PHOENIX, AZ – Enrollment in Evercare’s Medicare Advantage Special Needs Plan, or SNP, for Maricopa County residents with Alzheimer’s and related dementia is underway amid provider enthusiasm.
The health plan’s care model focuses on investing in front-end prevention to reduce cost down the road.
Evercare, a subsidiary of United Health Group, collects $1,000 a month up front to hire a care manager to provide proactive care in the home, resulting in “markedly reduced” hospitalization and better outcomes at a lower cost, said CEO John Mach, MD.
The care model also reduces fragmentation as the care manager coordinates all communication across providers and sites for each beneficiary.
The savings go to provider payments and beneficiary benefits. Some of the savings fund short-term emergency respites that enable enrollees to stay out of expensive nursing homes.
A key component to the SNP is Evercare’s collaboration with the Banner Alzheimer’s Institute. The health plan is leveraging the expertise of this Center of Excellence to understand and treat the disease.
“The model is designed to be replicated in standard clinical settings, involving collaborative disease management precepts among several disciplines,” said Pierre Tariot, MD, director of the Memory Disorders Center at the Banner Alzheimer’s Institute.
“It seems to me that focusing thoughtfully on better management of chronic illnesses is actually proving to be effective in improving quality of life, while also being cost effective for society,” he added.
The SNP was modeled after an Evercare demonstration project. Under the Medicare Modernization Act of 2003, Congress created a new type of Medicare Advantage plan for the coordinated care of individuals with special needs identified as institutionalized, dually eligible and/or with severe or disabling chronic conditions, according to a spokesperson for the Centers for Medicare and Medicaid Services.
Since 2004, approximately 1.2 million people have enrolled in SNPs.
“The growth has been phenomenal,” Mach said. “Consumers are hungry for something more.”
As for its Alzheimer’s health plan, Mach said, “We know our care model works. We can be a catalyst for other plans that want to partner with a Center of Excellence.”