1. Promoting Better Health For People with Medicare
Debbie Bisswurm
Greater WI Agency on Aging Resources, and
Anne Hvizdak
Department of Health Services/Office on Aging
Good morning and welcome to the training today. A quick housekeeping point: We are recording this webinar and it will be available later on the GWAAR website. At this time we ask you to please mute your phones by pressing *6. You may un-mute if you have a question.
Our intention with the training today is to share tools and strategies for conducting outreach regarding Medicare’s preventive benefits as well as for developing and maintaining a valuable partnership with your local health promotion programs.
I am joined by Anne Hvizdak from the Department of Health Services/Office on Aging, who will be providing valuable information about the Health Promotion programs and insight into the opportunities for collaboration.

2. Background/Reasons for this Training
Educate beneficiaries about benefits of preventive services.
MIPPA Grant
SHIP Grant
Increase awareness of Health Promotion Programs.
More than just financial health – Improve overall health!
Connect these programs to reach more people.
I’d like to take a moment to review the reasons we put this training together. Federal SHIP and MIPPA grants provide funding to support the outreach we are discussing today.
The first MIPPA grants focused primarily on the financial benefit programs. Then with the increase in preventive services after 2011, there was an increased focus on outreach regarding preventive services. And since the 2014 MIPPA grant, an emphasis was placed on outreach regarding both preventive services AND health promotion programs.
While you are reaching out to lower income Medicare beneficiaries about ways to save money, it makes sense to also teach them about the importance of preventive services - which can also save them money in the long run. Many of the lower income people we are trying to reach may tend to avoid medical appointments due to the cost.
So—to sum up—the reasons for this training are:
We want to be sure beneficiaries are educated about benefits of preventive services.
We want to Increase awareness of Health Promotion Programs.
WE realize that we can have an impact on—not just financial health but overall health through these efforts!
And by connecting these programs we can ultimately reach more people.

3. Training Objectives
Promote collaboration between benefit specialists and local Health Promotion Coordinators.
Provide information and materials to effectively conduct outreach to Medicare beneficiaries regarding Medicare Preventive Services and Health Promotion Programs.
Our specific objectives today are to:
Promote collaboration between benefit specialists and local Health Promotion Coordinators.
Provide information and materials to effectively conduct outreach to Medicare beneficiaries regarding Medicare Preventive Services and Health Promotion Programs.

4. Agenda Part 1: Medicare’s Preventive Services
Common Problems/issues
Materials for Outreach
Outreach Strategies
Part 2: Health Promotion Activities and Outreach
HP Classes—brief definitions
Part 3: Collaboration with Health Promotion Coordinators
Questions
We’ll start today with Medicare Preventive Benefits—review materials available for outreach—and discuss some outreach strategies as well.
Then Anne will share information about the Health Promotion Programs—and we’ll talk about Partnership opportunities.

5. Part 1: Medicare Preventive Services
Welcome to Medicare Preventive Visit
Yearly Wellness Visit
Additional screenings/tests/services
Just a brief overview of the Medicare covered preventive services. More and more people will be familiar with these but there will still be those who don’t know about them – this may especially be true for the older people who have been on MC for many years.
A few years back the coverage for preventive services was more limited—although there was always the Welcome to Medicare visit. In 2011, the Yearly Wellness Visit was added-- as well as many additional tests/screenings that are important for people to know about.

6. Welcome to Medicare Visit
Remind People that this is NOT a physical!
Visit Includes:
Height, weight, and blood pressure
Body mass index
Simple vision test
Review of potential risk for depression and level of safety
Discussion about advance directives if you choose
A written plan regarding screenings, shots, and other preventive services needed
The Welcome to Medicare Visit is available within the first 12 months that you have Part B. This visit includes a review of your medical and social history related to your health, and education and counseling about preventive services, including certain screenings, shots, and referrals for other care, if needed. It is important to note that this is NOT a physical.
The following will be covered during the Welcome to Medicare Visit:
Height, weight, and blood pressure measurements
A calculation of your body mass index
A simple vision test
A review of your potential risk for depression and your level of safety
An offer to talk with you about creating advance directives.
A written plan letting you know which screenings, shots, and other preventive services you need.
The visit is covered by Medicare, including the deductible and co-payment. However, if you receive additional tests, labs or services the usual deductible and co-payments amounts will apply.

7. Yearly Wellness Visit Not a physical! Visit Includes:
Review of medical and family history
Develop list of current providers and prescriptions
Record height, weight, blood pressure
Create list of risk factors and treatment options
Detection of cognitive impairment
Establish schedule of screenings for appropriate preventive services
Offer personalized health advice
Yearly Wellness Visit is also-- NOT a physical. The main focus of this visit is to develop or update a personalized prevention plan based on your current health and risk factors. You will be asked to complete a “Health Risk Assessment” to help your provider create a personalized prevention plan. The following will be covered during your Wellness Visit:
Review your medical and family history
Develop or update list of current providers and prescriptions
Height, weight, blood pressure, and other routine measurements
Create a list of risk factors and treatment options
Detection of any cognitive impairment
Establish a schedule of screenings for appropriate preventive services
Personalized health advice
The visit is covered after you have had Part B for longer than 12 months and once every 12 months after that. There is no charge, (No deductible or copayment) as long as doctor accepts assignment. However, if you receive additional tests, labs or services while you are there, the usual deductible and copays may apply.

8. Additional Preventive Services
Detailed information about Medicare Part B covered preventive services can be found in the Medicare & You Handbook (starting on page 35) as well as on the Medicare.gov website!
We have also created a Preventive Services Chart that can be used as a handout for your clients.
Most of the additional preventive services are covered in full by Medicare Part B (when done as part of your prevention plan), but some of the preventive services do require the Part B deductible and copays.
The complete list of Medicare covered preventive services can be found in the Medicare & You handbook, starting on page 35. In addition, CMS has other materials that give more details about each service. A link to the CMS handout: Staying Healthy—Medicare’s Preventive Services, can be found on the medicare.gov website and is also linked directly from our Medicare Outreach and Assistance page of the GWAAR website.
We also have a Preventive Services Chart that can be used as a handout for your clients or added to your information packets. It gives the basics—the test/service and the coverage information. I’ll talk more about that in a minute & I’ll also point out where you can find these materials.
I do want to point out that there is a new benefit we want you to be aware of—the National Medicare Diabetes Prevention Program, and Anne will talk a little about that program in a few minutes.

9. Common Problems/Issues
Yearly Wellness Visit must be asked for by name.
The screenings/tests must be coded as “preventive” not “diagnostic” for full coverage, otherwise deductible and copay may apply.
“Covered in full” may not apply to all services.
Other issues discussed at an appointment can be billed separately and charge for “office visit” may apply.
When in doubt, beneficiary should ask!
There are a few things to be aware of as you tell people about these preventive services.
First, the Yearly Wellness Visit must be asked for specifically by name so it is coded correctly. Many people at first assumed it was like – a complete physical – and made an appointment for a physical. They were, in turn, given a physical and MC did not cover it.
Also, if other issues are discussed at the visit – for example, concerns over their diabetes or a sore knee or whatever, the clinic can charge for an office visit for that portion of the visit. This is allowable.
Second, tests/services must be done as “prevention” to be covered with no deductible or copay. ie; if Mammogram is done as follow-up rather than prevention – if the person had breast cancer before - the mammogram will be considered diagnostic or follow-up and not preventive. Therefore, the usual deductible and copay would apply. Another example is if while getting a colonoscopy the doc finds a polyp and removes it, you may have to pay 20% of the doctor’s services and a copay in a hospital outpatient setting.
And the Third point, When we talk about “Covered in full”, it refers to the actual service such as the Bone Mass Measurement or Cardiovascular screening. If MD orders lab work, or other tests related to that service, they still could still receive a bill for those things. .

10. Medicare Preventive Services: Materials For Outreach
Brochure Insert—Health Promotion/Prevention
Preventive Services Chart
Medicare Placemat Prevention and Wellness
Articles to Customize
Medicare’s Annual Wellness Visit
Never Too Old to Immunize
Other prevention topics
There are several materials that may be of help to you in conducting this outreach:
We have a - brochure insert that highlights Medicare’s Preventive Benefits as well as the Healthy Living Programs. Remember, there is space for you to add your agency’s contact information. Bring these out to key locations in your service area.
The Preventive Services Chart I mentioned earlier is—a good handout. Include it with info packets and have it available as handout at presentations.
Placemats—use in your senior dining sites and could also be used with Home delivered meals. We have several variations on the website you can download.
There is also an article that discusses the Annual Wellness visit, as well as other articles on prevention topics.
**Please keep in mind with all of these resources, you can customize them to make them work best for you!!

11. Brochure Insert: Health Promotion Reverse side
Add your local contact info here
This is a quick view of the Prevention and Health Promotion insert for the brochure. On one side you can see information about Medicare’s preventive benefits and the other side promotes the health living programs. You can put your local contact information on the insert and include it in your packets, and as a handout at presentations.

12. Preventive Services Chart and
Medicare Placemat featuring Prevention and Health Promotion.
I apologize that these are rather small and difficult to read, but I just wanted to give you an idea of what these materials looked like.
On the left side you can see the Preventive Services Chart—again this lists the services as well as coverage information.
On the right you see a sample of a Placemat that you can find on our website. This placemat highlights the preventive benefits and health promotion programs. You can always customize these materials beyond just adding your contact information. If there is something you’d like to do to make it work better for your agency, such as take out the ADRC logo and put in your own agency’s logo, or move something around—that is fine to do. These materials are created to support your work, but if there is something that needs to be revised to make it work for you and your agency, please feel free to do that. And if you need assistance in doing something like that, just let me know.

13. Outreach Strategies: Preventive Benefits
Add Info to your website.
Add Preventive Services & HP materials to existing “packets”.
Welcome to Medicare Presentations
I & A staff
All other Outreach Targets:
Senior Centers, Meals on Wheels, Dining Sites
Libraries, churches
Create new partnerships.
Health Promotion Coordinators
Health care professionals
Local public health departments
Caregiver or other coalitions
As far as Outreach Strategies, there are several things that can be done:
Include the Prevention and Health Promotion information on your website.
Add P/HP information in your Medicare 101 packets, with your I & A staff. Bring this info out to other locations you do your “usual” outreach.
Create New partnerships:
Health Promotion Coordinators—early this week I sent out a document that outlines steps to take in developing a partnership w/ HP. The document, as well as the list of HP coordinators around the state, it available from the Adobe Connect screen and you can download it if you do not already have it. In a little while we’ll talk more specifically about that partnership.
Health care providers –doctors, nurses, social workers, PT, OT, Speech, Independent living centers
Take materials to medical offices—Great locations to talk about Medicare Preventive benefits.
Local Public Health Departments—very important partner and excellent place to share your outreach materials—you may even find that there are opportunities to join them in an event –such as a flu shot clinic—to help you reach more people.

14. Remember to report this outreach into SAMS!
Outreach to Beneficiaries
Partnership Outreach
Check “Prevention” as topic.
Enter “1” in CMS Special Use Field / MIPPA Event at bottom of section.
I want to take a minute to remind everyone that all of the outreach I’ve been talking about is outreach that should be reported. These are Public and Media events—whether you are directly talking to beneficiaries or to community partners—be sure to check “Prevention” as the topic. And enter a “1” in the special use field at the bottom.

15. Part 2: Health Promotion Activities and Outreach
Debbie
Introduce Anne Hvizdak from the Department of Health Services/Office on Aging.

16. Evidence-Based Health Promotion programs promoted by Wisconsin Institute for Healthy Aging
Living Well with Chronic Conditions (Self-Management Resource Center’s Chronic Disease Self-Management program, available in English and Spanish)
Healthy Living With Diabetes (Self-Management Resource Center’s Diabetes Self-Management Program available in Spanish and English)
Stepping On (available in English and Pisando Fuerte-Spanish version in select locations)
Powerful Tools For Caregivers/Powerful Tools for Caregivers of Adult children (available in English)
Walk with Ease
Tai Chi Fundamentals – rolling out in 2018
Visit the WIHA website for information about these and other evidence-based health promotion programs in Wisconsin

17. Additional Evidence-Based Health Promotion Programs
Strong Bodies (formerly Strong Women) Coordinated through UW Extension- focused on physical activity
Tai Chi: Moving for Better Balance- physical Activity
Enhance Fitness- at Select YMCA’s- Physical Activity
Arthritis Foundation Exercise program- Physical Activity
Screening Brief Intervention and Referral and Treatment Program (SBIRT)- reduction of alcohol and substance abuse in older adults
Mental Health First Aid- depression awareness
SAVVY Caregiver- dementia awareness
Memory Care Connections- (New York University’s Caregiver program)- Dementia awareness process to enhance communication within families and caregivers
A Matter of Balance- falls prevention
National Diabetes Prevention Program-focused on pre-diabetes
Information can be found on WIHA’s website

18. Screening activities
Malnutrition screening questionnaire at Congregate and Home delivered meal sites
STEADI Tool kit activities
Falls Prevention Quiz
Timed up and go activities
Centers for Disease Control Diabetes Quiz
SBIRT screening
Blood Pressure, Foot Care, and Oral Health screening activities

19. Health Promotion QUESTIONS?
Betsy – WIHA Deputy Director, Anne – EBPP Statewide Coordinator, Jill – GWAAR T.A. and a MT,

20. Part 3: Collaboration This Partnership Makes Sense!
Share target audience.
Physical Health + Financial Health = Overall Health.
Both programs will reach more people.
It is easy to see that this partnership with Health Promotion just makes sense!
We share a target audience,
We know that physical health and financial health are intertwined and can work together toward a person’s overall health.
And we also know, that by developing a partnership—in terms of educating each other and conducting outreach—both programs can reach more people with their important information.

21. Collaboration Contact Your local Health Promotion Coordinator
Meet to discuss partnership opportunities.
Educate about:
Your role
Medicare Preventive Benefits
Medicare Programs for People with limited incomes; MSP & LIS
So the first step is to contact your local HP Coordinator. <SHARE THE HANDOUT WITH---HP Coordinator List>
Explain how the partnership makes sense and how you may be able to increase the number of people you reach.
Again talk about the fact that--We have the same target audiences. Even if the class attendees are not on Medicare, they certainly know someone who is or will be on MC soon.
Overall health is important, not just physical health – need money to purchase medications which can also prevent falls. And in addition to financial health, people need to know the importance of taking care of their own physical health. They saved money on their diabetes medications by enrolling in Senior Care but in order for the medication to work most effectively they need to know how to manage their chronic condition.
Talk about your role. Explain the outreach you are doing regarding preventive benefits. Explain MSP and LIS--explain how these benefit programs can help people.

22. Develop the Relationship
Learn each other’s programs.
Need to be able to answer basic questions.
Share promotional materials.
Talk to people – do more than hand out brochures.
In order to be successful, you both Need to learn each others programs.
For you to effectively promote health promotion workshops you need to know the basics of what is being offered – not only the when and where but also a little about the class. Thanks to Anne, you now have some basic information about those classes.
Exchange resources that each of you can distribute at your outreach events
HP staff can share your resources before or after classes – not during—Anne, do you want to share any information about this?
Add workshop schedule to your information packets
Bring workshop handouts to presentations and talk about the value of the classes
TALK to people about the programs – don’t just have the brochures/handouts laying on a table.

23. Resources to Share with HP Coordinator
Brochure
Prevention and Health Promotion Insert
MSP/LIS/SeniorCare Insert
Preventive Services Handout
Brief Program Descriptions
We’ve talked about outreach materials already, but I just want to point out a few things that would be particularly helpful to share with the HP Coordinator:
Brochure & inserts etc.
Preventive Services Handout
Brief Program Descriptions—in order for someone to help spread the word about programs such as MSP and LIS they need to know how to describe them. You can of course use the other materials, but The program descriptions is a document that provides just a couple sentences about each of the benefit programs as well as about the preventive benefits and health promotion programs. You can also find it on the website. It might be helpful to hand this out to the HP Coordinator for a quick view of the programs.

24. Brief Program Descriptions
Medicare Savings Programs: Help Medicare beneficiaries with limited incomes and assets pay for some or all of Medicare’s premiums, deductibles, and copays. If qualified, at a minimum you would save over $100 per month!
Extra Help/Low Income Subsidy: Assist people with limited incomes and assets pay their Medicare Part D premiums, deductibles, and copays.
Senior Care: Wisconsin’s prescription drug program for people age 65 and older. There is no monthly premium and the deductible amount is based on the person’s income. Assets are not counted. People with lower incomes often find Senior Care to be more affordable than other Medicare drug plans.
These are the brief program descriptions I was talking about. Again, by presenting the information in a clear, brief way, they can more easily explain the programs to others.
Handout can be found on website under “Tools for Professionals”. Give to HP coordinator.
Feel free to adjust wording. The point is to have a brief description that enables the info to be easily shared.

25. Brief Program Descriptions
(continued)
Medicare Preventive Services: Medicare covers a wide range of preventive services and screenings including a yearly wellness visit, vaccinations and more – all at low or no cost. Preventive health care focuses on preventing disease and maintaining proper health which will allow you to live a longer, healthier life. Take advantage of these preventive services.
Health Promotion Classes: Educational programs designed for older people which have been researched and proven effective to help individuals manage their own health and improve their quality of life. Topics include fall prevention, managing chronic health conditions, living with diabetes and other wellness topics.
Again, these are just brief descriptions that may help people talk about the programs.

26. Additional Strategies
Offer to meet with HP Class Leaders to share info and resources.
Offer to share HP Class flyers/promotional materials in your outreach.
Share outreach ideas.
Health fairs/vendor booths
Presentations
Maintain communication.
Through your partnership you can continually look at ways to get your message out to people:
Ask if you can attend a HP staff meeting (if there is one) so you can share with all the class leaders the information about preventive benefits as well as the low-income benefit programs. Provide them materials to share.
Be sure to offer to share their flyers in your outreach.
Look for opportunities for the HP coordinator to join you for a presentation or other outreach event such as a senior health fair. You can keep each other informed about upcoming events, etc.
And once you have established a relationship, continue to check in with the HP coordinator regularly.

27. Accessing the Resources
I have talked with many of you directly about accessing materials on the website, but I want to provide a quick reminder or demonstration of where to find the resources.
So here is a snapshot of the home page of the GWAAR website. Looking at the toolbar at the top right, you will want to hover over Technical Assistance.

28. When the drop down menu displays, you can scroll down and click on Medicare Outreach and Assistance Resources.

29. When the page opens up you can see the menu of options.
Under New Pages, you will see a link to the Articles page. ON that page you will be able to select from several topics to see all the related articles.
Under Resources, you’ll find Additional Links.
And you can scroll down to Preventive Services. This is where you will find the Preventive Services Chart, the Placemats, etc.

30. Additional Links from GWAAR Website
Medicare Website:
Use this site to access coverage details regarding preventive services and other info.
CMS Preventive Services Materials
CMS Guide to Medicare Preventive Services
CMS Preventive Services Handout—Staying Healthy
Wisconsin Institute for Healthy Aging (WIHA)
Lists the Health Promotion Workshops being held in your county.
– Some of the links related to prevention and wellness-- that you’ll find when you click on Additional Links are;
Medicare website:
CMS materials on Medicare’s preventive services;
You can also find the Evidence Based Health Promotion Programs/the WIHA website – where you can search for all workshops being offered in your county.

31. Questions
So I hope this information has been helpful in terms of initiating a partnership with Health Promotion Programs. (Or good reminder and review for those who may already have a partnership with their HP coordinator. At this time we are happy to take any questions you may have. Remember, you can press *6 to un-mute your phone lines.

32. Contacts debbie.bisswurm@gwaar.org 608-228-0898
Anne Hvizdak, DHS
Thank you for joining us today. Again, we hope this training has been helpful to you.
Please fee free to contact Anne or me anytime.