Roundup Newsletter – May 2021 Issue
- Empowering Veterans with Care Options
- Safeguarding OCC Claims Data
- RCI Streamlines Referral Appointments
- Updated Patient Safety Guidebook Now Available
- CommCare CRM Supports Customer Service Interactions
- Webinar: CRM for VA Medical Facility Community Care Offices
- Consult Toolbox 2.0 Overview Course
- Updated Patient Safety Guidebook Now Available
- New! CCN Access Support
- Support
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Resources
Empowering Veterans with Care Options
Dear VHA Colleagues,
As the number of COVID-19 cases decline and pandemic restrictions are lifted, we’re expecting a significant increase in Veterans’ 
requests for health care appointments and specialty referrals. To meet this challenge and improve the overall referral process, the Office of Veterans Access to Care (OVAC) and Office of Community Care (OCC) are coordinating with the field to implement the nationwide Referral Coordination Initiative (RCI).
RCI will streamline, improve, and measure the effectiveness of our referral processes—and improve Veterans’ overall access to care. As you know, the major change with RCI is demonstrated by shifting the work of many of our clinical and administrative staff members to special Referral Coordination Teams (RCTs), with the goal of offering Veterans better care options and coordination both in VA and the community.
I want to thank those of you who have joined our dedicated RCTs across the country. By offering guidance through the range of care options, RCTs will empower Veterans to make informed decisions for the best and most timely care that meets their individual needs. I am confident that by working together, all VA medical centers will be able to reach our goal of providing Veterans with a world-class experience when seeking care within the VA system or through our community providers.
Thank you for your partnership and all your support for the RCI effort.
Sincerely,
Mark Upton, MD
Acting Assistant Under Secretary for Health (AUSH) for Community Care
People, Process and Technology 💻
OCC has implemented the Program Integrity Tool (PIT) to safeguard the integrity of the OCC claims process, protect the taxpayers’ investment, and prevent improper or fraudulent payments for OCC programs. The PIT data repository operation and maintenance responsibilities reside within OCC Department of Program Integrity (DPI), which is responsible for combating Fraud, Waste and Abuse (FWA).
PIT Functions:
- The Extract Transform Load (ETL) Service: Loads claims data from source systems into the data repository and posts returned claims scoring results for adjudication and payment.
- The Program Integrity Data Repository: Receives claims-related data from other systems, creating a centralized data repository. These other systems include the Plexis Claim Manager (PCM) system, the Electronic Claims Adjudication Management System (eCAMS), Community Care Reimbursement System (CCRS), and Claims Processing & Eligibility (CP&E) system.
- The Claims Scoring Tool (CST): Claims sent to the repository (as part of a batch process from the ETL) are subsequently processed by the scoring tool. The CST is comprised of business logic called JRules and Fraud Abuse Management System profiles (FAMS-IBM). When claims are scored in PIT, JRules are applied to the batch file such as duplicate logic. The output scoring results are provided back to the source system for pre-payment adjudication. FAMS profiles identify outlier providers by peer group and are subsequently used for post payment analysis and data mining for fraud investigations.
- Reporting and Analytics: DPI leverages the PIT data repository to create visualizations, reports, data extracts and business intelligence tools in support of the prevention, detection, and investigation of FWA.
To learn more and gain access to the data repository, visit the Operations & Quality Improvement Access site.
Resources and Support
- VHA Data Portal
- Questions? Contact Elizabeth.tyler@va.gov.
RCI Streamlines Referral Appointments
To streamline the scheduling of referral appointments for Veterans, using the Implementation Checklist, all VA Medical Centers (VAMCs) must implement the Referral Coordination Initiative (RCI) in all required specialties by June 30, 2021. This change shifts the work of multiple staff members to Referral Coordination Teams (RCTs) comprised of administrative and clinical staff.
Implementation Checklist
To assist VAMCs with effective implementation and compliance with the RCI Standards and Expectations for Fiscal Year (FY) 21 Memo, the RCI Implementation Checklist:
- Provides VAMCs with required elements to successfully implement, execute, and oversee this initiative.
- Captures high level tasks and sub-tasks broken down by implementation phases, such as planning, execution, and oversight.
- Highlights training and resources, including the Implementation Checklist training video.
To ensure Veterans have the information needed to make decisions about their care, RCTs will have meaningful discussions with Veterans about care options both within VA and in the community.
Resources and Support
- Referral Coordination Initiative SharePoint Site
- Standards and Expectations for FY 21 – Memo
- VHA Senior Leadership Quick Guide for RCI Implementation
- Staff Fact Sheet
- Questions? Contact the RCI Project Team.
Updated Patient Safety Guidebook Now Available
The VA Patient Safety Events in Community Care: Reporting, Investigation and Improvement Guidebook was recently updated to improve information sharing, reporting, and feedback to stakeholders of patient safety events (adverse events and close calls) in the community. The guidebook supports VA’s goal of preventing unintentional harm to patients resulting from their medical care. It also increases communication and collaboration between VA and its community providers.
The guidebook provides:
- Tools and processes to report, investigate, and improve patient safety for Veterans who receive community care.
- Clear roles, responsibilities, and procedures to address potential gaps related to patient safety event reporting and resolution for Veteran care referred in the community.
- Detailed processes related to identifying and reporting patient safety events, along with analyzing and resolving root causes related to the occurrence of those events.
- Guidance on procedures associated with community care-related patient safety events involving Third Party Administrators (TPAs) Optum or TriWest, established under the Patient-Centered Community Care (PC3) network or under the Community Care Network (CCN).
- Information on processing, investigative analysis and/or quality improvement initiatives, and implementation of corrective actions for community care-related patient safety events involving non-TPA community care providers/facilities providing care under Veterans Care Agreements (VCAs).
Resources and Support
- VHA CC Patient Safety Guidebook
- Patient Safety – Incident Reporting SharePoint
- Guidebook e-Learning Module
- Questions? Contact CC-PatientSafety@va.gov.
CommCare CRM Supports Customer Service Interactions
VHA Office of Community Care (OCC) customer service representatives have a new information sharing application to quickly and efficiently address nationwide community care questions and concerns. On May 24, 2021, VA launched Community Care Customer Relationship Management (CommCare CRM), a cloud-based software application designed to improve customer service interactions and response times.
CommCare CRM is a convenient platform to help OCC staff manage customer service interactions in real time. Veterans, beneficiaries, and community providers who contact any OCC customer service gateway can expect their VA representative to have access to notes, event-specific files, points of contact, and a history of how their query has been handled in a single, searchable database. CommCare CRM reduces the need for email correspondence since customer service representatives can immediately access relevant information. Callers can expect an improved response time to their query once the application is fully deployed nationwide.
Currrently, CommCare CRM is not a replacement for the Patient Advocate Tracking System-Replacement (PATS-R) tool. However, the CommCare CRM project team is working on integrations that will allow work to be passed between PATS-R and CommCare CRM. Future functionality will allow patient advocates (PAs) to assign requests in PATS-R to CommCare CRM users, and CommCare CRM users to report quality and safety issues, compliments, and complaints to PAs to be worked in PATS-R.
CommCare CRM will first be implemented at multiple locations in Veterans Integrated Service Networks (VISNs) 8 and 16. It will then be deployed to all other VHA facilities in phases through Nov. 1, 2021.
Resources and Support
- CommCare CRM National Deployment SharePoint
- Community Care Customer Service Guide
- Customer Experience Overview Training (TMS VA 4411363)
- Questions? Contact OCCCustomerExperience@va.gov.
Get Smart💡
New and updated community care training courses are now available in the updated training catalog (05/04/2021) on the Training Page of the Community Care Hub. Please see below for specific updates.
Webinar: Customer Relationship Management (CRM) for VA Medical Facility Community Care Offices (C3) combines instruction and a live system demo of the CRM application, and includes question and answer sessions. (TMS VA 4568386)
Eligibility Consults and Referrals Training/VAOS
Consult Toolbox 2.0 Overview Course provides users with an overview of the updated Consult Toolbox 2.0 and outlines the new functionalities and enhanced capabilities of the tool. (TMS VA 4568812)
Finance, Community Providers and Contract Administration
Community Care Patient Safety and Quality Processes: How VHA is Advocating for Change is an overview of historical influences and OCC efforts to improve patient safety and quality of care. (TMS VA 4568998)
New! CCN Access Support
The OCC Network Support Resources site is now more user friendly, allowing staff to spend less time documenting issues and more time coordinating care.If you have questions about network access or adequacy or are struggling to find providers to schedule appointments, this site can assist with access concerns.
The site provides suggested topics and agenda items to discuss with third party administrators (TPAs), Optum or TriWest, during your VA medical facility’s monthly network adequacy meeting. A common question might be:
Who do I contact if my facility is having issues with Network Access/Adequacy to CCN providers?
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Your facility’s Optum or TriWest representative
- Local and VISN staff should work closely with their TPA representative to resolve network-related inquiries (e.g., status of providers contracted and fully onboarded with the TPA, providers not appearing in Provider Profile Management System [PPMS], on-going recruitment efforts, etc.)
- Your VISN OCC field representative
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If issues are not adequately addressed at this level, please use your normal protocol to elevate concerns to your VISN office who should submit a report to the Network Access Issue Escalation site and contact your OCC CCN Deployment Team regional manager:
- Region 1: Angela Gilley: Angela.Gilley1@va.gov
- Region 2: Angela Gilley: Angela.Gilley1@va.gov
- Region 3: Kerry Paperman: Kerry.Paperman@va.gov
- Region 4: Lisa Jones: Lisa.Jones99@va.gov
- Region 5: Lisa Jones: Lisa.Jones99@va.gov
Resources and Support
- Network Access Issue Escalation site
- OCC Network Support Resources
- Email feedback, edits, or ideas for additional content to the OCC Network Adequacy team at VHANetworkAdequacyTeam@va.gov.
Support 🛠
Community Care Hub – General resources on community care programs and processes. (Intranet)
Field Guidebook – Technical operational guidance for community care operations. (Intranet)
Public Website – Main external website for community care. (Internet)
Public Website for Community Providers – Main public website for community providers. (Internet)
YouTube Channel – Public video library on a variety of community care and revenue operations topics.