5.19 HEALTHREACH DISEASE MANAGEMENT PROGRAMS
The Plan has partnered with HealthCare Strategies, Inc. (HCS) to provide their HealthReach program. HCS has developed a unique and comprehensive approach to disease management. HealthReach provides ongoing education, support, and mentoring to employees and their covered dependents that live with challenging medical conditions, like diabetes, heart disease, cancer, and others.
HealthReach Coaching: If you are selected to participate in the coaching program, a registered Nurse Care Manager will contact you by phone and mail to provide assistance with possible gaps in care, managing current health conditions, and support to reach personal goals. Your HealthReach Care Manager will provide you with confidential and personalized information to help you understand your options, work collaboratively with your doctors, and improve the care you receive.
Pharmacy Review: HCS will identify members who have medicines that are potentially duplicative – or might be harmful when taken together with other prescriptions. Your primary care physician will then be notified to help improve coordination of care among all doctors prescribing your medications.
Additional Charges for Not Participating in Disease Management: Plan members and dependents who are identified for HealthReach Coaching and choose not to participate will be subject to a penalty, reducing the amount of Plan benefits payable. Eligible individuals who, as certified by the disease management/chronic condition management vendor, choose not to participate in the Plan’s disease management program will have future medical claims (excluding preventive services required to be paid at 100%) penalized at a 10% reduction in the maximum percentage payable by the Plan. (For example, a charge normally paid 80% by the Plan will be paid 70% by the Plan; a charge normally paid 60% by the Plan will be paid at 50%; etc.) If you or a family member are subject to this reduction, the amount of this reduction will not apply to your or your family’s out-of-pocket maximum. The 10% penalty will be removed beginning with the first of the month following the time that the individual begins actively participating in the disease management program, as certified by the disease management vendor.
Please note all communications between members and HealthReach remain completely private and confidential.