PreManage Implementation Toolkit

Transcription

1 PreManage Implementation Toolkit

2 Table of contents Pre-Implementation -Tips for Successful Implementation... 1 PreManage Scheduled Reports... 3 PreManage Cohorts PreManage Member Cohorts... 5 Triaging PreManage Cohorts... 7 PreManage Groups PreManage Notifications Eligibility File Tip Sheet Care Recommendations... 24

3 PreManage Tips for Successful Implementation Adopting PreManage in the most effective way requires some level of clinic resources to ensure that staff are engaged and trained in how to use the tool, and that PreManage functions are optimized to meet your organization s needs. The following are recommended steps to ensure a successful implementation of PreManage: Identify Clinical Champion, IT Lead, Key Clinic Contacts The organizations that have had the greatest success adopting PreManage have identified a project lead or owner to serve as a primary liaison between the organization and CMT. Identify this person as your Primary Clinical Contact in the PreManage Primary Contacts Form of your onboarding packet. Suggested Role/Duties of a PreManage Program Lead Within Your Organization: Create a process to monitor/track questions, issues, concerns of staff and work with CMT staff to address these in a prioritized/queue fashion; Lead will have a clear understanding of clinic priorities and can work with CMT to ensure that top priorities are addressed before minor issues; Have a thorough knowledge of your clinic s operations and dedicate the time to investigate internal workflow/operations issues and troubleshoot with staff prior to engaging CMT; Project management expertise is helpful to streamline these various tasks and issues. Additionally, it is important to identify who will be the IT contact for your organization to work with CMT on configuring the eligibility file. For larger organizations, consider also identifying key clinic contacts that will be primary users of PreManage or super users who can be of assistance in helping to define cohorts, establish groups and reports. Identify Objectives and Key Populations of Focus Because of the flexibility of PreManage, there are several ways you can use the tool to improve patient care. The most successful organizations have used a focused approach with the use of the tool and define clear, measurable objectives. This will allow you to create needed workflows, show progress and report to leadership on your efforts. CMT provides a form to communicate your specific goals and objectives you hope to achieve with PreManage. By communicating this information, CMT can supply you with specific materials, sample workflows and in many cases, reports to help you measure your progress towards your objectives. The following are some examples of objectives: Follow-up with patients that have 3 ED visits in 90 days Track IP admits to coordinate post-discharge planning Enter care recommendations for all patients with 5 or more ED visits Hold PreManage Demo and Kick off Call with CMT and Key Clinic Contacts Once your clinic has its internal PreManage owner and key contacts identified, the next step is to schedule a PreManage demo and kick off call with CMT. Your assigned CMT CRM (Client Relations Manager) will assist in scheduling the call and forwarding a kick off agenda to all attendees. During the call, your team will have the opportunity to view a full PreManage demo, ask questions about PreManage features and typical use cases, and talk about next steps for the onboarding process. The call will end with a review of action items and anticipated due dates. Hold Follow up IT onboarding call(s) with CMT As your clinic reviews and signs the agreement with CMT to allow for data sharing, your IT team can begin working on building your clinic eligibility file. Your CRM will provide access to the technical PreManage Onboarding Site where your team can review file specifications to guide the buildout of your clinic file. During this time, your IT contacts will schedule one or more calls with CMT IT staff to ask questions, load and review test eligibility files, and discuss an ongoing process and schedule for updating eligibility files. Note: before clinic eligibility data can be shared with CMT, the clinic-cmt agreement must be signed and fully executed between both parties. 1 P a g e

4 Assess Existing Workflows, Policies and Processes Consider the impact of PreManage implementation on any current policies, processes and workflows of your end-users. Existing policies may have to be revised or updated. Review all current care coordination and other related workflows and processes, assessing for potential redundancy. A workflow analysis should include key tasks, how they are accomplished, by whom and it what sequence. Identify which workflows are impacted and whether there is a current workflow for each process (e.g., high risk care managers, care coordinators, health navigators). A successful implementation is dependent on a good evaluation of current workflows and determining any needed changes or development of new workflows. Develop an Implementation Plan Once your organization has decided to adopt PreManage, it is imperative to gain leadership support and staff buy-in as well as assign accountability for implementation to a specific group or team. Components to include in your implementation plan: Eligibility file timeline/update process Initial portal build out of key cohorts/notifications/reports Clinic Account Manager training by CMT/clinics establish user accounts and process for ongoing management Standard user training provided by CMT Implementation of new/revised workflows 30-day clinic user trial period based on initial portal build out 30-day check-in call with CMT to refine portal Complete exit checklist to confirm process for ongoing PreManage requests Staff Communication and Training Engaging end-users will be an ongoing process throughout implementation, however it is important to ensure that staff has adequate time to learn of your intent to roll out PreManage and how they might be impacted (prior to training). Considerations for staff communication: PreManage purpose and impact on your model of care delivery PreManage tools and content How PreManage will impact their workflow Effective implementation of PreManage is dependent on training of end-users to ensure that the system is viable and reflects your organization s daily practice. The following are suggested steps in building your training plan based on the context of your organization s culture, workflows, clinical practice and quality goals: Plan for training of all staff and partners, including a system for responding to user questions and requests Create tools that help to consistently orient new users to PreManage documentation and practice Highlight workflow impact and how roles and responsibilities might change Address potential areas of duplicative documentation or work Highlight relevant cohorts to be monitored by each discipline Review timing and method for notifications received for each cohort 2 P a g e

5 PreManage Scheduled Reports What is a PreManage Report? PreManage Scheduled Reports, also known more simply as PreManage Reports, are based from visits by your member population in a specific timeframe. Various columns can be included to help identify the patient, as well as show the services accessed and service related information. The most common reports we are asked for include a 24-hour census of ED patients for a managed population, a 24-hour census of all patient activity for a population, and a 72-hour discharge summary of patients. A very simple example might look like this: When would I use a Report rather than a Notification? PreManage Reports are best suited when you need a summary of hospital activity in a certain time period. They also provide the flexibility of including additional information compared to the more concise, real-time PreManage Notifications. However, if you need details about a specific visit at the time of care, please set up a PreManage Notifications rather than a report. Where can I find a PreManage report? PreManage Reports are found under the in the PreManage web portal under the Scheduled Reports tab in the lefthand navigation bar: A PreManage report can be dropped off or picked up onto a SFTP server for convenience. If you need assistance with this, please contact CMT support, support@collectivemedicaltech.com or , for assistance. Who usually uses a PreManage Report? There are several different audiences for a report depending on the data in the report. In most cases, PreManage Reports are used by case managers to understand hospital activity and coordinate follow-up care. However, because of the content of specific reports, some are used by an organization s leadership or by a data analytics team. What if I want a report about a segment of a population rather than my entire population? Not all PreManage reports are census reports. Reports can be created for your predefined groups (i.e. a specific line of business, by assigned case manager, etc.) if you have provided these predefined groups in your eligibility file or have manually entered them in PreManage. You can also request to have a report of visit activity only after they have had a certain amount of hospital visits (i.e. 5 ED visits in 12 months) or if the hospital entered a certain diagnosis for the visit. Please work with the CMT Client Relations team if you have a specific report need or would like to see some sample reports. 3 P a g e

6 What information is available to put in a PreManage Report? There are over 30 different data elements for the PreManage reports. Most of these data elements are based around the patient demographics as well as visit details. Please contact the CMT Client Relations team for a complete set of available data elements / columns that can be included in your report. How often are the reports made available? You may choose to have PreManage Reports delivered daily, weekly, or monthly. Can I make a change to my report? You can make changes to existing reports having your facility account manager reach out to CMT Support at support@collectivemedicaltech.com. Are there any limitations to the PreManage Scheduled Reports? Currently, you only have access 30 set data elements that are seen in the Report Builder Form. Also, you are receiving the Admit/Discharge/Transfer hospital data at the time the report is created. In other words, if an update is made to a visit, you would need to log into PreManage to see the update. Can you provide me with some examples of how reports are used in Oregon? Some common reports utilized in Oregon include: Daily admit reports Daily, weekly, and monthly discharge reports Monthly chronic disease cohort reports Specific hospital or regional reports Reports specific for patients with high utilization of the emergency department 4 P a g e

7 PreManage Member Cohorts What is a PreManage Cohort? A PreManage Member Cohort allows you to define populations at risk by creating custom filters for your patient population using criteria that your organization defines. The purpose of Member Cohorts is to stratify your population into smaller subpopulations so you can take necessary action to reduce risk and connect these individuals to appropriate services. Most clinics are not staffed to provide intensive care management for their entire population. Instead, most clinics start small by addressing their highest need patients. Member Cohorts can be used to help identify which patients are at highest need. Some clinics have significantly increased their efficiency by defining specific workflows around cohorts they established in PreManage. How do I View My Cohorts in PreManage? Member Cohorts are viewable from the home page of PreManage after you initially log in. See a sample list of cohorts to the right. You can also navigate to the Member Cohorts page from the menu on the left side of the PreManage web portal. Cohorts are listed in groups of ten on the Member Cohorts page. Some organizations have a great number of cohorts and for those clinics, you can scroll through multiple pages of cohorts using the navigator at the bottom of the list. Your CMT support contact can assist you with Member Cohort naming conventions to ensure that you will remember what each cohort represents. You can also change the timeframe that your cohorts are actively filtering for example, in real time you could check the results for a cohort based on the past week or the past month to see the difference in activity. How Do I Set Up Cohorts? Member Cohorts are initially established as part of your onboarding packet when you implement PreManage. The attached Cohorts form allows you to select from a menu of commonly used cohorts and you can also specify unique cohorts for your clinic or organization. To modify or add new cohorts after initial onboarding, simply contact your CMT support contact and they will be happy to assist you. What Criteria are Available or Useful for Cohorts? Designing your own Member Cohorts can be challenging at first. CMT can establish a cohort based on any data available in the PreManage database which is largely based on utilization and demographic information from Hospital Admit Discharge Transfer (ADT) feeds from electronic medical records. When in doubt about whether a certain data point or criteria exists, please ask your CMT support contact. A sample list of criteria that are regularly used is below: Demographic criteria (such as age or zip code) Hospital criteria (such as specific hospital or location) Utilization criteria (number and frequency of ED or inpatient visits, e.g., 5 ore more visits in 6 months) 5 P a g e

8 o Many clinics use these criteria to generate a full census for all ED admissions or inpatient visits. Please note that you can also refer to the Census function within PreManage to get your full census. Cohorts are intended to further stratify your population in meaningful ways. Diagnosis criteria: o CMT can create some criteria based on diagnosis codes (ICD-9, ICD-10) that you provide if you are interested in flagging specific diagnoses o CMT can also create text-search criteria that will look for language contained within data to ensure you are capturing relevant diagnosis events (e.g. searching for tooth or dental for a cohort on dentalrelated hospitalizations) Criteria can be mixed and matched to create unique cohorts. For example, you could combine demographic and diagnosis criteria to flag unique risk categories (e.g. youth (under age 18) living in a certain zip code who are hospitalized for asthma-related diagnoses). What is the Difference Between a Cohort and a Group? You may occasionally hear CMT staff or other colleagues refer to a group in PreManage. Groups and cohorts are distinct in the following ways: groups are meant to flag patients you have already identified as at-risk for example, patients that are already being actively case managed could be organized into a group and tracked using PreManage. Cohorts on the other hand, are intended for case finding identifying patients that you were not aware were at risk for example, you can create a cohort that identifies all patients that have visited the ED 5 or more times in the past 6 months. Using groups and cohorts together is an excellent way to ensure that you are tracking patients at risk for avoidable ED utilization, or patients at risk for missing follow up care or important transitions in and out of the hospital. Furthermore, you can also use groups as criteria for creating a cohort (e.g. utilization activity for just a specific group as identified by your organization). Are There Limitations to Cohorts? Cohorts are filters that are acting upon data in PreManage in real time. If that data is inaccurate, or if it changes, this will impact the patients that are captured in your cohorts. Hospital Admit Discharge Transfer (ADT) feeds, which send data directly to PreManage from hospital EMRs, comprise the bulk of the data that is flowing into the PreManage system. Occasionally these ADT feeds will miss an important piece of data, such as diagnosis or discharge date, that may impact your cohort. CMT works actively and regularly to improve hospital ADT to avoid these errors. If you find an error like this, please contact your CMT support contact. In addition, sometimes a diagnosis is part of a long problem list that is sent to PreManage. For example, if you have a cohort set up to capture diabetes-related hospital events, and patients are presenting to the hospital with an entire problem list that includes diabetes this individual will be captured in your cohort regardless of the reason for their most recent visit (e.g. a physical injury having nothing to do with diabetes). If you would like to augment or modify cohorts to address these issues, please contact your CMT support contact. New cohorts made in PreManage, or changes made to existing cohorts, will only impact future information cohorts are not retrospective in nature. If you are hoping to look backward at past member/patient history, you should consider a PreManage Report. 6 P a g e

9 Triaging PreManage Cohorts: Using the Review Visit feature to support a team approach to cohort review & follow-up Step 1: On the Cohorts page, select the Cohort you wish to review. 7 P a g e

10 Triaging PreManage Cohorts: Using the Review Visit feature to support a team approach to cohort review & follow-up Step 2: Select a Patient to Review and Right Click to open new tab for Patient Details Screen 10 P a g e

11 Triaging PreManage Cohorts: Using the Review Visit feature to support a team approach to cohort review & follow-up Step 3: On the patient record, select the visit you would like to review. 11 P a g e

12 Triaging PreManage Cohorts: Using the Review Visit feature to support a team approach to cohort review & follow-up Step 4: Once you click the blue hyperlink for that specific visit, a prompt will open that will look like this: Step 5: Click on the drop-down box that says, Expand to add details to review 12 P a g e

13 Triaging PreManage Cohorts: Using the Review Visit feature to support a team approach to cohort review & follow-up Step 6: Adjust the Privacy Level as needed (Default is Limited This review can only be seen by users from my facility ). Enter the details of the review. See example notes in the text field box below. 13 P a g e

14 Triaging PreManage Cohorts: Using the Review Visit feature to support a team approach to cohort review & follow-up Step 7: After notes are entered and privacy level is set, click Review Visit. 14 P a g e

15 Triaging PreManage Cohorts: Using the Review Visit feature to support a team approach to cohort review & follow-up Step 8: A dialog box will display saying Saved Visit Review 15 P a g e

16 Triaging PreManage Cohorts: Using the Review Visit feature to support a team approach to cohort review & follow-up Step 9: Once you see the green dialog box, click Ok in the bottom right hand of the box. 16 P a g e

17 Triaging PreManage Cohorts: Using the Review Visit feature to support a team approach to cohort review & follow-up Step 10: At the bottom of the page, you will now see the visit details you ve input in the Patient Correspondence section. Note: You may have to refresh the page after the note is saved to display this record. Step 11: Go back to the Cohorts Page to see a Yes in the Reviewed column indicating that the patient visit has been reviewed and acted on. 17 P a g e

18 PreManage Groups What is a PreManage Group? A PreManage Group is an identifier that gets associated with a patient to better organize and focus your care management activities on patients that have been identified as at risk. There are a great number of ways to use groups: they can be used to identify patients as part of existing care management services; they can be used to trigger very focused notifications; they can be used to delineate unique actions or care management workflows. Groups can also be established as part of your clinic s eligibility file so that this information is automatically updated. How Do I Set Up Groups? There are two ways to set up Groups in PreManage: Manual Entry: You can create a group or edit the members of that group using the PreManage web portal. For detailed instructions on how to create and edit Groups in PreManage, please contact your CMT support contact. Eligibility File: Many clinics provide CMT with group identifiers in their eligibility file (the regularly-updated file that contains your patient population information). For example, one common use for groups through an eligibility file is to provide group identifier by care manager assignment. If you have 100 patients, and 20 of them are being actively care managed, you can identify the care manager in your eligibility file for those 20 people. CMT will then create groups by care manager name that will include those 20 people as reflected in the file. The remaining 80 individuals will not be placed in a group. For additional instructions in how to add group information in your eligibility file, please refer to tip sheets for the Eligibility File set up. Where Do I Find Groups in PreManage? There are three ways to view Groups in PreManage: Patient Record View: If you are looking at a specific patient record in PreManage, you may notice colorful boxes under the patient s demographic information. These are tags that identify the groups that this patient is associated with in your PreManage portal. Groups Page: You can navigate to the Groups page, located on the left-hand menu in PreManage, to review all existing groups available in your web portal. There are pre-set groups that all PreManage users have access to and then there are Facility Groups which generally are located toward the bottom of the groups list. This list should include all active groups you have established either through manual entry or as established by your eligibility file. Clicking on any of these groups will pop up a list of the current patients that are part of that group you can also navigate to individual patient records from this list. Scheduled Reports: You may add a groups column to your scheduled reports. This will allow you to sort and filter your reports by your predefined groups. Can I be Notified when there is Group Activity in PreManage? One goal of groups is to use these identifiers to pivot notifications to specific individuals in real time thus allowing clinics to divide work or responsibilities of patient population management among multiple individuals. For example, if you have 3 care managers, you can create unique groups based on their patient assignments, so each one can receive real-time notifications for just their specific patients. To learn how to establish notifications, see PreManage Notifications tip sheet. 18 P a g e

19 What is the Difference Between a Cohort and a Group? You may occasionally hear CMT staff or other colleagues refer to a cohort in PreManage. Groups and cohorts are distinct in the following ways: groups are meant to flag patients you have already identified as at-risk for example, patients that are already being actively case managed could be organized into a group and tracked using PreManage. Cohorts on the other hand, are intended for case finding identifying patients that you were not aware were at risk for example, you can create a cohort that identifies all patients that have visited the ED 5 or more times in the past 6 months. Using groups and cohorts together is an excellent way to ensure that you are tracking patients at risk for avoidable ED utilization, or patients at risk for missing follow up care or important transitions in and out of the hospital. Furthermore, you can also use groups as criteria for creating a cohort (e.g. utilization activity for just a specific group as identified by your organization). Are There Limitations to Groups? The primary limitation to Groups is that they are based on either manual updating by users or through data updates from your eligibility file. If there is an issue with data entry or data contained in your eligibility file, it will translate to PreManage groups. Manual Updating: Clinics are busy places. It can be difficult for care managers and other PreManage users to consistently update manual groups. Therefore, CMT strongly encourages groups to be reflected in a clinic s eligibility file to ensure that they are functioning accurately. Eligibility File: Eligibility file configuration is key when the file is used to share group identifiers with CMT. For more information on how to establish groups and other configuration considerations through your eligibility file, refer to the Eligibility File tip sheet. If group information is configured incorrectly this can impact how groups behave. For example, it is best practice to articulate group information in a unique column from other data points in the eligibility file. Oregon Examples: The following are some example groups including the method used to create them that your colleagues in Oregon have used and have flagged as helpful: Manual Groups: watch groups of patients that are being flagged in the short-term for some purpose this information can then be captured in the eligibility file for automation. Eligibility File Groups: Enrollment Groups: Oregon Health Plan, Duals, Payer groups Programmatic Groups: transitional care team, diabetes management, etc. Care Coordinator/manager groups based on active caseload Risk Scores: medical or pharmacy risk score categories Care Gaps: CareOregon uses groups to flag active CCO or Medicare Stars gaps for patients 19 P a g e

20 PreManage Notifications What is a PreManage Notification? A PreManage Member Cohort allows you to define populations at risk by creating custom criteria for your patient population. These cohorts can be found on the Member Cohorts page in PreManage. However, if you need to know in real time when a patient has met one of your Member Cohort criteria, you will want to set up a PreManage Notification. The PreManage Notification will alert you within seconds of the triggering event / hospital visit. It will allow you to act quickly and engage in what is happening at that moment. PreManage Notifications can come in many different formats: text message, , printed fax, or network printer printout. Some organizations have chosen to do an integration with their electronic medical record in which case they are able to receive PreManage Notifications directly into their electronic record. What information is available to put in a PreManage Notification? Printed Notifications can be customized to include the information you need. Most commonly, a printed PreManage Notification will include the patient demographics, security events, care recommendations, visit history and visit details. Notifications can also include Patient Groups, Insurance information, and a list of the Criteria the patient met for the PreManage Notification. Please contact CMT support for a full list. Because they are not secure forms of communication, and text notifications do not include specifics about the patient but will alert you to check the PreManage web portal. If you subscribe to Notifications, the subject line of the will include the name of the cohort trigger and the body of the will include a PreManage link that will take you directly to the patient s page in PreManage. Please see the example of an notifications below: Who usually uses a PreManage Notification and how are they used? PreManage Notifications are often used by case management teams who need to understand in real time when one of their patients are at the hospital. The most common Notification method for this is an notification. How do I update a PreManage Notification or set up a new one? Your site admin can request new PreManage Notifications or update existing Notifications. Please contact your site admin to set up a PreManage Notification. If you have any questions, you may contact CMT support at support@collectivemedicaltech.com. Are there any limitations to PreManage Notifications? Depending on the form of Notification you choose, you may or may not need to sign into the PreManage site for additional information. All the printed Notifications should provide a good synopsis of the patient, their visit, and recommendations for that patient s care. An electronic integration with your EMR will provide these details as well. Text messages and s will have limited information since the method itself in not secure for the transfer of patient health information. You can securely log in to the PreManage site to receive additional details that are not found in the Notification. 20 P a g e

21 On occasion, if the hospital does not provide enough information for PreManage to identify the patient, you will not receive the Notification or it may be delayed until they provide additional demographic information. For example, we are unable to positively identify a patient by their name only and will need additional identifying information such as the social security number, date of birth, or home address. How are Notifications being used in Oregon? A Federally Qualified Health Center in Central Oregon is piloting the use of notifications to alert the clinic-based Behavioral Health Consultant when one of their patients hits the Emergency Department for behavioral health concerns. The direct notification pathway eliminates the need for a lengthy triage workflow for all the ED notifications that come in for their clinic s patients. By utilizing the notification feature in PreManage, the information is put directly in the hands of the person who can take action and reach out to the ED staff to collaborate on a plan of the care for the patient, or even go to the ED to meet with the patient if a relationship has already been established. This approach also aligns with lean thinking and effectively executing a team-based care approach, as the information is directly sent to the team managing that patient s care. 21 P a g e

22 PreManage Eligibility File Tip Sheet The following Tip Sheet is intended for clinical and administrative roles within your clinic. If you represent your organization s IT department, please refer to the Eligibility File Spec Sheet and if you have any questions about how to best design the file, please contact your CMT support person. What is the Eligibility File? The PreManage Eligibility File is a requirement for all organizations that implement PreManage. The eligibility file serves the primary function of defining the population that you can see within PreManage. Since the PreManage network is an open network and includes millions of lives across multiple states, the eligibility file-defined active population ensures that our system and your use of it complies with federal and state privacy laws, including HIPAA. The file can be extracted from an existing IT system like an EMR or database, or it can be manually created in Excel although CMT strongly encourages organizations to find some method of automating file creation. The file must be received on a regularly-updated basis to ensure that your active population in PreManage stays accurate as patients move, change providers, etc. Who Creates my Eligibility File? Most clinics create and upload their own eligibility file to ensure that you can control the patients that are contained in the file. This work is usually completed by your IT department, who pulls a data extract from an existing system you use to manage patients (e.g. an EMR). Some clinics lack the necessary IT resources to create their own file. In very limited circumstances, CMT will work its health plan customers to see if there is an alternative means of constructing a file for at least one payer segment of your population. What are Required Fields? Required fields are data elements that must be contained in your eligibility file to ensure that PreManage can appropriately match the right patient in our system. Several different identifiers are required for the same individual to increase the confidence that John Doe in your patient population is the same John Doe that PreManage has a record for, and has been to hospitals in our network. Some of the fields CMT uses to match the patient include: first name, last name, date of birth, social security number, phone number, and address. If you have concerns about some of these required fields, please contact your CMT support person. Multiple Patient Identifiers PreManage requires a unique patient identifier for each patient to ensure that patient matching is done in a consistent fashion. For many clinics identifiers change as a patient goes from an assigned patient to an active patient. For example, a patient may be referred to a clinic by a CCO using an Oregon Health Plan identifier but this same patient could then be assigned a unique clinic identifier after establishing a treatment relationship. To assist with managing multiple identifiers for the same patient simply provide each identifier in a unique column of the eligibility file. CMT can add logic to prioritize which identifier should be displayed in PreManage both identifiers can be used to search for patients. For additional questions about this use case, please contact your CMT support person. Optional Fields CMT will accept virtually any additional data element in your eligibility file for patients in your population beyond what is required. The benefit of including optional fields depends upon your use(s) of PreManage. For example, if you are trying to coordinate care with outside organizations a common purpose for using PreManage you may consider adding provider information associated with each patient and CMT can display this in PreManage in the patient s record. This way your organization as well as other PreManage network users can see your patients provider information. Note: Starting October 2017, the National Provider Identifier (NPI) will be required for providers to increase provider information accuracy. 22 P a g e

23 Because of the customizability of eligibility files, CMT expects to see a great number of additional optional fields added to eligibility files in the future. Some thoughts and considerations for optional fields follow below. Oregon Examples: The following examples from Oregon users demonstrate how clinics and other organizations are leveraging their eligibility file and optional fields to optimize their use of PreManage: Care Manager Groups in Eligibility File: A large Portland-area clinic has added a column in the eligibility file indicating the assigned care manager for each patient. In the PreManage portal there is a corresponding Facility Group for each care manager. Thus, when a care manager logs into PreManage, they can navigate directly to their relevant patients and determine whether hospital activity has occurred. Member Cohorts and Notifications can also be generated off this group so that the care managers can be alerted in real time when a hospitalization occurs. Multiple Portals for Multiple Sites: Some organizations have multiple sites and have need for multiple portals that reflect distinct populations. The Oregon Health Authority, for example, sends CMT one file for the entire long-term care population but includes an optional field with codes that map to specific site locations for AAA/APD field offices. End users only have access to the specific portal they need. Note: The data in the eligibility file must be reliable and consistent to ensure portals stay accurate. Moreover, if you are a clinic with multiple sites, but your care managers operate centrally, multiple portals are unlikely to serve your needs. Navigating in between multiple portals adds extra steps to the electronic workflow and should only be used in circumstances when restricted portal views are important. Where Can I Learn More? The CMT On-Boarding site will provide additional details on the available fields and how to send an eligibility file to CMT. For access to the on-boarding site, please contact us at support@collectivemedicaltech.com, P a g e

24 Flat File - PreManage Enrollment Basic Guidelines 1. Every file MUST include the headers as the first row of the file. 2. Unused columns should not be included in the file 3. Do not include blank rows, rows for human readability, rows containing only dashes, or other non-patient data rows except the header 4. Headers must match the values listed in the below charts exactly. 5. Each row should have its own line and be separated by a Unix newline character (" \n"). 6. Files may be created using a comma separated values format, tab delimited, or pipe (" ") delimited format. Values containing the chosen delimiter should be wrapped in quotes. 7. NULL values should be left blank. The word "Null" or "None" should NOT be used in place of a null value. 8. Please remove place holder values such as unknown dates of birth that are set to 1/1/1900 or SSN's that are set to Dates and Date Times should be formatted as follows: yyyy-mm-dd or MM/dd/yyyyHH:mm:ss. Dates not matching this format will be rejected. 10. All times should be in the facility s local time zone. 11. All reserved characters must be stripped from text. These include any newline characters ("\ n" or "\r"), or the chosen delimiter. 12. Files should use UTF-8 encoding. 13. Please remove punctuation from social security numbers and phone numbers. 14. If the data is not available for a required field, leave it blank and we will process it if we are able. Do not attempt to fill fields with fake values. 15. Your Collective Medical Client Relations Manager will provide you with facility identifiers other than your own if you need to include them in the file. 16. Filenames should be descriptive of the data being transmitted and should have the date of the extract appended. (e.g. Patient_Enrollment_ csv) 17. Remember, the more data you provide to CMT, the better the value we can provide back to your organization. Please include ALL possible data. Below you will find several different file types and field specifications that can be sent to EDIE or PreManage for loading various pieces of data. You are not required to send all the data listed below, in many cases just the Patient Enrollment Fields are sufficient. Other specifications are designed to enable specific workflows or processes within the system. Patient Enrollment/Membership Fields (REQUIRED) Column Name Description Field Required Maxi Char Allo w Patient Primary Identifier The patient's primary identifier; ID must be unique. Required 2 Patient Secondary Identifier An additional identifier used for members/patients. Examples include but are not limited to a Medicaid ID, internal patient identifier, and previous identifiers for lookup. Optional 2 Patient Tertiary Identifier An additional identifier used for members/patients. Examples include but are not limited to a Medicaid ID, internal patient identifier, and previous identifiers for lookup. Address Line 1 of the patient address. Required 2 Address2 Line 2 of the patient address, usually apartment number. Optional City The city where the patient resides. Required State The state where the patient resides. Two letter abbreviations. Required Zip The first five digits of the zip code where the patient resides. Required County The county where the patient resides. Optional SSN The patient s social security number. Required DOB The patient s date of birth. yyyy-mm-dd Required Gender The patient s gender. M, F, or O for Other. Required Home The patient s home phone number. Required First The patient s first name. Required Middle The patient s middle name. Optional 24 P a g e

25 Group An EDIE group that the patient will be put in to. Multiple groups may be defined by separating them with a '^'. Optional 2 Case Manager The name of the Case Manager from your facility assigned to the patient. Optional 2 CaseManagerID The identifier you will use for this Case Manager. Examples could be a system ID or an address. This is required when specifying a case manager name. Optional 2 CaseManagerPhone The case manager's phone number. Optional 2 CaseManagerFax The case manager's fax number. Optional 2 CaseManager The case manager's address. Optional 2 CaseManagerTaxonomy Optional 2 CaseManagerTitle Free text i.e. Transitions, High Risk, Mobile Team Optional CaseManagerStartDate The start date for this case manager s engagement with the patient. (yyyy-mm-dd). Optional CaseManagerEndDate The end date for this case manager s engagement with the patient. (yyyy-mm-dd). Optional InsurerName InsurerID The name of the Insurer covering this patient (If Insurer ID is specified, the existing name in EDIE or PreManage will be used). The Insurer facility with which this patient is associated. Use identifiers found in the Manage Facility -> Manage Facility Files section of EDIE or PreManage. Optional 2 Optional PolicyNumber The policy number for this patient. This field usually only applies to insurers. Optional PolicyNumberSuffix The policy suffix for this patient, usually for children and spouses Optional 2 InsurerGroupName The group name for the insured Optional 2 InsurerGroupID The group id for the insured Optional 2 LOB The Line of Business for this patient. This field usually only applies to insurers. Optional 2 EnrollmentStartDate EnrollmentEndDate The start date for this patient s enrollment with your organization. This field usually only applies to insurers. (yyyy-mm-dd). The end date this patient s enrollment was terminated. This field usually only applies to insurers. (yyyy-mm-dd). Optional Optional PCPFirstName The first name of the Primary Care Provider Optional 2 PCPMiddle Name The middle name of the Primary Care Provider Optional 2 PCPLast Name The last name of the Primary Care Provider Optional 2 PCPNPI The identifiers NPI Required PCPFacilityName The name of the facility the PCP is affiliated with Optional 2 PCPFacilityAddress The address of the facility the PCP is affiliated with Optional 2 PCPFacilityCity The city of the facility the PCP is affiliated with Optional 2 PCPFacilityState The state of the facility the PCP is affiliated with Optional 2 PCPFacilityZip The zip code of the facility the PCP is affiliated with Optional 2 PCPFacilityPhone The phone number of the facility the PCP is affiliated with Optional 2 PCPFacilityFax The fax number of the facility the PCP is affiliated with Optional 2 PCP The PPC's address Optional 2 PCPURL The URL of the facility the PCP is affiliated with Optional 2 PCPStateDate The date the PCP began their relationship with the patient (yyyy-mm-dd). Optional PCPEndDate The date the PCP terminated their relationship with the patient (yyyy-mm-dd). Optional Downloadable Sample Files Patient_Enrollment_Specification_ csv 25 P a g e

26 Frequently Asked Questions What legal requirements apply to inclusion of patients in this flat file? CMT will give users from your organization access to information for individuals included in this flat file. Under HIPAA and applicable state privacy laws, users from your organization may only access information on individuals with whom your organization has an active relationship for purposes of "treatment, payment or healthcare operations" as those terms are defined under HIPAA. For hospitals and other healthcare providers, this means you have a patientprovider treatment relationship. For a health plan or managed care organization (ACO or CCO) this means that the individual is currently a member for which you are responsible for paying for, arranging for coverage for, or helping to coordinate the provision of the member's healthcare services. How is patient matching done? See FAQ - Patient Matching for details. It is very important that you provide all these data items when they are available. CMT safeguards Social Security Numbers with additional precaution. SSNs are never stored in CMT databases in plain text. They are instead passed through a salt-and-hash encryption process that provides an irreversible hash value. During the matching process, incoming SSNs are salted-and-hashed in the same manner to yield the correct hash if the patient is a match. The plain text SSN is then discarded from memory. Please make every effort to send SSN and all other fields where available to allow for the best possible matching results with the patients in CMT s databases. Can you provide a sample of the Flat File? Yes, sample of any of the Flat File Specifications are available in the downloads section at the bottom of this page. Is it possible to add a field that is not listed in the specification? Yes, any new field may be included without affecting the processing of the required fields listed in a Specification. However, for the field to be processed, some custom development work will be required, which may delay the processing of the file. Please speak with your Collective Medical Technologies Client Relations Manager to understand the requirements. How do we test our Flat File to validate all data fields are properly handled? When uploading a file through the web application validation is performed automatically and will tell you if things are missing or needing to be changed before the file can be processed. How do we transfer the Flat File? There are two preferred ways to transfer the file to Collective Medical: 1. Web Application: Once an IT account is set up for you, click on the Manage Facility button located in the upper right-hand corner of your screen. On the left-hand side of the page, click on the Manage Facility Files button. In the Upload a Data File widget, select your file, the file type, and the file delimiter, and then click the Upload File button. 2. SFTP: If you have an automated system or ES B or your file is larger than 5MB you may request an SFTP account from Collective Medical by contacting your Client Relations Manager. The file can then be transmitted securely over SFTP. CMT can also download from a remote SFTP server if you prefer to host the server yourself. See Connectivity - SFTP for more information. What do I do if I have multiple identifiers for a patient? Can I send each identifier type in the file or do I need to choose just one? You can add additional fields if you have more than one identifier you use for a patient (i.e. medical record number, a Medicaid ID, insurance ID, etc.). Select the identifier you would like to be the primary identifier by labeling the field, "Patient Primary Identifier." Additional identifier fields can be labeled "Patient Secondary Identifier," "Patient Tertiary Identifier," and so forth. 26 P a g e

27 Care Recommendations Tips Care Recommendations are a powerful part of EDIE and PreManage intended to deliver brief, critical information to ED providers at the point of care (e.g., information delivered in a hallway conversation). When information is included in this section it will AUTOMATICALLY be sent to the ED once the patient presents. This Tip Sheet provides brief guidance to promote the consistent use of two features Patient Background and Care Recommendations to facilitate improved communication and cross organizational care coordination. Patient Background: The Patient Background Section is for objective information ( just the facts ) related to the patient s history. When information is included in Patient Background, it will AUTOMATICALLY be sent to the ED once the patient presents. Any EDIE/PreManage user with access to a patient record can add information in this section and can contribute to a shared understanding of the patient s background. This means multiple care managers/coordinators across organizations can contribute information to this section rather than creating an additional care recommendation. There are 6 different subsections or tabs that allow you to organize the type of information you d like to include: Medical/Surgical Infection/Chronic Substance Abuse/Overdose Behavioral Social Radiation Care Recommendations: Ideally there should be one care recommendation for each patient, developed by the individual who has the most firsthand knowledge of the patient in collaboration with others who are involved in their care. Care Recommendation authors are encouraged to keep the recommendations up to date (e.g., review and update guidelines every 3-6 months) in collaboration with a patient s care team. Care Recommendations remain viewable in a patient record for 18 months without updates. After that time, they are no longer sent to the ED but remain attached to the patient s record. There are 5 different subsections that allow you to organize the type of information you d like to include: NOTE: Even if only one of the five subsections is completed (see below), this will trigger the delivery of the Care Recommendation to the ED. Therefore, you don t need to complete all sections for the information to be sent. Care Recommendation: A recommendation for how a condition should be treated or has been successfully treated in the past Care Coordination: An explanation of the coordinated efforts regarding this patient's care Pain Management: A recommendation for how the patient's pain should be managed, including pain contracts, etc. Helpful ED-Based Interventions to Try: A list of helpful interventions that have been successful in prior ED visits. Other Information: (Any additional information relevant for the ED). o NOTE: This section should be used with caution as the most relevant patient information can likely fit into one of the above Patient Background Tabs or other Care Recommendations sections. CARE RECOMMENDATIONS This is a place to create a recommendation for how a condition should be treated or has been successfully treated in the past. Or in other words, Based on the above objective Patient Background information, this is the recommended care for the patient Patient goals for care Team recommendations for how the ED should treat a patient when they present Details about care the patient is currently receiving in an outpatient setting to help redirect them to the outpatient care plan 27 P a g e