Member NEWSLETTER SPRING ISSUE • MARCH 2026
Featured this issue NEWLY ACCREDITED – NCQA................................
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FIND YOUR PATH TO A HAPPIER, HEALTHIER YOU-CALM HEALTH MOBILE APP..........................................................................
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DECODE YOUR BENEFITS CROSSWORD - GAME #1 ...........................................
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SPRING 2026 Members Newsletter Online Flipbook You can view and access links with your phone or computer. Scan this QR Code or go online to: tinyurl.com/vchcpSpring2026
contents Patient Emergency & Provider After Hours..................................................... 3
SPRING ISSUE • MARCH 2026
CONTACT INFORMATION
Ventura County Health Care Plan Regular Business Hours are: Monday - Friday, 8:30 a.m. to 4:30 p.m. • vchcp.venturacounty.gov • VCHCP.Memberservices@venturacounty.gov • Phone: (805) 981-5050 • Toll-free: (800) 600-8247 • FAX: (805) 981-5051 • Language Line Services: Phone: (805) 981-5050 Toll-free: (800) 600-8247 • TDD to Voice: (800) 735-2929 • Voice to TDD: (800) 735-2922 • 24/7 Pharmacy Help: (800) 811-0293 or express-scripts.com • 24/7 Behavioral Health/Life Strategies: (800) 851-7407 liveandworkwell.com • 24/7 Nurse Advice Line: (800) 334-9023 • 24/7 Teladoc: (800) 835-2362
CAHPS Survey................................................ 3
OptumHealth Behavioral SolutionsLife Strategies..............................................28
Timely Access Requirements...................... 3
Autism Screening For All Children..........29
Wellness Wire - Cholesterol........................ 4
Autism Spectrum Disorders.....................29
How to Find a Provider................................ 4
VCHCP Maternal Mental Health Program and Maternal and Infant Health Program...............................30
A Message From our Case Management Nurse............................ 5 How Often Should You See Your Primary Care Physician?.............................. 5
Child Immunizations..................................30 Preventive Health Guidelines..................31
Open Board Meeting Position.................... 6
Adult Preventive Care................................ 31
Optum Health Public Policy Committee ..................................................... 6
VCHCP Member Behavioral Health and Substance Abuse Resources.............31
Referral & Prior Authorization Process and Services Requiring Prior Authorization....................................... 7
Gender Affirming Procedures and Services.................................................32
Did you know?............................................... 7 Case Management & Disease Management Services.................. 8
Why Gender Inclusive, Sensitive Language is Important..............................32 Newly Accredited - NCQA..........................32
Coordinating Your Care............................... 8
Accessing Services for Behavioral Health.......................................33
Population Health Management Programs......................................................... 9
Anti-Depressant Medication Management................................................33
What is Optum’s Complex Case Management Program?.............................10
Depression Education Materials Available.......................................................33
Case Management...................................... 12
What is MDD? Far More Than Just Feeling Sad...............34
2026 Affirmative Statement Regarding Utilization-Related Incentive................... 12
How Teamwork Can Help You..................35
Request Complex Case Management, Case Management or Disease Management ............................................... 13
OPTUM Mental Health Emergency? Call 988..........................................................36
New Medical Technology.......................... 13
Optum Psychosocial Care as First Line Treatment...................................39
Submitting an External Exception Review Request for the denial of Request for Step Therapy Exception, Formulary Exception, and Prior Authorization for a Medication............... 14 TAR Process.................................................. 15 Breast Cancer Screening...........................16 Colorectal Cancer Screening.................... 17 Omada Programs........................................18
Optum Calm Health App ..........................38
Formulary Web Posting.............................40 Pharmacy Updates.....................................40 2026 National Preferred Formulary Exclusions.................................40 Express Scripts.............................................40 How To Request a Step Therapy Exception, Formulary Exception and Prior Authorization Exception................. 41
VCHCP Utilization Management Staff
One Touch Meter.........................................18
Regular Business Hours are:
Education Materials.................................... 19
Emergency Room vs Urgent Care............42
Metabolic Testing Recommendations...20
Emergency Room Visit Copays and Follow Up..............................................42
Monday - Friday, 8:30 a.m. to 4:30 p.m.
Graphic Design & printing GSA Business Support/Creative Services Member Newsletter
Diabetic Retinal Exam................................ 19
Follow -Up Care for Children Prescribed ADHD Medications.................21 Everyone Deserves A Healthy SmokeFree Home........................................22
• (805) 981-5060
2
The Importance of Well Child Visits........27
First Prenatal Visit and Importance of Pregnancy Testing......................................24
Milliman Care Guidelines & Medical Policy Updates ............................ 41
Post Inpatient Discharge Follow-Up.......43 Clinical Practice Guidelines......................43 Decode Your Benefits Crossword Game #1........................................................44 Wellness Programs.....................................45
Prenatal Care in your First Trimester......25
VCHCP Network Updates..........................46
Doulas............................................................26
Top 10 Tips To Quit Smoking....................47
SPR I NG u M A RCH 2026 | vchcp.venturacounty.gov
Patient Emergency & Provider CAHPS AFTER HOURS CONTACT THE NURSE ADVICE LINE
Ventura County Medical Center Emergency Room 300 Hillmont Avenue, Ventura, CA 93003 (805) 652-6165 or
(805) 652-6000
Santa Paula Hospital
A Campus of Ventura County Medical Center 825 N Tenth Street Santa Paula, CA 93060 (805) 933-8632 or
(805) 933-8600
Ventura County Health Care Plan
on call Administrator available 24 hours per day for Emergency Providers (805) 981-5050 or
(800) 600-8247
1-800-334-9023
Available 24 hours a day, 7 days a week for Member questions regarding their medical status, about the health plan processes, or just general medical information. THERE IS ALSO A LINK ON THE MEMBER WEBSITE: vchcp.venturacounty.gov/nurse-advice-line that will take Members to a secured email where they may send an email directly to the advice line. The nurse advice line will respond within 24 hours. To speak with VCHCP UM Staff, please call The Ventura County Health Care Plan at the numbers below: QUESTIONS? CONTACT US: MONDAY - FRIDAY, 8:30 a.m. to 4:30 p.m.
Phone: (805) 981-5060 or toll-free (800) 600-8247 FAX: (805) 981-5051, vchcp.venturacounty.gov TDD to Voice: (800) 735-2929 Voice to TDD: (800) 735-2922 Ventura County Health Care Plan 24-hour Administrator access for emergency providers: (805) 981-5050 or (800) 600-8247 Language Assistance - Language Line Services: Phone (805) 981-5050 or toll-free (800) 600-8247
Survey COMING SOON
Will you be one of the randomly selected participants? The Consumer Assessment of Healthcare Providers & System (CAHPS) Survey is one of the most important surveys to the Ventura County Health Care Plan (VCHCP). This national survey conducted by Press Ganey is sent out to randomly selected health care members. If you are selected to participate, please take the time to complete the survey, as it is the best way you can let us know how the VCHCP can better serve you.
TIMELY ACCESS REQUIREMENTS VCHCP adheres to patient care access and availability standards as required by the Department of Managed Health Care (DMHC). The DMHC implemented these standards to ensure that members can get an appointment for care on a timely basis, can reach a provider over the phone and can access interpreter services, if needed. Contracted providers are expected to comply with these appointments, telephone access, practitioner availability and linguistic service standards. If a timely appointment is not available at any of our contracted clinics/facilities, then an out-of-network (OON) referral request should be sent by the referring provider to the Plan for authorization. The authorization request must include the details regarding the access issue and why an OON referral is required. NOTE: The referring provider may allow for an appointment outside of the timely access requirements if it will not be harmful to the patient’s health. These instances must be documented in the patient’s chart and communicated to the patient. Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
Type of Care
Wait Time or Availability
Emergency Services
Immediately, 24 hours a day, 7 days a week
Urgent Need – No Prior Authorization Required Urgent Need – Requires Prior Authorization Primary Care Specialty Care Ancillary services for diagnosis or treatment
Within 48 hours Within 96 hours Within 10 business days Within 15 business days Within 15 business days
Mental Health and Substance Use Disorder including nonurgent follow-up appointments with nonphysician mental health care or substance use disorder providers
Within 10 business days
Phone wait time for triage or screening by the provider office
Not to exceed 30 minutes
Wait time for enrollees to speak with a qualified Plan representative during business hours
Not to exceed 10 minutes
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
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Monthly Newsletter for Population Health Management
Wellness Wire
Monthly Newsletter for Population Health Management
Wire S Wellness eptember 2024 CHOLESTEROL
Let’s Stalk cholesterol and your health… e p t eabout mber 2 024
High for heart disease, the leading cause T H Icholesterol S M O N T His’aSmajor T O risk P I Cfactor : of death in the United States. High cholesterol means that there are elevated T H I S levels M O N of T Ha’waxy, S T O fat-like P I C : substance in the bloodstream which can build up, raising the risk for heart attack and stroke. Some people have a family history related to high cholesterol.
Cholesterol
Cholesterol Let’s talk about cholesterol and your health…
Beware of the “Silent Killer” High cholesterol typically does not have signs or symptoms. Many people do not know their cholesterol is high.
The great news is that cholesterol levels can be easily checked. If your Your doctor can check your Let’s talk aboutischolesterol and your health… cholesterol is too high, you lower itrisk by weight management, eating a High cholesterol acanmajor factor for heart disease, the leading cause of death cholesterol a simple heart-healthy diet, and increasing your exercise. Your doctor may also cholesterol is a major factor for heart disease, the leading cause of with death inHigh the United States. Highrisk cholesterol means that there are elevated levels of a blood test. prescribe medication, such as statins, to lower your cholesterol in in thefat-like United States. High cholesterol means that there are elevated levels of a waxy, substance addition to your lifestyle changes. in the bloodstream which can build up, raising the risk for
waxy, fat-like substance in the bloodstream which can build up, raising the risk for
heart attack stroke. Some people have a family related to high To learn talkand to your health care provider your risk. You canhistory heartmore, attack and stroke. Some people about have a family history related to high also visit the CDC’s website for information on cholesterol, risk factors, cholesterol. cholesterol. testing and treatment.If you do not have access to the website or would The great news thatcholesterol cholesterol levels The great news isisplease that levels like further information, call (805) 981-5060 and ask to speak with Beware of the “Silent Killer” Beware of the “Silent Killer” acan Disease Management Nurse. If If canbe be easily checked. your cholesterol easily checked. your cholesterol
How to Find a Provider
The online Provider Directory is
istoo toohigh, high, you can lower it by weight High cholesterol typically does not does not is lower it by weight High cholesterol typically About Cholesterol you can Risk Factors Testing Treatment updated weekly thus providing have signs or symptoms. Many people management, eating a heart-healthy diet, have signs or symptoms. Many people management, eating a heart-healthy diet, the most isaccurate cdc.gov/cholesterol/ cdc.gov/cholesterol/ cdc.gov/cholesterol/ cdc.gov/cholesterol/ do not know their cholesterol high. information and increasing your exercise. Your doctor do not knowavailable. their cholesterol is high. about/index.html and increasingrisk-factors/index.html your exercise.testing/index.html Your doctortreatment/index.html Your doctor can check your cholesterol may also prescribe medication, such as Your doctor can check your cholesterol test. may alsotoprescribe medication, as with a simple blood To access the statins, lower cholesterol in such Statin Myth #1: Statinsyour do not have benefits that outweigh their risks. with a simple blood test. directory please statins, toto lower your cholesterol addition your lifestyle changes. visit our website at vchcp. FALSE. Statins are effective at lowering cholesterolin and lowering the risk of heart attack and stroke.your Like most medications, statins do have side effects (such as addition lifestyle venturacounty.gov/ To learnto more, talk to your changes. health care provider about your risk. You can also visit the
muscle pain and digestive upset) that affect 10-15% of people. Trials of different ProviderSearch.php. For a website for information on cholesterol, risk factors, testing . also ToCDC’s learn more,dosing talk to yourarehealth care toprovider about yourand risk.treatment You can visit the statins and alternate regimens recommended improve tolerability.
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CholesterolonRisk Factors Testing Treatment CDC’s website About for information cholesterol, risk factors, testingMember and treatment . contact Services at Statin Myth #2: Statins frequently cause memory loss and/or diabetes. About Cholesterol Risk cause Factors Testing Treatment FALSE. There is no strong evidence that statins frequently memory loss 981-5050 Picture your bloodstream like the pipes of your(805) house. Similarorto(800) 600-8247 and/or diabetes. Patients receiving statins may have for how your kitchen sinkexisting pipesrisk canfactors get blocked with grease or via emailand at VCHCP. memory loss and diabetes due to their other risk factors such as advanced Picture your bloodstream like the pipes of your house. cooking oil, your arteries can get get clogged with cholesterol. Similar to Memberservices@ age, obesity, elevated blood Medications sugars and unhealthy lifestyle choices. such as statins can help reduce the amount of
how your kitchen sink pipes can get blocked with grease and venturacounty.gov. cholesterol youryour body makes. Reducing cholesterol helps Statin Myth #3: I have diabetes, but my cholesterol is fine. I don’t need cooking oil, arteries cana statin. get get clogged with“keep cholesterol. Select your plan: your in pipes clean”ages and40lowers your riskofof heart attack and stroke. FALSE. Statins are recommended all patients to 75 regardless Medications such as statins can help reduce thetype: amount of Select a provider their cholesterol level since people with diabetes are twice as likely to have cholesterol your body makes. ReducingSelect cholesterol helps “keep a specialty: heart disease or a stroke. Statin Myth #1: Statins do not have benefits that outweigh their risks. a city: attack and stroke. your pipes clean” and lowers your risk Select of heart Picture: https://www.cdc.gov/cholesterol/about/index.html
Picture: https://www.cdc.gov/cholesterol/about/index.html
The team here at Express Scripts by Evernorth are dedicated to helping you Select a language: False. are effective at lowering lowering the risk of heart achieve your Statins overall health and wellness goals withcholesterol the tools andand resources Select a gender: we have available. attack and stroke. Like mostdo medications, do have effects (such Statin Myth #1: Statins not havestatins benefits thatside outweigh theirasrisks. Select Name of Clinic... muscle pain and upset) thattoaffect 10-15% of people. Please contact us via onedigestive of the methods below get started on the pathway Trials of different Name of Hospital... to a statins happy, healthy life! and alternate dosing regimens are recommended to improveSelect tolerability.
False. Statins are effective at lowering cholesterol and lowering the risk of heart Scando andhave side effects (such as attack and stroke. Like most medications, statins Call 1-800-846-4008 to speak TIP: When searching for a specialist, download muscle pain and of people. Trials of different with one of ourdigestive pharmacistsupset) that affect 10-15% the app make sure to select a specialty but statins alternate dosing regimens are recommended toensure improve tolerability. Statinand Myth #2: Statins frequently cause memory loss and/or diabetes. that the provider type is set at “All
All Evernorth Health Services products and services are provided exclusively by or through affiliates of the Evernorth companies, including Evernorth Care Solutions, Inc., Evernorth Behavioral Health, Inc., Evernorth Behavioral Health of Texas, Inc. and Evernorth Behavioral Health of California, Inc. © 2024 Evernorth Health Services. All rights reserved. Some content provided under license. All pictures are used for illustrative purposes only.
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Provider Types” as selecting a provider
False. There is no strong evidence that statins frequently cause memory and/or type willloss limit the options available. diabetes. Patients receiving statins may have existing risk factors for memory loss and diabetesSPR due to their other risk factors such as advanced age, obesity, elevated Member Newsletter I NG u M A RCH 2026 | vchcp.venturacounty.gov Statin Statins frequently cause memory loss and/or diabetes. blood Myth sugars#2: and unhealthy lifestyle choices.
A MESSAGE FROM OUR Case Management Nurse Case Management (CM) is part of your VCHCP benefit, free of charge to all members. I am dedicated to assist in organizing your healthcare need(s) and assist with coordinating care you may need. I can communicate between your providers to help connect your care and achieve your health goals. I am your advocate and I will help to empower you to manage your health care needs. If you are “lost” in the system of navigating your health care needs, contact CM to discuss your options. If you would like to speak directly with a nurse, please call (805) 981-5060 and ask for a Case Manager or Disease Manager. Your call will be returned within 2 business days. Members can also self-refer to the program online on the Member page at vchcp.venturacounty.gov/request-casemanagement-or-disease-management or by scanning this QR Code. Nurse Advice/Health Information Line is available to Plan members 24-hours per day, 7 days/week.
Talk to a nurse anytime for FREE by calling (800) 334-9023. Talk to a doctor anytime, anywhere by phone or video. Get care now for $20. Visit Teladoc.com or Call 1-800-TELADOC (800-835-2362)
How Often Should You See Your
Primary Care Physician?
Your Primary Care Provider (PCP) is responsible for treating you when you are sick or injured, and at times is the coordinator of referrals to specialists and other services. Some members rarely see their PCP, which can make care difficult, especially in an emergent situation. Children and Adults should be seen by their PCP at least yearly (more frequently for children under 2 years of age). Preventive Health Visits, or Check-ups should occur regularly to have appropriate preventive screenings, immunizations, and an overall review of your health. This is an important visit to discuss health concerns or even health goals. Staying in contact with your PCP by having annual check-ups can help with establishing a good relationship with your PCP. This relationship can make times of illness or injury run smoother and give you peace of mind for the care you receive.
If you haven’t had a checkup in the last year, please call your PCP today to make an appointment. If you need assistance or have questions, please call Member Services at (805) 981-5050. Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
5
OPEN BOARD MEETING POSITION We are excited to announce that the Ventura County Health Care Plan (VCHCP) has a position available on its Standing Committee.
This is a fantastic opportunity for those who are passionate about contributing to the long-term success of VCHCP.
• 2 026 Meeting Schedule (Noon – 1:30pm):
The VCHCP Standing Committee was created by the Ventura County Board of Supervisors to carry out the combined responsibilities of plan governance and “public policy”.
This is a volunteer opportunity, and members must meet the following requirements:
» June 11th
The Board delegated responsibility for oversight of operational activities, including care management and related quality of care processes and programs to the Standing Committee.
• Must be a full-time County employee • Must be a VCHCP member • Must not be a VCHCP employee or network provider • Must be available to attend the quarterly meeting held at the Hall of Administration.
» March 12th » September 10th » December 10th
If you are interested, please send an email to vchcp.memberservices@venturacounty.gov, with the following information: • Name • Current Position/Department
• Qualifications/Experience • Motivation
Or you can apply online at venturacounty.gov/county-executive-office/clerk-ofthe-board/boardscommissionscommittees-information
We invite you to join our committee The Optum Health Behavioral Solutions of California Public Policy Committee
If you’re a current member of the health plan, you can join our Public Policy Committee. • Current members have the
opportunity to share their comments and opinions about Optum Health Behavioral Solutions of California as part of this committee.
• As required by CA law, the committee meets every three months. • The committee talks about what your mental health plan does.
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Member Newsletter
• You’ll have the opportunity to meet and discuss with mental health specialists from Optum Health Behavioral Solutions of California’s network
We highly encourage all current members to join. We look forward to seeing you at the next Public Policy Committee meeting.
• Committee members are encouraged to submit their ideas and suggestions about the services offered to you and all members under the health plan.
To join our committee or for more information, please contact:
You will be paid a stipend of $200 per meeting for your participation and commitment in this committee.
SPR I NG u M A RCH 2026 | vchcp.venturacounty.gov
Carla Middlebrooks Phone: 1-818-484-9185 carla.arrington@optum.com
VENTUR A COUNT Y HEALTH C ARE PL AN’S
Referral & Prior Authorization Process and Services Requiring Prior Authorization Need information on how and when to obtain referrals and authorization for specific services? We’ve got you covered! Not sure how or when to get a referral or authorization for certain services? Visit the VCHCP website (vchcp.venturacounty.gov), go to the Members section on the top of the page, and select Referrals and Prior Authorizations. Or you can go directly to the information by clicking this link: vchcp.venturacounty.gov/PriorAuthorizationProcess This area provides links for members to obtain specific information on the Plan’s prior authorization process, what services require prior authorization, timelines, and direct referral information. IF YOU HAVE ANY QUESTIONS, PLEASE CALL MEMBER SERVICES AT (805) 981-5050.
Did you know? DIRECT SPECIALTY REFERRAL • Did you know that the direct specialty referral allows your Primary Care Physician (PCP) to directly refer you to certain contracted specialty doctors for an initial consult and appropriate follow up visits without requiring a Treatment Authorization Request (TAR) submission and prior authorization from the Health Plan? • Did you know that specialists can perform certain procedures during your initial consultation and follow up visits without prior authorization from the Health Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
Plan? Also, any follow-up visits will not require prior authorization if you are seen by the specialist within a rolling year and your visit is for the original problem.
45 DAY PEND REVIEW PROCESS • Did you know that Utilization Management Department’s place phone calls or send messages to your doctor if additional information is needed from your doctor? • Did you know that the Plan’s Medical Director reviews all pended and denial letters/ determinations for appropriateness of decisions. vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
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CASE MANAGEMENT & VCHCP has a Case Management Program to help
our members who have complex needs by ensuring that our members work closely with their doctors to plan their care. Case Management is a collaborative process of assessment, planning, facilitation, and advocacy. Determination is made for the best options and services to meet a member’s individual health needs through communication and utilization of available resources to promote quality care and cost-effective clinical outcomes. The goals of Case Management are to help members get to their best health possible in the right setting; coordinate and manage healthcare resources; support the treatment plan ordered by the doctor; and to take action to improve member overall quality of life and health outcomes. As a member in Case Management, members with complicated health care issues and their family have a truly coordinated plan of care.
VCHCP identifies members for Case Management through several referral sources, including health care provider referrals and member self-referrals.
Your Healthcare plan for the future starts here!
Members appropriate for case management referral include those members with medical and psychosocial needs impacting their compliance with disease management and health improvement including increasing severity of condition, safety issues, decreasing functional status, new behavioral health issues, need for caregiver resources. Some examples of eligible medical conditions or events include multiple hospital admissions or re-admissions, multiple chronic conditions, major organ transplant candidates, and major trauma. A member identified for Complex Case Management is considered a participant in the program unless the member decides to opt-out (not accept the services/coordination of care offered). Once a nurse Case Manager evaluates a member, the Case Manager creates a care plan with the member and healthcare team input. The care plan is shared with the member’s doctor for his/her input and review. The care plan is monitored by the Case Manager and coordinated with the member and doctor.
Coordinating Your Care Your primary care physician is your main contact for maintaining good health and receiving medical care, so selecting a doctor and establishing a strong relationship with them is essential for your well-being. Your doctor monitors your health and ensures you see the appropriate specialists when necessary. One of your primary care doctor’s responsibilities is coordinating all of your medical care. If you are receiving services from more than one practitioner or getting care from a specialist, it is 8
Member Newsletter
SPR I NG u M A RCH 2026 | vchcp.venturacounty.gov
important for all your doctors to communicate valuable information with each other so they can work together to help ensure your care is complete and effective.
How can you help?
Please talk to your practitioner about sharing essential medical information with your PCP by requesting to sign a release of information. Share with your PCP the names and contact information of your other treating medical practitioners, so your PCP can request medical records.
DISEASE MANAGEMENT SERVICES The VCHCP Disease Management Program coordinates
health care interventions and communication for members with conditions where VCHCP support of member self-care activities can improve their conditions. VCHCP has two Disease Management programs: Asthma and Diabetes. VCHCP has systematic processes in place to proactively identify members who may be appropriate for these disease management services. Diagnosis information on claims encounter data and pharmacy data prescription drug information are used to systematically identify members for disease management. Members and providers may also refer to the applicable Disease Management program. Once identified, the member is automatically enrolled in the program unless the member chooses to opt out. The Disease Management team works with doctors and licensed professionals to improve these chronic conditions, so members obtain the best possible quality of life and functioning. Included in the Disease Management Program are mailed educational materials, provider education on evidence-based clinical guidelines, member education over the phone (health coaching) and care coordination. VCHCP has a variety of member materials about diabetes and asthma available to help you better understand your condition and manage your chronic disease. Our goal is to improve the health of our members.
The VCHCP programs for Case Management and Disease Management are for members with severe illnesses and chronic diseases to help plan their care with their primary doctor and learn more about self-care. These programs have nurses who work with members over the phone to guide them towards the best possible health for their conditions.
Participation in these programs is free and voluntary for eligible members. Members can opt out at any time and being in these programs does not affect benefits or eligibility. For more information or to submit a referral for the Case Management and Disease Management Program, please call 805-981-5060. Members can also self-refer to a program online on the Member page by clicking this link vchcp.venturacounty.gov/request-case-management-or-disease-management.
Population Health Management Programs Ventura County Health Care Plan provides ongoing support of our members to meet their healthcare needs. Our goal is to empower you to take control of your health. VCHCP wants to be sure you are aware of the many programs, services, and activities offered by us to support you in your health care goals. Please visit our website at vchcp.venturacounty.gov/VCHCPPopulationHealthManagement to see the list of programs/services offered, how you are eligible to participate, and how you decide to participate. If you need further information or have any questions regarding the programs or activities offered, please contact our Health Services Department at (805) 981-5060 or toll-free (800) 600-8247. Guidelines, please contact Member Services at (805) 981-5050 or at (800) 600-8247. Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
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What is Optum’s Complex Case Management Program? Optum offers a Complex Case Management program for individuals who could be helped through more intensive coordination of services. This program is intended to help people with complex behavioral health conditions connect with needed services and resources. Behavioral Health Advocates work intensely with you or your loved one in the development of a comprehensive plan of care which coordinates the following: • Therapeutic services (therapy, medication management, case management, etc.) • Community and Psychological supports (education/support regarding illness, coordination with support system, other supportive services) – Coordination of care between medical and behavioral physicians and clinicians • Recovery and Resiliency Services (peer support, development of a crisis/recovery plan, life planning activities) • Other services as appropriate (legal, shelter, basic needs, etc.)
Program Goals: • Movement to recovery • Enhanced wellness • Building resiliency through self-care and empowerment Criteria for acceptance into the program include: • Presence of complex behavioral health condition(s) which require a greater level and intensity of services • History of intensive behavioral health service utilization over the past 12 months • Willingness to actively participate in the program for at least 90 days If you believe you or a loved one meet these criteria and would benefit from Optum’s Complex Case Management program, please contact Optum via the toll-free number on the back of the member’s insurance card to ask for this program. Optum looks forward to partnering with you or your loved one on the path to recovery and wellness.
How we make decisions about benefit coverage All our staff follow strict rules when they decide about approval of benefits. Decisions are based on what your benefits cover and your medical need. We do not reward staff or healthcare providers for saying “no” to care or services. We do not give financials rewards to our staff or healthcare providers to make decisions that result in less care or service than what is needed.
How to contact us Our offices are open Monday through Friday. Our hours are from 8 a.m. to 5 p.m., except on holidays. You can call the toll-free number on your insurance card or health plan member ID card to learn about your benefits or get approval for care. Optum offers language assistance, at no added cost for members who prefer to speak a language other than English. Our offices have toll-free numbers for members with hearing impairments. You can also get help with services or ask questions. A Care Advocate can answer your questions about services and our decisions. Our staff will tell you their name, title, and where they work. If you have an emergency or urgent health concern, seek immediate attention or call 9-1-1. You can always contact one of our Care Advocates 24 hours a day, 7 days a week. You can even speak to a Care Advocate on weekdays and holidays. To call us, use the toll-free number on your health insurance card or health plan member ID card or in your benefits booklet or Evidence Coverage. 10
Member Newsletter
SPR I NG u M A RCH 2026 | vchcp.venturacounty.gov
What are my rights and responsibilities? 1. Members have a right to receive information about the organization, its services, its network clinicians, and members’ rights and responsibilities. 2.) Members have a right to be treated with respect and recognition of their dignity and right to privacy. 3.) Members have a right to participate with networks clinicians in making decisions about their health care.
• Periodic review of the treatment or program plan.
• An adequate number of competent, qualified, and experienced professional clinicians to supervise and carry out the treatment or program plan. 15. Members have a right to participate in the consideration of ethical issues that arise in the provision of care and services, including: • Resolving conflict. • Withholding resuscitative services. • Forgoing or withdrawing life-sustaining treatment. • Participating in investigational studies or clinical trials. 16. Members have a right to designate a surrogate decision-maker if the member is incapable of understanding a proposed treatment or procedure or is unable to communicate his or her wishes regarding care. 17. Members and their families have a right to be informed of their rights and responsibilities in a language they understand. 18. If a member chooses not to comply with recommended care, treatments, or procedures, the clinician is to inform the member of the potential consequences of not complying with the treatment recommendations. 19. Members have a right to be informed of rules and regulations concerning their own conduct. 20. Members have a right to be informed of the reason for any adverse determination, including the specific utilization review criteria or benefit provisions used in the determination. 21. Members have a right to have utilization management decisions made based on appropriateness of care. The organization does not reward network clinicians or other individuals conducting utilization review for issuing adverse determinations for coverage or services. 22. Members have a right to: • Inspect and copy their protected health information (PHI). • Request to amend their PHI. • Request an accounting of non-routine disclosure of PHI. • Request limitations on the use or disclosure of PHI. • Request confidential communications of PHI to be sent to an alternate address or by alternate means. • Make a complaint regarding use or disclosure of PHI. • Receive a Privacy Notice. 23. Members have a right to receive information about the organization’s clinical guidelines and Quality Improvement program.
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
2. Members have a right to a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage. 3. Members have a right to voice complaints or appeals about the organization of services it provides. 4. Members have a right to make recommendations regarding the organization’s members’ rights and responsibilities policies. 5. Members have a responsibility to supply information (to the extent possible) that the organization and its network clinicians need in order to provide care. 6. Members have a responsibility to follow plans and instructions for care that they have agreed on with their network clinicians. 7. Members have a responsibility to understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. 8. Members have a right to care that is considerate and that respects their personal values and beliefs systems. 9. Members have a right to personal privacy and confidentiality of information. 10. Members have a right to reasonable access to care, regardless of race, religion, gender, sexual orientation, ethnicity, age, or disability. 11. Members have a right to have their family members participate in treatment planning. Members over 12 years old have the right to participate in such planning. 12. Members have a right to individualized treatment, including: • Adequate and humane services regardless of the source(s) of financial support. • Provision of services within the last restrictive environment possible. • An individualized treatment or program plan.
11
Case Management Case Management is a process designed to coordinate services more efficiently, to provide a delivery methodology for targeted populations at risk, and to promote an interdisciplinary approach to meeting member needs throughout an episode of illness or continuum of care. It includes elements of behavioral change and self-management. VCHCP licensed healthcare professionals collaborate with members, families, and providers to evaluate the appropriateness of care in the most cost-effective setting without compromise to quality care. The goal of VCHCP’s Case Management program is to help members regain health and functional capability.
How to Make a Referral to Case Who Qualifies for Case Management/Members Management Appropriate for Referral to Case Management? If a provider identifies a VCHCP member needing case Case Management is provided to eligible members with specific diagnosis or special health care needs. This includes members with complex acute and chronic diagnoses, or specialty care management needs. These members typically require extensive use of resources and need assistance in navigating the healthcare delivery system. Members appropriate for case management referral include those members with medical and psychosocial needs impacting their compliance with disease management and health improvement including increasing severity of condition, safety issues, decreasing functional status, new behavioral health issues, need for caregiver resources. Services are free and voluntary for eligible members. Members consent to being in the program but can opt out at any time. Being in the program does not affect benefits or eligibility.
How Does Case Management Benefit the Member? Case management provides a consistent method for identifying, addressing, and documenting the health care and social needs of our members along the continuum of care. Once a member has been identified for case management, a nurse will work with the member to:
• Complete a comprehensive initial assessment. • Determine benefits and resources available to the member. • Develop and implement an individualized care plan in partnership with the member, his/her physician, and family or caregiver.
• Identify barriers to care. • Monitor and follow-up on progress toward care plan goals.
management, or has questions regarding the Case Management Program, the provider can make a direct referral by contacting VCHCP’s Case Management Department at (805) 981-5060, or (800) 600-8247. The VCHCP Case Manager can confirm if the member has an open case management case and works with physician/provider to coordinate the care plan. If a case is not open, the VCHCP Case Manager will confirm member demographics and clinical information to initiate referral through the QNXT module and assist the provider/Physician with care coordination, as appropriate. Members and caregivers can contact Member Services at (805) 981-5050 and request a referral for case management services. Members can also self-refer to a program online on the Member page at vchcp.venturacounty.gov/request-case-management-ordisease-management. Hospital discharge planning staff may contact the VCHCP Concurrent Review Nurse or VCHCP Case Manager to initiate a case management referral by calling the VCHCP’s Case Management Department at (805) 981-5060. The VCHCP Concurrent Review Nurse/VCHCP Case Manager can confirm if the member has an open case management case and works with the Discharge Planner to coordinate care plan. If a case is not open, the Concurrent Review Nurse/VCHCP Case Manager will confirm member demographics and clinical information to initiate referral through the Plan’s QNXT module and assist with care coordination, as appropriate.
2026 Affirmative Statement Regarding Utilization-Related Incentive* • Utilization Management (UM) decision making is based only on appropriateness of care and service and existence of coverage. • The organization does not specifically reward practitioners or other individuals for issuing denials of coverage or care. • Financial incentives for UM decision makers do not encourage decisions that may result in underutilization. • VCHCP does not use incentives to encourage barriers to care and service. 12
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• VCHCP does not make hiring, promotion or termination decisions based upon the likelihood or perceived likelihood that an individual will support or tend to support the denial of benefits. * Includes the following associates: Medical and Clinical Directors, Physicians, UM Directors and Managers, licensed UM staff including Management personnel who supervise clinical staff and any associate in any working capacity that may encounter members during their care continuum.
REQUEST Complex Case Management, Case Management or Disease Management In addition to VCHCP medical management staff, hospital discharge planners and practitioners; members and caregivers now have an opportunity to seek assistance for complex and or chronic medical needs such as asthma, diabetes, and coordination of challenging care online! Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, facilitation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. VCHCP’s CCM program is an opt-out program, and all eligible members have the right to participate or decline participation. Verbal consent is obtained prior to formally enrolling the member into the Complex Case Management Program. Members who are identified with the following situations include but are not limited to Transplants, ESRD, Traumatic Brain Injuries and High-Risk Diabetics. For a detailed information regarding complex case management, please refer to the policy and procedure on VCHCP’s website: vchcp.venturacounty.gov/ComplexCaseManagementPolicy Members and caregivers can contact Member Services at (805) 981-5050 and request a referral for case management or disease management services. Members can also self-refer to a program online on the Member page at vchcp.venturacounty.gov/request-case-management-or-disease-management . You will be prompted to enter member specific information. You will then submit this form to a secure email. A nurse will evaluate your request and call you within 2 business days. If you would like to speak directly with a nurse, please call (805) 981-5060 and ask for a Case Management Nurse.
New Medical Technology VCHCP’S MEDICAL DIRECTOR, or designee, evaluates new technology that has been approved by the appropriate regulatory body, such as the Food and Drug Administration (FDA) or the National Institutes of Health (NIH). Scientific evidence from many sources, specialists with expertise related to technology and outside consultants when applicable are used for the evaluation. The technology must demonstrate improvement in health outcomes or health risks, the benefit must outweigh any potential harm and it must be as beneficial as any established alternative. The technology must also be generally accepted as safe and effective by the medical community and not investigational. For help with new medication evaluations, the Plan looks to our Pharmacy Benefit Manager, Express Scripts, for their expertise. For new behavioral health procedures, the Plan uses evaluations done by our Behavioral Health delegate, OptumHealth Behavioral Solutions of California (also known as Life Strategies). Once new technology is evaluated by the Plan, the appropriate VCHCP committee reviews and discusses the evaluation and makes a final decision on whether to approve or deny the new technology. This final decision may also determine if any new technology is appropriate for inclusion in the plan’s benefit package in the future.
FOR ANY QUESTIONS, PLEASE CONTACT THE VCHCP Utilization Management Department at (805) 981-5060. Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
13
H ow To
SUBMITTING AN EXTERNAL EXCEPTION REVIEW REQUEST
for the denial of Request for Step Therapy Exception, Formulary Exception, and Prior Authorization for a Medication
You, your designee, or your prescribing doctor can request that the original step therapy exception request, formulary exception request, prior authorization request and subsequent denial of such requests be reviewed by an independent review organization by following the steps below:
• Submit an exception via online request available in the VCHCP member website by clicking vchcp.venturacounty.gov/request-forpharmacy-formulary-exception or by calling the Plan at (805) 981-5050.
•
Ask the Plan to make an exception to its coverage rules.
• There are several types of exceptions that can be requested such as:
- Cover a drug even if it is not on the Plan’s formulary. - Waive coverage restrictions or limits on a drug.
For example, the Plan limit the amount on certain drugs it covers. If the drug has a quantity limit, ask the Plan to waive the limit and cover more.
- Provide a higher level of coverage for a drug. For
example, if the drug is in the Non-Preferred Drug tier, ask the Plan to cover it at the cost-sharing amount that applies to drugs on the Preferred Brand Drug tier 3 instead. This applies so long as there is a formulary drug that treats your condition on the Preferred Brand Drug tier 3. This would lower the amount paid for medications.
• Once the Plan receives the exception request via
website or via phone call, the Plan’s Utilization Management will contact your doctor to process your External Exception Review Request.
•
The Plan sends your external exception review request to an independent review organization called IMEDECS/Kepro.
• VCHCP will ensure a decision and notification
within 72 hours in routine/standard circumstances or 24 hours in exigent circumstances.
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• The Plan will make its determination on the external exception request review and notify the enrollee or the enrollee’s designee and the prescribing provider of its coverage determination no later than 24 hours following receipt of the request, if the original request was an expedited formulary/prior authorization/step therapy exception request or 72 hours following receipt of the request, if the original request was a standard request for nonformulary prescription drugs/step therapy/prior authorization.
• If additional information is required to make a decision, the Plan in collaboration with IMEDECS/Kepro will send a letter via fax to your prescribing doctor advising that additional information is required.
• Exception request for step therapy/nonformulary/ prior authorization will be reviewed against the criteria in Section 1367.206(b) and, if the request is denied, the Plan will explain why the exception request for step therapy/nonformulary/ prior authorization drug did not meet any of the enumerated criteria in section 1367.206(b).
• The exception request review process does not affect or limit the enrollee’s eligibility for independent medical review or to file an internal appeal with VCHCP.
• The enrollee or enrollee’s designee or guardian
may appeal a denial of an exception request for coverage of a nonformulary drug, prior authorization request, or step therapy exception request by filing a grievance under Section 1368.
• If the independent review organization
reverses the denial of a prior authorization, formulary exception, or step therapy request, the decision is binding on the Plan.
• The decision of independent review organization to reverse a denial of a prior authorization, formulary exception, or step therapy request applies to the duration of the prescription including refills.
TAR Process When a Treatment Authorization Request (TAR) has been “pended for additional information” it means that VCHCP needs more information from the Provider to complete the TAR review process. THE PROCESS IS AS FOLLOWS: • When VCHCP clinical staff identifies that additional information is needed to complete a TAR determination, a pend letter will be sent to the requesting provider and to the member for whom the authorization is being requested. The pend letter will indicate that a) the TAR has been pended, b) what information is missing, and c) will provide for up to 45 calendar days (for routine TAR requests) for the requested additional information to be submitted to VCHCP. Per NCQA standards, a TAR can only be pended once, additional requests for information will not be sent and VCHCP will not send a reminder. • When the information is submitted within 45 days, a final determination will be made within 5 business days for a routine TAR, and notification will be sent to the requesting provider and to the member within 24 hours of the decision*. • If the requested information is not submitted within 45 days, a final determination will be made based on the initial information submitted and may be denied by the VCHCP Medical Director. • To assist VCHCP staff with the efficient review of these requests, and to avoid delays in the review process, the following is appreciated at the time the TAR is initially submitted:
“PENDED FOR ADDITIONAL INFORMATION”
◊ Please provide specific clinical information to support the TAR. For example, the History and Physical (H&P), key lab or test results, and plan of care from the most recent office visit (this is usually sufficient) if the office visit specifically relates to the TAR. ◊ For providers using CERNER, please provide the exact place in CERNER where the specific clinical information can be located to support the TAR. “See Notes in CERNER” does not adequately describe what clinical information supports the TAR, and should be reviewed. ◊ If written notes are submitted, please be sure they are legible. • In addition to faxing pend letters for needed additional information to providers, the Plan’s UM began sending messages through Cerner to inform VCMC requesting provider of pended request and clinical information needed by the Plan to make a medical necessity decision. For Non-VCMC providers, a phone call is placed to the requesting provider of the pended request and clinical information needed by the Plan. • The Plan’s pend letter was updated with an “Alert” to providers that clinical information is needed.
I f you have any questions, please contact VCHCP Utilization Management Department at: (805) 981-5060.
* These timeframes will apply in most situations. There may be some variance with urgent and retrospective TAR requests. Please see the VCHCP TAR Form for the timeline descriptions. Link: vchcp.venturacounty.gov/preAuthorizationTreatmentAuthorizationForm Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
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Breast Cancer Screening You may also see this information about Breast Cancer Screenings in the Plan’s Preventive Health Guidelines brochure. To view the brochure, please visit the VCHCP website at: vchcp.venturacounty.gov/wp-content/uploads/2023/03/preventiveHealthGuidelinesCommercial.pdf#page=6.
Contact one of the following providers to discuss the care that is appropriate for you: Your VCHCP Primary Care Provider | Your VCHCP OB/GYN Provider KEY FACTS:
• Mammograms can find breast cancer early, when it’s easier to treat. • Most breast lumps are not caused by cancer; many conditions can cause them. • Breast cancer symptoms vary, and some women don’t have symptoms. • Men can get breast cancer, but it is not very common. For every 100 cases of breast cancer, less than 1 is in men. PREVENTION TIPS:
• Keep a healthy weight and exercise regularly. • Limit the amount of alcohol you drink. • If you are taking hormone replacement therapy or birth control pills, ask your doctor about the risks and find out if it is right for you.
• Know
your family history of breast cancer. If you have a close relative with breast cancer, ask your doctor how you can manage your risk.
• A mammogram can’t prevent breast cancer, but it can help find it early. Talk to your health care provider about whether screening is right for you.
• Breast cancer screening means checking a woman’s breasts for cancer before she has any symptoms. A mammogram is an X-ray picture of the breast. Mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. • Most women who are 40 to 74 years old should have a screening mammogram every two years. If you think that you may have a higher risk of breast cancer, ask your doctor when to have a screening mammogram.
Content source: Centers for Disease Control and Prevention
EARLY DETECTION IS THE BEST PRACTICE AGAINST CANCER, ESPECIALLY BREAST CANCER. In an effort to increase awareness, VCHCP sent mammogram post cards to those who are due for their breast cancer screening. The postcards were mailed in August and again in October 2025. Our goal is to provide education to you to complete this important screening. You may bring this postcard to your doctor during your office visit to discuss more about your breast cancer screenings.
If you have any questions or concerns, please contact our Health
Services
Department
Early detection is your best protection against breast cancer You can now set an appointment for a screening mammogram directly with any VCHCP contracted radiology facility without a doctor’s prescription or order. There is no copay for a screening mammogram at any of these contracted facilities. The hours and capacity may vary per location, please make sure to call ahead and make an appointment.
GET YOUR SCREENING MAMMOGRAM DONE WHEN RECOMMENDED. VCHCP and the U.S. Preventive Services Task Force generally recommend a screening mammogram every two years between the ages of 40 and 74.
at (805) 981-5060. 16
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VCHCP NETWORK RADIOLOGY FACILITIES Ventura County Medical Center Radiology (VCMC) Santa Paula Hospital Radiology Center
(805) 652–6080 M-F 8:30am – 3:30pm
(805) 652-6080 M-F 7:30am – 3pm
Rolling Oaks Radiology [PRESS OPTION 1] (805) 357-0067 VENTURA (2705) LOCATION VENTURA (4516) LOCATION CAMARILLO LOCATION OXNARD (1901) LOCATION OXNARD (OUTLET CENTER) THOUSAND OAKS (415) LOCATION
Rolling Oaks St. John’s Imaging Center
T,W 8:30am – 4:30pm M-F 7am – 5:30pm T, TH 8am – 4:30pm M-F 8am – 4:30pm M,F 9:30am – 5:30pm M-F 7am – 4pm
(805) 983-0883 M,T,TH,F 8am – 6pm
Note: Copayment applies if you are having a diagnostic mammogram. Remember to request that your results be sent to your primary care doctor. *BRING THIS CARD TO YOUR APPOINTMENT AND GIVE IT TO THE RADIOLOGY OFFICE. 10/25
Colorectal Cancer Screening You may also see the information below about Colorectal Cancer Screenings in the Plan’s Preventive Health Guidelines brochure. To view the brochure, please visit the VCHCP website at: vchcp.venturacounty.gov/ members/docs/healthEducationInfo/preventiveHealthGuidelinesCommercial.pdf#page=7
Contact your VCHCP Primary Care Provider to discuss the care that is appropriate for you. KEY FACTS: • The best way to reduce your colorectal cancer risk is to get screened regularly beginning at age 45. • Colorectal cancer affects men and women of all racial and ethnic groups. • Colorectal polyps and colorectal cancer don’t always cause symptoms, especially at first. PREVENTION TIPS: • If you’re 45 years old or older, talk to your doctor about getting screened. • If you’re younger than 45 years old but may have a higher risk of colorectal cancer, ask your doctor if you should start screening before age 45. • Learn your family history of cancer and tell your doctor if you think you may have a higher risk. • Don’t smoke. Contact your VCHCP Primary Care Provider to discuss the care that is appropriate for you. • Get enough physical activity and limit your alcohol consumption. • Talk to your doctor if you have blood in or on your stool (bowel movement); stomach pain, aches, or cramps that don’t go away; or are losing weight and you don’t know why.
• Presently, the recommendation for colorectal screening is to begin at age 45 or older, and sooner for those who are at high risk for developing colorectal cancer. Special screening programs are used for those with family history of colorectal cancer and for those who are at high risk. There are several acceptable methods for colorectal cancer screening which includes fecal occult blood testing annually, sigmoidoscopy every 5 years or colonoscopy every 10 years.
Content source: Centers for Disease Control and Prevention
EARLY DETECTION IS THE BEST PRACTICE AGAINST CANCER, ESPECIALLY COLORECTAL CANCER. In an effort to increase awareness, VCHCP has sent postcards to all members who are due for their colorectal cancer screenings. The postcards will be mailed in October/ November 2026. Our goal is to
Your Gut Deserves the Spotlight Checking your colon is easier than you think.
provide education to our members
(Some people at higher risk may start sooner) Recommended by VCHCP and the U.S. Preventive Task Force
FIT or Stool DNA test kits — noninvasive and easy to do at home. These tests check for hidden blood or DNA changes in stool samples. Repeat every 1–3 years, depending on the test type.
and encourage them to complete these important screenings.
Colonoscopy — allows your doctor to examine the large intestine for abnormalities. Preparation and sedation are required, and you’ll need a ride home afterward. Repeat every 10 years.
You may bring this postcard to your doctor’s visit to discuss more about your colorectal cancer screenings.
If you have any questions or concerns, please contact Utilization Management at (805) 981-5060.
Ask your doctor about colorectal cancer screening starting at age 45, and ask which test is right for you.
Questions? Please contact VCHCP Utilization Management (805) 981-5060
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
CT Colonography — uses special X-ray imaging to look inside the large intestine for cancer or polyps. Repeat every 5 years. Flexible Sigmoidoscopy — views the rectum and lower colon. Similar to a colonoscopy, and usually done every 5 years or 10 years if combined with a yearly FIT test. 10/2025
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
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Omada Programs VCHCP offers our members the opportunity to manage their diabetes and high blood pressure without feeling overwhelmed through Omada. Omada is a virtual care program that empowers you to take control of your health with personalized coaching, smart digital tools, and proven programs designed to help you build healthy habits that last. Omada supports your health—right from home. Omada offers personalized programs to support your health journey: Omada Preventive Program Lower your risk of prediabetes and other chronic conditions. • Personalized health coaching • Nutrition guidance and healthy habit building • Weight management support • Motivation and accountability that fit your lifestyle Whether your goal is to eat healthier, lose weight, or stay on top of your health, Omada helps you make lasting changes. Omada Hypertension Program Managing high blood pressure doesn’t have to be overwhelming. •O ne-on-one support from a health coach and hypertension expert • Personalized guidance tailored to your lifestyle • Welcome kit with smart devices to help you stay on track:
• Blood pressure monitor that automatically tracks and syncs readings • Wireless smart scale (if eligible) to track weight and provide feedback • Track your blood pressure and weight effortlessly—devices are yours to keep Members can use Omada program services after enrollment in the programs. Enrolled members are sent information on how to access the Omada digital app which gives members access to healthy living, diet coaching, food tracking, community groups, weight and blood pressure tracking and learning modules to improve their well-being. Members can OPT into the Omada programs by using the link provided in the marketing materials or listed here omadahealth.com/express-scripts2. The link provided takes members to a clinical questionnaire page to enroll into Omada. After completing the questionnaire, and if the clinical criteria is met, the member is approved to enroll into the Omada program and can choose to participate. The Omada Program is an Opt-in program. Participation in these programs is free and voluntary for eligible members. You can choose to opt out at any time. Take the first step toward better health today—Omada is here to guide you on the journey to lower blood pressure and a healthier life. Join Omada today—enroll online, get your welcome kit, and start your personalized health journey! (omadahealth.com)
® Get Get your your OneTouch OneTouch® meter meter today! today! ® How How to to get get your your OneTouch OneTouch® meter: meter:
Use your insurance: OneTouch®® products are covered by most Use your insurance: OneTouch products are covered by most US insurance plans, often with low or no co-pay.* US insurance plans, often with low or no co-pay.* No insurance or your plan doesn’t cover OneTouch®® products: No insurance or your plan doesn’t cover OneTouch products: Bring this voucher and your prescription to your pharmacy to receive Bring this voucher and your prescription to your pharmacy to receive a OneTouch®® blood glucose meter for a $10 co-pay. a OneTouch blood glucose meter for a $10 co-pay.
Voucher valid with OneTouch Voucher valid with OneTouch Verio Flex®® and OneTouch and OneTouch Verio Flex Ultra®® 2 meters only. Ultra 2 meters only.
OneTouch® OneTouch® meters meters and and test test strips strips are are the the #1 #1 Doctor Doctor recommended† recommended† and customers' most-trusted‡ brand in the US. and customers' most-trusted‡ brand in the US. COPAY: COPAY: $10 $10
BIN: BIN: 601341 601341
RxPCN: RxPCN: OHCP OHCP
Group ID#: Group ID#: OHLC01021 OHLC01021
ID#: ID#: Y23100136180 Y23100136180
Patients: Patients: • Offer good while supplies last. Void where prohibited by law. Offeroffer good while suppliesInc. last.can Void where prohibitedwhere by law. •• This from LifeScan, only be redeemed OneTouch® products are sold and prescriptions can be processed. • This offer from LifeScan, Inc. can only be redeemed where OneTouch® products are sold and prescriptions can be processed. Pharmacist: Pharmacist: • Requires a valid prescription. Offer valid for one meter per patient every 36 months. •• Requires a valid valid for one meter per patient every 36 months. Submit this claimprescription. to IQVIA forOffer reimbursement plus a dispensing fee. Questions? Call 1-800-364-4767. Submit this claimintothis IQVIA for reimbursement plus a dispensing fee. Questions? •• By participating program or by otherwise processing a program voucher, Call you 1-800-364-4767. warrant that you will not submit a claim • for By participating in this program or by otherwise processing with a program voucher, you warrant that will not submit a claim reimbursement of any meter covered by this agreement any commercial payor or state oryou federal government funded for reimbursement of any meter covered by this agreement with any commercial payor or VA, state or federal government funded ® ). program (including but not limited to Medicare, Medicare Advantage, Medicaid, Medigap, DOD, or TriCare ® ).any time program (including butthe notright limited to Medicare, Medicare Advantage, or TriCareat • Lifescan, Inc. reserves to rescind, revoke, or amend this offer,Medicaid, program Medigap, eligibility, VA, andDOD, requirements • Lifescan, Inc. reserves the right to rescind, revoke, or amend this offer, program eligibility, and requirements at any time without notice. without notice. * MMIT Formulary Report July 2025. Some health plans may have more than one test strip * MMIT Formulary Report July 2025. Some health plans may have more than one test strip covered at the lowest co-pay. covered at the lowest co-pay. † Based on Symphony Health Solutions Manufacturer Market Share Prescribing Data, June '25. † Based on Symphony Health Solutions Manufacturer Market Share Prescribing Data, June '25. ‡ Voted #1 most trusted Blood Glucose Monitor brand by American shoppers based on the ‡ Voted #1 most trusted Blood Glucose Monitor brand by American shoppers based on the 2025 BrandSpark® American Trust Study. 2025 BrandSpark® American Trust Study. © 2026 LifeScan Enterprise LLC. All rights reserved. US-OTB-2500004 © 2026 LifeScan Enterprise LLC. All rights reserved. US-OTB-2500004
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Scan Scan QR QR code code for an electronic for an electronic version version of of voucher voucher
US-OTB-2500004 US-OTB-2500004
Diabetic Retinal Exam What is a diabetic retinal exam?
A diabetic retinal exam lets your eye doctor see the back of your eye (retina). It helps find eye problems such as diabetic retinopathy. This problem occurs when high blood sugar from diabetes damages the small blood vessels in the retina.
Diabetes eye exams
Diabetes can harm your eyes. It can damage the small blood vessels in your retina, the back wall of your eyeball. This condition is called diabetic retinopathy. Diabetes also increases your risk of glaucoma and other eye problems. You may not notice that your eyes are damaged until the problem is very bad. Your eye doctor can catch problems early if you get regular eye exams. This is very important. The early stages of diabetic retinopathy don’t cause changes in vision and you won’t have symptoms. Only an eye exam can detect the problem, so steps can be taken to prevent the eye damage from getting worse.
You Need Regular Eye Exams
Even if the health care provider who takes care of your diabetes checks your eyes, you need an eye exam every 1 to 2 years by an eye doctor who takes care of people with diabetes. An eye doctor has equipment that can check the back of your eye much better than your regular provider can.If you have eye problems because of diabetes, you will probably see your eye doctor more often. You may need special treatment to prevent your eye problems from getting worse. You may see two different types of eye doctors: • An ophthalmologist is a medical doctor who is an eye specialist. • An optometrist is a Doctor of Optometry. If you develop eye disease caused by diabetes, you will likely also see an ophthalmologist.
medicine taste in your mouth. Your eyes will have trouble focusing for up to 6 hours after the test. This will likely affect your near vision more than your far vision.
Your eyes may be sensitive to light. Wearing sunglasses may help until the drops wear off. Do not drive for a few hours after the test, unless your doctor says it is okay.
If your eye exam results are normal, your doctor may do follow-up exams every 2 years instead of every year. But if you have diabetic retinopathy, you may need eye exams more often. Please share your eye exam results with your PCP and endocrinologist. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments and call your doctor if you are having problems. Ask your doctor when you can expect to have your test results.
What happens after the exam?
Dilating drops may make your eyes sting. This will last for a few moments. They may also cause a
REFERENCES: Healthwise. 2024. Diabetic Retinal Exam: About This Test. healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.diabetic-retinal-exam-about-this-test.acn4674 MedlinePlus. 2023. Retina. medlineplus.gov/ency/article/002291.htm MedlinePlus. 2024. Diabetes eye exams. medlineplus.gov/ency/patientinstructions/000323.htm MedlinePlus. 2023. Diabetes and eye disease. medlineplus.gov/ency/article/001212.htm MedlinePlus. 2024. Glaucoma. medlineplus.gov/ency/article/001620.htm Asthma
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www.patie
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
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Metabolic testing recommendations For children and adolescents with severe mental illness and/or on antipsychotics Metabolic testing recommendations
For children and adolescents with severe mental illness and/or on antipsychotics
Metabolic testing recommendations
HEDIS® guidelines: Pediatric patients on antipsychotic medications should have the following metabolic tests annually: Metabolic testing recommendations
4
• Blood Glucose or Hemoglobin A1c HEDIS® guidelines: Pediatric patients on antipsychotic medications should have the following metabolic tests annually:4 • LDL-C or Cholesterol • Blood Glucose or Hemoglobin A1c guidelines: Pediatric patients on antipsychotic medications should have the following metabolic tests at baseline and •AAPLDL-C or Cholesterol on an ongoing basis:1 AAP guidelines: Pediatric patients on antipsychotic medications should have the following metabolic tests at baseline and • BMI on an ongoing basis:1 • Waist Circumference •• BMI Fasting Blood Glucose •• Waist Circumference Hemoglobin A1c •• Fasting Glucose Fasting Blood Lipid Concentrations • Hemoglobin A1c • Fasting Lipid Concentrations
Why metabolic testing is important
The American Academy of Pediatrics (AAP) and American Academy of Child and Adolescent Psychiatry recommend
Why metabolic testing is important baseline, ongoing and annual metabolic tests1 for pediatric patients with severe mental illness who have been prescribed
The American medications. Academy of Pediatrics (AAP) and American Child health and Adolescent Psychiatry recommend antipsychotic These tests can help monitor aAcademy patient’s of overall and can detect emerging health issues baseline, and side annual metabolic caused byongoing medication effects like: tests1 for pediatric patients with severe mental illness who have been prescribed antipsychotic medications. These tests can help monitor a patient’s overall health and can detect emerging health issues caused medication side effects like: • byMetabolic syndrome1 • Elevated prolactin levels1-2 •• Metabolic syndrome1 Extrapyramidal symptoms1 •• Elevated prolactin levels1-2 Cardiovascular changes2 •• Extrapyramidal Increased risk ofsymptoms1 diabetes and lipid abnormalities3 • Cardiovascular changes2 Coordination of risk careoftools and resources • Increased diabetes and lipid abnormalities3 Shared responsibility and coordination of care between mental health and primary care providers is essential. The following Coordination of coordinate care toolscare andfor resources resources can help pediatric patients: Shared responsibility and coordination of care between mental health and primary care providers is essential. The following 1. Coordination Care resources can helpofcoordinate care for pediatric patients: Get tips, checklist and additional resources. Use the Confidential Exchange of Information Form to facilitate coordination of 1. Coordination of Care health and medical providers. Be sure to ask for contact information for other treating providers. care among behavioral checklist and additional resources. Use the Confidential Exchange of Information Form to facilitate coordination of 2. Get Live tips, and Work Well care health andhealth medical providers. Be and surepatient to ask for contact(guest information other treating providers. Find among relevantbehavioral articles, behavioral provider search resources access for code: clinician) 2. and Work 3. Live Discover severeWell mental illness educational materials, best practice tips and screening tools: Find articles, search and patient resources (guest access code: clinician) • relevant Behavioral Healthbehavioral Providers:health Clinicalprovider and Quality Measures Toolkit 3. Discover severe mental illnessChild educational materials, best practice tipsToolkit and screening tools: • Primary Care Providers: and Adolescent Behavioral Health • Behavioral Health Providers: Clinical and Quality Measures Toolkit 1 Liwei, al. (2021). Collaborative Care inChild the Identification and Management of Psychosis in Adolescents • L., et. Primary Care Providers: and Adolescent Behavioral Health Toolkit and Young Adults. Pediatrics 147 (June). Available e2021051486. 10.1542/peds.2021-051486
2 Findling, R., et. al. (2011). Practice parameter for the use of atypical antipsychotic medications in children and adolescents. American Academy of Child and Adolescent 1 Liwei, L., et. al. (2021). Collaborative Care in the Identification and Management of Psychosis in Adolescents and Young Adults. Pediatrics 147 (June). Available e2021051486.
Psychiatry. Available https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/Atypical_Antipsychotic_Medications_Web.pdf 10.1542/peds.2021-051486 3 Ali, R.A., et. al. (2020) Barriers to monitoring and management of cardiovascular and metabolic health of patients prescribed antipsychotic drugs: a systematic review. BMC 2 Findling, R., et. al. (2011). Practice parameter for the use of atypical antipsychotic medications in children and adolescents. American Academy of Child and Adolescent Psychiatry (December). Available https://doi.org/10.1186/s12888-020-02990-6 Psychiatry. Available https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/Atypical_Antipsychotic_Medications_Web.pdf 4 National Committee for Quality Assurance 2025 HEDIS® Specifications, see NQF-Endorsed Measures at www.ncqa.org 3 Ali, R.A., et. al. (2020) Barriers to monitoring and management of cardiovascular and metabolic health of patients prescribed antipsychotic drugs: a systematic review. BMC 5 Pooja, G. P., et. al. (2022) A narrative review of metabolic monitoring of adult prescribed second-generation antipsychotics for severe mental illness. Clinical Epidemiology Psychiatry Available https://doi.org/10.1186/s12888-020-02990-6 and Global(December). Health 15 (May-June). Available https://www.sciencedirect.com/science/article/pii/S221339842200077X 4 National Committee for Quality Assurance 2025 HEDIS® Specifications, see NQF-Endorsed Measures at www.ncqa.org 5 Pooja, G. P., et. al. (2022) A narrative review of metabolic monitoring of adult prescribed second-generation antipsychotics for severe mental illness. Clinical Epidemiology and Global Health 15 (May-June). Available https://www.sciencedirect.com/science/article/pii/S221339842200077X
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Follow-up care recommendations
For children and adolescents prescribed ADHD medications American Academy of Pediatrics (AAP) guidelines2 – Children and adolescents on newly prescribed ADHD medications should have follow-up care with a prescribing provider within 2 weeks. HEDIS® guidelines1 – Schedule follow-up appointments as follows: • First follow-up within 30 days from the initial prescription date with a provider who has prescribing authority • At least 2 more follow-up appointments with any practitioner over the next 9 months
Why timely follow-up matters
Follow-up within 30 days of starting medication is critical for monitoring medication efficacy, side effects and adherence.1-2
Best practices for patient follow-up • • • • • • • • •
Schedule follow-up appointments before your patients leave the office3 Ensure all practice providers and office staff are aware of timely follow-up requirements Label appointment slots as "initial medication checks" to help prioritize scheduling Have Advanced Practice Registered Nurses conduct the follow-up visits Use home monitoring tools (e.g., blood pressure cuffs, smart scales and wearables) Train parents to record and report vitals during virtual visits Offer nurse-led vitals checks at local clinics or pharmacies Schedule hybrid visits combining brief in-person vitals with virtual consultations Combine behavioral therapy with medication to enhance attention, reduce impulsive behavior and minimize side effects and dosage needed
Coordination of care tools and resources
Remember to ask for contact information for other treating providers as you coordinate patient care. You may use this form to facilitate. Request coordination of care and referrals for members by calling the number on the back of the member’s health plan ID card or searching liveandworkwell.com (use code “clinician”). You can also find additional educational materials, best practice tips and screening tools at: • Behavioral health providers o Clinical and Quality Measures Toolkit • Medical health providers o Behavioral Health Toolkits for Medical Providers o Child and Adolescent Behavioral Health Toolkit National Committee for Quality Assurance HEDIS® Specifications; see HEDIS and Quality Measures at NCQA.org. American Academy of Pediatrics at AAP.org 3 Johns Hopkins Medicine. ADD-E - Follow-Up Care for Children Prescribed ADHD Medication. Available https://www.hopkinsmedicine.org/johns-hopkins-healthplans/providers-physicians/health-care-performance-measures/hedis/follow-up-care-children-prescribed-adhd-med 1 2
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
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EVERYONE DESERVES TO HAVE A
HEALTHY, SMOKEFREE HOME! DID YOU KNOW? People living in apartments are more likely to be exposed to secondhand smoke.1 » Smoke can enter your home through vents, electrical outlets, windows, and even tiny cracks in walls.
ANY AMOUNT OF SECONDHAND SMOKE CAN BE HARMFUL » 41,000 nonsmokers die from secondhand smoke each year in the U.S. 3
65%
Up to 65% of the air in an apartment can come from other units in the building. 2
It is especially dangerous for children and can cause permanent damage to growing lungs.4
YOUR LUNGS CAN’T TELL THE DIFFERENCE » Marijuana secondhand smoke is harmful just like cigarette smoke. 5 It has many of the same toxic chemicals that cause cancer and other diseases. » Vaping produces tiny droplets of harmful chemicals, including lead. It’s NOT just harmless water vapor!6
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YOU CAN MAKE A DIFFERENCE! TO FULLY PROTECT YOUR HOME FROM SECONDHAND SMOKE, YOUR ENTIRE APARTMENT COMPLEX NEEDS TO BE SMOKEFREE This includes: » Inside units » On patios and balconies » Outdoor common areas such as pools, parking lots, stairways, and courtyards.
» Apartment owners have the legal authority to make their property entirely smokefree. Contact your local health department for resources to offer managers and landlords about the benefits of a smokefree property. » Share information with neighbors about the harms of all forms of secondhand smoke. Try posting information on bulletin boards or in laundry rooms. » Reach out to city officials about local laws that would require apartments and other multi-unit housing to be smokefree. » Check the strength of your city’s smokefree policies and take action at www.secondhanddangers.org lung.org/research/sotc
Free help to quit tobacco is available from the Kick It California. Visit kickitca.org Call 1-800-300-8086 Text “Quit Smoking” or “Quit Vaping” to 66819 Download the free No Butts or No Vape mobile apps
Tobacco Education and Prevention Program
805-201-STOP (7867) callitquits@ventura.org
REFERENCES: » Tsai, J., et al. (2018). Exposure to Secondhand Smoke Among Nonsmokers - United States, 1988-2014. Morbidity and Mortality Weekly Report, 67(48), 1342–1346. » Center for Energy and Environment. (2004). Reduction of Environmental Tobacco Smoke Transfer in Minnesota Multifamily Buildings Using Air Sealing and Ventilation Treatments. » U.S. Department of Health and Human Services. (2014). The health consequences of smoking – 50 years of progress: A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. » Ibid. » Graves, BM, et al. (2020). Comprehensive characterization of mainstream marijuana and tobacco smoke. Scientific Reports, 10(1), 7160. https://doi.org/10.1038/s41598-020-63120-6 » National Academies of Sciences, Engineering, and Medicine. (2018). Public Health Consequences of E-Cigarettes. © 2021. California Department of Public Health. Funded under contract # 21-10001. J999 - 09/21.
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
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First Prenatal Visit and Importance of Pregnancy Testing Understanding Pregnancy Symptoms of pregnancy: What happens first Could you be pregnant? The proof is in the pregnancy test. But even before you miss a period, you might suspect — or hope — that you’re pregnant. Do you know the early symptoms of pregnancy? Classic signs and symptoms of pregnancy The most common early signs and symptoms of pregnancy might include: • Missed period • Tender, swollen breasts • Nausea with or without vomiting • Increased urination • Fatigue • Other less obvious signs and symptoms of pregnancy include moodiness, bloating, light spotting. Light spotting might be one of the first signs of pregnancy, known as implantation bleeding. Additional symptoms are cramping, constipation, food aversions. Importance of Early Pregnancy Testing Are you pregnant? You can take a pregnancy test as soon as you’ve missed your period. If you miss a period and notice some of the above signs or symptoms, take a home pregnancy test or see your doctor for a pregnancy test. The best time to take a pregnancy test is on the first day after a missed period, especially if you have regular cycles. If you have irregular periods, waiting at least 14 days after intercourse is recommended. While some tests claim to detect pregnancy earlier, waiting until after your missed 24
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irregular period minimizes the chance of a false negative. If your home pregnancy test is positive, make an appointment with your doctor immediately. The sooner your pregnancy is confirmed, the sooner you can begin prenatal care. Your First Prenatal Visit! Don’t Miss it! Your first prenatal visit may be between 6 and 12 weeks of pregnancy. This visit will help confirm your due date, check for any health risks, and start important care early. You may have an earlier appointment if you have health concerns or a history of complicated pregnancy. And it’s still best to schedule the first appointment as soon as you know you’re pregnant. Your first prenatal visit includes screenings, lab tests and advice on nutrition, supplements, and safe medications. VCHCP covers your first and all prenatal visits at no cost.
1. Schedule regular prenatal checkups to monitor your health and the baby’s development.
2. Take prenatal vitamins, especially those containing folic acid, as recommended by your healthcare provider.
3. Stop smoking, drinking alcohol, and using drugs to avoid birth defects and brain damage to a developing baby.
4. Maintain a healthy weight. 5. Eat a balanced diet with fruits, vegetables, whole grains, lean proteins and healthy fats.
6. Stay hydrated by drinking plenty of water throughout the day.
7. Get regular, moderate exercise if your provider says it’s safe.
8. Limit caffeine and avoid foods known to pose pregnancy risks, such as certain raw or undercooked items.
Early prenatal support is important for both your and the baby’s overall health and well-being. Schedule your prenatal exam as soon as you know you’re pregnant. A healthy pregnancy starts with early care.
9. Rest and prioritize good sleep.
The choices you make today can support your body, boost your fertility, and help ensure the best start for a future little one. Here are some ways to get yourself in the best shape—whenever the moment feels right.
from family, friends, or professionals if you’re feeling overwhelmed.
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10. Educate yourself about pregnancy stages, labor, and newborn care.
11. Reach out for support
Reference: Centers for Disease Control and Prevention. (2025, May 8). Planning for Pregnancy. cdc.gov/pregnancy/about/index.html
Prenatal Care in your First Trimester Pregnancy is an exciting time, but it can also be stressful. Knowing that you are doing all you can to stay healthy during pregnancy and give your baby a healthy start in life will help you to have peace of mind. When you find out you’re pregnant, make your first prenatal appointment. Set aside time for the first visit to go over your medical history and talk about any risk factors for pregnancy problems that you may have.
DUE DATE Your health care provider might do a physical exam, including a breast exam and a pelvic exam. You might need a Pap test, depending on how long it’s been since your last Pap test. Depending on your situation, you may need exams of your heart, lungs and thyroid. Prenatal tests can provide valuable information about your baby’s health. Your health care provider will typically offer a variety of prenatal genetic screening tests. They may include ultrasound or blood tests to check for certain fetal genetic problems, such as Down syndrome. Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.
DISCOMFORTS OF PREGNANCY You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe. Your next prenatal visits — often scheduled about every four weeks during the first trimester — might be shorter than the first. Near the end of the first trimester — by about 12 to 14 weeks of pregnancy — you might be able to hear your baby’s heartbeat with a small device, called a Doppler, that bounces sound waves off your baby’s heart. Your health care provider may offer a first trimester ultrasound, too. Your prenatal appointments are an ideal time to discuss questions you have. During your first visit, find out how to reach your health care team between appointments in case concerns come up. Knowing help is available can offer peace of mind. Sources: Prenatal care: 1st trimester visits - Mayo Clinic mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20044882 During Pregnancy - CDC - cdc.gov/pregnancy/during/?CDC_AAref_Val=https://www.cdc.gov/pregnancy/during.html Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
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DOULAS A Doula is a trained and certified professional who can provide support before, during and after delivery. They do not deliver the member’s baby, but instead compliment the care they will receive from your healthcare team. Having a doula may provide a great experience during a major milestone in their lives. According to the American Pregnancy Association Doulas provide emotional, physical and educational support to a mother who is expecting, is experiencing labor or has recently given birth. The purpose of having a Doula is to help empower women to have a safe, memorable and empowering birth experience.
Types of Doulas: • Birth Doula – Sometimes called birth companions or labor doulas. They prepare you for childbirth and ongoing support during labor. • Antepartum Doula – Assists with pregnancy that require special attention such as high-risk pregnancies (i.e. bed rest or unmanageable symptoms). • Post Partum Doula – Provides assistance after delivery. They assist in adjustment of life with an infant. Doulas typically meet with women and their partner every few months throughout their pregnancy to build rapport and discuss their goals of birth. This can be beneficial to women who have limited support system and who might otherwise be alone during the later stage of their pregnancy and childbirth. Doulas serve as your advocate and can help facilitate a positive and safe birthing experience. • Ventura County Health Care Plan has been covering Doula services since January 1, 2025. As a VCHCP member, you can receive doula services if you are a VCHCP member, are pregnant and the services are provided by one of VCHCP’s contracted doulas. For more information about Doula services, click this link vchcp.kinsta.cloud/DoulaServices American Pregnancy Association. (2024). Having a Doula – What are the Benefits? americanpregnancy.org/healthy-pregnancy/labor-and-birth/having-a-doula Harvard Health Publishing. (2023). What does a birth Doula do? health.harvard.edu/blog/what-does-a-birth-doula-do-202311222995 Cleveland Clinic. (2022). Doula. my.clevelandclinic.org/health/articles/23075-doula 26
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The Importance of Well Child Visits Keep Your Child Healthy: Don’t Skip Well-Child Visits! When your child is sick, seeing the pediatrician is important to treat the problem and help them feel better. But sick visits do not replace regular well-child checkups. Both types of visits serve different purposes and are essential for your child’s health. Well-child visits focus on prevention, growth, and long-term health. Sick Visits vs. Well-Child Visits • Sick visits: Treat specific illnesses, like fever, cough, or ear infections. • Well-child visits: Track growth and development, give vaccines, perform screenings, and provide preventive care. Why Well-Child Visits Matter Childhood is a time of rapid growth and change. Regular well-child visits help ensure your child is growing, developing, and staying healthy. These visits allow your pediatrician to catch potential problems early, provide preventive care, and support your child’s overall well-being. What Happens at a Well-Child Visit? • Measure growth: height, weight, head size • Check developmental milestones: speech, movement, social skills • Give vaccines and preventive care • Screen for vision, hearing, behavior, and emotional well-being • Answer parent questions and provide guidance for healthy habits Well-child visits are also a great time for parents to ask questions and get guidance on nutrition, sleep, safety, behavior, and school readiness—topics often not fully addressed during sick visits. Recommended Well-Child Visit Schedule:
• Newborn: within 2 weeks of birth • Infants: 2, 4, 6, 9 months • Toddlers: 1 year, 15 months, 18 months • Children: 2–10 years, annually • Adolescents: yearly until age 21 Remember:
Even if your child has been seen recently for a sick visit, keeping up with scheduled well-child visits ensures nothing is missed. Both types of visits work together to keep your child healthy, growing, and thriving. They help catch problems early, keep vaccines on schedule, and give you guidance to help your child thrive. Your pediatrician knows your child’s medical needs best—regular visits help them stay ahead of any concerns. Schedule your child’s next well-child visit today You may also find information on the Plan’s website under Preventive Health Guidelines 2025-2026 at vchcp.venturacounty.gov/wp-content/uploads/2023/03/preventiveHealthGuidelinesCommercial.pdf#page=2 Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
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VENTURA COUNTY HEALTH CARE PLAN CONTRACTS WITH
OptumHealth Behavioral Solutions (LIFE STRATEGIES) FOR MENTAL/BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES Optum’s Live and Work Well website is packed with valuable information for healthy living. For easy access to this information, look for Optum’s icon on the VCHCP website – click on it and you are on your way to learning more about healthy living! You can also access it through Behavioral Health, EAP, WorkLife & Mental Health Services | Live and Work Well.
Following are two examples of articles available for members to help with common behavioral health issues.
Attention Deficit Hyperactivity Disorder (ADHD)
The Basics: Autism Facts
What is attention deficit hyperactivity disorder?
What is Autism?
Attention deficit hyperactivity disorder (ADHD) is a condition in which a person has trouble paying attention and focusing on tasks, tends to act without thinking, and has trouble sitting still. It may begin in early childhood and can continue into adulthood. Without treatment, ADHD can cause problems at home, at school, at work, and with relationships. In the past, ADHD was called attention deficit disorder (ADD).
Autism is a developmental disorder. The disorder makes it hard to understand the world. Communication is especially challenging. It is hard for people with autism to attach meaning to words and facial expressions. Individuals with the disorder have trouble interacting with others. People with autism may engage in repetitive or obsessive behaviors and, in some cases, harmful behaviors, such as hitting their heads against a wall or repeatedly pinching themselves.
What causes ADHD? The exact cause is not clear, but ADHD tends to run in families.
What are the symptoms? The three types of ADHD symptoms include:
• Trouble paying attention. People with ADHD are easily
distracted. They have a hard time focusing on any one task.
• Trouble sitting still for even a short time. This is called
hyperactivity. Children with ADHD may squirm, fidget, or run around at the wrong times. Teens and adults often feel restless and fidgety. They aren’t able to enjoy reading or other quiet activities.
• Acting before thinking. People with ADHD may talk too loud,
laugh too loud, or become angrier than the situation calls for. Children may not be able to wait for their turn or to share. This makes it hard for them to play with other children. Teens and adults may make quick decisions that have a long-term impact on their lives. They may spend too much money or change jobs often.
How does ADHD affect adults? Many adults don’t realize that they have ADHD until their children are diagnosed. Then they begin to notice their own symptoms. Adults with ADHD may find it hard to focus, organize, and finish tasks. They often forget things. But they also often are very creative and curious. They love to ask questions and keep learning. Some adults with ADHD learn to manage their lives and find careers that let them use those strengths. 28
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| vchcp.venturacounty.gov
What are the Symptoms? Autism is usually noticed in the first three years. Sometimes the symptoms are apparent when comparing the development of your child to others their age. Other times the symptoms may come on all at once. Some signs to look for are:
Communication symptoms:
• Talks late or not at all; speaks loudly or with flat tones
• Points or uses other motions to indicate needs
• Repeats words or phrases without understanding the meaning
• May talk at length about something even if no one is listening
The Basics: Autism Facts CONTINUED
Social interaction symptoms: • Likes to be alone • Dislikes being held or touched • Does not know how to interact; poor listener
• May stare at something for a long time, ignoring the rest of the world
• Poor eye contact • Does not understand the feelings of others
Behavior symptoms:
• Likes routine; is upset by change • Does not pretend or use his or her imagination
• May have tantrums or show aggression • May become very attached • May engage in repetitive movements like rocking
• May bang his or her head or hurt self • May be sensitive to noises that others tolerate
• May have an unusual reaction to the way things smell, taste, look, feel or sound
Not everyone experiences autism in the same way. Some may have severe trouble with some things and not be as challenged by others. If you suspect that your child may have autism, trust your instincts. Take your child to a doctor and have them examined. Additionally, VCHCP has a Case Management Program specific to the needs of those with Autism. Contact the VCHCP Case Management Department for more information at (805) 981-5060 or submit a request online by visiting VCHCP’s website here: vchcp.venturacounty.gov/request-casemanagement-or-disease-management.
Autism Screening FOR ALL CHILDREN
Autism Spectrum Disorder (ASD) is the name for a group of developmental disorders. Studies show that when children with ASD are diagnosed early and receive early intervention, they have improved long-term outcomes. With this in mind, VCHCP has in place a Screening for Autism Policy that all Family Practitioners and Pediatricians caring for children age 2 and younger are to follow. Your child’s provider will administer a standardized screening and surveillance of risk factors at age 18 and 24 months. Also, your provider will perform a general observation at every well-child visit. Please understand that these screenings are to be provided for all children at age 18 and 24 months. If you have concerns about the screening or the results, contact your child’s provider.
If you have any questions about the Autism Screening Policy, please contact VCHCP Utilization Management department at (805) 981-5060.
Autism Spectrum DISORDERS
REQUEST
Members now have an opportunity to seek assistance for Autism Spectrum Disorders (ASD). VCHCP recommends all members with ASD or parents of children with ASD participate in our Autism Case Management Program.
Case Management or Disease Management
Visit vchcp.venturacounty.gov/request-case-management-ordisease-management to request Case Management or Disease Management. You will be prompted to enter member specific information. You will then submit this form to a secure email. A nurse will evaluate your request and call you within 2 business days.
If you would like to speak directly with a nurse, please call (805) 981-5060 and ask for a Case Management Nurse.
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
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VCHCP Maternal Mental Health Program and Maternal and Infant Health Program Effective January 1, 2025, your health plan (VCHCP) will cover at least one maternal mental health screening to be conducted during pregnancy, at least one additional screening to be conducted during the first six weeks after delivery (postpartum period), and additional postpartum screenings, if medically necessary according to your doctor. The maternal mental health screening is a part of the Plan’s maternal mental health program. The screenings will not require prior authorization and will not require any out-of-pocket expense (cost sharing). Effective January 1, 2025, VCHCP is implementing a maternal and infant equity program. This is also a part of the maternal mental health programs. The maternal and infant equity program was created to address health disparities and improve mother-child health outcomes by offering Doula services. The Doula, also called the birth doula or labor support companion, is a person trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, is experiencing labor, or has recently given birth. Their purpose is to help women have a safe, memorable, and empowering birthing experience. VCHCP will ensure access to Doulas by covering Doula services during the member’s pregnancy including prenatal, perinatal and post-partum stages, with a direct referral from the member’s doctor. Doula Services will be added to your VCHCP Evidence of Coverage (EOC). Your doctor will be able to find Doula providers on the VCHCP’s website under the “Find a Provider” section. You can call Member Services at (805) 981-5050 for Doula providers or additional information on Doula services. Reference: American Pregnancy Association, 2024. Having a Doula – What are the Benefits? Retrieved December 3, 2024, from americanpregnancy.org/healthy-pregnancy/labor-and-birth/having-a-doula your VCHCP Primary Care Provider to discuss Child Immunizations Contact the vaccination that is appropriate for your child.
VACCINES PREVENT DISEASE IN PEOPLE WHO OBTAIN THEM and protect those who come into contact with unvaccinated individuals. Vaccines are responsible for the control of many communicable diseases that were once widespread in this country, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, and Haemophilus influenza type b (Hib). Before vaccines, many children died from diseases that vaccines now inhibit, such as whooping cough, measles, and polio. Those same germs exist today, but babies are now protected by vaccines, so we do not see these diseases as frequently. Immunizing individual children also improves the wellbeing of our community, especially those people who are not immunized. People who are not immunized include those who are too young to be vaccinated, those who cannot be vaccinated for medical reasons (example: children with leukemia), and those who cannot make a satisfactory response to vaccination. This information about child immunizations can be found by visiting the VCHCP’s website at vchcp.venturacounty.gov/wp-content/uploads/2023/03/preventiveHealthGuidelinesCommercial.pdf#page=3
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Preventive Health Guidelines The 2025-2026 Preventive Health Guidelines is an excellent resource where members can find immunization schedules, preventive health screening information, and an adult preventive care timeline. The Preventive Health Guidelines include information from VCHCP, US Preventive Services Task Force (USPSTF), Centers for Disease Control (CDC), and the Agency for Healthcare Research and Quality (AHRQ) and are updated annually. Providers and members are given access to the Preventive Health Guidelines online at: vchcp.venturacounty.gov/preventiveHealthGuidelinesCommercial.
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
Adult Preventive Care Contact your VCHCP Primary Care Provider to make an appointment for your preventive care visit and to discuss the preventive care services that are appropriate for you.
Vaccinations for Adults - You’re NEVER too old to get vaccinated! Getting vaccinated is a lifelong, life-protecting job. Don’t leave your healthcare provider’s office without making sure you’ve had all the vaccinations you need. You may also see this information about Adult Preventive Health Visits/Care and a detailed list of vaccinations for adults in the Plan’s Preventive Health Guidelines brochure. To view the brochure, please visit the VCHCP website at: vchcp.venturacounty.gov/wp-content/uploads/2023/03/ preventiveHealthGuidelinesCommercial.pdf#page=6
VCHCP Member Behavioral Health and Substance Abuse RESOURCES Member Website and Provider Directory: LiveandWorkWell.com Optum Intake and Care Management For Intake and Referrals: (800) 851-7407 Optum covers all Substance-Use-Disorder services identified in the American Society of Addictions Medicine (ASAM) criteria, and as of January 1, 2021, this includes ASAM levels 3.1 and 3.2 WM services.
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
Substance Use Disorder Helpline: 1-855-780-5955 A 24/7 helpline for VCHCP Providers and Patients
If you have paid for these services out of pocket, you can submit claims for retrospective review to the following address:
Optum Claims Processing P.O. Box 30755 Salt Lake City, UT 84130-0755
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GENDER AFFIRMING PROCEDURES AND SERVICES Members should have access to affordable, high-quality health care, regardless of race, color, national origin, sex, gender identity, sexual orientation, age, or disability. Health plan benefits for transgender services are part of our commitment to the transgender community. Ventura County Health Care Plan (VCHCP) adheres to the guidelines of the World Professional Association for Transgender Health (WPATH) for gender-affirming care benefits. VCHCP does not limit sex-specific recommended preventive services based on your gender identity or recorded gender. To access the Nonprofit Professional Society, Standards of Care developed by the World Professional Association for Transgender Health (WPATH) through VCHCP, please visit: vchcp.venturacounty.gov/GenderAffirmingProcedures. To access the Standards of Care developed by the World of Professional Association for Transgender Health (WPATH), please visit the website at wpath.org/publications/soc8/. To access Optum Health’s Behavioral Health Clinical Criteria, please visit the website at: public.providerexpress.com/content/ope-provexpr/us/en/clinical-resources/guidelines-policies.html. Adopted Behavioral Health Clinical Criteria: • American Society of Addiction Medicine (ASAM) Criteria®, Fourth Edition • Level of Care Utilization System (LOCUS)
• Child and Adolescent Service Intensity Instrument (CASII) • Early Childhood Service Intensity Instrument (ECSII)
If you have questions, concerns, or would like a copy mailed to you at no cost, please contact Ventura County Health Care Plan at (805) 981-5050 or (800) 600-8247.
WHY GENDER INCLUSIVE, SENSITIVE LANGUAGE IS IMPORTANT Communication is crucial as it brings awareness, enables change, and promote transparency and accountability. Language and images powerfully reflect and influence attitudes, behaviors, and perceptions – they shape people’s reality. Gender inclusive and sensitive language is important because it minimize stereotypes, promote equality by avoiding language that favors one sex over another, and creates a more inclusive environment where everyone feels respected and acknowledged, contributing to positive social change and reducing gender bias in communication. VCHCP has a Provider toolkit on the website that providers can utilize when formulating written materials for members, ensuring that the written material are compliant with the National Culturally and Linguistically Appropriate Service (CLAS) Standards and Section 1557 of the Affordable Care Act (ACA). The toolkit may be found at vchcp.venturacounty.gov/Guidelines_for_Gender_Inclusive_Sensitive_Language.
NEWLY ACCREDITED - NCQA For 2026, we are proud to share that the Ventura County Health Care Plan has earned accreditation from the National Committee for Quality Assurance (NCQA), a nationally recognized organization that evaluates health plans based on rigorous standards for quality, access to care, and member satisfaction. What does this mean? NCQA accreditation confirms that our plan meets high standards for: • Coordinating care and supporting your health care needs • Providing safe, evidence-based services • Offering clear information and responsive member support Most importantly, it reflects our dedication to supporting your health care with timely, high-quality care you can trust. What hasn’t changed: Your benefits, coverage, providers, and how you access care all remain the same. No action is required from you. We are honored to serve you and will continue working every day to improve your health care experience. 32
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Accessing
Services
ANTI-DEPRESSANT
Medication Behavioral for Health Management M
Contact OptumHealth Behavioral Solutions of California “Life Strategies” Program at (800) 851-7407 or visit the website at Liveandworkwell.com/content/en/public.html.
Contact VCHCP Member Services at (805) 981-5050 to request an EOC copy or go to the Plan’s website at vchcp.venturacounty.gov/2025-EOC-Commercial. Optum contact information can also be found at the back of your VCHCP health insurance card. Information on authorization of Plan Mental Health and Substance abuse benefits is available by calling the Plan’s Behavioral Health Administrator (BHA) at (800) 851-7407. A Care Advocate is available twenty-four (24) hours a day, seven (7) days a week to assist you in accessing your behavioral healthcare needs. For nonemergency requests, either you or your Primary Care Provider may contact Life Strategies for the required authorization of benefits prior to seeking mental health and substance abuse care.
Further information may also be obtained by consulting your Ventura County Health Care Plan Commercial Members Combined Evidence of Coverage (EOC) Booklet and Disclosure Form.
embers who are diagnosed with depression and prescribed medication should work closely with their physician to ensure proper treatment. To achieve maximum results from anti-depressant medication, it is important to remain on the medication consistently for at least 6 months, or for the duration prescribed by your physician. VCHCP contracts with Express Scripts for prescription medications. If you have any questions about the services you may need, please contact your physician. In addition, for Behavioral Health services that you may need, please contact OptumHealth Behavioral Solutions of California “Life Strategies” Program at (800) 851-7407 or visit the website at liveandworkwell.com/content/en/public.html.
If you are seeing a primary care physician (PCP), be sure that your PCP is collaborating care with any of your other providers, especially your mental health specialist. Communication is the key for your overall health care. For more information, please visit the VCHCP website at vchcp.venturacounty.gov/ClinicianBrochure.
Depression is a chronic disease that requires long-term management, typically with medication.
DEPRESSION EDUCATION MATERIALS AVAILABLE Depression is a common mental illness that can be very limiting. When members are well informed and seek treatment, they can successfully work through life problems, identify coping skills, and retain a sense of control. VCHCP has created a brochure of depression information and resources available to members. This valuable resource is available on the VCHCP website at vchcp.venturacounty.gov/ClinicianBrochure. If you do not have access to the website or would like further information, please call (805) 981-5060 and ask to speak with a Disease Management Nurse. Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
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WHAT IS MDD? FAR MORE THAN JUST FEELING SAD Major depressive disorder (MDD), also known as major depression, unipolar depression, or clinical depression, is a common, serious, and treatable mental health condition. It is more than feeling sad or going through a rough patch and can cause severe symptoms that change the way a person thinks, feels, and acts. It has been estimated that 21 million adults (8.4% of the population) in the U.S. had depression in 2020. The word “depression” can be used to mean low mood seen in a wide range of different situations and health conditions. We will use “depression” here in this activity to refer to MDD. Depression is different for everyone. It can be a feeling of sadness that does not go away. People can stop wanting to do things they used to enjoy. Depression can involve changes in mood or behavior such as increased anger or irritability, becoming withdrawn, negative, or isolated, engaging in more high-risk activities, increasing use of alcohol or other drugs, problems with sexual desire or performance. For some, symptoms appear as physical problems like aches, pains, stomach upset, or chest tightening. Depression can affect many parts of daily life—work or study, relationships, and home life. Left untreated, depression can last months or years and can be devastating for people who have it and those who care for them. With early detection, diagnosis, and treatment, many people will get better. Sometimes people feel that they should be able to solve their own problems, or that nothing will help. Depression can make people think this way. If you are concerned that you or someone you care about might have depression, talk to a trusted healthcare professional, or reach out to a friend or family member, or a support group or helpline.
Why Are Follow-Up Visits Important? MONITOR YOUR PROGRESS Going to your follow-up visits is important in order to monitor your depression symptoms, make sure you are safe, and track your progress towards your treatment goals!
DISCUSS CONCERNS At each visit, you can talk to your care team about your concerns regarding your treatments and any side effects that are causing you problems. You can discuss how to address these problems and get answers to any questions that you have. SHARE INFORMATION You should also tell your care team about any care you are receiving from other providers, including specialists who may be treating other conditions.
Studies have shown that patient outcomes improve when primary care providers, case managers, and mental health specialists collaborate to screen for depression, monitor symptoms, provide treatment, and refer patients to specialty care as necessary. For additional educational materials, Optum Live and Work Well site, has related articles on Depression. Please check the following link: liveandworkwell.com/en/public/prevention/depression/overview Source: The Basics of MDD. 2024. Retrieved 10/24/24, from MDD.CARE, mdd.care/patient/the-basics-of-mdd/what-is-mdd-far-more-than-just-feeling-sad Why are Follow-Up Visits Important? Retrieved 10/24/24, from MDD.CARE,
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How
TEAMWORK Can Help You Y
our brain is part of the rest of your body. If you
are seeing a mental health specialist and your mental health specialist and medical doctor (Primary Care Physician or PCP) talk, you get better treatment. The way to make this possible is to sign a Confidential Exchange of Information Form and Authorization for Release of Information Form for each one of your providers. If you are seeing a mental health specialist, inform them how to contact your PCP and other healthcare providers. Also your PCP will want to know that you are seeing a mental health specialist.
Some reasons why working together is important: • You may be getting medicines from your psychiatrist as well as your PCP. • Some medicines do not work well together. • Your doctors need to know all the medicines, including non-prescription medicines you are taking. • Medical problems can cause mental health problems. • Mental health problems can cause medical problems. You can find the OptumHealth Behavioral Solutions of California Confidential Exchange of Information Form and Release of Information Form on liveandworkwell.com and also available at vchcp.venturacounty.gov/resources-and-forms. The information your healthcare providers share is private to the fullest extent permitted by law. Your PCP may decide to use their own Release of Information form. If so, make sure it includes the ability to exchange mental health information. List the names of all your healthcare providers. Share this list with each person you listed and ask them to work together. If you are seeing a PCP, be sure that your PCP is collaborating care with any of your other treating providers including a mental health specialist. Communication is the key for your overall health care. Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
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OPTUM Mental Health Emergency? Call 988
Mental health emergency?
Call 988. Life can be challenging. If you or someone you care about is struggling, know that help is available 24 hours a day. Call or text 988 if you have:1 • Thoughts of suicide • A mental health crisis • A substance use crisis The 988 Suicide & Crisis Lifeline connects you to caring support from a trained crisis counselor. There is hope. Call or text 988 today.
Every 11 minutes someone in the U.S. dies by suicide.2
1 of 5 high school students in the U.S. have seriously considered suicide.3
More than 50% of people in the U.S. will be diagnosed with mental illness during their lifetime.4
Prefer to chat? Visit 988lifeline.org.
1. Substance Abuse and Mental Health Services Administration. 988 key messages. samhsa.gov/find-help/988/key-messages. Last updated April 22, 2022. Accessed May 5, 2022. 2. Centers for Disease Control and Prevention (CDC). Facts about suicide. cdc.gov/suicide/facts/index.html. Last reviewed April 6, 2022. Accessed May 5, 2022. 3. Ivey-Stephenson AZ, Demissie Z, Crosby AE, et al. Suicidal ideation and behaviors among high school students — youth risk behavior survey, United States, 2019. cdc.gov/mmwr/ volumes/69/su/su6901a6.htm?s_cid=su6901a6_w. MMWR Suppl. 2020;69(1):47–55. Last reviewed August 20, 2020. Accessed May 5, 2022. 4. CDC. About mental health. cdc.gov/mentalhealth/learn/index.htm. Last reviewed June 28, 2021. Accessed May 5, 2022.
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Frequently asked questions about 988 What is 988? Dialing 988 connects you to the 988 Suicide & Crisis Lifeline. It’s available 24/7, and interpretation services are available in 150 languages. 1-800-273-TALK (8255) is still another way to reach the Lifeline. When should I call 988? Do I have to be suicidal to call? You can call 988 anytime you or a loved one is experiencing a mental health crisis. A crisis can look very different for everyone, so whatever feels like a mental health crisis to you is the right reason to call. Common reasons to call include having thoughts of suicide, feeling depressed or anxious, feeling overwhelmed or agitated, feeling like you cannot cope with the stress in your life, or needing advice on how to help a family member. Some callers need help with substance use, self-harm or feelings of wanting to hurt others. Is calling 988 the same as calling 911? Not exactly. When you call 911, you speak to a 911 operator who then sends help to you and gets off the phone. When you call 988, you are connected right away with the crisis worker who will help you during that call. Think of calling 988 as more like contacting someone to help you in the moment, not just as a person who will send someone else to help you. Nearly 90% of crisis calls to the Lifeline are resolved over the phone. If you or someone else is in life-threatening danger or has already caused self-harm, please call 911 so help can be sent right away. What happens when I call 988? When you dial 988, you will hear a message saying that you have contacted the 988 Suicide & Crisis Lifeline. You will be told to press 2 for Spanish and press 1 for veterans/service members. If you don’t select either option, your call will be routed to the Lifeline center nearest to you, based on your phone’s area code. What if I don’t want to talk to someone on the phone? You can text 988 and you will be given a short survey so the crisis center can understand what you’re going through, and then you’ll be connected with a counselor. If you’re more comfortable using a chat feature, visit suicidepreventionlifeline.org/chat. Similar to texting, you’ll be given a short survey so the crisis center can understand what you’re going through. You’ll then be connected with a counselor.
If you have thoughts of hurting yourself or others — or you know someone having those thoughts — seek help right away. If you or someone you know is in immediate danger, call 911 — or go to the closest emergency room. To reach a trained crisis counselor, call the 988 Suicide & Crisis Lifeline (previously known as the National Suicide Prevention Lifeline) at 988 or 1-800-273-TALK (1-800-273-8255). You may also text 988 or chat at 988.lifeline.org. The lifeline provides 24/7 free and confidential support.* *The Lifeline provides live crisis center phone services in English and Spanish and uses Language Line Solutions to provide translation services in over 250 additional languages for people who call 988. Optum does not recommend or endorse any treatment or medications, specific or otherwise. The information provided is for educational purposes only and is not meant to provide medical advice or otherwise replace professional advice. Consult with your clinician, physician or mental health care provider for specific health care needs, treatment or medications. Certain treatments may not be included in your insurance benefits. Check your health plan regarding your coverage of services. Optum® is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions. All other brand or product names are trademarks or registered marks the property of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer. © 2022 Optum, Inc. All rights reserved. WF7297820 219453-052022
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
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Find Find your your path path to to a a happier, happier, healthier healthier you you Calm Health offers mental health guidance and compassionate Calm Health offers mental health guidance and compassionate support for a wide range of health and wellbeing goals using support for a wide range of health and wellbeing goals using programs designed to strengthen the connection between your programs designed to strengthen the connection between your body and mind. And it’s available to you at no cost through your body and mind. And it’s available to you at no cost through your behavioral health benefits. behavioral health benefits.
Self-care courses and tools Self-care courses and tools Work toward wellbeing goals like: Work toward wellbeing goals like: • Getting better sleep to start your days refreshed • Getting better sleep to start your days refreshed • Building skills to help with stress and anxiety • Building skills to help with stress and anxiety • Developing resiliency to navigate life’s uncertainties • Developing resiliency to navigate life’s uncertainties • Practicing mindfulness for improved focus, movement and clarity • Practicing mindfulness for improved focus, movement and clarity
Personalized plan Personalized plan With short screenings, you can understand where you are in your With short screenings, you can understand where you are in your journey and get a more personalized experience. Based on your journey and get a more personalized experience. Based on your responses, you may receive recommendations for additional responses, you may receive recommendations for additional solutions and services from your health plan, such as coaching solutions and services from your health plan, such as coaching or therapy. or therapy.
Explore the benefits Explore the benefits
• Curated content tailored • Curated content tailored to you and your journey to you and your journey • Self-guided to go at your • Self-guided own pace to go at your own pace • No additional cost to you • No additional cost to you
Get started today Get started today
To register for the To register for the Calm Health app, Calm Health app, scan the QR code scan the QR code and enter your and enter your member ID, name and date member of birth. ID, name and date of birth.
Calm and Calm Health should not be used for urgent care needs. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room. If you are experiencing a non-life-threatening mental health crisis, callHealth or textshould 988. Calm Calm not intended toare diagnose or treatadepression, anxiety orcall any911 other mental physical health condition. of Calm or Calm Health is not a substitute for Calm and Calm not beand used forHealth urgentare care needs. If you experiencing medical emergency, or go to theornearest emergency room. IfThe you use are experiencing a non-life-threatening mental care bycrisis, a physician other provider. Anyare questions that you may haveorregarding the diagnosis, care of a or health condition be directed or health carea provider. health call oror text 988.health Calm care and Calm Health not intended to diagnose treat depression, anxiety or or anytreatment other mental physical healthshould condition. The usetoofyour Calmphysician or Calm Health is not substituteCalm for and Calm Health are mental wellness Participation is voluntary andmay subject the Calmthe anddiagnosis, Calm Health of use. of a health condition should be directed to your physician or health care provider. Calm and care by a physician or other healthproducts. care provider. Any questions that you havetoregarding careterms or treatment Calm Health are mental wellness products. voluntary and subject toAllthe Calm and Calm Health of use. Optum is a registered trademark of Optum,Participation Inc. in the U.S.is and other jurisdictions. other trademarks are theterms property of their respective owners. Because we are continuously improving our products and services, Optum the right to change specifications without prior notice. Optum is an Optum reserves is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions. Allequal otheropportunity trademarks employer. are the property of their respective owners. Because we are continuously improving our products and services, Optum theAll right to change specifications prior notice. © 2024 reserves Optum, Inc. rights reserved. WF15294551without 332229-112024 OHCOptum is an equal opportunity employer. © 2024 Optum, Inc. All rights reserved. WF15294551 332229-112024 OHC
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Psychosocial care is recommended as first-line treatment For children and adolescents with non-psychotic conditions
Psychosocial care before antipsychotic medication can lead to better outcomes Psychosocial care can offer better patient outcomes in pediatric patients with non-psychotic conditions, when initiated prior to or within 30 days of prescribing antipsychotic medications.1-3 Attention-deficit disorder and disruptive behaviors are examples of non-psychotic conditions.
Psychosocial care examples • • • •
Behavioral health services (e.g., individual, family, and group psychotherapy) Crisis intervention services Peer services Activity therapy (e.g., music, art, or non-recreational play therapy)
Medication side effects
The American Academy of Pediatrics (AAP) advises that providers take think carefully before prescribing antipsychotic medications because of their adverse effects, which include:1 • Metabolic syndrome2 • Elevated prolactin levels2-3 • Extrapyramidal symptoms2 • Cardiovascular changes3
Coordination of care tools and resources
Shared responsibility and coordination of care between mental health and primary care providers is essential. The following resources can help coordinate care for pediatric patients: 1. Coordination of Care: Use the Confidential Exchange of Information Form to facilitate coordination of care among behavioral health and medical providers. Be sure to ask for contact information for other treating providers. 2. Live and Work Well: Find relevant articles, behavioral health provider search, and resources for patients (guest access code: clinician) 3. Discover severe mental illness educational materials, best practice tips and screening tools: • Behavioral Health Providers: Clinical and Quality Measures Toolkit for Behavioral Providers • Primary Care Providers: Child and Adolescent Behavioral Health Toolkit Liwei, L., et. al. (2021) Collaborative Care in the Identification and Management of Psychosis in Adolescents and Young Adults. Pediatrics 147 (June). Available https://publications.aap.org/pediatrics/article/147/6/e2021051486/180278/Collaborative-Care-in-the-Identification-and?autologincheck=redirected 1
2
Pelham, W. E., et. al. (2016) Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions. Journal of Clinical Child & Adolescent Psychology 45 (February): 396–415. Available https://www.tandfonline.com/doi/full/10.1080/15374416.2015.1105138 3 Rajkumar, R. P. (2022) Antipsychotics in the management of disruptive behavior disorders in children and adolescents: An update and critical review. Biomedicines 10 (November): 2818. Available https://www.mdpi.com/2227-9059/10/11/2818 4 Shenkman, E. A., et. al. (2022) Florida Medicaid children's receipt of first-line psychosocial care prior to antipsychotic initiation. Academic Pediatrics 22 (April): S100-S107. Available https://pubmed.ncbi.nlm.nih.gov/35339236/
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
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FORMULARY WEB POSTING Ventura County Health Care Plan updates the formulary with changes on a monthly basis and re-posts monthly on VCHCP’s member and provider website. The formulary includes information on covered pharmaceuticals and pharmaceutical management procedures including co-payments, prior authorization, drug limits, generic substitution, therapeutic interchange, and step-therapy. Please refer to the Formulary Drug List by clicking this link: vchcp.venturacounty.gov/ProviderDrugList
PHARMACY UPDATES A list of additions and deletions for the Ventura County Health Care Plan’s formulary was recently approved by the Plan’s Pharmacy & Therapeutics Committee and can be found by visiting the Plan’s website at vchcp.vchcp. venturacounty.gov/Provider-Notification-Adds-and-Deletes. Additional information regarding the National Preferred Formulary is available through Express Scripts (ESI) express-scripts.com. Logging in is required. • Plan’s Drug Policies vchcp.venturacounty.gov/prior-authorization-drug-guidelines • Step Therapy vchcp.venturacounty.gov/StepTherapyCheatSheet • Drug Quantity Limit o vchcp.venturacounty.gov/DQMAdvantage o vchcp.venturacounty.gov/DQMAdvantagePlus o vchcp.venturacounty.gov/DQMLimited • Preferred Medications List vchcp.venturacounty.gov/pharmacy • National Preferred Formulary vchcp.venturacounty.gov/NationalPreferredFormulary A member or a member’s designee can request that the original step therapy exception request, formulary exception request, prior authorization request and subsequent denial of such requests be reviewed by an independent review organization, by submitting an exception via online request available in the VCHCP member website (vchcp.venturacounty.gov/request-for-pharmacy-formulary-exception) or by calling the Plan at (805) 981-5060. To access the policy and procedure for the Drug benefit Program of VCHCP, please click this link vchcp.venturacounty.gov/prescriptionmedicationbenefitprogramdescription-2
2026 National Preferred Formulary Exclusions The excluded medications are not covered by the National Preferred Formulary beginning January 1, 2026, unless otherwise noted. Please note that members filling prescriptions for one of these excluded drugs may pay the full retail price. Please discuss the alternative preferred medications with your patients and provide a new prescription for one that you feel is right for the patient. To access the list of National Preferred Formulary Exclusions, please visit our website at vchcp.venturacounty.gov/nationalpreferredformularyexclusions-3
If you have any questions or need to reach an Express Scripts Representative, please call (800) 811-0293. The Ventura County Health Care Plan provides pharmacy coverage through Express Scripts. Members have the ability to create an online Express Scripts profile account at express-scripts.com or you may also access Express Scripts by visiting the Plan’s website at vchcp.venturacounty.gov/pharmacy. Members have access to the following services and information once their profile is established. • Manage Prescriptions – Refill/Renew • Determine Financial Responsibility for a Drug • View Recent Orders & Status 40
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• View Prescription History – Ability to Search by RX Number • View Health and Benefit Information
SPR I NG u M A RCH 2026 | vchcp.venturacounty.gov
• View Account Information • Find the location of an in-network Pharmacy – Ability to Search by Zip-code
HOW TO REQUEST a Step Therapy Exception, Formulary Exception and Prior Authorization Exception Submitting Exception Requests To The Preferred Drug List Members can request individual exceptions to the preferred drug list through their primary care practitioner or directly to VCHCP by phone or through the VCHCP website. To submit an exception request, you may complete the online request form available on VCHCP’s website at vchcp.venturacounty.gov/request-for-pharmacy-formulary-exception, or by contacting the Plan directly at (805) 981-5050.
VCHCP will review your exception request and will either contact you or reach out to your doctor to get more clinical information. A Prior Authorization (PA) request can be submitted by the practitioner on the member’s behalf to VCHCP for consideration. Practitioners may themselves also initiate a petition for consideration of coverage. Practitioners should include relevant clinical history, previous medications prescribed and tried, contraindications or allergies to medications and any other contributory information deemed useful. VCHCP will review the information according to the PA policy. Because the PA requests are reviewed by the Plan and not the PBM, if the medication does not meet criteria on initial review by the nurse reviewer, it is reviewed by a physician reviewer and special consideration is given to the exception request based on the information received. The physician reviewers are also available by phone to discuss an exception request with the practitioner.
Guidelines &
VCHCP Utilization Management uses Milliman Care Guidelines 29th Edition, VCHCP Medical Policies and VCHCP Prior Authorization Drug Guidelines as criteria in performing medical necessity reviews. Due to proprietary reasons, we are unable to post the Milliman Care Guidelines on our website, but a hard copy of an individual guideline can be provided as requested.
Medical Policy
A complete listing of new and updated VCHCP medical policies and prescription drug policies are posted on The Plan’s website at: vchcp.venturacounty.gov/medical-policies.
Updates
To obtain printed copies of any of our VCHCP Medical/Drug Policies or Milliman Care Guidelines, please contact Member Services at (805) 981-5050 or at (800) 600-8247.
Milliman Care
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
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EMERGENCY ROOM VS URGENT CARE HOW SHOULD I CHOOSE?
EMERGENCY ROOM VISIT
Copays and Follow Up No one likes Emergency Room (ER) visits, nor how pricey they can become.
Avoid having to pay multiple ER copays by ensuring that you see your Primary Care Provider (PCP) for any follow-up care. Just a reminder... Additional ER copays will be applied when returning for follow-up care at the ER. A sudden trip to the ER can be difficult and often times results in a change in medication or treatment. After a visit to the ER, it is very important that you make an appointment to see your PCP and specialist when applicable, as soon as possible, or within 30 days. This visit is to update your PCP on what occurred that required you to seek emergency treatment, update your medication routine, and to be referred for additional care if needed. Establishing and keeping a good relationship with your PCP is vital to your health and your PCP’s ability to provide care to you. If you find that making an appointment with your PCP or specialist after an ER visit is difficult and you can’t be seen within 30 days, or if your ER visit was due to your inability to be seen by your PCP, please notify your Ventura County Health Care Plan Member Services Department at (805) 981-5050. Your ability to access health care is important to us. 42
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Post Inpatient DISCHARGE FOLLOW-UP Admission to a hospital, either planned or unexpected, can be difficult and often results in a change in your medication or treatment plan. After discharge from the hospital, it is very important that you make an appointment to see your Primary Care Provider (PCP) and specialist when applicable, as soon as possible, or within 30 days. This visit is to update your PCP and/or specialist on what occurred that required you to be admitted to the hospital, update your medication routine, and to be referred to additional care if needed. Establishing and keeping a good relationship with your PCP is vital to your health and your PCPs ability to provide care to you. If you feel you are having medical issues related to your recent hospitalization, for continuity of care, you should contact your doctor before going to the Emergency Room or if the issues are severe, like chest pain or sudden heavy bleeding, call 911. For less severe issues, we have several Urgent Care Centers in our network. VCHCP will send all members discharged from an inpatient stay a targeted letter instructing them to follow up with the specific time frame noted. Letters will also be sent to Providers to notify of members discharge from the hospital. If you find that making an appointment with your PCP or specialist after an inpatient hospital stay is difficult and you can’t be seen within 30 days, please notify your Ventura County Health Care Plan Member Services Department at (805) 981-5050. Your ability to access health care is important to us.
Clinical Practice Guidelines VCHCP encourages its providers to practice evidence-based medicine. VCHCP has links to clinical practice guidelines available to address conditions frequently seen in patients at their practice. All clinical practice guidelines included have been reviewed and approved by the VCHCP Quality Assurance Committee.
Recommended Clinical Practice Guidelines and links for providers: • Clinical Practice Guidelines • 2 Medical Conditions: Asthma & Diabetes
• Preventive Guidelines For All Age Groups o Perinatal Care Guidelines
o Joslin Diabetic Center and Joslin Clinic
o U.S. Preventive Services Task Force (USPSTF)
o American Diabetes Associates (ADA) at diabetes.org
o Advisory Committee on Immunization Practices (ACIP)
o National Asthma Education and Prevention Program Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma • 1 Behavioral Health Conditions: Depression
• Non-profit Professional Society, Standards of Care developed by the World Professional Association for Transgender Health (WPATH) o wpath.org/publications/soc8
o American Psychiatric Association Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
You may obtain hard copies of the above-listed Clinical Practice Guidelines by calling VCHCP at (805) 981-5050 or you may access it at the Health Plan’s website by clicking this link vchcp.venturacounty.gov/medical-policies. Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
43
DECODE YOUR BENEFITS CROSSWORD – GAME #1 1
2
3
4
6 5
7
Across
Down
1. C are like annual checkups, vaccines, and screenings to help keep you healthy. Hint: There is no copayment for these covered services.
2. A phone service where registered nurses can help answer health questions 24/7. Hint: There is no cost for this service. (three words, no spaces)
3. O ur pharmacy benefit partner who helps manage prescription coverage. (two words, no spaces)
4. V CHCP contracts with them to provide Mental/Behavioral health & Substance Use services.
4. T he most you’ll pay in a year for covered services before the plan pays 100%. Hint: This includes copayments for medical, mental/behavioral health, and pharmacy services. (four words, no spaces)
6. A fixed amount you pay at the time of a doctor visit or prescription pickup.
5. Approval needed from your health plan before certain services are covered. 7. Permission from your primary care provider to see a specialist. Hint: The health care plan is not involved, as these are between you and your doctor.
Down: 2 NURSEADVICELINE, 4 OPTUM, 6 COPAYMENT
ANSWERS
Across: 1 PREVENTIVE, 3 EXPRESSSCRIPTS, 4 OUTOFPOCKETMAXIMUM, 5 AUTHORIZATION, 7 REFERRAL 44
Member Newsletter
SPR I NG u M A RCH 2026 | vchcp.venturacounty.gov
Wellness Programs Ventura County Health Care Plan provides support and information to promote our members healthy living. To assist in meeting your wellness goals, VCHCP has identified self-management tools for members use. The links below connect to tools and resources to help you live well and take care of yourself. We encourage you to take advantage of these tools to help set your health and wellness goals, then work toward them. If you have any questions, please contact Jennylyn Regacho, QA nurse at (805) 981-5391. FACTOR 1. HEALTHY WEIGHT (BMI) MAINTENANCE - MAINTAINING A HEALTHY WEIGHT Adult:
cdc.gov/bmi/adult-calculator/ Child/Teen BMI:
cdc.gov/bmi/child-teen-calculator/widget.html?CDC_AAref_Val=https://www.cdc.gov/healthyweight/bmi/calculator.html Learn more about Healthy Weight, Nutrition, and Physical Activity:
cdc.gov/healthyweight/index.html
FACTOR 2. SMOKING AND TOBACCO USE CESSATION Quiz: How Strong is Your Nicotine Addiction?
smokefree.gov/challenges-when-quitting/withdrawal/nicotine-addiction-quiz
Quitting Starts Now. Make Your Quit Plan
smokefree.gov/build-your-quit-plan
FACTOR 3. ENCOURAGING PHYSICAL ACTIVITY Exercise Activity Calculator
cancer.org/cancer/risk-prevention/diet-physical-activity/get-active/exercise-counts-calculator.html How much physical activity do adults need?
cdc.gov/physical-activity-basics/guidelines/adults.html FACTOR 4. HEALTHY EATING Nutrition and Activity Quiz
cancer.org/cancer/risk-prevention/diet-physical-activity/nutrition-activity-quiz.html Calorie Counter
cancer.org/cancer/risk-prevention/diet-physical-activity/eat-healthy/calorie-counter-calculator.html Healthy Eating for a Healthy Weight
cdc.gov/healthy-weight-growth/healthy-eating/ FACTOR 5. MANAGING STRESS
FACTOR 6. AVOIDING AT-RISK DRINKING.
Anxiety Test
Alcohol Use Screening Tool cdc.gov/alcohol/checkyourdrinking/index.html
screening.mhanational.org/screening-tools/anxiety/?ref Coping with Stress cdc.gov/mental-health/living-with/?CDC
Alcohol Use and Your Health cdc.gov/alcohol/fact-sheets/states/excessive-alcohol-use-united-states.html#theNumbers
FACTOR 7. IDENTIFYING DEPRESSIVE SYMPTOMS Depression Test
screening.mhanational.org/screening-tools/depression/?layout=mhats,actions_a Online Mental Check-up
healthymindsphilly.org/screening/
Mental Health Conditions: Depression and Anxiety
cdc.gov/tobacco/campaign/tips/diseases/depression-anxiety.html
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
45
VCHCP
NETWORK
NEW TO THE NETWORK Adam Puchalski, M.D., an Endocrinologist at Adventist Health Physicians Network located at 2950 Sycamore Dr., Ste. 300 in Simi Valley, has been added effective December 2025. Adrian Castillo, M.D., a Cardiovascular Disease specialist at Cabrillo Cardiology Medical Group in Camarillo and Oxnard, has been added effective November 2025. Ahmed Hammoodi, M.D., a Family Medicine physician at Clinicas Del Camino Real Inc., in Fillmore, has been added effective November 2025. Anand Rajan, M.D., a Gastroenterologist at Island View Gastroenterology Associates in Ventura, has been added effective October 2025. Anjani Hagan, M.D., a Family Medicine physician at Clinicas Del Camino Real Inc., in Newbury Park, has been added effective November 2025. Ashley Smith Fraser, C.P.N.P., a Pediatric Nurse Practitioner at Dermatology Medical Group in Oxnard, has been added effective November 2025. Charu Singh, M.D., a Radiation Oncologist, at Cabrillo Radiation Center in Ventura and North Oaks Radiation Oncology Center in Thousand Oaks, has been added effective October 2025. Diana Chavkin, M.D., a Reproductive Endocrinologist at Southern California Reproductive Center in Santa Barbara and Ventura, has been added effective December 2025. Jessica Flanagan, N.P., a Nurse Practitioner at West Ventura Medical Clinic (VCMC) in Ventura, has been added effective December 2025.
Nicholas Khan, M.D., a Pediatrician at Coastal Kids located at 425 Haaland Dr., Ste. 104 in Thousand Oaks, has been added effective November 2025.
Sara San Pedro, F.N.P., a Nurse Practitioner at Clinicas Del Camino Real Inc., in Ventura, has left effective September 2025.
Sara San Pedro, F.N.P., a Nurse Practitioner at Magnolia West (VCMC) in Oxnard, has been added effective November 2025.
Shyam Kolangara, M.D., an Internal Medicine physician at Clinicas Del Camino Real Inc., in Fillmore, has left effective September 2025.
Ventura Infusion Pharmacy for home infusion therapy services in Camarillo, has been added effective February 2026.
Stacey Lowen, M.D., a Pediatrician at Coastal Kids in Ventura, has left effective February 2026.
Wendy Warwar, M.D., a Pediatrician at Coastal Kids in Ventura, has been added effective January 2026. Yael Straus, M.D., a Pediatrician at Sierra Vista Family Medical Clinic (VCMC) in Simi Valley, has been added effective December 2025.
LEAVING THE NETWORK Angelo Smith, P.A.-C., a Physician Assistant at Clinicas Del Camino Real Inc., La Colonia in Oxnard, has left effective November 2025. Anya Consiglio, M.D., an Internal Medicine physician at West Ventura Medical Center (VCMC) in Ventura, has left effective December 2025. Benjamin Capper, M.D., an Internal Medicine physician at Dignity Health Medical Group Ventura County located at 3901 Las Posas Rd., Ste. 10 in Camarillo, has left effective January 2026. Derek Andrzejewski, P.A.-C., a Physician Assistant at Ventura Orthopedics Medical Group in Thousand Oaks, has left effective January 2026. Donald Kuzyk, D.P.M., a Podiatrist in Simi Valley, has retired effective November 2025.
Kristine Corpuz, N.P., a Nurse Practitioner at Genesis Healthcare Partners in Camarillo and Oxnard, has been added effective November 2025.
Ishita Patel, M.D., a Pediatrician at Clinicas Del Camino Real Inc., in Ventura, has left effective December 2025.
Melody Adesuyan, M.D., a Family Medicine physician at Clinicas Del Camino Real Inc., in Ventura, has been added effective December 2025.
Kevin Major, M.D., a Vascular Surgeon at Coastal Vascular Center in Camarillo, Oxnard and Simi Valley, has retired effective October 2025.
Miriam Schwartz, M.D., a Geriatric Medicine physician at Sierra Vista Family Medical Clinic (VCMC) in Simi Valley, has been added effective January 2026.
Mohamud Qadi, M.D., an Internal Medicine physician at Clinicas Del Camino Real Inc., in Fillmore and Oxnard, has left effective September 2025.
Mohamud Qadi, M.D., an Internal Medicine physician at Clinicas Del Camino Real Inc., in Fillmore and Oxnard, has been added effective November 2025. 46
For a full list of participating providers please see our website: vchcp.venturacounty.gov/ProviderSearch.php or contact Member Services at (805) 981-5050 or (800) 600-8247.
Member Newsletter
Robert Dodge, M.D., a Family Medicine physician at Dignity Health Medical Group Ventura County in Ventura, has retired effective December 2025.
SPR I NG u M A RCH 2026 | vchcp.venturacounty.gov
Stephanie Greger, M.D., a Rheumatologist at Medicine Specialty Center West (VCMC) in Ventura, and Santa Paula Hospital Clinic (VCMC) in Santa Paula, has left effective January 2026. Thuhong Truong, M.D., a Family Medicine physician at Clinicas Del Camino Real Inc., in Ventura, has left effective December 2025. Timothy Chen, M.D., a Family Medicine physician at Clinicas Del Camino Real Inc., in Simi Valley, has left effective September 2025.
CHANGES Coastal Vascular Center has added a new location in Thousand Oaks, effective November 2025. Frank Stuhr, D.P.M., in Ventura has moved to a new
location within Ventura, effective November 2025. Genesis Healthcare Partners in Oxnard has moved to a new location within Oxnard, effective August 2025. Ojai Valley Family Medicine Center has been acquired by Primary Medical Group of Ventura Inc., effective January 2026 (applies to this location only). Facility name remains the same. R&J Prosthetic Appliance Co., has moved to a new location within Ventura, effective January 2026. Second Wave Physical Therapy has added a location in Santa Paula, effective January 2026. Ventura County Hematology-Oncology Specialists in Camarillo has moved to a new location within Camarillo, effective December 2025. Ventura County Hematology-Oncology Specialists in Ventura has moved to a new location within Ventura, effective December 2025. Ventura Orthopedics Medical Group has added a location in Westlake Village, effective January 2026.
Top 10 Tips To Quit Smoking Top 10 Tips To Quit Smoking
10
QUIT COACH
TIPS TO
QUIT TOBACCO & NICOTINE
1. FIND YOUR REASON Whether it’s for your health, your family, or your wallet, find a powerful reason to get motivated. This will help you stay strong when you’re tempted. 2. SET A QUIT DATE Pick a specific date to stop. Putting it on the calendar makes your commitment real. 3. MAKE A PLAN Know your triggers (like stress, coffee, or alcohol) and plan exactly what you’ll do instead when they hit. 4. CALL FOR BACKUP You’re twice as likely to succeed with help. Call Kick It California to speak with a free Quit Coach at 1-800-300-8086 5. GET YOUR CREW ON BOARD Tell your friends and family you’re quitting. Let them know how they can support you.
Quit Now Enroll online
www.kickitca.org
KNOW IT ’S HARD TO QUIT LET ’S CHAT @kickitca
6. USE A QUITTING AID Talk to your doctor about using nicotine patches, gum, or other FDA-approved meds. They cut withdrawal symptoms and increase your chances. 7. CREATE SMOKE-FREE ZONES Make your home and car 100% smoke-free to remove temptation and help others breathe easier. 8. CHANGE YOUR MINDSET Stop seeing yourself as a smoker who is “trying not to smoke.” You are a nonsmoker now. For nonsmokers, lighting up is never an option. 9. EXECUTE ON YOUR QUIT DATE When your quit day arrives, actually stop. A plan is useless without action. 10. NEVER QUIT QUITTING Most people try several times before succeeding. If you slip up, don’t treat it as a failure. Get back on track—every attempt brings you closer to your goal.
Funded by the California Department of Public Health and First 5 California.
Please contact Member Services at (805) 981-5050 if you need assistance or hard copies.
vchcp.venturacounty.gov | SPR I NG u M A RCH 2026 Member Newsletter
47
2220 E. Gonzales Road, Suite 210-B Oxnard, CA 93036