Catch Me If You Care Plan!
In the care plan the member preferences should be left in this status
What is open?
Critical Incidents should be entered within this timeframe
What is within 24 hours of notification
When a member is community stabilized we have ____ amount of time to outreach the guardian
What is the same day?
This letter is sent to the PCP
What is the care plan letter general?
When starting a call with a member/guardian, what 2 things do we need to confirm? Give an example
HIPAA and call disclosure
A guardian indicates that they have a need for food and housing - what do you need to do
1. Address the need
2. Include a CRD
3. Ensure there is a goal related to the food/housing issue or document refusal
*emergency referrals must be followed up on within 24 hours
Time Frame and Method
Members who go IP have to have a scheduled follow up appointment within ___ days of discharge
What is 7 days?
Referrals / CRDs are meant to be to a provider or resource directly (and not information only ex: dentaquest or the aetna website). Give an example of a referral you provide and how long you have to follow up
*example may vary
This system used to data mine updates hourly and has the most up to date phone numbers?
What is PCC/Collective Medical?
When we have a CI, what 2 things are we looking for in the care plan?
1. Updated goal related to crisis
2. ANE
Our first 4 calls to a member (intensive, 3 supportive) should be documented in this event
*until the member is reached
What is the initial outreach event?
A member needs a psych follow up for medication management documented within ___ days of discharge?
What is 14 days
long term goals should always be written as a what? give an example
I statement
*I want my child to go a year without cavities
GA foods referrals are charted here
What is the CRD and QNXT (and a goal in the care plan)
You have a member diagnosed with depression, diabetes, and heart failure. Mom is not willing to do the depression assessment or discuss it. All other CSAs are complete Which conditions should be in managing status
Diabetes and heart failure - we only put the conditions we are managing in management status
Depression should be put in "closed" status
Case Managers have this amount of time to chart ___ from when they spoke to the guardian/member
24 hours
Name the things that should be included in your IDCT event
Who attended, Presenting Problem, Data Mining, Guardian Reached? , Contact with MCR?, Most recent med fill, Next steps/recommendations
Member barriers identified should always relate to the member's presenting problem and be solved for in the care plan. If a member is non-verbal and has a developmental disability and does not have a pcp, give an example of a barrier you may pick
Member has cognitive limitations or member is not connected with a pcp or provider
*remember barriers are for the member not the caregiver
When an SNC member goes to pop health, tell us about the process for the CME
Member program type is changed to pop health - it is not closed and reopened
A member is diagnosed with ADHD, Anxiety, and Diabetes but mom is only willing to work on the ADHD. Where are you documenting these conditions?
ADHD: Peds assessment, CME, Condition Management (managing status), should have a CSA (if applicable) and a care plan goal related.
Anxiety and Diabetes: PEDS assessment, CME and IF on condition management page should be in closed status not in managing
A member goes into PO after this many intensive outreaches (in the initial outreach process)
What is the 3rd outreach? (Call / Letter / Call)
outreach 4 and 5 still happen in the 30 day timeframe
For community stabilized members, they should have an appointment with a mental health provider within ___ amount of time. Aetna contracts with ___ to provide that
24 hours, SCCP
You do this if a member's medication is not in dynamo to add to the med req
What is: enter in CMAT and alert section, ask manager or team lead to submit a MAS ticket to get medication added to dynamo
What is our talk time expectation? What does it equal to in hours per week? and which code should you be using for our town halls?
20%, 8 hours/week or 96 min per day and clinical audit prep