Acronyms Aplenty
Are you curious what all those acronyms mean? You may hear a member of your Care Team use one of these acronyms. Use this guide to better understand, and if you need additional information, ask a member of your Care Team.
- CCM – Chronic Care Management
- TCM – Transitional Care Management
- TCPI – Transitional Clinical Practice Initiative
- PTN – Practice Transformation Network
- NCQA – National Committee for Quality Assurance
- PCMH – Patient Centered Medical Home
- EDIE – Emergency Department Information Exchange
- CCP – Comprehensive Care Plan
- MARCA – Medicare Access and CHIP Reauthorization Act
- APM – Alternative Payment Model
- RAF – Patient Risk Adjustment Score
- MIPS – Merit-Based Incentive Payment System
- CMS – The Center for Medicare and Medicaid Services
National Committee for Quality Assurance
In December, the quality team finished up our corporate NCQA – National Committee for Quality Assurance application. We received a high quality score. We are currently working on applications for all our other sites. This designation is a benefit for all our patients and helps CCWV better serve as your Patient Centered Medical Home.
hronic Care Management and Population Health
Our electronic health record system, Athena, offers a Chronic Care Management software called Pop-Health. This software will help CCWV better navigate our patients to the best opportunities. Our plan includes:
1. STRATIFY & IDENTIFY GAPS
We use our software to organize and align patient data to the quality metrics specific to patients’ needs.
2. COMMUNICATE WITH PATIENTS
Athenahealth analyzes data to identify and test the most effective means for engaging different types of
patients.
3. COORDINATE CARE
We transform your data into a single, consolidated workflow for care teams, integrating with the population
health platform to eliminate swiveling among systems, providing better quality care management.
4. TRACK & OPTIMIZE
Athenahealth provides customized data to track and manage your overall healthcare outcomes.
Our electronic health record system, Athena, offers a Chronic Care Management software called Pop-Health. This software will help CCWV better navigate our patients to the best opportunities. Our plan includes:
1. STRATIFY & IDENTIFY GAPS
We use our software to organize and align patient data to the quality metrics specific to patients’ needs.
2. COMMUNICATE WITH PATIENTS
Athenahealth analyzes data to identify and test the most effective means for engaging different types of
patients.
3. COORDINATE CARE
We transform your data into a single, consolidated workflow for care teams, integrating with the population
health platform to eliminate swiveling among systems, providing better quality care management.
4. TRACK & OPTIMIZE
Athenahealth provides customized data to track and manage your overall healthcare outcomes.
Chronic Care Management and Cloud DX
To allow us to better serve our Medicare patients through additional contact and, for qualified patients, in-home monitoring.
Chronic Care Management has started. This program allows us to enroll Medicare patients who need additional outreach to have regular contact with our teams. We have two Care Coordinator Nurses ready to get started, Taylor Schoonover, RN, and Kathy Crites, LPN. Our on-site Care Teams will let our Care Coordinators know who would benefit from an extra call to check in on their chronic conditions or life stressors.
Through this program we will also be offering, for qualified patients, in-home monitoring. The company we are working with to offer this service to our patients is CLOUD DX. The patient will receive a simple set up with the option of video face-to-face with their Care Coordinator, blood pressure monitoring, glucose monitoring, pulse ox, EKG, and a weight scale. The results of the monitoring will be reported back to the patients’ Care Coordinators and should really help avoid unnecessary visits and ER admissions. This effort is all part of our effort to improve the quality of care for our patients.
To allow us to better serve our Medicare patients through additional contact and, for qualified patients, in-home monitoring.
Chronic Care Management has started. This program allows us to enroll Medicare patients who need additional outreach to have regular contact with our teams. We have two Care Coordinator Nurses ready to get started, Taylor Schoonover, RN, and Kathy Crites, LPN. Our on-site Care Teams will let our Care Coordinators know who would benefit from an extra call to check in on their chronic conditions or life stressors.
Through this program we will also be offering, for qualified patients, in-home monitoring. The company we are working with to offer this service to our patients is CLOUD DX. The patient will receive a simple set up with the option of video face-to-face with their Care Coordinator, blood pressure monitoring, glucose monitoring, pulse ox, EKG, and a weight scale. The results of the monitoring will be reported back to the patients’ Care Coordinators and should really help avoid unnecessary visits and ER admissions. This effort is all part of our effort to improve the quality of care for our patients.
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