Issue link: https://www.e-digitaleditions.com/i/55648
information to the primary care pro- vider about the patient's diagnoses, medications and plan of care to meet the quality care standard of facilitating communication to provide integrated between behavioral health and physical health providers. During a follow up call, the member was back on her anti- depressant medication and doing well. She was also continuing to work with the tobacco cessation coach to contin- ue her success beyond her 101st day of being tobacco free. CMCS also provides RN care manage- (left to right): Healthcare coordinators Amber, Rachel, Jennifer, Marshay Members C by Jennifer Sizelove Healthcare Coordinator ooperative Managed Care Services (CMCS) employs registered nurse care man- agers and healthcare coordinators to assist the provider offices with the care of their members. Navigating the complex healthcare system can be difficult, and sometimes a little guidance and support from a friend- ly healthcare advocate by phone can make a big difference in members getting preventative care and timely services. Two examples of how the CMCS team worked with providers to support the care of members are illustrated below. Jennifer, one of the healthcare co- ordinators at CMCS, received a call from Dr. Harris's office requesting assistance with a member who had missed several recent appointments and who had been using the ER fre- CMCS Helps Providers Manage Their quently for non-emergent care. Jennifer contacted the member and discovered that the member did not have reliable transportation. Jennifer connected her with the free transpor- tation services available through the member's Medicaid Managed Care Entity. The member was also educat- ed about keeping her appointments and calling her primary care pro- vider's office to see whether a visit to the ER was needed after hours, or if the problem could wait until the next day. Dr. Harris's office subsequently reported that this member has been keeping her appointments and not going to the ER for care that could be provided in the office. During a reach out call, another member indicated to Jennifer that she was interested in quitting smoking. Jennifer sent the member information on quitting tobacco and referred her to the 1-800-QUIT-NOW program for ongoing support with a telephone coach. When Jennifer called back the next month to see how the member was doing, the member indicated that she had stopped taking her antidepressant and she was severely depressed. The member was referred to the behav- ioral health nurse, who assessed the member's situation and needs. This RN care manager set up the appoint- ment with a behavioral health pro- vider and authorized the therapy with the provider. She also reminded the behavioral health provider to provide ment services for members with chronic diseases and complex care needs. The RN care manager works with the provid- er's office to facilitate a comprehensive plan of care, promote access to that care and find appropriate resources to assist the member to reach the optimal level of self-management of their health. For assistance with your members who are eligible for care management at CMCS, call 877-747-2138. NCQA and HEDIS T by Linda Grosser, RN, CNP he National Committee for Quality Assurance, also known as NCQA, is the organization that accredits Managed Care Entities and promotes healthcare quality for consumers. Managed Care Entities (MCE's), including Medicaid and Medicare, are required to promote NCQA quality measures when par- ticipating in state and federally funded healthcare programs, such as Indi- ana Medicaid and the Healthy Indiana Plan (HIP). Many commercial health plans also pursue NCQA accreditation. Employers and consumers can get reli- able information about MCE's and the quality of care and services that these organizations provide through data which is published by NCQA.* HEDIS, or Healthcare Effective- ness Data & Information Set, is a widely used set of quality measures developed and maintained by NCQA. (continued on next page) CMCS connections 4 first qu arter 2012