Tag: Managed Care

Classroom Attendance Calculator: A Tool for Monitoring Student Absences

Monitoring chronic absence data is essential for ensuring educators are equipped to support their students effectively. Amidst the busy school year, it can be easy to lose track of how absences accumulate for individual students. This is where the Classroom Attendance Calculator developed by Attendance Works comes into play. It helps educators determine whether a student’s absences place them in the satisfactory, at-risk, or chronic absence categories.

Importance of Monitoring Chronic Absences

Chronic absenteeism can significantly impact a student’s academic performance and overall well-being. Early identification of students who are frequently absent allows for timely interventions that can help mitigate the negative effects of missed school days. By regularly monitoring absence data, educators can ensure that every student receives the support they need to succeed.

Features of the Classroom Attendance Calculator

Self-Calculating Spreadsheet

The Classroom Attendance Calculator is a self-calculating spreadsheet designed to identify students who require early intervention due to excessive absences. If your district does not provide chronic absence reports, this tool can serve as an invaluable resource for tracking student attendance.

Categories of Absence

The calculator categorizes students’ absences into three groups:

  1. Satisfactory: Students whose absences are within an acceptable range.
  2. At-Risk: Students who are beginning to show a pattern of frequent absences.
  3. Chronic: Students whose absences are significantly impacting their academic progress and require immediate attention.

Comprehensive Tracking

The tool prompts educators to consider both excused and unexcused absences, as well as suspensions, ensuring a comprehensive view of each student’s attendance record. This holistic approach helps in identifying patterns and understanding the reasons behind frequent absences.

Step-by-Step Guide

The calculator comes with a step-by-step guide to help educators fill in the spreadsheet accurately. This guide ensures that the data entered is consistent and reliable, providing a clear picture of each student’s attendance status.

Action Plan Worksheet

In addition to the attendance calculator, a worksheet is included for educators to assess their current strategies and identify additional measures to reduce chronic absenteeism. This reflective tool encourages educators to think critically about their approaches and develop effective action plans.

Utilizing the Attendance Calculator

To use the Classroom Attendance Calculator effectively:

  1. Input Data: Enter each student’s absences, including excused, unexcused, and suspension days.
  2. Review Categories: Observe which category each student falls into based on their absence record.
  3. Develop Interventions: Use the action plan worksheet to devise strategies for supporting students with chronic absences.

By actively monitoring and addressing chronic absenteeism, educators can create a more supportive and conducive learning environment for all students. The Classroom Attendance Calculator from Attendance Works is a powerful tool that empowers educators to stay informed and take proactive steps in ensuring student success.

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Attendance Works seeks to advance student success and reduce equity gaps by reducing chronic absence. Their work includes influencing better federal, state and local policy and practices around school attendance, encouraging school districts to track chronic absence data from an early age, and partnering with families and community agencies to intervene as soon as poor attendance becomes evident for a child or school.

Managed Care Business Models 101 – Digital Therapeutics & Health Technology

The video titled “Managed Care Business Models 101 – Digital Therapeutics & Health Technology” on the channel Carenodes provides an in-depth discussion on healthcare business models, focusing on managed care, and is aimed at healthcare entrepreneurs, especially those new to the sector. Here’s a summary of key points covered in the transcribed part of the video:

The video titled “Managed Care Business Models 101 – Digital Therapeutics & Health Technology” on the channel Carenodes provides an in-depth discussion on healthcare business models, focusing on managed care, and is aimed at healthcare entrepreneurs, especially those new to the sector. Here’s a summary of key points covered in the transcribed part of the video:

  • Introduction to Healthcare Business:
    • The video begins with an overview of healthcare business, emphasizing the importance of understanding where healthcare money comes from and one’s role within the healthcare ecosystem.
    • It’s specifically designed for healthcare entrepreneurs, including those with varied backgrounds, highlighting the steep learning curve and business side of healthcare that is often overlooked by clinicians.
  • Speaker’s Background:
    • The speaker shares their extensive background in healthcare administration, including managing clinics, overseeing hospital networks, and working with health plans. This diverse experience underpins the insights shared in the presentation.
  • Key Concepts Discussed:
    • Healthcare as a Personal and Nuanced Field: The importance of hands-on, job-based learning over theoretical knowledge.
    • Navigating the Healthcare Ecosystem: For newcomers, understanding the ecosystem’s complexity and finding one’s place within it is crucial.
    • Importance of Demystifying Healthcare: Emphasizes the need for transparency and understanding in healthcare, drawing an analogy with a cave that becomes illuminated the moment a match is struck.
  • Ethical Considerations:
    • A significant portion of the video is dedicated to ethical considerations, urging participants to take healthcare seriously, understand their roles, and always prioritize patient well-being.
  • Managed Care and Its Components:
    • Managed care is defined, and its components are outlined, including payer-provider contracting, credentialing, and network development.
    • The video explains the managed care department’s role in ensuring that healthcare providers are credentialed and contracted with health plans.
  • The Business Side of Healthcare:
    • The speaker dives into the financial aspects of healthcare, explaining managed care’s focus on cost control and the shift towards value-based care.
    • Various healthcare financing mechanisms are discussed, with an emphasis on understanding the flow of funds within the healthcare system.

This summary covers the first part of the video. There are more pages available, indicating additional content not included here. If you’re interested in more detailed information or specific parts of the video, please let me know!

Watch the video here.

Maryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care

Maryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care

Maryland Physicians Care (MPC) Provider Relations Representatives Maryland Physicians Care

MPC providers have designated Provider Relations Representatives based on the practice/group location. This specialist will be your primary contact with MPC and will keep you updated on any policy changes. To find your Provider Relations Representative, select a territory for the list below.

Phone: 1-800-953-8854 (follow prompts to PR dept.)
Fax: 866-333-8024

Download the Territory List

MPC Provider Relations Representatives

Medi-Cal Managed Care Enrollment Report

This dataset contains the total number of Medi-Cal Managed Care enrollees based on the reported month, plan type, county, and health plan.

This dataset contains the total number of Medi-Cal Managed Care enrollees based on the reported month, plan type, county, and health plan.

Medi-Cal Managed Care Enrollment Report

The Medi-Cal Managed Care Enrollment Report is a dataset that contains information about the number of people enrolled in Medi-Cal Managed Care plans based on reported month, plan type, county, and health plan. This report is an important tool for policymakers and researchers who want to better understand the state of healthcare in California.

The dataset provides valuable insights into the number of people enrolled in Medi-Cal Managed Care plans, which are designed to provide affordable healthcare to low-income Californians. By analyzing the data in the report, policymakers and researchers can identify trends in enrollment, plan type, and county-level differences in enrollment rates.

One important trend that the report highlights is the increasing popularity of Medi-Cal Managed Care plans. As of the latest reported month, the total number of people enrolled in these plans was higher than ever before, indicating that more Californians are taking advantage of these affordable healthcare options.

Another important trend is the differences in enrollment rates across different counties in California. The report shows that some counties have higher enrollment rates than others, indicating that there may be disparities in access to healthcare across the state.

Overall, the Medi-Cal Managed Care Enrollment Report is an essential resource for anyone interested in understanding the state of healthcare in California. By providing detailed information about enrollment in Medi-Cal Managed Care plans, this report can help policymakers and researchers identify areas where improvements can be made, and ensure that all Californians have access to affordable, high-quality healthcare.

Medi-Cal Managed Care Enrollment Report

Medi-Cal Managed Care Quality Improvement Reports (CA)

Various reports from the State of California regarding the quality of care provided by Medi-Cal managed care health plans. Plan-specific evaluation reports are also prepared for each individual health plan reviewed.

The California Department of Health Care Services contracts with an external quality review organization to evaluate the care provided to Medi-Cal managed care beneficiaries in the areas of quality, access, and timeliness. Reports are available on the DHCS website, including member satisfaction surveys, encounter data validation study reports, managed care accountability sets, external quality review technical reports, plan-specific evaluation reports, health disparity reports, HEDIS® reports, MCP-specific performance evaluation reports, performance improvement project reports, and preventive services reports.

Outline

  • Introduction: Purpose of the DHCS external quality review organization
  • Available Reports:
    • Member Satisfaction Surveys
    • Encounter Data Validation Study Reports
    • Managed Care Accountability Sets/External Accountability Sets
    • External Quality Review Technical Reports and Plan-Specific Evaluation Reports
    • Health Disparity Reports
    • HEDIS® Reports
    • MCP-Specific Performance Evaluation Reports
    • Performance Improvement Project Reports
    • Preventive Services Report
  • Conclusion: Summary of available reports and their purpose.

In accordance with federal requirements, the California Department of Health Care Services (DHCS) contracts with an external quality review organization (EQRO) to conduct external quality reviews and evaluate the care provided to beneficiaries by Medi-Cal managed care health plans (MCPs) in the areas of quality, access, and timeliness. The EQRO presents these external quality review activities, results, and assessments in reports that help DHCS and Medi-Cal MCPs understand where to focus resources to further improve the quality of care.

Medi-Cal Managed Care Quality Strategy Reports

The Medi-Cal Managed Care Quality Strategy Reports are DHCS’ written strategy for assessing and improving the quality of managed care services offered by all Medi-Cal MCPs.

Member Satisfaction Surveys (CAHPS® Surveys)

Each Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey report aggregates the results of CAHPS® surveys, which ask Medi-Cal managed care beneficiaries to evaluate their experiences with their health care health care providers.

Encounter Data Validation Study Reports

Encounter Data Validation (EDV) Study Reports examine the completeness and accuracy of the encounter data submitted to DHCS by the MCPs.

Managed Care Accountability Sets / External Accountability Sets

The Managed Care Accountability Sets (MCAS) / External Accountability Set (EAS) is a set of performance measures that DHCS selects for annual reporting by Medi-Cal MCPs.

External Quality Review Technical Reports and Plan-Specific Evaluation Reports

The EQRO annually prepares an independent external quality review technical report that analyzes and evaluates aggregated information on the health care services provided by Medi-Cal MCPs. As part of the external quality review technical report, the EQRO prepares a plan-specific evaluation report of each of MCP.

Access these reports on the Medi-Cal Managed Care External Quality Review Technical Reports with Plan-Specific Evaluation Reports.

Health Disparity Reports

The Health Disparity Reports identify and understand health disparities affecting California’s Medi-Cal managed care members and are based on focused studies conducted annually by the EQRO. The reports analyze Managed Care Accountability Set (MCAS) measure results reported by Medi-Cal managed care plans (MCPs) for various demographic categories.

HEDIS® Reports

The Healthcare Effectiveness Data and Information Set (HEDIS®) Aggregate Report, also referred to as Performance Measurement Reports, provides performance rates of MCPs during a reporting year and trending using previous years’ data. The report also compares plan-specific and aggregated rates to national benchmarks.

MCP-Specific Performance Evaluation Reports

The MCP-Specific Performance Evaluation Reports are also referred to as Plan-Specific Performance Evaluation Reports.

Access these reports on the Medi-Cal Managed Care Quality Improvement Reports webpage

Performance Measures and HEDIS® Reports

Access Medi-Cal Managed Care’s annual performance measure, External Accountability Set, on the Medi-Cal Managed Care Quality Improvement Reports webpage.

The following performance measure results are also available on our website:

Performance Improvement Project Reports

Plan-Specific Performance Evaluation Reports

Plan-Specific Performance Evaluation Reports are also referred to as MCP-Specific Performance Evaluation Reports.

Access the reports on the  Medi-Cal Managed Care Quality Improvement Reports: External Quality Review Technical Reports and Plan-Specific Evaluation Reports.

Quality Improvement Project Reports

Quality Improvement Project (QIP) Reports are available on the Medi-Cal Managed Care Quality Improvement Reports: Quality Improvement Project Reports webpage.

Technical Reports

Technical Reports are available on the Medi-Cal Managed Care Quality Improvement Reports: External Quality Review Technical Reports webpage.

Preventive Services Report

The 2021 Preventive Services Report and Executive Summary assist with identifying and monitoring appropriate utilization of preventive services for children in Medi-Cal Managed Care.

The 2020 Preventive Services Report and Addendum assesses the provision of preventive services by pediatric Medi-Cal managed care members.

Managed Care Contracts and Health System Operational Alignment

CASE EXAMPLE of how we breakdown contracts and tie the terms to operational alignment

Because the business of healthcare is to deliver the highest quality care to patients, improving clinical performance is the driving focus. However, understanding and responding to financial pressures through increased efficiency and enhanced revenue capture is what makes high-quality clinical delivery possible and sustainable.

Reimbursement StructureActivity triggering a more robust financial return
Reimbursed primarily on a fee-for-service basis, generate more revenue by using your care team as a provider–extender, enabling more patients to see the provider for a billable visit each day
The organization accepts full risk for patient costs, Ensuring patients are taught how best to manage their illness and avoid specialist or emergency room visits. 
Capitated fee for primary care services, experimenting with alternative visit types may maximize your ability to care for more patients
Nonphysician payment for CCMPractices that rely on nonphysician team members to deliver CCM services will probably experience substantial net revenue gains but must enroll a sufficient number of eligible patients to recoup costs.
“If nonphysician staff were to deliver CCM services, net revenue to practices would increase despite opportunity and staffing costs. Practices could expect approximately $332 per enrolled patient per year (95% CI, $234 to $429) if CCM services were delivered by registered nurses (RNs), approximately $372 (CI, $276 to $468) if services were delivered by licensed practical nurses, and approximately $385 (CI, $286 to $485) if services were delivered by medical assistants. For a typical practice, this equates to more than $75 ,00 of net annual revenue per FTE physician and 12 hours of nursing service time per week if 50% of eligible patients enroll. At a minimum, 131 Medicare patients (CI, 115 to 140 patients) must enroll for practices to recoup the salary and overhead costs of hiring a full-time RN to provide CCM services.”
Non-visit-based payment for chronic care management (CCM)Measuring Net revenue per full-time equivalent (FTE) physician; time spent delivering CCM services.

Payer Contract Modeling

Contract modeling, or analyzing potential scenarios of reimbursements to understand financial outcomes, provides a proactive approach to financial management by analyzing the impact of different elements such as methodologies, rate changes, pricing, payor mix shifts and ever changing regulations on margins, rather than net revenue alone.

Do it like a Pro: Managed Care Payer Contract Analysis

Contract modeling, or analyzing potential scenarios of reimbursements to understand financial outcomes, provides a proactive approach to financial management by analyzing the impact of different elements such as methodologies, rate changes, pricing, payor mix shifts and ever changing regulations on margins, rather than net revenue alone.

To determine current and future performance, contract modeling can be applied to current contracts and various “what-if” scenarios.

Various Modeling Approaches

1. Medicare break-even computation

A simple way to evaluate the current state of contract performance is to conduct a basic Medicare break-even analysis. This analysis determines the financial impact if payment for all patient populations were according to Medicare rates. A Medicare break-even analysis is a way to benchmark how well commercial payers pay, and a way to evaluate the performance of key service lines, because it takes the payor mix out of the equation and instead uses a consistent reimbursement approach.

2. Assessment of performance of current contracts.

This straightforward analysis determines whether payment is in accordance with the terms of the commercial contract. The analysis will, for example, determine which service lines have the greatest variances between expected and actual payment.

3. Assessment of proposed contracts

This “what-if” analysis determines how changes in the rate and terms of a proposed contract would affect the yield. Changes in clinical services, types of products (i.e., HMO vs. PPO), or even payers can also be modeled. This provides an understanding of, either in actual dollars or percent, whether the proposed contract will result in shortcomings or whether it will improve the bottom line.4.

4. Comparison of traditional and non-traditional reimbursement methodologies.

Value-based payment models represent a new approach for providers. Many of these models put the provider at financial risk for meeting quality/outcomes targets, so understanding the financial implications of such methods before entering into a contract is critical. Likewise, modeling can help determine how implications of potential decreases in Medicaid funding resulting from changes or repeal of the Affordable Care Act, along with increased self pay and bad debt, will affect the bottom line.

5. Assessment of pricing changes.

Contract modeling can be used to better understand the impact of chargemaster pricing changes. For example, if the charge for a procedure increased by 10 percent, the modeling can show how reimbursement would be affected.

Healthcare Flow of Funds explained: Healthcare Entrepreneur Bootcamp

Agenda Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market.

Healthcare flow of funds explained. Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market. Session led by Alex Yarijanian, CEO Carenodes. The aim: providing healthcare entrepreneurs with a framework within which they will find their place in the business value chain.

No business doing business in healthcare.

No business doing business in healthcare if you don’t know healthcare business. With that said, you shouldn’t limit yourself because you might have value to contribute. But it should worry you because you don’t have the time necessary to gain tribal, on-the-job, healthcare know-how and work experience.

This session challenges the idea that, just because you don’t have healthcare experience, you can’t learn if knowledge is transmitted in uniquely effective styles and methods.

Providing healthcare entrepreneurs with a framework within which they will find their place in the healthcare business value-chain.

Crossing the Chasm of Healthcare Startups: Reduce go-to-market time by understanding your leverqage points vis a vie industry meta-dynamics and insider insight. Bend the learning curve that surprises, paralyzes, and discourages many health technology startups.

Session Notes

A PILOT

Crossing the Chasm of Healthcare Startups: Reduce go-to-market time by understanding your leverage points vis a vie industry meta-dynamics and insider insight. Bend the learning curve that surprises, paralyzes, and discourages many health technology startups.

Managed Care Boot-camp for Healthcare Entrepreneurs, was a ‘pilot’ session designed to impart otherwise difficult to synthesize knowledge. Given its ‘pilot’ nature, please excuse instances where your experience might be interrupted by factors such as difficulty in whiteboard visibility, etc.

BOOTCAMP SESSION EXPERIENCE & OUTCOMES

Everyone should be able to walk out of this session feeling empowered by having learned the basic flow of funds (starting at the payer) and reimbursement structures along the healthcare delivery value chain. 

Managed Care Boot-camp for Healthcare Entrepreneurs, a ‘pilot’ session designed to impart otherwise difficult to synthesize knowledge with the following objectives:

1. Bend the learning curve of entrepreneurs in healthcare
2. Provide a framework to contextualize health tech business models (aim: to help provide a framework within which you will find your place in the business value chain).

You should be able to better refine your understanding of what ‘buckets’, and mechanisms, of funding you should pursue and trigger so as to index your business accordingly. Trends, current industry practices, and changes set to be effective in the future will be weaved into the session so as to contextualize the material. 
Access the session here

For an outline of topics covered, Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market, see below.

to help healthcare entrepreneurs by providing a framework within which they will find their place in the business value chain.

otherwise, how else would you know how to price your deals and products?

Topics covered in this session are as follows:

I. Essential concepts
  • Crash course on 6 functional areas in any healthcare organization
    1. Operations: anything that hits P&Ls
    2. Compliance
    3. Network/Contracting
    4. Health Services: clinical services, medical director’s wheelhouse
    5. Quality: outcomes, QA/QI
    6. Engagement: outreach, customer services, etc.
  • Understanding Volume-to-Value drivers in payment
    • Business models for health technology companies
II. Managed Care Mindset: How to think like your customer.
  • Managed care: ‘utilization management’
  • Payment: Volume shift to value
  • Quality (‘value’) measured
    • Patient experience
    • Clinical outcomes
III. Lines of Business aka ‘LOB’ (funding source)
  • Medicare (Traditional Medicare and Medicare Advantage, Parts ABCD)
    Medicaid (managed Medicaid, state / federal, Medi-Cal)
  • Duals (Medicare and Medicaid beneficiaries)
  • Commercial (on exchange, off exchange)
IV. Products (benefit designs)
  • The spectrum of products: HMO, PPO, POS, EPO, FFS
  • Business ramifications
V. Difference between ‘LOB’ vs ‘product’
  • Difference between ‘LOB‘ (Medicare, commercial, etc) vs ‘product‘ (HMO, PPO, etc.)
VI. Main Reimbursement structures (payer/provider agreements)
  • Fee for service (FFS)
  • Value-based payment: upside, upside/downside
  • Predominate California Market Structure, determine who is at risk
    • Capitation
    • Delegation
  • Risk-based deals
    • Capitations and delegation of functions by the health plan to a third party
    • Global-risk, shared risk, dual risk.

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