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With Sharp Community Medical Group

3 Tips for Staying on Top of Your Medications

4 Need Help with Your Personal Health Goals?

5 Healthy Foods to Help with Spring Allergies

7 Health Insurance 101

inside this issue:

The Sun: Health Friend or Foe?

W ithout the sun’s brightly shining rays, winter would never end, plants would wither, and we’d probably sleep the days away. But too

much exposure to solar ultraviolet (UV) rays causes health hazards that extend from our head to our toes. Balancing out the benefits and risks of sunshine can help you emerge on the bright side of the equation.

Pro: Increases vitamin D levelsOur bodies need this important nutrient to absorb calcium, boost bone health, and help cells grow properly. Few foods contain high levels. But our skin produces vitamin D when exposed to UVB rays.

Sunscreen, cloud cover, and windows all block UVB rays, meaning you must be outdoors and unprotected to manufacture it. Some researchers suggest exposing your face, arms, legs, or back to the sun for 5 to 30 minutes twice a week ensures adequate vitamin D production. But they can’t be sure the benefits outweigh the risks. Talk with your doctor. If you have a high risk for skin cancer but low vitamin D levels, you might need a supplement.

Pro: Controls sleep cyclesHumans naturally wake up when it’s light and sleep when it’s dark. Exposure to the sun’s bright light sparks a nerve pathway that runs from the retina to a part of the brain called the hypothalamus. Control centers there adjust our hormones, body temperature, and other factors to make us feel energized and awake.

When the sun goes down, a pea-sized organ called the pineal gland jumps into action, producing the sleep-inducing hormone melatonin. Morning light blocks melatonin’s release, so we can stay alert until it’s time to hit the hay.

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The Sun: Health Friend or Foe? continued from page 1

Pro: Boosts moodWhen the seasons change and days grow shorter, many people—especially those in the far north—find themselves in a funk. The lack of sunlight produces biochemical imbalances in their brains, leading to sadness, fatigue, and a loss of interest or pleasure in once-enjoyed activities.

If you experience this condition—called seasonal affective disorder—you might need to work harder to seek sunlight in winter months. January and February tend to produce the worst symptoms. Sitting near a window or using a light therapy box can help you feel better without the risks for excess UV exposure.

Con: Causes skin cancerOf course, the sun’s most well-known health hazard is the risk for skin cancers, including deadly melanoma. Each year, more Americans develop skin cancer than breast, prostate, lung, and colon cancers combined. In fact, one in five Americans will eventually receive this diagnosis.

Exposure to UV rays from the sun causes more cases of skin cancer than any other preventable source. Unprotected skin sustains damage in as little as 15 minutes. Tans and sunburns mean your skin’s DNA has been altered. Over time, these mutations can lead to malignancy.

Con: Ages youUV rays have many other undesirable effects on your dermis. Years of tanning, either outdoors or in indoor beds, can leave you wrinkled, dry, and pocked with age spots. Sun reduces your skin’s elasticity and produces a thick, leathery effect.

Growths called actinic keratoses also frequently develop on skin areas exposed to the sun. You’ll know them by their

increases. So do your odds of developing macular degeneration, which harms the sharpest part of your vision.

Con: Suppresses your immune systemNormally your body's natural defenses can prevent cancers and other health threats. But UV radiation hampers these immune responses, meaning you’re less likely to fight off foreign invaders.

Sunburns harm your white blood cells—important germ-fighters—for up to 24 hours after you escape to the shade. And extended periods of UV radiation may cause lasting immune-system damage.

raised, reddish appearance and rough texture. Talk with your doctor if you spot them on your face, hands, forearms, or neck—over time, they can turn into skin cancer.

Con: Impairs your vision Cataracts cloud the lens of your eye, diminishing your sight. Exposure to UV radiation can contribute to the development of certain types of cataracts. Surgery can cure them, but still, they cost Americans billions in medical care each year.

The sun can blind you in other ways, as well. Your risk for growths called pterygium—which block vision—

THE BOTTOM LINE

Though we couldn’t survive without the sun, the health harms of overexposure add up quickly. Stay in the shade between 10 a.m. and 4 p.m., when UV rays blaze most intensely. When you do go out, protect yourself with a broad-spectrum sunscreen with an SPF of at least 30, sunglasses that offer 99 to 100 percent UV protection, and a hat with a wide brim.

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Tips for Staying on Top of Your Medications

If you’re using prescription medication, taking it regularly as prescribed is key to staying healthy. “Not taking your

medication can make you sicker, lead to hospitalization and increase your overall medical costs,” says Michele Bautista Meredith, PharmD., Manager of Pharmacy Benefits, Sharp Community Medical Group.

Meredith notes that, of all medication-related hospital admissions in the United States, 33 to 69 percent are due to people not taking their medicines as prescribed, with a resulting cost of about $100 billion a year.

If you’re taking multiple medications, it can be hard to remember to take all your medicines. It can also be difficult to afford all your medications. Here are some tips to help you afford your medicines and stay on your medication schedule.

Ways to cut medication costs:���Talk to your doctor. Your physician may be able to find generic alternatives for your medicines. He or she may also be able to simplify your medication regimens by eliminating duplicate or overlapping medications or supplements.�� Ask your pharmacist about manufacturer discount cards. Discount cards can reduce the copay for high-cost medications. They’re not available for all drugs, and typically do not apply to patients on Medicaid, Medicare or other state or federal health care programs such as Tricare.�� Use a mail-order service that ships medicines directly to your home. These services often provide patients with a 90-day supply of medication, and typically there is a reduced copay. �� Look for a patient assistance program. These programs help people based on their income, and are provided by drug companies, states or organizations to qualifying patients.

Customer ServiceMembers can contact SCMG for questions regarding:��eligibility��claims��referrals��benefit provision

guidelines or criteria��provider access issues��perceived quality

concerns��how to voice a

complaint��how to find contracted

providers’ names and addresses in order to obtain health care services

Call our Customer Service Department at 858-499-2550 during our expanded business hours: 7:30 a.m. to 5:00 p.m. Toll-Free outside of the 858 area code: 877-518-SCMG (7264). TDD/TTY: 711.

living well | spring 2016

Tools to help jog your memory:�� Use pill boxes. You can use weekly or monthly pill boxes to set up medications for the month. For medications that are taken two or three times a day, use weekly pill boxes with compartments for two or more daily doses. Involve family, friends or a caregiver to help you set up pill boxes.�� Use charts or calendars, or alarms on clocks, watches or cell phones to remind you to take medications.�� Connect taking medication to a daily activity such as meals, a favorite TV show or bedtime.�� Ask if your doctor can simplify your dosing regimens or change your medicines so that you take fewer pills on fewer occasions.�� If the problem is running out of medication when you need it, ask if your pharmacy offers an automatic refill program; medications you take regularly will be automatically refilled every month and the pharmacy will call you to pick them up. Using a mail-order service to get a 90-day supply of medication delivered to your home is another option.

4 www.scmg.org

Need Help with Your Personal Health Goals?

Because your doctor is a member of Sharp Community Medical Group (SCMG), you may benefit

from the care coordination services described below. The programs are provided by SCMG at no charge to patients who qualify for these programs.

SCMG has a comprehensive Ambulatory Case Management department that includes Complex/Transplant Case Management and Disease Management teams. Both teams may be significant resources for you. Features of both programs are listed below.

Complex Case Management ProgramThis program provides comprehensive care management for members with complex medical conditions requiring long-term, ongoing management. Patients in this program typically have one or more of these characteristics:�� Wellness coaching through patient engagement�� High-cost, high-risk treatment�� Solid organ and stem cell transplants (except corneal and skin)�� New treatments using cutting-edge technology�� Treatment under clinical trial�� Management of members treated out of area requiring close coordination and co-management of care and services with the health plan�� Use of specialized durable medical equipment�� Experimental/investigational treatments

Case Management and Resource Education (CARE) ProgramThe CARE Program involves:�� Connecting physicians and members to community social service support services�� Providing federal, state and community resources�� Providing member educational materials�� Linking members to health plan disease management programs

Disease Management ProgramThe Disease Management Program helps patients better manage chronic conditions. The diseases covered include diabetes, heart failure, COPD, asthma, coronary artery disease, and chronic kidney disease. The program highlights are:�� Disease-specific telephonic coaching by registered nurse disease case managers to help improve self-management skills�� Mailing of personalized patient education materials�� Referrals for diabetes education and testing supplies�� Information about community and Internet resources

�� Coordination of care plan and goals between the patient, the disease management coach, and the primary care physician

If you think you would benefit from participating in the Complex Case Management or Disease Management programs, or would like to learn about other Ambulatory Case Management programs that may benefit you, please call 858-499-3040 and choose option 8.

living well | spring 2016 5

I f you’re one of the millions of Americans who deal with hay fever each spring, you’re probably familiar

with the sneezing, runny nose, scratchy throat, and other symptoms that pop up when plants are in bloom. These symptoms occur when an allergen (such as pollen) enters the body and the immune system produces inflammatory substances—including histamine. Luckily, studies show that the following foods may help to ease pesky springtime allergy symptoms:

The food: Apples. Apples contain kellin, a compound that works to keep airways open. Kellin is also part of a powerful group of nutrients called flavonoids. These antioxidants prevent your body from pumping out histamines that cause those irritating allergy symptoms.

How to add more to your diet: Try applesauce and toss in raisins or cranberries. Or slice up apples to dip in peanut butter. Not a fan of apples? Not to worry: All fresh fruits and veggies can contribute to allergy relief. In one study,

adults and kids who ate the most produce were least likely to wheeze.

The food: Broccoli. Broccoli contains an anti-inflammatory compound called sulforaphane. In a recent study, a sulforaphane-rich broccoli extract reduced allergic reactions to harmful air particles. The dose delivered to participants was about the same as you’d consume in two cups of broccoli.

How to add more to your diet: This versatile veggie is a great addition to any stir-fry, soup, or pasta dish. Fold a handful into your morning omelet, or steam it for a nutritious dinner side dish.

The food: Fish, nuts, and olive oil.These three foods are staples to the Mediterranean diet—which also includes fruits, veggies, whole grains, and beans. When pregnant women followed this diet, their little ones were found to have fewer allergy and asthma symptoms years later. Another recent study found adults who followed this diet for 12 weeks had better control of their asthma symptoms. Experts

suspect the vitamin C, vitamin D, and omega-3 fatty acids this diet contains fight inflammation and cell damage in the lungs.

How to add more to your diet: For fish, simply bake at a high heat and add herbs, spices, and a drizzle of lemon juice. Add nuts to salads and stir-fries, stir them into yogurt, or add nut butter to smoothies. Use olive oil for grilling, roasting, or sautéing, or drizzle it over toasted bread and pasta dishes.

The food: Yogurt. Yogurt contains probiotics—healthy bacteria–which can alter the way your immune system responds to allergens. Studies show probiotics may also help to reduce your allergy symptoms.

How to add more to your diet: You could take supplements, but probiotics are absorbed more easily from foods. Use low-fat yogurt to top baked potatoes and fruit salad, or in some recipes, substitute plain yogurt for sour cream. Aged cheese and kefir also contain live cultures. So do nondairy foods such as miso, sauerkraut, and kimchi.

Healthy Foods to Help with Springtime Allergies

At Sharp Community Medical Group, our practitioners make utilization management decisions based only on appropriateness of care and service and existence of coverage. Practitioners and individuals who conduct utilization review are not rewarded for denials of coverage, and there are no financial incentives for utilization management decision makers to encourage decisions resulting in underutilization.

A Message to Our Members

www.scmg.org6

Turn a coffee date into a

walking date

Do an extra lap around the grocery store

before checking out

Take steps—in place or in circles—during commercial breaks or

between binge-watching episodes

Window shop at the mall

Get off the bus a stop early

Work at a desk? Set a phone alarm

to stand up and walk around a bit every 30 minutes

Walk a message down the hall to a co-worker

instead of emailing

Use a broom or rake instead of a leaf blower

Go around the block after

dinnertime

Instead of a movie,

go dancing or bowling

Park as far away from work or the mall as you can

Make the Most of Your

Fitness TrackerBy 2018, Americans will have shelled out an estimated $50 billion on wearable devices that measure steps, calories and other factors. Once you’ve geared up, how can you go about boosting your totals?

What do heart disease, stroke, osteoporosis, obesity, diabetes, and arthritis have in common? Regular, moderate physical activity can help prevent and treat all of these and many other health problems. According to the American Heart Association, physical activity is anything that makes you move your body and burn calories, such as climbing stairs or playing sports. To find more tips on exercise and on healthy eating, visit scmg.org and click on "Health & Wellness."

Find more definitions of common medical terms by visiting the Sharp Health Plan website at www.sharphealthplan.com/members.

7living well | spring 2016

Health Insurance 101

The Affordable Care Act (ACA) brought health insurance terminology to your nightly news broadcast and Facebook

newsfeed, but that lingo can still feel confusing. Familiarizing yourself with these terms can help you better understand the ACA and your own personal coverage, as well as make you a more informed consumer.

“Every profession has its own language, and health care is no different,” says Dr. Jennifer Tuteur, medical director of Sharp Health Plan. “It is easy to get confused. Many health care terms can sound alike, but their meanings are completely different. It’s important to understand these terms so you can make the best decisions for you and your family.”

Commonly Confused Terms Copay vs. coinsurance: A copay is a fixed amount you pay for covered health care services when you receive them. For example, you might have a $40 copay to see your primary care physician and a $20 copay for prescriptions. Coinsurance is your share of the cost of a covered service calculated as a percent of the allowed amount for the service. Using a 20 percent coinsurance example, if your health plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20 percent would be $20. You pay coinsurance after you have paid your deductible.

In-network vs. out-of-network: In-network includes health care facilities and doctors that participate in your health plan. Your plan approved these providers and negotiated a contract with them. Out-of-network includes

health care facilities and doctors that are not contracted with your health plan. Using them may cost significantly more.

Urgent care vs. emergency care: Urgent care refers to when you need to see a doctor right away, but it is not an emergency. Urgent care facilities are usually open after general business hours and on weekends, and are a more cost-effective option than going to the ER. Emergency care is care you get when you need treatment for life-threatening or severe conditions. Emergency facilities are open 24 hours a day, seven days a week, and typically cost more than an urgent care visit.

Commonly Misunderstood TermsPreventive care: Health care services you receive when you are well, such as check-ups, vaccinations and screenings (i.e., cholesterol, cervical cancer, diabetes, and obesity).

Formulary: A list of prescription drugs that offer the most value and are chosen for their safety and effectiveness.

Pharmacy tier: Drugs on a formulary are grouped into tiers, which determine drug cost. Generally, Tier 1 drugs are your lowest-cost medications, Tier 2 are mid-range cost medications, and Tier 3 and above have a higher cost.

Step therapy: To save patients money, doctors will try lower-tier medications first before stepping up to a higher tier. A higher-tier prescription can be covered by insurance if you have tried lower-tier options (i.e., step therapy) and they were ineffective.

COUSCOUS WITH BROCCOLIINGREDIENTS

� 2 medium plum tomatoes, roughly chopped � ¼ cup green onions, roughly chopped � ¼ cup raisins � 1 tbsp. olive oil � ¼ tsp. dried basil � ¼ tsp. ground cumin � ¼ tsp. freshly ground black pepper � 2 cups water � 2 ½ cups broccoli florets � 1 ¾ cups couscous

DIRECTIONSIn a mixing bowl, combine the tomatoes with the onions, raisins, oil, basil, cumin, and pepper. Set aside. Bring water to boil in large pot and add broccoli to boiling water. Boil for 1 to 2 minutes, just until broccoli is al dente. Add tomato mixture to pot and bring mixture back up to boiling (approximately 1 minute more). Add couscous, stir, cover, and remove from heat. Let stand for 5 to 10 minutes. Fluff lightly with fork before serving.

PER SERVINGServes EightEach serving provides:Calories: 180 Total fat: 2 gSaturated fat: 0 gTrans fat: 0 gCholesterol: 0 mgSodium: 10 mgTotal carbohydrates: 35 gFiber: 2 gProtein: 6 g

Printed on Recyclable Paper

livingwell

648M

Paul DurrCEO, Sharp Community Medical Group

Lynne Milgram, M.D.Chief Medical Officer, Sharp Community Medical Group

Todd MillsManager, Sharp Community Medical Group Marketing & Communications

Dave HargartenEditor, Living Well

Thank you to the following contributor: Michele Bautista Meredith, PharmD., Pharmacy Manager

Living Well is published by Sharp Community Medical Group. The information is intended to inform and educate about subjects pertinent to health, not as a substitute for consultation with a personal physician. ©2016. Printed in U.S.A.Developed by StayWell.

Visit our website! www.SCMG.org

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Postmaster: Please deliver within April 18-22.

SHARP Community Medical Group8695 Spectrum Center CourtSan Diego, CA 92123

Understanding How Medicare WorksIf you’re turning 65, or you’re still working and planning to retire soon, it’s time to start thinking about Medicare and your options. Attend this free educational meeting where an expert from Sharp will explain how Medicare works in clear, easy-to-understand language. You’ll learn about Medicare Parts A and B, special enrollment requirements if you start using Medicare after age 65, and the difference between Medicare Advantage and Medicare Supplement Insurance plans. There will be plenty of time for questions, too.

��6 p.m. to 7:30 p.m. ��Wednesdays, May 11; June 8; and July 13; and Tuesday, August 9��Sharp HealthCare Auditorium,

8695 Spectrum Center Blvd., San Diego, CA 92123

�Register at 1-800-82-SHARP (1-800-827-4277) or www.sharp.com/medicare.

Watch our series of helpful videos to learn answers to some of the common questions about Medicare. These brief videos cover what to do during the annual Medicare Open Enrollment period, and why and when to consider a Medicare Part D prescription drug plan, as well as many other Medicare topics. Visit www.sharp.com/medicarevideos.

New Videos Help You Learn About Medicare from the Convenience of Your Home