Care Improvement Plus Obtains Conditional CMS Approval For New Medicare Special Needs Plan In South Carolina

Main Category: Medicare / Medicaid / SCHIP
Article Date: 10 Aug 2006 - 0:00 PDT

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Care Improvement Plus has obtained conditional approval from the Centers for Medicare & Medicaid Services (CMS) to offer its new Regional PPO Special Needs Plan (RPPO SNP) to residents of South Carolina. A Medicare Advantage plan (MA-PD), Care Improvement Plus focuses exclusively on the unique healthcare needs of chronically ill Medicare beneficiaries living with diabetes, heart failure, chronic obstructive pulmonary disease, and end-stage renal disease (ESRD).

Pending formal CMS approval, Care Improvement Plus will offer all Medicare covered services, a tailored Medicare Part D drug benefit, disease management services, and additional services not typically covered by Medicare to approximately 160,000 eligible Medicare beneficiaries residing in South Carolina. The plan is currently available as an HMO in eight Maryland counties for those with diabetes, heart failure, and/or ESRD, and is offered by XLHealth, one of the nation's fastest-growing disease management companies.

"Our program focuses on empowering our members and helping them learn to manage their conditions," said XLHealth Chief Medical Officer Harry Leider. "We also support physicians by coordinating care with other medical professionals and providing valuable patient data they might otherwise have trouble obtaining. We've found that this two-pronged approach not only reduces the incidence of complications such as heart attack, blindness and amputation, but also improves quality of life and lowers healthcare costs."

"I know that better methods of managing chronic diseases are the key in South Carolina both to improve the quality of life of our senior population and to reduce the cost of their healthcare," said Lieutenant Governor Andre Bauer, who leads the Office on Aging. "I am excited about the potential the Care Improvement Plus plan has to help with both of these important goals. I look forward to having my Office on Aging work with XLHealth on research models to demonstrate the effectiveness of this outcomes-based, disease management approach."

Pending formal CMS approval late this summer, the plan will begin marketing to beneficiaries on October 1, 2006, and will open enrollment on November 15 for services effective January 1, 2007.

Each plan member is assigned a Care Improvement Plus care team comprising a dedicated local healthcare manager, local field nurse and telephone coach nurse - all of whom work closely with the beneficiary's physicians to coordinate services and help provide optimal care. Members receive coverage that offers the advantages of traditional Medicare, plus additional care coordination and services as appropriate, such as:

-- access to an open network of all physicians and other healthcare

providers who participate in Medicare

-- comprehensive prescription drug coverage under Medicare Part D - with a

formulary specifically designed for chronically ill members

-- medication and appointment reminders

-- nursing support

-- health education

-- tools to help monitor and manage health

-- patient advocacy support

Care Improvement Plus supports participating physicians with a variety of services designed to help them care for chronically ill patients, such as: compensation for time spent on non-Medicare covered services, an open-access model that doesn't require referrals, collection of medical histories in advance of office visits, and easy-to-read reports containing all of each patient's up-to-date information.

Care Improvement Plus is in the process of expanding its network of providers; to date, approximately 2,187 providers in South Carolina have joined the plan's network. To raise awareness of the plan, Care Improvement Plus is partnering with leading medical associations and other organizations across the state. Providers or other organizations interested in working with Care Improvement Plus can call (888) 858-5175, e-mail provider@careimprovementplus.com or visit the plan's Web site at http://www.careimprovementplus.com for more information.

About Care Improvement Plus

Care Improvement Plus, a new health plan that focuses on the unique healthcare needs of chronically ill Medicare beneficiaries, provides a Medicare Advantage health plan and disease management services to Medicare beneficiaries living with heart failure, diabetes, chronic obstructive pulmonary disease and/or end-stage renal disease. Care Improvement Plus also provides tailored Medicare Part D drug coverage, along with a variety of services designed to support physicians' efforts to care for their chronically ill patients. The plan is administered by Baltimore-based XLHealth, which recently earned Full Accreditation from the National Committee for Quality Assurance (NCQA) under its standards for patient and practitioner-oriented accreditation of disease management programs. More information about XLHealth and Care Improvement Plus can be found at http://www.careimprovementplus.com.

Care Improvement Plus
http://www.careimprovementplus.com