Objectives. Participants will learn how to:
- Coordinate with hospital staff on discharge planning and receive notifications when assigned members are admitted and discharged
- Develop and support case management programs for high-risk and highly-acute members
- Develop and manage chronic disease management priorities and programs that are supported with care teams, registries, protocols, alerts, analysis and reporting
- Develop and manage care plans
- Develop standards and policies for overseeing and managing appropriate care guidelines and utilization standards
- Create processes for reviewing member care based on medical necessity, quality and appropriateness
Note: Some of the objectives and topics may be supported by CCI curriculum and should be developed in coordination with CCI activities
Curriculum Description
- Care coordination and care transitions:
- Coordinating care with continuum partners including primary care, specialists hospitals, post-acute care (PAC), palliative care, pharmacy, lab and other services
- Creating mechanisms and processes for receiving and responding to notification when member are admitted to hospitals, EDs and PAC facilities
- Staffing requirements to manage access and support same day visits
- Conducting outreach to patients
- Understanding the impact of ACA Section 2703 (PCMH)
- Partnering with plans to identify high-risk patients and to support predictive analytics
- Case management:
- Coordinating with health plan case managers
- Embedding case managers at sites of care
- Understanding and establishing necessary qualifications and training requirements for case managers
- Chronic disease management and prevention:
- Developing care plans
- Creating and utilizing registries and EHR health maintenance modules (See also: Reporting & Analysis section)
- Utilizing appropriate alternative touches
- Overview of utilization management (UM) and utilization review (UR)
- Coordinating UM and UR processes with health plans and MSOs
Suggested team member participants: C Suite (CMO, COO), Care Management and Coordination, IT
If you have any dietary restrictions, please email Charlotte Reische, atcreische@cpca.org.