Banner Health Insurance Group Inc

Banner Health Insurance Group ("BHIG") operates exclusively to promote social welfare purposes within the meaning of Section 501(c)(4) of the Internal Revenue and is organized as a Medicare-only preferred provider organization (PPO) to serve Medicare beneficiaries through a Medicare-only Medicare Advantage Part D (MAPD) Plan. BHIG's sole shareholder is Banner Health Insurance Companies, LLC (BHIC), which is disregarded for federal tax purposes as a single-member LLC of Banner Health, a tax-exempt hospital system under Section 501(c)(3). Banner Health is one of the nation's largest nonprofit health care systems, and the leading tax-exempt provider of hospital services in every community it serves and, in some cases, the only inpatient facility available in some of those rural and/or medically underserved communities. BHIG is integrated into Banner's continuum of care for Banner Health patients, thereby strengthening its ability to care for those patients and promote community health. BHIG embraces and seeks to further Banner Health's mission of making health care easier, so life can be better and leverages Banner Health's vast Arizona managed care expertise to improve its elderly members' access to care and quality of care. Care and coverage are part of Banner Health's vertically integrated system and the cornerstone of BHIG which is designed to promote more efficient and effective care coordination and provision. Formed in 2019, BHIG's health plan is based in Arizona and serves only Arizona counties All counties included in BHIG's service areas - Maricopa, Pima, Pinal, Santa Cruz, and Yuma - are designated as medically underserved areas by the Health Resources and Services Administration (HRSA). BHIG is the only MAPD health plan in Arizona that can offer a fully integrated continuum of care and coverage. In its service area, it is unique in its ability to integrate provider care and operate under the umbrella of a tax-exempt health system. Under BHIG, members receive both quality health care and comprehensive insurance coverage including prescription drug coverage in a single plan. Through Banner Health, BHIG offers its members a choice of 5000+ providers, 17 Arizona hospitals, and three renowned academic medical centers. BHIG offers several programs to improve member health care, including a medical management program, care management program, and condition management program. In addition, BHIG coordinates member health plan benefits including emergency services and emergency inpatient care, inpatient care, primary care, specialty care, diagnostic and therapeutic ancillary care services, outpatient care, preventive care and emergency ambulance services. BHIG's member experience is further differentiated by allowing over the counter health products, hearing aids, annual eye exams, telehealth visits, meals, free virtual waiting rooms, and behavioral-based smart phone apps that allow BHIG to reach its members in a creative and integrated way, meeting both the physical and behavioral health needs of its members. BHIG provides each member a personalized health navigator to further develop the integrated experience and meet the member's health needs. The health navigator is a trusted steward to help members with their health goals and needs including: - Assisting with doctors' appointments or member provider selection - Assisting with home health orders, home medical equipment or filling medications - Discharge navigation and care coordination - Connection with member health or social needs BHIG also provides additional member resources including: - Certified health coach and/or registered dietitian - Works with the member on health goals - Dial into Diabetes - Evidence-based and individualized education and support for diabetics - Advance Care Planning - Social workers help with advance care planning and completing advanced directives - Nurse Now - 24 hour/365-day hotline for registered nurse support. - Fall Risk Reduction Program - Fall risk assessment and intervention for those at risk for falls or wanting a preventative approach - Care Management - Multidisciplinary team to help the member with disease management and/or to coordination of any supportive needs such as food boxes, transportation, or access to care barriers - Community-based Healthy Lifestyle Education Classes BHIG's comprehensive Medical Management (MM) program involves coordinating, facilitating, monitoring, evaluating, assessing and integrating both medical and behavioral health care services while ensuring continuity of care for all of BHIG's members. The MM program entails member and provider notifications, discharge planning, behavioral health services, care management, condition management, retrospective review, medical claims review, quality of care review, and medical management. The program supports BHIG's affiliated providers with analysis, education, development, operating systems and medical management expertise to improve the health of BHIG's members. As part of the MM program, BHIG's Quality Committee approves quality standards and oversees affiliate providers' adherence to these standards throughout BHIG's network and ensures that affiliated providers are informed of information related to their performance. It also investigates and analyzes quality of care issues, member abuse, and member complaints. BHIG achieves its mission, and the mission of Banner Health - "making health care easier so life can be better" through the MM program by focusing on continuous quality improvements, utilizing best practices throughout its network, and providing access to high quality, sustainable health care services to all members. BHIG conducts a Care Management (CM) program for its members with multiple or complex medical/mental health conditions, for the purpose of improving their physical health, behavioral health and quality of life. BHIG coordinates access to needed health care services and resources for these members to help them regain/maintain their optimal health and/or improve their functional capacity. Through the CM program, BHIG seeks to reduce care gaps, decrease unnecessary hospitalization and emergency department visits, improve member self-management skills, and remove barriers to needed care. BHIG's CM member services include care coordination, health risk assessments, health and disease management education, mental/behavioral health support, providing information on community resources, and assistance in care transitions (e.g., from hospital to home, to and from skilled nursing facilities). BHIG refers CM program members with additional needs such as meals, need for support groups, etc. to appropriate community resources or, if their needs are more extensive, to the appropriate BHIG Care Management department for further intervention. BHIG conducts a condition management program for members with select high risk conditions who could benefit from a concerted approach to managing their health, including those suffering from diabetes, cardiovascular issues, depression, and chronic obstructive pulmonary disease. BHIG's condition management services include assessments, analysis, member contacts, plan of care, individualized health education to each condition management member, and member interventions to improve member health. Such interventions include educational materials or workshops, telephonic and in-person care management, and home monitoring devices. As the largest employer, Medicare provider in Arizona, collaborator and innovator in health care delivery, Banner Health supports the Arizona safety net in significant ways providing stability and ongoing excellence in care and outcomes. As parent organization to the only locally owned MAPD plan, Banner and BHIG are dedicated to serving their communities. BHIG facilitates and coordinates medical care that demonstrates a passion to improve the health, well-being, and social welfare of BHIG communities. Both Banner Health and BHIG are taking action to meet the significant community health service needs of the community by: - Ensuring members of the Banner communities (including elderly members) have greater access to needed healthcare resources - Representing high need populations including the elderly, minority groups, low-income individuals, medically underserved and those with chronic conditions - Representing the underserved and uninsured - Catering to the chronic and often complex health needs of senior adults and responding to their health concerns - Delivery of an integrated, coordinated continuum of care - Provision of and access to health insurance coverage