Balance summer 2016

L IFE , HEALTH & WELLNESSS U M M E R 2 0 1 6

A P U B L I C A T I O N O F

One of our values is to take care of ourselves, so we can take care of others. Network Health helps us do that.Catalpa Health and Lisa Kogan-Praska do great work in the community.

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EDITORIAL STAFF Interim President and CEO Michael Muchnicki

Chief Administrative Penny Ransom Officer

Marketing Jessica Coordinator Thomaschefsky

Lead Designer Debra Sutton

EDITORIAL BOARD Dawn Rady, Mark Geiger, Renee Corral, Teri Koepke, Darren Brzozowski, Melanie Draheim, Gary Melis, Carisa Satorius, Stacy Schwandner, Joan Merwin, Jessica Fischer

Balance is published by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals.

© 2016 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.

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wellness12 Bug Off Finding the best insect repellent

12 Do You Need Help Submitting a Claim? How to arrange for reimbursement

13 Scam Alert Keep your financial and insurance information safe

14 Understanding Prediabetes Know your risk of developing type 2 diabetes

15 Evaluating New Technologies Network Health evaluates new technologies on a regular basis

16 Using and Understanding Our Provider Network Answers to questions about ThedaCare and other providers

19 The Advantage of Having a Primary Care Provider One main provider who knows you well is essential

19 Access and After Hours Care Timeliness for medical and behavioral services

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3 Leave Your Worries at Home Coverage while on vacation

4 In Case of Emergency Be prepared to weather the storm

4 Member Rights and Responsibilities Your rights as a Network Health member

5 Make Your Medication Work The importance of taking your medications as prescribed

6 End the Stigma Overcoming misconceptions about mental illness

6 Find Preventive Guidelines Online See our preventive care guidelines at networkhealth.com 7 Are You at Risk for Chronic Kidney Disease? Learn about the disease and the risks

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TELL US WHAT YOU THINK If you have questions or suggestions or would like to tell us how Network Health improved your life, send us an email [email protected].

You can also write to us at:Network HealthAttention: Jessica Thomaschefsky1570 Midway Pl.Menasha, WI 54952

HAVE A QUESTION? Call our award-winning customer service team.

HOURSMon., Wed. - Fri.: 8 a.m. to 5 p.m.Tuesday: 8 a.m. to 4 p.m.

PLANS THROUGH AN EMPLOYER800-826-0940

PLANS FOR INDIVIDUALS AND FAMILIES855-275-1400

WANT MORE HEALTH TIPS? Check out our blog at copilotwi.com. We add helpful information about health and well-being every week, so be sure to visit often.

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So We Can Take Care of Others

TAKING CARE OF OURSELVESHow the Millennium wellness program is helping Catalpa Health take care of their own

life Information to help you get the most out of your coverage

net workheal th .c om Summer 2016 • balance | 3

Leave Your Worries At HomeEMERGENCIES

If you have a medical emergency when you’re out of the service area, call 9-1-1 or get to the nearest emergency room. You have

health care benefits for emergency situations such as heart attacks, excessive bleeding, head traumas, broken bones or seizures. When out of the service area, you’re covered for an emergency hospitalization until you can be moved to a participating Network Health facility, as long as you let us know about your emergency within 48 hours of being admitted into the hospital. Be sure to show your Network Health member ID card when you check in.

URGENT CAREYou’re covered for urgent care situations like minor injuries, stitches, possible strep throat or ear infections when you cannot travel safely to your primary doctor. If you are outside of Network Health’s service area and you need to see a doctor but it isn’t an emergency, you can still visit a hospital or an urgent care clinic. However, if the doctor or facility is not in our network, you’ll need to notify us within 48 hours of receiving care. To do so, contact our customer service department at 800-826-0940 to request approval. Our customer service department is available from 8 a.m. to 5 p.m., Monday, Wednesday, Thursday and Friday, and from 8 a.m. to 4 p.m. on Tuesday.

FOLLOW-UP CAREYou’ll need to see your primary doctor, or another in-network provider for your follow-up care. If this isn’t possible, and you visit a doctor or hospital not in our network, you’ll need to call us for approval within 48 hours of treatment.

PAYMENT FOR CARESome medical facilities outside Network Health’s service area may require you to pay for your care when it’s provided. To get reimbursed, send the itemized bills and proof of payment within 90 days of receiving care to the address below.

You don’t plan on getting sick or injured while on a trip, but because vacations sometimes turn into unexpected adventures, Network Health has you covered when you’re away from home.

Network HealthAttn: ClaimsP.O. Box 568Menasha, WI 54952


life

Plan Ahead n Secure anything that could be blown around or torn loose. Garbage cans and lawn furniture have the potential to get picked up by strong winds and injure people or damage property.

n Assess your landscape and trim any dead branches or cut down dead trees to reduce the risk of them falling during a storm.

n Develop a storm plan with your family and identify a safe place for everyone to meet in the event that not all family members are together when a storm hits. Practice your plan once a year.

n Create an emergency kit containing some basic supplies to help you make it through at least 72 hours without electricity and water. Consider including the items below. n Water and non-perishable food n Flashlight and batteries (or hand-crank flashlight) n Radio and batteries n Backup cell phone battery n First aid kit and prescription medications n Travel-size toiletries n Important documents (birth certificates, social security cards, insurance policies and other documents) in a waterproof container

An emergency kit should fit easily into a backpack or duffel bag and be stored in a location like a hall closet for easy access.

Understand a Watch vs. a Warning Watch – Watches alert you that something could happen. A watch is issued two to six hours before a possible weather event.

Warning – Warnings alert you that a storm has been spotted and you should take shelter immediately. A warning is issued at least 10 minutes before a weather event will strike, whenever possible.

Be Informed If you have a Wireless Emergency Alert (WEA)-capable phone and your wireless carrier participates, the National Weather Service will automatically send alerts for extreme weather based on your location and the current weather in that area. You can also download a weather alert app on your phone to receive severe weather alerts.

The threat of storms and flooding increases in July and August in Wisconsin. Peak tornado season in Wisconsin runs from

April through August, but tornadoes can occur any time of year. Prepare to weather the storm season with the following tips.

In Case of EmergencyBE PREPARED

Member Rights and ResponsibilitiesDo you know your rights and responsibilities as a Network Health member? To learn more about how we provide you with service that respects your rights, go to networkhealth.com/rights or call the appropriate customer service number listed on page two of this publication.


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According to the Mayo Clinic, almost 70 percent of Americans take at least one medication, and more than half take at least two.

Not taking your medications exactly as your doctor prescribes is the main reason treatments fail, leading to worsening symptoms, more time spent in the hospital and higher health care costs. To make sure your medications continue to work effectively, you and your doctor should evaluate your medications, review lab tests and check your health status. As part of this plan, you can help by scheduling and attending regular appointments and having necessary lab tests. It’s important to know why you take the medications you do. For example, many members take over-the-counter aspirin for heart disease to help prevent a heart attack. If you take aspirin, know the proper dosage and frequency as well as the benefits, risks and potential interactions. Most medications have various side effects, so it’s important to understand what risks are associated with your medications. For example, high blood pressure medications like lisinopril (ACE) or losartan (ARB) have common side effects including dizziness, diarrhea and vomiting. Diuretics like Lasix or hydrochlorothiazide (more commonly known as “water pills”) are prescribed to adjust body fluids, and your doctor will want to monitor the dosage and how your body is reacting to the medication. Heart medicines such as digoxin should be monitored regularly by a doctor to make sure they are prescribed at a “therapeutic” level. Maintaining a therapeutic level ensures that the amount of medication in your body is at a sufficient level to help stabilize your cardiovascular system. Doctors also need to monitor how your body is reacting to the illness and any persistent or long-term medications. Your doctor may prescribe lab tests because long-term prescriptions can affect organ function. Members who have heart disease may require a regular blood test to elevate potassium levels and heart function. Those who have kidney disease may need a creatinine level as a part of their treatment plan. During future visits, your doctor will use lab results and the updated history you provide to monitor for signs of harmful effects. He or she may simply adjust the dosage or prescribe a different

medication. Together, you and your doctor can ensure your medications are working properly to maintain or improve your health.

Use this list of questions and tips to help make sure you’re doing things right.

UnderstandIf you don’t know or understand the answers to the following questions, ask your doctor or pharmacist for instructions.n Why am I taking this drug?n How and when should I take it?n How should I store it?n What are the possible side effects?

Organizen If you take multiple medications, create a list to help you remember the instructions for each. n Use a pill box to keep your medications in order.n Make a list of questions you have about your medications and bring the list to your next doctor’s appointment.

Avoidn Don’t alter the amount of a medication unless your doctor approves it.n Don’t take your medication for any symptoms it wasn’t prescribed for.n Don’t take someone else’s medications and don’t give your medications away. Prescriptions are specific to each individual’s health and wellness.Never stop any medications prescribed by your doctor without their approval. Discontinuing some medications suddenly can cause serious medical issues.

Make Your Medications Work

News and tips to help you maintain a healthy and happy life

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Find Preventive Guidelines OnlineTo help you prevent health problems, Network Health covers certain services at no cost to you. Go to networkhealth.com/members to see a list of these preventive services. Select the Resources tab on the right side of the page, click the Learn More button and then choose Preventive Services Guide.

M ost people know it’s important to seek treatment for physical ailments. We wouldn’t just ignore

a broken bone hoping it will get better on its own. Unfortunately, the same doesn’t hold true for mental health concerns. One in five adults and one in five children (ages 13-18) experience a mental health disorder annually. With those staggering statistics, it’s likely that someone in your personal circle is affected by mental illness. Less than one-third of adults and one-half of children will receive the necessary mental health intervention to treat their disorders. Too often people feel ashamed, blamed for their illness or too embarrassed to seek help. Stigma remains one of the biggest barriers preventing people from seeking treatment.

Each form of mental illness has its own set of symptoms. Here are a few common signs in adults and teens.

Mental health conditions can also develop in young children. The symptoms are more behavioral as small children are still learning about their emotions and how to communicate. A few common symptoms in children include the following.

If you notice these signs in yourself or someone you love, don’t be afraid to reach out for help. Contact your primary care doctor or visit the National Alliance of Mental Illness (NAMI) website at nami.org for expert information about mental illnesses and where you can find support. NAMI is committed to overcoming misconceptions about mental illness. Their goal is to replace stigma with compassion and understanding. Through education, and with access to quality mental health care, treatment works. Mental health recovery is possible.

End the Stigma

Excessive Worry or Fear

ExtremeMood Changes

Avoiding Friends and Social Activities

Changes in Sleeping and Eating Habits

Frequent Temper Tantrums

FrequentNightmares

Changes in School Performance

HyperactiveBehavior

For a complete list of recent changes to our provider network, go to networkhealth.com/providerchanges.


When was the last time you thought about your kidneys? These two bean-shaped organs have an incredible job. They filter waste and

extra fluid from the blood and produce urine. If waste builds up in your blood, it can make you feel sick. In fact, they’re so good at what they do that it can be tough to tell if something’s wrong. Unlike many diseases, kidney disease often has no symptoms until it reaches an advanced stage. The National Kidney Foundation estimates that more than 26 million U.S. adults have chronic kidney disease (CKD), and most are undiagnosed. In fact, kidney disease is the ninth leading cause of death in the U.S. There are things you can do to prevent kidney disease and make sure your kidneys continue working well. Speak with your doctor, especially if you answer yes to the questions below. Your doctor may order tests to measure your kidney function. A glomerular filtration rate (GFR) test measures how much blood your kidneys filter each minute. The doctor may also want to measure the level of proteins in your urine. This is done with an albuminuria or microalbuminuria test. Both tests are painless and routine diagnostic tools.Kidney disease is a progressive disease, which means that the damage tends to be permanent. However, that doesn’t mean you can’t prevent further damage, and treatments are very effective when caught in the early stages. Maintaining proper diet and nutrition are important factors in living well with kidney disease. As kidney disease progresses, your dietary needs will likely change with each stage of the disease. Be sure to talk with your doctor about your individual nutrition needs. For people with diabetes, controlling your blood pressure and improving your blood glucose levels can reduce the risk of kidney disease by 33-40 percent or help slow its progression.

Are You at Risk for Chronic Kidney Disease?

To learn more about managing chronic kidney disease, visit GoEmmi.com and enter code NETWORKCKD.

How can you tell if you’re at risk of chronic kidney disease?u Do you have diabetes?

u Do you have high

blood pressure?

u Do you have heart disease?

u Did a member of your immediate family have kidney disease?

S A Y W H A T ?

Albuminuria and microalbuminuria tests – Screenings to measure the level of protein in urine

C O V E R S T O R Y

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We are able to continue to do good in the community, because you’re doing good for us.- L I S A K O G A N - P R A S K A president and CEO of Catalpa Healt h

- K r i s t i e M a r x patient relat ions special ist

B y J e s s i c a T h o m a s c h e f s k yP h o t o g r a p h s b y B e t h D e s J a r d i n , T r o v e P h o t o g r a p h y

Catalpa Health, pronounced [kuh-tal-puh], was formed in November 2012. This team of health professionals came together to solve a growing need in the community for pediatric outpatient mental health and wellness services. A growing number of families were not able to access the care they needed for their children, so Catalpa Health was formed to provide the right care at the right time, close to home. > > >


So We Can Take Care of Others

TAKING CARE OF OURSELVES

DID YOU KNOW? The Catalpa tree is recognized as a symbol of strength, shelter and protection. It’s also known for its heart-shaped leaves.

You recently selected Network Health as your group’s health insurance plan.

Why did you choose Network Health?

JUSTIN: Cost was first and foremost. As a non-profit, cost makes a big difference. We were also impressed with the plan designs. They were a little different than what we were seeing with other insurers and a lot easier to understand.

LISA: Being local makes all the difference to Catalpa. A lot of our families have Network Health as their insurer, and it’s important for us to be able to have that partnership in place. We have a shared vision and shared ownership in the community. Network

Health is one of the only insurers that reached out to us and asked us how they can do things better.

You purchased the Millennium wellness program along with your

insurance plan. What made you decide to purchase a wellness plan?

LISA: It’s been on our radar for a long time, and we’ve always wanted a wellness program. We are a smaller organization so our employees wear a lot of hats, and we don’t have the time or resources to make wellness a part of someone’s job. We also don’t have the knowledge or expertise. Network Health makes it easy for us.

The fact that we could make it for everyone, not just those who took the insurance, is great. It’s a wonderful thing to be able to look at our values and our culture and then be able to offer our employees this great wellness plan without having it be a lot of work on our end. A lot of our employees have come from larger health care systems and were used to having a wellness program. They came to Catalpa, and the infrastructure wasn’t there to implement a program right away. It was refreshing to be able to offer it and have it done right. Also, the recruitment factor is huge. We are able to say that we invest in our

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Catalpa Health is a partnership between Affinity Health System, Children’s Hospital of Wisconsin and ThedaCare. “We really don’t know of anywhere else where three competing health care systems have come together for

the kids in their community and really put the kids and families first,” said Lisa Kogan-Praska. In just four short years, Catalpa Health has grown from a team of 32 employees to a team of 100 with four locations. They have served more than 9,500 patients with approximately 100,000 visits. Not only is Catalpa Health one of Network Health’s providers, but they are also members of our health insurance plan and Millennium wellness program. Millennium encourages and rewards individuals for meeting health and fitness goals and provides the tools they need to support their goals. In a recent interview, Lisa Kogan-Praska, Kristie Marx, Justin Dlugolenski, and Liz Miller revealed how their experiences with Network Health and the Millennium wellness program shape their vision of wellness for their own team, even as they help others on their journey to a healthy lifestyle. Here is what they had to say.

There is a real investment from Network Health because we are both in the community, both serving these families and wanting to serve them better together.- L I S A K O G A N - P R A S K A

‘‘’’

Pictured from left to right: Liz Miller, CFO, Lisa Kogan-Praska, president and CEO, Justin Dlugolenski, director of business operations and Kristie Marx, patient relations specialist


employee’s health and we take it seriously. We want to attract and retain the best talent because we are nothing if we don’t have talented team members. One of our values is to take care of ourselves, so we can take care of others. Network Health helps us do that.

How has the wellness program been received so far?

JUSTIN: This is something our employees really wanted. Even those not taking the insurance still want to be involved in the wellness program.

KRISTIE: Everyone is very excited. It has all the elements we were looking for, and it’s easy to use. Our employees really appreciate the online learning presentations that are available. They can sit at their desk, log in and earn wellness points. We can reserve a conference room and multiple staff members can come together and do the online learnings as a team. The education, screenings, tools and resources and rewards are all centralized on the website and can be customized. We also like that it’s not all online. We can have a personal touch by having Network Health Wellness Coordinator Aaron Hunnel come onsite and give presentations. We can also earn rewards for participating in community fitness events. We have a Fit and Fun team that plans potlucks, parties and wellness activities. We talk about topics for wellness presentations that we want to incorporate and then contact Aaron with those requests. We recently came up with an idea for exercises and stretches that employees can do at their desks. We contacted Aaron, and he made it happen. This type of thing wouldn’t normally happen with another program. It’s going above and beyond our expectations. Aaron is

amazing and has made it all very easy for us.

You have been one of Network Health’s providers since you opened your doors in 2012. What has that experience

been like?

JUSTIN: Our preauthorization team has exceptional things to say about contacting and communicating with Network Health. They are able to connect with someone right away, no waiting on hold or being transferred a number of times. And, when there is an issue, it’s always resolved timely.

LISA: When we did our day treatment planning we wanted to have the perspective of what our partners value. We were able to have someone from Network Health be involved in the planning process, take tours of the office and give us insights from the prospective of an insurer. That’s not something you would normally have with any other partner. There is a real investment from Network Health because we are both in the community, both serving these families and wanting to serve them better together. “We are able to continue to do good in the community because you’re doing good for us. That’s phenomenal, so thank you.”

Wellness in Real LifeLiz Miller, CFO at Catalpa, is an avid runner and keeps an eye on her health. Her husband, however, was a little hesitant to sign up and participate in the wellness program. With Liz’s encouragement and help he logged on to the website and set up his account. Once he learned that he could earn rewards redeemable for gift cards to places like Cabela’s, he was all in. The interactive Millennium website, which received a 2016 Digital Health Award, makes it easy for Liz’s husband to track his healthy activities and rewards. “For someone who isn’t tech-savvy or a physically active person focused on fitness and health, this has completely changed his perspective,” said Liz.

SAY WHAT?

Day treatment program – A program that offers more structure, support and treatment intensity than outpatient therapy can provide. Catalpa Health’s day treatment program for teens combines half-day intensive outpatient therapy with a half-day education component.

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Do You Need Help Submitting a Claim?

Most hospitals and doctor offices will submit claims on your behalf. But some out-of-area medical facilities may require that you pay for care at the time it’s given.

To arrange for reimbursement, you must send itemized bills and proof of payment within 90 days to Network Health. You can send these to the address below. For more information, contact our customer service department at 855-275-1400.

Don’t let bugs and ticks ruin a perfect summer day outdoors. There are many kinds of bug repellants on the store shelves, but how do

you know which one is right for you? Here are a few tips to help you make the right choice.

Look for effective ingredientsDEET – DEET has been the go-to repellent for decades. However, consumers are confused by how safe it actually is. According to a Consumer Reports study, products with 15 percent or more DEET work well. Concentrations above 30 percent do not work any better, and in fact, the higher the concentration, the more dangerous it can be. It can cause rashes, disorientation and even seizures. It’s also a good rule of thumb to never use a product containing DEET on babies younger than two months. If you are looking for an alternative to DEET, try Picaridin or oil of lemon eucalyptus. Both are good alternatives because they are considered safer and yet still effective.

Picaridin – Picaridin is made to resemble piperine, a chemical found in black pepper. It can be used on human skin or clothing to repel mosquitos, biting flies, ticks, fleas and chiggers. Picaridin comes in many forms such as spray, liquid, aerosol or wipes. Look for products containing 20 percent picaridin.

Oil of lemon eucalyptus – Oil of lemon eucalyptus is derived from the gum eucalyptus tree. Products containing 30 percent lemon

eucalyptus oil are effective at repelling mosquitos and ticks. Although the potential side effects are less severe than DEET, it can cause temporary eye injury and is not recommended for children under age three.

Keep safety in mindNo matter what type of insect repellent you select, make sure to use it as directed. Here are a few tips to keep you and your family safe when applying repellent. n Make sure to read the label and follow the directions for proper use and how much to apply. n Apply repellents to exposed skin and clothing only.n Do not spray or apply the repellent near your eyes or mouth. n Avoid breathing a spray product. n Never use over a cut or wound.

Visit the National Pesticide Information Center website at npic.orst.edu for more information on the ingredients used and the safe use of insect repellant.

Bug Off Finding the best insect repellent

Network Health, Attn: Claims DepartmentP.O. Box 568, Menasha, WI 54952

News and tips to help you maintain a healthy and happy life

If you’ve been diagnosed with chronic bronchitis, emphysema or COPD, let us help. Breathe at Ease is Network Health’s

proactive condition management program designed to help members avoid flare-ups, control symptoms and potentially improve their lung conditions. It’s intended to supplement a physician’s care with one-on-one support from a respiratory therapist. Breathe at Ease received the 2016 Innovation Award from the Wisconsin Society of Cardiovascular and Pulmonary Health & Rehabilitation. To learn more, visit networkhealth.com/Breathe or call Caroline Alterman, clinical program manager, at 920-720-1677. Breathe at Ease is available at the following locations.

St. Elizabeth HospitalAttention: Robyn West, RRT1506 S. Oneida St., Appleton, Wisconsin 54915Phone 920-831-1498, Fax [email protected]

Mercy Medical CenterAttention: Robyn West, RRT 500 S. Oakwood Rd., Oshkosh, WI 54904Phone 920-831-1498, Fax [email protected]

Affinity Medical Group New LondonAttention: Robyn West, RRT 1420 Algoma St., New London, WI 54961Phone 920-831-1498, Fax [email protected]

Calumet Medical CenterAttention: Peggy Nolan, RRT614 Memorial Dr., Chilton, WI 53014Phone 920-849-1816, Fax [email protected]

Holy Family Memorial Attention: Sandy Bauman, CRTand Lori Newberg, CRT2300 Western Ave., Manitowoc, WI 54220Phone 920-320-4247(4AIR), Fax [email protected] or [email protected]

Breathe easeatBreathe easeat


Be Aware of ScamsWe’ve all heard the phrase, “If it seems too good to be true, it probably

is.” Yet, many scam artists have found ways to convince us otherwise, stealing our financial and personal information for their benefit. With this in mind, it is important to protect yourself from both financial and insurance fraud. To do so, we recommend you follow these tips to keep your information safe and secure.n Never sign blank insurance claim forms.n Do not do business with door-to-door or telephone sales people who tell you that services of medical equipment are free or available for no direct cost to you.n Only give your insurance identification and Social Security number to those who have provided you with medical services.n Keep accurate records of all your health care appointments and verify your explanation of benefits and all bills for services.n Always watch your credit card and bank statements for any improper billing activity or fraudulent withdrawals.n Monitor your credit report regularly.

Sometimes people do not report scams because they are ashamed or embarrassed. It’s important to understand that it is not your fault. If you believe you may be a victim of an insurance scam, we are here to assist you. Call us at the number on page two or send an email to [email protected]


wellness

Understanding PrediabetesKnow your risk of developing type 2 diabetes

P rediabetes is a condition when blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. Prediabetes may sometimes be referred to as

impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). According to the American Diabetes Association, almost 80 million Americans have prediabetes. There are no obvious symptoms, so some people may have it and not know it. You typically find out you have prediabetes when you are being tested for type 2 diabetes.

What may increase your risk for prediabetes?Unfortunately, the exact cause is unknown, but family history and genetics typically play a big role. Here are a few risk factors.n Being overweight, with a body mass index (BMI) above 25n Inactivityn Being age 45 or oldern A family history of type 2 diabetesn High blood pressuren Being African-American, Hispanic, American Indian, Asian-American or a Pacific Islandern Developing gestational diabetes when pregnant If any of these apply to you, you may want to check with your doctor to see if a diabetes test is recommended. If left untreated, prediabetes can develop into type 2 diabetes.

What are the symptoms of type 2 diabetes?Classic symptoms to watch for that would suggest you’ve moved from prediabetes to type 2 diabetes include the following.n Increased thirstn Frequent urinationn Fatiguen Blurred vision

How can I prevent type 2 diabetes?If you have prediabetes, it doesn’t mean you’ll automatically develop type 2 diabetes. For some people, early treatment can actually return blood glucose levels to normal. Even if diabetes runs in your family, choosing a healthy lifestyle can help you prevent prediabetes and its progression.

Here’s what you can do.n Strive for a 5 to 10 percent reduction in weight and avoid weight gainn Maintain a BMI between 18.5 and 24.9n Exercise moderately for 30 minutes a day, five days a weekn Eat healthy foods Living a healthier lifestyle can prevent, treat or even reverse prediabetes. By knowing the risk factors and making the necessary lifestyle changes, you will improve your health dramatically.

To learn more about managing diabetes, visit GoEmmi.com and enter code NETWORKPREDIABETES.

S A Y W H A T ?

Prediabetes – When a person is at increased risk for developing diabetes because of higher than normal blood glucose levels.

Type 2 diabetes – When the pancreas does not make enough insulin or the body cannot use the insulin properly, resulting in a buildup of sugar in the blood.


Network Health’sSelf-Management WorkshopsAt Network Health, we connect you and your caregivers with workshops that provide the tools needed to manage your condition. For more information or to sign up for a workshop, call us at 800-769-3186, extension 87160. You can also visit networkhealth.com/workshops, and click Learn More for details about each workshop.

Living Well with Chronic ConditionsThis workshop is for anyone living with a chronic condition such as COPD, arthritis, heart disease, anxiety, migraines, depression, asthma and many other long-term illnesses. This workshop teaches self-management skills including goal setting, reducing fatigue, physical activities,healthy eating, stress relief, relaxation and more. This workshop meets once each week forsix weeks. Each session is two and a half hours, and caregivers are welcome to attend.

Healthy Living with DiabetesDesigned for any adult living with type 2 diabetes, prediabetes and their caregivers, Healthy Living with Diabetes helps you better manage your condition and related challenges. Each session is designed to help you learn practical ways to deal with your diabetes, discover better nutrition and physical activities and learn more about meal planning, carb counting, label reading, sick days, monitoring and preventing low blood sugar, communicating with doctors and navigating health care systems. This workshop meets once a week for six weeks. Each session is two and a half hours and will help you create a step-by-step plan to improve your health.

Stepping OnStepping On is a program for older adults living independently who may have fallen, worry about falling or are at risk of falling. This program promotes confidence and awareness by teaching strength and balance exercises, as well as providing information on how medication, nutrition, footwear and vision play important roles in the risk of falls and injury. This seven-week workshop meets once a week for two hours, and caregivers are welcome to attend. Communityprofessionals such as a vision specialist, police or safety officer, physical therapist and pharmacist will also be in attendance to provide helpful information.

Evaluating New TechnologiesNetwork Health evaluates new technology and new applications of existing

technologies on a regular basis. This includes the evaluation of medical procedures, drugs and devices. Decision making on technologies is based on, but not limited to the following. n FDA approvaln Manufacturer informationn Scientific evidence n Peer-reviewed articlesn Opinion of contracted providersn Risk/benefit analysis n Government regulatory agenciesn Assessments performed by agencies specializing in technology

New technologies are reviewed by a group of participating physicians and health plan staff (Medical Policy Committee) who make recommendations for inclusion as a covered benefit. The following technology assessments have been reviewed over the past 12 months. n Cologuard (colon cancer screening test) • Determined to be safe and appropriate for those who meet the specific medical criteria.n Intacs (corneal implants for Keratoconus) • This technology is safe and effective and a medical policy has been developed.n Corus CAD (blood test to assess if chest discomfort or other symptoms may be due to obstructive coronary artery disease) • This technology remains experimental and investigational.

If you have a question about a technology assessment, contact our care management department at 800-236-0208 (TTY users call 800-947-3529), Monday through Friday between 8 a.m. and 5 p.m. Bilingual language assistance or translation services are available.


USING AND UNDERSTANDING OUR PROVIDER NETWORKAnswers to Your Questions About ThedaCare and Other Providers

s a result of our recent agreement with ThedaCare to extend our relationship through December 31, 2016, we first want to thank you for your patience and feedback throughout the situation. Thousands of calls came into our local Menasha office, and many of you waited

on hold while we took time to talk to each person. Your voices were heard and became an integral part in reaching an agreement with ThedaCare. Throughout 2016, you can still access ThedaCare providers as you do now.

What happens now?As the year continues, Network Health’s priority to put members first will not change. We’ve compiled important information to keep you informed and connect you with resources to ensure you’ll continue to have access to affordable, high quality health care through Network Health in 2016 and beyond. As Network Health grows, we’ll continue to serve northeast Wisconsin with a different kind of health insurance experience. We’re not a nationwide health plan, and we like it that way.

Will my employer have to change plans or will I have to change my doctor for 2017?You may have heard rumors that employers will have to change their health plan if they want their employees to be able to use ThedaCare providers in 2017. Because Network Health has a variety of plan options available and we’re developing new plans, that’s not necessarily true.

The most important thing will be to watch for updates from your employer. When it’s time for open enrollment for your benefits, a Network Health plan may still be a great fit, and you may not have to change your doctor. If you have questions about what doctors you can see with the Network Health plan your employer is offering, we can help you look for doctors or find a new provider, if needed.

Search for Doctors and Hospitals OnlineVisit networkhealth.com and click Find a Doctor on the right side of the screen. Or, click Find a Facility to search for hospitals and clinics. Choose your plan and select your preferred search criteria (specialty, city, gender, accepting new patients and more).

A

Call Us for HelpIf you need additional help finding a doctor, call our customer service department at 800-826-0940. Our hours are Monday, Wednesday, Thursday and Friday from 8 a.m. - 5 p.m. and Tuesday from 8 a.m. - 4 p.m.

http://networkhealth.com


COMMON QUESTIONS AND ANSWERS ABOUT THEDACARE

The following providers are ThedaCare providers. These providers are part of ThedaCare’s contract with Network Health that is currently set to end December 31, 2016.

u Appleton Cardiology - Neenah u ThedaCare Regional Medical Center - Neenah u Berlin Memorial Hospitalu Community Health Network u CHN Medical Center - Green Lake u Juliette Manoru Peabody Manor u Riverside Medical Center u Shawano Medical Center u ThedaCare Regional Medical Center - Appleton u ThedaCare Physicians u Waushara Family Physiciansu Wild Rose Community Memorial Hospital u ThedaCare New London Medical Center

1 What providers are ThedaCare and what’s happening with their contract with Network Health?

You can search for doctors online at networkhealth.com. If you’d like help finding an Affinity Health System doctor, you can get help finding one or make an appointment by calling 920-831-9000, Monday - Friday, 8 a.m. - 5 p.m. Affinity has dedicated staff available to serve Network Health members looking to connect with a new provider.

Lots of other providers are also part of our network. If you need help finding one or need a printed provider directory, call us at 800-826-0940, Monday, Wednesday, Thursday and Friday from 8 a.m. - 8 p.m. or Tuesday from 8 a.m. - 4 p.m.

Yes. It’s important to know that not all providers in a ThedaCare facility or location are ThedaCare providers. Many doctors are independent, and they provide care at multiple facilities. These providers are listed below, they are not ThedaCare providers and you can continue to see them at a different location.

u Associates in Gastroenterology u Children’s Hospital of Wisconsin - Fox Valley u Digestive Health Specialists u Ear, Nose and Throat Specialists of Wisconsin u Forefront Dermatology u Fox Valley Hearing Center u Fox Valley Nephrology u Fox Valley Perinatology u Fox Valley Plastic Surgery u Fox Valley Pulmonary u Fox Valley Surgical Associates u Neuroscience Group u Northeast Wisconsin Retina Associates u Physio O&P u Rural Audiology u Wisconsin Institute of Urology u Women’s Health Specialists

The contract will not affect individual and family plan Prestige members, because ThedaCare is not in-network. Network Health has partnered with over 150 providers in northeast Wisconsin to offer individual and family plan members superior care at convenient locations.

To find a specific doctor or facility for our individual plans, visit networkhealth.com/doctors-prestige-ne and use the helpful Find a Doctor and Find a Facility search tools. These easy-to-use search features take the guesswork out of finding a doctor or facility in our network.

2 How do I search for doctors, specialists and hospitals?

3 Is it true not all doctors in a ThedaCare facility are ThedaCare providers?

4 Will the ThedaCare contract ending December 31, 2016, affect individual and family plan Prestige members?

http://networkhealth.com.

http://networkhealth.com/doctors-prestige-ne


Network Health’s Chief Medical Officer, Dr. Mary Davis, understands the importance of choosing the right doctor. Every member’s needs are different, and she provides her three most important things to consider.

1. Comfort Your doctor should get to know you, and you should feel comfortable talking with him or her about personal information. Building a relationship will help your doctor know what is and is not normal for you. Plus, feeling at ease with your doctor will make it easier for you to ask questions.

2. Needs Everyone’s health care needs are unique. You may have practical needs for your health care based on where you live. The state of your health may lead you to a doctor who specializes in a certain type of care you need, or if you’re healthy, you might not need much care. Your financial situation and Network Health insurance coverage could also affect your choices.

3. Preferences Your preferences for different factors can naturally help narrow your search for a doctor. For example, you might prefer a doctor who shares your gender or speaks a certain language. The amount of experience a doctor has might be another factor. As you consider your preferences, deciding which you value most may ultimately drive your decision.

WHAT TO CONSIDER WHEN CHOOSING A DOCTOR

Our Care Management Team Provides Personal SupportOur nurses at Network Health are actively preparing personalized care plans for all members with health conditions in our care management program. If you see a ThedaCare doctor or specialist and you have a health condition and a care manager here at Network Health, you may have already received a phone call or likely will soon. In the months ahead, our nurses will be working one-on-one with members to make sure their health care won’t be disrupted.

If you’ve recently been diagnosed with a health condition, we can partner you with a nurse to help coordinate your care. Our staff is available to anyone who has been diagnosed with a serious health problem. If you’d like to speak with one of our nurses, our care management team can be reached at 920-720-1600.

Dr. Mary Davis

The Advantage of Having a Primary Care ProviderH aving a doctor, nurse or nurse practitioner that knows you well is

essential. Your primary provider (sometimes called your primary care provider or PCP) can get to know you over a period of time, and he or she begins to recognize what is and isn’t normal for you. Your provider can track and note changes he or she observes, and if needed, work with other specialists to assure you receive the right care. Besides having a trusted partner when it comes to your care, your health records are in one central location and your medication can be better supervised. Your PCP gets to know your values, family situation, occupation and health goals. Knowledge of these things provides valuable information as he or she assesses what is troubling you. By preventing health issues before they become serious, you can save yourself from more challenging health conditions and the costs associated with them. To help your PCP provide you the best care, make a list of questions to ask before your appointment and be sure to share the following information.n Emergency room and urgent care visits (notify your PCP within 30 days of a visit)n Office visits or evaluations by a specialist, including lab work and procedures performed (be sure to request your records and share them with your PCP)n Behavioral health visitsn Changes in medication, including how much you take, new medications or any time you stop taking a medicationn Diabetic eye examsn Any admission or discharge from a hospital, rehabilitation facility or nursing home If you don’t currently have a PCP, visit networkhealth.com and click Find a Doctor. You can also call our customer service department for help. Available hours and our phone number are listed on page two.

Access and After Hours CareTimeliness for medical and behavioral services

Many of us experience the need for some type of health care in our life whether it’s access to after hours, urgent care, routine or

preventive care. Network Health‘s Quality Improvement Department works with doctors and hospitals to ensure you’re able to get medical care in a timely manner. You should always be able to get the care you need, so we require our providers to offer access to medical and behavioral health services without excessive scheduling delays. We communicate standards for timeliness of appointments and office waits with our provider network. If you don’t feel your need for urgent, routine or preventive care is being scheduled in a timely manner, please contact us at the number listed on page two. We’re here to help you get the care you need, when you need it.

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1570 Midway Pl.Menasha, WI 54952

MAILED ON 7/5/16

THE BEST COMPLIMENT ISA REFERRAL

AT NETWORK HEALTH, WE’RE FLATTERED THAT 93.2 PERCENT OF DOCTORS AND SPECIALISTS WOULD RECOMMEND US.

That’s probably also why Network Health earned an 84.2 percent satisfaction rating from its providers. Nearly 30 percent higher than our closest competitor. It’s what makes Network Health a different kind of insurance company.

networkhealth.com 800-276-8004

HMO plans underwritten by Network Health Plan. POS plans underwritten by Network Health Insurance Corporation, or Network Health Insurance Corporation and Network Health Plan. Self-funded plans administered by Network Health Administrative Services, LLC.

Source - Annual survey conducted by Symphony Performance Health (SPH) Analytics, an NCQA-certified survey organization.

93.2%

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Balance summer 2016

Documents

Transcript of Balance summer 2016