Case Management Evaluation for Medicaid Managed Care

1、Health Home Care Management Assessment Reporting Tool (HH-CMART)Introductory WebinarFebruary 13, 2013Anne SchettineDOH, Office of Quality and Patient SafetyLisa BalistreriIPROObjectivesProvide overview of care management evaluation Review HH-CMART data elements and response optionsDemonstrate use of

2、 the toolReview reporting periods and submission time framesProvide brief overview of data uses, feedback reports, and how to get help with questions2The Vision: Care Management for All3Evaluation of Care Management Across the Medicaid Program4Care Management Logic Model*Adapted from AHRQ: Effective

3、 Health Care Program “Comparative effectiveness of case management for adults with medical illness and complex care needs” (published online January 11, 2011 )Case Management5HH- CMART OverviewPopulationReportingElements6HH-CMART DataPopulation: Medicaid Managed Care and

4、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 curr

5、ent reporting period.SpecificationsVersion 1.0 (dated December 14, 2012)File:One Member-Level Care Management Data Submission File for each Health Home for the reporting periodSubmission Process:Files submitted by Health Homes to DOH via secure system (HCS secure file transfer)7HH-CMART Data Element

6、sGrouped by related itemsHealth Home and Reporting Period InformationMember InformationInitiation and OutreachAssessment, Care Planning and StratificationInterventions and Monitoring and EvaluationCare Management Services Functional Assessment EvaluationColor Coded by data collection needs for each

7、element by reporting periodGreen = changes each reporting periodRed = Once in, remains the same alwaysOrange = Needs to be reviewed for new information each reportBlue = DOH will fill in8Data ElementsHealth Home and Reporting Period Information9Element NameElement NumberFormatDescriptionPlanID#1Text

8、 Field,1111111Managed Care Plan ID or 8888888 for FFS. Required for reportingHHID#2NumericMMIS ID for the Health Home.Required for reportingReportDate#3Numeric FieldQ/YYYYJan-March = 1/YYYYApr-Jun = 2/YYYYJuly-Sep = 3/YYYYOct-Dec = 4/YYYYData ElementsMember Information10Element NameElement NumberFor

9、matDescriptionMedicaid CIN#4Text Field,AA11111ARequired for reportingLast Name#5Text FieldDOH will fill in the field using Medicaid data system. First Name#6Text FieldDOH will fill in the field using Medicaid data system. Date of Birth#7Numeric Field,MM/DD/YYYYMembers date of birthData Elements (con

10、tinued)Initiation and Outreach11Element NameElement NumberFormatDescriptionTriggerDate#8Numeric Field,MM/DD/YYYYDOH will complete using Begin Date of PTSAbleContact#10Drop down Yes/No or Yes/No Hiatus PeriodMay change between reporting periods, but once completed, stays the sameContactDate#11MM/DD/Y

11、YYYDate of initial contact or interaction OutreachEffort#12Numeric fieldCount of contact attempts for the reporting periodOptOut#16Drop downOpted out/Did not opt outMembers agreement or refusal to participate in Health HomeData Elements (continued)Assessment, Care Planning and Stratification12Elemen

12、t NameElement NumberFormatDescriptionProgram Type#9Drop down Program optionsPrimary focus of care management AppropriateCM#13Drop down Yes/NoMembers appropriateness for care managementAssessedCM#14Drop down Yes/NoMembers needs assessed with care plan AssessDate#15MM/DD/YYYYDate the initial assessmen

13、t and care plan are completedLevel of Intensity#20Drop downHigh/Medium/LowMaximum level of intensity needed for the reporting periodData Elements (continued)Interventions and Monitoring and Evaluation13Element NameElement NumberFormatDescriptionEngagedCM#17Drop down Yes/NoMember agrees to participat

14、e in care managementEngageCMDate#18Numeric Field,MM/DD/YYYYDOH will complete with Begin Date in PTSConsentDate#19Numeric Field,MM/DD/YYYYDOH will complete with Consent Date in PTSIntervention Counts#21, 22, 233 numeric fieldsMail, phone, in-personCounts of interventions for each mode for the reporti

15、ng periodData Elements (continued)Interventions and Monitoring and Evaluation14Element NameElement NumberFormatDescriptionCaseClosed#24Drop down Closed/OpenCare management segment endedClosureDate#25Numeric Field,MM/DD/YYYYDOH will complete with End Date in PTSReasonClosure #26Test FieldDOH will com

16、plete with Segment End Date Reason Code in PTSCaseReopened#27Drop downReopened/ Not ReopenedInactive segment is reactivated with member DateReopened#28Numeric Field,MM/DD/YYYYDOH will complete with Begin Date following an End date in PTSData Elements (continued)Care Management Services15Element Name

17、Element NumberFormatDescriptionPlanUpdate#29Text FieldIndicates care plan was reviewed, updated or modifiedCareManage#30Numeric FieldAssess needs, monitor progress , modify or update the care plan or goalsHealthPromote#31Numeric FieldAssist in scheduling and keeping appointments, advocate and arrang

18、e for needed servicesTransitionCare#32Numeric FieldEvaluate care needs at transitions, arrange safe transition plan, update care teamMemberSupport#33Numeric FieldSelf management, family meetings, peer supports, educate member rightsCommSocial#34Numeric FieldCollaborate with CBO for services or needs

19、.Data Elements (continued)Functional Assessment Evaluation16Element NameElement NumberFormatDescriptionDateFACTHH#35MM/DD/YYYYDate the assessment was completed.ReasonFACTHH#36INITIALANNUAL DISCHARGEThe reason this assessment was conducted.PWB#37NumericPhysical Well Being Subscale Score SWB#38Numeric

20、Social/Family Well Being Subscale ScoreEWB#39NumericEmotional Well Being Subscale ScoreFWB#40NumericFunctional Well Being Subscale ScoreFACTGP #41NumericFACT-GP Total ScoreData Elements (continued)Functional Assessment Evaluation - continued17Element NameElement NumberFormatDescriptionHH1 HH6#42-#47

21、NumericHealth home specific questionsHHSubscale#48NumericHH specific questions total scoreHHFACTGP#49NumericFACT-GP Total + HH specific Total(#41 + #48 = #49)Questions?18Reminder - Questions should be submitted using the questions section. HH-CMART Tool DemonstrationLisa BalistreriIPRO19HH-CMART Ove

22、rview20Tool developed with Microsoft AccessChoice of:Manual data entry directly into the tool or Importing data from an external Excel fileEight screens:1) Main Menu Plan Registration Screen 2) Manual Data Entry - Main Form3) Data Entry / Data Editing4) Import Data Menu5) Data Entry Errors - Report

23、Generation 6) Frequencies - Report Generation 7) Member-Level Data - Report Generation 8) Export DataScreen 1: Main Menu Plan Registration Screen21Screen 2: Manual Data Entry - Main Form22Screen 3: Data Entry / Data Editing23Screen 3: Data Entry / Data Editing NotesThe Health Home ID number is alway

24、s 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 sc

25、reen 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 s

26、pecified in the manual.24Screen 4: Import Data Menu25Screen 4: Import Data Menu NotesThe 1st 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

27、 the box between step 1 and step 2.The 2nd 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 3rd step is to click on the button “Return to the Main Menu” and make sure all information in blue cells has

28、 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.26Import Template27Screen 5: Data Entry Errors - Report Generation28Screen 5: Data Entry Errors NotesThe tool contains 16 edit checks in the Data Ent

29、ry 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 displa

30、ying erroneous data.Below are buttons corresponding to each individual report.If you find errors, return to the data to correct the errors.29Screen 6: Frequencies Report Generation30Screen 7: Member-Level Data Report Generation31Screen 8: Export Data Menu32Screen 8: Export Data Menu NotesThe 1st ste

31、p 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 pre

32、defined 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. 33LogisticsFor any entity using the HH CMART for 2 or more health homes, make a copy of the HH CMART Tool to use f

33、or 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 subm

34、it 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.34Any questions about using the tool?35Reminder - Questions should be submitted using the questions section. Reporting Periods and File Submission Da

35、tesReporting PeriodReportDate ElementHH-CMART File Submission DateCalendar Year 2012(Jan-Dec 2012)4/2012Monday, May 13, 2013First Two Quarters 2013 (Jan- June 2013)2/2013Monday, July 8, 2013Third Quarter 2013(July-Sep 2013)3/2013Monday, October 14, 2013Fourth Quarter 2013(Oct-Dec 2013)4/2013Monday,

36、January 13, 201436Reporting Process37Reporting ProcessHealth 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 t