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Medicare Advantage Updates: What’s New for 2012

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Enhanced Prescription Drug Benefits:

All Capital Health Plan Medicare Advantage (HMO) plans will offer a 90-day retail supply and a 90-day mail order supply of most prescriptions beginning January 2012.

To take advantage of the 90-day retail supply just ask your physician’s office for a 90-day prescription and fill the prescription at your local pharmacy.

To take advantage of the 90-day mail order service:

Contact your physician’s office and ask for a 90-day prescription with three refills. 

  • Fill out the Mail Service Order Form. 
    • Download the form at caremark.com under “Forms for Print.” 
    • Or, call Member Services at the numbers listed below, and we will mail you a form. 
  • Mail the form to Caremark at the address printed on the form.

Drugs available through mail order are drugs you take on a regular basis, for a chronic or long term medical conditions.  The drugs that are not available through mail order service are marked with a “NM” (not available at mail order) on your Formulary (drug list).   The Formulary is available on line at capitalhealth.com/2012 Medicare. All Medicare Advantage members enrolled in plans that renew between October 1 and January 1 have also received the new 2012 Formulary by mail.  

Medicare-Covered Preventive Services:  

Most preventive services have been covered by Capital Health Plan at no cost to members in the past.  However, in 2012 members will see some additional preventive services covered at no cost.  Please refer to your Evidence of Coverage, Chapter 4, for a list of preventive services.   This is a good time to check and make sure you have completed your annual screenings for 2011.

For other 2012 changes, please refer to your Annual Notices of Changes and Evidence of Coverage.

Questions:  Contact Member Services, 850-523-7441 or 1-877-247-6512 (TTY 850-383-3534 or 1-877-870-8943) 8:00 a.m. to 8:00 p.m., seven days a week.

H5938_DP 267 File & Use 11222011

Capital Health Plan #1 Medicare Plan in the Nation!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Capital Health Plan’s Medicare Advantage Plan is ranked number one in the nation according to “NCQA’s Health Insurance Plan Rankings 2010-2011 – Medicare” published by the National Committee for Quality Assurance (NCQA). The Medicare Advantage Plan has ranked in the top tier in past years, but is now the first ever Florida health care plan to be ranked number one.

“We are honored to receive the number one ranking from NCQA. It is a reflection of the commitment of our local physicians and clinical staff to consistently deliver quality medical care,” said Dr. Nancy Van Vessem, Capital Health Plan chief medical officer. “Collaboration between Capital Health Plan, physicians and members has led to continued success measured by consistently excellent results on quality and member satisfaction scores.”

Capital Health Plan is your local health plan serving Leon and the surrounding counties, but the plan brings the entire state of Florida national attention with its achievements. “As the only health care plan in Florida to receive such a commendable rating, we are committed to being a leader and continually improving Medicare services and patient care,” said John Hogan, CEO of Capital Health Plan.

To calculate plan rankings, NCQA uses HEDIS®, CAHPS® and NCQA Accreditation standards scores. These scores reflect the results of consumer surveys and the plan’s success in prevention and treatment compared to other plans.

The Healthcare Effectiveness Data and Information Set (HEDIS) measures performance on important dimensions of care and service. Capital Health Plan received the following important 2010 HEDIS results:

  • CHP scored the very highest in the nation for Colorectal cancer screenings.
  • CHP scored the very highest in the nation for Overall Effectiveness of Care.
  • CHP scored the very highest in the nation for Overall Preventive Screening Rate

What’s so important about Capital Health Plan’s #1 ranking?

You. Thank you, members, for once again letting us – and the nation – know that Capital Health Plan works for you. Our goal is protecting and supporting your health. Your continuing satisfaction is the real measure of our success.

That’s why for 28 years, CHP has maintained our high standards in medical care and a strong physician network. That’s why we strive to meet your evolving needs with innovative services like CHPConnect and CHP Health Coaching. And that’s why our local member services department strives to deliver efficient, expert service.

The source for data contained in this publication is Quality Compass® 2010 and is used with the permission of the National Committee for Quality Assurance (NCQA).Quality Compass 2010 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CHP is Your 5 Star Medicare Plan, Again.

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Capital Health Plan is the only Medicare Advantage plan in the nation to receive five out of five stars in both 2010 and 2011 from the Centers for Medicare and Medicaid Services. Once again, CHP is uniquely honored with this five star distinction along with only two other plans in the nation.

“It is an honor to be recognized nationally as a leading provider for Medicare Advantage,” said John Hogan, CEO of Capital Health Plan. “Thanks to our team of physicians, nurses and staff, our members continue to receive nationally-recognized service through our health plans.”

According to the Centers for Medicare and Medicaid Services, the five star rating system is used to monitor plans to ensure they meet Medicare’s quality standards. The system uses 53 quality measures including preventive care, chronic illness management, and customer satisfaction.

The release of the ratings comes just in time for the November 15th open enrollment for Medicare beneficiaries. Using the ratings system, prospective members can compare the quality of care and customer service among Medicare health and drug plans. All ratings are posted publicly in Medicare’s Plan Finder at www.medicare.gov.

“In addition to recognizing our outstanding commitment to our members, these ratings offer Medicare beneficiaries more transparency and the opportunity to learn about the quality and value of health plan options to ensure they find the one that best meets their needs,” said Dr. Nancy Van Vessem, Capital Health Plan chief medical officer. “We will continue to strive to provide our members with excellence in service.”

Advantage Primetime - Understanding Your Prescription Drug Coverage

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Here are some important prescription drug changes to Capital Health Plan Medicare Advantage plans for 2011.

Capital Health Plan Advantage Plus (HMO)

Capital Health Plan Preferred Advantage (HMO)

There is a new Formulary (list of covered drugs which can change each year). Check your Annual Notices of Changes and Evidence of Coverage for changes in coverage, Tiers, and/or restrictions.

Copayments for Tier 1 generic drugs have been lowered. Check your Annual Notice of Changes and Evidence of Coverage for other changes to copayments/coinsurance.

The initial coverage limit has been raised from $2830 in 2010 to $2840 in 2011.

Members will now generally receive a 50% discount for covered name brand drugs in the coverage gap (donut hole).

There were no changes in catastrophic coverage in 2011.

Capital Health Plan Retiree Advantage (HMO)

 

There is a new Formulary (list of covered drugs which can change each year). Check your Annual Notices of Changes and Evidence of Coverage for changes in coverage, Tiers, and/or restrictions.

Some plans have made copayment changes. Check your Schedule of Retiree Advantage (HMO) Copayments for more details.

 

 

 

 

 

The Formulary and plan specific Annual Notices of Changes and Evidence of Coverage for each plan can be accessed on our website.

What stays the same:

Members still have access to our national network of pharmacies. You can look up network pharmacies on our website. All service area pharmacies are also listed in the Directory of Physicians, Services Providers and Pharmacies. For questions, call Member Services at 850-523-7441 or 1-877-247-6512 (TTY/TDD 850-383-3534 or 1-800-955-8771, 8:00 a.m. to 8:00 p.m., seven days a week. From March 1 through October 15 voice mail is available on weekends and holidays.

Capital Health Plan is a Health Plan with a Medicare contract. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2012.

Capital Health Plan #1 Medicare Plan in the Nation!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Capital Health Plan Ranked Number One Medicare Plan in the Nation

-- Honored with top national awards by National Committee for Quality Assurance and Centers for Medicare and Medicaid Services --

TALLAHASSEE, Fla. – Capital Health Plan (CHP) a local, non-profit health plan announces that its Medicare Advantage Plan is ranked number one in the nation according to “NCQA’s Health Insurance Plan Rankings 2010-2011 – Medicare” published by the National Committee for Quality Assurance (NCQA). The Medicare Advantage Plan has ranked in the top tier in past years*, but is now the first ever Florida health care plan to be ranked number one.

"We are honored to receive the number one ranking from NCQA. It is a reflection of the commitment of our local physicians and clinical staff to consistently deliver quality medical care,” said Dr. Nancy Van Vessem, Capital Health Plan chief medical officer. “Collaboration between Capital Health Plan, physicians and members has led to continued success measured by consistently excellent results on quality and member satisfaction scores.”

Capital Health Plan serves Tallahassee and the surrounding counties, but the plan brings the entire state of Florida attention with its achievements. The Centers for Medicare and Medicaid Services (CMS) awarded CHP with five out of five stars for its Medicare Advantage health plan. Star ratings show how well each plan performs in a particular category, ranging from 1 star, meaning "poor" quality, to 5 stars, meaning "excellent" quality. The system was designed to help patients and their families more easily make decisions regarding Medicare services.

“As the only health care plan in Florida to receive such a commendable rating, we are committed to being a leader and continually improving Medicare services and patient care,” said John Hogan, CEO of Capital Health Plan. “The rankings we received from both the Centers for Medicare and Medicaid Services and the National Committee for Quality Assurance are a testament to the dedication of our staff and medical community to excellent care for our members.”

NCQA uses HEDIS®, CAHPS® and NCQA Accreditation standards scores to calculate plan rankings. These scores reflect the results of consumer surveys and the plan’s success in prevention and treatment compared to other plans. Medicare health plans voluntarily report their scores to NCQA using data from HEDIS® and CAHPS® in categories related to access to care, overall satisfaction, prevention and treatment.

CHP’s commitment to member satisfaction shows in the outstanding results of member surveys. CHP Connect, a secure, online personal health record, helps members take control of their health. CHP Health Coaching gives members access to online web modules and 24/7 advice from health care professionals to guide them through important medical decisions. Capital Health Plan’s local member services department consistently delivers efficient, expert service.

* U.S. News/NCQA “America’s Best Health Insurance Plans” 2005-2009 (annual). “America’s Best Health Insurance Plans” is a trademark of U.S. News & World Report.

Advantage Primetime

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Medicare Advantage (HMO) vs Medicare Supplemental Insurance

At Capital Health Plan, Medicare members are offered Medicare Advantage (HMO) plans. Medicare Advantage plans are different than Medigap (Medicare Supplemental Insurance) plans. This is because we are a Health Maintenance Organization and not a supplement to Original Medicare. Capital Health Plan Medicare Advantage plans actually become your Medicare and provide all of your Medicare coverage. Medicare members wondering if the Medicare Advantage plan is the right choice for them should know the difference between a Medicare Advantage and a Medigap plan.

The Medigap plan is a supplement to Original Medicare. It can help pay some of the costs that Original Medicare does not cover, like copayments, coinsurance, and deductibles. Original Medicare generally pays 80% of the cost of services after meeting deductibles (when they apply). The patient is responsible for the deductible and 20% of the cost. Costs vary by policy and by company. Some prevention services may not be covered. Medigap plans purchased after 2006 do not include prescription drug coverage, so individuals need an additional prescription drug plan or Medicare Part D plan. The Medigap premiums, deductibles, copayments, coinsurance and the extra cost of a prescription drug plan can add up.

Capital Health Plan’s Medicare Advantage plans are an excellent value. There are no deductibles – just copayments or coinsurance to pay. Some services have a $0 copayment. The CHP plans are comprehensive and offer all the benefits of Original Medicare plus MORE. They include prescription drug coverage (Medicare Part D) and wellness benefits not generally covered by supplemental plans. There is no need to worry about primary and secondary payers, no need to file claims or seek reimbursement like there could be with a Medigap plan.

If you have additional questions about the different Medicare plans please call our Member Services department.

 

 

HIV Screenings

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

The Center for Medicare and Medicaid Services asks us to periodically inform you about certain benefits. Here is important information for Retiree Advantage and Medicare Advantage members:

U.S. Food and Drug Administration (FDA)-approved and standard HIV rapid screening tests are a covered benefit under the following circumstances. There is no copayment or coinsurance for the screening tests.

1. Annual voluntary HIV screenings for Medicare members who are at increased risk for HIV infection per U.S. Preventive Services Task Force guidelines which include:

  • Men who have had sex with men after 1975;
  • Men and women having unprotected sex with multiple partners;
  • Past or present injection drug users;
  • Men and women who exchange sex for money or drugs, or have sex partners who do;
  • Individuals whose past or present sex partners were HIV-infected, bisexual or injection drug users;
  • Persons being treated for sexually transmitted diseases;
  • Persons with a history of blood transfusion between 1978 and 1985;
  • Persons who request an HIV test despite reporting no individual risk factors, since this group is likely to include individuals not willing to disclose high-risk behaviors.

2. Voluntary HIV screening of pregnant Medicare members when the diagnosis of pregnancy is known, during the third trimester, and at labor.

For additional information about HIV screening tests please contact your primary care physician.

 

 

CHP Medicare Advantage (HMO) Plans Receive 5 Stars

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

 

 

 

 

 

The Center for Medicare and Medicaid Services (CMS) has published the 2010 health plan star ratings for health plans at www.medicare.gov on the Health Plan Finder. Capital Health Plan is the only Medicare Advantage plan in Florida, and one of only three in the nation, to receive 5 stars for the summary rating of health plan quality from CMS.

Stars for each plan show how well the plan performs in that particular category. Star ratings range from 1 star to 5 stars, where 1 star means "poor" quality and a rating of 5 stars means "excellent" quality.

“These rankings are based on clinical performance, member satisfaction and accreditation information. CHP is always finding ways to improve the quality of the health care services we provide, and we are honored to receive this prestigious recognition,” said CHP Chief Medical Officer Dr. Nancy Van Vessem. “It is a reflection of the commitment of our physicians and clinical staff to consistently deliver quality service.”

If you have questions please contact our local Member Services.

 

Primary Care is Cost Effective!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

 

A recent study by Johns Hopkins University found that traditional fee-for-service Medicare could save approximately $10 billion a year by avoiding unnecessary hospitalizations.

The study, commissioned by the Alliance of Community Health Plans (ACHP), compared the Medicare Retiree Advantage programs of community based health plans, including Capital Health Plan, against traditional Medicare.

In traditional Medicare, hospital readmissions account for $17 billion of the $102.6 billion spent in hospital payments each year. The results of the study show that Capital Health Plan outperformed traditional Medicare in hospital readmission rates, preventable ER visits, and preventable hospital admissions. With rates similar to that of CHP, traditional Medicare could save approximately $10 billion annually.

Chief Medical Officer Dr. Nancy Van Vessem explains how we are able to accomplish these low rates:

“At Capital Health Plan we believe that access to strong, consistent outpatient care by a physician who knows the patient is the best defense for avoiding unnecessary hospital admissions and emergency room visits.”

“That same relationship improves transitions of care between the inpatient and outpatient setting and contributes to CHP’s low rate of readmissions within 30 days. Our Care Coordination Department and the nurses in our staff model practice, contact at-risk members to ensure that follow-up appointments with their primary care physician are organized within a week of discharge from the hospital.”

The Johns Hopkins research further supports Capital Health Plan’s philosophy that focusing on coordinated care and preventative health maintenance will improve care and lower costs.

 

Hospital Readmission Rate Within 30 days Preventable ER Visits (per 100 member months) Preventable Hospital Visits (per 100 member months)
Capital Health Plan 7.68% 2.76 1.44
Medicare Fee-for-Service 18.6% 15.5 19.0