Care Model. The ACO shall establish a model of care agreed to and implemented by all of its PMs. The model of care shall meet standards that assure quality, improve the health of the population and, over time, reduce overall cost. The Agency reserves the right to review and approve policies and procedures for all aspects of an ACO’s model of care to ensure that the ACO’s care model approach aligns with the purpose outlined in section 1.1.5 of this Agreement. The Agency agrees to collaborate with the ACO to ensure care plans support this approach.
Care Model. The vision of the ACC Program is to transform the health care delivery system from a traditional, unmanaged FFS model to a regional, outcome-focused, client/family- centered coordinated system of care. Under the ACC, payment to providers continues to be on a FFS basis, and beneficiaries remain free to choose among all participating Medicaid (and, in this Demonstration, Medicare) providers. However, through the seven Regional Care Collaborative Organizations, the ACC creates an accountability structure missing from a typical unmanaged FFS delivery system. The ACC model drives primary care reform through Primary Care Medical Providers. PCMPs provide whole-person, coordinated, culturally-competent care for beneficiaries. Through the ACC, participating PCMPs are eligible to receive per member per month payments and required to offer increased access to beneficiaries through, for example, extended office hours or same-day appointments. RCCOs also manage virtual networks of providers to promote beneficiary access to care and support providers with clinical tools, data, and analytics. The Demonstration will modify the existing ACC Program framework to support the potentially complex needs of Medicare-Medicaid enrollees and the particular financing of their services. The State will work with RCCOs, PCMPs, and other providers and systems of care to ensure that appropriate, high-quality care coordination is available for all beneficiaries who are served under the Demonstration. The Demonstration will include the full continuum of Medicare and Medicaid services that individuals eligible for both programs are entitled to receive, including Medicare Parts A and B and Part D, and all Medicaid State Plan and appropriate waiver services. Each beneficiary in the Demonstration will be enrolled with the RCCO serving his/her area of the State. For beneficiaries attributed to a PCMP, the RCCO or its designee will perform a comprehensive in-person health screening and work with the beneficiary to complete a Plan of Care within 60 days of enrollment in the RCCO. The Plan of Care articulates the beneficiary’s short- and long-term goals and objectives, and it becomes the blueprint for meeting beneficiary goals and improving The Plan of Care will provide a single, comprehensive view of all elements needed to coordinate a Demonstration enrollee’s physical, behavioral, and social health care, services, and supports. It ensures communication and coordination with the beneficiary, acro...
Care Model. The care model represents a significant change in how the Trust will deliver services to our local population, now and in the future. By fundamentally transforming the way we work and using the resources available to us differently, the Trust will be able to provide a credible, robust service offer which is financially sustainable and enables a cultural shift for both staff and local people in approaches towards health care and wellbeing. There will be a significant focus on changing culture and behaviour; moving from a paternalistic relationship between professional and patient, to a partnership approach where identifying ‘what matters to you’ is the new focus, as opposed to the traditional ‘what is the matter with you’ relationship. The Trust seeks to develop multi-agency partnership arrangements and ensure that volunteers, carers, neighbourhoods and civic functions all play an equal role within integrated multi-disciplinary teams, in the attainment of a balanced and empowered way of life for our residents of Torbay and South Devon. The core principles underpinning the care model will run as a thread through our plans for change: Shifting the focus of care into the community and away from a bed-based model of care. Providing consistent and reliable alternatives to hospital admission and embedding the ethos that, wherever possible, “the best bed is your own bed”.
Care Model. All materials relating to the Care Model and any HCV awareness programs conducted by or on behalf of AbbVie or its Affiliates comply and shall comply with all Applicable Laws.
Care Model. Living Well@Home development programme Care Homes outcomes based commissioning Accommodation, care and support strategy Outcomes based specification for extra care housing and procurement Autism Provide autism awareness training for all staff that come into contact with people with autism Provide specialist training for key staff, such as GPs and community care assessors. Undertake community care assessments for adults with autism irrespective of their IQ and perceived ability Appoint an Autism lead for Torbay Develop a clear pathway to diagnosis and assessment for adults with autism Commission services based on adequate population data and needs assessment Learning Disabilities Focus on people living full and independent lives, where secure homes and fulfilling lives are a priority We will help people and let them know what options they have to help them achieve their goals Improved accessibility to community services for those people who have a learning disability Improve access to employment and housing Mental Health Delivery of the improvement plan with joint commissioning arrangements with Devon County Council and South Devon and Torbay Clinical Commissioning Group Support for integrated personal care planning and brokerage Housing and Care Implement the homelessness prevention plan Re-commissioning of accommodation based and outreach support for single homeless and young peoples’ homelessness support services and young parents service Implement the Devon protocol to support joint action on improving health through housing Accommodation-based care and support plan Better use of equipment, home improvements, grants and technology Homelessness strategy delivery including, prevention and early intervention and alternatives to temporary accommodation and improved hospital discharge Undertake full assessment of the health needs of the homeless population of Torbay is carried out by Oct 2016 The physical development of Care Homes to provide an environment for fit for the provision of care and in support through the Villa Revival programme and Housing Strategy.
Care Model. Living Well@Home development programme • Care Homes outcomes based commissioning • Accommodation, care and support strategy • Outcomes based specification for extra care housing and procurement Autism • Provide autism awareness training for all staff that come into contact with people with autism • Provide specialist training for key staff, such as GPs and community care assessors. • Undertake community care assessments for adults with autism irrespective of their IQ and perceived ability • Appoint an Autism lead for Torbay • Develop a clear pathway to diagnosis and assessment for adults with autism • Commission services based on adequate population data and needs assessment Learning Disabilities • Focus on people living full and independent lives, where secure homes and fulfilling lives are a priority • We will help people and let them know what options they have to help them achieve their goals • Improved accessibility to community services for those people who have a learning disability • Improve access to employment and housing Mental Health • Delivery of the improvement plan with joint commissioning arrangements with Devon County Council and South Devon and Torbay Clinical Commissioning Group • Support for integrated personal care planning and brokerage Housing and Care • Implement the homelessness prevention plan • Re-commissioning of accommodation based and outreach support for single homeless and young peoples’ homelessness support services and young parents service • Implement the Devon protocol to support joint action on improving health through housing • Accommodation-based care and support plan • Better use of equipment, home improvements, grants and technology • Homelessness strategy delivery including, prevention and early intervention and alternatives to temporary accommodation and improved hospital discharge • Undertake full assessment of the health needs of the homeless population of Torbay is carried out by Oct 2016 • The physical development of Care Homes to provide an environment for fit for the provision of care and in support through the Villa Revival programme and Housing Strategy. Safeguarding Adults • Continue to prevent abuse and neglect wherever possible, understand the causes of abuse and neglect, and learn from experience • Safeguard adults in a way that supports choice and control and improves their lives • Provide information and promote public awareness to enable people in the community to be informed so that they know when,...
Care Model. A comprehensive approach developed and implemented by Contractor and Participating Providers to support Attributed Members with integrated care and coordinated services. The Care Model emphasizes screening and risk stratification of all Attributed Members; prevention, improvement, self-management, and coordinated treatment of disease; tailored interventions based on the level of risk; and effective team-based care. CMS: Centers for Medicare and Medicaid Services Cohorts: The Traditional Attribution Cohort and Expanded Attribution Cohort together.
