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Model of Care

2018 Progress Toward Goals for Special Needs Plans

Review results of the annual SNP MOC

The Centers for Medicare & Medicaid Services (CMS) requires Special Needs Plans (SNPs) to conduct a quality improvement program that measures the effectiveness of the Model of Care (MOC). Evaluation of the SNP MOC occurs each year through the collection, analysis and reporting of metrics from key health care domains, such as health outcomes, coordination of care and access to care.

MOC Goals:

Assure Access to Medical, Mental Health, & Social Services

Provide Access to Affordable Care

Improve Coordination of Care through an Identified Point of Contact

Assure Seamless Transitions of Care across Healthcare Settings, Providers & Health Services

Improve Access and Utilization of Preventive Services

Improve Appropriate Utilization of Services for Chronic Conditions

Improve Experiences of Care

Actions taken in 2018 for SNP goals not met

  • Enhance provider outreach in our day-to-day interactions with providers. and direct providers to the online resources such as the list of UM criteria and practice guidelines
  • Distributed reward cards to Medicare enrollees when they completed select preventive screenings including annual wellness visit (AWV)/preventive health exams/services, HRAs, flu shots, etc.
  • Provider Incentive: Implemented Provider Incentive Program (Q4-2018) and Clinical Care Incentive Program (CCIP) (2019) which rewards providers who close outstanding care gaps/meet metrics including conducting annual wellness visit (AWV), preventive exams/services, etc.
  • The Transitions of Care (TOC) program assists enrollees with post-hospitalization needs including: follow-up with PCP, reconciling medications post-hospitalization, assisting enrollees with getting medications and necessary follow-up needed as well as providing community resources.
  • Care coordination provided by Trillium in collaboration with Trillium Behavioral Health to better access and align enrollees with the right care.

2018 SNP Goals

Data Source

Goal Met/Not Met

Adults' Access to Preventive/ Ambulatory Health Services

HEDIS

NO

SNP Care Management

Part C Reporting

NO

HEDIS  Plan All-Cause Readmissions

HEDIS

YES

HEDIS Medication Reconciliation Post Discharge*

HEDIS

NO

HEDIS Breast Cancer Screening

HEDIS

YES

HEDIS Colorectal Cancer Screening

HEDIS

NO

HEDIS Hospitalization for Potentially Preventable Complications

HEDIS

NO

CAHPS Getting Needed Care

CAHPS

NO

CAHPS Getting Care Quickly

CAHPS

YES

CAHPS Care Coordination

CAHPS

NO

CAHPS Annual Flu Vaccine

CAHPS

NO

Health Outcome Survey (HOS) Improving or Maintaining Mental Health

HOS

NO

Health Outcomes Survey Improving or Maintaining Physical Health

HOS

NO

*Target goal updated from 42% for MY2017 to 55% for MY2018 based on established 4 Star cut point