systematic process for identifying determined by March patients who may benefit from care 31, 2016.” management services. Factors to Attachment J: consider include behavioral health will “PCMH-Kids conditions, high cost/high define methods for utilization and poorly controlled or identifying high-risk complex conditions patients” Using information from 2011 NCQA PCMH 3, Element B lists Allow partial NCQA and x See above #1. a variety of sources, in the explanation a variety of partial TCPI deeming. Attachment C: including payers and possible sources for identifying Separately verify that will continue “Practice practice clinicians, the patients. practices are using payers and to report quarterly on practice updates the list practice clinicians to update care coordination of high-risk patients at 2014 NCQA PCMH 4, Element A high-risk patient lists and that activities as agreed least quarterly. requires a systematic process and in the time period for updating upon by the payers the explanation lists a variety of the high-risk patient list is and providers.” possible sources for identifying being met. Attachment D: “High patients. risk panel reports shall be reported (by the health plan to the practice regarding eligible Subscribers) quarterly” Hannah notes: no specific requirement of the practice to update high risk list quarterly. Could possibly build into care coordination reporting requirements.
systematic process for identifying patients who may benefit from care management services. Factors to consider include behavioral health conditions, high cost/high utilization and poorly controlled or complex conditions determined by March 31, 2016.” Attachment J: “PCMH-Kids will define methods for identifying high-risk patients” Using information from a variety of sources, including payers and practice clinicians, the practice updates the list of high-risk patients at least quarterly. 2011 NCQA PCMH 3, Element B lists in the explanation a variety of possible sources for identifying patients. 2014 NCQA PCMH 4, Element A requires a systematic process and in the explanation lists a variety of possible sources for identifying patients. Allow partial NCQA and partial TCPI deeming. Separately verify that practices are using payers and practice clinicians to update high-risk patient lists and that the time period for updating the high-risk patient list is being met. See above #1. Attachment C: “Practice will continue to report quarterly on care coordination activities as agreed upon by the payers and providers.” Attachment D: “High risk panel reports shall be reported (by the health plan to the practice regarding eligible Subscribers) quarterly” Hannah notes: no specific requirement of the practice to update high risk list quarterly. Could possibly build into care coordination reporting requirements. x