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THN Beacon - January 12, 2022

Medical Director Moment

by: Dr. Beth Hodges

Happy January!  It is difficult to believe 2022 is here already, but we are starting to settle into a routine.  PCP offices are adjusting to the Gap-Q Program.  Hospital personnel and outpatient practices are dealing with yet another Covid surge, patients are breaking New Years’ resolutions.  The more things change, the more they stay the same, right?

Have many of your patients signed up for the Special Needs Plan (aka C-SNP) for HealthTeam Advantage?  Remember that this is for any patient with heart failure or diabetes mellitus, or both.  They get free, special care management and have enhanced prescription benefits for their diabetes and heart failure medications.  Remember that, because HTA is rated 5 Stars this year, any Medicare beneficiary can switch into the plan at any time during the year, so it is not too late if you think one of your patients would benefit.  Have your patient call 1(877)905-9216 for more information. I have an article below with more information about the enhanced pharmacy benefit.

Speaking of diabetes, do you have patients with DM who would benefit from CGM (continuous glucose monitoring) but cannot get coverage from their insurance or their out of pocket cost is too high?  You can give a patient a script for a 14-day Freestyle Libre which they can take to Costco and get 2 weeks of monitoring for $30!  I have used short term CGM with patients in several instances:

  1. Educate a newly diagnosed diabetic about how their current eating pattern effects their blood sugar.
  2.  Quickly get an idea of how a change in medication dosing is affecting blood sugar, especially insulin changes.
  3. Closely monitor a patient whom I suspect (or know) is having hypoglycemic events during the night. 

I encourage them to keep a food diary during the 2 weeks and usually have them come in for a visit with me weekly during the 2 week period if we are making quick changes.   Be aware that the device uses Bluetooth technology, so your patient has to have a smart phone (iPhone 7 or later, Android Operating System 5.0 or higher.)  If the patient is on Chronic Care Management with your office, you could consider having your CCM staff work with the patient instead of having the provider visit, depending on your usual workflow and comfort level.  

Did you see the article in Practical Cardiology in December about statin discontinuation association with excess MACE events in older patients?  Researchers in Denmark studied 65,000 statin users age 75 and older, both in terms of primary and secondary prevention.  As you know, until recently, it has been felt that individuals in their 80’s probably should be taken off statins due to lack of benefit.  Now, however, studies are starting to show that this assumption is incorrect.  The Denmark study found stopping statin use led to 1 extra event in 112 individuals using statins for primary prevention per year and 1 in 77 if using for secondary prevention per year.  Remember to consider using low intermittent dosing for statin phobic patients, especially if they have diabetes mellitus or signs of vascular disease, sus as aortic atherosclerosis.

HealthTeam Advantage C-SNP Pharmacy Benefit
The HTA PPO plans offer 5 Tiers for medication pricing:

  1. Tier 1: preferred generic medications
  2. Tier 2: other generic medications
  3. Tier 3: preferred brand name medications
  4. Tier 4: non preferred brand name and generic medications
  5. Tier 5: Specialty Medications

The C-SNP, or HMO plan for members with DM and/or heart failure, offers a 6th tier, which offers a special cost for select care medications (associated with the treatment of dm or chf, including certain insulins.) The costs for Tier 6 drugs are designed to encourage compliance with the medications which can most impact the target disease processes, dm and chf. Medications in Tier 6 have $0 copays up to the coverage gap (aka donut hole.) The C-SNP also continues to offer $0 copays for generic medications and certain insulins during the coverage gap. Brand Name medications on Tier 6 have $0 copays until the Coverage Gap Phase. In the coverage gap, the copay for a brand name medication will be 25% of the negotiated pharmacy price (negotiated by the Plan, not the patient.) A $95 deductible will apply to Tier 4 and 5 medications.

Remember that for all HTA plans, prescribing a medication for 90 days will cost the equivalent of 2 30-day copays (essentially giving the medication to the member for one month free) regardless of whether the member obtains the medication from a local retail pharmacy or mail order.

The formularies for either the CSNP plan or The PPO plan can be easily viewed online at the HealthTeam Advantage Plan Documents page or by using the online drug lookup tool.

CURO Conversations Training Available

Healthcare changes at a rapid pace but one thing doesn’t change….the importance of good communication. Since communication is such a critical component of any provider patient interaction, we are pleased to offer the training, “CURO Conversations”. CURO is Latin for “to care for”, and the model is broken down into the following elements: C is for connect, U is for understand, R is for reveal and relate, and O is for outcomes.
“CURO Conversations” was developed by a provider and is a provider led, interactive educational session. It was developed to help providers strengthen their conversation skills to enhance their provider patient interactions. “CURO Conversations” has been in place since 2017 and hundreds of providers throughout the healthcare system have benefited from participating in this training.
Please click on the link below to sign up for one of the 2 sessions offered, 1/20/22 and 1/25/2022, through SignUp Genius. There is a maximum of 15 attendees that can attend a session so please sign up quickly! You will then receive a WebEx invite to join once you sign up. Please let me know if you have any questions at all. Thank you! Register