Presbyterian Health Plan, Inc. P.O. Box 27489 Albuquerque, NM 87125-7489 www.phs.org Important plan information CC Standard U.S. Postage PAID Presbyterian Health Plan INSIDE Keep mental health in mind 3 Don’t lose your Medicaid benefits 11 Your Spring 2024 En español: Si usted desea obtener este boletín en español, llame al (505) 923-5200 o al 1-888-977-2333. Behavioral healthcare and substance use treatment Substance use rates in New Mexico and across the United States are on the rise. New studies from the U.S. Department of Health and Human Services show that rates of alcohol and other drug use have risen among youth and adults. This rise comes from things like economic stress, unmet mental health needs, and social norms. It is also easier to get alcohol and other drugs. To lower these rates, we need to understand and work to improve the risk factors. Good strategies to reduce substance use often involve a mix of prevention, treatment, and harm reduction methods. Prevention efforts focus on teaching, awareness, and policies to ban substance use. Gov. Michelle Lujan Grisham has asked mental health and substance use disorder providers to expand access to their services. This will help to treat New Mexicans as quickly and easily as possible. Treatment is also key to help this growing problem. This means giving support and resources for those struggling with substance dependence. Treatment can include counseling and Medication Assisted Treatment (MAT). Many people trying to recover from substance use are helped by MAT programs. A MAT program combines medications with counseling. The medications used in a MAT program help manage cravings, reduce withdrawal, and enable the member to focus on their treatment. Treatment also includes focusing on issues such as housing insecurity and nutrition or harm reduction programs. These programs reduce the negative effects of substance use without the need for abstinence. Public policies such as raising taxes on alcohol, tobacco, and cannabis can also help. We are here for you. If you have questions or need help, please contact the following: — Continued on page 3 • Presbyterian Customer Service Center, Monday through Friday, 8 a.m. to 6 p.m., at (505) 923-5200 or toll-free at 1-888-977-2333 • PresRN nurse advice line, 24 hours a day/365 days a year, at (505) 923-5677 or toll-free at 1-888-730-2300 There are a number of ways to find providers who can help. You can access our provider directory at www.phs.org/ centennialcare. You can request that a paper copy of the
2 Could your child benefit from mental health help? What to watch for in young children Children may: • Have frequent tantrums or be intensely irritable much of the time • Talk often about fears or worries • Complain of headaches or stomachaches with no known medical cause • Be unable to sit quietly except when watching TV or playing video games • Struggle in school or have a recent decline in grades • Repeat actions or often check things out of fear bad things will happen What to watch for in tweens and teens Older kids may: • Show less interest in activities or interests they once enjoyed • Have low energy • Sleep too much or too little • Diet or exercise too much or fear weight gain • Engage in self-harming behavior, such as cutting or burning their skin • Smoke, drink, or use drugs • Engage in risky behavior alone or with friends • Have thoughts of suicide • Say they hear things others can’t hear Speak with a Presbyterian nurse at any time You have access to PresRN, a nurse advice line, 24 hours a day, seven days a week, even on holidays. PresRN is an easy way to speak with a Presbyterian nurse if you are not feeling well and need advice. A PresRN nurse will help you and your family whether you require a trip to the emergency room or self-care at home. Presbyterian nurses are happy to answer any questions. Please call even if you are healthy but need some advice. As part of your Presbyterian Healthcare Team, we let your provider, care coordinator, and health coach know of your health concern so that you will have continued care and follow-up. We are here when you need answers! Call PresRN at (505) 923-5677 in Albuquerque or 1-888-730-2300 toll-free. If you are having a medical emergency, please call 911. Children and teens can be sad, anxious, angry, and irritable at times. In many cases, challenging behaviors and emotions are an expected part of growing up. Still, mental health disorders can appear in people of all ages, and some behaviors in children and teens may signal a more serious problem. What’s just a stage, and what’s cause for concern? These signs, as identified by the National Institute of Mental Health, can help you know when your child or teen may benefit from a healthcare provider’s attention. Mental health is an important part of your child’s overall well-being. Seek help if your child’s or teen’s behavior lasts for a few weeks or longer. Seek help if the behavior is distressing for your child or your family or if it interferes with your child’s ability to function at school, with friends, or at home. If your child’s behavior isn’t safe, or if your child talks about hurting themself or someone else, get help right away. Where to find help Contact your child’s primary care provider (PCP) if you think something is amiss. They can provide reassurance or help you get in touch with a specialist. Source: National Institute of Mental Health
www.phs.org/centennialcare 3 Mind your emotional health You know that protecting your physical health is important. But how about your mental health? Isn’t that important too? Absolutely. If you’re feeling overwhelmed by stress and other challenges, don’t hesitate to ask for help. You can start with your primary care provider (PCP), who can connect you to a mental health professional or counselor. Many people benefit from counseling. In the meantime, there are also steps you can take in your everyday life to manage stress and perhaps find a little more happiness. Here are some strategies to try: Get plenty of rest. Getting enough sleep may help relieve stress and lower your risk for anxiety and depression. Most adults need from seven to nine hours of nightly sleep. Lean into your social circle. Social connections can act as a buffer against stress and make life more enjoyable. If something’s bothering you, try talking with a trusted friend. You can also make social connections by joining a club or volunteering. Make time for what you love to do. That could be anything from listening to music to working at a hobby. Sources: Centers for Disease Control and Prevention; Mental Health America provider directory be mailed to you by reaching out to the Presbyterian Customer Service Center at (505) 923-5200 or toll-free at 1-888-977-2333. If you are engaged in care coordination, your care coordinator can also help get you a provider list. Members can access care coordination by contacting our Presbyterian Customer Service Center. Peer support services are also offered for members who want help managing their mental health or addiction struggles. Certified peer support workers are people who have been successful in the recovery process and help others who are in similar spots. Peer support workers help people stay engaged in the recovery process and reduce the chances of relapse. Peers work one on one with our members in their homes or at an agreed-upon location. The service will focus on wellness, recovery, relapse prevention, and resiliency. Additional resources and treatment options include: • Community support groups • Intensive outpatient programs • Detox/residential treatment • Partial hospitalization programs There is good news for those who are getting treatment. Presbyterian Health Plan’s Mental Health Statistical Improvement Project data for 2023 show progress in many areas. Also, 94.5% of members who had an interest in treatment for substance use disorders got the services they sought. Those members also said they now have the tools they need to stay sober. Our data show that members are happy with their care coordination services. The families and caregivers of children who are members also showed approval. They said they functioned better and had good treatment outcomes. Families also rated their care coordination with high scores, showing that our care coordination is meeting families’ needs. — Continued from front page Behavioral healthcare and substance use treatment
Expanding behavioral healthcare through Virtual Visits Your mental health is just as important as your physical health. You may have a mood disorder if you’ve been experiencing any of the following symptoms: • Lasting feelings of sadness • Feelings of helplessness or hopelessness • Lack of energy • Lack of interest in things you once enjoyed • Constant feelings of fear, worry, or nervousness Anxiety and depression are types of mood disorders. It’s normal to feel anxious or sad from time to time. However, if these symptoms happen more often and they affect your life, you should talk to your provider about treatment. Seeing a mental health provider in person can sometimes be hard for many reasons. Virtual Visits can make scheduling an appointment much easier, and you can access private and secure counseling (also known as talk therapy) with a behavioral health provider directly. You can schedule an appointment through MyChart. Patients may be seen at their Video Visit by a therapist or counselor. Patients who need medication management of their mood disorder can also see a psychiatrist via Virtual Visits. Providers will create a unique treatment plan. This may include treatments such as talk therapy, problem-solving therapy, or anxiety and depression medication. Communication is important to you and to us. That’s why we offer translation services if you need them. We want to make sure you have information in the language or format you use so you can take charge of your own healthcare. We have bilingual staff and certified translator services if you want to use these services. These services are available to help you talk with providers, nurses, and caregivers; learn about your health plan; and much more. Our translation and interpreter services include: Presbyterian’s translation and interpretation services It’s easy to request these services. Call the Presbyterian Customer Service Center at the number on your Presbyterian member ID card. • Language translation • Written materials translation • Telephonic interpreters • In-person interpreters • American Sign Language interpreters • Video remote interpreters 4
Sneezin’ and wheezin’? Tips for taming pollen allergies When you’re allergic to something in the air, it can be hard to get away from it. That’s what it’s like for the millions of people with seasonal allergies, also known as hay fever. Every spring, summer, and fall, plants release tiny pollen grains into the air to fertilize their companion plants. Most of the allergy-causing pollen comes from trees, weeds, and grasses. Once that pollen hits the air, it may trigger symptoms such as: Beat back pollen If you think you may have pollen allergies, your first step should be to see your primary care provider (PCP), who may refer you to an allergist. A skin-prick test can help reveal the exact pollens triggering your allergies. Your PCP or allergist can prescribe medications to relieve symptoms or recommend allergy shots to train your body not to react to the allergens. In the meantime, try these tips to lessen your exposure to pollen and reduce your risk of a reaction: • Start taking your allergy medicine before pollen season begins. • Try not to spend too much time outside when pollen counts are high. The American Academy of Allergy, Asthma & Immunology lists daily nationwide pollen counts at aaaai.org. • Wear sunglasses and a hat when you are outside to help keep pollen out of your eyes and off your hair. • Keep windows closed at home and in your car during pollen season. • Dry your clothes in a clothes dryer and not on an outdoor clothesline. Sources: American College of Allergy, Asthma & Immunology; Asthma and Allergy Foundation of America • A runny or stuffy nose • Itchy eyes, nose, ears, and mouth • Red and watery eyes • Swelling around the eyes • Sneezing • Wheezing www.phs.org/centennialcare 5
6 Spring is often thought of as a time of renewal — especially after the dark days of winter. This spring, take the time to refresh your commitment to a safe and healthy life with the following tips from the National Safety Council (NSC), National Institutes of Health (NIH), and other safety and wellness experts. Spring into wellness Stock up on sunscreen Since you’ll be spending more time outside, it’s important to remember to wear sunscreen to reduce your risk of skin cancer. The American Academy of Dermatology recommends that you buy sunscreen that has broadspectrum protection, has an SPF of 30 or higher, and is water-resistant. But don’t count on sunscreen alone to protect your skin. You should also: • Seek shade whenever you can, especially between 10 a.m. and 2 p.m. This is when the sun’s rays are strongest. • Wear a lightweight, long-sleeved shirt; long pants; a wide-brimmed hat; and sunglasses when you will be in the sun for long periods of time. Dust off your walking shoes Walking is one of the easiest ways to get the physical activity you need for good health. And when the weather is warmer and the sun is out longer, it’s a lot more pleasant to do. Health experts recommend that you get at least 30 minutes of moderately intense exercise most days of the week. You should aim for a total of 150 minutes per week. Walking at a brisk pace counts as a moderately intense activity. Test your in-home smoke and carbon monoxide alarms The switch to daylight saving time is a good reminder to check, and maybe change, the batteries in your smoke alarms and carbon monoxide detectors. According to the NSC, smoke alarms should be installed in every bedroom and in the common areas on every floor in a home. Carbon monoxide detectors should be installed outside each bedroom and on every floor of a home. This is also a good time to check the outdoor vents of your gas appliances to make sure they are clear of snow or blockage.
www.phs.org/centennialcare 7 Be safe while cleaning If spring has sparked the urge to clean up around your home, be sure to follow these basic safety tips: • When using a ladder, don’t lean too far on either side. Your belly button should not go beyond the sides of the ladder. • Lift heavy items properly. Keep your back straight and lift with your legs. • Cleaning the floor? Warn family members that the floor will be wet and slippery. • Don’t clutter walkways or stairs with boxes, bags, and other items people might trip over. • Try not to carry too many items at one time. You should always be able to see over the load you are carrying so you don’t trip. • Be sure not to mix cleaning products. This is especially true for ammonia and bleach, which combine to make toxic fumes. Plan your (edible) garden Planning and planting a garden of edible plants is a great way to get exercise and eat more healthy food. You can grow a variety of fruits and vegetables in your backyard. Try broccoli, spinach, lettuce, tomatoes, strawberries, and melons, to name a few. Don’t have a backyard or one large enough for a garden? Consider growing produce in containers or joining a community garden. Adding fruits and vegetables to your meals can lower your risk for chronic diseases, like heart disease and some types of cancer. And the fiber found in produce can help regulate your gut. Being outdoors and working in a garden can be good for your mental health too. According to the NIH, studies have found that being active outdoors in nature can improve your mood and lessen anxiety.
8 Brush those teeth Brushing your teeth isn’t an exciting habit, but it’s a healthy one. Plus, daily brushing and flossing has its rewards. Taking good care of your teeth: • Reduces plaque. Plaque is a sticky film of bacteria that everyone has on their teeth. If too much plaque collects on your teeth, gum disease can develop. Gum disease can range from mild to severe. • Can keep cavities away. If left untreated, cavities can cause pain, tooth infection, and even tooth loss. • Can help the rest of your body stay healthier too. • Can boost your self-image and self‑esteem. Brush up on your oral care Try these tips to be a better brusher: • Brush your teeth twice a day. Use a soft toothbrush and toothpaste with fluoride. • Brush all the surfaces of your teeth. • Brush your tongue gently. This will get rid of bacteria and freshen your breath. Using a mouthwash with fluoride can also help remove bacteria from your mouth and keep your breath fresh. • Floss your teeth once a day. Flossing removes plaque from between your teeth where your toothbrush can’t reach. Flossing is just as important as brushing. Visit your dentist regularly Take advantage of your dental benefits by seeing your dentist every six months (for kids) or 12 months (for adults) for checkups and cleanings. If you have cavities or other dental problems, the dentist will take care of them before they become severe. Your dentist and hygienist can show you the best way to brush and floss to keep your teeth and gums healthy. Good oral care isn’t hard, and it takes only a little time each day. It’s a healthy habit that pays off. Sources: Academy of General Dentistry; American Academy of Family Physicians; American Dental Association Rio Rancho dentist receives national honor Darlene Sorrell, DMD, was honored as a 2023 Health Equity Hero for her work in helping to improve oral health equity in the American Indian community. In her honor, Presbyterian’s dental health partner, DentaQuest, will be making a $5,000 donation to a charity of her choosing. Dr. Sorrell is a member of the Navajo Nation. She is also a founding member of the Society for American Indian Dentists (SAID). Her 38-year career has included: • Becoming the first Navajo dentist •Providing care with the Indian Health Service • Working at Nizhóní Smiles, the only nonprofit dental clinic of the Navajo Nation American Indian/Alaska Native people have three times the dental disease rate compared to the general population. The Navajo Nation has the highest dental disease rate within that group. Dr. Sorrell’s efforts have gone a long way in changing those statistics.
www.phs.org/centennialcare 9 If you do not have a provider for your prenatal and postpartum care, we can help. Call the number on the back of your Presbyterian member ID card and we can help find a provider in your area. The importance of prenatal and postpartum care We want to make sure our members get the best prenatal and postpartum care possible. We encourage members to learn about the importance of regular prenatal care visits. These visits help members to have a healthy pregnancy and baby. At least one prenatal visit is needed in the first trimester, or first 14 weeks of pregnancy. At least 10 visits are suggested during the second and third trimesters of pregnancy. After the birth of the baby, it is critical to have a postpartum visit within one to 12 weeks (seven to 84 days). Presbyterian Health Plan encourages members to attend their prenatal and postpartum checkups through the Pregnancy Passport program, formerly known as the Baby Benefits program. The program provides incentives to members for going to these visits. There is also the Baby Bonuses program, which rewards you for taking your child to their well-baby checkups. Visit www.phs.org/health-plans/ centennial-care-medicaid/baby -bonuses to learn more about these programs, or talk to your provider. New Mexico Human Services Department has also expanded access to Medicaid eligibility for pregnant members. If you qualify for Medicaid because you are pregnant, you will keep your Medicaid coverage for 12 months after you give birth. Pregnant members have a choice of who provides care and where you give birth. With the Medicaid Birthing Options Program, you can choose to give birth at a birthing center, a hospital, or your home, if you do not require more advanced care. You can also get care from a certified nursemidwife, nurse practitioner, licensed midwife, obstetrician, family practice practitioner, or physician assistant.
10 Keep these numbers handy The Presbyterian Customer Service Center (PCSC) is available for members Monday through Friday, 8 a.m. to 6 p.m. Members can reach the PCSC at the following numbers: (505) 923-5200 or 1-888-977-2333; TTY: 711 Navajo/Diné members: (505) 923-5157 or 1-888-806-8793; TTY: 711 Other important numbers PresRN: (505) 923-5677 or 1-888-730-2300; TTY: 711 Routine transportation (for nonemergency medical transportation): 1-855-774-7737 New Mexico Crisis and Access Line (for a behavioral health crisis): 1-855-662-7474 (1-855-NMCRISIS) 988 Suicide & Crisis Lifeline (available 24/7): 988 or 1-800-273-8255 Presbyterian Centennial Care Ombudsman: Phone: (505) 923-5780; email: ombudsman@phs.org Mindful eating An easy way to enjoy food and manage weight Do you want to get healthy, lose weight, and feel your best? The Path for Wellness Prevention Program can help! A focus of this program is mindful eating. Mindful eating is about paying attention to what you are eating. Here are some ways to try mindful eating: • Make eating the focus. Do not watch TV, read, or use your phone while eating a meal or snack. • Notice the colors, texture, smell, taste, and sound of your food. • Take small bites and put your fork down between bites. • Eat slowly and chew your food well. Do you want to get personalized support to improve your health through food and healthy lifestyle activities? You may be eligible for the Path for Wellness Prevention Program. This program is offered at no additional cost to eligible members who want to: • Lose or manage weight • Get more active • Reduce their risk of Type 2 diabetes It’s easy and fun to participate — the program is all by phone or online. The classes are also available in Spanish. Find out if the Path for Wellness Prevention Program is right for you: • Visit phppreventionprogram.good measures.com. • Call 1-855-249-8587.
www.phs.org/centennialcare 11 In partnership with you and the New Mexico Human Services Department (HSD), we have some important news to share about your extended Centennial Care (Medicaid) benefits. Everyone enrolled in Medicaid must renew their benefits. You will receive a turquoise envelope from HSD when it’s time to renew your Medicaid benefits. If you have signed up for HSD electronic notices, watch for email or text updates. When you are notified, log in at www.yes.state.nm.us. Click the “Renew My Benefits” button to complete your renewal application. If HSD requests more information, please provide it right away. You must complete your renewal application to check if you are still eligible to keep your benefits. Why do I need to renew? During the COVID-19 public health emergency, your Medicaid and SNAP benefits were automatically renewed. This has changed. Now, everyone will need to renew their Medicaid and/or SNAP benefits when notified. If you do not renew, your coverage will end. What if I am no longer eligible for Medicaid? If you are notified that you are no longer eligible for Medicaid, you can find low- or no-cost coverage through beWellnm. Check out all your choices online at bewellnm.com or by calling 1-833-862-3935. We’re here for you! Presbyterian Health Plan wants to help you through this change. We want to give you the support you need during this change so that you can continue your healthcare journey with us. Feel free to reach out to us with any questions or concerns you have. Call the Presbyterian Customer Service Center at the number on your Presbyterian member ID card, (505) 923-5200, or 1-888-977-2333. Get help with the Presbyterian Health Plan Ombudsman Program The Presbyterian Health Plan Ombudsman Program is here to help you learn how your insurance works and get the care that you need. How the ombudsman can help you: •Help solve issues or problems (before they enter the grievance or appeal process) •Learn about Presbyterian Health Plan •Get referrals and resources (aid) •Refer or recommend a care coordinator to you •Teach you about your rights under Centennial Care What is an ombudsman (awm-budz-muhn)? An ombudsman is someone who looks into member problems and helps to solve them. They do this without taking anyone’s side. What is the role of the ombudsman? The Presbyterian Centennial Care ombudsman works with you to help with issues through support and research. When should I call the ombudsman? Talk with the ombudsman early if you are having a problem with getting the care you need. If you are having trouble getting in touch with healthcare providers, use the ombudsman to help you with your needs. How can the ombudsman help me? The ombudsman works with you on issues and is not part of the grievance (complaint) system or appeals process. The ombudsman works with your care team to be your voice — to talk about your needs. What does an ombudsman not do? The ombudsman does not take the place of processes such as appeals or grievances. The ombudsman will not make final choices about your care. To reach the Centennial Care ombudsman: Phone: (505) 923-5780 Fax: (505) 923-8159 Email: ombudsman@phs.org Address: Presbyterian Health Plan 9521 San Mateo Blvd. NE Albuquerque, NM 87113 Be on the lookout for your benefit renewal application
Yourstory Your Story is published for members of Presbyterian Health Plan, Inc., and Presbyterian Insurance Company, Inc. P.O. Box 27489, Albuquerque, NM 87125-7489 www.phs.org Managing editor: fluentqc@phs.org 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. Such services are funded in part with the State of New Mexico. 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). Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’d66’, t’áá jiik’eh, éí ná hól=, koj8’ hódíílnih (505) 923-5420, 1-855-592-7737 (TTY: 711). Like us on Facebook Facebook.com/PresHealth 2024 © Coffey Communications, Inc. All rights reserved. MPC012403 Centennial Care Medicaid #6505 Directions • In skillet, heat 2 teaspoons olive oil over medium-high heat. Add cauliflower, broccoli, peppers, 1/2 cup onion, and garlic. Sauté 5 minutes until vegetables start to soften. Stir in herbs and sauté 2 minutes. Remove from stovetop and set aside. • In strainer, place quinoa and rinse thoroughly with cold water. Using your hand, swish quinoa under running water for 2 minutes to remove bitter natural coating. Drain and set aside. • In medium saucepan, heat remaining teaspoon olive oil over medium-high heat. Add remaining onion. Sauté about 3 to 4 minutes. Add broth and quinoa. Increase heat to bring mixture to boil. Reduce heat to medium-low, cover, and simmer until quinoa is tender, about 20 minutes. • Gently stir in vegetable mixture and combine well with quinoa. Season with salt and pepper to taste. Serve. Quinoa with cauliflower and broccoli Makes 8 servings. Ingredients 1 tablespoon extra-virgin olive oil, divided 2 cups cauliflower florets 2 cups broccoli florets 1 medium green bell pepper, sliced into strips 1 medium red bell pepper, sliced into strips 1 cup chopped onion, divided 3 cloves garlic, minced 1 tablespoon fresh thyme, chopped medium (1 teaspoon dried may be substituted) 1 tablespoon fresh oregano, chopped medium (1 teaspoon dried may be substituted) 1 cup quinoa 2 cups reduced-sodium vegetable broth Salt Freshly ground black pepper Nutrition information Serving size: 1/8 of recipe. Amount per serving: 120 calories, 3.5g total fat (0g saturated fat), 20g carbohydrates, 5g protein, 3g dietary fiber, 50mg sodium. Source: American Institute for Cancer Research
RkJQdWJsaXNoZXIy MjI2MTU5NA==