Written By Chryste Middleton, RN S UGGESTIONS FOR CM WORKFLOW P ROBLEM /S OLUTION A PPROACH Please...

SUGGESTIONS FOR CM WORKFLOW

PROBLEM/SOLUTION APPROACH

Please adjust your desktop

volume for voice narration

CURRENT PROBLEM

There is not enough time during each shift to complete:

The daily goal for open cases

Data entry on each opened case

Follow-ups

BBL’s/urgent notifications

MMO Initials and follow-ups

Pending calls

Upshots with PPOT’s

CURRENT BARRIERS

1. The current daily goals are distributed unevenly, and are set too high for the amount of work and time that is allotted to complete the task.

2. There is no triage role available to allow nursing care management and follow up time.

3. Nurses are attending to additional incoming calls that are non-revenue producing (Benefits and customer services questions, follow up call backs or WT for other nurses, MMO HED participants, enrollment callbacks, and outcomes callbacks.

BARRIER #1THE CURRENT DAILY TARGET GOALS ARE DISTRIBUTED UNEVENLY, AND ARE SET TOO HIGH FOR THE AMOUNT OF WORK AND TIME THAT IS ALLOTTED TO COMPLETE

THE TASK

Shifts Daily goals for open cases Time for data entry time for all non Medicaidparticipants30 mins – 45mins

Estimated data entry time for Medicaid campaign45 mins – 1hr

8 hours daily,(5 days)40 hrs weekly

5 cases daily25 cases weekly

2 hrs 30 -3 hrs 45 mins

3hr 45 mins -5 hrs



3 hrs 30 mins -5 hrs 25 mins

5hrs 15 mins -7 hrs



4hrs 30 mins - 6 hr 45 mins

6 hrs 45mins -9 hrs



2 hrs 30 mins -3hrs 45 mins

3 hrs 45 mins -5 hrs

LPN’s 8 hours daily(5 days)40 hrs weekly

8 cases daily40 cases weekly* No credit for closing cases

4 hrs -6 hrs

6 hrs -8 hrs

SOLUTION FOR BARRIER #1

REALISTIC GOALS AND DATA ENTRY TIMEShift Daily goals for open

casesEstimated daily open cases with current staff schedule

Time for data entry time for all non Medicaidparticipants30 mins – 45mins

Estimated data entry time for Medicaid campaign45 mins – 1hr



Florida 43 2 hrs 30 mins -3 hrs 45 mins

3hr 45 mins -5 hrs



Georgia 87 2 hrs 30 -3 hrs 45 mins

3hr 45 mins -5 hrs



Total Estimated daily goal 130

3 hrs 30mins - 5hrs 15 mins

5hrs 15 mins -7hrs



current daily goal 113 2hrs -3 hrs

3hrs -4hrs

LPN’s pending8 hours daily(5 days)40 hrs weekly

5 cases daily cases weekly 25***Credit for closed cases

2 hrs 30 mins -3 hrs 45 mins

3hrs 45 mins -5hrs

BARRIER #2CURRENTLY, THERE IS NO TRIAGE ROLE AVAILABLE TO ALLOW NURSING CARE MANAGEMENT AND FOLLOW UP TIME.

Process Flow

Comparison

Nurse care coordination and education

A Doctors Office or

L and D unitMaternalinkUHC/BCBS

The Purposeof this slide isto illustrate that the current PCMprocess flow reflects the expectation that a PCM shall perform several clinical roles daily.

SOLUTION TO BARRIER #2

Triage Nurse/PCM model (Goal Focus would change)

Rotational Team Approach (Focus on weekly goal versus daily)

There are no current URAC CM accreditation guidelines that prohibit triage nursing as an addition to CM nursing. Unfortunately, It does state that LPN’s can not complete assessments if URAC accreditation is warranted.

BARRIER#3

NURSES ARE ATTENDING TO ADDITIONAL INCOMING CALLS THAT ARE NON-REVENUE PRODUCING (BENEFITS AND

CUSTOMER SERVICES QUESTIONS, FOLLOW UP CALL BACKS FOR OTHER NURSES, MMO DISEASE MANAGEMENT

PARTICIPANTS, ENROLLMENT CALLBACKS, AND OUTCOMES CALLBACKS

SOLUTION TO BARRIER #3

Request that Telecom Sets up a voice guided phone option center that:

1. Has an allows consumer to contact their PCM directly by selecting their name from a directory.

2. Has an option to route calls to an assessment coordinator or to the outcomes department (this will require all staff to leave more detail messages)

3. Has option for customers to contact benefits dept for benefits related questions

4. Adds to BBL option that we can not answer medication/OTC meds questions.

Provides direct dedicated MMO and BBL ACD logins

STAFF MORALE BOOSTERS AND PRODUCTIVITY MOTIVATORS

If the team approach is utilized.

Place a dry erase achievement board up in CM to chart team performance.

Provide gas, grocery, or movie gift cards to your 2 top performers on a weekly basis. (GA and FL separate incentives)

Provide incentive for you top performing team on a monthly basis.

Provide a gas card or grocery gift card to the LPN that completed the most upshots.

Provide a gift card for the nurse that completed the most BBLs or MMO’s.

Conduct a pot luck lunch, and group discussion 1 x per month for 1 hour to allow staff speak freely with management.

Written By Chryste Middleton, RN S UGGESTIONS FOR CM WORKFLOW P ROBLEM /S OLUTION A PPROACH Please...

Documents

Transcript of Written By Chryste Middleton, RN S UGGESTIONS FOR CM WORKFLOW P ROBLEM /S OLUTION A PPROACH Please...