to the family. The care manager/care coordinator 2011 PCMH 3, Element C, (Must Pass) NCQA: The 2011 and x completes within a specified period of requires the care team to collaborate 2014 NCQA time (from the time that the high-risk with the patient/family to develop an requirements are not J: patient is placed in the care individual care plan, including prescriptive time manager’s/care coordinator’s active treatment goals that are reviewed and frame for completing the a caseload) a patient assessment based on updated at each relevant visit for at patient assessment and the patient’s specific symptoms, least 75% of high-risk patients. care plan. Allow NCQA complaints or situation, including the deeming regarding and patient’s preferences and lifestyle goals, NCQA PCMH 4, Element B: The care content of patient family self-management abilities and team and patient family/caregiver assessment. Separately socioeconomic circumstances that are collaborate (at relevant visits) to verify that the practice contributing to elevated near-term develop and update an individual care has established and that hospitalization and/or ED risk. plan for at least 75% of high risk implemented a process For children and youth, the care patients; Care plan incorporates the within specified coordinator shall complete a family patient preferences and functional timeframes for assessing family assessment that includes: lifestyle goals, identifies treatment and adding new patients status a family status and environment goals, assesses and addresses potential onto the High Risk and assessment (i.e., assessment of barriers to meeting goals, includes a Patient List, based on home medical/behavioral/dental health self-management plan and is given in care manager capacity. status; social supports of family and writing to the friends; financial needs; family patient/family/caregiver
to the The care manager/care coordinator completes within a specified period of time (from the time that the high-risk patient is placed in the care manager’s/care coordinator’s active caseload) a patient assessment based on the patient’s specific symptoms, complaints or situation, including the patient’s preferences and lifestyle goals, self-management abilities and socioeconomic circumstances that are contributing to elevated near-term hospitalization and/or ED risk. For children and youth, the care coordinator shall complete a family assessment that includes: a family status and environment assessment (i.e., assessment of medical/behavioral/dental health status; social supports of family and friends; financial needs; family 2011 PCMH 3, Element C, (Must Pass) requires the care team to collaborate with the patient/family to develop an individual care plan, including treatment goals that are reviewed and updated at each relevant visit for at least 75% of high-risk patients. NCQA PCMH 4, Element B: The care team and patient family/caregiver collaborate (at relevant visits) to develop and update an individual care plan for at least 75% of high risk patients; Care plan incorporates the patient preferences and functional lifestyle goals, identifies treatment goals, assesses and addresses potential barriers to meeting goals, includes a self-management plan and is given in writing to the patient/family/caregiver NCQA: The 2011 and 2014 NCQA requirements are not prescriptive time frame for completing the patient assessment and care plan. Allow NCQA deeming regarding content of patient assessment. Separately verify that the practice has established and implemented a process within specified timeframes for assessing and adding new patients onto the High Risk Patient List, based on care manager capacity. J: a and family that family status and home x family.
Cost%20Management%20Strategies%20with%20NCQA%20PCMH%20Kids%20crosswalk%2001152016.docx