The Green Park Collaborative (GPC) has developed a new tool to help health care decision makers confidently and consistently use Real World Evidence (RWE) when making tough coverage and care choices. Called RWE Decoder, the spreadsheet-based assessment tool lets users review and evaluate all existing studies and evidence for both rigor and relevance. Informed by these factors, users can assess study quality, and generate a visual summary to help gauge the evidence under review.
Published RWE studies developed from data-rich electronic medical records or medical claims data are increasingly available from health care systems. However, the quality of this research can vary widely, and payers, clinicians and other health care decision makers often dismiss it out of hand. RWE Decoder and its associated user guide and framework, offer a thoughtful approach to helping these decision makers assess whether RWE studies address their questions and can appropriately guide their choices.
The tool, user guide, and supporting white paper are available here: https://goo.gl/AhbHUw
Siloed thinking, practices and technology greatly undermines potential to advance research, treatments and cures for most diseases. This is a shot at a vision to address this challenge, starting with a disease called primary ciliary dyskinesia (PCD).
The Open Data era in health and social care, pop up uni, 12.00, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
How to communicate scientific and medical information to patients, advocates ...jangeissler
How to communicate scientific and medical information to patients, advocates and caregivers, presented by Jan Geissler at the European Medical Writer's Symposium (EMWA) on 12 May 2016
Implementing and Evaluating the Hospital Guide to Reducing Medicaid ReadmissionsJSI
Reducing readmissions is a growing priority in the pursuit of the Triple Aim. While much attention has been paid to Medicare readmissions, evidence demonstrates that Medicaid agencies are increasingly implementing payment penalties for readmissions, and the recent expansion of Medicaid eligibility under the Affordable Care Act (ACA) has provided millions of adults with new health coverage. Hospitals serving large numbers of Medical patients have a mounting interest in adopting strategies to reduce readmissions that address the distinct needs of this population.
The Green Park Collaborative (GPC) has developed a new tool to help health care decision makers confidently and consistently use Real World Evidence (RWE) when making tough coverage and care choices. Called RWE Decoder, the spreadsheet-based assessment tool lets users review and evaluate all existing studies and evidence for both rigor and relevance. Informed by these factors, users can assess study quality, and generate a visual summary to help gauge the evidence under review.
Published RWE studies developed from data-rich electronic medical records or medical claims data are increasingly available from health care systems. However, the quality of this research can vary widely, and payers, clinicians and other health care decision makers often dismiss it out of hand. RWE Decoder and its associated user guide and framework, offer a thoughtful approach to helping these decision makers assess whether RWE studies address their questions and can appropriately guide their choices.
The tool, user guide, and supporting white paper are available here: https://goo.gl/AhbHUw
Siloed thinking, practices and technology greatly undermines potential to advance research, treatments and cures for most diseases. This is a shot at a vision to address this challenge, starting with a disease called primary ciliary dyskinesia (PCD).
The Open Data era in health and social care, pop up uni, 12.00, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
How to communicate scientific and medical information to patients, advocates ...jangeissler
How to communicate scientific and medical information to patients, advocates and caregivers, presented by Jan Geissler at the European Medical Writer's Symposium (EMWA) on 12 May 2016
Implementing and Evaluating the Hospital Guide to Reducing Medicaid ReadmissionsJSI
Reducing readmissions is a growing priority in the pursuit of the Triple Aim. While much attention has been paid to Medicare readmissions, evidence demonstrates that Medicaid agencies are increasingly implementing payment penalties for readmissions, and the recent expansion of Medicaid eligibility under the Affordable Care Act (ACA) has provided millions of adults with new health coverage. Hospitals serving large numbers of Medical patients have a mounting interest in adopting strategies to reduce readmissions that address the distinct needs of this population.
A presentation showcasing some of the patient recruitment challenges that I encountered as a recruitment manager as well as some of the strategies -- DIGITAL ADVERTISING -- I used to overcome them.
AMA & MGMA Practice Innovation Challenge Winnershealth2dev
This slide provides descriptions for the 5 winners of the AMA & MGMA Practice Innovation Challenge. The winners were announced at the MGMA 2015 Annual Conference. Winners will work work with the AMA to develop their proposal into a module for the AMA Steps Forward Website.
weems-Texas Medicaid Health Home Pilot Project Evaluation MethodsNASHP HealthPolicy
Leslie A. Weems, LMSW, Senior Policy Analyst and Project Manager, Medicaid/CHIP Division, Texas Health and Human Services Commission discusses Texas Medicaid Health Home Pilot Project Evaluation Methods at the New Tactics for Building Medical Homes in State Medicaid and CHIP Programs webinar
Clinical trials are necessary for medical research. Producing new medicines to the market depends on the strength of research organizations and drug companies to test and verify their work vigorously through their Clinical Trials, but finding people willing to participate is notoriously tricky.
Slide presentation from Day Two of the PCORnet Partners meeting. The January 21-2, 2014 meeting took place at the Brookings Institute. This event launched the development of the nation’s most ambitious and promising clinical research network aimed at delivering high quality care through patient-centered outcomes research.
PrEP Implementation Planning for the USCHAMP Network
CHAMP Monthly Teleconference Training - PrEP's the Word: Everyone's Talking About It... But What Do We Need To Know, And Do, About Pre-Exposure Prophylaxis
The role of patients and healthcare providers in translational medicinejangeissler
The role of patients and healthcare providers in translational medicine, presented by Jan Geissler at the European Commission's Personalized Medicine Conference 2016 on 1 June 2016 in Brussels
Getting Investigators Onboard: Lab Preferences Make a Difference in Trial Par...Covance
Clinical trials are becoming increasingly complex and competitive, so attracting the best investigator sites to participate in a trial is a crucial step in meeting patient enrollment targets. Learn more about how investigator preference can help meet trial recruitment milestones.
We specialize in the successful placement of all physician specialties and sub-specialties in small rural facilities, large medical centers, healthcare systems, and academics. We ensure that your new physician will integrate well into your community as both a true leader and a valuable asset for your facility.
A presentation showcasing some of the patient recruitment challenges that I encountered as a recruitment manager as well as some of the strategies -- DIGITAL ADVERTISING -- I used to overcome them.
AMA & MGMA Practice Innovation Challenge Winnershealth2dev
This slide provides descriptions for the 5 winners of the AMA & MGMA Practice Innovation Challenge. The winners were announced at the MGMA 2015 Annual Conference. Winners will work work with the AMA to develop their proposal into a module for the AMA Steps Forward Website.
weems-Texas Medicaid Health Home Pilot Project Evaluation MethodsNASHP HealthPolicy
Leslie A. Weems, LMSW, Senior Policy Analyst and Project Manager, Medicaid/CHIP Division, Texas Health and Human Services Commission discusses Texas Medicaid Health Home Pilot Project Evaluation Methods at the New Tactics for Building Medical Homes in State Medicaid and CHIP Programs webinar
Clinical trials are necessary for medical research. Producing new medicines to the market depends on the strength of research organizations and drug companies to test and verify their work vigorously through their Clinical Trials, but finding people willing to participate is notoriously tricky.
Slide presentation from Day Two of the PCORnet Partners meeting. The January 21-2, 2014 meeting took place at the Brookings Institute. This event launched the development of the nation’s most ambitious and promising clinical research network aimed at delivering high quality care through patient-centered outcomes research.
PrEP Implementation Planning for the USCHAMP Network
CHAMP Monthly Teleconference Training - PrEP's the Word: Everyone's Talking About It... But What Do We Need To Know, And Do, About Pre-Exposure Prophylaxis
The role of patients and healthcare providers in translational medicinejangeissler
The role of patients and healthcare providers in translational medicine, presented by Jan Geissler at the European Commission's Personalized Medicine Conference 2016 on 1 June 2016 in Brussels
Getting Investigators Onboard: Lab Preferences Make a Difference in Trial Par...Covance
Clinical trials are becoming increasingly complex and competitive, so attracting the best investigator sites to participate in a trial is a crucial step in meeting patient enrollment targets. Learn more about how investigator preference can help meet trial recruitment milestones.
We specialize in the successful placement of all physician specialties and sub-specialties in small rural facilities, large medical centers, healthcare systems, and academics. We ensure that your new physician will integrate well into your community as both a true leader and a valuable asset for your facility.
PYA Consulting Manager Linda ClenDening helped connect the dots between the data at the 2013 AHIMA Convention and Exhibit in Atlanta. She spoke during the Innovation educational track on the topic: “Beyond Meaningful Use: Connecting Quality Data Requirements to Business Operational Improvements.”
The Next Generation ACO Model team hosted an open door forum on Tuesday, March 28, 2017. The Next Generation Model features three payment rule waivers, referred to as benefit enhancements. This open door forum provided an overview of the Model’s three benefit enhancements.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
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http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
A customized, comprehensive approach that delivers strategic solutions to communities, physicians, hospitals & health systems. Each component builds the foundation for the next to create true physician alignment & integration.
1. Policy Analysis
Introduction
Organizational policy alignment and adherence to laws and regulations is critical for overall corporate compliance and to decrease organizational risks (patient falls, medication errors, cyber hacks and PHI data breaches, infection control, et cetera). In this assignment, you will select, evaluate, and update one health care provider’s policy related to a significant regulatory risk to the health care organization.
Instructions
Select one of two options:
Option A
If you work for a hospital or health care organization you may select a policy that is of interest to you then follow these assignment instructions:
· Imagine you are a health care administrator at your current employer. Analyze the policy you selected, taking into consideration any recent changes. Evaluate what information and where that information would need to be updated. Propose revisions that are based on current identified standards and/or new guidelines that you have researched in the text or identified in other high-quality sources (that is, journals, government websites, and the like). Analyze the significance of the selected policy updates as it relates to potential litigation. (Why did the policy need updating? What threats do these changes help avoid?) Summarize your perspective on the revisions as well as any additional changes that should be considered. Present your work as an executive summary suitable for distribution to your organization’s board members.
Option B
If you do not work in the industry or do not have access to a health care policy, use the Hahnemann Falls Policy to complete this assignment. Then follow these assignment instructions:
· As you can see, this policy was written in 2012. Now, imagine you are a health care administrator working at the health care organization where this policy originates from. Analyze the policy, taking into consideration the changes in HIPAA and PHI since 2012. Evaluate what information and where that information would need to be updated for a current revision of this document. Locate the areas where you would update or add information to this 2012 version. Propose revisions that are based on current identified standards and/or new guidelines that you have researched in the text or identified in other high-quality sources (that is, journals, government websites, and the like). Analyze the significance of the selected policy updates as it relates to potential litigation. (Why did the policy need updating? What threats do these changes help avoid?) Summarize your perspective on the revisions as well as any additional changes that should be considered. Present your work as an executive summary suitable for distribution to your organization’s board members.
Your paper should be 3–5 pages long and should include a title page and references for a total of 5–7 pages.
Strayer Writing Standards
This course requires the use of Strayer Writing Standards. For assistance and information, please refer to t ...
1. Policy Analysis
Introduction
Organizational policy alignment and adherence to laws and regulations is critical for overall corporate compliance and to decrease organizational risks (patient falls, medication errors, cyber hacks and PHI data breaches, infection control, et cetera). In this assignment, you will select, evaluate, and update one health care provider’s policy related to a significant regulatory risk to the health care organization.
Instructions
Select one of two options:
Option A
If you work for a hospital or health care organization you may select a policy that is of interest to you then follow these assignment instructions:
· Imagine you are a health care administrator at your current employer. Analyze the policy you selected, taking into consideration any recent changes. Evaluate what information and where that information would need to be updated. Propose revisions that are based on current identified standards and/or new guidelines that you have researched in the text or identified in other high-quality sources (that is, journals, government websites, and the like). Analyze the significance of the selected policy updates as it relates to potential litigation. (Why did the policy need updating? What threats do these changes help avoid?) Summarize your perspective on the revisions as well as any additional changes that should be considered. Present your work as an executive summary suitable for distribution to your organization’s board members.
Option B
If you do not work in the industry or do not have access to a health care policy, use the Hahnemann Falls Policy to complete this assignment. Then follow these assignment instructions:
· As you can see, this policy was written in 2012. Now, imagine you are a health care administrator working at the health care organization where this policy originates from. Analyze the policy, taking into consideration the changes in HIPAA and PHI since 2012. Evaluate what information and where that information would need to be updated for a current revision of this document. Locate the areas where you would update or add information to this 2012 version. Propose revisions that are based on current identified standards and/or new guidelines that you have researched in the text or identified in other high-quality sources (that is, journals, government websites, and the like). Analyze the significance of the selected policy updates as it relates to potential litigation. (Why did the policy need updating? What threats do these changes help avoid?) Summarize your perspective on the revisions as well as any additional changes that should be considered. Present your work as an executive summary suitable for distribution to your organization’s board members.
Your paper should be 3–5 pages long and should include a title page and references for a total of 5–7 pages.
Strayer Writing Standards
This course requires the use of Strayer Writing Standards. For assistance and information, please refer to t ...
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Introduction to UCare’s
Medical Policy Program
•Why We Need Medical Policies
•What is Medical Policy?
•Overall Strategy
•What is Next?
•Who to Contact
11/15/2013
1
2. Why Do We Need Medical Policies?
• Move from using external guidance only (CMS, DHS) to
incorporate our own resources (Interqual, clinical practice
guidelines and now medical policies) along with external
guidance
• Meet Exchange (UCareChoices)
and NCQA needs
• Support Triple Aim:
11/15/2013
2
3. What is Medical Policy?
• UCare documents that provide assistance in making coverage
determinations regarding health services
▫ Generally accepted, evidence-based, cost-effective, universal to all
products (although coverage may differ by plan) and intended to help
our providers improve the health of our members
• A medical policy ≠ coverage decision
▫ Allows us to better define our position in relation to CMS/DHS coverage
determinations and the Exchange.
• Medical policies do not fully address payment or coding issues
11/15/2013
3
4. Medical Policy & Coverage Determination
Legislative
Mandates
(DHS, CMS)
Medical
Policy
Medical
Director
Decision
EOC, COC,
Contract
Clinical
Practice
Guidelines
Member
Eligibility
InterQual
11/15/2013
4
5. 5
Phase 1:
Development and
Publication
Phase 2:
Phase 3:
Implementation
Post-Implementation
•Medical policy topic
identified
•Medical Policy topic
prioritized
•Review of literature
and clinical evidence
•Medical policy
drafted
•IMPC
discussion/approval
•QIACC or P&T
Council
discussion/final
approval
•Clarification and
integration with
payment policy
•Integration into
systems and
processes
•Internal operational
use of medical
policies
•Measure the
utilization,
effectiveness and
outcomes
•Maintenance of
medical policies
•Collect feedback
•Continued
publication
•Initial publication
11/15/2013
5
7. Complexities of Development and
Implementation
Medical Directors
Payment Policy
Government Relations
Clinical Services
Coding
PEC
Claims
Information Systems
Provider Relations & Contracting
Customer Services
Marketing
Health Care Economics
11/15/2013
Pharmacy
Product
7
10. External Publication: Providers
External Medical Policy site
▫
11/15/2013
Medical Policies published for our members and providers on ucare.org are different from our
internal medical policies in that the do not include internal operations instructions, or cost
analysis information.
10
12. What is Next After Publication?
▫ Integration with:
Payment policy
Benefit design
Products
Provider Network
Systems
▫ Measurement
▫ Outcomes
Phase 1:
Development/
Publication
Development and final
approval of a medical policy
11/15/2013
Phase 2:
Implementation
Integration, publication,
systems, products,
operationalize
Phase 3:
Post-Implementation
Utilization, effectiveness,
maintenance, feedback
12
13. Who to Contact with Questions?
If you have questions about the medical policy program, specific medical
policies, or if you receive questions from members or providers about the
content of a medical policy, please forward them to Emily Barton at
ebarton@ucare.org for her to triage and track.
If you have comments or suggestions for a Medical Policy topic that you would
like to see available, please fill out the Topic Request form and inter-office it
to Emily Barton.
Topic Request Form
Located on the Resources tab under Medical Policies
11/15/2013
13
Editor's Notes
- WelcomeJohn Corlett publicationImplementationNot yet completed all elements of implementation
Codes listed in the policies are:may or may not be extensive to explain relevant codes to topics being discussed, but do not fully address all of the nuances needed for claim and payment adjudication. for referencenot superseding specific CMS/DHS guidance
Medical Policies do not supersede what we’ve done with the decision making sequence, all of that is unchangedMedical Policy is a component that will help review cases after other resources have been used if there is no other guidance.- Work that has not been done yet – authorizations, PEC set up
IMPC oversees medical policy development and implementation P& T assists in the management of drug benefitsQIACC provides guidance on the quality of care and approves medical policiesImplementation Workgroup integrates policies within current systems and processes, publishes approved MPs externally and internally
- Implementation kicked off this past spring and summer with John Corlett’s PM assistance.- The implementation workgroup identified steps needed to implement a policy.Policies are at different stages of the processThe more we’ve described the process, the reality is the complexities, it touches different areas, many groups involved, building a number of processes to address this.At this point, because much of this still has to be developed, it is not in place. But we are building a great understanding of what it will take to get policies implemented. We think this will be beneficial in a number of ways, consistency.
These are for internal use, and are the full policy.Internal versions will evolve over the next 6-12 months as we add payment policy and other operational elements of our operation.Only approved policies, they may or may not be implemented yetRollout just starting – will notify when you have access to these in the next week or so- Going forward these will be updated as new policies get approved.
Available to providers, members, and consumersDisclaimer that states these are for informational purposes only and do not constitute medical advice, authorization, payment, or explanation of benefits. Does not guarantee any results or outcomes- Internal staff should direct providers here, if you send or fax policies use the external version.
Implementation workgroup has started to build structure, using a form to trackImplications to benefit design, products, our network. Affects a number of areas.1st phase development, 2nd implementation, 3rd, evaluation/measurement- Third phase is very critical because we want to determine how effective our program is.
We are going to be producing a Lectora version of this presentation for new employees or if you want to review this presentation at a later date. Periodic updates and new policies will be posted on Myucare