This year we have added the option of coverage for individuals and families. We are one of only five issuers of Qualified Health Plans offered as part of Covered California, our State’s insurance marketplace. This opens the door for people who live in Santa Clara County to shop, compare, and enroll into coverage through VHP. This is an historic time in our country, where the Affordable Care Act gives individuals who have not had health insurance a way have an insurance card to present to their doctor’s offices, hospitals and pharmacies. Covered California benefits are specifically designed for individuals or small businesses. This expansion will not affect your coverage or benefits; and the medical plan you have through your employer will stay the same.
Winter 2014
Valley Health Plan will not change our core values that you are our most important asset and you come first! We are here for you! If you have any questions, please contact Member Services at 1.888.421.8444 (toll-free). Note From the CEO..............................1 VHP Advisory Board .........................2 NCQA Interim Accreditation.............2 NCQA Required Info...........................3 With Women in Mind..........................4 Diabetes Prevention & Management Program (DPMP)..................................5 Bariatric Support Group Update.......6
Pharmacy Corner.................................7 Take Steps Towards a Healthy Lifestyle..................................................8 Tips on Beating the Winter Blues......9
It’s Flu Season....................................10
Edamame and Red Rice Salad........11 Mindful Eating Class...................... 12
Table of Contents
Member Newsletter
Valley Health Plan is fast becoming the local health plan of choice for quality care in Santa Clara County. For the past 28 years, Valley Health Plan has offered health insurance to employer groups located throughout Santa Clara County.
Perspectives
NOTE FROM the CEO
VHP ADVISORY What is the VHP Advisory Board? Advisory Board members may assist Valley Health Plan (VHP) in establishing Public Policy. Public Policy means acts performed by VHP and its employees to assure the comfort, dignity, and convenience of Members who rely on VHP providers for services. The findings and recommendations of this Public Policy Committee or Advisory Board are regularly reported to VHP’s governing body. A minimum of 51% of the VHP Advisory Board must be VHP Members.
ncqa
Board Interested in Serving on the VHP Advisory Board? Valley Health Plan (VHP) is conducting brief phone interviews for VHP Members who are interested in serving on our Advisory Board. We encourage VHP Members from all of our employer groups to interview so that we ensure good representation on the Advisory Board. If you would like more information, please call Member Services at 1.888.421.8444 (toll-free), Monday through Friday, 9:00am to 5:00pm and ask to speak to Laura Eglesia, Member Services Manager, regarding the Advisory Board.
Dolly Goel, MD Stephen Harris, MD Michael Meade, MD Ginger Roehrig, MD Gary Steinke, MD 2014 Calendar Errors Please accept our apologies for the following: Passover - Sundown Apr. 14 Ramadan - Sundown June 28 Rosh Hashanah - Sundown Sept. 24 Yom Kippur - Sundown Oct. 3 Veterans Day - Nov. 11 Hanukkah - Sundown Dec. 16 Kwanzaa - Begins Dec. 26
Interim Accreditation
We are pleased to announce that on September 17, 2013, Valley Health Plan (VHP) was awarded National Committee for Quality Assurance (NCQA) Interim Accreditation. The NCQA seal is a reliable identifier of well-managed health plans who deliver high quality care and service. NCQA is an independent, non-profit organization that assesses, evaluates and reports on the quality of Health Plans. VHP’s participation in NCQA Accreditation was voluntary and demonstrates to members and the community the importance VHP places on quality care and service. Accreditation is only awarded to health plans that meet or exceed NCQA’s rigorous standards for consumer protection and quality improvement.
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VHP Medical Advisors
NCQA evaluates how well a health plan manages quality throughout every part of its delivery system including physicians, hospitals, affiliated providers, and administrative services. This accreditation is the most comprehensive evaluation in the nation, and is the only assessment program whose accreditation scores are based on actual results achieved on a set of clinical and consumer experience measures. This quality endeavor is a great example of how VHP continues to follow its vision of focusing on VHP members and measuring performance along with results. VHP is committed to applying this vision while continuing to improve quality and therefore meeting the needs of VHP members, providers and staff.
NCQA REQUIRED Affirmative Statement about Financial Incentives Valley Health Plan (VHP) affirms that: 1. Utilization Management (UM) decision making is based only on appropriateness of care and service and existence of coverage. 2. The Plan does not specifically reward practitioners or other individuals for issuing denials of coverage. 3. Financial incentives for UM decision makers do not encourage decisions that result in under utilization. Protected Health Information Valley Health Plan (VHP) is very serious about your Protected Health Information (PHI) that staff has access to. Information is shared on a need-to-know basis only and discussions regarding PHI are not held in common areas. Staff is trained upon hire about protecting PHI and all the safeguards around oral, written, and electronic access. All written documents that contain PHI are kept locked when not in immediate use. When no longer needed, written PHI is
Info placed in locked shred bins. All electronic PHI is safeguarded with passwords particular to employees who need access to perform job functions, and these passwords must be periodically changed. VHP has firewalls and monitors access to the system to prevent inadvertent loss of PHI. Inappropriate access or use of PHI by employees may result in immediate dismissal from VHP. Member’s Rights and Responsibilities VHP believes it is important for you to be aware of your rights and responsibilities. As a member you have: 1. A right to receive information about the organization, its services, its practitioners and providers and member rights and responsibilities. 2. A right to be treated with respect and recognition of their dignity and their right to privacy. 3. A right to participate with practitioners in making decisions about their health care. 4. A right to a candid discussion
of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage. 5. A right to voice complaints or appeals about the organization or the care it provides. 6. A right to make recommendations regarding the organization’s member rights and responsibilities policy. 7. A responsibility to supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care. 8. A responsibility to follow plans and instructions for care that they have agreed to with their practitioners. 9. A responsibility to understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible. If you have any questions, please contact VHP Member Services at 1.888.421.8444 (toll-free).
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WITH WOMEN
in Mind
Valley Health Plan (VHP) has our female members in mind. VHP offers women a wide variety of benefits with quality providers. Be sure to always schedule your annual physical appointments along with preventive care appointments like pap smears and mammography. Take the first step and call your doctor today! It is important to treat yourself to some YOU time. VHP offers many classes like yoga, tai chi, 4
cardio kickboxing, and more. We also offer prenatal classes to best help prepare you for motherhood. Contact our Health Education Department at 408.885.3490 or view classes online at www.valleyhealthplan.org For VHP benefit or other questions, please contact our Member Services Department at 1.888.421.8444 (toll-free) or by email at memberservices@vhp.sccgov.org Take good care of yourself today and always!
DIABETES PREVENTION AND MANAGEMENT PROGRAM (DPMP) Valley Health Plan (VHP) partners with the Indian Health Center of Santa Clara Valley (IHC) in San Jose to offer a FREE 17–week Diabetes Prevention and Management Program (DPMP) taught by a team of exercise experts, mental health specialists, health educators, and clinicians. This program is available to VHP Commercial Members who are 18 years of age or older and are: • Pre-diabetic; or • Diabetic not taking diabetes medicine ; or • Diabetic and taking only one diabetes medicine (not insulin) Learn how to reduce the risk of getting diabetes or diabetic complications by: • Learning to cook healthy meals • Exercising , walking or using IHC fitness center before and after class • Getting one-on-one nutrition counseling, fitness planning, and lifestyle coaching A doctor’s referral is required to enroll in the program. All DPMP enrollees will receive free walking shoes, a meal at each meeting, and other incentives. The new session runs from February 4 through May 27, 2014. For more information, please contact the Health Education Department at: healtheducation@vhp.sccgov.org or call 408.885.3490. 5
BARIATRIC SUPPORT GROUP Update Valley Health Plan (VHP) members interested in bariatric surgery must attend the support group at Santa Clara Valley Medical Center (SCMVC). If you attended a support group at Good Samaritan Hospital prior to January 1, 2014, your attendance will still count towards the support group requirement to qualify for surgery. VHP Members can continue to attend the support group at Good Samaritan Hospital; however attendance will not count for the bariatric surgery requirement. SCVMC Administrative Office Building (AOB) 2325 Enborg Lane, 1st Floor Seminar Room San Jose, CA 95128 2nd Wednesday, 6:30pm - 8:30pm
Good Samaritan Hospital (GSH) 2425 Samaritan Drive San Jose, CA 95124 2nd Tuesday & 4th Thursday, 7:00pm - 9:00pm
For more information, please contact the Health Education Department at: healtheducation@vhp.sccgov.org or call 408.885.3490. 6
pHARMACY
Corner
Formulary Review & Updates VHP drug Formulary is reviewed and updated by the VHP Pharmacy and Therapeutics (P&T) Committee quarterly. For additional information about VHP P&T Committee, please refer to your Valley Health Plan Benefits and Coverage Handbook – Combined Evidence of Coverage and Disclosure Form (EOC). Occasionally, VHP will require your provider to fill out a Prior Authorization for our Formulary drugs or an Exception to Coverage form for drugs that are not on our drug Formulary. These forms will be reviewed by a pharmacist and/ or a physician and approval will be based on established criteria and Medical Necessity. VHP posts a summary of updates to the drug formulary on our website www.valleyhealthplan.org Quarterly after each VHP P&T meeting. You can view the drug Formulary on the website at any
time. If you do not have access to the Internet and would like a hard copy of the VHP drug Formulary, please call Navitus Customer Care at 1.866.333.2757 or VHP’s Member Services at 1.888.421.8444 (toll-free). Navitus Health Solutions Navitus Health Solutions is Valley Health Plan’s (VHP) Prescription Benefit Manager (PBM). Navitus Health Solutions administers the pharmacy benefit on behalf of VHP, including customer service, formulary maintenance, Prior Authorization, Exception to Coverage, and drug recall notification. Navitus Customer Care is available to answer your pharmacy benefit questions 24/7, except Thanksgiving Day and Christmas Day, at 1.866.333.2757 (toll-free). Drug Recall Navitus identifies and notifies members and prescribing practitioners affected by a Class II Recall or voluntary drug
withdrawals from the market for safety reasons within 30 calendar days of the FDA notification. For Class I Recall, the communication to the affected member and prescribing practitioner will occur within two (2) business days after Navitus receives notification via the recall posting from the FDA. If you would like additional information on a recent recall, please contact Navitus Customer Care at 1.866.333.2757 (toll-free) or visit www.navitus.org Flu Vaccine VHP offers our members the option of going to a VHP network pharmacy to receive a flu vaccine. If you would like to get your flu vaccine at a VHP network pharmacy, please go to your local VHP network pharmacy and provide the pharmacy with your VHP ID card. If you would like additional information on VHP’s network pharmacy offering flu vaccine, please contact Navitus Customer Care at 1.866.333.2757 (toll-free).
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Take Steps Toward a Healthy Lifestyle
Happy New Year! Making some simple lifestyle changes can help you keep your New Year’s resolutions. Here are a few suggestions that can help you live more healthful in 2014. Eat Healthy Visit our website www.valleyhealthplan.org to discover nutrition tips, recipes, and even videos on how to prepare and cook low-fat meals. You can also visit www.choosemyplate.gov for tips on building healthy meals-on-the-go, healthy snack choices, and tracking your meals. Be Tobacco Free Quitting tobacco is not easy, but you can do it. We offer Tobacco Cessation classes to help you start a smoke-free life. Join us and learn new quit techniques and work with us to create your own quit plan to help you be successful. For additional support, you can visit www.californiasmokershelpline.org or call the Smoker’s Helpline at 1-800-NOBUTTS. Get Active Adults should get at least 30 minutes of physical activity daily. Try parking further away, taking the stairs, or adding a physical activity break into a long meeting. Any added activity is great way to get motivated! Visit www.health.gov/paguidelines to learn more. For Valley Health Plan Members Take advantage of FREE health and fitness classes for all skill levels like: • Jazzercise • Total Body Fitness • Tai-Chi
• Yoga • Pilates
Contact VHP Health Education at 408.885.3490 or visit www.valleyhealthplan.org for information on upcoming classes.
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TIPS ON BEATING the Winter Blues It’s that time of year when the days become shorter and the nights longer. It’s cold outside and all we may want to do is stay inside. One hour of aerobic exercise outside (even when it’s cloudy) has the same therapeutic effects as 2.5 hours of light treatment indoors. This is because it raises serotonin levels, which tend to get low when you have the winter blues. Here are a few suggestions to help you fight the winter blues and keep a smile on your face, a bounce in your step, and have you looking forward to spring.
Stay Active
Eat Healthy
Improve Your Mood
- Get some exercise to help raise your serotonin levels.
- Fight the urge to load up on carbohydrates or sweets that will only make you feel more tired later.
- Volunteer or do something good for someone.
- Take Advantage of seasonal sports like skiing, ice skating, or snowboarding. - Take an indoor exercise/ fitness class. - Even less active hobbies like photography and nature walks can help.
- Eat soup; it’s good for the body and the soul! - Take a multivitamin particularly high in Vitamin D.
- Treat yourself to something you enjoy. - Take a weekend trip with friends (perhaps to a warmer climate). - Laugh often. It’s scientifically proven to boost your mood. 9
IT’S FLU Season While influenza seasons are unpredictable, the one thing we do know is that they can begin as early as October. It’s not too late to get a vaccine now. Along with getting a flu vaccine, good hygiene habits, listed below, can help protect you and your family from the flu and other respiratory infections. • Wash your hands frequently. • When coughing, cover your mouth with a sleeve or tissue. • Stay home from work or school if you are sick. For more information, visit www.cdc.gov/flu For Valley Health Plan Members There are many ways to get your FREE flu vaccine this year! • Schedule a flu vaccine appointment with your PCP. • Ask for the vaccine at your next doctor’s visit. • Walk into any Walgreens or Safeway pharmacy and show your VHP ID card. For more details and information, visit www.valleyhealthplan.org or call VHP Member Services at 1.888.421.8444 (toll-free).
t e g or
f t ’ on
D
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lF u cine y a c d a V To
Edamame and Red Rice Salad 10 servings Recipe Courtesy of Chef Michelle Sugiyama Salad Ingredients
Dressing Ingredients
1 cup long grain red rice, uncooked
2 Tbsp rice vinegar
1 cup frozen shelled edamame (soybeans)
2 Tbsp fresh lime juice
1 cup shredded carrots 3 green onions, chopped ⅓ cup fresh cilantro, chopped
2 Tbsp canola oil 2 cloves of garlic, minced
2 tsp sesame oil 1 tsp salt ½ tsp fresh ground pepper
Directions Rice: 1. Cook red rice in rice cooker, saucepan, or according to package instructions. 2. If using a saucepan, add 2 cups of water and cover. Bring to a boil and simmer for 45 minutes. Turn off heat and let it stand for at least 2030 minutes.
Dressing:
Salad:
In a mixing bowl, whisk ingredients together.
Combine the cooked rice, dressing and remaining ingredients (edamame, shredded carrots, green onions and fresh cilantro).
3. Cool rice completely before making the salad. Nutrition Facts*: Calories 87.9, Total Fat 4.5g, Saturated 0.4g, Unsaturated Fat 3.4g, Cholesterol 0mg, Sodium 297.7mg, Potassium 79.9mg, Total Carb 9.6g, Dietary Fiber 1.8g, Sugars 2.0g, Protein 2.4g *SparkPeople® recipe calculator
Michelle Sugiyama’s passion is wellness. For the past 9 years, she’s been working with employee wellness teams, schools, and families in San Jose, CA and beyond to promote good health and nutrition. She has a strong desire to educate individuals, wherever they are in their wellness journey, on simple, effective ways to live healthier, happier lives.
Please visit Chef Michelle Sugiyama’s website www.mindful-eating.com
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Valley Health Plan
2480 N. First Street, Suite 200 San Jose, CA 95131 1.888.421-8444 (toll-free) www.valleyhealthplan.org
© 2014 Valley Health Plan
MINDFUL EATING
Class
Have you ever felt guilty about what or how much you eat? Do you eat when you are stressed? When you eat while driving, watching TV or at your desk, your mind is busy with things other than on eating. Your brain can only focus on one thing at a time. You can easily miss the signs of being full and you will not stop eating until you feel uncomfortable. Mindful eating is being aware of what and how much to eat – from how your food tastes and smells to how it makes you feel. Slowing down and paying close attention to what and how you eat is a great way to keep you at a healthy weight. Here are simple tips to keep “food in mind” while eating: • Plan: Make a plan ahead of time to create healthy meals and snacks. • Breathe: Take a deep breath between bites. This will calm your mind while you eat. 12
• Focus: Turn off the television so you can pay attention to your food. • Pause: Put your fork down between bites to help you slow down and enjoy your meal. VHP, in partnership with the Public Health Department, is offering a new class in 2014 on reducing stress with a focus on healthy eating. Learn how to enjoy eating without the guilt and create a plan to have regular meals and snacks. Look for this class in early 2014 at www.valleyhealthplan.org under Health Education.