SCAN Health PlanModel of Care:

Better Practices

Presented by

Sarah Bellefleur, MSW, MHA

Background

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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

SCAN SNPs

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C-SNP Heart 3,700

C-SNP Diabetes 11,300

C-SNP ESRD 800

D-SNP 7,800

D-SNP (FIDE) 2,200

I-SNP 4,600

SNP Membership

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What Do SCAN Special Needs Plans Provide?

HEALTHIER SENIORS

Preventive care

Fitness benefits

Wellness

communications

Care Navigators

Population Health &

Monitoring

“Be there when I need you”

CHRONICALLY ILL

Transportation

Low (no) cost meds

Affordable Dr. visits

Complex Care

Management/ Disease

Management

Care Navigators

“Help me stay healthy and navigate the

system”

FRAIL or END OF LIFE

In-home services to

assist with ADLs (FIDE

SNP only)

Care manager

Caregiver referrals

Advanced Illness

Management

“Help me stay at home”

A variety of benefits/services depending on where members are in the continuum of aging

Better Practices- Program Restructure

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Reorganized

Assess Smarter Manage Better

Added Staff &

Programs

Care Management Programs

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AIM

Complex Care Management

Disease Management

Care Coordination

Population Health Management

Programs

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AIM: Palliative Care

Complex Care Management

Disease Management

Care Coordination

Population Health Management

Members with end-of-life care needs

Members at high-risk for poor health outcomes and hospitalizations

Members with CHF or COPD

Members requiring health outreach efforts based on continuous data mining, predictive modeling algorithms and risk stratification

Members needing assistance with access, services, or transitions

Better Practices- Staffing

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PAL Unit • Dedicated Bi-lingual

customer service • Specialize in Medicaid

benefits/eligibility• Welcome calls

Care Navigators (new 2013) • Educational Calls• Care Coordination

Better Practices- HRA

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MAIL IVR CALLS IN-PERSON

Better Practices- Care Transitions

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Home visits for some high utilizers or members hard-of-

hearing

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

Care Transitions coaches struggling with complex

End of Life issues

Telephonic Model

More comprehensive probing and medication reconciliation

Referrals to Advanced Illness Management Program

Care Transitions Pilot

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• 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%)

Better Practices- Behavioral Health

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IMPACTImproving 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

Better Practices- Information Sharing

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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

Questions?

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