Blue Cross and Blue Shield of New Mexico | Blue for Your Health | Winter 2020

Blue Health FOR YOUR SM

INSIDE 5 EXPERTS IN

WOMEN’S HEALTH Certified nurse-midwives deliver more than babies

8 YOUR BEST CARE

Learn how to live better with diabetes

Winter 2020

To ask for auxiliary aids and services or materials in other formats and languages at no cost, please call 866-689‑1523 (TTY/TDD: 711 ). Blue Cross and Blue Shield of New Mexico complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 855- 710‑6984 (TTY: 711 ). Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dę́ę́’, t’áá jiik’eh, éí ná hólǫ́, kojį’ hódíílnih 855-710‑6984 (TTY:  711 ). Blue for Your Health is published for members of Blue Cross and Blue Shield of New Mexico’s Blue Cross Community Centennial health plan. Medicaid Operations P.O. Box 27838 Albuquerque, NM 87125-7838 Such services are funded in part with the State of New Mexico. Blue Cross and Blue Shield of New Mexico is a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an In- dependent Licensee of the Blue Cross and Blue Shield Association. Website: bcbsnm.com/community-centennial All providers referenced in this document are not employed by and are independent from BCBSNM. Information in Blue for Your Health is not meant to be taken as medical advice. If you have any concerns or questions about content that may affect your health, talk to your health care provider. Models may be used in photos and drawings. Programs offered by Blue Cross and Blue Shield of New Mexico, such as the 24/7 Nurseline and Special Beginnings, do not replace your doctor’s care. Always talk to your doctor about any health ques- tions or concerns. Benefit information provided is a brief summary, not a complete description of benefits. Limitations, copayments, and restrictions may apply. For more information, review your Member Handbook or contact Blue Cross Community Centennial Member Services at 866-689-1523 . If you are speech- or hearing-impaired, call 711 for TTY service. Benefits, formulary, pharmacy network, provider network, and/or copayments are subject to change. LogistiCare Solutions, LLC is an independent company that adminis- ters transportation services for Blue Cross Community Centennial. Prime Therapeutics, LLC is a separate company and is the Pharmacy Benefit Manager for Blue Cross Community Centennial. 2020 © Coffey Communications, Inc. All rights reserved. BCBSNM Medicaid Winter 2020

$ 20 GIFT CARD J O I N OU R AD V I S O R Y BOA R D ME E T I NG S We want to hear from you! Do you have questions about your Centennial Care health plan? Do you have ideas of ways we can improve? We want feedback from our Blue Cross Community Centennial SM members. The easiest way for you to be heard is to attend an advisory board meeting. The Member Advisory Board (MAB) meets six times a year. There are four meetings in Albuquerque and two meetings in other parts of the state. We want to hear about your experience with the services you receive. These services can include behavioral health, physical health, long-term care and more. All Blue Cross Community Centennial members are welcome. The Native American Advisory Board (NAAB) meets like the MAB. But NAAB is a team that can advise Blue Cross and Blue Shield of New Mexico (BCBSNM) on issues related to Native Americans. These can include issues with the health plan or the services you receive. NAAB meetings are held four times a year in different tribal communities in the state. The NAAB may include appointed tribal representatives as well as Native American plan members. We know your time is valuable. To learn more, email bccc_ab@bcbsnm.com or call Christine at 505-816-4316 . If you are speech- or hearing-impaired, call 711 for TTY service. You may also visit bcbsnm.com/community-centennial to view a meeting schedule. Medicaid primary care provider (PCP) update From July through September 2019, 0 PCPs left our Medicaid network . During that same time period, 77 PCPs joined the Medicaid network . For information about these providers and others in the network, go to bcbsnm.com/ community-centennial and click on Provider Finder ® . If you have questions about the provider network, call Member Services at 866-689-1523 (TTY: 711 ). Members who can attend the meeting in person will receive a $20 gift card.

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Keep these Blue Cross Community Centennial phone numbers handy

Member Services: 866-689-1523 (TTY: 711 ) Hours: Monday through Friday, 8 a.m. to 5 p.m. MT Weekends and holidays: Closed. If you call after hours, please leave a message. Your call will be returned the next business day. Care Coordination: 877-232-5518 (TTY: 711 ) The role of the Care Coordinator is to help members with special health care needs, whether at home or in the hospital. If you believe you or your child has special physical, behavioral, and/ or long-term health care 24/7 Nurseline/ AudioHealth Library: 877-213-2567 (TTY: 711 ) Need to know if an injury should be checked? Wor- ried about your child’s fever? Get answers to your health questions 24 hours a day, 7 days a week by calling the 24/7 Nurseline and talking with a regis- tered nurse. The nurse can help you decide what to do. There is also a phone library of more than 500 health topics available through the 24/7 Nurseline. Many of these topics are offered in Spanish. needs, please call the number listed above.

For medical emergencies, dial 911. For urgent care, you can go to an urgent care provider. See the Blue Cross Community Centennial provider directory for a list. Or call Member Services at 866-689-1523 (TTY: 711 ). LogistiCare ® (rides to medical appointments): 866-913-4342 (TTY: 866-288-3133 ) Hours: Monday through Friday, 8 a.m. to 5 p.m. MT If you have a non- emergency medical appointment and need a ride, call LogistiCare. Please call at least three business days in advance to arrange a ride. Do you need after-hours transpor- tation or a ride home from your appointment? Call LogistiCare Ride Assist at 866-418-9829 (TTY: 866-288-3133 ). Logisti- Care Ride Assist is avail- able 24 hours a day, 7 days a week. Ombudsman Specialist: 888-243-1134 (TTY: 711 ) The ombudsman specialist explores unresolved problems and deals with them fairly. The ombuds- man advocates for your rights. This is done by using Medicaid guidelines and BCBSNM resources to help you. The ombuds- man is independent from BCBSNM management.

Need help to manage your health conditions? Blue Cross Community Centennial members can take part in Complex Case Management. This is for members who have many health conditions or a com- plex illness. A provider’s referral is not needed. Interested members can refer themselves, or a caregiver can refer a member to the program. Members can opt out at any time. Our complex case managers are nurses. They will work with you to get care and services to help you manage your health condition(s). The goal of the program is to improve your overall health. When you join, you will get: ■ ■ A comprehensive assessment of your health ■ ■ A case manager who will work with you to develop a detailed care plan ■ ■ A case manager who will help coordi- nate the services you need ■ ■ Education about your conditions, treatment, and ways to manage your medical conditions ■ ■ Close follow-up and communication with your providers, with your approval ■ ■ Ongoing care planning from your entire care team If you would like to learn more about Complex Case Management, speak with your care coordinator, caregiver, or provider. You can also call BCBSNM at 877-232-5518 (TTY: 711 ).

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VA L U E - ADD E D S E R V I C E S AND C ENT ENN I A L R EWARDS F O R P R E GNAN T MEMB E R S Reap the rewards Infant car seat, crib, and baby wrap carrier at no cost to you If you are pregnant, you can receive a car seat, portable crib, and/or baby wrap carrier for your infant.*

To get the car seat :

To get the crib : ■ ■ Participate in the Special Beginnings maternity program ■ ■ Visit your OB provider during the first 12 weeks of pregnancy or within 42 days of enrollment in Blue Cross Community Centennial ■ ■ Call BCBSNM at 888-421-7781 (TTY: 711 ) to learn more

To get the baby wrap carrier : ■ ■ Participate in the Special Beginnings maternity program ■ ■ Visit your OB provider for a postpartum visit between 21 and 56 days after delivery ■ ■ Contact Special Beginnings at 888-421-7781 (TTY: 711 ) for a baby wrap carrier request form, then fax the completed form to 505-816-3854 *Limit: 1 car seat per newborn, 1 portable crib per newborn, 1 baby wrap carrier per newborn

■ ■ Participate in the Special Beginnings maternity program; there is no charge to participate in this program ■ ■ See your obstetrics (OB) provider for eight prenatal visits

about the Safe Sleep Program

Your Blue Cross Community Centennial health plan offers a Special Beginnings program for pregnant members. The program includes: ■ ■ Extra help for moms with special problems during pregnancy ■ ■ A 24-hour toll-free tele- phone hotline; you can talk Centennial Rewards Program To receive $100 in reward points: ■ ■ Participate in BCBSNM’s Special Beginnings program ■ ■ Register for Centennial Rewards by calling 877-806-8964 (TTY: 844-488-9722 )—or go to centennialrewards.com and choose your reward!

Special Beginnings ® for healthier moms and babies

with maternity nurses and ask questions ■ ■ Educational materials about your pregnancy, such as good nutrition and how babies grow ■ ■ Personal phone calls from a trained nurse to talk to you about how you and your baby are doing Call toll-free 888-421-7781 (TTY: 711 ) to participate or to

get more information about this program. You can also email NMCNTLSpecial Beginnings@bcbsnm.com . Participating in Special Beginnings is encouraged for pregnant Blue Cross Community Centennial members.

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C E R T I F I E D NU R S E - M I DW I V E S They deliver more than babies

Certified nurse-midwives (CNMs) are known for helping women give birth. But CNMs also care for women from the time of their first menstrual periods through menopause— and beyond. CNMs are licensed registered nurses. They have an advanced degree in midwifery and have passed a national certification exam. A wide range of services Their background, along with hands-on clinical training, quali- fies CNMs to care for laboring moms and deliver babies. It also allows them to offer a full range of primary care to women, such as: BCBSNM Drug List updates BCBSNM and the Prime Therapeutics Pharmacy and Therapeutics Committee have made changes to the BCBSNM Drug List. To see a complete summary of the changes, go to the website bcbsnm.com/community- centennial . Click on Plan Details . Choose Drug Cover- age and click on 2019 Drug List Updates . While there, you can view the entire Drug List and learn more about your drug benefits. You can also call Member Services at 866-689-1523 (TTY: 711 ) to get this information.

■ ■ Providing well-woman exams, including doing Pap tests and breast exams ■ ■ Providing information about health screenings, tests, and vaccines ■ ■ Writing prescriptions To find a midwife in the

network, go to bcbsnm.com/ community-centennial and click on Provider Finder , or call Member Services at 866- 689-1523 (TTY: 711 ).

Source: American College of Nurse-Midwives

Questions about your care? Call our Health Services department

You can talk to BCBSNM Health Services staff members about our utilization management (UM) process. UM means we look at medical records, claims, and prior authorization requests to make sure services are medically necessary, provided in the right setting, and consistent with the condition reported. Language assistance is available for members to discuss UM issues. You can call us Monday through Friday at 877-232-5518 (TTY: 711 ). These are toll-free numbers. Our hours are 8 a.m. to 5 p.m. MT. You can also call us after hours and leave a message. We will return your call the next business day. If your call is received after midnight, we will return your call on the same business day. Health Services staff will always identify themselves as BCBSNM employees. They will also give you their name and title.

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Are you getting the care you need, when you need it?

Every spring BCBSNM collects information to see if our Medicaid members are getting the care they need, when they need it. BCBSNM looks at the prior year to see if health behaviors are improving or not improving. This is the sixth year that we have looked at our Centennial Care members’ results. The results showed that some health care behaviors improved, and some did not improve.

Annual Dental Exam It is important to have a dental checkup every year. We looked to see if all children ages 2 to 20 had a dental visit in 2019. Over 67% of members got their dental visit. Remember to schedule an appointment with your dental provider in 2020.

Diabetes Care If you have diabetes, it is important to make sure you are getting the right tests. Diabetes can affect different parts of your body. It can cause blindness if your blood sugar is high for a long time. Your kidneys can stop working correctly if your blood sugar is too high. BCBSNM has a disease man- agement program that can help you learn ways to manage your diabetes. All results increased slightly from last year. Please remember to get your blood sugar tested regularly, a retinal or dilated eye exam every year, and a urine test.

2018 (measuring 2017 visits)

2019 (measuring 2018 visits)

Getting yearly dental visit 64.4%

67.9%

Care of Members with Asthma Asthma can be a very hard condition to control. If you have asthma, it is important to make sure you are seeing your PCP. Your PCP will make sure you are taking the right medication to control your asthma. BCBSNM has a pediatric asthma disease management program that can help children learn how to take care of their asthma.

2018 (measuring 2017 visits)

2019 (measuring 2018 visits)

Getting A1C test Getting retinal or dilated eye exam

82.0% 51.1%

83.0% 53.8%

Getting urine test

86.4%

88.6%

Controlling Blood Pressure If you have high blood pressure, try to keep it below 140/90. Getting your blood pressure checked regularly by your PCP will help. Remember to always take your blood pressure medication. The

2018 (measuring 2017 visits)

2019 (measuring 2018 visits)

Refilling asthma medication

51.5%

59.4%

Medicaid member satisfaction

You may have gotten a satisfaction survey this past spring. BCBSNM wanted to find out how happy you are with BCBSNM and your provider. BCBSNM would like to thank you for doing the survey or answering the questions over the phone. The satisfaction survey is called the Con- sumer Assessment of Healthcare Providers and Systems (CAHPS). From the results of the seven areas highlighted, our adult Medicaid members indicated satisfac- tion increasing in two areas: customer service and rating of personal doctor.

Adults—percent who said they were “always” or “usually” satisfied with:

2018 2019

Getting care quickly Getting needed care Customer service Rating of health plan Rating of all health care Rating of personal doctor

84% 80% 82% 82% 88% 90% 75% 75% 78% 74% 81% 84% 88% 84%

Rating of specialist seen most often

The child survey also indicated increased satisfac- tion with customer service.

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Breast Cancer Screening About the same number of women got a mammo- gram in 2019 as in 2018. If you are 40 or over, talk to your PCP about getting a mammogram. ■ ■ Women 40–49: Talk to your provider about when to start having routine screening mammograms. ■ ■ Women 50–74: Talk to your provider about having a mammogram every year or every two years. ■ ■ Women 75 and older: Talk to your provider about continuing with mammograms.

results for members controlling their blood pres- sure increased in 2019. Controlling your blood pressure is an important step in preventing heart attacks, strokes, and kidney disease.

2018 (measuring 2017 visits)

2019 (measuring 2018 visits)

Controlling your blood pressure

45.5%

48.7%

Pregnancy Care It is important for a pregnant woman to be seen by a PCP or obstetrician-gynecologist (OB-GYN) as soon as they can. This should be done in the first three months or when you find out you are preg- nant. Going to all appointments is very important for pregnant women and their unborn babies. Pregnant women receive services and education, so they can understand how to stay healthy and prevent health problems. One to 12 weeks after the baby is born is also a good time to see your provider. If you’re feeling sad or depressed after your baby is born, talk with your provider. The postpartum visit with your provider is important. Your provider can help navigate the many chal- lenges faced during this time. Both prenatal visits and postpartum visits went up over the past year.

2018 (measuring 2017 visits)

2019 (measuring 2018 visits)

Getting a mammogram 41.9%

42.5%

Other Health CareTopics

2018 (measuring 2017 visits)

2019 (measuring 2018 visits)

Getting immunizations

73.5% 73.0% 69.3% 75.2% 89.8% 90.0%

Getting tested for a sore throat Getting the right treatment for upper respiratory infection Avoiding antibiotics for acute bronchitis treatment Taking depression medication regularly for 84 days Taking depression medication regularly for 6 months Seeing a doctor within 7 days after being in hospital for mental health issue Checking weight – Body Mass Index (BMI)

32.9% 34.8%

47.8% 49.1%

32.6% 32.8%

37.4% 21.3%

2018 (measuring 2017 visits)

2019 (measuring 2018 visits)

79.6% 77.9%

Going to prenatal visit

78.6% 61.1%

80.8% 63.5%

Going to postpartum visit

Talking about nutrition Talking about exercise

54.3% 51.8% 47.9% 42.1%

Source: Healthcare Effectiveness Data and Information Set (HEDIS)

your needs. BCBSNM wants to help you access the care you need, when you need it. You may be picked to complete a satisfaction survey. This usually happens in the spring. Your feedback means a lot to BCBSNM! We hope you have the time to answer the questions. You can call us at any time about your satisfac- tion. The phone number for the Quality Improve- ment department is 800-205-9926 . You can also call Blue Cross Community Centennial Member Services at 866-689-1523 (TTY: 711 ) with any concerns. Source: Consumer Assessment of Healthcare Providers and Systems

Children and Children with chronic conditions—percent who said they were “always” or “usually” satisfied with:

2018 2019

Getting care quickly

91% 90%

Getting needed care Customer service Rating of health plan Rating of all health care Rating of personal doctor

82% 81% 85% 90% 88% 84% 87% 85% 91% 91% 88% 84%

Rating of specialist seen most often

BCBSNM works as a team to figure out ways to improve your satisfaction. The team is made up of leaders and other staff who help take care of

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Learn how to live better with diabetes in the coming year

When you learn that you have diabetes, your first question might be, “What can I eat?” Diabetic Self-Management Education and Support services (DSMES) will answer this question and many others. Your first step should be to ask your health care provider to refer you for DSMES. If your provider does not talk to you about these services, bring it up during your visit. DSMES services include a health care team who will teach you how to stay healthy and how to make what you learn a regular part of your life. DSMES services will help you: ■ ■ Make better decisions about your diabetes

■ ■ Work with your health care team to get the support you need ■ ■ Understand how to take care of yourself and learn the skills to: •  Eat healthy •  Be active •  Check your blood sugar (glucose) •  Take your medicine •  Solve problems •  Cope with the emotional side of diabetes •  Reduce your risk of other health problems Why is DSMES important? ■ ■ Learning how to control your diabetes will save money and time, plus help you have fewer emergency and hospital visits. ■ ■ Knowing how and when to

take your medication, how to monitor your blood sugar (glu- cose), and how to take care of yourself helps you manage your diabetes better. ■ ■ Managing your diabetes will help you avoid or delay serious health complications. ■ ■ People who have the knowl- edge and support to manage their diabetes are healthier than those who do not. ■ ■ The skills you learn will help you take better care of yourself. Diabetes management starts with you. DSMES services help people with diabetes learn how to take the best care of themselves. Ask your provider for a referral to DSMES services to help you manage your diabetes better. Schedule an appointment with a provider who is in the Blue Cross Community Centen- nial network. If you need help locating a provider, please contact Blue Cross Community Centennial Member Services at 866-689-1523 (TTY: 711 ). If you need a ride to your provider appointment, call LogistiCare (at least three working days before your visit) at 866-913-4342 (TTY: 866-288-3133 ). Centennial Rewards are available. To learn more, visit centennialrewards.com or call 877-806-8964 (TTY: 844-488-9722 ). Article derived and adapted from the Centers for Disease Control and Prevention, CDC.gov: cdc.gov/ diabetes/managing/education.html

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CAR E L I NK NM H E A LT H HOME S Mental health services for members Centennial member, you must be either:

Sometimes people wish there was someone who understood them better. Or they wish that someone was there to talk to when they feel lonely. Or they wish that someone could help with everyday things, like finding a job or a place to live. CareLink NM Health Homes can give you that extra help. A Health Home is not a place to live. It is a place in your community where you can get coordinated health care services to meet your needs. CareLink NM providers will help you get services for your medical, behavioral health, and social needs. These services, which can help you prevent illness and teach you more about managing illnesses, are for your better overall health. CareLink NM wants to help you meet your health goals. To get CareLink NM services as a Blue Cross Community

■ ■ A child or adolescent age 18 or younger who has been diagnosed with a severe emo- tional disturbance For more information or to see if you qualify, call BCBSNM Community Social Services at 877-232-5518 (TTY: 711 ).

■ ■ An adult over age 18 who has been diagnosed with a serious mental illness

Take medications the right way If you take medication, it’s important to take it exactly as your doctor or pharmacist has directed. Missing doses, taking too much or too little, or stopping cold turkey can be dangerous. Keep these tips in mind:

■ ■ Get organized. Try a pillbox with a com- partment for each day of the week. Another bonus: If you often forget whether you’ve taken your meds already, a glance at the box will tell you right away.

■ ■ Keep it simple. Work with your doctor so you’re only taking medications you really need. And opt for those that call for one dose per day, not multiple doses, if possible.

■ ■ Go on the clock. Take your pills at the same time every day. Try incorporating it into an existing habit, like brushing your teeth or eating breakfast.

■ ■ Make it easy to remember. Write yourself a sticky note. Set an alarm on your phone. Make a recur- ring calendar event. There are dozens of ways to keep your meds top of mind.

Sources: American Heart Association; BeMedWise; U.S. Food and Drug Administration

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Comprehensive care Family doctors are educated in all areas of medicine, which gives them the skills to care for people of all ages. After medical school, family doctors complete three years of residency. During that time they receive training in hospitals, doctors’ offices, and other settings. Family doctors update their training even after they begin practicing. This keeps them current with medical breakthroughs. Family doctors know all about:

■ ■ Treating all organ systems and diseases. ■ ■ Providing preventive medicine to help you maintain your health. ■ ■ Managing chronic conditions, such as diabetes. ■ ■ Providing well-woman care, reproductive counseling and family planning. Some family doctors also offer prenatal care and deliver babies. ■ ■ Caring for you as a whole person, including your mental, physical and emotional health. With these skills, family doctors often serve as primary care physicians. If you have a health condition that requires a specialist, your family doctor will guide you through that process and coordinate your care. Finding the right doctor It’s important to choose a family doctor that you’re comfortable with. Ask your friends and family to recommend someone. Then make an appointment to meet and talk with the doctor. At the visit, be aware of whether the doctor answers all your questions in a manner you can understand and whether you feel rushed during the appointment. For information about these providers and others in the network, go to bcbsnm.com/ community-centennial and click on Provider Finder . If you have questions about the provider network, call

What is a family doctor?

If you’re looking for a health care provider who can take care of your entire family— from your children to your aging parents—then you just might want a type of provider whose specialty name says it all: family doctor.

Member Services at 866-689-1523 (TTY: 711 ).

Source: American Academy of Family

Physicians

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