(LONG BEACH, Calif. – Dec. 22, 2014) — The unique healthcare challenges posed by Medicare members on Special Needs Plans (SNP) was the focus of a presentation from SCAN Health Plan executives at the Healthcare Education Associates’ 5th Annual Star Ratings Master Class conference held recently in Carlsbad, Calif.
“Special Needs Plan members often have lower income, less support, and more complex medical conditions than other seniors of a similar age,” said SCAN Medical Director Raymond Chan, M.D. “This makes it incumbent upon plans that coordinate their care to look for new approaches to engage their members and overcome the social, psychological and administrative hurdles that come with serving this population.”
Established in 2003, Special Needs Plans are a type of Medicare Advantage plans that limit membership to people with specific diseases or characteristics and tailor their benefits, provider choices and drug formularies to best meet the specific needs of the groups they serve. Included in this are C-SNPs for people with chronic conditions, I-SNPs for members who live in an institution or require nursing care at home, and D-SNPs for those with both Medicare and Medicaid.
As pointed out by David Meyer, SCAN vice president of risk adjustment, who shared the podium with Dr. Chan, the complex needs of these members coupled with often inadequate risk-adjustment strategies frequently skews a health plans’ overall quality standing as it pertains to the Five Star Quality Rating System established by the Centers for Medicare & Medicaid (CMS). Plans are graded on a one- to five-star rating based on more than 40 quality metrics including clinical outcomes, access to preventive services (such as screenings and vaccines), managing chronic conditions, preventive care and consumer satisfaction. CMS reimburses plans based on the quality of care provided to their members – the higher the star rating, the more dollars plans receive from the government.
“New models of care, enhanced member-engagement strategies and personal case management programs must all be put in place if we are to see the quality outcomes for SNP members that we all desire,” said Dr. Chan. “This includes improved coordination of care, better transition of care across the care continuum, better access to preventive health services, and an overall interdisciplinary team approach to health assessment and ongoing communication.”
SCAN Health Plan is one of the nation’s largest not-for-profit Medicare Advantage Prescription Drug plans currently serving 170,000 members in California. Further information may be obtained at scanhealthplan.com or on Facebook at facebook.com/scanhealthplan.
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