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Care Manager Qualitative Report Card

Designed to help Program Managers conduct quality improvement and performance evaluation reviews of the care management team

Andrea Liebsch avatar
Written by Andrea Liebsch
Updated over a year ago

Account Set Up and Consent/PHI Authorization

  • Are all patients assigned a care manager?

  • Do all patients have at least 2+ chronic conditions?

  • Is CCM consent documented for all enrolled patients?

    • If not…

      • Have all eligible patients received a full series of 2 Consent Outreaches from Phamily?

      • Have all eligible patients received a full series of 3 Enrollment Invitations from Phamily?

      • Have patients received phone call outreach for purposes of describing the program, its benefits, and goals? Is the outreach documented in Phamily?

    • Is CCM consent documented in Phamily and in the patient’s EHR?

    • Is PHI authorization documented in Phamily and in the patient’s EHR?

Care Plans

  • Do all patients have a care plan?

  • Do all care plans have 3 customized Health Goals set by the provider and the patient?

  • Are all care plans being shared once completed? (Mail, EMR, Phone #)

  • Are Health Goals in the care plan being met? If not, is there revision or adjustment of the Health Goals?

  • Are all medications and conditions in the care plan / check against the EMR?

  • Are care plans neat and professional, clinically sound and up to date?

  • Does the patient have a clear understanding of the health goals and the care plan?

Patient Engagement

  • Are all enrolled patients receiving Check-ins 2x weekly (one should be an Auto-suggest or follow up message)?

  • Are 60-80% of assigned patients progressing through the Minutes Gates throughout the month?

    • Are all patients at 5 mins by the end of Week 1?

    • At 10 mins by the end of Week 2?

    • At 15 mins by the end of Week 3?

    • At 20 mins by the end of Week 4?

  • Have all Normal status patients received Check-ins during the week? Optional: Have all Normal status patients received a "check-in" courtesy phone call about once a quarter?

  • Are patients with Manual - Call-only status receiving a phone call at least 1x a week, and is the discussion documented?

  • Are CMs responding to all patients within 2 business days?

  • Are patients with low or no engagement in the last 4 weeks receiving phone calls by their Care Manager?

Customer Service

  • Does the CM communicate back with the patient in the appropriate time frame? It is best practice to respond back within 48 hrs if not less.

  • Does the CM communicate in a friendly and engaging manner and with empathy towards patients?

  • Have all issues raised by patients been addressed? Has the CM closed all loops with patients and not left any patient “hanging”?

  • Is the CM communicating with patients about their Health Goals in a manner that will help them achieve the goals?

Escalations and Triage

  • Are there clear escalation protocols in place that the CM knows how to follow?

  • Is the CM following the provider’s escalation protocol(s)?

  • Did the CM triage or escalate all medically appropriate, urgent, emergent, and/or important issues to the provider, and documented in the EHR?

Documentation

  • Are all notes detailed and provide sufficient information of the CM activities?

  • Are all activities, Notes, and Tasks being logged appropriately?

  • Are CMs conducting thorough patient medical record reviews to identify and close/address care gaps?

Goal: Audits conducted weekly by reviewing 3-5 patient profiles in Phamily for each Care Manager

Questions?

Contact support@phamily.com, or click the question mark in Phamily

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