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Baseline Assessments / Swim Lane Diagrams

Baseline Assessments / Swim Lane Diagrams. Presented by: Helen C. Burch, MBA Managed Care Advisors, Inc. Presentation Overview. Process Assessment Assessment Criteria Business Process Mapping. Process Assessment. Research environment Interview stakeholders Collect documents

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Baseline Assessments / Swim Lane Diagrams

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  1. Baseline Assessments / Swim Lane Diagrams Presented by: Helen C. Burch, MBA Managed Care Advisors, Inc.

  2. Presentation Overview • Process Assessment • Assessment Criteria • Business Process Mapping

  3. Process Assessment • Research environment • Interview stakeholders • Collect documents • Review data sources • Verify information systems capabilities • Document existing processes – swim lanes

  4. Assessment Criteria • Core Measures • Case Management Measures • Data Measures

  5. Core Measures • Accountability & Structure • Regulatory Compliance • Documentation Compliance • Stakeholder Communication • Clinical Services

  6. Accountability & Structure • Philosophy, goals, objectives • Organizational structure • Committees

  7. Regulatory Compliance • Reporting • File maintenance • Staff responsibilities

  8. Documentation Compliance • Accuracy • Completeness

  9. Civilian Communications • Documents • Correspondence • Forms

  10. Clinical Services • Installation services • Community services

  11. Case Management Measures • Information Systems • Staffing • Patient Protections • Client Choice • Identification & Assignment • Client Disclosure • Client Assessment • Case Management Plan Requirements • Complaints • Discharge & Termination • Return to Work

  12. Information Systems • Systems integration • Access • Tools

  13. Staffing • Job descriptions • Credentials • Caseloads • Performance standards • Physician expertise • Staff development and management

  14. Patient Protections • Confidentiality • Security

  15. Client Choice • Client rights • Provider selection

  16. Identification & Assignment • Selection • Case Manager assignment • Integration with third parties

  17. Client Disclosure • Communications to client

  18. Client Assessment • Evaluation

  19. Case Management Plan • Plan development • Review and updating • Decision making

  20. Complaints • Management and referral

  21. Discharge & Termination • Case closure • Discharge and termination

  22. Return to Work • Vocational rehabilitation • Modified and restricted duty • Independent Medical Examinations (IMEs) • Transition to work

  23. Data Measures - Metrics • Program outcomes - frequency and cost • Case Manager performance

  24. Business Process Mapping • Swim Lane Diagram • Technique for mapping organizational structure to processes • Delineates ownership of all activities and processes within swim lanes

  25. Swim Lane Example

  26. Now What? • Assimilate and record all information • Review with stakeholders • Identify leakage points • Design and implement strategies for improvement • Monitor progress

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