Originally published in The Tennessean, September 2017
Even when we know what we’re supposed to do, sometimes we can let life get in the way of our preventive health care needs.
That was the case for Darlene, a 73-year-old BlueCross Medicare Advantage member who lives in Lyles, Tenn.
Lauren, a member of our outreach team, called to check on her and asked if she’d had her annual mammogram. Darlene hadn’t yet. “I just didn’t have time,” she told us.
So Lauren set up an appointment while she kept Darlene on the line. That phone call proved to be a defining moment in Darlene’s life.
“If she hadn’t called to make that appointment, I would never have had the mammogram and may have never caught the cancer,” she said. “Lauren was a blessing – my guardian angel.”
Lauren and her colleagues make tens of thousands of outreach calls each year because we know getting the right preventive and maintenance care improves and saves lives.
Promoting prevention is a priority for everyone in the health care system, including our partners in the provider community who provide education, encouragement and, of course, direct medical care to seniors.
A focus on prevention is also built in to the Medicare Advantage system, no matter which health insurer a customer chooses.
The Centers for Medicare and Medicaid Services holds health plans accountable for how well they help seniors get the care they need, through an annual quality rating program called STARS. Customers should compare each plan’s ratings before making a selection each year.
An insurer’s work begins by helping members identify their individual health care needs. At BlueCross, we follow widely accepted, evidence-based guidelines, paired with insights about our members’ health.
One of the conditions health plans prioritize is diabetes, because it can have a tremendous impact on a senior’s quality of life. It affects the entire body and is even a leading cause of blindness.
There are three key screenings that seniors with diabetes need to have performed regularly.
The first is a hemoglobin A1C, a blood test that helps a physician see how well someone has managed their blood glucose levels over a three-month period. Urine tests help show what impact, if any, diabetes is having on a person’s kidneys. And the third key test is a retinal eye exam.
When a member misses a key preventive screening, like a retinal eye exam, a mammogram, or a colorectal cancer screening, we call it an open gap-in-care. Our outreach teams work daily to help our members get these needed tests.
That means educating members and setting up appointments, like Lauren did for Darlene. We also coordinate community events to make it more convenient to get some of these services.
Tennessee seniors often have to keep up with multiple prescriptions to manage their health needs. That’s not easy for anyone, regardless of age.
For members managing health conditions like diabetes, high blood pressure or high cholesterol, following their doctors’ instructions is crucial. Helping members understand and stay on track with each medication they’re prescribed is another part of our daily work.
As fall rolls into Tennessee, Medicare Advantage plans will also be making a big push to promote flu shots. The flu poses significant risks for seniors, especially those with other health conditions, and the vaccine is the single best way to stay safe.
Regardless of who provides their health care coverage, seniors can improve their quality of life by taking advantage of preventive services, from flu shots to cancer screenings, that are covered with no out-of-pocket costs.
Seniors can also stay healthy by talking with people like Lauren when they call.
Todd leads the team managing our provider agreements, operations, data, and innovation that impact provider reimbursement and relationships across our commercial, Medicaid and Medicare line of business. He also leads the team managing and operating our 4-STAR quality rated Medicare Advantage plans and our Medicare Supplement products.