February 29, 2012 – Once again, the National Committee for Quality Assurance (NCQA) awarded Capital Health Plan its highest accreditation status of Excellent for service and clinical quality. Capital Health Plan was awarded the Excellent status for both its Commercial HMO and Medicare HMO plans. This means that Capital Health Plan met or exceeded NCQA's rigorous requirements for consumer protection and quality improvement.  CHP has held the Excellent accreditation status for 11 years.

The National Committee for Quality Assurance (NCQA) conducted an on-site survey at Capital Health Plan on February 13-14th, 2012. The results of the on-site survey show that CHP achieved a score 100% out of 100%.  This on-site survey score is combined together with the most recent HEDIS clinical measures and CAHPS member satisfaction scores to calculate the new accreditation rating score for 2012.

Capital Health Plan was also awarded Medicare Advantage Deemed Status in accordance with the requirements set forth by the Centers for Medicare & Medicaid Services.

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.

According to NCQA: “NCQA’s Excellent Accreditation status is reserved for the best health plans in the nation.  It is only awarded to those plans that meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvement and deliver excellent clinical care.

“Earning Excellent Accreditation reflects a health plan's ability to work with its members’ physicians to improve the quality of clinical care. It shows that the plan is building the kinds of partnerships that are critical to delivering great care and great service.”

April 16, 2012 is designated as National Health Care Decision Day. The goal of celebrating National Health Care Decision Day is to encourage everyone to communicate their health care wishes to family and medical providers before the need to make decisions arises. Capital Health Plan’s Advance Directive of choice is Five Wishes.

Current statistics reveal that only 15-20 percent of the population has completed an Advance Directive. The end of life is often treated as a medical moment rather than a process that completes the circle of life. If asked, most will tell you that they want to be allowed to die a natural death.  Almost everyone has a “horror story” of a loved one dying in pain or isolation. This can all be avoided by completing an Advance Directive now before you become ill or incapacitated.

Life can change in an instant. Please give your family the gift of having completed an Advance Directive today.  To have a copy of Five Wishes mailed to you, call CHP Health Promotions at 850-523-7422 option 3.  Visit the Advance Directives and Living Wills page for more info. 

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 you community to nominate Silver Stars.  Capital Health Plan is proud to be a major sponsor for the 2012 celebration which culminates in a festive awards dinner at the FSU University Center on May 10, 2012.

We bet you know some: those 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 1. 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. Forms can be downloaded here.

If you don’t have a CHP Urgent Care magnet for your fridge, call Member Services at 850-383-3311.

Call CHP Urgent Care for urgent medical conditions including: upper respiratory infections such as colds, ear infections, bronchitis and sore throats; minor, but acute cases, which include fever, nausea, vomiting and urinary tract infections; or minor trauma including ankle sprains and cuts.

CHP Urgent Care: 850-383-3382

By appointment only.

2140 Centerville Place Monday through Friday: 11 a.m. to 10 p.m. Weekends: 9 a.m. to 8 p.m. Holiday hours may vary. 

Enhanced Prescription Drug Benefits:

All Capital Health Plan Medicare Advantage (HMO) plans will offer a 90-day retail supply and a 90-day mail order supply of most prescriptions beginning January 2012.

To take advantage of the 90-day retail supply just ask your physician’s office for a 90-day prescription and fill the prescription at your local pharmacy.

To take advantage of the 90-day mail order service:

Contact your physician’s office and ask for a 90-day prescription with three refills. 

• Fill out the Mail Service Order Form. 
  • Download the form at caremark.com under “Forms for Print.” 
  • Or, call Member Services at the numbers listed below, and we will mail you a form. 
• Mail the form to Caremark at the address printed on the form.

Drugs available through mail order are drugs you take on a regular basis, for a chronic or long term medical conditions.  The drugs that are not available through mail order service are marked with a “NM” (not available at mail order) on your Formulary (drug list).   The Formulary is available on line at capitalhealth.com/2012 Medicare. All Medicare Advantage members enrolled in plans that renew between October 1 and January 1 have also received the new 2012 Formulary by mail.  

Medicare-Covered Preventive Services:  

Most preventive services have been covered by Capital Health Plan at no cost to members in the past.  However, in 2012 members will see some additional preventive services covered at no cost.  Please refer to your Evidence of Coverage, Chapter 4, for a list of preventive services.   This is a good time to check and make sure you have completed your annual screenings for 2011.

For other 2012 changes, please refer to your Annual Notices of Changes and Evidence of Coverage.

Questions:  Contact Member Services, 850-523-7441 or 1-877-247-6512 (TTY 850-383-3534 or 1-877-870-8943) 8:00 a.m. to 8:00 p.m., seven days a week.

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Question:How can I improve the benefits of my prescription drugs while reducing the risks?

Answer: In the last 25 years, we’ve seen a major increase in the number of drugs available to us. There are many obvious advantages to that availability, but one negative effect is that we expect there to be an effective pill for every condition. What we may not realize is not all pills are effective for everyone, many carry side effects that can outweigh their advantages, or many may simply control the adverse results of an unhealthy lifestyle rather than address underlying issues with diet and exercise.  To make informed decisions about your medical care, here are some things you should keep in mind about prescription drugs.  

Most medications are tested in young, healthy people who are not on other drugs. The effectiveness and safety of a drug is very different, for example, when taken by an elderly person with tired kidneys who is also taking six other drugs.

The problem is that over time, multiple doctors can continue to prescribe you medications without considering your total health picture. Some may be for symptoms which are bothersome but not life threatening. Those drugs may cause side effects and you may be prescribed more drugs to reduce the side effects.  You may be reluctant to stop any medication once you start it. And that can all add up to a real mess.  

Being proactive and knowledgeable about your prescriptions is very important in the event of a hospital stay. Let’s say you have an emergency and go to the hospital. Hospital

staff will try to find out what medications you are taking. If you or your family members don’t know the names and dosages of your medications, it can be hard for them to give you the best medical care. 

More complications can come when you are released from the hospital. Nurses try to reconcile medications you were taking before you went into the hospital with any new prescriptions from your hospital visit. They will develop a list and give it to you with instructions. You may be overwhelmed by all the new information. Make an appointment to follow up with your primary care physician who knows your medical history best. Be prepared to discuss new medications and any new side effects you may be experiencing. 

There are other simple things you can do to help avoid complications from prescriptions medications. Be honest with your physician about how regularly you take your medications. Let your physician know your goals. Do you want to minimize cost, maximize convenience, or minimize your medications? Working along with your physician, you can experience the advantages to the vast advances in prescription drugs, and avoid the disadvantages. 

Would you like to make fewer trips to the pharmacy?

Effective January 1, 2012, Capital Health Plan Commercial members (who receive their pharmacy benefits through CHP) can obtain a 90-day supply of Tier 1 generic medication for three copayments at participating network pharmacies.  This benefit will allow you to refill your Tier 1 generic medications just four times over the course of a year.  To take advantage of this benefit, simply ask your doctor to write a prescription for a 90-day supply of your Tier 1 generic medication, and then fill it at any CHP network pharmacy.

Why is using a generic drug the best value for your dollar?

Brand name drugs cost an average of six times more than generic drugs—yet according to the U.S. Food and Drug Administration (FDA), generics are just as safe and effective.  To start saving money today, ask your doctor about generic drugs and be sure to present your CHP membership card to receive the most from your pharmacy benefit!

Want to save even more money?

Ask your doctor if one of the generics found on our Low Cost Generics List (available at capitalhealth.com) is right for you. You’ll pay just $9.99 (plus a dispensing fee) for a 90-day supply.  This list offers you the best value on more than 300 generic maintenance medications for chronic conditions. 

It’s Time to Get Seizure Smart!

In recognition of National Epilepsy Awareness Month in November, the Epilepsy Foundation is challenging America to Get Seizure Smart!  The goals of this nationwide public awareness campaign are to educate millions of Americans about epilepsy because epilepsy affects nearly 3 million Americans and nearly 360,000 people in Florida are living with this chronic condition. Yet for many, the biggest problem is not the disorder itself, but society’s knowledge about the condition. That is why awareness—and talking about it—is so important. 

“We want to empower people with epilepsy to dispel myths and encourage the public to better understand the condition,” said Karen Egozi, chief executive officer of the Epilepsy Foundation of Florida. “It is important for people to know what a seizure is, how to recognize one and what to do—and not do-- if someone is having a seizure.”

If you saw someone having a seizure, would you know what to do?  If your answer is no, then it’s time to Get Seizure Smart.

The purpose of National Epilepsy Awareness Month is to:

• Dispel common myths about epilepsy
• Promote public awareness, seizure first aid, and an understanding of the condition
• Inform people with seizure disorders and their families about service programs and informational resources available nationally and in their local areas 
• Educate the public about the symptoms of epilepsy and seizure disorders to help eliminate the stigma unjustly associated with the condition

Throughout the month, you can visit www.GetSeizureSmart.org to take the interactive online Get Seizure Smart quiz and test your knowledge about seizures. On this site, you will also find a downloadable quiz you can print out and give to everyone you know, or forward to a friend so they will also be seizure smart. There are also downloadable fact sheets, short videos and other resources to arm Americans with tools that will help them recognize a seizure and know how to respond. 

Epilepsy, also known as a seizure disorder, is a medical condition that produces seizures affecting a variety of mental and physical functions. When a person has two or more unprovoked seizures, they are considered to have epilepsy. 

Join us in helping America Get Seizure Smart! Help us spread the word - visit www.GetSeizureSmart.org. 

Question:

How do I update my personal information at Capital Health Plan?

Answer:

Capital Health Plan strives to keep the most current and updated information for all of our members. If need to change your address or phone number, please use the following steps:

If your home or work number changes:

We can take this information over the phone. Please contact the Member Services Department.

• Commercial Members: Five days a week 8 a.m. – 5 p.m.850.383.3311 or 800.390.1434
• Medicare Members: Seven days a week 8 a.m.– 8 p.m.850.523.7441 or 877.247.6512
• TTY/ TTD: 850.383.3534 or 877.870.8943

If you need to update your address with Capital Health Plan:

We cannot take this information over the phone. Please use the following steps:

• Commercial  Members: Contact your Employer Group Administrator and ask that they submit your current updated address to us with a “Member Status Change Form.”
• Medicare Members: Please submit your information to Capital Health Plan through a written request.  
  • Mail to: Capital Health Plan Attention: Enrollment Department PO BOX 15349Tallahassee, Florida, 32317

If you have a Name Change:

We cannot take this information over the phone. Please use the following steps: 

• Commercial Members: Contact your Employer Group Administrator and ask that they submit your current updated name to us with a “Member Status Change Form.”
• Medicare Enrolled Members:  Please contact the Medicare Office at 1-800-MEDICARE (1-800-633-4223). They will update your information and forward your name change to Capital Health Plan for prompt updating.

Each year U.S. hospitals have 300,000 admissions for broken hips. Falling is often the cause of those fractures.

As we age, many physical factors put us at an increased risk of falling such as: hearing loss, vision loss, lack of mobility and loss of muscles mass. The average person will lose about one percent of their muscle mass per year after the age of forty five. The best way to counteract that is to use your muscles by leading an active lifestyle.  Balance exercises can help you stay independent by helping you avoid the often permanent physical disabilities that may result from falling.  And you don’t have to have fancy equipment to strengthen your muscles and improve your balance. There are many easy exercises you can do at home.

Stand on one foot.

• Stand on one foot behind a sturdy chair, holding on for balance.
• Hold position for up to 10 seconds.
• Repeat 10 to 15 times.
• Repeat with opposite leg

Walk heel to toe.

• Position the heel of one foot just in front of the toes of the other foot. Your heel and toes should touch or almost touch.
• Choose a spot ahead of you and focus on it to keep you steady as you walk.
• Take a step. Put your heel just in front of the toe of your other foot.
•  Repeat for 20 steps.

Back leg raises  (strengthens buttocks and low back)

• Stand behind a sturdy chair, holding on for balance.
• Flex your left foot, then slowly lift left leg straight back without bending your knee.  Try not to lean forward. Hold position for 1 second.
• Keep your right standing leg slightly bent.
•  Repeat 10 to 15 times with each leg

Side leg raises (strengthens hips, thighs, and buttocks) 

• Stand behind a sturdy chair with feet slightly apart, holding on for balance.
• Flex your left foot and slowly lift your left leg out to the side. Keep your back straight and your toes facing forward.
• Keep your right standing leg slightly bent and hold position for 1 second.
• Breathe in as you slowly lower your leg.
•  Repeat 10 to 15 times with each leg.