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Provider Educational Seminar

Provider Educational Seminar. Care Management: Part III. 9/15/2014. Care Management: Health Promotion & Wellness. Overview: Health Education and Health Coaching for members needing/wanting lifestyle management

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Provider Educational Seminar

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  1. Provider Educational Seminar Care Management: Part III 9/15/2014

  2. Care Management:Health Promotion & Wellness Overview: • Health Education and Health Coaching for members needing/wanting lifestyle management • Provide information, guidance, and assistance on a variety of health-related topics • Goal is to help member improve overall wellness and reduce risk of disease Presented by: Johns Hopkins HealthCare 9/15/2014

  3. Care Management:Health Promotion & Wellness Health Education: • Community and on-site classes • Community coalition participation • Consumer advisory board (Priority Partners) • Health fairs • Group programs on a variety of health topics including diabetes, asthma, nutrition and obesity, smoking cessation, teen health, family planning, and prenatal health Presented by: Johns Hopkins HealthCare 9/15/2014

  4. Care Management:Health Promotion & Wellness Health Coaching: • One-on-one monthly coaching sessions for six or more months • Convenient communication via telephone • Work with member to develop personal health action plan • Ongoing support and encouragement • Available to USFHP and some EHP members only • Work with members in Level 3 Presented by: Johns Hopkins HealthCare 9/15/2014

  5. Care Management:Health Promotion & Wellness Identification through Health Risk Assessments: • Now available online or by mail • Upon completion member receives detailed Personal Wellness Profile with overall wellness score, risk ratings, and recommendations for improving health • Direct contact with identified members Presented by: Johns Hopkins HealthCare 9/15/2014

  6. Care Management:Special Needs Coordination Priority Partners members with special needs include members who are: • Homeless • Physically or developmentally disabled • HIV/AIDS patients • Challenged to substance abuse problems • Language barriers • Pregnant women • Children who have a special health care need; in State-supervised foster care; with elevated blood lead levels Presented by: Johns Hopkins HealthCare 9/15/2014

  7. HEDIS • Healthcare Effectiveness Data and Information Set (HEDIS): a set of key performance measures designed to provide employers, government agencies, consumers, health plans and others with information needed to compare the performance of managed care organizations • The National Committee for Quality Assurance (NCQA) directs the HEDIS Program Presented by: Johns Hopkins HealthCare 9/15/2014

  8. HEDIS • Methodology for data collection: calculation of the measures are standardized across all plans, thereby allowing for comparisons • Benchmarks supplied by NCQA used for comparison purposes are: • The Maryland Average Reportable Rate 2005 • The National Medicaid HEDIS Means and Percentiles and Quality Compass • Plans are required to have data collection and methodologies audited by an NCQA certified auditor to ensure standardization of metrics Presented by: Johns Hopkins HealthCare 9/15/2014

  9. Care Management:Case Management – Moderate Intensity Overview: • Initial assessment • Health goal setting • TeleWatch condition monitoring • Medication adherence • Provider and member feedback Presented by: Johns Hopkins HealthCare 9/15/2014

  10. Care Management:Outreach Overview: • Answer member questions about benefits and access to care • Education on importance of preventive health care, immunizations, exams and diagnostics • Improve members compliance/adherence with care (program and appointment enrollment and follow-up) • Refer members to health education, special needs and case management for follow-up Presented by: Johns Hopkins HealthCare 9/15/2014

  11. Care Management:Outreach Process: • Review and distribute Health Risk Assessments results based on member status • Contact member (three attempts via phone and mail) • Identify barriers to care • Conference call with provider and member to coordinate appointment • Refer member to other care management divisions if appropriate Presented by: Johns Hopkins HealthCare 9/15/2014

  12. Care Management:Outreach Initiatives: • Childhood immunizations • Annual well-child visits • Emergency room • Prenatal/postpartum • Adopt-a-clinic • Referrals • Transportation Presented by: Johns Hopkins HealthCare 9/15/2014

  13. Care Management:Contact Information Case Management: • 1-800-557-6916 or populationhealth@jhhc.com Health Promotion and Wellness: • 1-800-957-9760 or healthcoach@jhhc.com Outreach: • 1-888-500-8786 or orferrals@jhhc.com Special Needs: • 1-800-261-2396, x 4906 or snc@jhhc.com Utilization Management: • 1-800-261-2421 Behavioral Health: 1-800-261-2429 or bhreferrals@jhhc.com Presented by: Johns Hopkins HealthCare 9/15/2014

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