How is a CSNP or DSNP member's care management health risk level determined?

The care management health risk level for a CSNP (Chronic Special Needs Plan) or DSNP (Dual Eligible Special Needs Plan) member is determined primarily by the completion of a Health Assessment that provides insights into their health status. This assessment is critical because it gathers comprehensive information about the member's medical history, current health conditions, medications, and social determinants of health.

By analyzing the responses provided in the Health Assessment, healthcare providers can accurately evaluate the patient's needs, identify areas that require attention, and tailor care management plans accordingly. This method helps in pinpointing specific health risks and allows for the creation of targeted interventions to improve the overall health outcomes for members.

Other methods, such as relying on a primary care provider's recommendation or conducting an annual review by the Medicare program, do not provide the same detailed and personalized understanding of the member's current health situation. While family member interviews can offer additional context, they are not a standardized or reliable method for determining health risk levels for CSNP or DSNP members.