The Model of Care: More than Just a Technical Requirement
The Model of Care (MOC) represents the backbone of a health plan’s operational infrastructure and offers powerful potential through which to drive quality improvement, service excellence and improved health outcomes.
Though only required for plans operating a Special Needs Plan (SNP), the MOC is not just a legal or regulatory requirement. The MOC captures and documents deep insights regarding plan leaders’ strategic vision by which to provide services to members, to work with providers, to manage and coordinate care, and to conduct operations. It also includes a thorough analysis of a plan’s staffing model, provider network and the local demographics of its members.
Perhaps because the MOC is such a lengthy and technical document, or perhaps because it addresses the entire spectrum of a health plan’s clinical and operational processes and systems, MOC’s are often developed and updated by a small team of highly experienced subject matter experts within a health plan. Despite CMS’ requirement that all health plan staff and providers receive annual training on the MOC, plans often miss the opportunity to leverage their MOC’s not only to comply with CMS regulations, but also to more deeply entrench their Quality Improvement (QI) and operational service models throughout the organization.
Developing and/or updating a MOC requires health plans to make important strategic and tactical decisions about the way in which their team, in conjunction with their provider network, will work together to coordinate care for their members. As a result, the MOC serves as the strategic plan for your care management, member services, provider relations, risk adjustment, Stars/quality and marketing teams.
By leveraging the strategic and tactical discussions necessary to develop a successful MOC, plans can use the MOC development process as a vehicle through which to develop, review, and enhance Star Ratings, Risk Adjustment and Provider Engagement strategies.
Gorman Health Group’s team of experienced clinicians has a deep understanding of how to leverage Models of Care to refine, document and hardwire your strategic vision for collaborations with your provider network to improve Star Ratings and optimize risk adjustment performance.
If your plan is preparing to develop or update your Model of Care, contact us today and let’s work together to help your plan achieve your strategic vision.
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Gorman Health Group is ready and available to execute a complete MOC evaluation that will provide the data and information needed to make smart decisions in refining your plan’s strategy of managing your SNP population. Contact us today >>
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