Care management for D-SNP populations: The key to compliance and member satisfaction

Dual Eligible Special Needs Plans (D-SNP) are a special kind of Medicare Advantage Plan for people who qualify for both Medicare and Medicaid. This program takes members’ Medicare, Medicaid, and Part D needs and puts them all together into one package to provide an overall healthcare experience.  D-SNP plans are unique in that they provide extra benefits. In addition to Medicare, Medicaid, and Part D coverage, they also help with additional healthcare coverage, including transportation (to doctor visits), dental or vision coverage, and credits to purchase OTC products.

Support for Highest-Need Populations

D-SNP members represent some of the most vulnerable populations in the United States. Health plans serving D-SNP programs need a holistic platform for end-to-end care management and population health that enables their unique Model of Care and keeps them compliant with state and federal regulations.

Best-in-class D-SNP care management platforms hinge on two critical factors: compliance and member satisfaction.

Compliance

  • Federal & state compliance
  • Compliance reporting
    • ODAG and CDAG Reporting
    • User-friendly documentation management
  • Complex Assessments
  • STARS ratings
  • HEDIS scores

Member Satisfaction

  • Coordination of care and collaboration
  • Coordination of activities of daily living (ADL) needs identified via responses to assessment questionnaire which will generate service plan needs that can automatically feed authorization of such required services.
  • Ongoing communication and engagement
  • Member care plans with intelligent automation and evidence-based goals and opportunities
  • Leverage social determinants of health (SDOH) connections to address nontraditional challenges for improved member outcomes

The right D-SNP managed care platform means better health outcomes and compliance with federal and state regulations.

HealthEdge’s GuidingCare: Next-gen care management platform for health plans with D-SNP

With strong expertise and experience in providing care management and population health services for government-funded payers and plans, HealthEdge is fluent in the needs of state-sponsored programs serving the most vulnerable and high-risk populations.

Nationally, 1 in 5 Medicaid members are managed on GuidingCare. GuidingCare is currently live in 35 states for Medicaid, 29 states for D-SNP, and 14 states for LTSS. Learn more about how GuidingCare supports D-SNP populations here.

About the Author

Tom Joyer

Thomas Joyer, Chief Commercial Officer, Altruista Health (a HealthEdge Company) 
LinkedIn
tjoyer@altruistahealth.com 

Tom Joyer is the Chief Commercial Officer with Altruista Health and is responsible for developing strategic opportunities for new business development and growth for the organization. Additionally, he works closely with existing customers to increase the value they receive from Altruista’s products and services. He is a well-trained and highly successful sales leader with nearly 20 years of experience operating in large complex sales environments. Previously, he served for over a decade as Vice President of Sales with Health Integrated, a leading provider of care management services. In this role, he successfully contracted large, complex agreements with leading payers serving Medicaid, Medicare, Special Needs Populations; Commercial and Federal Employee Programs. Prior to Health Integrated, he served as Vice President and General Manager of Global Healthcare Exchange (GHX) Pharma Solutions Group where he was responsible for managing the Pharmaceutical Validation and Contract Management markets. Prior to being acquired by GHX, he served in sales roles with Neoforma, a supplier of healthcare supply chain solutions. Tom began his sales career with Southwestern Bell Corporation. He received a bachelor’s degree in Business from the University of South Florida.

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