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

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1 ILLINOIS 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 registered nurse or licensed clinical social worker. He or she can help the member with issues. These include: Complex medical needs; Behavioral health 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. You may be eligible to receive this service at 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; HIV/AIDS; and Depression. 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.

2 Start Earning Rewards Now! The Healthy Behaviors Program rewards you for taking steps toward a healthy life. What happens when you complete a healthy behavior? We ll send you a $20 CVS Select gift card. Complete another healthy behavior? We ll load another $20 onto your card. It s that simple. Just complete your first healthy behavior. You will then receive the gift card in the mail. Keep making the healthy choices shown on the chart below. As you do, we ll add more rewards to your card. Money will be automatically reloaded to your card. Please keep it in a safe place. When you get these Healthy Behaviors services we ll give you these rewards First Harmony PCP visit: See your primary care provider (PCP) within 90 days of becoming a Harmony member Annual newborn well-child visit: Take your child to wellness visits from birth to age 15 months (reward given for each visit, up to six visits) Annual child health checkup: Take your child for checkups when he or she is ages 3 to 6 (reward given for each visit) Adolescent checkup: Take your child for checkups when he or she is ages 7 to 21 (reward given for each visit) Prenatal care visits: Go to six doctor visits before your baby is born Postpartum care visit: Visit your doctor after your baby is born Healthy Behaviors for New Members Healthy Behaviors for Kids Healthy Pregnancy Behaviors and your choice of a stroller or portable playpen Go to all your doctor visits before and after your baby is born and get an extra $20 reward 2 Member Newsletter

3 Well-Woman Healthy Behaviors Cervical cancer screening (Pap test): For members ages 21 to 64 Mammogram: For members ages 40 to 65 Diabetes Healthy Behaviors Program Eye exam: For members ages 18 to 75 who have diabetes Blood sugar level control (HbA1c): Reach a level lower than 8% LDL ( bad cholesterol) level control: Reach a level lower than 100 You can use your gift card to buy health-related items you use every day. This includes things like vitamins, pain-relief medicine, baby items and other over-thecounter items. Examples of items that you can t purchase are alcohol, cosmetics, candy and tobacco. Do you have questions? Please call Member Services. The number is on the back page. We re here to help! Need a Ride to Your Appointment? Your health and well-being are important. So getting a ride to the doctor shouldn t get in the way. That s why we offer FREE, UNLIMITED nonemergency medical transportation. Use the free rides whenever you need them. Transportation covers only the following: Family hospital visits; Pharmacy and medical equipment providers; and Women, Infants and Children (WIC) food assistance. Call Member Services at least 48 hours before you need a ride. Member Newsletter 3

4 Start Your Tobacco-Free Life With a Successful Quit Day Have you decided to finally quit tobacco? Then 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-YES ( ) 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 Services. The number is on the back page. Ask for the Disease Management Department. 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 The Health Benefits of Quitting Heart and circulation improve 1MINUTE 10YEARS 3-6MONTHS Easier to breathe Cancer risk cut in half Stroke, heart attack and lung disease risks drop 1YEAR 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. Source: Centers for Disease Control and Prevention, Health Effects of Cigarette Smoking, retrieved from 4 Member Newsletter

5 Harmony in the Community: Quality All-Star Maritza Zeno Shares Her Story At Harmony, 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 providers. 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. My job is to help members apply for this type of government benefit. I contacted the Social Security The member s mom was very appreciative. She sent me a thank-you with a picture of her son attached. 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 thankyou 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 Harmony 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: Responded to reported quality concerns; Encouraged you to go to well visits, including mammograms, eye exams for those with diabetes, immunizations and more; Met your language, cultural and ethnic needs; Made sure you could reach doctors by phone, get a timely appointment and find a doctor near your home; Made sure Harmony answered your calls quickly; and Ensured that claims were paid accurately. We will continue to ask if you are satisfied. This helps us make sure you are pleased with us and your doctors. We will ask what your doctor(s) think of our service. We ll use that feedback to improve. We will continue to review and update our guidelines. This will help us keep a safe and healthy environment for your care. Want to receive a copy of our Quality Improvement Program description? Call Member Services. The number is on the back page. Here are some of our goals for 2015: We will continue to measure the quality of the care and services you receive. We will continue working with you and your doctor(s). Together, we can meet your health care needs. We can also coordinate your health care. This improves the quality of service. 6 Member Newsletter

7 Team Up to Keep Asthma Under Control Do you have asthma? You and your health care provider can team up to keep it under control. Here are some parts of a long-term asthma strategy: You should receive a written asthma action plan. You should get regular asthma checkups. Your checkup may include a test called 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. Some will be for long-term control and some for quick relief. 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. This is the key to success. Source: National Heart, Lung, and Blood Institute, Tips for Getting Prescriptions Filled When your doctor gives you a prescription, go to a network pharmacy to get it filled. Show your Harmony member ID card. Want to find the latest about the drugs we cover? Visit our website. That s where you ll find our Preferred Drug List (PDL). Just go to You can also call us for updates. The phone number is listed on the back page. 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 Harmony. Also, Harmony does not guarantee any health results. You should review your 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 Harmony Health Plan, Inc. 29 North Wacker Drive, Suite 300 Chicago, IL PRSRT STD U.S. Postage Paid Wellcare Health Plans Para solicitar este documento en Español, llame al Servicios para Miembros al (TTY ). IL028542_CAD_NEW_ENG_Internal Approved WellCare 2015 IL_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: Tips on how to better manage asthma; 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 10867MI