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1.  Knox-Keene licensed since 1983  Medicare HMO with multiple products to serve the member: ◦ Standard MAPD ◦ Dual Special Needs Plan (D-SNP) ◦ Multiple.

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Presentation on theme: "1.  Knox-Keene licensed since 1983  Medicare HMO with multiple products to serve the member: ◦ Standard MAPD ◦ Dual Special Needs Plan (D-SNP) ◦ Multiple."— Presentation transcript:

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2  Knox-Keene licensed since 1983  Medicare HMO with multiple products to serve the member: ◦ Standard MAPD ◦ Dual Special Needs Plan (D-SNP) ◦ Multiple Chronic Special Needs Plans (C-SNPs)  C-SNP for individuals with Diabetes  C-SNP for the Chronically Mentally Ill  C-SNP for individuals with Major Depression  C-SNP for individuals with Dementia  C-SNP for individuals with Congestive Heart Failure (2015) 2

3  Competitive Benefit Plans  C-SNPs have “Paired Benefit Plans”: ◦ One for individuals with Medicare only and ◦ One for individuals with Dual Coverage (Medi-Cal and Medicare)  All C-SNPs are allowed to enroll year round  C-SNPs offer an alternative to Cal- MediConnect 3

4 T Mobile Apps Telserve Secure Cloud Database Telserve Secure Cloud Database Wireless BGM Monitoring & Support Intervention & Coaching Education Library Patient Portal Care Team Portals DME & Rx Delivery Home Delivery Tracking by Usage As part of the Member Portal Smart Phone Interface BND Member Diabetic Website Health Coaches to Support member, Caregiver, PCP & IPA. Develops ICP PCP/IPA Care Manager Website By 24 hour Care Team Of Certified Diabetic Educators Cellular Diabetic Meter 4

5 I.24/7 Monitoring of Acute Alerts II.Acute Intervention Coaching III.Personalized Coaching IV.Patient ICP Covering BND’s 7 Fundamentals of Chronic Care  Disease Education including complications  Nutrition  Exercising  Self Testing  Medication Adherence  Preventative Care Plan  Community Linkage 5

6  Monitor acute alerts via Notification Reports  Outreach to members through messaging  Live intervention & coaching at teachable moment  Education assessments for at-risk members  Develop member educational plans  Conduct ongoing education for at-risk members  Provide educational library and content  Chart progress and report to BND case managers 6

7  Clinical data repository allows real-time data monitoring  Care team dashboard reporting on stats, trends, alert lists, adherence to script, and patient information  Tools that support clinician interaction  Escalate just-in-time interventions  Messaging to device, phone, or email based upon glucose readings  Self management library  Triggered messages  Priority messages 7

8 #TriggerDefinition 1Sustained HighsAny user who has had 5 consecutive readings of >250 mg/ML 2Sustained LowsAny user who has had 3 consecutive readings of <70 mg/ML 3Pattern HighsAny user who has had 3 readings of >250 mg/ML with the same tag in 7 days 4Pattern LowsAny user who has had 2 readings of <70mg/ML with the same tag in 7 days 5Pattern Low – FastingAny user who has had 2 readings of <70mg/ML before breakfast in 7 days 6Extreme LowAny user who has a BG <50 mg/ML 7Extreme HighAny user who has a BG >350 mg/ML 8

9 Any Questions? Thank you for your time. Brand New Day 5455 Garden Grove Blvd., Suite 500 Westminster, CA 92683 (657) 400-1900 brandnewdayhmo.com 9


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