MARSP News & Announcements

The presentations given at the MARSP 2014 Health Insurance Update are now available online.  Each presentation can be found on the individual provider’s page in the “Health Insurance” section of this website or by clicking on the links below.

Master Health Care Plan (including prescription drug plan)

Blue Cross Blue Shield PPO – 2014 Health Insurance Update

Catamaran Rx – 2014 Health Insurance Update

HMOs

Blue Care Network Advantage – 2014 Health Insurance Update

HealthPlus – 2014 Health Insurance Update

Priority Health – 2014 Health Insurance Update

Dental & Vision

Blue Vision/VSP – 2014 Health Insurance Update

Delta Dental – 2014 Health Insurance Update

Click here to find a doctor with the Patient-Centered Medical Home (PCMH) designation with Blue Cross Blue Shield.

Putting the focus on the patient: Medical home defined

Submitted by Blue Cross Blue Shield of Michigan

The Patient-Centered Medical Home (PCMH) places the patient and primary care practice at the center of care and creates a healthcare setting that is a collaborative partnership between the patient and their personal physician.Blue Cross Blue Shield of Michigan’s patient-centered medical home program is transforming primary care across Michigan. The PCMH model was developed to strengthen the doctor-patient relationship and improve health care quality by helping primary care doctors and their health care teams more effectively manage their patients’ care.

To accomplish this goal, PCMH practices use such features as e-prescribing, chronic disease management, 24-hour access to a clinical decision-maker and patient registries to track and monitor care. Health care teams also work closely with patients to help them set individualized health goals and encourage them to take a more active role in their own health management.

In July 2012, Blue Cross Blue Shield of Michigan designated 994 primary care practices — representing 3,017 primary care doctors across the state — as PCMH practices.

What is the PCMH?

The PCMH is a model of healthcare based on an ongoing, personal relationship between a patient, doctor and the patient’s care team.  Whatever the medical needs – primary or secondary, preventive care, acute care, chronic care, or end-of-life care – the patient has a medical “home”; a single, trusted doctor and care team, through which continuous, comprehensive and integrated care is provided.

The PCMH model includes a personal doctor and care team that will provide medical care.  When specialty care is needed, at the patient’s request, the doctor and care team will personally manage, facilitate and coordinate the care with appropriate qualified professionals, such as hospitals, nursing homes, pharmacies and related community resources.

The PCMH model proposes to improve primary care by focusing on the patient-doctor relationship and to strengthen this dynamic through a more comprehensive approach to patient care and more active patient involvement.

What the Blues are Doing

Participating Blue Cross and Blue Shield companies are working with doctors, healthcare quality advocates, governmental entities, consumer advocate groups and employers to develop and test the PCMH model.

BCBS companies have PCMH initiatives in 40 states across the country and Washington, DC that explore effective means of provider reimbursement and integrate quality improvement, care management and patient educational tools into primary care practices.  More than 5 million members are currently benefitting from care delivered through a BCBS PCMH initiative.

BCBSA works with outside quality and research organizations to ensure the effectiveness of PCMH pilots to enhance the primary care practice infrastructure and improve clinical quality, outcomes, affordability, and physician and patient satisfaction. Additionally, BCBSA serves as conduit for patient advocacy groups, employers, business coalitions, physician professional societies, government officials and other interested stakeholders wanting to partner with BCBS companies to further the PCMH model of care.

Patient satisfaction, delivered in accordance with an agreed care plan, is the hallmark of the PCMH.  Patients who receive care through the PCMH model will benefit from the following:

• Access to doctors that utilize improved technologies to stay better connected with the medical community and manage care more efficiently.
• Improved access to care through easier scheduling of appointments and extended office hours.
• More focused, personal interaction with doctors and care teams that will help navigate through the complex healthcare system.
• A more comprehensive delivery of primary care through the improved coordination of care, managed by the patient’s personal doctor and their care team.

To find a physician with the PCMH designation, go to www.bcbsm.com and do the following:

• Click on “Advanced Search”.
• Select how many miles you are willing to drive to receive care and enter your zip code.
• Select “MPSERS” as your health plan
• Select “MPSERS Blue Preferred (PPO)” if you are non-Medicare or “MPSERS Medicare Plus Blue” if you are Medicare.
• Enter the 3-letter prefix from your Blue Cross card if it is different than what is listed on the screen.
• Select “Doctor, specialist, and medical professional” in the Step 3 box for “What are you looking for?”
• Select “Patient-Centered Medical Home” in the Step 4 box and click on “Go”.
• This will generate a list of providers in your area.
  • If there are no providers in your area, you may need to expand the number of miles you are willing to travel.

Click here to view the screenshots of this written procedure.

The Senate Government Operations Committee just now voted to move three bills to the Senate floor related to Medicaid expansion in Michigan.  The Senate Healthy Michigan workgroup developed a substitute for HB 4714 that builds upon the Medicaid expansion and reforms developed by the House, and passed the bill on a 4-0 vote.  The version of HB 4714 passed by the committee today is supported by Governor Snyder and Senate Majority Leader Randy Richardville.
 
Additionally, on 3-2 party-line votes, the Committee passed Senate Bill 422, sponsored by Senator Bruce Caswell (R-Hillsdale), and Senate Bills459 and 460, sponsored by Senator Patrick Colbeck (R-Canton Twp.). Senate Bill 322 would provide for state health care coverage to individuals under 100% of the Federal Poverty Level who do not otherwise currenty qualify for health insurance under existing programs, while Senate Bills 459-460 seek to create a free market, high deductible, private sector alternative to the Medicaid expansion.
 
The Senate will consider all three bills when it returns to session on August 27. 

Please click here to view the comparison summary between the Master Health Care Plan vs. HMOs offered by MPSERS.

Please click here for the 2012 insurance rates for MPSERS health insurance.

Blue Cross Blue Shield of Michigan/Catalyst Rx 2012 Updates

There are several changes to the Blue Cross Blue Shield Master Health Care Plan effective January 1, 2012. Here is a summary of those changes:

Completing the Living Well Assessment will save $100 on both the coinsurance maximum and deductible. The Living Well Assessment was mailed on October 14thto non-Medicare members and will be mailed the week of October 31st for Medicare members.

New Health Care Coverage Cards
Members will be receiving two cards for 2012 – one from Blue Cross Blue Shield for your Medicare Advantage Plus Blue Group PPO and one from Catalyst Rx for your prescription benefit. You will receive the new cards before January 1, 2012.

Prescription Drug Updates for 2012
Michigan Public School Employees Retirement System and Catalyst Rx, your pharmacy benefit manager, will be updating member coverage for the 2012 plan year for three drug classes: Proton Pump Inhibitors (PPIs), Non Sedating Antihistimines (NSAs), and Erectile Dysfunction (ED) drugs. Effective 1/1/12, these medications will no longer be covered through your prescription drug plan. However, Medicare will continue to offer coverage on some PPIs and NSAs for Medicare members. You should check the formulary for 2012 if you have questions about whether or not a PPI or NSA drug you are currently taking will continue to be covered in 2012. This formulary will be coming in the mail in the next few weeks for Medicare members.

PPIs are drugs used to treat conditions like Gastroesophogeal Reflux disease (GERD), heartburn, and ulcers. NSAs are drugs that treat seasonal allergies. Over the past several years, most of the drugs previously available only by prescription are now readily available over the counter (OTC), in both their brand and generic forms.

Lifestyle drugs are not covered under your plan. In 2012, this will include ED medications. ED medications, which are currently only available by prescription, will be available to MPSERS members at a 100% cost share of Catalyst Rx’s negotiated discounted price. For members who wish to obtain these drugs, present your prescription and prescription drug ID card to obtain this discount.

Medicare Prescription Drug Plan in 2012
Medicare-eligible members will be returning to a Medicare Part D Prescription Drug Plan (PDP) plan in 2012. You will not need to do anything to be a part of the 2012 PDP, your enrollment will be handled by the Retirement System. Many of you will remember the PDP from as recently as 2009 and know that it works very much like the plan today. Information about the 2012 PDP will be sent out to the Medicare membership in early November, so please be on the lookout!

Many members have questions regarding Part D Vaccine Coverage.Except for vaccines covered under Part B, Medicare drug plans must cover all commercially-available vaccines (like the shingles vaccine) when medically necessary to prevent illness.

Spectrum Health
Spectrum Health recently sent a letter out to all MPSERS members regarding which Medicare Advantage plans they will accept in 2012. In addition to those listed, Spectrum will also accept the MPSERS Medicare Advantage Plus Blue Group PPO in 2012. If you have additional questions, please contact Spectrum’s Patient Relations Department at 616-391-2624.

Please click here to view the schedule of upcoming regional seminars hosted by Blue Cross Blue Shield and Catalyst Rx.