Connect Archives

January 2010

Wednesday, January 13, 2010

Special Needs Program For Wellcare Access and Select Plan Members

Beginning in 2010, CMS imposed new accountability standards for HealthPlans with Medicare Advantage members. The requirements were implemented to ensure members with special needs or chronic illnesses would have increased access to preventative care, care management services, and Mental Health Services. In response to requirements of the 2008 Medicare Improvements for Patients and Providers Act (MIPPA), WellCare filed two plans with CMS, (Access and Select Plans), to receive additional attention as focused, special needs Model of Care Plans. Access and Select Members are considered enrolled in a Special Needs Plan by virtue of being a “dual-eligible” member, meaning Medicare and Medicaid eligible.

Special Needs Programs (SNP’s) typically require coordination of care of assigned members through Case Management services. Health First Network, in collaboration with MED3000 Medical Management staff will be implementing a focused Model of Care Program for eligible WellCare Access and Select Plan members. It will include proactive identification of members for Case Management services; a comprehensive health risk assessment of the member’s condition; coordination of services for members with complex conditions; trained case managers to assist members navigate through needed services in the right setting and in a cost-effective manner, as well as an interdisciplinary care team approach to managing a member’s care including collaborative PCP involvement with the Care Team.

As part of the requirements for the Special Needs Program, HFNI Physicians can expect to receive member care plans periodically throughout the year for existing and new members, including each time the Care Plan is updated. Health First Network is requesting Physician participation to review the faxed Care Plan for each SNP member to whom they provide care; to review and update care plans as needed with any changes and send it back to the case manager; and to communicate with the Interdisciplinary Care Team (ICT) as requested, to ensure optimal coordination of care and transition of care.

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Health First Network Performance Survey Results

Every year or two, Health First Network does a performance survey to determine, well, how the organization is doing in regards to serving its members. We are pleased to share this year’s results, which continue a positive response. First, network leadership is encouraged by the percentage of people who read the Connect eNewsletter– 86 percent of respondents.

Next, use of the Health First Network website is on the rise with 86 percent of survey participants indicating they visit the site. While our hope is that number continues to grow, we are excited that is attracting visitors.

As for the network’s performance, here are the results:

• Calls are returned promptly and to your satisfaction: 94 percent strongly agreed or agree
• Staff is courteous and helpful: 98 percent strongly agreed or agreed

Provider Relations:
• Staff is knowledgeable of Health First Network operations: 88 percent strongly agreed or agreed
• Adequate written information regarding Health First Network is available: 88 percent strongly agreed or agreed
• Calls are returned promptly and to your satisfaction: 96 percent strongly agreed or agreed
• Staff is courteous and helpful: 98 percent strongly agreed or agreed

• Process is effective: 80 percent strongly agreed or agreed
• Staff responds to my requests in a timely manner: 84 percent strongly agreed or agreed
• Staff is courteous and helpful: 88 percent strongly agreed or agreed

We offer a big thanks to everyone who participated in the survey. The more feedback we receive, the better we are positioned to deliver on our commitment to service.

Caring for Our Community

The HFNI Board of Directors has long known that a large number of our member physicians provide services at one of the three free clinics in our area. In recognition of this and as a part of our corporate donations, the HFNI Board unanimously voted to donate $1,000 to each of the three clinics. On December 1st, Charles Brewer of HFNI visited Health and Hope Clinic and on December 2nd, he visited St Joseph’s and Good Samaritan. Pictures of the donations are included. You will notice that in the picture for St. Joseph’s is Dr. William Whibbs, Medical Director of HFNI and in the Good Samaritan picture is Dr. William Zimmern, Chairman of the Board of HFNI. While it was certainly nice to have them included in the pictures, the reason they were there that day was they were providing medical services at the clinic. Another way that HFNI attempts to give back to the community.

Health First Network Staff Participates in United Way’s “Day of Caring”

On Friday, October 23rd, Health First Network staff members joined more than 1,200 other local volunteers to participate in the United Way's "Day of Caring". The Day of Caring is a one-day, community-wide event that utilizes individuals from various businesses and military commands to administer an assortment of volunteer projects at non-profit agencies and schools in our community.

Health First Network staff members spent their day at Wee Kare Academy reading books to children, and assisting with various art projects.

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WellCare’s Coverage of the H1N1 Influenza Vaccine

Health First Network was notified by WellCare Health Plans, Inc. that WellCare will cover the applicable administration charges for the H1N1 vaccine provided to WellCare members. The vaccine must be offered to eligible Medicare Advantage members at no charge. Member co-payments are not applicable for this service. For WellCare Medicare Advantage members the following code should be used for vaccine administration reimbursement:

• G9141, Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)

For the most accurate, up-to-date information on the vaccine, antiviral prophylaxis, and distribution issues, visit the CDC's Website.

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