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SCAN Health Plan Model of Care: Better Practices

SCAN Health Plan Model of Care: Better Practices . Presented by Sarah Bellefleur, MSW, MHA. Background . SCAN HEALTH PLAN S erving people on Medicare and Medicaid for over 35 years Started by seniors O riginal SHMO demonstration project

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SCAN Health Plan Model of Care: Better Practices

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  1. SCAN Health PlanModel 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

  5. Better Practices- Program Restructure

  6. Care Management Programs

  7. 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

  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 TelephonicModel 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

  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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