A How to Guide: Managing Workflows, Developing Protocols, Expanding Roles. November 12, Wisconsin Council on Medical Education & Workforce
|
|
- Mitchell Griffith
- 5 years ago
- Views:
Transcription
1 A How to Guide: Managing Workflows, Developing Protocols, Expanding Roles Wisconsin Council on Medical Education & Workforce November 12, 2015 Kathy Kerscher, Team Leader Primary Care Rob MacNeil, Sr. Project Manager
2
3 NEW MODEL OF CARE
4 Roles and Responsibilities
5 THE CORE TEAM: Office based staff involved with the office visit, the pre and post office visit work and in-between visit management. Consists of: Physician/Physician Assistant or Nurse Practitioner, Clinic RN, CMA/LPN (Care Team Coordinator), Scheduler, new member Behavioral Health Consultant 5
6 OFFICE VISIT PROCESS- CARE TEAM COORDINATOR ROLE Initiation of Patient Visit (before Provider): Follows standard rooming process Populates visit diagnoses from problem list Sets up refills Identifies visit agenda Identifies and addresses care gaps Pulls up appropriate templates Starts documentation 6
7 OFFICE VISIT PROCESS- CARE TEAM COORDINATOR ROLE With Provider in Room: Presents patient to provider Continues team documentation Enters orders for consults, new meds, and tests needed Acts as patient advocate Provider focuses on the patient (history, examination, and medical decision making.) 7
8 OFFICE VISIT PROCESS- CARE TEAM COORDINATOR ROLE Office Visit After Provider Reviews plan of care Reviews ordered tests or consults Enters future orders Schedules next appointment Reviews After Visit Summary with patient Engages extended care team member as needed Escorts patients to next station Provider responsible for editing and finalizing the team documentation for visit. 8
9 OFFICE VISIT PROCESS- CLINIC RN Medicare Wellness Visits Acute Care Visits Basic Chronic Condition Education Diabetes Blood Pressure Rechecks
10 OFFICE VISIT PROCESS- BEHAVIORAL HEALTH CONSULTANT Behavioral Health Screening PHQ-9 10> Warm Handoff by Primary Care Team Member Disengaged patient with a chronic Condition Non detected Behavioral health issue Initial and Follow-up visits in primary care setting.
11 BETWEEN VISIT PROCESSES RN and Care Team Coordinators work as a team to assist provider: Provider Team Inbasket Test result management per protocol Medication refills and other orders Increased verbal communication between members of the care team decreases electronic messaging preventing unnecessary messages to provider Panel management in conjunction with Central Care Management Team Provider responsible for signing off on in basket items. 11
12 Extended Care Team Health care professionals involved in the care and management of complex patients. Need is based on knowledge of the population data. Extended Care Team members communicate closely with the Core Team to allow for optimal care of these patients. 12
13 EXTENDED CARE TEAM MEMBERS Clinical Pharmacist assists the Core Team in the management of patients with multiple medications or medication issues Case Manager connects patients with necessary system or community resources to ensure health care needs are met RN Care Coordinator coordinates the care of patients with complex medical problems who are having difficulty managing their care Central Care Management works together with Core Team to provide support and advice for individuals with care gaps for a population Diabetes Educator provides information and education to enhance the care of patients with diabetes More to be included.. Purpose: Assist with population health management and complex patients 13
14 Team Based Care Office Visit Example Office Visit RN Visit
15 Project Management is Key for Managing Coordination of Roles / Creation of WorkFlows Coordinate and Create Workflows Organize and Store Files Remove Obstacles Assure Adherence to Timeline Obtain 3 rd Party Vendors for Tools Provide Status to Executive Leadership Chase Deliverables Create Metrics ETC.!
16 Workflow Example
17 Quality Results Win for the Patient, Care Team, and System Measure Baseline Actual Percentage Improvement Breast 55.37% 64.01% 8.64% Cervical 69.61% 77.57% 8.26% Colorectal 79.71% 84.38% 7.97% TARGET (<100) 65.79% 65.43%.36% BLOOD TARGET (<140/80) 50% 50.53%.53% TARGET 48.95% 57.98% 9.03% A1C POOR CONTROL (>9%) 6.11% 4.37% 1.74% RENAL PROTECTION 62.11% 68.62% 7.40% FOOT EXAM 21.05% 73.94% 52.89% RETINAL EXAM 32.63% 38.30% 5.67% PNEUMOVAX COMPLETED 54.21% 64.89% 10.68% HEP B COMPLETED 6.32% 7.45% 1.13%
18 Questions/Answers
19 Managing Workflows, Developing Protocols, & Expanding Roles WCMEW Team-Based Care Summit November 12, 2015
20 Improving Health Maintenance Workflows and Patient Outcomes Dr. Lynda Gruenewald-Schmitz, DNP, RN Vice President & Chief Nursing Officer Non-Acute Services
21 Purpose Taskforce chartered by Council for Ambulatory Practice Standards to improve the utilization of the Epic Health Maintenance (HM) module Recommendations included role accountability to close preventative care gaps as identified in HM 21
22 Action Plan Physician site leaders/department chair were engaged in process Super users trained in physician view Training focused on HM/Quality Super Smart Set Training included physicians, clinic staff, and their leaders Emphasis on workflow training All in decision point versus pilot phase 22
23 Primary Care Recommended Workflow for Health Maintenance Best Practice Themes: Pre-visit chart preparation Review HMR tab every visit! Team effort from all providers Patients scheduled for appointments/ diagnostics before patient leaves office setting 23
24 Primary Care Recommended Workflow for Health Maintenance Clinical associate, HIM tech, or appropriately trained associate reviews the patients schedule for the next day against the Epic Health Maintenance Record (HMR). Items due/due soon queried by searching paper chart, Portal, WIR/IRIS, Care Everywhere, or other sources and are followed-up with appropriate action. 24
25 Primary Care Recommended Workflow for Health Maintenance MA prints med list for patient review and update. MA pulls Vaccine Information Sheet for all immunizations due based on EHR and WIR/IRIS findings. Physician/NP/PA completes completes medication medication reconciliation reconciliation using using updated updated list from patient. list from patient. 25
26 Primary Care Recommended Workflow for Health Maintenance Physician/NP/PA opens Quality Care Super Smart Set in Dx and Orders tab. Items are reviewed with patient and ordered as indicated. All ordered tests, immunizations, and services are completed or scheduled for patient before leaving the office. 26
27 Pilot Results: Wauwatosa Campus Outpatient Center Sept-Oct 2015 Mammograms September increased 18.6% October increased 27.6% Colonoscopies September increased 19% October increased 42.8% Bone Densities September increased 15.3% October increased 50.9% *baseline = average of May August
28 Diabetes Registry Workflow 28
29 Questions/Answers 29
Achieving Population Health through Team Based Care
Achieving Population Health through Team Based Care Wisconsin Council on Medical Education and Workforce Conference November 12, 2015 Kathy Kerscher, Bellin Health Overview of Bellin Health 3 MISSION Bellin
More informationJoy At Work - BellinHealth and HealthPartners
Joy At Work - BellinHealth and HealthPartners Restoring Joy in Practice through Team Based Care IHI December 2016 James Jerzak M.D. Kathy Kerscher Bellin Health Green Bay, Wisconsin 1 Agenda Crisis Emerging
More informationPresbyterian Healthcare Services Care Management
Presbyterian Healthcare Services Care Management Kathy M. Garcia RN, BSN Director of Nursing, Primary Care Service Line November 2012 Future Healthcare Challenges Increasing number of patients Decreasing
More informationACHIEVING POPULATION HEALTH: THE POWER OF TEAM BASED CARE
ACHIEVING POPULATION HEALTH: THE POWER OF TEAM BASED CARE JAMES JERZAK M.D. KATHY KERSCHER, MBA BELLIN HEALTH GREEN BAY WI IHI NATIONAL FORUM 12 13 2017 2 GREEN BAY, WISCONSIN Agenda Why Team-Based Care
More informationCore Item: Clinical Outcomes/Value
Cover Page Core Item: Clinical Outcomes/Value Name of Applicant Organization: Fremont Family Care Organization s Address: 2540 N Healthy Way, Fremont, NE 68025 Submitter s Name: Elizabeth Belmont Submitter
More informationPatient Centered Medical Home The next generation in patient care
Patient Centered Medical Home The next generation in patient care Provider Training Module I OBJECTIVE To explain... What Patient Centered Medical Home is How it works Why it s important Where to begin
More informationDisclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws.
Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that
More informationExecutive Summary: Davies Ambulatory Award Community Health Organization (CHO)
Davies Ambulatory Award Community Health Organization (CHO) Name of Applicant Organization: Community Health Centers, Inc. Organization s Address: 110 S. Woodland St. Winter Garden, Florida 34787 Submitter
More informationPrimary Care Redesign Updates to DFM
Primary Care Redesign Updates to DFM Overview of Care Model Package 2 Care of the Complicated Patient March 5, 2014 Dr. Rich Welnick Susan Marks, Director of Population Health Lori Hauschild, Clinic Operations
More informationVHA Transformation to a Patient Centered Medical Home Model of Care
VHA Transformation to a Patient Centered Medical Home Model of Care Joanne M. Shear MS, FNP-BC VHA Primary Care Clinical Program Manager Office of Primary Care Operations & Policy Washington, DC Joanne.shear@va.gov
More informationMPA Reference Guide. Millennium Collaborative Care
Millennium Collaborative Care 1. MPA... 3 2. Provider Types... 3 2.1. Primary Care Practices... 3 2.2. Pediatric Practices... 9 2.3. Behavioral Health... 12 2.4. Acute Care... 18 2.5. Post-Acute Care...
More informationGoals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE
Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures
More informationMeaningful Use Stage 1 Guide for 2013
Meaningful Use Stage 1 Guide for 2013 Aprima PRM 2011 December 20, 2013 2013 Aprima Medical Software. All rights reserved. Aprima is a registered trademark of Aprima Medical Software. All other trademarks
More informationAn RHC Patient Centered Medical Home Experience
An RHC Patient Centered Medical Home Experience NARHC October 19, 2017 Kate Hill, RN The Compliance Team MACRA Recognition TCT Recognized for it s PCMH Program Today s Objectives Understand the difference
More informationMy Complete Medications List
Pharmacy Features 1 My Complete Medications List 2 My HealtheVet: Get Care Get Care: Care Givers Treatment Facilities My Coverage Health insurance Health Calendar To-Do s Wellness Reminders 3 My HealtheVet:
More informationAdvancing Primary Care Delivery
Advancing Primary Care Delivery Tenth National Pay for Performance Summit March 3, 2015 Simeon Schwartz, MD CEO, WESTMED Medical Group, P.C. WESTMED Medical Group Established 1996 by 16 physicians 300
More informationHouseCalls Objectives
Overview Agenda Overview Objectives Background Case studies Member Experience Primary Care Provider Experience Referrals and Follow-up Influence on Centers for Medicare & Medicaid Services (CMS) Star Ratings
More informationMeaningful Use Measures: Quick Reference Guide Stage 2 (2014 and Beyond)
Meaningful Use Measures: Quick Reference Guide Stage 2 (2014 and Beyond) Core Measures Required: All 17 objectives Objective: Requirement: Exclusions: Accomplish in Clinical 1. Computerized - Documenting
More informationCultural Transformation and the Road to an ACO Lee Sacks, M.D. CEO Mark Shields, M.D., MBA Senior Medical Director
Cultural Transformation and the Road to an ACO Lee Sacks, M.D. CEO Mark Shields, M.D., MBA Senior Medical Director AMGA Pre-conference Workshop 1 April 14, 2011 Washington, D.C. Disclosure Nothing in Today
More information1 Title Improving Wellness and Care Management with an Electronic Health Record System
HIMSS Stories of Success! Graybill Medical Group 1 Title Improving Wellness and Care Management with an Electronic Health Record System 2 Background Knowledge It is widely understood that providers wellness
More informationStrategy Guide Specialty Care Practice Assessment
Practice Transformation Network Strategy Guide Specialty Care Practice Assessment 1/20/2017 1 Strategy Guide: Specialty Care PAT 2.2 Contents: Demographics Tab: 3 Question 1: Aims... 3 Question 2: Aims...
More informationImproving Quality Outcomes in a Risk-Based World: A Davies Story Session #100, March 7, 2018
Improving Quality Outcomes in a Risk-Based World: A Davies Story Session #100, March 7, 2018 David Cloyed, MS, RN-BC, Applications Manager, Nebraska Medicine Tammy Winterboer, PharmD, BCPS, Director, Clinical
More informationArkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual
Arkansas Blue Cross and Blue Shield Patient Centered Medical Home Provider Manual 2017 This document is a guide to the 2017 Arkansas Blue Cross and Blue Shield Patient-Centered Medical Home program (Arkansas
More informationManaging Risk Through Population Health Initiatives
Managing Risk Through Health Initiatives Vicki DeBaca, DNS, RN Vice President, Health & Provider Services Sharp Rees-Stealy Medical Centers 1 Sharp Rees-Stealy Medical Centers San Diego s Multi-Specialty
More informationAccountable Care and the Laboratory Value Proposition. Les Duncan Director of Operations Highmark Health - Home and Community Services
Accountable Care and the Laboratory Value Proposition Les Duncan Director of Operations Highmark Health - Home and Community Services Agenda The Goals and Status of Delivery System Reform and Alternative
More informationStage 2 Meaningful Use: Menu Objectives and Clinical Quality Measures. James R. Christina, DPM Director Scientific Affairs APMA
Stage 2 Meaningful Use: Menu Objectives and Clinical Quality Measures James R. Christina, DPM Director Scientific Affairs APMA What Stage Am I In? 2 2 CMS Proposed Rule On May 20, 2014 CMS and Office of
More informationWorking at Top of License How do you reallocate work among a team? January 28, 2015
Working at Top of License How do you reallocate work among a team? January 28, 2015 We Want To Hear From You! Type questions into the Questions Pane at any time during this presentation Patient-Centered
More informationDesigning Reliable Value-based Systems of Care for Chronic Disease and Prevention
Designing Reliable Value-based Systems of Care for Chronic Disease and Prevention Frederick J. Bloom, Jr. MD MMM President, Guthrie Medical Group 1/23/15 Where We Want to Be 1. Affordable coverage for
More information2017 HIMSS DAVIES APPLICANT
2017 HIMSS DAVIES APPLICANT Introduction of NOMS Team Members Melissa Thomas IT Project Director Joshua Frederick, CPA, MT Chief Executive Officer Jennifer Hohman, MD Executive Vice President, NOMS Healthcare
More information2018 PROVIDER TOOLKIT
1100 Circle 75 Parkway Suite 1100 Atlanta, GA 30339 2018 PROVIDER TOOLKIT Understanding the Centers for Medicare and Medicaid (CMS) Stars Rating System What is CMS Quality Star Ratings program? CMS evaluates
More informationPopulation Management Supporting Patient Care. Office of Information Technology
Population Management Supporting Patient Care Office of Information Technology Using icare as a Case Management Tool May 17, 2016 Theresa Tsosie-Robledo MS RN-C OIT Nurse Informatacist Kathy Ray, CNM Navajo
More informationSeptember, James Misak, M.D. Linda Stokes, MSPH The MetroHealth System
Better Health Greater Cleveland relies on the presenter to obtain all rights to use and display copyright-protected information. Anyone claiming a right or interest in or to any posted information should
More informationCSM Physician Bulletin
CSM Physician Bulletin September 2015 Volume 5, Issue 7 Quality and Clinical Integration Status of Performance for FY 2016 Goals: July and August Results We continue to be a leader in breast cancer screening
More informationPPC2: Patient Tracking and Registry Functions
PPC2: Patient Tracking and Registry Functions Element F: Use of System for Population Management At we use our EMR, clinical event manager, and the ad hoc reporting system (Business Objects) for a multi-pronged
More informationQUALITY IMPROVEMENT PROGRAM
QUALITY IMPROVEMENT PROGRAM EmblemHealth s mission is to create healthier futures for our customers and communities. We will do this by providing members with a broad range of benefits and conscientious
More informationCare Redesign and Quality Improvement. Beth Averbeck, MD Senior Medical Director, Primary Care HealthPartners Medical Group
Care Redesign and Quality Improvement Beth Averbeck, MD Senior Medical Director, Primary Care HealthPartners Medical Group Consumer-governed, non-profit HealthPartners Medical Group Primary Care: 500,000
More informationBright Spots in primary care
Bright Spots in primary care A High- Performing Teaching Practice: Site Visit to Oregon Health & Science University s (OHSU) Family Medicine Clinic at Gabriel Park General information Tom Bodenheimer MD
More informationPay for Performance in the Context of the Military Patient- Centered Medical Home
Pay for Performance in the Context of the Military Patient- Centered Medical Home Michael Dinneen, MD, PhD COL John P. Kugler, MD, MPH Department of Defense 11 March 2009 Agenda Military Health System
More informationCLINICAL PRACTICE EVALUATION II: CLINICAL SYSTEMS REVIEW
Diplomate: CLINICAL PRACTICE EVALUATION II: CLINICAL SYSTEMS REVIEW A. INFORMATION MANAGEMENT 1. Does your practice currently use an electronic medical record system? Yes No 2. If Yes, how long has the
More informationChronic Care Management. Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky
Chronic Care Management Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Agenda Chronic Care Management (CCM) History Define Requirements
More informationAdvancing Care Information Performance Category Fact Sheet
Fact Sheet The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced three quality programs (the Medicare Electronic Health Record (EHR) Incentive program, the Physician Quality Reporting
More informationThe Role of Pharmacy Technician in Patient Care Services
By: Wendy Mobley-Bukstein PharmD, CDE Assistant Professor of Pharmacy Practice Drake University College of Pharmacy and Health Sciences Dr. Wendy Mobley-Bukstein PharmD is Assistant Professor of Pharmacy
More informationManaging Patients with Multiple Chronic Conditions
Best Practices Managing Patients with Multiple Chronic Conditions Fletcher Allen Health Care Case Study Organization Profile Located in Burlington, Fletcher Allen Health Care (FAHC) is Vermont s university
More informationPPS Performance and Outcome Measures: Additional Resources
PPS Performance and Outcome Measures: PPS Performance and Outcome Measures: This document includes supplemental resources to the content on PPS Performance and Outcome Measures presented at the December
More informationEnhancing Outcomes with Quality Improvement (QI) October 29, 2015
Enhancing Outcomes with Quality Improvement (QI) October 29, 2015 Learning Objectives! Introduce Quality Improvement (QI)! Explain Clinical Performance Person-Centered Medical Home (PCMH) Measures! Implement
More informationPart 2: PCMH 2014 Standards
Part 2: PCMH 2014 Standards Heather Russo, CCE PCMH Consultant September 15, 2015 Advancing Healthcare Improving Health For Practices Recognized at Level 2 or Level 3 under the 2011 Standards Your Guide
More informationMedicare Advantage Star Ratings
Medicare Advantage Star Ratings December 2017 The Star Rating System measures how well Medicare Advantage (MA) and its prescription drug plans perform for consumers. As an integrated health system, Presbyterian
More informationQuality: Finish Strong in Get Ready for October 28, 2016
Quality: Finish Strong in 2016. Get Ready for 2017 October 28, 2016 Agenda Stars: Medicare Advantage Quality Changes for 2017 Pay for Quality and PCMH Programs Important Announcements! 7 Stars: Medicare
More informationFrom Reactive to Proactive: Creating a Population Management Platform
Session D9 / E9 From Reactive to Proactive: Creating a Population Management Platform Richard Gitomer, MD Director, Brigham and Women s Primary Care Center of Excellence Vice Chair, Primary Care, Dept.
More informationPCC Resources For PCMH. Tim Proctor Users Conference 2017
PCC Resources For PCMH Tim Proctor (tim@pcc.com) Users Conference 2017 Agenda Current state of PCMH and what s coming Exploration of how PCC functionality applies to new 2017 PCMH factors PCC Resources
More informationGateway to Practitioner Excellence GPE 2017 Medicaid & Medicare
Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare Recognizing and Rewarding Excellent Practices Improving the Health of Gateway Members PRACTICE ELIGIBILITY (see PCMH slide #27 for separate
More informationDiabetes. Evidence Based/ Team Based Care in a Community Health Center ---
Diabetes Evidence Based/ Team Based Care in a Community Health Center --- Sharon Mulvehill MD North Texas Area Community Health Center August 23, 2014 The Challenges Busy schedules, little time for system
More informationGetting Ready for the Maryland Primary Care Program
Getting Ready for the Maryland Primary Care Program Presentation to Maryland Academy of Nutrition and Dietetics March 19, 2018 Maryland Department of Health All-Payer Model: Performance to Date Performance
More informationJumpstarting population health management
Jumpstarting population health management Issue Brief April 2016 kpmg.com Table of contents Taking small, tangible steps towards PHM for scalable achievements 2 The power of PHM: Five steps 3 Case study
More informationTips 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 informationThe PCMH St Joseph s Experience
The PCMH St Joseph s Experience Priya Radhakrishnan, MD Roshni Kundranda, MD, MSPH Binh Doung, DO Jenni Schroeder, RN, BSN ACP Regional Meeting Tucson, 2013 Disclosure No financial conflicts of interest
More informationThe Virtual Connection: Electronic Visits. Joseph E. Scherger, MD, MPH National Medical Home Summit March 3, 2009
The Virtual Connection: Electronic Visits Joseph E. Scherger, MD, MPH National Medical Home Summit March 3, 2009 The Holy Grail of Health Care 2009 Cost Reduction Quality Improvement Service Improvement
More informationQuality Measurement and Reporting Kickoff
Quality Measurement and Reporting Kickoff All Shared Savings Program ACOs April 11, 2017 Sandra Adams, RN; Rabia Khan, MPH Division of Shared Savings Program Medicare Shared Savings Program DISCLAIMER
More informationImproving Clinical Flow ECHO Collaborative Change Package
Primary Drivers (driver diagram) Change Concepts Change Ideas Examples, Tips, and Resources Engaged Leadership Develop culture for transformation Use walk-arounds and attendance at team meetings to talk
More informationCASE STUDY. An HIE-populated personal health record for cardiac revascularization patients
CASE STUDY An HIE-populated personal health record for cardiac revascularization patients PROGRAM NAME ONC Challenge Grant Consumer-Mediated Information Exchange PILOT SITE LOCATION Parkview Physicians
More informationUnitedHealth Center for Health Reform & Modernization September 2014
Health Reform & Modernization September 2014 2014 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. Overview Why Focus on Primary Care?
More informationCOLLABORATIVE PRACTICE SUCCESSES IN PRIMARY CARE
COLLABORATIVE PRACTICE SUCCESSES IN PRIMARY CARE KPhA Annual Meeting September 7, 2014 Tiffany R. Shin, PharmD, BCACP Lyndsey N. Hogg, PharmD, BCACP Objectives Describe basic concepts of collaborative
More informationAdvancing Care Information Measures
Participants: Advancing Care Information Measures In 2017, Advancing Care Information (ACI) measure reporting is optional for Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, CRNAs,
More informationPromoting Interoperability Measures
Promoting Interoperability Measures Previously known as Advancing Care Information for 2017 and Meaningful Use from 2011-2016 Participants: In 2018, promoting interoperability measure reporting (PI) is
More informationCare Management Framework:
WHITE PAPER Care Management Framework: The Critical Path to Implementing a Care Management Strategy An Encore Point of View Randy Thomas, FHIMSS, Barbara Doyle, MSN, RN, January 2017 Tina Burbine, MBA,
More informationPromoting Interoperability Performance Category Fact Sheet
Promoting Interoperability Fact Sheet Health Services Advisory Group (HSAG) provides this eight-page fact sheet to help providers with understanding Activities that are eligible for the Promoting Interoperability
More informationPartners HealthCare Primary Care Quality and Patient Experience Reports 2017
Partners HealthCare Primary Care Quality and Patient Experience Reports 2017 Massachusetts General Physicians Organization QUALITYANDSAFETY.PARTNERS.ORG 1 INTRODUCTION Dear Patients, Colleagues and members
More informationPartners HealthCare Primary Care Quality and Patient Experience Reports 2017
Partners HealthCare Primary Care Quality and Patient Experience Reports 2017 North Shore Health System QUALITYANDSAFETY.PARTNERS.ORG 1 INTRODUCTION Dear Patients, Colleagues and members of the Commonwealth
More informationINTEGRATION OF PRIMARY CARE AND BEHAVIORAL HEALTH
INTEGRATION OF PRIMARY CARE AND BEHAVIORAL HEALTH Integrating silos of care Goal of integration: no wrong door to quality health care Moving From Moving Toward Primary Care Mental Health Services Substance
More informationCLASSIC BLUE SECURE/BLUE CROSS BLUE SHIELD COMPLEMENTARY Monroe County Benefit Summary/Comparison (Over 65 Retirees)
WHO IS COVERED Enrollment Requirement Members must be enrolled in both Medicare Parts A and B Members must be enrolled in both Medicare Parts A and B Type of Tier Single only Single only Dependent/Student
More informationPiedmont Access to Health Services. Standing Orders for Patient Work-ups
Piedmont Access to Health Services Policy Number: 01-09-014 SUBJECT: Standing Orders for Patient Work-ups EFFECTIVE DATE: 8/3/09 REVIEWED/REVISED : 4/10/2012 POLICY: PATHS is committed to allowing each
More informationImprovement Activities for ACI Bonus Measures
Improvement Activity Performance Category Subcategory Expanded Practice Activity Name Activity Improvement Activity Performance Category Weight Provide 24/7 access to eligible clinicians or groups, who
More informationChapter 7. Unit 2: Quality Performance Measures
Chapter 7 Unit 2: Quality Performance Measures In This Unit Topic See Page Unit 2: QualityBLUE Physician Pay-for-Performance Program Clinical Quality 2 Acute Pharyngitis Testing 10 Adolescent Well Care
More informationMeaningful Use: a Primer
Health Information Technology Extension Center of Los Angeles Meaningful Use: a Primer Mary Mitchell Director of Meaningful Use Defined as: What is Meaningful Use? A. Use of a certified EHR in a meaningful
More informationPresentation Outline
Chronic Disease Toolkits: Spreading Quality Outcomes Simply Gerald H. Angoff, MD, FACC, MBA Steve Sarette, BA Presentation Outline It Introduction ti Setting the scene Quality Improvement Project Details
More informationDriving Obstetrical Excellence Through a Council Structure
Driving Obstetrical Excellence Through a Council Structure Elizabeth Deckers, MD Director of Labor and Delivery, Hartford Hospital Deborah Feldman, M.D. Division director, Maternal Fetal Medicine, Hartford
More informationIntegration 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 informationCMS Transforming Clinical Practices Initiative and. The Southern New England Practice Transformation Network (SNE PTN)
CMS Transforming Clinical Practices Initiative and The Southern New England Practice Transformation Network (SNE PTN) MIPS 2017- Selecting Performance Category Measures and Reporting Requirements 1/31/2017
More informationTeam Based Care Assessment & Action Plan
Team Based Care Assessment & Action Plan In the tables below, consider how fully each item has been implemented or functions in your practice. Circle the number that best reflects the completeness of implementation
More informationPutting PCMH into Practice: A Transformation Series Care Coordination & Care Transitions (CC) September 12, 2018
Putting PCMH into Practice: A Transformation Series Care Coordination & Care Transitions (CC) September 12, 2018 WEBINAR FACILITATOR Hannah Stanfield NCQA PCMH CCE Practice Transformation Coordinator WACMHC
More informationFraming Rural Health Value Webinar Series
600 East Superior Street, Suite 404 I Duluth, MN 55802 I Ph. 800.997.6685 or 218.727.9390 I www.ruralcenter.org Framing Rural Health Value Webinar Series Data Measurement, Outcomes and Impact Kami Norland
More informationTelecare Services 7/19/2017
Telecare Services 7/19/2017 Rebecca Sienko, RN Manager, Nurse Care Line 15,000 Employees 1,900 MDs/APCs 15 Hospitals 17 Clinics 7 Long Term Care Facilities 2 Assisted Living 4 Independent Living 5 Ambulance
More informationUniversity of California, Davis Family Practice Center: Update 2014
University of California, Davis Family Practice Center: Update 2014 by Lisel Blash, Catherine Dower, and Susan Chapman September 2014 Center for the Health Professions at UCSF ABSTRACT In response to long
More informationACO Practice Transformation Program
ACO Overview ACO Practice Transformation Program PROGRAM OVERVIEW As healthcare rapidly transforms to new value-based payment systems, your level of success will dramatically improve by participation in
More informationCare Management in the Patient Centered Medical Home. Self Study Module
Care Management in the Patient Centered Medical Home Self Study Module Objectives Describe the goals of care management Identify elements of successful care management Recognize the 5 step Care Management
More informationDRAFT Complex and Chronic Care Improvement Program Template. (Not approved by CMS subject to continuing review process)
DRAFT Complex and Chronic Care Improvement Program Template Performance Year 2017 (Not approved by CMS subject to continuing review process) 1 Page A. Introduction The Complex and Chronic Care Improvement
More informationQuality Measures Reporting Guide. Volume 2. Epic Clinical Documentation
Primary Care Improvement Collaborative (PCIC) Quality Measures Reporting Guide Volume 2 FY 2018 Epic Clinical Documentation Table of Contents Attribution Methodology... 3 PCIC Measures Quality Measure
More informationBCBSM Physician Group Incentive Program. Patient-Centered Medical Home Domains of Function. Interpretive Guidelines
BCBSM Physician Group Incentive Program Patient-Centered Medical Home Domains of Function Interpretive Guidelines October 2009 Table of Contents Page 1.0 PATIENT-PROVIDER PARTNERSHIP 1 2.0 PATIENT REGISTRY
More informationMIPS Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017
CMS Transforming Clinical Practices Initiative and The Southern New England Practice Transformation Network (SNE PTN) MIPS 2017- Scoring: Explanation and Estimation 2/7/2017 and 2/10/2017 2 Review Determine
More informationACOs: Transforming Systems with New Payment Models & Community Integration
ACOs: Transforming Systems with New Payment Models & Community Integration Sunnah Kim PNP (Moderator), American Academy of Pediatrics Herbert Druilhet, RN, DNP, FNP-BC Lafayette General Medical Doctors
More informationPRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management
PRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management Mission: To improve the health of the people of Connecticut through safe and effective medication
More information2017 QUALITY PLAN WORK PLAN. Kaiser Permanente of Washington 2017 Quality Work Plan
Kaiser Permanente of Washington 2017 Quality Work Plan 1 Achieve 2017 Quality Goals: Improve population health, the quality, safety and satisfaction of the customer experience while improving affordability
More informationAlexander Valley Healthcare Hypertension Blood Pressure Control Redwood Community Health Coalition Promising Practice
AVH Promising Practice Hypertension Control 08/23/18 PG. 1 Alexander Valley Healthcare Hypertension Blood Pressure Control Redwood Community Health Coalition Promising Practice PROMISING PRACTICE OVERVIEW
More informationMenu Item: Population Management
Cover Page Menu Item: Population Management Name of Applicant Organization: Fremont Family Care Organization s Address: 2540 N Healthy Way, Fremont, NE 68025 Submitter s Name: Elizabeth Belmont Submitter
More informationDriving the value of health care through integration. Kaiser Permanente All Rights Reserved.
Driving the value of health care through integration February 13, 2012 Kaiser Permanente 2010-2011. All Rights Reserved. 1 Today s agenda How Kaiser Permanente is transforming care How we re updating our
More informationACHIEVING THE TRIPLE AIM THROUGH LARGE SCALE IMPROVEMENT EFFORTS JASON FOLTZ, D.O. TEACHERS OF QUALITY ACADEMY QI SYMPOSIUM MARCH 2, 2016
ACHIEVING THE TRIPLE AIM THROUGH LARGE SCALE IMPROVEMENT EFFORTS JASON FOLTZ, D.O. TEACHERS OF QUALITY ACADEMY QI SYMPOSIUM MARCH 2, 2016 OVERVIEW: WHAT, WHO, HOW? What: How do you move a large multi-specialty
More informationSpecialty Payment Model Opportunities Assessment and Design
Approved for Public Release. Distribution Unlimited.14.2286. CMS Alliance to Modernize Healthcare (CAMH) Specialty Model Opportunities Assessment and Design Cardiology Technical Expert Panel April 8, 2014
More informationQuality Reporting: PQRS, CQM, GIQuIC. Erin Dettrey Product Manager, Analytics Sylvia Cohen gadvisor Team Lead Laurie Parker GIQuIC Executive Director
Quality Reporting: PQRS, CQM, GIQuIC Erin Dettrey Product Manager, Analytics Sylvia Cohen gadvisor Team Lead Laurie Parker GIQuIC Executive Director Agenda - Setting the stage - Value Based Modifier -
More information2011 Measures 2013 Objectives Goal is to guide and support care processes and care coordination
Improve quality, safety, efficiency, and reduce health disparities Provide access to comprehensive patient health data for patient s health care team Use evidencebased order sets and CPOE Apply clinical
More informationMeaningful Use Certification Details
May 2, 2016 TRIARQ Health 1050 Wilshire, Suite 300 Troy, MI 48084 Meaningful Use Certification Details CHPL Practice Date CERTIFICATION Product Version Classification PRODUCT Type Certified EDITION NUMBER
More information