Continuity of Care Implementing Compacts: A small practice journey
|
|
- Belinda Arleen Price
- 6 years ago
- Views:
Transcription
1 Continuity of Care Implementing Compacts: A small practice journey R. Scott Hammond, MD Chair, CAFP PCMH Task Force Medical Director, SOC-PCMH Grant, Colorado Associate Clinical Professor, Dept. of Family Medicine UCHSC Westminster Medical Clinic, Westminster, Colorado --PCMH Level 3
2 Continuity of Care Paradigm
3 Continuity of Care Informational continuity Every provider caring for patient has access to accurate information about patient s previous care. Relational or interpersonal continuity On-going relationship between the patient and the clinicians chosen by the patient as his/her usual source of care. Geographic continuity Delivery of care in multiple locations by a team of clinicians chosen by and known to the patient.
4 Systems Of Care-PCMH Grant, Planning Phase Colorado Research and Development Systems of Care Poll (700 responses/10,725 physicians) Focus groups SOC-PCMH Summit Action Plan Implementation Phase Outreach, Promotion, Education of the PCMH and Medical Neighborhood Evaluation Phase
5 Colorado Systems of Care Poll -10/09 PCP Specialty Aware of PCMH Very familiar/somewhat 80% 38% Concept of PCMH Extremely/Very important 72% 76% Definitely/probably will become PCMH after reading description 56% Willing to meet with PCP 79% Communication satisfaction with facilities Total/very satisfied Staff finds other office cooperative - Always/regularly Receives necessary information -- Always/regularly PCP included in care by specialist 36% 15% 21% 40% 54% 51% 36% Specialist care plan supported/followed by PCP 70%
6 Colorado SOC-PCMH Summit and Action Plan Summit Practice constraints and loss of personal relationships impede effective hand-offs and clinical communication Both PCPs and specialists wish to improve this relationship. Action Plan Focus on improving physician culture and communication Engage specialty societies, focus groups Develop Primary care-specialty care compact to standardize communication and expectations. Develop informational continuity with medical facilities. Pilot standards
7 Geographic continuity Primary Care Specialty Care Compact Research Working models (Kaiser, QHN) Literature (Chen, Forrest, JHU, COPIC) ACP, TransforMed, NCQA Development of Working Model 4 PCPs ( 3 PCMH FPs, 1 IM) 4 specialists (Cardiology, Oncology, Surgery, Endocrinology) Testing
8 Primary Care-Specialty Care Compact Purpose and Principles Definitions Types of Care Transition Service Agreement Transition of Care Access Care Management Medical Collaboration Patient communication Transition of Care Records (PCP and Specialist)
9 Primary Care-Specialty Care Compact Types of Care Transition Pre-consultation exchange Formal consultation Co-management (Referral) With Shared management With Principle Care Complete transfer of care (Specialty Medical Home Network) Emergency Care
10 Service Agreement Transition of Care Transition of Care Mutual Agreement Maintain accurate and up-to-date clinical record. Agree to standardized demographic and clinical information format such as the Continuity of Care Record [CCR] or Continuity of Care Document [CCD] Ensure safe and timely transfer of care of a prepared patient Expectations Primary Care Specialty Care PCP maintains complete and up-to-date clinical record including demographics. Transfers information as outlined in Patient Transition Record. Orders appropriate studies that would facilitate the specialty visit. Informs patient of need, purpose (specific question), expectations and goals of the specialty visit Provides patient with specialist contact information and expected timeframe for appointment. Determines and/or confirms insurance eligibility Provides single source referral contact person When needed, be ready to communicate with the PCP prior to the appointment to assist in the preparation of patient. Communicates appropriate pre-referral workup to PCP, as needed. Additional agreements/edits:
11 Service Agreement PCP Patient Transition Record 1. Practice details PCP, PCMH level, contact numbers (regular, emergency) 2. Patient demographics -- Patient name, identifying and contact information, insurance information, PCP designation and contact information. 3. Diagnosis -- ICD-9 code 4. Query/Request a clear clinical reason for patient transfer and anticipated goals of care and interventions. 5. Clinical Data Problem list Medical and surgical history Current medication Immunizations Allergy/contraindication list Care plan Relevant notes Pertinent labs and diagnostics tests Patient cognitive status Caregiver status Advanced directives List of other providers 6. Type of transition of care. 7. Visit status -- routine, urgent, emergent (specify time frame). 8. Follow-up request
12 Geographic continuity Hospitals CO PCMH Pilot: Hospital Subgroup committee Patient Identifier information wallet card PCMH ID Patient education and educational materials from health plans Bidirectional communication Care Coordination Form (hospital to PCP) ED Referral Form (PCP to hospital)
13 Geographic continuity Hospitals Care coordinator job description and communication policy List of facilities and contact personnel Informational continuity Daily census of admits, discharges, updates (hospitals, hospitalists, IPA) Post hospital transition (discharge care plan) ED/in-hospital medical information transfer
14 Patient Admission Friday, July 24, 2009 Patient presents to hospital SELF REFERRAL Patient presents to hospital FROM OFFICE Clinic: Medication notes faxed to hospital from PCP Hospital: to inform PCP office fax, phone, ? Clinic: Care Coordinator to fax medical info Emergency Room Admission to Floor Hospital: to notify of Admission to Hospitalist Hospital: to provide updates regarding patient progress Hospital: ER Notes faxed to Providers office Discharged Home Hospital: Case Manager to notify PCP office and proved care plan Discharged to Skilled Nursing Facility Discharged to Long Term Care SNF: to notify PCP -? Change PCP Appointment with PCP/Specialist Discharged to Home SNF: to notify and send discharge to PCP Color Key: Hospital Action Green Clinic Action Blue SNF Action Red Page 1
15 Geographic continuity -- WMC Referrals Specialist Report Card (adapted from Clinix) Preferred Specialist List PCMH Patient Referral Form (Specialist Rx) Specialty Compact
16 It can get dirty but change can be good
17 WMC Team
Primary Care Specialist Physician Compact
I. Purpose To provide optimal health care for our patients. To provide a framework for better communication and safe transition of care between primary care and specialty care providers. II. Principles
More informationThe Medical Neighborhood: Ensuring Continuity of Care with Hospital and Specialist Neighborhoods
The Medical Neighborhood: Ensuring Continuity of Care with Hospital and Specialist Neighborhoods R. Scott Hammond MD, FAAFP Chair, CAFP PCMH Task Force Medical Director, SOC-PCMH Initiative, Colorado Associate
More informationPhysician Hospital/SNF Collaborative Guidelines
Overview Physician Hospital/SNF Collaborative Guidelines Effective coordination of care is an essential element in any successful health care system and this element requires the willingness of specialists,
More informationThe Care Compact. 11 PCPI All rights reserved.
The Care Compact There are several change package ideas provided in this tool kit and none were more important than the Care Compact during the pilot project. It will be your starting point. So, what is
More informationCare Compact Guide Patient-Centered Specialty Care (PCSC) A Component of Medical Neighborhood Initiatives
Compact Guide Patient-Centered Specialty (PCSC) A Component of Medical Neighborhood Initiatives Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees
More informationCare Compact Guide Patient-Centered Specialty Care (PCSC) A Component of Medical Neighborhood Initiatives
Compact Guide Patient-Centered Specialty (PCSC) A Component of Medical Neighborhood Initiatives Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical
More informationMedical Home Summit September 20, 2011
Medical Home Summit September 20, 2011 1 Three Dimensions of Value by Institute of Healthcare Improvement Population Health Experience of Care Per Capita Cost Care Management : The unintended consequences
More informationPractice Transformation: Patient Centered Medical Home Overview
Practice Transformation: Patient Centered Medical Home Overview Megan A. Housley, MBA Business Development Director Kentucky Regional Extension Center The Triple Aim Population Health TRIPLE AIM Per Capita
More informationEnhancing Specialty and Primary Care Communication May 2016
Enhancing Specialty and Primary Care Communication May 2016 ACO Announcements Reminders: ACO Notifications PECOS-Maintain active enrollment 2016 Patient Prospective Lists Upcoming provider meetings: Annual
More informationAmerican College of Physicians Council of Subspecialty Societies (CSS) Patient-Centered Medical Home (PCMH) Workgroup
American College of Physicians Council of Subspecialty Societies (CSS) Patient-Centered Medical Home (PCMH) Workgroup PRINCIPLES OF SERVICE AGREEMENTS BETWEEN PATIENT CENTERED MEDICAL HOMES (PCMH) AND
More informationCare Coordination Overview. Janet Tennison, PhD UPV Standards October 8, 2013
Care Coordination Overview Janet Tennison, PhD UPV Standards October 8, 2013 What IS Care Coordination? The deliberate, proactive organization of patient care activities between two or more participants
More informationPatient Centered Specialty Practice: Are We Ready for. Course Schedule
Patient Centered Specialty Practice: Are We Ready for MACRA? Xiaoyan Huang, MD, MHCM, FACC Providence Heart Clinic December 5 th, 2016 28 th IHI National Forum Course Schedule Morning: Introduction Xiaoyan
More informationWHAT IT FEELS LIKE
PCMH and PCSP WHAT IT FEELS LIKE Presentation Outline Goals of the Patient Centered Medical Home and the Patient Centered Specialty Practice Identifying the Joint Principles Recognition Programs Standards
More informationRecognition, Publications, & Activities
Recognition, Publications, & Activities Research Publications Hammond, Barba. A Toolkit for Primary Care Specialty Care Integration. Medical Home News v3 no.2. Feb 2011. McDoniel, Hammond, A Comprehensive
More informationACOs: California Style
ACOs: California Style ACO Congress John E. Jenrette, M.D. Chief Executive Officer Sharp Community Medical Group November 2, 2011 California Style California Style A CO California Style California Style
More informationPatient-Centered Specialty Practice (PCSP) Recognition Program
Patient-Centered Specialty Practice (PCSP) Recognition Program Standards Workshop Part 2 2013 All materials 2013, National Committee for Quality Assurance Agenda Part 1 Content of PCSP Standards and Guidelines
More informationIV. Additional UM Requirements/Activities...29
I. HMO Responsibilities...2 A. HMO Program Structure... 2 B. Physician Involvement... 3 C. HMO UM Staff... 3 D. Program Scope... 3 E. Program Goals... 4 F. Clinical Criteria for UM Decisions... 4 G. Requirements
More informationCentral Ohio Primary Care (COPC) Spotlight on Innovation
Central Ohio Primary Care (COPC) Spotlight on Innovation BY BETTER MEDICARE ALLIANCE MARCH 2017 Central Ohio Primary Care Spotlight on Innovation 1 Central Ohio Primary Care (COPC) Spotlight on Innovation
More 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 informationExpansion of Pharmacy Services within Patient Centered Medical Homes. Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice
Expansion of Pharmacy Services within Patient Centered Medical Homes Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice What is a Patient Centered Medical Home (PCMH)? "an approach
More informationQuality Health Network 1/6
MESA COUNTY PHYSICIANS IPA INCENTIVE PROGRAM The Incentive Program for Mesa County Physician IPA (MCPIPA) has been developed to meet criteria established by the general membership of our association. Funding
More informationA High Quality, Low Cost Hospital and Healthcare Solution for the Sustainability of the Long Island College Hospital Community
A High Quality, Low Cost Hospital and Healthcare Solution for the Sustainability of the Long Island College Hospital Community STATE UNIVERSITY of NEW YORK REQUEST FOR PROPOSAL X002539 February 3, 2014
More informationeconsultation Technical Assistance Webinar #1: Background, Conceptual Framework and Early Successes SEPTEMBER 9, 2015 WEBINAR #1
econsultation Technical Assistance Webinar #1: Background, Conceptual Framework and Early Successes SEPTEMBER 9, 2015 WEBINAR #1 Agenda 1 2 3 Introductions of grantees Overview of program and foundation
More informationBlue Choice PPO SM Provider Manual - Preauthorization
In this Section Blue Choice PPO SM Provider Manual - The following topics are covered in this section. Topic Page Overview E 3 What Requires E 3 evicore Program E 3 Responsibility for E 3 When to Preauthorize
More informationUsing Data for Proactive Patient Population Management
Using Data for Proactive Patient Population Management Kate Lichtenberg, DO, MPH, FAAFP October 16, 2013 Topics Review population based care Understand the use of registries Harnessing the power of EHRs
More informationA BETTER WAY. to invest in employee health
A BETTER WAY to invest in employee health A BETTER WAY to take care of business Rely on A BETTER WAY Manage costs Invest in employee health Build the future 2 May 9, 2013 Kaiser Permanente 2012. All Rights
More informationPacificSource Community Solutions Referral Frequently Asked Questions
PacificSource Community Solutions Referral Frequently Asked Questions **For Provider Use Only** 1. What is the difference between a referral and a preapproval? A referral is the process by which the member
More informationTX Action Learning Collaborative: National Standards for Systems of Care for CYSHCN
TX Action Learning Collaborative: National Standards for Systems of Care for CYSHCN January 21, 2015. Children s Policy Council 1 http://www.amchp.org/aboutamchp/newsletters/member-briefs/documents/standards%20charts%20final.pdf
More informationMedicare Shared Savings ACOs: One Organization s Lessons Learned. Gregory A. Spencer MD FACP Chief Medical Officer Crystal Run Healthcare LLP
Medicare Shared Savings ACOs: One Organization s Lessons Learned Gregory A. Spencer MD FACP Chief Medical Officer Crystal Run Healthcare LLP Learning Objectives Identify organizational strengths and weaknesses
More informationNEW ENGLAND REGION COLLABORATIVE. 2 nd Annual Regional Learning Event June 27, 2017
NEW ENGLAND REGION COLLABORATIVE 2 nd Annual Regional Learning Event June 27, 2017 Important Webinar Notes 1. You are in listen-only mode 2. Please use the Q&A Function (top of screen) to ask questions
More informationCommunity Care Coordination Cross Continuum Care IHC Medical Home Conference September 5, 2012 Des Moines IA
Community Care Coordination Cross Continuum Care IHC Medical Home Conference September 5, 2012 Des Moines IA Peg Bradke, RN, MA Director of Heart Care Services St. Luke s Hospital, Cedar Rapids, IA Session
More informationPCMH Quality Assurance Program Education regarding quality assurance activities. Month XX, XXXX
PCMH Quality Assurance Program Education regarding quality assurance activities Month XX, XXXX Agenda Welcome & Introductions Review of six-month activities Maintaining documentation Validation criteria
More informationBuilding Coordinated, Patient Centered Care Management Teams
Building Coordinated, Patient Centered Care Management Teams Jim Barr, MD CMO/VP Physician Network Development Optimus Healthcare Partners ACO & VP of Medical Services Aveta Health Solutions MSO Patient
More informationRe: Non-participation in the new Horizon Medicare Blue Patient-Centered w/rx (HMO) product
Three Penn Plaza East Newark, NJ 07105-2200 HorizonBlue.com October 2014 Re: Non-participation in the new Horizon Medicare Blue Patient-Centered w/rx (HMO) product
More informationReducing Care Fragmentation Executive Summary
Reducing Care Fragmentation Executive Summary A TOOLKIT FOR COORDINATING CARE Reducing Care Fragmentation 49 Executive Summary Reducing Care Fragmentation: A Toolkit for Coordinating Care is for clinics,
More informationAbout the National Standards for CYSHCN
National Standards for Systems of Care for Children and Youth with Special Health Care Needs: Crosswalk to National Committee for Quality Assurance Primary Care Medical Home Recognition Standards Kate
More informationDeveloping and Implementing Alternative Payment Models. Presented by AllCare Health APM Team
Developing and Implementing Alternative Payment Models Presented by AllCare Health APM Team AllCare Service Area and Membership County Members Jackson 28,449 Josephine 19,016 Curry/Douglas 2,871 Total
More informationBCBSIL iexchange Reference Guide
BCBSIL iexchange Reference Guide April 2010 A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Table of
More informationBCBSRI & Delivery System Transformation. Gus Manocchia, MD Senior Vice President & Chief Medical Officer March 11, 2016
BCBSRI & Delivery System Transformation Gus Manocchia, MD Senior Vice President & Chief Medical Officer March 11, 2016 1 Overview Systems of Care Overview & Highlights Primary Care to Risk Arrangements
More informationPCC Resources For PCMH
PCC Resources For PCMH Tim Proctor Users Conference 2015 Goals and Takeaways Introduction to NCQA's 2014 PCMH. What is it? Why get recognition? Show how PCC functionality and reports can be used for PCMH
More informationProvider Manual Provider Rights and Responsibilities
Provider Manual Provider Rights and Welcome To Kaiser Permanente This section of the Manual was created to help guide you and your staff in understanding your rights and responsibilities as our contracting
More informationPCMH: Recognition to Impact
PCMH: Recognition to Impact 3.1.16 Prepared by: Shannon Nielson, MHA, PCMH CCE Prepared for: OACHC 2016 Annual Conference Centerprise, Inc Objectives Defining a Patient Centered Medical Home Translating
More informationWelcome to Kaiser Permanente: NAME (Please Print):
Welcome to Kaiser Permanente: NAME (Please Print): You have made a great choice for your health! We value each and every member and aim to make your transition from your prior insurance company to Kaiser
More informationPrecertification: Overview
Precertification: Overview Introduction Precertification determines whether medical services are: Medically Necessary or Experimental/Investigational Provided in the appropriate setting or at the appropriate
More informationPatient-Centered Medical Home (PCMH) & Patient-Centered Specialty Practice (PCSP)
Patient-Centered Medical Home (PCMH) & Patient-Centered Specialty Practice (PCSP) Foundation for a Better Health Care System Presenter Jeanette Ikan, M.D., MHAI Objectives: Definition and benefits of PCMH,
More informationCROSSWALK: CHANGE CONCEPTS FOR PRACTICE TRANSFORMATION AND 2014 NCQA PCMH TM RECOGNITION STANDARDS
CROSSWALK: CHANGE CONCEPTS FOR PRACTICE TRANSFORMATION AND 2014 NCQA PCMH TM RECOGNITION STANDARDS 1a. Provide visible and sustained leadership to lead overall cultural change as well as specific strategies
More informationNicole Harmon, MBA, PCMH CCE Senior Director, PCMH Advisory Services HANYS Solutions Patient-Centered Medical
Nicole Harmon, MBA, PCMH CCE Senior Director, PCMH Advisory Services 2017 HANYS Solutions Patient-Centered Medical Home Advisory Services Overview Current landscape Medical neighborhood Patient-Centered
More informationGPSC Fee Items for A GP For Me/Attachment & In-patient Care
A GP For Me/Attachment GPSC Fee Items for A GP For Me/Attachment & In-patient Care It is the intent of the General Practice Services Committee to make initiatives available to Family Physicians participating
More informationAPPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS
Appendix 2 NCQA PCMH 2011 and CMS Stage 1 Meaningful Use Requirements 2-1 APPENDIX 2 NCQA PCMH 2011 AND CMS STAGE 1 MEANINGFUL USE REQUIREMENTS CMS Meaningful Use Requirements* All Providers Must Meet
More informationReferrals, Prior Authorizations, Medical Management, and Appeals
Referrals, Prior Authorizations, Medical Management, and Appeals 1 An Independent Licensee of the Blue Cross Blue Shield Association 044506 (12-21-2017) 2017 Premera. Proprietary and Confidential. Referrals
More informationDenver Health Medical Plan, Inc Access Plan for Large Group and Exchange Plans
Denver Health Medical Plan, Inc. 2016 Access Plan for Large Group and Exchange Plans Table of Contents Page INTRODUCTION 3 I. DHMP NETWORKS OF PRIMARY CARE, SPECIALISTS, BEHAVIORAL HEALTH, HOSPITALS AND
More informationEXHIBIT AAA (3) Northeast Zone PROVIDER NETWORK COMPOSITION/SERVICE ACCESS
EXHIBIT AAA (3) Northeast Zone PROVIDER NETWORK COMPOSITION/SERVICE ACCESS 1. Network Composition The PH-MCO must consider the following in establishing and maintaining its Provider Network: The anticipated
More informationThe Patient Centered Medical Home (PCMH): Overview of the Model and Movement Part II. July 2010
The Patient Centered Medical Home (PCMH): Overview of the Model and Movement Part II July 2010 Shari M. Erickson, MPH Senior Associate, Center for Practice Improvement & Innovation American College of
More informationTransitions of Care: Primary Care Perspective. Patrick Noonan, DO
Transitions of Care: Primary Care Perspective Patrick Noonan, DO Disclosures None Bio Outpatient primary care internist at New Pueblo Medicine Completed residency at the University of Iowa Graduated from
More informationA County Organized Health System
A County Organized Health System Presentation to Intermediate Care Facilities Paul Roberts, Director of Provider Relations and Contracting Pam Kapustay, RN, MSN, Director of Health Services Melanie Frampton,
More informationBCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor
BCBSM Physician Group Incentive Program Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Interpretive Guidelines 2016-2017 V11.0 Blue Cross Blue Shield of Michigan is a nonprofit
More informationBCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor
BCBSM Physician Group Incentive Program Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Interpretive Guidelines 2017-2018 V12.0 Blue Cross Blue Shield of Michigan is a nonprofit
More informationKaiser Permanente. An Integrated Health Care Model for Marsh & McLennan Companies Benefits Overview October 19, 2017
Presented by: Erica Elder Executive Account Manager Kaiser Permanente An Integrated Health Care Model for Marsh & McLennan Companies 2018 Benefits Overview October 19, 2017 Welcome! Our agenda for today
More informationMedical Record Documentation Standards
Medical Record Documentation Standards Medical Record Documentation Standards and Performance Measures Compliance with the Standards is monitored as part of our Quality Improvement Program. Practitioner
More informationPRIMARY PARTNERS, LLC. Our Journey with the State HIE
PRIMARY PARTNERS, LLC Our Journey with the State HIE About Us As a 2012 starter, Primary Partners was one of the 1 st Medicare ACO s in the country Our 2 nd Medicare ACO was formed in 2013 In late 2014
More informationOverview of The Joint Commission s Primary Care Medical Home (PCMH) Certification
Overview of The Joint Commission s Primary Care Medical Home (PCMH) Certification Joyce Webb, RN, MBA Project Director, Standards and Survey Methods Program Lead, The Joint Commission s PCMH Initiative
More informationINFORMATION ABOUT YOUR OXFORD COVERAGE REIMBURSEMENT PART I OXFORD HEALTH PLANS OXFORD HEALTH PLANS (NJ), INC.
OXFORD HEALTH PLANS (NJ), INC. INFORMATION ABOUT YOUR OXFORD COVERAGE PART I REIMBURSEMENT Overview of Provider Reimbursement Methodologies Generally, Oxford pays Network Providers on a fee-for-service
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 informationUNDERSTANDING SHARED MEDICAL APPOINTMENTS AN INTRODUCTION TO GROUP VISITS
TO GROUP VISITS OVERVIEW The complex needs of today's patients present a challenge to medical group physicians who try to meet patients' needs within the constraints of the traditional office visit. Studies
More informationBlue Cross & Blue Shield of Rhode Island (BCBSRI) Advanced Primary Care Program Policies
Blue Cross & Blue Shield of Rhode Island (BCBSRI) Advanced Primary Care Program Policies Effective 1/1/2016 The following program policies are applicable to all contracted providers and practices participating
More informationKaiser Permanente: Integration, Innovation, and Transformation in Health Care
Kaiser Permanente: Integration, Innovation, and Transformation in Health Care March 2018 Karin Cooke, MBA, Director, Kaiser Permanente International Karin.C.Cooke@kp.org kp.org/international Copyright
More informationSharp HealthCare ACO. Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group
Sharp HealthCare ACO Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group Institute for Quality Leadership Annual Conference October 4, 2012 Sharp ACO Collaborations
More informationNCQA s Patient-Centered Medical Home (PCMH) 2011 Standards 11/21/11
NCQA s Patient-Centered Medical Home (PCMH) 2011 Standards 11/21/11 28 PCMH 1: Enhance Access and Continuity PCMH 1: Enhance Access and Continuity 20 points provides access to culturally and linguistically
More informationC O M M U N I T Y H E A L T H C E N T E R S 1
C O M M U N I T Y H E A L T H C E N T E R S 1 Medical/Dental Home? A Patient Centered Medical/Dental Home is called a "home" because we would like it to be the first place you think of for all your healthcare
More informationPOLICY & PROCEDURE DEFINITIONS: Referral Status
POLICY & PROCEDURE TITLE: Referral Policy and Procedure Scope/Purpose: To provide specialized services to patients to obtain accurate diagnoses and for improved patient satisfaction Division/Department:
More informationThe Physician s Perspective
The Physician s Perspective How the Changing Role of the PCP is Leading Healthcare Reform May 22, 2015 Carman A. Ciervo, DO Chief Physician Executive Our Vision To transform the healthcare To transform
More informationMilestones and Indicators of Progress: A Reference for Patient-Centered Primary Care Participating Practices
Milestones and Indicators of Progress: A Reference for Patient-Centered Primary Care Participating Practices How to Use This Guide The following Program Milestones and Indicators of Progress are drawn
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 informationCONTENTS. Introduction...3. Current State of Regulatory Burden...4. Burden Level by Regulatory Issue...5. The Move Toward Value...
R E G U L ATO RY B U R D E N S U RV E Y OCTOBER 2018 1 CONTENTS Introduction...3 Current State of Regulatory Burden...4 Burden Level by Regulatory Issue...5 The Move Toward Value...6 The Medicare Quality
More informationBlue Cross Physician Choice PPO Provider FAQ 8/1/17
Blue Cross Physician Choice PPO Provider FAQ 8/1/17 Background Blue Cross Physician Choice PPO is an innovative group plan centered on coordinating care through Organized Systems of Care, or OSCs. Physician
More informationPatient-Centered Connected Care 2015 Recognition Program Overview. All materials 2016, National Committee for Quality Assurance
Patient-Centered Connected Care 2015 Recognition Program Overview All materials 2016, National Committee for Quality Assurance Learning Objectives Introduction to Patient-Centered Connected Care and Eligibility
More informationMagellan Complete Care of Virginia Musculoskeletal Care Management (MSK)Program
Magellan Healthcare 1 Magellan Complete Care of Virginia Musculoskeletal Care Management (MSK)Program 1 National Imaging Associates, Inc. is a subsidiary of Magellan Healthcare, Inc. Magellan Healthcare
More informationLeveraging HIE to Bolster Accountable Care Organizations. Healthcare Unbound / July 12, 2013
Leveraging HIE to Bolster Accountable Care Organizations Healthcare Unbound / July 12, 2013 Types of Health Info. Exchange Direct (Point-to-Point) Query-Based 2013 Colorado Regional Health Information
More informationCare Management Policies
POLICY: Category: Care Management Policies Care Management 2.1 Patient Tracking and Registry Functions Effective Date: Est. 12/1/2010 Revised Date: Purpose: To ensure management and monitoring of patient
More informationBCBSM Physician Group Incentive Program. Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor
BCBSM Physician Group Incentive Program Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Interpretive Guidelines Specialist Edition 2016-2017 Blue Cross Blue Shield of Michigan
More informationBlue Medicare Private-Fee-For-Service SM (PFFS) 2008 Medicare Advantage Terms and Conditions
Blue Medicare Private-Fee-For-Service SM (PFFS) 2008 Medicare Advantage Terms and Conditions Medicare Advantage Table of Contents Page Plan Highlights...2 Provider Participation The Deeming Process...2
More informationRussell B Leftwich, MD
Russell B Leftwich, MD Chief Medical Informatics Officer Office of ehealth Initiatives, State of Tennessee 1 Eligible providers and hospitals can receive incentives for meaningful use of certified EHR
More informationWisconsin Homecare Organization
Wisconsin Homecare Organization Competitive Strategies: Key Elements for Thriving in a High-Stakes Outcomes Market Lynda Laff Strategic Healthcare Programs, LLC Thursday, May 15, 2008 2:00 p.m. 3:30 p.m.
More informationBuilding the Bridge- Enhancing PCP:Specialist Coordination
Building the Bridge- Enhancing PCP:Specialist Coordination Randall Curnow, Jr, MD, MBA, FACP, FACHE, FACPE Vice President of Medical Affairs Mercy Health Physicians- Cincinnati rtcurnow@health-partners.org
More informationCareCore National & Alliance Provider Training Material
EVIDENCE-BASED HEALTHCARE SOLUTIONS CareCore National & Alliance Provider Training Material Prepared for: March 6, 2014 Contents CareCore National... 3 Alliance and CareCore National Partnership... 4 Radiology
More informationPatient Centered Medical Home. History of PCMH concept. What does a PCMH look like? 10/1/2013. What is a Patient Centered Medical Home (PCMH)?
What is a Patient Centered Medical Home (PCMH)? Patient Centered Medical Home Jeremy Thomas, PharmD, CDE UAMS Department of Pharmacy "an approach to providing comprehensive primary care that facilitates
More informationI. OPERATIONAL CHARACTERISTIC: PATIENT-CENTEREDNESS
I. OPERATIONAL CHARACTERISTIC: PATIENT-CENTEREDNESS A. FOCUS AREA: INFORMATION TO PATIENTS ABOUT PCMH 1. The organization provides information to the patient about: (indicate Yes or No to each item) Yes
More informationPCSP 2016 PCMH 2014 Crosswalk
- Crosswalk 1 Crosswalk The table compares NCQA s Patient-Centered Specialty Practice (PCSP) 2016 standards with NCQA s Patient-Centered Medical Home (PCMH) 2014 standards. The column on the right identifies
More informationupdate An Inside Look Into the EHR Intersections of the Updated Patient-Centered Medical Home (PCMH) Care Model May 12, 2016
update An Inside Look Into the EHR Intersections of the Updated Patient-Centered Medical Home (PCMH) Care Model May 12, 2016 Agenda PCMH: 360 o PCMH to date o Evidence based results o Updated Standards:
More informationUTILIZATION MANAGEMENT Section 4. Overview The Plan s Utilization Management (UM)
Overview The Plan s Utilization Management (UM) Program is designed to meet contractual requirements and comply with federal regulations while providing members access to high quality, cost effective medically
More information2017 SPECIALTY REPORT ANNUAL REPORT
2017 SPECIALTY REPORT ANNUAL REPORT National Commission on Certification of Physician Assistants Table of Contents Message from the President... 3 About the Data Collection and Methodology...4 All Specialties....
More informationNCQA s Patient-Centered Medical Home Recognition and Beyond. Tricia Marine Barrett, VP Product Development
NCQA s Patient-Centered Medical Home Recognition and Beyond Tricia Marine Barrett, VP Product Development National Committee for Quality Assurance (NCQA) Private, independent non-profit health care quality
More informationAppendix 5. PCSP PCMH 2014 Crosswalk
Appendix 5 Crosswalk NCQA Patient-Centered Medical Home 2014 July 28, 2014 Appendix 5 Crosswalk 5-1 APPENDIX 5 Crosswalk The table compares NCQA s Patient-Centered Specialty Practice () standards with
More informationCHNCT Provider Collaborative Program
CHNCT Provider Collaborative Program Community Health Network of Connecticut, Inc. (CHNCT), on behalf of the Department of Social Services (DSS) and the HUSKY Health program, offers a comprehensive program
More informationPatient-Centered Specialty Practice: Building the Medical Neighborhood
Patient-Centered Specialty Practice: Building the Medical Neighborhood Margaret E. O Kane President, National Committee for Quality Assurance June 6, 2014 1 Overview Central challenge: Creating systems
More informationProvider Frequently Asked Questions (FAQs)
1 Provider Frequently Asked Questions (FAQs) November 2012 BlueAdvantage Administrators of Arkansas will be working with AIM Specialty HealthSM (AIM) on a new Integrated Imaging Program for outpatient
More informationPatient Centered Medical Home Lessons Learned in North Carolina. Debra Thompson, DNP, FNP BC, PCMH CCE Wilson Gabbard, MBA
Patient Centered Medical Home Lessons Learned in North Carolina Debra Thompson, DNP, FNP BC, PCMH CCE Wilson Gabbard, MBA Background Debra Thompson DNP, FNP BC, PCMH CCE Vidant Health Wilson Gabbard, MBA
More informationChild and Family Development and Support Services
Child and Services DEFINITION Child and Services address the needs of the family as a whole and are based in the homes, neighbourhoods, and communities of families who need help promoting positive development,
More informationBundled Payments to Align Providers and Increase Value to Patients
Bundled Payments to Align Providers and Increase Value to Patients Stephanie Calcasola, MSN, RN-BC Director of Quality and Medical Management Baystate Health Baystate Medical Center Baystate Health Is
More informationTORRANCE MEMORIAL MEDICAL STAFF
BYLAWS COMMITTEE: APPROVED WITH NO CHANGES 10/3/2017 Dates Approved: Medical Executive Committee 09/14/2010; 12/9/2014 PATIENT ATTRIBUTION PLAN: This Attribution Plan assures that all staff are able to
More information