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SCAN Health Plan Model of Care: Better Practices

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Presentation on theme: "SCAN Health Plan Model of Care: Better Practices"— Presentation transcript:

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

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


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


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?

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