Healthy Connections Prime is a program that marries the benefits of Medicare and Medicaid for South Carolina seniors age 65 and older. It is designed to integrate all the services of Medicare parts A, B, and Part D and Medicaid into a single benefits package. This sounds like a great program that everyone should know about, right?
Explaining Medicare and Medicaid to clients is challenging enough, especially to new enrollees. Adding this additional program to the mix may seem even more difficult. Clients want to hear that the plan includes perks such as: no insurance premiums, no copays for Medicare Part A and B services, and no costs for doctor visits and hospital stays. But, how can we truly get the message of the program across?
Here are some key points to emphasize when explaining Healthy Connections Prime to your clients whether you are a beginner or seasoned counselor.
Ease and Simplicity
Simplicity is one of the greatest perks of Healthy Connections Prime. One card, one party to bill, and one point of contact. Members who switch to Healthy Connections Prime will no longer need to carry around multiple cards because their coverage comes from one program. Also, providers can submit all their claims to one entity which makes the billing process easier. Finally, Healthy Connections Prime Members will only need to maintain one point of contact regardless of the service being provided. Emphasize simplicity when introducing the program to new clients.
Attention to Medical and Non-medical Needs
One of Healthy Connections Prime’s goals is to increase access to home and community-based services. The program does this by addressing medical and non-medical needs. Each participant is appointed an integrated care team and care coordinator. This team addresses multiple needs through community referrals and home and community-based services such as home-delivered meals, support for caregivers, minor home repairs or modifications and even transportation to and from doctors’ visits. When talking with your clients, it’s good to mention that the program focuses on more than just medical needs. It can cater to your client’s overall wellness. Below is a short testimonial about one client’s experience with Healthy Connections Prime.
“On a Friday, a Community Health Navigator (CHN) got a request from a member and her adult son, who cared for her. They needed food and had no transportation to buy food, and the son was scheduled to go into the hospital on Monday. The CHN reached out to several listed local food banks, but only one was open on Saturday and that local bank said they no longer had a food pantry. The CHN explained the dilemma to the staff member, who was touched and impressed by the CHN’s perseverance. Together, they figured out a solution: the staff member donated $50 of his own money, and he and the CHN drove an hour and a half to meet to deliver the check for the member to use at the grocery store. The following week, the member’s care team contacted a local church and explained the member’s situation. The church agreed to deliver food to her and her son once a week.”
Continuity of Care
Healthy Connections Prime also makes sure that each client’s care, including ongoing procedures and appointments is uninterrupted during their transition into the program. Patients will be able to continue any prior treatments from their current providers for six months. Care Coordinators will reach out during this transition period to encourage providers to join the network.
Any out-of-network primary care providers and specialists providing an ongoing course of treatment will be offered single case agreements to continue to care for the member beyond the transition period if the provider chooses not to join the plan’s network. Assure your clients that they will be supported throughout their transition into the program.
Emphasis on Home Independence
Healthy Connections Prime uses all these resources to delay the need for nursing or facility care. All the efforts this program makes is to keep the member healthy so they can stay at home with their families for as long as possible. This program is tailored for those that want to live independently. Furthermore, explain the emphasis on independence even in passing thanks to estate recovery exemptions. You can learn more about the estate recovery process and exemptions HERE.
While these highlights simply give a brief overview of the Healthy Connections Prime Program, we hope they help you spread the word about the program and its benefits. For more information on how you can apply for Healthy Connections Prime through SC Thrive click HERE.
For an overview of Healthy Connections Prime from the South Carolina Department of Health and Human Services (SCDHHS) click HERE.