Roles
What four roles make up an ideal Pod Core Team?
RN, CAC, CHW, and BHS/BHA
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma is dependent upon 3 factors. What are those three factors?
The traumatic event
The member's experience
The effects of the trauma on the member
What job aid/resource could be used to find the Care Model core tenets with their associated definition.
Intervention Framework
What are the two program lines are used in the Care Model program?
Care Model 2.0
Care Model 2.0 Extended
Which member of the Pod Core Team serves as the “Pod Quarterback”, who leads the daily huddle and supports the Pod Team with recommendations, clinical consults, and education?
RN
How frequently should Care Mangers successfully engage members to build deeper relationships with them?
Bi-weekly visits (or at a frequency preferred by the member)
What job aid/resource could be used to view the 3 main status and status descriptions used in Care Model?
Intervention Framework
*NOTE: The Care Manager process Job Aid only displays "Member Closure" status descriptions.
What program line does the Clinician led?
Care Model 2.0
Who is responsible for initial outreach for all Care Model identified members.
CHW
How are members identified as eligible for Care Model Pods?
Members are automatically identified and assigned via a stratification tool based on clinical need
Members can be referred via the Direct Referral process based on identified needs
What is the job aid that can be used to view the 4 outreach modalities and when to use them?
Intervention Framework
Care Model 2.0 Extended
What are the various roles that may provide support to the Pod Core Team?
Health Plan Leadership
Pod Managers
SMEs
Housing Navigators
A member has had a recent inpatient admission due to a newly identified health issue that is not outlined in the member’s health plan.
Which member outreach modality should be prioritized to gather more information and coordinate care before they are discharged?
Face-to-Face at the Facility
What job aid/resource could be used to determine what status description for a member that is no longer Medicaid eligible?
Intervention Framework
What is the only program line is NCQA-aligned?
Care Model 2.0
Regardless of the program line, who is the Care Plan sent to once the CHW completes it with the member?
Pod RN
How do Care Model Pods incorporate an awareness of trauma into care management and consider the impact of social determinants of health on the member?
Determining immediate needs related to SDoH
Facilitating an assessment (such as PRAPARE) to understand a member’s SDoH
Working with the Pod team to close the loop on identified member needs
What job aid/resource can be used to find the characteristics of the Pod Daily Huddles?
Daily Huddles QRG
What program line consists of high risk core Medicaid and non-LTSS DSNP?
Care Model 2.0 Extended