VHA Office of Community Care (OCC) - Transformation Updates - February 2019

Veterans Health Administration sent this bulletin at 02/11/2019 08:29 AM EST

OCC Transformation Updates
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VHA Office of Community Care

 

 

 


VHA Office of Community Care (OCC)
Transformation Updates - February 2019

Graphic illustrates intersection of health care and technology.


TriWest Expansion Completed - A Huge Thank You

The VHA Office of Community Care (OCC) and TriWest would like to thank each VA medical facility and the VHA staff members who participated in the virtual and onsite trainings for the TriWest Expansion initiative. The TriWest network expansion impacted 11 VISNs allowing the extension of current coverage for Veterans for the Patient-Centered Community Care (PC3) and Veterans Choice Program (VCP).

We appreciate your time, participation, and flexibility with the virtual and onsite trainings. OCC’s goal is to provide the skills and knowledge needed to operate the new systems and processes required to successfully support the TriWest Expansion. Your feedback was constructive in making each consecutive training more insightful and beneficial for VA medical facility staff, and provided lessons learned to help improve trainings for other OCC efforts.

Please utilize the TriWest Expansion embedded staff and SharePoint resources for any follow-up questions and refreshers on content reviewed during the virtual and onsite trainings. Clinical Integration Field Support staff will be contacting facilities for follow-up of implementation to determine if additional support is needed. Additionally, please share feedback and success stories regarding the TriWest Expansion, or any other OCC initiative, to VHAOCCOCM@va.gov.  Thank you!

Support:

Community Care Network (CCN) Regions 2 and 3 Contracts Protested - Internal VA Preparatory Activities Continue

On January 22, 2019, VA received notice of Government Accountability Office (GAO) protests for contracts recently awarded to Optum Public Sector Solutions (Optum) for Regions 2 and 3 of VA’s Community Care Network (CCN). As a result, Optum has been directed to immediately stop all work until the stop work order is lifted. VA is moving forward with the deployment of Region 1 of CCN in partnership with Optum.

Although VA’s work with Optum for Regions 2 and 3 of CCN stops immediately, internal VA activities to prepare for CCN continue. VA medical facilities should continue to partner with TriWest as it expands its provider networks and continue with other key CCN preparatory activities, such as those outlined below.

Table of CCN Key Tasks

For more detailed information, resources are available on the Community Care Hub.

Support:

Available materials include:

Electronic Claims Adjudication Management Software (eCAMS) Benefits and Proposed Implementation Schedule 

The Electronic Claims Adjudication Management System (eCAMS) is a commercial off-the-shelf claims processing software that centralizes and automates the processing of non-Community Care Network (CCN) claims. eCAMS will eventually replace the adjudication portions of the Fee Basis Claims System (FBCS). 

eCAMS will not change how community care providers submit claims, only how claims are adjudicated. This modernized solution will allow VA to process claims according to industry standards and is intended to increase automation, thereby reducing claims processing times. eCAMS brings the following advantages to OCC staff: 

  • Increasing automation capabilities
  • Decreasing claims processing times
  • Improving accuracy of claims processing
  • Standardizing and reducing complexity for users
  • Improving overall transparency
  • Reducing operational inefficiencies
  • Streamlining administrative operations

eCAMS impacts several OCC stakeholders including Revenue Operations, Payer Relations and Services, Delivery Operations, Claims Adjudication and Reimbursement, and Customer Experience staff. eCAMS will provide role-based access and be deployed nationally in a phased approach beginning in March 2019, as seen in the below draft implementation schedule.

eCAMs Schedule

A designated group of subject matter experts will train claims processing staff on the new system, and trainees will receive reference materials, access to the system, and detailed instruction on system standard operating procedures. 

Support:

Care Coordination Model - Embarking on Phase 2

CCM Principles

OCC end-to-end Care Coordination Model (CCM) streamlines various care coordination components, including a Screening/Triage (S/T) tool; a Care Coordination Plan (CCP) note; case management tools, if indicated; and when necessary, the 72-Hour hospital notification policy for emergency care. 

OCC is using a two-phased approach (5 months total) in Salisbury, NC to implement the enhancements with CCM. 

  • Phase 1 will finish in February 2019. Phase 1 implements use of the S/T tool, the CCP note in Computerized Patient Record System, and the enhanced 72-hour hospital notification note and process.
  • Phase 2 is slated to begin Spring 2019. Phase 2 identifies eligible Veterans in need of Case Management (CM) interventions and follows local policy for providing these services. Veterans’ level of care coordination is identified using the S/T tool. Once identified, eligibility and agreement to enroll in CM services is screened, then a detailed needs assessment is conducted using a 10-part questionnaire to identify specific CM needs. The following outlines the process flow used for Phase 2 just described:

 

CCM Process

Phase 2 also uses HealthShare Referral Manager’s (HSRM’s) care coordination capabilities to perform tasking and other care coordination activities. CCM elements will be integrated into HSRM, allowing users to assign consults to teams, send notifications/alerts, track incoming and outgoing documentation, and develop a care coordination plan. Phase 2 is expected to be completed by late Spring 2019.

Support 

Resources: Care Coordination Model Solutions Page 

HealthShare Referral Manager Demo Series - February 2019

To prepare for training and national deployment, the HealthShare Referral Manager (HSRM) Team will continue the HSRM Demo Series in February. The team will host two demos for interested VA stakeholders. Please attend to ask questions and learn about how HSRM will improve referral and authorization processing for facility community care staff. All demos will include an overview of HSRM, a live demonstration, and time for questions and answers. 

The dates and times for the next two demos are below. To RSVP and receive the dial-in information, please email Brinesha.jackson@va.gov and Hannah.childs@va.gov with the time slot you wish to attend. If multiple people from your facility want to attend, the HSRM team kindly requests that one person send an RSVP with the names and email addresses of all facility personnel who would like to join.   

HSRM Demo Schedule

Check this newsletter each month to find the dates for future demos in the HSRM Demo series.

Support

HealthShare Referral Manager (HSRM) Tours in Altoona and Wilkes-Barre

In January, the HSRM team visited staff and community providers in Altoona and Wilkes-Barre, Pennsylvania as part of an HSRM tour and overview of the system. Attendees expressed how valuable many of HSRM’s features are, including the ability to: 

  • Review services authorized within the standardized episode of care (SEOC)
  • Monitor actions being taken against a referral
  • Share medical documents in one system without faxing or emailing

The HSRM team received positive feedback from community providers who were excited about the ability to monitor and track new referrals and authorizations electronically. Community providers look forward to learning more about HSRM, so please be on the lookout when new information becomes available.    

What are HSRM Tours? The HSRM Team is conducting site visits to engage with VHA staff and their community providers, understand needs, and introduce this new system. These tours include a HSRM demo, and specifically invite dialogue with VA and community provider users to ask questions, express concerns, and provide feedback about HSRM.  

What is HSRM? HealthShare Referral Manager (HSRM) is a new software designed to improve the creation and processing of community care referrals and authorizations. In alignment with IT modernization efforts, VHA is deploying HSRM to help facilitate Veterans access to community care, accelerate medical document sharing for VA staff and community providers, and significantly improve referral status tracking.

 Support

Community Care Training Updates

New community care training courses all available on the Training Page of the Community Care Hub.  These include courses on the following topics:

CCN Core Courses

  • CCN Regional Transitions (Replaces CCN Transitions, Regions 1-4, courses): This course provides an overview of the changes associated with the Community Care Network (CCN) Transition of each region of CCN. Learners will gain knowledge of how the CCN guiding principles and transition strategy will enhance each region. Additionally, you will learn what is new and different with CCN and how to locate and utilize resources that are available.

Care Coordination

  • Standard Episodes of Care (SEOC) for Administrative Staff: This course will provide an overview of the Care Coordination Model in CCN, focusing on standardized episodes of care (SEOC). this course will focus on the role of the Administrative staff.
  • Standard Episodes of Care (SEOC) for Clinical Staff: This course provides an overview of the Care Coordination Model in the Community Care Network, focusing on standardized episodes of care (SEOC). this course will focus on the role of the Clinical staff.
  • National Deployment of the Screening/Triage Tool: This course provides an overview of what the Screening/Triage Tool is and why it is important to the Veterans’ care, especially as it relates to the care coordination process. The course describes the tool’s data inputs and outputs and reviews the roles and responsibilities of its end users (administrative and clinical).

Referrals and Authorization 

  • Consult Toolbox Complete Overview v2: The Consult Toolbox (CTB) Complete Overview course describes the functionalities of each section of the CTB, including updates from version 1.9.

 Support 

Upcoming Training Breakthrough Communications Webinar for Organizational Change Management 

Did you know that 90% of change projects fail not because technology did not work or meet expectations, but because of poor communication and lack of addressing staff’s concerns during the implementation? Have you ever sought after a forum to provide feedback and share success stories revolving around provider outreach and communication with front line staff? In an era where effective communication highly influences employee engagement and satisfaction, and accommodation to change, your voice matters. 

To support ongoing changes with community care, OCC is hosting a second “Breakthrough Communications” webinar in February to provide an overview of communication stakeholders’ roles, responsibilities, and communication needs. During the webinar, instructors will review data on communication preferences of VHA staff and identify common pitfalls with different communication types. 

In this webinar, participants will receive:

  • Industry best practices on effective communication
  • Tactical solutions to increase employee engagement and improve internal communication
  • Information regarding available communication resources and a guide

We hope you can attend this webinar to learn how breakthrough communications can generate success within your organization and help to mitigate potential risks during this season of change with community care.  A formal announcement followed by a calendar invite is forthcoming.

Finally, for those VHA staff who were not able to join the inaugural “Breakthrough Communications” webinar because we reached max capacity in the virtual room, please accept our apologies!  We have ensured this will not happen again.

Support

OCC Transformation Email Directory

A directory of all Transformation related email addresses are available on the Community Care Hub here.