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onnectionCV o l . 4 , I S S u e 1 , S P r I n G 2 0 1 3 K e e P I n G o u r M e M b e r S I n f o r M e d

A Newsletter for South Country Members

H2419, H5703_2152 Accepted

Spring has sprung! The weather is warming up and the trees, grass, and flowers are beginning to bloom. Unfortunately, many of us greet the arrival of spring each year with a stuffy nose and watery eyes. Springtime allergies are here, but we can help you beat the symptoms.

Common AllergensThe most common outdoor allergen is pollen, which is a tiny grain from plants that floats through the air. When inhaled, pollen can cause cold-like symptoms, including sneezing, watery eyes, nasal congestion, runny nose, itchy eyes and throat, and coughing. Mold spores are a springtime allergen that is found in soil, plants, and rotting wood, causing similar cold-like symptoms.

It may be difficult to tell whether you have allergies or a cold, so see your doctor if you are unsure.

WeAther FACtorsIf you have allergies, you may notice that some days your symptoms are worse than others.

When the weather is windy, warm, and dry, allergy symptoms tend to be worse, since the wind picks up more pollen and carries it

through the air. Rainy, cool days, on the other hand, cause a drop in pollen count, and you may have no symptoms at all.

Allergies & AsthmAAllergies can also make asthma symptoms worse. Wheezing and coughing will increase when you have allergies. It is important to take care of your allergy symptoms early to help avoid an asthma attack.

Allergy PreventionYou can’t avoid spring allergies altogether, but you can ease the symptoms. Here are a few tips:

• Try to stay indoors when the pollen and mold count is high, especially in the morning.

• Close your doors and windows to keep allergens out of your home.

• If you have air filters at home, clean them often.

• Wash your hair after going outside, because pollen can collect there.

• Use allergy medications before symptoms start.

Source: WebMD, 2012

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National Humor Month

Hypertension Care

Alcohol Awareness

BMI Calculation

Bike Safety

Fraud Prevention

Prescription Claims

2012 Annual Report

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SouTH CounTry senior mAnAgement

Leota Lind Chief Executive OfficerBrian V. HicksChief Financial OfficerJohn WhitingtonChief Information OfficerAlice LaineDirector of Quality ImprovementCea GrassDirector of Communications and Customer RelationsMaureen MurrayDirector of Health ServicesMark WardDirector of Provider Network Management Dr. Patrick IrvineMedical Director

SouTH CounTry Joint PoWers BoArD

Harold Pettis, Sibley County ChairNina Huntington, Steele County Vice ChairAndy Lochner, Brown CountyDave Erickson, Dodge CountyDan Rechtzigel, Goodhue CountyKathi Ellis, Kanabec CountyDon Meyer, Morrison CountyGary Kneisl, Todd CountyDavid Harms, Wabasha CountyBill Stearns, Wadena CountyJim Peterson, Waseca County

South Country Health Alliance (SCHA) is a county-based purchasing health plan providing coverage for Minnesota Health Care programs in Brown, Dodge, Freeborn, Goodhue, Kanabec, Morrison, Sibley, Steele, Todd, Wabasha, Wadena, and Waseca Counties.

SCHA is a Coordinated Care plan with a Medicare contract and a contract with the Minnesota Medicaid program.

mAKe ‘em LAUGHApril is National Humor Month

As the popular saying goes, “laughter is the best medicine.” After all, a healthy dose of humor has been found to improve both our emotional and physical health. During National Humor Month this April, make sure to add a little laughter to your daily routine.

Bringing more hUmor into yoUr liFeSometimes it can be difficult to find humor in our day-to-day routines. Still, we shouldn’t take ourselves too seriously. Add more laughter to your life with these tips:

• Smile. Smiling is the beginning of laughter.• Count your blessings. Consider the good things in your life, and

you will distance yourself from negative thoughts. Write a list, and remember these things when you are sad or upset.

• Spend time with positive people. When you are around people who laugh easily, their playful point of view can be contagious.

• Keep things in perspective. Many things in life are beyond your control, so find a way to deal with stress.

• Laugh at yourself. Share your embarrassing moments and laugh it off. We’ve all been there!

Go ahead and give it a try. Enjoy National Humor Month by smiling and laughing with the people in your life.

Physical HealthBoosts immune systemDecreases painRelaxes your musclesPrevents heart disease

BeneFits oF lAUghter

Source: Helpguide.org, 2013

Social HealthStrengthens relationshipsAttracts others to usEnhances teamworkHelps defuse conflict

Mental Health Eases anxiety and fearRelieves stressImproves moodEnhances resilience

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MediCAL NeCeSSitySouth Country Health Alliance makes authorization decisions using evidence-based standards of care, medical necessity criteria, and the member’s benefit coverage. South Country does not reward providers or other individuals for denying services to members, nor does South Country reward decisions that result in under-utilization of services.

General health information in the Member Connection is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have any concerns or questions about specific content that may affect your health, please contact your health care provider.

South Country believes it is the responsibility of everyone to report suspected fraud, waste, or abuse. You can report anonymously through our Report it hotline by calling 1-877-778-5463. You can also make a report at www.reportit.net. Username: SCHA, Password: Owatonna

RePORtiNGFraud, Waste, and Abuse

Copyright ©2013 by South Country Health Alliance.

The Connection is a publication of South Country

Health Alliance. For submission information or re-print permission,

please contact:

SCHA, 2300 Park Drive, Suite 100, Owatonna, MN 55060, USA

Email: marketing@mnscha.org Website: www.mnscha.org

KeeP hyPertension IN CHECKHypertension, or high blood pressure, is a common health issue that affects millions—even children and teens. The only way to know if you have high blood pressure is to see your primary care provider through regular checkups. Your doctor can monitor your blood pressure and keep track of any changes.

WhAt Are the symPtoms?One of the most dangerous things about high blood pressure is that many people don’t know they have it since there are often no symptoms. However, if your blood pressure is extremely high, you may experience the following symptoms:

• Severe headache• Fatigue or confusion• Vision problems• Chest pain or difficulty breathing• Irregular heartbeat

If you have any of these symptoms, you should see your doctor right away. Untreated hypertension can lead to serious health problems, such as stroke, heart disease, kidney failure, and eye problems.

WhAt CAUses high BlooD PressUre?No one knows exactly what causes high blood pressure, but several factors put you at risk. Some of these include family history of high blood pressure, poor diet, little to no exercise, high stress, and old age. High cholesterol can also lead to high blood pressure, so have your doctor monitor your cholesterol on a regular basis.

hoW CAn i loWer my risK?You can lower your risk of high blood pressure by maintaining a healthy weight, eating right, and getting regular exercise. Reducing your salt intake, drinking less, smoking less, and stressing less will also decrease your risk.

Source: WebMD, 2013

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AlCohol AWARENESS MONTHHelp for today. Hope for tomorrow.

This April during Alcohol Awareness Month, we encourage you to take the time to educate yourself, your friends, and your family about the dangers of alcohol abuse.

hoW Will DrinKing less or qUitting helP me?Drinking in moderation or not drinking at all can help you:

• Lower your blood pressure• Lower your risk of injury and disease• Lose weight• Save money• Get along better with your family and friends

hoW CAn i CUt BACK on my DrinKing?If you are drinking too much, you can improve your health by cutting back or quitting. Here are some strategies to help you cut back or stop drinking:

• Limit your drinking to no more than 1 drink a day for women and no more than 2 drinks a day for men.

• Keep track of how much you drink.• Don’t drink when you are upset.• Avoid places where people drink too much.• Make a list of reasons not to drink.

Remember to ask for help if you need it. Ask your friends and family to support you. Talk to a doctor or nurse if you are having a hard time cutting down on your drinking. You can also talk to your county’s chemical dependency assessor to request a chemical use assessment.

if your drinking is causing problems in your life, you have a drinking problem and should reach out for help.

Source: healthfinder.gov and Helpguide.org, 2012

hoW CAn i helP A loveD one?If you are concerned about someone else’s drinking, offer to help. Sometimes the problem is overwhelming, but in the long run, ignoring it will be more damaging to you, other family members, and the person with the drinking problem. It’s important to keep the following in mind:

• you cannot force someone to stop abusing alcohol. The choice is up to them.

• don’t expect the person to stop drinking and stay sober without help. Your loved one will need treatment and support to overcome a serious drinking problem.

• Recovery is an ongoing process. It requires a lot of time and patience.

Since drinking is so common in many cultures and the effects vary widely from person to person, it is not always easy to figure out where the line is between social drinking and problem drinking. The bottom line is how alcohol affects you.

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BOYS NEED hPv vACCineHuman papillomavirus (HPV) doesn’t just affect girls—it affects boys too.

There are over 40 types of HPV that infect an estimated 75-80% of males and females in their lifetime. For most people, HPV goes away by itself—many don’t even know they are infected. Unfortunately, HPV can also lead to serious health problems, like genital warts and certain types of cancer.

There is a vaccination for boys that helps protect against HPV. Talk to your doctor today about having your son vaccinated.

Source: Merck Sharp & Dohme Corp., 2010

HEALTHY STARTto sPringIs it too late for a flu shot?Even though it’s best to get vaccinated early, the flu shot can also be helpful later on. Flu season lasts from September until May, so it is still a good idea to get protected. It’s not too late!

What about a pneumonia vaccine?Pneumonia shots are not given yearly like the flu shot and is not for every age group. This vaccine is only recommended for children younger than 59 months, adults with certain risk factors, and all adults 65 or older. Ask your provider if it is time for a pneumonia vaccine.

CALCULATE yoUr heAlthYou don’t need us to tell you that staying healthy is important. Being physically active and eating right are critical factors in your weight and overall health.

If you’ve been thinking about your current weight, it may be because you’ve noticed a change in how your clothes fit or because your doctor told you that you have high blood pressure or high cholesterol and your weight is a contributing factor.

Before you decide to lose weight, a good step is to determine whether or not your current body weight is healthy.

WhAt is Bmi?Body Mass Index (BMI) is a number calculated from a person’s weight and height. For most people, BMI is a reliable indicator of body fat and is used to screen for weight categories:

• Underweight• Normal• Overweight• Obese

Obese and overweight describe ranges of weight that are greater than what is considered healthy. These weight categories have been shown to increase the likelihood of certain diseases and other physical and emotional problems.

Similarly, the underweight category describes the weight range that is less than what is considered healthy. People who are underweight might not be taking in the necessary nutrients, which can lead to other serious health issues.

Talk to your doctor to assess your BMI at your next doctor appointment. He or she will tell you how to make healthy changes so you can achieve a healthier body weight.

Source: The Centers for Disease Control and Prevention, 2013

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Colon CAnCer FACT SHEETYour health is important to us. Talk with your doctor about getting tested for colorectal cancer. Testing for colorectal cancer is a covered benefit under your plan with South Country.

• FACt: Colorectal cancer is the third most common cancer and the third leading cause of cancer death in both men and women in the U.S.

• FACt: Anyone can get colon cancer, no matter a person’s age, sex, race, or ethnicity.

• FACt: Early colorectal cancer often has no symptoms. • FACt: The risk of getting colorectal cancer increases with age. Most

new cases and deaths occur in people age 50 years and older.• FACt: Some people who get colorectal cancer have no family history

of colorectal cancer.Colorectal cancer screenings help detect cancers at earlier, more treatable stages. Call your doctor and ask about getting tested. There’s more than one way to test for colon cancer; your doctor will help choose the test that is best for you.

Source: The American Cancer Society, 2011

If you are pregnant or have a baby under age one, you can sign up to have free health and safety tips sent to you via text message through a program called text4baby.

Just text the word BABy (or BeBe in Spanish) to the number 511411 using your cell phone to sign up. You’ll get tips and reminders on prenatal and infant care, immunization, labor signs and symptoms, development milestones,

breast-feeding, car seat safety, safe sleep, and more. Learn more about the program at www.text4baby.org.

Remember, as soon as you learn you are pregnant, you should tell your county worker. You will have access to more benefits and will have no copays. Also make sure to tell your county worker when the baby is born to ensure he or she has health coverage.

DON’T overDo itWhen you are exercising, remember to pay attention to your body. Over exercising can be just as harmful as not exercising at all.

Forgetting to take proper care of yourself during a workout can lead to injury and illness. Follow these three tips to avoid overdoing it:

Stay hydrated. When you drink enough water, your body will perform better and can give you the results you want. If you don’t give yourself the liquids you need, your body will “steal” fluids from other sources.

Repair with protein. Within one hour after exercising, eat a lean protein to help your body recover and rebuild so it’s ready for your next workout.

take a break. Your body needs to rest. Take a few minutes between exercises to catch your breath, and be sure to have “rest days,” which will help your body become stronger and your energy last longer.

Source: Hope Health, 2013

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Are yoU SATISFIED?The feedback we receive from surveys helps us understand what we’re doing well and what we need to improve to better meet your needs.

Every year, some of our members receive a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to measure satisfaction with their health plans. These surveys give you a chance to rate the quality of services and care provided to you. Your responses are important to us!

Two CAHPS surveys have been mailed to members this spring, one from the Minnesota Department of Human Services (DHS) and one from the Centers for Medicare and Medicaid Services (CMS). Follow-up phone calls are now going out to those who have not yet responded. They are nearing the end of collecting your responses, but there is still time to take the survey.

Both surveys are important, and we strongly encourage you to complete them. We want to know what you think because we strive to improve our service to you!

Your participation in these surveys is anonymous, and the results given to South Country have no personal information about our members. We will receive the results later this year.

If you have questions about any health surveys, please call our Member Services at 1-866-567-7242 (tty 711).

BE SAFE BiKingRiding a bike is one of the best ways to enjoy the warmer weather outdoors. But before you and your kids start pedaling, make sure you stay safe. Even though bike riding is fun, accidents can still happen.

Every year, about 300,000 kids go to the emergency room because of bike injuries, most of which are head injuries. Head injuries can cause serious damage to the brain, which is why it’s so important to wear a bike helmet every time you ride.

helmet hoW-toA bike helmet should fit properly—not too big or too small. Make sure the helmet is level and covers your forehead. the straps should always be fastened, or else the helmet could fall off your head. They should also be adjusted so they’re snug enough that you can’t twist the helmet around.

sAFety CheCKlist 9 Make sure your seat, handlebars, and wheels fit tightly. 9 Check your brakes to be sure they work well. 9 Check your tires for enough air and pressure. 9 Wear bright clothes when you ride, and put reflectors on your bike.

roAD rUles• Always ride with your hands on the handlebars.• Stop and check for traffic before leaving the sidewalk or your driveway.• Cross at intersections and walk your bike across.• Ride on the right-hand side of the street. Never ride against traffic.• Watch out for changes in the road or sidewalk surface.• Stop at all stop signs and obey traffic lights just as cars do.• Call out “On your left!” when passing other bikers or people on the

street.

Source: KidsHealth®, 2010

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MEDICATIONmishAPsManaging your medicines correctly means taking the right medication, in the right amount, and at the right time. For some people, this can be tricky, especially if they have to take more than one medication.

If you are hospitalized, your doctor might decide to change your medications or add new ones. These changes might not be clearly communicated, which can lead to taking the wrong medications when you return home. Research shows that one in five elderly patients return to the hospital within 30 days after a hospital stay (New England Journal of Medicine, 2009). Many times this is due to taking the wrong medicine.

South Country wants to help you take the right medications after you return home from a hospital stay. A care coordinator will call you within a few days after you go home. He or she will set up a time to visit you at home and talk with you about your medications. This visit can help make sure you take the right medications and may keep you from going back to the hospital.

FrAUD PREVENTIONYou are one of the first lines of defense against Medicare fraud. The best way to protect yourself is to increase awareness of these common fraud schemes.

rePorting serviCes not ProviDeDIf you are billed for services or items that you did not receive, report them right away. Follow these tips when you review your plan statement:

• Make sure you received the services or items billed.• Check the number of services billed.• Ensure the same service has not been billed more than once.

iDentity theFt PreventionDon’t let anybody steal your identity. Look for these fraud schemes:

• People using your Medicare or health plan member number for reimbursements of services you never received.

• People calling you to ask for your Medicare or health plan numbers.• People trying to bribe you to use a doctor you don’t know to get

services you may not need.

Do yoUr PArtYou can protect your identity and your benefits.

• Never give out your Social Security, Medicare, health plan numbers, or banking information to someone you don’t know.

• Never let anyone use your information to get health care or prescriptions. Your plan benefits are for you alone.

• Review your Plan Statement to ensure all the information is correct.To discuss benefit, coverage, or claims payment concerns, contact Member Services at 1-866-567-7242 (tty 711).

To report suspected fraud, call 1-877-772-3379.

Source: The Centers for Medicare & Medicaid Services, 2013

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DiABetes testing sUPPlies CHANGEWe are committed to providing you with the best and most cost-effective products available to help you manage your diabetes.

Starting July 1, 2013, South Country will only cover Roche® Accu-chek® diabetic testing products. If you are currently using a Bayer or other brand product, you will need to make the change to Accu-chek® by July 1, 2013. We will replace your meter at no cost to you.

you will need a new prescription from your doctor for an Accu-chek® meter, test strips, lancing device, and lancets. Your pharmacist can help update your prescription if necessary.

We have let your doctor know about this change to your benefit coverage, as well as your need for a new prescription. If a different brand of diabetic testing supply is medically necessary, your doctor will need to request a prior authorization from South Country.

You can choose from these Accu-chek® products:

If you have any questions about this change, please call our Member Services at 1-866-567-7242 (tty 711).

Multiclix Lancet Device & LancetsFastclix Lancet Device & LancetsSoftclix Lancet Device & LancetsNano Meter & Smart View Test StripsAviva Plus Meter & Test StripsAviva Control SolutionSmart View Control Solution

NOTICE: PhArmACy BeneFitsIn January, South Country started a new partnership with a company to manage pharmacy benefits for our members. Since then, there have been changes to the way pharmacies bill South Country for payment. During this transition, it is possible some members paid out-of-pocket for their prescription drugs that are covered under the South Country formulary. Our members should not pay out-of-pocket for prescriptions, except for their copay amount.

If you believe you paid out-of-pocket for a medication earlier this year as a result of the change in our pharmacy benefit management transition, please contact our Member Services at 1-866-567-7242 (tty 711).

sChA WeBsite SURVEYWe want to improve the South Country Health Alliance website (www.mnscha.org) so that it is more useful for you.

In order to do this, it is important that we get your feedback about our current website. We invite you to participate in our Website Survey to let us know what you think about the South Country website.

This short survey will help us understand how you use the website now, what we’re doing well, and where we need to improve. We value your input and plan to make the necessary changes to make our website a better place for the information and tools you need.

To take the survey, please visit www.mnscha.org/WebSurvey.aspx. If you would like to request an electronic version of the survey, email us at marketing@mnscha.org.

We look forward to hearing your thoughts about our website.

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“The mission of South Country Health Alliance is to empower and engage our members to be as healthy as they can be, build connections with local agencies and providers who deliver quality services, and be an accountable partner to the Counties we serve.”

Restating our mission was more than just a change of words. It recognizes the values we share with our members, partners, and communities that continue to define us.

Over ten years ago, South Country Health Alliance was built on progressive ideas in a time when Minnesota was struggling with the rapid changes of health care. As we celebrated our 10-Year Anniversary last year, we were reminded that our next decade presents similar challenges. We are prepared to meet them with even more innovation than ever before.

Nowhere is this better illustrated than our partnerships with local health

systems in New Ulm and Owatonna.

These initiatives show that personalized care and cooper-ation between doctors, care managers, and health plans

help create healthier members. Our connection to other forward-

thinking providers like Open Door and PerformRx has also greatly

helped us improve your access to quality health care in rural areas.

We also worked to strengthen our partnership with county health and human services agencies through better communication efforts. During this past year, I visited every county board in each of our member counties. I used these visits to talk about our health plan’s progress and to listen to the concerns of your county’s commissioners and directors. In the fall, we also held a 10th Anniversary celebration in each county to thank our local agencies for their commitment to our communities. We hope to further develop our collaboration so we can serve you better.

Dedication to the health of our members is at the heart of everything we do, and this was reflected in our 2012 health program ratings. Our Minnesota Senior Health Options plan SeniorCare Complete earned a 4 out of 5 star quality rating from Medicare. This puts South Country in the top 25% of health plans in the nation serving this senior group. Our programs also

earned first and second place ratings among Minnesota health plans in over 24 areas, including “Overall Rating of Health Plan,” “Getting Needed Care,” and “Overall Customer Service.”

Your representatives on our Member Advisory Committee also continue to give us valuable insight and feedback about how we’re doing as a health plan. We appreciate this group and the time they spend sharing their experiences with our staff. South Country wouldn’t be the company it is today without our members.

In 2012, we took a giant step forward and moved from two separate Owatonna locations into one building. It was a large undertaking, but we were able to provide uninterrupted service to our members. Our new 2300 Park Drive office now allows everyone to work together on a daily basis. We also have more room to add to our highly skilled team of health management professionals.

South Country is ready to face the health care changes that will soon affect all of us here in Minnesota. We look forward to continue providing access to quality health care to meet the needs of our members, partners, and communities.

sChA 2012Moving Forward

with Vision

ANNUAL rePort

Leota Lind, South Country CEO

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2012 Summary of Financial StatementsBALANCe SHeet

Assets $ 42,340,634

Liabilities $ 24,535,257

Capital and Surplus $ 17,805,377

StAteMeNt OF ReVeNUeS ANd eXPeNSeS

Revenues $ 176,269,502

Health Care Expenses

Physician, Hospital, and Dental Expenses $ 139,454,188 Pharmacy Expenses $ 18,593,617

Less Reinsurance Recoveries $ (1,184,950) total Health Care expenses $ 156,862,855

Other Expenses

Claim Adjustment and Cost Containment $ 7,124,789 General Administrative Expenses $ 8,263,912 Decrease in Reserves for Health Contracts $ -0- total Other expenses $ 15,388,701

Net income $ 4,017,946

In 2012, South Country Health Alliance had a positive financial year. This marks the third year in a row that resulted in positive figures.

The following summary financial statement and overview is provided for our members’ information. The complete audited financial statements are available upon request.

South Country gets its income from DHS and Medicare based on membership. We use this income to pay for the medical expenses of our members. In 2012, South Country was charged $157 million for members’ health care expenses. This was 91.1% of our total expenses. The remaining income was spread between claim adjustment and cost containment expense and general administrative expense.

South Country has $21 million set aside in reserves on its balance sheet at 12/31/12 for future member medical benefit payments. In addition to these reserves, South Country has Capital and Surplus of $17.8 million. This Capital and Surplus exceeds the statutory net worth requirements of the State of Minnesota.

FinAnCiAl stAtement sUmmAry JANUARY - DECEMBER 2012

South Country Health Alliance moved to its new business location at 2300 Park Drive in Owatonna, Minn., in June 2012.

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This information is available in other forms to people with disabilities by calling 1-866-567-7242 (toll-free) or 711 for the hearing impaired, or through the Minnesota Relay at 1-800-627-3529 (TTY, Voice, ASCII, Hearing Carry Over), or 1-877-627-3848 (speech to speech relay service).

South Country Health Alliance Member Services1-866-567-7242 • 711 (TTY for the hearing impaired)

8 a.m. - 8 p.m., M-F • All calls are toll-free

Health or Wellness or Prevention Information

When it comes to helping our members, South Country Health Alliance Member Services staff are available to answer your phone calls from 8 a.m. to 8 p.m., Monday through Friday. The toll-free number to reach Member Services is 1-866-567-7242, or for the hearing impaired, dial 711.

Member Services can answer questions regarding covered benefits, prescription drug coverage, primary care clinics, wellness programs, interpreter needs, and more! If you are having problems getting services, they are here to help you.

We Are here FOR YOUNURSe HeLPLiNe: Ask MAyo CliniC

1-800-504-3451

Ask Mayo Clinic is a 24-hour nurse line that guides you to the appropriate level of care if you’re sick or injured. Experienced

registered nurses answer your health questions and offer reliable information to help you make better informed

health care decisions. If you have an emergency, call 911.

2300 Park Drive, Suite 100Owatonna, MN 55060