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Steps to
WELLNESS
MDwiseMarketplace.org
WINTER 2014
What’s Inside:
Avoiding Unnecessary
Hospital Admissions...............2
Develop Healthy Eating Habits...2
Manage Your Medicines............3
MDwise Care
Management Program.............4
List Your Reasons to Quit........5
NURSEon-call.......................4
Find Your Doctor
It is important to choose doctors who are right for you. We know it is important
to have quality doctors who meet your health needs. “Your doctor first” means
you can see a doctor who will get to know you. Your doctor is linked to a network
of other specialists, hospitals and emergency rooms to meet your health needs.
Go to MDwise.org/findamarketplacedoctor to find:
MDwise Commitment
to Quality Care.....................5
Pharmacy Drug List
Changes and Updates..............6
How We Protect Your Privacy...6
What is myMDwise................6
myMDwise Mobile.................6
•A primary medical provider (PMP). This is your in-network doctor.
•Doctor office locations.
•A list of doctors in your area.
•Doctor office phone numbers.
Pay Your Monthly
Premium On Time
•Whether a doctor is on a bus line.
Make sure you always pay
your monthly premium
payment by the last day of
every month.
•Languages the doctor speaks.
•Other facilities in the MDwise network. This includes hospitals.
MDwise customer service can look up specific doctors for you. They can also
answer questions about the quality of MDwise doctors.
This information is collected across the country by the Department of Health and
Human Services. Remember, it is better for your health to stay with your doctor
instead of changing doctors often.
You can:
•Pay online.
•Set up automatic payments.
•View other payment options.
Go to MDwise.org/paypremium to
learn more.
Avoiding Unnecessary
Hospital Admissions
MDwise cares about you staying well and
out of the hospital. Here are some tips to
help you.
Take your medicines like
your doctor tells you.
This is very important! It helps keep your
conditions controlled. See Manage Your
Medicines on page 3 for tips to help you
take your medicines as prescribed.
Know your warning signs.
Warning signs are signs that tell you
that your condition is getting worse.
Understanding what your warning signs
are will help keep you out of the hospital
or emergency room. Follow these tips.
1. Ask your doctor what you should
watch for.
2. Write down all your warning signs.
3. Ask the doctor how to handle each
warning sign.
4. Call your doctor RIGHT AWAY
when you think you see a red flag or
warning sign that your condition is
getting worse.
5. Ask for help. If you can’t contact your
doctor, ask your family or friends to
do it for you.
6. Know who to call after hours and
on the weekends. Ask your doctor
when you go for a regular visit. He or
she will give you instructions on who
to call or where to go.
If you do have to go to the hospital,
it is really important for you to see your
doctor no later than one week after you
are discharged. This helps reduce the risk
of being readmitted to the hospital. With
some conditions, appointments may need
to be even sooner.
2
Here are some helpful tips to get ready
for your follow-up doctor’s visit.
3 Plan ahead to be sure you have a
ride to the doctor’s office.
3 Write down questions as you think
of them so you are ready for your
appointment.
3 Take your discharge instructions
from the hospital with you.
3 Take your list of medicines you
are taking (new and old). Be sure to
write down any supplements you
are taking.
3 It is a good idea to take someone
with you. They can help listen to the
doctor’s instructions and write down
notes to help you remember later.
Some important things to ask your
doctor at this visit:
1. Ask your doctor about all the
medicines on your list. Be sure you
are taking everything the way the
doctor orders.
2. Ask your doctor for a list of
warning signs.
If you do not know who your regular
doctor is, call MDwise customer service.
We will tell you who your doctor is. We
can also help you get an appointment.
You can also call MDwise
NURSEon-call any time. A nurse is
available 24/7 for health care questions.
Call MDwise NURSEon-call at
855-417-5615. Choose option #2 for
member. Then choose option #2 for
current member. Finally, choose option
#4 for NURSEon-call.
You are in charge of your health.
Take action to stay out of the hospital.
Develop healthy eating habits
Healthy eating doesn’t need to be hard.
You and your family can develop healthy
eating habits. Here are some tips:
•Eat several servings of vegetables
and fruits every day.
•Eat whole-grains like oats and
whole-wheat bread every day.
•Include low-fat or non-fat dairy
like milk, cheese and yogurt.
•Eat lean meats, poultry, fish
and beans. These have good
protein.
•Serve smaller portions.
•Drink lots of water.
•Don’t drink a lot of sweetened
beverages like colas.
•Don’t eat foods with a lot of sugar.
•Avoid foods with saturated fat.
Source: Centers for Disease Control and Prevention
Manage Your Medicines
Taking your medicines like your doctor
tells you to is very important.
5. Be sure to update your list if your
doctor changes your medicines.
It helps keep your conditions controlled.
Your medicines can prevent flare-ups and
reduce your symptoms. This can keep
you from having to go to the emergency
room or being admitted to the hospital.
TALK WITH YOUR
DOCTOR OR PHARMACIST
6. Make sure you always plan ahead to
get refills. Don’t wait until you run
out of any of your medicines.
Your doctor and pharmacist will help you
understand all the medicines
you take. They will answer your questions
like:
Your doctor wants to know what
you think. If your doctor starts a new
medicine or stops a medicine you have
been taking, talk with your doctor about
what you think is best for you.
Here are some tips to manage your
medicines. Follow these same tips for
your child’s medicines.
1. Make a list of your current
medicines. Keep this list with you all
the time.
2. Be sure to include all prescription
and over-the-counter medicines.
3. Be sure to include any vitamins or
supplements you take. This includes
herbal supplements.
4. Be sure to show the list to your
doctor at each appointment.
7. Set up reminders for yourself so you
don’t forget to take your medicines.
Here are some things you can try:
• Set your medicines next to your
toothbrush.
• Put a note on the refrigerator or
the bathroom mirror.
• You may want to set up your
medicines in a pill organizer every
week. This helps you keep track
of the medicines you need to
take every day.
8. If you have trouble organizing your
medicines, talk to your pharmacy.
They are glad to help you.
9. It helps to use one pharmacy
for all your medicines. That way, the
pharmacist will know about ALL the
medicines you take. He or she can
check for any negative interactions
between your medicines.
1. What are they for?
2. What are the reasons I should
take them?
3. What are the reasons I should stop
taking them?
4. How should I take them?
5. What time of day should I
take them?
6. How often should I take them?
7. Will I need to continue taking them
once I feel better?
8. What are the side effects of
the medicine?
Always ask! You need to know. You will
stay healthier and safer when you get all
your questions answered.
3
MDwise Care Management Program
4
The MDwise care management program is in place for
members receiving medical and behavioral health care. The
member’s needs determine the level of case management
interventions. As the member’s needs change, the level of
service intensity may increase or decrease to achieve the
best outcomes for the member regarding access to and
coordination of services, adherence to the treatment plan,
and optimal functioning in the community. MDwise case
managers coordinate care between all providers involved
in the member’s care. They are responsible for facilitating
continuous communication between the behavioral health
and medical providers.
MDwise will also provide case management services for
members identified as at-risk for inpatient psychiatric or
substance abuse hospitalization. These members will receive
case management follow-up and support to help maintain
their care. Care management interventions can include
contacts with a member’s medical provider, behavioral
health provider, and identified community resources to
coordinate treatment and to ensure no gaps occur in
treatment. Contacts are made regularly to members to
provide support, assess needs and assist in resolving issues
that could be related to safety, food, housing, legal problems
or transportation.
Some key elements of the MDwise care management
program administered by the case manager include:
• Developing and implementing a comprehensive,
coordinated, collaborative and member-focused
plan of care, which meets the member’s needs,
promotes optimal outcomes and supports the
medical home concept
• Developing and facilitating interventions that
coordinate care across the continuum of health care
services to decrease fragmentation, duplication, and/or
lack of services, and promoting access or utilization
of appropriate resources
• Facilitation of information sharing among treating
providers to ensure services for members are
coordinated and duplication is eliminated
• Member appointment adherence
• Collaboration with the member, family/caregiver, and
providers on interventions outlined in the treatment plan
• Validating outcome measures related to the adequacy
and quality of the clinical management (i.e., adherence
to medication regime and follow-up medication
monitoring visits, etc.)
Upon behavioral health inpatient discharge, an outpatient
follow-up appointment is set for the member to see a
behavioral health professional within seven days. Inpatient
providers are responsible for making this appointment. The
member receives a call to remind him/her to attend this
appointment and to address any issues that may have arisen
since discharge. Case managers continue to follow up with
members through the recovery process to ensure treatment
adherence and coordination of services between medical
and behavioral providers.
Providers, family members, caregivers, and members
themselves may request case management or disease
specific services for members by completing an online
referral form or by calling customer service. The online
referral form is located at MDwise.org/cmdmreferral and
MDwise Marketplace customer service can be reached at
1-855-417-5615. Once MDwise receives the referral request,
a case manager will contact the member, explain the care
management program, and assess his/her needs.
List Your Reasons to Quit
Make a list of all of the reasons you
want to become SMOKE-free. Keep it
in a place where you will see it often.
Put it in your car or post it on your
refrigerator. When you feel the need to
smoke, take a look at the list. This will
remind you of why you want to quit.
Some reasons you may want to quit:
•You will be less likely to get sick.
•You will breathe easier and
cough less.
•Your chances of having cancer,
heart disease, strokes and other
diseases will go down.
•Your teeth and fingernails will not
be stained.
Go to MDwise.org/marketplace/
smokefree for more information.
For further advice and support,
call Indiana’s Tobacco Quitline at
1-800-QUIT-NOW (800-784-8669).
It’s available 24 hours a day, seven
days a week. You can also go to
quitnowindiana.com.
Source: Centers for Disease Control and Prevention
MDwise Commitment to Quality Care
MDwise is always looking for new
ways to help you improve your health.
All MDwise members deserve health
services that are high quality, safe, and
culturally appropriate. To make sure this
happens, the MDwise quality program
checks on care and services members
get throughout the year. The quality
program checks on:
• Members getting services they need
• Members getting service when
they need it
Always call your doctor first. If your doctor
is not available, call MDwise NURSEon-call
at 855-417-5615. Choose option #2 for
member. Then choose option #2 for current
member. Finally, choose option #4 for
NURSEon-call. NURSEon-call is available 24
hours a day. Other languages are available.
Your opinions are very important to us.
MDwise conducts a member satisfaction
survey in the spring of every year.
These surveys are first sent by mail. A
follow-up call is made if we do not get
a response in the mail. This survey helps
MDwise know how we can be the best
health plan possible. It helps us know
what we are doing well and where we
need to improve. We hope you will
take the time to fill out the survey and
let us know how we are doing.
Every year, we check to see if we met
the goals of our quality improvement
program. These checks help us to work
closely with our doctors to make any
changes that are needed. These checks
also help us know what information our
members need from us.
MDwise members may also get phone
calls from MDwise. One type of call
might be to check on your health needs.
Your answers help MDwise know
which programs might be right for
you. Another type of call might remind
members about important preventive
care. Any MDwise caller will tell you
right away who they are and why they
are calling.
A copy of the MDwise quality
improvement program is available on
our website at MDwise.org.
If you have questions at any time about
these calls or the survey, please call
MDwise customer service.
• Responses from our member
satisfaction surveys
Need help deciding whether
to see your doctor or go to the
emergency room?
Member Surveys and Outreach
5
Pharmacy Drug List
Changes and Updates
Changes are made from time to time to the list of drugs that are
covered and how they’re covered. These include:
What is myMDwise?
myMDwise is available 24 hours a day,
seven days a week. When you use
myMDwise, you can:
• Drugs added to the list
• Step therapy
•View your general eligibility
information, including the name
of your current doctor.
• Removed from the list
• Age limit
•Review your policy with MDwise.
• Changes in restrictions
related to prior
authorization
• Gender limit
• Quantity limits.
To search for information about drugs and how they’re covered
please go to: MDwise.org/findadrug.
•View your pharmacy claims.
•View your Summary of Benefits
and Coverage (SBC).
To sign up for myMDwise, go to
MDwise.org. Click the link "MDwise
Marketplace member login" in the
"myMDwise Login" box. Then click
“Create Member Account.” You will
be guided through this process.
How We Protect Your Privacy
Details about your health are personal.
That’s why we do all we can to protect
your privacy. We make sure your health
records and information about you are
kept safe. Only staff who need to see
your files to help you can get them.
Even then, our staff signs statements
promising not to share information
about you. Our doctors follow these
rules too.
If other people ask us for your records,
you must say it’s okay first. You have to
give permission in writing. The only time
we don’t check with you first is when
someone has a need and a right to see
the files. That is determined by law.
We often review the way we keep files
safe. We want you to have good care
and peace of mind. Our privacy policy is
in your member handbook starting on
page 24. The most recent version is at
MDwise.org/mm-handbook. You can
also have a copy of our privacy policy
mailed to you. Call MDwise Marketplace
customer service at 855-417-5615 to
if you want more information about
our privacy practices or if you have
questions or concerns.
STEPS TO WELLNESS is published for members of MDwise
Marketplace by MDwise Marketplace, Inc. P.O. Box 441099,
Indianapolis, IN 46244-1099, telephone 855-417-5615.
MDwiseMarketplace.org
MDwise Marketplace, Inc. is a
Qualified Health Plan issuer in the
Health Insurance Marketplace
6
Information in STEPS TO WELLNESS comes from a wide
range of medical experts and is not intended to provide
specific advice to any one individual. If you have any
concerns or questions about specific content that may affect
your health, please contact your health care provider.
Stock photography is used for all photos and illustrations.
Copyright © MDwise Marketplace, Inc.
myMDwise Mobile
Do you want to look up
the status of a pharmacy
claim? Or view your
MDwise Marketplace
ID card? Do you want
to check your coverage and benefits
information? Or find a doctor close to
home? With myMDwise Mobile you can
manage your health care on the go. Go
to your phone’s app store. Then search
for “myMDwise Mobile” and download.
Questions? Comments? Complaints?
If you need help with anything about MDwise
Marketplace or your doctor, we can help. Please call
MDwise Marketplace customer service at 855-417-5615.
MDwise Marketplace customer service offers language
services. Or we might use an interpreter. We also have
services for the hearing and speech impaired.
Si quiere que le mandemos esta información en español,
favor de llamar a nuestro departamento de Servicio al
Cliente de MDwise Mercado al 855-417-5615. También
puede encontrar esta información en español en nuestra
página web en MDwiseMarketplace.org.