Case Management Overview
"This tool helps optimize clinical workflows by aligning patients effectively, ensuring smooth scheduling and improved care coordination.
What is Patient Scheduling? "Maps"
A numerical score used in healthcare, particularly in Medicare Advantage and other value-based care models, to quantify the predicted healthcare costs of an individual based on their demographic and clinical characteristics. Significant multiplier in bonus structure.
What is Risk Adjustment Factor (RAF)?
A set of coordinated services and strategies designed to help individuals with chronic conditions manage their health and prevent complications. It involves a proactive, long-term approach to care that focuses on improving patient outcomes, reducing hospitalizations, and enhancing quality of life for those with chronic diseases such as diabetes, hypertension, heart disease, COPD, and others.
What is Chronic Care Management?
Navigate here in Core 2.0 to utilize a report that displays various metrics of patient care month to date for various place of services dependent upon filters selected. Examples: Patients seen, ACP %, Appts Kept, Appts Billed, Etc.
What is Region Performance?
What is RAF x 15 visits per year/ 12 months = ?
To ensure staff gets aligned correctly as a care team member.
What is Staff Repository?
Metric is measured by Hours (H). Refers to the requirement that all related documentation tasks—such as scheduling notes, chart preparation, patient outreach summaries, or necessary follow-ups—must be completed and finalized within 48 hours after the appointment is scheduled.
The percentage of scheduled appointments that are successfully converted into actual patient visits or encounters. It is a key performance metric in healthcare that helps organizations assess the effectiveness of their scheduling processes and patient engagement efforts.
What is Appt Conversion Rate?
Report that displays when the last specialty appt was for a specific diagnosis and when the next specialty appt is scheduled.
Hint: This report can be resourceful when identifying unspecified diagnosis!
What is Diagnosis Discovery?
The diagnosis listed below serve as examples:
What is a F code?
This icon displays active patient list to populate which patients are aligned to correct care group and correct care team.
What is the stethoscope icon?
Typically refers to the proportion of patients who have completed this process among those who are eligible. The process by which individuals plan ahead for their healthcare in the event that they become unable to make decisions for themselves. This may include documents like living wills, health care proxies, or advance directives, which outline their preferences for treatment and care.
What is ACP?
What is ACP percentage?
Staff member must enter in order to populate the count for services performed (examples: TCP, ACP, tele-assist) in PowerBi's staff view.
What is Clinii task type?
A report displaying diagnosis codes and capture dates for F codes and Z codes; would typically serve to track and document the integration of mental health services into primary care or other healthcare settings. This report helps to ensure that behavioral health diagnoses are properly documented, captured, and integrated into patient care. It can be used for clinical purposes, quality measurement, and compliance.
What is BHI?
This will display how many patients reside in a zip code on the 60 day census.
What is the Globe Icon (Maps)?
In healthcare, this refers to the structured distribution or allocation of resources, time, personnel, or services to ensure efficient delivery of care and operational effectiveness. It plays a crucial role in managing patient care, staffing, and resource utilization in a system where needs often exceed available capacity.
What is allotment?
This feature allows you to see data for patients such as care management time logged, tele assists performed, nonbillable time, ACP's performed, etc.
Hint: You can view patients that have no time logged here.
What is patient list?
Report that displays metrics to determine how many appointments where places of services are projected to land at End of Month by filters selected.
What is Revenue-Projections?
Originated by John Hopkins University Medical Center; refers to the level of risk and care complexity for a specific patient population, particularly in value-based care models. The term often arises in contexts like Medicare Advantage plans, Accountable Care Organizations (ACOs), or population health management, where patients are categorized based on their clinical needs, resource utilization, and cost risks.
What is C3 risk?
This feature displays medication costs month to date to determine if medications are affordable to patients to assist with medication adherence and improve overall clinical outcomes.
Displayed by selecting "SELECT ALL" as the drop down selection for "View by Selection" and then drilling down "Statewide" in Provider View.
Different entities displayed by selecting "______ Division" in "View by Selection" filter in Provider View.
What is Specialty?
The extra time spent by healthcare providers or care teams on Chronic Care Management (CCM) services beyond the standard allotted time that can be billed to the patient or insurance. This may occur when the complexity of a patient’s care requires more attention than anticipated, or additional services are provided to manage a chronic condition.
HINT: When an abundance is found recorded for a patient this could be an educational opportunity to coach care team on ensuring that we are capturing visits versus recording CCM time.
What is CCM Billable Overage?
Report utilized to track referrals and conversions as new patients enter Your Health Organization
Provides a structured, evidence-based approach to understanding and addressing mental health issues.
What is Cognitive Behavioral Assessment?