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 going 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 With Migration to D-SNP
Enrollment
- 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
Care Management
- 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.
