Athena Forum Staff Competencies in Care Management. Copyright (c) Athena Forum, LLC 1

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1 Athena Forum Staff Competencies in Care Management Copyright (c) Athena Forum, LLC 1

2 Athena Forum Overview MISSION: Improving staff competencies of case managers among health plans. FEATURES: Online core curriculum of 65 course modules, totaling 3,000 pages & growing, on chronic care management and business training topics. Accredited for RN and CCM case managers. Easy-to-use Staff Competency Program. BENEFITS: 1. Increasing staff competencies in chronic care management 2. Improving member assessments & care planning 3. Increasing member adherence 4. Supporting the company s priorities in med management 5. Improving staff morale (ideal for at-home workers) 6. Supporting NCQA and URAC standards 7. ROI forecast 400% ($195 tuition can save $1,000 in provider expenses per year) ACCREDITATION: 360 CE for RN, Social Workers & CCM (ANCC, NASW, CCMC). VALUE PROPOSITION: Enroll your case managers on Athena Forum and gain performance improvements in staff competencies and patient management. Copyright (c) Athena Forum, LLC 2

3 Athena Forum Design Designed by 400 health plan leaders as a job-performance tool to improve staff competencies in chronic care management. B2B & tuition-based: Health plans enroll teams through simple annual tuitions Content: Conforms to evidence-based medicine and regs standards (NCQA & URAC) Web site is ad-free: Athena Forum team works for case managers -- not advertisers Core curriculum: Courses are permanent and always updated (e.g. asthma, diabetes) Clinical Reference Tool: Key Word Search capability for on-the-job referencing Online platform: Ideal for at-home workers & geographically-dispersed teams Designed as a 3-in-1 business tool [see next slide] Copyright (c) Athena Forum, LLC 3

4 Athena Forum: 3-in-1 Business Tool 1. Staff Competency Program (Directors assign courses & document staff competencies with CE) 2. Clinical Reference Tool (Popular searches: glycemic control HINN adherence complications ) 3. CE Source for Case Managers (New employee benefit for RN s & CCM personnel) Copyright (c) Athena Forum, LLC 4

5 Staff Competency Program: Case Study MEMO TO: All Case Managers FROM: Director Care Coordination SUBJECT: Patient Management Priorities & Staff Competency Program As discussed, our med management priorities are to members with asthma, cardiovascular risk issues, diabetes and depression. To support our priorities and to generally improve our coaching skills to members, we ve enrolled everyone on Athena Forum.com, a high quality clinical training service that offers CE for RN and CCM personnel. There is no cost to you to participate. Starting this month we re assigning courses on Athena Forum to move us as a team to a more consistent level of chronic care support to members. Next week we ll announce Athena webinars for orientations. Please note: (a) you may take these CE courses at work or at home, wherever you feel most comfortable; (b) submit your CE certificates to [admin name] in order to document your performance; (c) your CE certificates will be filed in your personnel folder and will be a factor in your annual review; (d) you may use the CE for your personal licensure use; (e) you may record one hour of comp time per month to take the courses; (f) we ll discuss the course topics and our policy applications on our Wednesday conf calls. We re all confident this program will enhance our chronic care support to members. Thank you. Athena Forum Course Assignments: JAN: Asthma Pathophysiology FEB: Asthma Case Manager s Role MAR: Diabetes Therapies APR: Diabetes Care Standards MAY: Diabetes Complications JUN: Cardiovascular Risk: Pathophysiology JUL: Cardiovascular Risk: MI and CM Role AUG: Vacations. No courses. SEP: Cardiovascular Risk: Stroke and CM Role OCT: Behavioral Health: Depression NOV: Behavioral Health: Substance Abuse DEC: Happy Holidays. No courses. Copyright (c) Athena Forum, LLC 5

6 Athena Forum Clinical Series Permanent Courses Always Updated Key Word Searchable 3,000 Pages & Growing New Courses Added Quarterly Asthma Behavioral Health COPD Cardiovascular Care Colorectal Cancer Diabetes Heart Failure GI Disorders Multiple Sclerosis Obesity Management Pain Management Rheumatoid Arthritis Women s Health Wound Care & Payment Guidelines Copyright (c) Athena Forum, LLC 6

7 Excerpt: Clinical Series Improving Outcomes in Diabetes Care Intercurrent Illness The stress of illness frequently aggravates glycemic control and necessitates frequent monitoring of blood glucose and urine or blood ketones. Marked hyperglycemia requires adjustment of the treatment plan, and if accompanied by ketosis, frequent interaction with the diabetes care team. Patients treated with antidiabetes agents or MNT alone may temporarily require insulin. Adequate fluid and caloric intake must be assessed. Infection or dehydration is more likely to necessitate hospitalization of the patient with diabetes. A vomiting illness accompanied with ketosis may indicate DKA, a lifethreatening condition that requires immediate medical care to prevent complications and death (See Module A). Recommendations for Glycemic Control Treatment Lowering A1C has been associated with a reduction of microvascular and neuropathic complications of diabetes. Develop or adjust the management plan to achieve normal or near-normal glycemia with an A1C test goal of < 7%. Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. Self-monitoring of blood glucose (SMBG) is an integral component of therapy (See Module A). Instruct the patient in SMBG and routinely evaluate the patient's technique and ability to use data to adjust therapy. Less stringent treatment goals may be appropriate for patients with limited life expectancies, in the very young or older adults, and in individuals with co-morbid conditions. Copyright (c) Athena Forum, LLC 7

8 CM Excellence: Provider Perspectives Business Courses (500 pages always updated) Faculty (CM Directors) 1 Principles of Case Management Bonnie Boehlke, RN, ACM Conway Medical Center SC 2 Patient Advocacy Sharon Mass, PhD, LCSW, ACM Cedars-Sinai Med Center CA 3 Utilization Management Brian Pisarsky, RN, ACM, CPUR DCH Regional Med Center AL 4 Discharge Planning & Transitions of Care Beth Heinz, MHA, MSW, LICSW Regions Hospital / Health Partners MN 5 Case Mgmt & the Hospital Revenue Cycle Mary Whitehead, RN, BSN, MA Scripps Healthcare CA Copyright (c) Athena Forum, LLC 8

9 Excerpt: CM Excellence: Provider Perspectives Discharge Planning & Transitions of Care: Module A Hospitals provide Hospital-Issued Notices of Non-coverage (HINNs) to beneficiaries prior to admission, at admission, or at any point during an inpatient stay -- if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered because it is: 1. Not medically necessary, 2. Not delivered in the most appropriate setting, or 3. Is custodial in nature. (Resource for Medicare patients: Preadmission/Admission Hospital Issued Notice of Non-coverage (HINN) is available at CMS.gov Section V of the attachment is CR3903 Transmittal 594, dated June 24, 2005 and in effect 2009.) The patient and family who were earlier so happily ready to go home now may be devastated, confronted by an unexpected expense. The hospital case manager in the role of patient advocate needs to: 1. Support the patient, and 2. Investigate the situation. Question: Is the charge of not medically necessary accurate? Question: Why was the determination made? If it is accurate and can t be reversed, what, if any effect does it have on the discharge plan, especially on the post-discharge care part? Copyright (c) Athena Forum, LLC 9

10 Athena Forum Quality Control Quality Goal: Courses must be rated at 90% Excellent CE Activity: Number of CE tests passed in Q3 & Q = 15,303 CE Data: 15,303 CE evals rated courses at 95% Excellent (5% above goal) Oversight by Certified Case Managers Commission (CCMC). Copyright (c) Athena Forum, LLC 10

11 Testimonials: Among 10,000 CMs Enrolled We know it. We trust it. We love it. Director of CM Education, KY Athena has no competition. The finest we ve ever seen. Associate Medical Director, IN I assign courses, my staff submits CE certificates. Win-win. Team Leader, IL This is the 21 st Century way to learn. Athena Forum gets it. CM Director, WI Bargain of the Century. CM Director, KA Great resource 24/7 for my team content is up-to-date. Director of CM, CA Staff conversations are getting more professional. Director Care Mgmt, MO Athena helped us pass our URAC accreditation. Director of CM, GA Athena s Key Word Search is the new PDR. Director of CM, NY Copyright (c) Athena Forum, LLC 11

12 MCO Customers: Partial List Aetna Medicare Advantage NJ Aetna Medicare IL Aetna Commercial IL Allied Managed Care CA AmeriGroup USA Amgen Employee Health CA Anthem Blue Cross IN Athens Area Health Plan Select GA Berlex Employee Health NJ Bristol-Myers Employee Health NJ Cedars Sinai Health CA CIGNA NC Community Services Inc KY Freeman Disability Associates, Inc. WV Genentech Employee Health CA Health Plan of San Joaquin CA Henry Ford Med Center MI Humana Medicare USA Humana Military USA Humana Transplants KY Humana Commercial USA Humana Personal Nurses USA Humana Quality & Accreditation KY Independent Health Assoc NY Indian Health Service / HHS USA John Deere Employee Health IA Maryland Nurses Association MD Mayo Clinic, MN McKesson Health CO Memorial Sloan Kettering NY Montana State Govt Health MT Novo Nordisk Employee Health NJ OptumHealth USA PacificSource, OR Pfizer Employee Health NY Sanofi Aventis Employee Health NJ Scripps Healthcare CA UnitedHealthcare NY NC WI Copyright (c) Athena Forum, LLC 12

13 Invitation to Enroll Your CM Team: Athena Forum invites you to enroll your CM team and begin the journey of improvement Athena Forum issues one invoice yearly to Team Leader (e.g. 25 CMs X $195 = $4,800 year) Athena Forum provides complimentary tuitions to Team Leaders Athena Forum hosts complimentary webinars for staff orientations Athena Forum supports staff turnover during the year with pro-rated credits or charges Athena Forum issues quarterly usage reports to Team Leaders if desired Contact: Tom Rasmussen Tom@AthenaForum.com TEL: Rockville, MD Copyright (c) Athena Forum, LLC 13

14 Athena Forum Management Team: Tom Rasmussen Eloise Schwartz, RN, CCM, MBA Mindy Owen RN, CRRN, CCM CEO & Publisher Clinical Editor Online Vice President Education Senior Fellow Jefferson School Population Health Past Chair CCMC Former President CMSA Robin A. Moore Nancy McCaslin, RN-BC, MSN Danae Manus, MPA Director Enrollment Director CE Accreditations Director Course Planning Athena Forum, LLC RN CE Provider PAO Crofton Hill EIN # Rockville, MD TEL Athena was the mythological Greek goddess of wisdom and prudent warfare. Contact: Robin A. Moore, Director, Enrollments Robin@AthenaForum.com MAIN: Copyright (c) Athena Forum, LLC 14