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 Back-to-school checklist 2 We work nonstop to improve 9 Your Summer 2024 En español: Si usted desea obtener este boletín en español, llame al (505) 923-5200 o al 1-888-977-2333. Introducing Turquoise Care Turquoise Care is the new name for the New Mexico Medicaid Managed Care program that will begin on July 1, 2024. It was formerly known as Centennial Care. You should have received a letter in a yellow envelope from the Human Services Department. As a current Presbyterian Health Plan (PHP) Centennial Care member, you do not have to take any action if you choose to stay with PHP. Your benefits, providers, and care coordinator will remain the same. You will receive a new Turquoise Care handbook and ID card from us by July 1, 2024. You can find information about any new covered services in your handbook. Call the Presbyterian Customer Service Center at the number on the back of your Presbyterian member ID card if you have questions about your benefits. For more information on applying for Medicaid or to change or re-enroll with your MCO, please call 1-800-283-4465 or go to www.yes.state.nm.us.
2 Get your kids ready for the first day Your back-toschool prep list Are your kids prepared for the new school year? Are you? While kids need to prepare emotionally and mentally for getting into the back-to-school routine, parents need to get ready on many fronts too. Here’s a handy checklist of preparations to tackle before school starts. Health prep Help make sure your child stays healthy during the school year. Stay up to date on vaccinations. Immunizations can protect your child against serious childhood diseases. Check with the school to find out what vaccinations it requires. Arrange for a sports physical if your child plays sports. An exam can give you peace of mind that your kid can handle the physical demands asked of them in school sports and extracurricular activities. In fact, most sports require a physical for a medical eligibility form.
www.phs.org/centennialcare 3 At-home prep Before the first day of school, spend time with your child on some important issues. Transition to school sleep/wake schedule. A good night’s sleep will help your child concentrate, retain information, and prevent mood swings. To aid the change from vacation time to school time, figure out how many weeks it will take for your child to fall into an ideal sleep routine for school nights if they go to bed and wake up 15 minutes earlier every few days before school starts. Create a study area. Prepare a welllit place where your child can do their homework. Make sure it’s a quiet space without distractions. Choose a suitable backpack. For safety’s sake, a filled backpack should weigh no more than 10% to 20% of your child’s body weight. Adjust the backpack so the bottom meets your child’s waist. If your child’s load is heavy, consider a rolling backpack. And don’t forget to tuck an in-case-ofemergency card in the backpack. Talk to your kids about bullying. Bullying is linked to a range of educational and emotional problems. Make sure your child knows: • To seek a trusted adult for help if they are bullied • How to respond nonviolently to bullying • That you’re monitoring their texts and social media accounts for bullying behavior • That it’s never OK to bully someone, even if encouraged by others To-and-from-school prep Whether your child rides the bus, bicycles, or walks to school, take steps to ensure their safety. Review your child’s route to school in advance. Drive the route so your child knows what to expect. Or bicycle or walk the route with them. Set up carpooling shifts. If you prefer to drive your child, find other parents who are safety minded. Talk to your child about bus stop, bicycling, and walking safety. Make sure they know about crosswalk, biking, and walking protocols. Before-and-after-school care prep Arrange for caretaking. If you need help before or after school, look into responsible school programs, off-site institutions, or caretakers at your home or theirs. Life can get very busy, and things like vaccinations can be missed. If your child has missed any recommended vaccines, summer break might be a good time to catch up. Scheduling an appointment during a school break means your child won’t have to miss school. Vaccinations can also help keep other students healthy when they go back to class. Below is a list of vaccinations that your child should have by age group. • COVID-19 • Flu • Meningococcal conjugate vaccine Kids ages 13 to 18 • COVID-19 • Flu • COVID-19 • Flu • DTaP • Polio • MMR • Chickenpox Kids ages 2 to 3 Kids ages 4 to 6 Keeping track of your child’s vaccine status can be tough at times. You can always call your provider to ensure that your child is up to date on all their vaccines. Kids ages 7 to 10 • COVID-19 • Flu Kids ages 11 to 12 • COVID-19 • Flu • HPV • Tdap • Meningococcal conjugate vaccine Do your children have all their vaccines? Sources: American Academy of Pediatrics; Centers for Disease Control and Prevention; Sleep Foundation For safety’s sake, a filled backpack should weigh no more than 10% to 20% of your child’s body weight.
4 Water safety Talk to a primary care provider (PCP) before engaging in any water activity while taking medication for anxiety or other mental health issues. Certain medications may interfere with your balance, coordination, and judgment, making swimming difficult. Learn how to swim. You and your children must learn to swim. Drowning is one of the leading causes of death in children ages one to four. Use the buddy system. Bring a friend when you head into the water. Check for hazards. While the water at the beach may look inviting, be aware of your surroundings. And always keep an eye out for the weather and potential hazards, like strong currents. Exercise caution. Follow the rules of the beach or pool. Stay within your depth and comfort level in the water, and swim in designated areas only. Wear a life jacket. Flotation devices, such as life jackets, can save lives. Do not rely on air-filled or foam toys such as water wings, noodles, or inner tubes, as these are not certified safety devices. There is no better way to stay cool, have a fun time with family, and be active in hot months than water recreation. Water parks, pools, lakes, and beaches are great summer destinations. Stay safe and enjoy the water by following these safety tips: 101
www.phs.org/centennialcare 5 Find your healthy this summer Ready to improve your health and feel your best this summer? Join the Path for Wellness Prevention Program. This program offers healthy weight management and diabetes prevention to eligible Presbyterian Health Plan members at no added cost. It is designed to help members: •Build healthy habits •Lose or manage weight • Be more active •Reduce their risk of Type 2 diabetes It’s easy and fun to participate — the program can be done online or by phone. The classes are also available in Spanish. What’s included? When you sign up for the program, you will receive: •Your own lifestyle coach, a person who helps you build healthy habits •Access to your coach by phone or online •Online or phone group classes •An app that helps you choose healthy foods •A connected device such as a scale, blood pressure monitor, or glucose monitor to track and send information to your phone app Supervise children. Stay alert when children are in or around water. Consider safety features such as fences, locks, pool covers, and pool alarms. Know the risks of alcohol. Drinking alcohol or taking drugs can interfere with your judgment and coordination, making swimming very risky. Learn CPR. Knowing how to perform CPR can be a lifesaving skill. Sources: American Academy of Pediatrics; Centers for Disease Control and Prevention; U.S. Department of Agriculture To learn more about the program and how to sign up, visit www.phs.org/preventionprogram or call 1-855-249-8587.
6 • Make sure everyone wears wellfitting life vests on boats and near open water. • Never dive into water unless you know the depth and have checked for potentially dangerous underwater objects. Avoid bug bites. Most bug bites aren’t serious, but they are annoying. Here’s how to lessen your chance of being bitten or stung. • When hiking through areas with tall grasses and bushes, wear light-colored clothing that covers as much skin as possible. When you get back, examine your skin and scalp for bugs or bites. Have fun, stay Summer. It’s often packed with funfilled activities like picnics and water sports. While enjoying this sunny season, it’s important to keep in mind potential hazards that can derail your good times. Follow these vital tips to help keep your summer safe. Slather on the sunscreen. The sun may feel good on your skin, but it can do a lot of damage too. For example, sunburns raise your risk of developing skin cancer. Sunscreen can help shield your skin from the sun’s harmful rays. • Apply sunscreen every day — even when it’s cloudy — 15 minutes before going outdoors. • Spread it over all exposed skin. Don’t forget the tops of your feet and head and your lips, neck, and ears. • Reapply sunscreen every two hours or after you sweat or swim. • Choose a broad-spectrum, waterresistant sunscreen with an SPF (sun protection factor) of 30 or higher. • Use different types of sunscreens: creams for dry skin and your face, gels for areas with more hair — like the scalp — and sticks for the eye area. Be mindful around water. Whether you’re in a pool, on a boat, or near open water, take steps to protect yourself and others from drowning: • Never leave children alone near water. • Have rescue equipment nearby if you own a pool. Always have a phone nearby too. • Avoid using inflatable floaties for kids. They aren’t a good substitute for a life jacket, and they can give kids (and their parents) a false sense of security in the water.
www.phs.org/centennialcare 7 Sources: Academy of Nutrition and Dietetics; American Academy of Dermatology; American Academy of Family Physicians; American Academy of Pediatrics; Centers for Disease Control and Prevention Keep outdoor meals safe Nearly one in six Americans gets food poisoning each year, and hot temperatures and outdoor gatherings make summer a particularly risky time for getting sick from food. Don’t let food poisoning spoil your next picnic or backyard barbecue. Wash your hands and the surfaces and utensils being used to prepare and cook food. Wash fresh fruits and vegetables too. Keep raw meat, poultry, fish, and eggs away from other food. Use a food thermometer to make sure meats reach the proper recommended temperature. Cover and refrigerate foods within two hours of serving — one hour if it’s hotter than 90 degrees. safe this summer • Use bug spray that contains DEET. • Apply bug spray on top of sunscreen. Do not apply repellent on skin under clothing. • Wear insect-repellent clothing or use 0.5% permethrin to treat clothing. • Have over-the-counter treatments, like antihistamines or anti-itch creams, readily available just in case you do get stung or bitten.
8 With telehealth visits, you can see and talk to a provider from the comfort of your own home. All you need is a phone, tablet, or computer with internet access. The benefits of telehealth visits There are many reasons to use virtual medical visits, such as: • Reduced exposure to certain diseases • Ability to connect from your home or office • Easier to coordinate with children and/or pets • Easier access to specialists who live far away from you Of course, telehealth visits aren’t the answer for every medical issue. In many cases it’s best to see a healthcare provider in person so that you can get a physical exam and any tests you might need. Presbyterian Health Plan gives you telehealth options Presbyterian offers Virtual Primary Care that lets you establish care and build a real relationship with a provider online. You can see an online provider from home or anywhere else in New Mexico, making it easier to get the care you need. With Virtual Primary Care, 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 In addition to Virtual Primary Care, you may be able to use telehealth for urgent care Video Visits, specialty care, and behavioral health video appointments. Is a telehealth visit right for you? How to get started Visit www.phs.org/getcare to learn more and schedule a visit. Sources: Centers for Disease Control and Prevention; Telehealth.HHS.gov
www.phs.org/centennialcare 9 Presbyterian Health Plan (PHP) is committed to providing quality care and services to our Centennial Care members. At Presbyterian, we have a thorough Quality Improvement Program (QI Program) that assesses the care and services you receive. We work nonstop to improve your experience with care and services. 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 evaluate the QI Program to not only see how we did, but to see what we can do to better serve you the next year. As Mark Twain said, “Continuous improvement is better than delayed perfection.” In 2023, we learned and applied many new ways to better serve you in 2024. Here are a few of our 2023 actions and results: The Diabetes Prevention Program enrolled new participants in a 12-month structured program and coaching schedule. Members had one-on-one sessions with a coach to discuss physical activity, healthy food choices, eating patterns, and daily weight management. The 12-month Diabetes Prevention Program is offered to eligible members and is an evidence-based program. PHP partnered with Unite Us to create a closed-loop referral system to screen for health-related social needs and provide referrals based on those needs. PHP focused on engaging clinical and social service providers in six pilot counties: Dona Ana, Lincoln, Otero, Rio Arriba, Taos, and San Miguel. These providers will address healthrelated social needs for members who are pregnant, postpartum, or young children; seniors and those with long-term care needs; facing behavioral health needs; part of tribal communities; and justice-involved. Health and Wellness Resources were updated on the websites to support members’ health-related social needs. These include community resources for accessibility, housing, food, and financial assistance. PHP built a member self-referral form, called the Assistance Request Form, to request help for health-related social needs as part of the Unite Us project. PHP community health workers and care coordinators respond to member requests by connecting them to resources to address their needs. Presbyterian Quality Improvement Program
10 Presbyterian Health Plan values the health of all children. To help every child get the care they need, we are part of a program called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for children. EPSDT includes health checkups for immunizations, preventive care, and screenings to help avoid illness. This program is for all children, adolescents, and young adults under the age of Early and Periodic Screening, Diagnostic, and Treatment for children 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 Early: Assess and identify problems early. Periodic: Check children’s health at periodic, age-appropriate intervals. Screening: Provide physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems. Diagnostic: Perform diagnostic tests to follow up when a risk is identified. Treatment: Control, correct, or improve health problems found. What does EPSDT mean? 21 who are enrolled in Medicaid. The program covers preventive, dental, mental, developmental, and other healthcare needs. Parents have access to EPSDT program resources at www.phs.org/preventive. They can find links to: • The EPSDT article “What You Need to Know About EPSDT” • Checkups and screenings schedule • Immunization schedule
www.phs.org/centennialcare 11 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 selfcare 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! Speak with a Presbyterian nurse at any time Call PresRN at (505) 923-5677 in Albuquerque or at 1-888-730-2300 toll-free. If you are having a medical emergency, please call 911. Hola Presbyterian’s translation and interpretation services 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 the 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: • Language translation • Written materials translation • Telephonic interpreters • In-person interpreters • American Sign Language interpreters • Video remote interpreters It’s easy to request these services. Call the Presbyterian Customer Service Center at the number on your Presbyterian member ID card.
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. MPC032429 Medicaid #7005 Makes 4 servings. Ingredients For turkey burger: 12 ounces 99% fat-free ground turkey 1/2 c up scallions (green onions), rinsed and sliced 1/4 teaspoon ground black pepper 1 large egg 1 tablespoon olive oil For spread: 2 tablespoons light mayonnaise 1 tablespoon Dijon mustard For toppings: 4 o unces spinach or arugula, rinsed and dried 4 o unces portobello mushroom, rinsed, grilled or broiled, and sliced (optional) 4 whole-wheat hamburger buns Turkey club burger Lighten up your traditional hamburger with lean ground turkey — less saturated fat without less flavor Source: National Heart, Lung, and Blood Institute Directions • Preheat oven broiler on high temperature (with the rack 3 inches from heat source) or grill on medium-high heat. • To prepare burgers, combine ground turkey, scallions, pepper, and egg, and mix well. Form into 1/2- to 3/4-inch-thick patties, and coat each lightly with olive oil. • Broil or grill burgers for about 7 to 9 minutes on each side (to a minimum internal temperature of 160 degrees). • Combine mayonnaise and mustard to make a spread. • On each bun assemble 3/4 tablespoon spread, 1 ounce spinach or arugula, several slices of grilled portobello mushroom (optional), and one burger. Hint: To grill portobello mushrooms, scrape off the gills from underneath the mushroom caps. Lightly coat caps with olive oil, and grill or broil for 2 to 3 minutes on each side or until tender. Slice and set aside until burgers are ready. Nutrition information Serving size: 1 burger with toppings. Amount per serving: 299 calories, 11g total fat (2g saturated fat), 89mg cholesterol, 26g carbohydrates, 29g protein, 5g dietary fiber, 393mg sodium, 424mg potassium.
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