SNP Eligibility:
- Dual Eligible SNP for members eligible for Medicare and Medicaid
- Chronic SNP for Members with severe or disabling chronic conditions – an initial Attestation that member has specific condition is required from provider
- Institutional SNP for members requiring an institutional level of care or equivalent living in the community (Health Net does not have this type of SNP)
Health Risk Assessment:
- A HRA is conducted to identify medical, psychosocial, cognitive, functional and mental health needs and risks
- Health Net attempts to complete initial HRA telephonically within 90 days of enrollment and annually
- Three attempts are made to contact the member and the survey is mailed if unable to reach them telephonically
- The member’s HRA responses are used to identify needs, incorporated into the member’s care plan and communicated to care team via electronic medical management system, the provider portal or by mail
- Member is reassessed if there is a change in health condition and these and annual updates are used to update the care plan
Quality Improvement Program:
Health Plans offering a SNP must conduct a Quality Improvement program to monitor health outcomes and implementation of the Model of Care by:
- Identifying and defining measurable Model of Care goals and collecting data to evaluate annually if measurable goals have been met
- Collecting SNP specific HEDIS® measures
- Meeting NCQA SNP Structure and Process standards
- Conducting a Quality Improvement Project (QIP) annually that focuses on improving a clinical or service aspect that is relevant to the SNP population (Preventing Readmissions)
- Providing a Chronic Care Improvement Program (CCIP) that identifies eligible members, intervenes to improve disease management and evaluates program effectiveness (Cardiovascular Disease)
- Goal outcomes are communicated to stakeholders
SNP HEDIS Measures:
- Colorectal Cancer Screening
- Glaucoma Screening
- Spirometry Testing for COPD Pharmacotherapy
- Management of COPD Exacerbations
- Controlling High Blood Pressure
- Persistence of Beta-Blockers after Heart Attack
- Osteoporosis Management Older Women with Fracture
- Medication Reconciliation Post-Discharge
- Antidepressant Medication Management
- Follow-Up After Hospitalization for Mental illness - Done
- Annual Monitoring for Persistent Medications
- Potentially Harmful Drug Disease Interactions
- Use of High Risk Medications in the Elderly
- Care for Older Adults
- All Cause Readmission
- Board Certification
Measures:
Initial Assessments: Initial Numerator and Denominator
Reassessments: Reassess Numerator and Reassess Denominator
Extended Numerator:
Initial Unable to Contact
Initial Refusals
Reassess Unable to Contact
Reassess Refusals
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