The 2013 Dual Eligible SNPs Program Goals are:

* Increased access  to medical, mental health and social services demonstrated by 3% increase  in referrals to these services (PCP, Specialist provider, MHSA/PsychCare, MTM/Outcomes)

* Promote healthy lifestyle changes  through improved access to preventive health services as demonstrated by 3% improvement in the following Health Effectiveness Data and Information  Set  (HEDIS)  indicators  and  100%  of  members  receiving  education  related  to  self  directed  care:

  Mammography screening
  Colorectal Screening
  Osteoporosis Management in Older Women

* Improve member perception of independence and self-care management skills by 3%

* Reduce  dependence  on  Emergency  Department  (ED)  treatment  as  evidenced  by  a  1.5%  decrease in ED visits from previous year

* Reduce inpatient facility admission (IP) rate by 1.5% from previous year
* Reduce readmission rate by 1.5% from previous year

* Increase HRA completion rate within 30 days by 1% from previous year

* Increase specialist provider training by 1% from previous year

* Improve coordination of care through:
  An identified point of contact, the Care Manager, in 100% of managed members
  Individualized Care Plans created for 100% of SNP enrolled members

* Improve transitions of care through:
  Improving timeliness of Post Discharge Support contact by 5%
  Improve process to communicate ICT reviews with PCPs via telephonic and written  communication methods

*  Conduct ICT reviews on 80% of managed SNP members annually 

*  Improve member satisfaction with health status and care management services by 3%