Care Management Toolkit

Presentation: Using data insights to support care management activities
In this presentation, Sentara shares how they are tailoring services for population health management and value based purchasing, and the efforts they are making to detect high-risk members, engage them, and design programs for care management to optimally promote high-quality, cost-effective healthcare.

Behavioral Economics Based Incentives for Digital Health
A NIH funded study completed by VAL Health to measure the impact of the VAL Health Rewards behavioral economics-based incentives on a digital tobacco cessation program. The result? The control group had a 17% program completion rate and the VAL Health intervention group had 54% program completion.

Looking for utilization management guidelines for auth determinations?
As you prepare for your NCQA accreditation and/or update your utilization management (UM) workflow documents, reference these health plan policies, procedures and guidelines for industry best practices and standards.

Presentation: Innovation Session: Blending enrollment with onboarding and care management phases
Many beneficiaries newly enrolling in MA do not participate in important Care Management programs, due primarily to the limited success of costly health plan engagement efforts. This session explores how process, technology and focused public/private collaboration can quickly address this shortcoming, beginning at the Point of Sale. In a new pilot approved by CMS for the 2018 AEP, Bloom Insurance Agency is testing the theory that gathering health status (HRA) and a complete provider and Rx profile in conjunction with the enrollment, will result in more seamless, efficient and effective care and a more loyal member from day one. In this session, Bloom shares details about the program?s goals, feedback from CMS thus far, and how they see sales, compliance, and quality all coming together for a better member experience and more efficient use of health plan resources.

Care Management Services Medical Policy
This policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder contract. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. This guideline is solely for explaining correct procedure reporting and does not imply coverage and reimbursement.

5 Case Studies: Leveraging Mobile Tech to Engage Care Management’s Most-Difficult-to-Reach Patients
Download the executive summary about 5 real-world patient stories that illustrate how health plans and providers have leveraged mobile technology to successfully engage the most vulnerable and traditionally hard-to-reach patients.

Building Analytics for Population Health Management: Three Questions to Answer
While the perspective on and effects of Population Health Management (PHM) differ according to the stakeholder or “player,” the players seem to agree that they need cutting-edge analytics to make sense of their population.

Recording: The Camden Group Depression & Behavioral Health Training
Educational content will include review of depression, psychiatric and mental health conditions -assessments, best practices, interventions, tools, medications, referrals to appropriate providers and holistic strategies to manage patient's depression and/or mental health condition.

Presentation: The Camden Group Behavioral Health Training
Educational content will include review of psychiatric and mental health conditions -assessments, best practices, interventions, tools, medications, referrals to appropriate providers and holistic strategies to manage patient's mental health condition.

Presentation: The Camden Group Depression Training
Educational content will include review of different types of depression -assessments, best practices, interventions, tools, medications, referrals to appropriate providers and holistic strategies to manage patient's depression.

Recording: The Camden Group Diabetes Training
Educational content will include a review of diabetes- condition, assessments, best practices, interventions, tools and tele monitoring systems such as glucometers and other devices.

Presentation: The Camden Group Diabetes Training
Educational content will include a review of diabetes- condition, assessments, best practices, interventions, tools and tele monitoring systems such as glucometers and other devices.

Recording: The Camden Group Dementia & Renal Disease
Review of dementia and chronic kidney disease (CKD) - condition, assessments, best practices, interventions, tools, community - based services, caregiver support, and management techniques and tools with a special focus on patients on dialysis who are at risk for admissions.

Presentation: The Camden Group Renal Disease Training
Review of chronic kidney disease (CKD) and end stage renal disease - condition, assessments, best practices, interventions, and tools with a special focus on patients on dialysis who are at risk for admissions.

Presentation: The Camden Group Dementia Training
Review of dementia - condition, assessments, best practices, interventions, tools, community - based services, caregiver support, and management techniques.

Recording: The Camden Group Asthma Training
Recording includes a review of asthma for children and adults - condition assessment, best practices, interventions and tools.

Recording: The Camden Group COPD & Pneumonia Training
Presentation includes a review of Chronic Obstructive Pulmonary Disease (COPD) & Pneumonia condition, assessments, best practices, interventions, tools, technology, tele-monitoring, referrals, community and local resources and a special focus on inpatient readmission risk.

Presentation: The Camden Group Asthma Training
Presentation includes a review of asthma for children and adults - condition assessment, best practices, interventions and tools.

Presentation: The Camden Group COPD Training
Presentation includes a review of Chronic Obstructive Pulmonary Disease (COPD) condition, assessments, best practices, interventions, tools, technology, tele-monitoring, referrals, community and local resources and a special focus on inpatient readmission risk.

Presentation: The Camden Group Pneumonia Training
Presentation includes a review of pneumonia condition, assessments, best practices, interventions, tools, technology, tele-monitoring, referrals, community and local resources and a special focus on inpatient readmission risk.