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

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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.

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