wide variety of knowledge and experience, making them well-prepared to address just about any situation a member may W i n t e r 2 0 2 0 • balance

| 11

life. health. wellness.

We were confident we could get her the care she needed.

- Hannah N. experience, no matter how unique. Sheila is no exception. She’s been with Network Health for five years—the last two as a care manager— and has 20 years of experience in the medical field. Sheila’s done everything from pediatrics and hospice to high-risk pregnancies and long-term and acute rehabilitation.

“The people in the care management department are all experts.

They know all the care you should be getting and how to access it,” Hannah said. “They understand not just the insurance side of things, but the care side too. They provide an extra opportunity to get more information and more support as you are going through scheduling appointments, understanding test results or finding new doctors.

They’re just really good at what they do.”

Added Adam, “And don’t ever be afraid to ask questions. Ask a lot of questions. They’ll get you the answers.”

The Future

Despite all the Neylons have been through in the last five years, they

are not about to complain. They have embraced their journey and become stronger as a family.

“We appreciate how happy and healthy our children are,” Adam said.

“We feel very blessed. Our situation can be a challenge and can be a struggle at times. But if this is the worst it’s going to be for our kids, they have a very blessed and fulfilled life ahead of them.”

“These medical issues are just a part of our life,” added Hannah. “It’s not a tragedy that happened to us. It’s not something we are regretful of.

It’s just something that’s a part of our life and part of our kids’ lives.”

“We talk a lot in our family about the special things you are born with.

How people are born special instead of how they are born different.”

The Neylons look forward to what the coming years will bring. Like every parent, they can’t wait to watch their children grow and see who they become, because they know the possibilities are endless. For Hannah, Adam, Elizabeth, Tommy and Henry, the past only matters in how it has helped define their character and who they will be in the future.

How Do Health Plans Make Decisions?

D

id you know that utilization decisions made about care by Network Health are based on the appropriateness of care and service? Care and service include medical procedures, behavioral health procedures, pharmaceuticals and devices. Decisions are based on written criteria founded on sound clinical evidence and the benefits outlined in the various coverage documents. The written criteria are reviewed and approved annually by actively-participating practitioners. Criteria are available to providers, practitioners and/ or members/participants upon request. Requests for criteria can be submitted via telephone, fax, electronically or USPS. Once the request is received, utilization management associates send the requested criteria to the requestor via fax, electronically or USPS. Network Health does not reward, in any way, practitioners or other individuals conducting utilization reviews for denying coverage for care or service. Nor does Network Health prohibit providers from advocating on behalf of members/participants within the utilization management program. Network Health does not use incentives to encourage barriers to care and service, and it does not make decisions about hiring, promoting or terminating practitioners or other associates based on the likelihood, or the perceived likelihood, that the practitioner or associate supports, or tends to support, denial of benefits. The medical directors, associates (or designees), care

12 | balance • W i n t e r 2 0 2 0

management staff and supervisors of this staff receive no financial incentive to encourage decisions that result in underutilization.

In addition, treating practitioners may discuss medical necessity denial determinations with the physician review medical director by contacting our utilization management team at 920-720-1600 or 800-236-0208. For questions specific to behavioral health utilization, they can call 920-720-1340 or 800-555-3616.

Callers have the option to leave a message 24 hours a day, seven days a week. Messages are retrieved at 8 a.m., Monday through Friday, as well as periodically during the business day. All calls are returned promptly. Calls received after business hours are returned the next business day. Members/participants, practitioners and/or providers may also send inquiries to the care management department via fax, courier system and USPS. You can fax the utilization or care management department at 920-720-1916.

Network Health offers TDD/TTY services for deaf, hard of hearing or speech-impaired individuals. Anyone needing these services should call 800-947-3529. Bilingual language assistance or translation services are also available. Callers may leave a message 24 hours a day, seven days a week.

networkhealth.com

P

Preventive Care to Manage Your Health

reventive care is an important factor in managing your health. Catching potential problems early provides a chance to start treatment early, limiting costs and possible negative effects on your health.

A physical examination is the first step. This visit allows you and your personal doctor the opportunity to review risk factors related to your gender, age and health history, and create a plan for appropriate preventive screenings and services.

Some areas to consider include the following.

• Weight management – Being overweight can increase risk of diabetes, heart disease, and some cancers. If appropriate, your personal doctor can provide guidance regarding a weight loss plan that includes regular exercise and healthy eating habits.

• Mental health – Anxiety and stress can lead to other mental health issues such as depression or substance abuse. It’s important to have an open discussion with your personal doctor regarding stressors affecting your normal routines and how you feel before issues become more severe.

• Vaccinations – Staying up to date on immunizations is an easy and effective way to avoid common illnesses such as influenza. The Centers for Disease Control and Prevention (CDC) provides age-appropriate vaccination schedules on their website (www.cdc.gov/vaccines/schedules/ index.html).

• Preventive screenings – Your doctor will recommend screenings based on your gender, age and health history. The following screenings may be recommended.

• Screenings for certain cancers (cervical, breast, prostate, colorectal) • Hepatitis C screening • Blood pressure checks • Bone density screening • Cholesterol screening • Testing for type 2 diabetes The U.S. Department of Health and Human Services website provides a tool that allows you to see the preventive screenings and testing that may be appropriate based on your age and gender. You can visit the site at health.gov/myhealthfinder.

Preventive care can help catch illnesses in their earliest stages, and in some cases prevent illness from occurring. Developing and following an appropriate preventive plan can help control costs and allow you to live a longer, healthier life.

n e t w o r k h e a l t h . c o m

W i n t e r 2 0 2 0 • balance

| 13

life. health. wellness.

Ensuring You Receive the Service You Deserve A

t Network Health, we want to ensure you receive the service you need and deserve. If you have concerns, we want to make sure you understand all your options. If you do not agree with Network Health’s decisions about your care or what’s covered, you have the right to file an appeal or grievance. We have a team of appeals and grievance specialists who will work with you throughout this process.

When do I ask for a reconsideration?

If you would like to request a reconsideration—which is a re-review of your claim—you may call our member experience team at the number listed on the back of your member ID card.

If you request a claim review, Network Health will complete a second review of your claim and will provide you a decision once the review is complete.

If Network Health still denies your claim—referred to as upholding the denial—you will receive a written notification with the specific reason(s) for the continued denial.

When do I file a grievance?

You have the right to file a grievance if you do not agree with Network Health’s decisions about your health care. You can submit a grievance in writing within 60 calendar days of the date you receive a claim denial. Your written grievance should include your full name, member ID and detailed information about the decision you would like reviewed. You may also include any comments, documents, records or other information you would like Network Health to consider in its review.

14 | balance • W i n t e r 2 0 2 0

networkhealth.com

Examples of situations appropriate for a grievance include the following.

• Network Health will not approve care you believe should be covered.

• Network Health is ending coverage on care you still need.

• Network Health has denied payment for services or items you have received, and you think they should be covered.

Who may file a grievance?

You or someone you name to act for you (called your representative) may file a grievance. To name your representative, visit networkhealth.com and go to the Member Resources page (under Employer Plans if you get coverage through your employer or Individual and Family Plans if you buy insurance on your own). Complete the Appointment of Representative Form and send it to the address listed on the form.

What happens after I file a grievance?

When you file a grievance, you are formally requesting Network Health to review our decision. We will acknowledge your grievance within five business days of receiving it. The Grievance Committee will schedule a hearing to review your case and you will be notified at least seven days prior to that meeting. Before the meeting, you have the right to submit written comments, documents, records and information relevant to your grievance. You may attend the grievance meeting in person or on the phone to present any additional information. After the hearing, the Grievance Committee will address your grievance and provide a written response within 30 calendar days for a pre-service claim or 60 calendar days for a post-service claim.

How are medication grievances handled?

Medication grievances should be submitted in writing and are reviewed by a Network Health pharmacist and Network Health medical director, as needed. The pharmacist communicates with the prescribing provider if additional information is needed or discusses alternative covered medications. Our pharmacists strive to address medication appeals within four hours and have been successful over 90 percent of the time.

When do I file a complaint?

If you’re dissatisfied with the service or quality provided by your plan or doctor, we can help you work through any issues. You have the right to file a formal complaint about the service you receive from Network Health, our vendors or contracted providers.

These are examples of situations appropriate for a grievance.

• Difficulty getting through on the phone • Concerns about the quality of care or services provided • Interpersonal aspects of care (for example, rudeness of a provider or staff) • Failure to respect your rights

Say What?

Pre-service claim is prior authorization of a service or procedure Post service claim is a claim that is processed after the service has been performed

Customer Service is Now Member Experience O

ur customer service team has changed its name to the member experience team. This new name considers your entire journey, which is made up of all the experiences you have when interacting with Network Health.

Kathy W., Member Experience Team Member

n e t w o r k h e a l t h . c o m

At Network Health, you’re more than a customer. We know we are serving our neighbors, friends and family. The member experience team name is about supporting the best part of Network Health— you, our member. This team still provides the same great service you’ve come to expect—assisting with benefits, claims, authorizations, pharmacy and more. Now we’re just doing it with a name that more accurately describes what we do.

W i n t e r 2 0 2 0 • balance

| 15

life. health. wellness.

Antibiotics:

Avoid Overuse

By Jennifer Footit-Tank, BSN, RN, CCP, quality care coordinator at Network Health

ntibiotics are a game changer in the fight against infection. However, this medical miracle does have a downside, as overuse now threatens the ability of antibiotics to cure diseases for which they were designed. Antibiotic resistance is a growing concern we all can take part in preventing.

A

What are antibiotics? Antibiotics are medications designed to kill or slow growth of infections caused by certain bacteria. These medications come in pill, liquid, topical or intravenous (IV) forms and need to be prescribed by a provider. Antibiotic resistance occurs when antibiotics are used improperly, and the bacteria survive instead of becoming weak or dying. This then leads to infections becoming harder to treat because the antibiotics no longer work.

What do antibiotics treat? Antibiotics only treat certain infections caused by bacteria, such as strep throat, UTI or bacterial pneumonia. Antibiotics do not work on viruses, like flu, bronchitis, sore throats not caused by strep or colds with green or yellow mucus.

What are the side effects of antibiotics? Taking antibiotics puts you at risk for side effects such as dizziness, rash, nausea, diarrhea or yeast infections. More serious side effects are life-threatening allergic reactions. When antibiotics are necessary, the benefits far outweigh the risks.

Antibiotics are not always the answer. When you feel miserable you look for ways to feel better quicker. Many illnesses get better on their own in seven to ten days. Your personal doctor or pharmacist can direct you to over-the-counter medications that can provide relief from your symptoms.

You can also try the following methods at home before using antibiotics.

• Use honey to relieve a cough—for people over one year old • Breath in steam from a warm shower to ease congestion • Use a clean, cool mist humidifier for a stuffy nose • Try a saline nasal spray or sinus flush to clear out nasal passages Taking antibiotics that are not needed will not help you and the side effects could harm you.

Meeting with your personal doctor. When discussing your symptoms, ask about treatment options that do not involve antibiotics and ways to prevent getting sick, such as a flu shot and what to do if your symptoms do not improve.

What to do if you have been prescribed an antibiotic? Speak with your personal doctor or pharmacist about potential side effects and how to correctly take the antibiotic.

Ask your doctor what tests might be done to make sure you are getting the right antibiotic prescribed. Never share your left-over medications or take someone else’s antibiotics. Call your doctor if you experience any side effects. Take the medication exactly as directed and always finish the prescription, even after you feel better.

Antibiotics fight infection and save lives if we use them responsibly. Overuse of antibiotics can threaten the ability to fight infections. Working with your doctor or pharmacist on symptom management will allow you to get better in a healthier way.

16 | balance • W i n t e r 2 0 2 0

networkhealth.com

The Opioid Crisis – How We All Pitch In

By Ted Regalia, vice president of pharmacy at Network Health

A

nationwide effort to address the ongoing opioid crisis has made some progress, however, challenges still exist. The good news is, according to the American Medical Association, there has been a 37.3 percent decrease in opioid prescriptions over the last five years.

Network Health members have seen a 32.6 percent decrease in opioid prescriptions in just three years. Despite this progress, opioid related deaths continue to rise nationwide.

Opioid use disorders can happen to anyone. These disorders include opioid addiction, which can interfere with a person’s health, wellbeing and quality of life, not to mention the hardship and strain it can cause to loved ones.

are a type of medicationassisted treatment. These treatments do not require prior authorization, so our members can have these options readily available to them without delay. We also cover other treatment options. If you are concerned about your opioid use, please contact your personal doctor to discuss the options you have available.

So, what are we doing to address the opioid use crisis?

Our members, providers and Network Health all have a role in keeping our communities safe.

Physicians or Prescribers The state of Wisconsin has implemented a monitoring program that requires prescribers to consult a website any time they prescribe a controlled substance that includes opioids. This website displays prescriptions from other physicians and pharmacies across the United States and Wisconsin, so the prescriber has a full picture of the medications a patient is receiving.

Furthermore, Wisconsin physicians are required to take continuing education classes on safe opioid prescribing.

Network Health We have implemented quantity limits on new prescriptions for members who have not had an opioid in the last six months. In other words, if you are not a routine opioid user, you will be limited in the number of pills you can get at a time. This is important to prevent unused opioids sitting in the cabinet which could pose a risk for unintentional ingestion, overdoses or getting into the wrong hands. We have also put a prior authorization in place for cases where high-dose opioids are medically necessary. Again, this is to help promote safe opioid prescribing.

Medication-Assisted Treatments For patients experiencing opioid use disorders, specialized physicians have several different medication therapies that may help. Network Health covers both the treatments and treatment facilities. Methadone clinics

n e t w o r k h e a l t h . c o m

Pharmacies Wisconsin permits a pharmacist to dispense naloxone without a prescription. Naloxone is an opioid antidote and is a life saver in cases of opioid overdose. We strongly recommend you discuss naloxone with your physician and/or pharmacist. Ensure you teach those around you how to use naloxone in the event of an accidental overdose. Doing this can save lives.

Our Members You play the most important role. If you need pain control, make sure you are using alternative treatment options, including other medications, physical therapy and other interventions suggested by your doctor, to help minimize your use of opioids.

Speak with your doctor about realistic pain expectations and keep a pain diary to track how you rate your pain day to day, as well as what makes the pain better or worse.

This information can help your provider better understand and meet your needs. Lastly, make sure you are storing your pain medication in a safe, secure place. Do not share your medications with anyone else. And, if you have unused pain medication, make sure to dispose of it either at your pharmacy, local police department or follow disposal instructions provided by the U.S. Food and Drug Administration (FDA). Disposal instructions can be found on the FDA’s website, fda.gov.

W i n t e r 2 0 2 0 • balance

| 17

Keep Your Children’s Immunizations Current

By Anna Peterson Sanders, pharmacist at Network Health

B

eing a parent is hard. Being a parent during the coronavirus outbreak definitely adds another layer of complexity to the job. From changes in learning and education to disruptions in school or daycare to lack of extracurricular activities that keep our kids active and engaged, parents are adapting to almost on a daily basis. Navigating the health care system during this time poses its own challenges as well. Though virtual visits are a terrific option, there are times when an in-person visit with your children might be essential. Immunizations is one of those times.

The importance of keeping up on your child’s vaccination schedule cannot be emphasized enough. Offering both short-term benefits, like helping prevent influenza infection for the upcoming flu season, and long-term benefits, such as minimizing the risk of cancers related to human papillomavirus infections, keeping up to date on vaccinations provides immense benefits and can even prove to be lifesaving. However, if your child is behind schedule, it is never too late to get up-to-date. There are catch-up schedules published and maintained by the Advisory Committee on Immunization Practices (ACIP) that your personal doctor can reference. A few of the common vaccinations recommended during childhood are discussed below. For a complete list, please reach out to your child’s doctor.

Human Papillomavirus

Influenza

While commonly misinterpreted to be an issue affecting just females, it is as important to get males vaccinated as it is females to help in long-term complications that can affect both sexes, such as cancers of the genitalia, mouth and throat.

As we gear up for what the Centers for Disease Control and Prevention (CDC) say could be a very difficult winter, ensure your entire family is protected against influenza. One of the more serious complications of influenza infections is that individuals are more susceptible to coming down with pneumonia. Getting a flu vaccine will protect you and your loved ones as we all move indoors for the cold months.

Vaccine dosing schedule • Ages 9-14: Two-dose series, the first dose and again six to twelve months later • If receiving age at 15 or older: Three-dose series, the first dose, then one to two months later and the final at six-months Vaccine name: Gardasil 9

Chickenpox With the advent of the chickenpox vaccine, we can now provide immunity in a safe and controlled way. Serious risks posed with chickenpox infections can include brain swelling, bleeding disorders and pneumonia, so this certainly isn’t a minor infection.

Vaccine dosing schedule • Two-dose series at 12-15 months and again at four to six years of age Vaccine name: Varivax

18 | balance • W i n t e r 2 0 2 0

Vaccine dosing schedule • Ages six months to eight years: One or two doses for the year, depending on previous influenza vaccine history • Nine years and older: One dose each year Vaccine names (age ranges for which they are approved vary) • Afluria, Fluad, Fluarix, FluLaval, Fluzone • Egg free: Flublok, Flucelvax • Intranasal: FluMist Immunizations can be obtained at your doctor’s office or a pharmacy.

If the pharmacy is more convenient and accessible to you and your family, you may want to call ahead to ensure they have a pharmacist on site to administer vaccines to pediatric patients and to confirm they have the necessary vaccines on hand. In the meantime, stay safe, stay healthy and stay vaccinated.

networkhealth.com

life. health. wellness.

One-on-One Care Management

By Alice Parks, director of population health at Network Health

N

etwork Health offers care management services to members at no additional cost. Through this program, experienced nurses and social workers, also known as care managers, can support you with the following.

• Improving your overall health • Navigating the health care system • Coordinating community resources • Getting needed services in optimal, cost-effective settings If you are eligible and agree to participate, you can be enrolled into the program. When enrolled, a care manager works with you to identify your health care needs, develop goals based on your values and assists you in meeting those goals.

If you have complex chronic conditions or illnesses that could lead to high-risk conditions or an increased use of health care services, you may benefit from care management. These conditions or

circumstances could include any of the following.

• Complex chronic diseases • Catastrophic or rare conditions • Conditions requiring a transplant • Major complications from a surgery or an extended hospital stay • Circumstances where multiple physician specialists are involved in care • Conditions requiring multiple specialty equipment and service needs at home Those who might benefit from care management can be referred by their personal doctor or caregiver, or you can refer yourself. Network Health might also identify you as a candidate for services through claims or utilization processes.

Care managers are available by calling 800-236-0208 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m. and after hours by appointment.

Partners in Care and Quality

By Nancy Weber, BSN, MPA, RN, clinical integration program manager at Network Health

N

etwork Health has a clinical integration partnership with several provider partners, including our provider owners, Froedtert Health and Ascension Wisconsin. Through this partnership, we share goals to achieve the health outcomes that are important to you.

What is clinical integration?

Clinical integration is a coordinated effort between Network Health and your providers to ensure you receive effective care across all conditions, providers, settings and time. The expected outcome is high-quality care that is safe, efficient, timely, unbiased and patient-focused. Simply put, it means your providers and Network Health have a unique interactive connection to ensure you’re getting the best care possible for your individual needs and conditions.

Why would an insurance company need to know about the care I’m receiving from my provider(s)?

Network Health does more than pay your medical bills. We ensure your health and wellness journey is as streamlined and efficient as possible. As a Wisconsin-based company, our Hometown Advantage™ helps us grow personal relationships with our provider partners and members to deliver services that matter most to you. Being owned by two provider health systems allows us to work together to make your care a top priority in everything we do.

Isn’t my personal doctor responsible for coordinating my care?

It’s true that quality health care starts with your personal doctor. We encourage you to choose a doctor you trust for your routine care needs. He or she will provide guidance if an illness or health concern develops. And, by documenting your symptoms, your doctor gives other providers necessary information to use when additional care is needed.

Your opinions matter Your opinions about your experiences with doctors, nurses, hospitals and Network Health are extremely important. We take your input seriously and work closely with our provider partners to assure you have satisfying health care experiences. We rely heavily on input from surveys you complete on our behalf and on behalf of your providers.

n e t w o r k h e a l t h . c o m

W i n t e r 2 0 2 0 • balance

| 19

life. health. wellness.

WHERE SHOULD YOU GO

EMERGENCY ROOM?

URGENT CARE?

or

I

f you or a loved one are hurt or ill, panic and confusion can make it difficult to know what to do. If you feel you’re experiencing a medical emergency, it’s important to get to the nearest emergency room or call 911.

Sometimes you might not be sure if your condition is considered an emergency. If it’s not, you can get the necessary care through your personal doctor, a virtual visit or an urgent care walk-in clinic. Two questions can help you determine which type of care is right for you.

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

An emergency is an illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid serious harm. You typically receive emergency care at the emergency room.

VIRTUAL VISIT? or

Don’t forget to ask questions Anytime you visit the emergency room, a walk-in clinic or see your personal doctor, don’t be afraid to ask questions. Asking questions about your care is the best thing you can do to ensure your safety. There’s no such thing as a dumb question, especially when it comes to your health.

If something doesn’t seem right or make sense, ask about it.

Your coverage for each of these services varies depending on your plan. Be sure to call the member experience team at the number on the back of your member ID card or visit your member portal at login.networkhealth.com to verify your benefits.

Whichever form of care you choose, make sure to share information about the visit with your personal doctor.

Urgent care is for an unexpected injury or illness that is not life threatening, but still needs attention quickly so it doesn’t develop into a serious problem. You may get urgent care at your personal doctor’s office, a walk-in clinic or an urgent care facility.

Another option for care is a virtual visit with MDLIVE®. A virtual visit is a convenient way to get care through your computer, smartphone or tablet. Most Network Health plans offer virtual visits as an alternative to urgent care visits for non-emergency medical conditions. For more information, see the next page.

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

Being prepared and knowing what to do before an emergency can help you make the right decision quickly. For help determining if your situation is an emergency, you can contact your personal doctor. For a list of provider nurse lines, go to networkhealth.com and under the Health and Wellness tab, select Getting Care Quickly.

20 | balance • W i n t e r 2 0 2 0

networkhealth.com

Welcome to MDLIVE With MDLIVE, you can visit with a doctor or counselor 24/7 from your home, office or on-the-go

You have a virtual visit benefit offering you care, anywhere • • Board-certified doctors • Available anytime, day or night • Available anytime, day or night • Consults by mobile app, video or phone • Consults by mobile app, video or phone • Prescriptions can be sent to your nearest • Prescriptions can be sent to your nearest pharmacy pharmacy if medically necessary if medically necessary

We treat over 50 routine medical conditions including • Acne • Allergies • Cold and flu • Constipation • Cough

• Diarrhea • Acne • Ear problems • Allergies • Insect bites • • Nausea and vomiting • Constipation • Pink eye • Cough

• Rash • •Respiratory problems • •Sore throats • eye • And more •

•

•

•

•

• And more

Download Download the the app app

Join for free. free. Visit Visit aadoctor. doctor.

Join for

throats

MDLIVE.com/nhcommercial MDLIVE.com/nhcommercial 877-958-5455 877-958-5455

Copyright © 2020 MDLIVE Inc. All Rights Reserved. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not replace the primary care physician, is not an insurance Copyright 2019 MDLIVE All Rights Reserved. MDLIVE not be available certain states subject tocase state regulations.

MDLIVEcondition. does not replace the primary care physician, is not an insurance product and may not be able to substitute for traditional in person care in every case or for every condition. product and© may not beInc.able to substitute formaytraditional in inperson careandinis every or for every MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny certain other drugs which may be harmful because of their potential for abuse.

MDLIVE does not guarantee patients will receive a prescription.

Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit https://www.MDLIVE.com/terms-of-use/. careHMO if based on professional judgment case is inappropriate forInsurance telehealth or for misuse ofInsurance services.

MDLIVE and the MDLIVE written plans underwritten

by Network Health Plan. POS aplans underwritten

by Network Health Corporation or Network Health Corporation and Network Health Plan. logo are registered trademarks of MDLIVE, Inc. and may not be used without 1567-02-0419 permission. For complete terms of use visit https://www.MDLIVE.com/terms-of-use/.

Download Download the the app app

n e t w o r k h e a l t h . c o m

Join for free. free. Visit Visit aadoctor. doctor.

Join for

MDLIVE.com/nhcommercial MDLIVE.com/nhcommercial 877-958-5455 877-958-5455 W i n t e r 2 0 2 0 balance | 21 •

life. health. wellness.

Achieving a Balanced Work-Life Balance T

oday, more than ever before, employees are working from home. The reasons vary, with the most important being for employees to remain safe and unaffected by the coronavirus. This new version of the office is the way things are going to look for a while. What does that mean for all the employees who are fortunate enough to work remotely?

There are several benefits to working remotely—a great commute, flexibility, increased productivity and more time with the family. However, working from home can also make it more difficult to step back from the work day, which can upset your work-life balance, not to mention your emotional and mental health.

How can you maintain an acceptable work-life balance when your office is a room in the house?

1. Set a schedule

5. Enjoy your lunch

To make the most of your workday and be the most productive, it is very important to set a daily schedule for yourself. Working from home is more comfortable and a bit more relaxed compared to the office. Instilling a set schedule and structure to your day will help keep you focused and remove distractions. Set your work hours and log off at the end of your scheduled workday.

When working from home it is easy to glance over the lunchtime meal. Don’t. Take the time for a real lunch break and eat a decent meal. Step back, unplug and re-energize your body and mind with some food.

6. Create a virtual watercooler

Instead of rolling out of bed and settling into your office chair right away, treat your home office like your regular office. Wake up, shower, eat breakfast, maybe even do some yoga, before you sit down in front of your computer. Take the time you need to get ready for the day, like you would if you were working at the office.

When everyone is working from home, you get cut off from a lot of casual conversations and daily interactions. Schedule ten minutes a day to catch up and chat with coworkers through Zoom, Microsoft Teams or any other real-time communication tool. Use the time to talk and catch up with one another. The social interaction can help you decompress and continue to build relationships.

3. Set boundaries

7. Put your work away at the end of the day

4. Take breaks

Ultimately, your definition of work-life balance is completely up to you. If you begin each day with the proper mindset and a set of rules that work for you, working from home can be a successful venture.

Everyone is different. Find what works best for you, then embrace it.

2. Treat your home like your office

Have separate areas for work and play. Define your work time and work space and have your family define theirs. Keeping work and home separate, even though they are at the same place, will help resemble professionalism and balance between work and play.

Make sure you allow for time to stretch, rest your eyes and move around. Don’t get caught up or overwhelmed with work day activities.

Take a moment to step back and breath. Breaks serve to refresh your mind and spirit and will help you maintain productivity in the long run.

22 | balance • W i n t e r 2 0 2 0

Shut down your computer, clean up your office space and leave your work behind. This helps you make the transition from work mode to home mode. Mentally clocking out helps simulate the act of leaving the office at the end of the day.

HEADACHE networkhealth.com

Let’s Stay Socially Distant ... Together

By Jordan Kapellusch, digital marketing specialist at Network Health

T

o support our mission of building healthy and strong Wisconsin communities, Network Health has several social media profiles that allow you to connect with us. These pages not only allow you to contact us with questions about Network Health, our member events or the benefits of membership, but they also give you access to health and wellness content that will enrich and enlighten your life.

Our Grow in the Know blog features exclusive content on a variety of health care topics, written by experts from our integrated health team and local health care providers. Some of the topics we’ve featured include Everything to Know About Diabetes, How Your Diet Can Affect Bladder Incontinence, Which Fitness Tracker Should I Buy? and 8 Steps to Take to Better Focus on Mental Health. You can find our Grow in the Know blog at networkhealth.com/blog.

On Facebook, we regularly share content from Grow in the Know. In addition, you’ll find great discussions about health and wellness topics, as well as events and organizations in your community. We also feature groups that allow you to dig in to great articles and inspiring shareables while experiencing a great online community. All of this can be found on our Facebook page at facebook.com/networkhealthwi.

If you’re looking for even more behind-the-scenes Network Health action or craving interesting shareables and graphics, our Instagram page (@NetworkHealthWI), has plenty. Regularly updated, this page is an excellent way to stay in touch and see photos and videos of our Network Health values in action.

Maybe you prefer the brief and direct nature of Twitter. We frequently share our content and boost helpful health, wellness and insurance advice through our Twitter profile. We’re @NetworkHealthWI on Twitter.

Like Facebook, LinkedIn is a great place to learn more about what makes Network Health so unique. As a local, Wisconsin-based health plan, we’re plugged in with the businesses we support. LinkedIn is the place to go to see updates from our business partners and read about the events we host and attend. Learn more by visiting us on LinkedIn at linkedin.com/company/network-health-wi.

Finally, our YouTube channel not only gives you access to our library of video content, answering frequently asked questions about health insurance topics and showcasing healthy recipes, but it also has frequent updates featuring our media appearances and our local business partners. We’re on YouTube at youtube.com/user/ NetworkHealthWI. As always, if you have any questions about Network Health services or your plan, we’d love to hear from you. You can reach us at networkhealth.com/contact-us.

n e t w o r k h e a l t h . c o m

W i n t e r 2 0 2 0 • balance

| 23

life. health. wellness.

What Happens When We Focus on Quality N

etwork Health continues to focus on delivering high-quality service and care. We are committed to delivering a personalized member experience and collaborating with our provider partners to ensure our members continue receiving the right care at the right time and are treated with courtesy and respect. This focus on quality is reflected through multiple quality measures, many of which are higher than the national average.

Rating of Health Plan

Getting Care Quickly

Getting Needed Care

Coordination of Care

89.3%

90.1%

83.1%

86.9%

86.5%

89.9%

85.2%

89.1%

63.8%

67.1%

COMMERCIAL

Claims Processing

For more information on Network Health’s Quality and Performance Improvement Program, please call our member experience team at 800-378-5234 (TTY 800-947-3529) or email the quality health integration department at QI@networkhealth.com.

The source for data contained in this publication is NCQA CAHPS 2020 results. Any analysis, interpretation or conclusion based on this data is solely that of the authors.

NCQA specifically disclaims responsibility for any such analysis, interpretation or conclusion.

Do You Get Too Much Mail?

N

etwork Health now lets you choose which information you want to receive in the mail and which information you want to receive via email. You can go paperless for some communications and receive emailed information. Or, if there are communications you’d rather receive in the mail, you can select that preference. The choice is yours.

Select your preferences through your member portal at login.networkhealth.com. Simply log in to the portal, click your name in the upper right corner and select Change My Communication Preferences. From here, you can choose email for any or all the available categories. Make sure to click Next to save your choices.

24 | balance • W i n t e r 2 0 2 0

networkhealth.com

What Is Population Health Management?

By Alice Parks, director of population health management at Network Health

T

he goal of population health management is to improve a group’s health outcomes by monitoring and identifying individual patients within that group.

Network Health’s population health strategy is designed to support our mission of creating healthy and strong Wisconsin communities by doing the following.

• • • •

Enhancing our members’ experience Improving the quality and engagement of clinical management Providing proactive support to our members Promoting continuity of care and cost effectiveness through understanding the needs of all Network Health members

The population health strategy focuses on these areas.

• • • •

Keeping members healthy Managing members with emerging risk Patient safety or outcomes across settings Managing multiple chronic illnesses

Each of these areas of focus offers at least one program or service available to members within the target population. This population may be based on current diagnoses, risk factors, member-identified areas of interest or other health factors.

For more information about Network Health’s Population Health Programs, email QI@networkhealth.com.

n e t w o r k h e a l t h . c o m

W i n t e r 2 0 2 0 • balance

| 25

life. health. wellness.

Mental Health and Staying Positive

By Mary Zamost, quality care coordinator at Network Health

A

health crisis such as the coronavirus can cause emotional distress and anxiety for many people. Feelings of confusion, frustration and loneliness are common during events like this. From large increases of family time to homeschooling to working remotely or not working at all, the last year has changed the way we live, and the uncertainty we feel because of that can be overwhelming.

While we all know it’s helpful for everyone to stay positive, it’s sometimes easier said than done. Here are some suggestions to help you stay positive, lift your mood and keep a healthy outlook.

• Remember it will not be this way forever. Yes, this is a difficult time, but it is just that—a period of time.

• Recognize what you are doing well and give yourself credit. It may be difficult to do right now but reflect on the things you have managed well. Think about the physical, mental and emotional obstacles you may have encountered in the last several months and give yourself credit for how you were able to approach and handle those challenges.

• Get enough sleep and stay on top of things you usually push to the side.

If you are working from home and/or in quarantine, you may have more time on hand because you’re not travelling. Take that additional bit of time to get an extra hour of sleep or get to that project that keeps getting shoved to the bottom of your to-do list.

• Take some time for yourself and learn something new. Here are a few ideas.

• Learn a new language • Buy a cookbook or checkout online tutorials and try some new, healthy, immune-boosting recipes • Take some online yoga classes or learn to meditate • Learn how to play an instrument • Exercise. Aside from its physical benefits, exercising releases endorphins in your body, which trigger feelings of positivity, so be sure to include an exercise routine in your day.

• Embrace communication technology. Social distancing doesn’t mean we can’t stay in touch with our family and friends. Check-in and reconnect with those you may not have heard from for a while. Remember friends and family are likely dealing with the same anxiety and stress as you—sharing feelings can be comforting. Make an effort to keep the conversation positive.

Remaining calm, connected and constructive at times of uncertainty can help us navigate through difficulties and find a path toward healthy mental and physical well-being.

26 | balance • W i n t e r 2 0 2 0

networkhealth.com

New Behavioral Health App

SilverCloud Available for State of Wisconsin Employee Members

By Mary Zamost, quality care coordinator at Network Health

N

early everyone has experienced some sort of sadness, stress or anxiety sometime in their life. Over 16 million adults in the U.S suffer from depression, about one in three adults have an anxiety disorder and nearly 66 percent of adults are stressed due to uncertainty about the future or health issues.

Recognizing and being able to manage these feelings before they become overwhelming is important. Studies show that having good mental health can also have a positive impact on other aspects of our lives, including quality of life and physical health.

Network Health is excited to be able to offer state of Wisconsin members access to SilverCloud, and an online, self-guided mental health resource program. This online resource provides secure modules of therapeutic exercises and behavioral interventions to help people take control of their own mental health. The program provides online tools to help with the following and more.

• Manage day-to-day stresses and anxiety • Improve resilience • Learn skills to understand thoughts, feelings and behaviors • Reduce symptoms of depression and anxiety SilverCloud is available 24 hours a day, and can be used on any device (smartphone, tablet, computer). It’s easy to use and offers information and support for those experiencing mental health challenges such as anxiety, depression and stress.

Program modules contain text, video and audio clips, as well as interactive activities.

Each one takes about 40 minutes to complete, but users can work through them at their own pace.

SilverCloud can be used daily and be an effective tool to learn new coping skills and help reduce symptoms.

n e t w o r k h e a l t h . c o m

W i n t e r 2 0 2 0 • balance

| 27

PRESORT STD US POSTAGE PAID PERMIT 1033 GREEN BAY, WI

1570 Midway Pl. Menasha, WI 54952

MAIL ON 12/23/20

Know Someone Turning 65?

N

etwork Health offers health insurance options for all stages of your life. Whether you have insurance through your employer or you purchase it through the Health Insurance Exchange (also known as the Marketplace), you can continue receiving high quality medical coverage from Network Health after you turn 65 and become eligible for Medicare. Sign up for our new to Medicare e-newsletter at networkhealth.com/n2m-newsletter.

When am I eligible for Medicare?

3 months before turning 65

There is a seven-month window when you can enroll in Medicare.

your birthday month

3 months after your birthday

You may have a lifetime penalty if you don’t enroll during the initial enrollment period, depending on your current coverage.

What’s the difference between Original Medicare and a Medicare Advantage plan?

Original Medicare is federal health insurance for people 65 and older, people with disabilities and/or people with certain conditions. Original Medicare is broken into two parts. Medicare Advantage plans cover everything Original Medicare covers, and more.

Original Medicare Part A Hospital Insurance

You can add

Medicare Advantage Plan

Part B Medical Insurance

A

Medicare Supplement Insurance Policy

Part D Prescription Drug Coverage

C

Part C Combines Part A and Part B

or

May include, or you may be able to add Part D Prescription Drug Coverage (Most Part C plans cover prescription drugs. You may be able to add drug coverage to some plan types if it’s not already included.)

Sometimes, Medicare Supplement plans look like a great deal because of what you’ve been paying for health insurance coverage.

When you compare the coverage of a Network Health Medicare Advantage Plan to a Medicare Supplement plan, you’ll be surprised how much you get for the premium. Some Medicare Advantage Plans even offer extra benefits like drug coverage, vision, hearing or dental.

Call the Network Health sales team at 800-983-7587 for answers to your Medicare questions.