Reporting & Analysis

Reporting & Analysis

 Objectives. Participants will learn how to:

  1. Collect HEDIS data, understand measure numerators and denominators and report clinic achievement against goals
  2. Produce standard and ad-hoc eligibility reports (e.g., membership trends, payments for ineligible members)
  3. Analyze capitation payments and reconcile capitation payment with eligibility files, changes and carve-outs
  4. Develop standard and ad-hoc financial reports (e.g., PMPM expenditures, cost categories, cost trends, denials, high-cost claims)
  5. Develop, track and report key member service performance metrics (e.g., response time, time on hold, call volumes)
  6. Develop standard and ad-hoc utilization and care management reporting capabilities (e.g., Days/000, admits/000, ALOS, bed types, ED visits, visits/000, specialty consult trend reports,)

 Curriculum Description

  1. Claims/encounters, capitation payment reporting and reconciliation:
    1. Reconciling capitation payments with eligibility files (See also: Member Eligibility, Reconciliation & Management section)
    2. Dashboard reporting best practices
    3. Encounters reporting trends (e.g., submissions, rejections)
    4. Capturing point of care lab testing and on-site pharmacy fills and samples in discrete fields in the EHR
  2. Cash flow dashboard development and implementation:
    1. Developing KPIs
    2. Historical and trended financial reporting (e.g., cash flow, P&L, capitation, FFS, wrap payments)
    3. Resource and staffing requirements, including development of staffing ratios cost analysis for care team and panel management
  3. Eligibility dashboard reporting:
    1. Membership trends, including identification and trending of eligible members not seen or assigned
    2. Trending of retroactibe adds, deletes and changes
  4. Population health management, registries, quality and member services:
    1. Satisfying required quality metrics
    2. Linking EHR alerts to population health management programs and priorities
    3. Developing and using registries
    4. Creating and managing support reports, identifying and working lists of members “out of compliance” with care guidelines and quality measures
  5. Utilization and care management dashboard and trend reporting:
    1. Member access to primary care and other services (e.g., including wait times, days to next available appointment)
    2. Chart closures
    3. Encounters
    4. Hospital and ED utilization
    5. Ancillary and high-cost service identification and trend analyses

Suggested team member participants:  C Suite (CEO, COO), IT Staff, Quality Improvement and Assurance, Reporting and Analytics, Finance

If you have any dietary restrictions, please email Charlotte Reische, atcreische@cpca.org.


Please note this training is for CP3 Participating Pilots Only

Objectives.
 Participants will learn how to:

  1. Coordinate with hospital staff on discharge planning and receive notifications when assigned members are admitted and discharged
  2. Develop and support case management programs for high-risk and highly-acute members
  3. Develop and manage chronic disease management priorities and programs that are supported with care teams, registries, protocols, alerts, analysis and reporting
  4. Develop and manage care plans
  5. Develop standards and policies for overseeing and managing appropriate care guidelines and utilization standards
  6. 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

  1. Care coordination and care transitions:
    1. Coordinating care with continuum partners including primary care, specialists hospitals, post-acute care (PAC), palliative care, pharmacy, lab and other services
    2. Creating mechanisms and processes for receiving and responding to notification when member are admitted to hospitals, EDs and PAC facilities
    3. Staffing requirements to manage access and support same day visits
    4. Conducting outreach to patients
    5. Understanding the impact of ACA Section 2703 (PCMH)
    6. Partnering with plans to identify high-risk patients and to support predictive analytics
  2. Case management:
    1. Coordinating with health plan case managers
    2. Embedding case managers at sites of care
    3. Understanding and establishing necessary qualifications and training requirements for case managers
  3. Chronic disease management and prevention:
    1. Developing care plans
    2. Creating and utilizing registries and EHR health maintenance modules (See also: Reporting & Analysis section)
    3. Utilizing appropriate alternative touches
  4. Overview of utilization management (UM) and utilization review (UR)
    1. 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.

Please note this training is for CP3 Participating Pilots Only

Objectives.
 Participants will learn how to:

  1. Coordinate with hospital staff on discharge planning and receive notifications when assigned members are admitted and discharged
  2. Develop and support case management programs for high-risk and highly-acute members
  3. Develop and manage chronic disease management priorities and programs that are supported with care teams, registries, protocols, alerts, analysis and reporting
  4. Develop and manage care plans
  5. Develop standards and policies for overseeing and managing appropriate care guidelines and utilization standards
  6. 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

  1. Care coordination and care transitions:
    1. Coordinating care with continuum partners including primary care, specialists hospitals, post-acute care (PAC), palliative care, pharmacy, lab and other services
    2. Creating mechanisms and processes for receiving and responding to notification when member are admitted to hospitals, EDs and PAC facilities
    3. Staffing requirements to manage access and support same day visits
    4. Conducting outreach to patients
    5. Understanding the impact of ACA Section 2703 (PCMH)
    6. Partnering with plans to identify high-risk patients and to support predictive analytics
  2. Case management:
    1. Coordinating with health plan case managers
    2. Embedding case managers at sites of care
    3. Understanding and establishing necessary qualifications and training requirements for case managers
  3. Chronic disease management and prevention:
    1. Developing care plans
    2. Creating and utilizing registries and EHR health maintenance modules (See also: Reporting & Analysis section)
    3. Utilizing appropriate alternative touches
  4. Overview of utilization management (UM) and utilization review (UR)
    1. 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.

Please note this training is for CP3 Participating Pilots Only

Objectives.
 Participants will learn how to:

  1. Coordinate with hospital staff on discharge planning and receive notifications when assigned members are admitted and discharged
  2. Develop and support case management programs for high-risk and highly-acute members
  3. Develop and manage chronic disease management priorities and programs that are supported with care teams, registries, protocols, alerts, analysis and reporting
  4. Develop and manage care plans
  5. Develop standards and policies for overseeing and managing appropriate care guidelines and utilization standards
  6. 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

  1. Care coordination and care transitions:
    1. Coordinating care with continuum partners including primary care, specialists hospitals, post-acute care (PAC), palliative care, pharmacy, lab and other services
    2. Creating mechanisms and processes for receiving and responding to notification when member are admitted to hospitals, EDs and PAC facilities
    3. Staffing requirements to manage access and support same day visits
    4. Conducting outreach to patients
    5. Understanding the impact of ACA Section 2703 (PCMH)
    6. Partnering with plans to identify high-risk patients and to support predictive analytics
  2. Case management:
    1. Coordinating with health plan case managers
    2. Embedding case managers at sites of care
    3. Understanding and establishing necessary qualifications and training requirements for case managers
  3. Chronic disease management and prevention:
    1. Developing care plans
    2. Creating and utilizing registries and EHR health maintenance modules (See also: Reporting & Analysis section)
    3. Utilizing appropriate alternative touches
  4. Overview of utilization management (UM) and utilization review (UR)
    1. 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.

When
7/25/2017 9:00 AM - 4:30 PM
Where
The California Endowment - Sacramento 1414 K Street Suite 100 Sacramento, CA 95814 UNITED STATES
 

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