October 2009 |
Caring for Life eNewsletter | |
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It's flu season Flu season is here, and all signs indicate this could be a severe year for the flu. The U.S. Centers for Disease Control and Prevention (CDC) recommends that these groups of people get a flu shot between mid-October and December:
The influenza virus, or flu, contributes to many unplanned hospitalizations every year. In the worst cases, the flu can be life threatening. Flu shots prevent flu and ease symptoms if you get the flu. Visit your health care provider to get your free flu shot. Or get your flu shot at a designated location in your community. To find a flu shot location near you, call 1-877-PA HEALTH (1-877-724-3258) toll-free or visit www.dsf.health.state.pa.us/health and click on the green Focus on Flu button. So, do a “good health” favor for your family, your friends, and yourself — get a flu shot this year. |
Preparing for the H1N1 (Swine) Flu You’ve certainly seen and heard news media reports about the H1N1 flu in recent weeks. UPMC Health Plan has received calls from members wanting to know about the flu, and when a vaccine will be available. H1N1 flu, also called “swine flu,” is a new virus that began circulating earlier this year. Because it is a new flu virus, many people could be at risk for getting infection from this strain of the flu, and already a number of cases of H1N1 flu have been confirmed in our region. To date, most of the people who have been infected with the H1N1 virus have had mild illness and have recovered without requiring treatment. People who have chronic health conditions are at higher risk for more serious complications of H1N1 flu and should take symptoms seriously. The symptoms of H1N1 flu are the same as those caused by seasonal flu. They include cough, runny or stuffy nose, fever, muscle aches, headache, fatigue, nausea, diarrhea, and respiratory symptoms. Prescription antiviral drugs are available that may be appropriate for some flu patients. You may want to discuss this with your doctor. Vaccines for H1N1 flu are now becoming available at a number of locations in our region. As of October 9, approximately 90,000 doses have been made available in this area, and that number will increase over the next several weeks. The vaccine will be available at a variety of locations in our local communities over the next several weeks, including doctors’ offices, hospitals and pharmacies. These locations will be listed on the PA Department of Health (DOH) website — www.health.state.pa.us — and at our website, www.upmchealthplan.com as they become available. If you do not have access to the Internet, we suggest you contact your primary care physician or the Pennsylvania Department of Health at 1-877-PA-HEALTH (1-877-724-3258). UPMC for Life fully covers these vaccines for all members, whether you receive them at your doctor’s office or another location. If you show your UPMC for Life ID card, in most cases you won’t be charged for the vaccine. If you are charged, simply complete a reimbursement form found on the UPMC for Life website and return it with a copy of your receipt and UPMC for Life will reimburse you for the cost of the vaccine. The Centers for Disease Control and Prevention (CDC) recommends that these groups of people receive the H1N1 flu vaccine:
There are several types of H1N1 vaccines. To find out if you should get an H1N1 flu vaccine and what type you should get, discuss with your doctor, or check with the site where you plan to receive your vaccine. To protect yourself from getting the H1N1 flu, first and most important, wash your hands often. Wash with soap and warm water for 15 to 20 seconds. When soap and water are not available, use alcohol-based disposable hand wipes or gel sanitizer. In addition, get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious foods. Try not to touch surfaces that may be contaminated with the flu virus. Try not to touch your eyes, nose, or mouth. Avoid close contact with people who have flu symptoms; people who have H1N1 flu may be contagious for 1 day before symptoms begin and up to 7 days after. More information about the H1N1 virus and the H1N1 vaccine is becoming available daily. UPMC Health Plan will update our website – www.upmchealthplan.com – with this new information. You can also check the following websites for the latest information:
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Talking about end-of-life treatment decisions Dr. Clancy is a general internist and researcher as well as an expert in engaging consumers in their health care. She is Director of the Agency for Healthcare Research and Quality. It’s natural to avoid thinking — never mind talking — about dying. As a result, most people, including those who are nearing the end of life, do not make their wishes clear to loved ones or health care providers. One way to communicate your wishes about future health care decisions is through “advance directives,” which are legal documents that allow you to convey your decisions about your health care, especially end-of-life care. But fewer than half of severely or terminally ill patients have advance directives in their medical records, according to research sponsored by the Agency for Healthcare Research and Quality (AHRQ), an agency funded by the federal government. AHRQ’s mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Even before you become old or ill, you need to think and talk about the kind of care you would want should a stroke, terminal illness, or life-threatening event occur. Ideally, these discussions should take place long before you need care. If such conversations don’t take place, your family and physician must make decisions based on what they think you would want. As a physician, I know making decisions on behalf of a loved one is particularly difficult during an already stressful time. End-of-life planning involves some thought and effort, such as completing advance directives. In addition to talking about your wishes with family members, you should also talk with your doctor. Most doctors welcome the chance to discuss such issues but may be hesitant to raise the topic. We need more doctor-patient discussion in this area. As many as three-quarters of physicians whose patients had advance directives were unaware that those documents existed, according to the research. And only 12% of patients with advance directives had received input from their doctor. Discussing these matters increases the likelihood of getting your wishes met. Patients who are dying and family members who survive them say that lack of communication with doctors causes confusion about medical treatments, conditions, and choices that need to be made. Depending on your age and medical condition, your doctor may be helpful in starting your decision making. Once you’ve considered your options and had discussions, you need to put your desires in writing in the proper documents, called “advance directives.” Be sure to give copies to family members and your doctor. There are some differences in advance directives based on where you reside. Be sure to check with your doctor or a person familiar with these issues as they apply to your state. Types of advance directives worth considering include:
AHRQ Director Carolyn Clancy, MD, has prepared brief, easy-to-understand advice columns for consumers to help them navigate the health care system. Her articles address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. To read more of Dr. Clancy’s columns, go to www.ahrq.gov and search for “Dr. Clancy.” You can even sign up for e-mail updates. AHRQ-funded studies show that conversations with doctors about advance care planning led to increased satisfaction among patients age 65 and older. Patients who talked with their families or physicians about their preferences for end-of-life care:
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There will be important changes to your health care benefits in 2010. To keep you informed about these changes, we’re holding exclusive member events for UPMC for Life members and their friends and family. UPMC for Life representatives will be presenting our benefits for 2010 along with a variety of resources and programs that are available to you as a UPMC for Life member. This unique opportunity will allow you to learn about upcoming benefit changes and talk one-on-one with a representative. Featured presentations include:
UPMC for Life will also be sponsoring flu shot clinics for members at select locations during this event. The U.S. Centers for Disease Control and Prevention recommends that all people age 50 and older receive an annual flu shot. And we’ve got you covered — UPMC for Life members can receive a flu shot at no additional cost. You will be asked to present your member ID card at the time of service. Please note that only UPMC for Life members can receive flu shots at these clinics. If you are interested in attending, please call today to make a reservation as space is limited. Contact our Health Care Concierge team or the Member Services Department at 1-877-539-3080. You can call seven days a week, from 8 a.m. to 8 p.m. TTY users should call 1-800-361-2629. |
PREdiabetes — Not worth the risk Once you develop diabetes, it never goes away. That’s why it’s so important to avoid getting it. But according to the American Diabetes Association, 54 million adults have prediabetes. In less than 10 years, most of these adults will develop type 2 diabetes—unless they take preventive steps. At the very least, those steps should include: Eating healthier. Choose fruits, vegetables, and whole grains, along with foods that are low in fat and calories.
If you are at risk for prediabetes, call your doctor to talk about scheduling a blood glucose test. Remember, diabetes is a lifelong chronic illness. Do whatever you can to avoid developing it. |
Anxiety disorders Sometimes, Jerry’s worrying got so bad he couldn’t fall asleep, or he’d fall asleep but wake up in the middle of the night and stay up. Everyone kept telling him to relax and calm down — everything was fine. They told him that he worried too much. Jerry knew they were right, but he couldn’t stop himself. Jerry’s anxiety was affecting his quality of life and his ability to function. When anxiety affects a person in this way, it’s called an “anxiety disorder.” Anxiety is a normal and healthy part of life. Without it, we wouldn’t be able to stay focused on an important work project, study for an exam, or face a difficult situation in our personal life. Anxiety helps us cope with the difficulties that we face every day. But, sometimes, normal anxiety can overwhelm us and cause dread, panic, and fear. These feelings can make life difficult and, in some cases, become disabling. There are five types of anxiety disorders: Generalized Anxiety Disorder Obsessive-Compulsive Disorder Panic Disorder Post-Traumatic Stress Disorder Social Anxiety Disorder |
UPMC for Life offers a series of six classes, called Powerful Tools for Caregivers, that helps family caregivers increase their self-care skills and confidence. Each 90-minute class offers a wealth of tools to help you reduce your stress level, tell other family members and health care personnel what you need, communicate effectively in challenging situations, and deal with difficult feelings — plus help you make tough caregiving decisions. The first class is called Taking Care of You. This session emphasizes the importance of self-care. The challenges of caregiving and the importance of self-care are dramatized through a video, The Dollmaker, which vividly demonstrates what can happen when a caregiver ignores his or her own needs. Participants are introduced to setting goals and making action plans. Action plans are agreements that you make with yourself to do something that will help you take better care of yourself. Action plans are made at the end of every class. You will receive information in the mail when classes are available in your area. |
Know your rights as a UPMC for Life member You will get most or all of your care from UPMC for Life network providers — doctors and other health providers who are part of the UPMC for Life plan. You have the right to choose a network provider without interference from UPMC for Life (we can tell you which doctors are accepting new patients). You have the right to go to a women’s health specialist in our plan (such as a gynecologist) without a referral. You have the right to “timely access” to your providers and to see specialists when you need care from one. Timely access means that you can get appointments and services within a reasonable amount of time. We want to simplify women’s care and provide direct access to annual women’s care. Benefits for preventive women’s care include an annual Pap smear, a pelvic examination, a clinical breast examination, and a mammogram. You may also go to any network gynecologist for all other medically appropriate covered gynecological care, including outpatient services and inpatient admissions. |
Pharmacy Q&A Answer: That is a great question. In order to answer this question first let’s define what the “donut hole” is. The donut hole is the gap that exists between your Medicare Part D prescription drug benefit coverage limit and your catastrophic coverage threshold. When you are in this gap (the donut hole), you pay 100% of the cost of your prescription drugs before your catastrophic coverage kicks in. It takes $2,700 of total drug costs to get you to the donut hole. That $2,700 includes what you pay and what UPMC for Life pays for the prescription drugs covered by your drug benefit. Depending on what medications you take, you may reach the donut hole very quickly. Some people may not reach it at all. Catastrophic coverage doesn’t kick in until the amount you have paid in copayments and the amount you paid during the coverage gap/donut hole for the covered prescription drugs reaches $4,350. This amount is referred to as your True Out-of-Pocket (TROOP) expenses. Once catastrophic coverage kicks in, you begin paying 5% coinsurance on the cost of covered drugs, or a $2.40 copayment for covered generic drugs and a $6 copayment for covered brand-name drugs, whichever is greater. The drug plan year restarts in January, and a monthly Explanation of Benefits (EOB) report alerts you to where you are financially with your prescriptions. If falling into the donut hole is an issue for you, here are some things you can do:
Note: Members enrolled in the PPO Rx Enhanced Plan continue to receive generic drugs at the applicable copayment when they are in the donut hole. |
Quality improvement program update
UPMC for Life received strong ratings from members who believe they are receiving the care they need, as well as a high overall satisfaction rating. Members were very satisfied with their ability get information from the plan about prescription drug coverage and cost. They were also satisfied with their doctors’ communication skills. We are working to improve our service and care even more. Future improvement initiatives include:
Our website provides information about hospital quality and safety. If you would like a printed copy of the website information, or if you would like more information about the UPMC Health Plan Quality Improvement Program, please contact our UPMC for Life Health Care Concierge team at 1-877-539-3080. Representatives are available from 8 a.m. to 8 p.m., 7 days a week. TTY users can call 1-800-361-2629. |
June felt exhausted. “I wonder why I’m so tired all the time,” she asked herself. As she lay in bed one day, she reviewed her daily activities: She picked up her grandchildren in the morning and watched them until noon, like she does every day. She made lunch for her family, and after everyone left, she cleaned up. Then June took her husband to his doctor’s appointment. She also stopped at the grocery store on the way home. June spends two hours twice a week volunteering at a local retirement home, so she went there for the rest of the afternoon. When she got home, June just had enough time to prepare dinner. Then it was time to clean up — again! By that time, it was after 7 p.m. June spent some time talking to her husband and then arranged and organized things for the next day. By the time she set her alarm for 6:30 a.m., it was already after 11 p.m. “No wonder I’m exhausted,” she realized, as she drifted off to sleep. Women are usually so busy taking care of everyone and everything that they forget to take care of themselves. No matter what your age, you need to make time to pay attention to your health. No matter how busy you are, it’s vitally important to stay on top of two important health screenings and visit your doctor once a year for an exam. Osteoporosis To prevent osteoporosis, you need to keep your bones strong by maintaining a healthy diet and doing weight-bearing exercises, such as walking or using handheld weights.† When you are post-menopausal, you are at greater risk because the rate of bone loss speeds up as your estrogen level falls. The bones most likely to be affected by osteoporosis are the hip, wrist, and spine. Osteoporosis of the spine can lead to such things as sloping shoulders, back pain, and a protruding abdomen. The risk factors for osteoporosis include:
The best way to screen for bone loss is through a bone density scan, also known as a DEXA test. A DEXA test is most often performed on the lower spine and hips. While this test cannot predict fractures, it measures your bone density and identifies levels of risk. Remember — DEXA tests are covered under your UPMC for Life benefits.* To help prevent osteoporosis:
Source: U.S. Department of Agriculture (www.Mypyramid.gov) Breast cancer screening A mammogram is the best way to detect breast cancer early, when it is easier to treat. UPMC for Life covered services include a routine screening mammogram every 12 months for women age 40 and older. Mammography plays a central part in the early detection of breast cancers, because it can show changes in the breast long before you or your doctor can feel them. A mammogram is a safe, low-dose x-ray of the breast. It is still the best tool available for finding breast cancer early and saving lives. In addition, you should perform a breast self-examination monthly and see your health care provider once a year for a clinical breast examination. Starting at age 40, you should begin having regular mammograms. Talk to your doctor to determine the screening frequency appropriate for you. There are more than 100 mammography facilities in the UPMC for Life network. To find a mammography center by geographic location, click here. You also may call Member Services or our Health Care Concierge team at 1-877-539-3080. To read more about mammograms, including tips for getting ready for your mammogram, visit our eNewsletter center. |
Protect yourself – get vaccinated today Certain people are at greater risk for pneumococcal disease, including people age 65 and older, the very young, and people with health problems, such as heart or lung disease, kidney failure, diabetes, HIV infection, certain types of cancer, and those with alcoholism. Preventing pneumococcal infections is very important. The pneumococcal polysaccharide vaccine (PPV) protects against 23 types of pneumococcal bacteria. Most healthy adults who get the vaccine develop protection against most or all of these types within two to three weeks of getting the shot. The Centers for Disease Control and Prevention (CDC) recommends the following groups get vaccinated:
The vaccine may have mild side effects, such as redness or pain where the shot is given. The vaccine is a covered benefit of UPMC for Life. |
Provider directory on the Web We encourage you to get your medical services from doctors, hospitals, and health care providers in the UPMC for Life network so you can receive the highest level of benefits. With our easy-to-search provider directory, you can find out if the doctor or facility you want to go to is in our network. You can search for a doctor by name, office location(s) specialty, hospital or medical group affiliation, gender, languages spoken, and whether the doctor is accepting new patients. In addition, you can click on each listing to see the doctor’s office hours and board certifications, if any. When a doctor is board certified, that means he or she has additional education. If you’re looking for a hospital, you can search by name, location, and accreditation status. The hospital listing includes the address, phone number, and services offered, such as on-site lab or dialysis services. Of course, all of this information is available by calling our Health Care Concierge team at 1-877-539-3080. TTY users should call 1-800-361-2629. |
Resources for Life Q&A Corner Answer: UPMC’s Resources for Life can easily provide you with names of adult day care centers in your area. We can put you in touch with organizations, such as the Alzheimer’s Association, which have programs set up for caregivers in the same situation as you. We can also help you find support groups in your area for caregivers of those afflicted with Alzheimer’s disease. To access UPMC Resources for Life, call Member Services or our Health Care Concierge team toll-free at 1-877-539-3080, 8 a.m. to 8 p.m., seven days a week. TTY users should call 1-800-361-2629. |
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The content in this newsletter is not intended to provide specific medical advice, and members should contact their physician with questions about specific conditions and/or treatment. Not all benefits mentioned in this newsletter will necessarily be available to all members. Members should review their specific plan information to find out which benefits apply to them. Copyright 2009 UPMC Health Plan, Inc. All rights reserved. (TTY/TDD:1-800-361-2629) |