HealthyFocus Community Solutions

Medicaid Member News | Spring 2013

Special Needs (ENCC) page 2Stop Smoking page 3Healthy Beginnings page 4Healthy Lifestyle Programs page 5

InsideGym Memberships page 5Specialist Care page 6Our Website page 7Value Added Programs page 8

Central Oregon: 800.431.4135 toll-freeThe Gorge: 855.204.2965 toll-freeTTY: 800.735.2900Monday through Friday 8:00 a.m. to 5:00 p.m.

Customer Service

PacificSource Community Solutions manages your Oregon Health Plan (OHP). We use this newsletter to share helpful information about your plan. We want to give you and your family tools to help you live a healthy life.

Si necesita servicios de intérprete, llame al (800) 431-4135 para Central Oregon, o (855) 204-2965 para Columbia Gorge.

Why exercise?Improve your health, feel better, and have fun with exercise. Start slow and easy. Skip the elevator and take the stairs. Work in a garden, walk a dog, or play catch with a child. Try to work up to at least 30 minutes every day. The benefits of regular exercise can help you:• Burn calories to help you lose or maintain your

weight.• Reduce stress, improve your mood, and feel

more relaxed. Some people say they feel more confident and feel better about themselves.

• Sleep better.• Improve muscle strength and the way your

heart and lungs work. • Have more energy.• Improve your cholesterol.• Reduce your risk of heart disease.• Manage other health problems such as

diabetes, depression, arthritis, and falls.Check with your doctor before starting an exercise program. This is most important if you have health concerns.

Help for Members with Special Needs

Exceptional Needs Care Coordination (ENCC) for Members with Special NeedsWe care about you. Do you have many medical or special needs? Are you aged, blind, or disabled? Our nurses can help you get the care you need. We have a great team who manage our Exceptional Needs Care Coordination (ENCC) program. They can help you with your healthcare and community needs. This might include helping make medical appointments or finding transportation to your medical appointments. Our nurses can also help coordinate your care after you get out of the hospital. Their help is at no cost to you. To talk with our ENCC team, please call us.

If you are new to PacificSource Community Solutions and one or more of the following is true for you, please call us.

• You have special needs. You are not able to see your primary care provider (PCP) within your first month on your plan, and/or

• You need prescriptions, medical supplies, or other medical items or services.

We can help you get the medical supplies you need until you can see your PCP.

To get ENCC services, call our Member Support Specialists at (541) 330-2507 or toll-free at (888) 970-2507. TTY users should call (800) 725-2900.

We are open Monday through Friday from 8:00 a.m. to 5:00 p.m.

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If you need to get your plan information in a different

way, please let us know. Call our Customer

Service department

to request the format you

need.

Why should I stop smoking?

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Smoking During PregnancyIt’s no secret that smoking is harmful to your health. But, did you know that when you are pregnant it is also harmful to your baby? When you smoke, your baby is put in danger to the same harmful chemicals as you. Women who smoke during pregnancy are more likely to have medical problems including miscarriage. Babies born to women who smoke during pregnancy are more likely to:• Be born too early.• Have a low birth weight.• Have birth defects such as cleft lip or palate. Breathing in someone else’s smoke when you are pregnant is also harmful for you and your baby. It can cause your baby to be born at low birth weight.

Other Reasons to Stop Using TobaccoStop smoking so you can be a healthier person. Stop smoking so your family will not suffer from secondhand smoke. Here are some other benefits for you when you stop smoking:• Food tastes better.• Better sense of smell.• Cleaner teeth and fresher breath.• Healthier skin.• You are able to be more active.

Quit For Life® Program When you are ready to stop using tobacco, the Quit for Life® program is available to you. Find information at www.CommunitySolutions.PacificSource.com, call

(866) QUIT-4-LIFE or (866) 784-8454 toll-free, (877) 777-6534 (TTY), or enroll online at www.QuitNow.net.

Secondhand Smoke and BabiesSecondhand smoke is not just unhealthy for adults. It is bad for young children. Babies exposed to secondhand smoke can develop breathing problems such as asthma and slow lung growth. It can also cause ear infections.

Healthy Beginnings

Your Child’s Medical and Learning HealthThere is a local program where all children from birth through age five can get learning and medical health screenings. It is called Healthy Beginnings.

The Healthy Beginnings program provides a 12-Point Kid Inspection screening. These screenings are held in different places in Central Oregon. You and your child can visit as many as 12 different health and development stations. You will have one-on-one time with an expert at each station. They can answer your questions. They can help you make plans for any follow-up services that may be needed.

There is no cost. Every child is eligible. The 12 screening stations include:• Behavior and parenting concerns.• Car seat, seatbelt, and bicycle safety.• Concept or learning skills such as naming colors

and objects.• Dental health.• General information including home safety.• Health - height and weight, immunization

schedules, and more.• Hearing.• Infant growth and development.• Motor or movement skills.• Nutrition.• Speech.• Vision.To find a screening event near you, visit www.MyHB.org or call (541) 383-6357. If you have special needs, please email Healthy.Beginnings@HDESD.org for help. Appointments are required.

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The Healthy Beginnings VisionHealthy Beginnings wants all children to start school healthy and developmentally ready to learn.

Their health and learning screenings can help find medical or learning needs your child may have. They can help you get appointments and find the resources you and your child need. They give support to both parent and child to help your child be ready to learn and grow.

Healthy Lifestyle Programs

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Healthy Living Tools OnlineHealthCoach4me is a free online health program for you. It has many tools to help you on your journey to a healthier life.

Check it out! Go to our website at www.CommunitySolutions.PacificSource.com. Click on “Already a Member.” Click on “HealthCoach4Me” then “Register Now” to enroll for free.

After you register, you can get important information and a coaching plan for:• Asthma• Breast Cancer• COPD• Diabetes• Diet and Nutrition• Exercise and Activity• Heart Disease• Medicine• Migraine• Quit Smoking• Stress Management• Vaccinations• Weight Management

Low Cost Gym MembershipsYou can now get low cost health club memberships. Our new discount gym membership is called GlobalFit. What does that mean?• There are over 10,000 gyms nationwide. • Gyms include 24 Hour Fitness, Anytime

Fitness, Curves, Jazzercise, and more.• Discount rates are for new gym

memberships.• You have the same benefits as a full-cost

membership.You will have 24-hour access to online tips and resources. For more information or to find a gym near you, please click on the GlobalFit link under “Already a Member” at www.CommunitySolutions.PacificSource.com. Or, you can call Customer Service (phone numbers are on page 1).

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Referrals for Specialist Care

Care CoordinationDo you have a long-term (chronic) health condition such as diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure, or high blood pressure? We can help with one-on-one support to:• Improve your

health.• Identify your health

goals. • Coordinate your

care with your doctors.

For more information, please call our care coordinator at (541) 330-2507 or (888) 970-2507 TTY users, please call (800) 735-2900.

Specialist Care and ReferralsSometimes you might need to get specialty care. We want you to know that most specialist services require a referral from your PCP.

IMPORTANT! If you see a specialist without a referral from your PCP:• PacificSource Community Solutions will not pay for

your care. • You may be billed for those services.

The following is a list of services that do not need a referral from your PCP. Unless noted, you must use a PacificSource Community Solutions network provider.• Annual women’s exam.• Immunization shots.• Maternity care (referral from your PCP is needed to

see a specialist other than your maternity doctor).• Mental health (see referral list below*).• Chemical (drugs and alcohol) dependency.• Routine vision exams.

For Mental Health Referrals:• Deschutes County: Deschutes County Behavioral

Health at (541) 322-7500, TTY (541) 322-7610.• Crook County: Lutheran Community Services at

(541) 447-7441, TTY (866) 475-7113.• Jefferson County: Best Care Treatment Services at

(541) 504-9577, TTY (800) 735-2900.• The Gorge: Mid Columbia Center for Living at

(541) 296-5452 (The Dalles) or (541) 386-2620 (Hood River), TTY (800) 735-2900.

Information on our Website

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What can you do on our website?If you have questions about your health insurance, our website is a great place to start. It is open 24 hours a day. Go to www.CommunitySolutions.PacificSource.com.

You can find plan information, such as your member handbook. You can search for doctors who have a contract with us. You can find a network pharmacy near you. Do a search to see if your prescription is a covered drug. Learn if it is a generic or a brand name drug and if there are any limits. You will find other resources that can help you live a healthy life.

If you cannot find answers to your questions on our website, please call Customer Service (see page 1 for phone numbers.)

Look what you can find on our website!Go to www.CommunitySolutions.PacificSource.com. You will find important and interesting information about your health plan.• Find a doctor.• Find a pharmacy.• Find out if your drug is covered.• View your member handbook.• Printable forms.• Get helpful resources.• Get Medicaid information.• Get enrollment information.• Learn more about PacificSource.

2965 NE Conners AvenueBend, Oregon 97701

Community Solutions

MISC1768_DMAP Approved 03072013

Value Added Programs Now Available to You at No CostValue added programs are extra services we provide you as part of your medical benefits. These programs provide you with health services, tools, and information. They can help you reach your best possible health. We offer these programs at no additional cost for you.

We can help you find resources that meet your needs. We can answer any questions you may have. We can also see if one of our free programs may help you. If you need help with any of the topics on the left, please contact us (phone numbers are on page 1).

• Health concerns.• Mental health concerns.• Alcohol or drug use concerns.• Coordinating your care.• Working with your doctors.• Behavioral and mental health.• Trying to stop smoking?• Questions about your

medicines?