A Coventry Health Care Newsletter WINTER 2015
Find Prescription
Drug Facts on
Our Website
Our Payment Policies Help Protect You
People sometimes do not
understand utilization management
(UM) programs. At CoventryCares,
UM is a system for reviewing the
care that has been provided to our
CoventryCares members.
There are no financial incentives in
the review process. CoventryCares’
UM decision-making is based on
whether care and service were
proper. It is also based on whether
the member had health coverage.
In some cases, CoventryCares
pays providers and staff who
are involved in UM review.
You can find the following
pharmacy information
on our website at www.
CoventryCaresVA.com.
Select Members. Then
select Benefits & Services.
And then, Prescription
Formulary.
CoventryCares does not reward
individuals for denying coverage.
The payment that CoventryCares
provides does not encourage
decisions that result in denial
of care.
This policy is posted on our
website at www.CoventryCaresVA.
com. If you would like a copy of the
complete UM policy, please contact
Customer Service at 1-800-279-1878.
2 A list of preferred
medications. This
includes medicines
with restrictions
2 A list of medications
that require prior
authorization
2 A list of medications that
require step-therapy
2 A list and explanation
of medications that
have limits
2 Procedures for asking
for exceptions
2 Information on the use
management procedures
2 How we decide when
to add new medicines
to the list
Learn More!
Visit www.CoventryCaresVA.com for more information on
understanding and using your benefits.
W I N T E R 2 015
Help Prevent
Pneumonia
Pneumonia is a type of
infection that happens in the
lungs. It can be common,
but it also can be dangerous.
About 1 million people are
sent to the hospital every
year with the disease. Here’s
what you need to know about
pneumonia, and what you can
do to prevent it.
RISK FACTORS
Certain people have a higher
risk of getting pneumonia:
2 Adults 65 and older
2 Children younger than 5
2P
eople with asthma, heart
disease or diabetes
2P
eople recovering from a
serious illness
2 Smokers
Keep Your Kids Smiling
Does your child have Medicaid?
Did you know they have dental
coverage?
Dental services for children
enrolled in Medicaid, FAMIS
and FAMIS Plus are provided
through the Smiles For Children
program. The Smiles For
Children program encourages
good oral health. The program
recommends regular checkups
with your child’s dentist. You
should schedule your child’s first
visit with the dentist when the first
tooth breaks through the gum.
No matter what, the first visit
should be no later than
12 months.
There are no costs or
copayments for covered dental
services through the Smiles For
Children program. Your child
is covered for all medically
necessary dental services.
The services must be provided
by a participating dentist. For
information about Smiles For
Children or to find a dentist in
your area, call DentaQuest tollfree at 1-888-912-3456.
PREVENTING PNEUMONIA
2G
et a flu shot, since the
flu is a common cause of
pneumonia
2A
void close contact with
sick people
2 Wash hands regularly
2 Keep surfaces clean
2A
dults over age 50 should
consider a pneumonia shot
Your Health To-Do List
Put your health first this year
and make a “To-Do” list for
good health.
Get a Checkup. Regular
health exams give you the right
services, treatments and
screenings. They also can help
find health problems before
they start.
Be Organized. Organize your
health paperwork and review your
family health history. Be aware of
any screenings or vaccinations
needed for the upcoming year.
Quit Bad Habits. Stop smoking,
get more sleep and make
healthier food choices.
Stick to a Routine. Make sure to
try different activities you enjoy.
This will keep you from getting
bored and quitting.
A Fresh Start Resolve to kick your unhealthy habits. Start a workout routine, see your doctor
once a year and eat right in 2015. Then you’ll see some results.
2
How to Reduce
the Risk of SIDS
No one knows the exact causes
of Sudden Infant Death Syndrome
(SIDS). However, research by health
care professionals shows that steps
can be taken to help reduce the risk
of SIDS:
Take
as
Prescribed
1. Babies should be placed on their
backs when they sleep, never
face down
2. A baby’s mattress should be firm
and covered with a fitted sheet in a
safety-approved crib
In order for your medication
to work, you need to follow
the directions. About half of
all patients do not take their
medication correctly. Some
patients have a hard time keeping
track of when to take it. Others
stop because they think they are
getting better. If medication isn’t
taken correctly, it won’t work.
Here’s how to make sure you are
taking medications correctly.
Ask Questions. You need to
know what to expect from the
medication. Ask your doctor how
it will make you feel. Will there be
side effects? How long will you
need to take this medication? If
the cost is an issue, ask your doctor if he or she can prescribe a
generic prescription.
Set a Routine. Don’t forget to
take your medicine. To help you
remember, get in the habit of taking it at the same time every day,
or create a schedule to follow. A
pill box to organize the medicines
you take is also helpful.
Check In for Good Heart Health
Are you at risk for heart disease?
The only way to know for sure
is to have your blood pressure,
cholesterol and blood glucose
checked regularly.
BLOOD PRESSURE: Starting
at age 20, your blood pressure
should be checked at least every
year at your regular doctor’s visit.
3. Avoid co-sleeping with your baby.
It is OK for your baby to be in the
room with you, just not the bed for
sleeping. Your baby should not be
left alone on a chair, couch or in a
car-seat to sleep either
4. Pillows, blankets and other
soft objects should not be in
your baby’s crib. They can
cause suffocation
5. Keep your baby away from
cigarette smoke or other forms of
smoke during pregnancy and after
birth. SIDS rates are much higher
when a baby shares a bed with a
parent who smokes. If you need
help quitting, call 1-800-QUIT-NOW
or visit www.smokefree.gov.
Help is free.
Source: www.cdc.gov/sids/
Parents-Caregivers.htm
CHOLESTEROL: Your total
cholesterol should be measured
every four to six years. This
should start at age 20.
BLOOD GLUCOSE: Once you
reach age 45, you should have
this checked every three years.
High blood glucose puts you at a
higher risk for type 2 diabetes.
3
PRSRT STD
U.S. POSTAGE
PAID
LANCASTER PA
PERMIT NO. 236
9881 Mayland Dr.
Richmond, VA 23233-1458
BSH
1-800-279-1878
TTY 1-800-828-1120 or 711
www.CoventryCaresVA.com
Published by McMURRY/TMG, LLC. ©2015. All rights reserved. No material may be reproduced in whole or in part from this publication without the express written permission of
the publisher. The information in this publication is intended to complement—not take the place of—the recommendations of your health care provider. Consult your physician
before making major changes in your lifestyle or health care regimen. McMURRY/TMG makes no endorsements or warranties regarding any of the products and services included
in this publication or its articles.
Annual Member
Health Care Survey
Annual Quality
Study Results
Your opinion
matters to us!
CoventryCares of Virginia
takes part in a yearly project.
It helps us to assess our
members’ health. In 2014,
we looked at nearly
80 quality measures in
the following areas:
Each year we ask our members
if they are pleased with the
health care services they
receive. Thank you for letting
us know how you feel! This
helps us to improve our services
and maintain high-quality health
care for our members.
2 Access to care
2 Success of care
2 Use of services
Measure
Rating of Health Care Overall
National Average
70.85%
CoventryCares
Rating of Health Plan Overall
73.54%
79.50%
Rating of Personal Doctor
78.37%
82.86%
Rating of Specialist
78.97%
86.62%
Customer Service
86.30%
88.63%
Getting Care Quickly
81.16%
83.97%
Getting Needed Care
80.62%
84.69%
How Well Doctors Communicate
89.27%
Shared Decision Making
73.97*
90.83%
73.68%
71.53%
*Compared to the 2014 DSS Average
Bold = better than national averages for 2013
Check CoventryCares’ report card!
Our HEDIS scores are available at www.CoventryCaresVA.com.
These measures are
referred to as HEDIS®
(Healthcare Effectiveness
Data and Information
Set)1. HEDIS is part of our
NCQA (National Committee
on Quality Assurance)
accreditation score. Please
visit us online at www.
CoventryCaresVA.com for
results information.
HEDIS is a registered trademark
of the National Committee for
Quality Assurance (NCQA).
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