In today’s dynamic healthcare environment, Special Needs Plans (SNPs) are often viewed through the lens of regulatory compliance. As I speak to many healthcare leaders, I hear that the primary function of the SNP Care Team is to execute compliance. In other words, skilled clinicians are hired to check off regulatory boxes. Let that sink in. However, when approached strategically, the SNP Model of Care (MOC) becomes a powerful tool to achieve the Quadruple Aim: enhancing patient outcomes, reducing costs, improving patient and provider experiences, and promoting health equity.
Understanding the SNP Model of Care
At its core, the MOC is a comprehensive framework mandated by the Centers for Medicare & Medicaid Services (CMS) for SNPs. In particular, SNP MOC Section 2 outlines how SNPs coordinate care for high-risk, high-need populations, encompassing:
- Comprehensive Health Risk Assessments (HRAs): the identification of clinical and social determinants of health needs.
- Individualized Care Plans (ICPs): the co-creation of interventions to each member’s unique needs, developed by the Care Manager with input from the member, caregivers as applicable, and an interdisciplinary care team.
- Interdisciplinary Care Teams (ICTs): a collaboration among healthcare providers based on member needs to coordinate care and streamline communication to deliver efficient and individualized cost-effective care.
- Ongoing Care Coordination and Monitoring: the delivery of continuous, individualized and cohesive care delivery.
These components are not mere checkboxes; they are levers for meaningful transformation. There needs to be a shift to understand these elements as the foundation for strategic, person-centered care that can elevate every part of the member experience and your plan performance.
1. Shift from Form Filling to Personalized, Proactive Care
When implemented with intention, the MOC shifts from a bureaucratic requirement to a patient-centered approach:
- Timely HRAs uncover both clinical risks and social determinants of health to guide coordinated care early to optimize health and decrease utilization.
- ICPs support targeted, timely, and culturally competent interventions that are tailored to individual needs.
- ICTs foster collaboration, alignment, and accountability across the care continuum.
Strategic Outcomes: Enhanced patient outcomes, reduced hospitalizations, smoother care transitions, and stronger STAR performance.
2. The MOC Facilitates Achievement of the Quadruple Aim
- Better Health Outcomes: Targeted care planning and preventative interventions reduce acute events and readmissions.
- Improved Patient Experience: Individualized attention and culturally competent care minimize gaps.
- Lower Costs: Efficient care coordination and medication management reduce avoidable utilization.
- Provider Well-being: Clear care pathways and team alignment alleviate provider burden.
- Strategic Outcomes: When the MOC is aligned with operational goals, organizations can directly support quality performance and value-based care metrics.
3. Empower Leadership and Staff Through Coaching for a Strategic Mindset
The impact of the MOC depends on how it’s led, not just how it’s written. This means that coaching and capacity-building are non-negotiable. The success of the MOC hinges on active leadership with subject matter expertise and skilled staff:
- Leadership Coaching: Aim to cultivate a strategic mindset to champion the MOC rather than a checklist mindset.
- Staff Training: Help interdisciplinary teams understand the ‘why’ behind the MOC. Equip teams with skills to execute care plans and coordinate empathetically and precisely; understand value-based care and how the teams’ work impact total cost of care; how to engage and lead an ICT.
- Operational Alignment: Ensure that processes and technology reflect values-based leadership beyond compliance. Align technology platforms and team use with overarching organizational goals.
- Dynamic Planning: Treat the MOC as an evolving roadmap for impact.
Strategic Outcomes: Empowered teams delivering coordinated, cost-effective, and compassionate care.
4. Build Organizational Resilience
A well-operationalized MOC positions organizations to:
- Navigate CMS Audits Confidently: Demonstration of ability to adhere to quality standards.
- Align Clinical and Operational Strategies: Ensure cohesive and efficient care delivery.
- Demonstrate Value: Showcase commitment to members and stakeholders.
Strategic Outcomes: Greater agility, regulatory confidence, and long-term sustainability to position the organization as a compliant plan and a trusted, high-performing partner in value-based care.
5. Reinforce Partnerships with PCPs
The MOC provides a structure to engage primary care providers as true partners, rather than passive participants:
- Share care plans and risk stratification data with PCPs
- Co-manage high-risk members with ICTs using the plan’s interdisciplinary staff
- Close gaps in care collaboratively
- Reduce duplication and streamline transitions
Strategic Outcome: When PCPs are aligned with MOC strategy, care becomes more continuous, coordinated, and cost-effective.
The MOC Is a Blueprint for Impact
The Special Needs Plan Model of Care can be seen as a set of regulatory obligations or as a strategic lever for transformation. When healthcare leaders shift their mindsets from compliance to care strategy, the MOC becomes a living, breathing framework that powers organizational performance, improves patient outcomes, and advances health equity. This shift doesn’t happen by accident. It requires intention, investment, and leadership at every level.
If your MOC lives only as a document you need to check off, it’s time to bring it to life. It’s time to coach teams differently, structure systems intentionally, and lead with a vision that centers people, not paperwork. When done right, the Model of Care is not just how we check boxes, it’s how we change lives.