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Improving Care and Controlling Health Costs for Dual Eligibles

Improving Care and Controlling Health Costs for Dual Eligibles. Timothy Schwab, MD, FACP Chief Medical Officer May 1, 2012. SCAN Health Plan. SCAN Overview SCAN Metrics & Relation to Other D-SNPs SCAN’s Model Value to Beneficiaries, Medicaid, & Medicare Dual Integration Pilot Relationship.

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Improving Care and Controlling Health Costs for Dual Eligibles

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  1. Improving Care and Controlling Health Costs for Dual Eligibles Timothy Schwab, MD, FACP Chief Medical Officer May 1, 2012

  2. SCAN Health Plan • SCAN Overview • SCAN Metrics & Relation to Other D-SNPs • SCAN’s Model Value to Beneficiaries, Medicaid, & Medicare • Dual Integration Pilot Relationship

  3. SCAN Health Plan • Founded in 1977 by senior citizen activists frustrated by lack of access to appropriate services • Model of Care emphasizes prevention, early intervention, and providing right care at right time • State Social Case Management Waiver Programs • Two decades in CMS’ Social HMO Demo • Has successfully delayed or prevented 100,000 nursing home admissions in California

  4. Current Operations • Nation’s 4th largest not-for-profit MA plan • Manager of California’s largest MSSP site since 1980 • More than 8,000California dual eligibles in D-SNPs, I-SNP, and other MA-PD plans • Currently a 4-star quality plan in California

  5. SCAN’s Dual Eligible Metrics • Duals with NFLOC average 3-4 chronic conditions and more than 4 prescriptions • Less than 2% of NFLOC membership are enrolled in LTC institutions • More than 96% of SCAN members with six or more chronic conditions currently live at home • USC found a 26% greater likelihood of discharge from SNF to home through SCAN HCBS (avoiding conversion of short term to long term stay) • NFLOC members average less than 12% acute hospital readmission rate • HEDIS scores for most duals = 75th - >90th percentile

  6. Avalere Health Study • 5,500 SCAN duals and an equivalent number of duals enrolled in FFS Medicare in California • Risk profiles were matched to ensure accurate comparison • Examined hospitalizations and HEDIS 30-day all-cause readmissions rates • SCAN performed 25 percent better on hospital readmissions, and 14 percent better on initial admissions • SCAN had lower rates for all 12 measures comprising the PQI composite • $50 million in potential annual savings to California FFS

  7. Avalere Health Study: Hospitalization Rate

  8. Avalere Health Study: Risk-Adjusted Readmission Rate

  9. Avalere Health Study: Risk-Adjusted Readmission Rate

  10. Dual Integration Pilots • D-SNPs will subcontract with pilot plans 2013 • D-SNPs end 2014 • Pilot plans required to be Medi-Cal managed care plans

  11. Summary • Integrated models currently exist in select programs • Specific model of care can provide high quality care and save money • D-SNP is a current model that can play a large part in the integration effort

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