People who deal with chronic conditions or disabilities can often find it difficult to navigate the health care system. Unfortunately, they often have lower incomes, as well, which can exacerbate hurdles they face.
Dual-eligible individuals -- those who qualify for both Medicare and Medicaid -- often face complex health needs and barriers to accessing care. With Dual-Eligible Special Needs Plans (D-SNPs), they can gain access to a more tailored approach that can meet their unique needs.
“We focus specifically on the Dual-Eligible Special Needs population,” said John Cole, CEO of Shared Health, a health insurance company with a new plan available in Houston. “We aim to be more than just a health plan; we strive to be a support system and an advocate for our members. Our goal is to always be on their side and in their corner.”
Comprehensive coverage and coordinated care
Cole added that D-SNPs provide an integrated solution by combining Medicare and Medicaid benefits into one comprehensive plan. This means dual-eligible individuals may receive a wide array of health care services, including hospital stays, outpatient care, prescription drugs and long-term services.
D-SNPs also offer supplemental benefits not typically available through Medicaid, which can significantly reduce out-of-pocket costs for members.
“Our goal is to be more than just a health plan; we strive to be a support system and an advocate for our members,” said Cole.
He added that a standout feature of D-SNPs is the emphasis it places on care coordination. For example, at Shared Health, each member is assigned a personal assistant liaison (PAL) who serves as a dedicated contact to streamline health care management. Their PAL will connect them with doctors, specialists and community services.
“This could involve coordinating home care, setting up transportation to medical appointments and helping to ensure prescriptions are refilled correctly and on time,” Cole added. “A member can easily book transportation to a doctor’s visit or call a nurse hotline with questions, minimizing barriers.”
He said that it means there are fewer hoops to jump through to receive referrals or approvals for certain treatments. It makes the process of accessing care quicker and more efficient.
“The goal is to minimize the complexity of managing multiple benefits, making the member’s health care experience smoother and more cohesive.”
Access to additional benefits
Beyond standard health care services, D-SNPs frequently offer supplemental benefits that enhance the overall quality of life for dual-eligible individuals.
“In real-life terms, simplified access could mean a member using their Shared Health membership to access multiple benefits and services,” explained Cole. “They can take advantage of our fitness program, which gives them a free membership at a fitness center. They can also get nutrition counseling, smoking cessation support, health coaching and more.”
For someone looking to take charge of their health, these programs can be a tremendous help. They focus on preventive care and overall health. That can mean the potential for avoiding more serious health problems down the road.
“Our wellness programs also help members manage chronic conditions, with which so many dual-eligible individuals must contend,” said Cole.
The plan also includes allowances for dental, vision and hearing care, as well as meal deliveries and transportation.
Improved health outcomes
For dual-eligible individuals, the unique structure and services of D-SNPs represent a step toward more effective health care. It’s a proactive approach that aims to enhance health outcomes by addressing both medical and social determinants of health. Through preventive care, chronic disease management and coordinated services, these plans work to create a better quality of life.
“Our holistic approach supports members in various aspects of their lives, helping them stay healthy and active,” said Cole.
D-SNPs play a crucial role in enhancing health outcomes for a population that often faces significant challenges. Cole said Shared Health’s commitment to supporting dual-eligible individuals remains steadfast and that members will always receive the personalized care and attention they deserve.
“Unlike larger companies that offer D-SNP plans as part of a broader portfolio, we focus solely on the dual-eligible community,” Cole concluded. “This specialization allows us to provide the highest level of attention and care to our members, ensuring they receive the support they need to stay healthy and active.”
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