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



A Blooming Friendship Member Barb Rampolla shares her story of finding support and friendship in an unlikely place.

Due to the coronavirus outbreak, we are not offering special event tickets and all Network Health in-person events have been canceled at this time. Our priority is ensuring you stay safe and healthy during this time of uncertainty, which includes social distancing and following the Centers for Disease Control and Prevention’s preventive measures. For Network Health’s latest information about the coronavirus, please visit networkhealth.com/coronavirus.









3 Letter from the President and CEO 4 Emmi® – An Interactive Experience

14 Staying Active At Home

4 Advance Care Planning

18 Breaking Down Barriers to Care

6 What Happens When We Focus on Quality

18 Access to Network Health Care Management Employees and Services

7 Good Mental Health All Year Long

10 EDITORIAL STAFF President and CEO Chief Administrative Officer Strategic Marketing and Communications Manager Strategic Marketing and Communications Coordinator Visual Design Lead

16 The Impact of the Opioid Epidemic

7 Extra Benefits of Your Network Health Medicare Advantage Plan


8 Falls Are NOT a Natural Part of Aging

19 How Do Health Plans Make Decisions? 20 Understanding Your Skilled Nursing Facility Benefit 22 What Is Population Health Management? 23 Telehealth – Technology That Can Improve Your Health

9 Emergency Room, Urgent Care or Virtual Visit? FEATURE 10 A Blooming Friendship 13 My Health Journal

Coreen Dicus-Johnson Penny Ransom Romi Norton Becky Pashouwer Debra Sutton

19 Explanation of Benefits Enhancements

BACK COVER Community Resources

ASK NETWORK HEALTH If you have questions about anything you read in this issue of Concierge, call customer service at 800-378-5234 (TTY 800-947-3529) Monday–Friday, 8 a.m. to 8 p.m. You can also learn more at networkhealth.com. Concierge is a biannual publication of Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals. © 2020 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.

Network Health complies with applicable Federal civil rights laws, conscience and anti-discrimination laws and prohibiting exclusion, adverse treatment, coercion or other discrimination against individuals or entities on the basis of their religious beliefs or moral convictions and does not discriminate on the basis of race, color, national origin, age, disability, or sex. You may have the right under federal law to decline to undergo certain health care-related treatments, research, or services that violate your conscience, religious beliefs, or moral convictions. 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 800-378-5234 (TTY 800-947-3529). 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 800-378-5234 (TTY 800-947-3529). 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 800‑378‑5234 (TTY 800-947-3529). H1181_2656-01a-0320_C

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life. health. wellness.

Letter from the President and CEO The COVID-19 health crisis has been at the forefront of all our minds. The unprecedented daily changes impact each of us, sometimes in very challenging ways. Please know you can still count on Network Health. Our teams have business continuity plans that we test regularly to ensure you are supported from remote locations, just as we would if we were in the office, and your Network Health plan has you covered should you need care. We are here to provide the exceptional service you have come to expect—our hometown advantage. This is our way of doing business, because we know we are serving our neighbors, friends and family. As a Wisconsin-based company, we aim to improve the lives of individuals as we pursue our mission to create healthy and strong Wisconsin communities. We focus on making our community a better place to live by volunteering, sponsoring/hosting events and donating to local charities. As we do our part to take care of our communities and those around us, your health and safety is our highest priority. Furthermore, our members receive concierge-level support to ensure that plan benefits are understood. Our feature story showcases a member who experienced our concierge-level service from Craig Kandler, a health care concierge who has been with Network Health for 20 years. Craig is one example of how Network Health’s employees go above and beyond to provide a great experience for our members—that is the hometown advantage. Thank you for being a Network Health member and for giving us the opportunity to share the hometown advantage with you. If you have any questions in the coming weeks, please reach out to us. We are here for you. Wishing you health and safety,

Coreen Dicus-Johnson President and Chief Executive Officer In 2019, 77 percent of Network Health Medicare Advantage members reported receiving a flu shot, which was above the national average. Thank you for making your health a priority and getting your flu shot.


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Emmi – ®

An Interactive Experience

By KiErrin Phillips, MSN, RN, quality health integration clinical supervisor at Network Health


mmi allows you to take control of your health by watching short interactive videos on various health topics. These videos can help you better understand your health. You can view these videos on a computer, tablet or smartphone at your convenience. Emmi allows you to pause, rewind and repeat videos as many times as you like. These videos can help you feel prepared for a new or unfamiliar health care experience or help you prepare questions for your personal doctor that are specific to your needs.

Not sure where to start? Anywhere you see the Emmi logo throughout this issue of Concierge, you will find an Emmi link about that topic. Visit the link to watch the Emmi video. If you want guidance about which videos are best for you, based on your personal health and well-being, call our health care concierge team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. and ask to talk with a health coach. Or email us at healthcoaching@networkhealth.com.

Advance Care Planning By Alice Parks, director of population health at Network Health


ational Healthcare Decisions Day occurs every year on April 16. This day is meant to educate and empower the public and health care providers about the importance of advance care planning. If you haven’t had the opportunity to create or review your advance care plan, make sure you do that as soon as possible and share it with your family and health care providers.

What is advance care planning?

You may not have heard of advance care planning, but it affects each of us. It allows you to plan and make decisions now that guide your health care in the future if you are ever unable to speak for yourself or make your own decisions.

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Why is advance care planning important?

Usually, only you can make important decisions about your health. However, there are situations where you may not be able to do so, such as an accident or illness that causes confusion or affects your ability to communicate your wishes to your health care team. It’s hard to think about that type of situation, but if it were to happen, who would you want to make health decisions for you? And how would that person know what your wishes are? Advance care planning prepares your health care providers and the person you choose to make your health care decisions. It allows you to discuss what is important networkhealth.com

to you and what you value in life. You can determine the care you want to receive and leave instructions that take your values and preferences into account. This eliminates uncertainty for your doctors and family members. Advance care planning instructions can give peace of mind to you, your family and those making important decisions on your behalf.

When is the ideal time to have the talk?

You may not need to use the advance care plan, but it’s important to have a plan. The best time to talk about it is when you feel well and can clearly state your wishes. Like a retirement plan, things can change, so you might need to revisit it occasionally and have more discussions with your personal doctor and family.

Do not resuscitate (DNR) or do not intubate (DNI) orders – We recommend regularly

reviewing and updating legal documents. Make sure to discuss any changes with your personal doctor and family.

Want more information? Talk with your personal doctor, a social worker or call the care management team at 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m. and ask to speak with a care manager. my-emmi.com/SelfReg/ NHPMDIRECTIVES

Remember, your advance care plan is only used when you are unable to make your own health care decisions. At that point, your appointed decision maker will reference your wishes, values and beliefs before making health care decisions on your behalf.

How is advance care planning different than an advance directive?

The two are related, but an advance directive is different than advance care planning. Advance care planning is the process of deciding the type of care you want to receive at a time when you may not be able to speak for yourself. An advance directive is a written legal document that becomes effective if you are incapacitated and unable to speak for yourself. Advance directives are a part of the overall advance care planning process and include the following.

A living will – This allows you to specify if you would like to receive emergency treatments—such as CPR, artificial nutrition or hydration, use of ventilators or comfort care—which could be offered if you are dying or permanently unconscious. Durable power of attorney – A durable power of attorney allows you to name a health care proxy—a person who knows your wishes and will make treatment decisions for you if you are unable to do so. networkhealth.com

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life. health. wellness.

What Happens When We Focus on Quality


etwork Health delivers high-quality service and continues to be a top-rated health plan when compared to other national and state health plans. We provide an excellent member experience through our health care concierge team and our provider partners who give exceptional care.

Our focus on excellence is reflected in our quality ratings, which are higher than the national average. The Centers for Medicare & Medicaid Services (CMS) gave Network Health a 4.5 overall Star rating for our Medicare Advantage PPO plans. The national average is 4 Stars. In addition, the National Committee for Quality Assurance (NCQA) awarded Network Health a 4.5 out of 5 for Medicare for 2019-2020. These scores put Network Health in the top 25 Medicare plans nationwide.

Ease of using health plan to get prescribed medicines Network Health

Getting appointments and care quickly

Getting care, tests or treatments as nesessary

Got test results as soon as you needed them

Getting needed care














Rating of health care

National Average

For more information about Network Health’s quality and performance improvement program, please call the health care concierge team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. or email the quality health integration department at QI@networkhealth.com. The source for data contained in this publication is NCQA CAHPS 2019 results and CMS 2018 National Benchmarks. Any analysis, interpretation or conclusion based on this data is solely that of the authors. NCQA and CMS specifically disclaims responsibility for any such analysis, interpretation or conclusion. Medicare evaluates plans based on a 5-Star rating system. Star ratings are calculated each year and may change from one year to the next.

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Good Mental Health All Year Long

By Lisa Boucher, accreditation program manager at Network Health


s winter in Wisconsin comes to an end, we look forward to more sunshine and fresh air. It’s important to make sure you’re taking care of your mental health, especially during the current health crisis.

It’s easy to assume people who struggle with their mental health during the winter months are experiencing seasonal affective disorder (SAD)* and that it will pass once spring arrives. It’s important to remember many individuals struggle with mental health issues year-round, even with the longer days and warmer weather we enjoy during spring and summer. If you or someone you know displays any of these symptoms, it’s important to talk to someone—a friend, family member, church leader, community agency, your personal doctor or MDLIVE to learn about treatment options.

• Sadness • Hopelessness my-emmi.com/SelfReg/NHPMDEPRESSION • Irritability • Changes in appetite • Loss of interest in activities that usually bring enjoyment • Verbalizations or actions that indicate suicidal thoughts or ideas

Remember, there is no shame in seeking help. Mental health is just as important as physical health. Network Health cares about you and we want you to take care of yourself and be safe regardless of the season. *SAD is a mood disorder characterized by depression that occurs at the same time every year and most commonly presents in the winter months.

Extra Benefits of Your Network Health Medicare Advantage Plan As a Network Health Medicare Advantage Plan member, you have access to extra benefits not available to all Medicare beneficiaries. Once you meet your deductible, you pay $0 for Medicare-covered virtual visits, vision and dental services. You also have access to a hearing aid discount, even without meeting your deductible. As a NetworkPrime (MSA) member, you can receive gift card rewards when doing easy tasks to maintain your health, like completing your health risk assessment and seeing your doctor for an annual wellness visit. Visit networkhealth.com/medicare/additional-benefits to learn about the extra benefits offered through your plan, and to find a local provider.


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Falls Are NOT a Natural Part of Aging By Devon Lor, supervisor of quality health integration – clinical at Network Health


he Centers for Disease Control and Prevention (CDC) estimates that one in four adults over the age of 65 will experience a fall this year. Falling once doubles the chance of falling again. A diagnosis of osteoporosis—or brittle bones—increases the risk of serious injury from a fall. It’s important to know that falling is not a natural part of aging and many falls can be prevented with planning and simple lifestyle changes.

Follow these recommendations to decrease your risk of falls and/or injury.


Keep Moving Check Your Eyes Home Safety Check

Consider Self-Management Programs

• Discuss any concerns about falls with your personal doctor and get recommendations regarding an exercise program. • Women age 65 and older and/or those at risk for osteoporosis are advised to have a bone density scan (DEXA) and a repeat scan every two years or as determined by your doctor. Network Health offers many opportunities for bone density screenings. • Implement an exercise program that meets your individual needs. Exercises should focus on strengthening your legs and improving your balance. • Consult with your personal doctor before starting any exercise program. • Have your vision checked at least once every year by an eye doctor and update your glasses as recommended. • Many falls occur due to hazards in your home. Below are some safety recommendations to minimize your potential for falls. • Install grab bars and non-slip • Avoid clutter and don’t put items mats in your bath and/or shower on the floor • Repair loose handrails • Remove throw rugs • Wear non-slip shoes • Ensure your home—especially your bathroom—has nightlights • There are many programs which focus on avoiding falls like Stepping On, which is available in communities across Wisconsin. Visit wihealthyaging.org or call the Wisconsin Institute for Healthy Aging at 608-243-5690 for more information.


For more information about Network Health’s bone density screenings or falls prevention resources, please contact the Network Health Quality Health Integration Department at QI@networkhealth.com or call 800-826-0940, Monday–Friday from 8 a.m. to 5 p.m. 8 | C oncierge


What should I do if I think I might have the coronavirus? If you have symptoms of the coronavirus—unless it is an emergency—call your personal doctor before going to his or her office to discuss your symptoms and get further direction.

Emergency Room, Urgent Care or Virtual Visit? By Alice Parks, director of population health at Network Health


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.

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.

Sometimes you might not know if your condition is considered an emergency. If it’s not, you can contact your personal doctor or use a virtual visit to determine if you should make an in-person appointment or visit an urgent care walk-in clinic. Two questions can help determine which type of care is right for you.

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. These visits are an alternative to urgent care visits for non-emergency medical conditions. To find out which conditions MDLIVE helps with, go to networkhealth.com/getting-care-quickly.

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

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

An emergency is an illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid serious harm such as loss of life or limb. You typically receive emergency care at the emergency room. Urgent care is for an unexpected injury or illness

Don’t forget to ask questions

Being prepared and knowing what to do before an emergency can help you make the right decision quickly. If you need help determining if your situation is an emergency, you can contact your personal doctor. For more information, go to networkhealth.com/getting-care-quickly.


Anytime you visit the emergency room, a walk-in clinic, see your personal doctor or use MDLIVE, 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. Once you meet your $5,100 deductible, these services are covered at no cost to you. For more information about your plan, visit your member portal at login.networkhealth.com, click My Benefits, then Benefits Overview. You can call our health care concierge customer service team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. if you have questions. Whichever form of care you choose, make sure to share information about the visit with your personal doctor. networkhealth.com

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ablooming friendship


our years ago, Barb Rampolla and her husband joined Network Health. “I joined Network Health because my husband’s friend had this insurance. He always talked about how his wife had joint replacements and other health issues. He couldn’t say enough good things about Network Health.,” said Barb. They reviewed Network Health’s Medicare Advantage Plans and chose the Medicare Medical Savings Account (MSA) plan, NetworkPrime. Barb and her husband stayed on NetworkPrime for three years. In 2019, their medical needs changed, so they reviewed Network Health’s plan offerings to find a better fit. They found a plan that offered the benefits they needed at an affordable price, and they knew changing plans meant new details. They knew it was important to understand the benefits of their new plan, so they went to an Experience Network Health event to learn about it. At the beginning of the event Barb attended, Network Health employees went around the room and introduced themselves. Craig Kandler, health care concierge with Network Health for twenty years, was at this particular event. His experience and tenure with Network Health make him a valuable resource for members. When it was his turn to introduce himself, Craig had barely finished stating his name when Barb startled everyone by jumping out of her chair and running across the room to give Craig a big hug. “I lost my mind; I was so excited to meet him,” she said.

Barb and Craig meeting in person for the first time.

By Becky Pashouwer, Photography by Beth DesJardin, Trove Photography networkhealth.com

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It’s like when you go to a hairdresser or see the same lady at the grocery store for 20 years. I started to trust Craig, because anytime I would call, I’d get an answer I could understand.

Barb Rampolla, Network Health member

“It’s what the hometown advantage is all about,” said Craig. “I have a different relationship with each member, depending on what that individual needs. Some people I’ll know for 15 years and won’t know much about them personally. But some people, like Barb, I’ll connect with and immediately start to develop a more personal connection.” He continued, “I think that’s what really sets us apart from the larger insurance companies. We provide support based on the individual member’s needs. Our members are more than just a number to us—they’re the reason we’re here.” When Barb first joined Network Health four years ago, she had questions about NetworkPrime. She called Network Health’s health care concierge team and Craig answered. “She had questions about the money Medicare

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deposits into MSA members’ accounts each year. She was wondering how it gets deposited and what she could spend it on,” said Craig. “I distinctly remember Craig saying the money couldn’t be spent on a TV or I’d owe a tax on it at the end of the year. The way he explained everything made sense to me. This was the first time I had to call an insurance company. We used to have health insurance through my husband’s work and we didn’t have many issues. Now that we’re on a Medicare plan, I want to understand what everything means, so I need someone to explain it to me. Craig does it in a way that makes sense,” said Barb. Throughout her first year, Barb called the health care concierge number with questions about her plan. She


spoke to Craig a few different times and they started to build rapport. “I told her she could contact me directly with further questions and gave her my direct number,” said Craig. “From that day on, there was never a time I called with a question, or left a message, that I didn’t get a call back,” said Barb. She continued, “It’s like when you go to a hairdresser or see the same lady at the grocery store for 20 years. I started to trust Craig, because anytime I would call, I’d get an answer I could understand.”

Barb continued to call Craig directly to ask her health insurance questions. Every time they spoke, the conversations went beyond just health insurance. They’d spend a few minutes talking about their families and new things going on in their lives. “He answered my questions and I had no problem talking to him. I had a certain comfort level with him, like we’d known each other a long time,” said Barb.

Through her relationship with Craig, Barb experiences Network Health’s hometown advantage, which ties back to our mission to create healthy and strong Wisconsin Barb knows she’s not the only person who has questions communities. As a locally owned, Wisconsin-based about health insurance. “I’ve learned over the years no health insurance company, Network Health employees question is too dumb to ask. Health insurance can be live and work in the communities we serve. To engage confusing. I used to help my mom and best friend with our members, we offer various community events, such their insurance and they didn’t understand a lot of it. I only as fitness, gardening and cooking events. The hometown understand a little bit. I can’t imagine how hard it would advantage is the reason Craig and the other health care be for someone who doesn’t have any experience with concierge team members give the best service. They know health insurance,” she said. “That’s where Craig and the they’re helping our neighbors, families and friends. “Each customer service team come in.” member is different, but everyone is someone’s family member. I treat each member the way I’d want my parents Craig empathizes with members because he knows or grandparents treated,” said Craig. “And, it’s not just me. Medicare benefits can be difficult to understand. “I’m I’m not the only person at Network Health who thinks that there for my members and I respect them as individuals. way. The hometown advantage isn’t just two words we There are a lot of people out there with questions and I put together because we think they sound good. It’s our owe it to them to explain how their plan works, no matter culture. It’s the way we do business.” how much time it takes,” he said. Barb wouldn’t have it any other way.

My Health Journal Network Health provides tools to help improve or maintain your health. In 2020, we introduced My Health Journal, a booklet for tracking medical information, including your medical history, medications, allergies, immunizations and recommended preventive care. Please note, NetworkPrime (MSA) members will pay for all services, even those listed as preventive, until your deducible is met. You will pay nothing for Medicare-covered services, once the deductible is met. By having this information available in one place, you can easily share necessary information with your personal doctor. This helps you prepare for your doctor visits and allows you to spend more time talking to your doctor. A copy of My Health Journal was sent in your member guide and is also available electronically through your member portal at login.networkhealth.com. Select My Materials and you’ll find My Health Journal. If you’d like another copy of My Health Journal, you can call the health care concierge team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m.


My Health Journal Partner with your personal doctor and play an active role in your health and well-being. Keeping records and preparing for your visits will help you and your doctor create a plan that is right for you.

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life. health. wellness.

Staying Active at Home By Joanne Daane with SilverSneakers®

Exercise is a key part of maintaining a healthy lifestyle and can support a healthy immune system1. We put together some great tools for you to stay active while you stay at home. Working out at home

SilverSneakers has developed a full-body workout2 you can do in a small space. The focus of this workout is to work every major muscle group and counteract two common issues seen in older adults – loss of hip mobility and sitting and standing in a hunched over position. All you’ll need is a pair of light dumbbells. If you don’t have dumbbells available, use objects around the house, like soup cans or shampoo bottles.

How the exercise routine works Do one set of each of these five exercises. One set can be anywhere from six to 12 repetitions. Between moves, rest for 30 to 60 seconds, or longer if you need it. After the fifth exercise, rest one to two minutes, and repeat the full circuit one or two more times. For best results, do the full workout every other day. As always, safety is key. These exercises may be different than those you’ve done before. If you have a chronic condition (including osteoporosis), an injury or balance issues, modify these exercises by using a wall or chair for support. If you experience any pain or difficulty while exercising, please stop and consult with your doctor before continuing any exercise program3.

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The exercises Exercise #1 – Standing arm lift

Start in a hip hinge position, with your feet hip-width apart, knees slightly bent and torso at a 45-degree angle. Brace your core to stabilize your spine and pull your shoulders down and back. With palms facing down, extend your arms from your shoulders to form a Y. Next, bend your elbows and pull them back so your arms form a goalpost. Next, keeping your upper arms steady, straighten your arms to make a T. Finally, keeping your arms straight, squeeze your shoulder blades and gently push your arms back. Make it easier – If you have flexibility challenges, do just the first three positions (Y, goalpost, T). Focus on good form and squeezing your shoulder blades.


Exercise #2 – Bent-over row

Grab your dumbbells and stand tall with your feet shoulder-width apart. Pushing your hips back and allowing your knees to bend slightly, lower your torso until it’s almost parallel with the floor. Let the dumbbells hang at arm’s length from your shoulders, palms facing in. From here, squeeze your shoulder blades together as you bend your elbows and pull the dumbbells up to the sides of your torso. Pause, then slowly lower the dumbbells to return to starting position. Make it easier – If you feel any discomfort in your lower back while doing the movement, row one arm at a time.

Exercise #3 – Glute bridge

Lie on your back with knees bent, feet flat on the floor about hip-width apart and heels a few inches away from your buttocks. Press your arms into the floor for support and brace your core to minimize the arch in your lower back. From here, push through your heels and squeeze your glutes to lift your hips up until your body forms a straight line from your knees to shoulders. As you get stronger, focus on getting your shins as close to vertical as you comfortably can at the top of the movement. Pause, then slowly lower your hips to return to starting position.

Exercise #4 – Squat

Stand tall with your feet shoulder- to hip-width apart. Hold your arms straight out in front of you at shoulder level and brace your core. This is your starting position.

From here, push your hips back, and bend your knees to slowly lower your body into a squat, not letting your knees cave in as you do so. Pause, then push through your heels to slowly return to starting position. That’s one rep.

Exercise #5 – Stationary lunge

Stand tall with your arms down at your sides. Step back with your right foot, placing your toes on the ground and keeping your heel lifted. From this position, bend your front (left) knee to slowly lower your body as far as comfortable. Allow your back knee to bend as well until it hovers a few inches above the floor, but keep your weight pressed into your front heel. Draw your lower belly in and lift your chest. Pause, then press through your front foot to raise your body back to standing. Switch sides and repeat, making sure you do the same amount on each side. Make it easier – Troublesome knees? Lean forward slightly from the waist to reduce stress on your joints. Make it harder – Hold a dumbbell in each hand while you perform the exercise.

Facebook Live

SilverSneakers offers Facebook Live classes. Visit and follow the SilverSneakers Facebook page at Facebook.com/SilverSneakers for more details about each class, or to find the replay of previous classes. You don’t have to be a SilverSneakers member to follow along, so feel free to share it with all your friends.

Sources - 1 ncbi.nlm.nih.gov/pubmed/29713319h, 2 silversneakers.com/blog/small-space-full-body-workout-older-adults/ 3 health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf#page=68 SilverSneakers is a registered trademark of Tivity Health, Inc. © 2020 Tivity Health, Inc. All rights reserved. NHWI10814_0220


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The Impact of the Opioid Epidemic O

pioid use disorder is defined as the regular use of opioids, which causes significant impairment, health problems, disabilities and failure to fulfill major responsibilities. It affects all ages and older adults are no exception. According to the National Survey on Drug Use and Health, opioid misuse is increasing among adults aged 50 and older.1 The National Council on Aging (NCOA) recently conducted a survey asking more than 200 community-based organizations who serve older adults to evaluate how the opioid crisis is impacting their clients. Wisconsin organizations were the second largest contributor to this survey. The results are eye opening. Opioid-related stressors on adults over 50 come from all directions, like being the primary caregiver for grandchildren due to opioid addiction in adult children, financial concerns with buying pain medication and health issues related to opioid side effects. • Seventy percent of organizations that responded reported an increase in effort spent addressing problems relating to the opioid epidemic affecting older adult clients or their caregivers • In addition, 80 percent reported that older clients lacked information about safe and affordable alternatives to opioid medications, or how to safely store or dispose of opioids.2 When staggering numbers like this unfold, action must be taken to improve education.

What are opioid prescriptions?

Opioids are a class of medication that treat pain by attaching to a nerve cell in the brain and body to relieve discomfort and change the way pain is experienced. They

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By Beth Coopman, PharmD, pharmacist at Network Health

come from opium, which is found in the poppy plant or created synthetically in a lab. While opioids are legally available with a prescription, they are strictly controlled because they are highly addictive. This means doctors, pharmacies and health insurance companies all work together to make sure they are prescribed in small dosages and quantities. The most commonly prescribed opioids are oxycodone, hydrocodone, morphine, codeine, fentanyl, hydromorphone, methadone and tramadol.

What are safe and affordable alternatives to opioid prescriptions for pain? Pain Management Alternatives to Opioid Medications The first step to managing pain is to talk to your personal doctor openly and honestly. By telling your doctor the severity, type and frequency of your pain, he or she may be able to find other related conditions that can be treated to minimize your pain. It’s important to remember the capacity of the kidneys and liver to process medications can decline with age. Therefore, some remedies are safer than others, and should only be used for a short time or may require a lower dose.

Over-the-Counter (OTC) Pain Medications

These OTC medications can be effective in treating pain. • Acetaminophen (Tylenol®) • Nonsteroidal Anti-Inflammatory Drugs: ibuprofen (Motrin®, Advil®) or naproxen (Aleve®) • Topical agents, such as lidocaine 4 percent cream or patch, Capsaicin®, Bengay®, Icy Hot® or benzocaine


Non-Opioid Prescription Pain Medications

If OTC prescriptions aren’t working, non-opioid prescriptions can be used to treat pain. Discuss your pain with your personal doctor to determine if a non-opioid pain medication would work for you.

How can a person safely take an opioid prescription?

Those who must take opioid medications should follow these safety tips. • Use the lowest effective dose for the shortest period possible. • Be realistic about the expectations with treating pain and know that even opioid medications won’t completely eliminate your pain. • See a specially trained pain provider or a single provider who is the only one prescribing your pain medications. • When on opioids, avoid alcohol or sedating medications, such as alprazolam and diazepam, sleeping medications like zolpidem and muscle relaxants like cyclobenzaprine. • Do not drive while taking opioids. • Store opioids in a locked location so others do not have access to them. • Do not store opioids in places where other people will have easy access to them, like a bathroom or kitchen. • Only tell people who need to know that you are on opioid, such as your caregivers and providers. • Have NARCAN® available to reverse the symptoms of an opioid overdose and ensure someone close to you is trained to identify signs of an overdose and administer NARCAN. • Periodically, work with your prescribing doctor to see if you can potentially lower your opioid dosage.

How do you safely dispose of opioid prescriptions?

It’s important to dispose of unused opioid pills when they are no longer needed. Resist the urge to save them just in case, because that can lead to opioids getting into the wrong hands. Lastly, never share unused medications with anyone. Expired, unwanted and unused opioid pills can be disposed of at police stations; retail, clinic or hospital pharmacies; and mail-back programs. Another option is to watch for National Prescription Drug Take Back events where collection sites are set up in communities nationwide for safe disposal of prescription drugs. The next scheduled National Prescription Drug Take Back Day is April 25, 2020. Visit www.fda.gov/drugs/disposal-unused-medicines-what-youshould-know/drug-disposal-drug-take-back-locations to find permanent collection locations and sites near you or call the DEA Diversion Control Division Registration Call Center at 1-800-882-9539 for more information. Don’t let the conversation stop here. Continue to seek out answers regarding pain and opioids to avoid their possible dangers. If you have any questions pertaining to this article, please contact us at pharmacists@networkhealth.com.

my-emmi.com/ SelfReg/NHPMOP Sources

Substance Abuse and Mental Health Services Administration (2017). The CBHSQ Report. Opioid misuse increases among older adults. Retrieved from samhsa.gov/data/sites/default/files/report_3186/Spotlight-3186.pdf 2 National Council on Aging (2019). The Impact of the Opioid Epidemic on the Aging Services Network and the Older Adults They Serve. Retrieved from https://d2mkcg26uvg1cz.cloudfront.net/wp-content/uploads/2019-FPAD-006_Issue-Brief_Opioid-Epidemic_11-22.pdf 1


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Breaking Down Barriers to Care By Alice Parks, director of population health at Network Health

You may have heard of social determinants of health, but what are they? The World Health Organization defines social determinants of health as the conditions in which people are born, live, learn, work, play, worship and age that affect health outcomes and risks, functioning and quality of life. Put simply, it means factors in your life, outside of health care itself, can affect your health and wellness. Some of those factors can become barriers or challenges to feeling well and being healthy.

What barriers do people face? Here are some examples. • • • • • •

Having enough money to cover basic expenses, like food and clothing A place to live Access to transportation to get to the grocery store, the doctor, a support group or social activities you enjoy People to check in on you and support you, if needed The ability to understand information about your health—medical language is hard to understand and sometimes we speak and understand different languages Religious, spiritual or cultural beliefs and values that aren’t understood by your health care team

To determine which barriers you face, you should ask yourself two questions. • What barriers to feeling well and being healthy do I face? • What can I do to break down those barriers? Then, you can form a plan and take action. For example, if you or a family member has a language barrier, ask for a translator. Or, if a suggested plan of care conflicts with your values, let your health care team know. They can provide alternative care plans that fit your needs and meet your values. Remember, Network Health is here to support you on your health and wellness journey. We have nurses and social work care managers right here in Wisconsin to serve you and discuss the challenges you’re experiencing. To talk with a Network Health Care Manager, call 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m. We’ll help you find resources in your community to break down some of the barriers you face.

Access to Network Health Care Management Employees and Services


etwork Health provides access to medical and behavioral health employees for Medicare Advantage members, providers and their office staff who are looking for information about our care or utilization management programs. If you have questions about these programs, please contact care management at 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m.

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Health Plan Notices


Explanation of Benefits Enhancements You asked, and we listened.


any of you have requested less paper related to the Explanation of Benefits (EOB) you get each time you use your insurance. This statement explains the medical service(s) you received and how much your plan will cover.

This spring, to reduce the amount of paper and mailings sent to you, we’ll be making a change. You’ll only receive one EOB per month, if you received services during the previous month. For example, if you see your personal doctor twice in June, you’ll receive one EOB in July that contains information about both your visits in June. In addition to receiving only one EOB each month, you’ll notice it’s in a different, easy-to-read format. If you have questions about how to read your EOB, please contact our health care concierge team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. If you prefer to go paperless, you can choose that option in the 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. If you choose email as your communication preference for receiving EOBs, you’ll receive an email each time you have a new EOB available. Make sure to click Next to save your choice.

How Do Health Plans Make Decisions?

By Sarah Dencker, director of utilization management at Network Health hiring, promoting or terminating practitioners or other ecisions made about care by Network Health are associates based on the likelihood, or the perceived based on the appropriateness of care and service. likelihood, that the practitioner or associate supports, or This includes medical procedures, behavioral health tends to support, denial of benefits. The medical directors, procedures, pharmaceuticals and devices. The decisions associates (or designees), care management staff and are based on written criteria founded on sound clinical supervisors of this staff receive no financial incentive to evidence and on the benefits outlined in the various encourage decisions that result in underutilization. coverage documents. These written criteria are reviewed and approved annually by actively-participating In addition, treating practitioners may discuss medical practitioners. Criteria are available to providers, necessity denial determinations with the physician review practitioners and/or members upon request. Requests for medical director by contacting Network Health. The criteria can be submitted via telephone, fax, email or mail. Medicare team can be reached Monday–Friday from Once the request is received, members of the utilization 8 a.m. to 5 p.m. at 920-720-1602 or 866-709-0019 management team send the information to the requestor (TTY 800-947-3529). Bilingual language assistance or via fax, email or mail. translation services are also available. Callers can leave a


Network Health does not reward practitioners or other individuals conducting utilization review for denying coverage for care or service. Network Health does not prohibit providers from advocating on behalf of members 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 networkhealth.com

message 24 hours a day, seven days a week. All calls are returned promptly. Calls received after business hours are returned the next business day. Members, practitioners and/or providers may also send inquiries to the Medicare care management department by fax at 920-720-1916 or mail at 1570 Midway Pl., Menasha, WI 54952.

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Health Plan Notices

Understanding Your Skilled Nursing Facility Benefit By Alice Parks, director of population health at Network Health


f you have a planned or unexpected stay in a skilled nursing facility (SNF), it’s important to understand how your Network Health Medicare Advantage Plan covers that stay. Just being there can be difficult enough, without getting an unexpected bill.

What does that mean?

Usually, people are admitted to an SNF after a hospital stay. Before you are transferred, you will want to know whether your health plan covers the stay and if you have alternate options.

Complex wound care

The health care services you receive or will receive at the SNF are medically necessary. The services that the SNF team provides are skilled services. These services can be considered skilled services. Combination of physical therapy, occupational therapy and speech therapy

Coverage of an SNF stay depends on several factors. Generally, once you’ve met your deductible, your plan will pay for SNF care if all these criteria are met.

Complex medication plan that needs adjustment

You have a qualifying inpatient hospital stay before being admitted to the SNF. This means you must be in the hospital overnight for a certain number of days before transferring to the SNF. Some Network Health Medicare Advantage Plans have no inpatient qualifying hospital stay requirement and others require a three-day inpatient hospital stay. Review your Evidence of Coverage to confirm your SNF benefit.

New tracheostomy care

There are days left in your 100-day benefit period. Most of our Medicare Advantage plans have 100 days of coverage each time you are admitted to a SNF. Your benefit period starts over each time you are admitted. The SNF to which you are admitted is licensed by Medicare. 20 | C oncierge

Injections or infusions Tube feedings that need adjustment Complex medical teaching or training The skilled services are needed every day Your doctor requires you to have daily, skilled care services The daily skilled care is provided or needs to be overseen by licensed and/or registered medical personnel, such as a registered nurse or physical therapist The skilled services are required for the health condition for which you were admitted to the SNF The services can’t be provided at an outpatient facility or in your home


The health care services are not for individuals who need non-medical assistance. This type of care is called custodial care and includes providing care for a person who needs assistance with activities of daily living, like walking, getting in and out of bed, bathing, dressing, feeding, using the toilet, preparation of special diets and supervision of medication that a person can usually take him or herself. Custodial care does not require licensed or registered medical personnel. If these factors are met, Network Health covers all or part of your SNF health services, which may include the following. Meals Dietary counseling Shared rooms Medication

Other Considerations

Before any emergencies occur, it’s good to be familiar with your benefits, so you know which options you have available. Look into home care agencies that offer options that could meet your needs. Know who would be your support person to assist you at home, if needed. Look into facilities where you or your loved one would be comfortable staying if the need arises. Confirm the SNF is licensed by Medicare. Understand your specific plan requirements.

If you have questions about your benefits, call the health care concierge customer service team at 800-378-5234 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. We’re here to help you understand your coverage.

Physical therapy Care by medical staff Use of medical supplies and equipment

What isn’t covered?

As with any program, your SNF care benefit has limits. The following are not covered. SNF admissions that don’t meet qualifying inpatient hospital stay requirements. If an admission does not meet qualifying inpatient hospital stay requirements, Network Health won’t pay the costs of the SNF stay. This means you might be responsible for 100 percent of the SNF costs unless you have alternate funding, such as a Medicaid benefit. SNF stays over 100 days. If you stay in the SNF for over 100 days, Network Health will not pay the costs after the one-hundredth day. This means you must pay for all medical costs after 100 days, unless you have alternate funding, such as a Medicaid benefit. If Network Health is aware you were admitted to a SNF, we will provide you with notice when your 100-day benefit period is over. SNF stays that are not medically necessary. If a stay is not medically necessary, you must pay for all costs. Network Health will provide you with notice in advance if a stay is not medically necessary.


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Health Plan Notices

What Is Population Health Management? By Alice Parks, director of population health at Network Health


id you know Network Health offers personal wellness, condition management and care management services at no cost to you? Whether you’re dealing with an unexpected medical issue, a complex diagnosis, a chronic condition or just a need a little help maintaining your health, we can help you manage your health to increase your sense of well-being and put you in control. Our wellness programs focus on quitting smoking, eating healthy, controlling blood pressure and learning about easy ways to exercise. The condition management program helps people with diabetes, heart disease, heart failure and chronic obstructive pulmonary disease (COPD). Our care management program focuses on assisting people with complex medical and behavioral health needs which include cancer, end-stage disease and other life-threatening conditions. We’ll also help you create a successful transition plan to go home when you’re discharged from the hospital. Your health risk assessment and/or specific claims will help us identify you for health management services. Your doctor may also refer you or you can refer yourself. If you choose to participate, our health coaches or managers help you manage your health conditions and meet your health goals. Health management begins with a one-on-one conversation between you and one of our health coaches or managers. You may opt out of these

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programs at any time by calling the customer service number on your member ID card. After learning more about you and your health concerns, your coach or manager can do any of the following. • Answer any questions you have • Review your medications and treatment plans • Inform you about the signs that your health condition is worsening and when to act, including when you should contact your health care provider • Work with your health care providers to ensure they are aware of any health changes • Ensure you and/or your caregivers feel included in your health care decisions • Help you set health care goals and maintain or improve your health • Help you with coordination of care with doctors and community services • Provide you with educational resources, specific to your diagnosis • Work with you to meet your goals You can learn more about our programs at networkhealth.com under the Health and Wellness tab. If you could benefit from wellness, condition or care management support or would like to know more about our programs, call 866-709-0019 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 5 p.m. Callers may leave a message 24 hours a day, seven days a week.



Technology That Can Improve Your Health elehealth is technology that lets us respond to changing health needs based on how people receive and act on information. It allows us to share information between different locations, providing clinical support to help improve health outcomes.



Telehealth is a broad term that means using electronic information and communication technologies to provide access to the following services. • Long-distance clinical health care • Patient and professional health-related education • Public health information • Health administration It uses interactive audio and/or video equipment and includes telemedicine and remote monitoring. You can use these technologies from your home to access health services and manage or improve your health. Telemedicine is the clinical use of telehealth technology for two-way, real-time interactive communication between patient and doctor, who are at different, often distant, sites. Telemedicine can be a cost-effective option to the more traditional face-to-face way of providing medical care. Remote monitoring is the collection of a patient’s health data—such as weight, blood pressure, blood sugar, blood oxygen levels, heart rate and electrocardiogram readings— via a mobile medical device. The collected data is then sent to a health care professional for review and monitoring.

How can telehealth help you?

Telehealth services can do the following. • Make health care, including care with some specialists, more accessible to people who live in remote or isolated communities. • Make health services available, safe and convenient for everybody because you can get services from the comfort of your own home. • Provide you with support to self-manage health conditions.

Which telehealth services are available to you?

Network Health and our provider partners have telehealth tools available to help you manage your health and get the services you need. • Network Health’s member portal • MDLIVE – virtual visits for some urgent care and behavioral health needs* • Heart failure remote monitoring – offers remote monitoring for members with heart failure* • Emmi- Computer-based educational and decisionmaking tools

To learn more about the telehealth services available to you through your Network Health Medicare Advantage Plan, contact your health care concierge team at 800-378-5237 (TTY 800-947-3529), Monday–Friday from 8 a.m. to 8 p.m. *You will pay the Medicare-approved amount on these services until you meet your deductible. Once the deductible is met, you will pay $0 for these services. networkhealth.com

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1570 Midway Pl. Menasha, WI 54952

Health and wellness or prevention information



Community Resources Below is a brief list of community organizations and contact information. Organization Name

Services Offered Contact Information Northeast Wisconsin Fox Valley Advance Care • Advance care planning 229 S. Morrison St., Appleton, WI 54911 920-997-8412, fvacpp.org Planning Partnership Available in these counties: Calumet, Fond du Lac, Green United Way 211 • Health and human services Lake, Manitowoc, Marquette, Outagamie, Sheboygan, • Community information in Fox Cities Waushara, Waupaca and Winnebago. Dial: 2-1-1 times of disaster unitedwayfoxcities.org/our-work/united way-2-1-1/ Southeast Wisconsin Impact 211 Wisconsin • Personal crisis 6737 West Washington St., Suite 2225 • Community disaster Milwaukee, WI 53214 (Milwaukee) Dial: 2-1-1 or 866-211-3380 impactinc.org/impact-2-1-1/ 204 S Hamilton St., Madison, WI 53703 LeadingAge Wisconsin • Aging Services 608-255-7060, leadingagewi.org/ • Education • Advocacy Eastside Senior Services • Independent living 2618 N Hackett Ave, Milwaukee, WI 53211 • Stay connected to the community 414-210-5881, essmilw.org/ Locations throughout Wisconsin dhs.wisconsin.gov/adrc/consumer/index.htm Aging and Disability • In-home care Resource Center (ADRC) • Health and nutrition • Medicare, Medicaid and Social Security guidance carewisconsin.org/list11_wisconsin_senior_centers. Senior Centers • Health and wellness programs • Arts and other activities htm • Financial assistance • Meal and nutrition programs Meals on Wheels • Meals for seniors with limited mobility mealsonwheelsamerica.org/ and/or with financial hardships dhs.wisconsin.gov/aging/index.htm Services for Older Adults • Adult protective services • Benefits • Aging and disability resources • Healthy aging • Senior Employment Program (WISE) Due to the health risks associated with being in close proximity to other people, all Network Health events have been canceled at this time. Visit networkhealth.com/medicare/events for the most up-to-date information.

Profile for Network Health

Network Health Concierge Medicare member newsletter - NetworkPrime, spring 2020  

Network Health Concierge Medicare member newsletter - NetworkPrime, spring 2020

Network Health Concierge Medicare member newsletter - NetworkPrime, spring 2020  

Network Health Concierge Medicare member newsletter - NetworkPrime, spring 2020

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