CareNotes Issue 1 2021

Your health is important to us. That’s why our Member Services Representatives are specially trained to help you understand your benefits so you can reach your best health. If you have any questions, please call us at 1-844-444-4410 (TTY 711). We’re here for you 24 hours a day, seven days a week, 365 days per year.

Table of Contents

  • Your annual wellness exam: a key part of staying healthy

  • 5 tips to get the most from your plan

  • Our commitment to quality

  • Do you have an advance directive?

  • Coming soon: the Horizon NJ Health App

  • Important information for members with behavioral health conditions

  • Our member advocates are here for you

  • 5 ways to prevent falls

  • You may be eligible for Horizon NJ TotalCare (HMO D-SNP)

  • When is Urgent Care the right choice?

  • Follow-up care after an Emergency Room (ER) visit

  • Are you at risk for aspiration pneumonia?

  • New name, same service: LogistiCare is now ModivCare

  • 5 ways to keep your eyes healthy

  • Member rights and responsibilities

  • We can help you quit smoking or vaping

  • COVID-19 vaccine update

  • COVID-19 vaccines: what to expect

  • COVID-19 vaccination megasites in NJ

  • Changes to covered medicines

  • New generics

  • First aid for seizures

Your annual wellness exam: a key part of staying healthy

We make appointments to see our doctor for many different reasons. While some of us only go to the doctor when we are sick, your Primary Care Provider (PCP) can actually offer much more. One way to achieve good health is to have an annual wellness exam. Your PCP can address any concerns before they become serious issues down the road.

If you haven’t seen your PCP for a wellness exam in the past year, now is the time to get that visit on your calendar.

During your visit, talk to your PCP about:

  • Your blood pressure

  • Preventive screenings you may need, such as breast cancer, colorectal cancer and diabetes

  • Medications (over-the-counter and prescriptions) you are taking

  • Health concerns or questions you have

  • Vaccines you may need

There are no copays for annual wellness exams – they are part of your covered benefits.

4 reasons to schedule your annual wellness exam today:

  1. Prevent health problems. Annual wellness exams allow your doctor to review any changes that have occurred over the last year. Together, you can identify risk factors that could lead to future health problems.

  2. Strengthen the relationship between you and your doctor. People who get along with their doctors are more likely to go see them, be honest with them and listen to their advice.

  3. Update vaccines. Staying up to date on vaccines is an important way to prevent diseases.

  4. Review medicines. Your doctor will go over all of the medicines you are taking, including over-the-counter medicine. This will help identify issues such as side effects or drug interactions.

5 tips to get the most from your plan

We work hard to offer you exceptional programs, care management and member services that go beyond other MLTSS plans. To get the most from your Horizon NJ Health plan:

1. Build a relationship with your PCP.

The right care starts with your PCP. Your PCP should:

  • Listen carefully to your health concerns

  • Help you get access to a specialist

  • Explain things in a clear and understandable way

  • Talk to you about any medications you are taking

If you need to change your PCP for any reason, please call Member Services at 1-844-444-4410 (TTY 711).

2. Let your personal Care Manager help you coordinate all of your health care needs.

Our Care Management team can help you understand your benefits and coordinate the care you need.

You’ll get a Plan of Care with health goals that are right for you – with support along the way so you can reach them. Your Care Manager will help connect your doctors and pharmacists and even assist with prior authorizations (pre-approvals) for any services you need. To reach a Care Manager, call 1-844-444-4410 (TTY 711), weekdays, 8 a.m. to 5 p.m.

3. Schedule preventive care visits and health screenings.

We will send you reminders for preventive care, like your annual wellness visit and flu shot. When you get the reminders, make sure to schedule an appointment with your PCP or other provider. Staying up to date on your vaccines and preventive care can save your life.

4. Get appointments with your doctor quickly and easily.

Your time is valuable. If you’re on time for your appointment, you should not have to wait too long to see your doctor. Things to remember:

  • When making your appointment, ask to be the first one seen that day.

  • Call us if you need help getting an appointment with a specialist.

  • Ask your doctor’s office to let you know if they are running late.

5. Access your benefits with our online tools.

Sign in to our secure member web portal at horizonNJhealth.com to:

  • View your covered benefits

  • Enroll in a Disease Management program

  • Request a new member ID card

  • Change your PCP

Your voice matters.

You may get a survey in the mail asking about your experience with your health plan. Please complete this survey to let us know what we’re doing well – and help us understand what we can do better.

Our commitment to quality

We want to make sure that the care and services you get are appropriate, necessary and properly administered. That’s why we have a Quality Improvement (QI) program that works with members and providers to improve the quality of the care and services you receive.

We monitor areas that affect the care our members get, like access to care, screenings and member satisfaction.

For more information about how Horizon NJ Health’s QI program is improving the care you get, visit horizonNJhealth.com/quality, or call Member Services at 1-844-444-4410 (TTY 711) and ask for the Quality Department.

Do you have an advance directive?

An advance directive is a legal document that lets others know how you want to be cared for if you become too sick to tell them. If you don’t already have one, you should make one now, while you are healthy enough to make your own health care decisions.

In New Jersey, there are three kinds of advance directives:

• A proxy directive names the person you want to make your health care decisions for you when you no longer can. This person must be at least 18 years old.

• An instruction directive gives your wishes and instructions for your own care.

• A combined directive names a person and gives instructions for your care. It is a combination of a proxy directive and instruction directive.

Before you make an advance directive, you should talk to your doctor about your care options.
For more information and forms, you can visit state.nj.us/health/advancedirective.

Coming soon: the Horizon NJ Health App

Later this year, you will be able to use the Horizon NJ Health App to quickly and easily access your benefits from your smartphone or tablet. The app will be free to download. We will let you know when it becomes available.

Until then, make sure you register and sign in to the secure member web portal at horizonNJhealth.com. You can use the portal to change your PCP, enroll in a Disease Management Program, request a new member ID card and more!

Important information for members with behavioral health conditions
Do you need help with a medical, substance use disorder or behavioral health issue?

Seeking help in difficult times is an important step for your health and wellness. Many providers offer telehealth services to make it easier for patients to get the care they need from home. If you need care for a medical, substance use disorder or behavioral health issue, call Member Services at 1-844-444-4410 (TTY 711), and we will help you find a telehealth provider.

Are you missing important laboratory tests?

Certain medications that are used to treat mental health conditions or substance use disorders can increase your risk for other health concerns. Laboratory testing can find problems early and address them in a timely manner. If you are being treated for any of the conditions below, talk to your health care provider about which tests you may need.

Adults (18 years and older) being treated for bipolar disorder, schizophrenia or schizoaffective disorder should be screened for:

• Diabetes • Cholesterol

Children and teens who are prescribed medications such as haloperidol, risperidone, aripiprazole, quetiapine, olanzapine, ziprasidone and others should be screened for:

• Blood glucose levels • Cholesterol

Our Member Advocates are here for you

All MLTSS members have access to a Member Advocate. This person works with you to make sure any questions about your MLTSS benefits, services and decisions are answered. He or she works closely with you, your care team and state representatives to make sure your needs and goals are being met.

To speak with a Member Advocate, please call 1-844-444-4410 (TTY 711), weekdays, from 8 a.m. to 5 p.m. ET, or ask your Care Manager for a Member Advocate to contact you.

5 ways to prevent falls

Did you know that falls are the most common cause of injury in older adults? But, falls can be prevented.

Here are some ways you can prevent falls and stay independent:

1. Talk to your doctor about your medications and any changes you feel in your strength or balance.

2. Exercise to improve strength and balance, such as doing yoga, Tai Chi or resistance training.

3. Ask for help carrying groceries and home/yard maintenance.

4. Keep your home safe. Keep floors clear of tripping hazards and install grab bars in stairwells and the bathroom.

5. Have your eyes checked at least once a year.

You may be at a higher risk for falls if you:

• Are overweight • Have impaired vision or hearing

• Drink alcohol • Have low levels of vitamin D

• Have arthritis (joint swelling) • Take medicines that make you drowsy

• Have dementia

Talk to your doctor about your risk for falls and ask if you need to take vitamin D supplements to improve your bone, muscle and nerve health.

Source: cdc.gov

You may be eligible for Horizon NJ TotalCare (HMO D-SNP)

If you are eligible for both Medicaid and Medicare, you can get all your health care benefits at no cost under one, convenient plan. Horizon NJ TotalCare (HMO D-SNP) offers:

  • $0 copays

  • $0 premiums

  • No referrals

  • A $0 gym membership or home fitness program

  • $375 per quarter on an Over-the-Counter (OTC) Benefit Card to spend on health items at participating retail stores

  • $250 per quarter to spend on personal items from our catalog

  • For more information, call 1-888-328-5736 (TTY 711), 24 hours a day, seven days a week, or visit HorizonBlue.com/TotalCare.

When is Urgent Care the right choice?

For most medical care, your PCP should be the first person you call. But if you can’t reach your doctor or need care outside of regular office hours, an urgent care center can be used for an illness or injury that is not life-threatening.

An urgent care center is a walk-in clinic that offers medical care in a facility outside of a traditional Emergency Room (ER). Urgent care centers have doctors and other health care professionals on site and most can provide services such as X-rays and laboratory tests. The wait time for care is usually shorter than at the ER.

Conditions that can be treated in an urgent care center include:

  • Eye irritation and redness • Skin rash and infection

  • Fever or flu • Sprains and strains

  • Minor broken bones and fractures • Urinary tract infection

  • Sore throat and cough • Vomiting, diarrhea or dehydration

Remember, for a life-threatening emergency, such as a heart attack or serious head injury, you should call 911 or go to the nearest ER.

Follow-up care after an ER visit

After an ER visit, it’s important to follow up with your health care provider within seven days. This simple step can help prevent another trip to the ER. To make it easier to get care, many providers are offering telehealth visits. If you would like help finding a provider, call Member Services at 1-844-444-4410 (TTY 711), 24 hours a day, seven days a week.

Are you at risk for aspiration pneumonia?

Aspiration pneumonia happens when food, saliva, liquids or vomit are breathed into lungs instead of being swallowed into the stomach. Older adults, stroke survivors and people with conditions like dementia, Parkinson’s disease, multiple sclerosis or cerebral palsy have a higher risk of getting aspiration pneumonia.

Prevent aspiration pneumonia:

  • Alternate solid and liquid foods, and allow some rest between mouthfuls.

  • Avoid medicines that may cause drowsiness, which can increase difficulties with swallowing or coughing.

  • Eat slowly, and take small bites.

  • Practice good oral hygiene, especially after eating, to remove food particles and to help prevent a buildup of bacteria in the mouth.

  • Rest for 30 minutes after eating.

  • See a speech therapist or swallow therapist.

  • Sit upright when eating.

Sources: MedlinePlus, medlineplus.gov

New name, same service: LogistiCare is now ModivCare

LogistiCare, the non-emergency medical transportation vendor for NJ FamilyCare members, is now ModivCare. You still have access to the same benefits for non-emergency transportation for medical care, only the name has changed.

If you need to schedule a ride to a doctor’s appointment, you can call 1-866-527-9933 (TTY 1-866-288-3133) or visit ModivCare.com.

5 ways to keep your eyes healthy

Good vision is important to your overall health. Seeing an eye doctor for routine eye exams can help find problems early and protect your vision, especially as you age.

To keep your eyes healthy:

1. See an eye doctor once a year – Your doctor will check for problems like glaucoma and age-related macular degeneration.

2. Eat a healthy diet – Choose lots of fruits and vegetables.

3. Maintain a healthy weight – Exercise and stay active.

4. Wear sunglasses – Look for sunglasses that block UV-A and UV-B radiation.

5. Give your eyes a break – If you spend a lot of time on a computer, rest your eyes every 20 minutes.

Routine eye exams are covered under your benefits at no cost to you. If you need help finding an eye doctor, call 1-844-444-4410 (TTY 711) or visit horizonNJhealth.com/findadoctor.

Are you diabetic? Keeping your blood sugar, blood pressure and cholesterol under control will help protect your eyes. You should have a diabetic eye exam every year.

Member rights and responsibilities

As a Horizon NJ Health member, you have rights, responsibilities and choices in the care you get. Your member rights and responsibilities can be found in your Member Handbook and at horizonNJhealth.com/memberrights.

We can help you quit smoking or vaping

If you smoke or vape, quitting will reduce your risk of heart disease, cancer and other serious health problems. You will also save money and feel better.

The thought of quitting may be overwhelming, or you may not know where to start. We’re here to help. Horizon NJ Health covers counseling, prescription medications and over-the-counter products (like nicotine patches and gum) to help you stop smoking or vaping.

You can also get help from:

  • NJ Quitline: Design a program that fits your needs and get support from counselors. Call 1-866-NJ-STOPS (1-866-657-8677) (TTY 711), weekdays, from 8 a.m. to 8 p.m., and Saturday from 11 a.m. to 5 p.m., ET. Get support online at njquitline.org.

  • NJ QuitCenters: Receive professional face-to-face counseling in individual or group sessions. Locate a center by calling 1-866-657-8677 (TTY 711) or visit quitnet.com.

Don’t wait to quit – call your doctor today and make a plan!

COVID-19 vaccine update

A phased rollout for the COVID-19 vaccine has begun in New Jersey. The COVID-19 vaccine is covered at no cost to you. To learn more about COVID-19, the approved vaccines and information about where you can get vaccinated, visit covid19nj.gov.

It is important to continue to protect yourself and others from COVID-19, even after you get the vaccine. The Centers for Disease Control and Prevention (CDC) recommends you:

  • Wear a mask: cover your nose and mouth with a non-medical or cloth mask.

  • Practice social distancing: stay six feet apart from others not in your household.

  • Wash your hands frequently: use warm water and soap for 20 seconds or hand sanitizer with at least 60% alcohol.

  • Stay home and avoid contact with others if you are sick or start to have symptoms like a runny nose, cough or fever.

If you have been exposed to someone with COVID-19, or you are experiencing symptoms, call your doctor.

A message from Don Liss, MD

Vice President and Chief Medical Officer, Horizon Blue Cross Blue Shield of New Jersey

Horizon NJ Health encourages you to follow the recommendations of the CDC and the New Jersey Department of Health to get a Food and Drug Administration (FDA) authorized COVID-19 vaccination. The FDA requires extensive testing for safety and effectiveness before vaccines are used. Until everyone is protected by vaccination, you should continue to avoid people who are sick, social distance, wear a mask in public and wash your hands often to avoid spreading infection.

Changes to covered medicines

There are recent changes to our formulary list, also called a preferred drug list (see box). The changes found in this list will be added to our Drug Formulary list at horizonNJhealth.com/covered_drugs. This list includes an explanation and listing of step therapy, quantity/age limitations and drugs that require prior authorization (approval). Paper copies are available upon request. Here is a list of recent changes:
 

Here is a list of recent changes:

Covered Change Description

Brand (Generic) Drug Name

Alternatives (if applicable)

Covered

Insulin Lispro Kwikpen 75/25

Covered

Focalin XR (dexmethylphenidate ER)

Covered

Onfi (clobazam) tablets

Covered

Otovel (ciprofloxacin/fluocinolone)

Covered

Jelmyto (mitomycin)

Covered

Koselugo (selumetinib)

Covered

Tabrecta (capmatinib)

Covered

Retevmo (selpercatinib)

Covered

Rhinocort Allergy (budesonide)

Covered

Lyrica Solution (pregabalin)

Covered

Lunesta (eszopiclone)

Covered

Ambien CR (zolpidem ER)

Covered

Rapaflo (silodosin)

Covered

Micardis (telmisartan)

Covered

Tricor 48mg (fenofibrate)

Covered

Avsola (infliximab-axxq)

Covered

Evrysdi (risdiplam)

Covered

Oriahnn (elagolix, estradiol, and norethindrone acetate)

Covered

Enspryng (satralizumab-mwge)

Covered

Dojolvi (triheptanoin)

Not Covered

Cipro HC (ciprofloxacin/hydrocortisone)

generic Ciprodex

Not Covered

Cortisporin (neomycin/polymixin/hydrocortisone) suspension

generic Cortisporin solutionn

Please talk with your Primary Care Provider (PCP) about these changes. If your PCP decides that, for medical reasons, you must take a drug that is not on the formulary list or needs pre-approval, including a brand name medication exception, he or she can call us and ask for special permission (prior authorization) for you to get the drug. Please note that Horizon NJ Health maximum days supply limit is 30 days.

New generics

Horizon NJ Health is committed to providing the most up-to-date information regarding new generics that are available, and we encourage using generic products prior to using brand name products, when appropriate. Generic drugs are the same as brand name drugs in quality, strength, purity and stability, as required by the Food and Drug Administration.

The following generic drug is currently on the market or expected to be on the market within the next three (3) months.

Generic Name

Brand Name

Lubiprostone

Amitiza

First aid for seizures

Seizures can happen quickly and usually last a few minutes. Once a seizure starts, there isn’t much you can do to stop it. But, there are things you can do to protect the person from harm until their seizure stops.

If someone is having a seizure, you should:

  • Call 911 and check to see if the person has a medical alert bracelet.

  • Ease them to the floor, if possible.

  • Give them room. Keep other people back.

  • Clear hard or sharp objects, like glasses and furniture, away from the person.

  • Cushion their head, if possible.

  • Loosen clothing around their neck if you can safely do so.

  • If you can remember, time when the seizure starts and when it ends.

  • After the movements stop, gently place the person on their side if you can or turn their head to the side.

  • Stay with the person until the seizure ends or until medical help arrives.

  • Once the seizure stops, speak calmly, reassure the person and explain to them what happened.

  • Do not try to hold the person down or stop their movements.

  • Do not put anything in their mouth – you could damage their teeth, or they may bite you. You can’t swallow your tongue during a seizure.

If you have seizures or care for someone who does, talk with your doctor. There may be medication you can take for your condition.

Sources: American Epilepsy Society, aesnet.org, cdc.gov/epilepsy/about/first-aid.htm