High Desert Medical Group Connections for Life Program Description
|
|
- Joy Marsh
- 8 years ago
- Views:
Transcription
1 High Desert Medical Group Connections for Life Program Description POLICY: High Desert Medical Group ("HDMG") promotes patient health and wellbeing by actively coordinating services for members with multiple or complex chronic conditions. The Connections for Life program fills this role by helping patients access needed resources. Operating within HIPAA regulations, eligible members are proactively identified by PCP or specialist referral, interdisciplinary team review of urgent/ emergent care cases, claims data, hospital discharge data, and pharmacy data when provided by the Health Plan, in addition to data collection through the UM process (i.e. prior-authorization, concurrent review). Enrollment is voluntary. PURPOSE: The Connections for Life program consists of three main components, Communications for Life, Caring for Life, and Choices for Life that yield a multidisciplinary, continuum-based approach to health care delivery that proactively identifies populations with, or at risk for, chronic medical conditions. Using this team approach, Connections for Life emphasizes prevention of exacerbations and complications; and increases focus on patients' and family caregivers' roles, needs and goals. This is accomplished by supporting the physician-patient relationship, developing a plan of care, and facilitating health care communications across all settings. The three components of the program have multidisciplinary team meeting on a weekly basis, and the meetings also include a representative from the acute case management program as well. On an as needed basis, a clinical social worker, social services designee, and/ or respiratory therapist also attend the weekly team meetings. 1. Communications for Life: Promotes patient health and wellness through regular telephonic communication with HDMG patients who qualify or potentially qualify for the Caring for Life program. The Communications team contacts patients who have low level acuity/ complexity monthly as identified by their initial screening. This initial screening consists of an Activity of Daily Living questionnaire and a combined social history/ abbreviated medical history review. 2. Caring for Life: Actively manages those patients identified with needs for high intensity of service integration and with associated high resource utilization. These patients are identified by recent hospital admissions, emergency room visits, or recurrent visits for exacerbations of chronic disease. Case management interventions are aimed at resolving barriers to care, achieving healthy outcomes by adhering to accepted national standards and care recommendations, facilitating regular access for scheduled care and health maintenance, and assistance with addressing urgent care needs when necessary. Targeted areas include but are not limited to patient education to promote understanding of each of their disease processes and symptom awareness, medication safety, and advanced care planning. 3. Choices for Life: Serves the special needs of patients with critical or terminal conditions as they experience the reality of a life limiting disease. The mission and vision of Choices For Life is to empower patients and their families to make choices related to their disease processes, to support them as they experience the reality of a progressive life-limiting disease, and to provide comfort and support to patients and their loved ones with the help of a dedicated team of healthcare professionals trained in the delivery of Palliative and Hospice care. Patients and their families are encouraged to discuss and make decisions in advance about CQC Complex Care Management Toolkit Resource Shared with permission from High Desert Medical Group 1
2 their preferences for treatment when an illness begins to affect their quality of life. The Choices for Life team assists patients to prepare Advanced Directives. The Choices For Life program includes education regarding Hospice care. Hospice is a special type of care for patients with life-limiting diseases. Additionally, the case management team coordinates all non-hospice related care and works closely with the hospice team to see that patient needs are met. Other Choices For Life services include but are not limited to providing tools for maintaining independence, information for long-term care, clinical, social, and supportive needs. Connections for Life Program Goals: Manage patients with multiple and/or complex medical problems by providing a single point of contact available 24 hours a day Encourage collaborations with all health care team members during various transitions of care settings Promote prevention by appropriate utilization of routine health maintenance Prevent unnecessary hospitalizations of members Facilitate compliance with requested and/ or needed therapeutic services. Population: Target patient populations eligible for active case management include but are not limited to members who have had hospital admissions (or readmissions), repetitive Emergency room or Urgent care visits for same diagnosis or chronic disease related issues. Specifically identified chronic disease groups include but are not limited to cancer, spinal injuries, serious trauma, acquired immunodeficiency syndrome (AIDS), diabetes mellitus (DM), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), asthma, coronary artery disease (CAD), and chronic kidney disease/ end stage renal disease (CKD/ ESRD). The goals of the program are to capture those patients at highest risk for complications by either intrinsic or extrinsic factors (e.g. severity of disease, co- morbidities; non-compliance). Enrollment: To facilitate timely and appropriate enrollment into the program, multiple avenues are available. Referrals are generated from the Health Plan, hospital discharge planners, utilization management, primary care providers, specialists, claims or encounter data, pharmacy data, and member (selfreferral). Patients are contacted by Case Manager or Connections team staff and educated about the programs, and their opportunity to enroll. Enrollment is voluntary and consent is recorded in the EMR. The patient is permitted to voluntarily disenroll from the program at any time. Caring for Life and Communications for Life Process: The Communications for Life team serves multiple contact roles with our patients. An initial list of patients gathered by UM and insurance/ billing diagnoses, and utilization of inpatient services is the pool for potential enrollment. These patients are contacted and provided with education about the program, and given opportunity to enroll. Provided they consent to enroll, the staff then goes through initial questionnaires: ADL and a social history/ abbreviated medical history. Based on the answers to this initial screen, patients are then retained in the Communications for Life program (and rated Level I- lowest acuity/ complexity) or noted to need further review by the supervising RN. In addition to these initial contacts from pool of patients, the Communications for Life team makes regularly monthly to all the level I acuity patients. If the patients have new symptoms, demonstrate CQC Complex Care Management Toolkit Resource Shared with permission from High Desert Medical Group 2
3 progression in their symptoms (by answers to their disease specific questionnaires), or have other questions/ concerns, the issues are either directly tasked to the Case Manager (automated in the EMR), or if outside the purview of the regular questions are brought to the case manager, RN supervisor, or medical director for further review. Lastly the Communications team makes regular follow up calls to all Communications for Life patients who are seen in the Urgent Care setting. These phone calls are entered into the patient's EMR and are thus available to all team members and providers for review as indicated. Weekly and monthly reports are generated to track the phone calls. Program specific patient satisfaction surveys are sent out as described below under the 'Evaluation' heading. The population of Level I patients is also monitored for other objective quality measures including bed days and admissions per thousand, and per member per month expenditures. This is done on a monthly basis. From here, the remaining tasks are completed by the Caring for Life Case Managers and supervising staff (see below *). *For new referrals, the supervising RN or medical director review the case history as indicated and assign the patient to a case manager. At this time a complexity score questionnaire reviewing high-risk medication/ medication classes and diagnosis summary by body system are completed as is the remainder of the intake process. Based on their score, the patient is labeled a level I (moderate risk) or level III (highest risk). The case manager is able to review the case and increase a patient's level based on new information, changes in health status, or other factors. This is discussed at the weekly interdisciplinary team meetings. However, a patient is not permitted to be 'down-graded' a level without the case being reviewed directly by the program medical director or supervising RN in the director's absence. Case Management includes assessment of the following: Initial health assessment including cognitive status, and condition specific issues Documentation of medical history and medications Assessment of activities of daily living and life planning activities Evaluation of cultural, Jingoistic and religious needs/ preferences Evaluation of caregiver resources Evaluation of available benefits Identification of barriers to meeting goals or compliance with CM plan Development of a CM plan including long- and short-term goals for all level II and level III members Development of a schedule for follow up and regular communication with member Development and communication of self-management plan for member Process for assessment of progress on member's CM plan Goals, frequency of contact, and interventions are dependent upon the patient's acuity level. 1. Upon receipt and review of referral, the case manager will initiate contact with the patient within 72 hours of the case being assigned. (Receipt and review of referral by supervising RN or medical director is 48 hours or less.) With goal of completion of the enrollment process in 5 business days. Tracking of turn-around time from receipt of referral to completion of intake is updated weekly. 2. Completion of the enrollment process encompasses ADL screen, complexity score, CQC Complex Care Management Toolkit Resource Shared with permission from High Desert Medical Group 3
4 education of patient re Connections for Life program, patient consent to enroll, past medical history, medications review, setting of a minimum of 2 goals, plan for interventions based on goals, and plan for next follow up contact. The lists below are inclusive, but not limited to the noted items. Contact frequency, and expected staff responsibilities are outlined as follows: Level I: These patients are followed by the Connections team unless there is an acute change in their status, or a noted change in their regular monthly disease-based symptom questionnaire. Level I staffing shall include non-licensed personnel. Contacted a minimum of lx per month. Follow-up by case manager if there are changes in disease status Follow-up after urgent care, emergency visit, or hospital admission Level II: These patients are followed regularly by a designated Case Manager (LVN or RN). Contacted by Case Manager a minimum of twice (2x) monthly and 24/7 availability for urgent needs Health education to patient and caregivers as indicated, including promoting self-management Conduct medication reconciliation Assist with life planning Coordinate care with PCP and specialists, including facilitation of access Facilitate case conferences Home visits as needed Identifies and facilitates access to community resources and social services Increased support and care coordination during transitions in care If urgent care needed, facilitate access and care coordination Level III: These patients are followed regularly by a designated Case Manager. The itemized list for level III patients is the same as Level II with the noted exception of contact frequency. Contact Frequency is a minimum of 4 times (4x) per month, typically lx week. Transitional Case Management: An additional component of the Caring for Life team is a Transitional Case Manager (LVN or RN). The role of this person is to contact patients (with the exceptions of routine OB, and mental health, and under 65years of age orthopedics hospitalizations) who have had ER visits or inpatient stays to assess and assist with their post-hospitalization needs. Additionally, s/he may evaluate if the patient is a candidate for the Connections for Life program and offer the service if the patient is amenable and has the appropriate needs. This case manager follows any given patient for up to three (3) months. At that time or earlier, a determination is made if the changes in status are chronic or if the patient has returned to baseline. If the change is chronic and the patient is appropriate for CFL, then an ADL screen and complexity score are completed and a referral is entered so they can be assigned a long term case manager. This component serves to screen patients who are not enrolled but who are in transition from acute care setting back to home and may or may not improve over the short term... Discharge: Discharge criteria from Caring for Life include but are not limited to: Enrollment in hospice or palliative care, CQC Complex Care Management Toolkit Resource Shared with permission from High Desert Medical Group 4
5 Death of patient, Loss or change of insurance coverage, Relocated out of area, Patient no longer willing to participate in program, or Condition improved/ stabilized. Condition improved/ stabilized' is defined by risk factor criteria based on the chronic disease for which the patient is enrolled. The patient demonstrates by behavior, medication usage, claims history for his/ her chronic illnesses that he/she bas an understanding of disease processes, an awareness of symptoms, shows compliance with treatment recommendations, and thus has a reduction in emergent and inpatient service utilization over a specified interval of time (E.g. one year, 18 months). The patient's PCP is then notified that the patient is a candidate for disenrollment in the program and given the rationale for this recommendation. Provided the PCP concurs, the patient is then notified of the plan for disenrollment. Choices for Life Policy: To provide Palliative and Hospice care to patients who meet admission criteria. Care is provided by HDMG Choices for Life team consisting of physicians, case managers, social workers, and contracted Hospice agencies. Purpose: to produce a patient centered approach to care and to achieve the best quality of life for patients through relief of suffering and control of symptoms while remaining sensitive to personal, cultural, and religious values and practices. The Choices team is made up of Palliative Care Medical Director, nurse manager, and case managers. It is augmented by additional physicians on an as needed basis for support in following patients in residential settings, on-call and vacation times, Note- referring to 'patient/family' for Choices program serves as patient may or may not be cognitively intact, and thus may have a medical decision-maker designated, typically a family member. Care Venues: HDMG clinic Convalescent Nursing Facility Board and Care Facility Patient homes Palliative and Hospice Care Procedure: Admission guidelines include but are not limited to: 1. Patients/members with life limiting illnesses and an expected prognosis of 12 or fewer months for Palliative care and 6 or fewer months for Hospice care. 2. For Palliative care- does not meet Hospice Criteria for one or more of the following reasons: patient/ family have not accepted life-limiting diagnosis and prognosis patient/family is not amenable to ceasing aggressive therapies primary care physician is uncertain that patient's prognosis meets criteria 3. For Hospice care: published hospice criteria regarding diagnosis of life-limiting illness, with terminal prognosis within a6 month window. Referral procedure: 1. Provider (e.g. PCP, Specialist, hospitalist) assesses patient 2. If patient meets guidelines, a referral for Choices is generated within EMR and automatically CQC Complex Care Management Toolkit Resource Shared with permission from High Desert Medical Group 5
6 sent to Nurse Manager of Choices program. 3. Patient's records are reviewed for appropriateness for enrollment. If patient clearly suitable by chart review only, patient/ family is contacted, and Case Manager is assigned. 4. If it is uncertain patient is appropriate for services, patient is evaluated by Choices program provider for clinical evaluation. This evaluation occurs within 3 business days of referral. If appropriate, then case manager is assigned. 5. CM then facilitates completion of enrollment paperwork, advanced directives for care, and patient is assigned to Hospice agency or Palliative care services either in home, residential, or in-patient settings as indicated by care needs. CM notifies PCP of enrollment to program. Provision of Care Services: The Choices for Life program has contracts with several local/ regional Hospice care agencies. Eligibility for services is verified monthly. Care is provided directly by the assigned agencies. Palliative care services are provided by agency or directly by HDMG clinic with oversight by Palliative care medical director. For those that are receiving care by agency, Choices team attends regular interdisciplinary team (IDT) meetings (2-4 x/month) at each of the designated agencies. Regardless of from where/ whom the patient receives services, patient rosters are reviewed each week by the team. The Choices team updates any new needs, changes in status, disease progression, and assesses the patient for continued need of services, and appropriateness for level of service provided. Case Managers assist with plan of care, and record it in chart. Chart is marked Palliative/ Hospice care in EMR by automated alert and on paper charting of agency or care facility. Physician reviews patient medical records at residential facilities to verify that care plan is appropriate for goals and that patient continues to qualify for this level of care, Palliative medical director reviews charts on a monthly basis, recording findings in chart. Palliative care physicians see patients on an as-needed basis at the various locations. Discharge Guidelines: 1. Patient may progress from Palliative care to Hospice level care 2. Patient no longer meets Palliative care or Medicare hospice care criteria respectively for their enrollment; 3. Patient/ family no longer agree to palliative care philosophy. Note: patient/ family are then offered Caring for Life program (voluntary enrollment- see above). 4. Patient condition stabilizes and/ or symptoms have been under control with minimal risk of decline (again, patient/ family are offered services of Caring for Life) 5. Patient is no longer a full risk member of HDMG Evaluation of Choices Program: 1. Patient surveys are sent out at regular intervals, and to each patient/ family unit for program specific review. Additionally, the assigned agencies also utilize their own patient satisfaction surveys. Complaints about services with specific agencies or specific care providers with in an agency are tracked. 2. Length of services along with standard deviation is tracked for the program and compared to national averages for other Palliative/ Hospice care agencies. Average length of services is tracked monthly. In this instance, length of services increasing typically reflects an increase in benefit to the patient. 3. Total enrollment is also tracked and compared to national averages based on population needs of the group. Referral sources are tracked. Both of these allow the program to target resources to better provide services in populations which may have been previously overlooked. When CQC Complex Care Management Toolkit Resource Shared with permission from High Desert Medical Group 6
7 these areas are identified, further education of providers, support staff, and community are reiterated to provide better patient education and understanding of the program. Evaluation of Connections for Life Program: CFL Specific Patient satisfaction surveys are sent out to patients at regular intervals as follows: Level I patients: twice yearly Level II and III patients: quarterly Choices patients (or family) quarterly and/ or to each patient/ family Additionally, we continually analyze patient complaints, inquiries, and comments as they arise. Medical chart review is conducted regularly. Examples of patient feedback may include information about the overall program, program staff, usefulness of educational material, improvement in quality of life, pain management, and health status. Effectiveness of Connections for Life program is measured by quantitative data across a minimum of three parameters. The following guidelines must be fulfilled for each parameter: A relevant process or outcome is identified Valid methods that provide quantitative results will be used A performance goal is set. Measurement specifications are clearly identified Results will be reviewed and analyzed through utilization data, assuring statutory and regulatory compliance If applicable, opportunities for improvement are identified A plan for recurrent measurement is developed for longitudinal tracking of maintenance of quality standards and for tracking improvements after specified interventions Examples of performance assessments include Case management effectiveness related to a specific parameter of a chronic medical condition (e.g. cholesterol measures for CAD.and DM, prescription of asthma medications, HEDIS measures) Improvement in a service measure such as inpatient days per 1000, emergency visits per 1000, and admissions per 1000, total cost per member per month Readmission rate Satisfaction with CM services. Assessment of the effectiveness of the interdisciplinary team meetings These goals are completed with support from the UM/QM team and statistical analysts with data collected by a combination of automated extraction from EMR and insurance databases. The data is used to measure against both external and internal standards and to do intra- and inter- case manager tracking. CQC Complex Care Management Toolkit Resource Shared with permission from High Desert Medical Group 7
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
More informationAnn Hablitzel, RN, BSN, MBA Hospice Care of California
Ann Hablitzel, RN, BSN, MBA Hospice Care of California Objectives Describe the creations of new community based palliative care programs Identify criteria for admission Discuss philosophy and goals Analyze
More informationReinsurance for Early Retirees Program
Summary of Programs Disease Management CareFirst's approach to disease management seeks better management of members diagnosed with certain high frequency, high cost diseases through the early detection
More informationConcept Series Paper on Disease Management
Concept Series Paper on Disease Management Disease management is the concept of reducing health care costs and improving quality of life for individuals with chronic conditions by preventing or minimizing
More informationCoventry 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
More informationCoventry 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
More informationDisease 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
More informationMedical 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
More informationProvider 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
More informationHow To Manage Health Care Needs
HEALTH MANAGEMENT CUP recognizes the importance of promoting effective health management and preventive care for conditions that are relevant to our populations, thereby improving health care outcomes.
More informationUCare 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,
More informationMODULE 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
More informationPopulation Health Management Program
Population Health Management Program Program (formerly Disease Management) is dedicated to improving our members health and quality of life. Our Population Health Management Programs aim to improve care
More informationCHAPTER 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
More informationKaiser 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
More informationDavid Eubanks, RN, MSN Billie Papasifakis, RN-BC, MSN, AACC. Describe model of care most appropriate
THE BRIDGE PROGRAM David Eubanks, RN, MSN Billie Papasifakis, RN-BC, MSN, AACC Pamela Teenier, RN, MBA, COC-C, C HCS-D HCSD 1 Objectives Describe model of care most appropriate for a Bridge program from
More informationFrequently Asked Questions about Pediatric Hospice and Pediatric Palliative Care
Frequently Asked Questions about Pediatric Hospice and Pediatric Palliative Care Developed by the New Jersey Hospice and Palliative Care Organization Pediatric Council Items marked with an (H) discuss
More informationFrequently Asked Questions Regarding At Home and Inpatient Hospice Care
Frequently Asked Questions Regarding At Home and Inpatient Hospice Care Contents Page: Topic Overview Assistance in Consideration Process Locations in Which VNA Provides Hospice Care Determination of Type
More informationSection 6. Medical Management Program
Section 6. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.
More informationUTILIZATION 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
More informationcaresy caresync Chronic Care Management
caresy Chronic Care Management THE PROBLEM Chronic diseases and conditions, including heart disease, diabetes, COPD and obesity, are among the most common, expensive, and preventable health problems in
More informationIntroduction to Hospice
Introduction to Hospice Objectives The learner will be able to: Understand general hospice services Discuss ways that hospice services can be accessed Discuss Medicare regulations for hospice services
More informationV. 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
More informationRiverside Physician Network Utilization Management
Subject: Program Riverside Physician Network Author: Candis Kliewer, RN Department: Product: Commercial, Senior Revised by: Linda McKevitt, RN Approved by: Effective Date January 1997 Revision Date 1/21/15
More informationJohns 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
More information4. Program Regulations
Table of Contents iv 437.401: Introduction... 4-1 437.402: Definitions... 4-1 437.403: Eligible Members... 4-2 437.404: Provider Eligibility... 4-3 437.405: Out-of-State Hospice Services... 4-3 437.406:
More information2012 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
More informationGame 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
More informationTo provide standardized Supervised Exercise Programs across the province.
TITLE ALBERTA HEALTHY LIVING PROGRAM SUPERVISED EXERCISE PROGRAM DOCUMENT # HCS-67-01 APPROVAL LEVEL Executive Director Primary Health Care SPONSOR Senior Consultant Central Zone, Primary Health Care CATEGORY
More information3/11/15. COPD Disease Management Tackling the Transition. Objectives. Describe the multidisciplinary approach to inpatient care for COPD patients
Faculty Disclosures COPD Disease Management Tackling the Transition Dr. Cappelluti has no actual or potential conflicts of interest associated with this presentation. Jane Reardon has no actual or potential
More informationClinic/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
More informationDIABETES DISEASE MANAGEMENT PROGRAM DESCRIPTION FY11 FY12
DIABETES DISEASE MANAGEMENT PROGRAM DESCRIPTION FY11 FY12 TABLE OF CONTENTS 1. INTRODUCTION.3 2. SCOPE........3 3. PROGRAM STRUCTURE...4 3.1. General Educational Interventions.....4 3.2. Identification
More informationHospice Care It s About How You Live
Hospice Care It s About How You Live Beth Mahar, Director of Member Services Hospice & Palliative Care Association of NYS Thank you to: Elizabeth Peters RN The Community Hospice of Columbia/Greene Mission
More informationMedical 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
More informationHenry Ford Health System Care Coordination and Readmissions Update
Henry Ford Health System Care Coordination and Readmissions Update September 2013 BACKGROUND Most hospital readmissions are viewed as avoidable, costly, and in some cases as a potential marker of poor
More informationCHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes
CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes Understanding CCM Chronic Care Management (CCM) is defined as the non-face-to-face services provided to Medicare
More informationCall-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
More informationMedical Management. Table of Contents: Procedures Requiring Prior Authorization. How to Contact or Notify Medical Management
Medical Management Table of Contents: Page 2 Page 2 Page 2 Page 2 Page 3 Page 7 Page 11 Page 11 Page 12 Page 12 At a Glance Procedures Requiring Prior Authorization How to Contact or Notify Medical Management
More informationAccountable 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
More informationTo precertify inpatient admissions or transitional care services, call 1-866-688-3400 and select option #1.
Security Health Plan provides coverage of various mental health/aoda (alcohol and other drug abuse) benefits to individual and employer group members. These benefits are managed by Security Health Plan.
More informationMedicare 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
More informationHealthy Solutions for Life
Healthy Solutions for Life 2015 Presentation Overview About Healthy Solutions for Life Disease Management Health Coaching Model DM Programs TeleCare Monitoring 2013 Nurtur Health, Inc. All Rights Reserved.
More informationCompliance Tip Sheet CMS FY 2010 TOP TEN HOSPICE SURVEY DEFICIENCIES COMPLIANCE RECOMMENDATIONS CMS TOP TEN HOSPICE SURVEY DEFICIENCIES
Compliance Tip Sheet National Hospice and Palliative Care Organization www.nhpco.org/regulatory CMS FY 2010 TOP TEN HOSPICE SURVEY DEFICIENCIES COMPLIANCE RECOMMENDATIONS INTRODUCTION The Centers for Medicare
More informationCCNC Care Management Standardized Plan
Standardization & Reporting: Why is standardization important? Community Care Networks are responsible for the delivery of targeted care management services that will improve quality of care while containing
More informationInnovations@Home. Home Health Initiatives Reduce Avoidable Readmissions by Leveraging Innovation
How Does CMS Measure the Rate of Acute Care Hospitalization (ACH)? Until January 2013, CMS measured Acute Care Hospitalization (ACH) through the Outcomes Assessment and Information Set (OASIS) reporting
More informationHospice Care. To Make a No Obligation No Cost Referral Contact our Admissions office at: Phone: 541-512-5049 Fax: 888-611-8233
To Make a No Obligation No Cost Referral Contact our Admissions office at: Compliments of: Phone: 541-512-5049 Fax: 888-611-8233 Office Locations 29984 Ellensburg Ave. Gold Beach, OR 97444 541-247-7084
More informationAn Integrated, Holistic Approach to Care Management Blue Care Connection
An Integrated, Holistic Approach to Care Management Blue Care Connection With health care costs continuing to rise, both employers and health plans need innovative solutions to help employees manage their
More informationIRG/APS Healthcare Utilization Management Guidelines for West Virginia Health Homes - Bipolar and Hepatitis
IRG/APS Healthcare Utilization Management Guidelines for West Virginia Health Homes - Bipolar and Hepatitis CHANGE LOG Medicaid Chapter Policy # Effective Date Chapter 535 Health Homes 535.1 Bipolar and
More informationMEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT
MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated
More informationChronic 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,
More informationHospice Manual for Facility
Hospice Manual for Facility Home Health & Hospice Hospice in the Facility Objectives 1. Identify the mechanism for providing government regulated care in the facility. 2. Identify the Hospice policy and
More information8/14/2012 California Dual Demonstration DRAFT Quality Metrics
Stakeholder feedback is requested on the following: 1) metrics 69 through 94; and 2) withhold measures for years 1, 2, and 3. Steward/ 1 Antidepressant medication management Percentage of members 18 years
More informationSee page 331 of HEDIS 2013 Tech Specs Vol 2. HEDIS specs apply to plans. RARE applies to hospitals. Plan All-Cause Readmissions (PCR) *++
Hospitalizations Inpatient Utilization General Hospital/Acute Care (IPU) * This measure summarizes utilization of acute inpatient care and services in the following categories: Total inpatient. Medicine.
More informationCASE MANAGEMENT STANDARDS TRANSITIONAL GRANT AREA REA (TGA)
S OF CARE Oakland Transitional Grant Area Care and Treatment Services O C T O B E R 2 0 0 7 Office of AIDS Administration 1000 Broadway, Suite 310 Oakland, CA 94607 Tel: (510) 268-7630 Fax: (510) 768-7631
More informationPopulation Health Management
Population Health Management 1 Population Health Management At a Glance The MedStar Medical Management Department is responsible for managing health care resources for MedStar Select Health Plan. Our goal
More informationBreathe 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
More informationApproaches to Asthma Management:
Approaches to Asthma Management: BY CAROL MCPHILLIPS-TANGUM AND CAROLINE M. ERCEG ASTHMA IS A CHRONIC DISEASE that affects millions of people in the United States and disproportionately impacts children,
More informationCMS-1600-P 201. As we discussed in the CY 2013 PFS final rule with comment period, we are
CMS-1600-P 201 I. Complex Chronic Care Management Services As we discussed in the CY 2013 PFS final rule with comment period, we are committed to primary care and we have increasingly recognized care management
More informationMember Health Management Programs
Independent Health s Member Health Management Programs Helping employees manage their health. Helping you manage your costs. Independent Health s Member Health Management Programs A Comprehensive Approach...
More information2013 Complex Case Management Program Description. Our mission is to improve the health and quality of life of our members
2013 Complex Case Management Program Description Our mission is to improve the health and quality of life of our members I. Purpose To improve the health status and quality of life of members with multiple
More informationHOSPICE SERVICES. This document is subject to change. Please check our web site for updates.
HOSPICE SERVICES This document is subject to change. Please check our web site for updates. This provider manual outlines policy and claims submission guidelines for claims submitted to the North Dakota
More informationMedStar 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 informationEndLink: An Internet-based End of Life Care Education Program www.endlink.rhlurie.northwestern.edu ABOUT HOSPICE CARE
EndLink: An Internet-based End of Life Care Education Program www.endlink.rhlurie.northwestern.edu ABOUT HOSPICE CARE What is hospice? Hospice care focuses on improving the quality of life for persons
More informationMedical Management Program
Section 7. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.
More informationHealthy Living with Diabetes. Diabetes Disease Management Program
Healthy Living with Diabetes Diabetes Disease Management Program Healthy Living With Diabetes Diabetes Disease Management Program Background According to recent reports the incidence of diabetes (type
More informationUpdate on New Coordination of Care and Transition of Care Coding
Update on New Coordination of Care and Transition of Care Coding Michele Olivier ACP Colorado Chapter February 5, 2015 (303) 801-0123 Agenda Introduction Chronic Care Management Coding Advanced Care Planning
More informationVirginia 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
More informationUtilization 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
More information2.b.vii Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF)
2.b.vii Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF) Project Objective: Skilled nursing facilities (SNFs) will implement the evidence based INTERACT program developed
More information5/10/13 HEALTH CARE REFORM LONGITUDINAL CARE COORDINATION HEALTH CARE REFORM WHY = VALUE WHY WHAT HOW WHEN WHO WHY WHAT HOW WHEN WHO
TRANSITION CARE TRANSITION CARE WHY WHAT HOW WHEN WHO HEALTH CARE REFORM HEALTH CARE REFORM WHY = VALUE WHY WHAT HOW WHEN WHO Cost/Quality equation Higher cost care has not/does not equate with higher
More informationPopulation Health Management
Population Health Management 1 Population Health Management Table of Contents At a Glance..page 2 Procedures Requiring Prior Authorization..page 3 How to Contact or Notify Medical Management..page 4 Utilization
More informationOFFICE OF GROUP BENEFITS 2014 OFFICE OF GROUP BENEFITS CDHP PLAN FOR STATE OF LOUISIANA EMPLOYEES AND RETIREES PLAN AMENDMENT
OFFICE OF GROUP BENEFITS 2014 OFFICE OF GROUP BENEFITS CDHP PLAN FOR STATE OF LOUISIANA EMPLOYEES AND RETIREES PLAN AMENDMENT This Amendment is issued by the Plan Administrator for the Plan documents listed
More informationAcute Rehabilitation Center
Acute Rehabilitation Center Acute Rehabilitation Courtyard Our Center Community Westview Hospital's Acute Rehabilitation Center and programs are specially designed to meet the needs of our patients and
More informationSpecial 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
More informationWelcome to Magellan Complete Care
Magellan Complete Care of Florida Provider Newsletter Welcome to Magellan Complete Care On behalf of Magellan Complete Care of Florida, thank you for your continued support and collaboration. As the only
More informationADDENDUM 1 MEDICAL HOME TO SOONERCARE PHYSICIAN AGREEMENT FOR CHOICE PRIMARY CARE PROVIDERS
ADDENDUM 1 MEDICAL HOME TO SOONERCARE PHYSICIAN AGREEMENT FOR CHOICE PRIMARY CARE PROVIDERS 1.0 PURPOSE The purpose of this Addendum is for OHCA and PROVIDER to contract for PCP services in OHCA s SoonerCare
More informationINTRODUCTION. QM Program Reporting Structure and Accountability
QUALITY MANAGEMENT PROGRAM INTRODUCTION To assure services are appropriately monitored and continuously improved, ValueOptions has developed and implemented a comprehensive (QMP). The QMP includes strategies
More informationLife Choices. What is Palliative Care? Palliative? Palliative care emerged. A Program of Palliative Care
Life Choices A Program of Palliative Care Relieves suffering and improves quality of life for patients with advanced illnesses What is Palliative Care? Medical treatment that aims to relieve suffering
More informationTable 1 Performance Measures. Quality Monitoring P4P Yr1 Yr2 Yr3. Specification Source. # Category Performance Measure
Table 1 Performance Measures # Category Performance Measure 1 Behavioral Health Risk Assessment and Follow-up 1) Behavioral Screening/ Assessment within 60 days of enrollment New Enrollees who completed
More informationClinical Nurse Specialists Practitioners Contributing to Primary Care: A Briefing Paper
Clinical Nurse Specialists Practitioners Contributing to Primary Care: A Briefing Paper As the need grows for more practitioners of primary care, it is important to recognize the Clinical Nurse Specialist
More informationTelehealth Solutions Enhance Health Outcomes and Reduce Healthcare Costs
Text for a pull out can go heretext for a pull out can go heretext for a pull out can go Text for a pull out can go here Text for a pull out can go here Telehealth Solutions Enhance Health Outcomes and
More informationCoordinating Transitions of Care: It Takes a Village
Coordinating Transitions of Care: It Takes a Village Ken Laube RN, BSN, MBA: Vice President Clinical Excellence Situation/Background Patients face significant challenges when moving from one health care
More informationSpecial 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
More informationHow To Plan A Rehabilitation Program
Project Plan to Rehabilitation Service Connecting and Collaborating in the Continuity of Care in Rehabilitation Presented By: Arlene Whitehead, May 31, 2011 Rehabilitation Collaborative Overview OUTLINE
More informationHome Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques
Comprehensive EHR Infrastructure Across the Health Care System The goal of the Administration and the Department of Health and Human Services to achieve an infrastructure for interoperable electronic health
More informationHPC Healthcare, Inc. Administrative/Operational Policy and Procedure Manual
Operational and Procedure Manual 1 of 7 Subject: Corporate Compliance Plan Originating Department Quality & Compliance Effective Date 1/99 Administrative Approval Review/Revision Date(s) 6/00, 11/99, 2/02,
More informationPatient to Person. Transitions of Care. Colby Bearch, MA-SF, MA-M, BA, RN, CDONA Sharyn King, RN, BSN, CCM
Patient to Person Transitions of Care Colby Bearch, MA-SF, MA-M, BA, RN, CDONA Sharyn King, RN, BSN, CCM Transitions of Care Transitioning from school to adult services (vocational, medical day, etc.)
More informationCHRONIC KIDNEY DISEASE MANAGEMENT GUIDE
CHRONIC KIDNEY DISEASE MANAGEMENT GUIDE Outline I. Introduction II. Identifying Members with Kidney Disease III. Clinical Guidelines for Kidney Disease A. Chronic Kidney Disease B. End Stage Renal Disease
More informationJoan Carroll RN, CDMS, CCM Director of Care Transitions Lee Memorial Health System
Joan Carroll RN, CDMS, CCM Director of Care Transitions Lee Memorial Health System 1 Explain how patients experience transitions of care Identify variables that affect transitions due to lack of patient
More informationSPECIALTY CASE MANAGEMENT
SPECIALTY CASE MANAGEMENT Our Specialty Case Management programs boost ROI and empower members to make informed decisions and work with their physicians to better manage their health. KEPRO is Effectively
More informationGeneral Practitioner
Palliative Care/End of Life Related Fees Service Type Fee code When to use General Practitioner Palliative Care Planning 14063 Once a patient living in the community (own or family home or assisted living;
More informationIt s Time to Transition to ICD-10
July 22, 2015 It s Time to Transition to ICD-10 What do the changes mean to your SNF? Presented by: Linda S. Little, RN-BSN Clinical Consultant HMM Consulting Office: (631) 265-6289 E-Mail: llittle@horanmm.com
More informationPerson-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment
Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment Donna Zazworsky, RN, MS, CCM, FAAN Vice President: Community Health and Continuum Care Carondelet Health
More informationCheryl Schraeder, RN, PhD, FAAN. The demographic landscape of America is changing at an accelerated pace
Stepping up to the challenge: Changing the way we deliver care Cheryl Schraeder, RN, PhD, FAAN 1 Goals of Presentation To Identify: The key challenges in delivering evidence-based & cost-effective care
More informationACUTE TREATMENT SERVICES (ATS) FOR SUBSTANCE USE DISORDERS LEVEL III.7
ACUTE TREATMENT SERVICES (ATS) FOR SUBSTANCE USE DISORDERS LEVEL III.7 Providers contracted for this level of care or service are expected to comply with all requirements of these service-specific performance
More informationNurses in CCACs: Providing Care and Creating Connections Across Sectors
Nurses in CCACs: Providing Care and Creating Connections Across Sectors Janet McMullan, RN, BScN, MN, Client Services Specialist, Project Lead, OACCAC Jacklyn Baljit, RN, MScN, Client Services Specialist,
More informationFamily Caregiver s Guide to Hospice and Palliative Care
Family Caregiver Guide Family Caregiver s Guide to Hospice and Palliative Care Even though you have been through transitions before, this one may be harder. If you have been a family caregiver for a while,
More informationMedicare Savings and Reductions in Rehospitalizations Associated with Home Health Use
Medicare Savings and Reductions in Rehospitalizations Associated with Home Health Use June 23, 2011 Avalere Health LLC Avalere Health LLC The intersection of business strategy and public policy Table of
More informationImplementing Chronic Care Management (CCM) - CPT 99490
Implementing Chronic Care Management (CCM) - CPT 99490 Dulcian, Inc. May 2015 The Need Population-based statistics published by the Centers for Medicare and Medicaid Services (CMS) tell the story. Most
More informationCHAPTER 17: HEALTH PROMOTION AND DISEASE MANAGEMENT
CHAPTER 17: HEALTH PROMOTION AND DISEASE MANAGEMENT HEALTH SERVICES AND PROGRAMS The Plan s Health Promotion and Disease Management Department seeks to improve the health and overall well-being of our
More information