Case Management and Enabling Services

1. Case Management and Enabling Services Potential for lost opportunities – how to make sure you capture and report Enabling Services correctly on UDS

2. What are Enabling Services? • Non-clinical and non-medical services provided by a CHC that help to remove barriers that patients may face when trying to navigate the healthcare system.

3. Why are these services important? • We know that underserved minorities face barriers in the healthcare system. • Enabling services have been shown to facilitate access to healthcare. • Enabling services are key components to PCMH • CHCs have consistently done the work of enabling services, get credit for the work you do!

4. Enabling Services are key components of Patient‐Centered Medical Homes (PCMHs) Enabling Services Categories NCQA PCMH Standards Access and communication Patient tracking and registry functions Care management Patient self‐management support Electronic prescribing Test tracking Referral tracking Performance reporting and improvement Advanced electronic communications Payment Source: www.aapcho.org • Eligibility assistance and financial counseling • Interpretation • Transportation • Outreach • Health education • Case management • Other • Enabling services codifying & tracking

5. UDS Enabling Services • Case Management • Help individuals obtain safe, affordable, permanent housing • Assure access to treatment services • Provide crisis assistance • Identifying educational and employment options • Developing a social support network

6. UDS Enabling Services Continued • Enabling Services • Translation • Transportation Assistance • Assistance in establishing eligibility • Assistance in establishing income support • Outreach • Required for HCH 330(h) grant programs • Performed where homeless are found

7. Best Practice • Researched Enabling Services • Best Practice by Association of Asian Pacific Community Health Organizations (aapcho.org) • CHCs do them, let’s capture them! • Easy as 1 -2 -3 • Define services • Assign codes • Capture in 10 minute intervals

8. Case Management-Service 1 • Case Management Assessment - CM001 • Definition: Non-medical assessment that includes the use of an instrument measuring socioeconomic status, wellness or other non-medical health status

9. Case Management-Service 2 • Case Management Treatment and Facilitation - CM002 • Definition: An encounter with a center-registered patient and their household/or family member in which the patient’s treatment plan is developed or facilitated by a case manager. The plan must incorporate the services of multiple providers or healthcare disciplines.

10. Case Management-Service 3 • Case Management Referral – CM003 • Definition: Facilitation of a visit for a registered patient of the center to a healthcare or social service provider. This visit has not otherwise been counted under case management treatment and facilitation.

11. Financial and Eligibility Assistance • Financial counseling or eligibility assistance – FC001 • Definition: Counseling of a patient with financial limitations that result in a completed application to sliding fee scare or health insurance program including Medicare, Medicaid or pharmaceutical benefits program or development of a payment plan.

12. Health Education • Health Education and supportive counseling – HE001 • Definition: Provision of health education or supportive services to an individual in which wellness, preventive disease management or other improved health outcomes are attempted through behavior change methodology.

13. Health Education Subcategories • Some clinic systems want more granularity on their health education sessions – the AAPCHO stated its often those systems who have robust education already in their processes • HE002 – Health Education Group • HE003 – Health Education Individual • HE004 = Supportive Counseling

14. Interpretation • Interpretation – IN001 • Definition: The provision of interpreter services by a third party (other than the primary care provider) intended to reduce barriers to a limited English-proficient (LEP) patient or a patient with documented limitations in writing or speaking skills sufficient to affect the outcome of a medical visit or procedure.

15. Outreach Services • Outreach – OR001 • Definition: Patient services that result in the conversion of a patient who was formerly without a primary care provider to one who has been accepted into a provider’s panel. • This is not a health fair, this is a one on one conversation. • Activity takes place where homeless people gather; shelter, churches, soup kitchen, library, park, underpass, etc.

16. Transportation Services • Transportation – TR001 • Definition: Providing direct assistance to a patient by an employee or contractor of a primary care center to provide transportation for registered patients to receive necessary medical care.

17. Other • Other Enabling Services – OT001 • Definition: All other services that reduce access barriers to health care for a registered patient that do not fall into the above categories and are provided by an employee or contractor at the health center.

18. Documentation Criteria • Valid entries will meet the following criteria: • Service must be provided by a staff member of volunteer of the health center • Service must be linked to a medical patient of the health center • Services must be provided directly to the patient or their primary caregiver (parent) • Services must be documented in the patient chart • Services must be documented on one encounter form per patient, even if multiple enabling services are provided.

19. Documentation of Time • Services must last 10 minutes or greater • For services less than 10 minutes, do not document • Document services longer than 10 minutes in 10 minute increments. Time includes only direct patient time and does not include documentation time • To calculate time increments that fall between 10 minute increments, any amount ending in less than or equal to 4, round down, all amounts ending in 5 or more, round up to the nearest 10.

20. Recap of Enabling Services Codes

21. Enabling Services Encounter Form

22. Scenario

23. Scenario Data Capture • 10 minutes – Financial Counseling FC001 • 30 minutes – Case Management CM002 • 20 minutes – Case Management CM003 • What if? The patient discussed DM nutrition with medication management? • What it? The referral was to nutrition or exercise support group instead of PT? • Is there something else that might replace FC001?

24. Implementation • Information included in this presentation • Enabling Services Encounter Form • Administrative and data collection staff support • Meet often with Enabling Service providers to ensure consistent workflow and reporting – As scenario proved, there are grey areas to define for your center staff • Audit encounters to chart documentation • Track health outcomes!

25. Current and Potential Benefits • PCMH • Correlation of Enabling Services to improved health outcomes • AAPCHO is working with NACHC to develop standards for enabling services and data gathering • Cases of clinics negotiating increases capitated rates based on health outcomes of ES patients

26. Reporting on UDS • Table 5: report enabling services staff and patients served

27. Reporting on UDS continued • Table 5a: reports costs of providing enabling services

28. Sources • Some additional reading from this group: • http://www.aapcho.org/resources/ • Always go back to your UDS manual when reporting – there are nuances to the tables mentioned in this presentation • http://bphc.hrsa.gov/healthcenterdatastatistics/reporting/2013udsreport.pdf