Docstoc
EXCLUSIVE OFFER FOR DOCSTOC USERS
Try the all-new QuickBooks Online for FREE.  No credit card required.

healthtalk - River Valley

Document Sample
healthtalk - River Valley Powered By Docstoc
					                                                                                                                                                                                                    Winter 2006




                                                                                                       New lab
                                                                                                       provider
                                                                                                          As we approach 2007, UnitedHealthcare
                                                                                                       would like to announce an important
                                                                                                       change to our network of laboratory
                                                                                                                                                                         healthtalk
                                                                                                                                                                                your guide to running healthy


                                                                                                       service providers. We are pleased to
                                                                                                       announce that our company has reached              you can beat
                                                                                                       a 10-year agreement with Laboratory
                                                                                                       Corporation of America (LabCorp) to                the flu
                                                                                                       be UnitedHealthcare’s single national
                                                                                                       provider for laboratory services effective
                                                                                                       January 1, 2007. LabCorp’s national                men’s
                                                                                                       breadth and expanding capabilities will
                                                                                                       complement our wide range of local and             wellness
                                                                                                       regional laboratory service providers.             a health-
                                                                                                          Also effective January 1, 2007, Quest
                                                                                                                                                          conscious lifestyle
                                                                                                       Diagnostics will no longer participate
                                                                                                       in UnitedHealthcare’s network except
                                                                                                       in limited markets. To view a list of              how to
                                                                                                       participating laboratories for 2007, visit
                                                                                                       the UnitedHealthcare Lab Locator at                quit
                                                                                                       www.uhclablocater.com.
                                                                                                                                                          smoking
                                                                                                                                                          life after a
                                                                                                                                                          heart
                                                                                                                                                          attack
    HeALTHTALK ADVISORY PANeL


                                                                         healthtalk
                                                                                                                                         PRSRT STD
mEdical Editors:                                                                                                                        U.S. POSTAGE
Bruce Steffens, M.D.—Chief Medical Officer
Deepak Ahuja, M.D.—Vice President, Medical Management
Christine Petty, M.D.—Vice President, Medical Management                 1300 River Drive, Suite 200
                                                                                                                                         PAID
                                                                                                                                       General Learning
Editorial rEviEw tEam                                                    Moline, IL 61265-1638                                         Communications
Todd Florence                       Kathy Morelock, R.N.
Editor                              Manager, Quality Improvement
Lois Boyer                          Shayne McCartney
Manager, Medicare Managed Care      Coordinator, Health Plan
Kehla Garrett                       Communications
Regulatory Affairs Analyst          Mary Sweeney, R.N.
Kristine Klauer                     Administrator, Quality Improvement
Medicare Policy & Compliance        and Accreditation
Analyst                             Nancy Scott, R.N.
Gail Hasenmiller, R.N., C.C.M.      Disease Management Coordinator
Disease Management                  Denise Wahlert
Coordinator                         Business Analyst, Customer Care
                                                                         JDH-013
                                                                          healthtalk
    Winter 2006
                                                                                                                                              1       SECTION ONE                 your guide to wellness and prevention



                                                                                                                                              running healthy                                         [ prevention ]
                                  4
                                  each year,
                                  one in five
                                  Americans get


                                                                                                                                              Chlamydia
                                  the flu. Will
                                  you?


                                                                              16
                                                                              Fighting
                                                                              portion                                                          easy to get, easy to detect,
                                                                              distortion
                                                                                                                                               easy to treat
                                                                                                                                               Chlamydia is the most Common sexually

        1 running healthy                 2 going strong                      3 taking charge                 4 winning with                   transmitted disease in the united states.
                                                                                                                   good health                 More than four million men, women, and newborn babies
                                                                                                                                               are infected each year. It is more prevalent among African
    3 cHlamYdia Preventing              10 How to QUit                    14 rx corNEr Benefits              18 HEdis rEsUlts How              Americans than Caucasians, but anyone who is sexually
        the most common sexually           smoKiNG Double your                 information, plus five big       we measure up in our
                                                                                                                                               active is at risk.
        transmitted disease                chances of giving up                drugs go generic                 quest to provide high-
2                                          tobacco for good                                                     quality health care                 The disease can be spread during vaginal, anal, or oral
    4 BEat tHE FlU The flu                                                15 cUt-aNd-savE tiPs                  benefits                       sex with an infected partner. A pregnant woman can pass                                             3
        vaccine is your best shot       12 HEart attacK You                    Time-saving tips for your                                       the infection to her newborn during vaginal delivery.
        at avoiding the flu                have the power to prevent           next doctor’s visit           19 PlaN iNFormatioN                    Chlamydia is a bacterial infection that often has no
                                           a second heart attack                                                Know your appeal rights
                                                                          16 Food PortioNs It’s                 and understand your            symptoms. When there are symptoms, they start about
    6 mEN’s HEaltH It’s
        never too late to start                                                not just what you eat, it’s      coverage                       three weeks after the infection is acquired. Symptoms
        leading a health-conscious                                             how much                                                        include painful urination, discharge or bleeding from the
        lifestyle                                                                                                                              vagina or penis, abdominal pain, or painful intercourse.
                                                                                                                                                    A round of antibiotics usually knocks out chlamydia.
                                                                                                                                               However, if untreated, it can have serious consequences.
                                                                                                                                               In women, chlamydia can lead to infertility or tubal preg-


    Get your health news online!
                                                                                                                                               nancies. In men, it can cause urinary problems. Having
                                                                                                                                               chlamydia can increase your chances of getting infected
                                                                                                                                               with HIV if you are exposed to HIV. Chlamydia can cause
                                                                                                                                               babies to be born prematurely or to get a serious eye



                                                                                                             [ ]
         In 2007, HealthTalk will          You’ll see informative         UnitedHealthcare network.                          Visit www.uhc.    infection or pneumonia at birth.
    make way for a new monthly          stories and columns from          You’ll learn what actions           LEARN          com/myhealth-          The best way to find out if you have chlamydia is to
    electronic newsletter. With         doctors who are featured on       they took—and perhaps be            MORE           news.com to       get tested. The test is fast, easy, and painless. All sexually
    the new e-newsletter format,        programs such as “Oprah,”         inspired to make similar                           register and      active women should get tested each year. It’s even more
    you’ll be able to customize the     and in prominent magazines        changes yourself!                  to set your personal content      important for women under 25. If you are infected, it’s
    information you receive by          like Health. And, you’ll get           You can also choose to        preferences for the new           important to let your sexual partners know so they can
    selecting one or more health        tips from medical experts, like   learn about advances in care       e-newsletter. If you favor        be tested and treated, too.
    categories, such as:                breast-health pioneer Susan       for specific conditions, includ-   print, don’t worry—you’ll
    ■   Women’s Health                  Love, MD, and heart-health        ing the following:                 have the option of receiving
                                                                                                                                                              wHo is most at risK?
    ■   Men’s Health                    guru Mehmet C. Oz, MD.            ■   Cancer                         a printed newsletter twice
    ■   Family/Pediatric Health            The new e-newsletter           ■   Heart disease                  a year instead of a monthly       ■   Anyone having unprotected sex (without a condom)
    ■   Fitness/Nutrition               will also feature stories from    ■   Diabetes                       e-newsletter.                     ■   Anyone with multiple sexual partners or whose partner
    ■   Healthy Life—mental,            readers who have improved         ■   Asthma                                                               has multiple partners
        emotional, financial, and       their health through lifestyle    ■   Musculo-skeletal and                                             ■   Anyone who began having sex before the age of 18
        caregiver health                changes and care from the             lower-back pain


                                                                                                                                                                                                                          www.uhcrivervalley.com
    [ prevention ]


        How to beat the flu
                                                              two tYPEs oF vacciNEs
                                                                   The first type of vaccine is the flu shot—an inactivated
                                                              vaccine (containing killed virus) that is given with a needle,
                                                              usually in the arm. The flu shot is approved for use in people
                                                              older than 6 months, including healthy people and people with
              The flu can be serious, but it is preventable   chronic medical conditions.
                                                                   The second type is the nasal-spray flu vaccine, which is
                                                              made with live, weakened flu viruses that do not cause the flu.
                                                              The nasal spray is approved for use in healthy people 5 years
                                                              to 49 years of age who are not pregnant.


                                                              sHoUld YoU GEt a FlU vacciNE?
                             during Cold and flu                   Anyone who wants to avoid getting the flu can benefit
                             season, please keep in           from a flu vaccine. For some people, it’s even more important
                             mind the reCommenda-             to get vaccinated each year, such as:
                             tions for flu vaCCina-           ■   Children aged 6 months to 5 years
                             tions from the Centers           ■   Pregnant women
                             for disease Control              ■   People 50 years of age and older
                             and prevention (CdC).            ■   People of any age with certain chronic medical conditions
                                More than 200,000             ■   People who live in nursing homes and other long-term care

4
                             Americans are hospitalized
                             from flu complications, and      ■
                                                                  facilities
                                                                  Household contacts of persons at high risk for complications
                                                                                                                                      Two new vaccines                                            5
                             about 36,000 die each year
                             from the flu, warns the CDC.     ■
                                                                  from the flu
                                                                  Household contacts and out-of-home caregivers of children
                                                                                                                                      approved
                                The single best way               under 6 months of age (these children are too young to be
                                                                                                                                           Two new immunizations were approved by the
                             to protect against the flu is        vaccinated)
                                                                                                                                      Food and Drug Administration (FDA) in Spring of 2006:
                             to get vaccinated each fall.     ■   Health care workers
                                                                                                                                      ■   Zostavax® prevents outbreaks of shingles, a painful
                                                                                                                                          infection common in seniors.
                                                                       YoUr BENEFits For FlU vacciNatioNs
                                                                                                                                      ■   Gardasil® protects young women against infection
                                                                   UnitedHealthcare encourages flu vaccination per CDC                    with HPV, the virus that causes cervical cancer.
                                                              guidelines. Please remember that flu shots and the nasal-spray
                                                              flu vaccine are covered through participating network physicians
                                                                                                                                           wHY vacciNatE For HUmaN
                                                              and network health care professionals only. Check
                                                                                                                                           PaPillomavirUs (HPv)?
                                                              www.uhcrivervalley.com, or your member handbook, for a
                                                                                                                                           Cervical cancer may become a thing of the past.
                                                              list of network physicians and other health care professionals.
                                                                                                                                           Most cervical cancers are caused by HPV, a virus
                                                                   Network physicians and other network health care professionals
                                                                                                                                           that is sexually transmitted. At least 50 percent
                                                              will bill UnitedHealthcare directly. You will only be responsible
                                                                                                                                           of sexually active people will get HPV at some
                                                              for your co-payment, coinsurance, or deductible. Members will
                                                                                                                                           time in their lives, according to the Centers
                                                              not be reimbursed for flu shots given by non-network physicians
                                                                                                                                           for Disease Control and Prevention (CDC).
                                                              or other non-network health care professionals.
                                                                                                                                           The more sexual partners you have, the greater
                                                                   Due to lack of scientific evidence, rapid diagnostic testing for
                                                                                                                                           your risk of contracting HPV.
                                                              influenza will not be a covered service, effective mid-November,
                                                                                                                                               The new vaccine protects against cancer-
                                                              2006.
                                                                                                                                           causing strains of the virus. Studies showed it is
                                                                                                                                           100 percent effective in preventing HPV infection.
                                                                                                                                               The vaccine is given in a series of three doses.
                                                                                                                                           Vaccination recommendations for adolescents




                                                              [ ]
                                                                                 Questions? Call the toll-free Customer Service            and young women, ages 9 to 26, are currently
                                                                  LEARN          number on the back of your ID card.                       being developed.
                                                                  MORE

                                                                                                                                                                         www.uhcrivervalley.com
    [ Changes ]




                                                 “
                                                                            With his patients who are not health conscious,
                                                 there are two           Ilesh Kurani, MD, a family practitioner with John

                                                 kinds of men we         Deere Medical Group in Moline, Illinois, tries to
                                                                         catch them when they come into his office for minor
                                                 see—those who


         What kind
                                                                         problems and get them into the routine of preven-
                                                 are health con-         tion. He says, “I try to make sure being health-




                                                                 “
                                                 scious and those        conscious becomes part of their life rather than




         of man
                                                 who are not.            just a once-a-year thing.”
                                                                            There are many factors to leading a health-
                                                     —Dr. Ilesh Kurani   conscious lifestyle. Some of the most pressing
                                                                         concerns for men involve stress, smoking, sex,
                                                                         exercise, and simply getting to the doctor often
                                                                         enough for needed screenings and preventive




         are you?
                                                                         measures.
                                                                                                      (continued on page 8)




6                                                                                                                                                      



          It’s never too late to start leading
          a health-conscious lifestyle




                                                                                                                              www.uhcrivervalley.com
    [ Changes ]
    (continued from page 7)
    strEss                                                                                                       sEx
       Stress is a major, but                                                                                        “A healthy sex life is very    scrEENiNGs aNd PrEvENtioN
    controllable, factor in mens’                                                                                important for good health,”             It’s a stereotype that men don’t like to go to the
    health. “Mental health is very                                                                               says Dr. Kurani. He discusses      doctor unless they are really sick. However, many of
    important because it links to                                                                                risk factors for sexually trans-   these sick visits could be avoided by getting regular
    physical health. Under stress,                                                                               mitted diseases (STDs) with        checkups, screenings, and immunizations. Here are
    chemicals are released, and                                                                                  his patients. For men who          some preventive measures recommended for men.
    that is going to cause                                                                                       have multiple partners, con-       This list is not comprehensive. Talk to your doctor
    damage,” Dr. Kurani says.                                                                                    dom use can help prevent           about what’s appropriate for you.
       Dr. Kurani compares                                                                                       infection from STDs that often     ■   Heart disease prevention: Blood pressure checks
    unmanaged stress to abuse                                                                                    have no symptoms in men.               annually, low-dose aspirin therapy for men at risk for
    and insists his patients learn                                                                                   Quality of sex life is also        heart disease
    to cope with it. He tells them,                                                                              important. “Most of the time       ■   immunizations: Flu shots every year
    “If I gave you a bottle of poi-                                                                              if it is not in good shape, it     ■   cancer screenings: Testicle self-exams for young
    son and told you to drink it,                                                                                is because of the personal             men monthly, colonoscopy, prostate screening
    you would say no. You know it                                                                                relationship or they are not       ■   Blood tests: Tests for pre-diabetes, cholesterol levels
    will kill you. Stress is a poison.                                                                           taking enough time for them-       ■   so-called “women’s diseases”: Osteoporosis
    So control it immediately. It’s                                                                              selves,” Dr. Kurani says.              (thinning bones) and breast cancer are often thought
    just harder to accept because                              avoid or manage                  lead a healthy   One tip he recommends for              of as women’s diseases. While they are much more
    it’s a slow and silent killer.”                            stress.                          sex life.        a better sex life is to go to          common in women, men can get them, too.
       Massage, yoga, biofeed-                                                                                   bed at the same time as                Screenings are available.
8   back, music, or meditation are                                                                               your partner.                                                                                     9
    some of several techniques
    you can try to help keep stress
    under control.
                                                                                                                                                    PicK oNE aNd start oN tHE PatH
                                                                                                                                                    to a HEaltHY liFEstYlE
    smoKiNG                                                                                                      ExErcisE
                                                                                                                                                         There is no secret to leading a long and healthy
       “We ask every patient if                                                                                      Many men don’t make
                                                                                                                                                    life. You can reduce your risk for heart disease,
    they smoke,” says Dr. Kurani.                                                                                time for exercise. “All of a
                                                                                                                                                    cancer, diabetes, and other illnesses later in life by
    “If they smoke, at every visit                                                                               sudden they notice they are
                                                                                                                                                    leading a healthy lifestyle today. Even small lifestyle
    we ask if they have thought                                                                                  out of shape and have a big
                                                                                                                                                    changes can make a difference. And it’s never too late
    about quitting.” Smoking is                                                                                  belly. They can’t play with
                                                                                                                                                    to start.
    responsible for 87 percent of                                                                                their kids because they start
                                                                                                                                                         Pick one lifestyle component in which you could
    lung cancer deaths, accord-                                                                                  huffing and puffing,” Dr. Kurani
                                                                                                                                                    make improvements and set incremental, achievable
    ing to the National Cancer                                                                                   says. Make time to be physically
                                                                                                                                                    goals for yourself.
    Institute, and is a major                                                                                    active. Walking, playing with
                                                                                                                                                    ■   maintain a desirable weight. Obesity is a major risk
    contributor to heart disease,                                                                                your kids, and using a treadmill
                                                                                                                                                        factor for many conditions.
    stroke, and other leading                                                                                    are some ways to work in the
                                                                                                                                                    ■   Eat right. Get five to nine servings of fruits and
    causes of death.                                                                                             recommended 30 minutes of
                                                                                                                                                        vegetables a day. Eat more whole grains and high-fiber
                                                                                                                 physical activity a day.
                                                                                                                                                        foods. Reduce total fat intake to 30 percent or less
                                                                                                                                                        of total calorie intake.
                                                                                                                                                    ■   reduce alcohol consumption. Men should have
                                                                                                                                                        no more than two drinks per day.




                                         if you use tobacco,                     make time to
                                                                                                                 [                                  ■


                                                                                                                                                    ■
                                                                                                                                                        don’t smoke. If you use tobacco, quit. If you don’t
                                                                                                                                                        smoke or chew, don’t start.
                                                                                                                                                        Exercise regularly. Get at least 30 minutes of moder-
                                                                                                                                                        ate activity each day. It doesn’t have to be continuous.
                                         quit.                                   be active.                                                         ■   limit sun exposure. Avoid the sun mid-day, wear
                                                                                                                                                        sunscreen, and cover up.


                                                                                                                                                                                      www.uhcrivervalley.com
      2   SECTION TWO   your blueprint for coping with challenges




     going strong [ support ]




                                                                                  it isn’t easy to quit tobaCCo.
                                                                                  Without help, it Can take



                                                                Quitting
                                                                                  eight to 10 tries before you
                                                                                  quit for good.
                                                                                       Why put yourself through that




                                                                   time
                                                                                  again and again? With the right help,
                                                                                  you can more than double your chances
                                                                                  of quitting for good the first time
10                                                                                you try.                                                                                                                            11
                                                                                       The key to quitting successfully
                                                                                  is to address the physical and mental
                                                                                                                               Happy                                        Help is
                                                                                                                               quit day                                     available
                                                                                  issues that come with it. When you
                                                                    Double your   quit, your body has a reaction to the

                                                                    chances of    withdrawal of nicotine. At the same
                                                                                  time, you are giving up a habit, which          Once you have decided to quit                 You don’t have to go it alone. Find
                                                                    giving up     is psychologically hard to do.
                                                                                       Support, nicotine replacement
                                                                                                                               smoking, the next step is to pick a quit     an American Cancer Society Quitline
                                                                                                                               day no more than a month away. Make          support program in your area by
                                                                    tobacco for   therapy, and medications can each            sure you are held to this date—mark          calling 1-800-227-2345. Or try these
                                                                                  help. Combined, they are even more           the date on your calendar, and tell your     online resources:
                                                                    good          effective.                                   friends and family. Decide what kind of
                                                                                                                                                                            ■   www.smokefree.gov (sponsored by
                                                                                  ■   support from a trained counselor can     support, nicotine replacement therapy,
                                                                                                                                                                                several U.S. government agencies)
                                                                                      help you plan a quitting method that     and/or medications you will use before
                                                                                                                                                                            ■   www.cancer.org (American Cancer
                                                                                      suits you best. Support can be over      your quit day arrives.
                                                                                                                                                                                Society)
                                                                                      the phone, as individual in-person          When your quit day comes, get rid
                                                                                                                                                                            ■   www.americanheart.org (American
                                                                                      sessions, or in a group.                 of all your cigarettes, lighters, and ash-
                                                                                                                                                                                Heart Association)
                                                                                  ■   Nicotine replacement therapy helps       trays. Have substitutes for cigarettes
                                                                                      relieve withdrawal symptoms. Choose      handy, such as gum, hard candy, carrot
                                                                                      from gums, patches, sprays, inhalers,    sticks, or even drinking straws.
                                                                                      or lozenges.                                Stick with your plan and keep busy.
                                                                                  ■   medications work on chemicals in the     If you do slip up, don’t get discour-
                                                                                      brain to break your addiction. Zyban®,   aged. Just strengthen your resolve
                                                                                      an antidepressant, reduces withdrawal    and go right back to your plan. You
                                                                                      symptoms. Chantix®, approved by the      can do it.
                                                                                      FDA this summer, works by interfering
                                                                                      with nicotine receptors in the brain.
                                                                                      It makes smoking less pleasurable
                                                                                      while reducing withdrawal symptoms.


                                                                                                                                                                                           www.uhcrivervalley.com
     [ heart health ]


                        Stay on track                                                                                                 mix it up. try         Advances in treatments mean that
                                                                                                                                      biking one day      more and more people can lead a normal,
                                                                                                                                      and walking         even robust, life after a heart attack.



                        after a heart
                                                                                                                                      another day.        It’s up to you to stay on track and make
                                                                                                                                                          sure you are doing everything you can
                                                                                                                                                          to make that a reality for you.



                        attack                                                                                                                            commUNicatioN: tHE KEY to
                                                                                                                                                          YoUr HEart
                                                                                                                                                             It’s important to stay in touch with
                                                                 What’s worse, the patients least likely                                                  your primary care physician or cardiolo-
                               You have                       to follow doctor’s orders were those who                                                    gist after you have had a heart attack.

                               the power                      needed the medications the most—the                                                         Communication with your doctor is key,
                                                                                                                                                          says Nancy Scott, a UnitedHealthcare
                               to prevent                     elderly and those with heart failure and
                                                              other diseases.                                                                             Care Delivery nurse. For example, Scott

                               another one                       The study confirmed that taking                                                          finds that patients often stop taking
                                                                                                                                                          beta blockers because of side effects—
                                                              these drugs consistently was associ-         aFtEr a HEart attacK
                                                              ated with a lowered risk of dying from            While overall heart health is             without telling their doctors.
                               a seven-year duke
                                                              heart disease. It has been estimated that    important for everyone, it’s essential to         This is the wrong thing to do, Scott
                               university mediCal
                                                              80,000 lives could be saved in the U.S.      someone who has heart disease or has           says. “If you don’t feel well, tell your
                               Center study of more
                                                              alone if every patient who needed these      already had a heart attack. It’s important     doctor. Don’t just stop taking the drug.”
                               than 30,000 patients
12                             With heart disease             drugs was taking them.                       to follow your doctor’s orders faithfully      There are many different beta blockers      13
                                                                 Previous research had found that          and over the long haul. To prevent another     available, and an adjustment to your dos-
                               found that nearly
                                                              doctors were failing to prescribe these      heart attack, your doctor may suggest:         age or a change to a different drug might
                               half of the patients
                                                              drugs to patients leaving the hospital           low-sodium diet: Reducing sodium           relieve the side effects.
                               surveyed Were not                                                           ■

                               taking their mediCa-           after heart attacks. Programs were               decreases the amount of fluid in your
                               tion as presCribed.            put into place, such as measures in              blood, lowering your blood pressure
                                                              UnitedHealthcare’s Quality Management            and taking some strain off your heart.
                                                              program, to ensure doctors are prescrib-     ■   cholesterol-lowering medication:
                                                              ing them. And these programs are                 There are several cholesterol medica-
                                                              showing success. But what had not                tions that work in different ways. By
                                                              been studied extensively was whether             lowering cholesterol levels, you reduce
                                                              patients were actually taking them.              the amount of buildup that forms in
                                                                                                                                                                      Keep in touch.
                                                                                                               your arteries.                                         communication
                                                                                                           ■   Beta blockers: This class of drugs                     is the key to
                                                                                                               decreases heart rate and cardiac output.               a successful
                                                                                                               This lowers blood pressure, makes your                 recovery.
                                                                                                               heart beat more slowly and reduces the
                                                                                                               amount of work your heart needs to do.



                                                                                                                                                            ]
                                                                                                                                                                         United Healthcare has
                                                                                                           ■   aspirin: Daily low-dose aspirin therapy



                                                                                                                                                          [
                                                                                                               (one baby aspirin a day) helps prevent      LEARN         a program to help
                                        it has been
                                                                                                               blood clots from forming by preventing      MORE          members who have
                                  estimated that 80,000                                                                                                                  had a heart attack. Call
                                                                                                               blood platelets from sticking together.
                                   lives could be saved                                                                                                   1-800-369-2704, option 4, for more
                                                                                                           ■   Exercise: An exercise program geared
                                 in the U.s. if every heart                                                                                               information.
                                                                                                               to cardiac rehabilitation can help you
                                 attack patient followed
                                                                                                               exercise safely and get the maximum
                                    the recommended
                                                                                                               benefit for your heart. The key is to
                                      drug regimen.
                                                                                                               continue exercising after you graduate
                                                                                                               from rehab.



                                                                                                                                                                       www.uhcrivervalley.com
       3        SECTION THREE              your link to smart health choices




     taking charge [ rx Corner ]

     Pharmacy benefit                                                                                                                          Time-saving tips
                                                                                                                                                                                                                                                  It’s important to prepare for each
                                                                                                                                                                                                                                                  and every doctor visit. Make sure
                                                                                                                                                                                                                                                  that your key questions and issues

                                                                                                                                               for your next                                                                                      aren’t overlooked. The card below


     information for 2007                                                                                    Small changes
                                                                                                             can mean big                      doctor’s visit
                                                                                                                                                                                                                                                  lists some of the basic questions you
                                                                                                                                                                                                                                                  should review before a medical visit.
                                                                                                                                                                                                                                                  It folds into a convenient wallet-size
                                                                                                             savings                                                                                                                              reminder card. Cut and save it for
                                                                                                                                               Cut this helpful card, fold into three sections, and keep in your wallet:                          your next medical visit.

     as a member, your                 drugs will be added to the
                                                                                         FivE BiG drUGs Go GENEric
                                                                                                                                               ✁




                                                                                                                                                                                                                                        FOLD
                                                                                                                                                                                            FOLD
     formulary Will remain             3-Tier Formulary, and more
     in plaCe for the 2007
     Calendar year.
                                       additions are expected through-
                                       out the year. This is good news,
                                                                            Generic drugs may look
                                                                            different than their brand-
                                                                                                                Five popular drugs for
                                                                                                             common conditions are now
                                                                                                                                                   just ask
                                                                                                                                                                tips
        Throughout 2007,               giving you more “Tier-2” level       name counterparts, but they      available as generics. If you               BeFORe YOU GO TO YOUR               IF THe ReSULTS OF MeDICAL TeSTS             IF YOUR DOCTOR OR NURSe
                                                                                                                                                         DOCTOR OR OTHeR                     WON’T Be ReADY FOR A FeW DAYS:              ADVISeS YOU TO CHANGe YOUR
     UnitedHealthcare Services         choices. It may also save you        act the same. They have the      are taking any of these drugs,
                                                                                                                                                         HeALTHCARe PROVIDeR:                                                            DIeT OR LIFeSTYLe, OR SUGGeSTS
     Company of the River Valley       money on medications you are         same active ingredients and      ask your doctor if you should                                                   ■ asK YoUr doctor iF YoUr rEsUlts will      YOU TAKe MeDICINe, ASK:
     will also add medications to      currently taking.                    meet the same quality and        switch to the generic version               ■ maKE a list oF YoUr QUEstioNs,      BE mailEd to YoU or iF YoU sHoUld
14                                                                                                           before you refill your
                                                                                                                                                           sYmPtoms aNd coNcErNs.              ExPEct a PHoNE call.                      ■ How will tHEsE cHaNGEs HElP mE to               15
     its Formulary (the former John       If you have questions about       safety standards. In fact, the
                                                                                                                                                                                                                                           FEEl BEttEr or imProvE mY HEaltH?
     Deere Health Formulary) to take   your pharmacy benefits, please       same company that makes          prescription.                               ■ maKE a list oF all tHE mEdica-    ■ asK wHo will BE availaBlE to ExPlaiN
     advantage of lower pharmacy       contact the Pharmacy Call            the brand-name drug often                                                      tioNs (PrEscriPtioN, ovEr-tHE-      tHE rEsUlts to YoU.                       ■ wHat miGHt HaPPEN iF i doN’t Follow
                                                                                                             mobic®                                        coUNtEr aNd/or HErBal aNd                                                       tHE rEcommENdatioNs?
     prices UnitedHealthcare negoti-   Center by calling the Customer       makes the generic version,
                                                                                                                                                           NUtritioNal sUPPlEmENts) tHat     IF YOU NeeD TO ASK
     ates on a national basis.         Service number on the back of        too. And, generic drugs can      Generic name: Meloxicam                       YoU taKE. BEttEr YEt, BriNG a     qUeSTIONS LATeR:                            ■ wHat arE somE sPEciFic BEHavior
        Beginning January 1, a few     your Member ID card.                 save you money.                  A nonsteroidal anti-inflamma-                 BaG witH tHE actUal BottlEs                                                     cHaNGEs i sHoUld maKE? How caN
                                                                                                             tory drug (NSAID) used                        or PacKaGEs witH YoU to tHE       ■ FiNd oUt wHo to call iN YoUr                i maKE tHEm?
                                                                                                                                                           doctor.                             HEaltH carE ProvidEr’s oFFicE, aNd
                                                                                                             to relieve symptoms of
                                                                                                                                                                                               tHE BEst timEs to call.                   ■ wHat arE PossiBlE sidE EFFEcts From
                                                                                                             osteoarthritis                              ■ asK a FamilY mEmBEr or FriENd                                                   tHis mEdiciNE? wHat sHoUld i do iF
                                                                                                                                                           to accomPaNY YoU.                                                               i ExPEriENcE aNY oF tHEm?

                                                                                                             Proscar®
                                                                                                             Generic name: Finasteride           FOLD
                                                                                                             Prescribed to help shrink
                                                                                                             an enlarged prostate                                                                         sEt Goals For:
                                                                                                                                                ■ wEiGHt ____________________________          ■ Blood PrEssUrE ____________________           ■ cHolEstErol ______________________
                                                                                                             Zocor®                             ■ Blood sUGar _______________________          ■ ExErcisE PEr wEEK __________________

                                                                                                             Generic name: Simvastatin
                                                                                                                                                        date                weight                 Blood pressure      cholesterol              Blood sugar         amount of exercise
                                                                                                             A cholesterol-lowering drug


                                                                                                             Pravachol®
                                                                                                             Generic name: Pravastatin
                                                                   more “tier-2”                             sodium
                                                               drug choices will                             A cholesterol-lowering drug



                                                                                                                                               [
                                                               soon be available.
                                                                                                             Zoloft®


                                                                                                                                                                                                                                                       [ ]
                                                                                                             Generic name: Sertraline
                                                                                                             A selective serotonin re-uptake
                                                                                                             inhibitor (SSRI) prescribed for
                                                                                                             major depression

                                                                                                                                                                                                                                                        www.uhcrivervalley.com
     [health Consumer]                                                                                                                     [ reCipe makeover ]


     Portion distortion
                                                                                When food is in front of you, you’re tempted to eat it.
                                                                           The excess calories in our supersized meals and snacks
                                                                           lead to excess weight and the health problems that go
                                                                           along with it. New studies show that portion distortion,
                                                                           as this trend is called, shows no signs of slowing down.
                                                                                One study, published in a recent issue of the University
                                                                           of California Wellness Letter, reported that when children
     It’s not just what you eat, it’s how much   you’ve heard it before:
                                                      food portions are    were served double the size of a standard lunch entrée,
                                                  groWing right along      they ate 25 percent more food than when they were served
                                                      With the nation’s    a “normal” portion. When the children were allowed to
                                                              Waistline.   serve themselves, the amount of food they ate was closer
                                                                           to a typical serving size.
                                                                                Another study, published in the September 2006 issue
                                                                           of the Journal of the American Dietetic Association, found
                                                                           that portion sizes selected by young adults are not only
     three ounces
                                                                           larger than those established by the U.S. Department of
     of meat is the
     size of a deck
                                                                           Agriculture, they are significantly larger than portion sizes   Healthy Southwestern omelet
                                                                           selected by young adults two decades ago.
          of cards.
                                                                                According to the researchers: “Portion sizes of            The Challenge
                                                                           virtually all foods and beverages prepared for immediate        turn a sinfully delicious tex-mex breakfast staple into a tasty,
                                                                           consumption have increased over the last two decades.           low-fat, protein powerhouse.
16                                                                         Portion sizes of individually packaged and ready-to-eat                                                                               1
                                                                           prepared foods have increased, as well as the portion sizes     How wE did it
                                                                           served at fast-food, chain, and privately-owned restaurants.    This omelet’s original recipe really packs on the calories. But
                                                                           Consumers now perceive these larger portion sizes as the        you don’t have to give up good taste for good health. This recipe
                                                                           appropriate amount to eat at a single eating occasion, thus     uses cooking spray instead of oil, reduced-fat dairy products,
                                                                           experiencing portion distortion.”                               and a combination of egg whites and whole eggs to cut fat and




                                                                           “
                                                                                                                                           cholesterol without sacrificing taste.




                                                                                                                                     “
                                                                                     Consumers now perceive larger
                                                                                     portion sizes as appropriate.                         old iNGrEdiENts                      NEw iNGrEdiENts
                                                                                                                                           3 large eggs                         1 large egg, 2 egg whites
                                                                           arE YoUr EYEs BiGGEr tHaN YoUr stomacH?                         1 Tbsp half-and-half                 1 Tbsp fat-free half-and-half
         an ounce                                                               How much you eat is just as important as the foods         Salt and pepper to taste             Salt and pepper to taste
      and a half of                                                        you choose. It can be difficult to visualize measurements       2 Tbsp cheese                        2 Tbsp reduced-fat cheese
     cheese is the                                                         and eyeball what a proper serving size should be. The           ¼ cup chopped onions                 ¼ cup chopped onions
      size of three                                                        American Dietetic Association recommends making                 ¼ cup red bell peppers               ¼ cup red bell peppers
        dominoes.                                                          everyday comparisons to help you figure out your serving        2 Tbsp canned black beans,           2 Tbsp canned black beans,
                                                                           sizes, such as:                                                   drained                              drained
                                                                           ■   A teaspoon of margarine is the size of the tip of your      Black olives (optional)              Black olives (optional)
                                                                               thumb to the first joint.                                   Salsa                                Salsa
                                                                           ■   Three ounces of meat is the size of a deck of cards.        Sour cream (optional)                Fat-free sour cream (optional)
                                                                           ■   One cup of pasta is the size of a tennis ball.
                                                                           ■   One half of a medium bagel is the size of a hockey puck.    1. Preheat a nonstick pan at medium heat; spray with nonstick
                                                                           ■   An ounce and a half of cheese is the size of three            cooking spray.
                                                                               dominoes.                                                   2. Combine first four ingredients and beat together until foamy;
                                                                           ■   Two tablespoons of peanut butter are the size of a ping       pour into pan and allow eggs to cook, covered, until set.
                                                                               pong ball.                                                  3. Uncover and sprinkle with cheese, onions, peppers and beans.
                                                                           ■   One-half cup of vegetables is the size of a light bulb.       Cook until cheese melts.
                                                                           ■   A small baked potato is the size of a computer mouse.       4. Slide onto warm plate and top with salsa, a few sliced black
                                                                           ■   A medium piece of fruit is the size of a baseball.            olives, if desired, and a dollop of fat-free sour cream.


                                                                                                                                                                                    www.uhcrivervalley.com
         4       SECTION FOUR                your roadmap to health benefits




     winning with good health [ quality]

     How we measure up
          UnitedHealthcare Services     ■   Breast and other cancer      Health Plan Employer Data and Information Set (HEDIS®)                                              HEDIS and CAHPS results are
     Company of the River Valley            screenings                   and Consumer Assessment of Healthcare Providers & Systems                                      published in a nationally-recognized
     is committed to helping            ■   Cholesterol screenings       (CAHPS) are the means by which we measure the effectiveness                                    report card for health plans. It consists                                                      Your appeal
     members receive high-quality
     health care by striving to             We also monitor patient
                                                                         of our QM program.
                                                                              NCQA is an independent agency that evaluates and
                                                                                                                                                                        of standardized performance measures
                                                                                                                                                                        based on clinical care and member
                                                                                                                                                                                                                                                                       rights
     continuously improve its           safety and member satisfac-      compares the quality programs of managed care organizations.                                   satisfaction. Highlights are below.
     Quality Management (QM)            tion, and review the creden-     For the sixth consecutive year,
     program. Our QM program
     describes how we assess,
                                        tials of contracted physicians
                                        as part of the QM program.
                                                                         UnitedHealthcare Services
                                                                         Company of the River Valley,
                                                                                                           2005 HEdis rEsUlts                                ®


                                                                                                             mEasUrE                                                      UNitEdHEaltHcarE              2005 NatioNal avG           You have the right to appeal a coverage decision by
     measure, and improve the           A printed copy of the QM         Inc. and UnitedHealthcare
                                                                                                           rating of Health Plan*                                                  0%                          65%             UnitedHealthcare Services Company of the River Valley, Inc.
     quality of care and services       program is available upon        Plan of the River Valley, Inc.,
                                                                                                                                                                                                                                or UnitedHealthcare Plan of the River Valley, Inc. This member
     provided to our members.                                            have achieved an “Excellent”      rating of Health care*                                                  9%                          8%
                                        request. Please contact your
                                                                                                                                                                                                                                appeal process is governed by federal and state regulations.
          The program provides          local Customer Service repre-    accreditation from NCQA.          rating of Personal doctor*                                              6%                          %
                                                                                                                                                                                                                                    UnitedHealthcare also follows National Committee for
18   several member health              sentative for a copy.            This score is only granted        How well doctors communicate                                            92%                          92%                                                                                                                19
                                                                                                                                                                                                                                Quality Assurance (NCQA) accreditation standards. There are
     programs to help you improve                                        to plans that meet or exceed      customer service                                                        %                          1%             two levels of appeals available to you, including independent,
     or maintain your health.           tHE rEsUlts                      NCQA’s stringent require-         claims Processing                                                       94%                          89%             external reviews for medical necessity decisions.
          Health management pro-            The National Committee       ments for quality improvement
                                                                                                           childhood immunization status                                           85%                          8%                 For information on appeals, please refer to your plan docu-
     grams target members who:          for Quality Assurance (NCQA)     and consumer protection.
                                                                                                           Use of appropriate medication                                           93%                          90%             ments. If you do not have a copy, or you have questions, contact
     ■   Have asthma                                                     We also received the highest      for People with asthma                                                                                               Customer Service at the number on the back of your ID card.
     ■   Have diabetes                                                   rating (four stars) in all
                                                                                                           Beta Blocker after a Heart attack                                       99%                          9%
     ■   Have had a heart attack                                         categories of scoring:
                                                                                                           diabetes care:
     ■
     ■
         Have heart failure
         Need mental health care
                                                                         ■
                                                                         ■
                                                                             Access & Service
                                                                             Qualified Providers            a1c level Poorly controlled**                                          1%                          30%             Coverage of electrical
     ■   Are pregnant                                                    ■
                                                                         ■
                                                                             Staying Healthy
                                                                             Getting Better
                                                                                                            retinal Eye Exam Performed
                                                                                                            ldl cholesterol <130 mg/dl
                                                                                                                                                                                   60%
                                                                                                                                                                                   1%
                                                                                                                                                                                                                55%
                                                                                                                                                                                                                68%
                                                                                                                                                                                                                                stimulation or
          Preventive services are
     also promoted, such as:
                                                                         ■   Living with Illness            monitoring for diabetic Nephropathy                                    56%                          55%             electromagnetic therapy
     ■   Child, adolescent, and adult                                                                      * Percentage reflects members who rated their         HeDIS® (Health Plan employer Data and Information Set) is
                                                                                                           plan 8, 9, or 10 on a scale of 0-10, 10 being best.   a registered trademark of the National Committee for quality       Effective November 15, 2006, UnitedHealthcare will not cover
         immunizations                                                                                     ** A blood sugar test in which a lower percentage     Assurance (NCqA). For more information, visit www.ncqa.org.
                                                                                                                                                                                                                                the treatment of wounds and soft tissue injuries using electrical
                                                                                                           is better.
                                                                                                                                                                                                                                stimulation or electromagnetic therapy. There is no scientific
                                                                                                                                                                                                                                evidence showing a significant benefit of such treatments.
                                                                                                                                                                                                                                    Keep in mind that just because your health plan does not
                                                                                                                                                                                                                                cover a treatment or service, it does not mean you cannot
                                                                                                                                                                                                                                receive it. It only means it is a non-covered service and will
                                                                                                                                                                                                                                not be paid for by the health plan.


                                                                                                                                                                                                                                This newsletter contains general health information and is not a substitute for professional
                                                                                                                                                                                                                                health care. You should consult an appropriate health care professional for your specific




                                                                                                                                                                     [ ]
                                                                                                                                                                                                                                needs. Some treatments mentioned in this newsletter may not be covered by your health
                                                                                                                                                                                         For more information on
                                                                                                                                                                                                                                plan. Please refer to your benefit plan documents for information about coverage. Insurance
                                                                                                                                                                        LEARN            member health programs                 coverage provided by or through UnitedHealthcare Insurance Company, UnitedHealthcare
                                                                                                                                                                                                                                Plan of the River Valley, Inc., UnitedHealthcare Insurance Company of the River Valley, or their
                                                                                                                                                                        MORE             and NCqA/HeDIS, see                    affiliates. Administrative services to self-funded plans provided by UnitedHealthcare Insurance
                                                                                                                                                                                         www.uhcrivervalley.com.                Company, UnitedHealthcare Services LLC, or UnitedHealthcare Services Company of the River
                                                                                                                                                                                                                                Valley, Inc.


                                                                                                                                                                                                                                                                                   www.uhcrivervalley.com

				
DOCUMENT INFO
Categories:
Tags:
Stats:
views:0
posted:3/19/2013
language:Japanese
pages:10