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Your Journey to Wellness

At Health First Health Plans, we believe in a population health approach. In this approach, we assess our membership for opportunities and develop programs, services, and resources. We do this to improve the health and quality of life of our members. We want to partner with you to:

  • Help keep you healthy
  • Assist in managing new and existing health conditions
  • Assist with safe transitions across care settings
  • Help you manage chronic illnesses

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Screenings are tests that look to identify diseases before you experience symptoms. Early detection is important to identify and treat diseases early. You can get some screenings in your doctor's office. Others need special equipment, so you may need to go to a different office or clinic.

Some conditions that are commonly screened for include

  • Breast cancer and cervical cancer in women
  • Colorectal cancer
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Osteoporosis
  • Overweight and obesity
  • Prostate cancer in men
  • Your doctor will help to determine with which tests you need based on age, sex, family history, and risk factors for certain diseases.

    Visit our screenings page to learn more about recommended screenings and vaccines.

    Members receive a Personalized Health Report twice a year based on age and recommended screenings to help you keep track of which recommended screenings have been completed and which ones are still needed each calendar year. The Personalized Health Reports also has a removable section which can be brought to office visits to help members keep information current, track completed services and upcoming appointments. A Pediatric scorecard of Pediatric and Adolescent Wellness Recommendations is mailed based on age ranges to assist parents with informing them about the recommended appointments and vaccinations for their child as well as providing them a method to track appointments and vaccinations dates. The guidelines in this tool were developed using guidelines based on data from the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

    Medicare

    Individual

    Pediatric

    Medicare members are eligible to receive a Comprehensive Health Assessment (CHA) once a year. The CHA is a 60-minute visit, in office or home, from a clinician with the goal of updating medical history, providing information to the primary care physician, and care coordination. Upon completing your Comprehensive Health Assessment, members can earn a $50 reward. A CHA can be performed in addition to your Annual Wellness Visit.

    For further assistance scheduling your appointment contact us by calling 321.434.6712 (TTY/TDD relay: 1.800.955.8771)

    Members are eligible to receive an annual preventive visit with a Primary Care Provider which serves as an opportunity to discuss personal health, review medications, family history, and address any other health concerns. The visit may include a comprehensive physical exam, lab work, and an update of one's medical history. This annual visit also provides an opportunity to assess preventative health indicators such as vaccines, recommended screenings, and eye exams. Early signs of health concerns can be detected and addressed to help prevent health concerns from becoming worse.

    We offer fitness benefits to eligible members through programs called Silver&Fit or Active&Fit to promote a healthy lifestyle through a variety of exercise options.

    Medicare Members

    Silver&Fit Exercise & Healthy Aging Program provides members access to a broad network of participating fitness centers including Pro-Health, YMCAs and more. Home Fitness programs are also offered through Silver&Fit where members are given a choice of up to two home fitness kits per benefit year at no cost to you. In addition, all enrolled Silver&Fit members may view Healthy Aging materials online or request that they be mailed.

    This program is available to eligible Medicare members. To register visit SilverandFit.com or call 1.877.427.4788 (TTY/TDD: 1.877.710.2746)

    Individual & Family Plan Members

    Active&Fit exercise program provides enrolled members the option to choose from a variety of fitness options that best suit their needs such as no-cost access to a participating fitness center or at home workouts using up to two out of 32 Home Fitness Kits per year. Other great benefits of the Active&Fit Program include the Active&Fit Connected! ™ tool, a fun and easy way to track your exercise and activity from wearable fitness devices, including Apple Watch®, apps and exercise equipment, also available through Active&Fit's ASHConnect™ mobile app. as well as access to an online newsletter and other web tools like a fitness center search, online classes and more.

    This program is available to eligible Individual & Family plan members that have gym membership coverage as part of their medical benefits. Refer to your Summary of Benefits and Coverage to see if your plan offers gym access. Want to learn more and register visit, ActiveandFit.com.

    Care coordination includes a comprehensive assessment of the any existing conditions; determination of available benefits and resources; and development and implementation of a care management plan with performance goals, monitoring and follow-up. Through care coordination our care team assists our members in navigating the health care system.

    A social worker is also available as needed to offer problem-focused care. They will collaboratively assess the needs of our members and their family and/or support system when appropriate. They also work to arrange, coordinate counsel and advocate for services and support to meet specific complex needs.

    Call your Care Team for help finding a provider that can help coordinate your care which can include a Primary Care Providers, specialists, or a nurse case manager.

    For additional assistance members can also fill out an eligibility form below to be connected directly with a care manager.

    Privia Virtual Clinic

    Through Privia's Virtual Care, providers can connect with you to get the care you need at your convenience. Meet with a board-certified provider by using your mobile phone, tablet, or computer. There's no need to step foot in the office to get help for common issues such as the flu, skin conditions, cuts, scrapes and burns. Members can access this service by downloading the free MyPrivia app or by visiting HF.org to schedule a Virtual Visit with a doctor then select "Immediate Care" and "On-Demand Virtual visit". Members can also schedule a virtual visit with Health First Medical Group by calling 321.434.3131.

    Virtual Care

    Teladoc offers 24/7 virtual care including afterhours, weekends, and holidays. *

    When you need to talk to a provider, just log into your account and select Virtual Urgent Care. A health care provider will call or text you back in as little as 15 minutes. They'll:

    • Discuss any symptoms, relevant health history and may be able to give you a diagnosis.
    • Send some prescription medications to your pharmacy if you need any medicine. *
    *Cost shares may apply

    For additional assistance scheduling a virtual care appointment members can also call your Care Team.

    Our Condition Management program is offered to eligible members with chronic conditions such as Diabetes or Heart Failure. Members will receive ongoing collaboration with our care team to help ensure the most appropriate goal-oriented treatment plan, tools, and resources are in place to successfully manage existing conditions. These include education, self-monitoring techniques, support coordinating health care needs and identifying community resources. Our goal is to help members with these chronic conditions to recognize danger signs early and improve quality of life through self-management skills that help promote wellness and health.

    Health First Health Plans partners with Livongo, a digital disease management platform, to support members in a comprehensive manner. Livongo utilizes advanced technology, personalized recommendations, and real-time communication with members who are enrolled to help them better manage their health condition. Members have access to devices that transmit real time results for Blood Pressure checks and Blood Glucose levels to health coaches. Health coaches get involved with members in real time to offer guidance when results are outside of normal ranges. This helps members to take the right actions to improve their health outcomes. This program is available Medicare and Individual & Family Plan members with Diabetes and Hypertension. To verify eligibly for enrollment, call 1.800.945.4355.

    Our Chronic Kidney Disease (CKD) program seeks to slow the progression of CDK to End Stage Renal Disease (ESRD) or prevent it all together. This program is available to eligible Medicare & Commercial members with stages 3 and 4 Chronic Kidney Disease (CKD). Eligible members will be contacted by a Health Plan nurse who will work to ensure care is coordinated between your primary care provider, Nephrologist, and other specialists as indicated. An individualized plan of care will be developed in addition to providing members with resources and education on medications, nutrition, lifestyle changes and behavior modifications.

    Health Plan Pharmacists work with eligible members and providers to conduct outreach calls and education on the benefits of Statins (cholesterol medicine) to reduce the risk of a heart attack or stroke. This program aims to identify diabetic members that were not prescribed a Stain to help ensure the most effective cholesterol-lowering drugs are being prescribed.

    Statin Use in Persons with Cardiovascular Disease identifies members with heart disease to help ensure they get the most effective drugs to treat high cholesterol and lower their risk of developing heart disease. Health Plan Pharmacists complete outreach calls to members who have been prescribed a Statin. The pharmacist's goal is to provide members with education and assistance help to resolve any barriers with getting prescriptions filled.

    Medical Nutrition Therapy is a program that helps members choose the right foods to eat for specific health conditions with a focus on members who are overweight, underweight or have: diabetes, severe kidney disease, high blood pressure, congestive heart failure or high cholesterol. The program includes an appointment with a registered dietician, an initial nutrition and lifestyle assessment, nutrition counseling, diet management and follow up sessions to monitor progress. This program is available to eligible Medicare & Commercial members through a provider referral.

    Prescription medications can be lifesaving when taken properly but can also cause problems if not taken as prescribed or if taken with other medications. We provide professional counseling from a licensed pharmacist to help members follow doctor's orders and to ensure the medications you are prescribed can be taken together safely. This program is available to eligible Medicare Members with multiple health conditions who also take multiple medications.

    During the call, the pharmacist is also available to help answer any questions as well as offer helpful guidelines about current medications such as:

    • Side effects or other drug-related problems- Information on over-the-counter drugs and how they could interact with prescriptions.
    • For further assistance scheduling an appointment contact us by calling 1.800.716.7737 | 1.800.955.8771 (TDD/TYY)

    Health First Heath Plans contracts with Health First Private Duty to offer Medicare members a 1-hour in-home safety assessment after being discharged from a hospital stay. This service is available once per calendar year. During the visit, a Registered Nurse performs a safety assessment that includes, but is not limited to: reviewing for risk factors associated with falls, a home safety check to identify and remove potential harmful items in the home that may lead to a fall, and assess the need for home modifications including the need for in-home safety devices as appropriate. A comprehensive plan of care is created with the member to help prevent falls.

    In partnership with Health First Physical Therapy we offer classes to Medicare members focused on educating members on how to improve their balance, recognize safety risks and prevent falls. This hour-long seminar includes simple exercises to improve balance and tips to help prevent falls.

    Accidental loss or leaking of urine, called urinary incontinence (UI), is one of the most common bladder control problems. We partnered with Health First Physical Therapy to offer a seminar on Physical Activity and Bladder control topics lead by an occupational therapist specializing Pelvic Floor rehabilitation and strengthening. The class educates our members on the importance of physical activity and how to manage bladder control issues. The hour-long seminar includes simple exercises to improve health, physical ability and bladder control.

    Our Transitions of Care team provides personalized assistance to members who are discharged from a hospital or care facility and transitioning home. The goal of this service is to ensure our members have a safe and seamless transition home while working to prevent avoidable readmissions and unnecessary emergency room visits. Our care managers work with members to ensure they receive medication as prescribed, understand how to take medications properly, ensure follow up appointments have been scheduled, and educate members on self-management skills.

    The care team at Health First Health Plans conducts outreach calls to members who have been identified as having unmet care needs as a results of frequent Emergency Department visits. Our goal is to help ensure members have access to a Primary Care Provider (PCP), receive education on the importance of regular provider visits to help manage chronic conditions, understand the discharge plan, and get the additional support or resources needed to help manage conditions.

    Our program is focused on engaging with and assisting pregnant mothers who have been identified as high risk. Services will continue should the infant need NICU or specialized care for any condition identified at birth. Clinicians support parents during pregnancy, provide resources, support group information, guidance with clinical questions and assistance navigating the healthcare system. This program is available to eligible Medicare and Commercial members who areat risk for having premature births or low birth weight infants based on various risk factors.

    This outreach service is focused on engaging with new mothers after delivery to address any concerns during the immediate postpartum period, identify any potential signs of postpartum depression and assist in getting timely treatment as needed. Our team helps to ensure postpartum follow up and pediatric care is set up and completed. This service is available to eligible Medicare and commercial members. If you have recently delivered and are interested in being contacted by a nurse, please contact our care team.

    Complex Care Management is a service for members with serious or complex health needs who may need extra help navigating the healthcare system, learning about their condition, or accessing community support. Our team is led by a skilled nurse Case Manager and works one-on-one with members to assess needs and supplement the services of healthcare providers with the goal of helping members achieve optimal health. This program is available to eligible Medicare & Commercial members who have been identified as having 2 or more chronic conditions with unmanaged healthcare needs.

    Acute and Catastrophic Transitions is a highly specialized team of Nurse Care Managers that are available to assist eligible members in the most stressful times when facing difficult medical conditions such as newly diagnosed cancers, transplant services or complex pediatric condition(s). Care Managers provide support, education, guidance and assistance navigating the healthcare system to help members get the appropriate care, tests, or treatments needed. The goal is to help members improve their quality of life though education and self-management skills.

    A dedicated multidisciplinary team that works to improve the wellness and health of enrollees by providing proactive and coordinated care. This program complements the care a member currently receives from a primary care physician (PCP) and offers short-term, high-intensity services for patients who have more needs, require more time or need to be seen prior to a PCP available access. The ICP team works to stabilize a member's chronic conditions which will reduce the need for urgent care visits or other emergency services and better position a member to be successful in managing their health. This program is available to eligible Medicare & Commercial Members. For specific eligibility requirements or to see if you qualify please call us at 321.434.4113 toll-free 877.228.0861(TTY/TDD relay: 1.800.955.8771)

    Our behavioral health provider, Optum, specializes in treatment and management to provide a member-focused behavioral health program to our members. The clinical staff works together with Primary Care Providers in coordinating prevention interventions, care plans, community support and resources for members. Members are given unique access to a member website where a variety of tools and resources are available to help assist the member based on their needs. The site also provides members with several different tools, resource guides and many additional mental health resources. Support is available anytime, day or night for members needing crisis management.

    Whenever you need support for life's challenges, your network of mental health providers and facilities is here to support you. Through our partner Optum, you can even schedule virtual routine counseling visits right from home.

    Two ways to receive support

    • Talk to your primary care provider and share how you're feeling. They'll discuss your care options, ask questions, and help you figure out your next steps.
    • Find a mental health provider online or by calling Optum at 1.877.890.6970 (TDD/TTY: 711).

    As we develop, it becomes important to properly manage health conditions. These tools categorize symptoms into three zones, much like a traffic light. Additionally, the logs can be printed out and tracked at home. Such resources may help you continue to focus on improving your overall wellness and health at home.

    Health First Health Plans is an HMO plan with a Medicare contract. Enrollment in Health First Health Plans depends on contract renewal. For accommodations of persons with special needs at meetings call 1.800.716.7737 or TTY/TTD relay 1.800.955.8771.


    Y0089_EL9653_M | Accepted date: 10/1/2021

    Last updated: 2/16/2022