At Prizm Health, we use our experience in health plan operations, quality improvement and compliance to help clients clarify and implement complex CMS regulations specifically associated with Dual, Chronic and Institutional SNPs. Our goal is for clients to achieve compliance with SNP regulations while promoting excellent health outcomes for their SNP customers and maximizing financial results.
In short, while we understand the spectrum of tradeoffs and challenges in operating SNPs, we are strategists who strive to mitigate them. We want our clients and their SNP customers to “have it all”: strong compliance and return on investment for our clients and industry-leading care for each SNP customer through delivery of targeted benefits and enhanced care coordination.
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 Model of Care (SNP-MOC) 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:
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Program Design
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Model of Care Narratives
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Audit Readiness
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Reporting and Analytics
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Quality Improvement
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Vendor Vetting and Oversight
NCQA Health Plan Accreditation and HEDIS® Project Support
Prizm Health is able to support SNP or non-SNP Medicare Advantage plans in building the infrastructure and documentation necessary for a successful NCQA Health Plan Accreditation survey or HEDIS® Project.
Audit Remediation
Prizm Health can assist with corrective action plans and remediation of audit findings after a CMS SNP-MOC audit. We are also able to complement existing remediation project teams or staff from other consulting firms to achieve aggressive timelines for remediation.
Ad Hoc Consultations
Prizm Health is available for ad hoc consultations related to SNP strategy, policy analysis and implementation, SNP Model of Care best practices, common audit findings and risks, overall industry trends as well as other SNP-related topics. Feel free to contact us at info@prizmhealthadvisory.com with your topic of interest and to schedule a consultation.
Speaking Engagements and Training Seminars
In addition to participation in industry conferences, Prizm Health Advisory can lead and facilitate training sessions and workshops for client leadership and staff. Please contact us at info@prizmhealthadvisory.com.