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AltaMed Health Services has taken a phased approach to developing a comprehensive care management model to coordinate care for complex patients, including dual eligibles with chronic conditions.
The first step in developing the model was studying the utilization patterns and the demographic make-up of the population, according to Shameka Coles, associate vice president of medical management, AltaMed Health Services Corporation, a 23-site, multi-speciality physician organization in Southern California that has been designated by the Joint Commission as a Primary Care Medical Home and is the largest federally qualified health center in the United States.
During A Comprehensive Care Management Model: Care Coordination for Complex Patients, a May 6th, 2015 webinar, now available for replay, Ms. Coles shares the key steps in developing this care management model, including details on how it was rolled out across its highest-risk patients and preliminary results achieved from this model.
- How AltaMed engages and activates its members into the care management model;
- The key members of the interdisciplinary care team, their roles and responsibilities and where AltaMed learned it needed to up-staff after doing its population assessment;
- The details on how AltaMed aligned its care management model with its care management system, PCMH requirements, the Triple Aim measures and health plan compliance requirements;
- The impact the redesigned care management model has had on HEDIS measures, preventive care measures and inpatient metrics, including bed days, length of stay and readmissions; and
- The key lessons learned by AltaMed during this process, including staff training requirements, model revisions, documentation and standardization and how to support staffing ratios.
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