Healthline member newsletter

Capital Health Plan #1 Medicare Plan in the Nation!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Capital Health Plan’s Medicare Advantage Plan is ranked number one in the nation according to “NCQA’s Health Insurance Plan Rankings 2010-2011 – Medicare” published by the National Committee for Quality Assurance (NCQA). The Medicare Advantage Plan has ranked in the top tier in past years, but is now the first ever Florida health care plan to be ranked number one.

“We are honored to receive the number one ranking from NCQA. It is a reflection of the commitment of our local physicians and clinical staff to consistently deliver quality medical care,” said Dr. Nancy Van Vessem, Capital Health Plan chief medical officer. “Collaboration between Capital Health Plan, physicians and members has led to continued success measured by consistently excellent results on quality and member satisfaction scores.”

Capital Health Plan is your local health plan serving Leon and the surrounding counties, but the plan brings the entire state of Florida national attention with its achievements. “As the only health care plan in Florida to receive such a commendable rating, we are committed to being a leader and continually improving Medicare services and patient care,” said John Hogan, CEO of Capital Health Plan.

To calculate plan rankings, NCQA uses HEDIS®, CAHPS® and NCQA Accreditation standards scores. These scores reflect the results of consumer surveys and the plan’s success in prevention and treatment compared to other plans.

The Healthcare Effectiveness Data and Information Set (HEDIS) measures performance on important dimensions of care and service. Capital Health Plan received the following important 2010 HEDIS results:

  • CHP scored the very highest in the nation for Colorectal cancer screenings.
  • CHP scored the very highest in the nation for Overall Effectiveness of Care.
  • CHP scored the very highest in the nation for Overall Preventive Screening Rate

What’s so important about Capital Health Plan’s #1 ranking?

You. Thank you, members, for once again letting us – and the nation – know that Capital Health Plan works for you. Our goal is protecting and supporting your health. Your continuing satisfaction is the real measure of our success.

That’s why for 28 years, CHP has maintained our high standards in medical care and a strong physician network. That’s why we strive to meet your evolving needs with innovative services like CHPConnect and CHP Health Coaching. And that’s why our local member services department strives to deliver efficient, expert service.

The source for data contained in this publication is Quality Compass® 2010 and is used with the permission of the National Committee for Quality Assurance (NCQA).Quality Compass 2010 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CHP is Your 5 Star Medicare Plan, Again.

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

Capital Health Plan is the only Medicare Advantage plan in the nation to receive five out of five stars in both 2010 and 2011 from the Centers for Medicare and Medicaid Services. Once again, CHP is uniquely honored with this five star distinction along with only two other plans in the nation.

“It is an honor to be recognized nationally as a leading provider for Medicare Advantage,” said John Hogan, CEO of Capital Health Plan. “Thanks to our team of physicians, nurses and staff, our members continue to receive nationally-recognized service through our health plans.”

According to the Centers for Medicare and Medicaid Services, the five star rating system is used to monitor plans to ensure they meet Medicare’s quality standards. The system uses 53 quality measures including preventive care, chronic illness management, and customer satisfaction.

The release of the ratings comes just in time for the November 15th open enrollment for Medicare beneficiaries. Using the ratings system, prospective members can compare the quality of care and customer service among Medicare health and drug plans. All ratings are posted publicly in Medicare’s Plan Finder at www.medicare.gov.

“In addition to recognizing our outstanding commitment to our members, these ratings offer Medicare beneficiaries more transparency and the opportunity to learn about the quality and value of health plan options to ensure they find the one that best meets their needs,” said Dr. Nancy Van Vessem, Capital Health Plan chief medical officer. “We will continue to strive to provide our members with excellence in service.”

Ask Dr. Nancy: Urinary Incontinence, More than Just Embarrassing.

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

Urinary incontinence in adults is a common, often undisclosed problem. This unwanted leakage of urine occurs in both men and women but is more common in women. It can range from mild leaking of urine to uncontrollable wetting. Unfortunately it worsens with age. What starts out as an annoyance can become a significant social and economic problem.

About 50% of nursing home admissions are related to some extent to urinary incontinence. It’s expensive for individuals and families. The direct cost of treating urinary incontinence in men and women of all ages was estimated at $26.3 billion in 1995 for bladder control products, healthcare costs and nursing home costs.

Most urinary incontinence is treatable. The first thing to do is to tell your primary care physician. Keep a diary of urination and bring it with you to your visit. Here is some information so you are organized for your visit.

The underlying mechanism: Keeping urine in the bladder is a balance between the pressure in the bladder and the pressure in the urethra, the tube that drains urine from the bladder to the outside of the body. If the pressure in the bladder is greater than the pressure in the urethra, urine exits. See if you recognize some of these symptoms.

Stress incontinence is the involuntary loss of urine during activities such as coughing, laughing or exercising. The underlying abnormality is typically poor support from the pelvic floor muscles which support the “bladder neck,” the junction between the bladder and the urethra. This decreases the pressure in the urethra, so activities like coughing, which increase pressure on the bladder from above, force urine out below. Lack of normal usual pressure within the urethra is another factor. Tissue thinning associated with age in women, previous vaginal surgery and certain neurologic lesions are associated with poor urethral sphincter function.

An overactive bladder causing the involuntary loss of urine preceded by a strong urge to void, whether or not the bladder is full, is a symptom of the condition commonly referred to as "urge incontinence." Some cases of overactive bladder can be attributed to specific conditions, such as urinary tract infection, bladder cancer and bladder stones, but most cases result from an inability to suppress bladder muscle contractions.

Overflow incontinence is urine loss associated with over stretching of the bladder. Frequent or constant dribbling can be present, sometimes in association with overactive bladder or stress incontinence. Over distension is typically caused by an underactive bladder muscle and/or obstruction of the urethra. The bladder muscle may be underactive secondary to drug therapy or conditions such as diabetic neuropathy. Outlet obstruction in women is almost always a result of urethral occlusion from pelvic organs sagging downward or previous anti-incontinence surgery. Outlet obstruction in men is commonly related to enlargement of the prostate gland.

Treatment

The treatment is determined by the type of incontinence. If the type isn’t obvious from the patient’s history, tests can be done to measure bladder dynamics. As with every medical problem, the appropriate treatment has to be matched up with the right diagnosis. Here are some simple suggestions to get started.

First possible reversible causes should be addressed such as infection and certain drugs.

For stress incontinence, conservative treatment works. Overweight women need to lose only 5% - 10% of their weight to achieve a 50% decrease in urinary leakage according to a recent New England Journal of Medicine article. Tampons can be effective, especially for exercise-induced incontinence. Exercises that strengthen the pelvic floor to provide support to the bladder neck are recommended based on good and consistent scientific evidence. See article Consider Physical Therapy.

Overactive bladder treatment involves bladder retraining. Some medications have been shown to have a small beneficial effect on improving symptoms.

Overflow incontinence requires a medication review to see if this is a side effect of medication. Evaluation for obstruction to urine flow is essential and oftentimes can be successfully treated by surgery.

The American College of Physicians, American College of Obstetricians and Gynecologists, and the American Urological Association offer great resources for more information.

The key to success is to start early on urinary incontinence treatment.

Consider Physical Therapy

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

Do you experience symptoms of stress incontinence?

Many women believe the leakage of urine is a normal result of pregnancy, childbirth and aging; but this is not true. Exercises to strengthen the pelvic floor muscles may greatly reduce or even cure the problem.

Capital Health Plan has partnered with Tallahassee Memorial Outpatient Rehabilitation Services to provide a therapy program for urinary incontinence. Treatment includes strengthening exercises as well as education about posture, body mechanics and bladder fitness. Physical therapy can be an effective, non-invasive treatment option for those experiencing urinary leakage.

If you think you may benefit from physical therapy to treat your problem, consult your primary-care physician. When you are ready to schedule an appointment please call 431-6220.

Advantage Primetime - Understanding Your Prescription Drug Coverage

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

Here are some important prescription drug changes to Capital Health Plan Medicare Advantage plans for 2011.

Capital Health Plan Advantage Plus (HMO)

Capital Health Plan Preferred Advantage (HMO)

There is a new Formulary (list of covered drugs which can change each year). Check your Annual Notices of Changes and Evidence of Coverage for changes in coverage, Tiers, and/or restrictions.

Copayments for Tier 1 generic drugs have been lowered. Check your Annual Notice of Changes and Evidence of Coverage for other changes to copayments/coinsurance.

The initial coverage limit has been raised from $2830 in 2010 to $2840 in 2011.

Members will now generally receive a 50% discount for covered name brand drugs in the coverage gap (donut hole).

There were no changes in catastrophic coverage in 2011.

Capital Health Plan Retiree Advantage (HMO)

 

There is a new Formulary (list of covered drugs which can change each year). Check your Annual Notices of Changes and Evidence of Coverage for changes in coverage, Tiers, and/or restrictions.

Some plans have made copayment changes. Check your Schedule of Retiree Advantage (HMO) Copayments for more details.

 

 

 

 

 

The Formulary and plan specific Annual Notices of Changes and Evidence of Coverage for each plan can be accessed on our website.

What stays the same:

Members still have access to our national network of pharmacies. You can look up network pharmacies on our website. All service area pharmacies are also listed in the Directory of Physicians, Services Providers and Pharmacies. For questions, call Member Services at 850-523-7441 or 1-877-247-6512 (TTY/TDD 850-383-3534 or 1-800-955-8771, 8:00 a.m. to 8:00 p.m., seven days a week. From March 1 through October 15 voice mail is available on weekends and holidays.

Capital Health Plan is a Health Plan with a Medicare contract. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2012.

High Risk Medications

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

Did you know that our bodies begin to respond differently to medications as we get older?

As we age, various changes occur throughout the body. For example, the liver or kidneys may not clear a medication from our system as efficiently as it once did. Likewise, receptors in the body may become more sensitive to certain drugs.

For these reasons, certain medications are considered high risk for individuals age 65 and older. Consult your physician to see if you are at risk.

 

An article in the February 2010 HealthLINE listed examples of these medications. You can access the article at www.capitalhealth.com/Members/Healthline under the topic “Medications”, or by visiting www.captialhealth.com and searching “High Risk Medications.”

Senior Games

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

Look out for the 2011 Senior Games! Capital Health Plan will once again support the active seniors in our community at the Capital City Senior Games on February 10-14, 2011. Registered athletes can be 50 years young and compete in events like track, swimming, softball, basketball, archery, billiards, and even table tennis. Prizes are awarded to winners in each of five age categories.

Check www.flasports.com for more information.

Generic Drugs - An Even Greater Value

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

Did you know your employer’s benefit plan offers you one of the best values on more than 350 generic maintenance medications for chronic conditions? Consider this:

  • You can get up to 30 tablets or capsules of a generic drug for a copay of $3.33 plus a dispensing fee *†

To take advantage of these low costs, get your prescription filled at any retail store in the Capital Health Plan pharmacy network.

You can feel confident choosing a generic drug:

  • Generic drugs are becoming the top choice among doctors and patients—more than 65% of prescriptions filled today are for generic drugs, and that percentage is growing.1
  • All generic drugs must be reviewed and approved by the U.S. Food and Drug Administration and meet the same quality and safety standards as brand-name drugs.2
  • Brand drugs cost an average six times more than generic drugs1—yet according to the FDA generics are just as safe and effective.

Your Next Steps

  1. Ask your doctor if a generic is right for you.
  2. If so, have your doctor write a prescription for a value generic drug, including refills.
  3. Fill your prescription using any retail pharmacy in our network. Be sure to present your Capital Health Plan membership card in order to receive the discount.

A list of generic drugs available through this offer is available online. Visit www.capitalhealth.com and search “Value Generic Drugs” for more information. If you have questions, please contact Member Services at 850.383. 3311.

This discount is only available to CHP commercial (employer group) plan members (and Retiree Advantage members beginning in 2011). Capital Health Plan Advantage Plus and Preferred Advantage members should consult their plan specific Annual Notices of Changes and Evidence of Coverage for information on generic drug copayments.

*Copayment, copay or coinsurance means the amount a plan participant is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. †Applies only to generic medications on the CVS Caremark Value Generic Drug List. Conditions often treated by generic medications on the list include high/low blood pressure, high cholesterol, diabetes and more. 1 IMS Health, 2009. 2FDA Web site: .

The amount of your savings will be based on your plan. Source: Generic Pharmaceutical Association Web site: http://www.gphaonline.org/about-gpha/about-generics/case.

Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.

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It’s Not Too Late…Participate!

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

Join the thousands of Capital Health Plan members working to fight colon cancer.

As 2010 comes to a close, you may be reflecting on all your accomplishments of the past year. The Capital Health Plan Colon Screening Program has something to add to your list. CHP is ranked #1 in the nation for colon screening, and 27,138 of you helped. The ranking is a reflection of the number of Capital Health Plan patients, age 50-75, who participated in colon screening as compared to members in other health plans. This emphasizes the #1 priority CHP members make to staying healthy.

How did we get here?

A 1998 New York Times article declared that “Although colon cancer is the second-biggest killer among cancers in America, it is hardly the most talked about.” We’re proud to say this isn’t true at CHP where colon screening is a part of our daily focus.

Capital Health Plan members are committed to fighting colon cancer and have taken action. Each year more members participate by doing stool testing and colon exams (flexible sigmoidoscopy-“flex sigs” or colonoscopy). By utilizing the services that CHP offers, more and more members are taking steps to maximize their health.

How can you get involved?

During the busy holiday season, don’t let the priority of your health be overlooked. If you’re not up to date with screening, it’s not too late— participate!

The easiest and simplest way to get involved in colon screening, that won’t interrupt your pace this busy holiday season, is doing a stool kit. The test requires collection of only one small sample which can be tested for non-visible blood. Since there are no dietary or medication restrictions, this test allows you to easily and conveniently participate in screening, right from home. The completed kit can be sent to the Colon Screening Program for testing and your primary care doctor will automatically receive the result.

If you have not done a colon screening, and are 50-75, or are African American age 45-75, call 523-7350 and request a kit today.

We are proud of the care we give our patients, and we want to help you to be one of the thousands who make Capital Health Plan #1 in the colon cancer fight. Participate in screening now and give yourself something else to celebrate this holiday season….a healthy colon check.

Ask Your Local Member Services Representative

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

Capital Health Plan strives to provide our Members with outstanding customer service. This section of your Member newsletter focuses on answering general coverage or procedural questions that we receive on a regular basis.

Question:

What is a Primary Care Physician and how do I choose one for myself?

Answer:

One of the most important health care decisions you will ever make is selecting your primary care physician. This is your health care partner and central coordinator for everything pertaining to your good health. Primary care physicians include family physicians, internal medicine physicians and pediatricians.

The process for choosing your primary care physician is simple.

1) First, find a physician accepting new patients:

  • Access the CHP Physician Search Tool. Visit www.capitalhealth.com and on the homepage, under the phrase “Learn more about,” click on the word “Doctors”
  • On the Physician Search tool, click the “advanced search” link.
  • Use the drop down box in the category labeled “Accepting Patients” to choose “Yes”.
  • Check the box next to the words “Primary caregivers only” and then click “Go”. (If you want to narrow the search further, enter the zip code, city, medical group affiliation, and/or other search items accordingly.)
  • Review the list of primary care physicians accepting new patients and choose the one that you would like to have as your health care partner.

2) Then, notify your local Member Services Representative of your decision so our records will reflect your choice.

  • Call CHP Member Services at (850) 383-3311 - or -
  • Log on to your CHPConnect account and make your selection. This automatically sends a secure message to the Member Services staff; your selection will then be completed that evening. (You can register for a CHPConnect by visiting www.capitalhealth.com and clicking on the link titled
    in the left hand column.)

Member Services: Five days a week 8 a.m. – 5 p.m.

850.383.3311 or 800.390.1434

Medicare Member Services: Seven days a week 8 a.m.– 8 p.m.

850.523.7441 or 877.247.6512

TTY/ TTD: 850.383.3534 or 800.955.8771