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Assessing the needs of high-risk Medicare Advantage HMO and PPO members

March 29, 2012

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We are pleased to announce two outreach initiatives in 2012 for our high-risk Medicare Advantage HMO and PPO members: one for members who are currently in a contracted facility that provides skilled or custodial care (SNF program), and another for select high-risk members who reside at home (In-Home program). Through MedAssurant, an independent company, local physicians, nurse practitioners, and physician assistants will conduct comprehensive health risk assessments for members either at the facility or in the member?s home.

These programs provide face-to-face comprehensive medical assessments for high-risk Medicare Advantage HMO and PPO members with complex chronic conditions, at no cost to the member. These assessments will help support the care that primary care physicians (PCP) give to these Medicare Advantage HMO and PPO members and identify additional health risks and additional medical management opportunities.

As noted in communications to SNF and at-home members, a MedAssurant representative will contact applicable facilities and members to arrange these comprehensive health risk assessments and review charts as necessary with the members? consent. For the SNF program, facilities are responsible for providing inpatient medical records and assisting in contacting members? PCPs for information to complete the health risk assessments.

Once the comprehensive health risk assessment is completed, a letter will be sent to the Medicare Advantage HMO and PPO members? PCP or other designated provider informing them that an assessment was performed, along with the results. As part of the SNF program, a copy of the comprehensive health risk assessment shall be placed in the patient?s medical records in the facility. PCPs should file the comprehensive health risk assessment in their patients? charts and review the results with them during their next visit.

Last year, the comprehensive health risk assessments were well-received by both patients and the provider community. This year we look forward to serving the selected high-risk members and the provider community.

Please call Customer Service at 1-800-ASK-BLUE if you would like more information about this initiative or if you have further questions.

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