Hot Spotter Report User Guide

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Hot Spotter Report User Guide"

Transcription

1 PATIENT-CENTERED CARE Hot Spotter Report User Guide Overview The Hot Spotter Report is designed to give providers and care team members a heads up when their attributed patients appear to be at risk for inpatient readmissions, or could benefit from an intervention by the primary care team The Hot Spotter Report lists your patients at high risk who have been identified as likely needing care plans The report generally targets those with a recent inpatient admission as well as those with chronic diseases who have gaps in care Risk is determined based on variety of factors including readmission and chronic conditions High-risk patients are identified based on either an emergency room or inpatient visit or by diagnosis with one of five chronic conditions, along with a gap in care based on available claims data The Hot Spotter Report is updated daily to identify patients at risk for readmission, and monthly to identify patients at risk due one of five chronic illnesses: Chronic Obstructive Pulmonary Disease (COPD), Diabetes Mellitus, Congestive Heart Failure (CHF), Coronary Artery Disease (CAD) and Asthma (AST) Where to Find the Hot Spotter Report You can find the report on our Availity Portal under the Patient Centered Care Program heading Revised 5/21/2013

2 Reading the Hot Spotter Report Field New to report Patient: Name Patient: ID Patient: Gender Patient: Phone Months on Report Prospective Risk Score Description A patient who is on the report for the first time will have an X in this field Patient s first and last name Identification number assigned to the patient Displayed as M (male) or F (female) Patient s phone number Number of months the patient has been on the report, including the first date that the patient appeared on the report A number predicting future health care costs and utilization based on demographic factors (age, gender) and current chronic conditions and co morbidities (diagnoses codes from administrative health care claim data) Scores are updated monthly using DxCG software developed by Verisk Health The Prospective Risk Score (PRS) represents the relative risk of future health care costs and use over the next 12 months These scores account for the predicted influence of chronic conditions and co-morbidities on future health care costs and use A score of 1 represents an average member If someone has a score of 2 they are predicted to use twice the amount of medical services as the average member, and cost twice as much as the average member A score of 10 means the member is predicted to use 10 times the amount of services and cost as an average member 2

3 Prospective Risk Change Percent of change in the patient s risk score The readmission score is refreshed daily and the chronic risk is refreshed monthly on the Hot Spotter report Risk Change and Color Code: Less than 10%, no color From 10% to 20%, yellow cell More than 20%, red cell Readmission Risk Change: displays the value of difference between current month risk score and previous month A patient s predicted risk for an inpatient readmission within 90-days of a primary inpatient event Patient s risk is calculated with a WellPoint proprietary predictive model using: Current admission information Overall utilization history and cost risk Disease co morbidity Demographic data Patients admitted to the hospital are assigned a score that represents a percentage chance for being readmitted within next 90 days Primary Care Physician: Name Primary Care Physician: NPI The model uses claims data regarding chronic conditions, gaps in care, and utilization of health care services to assign the risk score The model also takes into account the patient s current admission information Provider s first and last name National Provider Identifier, a 10-digit identifier issued by the Centers for Medicare and Medicaid Services 3

4 Risk Model Chronic, Readmission, or Chronic & Readmission Risk model provided by Comprehensive Health Solutions analytics; used to identify patients who could benefit from a care plan Patients appear on the report based on one of three triggers that indicate they could benefit from a care plan: Readmission: if patient has recently been admitted and has moderate to high risk chance of being readmitted or a gap in care that can be addressed by a primary care physician they will appear on the report Chronic: If the patient scores higher than the general population in the prospective risk score, has one of the five core conditions, and has at least 1 gap in care they will appear on the report Five core chronic conditions are targeted: Diabetes, COPD, Asthma, Heart Failure and CAD Readmission AND Chronic: If patient was recently admitted, has a high risk of readmission and also triggers based on the chronic model Risk Driver 1 Risk Driver 2 Risk Driver 3 Risk Driver 4 Emergency Room Utilization: Visits Emergency Room Utilization: Last Visit Dt Emergency Room Utilization: Last Visit Diagnosis The top four risk categories for your patient Risk categories are associated with chronic disease, readmission or both Based on a risk model provided by our Comprehensive Health Solutions analytics Outlines potential gaps in care that are driving the prospective risk score higher Number of ER visits the patient had within the rolling 12 months Date of last ER visit within the rolling 12 months Diagnosis code used for the patient s last ER visit 4

5 Chronic Conditions Primary (1), secondary (2) and tertiary (3) chronic condition for your patient based on the our Comprehensive Health Solutions analytics risk model Top 3 diagnoses listed on claims Case Management History: Program The most recent care management program associ patient within the rolling 12 months Case Management History: Status The status of your patient s participation in a Case Management program Includes current status of program and the closure reason if applicable Disease Management History: Program The most recent disease management program associated with your patient within the rolling 12 months Disease Management History: Status Status of your patient s participation in disease management program Status indicators are: Participating, Declined with reason, Complete Includes current status of program and the closure reason if applicable UniCare Life & Health Insurance Company Registered mark of WellPoint, Inc 2013 WellPoint, Inc 5

Medicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings

Medicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings Medicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings May 11, 2009 Avalere Health LLC Avalere Health LLC The intersection

More information

From Risk Scores to Impactability Scores:

From Risk Scores to Impactability Scores: From Risk Scores to Impactability Scores: Innovations in Care Management Carlos T. Jackson, Ph.D. September 14, 2015 Outline Population Health What is Impactability? Complex Care Management Transitional

More information

ALL MENTAL HEALTH AND SUBSTANCE USE DISORDER PROGRAMS MUST INCLUDE PSYCHOSOCIAL AND PSYCHIATRIC EVALUATIONS

ALL MENTAL HEALTH AND SUBSTANCE USE DISORDER PROGRAMS MUST INCLUDE PSYCHOSOCIAL AND PSYCHIATRIC EVALUATIONS COUNTY of NASSAU DEPARTMENT OF HUMAN SERVICES Office of Mental Health, Chemical Dependency and Developmental Disabilities Services 60 Charles Lindbergh Boulevard, Suite 200, Uniondale, New York 11553-3687

More information

Ambulatory-care-sensitive admission rates: A key metric in evaluating health plan medicalmanagement effectiveness

Ambulatory-care-sensitive admission rates: A key metric in evaluating health plan medicalmanagement effectiveness Milliman Prepared by: Kathryn Fitch, RN, MEd Principal, Healthcare Management Consultant Kosuke Iwasaki, FIAJ, MAAA Consulting Actuary Ambulatory-care-sensitive admission rates: A key metric in evaluating

More information

Medicare Advantage Quality Improvement Project (QIP) & Chronic Care Improvement Program (CCIP)

Medicare Advantage Quality Improvement Project (QIP) & Chronic Care Improvement Program (CCIP) Medicare Advantage Quality Improvement Project (QIP) & Chronic Care Improvement Program (CCIP) Medicare Drug and Health Plan Contract Administration Group Donna Williamson & Brandy Alston December 6, 2016

More information

Deriving Value from a Health Information Exchange. HIMSS17 DA-CH Community Conference Healthix I New York I February 20, 2017

Deriving Value from a Health Information Exchange. HIMSS17 DA-CH Community Conference Healthix I New York I February 20, 2017 Deriving Value from a Health Information Exchange HIMSS17 DA-CH Community Conference Healthix I New York I February 20, 2017 About Healthix About Healthix Hundreds of healthcare organizations at more than

More information

The 5 W s of the CMS Core Quality Process and Outcome Measures

The 5 W s of the CMS Core Quality Process and Outcome Measures The 5 W s of the CMS Core Quality Process and Outcome Measures Understanding the process and the expectations Developed by Kathy Wonderly RN,BSPA, CPHQ Performance Improvement Coordinator Developed : September

More information

Type of intervention Secondary prevention of heart failure (HF)-related events in patients at risk of HF.

Type of intervention Secondary prevention of heart failure (HF)-related events in patients at risk of HF. Emergency department observation of heart failure: preliminary analysis of safety and cost Storrow A B, Collins S P, Lyons M S, Wagoner L E, Gibler W B, Lindsell C J Record Status This is a critical abstract

More information

Center for State Health Policy

Center for State Health Policy Center for State Health Policy A Unit of the Institute for Health, Health Care Policy and Aging Research Opportunities for Better Care and Lower Cost: Data Book on Hospital Utilization and Cost in Camden

More information

Collaborative Activation of Resources and Empowerment Services Building Programs to Fit Patients vs. Bending Patients to Fit Programs

Collaborative Activation of Resources and Empowerment Services Building Programs to Fit Patients vs. Bending Patients to Fit Programs Organization: Solution Title: Calvert Memorial Hospital Calvert CARES: Collaborative Activation of Resources and Empowerment Services Building Programs to Fit Patients vs. Bending Patients to Fit Programs

More information

Policy & Providers. for Managing Chronic Care Patients. Mary Alexander Strategic Alliances Director - Home Instead, Inc. Kelly Funk.

Policy & Providers. for Managing Chronic Care Patients. Mary Alexander Strategic Alliances Director - Home Instead, Inc. Kelly Funk. Policy & Providers Lessons From The Health Care Arena for Managing Chronic Care Patients Producer: Bob Bua President - CareScout Panel: Peter Sosnow VP Corporate Development - Humana / SeniorBridge Mary

More information

HIDD 101 HOSPITAL INPATIENT AND DISCHARGE DATA IN NEW MEXICO

HIDD 101 HOSPITAL INPATIENT AND DISCHARGE DATA IN NEW MEXICO HIDD 101 HOSPITAL INPATIENT AND DISCHARGE DATA IN NEW MEXICO Health Information System Act (24-14A-1, et seq. NMSA 1978) Provides authority for the Department of Health to collect health data. NMDOH had

More information

Date: Illinois Health Connect PCP 6/23/14 Page 1 of 8. Signature:

Date: Illinois Health Connect PCP 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

More information

Care Coordination (CC) assists members and their families with complex needs

Care Coordination (CC) assists members and their families with complex needs Care Coordination (CC) assists members and their families with complex needs Care is member-centered, family-focused, and culturally competent. CC assists in locating services to meet the health and social

More information

The Role of Analytics in the Development of a Successful Readmissions Program

The Role of Analytics in the Development of a Successful Readmissions Program The Role of Analytics in the Development of a Successful Readmissions Program Pierre Yong, MD, MPH Director, Quality Measurement & Value-Based Incentives Group Centers for Medicare & Medicaid Services

More information

ENGAGING PHYSICIANS FOR IMPROVED OUTCOMES: CLINICAL DOCUMENTATION, FINANCIAL & PATIENT CARE

ENGAGING PHYSICIANS FOR IMPROVED OUTCOMES: CLINICAL DOCUMENTATION, FINANCIAL & PATIENT CARE ENGAGING PHYSICIANS FOR IMPROVED OUTCOMES: CLINICAL DOCUMENTATION, FINANCIAL & PATIENT CARE Northeast Ohio HFMA GHALI May 20, 2016 James Begley, MD, MS Physician Champion, ICD-10 & Medical Records Committee

More information

PROVIDER NEWSLETTER. Illinois 2016 Issue II DISEASE MANAGEMENT IMPROVING MEMBERS HEALTH IN THIS ISSUE

PROVIDER NEWSLETTER. Illinois 2016 Issue II DISEASE MANAGEMENT IMPROVING MEMBERS HEALTH IN THIS ISSUE Illinois 2016 Issue II PROVIDER NEWSLETTER DISEASE MANAGEMENT IMPROVING MEMBERS HEALTH Disease Management is a no-cost, voluntary program to assist members with specific chronic conditions. A member is

More information

Special Needs Plan Provider Education

Special Needs Plan Provider Education Special Needs Plan Provider Education 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 Optimum Healthcare 2 Care

More information

Rethinking annual assessments: Identifying and closing gaps in care

Rethinking annual assessments: Identifying and closing gaps in care Rethinking annual assessments: Identifying and closing gaps in care Expert presenters Curtis A. Mock, MD, MBA, National Medical Director, Complex Population Management Annual in-home assessments provide

More information

OPERATIONS MANUAL CARE CONNECTIONS PROGRAM LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES

OPERATIONS MANUAL CARE CONNECTIONS PROGRAM LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES OPERATIONS MANUAL CARE CONNECTIONS PROGRAM LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES SECTION: PATIENT REFERRAL and INTAKE PROCEDURES 1 P age 1 CCP Referral Procedure Referrals for the Care Connections

More information

Chronic Disease Management: Breakthrough Opportunities for Improving the Health And Productivity of Iowans

Chronic Disease Management: Breakthrough Opportunities for Improving the Health And Productivity of Iowans Chronic Disease Management: Breakthrough Opportunities for Improving the Health And Productivity of Iowans A Report of the Iowa Chronic Care Consortium February 2003 Background The Iowa Chronic Care Consortium

More information

NGA and Center for Health Care Strategies Summit: High Utilizers

NGA and Center for Health Care Strategies Summit: High Utilizers Medicaid Chronic Care Initiative: Strategies for High Utilizers NGA and Center for Health Care Strategies Summit: High Utilizers February 12, 2013 Eileen Girling, MPH, RN, CAMS Director, VCCI Department

More information

Registering for PQRS Reporting and Understanding the Implications and Proposed Policies for the Value based Payment Modifier

Registering for PQRS Reporting and Understanding the Implications and Proposed Policies for the Value based Payment Modifier Registering for PQRS Reporting and Understanding the Implications and Proposed Policies for the Value based Payment Modifier Presented by: Centers for Medicare and Medicaid Services Performance Based Payment

More information

SNF * Readmissions Bootcamp The SNF Readmission Penalty, Post-Acute Networks, and Community Collaboratives

SNF * Readmissions Bootcamp The SNF Readmission Penalty, Post-Acute Networks, and Community Collaboratives SNF * Readmissions Bootcamp The SNF Readmission Penalty, Post-Acute Networks, and Community Collaboratives Lindsay Holland, MHA Associate Director, Care Transitions Health Services Advisory Group (HSAG)

More information

CMHC Healthcare Homes. The Natural Next Step

CMHC Healthcare Homes. The Natural Next Step CMHC Healthcare Homes The Natural Next Step Partners in Planning A collaborative effort involving Dept. of Social Services (Mo HealthNet) Dept. of Mental Health Primary Care Association (FQHCs) Coalition

More information

NEW PATIENT PACKET. Address: City: State: Zip: Home Phone: Cell Phone: Primary Contact: Home Phone Cell Phone. Address: Driver s License #:

NEW PATIENT PACKET. Address: City: State: Zip: Home Phone: Cell Phone: Primary Contact: Home Phone Cell Phone.  Address: Driver s License #: Patient s Name: NEW PATIENT PACKET Last Middle First Address: City: State: Zip: Home Phone: Cell Phone: Primary Contact: Home Phone Cell Phone Email Address: Driver s License #: DOB: Gender: Male Female

More information

2017 Catastrophic Care. Program Evaluation. Our mission is to improve the health and quality of life of our members

2017 Catastrophic Care. Program Evaluation. Our mission is to improve the health and quality of life of our members 2017 Catastrophic Care Program Evaluation Our mission is to improve the health and quality of life of our members 2017 Catastrophic Care Program Evaluation Table of Contents Program Purpose Page 1 Goals

More information

MEDICATION THERAPY MANAGEMENT. MemberChoice FORMULARY MANAGEMENT MEDICATION THERAPY MANAGEMENT (MTM) SPECIALTY DRUG MANAGEMENT

MEDICATION THERAPY MANAGEMENT. MemberChoice FORMULARY MANAGEMENT MEDICATION THERAPY MANAGEMENT (MTM) SPECIALTY DRUG MANAGEMENT MemberChoice FORMULARY MANAGEMENT MEDICATION THERAPY MANAGEMENT (MTM) SPECIALTY DRUG MANAGEMENT MEDICATION THERAPY MANAGEMENT Medication Therapy Management 1 $ 290 Billion Wasted in avoidable costs due

More information

SoonerCare Health Management Program 2 nd National Predictive Modeling Summit. Washington, DC.

SoonerCare Health Management Program 2 nd National Predictive Modeling Summit. Washington, DC. SoonerCare Health Management Program 2 nd National Predictive Modeling Summit. Washington, DC. Lynn Puckett Oklahoma Health Care Authority Karl Weimer MEDai, Inc., An Elsevier Company 08/28/2008 1 Agenda

More information

Health Indicators. for the Dallas/Fort Worth Combined Metropolitan Statistical Area Brad Walsh and Sue Pickens Owens

Health Indicators. for the Dallas/Fort Worth Combined Metropolitan Statistical Area Brad Walsh and Sue Pickens Owens Health Indicators Our Community Health for the Dallas/ Fort Worth Combined Metropolitan Statistical Area Checkup 2007 for the Dallas/Fort Worth Combined Metropolitan Statistical Area Brad Walsh and Sue

More information

Special Needs Plans (SNP) Model of Care (MOC) Initial and Annual Training

Special Needs Plans (SNP) Model of Care (MOC) Initial and Annual Training Special Needs Plans (SNP) Model of Care (MOC) Initial and Annual Training 2018 Learning Objectives Program participants will be able to: List the three overall goals of the SNP Model of Care Describe the

More information

Use of Information Technology in Physician Practices

Use of Information Technology in Physician Practices Use of Information Technology in Physician Practices 1. Do you have access to a computer at your current office practice? YES NO -- PLEASE SKIP TO QUESTION #2 If YES, please answer the following. a. Do

More information

The Effect of Professional Interpretation on Inpatient Length of Stay and Readmission Rates. Mary Lindholm, MD; Connie Camelo and Lee Hargraves, PhD;

The Effect of Professional Interpretation on Inpatient Length of Stay and Readmission Rates. Mary Lindholm, MD; Connie Camelo and Lee Hargraves, PhD; The Effect of Professional Interpretation on Inpatient Length of Stay and Readmission Rates Mary Lindholm, MD; Connie Camelo and Lee Hargraves, PhD; About UMass Memorial Medical Center A 781-bed (plus

More information

Medicare Inpatient Psychiatric Facility Prospective Payment System

Medicare Inpatient Psychiatric Facility Prospective Payment System Medicare Inpatient Psychiatric Facility Prospective Payment System Payment Rule Brief PROPOSED RULE Program Year: FFY 2016 Overview and Resources On April 24, 2015, the Centers for Medicare and Medicaid

More information

Programs and Procedures for Chronic and High Cost Conditions Related to the Early Retiree Reinsurance Program

Programs and Procedures for Chronic and High Cost Conditions Related to the Early Retiree Reinsurance Program s and Procedures for Chronic and High Cost Conditions Related to the Early Retiree Reinsurance HealthPartners Disease and Case Management programs are targeted to those who have been identified with a

More information

O U T C O M E. record-based. measures HOSPITAL RE-ADMISSION RATES: APPROACH TO DIAGNOSIS-BASED MEASURES FULL REPORT

O U T C O M E. record-based. measures HOSPITAL RE-ADMISSION RATES: APPROACH TO DIAGNOSIS-BASED MEASURES FULL REPORT HOSPITAL RE-ADMISSION RATES: APPROACH TO DIAGNOSIS-BASED MEASURES FULL REPORT record-based O U Michael Goldacre, David Yeates, Susan Flynn and Alastair Mason National Centre for Health Outcomes Development

More information

Regional Center for Border Health, Inc. San Luis Walk-In Clinic, Inc.

Regional Center for Border Health, Inc. San Luis Walk-In Clinic, Inc. Regional Center for Border Health, Inc. San Luis Walk-In Clinic, Inc. Community-Based Family Care Coordinator & Inter-Professional Patient Centered Care Model Initiative Amanda Aguirre, President & CEO

More information

30-day Hospital Readmissions in Washington State

30-day Hospital Readmissions in Washington State 30-day Hospital Readmissions in Washington State May 28, 2015 Seattle Readmissions Summit 2015 The Alliance: Who We Are Multi-stakeholder. More than 185 member organizations representing purchasers, plans,

More information

Developing a comparative effectiveness research agenda: The CONCERT experience

Developing a comparative effectiveness research agenda: The CONCERT experience Developing a comparative effectiveness research agenda: The CONCERT experience David H. Au, MD MS Associate Professor of Medicine University of Washington and Investigator Health Services Research and

More information

3/14/2014. Preventing Rehospitalizations How to Change Your When in Doubt, Send em Out Way of Thinking. Objectives. Background Information

3/14/2014. Preventing Rehospitalizations How to Change Your When in Doubt, Send em Out Way of Thinking. Objectives. Background Information Preventing Rehospitalizations How to Change Your When in Doubt, Send em Out Way of Thinking Jennifer Moore, RN Content Developer Objectives Describe two reasons why returns to the hospital are not desirable

More information

Managing Patients with Multiple Chronic Conditions

Managing Patients with Multiple Chronic Conditions Best Practices Managing Patients with Multiple Chronic Conditions Arch Health Partners Case Study Organization Profile Palomar Pomerado Health, a public hospital system that includes 2 hospital campuses

More information

New provider orientation

New provider orientation New provider orientation Welcome 2 Agenda Introduction to Amerigroup Provider resources Contact numbers and questions Provider responsibilities Member benefits and services Claims and billing Preservice

More information

How Title Xx Vermont s Broadening

How Title Xx Vermont s Broadening How Title Xx Vermont s Broadening Subtitle Xx APCD Offers New Opportunities to Drive Value & Efficiencies Adam Moody, Director of Analytic Operations Onpoint Health Data Pat Jones, Assistant Director Presenter,

More information

MEDICARE CCLF ANALYTICS: MEDICARE ANALYTICS DATA ENGINE (MADE)

MEDICARE CCLF ANALYTICS: MEDICARE ANALYTICS DATA ENGINE (MADE) MEDICARE CCLF ANALYTICS: MEDICARE ANALYTICS DATA ENGINE (MADE) Frequently Asked Questions 1.0 October 10, 2017 hmetrix hmetrix This document contains frequently asked questions regarding the utility, functionality,

More information

Hospital Inpatient Quality Reporting (IQR) Program

Hospital Inpatient Quality Reporting (IQR) Program Hospital IQR Program Hybrid Hospital-Wide 30-Day Readmission Measure Core Clinical Data Elements for Calendar Year 2018 Voluntary Data Submission Questions and Answers Moderator Artrina Sturges, EdD, MS

More information

the role of HCCs in a value-based payment system

the role of HCCs in a value-based payment system REPRINT October 2017 Donna M. Smith L. Gordon Moore healthcare financial management association hfma.org the role of HCCs in a value-based payment system Appropriate documentation and coding of hierarchical

More information

Full speech capability, allowing you to speak your information and inquiries or use your touchtone

Full speech capability, allowing you to speak your information and inquiries or use your touchtone NEW YORK 2015 ISSUE IV PROVIDER Newsletter NEW PROVIDER SERVICES TECHNOLOGY WellCare is excited to announce some major technology improvements within our call centers, making it easier for providers to

More information

Population health and potentially preventable events 3M solutions for population health, patient safety and cost-effective care

Population health and potentially preventable events 3M solutions for population health, patient safety and cost-effective care 3M Health Information Systems Population health and potentially preventable events 3M solutions for population health, patient safety and cost-effective care Challenge: Shifting the financial risk The

More information

Oxford Condition Management Programs:

Oxford Condition Management Programs: Oxford Condition Management Programs: Helping your employees learn, be encouraged and get support. Committed to helping improve the health and well-being of those we serve and improve the health care

More information

BCBSIL iexchange Reference Guide

BCBSIL iexchange Reference Guide BCBSIL iexchange Reference Guide April 2010 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Table of

More information

Southeast Michigan See You in 7 Hospital Collaborative: Session 8 Webinar. Thursday, December 13 at 8 am

Southeast Michigan See You in 7 Hospital Collaborative: Session 8 Webinar. Thursday, December 13 at 8 am Southeast Michigan See You in 7 Hospital Collaborative: Session 8 Webinar Thursday, December 13 at 8 am Agenda Welcome and Introductions Hospital/Nursing Home Collaboration to Improve Early Follow-Up for

More information

Paving the Way for. Health Homes

Paving the Way for. Health Homes Paving the Way for Health Homes Paving the Way for Healthcare Homes Affordable Care Act The Affordable Care Act passed by Congress and signed into law by the president in March 2010, provides a variety

More information

2.b.iv Care Transitions Intervention Model to Reduce 30-day Readmissions for Chronic Health Conditions

2.b.iv Care Transitions Intervention Model to Reduce 30-day Readmissions for Chronic Health Conditions 2.b.iv Care Transitions Intervention Model to Reduce 30-day Readmissions for Chronic Health Conditions Project Objective: To provide a 30-day supported transition period after a hospitalization to ensure

More information

The Camden Coalition of Healthcare. Management

The Camden Coalition of Healthcare. Management Camden Coalition of Healthcare Providers Camden Coalition of Healthcare Providers The Camden Coalition of Healthcare Providers Approach to Risk Stratified Care Management Presentation by: Kennen S. Gross,

More information

Appendix - A: Telecommuter Questionnaire

Appendix - A: Telecommuter Questionnaire Appendix - A: Telecommuter Questionnaire Introduction: Dear fellow IT professionals. Thank you for deciding to participate in this questionnaire. The questionnaire collects information about you and your

More information

INPATIENT HOSPITAL REIMBURSEMENT

INPATIENT HOSPITAL REIMBURSEMENT HCRA CLAIMS PROCESSING Reimbursement: HCRA is not Medicaid; however, HCRA covered services are reimbursed at the hospital s outpatient or inpatient reimbursement rate allowed for Florida Medicaid. The

More information

DRUG / MEDICATION ALLERGIES: (include: Type/Reaction)

DRUG / MEDICATION ALLERGIES: (include: Type/Reaction) NASSAU CHEST PHYSICIANS PC MEDICAL QUESTIONNAIRE 1 DATE: PATIENT NAME: DOB: DRUG / MEDICATION ALLERGIES: (include: Type/Reaction) 9/1/2014 PHARMACY NAME PHARMACY PHONE PHARMACY Street Address City State

More information

Highline Health Connections: Care Navigation for Vulnerable Populations

Highline Health Connections: Care Navigation for Vulnerable Populations Highline Health Connections: Care Navigation for Vulnerable Populations WSHA Readmissions Safe Table - Feb 14, 2017 Carolyn Bonner, Director Home Health, Health Connections, Cancer Center, Sleep Center

More information

BlueChoice HealthPlan Medicaid An Overview Community Outreach Perspective

BlueChoice HealthPlan Medicaid An Overview Community Outreach Perspective BlueChoice HealthPlan Medicaid An Overview Community Outreach Perspective 1 BlueChoice HealthPlan Medicaid In the Communities We Serve! 2 BlueChoice HealthPlan Medicaid Our focus is on preventive care.

More information

Risk Adjusted Diagnosis Coding:

Risk Adjusted Diagnosis Coding: Risk Adjusted Diagnosis Coding: Reporting ChronicDisease for Population Health Management Jeri Leong, R.N., CPC, CPC-H, CPMA, CPC-I Executive Director 1 Learning Objectives Explain the concept Medicare

More information

Patient survey report 2004

Patient survey report 2004 Inspecting Informing Improving Patient survey report 2004 Mental health survey 2004 Avon and Wiltshire Mental Health Partnership NHS Trust The mental health service user survey was designed, developed

More information

Dual-eligible SNPs should complete and submit Attachment A and, if serving beneficiaries with end-stage renal disease (ESRD), Attachment D.

Dual-eligible SNPs should complete and submit Attachment A and, if serving beneficiaries with end-stage renal disease (ESRD), Attachment D. Attachment A: Model of Care for Dual-eligible SNPs MA Contract Name: Geisinger Health Plan MA Contract Number: H3954-097 Type of Dual-eligible SNP: Full The model of care describes the MAO's approach to

More information

2016 Complex Case Management. Program Evaluation. Our mission is to improve the health and quality of life of our members

2016 Complex Case Management. Program Evaluation. Our mission is to improve the health and quality of life of our members 2016 Complex Case Management Program Evaluation Our mission is to improve the health and quality of life of our members 2016 Complex Case Management Program Evaluation Table of Contents Program Purpose

More information

Agenda. Surviving the New Program Requirements and the Financial Penalties Under MIPS 9/9/2016. Steps to take to prepare for MIPS

Agenda. Surviving the New Program Requirements and the Financial Penalties Under MIPS 9/9/2016. Steps to take to prepare for MIPS Surviving the New Program Requirements and the Financial Penalties Under MIPS September 2016 Selena Hood Agenda Steps to take to prepare for MIPS Introduction and Evaluation of the Merit-Based Incentive

More information

COPD & Pneumonia Readmission Reduction Program. October 25, 2017

COPD & Pneumonia Readmission Reduction Program. October 25, 2017 COPD & Pneumonia Readmission Reduction Program October 25, 2017 Susan J. Bowers, MBA, BSN, RN Chief Quality Officer Mercy Health - Lorain 2 Locations Mercy Health Lorain Hospital Lorain, Ohio 250 bed community

More information

ACOs: California Style

ACOs: California Style ACOs: California Style ACO Congress John E. Jenrette, M.D. Chief Executive Officer Sharp Community Medical Group November 2, 2011 California Style California Style A CO California Style California Style

More information

Reducing Preventable Hospital Readmissions in Post Acute Care Kim Barrows RN BSN

Reducing Preventable Hospital Readmissions in Post Acute Care Kim Barrows RN BSN Reducing Preventable Hospital Readmissions in Post Acute Care Kim Barrows RN BSN Session Objectives At the end of the session the learner will be able to: 1. Discuss the history of hospital readmission

More information

Hospital Utilization: Hospitalization and Emergent Care

Hospital Utilization: Hospitalization and Emergent Care Hospital Utilization: Hospitalization and Emergent Care SHP for Agencies Complete analysis of hospitalizations, rehospitalizations, and emergent care occurrences is available in the Agencies> Hospital

More information

Transitioning to ICD-10. Presented by: The Centers for Medicare & Medicaid Services

Transitioning to ICD-10. Presented by: The Centers for Medicare & Medicaid Services Transitioning to ICD-10 Presented by: The Centers for Medicare & Medicaid Services June 20, 2013 ICD-10 Basics ICD-10 Implementation ICD-10 Compliance Date The compliance deadline for ICD-10-CM and PCS

More information

National Hospice and Palliative Care OrganizatioN. Facts AND Figures. Hospice Care in America. NHPCO Facts & Figures edition

National Hospice and Palliative Care OrganizatioN. Facts AND Figures. Hospice Care in America. NHPCO Facts & Figures edition National Hospice and Palliative Care OrganizatioN Facts AND Figures Hospice Care in America 2017 Edition NHPCO Facts & Figures - 2017 edition Table of Contents 2 Introduction 2 About this report 2 What

More information

Meaningful Use Stage 1 Guide for 2013

Meaningful Use Stage 1 Guide for 2013 Meaningful Use Stage 1 Guide for 2013 Aprima PRM 2011 December 20, 2013 2013 Aprima Medical Software. All rights reserved. Aprima is a registered trademark of Aprima Medical Software. All other trademarks

More information

READMISSION ROOT CAUSE ANALYSIS REPORT

READMISSION ROOT CAUSE ANALYSIS REPORT USE RESTRICTED TO ABC Hospital READMISSION ROOT CAUSE ANALYSIS REPORT State: Community Name: YZ Cohort: Hospital: A ABC Hospital Reviewer: Jane Doe Abstraction Period: 1/1/2014 6/30/2014 Charts Abstracted:

More information

UPDATED Nursing/Intermediate Care Facility Providers

UPDATED Nursing/Intermediate Care Facility Providers December 2008 Provider Bulletin Number 8160 UPDATED Nursing/Intermediate Care Facility Providers Revenue Codes The revenue codes listed under field 42 for the UB-04 form were inadvertently deleted with

More information

2017 Quality Reporting: Claims and Administrative Data-Based Quality Measures For Medicare Shared Savings Program and Next Generation ACO Model ACOs

2017 Quality Reporting: Claims and Administrative Data-Based Quality Measures For Medicare Shared Savings Program and Next Generation ACO Model ACOs 2017 Quality Reporting: Claims and Administrative Data-Based Quality Measures For Medicare Shared Savings Program and Next Generation ACO Model ACOs June 15, 2017 Rabia Khan, MPH, CMS Chris Beadles, MD,

More information

Module 1 Program Description

Module 1 Program Description Module 1 Program Description Palliative Care Program Description 1. What type(s) of communities does your palliative care program serve? Check all that apply. Urban Suburban Rural 2. Which counties does

More information

Reducing emergency admissions

Reducing emergency admissions A picture of the National Audit Office logo Report by the Comptroller and Auditor General Department of Health & Social Care NHS England Reducing emergency admissions HC 833 SESSION 2017 2019 2 MARCH 2018

More information

Executive Summary: Davies Ambulatory Award Community Health Organization (CHO)

Executive Summary: Davies Ambulatory Award Community Health Organization (CHO) Davies Ambulatory Award Community Health Organization (CHO) Name of Applicant Organization: Community Health Centers, Inc. Organization s Address: 110 S. Woodland St. Winter Garden, Florida 34787 Submitter

More information

1/11/2016. The Metro Care Transitions Program (CCTP) OUR GOAL OUR HISTORY

1/11/2016. The Metro Care Transitions Program (CCTP) OUR GOAL OUR HISTORY The Metro Care Transitions Program (CCTP) OUR GOAL Build patient/caregiver confidence. Engage patients to take a more active role in self-management of chronic health conditions. Foster independence and

More information

The Metro Care Transitions Program (CCTP)

The Metro Care Transitions Program (CCTP) The Metro Care Transitions Program (CCTP) OUR GOAL Build patient/caregiver confidence. Engage patients to take a more active role in self-management of chronic health conditions. Foster independence and

More information

Enhancing Outcomes with Quality Improvement (QI) October 29, 2015

Enhancing Outcomes with Quality Improvement (QI) October 29, 2015 Enhancing Outcomes with Quality Improvement (QI) October 29, 2015 Learning Objectives! Introduce Quality Improvement (QI)! Explain Clinical Performance Person-Centered Medical Home (PCMH) Measures! Implement

More information

Sandra Robinson, RN, MSN, ACM, CEN

Sandra Robinson, RN, MSN, ACM, CEN Developing and Measuring Care Coordination Outcome Goals and Objectives ACMA National Conference April 28, 2015 Cleveland Clinic Care Management Sandra Robinson, RN, MSN, ACM, CEN (robinss12@ccf.org) Joan

More information

New Facts and Figures on Hospice Care in America

New Facts and Figures on Hospice Care in America New Facts and Figures on Hospice Care in America NHPCO has just released the 2010 edition of NHPCO Facts and Figures: Hospice Care in America. Through an easy-to-read narrative that is written for the

More information

Oklahoma Health Care Authority. Behavioral Health Quality Assessment and Performance Improvement (QAPI) Study

Oklahoma Health Care Authority. Behavioral Health Quality Assessment and Performance Improvement (QAPI) Study Oklahoma Health Care Authority Behavioral Health Quality Assessment and Performance Improvement (QAPI) Study Executive Summary Report for Contract: State Fiscal Year 2010 ( Data Reviewed: State Fiscal

More information

An Overview of NCQA Relative Resource Use Measures. Today s Agenda

An Overview of NCQA Relative Resource Use Measures. Today s Agenda An Overview of NCQA Relative Resource Use Measures Today s Agenda The need for measures of Resource Use Development and testing RRU measures Key features of NCQA RRU measures How NCQA calculates benchmarks

More information

NGA Paper. Using Data to Better Serve the Most Complex Patients: Highlights from NGA s Intensive Work with Seven States

NGA Paper. Using Data to Better Serve the Most Complex Patients: Highlights from NGA s Intensive Work with Seven States NGA Paper Using Data to Better Serve the Most Complex Patients: Highlights from NGA s Intensive Work with Seven States Executive Summary Across the country, health care systems continue to grapple with

More information

American Nurses Credentialing Center. Test Content Outline Effective Date: April 1, Ambulatory Care Nurse Board Certification Examination

American Nurses Credentialing Center. Test Content Outline Effective Date: April 1, Ambulatory Care Nurse Board Certification Examination American Nurses Credentialing Center Test Content Outline Board Certification Examination There are 175 questions on this examination. Of these, 150 are scored questions and 25 are nonscored pretest questions.

More information

PROPOSED POLICY AND PAYMENT CHANGES FOR INPATIENT STAYS IN ACUTE-CARE HOSPITALS AND LONG-TERM CARE HOSPITALS IN FY 2014

PROPOSED POLICY AND PAYMENT CHANGES FOR INPATIENT STAYS IN ACUTE-CARE HOSPITALS AND LONG-TERM CARE HOSPITALS IN FY 2014 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 FACT SHEET FOR IMMEDIATE RELEASE Contact: CMS Media Relations

More information

Cite this article as: BMJ, doi: /bmj ae (published 30 June 2006)

Cite this article as: BMJ, doi: /bmj ae (published 30 June 2006) Cite this article as: BMJ, doi:10.1136/bmj.38870.657917.ae (published 30 June 2006) BMJ Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patients

More information

Molina Healthcare Michigan Health Care Services Department Phone: (855) Fax: (800)

Molina Healthcare Michigan Health Care Services Department Phone: (855) Fax: (800) Utilization Management Program Molina Healthcare of Michigan s Utilization Management (UM) program utilizes a care management approach based upon empirically validated best practices, where experience

More information

Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC)

Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) Resource for Indicator Standards (RIS) Health Analytics Branch, Ministry of Health and Long-Term Care Indicator description RIS indicator

More information

Return On Investment (ROI) for a Model RN/CHW Practice

Return On Investment (ROI) for a Model RN/CHW Practice Return On Investment (ROI) for a Model RN/CHW Practice Raymond K. Neff, ScD Mark T. Lubberts RN, MSN Spectrum Health Healthier Communities July 19, 2016 2 Principal Objectives 1. Define Return on Investment

More information

Solution Title: Population Health: A Paradigm Shift in how we care for Behavioral Health Patients

Solution Title: Population Health: A Paradigm Shift in how we care for Behavioral Health Patients Solution Title: Population Health: A Paradigm Shift in how we care for Behavioral Health Patients Overview of Project A drive to Population Health and changes in reimbursement have prompted the need to

More information

MEDICAL RESPITE IN NEW YORK CITY

MEDICAL RESPITE IN NEW YORK CITY MEDICAL RESPITE IN NEW YORK CITY ROSA M. Gil, DSW Founder, President & CEO Comunilife, Inc. 14th Annual New York State Supportive Housing Conference June 5, 2014 INTRODUCTION National attention is increasingly

More information

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home Domains of Function. Interpretive Guidelines

BCBSM Physician Group Incentive Program. Patient-Centered Medical Home Domains of Function. Interpretive Guidelines BCBSM Physician Group Incentive Program Patient-Centered Medical Home Domains of Function Interpretive Guidelines October 2009 Table of Contents Page 1.0 PATIENT-PROVIDER PARTNERSHIP 1 2.0 PATIENT REGISTRY

More information

Practice Implications for Accountable Care Organizations

Practice Implications for Accountable Care Organizations Practice Implications for Accountable Care Organizations An Overview following the Final Rule Gregory M. Marsh, MPH, PMP December 14, 2011 Why CCME? Effective EHR/HIE Implementation will: Improve patient

More information

Saint Agnes Hospital. Pharmacist utilization of the LACE tool to prevent hospital readmissions. Program/Project Description, including Goals:

Saint Agnes Hospital. Pharmacist utilization of the LACE tool to prevent hospital readmissions. Program/Project Description, including Goals: Saint Agnes Hospital Pharmacist utilization of the LACE tool to prevent hospital readmissions Program/Project Description, including Goals: Safe transitions of care have always been a frontline patient

More information

Examining the Differences Between Commercial and Medicare ACO Models

Examining the Differences Between Commercial and Medicare ACO Models Examining the Differences Between Commercial and Medicare ACO Models Michelle Copenhaver December 10, 2015 Agenda 1 Understanding Accountable Care Organizations 2 Moving to Accountable Care: Enhancing

More information

OASIS QUALITY IMPROVEMENT REPORTS

OASIS QUALITY IMPROVEMENT REPORTS 6 OASIS QUALITY REPORTS GENERAL INFORMATION... 2 AGENCY PATIENT-RELATED CHARACTERISTICS (CASE MIX) REPORT... 4 AGENCY PATIENT-RELATED CHARACTERISTICS (CASE MIX) TALLY REPORT 9 HHA REVIEW AND CORRECT REPORT...13

More information