California Medi-Cal (CMC) plan models have long been innovative and tailored to specific regional differences. As a result of the recent CalAIM mission to offer integrated and full-scope benefits to dual-eligible individuals, the state took additional steps to ensure wraparound coverage to the dual-eligible population.
The Medicaid transformation required plans to form D-SNPs, completely revamp models of care, expand provider networks to ensure whole-person care, and raise the bar for each Medicare-Medicaid plan’s management of the dual-eligible population.
The aligned enrollment initiative for specific plans required large operational changes. As with any new program, the requirements were often confusing and conflicting. Very soon after go-live, it’s key that plans maintain enrollment for former CMC members, ensure continuity of care, and address potential causes for grievances and appeals.
How ATTAC Can Help
- ATTAC performs an end-to-end eligibility analysis related to missing enrollees from passive enrollment processes in the CalAIM transition to D-SNP models
- We conduct a root-cause analysis and suggest remediation for enrollment fluctuations during your first six months of program initiation
- We use a tactical approach to find root causes, apply operational fixes, and define/ implement solutions to drive operational excellence
- From models of care, to behavioral health integration, HEDIS and SDOH, our experts guide clients in design and implementation of high-performance, outcomes-focused programs
- In the Medicaid space, we work with a wide variety of health plans to improve care-management protocols and provide member care that’s compliant with ever-changing expectations from states and CMS
Grievances and Appeals
- Using our innovative combination of compliance and operations compliance analysis tools, ATTAC helps health plans review and analyze the root cause of any customer service or grievance/appeal spikes
Contact us to learn more about how ATTAC Consulting Group can help your plan evaluate and solve operational challenges across all functional areas.