Member Newsletter. The PacificSource Pharmacy Program. PacificSource Quality Improvement Goals for Better Care. Fall 2015

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1 Member Newsletter Fall 2015 PacificSource Quality Improvement Goals for Better Care Our Quality Improvement Program provides a framework to make sure that you as a member have access to high-quality healthcare that is effective, safe, and results in positive outcomes. The program is driven by our company values and our strategic goals and objectives: Embracing Triple Aim enhancing patient experience and quality, cost effectiveness, and improving population health Creating a supportive, simple, and convenient member experience Creating care management models that enhance, support, and coordinate with community- based services Our 2015 Annual Quality Improvement Work Plan encompasses more than 35 initiatives. It covers the areas of clinical quality improvement, service quality improvement, and improvement of patient safety and coordination of care. We use internal and external benchmarks to identify areas for quality improvement projects as well as monitor and measure our ongoing performance. You can view our 2015 Quality Program Highlights and Progress plan at PacificSource. com/yourplan/#quality. The PacificSource Pharmacy Program If your health plan includes a prescription drug benefit, understanding these benefits and knowing which drugs are included on your plan s drug list can help you and your doctor better coordinate your care. With that in mind, we strive to make sure that you have access to the latest news and updates about our prescription drug lists, 24/7. You ll find comprehensive information about our pharmacy program on our website at PacificSource.com/drug-news, including: The PacificSource Drug List, including restrictions and preferences, as well as regular updates to the Drug List How to use the pharmaceutical management procedures, such as preauthorization requirements Explanation of limits or quotas How to provide information to support an exception (prior authorization process) Generic substitution, therapeutic interchange, and step-therapy protocols If you have questions about our prescription drug lists or your pharmacy benefits, you re welcome to contact our Customer Service Department.

2 My Choice Rewards from CaféWell When you make choices that are good for you and your health, it s nice to be rewarded for your efforts. Our wellness portal for members CaféWell just got better. The My Choice Rewards program is now available through CaféWell.* This rewards system allows you to earn savings credits for completing healthy life activities. You may also earn credits for staying current on preventive services, such as well visits and agerelated screenings. Your savings credits reflect the dollar amount you can apply toward merchandise and travel discounts. Though items have discount limits, you ll experience great savings toward a variety of items. Getting Started Reward yourself! Get started with CaféWell today to start earning savings credits for your healthy life choices. Visit PacificSource. com, and log into or register for InTouch. From your InTouch home page, click the CaféWell button. Need more help? Check out our CaféWell resources at PacificSource.com/ cafewell. *Please note: Program exclusions may apply if you are enrolled in a PacificSource health plan through an employer who has implemented a company-specific rewards program within CaféWell. If you have questions about My Choice Rewards program eligibility, you re welcome to contact our Customer Service Department. Tobacco Cessation Outreach Calls We all know it s difficult to quit tobacco, but it s easier with someone to help you. The Quit For Life program has helped thousands of people, including PacificSource members, take control of their lives and their health by quitting tobacco. If you ve taken the health assessment through the CaféWell health portal and indicated that you re a tobacco user, you may have received a call from a Quit For Life program representative (or you may receive a call in the future). Representatives are making these calls to tell members about the program and invite them to participate. If you choose to participate, you ll be transferred to a Quit Coach to begin the coaching program. If you re a tobacco user and you haven t taken the health assessment or don t want to wait for a phone call, you can take the first step toward quitting. Visit PacificSource.com/ member/tobacco-cessation to learn more about the Quit For Life program, brought to you by the American Cancer Society and Alere Wellbeing. 2

3 Dental Anxiety? Preparation Can Help Many people have anxiety or fear about going to the dentist. Those fears can prevent people from getting dental care, which results in wasted benefits and potential harm to oral health. The good news is there are things you can do to prepare for your appointment so it s not quite so scary. Here are a few tips to help you make the most of your dental check-up: Know what to expect. During a check-up, you can expect a cleaning and exam. Your dentist may also talk to you about how to best care for your teeth, especially if they see any problems during the examination. If you re establishing yourself as a new patient, your dentist may also take x-rays of your teeth. Write down your questions before your appointment. It s easy to forget questions when you re at your appointment. Write them down before you go so you don t have to rely on memory. If you have anxiety about dental visits, tell your dentist. You re not alone. If your dentist knows about your fear, he or she can help make you more comfortable during the visit. Ask questions. During your check-up, if your dentist explains something that you don t understand, ask for more information or for him or her to rephrase what was said, and then write down the answer. Good dental health is important to your overall well-being. Don t have dental coverage? Explore our dental plans on our website at PacificSource.com. How to Get Help from a Case Manager Case management is a service available to all PacificSource members who have complex medical conditions and require support to manage their healthcare needs. It is a service aimed at improving health outcomes, increasing member satisfaction with their healthcare, and reducing healthcare costs. Our case managers are registered nurses and licensed mental health professionals with extensive clinical experience. They work collaboratively with you and your healthcare providers to provide improved clinical, humanistic, and financial outcomes for you. Case management can be of great help to members experiencing a wide range of complex medical issues, such as: Extended hospital or skilled nursing care Cancer diagnoses, especially those needing help with a new diagnosis Children with special needs Chronic and/or rare diseases and conditions Eating disorders, such as Anorexia Nervosa or Bulimia Nervosa Think you might benefit from case management? If you think you might benefit from case management, you re welcome to contact our Health Services Department, Monday through Friday, from 8:00 a.m. to 5:00 p.m.: Oregon: Phone: (541) Toll-free: (888) Fax: (541) Idaho: Phone: (208) Toll-free: (800) Fax: (208) Montana: Phone: (406) Toll free: (877) Fax: (406) TTY: (800) Language assistance: (541) or (800) ext Use the online form on our Contact Us page. 3

4 Everyday Tips for Financial Health There are many common tips for financial health; we re often advised to create a budget, establish an emergency fund, and save for retirement. These big-picture tips are great, but there are also little things you can do every day to keep on track. Try some of these tricks to stay financially healthy: 1. Recognize needs vs. wants. Do you need that afternoon latte, or just really want it? Ask yourself before each purchase if it's a need or a want. If it's just something you want, are there less expensive or free alternatives? 2. Save your pennies. Dig your loose change out of your pockets at the end of each day, and toss it in a change jar then stay out of it! You'll be surprised how quickly the savings add up. 3. Fix broken items. Do you have chipped coffee cups, wobbly chairs, or a tear in your sheets? Try fixing broken items before spending money to replace them. 4. Track your spending. For one week, write down everything you spend down to the last penny. At the end of the week, add it up. How much did you spend on dining or recreation? Identify areas where you may be able to cut back. 5. Have date night or family night at home. Instead of going out to dinner and a movie, try a new recipe and settle in with movies or board games at home. Schedule it ahead of time and make it something special to look forward to. 6. Simplify your life. What are you spending money on that you can live without? Maybe you're paying for a cable package with more than 150 channels when you only actually watch three. 7. Count your working hours. How many hours do you have to work to dine out two or three times a week or buy lunch every day? By thinking about your purchases in terms of work time instead of the dollar amount, you might rethink some of your buying decisions. 8. Carry cash. When you use a debit card, it can be easy to lose track 4 of how much you're spending. When you use cash for day-to-day buys, you can actually see your funds diminish, and you might think twice about spending your last five dollars on something you don't need. 9. Wait 24 hours. Impulse buys and the desire for instant gratification can get the best of us. The next time you see something you want to buy, but weren't planning on buying, wait 24 hours. Chances are it won't be worth going back for. 10. Ask yourself if an item is treasure or trash. Before buying something, ask yourself if it would be a longlasting, well-used item, or if it's likely to end up in the trash or in a garage sale.

5 Transitioning from a Pediatrician to a PCP If you or someone on your health plan is 18 years old or turning 18 this calendar year, it s time to consider transitioning to a primary care provider (PCP) for adults. This type of PCP can be a provider who specializes in family practice, general practice, geriatrics, internal medicine, or obstetrics-gynecology. Why Choose a PCP When you choose a PCP, you re partnering with a doctor you trust. This makes it easier to coordinate your care, achieve your health and wellness goals, and see the big picture of your health. How to Designate a PCP When you re ready, there are a couple of ways to designate your PCP: Use InTouch, our secure member portal. Register for or log into InTouch at PacificSource.com. Select Tools. Select Find a Doctor or Hospital. Enter information in the search fields to find a specific PCP, or search the directory. When you find the PCP you want, select Set as my PCP. Contact Customer Service. Our friendly Customer Service staff is happy to help you designate your PCP. Idaho: (800) Montana: (877) Oregon: (888) cs@pacificsource.com For more information about PCPs, provider networks, office visits, and more, visit PacificSoure.com/healthinsurance-101/video-FAQ. Find a Doctor and Information about Doctors Use our online Provider Directory at PacificSource. com/find-a-provider to find a doctor or other provider, and more information about those doctors and providers. You can search by specialty, name, location, or other details to access a list of providers that fit your criteria. Or you can create your own personalized provider directory to download and print. To maximize your plan's benefits, always make sure your healthcare provider is a PacificSource participating provider. If you receive services from a nonparticipating provider, it may result in greater out-of-pocket costs. For help finding doctors, dentists, and hospitals in your area, you re welcome to contact our Customer Service Department. Information about Covered Services and Benefits Your PacificSource member handbook or policy provides specific information about benefits and services covered by your plan. This information is available to you 24/7 online through our secure member portal, InTouch for Members. You'll need to register when you use InTouch for the first time. You'll find a link to the registration page on PacificSource.com. All you need is a valid address, your member ID number (you'll find this on your member ID card), or your social security number. You can find more information about your plan at PacificSource.com/yourplan. If you have a question about your benefits, you're welcome to contact our Customer Service Department. 5

6 ICD-10: What It Means for You There s been a big change in healthcare that could potentially affect you. On October 1, 2015, the Centers for Medicare and Medicaid Services (CMS) required all healthcare agencies covered under the Health Insurance Portability and Accountability Act (HIPAA) to update to the new ICD-10 coding system. This includes health insurance companies (such as PacificSource) and all healthcare providers. ICD-10 replaced the outdated coding system, ICD-9, and relates to your diagnosis when you see your doctor. For example, if you have a diagnosis of diabetes, your doctor will send us an ICD-10 code that is specific to the diagnosis, which is entered on your claim so that we can reimburse your doctor appropriately. In most cases, the transition to ICD-10 will not affect you. All healthcare providers and healthcare agencies have been aware of this transition and have been advised to prepare for it since Why do I need to know about this coding system? If your provider does happen to bill PacificSource using an old ICD-9 code, we will deny the claim with a new denial code: 6B0. You might see this new denial code on your explanation of benefits (EOB) with this explanation: As of , ICD-9 codes are not accepted. Please resubmit them as a new claim using the appropriate ICD-10 codes. If my EOB shows the denial code, does that mean I have to pay? No, you will not be responsible for charges billed under the outdated ICD-9 coding system. If your provider submits a claim using ICD-9, he or she will receive the denial code and will know to resubmit the bill with the correct ICD-10 code. You won t need to do anything to correct the error. If you have questions about the transition to ICD-10 or how this change affects the status of your claims, you re welcome to contact our Customer Service Department. Air Ambulance Services from Life Flight Network In serious medical emergencies, you can have greater peace of mind knowing you have expanded coverage for air transportation. As of October 1, 2015, Life Flight Network (LFN) is a participating provider for all of our commercial medical plans. If you use their services, you ll have lower out-of-pocket costs and no balance billing meaning LFN won t bill you for the difference between the amount PacificSource covers and the total cost of the service. LFN is the nation s largest not-for-profit air medical service. They have provided residents across the Northwest and Intermountain West with reliable air medical transport for more than 36 years. Based in Aurora, Oregon, LFN strategically locates its bases to provide maximum coverage to the communities it serves. Visit LifeFlight.org for more information. 6

7 WHY SHOULD YOU GET A FLU SHOT? Because chicken soup is better when you can actually taste it. Flu vaccines are designed to protect against the influenza viruses that are expected to be the most common during the upcoming season. Where can I get more information about the flu? There are several online resources available to you: How long is someone contagious before symptoms start? An individual is contagious one to two days before symptoms start. Find or Confirm a Participating Pharmacy: To determine if a pharmacy is part of our flu shot pharmacy network, please refer to our Pharmacy Network Directory at PacificSource.com/flu (updated July 15, 2015). For the best benefit and least out-of-pocket expense, visit a participating CVS Caremark vaccine clinic network pharmacy. If your pharmacy is not a member of the vaccine network (CVS Caremark s vaccine clinic network), you may need to pay additional for the vaccine based on your plan s deductibles, co-pays, and co-insurance. PacificSource.com/flu How long can an infected person spread the flu virus to others? People infected with seasonal flu may be able to infect others from one day before getting sick and up to seven days after. This infectious period can be longer with some people, especially children and people with weakened immune systems. WebMD.com/cold-and-flu Flu.gov (national website) Flu.oregon.gov Is the flu vaccine a shot, or is it available in other forms? Seasonal flu vaccine is available as a nasal mist and as an injection. However, health officials recommend that pregnant women, children younger than two, and people with asthma and other chronic respiratory diseases receive the injectable vaccine. How long does it take for the vaccine to work? After vaccination, most people are immune within 8 to 10 days. 7

8 PO Box 7068 Springfield OR Have you moved? To update your address, talk to your employer, or visit PacificSource. com/newaddress. Feel free to contact us toll-free: Idaho: (800) Montana: (877) Oregon: (888) Join the conversation! What s inside: PacificSource Quality Improvement Goals for Better Care The PacificSource Pharmacy Program My Choice Rewards from CaféWell Tobacco Cessation Outreach Calls Dental Anxiety? Preparation Can Help How to Get Help from a Nurse Case Manager Financial Health Tips Transitioning from a Pediatrician to a PCP Find a Doctor and Information about Doctors ICD-10: What It Means for You Air Ambulance Services from Life Flight Network Why Should You Get a Flu Shot? Go Paperless! Get the Member Newsletter by Help us reduce our reliance on paper resources by choosing to receive the Member Newsletter, as well as notices of your billing and Explanation of Benefit statements, by . Here s how: 1. Go to PacificSource.com. 2. Log into or register for InTouch for Members. 3. Select My Profile. 4. Choose the options you prefer. The notices will alert you when a new statement is available in InTouch. Note: All covered adults in your household, such as your spouse, would also need to opt out of paper. This newsletter is provided for general information only and is not to be used to determine benefits. Your benefits are determined only by your policy. Please refer to your plan materials or our Customer Service Department for specific benefit information. Printed on 10 percent post-consumer recycled paper. MemberNewsletter-Fall 2015