Provider Education Pivotal to Optimized Heart Patient Program Essay

Healthcare Implementation Quality Issues

Instructions-a. For each intervention listed arrange it to tell a story for studies findings of a Health failure program (only use the information given no reference are need. Each intervention story should be no more than 830 character limit that is including spaces). Make sure that the vital point with in each section is captured in the story. b. Paper format Label each section with corresponding story.

Intervention 1?- Symptom and Sign Management Intervention

Symptom and sign management will occur in the care plan development. For each member, this will include a care manager initiated assessment of the member's HF risk group, medication, diet, and methods for monitoring HF status including how to accurately weigh oneself and monitor symptoms. Management of symptoms will be guided by goals established in care plan. For example, a goal to maintain weight within 150-152 pounds will be measured by daily weights and feedback. Impact and Metrics Self-management allows worsening conditions to be recognized earlier and involves member in their own care. Effectiveness of this intervention will have two metrics: a) percentage of target population that has a documented care plan in the project year. b) percentage of care plans developed prior to June 30 of the Project Year that have an improvement in one or more of the goals. Sustainability As with any learning process, change in behavior will be sustainable on the basis of ongoing care management and member involvement.

Well-developed care plans for members in the HF risk group are pivotal to quality of care and the ability to monitor intervention effectiveness and member behavior change. Care plans facilitate the management of signs and symptoms during the treatment and recovery. The care manager is central to these processes as their duties include assessment of the following in the HF risk group: medication, diet, methods used for monitoring HF status. Member involvement is crucial for early recognition of worsening conditions and communication about progress toward care plan goals.Intervention effectiveness metrics include percentages of: 1) Documented care plans for target population, and 2) care plans showing improvement in one or more goals prior to 30 June, which a sustainability goal for Year 1.

Intervention 2-2. Cardiac Echo Evaluation Intervention

Provider of HF services either cardiologist or PCP will receive telephonic education and support as detailed above. In particular, the importance of initial left ventricular function evaluation and reassessment after change in status or treatment regimen will be discussed. Report cards will include the performance of this testing as documented by claims. In addition to identification of members who need evaluation, the case manager will facilitate member compliance with evaluation - arranging appointment and expediting authorizations. For those members lacking claims, echo reports will be obtained from the provider, incorporated into the reports that measure performance. Impact and Metrics Cardiac echo allows the clinician to understand the etiology of HF, determine other factors-such as valve disease, dilated atria, evidence of ischemic heart disease, etc. which will influence the treatment configuration. Most importantly, LV function will determine if true systolic dysfunction is occurring which will influence treatment decisions. Sustainability Provider education and improvement in cardiac testing practices will be sustained as the provider recognizes the "value added" through the case manager relationship.

Telephonic education and support in HF services will be provided to either the PCP or cardiologist. Claim status regarding testing for initial and post-intervention left ventricular function will be emphasized in the training. Case managers will identify members needing this evaluation, and will facilitate member compliance by arranging appointments or expediting authorization. Absent member claims, echo reports obtained from providers will be used to address performance. Cardiac echo enables the understanding of HF etiology and the determination of other factors influencing the treatment configuration. Importantly, LV function will be evaluated for presence of systolic dysfunction. Provider education and improved cardiac testing practices will demonstrate the value-add of….....