Care Improvement Plus

Care Improvement Plus is a unique Medicare Advantage Part D (MA-PD) health plan exclusively built to meet the specific needs of Medicare beneficiaries living with diabetes, heart failure, chronic obstructive pulmonary disease (COPD), and/or end stage renal disease (ESRD), and/or end stage renal disease (ESRD).

Situation

The medical costs of people living with chronic diseases account for more than 75 percent of the $1.4 trillion the United States spends each year on Medicare and Medicaid. Within Medicare, persons with diabetes and heart failure:

• represent a disproportionately high percentage of spending,
• have expected spending that is predictable; and,
• have risk factors that can be managed to reduce the risk of personally overwhelming and costly complications.

Solution

Care Improvement Plus provides all Medicare covered services. The plan provides all Medicare covered services, a tailored Medicare Part D drug benefit, disease management services, and additional services not covered by Medicare. Offered by XLHealth, Care Improvement Plus offers a number of supplemental services designed to educate members about their conditions and identify problems before they worsen and require high-cost hospitalization.

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, family members, and/or caregivers to coordinate services and provide optimal care. The plan includes:

• access to an open network of physicians and other healthcare providers
• comprehensive prescription drug coverage under Medicare Part D – with a formulary specifically designed for chronically ill members
• nursing support
• medication and appointment reminders 
  health education
  tools to help members monitor and manage their health
  patient advocacy support

Care Improvement Plus also 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.

Additionally, Medicaid programs stand to derive substantial savings from Care Improvement Plus’ targeted disease management program. By preventing progression of disease, the program will prevent persons from becoming institutionalized dual eligibles, which is the most costly part of Medicaid.

Better Health & Lower Costs

A focus of the Care Improvement Plus design, XLHealth’s disease management model improves the health of its participants, producing significant declines in complications and related costly utilization of health services. For example, during a previous XLHealth disease management program that was held over a four-year period, the program generated significant participant health improvements and savings:

• Heart bypass surgery rates declining by nearly 60 percent
• Amputation rates declining by more than 55 percent
• Renal failure admissions declining by more than 45 percent