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WHERE THE BRIGHTEST MINDS in health and IT meet.

Prioritizing Care Coordination for Patients Who Need It Most

February 20, 2017 — 01:30PM EST - 02:30PM EST
Orange County Convention Center
Room: W303A
Session ID: 
302
Continuing Education Credits: 
CME
1.00
CNE
1.00
ACHE
1.00
CAHIMS
1.00
CPHIMS
1.00
ABPM LLSA
1.00

Description

Medical Home Network (MHN) is a 501(c)3 that integrates disparate providers to create a seamless network upon which providers can effectively connect, communicate and collaborate around patient care for effective care coordination. MHN have improved value and outcomes with a team-based model of care, technology platform and success building provider-alignment has advanced the delivery of medical, behavioral and social services in one of the largest Medicaid settings in the country. This session will dive into MHN’s dynamic and predictive risk stratification methodology using not only historical claims but also real time behavioral and social determinant data, which is proven to be predictive of subsequent utilization and cost of care. We present analyses demonstrating the validity of the approach and the impact that can be identified at a patient level. We will facilitate a discussion on effective care coordination and developing a high impact, value-based integrated delivery system.

Learning Objectives: 

  • Describe how we identify and engage people to get health risk screening done
  • Discuss how to affectively administer health risk screening tools to identify the rising risk population
  • Illustrate how we augment claims-based risk stratification to better stratify and identify rising risk
  • Demonstrate how we use addressable barriers, including psychosocial factors, to drive effective care management

Audience: 

Nurse, CNO, CNIO
Physician, CMO, CMIO
C-Suite

Level: 

Advanced

WHERE THE BRIGHTEST MINDS

in health and IT meet.

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