For Payers

Model of care for SNPs

Use outsourcing to address the unique needs of each beneficiary while improving compliance, quality, and care/loss ratios for special needs plans (SNPs).

Impact the lives of those who need help the most.

With a focus on delivering an intervention model proven to have the maximum impact on the lives that need the most help, we improve your D-SNP and C-SNP members’ experience, helps your organization achieve compliance, and saves on medical and administrative costs.

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What makes us different

  • Identify more than 100 conditions in members with high risk.
  • Focus resources on people with the greatest impactability.
  • Determine the right interventions for each member.
  • Clinically designed programs are configured specifically with clinical content and business rules.
  • Leverage our multidisciplinary team to best engage with SNP members.

Achieve and maintain compliance.

  • Member outreach and contact sourcing processes that exceed CMS’s requirements
    • Engaging the PCP and any other providers who may have accurate contact information
    • Utilizing community health workers to find members
    • Leveraging SMS to communicate with the population
  • Align the operating plan to the language of the MOC
    • Support for MOC revisions to ensure the MOC meets CMS/NCQA requirements and aligns with the care management process
  • Sophisticated analytics, comprehensive program monitoring and reporting, and expertise in MA care management enable compliance and Star lift
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Reduce medical expense while improving quality.

  • Identify and address the root causes of care gaps and compliance failure.
  • Reduce unnecessary utilization (inpatient admissions and readmissions, ER visits, long-term care placement).
  • Apply the appropriate scope of member intervention using analytics, disciplined operational execution, and clinical resources that bend the cost curve.

Improve your member experience.

  • Increase member engagement and participation through channel of choice care solutions (e.g., SMS, telehealth).
  • Enhance member experience and satisfaction through attention to both quality of life and quality of care.
  • Identify, track, and close care gaps for improved health outcomes.

Our model of care for SNP program components

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Initial health risk assessment (HRA) for every member within 90 days of enrollment

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Individualized care plan (ICP) developed and implemented for every member

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Ongoing communication among the interdisciplinary care team (ICT) to manage the ICP

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Coordination of transitions of care

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Reassessment HRAs (within one year of the previous HRA)

This solution is right for SNP health plans who are looking to be compliant, impact their medical care ratio/medical loss ratio, and drive member satisfaction.

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Our healthcare accreditations

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