CARING for Life. We ve got you. In This Issue. upmchealthplan.com. UPMC for Life. One Chatham Center 112 Washington Place Pittsburgh, PA 15219

Transcription

1 Walks at the Zoo Page 2 Understanding generic drugs Page 6 Ask the Health Care Concierge Page 7 CARING for Life October 2008 A PUBLICATION OF UPMC HEALTH PLAN Don t get caught without a flu shot The flu season in Western Pennsylvania runs from November to April. Last year s flu season set a record with 1,442 reported cases. And that s only the reported cases many more are not reported. In This Issue National Senior Health and Fitness Day a big success...3 UPMC for Life Quality Improvement Program...4 Provider Directory on the Web...5 Traveling? Don t leave these important numbers behind!...7 Quitting smoking is advisable at any age... 8 UPMC for Life One Chatham Center 112 Washington Place Pittsburgh, PA upmchealthplan.com Member Services: Monday through Friday: 8 a.m. to 8 p.m. Saturday: 8 a.m. to 3 p.m. TTY Services: If you suspect you have the flu, call your doctor. Some bacterial diseases, like strep throat or pneumonia, can look like the flu or a cold. It s important to get medical attention immediately if you seem to be getting worse; are having any trouble breathing; have a high fever, a bad headache, or a sore throat; or are confused. To avoid getting and spreading the flu or a cold, along with many other illnesses, be sure to: Cover your nose and mouth with a tissue when coughing or sneezing. Wash your hands often with soap and water. Avoid close contact with people who are sick. Stay home from social gatherings when ill. Try not to touch your eyes, nose, or mouth. The U.S. Centers for Disease Control and Prevention (CDC) recommends that all people age 50 and older receive a flu shot. If you have family or contracted caregivers who regularly come into your home, you should ask them to get a flu shot. The CDC also recommends that children age 6 months to 19 years get a flu shot, so you might want to encourage any grandchildren to get their flu shots also. Please note that the CDC recommends that some people under age 50, including those with certain chronic medical conditions, also receive a flu shot. Please ask your doctor if you have a question about whether you or people who interact with you should receive a flu shot. If you do get the flu or a cold, make sure you: Get plenty of rest. Drink a lot of liquids. We ve got you covered! Flu shots are covered under your UPMC for Life benefits* Take medications such as acetaminophen to relieve fever and muscle aches. One Chatham Center 112 Washington Place Pittsburgh, PA When you see the icon, please visit our website at www. upmchealthplan.com to read an expanded version of the newsletter article. Did you know that you can read the current and past issues of Caring for Life on our website? Visit the enewsletter Center at to read the entire Caring for Life newsletter, read expanded information that s only available online, or sign up to receive any of our publications electronically.

2 CARING for Life Protect yourself get vaccinated today Pneumococcal disease kills more people in the United States each year than all other vaccinepreventable diseases combined. Anyone can get pneumococcal disease. This pneumococcal disease can lead to serious infections of the lungs (pneumonia), the blood (bacteremia), and the covering of the brain (meningitis). Out of every 20 people who get pneumonia, 1 person dies from it; 2 people out of 10 who get bacteremia die; and 3 people out of 10 who get meningitis die. Certain people are at greater risk for pneumococcal disease, including people age 65 and older, the very young, and people with special health problems, such as heart or lung disease, kidney failure, diabetes, HIV infection, certain types of cancer, or alcoholism. Prevention of pneumococcal infections is very important. The pneumococcal polysaccharide vaccine (PPV) protects against 23 types of pneumococcal bacteria. Most healthy adults who get the vaccine develop protection against most or all of these types within two to three weeks of getting the shot. The Centers for Disease Control and Prevention (CDC) recommends the following groups get vaccinated: All adults 65 years old or older. Anyone over 2 years old who has a long-term health problem, such as heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, or leaks of cerebrospinal fluid. Anyone over 2 years old who has a disease or condition that lowers the body s resistance to infection, such as Hodgkin s disease, lymphoma, leukemia, kidney failure, multiple myeloma, nephrotic syndrome, HIV infection or AIDS, a damaged spleen or no spleen, or an organ transplant. Anyone over 2 years old who is taking any drug or treatment that lowers the body s resistance to infection, such as long-term steroids, certain cancer drugs, or radiation therapy. Alaskan Natives and certain Native American populations. The vaccine is very safe. About half of the individuals who get the vaccine have very mild side effects, such as redness or pain where the shot is given. Getting the disease is much more likely to cause serious problems than getting the vaccine. 2 We ve got you covered! The pneumococcal vaccine is covered under your UPMC for Life benefits* Walks at the Zoo Hundreds of UPMC for Life members participated in this year s Walks at the Zoo events. The morning walks started in early April and finish in late October. It s as pleasant as can be, said Claude S., of the East End, who participated in a number of walks with his wife. It s a great setting and being at the zoo early in the morning is very, very nice. The animals are livelier in the morning and it s a completely different experience. On Walks at the Zoo days, UPMC for Life members and their guests are entitled to complimentary admission. Do you have grandchildren who need health insurance? The Children s Health Insurance Program (CHIP) may be the answer. CHIP is available to all uninsured children and teens (up to age 19) not eligible for Medical Assistance, regardless of family income. Now, no family makes too much money for CHIP. Many families will not have to pay for CHIP. Families with higher incomes will have to pay a low monthly premium and copayments for some services. UPMC Health Plan s CHIP product is called UPMC for Kids. Coverage includes medical, prescription drug, dental, vision, and other services. To learn more about how children and teens can be enrolled in CHIP, call UPMC for Kids at or visit our website at

3 upmchealthplan.com National Senior Health and Fitness Day a BIG success More than 1,000 UPMC for Life members and their guests enjoyed a day of fitness and fun at three different locations on the 15th annual National Senior Health and Fitness Day in May. UPMC for Life was the Pennsylvania state sponsor of the event. UPMC for Life members participated in a variety of events at three different sites the Pittsburgh Zoo & PPG Aquarium, Presque Isle in Erie, and the Penn State Altoona campus. The activities were designed to show how staying fit can be fun. In Pittsburgh, more than 700 members went to the Pittsburgh Zoo & PPG Aquarium to walk the grounds or to participate in the demonstration led by Leslie Sansone s Walk at Home team. It was a really nice outing, said Elda Murray, a UPMC for Life member from Wilkinsburg who attended the event at the zoo. I especially enjoyed doing those exercises. I hadn t been to the zoo in 27 years, said Dominic Citriniti, a UPMC for Life member from Penn Hills, who participated in a walk and in the group exercises. It was a good opportunity for me to take a walk through the zoo. It was a nice day. It was all worthwhile. In Erie, more than 50 members went to the Cookhouse Pavilion at Presque Isle to walk, take part in a Tai Chi demonstration, and listen to a presentation on Silver&Fit. During lunch, they enjoyed the music of the Dixie Doodlers. In Altoona, UPMC for Life teamed with Blair Senior Services for a day of fun on the campus of Penn State Altoona. Members participated in a walk and got advice from a certified laugh therapist. UPMC for Life is already looking forward to next year and planning ways to make these events bigger and better. Are you up to date on your vaccinations and health screenings? Getting regular checkups, preventive screenings, and immunizations are some of the most important things you can do for your health. Take the time to care for yourself call your doctor and schedule an appointment today. If you need help making your doctor appointment, your Health Care Concierge can assist you. Remember the Big 4 when scheduling your screenings and immunizations. 1 Pneumonia and Flu Vaccinations 2 Breast Cancer Screening 3 Colorectal Cancer Screening 4 Eye Health Screening

4 CARING for Life UPMC for Life Quality Improvement Program At UPMC Health Plan, the quality of health care our members receive is very important to us. Our Quality Improvement Program is overseen by a Quality Improvement Committee made up of physicians who are dedicated to improving the quality of care and service to members as well as to promoting hospital safety. UPMC Health Plan is a quality-focused health plan that is part of the University of Pittsburgh Medical Center. We combine the resources of the region s premier hospitals and doctors along with a behavioral health organization to provide high-quality health care for our members. And we continually work to improve care and service in many ways. For example: We carefully select our network of qualified doctors and other providers by checking their credentials and evaluating their performance. We work with members and doctors to coordinate preventive care and wellness efforts, manage complex cases, and manage chronic conditions. We measure our performance and work to continually improve the quality of care and service. These measurements include: - Member satisfaction - Preventive care - Care for chronic conditions, such as heart disease, diabetes, and osteoporosis - Medication management - Behavioral health care The UPMC for Life Quality Improvement Program has seen many successes. More members received recommended care for heart health, diabetes, behavioral health, and women s health. UPMC for Life doctors received strong ratings for the management of medications in older adults. Members were very satisfied with their ability to get needed care and get that care quickly. They also were satisfied with their doctors communication skills. We are working to improve our service and care even more. Future improvement initiatives include: Adding information to the online provider directory that can help members select providers based upon quality information. Specifying in the online provider directory the languages spoken in a provider practice. Improving follow-up with members to facilitate preventive care and care for clinical conditions. Providing Internet tools to help members manage their health, track the status of their claims, and find information about their pharmacy benefit. Our website, provides information about hospital quality and safety. If you would like a paper copy of the website information, or if you would like more information about the UPMC Health Plan Quality Improvement Program, please contact UPMC for Life Member Services at Representatives are available from 8 a.m. to 8 p.m., 7 days a week. TTY users should call Pneumonia (Pneumovax) and Flu Vaccinations. If you are 65 or older and have not had a pneumonia vaccination, or you are considered at high risk for pneumonia, you should talk to your doctor about getting a pneumonia vaccination. Remember to get your annual flu shot in the fall. Breast Cancer Screening. Women over the age of 40 should have a mammogram every 1 to 2 years. Mammograms are the most widely used test to screen for breast cancer. Colorectal Cancer Screening. Colorectal cancer is more likely to occur as people get older, although the disease can occur at any age. If you are over the age of 50, talk with your doctor about what tests you should have to screen for colorectal cancer and how often you should have those tests. Eye Health Screening. All adults should be tested for eye disease every 1 to 2 years. If you are over age 60 and have risk factors such as diabetes, high blood pressure, heart disease, or a family history of glaucoma, or are African American, talk to your doctor about having your eyes tested. Snap out this card as a reminder to keep up to date on your vaccinations and health screenings. You can place it on your refrigerator or copy the information on your calendar if you can t schedule an appointment today. If you have any questions or need assistance in finding a provider, call UPMC for Life Member Services at or your Health Care Concierge at Representatives are available Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m. TTY users should call Your benefit plan may not cover all your health care expenses. Read your contract carefully to determine which health care services are covered UPMC Health Plan, Inc. All Rights Reserved.

5 upmchealthplan.com Provider directory on the Web UPMC for Life has a large network of physicians, hospitals, and other health care providers. We encourage you to receive your medical services from the doctors and hospitals in our network in order to receive the highest level of benefits. Our provider directory can tell you whether your health care providers are in our network. We have a Web-based provider directory tool available at Select the Find a Provider link to obtain information, such as a provider s name, office location(s), telephone number(s), board certification status, specialty, hospital affiliation, medical group affiliation (if any), gender, languages spoken, and acceptance of new patients. You can find information about hospitals, including their location and their accreditation status. If you do not have access to the Internet, call Member Services at to obtain a paper copy of the directory. TTY users can call Benefits information online Your health is our priority. So is providing you with ways to actively manage your health care. That s why UPMC Health Plan s MyHealth program offers an interactive health and wellness tool called MyHealth OnLine. You can log in from any computer, even another family member s or one at your local library or community center. At MyHealth OnLine, information is organized into four categories MyHealth Record, MyBenefits, MyClaims, and MyTools. This Caring for Life newsletter features the MyTools section. MyTools provides a suite of helpful health care tools that can make it easier for you to understand your health status and make decisions about your health care. A practical interactive program within MyTools explains the risks and potential outcomes associated with various chronic conditions and more than 80 surgical procedures. Powered by Emmi TM Solutions, the program uses a high-quality, interactive presentation to provide detailed information on chronic conditions and specific surgeries and anesthesia. MyTools information includes: Fitness advice Healthy eating tips How to stop using tobacco Condition Centers Ways to decrease the cost of care Symptom Checker To register for MyHealth OnLine: 1. Go to and locate Secure login on the left side of the screen. 2. Select the link next to First-time users and follow the instructions, including choosing a challenge question. 3. To verify your identity, you will be asked to provide: 1. Your member ID number as listed on your ID card 2. The last four digits of your Social Security number 3. Your date of birth 4. Your zip code If you have already registered for MyHealth OnLine: 1. Go to 2. Enter your user ID in the Secure Login box on the left side of the screen. 3. After you enter your user ID and click Login, you may be asked a challenge question that you set up when you registered the first time. 4. Enter your password on the next screen. Always Online PROGRAM INFORMATION Benefit Plan Information Specialty Plan Part D Pharmacy Searchable Drug Formulary Pharmacy Directory Concierge Program Travel Assistance Program Health and Fitness FIND A PROVIDER Doctors Hospitals Behavioral Health Out of Area ADDITIONAL INFORMATION Filing a Complaint, Appeal, or Grievance Benefit Exclusions and Limitations Medicare Rights and Protections Privacy Information - Privacy Statement and Notice of Privacy Practices - Personal Representative Designation Form - Member Authorization to Use/ Disclose PHI HEALTH & WELLNESS Care Management Services Condition Management Programs Preventive Health Guidelines ABOUT US Quality and Safety (compare hospitals)* Quality Improvement Fraud & Abuse Prevention UPMC Classes & Events E-newsletters *Items with an asterisk (*) include recently updated information. If you wish to have any of the information on our website sent to you in printed form, call Member Services at

6 CARING for Life Understanding generic drugs Generic drugs are cost-effective alternatives that offer the same level of safety and quality as their brand-name equivalents. Generic drugs also have the same active ingredients as brand-name medications, but the inactive ingredients, such as dyes used to color generic medications or powders used to shape the tablets, can vary. These differences do not affect how generic medications work in the body. Not all drugs have a generic equivalent. Generally, new drugs are given patent protection for 20 years from the submission date of the patent. Once the patent expires, other pharmaceutical companies can produce the same drug in a generic formulation. Does the Food and Drug Administration (FDA) approve generic drugs? The FDA regulates generic drug manufacturers just as it regulates the makers of brand-name medications. Prior to selling generic medications in the United States, a company must meet certain criteria. To gain FDA approval, the maker of a generic drug must prove that the drug s active ingredients, drug strength, and dosage form are identical to those of the corresponding brand-name drug. The generic drug must also pass strict FDA measurements to ensure that it delivers the same amount of active ingredients in the same time frame as its brand-name counterpart. Finally, the manufacturer of the generic drug must prove that its product is produced under the same strict guidelines as the brand-name drug. The manufacturer can produce the generic medicine only after these requirements are met. After approval, the FDA continues to regularly inspect all manufacturing facilities of both brand and generic products to ensure that only high-quality medications are sold in the United States. Why do generic drugs cost less? Generic drugs have the same active ingredients as their brand-name equivalents, but they cost significantly less. Before the FDA allows a brand-name drug to be sold in the United States, scientists spend years testing the medication to establish its safety and efficacy in treating an illness or condition. Once a brand-name drug is approved, the company that developed it spends millions of dollars to promote the drug through advertising and educational programs. Companies that make generic drugs do not have to invest large amounts of money in research, since the brand-name drug manufacturers have already done this. In addition, generic companies do not promote their drug or spend significant amounts of money on magazine and television advertisements. Companies that make generic drugs pass these savings on to you. Why should I use generic drugs? Every year, generic drugs filled at pharmacies save consumers billions of dollars. By choosing a generic medication, you: Save money on your prescription copayment, Get the same quality and effectiveness as that of a brand-name drug, and Help keep medical care more affordable. Note: Please consult your physician before changing any prescription medication. How can I take advantage of the savings with generics? When your doctor writes you a prescription, ask if a generic drug is available. Although not all drugs have a generic counterpart, there may be a generic in the same class of drugs used to treat your condition. Visit the FDA Office of Generic Drugs website at for more information or log in to MyHealth OnLine at to: Find out more about generic drugs. Review what drugs are covered under your pharmacy benefit. Arrange for your prescriptions to be delivered to your home. Locate a pharmacy near you. Here are some common brand-name drugs and their generic equivalents: BRAND GENERIC COMMON USES Allegra fexofenadine Allergies Amaryl glimepiride Diabetes Ambien zolpidem tartrate Insomnia Celexa citalopram Depression Claritin OTC loratadine Allergies Coreg carvedilol High blood pressure Flonase (nasal spray) fluticasone Allergies Fosamax alendronate Osteoporosis Lamisil terbinafine Nail fungus Lotrel amlodipine besylate/ benazepril High blood pressure Norvasc amlodipine besylate High blood pressure Omnicef cefdinir Infection Paxil paroxetine Depression Pravachol pravastatin High cholesterol Prozac fluoxetine Depression Toprol XL metoprolol SR High blood pressure Zithromax azithromycin Infection Zocor simvastatin High cholesterol Zoloft sertraline Depression 6

7 upmchealthplan.com Have you moved? If you have recently moved or are planning to move, please let UPMC for Life know! You may contact your Health Care Concierge at or Member Services at with your new address and phone number. Ask the Health Care Concierge Q: Do I need to notify UPMC for Life before I change my primary care physician (PCP)? A: Yes, it is important to call us before you change your PCP and schedule your first appointment with him or her. Doing so helps ensure that all medical claims associated with the new PCP will be considered for payment. Your Health Care Concierge can help you locate a new PCP, make the PCP change, and schedule your first appointment. UPMC for Life Concierge Jessica Young Traveling? Don t leave these important phone numbers behind! You ve packed your suitcases and medications and made your travel arrangements. You ve thought of everything or have you? Do you know what to do if you need medical care while you re out of town? UPMC for Life has several ways to help. If you or another UPMC for Life member is having a medical emergency, seek care at the nearest hospital or urgent care facility. If you need to see a doctor for a non-urgent medical issue or you need to have a prescription refilled, contact UPMC for Life at You may also contact your Health Care Concierge at Representatives are available from 8 a.m. to 8 p.m. Monday through Friday and from 8 a.m. to 3 p.m. on Saturday. We can help you find a pharmacy close to you and we can coordinate any medical care that you need through your primary care physician at home. If you are 100 miles or more away from home and are facing a more complicated medical issue, you may call Assist America for help. Assist America is available by calling toll-free (within the United States) or collect at (outside the United States). Service is available 24 hours a day, 7 days a week. So don't forget to pack your medications and these important phone numbers. Don t let drugs become a problem You might not realize it, but the risk of drug use problems increases with age. This is due to several factors, including changes in your body s metabolism, having more than one illness, and taking multiple drugs at the same time. To avoid putting yourself at risk for problems with drug use: Talk to your doctor about everything you take, whether it s prescription medications, over-the-counter medications, vitamins, supplements, herbal products, alcohol, or illicit drugs. Share this information with all your doctors. Follow your doctors orders when taking medications. Do not stop your medications suddenly without speaking to your doctor. Do not take other people s medications. Limit or stop using alcohol, especially if your doctor advises you to do so. Do not take illegal drugs. Be aware of potential drug interactions (including interactions with over-the-counter medications) before you take any medications. A drug interaction means an effect in the body that happens when two or more drugs are in the body at the same time and one affects the other. To learn more about drugs and their effects, talk to your doctor or pharmacist. You also can log in to MyHealth OnLine at for information. If you are concerned about your drug use, call UPMC Health Plan Behavioral Health Services toll-free at for referral assistance or for benefit information about substance abuse treatment services. TTY users can call * 7

8 CARING for Life Quitting smoking is advisable at any age If you are an older smoker, chances are you ve been smoking for an average of 40 years and are a heavy smoker. You also are more likely to be suffering from a smokingrelated illness. Here are some facts you need to know about older adults and smoking: In 2005, 18.7 million Americans over the age of 45 smoked, accounting for over 41 percent of all adult smokers. Nine percent of Americans over 65 years of age smoked. Smoking is responsible for 90 percent of deaths from lung cancer, 21 percent of deaths from heart disease, 18 percent of deaths from stroke, and 80 to 90 percent of deaths from chronic obstructive pulmonary disease (emphysema and chronic bronchitis). These are all leading causes of death in people 50 years of age and over. Men 65 or older who smoke are twice as likely to die from a stroke, and women smokers are about one and a half times as likely to die from a stroke as their nonsmoking counterparts. The risk of dying from a heart attack is 60 percent higher for smokers than nonsmokers age 65 or older. Cigarette smokers are more than twice as likely as nonsmokers to develop dementia of any kind, including Alzheimer s disease. Smokers also have two to three times more risk of developing cataracts, the leading cause of blindness and visual loss, than do nonsmokers. Smoking reduces normal life expectancy by an average of 13 to 15 years. Quitting smoking has proven health benefits, even at a late age. When an older person quits smoking, circulation improves immediately and the lungs begin to repair damage. In one year, the added risk of heart disease is cut almost in half, and risk of stroke, lung disease, and cancer diminish. Among smokers who quit at age 65, men gained 1.4 to 2.0 years of life and women gained 2.7 to 3.4 years. UPMC for Life can guide you to resources to help you stop smoking. Contact UPMC for Life at You may also contact your Health Care Concierge at Representatives are available from 8 a.m. to 8 p.m. Monday through Friday and from 8 a.m. to 3 p.m. on Saturday.* Did you know? You have two opportunities to change your Medicare coverage during the year. You can do it during the Annual Election Period. During this time, all beneficiaries can make changes in how they receive coverage. The annual election period runs from November 15 to December 31 each year and your coverage will begin on January 1 of the following year. You also can change plans during the Open Enrollment Period. This period runs from January 1 through March 31 each year. During this switch period you can add or change to a plan with prescription drug coverage only if you already have Medicare prescription drug coverage. In certain situations, you may be able to join, switch, or drop plans at other times (for example, if you move out of the service area, have both Medicare and Medicaid, or qualify for extra help with your Medicare prescription drug coverage). Get help for depression through our health management program According to the National Alliance on Mental Illness, approximately 19 percent of older adults experience depression. In fact, depression is one of the most common health problems and affects people of all ages. UPMC Health Plan Behavioral Health Services has recently created a Depression Preventive Health Management Program that is designed to help UPMC for Life members learn more about depression and ways to recover from it. Depression can be managed, and the road to recovery is easier when you have the right information and resources. Educational newsletters about depression are available on our website at index.php at no charge. You may request paper copies of the website information by calling toll-free at TTY users can call Staff members are available to answer your questions or to provide more information about depression or other behavioral health topics. If you are depressed, please call toll-free at * *Not all benefits mentioned apply to all members. Your benefit plan may not cover all services. Please read your Evidence of Coverage or contact Member Services to determine which services are covered UPMC Health Plan, Inc. All Rights Reserved. CFL NWSLTR C (FL) 10/23/08 66M DL