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workshops and product overviews activities and networking events |
Breakout Sessions Monday, April 20, 2009 1:30 PM – 2:15 PM
Roundtable Discussion Shannon BrownleeDescription coming soon! CareWebQI® Valuation ProjectOpal Thomas, RN, St. Jude Medical Center and Connie Hill, RN, BS, CPHQ, CPUR, Milliman Care GuidelinesSt. Jude Medical Center, a division of St. Joseph Health System, and Milliman Care Guidelines worked collaboratively to conduct a five-month project to evaluate the impact of the use of the Care Guidelines and CareWebQI in the delivery of inpatient care at St. Jude Medical Center. We evaluated the impact of utilizing the Care Guidelines and CareWebQI with the modified St. Jude Medical Center medical management processes to better manage patients along the continuum of care, and promote quality by using evidence-based clinical best practices in the care delivered. Supporting Hospital Documentation, Workflow, and Electronic Health Record Integration Needs: The Care Guidelines PlanGarrett Foulke, MD, MMM, FACP, FCCM, FACPE, Milliman Care Guidelines and Ann O’Neill, RNC, MBA/HCM, Milliman Care GuidelinesThis session will review the salient issues uncovered by a major initiative to produce newly designed products that address today's hospital and electronic health record needs. The current status of new products and the Care Guidelines roadmap for the future will be presented. Inpatient Hospital ProfilerFrederick Huie, MD, MBA, Horizon BCBS;David Mirkin, MD, Milliman, Inc.This session will focus on how two large health plans use the Inpatient Hospital Profiler tool. The discussion will include tips on how to use the Inpatient Hospital Profiler tool to enhance the use of the Care Guidelines. 2:45 PM – 3:30 PM
Creating an Inpatient Model of Care for the Future Jamie Dunham, MS, BSN, and Shana Herzfeldt, RN, BSN, ThedaCareCollaborative Care is ThedaCare's proprietary innovation of inpatient hospital care that has eliminated wastes, defects, errors and delays. As a result of this model, nurses, doctors, pharmacists and other caregivers practice as partners in care delivery at the patient's bedside. Learn about the Collaborative Care journey from design to current state, and how a "progression of care" focus at the bedside is achieving some great results both for patients and caregivers. Application of Milliman Behavioral Health Criteria in a Mixed Staff and Network Model Medical HMOMark Leveaux, MD, Kaiser NorthwestThe introduction of medical necessity criteria in what was the predominantly staff model HMO of Group Health Cooperative of Washington was a process that took several years. These concepts were new to staff practicing in a capitated model of care. In addition, a concurrent geographical expansion and the introduction of new choice products necessitated expansion of services into a network delivery system, which needed to be managed against medical necessity criteria. The Behavioral Health Guidelines were very useful in introducing and implementing medical necessity concepts and processes to internal staff, as well as reviewing care requests from network staff and providers. A series of educational seminars facilitated this transition. Case Management Across BordersLisa Beichl, Milliman Care Guidelines; Karen Ball, RN, BA, BEd, MA, Active Care ManagementUS insurers and hospitals are tuning in to the global healthcare marketplace. Large hospitals are expanding or partnering with hospitals in other countries, and insurers and self insured groups are looking at international benefits seriously. Whether you have an accident while traveling abroad, are curious about the quality medical care abroad, or are looking at the lower costs of receiving care abroad, the role of the case manager is essential component of that patient journey. In this session, the expanding role of the case manager and new components to quality will be discussed. Attention to levels of corruption in a country, counterfeit medicines, as well as non-FDA approved procedures and equipment will be reviewed in the context of this growing market niche. Tuesday, April 21, 2009 10:00 AM – 11:00 AM
The Care Transitions Theme - A New Direction for Quality Improvement by CMS Jane Brock, MD, MSPH, Colorado Foundation for Medical CareThe Colorado Foundation for Medical Care led a small pilot to convene unaffiliated providers from various settings that care for a common group of fee-for-service Medicare beneficiaries, for the purposes of creating new standard processes for care coordination and to support reliable care transitions. The pilot led to a 50% reduction in 13 d hospital readmissions. The pilot has now been expanded to include 14 communities in 14 different states under the CMS’s Care Transitions Theme for Quality Improvement Organizations (QIOs). The eventual goal of this work is to enable communities of providers to design intentional care planning and delivery across settings for patients with many medical service needs. There is an obvious potential role for national guidelines to support best practices in delivering multi-setting care. Efficient Healthcare ManagementSusan Sloan, RN, CCM, Cox Health PlanThis session will focus on the experience of a small to mid-size health plan in their implementation of the Care Guidelines. Learn how a positive return on investment was achieved in a short amount of time and how staff satisfaction improved. Other topics to be explored will include provider communication and employer engagement. Health Literacy – The Rest of the StoryPaul Smith, MD, University of WisconsinIn this follow up session, Dr. Smith will review results of a health literacy focus group project he recently completed, promising health literacy practices for ambulatory environments and easily available selected health literacy resources. This will be an interactive session with time for audience questions. 11:30 AM – 12:15 PM
Show and Tell with the Editors Louise Bower, RN, Jim Schibanoff, MD, Helen Blumen, MD, MBA, Garrett Foulke, MD, MMM, FACP, FCCM, FACPE and Dorothy Correa, RN, FNP, MSN, Milliman Care GuidelinesThis program provides a presentation of the changes in the 13th Edition, along with an opportunity to discuss those changes with the editors. Interactive Software UpdateLynn Nemiccolo, RN and Tauheedah Avinger, RN, BSN, Milliman Care GuidelinesIn this session, you will see what’s new with CareWebQI for 2008. You will also have an overview of what is coming next for our interactive software. The Care Guidelines and Quality HealthcareSherrie Dulworth, BSN, CPHRM and Tiffanie Lenderman, MBA, MSHA, Milliman Care GuidelinesThis session will focus on the Care Guidelines and how they support quality healthcare. We will discuss potential and actual quality improvement activities and how the Care Guidelines can be used in those activities. In addition, we will explore the crossroads between quality, utilization management and the Care Guidelines. Statistical BenchmarkingJohn Ninomiya, PhD, MSc, FSA, MAAA, Milliman Care GuidelinesThis session reviews the data provided in the Care Guidelines to allow the comparison of actual utilization performance with Care Guidelines standards. The Inpatient Utilization Models and the Statistical Companion section of the Inpatient and Surgical Care product will be featured. The role of data analysis in the development and validation of the Care Guidelines will also be discussed. 1:30 PM – 2:15 PM
Your Requests for the 14th Edition Content (An Interactive Polling Session) Sherrie Dulworth, BSN, CPHRM, Jim Schibanoff, MD, Helen Blumen, MD, MBA, Geaarrett Foulke, MD, MMM, FACP, FCCM, FACPE and Dorothy Correa, RN, FNP, MSN, Milliman Care GuidelinesThis session will present topics, examples and prototypes for proposed future Care Guidelines product development and content enhancements and will allow the audience to provide feedback regarding their preferences and suggestions. Ask the Experts – A Session for Interactive ClientsRajesh Godavarthi, CSM, MCP, Maju Kuruvilla, Julie Arotin, MS, RN, CCP, Kevin Wagner, Gary Barnett, Milliman Care GuidelinesA panel of experts from Milliman Care Guidelines will be available to answer any technical, integration, work flow and reporting tools questions related to our Interactive tools.
Impact of the New Severity Adjusted DRGs (MSDRGs) on Hospitals and Physicians Mark Michelman, MD, MBA, Morton Plant Mease HealthcareThe new severity adjusted DRGs will have a significant impact on both hospitals and medical staffs. Crucial to the process is physician documentation or lack thereof. Interventions will be discussed to help bring together the physicians, clinical documentation specialists, and coders, in an effort to come up with the most appropriate MSDRG for the hospital encounter. The implications of poor/inadequate documentation will be discussed. Effectively Managing A Geriatric Population in the CommunityKim Motter, RN, BSN, CCM, HHS Health OptionsThe Geriatric population is increasing rapidly each year. This population brings new challenges for Case Managers while working to increase their quality of life, maximize their level of independence and prevent premature nursing home placement. Within this population there are two distinct groups of individuals who have different needs and different wants. The depression-era geriatrics want only enough services and support to meet their basic needs and they don't want to take services away from others that they believe need the services more than they do. The Baby Boomer generation wants quality services and they want services to keep them in the living style that they have become accustomed to. The goal is simple, person-centered planning that includes disease management, physician-case manager coordinated care and an effective support system. 2:45 PM – 3:45 PM
Transforming Medicaid: The Challenges of a Member-centric Approach in a Medicaid Environment Chris Ryan, SHPSThis presentation will focus on the challenges associated with providing member-centric care plans in an environment where public services are normally organized and delivered in silos. Present on Admission (POA) and The New Hospital Acquired Conditions (HAC): Legal, Financial, and Public Reporting Implications For Hospitals and Medical StaffMark Michelman, MD, MBA, Morton Plant Mease HealthcarePhysician and hospital documentation is absolutely critical to determine which hospital diagnoses were Present on Admission (POA) and which were not (acquired and/or preventable). This session will discuss the legal, financial, and public reporting implications of the new Present on Admission (POA) Indicator, and the Hospital Acquired Conditions, that medicare is not going to pay for. The unintended consequences that are occurring will be discussed along with interventions to minimize these legal, financial, and public reporting implications. New Learning Management Tool Enhances On Demand Training and Interrater Reliability EvaluationJeff Frater, RN, BSN, CCM, Debbie Jepson, RN, CCP and Donna McNamara, BSN, RN, PMP, Milliman Care GuidelinesConsistent, appropriate use of the Milliman Care Guidelines is vital to conducting quality Care Management functions. The On Demand Training modules provide comprehensive and interactive training to support retention of new skills, build confidence in the application of the Care Guidelines and support consistent application between users. The Interrater Reliability Tool enables organizations to measure the consistent and appropriate application of the Milliman Care Guidelines. This session will provide an overview of the key features and functions of the Learning Management tool and their application for the delivery of On Demand Training and Interrater Reliability testing. Using Information for Quality, Efficiency and Efficacy in HealthcareJohn Ninomiya, PhD, MSc, FSA, MAAA and Jim Schibanoff, MD, Milliman Care GuidelinesDescription coming soon! Wednesday, April 22, 2009 8:30 AM – 9:15 AM
Difficult Cases and How to Handle Them John Semmens, MD, Milliman, Inc.; Alan Greenfield, MD, MBA, Milliman Care GuidelinesClinical cases will be presented that represent scenarios in which the medical director/advisor must make decisions related to care, care resources and situations that require interaction with the treating physician. Your Requests for Interactive SoftwareLynn Nemiccolo, RN, Milliman Care GuidelinesYou’ve asked for an enhancement to our software. What happens with those requests? In this session, you will find out how Milliman Care Guidelines handles client requests. You will see some examples of changes, as well as a glimpse of new products and software. Integration of BlueCross BlueShield of Tennessee Medical Policy into the Milliman Care GuidelinesKathleen Vinson, RN, BSN, Melissa Vaughn, LaShonda Swoope, RN, and Anthony Watts, BS, BlueCross BlueShield TennesseeThis presentation will provide a description of the planning process and steps taken to integrate BCBST medical policies into the Milliman Care Guidelines. |
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©2008 Milliman Care Guidelines LLC, A Milliman Company. All rights reserved.