Volume 1 • 2017

With Focus on Your Health!

Get the Quality Care You Need Strengthen Your Bones To Prevent Fractures Quit Smoking

Member tips, tools and resources to support a healthy lifestyle Y0067_MBR_Mag2017_V1_1216 CMS Accepted 12/20/16

TXP-NTX MBRNEWSv1_17

In This Issue

Volume 1 • 2017 If you have questions about your plan, contact Member Services at the phone number printed on the back of your Member ID card. If you have suggestions for upcoming issues, contact us at MemberFeedback@ UniversalAmerican.com or write us at: Marketing Department 4888 Loop Central Drive Houston, TX 77081 Editor: Laurie Schaen Designers: Christine Akers Amy Rosenberg

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7 Tips for Effective Communication With Your Doctor

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Getting the Quality Care You Need

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Your Guide to Important Preventive Screenings, Tests and Treatments

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Maintain a Healthy Blood Pressure

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Live Healthy: Take Control of Your Health!

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Here When You Need Us

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What the CAHPS Survey Means to You

A Healthy New Year to All opinion matters “to Your us! If you receive a

CAHPS survey in the mail this spring, as you’ll read about on page 19, we hope you’ll take the time to answer questions about our plan and your experience with us. With your help, we will continue to learn and continue to improve the ways we serve you in the coming year – and, we hope, for many years to come.

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I must confess that I love this time of year, when we pause and reflect on the past before heading with renewed resolve into the future. It’s a time of purpose and promise, a time of intention and action, and the perfect time to focus on YOU. Indeed, we are focused on YOU, and we promise to go the extra mile for you this year. • When you call us, you can expect service that is friendly, helpful, professional and resourceful.

• When you have questions about your benefits or need help understanding how to use your coverage, you can expect us to answer your questions quickly with knowledge, honesty and respect.

• When you need assistance finding a doctor, hospital or other facility, you can expect us to work with you to find suitable options to meet your needs. • When you need help treating a chronic condition or transitioning back home from the hospital, you can expect us to collaborate with your doctor and provide you with extra support through our care coordination resources.

In short, we are here for YOU. That’s why this issue is focused on providing you the tools and tips you need to turn your positive intentions into healthy actions in 2017! With all good wishes for a very Healthy New Year! Erin Page President, Medicare Advantage 3

7 Tips

for Effective Communication With Your Doctor Have you ever left a doctor’s appointment with more questions than when you first arrived?

Take a Tip from Dr. Rabie! Dr. Trevor Rabie, your Medicare Advantage plan’s Chief Medical Officer, sees patients regularly. He offers this helpful reminder when visiting with your doctor: “When meeting with your doctor, it’s important to discuss ALL of your concerns at the beginning of the consultation. By stating your concerns upfront, your doctor will be better able to evaluate your health status on the whole, and determine the most appropriate course of care and treatment.”

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Your doctor wants to give you the best possible care, but may not be able to anticipate all of your concerns. When you communicate effectively with your doctor, you will be more likely to get the information you need at the time of your visit. Use the tips below to improve communication with your doctor. 1

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Prepare in Advance

Before you go to your appointment, write down any symptoms you may be experiencing. Be specific. It’s easier for a doctor to diagnose your health issue if you provide detailed descriptions. When you’re in an appointment, it may be hard to remember all of your exact symptoms.

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Take Notes

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Bring a pen and pad with you to your next appointment. It is easy to forget information after your visit, especially if you are overwhelmed with information related to your medical condition or an important healthcare decision.

Ask about Medications

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Say It in Your Own Words

Bring a Family Member or a Friend

It is a good idea to bring along a family member or close friend to your appointment. They can help you understand information being shared and even take notes for you.

Be Open

If a topic embarrasses you, it may be hard to be completely honest about your concerns. Difficult topics like impotence, incontinence, mental problems, or trouble at home may be hard to discuss. But to receive proper care, it’s important to be open and honest with your doctor. Your doctor is experienced in handling sensitive issues and will speak with you confidentially about your concerns.

2017

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When your doctor prescribes a new medication, be sure to ask important questions about the drug. You will want to know the name of the medication, how long it should be taken, any side effects, and why your doctor is prescribing it. At the end of your visit, repeat your doctor’s diagnosis in your own words and ask your doctor if your understanding is correct. This may help you avoid confusion later.

Take all of your regular medications (in their original containers) to every visit. This way, your doctor will know for sure which medications you are taking, including the dosage.

If you haven’t already scheduled your Annual Physical Exam with your doctor, be sure to do so soon.

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Getting the

Quality Care

How to Find a Doctor or Pharmacy

How to Check for Drug Information

Do you know that you can quickly obtain information about providers, pharmacies, and drugs in your plan by using our convenient online search tools? Using these tools, you can retrieve the most up-to-date and accurate information. If you aren’t yet familiar with these helpful resources, now is the time to take a closer look. To access the tools noted below, be sure to visit your plan website at the address printed on the back of your Member ID card.

“Find a Provider” Tool

“Find a Drug” Tool

Use this tool to search for Primary Care Physicians, Specialists, Hospitals, and other facilities participating in your plan. To get started, all you have to do is enter your zip code and select the type of provider you’d like to search for. If your plan includes prescription drug coverage, you can also use these helpful online search tools:

“Find a Pharmacy” Tool

Use this tool to search for pharmacies in your area and access important pharmacy information, such as a pharmacy type, address, phone number, and hours of operation. 6  |  LIVE HEALTHY WITH TEXANPLUS HMO ®

Use this tool to search for prescription drugs and to see if they are covered by your plan or if any alternatives are available. You can also use the tool to access prior authorization and exception forms for your drugs. We suggest checking our online search tools first, because they contain the most current and reliable information. But, if you would like a printed copy of our plan directories or formulary, you can request one by contacting Member Services at the telephone number printed on the back of your Member ID card. Printed directories are updated on a monthly basis.

You Need Understanding How Services are Authorized We are committed to ensuring that you receive high quality care and service. This is why we carefully and thoughtfully review the medical and pharmacy “Authorization of Service” requests that we receive from your provider on your behalf.

When assessing these requests, we evaluate whether the requested services are available and appropriate to your needs, medically necessary, and aligned with the care you receive from your provider. You may have heard this process referred to as “Coverage Decisions.” For medical requests they are known as “Organizational Determinations,” and for pharmacy requests they are known as “Coverage Determinations.”

When your provider requests a certain medical service, treatment, or prescription drug on your behalf, we move into action. Our qualified, licensed clinicians (including doctors, Registered Nurses, LVNs, and pharmacists) review the requests within the timeframes mandated by the Centers for Medicare & Medicaid Services (CMS) to ensure minimal delays or disruptions to your care or treatment. Decisions are based on the latest guidelines and coverage criteria.

Contact Us

We want you to receive the highest quality care through appropriate and effective treatment, to ensure your healthcare needs are met. If you would like more information about how these requests are reviewed, please contact Member Services at the telephone number printed on the back of your Member ID card. You can also locate this information in your 2017 Evidence of Coverage (EOC) document.

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SPECIAL SCREENING SECTION

Your Guide to Important Preventive Screenings, Tests and Treatments A Sensible Health Solution Your doctor will know if certain preventive screenings and tests are right for you. By following up accordingly, you will take positive steps toward maintaining or improving your health. And importantly, your doctor may be able to identify health problems early, when treatment is most effective.

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We created this guide to give you some helpful information about many beneficial preventive screenings, tests, and treatments. For more detailed information, it’s always best to consult with your doctor. For benefit information, contact Member Services at the telephone number printed on the back of your Member ID card.

Understand the Importance of Your Annual Physical Exam How to Prepare for Your Annual Physical Exam 1. When scheduling your appointment, ask if there is anything you should do before arriving. 2. Make a list of health concerns to discuss with your doctor. 3. Make a list of the medications you take and note any side effects or concern.

Additional Health Screenings An Annual Physical Exam is an important way to stay in control of your health. During your Annual Physical Exam, your doctor will check you from head to toe to help prevent illness and make sure you stay healthy.

During your Annual Physical Exam, your doctor may recommend having additional health screenings that may include tests for glaucoma, diabetes, or certain forms of cancer. Your doctor may also recommend having additional tests or vaccinations, such as a flu shot or pneumonia vaccine.

What to Expect During your Annual Physical Exam

If you haven’t had an Annual Physical Exam in the last 12 months, schedule your appointment today.

We know that you want you to live healthy and stay independent for as long as possible. That’s why it’s so important to schedule an Annual Physical Exam with your doctor.

Your Primary Care Physician will review your health history, including your medications, vaccinations, and family or personal health issues. During the exam, your doctor will check your vital signs, including blood pressure, heart rate, temperature, and respiration rate. Your doctor will also listen to your heart and lungs and check your abdomen. The exam typically includes an examination of your head, neck, arms, legs, and joints, and an evaluation of your reflexes, balance, and muscle strength, among other things. During the exam, your doctor may draw blood to test for certain conditions, or may order other lab work.

Schedule Your Annual Physical Exam Today!

Your Annual Physical Exam at a Glance Know what to expect when you visit your physician. Although exams may differ from doctor to doctor, your physician will likely: • • • • • • •

Check your blood pressure Listen to your heart and lungs Take your temperature Examine your abdomen Check your reflexes Look at your skin Assess your joints 9

SPECIAL SCREENING SECTION

Osteoporosis 10  |  LIVE HEALTHY WITH TEXANPLUS HMO ®

Osteoporosis: What Women Need to Know Following menopause, women are at an increased risk of developing osteoporosis, the most common bone disease. Osteoporosis weakens bones over time and can place you at a greater risk for fractures. Osteoporosis is the gradual loss of calcium, as well as structural changes, causing bones to become thinner and more fragile. Osteoporosis can occur in anyone, but it is most common in older women. Here are some facts from the National Osteoporosis Foundation:

• Of the estimated 10 million Americans with osteoporosis, about eight million are women. • Approximately one in two women over age 50 will break a bone because of osteoporosis.

• A woman’s risk of breaking a hip equals her combined risk of breast, uterine and ovarian cancer.

The reasons why more women get osteoporosis than men include:1

• Women often have smaller, thinner bones than men. • Estrogen, a hormone in women that protects bones, decreases sharply when women reach menopause.

Often there are no symptoms of bone loss. One telling sign of osteoporosis is getting a bone fracture after a minor injury. The bones most often affected are the wrist, hip and spine. Please take the steps necessary to protect your bones. Early detection of bone loss gives you a greater chance to prevent and treat osteoporosis. There are simple and noninvasive screenings to help diagnosis individuals who may be at risk.

Talk with your doctor about your risk for developing osteoporosis and ask if a screening is right for you.

Protection from Pneumonia Many adults are at risk for pneumococcal disease.2 Pneumococcal disease kills thousands of adults each year in the United States, including 18,000 adults 65 years or older, with many others who require hospitalization. Pneumococcal disease can cause severe infections of the lungs (pneumonia), bloodstream (bacteremia), and lining of the brain and spinal cord (meningitis). The best way to prevent pneumococcal disease is by getting vaccinated. Ask your doctor if this vaccine is right for you.

1 https://www.nof.org/prevention/general-facts/what-women-need-to-know/ 2 https://www.cdc.gov/features/adult-pneumococcal/ 11

SPECIAL SCREENING SECTION

Should You Be Checked for Colon Cancer? Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, according to the American Cancer Society. In addition, the organization reports that overall, the lifetime risk of developing colorectal cancer is about 1 in 21 (4.7%) for men, and 1 in 23 (4.4%) for women. Most importantly, the risk of getting colorectal cancer increases with age, as reported by the Centers for Disease Control and Prevention.

Colorectal cancer is a cancer that starts in the colon or the rectum. These cancers can also

be named “colon cancer” or “rectal cancer,” depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common. Preventive screenings can help your doctor check for signs of cancer in the colon or rectum. In fact, preventive screenings are perhaps the best way to find diseases in their early stages. There are several different screening methods available, a few of which are noted below. It’s a good idea to speak with your doctor about the risks associated with colorectal cancer, even if the topic makes you uncomfortable. If your doctor suggests getting screened, he or she can recommend an appropriate screening method, and can tell you how frequently to be re-tested. It will be important for you to follow up after having this discussion with your doctor. Colorectal cancer screenings can save lives. Don’t put off having this important discussion with your doctor.

SCREENING SCREENING Fecal FecalOccult occult Blood bloodTest test (FOBT) (FOBT) Flexible Flexible Sigmoidoscopy Sigmoidoscopy

Colonoscopy Colonoscopy

DESCRIPTION A lab test used to check stool samples for hidden (occult) blood. Occult blood in the stool may indicate colon cancer or polyps in the colon or rectum. A test in which the doctor looks for polyps of cancer located in the lower third of the colon. third of the colon. A test in which the doctor can closely inspect the inside of the entire colon and rectum. and rectum. During During the procedure, the procedure, the doctor the doctor can remove can remove any small any small polyps polyps that may be thatfound. may be If the found. doctor If the sees doctor a large sees polyp, a large a tumor, polyp,or a tumor, anything or else anything abnormal, else aabnormal, biopsy may a biopsy be done. may be done.

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An Eye on Diabetes Care

If you have diabetes, be sure to focus on your vision. Diabetes can damage small blood vessels in the back of your eyes. This condition is called diabetic retinopathy. According to the Centers for Disease Control and Prevention, keeping blood glucose levels close to normal helps prevent or delay diabetic eye disease. Even if your sight is fine, you should have a dilated eye exam once a year. An eye doctor will put drops in your eyes to widen the pupils. This dilation allows the doctor to see changes in the back of your eyes.

Treating any eye problems early can help save your sight. If you don’t already have an eye doctor, ask your Primary Care Physician for a recommendation. Or to find a provider to examine your eyes, call Member Services at the phone number printed on the back of your Member ID card.

Source: https://www.cdc.gov/diabetes/managing/problems.html

Breast Cancer Screening Mammograms Mammograms can help find breast cancer early, when treatments are more likely to be successful. In fact, it is recommended by the Centers for Disease Control and Prevention (CDC) that women who are ages 50-74 get a mammogram every two years.

What is a Mammogram?

A mammogram is an x-ray that examines breast tissue for any suspicious areas. They often show lumps before they can be felt and identify tiny clusters of calcium called micro-calcifications and cysts. Getting a mammogram early is the best defense against breast cancer, but there are also ways to reduce your risk. Here’s what you can do to reduce your risk of breast cancer:

• Maintain a healthy weight • Stay physically active • Eat fruits and vegetables • Do not smoke • Limit alcohol consumption

Ask your doctor if a breast cancer screening is right for you.

Source: http://www.cdc.gov/cancer/breast/basic_info/ prevention.htm 13

HEART HEALTH

Maintain a Healthy Blood Pressure Do you know that high blood pressure is one of the leading causes of heart attack, stroke, heart failure and kidney failure? That’s why controlling your high blood pressure can keep your arteries healthy and may be the single best thing you can do for your health. The American Heart Association recommends a blood pressure of less than 120/80 for adults without diabetes and less than 130/80 for diabetics.*

Simple steps to achieve a healthier blood pressure Monitor your pressure Measuring your blood pressure is quick and painless. In order to get an accurate result, be sure to sit quietly for a few minutes before taking the reading, and support your arm at the level of your heart during monitoring.

Take your blood pressure medication as prescribed

If you cannot afford your medications, or if you do not like the side effects of the medications, tell your doctor. Many drugs used to treat high blood pressure are available in generic formulas.

Make these healthy lifestyle changes ✔✔Achieve and maintain a healthy body weight.

✔✔Participate in some form of physical activity each day (be sure to ask your doctor if you are healthy enough to exercise).

✔✔Reduce your salt intake to 1500 milligrams a day, unless otherwise directed by your doctor. Watch out for fast foods, processed and prepackaged foods, which are often high in salt. ✔✔If you smoke, now is the time to stop. Keep reading to learn more!

By making these lifestyle changes, you can improve your blood pressure and prevent possible complications related to this silent condition. *http://www.heart.org/HEARTORG/ 14  |  LIVE HEALTHY WITH TEXANPLUS HMO ®

Quit Smoking Today! If you smoke on a regular basis, this message is for you. Do you know that every time you smoke a cigarette, you inhale more than 7,000 chemicals?1 The New Year is the perfect time to take control of your smoking habit and improve your health. Smoking increases your risk for heart attack, stroke and diabetes. If you smoke, we strongly recommend you stop. It’s never too late to quit.

Quick Tips to Quit Smoking

Some of the benefits of quitting are: 2

1) Decide when to quit and make a plan. 2) Know your reason for quitting.

3) Get support from friends and family.

Quitting is not easy. We are here to provide you with resources to help you break the habit once and for all. It’s a good idea to talk with your provider to see which option will fit best into your lifestyle. Quitting will improve your health, your finances, your self-esteem, and your everyday life.

• In 20 minutes, your body starts to heal • In 12 hours, carbon monoxide levels in your blood drop to normal • In 2 weeks to 3 months, lung function begins to improve

• In 1-9 months, coughing and shortness of breath decrease • In 1 year, your risk of heart disease, heart attack and stroke are cut in half

Take advantage of the resources and support available. Leave tobacco alone and Live Healthy! 24/7 SUPPORT To help you gather even more information about smoking, and to learn about your options for quitting, visit this helpful website hosted by Optum , our behavioral health partner: liveandworkwell.com. ®

Once you are on the homepage: • Log into the Guest Access section using the code “UAM,” or use your Member ID number.

• Reference the “Tobacco” information available in the “Health and Well-Being” section.

And to speak with one of Optum’s representatives confidentially at any time of the day or night, simply dial the phone number provided on the site.

1 http://www.lung.org/stop-smoking/smoking-facts/whats-in-a-cigarette.html?referrer=https://www.google.com/ 2 http://www.tobaccofreeco.org/quit/why-should-i-quit/benefits-of-quitting 15

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Take Control of Your Health! Take a look at all of the Live Healthy services available to you at no cost as part of your plan membership. As a reminder, some Live Healthy services are available on a seasonal basis. House Calls

Coordinating Your Care

Live Healthy Wellness Calls

House Calls offer you a great way to stay on top of your health through an easy and convenient check-up in the comfort of your home. During a scheduled visit, a licensed healthcare professional will take your blood pressure, listen to your heart and lungs, answer questions and address your concerns. Best of all, your results are shared with your Primary Care Physician, so you can follow-up with your regular doctor as needed. It's also important to know that a House Call will not replace your Annual Physical Exam with your Primary Care Physician. And, having a House Call visit will not affect your plan coverage in any way.

We provide you with personalized attention if you have a chronic disease, or if you need extra help for a short period of time. These care coordination services are one very important way in which we can help you Live Healthy.

You can also sign up for our Live Healthy Wellness Calls. Through this program, you will be reminded to schedule important annual check-ups, screenings and vaccinations. We can even help you schedule appointments with your Primary Care Physician and with your other doctors.

How to Participate?

Live Healthy Screenings

Your doctor may suggest having preventive screenings each year to ensure that your health is still at its best. Many important screenings are covered by your plan. And through our Live Healthy communications, we will remind you to check with your doctor about these preventive screenings so you can get them scheduled. We will even send you a Preventive Screenings Checklist during the year to help you stay on track.

Access to Free Flu Shots

A flu shot can help protect you against influenza. The flu brings body aches and pains, fever, and cold-like symptoms, and may prevent you from doing activities you enjoy for up to one week or more. This is why, during flu season, we will remind you about the importance of having your flu vaccination.

We will contact you by mail, e-mail, or phone when a Live Healthy service is available. To learn more about a particular service, call Member Services at the phone number printed on the back of your Member ID card. Get the most from your plan benefits by using our free and voluntary Live Healthy services.

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Here When You Need Us Need help? We’re here when you need us! When you call us, you talk to representatives who understand your plan. You can expect to have your questions answered quickly with knowledge, honesty, and respect. Our Member Services team is one of the most helpful resources available to you as a member. If you have any questions about your coverage, choosing a doctor, a bill you received, or anything else about your plan, we can help. We are committed to helping you get the most out of your plan. You can reach Member Services from 8:00 a.m. to 8:00 p.m. in your local time zone, Monday-Friday.

TexanPlus HMO:

1-800-958-2707 (TTY users call 711) 18  |  LIVE HEALTHY WITH TEXANPLUS HMO ®

Your opinion matters to us, and we want to hear from you! You may receive a CAHPS survey in the mail and we ask that you take the time to answer questions about your plan and its benefits. Your input makes a difference! The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is a joint effort of the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS). Based on responses to 70 questions, CAHPS measures members’ satisfaction with their plans and their doctors. These scores are then posted on the CMS website so consumers can see how well their plans are doing by a number of different measures — and compare their plans’ scores with competitors and national averages. The questions in the CAHPS survey cover everything from the amount of respect shown to you by your doctor to how easy it is to fill out paperwork from your health plan. The questions are designed to highlight areas that are working well, and pinpoint those that need improvement. Surveys are sent out by mail in the early spring. Members who don’t respond will be followed-up with by phone. If you receive a CAHPS survey, be sure to complete it. Your voice counts, so take this opportunity to make yourself heard.

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Health or wellness or prevention information Live Healthy provides general health information that supplements the advice of your doctor, and is not a substitute for professional health care. You should consult your Primary Care Physician or an appropriate health care professional for your specific needs. TexanPlus HMO is a Medicare Advantage plan with a Medicare contract. Enrollment in this plan depends on contract renewal. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. ®

TexanPlus HMO complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-736-7442 (TTY: 711). Chinese: 注意：如果您使用繁體中 文，您可以免費獲得語言援助服務。請致電 1-888-736-7442 (TTY: 711)。 ®