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Capital Health Plan Maintains Impressive Streak of Top NCQA Ratings

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CHP continues to be recognized as a national leader in quality health care

Capital Health Plan (CHP) today learned that its streak of more than a decade remains intact, as the National Committee for Quality Assurance (NCQA) once again has awarded CHP a superior distinction. Each year NCQA rates health plans across the country, and CHP has earned superior distinction since NCQA began comparing and ranking health plans in 2005. [Read more…] about Capital Health Plan Maintains Impressive Streak of Top NCQA Ratings

How to Protect Yourself from Medicare Fraud

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Every year, Medicare fraud affects consumers and companies across the nation. Estimates say that last year alone, there was over $1 billion in fraudulent Medicare billings . Not only does Medicare fraud inflate the cost of medical care for everyone, it can also compromise your private medical information, including past Medicare statements, claims, and even confidential items like your social security number. That’s why it’s important to take steps to defend yourself from a potential identity thief, especially when it comes to your medical records. 

Dr. Ryan Curran

First and foremost, protect your confidential information. When discussing your Medicare information — such as a Medicare ID number and Health Plan details — always take precautions to ensure that your personal information is protected. If an identity thief gains access to your Health Plan ID, they can access your physicians, order prescriptions, and even file a health insurance claim.

Starting in April, the Center for Medicare and Medicaid Services will issue new Medicare ID cards with a unique alphanumeric ID number rather than your social security number, but it’s still important to “guard your card” and keep it safe like you would a credit card or your social security card.

It’s also important to always keep a close eye on your account’s activity to spot anything unusual or incorrect. In addition to reviewing receipts, dates, and billing statements, make sure the details of your Medicare claims correctly match up with the services you received. You can check at MyMedicare.gov or by calling 1-800-MEDICARE.

And don’t overlook the Explanation of Benefits form sent from your insurance company. The form details how much you have been billed for a specific claim, what your insurance covers, and the deductible amount you’re ultimately responsible for. Compare the explanation of benefits to your medical provider’s receipt to detect any discrepancies that could hint toward a potential identity theft.

Some Medicare fraud has been linked to companies or individuals offering “free services or products” in exchange for your confidential information, including your Health Plan ID number. Be wary of phone calls or emails that ask for sensitive Medicare information, such as your Medicare ID, as they could be an attempt to steal your identity. Identity thieves may also call or email pretending to be a medical insurance professional in order to obtain your confidential information. If this happens, hang up or don’t reply, then immediately report it to your health insurance provider.

Medicare fraud can complicate your financial well-being, including your insurance record and credit report. It’s crucial to report any suspicious activity as soon as possible to prevent further fraudulent activity.

You can report suspected Medicare fraud to your health insurance company, to the toll-free number at 1-800-MEDICARE, or online to the Office of the Inspector General on the official Medicare website.

Learn more about the steps you should take to report Medicare fraud here.

Ryan Curran, MD is a family medicine physician with Capital Health Plan.

Understanding Diabetes

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Diabetes is a lifelong condition, so whether you have type 1 or type 2 diabetes, proper health care and a good relationship with physicians and specialists is imperative to a happy, healthy you. A diabetes diagnosis is no longer something to be afraid of, you can learn to live with the new normal and have a satisfying, healthful life.

Dr. Hayley Scott

Type 1 Diabetes: A Lack of Insulin
Insulin is a hormone that helps your body’s cells use sugar for energy and stores extra energy in muscle, fat, and liver cells. Without it, sugar can’t get into these cells, which causes your blood sugar levels to become high. High blood sugar can cause damage to the eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health complications. Type 1 diabetes occurs when your pancreas stops making insulin. It can happen at any age, but it generally starts in childhood or young adulthood. While there is no cure for type 1 diabetes, you can live a long and active life with the proper treatment.
There is a genetic factor to type 1 diabetes. Some people who have a parent or sibling with the disease are at a higher risk of developing it. Other risk factors include being Caucasian and having islet cell antibodies in the blood. Symptoms of type 1 diabetes that can be early warning signs include:

  • Being very thirsty
  • Urinating frequently
  • Unexplained weight loss
  • Being abnormally hungry at times
  • Blurred eyesight

Treatment plans include taking insulin, eating a healthy diet in which carbohydrates are spread throughout the day, checking blood sugar levels multiple times daily, and getting exercise regularly.
Type 2 Diabetes: Misused Insulin
You can get type 2 diabetes if your body doesn’t respond to insulin appropriately or if your pancreas doesn’t make enough insulin. If you are overweight, sedentary, or have a history of type 2 diabetes in your family, you are more likely to be at risk. It can be prevented or delayed if you live a healthy lifestyle. Treating type 2 diabetes includes making healthy food choices, losing weight if you’re overweight, getting regular exercise, and taking medications if necessary. You should also see your doctor regularly, test your blood sugar levels daily, keep your blood pressure and cholesterol under control, and quit smoking.
The Emotional Toll
Living with diabetes can seem insurmountable, but the good news is that it’s not! By following doctor’s orders, managing your weight, exercising, eating right, and staying on top of your blood sugar levels, you can lead a happy, healthy life regardless of your diagnosis. It’s common to feel upset, and that’s okay – just remember that you can still live your life to the fullest.
For more information about diabetes, visit Capital Health Plans’ Healthwise® Knowledgebase at capitalhealth.com.
Hayley Scott, MD, is a family medicine physician at Capital Health Plan and is fluent in American Sign Language.

What to do to fight the flu

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Dr. Steven LaRosa

It’s that time of year again. Your body aches, your throat hurts, the thermometer says you have a fever, and you can’t stop coughing. That’s right, it’s flu season. Influenza is an infection caused by a virus, and while everyone knows it’s no fun being sick, the flu doesn’t have to be the end ofthe world. Know your symptoms, get a proper diagnosis, and seek treatment – or better yet, get vaccinated.
Know Your Symptoms 
Your body will tell you when you have the flu, so listen to it. If you are suffering from any of the following symptoms, it’s possible you may have the flu:

  • Fever
  • Body aches
  • Headaches
  • Dry cough
  • Sore or dry throat
  • Fatigue
  • Loss of appetite

These symptoms tend to be at their worst for the first three or four days, although it may take a week or two to completely rid yourself of the flu.
Don’t Delay – Get Diagnosed and Treated
If you are feeling any symptoms of the flu, you should seek a diagnosis from your physician to be certain. Your doctor will give you an exam, which may include a blood test or a sample of fluid from your nose or throat, to nail down what type of flu virus you might have.
Once you have your diagnosis, you can work on a treatment plan. Many people treat their flu symptoms at home with rest, fluids, and over-the-counter medications to lower a fever. Hospitalization may be necessary for more severe cases. If you think you have the flu, get to your doctor as soon as possible. If you see your doctor within two days of initial onset, you may be able to get started on medication that will ease your symptoms. 
Prevention is Key to a Healthy You 
Why risk getting the flu when there are preventive measures in place? The U.S. Centers for Disease Control and Prevention recommends that everyone at least six months old get a flu vaccine. Getting vaccinated for the flu each year can reduce your chances of getting the virus.
Some people are at a higher risk of getting the flu than others. At especially high risk are young children, adults age 50 and older, individuals with long-term health problems or immune disorders, and pregnant women. Those who work in health care or live with a person at high risk for the flu should get vaccinated to lower their chances of catching it.
Take Charge of Your Health
If you do come down with the flu, remember to practice proper home care so your illness doesn’t progress into something more dangerous. Be sure to see your doctor as soon as you feel flu symptoms coming on. Most of all, get vaccinated whenever it becomes available. Additional information is available from the Healthwise Knowledgebase at capitalhealth.com.
Stephen LaRosa is a Family Medicine physician at Capital Health Plan.

Capital Health Plan Celebrates 35th Anniversary With Remarkable NCQA Ratings

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Capital Health Plan Celebrates 35th Anniversary With Remarkable NCQA Ratings

~ CHP continues to be recognized as a national leader in quality health care ~

TALLAHASSEE, Fla. – Capital Health Plan (CHP) celebrates its 35th anniversary this year with impressive ratings by the National Committee for Quality Assurance (NCQA). Each year, NCQA rates health plans across the country, bestowing CHP with superior distinction for more than 10 years now.

Since NCQA began comparing and ranking health plans in 2005, CHP has consistently been recognized as the top plan in Florida and amongst the highest rated plans in the nation. According to the committee’s Private Health Insurance Plan Ratings for 2017-2018, CHP’s private Commercial plan is rated 4.5 out of 5. According to its Medicare Health Insurance Plan Ratings for 2017-2018, CHP’s Medicare plan is rated 4.5 out of 5. No other health plan in the state of Florida achieved ratings this high for both their Commercial and Medicare plans. 

“Our consistently exceptional ratings reflect CHP’s commitment to delivering quality care to our local community,” said Dr. Nancy Van Vessem, Chief Medical Officer for Capital Health Plan. “We work to prioritize the needs of our members in an effort to continually improve services and promote health.”

Ratings are calculated based on combined scores of Healthcare Effectiveness Data and Information Set (HEDIS®), Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and NCQA Accreditation standards. Scores include the results of consumer surveys and compare the success of various plans in preventing and treating medical conditions. 

“While it is wonderful to be recognized as a leading health plan, the greatest measure of success is the strong support we’ve had from our members,” said John Hogan, CEO of Capital Health Plan. “We are honored to be the Big Bend’s local, trusted health care partner, and we’re thankful for our physician partners who have been so instrumental in our success over the years.”

Since opening in 1982, CHP has been committed to offering affordable, comprehensive health care to the area. In 35 years, they have grown to more than 135,000 members – with an extensive physician network and two exclusive CHP health centers that provide preventive, primary, and specialty care services.

“Every year we are growing and finding new ways to refine our services to deliver the best value for our customers and the communities we serve,” said Ken Boutwell, Chairman of the Board. “We are proud of how far we have come and we look forward to what the future has to offer.”

For more information about Capital Health Plan, visit www.capitalhealth.com.

National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS® is the most widely used performance measurement tool in health care. NCQA’s website (www.ncqa.org) contains information to help consumers, employers and others make more informed health care choices.

Capital Health Plan updates office closures, reminds members how to access benefits during and after Hurricane Irma

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Capital Health Plan Urgent Care will close today, Sunday, Sept. 10,  at 4 p.m. All CHP locations will remain closed at least until Wednesday (9/13) until further notice.
Members can access comprehensive information about how to receive care during and after the storm by reading the Disaster Care document, located on the red banner of CHP’s homepage. The document outlines how members can access medical care or prescription drugs in the aftermath of Irma.
Capital Health Plan’s member services telephone lines are open and should be available throughout the storm, even if power is lost. There is a potential for phone lines to function intermittently during the power outages.
If you live in an area that has been declared an emergency or disaster and you need emergent or urgent care during this time, you should go to the nearest emergency room or urgent care facility that can meet your needs. In emergency situations, normal prior authorization and out-of- network requirements will be waived. Inform the doctor or facility staff that you are a CHP member, and provide them with your CHP ID card if you have it. Once CHP’s phone system is operational again, the doctor/facility can confirm coverage, benefit information, and receive claim payment information by calling CHP’s Network Services at 850-523-7361.
Prescriptions will continue to be filled at any of the 50,000 pharmacies nationwide in our pharmacy network. For a list of pharmacies, please visit capitalhealth.com/network. During the declared disaster, CHP’s “refill-too-soon” limitations will be lifted so that you may fill any needed medications that were lost or damaged during the disaster. If a pharmacy has any trouble filling your medications during this time, the pharmacist should be directed to call the PRIME Pharmacy Technical Help Desk at 1-800-821-4795 or 1-866- 469-5662 (Non-Medicare members) and 1-866-590-3010 (Medicare members), 24 hours/day, 7 days/week. Please keep any receipts for any medical services or prescription medications that you have to pay for out of pocket during this time.

Capital Health Plan Announces Office Closure and Emergency Health Procedures

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Amid Hurricane Irma, CHP offices closed Monday

Due to the imminent threat of Hurricane Irma, Capital Health Plan offices will be closed Monday, September 11. If members are in need of emergency or urgent care during this State of Emergency declared for all counties in Florida, please visit the nearest emergency room or urgent care facility that can meet your needs. Inform the provider you are a Capital Health Plan member and provide them with your CHP ID card, if you have it.
CHP Urgent Care will be open on Saturday, September 9 from 9:00am – 8:00pm and on Sunday, September 10 from 9:00am – 4:00pm. CHP Urgent Care will be closed onMonday, September 11.
Medications will continue to be filled at any of the 50,000 pharmacies nationwide in the Prime Network, which can be viewed by visiting www.capitalhealth.com/network. If the pharmacy has any trouble filling your medications during this time, the pharmacist should be directed to call the Prime Pharmacy technical help desk at  1-800-821-4795 or 1-866-469-5662 for Non-Medicare members and 1-866-590-3010 for Medicare members, 24 hours/day, 7 days/week. State of Florida members please call CVS Caremark at 1-800-364-6331, relating to your prescription drug coverage.

Staying Healthy in the Heat

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With the hot summer sun beating down, it’s tempting to stay indoors and out of the heat. But don’t let your health suffer because of the temperature. Rather than lounging around on the couch all summer wishing you could be at the beach, become a great indoors enthusiast with these tips to stay active inside:

Dr. David Jones

  • Join a gym. Gym membership not in your budget? Check out the local YMCA or similar community center, or find free workout tutorials on YouTube.com.
  • Find places to walk indoors. Give yourself a few extra minutes when you go shopping and walk around the perimeter of the store. Go up and down different aisles you might not normally visit. Park further from the store entrance to add a few extra steps (every bit helps).
  • Get cleaning. Tackle those chores you’ve been putting off — things like washing the windows, cleaning out that “junk” closet, and cleaning the baseboards. You’ll get to check them off your to-do list while also staying active.
  • Go dancing. Instead of going to a movie, where you sit the whole time, check out a local dance venue or a restaurant that has a dance floor. You and your friends will enjoy the change of pace, and you’ll get a little exercise while you’re at it!

While sometimes it is too hot to be outdoors, it’s important to try to get outside for at least a little bit each day to get the benefits of natural air and sunlight. However, before you head outside (or instead choose to stay inside), consider these factors:

  • Humidity. Check the humidity, heat index, and other important weather stats on your local weather station or a weather app on your phone. If it’s warmer than 80 degrees and the humidity is higher than 60%, you might want to reconsider what outdoor activities you were planning.
  • Electrolytes. Before you go outside, make sure you are properly hydrated. If it’s particularly hot, or if the activity is significantly strenuous, bring along a sports drink with electrolytes to replenish your potassium and sodium levels and prevent dehydration.
  • Time of Day. Avoid outdoor activities, especially intense exercise, during the peak heat hours of the afternoon. Use that time to catch up on indoor housework, or relax while reading a book or watching a movie. Instead, go on morning or evening walks to enjoy the outdoors, without getting overheated or sunburned.
  • Wear sunscreen (at least SPF 15), a hat that blocks the sun from your face, and sunglasses with UVA protection. Light colored clothing can also help in deterring the sun. For pesky mosquitos, use insect repellant with 10% picaridin, 30% DEET, or eucalyptus oil.

So, whether you are indoors or out, make sure to enjoy an active summer. For more information about cool summer activities, visit Capital Health Plan’s Healthwise® Knowledgebase at capitalhealth.com.
David Jones, MD, is a Pediatric physician at Capital Health Plan and serves on the board of directors for Get Outdoors Florida!

Join the League of Extraordinarily Healthy Gentlemen

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By: Adekunle Omotayo, MD, FRCP
The average life expectancy of a man born in the U.S. in 2007 is 75 years and five months. The ability to enjoy life to its fullest requires investing time and effort but pays dividends almost immediately, and it’s never too late to begin.

Adekunle Omotayo, MD, FRCP

Our bodies are incredibly complex machines that require fuel (food, water, and air) to grow, function, and repair themselves. Like any machine, the body needs routine maintenance to make it last a long time and to function well throughout a person’s life. Let’s be honest: Most men hate going to the doctor. But June is Men’s Health Month, so consider your loved ones — for their sakes, make sure your lifestyle is healthy and schedule a check-up.
Using the body as it was intended and minimizing abuse also increases its ability to perform. Our bodies suffer through illnesses and accidents, and many are unavoidable. Taking care of your body also includes scheduled maintenance and screening examinations to detect illnesses at an early stage, which increases the potential for cure and a return to health. Learning to listen to the body’s warning signs and symptoms is the same as paying attention to the “check engine” light in your car — neither should be ignored.
A healthy lifestyle is not just an absence of disease but an opportunity to enjoy the years of life available to each person. Medical care can help the body maintain its performance as it ages. As the body ages, there is an expected and normal physiologic change in some of the hormones in the male body.
Most common diseases that affect men are potentially preventable. Interestingly, the presence of some diseases increases the chance that another will occur. Heart disease, stroke, peripheral vascular disease, and dementia all share the same risk factors, which include smoking, high blood pressure, high cholesterol, and family history.
A common condition in men that is part of the normal aging process is an enlarged prostate, making urination even more difficult. Symptoms of an enlarged prostate include urinating more often, the feeling that he has to empty the bladder urgently or risk wetting himself, and poor urine stream.
Heart disease is the No. 1 killer of men in the United States. The major risk factors for heart disease (and stroke and peripheral vascular disease) include smoking, high blood pressure, high cholesterol, diabetes, and family history.
Lung cancer is the No. 1 killer among cancers in men. Smoking causes 90 percent of all lung cancers, and while the number of smokers in the United States has decreased in the past generation, 20 percent of teenagers smoke and will be the future victims of lung cancer. Tobacco in its various forms, including smokeless or chewing tobacco, is related to a variety of other cancers including cancer of the mouth, throat, and larynx.
Prostate cancer affects the prostate gland. Prostate cancer is the most common cancer among men, and is a disease of aging and is rarely seen in men younger than 50 years of age. Often prostate cancer causes no symptoms and is diagnosed after a routine screening test. The cure rate for prostate cancer has increased but it still accounts for 10 percent of cancer deaths among men.
Colon and rectal cancers tie with prostate cancer as the second most common cause of cancer deaths in men. There are few symptoms in the early stages of colon and rectal cancers, so regular screenings are critical. Colon cancer can be nearly completely preventable with timely examinations.
Poorly controlled diabetes increases blood sugar levels in the bloodstream and over time affects the small blood vessels in the body, which can lead to multi-organ failure. Poorly controlled diabetes can cause vascular disease leading to heart attacks, strokes, limb amputations, kidney failure, blindness, and nerve damage (diabetic neuropathy). Be sure to eat a well-balanced diet, maintain a healthy weight, and exercise regularly.
This month, take yourself in for a tune-up. Resources are available from our Healthwise Knowledgebase at capitalhealth.com.
Adekunle Omotayo, MD, FRCP, is an Internal Medicine physician and is the Associate Medical Director at Capital Health Plan.

Blood Pressure: What do those numbers mean, anyway?

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110/90. 130/80. 140/90. Blood Pressure:
What do those numbers mean, anyway?

Dr. Kristi Reese, Family Medicine Physician with Capital Health Plan
We’ve all been there: sitting on the chair, arm propped out with blood pressure cuff around your bicep, when the nurse states two numbers that sound like a giant fraction.
Turns out, those numbers are very important to understand. But first thing’s first: what is blood pressure? Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body.

Dr. Kristi Reese

It’s normal for your blood pressure to change throughout the day. The problem is if your blood pressure stays up, rather than going back down. When this happens, you’re said to have “high blood pressure.” Sustained high blood pressure damages the blood vessel walls, increasing the risk of heart disease, stroke, and kidney problems.
Unlike many other serious health conditions, high blood pressure doesn’t show noticeable symptoms. Most people don’t know they have high blood pressure until they go to the doctor for a routine check-up or an unrelated health concern. But that doesn’t mean it’s any less serious.
What about the numbers?
The first number your nurse or doctor reads, the top number of the fraction, refers to “systolic pressure” – how hard the blood pushes when the heart is pumping. The second or bottom number is your “diastolic pressure” – how hard the blood pushes between heartbeats, when the heart is relaxed and filling with blood.
Ideal blood pressure for an adult is 120/80 or lower. High blood pressure is 140/90 or higher. You may be wondering, “If my blood pressure is 130/90, I’m good, right?”
Not quite. If your numbers fall anywhere above 120/80 but below 140/90, you have “prehypertension” – meaning you’re headed for high blood pressure soon. Good news: people with prehypertension have the ability to reverse, or at least delay, high blood pressure by making lifestyle changes such as eating heart-healthy foods, exercising regularly, and limiting alcohol consumption.
But if you really want to reduce the chances of developing high blood pressure, don’t wait until you have prehypertension. Start now by limiting salt intake, avoiding saturated fats, and eating more fruits, vegetables, and fish.
About one out of three adults in the United States has high blood pressure, which is a startling statistic. May is High Blood Pressure Education Month, so the next time you go to the doctor, take the opportunity to talk to him or her about your blood pressure number.
For heart-healthy tips and to learn more about blood pressure, visit our Healthwise® Knowledgebase at www.capitalhealth.com.
Dr. Reese is a board-certified Family Medicine physician at Capital Health Plan.