UnitedHealthcare Dual Special Needs Plans (DSNPs) are one type of Medicare Advantage Special Needs Plan. This protocol is applicable to:
It does not apply to members who are assigned to an Accountable Care Organization based upon the member’s PCP or whose PCP participates in a global capitation or risk-sharing arrangement with UnitedHealthcare.
This protocol establishes the guidelines and process for clinical integration, cooperation, and collaboration of and with respect to the care of members of UnitedHealthcare DSNPs managed by Optum. UnitedHealthcare or Optum will advise PCPs and members in those plans.
UnitedHealthcare DSNPs managed by Optum include the Optum At Home Program, which is an integrated care delivery program that coordinates the delivery and provision of clinical care of members in their place of residence. When members participate in this program, their health care providers must follow a communications structure that helps ensure better coordination of their medical care.
To promote the best possible outcomes, the program supports:
The Optum At Home Program’s Interdisciplinary Care Team includes an Optum-trained advanced practice clinician (ARNP/ PA), the member’s PCP and other health care providers as appropriate, in addition to the member and the member’s family. Together, they provide care customized to the member’s needs and goals of care.
We do member evaluations, care management and care coordination along with the member’s PCP, as well as other members of the Interdisciplinary Care Team.
The Optum At Home Program supplements care provided by our members’ PCPs. It is not intended to replace the care provided by our members’ PCPs.
If these protocols differ from or conflict with other protocols in connection with any matter pertaining to members of UnitedHealthcare DSNP plans managed by Optum, these protocols govern unless statutes and regulations dictate otherwise.
As the PCP of UnitedHealthcare DSNP members managed by Optum, you must: