Projects and Methodology

Prizm Health partners with clients to understand their priorities, goals and resource constraints and designs projects that best meet their needs. We work with health plans, provider groups and care management vendors that currently serve SNP customers or are planning to enter the market.

While we adjust our approach to meet the needs of each individual client, we typically begin with an evaluation of their current capabilities in serving existing SNP or other vulnerable customer populations and in meeting CMS SNP requirements and State Medicaid requirements, as applicable. We conduct this evaluation using current SNP Models of Care, care management program descriptions or process flows, monitoring dashboards, policies and procedures as well as direct process observations and staff interviews, as needed and available.

With this information, we are able to produce a comprehensive assessment of the client’s core competencies/best practices, potential compliance and audit risks and recommendations for improvement and risk mitigation. Compliance risk assessments are conducted against CMS SNP Care Coordination (SNPCC) Audit protocols as well as the client’s individual SNP Model of Care commitments.

Following this evaluation, Prizm Health is able to assist clients with the following:
• Program Design
• Model of Care Narratives
• Audit Readiness
• Reporting and Analytics
• Quality Improvement
• Vendor Vetting and Oversight