Model of Care Training Summary

Model of Care Overview

Provider Training Requirement

As a Special Needs Plan (SNP), Highmark Wholecare is required by the Centers for Medicare and Medicaid Services (CMS) to administer a Model of Care (MOC). In accordance with CMS guidelines, Highmark Wholecare's SNP MOC is the basis of design for our care management policies, procedures, and operational systems that will enable our Medicare Advantage Organization (MAO) to provide coordinated care for special needs individuals. Our network providers are expected to complete and attest to MOC training on an annual basis.

The SNP MOC is divided into four sections:

1. Description of the SNP population
2. Care Coordination
3. SNP Provider Network
4. Quality Measurement & Performance

The annual provider training focuses on the SNP Provider Network section and outlines what Highmark Wholecare expects from our providers in maintaining an effective MOC. The MOC ensures that the SNP Provider Network is comprehensive and able to care for the unique and specific needs of the population by implementing the following elements throughout the SNP provider network.

1. Specialized Expertise
2. Use of Clinical Practice Guidelines
3. Care Transition Protocols
4. Annual Model of Care Training

The training also includes common MOC terms and definitions as well as Highmark Wholecare contact information.

Action Required:

Review the Model of Care Provider Training found on our website. Once you have completed this training, please submit an attestation indicating that you have completed and comprehend the Model of Care training by submitting your attestation.