HRA & ICP PROCESS
This role performs outreach for care coordination for low/moderate-risk members and helps close care gaps.
Who is the Care Coordinator (CC)?
This must always be sent after the first unsuccessful attempt to reach a member.
What is the Generic Outreach letter?
If a member opts out, this letter is sent.
What is the Opt Out Letter?
What does HRA stand for?
What is Health Risk Assessment?
This task is triggered when no HRA is completed by the due date
What is the Non-Responder/Conduct ICT task?
Before making outreach, both CMs and CCs are reminded to always begin with this preparatory step.
What is a basic chart review?
This Assessment must be used by CMs or CCs when administering HRA through the non-responder process.
What is the Medicare Healthfirst Health Risk Assessment?
This task must be set up when no evidence exists of a member connecting to care in the past 6 months.
What is the Follow-Up Open Care Gap task?
CMs must complete the High-risk ICT task within this time frame.
What is 30 days?
This must remain open even when PGAs are closed.
What is the Care Plan?
This role provides proactive care management and monitors hospital admissions and TOC for high-risk members.
Who is the Care Manager (CM)?
If a member chooses to discontinue participation in CM, all PGAs must be closed using this reason.
What is “Member unwilling to participate”?
This task is added when additional support is needed and member agrees to further calls.
What is a Follow-Up Member Call task?
Members re-stratified from Low/Mod to High or vice versa trigger this task.
What is the Change in Risk Acuity task?
This letter is developed or updated after an HRA and includes Problems, Goals, and Actions (PGAs).
What is the Individualized Care Plan (ICP)?
This phrase must be documented at the end of the note when a member understands the ICP and knows when to contact PCP or CM.
What is: “Member stated they will reach out to PCP and/or CM team with additional questions or needs”?
This task must be set up after ICT review for implementation follow-up
What is the Follow-Up Member Call task?
These three providers make up the minimum required Interdisciplinary Care Team (ICT).
Who are the PCP, Care Manager, and Care Coordinator?
This task is generated when members fail to complete an Initial or Annual HRA.