Issuu

Perspectives M E M B E R NEWS LE T TE R | 2026 - VO LUME 1

2 Stay Connected with Health Education 3 Programs for Better Health Wellness Programs for VHP Members Get Help Quitting Tobacco Virta Health: Sustainable Weight Loss 5 Understanding Your Benefits Get the Right Care at the Right Time 24/7 Nurse Line MDLIVE Telehealth Referrals & Prior Authorizations Cost Calculator Tool

8 Cancer Awareness Screenings Save Lives American Cancer Society Resources Online Cancer Risk Assessment 11 Healthy Families Supporting Moms Beyond Pregnancy Healthy Smiles Start Early Simple Tips for Managing Blood Pressure Workplace Wellness

Stay Connected VHP Connect: A Simple Way to Reach Your Health Education Team Did you know you can now connect with the Valley Health Plan (VHP) health education team online through VHP Connect?

Other ways to connect with us:

With VHP Connect, members can now send a message to:

Send us a message through www.vhpconnect.org.

• Self-refer for health education & wellness programs • Request outreach from one of our health education specialists

Call the Health Education Department at 408-970-2299.

Whether you have questions about managing a health condition, finding a health and wellness program, or learning about available health programs, our team is here to help. Getting support is simple. Log in to VHP Connect through your member portal or MyChart account and send us a secure message today. No matter where you are, we are here to support your health and wellness journey. Page 2

Complete our online referral form at www.valleyhealthplan.org/members/ contact-health-education.

Scan the QR code to access VHP Connect.

Programs for Better Health Wellness Programs Available to VHP Members Taking care of your health is easier when you have support. VHP offers a variety of health and wellness programs designed to help members live healthier lives. Our programs include support for: • • • •

Controlling high blood pressure Diabetes prevention Fitness and aquatics classes Healthy pregnancy and postpartum care

• • • •

Nutrition classes Quitting tobacco Weight Watchers* And more

Our health education team can help connect you with resources, answer questions, and support your health goals. Many programs are available at no additional cost to eligible members. Some programs, such as Weight Watchers*, are available at a discounted rate. Get started today. Contact VHP’s Health Education Department to learn more about program eligibility or visit VHP’s member website to learn more about available programs and services. Whether you’re looking to improve your health, learn healthy habits, or find support for a specific health concern, we’re here to help.

Reach us your way: Send us a message through www.vhpconnect.org. Call the Health Education Department at 408-970-2299. Complete our online referral form at www.valleyhealthplan.org/members/ contact-health-education.

Thinking About Quitting Tobacco? We’re Here to Help Quitting tobacco is one of the best things you can do for your health. No matter how long you have used tobacco, quitting can improve your heart health, lung health, and overall well-being. VHP’s Tobacco Cessation Program offers personalized support from a health education specialist who will work with you one-on-one to create a plan that fits your needs and goals.

Page 3

During the program, you’ll learn: • • • •

Strategies for managing cravings and triggers Tips for staying motivated Ways to build healthy habits that support quitting Resources that can help you succeed

Sessions are available online or in-person, making it easy to get support in a way that works for you. Services are available in English, Spanish, and Vietnamese. Additional language assistance and interpreter services are available upon request. Many people make several quit attempts before quitting for good. That is normal. Every attempt is a step toward success, and support can make a difference. Whether you are just thinking about quitting or ready to act, our Health Education Specialists are

here to support you at your pace. Small steps can lead to big changes. Support is here when you are ready. Contact VHP’s Health Education Department to learn more about the Tobacco Cessation Program or to register.

Virta Health: Sustainable Weight Loss Program Now Available! Valley Health Plan expanded our partnership with Virta Health to include a weight loss program at no additional cost to eligible Commercial and Covered California members. Members with a BMI of 30 or above or with prediabetes may qualify. Virta offers a nutrition program designed to help members understand their bodies and the foods that nourish them. Participants may experience weight loss, lower blood sugar levels, and even the potential to reverse their pre-diabetes, if they have it. With a focus on personalized care, Virta’s dedicated team will create a sustainable and enjoyable nutrition plan tailored to individual health goals. Key features of the program include: • On-demand support from an expert health coach • Exclusive access to nutrition resources and recipes • A digital weight scale and meter VHP fully covers the cost of Virta (valued at over $3,000) for members and eligible family. Virta provides free language services to people whose primary language is not English. If you need Page 4

these services, please contact Virta at 1-844-8478216 or support@virtahealth.com. Virta’s other program available for members is their Type 2 Diabetes Reversal Program, which adds support from a dedicated medical provider to help lower blood sugar levels, reduce the number of medicines you are taking, and even help potentially reverse your type 2 diabetes.

Join Virta Today Interested in exploring this valuable resource? Start the application now or scan the QR code to find out if you qualify: English: www.virtahealth.com/join/ valleyhealthplan. Español: es.virtahealth.com/join/ valleyhealthplan.

Understand Your Benefits Get the Right Care at the Right Time When the doctor’s office is closed or unavailable and someone in the household is sick or injured, you have options for receiving care.

24/7 Nurse Advice Line

MDLIVE

The 24/7 Nurse Advice Line is available at no cost to VHP members and is an excellent resource. Members can use the 24/7 Nurse Advice Line for questions about where they should seek medical care and appropriate next steps based on their symptoms.

MDLIVE is a telehealth service where members can access a board-certified doctor via secure online video, phone, or the MDLIVE App, any day, any time. MDLIVE is an alternative to expensive urgent care visits or waiting days to get an appointment with primary care doctors for nonemergency medical conditions, such as cold, flu, urinary problems such as urinary tract infections, fever, and more.

Call anytime to speak to an experienced nurse if you need quick medical advice or are unsure about whether you should wait to see your doctor, go to urgent care, or head to the emergency room. Please use the 24/7 Nurse Advice Line for your specific plan listed below: • Covered CA/IFP: 1-855-348-9119 (toll-free) • Employer Group: 1-866-682-9492 (toll-free)

MDLIVE providers can diagnose symptoms, prescribe non-narcotic medication (if needed), and send e-prescriptions to members’ VHP plan pharmacy of choice. Visit www.mdlive.com/VHP or call 1-888-4674614 to set up an account or appointment.

Page 5

Urgent Care If you need urgent care services, use the Provider Search at vhpservices.sccgov.org to find an urgent care location near you. Click on the link, choose your plan type, and select Urgent Care under the Service Type drop-down menu. If you must receive urgent care services outside of the VHP service area and it is during VHP business hours (Monday through Friday, 9 a.m. to 5 p.m.), please call Member Services at 888-421-8444 (toll-free). If it is after business hours, please call the 24/7 Nurse Advice Line. They can direct you to the closest medical facility. When seeking services, present your VHP ID card as well as another form of photo ID.

Referrals & Prior Authorizations VHP works with your primary care provider (PCP) and other providers to make sure you get the health care that you need. Your PCP helps coordinate your health care. As a VHP member, you must get your care from VHP doctors and providers. There are a few exceptions: • Emergency care • Urgent care when you are outside your local service area • Services that VHP approves ahead of time (with prior authorization) Otherwise, if you get care outside the VHP network without approval, you may have to pay the full cost yourself.

What is Prior Authorization? Some services, medicines, or procedures need approval from VHP before you receive health care. This is called prior authorization. It helps make sure your care is safe, works well, and is covered by your insurance. It is usually needed for: • Specific locations (such as a hospital or surgery center) • Some prescription drugs • Specific treatments or procedures

Page 6

Reach us your way: Send us a message through www.vhpconnect.org. Call the Case Management Department at 669-220-5235. Call the Member Services Department at 888-421-8444 (toll-free).

In case of a life-threatening situation or emergency, call 911

Getting a Referral or Prior Authorization Your provider will help you get the health care services that you need. If you need a service that requires a referral or prior authorization:

Your provider sends the referral or prior authorization request to VHP. This includes referrals to other doctors or specialists.

VHP reviews the request and makes a decision using guidelines based on your health plan.

VHP sends a letter to you and your provider stating if the request is approved or denied. • Routine requests may take up to 5 business days. • Urgent requests may take up to 72 hours.

To see which services require prior authorization, visit www.valleyhealthplan.org/vhp-prior-authorization-guidelines.

If Your Request is Denied If your request for a service is denied and you disagree, you can file an appeal. An appeal is a request for reconsideration of a denial for health care services, supplies, and products. You must file your appeal within 180 days of the denial. Call VHP Member Services toll free at 1-888-421-8444 (TTY 711) or fill out an online grievance form. • Online Grievance Form: www.valleyhealthplan.org/members/member-materials/grievances/grievance-form

Cost Calculator Tool To estimate your out-of-pocket expenses for most common services including office visits, exams, and procedures, consider using the Cost Calculator through the member portal, VHP Connect.

What You Need to Get Started 1. Log in to your VHP Connect account at www.vhpconnect.org. 2. Locate the Cost Calculator option under the menu list 3. Enter the service procedure code or description of service 4. Read and accept the disclaimer 5. Narrow results by using the filter option

If you need help or have any questions, please call Member Services at 1-888-421-8444 or send an email to memberservices@vhp.sccgov.org. Page 7

Cancer Awareness Screenings Save Lives: What You Need to Know What steps are you taking to live your healthiest lifestyle? Are you eating well, working out regularly, and avoiding tobacco? If so, you are on the right track, but you may be missing one step that is easier than you think: Getting your regular cancer screenings. Cancer screenings can help find cancer early, when treatment may work best. That is why regular preventive screenings are an important part of staying healthy. According to American Cancer Society (ACS) research, breast cancer is the most common cancer in women in the U.S., except for skin cancers, and the second leading cause of cancer death in women. Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, excluding skin cancers, and the third-leading cause of cancer related death for men and fourth for women. The good news is that there are cancer screening tests for both breast and colorectal cancer that can catch cancer early when it may be easier to treat. Talk with your doctor about screenings that may be right for you, including:

Colorectal Cancer Screening • Most adults should begin colorectal cancer screening at age 45. • Several screening options are available, including stool-based tests and colonoscopy. • Talk with your doctor about which screening option is right for you. • 7 Things to Know about Getting a Colonoscopy: www.cancer.org/content/dam/cancerorg/cancer-control/en/bookletsflyers/7-things-to-know-about-getting-acolonoscopy.pdf

Breast Cancer Screening • Starting at age 40, talk with your doctor about when to begin breast cancer screening and how often you should be screened. • Your age, personal and family health history may affect the screening schedule that is right for you. Some people may need to start screening earlier. • 7 Things to Know About Getting a Mammogram: www.cancer.org/content/dam/cancer-org/ cancer-control/en/booklets-flyers/gettinga-mammogram.pdf

Screenings Matter for Everyone Some communities experience higher rates of cancer and may face barriers to preventive care. Regular screenings can help detect cancer early, when treatment may be more effective. The ACS also recommends talking to your doctor about starting earlier if you have a family history or other risk factors. Do not wait until you feel sick. Preventive screenings are an important way to protect your health.

Talk with your doctor to learn which cancer screenings are right for you and when you should start.

More American Cancer Society Resources ACS has recently launched Cancer Risk 360. This is a free online assessment and takes just a few minutes to complete. You’ll get personalized and practical steps to help reduce your cancer risk. Take the ACS CancerRisk360 assessment at acscancerrisk360.cancer.org.

Page 8

Healthy Families Supporting Moms Beyond Pregnancy Pregnancy and the months after childbirth can bring many changes. Valley Health Plan is committed to supporting members during this important time. VHP offers resources that may include: • • • •

Maternal mental health support Education and wellness resources Connections to community services Doula services for eligible members

It is normal to experience a range of emotions during and after pregnancy. If you are feeling overwhelmed, anxious, sad, or need additional support, help is available. Doulas can also provide emotional, physical, and informational support before, during, and after childbirth. You do not have to navigate this journey alone. Our case management and health education teams

can help connect you with available resources and services that support your health and well-being.

Reach us your way: Contact VHP’s Case Management and Health Education Departments to learn more about maternal mental health resources and doula services:

Send us a message through www.vhpconnect.org. Call the Case Management Department at 669-220-5235. Call the Health Education Department at 408-970-2299 (toll-free). Page 9

Healthy Smiles Start Early Good oral health starts in childhood. Healthy habits can help protect your child’s teeth and gums for years to come. To support a healthy smile: • Brush your child’s teeth twice a day with fluoride toothpaste • Schedule regular dental checkups • Limit sugary drinks and snacks • Encourage drinking water throughout the day Children should visit a dentist by their first birthday or when their first tooth appears. Baby teeth are important because they help children eat, speak, and make room for adult teeth. Taking care of them early can help prevent cavities and other dental problems. Parents and caregivers play an important role in helping children develop healthy oral health habits. Talk with your child’s dentist or doctor if you have questions about keeping your child’s smile healthy.

Know Your Numbers: Simple Tips for Managing Blood Pressure High blood pressure often has no symptoms, which is why it is sometimes called the “silent killer.” The only way to know if your blood pressure is healthy is to check it regularly.

Blood pressure is measured using two numbers:

Top number (systolic): Pressure when your heart beats

SYS mmHg

DIA

mmHg

Bottom number (diastolic):

PULSE

/min

Pressure when your heart rests between beats START STOP

A healthy blood pressure is generally below 120/80 mmHg. Talk with your doctor about the blood pressure goal that is right for you.

Page 10

Simple Ways to Help Manage Blood Pressure • Maintain a healthy weight. Even a small amount of weight loss can help. • Eat smart. Eat more fruits, veggies, and low-fat dairy and less saturated fat. • Cut back on sodium. Aim for under 1,500 mg per day. • Move daily. Aim for at least 30 minutes of activity, like walking. • Take your medications as prescribed, even when you feel well. • Check your blood pressure regularly and know your numbers.

High blood pressure can affect anyone, but some individuals and communities may be at higher risk. Knowing your blood pressure numbers, following your treatment plan, and making healthy lifestyle choices can help lower your risk of heart disease and stroke. Small changes can make a big difference. Talk to your doctor to learn more and create a plan that supports your health goals. Valley Health Plan’s Health Education team is also here to help. Members can get support, tips, and resources to help control high blood pressure and support heart health in our Controlling High Blood Pressure Program.

Knowing your numbers is the first step toward protecting your heart health.

Page 11

Workplace Wellness Understanding Work-Related Stress Work-related stress can have a big effect on mental health. However, healthy workplace policies, personal coping skills, and supportive environments can help reduce its impact. Over time, stress can lead to anxiety, depression, burnout, sleep problems, high blood pressure, and a weakened immune system. Risk Factors Several workplace issues can increase stress: • • • •

Heavy workloads and long hours Job insecurity or unpredictable pay Poor work-life balance Bullying, harassment, or lack of support • Shift work or night schedules that disrupt sleep

Page 12

Effects on Mental Health

Personal Coping Strategies

Long-term stress can cause or worsen mental health problems such as anxiety, depression, and burnout. Burnout often includes feeling exhausted, negative about work, and less effective on the job. Stress can also affect focus, decision-making,

Workers can manage stress by:

and relationships at work and home. Strategies for Employers Employers can reduce stress by: • Offering flexible schedules • Creating safe and supportive workplaces • Training managers to recognize stress • Providing counseling and mental health resources • Encouraging breaks, vacations, and healthy work-life boundaries

• Practicing mindfulness, meditation, or deep breathing • Exercising regularly • Getting enough sleep and eating healthy foods • Spending time with supportive friends and family • Identifying stress triggers and planning ways to handle them Work can provide purpose, structure, and social connection, but it can also create stress. By improving workplace conditions and using healthy coping strategies, both employers and employees can support better mental health and reduce burnout.