Objectives. Participants will learn how to:
- Collect HEDIS data, understand measure numerators and denominators and report clinic achievement against goals
- Produce standard and ad-hoc eligibility reports (e.g., membership trends, payments for ineligible members)
- Analyze capitation payments and reconcile capitation payment with eligibility files, changes and carve-outs
- Develop standard and ad-hoc financial reports (e.g., PMPM expenditures, cost categories, cost trends, denials, high-cost claims)
- Develop, track and report key member service performance metrics (e.g., response time, time on hold, call volumes)
- 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
- Claims/encounters, capitation payment reporting and reconciliation:
- Reconciling capitation payments with eligibility files (See also: Member Eligibility, Reconciliation & Management section)
- Dashboard reporting best practices
- Encounters reporting trends (e.g., submissions, rejections)
- Capturing point of care lab testing and on-site pharmacy fills and samples in discrete fields in the EHR
- Cash flow dashboard development and implementation:
- Developing KPIs
- Historical and trended financial reporting (e.g., cash flow, P&L, capitation, FFS, wrap payments)
- Resource and staffing requirements, including development of staffing ratios cost analysis for care team and panel management
- Eligibility dashboard reporting:
- Membership trends, including identification and trending of eligible members not seen or assigned
- Trending of retroactibe adds, deletes and changes
- Population health management, registries, quality and member services:
- Satisfying required quality metrics
- Linking EHR alerts to population health management programs and priorities
- Developing and using registries
- Creating and managing support reports, identifying and working lists of members “out of compliance” with care guidelines and quality measures
- Utilization and care management dashboard and trend reporting:
- Member access to primary care and other services (e.g., including wait times, days to next available appointment)
- Chart closures
- Encounters
- Hospital and ED utilization
- 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:
- 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.
Please note this training is for CP3 Participating Pilots Only
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.
Please note this training is for CP3 Participating Pilots Only
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.