Quality Management Report 2018 Q1
|
|
- Thomasine O’Neal’
- 5 years ago
- Views:
Transcription
1 Quality Management Report 2018 Q1
2 Care Wisconsin Participates in Many Quality Initiatives Across the State and Federal Levels These activities include: Centers for Medicare & Medicaid Services (CMS) Department of Health Services (DHS) Healthcare Effectiveness Data Integration System (HEDIS) Quality Indicator Monitoring Annual Quality Reviews Quality Indicator Monitoring Member Surveys (CAHPS & HOS) Chronic Care Improvement Projects and Quality Improvement Projects STAR Ratings Appeals and Grievances Member Satisfaction Surveys Performance Improvement Projects Pay for Performance Appeals and Grievances
3 Current Quality Initiatives Comprehensive Diabetes Management As part of the CMS-required Chronic Care Improvement Project we have various activities in place to improve HbA1C lab values, statin adherence rate, and blood pressure readings for members in the Partnership and Dual Advantage programs. Also, we are committed to ensuring members will have an annual eye exam, HbA1C labs, and visit the clinic to receive a kidney function test Dementia Care Wisconsin Quality Management is focused on improving care management of chronic health conditions. Currently there are many interventions and initiatives focused on our members with dementia. Honoring Choices We are committed to the Honoring Choices Wisconsin initiative which promotes advance care planning for our members. Incident Management System We manage member incidents through internal systems that track appropriate follow up and interventions, to avoid further incidents from occurring in the future. Internal File Reviews Care Wisconsin monitors the quality of documentation and care management of members through internal file reviews.
4 2018 Medicare Star Rating Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. 4½ Stars Above Average Overall Rating Care Wisconsin Health Plan, Inc. (Contract H5209)
5 STAR One of CMS s strategic goals is to improve the quality of care and general health status for Medicare beneficiaries CMS publishes Part C and D star Ratings each year to measure quality in Medicare Advantage plans Care Wisconsin Highest Rated STAR Measures: Medication Reconciliation Post-Discharge Diabetes Care Eye Exam Medication Adherence for Diabetes Medications Medication Therapy Management completion rate
6 Member Satisfaction Survey Results Everything is great. I couldn't be taken care of any better. Thank You Partnership Member
7 Member Satisfaction Survey Results I'm really thankful for Care Wisc. They stand behind their name. The care managers are all very adequate over everything. Faith, trust, responsibilities such as rides, help at home, with information, friendly, patient with elderly. -Family Care Member
8 Medicaid Appeals Care Wisconsin views the grievances and appeals process as important for both members and the organization. Care Wisconsin staff encourages members to utilize the Member Rights Specialists and resources that are available to them that will ensure they get a fair hearing and that their dignity and rights are a priority. A high appeal rate may not be an indication that something is wrong, but rather that members are exercising their rights.
9 Medicaid Mediation Our goal is to help maintain communication and encourage all Medicaid members to stay engaged in the process throughout their appeal by participating in mediation. In many cases, through mediation we are able to resolve differences without a formal appeal hearing. While not all members choose to participate, we offer mediation to all Medicaid members and work towards our goal of 100% member engagement.
Quality Management Report 2017 Q4
Quality Management Report 2017 Q4 Care Wisconsin Participates in Many Quality Initiatives Across the State and Federal Levels. These activities include: CMS DHS DHS & CMS HEDIS Member Satisfaction (CAHPS
More informationQuality Management Report 2017 Q2
Quality Management Report 2017 Q2 Quality Management Program CMS STAR Ratings Member Satisfaction (CAHPS & HOS) HEDIS Risk Adjustment DHS Member Incident Reporting Member Satisfaction Surveys Pay for Performance
More informationPassport Advantage Provider Manual Section 8.0 Quality Improvement
Passport Advantage Provider Manual Section 8.0 Quality Improvement Table of Contents 8.1 Quality Improvement Program 8.2 Clinical Practice Guidelines 8.3 Star s 8.4 Quality of Care Concerns 8.3 Practitioner
More informationPATH Program. Getting Started Guide
PATH Program Getting Started Guide We have a BIG opportunity. Together, we can empower and encourage people to take an active role in their health. Preventive health care services help people find and
More informationMedicare Advantage Star Ratings
Medicare Advantage Star Ratings December 2017 The Star Rating System measures how well Medicare Advantage (MA) and its prescription drug plans perform for consumers. As an integrated health system, Presbyterian
More informationQUALITY IMPROVEMENT PROGRAM
QUALITY IMPROVEMENT PROGRAM EmblemHealth s mission is to create healthier futures for our customers and communities. We will do this by providing members with a broad range of benefits and conscientious
More informationHouseCalls Objectives
Overview Agenda Overview Objectives Background Case studies Member Experience Primary Care Provider Experience Referrals and Follow-up Influence on Centers for Medicare & Medicaid Services (CMS) Star Ratings
More informationYour health comes first
Your health comes first Here are the many ways we re working to ensure the quality of your care At Amerigroup, our focus is on you. We want to help you get and stay healthy. That s why we have many programs
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 informationQuality Improvement Program Evaluation
Quality Improvement Program Evaluation 2013 Care Wisconsin 2013 Quality Improvement Program Evaluation INTRODUCTION Care Wisconsin s Quality Management Program uses the Home and Community-Based Quality
More informationPharmacy Quality Measures. Presentation Developed for the Academy of Managed Care Pharmacy Updated: February 2013
Pharmacy Quality Measures Presentation Developed for the Academy of Managed Care Pharmacy Updated: February 2013 Objectives Explain the purpose of quality measures and how they are developed Identify quality
More informationGetting Ready for the Maryland Primary Care Program
Getting Ready for the Maryland Primary Care Program Presentation to Maryland Academy of Nutrition and Dietetics March 19, 2018 Maryland Department of Health All-Payer Model: Performance to Date Performance
More informationAccelerating the Impact of Performance Measures: Role of Core Measures
Accelerating the Impact of Performance Measures: Role of Core Measures Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair
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 informationMedicare: 2018 Model of Care Training
Medicare: 2018 Model of Care Training Training Objectives This course will describe how Centene and its contracted providers work together to successfully deliver the duals Model of Care (MOC) program.
More informationMedicare: 2017 Model of Care Training 4/13/2017
Medicare: 2017 Model of Care Training Training Objectives This course will describe how MHS Health Wisconsin Medicare Advantage and its contracted providers work together to successfully deliver the Model
More information2019 Quality Improvement Program Description Overview
2019 Quality Improvement Program Description Overview Introduction Eon/Clear Spring s Quality Improvement (QI) program guides the company s activities to improve care and treatment for the member s we
More informationBlue Advantage (PPO) SM 2018 Quality+Partnerships
Blue Advantage (PPO) SM 2018 Quality+Partnerships Your Partner in Quality Care BlueCross BlueShield of Tennessee is committed to ensuring our members have access to a network of high quality providers.
More information2018 PROVIDER TOOLKIT
1100 Circle 75 Parkway Suite 1100 Atlanta, GA 30339 2018 PROVIDER TOOLKIT Understanding the Centers for Medicare and Medicaid (CMS) Stars Rating System What is CMS Quality Star Ratings program? CMS evaluates
More informationMI Health Link Program Nursing Facility Presentation October 27 th, Molina Healthcare of Michigan
Program Nursing Facility Presentation October 27 th, 2015 Molina Healthcare of Michigan Headline Goes Here MI Health Link Molina Healthcare of Michigan Molina Healthcare of Michigan is one of five health
More informationAssessing the Quality of California Dual Eligible Demonstration Health Plans
M A Y 2 0 1 2 Assessing the Quality of California Dual Eligible Demonstration Health Plans T A B L E O F C O N T E N T S Overview... 1 Introduction... 2 Table 1: Plan Rating Overview... Summary of Quality
More informationINSTITUTIONAL/INSTITUTIONAL EQUIVALENT (I/IESNP) DUAL SPECIAL NEEDS PLAN (DSNP) CHRONIC SPECIAL NEEDS PLAN (LSNP)
SNP MODEL OF CARE ANNUAL EVALUATIONS FOR 2013 INSTITUTIONAL/INSTITUTIONAL EQUIVALENT (I/IESNP) DUAL SPECIAL NEEDS PLAN (DSNP) CHRONIC SPECIAL NEEDS PLAN (LSNP) 1 7 0 1 P O N C E D E L E O N B L V D, S
More informationQuality: Finish Strong in Get Ready for October 28, 2016
Quality: Finish Strong in 2016. Get Ready for 2017 October 28, 2016 Agenda Stars: Medicare Advantage Quality Changes for 2017 Pay for Quality and PCMH Programs Important Announcements! 7 Stars: Medicare
More informationColorado Choice Health Plans
Quality Overview Health Plans Accreditation Exchange Product Accrediting Organization: Accreditation Status: URAC Health Plan Accreditation (Marketplace ) Full Full: Organization demonstrates full compliance
More informationMedicare Physician Group Practice Demonstration
Medicare Physician Group Practice Demonstration Disease Management Colloquium Philadelphia, Pennsylvania June 23, 2005 John Pilotte Senior Research Analyst Medicare Demonstrations Program Group Centers
More informationMedicare: 2017 Model of Care Training 12/14/201 7
Medicare: 2017 Model of Care Training 12/14/201 7 What is the Model of Care? The Model of Care (MOC) is Allwell s plan for delivering our integrated care management program for members with special needs.
More information08/06/2015. Special Needs Plans. SNP Legislative History Highlights
National Training Program RO V & RO VII St. Louis, August 10-11, 2015 Special Needs Plans Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people
More informationand HEDIS Measures
1 SC Medicaid Managed Care Initiative and HEDIS Measures - 2009 Ana Lòpez De Fede, PhD Institute for Families in Society University of South Carolina Regina Young, RNC SC Department of Health and Human
More informationHumana At Home-Star Member Talking Points
At Home-Star Member Talking Points What are the CMS Medicare Star Ratings? The Center for Medicare & Medicaid Services (CMS) is a federal agency that oversees Medicare & Medicaid, and is part of the Department
More informationSession 10: Integrating Data and Analytics into Provider Workflows Improves ACO Quality and Financial Performance
Session 10: Integrating Data and Analytics into Provider Workflows Improves ACO Quality and Financial Performance Joan Valentine, MSA, RN Executive Vice President Visiting Physicians Association David
More informationFQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction
FQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction Meaghan McCamman Assistant Director of Policy California Primary Care Association 1 Agenda Incentives in PPS: what does
More information10/6/2017. FQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction. Agenda. Incentives in PPS: what does excludable mean?
FQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction Meaghan McCamman Assistant Director of Policy California Primary Care Association Agenda Incentives in PPS: what does excludable
More informationNote: Accredited is the highest rating an exchange product can have for 2015.
Quality Overview Accreditation Exchange Product Accrediting Organization: NCQA HMO (Exchange) Accreditation Status: Accredited Note: Accredited is the highest rating an exchange product can have for 215.
More informationWhat Have we Learned from the Pioneer ACO Model?
What Have we Learned from the Pioneer ACO Model? Sherly Binu, CMMI December 7, 2016 Disclaimers 2 This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose
More informationGenerations Advantage Focus DC (HMO SNP) Diabetes Care Special Needs Plan GENERAL MODEL OF CARE (MOC) TRAINING
Generations Advantage Focus DC (HMO SNP) Diabetes Care Special Needs Plan GENERAL MODEL OF CARE (MOC) TRAINING Through this training you will learn: What is a SNP? What is Martin s Point Generations Advantage
More informationPatient Compl p ai l n ai t n s/ s G / r G ie i vanc van es
Patient Complaints/Grievances What all Employees Need to Know MCMH strongly encourages patients and/or the patient s representative to exercise their right to issue a complaint. Patients and families can
More informationFriday Health Plans of Colorado
QUALITY OVERVIEW Health Plans of Colorado (formerly Colorado Choice Health Plans) Serving Colorado for over 4 years, Health Plans utilizes a community-focused model. We work hand in hand with local providers
More informationMCS Model of Care For Special Needs Plans (SNP) Annual training for delegated entities and facilities
2018 MCS Model of Care For Special Needs Plans (SNP) Annual training for delegated entities and facilities Quality Department CAN_2790318S CMS Requirements The Centers of Medicare & Medicaid Services (CMS)
More informationEvolving Roles of Pharmacists: Integrating Medication Management Services
Evolving Roles of Pharmacists: Integrating Management Services Marie Smith, PharmD, FNAP Palmer Professor and Assistant Dean, Practice and Policy Partnerships UCONN School of Pharmacy (marie.smith@uconn.edu)
More informationPartner with Health Services Advisory Group
Partner with Health Services Advisory Group Bonnie Hollopeter, LPN, CPHQ, CPEHR Health Services Advisory Group (HSAG) Quality Improvement Lead Rosalie McGinnis, MS, RN HSAG Quality Improvement Lead November
More informationRethinking annual assessments: Identifying and closing gaps in care
Rethinking annual assessments: Identifying and closing gaps in care Expert presenters Curtis A. Mock, MD, MBA, National Medical Director, Complex Population Management Annual in-home assessments provide
More informationTotal Cost of Care Technical Appendix April 2015
Total Cost of Care Technical Appendix April 2015 This technical appendix supplements the Spring 2015 adult and pediatric Clinic Comparison Reports released by the Oregon Health Care Quality Corporation
More informationAnthem BlueCross and BlueShield
Quality Overview BlueCross and BlueShield Accreditation Exchange Product Accrediting Organization: Accreditation Status: NCQA Health Plan Accreditation (Commercial HMO) Accredited Accreditation Commercial
More informationAnthem HealthKeepers Medicare-Medicaid Plan (MMP), a Commonwealth Coordinated Care plan, provider orientation presentation
Anthem HealthKeepers Medicare-Medicaid Plan (MMP), a Commonwealth Coordinated Care plan, provider orientation presentation Anthem HealthKeepers MMP HealthKeepers, Inc. participates in the Virginia Commonwealth
More informationUPMC Health Plan. Value Based Insurance Design (VBID) Spark Your Health
UPMC Health Plan Value Based Insurance Design (VBID) Spark Your Health Value Based Insurance Design (VBID) Spark Your Health Medicare Advantage Summit April 6, 2017 Helene Weinraub 1 The statements contained
More informationThe Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including
The Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including charts, tables, and graphics may be difficult to read using
More informationALL NEW ALOHACARE WEBSITE
NEWS FOR PHYSICIANS AND PROVIDERS QUARTER 4 2017 NEW STREAMLINED PRIOR AUTHORIZATION PROCESS AlohaCare will implement a simplified and reduced list of services requiring Prior Authorization effective January
More informationBest Practices. SNP Alliance. October 2013 Commonwealth Care Alliance: Best Practices in Care for Frail and Disabled Medicare Medicaid Enrollees
SNP Alliance Best Practices October 2013 Commonwealth Care Alliance: Best Practices in Care for Frail and Disabled Medicare Medicaid Enrollees Commonwealth Care Alliance is a Massachusetts-based non-profit,
More informationCalifornia Pay for Performance: A Case Study with First Year Results. Tom Williams Integrated Healthcare Association (IHA) March 17, 2005
California Pay for Performance: A Case Study with First Year Results Tom Williams Integrated Healthcare Association (IHA) March 17, 2005 Agenda National Perspective California Program Overview Data Collection
More informationUse of Health Information Technology to Reduce Health Risk
Use of Health Information Technology to Reduce Health Risk Sandra M. Foote Senior Advisor, Chronic Care Improvement Centers for Medicare & Medicaid Services September 9, 2005 The MHS Challenge Develop
More informationChronic Care Management Services: Advantages for Your Practices
Chronic Care Management Services: Advantages for Your Practices Rachel S. Eichenbaum, RN, MSN Yvonne La-Garde, M.ED Susan Whittaker, CPC, CPMA This material was prepared by the New England Quality Innovation
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 information2016 Quality Management Annual Evaluation Executive Summary
2016 Quality Management Annual Evaluation Executive Summary July 2017 Mission and Vision The purpose of the 2016 Annual Evaluation is to assess IEHP s Quality Program. This assessment reviews the quality
More informationFor more information on any of the topics covered, please visit our provider self-service website at
Quality improvement summary The results are in We d like to share with you our annual quality improvement summary of clinical performance and service satisfaction. Throughout the year, we evaluate data
More informationAt EmblemHealth, we believe in helping people stay healthy, get well and live better.
At EmblemHealth, we believe in helping people stay healthy, get well and live better. Welcome to the 2017 course on Special Needs Plan Model of Care. This year s course is focused on how we can successfully
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services
More information2018 Medication Therapy Management Program Information
2018 Medication Therapy Management Program Information What is the Medication Therapy Management Program? The Medication Therapy Management Program is a service for members with multiple health conditions
More informationHIMSS Southern California David Sayen March 28, 2017
HIMSS Southern California David Sayen March 28, 2017 You re cured! 4 3 3 2 2 1 1 - Government Non-Government Medicare Group Practice Demo Physician Quality Reporting Initiative Premier Hospital P4P
More informationEmblemHealth Advocate for Quality
EmblemHealth Advocate for Quality 2013 Average Health Care Spending per Capita, 1980 2009 Adjusted for differences in cost of living 1 Dollars Source: OECD Health Data 2011 (June 2011). THE COMMONWEALTH
More informationHEDIS Measures and the Family Physician Office. Pablo J Calzada DO, MPH, FAAFP, FACOFP
HEDIS Measures and the Family Physician Office Pablo J Calzada DO, MPH, FAAFP, FACOFP Disclaimer HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). NCQA and payers
More informationMedicare Private Fee for Service Manual. Blue Cross Blue Shield of Michigan. Revised January 1, 2018
Revised January 1, 2018 For use by Michigan providers only. Many of the provisions don t apply to providers in other states. Confidence comes with every card. Blue Cross Blue Shield of Michigan Medicare
More informationPlease stand by. There is no audio being streamed right now. We are doing a audio/sound check before we begin the presentation 10/28/2015 1
Please stand by There is no audio being streamed right now. We are doing a audio/sound check before we begin the presentation 10/28/2015 1 Webinar Tips Today s webinar is a one-way audio broadcast through
More informationHumana Physician Quality Rewards Program 2014
Humana Physician Quality Rewards Program 2014 Medicare Glen Champlin MSO Director March 28, 2014 1430ALL0114-B What is CMS Stars and Why Should Providers Be Concerned? CMS Program of Quality & Performance
More informationKaiser Permanente QUALITY OVERVIEW OVERALL RATING : 3.4 COMPANY AT A GLANCE. Company Statistics. Accreditation Exchange Product
QUALITY OVERVIEW Permanente As the state s largest nonprofit health plan, Permanente is committed to improving the health of our members and our state as a whole. Permanente is made up of: Foundation Hospitals
More informationAnthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training
Anthem Blue Cross Cal MediConnect Plan (Medicare- Medicaid Plan) Santa Clara County Behavioral Health provider training Anthem Blue Cross Cal MediConnect Plan Effective January 1, 2015, Anthem Blue Cross
More informationMarch 3, i. Medication Reconciliation Post Discharge (Part C) (p. 79)
March 3, 2017 [Submitted electronically to AdvanceNotice2018@cms.hhs.gov] Centers for Medicare & Medicaid Services U.S. Dept. of Health & Human Services Attention: CMS-4159-P P.O. Box 8013 Baltimore, MD
More information2018 Full Dual (Medicare & Medicaid) Medicare Advantage Special Needs Plans (SNP) Maricopa County
2018 Full Dual (Medicare & Medicaid) Medicare Advantage Special Needs Plans (SNP) Maricopa County Special Needs Plans for Dual Eligible beneficiaries are an HMO plan that limits their membership to people
More informationQUALITY IMPROVEMENT. Molina Healthcare has defined the following goals for the QI Program:
QUALITY IMPROVEMENT Molina Healthcare maintains an active Quality Improvement (QI) Program. The QI program provides structure and key processes to carry out our ongoing commitment to improvement of care
More informationMEDICARE APPEALS AND QUALITY OF CARE GRIEVANCES AvMed April 1, 2017 through March 31, 2018
MEDICARE APPEALS AND QUALITY OF CARE GRIEVANCES AvMed What kind of information is this? When you ask for it, the government requires AvMed to provide you with reports that describe what happened to formal
More informationATTACHMENT II EXHIBIT II-C Effective Date: June 1, 2017 CHRONIC DISEASE SPECIALTY PLAN
ATTACHMENT II EXHIBIT II-C Effective Date: June 1, 2017 CHRONIC DISEASE SPECIALTY PLAN Section I. Definitions and Acronyms The definitions and acronyms in Attachment II, Section I, Definitions and Acronyms
More informationGateway to Practitioner Excellence GPE 2017 Medicaid & Medicare
Gateway to Practitioner Excellence GPE 2017 Medicaid & Medicare Recognizing and Rewarding Excellent Practices Improving the Health of Gateway Members PRACTICE ELIGIBILITY (see PCMH slide #27 for separate
More informationSPECIAL NEEDS PLAN (SNP) MODEL OF CARE (MOC) PROVIDER TRAINING
SPECIAL NEEDS PLAN (SNP) MODEL OF CARE (MOC) PROVIDER TRAINING AlohaCare Advantage Plus (HMO SNP) Revised May 2018 HISTORY AlohaCare was formed by a network of Hawaii community health centers in 1994.
More informationSpecial Needs Plan Model of Care Chinese Community Health Plan
Special Needs Plan Model of Care 2017 2017 Chinese Community Health Plan Elements of CCHP SNP Model of Care Special Needs Plan (SNP) Goals CCHP Dual Eligible SNP Enrollment & Eligibility Vulnerable Beneficiaries
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 informationQuality Measurement Approaches of State Medicaid Accountable Care Organization Programs
TECHNICAL ASSISTANCE TOOL September 2014 Quality Measurement Approaches of State Medicaid Accountable Care Organization Programs S tates interested in using an accountable care organization (ACO) model
More informationKEPRO Beneficiary and Family Centered Care Quality Improvement Organization. Andrea Plaskett, MPH
KEPRO Beneficiary and Family Centered Care Quality Improvement Organization Andrea Plaskett, MPH 1 KEPRO KEPRO is a federal contractor for the Centers for Medicare & Medicaid Services (CMS) KEPRO is the
More informationModel of Care. Quality Department 2017
Model of Care Quality Department 2017 1 Objectives Understand the four (4) Model of Care elements, aimed at improving healthcare for D-SNP members. Learn about the Model of Care that MCS offers to their
More informationSPECIAL NEEDS PLANS. Medicaid Managed Care Congress June 4-6, 2006 Mary B Kennedy, Vice President,State Public Policy
SPECIAL NEEDS PLANS Medicaid Managed Care Congress June 4-6, 2006 Mary B Kennedy, Vice President,State Public Policy Presentation Overview Background on the Evercare Model Transition to Special Needs Plans
More information6 18 Evaluation and Impact Measurement
6 18 Evaluation and Impact Measurement August 12, 2016 Center for Health Care Strategies Centers for Disease Control and Prevention Centers for Medicare and Medicaid Services Support provided by the Robert
More informationGoals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE
Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures
More 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 informationQuality Improvement Program
How we measure up At HealthKeepers, Inc., we focus on helping our Anthem HealthKeepers Plus members get healthy and stay healthy. To help us serve you the best we can, each year we look closely at the
More informationAnthem BlueCross and BlueShield HMO
Quality Overview BlueCross and BlueShield Accreditation Exchange Product Accrediting Organization: NCQA (Exchange) Accreditation Status: Accredited Note: Accredited is the highest rating an exchange product
More informationLessons Learned from MLTSS Implementation in Florida Where Have We Been and Where Are We Going?
Lessons Learned from MLTSS Implementation in Florida Where Have We Been and Where Are We Going? David Rogers Assistant Deputy Secretary for Medicaid Operations Agency for Health Care Administration 2016
More informationDraft 2014 CMS Advanced Notice and Call Letter to Medicare Advantage and Part D Prescription Drug Plans
Jonathan Blum Center for Medicare Center for Medicare and Medicaid Services Hubert H. Humphrey Building 200 Independence Avenue, SW, MS:314G Washington, DC 20201 [Submitted electronically to: AdvanceNotice2014@cms.hhs.gov]
More informationImproving Primary Care Medication Patient Safety: System-level Medication Adherence Issues
Improving Primary Care Medication Patient Safety: System-level Medication Adherence Issues Marie Smith, PharmD Professor and Asst. Dean, Practice and Public Policy Partnerships Meg Mello Moniz, PharmD
More informationHow to go paperless: To sign up, follow these three simple steps: National Medicare Coverage Changes page 7
HealthyYou Medicare Member News Winter 2015 Go paperless! It s quick and easy. Sign up online to receive certain communications electronically, such as: Newsletters Premium invoices Preventive care information
More informationExpanding Your Pharmacist Team
CALIFORNIA QUALITY COLLABORATIVE CHANGE PACKAGE Expanding Your Pharmacist Team Improving Medication Adherence and Beyond August 2017 TABLE OF CONTENTS Introduction and Purpose 1 The CQC Approach to Addressing
More information2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP) & Model of Care (MOC) Overview
2018 Medicare Advantage Dual Eligible Special Needs Plan (DSNP) & Model of Care (MOC) Overview Medicare Advantage (MA) Program Part C Medicare Advantage Medicare Part A and B benefits are administered
More informationCommunity Health Needs Assessment Three Year Summary
Community Health Needs Assessment Three Year Summary 2013 2016 Community Health Needs Assessment Three Year Summary 2014 2016 Key needs were identified by community stakeholders which included the following:
More informationBenchmark Data Sources
Medicare Shared Savings Program Quality Measure Benchmarks for the 2016 and 2017 Reporting Years Introduction This document describes methods for calculating the quality performance benchmarks for Accountable
More informationUnited Medical ACO Participation Criteria
United Medical ACO Participation Criteria Items Requiring Practice Reporting 1) Submission of Reports: Practices must report A,B, and C to UMACO A. Thirty-four ACO Quality Measures -See Appendix A B. Average
More informationQuality Measurement and Reporting Kickoff
Quality Measurement and Reporting Kickoff All Shared Savings Program ACOs April 11, 2017 Sandra Adams, RN; Rabia Khan, MPH Division of Shared Savings Program Medicare Shared Savings Program DISCLAIMER
More informationPopulation Health. Driving local and population health. Being the trusted partner for doctors and health care systems, we re changing how
02 Population Health Driving local and population health Being the trusted partner for doctors and health care systems, we re changing how people interact with the system to make it easier to navigate
More informationCMS Mandated Training
CMS Mandated Training 1. Mandated Training Requirements (who and when) 2. Standards / Code of Conduct 3. HIPAA Privacy and Security 4. Brand New Day Models of Care 5. Quality Improvement Program PRINT
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 informationSuccess of an MTM Program Beyond Medicare Part D: Is It Really a Pharmacy Pay for Performance Model? Jim Gartner RPh, MBA CareSource
Success of an MTM Program Beyond Medicare Part D: Is It Really a Pharmacy Pay for Performance Model? Jim Gartner RPh, MBA CareSource 10 28 2014 Learning Objectives Understand why a health plan would want
More informationALOHACARE CHANGE IN REFERRAL POLICY
NEWS FOR PHYSICIANS AND PROVIDERS QUARTER 3 2017 ALOHACARE CHANGE IN REFERRAL POLICY We are pleased to announce the elimination of Referral Notifications when you refer an AlohaCare member to other in-network
More informationShared Savings Program ACO Public Reporting Instructions. with Pre-Populated Template
Shared Savings Program ACO Public Reporting Instructions Introduction with Pre-Populated Template The purpose of this document is to provide ACOs participating in the Shared Savings Program with a public
More informationHow Does This Fit into the Provisions of the Affordable Care Act? The goals are aligned
Background April 2012 The Federal Centers for Medicare and Medicaid Services (CMS) approved 3 NJ Accountable Care Organizations (ACOs) to participate in the Medicare Shared Savings Program Accountable
More information