Welcome to Optimum Special Needs Plan. In this newsletter, we will give you some general information about your Plan.

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1 Spring 2012 Newsletter In This Issue: About Special Needs Plan What is a Care Plan? Nurse Case Management Education Information Care Transitions Assistance Dual Eligible Members Hospital Admissions Disease Tips: Asthma, Congestive Heart Failure, COPD, Diabetes and Heart Disease Concierge Locations Welcome to Optimum Special Needs Plan. In this newsletter, we will give you some general information about your Plan.

2 Welcome to Optimum Special Needs Plan! What is a Special Needs Plan? Special Needs Plans were developed by Medicare so that people with certain diseases would receive certain services that would help them better take care of their disease in order to stay healthier and more active. How did I qualify to be part of a Special Needs Plan? You became a part of a Special Needs Plan when you enrolled and said that you had a certain disease or that you had both Medicare and Medicaid. The Plan then verified this with your doctor or Medicaid and you became eligible to enroll. What is my Primary Care Physician responsible for when I am a part of this Plan? Your Primary Care Physician (PCP), through Medical Home, is responsible for managing all of your health and to make certain you are getting all the medically necessary services you need to better take care of yourself. Your PCP is responsible in making sure that your care follows certain accepted guidelines or medical practices that have been developed by specialists in the field of your disease. 2 Your PCP is responsible for making certain that your care follows a Care Plan that has been developed to better manage your healthcare. Optimum HealthCare - SNP Member Newsletter Spring 2012

3 What is a Care Plan? A Care Plan is an established plan that helps everyone who is involved in your care make certain that everything that needs to be done to improve your health is done. These Care Plans are developed using information from nationally accepted guidelines that were developed by leading experts on how to manage certain diseases. These Care Plans are different depending on how much help you may need to reach your health goals. Members are placed into one of three levels of care that are determined from the answers you gave on the Disease Specific Health Assessment you filled out when you enrolled. These Care Plans are sent to your PCP for his/her review and agreement with the plan of care. For those members who fall into Tier 3, you would need the most care and assistance to try to stay healthy. You will be called by a member of the Health Plan Case Disease Management Department who will find out more about your needs. Having a Nurse call you is strictly voluntary and you will be asked during the first phone call if you want to have a Nurse follow your care. Please feel free to say no if you do not want a Nurse to call you or follow your care. If you say yes, you will have a Nurse assigned to you, who will be monitoring your health care. Nurse Case Management If you feel you need the help of a Nurse Case/ Disease Manager, you may request to be contacted by calling and select option to speak to Case/Disease Management or you may ask your PCP to refer you to Case/Disease Management. You will then be evaluated to see if you require short or long term help with your healthcare needs TTY/TDD

4 4 What information will I receive? Initial Educational Booklet o This will be sent to you within the first three months of coming on the Plan. o This will include information about your specific disease and suggestions on how to best manage your healthcare. o Please read this and take it with you to your PCP appointment if you have any questions. o These suggestions, if followed, will help keep you out of the hospital. Quarterly Educational Information About every three months, you will receive another educational mailing with pertinent tips on helping you stay healthy Newsletter Twice a year you will receive a Special Needs Plan Member Newsletter that will have even more helpful information for you. Assistance Through Care Transitions What is a care transition? A care transition is any time you change the location of where your healthcare is being provided. A care transition could be any of the following: Being admitted to the hospital from home Being discharged from the hospital to a Skilled Nursing Facility Being discharged from the hospital to an Acute Rehabilitation Center Being discharged from the hospital back to home whether with or without home health Being admitted from home to a Skilled Nursing Facility All of these moves involve transitioning your care from one group of people to another. What can I do to prepare for a care transition? If you know you will be going into the hospital make sure you understand: Where you will be admitted and what needs to be done before you are admitted What medications you will be able to take or not take before being admitted and while you are in the hospital Will you be going home or need further care in another facility after the admission? What can I do during a care transition? While you are in the hospital or Skilled Nursing Facility and when you are discharged, make certain you: Ask where you will get care after discharge. If you need to receive more care at a Skilled Nursing Facility find out your choice of facilities. Ask if you will need any help at home after discharge. Make sure you understand what activities you can and cannot do. Ask if you will need any special equipment after going home and who will make the arrangements. Ask about your health condition and what you can do to help yourself get better. Ask about problems you need to watch for and what to do about them. Who you should call if you notice any problems. Have names and phone numbers of all the doctors who treated you while in the facility. Understand all the medicines you will be taking when you go home. Some of them may have changed or new ones added. If applicable, you or your caregiver need to make certain you understand how to change any bandages, etc. that may be required after going home. Read and understand your discharge instructions. Optimum HealthCare - SNP Member Newsletter Spring 2012

5 Medicare/Medicaid (Dual Eligible) Members Make sure you keep all your paperwork current with the State about your Medicaid benefits. If you have any questions about how to re-apply for your benefits, you can call Medicaid at (866) or Member Services at (866) Being in a Dual Eligible SNP helps you with the following: Your healthcare claims are paid for by Optimum, which means there is no confusion about what part is paid by Optimum and what part is paid by State Medicaid. You receive all your health benefits from Optimum and do not need to coordinate any care services with State Medicaid. You are able to see any of the participating doctors with the Plan and do not need to worry if they take Medicare or Medicaid. Your plan provides limited cost-sharing which is determined by how much assistance you receive from State Medicaid. This keeps your health care costs affordable. If you have a complaint, grievance or appeal, you can contact Optimum Member Services. It is not necessary to contact State Medicaid. Being Admitted to the Hospital Every time you are admitted to the hospital, have someone call your PCP as soon as possible so he/she knows you are there. Make sure you then see your PCP within 7 days after leaving the hospital. Take all your medicines with you. What can I do after a care transition? Once you have returned home, make certain you do the following: Fill all your prescriptions. Make certain all of your home medical equipment (if ordered) has arrived. Call your Primary Care Physician and make an appointment to be seen within 7 days of going home. Make sure you take all your medicines with you so they can be checked. Call your specialists and make your follow-up appointments (if needed). Make sure you take all your medicines with you so they can be checked. Further information about successful care transitions, is available on our website Select SNP Programs, Tools and Resources, Care Transition and you will be directed to Medicare s Your Discharge Planning Checklist: For patients and their caregivers preparing to leave a hospital, nursing home, or other health care setting. If you would like a copy of this Checklist to take with you when you are admitted, you can call ; TTY/TDD users call Who can I call if I need any assistance? Any questions about your health and your discharge instructions should be directed to the staff in the hospital. They should explain everything fully so you completely understand. Make sure to get your questions answered before you leave. After going home, any health questions should be directed to your Primary Care Physician or Specialist. If you have any questions about care transitions or need help, we have the Case/Disease Management Department that can be of assistance. You can reach this Department by calling ; TTY/TDD users call TTY/TDD

6 Disease Tips ASTHMA Prevent asthma triggers by avoiding or be aware of the following: Tobacco smoke. If you smoke quit. If someone in your home smokes work with them to quit smoking. Call your PCP about what is available through the Plan to help you. Dust Mites Sheets, pillows and blankets should be washed weekly in hot water. Your mattress and pillows should have dust proof covers Pollen during allergy season, try to keep windows closed. Make sure you have a rescue inhaler with you at all times and that you have an Asthma treatment plan from your doctor. CONGESTIVE HEART FAILURE Weigh yourself every day at the same time using the same scale. Call you doctor right away if you have gained more than 3 pounds in 1 day/week. Check your feet and ankles every day for swelling. Take your medicines as directed by your doctor. Watch your salt intake. If you smoke, Quit. 6 Optimum HealthCare - SNP Member Newsletter Spring 2012

7 COPD Take your medicines as directed by your doctor Use your oxygen or c-pap as directed If you smoke, quit. If anyone in your house smokes, encourage them to quit also. If you get a cold or flu, call your PCP right away so he/she can catch any serious problems early. DIABETES Have your HgBA1c checked twice a year and keep your level less than 7 See an eye doctor once a year for a dilated eye exam Check your feet every day for redness or sores. See your doctor right away if any are noticed. Check your blood sugars daily as instructed by your doctor. If you smoke, Quit. HEART DISEASE Keep your blood pressure less than 140/90. If you are Diabetic less than 130/80 Keep your bad cholesterol (LDL) less than 100 Limit use of salt and eating fried and fatty foods Exercise as instructed by your doctor If you smoke, Quit TTY/TDD

8 FEBRUARY 2011 P.O. Box Tampa, FL P.O. Box , Tampa, FL Member Newsletter Member Newsletter H EALTH & WELLNESS I NFORMATION Spring 2012 H e a l t h & W e l l n e s s I n f o r m a t i o n Concierge Service Visit one of our Locations Hillsborough/Pinellas/Polk 5403 N. Church Ave Tampa, FL Phone: (813) ext 1200 Our Local Concierge Centers Offer: Staff to help expedite general issues (replacement cards, PCP changes, etc.) Licensed agents One-hour resolution time and more. 8 Hernando/Pasco/Citrus 8373 Northcliffe Blvd Spring Hill, FL Phone: (352) Orange/Osceola/Seminole/Brevard 950 S. Winter Park Dr, Ste.340 Casselberry, FL Phone: (407) Marion/Lake/Sumter/Volusia 2102 SW 20th Place, Building 200, Suite 201 Ocala, FL Phone: (352) Sarasota/Manatee/Charlotte/Desoto 3870 E SR 64 Bradenton, FL Phone: (941) Lee/Collier 6831 Palisades Park Ct., Suite 1 Ft. Myers, FL Phone: (239) Indian River/St.Lucie/Martin 1187 S US Hwy 1 Vero Beach, FL Phone: (772) am - 8am 5pm, - 8pm, Mon - Fri Mon - Fri TTY/TDD