Ally Rx D-SNP Model of Care Summary
Security Health Plan's Medicare Advantage product line includes its Ally Rx Dual-eligible Special Needs Plan (D-SNP). Hand in hand with the new plan is our new D-SNP Care Management program. This program coordinates care for members who have both managed Medicare (Medicare Advantage) and full-benefit fee-for-service Wisconsin Medicaid. The program focus is to ensure members have high-touch care coordination and are following the plan of care their providers have created for them.
Security Health Plan’s Care Management team and each D-SNP member’s primary care provider work together closely to establish an individualized plan of care that ensures the member’s success in the program. Each D-SNP member's Care Management team includes a registered nurse, a social worker and community support specialists who work one-on-one to provide personalized care, education, and guidance for the individual health care needs of the member. Overall the goal of the D-SNP program is to allow our members to have improved access to care, seamless transitions of care and improved member outcomes, as well as to ensure appropriate utilization of services.
The D-SNP program values are:
- Improving access to care (medical, mental health and social services)
- Improving access to affordable care
- Improving coordination of care through an identified point of contact
- Improving seamless transitions of care across healthcare settings, providers and health services
- Improving access to preventive health services
- Assuring appropriate utilization of services
- Improving member outcomes
The D-SNP program focus is:
- Monitoring health status of a targeted population
- Identifying their needs
- Improving access to quality healthcare services and benefits
- Managing chronic diseases
- Avoiding inappropriate hospitalizations and ER visits
- Decreasing the members’ medical, mental and social risks
All providers involved in the care of a Security Health Plan member need to have an understanding of our comprehensive care management model for the D-SNP program. This is also referred to as our Model of Care.
In line with regulatory requirements of the Centers for Medicare and Medicaid Services (CMS), Security Health Plan has developed a training program for its D-SNP Model of Care. The training consists of 22 PowerPoint slides plus a short test to ensure all care management employees and providers who work with our D-SNP members have the specialized training this unique population requires. Click here to access the Security Health Plan D-SNP Model of Care training.
The D-SNP Model of Care is comprised of four elements:
- Description of the overall special needs population – our members within the Dual-eligible Special Needs Plan are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid); offer specific opportunities for enhanced benefits by combining those available through Medicare and Medicaid
- Care Coordination – care coordination maximizes the use of effective, efficient, safe and high quality patient services that lead to improved healthcare outcomes
- Provider Network – all members’ primary care physicians will receive a copy/summary of the initial care plan with yearly notifications of applicable changes
- Quality Measurements and Performance Improvement – quality measures which include:
- Decreased ER visits and hospitalizations
- Provider access and availability
- Access to long term services, mental health and social supports
- Improved coordination of care through an identified point of contact
Upon enrollment in the D-SNP care management program, members are assessed for both medical and psychosocial needs, which will develop a stratification level and help in development of a care plan tailored to their specific needs. Physicians will be involved as needed with care transitions (hospitalizations, nursing home admissions, etc.), assessments and care planning.
To benefit the member we must all work together. Working together as a team will provide unlimited benefits to Security Health Plan D-SNP members, such as:
- Enhanced communication
- Comprehensive coordination of services
- Help to support the member’s preferences
- Provide an interdisciplinary approach
- Help reinforce the member’s connection with their D-SNP team