a p u b l i c at i o n o f
John D. Shier, RN PhD
Choose Today, Live Tomorrow How John Shier helps people view health in a way they haven’t before.
ave you ever experienced an event that had such a strong impact you knew it would change the direction of your life? Network Health Medicare Advantage PPO member, John Shier, has. Thirty years ago, John watched his best friend struggle with cancer and ultimately lose the battle. Even though quite a bit of time has passed, he still gets a solemn look when he describes his experience. After his friend’s death, John decided he wanted to help others with terminal illnesses, so he became a hospice volunteer. John found the work both challenging and rewarding. In fact, he enjoyed the work so much that at the age of 57, he decided to return to school and earn a degree as a registered nurse. He jokes that his wife, Rosalie, didn’t take much convincing, since
I always wanted to be a , not a teller.
H5215_MbrNewsV4 Accepted 02182013
she was excited to have the house to herself during the week. With Rosalie’s blessing, John enrolled in the nursing program at University of WisconsinMilwaukee and moved into student housing. Like any good college student, he returned every couple weekends to do laundry. At age 60, John graduated and began his new career in nursing. Instead of volunteering, John was a staff nurse at Unit Hospice and worked full time at Bellin hospital in cardiac care and occupational health. It was quite a change of pace from his previous career as an assistant philosophy professor at University of Wisconsin-Green Bay. John explains that his background in philosophy was a great asset in his new career. As a nurse, John was concerned with the best course of care for his patients. But as a philosopher, he also thought about the reason behind his patients’ conditions. “It didn’t take long for me to realize a lot of my patients with chronic conditions John and Rosalie have been happily married for 52 years. had made choices or lived lifestyles that led to the development of their disease— like diabetes, obesity and heart disease.” As continued on page 2 »
Volume 1 | Number 4 | 2013
life, health & wellness
continued from page 1 »
The best motivator in the world is
EDITORIAL STAFF President Chief Administrative Officer Publications Coordinator Graphic Designer
John’s focus is on helping people change their perspectives on health.
The job of the philosopher is to help people see the world
a philosopher, he wanted to understand the reason behind these choices. He believed that understanding a person’s motivation was important not only for treatment, but prevention as well. John began developing programs that would help individuals take responsibility for their health. He felt the medical field was very good at keeping people alive but that we could use help improving how we live. His program, “Live Long, Die Healthy,” teaches how to partner with health care professionals to take charge of your health. It also explains the importance of preventive care, physical activity and good nutrition. John often uses humor to make his point, making the program entertaining, even if you’re not too health conscious. John has been asked by hundreds of companies across the United States (and some that call Wisconsin home) to share his presentation with their employees. In the presentation, John explains his five rules for long-term health and how to make the health system work for you. Rosalie often travels with him, but usually to the warmer locations. John’s presentations are always a big hit, and he’s often asked back. He credits his background in teaching for his success. “I always wanted to be a teacher, not a teller,” he explains. “The best motivator
in different ways.
in the world is understanding.” By helping people understand how their actions affect their health, they’re encouraged to make choices that will lead to a healthier, more enjoyable life.
Would you like to learn more about John Shier and his wellness programs? Check out his website--thatguynurse.com. For questions about event scheduling, contact Meredith Bartos at 920-399-1324. 2 | C oncierge
Sheila Jenkins Penny Ransom Cassie Goodman Debra Sutton
Editorial Board Marcia Broeren, Joan Merwin, Angie Keenan, Jennifer Coppock, Jeanne Skinner, Melanie Draheim, Dawn Rady, Deborah Anderson, Renee Corral, Barb Gore, Chuck Rynearson Concierge is published quarterly by Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals. © 2013 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation. Network Health Insurance Corporation is a Medicare Advantage organization with a Medicare contract. Tell Us What You Think Thank you for your comments about the last issue of Concierge. Please continue to email your feedback to firstname.lastname@example.org. You can also write to us Network Health Attention: Cassie Goodman 1570 Midway Pl., Menasha, WI 54952
The real challenge in getting healthy isn’t physical,
How to Get
ealthy living isn’t easy. If it were, we’ d all look a lot more like the professional athletes we see on TV. But, there’s no denying the benefits of eating well and getting active. By now, you probably already know regular exercise can help you avoid conditions like diabetes, obesity and heart disease. And, you’ve likely heard that eating right lowers your risk for heart attack and stroke. So if we already know these things, why aren’t more of us taking steps to get healthy? The truth is, it’s hard. We don’t want to walk every day or take that aerobics class our friend has been bugging us about. The real challenge in getting healthy isn’t physical, it’s mental. So before you give up on your New Year’s resolution, consider the tips below. Be realistic. People often quit on their health goals because they set unrealistic expectations. If you haven’t gone for a run in years, chances are you won’t be ready for a marathon by the end of next week—or even next month. Building strength and endurance takes time. Set realistic goals and you’ll increase your chance of success. Write down your goal. Create an attainable goal and write it down. It’s OK to dream big or start small. Just make sure you give yourself plenty of time to achieve it. Keep in mind bigger goals, like losing 20 pounds or WHAT’S That? S.M.A.R.T. Goals
Specific, Measurable, Action-Oriented, Realistic and Timely
What to Do After an Emergency
No one wants to visit the emergency room, and when you’re there, you probably just want to get in and out as fast as possible. But before leaving, it’s important to make sure you understand the instructions for your follow-up care. If you feel comfortable sharing your health information with a friend or relative, consider asking the doctor to explain your care instructions to him or her. Often, patients are unfocused (either because of stress or medications) which makes it difficult to understand and remember detailed orders. Having someone else present is a good way to make sure you remember all the steps the doctor or nurse explained. It’s the goal of our quality improvement department that you receive the highest quality care, and we recommend you contact your primary care physician after any emergency department visit. To help you avoid future problems, he or she will want to know when you went to the emergency room, the symptoms you experienced and the medical and prescription drug treatment you received. After an emergency care visit, make sure to ask your primary care physician the following. • What signs and symptoms should I watch for? • When do I need to seek medical attention for my symptoms? • Can you write down my care instructions? NetworkHealthMedicare.com
running long distances, will need a little more planning. Record the steps you plan on taking to reach your long-term goal and create a manageable timeline. If you’d like help setting a goal or developing a wellness plan, check out our S.M.A.R.T. goals form at NetworkHealthMedicare.com. To find the form, click Member’s Corner, select Discover Healthy Benefits and choose the link to the S.M.A.R.T. goals form. Stay on track. After writing down your goal, put it in a place where you will see it often. It’s also helpful to monitor your progress and record it in a workout or food journal. It might seem inconvenient at first, but over time, it can be quite inspirational to see your progress. You may also want to consider having a fitness partner. Share your goal with a friend or relative and ask him or her to help you stay on track. The person you choose should be supportive of your goal and provide encouragement when you need help getting motivated. Manage temptations. Nobody is perfect. Remember, there are going to be days when you don’t make it to the gym or you eat that second (or third) brownie. Don’t be too hard on yourself and accept there are days that will be better than others.
5 Fun Ways to
Workout Are you stuck in a workout rut?
hy not try a different way to get active? Adding a little variety to your exercise plan is a good way to stay inspired. Check out the suggestions below. Your local YMCA or community center may offer organized activities like these and more.
1. Dancing You’ll have so much fun with this exercise, you’ll forget you’re
burning calories. Check with your area’s senior center or local YMCA to see what dance classes are offered in your area. 2. Swimming You could take a water aerobics class with others or swim laps on your own. Either way, getting in the pool for your daily exercise is a good way to keep things interesting. 3. Cycling As a kid, you probably loved going for a bike ride. Why not give it another try? During the winter, consider signing up for a cycling class. When the weather gets nicer, try out some of the local trails. 4. Yoga This is a great way to manage stress and build muscle strength at the same time. Yoga can also help improve your balance and even your mood. 5. Kickboxing or martial arts Many gyms and local YMCAs offer kickboxing classes that range in intensity. If you don’t think kickboxing is for you, consider tai chi. It is a gentle form of martial arts that helps you relax and offers many health benefits. C oncierge • W inter 2013 | 3
health Breathe Easy with COPD H
ave you ever noticed how a cold day can make it difficult to breathe? Taking a deep breath when the temperature is barely above freezing can make many of us start coughing or wheezing, especially if you have chronic obstructive pulmonary disease, or COPD. If you have COPD, you’ll want to take steps to avoid a flare-up (or a worsening of symptoms). Here are some tips to help you breathe a little easier this winter.
Prevent infection. Flu and pneumonia are the top causes of breathing difficulty and hospitalization for people with COPD. Get vaccinated to help reduce your risk of getting infected.
Take your medications. Make sure you understand your doctor’s medication instructions. Closely following your treatment plan can help prevent COPD flare-ups. Avoid your triggers. Know what makes your COPD symptoms worse. Common factors include cold weather, strong fumes and smoking or secondhand smoke. Consider keeping a journal of your flare-ups to help you identify what your triggers are and how to avoid them.
Talk to your doctor. Ask your doctor about a spirometry or lung
function test. This test not only helps determine if you have COPD, but also shows how severe it is.
Develop a COPD action plan. It’s not always possible to avoid a COPD
flare-up. But, you can identify the early warning signs and take action to keep breathing difficulty from becoming an emergency. Ask your doctor about developing a personal plan.
Have You Had a Bone Density Test?
f you’re a woman over 65 and you haven’t had a bone density test, ask your doctor about it, especially if you’ve broken a bone. It’s important to talk to your doctor about bone health, and this quick and painless test is the best way to measure how strong (or dense) your bones are and whether you have osteoporosis. It can also tell what your chances are of breaking a bone.
If you’re 66 or older and you’ve broken a bone, make sure to contact your doctor after your fracture so you can either have a bone density test completed or start a medication within six months to best improve or preserve your bone density. A woman’s risk of repeat fractures increases significantly after each fracture. If your bone density test reveals you have osteoporosis, treatment started within six months of a fracture can do the most to help preserve your bone density.
Know your numbers Blood Pressure Near or above goal
High blood pressure
Near or above goal Less than 150 mg/dL
140 160 180
Borderline High 150-199
Very High 500 or above
60 40 20
4 | C oncierge
Cholesterol Type of Cholesterol
240 or higher
160 or higher
Women: 50 or higher Men: 40 or higher
Women: below 50 Men: below 40
Have You Moved?
If so, make sure to call your health care concierge and tell him or her about your change of address so we can update our records.
How We Stack Up N QUALITY AND PERFORMANCE
etwork Health evaluates the quality of care and services provided to members using two nationally recognized tools, the Healthcare Effectiveness and Data Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®). Each tool scores our service in a different way. The following tables highlight our 2012 results and show the excellent ratings of Network Health’s Medicare Advantage PPO plans on both state and national levels.
Network Health Medicare Advantage 2012 HEDIS Results
Category Breast Cancer Screening Glaucoma Screening Hemoglobin A1C Testing in Diabetics Medical Attention for Nephropathy in Diabetics Cholesterol Screening for Diabetics Cholesterol Screening for Members with a Cardiovascular Condition Proper Drug Therapy for Members with Rheumatoid Arthritis Members with a Preventive or Ambulatory Visit in the Year
Network Health Medicare Advantage Results
Wisconsin Average Results
National Average Results
75.30% 70.98% 94.16% 90.51% 88.81% 92.02% 85.19% 96%
73.52% 71.57% 93.19% 90.97% 88.51% 87.94% 83.55% 95.86%
67.93% 66.06% 91.03% 89.32% 87.79% 88.67% 74.06% 94.92%
The source for data reported above is Quality Compass© and is used with the permission of the National Committee for Quality Assurance (NCQA). Any analysis, interpretation or conclusion based on this data is solely that of the authors, and NCQA specifically disclaims any responsibility for any such analysis, interpretation or conclusion. Quality Compass is a trademark of NCQA.
Network Health Medicare Advantage 2012 CAHPS Results Percentages reflect the number of members who gave positive reviews. A positive review is defined as a member answering 8, 9 or 10.
Category/Measure In the last six months, how often did your health plan’s customer service staff treat you with courtesy and respect? In the last six months, how often did your health plan’s customer service give you the information or help you needed? Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your health plan? Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor?
Network Health Medicare Advantage Results
Wisconsin Average Results
National Average Results
The source for the data reported above is the 2012 Medicare Advantage CAHPS Results provided by the Centers for Medicare and Medicaid Services. Any analysis, interpretation or conclusion based on the data is solely that of the authors. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
Quality Program Information
t Network Health, we have an entire program and department focused on quality. Each year, we update our quality improvement program structure, which includes the program’s goals, its role and a written description of the program. The quality improvement program reports to the board of directors, and a quality-improvement committee oversees the function of the organization. We develop an annual quality work plan and a description of company resources devoted to the program. In addition, both behavioral health and patient safety are specifically
addressed in the program description; the quality improvement committee includes a designated physician and a designated behavioral health practitioner who have substantial involvement in the program. Also addressed in the description is the role, structure and function of the quality improvement committee, along with other connected committees and how often they meet. For more information about our quality improvement program, please call the Network Health Quality Improvement Department at 920-720-1229, or toll-free at 800-826-0940, extension 1229 (TTY 800-947-3529).
Network Health and the PAC have teamed up again to offer new low rates for the following performance. War Horse
Sunday, June 30 at 6:30 p.m. Tickets available for $36
To claim this offer, you must register between February 15 - March 15. Log on to eventusher.com and type Medicare in the password field. Then, purchase your ticket by following the simple instructions that appear.
This offer is only valid for Network Health Medicare Advantage members and their families. Not valid on previously purchased tickets. Valid while supplies last. NetworkHealthMedicare.com
C oncierge • W inter 2013 | 5
Things You Thought
You Knew about Heart Health
ou’ve probably heard the old saying, what you don’t know won’t hurt you. Unfortunately, when it comes to heart health, that’s just not true. There are many misconceptions about high blood pressure, high cholesterol and heart disease.
Do you know better than to believe these five popular myths?
There’s nothing I can do to prevent heart disease. It runs in my family. False. There are many different activities and lifestyle choices that can help limit your risk for developing heart disease, despite your genetics. If your family has a history of heart disease, then it’s even more important to take steps to prevent it. Stress management, good nutrition and exercise will help limit your risk.
High blood pressure isn’t a big deal. Many people have it. While it’s true many U.S. adults have high blood pressure (nearly one out of three, according to the Centers for Disease Control and Prevention), it’s a serious condition that can greatly affect your health. High blood pressure increases your risk for heart attack and stroke. If you have high blood pressure, discuss treatment options with your doctor. If you’re unsure of your blood pressure levels, make arrangements to have your blood pressure checked. See the Know Your Numbers graphic on page 4 to learn blood pressure goals.
I shouldn’t exercise. I had a heart attack before, and I don’t want to trigger another.
Many people are afraid of experiencing a second heart attack, but being physically active is an important part of getting healthy again. After a heart attack, you’ll need to get your doctor’s approval before starting an exercise plan. There are several types of aerobics and strength training exercises that are safe for heart attack survivors. You’ll have to work with your doctor to develop a plan that’s right for you, and make sure to wait the recommended length of time before starting.
I feel fine. I don’t have high cholesterol. I would know. The Centers for Disease Control and Prevention reports that one in six Americans has high cholesterol. There are no symptoms, so the only way to find out is to get checked. A simple blood test can tell your cholesterol levels. See the Know Your Numbers graphic on page 4 to learn cholesterol goals.
A heart-healthy diet just doesn’t taste good. It’s too hard to stick to foods low in fat and cholesterol.
Changing your eating habits is never easy, but you can start by taking small steps to incorporate more fruits, vegetables and lean proteins in your diet. There are many flavorful recipes available that will fill you up, help your heart and still taste great. Looking for a tasty, heart-healthy recipe for dinner tonight? Check out the fish taco recipe below.
Grilled Fish Tacos Ingredients
Recipe adapted from Heart Healthy Living®. 6 | C oncierge
• 1 pound fresh or frozen skinless cod, sole or flounder fillets, 1/2 inch thick • 1 tablespoon lemon juice • 1 tablespoon olive oil • 1 teaspoon chili powder • 1/2 teaspoon ground cumin • 1/4 teaspoon salt • 1/4 teaspoon ground black pepper • 12 tortillas 7 - 8 inch fat-free flour • 1 jar of pineapple salsa or chipotle coleslaw
Makes 6 servings
Preparation time - 15 minutes Chill - 15 minutes Cook - 9 minutes
If you’re using frozen fish, make sure to thaw it thoroughly. Put fish fillets in a 2-quart baking dish; set aside. Whisk lemon juice, oil, chili powder, cumin, salt and pepper together in a small bowl. Use this mixture to brush over fillets. Coat both sides of the fillet with the mixture. Cover and chill for 15 minutes. Wrap the stacked tortillas in foil. Preheat oven to 425°. Then, bake the fillets for nine minutes or until fish flakes easily when tested with a fork. Place fillets in a bowl; break into 1-inch pieces. Heat tortillas according to package directions. Divide the fish evenly among the tortillas and top with pineapple salsa and/or chipotle coleslaw. Enjoy!
According to the Centers for Disease Control and Prevention, nearly one in three people in America will develop shingles, and the risk increases as you get older.
See below for vaccine information.
Do You Have Our Prescription Drug Coverage? Here’s something you should know.
hen you visit a preferred pharmacy, you get certain prescription drugs for $1. If you take any of the drugs below, remind your pharmacist you should receive a one-month supply for $1. This is new for 2013, so make sure to show your Network Health Medicare ID card when getting these prescriptions filled.
benazepril hcl captopril enalapril maleate fosinopril sodium glimepiride glipizide glipizide xl (5 mg) glyburide glyburide-metformin
glyburide micro lisinopril lovastatin metformin hcl metformin hcl er (500 mg) pravastatin sodium (10/20/40 mg) quinapril simvastatin
Network Health Earns Highest Accreditation for Medicare Product
he National Committee for Quality Assurance (NCQA) has awarded Network Health Medicare Advantage (PPO) plans its highest accreditation level of Excellent. To earn Excellent status, health plans must demonstrate levels of service and clinical quality that meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvements. NCQA’s comprehensive review evaluates how well a health plan manages quality throughout every part of its delivery systems— physicians, hospitals, affiliated providers and administrative services— to continuously improve health care for its members. “We prepared for NCQA’s initial accreditation review for more than a year,” said Marcia Broeren, vice president and general manager for Network Health’s Medicare division. “The accreditation we received is a direct reflection of not only the hard work we put in this past year, but also the work we do each and every day to ensure our members receive the highest quality of service and care possible.” NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations.
Get Discounts Important Note about Zostavax (Shingles) Vaccine If you have medical and prescription drug coverage (Part D) with Network Health, getting the Zostavax vaccine at a network pharmacy can be easier and cost less than getting it in a doctor’s office. (Remember, if you have a plan without drug coverage, the Zostavax vaccine is not covered.) When you get the Zostavax vaccine in a doctor’s office, you’ll have to submit a claim to get reimbursed. Though you’ll only end up paying your copayment, the total cost (what you and Network Health pay) will be greater than if you got this vaccine at the pharmacy. This means the higher total cost will count toward the coverage gap, and it could make you reach the gap faster. However, if you get the Zostavax vaccine at a network pharmacy instead, the total cost will be less, and you don’t have to submit a claim to get reimbursed because the pharmacy will handle it like any other prescription. If your doctor recommends you receive this vaccine, call your network pharmacy to see if you can get vaccinated there. The benefit information provided is a brief summary, not a complete description of benefits. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change January 1 of each year. Limitations, copayments and restrictions may apply. For more information, contact Network Health. WHAT’S That? Network Pharmacy
Network Health has contracted with certain pharmacies to help save you money. When you visit these pharmacies, you can fill prescriptions at a lower cost. You can search network pharmacies at NetworkHealthMedicare.com. NetworkHealthMedicare.com
ALT RK HE H MEDI CA WO T E
With Platinum Perks, Network Health’s exclusive discount program for our Medicare Advantage (PPO) members, you’ll get discounts and save at several local businesses just for being a member.
How does Platinum Perks work? We’ve partnered with businesses throughout northeast Wisconsin to offer you discounts on products, services, food and more. Simply show your Network Health Medicare Advantage member ID card to participating businesses, and you’ll receive their discount.
Where can I get the discounts?
Many companies in several counties have chosen to participate. If you have not received our Platinum Perks booklet that lists all the businesses and their discounts, you can find the list on our website, NetworkHealthMedicare.com, in the Member’s Corner section under Get Member Discounts and Extras. If you’d like a hard copy list, call us at 800-378-5234 to request one, Monday – Friday, 8 a.m. – 8 p.m. (TTY 800-947-3529).
When do the discounts start?
The discounts started on January 1, 2013, and continue through December 31, 2013. C oncierge • W inter 2013 | 7
Meet Jean Trochta
To help you get to know your health care concierge a little bit better, watch for a feature on a different concierge in every issue of our newsletter.
I try to help members by communicating clearly and using language that can easily be understood. JEAN — Jean Trochta, Health Care Concierge
ean Trochta has been a devoted health care concierge for over six years. She knows it can often be a struggle to understand all of Medicare’s rules and pricing. Luckily, she has a talent for explaining Medicare’s complexities in a way her members can appreciate.
TRO C HT A
Jean and Scott Trochta
Q: How did Jean begin her career as a health care concierge? A: Jean joined Network Health in December of 2006. She had been with Affinity Health System (Network Health’s parent company) since 1999. Jean explains she was excited to switch to Network Health, “I had always heard about what a great place it was to work.” She says she loves working with people, and her position as a concierge has allowed her to do just that. Q: What does Jean enjoy most about her job? A: Jean loves problem solving. When her members call her with questions or concerns, she finds satisfaction in being able to resolve their issue. And when a member calls with a problem that she can’t solve for them, she knows she can find the person who can. Q: What are some of the challenges as a health care concierge? A: “I know a lot of my members are on a fixed budget, so it would be nice if I could always give them specific pricing.” Jean understands how frustrating it can be for the member to have to wait to hear how much services will end up costing. She also knows how irritating it can be when there are changes to services and pricing. She tries to help members with this by communicating the changes clearly and using plain language. Q:How is Network Health different from other places you’ve worked? A: “Everyone here works together very well.” She likes working for a company where people are always willing to help one another out. She also likes the friendly feeling here. “We’re a bigger company, but everyone still knows each other. People here are very personable.” Q: How does Jean spend her free time? A: Jean loves spending time with family. She has a 20-year-old daughter named Kirsten, a 17-year-old son named Quentin and she’s been married to her husband Scott for 22 years. The family enjoys taking camping trips, going bowling and for walks. In the fall, Jean and her husband spend their Friday nights watching their son play football for Brillion High School. Unfortunately, an injury cut Quentin’s season short this year, but the Trochtas are already looking forward to supporting him next season.
1570 Midway Place, Menasha, WI 54952
Do You Need Help Submitting Claims? Your 2013 Evidence of Coverage explains how to ask Network Health to pay our share of a bill you received for covered medical services or prescription drugs. Here are some highlights. You must submit your claim to us within 12 months of the date you received the service, item or drug. When submitting a prescription drug claim, make sure to include a copy of the itemized receipt showing the name of the drug, strength, quantity, date of service, the name of the physician who prescribed it and the amount charged. Claims should be mailed to: Network Health Insurance Corporation, Attn: Medicare Advantage Plans, P.O. Box 120, 1570 Midway Place, Menasha, WI 54952. You may also call us to request payment or give us more information about a request for payment you have already sent us.
• • • •
If you have any questions, contact customer service at 800-378-5234, Monday – Friday, 8 a.m. to 8 p.m. (TTY 800-947-3529).
Congratulations to Thomas Kloeckl Thomas is the lucky recipient of the $15 gas gift card for sending his feedback about our last issue of Concierge. Make sure to keep sending us your opinions or suggestions for future article topics.
Health or wellness or prevention information
WHAT’S That? Health Care Concierge Your personal Network Health customer service representative. You can always call this person directly.