amily
F Health tips
Transparency
needed for drug
prices
Page 2
Recommendations:
Doctor, urgent care
or ER?
Page 5
Penney Dupee,
Susie Krutza &
Margie Straka
Doing better
thanks to two
care managers
Page 8
Security Health Plan of Wisconsin, Inc.
PO Box 8000
Marshfield, WI 54449-8000
Nonprofit
Organization
U.S. Postage
Paid
Security Health Plan
of Wisconsin, INC.
A clear picture is needed
to address rising drug costs
The cost of many prescription drugs is rising
fast. One example is Humira. This drug is
used to treat rheumatoid arthritis (RA). Since
2013 its cost has gone up 68.7 percent. It
now costs more than $3,600 per month. And
it is not the most expensive RA medicine.
Higher costs have also hit drugs that treat
other chronic conditions such as diabetes.
Julie Brussow
Chief Executive Officer
As a BadgerCare member you don’t pay this
cost directly. But higher drug costs affect
everyone in the end.
High drug costs can lead patients to skip
doses or just not take them at all. Hospitals
and insurers have to treat problems that
occur when patients don’t take their
medicines. Patients with RA need to take
their medicines. If not treated RA can lead to
permanent disability.
Rising drug costs may cause employers to
cut benefits for their workers. Some types
of health care coverage could be too costly.
Taxpayers are also affected. They could
pay more in taxes due to higher costs for
Medicare and Medicaid.
Security Health Plan and our colleagues
in the Alliance of Community Health Plans
(ACHP) are working to combat this trend.
We work with some of the leading health
plans in the country. We share what we’ve
learned. Together we talk with law makers
in Washington, D.C. on issues that matter to
members.
Here at home we do our best to provide our
members with high-quality care and drugs
they can afford. Here are some steps we are
taking:
n
Our pharmacists regularly review and
update our drug list to ensure safe and
cost-effective treatments are available to
our members
n
We follow specific rules to assure
medications are being used according to
approved treatment guidelines
n
We educate doctors about cost-effective
treatment options and preferred
medications
These programs help manage overall drug
costs. But it is not enough.
What is needed is a clear picture of what
makes up the cost of a drug. This can help
those in health care get a better sense of
how drugs compare to other treatment
options. It will help insurers, hospitals
and doctors choose the best care for their
members and patients.
Good choices for Medicare
Will you be turning 65 soon? How about someone
you know? You’ll want to learn about Medicare.
Medicare is the government’s health care program.
It helps you stay healthy and get the care you need.
Most people are able to sign up for Medicare at age 65.
People with certain disabilities can join Medicare
before age 65.
2
Family Health Tips Spring/summer 2016
You have a 7-month window to join Medicare when you are
first eligible. You can enroll:
• During the three months before you become eligible for
Medicare
• During your birth month
• During three months that follow your first month of eligibility
In other words, you could sign up in June even if you don’t
turn 65 until September.
life and save lives, but what if not everyone can afford them?
DRUG PRICES ARE RISING AT AN
UNSUSTAINABLE AND IRRATIONAL RATE.
RA Drug Prices for 30-Day Supply, 2013–2016
$4,500
The cost of treating RA in the U.S.
will increase from $6.4 billion in
2013 to $9.3 billion by 2020.6
$4,000
4500
Track your
health at
My Security
Health Plan
$3,500
4000
The
Spike in Drug Costs: Rheumatoid Arthritis
$3,000
Advancements in pharmaceuticals can result in drugs that offer fewer side effects,
improve a patient’s quality of life and save lives, but what if not everyone can afford them?
DRUG PRICES ARE RISING AT AN
UNSUSTAINABLE AND IRRATIONAL RATE.
GENERAL STATISTICS
$2,500
$4,500
1.3 million
About 1.3 million Americans have
rheumatoid arthritis (RA)1 and
this number is forecast to reach
1.68 million by 2020.2
$2,000
3500
RA Drug Prices for 30-Day Supply, 2013–2016
The cost of treating RA in the U.S.
will increase from $6.4 billion in
2013 to $9.3 billion by 2020.6
$4,000
4500
Jan
2013
Jan
2014
Jan
2015
$3,500
RA can cause painful inflammation
and swelling of joints that is
Note: Price modifications will alter the values reflected above.
sometimes severe, and can cause
®
$3,000
3
Source:
Medi-Span
Price Rx®. Figures reflect wholesale acquisition
permanent disability.
Enbrel
$2,500
80.3%
The cost of taking RA drugs can
exceed $1 million over the course
of an individual’s lifetime.4
INCREASE
4000
68.7%
44.3%
3500
INCREASE
Jan
2014
Jan
2015
3000
Jan
2016
. Figures
T H AT W O U L D B E L I K E ISource:
N CMedi-Span
R E APrice
S RxI N
G reflect
T Hwholesale
E Pacquisition
R I Ccost.E O F…
Note: Price modifications will alter the values reflected above.
RA drugs can slow or modify
the progression of the disease,
but can be out of reach for many
people because of their cost.
®
®
Enbrel
Humira
Xeljanz
80.3%
68.7%
44.3%
INCREASE
INCREASE
2500
INCREASE
T H AT W O U L D B E L I K E I N C R E A S I N G T H E P R I C E O F…
Sixty percent of people with
inadequately treated RA are unable
to work 10 years after onset.5
A gallon of milk
from $3.31 to $5.977
2000
An iPhone 6
A 2016 Ford Focus
An iPhone
6
A 2016 Ford Focus
8
from $549 to $926
to $24,8569
from $549 to $926 from
from $17,225
$17,225 to $24,856
A gallon of milk
from $3.31 to $5.977
n
check on prior authorizations
n
take their online health assessment
n
request a call from a nurse
n
and more
cost.
Xeljanz
Jan
2013
My Security Health Plan is a new online
experience. It lets members track their
health. In one easy-to-use service
members can:
3000
Jan
2016
Humira
INCREASE
$2,000
Security Health Plan is pleased to
announce My Security Health Plan. This
is a faster and better way for members
to manage their health care.
8
9
ACHP promotes greater transparency on prescription
Source:
Alliance of Community Health Plans (ACHP)
2500
To start, go to www.securityhealth.org
and click on My Account in the upper
2000
right corner.
Do you already have an online
account? Simply use your current
username and password. Don’t have
an account or can’t remember your
password? Simply follow the easy to
enroll features included in the website.
drug research, development and pricing.
ACHP promotes greater
transparency on prescription
drug research, development and pricing.
SOURCES >>
SOURCES >>
We hold events for anyone who will soon join Medicare.
We have several plan options to help fit your budget
and health needs. At these events a sales person will be
present with information and applications. This person
can answer your questions and help you enroll.
You can learn more on our website at
www.securityhealth.org/seminar. You can sign up
for an event near you. Or you can schedule a time
to talk one on one with one of our experts.
Security Health Plan is an HMO-POS and MSA plan with
a Medicare contract. Enrollment in Security Health Plan
depends on contract renewal.
For accommodation of persons with special needs at
sales meetings call us at 1-877-998-0998 (TTY 711).
You can call us 7 days a week from 8 a.m. to 8 p.m.
spring/summer 2016 Family Health Tips
3
Doctor’s office, urgent care or emergency room?
Where should you get your health care? Your doctor’s office is the first choice. At times you
may need urgent care or the emergency room (ER). It’s important to use your best judgment.
You can also call our 24-hour Nurse Line at 1-800-549-3174 for guidance.
Here’s some advice from Security Health Plan Medical Director Dr.Sumedha Pathak:
Start with your doctor
Sumedha Pathak,
M.D.
Medical Director
When you’re hurting or sick, your personal doctor is usually the best place to start. He or
she knows your health history and any conditions you may have. A doctor’s visit won’t tie
up vital emergency medical services. The doctor may decide that the condition can be
treated in his or her office or at home. This saves your time and the hospital’s time.
If you think you need to go to the ER, it’s sometimes helpful to first call your doctor. Your doctor
can advise you as to whether the situation is an emergency. But do this only if you have the time
and can reach the doctor immediately. If not, you should call 911 or go to the nearest hospital.
When to go to urgent care
Sometimes your condition isn’t life-threatening but needs to be taken care of right away.
Urgent care may be the right choice. Urgent care is a walk-in medical facility that works well
when it isn’t an emergency and your personal doctor is not in. An urgent care center usually
can do simple lab tests and treatments.
Urgent care centers are usually open after normal business hours, such as evenings and
weekends. Many offer on-site diagnostic tests. Most of the time you’ll save time by going to
urgent care instead of the ER. Urgent care commonly treats:
• Sprained ankles
• Ear infections
• Minor burns or injuries
• Coughs, colds and sore throats
• Fevers
At times the urgent care provider might feel that the illness or injury requires a higher level
of care. He or she will transfer your care to the ER or a hospital for testing.
When to go to the ER
Emergency rooms are the best place for severe and life-threatening conditions. They’re
open 24 hours a day, 7 days a week. They have the widest range of services for emergency
after-hours care. They offer diagnostic tests and access to specialists.
Patients with the most severe problems are treated first in the ER. If your need isn’t lifethreatening, you might have to wait to get treated.
Here are warning signs of a medical emergency, according to the American College of
Emergency Room Physicians:
• Chest pain or upper abdominal pain
that lasts at least 2 minutes
• Uncontrolled bleeding
• Sudden or severe pain
• Coughing or vomiting blood
• Difficulty breathing, shortness of breath
• Sudden dizziness, weakness or change
in vision
• Severe or persistent vomiting or diarrhea
• Change in mental status such as
confusion
4
Family Health Tips Spring/summer 2016
• Difficulty speaking
• Unusual abdominal pain
• Suicidal or homicidal thoughts
• High fever, fever with rash or fever in
infants
• Allergic reactions (some are severe and
may be life-threatening)
• Broken bones
• Animal bites (these can be significant
in some cases)
Get preventive screenings for these silent threats
Many illnesses display obvious symptoms. They cause a rash, a cough, a lump or pain. But four of the most serious threats
often develop silently. Each is easily detected. If caught early there’s less chance of long-term risk.
As a Security Health Plan member your regular screenings are covered. Talk with your primary care provider. Make sure
that you stay on schedule for these vital screenings.
Security Health Plan recommends screenings for these silent threats:
Cervical Cancer – Regular screenings make this one of the easiest female cancers to prevent. In most
cases cervical cancer progresses slowly. There are few clear-cut symptoms. Women should be screened
every 3 years starting at age 21. It’s important to have a Pap test and pelvic exam regularly. These tests
can detect problems before they lead to cancer of the cervix.
n
Colorectal Cancer (Colon Cancer) – Everyone over age 50 should be screened regularly for colorectal
cancer. Start at age 45 if you are African American; research has shown that you may show signs of colon
cancer at a younger age. We recommend a colonoscopy every 10 years. Talk to your provider about other
screening methods.
n
n Breast Cancer – Experts say a woman has a 1 in 8 chance to develop breast cancer during her lifetime.
Many things can increase a woman’s risk of breast cancer. But age is the most important factor. Most
breast cancers occur in women over age 50. A mammogram is an X-ray of the breast. We encourage
women over 50 to have one every 1 to 2 years. Women ages 40-49 should ask their provider if they
should start screening earlier.
Chlamydia – Chlamydia is the most common sexually transmitted disease. It also may be the most
threatening. Infected women have very few symptoms. If untreated, it causes damage that can’t be
reversed. It can affect a woman’s ability to have children. But when detected it is easy to treat and cure.
We want sexually active women under age 24 to be screened for chlamydia. This test is a simple urine
test. Women over 21 should ask your doctor to combine it with your Pap test.
n
Visit www.securityhealth.org/preventive. Find a list by age and gender of the care you should receive to protect your health. If
you have questions or would like a paper copy, please call Security Health Plan Customer Service at 1-800-791-3044.
Don’t forget to take
your health assessment
They say “the first step is always the hardest.” Well, we’ve
made the first step toward a healthier you an easy step.
Your online health assessment is just 10 minutes and a few
mouse clicks away. Go to www.securityhealth.org and
click on My Account at the top of the page. From there, click
on Wellness Resources and the Health Assessment button.
Once you have completed your health assessment you’ll
receive a personalized wellness plan. The plan comes from
our partners at WebMD, one of the nation’s most respected
resources for online health information.
Remember to visit
providers in your
network
It’s up to you to know whether your provider
is in your network.
Not all providers are in all networks. If you
use a non-network provider you may not
be covered. If you are unsure about your
providers or have questions, please call
Customer Service at 1-800-791-3044.
spring/summer 2016 Family Health Tips
5
Our Community Benefits program
helps members and communities
Some students with learning
disorders are in a classroom
near Ladysmith. They sit at
specially designed desks. The
desks help them burn excess
energy. In turn they can focus
better on their lessons.
Jay Shrader
Director of Disease
Management and Wellness
At a senior center in Granton,
older adults attend a workshop.
They learn how to read a drug
label. This helps them know how
to take their medicines properly.
In Marathon County medical professionals make “house
calls” to farm families. They provide in-home or on-site
health care. Doing this helps farm families to get timely
health care.
Community Benefits program we joined in 86 such efforts.
We touched more than 40,000 lives.
“We work with groups that share our goals in three
strategic areas,” said Jay Shrader. Shrader is director of
disease management and wellness for Security Health
Plan. “We focus on aging health, behavioral health and
children’s health. We also help people obtain, understand
and act upon basic health information and services.”
The 2016 program will be just as dynamic, Shrader said.
It starts with our Healthy Aging Grant program. We’ll give
grants to support community classes and programs. Topics
will cover nutrition, chronic disease, behavioral health
and physical activity.
We’ll soon have news about other new programs on
behalf of our members, friends and neighbors.
It can be hard to see the early signs of mental health
crises. We supported intensive training for 20 new Mental
Health First Aid Instructors. They now teach Mental Health
First Aid in their communities.
“Our goal is to improve the health and well-being of our
members and the communities we serve,” Shrader said.
“Businesses and community groups cannot solve these
health issues alone. Working together is the key.”
These are some of the ways Security Health Plan
helps our members and our communities. In our 2015
Our Community Benefits Report can be found at:
www.securityhealthplan/communitygiving
Flambeau Elementary
School 1st grade
students sit on special
stability ball chairs that
help them burn extra
energy as they listen to
teacher Sandy Barnett.
6
Family Health Tips Spring/summer 2016
Remember to renew
your benefits
Once you are enrolled in Medicaid, BadgerCare Plus or Family
Planning Only Services, you must renew at least once each year.
The renewal is to make sure you still meet all program rules and are
getting the correct benefit.
If the renewal is not done, your benefits will end.
Family
Health tips
Family Health Tips
is published for members
of Security Health Plan.
There are many ways to renew. You can do your renewal online at
ACCESS.wi.gov. You can also renew by phone, mail or in-person.
The month before your renewal is due you will be notified by mail.
If your renewal is due in June, a letter will be sent to you
in May. This letter will tell you how you can renew.
How we improve quality
Security Health Plan strives to ensure you get high-quality health
care. We work with our doctors to keep improving our programs and
services for you. You can find out more about our quality efforts.
Visit www.securityhealth.org/quality.
Visit www.securityhealth.org to view these documents related
to your health:
• Member Handbook and Provider Directory
• Privacy notice
Information comes from
a wide range of medical
experts. Models may be
used in photos and
illustrations. If you have
any concerns or questions
about specific content that
may affect your health,
please contact your health
care provider.
How to reach us:
We will help you
get a second opinion
Security Health Plan does not require second opinions. But we know
that in some cases you may want one. You have the right to get one.
Talk to your primary care provider or call Customer Service at
1-800-791-3044 if you want a second opinion. We will help you get
one from a provider who is part of your network. In a rare instance
there may be no network provider who can give the opinion. If this
occurs we will arrange for you to see a provider who is not in our
network. This will happen at no extra cost to you.
24-hour Nurse Line (1-800-549-3174)
Do you wonder whether your condition is serious? Do you need to go
to urgent care? Can you wait to visit your health care provider? Check
with a registered nurse first.
As a Security Health Plan member you have access to our 24-hour
Nurse Line. We have a registered nurse available 24 hours a day,
7 days a week. This nurse can answer your health care questions.
Customer Service:
1-800-791-3044
(TTY: 711)
7 a.m. to 5:30 p.m., Monday - Friday
Website:
www.securityhealth.org
Email:
[email protected]
New address?
Update your information by calling
our Customer Service Department.
Copyright 2016
Security Health Plan
of Wisconsin, Inc.
HP-30255
spring/summer 2016 Family Health Tips
7
Care managers work
together to help
members
It was late last year as autumn descended into winter. Susie
Krutza felt overwhelmed by chronic health issues. She began
to sink into a depressed mood.
A Security Health Plan member, Krutza was already enrolled
in care management. She had previously talked with Nurse
Care Manager Margie Straka. One day Straka received an
unexpected phone call from Krutza. Straka could tell that
Krutza was “having problems.”
Straka visited Krutza at her home. During that visit, Straka
sensed that stress was affecting Krutza’s progress as she tried
to cope with high blood pressure. Straka suggested and Krutza
agreed to talk with Social Work Care Manager Penney Dupee.
On her way home from that visit Straka called Dupee to
express her concerns. Soon the three began working together.
Their teamwork has produced positive results for Krutza’s
physical and emotional well-being.
“At that time last fall when Margie came to my home, I was
feeling very uncomfortable. But I’m in a much better state
now,” Krutza said recently, giving the two care managers a
warm hug. “Penney guided me through some situations just
by telephone conversations. She’s such a gifted lady. I was
surprised when Margie suggested that I talk with Penney.
I didn’t know Security Health Plan had (social work care
Susie Krutza puts her arms around Social Work Care Manager
Penney Dupee (left) and Nurse Care Manager Margie Straka (right)
managers). I thought, ‘How come I’m lucky enough to have two
people care for me?’”
In fact, nurse and social work care managers often work
together to help Security Health Plan members. When Straka
talks with members, she always watches for signs of emotional
factors that might affect the member’s health. The same is
true with Dupee. When she works with a member who has
behavioral health problems, she knows these troubles may be
harming a member’s physical health.
“Awareness that one aspect of health affects the other makes
working together special,” Dupee said. “Everyone is on the
same page and working for the good of our members.”
If you want more information about care management call: 1-888-799-1599
Our workshops will help you live
well with chronic conditions
It’s not enough to deal with a chronic condition. Security Health Plan wants you to live well
with a chronic condition.
Learn how by joining a Living Well with Chronic Conditions workshop. We are offering five
of these workshops during 2016 in partnership with Aging and Disability Resource Centers
(ADRCs) in Wisconsin.
The workshops are best for anyone who has one or more chronic conditions. These include
as asthma, COPD, diabetes, heart disease, high cholesterol, high blood pressure or chronic
pain. The workshops are also good if you live with someone who has a chronic condition. Living Well workshops meet for 2½ hours a week for 6 weeks. Classes are fun and get
you involved. They help you gain confidence. You learn that you can manage your health
condition and maintain active and fulfilling lives. M
ost of the learning comes from sharing
and helping others with similar challenges.
Each participant will be able to borrow the class workbook free of charge during the class.
To register call
1-844-519-8503.
Space is limited.
Minocqua
July 11 – August 15
9 – 11:30 a.m. & 1 – 3:30 p.m.
Marshfield Clinic
Minocqua Center,
9601 Townline Road, Minocqua
Eau Claire
September 13 – October 18
9:30 – 11:30 a.m. & 1 – 3:30 p.m.
Grace Willowbrook Chuch
4868 Otteson Lane, Eau Claire
Marshfield
November 1 – December 6
9:30 a.m. – noon
Faith Fellowship Church
217 W. McMillan St., Marshfield