Transcript WellCare SNP Model of Care Program

WellCare SNP Model of Care
Program
WellCare Special Needs Care
Planning for Access and Select
Members
HFN Provider Training Slides
2009 Annual Training
WellCare SNP Model of Care
• WellCare filed 2 Plans with CMS for SNP
Model of Care enhanced Case
Management services – the Access and
Select Plans.
• Members are considered enrolled in a
WellCare SNP Program by virtue of being
a dual-eligible member.
• A member must be dual eligible to be in an
Access or Select Plan.
2009 Annual Training
What is a SNP Model of Care
Program
• SNP Model of Care is the Architecture for Care
Management policy, procedures, and operational data
systems.
• The focused Model of Care Program targets dual eligible
Access and Select Plan members.
• Care is coordinated through Case Management, with
transition of care across health care settings.
• All SNP Members will receive a comprehensive Health
Risk Assessment, Individualized Care Plan, Regular
telephone contact with an assigned Case Manager,
regular Interdisciplinary Care Team meetings to reevaluate members’ needs.
• Access to preventive health, social and mental health
services.
2009 Annual Training
Requirements for a SNP Model of
Care Program
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Proactive identification of members for Case Management services using
available data systems.
Coordination of services for members with complex conditions and
assistance for the members to access needed services, including mental
health and social services.
Trained case managers to help members regain optimum health or improved
functional capacity in the right setting and in a cost-effective manner.
Case Management involvement in developing a comprehensive assessment
of a members’ condition, including clinical history, ADL’s, Mental Health
stats, caregiver resources, determination of available insurance benefits and
resources, individual care planning and performance goal development, self
management activities and a monitoring and follow-up schedule.
An interdisciplinary care team approach to managing a member’s care
including collaborative PCP involvement with the Care Team.
Management of the process of care transitions and identification of problems
that could cause transitions, and, where possible, prevent unplanned
transitions.
Coordination of Medicare and Medicaid benefits and services for members.
2009 Annual Training
PCP/Provider Requirements
• WellCare is requesting HFN PCP’s and Specialists
ongoing participation in this SNP Program:
• To review faxed Care Plans for each SNP member to
whom they provide care.
• To update Care Plan with any changes and send back to
Case Manager.
• To communicate with the Interdisciplinary Care Team
(ICT) as requested to ensure optimal coordination of care
& transition of care.
• Initial and annual training is required. Training can be
web-based, self-study or by printed material or electronic
media.
2009 Annual Training
PCP and Specialist Involvement
• PCP’s will receive Member Care Plans
throughout the year for existing and new
members, including each time the Care
Plan is updated.
• Case Managers will facilitate regular
communication with Providers.
• Physician participation is requested to
ensure the member understands their care
plan and received needed care.
2009 Annual Training