- SeniorBridge

Report
Humana Cares
SeniorBridge
HC Learning
& Development
2013
Internal/External Referrals, Resources, &
Approved Materials
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
Resources
•
•
•
Understanding the Rules, the Regulations and the
Limitations
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 :
1.
Stay on top of changes.
2.
Overcome barriers and challenges.
3.
Notify Clinical Consultant and [email protected] if these issues occur.
Humana Cares / SeniorBridge
Village Health
Transplant Management
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: 1-866-96MEALS (1-866-966-3257) 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
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 1-800-767-0063 (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
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:
–
1-866-952-6028
–
Clinical Advocates are available Mon - Fri 8 a.m. to 6 pm.
You can e-mail Humana Achieve Program at
–
([email protected])
*Always verify member has this benefit with Member Services.
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 - email completed survey to [email protected] or call Transplant Management at 1-866-4215663, include transplant referral details. You can obtain a survey form by calling the above number.
Humana Cares / SeniorBridge
What have we learned?
Well Dine
•
Humana’s meal service, post discharge and chronic conditions
–
Call Well Dine: 1-866-96MEALS (1-866-966-3257) provide Member’s H#
Village Health
•
For members with End Stage Renal Disease, call 1-800-767-0063 or
fax to 1-877-714-4299
Transplant Management
•
•
For member from initial referral, during, and post one year
To Refer, call Transplant Management at 1-866-421-5663
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 1-866-952-6028
Humana Cares / SeniorBridge
Humana Inc.
Approved Resources
Humana Cares / SeniorBridge
Healthwise Health Library
Use the search bar to enter a condition or medication
Healthwise is one of Humana Cares approved resources. Access Healthwise at
www.healthwise.net/humana.
Search Topics
A-Z or use
the Quick
Links
Humana Cares / SeniorBridge
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: 1-866-452-6442
Electronically - www.HumanaActiveOutlook.com or through a member’s homepage at www.Humana.com
*Always verify member has this benefit with Member Services.
Humana Cares / SeniorBridge
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 1-800-536-7092 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, email the material to the Care Manager
or call the Care Manager. You can also submit an email referral form.
You can find that on our website.
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
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
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
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
Humana Fitness
Inc. Approved Resources
Humana
Humana has two fitness programs:
• Silver&Fit is in PA and NV
• SilverSneakers is everywhere else
Each includes a gym membership, an athome 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
Approved External
Links
Humana
Inc. Approved
Resources
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
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 01-003 Humana Cares Approved Resources and
Materials.
Humana Cares / SeniorBridge
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
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
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, www.HumanaActiveOutlook.com or by phone 1-866-452-6442.
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 email or fax anything to a member.
Humana Cares / SeniorBridge
Humana Cares / SeniorBridge
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 1-855-254-8433, or member can call on their own-1-800-379-0092.
–
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 1-800-379-0092 or faxing 1-800-379-7617.
Humana Cares / SeniorBridge
Humana Pharmacy Resources
Rx Mentor and Medication Therapy Management
Rx Mentor
A pharmacist to provide clinically sound cost, safety, and quality interventions via telephonic methods for eligible Medicare and Commercial
members. Call: 1-877-255-5093 to inquire if a member is eligible
Necessary information for referral includes:
Member Name
Member ID
Member phone number
Referring Program Name and Number - 102 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
What have we learned?
RightSource Rx
•
Humana's prescription mail-order service for medication and diabetic supplies, equipment.
–
Call 1-855-254-8433
Rx Mentor/ Medication Therapy Management
•
Clinical pharmacy consultations
– Call 1-877-255-5093
Humana Cares / SeniorBridge
Materials and resources available for our members
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
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
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
LifeKeeper - Availability
LifeKeeper Kits can be ordered by you, calling 1-888-445-4802 or by the member, calling 1-888-445-8642.
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
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
The HCCP Professionals on your Team
Humana Cares / SeniorBridge
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
[email protected]
Medical Director – Dr. Jackie Germain
[email protected]
Clinical Pharmacist – Savi Lenis, PharmD, CPh
Clinical Pharmacist – Lisa Lenzi
[email protected]
Registered Dietician – Jennifer Shoemaker, RD
[email protected]
You can submit referrals or ask questions of the HCCP providers and specialists by sending a Secure email.
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
Language Line
For phone calls requiring an Interpreter
For calls requiring language interpreter service:
Call - 1-866-896-5899 and use ID# : 248228
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: 1-877-486-2048
for the TDD line.
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 email
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
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
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 email, computer based training, or facilitation.
Humana Cares / SeniorBridge
Humana Cares / SeniorBridge

similar documents