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