humana cares seniorbridge internal external referrals resources approved materials n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Humana Cares SeniorBridge Internal/External Referrals, Resources, & Approved Materials PowerPoint Presentation
Download Presentation
Humana Cares SeniorBridge Internal/External Referrals, Resources, & Approved Materials

Loading in 2 Seconds...

play fullscreen
1 / 42

Humana Cares SeniorBridge Internal/External Referrals, Resources, & Approved Materials - PowerPoint PPT Presentation


  • 501 Views
  • Uploaded on

HC Learning & Development 2013. Humana Cares SeniorBridge Internal/External Referrals, Resources, & Approved Materials. Working with Humana Members. As a representative of Humana, a Medicare approved company,  the following protocol must be followed:

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Humana Cares SeniorBridge Internal/External Referrals, Resources, & Approved Materials' - zuzela


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
humana cares seniorbridge internal external referrals resources approved materials
HC Learning

& Development

2013

Humana CaresSeniorBridgeInternal/External Referrals, Resources, & Approved Materials

slide2

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.
slide3

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 TrainingHelp@seniorbridge.comif these issues occur.
slide4

Village Health

Transplant Management

well dine
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 diseaseand 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.

village health
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 achieve lifesynch
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
    • (LifeSynchReferrals@lifesynch.com)

*Always verify member has this benefit with Member Services.

slide8

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 Transplant@Humana.com or call Transplant Management at 1-866-421-5663, include transplant referral details. You can obtain a survey form by calling the above number.

slide9

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
slide10

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
slide11

Humana Inc.

Approved Resources

healthwise health library
Healthwise Health Library

Use the search bar to enter a condition or medication

Healthwise is one of Humana Cares approved resources. Access Healthwiseat www.healthwise.net/humana.

Search Topics A-Z or use the Quick Links

humana inc approved resources
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.comor through a member’s homepage at www.Humana.com

*Always verify member has this benefit with Member Services.

humana cares resources
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.
my humana
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
my humana highlights
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.
my humana highlights1
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)
my humana highlights2
MyHumanaHighlights

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 inc approved resources1

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

*Always verify member has this benefit with Member Services.

humana inc approved resources2

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
resource approval
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 01-003Humana Cares Approved Resources and Materials.
use of approved resources
Use of Approved Resources

Disclaimer

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.
slide23

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
slide24

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 pharmacy resources rightsource
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 pharmacy resources rx mentor and medication therapy management
Humana Pharmacy Resources Rx Mentor and Medication Therapy Management

Rx Mentor

Apharmacist 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

slide28

What have we learned?

  • RightSourceRx
  • 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
slide29

End of Life

Planning

Materials and resources available for our members

end of life planning and materials
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.
five wishes purpose
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
lifekeeper purpose
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
lifekeeper availability
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

slide34

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
consult the providers specialists care team
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
    • HC_AskDrJoe@humana.com
    • Medical Director – Dr. Jackie Germain
    • HC_AskDrGermain@humana.com
    • Clinical Pharmacist – Savi Lenis, PharmD, CPh
    • Clinical Pharmacist – Lisa Lenzi
    • HC_Ask_Clinical_PharmD@humana.com
    • Registered Dietician – Jennifer Shoemaker, RD
    • HC_DietitianReferral@humana.com
  • You can submit referrals or ask questions of the HCCP providers and specialists by sending a Secure email.
contact with member
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.
language line for phone calls requiring an interpreter
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. 

slide39

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.
slide40

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
slide41

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.