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Centene Corporation Special Needs Plans (SNPs). Overview Overview of the Centene D-SNPs Evolution of Care Transitions Oversight.

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Presentation on theme: "Centene Corporation Special Needs Plans (SNPs). Overview Overview of the Centene D-SNPs Evolution of Care Transitions Oversight."— Presentation transcript:

1 Centene Corporation Special Needs Plans (SNPs)

2 Overview Overview of the Centene D-SNPs Evolution of Care Transitions Oversight

3 Advantage by Bridgeway Health Solutions (AZ) Advantage by Buckeye Community Health Plan (OH) Advantage by Managed Health Services (WI) Advantage by Peach State Health Plan (GA) Advantage by Superior HealthPlan (TX) Advantage by Sunshine State Health Plan (FL) Contract arrangements vary by state: AZ, WI, & TX enrollees may have Medicare and Medicaid with the Centene health plan, or Medicaid coverage through another health plan. OH, GA, & FL enrollees have FFS Medicaid. Dual-eligible SNPs only

4 Care Transitions Centene initially developed a P&P to meet SNP 4. An audit tool was created to monitor care transitions metrics, based on the SNP 4 factors only.

5 Care Transitions As more audits were conducted, it was evident the audit tool needed to be enhanced. The tool identified if a factor was met/not met, but not why.

6 Original Audit Tool Name:Member ID: Audit Date:Case Open Date: Date Reviewed with Case Manager:Case Close Date: IndicatorMetDate MetNot MetN/A 16 Applicable to cases where the member is eligible for Medicare SNP: For planned transitions, there is documentation the care plan is shared from the member’s usual care setting to the hospital or from the hospital to the next care setting. 17 Applicable to cases where the member is eligible for Medicare SNP: For unplanned transitions, there is documentation the care plan is shared from the member's usual care setting to the hospital or from the hospital to the next care setting. 18 Applicable to cases where the member is eligible for Medicare SNP: For planned and unplanned transitions, there is documenation of communication with the member ore responsible party about the care transition process. 19 Applicable to cases where the member is eligible for Medicare SNP: For planned and unplanned transitions, there is documenation of communication with the member or responsible party about changes to the member's health status and plan of care. 20 Applicable to cases where the member is eligible for Medicare SNP: For planned and unplanned transitions, there is documentation the member's usual practitioner was notified of the transition.

7 Care Transitions To identify the activities/tasks that needed to be captured on the audit tool, we mapped out the process.

8 Care Transitions Five work flows were developed: Planned Transition from Member's Usual Setting of Care to IP Facility Planned Transition from IP Facility to Next Setting of Care Unplanned Transition from Member's Usual Setting of Care to IP Facility Unplanned Transition from IP Facility to Next Setting of Care All Other Planned and Unplanned Transitions from Any Care Setting to Another Setting

9 Process Mapping Example Process Mapping Example Planned Transition from Member’s Usual Setting of Care to IP Facility

10 Care Transitions Improved audit tool captures additional part of the process: CM request for the sending setting to share the care plan with the receiving setting. CM follow up to confirm whether the care plan was actually received by the receiving setting. A second attempt for the care plan to be sent.

11 Revised Audit Tool

12 Care Transitions Enhanced audit tool provides the following capabilities: Perform more detailed analysis Identify specific barriers and opportunities such as staff or provider training Promote consistent standardized documentation

13 Care Transitions - Next Steps Simplify audit tool to streamline audits. Revise templates for clearer documentation. Enhance staff training to include practice scenarios and IRR testing. Develop additional provider educational materials. Outreach to providers identified as least compliant with meeting the SNP 4 requirements.

14 Questions?


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