Inpatient Hospital Review Program Overview Case Management Agency - - PowerPoint PPT Presentation
Inpatient Hospital Review Program Overview Case Management Agency Meeting November 1, 2018 S tephanie Ziegler, Cost Control & Quality Improvement Office Director 1 Agenda Principles of Quality Improvement & Cost Control
S tephanie Ziegler, Cost Control & Quality Improvement Office Director
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November 1, 2018
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addresses individual needs
tay connected in between care settings
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Cost Access Quality
Member-centric
Through S B 18-266, the Department is implementing an inpatient hospital review program in collaboration with our stakeholders Program Goals
length based on individual’ s needs
then assist those Members needing the most assistance
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Prior or contemporaneous to admission
Concurrent with inpatient stay
Post inpatient stay
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Improving the daily data feeds to our partners with potential high-risk members prioritized:
assist care coordination
tay Reviews - continued stays over 4 days prioritizing potential high risk members with their proj ected discharge date
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File Feed RAE Receipt of Notification eQS uite Generates Notification Provider Portal - Inpatient Authorization Request S ubmitted
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Daily reports will have patients listed in priority order to allow targeted coordination of care
List Order History of Behavioral or Mental Health Diagnoses or last (2) years Any Occurrence
day readmissions
years Patients with high-ED (emergency department) utilization, with three (3) or more visits over the last year High-risk pregnancies First X X X X S econd X X X Third X X Other Any other subset of the population
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approximately 99%
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B 18-266)
takeholder Meeting Information
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