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Patrice King Brown: Whether you’re new to Medicare, exploring your options, or just want to keep up with the latest in Medicare news, we’ve got you covered.
Stacy Smith: No fluff, no jargon. Just real conversations to help you navigate Medicare with confidence. I’m Stacy Smith.
Patrice King Brown: And I’m Patrice King Brown. Welcome to “Medicare for the Record,” brought to you by UPMC for Life.
Stacy Smith: Welcome to this episode of “Medicare for the Record.” We are pleased to have with us today, Cynthia Lentz. She's the Associate Vice President of Care Management and Clinical Business Operations for UPMC Health Plan. Cynthia, thanks for joining us.
Cynthia Lentz: Pleasure to be here. Thank you.
Stacy Smith: Now Cynthia's going to talk with us a little bit about what whole-person care means and having it in the health plan and how it can work with—not only for you, but with your doctors and other specialists. So before we get into that, tell us a little bit about yourself.
Cynthia Lentz: I'm a nurse. I've been a nurse for many years. I started in surgical services within UPMC Provider Services, and in 2012 I made the switch over to the Health Plan and I started in the Quality Department and found myself in care management, which is what we're going to talk about today, specifically for our Medicare products.
Patrice King Brown: So Cynthia, what should consumers look for when they're searching for a plan in regard to working with your doctors? I mean, what's it mean to be a Partner in Care?
Cynthia Lentz: So ”Partners in Care” is a very important phrase for us. It's talking about your care team. So you as an individual have others that can support you besides your family and friends that you have. We want to ensure that you have coordinated care—so that's care with your providers, with your health plan, and with the services that you use and hospitals or care delivery systems.
Stacy Smith: So what programs are available with Medicare Advantage plans and how would someone have access to them?
Cynthia Lentz: So Medicare Advantage plans have additional supplemental benefits associated with them. So besides your regular health care that everyone is familiar with, there are other sources of support, as in an over-the-counter card to help you support some needs there. We provide transportation on, in some of our plans for your doctor's appointments. We ensure that you have care coordination, which is important as I spoke to being your Partner in Care, along with gym benefits and a variety of other sources of resources available for you.
Stacy Smith: So if someone's unsure about how to utilize these services, how would they go about that?
Cynthia Lentz: That is very easy. We have a variety of ways to do so. If you outreach to our Member Services, we provide newsletters throughout the year that have that information as well—and also available on the website. And if you need help accessing that website, we have tech support to help you learn how to log in and use your services directly. Based upon the plan that you're enrolled in, those are the benefits that are available to you. And our Service, Member Services individuals are very familiar with those and can walk you through what's available and how to access it.
Patrice King Brown: Oh, that's good to know. Now, we know it's important for doctors and specialists to communicate, but specifically why?
Cynthia Lentz: Care coordination is important because we don't want duplication of services. We want to ensure that there is a planned care, a care plan that you as a member are comfortable with and all of your treating providers are also aware of. We wouldn't want duplicate medications, which can be extremely dangerous. We want to ensure that everyone is aware the care that you're getting, because it needs to be coordinated. We do have opportunity with electronic health records, et cetera, where there is communication of some of these things, but your care manager and through the health plan ensures that that is being done.
Patrice King Brown: What tools do some plans, plans offer to help connect providers?
Cynthia Lentz: We want to have communication with you, and we have that electronic health record and not all physicians and providers are linked into that. So at the Health Plan, we're able to ensure and communicate between your providers for you, and it's important for us to provide to you also the knowledge that you're ensuring what each of your providers need to know from you as a member for your own health care.
Stacy Smith: But how does that necessarily work? I go to the doctor's office and he's saying, well, maybe you need to go see this particular specialist or something. Do you have to make the phone calls? Do you call someone at the Medicare Advantage plan? How does that work?
Cynthia Lentz: It truly depends on what the specifics are with a provider that's referring you. A provider may refer you and link you to that individual automatically. Or you can call in to the health plan and understand what providers are available in your area, understand what services that they have, who they are, and we can arrange to make appointments for you on your behalf.
Patrice King Brown: Boy, that's good to know, yeah. It depends, of course, on your plan, on your Medicare Advantage plan.
Cynthia Lentz: It depends on your Medicare Advantage plan.
Patrice King Brown: OK. So I've heard of something called—OK, it sounds kind of mystical, the “eight dimensions of wellness.” Can you tell us what they are and how one's plan might come into making sure that that works?
Cynthia Lentz: So the eight dimensions of wellness are extremely important because it's not just your physical health, there's your emotional health, social, financial, your spiritual well-being, your behavioral health, occupational, all of these things play together and not one is more important than the other. They each affect each other. And if one is neglected over time it can become detrimental to your well-being.
So through our care management structure, there's a philosophy of these eight different areas of your well-being. So we want to ensure that you have all of those basic needs, that you have the knowledge and understand what your needs are. We are certainly talking about your health, so chronic conditions or wellness and preventive care as well. We're looking at things that are financial, your living situation, the food that you need, what's important to you. Because what's important to you is where a care manager has to start to help support your needs into that wellness. It's part of your well-being. It's a philosophy that we work by and we want to ensure you as a person that the whole person is managed.
Stacy Smith: All right. You referred to the whole-person care. What does that really mean in the context of Medicare Advantage?
Cynthia Lentz: So for Medicare Advantage, we want to ensure, again, that your health is being taken care of. So that includes things like vision and dental included in your Medicare Advantage plan, hearing. We have supports to attend a gym if you'd want to. We have supports for financial, caregiver supports, transportation, all of those things. It's not just focusing on what medical conditions you may be managing, but what is supporting you to manage those things.
Stacy Smith: You say you're a licensed nurse, or you were?
Cynthia Lentz: I am.
Stacy Smith: You still are? OK.
Cynthia Lentz: I still am.
Stacy Smith: So what role do nurses and social workers play in these plans?
Cynthia Lentz: So our care management teams that support our Medicare Advantage UPMC for Life products, they're nurses and social workers, but they work holistically with the members. So every one of our members has a care manager assigned to them. So they know who you are, the care that you've been receiving, what your needs are. They'll outreach to engage with you to see what needs that you have. It helps us as a plan to learn what we would need for our members as a whole, as well as the individual. And they have moments that they are always going to be in connection with you: transitions of care if you've been hospitalized, if you had an emergency room visit, if we're seeing that medication is not being filled to help understand why, to do education. One of the most important pieces that our care managers do is education so that you can understand what you are dealing with, the why that your treatment plan is how it is, and the importance of those treatments, medications, et cetera. So these individuals are very caring. They also offer a lot of emotional support to our membership as well.
Patrice King Brown: That's important. As you mentioned at times as we age, the unit gets smaller.
Cynthia Lentz: Yes.
Patrice King Brown: Yeah. The support around us gets smaller. Cynthia, how do plans ensure that follow-up care is scheduled and medications reviewed following a hospital stay?
Cynthia Lentz: So I talked about transitions of care, which is a very vulnerable point in a person's well-being. If you've gone to the hospital, something most likely has changed, your medication has changed. Another provider might not know that you had been in that hospital, so there's that coordination of care, ensuring that those providers also know what your needs are for that. So we will call and try and connect with you and understand—if you understand your discharge directions, if you have home health services ordered or physical therapy or occupational therapy that's been ordered after, if you have everything that was ordered for you—you might have had some equipment ordered for you, perhaps you needed a walker or some type of device to help you in your activities of daily living. We ensure that those things are in place. If you have new oxygen needs, we ensure those things are placed. And we will stay connected to you until you're comfortable with what is going on with that change and know that something new has changed. It might be something small, it might be something that was planned. You might have had a planned orthopedic procedure, you might have had a cataract surgery. But each one of those things are a change in where you're receiving your care.
So we talk about transitions as a change from a site of care. So if you're going from your home into the hospital, now that's where your care. You might be going to a skilled nursing facility, now that's where your care. We need to ensure that that coordination occurs, and that's the role of care managers to help you with that. It's also extremely important to help identify who in your life can support you. We talk about a personal representative that's designated for you. So it might be a spouse, it might be a child, a parent, it could be a friend. So we ensure that we have a way to connect with you maybe when you're not able to do so by yourself.
Patrice King Brown: So these are examples of how plans support people?
Cynthia Lentz: Yes, exactly.
Patrice King Brown: OK. After they've had a procedure or whatever, definite follow-up. I'm not sure that everyone is aware that these things are available.
Cynthia Lentz: I don’t…sometimes It's very surprising when we talk to our members that they're not aware of it. We do a lot of education, a lot of things, again in our newsletters to understand, to say that that's there.
There's a couple different levels of care. We have what we would say are health coaches to help you through some change that you want in your life, if it be weight management or nutrition challenges, et cetera. People are a little more familiar with that. We certainly have our Member Services, which are not clinical people, but they're there to support you through your benefits and to connect you with appointments and those types of needs that you may have. But that licensed care manager isn't always as visible, but our members are extremely grateful to have that connection.
Patrice King Brown: I was going to say—no, thank you, Cynthia. That is really good news for folks. And you just have to examine your plan to find out what might be available for you, correct?
Cynthia Lentz: Yes, yes.
Stacy Smith: I'd like to delve into one other aspect, because you mentioned about someone in your family that could help you as such, whether it be your spouse or your children or something. How will that work in one of these plans in utilizing this kind of care?
Cynthia Lentz: So when you join the plan, we have many questions for you to understand where you are in your health journey, including all of those different eight areas that we talked about. And when we talk to you about that, we want to understand who your providers are today, what are the medications that you're taking, and then who your support is. So we actually need a formal written document that’s, that will allow us to speak to, perhaps, your spouse. If we don't have that document, we're not able to do so, legally.
Patrice King Brown: Oh, yes.
Cynthia Lentz: So it's extremely important. So we want to ensure that we have that information, that personal representative, who is your PCP, what are the medications you're taking, what other supports that you may have. Because there's a variety of services that are in the community or through government programs. We want to ensure we have that information to support you through your journey of wellness.
Stacy Smith: There is so much involved in Medicare and Medicare Advantage. It sounds like it could be confusing for someone, but it's really not all that difficult to get through this, is it?
Cynthia Lentz: It's not. There's a variety of sources that you can use to understand all of the different options of plans that are available. There are ways of comparing what you have today if you're new to Medicare and where you're going, if you're going to go into the Medicare product now, if you're leaving, perhaps you're leaving the workforce where you had a plan that was already there. There's a lot of support, both for individual health plans—UPMC for Life has a department that is available to support you in making those decisions and understand what's available in each different plan, where it's available, what the providers are that are available for you directly and out-of-network, along with travel benefits when you're going out of state or traveling. That's something extremely important to look to as well. Where can I use my health plan if I am traveling?
Patrice King Brown: …if you're elsewhere. So basically, we just have to ask, you know? You have to look it up…
Cynthia Lentz: You have to ask.
Patrice King Brown: … follow your plan, but then you have to ask.
Cynthia Lentz: You have to ask. and know that the support's there. On the website, everything is available on the website for you. But there are challenges for some to access that for a variety of reasons. But that's why we have that tech department that can support you in doing that. Do everything on your phone. Everyone does everything on their phone now. Yeah.
Patrice King Brown: Cynthia, thank you so much for joining us today and sharing all of that really good information.
Stacy Smith: Indeed, a lot of good information. But as we leave this podcast, we'd like for you to remember a couple of things. And that is, Medicare Advantage Plans offer more than just medical coverage. Members have access to wellness programs, to transportation, fitness benefits, over-the-counter product allowances, and some other things as well.
Patrice King Brown: And care coordination is key. That means licensed nurses, social workers, and care managers help connect people with providers. And that ensures a very smooth transition from hospital to home.
Stacy Smith: And remember that whole-person care matters. Plans support all aspects of health, including physical and mental wellness and preventive care as well. Thank you again for joining us for this episode of “Medicare for the Record.”
Thanks for tuning in to “Medicare for the Record,” brought to you by UPMC for Life. To learn more about your Medicare options, visit upmchealthplan.com/fortherecord.
This podcast is provided for general informational and educational purposes only. It is not medical care or advice. For questions regarding medical care, please consult with your health care provider. Views and opinions expressed by the participants are solely their own and do not necessarily reflect those of UPMC Health Plan, its subsidiaries, parents, or affiliates.
UPMC for Life has a contract with Medicare to provide HMO, HMO D-SNP, and PPO plans. The HMO D-SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., UPMC for You Inc., and UPMC Health Coverage Inc.
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