payments, including quality care managers will be responsible for gathering pertinent data measures if information sits within the PDP EHR. Our Health Information Technology team will provide and make available reports via Healthy Planet that assess health care and medication utilization trends. The within Healthy Planet will allow our team to identify trends that exceed Define the information norms for patients with like demographics and DRGs. Care systems to support care managers will work with these identified patients and the PDP redesign and information to develop Care Plans specific to each patient in an effort to sharing better manage utilization and outcomes. Specific factors will be assessed including: multiple primary care providers, use of specialists, extended inpatient stays, co-occurring diagnostic morbidities and medications prescribed and medications filled. Care management will hire a combination of RNs, Social Workers and Community Health Workers. They will be trained in advance of recruiting patients. Identify care management staff and their respective The ratios are the following: patient to staff ratios. Will the RNs or Social Worker (Care Managers) to patients 1/110 ratios be evaluated during the Community Health workers to patients 1/149 program? Staffing ratios will be examined quarter to ensure that quality care management is being provided. Describe the supervision and The Care Management Supervisor with each staff monitoring of the care member weekly to review cases and monitor work. The management staff. How will supervisor has access to reports generated by Epic’s Healthy you ensure that the care Planet, our Care Management platform to monitor activities of
payments, including quality measures care managers will be responsible for gathering pertinent data if information sits within the PDP EHR. Define the information systems to support care redesign and information sharing Our Health Information Technology team will provide and make available reports via Healthy Planet that assess health care and medication utilization trends. The within Healthy Planet will allow our team to identify trends that exceed norms for patients with like demographics and DRGs. Care managers will work with these identified patients and the PDP to develop Care Plans specific to each patient in an effort to better manage utilization and outcomes. Specific factors will be assessed including: multiple primary care providers, use of specialists, extended inpatient stays, co-occurring diagnostic morbidities and medications prescribed and medications filled. Identify care management staff and their respective patient to staff ratios. Will the ratios be evaluated during the program? Care management will hire a combination of RNs, Social Workers and Community Health Workers. They will be trained in advance of recruiting patients. The ratios are the following: RNs or Social Worker (Care Managers) to patients 1/110 Community Health workers to patients 1/149 Staffing ratios will be examined quarter to ensure that quality care management is being provided. Describe the supervision and monitoring of the care management staff. How will you ensure that the care The Care Management Supervisor with each staff member weekly to review cases and monitor work. The supervisor has access to reports generated by Epic’s Healthy Planet, our Care Management platform to monitor activities of
CCIP-IP-Sample-20170110.docx