WV Workflow
How long does a PRM have with a pt before MA time?
What is 20 minutes
Once the PRM has spoken with the patient regarding switching their PCP or connecting to an IA the opportunity should be moved to _______. The opportunity will remain in _______and next steps will be tracked through tasks.
What is Working
Patient is only at Oak Street to receive a prescription or refill for a controlled substance.
Cancel visit + document
Contact OD / CC Sales
True or False: If the patient's phone number is disconnected/ or no longer a working number. We just case lose the cases because we are unable to reach pt.
False: please work with your scribes for an alternative number
When uploading a bill to Salesforce, what button must be selected when you want the MMT team to complete the billing case?
What is Assign MMT
Mrs.Mathews walks up to the check-in desk. She lets the WCs know that she is here for a WV. Upon reading consents, she immediately informed the WCs that she will NOT sign any forms until she made her decision on establishing care. What must be done for pt to be seen?
Consent and Acknowledgment form MUST be signed for pt to be seen
a.k.a Consent to treat
A notification on a patient’s retention opportunity that lets us know the patient used to be on our roster, but is no longer on MA plan and/or OSH PCP.
What is Dropped Case
Pt has decision-making capacity concerns
Speak with caregiver or (if no caregiver) ask provider
Cancel visit (if appropriate) + document
Contact OD / CC Sales
What is the goal of the Drop Case?
To get the patient back/ service recovery
Will the VA fill OSH ordered prescriptions?
No
VA facilities will not fill a civilian provider
prescription order.
It's Monday and the Medicare portal isn't working! After several attempts, you conclude that you are unable to upload the pts Blue Button. What should you do?
Alert Care team that BB was not uploaded. Send an email to Sr. PRM cc PM informing leadership that BB was not successfully uploaded.
Always associated with person accounts. Sales growth can be reported on by the number of ______ in the “Closed Won” stage. There are three types of ________: New Patient, Managed Care Growth, and Membership Retention.
What is Opportunities
"I’m only here to meet the provider. " Should pt be seen?
Yes! We want the patient to have the opportunity to be won over by our providers and our care model.
Once you close the case, what is the next step?
Make sure we close/or close loss the pt retention opportunity
Pt informs you he just got out of rehab and lost everything while institutionalized. Pt wants to get scheduled with his provider but only has Traditional Medicare left. Pt wants to get back on an MA plan but it's June. What could he do?
Once you move to/out of or reside in a qualified institution, you can enroll in or disenroll from a Medicare Advantage Plan or Part D plan or change your plan once a month.
Brittney is in the middle of uploading a WVs Blue button when suddenly the MA came to start the appointment. Brittney didn't get to finish going over benefits with the pt. What should Brittney do in order to ensure the pt sees her before leaving?
What is:
Select Unkown role in Canopy Tracker/leave comment in notes for careteam, G-chat team etc.
The opportunity will be moved to “______” once the patient has adamantly refused multiple times. The refusals need to be documented so that the Sr PRM has the ability to review and evaluate if the opportunity should be in the stage.
What is Closed lost
Patient is interested in a checking out / touring the center, but they are not ready for a medical visit.
(When available) Bring in Outreach/PM for conversation
Complete tour or invite patient to next MM@OSH
Cancel visit + document
Contact OD / CC Sales leadership
Where do you find your cases?
Central PRM Growth Opportunities
A pt with partial Medicaid can only be eligible for partial LIS?
True or False
False starting in 2024 all eligible LIS recipients will qualify for FULL LIS.
Dr. Travis g-chats you, asking if Mr. Brown can have labs done at his WV. He's hesitant because he's been billed for lab work before and doesn't want any surprises. Mr. Brown has an Aetna HMO plan. Can he get same day labs?
What is No!
What Dashboard can I find patients with Open Billing Cases: Patients with open billing cases, with the ability to easily see if the case is assigned to the PRM vs. the case assigned to MMT?
What is Central PRM Retention Opportunities Dashboard
“I’m here for a gift card/T-shirt”
Cancel visit + document
Contact OD / CC Sales
Report to Compliance
Miss Kerr used to have Oak Street listed as her primary doctor, but for some reason, she was auto-assigned to a different provider. After speaking with the patient, it was confirmed that she is no longer interested in continuing her care at Oak Street Health. How do you close this case?
Case Reason: Non-Experience Related Issue
Plan/OSH Issue Subtype: Auto-Enrollment into other PCP
Case Resolution: Did not save patient
What does PPO stand for?
Preferred Provider Organization