1. SCAN Health Plan Model of Care: Better Practices
Presented by
Sarah Bellefleur, MSW, MHA

2. Background SCAN HEALTH PLAN
Serving people on Medicare and Medicaid for over 35 years
Started by seniors
Original SHMO demonstration project
Non-Profit Mission: keep seniors healthy and independent
CA and AZ
160,000 Members
~20% SNP Membership

3. SCAN SNPs

4. What Do SCAN Special Needs Plans Provide?
A variety of benefits/services depending
on where members are in the continuum of aging
HEALTHIER SENIORS
Preventive care
Fitness benefits
Wellness communications
Care Navigators
Population Health & Monitoring
“Be there when I need you”
CHRONICALLY ILL
Transportation
Low (no) cost meds
Affordable Dr. visits
Complex Care Management/ Disease Management
Care Navigators
“Help me stay healthy and navigate the system”
FRAIL or END OF LIFE
In-home services to assist with ADLs (FIDE SNP only)
Care manager
Caregiver referrals
Advanced Illness Management
“Help me stay at home”

5. Better Practices- Program Restructure
Reorganized
Assess Smarter Manage Better
Added Staff & Programs

6. Care Management Programs
AIM
Complex Care Management
Disease Management
Care Coordination
Population Health Management

7. Complex Care Management
Programs
AIM: Palliative Care
Members with end-of-life care needs
Complex Care Management
Members at high-risk for poor health outcomes and hospitalizations
Disease Management
Members with CHF or COPD
Members needing assistance with access, services, or transitions
Care Coordination
Members requiring health outreach efforts based on continuous data mining, predictive modeling algorithms and risk stratification
Population Health Management

8. Better Practices- Staffing
PAL Unit
Dedicated Bi-lingual customer service
Specialize in Medicaid benefits/eligibility
Welcome calls
Care Navigators (new 2013)
Educational Calls
Care Coordination
Inbound and Outbound calls
Much higher call-times
~8 min vs 2-3min
0:16 speed to answer

9. Better Practices- HRA
MAIL
IVR
CALLS
IN-PERSON

10. Better Practices- Care Transitions
Home visits for some high utilizers or members hard-of-hearing
Telephonic Model
Empowered Members to make follow-up MD appointments
Conference call with MD office to make follow up appointment
Assessment asks if members understand meds & dc instructions
More comprehensive probing and medication reconciliation
Care Transitions coaches struggling with complex End of Life issues
Referrals to Advanced Illness Management Program

11. Care Transitions Pilot
3 month pilot HIPPA compliant Video Messaging Platform
Goal: improve engagement through more personalized interaction (reduce readmissions)
Send reminders for Medication & Appointments
Reinforcing education and tools
Barriers: technology & pt health status
Program offered: 235
Agreed to participate: 36 (15%)
# who viewed messages: 12 (33%)

12. Better Practices- Behavioral Health
IMPACT
Improving Mood -- Promoting Access to Collaborative Treatment
Evidence-Based Model for reducing depression and improving clinical outcomes
Trained, embedded Care Manager with PCPs
Collaboration with Psychiatrist
Identifying Provider Partners
Depression = 60% increased risk of developing type 2 diabetes
Members with diabetes are twice as likely to have depression

13. Better Practices- Information Sharing
No standard platform for sharing information with providers
SFTP SITE
(Secure File Transfer Protocol)
SNP Membership Reports
Care Mgmt Trigger Reports
Copies of HRA’s & Care Plans

14. Questions?