20-1008 Learn How We Performed on Our 2019 Special Needs Plans Model of Care

Date: 12/10/20

This information applies to Physicians & Participating Physician Groups (PPGs).

Plan of action is in place to ensure appropriate services are delivered to our SNP members

Per the Centers for Medicare & Medicaid Services (CMS), yearly, we must assess our Special Needs Plans (SNP) Model of Care (MOC) and communicate the findings to our providers. The purpose is to conduct a quality improvement program that measures the effectiveness of the MOC and identifies areas for improvement.

How do we gather our findings?

Health Net offers these SNPs:

• Dual Eligible SNP – Amber I
• Dual Eligible SNP – Amber II
• Dual Eligible SNP – Amber II Premier
• Chronic SNP – Jade for diabetes, chronic heart failure and/or cardiovascular disorders

Evaluation of the SNP MOC is done by collecting, reporting, and analyzing metrics from key health care domains, such as health outcomes, coordination of care and access to care.

Measurable goals for each SNP are compared to the past year to established benchmarks (refer to the table below). Goals are updated or revised based on what we find from the yearly evaluation.

Actions taken in 2019 for SNP goals that were not met

A summary of actions performed to improve clinical outcomes, access to care and the member experience are as follows:

• Educated members on topics and available resources such as hypertension, preventive screenings, medication adherence, and the online myStrength tool to help members stay mentally and physically healthy.
• Leveraged partnerships with American Diabetes Association (ADA) and the American Heart Association (AHA) to inform, educate and empower members about their health and self-management of chronic condition(s).
• Continued implementation of a rewards program to encourage members to get suggested preventive screenings and chronic care.
• Created and carried out educational resources/trainings for Member Services agents so they are better able to address member questions.
• Conducted live calls to members with several gaps in care to help with appointment scheduling, promote the Annual Wellness Visit (AWV), allow opt-in for in home test kits/screenings, and address barriers to accessing care.
• Educated providers on best practices to decrease hospital readmissions, including improving care transitions and medication reconciliation post-discharge.

Increase rate of members reporting that they were able to get appointments when needed, or achieve 73%

Increase rate of members who had an ambulatory or preventive care visit, or achieve 95%

Increase rate of members reporting that they were able to get the information they needed to meet health care needs, or achieve 70%

Measurable goals for each SNP

2019 SNP goals	Amber I Goal met	Amber II Goal met	Amber II Premier Goal met	Jade Goal met
Increase rate of members reporting that they were able to get appointments when needed, or achieve 73%	Yes	Yes	Yes	Yes
Increase rate of members who had an ambulatory or preventive care visit, or achieve 95%	Yes	No	Yes	Yes
Increase rate of members reporting that they were able to get the information they needed to meet health care needs, or achieve 70%	No	No	No	No
Increase rate of members reporting that they received assistance with getting doctor visits or services, or achieve 70%	No	No	No	No
Improve overall completion of care plans for delegated members	Yes	Yes	Yes	Yes
Improve overall completion of health risk assessment (HRA), or achieve 71%	Yes	Yes	Yes	Yes
Improve rate of members reporting that they had information needed to manage their care at home after a transition, or achieve 85%	No	No	No	No
Improve completion of medication reconciliation within 30 days of discharge from a hospital, or achieve 57%	Yes	Yes	NR	No
Increase rate of members reporting that they had received a flu vaccine, or achieve 72%	Yes	Yes	Yes	Yes
Increase rate of members reporting that they received their colorectal cancer screening, or achieve 73%	Yes	No	No	Yes
Increase rate of diabetic members who completed an annual retinal eye exam, or achieve 75%	Yes	Yes	Yes	Yes
Decrease rate of members experiencing a readmission within 30 days of a hospital discharge, or achieve 8%	Yes	No	No	No
Increase rate of members engaging in alcohol and other drug abuse or dependence treatment, or achieve 4%	No	No	NR	Yes
Increase rate of medication compliance (effective continuation phase treatment) for members with a diagnosis of major depression and newly treated with antidepressant medication.	No	No	NR	Yes
Increase rate of members who have high blood pressure that have it under control, or achieve 69%	Yes	Yes	No	Yes
Percentage of goals met	67%	47%	50%	67%

NR – Not reportable

Additional information

Line of Business	Telephone Number	Provider Portal	Email Address
Medicare (individual)	1-800-929-9224	provider.healthnetcalifornia.com	provider_services@healthnet.com
Medicare (employer group)	1-800-929-9224	provider.healthnet.com	provider_services@healthnet.com