HealthPartners SNBC Inspire

Transcription

1 Click to edit Master title style HealthPartners SNBC Inspire March 28 & 30, 2017

2 Agenda New Team Members DHS SNBC Audit 6 Month Follow Up Calls Benefit Exception Inquiry Form Adjustments HealthPartners Inspire SNBC Intensive Case Management Referral Process HealthPartners Inspire Complex Case Rounds Reports Registry ER HRA logs Spotlight: Dental

3 Care Coordinators Whitney Penny Crystal Wimpfheimer

4 Operations Support Nasha Rogers Lisa Ciesynski Ben Burgeson

5 SNBC DHS Audit Completing chart audits this Spring/Summer with all delegated entities Requesting 35 charts to be pulled to capture a mix of completed HRAs and Care Plans, Unable to Reach, Refusals and Care Transitions HealthPartners will be reaching out (or may have already) to schedule an onsite visit You will receive your sample 3 weeks prior to the audit date The audit tool to be used is the DHS Managed Care SNBC Care Planning, 2016 Audit Protocol available on our portal Will do post audit webinar meetings with each delegate Review strengths/best Practice Review opportunities

6 Upcoming Stake Holder Meeting HealthPartners is hosting an SNBC stakeholders meeting scheduled in Duluth on Tuesday, May 23 rd Members should be getting mailers /communication regarding this meeting Members must RSVP to attend Can request transportation at this time Care Coordinators are welcomed to attend There will be another stakeholder meeting this Fall. Location yet to be determined.

7 Benefit Exception/Homecare Authorization Inquiry Changes Added Service Provider Name and Location to form Provides additional information for internal staff when creating authorizations Reminder when using the forms to identify only one service/need per form If RN and HHA services are needed, please complete two inquiries 7

8 Portal Changes- SNBC Provider Network Search Feature New Link on SNBC Portal provides a direct link to SNBC specific providers Ability to search by doctor, dentist, clinic, urgent care or hospital by zip code 8

9 Portal Changes: Health Survey Retiring the Health Survey Letter as of April 1 st Updated language to: Unable to Contact/Health Survey from Unable to Contact/HRA Those that complete the health survey are considered a decline. Information from the health survey should be used to obtain greater insight on the members needs and as a tool to increase further engagement with the member Unable to contact letter should only be sent out at annual assessment time 9

10 Portal Changes- Transfer Forms As of April 1 st, we will be retiring the use of the Member Transfer Form All transfers going forward will use the Home and Community-Based Services (HCBS) Transfer and Communication Form- DHS 6037 Allows delegates to have a stream lined approach for all transfers All transfers should attach additional documentation to HCBS form if applicable; OBRA, Care Plan, Medication List and HRA. 10

11 Portal Changes- 6 Month Checklist Best Practice is to complete 3 outreach attempts with members at different times/dates Unable to contact letter/health survey does not need to be sent out at 6 month outreach. Only annually Unsuccessful outreach of member still requires documentation of your research of what you were able to review; hx of ED visits, hospitalizations, medical chart review when available, etc. Document refusals/offered interventions during goal review or any other touch points with members/responsible parties 11

12 Example: 6 Month Care Plan Review Note Example Note: Member unable to reach Attempted to reach patient to complete review of goals. Needed to again leave a message and asked for call back. Reviewed medical chart and recent changes or needs: seen at HE spine center in 02/2017 for back pain, saw urgent care on 02/11/17 for upper respiratory infection, had eye exam 12/21/16 and has had a recent primary care visit. Appears to be seeing providers as needed and no other changes noted in continued chronic care needs. Reviewed goals and HRA and no changes at this time. Example: Review of Care Plan/Goals able to reach member: 6 mo f/u call completed with patient. Pt reports no changes to health/conditions in last few months. States everything currently is well managed with current services adequately meeting her needs. She notes that she will be seeing her PCP and Psychiatrist 11/12 for routine follow up examinations and yesterday went to pain clinic for routine f/u as well. No changes made to current pain medication regimen. Denies any falls in her home. Receives regular help from PCA /Homemaker for IADL/ADL needs. Family visits/calls on regular basis. Conditions reviewed with patient; continues to be well managed. No additional supports/services identified from call with patient. Continue to follow as needed. Care plan reviewed no changes made.

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14 HRA Log Reports - Changes Type of HRA: Removed Termed b4 HRA due option Method of HRA: Clarified Mail and UTR by phone options Added an UTR option indicating the CC is unable to leave a message for the member Date HRA Completed: Renamed and clarified; now HRA or Refusal Date All returned records must have a date No longer requiring the following Information-removed from report Name of Assessor Care Plan Complete and to Pt date. Detailed instructions have been added to Read Me tab of the HRA log report

15 Returning HRA Log Reports Please leave the Delegate s name and the month and year in the name of the report when you return them to HealthPartners. Suggestion: Save the report to delegate s own server with name of report with Copy in front of the name. Example: Becker County receives report name: Becker County_HealthPartners_SNBC_1695_SM_M_HRA_Log-Feb17 Becker County returns to HealthPartners report named: Copy of Becker County_HealthPartners_SNBC_1695_SM_M_HRA_Log-Feb17

16 HRA Log Sample with Changes 16

17 Registry Reports Gives the Care Coordinator an awareness of who has a diagnosis of core conditions identified as low and high risk CHF, Diabetes, CAD, COPD, Asthma Review report prior to completing an HRA or follow up call For those members who are high risk, ask how they are managing their chronic disease or if they feel they need more help/education Using our clinical care guides as a reference, talk with members regarding how they are managing their chronic condition(s) and determine if the condition seems well managed or not. Use the guides to help you provide support or education & to create a goal in the members care plan If it is evident member is not managing their chronic condition(s) well, verify that they are seeing a primary care physician, if not, facilitate a clinic visit If they are connected with a primary care physician, and not managing their condition(s) well, and the care coordinator would like additional support, contact our internal team for next steps Link SNBC Care Coordination Web Page Individual condition guides are listed under Resources

18 ER Reports Claims report of all ER visits per member since 7/1/2016 provided monthly. Work flow expectations for use of this report are being developed and will be shared at a later date For now, review prior to completing the HRA or scheduled follow up with your member Discuss with member events leading up to ER visit, determine if there are barriers in place or if alternative services would have been more appropriate: Dental reasons- facilitate dental clinic visit Provide listing of close Urgent Care Clinics Facilitate Primary Care Visit

19 SNBC Member Rewards Healthy Pregnancy- 2 $25/gift cards Car Seat Safety- Free New Mom Care- $25 gift card for follow up appointment Primary Care- $25 gift card for annual visit Cervical Cancer Screening- $25 gift card

20 SNBC Member Perks Health Discounts- eyewear, exercise equipment/classes Fitness benefit- Silver & Fit membership or 2 home exercise kits Flexible transportation- 2 rides per month to fitness facilities, Alcoholic Anonymous or Narcotics Anonymous meetings

21 Intensive Case Management- Medical The following triggers guide referring members for intensive medical case management Medical conditions(s) deteriorating clinically Inability to work or participate in desired activities due to deteriorating health Non-adherence with treatment plan, resulting in high risk for inpatient admission Multiple chronic or complex diagnoses, including rare diseases Multiple Emergency Department or Urgent Care visits, particularly when member is not appropriately accessing primary or specialty outpatient care Multiple hospital admissions for exacerbation of a chronic condition Chronic pain/low back pain that is self-limiting High-risk maternity Transplants

22 Intensive Case Management- Behavioral Health The following triggers guide referring members for intensive behavioral case management Dual Diagnosis (both mental health and chemical dependency) Schizophrenia Bipolar Severe depression with psychiatric hospitalization

23 Referrals for Intensive Case Management Access available two ways: Key Contacts guide, located under Resources OR access via the link located under Forms on the SNBC CC Portal When filling out the online referral form, the treating physician is the provider and the care coordinator is the contact person Form is submitted electronically 23

24 Complex Case Reviews/Rounds Behavioral case rounds HealthPartners interdisciplinary team includes: Pharmacy, Behavioral Health Specialists, Pharmacist, Social Worker, Registered Nurse Medical case rounds HealthPartners interdisciplinary team includes: Dr. Cross Associate Medical Director, Behavioral Health Specialists, Pharmacist, Social Worker, Registered Nurse CC needs assistance to work through barriers or brainstorm interventions Typically members with high utilization patterns and/or not clinically well managed Participation in complex rounds may be by HealthPartners or Care Coordinator identification. To request participation CCs will be notified of members HP selects for complex rounds ideally two weeks prior to the date of rounds

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26 Kate Sahnow Michelle Scearcy

27 Increased DHS focus on Dental Upcoming project work specifically focused on dental

28 Care Coordination Review dental during the HRA process Have they seen the dentist in the past year? If no, probe a little further Identify barriers to seeing a dentist

29 Network If member has received care in the past at a non-contracted clinic, communicate this information to our Dental Contracting area so we can reach out to the clinic in an effort to contract with them

30 Riverview Member Services Can help you locate a clinic Connect with Dental Navigators

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