SynCare’s Case Management Process Includes:

Member Enrollment & Eligibility Verification
Participation in SynCare programs is voluntary. Upon receiving new member data, SynCare verifies eligibility and for eligible member, proceed to contact members to enroll and participate in the program. For those ineligible members, SynCare disenrolles until member is once again eligibility for services.

Opt-In/Opt-Out Processing
SynCare’s Opt-In/Opt-Out process is a one-time procedure in which individuals indicate whether they wish to participate in the program. Once an individual has opted in, SynCare assigns them to a care team based on individual risk assessment levels, geographic location, and cultural/language requirements.

Risk Assessment & Stratification
SynCare administers a risk assessment survey to stratify participants into appropriate risk levels based on medical history, psychosocial and environmental factors, and family and community support systems. Key measures are utilized to identify a participant’s readiness to change and ensure effective risk stratification. Routine follow-up assessments are conducted throughout the program and at program completion.

Incentives
Maintaining healthy lifestyle change requires significant, long-term commitment and effort. In order to reward such efforts and help motivate participants toward success, SynCare offers a variety of incentives including cash, gift cards or discounts to physical fitness facilities.

Telephonic Interactions
SynCare provides telephonic support as needed based on a participant’s risk stratification level. Interactions are focused and goal-oriented, and SynCare’s case managers are trained in motivational interviewing and behavior modification techniques. During these interactions, case managers may assist participants with scheduling medical appointments, offer guidance on fitness and nutrition plans, provide coaching on risk reduction, or offer information about community activities and resources.

Face-to-Face Interactions
SynCare also offers the option of face-to-face interactions. Similar in content and goals to telephonic support, these visits are typically reserved for highest risk patients and may occur in a participant’s home, place of employment, or an alternate location.

Telemonitoring
Telemonitoring services provide remote access to vital statistics data, in real time which allow for more efficient case management of the member populations.

Educational Materials
SynCare provides health education materials that follow national clinical guidelines to improve clinical outcomes and lower associated medical expenses. These are available as needed, and may be delivered through the at the home visits, mail or via the Web.

Community Resource Linkage
During direct patient interactions, SynCare often identifies additional participant needs and provides linkage to community resources that are available to help meet those needs. These include financial, environmental, material, abuse, smoking cessation, or behavioral health stressors.

Physician Participation
SynCare recognizes the value and strength of the relationship between the physician and patient and works to maintain positive relationships with our participants’ providers. SynCare’s staff communicates regularly with providers, and providers are encouraged to review, adjust or enhance participant care plans.

Data Management (SynCMS™)
A vital part of SynCare’s services is our proprietary case management application, SynCMS. Feature-rich and HIPAA compliant, SynCMS is an integrated case management solution that offers real-time participant information in an easy-to-use dashboard format. It also offers comprehensive program evaluation, outcomes analysis and customizable reporting tools.

Satisfaction Surveys
SynCare administers participant and physician satisfaction surveys quarterly based on guidelines established by the NCQA.