Concierge spring 2017

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

S P R I N G 2 0 17

Paying it Forward A Fox Cities couple finds new purpose in retirement

inside PAGE 6

Save a Trip to the Doctor with MDLIVE® Virtual Visits

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Are You Eligible for Medication Therapy Management?

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If It Ain’t Broke …

You Should STILL See Your Doctor

A PUBLICATION OF

Exclusive Reduced Rates for Network Health Medicare Advantage Plan Members For ticket information, visit NetworkHealthMedicare.com/offers. Offers expire April 26.

Fox Cities Performing Arts Center - Appleton, Wisconsin

DRIVING MISS DAISY – April 27 at 7:30 p.m.

WICKED – August 31 at 2 p.m.

Marcus Center - Milwaukee, Wisconsin

CHICAGO – April 30 at 1 p.m.

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5 Get Active with SilverSneakers® Fitness 6 Save a Trip to the Doctor with MDLIVE® Virtual Visits 7 Deciding Where to Go 8 Help Accessing Providers

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3 How Your Input Improves Our Service 3 Hearing Aid Benefit Spring into Action 4

8 Your Primary Care Physician 9 At Your Service Personalized Case Management FEATURE 10 PAYING IT FORWARD A Fox Cities couple finds new purpose in retirement 14 Help Taking Your Medications as Prescribed

These limited-time ticket offers are for Network Health Medicare members and their families only. Not valid on previously purchased tickets. While supplies last.

15 Are You Eligible for Medication Therapy Management?

16 Network Health’s Approach to Utilization Management 17 Three Tips to Avoid Returning to the Hospital 18 Farm to Table An Old-Fashioned Food Trend 19 Diabetes Monitoring Checklist 20 If It Ain’t Broke …

You Should STILL See Your Doctor 21 Schedule and Track Your Screenings 23 Make the Most of Your Doctor Visit with Open Communication BACK COVER Tired of Too Much Mail?

Sign Up for E-Delivery or Householding Y0108_1026_031017 Accepted 03/14/2017

EDITORIAL STAFF

President and CEO Chief Administrative Officer

Marketing Coordinator

Lead Designer

Coreen Dicus-Johnson Penny Ransom Kari Navis Debra Sutton

ASK NETWORK HEALTH If you have questions about anything you read in this issue of Concierge, call customer service at 800-378-5234 Monday through Friday, 8 a.m. to 8 p.m. From October 1–February 14, we’re here every day, 8 a.m. to 8 p.m. You can also learn more at NetworkHealthMedicare.com.

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. These services are offered to support Network Health’s Medicare-related programs and services, including utilization management.

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. © 2017 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 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 800-378-5234. 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. 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.

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life. health. wellness.

How Your Input Improves Our Service T

hroughout the year, Network Health conducts member surveys because we want to know how you feel about your Medicare Advantage plan and your doctors. Surveys gauge our performance and your satisfaction with topics like customer service, benefits and quality measures such as flu shots, physical activity and access to care.

Network Health conducts some surveys, but often, a third party survey administrator will conduct the research. This is an industry best practice to help ensure questions are impartial and results are accurate.

Some surveys tie directly to quality measures, including our Medicare Star Rating. These ratings help Medicare members compare plans and coverage. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is one example of how your feedback influences Network Health’s ratings.

Survey results also shape decisions at Network Health. Your feedback helps define which aspects of our business are thriving, and identify areas for improvement. When we improve based on your feedback from CAHPS surveys, it increases our CMS-issued Star Rating, which in turn, helps keep your costs low.

Surveys are issued anonymously and at random, allowing you to provide feedback on Network Health with complete confidentiality. If you receive a mailing or phone call from SPH Analytics, share your experience to be part of the CAHPS survey results. By doing so, you’ll help us continue to improve and meet your needs as a member.

HEARING AID BENEFIT

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y age 65, one in three people are living with hearing loss, according to the Hearing Loss Association of America. Many wait years before they seek help, and during that time, their careers, relationships and enjoyment of life can suffer.

This year, Network Health is offering a hearing aid discount program with Simpli Hearing, LLC and Widex Hearing Instruments. Through this supplemental benefit, Network Health Medicare PPO and PPO SNP members can save on three levels of quality hearing instruments through participating audiology providers.

• Widex Dream 220 $1,195 per device (limit 2 hearing aids)

• Widex Dream 330 $1,395 per device (limit 2 hearing aids)

• Widex Dream 440 $1,595 per device (limit 2 hearing aids) The discount includes a one-year warranty, three office visits, one pack of batteries and one year of loss and damage insurance. For a list of participating providers, call 888-3SIMPLI (888-374-6754) or visit NetworkHealthMedicare.com/hearingaid.

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SPR NG ACTION i n t o

Tips for Exercise and Eating Well

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ou wouldn’t expect your car to keep running if you never filled up the gas tank or changed the oil. So, why would you expect to be in good health if you don’t give your body the healthy foods and exercise it needs? Your lifestyle choices can make all the difference.

EATING WELL

Good health starts with good nutrition.

Making changes to your diet can give you more energy and put you in a better mood. Consider the following when filling up your plate.

Eat your fruits and vegetables. Make sure to eat a variety of colors, such as tomatoes, carrots, broccoli and arugula. These veggies are a good source of vitamin A, C and K. An easy way to get your daily recommendation is to fill up half of your plate with fruits and vegetables at every meal.

Choose lean proteins. Instead of pork, ground beef or marbled steaks, select chicken, turkey, salmon or lean beef. These foods are not only delicious, but also a great source of healthy proteins that are good for your skin and help maintain muscle.

Know recommended portion sizes. Did you know that meals from a restaurant often contain two or three servings? By understanding portions, you can reduce your fat and calorie intake.

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EXERCISE

Ask your doctor. Before you start exercising, especially if you have existing health concerns, ask your doctor for guidance. Your doctor can suggest the exercises that will benefit you most and suggest how to start, increase or maintain your level of physical activity.

Be active for 30 minutes a day, five times a week. If it helps, you can split the time into two or three segments.

It’s important to take steps to reduce the amount of time spent sitting.

Mix up your workouts. Mixing cardiovascular, strength training and flexibility training can keep your workouts interesting and help you achieve your health goals.

Work out with a friend. Take a buddy with you when you head to the gym, or take your dog for a walk around the block. Group exercise classes can be a great way to make new friends.

Create a fitness goal. Is there something you’ve always wanted to accomplish? Maybe it’s jogging for a mile or biking to a favorite spot. Whatever your goal is, write it down and start taking steps to achieve it.

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Get Active with SilverSneakers Fitness

®

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ave you worked out with your SilverSneakers Fitness benefit yet? The program is included in Network Health’s Medicare Advantage PPO and PPO SNP plan benefits and gives you access to more than 13,000 gyms nationwide.

Try the signature group classes, use the fitness equipment or work out in a pool. With coed and women-only classes, you can socialize and maintain or improve your fitness. If you’re new to fitness, that’s okay. Nearly half of SilverSneakers members had never been to a fitness location before joining SilverSneakers.

On your first day, remember to wear comfortable workout clothes, wear athletic shoes with good support and bring your SilverSneakers member ID card to get started. Visit SilverSneakers.com to find a location near you or contact a member of your health care concierge team.

Looking for a Location Near You?

Call SilverSneakers at 888-423-4632 (TTY 711), Monday through Friday, 9 a.m. to 9 p.m. Ask for suggestions in your area or recommend your favorite fitness facility.

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Save a Trip to the Doctor ® with MDLIVE Virtual Visits W

e know our Medicare members today are busier than ever, and it can be tough to take time out for a minor ailment. In just an average of 10 minutes, you could be consulting with a board-certified doctor and getting the treatment you need, wherever you are.

This year, Network Health’s Medicare members have access to MDLIVE’s virtual visits for non-urgent medical conditions, at no cost.

With virtual access, you can get care at any time, day or night, from the comfort of your home or while traveling. You can consult with a doctor by phone, secure video or MDLIVE App for common conditions.

MDLIVE treats the following ailments.

• Allergies • Cough • Fever • Nausea or vomiting • Sinus problems

• Cold and flu • Diarrhea • Headache • Rash • Sore throats

• Constipation • Ear problems • Insect bites • Respiratory problems • Urinary problems or UTI

MDLIVE doctors can even prescribe non-narcotic medication (if needed) and send e-prescriptions to an in-network pharmacy.

Activate MDLIVE today • Access MDLIVE by visiting NetworkHealthMedicare.com/MyAccount.

• MDLIVE virtual visits are provided at no cost to you

as part of your plan.

• Visit MDLIVE.com. To avoid complications when activating your account directly on the MDLIVE website, enter “Network Health Medicare” in the company name field.

If you have questions about virtual visits, please call MDLIVE at 877-958-5455.

If you are experiencing a medical emergency, call 911.

MDLIVE does not replace the primary care physician. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written.

MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. MDLIVE interactive audio consultations with store and forward technology are available 24/7/365, while video consultations are available during the hours of 7 a.m. to 9 p.m. seven days a week or by scheduled availability. 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 mdlive.com/pages/terms.html.

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Deciding Where to Go

Is Emergency Care, Urgent Care or Your Primary Doctor the Right Choice for You Right Now?

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hen you or someone you love is sick or in pain, how do you pick the best option? Emergency care, urgent care or your primary care doctor could all be the best answer. Knowing what to do before an emergency will help you make the right decision quickly.

Primary Care Doctor

If you have a health concern that’s not life threatening, your first call should be to your primary care doctor’s office. When you work with a primary care doctor, you build a relationship. Your doctor learns about your health, provides preventive care and can help spot health concerns early. Plus, a visit to your primary care doctor is usually the most costeffective type of visit.

If you’re worried about getting in to see your doctor, give the office a call. Many doctors’ offices hold appointments each day for people who have common illnesses or injuries, like influenza or a sprained wrist.

Most doctors will allow you to leave a message for your doctor and can return your call within the day. Depending on your concern, they may be able to get you an appointment more quickly than you might expect.

Urgent Care

Urgent care is designed for unexpected injuries or illnesses that are not life threatening but still need attention quickly so you don’t develop a serious problem. There are several types of facilities that offer urgent care, such as walk-in clinics, urgent care facilities or even your primary doctor’s office. Urgent care can be a great resource for non-life threatening situations, especially on weekends and holidays. Examples of urgent care situations include minor breaks, bronchitis and minor injuries like a cut that needs stitches.

Emergency Care

If you’re facing an immediate, life-threatening injury or condition, get to the nearest emergency room or call 911. 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 in the emergency room of a hospital. Examples of emergency care situations include heart attacks, strokes, serious fractures and other life-threatening situations.

MDLIVE® Virtual Visits

This year, Network Health’s Medicare members have access to MDLIVE’s virtual visits for non-urgent medical conditions, at no cost. With virtual access, you can get care at any time, day or night, from the comfort of your home or while traveling. You can consult with a doctor by phone, secure video or MDLIVE App for common conditions. Visit NetworkHealthMedicare.com/MyAccount, and click on the MDLIVE link once you’re signed in to your account.

NEED ADVICE AFTER HOURS?

Network Health’s Nurse Line is available when you have health care questions any time of the day or night. This free 24-hour phone service is available 365 days a year through Health Dialog. The nurse advice line can be accessed by calling 888-879-8960 (TTY 888-833-4271). Health Dialog has been providing services for more than 20 years, and the nurses you speak with can help answer your medical questions and guide you where to seek care.

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Help Accessing Providers

Did you know that Network Health’s provider network is expanding?

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ast year, Network Health added 4,780 in-network Medicare providers. Remember, with all of Network Health’s Medicare Advantage Plans, you can see both in- and out-of-network providers. This means you can select any provider who accepts Medicare beneficiaries.

To help ensure your access to providers, Network Health monitors the access and availability of our health care providers on a quarterly basis. Our contracting associates review member survey questionnaires and analyze member complaints. Each month, they analyze any provider access gaps as defined by the Centers for Medicare and Medicaid Services (CMS) and work to resolve them by adding providers.

Network Health works with providers to ensure you receive quality care. If you are unsatisfied with your experience, let us assist you in getting the quality of care you expect and deserve as a Network Health member. Health care concierges can also assist if you’re experiencing delays in care due to scheduling delays or struggling with a lack of providers in your area.

When you call, describe your needs and experience so a concierge can help you find a provider or schedule an appointment in a timely manner. The health care concierge will share your experience with the contracting team, to help eliminate issues for other members seeking similar care.

Your Primary Care Physician If you’d like to select a primary care physician (PCP), please share this information with customer service. If you haven’t or don’t wish to designate a PCP, Network Health relies on claims data to assign PCPs to members. Our system automatically assigns PCPs to members based on doctors you’ve seen the most who are part of your plan, designated as a PCP specialty and accepting new patients. For those who haven’t seen a PCP in two years, our system assigns PCPs based on doctors who are closest to you, part of your plan and accepting new patients. Whether your PCP is selected or assigned, you’ll receive the same high quality care you’ve come to expect, and we will communicate with your PCP to help coordinate your care.

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Watch for your next issue of Concierge in fall of 2017.

At Your Service D

PERSONALIZED CASE MANAGEMENT

id you know Network Health offers personal care management and condition management services at no cost to you? Whether you’re dealing with a short-term treatment plan or a more complex diagnosis, case management services can support you in getting the health care you need.

Case management begins with a one-on-one conversation between you and one of our care managers. If you choose to continue, our care management coordinators work with you to manage your health conditions and help you meet your health goals.

After learning more about you and your health concerns, your care management coordinator can assist you with the following.

Help manage your health conditions to increase your sense of well-being and put you in control of your health Answer any questions you may have

Review medications and treatments

Inform you about the signs that your health condition is worsening, including when you should contact your health care provider

Work with your health care providers to ensure they are aware of changes in your health

Ensure you feel included in your health care decisions If you have diabetes, heart disease, heart failure, stroke, chronic obstructive pulmonary disease (COPD) or depression, our condition management team can provide educational resources specific to your diagnosis.

If you feel you could benefit from care management support, call 866-709-0019 (TTY 800-947-3529) Monday through Friday, 8 a.m. to 5 p.m. Callers may leave a message 24 hours a day, seven days a week. You may also opt out of case management at any time by calling the customer service number on your ID card.

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COVER STORY

For Ray and Joy, the camaraderie is irreplaceable, saying,

“

If you’re gone for a few days, people notice, and they care enough to give you a call.

“

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Paying It

FORWARD A Fox Cities couple finds new purpose in retirement

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ou have to do something about this.” Those words from his wife, Joy, were all the motivation Ray Zuelke needed to get more involved in one of their favorite organizations, the Thompson Community Center. With heavy hearts, they had learned in late 2015 that the senior center on College Avenue in Appleton was closing its doors due to operating costs. It was one of the Combined Locks couple’s favorite places to spend time, enjoying their hobbies and the company of other seniors.

Both Network Health members, Ray and Joy are invested in the community they have called home for 50 years. As they retired and faced some serious health concerns, they discovered the Thompson Community Center by attending an informational seminar on social security and Medicare. That session led them to discover Network Health and a new network of friends at the center. Ray is an avid billiards player, and Joy loves a good game of Sheepshead. There were groups already meeting each week to do both, so they joined in.

With the closing of the Thompson Center on the horizon, Ray, along with members of the Thompson Community Center Civic League and volunteers, set about finding a new home for the activities, and the St. Bernadette Parish offered the vacant space that previously housed St. Bernadette Parish School. The classrooms could accommodate the different activities, the gym and cafeteria offered space for larger gatherings, and the elevator made it easy to navigate.

With some rezoning of the space and the addition of a full-time operations coordinator, the Thompson Center on Lourdes was launched in April of 2016.

Today, Ray serves on the board of directors for the soon-to-be non-profit which plans to operate as an independent 501(c)3 nondenominational organization. His passion for helping his fellow seniors connect and thrive helps drive the group forward. He also serves on the regional Long-Term Task Force Focusing on the Needs of Older Adults, which is bringing organizations together to form a stronger support network for seniors living in the Fox Cities region.

By Kari Navis, Photography by Beth DesJardin, Trove Photography

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COVER STORY

The Thompson Center on Lourdes is developing a ten-year plan to sustain the organization and continue expanding activities for seniors. As someone involved in the task force, Ray is confident that the center will be a part of and complement efforts that develop in the Fox Cities.

The center is now open to seniors Monday through Friday from 8:30 a.m. to 4:30 p.m., and Ray is proud to say that participants didn’t miss a single day of activities, even with the change in location and operations. Each week, an estimated 375 local seniors attend activities, ranging in age from 50 to 100+.

There are groups for a wide variety of interests, ranging from bingo to crochet, from line dancing to potlucks to woodcarving, just to name a few. The center hosts educational opportunities, including Apple iPad basics, computer courses, Spanish and even health-themed workshops like Living Well with Chronic Conditions and Stepping On Falls Prevention.

Jenny Craanen, the center’s operations coordinator, emphasized that anyone is welcome to stop in and check out the facility and the activities. Most activities cost $2, and for the community health courses, Network Health may be able to reimburse registration fees for Medicare members.

Most importantly, the center has opportunities for seniors to socialize, become part of a peer group and continue learning. Jenny stresses that it’s an open arms community, with no need to register in advance or pay a membership fee. She testified that, “Some people come in 12 | C oncierge

not knowing how to play a certain card game or how to crochet very well. The people here welcome them, help them, support them and teach them, and eventually we see those same people paying it forward.”

For Ray and Joy, the camaraderie is irreplaceable, saying, “If you’re gone for a few days, people notice, and they care enough to give you a call.”

The Zuelkes learned the important role a strong support network can play in helping a person maintain their health and quality of life. In 2003, Joy was diagnosed with a rare form of cancer called Waldenstrom’s macroglobulinemia.

Then, after achieving remission, she was diagnosed with breast cancer in 2007. Later, she underwent a series of surgeries to replace three discs in her neck and repair her vocal chords.

After two years of not speaking, Joy powered through voice therapy in 2015, which has allowed her to once again socialize with ease. Ray is obviously in awe of Joy and her recovery. “What we take for granted–totally for granted– every breath, every syllable, every vowel. She had to learn it all over again.”

One of the toughest chapters of their lives was their journey with breast cancer. Joy scheduled a routine preventive mammogram, and her doctor discovered a lump.

The diagnosis, although early, was especially daunting for the couple because one of their three daughters, Michelle, had passed away in 1999 at age 33 from the disease. The thought of another round of chemo, radiation and losing her hair for a second time was disheartening. But in NetworkHealthMedicare.com

their words, Joy and Ray were determined to show their two surviving daughters that breast cancer can be beaten. Ray says, “Joy wanted to be a role model for them, to show that you survive and go on. You never give up.”

Today, Joy is cancer free, speaking with ease and thankful for every moment she shares with family and friends. You’ll find her busy planning her week around cards at the Thompson Center on Lourdes and babysitting her grandchildren. She’s quick to show smiling pictures of her two grandsons and her two-year-old granddaughter. She’s looking forward to the birth of a second granddaughter this spring.

In their spare time, Ray and Joy enjoy seeing performances at the Fox Cities P.A.C., caring for their “dream home” in Combined Locks and spending time at their summer home on Shawano Lake. Ray is an environmental advocate, helping to improve the water quality of the lake their family loves year-round. You’ll also find the couple at the YMCA, taking advantage of their SilverSneakers benefit. Ray says, “The time we spend together walking on the track, we cherish. It’s warm in the winter, and air conditioned in the summer. We look forward to going to the Y together.”

After 52 years of marriage, Ray and Joy can almost finish each other’s sentences. When asked the secret to Joy’s recovery and their health, they credit taking control, researching and educating themselves on the conditions and the importance of open communication with their doctors. And acknowledge the importance of an active lifestyle, staying engaged with their community and their strong faith. And, they also appreciate the value of their Network Health Medicare Advantage Plan, which has been a part of their lives since they were eligible for Medicare.

With everything they’ve been through, the Zuelkes need a good insurance partner. “Network Health is a simple choice for us. Health insurance has a high potential to be a nightmare, but it wasn’t for us. Never once. We always checked ahead of time for peace of mind, but that was one stress we didn’t have to worry about.” They continue to work with their doctors, both in- and out-of-network, without issue. They recently changed their primary care doctor and found a good fit with a ThedaCare physician. They wondered if they would have any issues moving to a ThedaCare doctor, but Joy had a positive experience. When she arrived for her appointment, “They said right away, don’t worry about it. You’re covered.”

Ray says, “It’s easy to keep busy in retirement. You need something meaningful, and for me that was volunteering—if you can make a difference.” Ray smiles at Joy, “I can barely keep up with her.” With their health concerns covered by Network Health, Ray and Joy are free to focus on what matters most to them—their family, friends and the community they have helped grow at the Thompson Center on Lourdes.

NetworkHealthMedicare.com

According to the National Council on Aging, senior centers have a lot to offer.

Compared with peers, seniors who use a senior center have higher levels of health, social interaction and life satisfaction.

Senior centers serve as a gateway for many, connecting seniors with community services to help them stay healthy and independent.

Senior centers continue to evolve to serve the boomer generation with new programs and activities.

Get Involved The Thompson Center on Lourdes is only one of many senior center organizations throughout northeast and southeast Wisconsin. To find a group in or near your community, use these three tips.

Contact the Thompson Center on

Lourdes, 2331 E. Lourdes Dr.,

Appleton, WI 54915

920-939-3088 or

thompsoncenteronlourdes.org Use an online search engine to look

online for a center near you Contact the Wisconsin Association of

Senior Centers at

wiseniorcenters@gmail.com Ask your county’s Aging and Disability

Resource Center

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Help Taking Your Medications as Prescribed T

he medical term for taking your medicine as prescribed is “medication adherence.” It sounds a bit harsh, but then again, taking medications as prescribed is vitally important to your well-being. Pills and inhalers are packed with powerful treatments.

Taking medications as prescribed helps you get the most out of your treatment. When you miss a dose—or several doses—you miss your chance to maintain or improve your health. You could find your health not improving as the doctor expects, your condition worsening faster than necessary or yourself in the back of an ambulance headed to the emergency room. Failing to take medications as prescribed is a leading cause of readmissions to the hospital, especially if your prescriptions change.

Network Health’s pharmacists have a few tips to help you take your medications as prescribed. If you find yourself struggling with medications, call 800-378-5234 (TTY 800-947-3529) Monday through Friday, 8 a.m. to 8 p.m. You can speak with a pharmacist from 8 a.m. to 5 p.m.

Do you have difficulty remembering to refill medications?

Ask your pharmacy if they offer a service for automatic refills or refill reminders.

If you usually receive a 30-day supply, ask your doctor or pharmacy about options for a 90-day supply.

If getting your medications through the mail is more convenient, ask your Network Health pharmacist about our mail order pharmacy service.

Is the cost of medications an issue?

Discuss your financial concerns with your doctor or pharmacist. They may have less expensive options that will work for you.

Ask if you are getting a generic or brand name medication. Generic medications, when

available, are just as effective and more affordable, which saves you money.

Fill your prescriptions at a preferred pharmacy, rather than a standard pharmacy. A health care concierge can assist you in finding a preferred pharmacy in your area.

Are side effects preventing you from taking your medications?

If you don’t take your medicine because of side effects, discuss them with a pharmacist or your doctor. You may be able to take a different medication or adjust how you take it to lessen the effects.

Discuss all of the over-the-counter medications you are taking with your doctor or pharmacist, including vitamins, minerals and supplements. These medications could interact and cause side effects of their own.

Do you simply forget to take your medications?

Try using a medication planner or organizer to manage your medications. Place it in a convenient spot like next to your coffeemaker or on your bedside table. You can find one at your pharmacy or retail stores which have pharmacies.

Use your smartphone to set an alarm or find an app to remind you what time to take your medications.

Ask your pharmacy if they offer bubble packing or blister packing. This is an easy way to organize your

medications, but there may be a charge for this service. Ask your pharmacist about pricing.

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Are You Eligible for Medication Therapy Management?

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any Medicare members find prescription drug coverage to be confusing. It certainly can be, especially if you’re taking multiple medications. Network Health’s Pharmacy Department can be a great source for information. In fact, you may already qualify for the medication therapy management program.

How do I know if I’m eligible?

To be eligible, the following statements must apply to you.

I have at least three long-term medical conditions such as asthma, heart failure, chronic obstructive pulmonary disease (COPD), depression, diabetes, end stage renal disease (ESRD), high blood fat levels, high blood pressure or osteoporosis.

I take seven or more daily medications that are covered by Medicare Part D. My Part D covered medications will cost more than $3,919 in 2017.

How does this benefit me?

Medication therapy management is available at no cost to you, as part of your Network Health Medicare Advantage Plan. If you qualify for this program, you can speak one-on-one with a Network Health pharmacist about your medications. The pharmacist will help with tips for taking your medications as prescribed, answer questions you have and recommend potential cost savings.

What should I expect if I’m eligible for medication therapy management?

If claims data shows you qualify, you’re automatically enrolled. You’ll receive a letter that explains how to get started with a one-on-one phone appointment with a Network Health pharmacist. After the appointment, you’ll receive a letter detailing the topics you discussed.

Share this letter with your doctor and pharmacist.

What if I could use help, but I don’t qualify?

It’s great that you want to be proactive in your health.

Call Network Health at 800-378-5234 (TTY 800-947-3529) Monday through Friday, 8 a.m. to 8 p.m. You can speak with a pharmacist from 8 a.m. to 5 p.m. A pharmacist is available from 8 a.m. to 5 p.m. Our pharmacy department will schedule a medication therapy management phone call with a pharmacist at no cost to you.

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Network Health’s Approach to Utilization Management W

hat’s utilization management? At Network Health, the term refers to a team of medical professionals who oversee the prior authorization (or approval) process and help ensure that procedures and services are medically necessary, as defined by Medicare. These associates are led by our medical directors and work closely with our care management team to make sure our members get the care Patient they need, when they need it.

Education and Improved Provide Coaching for Patient Flexibility How Does Network Chronic Disease Outcome Management Health Make

Decisions on Care?

Network Health makes utilization decisions based on the appropriateness of care and service. Decisions are based on sound clinical evidence and the benefits outlined for each plan. Care and service can include medical procedures, behavioral health procedures, pharmaceuticals and devices.

The written criteria are reviewed and approved annually by practicing doctors. The criteria are available to providers and/or members upon request. Requests for criteria can be submitted via telephone, fax, mail or email. Once a request is received, care management associates send the requested criteria to the requestor via fax, email or mail.

Network Health does not, in any way, reward practitioners or other individuals conducting utilization review for denying coverage for care or service. We also do not prohibit providers from advocating on behalf of members within the utilization management program. Incentives to encourage barriers to care and service are not used, and Network Health 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.

Medical directors, associates (or designees), care management staff and supervisors receive no financial incentive to encourage decisions that result in underutilization.

In addition, your doctor may discuss medical necessity denials with a medical director by contacting Network Health.

How to Contact Utilization Management

Providers work closely with our utilization management team on a routine basis, but you can work with them directly, too. If you have questions about the utilization management process or would like a copy of specific criteria, call 866-709-0019 (TTY 800-947-3529) Monday through Friday, 8 a.m. to 5 p.m.

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, practitioners and/or providers may also send inquiries to the utilization management department via fax, courier system and mail. The Medicare fax number for the utilization management department is 920-720-1916.

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NetworkHealthMedicare.com

Three Tips to Avoid Returning to the Hospital A

ccording to reports by Kaiser Health News, approximately 20 percent of Medicare patients sent to the hospital will be readmitted within a month. While some returns are unavoidable, many can be prevented with clear communication, a good plan for support and monitoring by your primary care doctor.

If you find yourself in the hospital, here are three tips to help you avoid a repeat trip.

1

Ask questions. Good communication is key to your recovery. When you’re talking with your doctors and care team during your hospital stay, take detailed notes and ask for instructions in writing, especially during discharge.

If the instructions aren’t clear, ask more questions until you understand. Inquire about any changes to your medications, diet and activity. Ask a family member or friend to listen to the instructions with you, so they can help you remember and stick to your plan.

2 3

Know your medications, because medication issues are a top reason people need to be re-hospitalized.

Remember, your doctor may change your medications during your hospital stay. Before you are discharged, make sure to speak with your doctor and pharmacist to understand when and how to take your prescriptions, especially any new medications.

Ask for help. No one likes to ask for help, but friends, family and neighbors are usually happy to help you recover. Many people recover best in their own homes, so talk with your doctor or discharge planner before you leave the hospital about your needs. Depending on your situation, you may be eligible for home health care. A Network Health health care concierge is also a great resource for information on this benefit as you return home. Our health care concierges can also refer you to our case and condition management teams for additional support.

If you have a chronic condition that’s difficult to manage, like chronic obstructive pulmonary disease (COPD) or heart failure, you may be more at risk for readmission. If you don’t have a follow-up appointment in the near future, schedule one with your doctor before you leave the hospital. It’s important for your primary care doctor to know about your recent hospital stay and changes in your health. They can help monitor your recovery and avoid another hospital stay. To learn more tips to help avoid returning to the hospital, visit GoEmmi.com and enter the code NETWORKDISCHARGE. As a Network Health member, this easy online learning program is available to you at no cost.

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life. health. wellness.

FARM to TABLE An Old-Fashioned Food Trend

D

oesn’t all food come from a farm and end up on a table? Yes, perhaps, but the phrase “farm to table” refers to the journey your food takes to get on your plate. Farm to table refers to fresh, locally-sourced food sold to local consumers or restaurants.

eggs

Seeking out locally grown foods can make eating healthy more enjoyable. Fruits and vegetables are fresher because they haven’t traveled for days and thousands of miles.

They’re also picked at peak ripeness, so they taste better and have more nutrients.

You’ll also find different options at farmers markets, including heirloom varieties you may not be able to buy at the store.

Buying local can also improve your health by helping to keep you physically active and engaged in your community. Plus, buying local supports your community’s economy and shrinks your carbon footprint.

Farmers Markets

Farmers markets bring together products from multiple farms and vendors on a weekly basis, who sell directly to consumers.

eggplant

Tip: Farmers markets are family friendly. Take the grandkids and tell them about foods you loved when you were a kid.

Community Supported Agriculture (CSA) CSAs are like a subscription service that benefits both farmers and consumers. Participating usually requires a financial commitment in the winter or spring for a “share” of the harvest. Many CSAs have local delivery options, making it convenient to pick up your share.

Tip: Some CSAs also offer work shares, which can be a way to reduce costs and get more involved.

On-Farm Markets

Some farmers sell their products directly to consumers on their farm. Look for local orchards and signs for farm fresh eggs and grass-fed meats, which are typically lower in fat.

Tip: Ask about pick-your-own produce or a tour of the farm, and take the grandkids on an adventure.

To find a local farmers market, CSA or on-farm market, visit the U.S. Department of Agriculture’s Local Food Directories. You can search by type and location to at https://www.ams.usda.gov/services/local-regional/fooddirectories-listings.

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Diabetes Monitoring Checklist

W

hen it comes to managing diabetes, the bulk of the responsibility falls on you. Actions such as testing your blood, managing your diet, exercising and working closely with your doctor all play a key role in your health. At Network Health, we want to help support you in living a longer, healthier life. If you are living with diabetes, we encourage you to get the appointments, screenings and services you need to help maintain your health.

The chart below includes the nationally recognized recommendations of testing for members with diabetes. These tests help your medical team monitor your condition and minimize the risk of developing serious complications and other chronic conditions. According to the Centers for Disease Control and Prevention (CDC), every percentage point drop in an A1c blood test result can reduce the risk of eye, kidney and nerve diseases by 40 percent.

You should discuss your treatment plan, testing, results and goals with your doctor to determine levels that are appropriate for you. If you would like help finding a doctor or determining which screenings are covered by your plan, contact a health care concierge at 800-378-5234 (TTY 800-947-3529), Monday through Friday, 8 a.m. to 8 p.m.

Complete

Description of Diabetic Tests and Screenings

Date Completed

Recommended

A1c Testing

Every 3-6 months The A1c test is a blood test that measures your average blood (or as directed by sugars over the last three months. Doctors recommend an A1c number less than 7 percent, but your target A1c number depends your doctor) on many individual factors.

LDL Cholesterol Testing

An LDL test measures the bad fats in your blood vessels. If you have diabetes, you should have your cholesterol checked at the time of diagnosis, and/or at 40 years of age and periodically thereafter as recommended by your doctor.

Every 12 months (or as directed by your doctor)

Blood Pressure Check

A blood pressure screening involves your doctor using an arm cuff to measure the pressure within your blood vessels. Ideally, blood pressure levels should be less than 140/90. Controlling your blood pressure can help prevent long-term complications of diabetes.

Every office visit

Kidney Screening (Microalbumin Test)

The kidney screening is a urine test that measures the protein albumin in your urine. The screening measures how your kidneys are functioning because about 1/3 of people with diabetes develop kidney disease.

Every 12 months

Dilated Eye Exam

Every 12 months Dilated eye exams are done by an eye doctor. The eye doctor dilates the pupil with drops to check for signs of retinopathy. Early or as directed by diagnosis of retinopathy has been shown to prevent vision loss in your doctor more than 90 percent of patients with diabetes.

NetworkHealthMedicare.com

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life. health. wellness.

If It Ain’t Broke …

You Should STILL See Your Doctor Don’t Underestimate the Importance of Preventive Care

W

hen was the last time you saw your doctor for a preventive visit? Are you putting it off? If you want to maintain or improve your health, it’s important to keep track of preventive visits and screenings, so you stay up to date on your care. It’s one of the best moves you can make for continued health.

Here’s just one example. If you’re a man or woman over age 50 with a normal risk for colorectal cancer, Network Health recommends getting screened in one of three ways.

A fecal-occult blood test every 12 months A flexible sigmoidoscopy or barium enema every four years A colonoscopy every 10 years

You’ll be hard-pressed to find anyone who looks forward to a colonoscopy, but you may very well know someone living with colon cancer. It’s a leading cause of cancerrelated deaths in both men and women, but if found and treated early, the prognosis is good. The five-year survival rate is about 90 percent. Still, only four out of 10 cases are diagnosed in the early stages when treatment is most successful. In perspective, a simple fecal test once a year doesn’t sound so bad.

Medicare Preventive Health Checklist Network Health has a useful chart to help you track preventive care as you receive it. We’ve included an abbreviated checklist, on the next page, highlighting some of the most common, Medicare-covered preventive services.

To view Network Health’s full Medicare Preventive Health Checklist, which includes additional screenings for people at high risk, visit NetworkHealthMedicare.com. Select Member’s Corner, click Benefits for Better Health and click Preventive Health Checklist, under Preventive Care. You can also request a printed copy by calling customer service.

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Schedule and Track Your Screenings

I

t can be tough to keep all the recommended preventive care and screenings straight, but they are crucial for early detection and treatment.

Keep this chart handy to help you track care as you receive it. If you have questions, please refer to your Evidence of Coverage document.

For specific coverage information, refer to your Evidence of Coverage document. Remember, costs and coverage for these services can vary depending on the plan you have. This is especially true for NetworkPrime (MSA) members.

If you have any questions about your coverage for these preventive screenings, contact a member of your health care concierge team at 800-378-5234 (TTY 800-947-3529) before you schedule a doctor appointment.

APPOINTMENT SCREENING SCHEDULED COMPLETE

PREVENTIVE SERVICE

“

COVERED FREQUENCY

One-time visit within the Welcome to Medicare visit first 12 months of having TIP - Ask your doctor’s office to schedule your “Welcome to Medicare” Medicare Part B preventive visit when you make this appointment.

Every 12 months (once you’ve had Part B for longer than 12 months)

OR

Annual wellness visit

Must be at least 12 months after your “Welcome to Medicare” preventive visit.

Annual routine physical exam

Every 12 months

One-time vaccination

To be covered, this exam must include preventive medicine evaluation and management, including an age and gender appropriate history, examination and counseling/anticipatory guidance/risk factor reduction interventions.

Pneumonia vaccine Most people only need this vaccine once in their lifetime, unless advised by a doctor. Pneumonia booster vaccines must be administered at least one year from the initial vaccine.

TIP

You are able to have lab screening for early detection of diabetes, high cholesterol or blood disorders. As part of your wellness visit OR your routine physical, you can have a fasting blood sugar, lipid panel and/or complete blood count that are included in the cost.

Note: These screening labs are intended to assist in early detection of new health conditions and are not part of routine monitoring of existing health conditions.

NetworkHealthMedicare.com

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life. health. wellness.

COVERED FREQUENCY

PREVENTIVE SERVICE

Varies Twice within 12 months

APPOINTMENT SCREENING SCHEDULED COMPLETE

Obesity screening and counseling Intensive counseling for people with a body mass index (BMI) of 30 or more received in a primary care setting.

Tobacco cessation counseling If you have signs or symptoms of tobacco-related disease, you may be responsible for additional costs.

Every 12 months

Annual flu shot recommended in the fall or winter.

Every 12 months

Cardiovascular disease Behavioral therapy in a primary care setting only.

Every 12 months

Depression screening in a primary care setting only.

Every 12 months

Diabetes screening Based on results, you may be eligible for up to two screenings every 12 months.

Every 24 months

Bone mass measurement If medically necessary, these may occur more frequently.

Date of last screening

Every five years

Cardiovascular screenings This screening includes blood tests for the detection of cardiovascular disease.

Date of last screening

CANCER SCREENINGS COVERED FREQUENCY

PREVENTIVE SERVICE

APPOINTMENT SCREENING SCHEDULED COMPLETE

BREAST CANCER SCREENINGS – RECOMMENDED FOR WOMEN AGE 40 AND OLDER Every 12 months

Mammogram

Every 24 months

Clinical breast exam

Date of last screening

CERVICAL AND VAGINAL CANCER SCREENING Cervical and vaginal cancer screening For those at high risk, one Pap is test recommended every 12 months.

Every 24 months

Date of last screening

COLORECTAL CANCER SCREENINGS – RECOMMENDED FOR PEOPLE AGE 50 AND OLDER Every 12 months

Fecal occult blood test

Every four years

Flexible sigmoidoscopy or barium enema For people at high risk, a colonoscopy or barium enema is recommended every 24 months.

Date of last screening

Every 10 years

Colonoscopy For people at high risk, a colonoscopy or barium enema is recommended every 24 months.

Date of last screening

PROSTATE CANCER SCREENINGS – RECOMMENDED FOR MEN AGE 50 AND OLDER Every 12 months

Digital rectal exam

Every 12 months

Prostate specific antigen (PSA) test

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Make the Most of Your Doctor Visits with Open Communication

I

t can be tough to talk to a doctor about something that makes you nervous or embarrassed. But remember, your doctor can’t read your mind. It’s important to build a relationship with your doctor, so you feel comfortable being honest, trust your doctor and feel confident in his or her confidentiality.

As you build a relationship or transition to a new doctor, here are a few tips to make the unmentionable, well, mentionable.

Know you’re not the first.

Whatever your concern, it likely won’t be the first time your doctor has treated a patient with similar symptoms. Trust his or her experience and professionalism to get you through a difficult conversation.

Write down your concerns.

Making a list can help you put your concerns into words and provides a reference for you during your appointment. Plus, sharing this list can help you avoid embarrassment and gives your doctor a road map to address topics that may not be obvious.

Doctors can assist you with variety of concerns.

Whether it’s a challenge paying for health care, dealing with symptoms of depression, concerns about falling or even struggling with incontinence (urine leakage), your doctor can offer advice or point you in the right direction to get the help you need.

Make and keep routine appointments.

Asking questions and sharing any minor concerns with your doctor on a regular basis could help identify a condition before it becomes a serious concern.

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1570 Midway Pl. Menasha, WI 54952 Health and Wellness or Prevention Information

Tired of Too Much Mail?

We have two options to help reduce the amount of mail you receive regarding your plan information.

E-Delivery of Your Annual Member Materials - You have the option to sign-up for e-delivery, which

delivers your plan materials to your email address, rather than your mailbox.

Householding of Your Annual Member Materials - If you and another member of your household are

on the same Network Health Medicare Advantage Plan, you can opt to get one copy of your materials,

rather than two.

To cut down on your mail this year, sign up for e-delivery or householding by September 1.

E-Delivery Instructions

1. Go to NetworkHealthOptions.com.

2. Type in your last name, date of birth and member ID number.

3. Follow the instructions on the next screen and choose email.

4. Approve your selection and you’ll get a thank you message and a confirmation email.

Householding Instructions Both members must follow these three steps to sign up for householding, to ensure you both agree to this option.

You must log in separately and choose householding in both individual’s accounts.

1. Go to NetworkHealthOptions.com.

2. Type in your last name, date of birth and member ID number.

3. If it’s your first time signing in, follow the prompts to select “I would like my materials mailed to my home.”

Click Submit.

4. Follow the prompts and choose, “Send one set of materials to my household whenever possible.” Click Submit.

Out-of-network/non-contracted providers are under no obligation to treat Network Health Medicare Advantage Plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Network Health Medicare Advantage plans include MSA and PPO plans with a Medicare contract. Enrollment in Network Health Medicare Advantage Plans depends on contract renewal.

NetworkCares is a PPO SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. This plan is available to anyone who has both Medical Assistance from the State and Medicare. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/ coinsurance may change January 1 of each year. You will receive notice when necessary. The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary. Contact the plan at 800-378-5234 (TTY 800-947-3529) for additional information. As an enrollee of our plan, you can get a long-term supply (up to 90 days) of drugs shipped to your home using our plan’s network mail order delivery program. Usually you will receive your mail order prescriptions within 14 calendar days. If your order does not arrive within the estimated timeframe, call Express Scripts customer service at 800-316-3107 (TTY 800-899-2114), 24 hours a day/7 days a week.