how to use the current pregnancies patient list€¦ · use cases use case 1 to view miis priority...

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Pregnancy Care Management Program Manual How to Use the Current Pregnancy Patient List 07/19/2019

How to Use the Current Pregnancies Patient List

The Current Pregnancies Patient List is available within OneLogin using the following path: OneLogin>CareImpact>Care Impact for OBCM and CC4C>Current Pregnancies Patient List Select the appropriate filters from these options to create a patient list: County, Priority Group, Patient Became Priority – Current Pregnancy Became Priority, Pregnancy Care Manager, Due Date Month Year and/or OB Case Status

After the list has generated, click “EXPORT DATA” to download the list into an Excel file.

I. Applying filters to the Excel file 1. When the report opens in Excel, click the yellow “Enable Editing” bar.

2. Click on the triangle located to the left of column A and above row 1. This will highlight all the cells in the spreadsheet.

3. Once all the cells are highlighted, click “Format” then “Auto Fit Column Width.”

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4. Highlight the entire row with the category headings by clicking on the row number.

5. Click the “Sort & Filter” tab at the top right of the Excel file and select “Filter.”

6. Drop down arrows will be added to each column for the row highlighted:

7. You can now use these drop-down options to filter the data.

II. Removing filter selections on the Excel file When using filters, it is important to remove certain filters when moving between different use cases (see below for use case examples). Otherwise, the results may be limited, because members were accidentally filtered out due to previously selected filters still being in place.

1. To remove the filter selection(s), select “Sort and Filter.” then click “Clear.” This will

remove all filters you have placed on the report.

2. To remove only one filter and leave additional filter selections, select the filtered

column, you would like to remove the filter from and click “Clear Filter From…”

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III. Use Cases

Use Case 1 To view MIIS Priority members (all members with a score of 200+)

1. Apply filter to “Priority Group” by selecting “200-499” and “500-1000.”

2. After the list has generated, click “EXPORT DATA” to download the list into an Excel file.

This will provide an Excel file of all MIIS Priority members on the report.

Use Case 2 To view “OB Case Status” of MIIS Priority members:

A. Closed Case Status –


2. Apply filter to “OB Case Status” by selecting “Closed.”

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This will provide an Excel file of all MIIS Priority Members in a Closed OB Case Status. Follow up guidance for MIIS priority members in Closed status: a) “Ineligible”: Follow up with assigned OBCM about the use of this closed status reason. MIIS

priority members should not be closed for this reason. b) “Declined”: Monitor for patterns in the use of this closed status reason. Are most of these

cases associated with a specific OBCM? If so, does the OBCM need further training on how to effectively engage members in OBCM services?

c) “Lost Contact”: Review OBCM documentation for these members to ensure that appropriate efforts were made to contact and engage the member, which includes outreach to the prenatal care provider. Send a message to the assigned OBCM to continue outreach efforts, if appropriate.

d) “Terminated”: This status should not be used with members receiving OBCM services. If an episode needs to be closed because the member no longer has Medicaid or has moved out of the state, then set the status to “Ineligible.”

B. Monitored Case Status –


2. Apply filter to “OB Case Status” by selecting “Monitored.”

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This will provide an Excel file of all MIIS Priority Members in a Monitored OB Case Status. 4. Review MIIS priority members in Monitored status.

Follow up Guidance for MIIS priority members in Monitored status: Review documentation in the member’s record to determine if this case status is being used appropriately. Monitored status should be used if the member is not actively receiving care management interventions. Examples include: if the member is incarcerated for a short time and the OBCM plans to work with the member later during the pregnancy or postpartum period; if the member is in a residential substance use treatment facility; if the member is receiving services from an intensive home visiting program. The OBCM should continue to document care coordination and all interactions (such as communication with intensive home visiting program) during the period when not directly providing interventions to the member.

C. Pending Case Status –


2. Apply filter to “OB Case Status” by selecting “Pending.” This will display all MIIS priority members in Pending status.

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This will provide an Excel file of all MIIS Priority Members in a Pending Case Status. 4. Review MIIS priority members in Pending status. Pending status indicates that a referral has

been received but the member has not been assigned to an OBCM.

D. Pending Case Status, for more than 30 days – 1. Keep the filters on “Priority Group” and “OB Case Status” as described in the previous Use

Case 2C.

2. Apply a third filter on “Patient Became Priority – Current Pregnancy Became Priority” by selecting “>30 days ago.”


4. Review the documentation for outreach attempts that are being made to contact members.

Do each of these members have at least one or more attempted tasks?

E. No Case Status - 1. Apply filter to “Priority Group” by selecting “200-499” and “500-1000.”

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2. Apply filter to “OB Case Status” by selecting “No Case Status.”


4. Review documentation to determine why these MIIS priority members do not have a documented case status. All members receiving Pregnancy Care Management services should have an open OB Case Status (Managed or Monitored).

Use Case 3 To View OB Engagement Levels:

A. MIIS priority members in Managed status with an Intermittent or Missing Engagement Level -

1. Apply filters to select MIIS priority members as demonstrated in Use Case 1.

2. Apply filter to “OB Case Status” by selecting “Managed.”

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4. Open the Excel file and apply filters as demonstrated in Section I: Applying filters to an Excel

file.

5. Click the “OB Engagement Level” column and select “Intermittent” and “Blanks” to view MIIS priority members in an Intermittent Engagement Level and MIIS priority members without an Engagement Level.

6. Review the documentation with the assigned OBCM to ensure understanding and

competence of programmatic expectations for MIIS priority members in a Managed OB Case Status.

Follow up Guidance for MIIS priority members--OB Engagement Level in Managed status: All members in with an open OB Episode Status must have an Engagement Level set that reflects the frequency of planned care management activity. Members in a managed status should have an engagement level of high, medium, or low, which would indicate that there is at least one intervention with the member every 30 days.

B. MIIS priority members in Monitored OB Case Status with an Engagement Level of High, Medium, Low and/or missing an Engagement Level

1. Apply filters to select MIIS priority members in Monitored status and download list into an

Excel file as demonstrated in Use Case 2B.

2. Open the Excel file and apply filters as demonstrated in Section I: Applying filters to an Excel file.

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3. Click on the “OB Engagement Level” column and select “High,” “Medium,”“Low” and/or “Blanks.” This will provide a list of the MIIS priority members with a monitored status that may have an inaccurate or missing Engagement Level.

Follow up Guidance for MIIS priority members--OB Engagement Level in Monitored Status: a) Follow up with assigned OBCM regarding program guidelines for MIIS Priority members in

Monitored status. All members in an open status should have an engagement level set that reflects the frequency of planned care management activity. Members that are in a Monitored status are not actively receiving care management interventions, however the OBCM is to continue documenting care coordination interactions during the period when they are not directly providing interventions to the member.

b) MIIS priority members in a Monitored status with an OB Engagement Level of High, Medium, Low should be reviewed to assure they are in an accurate OB Case Status.

c) MIIS priority members without a documented OB Engagement Level should be reviewed and an appropriate OB Engagement Level set to reflect frequency of planned care management activity.

Use Case 4 To view MIIS priority members who became priority within the last 14 days:

1. Apply filters to “Priority Group” by selecting “200-499” and “500-1000.”

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2. Apply filter to “Patient Became Priority – Current Pregnancy Became Priority” by selecting “0-7 days ago” and “8-14 days ago.”


4. Open the Excel file and apply filters as demonstrated in Section I: Applying filters to an Excel file.

5. To view MIIS Priority members who became priority within the last 14 days without any completed and/or attempted face-to-face or phone interactions this pregnancy; review the following columns for “0”: “Completed FTF Interactions This Pregnancy”, “Attempted FTF Interactions This Pregnancy”, “Completed Phone Interactions This Pregnancy”, and “Attempted Phone Interactions This Pregnancy.”

Follow up guidance for MIIS priority members who became priority in the last 14 days without any completed and/or attempted face-to-face and/or phone interactions: a) Review members in Closed status and use follow up guidance regarding Closed status in

Section III Use Case 2A. b) Review members in Monitored status and use follow up guidance regarding Monitored

status in Section III Use Case 2B. c) Review members in Pending Status and assign to an OBCM for outreach and engagement.

Pending status is assigned when a new referral has been received and there is no OBCM assigned.

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Use Case 5 To review face-to-face encounters: MIIS Priority members in an active OB Case Status without a face-to-face encounter –

1. Apply filters to “Priority Group” by selecting “200-499” and “500-1000.”

2. Apply filter to “OB Case Status” by selecting “Managed” and “Monitored.”

3. Apply filter to “Patient Became Priority – Current Pregnancy Became Priority” by selecting

“>30days.”


5. Open the Excel file and apply filters as demonstrated in Section I: Applying filters to an Excel

file.

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6. Click on the column “Completed FTF Interactions This Pregnancy” and select “0.”

This will provide a list of all MIIS priority members who have been a priority for greater than 30 days and who have not had a completed face-to-face encounter. Follow up guidance for members without a completed face-to-face encounter who have been priority for greater than 30 days: a) Look for patterns in the following: assigned OBCM, assigned OB Provider, attempted FTF

tasks, gestational age of the member, etc. b) Members with no completed or attempted face-to-face encounters should be engaged in

services immediately. c) Assess attempted face-to-face encounters for members and determine additional follow up

options to engage members, i.e. home visit, community encounter.

Use Case 6 To view MIIS priority members in Engaged OB Case Status for more than 30 days:


2. Apply filter to “Patient Became Priority – Current Pregnancy Became Priority” by selecting “>30days.”

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3. Apply filter to “OB Case Status” by selecting “Engaged.”


5. Review documentation for any members that have been priority for more than 30 days and

remain in an “Engaged” OB Case Status.

Follow up guidance for MIIS priority members in Engaged OB Case Status for more than 30 days: Engaged OB Case Status indicates that the member has accepted services as indicated on the Interaction Tracker. To consider a member in active care management, the care plan must be signed by the Pregnancy Care Manager and the member; at least one problem on the care plan must be in “Managed” status for the OB Episode Status to update to “Managed.”

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