Dr. Sepi Chegini joins SNPA Board of Directory
May 7, 2018
Dr. Chegini graduated from University of Rochester School of Medicine in 1999. There, she developed her passion for the bio-psycho-social medicine model and palliative and end-of-life care. She went on to George Washington University for her post-graduate training, where she recognized her life’s mission to contribute to the care of medically and psychosocially complex patients. Yet she found the general fragmentation of care and lack of adequate services for the vulnerable population frustrating. It was during that time, when she was drawn to the CareMore’s integrated model of care. She has been a practicing physician with CareMore since 2002, focusing on the geriatric population and those with complex medical and psychosocial needs. She has delivered care in different clinical settings. She was instrumental in developing CareMore’s first palliative care program. Prior to her current position, she was one of CareMore’s Regional Medical Officers in Los Angeles County, overseeing the care of patients in hospitals, skilled nursing facilities, as well as the disease management programs for high risk and vulnerable SNP members with chronic conditions in CareMore Care Centers.
In July of 2017, she became the Senior Medical Officer for CareMore’s Touch program, which is an institutional special needs plan (iSNP) of Anthem. The Touch program serves over 5,300 individuals in assisted living centers, nursing facilities and group homes in 4 different states. She is responsible for the clinical operations, the integrity of the clinical model, compliance and quality of care. Her goal is to improve coordination of care, and facilitate the delivery of high quality, high-tech and innovative care, in addition to on-site disease management and palliative care to those individuals living in institutional settings in a cost-efficient way. Her assets are her clinical experience and knowledge of both special needs plans and challenges of providing services for high-risk and high-cost populations.
News from the 2018 Spring Roundtable
April 10, 2018
The Special Needs Plan Alliance, the nation’s leading advocate for Special Needs and Medicare-Medicaid Plans, recently held its Spring Roundtable at the Capital Hilton in Washington, D.C. The bi-annual conference of insurers, state government representatives and federal rule makers was well attended and, this year, set against a milestone backdrop—Congress’ 2018 approval of permanent reauthorization for Medicare Advantage Special Needs Plans. Permanency, which the Alliance and its membership had long championed, was the star of the occasion.
The concept of integration looks to define the era of permanency; not merely through the alignment of Medicare and Medicaid benefits, but through the redefining of person-centered medicine and the infrastructure necessary to support whole-person care. With his keynote discussion on Integration for High-Risk Populations: Aligning Complex Medical, Behavioral Health and Social Support Needs, Dr. Roger Kathol set the tone for the two-day conference, conscientiously advocating for how permanency will enable plans to tackle the alignment of behavioral, social support and medical services along the lines of both care planning and payment reform. Moderated by SNP Alliance President and CEO Dr. Cheryl Miller, Dr. Kathol’s opening session highlighted both the unique patient populations served by SNPs and MMPs in addition to the challenges faced by plans in terms of behavioral health integration and at-home support for patients with multiple chronic behavioral health conditions.
A collection of leading state entitlement policy experts, along with their counterparts at the federal level, addressed the likely healthcare issues facing the Congress in 2018, as well as various issues at the state level that are front and center for SNPs and their enrollees. Central to these discussions were the challenges that are anticipated around implementation of unified grievance and appeals (G&A) requirements, how are states likely to modify MIPPA contracts to address integration options, and how can states and D-SNPs work toward integrated Models of Care.
The topic of Medicare Advantage revenue, sure to be the hotbed issue of 2018 in light of MedPAC’s recent urging for a revised MA payment formula, was focused through the lens of risk adjustment at a session that included a discussion of revenue-related topics from the 2019 Advance Notice. The focus on understanding the projected impact of the proposed changes in the CMS-HCC risk adjustment model, including the specific impact on average risk scores for dual eligible, disabled and aged groups, drove a thoroughly detailed conversation between Advanced Analytics’ Christie Teigland and Milliman’s Eric Goetsch.
The roundtable’s most heavily attended breakout was a listening session with CMS’ Medicare-Medicaid Coordination Office and Medicare Enrollment and Appeals Group staff on G&A and integration standards. The listening session explored provisions of the new integration legislation, allowing a direct conversation with rule makers before comments on the Dual Integration-MMCO Request for Stakeholder Input on Unified G&A are due April 11. The discussion was a candid and valuable exchange that members remarked would strengthen the underlying logic of their forthcoming comments; Marc Steinberg and Tobey Oliver from CMS moderated.
The Special Needs Plan Alliance’s Fall Roundtable will take place October 15 & 16, 2018 at the Omni Shoreham Hotel in Washington, D.C.
Implementing Improved Care for Special Needs Populations:
A Planning Grant
March 19, 2018
The Special Needs Plans Alliance received funding from The SCAN Foundation to conduct a planning and design effort on examining implementation of evidence-based care management or other best practices designed for special needs populations.
Final Report - 2018
March 5, 2018
SNP Alliance submitted two comment letters and an attachment to CMS sharing comments on the Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for the Medicare Advantage (MA) CMS-HCC Risk Adjustment Model.
Feburary 9, 2018
SNP Alliance celebrates that Special Needs Plans achieve permanency with the Passage of H.R. 1982, the “Bipartisan Budget Act of 2018.”
November 20, 2017
SNP Alliance provides comment letter to the Centers for Medicare and Medicaid: Innovation Center New Directions Request for Information (RFI)
October 2017 - Project Update
SNP Alliance received funding from The SCAN Foundation to conduct a planning and design effort on examining implementation of evidence-based care management or other best practices designed for special needs populations.
May 25, 2017
A report developed by the SNP Alliance and the Center for Consumer Engagement in Health Innovation at Community Catalyst. The report examines how two special needs health plans are responding to the social determinant of health characteristics to improve health outcomes for people who are dually eligible for Medicare and Medicaid. Social determinants of health―also known as social risk factors―can significantly impact medical and health outcomes. Individuals who are dually eligible (low-income meeting Medicaid criteria, and disabled or elderly meeting Medicare criteria) often have more social risk factors than the general population.
March 31, 2015 - Inovalon
With input from The SNP Alliance, Inovalon conducted a study of CMS Star Measures, comparing unadjusted results of dual eligible to non-dual beneficiaries enrolled in the same health plan. Their "An Investigation of Medicare Advantage Dual Eligibles Member-Level Performance on the Centers for Medicare and Medicaid Services (CMS) Five-Star Quality Measures," found that beneficiary income and other sociodemographic factors were strongly associated with adverse health outcomes. The findings support other evidence that factors and characteristics outside of the health plan and providers control affect outcomes and that plans that specialize in serving these vulnerable populations may be penalized in the quality measurement system.