Provider Practice Transformation

Practice transformation refers to a process of change. It is designed to help provider agencies develop the tools, skills and knowledge necessary to shift to measurement-based care and to participate in alternative payment models.

Alliance Health’s success as a health plan is intrinsically tied to the ability of our provider network to deliver high-value and cost-efficient care to our members. To this end, Alliance has developed a practice transformation program to helps guide our network providers through a process of sustainable change. Alliance’s practice transformation program is designed to assist provider agencies develop the tools, skills, workflows, continuous quality improvement processes and knowledge necessary to make the shift towards measurement-based and outcome-driven care, enabling successful participation in alternative payment models. Practice transformation is not about developing interventions for providers to implement. It is a supportive process that ensures that provider organizations have the skills, dat and tools to monitor their performance, identify gaps and issues and implement corrective actions and innovative approaches to improve the delivery of care.

Alliance offers a tiered approach to transformation, including a strategic transformation program for large providers and providers seeking care management certification. For practices that are not part of a formal transformation process, Alliance will share scorecards on several key measures and provide access to a resource library available on this site. Support will also be made available upon request from provider organizations who seek help on specific measures or issues.

EHR Funding Opportunity

Alliance Health is providing $1 million to help small providers and historically underutilized providers offset the cost of implementing or updating their electronic health record (EHR) systems. Interested providers should submit the Alliance Health EHR Funding Application. Additional details are available on the application form.

Plan Overview

Comparison of NC Medicaid Standard Plan, Medicaid Direct and Tailored Plan

Medical/Pharmacy

Adherence to Antipsychotic Medications for Individuals with Schizophrenia
Antipsychotic Medications and Metabolic Syndrome Handout
Clozapine
Enhanced Pharmacy Services
Health And Safety for People Receiving Antipsychotic Therapy
Long Acting Antipsychotic Medications
Medication Adherence for Providers
Medication Reconciliation
Medication Synchronization
Monitoring for Metabolic Risk Factors
Pharmacy Lock-In Program

Process/Workflow

Member and Recipient Services Line
EHR and/or Data Analytic Vendor Selection
Hospital Transition Team
Integrated Care Management
Open Access
Patient Risk List
Point of Care Labs
Population Health
Team Based Care
Unmet Health Related Needs
Warm Handoff
1915i Assessment
Resource Guide for PLEs
Nurse Advice Line (NAL)

Quality Improvement

HEDIS® Child and Adolescent Well-Care Visits
Chlamydia Screening in Women (CHL)
HEDIS® APM
HEDIS® Cervical Cancer Screening (CCS) Measure
HEDIS® Diabetes Monitoring for People with Diabetes and Schizophrenia (SMD)
HEDIS® Follow-Up After Emergency Department Visit for Mental Illness (FUM)
HEDIS® Follow-Up After Hospitalization for Mental Illness (FUH)
HEDIS® SAA
HEDIS® SSD
Hemoglobin A1c Control for Patients with Diabetes (HBD)
IHI Quality Improvement Essentials Toolkit
Immunizations for Adolescents (IMA)
Seven Day Follow Up After Discharge
Pre-Visit Planning
Pre-Visit Planning Checklist
Emergency Department (ED) Visits
Daily Team Huddles
Care From the Inside Out: Lessons That Work
Timely Post-Hospital Follow-Up: A CQI PDSA
CQI Project-Improving FUH-7 Member Follow-Up Using the PDSA Cycle
Tips for Engaging Members to Increase Continuous Engagement

Financials/Contracts

Alternative Payment Model (APM) Framework One-Pager

Care Management Agency/AMH+

90–Day Post Discharge Transition Plan
Alliance Health Behavioral Health Crisis Alerts
Care Management Platform Options
Care Management Training Plan Template
Children With Complex Needs
Conflict-Free Care Management
Documentation for Care Management
Functions/Responsibilities of Transitional Care Management, Part I
Functions/Responsibilities of Transitional Care Management, Part II: In-Reach and Transition
Functions/Responsibilities of Transitional Care Management, Part III: Diversion from Institutional Settings
Member Contact and Documentation Requirements for Tailored Care Management
Q&As for CMAs/AMH+s
Risk Stratification
Staff, Caseload, and Financial Modeling Tools for CMAs AMH+s
Step-By-Step Guide to Working with Members as a CMA/AMH+
TCM Data and Data Sources
Tips for Engaging Members in Tailored Care Management
Tips for NCQA Site Review Submission
TP CM Engagement Workflow with Acuity Timeline
Transitions for Members in State Facilities
Value Added Services Overview
Value Added Services Overview–Spanish
Verification of Education and Experience for Tailored Care Management Staff
Warm Handoffs and Transitions for Services Excluded from Tailored Care Management
Warm Handoffs from Alliance to Provider-Led Tailored Care Management

Innovations

DSS Innovations Request Letter
Innovations Budget Basics
NC Innovations Individual Budget
Innovations Submission Document Checklist
Innovations Waiver/Freedom of Choice Form
Limits on Sets of Services
ICF/IID In-Reach and Transition Services
Individual and Family Directed Services (IFDS)- Agency with Choice Model  (document)
Individual and Family Directed Services (IFDS)- Agency with Choice Model  (video)

Integrated Health

Integrated Network Directory

1915i

1915i Plan Template
1915i Plan Update Template

Forms

Care Management Opt Out/Change Provider Form
Daily Team Huddle Template
IDM Form B
Transition of Care Warm Handoff Summary

CM Collaborative documents

Prevent Avoidable ED Visits
Intervene Early – Early Intervention
Spring CM Collaborative: Event Flow
Intensive Support – High Utilizers