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Humana Cares / SeniorBridge

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Presentation on theme: "Humana Cares / SeniorBridge"— Presentation transcript:

1 Humana Cares / SeniorBridge
HC Learning & Development 2013 Humana Cares SeniorBridge Internal/External Referrals, Resources, & Approved Materials Humana Cares / SeniorBridge

2 Humana Cares / SeniorBridge
Working with Humana Members As a representative of Humana, a Medicare approved company,  the following protocol must be followed: All appointments must be pre-scheduled and approved by the member. Announce oneself when entering a member’s home and include the company name.  Clearly display the self picture badge with your name, Humana/SeniorBridge clearly noted. Refrain from giving gifts to members. Motivate people to accept the best services within HCCP. Humana Cares / SeniorBridge

3 Humana Cares / SeniorBridge
Understanding the Rules, the Regulations and the Limitations Resources All referrals to third party resources and utilization of collaterals must be approved by Humana. Access to community resources and government entitlements is influenced by and is contingent upon funding. Eligibility for Humana programs is determined by the member’s specific Medicare Advantage plan benefits. The Care Manager Mission : Stay on top of changes. Overcome barriers and challenges. Notify Clinical Consultant and if these issues occur. Humana Cares / SeniorBridge

4 Humana Cares / SeniorBridge
Village Health Transplant Management Humana Cares / SeniorBridge

5 Humana Cares / SeniorBridge
Well Dine Member Benefit Provides 10 pre-cooked, frozen meals after each overnight hospital or Special Needs Facility (SNF) stay if referred within 30 days post discharge Chronic Condition Benefit Provides 10 meals /week for three weeks to those members with diabetes, coronary artery disease and congestive heart disease to help with dietary modification and life style changes-call to check on this benefit as our LTIH members may not qualify Post delivery Support: Delivery Confirmation Buddy Assurance Calls Nutritional content brochure, includes nutrition information for each meal type To Refer: Call Well Dine: MEALS ( ) provide member’s H# and make sure they have the correct mailing address. It can’t be shipped to a PO Box *Always verify member has this benefit with Member Services. Humana Cares / SeniorBridge

6 Humana Cares / SeniorBridge
Village Health For members with End Stage Renal Disease. Field-based and telephonic nephrology nurses coordinate all aspects of member care for Hemo or Peritoneal dialysis. Referral:  Identify your members that meet the referral criteria Discuss the benefits of the Village Health Referral with your member Call Village Health at (Hours of Operation: 7AM – 7PM EST) Below are the pieces of information you should provide to the Village Health represenative: Care Manager Name and Phone number Member First and Last Name Member DOB Member Address Member Phone Number Member subscriber ID Additional information regarding member’s dialysis schedule, disease, etc. are helpful but are not necessary Humana Cares / SeniorBridge

7 Humana Achieve/LifeSynch
LifeSynch provides more intensive mental/behavioral health assistance and goal-setting for members who have medical and behavioral co-morbid symptoms. You can contact the Humana Achieve Program by telephone: Clinical Advocates are available Mon - Fri 8 a.m. to 6 pm. You can Humana Achieve Program at *Always verify member has this benefit with Member Services. Humana Cares / SeniorBridge

8 Humana Cares / SeniorBridge
Transplant Management Transplant Management provides guidance, from initial referral, during entire transplant process, and throughout status post one year of receiving transplant, for members undergoing evaluation for solid organ or one marrow/peripheral stem cell/cord blood transplant. To Refer - completed survey to or call Transplant Management at , include transplant referral details. You can obtain a survey form by calling the above number. Humana Cares / SeniorBridge

9 Humana Cares / SeniorBridge
What have we learned? Well Dine Humana’s meal service, post discharge and chronic conditions Call Well Dine: MEALS ( ) provide Member’s H# Village Health For members with End Stage Renal Disease, call or fax to Transplant Management For member from initial referral, during, and post one year To Refer, call Transplant Management at Humana Cares / SeniorBridge

10 Humana Cares / SeniorBridge
What have we learned? Humana Achieve/LifeSynch Provides mental/behavioral health assistance and goal-setting for members who have medical and behavioral co-morbid symptoms. Contact the Humana Achieve Program Humana Cares / SeniorBridge

11 Humana Cares / SeniorBridge
Humana Inc. Approved Resources Humana Cares / SeniorBridge

12 Healthwise Health Library
Use the search bar to enter a condition or medication Healthwise is one of Humana Cares approved resources. Access Healthwise at Search Topics A-Z or use the Quick Links Humana Cares / SeniorBridge

13 Humana Inc. Approved Resources
Humana Active Outlook – The Humana Active Outlook (HAO) branded Personal Health Programs are health and wellness services. These program offerings promote proactive, healthy behaviors, and healthy living for Humana Medicare members. Members can access the Personal Health Program by either way listed below: Telephonically: Electronically - or through a member’s homepage at *Always verify member has this benefit with Member Services. Humana Cares / SeniorBridge

14 Humana Cares Resources
Community Resource Directory A comprehensive online application listing of national, state, county, city (local) member-centric, community resources, agencies, and organizations, (i.e. AARP, Transportation, and Senior Centers etc.) This resource directory is maintained by the HC Community Resource Specialists. Call and speak to a Community Resource Specialist who will assist to help locate the resource your member needs. They will mail printed material to the member, the material to the Care Manager or call the Care Manager. You can also submit an referral form. You can find that on our website. Humana Cares / SeniorBridge

15 Humana Cares / SeniorBridge
My Humana Provides tools members need to maximize their plan. The tools will better help you guide the member’s benefit decisions. Available to members and accessed through Humana.com (It is their personal web page) Online 24 hours per day/ 7days per week Humana Cares / SeniorBridge

16 Humana Cares / SeniorBridge
My Humana Highlights Provider Tools Physician, Dentist, Hospital, Urgent Care, Pharmacy, Vision Providers, and Mental Health and Substance Abuse Counselors. Alternative Healthcare Provider Search Members can receive up to 30% discount for chiropractors, massage therapists, and acupuncture. Humana Cares / SeniorBridge

17 Humana Cares / SeniorBridge
My Humana Highlights Pharmacy Tools Drug Coverage searches Benefit and coverage details Comparison and spending tools Drug libraries also in Spanish Drug Interaction tables Information about generic drugs Right Source information and online registration Medication Therapy Management (MTM) Humana Cares / SeniorBridge

18 Humana Cares / SeniorBridge
MyHumana Highlights Member Benefit Information Coverage details and plan design Can request Humana ID card Claims Member can access Personal claims details Payment processing specifics Financial Tools Calculators, cost projections, budgeting tools Humana Cares / SeniorBridge

19 Humana Inc. Approved Resources
Humana Fitness Humana Inc. Approved Resources Humana has two fitness programs: Silver&Fit is in PA and NV SilverSneakers is everywhere else Each includes a gym membership, an at-home option, and other features Program # Members as of 9 Jan 2013 % of Members SilverSneakers Fitness Program 1,588,354  81.4%  Silver&Fit Fitness Program 71,557  3.6%  No access 286,655 14.7% *Always verify member has this benefit with Member Services. Humana Cares / SeniorBridge

20 Humana Inc. Approved Resources
Approved External Links Approved external links can be accessed through Humana.com or MyHumana The approved links on these pages are the only approved links associates should access. Written information given to the members must be in PDF format. Examples are: National Institutes of Health National Institutes on Aging Centers for Disease Control, CDC American Diabetes Association, ADA American Heart Association, AHA Humana Cares / SeniorBridge

21 Humana Cares / SeniorBridge
Resource Approval Associates are to utilize all previously mentioned resources to provide the member with the information that they have requested. If you are unable to locate what you need from the list of approved items and you find something from another source, then you must send a request to your immediate supervisor or manager along with copies of the materials or resource and a statement of justification of its use and benefit. If you have questions, please refer to Policy HC POL Humana Cares Approved Resources and Materials. Humana Cares / SeniorBridge

22 Use of Approved Resources
Disclaimer Use of Approved Resources When providing care management to Humana members Care Managers are required to work solely with fully approved websites, electronic resources, and educational materials for their own purposes and on behalf of the members they are serving. Care Managers should download information and resources or contact agencies by phone. When needed, the Care Manager can assist the member through 3-way calls or send approved materials to the member. Humana Cares / SeniorBridge

23 Humana Cares / SeniorBridge
What have we learned? Approved online resources Approved external links may be accessed through Humana.com or MyHumana These are the only approved links associates should access. Examples are: National Institutes of Health; National Institutes of Aging Centers for Disease Control (CDC) American Diabetes Association, (ADA) American Heart Association, AHA Humana has two fitness programs: Silver & Fit is in PA and NV (Check with member services for verification of benefit) Silver Sneakers is everywhere else (Check with member services for verification of benefit) MyHumana - An online Member tool through Humana.com Humana Cares / SeniorBridge

24 Humana Cares / SeniorBridge
What have we learned? Healthwise A website with material clinical information on a variety of health and wellbeing topics to help manage treatments and to manage conditions. Humana Active Outlook Health and wellness services available online, or by phone CRD/Approved Resources Utilize all previously mentioned resources to provide the member with the information that they have requested. Care Managers are required to work solely with fully approved websites, electronic resources, and educational materials for their own purposes and on behalf of the members they are serving. When needed, the Care Manager can assist the member through 3-way calls or send approved materials to the member. Humana Cares/Senior Bridge associates are not permitted to or fax anything to a member. Humana Cares / SeniorBridge

25 Humana Pharmacy Resource Humana Cares / SeniorBridge

26 Humana Pharmacy Resources: RightSource
RightSource Rx Humana's prescription mail-order service for medication, diabetic supplies, and equipment. Eligibility: Check that member has pharmacy mail-order benefit and ensure the member is eligible for RightSource Rx mail-order. Benefits: Savings Convenience Safety and Accuracy Easy Communication Cost saving ($0 copayments for preferred generics- (as long as they are not in the donut hole) To Refer: Case Manager can call , or member can call on their own Member/caregiver can use RightSourceRx.com or Humana.com. Request their eligible prescriptions be moved from retail to RS Rx. Physician can send prescription by calling or faxing Humana Cares / SeniorBridge

27 Humana Pharmacy Resources Rx Mentor and Medication Therapy Management
A pharmacist to provide clinically sound cost, safety, and quality interventions via telephonic methods for eligible Medicare and Commercial members. Call: to inquire if a member is eligible Necessary information for referral includes: Member Name Member ID Member phone number Referring Program Name and Number Humana Care Member’s Chief Complaint (i.e. Reason for referral to RxMentor) Medication Therapy Management A series of personalized consultations with a health professional regarding the member’s medications. The member will receive a letter inviting them to join this program Humana Cares / SeniorBridge

28 Humana Cares / SeniorBridge
What have we learned? RightSource Rx Humana's prescription mail-order service for medication and diabetic supplies, equipment. Call Rx Mentor/ Medication Therapy Management Clinical pharmacy consultations Call Humana Cares / SeniorBridge

29 End of Life Planning Materials and resources available for our members

30 End of Life – Planning and Materials
Promote Advance Care Planning for our members. Bridge communication with our members, their doctor, and family. Helping members understanding the purpose and function of a living will. Giving the member a voice; making their wishes known when and if they are unable to vocalize those wishes. LifeKeeper Kit and Five Wishes. Humana Cares / SeniorBridge

31 Humana Cares / SeniorBridge
Five Wishes - Purpose America’s most popular Living Will Written in everyday language Helps people express their wishes in areas that matter most the personal and spiritual in addition to the medical and legal. Completing Five Wishes is a gift to your family, friends and your doctor because it keeps them out of the difficult position of having to guess what kind of treatment you want or don’t want. Families also use Five Wishes to help start and guide family conversations about care in times of serious illness. You may access the Five Wishes booklet by notifying your clinical consultant, to make sure it is legal in your state Humana Cares / SeniorBridge

32 Humana Cares / SeniorBridge
LifeKeeper - Purpose Writing down important life choices brings peace of mind. LifeKeeper helps members work through their financial, legal, and health matters. LifeKeeper includes: Advice on getting organized Forms to record personal information Education on end-of-life issues Legal advance directive forms for the member’s state Humana Cares / SeniorBridge

33 LifeKeeper - Availability
LifeKeeper Kits can be ordered by you, calling or by the member, calling Remember that the LifeKeeper Kit is 128 pages and should be recommended for members that want a fully comprehensive tool. For some members this may be too overwhelming; the 5 Wishes Booklet is recommended in those cases. or Humana Cares / SeniorBridge

34 Humana Cares / SeniorBridge
What have we learned? End of Life – Planning and Materials 5 Wishes – more specific to the last days of life experience LifeKeeper Kit – Comprehensive full spectrum EOL plan Humana Cares / SeniorBridge

35 Humana Cares / SeniorBridge
The HCCP Professionals on your Team Humana Cares / SeniorBridge

36 Consult the Providers & Specialists Care Team
The HCCP Interdisciplinary Care Team consists of a telephonic team that includes: Providers and Specialists Medical Director – Dr. Joseph Migliozzi Medical Director – Dr. Jackie Germain Clinical Pharmacist – Savi Lenis, PharmD, CPh Clinical Pharmacist – Lisa Lenzi Registered Dietician – Jennifer Shoemaker, RD You can submit referrals or ask questions of the HCCP providers and specialists by sending a Secure . Humana Cares / SeniorBridge

37 Humana Cares / SeniorBridge
Contact with Member As a representative of Humana, a Medicare approved company, the following protocol must be followed: All appointments must be pre-scheduled and approved by the member. Announce oneself when entering a member’s home and include the company name.  Clearly display the self picture badge with your name, Humana/SeniorBridge clearly noted Refrain from giving gifts to members Motivate people to accept the best services within HCCP. We should not Suggest purchase of added Humana programs. Encourage members to leave Medicare Advantage and go to Medicare and a Part D plan, etc. Handle money. Humana Cares / SeniorBridge

38 Language Line For phone calls requiring an Interpreter
For calls requiring language interpreter service: Call and use ID# : Press 0 or stay on the line for assistance An Interpreter will be connected to the call. Brief the Interpreter. Summarize what you want to accomplish and give any special instructions. Say “End of Call” to the Interpreter when the call is completed. For communication with a member or member’s representative with a speech or hearing impairment: Dial: for the TDD line.  Humana Cares / SeniorBridge

39 Humana Cares / SeniorBridge
What have we learned? You can submit referrals or ask questions of the Humana Cares providers and specialists by sending a Secure Contact with a Member - Follows a protocol Appointments are pre-scheduled and approved by the member. Always announce oneself when entering a member’s home and include the company name.  Clearly display the self picture badge with your name and Humana/SeniorBridge included. Refrain from giving gifts to members. Motivate people to accept the best services within HCCP. Humana Cares / SeniorBridge

40 Humana Cares / SeniorBridge
What have we learned? We should not Suggest purchase of added Humana programs Discuss leaving Medicare Advantage and go to Medicare and a Part D plan. Handle money Humana Cares / SeniorBridge

41 Humana Cares / SeniorBridge
Change is Good Please keep in mind that during the integration between Senior Bridge and Humana Cares there will be some change involved. And as new policies and procedures are introduced, the new information will be delivered to you in the way of updates via , computer based training, or facilitation. Humana Cares / SeniorBridge

42 Humana Cares / SeniorBridge
Questions Humana Cares / SeniorBridge


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