Author Archive

UPHP Coverage Information Updates for Members Amid COVID-19 Outbreak
Posted on March 16, 2020
COVID-19 Update for UPHP Members

Marquette, Mich. – Upper Peninsula Health Plan (UPHP) will be taking action to ensure the health and safety of our members during the worldwide outbreak of a new coronavirus. The disease caused by the new coronavirus, called COVID-19, causes symptoms including fever, cough and shortness of breath. The number of cases of COVID-19 in the U.S. continue to spread from state-to-state and are increasing daily.

The information below outlines coverage changes for UPHP amid the COVID-19 outbreak. These changes will take effect immediately until further notice.

Diagnostic Testing Coverage Related to COVID-19

  • For all UPHP members types (which includes Medicare Advantage, MI Health Link, Medicaid, Health Michigan Plan, and Children With Special Health Care Services [CSHCS]): UPHP is waiving all costs associated with any diagnostic laboratory tests for COVID-19, when used in accordance with Centers for Disease Control and Prevention (CDC) testing recommendations. This measure will ensure patient testing and ensuing care is completed in an efficient, coordinated way with specialists at every level.
  • For all UPHP member types: UPHP is waiving prior authorizations for diagnostic tests and for covered services related to COVID-19 that are medically necessary and in accordance with CDC guidelines. Prior authorization is approval from a plan that is required before the plan pays for certain services, medical equipment, prescriptions.

Prescription Medication Coverage

  • For UPHP MI Health Link, Medicaid, Healthy Michigan Plan, and CSHCS members: UPHP is removing the current 30-day prescription limit and allowing 90-day supplies for maintenance medications, except for Controlled Substances and Specialty Medications.
  • For UPHP Medicare Advantage (UPHP Advantage and UPHP Choice) members: UPHP continues to encourage members to utilize 90-day supplies of medications at their local or mail-order pharmacies.

Telehealth Services

Individuals seeking care for mild issues other than COVID-19 should consider telehealth options in order to avoid clinics and health care facilities with COVID-19 patients. This will help to stop the spread of disease and reduce the burden on health care facilities that may be overwhelmed with patients seeking care for respiratory illness.

  • For UPHP Medicare Advantage (UPHP Advantage and UPHP Choice) members: UPHP is waiving all copays for telehealth services for the next 90 days.
  • For UPHP MI Health Link, Medicaid, Healthy Michigan Plan, and CSHCS members: Access to telehealth services has been expanded by the State of Michigan and will be a covered benefit until further notice.
    • Note: Telehealth services must meet Centers for Medicare and Medicaid Services and Michigan Department of Health & Human Services guidelines, be HIPAA compliant, and be furnished by a physician or other authorized practitioner.
  • All UPHP member types: A 24-hour Nurse Advice Line is available anytime of the day or night at no cost to members. This help over the phone can answer your questions regarding symptoms and help point you in the right direction for any next steps in care. If you have questions about your health, please call the 24-hour Nurse Advice Line at 1-844-411-3695.

This is situation is developing quickly and information is constantly being updated as officials learn more about the virus. We will continue to track all updates regarding the disease’s activity, symptoms, travel restrictions and risk assessments from our federal, state, and local partners. UPHP staff are working diligently to provide our members with the utmost level of care and access to services at this time. Please visit http://www.uphp.com/coronavirus for up-to-date member information or call UPHP Customer Service at 1-800-835-2556 (TTY: 711). 

Upper Peninsula Health Plan currently manages the care of nearly 50,000 Upper Peninsula residents enrolled in Michigan Medicaid, Children’s Special Health Care Services, the Healthy Michigan Plan, MI Health Link, and Medicare Advantage. Its network exceeds 2,000 providers. Learn more at www.uphp.com.

UPHP one of the highest-rated health plans in the nation, top in Michigan
Posted on October 22, 2019
UPHP logo

FOR IMMEDIATE RELEASE

Marquette – Upper Peninsula Health Plan is again one of the nation’s best Medicaid health plans, according to a recent national rating of Medicaid health plans. The health plan ranks in the top 15 among Medicaid managed-care plans in the United States, according to the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2019-2020. UPHP is the top rated plan in the State of Michigan earning a 4.5 out of 5 rating.

NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction, and NCQA Accreditation Survey results. This rating system emphasizes care outcomes and what patients say about their care. 

“We are truly honored to receive this rating from NCQA. This rating highlights the exceptional work our UPHP staff and U.P. providers do every day serving our members,” said Melissa Holmquist, UPHP Chief Executive Officer. “We are caring for our friends and neighbors and everyone takes great pride in ensuring all UPHP members have access to the highest quality care and services they deserve.”

The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS® is the most widely used performance measurement tool in health care. NCQA’s website (www.ncqa.org) contains information to help consumers, employers and others make informed health care choices.

The complete Medicaid health-plan rankings are available at https://www.ncqa.org. Rankings for Medicare and private plans are also available.


About UPHP
Upper Peninsula Health Plan currently serves nearly 50,000 members across five product lines (Michigan Medicaid, Children with Special Health Care Services, Healthy Michigan Plan, MI Health Link, and Medicare Advantage) and its network exceeds 2,000 providers. Learn more at https://www.uphp.com.

UPHP Member Portal
Posted on July 16, 2019

UPHP Update: Appropriate Antibiotic Usage
Posted on February 19, 2019

UPHG Provider Resource Services Advisor, Rachel Riley

Marquette, MI – (Great Lakes Radio) – On the latest Upper Peninsula Health Plan update, we heard from Rachel Riley, Provider Resource Services Advisor under Upper Peninsula Health Group.

Riley explained that UPHP and UPHG are currently working together on the SmartRx Campaign to assist providers in educating patients on appropriate antibiotic use as antibiotics are not indicated for viruses.

She also talked about the differences between a viral infection and a bacterial infection and shared some good tips on staying healthy during this cold and flu season.

Riley said that the two groups are providing materials to practices to assist in staying healthy and to help if someone becomes sick with a viral infection.

They include informational posters for waiting rooms/lobbies and Cold Kits that consist of tissues, lip balm, thermometers, and hand sanitizer as an alternative treatments.

Riley added that for more information about appropriate antibiotic use go to www.cdc.gov/antibiotic-use/ or visit the UPHP Facebook and Twitter pages.

LISTEN IN – Rachel Riley with more about appropriate antibiotic use.

This story was originally posted here by Great Lakes Radio, Inc. on February 7, 2019.

Tight Budgets Slow Medicaid Plans Pursuit Of Social Determinants Of Health
Posted on January 22, 2019

The following story was written for Forbes by Senior Contributor, Bruce Japsen:

Health plans that contract with state Medicaid programs are moving to address social determinants of health by paying for affordable housing, food vouchers to purchase fresh vegetables and education screenings at the doctor’s office.

But challenges remain from inadequate funding to the lack of data sharing between medical care providers, insurers and community organizations, a new report from the nonprofit The Institute for Medicaid Innovation shows.

“Despite the increasing focus shown in our report on the role of social determinants on health care and outcomes, more needs to be done to create systems to address unmet social needs, especially finding sustainable funding to support these programs,” The Institute for Medicaid Innovation’s executive director, Jennifer Moore, said in a statement accompanying the report called “Innovation and Opportunities to Address Social Determinants of Health in Medicaid Managed Care.”

The report comes as medical providers, insurers and policymakers including high-ranking officials in the Trump administration increasingly see the need to address social determinants of health as a way to improve healthcare and reduce costs. Supporters of spending on ways to address social determinants reason “non-medical factors” of patients like their “housing, education, food insecurity, and poverty can adversely affect population health,” the report says.

There are more than 70 million Americans covered by Medicaid thanks in part to the expansion of such benefits under the Affordable Care Act. Nearly 70% of these Medicaid beneficiaries have their care managed by health plans operated by dozens of health plans including Aetna, Anthem, Centene, Cigna, Molina Healthcare, UnitedHealth Group and most Blue Cross and Blue Shield plans.

There are many emerging success stories. And here are some outlined in the report such as:

  • AmeriHealth Caritas DC’s “food as medicine” initiative. The Medicaid health plan has a partnership “with several community-based organizations to improve access to nutritious meals,” the Institute’s report says. “The approach includes vouchers to community farmer’s markets, as well as meal delivery to address client-specific chronic conditions such as pre-diabetes, diabetes, or hypertension.”
  • The North Carolina Department of Health and Human Services requires Medicaid health plans in contracts with the state to “to adopt standardized social needs screening beginning in mid-2019 as part of their care management strategies.” The information is then shared with the Medicaid health plan enrollee’s primary care providers.
  • Upper Peninsula Health Plan’s “Connected Communities for Health” initiative which works to address enrollees social determinants of health by working with community, state, faith-based and other organizations to meet patient needs. “Members are screened by customer service representatives for needs in the areas of adult education, childcare, commodities (e.g. household goods/furniture, baby supplies, clothing), employment, finance, food, housing, legal services, transportation, and utility assistance,” the report says.
The Importance of Preventive Care in Staying Healthy
Posted on January 14, 2019

Marquette, MI – (Great Lakes Radio) – On the latest UPHP Update, we heard from Clinical Coordinator Chris Rhoades about preventive care in living a longer, healthier life.

Rhoades joined the Sunny Morning Show to talk about what preventive care is and what some good examples of it are.

He also explained the differences between preventive care and diagnostic care as part of your personal health journey.

Rhoades also delved into the importance of knowing your insurance benefit coverage and how to use it to maintain your preventive care regimen.

He wrapped up with some good tips about preventive care and using the new year as the springboard to get checked and get active.

LISTEN IN – UPHP Clinical Care Coordinator Chris Rhoades with more about preventive care.

This story was originally posted here by Great Lakes Radio, Inc. on January 8, 2019.

 

UPHP Supports Beacon House’s “Legacy of Love” Campaign
Posted on December 20, 2018

MARQUETTE – Upper Peninsula Health Plan has made a $50,000 contribution to the Beacon House’s “Legacy of Love” capital campaign. The Beacon House is an independent, non-profit organization and does not charge guests for their stay. The “Legacy of Love” capital campaign project kicked off in 2016, since then dozens of sponsors have pledged their financial support. To date the Beacon House has raised $2.1 million of the $3 million phase one goal of the building project.

Upper Peninsula Health Plan and the Beacon House have long been partners. The Beacon House has provided hospitality for UPHP members and their families since opening their doors in 2002. UPHP members travel from across the Upper Peninsula to receive specialty medical care in Marquette and the Beacon House allows them to stay near their loved ones. Hospitality houses need to be within walking distance of hospitals. There is a strong correlation between proximity to healthcare services and recovery. The Beacon House has provided several thousand overnight stays for UPHP members from all across the Upper Peninsula- averaging 750 nights annually in recent years.

For over 16 years, the Beacon House has been a home away from home for patients and families traveling to Marquette for specialty medical care. “Worrying about where you will stay when a loved one is in the hospital can be stressful. Having a facility like the Beacon House close to the hospital can help reduce fear and anxiety allowing the focus to be on recovery,” said Melissa Holmquist, UPHP CEO.

The Beacon House operates on a donation basis and guests are expected to contribute at a level that is affordable to them. No family is ever turned away for lack of funds. To contribute to the Beacon House’s “Legacy of Love” capital campaign, you can make a donation or pledge online at www.upbeaconhouse.org or by calling 906-225-7100. For additional information please contact Mary Tavernini Dowling at mary@upbeaconhouse.org or 906-225-7100.

About UPHP
Upper Peninsula Health Plan currently serves nearly 50,000 members across five product lines (Michigan Medicaid, Children with Special Health Care Services, Healthy Michigan Plan, MI Health Link, and Medicare Advantage) and its network exceeds 2,000 providers. Learn more at www.uphp.com.

2018 Community Benefit Report
Posted on December 17, 2018

UPHP Encourages Managing Stress For Good Health
Posted on December 12, 2018

Marquette, MI – (Great Lakes Radio) – On the latest Upper Peninsula Health Plan update, the conversation focused on stress management and how it it’s key to staying healthy.

Steve Rudness, Clinical Coordinator with UPHP, joined the Sunny Morning Show today to talk about what stress is, how it can affect us and how to find ways to manage it.

Rudness explained that stress is a natural reaction in our bodies to external pressures that can be both physical and mental and it really only becomes an issue when we allow it to build up within us.

He said there are plenty of ways to manage stress, but one of the best ways is to simply take the time to take care of yourself by doing things you enjoy to do, whether it’s exercising, socializing or just having some quiet time alone.

Rudness also shared several resources to find help in managing your stress in order to live a healthy life.

LISTEN IN – Steve Rudness of Upper Peninsula Health Plan with more about stress management.

This story was originally posted here by Great Lakes Radio, Inc. on December 4, 2018.

 

UPHP Repeats as Top Scoring Medicare-Medicaid Plan on CAHPS Overall Rating
Posted on December 12, 2018

MARQUETTE – The Integrated Care Resource Center announced on Wednesday, December 12th that for the second year in a row Upper Peninsula Health Plan (UPHP) has tied for first place in the nation for overall rating of a Medicare-Medicaid Plan (MMP). UPHP was approved by the State of Michigan and the Centers for Medicare & Medicare Services (CMS) to provide the services of a dual eligible program called MI Health Link. The advantages of the MI Health Link program are to make member’s Medicare and Michigan Medicaid benefits work better together. MI Health Link members use one plan and one card for health care, behavioral health care, home and community based services, nursing home care, and medications.

Under the Medicare-Medicaid Financial Alignment Initiative, CMS measures consumer experience in multiple ways, including through beneficiary surveys such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Under the capitated financial alignment model, Medicare-Medicaid Plans (MMPs) are required to annually conduct the Medicare Advantage Prescription Drug (MA-PD) CAHPS survey. The MA-PD CAHPS survey is designed to measure important aspects of an individual’s health care experience including the accessibility to and quality of services.

As part of the MA-PD CAHPS survey, respondents are asked to rate their health plan on a scale from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible. The scores below are the percentage of the best possible score each contract earned:

“We are thrilled to be recognized for a second year in a row as one of the top Medicare-Medicaid Health Plans in the nation. The credit for this recognition goes to our hard working staff and network of providers who dedicate themselves to serving our members. It is their effort that is reflected in our member satisfaction via this CAHPS survey,” said UPHP CEO, Melissa Holmquist.

In order to report MA-PD CAHPS in a given year, health plans, including MMPs, must have a minimum of 600 enrollees as of July 1st of the preceding calendar year. In early 2018, surveys were sent to a sample of Medicare-Medicaid Plan enrollees with at least six months of continuous enrollment. Enrollees were asked to evaluate their health care experience over the previous six months. As a result, 41 MMPs participating in nine capitated model demonstrations were able to report CAHPS during the 2018 reporting cycle.

CMS anticipates making additional information regarding 2018 CAHPS results under the Medicare-Medicaid Financial Alignment Initiative available soon. For more information on the MA-PD CAHPS survey see http://www.ma-pdpcahps.org/.

About UPHP

Upper Peninsula Health Plan currently serves nearly 50,000 members across five product lines (Michigan Medicaid, Children with Special Health Care Services, Healthy Michigan Plan, MI Health Link, and Medicare Advantage) and its network exceeds 2,000 providers. Learn more at www.uphp.com.