Presbyterian Health Plan, Inc. P.O. Box 27489 Albuquerque, NM 87125-7489 www.phs.org Important plan information MC Standard U.S. Postage PAID Presbyterian Health Plan INSIDE Check out the Health Plan Place! 6 Tips for mental well-being 8 Your Summer 2024 for Presbyterian Senior Care (HMO/HMO-POS), Presbyterian MediCare PPO, Presbyterian UltraFlex (HMO-POS), and Presbyterian Dual Plus (HMO D-SNP) members Everyone knows it’s important to stay healthy and prioritize your well-being, but sometimes it can be hard to know how to do that or where to begin. Being actively involved in your healthcare and understanding the resources available to you is a great place to start. Presbyterian Health Plan (PHP) has many great ways to help you take control of your health journey. Get care. Go to www.phs.org/getcare for your one-stop shop for getting the care you need. You can explore options for virtual and in-person care. You can find and schedule primary care, urgent care, or behavioral health Virtual Visits; call the PresRN nurse advice line; or find and schedule in-person primary care, specialty care, urgent care visits, and more! Digital tools. Presbyterian Health Plan offers a variety of digital resources to help you learn about simple and more convenient ways to manage your health and health plan benefits. See page 3 Get involved in your care! for more details about the digital tools available to you. PresRN nurse advice. Presbyterian Health Plan members can call a registered nurse who can help answer questions and guide you to the right care options. PresRN is available 24 hours a day, 365 days a year, at no cost to PHP members. Free interpreter services are available upon request. Call (505) 923-5573 or 1-888-887-9917. — Continued on page 2
2 Presbyterian Health Plan may ask you to complete a survey at various times throughout the year. We hope you’ll take the time to respond. Learning about your experiences is very important to us. It helps us improve in the ways that are most meaningful to our members and deliver the high-quality care you’ve come to expect from your Presbyterian Health Plan. myPRES app. Managing your health is easier than ever when you download the myPRES app. You can access your Presbyterian member ID card from the homepage, view your benefits, view bills and claims, track prior authorizations, and access MyChart. You can download the app on Apple and Android devices. Simply search for myPRES in the Apple App Store or the Google Play Store. If you do not have a myPRES account, you will need to create an account. You can create an account at www.phs.org/mypres. Care coordination. Care coordination is provided through PHP at no cost to help you access the care and services you need. Care coordinators work with you to find out what physical, social, and behavioral health needs you may have. This is for members with chronic long-term, complex, or behavioral health needs. The level of care coordination you receive depends on your needs. The care coordinator does not provide direct care services, such as home care or therapy services. They work with you and your primary care provider (PCP) to determine the services you need and then refer you to services and programs in your community that can help you. Your care coordinator will be your main point of contact with PHP. Call the number on the back of your Presbyterian member ID card for more information. Health Plan Place. Located at Winrock Town Center, Albuquerque, Health Plan Place is a service and support center focused on providing comfort, wellness, and community to Presbyterian Health Plan Medicare Advantage members and the public. Learn more about Health Plan Place on page 6 or visit www.phs.org/health-plan-place. SilverSneakers. Keep improving your fitness with SilverSneakers at no cost. SilverSneakers includes membership to thousands of fitness locations and group exercise classes designed for all abilities. The program also has digital options for staying fit, like online workout videos and a mobile app to keep you moving wherever you are. Visit www.silversneakers.com to learn more. Get involved in your care! Remember, it’s important to speak up if you have questions or need help. Presbyterian Customer Service Center will gladly assist you. Just call the number on the back of your member ID card. — Continued from front page Presbyterian Health Plan (PHP) wants to make you aware of your right to opt out of future marketing calls from its Medicare Sales team. PHP does not typically market to its members through the phone, but all members have the right to opt out of future calls at any time. This could include calls to discuss Medicare Advantage products that are different from your current Medicare plan, whether you’re new to PHP, aging-in to Medicare, or are an existing enrollee. If you would like to opt out, please call the number on the back of your ID card and ask to opt out from marketing calls. Opt out of marketing calls Your feedback matters — please take part in surveys!
www.phs.org/Medicare 3 You can use your phone, tablet, or computer for just about anything these days, including your healthcare. From Video Visits to wellness apps and more, there are many benefits to using telehealth and digital tools to help take charge of your health and well-being. Get help with digital tools Telehealth visits are a convenient way for you to get in touch with your provider and engage with your healthcare team. Go to www.phs.org/getcare to get started with a Virtual Primary Care, Virtual Urgent Care, or PHP Talk Therapy Video Visit. You can get access to care when an in-person visit may not be needed, which also reduces time and the hassle of transportation. It’s not only Video Visits — there are many other ways to digitally engage for your healthcare needs: However, sometimes navigating technology can feel overwhelming. If it does, you’re not alone, and we’re here to help. Here are some resources to get you started. Even if you’re not tech-savvy, resources at www.digitallearn.org are designed with you in mind. Sign up for myPRES, our secure member portal that offers even more tools to help you take charge of your health. Learn more at www.phs.org. Visit Health Plan Place at Winrock Town Center, Albuquerque, to learn how to: Here are some ways telehealth and digital tools can help you: If you need help learning about how to obtain a cellphone, there are resources that can help. You may be eligible to receive free government phone service and a phone based on income or if you participate in qualifying government programs. Please visit www.phspartner.link/ assurancewireless to learn more. » Schedule an in-person or video appointment with a provider » See the status of your health insurance claims » Pay bills online » Check test results » Make follow-up appointments » Access your electronic health record » Communicate electronically with your healthcare team » Recognize reliable online health information » Use health and wellness apps » Access our wellness library and tools » Learn how to use wearable health devices » And more!
4 for an aging parent? Caring How to reduce your risk of caregiving burnout
www.phs.org/Medicare 5 Take action Burnout often happens when caregivers don’t take time to care for their own physical and emotional health. Here are some tips from experts that can help reduce your risk for burnout and make you a better, happier caregiver. Ask for caregiving help. Other family members or even friends may be willing to help with some daily tasks — like driving your parent to medical appointments or running errands. Nourish your health. Eat a healthy, balanced diet and get enough exercise and sleep. If you can, take your parent on short walks. Am I burned out? The symptoms of caregiver burnout can include: • Eating too much or too little or drinking or smoking more • Feeling tired or run down a lot • Having trouble concentrating • Feeling irritable or resentful toward your parent • Neglecting your own needs Caregiver stress and burnout can also contribute to mental health problems, like depression, and can even harm your physical health. Make time for hobbies or other activities you enjoy. Try to take at least a few minutes each day to unwind and recharge. Get relief. Ask a relative or close friend to stay with your parent or consider using a respite service (such as an adult day center) so you can take a break. Stay connected. It’s important to keep up your friendships. If you can’t leave the house, invite a friend over for coffee or lunch. Stepping into the role of caregiver for your older parent can be very rewarding. It’s heartfelt work — and it’s also often stressful work. Over time, too much stress can wear anyone down. If the stress becomes overwhelming, you could begin to experience a sense of exhaustion and hopelessness that experts call caregiver burnout. And at that point, you can’t properly take care of your own health, much less tend to your parent’s health and needs. Join a support group in person or online. Share your feelings with other people who may know what you’re going through and who can offer encouragement and possible solutions to ongoing problems. Schedule checkups with your doctor. Speak up if you feel sad, hopeless, or overwhelmed. Sources: American Heart Association; Family Caregiver Alliance; HelpGuide
6 is here Health Plan Place Studies have shown that staying active and connected to friends and your community can keep you young at heart. Presbyterian’s Health Plan Place can help you get the most out of your retirement years. Conveniently located at Winrock Town Center in Albuquerque, it provides classes, volunteer opportunities, health and fitness programs, and social activities for our Medicare Advantage members and local community. Here are some ideas to help you stay active and connected. Make time to do the things you love. If you enjoy cooking, consider taking a cooking class or get together with friends to try out a new recipe or restaurant. Other activities such as crafts, reading, or hobbies can be shared with others, and this might be an opportunity to teach your friends or grandkids some new skills. Connect with new people. Social connections can improve your mood and keep your brain active. Meeting new people can be hard, but there are localto-you resources that can help find people with similar interests. There are also many events and classes at Health Plan Place to help you connect with other people and foster community.
www.phs.org/Medicare 7 to help you enjoy life to the fullest See all that Presbyterian’s Health Plan Place has to offer at www.phs.org/health-plan-place. Make a difference with volunteering or taking part in community events. Giving back to your community is a rewarding activity at any age, but you may find you have some extra time after retirement. If you have skills in a certain area, consider teaching young people how to sew or do carpentry, volunteer for a worthy cause like your local animal shelter or hospital, or just lend a hand to a neighbor who needs a green thumb in their garden. Check out Health Plan Place to see more volunteer opportunities. Expand your mind. Learn new things and take classes to keep your brain active. Participate in a book group and talk about book topics, current events, or favorite titles with others. Keep active in a way that you enjoy. Being physically active on a regular basis will improve your overall health. If you enjoy being outdoors, take a walk with friends and catch up on what is going on in their lives. Try a yoga or Pilates class to stay flexible and practice balance. Health Plan Place also offers a variety of classes for every level of ability.
8 Mental health is an essential part of overall health. It doesn’t become less important with age. In fact, good mental health can help older adults live independently and improve their quality of life. Signs of mental health issues When a person’s mental health is suffering, they may express it in many ways. Some of the most common symptoms in older adults are: • Noticeable mood changes, such as anger, anxiety, irritability, or sadness • Sleeping too much or too little • Less interest in doing things they once found enjoyable • Using alcohol or drugs to cope • Loss of appetite or an unwanted weight change • Difficulty concentrating • Thoughts or behaviors that are disturbing to others Tips for boosting mental well-being Research indicates a link between mental illness and cognitive decline in adults. Helping your aging loved one make healthy changes can improve their outlook on life. Consider these triedand-true tips. A regular exercise routine, especially outdoors. Physical activity and spending time in nature are proven ways to lift spirits. A daily 30-minute walk, or a few rounds of exercise throughout the day (for a total of 30 minutes), is a great habit. Help older loved ones with their mental health Meaningful social connection. Spending quality time with family and friends is an obvious choice. Volunteering is another way to meet new people who have common interests and build a sense of purpose. A healthy diet. Good nutrition, such as eating a variety of fruits, vegetables, and healthy proteins, supports mental health. Good-quality sleep. Maintaining a regular sleep schedule helps seniors get enough rest, as does avoiding TV and mobile device screens before bedtime. Talk therapy. We’re never too old to get help. Therapy — especially with a mental health professional who specializes in counseling older adults — can help your loved one with anxiety, depression, grief, and self-acceptance. Sources: AARP; National Council on Aging; National Institute of Mental Health If you need to schedule a mental health evaluation for a loved one or for yourself, call the number on the back of your Presbyterian member ID card or go to www.phs.org/getcare.
www.phs.org/Medicare 9 Hospice is a special type of medical care. It is meant for someone who is very ill and nearing the end of their life. They often have less than six months to live. In hospice care, a team of providers, nurses, social workers, and others works to: • Keep the person comfortable • Control symptoms, like pain and nausea • Offer emotional and spiritual support The hospice team values input from family members. They keep the family involved in the person’s care. Hospice is a choice. It doesn’t mean the person is giving up. A person can decide to enter hospice if their illness can’t be cured or if they want to stop treatment. Hospice care can manage the side effects of the illness. It also will treat the person’s other health problems. It focuses on quality of life. A person can receive hospice care in: • A hospital • An assisted-living facility • A hospice facility • A nursing home • Their own home Palliative care This care is similar to hospice, but in this case, the ill person isn’t at the end of their life yet. They can still get treatment for the illness. They also will be treated for pain and other side effects. Palliative care can start at any point in a person’s illness. A person who is thinking about end-oflife care should talk with their provider about their options. Sources: AARP; American Cancer Society; National Institute on Aging What to know about hospice care If you would like to learn more about Presbyterian’s hospice services, visit www.phs.org/doctors-services/ healthcare-at-home/hospice.
10 Need a little extra care? The Annual Health and Wellness Assessment (AHWA) program is contracted by Presbyterian Health Plan to perform annual health and wellness exams. The AHWA program provides home, video, and clinic visits at no cost to PHP Medicare Advantage members. These visits provide an opportunity to expand the ways in which your concerns and health issues are addressed. The goal of the program is to provide you with the best experience and most comprehensive care possible. The AHWA program performs visits that are designed to enhance the patientprovider experience. They do not serve as a replacement for your primary care provider. While the program serves the entire state, it has proven to be extra helpful for those in remote areas throughout New Mexico, where it might be harder to access care. If you are interested in scheduling a visit, please call (505) 923-6075. Virtual Primary Care makes it easy to get care Presbyterian offers Virtual Primary Care that allows you to see an online provider from home or anywhere else in New Mexico. If you have transportation or health issues that might prevent you from visiting a primary care provider (PCP) in-person, Virtual Primary Care can make it easier to access the care you need. You can establish care and build a relationship with a PCP online. You can be seen for: • Preventive care • Chronic care management • Medication management • Prescription orders and refills • Lab and radiology orders • Referrals to specialists and in-person primary care when needed Visit www.phs.org/getcare to learn more and schedule a visit. Annual Health and Wellness Assessment
www.phs.org/Medicare 11 Presbyterian Health Plan, Inc. and Presbyterian Insurance Company, Inc. (Presbyterian) are committed to providing outstanding care and services to our members. Our goal is to work continuously to improve your experience. We have a comprehensive Quality Improvement Program (QI Program) that evaluates the care and services you receive. The QI Program includes: • Member experience activities • Quality and safety of clinical care • Quality of service • Annual goals, processes, and activities At the end of each year, we use the QI Program to not only see how we did, but to see what we can do to better serve you the following year. As Mark Twain said, “Continuous improvement is better than delayed perfection.” We learned and implemented many new ways to better serve you in 2023 that we are taking into 2024. Here are just a few of our 2023 activities and results: Presbyterian launched Health Plan Place in the heart of Albuquerque, which creates a tailored, in-person experience for Medicare Advantage members and the community in an environment committed to belonging, community, and health. A new Medicare Advantage clinic also opened at Health Plan Place. This clinic was designed to promote preventive care, complete screenings, optimize therapies, and provide facilitated virtual care. We implemented a treatment cost estimation online tool to give our members the ability to search and compare prices on procedures. Members can also request member ID cards and search for providers on the Presbyterian website. We look forward to continuing to serve you in 2024 and beyond. Our local Presbyterian Customer Service Center (PCSC) is here to help! We’re available 8 a.m. to 8 p.m., seven days a week (except holidays), from October 1 through March 31, and 8 a.m. to 8 p.m., Monday through Friday (except holidays), from April 1 through September 30. Members can reach the PCSC at the following numbers: Presbyterian Senior Care (HMO)/(HMO-POS), Presbyterian UltraFlex (HMO-POS), and Presbyterian MediCare PPO members call: (505) 923-6060 or 1-800-797-5343, TTY: 711 Presbyterian Dual Plus (HMO D-SNP) members call: (505) 923-7675 or 1-855-465-7737, TTY: 711 Other important numbers PresRN: (505) 923-5573 or 1-888-887-9917, TTY: 711 New Mexico Crisis and Access Line (for a behavioral health crisis): 1-855-662-7474 (1-855-NMCRISIS) DentaQuest: 1-888-278-7310 or visit www.dentaquest.com TruHearing: 1-866-202-0110 or visit www.truhearing.com Superior Vision: 1-800-879-6901 or visit www.superiorvision.com (for D-SNP members only) Routine Transportation (for non-emergency medical transportation): 1-855-774-7737 (for D-SNP members only) Over-the-Counter Benefit — Nations OTC: 1-833-746-7682 or visit www.nationsotc.com (for D-SNP and UltraFlex members only) Keep these numbers handy Quality Improvement Program
Yourstory Your Story is published as a community service for the friends and patrons of: Presbyterian Health Plan and Presbyterian Insurance Company, Inc. Managing editor: fluentqc@phs.org A publication of Presbyterian Medicare Advantage Plans. Information in Your Story comes from a wide range of medical experts. Models may be used in photos and illustrations. If you have any concerns or questions about specific content that may affect your health, please contact your healthcare provider. 2024 © Coffey Communications, Inc. All rights reserved. Y0055_MPC032428_ NSR_C_04012024 Like us on Facebook: Facebook.com/PresHealth Presbyterian Senior Care (HMO/HMO-POS), Presbyterian MediCare PPO, and Presbyterian UltraFlex (HMO-POS) are Medicare Advantage Plans with a Medicare contract. Enrollment in Presbyterian Senior Care (HMO/HMO-POS), Presbyterian MediCare PPO, and Presbyterian UltraFlex (HMO-POS) depends on contract renewal. Presbyterian Dual Plus is an HMO Special Needs Plan (SNP) with a Medicare contract and a contract with the State of New Mexico Human Services Department Medicaid program. Enrollment in Presbyterian Dual Plus (HMO D-SNP) depends on contract renewal. Based on a Model of Care review, Presbyterian Dual Plus (HMO D-SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate a Special Needs Plan (SNP) through 2025. Presbyterian 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 (505) 923-5420, 1-855-592-7737 (TTY: 711). Providers featured in articles are representative of our network of practitioners and providers. For an entire list of network practitioners and providers, please contact customer service Monday through Friday (April 1 through September 30) from 8 a.m. to 8 p.m. Presbyterian Senior Care (HMO/HMO-POS), Presbyterian MediCare PPO, and Presbyterian UltraFlex (HMO-POS) plan Phone: (505) 923-6060 1-800-797-5343 TTY: 711 Presbyterian Dual Plus (HMO D-SNP) Phone: (505) 923-7675 1-855-465-7737 TTY: 711 Makes 1 serving. Ingredients 1 ounce lean ground beef 1 tablespoon onion, chopped 1 cup romaine lettuce, shredded 1/4 cup fresh tomatoes, diced 1/4 cup cucumber, diced 1 whole-wheat tortilla (8 inches) 1 t ablespoon fat-free ranch salad dressing Directions • Brown ground beef and onion in skillet over medium heat. Drain excess fat. • Mix lettuce and tomato with ground beef mixture. • Chop cucumber and mix with salad dressing. • Place tortilla on a plate and spread with beef mixture. Top with cucumber and salad dressing mixture, and roll wrap. Nutrition information Serving size: 1 wrap. Amount per serving: 238 calories, 5.4g total fat (1g saturated fat), 22mg cholesterol, 33g carbohydrates, 13g protein, 4g dietary fiber, 373mg sodium. Source: Produce for Better Health Foundation Cosmic cucumber wrap Each serving provides an excellent source of vitamins A and C and folate and is a good source of potassium and fiber.
RkJQdWJsaXNoZXIy OTI0MzU=