Extra Help toKeep Your Medicare PatientsHealthy

At Network Health, we greatly value the high-quality service, coverage and care provided to every patent, every day. In the following pages, you’ll find helpful information about programs and benefits we offer our members to help support healthy outcomes.

We hope you will encourage Network Health Medicare Advantage (PPO) members to take advantage of these beneficial programs, most which are available at no extra cost. If you have questions about any of the programs mentioned, don’t hesitate to call us at 800-378-5234.

Home Assessments ..........................................page 1

Care Management ............................................page 2

Condition Management .................................page 3

Self-Management Workshops ............page 4 & 5

Courage Program ...............................................page 6

Home Again ....................................................page 7 & 8

Breathe at Ease ........................................ page 9 & 10

Home Telemonitoring ..........................page 11 & 12

1

Home Assessments This program identifies Network Health members who could benefit from an annual health visit in their home. There is no cost for this visit, and spouses can receive an assessment, too, if they’re also members.

How does the program work?A health care professional will visit the member’s home and spend ninety minutes completing a review of health history, current health status and any health concerns.

The home visit includes the following.w Routine measurements such as height, weight, blood pressure and body mass index (BMI)w A review of medical and family historyw Help establishing a list of current providers, suppliers and medicationsw A personal health risk assessmentw Home safety revieww Medication revieww Help developing a personal health plan that outlines recommended next steps and follow-up health screeningsw Assistance in scheduling a follow-up appointment with a primary doctorw Advice that may help intervene and treat potential health risksw Help with any health concerns and connecting you with resources

What else should I know?The visit is offered once a year, and it is completely voluntary. The visits are typically completed by a registered nurse practitioner, but occasionally by physician assistants or physicians.

Who can I call to learn more?If you have questions about our home assessment programs, call customer service at 800-378-5234 (TTY 800-947-3529), Monday through Friday, 8 a.m. to 8 p.m.

2

Care ManagementMembers with a serious health problem are connected with a registered nurse care manager who will work with them to manage their health condition and meet health goals. It’s offered at no cost.

How it worksOnce enrolled in a care management program, members can expect-- w Calls to monitor their conditionw Visits from the nurse care manager while they’re in the hospitalw Assistance understanding medical instructionsw Help navigating the health care system and getting necessary services in the best setting w Guidance on how to avoid complicationsw Assistance finding specialists w Help reviewing medications and treatmentsw Someone to find answers to any questions they may have

Who can enroll in care management?Members may be identified by Network Health by a provider. To make a referral, call 920-720-1602.

Personal Health RecordNurse care managers will also help members create a Personal Health Record—a small booklet they can use to record their health history.

Common things to include are:w Doctor visitsw Hospitalizationsw Lab test dates and resultsw Immunizationsw Current medicationsw Emergency room visitsw Surgeries

If you have any questions about our care management services, call 920-720-1602 or 866-709-0019.

1570 Midway PlaceP.O. Box 120Menasha,WI 54952920-720-16021-866-709-0019

nppdrugplans.com

PERSONALHEALTH RECORDFOR OUR MEDICARE MEMBERS

H5215_PHRCRD 7/2009

3

Condition Management ProgramsA team of registered nurses created our condition management programs to provide information and educational resources to help members with the following conditions.

w Diabetesw Heart failurew COPDw Depressionw Heart disease or stroke conditions related to vessel blockage

Here’s what our nurses do. w Connect members with educational workshops and events in their communityw Help them monitor health conditions and offer opportunities to successfully manage their healthw Promote healthy lifestyle behaviors such as exercise and eating rightw Support communication between members and doctorsw With permission, work with a caregiver or family member to educate them about a member’s condition

Who can enroll in a condition management program?Members are automatically enrolled if they have a medical claim for one or more of the conditions above. Members may also be enrolled based on information from their Health Questionnaire. Providers can refer by calling 920-720-1655, Monday through Friday, 8 a.m. - 5 p.m.

Self-Management WorkshopsMembers also have access to classes throughout northeast Wisconsin that teach how to best manage the most common symptoms of a chronic condition. We currently offer three workshops.

w Living Well with Chronic ConditionsA Living Well with Chronic Conditions workshop can help members with a conditions, such as diabetes, arthritis, high blood pressure, heart disease, chronic pain or anxiety, feel better.

How does it work? w It’s a six-week course that meets once a week for two and a half hours.w Members will learn from trained volunteer leaders that have health conditions themselves.

What will they learn?w Practical ways to deal with pain and fatiguew Easy exercises to help improve or maintain strength and energyw Better nutrition and eating habitsw How to effectively communicate with doctors and family about health concerns

w Stepping On (Falls Prevention)This program can empower members to carry out healthy behaviors that reduce their risk of falling, improve self-management and increase quality of life. The workshop can benefit anyone who has fallen one or more times, has a fear of falling or is at risk of falling.

How does it work? w It’s a seven-week course that meets once a week.w Cost varies by agency, but is usually between $10 and $30. It includes a Stepping On participant guide.w Scholarships are available to all based upon need, and NetworkCares members can recieve reimbursement from Network Health.

What will members learn? w Simple and fun ways to improve balance and strengthw The role vision plays in maintaining balancew How medications can contribute to fallsw Ways to stay safe when out and about in the communityw The importance of proper footwearw How to check home for safety concerns

4

5

w Healthy Living with DiabetesHealthy Living with Diabetes can help members manage their condition. This workshop will help members set goals and make a step-by-step plan to improve their health.

How does it work?w It’s a six-week course that meets once a week for two and a half hours.w The course is developed by the Stanford Patient Education Research Center.w Each workshop is led by two trained leaders, one or both of whom have diabetes themselves.

What will members learn? w Techniques to deal with symptoms, fatigue, pain, hyper/hypoglycemia, stress and emotional problems such as depression, anger, fear and frustrationw Appropriate exercises to help improve or maintain strength and endurancew Healthy eating choices and habitsw Appropriate use of medicationw How to work more effectively with health care providersw More effective ways to talk with doctors and family about diabetes

HOW TO SIGN UPMembers can find dates and times for any of the above workshops by visiting wihealthyaging.org and clicking on Find a Workshop or by calling

920-720-1655, Monday through Friday, 8 a.m. - 5 p.m.

6

For members who have, or are at risk for, cardiovascular disease, our Courage program can provide the tools needed to prevent heart attacks and reduce risk of chronic heart disease.

Using a personalized team approach, the 12-month program can lead members to a better quality of life by— w Giving regular access to a cardiac pulmonary rehabilitation specialist, a registered dietitian and a pharmacistw Helping members control risk factors w Showing members how to improve exercise habits and nutrition w Teaching members how to set and achieve healthy goals

The program includes six in-person visits and is available at the two locations below. Call either location for more information about this program.

Mercy Medical Center - Cardiac and Pulmonary Rehabilitation Department - 920-223-1123

St. Elizabeth Hospital - Cardiac and Pulmonary Rehabilitation Department - 920-738-2558

Peripheral Artery Disease BenefitMembers with peripheral artery disease (PAD) have extra help available. Because people with PAD often experience pain which keeps them from being active, they’ll have access to a rehabilitation benefit that includes supervised exercise three times a week for 12 weeks. The benefit is based on medical research proving this exercise schedule can lead to significant improvements in activity and reduced pain.

For more information about this benefit, call customer service at 800-378-5234 (TTY 800-947-3529), Monday through Friday, 8 a.m. to 8 p.m.

program

program

for heart health

for heart health

7

HOME AGAINA Joint Replacement Benefit

This benefit is designed for members who need elective total joint replacement surgery (hip or knee). It’s for members who are candidates for recovering and rehabilitating in their home, instead of in a skilled nursing facility.

What is the cost?

This benefit is available at no additional cost to the member.

This benefit includes the following.w A preoperative assessment by an RN and a PT or OT from a certified home health agency. w A personalized post-operative plan of care for recovery and

rehabilitation to assure a safe transition back to the patient’s home. The patient and their designated support person(s) will be educated regarding the care plan.

w Review and reinforcement of the surgeon’s protocols and post-operative plan, including the review of all medication, pain

management and therapy orders preoperatively.w A home safety assessment.w Post operatively, the patient will receive two hours of personal caregiver

services per week for two weeks to assist with ADLs.w Post operatively, the patient will receive 10 home delivered meals immediately following surgery.w Post operatively, the patient will receive one month of a personal

emergency response system.

How will it help my patient?Following surgery, most patients want to recover in their own home. This benefit provides the comfort, support and tools needed to do that–perfectly complimenting home health therapy and skilled nursing services.

8

How will it help me and my practice?Home Again is focused on recovery, rehabilitation and prevention of hospital readmissions. By providing a pre-op assessment and complimentary services after discharge, your participating patients will experience the following.w Once admitted to home care, members will receive the following. w A review and reinforcement of the surgeon’s protocols and post-operative plan w Nursing care and physical therapy based on the surgeon’s orders carried out in their home where they are most comfortable and familiar w Promotion of follow-up care with their primary care physician and transition to outpatient care as appropriate.

Who can I call to refer my patient to Home Again?For more information, or to make a referral, please contact Network Health Customer Service at 800-378-5234 (TTY 800-947-3529). We’re available Monday - Friday, 8 a.m. - 8 p.m.

HOME AGAINA Joint Replacement Benefit continued

9

Breathe easeatBreathe easeatWhat is Breathe at Ease?It’s a proactive, condition management program designed to help members improve and/or better manage their chronic lung condition. It’s intended to supplement the physician’s care for those with COPD.

Who is eligible?Network Health commercial (fully insured) and Medicare Advantage PPO members who need personal attention to better manage COPD, emphysema, or chronic bronchitis. The program is not available to Network Health self-funded participants.

High-risk members include:w Those who’ve had an emergency room visit or inpatient hospital visit within the last 12 monthsw Those who have had a course of steroids or antibiotics for an exacerbation in the last six monthsw Those who are on home oxygen

A pulmonary function test within the last 12 months is preferred.

What is the cost?This is a covered service for Network Health commercial (fully insured) and Medicare Advantage PPO members with COPD. There are no copayments, deductibles or out-of-pocket costs to the member.

How does the program work?A registered respiratory therapist (RRT) conducts the program in the outpatient pulmonary rehab department at St. Elizabeth Hospital or Mercy Medical Center.

10

Once enrolled in the program, the member will:

w receive a thorough assessment from the respiratory therapistw participate in the development of an individualized COPD action plan to follow at homew receive education on medication adherence and reinforcement of proper use of inhaler and rescue inhalersw be educated on disease management w receive exercise tolerance recommendations w be screened for quality of life, depression and sleep disturbancesw receive scheduled monthly follow-up telephone calls to track progress, reinforce areas of focus and address any new issues

The program lasts for 12 consecutive months with an option to be renewed for another year if deemed beneficial.

Breathe easeatBreathe easeat

continued

HOW CAN I REFER MY PATIENT? Providers can email, call or fax to refer someone

to the Breathe at Ease program.

To make a referral for St. Elizabeth’s Hospital or Mercy Medical Center, call Robyn West, RRT

at 920-831-1498, fax 920-831-1281 or email rwest@affinityhealth.org.

For Calumet Medical Center, call Peggy Nolan at 920-849-1816, fax 920-849-7529

or email pnolan@affinityhealth.org.

11

Home TelemonitoringThe telemonitoring benefit is designed for members who are diagnosed with heart failure. This is a covered benefit and there is no cost to members who qualify. The benefit provides the following.w Members will receive an assessment from one of our contracted home health care team membersw Members are given an easy-to-use monitoring system that will regularly record and send weight, blood pressure, pulse and oxygen level to help monitor their condition. A home health care team member will teach them how to use the telemonitoring equipment. Also a set of questions related to symptoms is answered daily by the member and transmitted to the home care agency.w Members get personal attention and phone calls from home health care team members with results sent directly to you.

How can home telemonitoring help my patient?The goal of this benefit is to reduce emergency room visits and hospital readmissions among those 65 and older. The benefit is an effective tool to help empower newly diagnosed patients as well as those who have been living with heart failure to self-manage more effectively.

As the primary care provider or treating specialist, how will telemonitoring help me and my practice?

You will be involved throughout the home telemonitoring process. The home health care agency will--w Contact you to establish a start of care date, time and obtain order.w Establish that you will manage the patient’s condition.w Confirm telemonitoring parameters for your patient.w Contact you when your patient’s condition changes or when vitals are out of given parameters.w Readings will be faxed to you on a weekly basis or before scheduled clinic appointments. w For engaged clients (stable and compliant), the home health care agency will reach out to your patient once per month for positive reinforcement.w Upon discharge from telemonitoring, the home health care agency will notify you and Network Health’s Medicare Care Management Department.The primary care provider and treating specialist will be included in all

The primary care provider and treating specialist will be included in all home telemonitoring communications.

No prior authorization is required. If you have any questions about Network Health’s telemonitoring benefit, please call Network Health Customer Service Department at 800-378-5234. We’re available Monday through Friday, 8 a.m. to 8 p.m. (TTY 800-947-3529).

12

Home Telemonitoring

800-378-5234 (TTY 800-947-3529)Monday - Friday, 8 a.m. - 8 p.m.

Network Health Medicare Advantage plans include MSA and PPO

plans with a Medicare contract. NetworkCares is a PPO SNP plan with a Medicare contract and a contract with the Forward Health Wisconsin Medicaid program. Enrollment in Network Health Medicare Advantage

Plans depends on contract renewal.

m-prcnt-hlthmgmt.bklt-1014Y0108_425_103114 NHIC 10/2014