Commonwealth Coordinator Procedural Memo – download Annual Enrollment instructions for GIC Coordinators at all HR/CMS, UMass and Offline agencies.
Municipal Coordinator Procedural Memo – download Annual Enrollment instructions for GIC Municipal Coordinators.
February 14, 2014
Our Commission met today to review our progress on Centered Care and vote on benefits effective July 1, 2014. Progress on the GIC’s Centered Care Initiative continues. This initiative seeks to improve health care coordination and quality while reducing costs. Primary Care Providers play a critical role in helping their patients get the right care at the right place with the right provider. The central idea is to focus attention and coordination of health care services on patients. Because health care costs are consuming so much money, Centered Care also seeks to engage providers and health plans on managing these dollars more efficiently so that everyone can benefit.
In addition to helping to keep premiums in check, how does this affect members?
There are 10 key elements of Centered Care and we’ve outlined three of them in our recent newsletter :
- Primary Care Provider (PCP) designation – your health plan keeps track of who your PCP is and lets the provider know that you are their patient and you have selected him or her to coordinate your care.
- PCP engagement – your PCP helps coordinate your care.
- Data sharing – electronic health records provide secure access to your health history, prescriptions, lab results and appointments to help your PCP another providers keep track of your medical needs and make sure they are met.
Other key attributes that are already implemented or we are working to implement:
- Low cost providers are encouraged. Patients will continue to have incentives for choosing low cost, high quality specialists and hospitals.
- Expanded hours and urgent care access – the GIC and our health plans are working to expand providers’ hours to include some evenings and weekend appointments making it more convenient for members for urgent care needs off hours.
- High level of care for chronically ill - If members have a chronic condition, their PCP will monitor and advise them all year long.
- Disease management: A members’ health plan will identify patients at risk for complications and will help those members and their provider navigate the care and find out about best practices.
- Group visits: Patients with similar conditions may sometimes meet together with their providers. An organized, typically multi-disciplinary, office visit for a small group of patients that includes education, promotion of self-management, group interaction and support as well as direct patient-practitioner encounter. Examples of these types of visits can include wellness programs for patients with weight-related issues and support sessions for those suffering from lower back pain.
- Transitional care management: When a patient is released from the hospital to rehab or home, care will be provided to make sure the patient’s treatment plan and medications go with them.
- Essential reporting package: Our health plans will help providers to help our members by giving them timely reports on patients, their fellow physicians, and best practices.
How Will Centered Care Affect Benefits for July 1? Benefit changes will help support this initiative:
- All GIC health plans will be reaching out to members to acquire PCP information.
- Neighborhood Health Plan will no longer tier PCPs: PCP and Outpatient Mental Health/Substance Abuse Copay: $20 per visit
- Tufts Health Plan Navigator will no longer tier hospitals by different types of services. Hospitals will be tiered for all services combined based on quality and/or cost.
- UniCare Indemnity Plan PLUS will give an incentive through a lower copay when members visit Centered Care PCPs: $15 per visit
There will be benefit changes related to federal health care reform and mental health parity:
- Increased coverage for:
- Low protein food
- Medically necessary infant to age 3 early intervention services
- In-home dialysis
- Speech therapy
- $5,000 per person and $10,000 per family out-of-pocket maximum for mental and mental health services. Most of the GIC’s HMOs will also include prescription drug benefits in the limit.
- New ACA-related fees will be incorporated into the final premiums that are voted in March: health insurer, transitional reinsurance, and patient-centered outcome research
Other benefit changes include the implementation of moving management and dispensing of certain specialty drugs used to treat arthritis, multiple sclerosis and immune diseases from UniCare Basic, Community Choice and PLUS to CVS Caremark. Details of benefit changes will be in the Benefit Decision Guides.
As of right now, Fallon Health has not submitted a bid for their Select Care plan in keeping with the terms of their GIC contract. We will have final information on this plan at the March 5 Commission meeting and will provide you with additional information at that time.
North Andover will be offering the GIC’s Retiree Dental plan coverage for the first time. We will also be adding three new municipalities to the municipal health program: East Bridgewater, Framingham, and Middleborough.
We will hold 12 health fairs this year, geographically distributed across the state with emphasis on locations for new municipal members.
For state employees:
- Special Life Insurance Open Enrollment: for the first time in 10 years, we will be offering a special life insurance open enrollment. Active state employees will be able to enroll for the first time for coverage amounts of one, two or three times salary. State employees already enrolled will be able to increase their coverage by one, two or three times their current amount (for example, if they have 2x salary now, they will be able to enroll for 3x, 4x or 5x coverage). Under the open enrollment, proof of good health will not be required. The enrollment period will extend from April 9 – June 13 and coverage will be effective October 1, 2014.
- Long Term Disability: Mental health benefits will increase from 24 months to 36 months for disabilities occurring on or after July 1, 2014.
- Life Insurance: Effective July 1, 2014, upon payment of the accelerated life benefit, future premiums will be waived regardless of a member’s age.
GIC Coordinator Training
Attend one of the GIC’s five training sessions the first week of April. We will provide details about Centered Care, Annual Enrollment, and will host a question and answer session with the health plans and the life insurance carrier. The GIC will also provide an overview of GIC benefits, which will be particularly helpful to new Coordinators or Coordinators who want to brush up on their benefit knowledge. A section on procedures will also be included. Please RSVP to Liz Layton no later than March 19.
Other Important Reminders
Annual Enrollment is Wednesday, April 9 – Wednesday, May 7 for changes effective July 1, 2014; Life Insurance Open Enrollment April 9 – June 13 for changes effective October 1, 2014. Benefit Decision Guides will be shipped to agencies and municipalities beginning April 1 and will be available as a download on our website at the end of March.
Provider networks and hospital/specialist tier designations change each July 1: Members need to do their homework during Annual Enrollment. The best source of information is the health plans and not by calling the doctors’ offices. Members should visit the health plan websites (April 4 or later) to find out if their own and their covered family members’ doctors and hospitals are in the plan. They should be specific with their searches (e.g., Harvard Primary Choice or Independence). They can also call the health plan customer service phone numbers.
Plan selections are binding for a year, unless the member experiences a qualifying event such as moving out of the plan’s service area or retiring and becoming Medicare eligible (in which case, the member must switch to a Medicare plan). If a doctor or hospital leaves the member’s health plan, the member remains in that health plan. The plan will help the member find a new provider.
Municipality Rate Sheets: Be sure to sign off on your rate sheets with Danielle no later than March 14. Late signoff can delay your guide shipments.
Procedural Memo: Paul and Donna will send additional details about procedures toward the end of March.
Survey: We will be distributing a member survey by email and mail prior to the start of Annual Enrollment. Additional details will follow at the end of March.
RSVP: Don’t forget to RSVP to Liz for the Coordinator training; first come, first serve on date/location choice.
See you in the spring!
This information provided by the Group Insurance Commission .
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