23-1280 Measuring the Success of Putting Members First: Our 2022 Special Needs Plan Model of Care Performance
Date: 11/08/23
A plan of action is in place for goals not met to ensure appropriate services are delivered to our SNP members
The Centers for Medicare & Medicaid Services (CMS) states that 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 – Wellcare Dual Liberty
- Dual Eligible SNP – Wellcare Dual Liberty Amber
- Chronic SNP – Wellcare Specialty No Premium (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 2022 to meet SNP goals
A summary of actions performed to improve clinical outcomes, access to care and the member experience are as follows:
- Continued member education 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.
- Tailored messages to providers and members to meet the needs of members with chronic conditions at key points in therapy focusing on adherence and gaps in care.
- Continued implementation of a rewards program to encourage members to get suggested preventive screenings and chronic care.
- Deployed RxEffect to provider practices to help prioritize outreach to members most at risk for medication adherence.
- 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
2022 SNP goals | Wellcare Dual Liberty (HMO D-SNP) | Wellcare Dual Liberty Amber (HMO D-SNP) | Wellcare Specialty No Premium (HMO C-SNP) |
|---|---|---|---|
Goal met | Goal met | Goal met | |
Increase rate of members reporting that they were able to get appointments when needed; increase by 1% or achieve 77% | Yes | Yes | Yes |
Increase rate of members who had an ambulatory or preventive care visit; increase by 0.5% or achieve 94% | No | Yes | Yes |
Increase health plan customer service rate to provide information or help when needed; increase by 2% or achieve 90% | Yes | Yes | Yes |
Increase rate of members reporting that they received assistance with getting doctor visits or services; improve by 2% or achieve 81% | Yes | Yes | Yes |
Increase rate of members reporting that they received assistance from personal doctor’s office to manage care among different providers and services; improve by 1% or achieve 86% | Yes | Yes | Yes |
Improve overall completion of care plans for delegated members; achieve 100% | No | No | No |
Improve overall completion of health risk assessment (HRA); achieve 100% | No | No | No |
Improve rate of members reporting that they had information needed to manage their care at home after a transition; improve by 1% or achieve 85% | Yes | Yes | Yes |
Improve completion of medication reconciliation within 30 days of discharge from a hospital; improve by 2% or achieve 67% | Yes | NR | Yes |
Increase rate of members reporting that they had received a flu vaccine; increase by 1% or achieve 73% | Yes | No | Yes |
Increase rate of members reporting that they received their colorectal cancer screening; increase by 1% achieve 72% | Yes | No | No |
Increase rate of members engaging in alcohol and other drug abuse or dependence treatment; increase by 0.5% or achieve 5.1% | No | NR | No |
Decrease rate of members experiencing a readmission within 30 days of a hospital discharge by 0.5%% | No | NR | Yes |
Increase medication adherence rate for diabetic members; increase by 1% or achieve 86% | No | Yes | Yes |
Increase rate of diabetic members who have their blood sugar under control; increase by 1% or achieve 78% | Yes | Yes | Yes |
Increase rate of members who have high blood pressure who have it under control; increase by 1% or achieve 71% | No | Yes | Yes |
Percentage of goals met | 56% | 69% | 75% |
1 NR – Not reportable
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
This information applies to Physicians and Participating Physician Groups (PPGs).