WGU D046 Retake Latest 2023 Graded A

WGU D046 Retake Latest 2023 Graded A OARS Open-ended questions Affirmations Reflective listening Summaries Positive reframing of thoughts/Form of MI motivational interviewing a collaborative, person-centered form of guiding to elicit and strengthen motivation for change. Empathy for difficult task CBT & DBT Biopsychososcial history through interviewing, asking open ended questions. Narrative Based Therapy Looking at a problem focused story of a clients life. Cognative Reframing A form of cogantive behavioral therapy that assists individuals in reframing their thinking about stressors, promote positive perspectives. Focuses on problem, does NO diagnoses transitional care Activities that prevent repeated and avoidable readmissions and negative health outcomes after a discharge. motivational interviewing a collaborative, person-centered form of guiding to elicit and strengthen motivation for change Case Management Process 1. Client Identification/Selection 2.Assessment and problem/oppertunity identification 3.Development of case management plan 4.Implementation and coordination of care activities. 5.Evaluation of the case management plan and follow up 6.Termination of the case mgmt process Utilization management Medical Necessity Review care plans and charts for medical necessity Ensure patients length of stay in hospital is appropriate, given their diagnosises, health issues, and types of treatment being administered. Care reimbursment is based upon evidence of medical necessity. Medicare Part A (aka Hospital Insurance or HI) Hospice care Medicare Part B The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies. Medicare Part C includes a+b, with additional offerings like vision, dental Medicare part D Prescription drug coverage Credentialing Affirmation of the working knowledge of care coordination in the field with having met the requirements for certification. credentialed-work exp Certification Assessment driven validation of the knowledge and application of care coordination in the field and validation of knowledge and critical thinking skills to successfully implement a quality outcome for the client. cert-test Curative Treatment Help a patient regain strength and work toward some level of recovery. care coordinators role: reinforce education on illness treatment, resources and referalls. Palliative Care Simple, focused care to improve the comfort of the client in a familiar enviroment, improves QOL. comfort care with or without curative options cc role: offer and educate at time of chronic illness diagnoses. afforable care act law enacted in 2009 that provides healthcare coverage options via state run insurance options patients are protected from lack of health insurance or pre existing conditions that could have excluded employers from providing coverage plans for their full time employees without penalty. SMART T Timely Does the objective propose a timeline when the objective will be met? Accountable Care Organization (ACO) Improve patient outcomes through coordination of care measures and services that improve a patients qol. goal. reduce hospital readmission and improve patient compliance in community settings. value based care models shift the healthcare system to rewarding physicians for quality of care provided rather than a fee based system with a quantity over quality focus. Smart S specific who is the target population? what will be accomplished? Smart M measurable Is the objective quantifiable? can it be measuered? How much change is expected? Smart A achievable can the objective be accomplished in the proposed time frame? smart R realistic Does thr objective address the goal? Will the objective have an impact on the goal? DRG Patient classification system to help control and standardize costs for inpatient services. used along with patient and regional demographic data to determine the median cost for a particualr procedure/service. categorize patients into groups based on diagnoses, type of treatment (ex. surgical) complications or co-morbidities, age, gender, or discharge status. Determine length of stay, average cost the hospital should charge for similar patients. PCMH-patient centered medical home HUB/WHEEL coordinated through primary care physician to make sure patients recieve care they need. partnership between patients and their personal healthcare team. centralized "neighborhood" of communtiy resources. AIMS Model Patient engagement Assessment and care plan development Case management Ongoing care as needed PACO LIKE TACO Primary care coordination in the guided care model, a specially educated RN is responisble for patients with multiple chronic conditions. coordinates specially with other providers to ensure nothing is missed. Accute care coordination accute health problems (heart attack/stroke) require complex level of care becuae of critical emergency nature. risk for communication breakdowns, redundancies and medical errors can increase with diffrent providers involved. continues when emergency has passed. scheduling follow up visits, making sure meds filled, reviewing follow up instructions. goal is to reduce hospital readmission rates, prevent avoidable er visits Tripple Aim/Quadruple Aim Improve patient outcoms Improve patient experience Lower cost of care for patient. QA-Improve phyisican experiance. added to prevent burnout Post accute long term care coordination Rehab, long term care (LTC), post accute care PAC facilities may need to move between facilities or diffrent levels within same facilities. predominatly senior aged. readmission risk factors may signify inadequate transitional care process or a mismatch between patients needs and PAC resources Population Health Health outcomes and efforts to influence these outcomes of a group of individuals key-pop with a similar characteristic.(age, geographic proximity, similar diagnoses) Clinical case management model (counselor/therapist) clinical care provider serves as case manager. provides direct counseling for a clients individual needs. encourages the client to connect with informal resources such as family, friends and peers. Strengths based case management model focuses on empowering clients and their families growth, education, and skill development. recognizes value of community services encourages client to take lead in identifiying their own needs. involves outreach, clinical services, advocacy. clinical community linkages Helps connect HCP, community organizations to improve patients access to preventative and chronic care services. patients get more help in changing unhealthy behaviors. clinicians get help in offering services to patients that they cannot provide themselves community programs get help in connecting with client for whom their services were designed. AIMS Patient engagement phase PACO Interact with the patient and their family, ensure that their questions are answered, and to provide guidance and resources that will help navigate patients through their care plan Validating a patient's concerns Reinforcing the role of the coordinator as a helper/resource Giving information to address immediate concerns AIMS Assesment PACO Allow the coordinator to "identify social and environmental factors that may affect medical plan adherence, health care services utilization, and health care outcomes. The assessment process collects information that is helpful for interpreting the completed assessment and using that information to develop a comprehensive care plan that will address the patient's medical and non-medical challenges. AIMS Case Management Phase PACO is all about ensuring that the patient stays on track and has the support and he/she needs. Under this model, case management includes Monitoring goal progress Offering support Modifying the care plan as necessary to align with the patient's changing needs Care Coordination Step 1 Identification/Referal Patients who may benefit from coordinated care are identified or referred to the care coordinator. There are checklists that a coordinator would complete to verify that a patient is eligible to receive the services, from an insurance standpoint. Additionally, the patient must consent to receiving this care intervention. Care Coordination Step 2 Assess Client Goals, Needs, and Care Team Members The patient would come for an initial assessment visit with the care coordinator to begin the planning process. Documentation of the patient's health history, medication history, social history, mental health history, and any family or cultural considerations are documented as part of the assessment. Care coordinators should use this interaction to set the stage for a positive trust-based relationship with the client. Based upon the types of care and services that the patient may need, a care team of medical and behavioral health providers would be identified, along with other resources such as therapists, a case manager, a social worker, or community-based resources that the patient may need An initial draft of a coordinated care plan is drafted for review and discussion by the new care team, and the initial care conference with the patient and care team members is scheduled. Care team members will draw from their experience and backgrounds, along with sources of evidence-based care approaches, to make recommendations on the most appropriate treatment options for the patient. Ideally, the use of technology would be implemented to allow members of the care team to share information between care team members and with the patient. Electronic medical records, electronic sources of evidence-based practices, patient portals, and other mechanisms for tracking client information and their progress will allow the care team to best support the patient throughout the coordinated care continuum. Care Coordination Step 3 Care Conference The care team will meet with the patient and further discuss the care plan to identify opportunities to gain the patient's feedback on how their healthcare needs may best be met by the care team. Depending on the patient's complex health issues, the team may recommend various short-term and long-term treatments (referred to as interventions) and provide the patient with different options so he or she may participate in shared decision-making with the team. Care Coordination Step 4 System Navigation A member of the care team will be identified to be the system navigator: the person who will guide the patient through various aspects of the care plan, as well as coordinate treatments, referrals, follow-ups, laboratory services, and any other support the patient may need. The system navigator may help the patient with staying on track with care appointments and referrals to new providers. The navigator maintains close contact with the patient's primary care provider (PCP) and the care coordinator concerning treatment plan progress and other information that the coordinator and PCP may need to document or address during follow-up visits with the patien Care Coordination Step 5 Follow Up Care Conference The system navigator (or the care coordinator) would host a follow-up visit between the care team and the patient to review progress that has been made. The team, patient (and patient family members or caregivers) could discuss the patient's interventions and any lifestyle changes that were identified as goals, then determine how well the patient has been able to stay on track with the treatment plan. If the patient has been challenged with staying on track or does not understand some aspect of his or her care, the team can suggest other options for providing the patient with additional support tools, as appropriate. This also gives the patient the opportunity to voice any issues or concerns that have not been addressed, and to have any questions answered. Communication Skills Set the stageGreet patient appropriately and acknowledge the wait time if neededFind out how the patient is feeling about the consultationIntroduce the computer into the coordinator-patient triadExplain and reassure the patient of confidentiality of EMR Elicit informationIntermittently look at the computer for previous relevant information while interviewing the patientPoint to relevant areas on the screen when neededAvoid computer use when the patient is addressing a concern with a significant psychological burdenInvolve the patient in verifying EMR data entry’s accuracy and completion Give informationWhen sharing the screen, verify the patient’s ability to view contents optimallyEncourage the patient to ask questions and check for patient understandingShare coordination materials using electronic resources, as appropriateKeep balanced eye contact, while maintaining awareness of cultural norms associated with eye contact Understand the patient’s perspectiveRecognize the patient’s perspective on the use of the computer in the healthcare environment, and act accordingly End encounterProvide handouts or website references and community support services as outlined in the patient’s coordinated care plan Case Management Process Step 1: Patient Identification Focuses on identifying clients who would benefit from case management services. This step may include obtaining consent for case management services, if appropriate. Case Management Process Step 2: Assesment and problem/oppertunity identification Begins after the completion of the case selection and intake into case management and occurs intermittently, as needed, throughout the case. Case Management Process Step 3: Development of the case management plan Establishes goals of the intervention and prioritizes the needs of the client, support system, and/or family caregiver, as well as determines the type of services and resources that are available in order to address the established goals or desired outcomes. Case Management Process step 4: Implementation and coordination of care activities Puts the case management plan into action Case Management Process Step 5: Evaluation of the case management plan and follow up. Involves the evaluation of the client's status and goals and the associated outcomes. Case Management Process Step 6: Termination of the case management process Brings closure to the care and/or episode of illness. The process focuses on discontinuing case management when the client transitions to the highest level of function, the best possible outcome has been attained, or the needs/desires of the client change. DICE C Commitment. is the dedication level of leaders to a change initiative. DICE I Integrity. refers to the project team's performance and ability to achieve project goals within the defined timeline. DICE C Commitment. is the dedication level of leaders to a change initiative. The level of commitment, or lack thereof, must be apparent across the organization undertaking change. HIPPA Privacy Rule protection of individually identifiable health information by three types of covered entities: health plans, health care clearinghouses, and health care providers who conduct the standard health care transactions electronically.** HIPPA Security Rule regulations outlining the minimum administrative, technical, and physical safeguards required to prevent unauthorized access to protected health care information