Focus newsletter winter 2017

Winter 2017

Your Health FOCUS

Medication Safety Medications, or meds, are the leading cause of child poisoning. In 2013, over 59,000 children were seen in emergency room or ER visits for child poisoning. That’s one child each nine minutes. One and 2 year olds make up the most ER visits for poisoning. Almost all of these visits are because the child got into medications (meds) during a moment alone.

Children are curious by nature and it makes sense that they would be even more curious when it comes to meds. Many meds

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NCQA Quality Program

look and taste like candy. While it’s vital to push kids to explore and learn new things, when it comes to meds, safety comes first!

1. Keep all meds in their own packages from the store.

2. Read and follow the labels on your meds.

3. Place purses and bags in high places and do not leave meds on a nightstand, dresser, table or the floor.

Complex Case Management Program

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Long-Term Use of Acid Reducers

Find What You Need at www.hpsj.com

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Medication Safety Tips:

4. Store vitamins, diaper rash creams, eye drops, nose sprays and hand sanitizers away and out of sight.

5. Marijuana or weed can make children very sick. Store and lock all weed out of reach and sight.

6. If you have questions about your child’s meds or how much your child needs to take, call your child’s doctor, pharmacist or the Poison Help line.

7. The best way to give liquid meds to children is to use a syringe.

8. Do not use or save meds that are out-of-date.

9. To get rid of meds like pills and tablets:

• Mix them with water and Kitty Litter, or coffee grounds in a sealable plastic bag, and throw them in the trash.

• Take meds you do not use anymore to a local drop-off site. Find out if your local trash company, drugstore or hospital offers a place to drop off meds.

10. Store the Poison Help line’s phone number in your phone, 1-800-222-1222.

Now that you know how to keep children safe around meds, share these tips with the people around you like, friends, caregivers, babysitters, parents and grandparents.

NCQA Quality Program Information about the quality improvement program for members Putting Your Health Needs First Our Quality Improvement (QI) program puts your needs first.

We focus on making programs to help give you the best care.

This helps you stay healthy. HPSJ’s QI team always works to improve the safety and quality of care you get.

People who are enrolled in HPSJ, local doctors and our staff are part of our QI committees. The committees use feedback from people who are enrolled and doctors. They also use a lot of data and reports to check how we are doing. They look for ways to make our programs better.

Every year, we check our QI program to look for needs and set new goals. During the year, we keep checking the progress and

look for ways to make our programs better. We use measures to check the quality of care that you get. These are called HEDIS measures. Last year, we met or beat the minimum performance level for 34 of 38 HEDIS measures in San Joaquin County. This year, our goal is to meet or beat the minimum performance level for all 38 HEDIS measures in San Joaquin County. We also have a goal to get better scores in Stanislaus County.

Last year, HPSJ did a survey for people enrolled in HPSJ. The survey showed that our scores for customer service are good. It also shows that satisfaction with specialists is better than half of all other health plans in our country.

Do You Have a Complaint?

The best way to take care of a problem is to talk to your doctor. If you are not happy with the health care you received, you can file a grievance, also known as a complaint.

• It is your right to file a complaint.

• You will not be discriminated against or lose your benefits.

• If you want to file a grievance, please call Customer Service at 1.888.936.PLAN (7526), TTY/TDD 711, Monday through Friday from 8 a.m. to 7 p.m.

Complex Case Management Program

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What is Complex Case Management (CCM)?

• It is a program that gives you care to meet your health care needs.

• Our nurses work with you, your doctors and the person taking care of you to craft a plan of care that can help you with your health needs.

This Program Was Made To: • Help better your life.

• Raise your skills to help take care of your health needs.

How Can I Join?

HPSJ finds members by using information from many sources.

Then a score is created. This score tells our nurses to reach out to you about how we can better help you. The program is a choice for members. You can drop out of the program at any time.

Members who would like to be in the CCM program can: • Be referred by your doctor to special doctors or health providers • Be referred by the person taking care of you

• Tell us you would like to be a part of the CCM program; call at 1-888-936-PLAN (7526), or TTY/TDD 711

What Can You Expect?

If you join the CCM program: • You will be given a health test

• You will be given a case manager who will work with you, the person taking care of you and your doctor

• Your case manager will make a plan to help make your life better and teach you how to deal with your health issue • You will be given health tip sheets about your health issue • We will help you get care or tools you may need

• We will give you referrals to helpful aids in your area

Language Help – You Speak, We Listen Health Plan of San Joaquin wants our members to know we speak their language. Or, we can offer a helpful person who does.

For doctor visits, a trained health interpreter can be requested, when needed. You do not have to ask family or friends to tell you what your doctor is saying. Call us, at 888-936-7526, or TTY/ TDD 711, to get help. Doctors and HPSJ members can ask for an interpreter at no cost.

You can get interpreter service in many languages, as well as American Sign Language. Be sure to ask for an interpreter when you make a doctor visit.

If you would like to use a face-to-face interpreter, please contact us: • Five (5) to seven (7) business days in advance, for any language need • Ten (10) business days in advance, for sign language

If you find that, you need an interpreter and your appointment is in three (3) days, please call us and we will work with you to get you the help you need. We are here to help make sure you can

understand your doctor in your language, and understand that you cannot always call in the preferred timeframe we have listed for you.

Translation of Member Materials

Health Plan of San Joaquin gives written papers in a language that our members can read. Most papers are written in English and Spanish. If you cannot read these languages, or you are not getting papers in your preferred language, let us know.

To serve you better, please call our Customer Service department at 888-936-7526, or TTY/TDD 711, and tell us your: 1. Written language of choice 2. Spoken language of choice 3. Your race and ethnicity

We will make a note in your file.

This way, we can serve you better.

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Long-Term Use of Acid Reducers

Do you have heartburn?

Are you taking any meds like Prilosec (Omeprazole), Nexium (Esomeprazole) or Prevacid (Lansoprazole)?

Did you know that they could cause side effects like loose stools, lung infections or bone breaks, when used long term for just heartburn?

You can get these meds over the counter (OTC) or as a med from your doctor. Most often, you can use OTC meds for two weeks.

If the heartburn does not get better, then you should see your doctor. He/she might have you use a heartburn reducing med for up to eight weeks. Not everyone taking a med like Prilosec needs to be on it for a long time. It is vital to check with your doctor to see if you still need it after the eight weeks have passed.

Are you on a heartburn med? Take action!

Did you know that you could treat feelings of heartburn without meds? Here are some things you can do: • Live a balanced lifestyle with a food plan and by working out • Raise the head of your bed with pillows • Avoid late night meals 2-3 hours before going to sleep • Avoid foods that cause the heartburn symptoms (such as chocolate, coffee/tea or spicy foods)

Talk to your doctor about your heartburn meds at your next doctor’s visit!

Baby Blues or Postpartum Depression?

Baby Blues can be a normal experience for a new mother.

Baby Blues is something that happens in about 80 percent of women. Think of your five closest friends. There’s a chance that of these five women, four of them have felt Baby Blues after giving birth. The new demands of caring for a new baby can cause loss of sleep, loss of hunger and making you feel overwhelmed. More stress can lead to a sense of worry and anxiety about not being a good mother. These feelings can be normal during the first few weeks after birth and should go away without treatment. Support from family and friends, rest and time can help moms feel better.

What is Postpartum Depression (PPD)?

Postpartum Depression (PPD) is not the same as “Baby Blues.” Sudden changes and the rush of hormones that happen after the baby is born can last for a few weeks. But PPD can be worse and lasts longer. It is not expected to go away if left untreated. Women who may have had depression during other births can have depression with each new pregnancy. Having depression before having children may also lead to PPD.

Signs of PPD:

• Feeling sad or depressed

• Feeling more irritable or angry with those around you • Having a hard time bonding with your baby • Feeling nervous or panicky

• Problems eating and/or sleeping

• Having upsetting thoughts that will not leave your mind • Feeling as if you are “out of control” or “going crazy”

• Feeling like you never should have become a mother • Worrying that you might hurt your baby or yourself

Treatment for PPD

If you feel you – or a loved one – may have PPD, talk to your doctor today. If you are not sure, but you would like to talk to someone privately and from the comfort of your home, you can call Beacon Health Services at 1-888-581-7526. As a Health Plan of San Joaquin (HPSJ) member, you can talk to a professional at no cost.

Find What You Need at www.hpsj.com Our website, www.hpsj.com puts the news you need at your fingertips. Many members use hpsj.com online tools to handle their care and fix their health. It is also the best way to: • Get the most up-to-date facts about your plan • Find out how to reach us

• Know what to do in a sudden event that must be handled right away

Visit www.hpsj.com from your PC, tablet or mobile phone. On www.hpsj.com you will find the news for the topics listed below: Reach Out to Us • Find our toll-free number.

• Call us if you have questions.

• Ask about the TDD/TTY line if you have a hearing problem.

• Find out how to reach your doctor.

• Learn about language help if you do not speak English well.

• Find facts about our Quality Improvement (QI) program, what we do, how we do it and our program goals.

Getting Care

• Choose your primary care practitioner (PCP).

• Our list shows each provider’s languages and sex.

You can also find out about: ◦◦ Their license

◦◦ Medical school they went to

◦◦ Residency they did and board status of a doctor – You can also call us for help

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• Find how to reach your PCP.

• Choose a hospital by name or place.

• How to get:

◦◦ Care during normal office hours ◦◦ After-Hours Care ◦◦ Specialty Care

◦◦ Emergency Care & when to use 911 ◦◦ Mental Health Care ◦◦ Hospital Services

◦◦ Out-of-Area Care and Coverage

What Your Plan Covers

Find your Evidence of Coverage (EOC) online. It tells you: • What is and is not covered

• Your benefits and limits, in and out of our service area

• How we decide to involve a new technology as a covered benefit

Pharmacy Benefits

• When do we use generic medicine

• How to ask for brand name medicine

• How to ask for a medicine that is not covered

• Find out if your medicines are covered, need approval, or are limited.

• Learn about Therapeutic Interchange Protocol (TIP) for meds that work in a similar way and Step Therapy for other meds.

Payments & Claims

• Learn what to do with fees, bills or other charges.

• Send a Claim for a covered service you paid

• Online Tools to Handle – & Better – Your Health

• Your Personal Health Assessment (PHA) & Health Risks.

• Track Your Health Goals.

• Learn about Preventive Health Care Visits.

• Tips & Tools to Keep You Healthy.

Member Responsibilities, Rights & Privacy • Member Rights and Responsibilities.

• How HPSJ protects your privacy.

• Routine Okay – what it means and what it covers.

• How we use and share your personal data.

• How we get your consent to use your personal data.

• How to ask for limits.

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6 • How you may see your personal data.

• Sharing non-routine information.

• Limiting how your personal data is used or shared.

• Change your health personal data.

• Find out who can see/has seen your private data.

How HPSJ Makes Health Care Decisions

Complaints

• Here is our rule: We do not financially reward a person for Utilization Management (UM) decisions.

If you do not agree with a ruling about your care or benefits, or have a problem with a doctor, our website explains how you can file a complaint.

• External Appeals Steps.

How You Can Join Our: • Case Management (CM) Programs

• Disease Management (DM) Programs

Also, how your caregiver can guide you.

Visit us online at www.hpsj.com.

Learn more about these topics in your online Evidence of Coverage (EOC).

Or call Customer Service, toll-free, at: 1-888-936-PLAN (7526), or TTY/TDD 711.

COPD 3 Steps to Breathing Easier

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Know your Triggers

• Quit Smoking • Avoid smoke, fumes, or chemicals

Your Medication

Check your labels and ask your doctor about how each medication works

Prevent Infections

Get your flu and pneumonia shots

Chronic Obstructive Pulmonary Disease (COPD) causes shortness of breath, wheezing and coughing, which can get worse over time. By managing your COPD you will be able to breathe easier.

If you need a hand with these steps or if you’re not sure where to get started call Health Plan of San Joaquin. Our COPD Management Program can guide you to better health.

Call Disease Management at 888.936.7526 TTY/TDD 711 or visit www.hpsj.com/COPD

Diabetes and Foot Care

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Diabetic Foot Exam

Get Help Through Care Management

If you have diabetes your doctor should check your feet at every exam. Diabetes can change how you feel pain, and you may not even feel pain when you have been injured. High blood sugars can make it harder for you to heal. This means bad infections can happen because of diabetes. Here are some things you can do to keep your feet healthy.

Your health is nothing to play around with. Sometimes you need more than one person to help you. Health Plan of San Joaquin has a team of nurses, social workers, and patient health navigators who are here to help you reach your health goals. Let us help if you have questions about:

At Your Doctor’s Office:

• Ask your doctor to check your feet at every visit

• Tell your doctor if you have a cut or any type of foot problem

• If you have a foot problem between visits, call your doctor to let them know • Ask about the best way to control your diabetes

Choosing the Right Shoes: • Measure your feet while you’re standing

• Try on lots of different types and sizes to make sure they’re the right fit • Make sure you’re wearing the socks you want to wear with the shoes • You should be able to fit your thumb in the space between your big toe and the front of the shoe • Wiggle your toes. Are they still comfortable?

• Avoid high heels. Look for cushioned and flexible shoes

• • • • • • • • • • •

Diabetes Asthma Heart Disease Chronic Obstructive Pulmonary Disease (COPD) Congestive Heart Failure (CHF) Medications Transportation to appointments Depression Anxiety Substance Abuse Pregnancy and Prenatal Care

Or if you are wondering how to take control of your health, your HPSJ Care Management team is here for you. Our Nurses can answer questions about medications and treatments. Our Social Workers can connect you with services ranging from getting to appointments to mental health and substance abuse. Our Health Navigators can guide you in the right direction. We are one call away. And we are ready to help you find the right answers.

Do you need some extra one-on-one help to manage your diabetes, asthma, COPD or CHF? HPSJ has a team of Disease Management nurses that can help you. We want to support you as you set goals to improve your health, and get the information you need to live a healthier life.

Take charge of your health with the help of your HPSJ Team. Here is how to connect with us.

• Care Management: 209-942-6352; TTY/TDD 711 • Disease Management: 888-936-7526; TTY/TDD 711 • Health Education/Prenatal Program: 209-942-6356; TTY/ TDD 711 or www.hpsj.com/prenatal • Or visit our website at www.hpsj.com/condition-management

Our Pledge to You The goal of Health Plan of San Joaquin (HPSJ) is to improve the health of our members. We want to give health care value and advance healthcare outcomes.

When we think about Utilization Management (UM) rewards, we keep in mind: 1. The right care and support.

2. Health plan coverage at the time.

We do not reward doctors for giving out denial letters. There are no rewards to support using less resources.

If you have any questions, please call us at 1.888.936.PLAN (7526); TTY/TDD 711.

7751 S. Manthey Road French Camp, CA 95231 888.936.PLAN (7526) TTY/TDD 711 www.hpsj.com

years of community Your HPSJ Member ID Card is different from your Medi-Cal Beneficiary ID Card Did you know that your HPSJ ID card can keep you from getting a bill for your health care? By keeping your HPSJ ID card with you at all times, you will be able to give your doctors your HPSJ ID number. So HPSJ gets the bill and not you. The back of your HPSJ ID card also has some useful phone numbers. Like the HPSJ Customer Service line and the HPSJ Advice Nurse line.

HPSJ Member Rights and Responsibilities Some of These Are: • How HPSJ protects your privacy

• Routine approval: What it means and what it covers • How we use and share your information (info) • How we get your approval to use your info • How to ask for limits

HPSJ Member ID Card Medi-Cal New and Old Cards Need a new card? Call HPSJ Customer Service at 1- 888-896-PLAN (7526), TTY/TDD 711, or download the MyHPSJ Mobile App today!

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• How you may see your info • Sharing non-routine info

• How to limit how your info is used or shared • How to change your health info

• Find out who can see/has seen your private info For the complete list, please go to our website: www.hpsj.com/rights-responsibilities/