Bob DeMarco Alzheimer's Reading Room

Thursday, October 25, 2007

Alzheimer's health plan debuts (Medicare)


We are keeping an eye on this new Medicare Program. You should consider joining our mailing list if you would like to be kept up to date on this program as it expands.

Alzheimer's sufferers in the Valley will have access to the nation's first Medicare health plan designed specifically for them.

Evercare, a subsidiary of United Health Group, Wednesday is unveiling its Medicare Advantage Special Needs Plan, which includes coverage for prescription drugs and the Alzheimer's Association Safe Return program.




Source Phoenix Business Journal

Alzheimer's sufferers in the Valley will have access to the nation's first Medicare health plan designed specifically for them.

Evercare, a subsidiary of United Health Group, Wednesday is unveiling its Medicare Advantage Special Needs Plan, which includes coverage for prescription drugs and the Alzheimer's Association Safe Return program.

The company initially will target Maricopa County's estimated 47,000 people with Alzheimer's and related dementia, with plans to expand nationwide.

Banner Alzheimer's Institute doctors played a strong role in guiding the formation of the new Medicare plan, which has received approval from the U.S. Centers for Medicare and Medicaid.

Dr. Pierre Tariot, director of the Memory Disorders Center at the institute, said he hopes other health insurers will follow Evercare's lead in developing plans specifically for patients with Alzheimer's.

"We think this is a pretty big deal," Tariot said. "The fact that this is the first in the nation, we think, says a lot about Evercare's courage and vision."

Because insurance is based on spreading risk over a largely healthy population, establishing a health plan specifically for heavy users of health insurance goes against the grain of the insurance philosophy.

But Chuck Dow, executive director for Evercare's Southwest region, said the company will employ care managers to oversee Alzheimer's patients' treatment.

"We really will be putting a big emphasis on preventive types of care measures, identifying things much earlier in the disease state," he said.

"We know that this population that we are intending to serve is a high utilizer of very expensive services, and there's a lot of risk for United," said Dr. Ana Fuentevilla, medical director for Evercare in Arizona. "However, we really have a lot of confidence in working with our care management model and with the Banner Institute through a very staff-intensive model. Patients and families will get quite a bit of attention from our critical care managers to get on top of problems before they become a crisis."

As with any Medicare Advantage plan, members pay a monthly $93.50 Medicare part B premium, plus a $15.90 monthly premium for prescription drug coverage.

Drugs specific to the treatment of Alzheimer's, such as Aricept, will be included in the formulary (the list of drugs covered) at no additional cost. Fuentevilla said Alzheimer's-specific drugs are available on other Medicare Advantage formularies -- but at a higher tier, which means the co-payment would be greater.

Jim Hertel, publisher of the Arizona Managed Care Newsletter, said he is seeing a trend toward health insurance companies adding special-needs plans for certain medical conditions. For example, Sun Health has one for heart patients, and HealthNet has one for those with high cholesterol.

Evercare also operates another special-needs plan to target patients who have dual enrollment for Medicare and Medicaid, as well as a plan for patients in nursing homes.

"The key to the success of any special-needs program is the ability to save costs through effective management," Hertel said. "Because of Banner's interest in Alzheimer's and its development of special programs focused on treating Alzheimer's patients, they've struck a partnership with United to see if they can demonstrate a cost-effective application of these procedures with a special-needs plan."

United Healthcare: www.uhc.com

Banner Health: www.bannerhealth.com

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Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 1,610 articles with more than 8,000 links on the Internet. Bob resides in Delray Beach, FL.

Original content Bob DeMarco, the Alzheimer's Reading Room