HEaLtH MattERS. 2 Avoid rubbing your eyes, nose or mouth

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1 HEaLtH MattERS A Newsletter for PPO and HmO medicare members Fall 2011 let S TAlK HeAlTH CARe have You had Your Flu shot? Protect your lungs from flu and pneumonia this season. In THIS ISSUe 4 Beta Blockers Protect Your Heart 5 You Can Stop a Stroke 6 Ease That Ache Stay strong and healthy this season by avoiding flu and pneumonia. The first step is getting your annual flu shot. For older adults, the vaccine is especially important since the immune system weakens with age. Remember that the flu can be serious and even deadly. In fact, more than half of people hospitalized with the flu are over age 65. The Centers for Disease Control and Prevention (CDC) recommends getting the flu vaccine as soon as it becomes available in your community. Immunity takes a few weeks to build up in your body, but it lasts throughout flu season. The flu vaccine is safe and effective. In addition, here are some other ways to avoid this seasonal illness: 2 Wash your hands often 2 Avoid people who are sick 2 Get plenty of sleep and eat right 2 Avoid rubbing your eyes, nose or mouth Know pneumonia While flu gets the most attention, older adults need to protect themselves from pneumonia, too. Pneumonia is a common, but dangerous, lung infection. The CDC recommends that everyone over age 65 be vaccinated for pneumonia. One shot of the vaccine works for most people. You might need a second dose if your immune system is weakened by illness or if you got the first dose more than five years ago and you are now over age 65. Smokers and people with asthma or heart conditions may need the pneumonia vaccine earlier. Talk to your doctor about the pneumonia vaccine while getting your annual flu shot. You ll be protecting your health and the health of your loved ones. Y0026_ NS

2 you re covered emblem behavioral health services Should you ever need behavioral health services, your plan has you covered. And coming soon, Emblem Behavioral Health Services (EBHS) will be providing members with mental health and substance abuse care. We re offering this network to serve you better, give you a complete wellness program and help you improve your health. Access to the Emblem Behavioral Health Services network will be easy. To search for a therapist, just use our Find a Doctor tool on If you re receiving care from a therapist outside our network, it may help to know we re asking those providers to join our network. This will allow you to keep receiving care from your chosen provider without any breaks. For help finding a therapist or to check on the EBHS effective date, visit our Web site or call the number on the back of your ID card. Health Care Made Simple We realize that you re looking for time-saving ways to stay on top of your health care. That s why we moved the GHI and HIP Web sites to Simply use your current sign-in information to get quick access to detailed statements and convenient online tools like care reminders and health risk assessments. Now staying healthy is easier than ever. Talk About Speed and Convenience! Forget the stamps, paperwork and time-consuming check writing. Beginning this fall, Direct Pay members will notice a Pay My Bill option after successfully signing in to the secure member area of www. emblemhealth.com. Select this option and follow the prompts to register and create your payment profile. You ll have a choice of payment method (bank account debit, credit card or debit card) and payment frequency (one time or recurring). You can review payment requests before authorizing them and receive an confirmation to complete the transaction. Never worry about late payments again! Get With the Green Routine Going paperless is a great way to save trees, reduce clutter and organize your coverage information in one safe place. It s easy! Sign up today at Health Matters is published by EmblemHealth to inform members of current health issues and improve the use of services. This publication should not replace the care and advice of your doctor. Always talk to your doctor about your personal health needs. 2 Fall 2011

3 spotlighting our shining stars emblemhealth would like to congratulate and thank eva santiago and Diaram Khublall from Queens-long Island medical Group (QlImG) in Forest Hills for the exceptional service they provide to our members. Here are comments from letters sent to us about ms. Santiago and mr. Khublall: F.L. of Queens Village writes: Eva works the front desk and noticed my distress during a long wait for a follow-up test. She took the time to come over and comfort me. Eva called to obtain the necessary approvals and continued to check on me to ensure my well-being. Eva s kindness and compassion got me through this trying time. That s why I think she s a Shining Star. S.J. of Jamaica writes: I would like to nominate Diaram for his friendly and courteous attitude. Since I experience acute stress during doctor s appointments, he takes the time to reassure me. He is professional and accommodating. Going to the doctor s office is now a pleasurable experience and why Diaram is a Shining Star! Thank you eva Santiago and Diaram Khublall! To recognize these Shining Stars for their caring and superior service, they have each been awarded a $100 gift card. Tell Us About Your Shining Star Is there a staff member in your GHI or HIP network doctor s office whom you d like to acknowledge? let us know! mail your thoughts to: emblemhealth Attn: John mcconnell 55 Water Street, Sixth Floor New York, NY Or providercomm@emblemhealth.com. Include your name, member ID number, address and daytime phone number. Your letter may be edited for clarity. HOW ARe We DOING? Are you satisfied with your membership? Are you receiving outstanding customer service? Are there ways we could serve you more effectively? Your answers help us improve the way that we serve you. To learn your views, we invite members to participate in one of our member forums. These meetings are a great way to share your experiences and ask questions of management and Member Council representatives. Any member may request an invitation to the forums, but due to space restrictions we have to limit attendance. To ensure that the entire membership is well represented, we choose attendees by age, gender, location and type of membership. If you d like to participate, call , Monday through Friday, 9 am to 5 pm, beginning Sept. 27 through Oct. 13. Our TDD number is The forums are from 6 to 8 pm and are listed below. If you are selected to attend, you will receive an invitation by mail. Oct. 17 Queens Oct. 18 brooklyn Oct. 19 manhattan Oct. 20 bronx/westchester Oct. 25 Staten Island Oct. 27 Nassau/Suffolk Health Matters 3

4 take charge FOLLOW YOUR PLAN One out of every two adults has a chronic health condition such as asthma, diabetes or heart failure, according to the National Institutes of Health. These conditions are serious, but they don t have to be debilitating. New and better drugs exist to treat them, which can improve your quality of life if you take them as directed. In other words, don t ditch your inhaler or forego your beta blockers on a day when you re feeling good. The best way to avoid longterm health problems is to take your medications as directed, all the time. Talk to your doctor if you cannot afford your medicine or you experience uncomfortable side effects. beta blockers Protect Your Heart if you ve had a heart attack, preventing another one is top priority. Once you ve had a heart attack, your daily routine almost certainly changes. One of the biggest changes you may experience is in the medications you take. Your doctor will likely prescribe long-term medication to meet your cardiac needs. This drug therapy often includes beta blockers. This type of drug lessens the heart s workload. Beta blockers decrease your heart rate, which lowers blood pressure and makes the heart beat with less force. Beta blockers help the heart relax after a first heart attack. Over time, they can improve the heart s pumping capability and decrease the risk of a second, more serious, heart attack. Though most commonly used for heart failure and heart attacks, beta blockers are sometimes prescribed to treat glaucoma and migraine headaches. The drugs are used by millions of Americans, and numerous studies show they reduce the risk of sudden death from a heart attack. Take as Directed If you take beta blockers, stay in contact with your doctor and follow his or her directions. Tell your doctor about any other medications you take. If you start a new prescription or over-the-counter medicine, make sure your doctor knows about it first. This will help you avoid negative side effects. Always take beta blockers exactly as prescribed, and never stop taking them unless directed by your doctor. While beta blockers help your heart, they can also cause side effects. If you feel dizzy or tired, or have cold hands and feet, a slow pulse, vomiting or diarrhea, call your doctor. Adjusting the dose or time of day you take the medication may help you feel better. As you age, you may need a lower dose than a younger adult. Many people return to normal activities after a heart attack. Treatment, including beta blocker therapy, lessens heart damage and helps keep you active for years to come. 4 Fall 2011

5 You Can Stop a Stroke Know the risk factors and symptoms to protect your health. Anyone at any age can have a stroke. However, about 75 percent of strokes occur in people over age 65. Stroke is also the leading cause of long-term disability, according to the Centers for Disease Control and Prevention. Those are unsettling facts, but knowing the risk factors and screening methods can help you stop a stroke. Leading Risks A stroke happens when a blood vessel in the brain bursts or a blood clot damages the brain. Some risk factors for stroke include: 2 High Blood Pressure. This is the force of your blood on your artery walls. 2 High Cholesterol. Plaque that builds up on blood vessel walls blocks blood flow to the brain. 2 Heart Disease. Heart problems can cause blood clots or contribute to high cholesterol. 2 Diabetes. Having diabetes increases the risk of stroke and can worsen the outcome. 2 Overweight and Obesity. Extra weight can raise your cholesterol and cause heart damage and diabetes. Lifestyle choices such as smoking, alcohol use and a lack of exercise raise the chances of stroke. So does a family history of stroke, or being male, black, Hispanic or Native American. Prevention Making healthy choices every day can help prevent a stroke. That means eating a healthy diet with lots of fruits and vegetables, maintaining a healthy weight, staying active, quitting smoking and limiting drinking. Screenings can also keep you healthy. Have your cholesterol checked every few years and monitor your blood pressure more often. If you have diabetes, manage the condition and see your doctors for all routine checkups. Remember to take any medicines the doctor gives you and follow directions. Get Help Right Away If you think you or someone you know is having a stroke, act FAST and call 911 right away. FAST is an easy way to learn what to do. Look for these warning signs: FACE: Smile. Does one side of the face droop? ARMS: Raise both arms. Does one arm drift down? SPEECH: Repeat a simple phrase. Are any words slurred or strange? TIME: If you see any of these signs, call 911 right away. Quit the Habit When you re ready to kick the habit for good, our Tobacco-Free PATH program is available to members 18 years and older at no cost. You ll have unlimited access to a tobacco cessation specialist, plus coverage for nicotine replacement therapy. To join, call QUIT ( ) or TDD , 24 hours a day, seven days a week. Health Matters 5

6 do this Mind on Your MAMMOGrAM Did you know that the risk of breast cancer increases with age? In fact, the number of breast cancer cases is highest in women over age 60, according to the National Cancer Institute (NCI). So while you ve probably had mammograms before, now is no time to skip them, even if you think everything is probably fine. Stick to the recommended NCI recommendation: Women ages 40 and older should have a mammogram every one to two years. If you are at higher risk for cancer, you might need more frequent screening. Talk to your doctor about what is right for you. Early detection means that treatment can start sooner. So when are you due for your next mammogram? Ease that ache Back pain is one of the most common reasons people seek medical treatment. It s most frequently caused by an injury or muscle strain. If you have back pain, the National Institutes of Health (NIH) suggests you take these steps to feel better now: 2 Use over-the-counter medication such as acetaminophen, aspirin and ibuprofen. 2 Apply hot or cold compresses, or alternate the two. 2 Improve the way you lift things to place the least amount of stress on your back. 2 Resist the urge to sit or lie still for more than a day or so after a minor back injury staying up and moving (gently) will help you regain mobility. Most back pain goes away without medical intervention, but call your doctor if you have any of the following: 2 Numbness or tingling in your back, legs or arms. 2 Pain after a fall. 2 Severe pain for a sustained length of time. 2 Pain accompanied by fever, trouble urinating or unexplained weight loss. Your doctor may use X-rays, magnetic resonance imaging (MRI) or computed tomography (CT) scans to identify where your pain started and suggest treatments. rights and responsibilities: YOURS AND OURS Understanding your rights and responsibilities as a plan member can help you and help us help you make the most of your membership. That s why we urge you to visit and read your Member Rights and Responsibilities. You'll also find it in your Member Handbook. It outlines what you can expect of us as well as what we expect from you. Becoming familiar with your rights and responsibilities will make it easier for us to provide you with access to the best health care possible. 6 Fall 2011

7 Health Briefs Case Management Services We want you and your family to live life to its fullest, even if you have a serious illness, injury or condition. That s why we offer programs to assess, plan, implement, coordinate, monitor and evaluate medical and mental health care options on your behalf. While your primary care doctor is the one who determines your care needs, your plan s case managers can work closely with your doctor to help you make the most of your treatment. As part of the case management program, registered nurses and social workers offer: 2 A better understanding of your disease or condition 2 A link between you and the doctors and nurses on your care team 2 A liaison with community agencies 2 A health care advocate 2 More personalized attention 2 Expert guidance on effective self-care For conditions that call for a higher level of care coordination, we have case managers to help you get the right care in the right setting. If you think you may be a candidate for our case management program, speak with your doctor or call Save Money With Online Coupons Your plan offers coupons for leading brand products and services that can help you and your family save money and stay healthy. The coupons may be used at supermarkets, drugstores and other retailers nationwide. # At sign in and go to the Healthy Discounts section of Health Manager. Check back often because new coupons are posted regularly. You may also call Customer Service to have coupons mailed to you. The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the EmblemHealth grievance process. Antibiotic ABCs Asking your doctor for an antibiotic at the first sign of the sniffles may seem like the quickest way to feel better. In the long run, it may actually make you feel worse. Taking antibiotics as prescribed can help fight bacterial infections, but it won t cure illnesses caused by viruses like most colds, flu and sore throats. In fact, increased use over time makes antibiotics less effective when they are needed. Avoid resistance by taking antibiotics only to treat bacteria-related illnesses. Relieve symptoms of viral infections as the Centers for Disease Control and Prevention recommends, using fluids, throat lozenges or a cool mist vaporizer. Health Matters 7

8 Health or wellness or prevention information Watch Your Step Prevent falls, indoors and out. Colder weather makes it harder to get around. Not only are roadways and sidewalks more dangerous, but your home entryway may become cluttered and slippery. With all these obstacles, you re more likely to injure yourself in a fall. Here are some reminders to avoid trips to the emergency room. Outside 2 Make sure your boots have non-skid soles and are in good shape. 2 Clear walkways and driveways of leaves. Ask a neighbor or relative to help. 2 Walk and drive with caution. Use a cane for balance, if needed. 2 Allow extra time to leave the house so you won t feel rushed. 2 Avoid going out in bad weather or at night when visibility is poor. Inside 2 Clear clutter from entryways, hallways and stairs. 2 Install grab bars in the bathroom and near stairs. 2 Use non-slip mats in the kitchen and bathroom. 2 Remove small throw rugs that may trip you. 2 Improve lighting throughout your home, especially near stairs. 2 Wear shoes with good support and non-slip soles. 2 Put items you use often in easily accessible cabinets, so you don t have to climb up on stepstools or ladders. HOW TO CONTACT US Customer Service PPO: ; TDD: HMO: ; TDD: Monday to Sunday, 8 am to 8 pm TDD Hours: 8 am to 8 pm Quit Smoking Program ; TDD: Lab Services Quest Diagnostics Appointments: Mental Health & Substance Abuse PPO NYC resident members: PPO non-nyc resident members: HMO members: Report Insurance Fraud KO-Fraud ( ) For TDD assistance, any of the above numbers can be reached by calling NYS Relay services at 711. Web Resources PPO only: HIP Health Plan of New York (HIP) is a Medicare Advantage organization with a Medicare contract. Group Health Incorporated (GHI) is a Medicare Advantage organization and a standalone prescription drug plan with a Medicare contract. HIP and GHI are EmblemHealth companies.