Submit an example of the complex Case Management satisfaction tool or Bidder’s similar tool. Submit an example of a quarterly summary complex Case Management report. Provide two (2) Case Management summaries: One case with a member with a primary Behavioral Health condition, including Case Management assessment, care plan, Case Management interventions for both Behavioral Health and physical health issues, and a description of the outcomes from the Case Management interventions. One case with a member with a primary physical health condition, including Case Management assessment, care plan, Case Management interventions for both Behavioral Health and physical health issues, and a description of the outcomes from the Case Management interventions. Evaluation and Scoring Insight None. Bidder Response Not to exceed sixteen (16) pages, excluding Required Accompanying Documents. Exhibit 2.4 Chronic Condition Management Overview The HCA requires a chronic condition management program that is embedded whenever possible into Primary Care practices. The management program should demonstrate how it incorporates the tenets of the Chronic Care Model and Patient Centered Medical Home (PCMH). The ASB must use HCA evidence-based medical policies and guidelines, when available, as well as available Bree Collaborative recommendations in the chronic condition management care planning and decision-making processes. The ASB must use its own criteria for chronic condition management when there are no HCA criteria. The HCA requires the ASB to conduct chronic condition management for physical health and Behavioral Health. Any chronic condition management programs the ASB provides to its Book-of-Business, must be offered to the HCA at no additional cost, but must be approved by the HCA before implementation. The ASB will update the HCA quarterly on all Clinical Management programs, including but not limited to chronic condition management programs. The Bidder must provide chronic condition management programs for UMP Plans, grounded in the tenets of the Chronic Care Model, evidence-based practice, patient self-management and Shared Decision Making, facilitate timely and appropriate referrals for physical health and Behavioral Health services, coordinates care across the healthcare delivery system, and provide positive patient and provider experiences. The ASB will provide a chronic condition management business function that identifies Members with multiple, persistent, severe healthcare needs to ensure: Incorporation of the tenets of the Chronic Care Model and PCMH. If telephonic process is used, please describe how the Bidder works with Primary Care team to patient’s integrate as much as possible.
Submit an example of the Bidder’s complex Case Management satisfaction tool or similar tool. Submit an example of a quarterly summary complex Case Management report. Provide two (2) Case Management summaries: One case with a member with a primary Behavioral Health condition, including Case Management assessment, care plan, Case Management interventions for both Behavioral Health and physical health issues, and a description of the outcomes from the Case Management interventions. One case with a member with a primary physical health condition, including Case Management assessment, care plan, Case Management interventions for both Behavioral Health and physical health issues, and a description of the outcomes from the Case Management interventions. Evaluation and Scoring Insight None. Bidder Response Not to exceed sixteen (16) pages, excluding Required Accompanying Documents. Exhibit 2.4 Chronic Condition Management Overview The HCA requires a chronic condition management program that is embedded whenever possible into Primary Care practices. The management program should demonstrate how it incorporates the tenets of the Chronic Care Model and Patient Centered Medical Home (PCMH). The ASB must use HCA evidence-based medical policies and guidelines, when available, as well as available Bree Collaborative recommendations in the chronic condition management care planning and decision-making processes. The ASB must use its own criteria for chronic condition management when there are no HCA criteria. The HCA requires the ASB to conduct chronic condition management for physical health and Behavioral Health. Any chronic condition management programs the ASB provides to its Book-of-Business, must be offered to the HCA at no additional cost, but must be approved by the HCA before implementation. The ASB will update the HCA quarterly on all Clinical Management programs, including but not limited to chronic condition management programs. The Bidder must provide chronic condition management programs for UMP Plans, grounded in the tenets of the Chronic Care Model, evidence-based practice, patient self-management and Shared Decision Making, facilitate timely and appropriate referrals for physical health and Behavioral Health services, coordinates care across the healthcare delivery system, and provide positive patient and provider experiences. The ASB will provide a chronic condition management business function that identifies Members with multiple, persistent, severe healthcare needs to ensure: Incorporation of the tenets of the Chronic Care Model and PCMH. If telephonic process is used, please describe how the Bidder works with patient’s Primary Care team to integrate as much as possible.