Models of Care Explained: Requirements for Special Needs Plans
Presented by Ellen R. Strunk
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This course provides healthcare professionals with a comprehensive understanding of the requirements and applications of Models of Care (MOCs) for Medicare Special Needs Plans (SNPs). Participants will explore the regulatory framework, patient populations, and interdisciplinary roles essential for achieving value-based care. By completing this training, providers will be better equipped to coordinate care, enhance patient outcomes, and meet compliance requirements across various clinical settings, including skilled nursing facilities, home health agencies, and therapy practices.
Learning Objectives
- Recognize the reasons healthcare professionals should complete Model of Care training
- Define the patient populations eligible for Special Needs Plans
- Identify the core components of a Model of Care to ensure care coordination
- Recognize the roles that members of the provider network have in meeting the requirements of the Model of Care
- Differentiate between the goals and health outcomes in each Model of Care
Meet your instructor
Ellen R. Strunk
Ellen R. Strunk has worked in various roles and settings as a clinician, manager/director, and policy expert. Ellen is an expert at helping customers understand the Centers for Medicare & Medicaid Services (CMS) prospective payment systems in the skilled nursing facility and home health settings, as well as outpatient therapy…
Chapters & learning objectives
1. The Reasons for a Model of Care (MOC)
This chapter introduces the concept of a Model of Care as a framework for delivering comprehensive, value-based healthcare services. It highlights the Quadruple Aim goals, and how a Model of Care contributes to those goals by emphasizing care integration, patient engagement, and cost reduction to ensure regulatory compliance and improve overall care quality.
2. What Is a Special Needs Plan (SNP)?
This chapter explains the origins and objectives of Special Needs Plans (SNPs), including the four types of SNPs: Chronic Condition SNPs, Dual Eligible SNPs, Institutional SNPs, and Institutional Equivalent SNPs. Participants will learn how SNPs cater to specific populations, offering targeted benefits, and opportunities for healthcare providers to contribute to better health outcomes.
3. The Elements of a Special Needs Plan Model of Care
This chapter examines the core elements of SNP Models of Care, including health risk assessments, face-to-face encounters, and individualized care plans. It discusses how these components support care coordination and address the multifaceted needs of SNP beneficiaries to improve clinical outcomes.
4. Provider Networks in Special Needs Plans
This chapter focuses on the role of interdisciplinary care teams and evidence-based clinical practice guidelines in Special Needs Plans. It underscores the importance of collaboration among providers to maintain individualized care plans and achieve seamless care coordination.
5. Quality Measurement and Performance Improvement
This chapter details the quality and performance metrics for SNPs, including transitions of care, patient experience surveys, and clinical outcomes. Participants will gain insights into how SNPs are evaluated and the strategies used to improve care delivery and achieve higher performance scores.