Special Needs Plans (SNPs)
Optimize care. Enhance health equity. Improve quality and outcomes.
World-Class Advisory Services and Clinical Operations Services
Whether you are starting a Special Needs Plan (SNP) or seeking to achieve best-in-class operational execution, Toney Healthcare offers deep expertise to support all forms of SNPs. Our highly experienced team can be quickly deployed to help you more effectively manage your most vulnerable members, promote health equity, maintain compliance and deliver high-quality, member-centric services.
Our team can fill the gap if you need guidance or leadership, you’re shorthanded, or you’re trying to expand or get a new program up and running. Three service delivery models are available:
Advisory Services
Deep expertise in best practices, policies, procedures and planning helps map the strategies that best achieve your SNP objectives and improve processes, day-to-day operations and outcomes. This collaborative approach ensures your operations are efficient, effective and compliant.
Clinical Operations
We Engage Your Way
Staff Augmentation—Our team of non-clinical and clinical staff, appropriately licensed and with health plan experience, are available for specific, individual assignments or as functional teams to ensure continuity and smooth operation of essential SNP clinical functions for as long or short as needed. This program is ideal if you’re short-handed and need a few experts for a limited time period, such as care managers or a physician to serve on an interdisciplinary care team.
Insource Partnership—Our comprehensive dedicated clinical operations teams become an extension of the health plan, assuming full responsibility including performance management, team productivity and quality standards for a SNP medical management function (e.g., utilization management, MOC 2). Each team is led and managed by an experienced, director-level Toney clinical operator that manages KPIs and provides insights to continually improve processes, operations and program outcomes, reporting into the plan’s operations management team. Available with a fixed-fee or PMPM model for predictable budgeting, our teams are non-delegated and are dedicated to the plan.
SNP Clinical Operations
We have a deep bench of resources to support SNP clinical operations. We work in your systems and follow your policies and procedures for complete data transparency and control, eliminating the need for burdensome data transfer, reporting delays or delegation oversight.
Our teams include care manager nurses (RN), behavioral health clinicians (LCSW, etc.), pharmacists, non-clinical support/engagement staff (including community health workers), and medical directors if needed for interdisciplinary care team and program oversight.
Medical, behavioral health, and integrated case management supporting all SNP types, including medical-behavioral-SDOH integration and serving multi-chronic, vulnerable populations
All elements (A – E) of MOC 2 (Care Coordination): Care managers (RN and LCSW), pharmacists, physicians, support staff
Medical and behavioral health utilization management and physician review services, including appeals
Analytics support, filters and algorithms to enable identification and stratification and support reporting requirements
MOC 3: Provider network development
MOC 4: Quality measurement and performance improvement
Why Toney Healthcare
Deep expertise in physical and behavioral health integration
Industry-leading clinical operations resources
Highly effective Progressive Cognitive Resonance approach to care management
Extensive line-of-business expertise (Medicare Advantage, Medicaid, SNP, MLTSS, TRICARE, Commercial/ACA)
Episode-based billing enhancing quality of care initiatives can be counted toward MLR, with other billing models available
No recruiting or hiring burden
Medical and behavioral health support
Complete transparency and reporting by working within your information management system
Risk-based performance metrics
SNP Advisory Services
Program Development and Implementation
Population health, including population assessment and evaluation, condition targeting, stratification and identification
Complex case management and cost containment strategies
Utilization management and transitions of care program, including UM committee development to meet CMS Final Rule requirements
Model of Care writing and submission (writing or co-writing)
SNP policy and procedure development and DLPs
Committee structure development, charters, membership and reporting
Health Equity Index strategies
Payment integrity and prepayment claims review
Risk adjustment best practices, policies and procedures, workflows, HCC gap closure strategies
Systems assessment and analysis to support SNP requirements, including reporting, dashboards, KPIs and universe development
Department training for Model of Care and other programs, in-person or computer-based
Program Development and Implementation
Alignment with CMS and state regulatory requirements and programs, pharmacy regulations
NCQA support and accreditation including Medicare Advantage Deeming for SNP MOC and Health Equity Accreditation
Quality improvement program evaluation, development and implementation, including strategies and multi-year initiatives and roadmaps for Star, HEDIS, CAHPs, HOS, Chronic Care Improvement Program (CCIP)
Mock audits, independent validation audits, audit preparation and playbooks
Regulatory and compliance submissions
Toney Healthcare’s team of experts is ready to help you address your utilization, care and behavioral health resource needs with plug-and-play health management services and expertise so you get the help you need, fast—and without HR headaches.