How Care Management Can Help You. Disease Management Program. MISSOURI 2015 ISSUE ii

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1 MISSOURI 2015 ISSUE ii How Care Management Can Help You Got a question or concern about your health? Care Management helps members with special needs. It pairs a member with a care manager. The care manager is a nurse. He or she can help the member with issues. These include: Complex medical needs; Solid organ and tissue transplants; Children with special health care needs; and Lead poisoning. We re here to help you! Call us for more information. The number for Member Services is on the back page. Ask for the Care Management Department. This service is no cost to you. Disease Management Program Disease Management is similar to Care Management. The program supports members with health problems. These may include, but are not limited to: Asthma; Diabetes; Hypertension; Heart disease; and HIV/AIDS. Do you have any of these conditions? Are you interested in this program? Please call Member Services. The number is on the back page. You can get educational materials. In some cases, you may get coaching from a registered nurse. MOC15066

2 The Care You Need While You re Pregnant Moms-to-be and their babies need to be healthy. Prenatal care is the special health care you get while you re pregnant. See your health care provider as soon as you think you are pregnant. Most experts say you should see your health care provider: Once a month for the first six months; Every two weeks in months seven and eight; and Every week in month nine. Everyone is different. Your provider may need to see you more often. Follow his or her advice and take your prenatal vitamins. At prenatal visits, your provider will check to see how you and your baby are doing. He or she may: Ask about your health and pregnancy history; Ask about your family s health history; Give you a complete physical exam; Figure out your due date; Answer your questions; Check your baby s growth; Check your baby s heart rate; and Educate you about you and your baby. See your provider early and often. This may help you have a healthier baby. Don t miss any of your prenatal visits. They are all important! Do you have concerns or questions about the health of you and your baby? The Nurse Advice Line is there for you. Talk with a nurse 24/7 at no cost to you. The toll-free number is (TTY 711). Source: U.S. Department of Health and Human Services, Prenatal Care Fact Sheet, retrieved from publications/our-publications/fact-sheet/prenatal-care.html 2 Member Newsletter

3 Screenings for Women s Health Screenings can save lives. They can find illnesses before you have symptoms. Breast Cancer and Mammograms A mammogram can find breast cancer early. You can get it at no cost to you. It s one of your covered benefits. Women ages 40 and older should have one every one to two years. Women at higher risk may need them more often. Screening for Cervical Cancer A Pap test screens for cervical cancer. Cervical cancer occurs in the lower part of the uterus. Most women should have a Pap test every two years. This should start at age 21. Screening for Chlamydia Chlamydia spreads through sexual contact. It can cause infertility. It can also increase risk for HIV. Studies have also shown a link between chlamydia and higher risk for cervical cancer. There are often no symptoms. Regular screenings may be the only way to find it. Women ages 25 and younger who are sexually active should be tested. So should women older than age 25 who have a new partner or have more than one partner. Talk with your primary care provider. Find out about testing in your area. Visit STDTesting.aspx. Colorectal Cancer Screening Screen for colorectal cancer every one to 10 years beginning at age 50. A colonoscopy is the most accurate screening method. But there are other methods to consider. Sources: National Cancer Institute, Breast Cancer, retrieved from types/breast, and Cervical Cancer, www. cancer.gov/cancertopics/types/cervical Womenshealth.gov, Chlamydia Fact Sheet, retrieved from publications/our-publications/fact-sheet/ chlamydia.html Member Newsletter 3

4 Start Your Tobacco-Free Life With a Successful Quit Day Have you decided to finally quit tobacco? If so, congratulations! Cigarettes, pipes, hookahs and smokeless tobacco are all bad for you. Quitting is one of the best things you can do for your health. Now you can focus on that first step your Quit Day. This is the day you begin a tobacco-free life. Here are some tips for getting through your Quit Day. They come from Reach Out for Support Use a support program. Call QUIT- NOW ( ) to learn more. Are you using medications like gums or patches to help you? Use them as directed. Our Disease Management Department can help. Get educational materials and advice on how to quit. Call Member The Health Benefits of Quitting Services. The number is on the back page. Ask for the Disease Management Department. Keep Busy Stay as busy as possible on your Quit Day. Go to a movie or take long walks. Spend time in places where smoking isn t allowed. Do you miss having a cigarette in your hand? Hold something else. Try a pencil. Have a craving? Try chewing on gum, hard candies, toothpicks, or carrot or celery sticks. Drink plenty of water or fruit juice. But avoid drinks that may be triggers. This could be alcohol or coffee. Source: Steps to Take on Your Quit Day, retrieved from Heart and circulation improve 1MINUTE 3-6MONTHS Easier to breathe Stroke, heart attack and lung disease risks drop 1YEAR 10YEARS Cancer risk cut in half Source: Center for Disease Control and Prevention, Health Effects of Cigarette Smoking, retrieved from 4 Member Newsletter

5 Missouri Care in the Community: Quality All-Star Maritza Zeno Shares Her Story At Missouri Care, we know our members have unique needs. And we want to address them all. That s why we use a team approach to care. We involve members, their families and their primary care physicians. We also work with community groups and government programs. Together, we deliver health care seamlessly. Here is an example from Quality All-Star Maritza Zeno. She s a social service specialist. Recently, she helped a family get financial support. This helped them manage a severe illness. A member s newborn son was diagnosed with Kawasaki disease. This condition causes inflammation in the arteries. It is usually treatable. But in this case, it had damaged arteries around the boy s heart. The mother had applied for special federal benefits twice. She had been denied both times. The member s mom was very appreciative. She sent me a thank-you with a picture of her son attached. My job is to help members apply for this type of government benefit. I contacted the Social Security Administration. I asked to get the case reopened. They told me what they told the mother. We would need to send an appeal for a hearing. I then asked to speak with the operations manager. I was able to get the case reopened. The case was approved. The member s mom was very appreciative. She sent me a thank-you with a picture of her son attached. Dealing with health care and social services can be challenging. We can help. Call Member Services. The number is on the back page. You may be eligible to get this service at no cost. Member Newsletter 5

6 Team Up to Keep Asthma Under Control Do you have asthma? Team up with your doctor to form a long-term asthma strategy: You should receive a written asthma action plan. You should get regular asthma checkups. Your checkup may include a spirometry. This measures how much air you can inhale and exhale. It also tests how fast you can push air out of your lungs. You ll get medication. You ll find out about allergens or irritants you ll want to avoid. Remember that asthma can change over time. That means your action plan may have to change, too. Work with your provider on a regular basis. Source: National Heart, Lung, and Blood Institute, retrieved from Missouri Care s Commitment to Quality Quality is one of our most important goals. We want to make sure you are getting the right care for your health. In 2014, the Quality Program did many things to improve the quality of your health care. The program: Created rewards programs for getting preventive screenings and wellness visits; Encouraged members to go to well visits; Met members language, cultural and ethnic needs; Made sure Missouri Care answered calls quickly; Ensured claims were paid accurately; Encouraged coordination of care between providers and specialists; and Provided information about Missouri Care s services at community events. Here are some of our goals for 2015: Reward members for healthy behaviors and encourage providers to close care gaps. Coordinate members health care. Continue to ask if members are satisfied. Ask what providers think of our service. We ll use this feedback to improve. Review and update our guidelines. Improve members health care through Care Management and Disease Management. Monitor members care through medical record review. For more information about our Quality Improvement Program, call Member Services. 6 Member Newsletter

7 Help Is Available for Substance Abuse Problems Anyone at any age can get into trouble with drugs and/or drinking. People often use drugs and/or alcohol to relieve stress or deal with emotional pain. Drugs and/or alcohol may seem to work for a while. But they only make things worse in the end. What is a substance abuse problem? It is any drinking and/or drug use that harms the user or puts others at risk. The good news is substance abuse can be treated. You can talk with your doctor or a substance abuse counselor. Ask him or her for help to quit. Be honest. Talk about what you use, how much and how often. Anything you say will be kept confidential. The following are some helpful resources: Substance Abuse and Mental Health Services Administration: SAMHSA 24/7 Treatment Referral Line: HELP (4357) Partnership for a Drug-Free America: Narcotics Anonymous: Cocaine Anonymous: Alcoholics Anonymous: Missouri Department of Mental Health: Sources: Substance Abuse Consumer Fact Sheet, NC Division of Mental Health, Developmental Disabilities and Substance Abuse; Health Bulletin #61, New York City Department of Health and Mental Hygiene Always talk with your doctor(s) about the care that is right for you. This material does not replace your doctor s advice. It is based on third party sources. We are presenting it for your information only. It does not imply that these are benefits covered by Missouri Care. Also, Missouri Care does not guarantee any health results. You should review your health plan or call Member Services to find out if a service is covered. Call 911 or your doctor right away in a health emergency. Member Newsletter 7

8 P.O. Box Tampa, FL PRSRT STD U.S. Postage Paid Wellcare Health Plans Para solicitar este documento en Español, llame al Servicios para Miembros al (TTY ). MO028539_CAD_NEW_ENG_State Approved WellCare 2015 MO_12_ In This Issue We re pleased to deliver another newsletter issue. It s full of helpful ideas about ways to live healthier. Here s what you ll find inside: Information on pregnancy care and women s screenings; How to start a tobacco-free life; and Information on our Care and Disease Management programs. There s much more inside. Please take a moment to explore. As always, we wish you good health. Numbers to Know We re just a phone call (or click) away! Call Member Services: TTY Monday Friday, 8 a.m. 5 p.m. CST Or visit Nurse Advice Line: (TTY 711) 24 hours a day/7 days a week 10867MC