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

Size: px
Start display at page:

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

Transcription

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

2 The Special Needs Plans (SNPs) Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. www. medicare.gov 2

3 The Special Needs Plans (SNPs) Medicare limits SNPs to: 1) people who live in certain institutions (like a nursing home) or who require nursing care at home ( I-SNP ) 2) people who are eligible for both Medicare and Medicaid ( D-SNP ) 3) people who have specific chronic or disabling conditions ( C-SNP ) 3

4 CareMore offers 6 Special Needs Plans CareMore Touch I-SNP for people who live in certain institutions (like a nursing home) or who require nursing care at home CareMore Connect D-SNP for people who are eligible for both Medicare and Medicaid CareMore Breathe C-SNP for people who have specific chronic lung conditions CareMore Diabetes C-SNP for people who have diabetes CareMore ESRD C-SNP for people who have End-Stage Renal Disease CareMore Heart C-SNP for people who have specific chronic cardiovascular conditions 4

5 The SNP Model of Care (MOC) CareMore has a formal Model of Care which describes the care and resources offered by the SNPs. The MOC also establishes performance goals to ensure the SNPs provide high-quality care to members. Every year, we evaluate how the SNPs meet the Model of Care and report this information to members, healthcare providers, and health plan teams. 5

6 Special Need Plans Model of Care Care Coordination Health Risk Assessments Individualized Care Plan Interdisciplinary Care Team Care Transitions/Case Management Referrals

7 Health Risk Assessment (HRA) SNP members should complete a Health Risk Assessment (HRA) when they join the plan and then every year afterward CareMore Care Centers offer special HRA visits* Healthy Start visit for new SNP members, first 90 days of enrollment Healthy Journey visit for existing SNP members at least annually, or as health care status changes *I-SNP members receive HRAs unique to the CareMore Touch program HRAs address medical, cognitive, functional, psychosocial and mental health of each SNP member The HRA Tool is integrated into our Electronic Health Records (EHR) systems and used to develop the Individualized Care Plan (ICP) 7

8 Individual Care Plan (ICP) The Individualized Care Plan (ICP) is created based on needs identified in the HRA. Each member is involved in developing his or her own care plan and goals. The ICP considers personal preferences It includes self-management plans and goals It identifies potential barriers and progress It is reviewed and/or updated at least annually, or as health care status changes It is shared with the Interdisciplinary Care Team (ICT), which includes healthcare providers, the member, plus caregivers and others needed to ensure comprehensive coordination of care 8

9 Interdisciplinary Care Team (ICT) At the highest level, the Interdisciplinary Care Team (ICT) evaluates the needs of members based on their risk levels and severity of their healthcare needs. This team includes: The member and caregiver(s) Primary Care Physicians, Extensivist Physicians, and Specialists Nurse Practitioners, Behavioral Health providers, and Registered Dieticians Case Managers and Social Workers and others needed to ensure comprehensive coordination of care Communication within the ICT includes telephonic and/or face-to-face meetings and electronic data transfer record keeping 9

10 Care Transitions A Care Transition refers to the movement of a patient between one healthcare setting to another. This could be from doctor s office to hospital, or from hospital to skilled nursing facility, but patients are at their most vulnerable when transitioning from hospital to home. A main objective of the SNP Model of Care is to assist the member through all care transitions, with a special focus on hospital stay and post-hospital follow up care: Planning and preparing for care transitions Ensuring care after transitions are completed Communication with and coordination of treating providers This is accomplished by: Interdisciplinary care transition protocols Updating, communication, and implementing ICPs Providing clear communication and needed education to members and caregivers Periodic re-evaluation of progress or decline in health status 10

11 Care Transitions When the health status of a SNP member changes, the ICT is mobilized to provide the unique care that is needed Extensivist Physicians visit patients in the hospital or skilled nursing facility Primary Care Providers are notified/consulted on recommended plan of care Specialty Providers are consulted as needed Case Managers provide outreach and discharge planning support Schedule post-hospital follow up visits with Extensivists Continue communication with member based on post-discharge risk protocols Coordinate with Extensivist and Advance Practice Clinician to update the ICP with communication back to the Primary Care Provider 11

12 Case Management The Case Management Department is designed to ensure members receive personalized care coordination across the entire delivery of care model and is focused on the clinical, behavioral and social needs of CareMore members Complex Case Management Social Worker Services Palliative Care Referring to other services as needed Behavioral Health CareMore Care Center programs Long-Term Services and Supports (LTSS) if available Home Health Hospice 12

13 Special Need Plans Model of Care 2015 Model of Care Performance Evaluation

14 2015 vs Goal Measured by Status Improve Access Improving access to affordable medical, mental health and social services Improve Coordination of Care Improving coordination of care Improving transitions of care across health care settings Improve Utilization and Health Outcomes Improve appropriate utilization of preventive health services Identifying baselines and benchmarks for marked patient health outcomes Access and Availability Studies Program Participation SNP Benefits review HRA and ICP Completion Readmissions Post Discharge Follow-up within 30 days SNP healthcare quality measures (4-star or higher) Member Satisfaction Surveys Met Goals for All Measures 60% 17% % 13.9% <70% 90% 89% Needs Improvement Met Goal Needs Improvement Met Goal Met Goal 14

15 2016 Initiatives Based on review of 2015 performance, the CareMore advisory committee recommends the following course of action for 2016: Improve Access & Affordability Initiatives Increase CareMore Care Center disease management program participation Improve Coordination of Care Increase rate of Kept Appointments for Post-Hospital Follow-Up Enhance telephonic HRAs and ICPs for member convenience Improve Utilization and Health Care Outcomes Continue outreach for preventive screenings and quality healthcare measures Introduce real-time patient satisfaction surveys in the CareMore Care Centers 15

16 Special Needs Plans Model of Care Questions and Inquiries can be submitted to: CareMore Quality Management 16

Special Needs Plan (SNP) Model of Care Training 2018

Special Needs Plan (SNP) Model of Care Training 2018 Special Needs Plan (SNP) Model of Care Training 2018 Table of Contents Training Overview Pg. 1 Denver Health Medical Plan s (HMO SNP) MOC Annual Training Pg. 2 Special Needs Plans (SNPs) Pg. 2 Special

More information

MOC Communication & ICT September 5, Training for PPGs

MOC Communication & ICT September 5, Training for PPGs MOC Communication & ICT September 5, 2014 Training for PPGs Learning Objective After this training you will understand the roles of the Interdisciplinary Care Team (ICT) in the SNP & Cal MediConnect Model

More information

Medicare: 2017 Model of Care Training 12/14/201 7

Medicare: 2017 Model of Care Training 12/14/201 7 Medicare: 2017 Model of Care Training 12/14/201 7 What is the Model of Care? The Model of Care (MOC) is Allwell s plan for delivering our integrated care management program for members with special needs.

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

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

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

At EmblemHealth, we believe in helping people stay healthy, get well and live better.

At EmblemHealth, we believe in helping people stay healthy, get well and live better. At EmblemHealth, we believe in helping people stay healthy, get well and live better. Welcome to the 2017 course on Special Needs Plan Model of Care. This year s course is focused on how we can successfully

More information

2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP) & Model of Care (MOC) Overview

2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP) & Model of Care (MOC) Overview 2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP) & Model of Care (MOC) Overview Medicare Advantage (MA) Program Part C Medicare Advantage Medicare Part A and B benefits are administered

More information

Medicare: 2018 Model of Care Training

Medicare: 2018 Model of Care Training Medicare: 2018 Model of Care Training Training Objectives This course will describe how Centene and its contracted providers work together to successfully deliver the duals Model of Care (MOC) program.

More information

2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP), Chronic Special Needs Plan ESRD (CSNP ESRD) & Model of Care (MOC) Overview

2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP), Chronic Special Needs Plan ESRD (CSNP ESRD) & Model of Care (MOC) Overview 2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP), Chronic Special Needs Plan ESRD (CSNP ESRD) & Model of Care (MOC) Overview Medicare Advantage (MA) Program Part C Medicare Advantage Medicare

More information

Generations 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 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 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

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

Medicare: 2017 Model of Care Training 4/13/2017

Medicare: 2017 Model of Care Training 4/13/2017 Medicare: 2017 Model of Care Training Training Objectives This course will describe how MHS Health Wisconsin Medicare Advantage and its contracted providers work together to successfully deliver the Model

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

Model of Care Scoring Guidelines CY October 8, 2015

Model of Care Scoring Guidelines CY October 8, 2015 Model of Care Guidelines CY 2017 October 8, 2015 Table of Contents Model of Care Guidelines Table of Contents MOC 1: Description of SNP Population (General Population)... 1 MOC 2: Care Coordination...

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

SPECIAL NEEDS PLAN (SNP) MODEL OF CARE (MOC) PROVIDER TRAINING

SPECIAL NEEDS PLAN (SNP) MODEL OF CARE (MOC) PROVIDER TRAINING SPECIAL NEEDS PLAN (SNP) MODEL OF CARE (MOC) PROVIDER TRAINING AlohaCare Advantage Plus (HMO SNP) Revised May 2018 HISTORY AlohaCare was formed by a network of Hawaii community health centers in 1994.

More information

Care1st Provider Model of Care Training

Care1st Provider Model of Care Training Care1st Provider Model of Care Training Special Needs Plan (SNP) 2017-2018 SNP Model of Care (MOC) The Medicare Act of 2003 established a Medicare Advantage coordinated care plan that is designed to provide

More information

Model of Care Training

Model 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 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

2014 Model of Care. Provider Training. Molina Medicare _rev_8-14_cab

2014 Model of Care. Provider Training. Molina Medicare _rev_8-14_cab 2014 Model of Care Provider Training Molina Medicare 2014 5-2013_rev_8-14_cab Course Overview The Model of Care (MOC) is Molina Healthcare s documentation of the CMS directed plan for delivering coordinated

More information

08/06/2015. Special Needs Plans. SNP Legislative History Highlights

08/06/2015. Special Needs Plans. SNP Legislative History Highlights National Training Program RO V & RO VII St. Louis, August 10-11, 2015 Special Needs Plans Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people

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. Quality Department 2017

Model of Care. Quality Department 2017 Model of Care Quality Department 2017 1 Objectives Understand the four (4) Model of Care elements, aimed at improving healthcare for D-SNP members. Learn about the Model of Care that MCS offers to their

More information

Model of Care Training Special Needs Plan

Model of Care Training Special Needs Plan Care1st Provider Model of Care Training Special Needs Plan (SNP) 2017 SNP Model of Care(MOC) The Medicare Act of 2003 established a Medicare Advantage coordinated care plan that is designed to provide

More information

Model of Care Provider Program. This Model of Care Program only applies to those Members enrolled in Freedom plans.

Model of Care Provider Program. This Model of Care Program only applies to those Members enrolled in Freedom plans. Model of Care Provider Program This Model of Care Program only applies to those Members enrolled in Freedom plans. Course Rules and Tools Duration: 30 minutes Approximate time this course will require.

More information

Model of Care Training Special Needs Plan

Model of Care Training Special Needs Plan Care1st Provider Model of Care Training Special Needs Plan (SNP) 2017 SNP Model of Care(MOC) The Medicare Act of 2003 established a Medicare Advantage coordinated care plan that is designed to provide

More information

CIGNA Medicare Select Dual Special Needs Plan (D-SNP)

CIGNA Medicare Select Dual Special Needs Plan (D-SNP) A CIGNA Medicare Select Dual Special Needs Plan (D-SNP) Model of Care Training for Contracted Health Care Professionals Prepared: October 2010 CIGNA Medicare Services," "CIGNA Medicare Select Plus Rx"

More information

Affinity SNP Model of Care

Affinity SNP Model of Care Affinity SNP Model of Care The MIPPA Act of 2008 mandated all SNPs comply with additional requirements to implement an evidence based Model of Care and evaluate the effectiveness of its care management.

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

MODEL OF CARE TRAINING 2018

MODEL OF CARE TRAINING 2018 MDEL F CARE TRAINING 2018 Content Introduction to SNP SNP Model of Care CHMP SNP population and vulnerable population SNP Benefit Roles and Responsibility HRA ICT Team Care Transition process Provider

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

NetworkCares (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_ 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 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

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

Medicare Advantage. Financial Alignment: Medicare and Medicaid 08/19/2015. Types of SNPs

Medicare Advantage. Financial Alignment: Medicare and Medicaid 08/19/2015. Types of SNPs Medicare Advantage Other Medicare Plans September, 2015 Types of SNPs SNPs may be any type of Medicare Advantage Coordinated Care Plan, including local or regional preferred provider organization (PPO)

More information

SNP Target Populations

SNP Target Populations Background of SNP Established by Medicare Modernization Act of 2003 (MMA 2003) Special Needs Plans (SNPs) are different from most types of Medicare Advantage Plans in that they focus on beneficiaries that

More information

Special Needs Plan Provider Education

Special Needs Plan Provider Education Special Needs Plan Provider Education Learning Goals What is a Special Needs Plan (SNPs) What differentiates a SNP from other MA plans What SNPs are offered by Freedom Health and Optimum Healthcare 2 Care

More information

INSTITUTIONAL/INSTITUTIONAL EQUIVALENT (I/IESNP) DUAL SPECIAL NEEDS PLAN (DSNP) CHRONIC SPECIAL NEEDS PLAN (LSNP)

INSTITUTIONAL/INSTITUTIONAL EQUIVALENT (I/IESNP) DUAL SPECIAL NEEDS PLAN (DSNP) CHRONIC SPECIAL NEEDS PLAN (LSNP) SNP MODEL OF CARE ANNUAL EVALUATIONS FOR 2013 INSTITUTIONAL/INSTITUTIONAL EQUIVALENT (I/IESNP) DUAL SPECIAL NEEDS PLAN (DSNP) CHRONIC SPECIAL NEEDS PLAN (LSNP) 1 7 0 1 P O N C E D E L E O N B L V D, S

More information

Dual Eligible Special Needs Plans For 2015

Dual Eligible Special Needs Plans For 2015 Dual Eligible Special Needs Plans For 2015 Introduction: Amerigroup Community Care is offering Dual Eligible Special Needs Plans (D-SNPs) to people who are eligible for both Medicare and Medicaid benefits

More information

Providers who see Empire Medicare Advantage HMO members also are considered contractually eligible to see Empire D-SNP members.

Providers who see Empire Medicare Advantage HMO members also are considered contractually eligible to see Empire D-SNP members. Empire BlueCross BlueShield FAQs for 2017 D-SNP Plans Introduction: Empire BlueCross BlueShield is offering Special Needs Plans (SNPs) to people who are eligible for both Medicare and Medicaid benefits

More information

CAL MEDICONNECT: Understanding the Health Risk Assessment. Physician Webinar Series

CAL MEDICONNECT: Understanding the Health Risk Assessment. Physician Webinar Series CAL MEDICONNECT: Understanding the Health Risk Assessment Physician Webinar Series Today s Webinar This webinar is part of a series designed specifically for CAPG members. For a general overview of the

More information

Best Practices for Integrated Care Teams

Best Practices for Integrated Care Teams Best Practices for Integrated Care Teams Cal MediConnect Providers Summit January 21, 2015 Moderator: Alexandra Kruse, Senior Program Officer, CHCS www.chcs.org Interdisciplinary Care Teams Providers have

More information

Breaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery

Breaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery Breaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery Betty Shephard Lead VP, Care Management HealthCare Partners National Health Policy Forum October 19, 2012 HCP

More information

Special Needs Plans (SNPs) Model of Care

Special Needs Plans (SNPs) Model of Care Special Needs Plans (SNPs) Model of Care Annual Training Presentation For: Provider Webinar 2/15/17 Janis E. Carter Health Net Presentation By: Candace Ryan, QI Manager Medicare Roxanne Topel, Manager,

More information

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

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

More information

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

CareMore: Radical care for those who need it most. Vivek Garg, MD, MBA

CareMore: Radical care for those who need it most. Vivek Garg, MD, MBA CareMore: Radical care for those who need it most Vivek Garg, MD, MBA DOWNEY, CA THE BIRTH OF AN IDEA 25 YEARS AGO RELENTLESS COMMITMENT + UNSWERVING DEDICATION TO PATIENTS FOCUS on sickest of the sick

More information

Comment Template for Care Coordination Standards

Comment Template for Care Coordination Standards GENERAL COMMENTS Thank you for the opportunity to provide input into these very important standards. We offer the following comments in the spirit of improving clarity, consistency, and ease of reading

More information

CHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE

CHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE CHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE TABLE OF CONTENTS What is Chronic Care Management (CCM)?... 2 Why CCM?... 2 Clinician/Practice Benefits... 3 Patient Benefits... 4 What is Included in CCM?...

More information

CAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team. Physician Group Webinar Series

CAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team. Physician Group Webinar Series CAL MEDICONNECT: Understanding the Individualized Care Plan & Interdisciplinary Care Team Physician Group Webinar Series Today s Webinar This webinar is part of a series designed specifically for physicians.

More information

Central Ohio Primary Care (COPC) Spotlight on Innovation

Central 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 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

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

Tufts Health Plan Senior Care Options Care Model Training. Designed for Providers 2018

Tufts Health Plan Senior Care Options Care Model Training. Designed for Providers 2018 Tufts Health Plan Senior Care Options Care Model Training Designed for Providers 2018 1 Tufts Health Plan Senior Care Options (SCO) Overview Tufts Health Plan SCO is a benefit plan offered through a contract

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

PROVIDER UPDATE An Update for Gateway Health SM Providers and Clinicians

PROVIDER UPDATE An Update for Gateway Health SM Providers and Clinicians PROVIDER UPDATE An Update for Gateway Health SM Providers and Clinicians THIS ISSUE Page PROGRAM AND BENEFITS UPDATES Learning and Earning With Gateway Health...2 Postpartum Care and Contraception Webinar...3

More information

Optima Health Provider Training Special Needs Plan (SNP) Optima Community Complete

Optima Health Provider Training Special Needs Plan (SNP) Optima Community Complete Optima Health Provider Training Special Needs Plan (SNP) Optima Community Complete Subject Areas I. Background on SNP II. D-SNP Eligibility Requirements III. Description of Targeted Populations IV. D-SNP

More information

Quality Measurement at the Interface of Health Care and Population Health

Quality Measurement at the Interface of Health Care and Population Health 1 Institute of Medicine Committee on Quality Measures Healthy People Leading Health Indicators December 10, 2012 Quality Measurement at the Interface of Health Care and Population Health Shari M. Ling,

More information

FACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6

FACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6 FACT SHEET Low Income Assistance: Cal MediConnect(E-004) p. 1 of 6 Low Income Assistance: Cal MediConnect What is Cal MediConnect? California is 1 of 15 states that has signed a Memorandum of Understanding

More information

3 rd Quarter MSHO/MSC+ Care Coordination Training

3 rd Quarter MSHO/MSC+ Care Coordination Training 3 rd Quarter MSHO/MSC+ Care Coordination Training Care Systems & UCare Care Coordinators: September 13 th, 2017 Recorded WebEx: September 14 th, 2017 Agenda STARS Cindy Radke Bus Pass Transportation Jeremy

More information

Duals Demonstration. An Overview for Home Medical Equipment Providers

Duals 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 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

National Coalition on Care Coordination (N3C) Care Coordination and the Role of the Aging Network. Monday, September 12, 2011

National Coalition on Care Coordination (N3C) Care Coordination and the Role of the Aging Network. Monday, September 12, 2011 National Coalition on Care Coordination (N3C) Care Coordination and the Role of the Aging Network Monday, September 12, 2011 Washington, DC Hyatt Regency on Capitol Hill Yellowstone/Everglades 4:00 PM

More information

Introduction to the BFCC-QIO Program

Introduction to the BFCC-QIO Program Introduction to the BFCC-QIO Program Bryan Fischer Communications Lead 11-SOW-MD-2017-QIOBFCC-CP2 About Livanta LLC Established in 2004 Privately-held, government contracting firm headquartered in Annapolis

More information

Your health comes first

Your health comes first Your health comes first Here are the many ways we re working to ensure the quality of your care At Amerigroup, our focus is on you. We want to help you get and stay healthy. That s why we have many programs

More information

Spotlight on Innovation: Medicare Advantage Special Needs Plans

Spotlight on Innovation: Medicare Advantage Special Needs Plans Spotlight on Innovation: Medicare Advantage Special Needs Plans BY BETTER MEDICARE ALLIANCE JULY 2017 Spotlight on Innovation: Medicare Advantage Special Needs Plans BY BETTER MEDICARE ALLIANCE JULY 2017

More information

OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) OneCare Connect Program Overview

OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) OneCare Connect Program Overview OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) OneCare Connect Program Overview 2018 1 Learning Objectives After completing this module you will: Have gained an awareness and knowledge about

More information

CMS Mandated Training

CMS Mandated Training CMS Mandated Training Brand New Day Models of Care PRINT Your Name: SIGN Your Name: Print Today s Date: F:\QM\COMPLIANCE\COMPLIANCE TRAINING\MOC\BRAND NEW DAY MOC TRAINING.docx Brand New Day Medicare Mandated

More information

ANCHOR An Interdisciplinary Community- Based Research Project in Nova Scotia: Overview & Some Preliminary Results

ANCHOR An Interdisciplinary Community- Based Research Project in Nova Scotia: Overview & Some Preliminary Results ANCHOR An Interdisciplinary Community- Based Research Project in Nova Scotia: Overview & Some Preliminary Results Why ANCHOR? Growing burden of cardiovascular/metabolic conditions and their risk factors

More information

Kaiser Permanente QUALITY OVERVIEW OVERALL RATING : 3.4 COMPANY AT A GLANCE. Company Statistics. Accreditation Exchange Product

Kaiser Permanente QUALITY OVERVIEW OVERALL RATING : 3.4 COMPANY AT A GLANCE. Company Statistics. Accreditation Exchange Product QUALITY OVERVIEW Permanente As the state s largest nonprofit health plan, Permanente is committed to improving the health of our members and our state as a whole. Permanente is made up of: Foundation Hospitals

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

Working with Anthem Subject Specific Webinar Series

Working with Anthem Subject Specific Webinar Series Working with Anthem Subject Specific Webinar Series Special Session 2015 Medicare Advantage Dual Eligible Special Needs Plans Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference

More information

A Care Coordination Model for Value-Based Performance Programs

A Care Coordination Model for Value-Based Performance Programs A Care Coordination Model for Value-Based Performance Programs Richard S. Chung, MD Chief Clinical Officer APS Healthcare 8th National Pay for Performance (P4P) Summit February 20, 2013 Hyatt Regency Hotel,

More information

Humana Physician Quality Rewards Program 2014

Humana Physician Quality Rewards Program 2014 Humana Physician Quality Rewards Program 2014 Medicare Glen Champlin MSO Director March 28, 2014 1430ALL0114-B What is CMS Stars and Why Should Providers Be Concerned? CMS Program of Quality & Performance

More information

Best Practices. SNP Alliance. October 2013 Commonwealth Care Alliance: Best Practices in Care for Frail and Disabled Medicare Medicaid Enrollees

Best Practices. SNP Alliance. October 2013 Commonwealth Care Alliance: Best Practices in Care for Frail and Disabled Medicare Medicaid Enrollees SNP Alliance Best Practices October 2013 Commonwealth Care Alliance: Best Practices in Care for Frail and Disabled Medicare Medicaid Enrollees Commonwealth Care Alliance is a Massachusetts-based non-profit,

More information

11/18/2016. A Regional Medicaid Accountable Care Organization (ACO) that would leverage the existing behavioral health managed care foundation.

11/18/2016. A Regional Medicaid Accountable Care Organization (ACO) that would leverage the existing behavioral health managed care foundation. This collaborative effort gained momentum and resulted in the release of a white paper, which proposed a solution to the vision of the Governor and General Assembly for integrated care in a capitated environment.

More information

Understanding and Leveraging Continuity of Care

Understanding and Leveraging Continuity of Care Understanding and Leveraging Continuity of Care Cal MediConnect Providers Summit January 21, 2015 Moderator: Jane Ogle, Consultant, Harbage Consulting www.chcs.org An Overview of Continuity of Care in

More information

Welcome to Health Net

Welcome to Health Net Welcome to Health Net When it comes to Medicare coverage, the right choice depends on your health, your budget and your lifestyle. Health Net makes choosing quality, cost-effective health care coverage

More information

Defining and Driving Value: Provider and Payer Perspectives

Defining and Driving Value: Provider and Payer Perspectives Defining and Driving Value: Provider and Payer Perspectives NAHC Financial Managers Meeting June 2013 Serving the Midcoast of Maine in Knox Waldo Lincoln Counties 1 Who we are... Medicare Certified & State

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

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

EmblemHealth Advocate for Quality

EmblemHealth Advocate for Quality EmblemHealth Advocate for Quality 2013 Average Health Care Spending per Capita, 1980 2009 Adjusted for differences in cost of living 1 Dollars Source: OECD Health Data 2011 (June 2011). THE COMMONWEALTH

More information

Monarch HealthCare, a Medical Group, Inc.

Monarch 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 information

WHAT IT FEELS LIKE

WHAT IT FEELS LIKE PCMH and PCSP WHAT IT FEELS LIKE Presentation Outline Goals of the Patient Centered Medical Home and the Patient Centered Specialty Practice Identifying the Joint Principles Recognition Programs Standards

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

Introduction for Texas Providers. AmeriHealth Caritas Corporate Provider Network Management

Introduction for Texas Providers. AmeriHealth Caritas Corporate Provider Network Management Introduction for Texas Providers AmeriHealth Caritas Corporate Provider Network Management Texas snapshot. Who we are. Why AmeriHealth Caritas? Overview Why partner with us? Medical management. Quality

More information

Cal MediConnect (CMC) Model of Care

Cal MediConnect (CMC) Model of Care Cal MediConnect (CMC) Model of Care CMC MOC Annual Training Presentation for Providers and Health Net Associates Presentation by Health Net Medical Management Training Department Herminia Escobedo Health

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

Humana At Home-Star Member Talking Points

Humana At Home-Star Member Talking Points At Home-Star Member Talking Points What are the CMS Medicare Star Ratings? The Center for Medicare & Medicaid Services (CMS) is a federal agency that oversees Medicare & Medicaid, and is part of the Department

More information

FirstHealth Moore Regional Hospital. Implementation Plan

FirstHealth Moore Regional Hospital. Implementation Plan FirstHealth Moore Regional Hospital Implementation Plan FirstHealth Moore Regional Hospital Implementation Plan For 2016 Community Health Needs Assessment Summary of Community Health Needs Assessment Results

More information

Cathy Schoen. The Commonwealth Fund Grantmakers In Health Webinar October 3, 2012

Cathy Schoen. The Commonwealth Fund  Grantmakers In Health Webinar October 3, 2012 Innovating Care for Chronically Ill Patients Cathy Schoen Senior Vice President The Commonwealth Fund www.commonwealthfund.org cs@cmwf.org Grantmakers In Health Webinar October 3, 2012 Chronically Ill:

More information

FOR LEADINGAGE POST-ACUTE AND LONG TERM SERVICES AND SUPPORTS

FOR LEADINGAGE POST-ACUTE AND LONG TERM SERVICES AND SUPPORTS December 2016 MODEL SCORE CARD ELEMENTS FOR LEADINGAGE POST-ACUTE AND LONG TERM SERVICES AND SUPPORTS BACKGROUND The purpose of this scorecard is threefold: 1. To help organize quality measures into internal

More information

TABLE H: Finalized Improvement Activities Inventory

TABLE H: Finalized Improvement Activities Inventory TABLE H: Finalized Improvement Activities Inventory [We invited comments on the reassignment of improvement activities under alternate subcategories, and on the scoring weights assigned to improvement

More information

Chesapeake Regional Healthcare. by Ramil Bollozos Margarita Bondarenko Jeff Wan

Chesapeake Regional Healthcare. by Ramil Bollozos Margarita Bondarenko Jeff Wan Chesapeake Regional Healthcare by Ramil Bollozos Margarita Bondarenko Jeff Wan Strategic Plan Physician Engagement Physician Engagement Hospitalists Physician Satisfaction Physicians with Admitting Privileges

More information

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

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

More information

Thought Leadership Series White Paper The Journey to Population Health and Risk

Thought Leadership Series White Paper The Journey to Population Health and Risk AMGA Consulting Thought Leadership Series White Paper The Journey to Population Health and Risk The Journey to Population Health and Risk Howard B. Graman, M.D., FACP White Paper, January 2016 While the

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

Introduction for New Mexico Providers. Corporate Provider Network Management

Introduction for New Mexico Providers. Corporate Provider Network Management Introduction for New Mexico Providers Corporate Provider Network Management Overview New Mexico snapshot. Who we are. Why Medicaid managed care? Why AmeriHealth Caritas? Why partner with us? Medical Management

More information