Medicare Special Section 2019

Expert explains Medicare plan in chronic disease management

Michael Genord, M.D.
for HAP
Michael Genord, M.D. explains how Medicare plans can impact chronic disease management.

More than two-thirds of Medicare beneficiaries have two or more chronic diseases. A chronic disease is generally defined as an ongoing condition that requires medical attention or limits daily activities or both. Diabetes, hypertension and congestive heart failure are examples of chronic diseases that, if not managed properly, can lead to other health complications or even death.  

As a result of recent public policy changes, the Centers for Medicare & Medicaid Services, or CMS, has changed some of its rules for 2020 and is allowing insurers to offer special programs for Medicare beneficiaries who have certain chronic conditions.

If you have one or more chronic diseases, you should look for a health plan that has a solid transition of care program that assists you while you are hospitalized and after you are sent home. Health plans can play a critical role in partnering with doctors and hospitals to help manage your conditions, which in turn can reduce the number of return trips to the hospital. 

With this in mind, here are some considerations that will help you pick a Medicare Advantage plan that works for you:    

People with chronic diseases often take many medicines to manage those conditions.

Since most medications have specific instructions requiring each drug to be taken at different times of day, managing the process can be challenging for patients and caregivers. Not taking each medication at the right time is a leading cause of unnecessary hospital readmissions, especially since those hospitalized for diabetes, hypertension or congestive heart failure are often sent home with new or different medications. 

Insurers have teams of medical professionals on staff to help manage this process. Look for an insurer that offers a free medication review in partnership with your doctor following your hospital discharge to make sure you know exactly which medications to take and when.

If you are hospitalized for your chronic condition, does your insurer offer additional post-discharge support like home-delivered meals?

HAP, for example, arranges to have fully prepared, refrigerated meals delivered to the homes of those with certain chronic conditions who have recently been discharged from the hospital. For two weeks following discharge (two meals a day for 14 days), these members get the nutrition they need at a time when they might not be able to leave their home.

Diabetes can be deadly if not managed the right way.

If you have diabetes, look for an insurer that helps you manage this condition through 24/7 personalized support, which may include unlimited testing supplies. Some insurers offer cellular-enabled blood glucose meters that make it easy to share your blood glucose readings with your doctor and family members in real time. This enables those responsible for your care to see if you are in distress and act immediately.

Research has shown that those who take their medications properly, get the proper nutrition and manage their diabetes tend to have reduced rehospitalization rates, better health outcomes and improved quality of life.

That’s reason enough to ask your insurer about its health care management programs and how they can work for you.


Michael Genord, M.D., is interim president and CEO of Health Alliance Plan. He has held leadership positions throughout his career and managed a private medical practice for 17 years. He is board certified in obstetrics and gynecology.