Despite astounding advances in medical technology from diagnosis to treatment, there is still no substitute for frequent, hands-on, personal care. This philosophy of person-centered and compassionate care is central to the Fidelis approach to clinical care. Our Medicare Advantage Special Needs Plans are specifically designed to cover the complete health needs of qualified seniors living in nursing homes and assisted living communities… individuals who require more specialized healthcare than original Medicare provides. Our plans combine specialized clinical services with a package of supplemental health benefits tailored to our Members’ special health requirements.
Specialized Clinical Services
Health Plan Benefits
- Increased clinical visits in the Member’s home
- Dedicated clinical care team with extensive experience in geriatrics
- Ongoing monitoring and assessment
- Early symptom identification and treatment to help prevent emergencies
- Medication monitoring and profile review
- Central coordination via a dedicated Care Manager to ensure treatment plan compliance and communication among all providers and family members
- Psychosocial support services and activities for Members and their families
- Part D Prescription Drug Coverage included with $0 annual deductible and copays as low as $5.00.
- Maximum $500 annual out-of-pocket limit on Medicare-approved services
- $0 deductible plans available with $0 copays for most services
- Preventive care and screenings, plus annual physical exam
- Vision, dental and hearing services
- Scheduling and paid transportation to off-site medical appointments
- 24/7 care management hotline
- Waiver of Medicare’s three-day hospital stay requirement for skilled care
- Health and wellness programs
As with all health plans, limitations, restrictions and exclusions may apply. See plans for details.
Fidelis is much more than a health insurance company.
We are, in essence, an innovative payor that delivers individualized care. Due to our on-site monitoring and assessment regimen, we become a reassuring constant in our Members lives, the eyes and ears of their families, and a compassionate and proactive advocate of their physicians treatment plans. We believe that the quality of life of our Members can be significantly enhanced, and their rate of decline measurably reduced, through the comprehensive management of their medical care.
The Fidelis Care Team
Central to the Fidelis approach is our integrated, multi-disciplinary team of physicians, specialists, physician assistants, nurse practitioners, residence staff, pharmacists and the Fidelis Care Managers. Each professional has extensive knowledge and experience in the care of elders with complex chronic conditions. All share our commitment to providing consistent, personally attentive, holistic care.
The role of the Fidelis Care Manager is to act as the physicians eyes and ears in-between primary care team visits. Each Manager is a geriatric-trained registered nurse (RN) or nurse practitioner (NP). They monitor the entire care process, coordinating all aspects of each Members clinical care, whether that care is delivered at home or in the hospital. Care Managers continually check for any changes in condition and work to maximize treatment plan compliance. When condition changes are detected, prompt intervention can occur, preventing emergencies and unnecessary hospitalization.
The on-site Care Team monitors and assesses Members’ health…
- Weekly for Members receiving
• "Heightened Awareness” monitoring (chronic but acute problems)
• Skilled nursing or therapy monitoring
• Palliative care monitoring
- Bi-Monthly for Members who are
• Chronic but stable
- Monthly for Hospice Members
Care Treatment Plan Assessment and Support
Upon enrollment, the Fidelis Care Team conducts a comprehensive health assessment, reviewing the current care plan or service plan in place as well as the established goals of care. Together, they identify how the expanded Care Team can best support the Member’s treatment plan and improve upon the care process. Over time, as the Care Team works together with family and residence staff, the plan can be amended to reflect the Member’s changing needs. During all phases of a Member’s care, frequent, clear communication among all parties is paramount and includes:
- An initial conference to discuss goals of care and recommendations
- Daily conferencing of all Care Team clinical practitioners to review at-risk and hospitalized Members
- Contact with family members if there’s any change in condition or when the care treatment plan changes
- Routine monthly updates for all team and appropriate family members
24/7 Care Manager Hotline
We understand that caring for a loved one involves more than just doctor or nursing care. That’s why our comprehensive program includes a 24-hour hotline for:
- Instant access for the Member’s family and staff
- Prompt arrangements for necessary medical appointments
- Immediate transportation needs or other ancillary services
Fidelis Part D Prescription Drug Coverage
All Fidelis SecureCare plans include comprehensive Medicare Part D Prescription Drug
coverage. Our formulary includes the prescription drugs most commonly used by our special needs population and is updated on a regular basis by medical and pharmacy professionals. To learn more about the details, click on Pharmacy and select your state plan.
Comprehensive Medication Management
Medication monitoring and management is a critical component of the Fidelis Care Model. Advancements in prescription medications have significantly improved the lives of people with chronic conditions. But if drugs are not properly managed, they can cause new problems even as they solve existing ones. Polypharmacy is the use of multiple drugs to treat chronic conditions. National data has confirmed that polypharmacy is common among elderly individuals in the long term care setting—and it can be harmful.*
On average, long term care community residents have more than nine prescription medications, making drug interactions a virtual certainty, often leading to functional, cognitive and physical impairments. That’s why, during our initial assessment, Fidelis Team Pharmacists review each Member’s medication profile, assessing for appropriateness, accurate dosing, drug interactions, side effects and duplication. Our experienced pharmacists apply evidence-based clinical guidelines developed specifically for the senior population and work with the Member’s primary care physician to adjust the pharmaceutical care plan when and as necessary.
End-of life care and planning
The end-of-life process is often difficult for the Member and painful for family and loved ones. Hospice services can provide added benefits and support for all during this time of great emotional need. Fidelis is dedicated to ensuring that hospice services are available for those Members who choose to avail themselves of its benefits. Of course, the Primary Care Team will continue to provide direct primary care regardless of the Member’s hospice election.
Fidelis Care Managers are well trained in dealing with the complexities of end-of-life planning, including handling issues of cultural sensitivity. Families and caregivers who would like to know more about the important benefits of hospice and other difficult and sensitive end-of-life issues such as Advance Directives should speak with their Fidelis Care Manager at any time. You’ll also find links to valuable resources in the Caregivers section of our website.
The next generation of long term care
At Fidelis, changing lives for the better is our reason for being. Improving the way long term care is delivered is our mission. From initial care treatment plan to end of life, we work to support the dignity of our frail and elderly Members, improving their quality of life by delivering a level of care that is clinically superior, compassionate and attentive to their individual and total needs. Working together with our support team and network of outstanding healthcare professionals, we are bringing a new culture of caring into the lives of our enrollees and their families. Fidelis SecureCare is, truly, the next generation of long term care.
If you would like to read more about how Fidelis SecureCare works in the nursing home environment or in assisted living communities, download our brochures here:
Fidelis SecureCare for nursing home residents
Fidelis SecureCare for assisted living community residents