Spring 2024 Insight Employer Newsletter

One plan for clinical quality, integrated care, constant innovation and outstanding service

As the only locally-focused health plan in Western New York, Independent Health believes we are better suited to serve you and your employees. Through our relationships with doctors, hospitals, and the work we do in our community, the decisions we make here, and the partnerships we help foster here, create value from and for our community.

With Independent Health, you can count on your employees receiving the high-quality care they need and the exceptional service they deserve. It’s just one of the many reasons Independent Health’s HMO/POS (Commercial) plan was one of only two plans in the nation to earn the highest rating for 2023 from the National Committee for Quality Assurance’s (NCQA), which is a private, non-profit organization dedicated to improving health care quality. We are also the only insurer to be recognized by the Centers for Medicare and Medicaid Services (CMS) as a 5-Star Rated Medicare Advantage Plan for 2024 in the eight county service area of Western New York.

The prestigious recognition Independent Health has achieved is a testament to the fact that not only are our members pleased with the care and service they are receiving, but they are also benefitting from our many efforts to educate them about the importance of preventive care and improve their overall experience as a patient.

In addition to being recognized by NCQA and CMS, here are a few other examples of what sets us apart from other health insurers both locally and nationally:

• In-house alignment. Independent Health’s home-grown family of companies unites all the aspects of health plan management under one roof, providing a unique ability to drive better outcomes and address the complex drivers of health care costs. Only Independent Health can offer a fully aligned medical and pharmacy benefit management solution, which is increasingly important as pharmacy costs continue to be the fastest-growing component of health care spending locally and nationally. With Independent Health’s fully transparent model, employer groups benefit from less confusion and uncertainty, more savings, and a seamless member experience.
• Restless innovation. Independent Health’s innovation in care delivery has advanced primary care locally by pioneering a value-based care and payment model that rewards physicians for improving the health of their patients. More recently, we have developed a home-based model of care called “Care For You” that has driven improved health and cost of care for members with multiple chronic and social conditions that have previously been challenging to manage.
• RedShirt^® Treatment. At Independent Health, we’ve got your back. Our local team of RedShirts are dedicated to helping you meet your group’s needs and those of your employees. We’re always here to provide you with personalized, one-on-one attention and we’ll stay connected until your problem is solved or your question is answered. According to Independent Health Commercial Phone Performance Metrics from August 2023, 89% of all service call are answered by our servicing team within 30 seconds and we are able to fully meet our customers’ needs the first time they contact us 88% of the time.

As always, if you have any questions about your current plan offerings or would like to learn how our other plan options could fit your benefits strategy, please contact your account manager.

Improving the overall health of our community through population health management programs

Population health management (PHM) is a relatively new term, but it is by no means a new concept. PHM is a model of care that addresses individuals’ health needs at all points along the continuum of care – including in the community setting – through participation, engagement, and targeted interventions for a defined population.

The goal of PHM is to maintain or improve the physical and psychosocial well-being of individuals, while assessing and addressing health disparities through cost-effective and tailored health solutions. Independent Health’s PHM efforts include chronic condition and case management programs that are designed to help your employees with their ongoing health care needs.

Chronic condition management

Having a chronic condition can significantly impact one’s everyday life and often requires additional care and regular doctor’s visits. Chronic diseases are the leading causes of illness, disability, and death in the United States.

By offering chronic condition management programs, we can help reduce health care costs and improve quality of life for our members with chronic conditions by preventing or minimizing the effects of the disease through integrated care. Our chronic condition management program focuses on various conditions, including:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Cardiac (e.g., hypertension and congestive heart failure)
• Prediabetes
• Diabetes
• Chronic Kidney Disease

Case management

The overall goal of case management is to help individuals regain optimum health or improved functional capability, in the right setting and in a cost-effective manner. It involves comprehensive assessment of the member’s condition; determination of available benefits and resources; and development and implementation of a member centered case management plan with established performance goals, monitoring, and follow-up.

Independent Health’s Case Management Team of experienced and highly trained nurses, social workers and other care specialists (including behavioral health, physical therapy, exercise physiologist, and a registered dietician/certified diabetes educator) are here to provide additional help and support. If you have an employee who has been in the hospital with a serious health condition or experienced complications, are living with multiple health conditions and/or finding it difficult to manage their daily activities, one of our case managers may call to help them:

• Understand their diagnosis and treatment options
• Coordinate their care with their primary care physician, specialist(s) and other health care providers
• Prevent hospitalization and re-hospitalization
• Understand their medications and how to take them as prescribed
• Address barriers they may have with obtaining their medications
• Connect them with our Member Services team who can explain their plan benefits

Our case managers also educate and coordinate care and services for our highest risk members by providing linkage to needed community resources and evidence-based programs. Case management programs include complex medical conditions, behavioral health, high-risk maternity and HIV/AIDS.

Case management services are provided by phone as part of your group’s plan benefits. There is no additional cost. We offer case management for medical conditions as well as behavioral health conditions.

Your employees can get rewarded by taking charge of their health

Independent Health is incentivizing your employees to stay on top of their health this year through our RedShirt Rewards^SM program. Beginning on your plan’s 2024 renewal or effective date, your employees may be eligible to earn up to $30 in RedShirt Rewards* by completing three of the following health actions:

• Annual Checkup
• Flu Shot**
• COVID-19 Vaccine**
• Breast Cancer Screening
• Colon Cancer Screening
• Prediabetes – Enrollment in Diabetes Prevention Program
• Diabetes Care – Diabetic Retinal Eye Exam
• Diabetes Care – A1C Test
• Statin Medication Received (for people with heart disease or diabetes)

Your employees can earn a $10 RedShirt Reward for each eligible action – up to $30 each plan year. Plus, they can make it a family affair, because each member in their plan 18 years of age and older (spouse and dependents) is eligible to earn their own rewards just for completing the actions that are right for them.

How it works

1. Eligible members can opt into the program through their secure MyIH account (which can be accessed online or through the MyIH mobile app).
2. They must complete an eligible action listed above.
3. 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.com Gift Card, Nike, Target and more. Please note: The gift card redemption link expires 90 days after being issued. The member will forfeit their reward if they have not selected a gift card. However, once they choose a gift card, the gift card itself does not expire.
4. They can track their progress and reward totals through their member account.

As always, benefits vary by plan. If you have any questions about RedShirt Rewards, please contact your account manager.

*Rewards 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). **For 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.