CAHPS : Health Care Quality from Your Point of View. Utilization Management: Reviews to Ensure the Right Care GEORGIA 2014 ISSUE I

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1 GEORGIA 2014 ISSUE I CAHPS : Health Care Quality from Your Point of View What is CAHPS? It stands for Consumer Assessment of Health Care Providers and Systems. It s a program that asks members like you what you think about the quality of care you get. You may get a CAHPS survey by mail or over the phone. If you do, please take a few minutes to complete it. Your opinion matters! The answers you give can help us improve the services we give you. It also helps health care providers know how they are doing. The survey asks about your personal experiences with providers and your health plan. Topics in the survey may include: How well you can access the care you need How well your providers communicate with you Your experiences with our customer service The health care information you receive CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Source: To learn more about the CAHPS program and its products and services, visit Utilization Management: Reviews to Ensure the Right Care WellCare of Georgia has a process for reviewing the care members get. It s called the Utilization Management (UM) Program, and it bases decisions on the following: Appropriateness of care service Existence of coverage The plan doesn t reward anyone for denying coverage. There are no rewards to encourage fewer services. Questions? Our Customer Service team can help. Just call TTY users may call You ll also find details about the UM program in your Member Handbook. Also know that you may call to get the handbook and other materials in a different format. This includes other languages, large print and audio tapes. There s no charge for this.

2 Child Checkups to Keep Kids Healthy Did you know your children should get a checkup once a year, even if they aren t sick? The American Academy of Pediatrics recommends that every child receive a child health checkup: Eight visits from birth to 12 months of age Four visits from between 15 months to 30 months of age Every year from three years to 20 years of age These checkups are part of a child s preventive care. They re done by a primary care provider (PCP). And they re tailored to the age of your children to make sure they stay healthy as they grow. There are several things the doctor will check during your child s health checkup: Your child s complete health history and examination Perform an assessment of physical and mental development Provide age-appropriate vaccines (shots), labs or diagnostic tests Evaluate possible health issues your child may face and discuss ways to stay healthy as your child continues to develop (as age and gender appropriate) Talk with your doctor to make sure you and your family get the right tests and care. Source: American Academy of Pediatrics 2 Member Newsletter

3 Keep Your Child Safe from Lead Lead is a metal found in some paints, contaminated dust and other sources. It can be harmful, especially to children under the age of six. This is because their bodies easily absorb lead. And kids like to chew things including paint chips, soil and other things that may contain lead. Why Is Lead Harmful? Exposure to lead can be bad for developing brains and other organs. It can cause very serious conditions such as: Speech, language and behavioral problems Learning disabilities and attention deficit disorder (ADD) Mental retardation Possibly death What Can You Do to Protect Your Child? Make sure your child has a blood lead test because there are no visible symptoms for lead poisoning. Your child s primary care provider (PCP) should order a lead blood test at 12 and 24 months of age. The PCP will continue to watch out for lead risks while your child is between ages 2 and 6. Other steps you can take include: Wash floors, window sills, toys and pacifiers often. Use cold tap water for making baby formula, drinking and cooking. Let the cold water run for a couple of minutes before using it. Make sure there is no peeling paint in places your child visits If your child has had contact with chemicals and is unconscious or having trouble breathing, call 911. You may also contact your area Poison Control Center 24 hours a day, 7 days a week. Call toll-free: Member Newsletter 3

4 Have Health Questions? The Nurse Advice Line Has Answers! When you have health concerns or questions, the Nurse Advice Line is there to help. It lets you speak with a Registered Nurse 24 hours a day, any day of the year. It s also available at no charge to members. The Nurse Advice Line Can Get you health information quickly Help you care for yourself or a sick family member Save you time and money Advise you when you aren t sure if you need to go to an emergency room It s confidential and there when you need it. Call Important Benefit Information, Starting March 1, 2014 WellCare is committed to providing you with extra benefits to keep you healthy. We are excited to let you know that beginning March 1, 2014, the following benefits are now covered. Members age 21 and older will receive the following: Routine dental services: FREE oral exams and cleanings every six months FREE annual bitewing X-ray FREE simple tooth removals No referrals needed for primary and routine dental care Routine vision services: FREE eye exam one per year $40 toward glasses you can choose glasses outside of what is covered by Medicaid Need help finding a provider for these services? Try our Find a Provider tool at this link: georgia.wellcare.com/fap_search. Or you can refer to your provider directory. (continued on next page) 4 Member Newsletter

5 (continued from previous page) Members will also continue to receive these great extra benefits and services at no charge! FREE Over-the-Counter (OTC) Items: Get up to $120 a year of products. Choose from diapers, pain relievers, vitamins and more. That s $10 dollars a month mailed right to your home! FREE Boys & Girls Club Membership: For children ages 6 18 (does not include summer camp and program fees). FREE Weight Watchers Membership: Qualified members age 13 and over who meet the required criteria get a six month membership. FREE Baby Stroller or Play Yard: When you go to all of your prenatal and postpartum doctor visits. FREE Baby Showers: Pregnant members get gifts and tips for staying healthy. Plus a chance to win a FREE Grand Prize FREE Hypoallergenic Bedding: For qualified members who have asthma FREE Cell Phone: For qualified pregnant members who have a high risk pregnancy so they can stay in touch with their case manager, doctor and family members. FREE GED Exam: Available to members age 16 and over, without a high school diploma. FREE Health and Wellness tools: Includes a Health Coach and tips on our website to help you stay healthy. FREE Personalized Case Manager: To help you meet your health care needs. FREE 24-Hour Nurse Advice Line: Call hours a day, seven days a week any time you need a nurse. FREE Flu Shots Please see your member handbook for more information about the programs and benefits that WellCare offers. You can also call us Monday Friday from 7 a.m. 7 p.m. at (TTY/TDD ). Click or Call for the Latest Drug Coverage Updates Want to find the latest about the drugs we cover? Be sure to stop by our website. You ll find our Preferred Drug List (or PDL for short). You can learn about recent medication additions and removals. You ll also find changes to any drug requirements or coverage limits. Just go to georgia.wellcare.com. Then click on Pharmacy. You can also call us for updates at Member Newsletter 5

6 Welcome to WellCare s Weight Management Program! WellCare and Weight Watchers now offer a weight-loss program just for you. This new benefit is at no cost to you. In the program you will: Participate in Weight Watchers PointsPlus program Learn ways to make healthier food choices Get a weight-loss plan based on the latest nutritional science Have flexibility for indulgences Stay fuller longer, with Power Foods like fruits and most vegetables It s easy to get started. Just do the following: Make an appointment with your doctor. Ask your doctor to fill out the Baseline Initial Form. You can find the form at georgia.wellcare.com/member/weight_ watchers. Your WellCare Health Coach must get it before you enroll. Go to at least one Weight Watchers meeting a week. You ll need reliable transportation. WellCare does not provide rides to meetings. We ll send you vouchers for six months of Weight Watchers meetings. You can use the vouchers to attend the meetings at no cost. Finish the six-month program and have your doctor fill out the Weight Watchers Baseline Outcome Form. You can find the form at georgia.wellcare. com/member/weight_watchers. For more information, please call our WellCare Health Coaches at (TTY/TDD ). Watch Your Weight, Eat Healthy and Move More The number of overweight and obese people continues to increase. Those who are overweight are at higher risk for: Heart disease Diabetes Arthritis-related conditions High blood pressure Some cancers What can you do to control your weight? Follow a healthy diet. Also exercise at least 30 minutes a day, five days a week. Here are some suggestions. Exercise: Walking Raking leaves Riding a bike Swimming Running or jogging Climbing steps for 10 minutes Healthy Eating: Eat a balanced breakfast with protein, whole grains, fruits and vegetables Limit fast food and junk food Drink 8 cups of water daily Snack on fruits and vegetables Eat low-fat and reduced-fat foods Talk to your doctor about diet and exercise plans to fit your needs. Source: Weight-control Information Network 6 Member Newsletter

7 When Should Dental Care Start? Many parents have a tough time judging how much dental care their kids need. They know they want to prevent cavities, but they don t always know the best way to do so. Easy Dental Guidelines Run a damp washcloth over your baby s gums following feedings Schedule your child s first dental visit when their first tooth comes in, but no later than their first birthday Take your child for the next dental checkup between ages 1 and 2, and then every six months until age 18 Brushing with just water and a soft toothbrush is recommended for children under age 2 Use a pea-sized amount of toothpaste with fluoride for children 2 and over Begin using floss once your child has two teeth that touch Source: MedlinePlus Member Newsletter 7

8 211 Perimeter Center Parkway Suite 800 Atlanta, GA Para solicitar este documento en español, llame al Servicio al Cliente al (TTY/TDD ). GA025356_CAD_NEW_ENG State Approved WellCare 2014 GA_01_ In This Issue Welcome to another issue of our newsletter. We ve created it with you in mind and included tips for healthy living and reminders to get the care you need. Here s some of what you ll find: Help watching your weight Dental care for infants Keeping kids safe from lead Sharing your opinion on the care you get So please take a moment and explore what s inside. And as always, we wish you good health. Numbers to Know We re just a phone call (or click) away! Call Customer Service: TTY/TDD Monday Friday, 7 a.m. to 7 p.m. Or visit georgia.wellcare.com Nurse Advice Line: