Preventive services are the key to maintaining your physical well-being.  Investing a few hours each year in keeping your health up to date goes a long way in preventing long-term health complications.  By scheduling annual check-ups, your physician is able to isolate health issues earlier and before they become more serious.

Preventive care services apply to all of us—and from childhood up through old age it is important to go to the doctor for regular screenings and vaccinations.  Some common tests that are done to screen for health conditions include:

• Measuring your blood pressure
• Checking your blood sugar
• Testing your cholesterol levels

Screening tests for cancer get better each year, and are important preventive measures that have been proven to keep us healthier.

For women, having a mammogram and a pap smear are screening tests that your primary care doctor can help arrange for you.

For men, discuss prostate and other reproductive organ screening exams [ATL: For men, discuss testicle and prostate screening exams] with your primary care doctor.

And everyone over the age of 50 should begin regular colon cancer screening.

It is important to see your doctor annually and have a conversation about what types of screenings are right for you, considering your age and family history.

One of the most important decisions we make in managing our health is choosing a primary care doctor (PCP).  A PCP is your main healthcare practitioner that you see when you have non-emergency medical problems and he/she also plays an important role in your overall wellness and prevention efforts. 

There are many ways to find a PCP.  You can research online, ask your friends and neighbors, call your local hospital or even your insurance provider.  But to find the doctor that is right for you, you need to choose someone with whom you are comfortable.  Interview potential doctors to see if you are compatible, learn more about them and how they will interact with you as a patient.   When making this choice keep in mind the following:

• Are you comfortable with this doctor?
• Does this doctor make you feel important?
• Will this doctor listen to you?
• Is the office friendly and welcoming?
• Is the office convenient to get to?
• Do the hours of the office fit into your schedule?
• If English is not your primary language, does the doctor and others in the office speak your primary language?
• Is the provider affiliated with a particular hospital or facility that you prefer?
• Does the provider have a special interest in a disease or condition that you may have, such as heart disease, diabetes or high blood pressure?

Choosing a PCP is a very personal decision as you need to choose the one that feels right for you, not anyone else.  People often stay with the same PCP for many years, so choosing the right one is a decision that will help keep you healthy and serve you well for a lifetime. 

Describe your role at CeltiCare?

As a Program Coordinator in Medical Management I provide outreach to members who may have questions about their benefits or are candidates for case management and other services we offer.  It could be as simple as helping a member coordinate a doctor’s visit or overcome the challenges of scheduling an appointment with a specialist.  Also, if a member is diagnosed with an illness, we are able to answer any questions they may have and provide health education so they can better understand their condition.  We do what we can to remove any barriers that may stand in the way of our members getting the care they need. 

Being bilingual in Spanish, how does this help with your work?

A large number of our members don’t speak English, so there’s definitely an advantage in being bilingual.  Some members don’t understand the information they receive which is important to their health, so I’m able to explain these letters to them directly.

What do you like most about CeltiCare?

I like the fact that everyone works together.  There’s a lot of teamwork, and for any case I have there are others that can get involved and help.  We all have the same goal: to make sure our members get the services they need without the hassle. 

Can you describe a situation where you really felt you helped a member?

Every day I feel like I am able to help members.  I can recall once situation—one of my first since joining CeltiCare—where a member dealing with a serious illness was not happy because he was unable to schedule an appointment with a specialist.  I was able to call around to find the right provider, contact them on his behalf and get the appropriate paperwork completed.  There are members out there who are very sick and must go back and forth to providers—they shouldn’t be going through that.  It makes me feel good that they know there’s someone there to help.

Stay tuned as we continue to feature employees throughout the company.

Appointment timeframes are based on the type of doctor you see, and whether you are injured or currently sick. Your doctor or medical clinic will ask you why you are seeking care and may ask specific questions about your condition. It is important for you to give your doctor’s office the important facts about your injury, illness and or symptoms so they can decide how soon you should be seen.

If you are injured or sick and have symptoms, or need urgent care, you can expect to be seen sooner than when you are not actively ill or need non-urgent care.

Below are the times you can expect to wait when you call to schedule an appointment:

Primary Care Physicians (PCPs):

• Urgent Care – within 48 hours

• Non-urgent Care with symptoms – within 10 calendar days

• Non-Urgent Care without symptoms – within 45 calendar days

Specialty Care (other than Behavioral Health):

• Urgent Care – within 48 hours

• Non-urgent Care with symptoms – within 30 calendar days

• Non-Urgent Care without symptoms – within 60 calendar days

If you are a CeltiCare member and need help finding a Primary Care Physician or Specialist, please contact CeltiCare’s Member Services Department at 1-866-895-1786 or 1-866-614-1949 (TDD/TYY).

Researchers at the Washington University in St. Louis have found a potential link between daily exercise, like a walk or a jog, and a reduced risk of developing Alzheimer’s disease.  The study, which was covered in the New York Times, was published in The Archives of Neurology.

The study tested more than 200 adults ages 45 to 88 to first see if a brain scan showed signs for amyloid plaques, which are typical in people with memory loss.  Researchers then tested each patient for a gene variant that is known to increase the risk for Alzheimer’s disease.  The results were then analyzed alongside questionnaires that the volunteers completed about their exercise habits during the past 10 years. 

The results of the study showed that carriers of the gene who reported walking or jogging for at least 30 minutes per day, five times a week, had a level of plaque accumulation similar to those without the gene.  Alternatively, researchers found that those patients who were inactive had an increased accumulation of the plaque and were at a greater risk for developing Alzheimer’s. 

If that’s not an incentive to take that lunchtime walk around the park, I’m not sure what is!

“At CeltiCare we care about being part of the community that we serve,” said Michael Kirby, president and CEO of CeltiCare.  “Sponsoring La Lista de Boston 2012 allows us to be a part of a campaign that highlights local businesses and community members who are passionate about the work and services they provide to the communities our members live in.”

From Feb. 6^th until March 30^th, Bostonians are invited to vote for the places, people, and things that highlight Boston’s unique Latino/Hispanic community on Boston.com’s La Lista website (www.boston.com/lalista). Individuals are encouraged to nominate their favorite people, boutiques, restaurants, local media personalities, services and attractions in the Greater Boston area.  The winner in each category will gain the title of “best” in the city and earn an invitation to a winner’s party in April.

“It is easy for marketers to say they support local businesses and the Latino and Hispanic community in Boston, but by sponsoring the first annual La Lista promotion, CelitiCare has stepped up to do both,” said Josh Walker, CEO of CityVoter.  “We’re eager to work with CeltiCare and all our fantastic media partners to recognize the best in our Boston Latino and Hispanic community.”

La Lista is a collaborative effort being led by four of Boston’s leading media companies: Boston.com, El Mundo, MasTV and CityVoter Inc and an extension of the popular annual Boston.com A-List program where in 2011 more than 26,000 consumers voted to choose their favorite local businesses.  To date, La Lista already has more than 350 nominated businesses from the Latino/Hispanic community.  

About CeltiCare Health Plan of Massachusetts:  Founded in 2009, Boston-based CeltiCare Health Plan of Massachusetts is a managed care organization that provides high-quality, cost-effective health insurance to Massachusetts residents.  CeltiCare is committed to helping its members achieve better health outcomes by providing high-quality benefits, services and wellness education.  Backed by parent company Centene Corporation, CeltiCare offers a new form of local managed care that is tailored to the needs of Massachusetts’ progressive healthcare system.

 What is a typical day for you?

I spend about half of my day on the phone handling calls from members and providers.  I work with customers who have questions and help direct them to the information, options and answers they need.  The questions vary and sometimes it can take a few calls with members and providers, but my ultimate goal is always to end with a satisfied member.  Sometimes the work comes from regular reports or projects, and I have also been helping out with projects related to quality assurance.

 What is it like to work at CeltiCare?

It really feels like we are all part of a big team. It is helpful to know that I have peers down the hall who are available to share tips and experiences with to help each of us be more efficient and ultimately, more helpful to our members. 

 What would people never guess you do as a Member Service Representative?

People outside the company wouldn’t expect that I get to work directly with team leads and superiors like we’re equals. Managers have an open door policy, which is great. It really helps me have an impactful role within the company in a way people might not typically expect from member service reps.

 What do you like most about CeltiCare?

I like the company’s mission to help make sure our members have the healthcare services they need.  I also like that nothing feels in vain as everything I do is helping a member or provider.

 Was there ever a time when you really felt you helped someone?

It’s hard to pick one thing because it is a daily task. Recently I worked with a member who needed a couple of bills settled, so I set aside some time to take care of her. She then reached out to me to ask about a very specific doctor that she could not get approval to see. After working in collaboration with another department, I discovered the doctor was indeed covered and the member felt saved.  Really each day is an experience in helping people.

We plan to showcase employees from throughout the company so keep an eye out for more highlights from behind the scenes!

Last month, CeltiCare employees held a food and clothing drive for Rosie’s Place which provides emergency and long-term assistance to poor and homeless women who have nowhere else to turn. Spearheaded by Melissa Ordway of Process and Performance Support, the effort was a huge success with employees from across the company contributing food for the food pantry, winter coats, blankets, and clothing. A few employee volunteers made the trek to Rosie’s Place to deliver the items in person to the very grateful staff and clients.

Since its inception in 1974, Rosie’s Place has accepted no government funds, relying instead on committed volunteers and private supporters to deliver its mission. If you are interested in additional information on Rosie’s Place or how you can help the organization please visit their website at http://www.rosiesplace.org/.

Through our MemberConnections program, CeltiCare has been involved with Rosie’s Place for the past two years. Each month a connections representative helps members and non-members at Rosie’s Place locate quality healthcare and community social services resources available to them.

We plan to conduct more food and clothing drives in the future to support the many non-profit organizations that do so much good for our community. As we all know, this support is needed all year long and not just during the holiday season.

• Stay active and fit by participating in a local charity run or walk.  There’s nothing better than supporting your community and maintaining a healthy lifestyle at the same time.
• Celebrate the holiday season in style, and cook for your family and friends in a healthy way!  Check out some of these nutritious and delicious recipes.
• Review the health screenings recommended based on your age, gender, family history and whether you have risk factors for certain diseases.
• Fight the flu!  It’s not too late to get a flu shot at a local clinic near you.
• Hydrate, sleep well, and relax!  Here are some ways to de-stress, unwind and enjoy the winter.

Get a jump on your New Year’s resolutions and start living a healthier life today!

Dr. Robert LoNigro (on the right) presenting the Summit Award to Dr. Joel Gorn at the Lawrence Family Doctors office.

Last month we were proud to join in the tradition of our Centene colleagues and recognize providers who deliver high quality care to CeltiCare members with the 2011 Summit Awards for Excellence in Care.  Our first two recipients are Dr. Joel Gorn who practices at Lawrence Family Doctors and Dr. Philip Severin from the Codman Community Health Center in Dorchester. I had the privilege of presenting Dr. Gorn with his award earlier in November and look forward to presenting Dr. Severin with his award in the coming weeks. While at Dr. Gorn’s office we had the opportunity to speak with his staff and witnessed firsthand the positive energy and enthusiasm that helps makes this practice such a success.  The shrimp pizza we all enjoyed for lunch was also quite tasty!

Some people may ask, “Why are you thanking people for doing their jobs?” We choose to look at it differently.  Our mission at CeltiCare is to provide exceptional patient care and that means going above and beyond to ensure that our members are healthy and happy with their medical care experience.  We view our provider partners as part of our team and feel it is important to recognize those who not only share our core values but live them each day in their delivery of care to our members.  

If you have a provider that has gone above and beyond and want to share your experience with us, we’d love to hear about it. Please contact our Member Services Department at 1-866-895-1786 (TTY/TDD 1-866-614-1949).  I look forward to next year’s 2^nd annual Summit Awards and the formal opportunity to thank our dedicated providers for their commitment to our members’ health and well-being, something we are all grateful for each day. 

Written by Dr. Robert LoNigro, CeltiCare’s Chief Medical Director