Perspectives - Summer Fall 2016

Regardless of the national political environment, Valley Health Plan’s (VHP) commitment to highquality and affordable healthcare is unchanged.

Also unchanged is the County of Santa Clara’s commitment to provide service to its employees and residents, as shown by the backing and support of the Board of Supervisors, the County Executive, and Santa Clara Valley Health & Hospital System. All of us at VHP are proud to be part of an organization with this commitment and we look forward to continuing to serve you in the years ahead.

Summer | Fall 2016

A Message from Bruce Butler, CEO .....1 NEW VHP Member ID Card....................2 New Mail Order Pharmacy Provider ....2 Pharmacy Information ..........................3 Timely Access...........................................4 VHC Downtown Clinic Now Open........5 Attention-Deficit/Hyperactivity Disorder (ADHD) Quality Care That You Deserve.....................................6 Your Satisfaction is Our #1 Priority.........7 Member Information...............................8 Speaking the Language of Health in Your Preferred Language...................9 Avoid the Flu.............................................9

Member Grievance..............................10 Discrimination is Against the Law ...... 11 Preventive Health Guidelines.............. 11 Choose Health Live Well.......................12 Staying Healthy with Diabetes.............12 New Diabetes Prevention Program....12 VHP Cares About Your Health.............13 Save Money by Staying in Network....14 SCC Local Farmers’ Markets................14

Medication Adherence for Members with Depression....................15

Table of Contents VHP Chief medical officer Dolly C. Goel, MD

Medical Advisors Stephen Harris, MD Michael Meade, MD Gary Steinke, MD

Member Newsletter

Our recent national election has “certainly introduced uncertainty” regarding the future of health care. Particularly for those who have benefited from the expansion of Medi-Cal, the availability of health insurance through Covered California, enhancements to employer group insurance coverage, and other elements of the Affordable Care Act (“Obamacare”), current political views and media coverage may be concerning. In reality, we simply don’t know at this time what types of changes, if any, will occur.

Perspectives

A Message from Bruce Butler, CEO

IMPORTANT INFORMATION NEW VHP Member I.D. Cards

VHP will be sending all members a new VHP Identification (ID) card effective January 1, 2017. The new and updated ID cards include critical information that VHP pharmacy providers use to identify you, your eligibility, and your pharmacy coverage.

It is important that you replace and start using your new ID card effective January 1, 2017. Please destroy any other VHP ID cards as the information will no longer be valid with our pharmacy providers and could cause a delay in receiving your prescription.

If you have any questions or concerns, please contact Member Services at 1.888.421.8444 (toll-free) or member.services@vhp.sccgov.org.

new mail order Pharmacy Provider

Valley Health Plan (VHP) & Navitus Health Solutions are pleased to announce that members can now enroll with the new mail order provider, NoviXus Pharmacy Services (effective November 1, 2016).

how to enroll Members can enroll at www.Novixus.com or call 1.888.240.2211 (toll-free), Monday – Friday between 4:00am to 4:00pm PST, and on Saturdays between 6:00am to 10:00pm PST. how to renew or fill a new prescription Members can send prescriptions directly to: NoviXus P.O. Box 8004 Novi, MI 48376-8004 Prescriptions should include: • Member name • Date of birth • Phone number • Mailing address Physicians can prescribe by: • Calling the NoviXus physician’s line at 1.877.269.1159 (toll-free)

pharmacy Information Formulary Review & Updates The Valley Health Plan (VHP) drug formulary is reviewed quarterly and updated by the VHP Pharmacy and Therapeutics (P&T) Committee. The P&T Committee uses information from many sources to determine the status of each drug. The Committee decisions include adding drugs to the formulary, requiring prior authorization for some drugs, requiring quantity limits or step therapy, the process for generic substitution, therapeutic interchange, or not adding the drug to the formulary. These decisions are based on US Food and Drug Administration (FDA) approval, scientific articles, drug safety, and whether there are other like drugs available that accomplish similar results.

For information about VHP P&T Committee, please refer to your Valley Health Plan Benefits and Coverage Handbook – Combined Evidence of Coverage and Disclosure Form (EOC), including additional supplemental pharmaceutical management procedures.

Occasionally, VHP will require your provider to fill out a Prescription Drug Prior Authorization Request Form for drugs that have Prior Authorization criteria or are not on the VHP Formulary. These forms will be reviewed by a pharmacist and/or a physician and approval will be based on established criteria and medical necessity.

VHP posts a drug formulary and a summary of updates to the website quarterly after each VHP P&T meeting.

Visit www.valleyhealthplan.org for additional information or to view the drug Formulary, summary of updates, and the EOC online.

If you do not have access to the Internet and would like a printed copy of any material, please call VHP Member Services at 1.888.421.8444 (toll-free).

Navitus Health Solutions Navitus Health Solutions is Valley Health Plan’s (VHP) Pharmacy Benefit Manager (PBM). Navitus Health Solutions administers the pharmacy benefit on behalf of VHP including customer service, formulary maintenance, Prior Authorizations, Exception to Coverage, and drug recall notifications.

If you have any questions, please call VHP Member Services at 1.888.421.8444 (toll-free) to answer your pharmacy benefit questions.

Drug Recall Navitus receives notification from the US Food and Drug Administration’s (FDA) recall posting. Valley Health Plan members and prescribing practitioners affected by a Class II recall or voluntary drug withdrawals from the market for safety reasons will be identified and notified within 30 calendar days of the posting, and within two (2) business days for a Class I recall.

If you would like additional information on a recent recall, please visit www.navitus.com

• Fax: 1.877.395.4836 • e-Prescription: NCPDP# 2372528

HOW WILL I KNOW WHEN IT IS TIME TO REFILL MY PRESCRIPTION OR WHEN NOVIXUS RECEIVES NEW PRESCRIPTIONS? NoviXus’ interactive automated call system will call members: • Upon receipt of a new prescription; • When a prescription mails; • Within 14 days of an eligible refill of a prescription (members will need to provide identification information for refills); and • Five days after a prescription was due.

Members can go online at www.Novixus.com to view order status and tracking information.

For questions, call NoviXus at 1.888.240.2211 (toll-free), Monday – Friday between 4:00am to 4:00pm PST, and on Saturdays between 6:00am to 10:00am PST. A pharmacist is on-call 24/7/365 days for after-hours emergencies. For questions about your pharmacy benefit, please contact VHP Member Services at 1.888.421.8444 (toll-free).

2 Perspectives | Summer - Fall 2016

www.valleyhealthplan.com 3

timely access

How Much Time Should it Take to Access Health Care Services?

Valley Health Plan (VHP) would like to keep you informed of the important facts regarding the California Timely Access Standards. The California Department of Managed Health Care (DMHC) requires health plan members to be seen in a timely manner. The primary intent of these regulations and the underlying legislation is to ensure that the VHP network of providers have the capacity and availability to provide care to you within certain timeframes for the various levels of care. However, sometimes waiting longer for care is not a problem.

Your Physician may give you a longer wait time if it would not be harmful or your health. It must be noted in your record that a longer wait time will not be harmful to your health.

Please take time to read the following California Timely Access Standards.

Appointment Scheduling

Waiting Time

Emergency services

Immediately

Urgent Care appointments that do not require prior authorization from a Primary Care Practitioner (PCP)

48 hours of request

Urgent Care appointments that require prior authorization

96 hours of request

Non-urgent appointments for PCP Non-urgent appointments with Specialty Care Physicians (SCP) including Obstetrical Care Non-urgent appointments for Ancillary Services (for diagnosis or treatment of injury, illness, or other health condition) Office/Clinic Wait Time (From appointment registration time to when seen by the practitioner/doctor.)

VHP sincerely appreciates you for being our valued Members. Thank you for your continued confidence as we look for ways of providing you with the best available care and services possible.

For more information, please visit VHP website at www.valleyhealthplan.org, review the Combined Evidence of Coverage (EOC) and Disclosure Form, call your health care provider, or contact VHP Member Services at 1.888.421.8444 (toll-free).

15 business days of request 15 business days of request

30 minutes (VHP Standard)

Waiting Time

Life threatening emergency

Immediately

Urgent Care appointments

VHP, along with our Community Health Partners and Network Practitioners, works collaboratively to provide the utmost quality of care to meet or exceed the timely access requirements necessary to meet your health needs.

10 business days of request

Availability of Behavioral Health Care practitioners Non-life threatening emergency

VHP would also like to advise you that it is important for you to receive a call back from your health professionals and practitioners. If you are unable to directly reach your health care provider, the law requires you to be told, by live operator or recorded message, how long it will take to get back to you. For triage and screening services, health plans are required to provide 24/7 triage or screening services for you by telephone. Waiting times for triage or screening services may not exceed 30 minutes. However, the waiting time must be appropriate for the problem and if that problem is urgent, a plan’s screening and triage must respond more quickly. Lastly, VHP continues to provide health care advice through the 24/7 Nurse Advice Line including holidays and weekends. Employer Group Members can call 1.866.682.9492 (toll-free) and Covered California and Individual & Family Plan Members can call 1.855.348.9119 (toll-free).

6 hours 48 hours of request

Non-urgent appointments with Psychiatrists

10 business days

vhc downtown clinic Now Open

Non-urgent appointments with a non-physician Behavioral Health Care Practitioner (Psychologist, MFT, LCSW) and Psychiatrist

10 business days

The June 2016 opening of the Valley Health Center Downtown Clinic marks the return of a wide range of healthcare services to the downtown San Jose community including urgent care and primary care services.

Office/Clinic Wait Time

After-Hours Care 24/7 Nurse Advice Line

4 Perspectives | Summer - Fall 2016

VHP has a standard of 30 minutes maximum (The time from appointment registration until you see the practitioner/doctor) AVAILABILITY Employer Group Members: Call 1.866.682.9492 (toll-free) including holidays and weekends.

Covered California and Individual & Family Plan Members: Call 1.855.348.9119 (toll-free) including holidays and weekends.

The clinic’s excellent medical staff provides primary care services for women, children, and families. Other services such as laboratory, pharmacy, and radiology are also open making it easier for patients to get needed tests and prescriptions.

The Urgent Care clinic is open seven days a week from 8 am to 10 pm for those with an illness or minor injuries that happen outside of regular office hours or they cannot immediately visit their primary care physician.

Valley Health Center Downtown 777 E. Santa Clara Street San Jose, CA 95113 Appointments & Advice 1.888.334.1000 www.vhcdowntown.org www.valleyhealthplan.com 5

attention-deficit / hyperactivity disorder (ADHD) Quality Care That You Deserve

your satisfaction Is

Our #1 Priority

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder in children which can significantly impact school academics, socialization, and over all well-being of the child as noted by the American Academy of Pediatrics1. This disorder affects 5 to 8 percent of school age children2. ADHD is usually diagnosed in early childhood and can last throughout adulthood.

Early diagnosis and appropriate treatment is important because without the identification of the condition and implementation of an appropriate doctor lead treatment plan, this condition can impact an individual’s entire life, which could lead to school failure, school dropout, depression, challenges with relationships including failed relationships, substance abuse, and underachievement in the workplace environment3. Appropriate treatment may help an individual lead a productive and satisfying life.

Visit the Centers for Disease Control and Prevention (CDC) ADHD informational website at www.cdc.gov/ncbddd/adhd/facts.html for information about signs, symptoms, causes, diagnosis, and treatment.

Signs and symptoms: People may daydream a lot, forget or lose things often, squirm or fidget, talk too much, make careless mistakes or take unnecessary risks, have a hard time resisting temptation, have trouble taking turns, and have difficulty getting along with others.

Diagnosis: The diagnosis of ADHD is not done by any single assessment. It is a multi-faceted process which takes into consideration the information from parents, teachers, and at times the child.

Treatment: In some cases, ADHD may be treated with a combination of behavioral therapy and medication. Unfortunately, there is no single treatment that is effective for every person and a good treatment plan will include close monitoring, follow-ups, and adapt to needed changes.

ADHD medications can be an important part of the treatment plan, which can help manage symptoms effectively.

Follow-Up Visit(s): Valley Health Plan’s (VHP) mission is to ensure that you receive quality care and service at the right time, right place, and by the right provider. VHP believes it is important for members who are newly diagnosed and prescribed ADHD medication to have a face-to-face follow-up visit with the prescribing doctor at a minimum of within 30 days of the new prescription, especially those 6 to 12 years of age. The 30 days following the initiation of the ADHD medication is a critical phase as this is the stage where the medication regimen could be fine-tuned.

A person’s response to medications used to treat ADHD can vary, ranging from minor to serious. In addition, some medications work better than others. VHP encourages you to schedule a follow-up appointment with the member’s doctor when prescribed an ADHD medicine to discuss any issues or concerns. Keeping your follow-up appointment is key, so be sure to mark your calendar. Once the doctor determines the person is stable on the medication, visits may be spaced out.

Speak UP: Your doctor is there to help. Don’t be afraid to ask them any questions you may have about any new medications. A follow-up visit provides an opportunity to closely monitor side effects, adverse reactions, or any unusual circumstances. This is also an opportunity for you to discuss how the individualized behavioral treatment plan is working for you and your family.

Remember to ask questions and be an active member of the care team. Know that a positive outcome may depend on a strong partnership between patients, families, and their doctors. Keep your follow-up appointment within 30 days of new prescription!

1.

American Academy of Pediatrics – From the American academy of Pediatrics Guidance for the Clinician in Rendering Pediatric Care. Pediatrics Volume 128, Number 5, November 2011.

2.

National Resource Center on ADHD – A Program of CHADD. Managing Medication for Children and Adolescents with ADHD (What We Know – Sheet 3).

3.

National Resource Center on ADHD – A Program of CHADD. Managing Medication for Children and Adolescents with ADHD (What We Know – Sheet 3).

6 Perspectives | Summer - Fall 2016

VHP’s main goal is to make sure our members are happy with the care they get from us and our providers.

VHP is focusing on a number of different activities this year to improve the quality of service you are getting from us. This includes: • Adding more staff to the Member Services Department so we can answer the phone lines faster so you don’t have to wait long before talking to a live person; • Hiring a number of staff in the Utilization Management Department to approve the services you need quickly so you can get the care you need when you need it; • Adding a number of tools on our website so you can request things like a new ID card, change in your primary care physician, and other services online without having to wait on the phone; • Improving members’ experiences with services and care received by working with the doctors’ offices and their staff; • Hiring additional staff in our Claims Department to make sure payments are made in a timely and correct manner; • Educating provider offices about seeing their patient’s when they need care; • Providing culturally sensitive and linguistically appropriate services our members need by contracting with services that can help interpret in your language of choice; and • Making sure that provider offices follow timely access and availability standards and are able to take care of the needs of all members including those with complex or special needs.

HOW DO WE IMPROVE QUALITY? In 2016, VHP initiated a number of different activities to help promote healthy behaviors among our members.

• We are focusing on preventive health activities by sending newsletters and making automated calls to remind members to get the tests they need.

• We are also educating members on how to better manage chronic conditions through educational materials, patient camps, etc.

• We are also improving patient safety by ensuring that our doctors follow evidence-based clinical practice guidelines.

WE NEED YOUR HELP VHP has started a team-based approach to identify problems and develop a plan to solve those problems.

You can help us in this approach, as you are an important part of our team. We value getting your feedback and would like to remind you to participate in the member satisfaction survey as your voice counts! www.valleyhealthplan.com 7

member Information Is Your Information Up-to-Date?

It is very important that Valley Health Plan (VHP) has your correct address and phone number on file. We want to make sure you receive our important mailings about additions or changes to benefits, providers/networks, or tools to help you maintain your overall health.

If your information has changed, please call the number that applies to your coverage: • Employer Group Plan Members: Human Resources Department • Covered California Plan Members: Covered California Service Center 1.800.300.1506 • Individual & Family Plan Members: VHP Member Services 1.888.421.8444 (toll-free), Option 3

Member Fraud Notice Valley Health Plan (VHP) is committed to providing Members with quality care. Please notify VHP of any suspicious activity you might witness while receiving care from a Plan Provider. All complaints regarding fraud will be investigated and necessary actions will be taken to protect members from unlawful activities.

If you believe you’ve experienced or are aware of any type of fraud (waste or abuse of VHP healthcare resources), please contact VHP Member Services Department at memberservices@vhp.sccgov.org or by calling 1.888.421.8444 (toll-free).

Member Updates Periodically, Valley Health Plan sends Member Updates that include information such as benefit information or changes, network additions, changes in policy, and new state regulations. Please keep these updates with your VHP Evidence of Coverage & Disclosure Form (EOC) booklet. These Member Updates along with articles in the Perspectives Newsletter will be your notification of changes related to your contract with Valley Health Plan.

New Technology Review Valley Health Plan has a rigorous process in place to evaluate new technologies that are being developed such as for drugs, medical and behavioral health procedures, and medical devices. VHP’s Utilization Management Committee and Pharmacy & Therapeutics Committee, under the supervision of the VHP Chief Medical Officer, review many areas to make sure that these are safe and effective prior to covering the new technology as a benefit. VHP uses scientific literature, peer-reviewed journal articles, information from medical societies, and government agencies such as the Food and Drug Administration (FDA) to make decisions. New technology that has not been initially approved because its safety or effectiveness has not been demonstrated can be reviewed in the future when more information becomes available.

Provider Directory Valley Health Plan or a delegated entity (such as a hospital or medical group) credentials all physicians in the network and verifies the background and education of all practitioners. The Provider Directory provides general information on all practitioners. If you would like specific information on a physician such as the medical school attended, residency completed, or board certification status, please contact Member Services at 1.888.421.8444 (toll-free).

CHOOSING & cHANGING YOUR pRIMARY CARE PHYSICIAN (pcp) VHP offers you several ways to choose a PCP. You can make an informed decision and find the right provider for you and your family by: • Visiting www.valleyhealthplan.org to learn about our provider networks using our Provider Search • Talking to our knowledgeable Member Services staff about our providers at 1.888.421.8444 (toll-free).

As a Member, you have the right to change your PCP at any time. The change will take effect on the first day of the next month after your request is received. A new card will be sent to you with the name of your new PCP. It is important that you wait to seek services from your new PCP until the change has become effective or you could be financially responsible.

8 Perspectives | Summer - Fall 2016

speaking the language of health

In Your Preferred Language

English Speaking the Language of Health…in your Preferred Language As a Member, Valley Health Plan can help you in your language at no cost. If you would like to talk to us or ask for information in your language, please call 1.888.421.8444 during business hours.

Spanish Le servimos…En el idioma de su preferencia Como miembro, Valley Health Plan puede ayudarle en su idioma sin costo alguno. Si desea hablar con nosotros o recibir información en su idioma, por favor llame al 1.888.421.8444 durante horas de oficina.

Vietnamese Chúng Tôi Chăm Sóc Sức Khỏe Cho Qúy Vị… Bằng Ngôn Ngữ của Qúy Vị Là hội viên, Valley Health Plan có thể giúp qúy vị bằng ngôn ngữ của qúy vị miễn phí. Nếu qúy vị muốn nói chuyện với chúng tôi hoặc yêu cầu thông tin bằng ngôn ngữ của qúy vị, xin vui lòng gọi 1.888.421.8444 trong giờ làm việc.

avoid the flu And Have a Fun Holiday Season Staying healthy is ONLY a shot away - Get Vaccinated!

One of the best ways you can stay healthy this season is by getting the flu vaccine.

What is the Flu? The flu is a contagious lung disease caused by the influenza virus. It can cause mild to severe illness. In some cases, it can also lead to death.

How does flu shot work?

The flu shot takes about two weeks to work so it is better to get it early in the flu season. The flu season starts around October and lasts as late as May of the following year. The earlier you get the flu shot, the earlier you are protected. The flu vaccine may protect you for the entire flu season.

What are the other things you can do to stay healthy?

You should always cover your nose and mouth when you cough or sneeze. Wash your hands often with soap and warm water. Try to avoid close contact with people who may have the flu. Get plenty of rest, exercise regularly, drink plenty of water, and eat healthy!

What should I do if I have the flu?

If you get the flu, stay home from work, school, and social gatherings. Try not to touch your eyes, nose, or mouth. Germs often spread this way. Eat lots of green vegetables. More than anything, prevention is the best medicine. www.valleyhealthplan.com 9

member Grievance

discrimination is Against the Law

At Valley Health Plan (VHP), we take pride in being a member focused health plan. Our Member Services Department can assist you in resolving your concerns. VHP Member Services Representatives can be reached by calling 1.888.421.8444 (toll-free), Monday through Friday between 9:00am to 5:00pm.

Valley Health Plan (VHP) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, gender expression, or any other classification prohibited by state or federal laws.

VHP provides free aids and services to people with disabilities to communicate effectively with us, such as: • Qualified sign language interpreters • Written information in other formats (large print, audio, accessible electronic formats, other formats) VHP also provides free language services to people whose primary language is not English, such as:

If you have a problem or concern and you would like to file a Grievance, you can contact the Member Services Department by phone, send a letter or complete a Grievance form and submit it to VHP. Grievance forms are available through VHP, at www.valleyhealthplan.org, or at your provider’s office.

Send your Grievance to: Valley Health Plan Attn: Grievance Manager, 2480 N. First Street, Ste. 200 San Jose, CA 95131 Alternatively, you may also submit your Grievance online at

www.valleyhealthplan.org Please include all pertinent information from your VHP ID Card as well as the details and circumstances surrounding your concern or problem. Providing as much information as possible may eliminate the time required to collect such data. Pertinent information should include any medical records or physician opinions in support of your Grievance. If these are not provided, your medical records may need to be obtained from your Plan Physician or you may need to obtain them from a Non-Plan Physician.

VHP will review your Grievance. You will be notified of the outcome within thirty (30) calendar days of receiving your Grievance. If the Grievance involves an imminent and serious threat to your health or the health of your Dependents, including but not limited to, severe pain, psychological well-being, potential loss of life, limb 10 Perspectives | Summer - Fall 2016

• Qualified interpreters • Vital documents written in other languages If you need any of these services, please contact VHP Member Services Department at MemberServices@vhp.sccgov.org or 1.888.421.8444 (toll-free).

If you believe that VHP has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, gender expression, or any other classification prohibited by state or federal laws, you can file a grievance with: VHP Member Services 2480 N. First Street, Ste. 200, San Jose, CA 95131 1.888.421.8444 (toll-free) California Relay Service (CRS) 711 or the 800 CSR number from your modality. www.valleyhealthplan.org

or major bodily function, you will be entitled to an Expedited Review.

The Grievance must initially state that you are requesting an Expedited Review. If your Grievance meets the criteria for an Expedited Review you will be notified of the outcome or status within three (3) working days of receipt of the Expedited Grievance.

You can file a grievance in person, by mail, fax, or online. If you need help filing a grievance, VHP Member Services is available to help you.

If you are not satisfied with the decision of your Grievance, you may contact the California Department of Managed Health Care (DMHC) by following the procedures outlined below.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by contacting:

DMHC Consumer Help-Line “The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at 1.888.421.8444 (toll-free) or visit the Website www.valleyhealthplan. org and use your health plan’s grievance process before contacting the Department. For the hearing and speech impaired, call the California Relay Service (CRS) by simply dialing 711 or the 800 CRS number of your modality. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the Department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The Department also has a toll-free telephone number (1.888HMO.2219) and a TDD line (1.877.688.9891) for the hearing and speech impaired. The Department’s Internet Web site www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.”

U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1.800.368.1019 (toll-free) 1.800.537.7697 (TDD) Complaint forms are available at www.hhs.gov/ocr/office/file/index.html

preventive health Guidelines Valley Health Plan (VHP) encourages you to make an appointment with your Primary Care Physician (PCP) every year. Visit www.valleyhealthplan.org > Member Materials > Forms & Resources to find the recommended preventive health guidelines for screenings and immunizations. These guidelines are updated annually by the VHP Utilization Management Committee that includes practicing physicians. These guidelines are based on those from the Centers for Disease Control (CDC) and the United States Preventive Services Task Force (USPSTF).

If you don’t have access to the internet and would like a copy of the guidelines, please contact Member Services at memberservices@vhp.sccgov.org or 1.888.421.8444 (toll-free). www.valleyhealthplan.com 11

choose health Live Well

VHP Cares About Your Health & Well-Being

Start your New Year right by choosing health and living well. The Valley Health Plan (VHP) Health Education Department supports members by providing education and classes to help get you well and also to keep you well.

It is important to know about common preventive screenings to take care of yourself and family. Visit www.valleyhealthplan.org > Member Materials > Forms & Resources to find the recommended preventive health guidelines for screenings and immunizations.

VHP offers a free online wellness portal. This easy 15-minute Personal Health Assessment (PHA) will help you understand your current health status.

Breast Cancer Screening

Visit vhp.mycernerwellness.com to start earning wellness points for rewards and to: • Get your personalized PHA results and wellness recommendations; • Sync your Fitbit ® and mobile app to conveniently track your exercise and fitness; • Access exercise video clips and online health education workshops; • Track your daily food and water intake; • Chat with certified personal trainers and registered dietitians about your health questions; and • Try healthy recipes and specialized meal plans to keep you motivated.

For more information, contact the Health Education Department at healtheducation@vhp.sccgov.org or by calling 408.885.3490.

staying healthy With Diabetes

Know Your A1C Level High blood sugars can damage your body in many ways. The Hemoglobin A1C test (often referred to as A1C) is a good way to monitor your average blood sugar level over several months. If your A1C level is above 8.0, your doctor can give you advice on how you can get your blood sugars under better control and prevent complications.

Keep Your Blood Pressure in Check When you have diabetes, you have an increased risk of high blood pressure. If your blood pressure is high, you are at risk for kidney damage, stroke, and having a heart attack. It is important to check your blood pressure regularly and take the prescribed medications.

Treat Your Feet with Care Caring for your feet is one of the most important things you can do to stay healthy. Diabetes affects the nerves in your feet making you more prone to injuries, infections, circulation problems, and amputation.

Don’t Forget an Eye Exam Diabetes has a slow impact on vision and problems may go unnoticed. Diabetes can lead to permanent eye damage and sometimes blindness if it is not treated. Make sure to have a dilated retinal eye exam by an eye doctor every year so that you can identify problems early and get vision saving treatment if needed.

New Diabetes Prevention Program Have you been told you have pre-diabetes or borderline diabetes? Do you have high blood sugar? Have you had gestational diabetes? Do you have a family history of diabetes? If so, you may be at high risk for developing type 2 diabetes.

There is good news! VHP is partnering with the YMCA to offer a FREE 16-week Diabetes Prevention Program including YMCA membership.

• Fact: 1 in 8 women will be diagnosed with breast cancer in their lifetime.

• Good News: If breast cancer is detected early, it can be treated.

• Good News: Breast cancer prevention screenings are free! VHP covers the cost of a breast exam and mammogram.

Breast cancer is a serious threat to women of all ages and in particular women that are between the ages of 50 to 74. Your doctor should give you a breast exam during your annual physical. If you have a family history of breast cancer, mammogram screenings should begin at age 40.

Cervical Cancer Screening • Fact: Regular screening decreases cancer of the cervix by at least 80%.

• Good News: Cervical cancer can usually be treated if it is found and treated in the early stages.

• Good News: Cervical cancer screening is free! VHP covers the cost of the cervical screening test.

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The most important thing you can do to prevent cervical cancer is to have regular screenings starting at the age of 21. There are two tests that can help prevent or find cervical cancer early.

• Pap Test or Pap Smear: This test can find certain cells which can be removed before you develop cervical cancer. This test can also find cervical cancer at an early stage, which can be treated successfully.

• HPV Test: If you are 30 years or older, you may choose to get the human papillomavirus (HPV) test along with your Pap Smear. This test looks for a cervical cancer causing virus that can damage your cells.

Chlamydia Testing • Fact: Chlamydia affects nearly 3 million Americans each year of which most are women under the age of 25. Nearly 1 in 10 teenage girls tested for chlamydia tested positive and approximately 75% of women with chlamydia did not realize they were infected.

• Good News: Chlamydia is painless to treat.

• Good News: Chlamydia screening tests are free if you are under 25 years of age. VHP covers the cost of the test under the age of 25, as well as women older than 25 in some cases.

Many people with chlamydia have no symptoms, spreading the infection to others. There is no way to tell except to get tested. Undetected infections can cause problems with pregnancies and may increase the risk of getting or spreading HIV. In some cases, long term pelvic pain can occur if chlamydia is left untreated.

Early Childhood Immunizations Immunizations protect your child, family, and friends from getting preventable diseases.

According to the World Health Organization, in 2014 there were 114,900 deaths from measles globally – about 314 deaths every day or 13 deaths every hour. There were even a number of preventable cases of pertussis (Whooping Cough) and measles recently in California.

The YMCA’s Diabetes Prevention Program can help you make lifestyle changes to improve your overall health & well-being while lowering your disease risk. Enroll today! Change is tough – we can help.

Take your child to see their doctor regularly to make sure all vaccines are up to date for their age. If your child has missed any recommended vaccines, talk to their doctor about a catch-up schedule to prevent the risk of infections. If you have concerns about vaccines, talk to their doctor instead of avoiding vaccinations.

Contact the YMCA Diabetes Prevention Program at ymcadpp@ymcasv.org or 408.351.6440 or visit www.ymca.net/diabetes-prevention to learn more.

Visit www.valleyhealthplan.org > Member Materials > Forms & Resources to find the recommended preventive health guidelines for screenings and immunizations.

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save money By Staying in Network

medication adherence For Members with Depression

What does it mean when we say you can save on health care costs by “staying in network”? Many people find this term confusing. Valley Health Plan (VHP) is here to help you understand.

The Valley Health Plan (VHP) Quality Management Department reviewed Member’s non-adherence with medication pick-up for first prescription with major depressive disorder: single episode for 2013. The data showed 15.3% of Members who were prescribed a medication for major depressive disorder did not pick up their medication. VHP worked with the Behavioral Health Committees and determined this was a quality improvement opportunity.

A network is a group of health care providers. It includes your Primary Care Physician (PCP), specialists, hospitals, surgical centers and other facilities. These health care providers are contracted with VHP. Your doctor has a direct relationship with these network providers and can easily access or exchange information about you with them, this can lead to better coordination of care for you.

As part of the contract, network providers provide services to our members at a pre-determined rate. This contracted rate is usually much lower than with a non-contracted provider. These providers also agree to accept the contract rate as full payment (minus any applicable co-insurance or co-payment along with your deductible).

Why Out-of-Network Care Costs More Out-of-network providers do not have a contract with VHP and thereby do not give our members a discounted rate. If you go to an out-of-network provider, your out-of-pocket costs may be higher.

An out-of-network doctor sets the rate they charge you. It is usually higher than the amount VHP will pay.

An out-of-network doctor can bill you directly for any costs above the amount that VHP recognizes or allows for non-emergency services. This is called “balance billing.” VHP network doctors have agreed not to do that.

You’ll have more work, too VHP will need to approve some medical procedures before they are done. This is called prior authorization.

Some common procedures that require prior authorization include: non-emergency surgery, outpatient physical rehabilitation, inpatient hospice, CT scans, and MRIs. If you visit a network doctor, that doctor will obtain prior authorization for you. If you go out-of-network and do not obtain prior authorization, the services you receive may not be covered.

You are Covered for Emergency Care Emergency care is part of your benefit whether you are near your home, traveling, or are a student away at school.

When you need emergency care, you can go to any doctor, walk-in clinic, urgent care center or emergency room. It is your responsibility to notify VHP if you receive out-of-network care, provide bills and documentation of the services for review. You will be responsible to pay your plan’s co-payment, coinsurance and deductible, if applicable.

When you are unsure of the medical care you need, you should always call the 24/7 Nurse Advice Line phone number located on your VHP ID card. The advice nurse can help guide you toward the appropriate level of care you need.

unbeatable quality at local farmers’ markets Your local farmers’ market is a great place to buy produce and fresh foods for you and your family. Most Santa Clara County farmers’ markets now accept CalFresh/EBT cards. You can swipe your EBT card at the information booth and get CalFresh tokens to spend at the market.

For every CalFresh dollar you spend at participating farmers’ markets, you will get a dollar-for-dollar match FREE up to $10 to spend on fruits and vegetables through the Market Match incentive program. Market Match makes produce more affordable and helps stretch your food budget.

For more information or questions, please contact the Santa Clara County Public Health Department Center for Chronic Disease and Injury Prevention (CDIP) at 408.793.2700.

VHP’s hope is that Providers will: 1. Continue to foster and/or enhance participation in your planned care; 2. Ensure that you have a clear understanding of why picking up and taking the medication you have been prescribed is important;

3. Help you understand how the medication can benefit you and that it may take time to work; and 4. Explain the possible side effects that you may experience and how you can cope with it.

Continuity and Coordination of Care VHP wants you, our Members, to receive the best health care possible. One of the most important steps you can take is to make sure that your doctor knows about all the health care you are receiving from other doctors or health care professionals you are seeing. This includes obstetricians and gynecologists (OB/GYNs), family planning providers, dentists, behavioral health providers such as psychiatrists, psychologists and counselors, chiropractors and eye doctors. Also, ask any specialist you are seeing to let your doctor know about any care or medications prescribed to you. They can share this information if you sign an Authorization for Use and/or Disclosure of Protected Health Information form that permits your doctor or health care professional to share information about your care with each other. You can also talk to your doctor about any information that other health care professionals have given you about your care or any drugs that you have been told to take. It is very important that all of your doctors know about the medications you take, even over-the-counter medications, such as vitamins or herbal supplements. Keep a list (electronic and/or written) of the medications you take and share this information with your doctor. Remember to keep your list updated when changes occur to make sure it includes all current medicines and doses.

Treating Depression Everyone feels sad once in a while. Usually these feelings pass in a few days, but if you feel sad or down for days at time, see your doctor. Seek help immediately if you feel hopeless, are thinking about suicide, or turn to alcohol or drugs for relief. If you are experiencing depression, you can get better with the proper medical care. You may need medical treatment with medication and/or counseling or you may only need treatment to get past the feelings of depression. If you have questions about the treatment plan, talk to your doctor and/or counselor.

Some common thoughts you may have: a. “I do not need or want medication and I do not want to pick up my prescription.”

It is always important to be a part of the decision on what prescription you may need to take, please speak with your doctor about the medication they are prescribing. When you play a part in this important decision, you will better understand the importance of picking up and taking your medication. b. “I am feeling better and do not need any more medication.”

Feeling better is great news, and it may be the right time to stop your treatment, however, it is important to ask your doctor how long to continue taking your medication and be sure that you both agree on the treatment plan. Sudden stopping of your medications could result in a return of your depression or withdrawal symptoms such as dizziness, sleeping problems, and anxiety. It is important for you and your doctor to work together to determine when it is right for you to stop or start reducing your medication.

Visit http://ecologycenter.org/fmfinder/ to find a Farmers’ Market near you.

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Valley Health Plan 2480 N. First Street, Suite 200 San José, CA 95131 1.888.421.8444 (toll-free) www.valleyhealthplan.org

© 2016 Valley Health Plan

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c. “I do not like the side effects of the medication.”

If the side effects are bothering you, let your doctor know. Explain what you are experiencing so your doctor can adjust or change your medication or treatment. You may also find that some side effects of the medications will get better with time, your doctor can tell you about this for the medication prescribed to you. d. “This medication is not working.”

Make sure you give the medication enough time to work. Some medications can take several weeks or longer before you start feeling much better. If a medication does not work for you, let your doctor know. You and your doctor can work together and discuss whether to change the medication. You can also talk to your doctor about counseling, “talk therapy”. Along with taking the medication, adding counseling can be very effective.

Once you and your doctor figure out the right treatment plan for you, you will be well on your way to feeling good again.

Here are some easy tips to help you manage your medicines: 1. Be a participant with your doctor on your treatment plan, which includes your medications.

2. Please pick up your medication.

3. When picking up your medication, if you have questions – ask the pharmacist. You can also talk to your doctor.

4. Read all the information about your medication before you take it.

5. Always keep enough of your medication on hand; get refills before you run out of your medication.

6. Develop a schedule for taking your medication and stick to it.

7. Remind yourself by setting an alert on your cellphone or other electronic device, sending yourself an email or text, writing a note, creating a checklist, or some other type of self-reminder.

8. Develop a supportive network of your family and friends.