Special Needs Programs Overview. Diabetes

Transcription

1 Special Needs Programs Overview Brand New Day health plan has several special programs for individuals with one or more of the following chronic conditions: Diabetes, Dementia, or Mental Illness. Below is a brief description of each of those programs and the extra benefits available through the Medicare Chronic Care Special Needs Plan. This type of plan is also called a C-SNP. Additionally, Brand New Day has a Special Needs Plan for persons who are eligible for both Medicare and Medi-CAL coverage. This plan is called a Dual Eligible Special Needs Plan or D-SNP. Diabetes Brand New Day has a specialized program for individuals with Type II Diabetes (adult onset). The program has important elements to help support the members management of their diabetes. The Brand New Day diabetes program includes the following services and equipment: Specialized electronic blood sugar monitoring meter (Glucometer) which includes a two way communication to a specialized call center to help you 24 hours a day, 7 days a week Personal caring doctors with expertise in treating diabetes Health Coach to support you in managing your diabetes, including support of your diet and exercise program Specialized web site including programs with recommended diet, exercise, and support programs. Online diabetic appropriate receipts and support. Two benefit plans to choose from; one to reduce your pharmacy costs (Diabetic enhanced pharmacy plan), and one with additional benefits (Diabetic extra benefit plan). The Diabetic extra benefit plan is often chosen by members with both Medicare and Medi-Cal because the Medi- Cal program covers additional things that Medicare can t cover. Plan benefits include the following: Enhanced pharmacy Extra benefits Reduced doctor copayment X X Reduced hospitalization copayment X X Reduced pharmacy copayment X Dental coverage X X

2 Vision coverage X X Transportation to doctor visits X Health Coach to support your diabetic care X X Brand New Day furnishes the 2-way meter, test strips, supplies all at no cost to the member. Test strips and supplies are mailed to the member routinely without the member having to order these. Additionally, all members have access to Brand New Day specialized care management programs, such as o Addiction programs Brand New Day doctors and staff are proud of the success of this program Mental Illness This program provides a specialized support system for individuals who are diagnosed with any of the following: Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depressive Disorder, and Paranoid Disorder. This specialized program allows the members ( you ) to have direct access to a coordinated team of doctors and case managers to support your healthcare needs. The team includes a personal medical doctor, a psychiatrist, a social worker, a behavioral health trained life coach, and a voluntary day treatment program (drop in center). Each of the healthcare professionals works in a coordinated way to care for you. Your assigned case manager works with you to develop a plan to address any needed behavioral health issues, health issues, and

3 to help schedule recommended preventative health services (to keep you healthy). When assigned to this program Brand New Day members receive additional benefits not provided by standard Medicare including the following as needed: Dental coverage Vision coverage Up to 36 one way taxi rides to doctor appointments Monthly Bus pass No copayment to see your doctors Access to Brand New Day specialized care management programs, such as o Specialists o Addiction programs o Special program for individuals with diabetes o Medication Therapy Management o Housing support program Brand New Day doctors and staff are proud of the success achieved by the thousands of individuals who have joined the program over the past fourteen years. Dementia program Brand New Day has a specialized program for individuals with Dementia. The program has important elements which help support the members management

4 of their dementia and support the members caregivers. The Brand New Day dementia program provides the following services and benefits: Specialized doctor network to care for individuals diagnosed with Dementia Each member is assigned to a Health Coach to assist with coordination of care. Each member has an individualized care plan developed by their own Care Team. Brand New Day makes referrals to member and family support programs as needed. Brand New Day helps members with both Medicare and Medi-Cal coverage apply for State programs such as In Home Support Services. Brand New Day refers members with Medicare-only coverage to community resources and private pay support programs. Health Coaches recommend Housing placement support as needed. All members have access to Brand New Day specialized care management programs, such as o Palliative care program The Dementia C-SNP has Paired Benefits, meaning there are two benefit plans within the SNP to choose from: one with reduced pharmacy costs for you (Dementia enhanced pharmacy plan), and one with additional benefits and higher pharmacy costs (Dementia extra benefit plan). The Dementia extra benefit plan is often chosen by members with Medicare and Medi-Cal because the Medi-Cal program pays for many of the non-covered benefits costs. Plan benefits include those paid by Medicare plus improved coverage as follows Enhanced pharmacy Extra benefits

5 Reduced doctor cost share X X Reduced hospitalization cost share X X Reduced pharmacy cost share X Dental coverage X X Vision coverage X X Transportation to doctor visits X Health Coach X X Dual Eligible (Medi-Medi) Plan Brand New Day has designed a plan suited for those with both Medicare and Medi-CAL coverage. The program has important elements for Medi-Medi members, to help ensure their benefits are coordinated in such a way as to maximize their health and prescription drug coverage. This D-SNP includes the following services and benefits: A large network of doctors and providers who accept both Medicare and Medi-CAL patients. A Member Advocate or Personal Service Coordinator to proactively help the member access and coordinate care. Monthly Gym Membership at 24-Hour Fitness or Nifty After Fifty (no cost to the member) Dental Benefit Vision Benefit Monthly Bus Pass Taxi transportation to medical appointments (with authorization and limits)

6 Additionally, all members have access to Brand New Day specialized care management programs, such as o Addiction programs Brand New Day doctors and staff are proud of the success of this program This page last updated 8/18/14