Coventry Health Care of Florida. Special Needs Plan (SNP) Model of Care Annual Training
|
|
- Agnes Hunter
- 1 years ago
- Views:
Transcription
1 Coventry Health Care of Florida Special Needs Plan (SNP) Model of Care Annual Training 1
2 Course Overview The Centers for Medicare and Medicaid (CMS) require all contracted medical providers to receive basic training about the Special Needs Plans (SNP) Model of Care. The SNP Model of Care is the plan for delivering coordinated care and case management to special needs members. This course will describe how Coventry and its contracted providers can work together to successfully deliver the SNP Model of Care. 2
3 Learning Objectives After the training, attendees will be able to: Describe the basic components of the Coventry SNP Model of Care. Explain how Coventry case management programs work and how contracted providers will work with the programs. Describe the essential role of contracted providers in delivering the SNP Model of Care. 3
4 What are Special Needs Plans? Medicare Advantage Special Needs Plans (SNPs) are designed for specific groups of members with special health care needs. Medicare SNPs are specially designed to have the following features: Enrollment limited to Medicare beneficiaries within the target SNP population. The benefit plan custom designed to meet the needs of the designated population. Additional election periods during which SNP members may change their Medicare coverage. 4
5 What are SNPs? (cont d) There are three types of Medicare SNPs: Individuals Dually Eligible for Medicare and Medicaid benefits and services Individuals with Chronic Conditions Individuals who are Institutionalized or eligible for nursing home care Coventry has 5 Dual Eligible Special Needs Plans 5
6 What is the SNP Model of Care? The SNP Model of Care is the plan for delivering case management services for Medicare Advantage members with special needs. 6
7 What is the SNP Model of Care? Model of Care elements 1.SNP-Specific Target Population 2.Measurable Goals 3.Staff Structure and Care Management Roles 4.Interdisciplinary Care Team (ICT) 5.Provider Network with Expertise and Use of Clinical Practice Guidelines 6.Model of Care Training for Provider Network 7.Health Risk Assessment 8.Individualized Care Plan (ICP) 9.Communication Network 10.Care Management of the Most Vulnerable Subpopulations 11.Performance and Health Outcome Measures 7
8 Model of Care Element: SNP-Specific Target Population 74% of Coventry SNP members are over age 65 years and 57% are female and 43% male Type of Dual SNP 36% are Full Medicaid recipients 71% are Qualified Medicare Beneficiaries (QMB) 17% are Specified Low Income Medicare Beneficiaries (SLMB) 8
9 Model of Care Element: SNP-Specific Target Population Conditions ranked by prevalence Diabetes Behavioral Health CHF Coronary Artery Disease Conditions ranked by cost Renal Failure Pharmacy Malignancies AIDS/HIV 9
10 Model of Care Element: Measurable Goals Coventry s mission is to optimize the health and well being its aging, vulnerable and chronically ill members. Examples of measurable goals: To ensure care is coordinated across specialty, multi-setting care continuum through a central point of access 100% of Coventry SNP members will be enrolled in case management. To provide a seamless transition across health care settings, Coventry has initiated a Transition of Care Program that is geared towards the prevention of readmissions. 10
11 Model of Care Element: Staff Structure and Care Management Roles Coventry recognizes the needs of the SNP membership and provides the appropriate staff to perform the functions needed to support this population. Clinical staff include Nurse Case Mangers, Medical Directors, Social Workers, Behavioral Health specialists and Pharmacists. Administrative staff include Administrative Assistants, Enrollment Specialists, Customer Service Reps, Grievance and Appeals Investigators. 11
12 Model of Care Element: Interdisciplinary Care Team (ICT) The Coventry ICT is assigned to each SNP member. The composition of the ICT is determined by the needs of the individual member. The ICT uses Health Risk Assessments (HRA) findings, medical history and current clinical diagnostics and assessments to continually modify the member s Individualized Care Plan (ICP) so that it reflects the member s most current condition and needs. After each ICT, the member s Case Manager updates the member s ICP and is responsible for facilitating completion of the member s goals. 12
13 Model of Care Element: Interdisciplinary Care Team (ICT) Sample ICT composition The Coventry SNP Medical Director SNP Case Managers SNP Social worker The plan s delegated behavioral health provider Coventry s pharmacist The beneficiaries PCP (if applicable) The beneficiary and/or their designated advocate or caregiver (if possible) 13
14 Coventry SNP Interdisciplinary Team Home Health Coventry SNP Management Team Primary Care Provider Coventry Vendors Member & Case Manager Specialists Pharmacists Family/Caregiver Social Services 14
15 Model of Care Element: Provider Network with Expertise and Use of Clinical Practice Guidelines All major specialties and services are represented on the Coventry panel of participating providers. A geo-access evaluation is performed annually to assure SNP members have access to providers necessary for rendering needed care. All Coventry Health Care providers are expected to practice evidence-based medicine. Coventry s Provider Portals contain clinical practice guidelines for reference. 15
16 Model of Care Element: Model of Care Training for Provider Network Coventry providers will have access to MOC training annually via DirectProvider.com. Yearly attestation of completion is required and can also be done through the site. Coventry staff are also trained annually either on-site and/or via teleconferences. 16
17 Model of Care Element: Health Risk Assessment (HRA) Every SNP member is evaluated at least twice annually with a comprehensive telephonic or faceto-face Health Risk Assessment. Results of this HRA are available to the provider via the SNP Management Department. 17
18 Model of Care Element: Individualized Care Plan (ICP) Results of the HRA are combined with laboratory, pharmacy, emergency department and hospital claims data to generate an Individualized Care Plan (ICP) for each member. The Interdisciplinary Care Team finalized the ICP with input from PCPs, specialists, members and their caregivers and/or families. The ICP is the initial and ongoing mechanism of evaluating the member s current health status and formulating an action plan to address care needs in conjunction with the ICT and member. Members are then placed into case management and triaged to any appropriate Coventry Disease Management programs. 18
19 Model of Care Element: Communication Network CMS requires ongoing communication between the member, provider and the Health Plan for all SNP members. Communication with providers and members occurs in a variety of ways Telephonic outreach by Case Managers and Social Workers Educational and informational mailings Blast Faxes Care Plan web portal Coventry Provider Portal 19
20 Model of Care Element: Care Management of the Most Vulnerable Subpopulations Coventry s SNP population is tiered based on the member s current health status and needs Tier 3 contains the most vulnerable members including those at risk of unplanned transitions of care. Tier 3 members are generally enrolled in several Coventry Disease Management programs. Tier 1 contains the most stable SNP members. 20
21 Model of Care Element: Performance & Health Outcome Measures Coventry conducts a Quality Improvement program to monitor health outcomes and implementation of the Model of Care by: Collecting SNP specific HEDIS measures Meeting NCQA SNP Structure and Process standards Conducting a Quality Improvement Project (QIP) annually that focuses on improving a clinical or service aspect that is relevant to the SNP population (for example Fall Prevention) Providing a Chronic Care Improvement Program (CCIP) for chronic disease that identifies eligible members, intervenes to improve disease management and evaluates program effectiveness Collecting data to evaluate if SNP program goals are met 21
22 What are the SNP Model of Care Goals for our Coventry members? The SNP Model of Care Goals for our members fall into six categories: 1. Improve Access to medical, mental health, social services, affordable care and preventative health services 2. Improved Coordination of Care through an identified point of contact 3. Improved Transition of Care across health care settings and practitioners 4. Assure Appropriate Utilization of services 5. Assure Cost-Effective service delivery 6. Improve Beneficiary Health Outcomes 22
23 Coventry SNP Model of Care (cont d) Members receive follow up, referral, education Member is re-assessed at least annually Case Managers and PCPs work closely together to monitor the Individualized Care Plan Coventry will disseminate evidence-based clinical guidelines and will conduct studies: To measure benefits to member and Coventry To monitor quality of care To evaluate the Model of Care 23
24 Coordination of Services Coventry Health Care considers its SNP management program to be an important and effective model that enhances the member s access to care, improves quality of care, and ensures the continuity of beneficial services, including medical, behavioral health, social, dental, and pharmacy services. 24
25 Coventry SNP Management Program Inpatient Census Enrollment Initial Health Screening Monthly Risk Stratification Member Self Referral Community Referral Physician Specialist Referral Case Management: Health Risk Assessment (HRA) UM Case Management/ Care Transitions Program Disease Management Community Services End of Life/Palliative Care Behavioral Health Emergency Department Utilization Management 25
26 Coventry Case Management Programs: Inpatient Care Management & Care Transitions Inpatient Care Management Coventry clinical staff coordinate with providers to assist members in the hospital or in a skilled nursing facility to access care at the most appropriate level Care Transitions The SNP Case Managers and Social Workers ensure members have appropriate follow-up care after a hospitalization The goal is to prevent hospital re-admissions 26
27 Coventry Case Management Programs: Disease Management Disease Management Helps members with Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD)/Asthma, End Stage Renal Disease (ESRD), Diabetes, Falls and Fractures, and Hypertension. Provides education to members about their disease, self-management/self-care, medication and nutrition. 27
28 What Coventry Case Management can do to help Providers Determine member s personal goals and needs Coordinate care Identify problems/anticipate crises Educate members about their health conditions and medications Coach members to manage according to the provider s plan of care Prepare members/caregivers for their provider visit Refer members to community resources 28
29 What Coventry Case Management can do to help Providers Manage the process of care transitions Identify problems that could cause transitions Where possible prevent unplanned transitions Coordinate Medicare and Medicaid benefits for members Identify and assisting members with changes in their Medicaid eligibility 29
30 Working with our Providers Coventry s Provider partners are an invaluable part of the SNP Management Team. Coventry s SNP Model of Care offers an opportunity for us to work together for the benefit of our member, your patient, by Enhanced communication Focusing on each individual member s special needs Delivering case management programs to assist with the patient s non-medical needs Supporting your plan of care 30
31 Your role as the Provider Communicate with Coventry SNP Case Managers, members of the Interdisciplinary Care Team (ICT), members and caregivers Collaborate with Coventry on the Individualized Care Plan (ICP) Review and respond to patient-specific communication Maintain ICP in member s medical record Participate in ICT 31
32 Model of Care Key Elements: Table of Responsibility 32
33 Coventry Contacts for SNP Model of Care Yisel De Llano, MS Health Services Director SNP Program Lissette Gomez Administrative Assistant SNP Program Mary R Mailloux, MD, MMM, FACEP Medical Director SNP Program
2014 Model of Care Training SHP_2014838A
2014 Model of Care Training SHP_2014838A 1 Model of Care Training This course is offered to meet the CMS regulatory requirements for Model of Care Training for our Special Needs Plans. It also ensures
MODEL OF CARE OVERVIEW
MODEL OF CARE OVERVIEW Gateway Health SM (Gateway) currently offers four Special Needs Plans (SNPs): Gateway Health Medicare Assured Diamond SM Is a Dual Eligible Special Needs Plan (DSNP) and covers those
Medicare: 2015 Model of Care Training 04/2015
Medicare: 2015 Model of Care Training 04/2015 1 Model of Care Training This course is offered to meet the CMS regulatory requirements for Model of Care Training for our Special Needs Plans. It also ensures
Special Needs Plan Model of Care 101
Special Needs Plan Model of Care 101 What is a Special Needs Plan? First of all it s a Medicare MA-PD, typically an HMO Consists of Medicare enrollees who meet special eligibility requirements In our case
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Medicare Quality Management Program Overview Quality Improvement (QI) Overview At Coventry, we
Model of Care- Provider Program
Model of Care- Provider Program This Model of Care Program only applies to those Members enrolled in Freedom and Access plans Developed by: Quality Improvement Revised: 09/24/2015 EC Internal Approval_086_MOC_Provider
Passport Advantage Provider Manual Section 10.0 Care Management Table of Contents
Passport Advantage Provider Manual Section 10.0 Care Management Table of Contents 10.1 Model of Care 10.2 Medication Therapy Management 10.3 Care Coordination 10.4 Complex Case Management 10.0 Care Management
Special Needs Plan Provider Education
Special Needs Plan Provider Education Reviewed September 2014 Learning Goals What is a Special Needs Plan (SNPs) What differentiates a SNP from other MA plans What SNPs are offered by Freedom Health and
Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases
Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Epidemiology Over 145 million people ( nearly half the population) - suffer from asthma, depression and other chronic
Special Needs Program Model of Care Training 2013
Special Needs Program Model of Care Training 2013 Medical Management Department Presented by: Emblem Health February 1, 2013 TABLE OF CONTENTS Special Needs Plans: Overview.. Slide 4 Special Needs Plans:
NetworkCares (PPO SNP) 2016 Model of Care Training. H5215_360r1_092714 NHIC 12/2015 m-cnm-ncprovpres-1215
NetworkCares (PPO SNP) 2016 Model of Care Training H5215_360r1_092714 NHIC 12/2015 m-cnm-ncprovpres-1215 Introduction This course is offered to meet the CMS regulatory requirements for Model of Care Training
Medicare Managed Care Manual Chapter 5 - Quality Assessment
Medicare Managed Care Manual Chapter 5 - Quality Assessment Transmittals Issued for this Chapter Table of Contents (Rev. 117, 08-08-14) 10 Introduction 20 Medicare Quality Improvement Program 20.1 Chronic
Virginia s Healthy Returns Alternative Benefit Design
Virginia s Healthy Returns Alternative Benefit Design Presentation to the: National Governors Association s Center for Best Practices: State Defined Benefit Package Workshop Patrick W. Finnerty, Director
Department of Human Services Health Care Reform Review Committee Representative George Keiser, Chairman March 19, 2014
Department of Human Services Health Care Reform Review Committee Representative George Keiser, Chairman March 19, 2014 Chairman Keiser, members of the Health Care Reform Review Committee, I am Julie Schwab,
VNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City. Roberta Brill Vice President, VNS Health Plans
VNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City Roberta Brill Vice President, VNS Health Plans VNS CHOICE Organization Subsidiary of the Visiting Nurse Service of New York
SNP Model of Care Provider Training
SNP Model of Care Provider Training The Centers for Medicare and Medicaid Services (CMS) requires all Medicare Advantage Special Needs Plans (SNPs) to have a Model of Care (MOC) All information about the
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Quality Management Program 2012 Overview Quality Improvement
Quality Management (QM) Program Goals and Objectives
Quality Management (QM) Program Goals and Objectives The goals and objectives of the QM Program are: To improve the quality of medical and behavioral health care and service provided to Members through
Quality Management (QM) Program Goals and Objectives The goals and objectives of the QM Program are: To improve the quality of medical and behavioral
Quality Management (QM) Program Goals and Objectives The goals and objectives of the QM Program are: To improve the quality of medical and behavioral health care and service provided to Members through
MODULE 11: Developing Care Management Support
MODULE 11: Developing Care Management Support In this module, we will describe the essential role local care managers play in health care delivery improvement programs and review some of the tools and
Special Needs Plans (SNPs) Model of Care
Special Needs Plans (SNPs) Model of Care Annual Training Herminia Escobedo Health Net Presentation for Provider Teleconference 2/25/15 Presentation by Candace Ryan, QI Manager Medicare Rhonda Combs, Director
Section Care Management for Serious Mental Illness (SMI) Members
Section 15.0 - Care Management for Serious Mental Illness (SMI) Members 15.1.1 Introduction 15.2.1 Scope 15.3.1 Objectives 15.4.1 Procedures 15.4.1-A. Responsibilities 15.4.1-B. Eligibility 15.4.1-C. Member
Kaiser Permanente of Ohio
Kaiser Permanente of Ohio Chronic Disease Management Program March 11, 2011 Presenters: Amy Kramer and Audrey L. Callahan 1 Objectives 1. Define the roles and responsibilities of the Care Managers in the
CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions...
TABLE OF CONTENTS SECTION PAGE NUMBER Background... 2 Policy... 2 535.1 Member Eligibility and Enrollment... 2 535.2 Health Home Required Functions... 3 535.3 Health Home Coordination Role... 4 535.4 Health
Accountable Care Fundamentals for Medical Practice Executives
Accountable Care Fundamentals for Medical Practice Executives Nathan Anspach, FACMPE Senior Vice President and Chief Executive Officer John C. Lincoln Accountable Care Organization and John C. Lincoln
MEDICARE HEALTH OUTCOMES SURVEY (HOS) AN OVERVIEW FOR PROVIDERS
MEDICARE HEALTH OUTCOMES SURVEY (HOS) AN OVERVIEW FOR PROVIDERS WHAT IS MEDICARE HEALTH OUTCOMES SURVEY (HOS)? HOS is: A patient-reported, confidential survey designed to collect valid and reliable clinical
UTILIZATION MANAGEMENT PROGRAM Introduction Health Care Services
UTILIZATION MANAGEMENT PROGRAM Introduction Health Care Services Call us: 1-888-898-7969, Option 1, then Option 4 Fax us: 1-800-594-7404 Business hours: Monday Friday (excluding holidays), 8:30 a.m. to
2012 Serving Dual Eligible Members
Cover area with cropped image. Do not overlap blue bar. Completely cover gray area. Cover area with cropped image. Do not overlap blue bar. Completely cover gray area. Cover area with cropped image. Do
HealthCare Partners of Nevada. Heart Failure
HealthCare Partners of Nevada Heart Failure Disease Management Program 2010 HF DISEASE MANAGEMENT PROGRAM The HealthCare Partners of Nevada (HCPNV) offers a Disease Management program for members with
HMO Special Needs Plan (SNP)
HMO Special Needs Plan (SNP) BlueCare Plus Tennessee, an Independent Licensee of the BlueCross BlueShield Association BlueCare Plus Tennessee is an HMO SNP plan with a Medicare contract and a contract
Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
Page1 G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify G.6 When to Notify G.11 Case Management Services G.14 Special Needs Services G.16 Health Management Programs
Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014
Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014 Introduction The Office of Mental Health (OMH) licensed and regulated Assertive Community
Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.9 Case Management Services G.12 Special Needs Services
Quality Improvement Program
Introduction Molina Healthcare of Michigan serves Michigan members in counties throughout the state since 2000. For all plan members, Molina Healthcare emphasizes personalized care that places the physician
Breathe With Ease. Asthma Disease Management Program
Breathe With Ease Asthma Disease Management Program MOLINA Breathe With Ease Pediatric and Adult Asthma Disease Management Program Background According to the National Asthma Education and Prevention Program
GUILDNET HEALTH ADVANTAGE MODEL OF CARE
GUILDNET HEALTH ADVANTAGE MODEL OF CARE Introduction: GuildNet Health Advantage is a dual eligible SNP. The plan provides a rich benefit package to beneficiaries eligible for Medicare and full Medicaid
Care Coordination. The Embedded Care Manager. Presented by Thomas Decker, MD Mary Finnegan, BSN, M.Ed
Care Coordination The Embedded Care Manager Presented by Thomas Decker, MD Mary Finnegan, BSN, M.Ed Goals of Care Management The goals of care Management are consistent with the Triple Aim: Improve population
CCNC Care Management
CCNC Care Management Community Care of North Carolina (CCNC) is a statewide population management and care coordination infrastructure founded on the primary care medical home model. CCNC incorporates
MI Health Link Program Nursing Facility Presentation June 3, 2015. Molina Healthcare of Michigan
Program Nursing Facility Presentation June 3, 2015 Molina Healthcare of Michigan Headline Goes Here The Molina Story In 1980, the late Dr. C. David Molina, founded Molina Healthcare with a single clinic
Provider Manual. Section 18.0 - Case Management and Disease Management
Section 18.0 - Case Management and Disease Management 18.1.1 Introduction 18.2.1 Scope 18.3.1 Objectives 18.4.1 Procedures Case Management 18.4.1-A. Referrals 18.4.1-B. Case Management Mercy Maricopa Acute
UCare provides case management for all UCare members not affiliated with one of the above listed care systems. 2011 UCare for Seniors
Case Requirements Updated 3/16/2011 According to the Case Society of America (CMSA), Case Model Act of 2009, Case management is a collaborative process of assessment, planning, facilitation, care coordination,
Dual Eligibles and State Innovations in Care Management
Dual Eligibles and State Innovations in Care Management Ann Kohler, Director of Health Services National Association of State Medicaid Directors American Public Human Services Association Ann.Kohler@aphsa.org
MDFlow Case Management & Disease Management (CM/DM) System
MDFlow Case Management & Disease Management (CM/DM) System The COMPLETE and CUSTOMIZED Case and Disease Management Solution for Healthcare Payers (HMOs, PPOs and MA Plans) Accountable Care Organizations
Game Changer at the Primary Care Practice Embedded Care Management. Ruth Clark, RN, BSN, MPA Integrated Health Partners October 30, 2012
Game Changer at the Primary Care Practice Embedded Care Management Ruth Clark, RN, BSN, MPA Integrated Health Partners October 30, 2012 Objectives To describe the recent evolution of care management at
Medicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Kentucky Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...
Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs
Idaho Health Home State Plan Amendment Matrix: Summary Overview This matrix outlines key program design features from health home State Plan Amendments (SPAs) approved by the Centers for Medicare & Medicaid
Medicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013
Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013 Introduction The OMH licensed and regulated Assertive Community Treatment Program (ACT) will
Continuity of Care Guide for Ambulatory Medical Practices
Continuity of Care Guide for Ambulatory Medical Practices www.himss.org t ra n sf o r m i ng he a lth c a re th rou g h IT TM Table of Contents Introduction 3 Roles and Responsibilities 4 List of work/responsibilities
Humana Physician Quality Rewards Program 2014
Humana Physician Quality Rewards Program 2014 Medicare Name Date External Presentation 1430ALL0114 B Humana s Accountable Care Continuum Provider Quality Rewards HEDIS based quality metrics Clinical +
Call-A-Nurse Location
Call-A-Nurse A 24-hour medical call center, specializing in registered nurse telephone triage, answering service, physician and service referral, and class registration. Call-A-Nurse Location Call-A-Nurse
CONTENTS. o o o o o o o o o o o o
CONTENTS o o o o o o o o o o o o What Are Medicare Advantage (MA) Plans? Who Can Join and When? MA Trial Right Special Election Period How MA Plans Work MA Costs Types of Medicare Advantage Plans Rights
Special Needs Plan. Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of True Blue Special Needs Plan (HMO).
2010 Evidence of Coverage HMO Special Needs Plan Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of True Blue Special Needs Plan (HMO). This booklet gives you the
ACO Project Overview and Key Elements. Presented to FSSA September 3, 2013. 2013 Franciscan Alliance, Inc.
ACO Project Overview and Key Elements Presented to FSSA September 3, 2013 2013 Franciscan Alliance, Inc. Background of Presentation House Enrolled Act 1328 requires the Indiana Family and Social Services
Medicare Advantage special needs plans
C h a p t e r14 Medicare Advantage special needs plans R E C O M M E N D A T I O N S 14-1 The Congress should permanently reauthorize institutional special needs plans. COMMISSIONER VOTES: YES 16 NO 0
Medicaid Health Plans: Adding Value for Beneficiaries and States
Medicaid Health Plans: Adding Value for Beneficiaries and States Medicaid is a program with numerous challenges, both for its beneficiaries and the state and federal government. In comparison to the general
Our Patient-Centered Medical Home a Process, not a Click
Our Patient-Centered Medical Home a Process, not a Click Richard Johnston, M.D. President, Medical Clinic of North Texas, P.A. Medical Clinic of North Texas, P.A. MCNT Physician Owned Primary Care Medical
Response to Serving the Medi Cal SPD Population in Alameda County
Expanding Health Coverage and Increasing Access to High Quality Care Response to Serving the Medi Cal SPD Population in Alameda County As the State has acknowledged in the 1115 waiver concept paper, the
CCI Stakeholder Meeting Friday, May 9, 2014 1:00 pm 3:00 pm Meeting Minutes
CCI Stakeholder Meeting Friday, May 9, 2014 1:00 pm 3:00 pm Meeting Minutes Welcome and Introductions Bobbie Wunsch, Facilitator L.A. Care CCI/CMC Update John Wallace, Chief Operating Officer Mr. Wallace
Pushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association
Pushing the Boundaries of Population Health Management: How University Hospitals Launched Three ACOs July 26, 2013 American Hospital Association Eric J. Bieber, M.D. Chief Medical Officer, University Hospitals
Disease Management Identifications and Stratification Health Risk Assessment Level 1: Level 2: Level 3: Stratification
Disease Management UnitedHealthcare Disease Management (DM) programs are part of our innovative Care Management Program. Our Disease Management (DM) program is guided by the principles of the UnitedHealthcare
How are Health Home Services Provided to the Medically Needy?
Id: NEW YORK State: New York Health Home Services Effective Date- January 1, 2012 SPA includes both Categorically Needy and Medically Needy Beneficiaries- check box 3.1 - A: Categorically Needy View Attachment
2015 Optimum Healthcare Sales Presentation Video Transcript-
2015 Optimum Healthcare Sales Presentation Video Transcript- H5594_15SalesPresVidv2_CMS_Approved Welcome to this presentation on Optimum HealthCare s Medicare Advantage Plans. Today you will learn about
The GRACE Model Geriatric Resources for Assessment and Care of Elders
Evidence-Based Care Transition Programs AoA, CMS, VA Grantee Meeting The GRACE Model Geriatric Resources for Assessment and Care of Elders Steven R. Counsell, MD Mary Elizabeth Mitchell Professor and Director,
2012 Indiana Health Coverage Programs Annual Seminar. Care Select 101: Indiana Care Select Program Overview
PCS0144 (9/12) Mitchell E. Daniels, Jr., Governor State of Indiana Indiana Family and Social Services Administration 2012 Indiana Health Coverage Programs Annual Seminar Care Select 101: Indiana Care Select
Hospital April 2016. EHR Interoperability in Conjunction with Inovalon Pilot
Hospital April 2016 IN THIS EDITION: EHR Interoperability in Conjunction with Inovalon Pilot Lifestyle Management Programs Model of Care Overview Reminder on Prior Authorization EHR Interoperability in
MedStar Family Choice (MFC) Case Management Program. Cyd Campbell, MD, FAAP Medical Director, MFC MCAC June 24, 2015
MedStar Family Choice (MFC) Case Management Program Cyd Campbell, MD, FAAP Medical Director, MFC MCAC June 24, 2015 Case Management Program Presentation Overview CM Programs Disease Management Complex
More than a score: working together to achieve better health outcomes while meeting HEDIS measures
NEVADA ProviderNews Vol. 3 2014 More than a score: working together to achieve better health outcomes while meeting HEDIS measures We know you ve heard of Healthcare Effectiveness Data and Information
V. Utilization Management (UM) Program
V. Utilization Management (UM) Program Overview Better Health Network s Utilization Management (UM) Program is designed to provide quality, cost-effective and medically necessary services while meeting
Risk Adjustment in the Medicare ACO Shared Savings Program
Risk Adjustment in the Medicare ACO Shared Savings Program Presented by: John Kautter Presented at: AcademyHealth Conference Baltimore, MD June 23-25, 2013 RTI International is a trade name of Research
October 2013 Family Choice: Best Practices in Care for Nursing Home Residents
SNP Alliance Best Practices October 2013 Family Choice: Best Practices in Care for Nursing Home Residents Overview of Family Choice of New York I-SNP Independent Health s Medicare Advantage Family Choice
Chronic Care Management. WPS Chronic Care Management Next Generation Disease Management
Chronic Care Management WPS Chronic Care Management Next Generation Disease Management Taking on Chronic Illness and Winning. People with chronic illnesses make up only 20 percent of your employee population,
2015 Freedom Health Sales Presentation Video Transcript- (Host) (Member Testimony) H5427_15FHSalesPresVidv2_CMS Approved
2015 Freedom Health Sales Presentation Video Transcript- H5427_15FHSalesPresVidv2_CMS Approved Welcome to this presentation on Freedom Health s Medicare Advantage Plans. Today you will learn about the
Blue Cross Blue Shield of Arizona. Patient Centered. Medical home. Innovating to Improve Patient Health
Blue Cross Blue Shield of Arizona Patient Centered Medical home Innovating to Improve Patient Health 1 Background The (PCMH) model is defined as a healthcare setting that facilitates partnerships between
Social Worker s Role in Care Coordination in a PACE Program On Lok Lifeways
Social Worker s Role in Care Coordination in a PACE Program On Lok Lifeways Jackie Wong, LCSW Social Work Specialist jackie@onlok.org CalSWED Aging Initiative Summit September 19, 2012 committed to serving
Standards of Practice & Scope of Services. for Health Care Delivery System Case Management and Transitions of Care (TOC) Professionals
A M E R I C A N C A S E M A N A G E M E N T A S S O C I A T I O N Standards of Practice & Scope of Services for Health Care Delivery System Case Management and Transitions of Care (TOC) Professionals O
Clinic/Provider Name (Please Print or Type) North Dakota Medicaid ID Number
Contract to Provide Health Management Services Supplementary Agreement Between The Department of Human Services, Medical Services Division (North Dakota Medicaid) and Clinic/Provider Name (Please Print
Presented to: Long Term Care Workgroup May 26, 2011
Presented to: Long Term Care Workgroup May 26, 2011 Partners in the Grant SC Department of Health and Human Services Sam Waldrep Roy Smith Project Coordinator Office of Research and Statistics Institute
Special Needs Programs Overview. Diabetes
Special Needs Programs Overview Brand New Day health plan has several special programs for individuals with one or more of the following chronic conditions: Diabetes, Dementia, or Mental Illness. Below
Coordinating care for dual-eligible beneficiaries
C h a p t e r5 Coordinating care for dual-eligible beneficiaries C H A P T E R 5 Coordinating care for dual-eligible beneficiaries Chapter summary In this chapter Beneficiaries who qualify for Medicare
Utilization Management Program
Utilization Management Program The Utilization Management (UM) Program facilitates quality, cost-effective and medically appropriate services across a continuum of care that integrates a range of services
ESCO- Information Technology Requirements With An Example of Solutions
ESCO- Information Technology Requirements With An Example of Solutions Pramen Applasamy DCI Application Manager Doug Johnson, MD DCI Vice Chairman of the Board July 15, 2014 15-WEEK WEBINAR SERIES EVERY
DRAFT Health Home Concept Paper
DRAFT Health Home Concept Paper 1. How are health home services provided? Illinois Medicaid has been primarily a fee-for-service system, involving thousands of healthcare providers who have provided invaluable
Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION
Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for
HOW TO UNDERSTAND YOUR QUALITY AND RESOURCE USE REPORT
HOW TO UNDERSTAND YOUR QUALITY AND RESOURCE USE REPORT CONTENTS A BACKGROUND AND PURPOSE OF THE MID-YEAR QUALITY AND RESOURCE USE REPORTS... 1 B EXHIBITS INCLUDED IN THE MID-YEAR QUALITY AND RESOURCE USE
Building an Accountable Care Organization. Jean Malouin, MD MPH University of Michigan Health System September 21, 2012
Building an Accountable Care Organization Jean Malouin, MD MPH University of Michigan Health System September 21, 2012 Agenda UMHS overview PGP demo ACO precursor Current efforts underway Role of primary
Physician Value-Based Payment Modifier How will the VBM Impact Your Practice?
Physician Value-Based Payment Modifier How will the VBM Impact Your Practice? What is the Value-Based Payment Modifier (VBM)? The VBM provides for differential payment to a physician or group of physicians
Appendix VI. Patient-Centered Medical Homes (Initiative Memorandum) APRIL 2013
Appendix VI. Patient-Centered Medical Homes (Initiative Memorandum) APRIL 2013 http://berkeleyhealthcareforum.berkeley.edu 1 Appendix VI. Patient-Centered Medical Homes (Initiative Memorandum) See Appendix
Date: IHC Site Application CCE/ACE 6/23/14 Page 1 of 8. Signature:
Illinois Department of Healthcare and Family Services Illinois Health Connect Primary Care Provider Agreement This Agreement pertains only to the relationship between the Illinois Department of Healthcare
Behavioral Health Provider Orientation WELCOME TO MOLINA HEALTHCARE
Behavioral Health Provider Orientation WELCOME TO MOLINA HEALTHCARE 2012 Welcome to the Molina Behavioral Health Network Benefits of Participation Easy to follow procedures Prompt payment process Dedicated
Optum s Role in Mycare Ohio
Optum s Role in Mycare Ohio What is MyCare Ohio? New opportunities generated by the Affordable Care Act have allowed Ohio to implement the MyCare Ohio program. MyCare Ohio is a demonstration project that
PATIENT 1 st of ALABAMA
PATIENT 1 st of ALABAMA Agreement between the Care Network of East Alabama, Inc. and Patient 1 st Primary Medical Provider THIS AGREEMENT is entered into as of (date) between Care Network of East Alabama,
Maureen Mangotich, MD, MPH Medical Director
Maureen Mangotich, MD, MPH Medical Director Prepared for the National Governors Association Healthy America: State Policy Leaders Meeting, December 2005 Delivering value from the center of healthcare Pharmaceutical
Barriers to Care Coordination. Pitfalls. Ineffective Transitions Lead to Poor Outcomes
Eliminating the Pitfalls and Barriers to Reducing Rehospitalizations Evelyn Thompson RN,CMC Director of Care Transitions Genesis Healthcare October 2013 Barriers to Care Coordination System level barriers
WHAT IS MEDICAL MANAGEMENT? WHAT IS THE PURPOSE OF MEDICAL MANAGEMENT?
WHAT IS MEDICAL MANAGEMENT? How health plans make decisions to approve payment for medical treatment is a poorly understood part of the healthcare system. One part of the process, known as medical management,
Understanding the Implications of Medicare s Physician Value-Based Payment Modifier
Understanding the Implications of Medicare s Physician Value-Based Payment Modifier D. Louis Glaser Katten Muchin Rosenman LLP 525 W. Monroe Chicago, Illinois Agenda Introduction PQRS v. VBPM VBPM Adjustments
Service Inventory of Managed Care Entities to Support Development of a Health Homes State Plan Amendment
Service Inventory of Managed Care Entities to Support Development of a Health Homes State Plan Amendment March 2012 MassHealth Managed Care Entities (MCO, SCO, PACE) Health Homes Inventory to Support State
Medicare Advantage Plans: An Overview
Medicare Advantage Plans: An Overview June 2014 Prepared by: Penny Finch, Benefits Consultant Copyright 2014 by The Segal Group, Inc. All rights reserved. 5432273.1 CONTENTS Medicare 101 Understanding
What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company?
What is an Accountable Care Organization & Why is it Important to Your Home Infusion Company? Lisa Harvey McPherson RN, MBA, MPPM EMHS Vice President Continuum of Care & Chief Advocacy Officer Disclosures
Health Care Reform and Its Impact on Nursing Practice
Health Care Reform and Its Impact on Nursing Practice UNAC-UHCP Convention Las Vegas, NV November 9, 2010 Katherine Cox AFSCME International What Have Your Heard? What Do You Think? How do you think the