Connect Archives

November 2008

Saturday, November 01, 2008

Medicare Open Enrollment: What Physicians and Patients Need to Know

Medicare Open Enrollment is quickly approaching, and Health First Network encourages its physicians to support their patients through this process. Please note that Health First Network only has contracts with WellCare and HealthSpring. Key dates, patient tips, and helpful information are included in this article.

Key dates to keep in mind and share with patients:

Sneak Peak:
October 1, 2008: This marks the day that health plans can begin to offer a "sneak peak" of what's to come. It is when health plans begin to advertise what their new plans will look like, generally speaking.

Full Disclosure:
Mid-October: Medicare will disclose all of its plans in full. This is when physicians and patients will learn anything and everything there is to know about 2008 plans and benefits.

Annual Enrollment Period (AEP):
November 15 through December 31, 2008: During this period, Medicare patients have the most flexibility. They can choose to enroll in Medicare Advantage or, if they are already Medicare Advantage members, they can change plans. People have the option of making more than one change; however, it is important that they understand that the application with the latest date will become effective on January 1, 2009.

Open Enrollment Period (OEP):
January 1 through March 31, 2009: In this time frame, eligible individuals may make ONE change to a plan centered on their Part D coverage. This means that if an eligible person is in a plan that has no Part D coverage, they may only change to another plan with no Part D coverage.

Special Enrollment Plan (SEP):
In certain cases, qualified individuals may enroll in, disenroll from, or change to a different Medicare Advantage plan or Original Medicare. Time frames for this kind of enrollment are determined on case-by-case scenarios. SEP situations might include:
* Changes in residence
* Turning 65
* Termination of a Medicare Advantage contract

Enrollment for Dual Eligibles:
In addition to the enrollment periods listed above, please note and let patients know that individuals who are dual eligible - meaning they qualify for Medicare AND Medicaid - benefit from a permanent open enrollment period. This group can make changes to their plans anytime during the year.

Tips to offer patients regarding the Medicare Enrollment process:
* Be open to switching plans. New plans will be introduced this fall. This means more options from which to choose.
* Learn about each plan to determine which one is the best fit. Every person is different so is every plan.
* Pay special attention to the pharmacy benefits/drug formularies. This is especially important for patients who rely heavily on medications.
* Don't wait until the last minute.

Healthy Kids Product awarded to Vista Healthplan (Coventry)

Effective October 1, 2008, the Healthy Kids product for both Escambia and Santa Rosa Counties have been awarded to Vista Health Plan (Coventry). Prior to this time Healthy Kids in Escambia County was through HealthEase and was contracted through Health First Network. Santa Rosa County was through Blue Cross and Health First was not involved.

Health First Network will be responsible for providing professional services for this product in both counties. We will operate the Healthy Kids in the same manner as Health First currently provides services for the Vista Commercial HMO products. To you, this means that referrals for professional services will be approved through Health First Network while authorization for facility based services will be through Vista. The list of services requiring pre-authorization for Vista Healthy Kids will be placed on the HFN website, www.hfni.com.

It is important to note that we have made an effort for all of the children to remain with their current primary care physician. HFN provided a list of the Escambia members and their respective PCP to Vista for them to load in their system. It is our understanding that Blue Cross did the same for the Santa Rosa members.

Please email Jenny Caillouet at JCaillouet@hfni.com or call her at 850-438-4487 with any question or concerns you might have.

Health First Network Welcomes New Staff Members

Health First Network would like to introduce two new employees added to our staff.

Heather Ochoa accepted a position with HFNI as a Certified Professional Coder. Her knowledge in coding to the highest specificity will ensure that HFNI physicians are maximizing their reimbursement.

Jackie Murph is HFNI's new Provider Relations Representative. She brings 20 years of experience in Practice Management. Jackie will serve as a liaison between HFNI provider offices and insurance companies to ensure physician's offices continue to improve healthcare services.

Health First Network - Caring for our community

On Friday, October 24th, Health First Network staff members joined more than 1,100 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 Spencer Bibbs Elementary School reading books to children, and assisting with various school projects.

This incredible event celebrates the spirit of caring and voluntarism that is so vital to our community.

Participating Pharmacy now contracted for Diabetic Education

In the January 2008 issue of the e-Connect Newsletter, Health First Network featured an article highlighting a local participating pharmacy, Thrif T Drugs and Darrell Miller, Pharm D.

Thrif T Drugs is a contracted Pharmacy with Health First Network, and a top ally of the organization. Darrell and his team go above and beyond delivering medicine and top-notch care and customer service to clients. They focus on taking care of the patient, educating their customers on how to take and use their prescriptions, and even offering delivery services. Pharmacists at the two locations pride themselves on working closely with patients to promote proper use and compliance with medications.

Under a new contract, Thrif T Drugs is now contracted for Diabetic Education in individual and/or group sessions for WellCare members with Pharmacist Darrell Miller. Your WellCare members on Diabetic Medications and those using Glucometers for Blood Sugar testing, may benefit from this new service.

WellCare members with diabetes have the benefit of a glucometer that can be dispensed at no cost to them from the Healthplan. Several different models are available. Occasionally, due to diabetic or age-related conditions such as arthritic fingers or visual problems, the member cannot use the machine they are issued, and, as a result, stop using it and fail to monitor their blood sugar levels. Darrell and his team can assist these members by sitting down with them in a one-on-one teaching session and reviewing their medication and glucometer usage. Darrell can recommend different Glucometer machines that may be more functional for the member. Thrif T Drugs can also provide diabetic supplies, test strips and lancets, with a prescription with no referral or pre-authorization needed.

Physicians, office staff and case managers can refer a member for diabetic education at Thrif T Drugs by calling Darrell Miller at the Jordan Street store at 850-433-2165. Speak to him directly, or, if he is not immediately available, leave a message for him to return the call, or e-mail him at dmiller2008@cox.net and leave the information and contact number. No pre-authorization or referral authorization number is needed to refer a WellCare member for these diabetic education services with Thrif T Drugs.

CME Credits Available Online

Once again, it’s that time of year to think about License Renewal, and the current state required CME that goes with it. Since 2006, the rules and requirements have changed, and it’s worth the effort to review what we each need to do. The easiest approach is to access the Mecop website. Both the requirements, and links to approved courses are there. Another option is to access the Florida Department of Health at
http://www.doh.state.fl.us/mqa/medical/me_ceu.html , which has all of the requirements.

A message from Dr. Whibbs, HFNI Medical Director

I would like to stop for a moment and thank all of the physicians and their staff for their cooperation, and especially for their help over the past year. The difficult times will continue as healthcare reform taxis down the runway and tries to get off the ground. Health First Network will continue to be a hugely positive influence
on healthcare delivery in our community because of the care, the concern, the skill, and the involvement of our physicians…and that makes my job working for you so much easier.