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Important Notifications

Allwell from Superior HealthPlan is dedicated to providing high-quality care to our members. One of the ways we demonstrate this commitment is by regularly measuring and evaluating how we deliver care.

The Model of Care (MOC) is the plan that Allwell follows to provide coordinated care to our Allwell Dual Medicare (HMO D-SNP) members. The goal of the MOC is to improve access to important medical, behavioral health and community-based services so our members can get the care they need when they need it.

To ensure that Allwell is always improving the quality of care for our members, we evaluate the MOC annually based on the following criteria:

  • Member feedback from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey and Health Outcomes Survey (HOS)
  • Healthcare Effectiveness Data and Information Set (HEDIS) measures
  • How Allwell operates as a health plan

Based on these criteria, we identified 13 goals that we used to measure the success of the MOC. We met our goals in eight of these areas, including areas related to avoiding preventable hospitalizations and access to preventive and ambulatory health services. Allwell also performed well in areas like the number of members who received a flu shot and the number of members who completed breast and colorectal cancer screenings.

Although we improved our scores in every goal measured, we identified some opportunities for improvement. Below is a summary of the five measures Allwell is working on and what steps we are taking to improve.

1.

Getting Needed Care (CAHPS measure): This goal measures how easily Allwell members can get necessary care, tests or treatment, and how soon members can get appointments with specialists.

How we scored: This measure improved by 5 percentage points to 81%, but fell short of the goal of 84%.

What we are doing to improve:

  • Monitoring the availability of routine and urgent appointments with Primary Care Providers (PCPs) and high-volume specialists in the Allwell network to ensure our members can get appointments with providers.
  • Working with Allwell providers to remind members that Allwell offers a variety of services that can help them access care, including reminder calls and transportation assistance.
2.

Getting Appointments and Care Quickly (CAHPS measure): This goal measures how soon Allwell members can get care for an illness or injury and how quickly members can get a non-urgent medical appointment.

How we scored: The measure increased 2 percentage points to 74%, but fell short of the goal of 77%.

What we are doing to improve:

  • Using data to track how many members we are sending to PCPs and identifying patterns in appointment availability.
  • Distributing a member newsletter that provides information about access to providers and how soon a member should expect to be able to get an appointment with a provider.
  • Making educational outreach calls to members who received non-urgent care.
3.

Care Coordination (CAHPS measure): This goal measures how well providers, members and the health plan work together to deliver care.

How we scored: This measure increased 1 percentage point to 82%, but fell short of the goal of 86%.

What we are doing to improve:

  • Allwell’s Care Management team is working with provider offices to share test results and is making sure providers have the most up-to-date member medical records.
  • Monitoring grievances and complaints to identify issues related to member access to providers or facilities.
  • Using technology to connect members with Care Managers for support with health issues through Wellframe, a care management app that is available for download on smartphones and tablets.
  • Working with providers to regularly follow up with members on their test results.
4.

Improving/Maintaining Mental Health (HOS measure): This measure asks whether a member’s mental health is the same or better after two years.

How we scored: This measure increased 9 percentage points to 85%, but fell short of the goal of 88%.

What we are doing to improve:

  • Making outreach calls to members who take antidepressants to provide education on the importance of taking medication as directed by a provider.
  • Distributing a member newsletter that addresses topics related to wellness and mental health.
5.

Improving/Maintaining Physical Health (HOS measure): This measure asks whether a member’s physical health is the same or better after two years.

How we scored: This measure increased 2 percentage points to 67%, but fell short of the goal of 72%.

What we are doing to improve:

  • Developing care plans that allow members to be more involved in their care.
  • Distributing health education materials to members to emphasize the importance of preventive care with topics related to depression, wellness, diabetes and preventive screenings.
  • Making outreach calls to members to remind them to get important preventive health screenings throughout the year.

If you have any questions, please reach out to your Care Manager or call Allwell Member Services at 1-877-935-8023 (TTY: 711). From October 1 to March 31, you can call us 7 days a week from 8 a.m. to 8 p.m. From April 1 to September 30, you can call us Monday through Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends, and on federal holidays. You can also call Allwell Member Services to request a hard copy of this information or to request a copy of this information in your preferred language.

 

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Due to severe storms in the State of Texas, Governor Greg Abbott declared a state of emergency in the following Counties:   Cass, Cameron, Collin, Dallas, Ellis, Erath, Hunt, Kaufman, Lamar, Paola, Rains, Rockwall, Rusk, Tarrant, Van Zandt, and Wood

Your health and safety are our primary concerns and if you leave your home to avoid this disaster or emergency, we do not want any undue barriers to keep you from getting your medication or to seeing a medical professional.  

For our members who live in one of these impacted areas, we have removed the refill too soon edits for your Part D Prescription Drugs, and removed the out-of-network authorization requirements for out-of-network providers.  You must still use Medicare certified facilities and providers.

Prior authorization for medical services or medication may still be needed for medical necessity. This change is in effect until the emergency notice is closed November 20, 2019.  For public health emergencies, the lift for your Part D prescription drugs refill too soon edit will remain in effect until the emergency no longer exists or upon the expiration of the 90-day period beginning from the initial declaration, whichever occurs first.

Date: 08/06/2019

Allwell from Superior HealthPlan extends our deepest condolences to those affected by the tragic events in El Paso. If you are an Allwell member and were impacted in any way, we want to support you.

Call our free 24-hour Crisis Hotline at 1-855-769-6828 (TTY: 711) if you need to:

  • Get help dealing with stress or depression.
  • Speak with a licensed, professional counselor.

For any other assistance, you can call Member Services.

1-844-796-6811 (HMO); 1-877-935-8023 (HMO SNP) (TTY: 711)

From October 1 – March 31, you can call us 7 days a week from 8 a.m. to 8 p.m. From April 1 – September 30, you can call us Monday – Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends, and on federal holidays.

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