PEIA Plan Year Provider Workshops April/May For training purposes, do not distribute. Actual plan details may be subject to change.

Transcription

1 PEIA Plan Year 2017 Provider Workshops April/May 2016

2 Christine DeRienzo PEIA Debbie Duespohl HealthSmart Benefit Solutions J Hart HealthSmart Benefit Solutions

3 Overview Comprehensive Care Partnership Program (CCP) Healthy Tomorrow s Wellness Programs Choosing Wisely General Plan Changes

4 Comprehensive Care Partnership CCP Program (CCP) Program Primary care provider manages health care Focus on prevention, quality of care and cost containment Increased access to provider Provider is paid on a PMPM capitation for enrolled members with shared savings opportunity Enrolled members have reduced or no copayments, deductible or coinsurance for specified covered services received at CCP provider

5 PEIA CCP Program 8 CCP provider groups Cabin Creek Health System Community Care of WV FamilyCare Health Center Marshall Health Monongahela Valley Association of Health Centers New River Health Pocahontas Memorial Hospital Valley Health 83 Locations in 18 Counties 10,132 members enrolled

6 CCP Enrollment Providers Contact Provider Relations Manager Members Complete enrollment on PEIA website or use paper enrollment form Need Provider ID# from directory!

7 2016 PEIA Healthy Tomorrow s Plan Year completed Employees need to chose a provider on-line or submit a form if they do not have access to the internet. Plan Year due by May 15, 2016 Chose a provider and record measurements. Blood Pressure, Glucose, Cholesterol and Waist Circumference Plan Year 2018 due by May 15, 2017 Chose a provider and meet measurement goals. BP <140/90, Cholesterol <245, Glucose <125 Waist Circumference (report only) Men <40, Women <35 Additional $500 deductible for non-compliance.

8

9

10 Worksite Wellness PEIA Pathways to Wellness Fitness, nutrition and stress management classes available for PPB or Health Plan members Lifestyle coaching Fitness assessments and planning At over 900 worksites across WV Access to healthy food through community supported agriculture Classes on healthy eating, cooking, gardening through WVU and WVSU Extension Services

11 Weight Management Individualized services from dietitians and exercise professionals for PPB members Up to two years in length Two attempts per lifetime (if didn t complete first time) Eligibility: BMI of 25 or greater; or waist circumference of 35 inches or more for woman; 40 inches or more for man At over 70 fitness centers across state Call or can apply on line at Face to Face Diabetes Education from Pharmacists and certified diabetes educators Waived co-pays for generic and preferred brand medications, including testing supplies New By June 30, participants must report a current Hemoglobin A1c to their F2F provider. If Hemoglobin A1c is 8.1 or above they will be dis-enrolled, unless they submit documentation from treating physician Participants will graduate after two years of participation

12 Tobacco Cessation Benefit Initial and follow up physician visits covered with no out of pocket cost to member 12 week course of therapy covered 100% Twice per rolling 12 month period Full coverage during any pregnancy No lifetime limit Member must be paying tobacco user premium to receive the benefit

13 Choosing Wisely Choosing Wisely is a national initiative to educate providers and patients on the appropriate use of health care services Under the leadership of the American Board of Internal Medicine (ABIM) Foundation, more than 60 physician and nursing organizations have each identified at least five tests, procedures or drugs in their area of expertise that have questionable value PEIA supports CW and members have access to the 5 Questions, Appropriate Antibiotic and Chronic Pain Management Tools on-line

14 Plan Changes Detailed document in the Provider Packet Available on-line at Highlights

15 For More Information Provider Relations ext

16