Spring 2023 Insight Employer Newsletter

When the COVID-19 pandemic was declared a public health emergency, there were changes to how health plans covered services related to the prevention, diagnosis and treatment of COVID-19. However, with the emergency declaration ending, the following changes will occur to COVID-19-related coverage on May 12, 2023:

• At-home, over-the-counter COVID-19 tests will no longer be covered by Independent Health after May 11, 2023.
• Lab tests for the diagnosis of COVID-19 and pre-surgical testing for COVID-19 will be covered like other lab tests: depending on your plan you may have a cost share for the COVID-19 lab test, along with the applicable office visit. If you have a diagnostic COVID-19 test at an urgent care center, your urgent care cost share will apply.

Independent Health will continue to cover COVID-19 vaccinations and booster shots in full like many other preventive care services.

Special deadline extensions to end

In addition to coverage changes, certain deadline extensions for fully-insured plans that were put in place as the result of the COVID-19 National Emergency declaration will come to an end on June 9, 2023. This includes deadlines affecting COBRA continuation coverage, special enrollment periods, claims for benefits, appeals of denied claims and external review of certain claims.

We will be posting updates for you and your employees on the COVID-19 section of our website . If you have any questions, please contact your account manager.

When it comes to the health of our members, Independent Health likes to take a proactive approach because that ultimately leads to better health outcomes. We offer more than 60 preventive care services and screenings at a $0 copayment as a way to make it easier for your employees to get healthy and stay healthy. These services are covered in full when rendered by an in-network/participating health care provider. Plus, they are excluded from deductibles—so those enrolled in a deductible plan can get these services right from the start.

Providing health recommendations and reminders

To help ensure your employees are taking advantage of their $0 preventive care benefits, Independent Health offers them personalized health recommendations through their online member account. Since these recommendations are based on factors such as medical history, age, gender and past screenings, they are more relevant and useful to each individual’s unique needs and risks.

Using your employees’ personalized health recommendations, we send them e-mail reminders when it's time to engage in preventive services, screenings or other health actions. For instance, over the past few months, we have launched e-mail campaigns around the importance of scheduling annual well visits and colorectal cancer screenings. More than 90,000 members have been notified as part of these campaigns, and the open rate has exceeded 40% for both of them. From an e-mail engagement standpoint, these are significantly higher rates than industry standard rates, which are usually between 17-28%. Traditionally, our preventive service campaigns have been quite effective as we often see a spike in preventive care utilization rates among our membership in the months immediately following our outreach efforts.

Rewarding members for taking charge of their health

New for 2023, Independent Health is pleased to offer RedShirt Rewards¹, a program that provides our members with incentives for completing various preventive services and activities that can help them stay healthy and increase their odds of living longer. Beginning on your group’s 2023 plan renewal or effective date, your employees may be eligible to earn up to $30 in RedShirt Rewards² by completing three or more eligible health actions, including an annual checkup, colorectal cancer screening, breast cancer screening, flu shot³, COVID-19 vaccine and booster³, and various diabetes-related services and tests.

Eligible members can activate RedShirt Rewards through their secure member account (which can be accessed online or through the MyIH mobile app). Once they provide their consent and complete an eligible action listed above, they will then receive a secure message through their member account that will allow them to choose a gift card from a wide range of participating retailers, including Amazon, Nike, Target and more!

We encourage you to help us spread the word about RedShirt Rewards by sharing our RedShirt Rewards website with your employers.

¹As always, benefits vary by plan. ²Rewards will be issued when Independent Health receives notification of a claim for each activity, which may take up to 90 days for a provider to submit the claim(s). ³For members who do not have pharmacy coverage through Independent Health or Pharmacy Benefit Dimensions, these actions must be provided in a medical facility, such as a doctor’s office, hospital or urgent care center. Pharmacies or community centers do not qualify.

Care and treatment of medically complex individuals adds to health care expenditures which affect health care premiums – in fact, up to 75 percent of medical costs are driven by chronic health conditions such as hypertension and diabetes – which is one reason why proactive health care management for this patient population is essential. 

Independent Health has always found that solutions to these challenges are found in better alignment and more coordinated care among providers and health plans to reduce the need for hospitalizations and provide care in alternative settings when appropriate. In 2021, Independent Health introduced the Care for You program to help its members with chronic health conditions get the medical care and assistance they need without having to navigate the health care system alone.

Initially focused on our Medicare Advantage members, Care for You has proven to be so successful that we have recently expanded the program to our fully-insured commercial plan members*. There is no cost to take part in the Care for You program.

How the program works

Care for You doesn’t replace the primary care doctor or specialists, but rather enhances access to the most appropriate care for individuals in order to reduce hospitalizations, readmissions and emergency room visits by wrapping around the delivery system to help enhance coordination and communication.

To address the specific and extensive care required by individuals with multiple chronic conditions, Care for You involves a dedicated care team of physicians, physician assistants, nurse practitioners, registered nurses, social workers, dietitians, and community health workers who work with the patients to develop individualized, proactive care plans in concert with their primary care physician.

When patients receive care in one of four settings – in the home, hospital, nursing home, or clinic – Care for You staff support accessibility and efficiency and manage preventable admissions/readmissions. The Care for You patients also undergo an assessment of social determinants of health so the care team can link them with applicable community resources and educate and promote medication adherence. Any services received from Care for You staff members will not require member deductible, copayment or coinsurance.

By providing timely, coordinated care in members’ homes, the Care for You program also alleviates some of the pressure facing the local health care system by reducing emergency room visits and inpatient hospital stays. Providing access to non-emergent care in alternative settings (e.g., in the home or clinics) reduces emergency department crowding and results in better, more efficient care.

Impressive results

Across all aspects of care, our Care for You members are showing savings between $350 to $450 per month when compared to their expected cost. Among those who participate in the program, we have seen a 54% decrease in preventable admissions, 42% decrease in acute inpatient stays and 23% decrease in emergency room visits.

We are in the process of identifying commercial plan members who qualify for Care For You and contacting them to see if they may be interested in enrolling in the program. This may include some of your employees. If you have any questions about Care for You, please contact your account manager.

*Excluding HSA-Qualified High Deductible Health Plans

Since 2014, Independent Health and the Buffalo Bills have teamed up to offer the Health & Wellness Challenge as a way to encourage thousands of Western New Yorkers to adopt healthier habits by offering them a chance to win prizes.

During this spring’s Challenge, participants can earn points for tracking their physical activity, completing daily challenges – like drinking eight glasses of water or eating five servings of fruits and veggies – and participating in weekly special activities that focus on emotional wellness, intellectual wellness, nutritional wellness, and more. Participants can automatically earn points for physical activity by connecting a compatible health and wellness app or device to Wellable, an award-winning wellness technology platform.

The more that participants do to get healthy, the more points they’ll earn, and the greater their chances at winning a prize.

More than 25 prizes to be awarded

Among the prizes that will be up for grabs are autographed Bills memorabilia, fitness trackers, wireless ear buds, gift cards and other prizes. Plus, one lucky Challenge participant will be randomly chosen as the grand prize winner and receive eight tickets with parking to a Bills preseason home game, an autographed Bills helmet, prize packs from the Bills and Independent Health, and a $1,000 Visa gift card.

The number of points earned throughout the six-week Challenge will determine the number of chances each participant has in the prize drawing (one point = one entry). To be eligible to win a prize, participants must earn at least 25 Wellable points, while also being at least 18 years of age and a legal resident of New York State at the time of entry.

Join us for Workout Wednesdays

All Health & Wellness Challenge participants are also invited to attend free “Workout Wednesday” fitness classes led by YMCA certified instructors! Boot camps will be held inside the ADPRO Sports Training Center at 6 p.m. every Wednesday during the Challenge. This is a great way to get fit and earn points.

Sign up today!

Registration for this spring’s Health & Wellness Challenge is now open, and you do not need to be an Independent Health member to participate. To register and learn more, simply visit the Wellable website.