Care Coordination Program. Misty VanCampen,BSN,RN,CCM
|
|
- Arthur Green
- 6 years ago
- Views:
Transcription
1 Care Coordination Program Misty VanCampen,BSN,RN,CCM
2 Objectives Define complex care coordination. Discuss the importance of implementing complex care coordination programs in pediatric health care organizations. Describe strategies that may be implemented in a complex care coordination program to facilitate compliance and positive patient outcomes.
3 Medically Complex Congenital Genetic Anomalies Child Medically Fragile Disabled/ Disability Physically Challenged Children with special health care needs Developmentally Delayed Chronic Complex Conditions Gifted Child Technologically Dependent
4 Medically Complex Chronic/severe health conditions Significant family-identified service needs Functional limitations High health resource utilization
5 At Risk Increased risk for Chronic physical conditions Chronic developmental conditions Chronic behavioral conditions, or Chronic emotional conditions Require services beyond those of healthy children Increased health services Increased social services (American Academy of Pediatrics)
6 Medication Errors Lost to follow up Fragmented Care Literacy issues Compliance issues Stress and Fatigue Care Giver = Care Coordinator
7 Promise Cook Children's Promise: Knowing that every child s life is sacred, it is the promise of Cook Children s to improve the health of every child in our region through the prevention and treatment of illness, disease and injury.
8 We serve over 10 thousand complex medically fragile children Vision
9 Genesis Oct Nov Dec.2012 Approval of program for budget year; Job descriptions for RN Case Manager and Social Worker written RN Case Manager and Social Worker hired for positions Meetings/ Data Collection/ More Data Collection/ Ohio Project Overview of program developed MCCM meetings, Meeting with Family Advisory Council Develop Overview of Program Jan Feb Presented to Medical Director Forum Meetings with Physicians Initiated first Home Visit Palliative Care Team Meetings with Hospitalists Live with MCCM Home Visits Pharmacy Clinic meetings
10 Data Repository Data
11 Referral Criteria High ED Visits High Inpatient Admissions High Cost to the System Multiple Specialists CCMC Primary Service Area
12 Return On Investment
13 Staffing Model RN Case Manager for healthcare case management services with emphasis on assessment of health care needs, education, and implementation of the plan of care with continue evaluation. Social Worker Case Manager to coordinate and provide psychosocial services and resources to meet the needs of the patient and caregiver.
14 Services Identify Coordinate Home visits Collaborate Assist Advocate Educate
15 Team Approach Specialists
16 Prepare
17 MCCM Worklist Work lists CACO ER Initial Maintenance
18 Activities Activities
19 Capturing Activity Data
20 Windshield Survey Assess the Surroundings: Type of dwelling Access points to care (pcp, UCC) Dental Food Parks Safety Socioeconomic Crime Hazards: waste, industrial pollution
21 Home Visit Medication Reconciliation Identify Barriers
22 Assessment Psychosocial and Medical Case Management Assessment
23 Referrals for Medical/Developmental/Mental Health Medical Medicaid Waiver Programs MDCP- Money Follows the Person application Community Living Assistance Support Services (CLASS) Home and Community Based Services (HCS) MHMR Personal Care Services (PCS) Developmental ECI under age 3 PT/OT/ST over age 3 (under age 3 if aggressive therapy needed) and need for additional services Mental Health Counseling referrals Therapist or psychiatrist referrals MHMR services
24 School Navigating the Education System Information on ARD meetings (IEP) Advocating education (IDEA, 504b) Assist with Individualized Health Plan (example: seizure, asthma, etc )
25 Coordinated Care PCP Specialists Care Coordination Community DME/ Home Health
26 Success Story
27 Patient Plan Dental DME MDCP Medicaid Programs Physician Nursing Community Resources Catholic Charities, SAVE, 211 Clinic Visits School Care Coordination
28 Key to Success Physician and Administrative Support Data Collection Home Visits Team work across disciplines: palliative, clinics, hospitalists, neighborhood clinics, home health agencies and DME providers
29 Tough Questions End of Life Planning DNR Hospice
30 Bridge the Gap Palliative Care and Hospice Case Studies
31 Results: ROI
32 References Cohen E, Kuo DZ, Agrawal R, et al. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics. March, 2011; 127(3): Berry JG, Agrawal RK, Cohen E, et al. The Landscape of Medical Care for Children with Medical Complexity. CHA Special Report. June, Berry JG, Agrawal RK, Cohen E, et al. Characteristics Of Hospitalizations For Patients Who Use A Structured Clinical Care Program For Children With Medical Complexity, The Journal Of Pediatrics Tubb, Larry. Cook Children s Health Care System and The Medically Complex Child, Retrieved: 03/25/2014
33 Questions
About the National Standards for CYSHCN
National Standards for Systems of Care for Children and Youth with Special Health Care Needs: Crosswalk to National Committee for Quality Assurance Primary Care Medical Home Recognition Standards Kate
More informationHighline 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 informationCare Management in the Patient Centered Medical Home. Self Study Module
Care Management in the Patient Centered Medical Home Self Study Module Objectives Describe the goals of care management Identify elements of successful care management Recognize the 5 step Care Management
More informationMonarch HealthCare, a Medical Group, Inc.
Monarch HealthCare, a Medical Group, Inc. Accountable Care in the Independent Practice Model June 7, 2010 Jay J. Cohen, MD, MBA President/Chairman Monarch HealthCare Monarch HealthCare, a Medical Group,
More informationModel of Care Training
Medicare Advantage Special Needs Plan Chronic Care Program Model of Care Training 2012-2013 Course Overview This course will describe: PHP s Model of Care Chronic Care Program Health Homes Interdisciplinary
More informationDiamond State Health Plan Plus
I N T E G R A T E D L O N G T E R M Diamond State Health Plan Plus DSHP-Plus C A R E 1115 Demonstration Waiver Diamond State Health Plan (DSHP) Managed Care Delivery System Operational since January 1996
More informationSan Diego-Imperial Counties Developmental Services, Inc Performance Contract Plan Outcomes and Activities
1. Outcome: Decrease percentage of Regional Center caseload in Developmental Centers. Implement the Community Placement Plan (CPP). Assess and identify 20 persons residing in the developmental centers;
More informationMEDICALLY COMPLEX CHILDREN S WAIVER
MEDICALLY COMPLEX CHILDREN S WAIVER About Us Who is South Carolina Solutions? We are a part of a Family of Companies. Our corporate office, Community Health Solutions, is located in St. Petersburg, FL.
More informationGenerations Advantage Focus DC (HMO SNP) Diabetes Care Special Needs Plan GENERAL MODEL OF CARE (MOC) TRAINING
Generations Advantage Focus DC (HMO SNP) Diabetes Care Special Needs Plan GENERAL MODEL OF CARE (MOC) TRAINING Through this training you will learn: What is a SNP? What is Martin s Point Generations Advantage
More informationReadmission Project 2017 Janice M. Maupin, RN, MSN, CPHQ. A Catholic healthcare ministry serving Ohio and Kentucky
Readmission Project 2017 Janice M. Maupin, RN, MSN, CPHQ A Catholic healthcare ministry serving Ohio and Kentucky 1 Mission, Values and Promise Our Mission We extend the healing ministry of Jesus by improving
More informationIdentifying Errors: A Case for Medication Reconciliation Technicians
Organization: Solution Title: Calvert Memorial Hospital Identifying Errors: A Case for Medication Reconciliation Technicians Program/Project Description and Goals: What was the problem to be solved? To
More informationCook Children s Health Plan STAR Kids Update
Cook Children s Health Plan 1 Cook Children s Health Plan STAR Kids Update October 5 th, 2016 UNTHCS Grand Rounds Cook Children s Health Plan 2 STAR Kids Program Overview STAR Kids -- new Texas Medicaid
More informationTABLE OF CONTENTS Section 9: Care Coordination Provider Manual: July 2016 Section 9 TOC
TABLE OF CONTENTS Section 9: Care Coordination... 9-1 Integrated Care Coordination... 9-1 Complex Case Management (CCM)... 9-1 Disease Management Programs... 9-2 Transgender Program... 9-3 Social Services...
More informationAETNA BETTER HEALTH OF TEXAS STAR Kids Newsletter
AETNA BETTER HEALTH OF TEXAS STAR Kids Newsletter Fall 2016 Table of contents Aetna Better Health of Texas welcomes STAR Kids from CEO, Patrina Fowler... 1 A word from our Chief Medical Offcer of STAR
More informationExploring the Care of Medically Complex Children
Exploring the Care of Medically Complex Children Disclosure Wisdeen Wu, DO April 14, 2017 Wisdeen Wu, D.O. has no relationships with commercial companies to disclose. Learning Objectives At the end of
More informationEvolving Roles of Pharmacists: Integrating Medication Management Services
Evolving Roles of Pharmacists: Integrating Management Services Marie Smith, PharmD, FNAP Palmer Professor and Assistant Dean, Practice and Policy Partnerships UCONN School of Pharmacy (marie.smith@uconn.edu)
More informationMEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN
Louisiana Behavioral Health Partnership MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN Rosanne Mahaney - Delaware Lou Ann Owen - Louisiana Brenda Jackson,
More informationPatient-Centered Specialty Practice (PCSP) Recognition Program
Patient-Centered Specialty Practice (PCSP) Recognition Program Standards Workshop Part 2 2013 All materials 2013, National Committee for Quality Assurance Agenda Part 1 Content of PCSP Standards and Guidelines
More informationWelcome Providers. Thursday, November 11, Page 1
Welcome Providers Thursday, November 11, 2010 Page 1 What is a 3 Share Plan? The 3 Share Plan is an affordable health plan for small businesses. Cost is shared among employers, their employees, and one
More informationWellness along the Cancer Journey: Palliative Care Revised October 2015
Wellness along the Cancer Journey: Palliative Care Revised October 2015 Chapter 4: Home Care Palliative Care Rev. 10.8.15 Page 366 Home Care Group Discussion True False Not Sure 1. Hospice care is the
More informationComparative Effectiveness Research and Patient Centered Outcomes Research in Public Health Settings: Design, Analysis, and Funding Considerations
University of Kentucky UKnowledge Health Management and Policy Presentations Health Management and Policy 12-7-2012 Comparative Effectiveness Research and Patient Centered Outcomes Research in Public Health
More informationCare Compact Guide Patient-Centered Specialty Care (PCSC) A Component of Medical Neighborhood Initiatives
Compact Guide Patient-Centered Specialty (PCSC) A Component of Medical Neighborhood Initiatives Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
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.11 Case Management Services G.14 Special Needs Services
More informationCentral Ohio Primary Care (COPC) Spotlight on Innovation
Central Ohio Primary Care (COPC) Spotlight on Innovation BY BETTER MEDICARE ALLIANCE MARCH 2017 Central Ohio Primary Care Spotlight on Innovation 1 Central Ohio Primary Care (COPC) Spotlight on Innovation
More informationDeborah Perian, RN MHA CPHQ. Reduce Unplanned Hospital Admissions: Focus on Patient Safety
Deborah Perian, RN MHA CPHQ Reduce Unplanned Hospital Admissions: Focus on Patient Safety Objectives At the end of this lesson, the learner will be able to: Identify key clinical and policy issues associated
More informationChildren with Medical Complexity: A Unique Population with Unique Needs
Children with Medical Complexity: A Unique Population with Unique Needs Nancy Murphy MD, Professor and Chief, Division of Pediatric PM&R, University of Utah School of Medicine Rishi Agrawal MD, MPH, Lurie
More informationManaging Risk Through Population Health Initiatives
Managing Risk Through Health Initiatives Vicki DeBaca, DNS, RN Vice President, Health & Provider Services Sharp Rees-Stealy Medical Centers 1 Sharp Rees-Stealy Medical Centers San Diego s Multi-Specialty
More informationComprehensive, Coordinated, Collaborative Care
Comprehensive, Coordinated, Collaborative Care American Academy of Pediatrics Family Voices Maternal and Child Health Bureau National Association of Children s Hospitals and Related Institutions and Shriners
More informationWellCare of Kentucky s Quest for Quality
WellCare of Kentucky s Quest for Quality WellCare of Kentucky Offices Lexington Office 859-264-5100 Louisville Office 502-253-5100 Ashland Office 606-327-6200 Owensboro Office 270-688-7000 Hazard Office
More informationOvercoming Psycho-Social Hurdles to Transitional Care
Overcoming Psycho-Social Hurdles to Transitional Care Matt Eisenhower Director, Community Health Development Peter Rice, M.D. Medical Director Overcoming Psycho-Social Hurdles to Transitional Care This
More informationFHA HIIN Readmissions Peer Sharing Webinar: Improving Care Transitions through a Discharge Lounge. July 24, 2018
FHA HIIN Readmissions Peer Sharing Webinar: Improving Care Transitions through a Discharge Lounge July 24, 2018 Welcome & Overview How are we doing on Reducing Readmissions? Peer Sharing Presentation:
More informationChronic Care Management
Chronic Care Management Increase Practice Revenue, While Increasing Patient Care Presented by Steven Kress CEO, Renova PCA Introduction Mr. Kress is a founding Member and Serves on the Board of Directors
More informationOregon Health Leadership Council: High Value Patient Centered Care Model
February 21, 2013 Oregon Health Leadership Council: High Value Patient Centered Care Model Mini Summit VII: Intensive Outpatient Care Programs Denise L. Honzel Executive Director Oregon Health Leadership
More informationThe Community Care Navigator Program At Lawrence Memorial Hospital
The Community Care Navigator Program At Lawrence Memorial Hospital Presented By: Linda Gall, MSN, RN, ACM Director of Care Coordination October 21, 2011 Learning Objectives: 1. Describe the vision and
More informationEXECUTIVE SUMMARY: briefopinion: Hospital Readmissions Survey. Purpose & Methods. Results
briefopinion: Hospital Readmissions Survey EXECUTIVE SUMMARY: Purpose & Methods The purpose of this survey was to collect information about hospital readmission rates and practices. The survey was available
More informationProject Description: Page Memorial Hospital (PMH) identified a need for patient care coordination and continuity for post discharge care.
Title: Improving Care Transitions by Utilizing a Multidisciplinary Approach Including a Transition Coach and Primary Care Model Hospital: Valley Health Page Memorial Contacts: Portia Brown Vice President
More informationPartnering with Managed Care Entities A Path to Coordination and Collaboration
Partnering with Managed Care Entities A Path to Coordination and Collaboration Presented by: Caroline Carney Doebbeling, MD, MSc Chief Medical Officer, MDwise May 9, 2013 Agenda Are new care models on
More informationEmbedded Case Manager
Embedded Case Manager Joann Sciandra, RN, BSN, CCM Medical Home Summit ProvenHealth Navigator Geisinger Health System An Integrated Health Service Organization Provider Facilities Managed Care Companies
More informationTABLE OF CONTENTS. Primary Care 3. Child Health Services. 10. Women s Health Services. 13. Specialist Health Services 16. Mental Health Services.
TABLE OF CONTENTS Primary Care 3 Child Health Services. 10 Women s Health Services. 13 Specialist Health Services 16 Mental Health Services. 24 2 PRIMARY CARE What is it? Primary care is a patient's first
More informationCare Compact Guide Patient-Centered Specialty Care (PCSC) A Component of Medical Neighborhood Initiatives
Compact Guide Patient-Centered Specialty (PCSC) A Component of Medical Neighborhood Initiatives Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical
More informationPRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management
PRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management Mission: To improve the health of the people of Connecticut through safe and effective medication
More informationVNAA Blueprint for Excellence PATHWAY TO BEST PRACTICES
VNAA Blueprint for Excellence PATHWAY TO BEST PRACTICES Care Initiation: Critical Interventions VNAA Best Practice for Hospice and Palliative Care The first few days following a patient s admission to
More informationAdministrative Update: How to Implement Discharge Pharmacy Services (DPS) Objectives
Administrative Update: How to Implement Discharge Pharmacy Services (DPS) Morgan Pendleton, PharmD, BCOP Hematology/Oncology Clinical Pharmacist Wake Forest Baptist Health Objectives Evaluate the need
More informationProcedures that require authorization by evicore healthcare
Go directly to the Blue Cross code lists. Go directly to the BCN code lists. Overview The codes listed in this document represent the procedures requiring authorization for the following: Select Blue Cross
More informationRhonda Weathers, MS, Research Associate, North Dakota Center for Persons with Disabilities (NDCPD) Dr. Thomas Carver, DO, Pediatrician, Trinity Health
Rhonda Weathers, MS, Research Associate, North Dakota Center for Persons with Disabilities (NDCPD) Dr. Thomas Carver, DO, Pediatrician, Trinity Health October 2014 Edwards Time/Effort Law Effort X Time
More informationThe Role of the Pharmacist in Value Based Health Care Systems. Len Fromer, M.D., FAAFP Assistant Clinical Professor UCLA School of Medicine
The Role of the Pharmacist in Value Based Health Care Systems Len Fromer, M.D., FAAFP Assistant Clinical Professor UCLA School of Medicine It is not the strongest of the species that survives, nor the
More informationDisclosures. Updates: Psychological Support for Families in the NICU NPA Interdisciplinary Recommendations
Disclosures Updates: Psychological Support for Families in the NICU NPA Interdisciplinary Recommendations Janet N. Press, C.N.S.,M.S.N.,C.T.,R.N. C. Perinatal/ Obstetrical Coordinator Central New York
More informationExpansion of Pharmacy Services within Patient Centered Medical Homes. Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice
Expansion of Pharmacy Services within Patient Centered Medical Homes Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice What is a Patient Centered Medical Home (PCMH)? "an approach
More informationGonzalo Paz-Soldán, MD, FAAP, CPE Executive Medical Director - Pediatrics Reliant Medical Group
Gonzalo Paz-Soldán, MD, FAAP, CPE Executive Medical Director - Pediatrics Reliant Medical Group Describe the main characteristics of a PCMH Analyze potential benefits of becoming a PCMH Examine the criteria
More informationBest Management Practices In Integrated Behavioral Health/Primary Care Programs
Best Management Practices In Integrated Behavioral Health/Primary Care Programs The 2017 OPEN MINDS Strategy & Innovation Institute Wednesday, June 7, 2017 2:00pm 3:15pm Steve Ramsland, Ed.D., Senior Associate,
More informationSPECIALIZED CARE FOR CHILDREN. Family Handbook. Core Program
SPECIALIZED CARE FOR CHILDREN Family Handbook Core Program Table of Contents Who We Are... 1 How We Help... 2 Is My Child Eligible?... 3 Care Coordination Tools... 4 ID Card... 5 When Should I Call My
More informationTargeting Readmissions:
Targeting Readmissions: A Collaborative Strategy for Hospitals, Health Plans and Local Communities Speaker: Gina Lasky, PhD, Senior Consultant, Warren Lyons, Principal, Suzanne Mitchell, MD, Principal,
More informationCommunity Health Improvement Plan
Community Health Improvement Plan Methodist Le Bonheur Germantown Hospital Methodist Le Bonheur Healthcare (MLH) is an integrated, not-for-profit healthcare delivery system based in Memphis, Tennessee,
More informationWhat services does Open Door provide? Open Door provides prevention-focused services that extend beyond the exam room.
What is Open Door? Open Door has been delivering top-notch health care services since 1973. We provide prevention-focused health care for low-income people in Westchester and Putnam, regardless of ability
More informationMHS Care Management Program 1017.PR.P.PP.1 10/17
MHS Care Management Program 1017.PR.P.PP.1 10/17 Sample Integrated Transitional Care Model Inpatient Admission Process Admission thru discharge and beyond Goals: Ensure safe and timely transitions of care
More informationOneCare Model of Care
OneCare Model of Care Note: Content of this course was current at the time it was published. As Medicare policy changes frequently, check with your immediate supervisor regarding recent updates. 2018 Learning
More informationCalifornia s Health Homes Program
California s Health Homes Program HPSM Network Webinar 9/05/18 Goals for Today: Health Homes Program overview CB-CME requirements Program readiness and implementation timeline Gather take-away questions
More information2009 Community Service Plan
2009 Community Service Plan 169 Riverside Drive Binghamton, NY 607-798-5111 www.lourdes.com MESSAGE Overview from of the Programs CEO & Services Dear Friends, Providing community benefit is an important
More informationCAMDEN CLARK MEDICAL CENTER:
INSIGHT DRIVEN HEALTH CAMDEN CLARK MEDICAL CENTER: CARE MANAGEMENT TRANSFORMATION GENERATES SAVINGS AND ENHANCES CARE OVERVIEW Accenture helped Camden Clark Medical Center, (CCMC), a West Virginia-based
More informationMina Li, MD., PhD., CSM Institute for Disability Studies (IDS) The University of Southern Mississippi
Mina Li, MD., PhD., CSM Institute for Disability Studies (IDS) The University of Southern Mississippi October 9, 2010 Who are CYSHCN? Children/Youth with Special Health Care Needs (CYSHCN) are those who
More informationEmergencies in Medically Complex Children: Tip & Tools
Emergencies in Medically Complex Children: Tip & Tools ANGIE CUNNINGHAM, BSN, RN, CCRN-K, C-NPT TRANSPORT OUTREACH AND EMS RELATIONS COORDINATOR CHILDREN S MERCY CRITICAL CARE TRANSPORT KANSAS CITY, MO
More informationSouth Dakota Health Homes Care Coordination Innovation
South Dakota Health Homes Care Coordination Innovation Senator Deb Soholt NCSL Health Innovation Task Force December 6, 2016 South Dakota Health Homes Health Homes (HH)- provide enhanced health care services
More informationELDER MEDICAL CARE. Elder Medical. Counseling & Support. Hospice. Care. Care
ELDER MEDICAL CARE Counseling & Support Elder Medical Care Hospice Care Mission To provide counseling, support and care to anyone with a serious illness, so they may live life to the fullest. Vision We
More informationAdministrators. Medical Directors. 61% The negative impact on our hospital-based program s. 44% We will need to consider the most appropriate or most
2016 This annual survey, which began in 2009, provides key insight into nationwide developments in the business of cancer care. To better capture information from its multidisciplinary membership, this
More informationDuals Demonstration. An Overview for Home Medical Equipment Providers
Duals Demonstration An Overview for Home Medical Equipment Providers Overview Background Medi-Cal Delivery Models State Budget Coordinated Care Initiative Duals Demonstration Overview Goals Population
More informationMHP Work Plan: 1 Behavioral Health Integrated Access
PROGRAM INFORMATION: Program Title: Youth Wellness Center Provider: Department of Behavioral Health Program Description: The Department of Behavioral Health (DBH) Youth Wellness Center is designed to improve
More informationTransitioning Care to Reduce Admissions and Readmissions. Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH
Transitioning Care to Reduce Admissions and Readmissions Sven T. Berg, MD, MPH Julie Mobayed RN, BSN, MPH Disclaimer: Potential for Error Type One Error Rejecting the null hypothesis when it is true
More informationMUST SUBMIT STATE APPLICATION PD 107
NORTHAMPTON COUNTY HEALTH DEPARTMENT NOTIFICATION OF VACANCY Department: Northampton County Health Department Position Title: Public Health Nurse II (RN) Community Care Program (CCP) Position Grade: 72
More informationWhat does it mean. What is the Patient Advocacy program at Open Door? What is the Behavioral Health program
What does it mean to be an FQHC? FQHC s like Open Door are required to: Serve a medically underserved area or population. Offer a sliding fee scale. Provide comprehensive services. Meet rigorous health
More informationNetworkCares (PPO SNP) 2017 Model of Care Training. H5215_360r2_ NHIC 01/2017 m-hm-ncprovpres-0117
NetworkCares (PPO SNP) 2017 Model of Care Training H5215_360r2_092714 NHIC 01/2017 m-hm-ncprovpres-0117 Introduction This course is offered to meet the CMS regulatory requirements for Model of Care Training
More informationEffective Care for High-Need, High-Cost Patients: How to Maximize Prevention and Population Health Efforts
Effective Care for High-Need, High-Cost Patients: How to Maximize Prevention and Population Health Efforts May 9, 2018 www.hcttf.org 1 Speakers Jeff Micklos Executive Director HCTTF Kelly McCracken National
More informationProvider Guide. Medi-Cal Health Homes Program
Medi-Cal Health Provider Guide This provider guide provides information on the California Medi-Cal Health (HHP) for Community-Based Care Management Entities (CB-CMEs), providers, community-based organizations,
More informationCoordinating Care for Individuals with Serious Mental Illness
Coordinating Care for Individuals with Serious Mental Illness Kishor Malavade, MD Chief Medical Officer for Behavioral Health, Department of Population Health Maimonides Medical Center Who we are Maimonides
More informationMolina Medicare Model of Care. Healthcare Services Molina Healthcare 2016
Molina Medicare Model of Care Healthcare Services Molina Healthcare 2016 MHTPS_MOCTRN_062016 1 Molina s Mission Our mission is to provide quality health services to financially vulnerable families and
More informationHospice Policies & Procedures PATIENT CARE
Hospice Policies & Procedures PATIENT CARE Copyright 2017 by Weatherbee Resources, Inc. All rights reserved. Purchasers of Hospice Policies and Procedures: Patient Care are permitted to use and reproduce
More informationHOSPICE CONTRACTING CHECKLIST FOR INPATIENT SERVICES, RESPITE CARE AND VENDOR AGREEMENTS
HOSPICE CONTRACTING CHECKLIST FOR INPATIENT SERVICES, RESPITE CARE AND VENDOR AGREEMENTS The following checklist can be used to verify that the regulatory requirements are addressed in hospice contracts
More informationIV. Benefits and Services
IV. Benefits and A. HealthChoice Benefits This table lists the basic benefits that all MCOs must offer to HealthChoice members. Review the table carefully as some benefits have limits, you may have to
More informationOverview. Patient Centered Medical Home. Demonstrations and Pilots: Judith Steinberg, MD, MPH March 6, 2009
Patient Centered Medical Home Judith Steinberg, MD, MPH March 6, 2009 Patient Centered Medical Home Payment Reform & Incentive Alignment Transparency and Measurement Quality Improvement Practice Transformation
More informationTO BE RESCINDED Patient-centered medical homes (PCMH): eligible providers.
ACTION: Final DATE: 09/21/2018 3:40 PM TO BE RESCINDED 5160-1-71 Patient-centered medical homes (PCMH): eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model
More informationProviderReport. Managing complex care. Supporting member health.
ProviderReport Supporting member health Managing complex care Do you have patients whose conditions need complex, coordinated care they may not be able to facilitate on their own? A care manager may be
More informationBuilding & Strengthening Patient Centered Medical Homes in the Safety Net
Blue Shield of California Foundation County Coverage Expansion Planning Workshop #2 Building & Strengthening Patient Centered Medical Homes in the Safety Net July 8, 2011 Presented by: Kathryn Phillips,
More informationNATIONAL HEALTH CARE REFORM
MACMHB Conference February 2015 NATIONAL HEALTH CARE REFORM Oh no not again but then again change is good right? 1 Are we preparing? or Northwest Michigan Health Services Crystal Lake Health Center Centra
More informationWhat is Transition of Care?
Transitions of Care and Reducing Readmissions Jackie Vance, RN, CDONA, FACDONA Director of Clinical Affairs and Industry Relations, AMDA NTOCC is chaired and coordinated by CMSA in partnership with sanofi
More information2017 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 informationPatient Encounters & Hospital Reach
Patient Encounters & Hospital Reach Palliative Care Service Penetration Palliative care service penetration is the percentage of annual hospital admissions seen by the palliative care team. Penetration
More informationCare & Support Through the Stages of Serious Illness. n Palliative Care. n Hospice Care. n Grief Support. n Opportunities to Learn
Care & Support Through the Stages of Serious Illness n Palliative Care n Hospice Care n Grief Support n Opportunities to Learn n Ways to Support Our Mission More comfort, less stress. It s possible for
More informationCOLLABORATIVE PRACTICE SUCCESSES IN PRIMARY CARE
COLLABORATIVE PRACTICE SUCCESSES IN PRIMARY CARE KPhA Annual Meeting September 7, 2014 Tiffany R. Shin, PharmD, BCACP Lyndsey N. Hogg, PharmD, BCACP Objectives Describe basic concepts of collaborative
More informationProvider Information Guide Complex Care and Condition Care Overview
Complex and Overview Introduction Complex and are essential components of Passport Health Plan s (Passport) Coordination services, which are used to support the practitioner-patient relationship and plan
More informationSection IX Special Needs & Case Management
Section IX Special Needs & Case Management Special Needs and Case Management 181 Integrated Health Care Management (IHCM) The Integrated Health Care Management (IHCM) program is a population-based health
More informationREQUEST FOR PROPOSALS Community Placement Plan Fiscal Year
REQUEST FOR PROPOSALS Community Placement Plan Fiscal Year 2015-2016 North Bay Regional Center (NBRC) is a community- based, private non-profit corporation that is funded by the State of California to
More informationImproving Patient Safety Across Michigan and Illinois
Improving Patient Safety Across Michigan and Illinois Readmissions Collaborative Kickoff January 20, 2016 1 Agenda Readmissions Collaborative Structure and Overview Business case for readmissions Using
More informationHospice Clinical Record Review
Purpose: Surveyors may use this worksheet when conducting clinical record reviews during a hospice survey. Directions: Fill in appropriate data. Table 1. Patient Information Patient Information Residence
More informationThis study serves as an annual follow-up to the initial study conducted in 2016.
Community Mental Health Association of Michigan: Center for Healthcare Research and Innovation Healthcare Integration and Coordination 2017/2018 Update Hundreds of innovative initiatives identified in
More informationCommunity Health and Child Advocacy Goals, Activities, and Competencies
Community Health and Child Advocacy Goals, Activities, and A. Culturally Effective Care Pediatricians must demonstrate skills that result in effective care of children and families from all cultural backgrounds
More informationKatherine Schneider, MD, MPhil Senior Vice President, Health Engagement July 29, 2011
Accountable Care: Health System View CHC Best Practices Forum Katherine Schneider, MD, MPhil Senior Vice President, Health Engagement July 29, 2011 Who we are Southeastern New Jersey s largest health system
More informationPatient-Centered Medical Home (PCMH) & Patient-Centered Specialty Practice (PCSP)
Patient-Centered Medical Home (PCMH) & Patient-Centered Specialty Practice (PCSP) Foundation for a Better Health Care System Presenter Jeanette Ikan, M.D., MHAI Objectives: Definition and benefits of PCMH,
More informationEnhancing Psychosocial Care for Patients with Palliative Care Needs in the Acute Medical Wards
Enhancing Psychosocial Care for Patients with Palliative Care Needs in the Acute Medical Wards Dr Stephanie Chu Associate Consultant Department of Medicine Queen Elizabeth Hospital Hospital Authority Convention
More informationMolina Medicare Model of Care
Molina Medicare Model of Care Provider Network Molina Healthcare 2018 1 Molina s Mission and Vision Our Vision: We envision a future where everyone receives quality health care Our Mission: To provide
More informationThe SOMC Employee Wellness Program
The SOMC Employee Wellness Program A Focus on Results Not Participation Pike County Health Coalition Julie Thornsberry, RN, BSN Manager Employee Health & Wellness What are today s objectives? Identify
More information