Blue Plus SecureBlue SNP-MOC Training for Providers and Clinical Staff

1. The Blue Plus SecureBlue Special Needs Plan Model of Care (SNP-MOC): Training for Providers and Clinical staff

2. SecureBlue Special Needs Plan (SNP) • A fully integrated Medicare (Parts A, B, and D) and Medicaid product which includes Elderly Waiver Home and Community Based Services • Also referred to as Minnesota Senior Health Option (MSHO) • Members must: • Be Medicare and Medicaid eligible (dual eligible) • Be 65+ years or older • Reside within service area approved by Minnesota Department of Health and Centers for Medicare & Medicaid Services

3. SecureBlue Special Needs Plan (SNP) Enrollment is voluntary Different ways to enroll: • Member’s county financial worker • Blue Plus Enrollment: 1-866-477-1584 • Senior Linkage Line: 1-800-333-2433

4. SecureBlue Special Needs Plan (SNP) • Frail and vulnerable • Average age of 82 • High need for social supports • 68% live in the community • 45% receive Elderly Waiver and Community Based Services • Poor socioeconomic status • 41% earn $10,000 per year or less • Low health literacy • 36% did not graduate high school • Complex medical needs • Cognitive and sensory impairments

5. The Model of Care (SNP-MOC) • Required of all Special Needs Plans (SNPs). • A document submitted to CMS at least every 3 years. • Describes staff, systems, procedures, and improvement activities. • The way Blue Plus operationalizes the SecureBlue plan. • Goal: To simplify access to healthcare and reduce fragmentation of care delivery for our members. • Focus: Coordinate access and delivery of all preventive, primary, specialty, acute, post-acute and long term care services among different health and social service professionals and across settings of care.

6. The Model of Care (SNP-MOC) • The SecureBlue population • Demographics, health conditions, co-morbidities, limitations and barriers, potential health disparities • Benefits and services • Staff roles and responsibilities across health plan functions • Delivery of care coordination • Provider network • Specialized expertise, participation in the Interdisciplinary Care Team, continuity of care • Measurable quality and performance improvement goals • The MOC describes in detail:

7. The Interdisciplinary Care Team (ICT) • At a minimum, the ICT includes: • Member and/or Authorized Rep • Care Coordinator • Primary Care Physician • Based on the member’s clinical and social needs, ICT may also include: • Specialists • Psychiatrist or other behavioral health clinician • Local or social service agency case managers • Blue Plus Health Coaches

8. Care Coordinator – Role & Responsibilities • Ensure communication between members of ICT. • Conduct Health Risk Assessment (HRA): • Identify member’s medical, functional, cognitive, psychosocial, and mental health needs. • Develop person-centered Collaborative Care Plan: • Address the needs identified in the HRA. • Connect members to resources, care, and services. • Support smooth care transitions between care settings. • Monitor and document progress toward health goals and changes in health status.

9. Provider – Role & Responsibilities • Work with the Care Coordinator to: • Develop, monitor, and update the member’s Care Plan. • Support the member reaching their health care goals. • Inform the Care Coordinator of: • Changes in the member’s heath care service needs and supports. • Planned or unplanned transitions of care. • Maintain effective and ongoing communication with other care providers. • Adhere to Blue Plus Policies & Procedures.

10. Helpful Resources • The Blue Plus Provider Manual (Chapter 3: Government Programs) • Provider Policy and Procedure Manual (Chapter 6: Blue Plus) www.bluecrossmn.com/healthy/public/personal/home/providers/forms-and-publications • Care Coordination Delegate Guidelines https://carecoordination.bluecrossmn.com/manuals-guides/secureblue-msho/

11. Support for the Model of Care (SNP-MOC) Contact your member’s Care Coordinator for technical assistance on topics such as care coordination procedure and policy clarification. To locate your patient’s Care Coordinator, contact Blue Plus’s Partner Relations Consultant team at Partner.Relations@bluecrossmn.com

12. Confirmation of Training Completion Thank you for completing the Blue Plus SecureBlue Model of Care Training! Please note that providers must document and maintain training completion records and provide such records to Blue Plus upon request. If you have questions, or require assistance, please email: medicare.compliance.training@bluecrossmn.com