Scan Health Plan

KEEP SENIORS HEALTHY AND INDEPENDENT.

SCAN HEALTH CARE SERVICES:SCAN HEALTH PLAN HAS A CULTURE OF QUALITY AND A LONG HISTORY OF FULFILLING OUR MISSION: KEEPING SENIORS HEALTHY AND INDEPENDENT. AS A MEDICARE ADVANTAGE AND PRESCRIPTION DRUG PLAN (MAPD) IN CALIFORNIA, SCAN COLLABORATES WITH A NETWORK OF DELEGATED PROVIDERS TO OFFER MEDICARE AND MEDI-CAL COVERED HEALTH AND BEHAVIORAL HEALTHCARE AND ADDITIONAL SUPPLEMENTAL BENEFITS. OUR MEMBER-CENTRIC MODEL OF CARE ENSURES QUALITY, INDIVIDUALIZED CARE FOR ALL MEMBERS, INCLUDING MEMBERS WITH SPECIAL NEEDS SUCH AS MEMBERS ELIGIBLE FOR BOTH MEDICARE AND MEDICAID, MEMBERS WITH CHRONIC CONDITIONS AND FRAIL MEMBERS WITH FUNCTIONAL DEFICITS.THE HEALTH CARE SERVICES PROGRAMS AT SCAN ARE EVIDENCED-BASED AND ALIGNED WITH GERIATRIC BEST PRACTICES. THEY INCLUDE BUT ARE NOT LIMITED TO, COMPLEX CARE MANAGEMENT, ADVANCED ILLNESS MANAGEMENT, MEMORY PROGRAM, DISEASE MANAGEMENT, AND CARE NAVIGATION AND COORDINATION. THE PROGRAMS ARE ALIGNED WITH THE INSTITUTE FOR HEALTHCARE IMPROVEMENT PROGRAMS. TRIPLE AIM AND SEEK TO ENSURE:- A SAFE AND SATISFYING HEALTH CARE EXPERIENCE- IMPROVED HEALTH OUTCOMES FOR INDIVIDUALS AND POPULATIONS- ACCESS AND AFFORDABILITY FOR OUR MEMBERSIN GENERAL, POPULATION BASED QUALITY ACTIVITIES ARE PERFORMED BY SCAN'S HEALTH CARE SERVICES DEPARTMENT, WHICH INCLUDES A DEDICATED AND HIGHLY QUALIFIED TEAM OF REGISTERED NURSES AND MASTER'S PREPARED SOCIAL WORKERS, SUPPORTED BY AN INTERDISCIPLINARY TEAM OF NURSES, SOCIALWORKERS, GERONTOLOGISTS, A BOARD CERTIFIED GERIATRICIAN, A BEHAVIORAL HEALTH SPECIALIST, AND A CLINICAL PHARMACIST.SCAN HEALTH PLAN SUPPORTED THE FORMATION OF THE SCAN FOUNDATION IN 2007 WITH A CONTRIBUTION OF $205 MILLION; FOR CALENDAR YEAR 2021 THE SCAN FOUNDATION AWARDED GRANTS IN THE AMOUNT OF $5,195,388 AND INCURRED PROGRAM EXPENSES IN THE AMOUNT OF $8,412,822IN ADDITION, SCAN HEALTH PLAN PARTICIPATES IN NUMEROUS ACTIVITIES RELATED TO THE CARE OF SENIORS WHICH PROVIDE SIGNIFICANT COMMUNITY BENEFIT, INCLUDING BUT NOT LIMITED TO THE FOLLOWING:1. SUPPORT CALIFORNIA ASSOCIATION OF LONG TERM CARE MEDICINE (CALTCM) BY PROVIDING CEO AND BOARD MEMBERS EDUCATIONAL PROGRAMS INCLUDING COVID MANAGEMENT AND EDUCATION: CALTCM IS AN ORGANIZATION OF PROFESSIONALS IN THE LONG TERM CARE FIELD. THE ORGANIZATION OFFERS PERFORMANCE IMPROVEMENT EDUCATION PROGRAMS TO IMPROVE THE QUALITY OF CARE AND PROFESSIONALISM OF STAFF IN LONG TERM SETTINGS.2. NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA): LONG TERM SERVICES AND SUPPORT ADVISORY COMMITTEE MEMBER; THIS COMMITTEE ASSISTS NCQA WITH THE DEVELOPMENT OF QUALITY STANDARDS FOR LONG TERM SERVICES AND SUPPORT (LTSS).3. BOARD MEMBER OF WISE & HEALTH AGING: SERVE AS BOARD MEMBER OF COMMUNITY AGENCY THAT SERVES VULNERABLE OLDER PEOPLE IN SANTA MONICA AND THE VICINITY. DEVELOPS CAPACITY OF AGENCY TO BETTER SERVE POPULATION. 4. SERVICE ON BOARDS OF DIRECTORS AND COMMITTEES FOR INDUSTRY GROUPS I.E., RESOURCE, INITIATIVE AND SOCIETY FOR EDUCATION (RISE); PHARMACY QUALITY ALLIANCE AND, AHIP; THESE AND OTHER INDUSTRY GROUPS CREATE POLICY AND SHARE BEST PRACTICES ON SUBJECTS RANGING FROM AUDIT AND ENCOUNTER SUBMISSION TO GENERAL INDUSTRY ISSUES; OUR EMPLOYEES ARE ACTIVE MEMBERS OF A NUMBER OF OTHER ORGANIZATIONS AS WELL.

INDEPENDENCE AT HOME:SCAN'S MISSION OF KEEPING SENIORS HEALTHY AND INDEPENDENT IS NOT LIMITED TO SCAN MEMBERS. SCAN RECOGNIZES ITS RESPONSIBILITY TO ENHANCE THE QUALITY OF LIFE FOR ALL THOSE IN THE COMMUNITIES WE SERVE. TO THAT END, SCAN SPONSORS AND PROMOTES INNOVATIVE GERIATRIC RESEARCH, INVESTS IN SIGNIFICANT COMMUNITY EDUCATION AND OUTREACH EFFORTS, AND SUPPORTS LIKE-MINDED COMMUNITY ORGANIZATIONS THROUGH GRANTS. THE CORNERSTONE OF SCAN'S COMMUNITY ENGAGEMENT COMES THROUGH INDEPENDENCE AT HOME (IAH), SCAN'S COMMUNITY BENEFIT DIVISION.THROUGH THE PROGRAMS RUN BY IAH, SCAN HAS CONNECTED WITH TENS OF THOUSANDS OF SENIORS AND CAREGIVERS ACROSS ITS SERVICE AREAS.IAH IS FUNDED BY STATE CONTRACT AS WELL AS SCAN HEALTH PLAN. THE PROGRAMS ARE GEARED TO SUPPORT THE UNDERSERVED, FRAIL AND DISABLED SENIORS IN OUR COMMUNITY.IAH'S HALLMARK PROGRAMS ARE:- MULTIPURPOSE SENIOR SERVICES PROGRAM (MSSP): SINCE 1977, THIS PROGRAM HAS PROVIDED LONG-TERM IN-HOME CARE MANAGEMENT FOR ADULTS 65 PLUS WHO QUALIFY FOR MEDI-CAL.- INSIGHTS: THIS PROGRAM PROVIDES IN-HOME MENTAL HEALTH SUPPORT.- COMMUNITY MEDICATION, EDUCATION, DATA & SAFETY (CMEDS): IN-HOME MEDICATION SAFETY AND ADHERENCE PROGRAM.- CAREGIVERS & OLDER ADULTS CONNECTED AND HEALTHY (COACH): IN-HOME CARE MANAGEMENT FOR SENIORS AND/OR THEIR CAREGIVERS.SCAN HEALTH PLAN COMMUNITY GIVING PROGRAM: SCAN'S COMMUNITY GIVING (CG) PROGRAM IS FOCUSED ON MEETING AN INDIVIDUAL'S BASIC NEEDS INCLUDING NUTRITION, SHELTER, HEALTH AND SOCIALIZATION, AND ON ENHANCING AN INDIVIDUAL'S ABILITY TO REMAIN INDEPENDENT IN THEIR OWN COMMUNITY.THIS IS ACCOMPLISHED THROUGH ONE-TIME OPERATING GRANTS. THE SCAN COMMUNITY GIVING COMMITTEE IDENTIFIES ORGANIZATIONS WHO'S MISSION ALIGNS WITH THE PROGRAM PRIORITIES. AS A RESULT OF THIS APPROACH, THE MAJORITY OF GRANTEES ARE IDENTIFIED AND CONTACTED BY OUR STAFF.POLICIES AND PROCEDURES:A. IDENTIFICATION AND VETTING OF POTENTIAL PROGRAM GRANTEES THE DIRECTOR, COMMUNITY OUTREACH, COLLABORATES WITH VARIOUS SCAN HEALTH PLAN DEPARTMENTS (I.E., HEALTH CARE SERVICES AND INDEPENDENCE AT HOME) AND REPUTABLE AGENCIES TO IDENTIFY PROSPECTIVE GRANTEE ORGANIZATIONS. THE PROSPECTIVE GRANTEES UNDERGO THE COMMUNITY GROUP VETTING PROCESS AND ARE MEASURED AGAINST THE FOLLOWING CRITERIA: 1) ALIGNMENT WITH THE SCAN HEALTH PLAN MISSION; 2) VERIFIED STATUS AS A NONPROFIT OR GOVERNMENTAL AGENCY WITH TAX-EXEMPT STATUS; AND 3) THE ORGANIZATION IS AT LEAST TWO YEARS OLD. SUCCESSFUL CANDIDATES ARE ADDED TO THE LARGER SCAN HEALTH PLAN GRANTEE POOL.B. SHORT LISTING POTENTIAL GRANTEES - THE DIRECTORS AND THE MANAGER, COMMUNITY OUTREACH AND GIVING, USE VARIOUS METHODS, INCLUDING OUTBOUND CALLS, INTERNET RESEARCH, AND INDUSTRY RATINGS TO REVIEW THE POTENTIAL GRANTEE POOL AND GENERATE A SHORTLIST.C. EVALUATION AND SELECTION OF GRANTEES BY THE COMMUNITY GIVING COMMITTEE (CGC) - THE CGC IS A NINE-MEMBER COMMITTEE REPRESENTATIVE OF ALL LEVELS OF MANAGEMENT AND CHAIRED BY THE VICE-PRESIDENT OF INDEPENDENCE AT HOME (IAH). THE CGC MEETS ON A QUARTERLY BASIS AND ITS ROLE IS TWOFOLD: 1) EVALUATE, SELECT, AND DECIDE THE AMOUNT TO BE AWARDED TO THE GRANTEE ORGANIZATIONS, AND 2) STEER THE COMMUNITY GIVING PROGRAM. THE CGC BASES ITS DECISION TO MAKE AWARDS ON THE INFRASTRUCTURE OF THE GRANTEE ORGANIZATION, THEIR PERCEIVED ABILITY TO EFFECTIVELY AND EFFICIENTLY IMPACT THE LIVES OF SENIORS, AND THEIR ABILITY TO CONTINUE A SUSTAINABLE RELATIONSHIP.D. GRANTEE OUTREACH - SUBSEQUENT TO THE CGC EARMARKING AND APPROVING GRANT FUNDS, THE DIRECTOR, COMMUNITY OUTREACH AND GIVING OR DESIGNEE, PLACES AN OUTREACH CALL TO THE PROSPECTIVE GRANTEE ORGANIZATION. THE GRANTEE ORGANIZATION IS INFORMED OF ITS SELECTION TO APPLY FOR A ONE-TIME GRANT VIA SCAN'S ONLINE GRANT TRACKING SYSTEM. THE DIRECTOR, COMMUNITY OUTREACH AND GIVING, REVIEWS EACH APPLICATION AND DISCUSSES CRITERIA WITH THE IAH VICE PRESIDENT AND COMMUNITY OUTREACH TEAM, IN ORDER TO MAKE A RECOMMENDATION FOR FUNDING. THE LIST OF RECOMMENDED GRANTEES IS SUBMITTED TO THE CGC EACH QUARTER TO BE DISCUSSED AND VOTED ON. A GRANT AGREEMENT IS DEVELOPED FOR EACH APPROVED GRANT, CONTAINING INFORMATION ON FUNDING RESTRICTIONS AND REQUIREMENTS FOR GRANT REPORTING. ONLY AFTER A SIGNED AGREEMENT HAS BEEN FULLY EXECUTED WILL THE GRANT PAYMENT PHASE BE INITIATED. IF THE FUNDING IS CONSIDERED EMERGENCY NEED DUE TO A PUBLIC HEALTH EMERGENCY OR NATURAL DISASTER, THIS PROCESS WILL EXCELERATE WITH THE COMMITTEE REVIEWING AND APPROVING REQUESTS MORE FREQUENTLY.