MISC
What is an example of an open-ended question that you could ask your member to learn more about their needs?
What is your biggest health concern?
How are you managing your “condition”?
What motivates you to improve your health?
What are some things you would like to be able to do, that you can’t do right now?
How are you coping with your concerns?
What are the two ways we interact with our members?
Telephonic and Face-to-Face field visits
What must happen to an OGI, that would mean the member has made progress and resolved the OGI that you had been working on with them?
The goal must be met
How you would add Anxiety Disorder as a condition to your member's record.
Health > Diagnosis > Add New Condition > Select Diabetes Medical > Enter any start date > Add
How do you access the Care Model Core Adult Assessment in CommunityCare?
Action > Run Script > Select a Script: Care Model Core Adult Assessment
*Adult Core 3.0 > Single Screen > From Demographics Only
There are many assessments available in CommunityCare. Will you be required to use all of them? Explain your answer.
No
The assessment requirements are determined by things like member needs, role, program, and/or state/health plan.
What are examples of factor summaries for a comprehensive assessment according to NCQA?
Verify follow up appointment & reconcile medications
Assess for needs related to: DME, caregiver, understanding & compliance with discharge plan, knowledge of condition, sign/symptoms to report, activity limitations, dietary restrictions, community resources
*Use LTSS Distinction
What status is used in CommunityCare to show that you and the member are actively working on an opportunity/goal?
Member agrees to goal - in progress
How you would add lisinopril 5MG daily to your member's record.
Documentation must include:
Name of medication
Dose
Frequency
Route
Taken as Prescribed (if available in system)
Start Date
Your member informed you they have a new cellphone number., 555-555-5555. How you would add the new number to the member record.
Member Info > Edit > Cell Phone field: 555-555-5555 > Update
What are the documentation requirements for prioritized goals according to NCQA?
Two goals are required, and one must be self-management. When creating goals, they must follow the SMART format, prioritized (high, medium, low, or 1, 2, 3), contain an intervention.
*Use Complex Case Mgmt
What status in CommunityCare shows a member is not willing to work on an opportunity/problem?
Member Declined Goal
Where would you click to manually add an OGI.
Care Plan > Team Care Plan/Care Plan Overview > Add manual OGI
What tasks should you review prior to calling the member?
Reason for referral/case assignment
Language preference
Recent inpatient hospital admissions/discharges
Eligibility
Notes
If your member was discharged from the hospital, what are some examples of things you could access following discharge.
Verify follow up appointment & reconcile medications
Assess for needs related to: DME, caregiver, understanding & compliance with discharge plan, knowledge of condition, sign/symptoms to report, activity limitations, dietary restrictions, community resources
What status in CommunityCare would you use when a member has achieved the goal and no longer has a need/opportunity?
Task complete- Goal Met
Demonstrate how to add your next follow up activity assuming you will be using the Activity Type: Care Coordination and you will be meeting with the member at his home 1 week from today at 3:00 PM.
Action > Add Activity > Activity Type: Care Coordination > Contact Type: Face to Face – Home > Scheduled Date: should be 1 week in the future at 3:00 PM > Add and Close
Assume you got distracted while wrapping up your documentation with the member and you can’t recall if you scheduled the follow up interaction activity. Where can you go to see your future planned activities / interactions and verify your next planned care coordination activity is scheduled?
HINT: There are two places you can view
Activity Record > Outstanding Activities > locate the care coordination activity with future date
Dashboard > My Calendar > locate the care coordination activity for the member with the future date
Your member has a concern about transportation being a potential barrier to his provider appointment. How would you manually add this OGI to the Care Plan, keeping in mind the member is willing to work on this OGI over the next two months.
Select an appropriate Goal and Intervention
Complete the rest of the required documentation
The member is willing to work on this OGI over the next 2 months
Keyword: Transportation
Start and End Date should be within a 2-month date range
Status: Member Agrees to Goal in Progress
Note: Should pertain to care being with mechanic, could make up transportation resource to add to the note
Add