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D.C. Healthy Families/ D.C. Healthcare Alliance

MEDSTAR FAMILY CHOICE • SUMMER 2014

Schedule Your Diabetes Testing ...............................2

What are Clinic Days .......2

Free Interpreter Services .............................2

Tip for Serving Food .......2

What is Care Management? ..................3

Complex Case Management Program ....3

Disease Management Program ............................3

Here When You Need Us ............................3

Is it Time for You to Recertify .......................4

Member Notice ................4

IN THIS ISSUE uuAsthma Tips for Adults and ChildrenAllergies can cause asthma attacks for both kids and adults. Here are some tips to help you manage your child’s or your own asthma.

• Use asthma controller and allergy medications every day as prescribed.• Call your doctor for refills on your asthma controller and allergy medications.

Types of asthma controller medications are: Advair®, Asmanex®, Dulera®, Flovent®, Pulmicort®, Qvar®, and Symbicort®.

• If you have asthma and start to cough, try using a rescue inhaler. Types of asthma rescue inhalers are: albuterol, Proair®, Proventil®, and Ventolin®.

• Watery, itchy eyes, sneezing, or dry, scratchy throat are signs of seasonal allergies, and you should be on an allergy medication. MedStar Family Choice pays for over-the-counter allergy medications, such as Benadryl®, Claritin® and Zyrtec®, with a prescription from your doctor.

• Talk to your doctor about having allergy testing to identify unknown triggers.

• Know your triggers and help avoid them as much as possible.

• Limit open windows in your home as this allows triggers from the outside to enter your home. Outside triggers in the air can lead to attacks.

• Clean up surface dust inside your home as often as possible with a damp cloth or mop.

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SUMMER 2014

Schedule Your Diabetes TestingA1C lets you see if your overall diabetes control is on target. If your A1C is high (more than seven), your doctor can change your diabetes treatment plan to help you get better control and prevent complications.

LDL is your bad cholesterol. If your LDL is high, your doctor can treat it so you can prevent heart disease.

Microalbumin, or protein in your urine, might mean that diabetes has affected your kidneys. If your microalbumin is high, your doctor can provide treatment.

An eye exam with drops allows the doctor to identify whether or not diabetes has affected your eyes. If you have eye disease, it can be treated. Undetected diabetic eye disease is a leading cause of preventable blindness.

• Get a $25 gift card if you have all four tests/exams done in 2014.

• Get an additional $25 gift card if your A1C has dropped by two points in 2014 or if your A1C is less than seven.

• You MUST have diabetes and be 18 or older to qualify for the gift card.

• This program is available for D.C. Healthy Families and D.C. Healthcare Alliance members.

Ask your doctor if you have had all of your diabetes tests in 2014. Call your care coordinator at 855-210-6203 if you think that you have had all of your diabetes tests/exams for 2014 or if you need help scheduling them.

What are Clinic Days?We have developed clinic days for our members to provide them with the health services that they need. Currently, the Outreach department has a few days scheduled each a month with clinics in our network and our staff reaches out to members who are in need of a doctor’s appointment. Please contact the MedStar Family Choice Outreach department at 855-210-6203 for information on how to schedule an appointment during a clinic day.

Free Interpreter Services AvailableWe have interpreters to help members when visiting their doctors. We will also provide an interpreter to help nonEnglish speaking members read written information sent by Member Services. If you or someone you know is deaf or has trouble hearing, call 711 for assistance. MedStar Family Choice also has people available who can use sign language to help you when you see your doctor. You, or someone who can speak for you, must let the Member Services representative know that you, need an interpreter. Si necesita un interprete, por favor contacte al departamento de Servicio al Miembro al 888-404-3549.

Tip for Serving FoodWhen taking food off the stove or grill, don’t put cooked food on the same plate that was used for uncooked meat or poultry. Always use a clean plate. Any harmful bacteria present in the raw meat juices could infect cooked food.

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MEDSTAR FAMILY CHOICE

What is Care Management?Utilization ReviewThe utilization review process begins when a doctor sends a request for a patient service. Decisions about a request are based only on needed care of coverage. We do not financially reward our providers, staff or anyone contracted with MedStar Family Choice for denying services. In addition, we do not financially reward anyone involved in the decision process in such a way that would encourage less use of services. Call 888-404-3549 to contact Member Services for additional information or for language assistance. We are open from 8 a.m. to 5:30 p.m., Monday through Friday. If you, or someone you know, is deaf or has trouble hearing, call 711 for assistance. This information is also available on our website at MedStarFamilyChoice.com.

Complex Case Management ProgramComplex Case Management is for our members who have many medical conditions and need help. Nurses and social workers provide the services. The case managers work closely with doctors. They work with members by telephone or in person to help with doctor visits, medicines and medical equipment. Call 855-210-6203 if you would like more information about this program, or if you are already in one of these programs and would like to stop. We are here from 8 a.m. to 5:30 p.m., Monday through Friday. Voice messages received after hours are returned during the next business day.

Disease Management ProgramDisease management is available to our members who need help with their long-term diseases. This service is provided by nurses and social workers who work closely with our members and their doctors. They contact members by telephone or in person. They also help members understand their diseases and get up to date on all of their testing and check-ups. The programs are:

• Adult High Blood Pressure • Pediatric Asthma • Adult Respiratory • Pregnancy • HIV/AIDS • Drug Abuse/Mental Health Needs

MedStar Family Choice members do not have to enroll in these services. You may be automatically enrolled if we see that you have certain illnesses. Membership is voluntary. Contact us at 855-210-6203 if you would like to ask about one of these programs, or if you are already in one of these programs and you would like to stop. We are available from 8 a.m. to 5:30 p.m., Monday through Friday. Voice messages received after business hours are called back during the next business day.

At MedStar Family Choice, we know a health problem can happen when you least expect it.

Our nurse advice line is here for you 24 hours a day, seven days a week. Just pick up the phone and call.

If you have an illness, injury or just a question about your health, our nurse advice line can help you get the care you need—whenever you need it. Call 855-210-6204 any time.

Here when you need us 24/7 nurse advice line

• Heart Conditions in Adults• Infants, Toddlers, School-age

Children, and Adolescents with Delay and/or Mental Disabilities

• Children and Adults with Diabetes

901 D St., SW, Suite 1050 Washington, DC 20024888-404-3549 PHONE

MedStarFamilyChoice.com

The MedStar Family Choice member newsletter is a publication of MedStar Family Choice.

Submit new items for the next issue to theresa.hudnall@medstar.net.

14-MFC-3279.082014

MEDSTAR FAMILY CHOICE

SUMMER 2014

Kenneth Samet MedStar Health CEO

Theresa Hudnall Editor

Eric Wagner President

Cyd Campbell, MD Medical Director

Member Notice:Effective Oct. 1, the member rights and responsibilities will be changing. Please look for this update in the 2014/2015 member handbook being sent to you in the fall.

Overview of the changes:• Your rights to respect and access have been explained more clearly.• Members will never be asked to pay for benefits that were provided during an appeal process.• Information on how to receive a copy of practice guidelines is now included.• Additional details on fraud and abuse are included.

Please call Member Services at 888-404-3549 for more information about these upcoming changes.

Is it Time for You to Recertify?• D.C. Healthy Families members have to recertify

once a year by mail. • D.C. Alliance members have to recertify every

six months in person at the Department of Human Services (DHS).

• All members should receive a letter and/or recertification form 45 to 60 days prior to their recertification date.

• If enrolled in D.C. Healthy Families, members are advised to fill out the form and mail it back to DHS as soon as possible.

Alliance members must have a face-to-face interview with the Department of Human Services every six months unless the member is 65 years of age or

This program is funded in part by the Government of the District of Columbia Department of Health Care Finance.

older, disabled or in the hospital. Contact the DHS or the Economic Security Administration (ESA) at 202-724-5506 if you have not received information on how to recertify, if you have questions or if you need to have a copy of your recertification information sent to you so there will be no breaks in your healthcare benefits.