21-836 Learn How We Performed on Our 2020 Special Needs Plans Model of Care
Date: 12/21/21
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 on page 2). Goals are updated or revised based on what we find from the yearly evaluation.
Actions taken in 2020 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.
Measurable goals for each SNP
2020 SNP goals | Amber I | Amber II | Amber II Premier | Jade |
|---|---|---|---|---|
Goal met | Goal met | Goal met | Goal met | |
Increase rate of members reporting that they were able to get appointments when needed | Yes | Yes | Yes | Yes |
Increase rate of members who had an ambulatory or preventive care visit, or by 0.5% | No | Yes | No | No |
Increase rate of members reporting that they were able to get the information they needed to meet health care needs by 2% | No | No | No | No |
Increase rate of members reporting that they received assistance with getting doctor visits or services by 2% | Yes | Yes | Yes | Yes |
Improve overall completion of care plans for delegated members by 2% | Yes | Yes | Yes | Yes |
Improve overall completion of health risk assessment (HRA) by 3% | No | No | No | No |
Improve rate of members reporting that they had information needed to manage their care at home after a transition by 1% | No | No | No | No |
Improve completion of medication reconciliation within 30 days of discharge from a hospital by 2% | No | No | NR | Yes |
Increase rate of members reporting that they had received a flu vaccine by 1% | No | Yes | Yes | No |
Increase rate of members reporting that they received their colorectal cancer screening by 1% | Yes | No | Yes | No |
Increase rate of diabetic members who completed an annual retinal eye exam by 1% | No | No | No | No |
Decrease rate of members experiencing a readmission within 30 days of a hospital discharge by 0.5% | Yes | Yes | NR | Yes |
Increase rate of members engaging in alcohol and other drug abuse or dependence treatment by 0.5% | No | Yes | NR | No |
Increase rate of medication compliance (effective continuation phase treatment) for members with a diagnosis of major depression and newly treated with antidepressant medication by 1%. | No | Yes | NR | No |
Increase rate of members who have high blood pressure who have it under control by 1% | No | No | Yes | Yes |
Percentage of goals met | 33% | 53% | 55% | 40% |
NR – Not reportable
Additional Information
Medicare (individual & employer group) (Wellcare By Health Net)
800-929-9224