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Health Plan Options |
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NEW PROGRAMS AVAILABLE FOR LEHIGH VALLEY FLEX BLUE MEMBERS In an effort to find ways to better manage our members and control total cost of care, we are introducing two new programs to our Lehigh Valley Flex Blue program effective April 1, 2021. POPULYTICS INC. Populytics, Inc., a wholly owned subsidiary of Lehigh Valley Health Network (LVHN), will provide case management and condition support (disease management) services to patients spanning the care continuum from the prevention of disease through chronic condition, transition of care, emergency department utilization, complex case management and interventions for chronic conditions.
Members will be identified for case management and condition support services using a variety of information and data including but not limited to registry information, referrals from providers, self-referrals, referrals from other departments, newly diagnosed select chronic conditions, inpatient Transition of Care outreach, emergency department follow-up referral calls, payer reports, and care gap closure outreach.
Lehigh Valley Flex Blue members will receive communication introducing Populytics as the vendor that will be providing case and condition support services and support on behalf of Highmark.
Please note that Highmark will still provide support and services for specialty case management (transplants, oncology, hemophilia/HAE), NICU, high risk pregnancy, behavioral health, substance abuse, depression, wellness and the Baby Blueprints program. PHARMACY WELLNESS PROGRAM Also, being introduced for Lehigh Valley Flex Blue clients with our prescription drug benefit is a Pharmacy Wellness Program, which is made up of the following components:
1) Annual Medication Review: a comprehensive, interactive review all of a patient’s medications, including prescription medications, over-the-counter (OTC) products, dietary/herbal supplements
2) New Medication Counseling: a telephonic pharmacist-patient interaction following the initiation of a new prescription drug therapy.
The Annual Medication Review program will proactively engage eligible members via targeted outreach. Eligibility parameters are intended to identify those who are likely to experience drug therapy problems and may achieve better clinical outcomes and/or a reduction in the total cost of care from review.
New Medication Counseling will identify members who initiate therapy in a select group of targeted medication classes. A pharmacist will provide medication counseling and field questions from the patient early in their therapy journey. Patient outreach is to occur within four months of the initiation of therapy.
Members can begin to expect outreach related to these new programs at any time.
You can also find additional information in this informational flyer.
We are excited about the opportunity to partner with LVHN to further engage our members, providing them with a differentiated experience under the Lehigh Valley Flex Blue product.
If you have any questions, please reach out to your Highmark Client Manager or Producer Strategy Consultant. |
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Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association. Insurance or benefit administration may be provided by or through Highmark Inc. or one of its affiliated Blue companies. Highmark Inc. d/b/a Highmark Blue Shield and certain of its affiliated Blue companies serve Blue Shield members in the 21 counties of central Pennsylvania. As a partner in joint operating agreements, Highmark Blue Shield also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Inc. or certain of its affiliated Blue companies serve Blue Cross Blue Shield members in the 29 counties of western Pennsylvania, 13 counties in northeast Pennsylvania, the state of West Virginia plus Washington County, Ohio, and the entire state of Delaware. |
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