Chronic Care Challenges: People, Places, and Principles
|
|
- Helena Elliott
- 5 years ago
- Views:
Transcription
1 Chronic Care Challenges: People, Places, and Principles David B. Reuben, MD Archstone Foundation Chair and Professor David Geffen School of Medicine at UCLA
2 Outline of next 15 minutes Population-based health care needs Physicians roles in coordinating care Meeting population-based health needs Framework and principles for successful models
3 Population-based Health Care Who are the elderly Americans? Not sick + chronic diseases
4
5
6 Population-based Health Care Who are the elderly Americans? Not sick + chronic diseases Sick, functionally impaired
7
8 Population-based Health Care Who are the elderly Americans? Not sick + chronic diseases Sick, functionally impaired At the end of life
9 Population-based Health Care Where do the elderly Americans receive their health care? Community Hospital Nursing home
10 Hospital Nursing Home Not Sick Functionally Intact + Chronic Diseases Sick Functional Impairment Multiple Chronic Diseases End-of-Life Community Specific Diseases Depression Dementia Diabetes
11 What are the roles of a primary care physician?
12 OFFICE PCP $ Patient
13 OFFICE Inside Healthcare PCP Outside Healthcare $ Coverage Other physicians Lab/Tech Home Health Hospice ED Pharmacy Insurers $ Patient/Family Community services Support groups Living facilities Governmental agencies
14 HOSPITAL Patient/Family $ OFFICE PCP Physicians Hospitalists/Coverage Other Physicians Nursing Discharge Planning
15 OFFICE PCP $ NURSING HOME Patient/Family Physicians SNFists Coverage Other Physicians Nursing Discharge Planning
16 HOSPITAL OFFICE NURSING HOME Patient/Family $ $ PCP Inside Healthcare Outside Healthcare Patient/Family Physicians $ Physicians Nursing Patient/Family Nursing Discharge Planning Discharge Planning
17 Meeting Population-based Health Needs Building systems for caring for patients Not sick + chronic diseases Sick, functionally impaired End of life care Managing patient transitions between settings Redesigning providers roles
18 Not Sick + Chronic Diseases Preventive and Episodic Care Preventive care is as comprehensive and inexpensively as possible Patient trust in the health care system rather than the individual provider High caliber, convenient, prompt, episodic care is available
19 Not Sick + Chronic Diseases Chronic disease care Team care: who, when, by whom? Identifiable physician in the team Disease management strategies Self-management skills Shared decision-making
20 Sick, Functionally Impaired Redesigning hospital and nursing home care Care management-team care Disease management and patient management Physician intimately involved Active discussions about prognosis, quality of life, and preferences for care
21 End-of Life Care Begin process early Trust between provider and patient Information sharing prognostic quality of life Symptom management Polished end of life care
22 Managing Patient Transitions Between Settings Flow of clinical information between settings Seamless care shared among different providers Ongoing re-evaluation of goals
23 The Roles of Providers Physician s role will differ based on patient needs May not be the first or primary contact Delegation of responsibilities Re-examination of scopes of practice What s in a title? Working to highest level of competency
24 Framework and principles for successful models
25 Chronic Care Model Community Resources and Policies Health System Organization of Health Care Self- Management Support Delivery System Design Decision Support Clinical Information Systems Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Functional and Clinical Outcomes
26 Six Guiding Principles for Geriatric Health Care Delivery 1. Care must be personalized to meet each patient s goals, values, and resources 2. Care should be provided in accordance with best practices 3. It takes a team to provide the best care
27 Six Guiding Principles for Geriatric Health Care Delivery 4. Care must be coordinated among providers 5. Care must consider the resources and environment of the person 6. Older persons must be included as active partners in their care
Integration 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 informationTRANSITIONS of CARE. Francis A. Komara, D.O. Michigan State University College of Osteopathic Medicine
TRANSITIONS of CARE Francis A. Komara, D.O. Michigan State University College of Osteopathic Medicine 5-15-15 Objectives At the conclusion of the presentation, the participant will be able to: 1. Improve
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 informationSpecialty practices and primary care practices join forces in providing patient centered medical care
Welcome, Neighbor! Specialty practices and primary care practices join forces in providing patient centered medical care We often hear our patients express their frustration as they navigate among their
More informationNew job role delivers seamless service
New job role delivers seamless service St Monica Trust A new job role, devised by St Monica Trust, successfully blends nursing with care assistant duties and effectively uses resources. Background St Monica
More informationBreaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery
Breaking Down Silos of Care: Integration of Social Support Services with Health Care Delivery Betty Shephard Lead VP, Care Management HealthCare Partners National Health Policy Forum October 19, 2012 HCP
More informationDual-eligible SNPs should complete and submit Attachment A and, if serving beneficiaries with end-stage renal disease (ESRD), Attachment D.
Attachment A: Model of Care for Dual-eligible SNPs MA Contract Name: Geisinger Health Plan MA Contract Number: H3954-097 Type of Dual-eligible SNP: Full The model of care describes the MAO's approach to
More informationA Journey from Evidence to Impact
1 TRANSITIONAL CARE MODEL A Journey from Evidence to Impact Mary D. Naylor, Ph.D., RN Marian S. Ware Professor in Gerontology Director, NewCourtland Center for Transitions and Health University of Pennsylvania
More informationSPECIAL NEEDS PLAN. Model of Care Training
SPECIAL NEEDS PLAN Model of Care Training WHAT IS A SNP? The Medicare Modernization Act of 2003 established Special Needs Plans (SNP). Centers Plan for Healthy Living (CPHL) participates in two types of
More informationFAMU OFFICE OF HUMAN RESOURCES FLORIDA AGRICULTURAL & MECHANICAL UNIVERSITY
FAMU OFFICE OF HUMAN RESOURCES FLORIDA AGRICULTURAL & MECHANICAL UNIVERSITY Family and Medical Leave Act (FMLA) Certification of Health Care Provider Form for Employee s Serious Health Condition Instructions
More information2017/2018 Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario
2017/2018 Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 3/09/2017 Queensway Carleton Hospital 1 Overview Queensway Carleton Hospital is pleased to present our annual
More informationPatient-centered medical homes (PCMH): eligible providers.
ACTION: Final DATE: 09/21/2018 3:40 PM 5160-1-71 Patient-centered medical homes (PCMH): eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model led by primary
More informationCaring for Patients with Advanced and Serious Illnesses: Changing Medical Practice and Patient Expectations. Aetna s Compassionate Care SM Program
Caring for Patients with Advanced and Serious Illnesses: Changing Medical Practice and Patient Expectations Aetna s Compassionate Care SM Program Our chief want in life is somebody who shall make us do
More informationELDER MEDICAL CARE. Elder Medical. Counseling & Support. Hospice. Care. Care
ELDER MEDICAL CARE Counseling & Support Elder Medical Care Hospice Care Mission To provide counseling, support and care to anyone with a serious illness, so they may live life to the fullest. Vision We
More informationSPECIAL NEEDS PLAN (SNP) MODEL OF CARE TRAINING 2015
SPECIAL NEEDS PLAN (SNP) MODEL OF CARE TRAINING 2015 Introduction This course is offered to meet the CMS regulatory requirements for Model of Care Training for our Special Needs Plan at Care Wisconsin.
More informationMultidisciplinary care of a patient with heart failure. patient with heart failure. Dr Claire Hookey
Multidisciplinary care of a patient with heart failure patient with heart failure Dr Claire Hookey Mr E.S 61 year old gentleman Referred to the hospice by the heart failure specialist nurse May 2010 Heart
More information4/17/2017 OBJECTIVES FEDERAL REQUIREMENTS. Having the Difficult Conversation: We need to Discharge You from Hospice
Having the Difficult Conversation: We need to Discharge You from Hospice Lisa Meadows/MSW Clinical Compliance Educator Accreditation Commission for Health Care OBJECTIVES Identify the regulatory requirements
More informationPatient-centered medical homes (PCMH): Eligible providers.
ACTION: Final DATE: 09/20/2016 8:11 AM 5160-1-71 Patient-centered medical homes (PCMH): Eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model led by primary
More informationCoordinated Care Planning
Coordinated Care Planning What is a Coordinated Care Plan? A plan for your care that is created with you and your family (as per your direction) and involves all the members of your health care team. What
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 informationA Journey from Evidence to Impact
1 TRANSITIONAL CARE MODEL A Journey from Evidence to Impact Mary D. Naylor, Ph.D., RN 2015-2016 UCSF Presidential Chair Marian S. Ware Professor in Gerontology Director, NewCourtland Center for Transitions
More informationAlabama. Phone. Agency. Department of Public Health, Bureau of Health Provider Standards (334) Contact Kelley Mitchell (334)
Alabama Agency Department of Public Health, Bureau of Health Provider Standards (334) 206-5575 Contact Kelley Mitchell (334) 206-5366 E-mail Kelley.Mitchell@adph.state.al.us Phone Web Site http://www.adph.org/healthcarefacilities/
More informationAdmissions, Readmissions & Transitions Core Functions & Recommended Actions
How to use this resource An important single component of COMPASS for accomplishing the goals promised to CMS is the reduction of avoidable hospital admissions and readmissions as well as emergency room
More informationFor more information on the FMLA, visit the Department of Labor s website at https://www.dol.gov/whd/fmla/
For Office Use Only CERTIFICATION OF FAMILY AND MEDICAL LEAVE FOR FAMILY MEMBER S SERIOUS HEALTH CONDITION Person ID: ACSD: UDDS: Date Received: SECTION I: For Completion by the EMPLOYEE Employee s Name:
More informationCURRENT HEALTH SYSTEM:
THE AFFORDABLE CARE ACT: IMPLICATION FOR NURSES Trula E. Minton, MS, RN, NEA-BC 1 CURRENT HEALTH SYSTEM: 2 1 HOW IS THE CURRENT SYSTEM WORKING FOR US? 3 THE CHANGE COMING 4 2 TRANSFORMED HEALTH SYSTEM
More informationMEDICAL HOME Implementation for Primary Care. Disclosure. Medical Home Building and Implementation for Primary Care: No Child Left Behind
Medical Home Building and Implementation for Primary Care: No Child Left Behind A. Chris Olson, MD, MHPA Clinical Professor, University of Washington Medical Director, Sacred Heart Children s Hosp. Providence
More informationDepartment of Veterans Affairs VHA DIRECTIVE Veterans Health Administration Washington, DC December 7, 2005
Department of Veterans Affairs VHA DIRECTIVE 2005-061 Veterans Health Administration Washington, DC 20420 VA NURSING HOME CARE UNIT (NHCU) ADMISSION CRITERIA, SERVICE CODES, AND DISCHARGE CRITERIA 1. PURPOSE:
More informationMedical Home as a Platform for Population Health
Medical Home as a Platform for Population Health Population Health Colloquium March 8, 2016 Emily Brower Vice President, Population Health Atrius Health Emily_Brower@atriushealth.org 2016 Atrius Health,
More informationUsing Facets of Midas+ Hospital Case Management to Support Transitions of Care. Barbara Craig, Midas+ SaaS Advisor
Using Facets of Midas+ Hospital Case Management to Support Transitions of Care Barbara Craig, Midas+ SaaS Advisor What does Transitional Care Include? Transitional Care is the smooth conversion of a patient
More informationCareMore: Radical care for those who need it most. Vivek Garg, MD, MBA
CareMore: Radical care for those who need it most Vivek Garg, MD, MBA DOWNEY, CA THE BIRTH OF AN IDEA 25 YEARS AGO RELENTLESS COMMITMENT + UNSWERVING DEDICATION TO PATIENTS FOCUS on sickest of the sick
More 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 informationPalliative and Hospice Care In the United States Jean Root, DO
Palliative and Hospice Care In the United States Jean Root, DO Hello. My name is Jean Root. I am an Osteopathic Physician who specializes in Geriatrics, or care of the elderly. I teach and practice Geriatric
More informationEnvisioning enhanced primary care in Singapore: a group model building approach
Envisioning enhanced primary care in Singapore: a group model building approach 2 nd Asia-Pacific Region System Dynamics Conference John P. Ansah, PhD Assistant Professor Program in Health Services and
More informationOPERATIONS MANUAL CARE CONNECTIONS PROGRAM LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES
OPERATIONS MANUAL CARE CONNECTIONS PROGRAM LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES SECTION: PATIENT REFERRAL and INTAKE PROCEDURES 1 P age 1 CCP Referral Procedure Referrals for the Care Connections
More informationHaving the Difficult Conversation: We need to Discharge You from Hospice
Having the Difficult Conversation: We need to Discharge You from Hospice Lisa Meadows/MSW Clinical Compliance Educator Accreditation Commission for Health Care OBJECTIVES Identify the regulatory requirements
More informationInnovations in Community- Based Advanced Illness Care: A Population Health Approach
Innovations in Community- Based Advanced Illness Care: A Population Health Approach LORI YOSICK, LISW -S, CHPCA DIRECTOR COMMUNITY PALLIATIVE CARE TRINITY HEALTH TERRI MAXWELL PHD, APRN CHIEF CLINICAL
More informationThe Role of the Pharmacist in Value Based Health Care Systems. Len Fromer, M.D., FAAFP Assistant Clinical Professor UCLA School of Medicine
The Role of the Pharmacist in Value Based Health Care Systems Len Fromer, M.D., FAAFP Assistant Clinical Professor UCLA School of Medicine It is not the strongest of the species that survives, nor the
More informationMedi-Cal Program. Benefit. Benefits Chart
Chart Please note that the table below is only a summary. More details about benefits can be found in the section of the Medi-Cal Evidence of Coverage booklet. All health care is arranged through your
More informationHOSPICE FINAL RULE by SHARON HARDER, President - C3 Advisors, LLC
FAQ: THE 2018 HOSPICE FINAL RULE 1 FAQ FREQUENTLY ASKED QUESTIONS ABOUT The 2018 HOSPICE FINAL RULE by SHARON HARDER, President - C3 Advisors, LLC and BETH NOYCE, RN, BSJMC, HCS-H, HCS-D, COS-C, Consultant
More informationInteroperability and Patient Centred Care Coordination. Russell Leftwich, MD
Interoperability and Patient Centred Care Coordination Russell Leftwich, MD Agenda The data of care coordination Interoperability Clinical information models and FHIR profiles The path ahead Coordination
More informationHealthcare Leadership Council: John Perticone Golden Living 3/9/2016
Healthcare Leadership Council: Care Transitions in Post Acute Care John Perticone Golden Living 3/9/2016 Golden Living Profile Golden Living Centers and Communities 296 skilled nursing facilities 15 assisted
More informationShaping Perceptions of Biopsychosocial Dementia Care with Interprofessional Collaboration DRS. BENJAMIN A. BENSADON & MARÍA ORDÓÑEZ
Shaping Perceptions of Biopsychosocial Dementia Care with Interprofessional Collaboration DRS. BENJAMIN A. BENSADON & MARÍA ORDÓÑEZ FAU College of Medicine Small cohorts ( 64 students each) Longitudinal
More informationPrograms and Procedures for Chronic and High Cost Conditions Related to the Early Retiree Reinsurance Program
s and Procedures for Chronic and High Cost Conditions Related to the Early Retiree Reinsurance HealthPartners Disease and Case Management programs are targeted to those who have been identified with a
More informationPalliative Care in the Skilled Nursing Facility Setting: Opportunities Abound
Palliative Care in the Skilled Nursing Facility Setting: Opportunities Abound Date: February 1, 2017 Jennifer Judson, Project Lead: Palliative Care Jennifer Hodge, HIIN Quality Specialist 1/18/2017 2 Objectives
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 informationCommercial Risk Adjustment (CRA) Enrollee Health Assessment Program. Provider User Guide. Table of Contents
Commercial Risk Adjustment (CRA) Enrollee Health Assessment Program Provider User Guide Table of Contents 1. Commercial Risk Adjustment (CRA)... 2 2. Enrollee Health Assessment (EHA) Program... 2 3. Program
More informationProvider Information Guide Complex Care and Condition Care Overview
Complex and Overview Introduction Complex and are essential components of Passport Health Plan s (Passport) Coordination services, which are used to support the practitioner-patient relationship and plan
More informationNational Coalition on Care Coordination (N3C) Care Coordination and the Role of the Aging Network. Monday, September 12, 2011
National Coalition on Care Coordination (N3C) Care Coordination and the Role of the Aging Network Monday, September 12, 2011 Washington, DC Hyatt Regency on Capitol Hill Yellowstone/Everglades 4:00 PM
More informationThe greatest difficulty in the world is not for people to accept new ideas but to get them to forget their old ones.
Dr. Marie S, Gustin Nursing Excellence Conference, 2012 The greatest difficulty in the world is not for people to accept new ideas but to get them to forget their old ones. John Maynard Keynes Chaos, Complexity,
More informationarizona health net a better decision sm Putting you at the center of everything we do.
arizona health net a better decision sm Putting you at the center of everything we do. Nothing s more important than your health. When you re healthy, you want to stay healthy. When you re sick or have
More informationBringing Person-Centered Care to Life
Bringing Person-Centered Care to Life Laura Mosqueda, MD, FAAFP, AGSF Professor of Family Medicine and Gerontology Director, National Center on Elder Abuse @MosquedaMD #PersonCenteredCare 2016 California
More informationA Hard Day s Night. The carer strain experienced by the friends and family of older people with mental health problems. Photos provided by Hannah Fox
A Hard Day s Night The carer strain experienced by the friends and family of older people with mental health problems. Photos provided by Hannah Fox This presentation presents independent research commissioned
More informationCorporate Information for Patient Referrals & Charges effective 1 April 2017
Corporate Information for Patient Referrals & Charges effective 1 April 2017 Our team Family physicians with special training in rehabilitation and community geriatrics Visiting specialists to complement
More informationAdvancing Health in America Strategic Plan
2017 2020 Plan Advancing Health in America 20 18 Up d ate Our vision is of a society of healthy communities, where all individuals reach their highest potential for health. Our mission is to advance the
More informationNALC Form 1 - Family and Medical Leave Act of 1993 Employee Should Deliver Completed Form to Postal Service Supervisor, and Keep a Copy
NALC Form - Family and Medical Leave Act of 99 Employee Should Deliver Completed Form to Postal Service Supervisor, and Keep a Copy Employee's Notification of New Child in the Family To take FMLA leave
More informationWhen and How to Introduce Palliative Care
When and How to Introduce Palliative Care Phil Rodgers, MD FAAHPM Associate Professor, Departments of Family Medicine and Internal Medicine Associate Director for Clinical Services, Adult Palliative Medicine
More informationIV. Benefits and Services
IV. Benefits and A. HealthChoice Benefits This table lists the basic benefits that all MCOs must offer to HealthChoice members. Review the table carefully as some benefits have limits, you may have to
More informationThe future of mental health: the Taskforce 5 year forward view and beyond
The future of mental health: the Taskforce 5 year forward view and beyond May 2016 Content Mental Health Taskforce Overview Achieving Better Access Safe, Effective and Compassionate Care Integrating Physical
More informationTransforming health and social care in South Nottinghamshire. Jane Laughton Transformation Associate South Nottinghamshire Transformation Programme
Transforming health and social care in South Nottinghamshire Jane Laughton Transformation Associate South Nottinghamshire Transformation Programme National case for change 1 July 2013 - A Call to Action:
More informationFOR LEADINGAGE POST-ACUTE AND LONG TERM SERVICES AND SUPPORTS
December 2016 MODEL SCORE CARD ELEMENTS FOR LEADINGAGE POST-ACUTE AND LONG TERM SERVICES AND SUPPORTS BACKGROUND The purpose of this scorecard is threefold: 1. To help organize quality measures into internal
More informationCommunity and. Patti-Ann Allen Manager of Community & Population Health Services
Community and Population Health Services Patti-Ann Allen Manager of Community & Population Health Services October 2017 Community and Population Health Services-HHS ALC Corporate Planning Site Admin Managers
More informationBenefits. Benefits Covered by UnitedHealthcare Community Plan
Benefits Covered by UnitedHealthcare Community Plan As a member of UnitedHealthcare Community Plan, you are covered for the following MO HealthNet Managed Care services. (Remember to always show your current
More informationCare Model for Tufts Health Plan Senior Care Options
Care Model for Tufts Health Plan Senior Care Options Tufts Health Plan Core Principles The overarching construct for the Tufts Health Plan Senior Care Options (SCO-SNP) is to improve access to medical,
More informationBeyond the Hospital Walls: Impact of a SNFist Practice Model
Beyond the Hospital Walls: Impact of a SNFist Practice Model Aaron Snyder, MD Vice President, US Acute Care Solutions Kim Repac Chief Financial Officer, WMHS Aging Population 50 Million Distribution
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 informationDeveloping A Discharge Process: Merging Regulation and Patient/Family Satisfaction
Developing A Discharge Process: Merging Regulation and Patient/Family Satisfaction Lisa Meadows/MSW Clinical Compliance Educator Accreditation Commission for Health Care Objectives Gain an understanding
More informationUnderstanding and Leveraging Continuity of Care
Understanding and Leveraging Continuity of Care Cal MediConnect Providers Summit January 21, 2015 Moderator: Jane Ogle, Consultant, Harbage Consulting www.chcs.org An Overview of Continuity of Care in
More informationRNAO Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Recommendation Comparison Chart
RNAO Delirium, Dementia, and Depression in Older Adults: Assessment and Care Recommendation Comparison Chart RECOMMENDATIONS FROM SCREENING FOR DELIRIUM, DEMENTIA AND DEPRESSION IN THE OLDER ADULT (2010)
More informationCalifornia Academy of Family Physicians Diabetes Initiative Care Model Change Package
California Academy of Family Physicians Diabetes Initiative Care Model Change Package Introduction The Care Model (CM) is a unique and proven approach for implementing proactive strategies that are responsive
More informationRICHARDSON INDEPENDENT SCHOOL DISTRICT
HEALTH SERVICES RICHARDSON INDEPENDENT SCHOOL DISTRICT Guidelines for Managing Students with Diabetes in the School The Richardson Independent School District (RISD or the District) is committed to providing
More informationNew provider orientation
New provider orientation Welcome 2 Agenda Introduction to Amerigroup Provider resources Contact numbers and questions Provider responsibilities Member benefits and services Claims and billing Preservice
More informationEmployee s Name: EIN: FMLA Case # (if known):
NALC Form 1 - Family and Medical Leave Act Health Care Provider: Please complete this form in order to aid the employer in making its FMLA determination. Medical Certification Employee s Own Serious Health
More informationPlan for investment of retained marginal rate payment for emergency admissions in Gloucestershire
Plan for investment of retained marginal rate payment for emergency admissions in Gloucestershire 1. Purpose of document This document summarises and explains how Gloucestershire CCG has used the funds
More informationObjectives. Integrating Palliative Care Principles into Critical Care Nursing
1 Integrating Palliative Care Principles into Critical Care Nursing It s the Caring, Compassionate, Holistic, Patient and Family Centered, Better Communication, Keeping my patient comfortable amidst the
More informationClinical Webinar: Integrated Pharmacy
Clinical Webinar: Integrated Pharmacy Benjamin Gross, Pharm D, MBA, BCPS, BCACP, CDE, BC ADM, ASH CHC Associate Professor Director of Residency Programs Lipscomb University College of Pharmacy Objectives
More informationCare Coordination (CC) assists members and their families with complex needs
Care Coordination (CC) assists members and their families with complex needs Care is member-centered, family-focused, and culturally competent. CC assists in locating services to meet the health and social
More informationTO BE RESCINDED Patient-centered medical homes (PCMH): eligible providers.
ACTION: Final DATE: 09/21/2018 3:40 PM TO BE RESCINDED 5160-1-71 Patient-centered medical homes (PCMH): eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model
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 informationChanging Relationships: You and Your Aging Parent/Relative
Changing Relationships: You and Your Aging Parent/Relative Presenter Camille Koonce Camille Koonce is a certified case manager and aging life care expert. She has a diverse nonprofit background serving
More informationNew York State Medicaid Value Based Payment: Data Driven Strategies. Bundled Payment Summit June 27, 2017
New York State Medicaid Value Based Payment: Data Driven Strategies Bundled Payment Summit June 27, 2017 Panelists Moderator Paloma Hernandez Anthony Thompson Marc Berg President and CEO Urban Health Plan
More informationThe Patient-Centered Medical Home & You: Frequently Asked Questions (FAQ) for Patients and
The Patient-Centered Medical Home & You: Frequently Asked Questions (FAQ) for Patients and Families What is a Patient- Centered Medical Home? A Medical Home is all about you. Caring about you is the most
More informationHaving the End of Life Conversation: Practical Concepts for Advocacy Within the Continuum of Care
Having the End of Life Conversation: Practical Concepts for Advocacy Within the Continuum of Care July 24, 2012 Presented by: Cindy Campbell RN, BSN Associate Director, Operational Consulting Fazzi Associates
More informationHealth and Long-Term Care Use Patterns for Ohio s Dual Eligible Population Experiencing Chronic Disability
Health and Long-Term Care Use Patterns for Ohio s Dual Eligible Population Experiencing Chronic Disability Shahla A. Mehdizadeh, Ph.D. 1 Robert A. Applebaum, Ph.D. 2 Gregg Warshaw, M.D. 3 Jane K. Straker,
More informationSolution Title: Meeting the Challenge of Health Care Change
Organization: Western Maryland Health System Solution Title: Meeting the Challenge of Health Care Change Program/Project Description, including Goals: What was the problem to be solved? How was it identified?
More informationMedicare and Medicaid Spending on Dual Eligible Beneficiaries
Medicare and Medicaid Spending on Dual Eligible Beneficiaries June 2010 Presentation at the AcademyHealth Annual Research Meeting Arkadipta Ghosh James Verdier Mark Flick Ellen Singer Characteristics of
More informationPost Acute Continuum Lessons Learned from Geisinger s ProvenHealth Navigator
Post Acute Continuum Lessons Learned from Geisinger s ProvenHealth Navigator Janet Tomcavage, RN, MSN VP Health Services, Geisinger Health Plan Danville, PA February 3, 2012 Patient-centered primary care
More informationMalnutrition Quality Improvement Opportunities for the District Hospital Leadership Forum. May 2015 avalere.com
Malnutrition Quality Improvement Opportunities for the District Hospital Leadership Forum May 2015 avalere.com Malnutrition Has a Significant Impact on Patient Outcomes MALNUTRITION IS ASSOCIATED WITH
More informationVeterans Choice Program. December 2015
Veterans Choice Program December 2015 Executive Summary Purpose: To gain feedback on the plan to consolidate VA s various community care activities The VA Budget and Choice Improvement Act calls for improving
More informationCGS Administrators, LLC Clinical Hospice Documentation from CGS Missouri Hospice & Palliative Care Assoc. October 3, 2016
Missouri Hospice & Palliative Care Conference Reviewer s decision is reliant upon documentation Results in a full denial for the submission Documentation must be legible Medical necessity is always based
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 informationHealthcare Clinic at Walgreens Access to Care Innovations Panel March 5, 2014
Healthcare Clinic at Walgreens Access to Care Innovations Panel March 5, 2014 Dr. Alan London Vice President, Strategic Clinical Partnerships 2014 Walgreen Co. All rights reserved. Walgreens is Well-Positioned
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 informationCare Transitions: Don t Lose Your Patients
Care Transitions: Don t Lose Your Patients Sabrina Edgington, MSSW Program and Policy Specialist National Health Care for the Homeless Council March 14, 2013 CARE TRANSITIONS Definition The movement of
More informationConsumer ehealth Affinity Group
Consumer ehealth Affinity Group Embracing Barriers in the Delivery of IVR Technology for Older, Chronically ll Patients Jeremy Rich HealthCare Partners Institute and HealthCare Partners Medical Group Janelle
More informationThe Monthly Publication of the National Hospice and Palliative Care Organization
The Monthly Publication of the National Hospice and Palliative Care Organization Print-friendly PDF From September 2012 Issue A Hospice Provider s Guide to Live Discharges By Jennifer Kennedy, MA, BSN,
More informationCOMMUNITY LEARNING FORUM. Sponsored for the Oakland community by:
COMMUNITY LEARNING FORUM Sponsored for the Oakland community by: Making Knowledge part of YOUR HEALTH PLAN The CLF health education series is offered annually to residents of the Oakland community to enhance
More informationOverview of Medicaid. and the 1115 Medicaid Transformation Waiver. Opportunities for Supportive Housing Providers and Tenants August 2, 2016
Overview of Medicaid and the 1115 Medicaid Transformation Waiver Opportunities for Supportive Housing Providers and Tenants August 2, 2016 Speaker Carol Wilkins, MPP Consultant carol.wilkins.ca@gmail.com
More informationPhysicians Plus MEMBER NEWSLETTER
Physicians Plus MEMBER NEWSLETTER FALL 2016 Inside This Issue Ten Reasons Why You Need a Primary Care Doctor...p. 2 How can I confirm my Primary Care Physician (PCP) selection?...p. 2 Who s the Right Doctor
More informationCertification of Health Care Provider for Family Member's Serious Health Condition (Family and Medical Leave Act)
1 Horry County Human Resources Department 1301 Second Avenue Conway, SC 29526 Post Office Box 997 Conway, SC 29528-0296 Phone: (843) 915-5230 Fax: (843) 915-6230 E-mail: hagemeid@horrycounty.org bellamyf@horrycounty.org
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
More information