Once patients are noncompliant for the following measures, they cannot be made compliant for the rest of the year:

1. Concurrent Use of Opioids and Benzodiazepines (COB)
2. Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH)

Preventive health checklist to identify gaps

In our ongoing commitment to improving health outcomes, we’re sending all our members a checklist of generally recommended care to help them take actionable steps to address preventive care needs in early 2026.

We encourage members to share these checklists with their primary care providers to determine the services right for them.

CMS requires annual model of care (MOC) training for all health care providers who treat patients enrolled in a Medicare Advantage special needs plan (SNP). The training is reviewed and updated annually to reflect current practices related to care coordination. This includes communicating with your SNP patients about their Individualized Care Plan—a required component of the MOC.

Annual wellness visits (AWVs) are an important opportunity to provide excellent patient experiences. They offer a way for your patients to connect with you, ask questions and receive personalized guidance from you. That’s why we encourage our plan members to have this visit.

As a reminder, all Peoples Health plans offer a supplemental telehealth benefit for 2025, covering services beyond Original Medicare coverage. Peoples Health members pay $0 for supplemental telehealth visits, which include urgent, primary and specialist care, as well as visits for outpatient mental health and substance use disorder.

Annual wellness visits (AWVs) are an important opportunity to provide excellent patient experiences. They offer a way for your patients to connect with you, ask questions and receive personalized guidance from you. That’s why we encourage our plan members to have this visit.

Cultural competency can play a critical role in improving patient care. Gaining an understanding of factors such as ethnicity, social structure, language, values and faith can lead to more accurate diagnoses, personalized treatment plans and improved patient outcomes.

People ages 65 and older—such as the majority of your Peoples Health patients—are at higher risk of developing complications from the flu. And for those with chronic conditions, such as diabetes, heart disease and respiratory illnesses, the risk is even higher.

Be assured that Peoples Health makes decisions about coverage for health care services as such:

• Utilization management decision-making is based only on medical necessity, appropriateness of care and services, and existence of coverage.
• Peoples Health does not reward practitioners or other individuals for issuing denials of coverage.
• Financial incentives for utilization management decision-makers do not encourage decisions that result in underutilization.

Cultural education for health care professionals is an important component of improving the delivery of care to diverse patient populations.

Resources are available to help address racial and ethnic disparities in health care. These include provider materials from various agencies, such as the U.S. Department of Health and Human Services Office of Minority Health, which offers cultural competency education modules.