Health Integrated is playing a role in the return of Passport Health Plan's return to the D-SNP market in Kentucky. The Passport Advantage product being rolled out in mid-October serves beneficiaries eligible for both Medicaid and Medicare.
Health Integrated and Passport Health Plan today said that Passport will re-enter the D-SNP market in Greater Louisville and has chosen Health Integrated to help manage care for dual-eligible beneficiaries. Open enrollment for Passport Advantage 2016 coverage begins on Oct. 15 for eligible residents of Bullitt, Hardin, Jefferson and Nelson counties in Kentucky.
“Passport temporarily exited the Medicare Advantage business at the end of 2011 to focus on our Medicaid product delivery and service,” said Passport Health Plan CEO Mark B. Carter. “Doing so allowed us to gain record growth while maintaining the highest NCQA ranking for any Medicaid plan in Kentucky. By returning to the Medicare Advantage market with ‘Passport Advantage,’ we will be able to provide improved care and continuity using the same providers for people eligible for Medicaid and Medicare benefits.”
With more than 10 million individuals eligible for both Medicaid and Medicare nationwide, a unique set of requirements set forth by the U.S. Centers for Medicare & Medicaid Services (CMS) must be followed in order to qualify for and maintain a Special Needs Plan for dual-eligibles. More than 40 percent of beneficiaries qualify for Medicare because of a disability, and the majority of individuals qualify for traditional Medicaid by falling below the federal poverty level.
Health Integrated specializes in working with the most challenging and vulnerable patients in the country, such as dual-eligibles, who often have multiple conditions and social barriers to care. The company has a unique focus in Precision Empowered Care Management™, addressing the interplay of physical, behavioral and social determinants of health. It offers a D-SNP Model of Care (MOC) solution for care coordination, which is a critical component of the four components (called MOCs) required by CMS. Focused on integrated care and service delivery, Health Integrated’s care coordination complies with multifaceted regulations and includes all of the required tools: health risk assessments, individualized care plans, interdisciplinary care teams and more.
According to the Congressional Budget Office, 55 percent of dual-eligible beneficiaries have been diagnosed with a mental illness, and 30 percent have a severe and persistent mental illness like schizophrenia, schizoaffective disorder or bipolar disorder.
“This creates the need for greater clinical resources and expertise devoted to behavioral health in addition to the medical resources required to treat the chronic physical conditions and disabilities seen in the duals population,” said Shan Padda, Health Integrated CEO. “Our focus has always been to tie these two together and treat beneficiaries as whole individuals. No longer can our health care system treat physical, behavioral and social aspects of health separately and expect to see improved outcomes.
“We are delighted that we were able to partner on Passport’s successful application to CMS and to assume their D-SNP care management function,” Padda said. “We are also honored that they selected us to provide medical and behavioral health utilization management for this population as part of our new agreement.”
About Passport Health Plan
Passport Health Plan is a provider-sponsored, non-profit, community-based health plan administering Medicaid benefits to more than 270,000 people around Kentucky. Named the top Medicaid plan in Kentucky by the National Committee for Quality Assurance (NCQA) for 2015-16, Passport has been contracted with Kentucky’s Cabinet for Health and Family Services to administer Medicaid benefits since 1997 and has been serving the entire Commonwealth since Jan. 1, 2014. For more information, go online to passporthealthplan.com or passportadvantage.com.