Region 4 Kelly Bowman Crisis Systems Manager Leverage strengths - PowerPoint PPT Presentation

Region 4 Kelly Bowman – Crisis Systems Manager

• Leverage strengths of current infrastructure to support collaborative continuum of care coordination CCS Follow Up Care Coordination Case Management

• Current Success • EHR uniformity • Communication access between coordination teams • Long standing community ties

Scope of CCS • Non payor driven system Integration Challenge coordinating lower levels of care Barriers • Care Coordinators only notified for inpatient hospitalization & residential services Real time data

Looking Ahead & Maximizing Success Prioritize Outreach & Education • Connect CCS with RAE involved initiatives & community partners Operationalize works flows to more clearly identify triggers points & level set expectations for coordination teams. Maximize outreach without duplication. Establish a monthly “Coordination Collaborative” for care coordinators, case managers, & CCS follow up teams. • Increase resource sharing • Clearly define roles & responsibilities • Identify best practices for coordination of high acute complex Members • Training collaborative & skill building • Improve interagency communication

Aligning Vision to Improve Performance Metrics Readmission 7 Day Follow Up Level ER Utilization Appointments Improvements