Case Management Evaluation for Medicaid Managed Care

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Health Home Care Management Assessment Reporting Tool (HH-CMART)Introductory Webinar,February 13, 2013,Anne Schettine,DOH, Office of Quality and Patient Safety,Lisa Balistreri,IPRO,Objectives,Provide overview of care management evaluation,Review HH-CMART data elements and response options,Demonstrate use of the tool,Review reporting periods and submission time frames,Provide brief overview of data uses, feedback reports, and how to get help with questions,2,The Vision: Care Management for All,3,Evaluation of Care Management Across the Medicaid Program,4,Care Management Logic Model*,*Adapted from AHRQ: Effective Health Care Program “Comparative effectiveness of case management for adults with medical illness and complex care needs” (published online January 11, 2011 effectivehealthcare.ahrq.gov),Case Management,5,HH- CMART Overview,Population,Reporting,Elements,6,HH-CMART Data,Population:,Medicaid Managed Care and Medicaid Fee-for service members participating in a Health Home. Participation is defined as member accepted by the Health Home with initiation of either outreach or active care management services.,If a members case is closed in the prior reporting period, the member is not in the file for the current reporting period.,Specifications,Version 1.0 (dated December 14, 2012),File:,One Member-Level Care Management Data Submission File for each Health Home for the reporting period,Submission Process:,Files submitted by Health Homes to DOH via secure system (HCS secure file transfer),7,HH-CMART Data Elements,Grouped by related items,Health Home and Reporting Period Information,Member Information,Initiation and Outreach,Assessment, Care Planning and Stratification,Interventions and Monitoring and Evaluation,Care Management Services,Functional Assessment Evaluation,Color Coded by data collection needs for each element by reporting period,Green = changes each reporting period,Red = Once in, remains the same always,Orange = Needs to be reviewed for new information each report,Blue = DOH will fill in,8,Data Elements,Health Home and Reporting Period Information,9,Element Name,Element Number,Format,Description,PlanID,#1,Text Field,1111111,Managed Care Plan ID or 8888888 for FFS. Required for reporting,HHID,#2,Numeric,MMIS ID for the Health Home.,Required for reporting,ReportDate,#3,Numeric Field,Q/YYYY,Jan-March = 1/YYYY,Apr-Jun = 2/YYYY,July-Sep = 3/YYYY,Oct-Dec = 4/YYYY,Data Elements,Member Information,10,Element Name,Element Number,Format,Description,Medicaid CIN,#4,Text Field,AA11111A,Required for reporting,Last Name,#5,Text Field,DOH will fill in the field using Medicaid data system.,First Name,#6,Text Field,DOH will fill in the field using Medicaid data system.,Date of Birth,#7,Numeric Field,MM/DD/YYYY,Members date of birth,Data Elements (continued),Initiation and Outreach,11,Element Name,Element Number,Format,Description,TriggerDate,#8,Numeric Field,MM/DD/YYYY,DOH will complete using Begin Date of PTS,AbleContact,#10,Drop down Yes/No or Yes/No Hiatus Period,May change between reporting periods, but once completed, stays the same,ContactDate,#11,MM/DD/YYYY,Date of initial contact or interaction,OutreachEffort,#12,Numeric field,Count of contact attempts for the reporting period,OptOut,#16,Drop down,Opted out/Did not opt out,Members agreement or refusal to participate in Health Home,Data Elements (continued),Assessment, Care Planning and Stratification,12,Element Name,Element Number,Format,Description,Program Type,#9,Drop down,Program options,Primary focus of care management,AppropriateCM,#13,Drop down Yes/No,Members appropriateness for care management,AssessedCM,#14,Drop down Yes/No,Members needs assessed with care plan,AssessDate,#15,MM/DD/YYYY,Date the initial assessment and care plan are completed,Level of Intensity,#20,Drop down,High/Medium/Low,Maximum,level of intensity needed for the reporting period,Data Elements (continued),Interventions and Monitoring and Evaluation,13,Element Name,Element Number,Format,Description,EngagedCM,#17,Drop down Yes/No,Member agrees to participate in care management,EngageCMDate,#18,Numeric Field,MM/DD/YYYY,DOH will complete with Begin Date in PTS,ConsentDate,#19,Numeric Field,MM/DD/YYYY,DOH will complete with Consent Date in PTS,Intervention Counts,#21, 22, 23,3 numeric fields,Mail, phone, in-person,Counts of interventions for each mode for the reporting period,Data Elements (continued),Interventions and Monitoring and Evaluation,14,Element Name,Element Number,Format,Description,CaseClosed,#24,Drop down Closed/Open,Care management segment ended,ClosureDate,#25,Numeric Field,MM/DD/YYYY,DOH will complete with End Date in PTS,ReasonClosure,#26,Test Field,DOH will complete with Segment End Date Reason Code in PTS,CaseReopened,#27,Drop down,Reopened/ Not Reopened,Inactive segment is reactivated with member,DateReopened,#28,Numeric Field,MM/DD/YYYY,DOH will complete with Begin Date following an End date in PTS,Data Elements (continued),Care Management Services,15,Element Name,Element Number,Format,Description,PlanUpdate,#29,Text Field,Indicates care plan was reviewed, updated or modified,CareManage,#30,Numeric Field,Assess needs, monitor progress , modify or update the care plan or goals,HealthPromote,#31,Numeric Field,Assist in scheduling and keeping appointments, advocate and arrange for needed services,TransitionCare,#32,Numeric Field,Evaluate care needs at transitions, arrange safe transition plan, update care team,MemberSupport,#33,Numeric Field,Self management, family meetings, peer supports, educate member rights,CommSocial,#34,Numeric Field,Collaborate with CBO for services or needs.,Data Elements (continued),Functional Assessment Evaluation,16,Element Name,Element Number,Format,Description,DateFACTHH,#35,MM/DD/YYYY,Date the assessment was completed.,ReasonFACTHH,#36,INITIAL,ANNUAL,DISCHARGE,The reason this assessment was conducted.,PWB,#37,Numeric,Physical Well Being Subscale Score,SWB,#38,Numeric,Social/Family Well Being Subscale Score,EWB,#39,Numeric,Emotional Well Being Subscale Score,FWB,#40,Numeric,Functional Well Being Subscale Score,FACTGP,#41,Numeric,FACT-GP Total Score,Data Elements (continued),Functional Assessment Evaluation - continued,17,Element Name,Element Number,Format,Description,HH1 HH6,#42-#47,Numeric,Health home specific questions,HHSubscale,#48,Numeric,HH specific questions total score,HHFACTGP,#49,Numeric,FACT-GP Total + HH specific Total,(#41 + #48 = #49),Questions?,18,Reminder - Questions should be submitted using the questions section.,HH-CMART Tool Demonstration,Lisa Balistreri,IPRO,19,HH-CMART Overview,20,Tool developed with Microsoft Access,Choice of:,Manual data entry directly into the tool or,Importing data from an external Excel file,Eight screens:,1) Main Menu Plan Registration Screen,2) Manual Data Entry - Main Form,3) Data Entry / Data Editing,4) Import Data Menu,5) Data Entry Errors - Report Generation,6) Frequencies - Report Generation,7) Member-Level Data - Report Generation,8) Export Data,Screen 1: Main Menu Plan Registration Screen,21,Screen 2: Manual Data Entry - Main Form,22,Screen 3: Data Entry / Data Editing,23,Screen 3: Data Entry / Data Editing Notes,The Health Home ID number is always autopopulated.,The CIN and Plan ID # are required data elements in order to save data entry for the record.,The data entry form includes drop down menus with response options to select.,All dates have prepopulated slashes to separate months, days, and years, and the user will enter MMDDYYYY.,This screen contains edit checks to minimize data entry errors. If an invalid entry occurs, a warning message will alert the user.,Some items are permanently grayed out because they will be filled in by the state and do not have to be entered by the user.,To account for unknown data, use the missing flags specified in the manual.,24,Screen 4: Import Data Menu,25,Screen 4: Import Data Menu Notes,The 1,st,step is to click on the Browse button to find your Care Management Excel file. This Excel file must adhere to the field names listed in the Users manual.,Once you select the file, the file name will appear in the box between step 1 and step 2.,The 2,nd,step is to click the Import File button to import your Excel file. If successful, a message will appear that notifies you that the import worked.,The 3,rd,step is to click on the button “Return to the Main Menu” and make sure all information in blue cells has been entered.,If you use the import feature more than once, any member-level data that had been imported previously will be deleted prior to importing.,26,Import Template,27,Screen 5: Data Entry Errors - Report Generation,28,Screen 5: Data Entry Errors Notes,The tool contains 16 edit checks in the Data Entry Errors feature, which should be used to minimize errors in the data.,The user can preview or print each report.,The first report on the screen is a summary of the count of errors per edit check. Each count should be 0.,The second button “All Error Reports” will print or preview all 16 reports displaying erroneous data.,Below are buttons corresponding to each individual report.,If you find errors, return to the data to correct the errors.,29,Screen 6: Frequencies Report Generation,30,Screen 7: Member-Level Data Report Generation,31,Screen 8: Export Data Menu,32,Screen 8: Export Data Menu Notes,The 1,st,step is to select a health home from the drop down box.,The second step is to click on the button “Export Data to Excel”. A pop up message will appear asking you to choose between 2 options.,Click YES if you want to automatically export the file into the folder “My Documents” in your C drive with a predefined filename, beginning with the specific Health Home ID you chose, and followed by “HH CMART”.,Click NO if you want to choose a specific folder and name the exported file yourself.,33,Logistics,For any entity using the HH CMART for 2 or more health homes, make a copy of the HH CMART Tool to use for each of the health homes separately prior to entering any data. You should not use the same HH CMART Tool for entering more than one health homes data.,Since the database was developed with Microsoft Access, your computer should have Microsoft Access, version 2000 or later to use this tool.,To submit the file, a secure file transfer must be used as the file contains member level data.,For each quarterly submission, use a new version of the CMART.,34,Any questions about using the tool?,35,Reminder - Questions should be submitted using the questions section.,Reporting Periods and File Submission Dates,Reporting Period,ReportDate Element,HH-CMART File Submission Date,Calendar Year 2012,(Jan-Dec 2012),4/2012,Monday, May 13, 2013,First Two Quarters 2013 (Jan- June 2013),2/2013,Monday, July 8, 2013,Third Quarter 2013,(July-Sep 2013),3/2013,Monday, October 14, 2013,Fourth Quarter 2013,(Oct-Dec 2013),4/2013,Monday, January 13, 2014,36,Reporting Process,37,Reporting Process,Health Homes will collect data from care management providers for the reporting period and import or enter data into a copy of the HH-CMART.,Health Homes will review the reports in the tool, correct errors as needed.,The completed tool should be saved as the quarters file (ie. 4Q2012.mdb) and the data can be exported out to be used as the template for importing the next quarter.,Completed files are sent through the Health Commerce System (HCS) using the,Secure File Transfer Application from the Applications,tab. Name the file with the Health Home name and upload the file (ie. CapitalHealth.mdb). Send,the file to Laura Morris .,Feedback reports,Initial Data Questions,Issues will be directed to Health Homes for further clarification of elements or care management processes.,Files may need some correction and resubmission (using same process as original).,Data Completeness Reports,Once files are in and processed, data completeness reports will be shared showing summary of responses in elements with information about the overall information received from Health Homes.,Process Measure Reports,Information about intake and engagement rates, length of time to engage, modes of interventions and types of care management services.,Cost and Utilization Reports,Inpatient and ED utilization post engagement in Health Homes.,38,CM,Process,Utilization & Cost,Individual Success,Program Effectiveness,Trends,Over Time,Care,Management,Care Management Analytic Framework,39,How do you get help if needed?,Email the Health Home Team at,with the Subject : HH CMART,Weekly calls on Wednesdays from,10 to 11 a.m. starting on February 20, 2013,Slides from today will be on the web site for Health Homes,40,