Central Health Plan’s Special Needs Plan (SNP) for Medicare beneficiaries continue to extend its outreach in the following counties: Los Angeles, San Bernardino, Ventura and Orange county. There remains a propensity for complex or multiple chronic conditions as well as a subset of the population that is considered amongst the Frail Elderly. Our goal is to continue to coordinate care and engage members, their caregivers and health care providers in order to improve members’ overall health through health education and timely access to affordable care and preventive services.

The responsibility of caregiving or health decision making among the Asian and Latino for maintaining their health is usually delegated to the authority figure or head of household. The SNP team continues to reach out to members and/or their caregivers in completing Health Risk Assessments, engaging them in the creation of Individualized Care Plan and encouraging their active participation in Interdisciplinary Team Meetings. Language barriers, which impact members’ overall health is mitigated by providing health education in the members’ preferred language. Key health interventions include focus on healthy living choices to reduce alcohol use, smoking and obesity, improve daily physical activity, and promote emotional health solutions. Age-appropriate screenings/preventive care, including timely referral to community resources and specialists can also improve overall health, reduce development of/worsening of chronic conditions, and the need for emergency room visits or acute care hospitalizations.

Below are the 2021 SNP MOC performance metric results, which shows readmission rate (20%) among members with diabetes and or cardiovascular disorder is not at goal, which is a 4% increase from 2020. Beginning this year, the Chronic Care Improvement Program has shifted focus to Diabetes management with the following goals: 1) Promote effective personalized Diabetes self-management; 2) increase parity in access to Diabetes care; and 3) maintain excellence in HEIDIS measures. Targeted opportunities include improving access to diabetic eye exam, improving glycemic control (A1c < 9%), and improving adherence to diabetic medications and statin therapy.

Plan Benefit Goal: < 15% 30 Day Readmission Rate Goal: 80% A1c < 9.0% Goal: 80% HRA completion Rate Goal: 95% with completed Interdisciplinary Care Plan Goal: 90% Member Satisfaction Survey Score
MA 002 14% 95% 79% 96% 94%
MA 006 20% 85% 79% 95% 94%
MA 009 8% 97% 84% 94% 94%

In order to meet our SNP MOC mission and goals, it is important that the entire CHMP Team, including our Members continue to work together. To our network providers, we encourage your participation in our interdisciplinary team meetings as well as complete the annual MOC training as required by CMS at https://www.centralhealthplan.com/cpa/Home/SNP and complete the Attestation Form. We also encourage provider participation in our ICT meetings and member completion of satisfaction surveys in order to better serve our members.