JOHNS HOPKINS US FAMILY HEALTH PLAN

PatriotLifeWINTER 2015

WINNINGTHE NUMBERSGAME

Giving Asthma the Cold Shoulder

Dispelling Myths About Childhood Vaccinations

Shedding Light on Vitamin D

2 • PatriotLife • WINTER 2015

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As winter settles in, people with asthma need to be especially careful. When indoors, pet dan-der, mold and smoke from the

fireplace can trigger asthma. Outdoors, inhaling cold, dry air can be a trigger. Francis Chuidian, M.D., a pulmonolo-gist with Johns Hopkins Community Physicians, Howard General Hospital in Columbia, Maryland, offers the following tips:

Get a flu shot. Respiratory infections can trigger asthma, so protect yourself with a flu shot. Also consider getting a pneumo-nia vaccine if you are 65 or older, or if you are at high risk for pneumococcal disease. Check with your primary care physician.

Know your asthma. Be aware of your asthma triggers and root causes, and know how to manage them and their symptoms. For example, if you have chronic sinus disease and asthma and you contract bronchitis, you need to address

these issues and take medications other than antibiotics, such as antihistamines and saline nasal spray. Wrap up. Avoid inhaling cold air out-doors by draping a scarf across your mouth and nose or wearing a winter face mask that covers the bottom half of your face. Instead of exercising outdoors, go to a gym or walk laps in a mall.

Monitor symptoms. Carefully monitor-ing asthma symptoms is critical. “It’s your symptoms that tell you when to seek medical help,” Chuidian says. “Don’t wait too long to get medical help, because it makes the asthma harder to treat.”

Shedding Light on Vitamin D

W inter’s shorter days are are a reason to consider

whether you’re getting enough vitamin D.

Produced by the body par-ticularly when you’re in the sun, vitamin D acts as a hormone and regulates more than 200 genes. It keeps abnormal cells from multiplying in breast and colon tissues, and it helps regu-late blood pressure in the kidney and blood sugar levels in the pancreas. It’s also important for calcium absorption and bone formation, notes Erin Donnelly Michos, M.D., a cardiologist at The Johns Hopkins Hospital.

The recommended daily al-lowance of vitamin D is 600 international units for people

under 70, and 800 international units for those 70 and older for bone health. To ensure that you’re getting enough, advises Michos, consider the following:

Giving Asthma the Cold Shoulder

For more information on managing asthma, please call Care Management at 800-557-6916 or email populationhealth@jhhc.com.

TO YOUR HEALTH

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• SunlightisthestrongestnaturalsourceofvitaminD. Get 10 minutes a day of moderate summer sun expo-sure to arms and legs with-out sunscreen, and you’ll take in about 3,000 interna-tional units of vitamin D.

•Drinkmilkandfortifiedorangejuice. An 8-ounce serving of either contains about 100 international units of vitamin D.

• AskyourdoctortocheckyourvitaminDlevel with a simple blood test to make sure it’s in the healthy range.

www.hopkinsmedicine.org/usfhp PatriotLife • WINTER 2015 • 3

A national celebrity says she doesn’t vaccinate her children and suggests you shouldn’t ei-ther. Your co-worker refuses to get a flu shot because she says it gave her family the flu last

year. Or a neighbor suggests that spreading out a child’s vaccinations might help lessen side effects.

Myths and misinformation about childhood im-munizations abound, says Kisa Crosse, M.D., a family practice physician with Johns Hopkins Community Physicians, Fulton. Here she distills fact from fiction. Vaccination rates have dropped in some areas of the United States. Why?It goes back to several years ago, when reports came out about a very small study that made a correlation between autism and the ad-ministration of certain childhood vaccines. Subsequent reports indicated that this cor-relation wasn’t true, but because that incor-rect information spread and a lot of public figures were stating that they weren’t vacci-nating their children, a lot of parents either stopped vaccinating their kids or started following a different vaccination schedule than is recommended by spreading child-hood vaccinations out over a longer period of time. What’s the risk of delaying or avoiding childhood vaccinations?Delaying or avoiding vaccinations can put a child at risk for infection and illness. The first year of life is especially important for vaccinations because the infant immune system is so compromised. We need to vaccinate infants against diseases including diphtheria, pertussis, tetanus, hepatitis B, pneumonia, meningitis and polio to protect them. Other vaccines we give children by 12 months in-clude flu, measles/mumps/rubella and chicken pox. What are the most common myths you’ve encountered?The biggest myth I’ve heard is childhood vaccines cause learning disabilities or autism. That’s not true. Also, some people believe that the flu vaccine can cause you to get the flu, but that’s false—the vaccine contains killed flu protein, not a live virus, and cannot cause infection.

My older children don’t need vaccines, do they?Yes, they do. In Maryland, adolescents must have a tetanus booster and a meningitis vaccine before entering seventh grade. The HPV vaccine is indicated for those between the ages of 9 and 26 to protect against the virus, which can cause genital warts and changes to the cervix, possibly leading to cervical cancer in women. In addition, everyone over the age of 9 months should have a flu shot annually. Every time my child is vaccinated, I’m informed of the side effects associated with the vaccine, some of which sound scary. Would it be better to skip the vaccine altogether?

I do understand that it can be very scary when you are given a long list of possible side effects, but you have to be made aware of these side effects. They may have happened in one patient, and you need to know what to look out for. These vaccines were created for a reason, and they are necessary. I don’t recommend that you skip them. As a parent, how can I ensure that my kids are getting all of the vaccinations they need to stay healthy?Follow preventive care guidelines and have your child visit his or her pediatrician for an

annual physical, even if he or she isn’t attending camp, starting a new school or participating in school sports. There are new immunization recommendations being passed all the time, so you need to come in on a regular basis to ensure you’re not missing anything.

Kisa Crosse, M.D., is board certified in family medicine and is a member of the American Academy of Family Physicians. She has worked for Johns Hopkins since 2005 in several capacities: as a family practice physician, a member-at-large of Johns Hopkins Community Physicians’ Medical Executive Board and as office medical director of its Fulton location, and as an associate professor for the Johns Hopkins University School of Medicine. Crosse was recently selected by the Washington Post as a “Rising Star” physician for the Maryland/Washington, D.C., area.

Dispelling Myths About Childhood Vaccinations

“DELAYING OR AVOIDING VACCINATIONS CAN PUT A CHILD AT RISK FOR INFECTION

AND ILLNESS. THE FIRST YEAR OF LIFE IS ESPECIALLY IMPORTANT FOR VACCINATIONS

BECAUSE THE INFANT IMMUNE SYSTEM IS SO COMPROMISED.”

About 15 years ago, Gene Hale was diagnosed with hypertension.

The diagnosis didn’t really come as a surprise. He was in his mid-50s, ate a lot of fast food, and had a history of high cholesterol

and a stressful job. Hale, who lives in Knoxville, Maryland,

started taking the blood pressure medication his doctor prescribed and hoped his condition would improve. “I just continued on,” he says.

Some 67 million Americans—about 30 per-cent of adults—have hypertension, according to the Centers for Disease Control and Prevention. The condition, also known as high blood pres-sure, occurs when the force of the blood against your artery walls is elevated enough that it may eventually cause health problems.

Hypertension usually has no symptoms and is known as “the silent killer” because of the damage it can cause. Only about 47 percent of people with hypertension have the condition under control, and that’s a concern, says Margaret Oberman, M.D., an internist at Johns Hopkins Community Physicians, Montgomery Grove.

“We know that high blood pressure can lead to heart disease, stroke, kidney disease and pe-ripheral vascular disease,” explains Oberman.

Hypertension is known as “the silent killer,” but making simple lifestyle changes can go a long way toward preventing and reducing its health-robbing effects.

WINNING THE NUMBERS GAME

4 • PatriotLife • WINTER 2015 www.hopkinsmedicine.org/usfhp

Faith and Gene Hale

COVER STORY

Help for HypertensionHere are some resources for US Family Health Plan members seeking to manage their hypertension: Heart to Heart: This two-day, 90-minute class focuses on heart disease, stroke and related health conditions. The program addresses behavior changes and lifestyle management skills, and teaches participants how to manage their risk factors and live a heart-healthy life. Classes in adult weight management, tobacco cessation and other topics are also available. Email healtheducation@jhhc.com or call 800-957-9760 for more information.

Health coaching: Work one on one with a personalized health coach and create an individualized action plan to manage stress, lose weight, improve fitness and nutrition, or quit smoking. Call 800-957-9760 or email healthcoach@jhhc.com for more information. On the Web: The American Heart Association’s website, www.heart.org, offers a wealth of information about managing hypertension, including tips on managing weight and stress, getting more exercise, eating healthy and quitting smoking.

The most common risk factors for hypertension include:•Aging•Obesity•Tobacco and alcohol use•Family history of high blood

pressure

In addition, certain groups, includ-ing African-Americans, have a higher risk of high blood pressure, Oberman says.

Oberman, who defines hyperten-sion as two blood pressure readings of greater than 140 over 90, says there are two types of high blood pressure. Primary hypertension, which is the most common, is caused by the fac-tors listed above. Secondary hyperten-sion may be caused by diseases of the kidney or by vascular and endocrine abnormalities.

“I saw secondary hypertension a lot as a military doctor,” says Oberman, who served as an active-duty Navy internal medicine physician and as a civilian internal medicine physician for the Navy before coming to Johns Hopkins. “If we found a young pa-tient with high blood pressure but no other risk factors, we’d start looking for secondary causes for that eleva-tion.”

Treatment for high blood pressure often includes medication. But the importance of making lifestyle modi-fications, including quitting smoking, losing weight, getting regular exercise and following a low-salt diet, can’t be overlooked. These changes can even help prevent and reduce hypertension. “We still believe first-line therapy for hypertension is lifestyle modifica-tion,” Oberman says. “Patients really do play the largest role in treating their condition.”

Hale is a case in point. Last winter, some 15 years after his initial hyper-tension diagnosis, he took a two-day Johns Hopkins patient education course on managing heart disease and stroke called Heart to Heart (see “Help for Hypertension”).

Originally, Gene and his wife, Faith, enrolled so they could help Gene’s mother, Dora—who had just suffered a heart attack at 84—better manage her heart disease. By the end of the class, which was developed by Johns Hopkins health educator Karen Stewart, the Hales had made some major changes in their own lives.

They stopped eating fast food and started exercising regularly. They now read nutrition labels; eat a low-salt, low-fat diet; and order salads and baked foods instead of fried when they eat out. So far, Gene has lost 15 pounds, and his cholesterol and blood pressure have decreased.

“At my last physical, my numbers were great—my blood pressure was down to 128 over 78,” Gene says.

His physician had only one sugges-tion. “Whatever you’re doing, keep doing it.”

Only about 47 percent of people with hyperten-sion have the condition under control, and that’s a concern, says Margaret Oberman, M.D. “We know that high blood pressure can lead to heart disease, stroke, kidney disease and peripheral vascular disease.”

www.hopkinsmedicine.org/usfhp PatriotLife • WINTER 2015 • 5

6 • PatriotLife • WINTER 2015

Blood Pres . sure: the force with which blood moves through a person’s body

What the numbers mean

12080

Systolic: This number represents the pressure in your blood vessels when your heart beats.

Diastolic: This number represents the pressure in your vessels when your heart rests between beats.

noun

12080

Normal

12080

At Risk

13990

14090

High

Blood PressureLevels

We have been notified by the Department of

Defense that pharmacy copayments will change

for TRICARE® beneficiaries, including Johns Hopkins

US Family Health Plan members, effective March 1,

2015. USFHP members will receive a letter outlining

the new copay amounts.

Check “What’s New” at hopkinsmedicine.org/usfhp for

updates, or call Customer Service at 1-800-808-7347 if

you have any questions.

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BRIEFING ROOM

In the fall issue of Patriot Life, we included an error in our advice for preventing urinary tract infections (p. 2). The article should have read: “Practice good hygiene by wiping from front to back.” We apologize for the mistake.

Correction

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A variety of pharmacy information and resources are available to you on the USFHP member website. Resources include TRICARE Formulary information, which is a list of medications that are covered by USFHP. It explains how you or your doctor can request approval for medications that require prior authorization. The TRICARE Formulary is updated regularly to include new medications and safety information. Look for updates to the TRICARE Formulary at hopkinsmedicine.org/usfhp/pharmacy. You can also contact Customer Service at 800-808-7347 with any questions about pharmacy benefits.

Quick Reference

The winter season is a popular time for traveling, which brings the risk of incurring medical costs while you’re away from home. The good news? If you must pay for urgent or emergency care while traveling, you may be reimbursed for medically necessary, covered expenses once you have completed and submitted a member reimbursement form and the appropriate supporting documentation. Member reimbursement forms can be obtained online at: www.hopkinsmedicine.org/usfhp/mem-ber_forms.

To ensure prompt reimbursement, please be sure to include the following documentation with the completed reimburse-ment form:

• Proof of payment (i.e., canceled check, credit card receipt, electronic funds transfer receipt, receipt from provider’s office)

• Copy of itemized bill, invoice or receipt• CPT code or description of services• ICD-9 code or description of diagnosis• Date(s) of service• Provider ID number, name and address• Billed amount for each service• Signed and dated member reimbursement form

Completed forms must be received no later than 365 days after the date of service. In most instances, the reimbursement check will be issued to the sponsor. If a valid reimbursement form is signed and submit-ted by an eligible family member over the age of 18, payment may be issued to that family member. Need help? Call our customer service team toll free at 800-808-7347 Monday through Friday from 8 a.m. through 4:30 p.m. for assistance.

Pharmacy Resources

Get Reimbursed

PatriotLife • WINTER 2015 • 7

Privacy and Confidentiality

It is the policy of the Johns Hopkins US Family Health Plan, the “Plan,” to protect the privacy and security rights of all of its health plan members; to maintain the confidentiality of health plan information (oral, written, and electronic); and to comply with all appli-cable federal and state privacy and security laws and regulations, including those under the Health Insurance Portability and Accountability Act (HIPAA). Information provided to the Plan is kept confidential and will only be used by the Plan for such purposes as but not limited to:

• Care coordination • Claims processing• Coordination of benefits with other plans• Subrogation of claims, review of a disputed claim• Program integrity activities (examples: investigation of fraud,

waste, abuse or privacy theft)• Quality improvement activities• Other health care operations and/or payment purposes

To ensure responsible maintenance of your protected health information (PHI), the Plan has implemented internal policies and procedures to address how we further protect, secure and limit use and disclosure of your oral, written and electronic health Plan information. USFHP verifies the identities of both the member and requestor prior to responding to a request for a member’s PHI. Examples of such contact include but are not limited to:

1. Questions about your care management or payment activities 2. Requests to look at, copy, obtain or amend your plan records 3. Requests to obtain a list of plan disclosures of your health information

The Plan secures and limits access to hard copy and electronic files. Electronic data is password protected. Internal controls are in place to ensure that only those workforce members with a “need to know” have access to information required to perform their specific job functions. All workforce members are required to only utilize and/or ac-cess the “minimum necessary” information to perform their assigned tasks. For additional information regarding your privacy rights, please see your notice of pri-vacy practices. If you don’t have one, you may obtain a copy by calling Customer Ser-vice at 800-808-7347 or 410-424-4528. You can also find a copy of this document on our website at hopkinsmedicine.org/usfhp.

WINTER 2015www.hopkinsmedicine.org/usfhp

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WINTER 2015www.hopkinsmedicine.org/usfhp

Quality ImprovementWe continually strive to improve the quality of care and services delivered to you, the Johns Hop-kins US Family Health Plan members. We use a variety of tools to assist in measuring quality, a few of which include HEDIS (Health Effective-ness Data Information Set) and member and provider satisfaction surveys. To learn more about our quality improvement program and our prog-ress toward meeting our goals, call 410-424-4528 or visit hopkinsmedicine.org/usfhp. Watch the website and Patriot Life throughout the year for updates. Population Health ProgramsWe have a variety of programs to help you man-age chronic health conditions, recover fromserious illness and make healthy lifestyle choices.These services are provided at no cost to you.Members with certain needs may be enrolled au-tomatically in appropriate programs but are underno obligation to participate. For details, visithopkinsmedicine.org/usfhp. If you have questionsabout the population health programs and wouldlike to participate, call 410-762-5206 or 800-557-6916 Monday through Friday, 8:30 a.m. to 5 p.m.,or email us at populationhealth@jhhc.com. Utilization ManagementOur utilization management program ensures that you receive the right care at the right time in the right setting. Utilization management deci-sions are based on the need to provide appropriate care and verify the existence of coverage. USFHP does not provide financial incentives to staff for denials nor does it promote underutilization of services. To contact utilization management, call 410-424-4480 or 800-261-2421. Private Health InformationUSFHP is committed to respecting your privacy and confidentiality. Information regarding the collection, use, disclosure and internal protection of your protected health information (PHI) is outlined in the NoticeofPrivacyPractices (NPP) publication and privacy and confidentiality state-ment that you can view on our website. Simply go to hopkinsmedicine.org/usfhp and click on the Members & Visitors link. To receive a paper copy, call USFHP Customer Service at 800-808-7347. USFHP Member HandbookOur recently revised USFHP Member Handbookis packed with vital information about yourbenefits and how to use them. To view the hand-book, go to hopkinsmedicine.org/usfhp and clickon the Members & Visitors link. To receive apaper copy, call USFHP Customer Service at 800-808-7347.

The handbook explains:

•How to access care and obtain primary care services

•Benefits and services included and excluded from your coverage

•Your financial responsibilities for health care services

•Coverage when you are out of the service area •Prescription plan and pharmacy information •How to submit a claim if you receive a bill you

don’t think you have to pay •Your rights and responsibilities as a health plan

member • Information about our network providers and

their qualifications •How to obtain care after normal office hours •How to obtain care from a specialist, mental

health and substance abuse providers, or hospitals

•How to pay us a compliment, submit a complaint or request a review of an adverse decision

•What to do if you think the situation is a medical emergency

•How to obtain assistance if your primary language is not English

•How USFHP evaluates new medical treatments to determine whether or not they should be covered

NurseLineThe USFHP NurseLine gives members real-time telephone access to a registered nurse so that you can get answers to your medical questions to help you understand and assess your situation. The ser-vice is available 24 hours a day, 7 days a week, by calling 866-444-3008. NurseChatJohns Hopkins USFHP members can call or chat with a registered nurse any time of the day or night using NurseLine or NurseChat. Nurses will answer questions and provide information about your medical concerns. If you prefer to use the Internet to get a health question answered, go to hopkinsmedicine.org/usfhp and click on the Contact Us link and scroll down to find Nurse-Chat. This will allow you to reach a registered nurse any time of the day or night. While you’re on the website, check out our other health re-sources, such as the Health Information Library and the Symptom Checker.

Quick Reference

For Important U

S Family H

ealth Plan Services

6704 Curtis CourtGlen Burnie, MD 21060

Johns Hopkins Medicine US Family Health Plan

Mary Cooke, DHAVice President, Johns Hopkins US Family Health Plan & Strategic Military AlliancesJohns Hopkins Health System Melissa Teves, Senior Director, Administration, USFHPKeith Langrehr, Marketing Director, USFHP Susan Fratto, Marketing Manager, USFHPSue De Pasquale, Editor Maria Blackburn, Writer Jason Teves, Designer, USFHP Project ManagerKeith Weller, Photographer (on cover story)

On the cover: Faith and Gene Hale www.hopkinsmedicine.org/usfhp© 2015 The Johns Hopkins University and The Johns Hopkins Health System Corporation

NonProfit Org.U.S. Postage

PAIDAbingdon, MDPermit No. 391PatriotLife

Patriot Life, the official newsletter of the Johns Hopkins US Family Health Plan (USFHP), is published quarterly by Johns Hopkins Medicine Marketing and Communica-tions. For more information, call 800-808-7347.

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