Many of us are waiting weeks or months to book medical appointments. Or taking a long drive to get to the only provider taking new patients—often more than an hour away. And once in the office, chances are we’re spending more time in waiting rooms just for a routine appointment.
The national shortage of healthcare workers has been well-documented, and Maine is feeling it, too, with access to providers emerging as one of the greatest barriers to treatment. By the end of 2022, Maine had just 580 doctors practicing family medicine, an 18% decline from 2019, according to The Portland Press Herald, leaving fewer doctors for a growing population.
During the pandemic, patients discovered the convenience of telehealth and began meeting with their providers through a phone call or video chat from the comfort of their own homes. The concept certainly wasn’t new—Community Health Options Members had access to Amwell® behavioral telehealth well before Covid-19 struck.
That concept has expanded to virtual primary care, giving people the option through an online care team, expanding access to care. Alongside its traditional provider network, Community Health Options now offers Members 18 and older the option to choose a virtual-first primary care team through Firefly Health.
When it comes to health outcomes, many studies have shown patients miss fewer virtual appointments, helping them to stay on track with their health needs. And in a recent pilot program, Walmart employees with diabetes who used virtual care saw a 24% average reduction in glucose levels and patients with hypertension had a 14% reduction in blood pressure, the company said in 2023 when it expanded its program to Maine, among other states.
So how can you access telehealth with traditional care?
How does virtual primary care work?
Community Health Options Members can download and use the Firefly app to choose a primary care team comprising a medical doctor, nurse practitioner, behavioral health specialist and health guide, and make an initial appointment within three business days. The team addresses all aspects of primary care and provides referrals for in-person care when necessary.
There are programs available to help people get the tech they need to access this kind of care, For example, people needing help paying for a cell phone, internet access or cell minutes, can apply for assistance through Lifeline, a federal program that makes communications services more affordable for eligible individuals.
Members with questions about virtual care or the Community Health Options provider network can call our Maine-based Member Services team at (855) 624-6463 between 8 a.m. and 6 p.m., Monday through Friday.
The year ahead comes with a few changes to Health Options’ health insurance plans – and it’s all good news. One change we are excited to announce is a new tiered provider network option available in select individual/family Health Maintenance Organization (HMO) plans. While tiered plans may be new to Health Options, they are not new to health insurance. In fact, they are a proven way to save money on medical expenses. Read on to learn what tiering means to insurance plans and what it means to you as a health insurance consumer.
Tiered provider networks are a way to better manage the costs of healthcare services. They also provide health insurance consumers a better way to consider the cost of care when choosing their care options. Plans featuring tiered provider networks generally combine quality and cost in developing a preferred tier. Providers with high-quality outcomes and lower contracted prices are typically placed in the most preferred tier rankings.
As a consumer, you may wonder how Health Options decides which providers are considered part of our preferred tier. It is important to note, that all providers meet our quality standards, which is why they are part of the Health Options network. For tiered providers, we review claims history to analyze the quality of provider outcomes combined with their contracted cost and efficiency. Providers and facilities that meet or exceed our standards for quality, cost, and efficiency are “preferred,” and others are “standard.”
To take advantage of tiered providers, you will need to select an individual/family plan with a tiered network option, which is available in both bronze and silver metal level plans for 2022. It’s important to note, that on a tiered plan, you always have the option to visit standard providers with a standard co-pay.
As we enter the Open Enrollment season for 2022, we are proud to offer the highest quality healthcare at the best possible value with all our plans, and our new tiered network offers additional savings. If you have questions about tiered network plans and want help finding the health insurance plan that best suits your needs, contact our Member Services team at (855) 624-6463.
