Medicare Programs Innovations

Posted on November 11th, 2019 in Bulletin Board by chpadmin

The CHPW Medicare Advantage product design will provide extra help for members with certain chronic conditions, allowing us to more directly address the social determinants of health challenging our communities. Historically, CMS did not permit allowances for population subsets. Medicare Advantage (MA) organizations are now allowed to provide enriched benefits and reduced cost-sharing for members with certain disease states under the Uniformity Flexibility (UF) benefit option.

We are excited that we are now able to provide extra help for Medicare Advantage members with certain chronic conditions and to offer them some special services designed to help them remain healthy. This is a summary of the innovations CHPW is offering our Medicare members.

Zero Copays for Visits for Management of Certain Chronic Diseases for All Our Medicare Members

An important part of managing chronic conditions is having dedicated follow-up clinic visits to address those conditions. The copays can be prohibitive for many patients. CHPW has long believed it is contradictory to encourage members to seek treatment to address chronic illness while still requiring copays and coinsurance, which often serve as barriers to care. To decrease barriers to appropriate follow-up, we are reducing the copay to zero for visits to address the below conditions. (Member will present a Zero Cost Services ID card along with the regular CHPW Medicare Advantage member ID Card at time of service to qualify for the zero copay.)

Chronic obstructive pulmonary disease (COPD)

The copay will be zero for visits to primary care and pulmonology for a primary diagnosis related to COPD. Copays for Oxygen DME will also be zero for members with COPD.

Diabetes

The copay will be zero for visits to PCP, endocrinology, ophthalmology or optometry for a primary diagnosis related to Diabetes (or diabetic retinal exam).

Heart failure

The copay will be zero for visits to PCP and cardiology with a primary diagnosis related to Heart Failure.

Zero Cost Items to Help All Our Medicare Members with Specific Conditions Who Are Participating In Care Management

To encourage self-management and participation in case management, CHPW has decided to offer the following items to Medicare members with specific chronic conditions who participate in case management:

• Members with a diagnosis of Heart Failure who are participating in care management will be eligible for a body weight scale
• Members with a diagnosis of Refractory Hypertension who are participating in care management will be eligible for a home blood pressure cuff
• Members with a diagnosis of Frailty who are participating in care management will be eligible for a Personal Emergency Response System (PERS)

Non-Opioid Treatment Options for All Medicare Members with Chronic Pain

We are expanding our alternative medicine benefit to offer Medicare members more options for the treatment of chronic pain. All our Medicare members will have a combined total of twelve alternative medicine visits with the option of acupuncture, naturopathy, or routine chiropractic.

These services are not covered by traditional Medicare. Given the diversity of our membership and the need for alternatives to opioids, we are excited to expand the quantity and choices of alternative medicine benefits.

Nutritional Support for Members Post Discharge for Medicare-SNP Plan 014 and MA Extra (Plan 010) Members

Twenty to eighty percent of hospitalized patients are at additional risk of further health problems due to poor nutrition. Nutritional status tends to worsen over the course of a hospitalization. This contributes to worse outcomes, readmissions, and increased risk of mortality.  Many patients are still too ill at the time of discharge to prepare their own meals, particularly if their diet needs to change due to their illness. To support members of our two lower income Medicare plans, the dual-eligible Special Needs Plan Plan 014 (SNP) and the MA Extra (Plan 010), CHPW will be providing two medically appropriate meals per day for fourteen days post-discharge.

CHPW extends this benefit to these members after any inpatient discharge—medical, surgical, mental health, Skilled Nursing Facilities (SNF), and Rehabilitation — for any diagnosis, with the goal of easing members’ transition back home and preventing members from experiencing unnecessary readmissions and other complications. The meals that our members receive will be appropriate for their conditions, such as low-sodium or diabetic diets.

Sources:

¹Holst M, Rasmussen HH. Nutrition Therapy in the Transition between Hospital and Home: An Investigation of Barriers. Journal of Nutrition and Metabolism. 2013; 2013: 463751

²Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. International Journal of Environmental Research and Public Health. 2011 Feb 16.