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a p u b l i c a ti o n o f

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I went from feeling great to lying in a

hospital bed. How a health scare proved to Terry Tackman that Network Health was the right coverage for him

W I N T E R

2 0 1 3


from the president

Dear Readers

A

lthough it hasn’t been too long since we made our resolutions, I’ve already been noticing there’s more room when I’m at the gym and in the fruit and vegetable aisle at the grocery store. Have you noticed this, too? This time of the year, many of us tend to get more relaxed with our New Year’s resolutions and goals. Then, in the blink of an eye, another New Year approaches and we’re making the same resolutions as last year. Sheila Jenkins But this doesn’t have to President be the outcome this year. Network Health As we begin to anticipate warmer weather and longer days, now is the perfect time to renew your health and fitness goals for 2013. The benefits of practicing better eating habits and fitness schedules are endless. And, the best part is, you don’t have to make monumental changes to greatly impact your overall health. To successfully achieve your goals this year, look to others, including

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Network Health, for support and guidance. Many of our members appreciate that we strive to be much more than a typical health plan. While we do many of the same things other health plans do, unlike others, we provide resources to help you reach your health goals. Many of your employers, as well as our Individual and Family plan members, participate in our healthy rewards programs that actually reward participants for making good health choices. Our members also enjoy using WebMD®, which offers a wealth of information and tips. In addition, classes are held throughout northeast Wisconsin to help teach people how to live with certain diseases. Getting the information, support and motivation you’re looking for can start right now by just turning the page. This issue of Balance features articles, tips and facts aimed to better your health. Be sure to check out the story about staying motivated with your health goals throughout the year. On behalf of everyone at Network Health, we’re looking forward to helping you make your health goals a reality this year.

life 3 Finding Motivation

 Tips for maintaining motivation in 2013

4  Get In the Know

 Your rights and responsibilities as a Network Health member

4 Do You Need Help Submitting a Claim?

 How to arrange for reimbursement if a medical facility requires immediate payment

4  Did You Know?

 A reminder to contact your primary care practitioner after an emergency room visit

2 | balance • W i n t e r 2 01 3

08

health

5 Know Your BMI

 How to use the body mass index to tell if you’re at a healthy weight

6  The Importance of Omega-3 Acids  What are omega-3s, where can I find them and why are they important?

E DITORIAL STAFF President Sheila Jenkins Chief Administrative Penny Ransom Officer Publications Sam Darcy Coordinator Graphic Design Darren Brzozowski Coordinator

E ditorial Board P eggy Huss, David Weiss, Dawn Rady, Deborah Anderson, Renee Corral, Barb Gore, Chuck Rynearson Balance is published quarterly by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals. © 2013 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.

Tell Us What You Think I f you have questions or suggestions or would like to tell us how Network Health improved your life, send us an email at balance@networkhealth.com. You can also write to us at: Network Health Attention: Sam Darcy 1570 Midway Pl. Menasha, WI 54952

7 10 Ways to Rev Up Your Metabolism

 Ten tips to naturally boost your metabolism

FEATURE 8 A Blessing in Disguise

 How Terry Tackman’s opinion of Network Health did a 180°, and the health journey that prompted it

wellness 12 Feeling SAD This Winter?

 The signs, symptoms and treatment for seasonal affective disorder

13 A Focus on Quality Health Care  The 2012 HEDIS/CAHPS report

14 Breathe Easy with COPD  Steps to avoid COPD flare-ups

15 Best in Wisconsin

 Network Health honored for customer service excellence networkhealth.com


life

Information to help you get the most out of your coverage

Finding Motivation With these tips and some determination, you won’t have to make getting into shape a resolution when you ring in 2014.

B

y now, those New Year’s resolutions you made are probably in the rearview mirror. Just because you didn’t stick to your guns to get healthy this January doesn’t mean you have to wait until 2014 to try again. The truth is, it’s hard. Most everyone knows the benefits of getting healthy, and most of us want to. The real challenge isn’t physical, it’s mental. So instead of giving up on your plans to get healthy this year, try these helpful tips for getting motivated.

Be Realistic

People commonly quit on their health goals because they set unrealistic expectations. If you haven’t gone for a run in years, don’t plan on running a marathon in a month. Building strength and endurance takes time. Set realistic goals and your chances for success will increase.

Write Down Your Goal

Create an attainable goal and write it down. It’s OK to dream big, and there’s nothing wrong with starting small. Just make sure you give yourself plenty of time to achieve your goal. Keep in mind that bigger goals, like losing 20 pounds or running long distances, will need a little more planning. Record the steps you plan on taking to reach your longterm goal and create a manageable timeline.

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 inspirational to see your progress. A journal may serve as a learning tool too, letting you know what to correct in the case of a setback. net workhealth.com

Also, try to share your goal with someone who will motivate you to stay on track. The person you choose should be supportive of your goal and provide encouragement when you need help getting motivated.

Manage Temptation

Nobody is perfect. Remember, there are going to be days when you don’t make it to the gym or you cheat on your diet. Don’t be too hard on yourself and accept there are days that will be better than others.

However, it’s important to take steps to prevent lapses. Don’t surround yourself with junk food. Instead, buy healthy snacks to take with you when you’re on the go, like vegetables, fruits or yogurt. Eating a small snack every two or three hours can keep you full and stop you from overeating later. And, if something comes up when you know you will miss out on a workout, go for brisk 20-minute walk at lunch or when you get home. Even a modest amount of exercise can be beneficial to your health. W i n t e r 2 01 3

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life { YOUR COVERAGE }

Get In the Know

eligibility, claims or other Network Health matters. > Be informed of your diagnosis, treatments and prognoses from practitioners in terms you understand. > Refuse treatment and to know of the probable consequences of that action. > Make recommendations about the organization’s member rights and responsibilities.

Your Responsibilities Are To…

Communicate openly with providers or health plan personnel. If you have questions about your treatment plan, it’s your responsibility to discuss concerns and understand any explanation or instructions. > Read and understand your benefits as outlined in the summary of member responsibility table and certificate of coverage. > Follow the policies and procedures that we’ve established in your certificate of coverage. > Follow the plans and instructions for care that you and your practitioner have developed. > Treat all providers and health plan personnel with respect and courtesy. > Provide information that health care professionals need to take care of you. > Notify providers and Network Health of changes in coverage, eligibility, addresses or phone numbers. > Keep scheduled appointments or to give proper notice of delay or cancellation. > Express concerns of dissatisfaction with us or your providers so we can fix the situation. > Participate in understanding your health problems and develop treatment goals. >

Your Member Handbook and Certificate of Coverage contain important information regarding your benefits, rights and responsibilities.

A

s a Network Health member, you have certain rights and responsibilities. We try to make sure we provide you with services that respect your rights.

You Have the Right To…

Receive information about the managed care organization, its services, practitioners and providers. > Be treated with respect, in regard to dignity and privacy. > Participate with practitioners in decision making about your health care. >

Discuss appropriate or necessary treatment options for conditions, regardless of price or coverage. > Voice complaints or appeals about the managed care organization, the care received and/or the privacy of protected health information. > Select or change a primary care practitioner for any reason. > Review medical records with your primary care practitioner. > Receive prompt and courteous service from representatives regarding benefits, >

Do You Need Help Submitting a Claim?

M

ost providers will submit claims on behalf of members. But some out-of-area medical facilities may require payment for care at the time it is given. To arrange for reimbursement, you must send itemized bills and proof of payment within 90 days to Network Health, Attn: Claims Department, P.O. Box 568, Menasha, WI 54952. For more information, contact our customer service department at 800-826-0940 or 920-720-1300.

4 | balance • W i n t e r 2 01 3

? did

you know

Network Health’s Quality Improvement Department works to make sure you receive the highest quality of care. With this is mind, we recommend that you contact your primary care practitioner after any visit to an emergency department. This ensures that you have access to coordinated and continued care, and receive assistance with any further medical needs.

networkhealth.com


health

News and tips to help you maintain a healthy and happy life

Know Your BMI P

art of staying healthy means maintaining a healthy body weight. When you gain weight, you can increase your risk for high blood pressure, diabetes, high cholesterol and heart disease. So how do you know if your body weight is putting your health at risk? One of the best ways to tell if you’re at a healthy weight is to calculate your body mass index (BMI).

What is BMI?

BMI is a cheap and easy way for you to measure your body mass. For most people, it can be a reliable indicator of the amount of body fat you’re carrying, which is related to the risk of life-threatening diseases. Because calculation only requires height and weight, it’s a simple way for you to compare your weight against the general population.

How is BMI Calculated?

For both adults and children, BMI is calculated by dividing your weight (in pounds) by your height (in inches) squared and multiplying it by 703. For example, the BMI calculation for a 6 foot tall (72 inches), 200 pound person would be:[200÷(72)²] x 703 = 27.1 A child’s BMI should not be measured the same way as an adult’s. For children and teens, BMI is age and sex specific and is plotted on a growth chart to obtain a percentile ranking. net workhealth.com

BMI Ranges for Adults BMI

Weight Status

Below 18.5

Underweight

18.5-24.9

Normal

25-29.9

Overweight

30 and above

Obese

How Reliable is BMI?

The link between BMI and body fat is high, but it can vary based on age, race and gender. There are also limitations to BMI, such as overestimating body fat in people who have a muscular build and underestimating body fat in older people who have lost muscle mass.

Concerned About Your BMI?

Talk to your doctor to see whether your health is at risk and whether you should lose weight. Your doctor will evaluate your BMI and other risk factors for heart disease. W i n t e r 2 01 3

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Network Health offers TTY services for deaf, hard of hearing or speech-impaired members. Members who need these services should call 800-947-3529.

The Importance of Omega-3 Acids

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n the past, you may have heard talk of omega-3 fatty acids. But what are they and how much do you need? Simply put, they can do your body a whole lot of good. But unfortunately, our bodies can’t produce them on our own. This means it’s important to know what they are, what they do and where to find them.

What are omega-3 fatty acids? Omega-3 fatty acids are polyunsaturated fatty acids that are essential nutrients for good health. They help your body work normally, and also provide numerous health benefits.

Why are they important?

Omega-3s benefit your health in several ways, such as reducing inflammation throughout the body, controlling blood clots and building cell membranes in the brain. Also, they appear to play a role in cognitive and behavioral function. New studies identify potential benefits for a range of health conditions that include cancer, heart disease and arthritis.

What are the main types of omega-3s?

There are several forms of omega-3s, and they come from different sources. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are two of the most crucial types of omega-3 fatty acids. The other major type is alpha-linolenic acid (ALA). EPA and DHA have better

Omega-3s may help with: » Blood fat (triglycerides) » Heart disease » Rheumatoid arthritis » Depression » Asthma » Prenatal health 6 | balance • W i n t e r 2 01 3

established health benefits than ALA, but your body coverts ALA into EPA and DHA when consumed.

Where can I find omega-3s?

Since your body can’t make omega-3s, we need to get them from our diet. Unfortunately, most Americans do not eat enough foods that contain omega-3s. For good health, you should try to get at least one source of omega-3 in your diet every day. EPA and DHA (the most crucial types of omega-3s) You can find EPA and DHA acids together in fatty fish and fish oil. The best sources include the following. > Salmon (wild salmon contains more omega-3s than farmed) > Tuna > Lake trout > Sturgeon > Sardines > Mackerel > Herring ALA (another major type of omega-3, but not as good as APE and DHA) Here are some primary sources of ALA. > Walnuts > Flax and flaxseed oil > Certain vegetable oils (canola, olive and soybean) > Some green vegetables (brussels sprouts, kale, spinach and salad greens)

Is it better to get omega-3s from foods or supplements?

You should try to get your omega-3s from foods because plants and fish that contain the acids also provide other good nutrients. If you don’t eat fish or other foods rich in omega-3 fatty acids, you might want to consider taking a supplement, such as fish oil. But, remember to first discuss a supplement with your doctor to make sure it’s beneficial for you. S ay W h at ?

Polyunsaturated fatty acids – A type of healthy fat that can help lower blood cholesterol levels.

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For a complete list of recent changes to our provider network, go to networkhealth.com/providerchanges.

10 Ways to Rev Up Your Metabolism Your metabolism is basically the amount of calories your body needs every day. About 70 percent of these calories go to performing basic functions, and an additional 20 percent are needed for physical activity. The remaining 10 percent is used for digestion. But when you start taking in more calories than your body needs to perform these functions, you start to put on the pounds. Gender and genetics both play a role in our metabolism. But if you feel you’ve been cursed with a metabolism that works at a snail’s pace, there are steps you can take to speed things up. Here are ten tips to give yourself a boost. 1. Build Muscle. The more lean muscle you have, the more calories you burn. That’s because muscles use energy even when you’re resting. Research shows that every pound of muscle uses six calories a day to sustain itself. 2. Get Aerobic Exercise. Aerobic exercise can double the amount of calories you burn during a workout, as well as raise your post-workout metabolic rate for as long as an hour after you stop exercising. 3. Drink Water. If you are dehydrated, your metabolism may slow down. Try to drink a glass of water with every meal, as your body needs water to process calories. 4. Eat Often. When you eat large meals that are hours apart, your metabolism will slow down. Having a healthy, small meal or snack every three to four hours will help you burn calories throughout the day. It will also help keep you from overeating later. 5. Spice It Up. Adding spice to your foods can temporarily speed up your metabolism. And, if you routinely eat spicy dishes, the benefits can add up. 6. Add Protein. Your body burns more calories digesting protein than it does for fats or carbohydrates. Try replacing some carbs with proteinrich foods like fish, lean beef, chicken, turkey and eggs. 7. Avoid Crash Diets. Any diet that involves eating less than 1,000 calories per day is terrible for boosting metabolism. Depriving yourself of calories will decrease muscle mass, meaning you’ll burn less calories than you did before the diet. 8. Try Green Tea. Research shows that green tea can speed up your metabolism for a short period of time. According to WebMD, drinking two to four cups of tea will temporarily help you burn 17 percent more calories during moderate exercise. 9. Exercise in the Evening. Studies show that your metabolism slows down when you sleep. But, a moderately intense workout a few hours before bed can speed up your overnight metabolism up to 10 percent. 10. Eat Breakfast. The morning is the best time of the day for your body to turn calories into muscle. This is because a hormone in your body, called cortisol, is highest just before you wake up. net workhealth.com

S ay W h at ?

Cortisol – A hormone that affects the metabolism of glucose, proteins and fats. Females

(does not include women who are pregnant or breastfeeding)

Age

Sedentary

Moderately Active Active

4-8

1,200-1,400 calories

1,400-1,600

1,400-1,800

9-13

1,400-1,600

1,600-2,000

1,800-2,200

14-18

1,800

2,000

2,400

19-30

1,800-2,000

2,000-2,200

2,400

31-50

1,800

2,000

2,200

51 and older 1,600

1,800

2,000-2,200

Males Age

Sedentary

Moderately Active Active

4-8

1,200-1,400 calories

1,400-1,600

1,600-2,000

9-13

1,600-2,000

1,800-2,200

2,000-2,600

14-18

2,000-2,400

2,400-2,800

2,800-3,200

19-30

2,400-2,600

2,600-2,800

3,000

31-50

2,200-2,400

2,400-2,600

2,800-3,000

51 and older 2,000-2,200

2,200-2,400

2,400-2,800

Source: 2010 Dietary Guidelines for Americans, from the U.S. Department of Agriculture W i n t e r 2 01 3

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S T O C O V E R Y

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2 01 2


Blessing

A

in Disguise

When Terry Tackman’s employer switched to Network Health coverage, he wasn’t happy. But when his health became compromised, he was thankful to have Network Health in his corner.

The saying goes that you never get a second chance to make a first impression. For Terry Tackman, fair or unfair, his first impression of Network Health was that it wasn’t for him. Fortunately, it was the lasting impression that really mattered. In 2009, when Terry’s employer, the Hortonville School District, proposed switching health insurance carriers to Network Health, Terry strongly opposed the move. “I was probably the biggest person against Network Health,” he said. “I thought our carrier was doing fine, and was reluctant to change.”

By Sam Darcy

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

|

>>>

Photographs by Shane Van Boxtel, Image Studios

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S T C O V E R R Y

S ay W h at ?

Terry said when his employer switched coverage entirely to Network Health, he lobbied against the change and sent district-wide emails to try and stop it, but he was outvoted. Terry’s reluctance stemmed from his personal health history, and he was afraid that Network Health wouldn’t cover his preexisting medical condition or allow him to continue to see his current medical team. “I was assured that I would still be covered,” he said. “But I was still against switching to Network Health.” For the better part of the last 15 years, Terry had a kidney disease. But fortunately for Terry, it was well-managed and he mostly just had to watch his numbers. But in August 2010, a year after the switch to Network Health coverage, things changed. Terry was preparing for his 16th school year as a teacher at Hortonville Middle School when he became sick with pneumonia. It was shortly before classes began, and the timing couldn’t have been worse. “I was stubborn and came back to work. With it being the start of the school year, I had too much to do and refused to take sick days,” Terry said. He made it through the first day of school before going to see the doctor, his nephrologist. By the time he got there, he didn’t even have the energy to talk. “I had less than 70 percent oxygen,” he said. “I was completely out of it, and my kidneys were wiped out.” For a body to function properly, a person needs a constant level of oxygen circulating in the blood, usually 95 to 100 percent. At 70 percent, Terry’s oxygen level was dangerously low. With a team of medical doctors evaluating him, Terry was told he needed a new kidney. For the husband and father of two, it was a reminder of how fast things can change. “I went from feeling great to lying in a hospital bed. It happened so quick, and it wasn’t the way we had it all planned.” The plan was for Terry’s wife to donate her kidney. It would be about the easiest solution a situation like that could have.

Nephrologist – Medical doctor who specializes in kidney care. Dialysis – A blood-cleansing treatment that removes waste, salt and extra water. It is needed when kidney’s can no longer take care of the body’s needs. 10 | balance • W i n t e r 2 01 3

Terry would be back to himself in no time. But, shortly before she could donate, Terry’s wife hurt her back. She had a bulging disc, and her doctor could not authorize her to go into surgery. Terry had to go on a donor list, and he had to start kidney dialysis. “Dialysis was three days a week. I would work all day and then go get treatment, I wouldn’t get home until 8 p.m.,” he said. “That was my life.”

“The personal attention you get from Network Health is fantastic. It’s a huge advantage that Network Health is small and local. I’ve never gotten the runaround when I’ve called.” With the sudden health scare, Terry became fearful that his new health coverage wouldn’t be there for him when he needed it. He worried that without the familiarity of his old plan, he would be back to square one. According to his Network Health Case Management Coordinator, Rosanne Rott, it took some time to prove to Terry that the transition to Network Health would prove to be beneficial. networkhealth.com


“It was trying times and that was where Rosanne helped. She was a friend and an expert in the field. I wouldn’t have had that with my old coverage.”

“He had a fear of the unknown,” Rosanne said. “It’s scary to have your health insurance change, especially when you are on a donor list.” Rosanne said it took some time to build up Terry’s trust, but she kept working with him and doing everything she could to help. “At first he was a tough nut to crack,” she said. “But he eventually figured out that I was here to help and it worked out well in the end,” she said. Soon, Terry realized how grateful he was to have Network Health’s coverage and his own personal case management coordinator in Rosanne. “It was trying times and that was where Rosanne helped,” he said. “She was a friend and an expert in the field. I wouldn’t have had that with my old coverage.” With medical bills and much uncertainty, Terry continued to turn to Network Health for help. Rosanne worked to coordinate his care and coverage, as well as answer any questions that he had. “The personal attention you get from Network Health is fantastic,” he said. “It’s a huge advantage that Network Health is small and local. I’ve never gotten the runaround when I’ve called.” Finally, in late November 2010, Terry got the phone call he had been waiting for. His name came up on the donor list, and he would get the transplant. And, on the day before Thanksgiving, Terry finally received a new kidney. To make sure his body didn’t reject the new kidney, Terry had to net workhealth.com

have lab work done every day for that first month. Eventually, testing went down to a couple of days each week, to once a month and now once every six months. Today, Terry has made a full recovery and is back to enjoying time with his wife and two children. And, he’s grateful to everyone that helped him get there—especially Rosanne, who he still calls, even if it’s just to talk. “The amount she helped me is immeasurable. How do you measure peace of mind?” he said. “She’s fantastic at what she does.” Terry admits that the health insurance carrier that he never wanted has turned out to be one of his best assets. “Health insurance can be crazy, but Network Health has been better than I could have hoped,” he said. “I always receive fast, attentive service, regardless of the issue.” Terry said he would have paid much more out of pocket with his old health plan, but it’s really the personal care that makes Network Health stand out. “It’s all about customer service; you can always talk to someone,” he said. “Network Health is everything that you’d want in an insurance company.” In the end, the help Terry received from Rosanne and all of Network Health eased his worries and concerns while leaving a greater impression on him than he ever imagined. “I was one of their biggest opponents in the beginning,” he said. “But, I would be fighting to stay with Network Health now.” W i n t e r 2 01 3

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wellness

Tools to empower your personal health

Feeling SAD This Winter?

T

he cold days and dark nights of Wisconsin winter can wear on all of us. But, if you experience serious mood and behavior changes every winter, it may be a condition called seasonal affective disorder (SAD). Seasonal affective disorder is a type of depression that affects you during the same season each year. This is because it is believed to be related to seasonal variations of light. According to Mental Health America, SAD affects half a million people every year between September and April, peaking in December, January and February. Although SAD could affect anyone, it’s most common in: > Women > People between the ages of 18 and 30 > Areas with long winters where there are big changes in the amount of sunlight from season to season Experts aren’t sure what causes SAD, but many believe it’s caused by a lack of sunlight. Not enough sunlight can disrupt sleep cycles, and increase the amount of melatonin your body produces. Melatonin is a hormone that is produced at increased levels in the dark and may cause symptoms of depression. 12 | balance • W i n t e r 2 01 3

Symptoms

Oversleeping or difficulty staying awake in the daytime Overeating, especially a craving for carbohydrates resulting in weight gain > Feeling sad, anxious, moody and lethargic > Loss of interest in your usual activities and routine Doctors often prescribe light therapy to treat SAD. This treatment includes sitting in front of lights that are up to ten times the intensity of normal domestic lighting for up to four hours a day. Also, spending time outdoors in the sunlight or exercising can help. Light therapy should not be confused with tanning, which poses risks to your health. Light therapy does not cause tanning because the ultraviolet rays that cause tanning are filtered out. Medical experts caution that exposure to unfiltered bright lights for extended periods of time may eventually cause damage to your body. If you have felt depressed during only a particular season for at least two years in a row, talk to your doctor or a mental health professional. He or she may advise treatment to help you feel more like yourself. > >

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A Focus on Quality Health Care

N

etwork Health evaluates the quality of care and services provided using two nationally recognized tests, the Healthcare Effectiveness Data and Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®). Each test scores our services in a different way. HEDIS measures preventive care and our care for chronic diseases. CAHPS evaluates customer satisfaction with services provided by customer service, claims and physicians. Both tables show Network Health’s excellent rankings on both state and national levels.

How We’re Doing

(Percentages reflect the number of members who used the offered services and had results within the reported level.) Category Studied Cervical Cancer Screening Childhood Immunization Status Combo 5 (includes DTaP, IPV, MMR, HiB Hepatitis B, ChickenPox, Rotavirus)

86.11%

Ranks 8th

80.4%

Ranks 5th

Wisconsin Health Plans Average Results

National Average Results

78.11%

75.55%

67.56%

87.33%

71.46%

Appropriate Treatment for Children with Upper Respiratory Infection

94.28%

88.63%

83.04%

Prenatal and Postpartum Care – Postpartum Care

93.66%

84.62%

76.19%

Comprehensive Diabetes Care – HbA1c Tested

94.67%

92.27%

88.59%

Comprehensive Diabetes Care – HbA1c Level less than 8%

71.24%

66.36%

58.75%

93.90%

87.79%

85.97%

Cholestrol Management for Patients with Cardiovascular Conditions – LDL-C Tested

Ranks 11th Ranks 29th

Ranks 20th

Ranks 20th

The source for the 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 the 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. net workhealth.com

Category/Measure

How often did your health plan’s customer service give you the information or help you needed? How often did the written materials or the Internet provide the information you needed about how your health plan works? How often did your health plan handle your claims correctly?

92.47%

Ranks 22nd

(Percentages reflect the number of members who gave positive reviews.)

57.77%

Adolescent Immunization – Tdap/Td

Ranks 18th

2012 Reporting Year Network Health HMO (Commercial) CAHPS 4.0H Results

How often did your health plan’s customer service staff treat you with courtesy and respect?

2012 Reporting Year Network Health HMO (Commercial) HEDIS Results

Network Health HMO Results –   National Ranking

How You Rate Us

Wisconsin Health Plans Average Results

National   Average Results

98.60%

94.06%

91.94%

86.11%

81.09%

76.33%

75.97%

66.39%

65.93%

94.79%

90.85%

88.89%

Network Health HMO Results –   National Ranking  

Ranks 1st

Ranks 19th

Ranks 18th

Ranks 32nd

Quality Program information Each year Network Health’s Quality Improvement (QI) Department updates its QI Program structure to include: > A written description of the QI Program. > Behavioral health care is specifically addressed in the program description. > Patient safety is specifically addressed in the program description. > The QI Program is accountable to the Board of Directors. > A designated physician has substantial involvement in the QI Program. > A designated behavioral health care practitioner is involved in the behavioral health care aspects of the QI Program. > A QI Committee oversees the function of the organization. > The specific role, structure and function of the QI Committee and other committees, including frequency, are addressed in the program description. > An annual quality work plan. > A description of resources the organization devotes to the QI Program. For more information about Network Health’s Quality Improvement Program, please call 920-720-1229, or toll free at 800-826-0940, ext. 01299. 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). W i n t e r 2 01 3

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wellness

Breathe Easy with COPD

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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 COPD. COPD, or chronic obstructive pulmonary disease, refers to a group of lung diseases that block airflow and make it hard to breathe. Two of the most common conditions of COPD are emphysema and chronic bronchitis. 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.

Self-Management Workshops Spring Schedule For more information or to sign up for a workshop, call us at 920-720-1655 or 800-769-3186, extension 01655. Or, visit us online at networkhealth.com/register and search for Living Well. Living Well with Chronic Conditions This workshop meets once a week for six weeks. St. Elizabeth Hospital, Fowler Conference Room Three 1506 S. Oneida St., Appleton, WI 54915 Meets Mondays, March 11 - April 15 5:30 p.m. - 8 p.m. Mercy Medical Center, Classroom One 500 S. Oakwood Rd., Oshkosh, WI 54904 Meets Wednesdays, April 10 - May 15 1 p.m. - 3:30 p.m. Living Well with Diabetes This workshop meets once a week for six weeks. St. Elizabeth Hospital, Fowler Conference Room One 1506 S. Oneida St., Appleton, WI 54915 Meets Tuesdays, March 19 - April 23 5:30 p.m. - 8 p.m.

Prevent infection

C.O.P.E with COPD Education and support to help with chronic lung disease. Oshkosh Senior Center 234 N. Campbell Rd., Oshkosh, WI 54902 Second Tuesday of every month, 1 p.m. - 3 p.m.

Take your medications

Better Breathers A community-wide support group for people with COPD and other chronic lung diseases. Families and caregivers are welcome to attend. St. Elizabeth Hospital, Fowler Conference Rooms 1506 S. Oneida St., Appleton, WI 54915 Meets the fourth Wednesday of every month starting February 27. 1 p.m. - 2 p.m. program, 2 p.m. - 3 p.m. social hour

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.

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 the COPD is. 14 | balance • W i n t e r 2 01 3

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 difficulties from becoming an emergency. Ask your doctor about developing a personal plan.

Could you use help managing your COPD?

If you would like more information regarding COPD, please call us at 920-720-1651 or 800-769-3186.

Attention Wellness Pathways and Millennium Participants All wellness forms should be faxed to 920-720-1750.

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proven excellence

Awarded Best in Wisconsin Network Health honored for customer service

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ast fall, Corporate Report Wisconsin honored Network Health with its 2012 Corporate Citizenship Award. The award, for the customer service category, is given to one company in the state of Wisconsin each year. The Corporate Citizenship Awards recognize Wisconsin companies that have made unique contributions to their communities, organizations and the environment. In February 2012, we launched our “We Speak Your Language” campaign, which included every employee pledging to end the use of insurance jargon. Now a year later, we’ve received extremely positive feedback from our members and agents and our competitors are taking notice too, which was one of our goals. The Corporate Citizenship Award reaffirmed the commitment we made last fall, and rewarded us for the personal service that we strive to offer every day. Ultimately, we want to set a new standard for the way health plans should operate not just here in Wisconsin, but throughout the nation. And by winning an award where one of the major components was customer satisfaction, it proves we are taking steps in the right direction.

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1570 Midway Pl. Menasha, WI 54952

MediCAre WiTH NO JArGON We know Medicare can be complex. That’s why we use simple, straightforward language. And with our concierge service and extra help to get and stay healthy, you’ll see why more than 50,000 Medicare Advantage (PPO) members already trust Network Health. Our Medicare Advantage plans offer: -

Affordable rates Quality coverage Friendly, local service Health management programs

Call 800-983-7587. We’re available Monday-Friday, 8 a.m. to 8 p.m. Or visit NetworkHealthMedicare.com to learn more today.

8 0 0 -983-7587 \ T T Y 800- 947- 3529 \ Net workHealt hMedic are .com This is an advertisement. Network Health Insurance Corporation is a Medicare Advantage organization with a Medicare contract. H5215_BalanceAd


Network Health - Balance Winter 2013 final