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WINTER 2016 Colon Cancer Awareness Month Page 2 Health Coaching Page 4 Eating by Season Page 6 Medicare Spotlight Page 8 “Like” Denver Health Medical Plan on Facebook Colon Cancer Awareness Month C olorectal cancer is the second leading cause of death from cancer in the United States. But, there is good news. The number of deaths from these cancers has decreased with the increased use of preventive screenings such as colonoscopies. According to the National Cancer Institute, new cases have decreased on average 3.2% each year since 2005. Most cases of colorectal cancer start as small, noncancerous clumps of cells called benign polyps. Over time some of these polyps, if left untreated, can become colon cancer. Polyps may be small and create few, if any, symptoms. For this reason, doctors suggest regular screenings to help prevent colon cancer by finding and removing polyps before they become cancer. • Constant stomach pain, aches or cramps • Unexplained weight loss Prevention The best way to reduce your risk of colorectal cancer is by having regular colorectal cancer screenings beginning at age 50, based on your doctor’s recommendation. Your doctor may suggest regular screenings even if you show no symptoms of cancer. Work with your primary care provider to decide the best screening option for you. Colorectal screening is covered as preventive care with no charge to the member. The tests below screen for colorectal cancer: Uncontrollable Risks: • Age • Inflammatory bowel disease such as Crohn’s disease or ulcerative colitis • Personal or family history • Fecal Occult Blood Test: A small stool sample is sent to a lab and tested for blood, which may be a sign of polyps or cancer. • Colonoscopy and Sigmoidoscopy: These procedures are similar and look inside the rectum, sigmoid (lower) colon and upper colon for polyps, abnormalities or cancer. A sigmoidoscope or colonoscope (thin, tube-like instrument with a light, lens and tissue removal tool) is inserted through the rectum into the colon. If tissue is taken during the procedure, it is checked under a microscope for signs of cancer. • Barium Enema: This is a series of lower gastrointestinal tract x-rays. Barium (silver-white metallic compound) containing liquid is put into the rectum and colon so the x-ray can find abnormalities. These lifestyle changes may also help lower your risk of many types of cancer, including colorectal cancer: • Eat plenty of fruits, vegetables and whole grains. • Limit red meat and processed meat such as lunch meat and hot dogs. Lifestyle Risks: • • • • • • Lack of regular physical activity Diet low in fruits, vegetables and fiber Diet high in fat Obesity Alcohol use Tobacco use Signs and Symptoms If you experience any of the following, see your doctor: • Changes in bowel habits • Blood in the stool (solid waste) If you need any of the information in this newsletter in Spanish, please call Member Services at 303-602-2100 for DHMP or 303-602-2111 for Medicare Choice/Select. Si necesita en Español alguna parte de la información contenida en este boletin, llame Servicios de los Miembros al 303-602-2100 para DHMP o al 303-602-2111 para Medicare Choice/Select. 2 The Power of Probiotics • Limit alcohol—no more than two drinks per day for men and one for women. • Stop tobacco use. • Exercise 30 minutes most days of the week. • Maintain a healthy weight. The human digestive system holds about 400 types of helpful bacteria that help optimize normal digestion, kill disease-causing microorganisms, and produce vitamins. Keeping our stomach, intestines and colon in good working order is key to good health. Facts • Death rates rise with age - 90% of colorectal cancer occurs in people over the age of 50. • About one in seven of people diagnosed with colorectal cancer will be under 50 years old— and this number is going up. • The American Cancer Society estimates that the number of colorectal cases in the U.S. in 2016 was 134,490. • The percent of colorectal cancer deaths is highest among people between 75 and 84. • 65.1% of people diagnosed with colorectal cancer survive five or more years. Probiotics are bacteria found naturally in many foods and drinks and when consumed, are believed to help keep the healthy balance of organisms in the human gut. Many people consume probiotics for their health benefits such as aiding in digestion and helping to maintain a healthy immune system. Individuals may use probiotics to help with cramping, gassiness and diarrhea related to gastrointestinal issues. Researchers are also studying probiotics for the treatment of colon cancer, vaginal infections, skin infections, tooth decay, irritable bowel syndrome and other conditions. On the Rise in Younger Adults Due to the use of more regular screenings, the number of new cases of colorectal cancer has steadily decreased over the past decade. However, U.S. incidence rates of colorectal cancer in adults younger than 50 has risen 1.5% in men and 1.6% in women per year from 1992 to 2005. It is still unclear what is causing the increase in cases. How do they help your colorectal health? Billions of bacteria live naturally in the human colon and help aid in the final stages of digestion. Probiotics taken by mouth through foods or supplements may help keep a healthy balance of the good bacteria that helps maintain a healthy colon. Since regular screenings are not performed on younger patients, the disease is often not caught until it’s progressed to late-stage cancer. Younger people may not know the symptoms and even physicians tend to mis-diagnose the disease upon initial consult with patients under 50. The American Cancer Society still suggests regular screenings begin at the age of 50 in adults with normal risk factors. However, adults with higher risk factors might start screenings at a younger age and have them more often. Where are probiotics found? • Yogurt, sauerkraut, miso, kimchi, kefir and tempeh • Dietary supplements • Packaged foods enriched with probiotics such as cereal, chocolate, nuts, tea, salad dressing and snack bars The U.S. Food and Drug Administration has not approved any probiotics for preventing or treating any health problem. Even though side effects from using probiotics are usually minor or non-existent, you should still check with your doctor before adding supplemental probiotics to your diet to see if they may be helpful for you. Sources https://www.cancer.gov/types/colorectal http://www.cdc.gov/cancer/colorectal/basic_info/prevention.htm http://www.mayoclinic.org/diseases-conditions/colon-cancer/ manage/ptc-20188388 https://seer.cancer.gov/statfacts/html/colorect.html http://www.medscape.com/viewarticle/857294 http://www.cancer.org/cancer/news/news/colon-cancer-casesrising-among-young-adults 3 Sources http://www.webmd.com/digestive-disorders/tc/probiotics-topicoverview http://www.everydayhealth.com/digestive-health/probiotics-fordigestive-health.aspx http://www.askdrsears.com/topics/health-concerns/childhoodillnesses/colon-health-101 https://nccih.nih.gov/health/probiotics/introduction.htm Health Management Health Coaching Have you thought about having a health coach? Health coaching can help you take a more active role in your health care and control some of your illnesses. Your health coach will work with you to set goals that you can reach. You may work on topics such as diabetes, weight management, congestive heart failure, depression, asthma, chronic pain or smoking. As a plan member, there is no cost to you to participate in health coaching. Our members regularly thank us for helping them get healthier! Here are some of the things they have to say: I’m very satisfied with this health coaching program and received some very useful information. Liesel was great! Here is an example of the success one of our members had in our program: I’m extremely thankful for all the information and patience provided by my health coach, Karen. I think this is a great program. My health coach was very helpful and provided useful resources. She also helped me realize my health status. Mr. M completed all 8 sessions of the Weight Management program and was proud to tell his Health Coach that instead of drinking soda and juice he now drinks only water. He has increased his water intake from 2 glasses per day to 4 glasses. He also now engages in low impact chair exercises 2-3 times per week and walks his dogs around the block twice per day. Previously Mr. M did not eat any vegetables but now says he eats salad twice per week and has fruit as a snack. He found the program to be very helpful in achieving these goals! I completed the Health Coaching program with Jayna and am in FAR better shape after her help. Without her help, I honestly believe that I would be seriously ill, and perhaps admitted into the hospital, damaging my health even further. I’m SO grateful for Jayna. I cannot put into words how helpful she has been to me. If you would like to enroll in health coaching, please call Health Management at (303) 602-2136. 4 NurseLine Advice Food Poisoning By: Marie Richardson RN, BSN is suspected. If you are healthy but have any of the below symptoms, call the Nurseline: What is Food Poisoning? • Vomiting and nausea last for more than 24 hours • A feeling of extreme weakness with severe vomiting and nausea • Any of the symptoms occur with a fever over 102 F • Diarrhea or vomit contains blood Food poisoning is a reaction to water or food that has been contaminated from improper storage, handling, and cooking. Bacteria, such as E. coli and salmonella, viruses, toxins and parasites are common causes. Symptoms often last 1-3 days, but some cases can be dangerous. Symptoms include: vomiting and nausea, abdominal cramping, diarrhea, general weakness, and fever. How to Prevent Food Poisoning: Wash your hands well with warm and soapy water before and after touching or prepping food. Wash utensils, food surfaces and cutting boards with hot soapy water. Keep raw foods away from prepared foods, preventing cross-contamination. Cook meat well and use a food thermometer, as most harmful organisms can be killed by simply cooking them at the right temperature (ground beef 160F; steaks 145F; chicken and turkey 165F). Shellfish and fish should be cooked thoroughly. Food should be refrigerated or frozen within 2 hours of purchasing or preparing. Defrosting food in the refrigerator is the safest way. When in doubt and you are not sure if food is safe, throw it out. When food is left out too long, some toxins and bacteria cannot be destroyed by cooking it. When and how to treat at home: Stay hydrated; drink plenty of fluids (water, Gatorade, non caffeinated sports drinks, broth, clear soda), or suck on ice chips (adolescents through adult). If vomiting, sip or take in very small amounts (for children 1-3 tsp every five minutes) to relieve the stress on the stomach and intestines. If your urine is clear and you are urinating normally, then you are most likely getting enough fluids. Stay clear of dairy, caffeine, fatty or spicy foods, alcohol, and tobacco. Bland foods are to be started after vomiting has stopped. Adults with diarrhea that does not contain blood and without a fever may get relief from OTC Loperamide or Pepto-Bismol. However, these are not appropriate for children. Be sure to get plenty of rest! Have questions or want more information? Call the Denver Health NurseLine 24 hours a day, seven days a week at 303-739-1211. For all life threatening emergencies call 911 right away! When to call the Nurseline: Most at risk are those with a weakened immune system (diabetes, HIV/AIDS, undergoing chemo/ radiation), pregnant women, young children and the elderly. If you fall into one of these categories you should call the Nurseline as soon as food poisoning Sources: www.mayoclinic.org/diseases-conditions/food-poisoning/basics/ definition/con-20031705 www.cdc.gov/foodsaftey/foodborne-germs.htm 5 Eating by Season Homemade Power Bars • Put 1 c of diced almonds/walnuts in same toasting pan, toast, then add to big bowl. Add in: 1/2 c soy protein powder 1/2 c flax meal 1/4 c wheat germ, toasted or regular 1/2 tsp salt substitute • In saucepan, put: 1/2 c peanut or almond butter, 1/2 c dates pitted and chopped till mashed, 1/2 c brown rice syrup, ~ 3 tbsp water and 1/2 tsp vanilla • Heat the mixture, stirring briskly until smooth. Try to mash the dates/figs as fine as possible. Add peanut butter mixture to dry ingredients and stir well. If crumbly, add a couple teaspoons of water. • Lightly oil a 7.5 X 11.5” pan. Pour the mixture into the pan and press in firmly. If you’d like, add a chocolate topping. Here is how: sprinkle about 3/4 cup chocolate chips (or chopped dark chocolate) over the pressed bars. The bars should still be warm. Cover with a cutting board for about 30 min to passively melt the chocolate. Use a frosting spatula to smooth out the melted chips over the bars. Let sit for about 45 min until the chocolate is firm to the touch. You can refrigerate, just be sure to pull it out when the chocolate is barely firm. • Once chocolate is firm to the touch, use a pizza cutter to cut bars into any size you want. After cut, you can put the pan into the fridge or freezer to firm up. Place into baggies so they are ready to grab when you’re on the run. The bars will last weeks in the fridge! What You Need: • 1 c Oats • 1⁄2 c Mixed Seeds (pumpkin, sesame and chia) • 1 c Fruit (dried and chopped. options: cherries, apricots, currants (no need to chop), blueberries, golden raisin - to name just a few • 4 T Cacao Nibs • 1 c Almonds or Walnuts (diced) • 1⁄2 c Soy Protein Powder • 1⁄2 c Flax Meal • 1⁄4 c Wheat Germ (toasted or regular) • 1⁄2 t Salt Substitute • 1⁄2 c Peanut Butter or Almond Butter • 1⁄2 c Dates (pitted and chopped till mashed) • 1⁄2 c Brown Rice Syrup • 3 T Water • 1⁄2 t Vanilla To Make: • Take 1 c oats,1/2 c mixed seeds (pumpkin, sesame and chia seeds) and toast in pan over medium to low heat, stirring often so they don’t burn. • Put in food processor/chopper/grinder to grind then place in big mixing bowl. • Add 1 c finely chopped dried fruit to mixing bowl. • Put 4 tbsp cacao nibs into a 1 c measuring cup. Add fine, unsweetened coconut to make 1 c. and add to mixing bowl. 6 Great Indoor Workouts for the Winter keeping stamina up in the ring, you’ll tone muscles rather than bulking up. The winning card: Technique is more important than experience, so it’s OK to be a newbie. Ride it out. Wiping out on black ice or feeling the cold breeze freeze your face while bike riding isn’t appealing? Spin class might be for you. These intense indoor cycling classes can burn up to hundreds of calories and keep bones strong. Interval-based rides will also strengthen the butt, thighs, calves, and even the core. Zen out. Give your mind and body a workout with yoga. Believed to reduce stress, anxiety, and fatigue, yoga also improves strength and flexibility through a range of asanas (or poses). It’s also an ideal indoor cross-training activity for more cardiointense activities like running. From Vinyasa flow to hot and sweaty Bikram yoga, there’s a style to suit just about anyone. Lap it up. It’s never too early to dig up that swimsuit. Head to your gym or rec center’s indoor pool to get in a few solid swims before summer hits. This low-impact exercise lets athletes exercise longer without excess muscle strain, and might even beat yoga when it comes to improving breathing technique. Bonus: An improved mood, and a leaner physique to boot. Jump on it. Unleash the kid in you and hop to the nearest trampoline. This bouncy childhood favorite is the latest fitness craze, and not just because it’s super fun. Just 6 minutes of cardio moves on a trampoline is equal to running, oh, about a mile. And thanks to the trampoline’s low-impact cushioning, joints are safe as you jump up and down. Try a local trampoline class or visit a trampoline park to bust a move. Hit a wall. An indoor rock climbing wall, that is. This non-traditional cardio workout really hits the mark for those who want to exercise their mental strength (what happens to my legs if my arms go here?). But it’s about physical skill as well — scaling indoor walls will increase heart rates and torch up to 650 calories per hour. Not only does it work the arm muscles, it also activates the legs, back, and shoulders. Cue the bragging rights once you’ve reached the top! Soc-it to me. Don’t relegate soccer to a warmer weather-only sport. When it’s too cold to get outdoors, indoor soccer is a solid choice for kicking out your frustrations and working up a sweat. And the benefits are worth it: Soccer means crazy good cardio, plus some sneaky core work with each pass, shot, and corner kick. Studies show the world’s favorite sport can also improve oxygen uptake (a measure of cardiovascular fitness) in adult athletes, and help with balance, too. Score! Lace up. Ice skating isn’t just for kids. If it’s too cold for outdoor skating to be fun, head to your local indoor rink to carve up the ice. Aside from being super fun, skating tones the legs, core, and butt. At a moderate pace, ice skating also burns about 500 calories per hour (and that’s not counting those bonus points for jumps and spins!). Source: http://greatist.com/fitness/20-awesome-indoor-workoutstry-winters-over Get your gloves up. Make like Rocky and get to a kick-butt boxing class. A few rounds in the ring offer a full-body workout as you duck, block, and throw punches. And because the moves focus on cardio and 7 SPOTLIGHT This edit can be overridden by your pharmacist if they feel it is safe to do so. If the pharmacist feels it is safe to override this alert, you will be able to pick up your opioid medicine. Denver Health Medical Plan (DHMP) wants to tell you about a change that took place January 1, 2017 that may affect you if you take opioid medications for pain. If you do not take any opioid pain medicines, you do not need to worry about this information. Opioid medicines or “narcotics” are used to ease pain. Types of these medicines include oxycodone, morphine, fentanyl and Vicodin. • Opioid “Hard” Edits: When a patient reaches a higher dose, the prescription will not be able to be filled. Your provider will need to complete a prior authorization request and send to DHMP Pharmacy Department for review. You will need to wait until the prior authorization is approved before you are able to pick up your opioid medicine. The Center for Medicaid and Medicare Services (CMS) wants to make sure Medicare members are using opioid pain medicines safely. These medicines can be dangerous to your health when taken at high doses. CMS is starting the Cumulative Opioid Morphine If you have questions about this change or how to Equivalent Dose (MED) Point-of-Sale (POS) Edit. There are two different edits that may affect you. get a prior authorization started, you can talk to your provider, the pharmacy you fill your prescriptions at, or call the DHMP Pharmacy Department, Monday-Friday • Opioid “Soft” Edits: Pharmacists will get a 8am-5pm at 303-602-2070 or 1-877-357-0963 for message that tells them when a patient reaches help. TTY/TDD services are available at 711. a certain pain medication dose and if the opioid medicines are prescribed by 2 or more providers. What is New with My Pharmacy Benefits? Your pharmacy benefits are updated many times over the course of the year. To see what’s new or changed on your drug formulary, visit DenverHealthMedicalPlan.org. This link will also make clear the formulary restrictions, limits or quotas, and your plan’s process for generic substitution, therapeutic interchange, and step therapies.You can also find out how your provider can ask for a prior authorization or exception request (non-urgent requests may be processed the next business day). If you have questions about your pharmacy benefits, please call Member Services at 303-602-2100 or 1-800-7008140. TTY/TDD users should call 711. Click on the Employer Group Plans link and choose the link to your plan. The Formulary Updates links will get you up-to-date on any changes in your plan’s formulary, which could be newly added drugs, new generics and more. To learn more about your prescription benefits and a full list of covered drugs, please go to the link for your plan’s Drug Formulary and Pharmaceutical Management Procedures. *This does not apply to DHMP Medicare Choice HMO SNP and DHMP Medicare Select HMO. 8 When you need care today and can’t get in to see your provider… 1 The NurseLine is here to help you. 2 DispatchHealth will come to you. Call 303-739-1261 and speak to a Denver Health nurse about your health concerns. Sometimes they can even call in a prescription for you. DispatchHealth is bringing back the house call. DispatchHealth is our on-demand health care provider that can treat a range of injuries and illnesses in the comfort and convenience of your home. Avoid unnecessary expenses and long waits in the emergency room. DispatchHealth physicians, nurse practitioners and physician assistants have years of experience working in urgent care centers and emergency rooms. They will come to you for only the cost of an urgent care copay. DispatchHealth is open 7 days a week 8am – 10pm. Visit DispatchHealth www.dispatchhealth.com, download the free app or call 303-500-1518. 3 Visit a Walgreens Healthcare Clinic or a King Soopers Little Clinic. 4 Visit an Urgent Care center. 5 Emergency room. As a member of Denver Health Medical Plan, you have access to all Walgreens Healthcare Clinics and King Soopers Little Clinics in the Denver area. These clinics are a good option for you if you have a sore throat, sinus infection or the flu. You can visit any urgent care center that is convenient for you.You are covered at any urgent care center in the U.S. If you need emergency care, go to the nearest hospital or call 9-1-1. Your DHMP plan will cover you at any emergency room, anywhere in the U.S. 9 Do You Want to Make a Difference in Health Care Research? How much time will it take? In partnership with Denver Health, Kaiser Permanente Colorado has launched the Colorado Patient Partners in Research (CoPPiR) Network to connect interested patients with research study teams. It depends on the particular project, but you could be asked to attend monthly meetings or conference calls. Many projects will ask that you be open to communication via email as well. Most studies will offer you some form of compensation for your time and contribution. How is my participation in CoPPiR different than joining any other research study? Why else should I want to join? Patients who join the CoPPiR network become eligible to join future research teams. By providing basic health information, a patient can be matched with a research team depending on the patient’s age, gender, health experience or interest. CoPPiR is for Patient Partners who want to provide input to research study design and grant submission, develop patient enrollment materials and methods, provide feedback on interpretation of the results, and help communicate results to patients, organizations, and research communities. Joining any team is entirely voluntary. By joining a research team, you can learn about: • Health research and the research process • Health systems like Denver Health and Kaiser Permanente • Medical terms and concepts And many Patient Partners find that the experience gives them a way to “give back” on a personal health issue they’re intensely familiar with, and contribute in ways that could save future patients from having to go through some of the challenges that they faced. Many Patient Partners also find that participating as a member of a research teams gives them more confidence when they’re talking to their own doctors – they’ve become better health advocates for themselves and their loved ones! Who can join? Any adult 18 years or older who lives in Colorado and has experience as a patient of any kind or caregiver of a patient can join the network. You don’t need a science background or any other special training. Your expertise is your experience with the healthcare system being a patient or a caregiver. How do I find out more? To learn more about the CoPPiR network, visit [email protected]. When you are ready to sign up, go to http://coppir.org/participate. If you have any questions, you can reach us at [email protected] or call 303-614-1410. What will I be asked to do? When a new project matches your interests, you will receive an informational email with basic information about the project. If it sounds like something that could work for you, you will have the research team’s contact information to find out more. They will never know were “matched” to their project. If you choose to reach out to the study team, they will provide you with more in-depth information about the project and together you can decide if it’s a good fit for everyone. 10 You can help us make Denver Health Medical Plan and Denver Health Medicare Choice/Select the best health plans for you. In the next few weeks you may get a survey about your Denver Health Medical Plan or Denver Health Medicare Choice/Select Plan. Please fill it out and mail it back as soon as you can. If you do not have a chance to fill out this survey you may get a call to take the survey on the phone. This survey is sent to a select group of members. We would like to hear your thoughts about your health plan services and benefits. If there is anything we can do to help, please call DHMP Member Services at (303) 6022100, DPS Member Services at (303) 602-4DPS (4377) or DH Medicare Choice/Select Member Services at (303) 602-2111. TTY users please call 711. Our DHMP hours of operation are 8am to 5pm Monday through Friday. DPS and DH Medicare Choice/Select hours of operation are 8am to 8pm Monday through Friday. Early and Periodic Screening, Diagnostic and Treatment • • • • • The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for Denver Health Medicaid members age 20 and under along with pregnant adults. EPSDT is key to ensuring that children and youth receive appropriate preventive, dental, mental health, developmental and specialty services. For more information on EPSDT and included services, please see the member handbook at www.denverhealthmedicalplan.org Your child can get these services at no cost to you. Services include: • • • • Home Health Services Substance Use Disorders Treatment Vision and Eyeglasses Hearing Dental Care Speech Well Child Check-ups Immunizations Physical or Occupational Therapies 11 777 Bannock Street, MC 6000 Denver, CO 80204 How to Prepare for Your Annual Preventive Visit Are you nervous to ask your provider questions? Don’t be. You may be surprised to learn that your medical team wants you to let them know that you need help. Like all of us, health care providers have busy schedules. Be informed! Your provider wants you to know: Use the Ask Me 3 questions each time you talk with a health care provider to help you be an active member of your health care team. Asking these questions can help you take care of your health, get ready for medical tests, and take medicines right away. Bring your medicines with you the next time you visit a health care provider. Like many people, you may see more than one health care provider. It is important that they all know about all of the medicines you are taking so that you can stay healthy. 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this? • All you can about your condition • Why this is important for your health • Steps to take to keep your condition under control