Spring | S u m m e r 2 0 13 The We llne s s M agazine by Independent H ealth How to control pollens and molds—and manage your asthma Easy ways to remember to take your medications Helping to create a culture of health one initiative at a time ALSO INSIDE: Page 2 Health Reform New way to get health insurance Page 4 KIDS RUN 25 years of family, fitness and fun Page 14 Prenatal Care Assess your health before pregnancy He alth c are reform $0 copay preventive services reminder Many top-risk factors leading to illness and premature death are preventable. That’s why preventive care is the most important step you can take to manage your health. Preventive services can find health problems early, when treatment works best, and can reduce your risk for getting certain diseases. As an Independent Health member, you may currently be eligible to receive more than 60 preventive care services and screenings at no cost to you when performed by an in-network health care provider.* These services include mammograms, cholesterol screenings, colonoscopies, annual physicals, women and children well visits, immunizations and more. Please note that if you visit your doctor for a preventive service, any non-preventive service rendered as part of your visit is subject to the applicable member liability as outlined in your General Health Contract. For example, if your physician determines that an electrocardiogram is required during your routine physical, you would be responsible for the applicable copayment, coinsurance or deductible based on your plan option for that test. Well visits that turn into sick visits are also subject to member liability. For example, during a routine physical, you mention to your doctor that you’ve been experiencing some discomfort in your ear and, upon examination, you’re diagnosed with an ear infection. This would be considered a sick visit. What the Health Benefits Exchange will mean to you If you ever wished you could comparison shop for health insurance and buy your coverage with the click of a mouse, the Affordable Care Act (ACA) is about to make it a reality. A new Web-based health insurance marketplace is opening on October 1, 2013; it allows individuals and small employer groups to choose their coverage (which begins January 1, 2014). This marketplace, called the Health Benefits Exchange, will be a one-stop shopping experience similar to Travelocity® or Esurance®, where shoppers can go online to look at plan options, including prices and benefits. A toll-free telephone line will also be available for consumers. New York State will operate the marketplace based on federal specifications. A majority of people are used to receiving health care coverage on the job, and for many that will not change. For those who do not have access to coverage currently or for those who lose coverage, this new marketplace will let you shop for plans, enroll in a plan and pay premiums online. Every plan sold in the Health Benefits Exchange will cover services that include preventive screenings (offered with no copayment or deductible), prescription drugs, hospitalization, maternity care and chronic disease management. Individuals are guaranteed coverage regardless of pre-existing conditions. Organizations known as Navigators will be available to help shoppers find the coverage that meets their needs. Individuals who meet income guidelines will receive federal assistance to pay a portion of premium costs or even some out-of-pocket expenses, such as copayments or deductibles. The streamlined one-page application will also determine if individuals are eligible for Medicaid coverage and assist with enrollment in that program. Independent Health’s Member Services Department is available to answer your questions about this new marketplace, or you can visit New York State’s website at: http://healthbenefitexchange.ny.gov. We encourage you to take advantage of $0 preventive care services. To learn more about these services, please visit the Member section at independenthealth.com or www.healthcare.gov. Also, talk with your doctor to make sure you are up-to-date on your preventive care. *Benefits vary by plan. 2 HealthStyles | Spring/Summer 2013 commun it y i n itiative s Helping to create a culture of health one initiative at a time Independent Health has partnered with several local organizations to offer initiatives that help Western New Yorkers take charge of their health. • The Independent Health Family Branch YMCA is YMCA Buffalo Niagara’s newest and largest branch. Located at 150 Tech Drive in Amherst, this state-of-the-art 94,000-square-foot facility houses an Independent Health Member Information Center, rehabilitation offices run by Buffalo Rehab Group and a demonstration kitchen sponsored by Wegmans. Other features include two 7,700-square-foot gymnasiums, an indoor running/ jogging track, fitness center/weight room, two swimming pools, aerobic studios and an Alaskan Adventure Room for children sponsored by First Niagara Foundation. Independent Health also provides health and wellness programs and resources. Visit independenthealth.com to view our calendar of activities. • In conjunction with YMCA Buffalo Niagara, Independent Health introduced Fitness in the Parks during the summer of 2012. Open to the entire community, this free weekly exercise program was developed to encourage individuals to stay on track with their fitness goals by attending fitness classes at participating parks throughout the region. Under the direction of a YMCA certified instructor, individuals had the opportunity to take part in Pilates, Zumba® and yoga classes. We look forward to working with YMCA Buffalo Niagara to offer this program again this summer. • In an effort to promote healthier lifestyles in our community, Independent Health has joined forces with Snyder Corporation and Fitness Ridge Worldwide to bring the Biggest Loser Resort Niagara to Western New York at the Beaver Hollow Conference Center in Wyoming County. Inspired by NBC’s hit weight-loss series, The Biggest Loser, the resort focuses on exercise, healthy nutrition and education. The rigorous program gives participants the tools they need to adopt lifestyle changes to stay healthy and reduce their risk for chronic disease, like diabetes and heart disease. Independent Health will continue to collaborate with community partners as we establish a culture of health and wellness here in Western New York. In doing so, we will further improve the health and vitality of the community, while lowering rates of preventable illness and overall medical costs. The Buffalo Museum of Science presents BODY WORLDS Vital BODY WORLDS Vital—sponsored by Independent Health—is the latest chapter in the series of BODY WORLDS Human Saga exhibitions. Opening May 31 for a limited engagement, Vital presents a special collection of specimens designed to show visitors the essentials for human health and wellness. The exhibition includes whole-body plastinates, a large arrangement of individual organs, organ and arterial configurations, and translucent slices that give a complete picture of how the human body works. Vital tells the fascinating story of how to best fight, manage and prevent life-threatening diseases—such as cancer, diabetes and heart ailments—through healthy choices and lifestyle changes. The BODY WORLDS display by Gunther von Hagens, M.D., features independenthealth.com authentic human bodies, willed by donors and preserved through plastination. The series is designed to educate the public about the human body and increase health awareness. Learn more at www.sciencebuff.org. Show your Independent Health member ID card at the Buffalo Museum of Science box office to receive a $2 discount on the regular exhibit admission. After visiting Vital, be sure to check out all the new experiences the museum has to offer, including its interactive health sciences studio, Explore YOU, presented by Independent Health. Explore YOU offers visitors a hands-on experience to explore all there is to know about the human body, ways to stay healthy and advances in life-changing medical technology. 3 fitness focus Three healthy habits to teach your children Want to leave a lasting legacy that will benefit your children for their entire lives? Teach them healthy habits. Better yet, show them how to practice healthy living through your example. Set a good example for your kids by following these three simple habits: Habit 1: Eat slowly In today’s busy families, too often kids rush through meals before running off to activities. Show your children how to slow down and enjoy their food, by chewing thoroughly and taking breaks between bites. The benefit: Food digests better, you can savor a meal’s flavors and you are less apt to overeat. Habit 2: Quench thirst wisely Don’t buy and serve sugary drinks or foods just to please your children. When they’re thirsty, serve water. With meals, offer a glass of 100% fruit juice or calcium-rich milk. The benefit: You avoid drinks that offer “empty” calories, which can lead to weight problems. Habit 3: Buckle up for safety Car accidents are a leading cause of death among American children. Sadly, many of these deaths could be prevented if youngsters were properly restrained with seat belts or child safety seats. Refuse to start your car until all passengers— yourself included—are buckled in. The benefit: Greater safety for everyone and better peace of mind for you. Remember, what you do may have far more influence than what you say. Practicing these habits just may boost your own health and wellbeing, too. 4 Kids Run celebrating 25 years of family, fitness and fun If you’re looking for a fun and healthy way to spend time with your family, we invite you to take part in the 25th annual Independent Health Foundation’s Kids Run, which is scheduled for 9 a.m., Saturday, June 1, at the Zoofari Courtyard at Delaware Park. This free event includes a mini dash for kids ages 2 to 5 and a 1.8-mile run/ walk for all ages. Trophies are awarded to the winning boys and girls, and each participant receives a medal (while supplies last) at the finish line. All ages are welcome—strollers, too. After the race, make a day of it at the Buffalo Zoo with discounted admission for all participants. Kids Run is made possible by Wegmans. Soccer for Success Youngsters from the Soccer for Success program will also be on hand at the Kids Run to display their soccer skills. Soccer for Success is a free after-school, sportsbased youth development program that uses soccer as a tool to combat childhood obesity and provides nutrition education and mentorship to children in underresourced communities. More than 700 children have participated in the program since it was launched last fall by the Independent Health Foundation. Participants have had an overall increase in physical endurance, while lowering their overall body mass indexes. Soccer for Success is made possible by a grant from the U.S. Soccer Foundation and is run in collaboration with the Buffalo Soccer Club and the United Way of Buffalo and Erie County. Register for the Kids Run To learn how you, your family or your organization can participate in the Kids Run, visit independenthealth.com/ foundation or call the Foundation at (716) 635-4959. We also encourage you to Like the Independent Health Foundation on Facebook. HealthEdge, Delta Dental and Personal Computers, are proud sponsors of the Independent Health Foundation’s programs. HealthStyles | Spring/Summer 2013 e ati ng well Offering healthy options at the Taste of Buffalo The Independent Health Foundation’s Healthy Options program is once again partnering with the Taste of Buffalo to require that all participating restaurants serve a healthy food item at this year’s event, which is scheduled for July 13 and 14. The Healthy Options program was integrated into the Taste of Buffalo in 2007, making it the only food festival in the United States to require that all participating restaurants offer a healthy option item. Last year, more than 50 restaurants offered a variety of healthy options, from garlic grilled shrimp skewers to veggie bliss sandwiches. The 2012 Healthy Options Contest winners were: • First place—Kabab & Curry’s Malai Tikka (grilled chicken skewer with sour cream and yogurt marinade) • Second place—Orazio’s Faye Salad (mixed greens topped with candied walnuts, craisins, mandarin oranges, red onions, Kalamata olives and Gorgonzola cheese, served with a fatfree raspberry vinaigrette) • Third place—Applebee’s Grilled Jalapeno Lime Shrimp (marinated chipotle lime shrimp paired with a black bean corn salsa on grilled zucchini, tomatoes, onions and red peppers) Established in 2004, the Healthy Options program is designed to help our community make more informed decisions when dining out and help address the high rates of stroke and heart disease prevalent in Western New York. Through this program, the Foundation works with area restaurants to offer heart-healthy food options, which are considered lower in fat, saturated fat, cholesterol and sodium. “We want to make sure your diningout experiences are just as healthy as the ones in your own kitchen,” said Carrie Meyer, executive director, Independent Health Foundation. “By working with area chefs, we can help you make better decisions about the meals you order when eating out. And the best part is, you don’t have to compromise on taste. You can be sure that along with being healthy, meals also taste great.” Looking for a great place to eat? For a list of participating restaurants, please visit healthyoptionsbuffalo.com. The Healthy Options program is made possible by Roche Diagnostics. 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One way we help our members understand their coverage is by holding informational orientation sessions on a quarterly basis. Upcoming member orientations are scheduled for the following dates: • Wednesday, June 12 • Wednesday, September 18 • Wednesday, December 11 By attending one of these sessions, you will have the opportunity to ask specific questions about the health plan you are enrolled in. These sessions are held at our Customer Service Center, located at 250 Essjay Drive in Williamsville, and begin promptly at 6 p.m. Reservations are strongly encouraged. To register for one of these orientation sessions, please call our Member Services Department at (716) 631-8701 or 1 (800) 501-3439, Monday through Friday, from 8 a.m. to 8 p.m., or email us at [email protected] independenthealth.com. 6 Get the information you need, quickly and securely At Independent Health, we understand that it’s important that our members be able to safely access their health insurance information whenever and wherever they need it. That’s why we were pleased to be the first health plan in Western New York to offer a mobile app to its members, when we introduced MyIH in May 2012. Available as a free download for Android and iPhone, the MyIH app provides our members (depending on their plan) with the information they are looking for whether they are at home, at work or on the go. The virtual ID card is especially convenient for members who are out of town on business or vacation and college students who are away from home. Key features and member benefits of the MyIH app include: • Find a Doctor or Facility—members can search Independent Health’s entire local network of participating doctors, hospitals, pharmacies and other providers, such as urgent care centers, and use GPS technology to find directions and maps to their addresses. This feature also allows users to call the physician or provider directly from the search result. • My ID Card—allows members the ability to see and show their health insurance ID cards, and email and fax their cards to any health care provider or facility, so users’ ID cards will never be forgotten for a visit to the doctor’s office or unavailable for an unexpected trip to the emergency room. • My Benefits—provides members of our fully insured plans with easy access to benefit summary information, including copayments and coinsurance, benefit limits and coverage. Online account You can also keep your membership information up-to-date and have instant access to the information you want and need, 24 hours a day, seven days a week, at the Independent Health website. By registering your online account, you will be able to: • Update your address and telephone number • Verify your plan details and copayments • Check the status of a claim • Change or add a primary care physician • Order new ID cards To enroll for your own secure account, simply visit independenthealth.com and click on the “Register” link in the “Secure Log In” box, which is located in the upper right-hand corner of our website. HealthStyles | Spring/Summer 2013 plan i nformation Understanding how your deductible works As a way to provide individuals greater flexibility and control over their health care decisions, Independent Health offers several high-deductible health plans, including iDirect, Empower and Evolve. Members of these plans pay out of pocket for covered health care services until their annual deductibles are met, at which time copayments or coinsurance may apply. To help make it easier for our members to use their high-deductible health plans, here are the answers to several common questions about deductibles: Q: Do all my medical services go toward my deductible? No. Select in-network preventive care, vision and dental services do not apply toward the deductible. Please refer to your Benefit Summary for the listing of in-network preventive services. Q: If I needed surgery, would that be subject to my deductible? Yes, only in-network preventive care services can be waived from the deductible on a qualified high-deductible health plan. Vision and dental services are also not subject to the deductible. Q: How is the deductible calculated? Independent Health determines the deductible as of the date the claim is processed, not the date services were rendered. Because providers have up to 120 days to file claims, it could possibly take up to three months after the original date of service for a claim to be received and processed by Independent Health. Q: What is the difference between my deductible and the out-of-pocket expense limit? A deductible is the initial out-of-pocket amount that you must reach before you are eligible to pay copayments or coinsurance. The out-of-pocket maximum is the dollar limit for deductibles, copayments and coinsurance amounts that you are responsible for in a given time period. Once you reach your out-of-pocket maximum, all services are covered in full for the remainder of your contract year. As always, if you have any questions about your coverage, please call our Member Services Department at (716) 631-8701 or 1 (800) 501-3439, Monday through Friday, from 8 a.m. to 8 p.m. Q: How do I know whether I’ve met the deductible? Independent Health now provides you with a monthly deductible balance statement that summarizes the amount you have paid toward your iDirect plan deductible the previous month and your remaining plan year deductible balance. The statement also includes an overview of your out-of-pocket expense limit (if applicable). In addition, you can track your claims and/or get your deductible balance by: • Referring to your Explanation of Benefits (EOB) • Logging on to your online account at independenthealth.com Reminder for FlexFit and FlexFit Select members Independent Health’s FlexFit® and FlexFit Select® are lifestyle plans that make it easier for individuals to build a healthier life. One of the unique benefits of being enrolled in these plans is that they offer two options: Active or Family. As a result, you can choose the plan option that fits you, or your family, best. Members of both the Active and Family options receive debit cards for as much as $250, which can be used for participating fitness center memberships. In addition, members with the Active option can use their debit cards toward yoga and tai chi classes, vitamins, diet consultations, acupuncture and massage. Members with the Family option independenthealth.com can use their debit cards for swimming lessons, youth soccer leagues, gymnastics classes and after-school programs. As an added convenience to our FlexFit debit card holders, we now provide monthly balance statements. In addition, our members can now create a Personal Identification Number (PIN) for their FlexFit debit card by contacting the Card Activation Center at 1 (866) 898-9795. This PIN option is also available to members who have a personalBest! debit card. To search the health and wellness locations where FlexFit cash is accepted, please visit the “FlexFit and FlexFit Select” page in the “Health Plans” section at independenthealth.com. 7 your he alth c are Don’t wait— Complete a health care proxy today! Research shows nearly a quarter of older adults may require someone else to make end-of-life decisions for them. Do your loved ones know what your wishes are should you become incapacitated? It’s not easy to talk about these types of issues, but avoiding them may make it harder on your loved ones in a time of crisis. Independent Health encourages you, if you haven’t done so, to have the conversation about your wishes and complete a health care proxy. Plan ahead with four easy steps: 1. Think about what is important to you and how you want to receive care. 2. Select a person (health care agent) to speak for you if you are unable to speak for yourself. Choose someone you trust and who is agreeable to the role. You may choose an alternate agent to speak for you if your primary agent is not available. Also, make sure family members know the choices you’ve made and who your agent is. 3. Talk about your health care wishes. 4. Put your health care choices in writing using the New York State Health Care Proxy Form. Health care proxy forms are available from your doctor and at hospitals. In addition, you can download a form by visiting the “Frequently Used Forms” section at independenthealth.com. Once your form is signed, keep the original and give copies to your doctors and your health care agent. 8 Revitalizing primary care by empowering physicians Using Patient-Centered Medical Home (PCMH) principles as the foundation, a group of community physicians and Independent Health launched The Primary Connection, a unique, innovative approach to health care delivery that connects a strong, collaborative group of primary care physician practices with specialists and other health care providers. This physician-led initiative is designed to focus on improving patients’ experience of care, enable closer coordination with specialists and other providers, and achieve better outcomes, which will lead to lower health care costs. While the PCMH program focused on each individual physician’s practice, The Primary Connection model will focus on increased coordination and collaboration between primary care physicians and specialists. Primary care physician Fuad Sheriff, M.D., FACP, of Amherst Medical Associates, participates in The Primary Connection because he believes primary care in the U.S. must improve. “When there is inability of patients to access care, the quality of care goes down, and this drives up the cost,” said Dr. Sheriff. According to Independent Health Executive Vice President and Chief Medical Officer Thomas Foels, M.D., the collaborative program improves efficiency and access through enhanced coordination between all areas of care. “The Primary Connection allows the primary care physician to be a vital part of improving our health care system,” said Dr. Foels. “We are empowering primary care physicians to expand their influence and provide more patientcentered care. The successes we have experienced in our PCMH program have well-positioned us for continued success as we begin to implement The Primary Connection program.” This progressive approach initially involves 28 practices and their 168 adult and pediatric primary care physicians. Practices are undergoing transformation to improve care coordination, access and availability. Plus, physicians are engaging their employees and transforming their relationships with specialists, focusing on advance communication. “We are talking to specialists, doing what is known as a preconsult,” said Dr. Sheriff. “Even before the patient ends up in their office, we call them up by phone or send an electronic message telling them about the visit, the history of the patient and why we want the patient to have a consult in the first place.” Dr. Sheriff and his team are building upon the valuable skills and resources obtained through the physician collaborative sessions Independent Health offers. Applying these cutting-edge concepts at Amherst Medical Associates has resulted in noticeable benefits for patients. “Years ago, just getting blood work results took weeks,” added Dr. Sheriff. “Now with our patient portal system, we have results the next day. It’s a considerable improvement.” HealthStyles | Spring/Summer 2013 your he alth c are HEALTHeLINK: Improving care quality through clinical information exchange As an emergency room physician at Erie County Medical Center (ECMC), David Ellis, M.D., FACEP, (pictured right) must make timely decisions regarding patient care—often without knowing the patient’s medical history. Fortunately, with HEALTHeLINK, Western New York’s clinical information exchange, linking local hospitals, physicians and health plans to patients’ up-to-date clinical information, Dr. Ellis can quickly review a patient’s history and determine the best course of action in emergency situations. “In the Emergency Department, every patient is a new patient,” he said. “We have to very quickly find out what is going on with the person, what is happening with them and where this episode they’re presenting fits into their overall course of care.” Nearly 500,000 Western New Yorkers have authorized treating physicians to access their electronic medical records through HEALTHeLINK. The elimination of redundant, costly and potentially harmful diagnostic testing has been the biggest benefit of HEALTHeLINK, Dr. Ellis said. He pointed to an example of a young woman who arrived at ECMC with a condition normally requiring a diagnostic test, such as a computed tomography (CT) scan. “Exposing young women to radiation is something that we’re very careful about, and we want to try to avoid it at all costs,” Ellis said. “Just as we were at the point of thinking, ‘We’re going to have to order this test,’ we were able to find out the information we needed on HEALTHeLINK and avoid that whole process.” Independent Health was one of the various health care stakeholders that helped establish HEALTHeLINK in 2006, with Michael W. Cropp, M.D., president and CEO, as the inaugural chairman of the board. As Ellis said, “One of the beauties of the system here in Buffalo is the involvement of all the major components of our health care system, and one of the biggest components is Independent Health.” If you would like providers to have access to your electronic medical records through HEALTHeLINK, you must first sign a consent form. At your next doctor’s appointment, ask for a HEALTHeLINK consent form or download one at www.getlinkedwny.com. We want to make sure you’re receiving quality care Independent Health’s Quality Management approach is guided by the knowledge of and commitment to our principles, which incorporate a “continual improvement” methodology. Quality is a way of thinking, a way of acting and a way of understanding the data generated by our processes. It’s more than graphs and numbers. It’s our ability to understand the messages contained in our data. independenthealth.com If you would like to receive a complete paper copy of Independent Health’s Quality Management Program, which includes our Patient Safety Program, please call our Servicing Department at (716) 631-8701 or 1 (800) 501-3439. TDD users: (716) 631-3108. You also may view it online at independenthealth.com. 9 medic ations Easy ways to remember when it’s time to take your medications A significant number of the 3.9 billion prescriptions filled each year aren’t taken correctly. As a result, many Americans are putting their health and lives at risk. Taking medication as prescribed is important to properly manage your health; an extra, missed or wrong dosage can be dangerous. But there are things you can do to personalize your pill-taking routine so that taking the right medication at the right time becomes automatic. Have a system If you have more than two medications to manage, consider getting a pill organizer—a special container marked with the days of the week. Besides housing multiple medications, a compartmentalized organizer can be useful for keeping track of the medications you’ve taken. Many people can’t remember if they took their pill or if they simply thought about taking it, so they skip dosages or take too many pills. But by using an organizer, you can simply check to see if the pill is missing from that day’s bin. Still, if you use an organizer, be sure to label each bin with the name of the medication and other relevant information so that you consistently load the organizer correctly. Take your cues If you have trouble remembering to take your medications, you’ll need to develop cues that remind you, perhaps in addition to using an organizer. For example, consider programming your cellphone alarm or investing in a triathlon wristwatch, which can be set to sound reminder alarms. Also, you can purchase pill caps that beep or sound an alarm when you need to take the medications. After you replace the pill cap, the timer is automatically reset for the next time. If your problem is remembering to take your medications in the morning or at night, train yourself to remember to do it by placing them in strategic locations. If you have orange juice every morning, for example, put your medications on the breakfast table and consciously try to take your pills every morning when you drink your juice. A surprisingly effective, low-tech option is to make a checklist of all your medications and the time and day you need to take them, then put it on your refrigerator or another prominent place. You simply make a checkmark every time you take your medication. Make sure you’re charged correctly by showing your member ID card Many pharmacies offer low-cost generic drugs, oftentimes at a price lower than a member’s copayment. Since Independent Health requires pharmacies to accept the lower of a member’s copayment or the Usual and Customary Retail (UCR) price, members will automatically pay the lower costs that the pharmacies are charging. For example, a member with a $7 tier 1 copayment would pay $7 for all tier 1 drugs that have a retail price of $7 or higher. However, if the price has dropped to $4 for the same generic drug, the member would only be charged $4. Likewise, if a pharmacy is offering a drug at a cost of $0 for a tier 1 drug, this drug would be covered in full at no cost to the member (in accordance with the member’s prescription drug formulary). Therefore, it’s important that you always present your pharmacist with your current Independent Health member ID card so that all your prescription claims are billed correctly. Not only will this ensure you receive the proper pricing, it will allow us to have a complete health record for you, which will enable us to provide appropriate care oversight, such as drug interaction screening. 10 HealthStyles | Spring/Summer 2013 g o o d t o kn o w Several resources available for those who have HIV What you can do to help prevent health care fraud Health care fraud is a serious crime that affects everyone. It’s committed when a dishonest provider or consumer intentionally submits, or causes someone else to submit, false or misleading information in order to obtain benefits they may not be entitled to. Some examples of health care fraud include: • Filing claims for services or medications not received • Forging or altering bills or receipts • Using someone else’s coverage or insurance card • Leaving other dependents on your health insurance contract when they are no longer eligible • Faking workers’ compensation injury to receive disability payments The National Health Care Anti-Fraud Association estimates that the financial losses due to health care fraud are in the tens of billions of dollars each year. Here are some simple ways you can avoid health care fraud and keep health care costs down for everyone: • Protect your health insurance ID card like you would a credit card. In the wrong hands, a health insurance card is a license to steal. Don’t give out policy numbers to door-to-door salespeople, to telephone solicitors or over the Internet. Be careful about disclosing your insurance information, and if you lose your insurance ID card, report it to your insurance company immediately. • Be informed about the health care services you receive, keep good records of your medical care and closely review all medical bills you receive. • Read your policy and benefits statements. Read your policy, Explanation of Benefits (EOB) statements and any paperwork you receive from your insurance company. Make sure you actually received the treatments for which your insurance was charged, and question suspicious expenses. Are the dates of service documented on the forms correct? Were the services identified and billed for actually performed? • Beware of offers for free health care services, tests or treatments. These offers are usually too good to be true and are often fraud schemes designed to bill you and your insurance company illegally for thousands of dollars of treatments you never received. Human immunodeficiency virus, commonly known as HIV, is a virus that attacks the body’s immune system. Over time, most people infected with HIV become less able to fight off life-threatening infections and cancers. AIDS (acquired immune deficiency syndrome) is the last stage of HIV disease. HIV knows no boundaries. A person of any age, sex, race, ethnic group, religion, economic background or sexual orientation can become infected with this virus if he or she participates in unprotected sex or needle-sharing activities with someone who is already infected. Women with HIV can pass the virus to their babies during pregnancy, delivery or breast-feeding. It’s very important to seek medical guidance if you feel you have been exposed to HIV. The New York State Department of Health has the following resources for people exposed to the HIV virus: • 1 (800) 541-2437 (AIDS General Information) • 1 (800) 872-2777 (HIV Counseling) • 1 (800) 542-2437 (AIDS Drug Assistance Program) • 1 (800) 233-7432 Español (Spanish AIDS Hotline) Independent Health’s Case Management Department is available for members with HIV or AIDS and can help you receive proper treatment. If you would like more information, please call 1 (800) 501-3439 and ask to speak with a member of our case management team. All calls are kept confidential. In addition, if you suspect possible fraud or abuse, call our confidential Fraud Hotline at 1 (800) 665-1182. Callers have the option of remaining anonymous. independenthealth.com 11 preventive care Manage your asthma by controlling pollens and molds When you have asthma, your airways may be sensitive to tiny particles in the air, such as pollens and molds. In fact, these allergy and asthma triggers can leave you struggling to catch your breath. Not all asthma is aggravated by pollens and molds; other allergies, such as allergies to dust mites, cockroaches and pets, can trigger asthma. In addition, respiratory infections (such as the common cold), change of weather and irritants like cigarette smoke exposure and air pollution can bring on asthma symptoms. However, in many cases, pollen and mold are major contributors; therefore, the following information should be of help in understanding asthma. What are pollens and molds? The wind carries pollen from weeds, grasses and trees. Plants can release pollen from early spring to late fall—and yearround in warm climates. Like pollen, mold spores are in the air during the growing season and year-round in warm climates. But mold can also grow indoors in damp, moist areas of your home anytime. People who are allergic to pollen or molds can have many symptoms, such as sneezing, stuffy or runny nose, watery eyes, and itchy eyes, nose and throat. What can you do to control your allergies? The best way to prevent an asthma attack is to stay away from triggers such as pollen and mold. Here are some helpful tips: • Check your daily weather reports to find out local pollen and mold counts. When counts are high, stay indoors or reduce your outdoor activity. Pollen counts are usually highest on warm, dry, windy days. Mold counts can be high during both dry and humid weather, depending on the type of mold. • Try gardening in the early morning or evening, when the pollen count is at its lowest. If possible, avoid raking wet leaves, mowing the grass or handling gardening material, like compost and mulch. 12 • When you come in from outside, wash your skin and hair, if possible. • If you have them, turn on the air conditioners at home and in your car; and close windows and doors when pollen and mold counts are high. • Keep your home dry by removing carpet from damp rooms and cleaning moist areas and surfaces in your kitchen and bathroom. Use a dehumidifier to keep indoor humidity at less than 50%. • Use safer cleaning products. Look for the Environmental Protection Agency (EPA) Design for the Environment (DFe) logo on the label. • Clean or replace the filters on air conditioners and other ventilation systems. Air filters can reduce a variety of airborne substances that may worsen your asthma. • Be sure to use your controller medication as prescribed, even if you are feeling well. Always have your quick-relief medicine—such as albuterol—at hand. If steps to reduce your exposure to pollens and molds do not keep your asthma under control, your doctor may prescribe allergy medications or allergy shots. With your doctor’s help, you can also create an asthma action plan. Need help managing your asthma and allergies? Work with your doctor to create an asthma action plan. Your doctor may also prescribe allergy medications or allergy shots. In addition, a Health Coach from Independent Health can give you the support and knowledge you need to make lasting changes to achieve better health and well-being. Call us at 1 (800) 501-3439, Monday through Friday, from 8 a.m. to 5 p.m., and ask to speak with a Health Coach. HealthStyles | Spring/Summer 2013 preventive care How to live well with COPD Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis, is a chronic lung disease that makes it hard to breathe. About 12 million Americans have COPD. In a given year, the condition will cause 126,000 deaths. Cigarette smoking is the leading cause of COPD. Cigar and secondhand smoke, air pollution and workplace exposure to dust, fumes, smoke, gases and vapors also increase the risk for the condition. COPD tends to develop slowly over time, affecting middle-aged and older adults more than younger people. It’s not contagious. Although COPD has no cure, medical treatment and self-care can improve the symptoms and slow the condition’s progress. Symptoms and treatments People with COPD may find they cough or wheeze a lot, are short of breath and have increased sputum or mucus. Also, physical activity may be a struggle for them. In addition, tests may show their blood is low in oxygen and high in carbon dioxide. The most important test to determine whether a person has COPD is a simple breathing test called spirometry. COPD treatments may include: • Bronchodilators, inhaled steroids, antibiotics or all three • Supplemental oxygen • Pulmonary rehabilitation (a program of breathing help that can include exercise or nutrition training) • Flu and pneumonia vaccines Making the following lifestyle changes can also help you manage the symptoms of COPD: • Don’t smoke. Talk with your doctor if you have trouble quitting. • Avoid secondhand smoke, air pollution and other lung irritants. • Take all medications as prescribed. • Adjust your physical activities to accommodate your energy level. Avoid climbing stairs, for instance. Asking for support from friends and relatives can help make living with COPD easier and less stressful. In addition, if you have any concerns, talk with your doctor or call Independent Health at 1 (800) 501-3439, Monday through Friday, from 8 a.m. to 5 p.m., and ask to speak to one of our Health Coaches. Should aspirin be part of your daily routine? Cardiovascular disease results in one of every three deaths in the United States. There are many effective ways to take control of your heart health, such as understanding your risk for heart disease, increasing regular physical activity, and eating fresh fruits, vegetables and foods low in sodium, saturated fats, trans fat and cholesterol. Treating heart disease also means following your doctor’s advice for medicines and taking aspirin, if advised by your doctor. Research now shows that aspirin reduces the risk for another heart attack or stroke. How can aspirin help? Aspirin is part of a group of medicines called salicylates. When you take it, your body stops producing substances that cause blood clots, swelling, pain and fevers. By preventing blood clots from forming in blood vessels, low-dose aspirin may reduce your risk for heart attack and some types of stroke. Talk with your doctor about taking a recommended dosage daily if you: • Are a man between ages 45 and 79 or a woman ages 55 to 79 • Have heart disease in your family • Have high blood pressure, high cholesterol or diabetes • Smoke • Have had a heart attack or stroke before Talk with your doctor People who should avoid taking aspirin include those with bleeding disorders or an aspirin allergy. For many others, the benefits of daily aspirin outweigh the risks. Therefore, you should never start— or stop—taking regular aspirin unless you’ve discussed it with your doctor. independenthealth.com 13 prenatal c arE Is labor induction right for you? When you’re pregnant, it can feel like a long wait to have your baby. And if your labor is slow or late to start, you may begin to feel impatient. In some cases, no earlier than 39 weeks into your pregnancy, your doctor may offer you a medication or other methods to start your labor. This is called inducing labor. Health risks Inducing labor has become a fairly common practice. It helps new mothers and doctors plan for birth. But studies show that it may cause health risks for mothers and their babies. Some of these risks include: • More cesarean section (C-section) deliveries. One study showed that one-third of women who were induced had a C-section. Only onefifth of those who were not induced had a C-section. Having a C-section can cause the baby to have breathing problems and a reaction to the medication used to induce labor. It can also cause more bleeding, a risk for infection and a longer recovery time for the mother. • Preterm birth. It’s hard to know exactly when a baby is conceived. If you are induced, your baby might not yet be full term. Babies born just a few weeks early can have more problems with feeding, breathing, temperature control and jaundice. • Problems with the umbilical cord, such as a compressed cord. This can limit the baby’s oxygen supply and cause serious problems. • Lowering of the baby’s heart rate. The drug given to induce labor can lower the baby’s heart rate during birth. When induction is necessary Sometimes labor is induced for medical reasons. This might happen when the mother has a medical problem, such as diabetes or an infection. In these cases, the benefits of inducing labor may outweigh the risks. If your doctor suggests inducing labor, be sure to ask about the risks and benefits for you. It’s important to assess your health before pregnancy If there’s a chance that you could start a family soon, take time to take stock of your health. The Centers for Disease Control and Prevention provides guidelines that advise women to focus on their health before they become pregnant—for the first time or the next time. It’s best to check in with your doctor before conception, if possible. During your doctor’s visit, you can review your health history, as well as your family’s. In addition, your doctor may advise you to take these steps: • Get 400 micrograms of folate daily. Folate can be found in asparagus, broccoli, romaine lettuce, spinach and orange juice. You can get folic acid by eating fortified breakfast cereal and enriched breads and pastas, or by taking a folic acid supplement, doctor-recommended prenatal vitamins and some multivitamins. Folate can reduce the risk for birth defects. 14 • Make sure you’ve had all the vaccinations and preventive health screenings you need. • Tell your doctor about any prescription and over-the-counter medicines you take. • Stop smoking if you smoke. Women who smoke risk premature birth or birth defects. • Avoid alcohol because you may become pregnant and not know for several weeks or more. • Lose weight if you are overweight. This can reduce the risks for complications during pregnancy, including type 2 diabetes and heart disease. • Manage any medical conditions you have, such as asthma or diabetes. Another way to protect your baby is to steer clear of certain harmful substances. For example, avoid chemicals such as fertilizers and pesticides. The same goes for secondhand smoke. HealthStyles | Spring/Summer 2013 prenatal c are gu i deli ne s immunizations counseling and Education Services/Screening Tests Exam Frequency This chart outlines the services that are generally provided at each visit during the course of a woman’s pregnancy. If you’re planning to become pregnant, we recommend that you speak with your doctor first. It’s important to talk about your health and lifestyle to make sure that your pregnancy is as healthy as it can be. Visit 1 6 to 8 Weeks Visit 2 12 Weeks Visit 3 16 to 18 Weeks (Monthly) Visit 4 22 Weeks (Monthly) Visits 5 and 6 28 and 30 Weeks (Every 2 Weeks) Visits 7 and 8 32 Weeks (Every 2 Weeks) Visits 9 and 10 36 Weeks (Every 2 Weeks) Visits 11 to 13, 38 to 41 Weeks (Weekly) Risk profiles Height and weight OB history and physical CBC (complete blood count) Rubella (German measles) Varicella (chickenpox) Rh factor Urine culture Hepatitis C/HIV Domestic abuse Sickle cell Pap test Sexually transmitted diseases Thyroid screening Weight Blood pressure Fetal heart tones Weight Blood pressure Fetal heart tones Screening for possible birth defects Sonogram (optional) Uterus height Weight Blood pressure Fetal heart tones Uterus height Assess infectious disease risk Preterm labor risk Weight Blood pressure Fetal heart tones Uterus height Diabetes with pregnancy/ glucose tolerance testing Domestic abuse screening Rh antibody status CBC and platelets Weight Blood pressure Fetal heart tones Uterus height Weight Blood pressure Fetal heart tones Uterus height Confirm fetal position Culture for Group B strep Screen for Depression Weight Blood pressure Fetal heart tones Uterus height Vaginal exam Lifestyle/nutrition Warning signs Course of care Body changes during pregnancy Testing for risks in pregnancy Smoking cessation Alcohol and drug abuse HIV Fetal growth Review lab results Breast-feeding Body mechanics Emotional changes Second-trimester growth Baby movement Lifestyle Body changes during pregnancy Preterm labor signs Prenatal classes Family issues Length of stay Diabetes with pregnancy Rhogam Work activity Physiology of pregnancy Preregistration Fetal growth Awareness of fetal movement Preterm labor symptoms Repeat cesarean section vs. vaginal birth after cesarean—risks and benefits Travel Sexuality Pediatric care Episiotomy Labor and delivery issues Warning signs/ pregnancyinduced hypertension Postpartum care Management of late pregnancy symptoms including depression Contraception When to call provider Postpartum vaccinations Infant CPR Post-term management Labor and delivery update TD (tetanus/ diptheria) booster Nutritional supplements (if needed) Hepatitis B (if needed) independenthealth.com Rhogam Influenza These guidelines are an overview of what pregnant women should expect at each prenatal visit. They are a framework for the evaluation, care, and medical treatment of expectant mothers. They should not be considered a replacement for the judgment of a doctor or other health care professional. Postpartum Visit 4 to 6 Weeks After Delivery Interval history Weight Blood pressure Breasts Abdomen Pelvic examination Incision/episiotomy evaluation Uterine height Emotional status Depression screening Contraception 15 healthstyles The Wellness Magazine for Independent Health Members Postmaster: Please deliver between May 6 and 10. PRSRT STD US Postage PA I D Independent Health 511 Farber Lakes Drive Buffalo, NY 14221 david courtney Vice President, Servicing keith page Editor Material published in HealthStyles® is not intended to provide personal medical advice. Consult your physician before making changes in your health care regimen. Benefits discussed in HealthStyles® may vary by plan. © 2013 Printed on Recyclable Paper 530M Are you part of the hypertension epidemic? The silent killer lurks in the bodies of about 68 million Americans. It often causes no warning signs. And as it spreads, it’s striking at younger ages. It’s not a vicious bug in a horror movie— it’s high blood pressure, and it contributes to about 1,000 U.S. deaths each day. High blood pressure is a major risk factor for heart disease, stroke, kidney disease and other life-threatening illnesses. Fortunately, treatment and lifestyle changes can help keep this problem in check. Younger generations at risk Blood pressure tends to rise with age. People ages 55 and older are still at highest risk for hypertension. However, the childhood obesity epidemic has increased the number of young patients. According to a new study in the journal Hypertension, the number of children hospitalized with high blood pressure nearly doubled over a 10-year period. Other risk factors include: • Family history • Smoking • Lack of exercise • Poor diets with too much salt and unhealthy fats High blood pressure typically has no symptoms. But inside your body, your blood is pushing harder against your blood vessels. Over time, this pressure can weaken vessel walls; damage organs, such as your kidneys and eyes; and cause blood clots that lead to heart attack and stroke. Turning the numbers around No matter your age, a healthy lifestyle can reverse high blood pressure or prevent it from developing. Start by: • Changing your diet. Add fruits, vegetables and whole grains. Decrease saturated and trans fat, cholesterol and salt. • Maintaining a healthy weight. • Coping with stress through exercise, music or other relaxation techniques. Time for a change? • Getting at least 30 minutes of physical activity most days of the week. This may be especially important for people with a family history of high blood pressure, according to a recent study. Have your blood pressure checked regularly. The top number should be lower than 120 mm Hg, and the bottom number lower than 90 mm Hg. Your health care team, including your doctor and pharmacist, may recommend medications to bring high numbers down. Our Health Coaches can help you make lasting lifestyle changes to achieve better health. To learn more, call 1 (800) 501-3439, Monday through Friday, from 8 a.m. to 5 p.m., and ask to speak with a Health Coach.
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