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

Size: px
Start display at page:

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

Transcription

1 2017 Catastrophic Care Program Evaluation Our mission is to improve the health and quality of life of our members

2 2017 Catastrophic Care Program Evaluation Table of Contents Program Purpose Page 1 Goals and Objectives Page 1-2 Member Interactions Page 2 Evaluation Top 15 Primary Diagnoses for Members in Catastrophic Care Pages 2-3 Number of Referrals by Source Page 4 Catastrophic Care Emergency, Admission and Readmission Utilization Pages 5 Member Discharge Status Page 6 Goals Met/ Not Met Page 7 Member Satisfaction Survey Results with Catastrophic Care Services Received Member Satisfaction Survey Results for Improvement of Health or Quality of Life Pages 8-9 Pages Annual Review of Passport Health Plan s Total Population Pages Barriers/Opportunities Page 14 Activities Pages 15-16

3 2017 Catastrophic Care Program Evaluation Program Title: Catastrophic Care (CC) Program Evaluation Evaluation Period: January 1, 2017 December 31, 2017 Program Purpose: The CC Program employs a member-centric approach that helps members and caregivers understand and engage in attaining or maintaining their optimal health. The objectives of the Program are to: Improve care coordination for members in collaboration with their primary care physician (PCP) and specialist treating clinicians. Support the clinician s treatment plan. Facilitate and coordinate transitioning the member to the least restrictive setting. Optimize chronic condition management by educating members about diagnoses and self-management. Implement personalized care plans. Improve medication adherence. Address member/caregiver needs regarding adequate support and resources at home. Improve adherence to the hospital discharge care plan for members discharged to home. Decrease avoidable utilization events (e.g., readmissions) and increase the number of members engaged with a Care Advisor. Program Goals and Objectives: Directly identify catastrophic and highly intensive cases through the utilization management (UM) process, member self-referral, clinician referral and predictive model. Facilitate safe care transitions. Honor the member s preferences for care. Partner with the member, caregiver and the primary and specialty care clinicians to develop a personalized plan of care in the least restrictive setting. Improve medication compliance. Address member/caregiver needs regarding adequate support and resources at home. Coordinate a comprehensive community based and home health care network of services. Identify and negotiate contracts with those services outside of the existing network. Facilitate appropriate communication across the entire care team. Support end of life and palliative care options with members and their clinicians. 3/15/18 DRAFT Page 1

4 Optimize chronic care management and close relevant gaps in evidence based care. Educate members about diagnoses and self-management. Lower total medical expense by avoidance of readmissions, emergency room (ER) visits, duplicative and unwarranted services, and specialist costs through coordinating care during acute, intensive care episodes. Member Interactions: CC interacted with 434 members in Evaluation I. Graph 1 Top 15 Primary Diagnoses for Members in CC Chronic obstructive pulmonary disease and bronchiectasis Spondylosis; intervertebral disc disorders; other back problems Chronic kidney disease Other lower respiratory disease Other aftercare Respiratory failure; insufficiency; arrest (adult) Other non-traumatic joint disorders Residual codes; unclassified Pneumonia (except that caused by tuberculosis or sexually Essential hypertension Other screening for suspected conditions (not mental Septicemia (except in labor) Cancer of brain and nervous system Complications of surgical procedures or medical care Other connective tissue disease Objective: To annually evaluate the primary diagnosis or Special Needs Category of members who trigger and enroll in CC services to ensure Passport Health Plan (Passport) has the appropriate staff, materials, and resources to assist members in improving their health and quality of life. 3/15/18 DRAFT Page 2

5 Analysis of Findings: Graph 1 represents members by diagnosis enrolled into CC. The top three diagnoses were: 1) Chronic obstructive pulmonary disease and bronchiectasis 2) Spondylosis; intervertebral disc disorders; other back problems 3) Chronic kidney disease Individuals with Special Health Care Needs: Passport evaluated the population for Individuals with Special Health Care Needs or ISHCN. Members defined as having special healthcare needs are members who have or are at risk for chronic physical, developmental, behavioral, neurological, or emotional conditions and who may require a broad range of primary, specialized medical, behavioral health (BH), and/or related services. ISHCN may have an increased need for healthcare or related services due to their respective conditions; therefore, Passport proactively identified, outreached, and enrolled these members into CC. In 2017, the Department of Health School Board Manager identified children with special healthcare needs and coordinated with health departments and schools throughout the state to ensure coordination of care and prevent duplication of care. Medically Complex Foster Children: Medically complex foster care children are identified by Department of Community Based Services (DCBS) worker, DCBS service plan, and/or via a medically complex foster care report provided monthly by the Department for Medicaid Services (DMS). All identified medically complex foster care children are enrolled in care management. Some also receive care management or case consultation from the BH Case Management Team. Care Advisors, Health Educators, Dietitians, Social Workers, and BH Case Managers collaborate during regular integrated meetings and via ongoing contact with one another to ensure the needs of these vulnerable members are being met. Care Advisors maintain regular communication with the Passport Foster Care and Guardianship Specialists and/or Manager of Specialty Populations to consult as well. The Care Advisor assigned to the member as well as the Foster Care Specialist participate in team conference calls led by the Children s Review Program (CRP) when the member s needs or presenting issues are impacting CRP s ability to locate appropriate placement for the child. 3/15/18 DRAFT Page 3

6 II. Graph Referral Sources Total Stratification Utilization Management 25 Rapid Response Outreach Team (RROT) Program: Transition Care Member/Caregiver Other Practitioner Program: Condition Care Program: Complex Care Program: Maternity Care Objective: Identify members proactively for CC through multiple resource avenues. Analysis of Findings: Graph 2 represents referrals by source. The top three sources were: 1) Stratification 2) Utilization Management 3) RROT, Transition Care and Member/Caregiver Multiple avenues are used to proactively identify members for CC. Education and information is distributed via the Member and Provider Handbooks, Member Newsletter, New Member Packets, and Member and Provider Program brochures. Provider Referral Forms are available as well on the Passport website. Education is provided through internal department meetings and the use of internal referral forms between CC and BH is encouraged. A daily report is obtained from the Health Information Line (24-Hour Nurse Line) of identified members. Health Risk Assessments (HRA) are utilized as a means of risk screening for the member. An attempt is made to obtain an HRA for all members. 3/15/18 DRAFT Page 4

7 III. CC Emergency, Admission and Readmission Utilization Goal: Emergency Department (ED), Inpatient Admission, and 30-day Readmission Reduction of 20% or greater. Analysis of Findings: This is a comparison of utilization specifically related to members in CC. It analyzes rates during 2017 of utilization prior to enrollment in CC comparative to after. The goal of reducing ED, inpatient admission, and 30-day readmission rates by 20% or greater was exceeded for Inpatient utilization. The target was not met for ER utilization, Readmission Rates, or enrollment in CC. After CC involvement during 2017, the data demonstrates: An increase of 82% in ER utilization. A decrease of 92% in Inpatient utilization. A decrease of 18% in Readmissions Rates. Data demonstrates an increase of 9% in enrollment in CC compared to /15/18 DRAFT Page 5

8 IV. Graph Member Discharge Status Unable to Reach Declines Participation Problem Resolved/Goals Met 160 Insurance Terminated 140 Lost Contact 120 Deceased Not Appropriate for Program Externally Managed Patient in Hospice Patient in Long-Term Care Transferred to Complex Care Identified No Contact Info Transferred to Condition Care Objective: Identify barriers for CC from discharge status to reduce inability to sustain engagement with members. Analysis of Findings: Graph 3 represents reasons for member s discharge from CC during The top three reasons were: 1) Closed Unable to Reach 2) Declines Participation 3) Problem Resolved/Goals Met There were 188 (38%) members discharged due to Care Advisor being unable to reach the member; 71 (14%) members declined participation and 67 (14%) members were discharged/closed due to problem resolved/goals met. Discharge reasons remains consistent with /15/18 DRAFT Page 6

9 V. Graph 4 Goal: Meet or exceed a rate of 90% of goals partially or completely met for members enrolled in CC. Analysis of Findings: Graph 4 represents the status of goals for members enrolled in the CC Program. In 2017, 379 goals were completed/partially completed, an 84% increase compared to There was a total of one (1) goal that was not met, a 4% decrease compared to There was a goal completion rate of 99.99% for 2017; an increase of 44% from The goal to meet or exceed the target of 90% of goals partially or completely met for members enrolled in CC was exceeded. 3/15/18 DRAFT Page 7

10 VI. Member Satisfaction Survey Results with CC Services Received 100% 80% Member Satisfaction Survey Results for CC Services Received 100% 100% 100% 100% 100% 100% 100% 100% 75% 94% Goal 90% 60% 40% 20% 0% Understand Health Condition Professional and Courteous Manner Value of Written Materials Help with Making Decisions Total 1st Qtr 17 2nd Qtr 17 n = 1 n = 4 Member Satisfaction Survey Results for CC Services Received 100% 100% 100% 100% 100% 100% Goal 90% 80% 60% 40% 20% 0% 0% 0% 0% 0% 0% Happy with Services Received Support for Health Care Needs Create Plan of Care of Health Needs Help with Care and Supplies Needed at Home 3rd Qtr 17 4th Qtr 17 n = 0 n = 4 Total Goal: Achieve or exceed a score of 90% or above in all areas of member satisfaction for CC services. 3/15/18 DRAFT Page 8

11 Analysis of Findings: The areas surveyed in the first graph include: 1) Understand Health Condition 2) Professional and Courteous Manner 3) Value of Written Materials 4) Help with Making Decisions The goal is to achieve 90% satisfaction for each area. During 2017, sixty (60) member surveys were distributed, of which five (5) were returned (8% response rate). Of the members who responded to the survey, 100%, 75%, respectively for 1st and 2nd Quarter 2017, reported they could understand health condition better, and 100%, 100% respectively for 1st and 2nd Quarter 2017, reported the Care Advisor had a professional and courteous manner, the written materials they received had value, and they received help with making decisions regarding their health. The areas surveyed in the second graph include: 1) Happy with Services Received 2) Support for Health Care Needs 3) Create Plan of Care of Health Needs 4) Help with Care and Supplies Needed at Home The goal is to achieve 90% satisfaction for each area. During 2017, eighteen (18) telephonic member surveys were conducted, of which four (4) members responded (22% return rate). Of the members who responded to the survey, 0%, 100%, respectively for 3rd and 4th Quarter 2017, reported satisfaction in the following areas: happy with the services they received, support given regarding their health care needs, creating a plan of care, and help with care and supplies needed at home. Only one topic (Understand Health Condition) fell below satisfaction rate target. Target was met or exceeded in all other areas. The total number of returned surveys (9) is too small to draw conclusions about the generalizability of the results. 3/15/18 DRAFT Page 9

12 VII. Member Satisfaction Survey Results for Improvement of Health or Quality of Life Member Satisfaction Survey Results for Improvement of Health and Quality of Life 100% 100% 100% 100% 100% 100% 80% Goal 75% 67% 60% 50% 50% 40% 20% 0% Deal with Health Condition Quality of Life Overall Health Total 1st Qtr 17 2nd Qtr 17 n = 1 n = 4 Member Satisfaction Survey Results for Improvement of Health and Quality of Life 100% 100% 100% 93% 80% 80% Goal 75% 60% 40% 20% 0% 0% 0% 0% 0% Set Goals Plan for Assistance Overall Quality of Life Total 3rd Qtr 17 4th Qtr 17 n = 0 n = 4 Goal: Achieve or exceed a score of 75% or above in member's perception of improved overall health status and quality of life. 3/15/18 DRAFT Page 10

13 Analysis of Findings: The graphs above represent the members satisfaction regarding improvement in health or quality of life. The areas surveyed in the first graph include: 1) Deal with Health Condition 2) Quality of Life 3) Overall Health The goal is to achieve 75% satisfaction/agreement for each topic. Of the members who responded to the survey, 100%, 100%, respectively for 1st and 2nd Quarter 2017, reported they could understand their health condition better, and 100%, 50% respectively for 1st and 2nd Quarter 2017, reported improvement in quality of life, and improvement in overall health. The survey areas represented in the second graph include: 1) Goals set by Care Advisor and Member 2) Plan for Assistance 3) Overall Quality of Life The goal is to achieve 75% satisfaction/agreement for all topics. Of the members who responded to the survey, 0%, 100%, respectively for 3rd and 4th Quarter 2017, reported they could set and follow goals better and could plan for assistance when needed, and 0%, 80% respectively for 3rd and 4th Quarter 2017, reported improvement in overall quality of life. In 1st Quarter 2017, the target was not met in the areas of Quality of Life and Overall Health. Targets were met or exceeded in all other areas. The total number of returned surveys (9) is too small to draw conclusions about the generalizability of the results. During 2017, there were no complaints received regarding the CC Program or Care Advisors. 3/15/18 DRAFT Page 11

14 VIII. Annual Review of Passport s Total Population 3/15/18 DRAFT Page 12

15 5,471 5, , , , , , , , , , , , , , , & 2017 Member Demographics 400, , , , , , ,000 50,000 - Male Female Age 0-17 Age Age 65+ Urban Rural Total Members Gender Age Group Location Objective: To annually assess the characteristics of Passport s populations and evaluate available resources to meet the needs of these members. Analysis of Findings: Population Analysis: At least annually, Passport assesses, analyzes, and evaluates the characteristics and needs of its member population to identify relevant subpopulations, revise and update its processes to meet member needs, and to assure Passport has all the needed resources to address member s needs. During 2017, Passport focused on several subpopulations for enrollment in CC services. Children have been a majority of our plan enrolled population in years past; however, the adult population has increased over the past two years due to Medicaid expansion. Adults were the majority of enrollees in the CC Program in In years past, Passport had more female members than male, which remains consistent in Members with an End Stage Renal Disease (ESRD) diagnosis are enrolled in the CC Program (versus other available care management programs) due to needing dialysis and a higher level of care coordination. Therefore, Passport has made a conscious decision to keep those members in CC. No barriers are identified thus no changes are needed at this point. The presence of substance abuse has increased with CC enrollees. This corresponds to the opioid epidemic that has been declared in the state. Member Engagement: Care Advisors engaged 136 members in This represents a 9% increase from Members appropriate for this program have multiple and complex co-morbidities and psychosocial barriers. Care Advisors work with the members to decrease readmissions and ER utilization and to increase utilization of outpatient services and compliance with treatment and care plans. 3/15/18 DRAFT Page 13

16 Barriers and Opportunities Barrier: Inability to locate member for initial assessment or ongoing contact. Opportunity: Collaborate with clinicians to encourage member participation and locate additional demographics. Attempt to obtain working phone numbers through unable to reach, providers, pharmacies, Spokeo, and TracFone. Barrier: Member unwilling to comply with treatment plan and its completion. Opportunity: Member education regarding the benefits of CC through individualized contact with the member. Collaborate with providers to encourage member participation. Barrier: Limited member response to the CC survey. Opportunity: Encourage member response to survey at the time of discharge. Developed new telephonic Member Satisfaction Survey. Questions include happy with services received, provided support to take care of health needs, care team worked well to create a plan to take care of health needs, help to get care and supplies needed at home, set goals that helped improve day-to-day needs, helped make plans so member can get help when needed, and if their overall quality of life had improved since working with the Care Advisor. 3/15/18 DRAFT Page 14

17 Activities for 2017: Provider Education: Encouraged provider involvement with CC. Member Education: Educated members/caregivers regarding CC benefits and services through telephonic outreach, Passport s website, and member educational material. CC identified and enrolled medically complex foster care members, and members identified as individuals with special health care needs. Developed new telephonic Member Satisfaction Survey. Questions include happy with services received, provided support to take care of health needs, care team worked well to create a plan to take care of health needs, help to get care and supplies needed at home, set goals that helped improve day-to-day needs, helped make plans so member can get help when needed, and if their overall quality of life had improved since working with the Care Advisor. Screening Activities: Administered the Patient Health Questionnaire (PHQ) 2 and the Pediatric Symptom Checklist-17 (PSC-17) a BH screening used with member s ages 4 to 17. There were 48 adult members screened and 2% of those members had a positive result, leading to the PHQ-9 being administered. Of those members, eight (8) were referred for BH services. There were no pediatric members screened using the PSC- 17 screening tool during Administered the Member Satisfaction Survey telephonically to members enrolled in the CC Program, reviewed surveys as received and conducted outreach to those members who indicate fair or poor responses on their survey (if the member completes contact information section of the survey tool) and monitored surveys for trends, none identified. Provided feedback to individual staff when appropriate and addressed any identified areas that needed improvement, none identified. Identification Activities: CC interacted with 434 members in Care Advisors exhausted all measures to establish and maintain contact with members including calling clinician offices, utilizing the Medical Management System to locate current address and phone numbers, and mailing unable to contact letters with business cards attached. Collaborated with other departments such as UM, Member Services, and Provider Relations to identify members who could potentially benefit from CC services. 3/15/18 DRAFT Page 15

18 Activities for 2017 (Continued): Activities for 2018: Continued to improve integration and collaboration with BH to improve overall coordination of care for members with co-existing medical and BH diagnoses/conditions. Continued Interventions: Encourage provider involvement with CC. Identify and enroll medically complex foster care members, and members identified as individuals with special health care needs into CC. Increase provider/practice engagement, targeting select practices to implement care conferences where CC needs of patient roster will be discussed. Educate members/caregivers through: o Telephonic outreach o Member newsletters o On-hold SoundCare messages o Passport s website o Member educational materials Continue to monitor member care gaps and work with member and clinician to increase preventative health screenings. Evaluate alternate methods of communication with members for health messaging. Build the PSC-17 into the care management platform. Administer the PHQ-2, PHQ-9 (for adults) and PSC-17 (for children ages 4-17) to prescreen and screen for depression in members and referred members to the BH team as needed. Review surveys as received and conduct outreach to those members who indicate fair or poor responses on their survey (if the member completes contact information section of the survey tool). Monitor for trends, provide feedback both positive and negative to individual staff and address any identified areas that need improvement. Collaborate with other departments such as UM, Member Services, and Provider Relations to identify members who could potentially benefit from CC services. Continue to improve collaboration with BH to improve overall coordination of care for members with co-existing medical and BH diagnoses. To include behavioral health/substance abuse facilities. Revise member and clinician correspondence (i.e., letters, materials, etc.) to improve member and clinician education regarding CC services. Overall the CC Program noted improvements in Once again, Passport noted an increase in the number of members participating in the CC Program. Based upon the 2017 evaluation, Passport continued to adapt and evolve in working toward the overall goal of improving the health and quality of life for our members with catastrophic conditions. 3/15/18 DRAFT Page 16

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

2016 Embedded and Rapid Response Care Management

2016 Embedded and Rapid Response Care Management 2016 Embedded and Rapid Response Care Management Program Evaluation Our mission is to improve the health and quality of life of our members 2016 Embedded and Rapid Response Care Management Program Evaluation

More information

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

2016 Complex Case Management Program Description. Our mission is to improve the health and quality of life of our members 2016 Complex Case Management Program Description Our mission is to improve the health and quality of life of our members Complex Case Management Program Description I. Purpose To improve the health status

More information

2017 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members

2017 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members 2017 Congestive Heart Failure Program Evaluation Our mission is to improve the health and quality of life of our members 2017 Congestive Heart Failure Program Evaluation Program Title: Congestive Heart

More information

2015 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members

2015 Congestive Heart Failure. Program Evaluation. Our mission is to improve the health and quality of life of our members 2015 Congestive Heart Failure Program Evaluation Our mission is to improve the health and quality of life of our members 2015 Congestive Heart Failure Program Evaluation Program Title: Congestive Heart

More information

EVOLENT HEALTH, LLC. Heart Failure Program Description 2017

EVOLENT HEALTH, LLC. Heart Failure Program Description 2017 EVOLENT HEALTH, LLC Heart Failure Program Description 2017 1 Evolent Health Heart Failure Program Description 2017 Table of Contents Section Page Number I. Introduction. 3 II. Program Scope. 3 III. Program

More information

QUALITY IMPROVEMENT. Molina Healthcare has defined the following goals for the QI Program:

QUALITY IMPROVEMENT. Molina Healthcare has defined the following goals for the QI Program: QUALITY IMPROVEMENT Molina Healthcare maintains an active Quality Improvement (QI) Program. The QI program provides structure and key processes to carry out our ongoing commitment to improvement of care

More information

EVOLENT HEALTH, LLC Diabetes Program Description 2018

EVOLENT HEALTH, LLC Diabetes Program Description 2018 EVOLENT HEALTH, LLC Diabetes Program Description 2018 1 Evolent Health Diabetes Program Description 2018 Table of Contents Section Page Number I. Introduction... 3 II. Program Scope... 3 III. Program Goals...

More information

2013 Mommy Steps. Program Description. Our mission is to improve the health and quality of life of our members

2013 Mommy Steps. Program Description. Our mission is to improve the health and quality of life of our members 2013 Mommy Steps Program Description Our mission is to improve the health and quality of life of our members I. Purpose Passport Health Plan (PHP) has developed approaches to the management of members

More information

EVOLENT HEALTH, LLC. Asthma Program Description 2018

EVOLENT HEALTH, LLC. Asthma Program Description 2018 EVOLENT HEALTH, LLC Asthma Program Description 2018 1 Evolent Health Asthma Program Description 2018 Table of Contents Section Page Number I. Introduction... 3 II. Program Scope... 3 III. Program Goals...

More information

2016 Mommy Steps Program Descriptions

2016 Mommy Steps Program Descriptions 2016 Mommy Steps Program Descriptions Our mission is to improve the health and quality of life of our members Mommy Steps Program Descriptions I. Purpose Passport Health Plan (Passport) has developed approaches

More information

Provider Information Guide Complex Care and Condition Care Overview

Provider 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 information

EVOLENT HEALTH, LLC. Asthma Program Description 2017

EVOLENT HEALTH, LLC. Asthma Program Description 2017 EVOLENT HEALTH, LLC Asthma Program Description 2017 1 Evolent Health Asthma Program Description 2017 Table of Contents Section Page Number I. Introduction.. 3 II. Program Scope 3 III. Program Goals 4 IV.

More information

2017 Quality Improvement Work Plan Summary

2017 Quality Improvement Work Plan Summary Project Member Service and Satisfaction Commercial Products: Commercial Project Description: To improve member service and satisfaction and increase member understanding of how the member s plan works.

More information

Community Care of North Carolina

Community Care of North Carolina Community Care of North Carolina 2007 Community Care of North Carolina Mail Service Center 2009 Raleigh, NC 27699-2009 (919) 715-1453 www.communitycarenc.com Background Several networks in the Community

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

Passport Advantage Provider Manual Section 10.0 Care Management

Passport Advantage Provider Manual Section 10.0 Care Management Passport Advantage Provider Manual Section 10.0 Care Management Table of Contents 10.1 Model of Care 10.2 Medication Therapy Management 10.3 Care Coordination 10.4 Complex Case Management Page 1 of 9 10.0

More information

Integration Workgroup: Bi-Directional Integration Behavioral Health Settings

Integration Workgroup: Bi-Directional Integration Behavioral Health Settings The Accountable Community for Health of King County Integration Workgroup: Bi-Directional Integration Behavioral Health Settings May 7, 2018 1 Integrated Whole Person Care in Community Behavioral Health

More information

Passport Advantage (HMO SNP) Model of Care Training (Providers)

Passport Advantage (HMO SNP) Model of Care Training (Providers) Passport Advantage (HMO SNP) Model of Care Training (Providers) 2018 Passport Advantage (HMO SNP) is an HMO Special Needs plan with a Medicare contract and an agreement with the Kentucky Department for

More information

Payment Reforms to Improve Care for Patients with Serious Illness

Payment Reforms to Improve Care for Patients with Serious Illness Payment Reforms to Improve Care for Patients with Serious Illness Discussion Draft March 2017 Payment Reforms to Improve Care for Patients with Serious Illness Page 2 PAYMENT REFORMS TO IMPROVE CARE FOR

More information

CareMore Special Needs Plans Model of Care. Annual Evaluation 2015 Performance

CareMore Special Needs Plans Model of Care. Annual Evaluation 2015 Performance CareMore Special Needs Plans Model of Care Annual Evaluation 2015 Performance The Special Needs Plans (SNPs) Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit

More information

DISEASE MANAGEMENT PROGRAMS. Procedural Manual. CMPCN Policy #5710

DISEASE MANAGEMENT PROGRAMS. Procedural Manual. CMPCN Policy #5710 DISEASE MANAGEMENT PROGRAMS Procedural Manual CMPCN Policy #5710 Effective Date: 01/01/2012 Revision Date(s) 11/18/2012; 10/01/13 ; 01/07/14 Approval Date(s) 12/18/2012 ; 10/23/13, 05/27,14 Annotated to

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

Institutional Handbook of Operating Procedures Policy

Institutional Handbook of Operating Procedures Policy Section: Clinical Policies Institutional Handbook of Operating Procedures Policy 09.01.13 Responsible Vice President: EVP and CEO Health System Subject: Admission, Discharge, and Transfer Responsible Entity:

More information

WORK PROCESS DOCUMENT NAME: Medical Necessity Review for Behavioral Health and Substance Use Disorder REPLACES DOCUMENT: RETIRED:

WORK PROCESS DOCUMENT NAME: Medical Necessity Review for Behavioral Health and Substance Use Disorder REPLACES DOCUMENT: RETIRED: PAGE: 1 of 7 SCOPE: Coordinated Care Departments for Behavioral Health and Substance Use Disorder (SUD) Reviews for members enrolled in Integrated Managed Care and Behavioral Health Services Only PURPOSE:

More information

2016 Member Incentive. Program Descriptions. Our mission is to improve the health and quality of life of our members

2016 Member Incentive. Program Descriptions. Our mission is to improve the health and quality of life of our members 2016 Member Incentive Program Descriptions Our mission is to improve the health and quality of life of our members Member Incentive Program Descriptions I. Purpose Passport Health Plan (Passport) has developed

More information

Follow-Up after Hospitalization for Mental Illness (FUH) Improvement Strategies

Follow-Up after Hospitalization for Mental Illness (FUH) Improvement Strategies Follow-Up after Hospitalization for Mental Illness (FUH) Improvement Strategies 1. What efforts and/or strategies have you put in place to improve your plans performance on the Follow-Up After Hospitalization

More information

DELAWARE FACTBOOK EXECUTIVE SUMMARY

DELAWARE FACTBOOK EXECUTIVE SUMMARY DELAWARE FACTBOOK EXECUTIVE SUMMARY DaimlerChrysler and the International Union, United Auto Workers (UAW) launched a Community Health Initiative in Delaware to encourage continued improvement in the state

More information

Hendrick Center for Extended Care. Community Health Needs Assessment Implementation Plan

Hendrick Center for Extended Care. Community Health Needs Assessment Implementation Plan Hendrick Center for Extended Care Community Health Needs Assessment Implementation Plan - 2014-2016 Overview: Hendrick Center for Extended Care ( HCEC ) is a Long Term Acute Care Hospital, within Hendrick

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

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services

More information

UTILIZATION MANAGEMENT AND CARE COORDINATION Section 8

UTILIZATION MANAGEMENT AND CARE COORDINATION Section 8 Overview The focus of WellCare s Utilization Management (UM) Program is to provide members access to quality care and to monitor the appropriate utilization of services. WellCare s UM Program has five

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

Model of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018

Model of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018 Model of Care Model of Care 2018 Learning Objectives Program participants will be able to: List two differences between the Complex Care Management (CCM), and Special Needs Program (SNP) programs. Identify

More information

Model Of Care: Care Coordination Interdisciplinary Care Team (ICT)

Model Of Care: Care Coordination Interdisciplinary Care Team (ICT) Cal MediConnect 2017 Model Of Care: Care Coordination Interdisciplinary Care Team (ICT) 2017 CMC Annual Training Learning Objectives Define the L.A. Care Cal MediConnect (CMC) Model of Care Describe the

More information

About the National Standards for CYSHCN

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 information

2015 Quality Improvement Work Plan Summary

2015 Quality Improvement Work Plan Summary 2015 Quality Improvement Project Member Service and Satisfaction Commercial Products: Commercial Project Description: To improve member service and satisfaction and increase member understanding of how

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

Welcome to the Cenpatico 2017 Provider Newsletter

Welcome to the Cenpatico 2017 Provider Newsletter Improving Lives 2017 ISSUE You want to help your patients. We re here to help you. This newsletter will provide you with information regarding our clinical and operational resources, and programs, all

More information

Managing Patients with Multiple Chronic Conditions

Managing Patients with Multiple Chronic Conditions Best Practices Managing Patients with Multiple Chronic Conditions Dartmouth-Hitchcock Physicians Case Study Organization Profile Headquartered in Bedford, New Hampshire, Dartmouth-Hitchcock is a large

More information

The Heart and Vascular Disease Management Program

The Heart and Vascular Disease Management Program Element A: Program Content The Heart and Vascular Disease Management Program GHC-SCW is committed to helping members, and their practitioners, manage chronic illness by providing tools and resources to

More information

2015 Member Incentive. Program Evaluation. Our mission is to improve the health and quality of life of our members

2015 Member Incentive. Program Evaluation. Our mission is to improve the health and quality of life of our members 25 Member Incentive Program Evaluation Our mission is to improve the health and quality of life of our members 25 Member Incentive Program Evaluation Annual Participation Rate Program Title: Member Incentive

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

The TeleHealth Model THE TELEHEALTH SOLUTION

The TeleHealth Model THE TELEHEALTH SOLUTION The Model 1 CareCycle Solutions The Solution Calendar Year 2011 Data Company Overview CareCycle Solutions (CCS) specializes in managing the needs of chronically ill patients through the use of Interventional

More information

Medical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management

Medical 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 information

Quality Management and Improvement 2016 Year-end Report

Quality Management and Improvement 2016 Year-end Report Quality Management and Improvement Table of Contents Introduction... 4 Scope of Activities...5 Patient Safety...6 Utilization Management Quality Activities Clinical Activities... 7 Timeliness of Utilization

More information

Readmissions Moving beyond blame to fill the patient needs. Jackie Conrad RN, MBA, RCC Cynosure Health

Readmissions Moving beyond blame to fill the patient needs. Jackie Conrad RN, MBA, RCC Cynosure Health Readmissions Moving beyond blame to fill the patient needs Jackie Conrad RN, MBA, RCC Cynosure Health jconrad@cynosurehealth.org 1 51 year old male with 3 acute care admissions and 2 ED visits in the past

More information

RYAN WHITE HIV/AIDS PROGRAM SERVICES Definitions for Eligible Services

RYAN WHITE HIV/AIDS PROGRAM SERVICES Definitions for Eligible Services RYAN WHITE HIV/AIDS PROGRAM SERVICES Definitions for Eligible Services (Last Updated: July 15, 2013) Ryan White HIV/AIDS Program funds are intended to support only the HIV-related needs of clients. All

More information

Molina Medicare Model of Care. Healthcare Services Molina Healthcare 2016

Molina 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 information

Special Needs Program Training. Quality Management Department

Special Needs Program Training. Quality Management Department 10/26/2017 1 Special Needs Program Training Quality Management Department 10/26/2017 2 Special Needs Plan (SNP) Overview 3 SNP Overview Medicare Advantage (MA) plans were created by the Medicare Modernization

More information

Provider Guide. Medi-Cal Health Homes Program

Provider 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 information

Section IX Special Needs & Case Management

Section 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 information

Domain 1 Patient Engagement Speed Data Reports & Schedule

Domain 1 Patient Engagement Speed Data Reports & Schedule Domain 1 Patient Engagement Speed Data Reports & Schedule Suffolk Care Collaborative (SCC) Suffolk County Performing Provider System (PPS) Delivery System Reform Incentive Payment (DSRIP) Program 2 PRESENTATION

More information

SPECIAL NEEDS PLAN. Model of Care Training

SPECIAL NEEDS PLAN. Model of Care Training SPECIAL NEEDS PLAN Model of Care Training WHAT IS A SNP? The Medicare Modernization Act of 2003 established Special Needs Plans (SNP). Centers Plan for Healthy Living (CPHL) participates in two types of

More information

Department of Behavioral Health

Department of Behavioral Health PROGRAM INFORMATION: Program Title: Program Description: Mental Health Service Act (MHSA) Perinatal Team The Department of Behavioral Health (DBH) Perinatal Wellness Center provides outpatient mental health

More information

QUALITY MEASURES WHAT S ON THE HORIZON

QUALITY MEASURES WHAT S ON THE HORIZON QUALITY MEASURES WHAT S ON THE HORIZON The Hospice Quality Reporting Program (HQRP) November 2013 Plan for the Day Discuss the implementation of the Hospice Item Set (HIS) Discuss the implementation of

More information

Policy Brief October 2014

Policy Brief October 2014 Policy Brief October 2014 Does ity Affect Observation Care Services Use in CAHs for Medicare Beneficiaries? Yvonne Jonk, PhD; Heidi O Connor, MS; Walter Gregg, MA, MPH Key Findings Medicare claims data

More information

Molina Medicare Model of Care

Molina 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 information

New York State Medicaid Value Based Payment: Data Driven Strategies. Bundled Payment Summit June 27, 2017

New York State Medicaid Value Based Payment: Data Driven Strategies. Bundled Payment Summit June 27, 2017 New York State Medicaid Value Based Payment: Data Driven Strategies Bundled Payment Summit June 27, 2017 Panelists Moderator Paloma Hernandez Anthony Thompson Marc Berg President and CEO Urban Health Plan

More information

Special Needs Plan Model of Care Chinese Community Health Plan

Special Needs Plan Model of Care Chinese Community Health Plan Special Needs Plan Model of Care 2017 2017 Chinese Community Health Plan Elements of CCHP SNP Model of Care Special Needs Plan (SNP) Goals CCHP Dual Eligible SNP Enrollment & Eligibility Vulnerable Beneficiaries

More information

MCS Model of Care For Special Needs Plans (SNP) Annual training for delegated entities and facilities

MCS Model of Care For Special Needs Plans (SNP) Annual training for delegated entities and facilities 2018 MCS Model of Care For Special Needs Plans (SNP) Annual training for delegated entities and facilities Quality Department CAN_2790318S CMS Requirements The Centers of Medicare & Medicaid Services (CMS)

More information

L8: Care Management for Complex Patients: Strategies, Tools and Outcomes

L8: Care Management for Complex Patients: Strategies, Tools and Outcomes The Triple Aim 16 th Annual Summit: Institutes for Healthcare Improvement - Improving Patient Care in the Office Practice and the Community March 16, 2015 Dallas, Texas L8: Care Management for Complex

More information

Complex Care Management Protocols and Procedures

Complex Care Management Protocols and Procedures Complex Care Management Protocols and Procedures December 2014 Version 3.0 1 Table of Contents I. Complex Care Management Program Staff Roles and Responsibilities... 4 II. Complex Care Management Program

More information

Asthma Disease Management Program

Asthma Disease Management Program Asthma Disease Management Program A: Program Content GHC-SCW is committed to helping members, and their practitioners, manage chronic illness by providing tools and resources to empower members to self-manage

More information

Hendrick Medical Center. Community Health Needs Assessment Implementation Plan

Hendrick Medical Center. Community Health Needs Assessment Implementation Plan Hendrick Medical Center Community Health Needs Assessment Implementation Plan - 2014-2016 Hendrick Medical Center Community Health Needs Assessment Implementation Plan - 2014-2016 Overview: Hendrick Medical

More information

Hot Spotter Report User Guide

Hot Spotter Report User Guide 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

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

2019 Quality Improvement Program Description Overview

2019 Quality Improvement Program Description Overview 2019 Quality Improvement Program Description Overview Introduction Eon/Clear Spring s Quality Improvement (QI) program guides the company s activities to improve care and treatment for the member s we

More information

Partnering with Managed Care Entities A Path to Coordination and Collaboration

Partnering 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 information

HEALTHY EMPLOYEES HEALTHY EMPLOYEE BENEFIT PLAN

HEALTHY EMPLOYEES HEALTHY EMPLOYEE BENEFIT PLAN HEALTHY EMPLOYEES HEALTHY EMPLOYEE BENEFIT PLAN At a point in time when many employers are forced to cut benefits healthcare costs are increasing at 3 to 4 times the rate of inflation access to quality

More information

Stage 2 GP longitudinal placement learning outcomes

Stage 2 GP longitudinal placement learning outcomes Faculty of Life Sciences and Medicine Department of Primary Care & Public Health Sciences Stage 2 GP longitudinal placement learning outcomes Description This block focuses on how people and their health

More information

Course Module Objectives

Course Module Objectives Course Module Objectives CM100-18: Scope of Services, Practice, and Education CM200-18: The Professional Case Manager Case Management History, Regulations and Practice Settings Case Management Scope of

More information

Community Health Needs Assessment Three Year Summary

Community Health Needs Assessment Three Year Summary Community Health Needs Assessment Three Year Summary 2013 2016 Community Health Needs Assessment Three Year Summary 2014 2016 Key needs were identified by community stakeholders which included the following:

More information

Medicaid Covered Services Not Provided by Managed Medical Assistance Plans

Medicaid Covered Services Not Provided by Managed Medical Assistance Plans Medicaid Covered Services Not Provided by Managed Medical Assistance Plans This document outlines services not provided by MMA plans, but are available to Medicaid recipients through Medicaid fee-for-service.

More information

Safe Transitions Best Practice Measures for

Safe Transitions Best Practice Measures for Safe Transitions Best Practice Measures for Nursing Homes Setting-specific process measures focused on cross-setting communication and patient activation, supporting safe patient care across the continuum

More information

Understanding Patient Choice Insights Patient Choice Insights Network

Understanding Patient Choice Insights Patient Choice Insights Network Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Understanding Patient Choice Insights Patient Choice Insights Network SM www.aetna.com Helping consumers gain

More information

A Regional Payer/Provider Partnership to Reduce Readmissions The Bronx Collaborative Care Transitions Program: Outcomes and Lessons Learned

A Regional Payer/Provider Partnership to Reduce Readmissions The Bronx Collaborative Care Transitions Program: Outcomes and Lessons Learned A Regional Payer/Provider Partnership to Reduce Readmissions The Bronx Collaborative Care Transitions Program: Outcomes and Lessons Learned Stephen Rosenthal, MBA President and COO, Montefiore Care Management

More information

ILLINOIS 1115 WAIVER BRIEF

ILLINOIS 1115 WAIVER BRIEF ILLINOIS 1115 WAIVER BRIEF STATE TESTING FOR THE FOLLOWING ACHIEVED RESULTS: 1. Increased rates of identification, initiation, and engagement in treatment 2. Increased adherence to and retention in treatment

More information

APPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS

APPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS Appendix 2 NCQA PCMH 2011 and CMS Stage 1 Meaningful Use Requirements 2-1 APPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS CMS Meaningful Use Requirements* All Providers Must Meet

More information

PRINCIPAL DUTIES AND RESPONSIBILITIES:

PRINCIPAL DUTIES AND RESPONSIBILITIES: Position Title: Licensed Clinical Social Worker Union Community Health Center (UNION) is one of the largest FQHC s in New York State, serving approximately 38,000 patients from six locations in the central

More information

OneCare Model of Care

OneCare 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 information

IV. Clinical Policies and Procedures

IV. Clinical Policies and Procedures A. Introduction The role of ValueOptions NorthSTAR is to coordinate the delivery of clinical services. There are three parties to this care coordination process: the Enrollee, the Provider(s), and the

More information

DRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM (DMC-ODS) PERFORMANCE METRICS. (version 6/23/17)

DRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM (DMC-ODS) PERFORMANCE METRICS. (version 6/23/17) 1 Access Enrollment information to include the number of DMC-ODS beneficiaries served in the DMC-ODS program Clients Served: 1. Number of DMC-ODS beneficiaries served (admissions) by the DMC- ODS County

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following:

KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant

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

I. Coordinating Quality Strategies Across Managed Care Plans

I. Coordinating Quality Strategies Across Managed Care Plans Jennifer Kent Director California Department of Health Care Services 1501 Capitol Avenue Sacramento, CA 95814 SUBJECT: California Department of Health Care Services Medi-Cal Managed Care Quality Strategy

More information

Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012

Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012 Coordinated Care Initiative DRAFT Assessment and Care Coordination Standards November 20, 2012 Table of Contents CARE COORDINATION GENERAL REQUIREMENTS...4 RISK STRATIFICATION AND HEALTH ASSESSMENT PROCESS...6

More information

Behavioral Health Provider Training: Program Overview & Helpful Information

Behavioral Health Provider Training: Program Overview & Helpful Information Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused

More information

PCMH 2014 Recognition Checklist

PCMH 2014 Recognition Checklist 1 PCMH1: Patient Centered Access 10.00 points Element A - Patient-Centered Appointment Access ~~ MUST PASS 4.50 points 1 Providing same-day appointments for routine and urgent care (Critical Factor) Policy

More information

MEDICAL POLICY No R1 TELEMEDICINE

MEDICAL POLICY No R1 TELEMEDICINE Summary of Changes MEDICAL POLICY TELEMEDICINE Effective Date: March 1, 2016 Review Dates: 12/12, 12/13, 11/14, 11/15 Date Of Origin: December 12, 2012 Status: Current Clarifications: Deletions: Pg. 4,

More information

PeachCare for Kids. Handbook

PeachCare for Kids. Handbook PeachCare for Kids Handbook Table of Contents What is PeachCare for Kids?...2 Who is eligible?...3 How do you apply for PeachCare for Kids?...3 Who will be your child s primary doctor?...4 Your child s

More information

KY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for

KY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant

More information

Tips for PCMH Application Submission

Tips for PCMH Application Submission Tips for PCMH Application Submission Remain calm. The certification process is not as complicated as it looks. You will probably find you are already doing many of the required processes, and these are

More information

Macomb County Community Mental Health Level of Care Training Manual

Macomb County Community Mental Health Level of Care Training Manual 1 Macomb County Community Mental Health Level of Care Training Manual Introduction Services to Medicaid recipients are based on medical necessity for the service and not specific diagnoses. Services may

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

Clinical Utilization Management Guideline

Clinical Utilization Management Guideline Clinical Utilization Management Guideline Subject: Therapeutic Behavioral On-Site Services for Recipients Under the Age of 21 Years Status: New Current Effective Date: January 2018 Description Last Review

More information

SPECIAL NEEDS PLAN (SNP) MODEL OF CARE TRAINING 2015

SPECIAL NEEDS PLAN (SNP) MODEL OF CARE TRAINING 2015 SPECIAL NEEDS PLAN (SNP) MODEL OF CARE TRAINING 2015 Introduction This course is offered to meet the CMS regulatory requirements for Model of Care Training for our Special Needs Plan at Care Wisconsin.

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

Provider Manual. Utilization Management Care Management

Provider Manual. Utilization Management Care Management Provider Manual Utilization Management Care Management Utilization Management This section of the Manual was created to help guide you and your staff in working with Kaiser Permanente s Resource Stewardship

More information