CedarValley United Way

Progress Report 2013/2014

Target Issue: Health-Basic Health Care Prevention and Access

RSVP/Covenant Medical Center2013/2014 Request:$15,500

SHIIP 2013/2014 Award:$8,137

Number of anticipated participants to be directly served by the program annually: _1100

  • Changes to the number of anticipated participants based on current conditions (such as previous year totals and to date totals: _1500
  • Total number of actual participants: Phase 1: 1230_Phase 2: 535

Phase 1*Phase 2* Cumulative Totals*

# of participants who are able to access appropriate health care / 1230 / 535 / 1,765
# of participants that are on track to successfully exit this program / 1230 / 535 / 1765
# of participants who received an explanation of current Medicare Benefits, includes prevention / 351 attendees at presentations that focused on Medicare Benefits, which include preventative coverage. This information may also be included when a counselor is meeting with a client. However, it may not be identified; as the purpose of the meeting maybe choosing a Part D plan or a coverage issue, etc. / 181 attendees at presentations that focused on Medicare Benefits, which include preventative coverage. This information may also be included when a counselor is meeting with a client. However, it may not be identified; as the purpose of the meeting maybe choosing a Part D plan or a coverage issue, etc. / 532 attendees at presentations that focused on Medicare Benefits, which include preventative coverage. This information may also be included when a counselor is meeting with a client. However, it may not be identified; as the purpose of the meeting maybe choosing a Part D plan or a coverage issue, etc.

*Report only unduplicated numbers

Based on the above information, what changes, challenges or improvements are being implemented or experienced to impact the effectiveness of the program?

  • Phase 1: A challenge that occurred was the dropping of retirees’ employer health coverage, which has happened several times over the years. However each time, the counselors need to understand and work within the alternative provisions being made for the retirees by the company. Any changes that occur with Medicare are immediately addressed by the SHIIP state office with the SHIIP Counselors, in addition to the 2 mandatory attendance counselor updates each year. We are looking to make some changes to the appointment scheduleduring Part D Open Enrollment. This is an internal change that will be more efficient and still just as effective use of staff time. Although this likely makes little difference to the reviewer of this report; it is important to note we always are open to suggestions from staff or volunteers or clients in how we can improve the deliver on any of our services; and/or improve the service itself.
  • Phase 2: To clarify why the number of clients able to access health care was so much lower in this 6 months, is Medicare Part D Open Enrollment was held in the fall of 2013. Medicare recipients are encouraged to have a Part D Plan comparison done during Open Enrollment to ensure they have the best plan for their set of circumstances.

Share at least one of the “success stories” or accomplishments that a participant has experienced during each reporting period. This must be participant focused and aligned with the intent of this award.

  • Phase 1: A client had been on a “life sustaining type” of medication for a number of years, which the respective Part D (drug) plan had paidroutinely. At one point the client went to have the drug filled as usual and was denied coverage. The client contacted this SHIIP site and although other drug plans were reviewed it was determined to be in this client’s best interest to remain with this drug plan if the drug plan would agree to reinstate covering this medication for this client. The client’s doctor was contacted to provide an urgent letter of exception on behalf of his/her client and submit it to the insurance plan. The doctor complied and the insurance plan agreed to continue to cover this drug for this client. It is doubtful this client would have known about the option of the action taken. The client may have not found a plan that would cover this drug or the premium would have been much higher; potentially creating a financial hardship. This is where the SHIIP Coordinator is so important to this service. The collaboration of the Coordinator with the SHIIP volunteer can help sort out the issue and the options available.
  • Phase 2:A female client, age 50, was on Medicare due to disability; in addition wasalso covered by her husband's employer insurance. She was going through a divorce and was going to lose the husband’s employercoverage. Her only income after the divorce is final would be $826 a month from Social Security Disability Income. The SHIIP counselor identified she would qualify for the Medicare Savings Program. This would cover her monthly Part B & D premiums, as well as Part A & B copays and lower her cost of prescription medications with no donut hole.One of her medications is very expensive and through this program she will only have to pay $6.35 a month.The application process was able to be completed with the SHIIP counselor and submitted for approval to Department of Human Services (DHS). The SHIIP Coordinator encourages the volunteer SHIIP counselors to include all documentation with the initial application, as that will expedite the approval process.

Phase 1= July 1, 2013-December 31, 2013Report Due: January 15, 2014

Phase 2=January 1, 2014-June 30, 2014Report Due: July 15, 2014