Members: Searching for a dual-eligible special needs plan (D-SNP)? Visit our D-SNP page.

Model of Care for D-SNP

The Health Plan has developed a specific model of care (MOC) to help address the complex health care needs of members enrolled in the dual eligible special needs (D-SNP) plan. The Health Plan’s MOC is a written document that describes the measurable goals of the program, along with The Health Plan staff structure and care management roles, and the use of clinical practice guidelines and protocols. The program includes training for personnel and providers, a health risk assessment tool to collect information on the health needs of our members as they enroll and the development of an individualized care plan for each member. Our communication efforts and care management strategies for the most vulnerable sub-populations represented in this product are essential to ensure optimal health outcomes.

Measurable goals include:

  • Improving access to essential services including medical, behavioral health, and social services by providing a comprehensive network. D-SNP members will select a primary care physician and, in many cases, a secondary care physician appropriate to his or her clinical needs.
  • Streamlining the process of transition of care across health care settings by working with our physicians and other providers.
  • Improving access to preventive care as well as ongoing chronic needs.
  • Improving member health outcomes as reflected through annual HEDIS® data collection as well as member survey measures.
  • Providing each D-SNP member with an assigned case manager who can assess ongoing needs and access needed social services that are appropriate.

All participating Medicare Advantage providers must complete and attest to D-SNP Model of Care training annually. You can access training slides and the attestation form on our secure Provider Portal Resource Library. Instructions are included on the attestation form.