Banner-University Care Advantage

MANAGE AND COORDINATE THE DELIVERY OF QUALITY HEALTH CARE SERVICES TO ENROLLEES WHO QUALIFY AS PART OF A SPECIAL NEEDS PLAN AND ARE DUALLY ELIGIBLE FOR BOTH MEDICARE AND MEDICAID BENEFITS.

SEE SCHEDULE O. BANNER-UNIVERSITY ("CARE ADVANTAGE") HOLDS A CONTRACT WITH THE CENTERS FOR MEDICARE & MEDICAID SERVICES FOR THE OPERATION OF A MEDICARE ADVANTAGE PRESCRIPTION DRUG HEALTH PLAN. THE PLAN IS A QUALIFIED PLAN UNDER MEDICARE TO PROVIDE COVERAGE TO CERTAIN ENROLLEES WHO QUALIFY AS PART OF A SPECIAL NEEDS POPULATION, WHO ARE DUALLY ELIGIBLE FOR BOTH MEDICARE AND MEDICAID BENEFITS. CARE ADVANTAGE PROMOTES THE HEALTH OF THE COMMUNITY BY ENGAGING THE FOLLOWING: (1) THE PROVISION OF EDUCATION PROGRAMS REGARDING THE BENEFITS PROVIDED BY CARE ADVANTAGE TO ENROLLEES; (2) COUNSELING AND THE PROVISION OF ASSISTANCE TO ENROLLEES MAKING THE TRANSITION TO A NETWORK-BASED MANAGED CARE PLAN; (3) THE PROVISION OF PREVENTATIVE HEALTHCARE PROGRAMS FOR CARE ADVANTAGE ENROLLEES; (4) THE COORDINATION OF HEALTHCARE SERVICES AMONG PROVIDERS IN THE CARE ADVANTAGE PROVIDER NETWORK; AND (5) THE FACILITATION OF ACCESS TO THE CARE ADVANTAGE PROVIDER NETWORK. CARE ADVANTAGE HAS WORKED DILIGENTLY TO DEVELOP AND MAINTAIN A COMPREHENSIVE PROVIDER NETWORK WHICH PROVIDES A FOUNDATION THAT SUPPORTS BOTH INDIVIDUAL MEMBER NEEDS AS WELL AS CARE ADVANTAGE'S MEMBERSHIP IN ITS 10 COUNTY SERVICE AREAS. CARE ADVANTAGE CONTINUALLY STRIVES TO HAVE A HIGH QUALITY CONTRACTED PROVIDER NETWORK THAT EXCEEDS ACCESSIBILITY REQUIREMENTS ISSUED BY REGULATORY AUTHORITIES, IS SERVICE FOCUSED, AND CULTURALLY DIVERSE IN ORDER TO MEET MEMBER NEEDS, BOTH IMMEDIATE AS WELL AS LONG RANGE. CARE ADVANTAGE MAINTAINS A FULLY STAFFED SERVICE CENTER THAT MEMBERS CAN ACCESS IN ORDER TO OBTAIN GUIDANCE ON ACCESSING NEEDED CARE. THE SERVICE CENTER CAN BE ACCESSED AT 877-874-3930. CARE ADVANTAGE CONTRACTS WITH BANNER HEALTH (BH) FOR BH TO PROVIDE PRIMARY HEALTH CARE SERVICES TO CARE ADVANTAGE'S ENROLLEES. BH PROVIDES ALMOST ALL OF THESE SERVICES AT ITS CLINICS THROUGH ITS EMPLOYED HEALTH CARE PROVIDERS. CARE ADVANTAGE ALSO CONTRACTS WITH INDEPENDENT PHYSICIANS ENGAGED IN THE PRIVATE PRACTICE OF MEDICINE TO PROVIDE PRIMARY AND SPECIALTY HEALTH CARE SERVICES TO CARE ADVANTAGE'S ENROLLEES AT THE PHYSICIANS' OWN FACILITIES ON A NON-EXCLUSIVE BASIS. IN ADDITION, CARE ADVANTAGE HAS NEGOTIATED WITH SEVERAL UNRELATED HOSPITALS TO PROVIDE INPATIENT AND OUTPATIENT HOSPITAL SERVICES TO CARE ADVANTAGE'S ENROLLEES. CARE ADVANTAGE ENSURES THAT ENROLLED BENEFICIARIES ARE ADEQUATELY INFORMED ABOUT THEIR HEALTH CARE BENEFITS, PROVIDING COUNSELING AND ASSISTANCE IN MAKING THE TRANSITION TO MANAGED CARE. CARE ADVANTAGE EDUCATES BENEFICIARIES REGARDING ACCESS TO HEALTH CARE, PROVIDING DIRECTION AS TO THE APPROPRIATE UTILIZATION OF HEALTH CARE FACILITIES AND ENCOURAGING THE USE OF PREVENTIVE HEALTH CARE MEASURES. CARE ADVANTAGE ALSO ENSURES THAT ENROLLED MEDICAID BENEFICIARIES OBTAIN APPROPRIATE HEALTH CARE BY ENSURING THAT PROVIDERS ARE AVAILABLE AND THAT SERVICES WILL BE PROVIDED IN A COORDINATED MANNER.