Healthline member newsletter

Ask Dr. Nancy

Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) to help physicians and patients engage in conversations about the overuse of tests and procedures. The ABIM physician charter includes commitments to professional competence, honesty with patients, improving quality of care, maintaining trust by managing conflicts of interest and a just distribution of finite resources.

The Choosing Wisely campaign now has 60 physician specialty societies as collaborators who have each developed lists entitled "Five Things Physicians & Patients Should Question". Each society was free to determine how to create the lists and each item was within the specialty’s purview and control.

Consumer Reports Health has developed consumer friendly explanations of many of these items which can be accessed free of charge at choosingwisely.org.

One particular report to pay attention to is entitled "5 Questions to Ask Your Doctor" before you get any test, treatment or procedure:

 

  1. Do I really need this?
  2. What are the downsides?
  3. Are there simpler, safer options?
  4. What happens if I do nothing?
  5. How much does it cost?

In a recent survey of over 13,000 physicians, "defensive medicine" was felt to be the top major driver of healthcare costs+. Defensive medicine leads to tests and procedures due to a fear of malpractice risk rather than from a conviction that the
patient actually needs these tests.

In some situations, what was customary to do at one time and is no longer is a simple matter of research leading to changes in recommendations. The Mayo Clinic Proceedings published a paper in August, 2013 entitled "A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices". The conclusion was "The reversal of established medical practice is common and occurs across all classes of medical practice".

Don’t be surprised when recommendations change. We are all learning more about high value healthcare practices. Choosing Wisely is just the beginning, led by physicians and patients, of the culture change taking place to reduce waste in healthcare while improving quality and the individual patient experience.

You can read all of the recommendations at choosingwisely.org. If you have any questions please call the Health Information Line at 850-383-3400. The nurses answering the Health Information line are available to assist you in planning for your physician’s office visit by answering your questions and providing health information on a wide variety of topics.

+A Survey of America’s Physicians: Practice Patterns and Perspectives

Dr. Nancy Van Vessem is board certified in internal medicine. She has developed innovative disease management and quality improvement programs promoting the use of best evidence medicine, propelling Capital Health Plan to national recognition for quality of care.

CAHPS Survey

We want to hear from you!

Annually, Capital Health Plan surveys our members to learn how we are doing and if you are receiving the medical care that you need. This year the surveys will be mailed to a random sample of members beginning in early April.

Capital Health Plan works with a vendor who mails out the surveys, receives the responses, and analyzes the data. Your responses are completely anonymous. If you receive a survey, please help by completing the survey. It takes about 15 minutes to complete. A return postage paid envelope will be included for your convenience.

If you have questions regarding the survey, please contact Member Services at 850-383-3311.

Workplace Eye Wellness

As computers have become more popular in the workplace, complaints of eye strain, headaches, blurred vision and dry eyes have become more prevalent. These symptoms may be due to a condition known as Computer Vision Syndrome (CVS). CVS is caused by prolonged computer use and can cause mild to severe visual discomfort.

Causes of Computer Vision Syndrome:

  • Glare
  • Poor lighting conditions
  • mproper viewing distance
  • Uncorrected vision (glasses needed)

Preventing Computer Vision Syndrome:

  • Monitor placement
    • Place monitor 20-28 inches from the eyes and angle monitor to prevent glare
  • Consider a screen glare filter
  • Remember 20/20
    • For every 20 minutes of computer use take 20 seconds to look in the distance. It is also a good idea to take a break and walk away from your computer every so often if using it for a prolonged amount of time. If possible during this break, focus out a window at a distant object in order to re-focus your eyes.
  • Think to blink
    • Blink rate is reduced while focusing on a computer screen for long periods of time, which can lead to dry eye symptoms. Remember to blink often and/or use preservative free artificial tears as directed by your eye care professional.
  • Update your eyeglasses prescription
    • Out of date eyeglasses or uncorrected visual acuity can possibly lead to headaches and/or blurred vision after prolonged computer use. Your eye care professional may have you measure the distance from your eyes to your computer monitor in order to ensure an accurate computer eyeglasses prescription. In addition, an anti-reflective or anti-glare coating can be added to eyeglasses in order to reduce glare from your computer screen and overhead lighting.

Eye Protection in the Workplace:

  • Wear eye protection
    • For those that work with haardous materials, eye protection such as goggles, face shields, or safety glasses must be used when working near or around hazardous materials. Welders, mechanics, wood workers, etc. will benefit from wearing goggles in order to prevent objects from entering and injuring the eye.
  • Chemical splashes to the eyes
    • If your eyes come into contact with any hazardous material, copiously irrigate the eyes immediately using saline or Ringer lactate solution for at least 30 minutes and follow up with your eye care professional.

Make sure to see your eye care professional regularly for routine eye exams. Certain eye conditions can affect your vision such as dry eyes, cataracts, and age-related macular degeneration which can only be diagnosed through routine eye exams. Certain eye conditions can affect your vision such as dry eyes, cataracts, and age-related macular degeneration which can only be diagnosed through routine eye exams.

Article written by Marissa Adamson, O.D., Capital Health Plan’s Associate Chief of Eye Care and Daniel Lazar, O.D., Capital Health Plan’s Chief of Eye Care.

Nominate a Senior in Our Community

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

The Silver Stars Celebration is one of Tallahassee’s premier senior recognition events, honoring a select group of people for their special contributions. The Tallahassee Senior Center, which spearheads the event, invites the community to nominate a senior for a Silver Star. Capital Health Plan is proud to be a major sponsor for the 2014 celebration which culminates in a festive awards dinner at the FSU University Center on May 22, 2014.

We bet you know some shining women and men who reach age 60 and just keep bringing more brightness into the world. Who can be a star? Your friends, neighbors, relatives who…

  • Since age 60 have accomplished outstanding achievements
  • Demonstrated exemplary service to others and our community
  • Are inspiring models of active aging

From athletes to caregivers, Silver Stars illuminate many paths in life. Past honorees include athletes, executive directors, community advocates, caregivers, volunteers, and entrepreneurs. If you know someone 60 or older whose life of service you admire, whatever the arena, share your appreciation! Nominate a senior star and let the whole community know.

Nominations are sought from the community and must be received by February 14. Send a nomination form or a letter of nomination - not to exceed 100 words - to: Silver Stars Nomination, Tallahassee Senior Center, 1400 N. Monroe St., Tallahassee, Florida, 32303. Be sure to describe the individual's outstanding achievements or contributions since reaching age 60. Include the nominee's and nominator's contact names and information, and be sure to get permission from the nominee. Nomination forms can be downloaded here.

For more information on the Silver Stars Celebration, click here.

Ask Dr. Nancy

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Quantity limits on narcotics go into effect on January 1, 2014.

Prescriptions narcotics, the "opioid" pain killers, like Vicoden, Percocet, and Oxycontin account for the fastest growing drug overuse problem in the U.S. Since 2003, more people died from prescription opioid overdose every year than from heroin and
cocaine overdoses combined.

In 2007, there were 27,000 unintentional drug overdose deaths. For every overdose from prescription painkillers, there are nine treatment admissions for substance abuse, 35 emergency department visits for misuse or abuse, 161 report drug abuse or dependence and 461 report non-medical use of prescription opioids. 76% of nonmedical users reported getting drugs that had been prescribed to someone else. +

Overall, the highest rates of prescription opioid misuse and overdose deaths are in men, persons aged 20-64 years old, non-Hispanic whites and poor or rural populations. ++

Opioids have significant risks besides addiction and misuse. These risks include respiratory depression, serious fractures from falls, low sex hormone levels such as testosterone, other endocrine effects that can cause a spectrum of adverse effects,
sleep-disordered breathing, chronic constipation, serious fecal impaction, and chronic dry mouth which can lead to tooth decay. +++

The Centers for Disease Control and Prevention notes that the benefits of chronic (greater than 3 months) opioid therapy should be questioned. 100% of patients on chronic opioids develop dependence. Because we develop a tolerance for opioids the scientific evidence is weak for its effective use as a chronic therapy, especially in light of the unproven premise that tolerance can be overcome by increasing the dose.

In 2011, Florida Statute 456.44 Controlled Substance Prescribing, required physicians who voluntarily prescribe opioids for chronic pain, not related to cancer, follow certain guidelines which include a written agreement with the patient. The written agreement should consist of who the single treating and prescribing physician is and their authority to conduct random drug testing. Florida’s Prescription Drug Diversion and Abuse Roadmap 2012 – 2015 spells out the multiple steps which are being taken to "end Florida’s reign as the epicenter of the national prescription drug epidemic."

Medicare has implemented oversight as well, which requires at a minimum, that there are maximum dose restrictions, monitoring of cumulative dosing for individual patients, monitoring of prescribing patterns and case management referrals for patients who hit certain limits on overall opioid prescriptions. This kind of oversight will also be in place for non-Medicare members.

If you are currently filling prescriptions in quantities that exceed the new limits in effect January 1, 2014, please be advised that you will no longer be able to obtain such quantities without first undergoing a medical review. The overall dose of narcotics prescribed will be calculated at the pharmacy. If it exceeds the limit of 120 mg morphine equivalents daily (MED), then the pharmacist will not be allowed to fill the prescription. (The dose is calculated over multiple prescriptions.) This will happen for the Employer Group or Commercial members who have their pharmacy benefit through Capital Health Plan and all Medicare members.

How much is 120mg MED?

  • Oxycontin® 40mg twice a day, quantity of 60 tabs per month is equivalent to 120mg MED
  • Morphine sulfate extended release 60mg twice a day, quantity of 60 tabs per month is equivalent to 120mg MED
  • Percocet® 5/325mg, 2 tabs four times daily, quantity of 240 tabs per month is equivalent to 60mg MED OR Vicodin® 10/325mg, 2 tabs three times daily, quantity of 180 per month is equivalent to 60mg MED. Either drug combined with Morphine sulfate extended release 30mg twice a day, quantity of 60 tabs per month (60mg MED) is equivalent to 120mg MED.

The clinical reasoning behind the level of 120mg MED is that ongoing opioid therapy requires ongoing assessment to optimize therapy. This is important in light of the evidence that not all patients receive pain relief from opioids. Some develop increased pain which only goes away after titrating down the medication. This is particularly true for patients with headaches. The term for this is "rebound headache" and can occur with any pain medication. Others develop abnormal pain sensitivity with chronic high dose opioid therapy. If the physician feels that current treatment is not benefiting the patient, a dose reduction or discontinuation is warranted. However, if current treatment is benefiting the patient as
demonstrated by objective measures of function and pain, it may be appropriate to continue, while monitoring therapy as the patient’s condition changes over time.

Capital Health Plan’s Pharmacy Committee will notify physicians of the limits. Commercial members who have filled high quantities of opioids in the last ninety days will have already received a letter in November. The letter contains the
information needed to proceed with the medical review which will involve the prescribing physician.

Opioids are useful medications when used in an appropriate manner. These changes will help to improve the safety of their use for Capital Health Plan members.

+Center for Disease Control Prevention, MMWR 2012

++CDC, 2012
+++ www.responsibleopioidprescribing.org

Medicare Advantage and Healthcare Reform

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

How will Healthcare Reform, the Affordable Care Act, affect my Medicare Advantage coverage with Capital Health Plan?

These are questions we are asked every day. To clarify, Healthcare Reform, the Affordable Care Act and Obamacare are all the same. This is the Federal law authorizing change to health plan coverage. The good news is there are minimal changes to Medicare Advantage plans. Medicare coverage is not a part of the Health Insurance Marketplace or Exchanges. You do not have to replace your Medicare coverage nor will you purchase Medicare plans through the Exchanges.

So how does the Affordable Care Act affect Medicare Advantage plans?

Changes that have been made or are being made to Medicare Advantage plans include:

  • Expanded coverage of certain preventive services without charging a copayment, coinsurance or deductible. Capital Health Plan Medicare Advantage plans do not have deductibles and most preventive services were already covered at a $0 copayment. A new preventative service for 2014 is a yearly "Wellness" visit with your Primary Care Physician.
  • The gap in prescription drug coverage (donut hole) is slowly closing. If you are in a plan that has coverage gap cost shares the cost is decreasing for generic drugs from 79% to 72% in 2014. You can expect additional savings on your brand name and generic drugs during the coverage gap over the next several years until it closes in 2020.
  • The drug manufacturers’ 50% discount on brand-name drugs in the coverage gap will continue in 2014.
  • It is estimated the life of the Medicare Trust Fund will be extended to at least 2029 – a 12 year extension due to reductions in waste, fraud and abuse.

Please refer to your Annual Notice of Changes (ANOC) for specific changes to our Medicare Advantage Plans.

If you have other questions, please call Member Services at 850-523-7441 or 1-877-247-6512 (TTY 850-383-3534 or 1-877-870-8943) 8:00 a.m. – 8:00 p.m., seven days a week, October 1 – February 14; 8:00 a.m. – 8:00 p.m., Monday – Friday, February 15 – September 30. State of Florida members call 1-877-392-1532, 7:00 a.m. – 8:00 p.m.

H5938_DP 540 CMS Accepted 11122013

Congratulations, You're Having a Baby!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Breastfeeding provides your baby with the best possible infant food. Human milk contains all the nutrients newborns need and is easily digested. A diet of mother’s milk for the first six months readies your baby’s body for other foods.

As you make plans for the arrival of your baby, parents find themselves facing many decisions. One of those decisions often is deciding to breast or bottle feed. Knowing the facts enhances your decision making abilities.

Advantages for Mom

  • The hormone oxytocin, release during breastfeeding acts to return the uterus to regular size more quickly and can reduce postpartum bleeding
  • Women who have breast fed experience reduced rates of breast and ovarian cancer later in life
  • Breastfeeding may also reduce the risk of developing type II diabetes, rheumatoid arthritis and cardiovascular disease including high blood pressure and high cholesterol
  • Many women report additional person benefits such as increased confidence and stronger snese of connection with their babies

Advantages for Baby

  • Human milk provides all the protein, sugar and fat baby needs to stay healthy and contains substabces that benefit the baby's immune system protecting him/her from a wide variety of infections
  • Mother's milk changes to meet the physical demands of a growing baby so that a perfect balance of nutrients are consistently provided
  • Breast fed babies have a lower risk of developing:
    • asthma
    • obesity
    • type II diabetes

Still not sure if breastfeeding is right for you? Both local hospitals provide breastfeeding support during the mother’s inpatient stay as well as outpatient support groups. A prenatal breastfeeding class is provided by Tallahassee Memorial Health Care (TMH). Capital Health Plan covers a personal dual electric pump at no additional cost to our members for every birth through TMH. Regardless of the location of your delivery, you may obtain your pump from TMH.

Additional information on breastfeeding and benefit coverage can be found by clicking here or by contacting Capital Health Plan Member Services.

Ask Your Local Member Services Department

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Q: How do I refill my 90-day prescription in December when Capital Health Plan is changing their Pharmacy Benefit Manager?

Capital Health Plan will be changing their Pharmacy Benefit Manager (PBM) to Prime Therapeutics (Prime) effective January 1, 2014. Our current PBM is CVS/Caremark and they will continue to process all prescription refills for Capital Health Plan through December 31, 2013.

Effective January 1, 2014, all prescriptions that are on file at CVS/Caremark will be transferred to Prime unless the medication is a controlled substance, compound or there are no refills. These types of prescriptions will require a new written prescription from your prescribing physician.

Please note that credit card information will not be transferred. Prime Mail and Prime Specialty will be mailing out information to members that have a history of claims with Caremark Mail/Specialty. Members will have to complete enrollment forms and return to Prime for set up before prescriptions are filled. Capital Health Plan members can also call Prime to enroll or enroll online.

For any additional information please contact your Capital Health Plan Member Services Department.

Flu Vaccine: Get Your Flu Shot Today!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

The flu season has started early this year. Make sure you receive your flu vaccine!

Capital Health Plan Members can receive their flu vaccine thru the following methods:

1. The flu vaccine is a covered benefit through your primary care physician's (PCP) office. Call your PCP to verify if an appointment is needed. There is a $0 copay for flu vaccines and/or pneumococcal vaccine if the office visit is only for the vaccine. Other services may require a copayment.

2. Flu vaccines can be obtained from the local health departments listed below. You should contact the facility directly for scheduling.

3. Additionally, for members who have a prescription drug benefit with Capital Health Plan, retail pharmacies in Capital Health Plan's network can administer the flu vaccine. You will need to work with your pharmacy regarding their specific appointment processes and you should have your Capital Health Plan ID card available when receiving the vaccine. The Retail Pharmacy vaccination program applies only to adults 18 and over. Pediatric patients should see their PCP.

If you have questions, please contact Capital Health Plan Member Services.

Change Is In The Air: See What May Affect You In 2014

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

The federal law known as the Affordable Care Act (ACA) is bringing change to the health care market. The changes and timelines are different depending on the size of the employer that you work for. Additionally, Capital Health Plan is making changes too. During your next open enrollment, please note the changes that will be taking place.

Small Employer Plans (2-50 full-time equivalent employees) – effective on Small Employer Group renewal dates in 2014:

All small group plans will be Essential Health Benefit (EHB) compliant. You will be receiving new plan documents prior to your employer’s renewal date – watch your US Postal mail for the Capital Health Plan CD.

Essential health benefits (EHBs) include:

• Ambulatory patient services

• Emergency services

• Hospitalization

• Maternity and newborn care

• Mental health and substance abuse disorder services and devices

• Prescription drugs

• Rehabilitative, habilitative services, devices

• Laboratory services

• Preventive, wellness and chronic disease management

• Pediatric services including oral and vision care

• Plans will be modified to remove all pre-existing limitations.

Large Employer Plans (> 50 total full-time equivalent employees) - effective on Large Employer Group renewal dates in 2015 (due to delay in Employer mandate):

• The Affordable Care Act requires most people to have health care coverage that qualifies as "minimum essential coverage." Your Capital Health Plan employer health coverage does provide minimum essential coverage.

• The Affordable Care Act establishes a minimum value standard for benefits of a health plan. Your Capital Health Plan employer health coverage exceeds the minimum value standard for the benefits it provides.

All Plans that provide a Pharmacy benefit:

• Capital Health Plan is changing our Pharmacy Benefit Manager (PBM). Prime Therapeutics (Prime) will replace CVS/Caremark as the new PBM. This change will generally not affect the local pharmacy network, so the pharmacies that you are currently using will not change. Prime has a nationwide pharmacy network with over 50,000 pharmacies. Please review the new formularies (drug lists) carefully and note any changes to your current prescription drug requirements and tier levels. The formulary is located on our website at capitalhealth.com.

• Due to these changes you will receive a new ID card for 1/1/2014 and may receive an updated card upon your employer group’s renewal date. Please watch your mail for your new ID cards.

It is our goal to be compliant with the ACA while causing the least amount of disruption to our members. Capital Health Plan is the only non-profit local health plan in the Big Bend area. Our offices are local, our Member Services department is local, and we live where you live. For more than 30 years, we have been providing members with comprehensive and affordable health care. We look forward to providing you and our community a health partnership that has continuing value.