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Select News: May 2016

CenteringPregnancy® improves moms’ and babies’ health

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CenteringPregnancy is a great way for our pregnant members, your patients, to prepare for a baby. A component of the Birth Outcomes Initiative, CenteringPregnancy is a multifaceted model of care that integrates health assessment, education and support within a group setting. Women with similar gestational ages meet throughout pregnancy and early postpartum to learn care skills, participate in facilitated discussions and develop a support network. Improved outcomes include fewer preterm births and more member empowerment. Centering also increases trust between members and providers as they learn from one another.

Providers complete standard physical health assessments and can submit claims for “group clinical visits for the management of pregnancy” using procedure code 99078 with a TH modifier. To refer a First Choice member, call our Bright Start® program at 1-888-276-2020.

Physician champion

We’d like to spotlight and thank Sumter OB/GYN, which recently received certification for its continued dedication to the CenteringPregnancy model and its impact on the health of mothers and their babies. “Studies have shown a reduction in preterm birth with Centering,” says Triz Smith, M.D., an obstetrician with Sumter OB/GYN. “Centering benefits patients by giving them more time with the physician. We’ve noticed fewer emergency and labor and delivery visits because women are more educated about whether they’re experiencing a normal pregnancy discomfort or something to worry about.” Centering helps physicians, as well: “We get to know patients and their needs.”

We can help: Just “Let Us Know”

Our Let Us Know program helps engage chronically ill members in their health care. We have support teams and tools to help identify, outreach to and educate our members, as well as clinical resources for care management.

  • Contact our Rapid Response and Outreach Team at 1-866-899-5406 to address urgent needs. The Rapid Response and Outreach Team connects with members to verify, schedule, or reschedule appointments and ensure they have transportation.
  • Request outreach with the Let Us Know form.
  • Use the NaviNet Care Gap worksheet to get pop-up alerts to flag members at risk due to missing or overdue preventive services, or under-utilization or absence of disease-specific controller medications.

Pharmacy and Therapeutics Committee updates

Effective June 1, 2016, the following will be removed from the Select Health Preferred Drug List (PDL). Please substitute one of the preferred alternative products for your First Choice patients currently receiving one of the medications being removed. We are notifying members in writing about this change to allow time to change to a preferred medication or submission of requests for prior authorization.

PDL removals PDL alternatives
Avonex 30mcg vial Plegridy 63-94mcg/0.5ml syringe, pen; 125mcg/0.5ml syringe, pen
Avonex 30mcg/0.5ml autoinjector Plegridy 63-94mcg/0.5ml syringe, pen; 125mcg/0.5ml syringe, pen
Avonex 30mcg/0.5ml syringe Plegridy 63-94mcg/0.5ml syringe, pen; 125mcg/0.5ml syringe, pen
Baraclude 0.05mg/ml oral solution Viread 300mg tablets
Claritin 5mg RediTabs disintegrating tablet Loratadine 5mg/5ml oral solution
Kombiglyze XR 2.5-1000mg tablet Janumet XR 50/500mg, 50/1000mg, 100/1000mg tablets
Kombiglyze XR 5-1000mg tablet Janumet XR 50/500mg, 50/1000mg, 100/1000mg tablets
Kombiglyze XR 5-500mg tablet Janumet XR 50/500mg, 50/1000mg, 100/1000mg tablets
Namenda 10mg/5ml oral solution Memantine 5mg, 10mg tablets
Onglyza 2.5mg tablet Januvia 25mg, 50mg, 100mg tablets
Onglyza 5mg tablet Januvia 25mg, 50mg, 100mg tablets
Tyzeka 600mg tablet Viread 300mg tablets

You can find up-to-date pharmacy information on our website or contact PerformRx℠ Pharmacy Services department at 1-866-610-2773.

Play ball with Marcus! No cost for the first 25 who register

Select Health is again sponsoring First Choice Fit® Marcus Lattimore football camps for our members ages 5 to 17. Each camp is available at no cost to the first 25 members who register using the promo code HEALTHY. There is a $40 fee for all others. Camp dates and locations:
June 4 — Charleston, Harmon Field
July 16 — Greenville, Kroc Center
July 30 — Columbia, Dreher High School
August 13 — Myrtle Beach, Carolina Forest High School

Camps run from 8 a.m. to 2 p.m. and include community health fairs with health screenings and education at no cost.

Encourage patients to visit our website

Please remind your First Choice patients they can access the member portal online to review benefits, health history and personal health information. They can learn about language services, search for preferred drugs, find a doctor and more.

Member rights and responsibilities

As a reminder, please review the rights and responsibilities of our First Choice members. These are also available in our Health Care Professional and Provider Manual. Contact your account executive if you have questions.

New and current subscribers: Win $50

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We hold random monthly drawings for a $50 Amazon.com e-certificate for online subscribers. Subscribe for a chance to win. Current subscribers are automatically included. Stacey Garcia of Aiken Professional Association-Surgery was April’s winner. We’ll notify May’s winner in June, so sign up now!