advantage living and access to high-quality healthcare. here are a few things to be excited about in...
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Helping People Live the Healthiest Lives Possible®
At SelectHealth, our mission is to help people live the healthiest lives possible. From embracing healthy lifestyles to getting preventive care, we strive to provide superior service, affordable premiums, and access to high-quality healthcare. Here are a few things to be excited about in 2017:
•$0orlowpremiums.Our plans have $0 or low premiums.
•$0medicaldeductible. Our plans have no medical deductible.
•Engagedproviders.The doctors who participate in our network share our commitment to continuously improve healthcare and reduce costs by using data-driven, evidence-based care practices.
•Superiorservice.We are dedicated to making sure our service exceeds your expectations. Not only do we have knowledgeable, responsive customer service representatives, our Member Advocates can help you find the right doctor and schedule appointments. Our nurse care managers will work with your doctors to coordinate care on your behalf.
•Spendlesstime—andmoney—atthepharmacy.With Intermountain Home Delivery Pharmacy you can get three months’ worth of your generic drug prescription for the price of two, delivered right to your door.
•SeekwellnesswithLiVeWellSMAdvantage.You pay $0 copay for covered preventive services. And with our flexible wellness benefits, you can get reimbursed up to $240 per year for gym memberships, approved weight loss programs, and health education classes. You can also earn a $50 VISA or Amazon gift card through the SelectHealth Healthy Living® program.
WINTER2016SELECTHEALTH®
advantageLivingTM
2 How Shared Decision-making Can Help You Make Better Healthcare Decisions
3 Enhanced Dental and Eyewear Benefits Hearing Aids
4 Holiday Cranberry Salsa Intermountain Connect Care®
5 What is Medication Therapy Management Earn a $50 gift card in 2017 with the
Healthy Living Program
6 Go Paperless! Idaho Diabetes Prevention Program
7 National Coverage Determinations Update
Inside
H1994_398889 Accepted
2 selecthealthadvantage.org | winter 2016 | advantageLiving™
better health
From the Desk of DR.RUSSKUZEL
How Shared Decision-making Can Help You Make Better Healthcare Decisions
Have you ever been faced with a tough decision for which you created a pros and cons list? Perhaps you researched the outcomes and weighed your options with a trusted friend before making your decision. If so, you’ve participated in a form of shared decision-making.
When it comes to making decisions about your health, shared decision-making means making an informed decision with support from your doctor and other members of your healthcare team such as a nurse or a specialist. It may involve the use of a decision aid such as visual representations of outcomes or statistics, learning modules, or questionnaires that help you think through the decision from every angle.
Some medical decisions are straightforward—a broken bone requires immediate care, and a bacterial infection likely requires antibiotics. But for more complicated issues like low back pain, how to treat high cholesterol to prevent heart disease, or whether to have surgery, it might be worth spending a little more time to determine the best strategy. When there is more than one treatment option, consider using shared decision-making to come to a shared decision with your doctor.
THESHAREDDECISION-MAKINGPROCESS
What can you expect from your doctor? To facilitate shared decision-making, your doctor should:
•Providesupport.Your doctor may ask, “What matters to you?” He or she will listen to you, discuss your values, and help you understand the risk involved for a procedure or treatment approach.
•Offerdecision-makingtools.These may be questionnaires, informational materials, a website, or even a learning module that will give you more information about your condition, surgery, or other healthcare service.
•Bereceptivetoquestions.Shared decision-making is a good time to ask even the most sensitive questions, and your doctor’s role in this process should be as a partner or a health coach, not just a source of knowledge.
As a patient, your role in shared decision-making is to:
•Askquestions.Your doctor can’t answer questions you haven’t asked. It’s your job to be informed about treatment options, side effects, and possible complications. What type of outcome can you expect? How can you learn more? Are there other—perhaps less expensive—options?
•Communicateyourpreferences.If you clarify your values or what’s most important to you, it may help your doctor better understand your needs and suggest treatment that’s right for your situation.
•Beengaged.Typically, patients who are the happiest with their healthcare are those who play a role in the decision-making process. It’s worth taking the time to be informed about your health.
Shared decision-making is an important part of your healthcare. It generally leads to a more satisfactory experience for you and your doctor, and it can help you make medical choices that best reflect your personal needs and values.
REFERENCES
1. Barry, Michael J, MD and Susan Edgman-Levitan, PA. The New England Journal of Medicine. DOI: 10.1056/NEJMp1109283. “Shared Decision-making—The Pinnacle of Patient-Centered Care.” 1 Mar 2012. Web. 26 Oct. 2016. <http://www.nejm.org/doi/full/10.1056/NEJMp1109283#t=article>
2. National Learning Consortium: Advancing America’s Healthcare. HealthIT.gov. “Shared Decision-making Fact Sheet.” Web. 27 Oct. 2016. <https://www.healthit.gov/sites/default/files/nlc_shared_decision_making_fact_sheet.pdf>
3selecthealthadvantage.org | winter 2016 | advantageLiving™
my selecthealth
Hearing Aids:A New Benefit for Members Residing in the Treasure Valley and Magic Valley Service Areas*SelectHealth Advantage members residing in the Treasure Valley and Magic Valley service areas can now use a new hearing aid benefit.
Select hearing aids purchased through St. Luke's audiologists are covered under one of four benefit tiers.
• Tier 1 – Essential: $699 • Tier 2 – Standard: $999 • Tier 3 – Advanced: $1,399• Tier 4 – Premium: $1,899
The applicable tier for each product depends on the technology and unique features built into the device. The tier fee includes the hearing aid, hearing aid fitting, two follow-up adjustment visits within 12 months of
purchase, and a one-year supply of batteries. Additional accessories or upgrades beyond the devices described as part of this benefit (such as Bluetooth® connectivity) are not covered under the hearing aid benefit, but may be available from your provider for an additional fee.
Refer to Chapter 4 of your 2017 Evidence of Coverage for more details, and visit selecthealthadvantage.org for a list of St. Luke's audiologists.
*Includes the following Idaho counties: Ada, Adams, Blaine, Boise, Canyon, Cassia, Elmore, Gem, Jerome, Minidoka, Owyhee, Twin Falls, and Washington.
Enhanced Dental and Eyewear BenefitsDid you know that as a SelectHealth Advantage® (HMO) member, you may have the option to purchase dental and vision coverage? Even though the Annual Enrollment Period (AEP) has ended, you can still enroll in Optional Supplemental Benefits until January 30, 2017. Optional Supplemental Benefits plans are available for an additional monthly premium and are designed to enhance the basic dental and
IDAHOOPTIONALSUPPLEMENTALBENEFITS:
• Dental: Delta Dental Idaho Advantage
• Dental and Eyewear: Delta Dental Idaho Advantage Plus Eyewear through Eyemed
UTAHOPTIONALSUPPLEMENTALBENEFITS:
• Dental: SelectHealth Dental® Comprehensive Benefit
• Dental and Eyewear: SelectHealth Dental Comprehensive Plus Eyewear through Eyemed
Formoreinformationaboutplancoveragedetailsandpremiums,callusat855-442-9940.
eyewear benefits covered by original Medicare, as explained in Chapter 4, Section 2.1 of the Evidence of Coverage document.
To learn more about our optional supplemental benefits, visit selecthealthadvantage.org and click on Explore Benefits. On the Benefits at a Glance page, choose Flexible Benefits.
4 selecthealthadvantage.org | winter 2016 | advantageLiving™
Holiday Cranberry Salsa
better health
NUTRITIONINFORMATION
Per serving: 36 calories, 0 g total fat (0 g saturated
fat),9 g carbohydrate, 0 g protein, 1.5 g dietary
fiber, 2 mg sodium.
MAKES8(1⁄4cup)SERVINGS.
Dress up your holiday table with a cranberry side that’s not in the shape of a can. This classic raw relish combines fresh cranberries, Fuji apple, lime juice, and spicy jalapeño. Its sweetness means remarkably little sugar is needed to offset the tartness of the cranberries.
INGREDIENTS
1 bag (12 oz.) fresh or frozen unsweetened cranberries
1/2 medium Fuji apple, peeled, cored, and chopped
1/4 cup chopped red onion
2 strips (1-inch x 1/2-inch) lime zest, coarsely chopped
1 small jalapeño pepper, without seeds, chopped
3 Tbsp. turbinado/raw sugar
1 Tbsp. fresh lime juice
1/3 cup loosely packed cilantro leaves
Salt
DIRECTIONS
• In food processor, pulse cranberries just until coarsely chopped. Add apple, onion, lime zest, jalapeño, sugar, and lime juice. Pulse (quick pulses) until salsa is still slightly chunky, about 15-20 times.
• Add cilantro and pulse until it is chopped but not mushy, about 10 times, stopping to scrape down bowl as needed. Season with a 1/8 teaspoon of salt.
• Let salsa sit for 20 minutes for flavors to marry. Serve same day.
Source: American Institute for Cancer Research
Intermountain Connect Care®
Intermountain Connect Care allows you to visit 24/7 with an Intermountain clinician using your smartphone, tablet, or computer for just $20 a visit. Use Connect Care if you have cold or flu-like symptoms, sinus or ear pain, sore throat, painful urination, a minor rash or skin issue, upset stomach, or other minor symptoms. If necessary, they can send a prescription to your pharmacy. They will document the visit in your medical record so your regular provider can see the results and incorporate them into your overall care.
This new benefit will be available to all Utah service areas in 2017.
For more information on Connect Care coverage, please call Member Services at 855-442-9900 (toll-free).
Download the Connect Care app:
5selecthealthadvantage.org | winter 2016 | advantageLiving™
better health
Earn a $50 gift card in 2017 with the Healthy Living ProgramAs part of our Healthy Living program, you can earn a $50 reward by making healthy choices. To earn your $50 gift card you choose wellness activities, track and complete those activities to earn 70 points, and redeem points for the reward.
• Choose wellness activities to earn 70 points. You earn points by completing activities like these:
> Annual Wellness Visit (40 points) – You have to complete your Annual Wellness Visit to be eligible for the $50 reward.
> Colonoscopy (20 points)
> Mammogram (20 points)
> Flu Shot (20 points)
> Eye Exam (10 points)
> Enroll in My Health (10 points)
> Physical Activity (10 points) – Participating in at least 30 minutes of physical activity per day for three consecutive weeks.
> Your Choice (10 Points) – Tell us what you did to participate in Healthy Living.
• Record and track the completion of your wellness activities by using the online form or calling us any time until December 14, 2017.
• Redeem points for a $50 Visa or Amazon gift card.
If you have questions about the Healthy Living program or need help recording activities and redeeming your Healthy Living points, visit selecthealthadvantage.org or call Member Services at 855-442-9900 (toll-free).
What is Medication Therapy Management?The Medication Therapy Management program (MTM) is a free service to help with complex health needs. The MTM program is available for all qualified beneficiaries. These programs offer consultation with a specialized pharmacist and other healthcare professionals to help you get the most benefit from your medications. The program is not considered a benefit because not all members will qualify for the MTM Program.
If you are automatically enrolled and would like additional information about this program or you do not wish to take part in the MTM Program, please call Member Services at 855-442-9900 (toll-free).
THREEREQUIREMENTS
You will be automatically enrolled in this program if you meet these three requirements:
• Have at least three of the following chronic health conditions:
> Asthma > Heart Failure
> High Cholesterol > Diabetes
> High Blood Pressure > COPD
> Osteoporosis
• Take at least eight medications
• Total cost of your medications for the year combined is more than $3,507 (your costs and costs covered by your plan)
6 selecthealthadvantage.org | winter 2016 | advantageLiving™
better health
Idaho Diabetes Prevention Program
The YMCA offers a 16-week program for those at risk for developing diabetes. The program is available in Boise, Eagle, Meridian, Caldwell, McCall, Mountain Home, Twin Falls, and Wood River Valley.
The program includes:• Weekly sessions with a group of 12 to 15 participants
• A lifestyle coach who can help with behavior change
• Weekly discussions on healthy eating and physical activity, and hearing from guest speakers such as dietitians and personal trainers
• A four-month YMCA membership for the duration of the program—if you would like to continue the membership after the program, the YMCA will waive the start-up fee and can offer financial assistance to those who qualify
For information about the criteria to participate and enrolling, please visit ymcatvidaho.org and search “diabetes prevention.”
You can also use the Wellness Reimbursement benefit to pay for this program.
Go Paperless!We are required to send you a copy of your Annual Notice of Change (ANOC), Evidence of Coverage, and Abridged Formulary. But did you know that you can choose to receive them electronically?
To go paperless:
• Call us at 855-442-9900 (toll-free)
• Visit selecthealthadvantage.org
• Click on “Already a Member?” at the top of the page.
• Look for the “Go paperless” on the right-hand side of the page.
You will need your member ID number, found on your SelectHealth Advantage card.
If you decide you would like a printed copy later on, give us a call.
If you signed up for paperless last year and would like to make a change or update your email address, visit selecthealthadvantage.org or call us at the number above.
7selecthealthadvantage.org | winter 2016 | advantageLiving™
National Coverage Determination UpdatesEFFECTIVEDATE BENEFITUPDATE
02/08/2016
PercutaneousLeftAtrialAppendageClosure(LAAC)
Consistent with Medicare guidelines, percutaneous LAAC will be covered when furnished in patients with Non-Valvular Atrial Fibrillation (NVAF) through Coverage with Evidence Development and according to an FDA approved indication for percutaneous LAAC with an FDA-approved device. Specific condition requirements must be met for coverage.
01/27/2016
AllogenicHematopoieticStemCellTransplantation(HSCT)
Consistent with Medicare guidelines, allogenic hematopoietic stem cell transplantation (HSCT) for the treatment of Multiple Myeloma, Myelofibrosis, and Sickle Cell Disease is only covered by SelectHealth Advantage if provided as part of a Medicare-approved clinical study meeting specific criteria under coverage with evidence development (CED).
OURCONTACTINFORMATION
If you have questions, contact Member Services at 855-442-9900 (toll-free):
•October1toFebruary14:Weekdays 7:00 a.m. to 8:00 p.m., Saturday and Sunday 8:00 a.m. to 8:00 p.m.
•February15toSeptember30:Weekdays 7:00 a.m. to 8:00 p.m., Saturday 9:00 a.m. to 2:00 p.m., closed Sunday.
Outside of these hours of operation, please leave a message; and your call will be returned within one business day. TTY users, please call 800-346-4128 (Utah), 800-377-3529 (Idaho), or 711.
IMPORTANTINFORMATION
The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns. The information that is contained in this newsletter does not guarantee benefits. If you have questions or want to confirm your benefits, contact Member Services toll-free at 855-442-9900, weekdays 7:00 a.m. to 8:00 p.m., Saturday and Sunday 8:00 a.m. to 8:00 p.m.
Outside of these hours of operation, please leave a message and your call with be returned within one business day. SelectHealth is an HMO plan sponsor with a Medicare contract. Enrollment in SelectHealth Advantage depends on contract renewal. You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium, and copayments may change on January 1 of each year. SelectHealth complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Spanish
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a SelectHealth Advantage: 1-855-442-9900 (TTY: 711).
Chinese
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 SelectHealth Advantage: 1-855-442-9900 (TTY: 711).
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Hyves
2016 © SelectHealth. All rights reserved. 398889 12/16
Advantage Living is a trademark of SelectHealth.
Health and wellness or prevention information
have a question or concern?CALLUS!If you have a concern, a complaint, or a
compliment, we want to know about it. Call us first
with any feedback you may have (good or bad). We
want to hear from you. More importantly, if there's a
problem, we want to fix it. Call Member Services or
send an email to [email protected].
OURCONTACTINFORMATION
If you have questions, contact Member Services at
855-442-9900 (toll-free):
•October1toFebruary14:Weekdays 7:00 a.m.
to 8:00 p.m., Saturday and Sunday 8:00 a.m. to
8:00 p.m.
•February15toSeptember30:Weekdays
7:00 a.m. to 8:00 p.m., Saturday 9:00 a.m. to
2:00 p.m., closed Sunday.
Outside of these hours of operation, please leave a
message; and your call will be returned within one
business day. TTY users, please call 800-346-4128
(Utah), 800-377-3529 (Idaho), or 711.