Banner Health Plan

SEE SCHEDULE O. BHP operates exclusively to promote social welfare purposes within the meaning of Section 501(c)(4) of the Internal Revenue and is organized as a Medicare-only health maintenance organization (HMO) to serve Medicare beneficiaries through a Medicare-only Medicare Advantage Part D (MAPD) Plan. BHP's sole member is Banner Health Insurance Companies, LLC (BHIC), which is disregarded for federal tax purposes as a single-member LLC of Banner Health, a tax-exempt hospital system under Section 501(c)(3). BH is one of the nation's largest nonprofit health care systems, and the leading tax-exempt provider of hospital services in every community it serves and, in some cases, the only inpatient facility available in some of those rural and/or medically underserved communities. BHP is integrated into BH'S continuum of care for BH patients, thereby strengthening its ability to care for those patients and promote community health. BHP embraces and seeks to further BH's mission of making health care easier, so life can be better and leverages BH's vast Arizona managed care expertise to improve its elderly members' access to care and quality of care. Care and coverage are part of BH's vertically integrated system and the cornerstone of BHP which is designed to promote more efficient and effective care coordination and provision. BHP's health plan is based in Arizona and serves only Arizona counties All counties included in BHP's service areas - Maricopa, Pima, Pinal, Santa Cruz, and Yuma - are designated as medically underserved areas by the Health Resources and Services Administration (HRSA). BHP is the only MAPD health plan in Arizona that can offer a fully integrated continuum of care and coverage and in its service area, it is unique in its ability to integrate provider care and operate under the umbrella of a tax-exempt health system. Under BHP, members receive both quality health care and comprehensive insurance coverage including prescription drug coverage in a single plan. Through BH, BHP offers its members a choice of 5000+ providers, 17 Arizona hospitals, and three renowned academic medical centers. BHP offers several programs to improve member health care and access, including a medical management program, care management program, and condition management program. In addition, BHP coordinates member health plan benefits including emergency services and emergency inpatient care, inpatient care, primary care, specialty care, diagnostic and therapeutic ancillary care services, outpatient care, preventive care, and emergency ambulance services. BHP's member experience is further differentiated by allowing over the counter health products, hearing aids, annual eye exams, telehealth visits, meals, free virtual waiting rooms, and behavioral-based smart phone apps that allow BHP to reach its members in a creative and integrated way, meeting both the physical and behavioral health needs of its members. BHP provides each member a personalized health navigator to further develop the integrated experience and meet the member's health needs. The health navigator is a trusted steward to help members with their health goals and needs including: - Assisting with doctors' appointments or member provider selection - Assisting with home health orders, home medical equipment, or filling medications - Discharge navigation and care coordination - Connection with member health or social needs BHP also provides additional member resources including: - Certified health coach and/or registered dietitian - Works with the member on health goals - Dial into Diabetes - Evidence-based and individualized education and support for diabetics - Advance Care Planning - Social workers help with advance care planning and completing advanced directives - Nurse Now - 24 hour/365-day hotline for registered nurse support. - Fall Risk Reduction Program - Fall risk assessment and intervention for those at risk for falls or wanting a preventative approach - Care Management - Multidisciplinary team to help the member with disease management and/or to coordination of any supportive needs such as food boxes, transportation, or access to care barriers - Community-based Healthy Lifestyle Education Classes BHP's comprehensive medical management (MM) program involves coordinating, facilitating, monitoring, evaluating, assessing, and integrating both medical and behavioral health care services while ensuring continuity of care for all of BHP's members. The MM program entails member and provider notifications, discharge planning, behavioral health services, care management, condition management, retrospective review, medical claims review, quality of care review, and medical management. The program supports BHP's affiliated providers with analysis, education, development, operating systems, and medical management expertise to improve the health of BHP's members. As part of the MM program, BHP's Quality Committee approves quality standards and oversees affiliate providers' adherence to these standards throughout BHP's network and ensures that affiliated providers are informed of information related to their performance. It also investigates and analyzes quality of care issues, member abuse, and member complaints. BHP achieves its mission, and the mission of BH - making health care easier so life can be better through the MM program by focusing on continuous quality improvements, utilizing best practices throughout its network, and providing access to high quality, sustainable health care services to all members. BHP conducts a care management (CM) program for its members with multiple or complex medical/mental health conditions, for the purpose of improving their physical and behavioral health and quality of life. BHP coordinates access to needed health care services and resources for these members to help them regain/maintain their optimal health and/or improve their functional capacity. Through the CM program, BHP seeks to reduce care gaps, decrease unnecessary hospitalization and emergency department visits, improve member self-management skills, and remove barriers to needed care. BHP's CM member services include care coordination, health risk assessments, health and disease management education, mental/behavioral health support, providing information on community resources, and assistance in care transitions (e.g., from hospital to home, to and from skilled nursing facilities). BHP refers CM program members with additional needs such as meals, need for support groups, etc. to appropriate community resources or, if their needs are more extensive, to the appropriate BHP Care Management department for further intervention. BHP conducts a condition management program for members with select high risk conditions who could benefit from a concerted approach to managing their health, including those suffering from diabetes, cardiovascular issues, depression, and chronic obstructive pulmonary disease. BHP's condition management services include assessments, analysis, member contacts, plan of care, individualized health education to each condition management member, and member interventions to improve member health. Such interventions include educational materials or workshops, telephonic and in-person care management, and home monitoring devices. As the largest employer and Medicare provider in Arizona and collaborator and innovator in health care delivery, BH supports the Arizona safety net in significant ways providing stability and ongoing excellence in care and outcomes. As parent organization to the only locally owned MAPD plan, Banner and BHP are dedicated to serving their communities and BHP facilitates and coordinates medical care that demonstrates a passion to improving the health, well-being, and social welfare of BHP communities. Significant community health needs that both BH and BHP are taking action to meet in service to the community include: - Ensuring members of the Banner communities (including elderly members) have greater access to needed healthcare resources - Representing high need populations including the elderly, minority groups, low-income individuals, medically underserved and those with chronic conditions - Representing the underserved and uninsured - Catering to the chronic and often complex health needs of senior adults and responding to their health concerns - Delivery of an integrated, coordinated continuum of care - Provision of and access to health insurance coverage