Ascension (SmartHealth) - General Information

Ascension is a Healthcare Information Technology Company. They are the leading nonprofit and Catholic Hospital System in the US.

Important Note: The client is Ascension, but during enrollment, members select Ascension SmartHealth, as SmartHealth is the member-facing name. 

Zendesk Org Tag: Ascension (SmartHealth)

Landing Page: https://www.vida.com/smarthealth

Programs & Devices Offered

• For full details on programs offered, please review this Vidapedia Card
• For full details on devices offered, please review Device Eligibility Google Doc

AOM Prescribing

Use Case 1 - Prior Authorization (PA)

• Enrollment in Vida’s WH program is required for GLP1 coverage for members with diabetes (not obesity).
• Technically, enrollment into ANY Vida program will trigger PA, but most members will be recommended WH Groups

Talk Track when explaining this requirement:

Smarthealth wants to optimize patient outcomes for those on the GLP-1 for diabetes. For this reason, they require Vida as part of their prior authorization process to support FDA labeling guidelines that nutrition and exercise be a companion to members taking GLP-1.

Note: Smarthealth has several (6-7) GLP-1 brands for diabetes covered in their plan. 3 of these brands (Ozempic, Mounjaro and Rybelsus) have this PA policy in place.

Your employer wants to ensure you get the best care companion to accompany your prescription. Smarthealth’s policy is to require members on GLP-1 to enroll in Vida to maintain their eligibility. As you do so, Vida will help you manage your condition, provide nutrition and exercise guidance, and ensure actions are taken to maintain your eligibility for GLP-1.

IMPORTANT NOTE: When enrolling a member, please ask if they are currently experiencing a PA rejection at the pharmacy. If so, Please note this in the ticket and tag your lead for tracking purposes. 

• Ascension covers GLP-1s for diabetes for ~4,000 members today. Coverage is not changing for these GLP-1s in 2024 except for Vida PA. Trulicity will not include Vida enrollment requirement.
  • Ascension members on Ozempic, Mounjaro, Rybelsus will require enrollment to Vida for coverage. 
    • Members with an active prescription before 1/1/24 will have until 3/31/24 to enroll in Vida. If they do not enroll in Vida before April, they will start receiving coverage rejections for these drugs.
    • Members who receive a new/initial script for these GLP1s anytime after 1/1/24 will require Vida enrollment immediately before they can receive coverage for these meds.
  • Members may lose GLP1 coverage for diabetes if they don’t enroll in WH, or another Vida program
    • Educate members on this requirement and offer enrollment assistance
    • Place members in WH group coaching by default. This should be recommended during enrollment, as program engagement will be low given most are just enrolling in order to have GLP-1 coverage.
       

If an enrolled member is currently having their prescription rejected by the pharmacy, we have a process in place to send the member an attestation form in the app to be shared with their prescriber. This provides the prescriber with attestation of the member’s enrollment in Vida so the prescriber can update this in the prior authorization form. Unfortunately, there is currently no automated process for Vida enrollment to be processed by the PBM, so this is a short term solution to help member’s get PA for these meds.

1. If Ascension members are getting a rejection at the pharmacy and need a Prior-Auth Attestation letter, please add the macro " Ascension Prior Authorization (PA) Attestation Letter Request," add the member's UUID, and post to the #urgent-prior-auth-mitigation channel via a Slack Side-Conversation. These should be actioned and filled within 48 hours by the prodops team. Remember that this is only for Ascension SmartHealth members and we do not currently send attestation letters for any other orgs.
2. Send the member the Ascension PA Attestation Document and Comms Sent macro response after the letter is requested.

See the Use Case 1 section here: https://support.vida.com/hc/en-us/articles/23889726866195-Anti-Obesity-Medication-AOM-Prescribing-and-Prior-Auth-Use-Cases 

Population Details

• 190,000 total eligible lives (spouses and dependents included)
  • 43,000 to target. Eligibles with at least one chronic condition or obesity/prediabetes

65% Female

Average age 42 years (18-98 years)

Members located in all 50 states

• 97% live in FL, TX, NY, MD, AL, TN, KS, MO, IL, IN, MI, WI

Additional Info

• What segment is this org in?
  • Employer
• Are there any Fees at risk (FAR)?
  • Yes
    • No support-specific SLAs to track and report
• When did we launch with this org?
  • 7/1/2023
• How is the service being paid for?
  • Vida is available at no cost to employees and their spouses/dependents
• How do members enroll?
  • Vida App, VSC outreach campaign
• Where should non-eligible members be directed?
  • Human Resource Center 844-847-4747, or go to MyHR and under myBenefits to view their elections
  • For Pharmacy Benefits information they can call Maxor+ using the number on the back of their insurance card
• Who is eligible?
  • All SmartHealth members and their spouses/dependents 18+ enrolled in the (Ascension) medical plan that have been diagnosed with a chronic condition (such as obesity, diabetes, pre-diabetes, high blood pressure, high cholesterol, etc.) are eligible for Vida Health Coaching.
  • 
• Is the org on the eligibility file?
  • YES
    • Key Identifiers: FN/LN, EMPLOYEE ID and DOB
• How often will terminations take place?
  • Monthly
• Do we offer Phone and/or Email support?
  • Phone and Email
• Is VSC outreach involved?
  • YES