Omicron Delta Chapter

MEMBER SPOTLIGHT

  Michael Puckett

Sigma Theta Tau’s 2010 Inductee Has Exciting New Role

Michael Puckett, BSN, BHA, MBA, IQCI, is one of the 2010 inductees into Sigma Theta Tau International: Omicron Chapter. As the Manager, Unity Clinical Programs for Health Integrated, Michael is responsible for the design, development and delivery of a SNP Model of Care (SNP MoC) program to meet the expectations of health plans as well as the directives provided through the Center for Medicare and Medicaid Services (CMS) guidance. Puckett’s work addresses the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) legislation that defines specific activity required of a Special Needs Program (SNP). According to the CMS, all SNPs are required to make an initial assessment of each new member’s needs and use the assessment to create specific and individualized care plans. MIPPA focuses on individuals with one or more of 15 chronic conditions ranging from drug dependence to diabetes.

The complexity of a case management strategy to meet the biopsychosocial needs of a SNP population and the expectations of regulatory bodies, like the National Committee for Quality Assurance (NCQA), requires diligence. To address this new and specific form of case management, Puckett helped create a program that includes:

*  An individualized health risk assessment;

*  Member stratification based on specific care needs;

*  An individualized care plan development;

*  Integrated care team approach that combines a social, behavioral and medical approach to establishing solutions for each  SNP enrollee’s needs;

*  Close communication with primary care physicians and clinicians; and

Providing reports to establish compliance with regulatory agencies and expectations of a health plan that assist with meeting Healthcare Expectations Data and Information Set (HEDIS) measures.

Developed in collaboration with leading Medicaid managed care plans and SNP providers, Puckett helped create a care management program that is complementary to a health plan’s own care management strategies. Additionally, the program is in lock step with CMS’s intentions to improve coordination and quality of care while reducing health care costs as designed by the MIPPA guidelines. Health plans that implement the Health Integrated SNP MoC solution will share a collective interpretation of the CMS regulations and best practices with other plans. Puckett’s team includes care coordinators and case managers to assist with the program. With their deep understanding of vulnerable populations, nurses establish a relationship with SNP MoC enrollees by educating them on how, when, why and where to obtain access to quality care.

Puckett’s journey has just begun, and will continue to grow as new legislation and new care management strategies evolve to meet the challenges of the current health care continuum.