Affinity SNP Model of Care
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- Marianna Copeland
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1 Affinity SNP Model of Care The MIPPA Act of 2008 mandated all SNPs comply with additional requirements to implement an evidence based Model of Care and evaluate the effectiveness of its care management. The Model of Care is designed to improve Members access to medical, social and mental health services while improving transitions of care across health care settings. Page 1
2 Affinity SNP Model of Care Key Components To develop and execute an effective Model of Care Affinity must ensure that Key Components are in place. Appropriate Staff - Affinity must ensure it has appropriate staff with clearly defined roles to provide the infrastructure necessary to run the Model of Care. Case Management Program- Affinity members are automatically enrolled in our Case Management program. A member may choose to opt out at any time. Comprehensive Health Risk Assessment (HRA) Affinity must conducted an HRA for every member within 90 days of enrollment. The HRA asks members questions about their current health status. In addition Affinity must conduct a reassessment for the member at least annually, but more often if necessary. Page 2
3 Affinity SNP Model of Care Key Components Individualized Care Plans (ICP) Affinity develops ICPs based on HRA information, available claims, utilization and pharmacy data, if available Interdisciplinary Care Team (ICT) Affinity collaborates with an ICT regarding the members care plan Provider Network Affinity's network has special expertise to provide a broad provider representation from the medical, diagnostic, and treatment arenas to care for our Dual Eligible SNP members. Providers use nationally recognized evidencebased clinical guidelines Performance and Health Outcomes Affinity monitors performance and health outcomes measure to evaluate effectiveness of the model of care and make changes as necessary. Page 3
4 Goals of Affinity s Model of Care Affinity has identified specific measurable goals for the Model of Care: Improve service access to medical, mental health and social services Affinity strives to ensure that all SNP members have timely and ready access to the full array of medical, behavioral health and social services required to maintain and improve their health. Improve access to affordable care Affinity tracks and trends grievances related to benefits and copay issues in order to assure member have access to affordable care. Improve coordination of care through an identified point of contact Affinity SNP members require enhanced coordination of care, particularly because of the prevalence of chronic, co-morbid medical and behavioral conditions within this population. Affinity s staff coordinates care across all levels. Page 4
5 Goals of Affinity s Model of Care Improve seamless transitions of care across healthcare settings The Affinity case management team promotes seamless care transitions across healthcare settings and ensures members understand the updated care plan once a transition occurs. Improve access to preventive health services Prevention is an important feature of the Affinity Model of Care and is achieved through a combination of member education, provider education, increased availability of preventive services and quality improvement efforts. Assure appropriate utilization of services Affinity monitors the utilization of services through prospective, concurrent, and retrospective review using Milliman criteria, CMS guidelines and clinical judgment of Medical Directors and external experts, when needed. Page 5
6 Goals of Affinity s Model of Care Assure cost-effective service delivery The effectiveness of the quality improvement activities are monitored and evaluated on an ongoing basis. The overall performance of the SNP Model of Care is assessed and reported to the Clinical Affairs Committee on an annual basis. Improve beneficiary health outcomes Affinity s Model of Care strives to achieve improved health outcomes as measured by objective clinical data as well as member self-reporting. Page 6
7 Affinity Communication Affinity will continuously provide information on these projects and other initiatives through: Hot Topics: brief updates for providers of latest issues Synergy: provider newsletter Healthy streets: member newsletter Affinity website Information For more information on Affinity s Medicare Advantage plans, please visit our website at Page 7
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