Healthline member newsletter

Flu Vaccine: Get Your Flu Shot Today!

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.

Ask Dr. Nancy: What is your risk of a heart attack in the next 10 years?

Through technology, new tools have been made available to help us understand our personal health risks.

Heart attack risk assessment tools have gained momentum recently due to recommendations by the American Heart Association (AHA) and the American College of Cardiology (ACC). They recommend the use of a risk calculator to help physicians and patients create individualized treatment plans to reduce cardiovascular risk. Cardiovascular disease is the primary cause of death in the United States;therefore, we can expect that someone we know, or even ourself, will be part of those statistics.

Some of us are at higher risk than others. Our risk depends on numerous factors such as age, lifestyle habits, race, smoking, blood pressure, weight, cholesterol levels and family history. The risk calculators, generally, are programmed for people without known heart disease or diabetes and are 20 years of age or older.

The risk calculator allows users to input of a variety of information and returns an approximate risk number, for example, "20% risk of a heart attack in the next 10 years". You can modify the information to see what will happen if you take action to reduce your risk. For example, if you decide to exercise or keep your blood pressure down, then your overall risk will decrease.

AHA and ACC recommend if you are at high risk already, meaning you have heart disease, are a diabetic between the ages of 40-75 or have an LDL-C level of >190 mg/dL, then use a high dose statin medication (no matter what your cholesterol is on blood testing). If you don’t fall into one of the known high risk categories, use the risk calculator to determine if medications are recommended. If your risk is 7.5% or greater, then it is worth a discussion with your primary care physician (PCP).

If you are already on a statin medication, the guidelines no longer recommend getting cholesterol levels down to a certain number. High dose statins are recommended for people at high risk; lower dose statins are recommended for people at lower risk.

A welcomed trend we are seeing is that there is more emphasis on "outcomes" or what happens to the patients. This means there is a greater emphasis on trying to reduce heart attacks rather than reduce a lab values. As more research is done, we can expect these guidelines to be refined over time. One thing that will not change is the recommendation for a healthy lifestyle. The recommendations are simple. Moderate exercise; 150 minutes a week, and a healthy diet with smaller portions of fresh foods, will go a long way to reduce your risk for many diseases.

For more information regarding the risk calculator for heart attacks from the American Heart Association and the American College of Cardiology please click here.

Ask Your Member Services Department

When should I go to Urgent Care?

Understanding your options now will give you peace of mind later when you have to make quick decisions about urgent health care needs.

Many sicknesses and injuries may cause you to seek immediate help; however, only severe and life threatening conditions require a trip to the Emergency Room (ER). You will find that you save time and money by going to an Urgent Care Center instead of an ER. When an ER is inappropriately utilized it typically will cost you, in premiums and increased cost shares, twenty times more than an Urgent Care Center. If you have an illness or injury that requires immediate attention that you would normally see your primary care physician (PCP) for and cannot get an appointment that same day, Urgent Care is the right choice.

Your PCP is your health care partner and central coordinator for everything pertaining to your good health. S/he knows you well and provides health care advice tailored to your needs. We therefore encourage you to see your PCP, if possible.

Go Paperless! Benefit Materials on CHPConnect

Capital Health Plan is pleased to announce that your benefit documents are now accessible through CHPConnect, your secure online personal health record. All Capital Health Plan Members have access to this online system at no additional cost. This allows you, our member, to view important information related to your health care 24 hours per day, 7 days a week.

Within CHPConnect, you will have access to the following:

Benefit Documents: Have questions about your benefits? You can view your benefits documents from the Benefits and Eligibility tab in the left-hand navigation menu. You can access documents such as the Member Handbook, Summary of Benefits & Coverage (SBCs), and more.

Now that all of your benefit documentation is securely posted online, Capital Health Plan is discontinuing the process of sending benefit documents on CDs through the mail. If you still prefer a paper copy of your benefit documents, you may contact Member Services.

2015 Plan Changes

Our Formulary (list of covered prescription drugs) is changing January 1, 2015.

Capital Health Plan has a nationwide pharmacy network available to our members (who receive their pharmacy benefits through Capital Health Plan) with over 50,000 pharmacies.

The 2015 Commercial and Medicare Formulary is available online beginning on October 1, 2014. Visit our website to see if the 2015 changes affect your prescription drugs. In addition, mail order prescription services will be available through PrimeMail® for all Capital Health Plan members!

New health care regulations and decisions of your employer may have affected your group plan. When it’s time for your 2015 open enrollment, be sure to read your policy information thoroughly and work with your group administrator to understand all the changes.

Notice: Capital Health Plan Recorded Phone Calls

Call monitoring is an effective method for improving the level of service provided to our customers, our patients and our members.

Part of Capital Health Plan’s overall strategy is to provide top-level customer service throughout the organization, including telephone etiquette and accurate information. Incoming and outgoing calls are recorded in departments in which our staff routinely communicates with you. When our staff places an outbound call to you, they will indicate that the call is recorded, when applicable. You may also hear beeping during your call, letting you know your conversation is being recorded.

Capital Health Plan Again Honored as NCQA’s Highest-Ranked Health Plan in Florida

TALLAHASSEE, Fla.– Continuing its long-standing tradition of excellence, Capital Health Plan has once again been recognized as the best health plan in Florida and among the very best in the nation. For the 10th consecutive year, Capital Health Plan earned the exceptional distinction from the National Committee for Quality Assurance (NCQA). In its annual ranking of health plans across theUnited States, NCQA also gave Capital Health Plan’s Medicare Advantage Plan the highest ranking in Florida and one of the top rankings in the nation.

“We are deeply honored to once again be ranked as the top health plan in Florida,” said Dr. Nancy Van Vessem, Capital Health Plan’s Chief Medical Officer. “We are continually pursuing new and innovative ways to serve our members’ health care needs, and we are grateful to be recognized for a full decade of outstanding member-focused approach by experts in our industry.”

Since NCQA began releasing national rankings in 2005, Capital Health Plan has consistently been recognized among the highest ranked plans in the nation. According to the report “NCQA’s Private Health Insurance Plan Rankings 2014-2015,”Capital Health Plan’s commercial plan is the top private plan in Florida and the 16th best in the country, out of 617 plans. Similarly, Capital Health Plan’s Medicare Advantage HMO plans were also deemed the best in Florida, while earning the fourth highest spot in America in NCQA’s national assessment.

“We are deeply committed to this community and take great pride in being recognized for the 10th year in a row,” said John Hogan,CEO of Capital Health Plan. “This distinction reflects the hard work and dedication of our staff and medical team, and the positive response of the members we serve every day.”

The National Committee for Quality Assurance is based on several of the most widely used measurement tools in health care, including scores from HEDIS®, CAHPS® and NCQA Accreditation standards to calculate plan rankings. Scores reflect the results of consumer surveys and the plan’s success, compared to other plans, in preventing and treating medical conditions.

Since 2001, Capital Health Plan has also maintained an “Excellent” accreditation rating from NCQA. Capital Health Plan currently holds an “Excellent” status for both its Commercial HMO and Medicare HMO plans, meaning Capital Health Plan met or exceeded NCQA's rigorous requirements for consumer protection and quality improvement.

Capital Health Plan’s commitment to member satisfaction shows in the outstanding results of member surveys. Those surveys show high satisfaction with members rating of health plan and members rating of health care.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. For more information on NCQA rankings, visit www.ncqa.org.

For more information about the rankings, please 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.

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

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

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

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

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.