8/17/2015 Provider Educational Seminar Care Management: Part III 8/17/2015.

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Presentation transcript:

8/17/2015 Provider Educational Seminar Care Management: Part III 8/17/2015

Overview: Health Education and Health Coaching for members needing/wanting lifestyle management Provide information, guidance, and assistance on a variety of health- related topics Goal is to help member improve overall wellness and reduce risk of disease 8/17/2015 Presented by: Johns Hopkins HealthCare Care Management: Health Promotion & Wellness

Health Education: Community and on-site classes Community coalition participation Consumer advisory board (Priority Partners) Health fairs Group programs on a variety of health topics including diabetes, asthma, nutrition and obesity, smoking cessation, teen health, family planning, and prenatal health 8/17/2015 Presented by: Johns Hopkins HealthCare Care Management: Health Promotion & Wellness

Health Coaching: One-on-one monthly coaching sessions for six or more months Convenient communication via telephone Work with member to develop personal health action plan Ongoing support and encouragement Available to USFHP and some EHP members only Work with members in Level 3 8/17/2015 Presented by: Johns Hopkins HealthCare Care Management: Health Promotion & Wellness

Identification through Health Risk Assessments: Now available online or by mail Upon completion member receives detailed Personal Wellness Profile with overall wellness score, risk ratings, and recommendations for improving health Direct contact with identified members 8/17/2015 Presented by: Johns Hopkins HealthCare Care Management: Health Promotion & Wellness

Priority Partners members with special needs include members who are: Homeless Physically or developmentally disabled HIV/AIDS patients Challenged to substance abuse problems Language barriers Pregnant women Children who have a special health care need; in State-supervised foster care; with elevated blood lead levels 8/17/2015 Presented by: Johns Hopkins HealthCare Care Management: Special Needs Coordination

8/17/2015 Presented by: Johns Hopkins HealthCare HEDIS Healthcare Effectiveness Data and Information Set (HEDIS): a set of key performance measures designed to provide employers, government agencies, consumers, health plans and others with information needed to compare the performance of managed care organizations The National Committee for Quality Assurance (NCQA) directs the HEDIS Program

8/17/2015 Presented by: Johns Hopkins HealthCare HEDIS Methodology for data collection: calculation of the measures are standardized across all plans, thereby allowing for comparisons Benchmarks supplied by NCQA used for comparison purposes are:  The Maryland Average Reportable Rate 2005  The National Medicaid HEDIS Means and Percentiles and Quality Compass Plans are required to have data collection and methodologies audited by an NCQA certified auditor to ensure standardization of metrics

Overview: Initial assessment Health goal setting TeleWatch condition monitoring Medication adherence Provider and member feedback 8/17/2015 Presented by: Johns Hopkins HealthCare Care Management: Case Management – Moderate Intensity

Overview: Answer member questions about benefits and access to care Education on importance of preventive health care, immunizations, exams and diagnostics Improve members compliance/adherence with care (program and appointment enrollment and follow-up) Refer members to health education, special needs and case management for follow-up 8/17/2015 Presented by: Johns Hopkins HealthCare Care Management: Outreach

Process: Review and distribute Health Risk Assessments results based on member status Contact member (three attempts via phone and mail) Identify barriers to care Conference call with provider and member to coordinate appointment Refer member to other care management divisions if appropriate 8/17/2015 Presented by: Johns Hopkins HealthCare Care Management: Outreach

Initiatives: Childhood immunizations Annual well-child visits Emergency room Prenatal/postpartum Adopt-a-clinic Referrals Transportation 8/17/2015 Presented by: Johns Hopkins HealthCare Care Management: Outreach

Case Management: or Health Promotion and Wellness: or Outreach: or Special Needs: , x 4906 or Utilization Management: Behavioral Health: or 8/17/2015 Presented by: Johns Hopkins HealthCare Care Management: Contact Information