2. Written By Chryste Middleton, RN S UGGESTIONS FOR CM WORKFLOW P ROBLEM /S OLUTION A PPROACH Please adjust your desktop volume for voice narration

3. C URRENT P ROBLEM There is not enough time during each shift to complete:  The daily goal for open cases  Data entry on each opened case  Follow-ups  BBL’s/urgent notifications  MMO Initials and follow-ups  Pending calls  Upshots with PPOT’s

4. C URRENT B ARRIERS 1.The current daily goals are distributed unevenly, and are set too high for the amount of work and time that is allotted to complete the task. 2.There is no triage role available to allow nursing care management and follow up time. 3.Nurses are attending to additional incoming calls that are non-revenue producing (Benefits and customer services questions, follow up call backs or WT for other nurses, MMO HED participants, enrollment callbacks, and outcomes callbacks.

5. B ARRIER #1 T HE CURRENT DAILY T ARGET GOALS ARE DISTRIBUTED UNEVENLY, AND ARE SET TOO HIGH FOR THE AMOUNT OF WORK AND TIME THAT IS ALLOTTED TO COMPLETE THE TASK ShiftsDaily goals for open casesTime for data entry time for all non Medicaid participants 30 mins – 45mins Estimated data entry time for Medicaid campaign 45 mins – 1hr 8 hours daily, (5 days) 40 hrs weekly 5 cases daily 25 cases weekly 2 hrs 30 - 3 hrs 45 mins 3hr 45 mins - 5 hrs 10 hours daily, (4 days) 40 hrs weekly 7 cases daily 28 cases weekly 3 hrs 30 mins - 5 hrs 25 mins 5hrs 15 mins - 7 hrs 12 hours daily, (3 days) 36 hrs weekly 9 cases daily 27 cases weekly 4hrs 30 mins - 6 hr 45 mins 6 hrs 45mins - 9 hrs 8 hours daily, (4 days) 32 hrs weekly 5 cases daily 20 cases weekly 2 hrs 30 mins - 3hrs 45 mins - 5 hrs LPN’s 8 hours daily (5 days) 40 hrs weekly 8 cases daily 40 cases weekly * No credit for closing cases 4 hrs - 6 hrs - 8 hrs

6. S OLUTION F OR B ARRIER #1 R EALISTIC G OALS AND DATA ENTRY TIME ShiftDaily goals for open cases Estimated daily open cases with current staff schedule Time for data entry time for all non Medicaid participants 30 mins – 45mins Estimated data entry time for Medicaid campaign 45 mins – 1hr 8 hours daily, (5 days) 40 hrs weekly 5 cases daily 25 cases weekly Florida 432 hrs 30 mins - 3 hrs 45 mins 3hr 45 mins - 5 hrs 10 hours daily, (4 days) 40 hrs weekly 5 cases daily 25 cases weekly Georgia 872 hrs 30 - 3 hrs 45 mins 3hr 45 mins - 5 hrs 12 hours daily, (3 days) 36 hrs weekly 7 cases daily 21 cases weekly Total Estimated daily goal 130 3 hrs 30mins - 5hrs 15 mins - 7hrs 8 hours daily, (4 days) 32 hrs weekly 4 cases daily 16 cases weekly current daily goal 1132hrs - 3 hrs - 4hrs LPN’s pending 8 hours daily (5 days) 40 hrs weekly 5 cases daily cases weekly 25 ***Credit for closed cases 2 hrs 30 mins - 3 hrs 45 mins - 5hrs

7. B ARRIER # 2 C URRENTLY, THERE IS NO TRIAGE ROLE AVAILABLE TO ALLOW NURSING CARE MANAGEMENT AND FOLLOW UP TIME. Impact Pro/Predictive ModelOSC/ Scheduler/Triage CM assessment, f/u, and referral for services Assessment Coordinator Case Manager /Triage/Initial assessment/Schedules next appt./BBL/MMO/Urgent Notification/Misc calls/F/u for already enrolled participants Case Management f/u assessment, education, PPOT for treatment Nurse care coordination and Upshot submission Discharge planning and case closure Triage/scheduler/reception MA/LPN/RN Triage/Initial assessment Doctor Assessment/f/u, education and treatment Process Flow Comparison Nurse care coordination and education A Doctors Office or L and D unit Maternalink UHC/BCBS The Purpose of this slide is to illustrate that the current PCM process flow reflects the expectation that a PCM shall perform several clinical roles daily.

8. S OLUTION TO B ARRIER #2 Triage Nurse/PCM model (Goal Focus would change) LPN PPOTs with fax, Upshots, Care Coordination, Charting in CM of care coordination results, closure of Term Gestation. Possible pending if URAC accept proposal to utilize LPN for data collection versus assessments PCM BBL Overflow/MMO’s/Pending/Follow up assessments Triage Nurse Accepts WT’s, Assigns to PCM, MMO’s, Pending, CM callbacks Telephone on available until goal met, then completes data entry. Rotational Team Approach (Focus on weekly goal versus daily) LPN PPOTs with fax, Upshots, Care Coordination, Charting in CM of care coordination results, closure of Term Gestation. Possible Pending Arizona Dedicated (Possible 5am start) BBL/Pending/MMO’s Dedicated BBL/Pending/MMO’s Team A/B/C rotational ATL/FL All week. All nurses would take WT/call pending/CM callbacks. Overflow of BBL/MMO is routed to 1 nurse on the team. One day per week each team will have a full day for f/u assessments and back charting There are no current URAC CM accreditation guidelines that prohibit triage nursing as an addition to CM nursing. Unfortunately, It does state that LPN’s can not complete assessments if URAC accreditation is warranted.

9. B ARRIER #3 N URSES ARE ATTENDING TO ADDITIONAL INCOMING CALLS THAT ARE NON - REVENUE PRODUCING (B ENEFITS AND CUSTOMER SERVICES QUESTIONS, FOLLOW UP CALL BACKS FOR OTHER NURSES, MMO DISEASE MANAGEMENT PARTICIPANTS, ENROLLMENT CALLBACKS, AND OUTCOMES CALLBACKS

10. S OLUTION TO B ARRIER #3 Request that Telecom  Sets up a voice guided phone option center that: 1. Has an allows consumer to contact their PCM directly by selecting their name from a directory. 2. Has an option to route calls to an assessment coordinator or to the outcomes department (this will require all staff to leave more detail messages) 3. Has option for customers to contact benefits dept for benefits related questions 4. Adds to BBL option that we can not answer medication/OTC meds questions.  Provides direct dedicated MMO and BBL ACD logins

11. STAFF M ORALE BOOSTERS AND PRODUCTIVITY MOTIVATORS  If the team approach is utilized.  Place a dry erase achievement board up in CM to chart team performance.  Provide gas, grocery, or movie gift cards to your 2 top performers on a weekly basis. (GA and FL separate incentives)  Provide incentive for you top performing team on a monthly basis.  Provide a gas card or grocery gift card to the LPN that completed the most upshots.  Provide a gift card for the nurse that completed the most BBLs or MMO’s.  Conduct a pot luck lunch, and group discussion 1 x per month for 1 hour to allow staff speak freely with management.