The Peoples Health care team follows up with members on the status of their health goals at intervals based on their risk stratification. The member and the member’s primary care physician receive a copy of the ICP upon initial completion and with every modification. It also dictates how the SNP interdisciplinary care team assists the members in managing their health. The ICP consists of health goals related to the needs identified, along with recommended actions the member may take to attain the goals. The SNP interdisciplinary care team evaluates the member’s response to the health risk assessment, along with available medical records, and creates an individualized care plan (ICP). The health risk assessment is completed within the first 90 days of the member’s enrollment and at least annually thereafter, including whenever the member undergoes a change in health status. Peoples Health conducts a standardized health risk assessment for all SNP members that evaluates medical, psychosocial, cognitive, functional and mental health needs. With the goal of assisting members in moving from high risk to lower risk on the care continuum, the care team focuses on monitoring health status to identify controllable issues, initiate timely and appropriate interventions, and eliminate or mitigate the need for preventable emergent care and unnecessary hospitalizations. Through regular written, telephonic and in-person contacts, assessments and educational support, the Peoples Health care team (including primary care physicians, nurse navigators, care coordinator nurses, care coordinator social workers, nurse practitioners, chronic care clinical program specialists and clinical pharmacists) builds and maintains relationships with members. The SNP model of care is a member-centric model that uses a team approach to assist members with self-management of their health care. SNP members may experience intricate challenges that include physical compromises, as well as cognitive, social and financial issues, multiple co-morbidities, chronic conditions, frailty, disability, end-of-life issues, isolation, depression and polypharmacy. SNP members have lower out-of-pocket costs for most covered health care services and prescription drugs due to benefits and waiver services received through Louisiana Medicaid. Peoples Health has created a model of care that addresses the needs of SNP members by providing access to affordable care, as well as assistance with health education and the management of complex health issues. These plans are all-dual D-SNPs, which means they provide specialized care for members who have Medicare and are entitled to medical assistance under Louisiana Medicaid (Title XIX) on the basis of income or disability. Peoples Health SNPs comply with and are structured according to the regulations of the CMS Managed Care Manual. Model of Care for Special Needs Plans (SNPs) You will need to provide the plan name and member ID number, which you can find on the front of the patient’s Peoples Health ID card.įor more information, visit Information for Out of Network Providers. To verify patient eligibility, contact the provider services department at 1-87, Monday through Friday, from 8 a.m. If you do not have portal access, complete an authorization request using a Medical Necessity Form, and fax the form and any supporting documentation to one of the numbers on the form. To submit authorization requests and verify patient eligibility online, you can sign up for a Provider Portal account. Peoples Health Group Medicare (HMO-POS) Office of Group Benefitsįor more information about these plans, visit the Provider Plan Documents and Forms page.įor services requiring authorization, you must obtain prior authorization from Peoples Health before rendering the service. Members may pay higher costs for out-of-network services.
Most Peoples Health plans require that plan members receive care from network providers, except in emergency or urgent situations however, the following plans do offer an out-of-network benefit that allows enrolled members to receive other services from out-of-network providers.
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