HealthyLiving. Stay on Course. for Good Health. Keep Diabetes in Check The Power of Preventive Care

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1 News for Medicare Advantage Members of Florida Hospital Care Advantage Administered by Health First Health Plans myfhca.org Winter HealthyLiving Keep Diabetes in Check The Power of Preventive Care Stay on Course for Good Health

2 HEALTHY LIVING Winter Inside This Issue Preventive Care PAGE 7 Contact Customer Service ONLINE myfhca.org Click on Contact Us at the top of the page. BY PHONE Medicare Advantage Members Toll-free TTY/TDD Monday through Friday, 8 a.m. to 8 p.m. Saturday, 8 a.m. to noon From October 1 through February 14, we re available seven days a week from 8 a.m. to 8 p.m. BY MAIL Florida Hospital Care Advantage Health First Health Plans 6450 U.S. Highway 1 Rockledge, FL IN PERSON 1425 West Granada Blvd., Suite 4 Ormond Beach, FL Monday through Friday, 8 a.m. to 5 p.m. If you suspect medical fraud, waste or abuse, please contact Florida Hospital Care Advantage immediately. Any suspicious activity will be referred to the Special Investigations Unit, where fraud, waste and abuse issues are investigated. Florida Hospital Care Advantage received 4 out of 5 stars for an Overall Star Rating from the Centers for Medicare & Medicaid Services (CMS) for In addition, Florida Hospital Care Advantage was rated 4 out of 5 in National Committee for Quality Assurance s (NCQA) Medicare Health Insurance Plan Ratings Our stars are your reward. As a member of Florida Hospital Care Advantage, you can trust that we have your best health in mind. You have helped us earn 4 out of 5 stars for an Overall Star Rating from the Centers for Medicare & Medicaid Services (CMS). We earn our stars based on: How well we do in helping you stay healthy with screenings, tests and vaccines Helping our members manage chronic conditions How you rate our responsiveness and the care you receive from your doctors How well we take care of complaints and appeals Your experience while on the phone with our customer service representatives Thank you for being one of our most valued members. Look for this icon throughout this issue to explore more features available to you in the online member portal. 2 HEALTHY LIVING Winter

3 Your primary care provider can help you decide what colorectal cancer screening is right for you. To find a primary care provider in your area, call or visit myfhca.org and click on Provider Directory. ASK THE EXPERT: What Should I Know About Colorectal Cancer? Colorectal cancer is the third most common cancer in both men and women in the United States. Anyone can develop it, even Badar Anwer, MD younger people. Gastroenterologist Sixty percent of colorectal cancer deaths can be avoided with routine screening starting at age 50, says the Centers for Disease Control and Prevention. Badar Anwer, MD, gastroenterologist, answers common questions you may have about this type of cancer and how to prevent it. Q: Who is at risk for colorectal cancer? A: People with a family history are at increased risk. And about 90 percent of people with colorectal cancer are older than age 50. The risk is slightly higher in men than in women. African-Americans develop colorectal cancer at a higher rate than other ethnic groups. Smokers and people who are obese or physically inactive also face a higher risk. Q: What symptoms should I watch for? A: Common signs of colorectal cancer include: A change in bowel habits that lasts for more than a few days Blood (either bright red or very dark) in the stool Diarrhea, constipation or a feeling that the bowel is still not empty Gas pains, bloating, fullness or cramps Stool that is thinner than usual Weakness and fatigue Weight loss for no known reason Q: Can colorectal cancer be prevented? A: Eating a diet with lots of fruits and vegetables can help. Routine exercise and staying at a healthy weight may lower your risk, as well as avoiding smoking or excessive alcohol consumption. Another important way to lower the risk is to have regular screening tests starting at age 50. Q: Is there some way to find colorectal cancer early? A: Screening tests help find the cancer early, so it can be treated before it spreads. These tests also help find polyps before they become cancer. Colorectal cancer exams include: Colonoscopy. The U.S. Preventive Services Task Force recommends most people (those ages 50 years and older with average risk and no symptoms) get a colonoscopy once every 10 years to check for colorectal cancer. Sigmoidoscopy. This is another option for most people and needs to be performed every five years. Fecal occult blood test. This screening tests for blood in the stool and must be performed annually. Consult with your provider to determine the proper screening for you, based on your history and condition. myfhca.org 3

4 Diabetes Control: What Older Americans Should Know Approximately 25 percent of Americans older than age 60 have diabetes. As we age, our bodies change and so do our needs when it comes to diabetes care. In general, diabetes management goals should be similar between older and younger adults. But there are a few important ways that diabetes care is different for older adults. Special Considerations for Older Adults Older adults are more likely to have serious problems if their blood sugar goes too low, such as extreme confusion or passing out. Older adults are also more likely to suffer from depression. Some factors that affect diabetes care include: Disability and the risk of falling Memory and thinking problems Other illnesses, such as heart disease, stroke and high blood pressure Persistent pain Taking numerous medications, some of which may have serious side effects for people with diabetes When to Ease Up If you re having other health problems, your target numbers for blood sugar levels and other tests may change as you grow older. It s important to talk with your doctor to determine the right goals for you. He or she may recommend less stringent goals if: You have a hard time doing day-to-day activities or being physically active. You have at least three chronic illnesses, including diabetes. Chronic illnesses include cancer, arthritis, heart disease, depression, high blood pressure, emphysema and others. You have mild to severe thinking, reasoning or memory problems. Talk with Your Doctor No matter your age, daily physical activity is an important part of managing your diabetes. If it s hard for you to move, do as much physical activity as you can. Try taking a 10-minute walk three times a day to start. Check with your doctor before starting a new exercise plan. If you have trouble with any part of your diabetes treatment, such as forgetting to take medications, talk with your doctor. He or she can help you find solutions to keep you healthy. Did you know Florida Hospital Care Advantage offers a Diabetes Self-Management Education Program? You will learn to better care for yourself through proper nutrition, medication, exercise and monitoring of symptoms. All you need is a referral from your physician. Visit floridahospitaldiabetes.com or call for more information. For members in Deland, call For members in Highlands and Hardee counties, call For members in Daytona, call HEALTHY LIVING Winter

5 Four Steps to Kick-Start Your Diabetes Treatment Start taking care of your diabetes today to boost your energy, improve your body s ability to heal and prevent future health problems. Step 1: Learn about diabetes. Take a class, join a support group and do online research. Understanding diabetes can help you make better choices for your health on a daily basis. Step 2: Check your ABCs. A stands for A1c, a blood test that measures your average blood glucose level over the past few months. B stands for blood pressure. Healthy blood pressure helps prevent heart attack, stroke, and kidney and eye damage. C stands for cholesterol. Managing your cholesterol helps prevent heart attack and stroke. Ask your physician what your ideal cholesterol numbers are they can vary from person to person. Step 3: Start making changes to your daily life. Work with a dietitian to develop a healthy meal plan. Be more active. Work your way up to getting 30 to 60 minutes of physical activity most days of the week. Take your medicines and check your blood glucose as directed by your doctor. Strength training is also very import in controlling diabetes as well as strengthening your bones and muscles. Step 4: Schedule regular checkups and tests. Your A1c should be checked at least twice a year. Your doctor will also check your blood pressure, feet and weight. You also need a complete foot exam, dental exam, eye exam, flu shot, cholesterol test and tests to check for kidney problems. It is important to find and treat complications and problems early. If you need help finding a primary care provider, call Customer Service. See page 2 for number and hours. You can also find the number on the back of your Member ID card. myfhca.org 5

6 Take Charge of Your Health With Preventive Care Preventive care is an important part of healthy aging. It can help you stay healthier and independent longer. However, less than 50 percent of adults ages 65 and older are up-to-date on preventive services and health screenings. Are you? Read on and then talk with your doctor about what screenings are right for you. Health exam. Having regular checkups can keep you healthy. Your doctor will assess you and help you make a plan to stay as healthy as possible. Blood pressure screening. High blood pressure is known as the silent killer. Without a screening, you won t know if you have high blood pressure. It s important to know because it can cause serious health problems, including stroke, heart attack and kidney failure. Getting your blood pressure checked regularly lets your doctor monitor your levels and make lifestyle suggestions to lower them. Diabetes screening. If you get screened regularly for diabetes, your doctor can assess your risk and recommend lifestyles changes. You can A primary care physician can help you manage your health and keep track of preventive screenings. Need a doctor? If you are looking for a primary care physician, call Customer Service or visit myfhca.org and click on Provider Directory. prevent or delay diabetes by being active, eating healthy and maintaining a healthy weight. If you have diabetes, be sure to complete regular A1c screenings, eye exams, foot checks and more. Colon cancer screening. Screenings can identify precancerous growths so doctors can remove them before cancer develops. These tests can also detect colon cancer in its early stages, when treatment is more successful. Turn to page 3 to learn more about your options for screening. Cholesterol and lipid screening. Most people don t know if their levels are high or abnormal without getting a test. If your results are abnormal, or if you re at high risk, your doctor will monitor your levels and suggest lifestyle changes to lower them. High cholesterol and lipid levels increase your risk for heart disease and stroke. Other services. Talk with your doctor about other preventive care measures, including immunizations. Men should discuss prostate cancer screenings. Women should ask about osteoporosis screenings, cervical cancer Pap tests and mammograms. Your doctor will order screenings based on your age, gender, family history and other risk factors. Schedule an appointment with your doctor to discuss screenings and other health services. Taking advantage of preventive care puts you in charge of your health. 6 HEALTHY LIVING Winter

7 When is a test preventive? When is it diagnostic? Sometimes there s no cost share for your mammogram or colonoscopy, and sometimes you have to pay your share of the cost. How do you know what to expect? With expanded coverage of preventive services under healthcare reform (the Affordable Care Act), this question has become increasingly important to members who want to estimate their costs for medical care. Certain preventive services are covered with no cost share when obtained from contracted health plan providers, so it is important to distinguish a preventive (also called screening ) exam from one that is considered diagnostic or not covered at all. How can you tell the difference? No-Cost, Cost Share, Not Covered In general, a preventive/screening exam is performed when you do not have signs or symptoms of the condition in question the goal is to detect problems early, before symptoms appear, and prevent serious medical conditions from developing or getting worse. For a test to be considered a preventive screening under the law and covered with no cost share, it must have a rating of A or Be sure to schedule an adult well-care visit with your primary care provider. For a list of immunizations and tests to discuss at your appointment, log in to your health portal. Visit myfhca.org/myportal and click on Adult Well-Care Visit. B by the U.S. Preventive Services Task Force (USPSTF) and meet established recommendations related to gender, age, risk and frequency. If you have symptoms of the condition you are being tested for, or if you ve already been diagnosed with the condition, related tests would be considered diagnostic and a cost share may apply. Screening tests that do not meet the USPSTF s recommendations may not be covered at all. Examples of Tests Common examples of preventive screening exams include mammograms, certain blood tests for cholesterol and diabetes, and colorectal cancer exams. Some colorectal cancer exams include: Colonoscopy. The USPSTF recommends most people (those ages 50 years and older with average risk and no symptoms) get a colonoscopy once every 10 years to check for colorectal cancer. Sigmoidoscopy. This is another option for most people and needs to be performed every five years. Fecal occult blood test. This screening tests for blood in the stool and must be performed annually. You must consult with your provider to determine the proper screening for you, based on your history and condition. If you re simply getting one of these tests because you just turned 50 or it s been 10 years since your last colonoscopy, these tests are screenings, so they re covered with no cost share, even if a polyp is removed during the colonoscopy or sigmoidoscopy. For people at high risk, including those with a personal or family history of colon cancer, Florida Hospital Care Advantage covers more frequent screenings those members can get a preventive colonoscopy or sigmoidoscopy every three years with no cost share. If you re having gastrointestinal problems and need a colonoscopy or another test to find out what s wrong, that test would be diagnostic and a cost share would apply. The exact amount depends on your plan. Your Annual Physical Prevention is an important part of your health care, so make sure you see your doctor every year for a physical exam and to discuss other preventive services that are appropriate for you. For a current list of recommended preventive services at any time, visit healthcare.gov, and contact Customer Service at with questions about preventive coverage. myfhca.org 7

8 GOING FOR YOUR MAMMOGRAM Not counting some kinds of skin cancer, breast cancer in the United States is the most common cancer in women. In 2016, it is estimated that among U.S. women there will be 246,660 new cases of invasive breast cancer. Seventy-five percent of women diagnosed with breast cancer have no family history and are not considered high risk. How Mammograms Help Mammograms can help detect breast cancer early when it is much easier to treat. Doctors generally agree that mammograms are the best way to find breast tumors early, while they re smaller and easier to treat. Many tumors that are too small to be felt during a breast self-exam are found by mammograms. Your Role in Screening Choose a facility that specializes in women s healthcare services for your mammography. The process will be more comfortable and produce a better image. Check beforehand for special instructions. Mammograms usually take about 20 minutes. You ll need to disrobe above the waist, so wear a skirt, shorts or pants. Don t use deodorant, perfume, lotion or powder under your arms or on your breasts the day of your mammogram. They can cloud the picture. Did you know... Most women who get mammograms are thrilled to learn they don t have anything to be concerned about. But for those who do discover cancer, catching it early usually means treatment and recovery will be much quicker and more effective. Like all medical tests, mammograms aren t absolutely perfect, but they do detect nearly 90 percent of breast cancers in women without symptoms long before you may feel a lump. The American College of Radiology recommends that all women get a mammogram regularly every year for women ages 40 and older (and perhaps earlier if you have a family history of breast cancer). If you are having any breast cancer symptoms, please see your physician. Call us to schedule your mammogram. Highlands and Hardee counties: DeLand: Deltona: Flagler County: Ormond Beach and New Smyrna Beach: HEALTHY LIVING Winter

9 Shoo Away the Flu: New Vaccines Provide Better Protection Getting the flu vaccine is always your best bet for avoiding the flu. You re not only protecting yourself from the virus, but your friends, family and everyone around you, too. Even in years when the vaccine is less effective, CDC research shows that the vaccine prevents outbreaks of the virus. And, even if you get the flu after being vaccinated, you will likely have a milder illness and lower your risk of developing serious health complications such as pneumonia. A CDC study looking at the flu season showed that people who got the regular flu vaccine were 71 percent less likely to be hospitalized with the flu. So this flu season, make sure you get your flu shot to protect you, your friends, your family and overall public health. protein, this newer vaccine offers them another option. Are you up-to-date with your pneumonia vaccine? Scientists have improved a vaccine for pneumonia, too. At first, the vaccine guarded against seven types of a bacterium that causes pneumonia. But now the vaccine, called Prevnar 13, offers protection against 13 strains of this bacterium. All adults ages 65 or older should get the pneumonia vaccine, unless they received it when they were younger than 65. Don t delay getting your shots. Flu outbreaks can start as early as October. You ll need a flu shot every year because flu viruses always change. But you ll need this pneumonia shot just once. Vaccines: Not Just for Kids Even if you ve long outgrown the pediatrician, you still need to get shots. Each year, the Advisory Committee on Immunization Practices reviews its adult immunization schedule. The vaccines you need will depend on your risk factors and medical history. Recommended vaccines include: Hepatitis A and B Measles, mumps, rubella (MMR) Meningococcal Pneumococcal Tetanus, diphtheria, pertussis (Td/Tdap) Varicella (the chickenpox vaccine) Zoster (shingles) Have an allergy to egg? No problem! There is also now a vaccine that is 100 percent eggfree. Until recently, all flu vaccines contained a small amount of egg protein. But scientists have created a new flu shot using a technique that requires no eggs. Although recent studies have shown that people who are allergic to eggs can safely receive vaccines with egg Did you know? You can get the cost of your flu vaccination reimbursed If you get your flu vaccination at locations outside of your local pharmacy, doctor s office or hospital, complete the member reimbursement form located at myfhca.org/myportal under Claims. Please include a copy of your flu vaccine receipt. Please send the form and receipt to Florida Hospital Care Advantage, Pharmaceutical Services Department, 6450 U.S. Highway 1, Rockledge, FL A check will be sent to you for the cost of your flu shot only (up to the Medicare allowable amount). myfhca.org 9

10 Plan Information for Members MEDICARE SURVEYS COMING TO YOU THIS SPRING The Medicare Satisfaction Survey, also known as the Consumer Assessment of Healthcare Providers and Systems (CAHPS), will be sent to a random sample of Medicare Advantage members in March or April. This survey, created by the Centers for Medicare & Medicaid Services (CMS), monitors the quality of care provided to Medicare beneficiaries. Some members may also receive the Medicare Health Outcomes Survey (HOS), which asks members questions to see whether their health status has changed, remained the same or improved over a specific period. The HOS survey is sent to participants twice over a three-year period so health status can be measured over time. Not all Florida Hospital Care Advantage Medicare members will receive a survey. However, if you receive one or both of these surveys in the mail, we ask that you please complete them. Your response will help us improve our service. Thank you in advance for participating in these surveys. We are proud of our Star rating and will continue to focus on improving the quality of care our members receive. Member Rights and Responsibilities are available online or call the Customer Service number on the back of your Member ID card for more information. What is Medical Nutrition Therapy? Medical Nutrition Therapy is a service that helps you choose the right foods to eat for a specific health condition. You can qualify if you are overweight or have: Diabetes Severe kidney disease Congestive heart failure Medical Nutrition Therapy includes: An appointment with a registered dietitian An initial nutrition and lifestyle assessment High cholesterol Nutrition counseling High blood Diet management Other qualifying pressure health conditions Follow-up sessions to monitor your progress Coverage is limited to three hours the first year and two hours per year thereafter. Contact your physician to see if you qualify for Medical Nutrition Therapy. If you need a physician, call Customer Service at the numbers listed on page HEALTHY LIVING Winter

11 Stay Well with Medication Adherence If your doctor has prescribed a medication, it s important to take it as directed. Even if you start to feel better, you should continue taking it as prescribed. If you do not take your prescriptions as directed, you run the risk of: Harmful side effects Illness returning Unnecessary trips to hospital or urgent care While you are taking medication, you should follow these helpful tips to ensure you stay well: Communicate with all your doctors about which medications you are taking, even which vitamins or herbal remedies you might be using. HEALTH 360 Tell your doctor if you are experiencing side effects. Take your medications at the same time every day. You could set an alarm or schedule it during an everyday activity like brushing your teeth. Save money by asking your doctor or pharmacist to switch to a lower-cost alternative medication or about decreasing the number of pills or medications you take daily. To ensure you never run out of your important medications, talk with your pharmacist about aligning all your medication refills to the same day of the month so you only make one trip to the pharmacy. You may also ask to get a 90-day supply and have prescriptions mailed right to your house for convenience. For your convenience, we have provided you with information on our programs and services designed to help you with your medications: Mail Order Pharmacy Medication Review Program Medication Adherence Program Have a 90-day supply of your medications mailed to your home at a lower cost. VISIT myfhca.org/directory Find the list of pharmacies in your area on our searchable Provider Directory. CALL Local: Toll-Free: Speak with a pharmacist on the phone to review your medications costs, amounts and alternatives. CALL For more information on our Medication Adherence Program, call Customer Service toll-free at (TTY/TDD relay: ) weekdays from 8 a.m. to 8 p.m. and Saturdays from 8 a.m. to noon. From October 1 to February 14, we re available seven days a week from 8 a.m. to 8 p.m. myfhca.org 11

12 Healthy Living is published as a service for members of Florida Hospital Care Advantage, administered by Health First Health Plans. Jennifer Brady, MD Chief Medical Officer Laura Breisch Director, Government Programs Jennifer Gammichia Editor, Marketing/Communications Information in Healthy Living comes from a wide range of medical experts. If you have any concerns or questions about specific content that may affect your health, please contact your healthcare provider. Models may be used in photos and illustrations. Developed by StayWell Y0089_MPINFO6257FH (11/16) Florida Hospital Care Advantage Health First Health Plans 6450 US Highway 1 Rockledge, FL PRST STD U.S. POSTAGE PAID Health First Health Plans, Inc. Health and wellness or prevention information 10768MB Healthy Recipe: Cranberry Salsa Preparation time: 10 minutes Number of servings: 8 Ingredients 4 oz. 100% cranberry juice blend 1½ cups diced tomatoes 1 cup fresh cranberries, sliced thin ¼ cup ripe medium avocado, diced ½ cup diced pineapple Doreen Colondres, ½ cup thinly sliced scallions Univision Star and (including green tops) Celebrity Chef 2 tbsp. lemon juice ¼ cup finely chopped jalapeno peppers 2 cloves crushed garlic (about 1 tsp.) More Healthy Recipes Online Find free and delicious hearthealthy recipes and cookbooks. Go to healthyeating.nhlbi.nih.gov. Directions Place juice into a saucepan. Boil for about five minutes until reduced to about 1 tablespoon of syrup. Place the reduced juice and all remaining ingredients into a medium bowl and stir until incorporated. Chill and serve immediately with favorite chips and vegetables. Source: Univision Star and Celebrity Chef, Doreen Colondres Florida Hospital Care Advantage is administered by Health First Health Plans. Health First Health Plans is an HMO plan with a Medicare contract. Enrollment in Health First Health Plans depends on contract renewal. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.