Senior Care Action Network (SCAN) is a mission-driven, non-profit health plan that aims to keep older adults healthy and independent. SCAN serves more than 280,000 members across Arizona, California, Nevada, and Texas.1 SCAN is the only Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) in California.
SCAN’s FIDE-SNP serves individuals dually eligible for Medicare and Medicaid. All covered services are provided under a single plan to prevent fragmentation of care. Important plan features include long-term services and supports (LTSS), collaboration with the Member Services Department, a dedicated phone line, and postcards sent to hard-to-reach members. Evidence suggests the benefits of care coordination in promoting better outcomes for community dwelling individuals, and the ability for home and community-based services to delay admission to an institution.2,3 SCAN supports members living within the community by coordinating services and communications across government sponsored programs. To meet this goal, the health plan has developed specialized programs to address the complex needs of the population they serve.
Personal Assistance Line (PAL)
The personal assistance line (PAL) is a team of non-clinical care coordinators, highly trained in Medicaid benefits and resources, created by SCAN to specifically address the unique needs of the dually eligible population.4 PAL representatives help members receive culturally and linguistically appropriate care; are trained in motivational interviewing to uncover medical, social, and financial barriers; and are knowledgeable in Medicaid eligibility criteria to support members with ongoing enrollment. For example, SCAN receives a notification from the state when a member’s eligibility may be at risk and informs the member to follow up with the Medicaid enrollment services to correct any issues that may result in a coverage lapse. The PAL aims to be a trusted resource for members during times of need and has been a successful initiative of SCAN since 2007.5 Members have provided personal testimony of how beneficial the PAL representatives are when explaining and coordinating their member benefits, and that Spanish-language representatives also provide added value.
Key components of PAL services include care navigation, Health Risk Assessments (HRAs), and Individualized Care Plans (ICPs). Members are onboarded to the health plan through an approval letter and welcome call within 90-days of enrollment. They also have the opportunity to be familiarized to the plan through a Quick Start Guide – a website where they can see an example ID card and find ongoing support to navigate services and benefits.6,7 Completion of the HRAs allow for early facilitation of members’ medical, social, and cognitive needs. When barriers to care are identified, members are triaged to care management and LTSS, as well as to available local and community resources. Interventions include liaising between members and provider services, assisting with transportation to appointments and any issues with Medicaid eligibility, and informing members of the appeals and grievance processes when services are denied. Every member receives an ICP, informed by their HRA, that is shared with the interdisciplinary care team for the coordination of services. Additional benefits associated with PAL services include member satisfaction, reducing gaps in care, and connecting members to necessary treatment.
Care Coordination Best Practices
There are important actions that health plans can take to provide effective care coordination to their dually eligible members facing health system fragmentation. Below are best practices shared by SCAN.
- Identification of Member Expectations and Needs: Health plans must consider what is most important to a member and how to ensure their needs are met. SCAN PAL representatives leverage HRAs and ICPs to better understand the members they serve.
- Engaging in Streamlined and Effective Communication with Members:
- Members should know how to get in touch with a health plan’s care coordination services. In addition to plan onboarding documents and various outreach methods, SCAN sends the member a welcome letter with the PAL team contact information.
- Health plans can simplify and tailor the process of gathering member information to reduce burden to members and care coordinators. SCAN shortened the length of HRAs to allow staff to be more efficient and focus time on the members, and offers the questionnaire by phone, traditional mail, and through their online member portal to suit member preferences.
- Directing member calls to the appropriate health plan department can minimize hold times. SCAN manages inbound calls through member services, ensuring that phone calls are always answered. SCAN implemented a team-based approach, rather than a one-on-one approach, to reduce members’ wait time to reach a PAL representative.
- Supporting Member Satisfaction: SCAN works to improve Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS) measures for physical and mental health indicating member-reported experience satisfaction and success in health outcomes.8 The health plan hopes to empower members to be confident in advocating for their own healthcare needs.
- SCAN’s CAHPs Concept Model triangulates members’ experiences and feedback on onboarding as a new patient, their access to care, and their care coordination to address any identified issues and create a highly satisfied member experience so enrollees will continue to choose SCAN.9
- They also offer best practice tips to the healthcare providers and medical groups in their network to improve the member experience intended to drive the health plan toward a five-star rating. The 5-Star Best Practices tip sheet explains the CAHPs and HOS questionnaire processes and offers strategies to improve survey scores.10 Suggestions include taking advantage of SCAN’s training programs for office managers, developing new patient on-boarding programs to ensure patients understand how best to access the care they need, reserving appointments for urgent visits, and providing nurse advice lines and secure self-service e-portals.
- Being Prepared for Uncertainties: The COVID-19 public health emergency presented additional challenges and complexities for health plans serving dually eligible members.11 With the existing network of specialists, SCAN deployed PAL representatives to the community to connect with hard-to-reach members, some of whom were facing homelessness, and link them to necessary healthcare resources.
For nearly 15 years, SCAN has leveraged their PAL to develop an in-depth understanding of the dually eligible population, enhance the customer experience, and support improved health outcomes. SCAN PAL representatives deploy established strategies, such as the member HRAs and ICPs, to support care coordination. Identifying specific member needs, establishing various communication pathways, incorporating member feedback to improve healthcare delivery, and developing a structure that can ease unforeseen challenges are some of the additional ways SCAN supports specialized care coordination for dually eligible members. Other health plans serving dually eligible members have the opportunity to adopt customized approaches that address the unique needs of the members they serve and better integrate their complex care.
Resources
For additional information, please watch the following video on SCAN’s PAL.
1SCAN Health Plan (2016). About SCAN. Retrieved from https://www.scanhealthplan.com/about-scan.
2Wang, S., Yan, D., Temkin-Greener, H., & Cai, S. (2020). Does Medicaid HCBS generosity influence nursing home placement for dually eligible ADRD patients? Health Services Research, 55(S1), 23–24. Retrieved from https://doi.org/10.1111/1475-6773.13356.
3Office of the Assistant Secretary for Planning and Evaluation. (2016). Does Home Care Prevent or Defer Nursing Home Use? Retrieved from https://aspe.hhs.gov/reports/does-home-care-prevent-or-defer-nursing-home-use.
4SCAN Health Plan. (2020). Fact Sheet: Personal Assistance Line (PAL). Retrieved from: https://www.scanhealthplan.com/-/media/scan/documents/sales/snp/personal-assistance-line-pal-fact-sheet-2020.pdf.
5SCAN Health Plan. (2022). SCAN Connections: The dual-eligible Special Needs Plan with a Personal Assistant Line. Retrieved from: https://players.brightcove.net/5712514612001/default_default/index.html?videoId=6291689016001.
6SCAN Health Plan. (2021). Member Enrollment. Retrieved from: https://www.scanhealthplan.com/members/member-enrollment.
7SCAN Health Plan. (2022). Get Your Membership Off to a Quick Start. Retrieved from: https://www.scanhealthplan.com/welcome-to-scan-quickstart.
8SCAN Health Plan. (2022). Care Coordination. Retrieved from: https://www.scanhealthplan.com/providers/quality-5-star-resources/providers-and-provider-groups/care-coordination.
9SCAN Health Plan. (2019). CAHPS Concept Model. Retrieved from: https://www.scanhealthplan.com/-/media/scan/documents/providers/trainthetrainer/2020/cahps-concept-model.pdf#zoom=100.
10SCAN Health Plan. (2018). 5-Star Best Practices. Retrieved from: https://www.scanhealthplan.com/-/media/scan/documents/providers/trainthetrainer/cahps-tip-sheet_sep2018.pdf#zoom=100.
11Archibald, N. & Herman Soper, M. (2020, November 2). Center for Health Care Strategies: COVID-19’s Effect on Dually Eligible Populations. Retrieved from: https://www.chcs.org/covid-19s-effect-on-dually-eligible-populations/.