housecall your member newsletter SUMMER 2015

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welcome new board of director members

At the Annual Membership Meeting in May, three new directors were elected to serve on the GHC-SCW Board of Directors.

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making a difference in our community

GHC-SCW has joined with the HungerCare Coalition, a project of Second Harvest Foodbank of Southern Wisconsin, to bridge the gap of hunger in our community.

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healthy skin tips

Try our 5-minute self-exam and learn how to protect your skin from the summer sun.

ghcscw.com

cooperative news The latest news and updates from your Cooperative. Dr. Mark Huth Appointed GHC-SCW Interim CEO In May 2015, the Group Health Cooperative of South Central Wisconsin (GHC-SCW) Board of Directors appointed Dr. Mark Huth as interim Chief Executive Officer. This appointment followed the resignation of Kevin Hayden as the organization’s CEO. Ken Machtan, President of GHC-SCW Board announced, “Mark Huth has provided exceptional leadership throughout his career at GHC-SCW. As Chief Medical Officer, he has led significant efforts to further enhance our promise of providing ‘superb care and impeccable service’ in our health care market.” Dr. Huth joined the organization as a Family Practice physician in 2007. He was named Site Chief of the GHC-SCW Hatchery Hill Clinic in 2009 and promoted to Chief of Staff in 2011. Under his leadership as Chief Medical Officer, GHC-SCW has achieved same-day access to appointments in primary care, integrated behavioral health onto primary care teams, introduced the on-line clinical innovation virtuwell® to members and helped bridge the important collaborative work between health care delivery and insurance operations of the Cooperative. Upon his appointment Dr. Huth said, “I am humbled to serve in this leadership role. I look forward to working closely with our senior leadership team on day-to-day operations and the overall management of the Cooperative.” The Board of Directors intends to conduct a search for a new Chief Executive Officer later this year.

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GHC-SCW Board of Directors Welcomes Three New Members. At the Annual Membership Meeting on May 14th, three new directors were elected to serve on the GHC-SCW Board of Directors. Ann Hoyt A member for 30 years, Dr. Hoyt is a UW-Madison professor emeritus and consumer cooperative specialist. She has served on the UW Credit Union Board for 22 years (and as board chair 1996-2005) and is a 23-year director at the National Cooperative Business Association (chairing from 2004-2006). She is past director of the National Cooperative Bank and past chair of the UW-Madison University Committee. A nationally known expert in cooperative operations and governance, she is a 2015 inductee into the National Cooperative Hall of Fame for her work with cooperatives. She holds a Ph.D. in Family Economics from Kansas State University. Dr. Hoyt says, “I am delighted to serve our members. GHC-SCW has an outstanding record for providing quality care and cutting-edge customer service. Given rapid changes in the health care industry, our cooperative will face significant challenges and opportunities in the coming years.”

Bill Oemichen Mr. Oemichen has been a long-time member and volunteer with GHC-SCW, having chaired the Board Nominations Committee for over eight years. Professionally, he represents 440+ member-owned cooperatives as President/CEO of the Madison-based Cooperative Network. Mr. Oemichen recently chaired the Monroe Clinic Board of Directors and served on the Consumer Operated and Oriented Plans Advisory Board (CO-OP) at the U.S. Department of Health and Human Services. Mr. Oemichen currently chairs the $3.9 billion Edvest Wisconsin’s College Savings Plan Board of Trustees and served more than five years as Wisconsin’s chief consumer advocate. Mr. Oemichen remarks, “This is a dynamic time in the health care delivery and insurance industry. I am honored to serve on the GHC-SCW Board. I plan to apply my background in health care, financial, regulatory, legal and cooperative governance matters in service to our members as a new board member.”

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Judy Ziewacz Ms. Ziewacz served on the GHC-SCW Board in the 1980’s and now returns to serve again. She has worked in the policy arena at the state and federal levels since 1975, as Chief of Staff to a U.S. Congressman, Deputy Secretary at the Wisconsin Department of Agriculture, Trade and Consumer Protection and as a lobbyist for state and national cooperative trade associations. For the past four years she has served as a consultant to a national foundation on home care cooperatives and senior housing. She is on the Board of Directors of the National Cooperative Bank and Capital Impact Partners. Ms. Ziewacz is a Wisconsin native and graduate of UW-Madison. Ms. Ziewacz says, “GHC-SCW has an outstanding reputation for delivering quality care to its members. I would like to contribute my public policy and cooperative organization experience to help the GHC-SCW members maintain control of their health care.” The new directors started their terms in June. Each is elected to a three-year term.

Thank You Former Board Members The GHC-SCW Board of Directors and GHC-SCW employees wanted to thank Bret Clostermery and Pat Gadow for their service to the Cooperative over the past several years. As member-elected Board members, Mr. Clostermery and Ms. Gadow have made a real difference on behalf of members by lending their extensive expertise. Throughout their service, they continued to be innovative thinkers with deep knowledge in areas of accounting, public health, board practices and general management. We appreciate their undeniable passion and steadfast determination to create an outstanding health care Cooperative. We wish them much success in all future endeavors.

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making a difference As a non-profit Cooperative, we are proud to stand behind the causes you care about. Hunger Screening One in five children in Wisconsin regularly struggle with hunger and food insecurity. To make ends meet, parents often rely on cheap, unhealthy, watered down food sources. Most of these Wisconsin families include a working parent with annual incomes less than $20,000. Some make too much to qualify for food assistance, but not enough to cover basic household expenses. They face difficult choices between paying for food or other household basics, like rent and utilities. Research shows that hunger significantly affects a child’s physical health, emotional wellbeing, development and school performance. GHC-SCW has joined with the HungerCare Coalition, a project of Second Harvest Foodbank of Southern Wisconsin, to bridge the gap of hunger in our community. As a health care organization committed to community service and preventive medicine, we will move beyond the prescription pad to address the root cause of childhood illnesses and health disparities by identifying families at-risk of hunger. On June 2, 2015, GHC-SCW was the first health care organization in Dane County to systematically screen toddlers, children and teens for food insecurity at their well-child checkups. When a family shares their concerns about food insecurity with our health care providers, we provide information, referrals and resources through our Community Care department. Our health care providers are trained to address food insecurity concerns with the utmost respect and dignity for families as they navigate ways to support their children. Through the efforts of many, we can make a difference because we are Better Together.

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TIPS FOR HEALTHY SKIN Too much sun exposure and its harmful ultraviolet (UV) rays can cause skin cancer. You can reduce your chances of skin cancer when you protect your skin (and your family’s skin). Your best bet is to plan ahead for your day.

Protect & Prevent

It’s important to stay out of the sun during the hottest hours of the day (10 a.m. – 4 p.m.), so try scheduling outdoor activities to avoid the strongest daylight. When you do venture outside, keep these tips in mind:

Talk to Your Doctor

»» In addition to self-exams, regular skin exams are sometimes recommended every three to six months (or periods recommended by your Primary Care Provider).

»» Wide-brimmed hats can help protect your face and neck. »» Wear wraparound sunglasses that block at least 99% of UV rays. »» Dark clothes that absorb UV rays can help block out the sun. »» Long-sleeved and protective clothes can cover and shield your skin. »» Apply sunscreen with an SPF of 30 or higher. Make sure to reapply! (Even on cloudy days it will help prevent burns.) »» Skin changes usually happen in areas that get the most sun, like your head, neck, back, chest, or shoulders.

Online Resources

»» Learn more about what you can do to avoid skin caner or about skin cancer in general by visiting the American Academy of Dermatology at aad.org or visit cancer.gov for the National Cancer Institute’s website.

Try It! 5 Minute Self-Exam

Adults should examine their skin once every month to keep an eye out for potential skin irregularities. You should look for any abnormal skin growth or any change in the color, shape, size, or appearance of a skin growth. If you detect any, you should contact your Primary Care Provider.

What You’ll Need

»» A little privacy and about 5 minutes »» Full length mirror »» Smaller hand mirror »» Your body

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1. Don’t be shy! Strip down and find the nearest full-length mirror and a bright room to check your body from front to back, head to toe, and everywhere in between. 2. Arms Up! Check your sides and under your arms too. 3. Don’t forget those guns! Bend your elbows and examine the front and back of your forearms, upper arms, and palms. 4. You’ll need that hand mirror to help you see the back of your legs, neck, buttocks, and private area. 5. Finally, make sure to examine your scalp carefully by parting your hair several times in different places.

Tanning

»» Try avoiding artificial sources of UV rays, including sunlamps and tanning booths. Like the sun, they can cause skin damage and increase the risk of skin cancer.

cooperative insights We hope you get empowered with our health knowledge. Turn to this section as your source for health advice and tips. Did you know? As a member of our Cooperative, we want to provide you with the best ways to navigate the complex health care system. For the convenience of our members, nearly all Wisconsin pharmacies and most major chain pharmacies across the country are part of our network. But some pharmacies demand a higher price than others to participate in the network. We recently checked prices for several common prescriptions at four different pharmacies and found a wide range of prices for the same drugs. Other pharmacies may have different prices, but the point is clear: some pharmacies are more expensive than others. If you have a deductible or higher co-pay, you will certainly feel the pinch. Yet for many of our members who have the same co-pay no matter where you go, the higher costs do have long-term affects on you and the cooperative as a whole, in premiums. Where you shop does make a difference. If you are so inclined, join our team of smart cooperative consumers and check the prices at your pharmacies.

Wellness Reimbursement – Up to $200 for a Family or $100 for an Individual Don’t forget to take advantage of a Wellness Reimbursement from your Cooperative. We’ll give you cash back for things you already do, like going to the gym, purchasing farm produce (community supported agriculture shares), buying new athletic shoes and much more! Visit ghcscw.com and select “Be Well” for Wellness Reimbursement details.

* Prices listed are based on retail prices.

Complementary Medicine 30-minute Appointment Options If you have acute pain and need to be seen quickly or simply want a shorter appointment over the lunch hour, GHC-SCW Complementary Medicine now offers 30-minute appointments. Register and pay online for GHC-SCW Complementary Medicine services. It's easy! • For therapeutic sessions, including massage and acupuncture, use your GHCMyChartSM account to schedule and pay in advance for your appointments. • For group classes, including yoga and tai chi, whether you are a GHC-SCW member or not, you can register and pay for classes online.

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cooperative comments Information about topics related to getting care with GHC-SCW. GHC Nurse Connect – Your 24-Hour Nurse Advice Line Need medical care and not sure what to do? Call (608) 661–7350 local or (855) 661–7350 tollfree. • Have your concerns addressed over the phone by a Registered Nurse. • Get general care advice. • Determine what level of care is most appropriate for your condition (home care advice, appointment with your PCP or Urgent Care, etc.). • Learn/refer to GHC-SCW Disease Management, Case Management and Complex Case Management programs for you or your caregiver. • Save a trip to urgent care and much more!

The GHC-SCW Prescription Benefit A list of covered drugs, called a Formulary, is always available at ghcscw.com. There are several versions; 3 Tier, 4 Tier and Metal. All comprehensive Formularies contain at least three categories of drugs: Tier 1, Tier 2, and specialty. The Formularies (Tier 4 and Metal, formerly Marketplace) contain four categories of drugs. If you are unsure which formulary applies to you, contact GHC-SCW Pharmacy Administration and they will assist you. Formularies may be revised monthly to include new drugs, remove older or non-preferred drugs or change the tier a drug is assigned to. Formulary updates are provided quarterly in Housecall publications. See updates for this issue listed below. Generic substitution is encouraged and allows the lowest copayment available for a benefit plan. Lower-cost drugs (most generics) are generally assigned to Tier 1. Other preferred drugs are assigned to Tier 2. If a formulary includes some nonpreferred drugs, those are assigned to Tier 3. Specialty drugs, usually for less-common diseases and in Tier 4, are extra ordinarily expensive. These drugs are typically prescribed by specialty physicians, often require special monitoring, and may be available from a limited set of pharmacies.

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Drugs with criteria are shown on the Formulary. Quantity Limits (QL) may restrict the amount of drug dispensable. Step Therapy (ST) means certain other drugs must be tried first. Prior authorization (PA) means certain criteria must be met, and the exception request to use those drugs must be supported by information obtained from your prescriber. You can initiate a request for coverage of a drug that requires prior authorization or is not on the formulary by: 1. Login to your GHCMyChart SM account, select “Meds & Orders,” and click on “Drug Formulary.” From there click on “Ask the Pharmacy” to send a message identifying the drug desired, the medical reasons and your Primary Care Provider (PCP). We will contact your PCP for any necessary medical documentation to support the request. 2. Access the Prior Authorization Request Form on ghcscw.com and have your provider complete and submit it to: GHC-SCW Pharmacy Benefits, fax: (608) 828-4810.

Formulary Changes as of June 2015 DRUG Aerospan Amlodipine/valsartan – Tier 2 Amlodipine/valsartan/HCTZ – Tier 2 Arnuity Ellipta – Tier 1 Exforge Exforge HCT Incruse Ellipta – Tier 2 Qvar Telmisartan – Tier 2 Toujeo – Tier 2 Tudorza Vitekta – Tier 2

ACTION Removal: 7/1/2015 Addition: 6/1/2015 Addition: 6/1/2015 Addition: 7/1/2015 Removal: 6/1/2015 Removal: 6/1/2015 Addition: 7/1/2015 Removal: 7/1/2015 Addition: 6/1/2015 Addition: 6/1/2015 Removal: 7/1/2015 Addition: 6/1/2015

Provide Directory Changes as of June 2015 New Providers to GHC-SCW: Erin Trost, MD, Family Medicine, Sauk Trails Clinic Departing Providers: GHC-SCW Clinics Maciej Czechowski, MD Ward Dieter, PA-C Ivy Dowd, PA-C Jeanette Everson, MD Teresa Sizer, MD Anthony Weston, MD Joan Young, APNP

For the most up-to-date listing of all GHC-SCW network providers, please visit ghcscw.com and select “Find a Provider” at the top of the page. GHC-SCW updates our online provider directory within 30 days of learning about a provider change.

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virtuwell®

GHC Nurse Connect

Visit ghcscw.com/Virtuwell

Call (608) 661-7350 or toll-free (855) 661-7350

virtuwell® is your 24/7 online clinic for a diagnosis, treatment plan and even a prescription for common medical conditions. Get better faster.

GHC Nurse Connect is your 24-hour nurse advice line when you need general care advice over the phone. Get the information you need when you need it.

GHC-SCW URGENT CARE

Anytime you need medical care (except for emergencies), you should first call your primary care clinic for an available appointment. If you need medical care after normal primary care clinic hours, call the GHC-SCW urgent care clinic to schedule an appointment:

(608) 442–8100 675 W.Washington Ave., Madison, WI 53703 Mon – Fri, 8 a.m. – 9 p.m. & Sat – Sun, 9 a.m. – 9 p.m. We schedule urgent care appointments to better serve your same-day access needs.

PRIMARY CARE CLINICS GHC-SCW CLINICS Capitol Clinic

Sauk Trails Clinic

Mt. Horeb Clinic

(608) 257–9700 675 W. Washington Ave., Madison 53703 Wed, Fri, 8 a.m. – 5 p.m. Mon, Tues, Thurs, 8 a.m. – 7 p.m.

(608) 831–1766 8202 Excelsior Dr., Madison 53717 Mon, 8 a.m. – 7 p.m. Tues – Fri, 8 a.m. – 5 p.m.

(608) 437–3064 600 N. 8th Street, Mt. Horeb 53572 Mon – Fri, 8 a.m. – 5 p.m.

DeForest Clinic

UW HEALTH FAMILY MEDICINE CLINICS Belleville Clinic

(608) 846–4787 815 S. Main St., DeForest 53532 Mon – Fri, 8 a.m. – 4:30 p.m.

East Clinic (608) 222–9777 5249 E. Terrace Dr., Madison 53718 Mon, 8 a.m. – 7 p.m. Tues – Fri, 8 a.m. – 5 p.m.

Hatchery Hill Clinic

(608) 424–3384 1121 Bell West Blvd, Belleville 53508 Mon – Fri, 8 a.m. – 5 p.m.

Northeast Clinic Family Medical Center (608) 241–9020 3209 Dryden Dr., Madison 53704 Mon – Fri, 8 a.m. – 5:30 p.m.

UW HEALTH – STOUGHTON CLINIC Stoughton Clinic (608) 877–2660 1001 Nygaard St., Stoughton 53589 Mon – Fri, 8 a.m. – 5 p.m.

ACCESS COMMUNITY HEALTH CENTERS Joyce and Marshall Erdman Clinic (608) 443–5480 2202 S. Park St., Madison 53713 Mon – Fri, 8 a.m. – 5 p.m.

(608) 661–7200 3051 Cahill Main, Fitchburg 53711 Mon, Wed – Fri 8 a.m. – 5 p.m. Tues, 8 a.m. – 7 p.m.

Verona Clinic

Madison College Community Clinic

UW HEALTH CLINICS Cottage Grove Clinic

Wingra Family Medical Center

(608) 839–3104 4590 Hwy N, Cottage Grove 53527 Mon – Fri, 8 a.m. – 5 p.m.

(608) 263–3111 1102 S. Park St., Madison 53715 Mon – Fri, 8:00 a.m. – 5 p.m.

(608) 441–3220 Health Education Center–Truax Campus 1705 Hoffman St., Madison 53704 Mon, 7 a.m. – 7 p.m. Tue – Fri, 7 a.m. – 5 p.m.

(608) 845–9531 100 N. Nine Mound Rd., Verona 53593 Mon – Fri, 8 a.m. – 5 p.m.

William T. Evjue Clinic (608) 443–5480 3434 E. Washington Ave., Madison 53704 Mon – Fri, 8 a.m. – 5 p.m.

Cross Plains Clinic (608) 798–3344 2418 Brewery Rd., Cross Plains 53528 Mon – Fri, 8 a.m. – 5 p.m.

Housecall provides current health care and policy/procedure information to members of Group Health Cooperative of South Central Wisconsin (GHC-SCW). Comments and suggestions regarding Housecall are encouraged and may be directed to: Housecall Editor, GHC-SCW, P.O. Box 44971, Madison, WI 53744–4971. MK15–87–0(05/15)N