Presentation is loading. Please wait.

Presentation is loading. Please wait.

Presented by Sarah Bellefleur, MSW, MHA. 2 SCAN HEALTH PLAN Serving people on Medicare and Medicaid for over 35 years Started by seniors Original SHMO.

Similar presentations


Presentation on theme: "Presented by Sarah Bellefleur, MSW, MHA. 2 SCAN HEALTH PLAN Serving people on Medicare and Medicaid for over 35 years Started by seniors Original SHMO."— Presentation transcript:

1 Presented by Sarah Bellefleur, MSW, MHA

2 2 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 3

4 4 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” A variety of benefits/services depending on where members are in the continuum of aging

5 5 Reorganized Assess Smarter Manage Better Added Staff & Programs

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

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

8 8 PAL Unit Dedicated Bi-lingual customer service Specialize in Medicaid benefits/eligibility Welcome calls PAL Unit Dedicated Bi-lingual customer service Specialize in Medicaid benefits/eligibility Welcome calls Care Navigators (new 2013) Educational Calls Care Coordination Care Navigators (new 2013) Educational Calls Care Coordination

9 9 MAIL IVRCALLSIN-PERSON

10 10 Home visits for some high utilizers or members hard-of- hearing 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 Care Transitions coaches struggling with complex End of Life issues Telephonic Model More comprehensive probing and medication reconciliation Referrals to Advanced Illness Management Program

11 11 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 12 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

13 13 No standard platform for sharing information with providers SFTP SITE (Secure File Transfer Protocol) SNP Membership ReportsSNP Membership Reports Care Mgmt Trigger ReportsCare Mgmt Trigger Reports Copies of HRA’s & Care PlansCopies of HRA’s & Care Plans

14 14


Download ppt "Presented by Sarah Bellefleur, MSW, MHA. 2 SCAN HEALTH PLAN Serving people on Medicare and Medicaid for over 35 years Started by seniors Original SHMO."

Similar presentations


Ads by Google