Bring Dual-Eligible Special Needs Program In-house

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Our consultants have worked in a variety of management positions within commercial and government payer organizations, and average more than 15 years of experience in the healthcare industry. We have first-hand knowledge of your challenges, and understand how to overcome competitive pressures, organizational obstacles, and limited resources.

Use Case

A long-standing client asked the Change Healthcare Consulting team for advice on implementing a new model of care for its dual-eligible special needs plan (D-SNP) line of business. D-SNP is a government programs plan for members who are eligible for both Medicare and Medicaid. A model of care outlines how a plan will case-manage and coordinate care for this vulnerable population, with the goal of improving health outcomes.

The Midwestern payer previously outsourced its model of care activities to a vendor, but asked the consulting team to properly bring these activities in-house within a short timeframe. The client needed a variety of services, including system customization; extensive testing; policies and procedures (P&P) development; staff onboarding and training; creation of reporting to meet CMS standards; and revision of its existing model of care program document.

Challenges

Change Healthcare Consulting took leadership of the project with a very short turnaround time. There were only six weeks to go-live with no option to delay, as the vendor was dissolving operations. Since this specific business line hadn’t existed internally for several years, the client did not possess legacy D-SNP model of care knowledge. The client’s system also required major modification, as it was reliant upon an older software version. As one process was modified, another would break.

Solutions

The Consulting team worked quickly to get up to speed in order to meet the scheduled six-week turnaround. The entire team also provided in-depth D-SNP knowledge to fill the client’s gaps and adequately train the new staff. Due to the outdated software, the older system presented an obstacle. Through exhaustive testing, a collaborative partnership, and productive communication with the software vendor, the team led the creation of a customized system to satisfy the health plan’s needs.

Project Results

Despite the challenges imposed by an older system and a limited timeline, the Change Healthcare Consulting team led a smooth, successful go-live. The client is now fully operational on all D-SNP model of care processes, and stabilization efforts are currently underway. The health plan also has a newly educated staff and a robust policy set built in a customized system that fulfills all its specific needs.

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