Plan targets seniors with high cholesterol
Plan targets seniors with high cholesterol
Program focuses on prevention of coronary disease
As part of its efforts to take a proactive approach to heart disease, Health Net Inc. has launched the first-ever Medicare Advantage Special Needs Plan designed specifically for seniors with high cholesterol.
Traditionally, special needs plans concentrate on helping seniors manage their existing chronic diseases. Health Net also offers coronary disease management and complex disease management to coordinate the care of seniors with coronary disease.
This special needs plan is unique in that it takes a preventive approach, says Richard Jacobs, MD, MBA, chief medical officer for Health Net of Arizona Inc.
"Traditional Special Needs Plans focus on people with serious and complicated medical conditions like diabetes and congestive heart failure. While we need to do that, it is sort of like trying to take care of the horse after he gets out of the barn. Early interventions mean that we prevent the disease instead of waiting until it costs three to four times more to treat the disease," he says.
The Special Needs Program gives seniors the resources they need to become actively involved in their own health and to prevent heart disease by keeping their cholesterol under control, Jacobs adds.
High cholesterol can lead to an increased risk for heart disease, poor circulation, and stroke, he says.
"Learning to manage their high cholesterol properly and proactively could make a life-saving difference for these individuals," he says.
Members who join the program receive a health assessment, personal help from health coaches, and other tools to help them comply with their treatment plan. The health plan also offers an advice line that seniors can call with questions or concerns.
"It's painfully obvious that the No. 1 killer for this age group nationwide is cardiovascular disease and it's the No. 1 cost driver when it comes to care. This product focuses on prevention and seeks to delay or thwart altogether the onset of chronic illness linked to high cholesterol," he says.
About half of the Medicare population has high cholesterol but only a fraction of those are taking medication for the condition. Non-compliance is high because high cholesterol is a silent problem with no symptoms, he says.
Literature shows that only about four in 10 people who should be taking cholesterol-lowering drugs are actually taking them, Jacobs says.
"High cholesterol is a silent condition. People feel well so they don't manage the condition well. As a result, more are likely to develop chronic heart disease," he adds.
Some people stop taking statins because they have side effects. Others forget to refill their prescription. Still others don't want to take it because they feel fine and are in denial.
"Evidence shows that when a caring medical professional constantly reminds them to take their medication, the odds of their continuing to adhere to the treatment plan skyrockets," he says.
Initially about 40% of the people who joined Health Net's program were already taking a statin to control their cholesterol. At the end of the first year, statin use had risen to 55%. The health plan's goal is 70% compliance.
Health Net marketed the program to the entire Medicare population. Any member who has a total cholesterol of more than 200 is eligible for the plan.
"Everyone who joins the program has elevated cholesterol, which means we don't have to spend resources to find them. In addition, they are saying that they are ready to do something about the problems so we have an opportunity to focus on them efficiently and help them get the problem under control," he says.
One factor that distinguishes the Special Needs Plan from the health plan's main Medicare Advantage plan is that seniors can sign up for the Special Needs Plan at any time, rather than having to wait until open enrollment.
"There are no open enrollment restrictions with the cholesterol Special Needs Plan. We try to take away all the barriers to helping patients become adherent with their prescribed medications," he says.
A special needs plan is the perfect vehicle for engaging Medicare beneficiaries with high cholesterol because seniors have the opportunity to opt in to the plan, saving the health plan the time and expense of identifying eligible members and engaging them in the program.
"We know that about half of the seniors in our main Medicare plan have high cholesterol but we don't know who they are. It takes tremendous resources to find them and get them into a program. The second problem is that even when we find out who they are, when we contact seniors with high cholesterol, a significant percentage are not interested in doing anything about it," he says.
Elevated cholesterol is a modifiable risk factor for cardiac disease, he points out.
"Regardless of what plans the seniors sign up for, whether it's our main Medicare Advantage plan or a special needs plan, if beneficiaries have elevated cholesterol or any other risk factor, we address them," he says.
If people who already have heart disease select the plan, they are triaged into a higher intensity case management program for coronary artery disease. The same is true with people who have diabetes, congestive heart failure, or other chronic illnesses.
As part of its efforts to take a proactive approach to heart disease, Health Net Inc. has launched the first-ever Medicare Advantage Special Needs Plan designed specifically for seniors with high cholesterol.Subscribe Now for Access
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