Medicaid and Medicare beneficiaries often need a place to turn to navigate the complexities of health insurance regulations, coverage guidance and medical provider information. These eligible individuals have the unique ability to access additional care management and support services through health maintenance organizations (HMOs).
Kalos Health, a regional nonprofit health insurance company, is commemorating its fifth anniversary of managing care and improving the quality of life for Western New Yorkers with chronic health conditions and special needs.
Founded in 2014, Kalos (Greek for “noble” or “good”) coordinates health care services through a vast network of medical providers designed to meet the medical needs of the diverse populations it serves. The organization began its journey as a Managed Long-Term Care (MLTC) plan for Medicaid recipients who are disabled or have chronic health conditions and wish to stay in their homes. It expanded its scope in 2018 to include an HMO-Special Needs Plan (SNP), called Kalos Health Gold Plus (HMO-SNP), for members with dual advantage benefits through Medicare and Medicaid.
Through these two health insurance plans, Kalos Health educates and empowers members across a variety of communities to maintain a healthy lifestyle that supports their personal goals. Cross-functional staff guide members through the enrollment process and coverage options while ensuring they have access to quality care from providers, specialists and preventive services when and where they need it.
“Our focus is always on improving the quality of life for our members as they are challenged by a variety of health conditions and symptoms that need managing and extra support,” said Kathleen Velasquez, Vice President & Executive Director of Kalos Health. “The ultimate goal is to preserve the independence of our members and support them as they remain in their homes and communities for as long as possible. We are dedicated to delivering thorough, personalized care and counsel for each member’s unique circumstances, and we are proud of our trusted network of medical providers that collaborate with us to elevate the wellness and peace of mind for Western New Yorkers of all ages.”
The Kalos Health Gold Plus (HMO-SNP) plan was created to aid dual advantage recipients in maximizing their benefits and receiving more personalized care. Members must be 21 years of age and older, live in Erie, Niagara, Orleans or Cattaraugus county, have Medicare Part A and Part B and full New York State Medicaid benefits. Kalos Health works with each member to create a personalized care plan to remain healthy and active and reduce unnecessary hospitalizations. The plan has no monthly premium and features free preventive care while providing everything that Medicare and Medicaid cover. It also offers prescription drug coverage and a $75 monthly over-the-counter benefit card.
The Gold Plus care plan includes the member’s chosen team of doctors and provides a licensed Medicare advisor, master social worker, licensed practical nurse for care coordination, registered nurse for case management and a nurse practitioner for members in nursing homes. This multi-disciplinary team fulfills enrollment, assists in coordinating appointments and transportation and helps manage symptoms and conditions.
“We are dedicated to the members we serve not only as health care providers but also as residents ourselves of the communities where our members reside. Our staff understands the unique challenges and health needs of the Western New York population and are better able to assist members in coordinating their care plan through our large network of participating providers,” said Jessica Dolansky, Director of Clinical Operations. “We take pride in getting to know our members and what matters most to them. This approach helps ensure we provide the highest level of personalized care while remaining committed to members’ achievement of overall wellness goals.”
The MLTC plan provides experienced registered nurse care managers that develop a comprehensive team of professionals to provide access to care 24 hours a day, seven days a week. Plan members must be 18 years and older, live in Erie, Niagara, Monroe, Chautauqua, Genesee or Orleans county, be covered by or eligible for Medicaid, able to live safely at home with assistance for daily living activities and require home- and community-based services in excess of 120 days a year for nursing care, therapies and related personal assistant services.
“I liked that they are independent and not a conglomerate and they provide better personal service. They keep in touch with me every month. I always hear from them, and that’s very important to me. They go above and beyond what other insurance companies do. They check in to see if you need other services and never wait for you to call with needs,” said Laura Dubois, a charter member of the Kalos Health MLTC plan since July 2014. “I would tell people they would be very happy with Kalos Health, they treat you like a person and not a number.”
This fall, the organization plans to launch its “Kalos Kares” community service program for managers and employees who will volunteer for a variety of tasks in the communities where plan members live. The organization would like to partner with schools and businesses to complete improvement projects in neighborhoods seeking assistance. Companies and schools interested in collaborating with Kalos Health on community service initiatives are encouraged to call 716-304-6483.
“We are looking forward to pursuing a variety of different community projects that will support where our members live, and we welcome other organizations to contact us to develop a plan for identifying pressing needs and organizing volunteers,” said Velasquez.
As it continues to grow to serve more Western New Yorkers, Kalos Health remains committed to high-quality care and health management services for all of its members. The organization continues to expand its network to meet the growing medical needs of diverse populations. The staff’s sole mission is to improve members’ quality of life by enabling them to remain active and receive the best health care options available.
“We really take the successes and setbacks of our members to heart. We continually monitor and act on process and outcome data to ensure that the integrated care system is supporting each member’s best health status,” said Eric Adamski, Director of Quality Healthcare Management. “It’s a massive effort, but we gladly embrace it as part of our caring culture.”
For eligibility and enrollment information, Kalos Health member services is available at 1-800-399-1954 9 (TTY: 711) from 8 a.m. to 8 p.m. Monday through Friday. From October 1 through March 31, member services is available seven days a week at the toll-free number. For more information, visit KalosHealth.org.
Kalos Health Gold Plus (HMO SNP) is a Special Needs Plan (SNP) with a Medicare contract and coordination of benefits agreement with the New York State Department of Health. Enrollment in Kalos Health Gold Plus depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments and restrictions may apply. Benefit, premium and/or co-payment/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.