Delegation Model

The Alliance assigns certain plan functions to delegates, or subcontractors and downstream subcontractors. The Alliance’s Delegate Oversight (“DO”) program detailed throughout this document is executed with the same level of diligence, care and resolve across all the counties the Alliance operates in.

The DO program helps achieve the following goals;

• Capacity and access: expand provider capacity and access. Improve the number and type of providers and/or timely access to care.
• Better health outcomes: improve quality of care and achieve better health outcomes. This is measured via Clinical Measures performance levels (CBI/HEDIS).
• Member satisfaction: increase member satisfaction. This is measured by the CAHPS Clinician and Group Survey.

The Alliance’s Delegation Model is designed and implemented to positively impact Alliance members. In summary, the Delegation Model operates as follows:

• Identified opportunity: the Alliance identifies an opportunity to delegate a plan function to improve members’ satisfaction, quality of care and/or timely access to care.
• Delegation assessment: evaluation of delegate’s capacity to meet Alliance standards, legal requirements and to perform delegated functions.
• Contract execution: execute legal agreement binding the Alliance and its Delegate to legal requirements and performance standards.
• Ongoing monitoring: review contact reporting requirements and performance indicators. Issue performance corrections as needed.
• Annual evaluation: assessment of delegated function standards. Issue performance corrections as needed.
• Corrective action: Corrective Action Plan > De-delegation.