Acute Care Session = Acute Care Session
Long Term and Skilled Care Session = Long Term and Skilled Care Session
Physician Advisor, Medical Director Session = Physician Advisor, Medical Director Session
Ambulatory Session = Ambulatory-Session
Pediatric Session = Pediatric Session
Rehabilitation Session = Rehabilitation Session
Home Health Session = Home Health Session
Primary Care Session = Primary Care Session
Veterans Care Session = Veterans Care Session

Morning Pre-Con Session Options
Sunday, April 14, 2019

Pre-Conference Intensives
8:00 AM - 12:30 PM

Abstract:
Select one option below:
1. Volume to Value: Population Health Intensive
    Road from Volume to Value: Population Health Primer
    Partnering with Primary Care
    Operationalizing a Longitudinal Approach to Care Management
    Roundtable Discussion: Comprehensive Approaches & Success Strategies

2. Health Care Landscape: Strategic Planning Intensive 
    Strategic Planning: Creating a Foundation for Success
    Partnering with Physicians & IT to Create a Strategic Planning Roadmap
    Assuring Value with Innovation: Integrating Care Delivery
    Roundtable Discussion: Your Roadmap to Success

3. Foundations for Physician Advisors


For Individual Session Details within each option please visit http://www.casemanagementconference.com/pages/pre-conference.aspx  




P1 - Volume to Value: Population Health Intensive | Participant Level - Intermediate 4 CEs
8:00 AM - 12:30 PM

James Whitfill, MD

Karen Vanaskie, DNP, MSN, RN

Ann Greiner, MCP
President and CEO
Patient-Centered Primary Care Collaborative

Kathleen Ferket, MSN, APN-BC

Faculty Biography:
Dr. Whitfill is currently the Chief Medical Officer for Innovation Care Partners, a Clinically Integrated Network in Phoenix Arizona. Dr. Whitfill received his AB from Princeton University, and his MD from the University of Pennsylvania. He did his Residency and Chief Residency in Internal Medicine at the Hospital of the University of Pennsylvania and completed a fellowship in Medical Informatics in the University Of Pennsylvania Department Of Medicine. At for Innovation Care Partners , he has been a key part of the team which has delivered cost savings across multiple payer sources including commercial, Medicare ACO, direct to employer and Medicare Advantage plans. He currently serves as a Clinical Associate Professor in the Departments of Internal Medicine and Biomedical Informatics at the University of Arizona College of Medicine-Phoenix. He is also a frequent lecturer at the Biomedical Informatics Graduate and Undergraduate programs at Arizona State University. He enjoys running, skiing and camping with his wife and three children.

Karen currently serves as the Chief Clinical Officer for Innovation Care Partners. Her extensive experience in health care leadership includes clinically integrated health systems, accountable care organizations, inpatient and outpatient settings, home health, multi-specialty medical groups, and independent physician associations. Karen’s healthcare leadership experience spans over 30 years. Karen has served in many key leadership roles designing and directing case management, quality, outpatient, and post-acute programs. Karen’s formal education includes earning a Baccalaureate Degree in the Science of Nursing (B.S.N.), a master’s degree in the Science of Nursing (M.S.N.), and a Doctorate in Nursing Practice (D.N.P). She is a member of the Case Management Society of America and is currently serving as the Past President for the Arizona Chapter of the American Case Management Association. She serves on the National ACMA Chapter Advisory Committee and as a board mentor to the Northern California and Washington Chapters for the ACMA.

Ann Greiner serves as President & Chief Executive Officer of the Patient-Centered Primary Care Collaborative. In this role, she is responsible for leading the overall organizational strategy and fostering strategic partnerships throughout the health care sector nationally. At a critical time in U.S. health policy, Ann directs the PCPCC’s policy agenda, working across a diverse stakeholder group of more than 60 executive member organizations to advance an effective and efficient health care system built on a strong foundation of primary care and the patient-centered medical home (PCMH). Ann has dedicated her entire career to advancing the quality of U.S. health and health care. She has more than 25 years of experience, including senior-level positions at prestigious national not-for-profit organizations. Prior to leading the PCPCC, she served as Vice President of Public Affairs for the National Quality Forum where she increased the visibility and influence of NQF on Capitol Hill. Before working at NQF, Ann held high-profile policy, research, and public affairs roles at the American Board of Internal Medicine, the National Academy of Medicine and the National Committee for Quality Assurance (NCQA). In these roles, she pioneered research to help the field and the public understand the extent of the U.S. health care quality problem, helped spearhead the publishing of some of the first-ever quality ratings in health care, and led an effort to integrate the physician certifying boards into the CMS accountability framework. Ann has a master’s degree in Urban Planning from the Massachusetts Institute of Technology and a Bachelor of Arts Degree in English Literature from Hobart and William Smith Colleges.

Kathleen is an experienced and transformational nursing executive, speaker, author and a recognized leader in case management, clinical integration, value-based care, and population health. Ferket Advisory Services, LLC was formed in 2018 and Kathy consults with organizations across the care continuum to achieve value-based care outcomes. As the Principal for Ferket Advisory Services, LLC she serves as senior consultant for Associations and healthcare agencies, including the American Association of Case Management, Pillars Community Health, FQHC and Pangea Medical, LLC. Most recently, she served as Care Continuum Vice President for a nine-hospital system in the Midwest where she led acute care management and alignment for post-acute services for the health system. Previous executive roles included hospital operations, service line leadership, clinical reliability and population health. As a board-certified nurse practitioner, Kathy has been recognized by the Nursing Spectrum for Advancing Nursing Practice and received the Ron Lee Lifetime Achievement award from the Illinois Department of Public Health. Kathleen volunteers for the Illinois Multiple Sclerosis Foundation and has served on the Board of Directors for the Illinois Organization of Nurse Leaders and the Infant Welfare Society. As a registered leadership coach and Green Belt LEAN champion, Kathy mentors and develops leaders in navigating change, workplace conflict, teambuilding and purposeful communication. She has published in peer reviewed nursing journals and contributed to book chapters on Patient Safety and Population Health. Kathy received her Bachelor’s in Nursing degree from DePaul University and a master’s degree from Rush University.

Abstract:
Aggregating data and analytics, outcomes and reporting, defining at-risk populations, care management frameworks and touch points, incentives and reimbursement, longitudinal care approaches and primary care partnerships.

Learning Objectives:
  1. Review population health management systems and frameworks
  2. Define population health metrics with a focus on at-risk populations
  3. Apply best practices to leverage advanced primary care models and align incentives
  4. Explore strategies to structure effective longitudinal care management

P2 - Healthcare Landscape: Strategic Planning Intensive | Participant Level - Intermediate 4 CEs
8:00 AM - 12:30 PM

Debra McElroy, MPH, RN

Julie Mirkin, DNP, MA RN Wharton Fellow
Chief Nurse Officer
Stony Brook Medicine

Robert Grant, MD, MSc, FACS

Mary Beth Pace, RN, BSN, MBA, ACM-RN, CMAC

Colleen Fitzgerald, MSN, CCM, ACM-RN

Michael Gao, Ph.D., MD

Faculty Biography:
Debra is the Senior Vice President for Practice Development for the American Case Management Association (ACMA). Her operational focus for ACMA is on case management education and practice at the regional and national level, as well as new initiatives which include the newly developed Transitions of Care Standards, the ACMA Advanced Care Transition Simulations (ACTS) program and the Association for Physician Leadership in Care Management (APLCM). Deb is the former national nursing leader for the largest national health care improvement organization and healthcare collaborative, where she had responsibility for programs and data products supporting nursing leaders and inter-professional practice across the country. She has extensive experience in the community and public health sector, previously directing healthcare coalitions and federally funded initiatives that established infrastructure for medical homes. Deb holds a master’s degree in public health and a bachelor’s degree in nursing. Her publications include topics related to chronic disease, nurse residency and advanced practice.

Julie is currently the Chief Nursing Officer for Stony Brook Medicine, Long Island’s premier 603 bed Academic Medical Center. In this role, Dr. Mirkin is responsible for enhancing patient outcomes through Evidenced Based Practice and Staff Engagement, and developing a collaborative practice environment among Nursing, Physicians and the healthcare team. Dr. Mirkin was most recently the Vice President of Care Coordination for the NY Presbyterian Hospital and Health Care System. In this role, she led strategic planning, development, and implementation of best practices for the Hospital’s Care Coordination/ Social Work program across all seven campuses, and the three Regional Hospitals to ensure the delivery of safe, efficient, and cost-effective inpatient and ambulatory care. Dr. Mirkin has presented at numerous regional and national conferences on the subjects of leadership, change management, emotional intelligence and building high performing teams. She has recently published articles in AONE Nurse Leader and Collaborative Case Management on the topics of Leadership, The Complex Role of the Care Manager, and Emotional Intelligence. Dr. Mirkin is an active member of the American Case Management Association (ACMA) and is the Co-Chair of the ACMA Research Committee. Dr. Mirkin has facilitated the formation of the New York Chapter for ACMA. She is currently serving as the inaugural President of the New York ACMA Chapter. Dr. Mirkin received her Bachelor of Science in Nursing from State University of New York at Stony Brook, Master of Arts in Nursing Administration from Columbia University Teacher’s College, Doctorate in Nursing Practice from Case Western Reserve University, and a Wharton Fellowship in the Nursing Executive Program from Wharton School of Business, University of Pennsylvania.

Dr. Grant is Plastic Surgeon-in-Chief at New York-Presbyterian Hospital, the University Hospitals of Columbia and Cornell. He is Professor of Surgery at Columbia University’s College of Physicians and Surgeons and an Adjunct Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College. Dr. Grant received his MD degree from Albany Medical College. He completed General Surgery and Plastic Surgery Residencies at The New York Hospital-Cornell Medical Center. He finished clinical training with a Microsurgical fellowship at NYU Medical Center/Bellevue Hospital. In 1999 he received his MS degree in Management from NYU. Dr. Grant is a member of the American Association of Plastic Surgeons, the American Society of Plastic Surgery and the American Case Management Association. Dr. Grant serves as New York-Presbyterian Hospital System’s Physician Advisor and Director of Care Coordination and Co-Chair of Columbia Doctors Managed Care Committee.

Mary Beth has been in Health Care for over 30 years. She is a nurse by background. She received her BSN from Oakland University and her MBA from University of Phoenix. She started as a floor nurse, cutting her teeth on an Orthopedic unit for 5 years. She then became a Discharge Planner and went from strictly discharge planning to learning UR, CDI, and how Care Management works. After that she began to rise in the departments and soon became the Director. Her experience was strictly limited to Michigan until the last 7 years. Mary Beth is now responsible for assisting with day to day operations of Care Management at Trinity Health. Trinity spans 22 states, 93 hospitals, 47 home care agencies, 59 continuing care facilities and 15 PACE center locations. Trinity Health has 24K Affiliated Physicians and 5.3K Employed Physicians. She leads Care Management, including Acute and Ambulatory in her organization. She is also the Clinical lead for Trinity's BPCI-A program, which includes 30 sites spanning the program. Trinity also has 2 sites involved in CJR as well.

Colleen has been in healthcare for over 30 years. She is a nurse by background. She received her ADN from Henry Ford Community College, her BS in Medical Case Management from Detroit College of Business and her MSN from University of Detroit Mercy. She started as a floor nurse for 8 years. After getting her degree in medical case management she became a case manager at the hospital and then moved to HR and did workers' compensation case management for the healthcare system and then was the benefits administrator. She then went on to be the manager of appeals and then the director both at the hospital and then for the healthcare system. Colleen has spent the last 3 and a half years as a member of Mary Beth's team at Trinity Health. Her focus is on the acute care side and working to make seamless transitions for our patients across the continuum. She is also an Adjunct Faculty at Davenport University in their Medical Case Management Program.

Abstract:
Case management trends and future implications, predictive analytics and tools, strategic partnerships to achieve outcomes, value-driven health system innovations and redesign.

Learning Objectives:
  1. Increase awareness of case management trends to anticipate and prepare for the future
  2. Apply performance improvement and analytics to redesign processes and operations to deliver the best possible care at the best price
  3. Review strategic partnership applications and potential value within your setting
  4. Discuss multi-site system volume to value redesign and identify transferable concepts

P3 - Foundations for Physician Advisors | Participant Level - Intermediate 4 CEs
8:00 AM - 12:30 PM

Bruce Ermann, MD

Faculty Biography:
Dr. Ermann is a Physician Advisor in the Catholic Health Initiatives Internal Physician Advisor Service (IPAS) group, which performs secondary PA Utilization Management reviews across much of the CHI hospital system. Dr. Ermann serves as the IPAS Regulatory Compliance Lead, the IPAS Market Lead for the CHI Pacific Northwest and Southeast hospital markets, and the chair of the IPAS Education Committee. Dr. Ermann is a board certified Internal Medicine physician who practiced primary care and Hospitalist medicine for 23 years prior to transitioning to Medical Staff and Physician Leadership roles. Dr. Ermann is a graduate of the Rosalind Franklin School of Medicine/Chicago Medical School, completed his Internal Medicine Residency at Cedars Sinai Medical Center, and served as the UCLA/Cedars Sinai Rex Kennamer Fellow where he completed research in clinical quality and efficiency. Prior to joining CHI in 2015, Dr. Ermann functioned as his hospital’s Chief of Staff and Medical Director of Clinical Process Improvement, and subsequently served as the Dignity Health system level Medical Director of Medical Management, where he led the 40 hospital system’s Physician Advisors, the Hospitalist Leadership Counsel, ICD-10 physician readiness activities, a Physician Champion Network for Clinical Documentation Improvement, and spearheaded clinical efficiency processes that helped to significantly reduce Medicare Length of Stay. Dr. Ermann has been a Physician Advisor since 2003. Dr. Ermann and his wife, Olivia, live in the San Francisco area, where they enjoy music, outdoor hiking, and looking after their four grown children.

Abstract:
Attention NJ Social Workers: This session is not applicable for CE’s.
This session offers lecture and interactive learning and will equip new Physician Advisors with the knowledge required to perform effectively and for case management directors or chief medical officers looking to improve their Physician Advisor function. The session will include an interactive session engaging participants to physician leaders in care management and those in the physician advisor role.

Learning Objectives:
  1. Describe the role, responsibilities and success characteristics for Physician Advisors
  2. Review and identify the CMS Utilization Management Conditions of Participation and the Physician Advisor role in the UM process
  3. Describe foundational areas of knowledge, skill and abilities related to Physician Advisor work, including regulatory, utilization management and workflow considerations
  4. Decide the resolution of complex case studies in an interactive group discussion

Afternoon Pre-Con Sessions
Sunday, April 14, 2019

Afternoon Pre-Con Breakout Sessions
2:00 PM - 3:45 PM

Abstract:

Select one below:
1. Advanced Care Planning: Simulation & Case Management Applications
2. Case Management and Physician Partnerships: Innovations and Outcomes
3. Assuring Excellence in the Case Manager Role Across the Continuum


For Individual Session Details please visit http://www.casemanagementconference.com/pages/pre-conference.aspx  




APC1 - Advance Care Planning and Palliative Care: Discussions through Simulation Training | Participant Level - Intermediate 1.5 CE
2:00 PM - 3:45 PM

Antonia Ferrer, MPA, BSN, RN

Ana Mola, PhD, RN, ANP-C

Christopher Oates, LCSW, MPA

Sharre Thompson, MSN, RN

Faculty Biography:
Antonia currently serves as Assistant Director of the Supportive Care Program at New York University Langone Health Systems. Prior to joining NYU Langone Health Systems, Antonia was the Assistant Director of Palliative Care and Post-Acute Programs at Montefiore Medical Center’s Care Management Organization (CMO). Working with external stakeholders, Antonia successfully launched an early palliative and hospice screening program within two skilled nursing facilities, and a hospice pilot that integrated palliative RN generalists to assist an inpatient palliative care team with hospice referrals in the acute care setting. Antonia holds a Bachelor of Science degree in Nursing from New York University and a Master of Public Administration from the NYU-Wagner Graduate School of Public Service with honors.

Dr. Mola’s clinical and research background includes cardiovascular risk factor management, tobacco cessation, and the impact of healthcare reform on care coordination. Her care coordination experience includes providing leadership and strategic direction to readmission reduction initiatives of high risk complex care populations and education on value based management of bundle care model programs. Additional experiences have comprised the development of effective relationships with payers, post-acute care providers and referral sources to facilitate appropriate utilization of clinical services and innovative care coordination initiatives. Population health management activities includes areas of research focused on hospital discharge planning risk tools and inpatient electronic -clinical quality measures of tobacco use.

Christopher is currently a Social Work Manager in the Palliative Care Department at the New York University Langone Medical Center. He has over 25 years experience in health care administration and clinical social work in an executive position in the nonprofit or health care sector. He earned an MPA at Baruch College in New York. Christoper also does extensive volunteering and is currently Chair and Board Member of the Helen Rehr Center for Social Work Practice.

Sharre is currently the Care Coordinator Educator at NYU Langone Health, Care Management Department. She holds an MSN in Adult Gerontology. Her experience includes acute rehabilitation, medicine, and surgery care management. Her motto is “Case management is not for the faint of heart, but for those who dare to be a catalyst of change to provide holistic, patient-centered care to an increasingly demanding healthcare environment”.

Abstract:
When patients and their families have an increased understanding of advance care planning, diagnoses, prognoses, and palliative or hospice options, they are more able to make informed end-of-life decisions. Providing clinicians with educational opportunities to participate in simulations of difficult patient discussions, allows them to practice therapeutic communication skills in a safe environment. Their ability to facilitate these important conversations improves. Targeted activities develop the skills required to successfully explore patients’ and families’ understanding of a patient’s diagnosis and prognosis. This presentation will share two case scenarios, crafted to explore patients’ personal values, preferences, goals of care, help clinicians assess a patient’s care goals and the develop a discharge plan that honors those goals.

Learning Objectives:
  1. Describe the design, implementation and evaluation of an advance care planning and palliative care simulation activity with case managers, social workers and standardized patients
  2. Review two practice scenarios designed to improve advance care planning and care coordination discussions as well as family meetings focused on end of life conversations
  3. Explore the impact of a didactic in-service and simulation exercise on the confidence level of case managers and social workers providing care planning and end of life conversations with patients

APC2 - Case Management and Physician Partnerships: Innovations & Outcomes | Participant Level - Intermediate 1.5 CE
2:00 PM - 3:45 PM

Robert Grant, MD, MSc, FACS
Physician Advisor and Chairman Utilization Management Committee
New York-Presbyterian

Abstract:

Synergies created with physician-case management partnerships led to advancements in operations and clinical practice within this multi-site health care system. Providing infrastructure, training, tools, data mining and outcome monitoring were integral components in developing a team of physician champions. During this interactive session panelists will provide case examples to illustrate key factors leading to process improvements and innovations. Successful outcomes were realized with Care Traffic Control Boards tracking pre-admission- discharge flow, barriers to care within adult and Pediatric care.

 


APC3 - Assuring Excellence in the Case Manager Role Across the Continuum | Participant Level - Intermediate 1.5 CE
2:00 PM - 3:45 PM

Steven McGaffigan, LCSW, ACM-SW

Karen Nelson, MSW, MBA

Annita Paolucci, MA, CCC/SLP, CCM

Amy Singer, MSN, RN

Stacy Galik, LMHC, CCM

Pamela Andrews, RN, MSW, MBA, CCM, ACM-SW

Faculty Biography:
Steven currently serves as the Administrative Director, Transition Management office at Vanderbilt University Medical Center. Within this role he applies a data driven approach to monitor and improve key case management performance indicators. He has 38 years’ case management and transition resource management experience and has served in administrative roles at Alexian Brothers Health System, Tampa General and Northwestern Memorial Hospital. Steven received his Master of Social Work at St. Louis University and is an Accredited Case Manager.

Karen is a graduate of the BA and MSW programs at Wilfrid Laurier University in Waterloo, Canada and the MBA program at the Telfer School of Management in Ottawa, Canada. She has practiced and held leadership positions in the fields of mental health, rehabilitation, pediatric care, acute care hospitals, school social work and the criminal justice system. She has over 10 years of experience teaching at the MSW level. Karen is a Board Member of the ACMA Northern California Branch where she has chaired the Public Policy Committee and is a frequent presenter at national and international business and healthcare conferences. She is currently employed at Stanford Healthcare where she holds the position of Director, Social Work, Case Management, Spiritual Care and Aging Adult Services.

Annita has served as the Clinical Educator for Case Management and Social Work at Ohio State University Wexner Medical Center since 2010. Prior to her current role, Annita blended her interest in hospital case management and the opportunity to apply her clinical knowledge working with patients and families as a Neuroscience Clinical Case Manager. Annita is a certified Case Manager and InterQual trainer and is a member of the American Academy for Certification of Brain Injury Specialists. She received her Master of Arts in Communication Disorders from St. Louis University.

Amy is a nurse educator for The James Cancer Hospital, Patient Care Resource Management and Social Work Department. She is responsible for all education programming including onboarding and professional development education for oncology case managers. Amy has over 20 years experience in healthcare, which includes the acute care setting, academic medical center and community health settings. She also has several years experience working as a case manager in oncology care.

Stacy is the Director of Hospital Care Coordination for 5 acute care hospitals within the BayCare Health System (a large, non-profit healthcare system in the greater Tampa Bay area). Stacy’s departments are responsible for managing hospital length of stay, reducing readmissions, oversight of observation patients, discharge coordination to the appropriate post-acute level of care, and contributing to a positive patient experience. For the past 14 years, Stacy has worked in hospital case management/social services in both medical and behavioral health programs. She received her Bachelor’s Degree in Psychology from the University of South Florida and Master’s Degree in Rehabilitation & Mental Health Counseling also from the University of South Florida. Stacy is an active member of the American Case Management Association (ACMA) and the Morton Plant Mease Ethics Committee. Stacy is a certified case manager (CCM) and serves as a trustee/board member for Mease Manor (a local CCRC-continuing care retirement community).

Pamela is the Assistant Vice President of Case Management of Case Management at Inova Health System. She has worked for Inova for 18 years. During this time she has served in several roles aligned with transitional planning. She has served as Director of Case Management for 4-5 hospitals and as Senior Director of Regulatory Strategy and Outreach in the Population Health Medicaid Division.Pamela is a Registered Nurse, has a Master Degree from the University of Scranton in Scranton PA. She actively serves as the President-Elect for the National Board of the American Case Management Association and Participates as the Past-President for the State of Virginia.

Abstract:
Providing orientation to the case management role, and supporting ongoing professional development, is critical in the case management role as systems continue to expand their care delivery continuum. Often the default for orientation, shadowing with an experienced care manager/social worker may offer positive observation of an experienced coworker but may also perpetuate non-evidenced-based practice or modeling of entrenched attitudes. Standardize, comprehensive training and ongoing professional development for the case management role have become increasingly important. ACMA engaged key organizations to beta test the addition of experiential learning to the educational journey of new and seasoned professionals. Hear strategies from leading health systems on how they are working to expand and standardize orientation assess competency and reduce variation in practice in the case management role.

Learning Objectives:
  1. Share current approaches to onboarding new case managers and providing ongoing professional development
  2. Discuss opportunities and lessons learned as a beta site for application of simulation in case management
  3. Describe success and opportunities in care coordination across the continuum of care within leading health systems

MAIN CONFERENCE DAY 1 INDIVIDUAL SESSIONS
Monday, April 15, 2019

Welcome and Keynote Address: Lessons in Leadership | Participant Level – Intermediate 1 CE
8:00 AM - 9:30 AM

Carey Lohrenz

Faculty Biography:
Carey is the first female F-14 Tomcat Fighter Pilot in the U.S. Navy, having flown missions worldwide as a combat-mission-ready United States Navy pilot, Lohrenz is used to working in fast moving, dynamic environments, where inconsistent execution can generate catastrophic results. The same challenges are found in business: markets change, customer needs evolve and if you do not adapt quickly your company is at risk. In her motivating and engaging keynote presentations, Carey shares her fascinating experiences operating in one of the world's most challenging environments - an aircraft carrier. She is uniquely qualified in the fundamentals of winning under pressure, reducing errors and overcoming obstacles. Her mastery of these fundamentals can help your team triumph in this high-risk, time crunched world. Carey Lohrenz's timely message about High Performing Teams and developing a Culture of Learning is based on the best-practices of high reliability organizations. The processes of Planning, Briefing, Debriefing and Adjusting help businesses manage risk while becoming a High Performing Organization. This message resonates with diverse audiences at every level of the company. Carey has been requested by name from some of the top Fortune 100 businesses. Her ability to connect with both an audience and on a one-on-one level, coupled with her knowledge and experience in leading high-performing, diverse teams, has made her highly sought after as a business consultant and speaker. Carey is a powerhouse in the field of delivering engaging Leadership, High Performing Organizations and Diversity Training that directly impacts a company’s ROI and bottom line. Her experience in the all-male environment of fighter aviation and her ability to pass on the Lessons Learned in her career allow her to deliver insight and guidance from a credible platform on Women’s Leadership Issues. Carey graduated from the University of Wisconsin where she was a varsity rower, also training at the pre-Olympic level. After graduation, she attended the Navy’s Aviation Officer Candidate School before starting flight training and her naval career. She is currently working on her Master’s in Business Administration in Strategic Leadership.

Abstract:

As the first female U.S. Navy F-14 Tomcat fighter pilot, Carey Lohrenz knows what it takes to succeed in one of the most demanding, extreme environments imaginable: the cockpit at Mach 2. As a former combat-mission-ready U.S. Navy pilot, Lohrenz is an expert at working in fast-moving, dynamic environments, where inconsistent execution can generate catastrophic results.

By seamlessly translating the lessons she learned to challenges in business, she provides applicable insight on market change, customer evolution and the importance of adaptability. Author of the Wall Street Journal bestselling book, Fearless Leadership: High-Performance Lessons from the Flight Deck, she outlines her experiences and advice on how to supercharge performance in today’s competitive business environments. Praised by top business leaders, from Fortune 500 executives to middle managers, her book provides insight on the importance of setting a bold vision to bring the team together and stay resilient through hard times.



Learning Objectives:
  1. Discuss key leadership skills that can be applied to effectively manage change
  2. Identify dynamic, high stress situations within health care that require expedient strategic decision-making skills
  3. Apply lessons learned to overcome challenges and stay resilient

Rapid Cycle Learning: Interactive Poster Review | Participant Level - Intermediate 1 CE
1:00 PM - 2:00 PM

Stacy Wright, LCSW, MHA, MBA, ACM-SW

Faculty Biography:
Stacy is a Senior Director of Case Management with Novant Health and her territory takes her from Charlotte to Northern Virginia. She has a BSW from Appalachian State University, her MSW from UNC-Chapel Hill and her MBA/MHA from Pfeiffer University. She has over 26 years of case management experience. Her passion is working with patients/families to provide continuity of care as well as growing the awareness of the profession of case management in her workplace.

Abstract:
During these interactive sessions, attendees will select from topics of interest within their practice area and attend at least 10 rapid cycle presentations that address current healthcare planning, delivery, access, coordination, and/or transitions issues within various settings. Through interactive discussion- innovations, best practices, advancements and interventions will be explored for attendees to apply in their practice to improve outcomes. Content areas include: Financial: Value Based Purchasing, Utilization and Denial Avoidance; Care Management: Case Management Models, Collaborative Teams, Population Health; Effective Care Transitions: Risk Screening, Discharge Barriers, Readmission Avoidance.

Learning Objectives:
  1. Present healthcare coordination and care management challenges and barriers to providing cost effective, quality care & transitions
  2. Discuss interventions to achieve outcomes
  3. Apply innovations, best practices and tools

Breakout Session A
Monday, April 15, 2019

A1 - ED Transitions: Using Social Determinants of Health to Reduce Re-visit Rates | Participant Level – Beginner 1 CE
Practice Setting:  

9:45 AM - 10:45 AM

Lene Hudson, MSN, RN, CCM, CCDS,

Sondra King, MSN, ACM-RN

Faculty Biography:
Lene is a Registered Nurse with expertise is in Case Management and Care Coordination program development. She has 30 + years of healthcare experience, of which 20 + years being in Care Coordination. Prior to joining Maricopa Integrated Health System, Lene was responsible for ensuring client customer success in revenue cycle solutions which included Case Management and Clinical documentation initiatives in a variety of healthcare settings. In these roles, she was accountable for leading innovative Case Management and Care Coordination operational activities throughout the continuum that have improved patient experience, quality and cost. She directed all process-improvement initiatives, developed key metrics of performance (KPI’s) for Case Management, led diversified teams to success, developed community post-acute transitional programs, and ensured that the department met federal and state regulatory guidelines. Lene enjoys the outdoors, kayaking, hiking, and fishing. During her downtime, Lene enjoys her family, the gym, yoga, and her dogs. She has two sons and one grandson.

Sondra is a registered nurse with over 18 years’ experience in inpatient and outpatient care coordination. In 1999, she began her career as a medical assistant with El Rio Health Center in Tucson, Arizona. It was there that she learned about community and what it means to provide affordable, comprehensive, quality and compassionate care to ALL patients. This is the mission that she carried on in her heart and lead her to pursue a degree in nursing. In 2009, she graduated from Apollo College with an Associate Degree in Nursing. She then worked as an emergency department and trauma nurse for the next several years. Sondra realized that her passion was ensuring that after an acute stay, patients were getting the care they needed and being appropriately connected to care. This led her pursue Case Management. She enrolled at American Sentinel University and graduate in 2015 with a Master of Science in Nursing with a Case Management focus. She is currently a Transitional Care Coordinator in the ER. Where her focus is on reducing unnecessary ED visits by coordinating outpatient care and close follow up. Sondra and her wife, Portia, have been married for 10 years. She also has a 19 year old son, Kameron. She enjoys traveling, cooking, and trying new restaurants in The Valley.

Abstract:

Patients who present to the ED with chronic medical and behavioral health needs, in conjunction with two or more adverse social determinants of health, are at risk for high ED re-visit rates. This program focuses on establishing care in the appropriate post-ED setting through coordinating the required outpatient resources to support those patients who are ready for discharge but at high risk of a 30-day re-visit to the emergency department as evaluated by the social determinants of health screening. The outcomes of ED Transitions-360 Transitional Care Program are: a reduction of the 30-day ED revisit rate, and an increase in plans to address patients’ social determinants of health that negatively impact the current episode of care.



Learning Objectives:
  1. Identify social determinants of health that often lead to inappropriate emergency department utilization
  2. Master the use a social determinants of health screening tool to assess patients with chronic medical and/or behavioral health needs
  3. Master the use a social determinants of health screening tool to assess patients with chronic medical and/or behavioral health needs

A2 - Business Case for Cross-Continuum Care Management: An ACO Solution | Participant Level – Beginner 1 CE
Practice Setting:  

9:45 AM - 10:45 AM

Nancy Turner, BSN, ACM-RN

Faculty Biography:
Nancy is the Director of Care Management at Lancaster General Hospital. She oversees inpatient and ambulatory case management services and the Care Connections program. Nancy has 20 years’ experience within inpatient and ambulatory care management. She is certified in Case Management, InterQual (IQCI) and is a Green Belt with extensive knowledge in LEAN management systems.

Abstract:

This presentation will provide a toolkit for selling and implementing a Cross-Continuum Care Management Model. This model has demonstrated results with high risk/high needs patients for five years. The model includes inpatient, ambulatory and community care management components as well as a high-risk clinic for the top 3% high utilizing patients who account for 50% of the annual healthcare spend. The inpatient team works to transition patients to the appropriate level of care. The ambulatory team is focused on high-risk patients to prevent readmissions, close gaps in care and engage patients in self-care. The community care managers support the Preferred Provider Skilled Nursing Network, working to reduce readmissions and length of stay. Results are positive on all metrics, including $4M cost savings for Medicare Share Savings patients and a nearly 50% reduction in readmissions rates.



Learning Objectives:
  1. Define the strategies used to build a Cross-Continuum Care Management Model
  2. Identify the key elements needed to build: a. an Ambulatory Care Management program b. a Preferred Provider Network and Community Care Management Program c. Care Management support for a high risk clinic
  3. Select Cross-Continuum Care model strategies and tools to be applied within your setting

A3 - Negotiating with Patients: Overcoming Resistance to Home Services | Participant Level – Intermediate 1 CE
Practice Setting:  

9:45 AM - 10:45 AM

Lee Lindquist, MD, MPH, MBA

Annie Seltzer, LCSW, CSW-G

Faculty Biography:
Dr. Lindquist is the Chief of Geriatrics at Northwestern University Feinberg School of Medicine, Chicago, IL. She is a graduate of Northwestern University Feinberg School of Medicine and has also completed her Masters in Public Health and MBA from Kellogg School of Business at Northwestern. She has lead multiple research studies helping older adults to successfully age in their own homes and communities. She is federally funded by PCORI, NIH, AHRQ, and CMS. Dr. Lindquist has been published in many diverse journals both in the medical and non-medical realms. Most notably, Dr. Lindquist has been sought as an expert for the New York Times, Harper’s, Boston Globe, Wall Street Journal, and multiple other regional sources. Appearing on CNN, MSNBC, and national syndicated talk shows, she has been tapped by multiple news sources to cover health topics related to successful aging-in-place.

Annie is a Licensed Clinical Social Worker and leads the Outpatient Geriatrics Social Worker team at Northwestern Memorial Hospital. She has been instrumental in working with an interdisciplinary team of geriatricians, medical residents, nurses, and medical assistants to provide best possible care to older adults. She has presented at multiple annual meetings and her work has been published in multiple venues. At the Annual ACMA 2016 meeting, she was awarded the most innovative research for her work with older adults and planning for their home-based needs (PlanYourLifespan.org).

Abstract:

Older adults who need support in the home will sometimes refuse it even when it is the best strategy to allow them to safely age in place. Research with 68 older adults from multiple rural, suburban and urban sites revealed what is often behind the reluctance and insights to overcome resistance. This presentation will connect these insights with business school-taught negotiation tactics, demonstrating a practical means to achieve acceptance of home services. These Refusal of Care (ROC) negotiation techniques have been taught to nurses, social workers, case managers and providers. Case studies to illustrate how ROC negotiation techniques were successfully used in discharging patients from the hospital, in ambulatory/outpatient care, and home settings will be shared.



Learning Objectives:
  1. Identify common reasons why older adult patients refuse home-based services
  2. Determine strategies that can help older adults accept home services
  3. Master use of ROC negotiation tactics in real-world health care settings

A4 - Building Resilience and Gratitude in Case Management Practice | Participant Level – Intermediate 1 CE
Practice Setting:  

9:45 AM - 10:45 AM

Joan Brueggeman, RN, BSN, ACM-RN

Faculty Biography:
Joan has served as the Director of Care Coordination and Utilization Management at Gunderson Health System in La Crosse, WI since 2007. In her 30-year nursing career, Joan held positions in private and public organizations, with the last 24 years dedicated to work in case management/care coordination and utilization management specifically. She has authored articles on care coordination spanning inpatient and outpatient settings. Joan has held numerous positions within National professional organizations including the Wisconsin Chapter ACMA Board and has served as a Collaborative Case Management editorial board member.

Abstract:

Case management professionals work in a rapidly changing and evolving health care environment. Personal attributes and skills are necessary to navigate change successfully. The use of disciplined rather than default behaviors
during stressful interactions and techniques of resilience that are relevant to case management practice will be reviewed. Interactive exercises will build upon strengths and weaknesses that each individual can contribute to moving the team forward. The session will conclude with a discussion and exercise on gratitude that will enhance self-care and fulfillment.



Learning Objectives:
  1. Describe the concept of resilience and the value within case management practice
  2. Review disciplined versus default behaviors and what can trigger the behaviors during stressful situations
  3. Perform an exercise in gratitude to replicate within practice settings

A5 - Pediatric Care Coordination: Best Practices to Avoid Readmissions | Participant Level – Intermediate 1 CE
Practice Setting:  

9:45 AM - 10:45 AM

Cyndi Fisher, RN, MSN, CPNP, ACM-RN

Faculty Biography:
Cyndi is a certified Pediatric Nurse Practitioner who works with the Inpatient and Emergency Department Case Managers and the Community Based Complex Care Managers at Children’s Hospital Of The Kings Daughters. Her desire through these departments is to promote quality and safety in all the pediatric system encounters and to optimize the health and well-being of the children and youth with special health care needs in the community. Her passion for this work evolved from her role as a nurse in the neonatal ICU at CHKD in the early 90’s. Cyndi believes effective care coordination is the key element to assuring safe and sustainable transitions of care. Cyndi designed and implemented the first case management program at CHKD in the NICU. She was a partner in the creation of the community based model at CHKD and implemented the complex community based coordination program at CHKD known as Care Connection for Children. She has successfully secured the funding and assured the mission of this program for the past 15 years. She has participated in the NICHQ medical home initiative and developed tools for transition and emergency preparedness that are used across the state. Cyndi has served as a local Coordinator for the Safe Kids Coalition, she has been the recipient of her local NAPNAP chapter’s award of excellence, and has been recognized by Champions for Children for innovation. Cyndi holds a Master’s degree in Pediatric Nursing from Old Dominion University.

Abstract:

This children’s hospital required a strategy to reduce seven-day readmission rates by 10% over the course of a year. Evidence-based interventions known to lower readmission rates include identification of at-risk patients, clinician feedback, scheduling follow-up appointments and evaluation of the efficiency of discharge planning. This session will provide an overview of focused improvements that resulted in a 13.7% reduction in the seven-day readmission rate rolling average. Case management surveys in the emergency department, garnering and sharing feedback on quality of discharge plans, technical improvements in arranging follow-up appointments and follow-up calls have proven to be effective interventions.



Learning Objectives:
  1. Demonstrate effectiveness of a collaborative approach to reduce pediatric readmissions
  2. Discuss the involvement of parent partners in readmission prevention
  3. Share tools for readmission review that enhance effectiveness in metrics reporting

A6 - High Demand Session (Repeated)
9:45 AM - 10:45 AM

Abstract:
You asked, and we listened. Based on feedback from attendees one high demand session will be repeate during the conference. 


A7 - Improving Outcomes and Experiences with Palliative Care Skills | Participant Level – Beginner 1 CE
Practice Setting:  

9:45 AM - 10:45 AM

Ruth Maclntosh, BS, RN, CCM

Allison Silvers, MBA

Faculty Biography:
Ruth recently retired from Aetna as the Continuum of Care Manager of Aetna’s Compassionate Care Program. Her nursing background was spent in hospice and home care, along with staff development, prior to her career at Aetna. As Continuum of Care Manager, she had oversight and responsibility for delivery and implementation of Aetna’s Compassionate Care Program which provides Case Manager Support for those with Advanced Illness. As the Continuum of Care Manager her responsibilities included: Manage the program, Develop and present new hire training/ preceptor support, Report review oversight, Leader of workgroups comprised of multiple clinical roles. Develop workflows, Key clinical resource for the Aetna Compassionate Care Program for business within company.

Allison serves as the Vice President for Payment and Policy at the Center to Advance Palliative Care (CAPC). In this role, Ms. Silvers educates health plans, policymakers, and health systems. Prior to joining CAPC, she served as the Chief Strategy Officer for Village Care, where she oversaw a CMS Innovation Award to improve treatment adherence for people living with HIV/AIDS, along with leading a Medicare Bundled Payment for Care Improvement initiative for post-acute services. Allison served as the long-term care subject matter expert for a New York State Commission, and directed a Medicare Coordinated Care Demonstration. She has authored numerous publications, holds an MBA from Yale University and a BS in Economics from the Wharton School, University of Pennsylvania.

Abstract:

Participants in this session will be introduced to a new set of skills – drawn from the field of palliative care that impact patient quality-of-life, satisfaction and avoidable utilization. These skills include: clarifying patient’s values and goals; assessing symptom burden, emotional and spiritual needs, and caregiver burden; and communicating with the care team to align treatment with what is most important to the patient. The session will describe how this skill training was implemented in a health plan, accountable care organization (ACO) and hospital transitions program. After a didactic presentation, there will be brief role play to illustrate these skills in action, and then participants will learn about resources available for skill training and assessment tools. An interactive Q & A will conclude the session.



Learning Objectives:
  1. Describe the differences in need between the seriously-ill and other high-risk patients
  2. Describe at least 4 assessments needed for the seriously-ill population that are not commonly completed
  3. Demonstrate and apply skills to communicate with patients about their values, helping to ensure shared decision-making and alignment

A8 - Combatting the Opioid Epidemic and Drug Misuse | Participant Level – Intermediate 1 CE
Practice Setting:  

9:45 AM - 10:45 AM

Darren E. Totty, Pharm.D., APh

Faculty Biography:
Darren graduated with Doctor of Pharmacy in 1995 from UCSF, completed a post-doctoral Primary Care Residency in 1996 and has worked in many different facets of clinical pharmacy including nutrition support, SNF consulting, Hospice Consulting, Pharmacy Benefits Management, Ambulatory clinics, and has experience in retail pharmacy. Most recently, he earned Advanced Practice Pharmacist licensure from the California State Board of Pharmacy based on his collaborative practice agreements within the Sutter Health System. He works closely with Primary Care Physicians and other clinicians managing Chronic Medical conditions. Recently has worked extensively to help Providers deal with the Opioid Crisis weaning patients either off opioids or to a more manageable level of use.

Abstract:

Prescription opioid misuse results in 115 deaths each day in the United States and is growing. Strategies are needed in outpatient settings to bring a creative approach to addressing the growing opioid crisis. The speaker will present multifaceted, integrated approaches to combating this particular crisis, spanning various settings and applying techniques to demonstrate a positive impact.



Learning Objectives:
  1. Describe opioid crisis manifestations in health care
  2. Review key identification strategies, screening and assessment techniques as well as interventions
  3. Identify multidisciplinary approaches to apply in combating the opioid epidemic

Breakout Session B
Monday, April 15, 2019

B1 - Integrating Episodic and Longitudinal Care Management: A 30-Day Transition Model | Participant Level – Beginner 1 CE
Practice Setting:  

11:00 AM - 12:00 PM

Stephanie Kleier, RN

Verda Weston
LSSBB

Faculty Biography:
Stephanie is a transitional care nurse at Utica Park Clinic in Tulsa OK. She has over 20 years nursing and supervisory experience within a variety of settings including inpatient care, Shelter Health Services, a Juvenile care center and Cardiology services. She holds Lean Six Sigma and BLS certification.

Verda is the Director of Population Health at with Hillcrest Health Systems at Utica Park Clinic. In this role, she is responsible for the Population Health department operations and oversees the CPC plus initiative consisting of 112 primary care providers in 28 CPC primary care clinics located in northeast Oklahoma. Verda has over 35 years of experience in hospital operations encompassing administrative and executive roles in acute care hospitals. She has been a speaker at several national and state professional conferences including the CMS CPC presentations, the American Health Information Management Association (AHIMA), the Healthcare Information and Management System Society (HIMSS) and the American Case Management Association (ACMA).

Abstract:

A transition of care phone call after discharge from an inpatient hospital stay is critical, but it is only the beginning. To lower risk of readmission, improve patient quality of life and integrate self-care and preventive care into a patient’s post-discharge routine, a comprehensive Transition of Care Management program is required. Hospitals and ambulatory clinics can provide more cohesive transitions between care settings. The session will detail a model that incorporates the relationship between transition of care nurses that work alongside case managers on the hospital floors and care managers who are embedded into the primary care clinics, showcasing how that relationship can provide better management of the patient through complex post-discharge transitions.



Learning Objectives:
  1. Discuss the Transition of Care model that integrates acute and ambulatory care management
  2. Identify the benefits of the three unique roles: acute care managers, transitions care managers and longitudinal care managers in ambulatory clinics
  3. Define the steps to implement a Transition of Care Management Program

B2 - Centralized Authorizations, Denials & Appeals: A Model for a Multi-Hospital System | Participant Level – Intermediate 1 CE
Practice Setting:  

11:00 AM - 12:00 PM

Michael McEntire, RN, ACM-RN, CRCR, IQCI

Deborah Wener, RN, CCM, CRCR, IQCI

Faculty Biography:
Michael is a Corporate Regional Director of Care Coordination for Adventist Health System, overseeing eleven hospitals in the western Florida market. Prior to this role, Michael served in various clinical roles including: Clinical Documentation & Care Coordination Educator/Analyst, RAC Coordinator and RN Case Manager. He received his Master of Business Administration from Southern New Hampshire University in Manchester, NH. Michael is an accredited Case Manager and InterQual certified instructor.

Deborah is the Corporate Regional Director of Care Coordination for Adventist Health System, overseeing six hospitals in the Eastern Florida market since 2015. Prior to her current position, Deborah brought 13 years of Utilization Management and Case Management expertise to her various leadership roles. She is a Certified Case Manager, Certified Revenue Cycle Representative (CRCR) and InterQual Certified Instructor (IQCI).

Abstract:

One multi-hospital region of Adventist Health System introduced a centralized model for authorizations, denials and appeals rather than a centralized utilization review function and achieved a decrease in claims denials from $95 million in 2015 to $24 million in 2017. Expanding on this success, a new pilot program this year will broaden the department’s scope past the initial focus of inpatient and observation authorizations by adding elective surgical procedures, working to pre-authorize 100% by collaborating with coders, physicians and payers to obtain authorizations for all potential CPTs. This year, other regions adopted this model and results from all regions will be presented, including what has worked well and what has not.



Learning Objectives:
  1. Describe the impacts of increased UR productivity, reduced AR, and decreased denials
  2. Explain the benefits of tracking payer behaviors across a region, insuring accountability to contractual standards
  3. Identify the advantages in keeping UR staff onsite

B3 - Intersection of Human Trafficking and Healthcare | Participant Level – Intermediate 1 CE
Practice Setting:  

11:00 AM - 12:00 PM

Tejal S. Patel, Esq.

Karen B. Silva, PhD., MFN, MSN, RN-BC

Divina E. Franco, LCSW, MPH, MPH, ACM-SW

Faculty Biography:
Tejal (TJ) has worked in Healthcare since 2005, as a practicing attorney and as an insurance broker. She currently works in the Risk Management Department of Cedars-Sinai Medical Center and specializes in insurance and claims oversight. TJ has been involved with victims of Human Trafficking since her law school days as part of a multi-disciplinary task force in San Diego County, where extensive victim transport networks originate and extend to and from Hawaii.

Karen currently works as an education program coordinator and instructor of psychiatry at Cedars-Sinai Medical Center. She has a master’s degree in Advanced Practice Nursing (Adult and Geriatric), a post-master’s certificate in Forensic Nursing, and PhD in General Psychology. She is board certified in Mental Health and Psychiatric Nursing. Karen is cross trained as a medical-legal death investigator and as a sexual assault nurse examiner. She is one of the founders of Brazilian Society of Forensic Nursing and she is a member of the International Association of Forensic Nursing. Here at Cedars-Sinai Medical Center, she is a member of the human trafficking taskforce.

Divina is the clinical social worker for 7 SouthEast at Cedars-Sinai Medical Center. She has a master’s degree in both Social Work and Public Health from the University of Southern California. She's been in the field of Social Work for 4 years and has served as an advocate providing in-person crisis interventions to sexual assault survivors.

Abstract:

A 2017 survey from the Coalition to Abolish Slavery & Trafficking (CAST) of labor and sex trafficking victims, shows nearly 50% of human trafficking victims reported at least one healthcare encounter during victimization and 97% received no information about human trafficking. Medical care providers are often unprepared to identify and appropriately respond to trafficked persons. Less than .01% of the more than 5,500 hospitals in the U.S. have a plan in place for treating trafficked patients. Cedars-Sinai Medical Center’s Human Trafficking Task Force, made up of social workers, nurses, PhDs, a forensic nurse-educator and an attorney-risk manager, educates healthcare providers about the physical, emotional and behavioral symptoms of a potential victim. An action plan involving a trauma- informed approach and a sample conversation/template for clinicians is part of the training.



Learning Objectives:
  1. Define Human Trafficking
  2. Describe Trauma and Effects on Victims
  3. Master identification of and response to victims

B4 - Pathway Home: Bridging Behavioral Inpatient Stays with Community Services | Participant Level – Intermediate 1 CE
Practice Setting:  

11:00 AM - 12:00 PM

Mark Graham, LCSW

Barry Granek, LMHC

Faculty Biography:
Mark is the Associate Executive Director of Operations at Coordinated Behavioral Care (CBC). Since joining CBC in 2014, Mark has played a critical role in managing CBC’s program expansion. He was instrumental in the launch of CBC’s innovative Pathway Home program, which uses the evidence-based Critical Time Intervention (CTI) to engage and effectively transition individuals from intensive behavioral health settings to the community. Under his leadership, this pilot project has now grown to 3 teams covering 4 boroughs and is funded through the State Office of Mental Health. He followed the success of Pathway Home with the development of a variety of programs, including the Staten Island CARES Health Home at Risk project which served over 1,500 clients in 2016. In addition to his work at CBC, Mark regularly teaches a class on Critical Time Intervention at Hunter College and has taught at University College Dublin in Ireland. Throughout his career, Mark has strived to improve the quality of care and outcomes for individuals experiencing social, economic and health-related crises. Prior to CBC, Mark provided direct clinical care and managed programs in NYC, Manchester, England and Dublin, Ireland with a focus on the homeless, people with serious mental illness, and those with chronic health conditions.

Barry earned his Master’s Degree in Clinical Community Counseling and Post Master’s Degree in Counseling At-Risk Youth at Johns Hopkins University and is Licensed Mental Health Counselor in New York State. Barry began his career as a Supported Employment Specialist where he gained experience assessing and treating individuals with emotional and mental disorders and helping people deal with the personal, social, and vocational effects of mental illness. As Team Leader of a NYC Assertive Community Treatment (ACT) Teams, Barry has operated and provided clinical supervision for a team that service individuals with severe mental illness, homelessness, with poor access to care and limited support. In 2015, Barry joined Coordinated Behavioral Care (CBC) as the Program Director for the innovative Pathway Home Program where he has been integral to the development and oversight of the program. Under his guidance, CBC Pathway Home has grown adding 3 new teams and targeting additional populations. Barry is also psychotherapist in private practice with expertise providing individual, group, and family therapy to children, adolescents, and adults in clinical, school, community, and in-home settings. His specialty is using play therapy with pre-school age children and their families.

Abstract:

Traditional Behavioral Health Care Management services offered to Medicaid recipients in New York City often lack the scope and expertise to address the complex needs of individuals with serious mental illness (SMI). The challenges faced after being discharged from long inpatient stays at psychiatric hospital facilities are unique. CBC Pathway Home (PH) is designed to bridge the post-discharge period when individuals are most vulnerable and face significant challenges engaging with community-based services. Multidisciplinary teams offer community-based time-limited intensive support to adults with SMI returning to the community. The audience will learn how the PH teams engage this reluctant population and address clinical and social determinants of health and improved health outcomes.



Learning Objectives:
  1. Recognize how the evidenced-based Critical Time Intervention (CTI) model-of-care provides intensive, personalized services, and how the three phases of the CTI model can be adapted for a Community-Based Care Management Program
  2. Identify the resources necessary to effectively implement the Five Guiding Principles of Pathway Home within other local care transitions model programs
  3. Apply key operational factors that lead to positive outcomes and best practices for Care Transition Programs

B5 - Pediatric Case Management and Outpatient Service Coordination in the Emergency Department | Participant Level – Beginner 1 CE
Practice Setting:  

11:00 AM - 12:00 PM

Mary Daymont, RN, MSN, CCM

Faculty Biography:
Mary is the Vice President of Revenue Cycle and Care Management at Children’s National Health System in Washington, D.C. In her unique role as a nurse Vice President for Revenue Cycle and Care Management she advances healthcare financing and innovative care model designs. As a national expert Mary has consulted through the Center for Case Management with hospitals and health systems across the nation that desire to improve or expand care management services to meet quadruple aim and value-based care objectives. She received her BSN and MSN from George Mason University School of Nursing.

Abstract:

Emergency department and urgent care utilization by the pediatric patient population can create challenges for any health system. On-site care coordination and case management services along with increased awareness and availability of community resources are imperative. These capabilities enhance emergency department efficiency and promote patient and caregiver satisfaction, especially for pediatric clients. This session will provide examples of services provided within healthcare settings to achieve improved efficiency and patient satisfaction results.



Learning Objectives:
  1. Describe common pediatric patient emergency department and urgent care needs
  2. Discuss emergency department case management and social work services and processes
  3. Review case examples and approaches to apply within a variety of settings

B6 - Improved Hospital/SNF Partnerships: Expediting Transfer of Complex Patients | Participant Level – Intermediate 1 CE
Practice Setting:  

11:00 AM - 12:00 PM

Mona Chambers

Faculty Biography:
Mona is the Assistant Nurse Manager for the Continuity of Care Program and the Bed Readiness Continuity of Care Nurse at Harborview Medical Center in Seattle, WA. She has 12 years’ experience in care coordination services and is certified in Case Management. Mona has worked at Harborview for 18 years in a variety of healthcare roles and is currently pursuing her Master's in Nursing at UW Bothell.

Abstract:

Faced with high census, high daily boarder-patient counts and increasing length of stay, Harborview Medical Center’s Bed Readiness Program partners with three local skilled-nursing facilities to expedite the discharge of clinically and socially complex patients. The program provides financial incentives for the skilled-nursing facility, as well as care coordination support and collaboration. This helps the hospital with patient throughput, which improves the hospital’s ability to serve more patients in the community.



Learning Objectives:
  1. Identify the impetus for the establishment of the program
  2. Understand the key elements of the program.
  3. Recognize the key quality measures for the program

B7 - Non-Medical Home Care: How It’s Accessed/Funded | Participant Level – Beginner 1 CE
Practice Setting:  

11:00 AM - 12:00 PM

Gavin Ward, BS
Certified in Readmission Prevention and Bundled Payments

Faculty Biography:
Gavin is the Regional Director of Continuing Education, Strategy & Partnerships for 24Hr Homecare. He is Bundled Payment Certified, was the first Certified Readmissions Fellow by the National Readmission Prevention Collaborative, and is a continuing education instructor for nurses, social workers, and certified case managers. Gavin received his Bachelor of Arts in Communications from Westmont College, in Santa Barbara, CA and has 15 years of healthcare experience.

Abstract:

This presentation will discuss the growing utilization of non-medical caregivers as care extenders to health care organizations throughout the country. Providing this non-medical care is demonstrated to reduce acute care episodes of those receiving the support. As many as 90% of aging adults wish to age in place, and care models are responding by delivering in-home care. Complementary non-medical home care must also become more available. In fact, 31 state Medicaid programs now provide funding for non-medical care as an alternative to nursing home placement. Attendees will learn from existing models of care that leverage the non-medical workforce and are showing some promising results with lower costs of care. A variety of funding sources will be uncovered, including grants and Medicare Advantage Plans funding.



Learning Objectives:
  1. Define non-medical home care
  2. Explain why non-medical homecare is being utilized and funded by healthcare organizations, health plans, community-based organizations, and government entities
  3. Name different funding sources for in-home care

B8 - Providing Integrated Behavioral Health Services | Participant Level – Beginner 1 CE
Practice Setting:  

11:00 AM - 12:00 PM

Catrina Litzenburg, Ph.D.

Mark McGovern, Ph.D.

Twinchit Salcedo Singer, MS, LCSW

Faculty Biography:
Catrina is a Licensed Psychologist at Nationwide Children’s Hospital and Assistant Professor – Clinical at The Ohio State University. Dr. Litzenburg has over five years of experience working in integrated primary care settings across the lifespan. Since October 2016, she has been part of a team of psychologists developing a program of integrated pediatric primary care at Nationwide Children’s Hospital in Columbus, Ohio. In addition to clinical service, Dr. Litzenburg participates in quality improvement and program evaluation efforts. She also engages in training and mentoring activities with psychology interns and postdoctoral fellows as well as pediatric and family medicine residents.

Dr. McGovern is a Professor in the Department of Psychiatry and Behavioral Sciences, and in the Department of Medicine at Stanford University School of Medicine. He is the Co-Chief of the Division of Public Mental Health and Population Sciences (Psychiatry) and Medical Director of Integrated Behavioral Health in the Division of Primary Care and Population Health (Medicine). Dr. McGovern is the Director of the Center for Behavioral Health Services and Implementation Research. His overarching goal is the to get the most effective treatments available to those who need them most. With nearly 25 years of continuous NIH and foundation funding, and using rigorous methods and metrics from implementation science, Dr. McGovern’s work focuses on two primary content areas: 1) Integrating behavioral health services—including mental health and addiction—in routine medical practice settings; and 2) Scaling up evidence based interventions for addiction—particularly medications for opioid use disorders—across systems of care. Because implementation research in health care cuts across all disciplines and specialties, Dr. McGovern is actively engaged in mentoring other Stanford faculty, post-doctoral fellows, residents and students in the science of implementation. In his position at the Palo Alto VA, he serves as the Deputy Director of the HSRD Center for Innovation to Implementation. He is a Core Faculty at the NIH Implementation Research Institute and a standing member of the NIDA study section on Interventions for the Prevention and Treatment of Addiction.

Twinchit brings over twenty years of clinical experience to her social work practice. Twin's multidisciplinary training is exemplified by her two Master's Degrees in Community Counseling and Clinical Social Work, each in a different branch of the human service field. Known for her rapid rapport building skills, her warm demeanor, her holistic perspective and her broad understanding of cultural and ethnic needs. Twinchit has a rare knack for not only helping clients to feel comfortable enough to share their story but also assisting patients in effectively navigating their medical care. Twinchit's robust and varied experience at Sacramento County Mental Health as a Mental Health Counselor and the Veteran's Administration as a Medical Social Worker positioned her well to be a pioneer of integrated behavioral health in her current role as Medical Social Worker at Sutter Health. She works diligently to seamlessly integrate the best practices of the social work and counseling fields into the primary care setting in a way that enhances interdisciplinary coordination and communication while honoring the humanity of all patients.

Abstract:

Accessible, affordable and available ambulatory behavioral health resources are limited in many communities. Integration of behavior health with primary care settings is important to meet the needs of patients seeking care for mental illness. This session will explore options and present community programs piloted among leading institutions to meet the care management needs of the behavioral health population.



Learning Objectives:
  1. Describe current state, gaps and barriers within ambulatory behavioral health services
  2. Review strategies, resources and delivery models to meet patients’ needs
  3. Investigate and apply community program pilot options that address needs within local communities

Breakout Session C
Monday, April 15, 2019

C1 - Managing Readmissions Across 28 Hospitals: A “How To” Transitions of Care Manual | Participant Level – Intermediate 1 CE
Practice Setting:  

2:00 PM - 3:00 PM

Devonne Grizzle, RN, MSN, CCM

Sue Muchler, RN, MSN, MBA, FACHE

Faculty Biography:
As the Vice President of Case Management, DeVonne uses her experience in case management and quality in her clinical leadership role at Quorum Health. DeVonne brings over 20 years of Nursing, Quality, and Case Management experience to her role as Vice President of Case Management at Quorum Health. In addition to Case Management, DeVonne is also responsible for CarePledge Alliance, QHC’s Accountable Care Organization which serves over 17,000 lives. Previously, DeVonne role with CHS was that of a Regional Case Management Director serving Division II (South Central United States) and Division IV (Western Region of United States). Prior to her career with CHS, DeVonne served as the Executive Director of Quality, Research and Nursing Education at a large teaching hospital in Western Arkansas. She started her case management career in the outpatient setting as the Director of Donor Services for United Blood Services. As a Certified Case Management Professional, DeVonne provides knowledge that bridges the clinical aspects of healthcare to the ever-changing financial aspect of healthcare while remaining centered on high quality patient care. DeVonne graduated Magna Cum Laude from Arkansas Technical University with her Bachelor’s of Science in Nursing. DeVonne then went on to earn her Master’s Degree in Nursing Administration, with an emphasis on Case Management, from the University of South Alabama in 2007.

Susan has served as the Regional Director of Case Management East at Quorum Health Corporation since 2016. Prior to her current role, she was a Senior Project Manager for Corporate Case Management. Susan earned her Master of Business Administration, and Master of Science in Nursing Administration from Lewis University in Romeoville, Illinois. As a Fellow of the American College of Healthcare Executives, she is a Board-Certified Healthcare Executive and a past member of the Chicago Regents Advisory Council, as well as a founding Board Member for the Western Florida ACHE chapter.

Abstract:

Quorum Health Corporation is a nationwide health system with locations in non-urban markets. In January of 2017, to address the ongoing impact of CMS readmission penalties, Quorum instituted a readmissions management program that included a “how-to” manual with electronic forms, tools and resources. The focus is a transitions of care program that includes COPD, CHF and Pneumonia DRGs and is implemented at each of the 28 hospitals in the system. Each hospital operationalizes the program according to facility size and patient population served. By Q3 2017 penalty reductions in several of the facilities were below 1.0. Now with an ACO and with the transitions of care program in place, acute care case management will connect with a population health nurse to improve care transitions and chronic care management, improving performance further.



Learning Objectives:
  1. Define the scope of work for a successful readmission management program: the four basic elements
  2. Determine the components of Transitions of Care Program implementation
  3. Identify the metrics for measurement of program success

C2 - Managing Observation Status and Reducing Denials | Participant Level – Beginner 1 CE
Practice Setting:  

2:00 PM - 3:00 PM

Susan O'Connell, RN, BSN, MPA

Faculty Biography:
Susan is the Director of Case Management at Houston Methodist Willowbrook Hospital. She received her Bachelors Degree in Nursing from Milliken University. She received her Masters Degree from Grand Canyon University in Public Administration. She has worked in the hospital setting for 35 years most of that time in Case Management. She has been involved in the management of observation units for many years. She is a Certified InterQual Instructor and stresses the importance of accurate clinical reviews to determine status. "Susan says that having a dedicated observation unit and accurate medical necessity requires are key to having a successful observation program".

Abstract:

Management of Medicare and Medicare Advantage observation status is best accomplished with a multidisciplinary team and process. This presentation will be both a primer on the observation rules and nuances, as well as an overview of the components of a successful multidisciplinary process. The process integrates the daily observation huddle, the monthly observation data review and the escalation process for delays in service. Implementing this approach has led to a reduction from 33% to 22% in initial observation rates and a corresponding reduction in claim denials during the first half of 2018.



Learning Objectives:
  1. Define the rules of Medicare and Medicare Advantage observation status
  2. Identify the impact interdisciplinary management can have on observation rate and length of stay
  3. Evaluate the benefit of using observation patient cohorts

C3 - Elder Abuse in Healthcare Settings: Early Identification and Comprehensive Assessment |Participant Level – Intermediate 1 CE
Practice Setting:  

2:00 PM - 3:00 PM

Lisa Bednarz, LCSW, ACM-SW

Faculty Biography:
Lisa manages the Care Coordinators and Social Workers on the medicine and transplant service lines at NewYork-Presbyterian Hospital/Columbia University Medical Center. In this role, she leads several initiatives create new infrastructure and leverage information technology to support our most vulnerable patient populations. Along with the NYP Innovation Center, Lisa is working to integrate machine learning and predictive analytics into clinical operations to improve healthcare access and quality. Lisa is a Reynolds Scholar in Social Entrepreneurship and has post-graduate training in healthcare reform and management. She currently enrolled in University of Pennsylvania’s Healthcare Innovation program.

Abstract:

Elder abuse is a complex and under-reported issue associated with increased use of health care services including emergency rooms, sub-acute rehabilitation programs and long-term care facilities. These institutions are uniquely positioned to address this reporting crisis. During discharge planning, case managers assess patients’ functional status, environment and support system. This responsibility provides an opportunity and the authority to identify survivors of elder abuse and to provide prevention and intervention services. This presentation will discuss assessments of physical, financial, emotional and sexual abuses through both questionings and using medical records to identify forensic biomarkers that may point to such abuse. Case studies highlighting successful and missed interventions will be presented.



Learning Objectives:
  1. Recognize factors that contribute to severe or escalating abuse going undetected within the healthcare setting
  2. Identify forensic biomarkers that can indicate elder abuse
  3. Modify current practice to include elder abuse assessment techniques and reporting procedures

C4 - Speed Learning: Case Management Innovation Showcase | Participant Level – Intermediate 1 CE
Practice Setting:  

2:00 PM - 3:00 PM

Stacy Wright, LCSW, MHA, MBA, ACM-SW

Faculty Biography:
Stacy is a Senior Director of Case Management with Novant Health and her territory takes her from Charlotte to Northern Virginia. She has a BSW from Appalachian State University, her MSW from UNC-Chapel Hill and her MBA/MHA from Pfeiffer University. She has over 26 years of case management experience. Her passion is working with patients/families to provide continuity of care as well as growing the awareness of the profession of case management in her workplace.

Abstract:

This session will feature case management innovations that have been successfully implemented in health care settings. Panelists representing five innovations will provide a ten-minute overview of project goals, implementation and outcomes. Interactive Q & A and audience participation will follow the panel presentations.



Learning Objectives:
  1. Discuss new innovations within case management practice
  2. Explain implications for case management practice and provide performance data to track outcomes
  3. Review implementation strategies and key components to achieve desired outcomes

C5 - Improving Hospital Throughput Using Discharge Milestones | Participant Level – Intermediate 1 CE
Practice Setting:  

2:00 PM - 3:00 PM

Joan Cullen, MSN, RN, CCM, CNL

Lesly Whitlow, DNP, MBA, RN, CCM

Faculty Biography:
Joan is a Manager of Case Management at Ann & Robert Lurie Children’s Hospital of Chicago. Within this role, she provides leadership and supervision for the case management team, serves as a clinical expert, staff resource and role model. Joan received her Master of Science- Nursing Clinical Leader at Rush University in Chicago and is a certified case manager and InterQual Instructor.

Lesly is the Senior Director of Patient Services at Ann & Robert Lurie Children’s Hospital in Chicago. She is responsible for leading strategic planning, coordination, communication, and delivery of patient services that support effective management and operation of the following areas within Patient Services: Case Management, Centralized Scheduling, Transplant Services, and International Patient Services. She has over 16 years of health care experience and has served in leadership roles within case management, care coordination, clinical documentation improvement and denial management. Lesly received her Master of Science in Health Administration and Master of Business Administration from the University of St. Francis, in Joliet, Illinois and her Doctorate in Nursing Practice-System Leadership from Rush University in Chicago.

Abstract:

Ineffective hospital throughput contributes to decreased patient satisfaction, decreased quality of care and missed revenue opportunities. Since most children at this institution are discharged in the evening, a multidisciplinary campaign was launched to identify discharge tasks that resulted in delays. Common barriers to timely discharges include: ordering medications, arranging transportation and entering discharge orders. Interdisciplinary collaborative efforts resulted in an improved patient and family experience as well as smooth, efficient transitions.



Learning Objectives:
  1. Develop improved communication techniques within multidisciplinary teams to ensure a target discharge date is met
  2. Define the impact the case manager role has on timely discharges
  3. Identify inefficiencies that can be targeted with improvement strategies

C6 - Post-Acute Care: Authorization and Denial Avoidance | Participant Level – Intermediate 1 CE
Practice Setting:  

2:00 PM - 3:00 PM

Janeen Foreman, RN, BSN, MHHS, CPHQ

Karla White, MSW, LCSW

Faculty Biography:
Janeen is the Corporate Director of Case Management for LifeCare Health Partners. In this role she oversees the case management and clinical documentation improvement activities for all eighteen of LifeCare’s Long Terms Acute Care Hospitals. Janeen holds a Master’s degree in Health and Human Services and a Bachelor’s degree in Nursing from Youngstown State University, in Youngstown Ohio.

Karla is a Case Management Support Director for LifeCare Health Partners. In this role, Karla provides education and hands on assistance to the Case Management teams at LifeCare’s 18 LTAC hospitals. Karla holds a Master’s degree in Social Work and has worked in hospital case management for 25 years, 20 of them in an LTAC setting.

Abstract:

Securing authorization for services and treatment and accessing funds for underfunded patients is becoming increasingly difficult. Long-term Acute Care (LTAC) facilities, skilled facilities and acute rehab settings are increasingly scrutinized by both payers and regulatory bodies in order to certify care. In this session, successful approaches to obtain authorization for the right care at the right level and transition from acute short-term to LTAC while avoiding payment denials will be presented.



Learning Objectives:
  1. Develop the case for obtaining authorization for post-acute care
  2. Review success strategies to obtain authorization and avoid denials
  3. Describe resources for underfunded patients

C7 - Strategies to Improve Patient and Family Satisfaction | Participant Level – Intermediate 1 CE
Practice Setting:  

2:00 PM - 3:00 PM

Russell Hilliard, Ph.D.

Faculty Biography:
Russell is the Senior Vice President of Key Initiatives at Seasons Hospice and Palliative Care based out of Chicago, IL and the Founder of the Centers for Music Therapy in End of Life Care. In his 25-year hospice career, he has created innovative end of life care programs, devised robust documentation procedures, and assured processes support the highest quality patient and family care. His research, advocacy, and consultation have resulted in the development of first-time music therapy programs in hospices throughout the nation, thereby creating many new music therapy positions. He is the author of the text, Hospice and Palliative Care Music Therapy: A Guide to Program Development and Clinical Care, and his research has been published in a wide variety of scholarly journals. He also wrote a chapter titled, Music and Grief Work with Children and Adolescents, in a book titled Creative Interventions with Traumatized Children, edited by Cathy A. Malchiodi as well as the chapter titled Songs of Faith in End of Life Care in a book titled Developments in Music Therapy Practice: Case Study Perspectives. Dr. Hilliard has provided keynote addresses for healthcare conferences and is a frequent presenter at professional conferences world-wide.

Abstract:

What are the keys to achieving patient and family satisfaction within the community? Does this differ from the acute care experience? During this session, case examples will highlight factors influencing patient satisfaction. Cultural sensitivity and communication styles will be explored. The presenter will discuss innovative approaches, strategies and outcome data to apply and improve performance.



Learning Objectives:
  1. Describe common factors that influence satisfaction and engagement
  2. Identify creative solutions to improve the patient experience
  3. Discuss case examples and provide data to monitor patient satisfaction outcomes

C8 - Best Practices in Population Health Management | Participant Level – Intermediate 1 CE
Practice Setting:  

2:00 PM - 3:00 PM

James Whitfill, MD

Faculty Biography:
Dr. Whitfill is currently the Chief Medical Officer for Innovation Care Partners, a Clinically Integrated Network in Phoenix Arizona. Dr. Whitfill received his AB from Princeton University, and his MD from the University of Pennsylvania. He did his Residency and Chief Residency in Internal Medicine at the Hospital of the University of Pennsylvania and completed a fellowship in Medical Informatics in the University Of Pennsylvania Department Of Medicine. At for Innovation Care Partners , he has been a key part of the team which has delivered cost savings across multiple payer sources including commercial, Medicare ACO, direct to employer and Medicare Advantage plans. He currently serves as a Clinical Associate Professor in the Departments of Internal Medicine and Biomedical Informatics at the University of Arizona College of Medicine-Phoenix. He is also a frequent lecturer at the Biomedical Informatics Graduate and Undergraduate programs at Arizona State University. He enjoys running, skiing and camping with his wife and three children.

Abstract:

Best practices in population health management require integration of several aspects of care delivery. This session will include a discussion of best use technologies, predictive analytics and access to electronic medical record information. Approaches to complex care planning, chronic disease management, multiple provider or setting coordination, identification of high-risk patients and patient/family navigation will all be presented.



Learning Objectives:
  1. Describe the evolving practices within ambulatory population health
  2. Discuss common challenges to integrating care delivery and promoting population health in community settings
  3. Identify strategies and approaches to address challenges and achieve optimal health care

Breakout Session D
Monday, April 15, 2019

D1 - Bedside Case Managers: Using an Actionable Dashboard | Participant Level – Intermediate 1 CE
Practice Setting:  

3:15 PM - 4:15 PM

Todd McClure Cook, MBA, MSW, Ed.D, FAIHQ, FABQAURP, FABC, ACM-SW

Faculty Biography:
Dr. Cook currently serves as the Vice President of Integrated Care Management at Sharp HealthCare in San Diego, CA. With greater than 25-years’ experience, he is a national subject-matter expert and executive leader for integrated care management, case management, population health and health care executive leadership Dr. Cook attained his masters’ in business administration from California Pacific University, his masters’ in social work from the University of Southern California, and his doctorate in organizational change and leadership, with a focus on complex health care organizations and systems from the University of Southern California. He has 3-fellowships from the: American Board of Quality Assurance and Utilization Review Physicians, American Institute for Healthcare Quality, and the Advisory Board Company.

Abstract:

An opportunity to bring real-time, measurable data to the bedside case manager arose as part of a training re-design process. Bedside case managers identified a need to quickly focus on the most important variances related to a patient’s stay. Importantly, these variances must respond to immediate actions with measurable and meaningful outcomes. An Actionable Dashboard (AD) was created. The AD is a real-time reporting function embedded in the institution’s EMR system. This AD facilitates the objective measurement and communication of work performance and ties dollar impact to that work. Over a nine-month period, the AD has resulted in multi-million dollar measurable contribution to the bottom line, directly related to case manager action. This has a favorable impacted case manager engagement and a positive impact on system executive perception of case management’s contribution.



Learning Objectives:
  1. Describe an actionable dashboard
  2. Identify critical metrics for dashboard inclusion
  3. Use provided examples as a framework to design their own actionable dashboard

D2 - Clinical Documentation Improvement: Analytical Tools and Physician Education to Improve Results | Participant Level – Intermediate 1 CE
Practice Setting:  

3:15 PM - 4:15 PM

Debra Scavitto Jaeger, MSN, RN

Faculty Biography:
Debra has over twenty-four years of experience in hospital operations, population health management, nursing, case management, audit, billing, compliance, workers compensation, and administration in various healthcare settings. She is currently Corporate Director of Case Management at Universal Health Services, UHS, where she has oversight of UHS’s acute care division, denials and appeals management, patient access, clinical documentation improvement, and value-based contract performance. Before UHS, she held several nursing case management positions including as Director of Case Management at Penn Medicine, Chester County Hospital and at Reading Hospital and Medical Center. Debra received a Bachelor of Science in Nursing from Eastern College and a Master’s of Science in Nursing with a concentration in Leadership in Health System Management from Drexel University.

Abstract:

Clinical documentation improvement will lead to improved outcomes and increase efficiency for all teams involved in documentation and coding. Analytics support the assessment of risk and identification of improvement opportunities. Assessments focused on the identification of cases requiring further evaluation, including physician documentation review. Physician chart reviews followed to determine whether the greatest impact would be process improvement or physician education. This session will highlight tools the participants can apply in their organizations to identify and prioritize cases for review and share specific examples of quality outcomes and tools used for physician education.



Learning Objectives:
  1. Identify the key metrics that determine risk and opportunities for hospital documentation
  2. Recommend metrics, process and implementation plan to improve Clinical Documentation
  3. Recommend metrics, process and implementation plan to improve Clinical Documentation

D3 - Health System-Payer Partnership: Shared Data and Coordinated Care | Participant Level – Intermediate 1 CE
Practice Setting:  

3:15 PM - 4:15 PM

Nancy Magee, RN, MSN, ACM-RN

Phyllis Rebholz, RN, MSEd

Faculty Biography:
Nancy has over 20 years of experience in health care leadership, and a proven track record in productivity measurement, process re-engineering, and development of departmental leadership. She has held a variety of senior leadership positions in Hospitals and service lines where she developed expertise in resource utilization, case management, and interdisciplinary care progression and transition practices. For the past 7 years, as a health care consultant, she worked collaboratively with organizations to establish case management and physician advisor programs, provide on-site coaching and mentoring, and re-engineer care delivery to support cost reduction and effective patient outcomes. Nancy recently joined the Allegheny Health Network as the Vice President of Care Management for the 7-Hospital system, where she is responsible for case management operations as well as creating the vision for population heath and transitions across the continuum of care.

Phyllis has served as the National Director of Case Management at Highmark, Inc. since May 2018. Prior to her current role, Phyllis worked in Case Management/Care Coordination Director and Manager roles. She is an experienced nurse case manager and master’s-level educator with strong background directing operations and financial aspects of impactful hospital care coordination programs. Phyllis received her Master of Science in Education from Duquesne University and her BSN from Carlow College.

Abstract:

The merger of a health system with a major payer in our market positioned us to impact health outcomes and the cost of care within our shared population. Community partnerships were created, and primary care and chronic disease delivery models were transformed. Data transparency provided solid metrics to analyze shared data and identify at-risk populations. An assessment tool and common patient-centered interdisciplinary documentation care plans span the continuum. This session will equip you with ideas and tools to streamline processes and apply strategies within an integrated delivery system.



Learning Objectives:
  1. Identify key goals of an integrated delivery and finance system
  2. Articulate key social determinants influencing patients' health
  3. Describe key strategies to create effective payor-provider parternships for transition planning

D4 - Pediatric Case Management When Medical Child Abuse Is Suspected | Participant Level – Intermediate 1 CE
Practice Setting:  

3:15 PM - 4:15 PM

Candice Ferguson, ADN, RN

Amy Munoz, LMSW

Faculty Biography:
Candice is a Registered Nurse Case Manager at Cook Children’s Medical Center. She began her nursing career as a Licensed Vocational Nurse working in the pediatric primary care setting. She later went on to work for Cook Children’s Home Health where she served as a Private Duty Nurse, Nursing Field Coordinator, Chemotherapy Coordinator, and Clinical Coordinator. During that time, Candice obtained her ADN from Lamar State University which allowed her to pursue Case Management. Currently, Candice serves as the Nurse Case Manager for the Care Coordination Program (CACO) and the Medical Child Abuse Monitoring Program (MCAMP) at Cook Children’s Medical Center. She will continue her education at Western Governors University and plans on obtaining her MSN-Ed by 2021. Candice is a member of the American Case Management Association and the Association of Pediatric Hematology/Oncology Nurses.

Amy is a Licensed Master Social Worker Coordinator (LMSW) at Cook Children’s Medical Center, where she case manages, coordinates care and provides support to children and their families enrolled in the Care Coordination Program and Medical Child Abuse Monitoring Program. She began her Social Work career at the Texas Department of Protective and Regulatory Services, where she investigated allegations of child abuse and neglect. She went on to work in the field of adoption, where she served as a Family Services Caseworker, Admissions Coordinator and Public Relations/Outreach Coordinator. Amy received her BSW from the University of North Texas and her MSSW from The University of Texas in Arlington. She is a member of the American Case Management Association and National Association of Social Workers.

Abstract:

Medical child abuse, often a result of Munchausen by Proxy behavior of the caregiver, occurs when a parent or caregiver is suspected of lying about their medical history or causing symptoms that lead to unnecessary treatments or procedures. There are no reliable statistics regarding the number of children who suffer this type of abuse. While commonly considered rare, evidence suggests this is not the case. The staff at Cook Children’s Medical Center recently identified processes to monitor, track and case manage these types of situations. Presenters will discuss the development and implementation of the Medical Child Abuse Monitoring Program (MCAMP), highlighting the importance of a multidisciplinary approach, which includes internal medical and legal teams and outside agencies such as child protective services, law enforcement, the district attorney’s office and local advocacy centers. Case scenarios will be reviewed.



Learning Objectives:
  1. Describe components of medical child abuse and the possible motives of the perpetrator
  2. Explain the value of a multidisciplinary approach and proper case management plan in place to identify and monitor medical child abuse cases
  3. Develop the ability to engage local agencies to create a multidisciplinary team

D5 - Pediatric Case Management Models: A Panel Discussion | Participant Level – Intermediate 1 CE
Practice Setting:  

3:15 PM - 4:15 PM

Deborah Hill-Rodriguez, MSN, MBA-HMA, ARNP, NE-BC

Gay Matthews, MSN, RN, CCRN-K

Susan Navarro, RN, ACM-RN

Faculty Biography:
Deborah has been an advance practice RN for over 28 years in the pediatric setting at Nicklaus Children’s Hospital. She has worked in many capacities including Clinical Nurse Specialist, Magnet Program Director, Clinical Manager, Clinical Director and now Director of Care Management Transformation. Deborah has a Master’s prepared in Child Health Nursing and an MBA in Healthcare Management as well as ANCC certified as a Nurse Executive. Among many accomplishments, she is best known for creating the Humpty Dumpty Falls Prevention program which is utilized in almost 3000 hospitals internationally.

Gay is the Assistant Director for the Care Management department at Texas Children’s Hospital. She has over 30 years of nursing experience, with 28 years at Texas Children’s Hospital and the last 4 years in the Care Management department. She is currently involved in the transition planning for Care Coordination within her organization. She is on the planning subcommittee for pediatrics with ACMA and this is her 2nd year to speak at the ACMA conference.

Susan is a Registered Nurse and an Accredited Case Manager at Ann & Robert H Lurie Children’s Hospital of Chicago. She has been an RN for 40 years with a diverse medical background in the hospital setting, insurance company and transplant environment. Presently, Susan is a Clinical Case manager for the Pediatric Intensive Care Unit as well as the Transitional Care Unit. She works with medically complex children who are trach and vented to ensure the safe transition to sub-acute care facilities or home for these children and their families. Susan has been a member of the ACMA since 2013 and at present is the Chair person for the Education Committee for the Illinois Chapter.

Abstract:

Changes in the healthcare delivery system have led to restructuring pediatric case management departments and service delivery processes. During this session, panelists will review indications for change, as well as compare the structure of case management models, role delineation, assignments, caseloads and service sites. Model strengths and challenges will be discussed. Outcomes and key performance indicators (KPIs) will be shared.



Learning Objectives:
  1. Compare the benefits and challenges of current case management models
  2. Describe training, standard work, tools and resources for successful implementation of a new model
  3. Review lessons learned, process matrixes and outcomes

D6 - Successful Transitions and Hand-offs to Community Providers and Facilities | Participant Level – Intermediate 1 CE
Practice Setting:  

3:15 PM - 4:15 PM

Lory Arquilla-Maltby, DNP, ANP, APRN-BC

Donna Smith, MSN, MHA, RN, CCM, CRRN

Faculty Biography:
Lory currently serves as the team leader for a nurse practitioner-physician program for Rush Enterprise hospitals in the Chicago area. In this role she provides primary care to patients transferred to Post-Acute/Long term care facilities, works closely with hospital and facility staff to create and coordinate transitions of care and evaluates and creates best practice guidelines to improve quality of care and reduce cost. Lory is a frequent podium and poster presenter at the Gerontological Advanced Practice Nurses national conventions on topics such as a heart failure bridge program utilizing a Post-Acute/Long term care facility and partnering of an inner city Post-Acute/Long term care facility with an academic hospital. Lory received her Master of Nursing from Loyola University of Chicago and her Doctor of Nursing Practice from Rush College of Nursing in Chicago.

Donna is the Manager of Health Management for the Memorial Hermann Health Systems Population Services Health Organization (PHSO) and is responsible for the remote patient monitoring program. She has more than 30 years of nursing and case management experience, primarily in acute rehabilitation and the post-acute arena. Her passion is developing strategies to lead exceptional teams who successfully transition high risk patients from acute fare to the home setting by coordinating care and proving education via remote monitoring in order to avoid readmissions and reduce ED utilization. Donna is certified in both case management and rehabilitation nursing and has a variety of teaching experience in clinical as well as community settings.

Abstract:

Communication is critical to ensure safe, effective care transitions to skilled, rehab and long-term care facilities. During this session, health care professionals representing various care settings will provide tips, tools and examples applied at the point of hand-off within their practice. Transitions of care standards and best practices will be presented related to the multifaceted communication process involving: preplanning and goals of care establishment, hospital-to-post acute facility communications and preparation of patient and family.



Learning Objectives:
  1. Discuss obstacles faced during transitions between facilities
  2. Share tools and best practices for safe, effective transitions between facilities
  3. Provide outcome data showing impact of use of effective transition planning and tools

D7 - Home Care Industry: Overview and Update | Participant Level – Advanced 1 CE
Practice Setting:  

3:15 PM - 4:15 PM

William Dombi, Esq.

Faculty Biography:
Bill is the President of the National Association for Home Care & Hospice. He previously served as the Vice President for Law at NAHC beginning in 1987. As a key part of his responsibilities, Bill specializes in legal, legislative, and regulatory advocacy on behalf of patients and providers of home health and hospice care. With nearly 40 years of experience in health care law and policy, Bill has been involved in virtually all legislative and regulatory efforts affecting home care and hospice since 1975, including the expansion of the Medicare home health benefit in 1980, the formation of the hospice benefit in 1983, the institution on Medicare PPS for home health in 2000, and the national health care reform legislation in 2010. With litigation, Bill was lead counsel in the landmark lawsuit that reformed the Medicare home health services benefit, challenges to HMO home care cutbacks for high-tech home care patients, lawsuits against Medicaid programs for inadequate payment rates, along with current lawsuits challenging the Medicare home health face-to-face encounter rule and the Department of labor changes to the overtime rules under the Fair Labor Standards Act. In addition to litigation, Bill offers extensive community and professional educational services through lectures, publications, teleconferences, and videos. His lectures include market trends in home care, compliance, risk management, patient rights, fraud and abuse, health care reimbursement, legislative and regulatory reforms, and legal issues in telehealth services.

Abstract:

Obtain insights on the expected direction within the home health and hospice arena to address upcoming industry changes and meet standards for cost-effective quality care and services. During this session updates on new regulatory requirements such as the Home Health Groupings Model (HHGM), the revised CoPs and quality initiatives such as value-based purchasing, 5-star ratings, face-to-face reviews and bundled payment models will be shared.



Learning Objectives:
  1. Discuss upcoming home care industry regulatory changes and quality initiatives
  2. Identify potential impact on current home care service delivery and care transitions planning
  3. Apply information to prepare for changes and achieve healthcare outcomes

D8 - Building Patient Engagement Beyond Hospital Walls | Participant Level – Intermediate 1 CE
Practice Setting:  

3:15 PM - 4:15 PM

Jeanne Fears-Wickliffe, RN, BSN, MHA, CPN

Peggy Tyndall, RN, MBA

Faculty Biography:
Jeanne enjoys ocean-side vacations, singing, dancing, crocheting and movie watching with her husband. Serving children and serving those who serve children gives her a sense of purpose. Professionally, Jeanne is a Pediatric Nurse who received her Bachelor Degree in Nursing from the College of Mount Saint Joseph, Cincinnati Ohio and a Graduate Degree in Health Administration from Ohio University. She serves on her church usher board and volunteers with the Out Reach Ministry. Jeanne is currently employed with Nationwide Children’s Hospital in Columbus Ohio working in the Ambulatory Department as a Nurse Program Supervisor where she manages and coordinates atypical primary care services that include managing staff and programs for children, teens and young adults. Jeanne’s ultimate professional goal is to provide health care in areas of the US and world that are lacking in providing quality care to children.

Peggy currently serves as the Operations Director, Care Management Program, at Innovation Care Partners. She has many years of experience working in healthcare including acute care, outpatient, and Primary Care. Her extensive experience includes over 14 years of consulting in Medical Management, Care Management, Clinical Resource Management, Revenue Cycle, Patient Throughput, and Clinical Documentation Improvement. She is experienced working with Health Plans, Hospital systems and Payors. Peggy’s experience also includes Director of Case Management positions in several multi-hospital systems. She is a Registered Nurse with a BS in Healthcare Administration and a Master of Business Administration with a Major in Health Care Administration.

Abstract:

Involving patients in care before, during and after outpatient or ambulatory services can improve outcomes and lower costs. During this session, tips, tools and best practices to provide patient-centric care will be reviewed. Identification of key strategies, performance metrics and essential components for patient engagement will be discussed.



Learning Objectives:
  1. Discuss the challenges within ambulatory care delivery sites that impact engagement
  2. Compare approaches, tools and successes within various sites
  3. Identify strategies to enhance engagement with patients and providers

Breakout Session E
Monday, April 15, 2019

E1A - Speed Learning: Weekend Interdisciplinary Rounds – An Implementation Tool Kit | Participant Level – Intermediate 1 CE
Attention NJ Social Workers: This session is not applicable for CE’s

Practice Setting:  

4:30 PM - 5:30 PM

Renuka Gupta, MD

Lisa Bednarz, LCSW, ACM-SW

Tanya Mighty, RN, MS, BSN

Faculty Biography:
Lisa manages the Care Coordinators and Social Workers on the medicine and transplant service lines at NewYork-Presbyterian Hospital/Columbia University Medical Center. In this role, she leads several initiatives create new infrastructure and leverage information technology to support our most vulnerable patient populations. Along with the NYP Innovation Center, Lisa is working to integrate machine learning and predictive analytics into clinical operations to improve healthcare access and quality. Lisa is a Reynolds Scholar in Social Entrepreneurship and has post-graduate training in healthcare reform and management. She currently enrolled in University of Pennsylvania’s Healthcare Innovation program.

Tanya is the Manager of Care Coordination and Social Work in the Medicine service line at New York-Presbyterian Hospital/Weill Cornell Medical Center. In addition to her management and case management experience, she has a diverse background in education, quality, and outreach and has worked in multiple settings across the care continuum. Tanya received her Master’s degree in Nursing Administration from New York University.

Abstract:
This presentation will provide an implementation toolkit with a focus on staffing models, strategic partnerships and information technology necessary to implement efficient interdisciplinary rounds on the weekends. Weekend rounding programs can lead to meaningful increases in weekend discharges and decreases in length of stay. Data will demonstrate success in increasing Saturday and Sunday discharges between 40–60% with the corresponding decrease in length of stay.

Learning Objectives:
  1. Assess patient volume and overall staffing to determine weekend assignments
  2. Identify key stakeholders for the implementation of weekend rounds
  3. Determine information technology tools that can support weekend rounds

E2 - Leveraging Predictive Analytics to Drive Estimated Day of Discharge | Participant Level – Intermediate 1 CE
Practice Setting:  

4:30 PM - 5:30 PM

Elizabeth Halbert, RN, BSN

Ginna Parker, LCSW

Faculty Biography:
Elizabeth Halbert RN is a Care Coordinator in the Department of Medicine at NYP Weill Cornell. She holds a BS in Nursing from the College of Mount Saint Vincent and is an ACM certification candidate. She is a member of the Quality Improvement committee, the Recognition, Retention, Recruitment and Respect Committee. She is the recipient of the 2018 Social Work Care Management Partner Award. Her previous career experiences include home care and critical care. She is a native New Yorker.

Virginia (Ginna) is an advanced social work clinician in the Department of Medicine and Community Clinic at NYP Weill Cornell. She has over 10 years’ experience within inpatient and community settings. Ms. Parker serves as the chairperson of the Department of Care Coordination and Social Work's Resource Committee at NYP and is the recipient of the NYP 2018 Excellence in Social Work Award. She holds an MSW from Boston University and a Certificate in Palliative and End of Life Care from New York University.

Abstract:

Individual patient variance in healing and recovery create such uncertainties in length of stay (LOS) that providers are often reluctant to predict a specific patient’s estimated discharge date. DRG guidelines fall short of predictive value for the complex patient. Learn how an integrated academic health care delivery system improved LOS and patient outcomes by predicting estimated date of discharge (EDD) using analytics and technologies such as data mining and artificial intelligence. This presentation will share the important elements of a predictive tool, some of the challenges of implementing predictive analytics and specific outcomes.
These analyses are paired with virtual interdisciplinary rounding boards and cross-department teams that address social and intra-institutional barriers to discharge.



Learning Objectives:
  1. Determine the best practices in utilizing predictive analytics and the application to healthcare
  2. Identify the necessary elements and appropriate patient populations to include in the predictive algorithms
  3. Explain how to create a culture of shared responsibility among the healthcare team for timely transitions of care

E3A - Speed Learning: A Clinical Supervision Cohorts Model – Managing Social Workers in a Case Management Practice | Participant Level – Intermediate 1 CE
Attention NJ Social Workers: This session is not applicable for CE’s

Practice Setting:  

4:30 PM - 5:30 PM

Dawn St. Aubyn, MSW, LICSW

Faculty Biography:
Dawn earned her MSW from New Mexico State University in 1999. She is a Licensed Independent Clinical Social Worker in Washington State, employed at Swedish Medical Center. In her role as Clinical Supervisor for Case Management, she has developed a comprehensive clinical supervision program providing clinical supervision for associate level MSWs throughout the SMC system. She has over 30 years’ experience in a variety of settings and roles including emergency department social work; program development; community mental health; case management; child and family therapy; crisis and commitment work; court evaluation and expert witness testimony. She lives in Seattle with her wife and daughter.

Abstract:

Many case management departments include a mix of RN and MSW case managers. Often RN case managers are tenured nurses while many MSW staff members are new to case management. These MSWs work under a provisional license that includes a requirement of formalized clinical supervision. Clinical Supervision (CS) Cohorts, is a specific supervisory format designed to meet targeted clinical and professional development needs of provisionally licensed MSW case managers using a combination of didactic and practical learning in a focused, supportive environment. The presentation will introduce this format, discuss outcomes and share lessons learned. Finally, we will demonstrate how CS Cohorts can be customized to a variety of case management practice environments.



Learning Objectives:
  1. Outline Clinical Supervision Cohort format including sample curriculum
  2. Illustrate 3 outcomes CS Cohorts have achieved toward supporting the professional development needs of social workers and how the organization has benefited by those outcomes
  3. Develop a framework for best practice in customizing CS Cohorts to a variety of case management settings

E3B - Speed Learning: Twenty Strategies to Reduce Inpatient Readmissions to Implement Now | Participant Level – Intermediate 1 CE
Attention NJ Social Workers: This session is not applicable for CE’s

Practice Setting:  

4:30 PM - 5:30 PM

Kimberly Jungkind, MPH, MBA, BSN, CCM

Faculty Biography:
Kimberly is a clinical case management leader with over 20 years of experience in the healthcare industry in a variety of professional clinical case management and healthcare roles. She graduated from Widener University with a double major in Nursing and Psychology, and received her Master’s Degree in Public Health from Temple University in Philadelphia, PA. She recently completed a Multi-Sector Healthcare MBA from St. George’s University and has been a certified case manager for many years. Kim has lectured nationally & internationally on understanding chronic diseases, disease management and clinical topics related to case management. She has authored over fifteen peer-reviewed articles, including two separate chapters in clinical texts and a book. Currently, Kim is a Director of Comprehensive Care Management for two hospitals where she manages a team of care managers and social workers for two hospitals in the Texas based health care system. Kim has been recognized for innovative chronic disease management programs including secondary heart disease, stroke, asthma, COPD, pneumonia and depression, etc.

Abstract:
As many as 1 in 4 readmissions are defined as potentially avoidable, meaning there is a 50% chance the readmission could have been avoided. This presentation will provide 20 ideas and strategies to reduce inpatient readmissions for quick implementation. Each innovative solution presented will be reviewed with examples to consider implementing right away.  In addition, high risk populations will be discussed with unique ways of utilizing resources.

Learning Objectives:
  1. Explain specific strategies that include interdisciplinary teams
  2. Identify high risk populations and unique resource utilization ideas
  3. Evaluate Case Management metrics and trends to create innovative solutions

E4 - Impact of Evidence-Based Protocols on Remote Patient Monitoring | Participant Level – Beginner 1 CE
Practice Setting:  

4:30 PM - 5:30 PM

Karen Hercules-Doerr, MBA

Faculty Biography:
Karen is the Executive Vice President of Sales, Epharmix and leads sales and marketing efforts in search of exceptional partners. Epharmix is the leader in evidence-based remote patient engagement with 24 interventions that empowers clinical teams in identification and management of high and rising risk patients. She has held multiple executive posts within organizations in the disability, chronic care management, physician practice management, rehabilitation and sub-acute care space. Karen has over 25 years in sales, marketing, clinical operations, case management and physician practice management with an emphasis in ambulatory care. Prior to joining Epharmix, she was National Sales Director at Allsup; Vice President, Physician Networks for CareLinc Options and Vice President of Clinical Operations and Care Management for Rehab Care Group. Karen is passionate about improving patient literacy regarding their health status and has devoted her career to improving communication between providers, care managers and their patients/families for those with complex chronic illness. Epharmix is an exceptional organization that allows her the opportunity to leverage clinical, operational, sales and marketing skills in order to change health disparities.

Abstract:

Ensuring long-term patient engagement is imperative in population health and value-based care initiatives. Barriers include patients not understanding the importance of reporting key symptoms to their providers on a timely basis and the cumulative effect often experienced when multiple co-morbidities exist. Accessible technology should require low patient activation that can be used by any patient regardless of health literacy or tech savvy. Remote patient monitoring should facilitate an increased understanding of signs and symptoms related to the patient’s chronic disease so that they are more active in their health management. Evidence-based protocols presented in this session will consider patient engagement, ease of patient accessibility and impact on utilization demonstrated with verifiable clinical outcomes.



Learning Objectives:
  1. Describe three ways care managers can identify rising risk patients and the importance in population health and value-based care
  2. Associate outcomes with dialysis, COPD, diabetes and depression using evidence-based tools in various clinical settings
  3. Quantify the impact on care management capacity to monitor patients via remote patient monitoring and digital health tools

E5A - Speed Learning: Providing Well-Coordinated Care for Pediatric Behavioral Health Patients | Participant Level – Intermediate 1 CE
Attention NJ Social Workers: This session is not applicable for CE’s

Practice Setting:  

4:30 PM - 5:30 PM

Carey Spain, MSW, MBA, LCSW, LSCSW, CCM

Mindy Schneider, MSW, LCSW, LMSW, ACM-SW

Faculty Biography:
Carey is a Certified Case Manager and masters prepared Social Worker with more than 20 years’ experience in pediatric and adult healthcare. As the Director of Social Work Care Management, Carey oversees day to day operations to enhance and support a cohesive and efficient work environment for her teams. Carey’s primary focus has been on inpatient work, but she recently expanded her responsibilities to include to population health work through a partnership with a local school district for the provision of social work services. Carey served as a board member for the Missouri-Kansas Chapter of ACMA from 2015-2018.

Mindy is a Clinical Social Work Manager at Children’s Mercy Hospital in Kansas City, MO. She leads a team of 20 social workers who support the Med/Surg and Critical Care units at their 350-bed hospital. She has 15 years of social work practice, with focus in the areas of child protection and medical social work. Mindy is an accredited Case Manager and received her Master of Social Work from the University of Missouri- Kansas City.

Abstract:

Managing youth with complex behavioral health needs in the acute medical setting is common. To meet the growing centers for medicare and medicaid services (CMS) demands required by increased volume and limited community resources, children’s hospitals create safe spaces, policies and education programs. One children’s hospital saw a 56% increase in the number of children admitted for behavior health concerns during 2016-17. Pediatric facilities are not equipped to be safe spaces, lack staff with specialized skills and may often be overwhelmed by the demands created by these patient needs. Attendees will learn how one facility addressed this challenge.



Learning Objectives:
  1. Analyze the challenges in managing behavioral health patients in the acute care setting
  2. Review a new method to coordinate care for behavioral health patients
  3. Describe the importance of collaboration to make changes necessary to improve behavioral health patient outcomes

E5B - Speed Learning: Managing Pediatric Behavioral Health Issues | Participant Level – Intermediate 1 CE
Attention NJ Social Workers: This session is not applicable for CE’s

Practice Setting:  

4:30 PM - 5:30 PM

Caroline Cortezia, M.S. CCLS III

Faculty Biography:
Caroline is an experienced Certified Senior Child Life Specialist with a demonstrated history of over 13 years of working in the both the hospital & health care and education industry. She is the supervisor of the Child Life Services at University of California San Francisco Benioff Children’s Hospital. Skilled in special education and health care-based interventions with a focus on Autism Spectrum Disorder, development of healthcare policies and protocols, LEAN methodology, peer mentoring and skills development, public speaking including Grand Rounds and interventional education. Caroline is a strong professional with a B.S. focused in Child and Family Sciences/Elementary Education from Florida State University and a M.S. Exceptional Student Education Pre-K Disabilities/Exceptional Student Education K-12/ESOL-Reading from the University of Miami. She speaks trilingual -English/Spanish/Portuguese.

Abstract:
Limited financial and community resources, as well as common regulatory and legal commitment bottlenecks, pose challenges when coordinating plans for pediatric patients who have behavioral health problems. During this session, the presenter will describe one institution’s efforts to address these challenges so that children’s needs are met.

Learning Objectives:
  1. Describe common challenges and barriers in pediatric behavioral health
  2. Review regulatory and commitment issues
  3. Discuss strategies to address bottlenecks and overcome barriers

E6 - A Post-Acute Network for Elderly Patients: The HOPE SNF Collaborative | Participant Level – Beginner 1 CE
Practice Setting:  

4:30 PM - 5:30 PM

Heather N. Jacobson, MHA, MS, CCC-SLP

Faculty Biography:
Heather is a Senior Planning and Strategic Service Analyst for Duke Population Health Management Office. In this role she leads the post-acute care strategy and analysis for Duke Connected Care, Duke’s ACO, including operationalizing the Duke HOPE Skilled Nursing Facility Collaborative. Prior to this role, she was a Quality Reporting Consultant for Duke Health Private Diagnostic Clinic, PLLC, the multi-specialty faculty practice plan for Duke. There she managed the ambulatory Meaningful Use program, responsible for over 1,200 eligible providers. Before to coming to Duke, Heather worked as a speech language pathologist, spending over 8 years providing interdisciplinary care across a variety of healthcare settings. Heather received both her Master in Health Administration and MS in Speech Language Pathology from the University of North Carolina at Chapel Hill and her BA in Speech and Hearing Science from The Ohio State University.

Abstract:

Value-based payment models encourage hospital systems to collaborate with post-acute care (PAC) providers to integrate resources and reduce health care spending and hospital readmission rates. There is a variety of approaches in scope and objectives as well as in financial benefit. In 2017, Duke University Health System Accountable Care Organization launched the HOPE Skilled Nursing Facility (SNF) Collaborative. It includes facilities with varied Star rankings, geographic locations and re-hospitalization rates. This presentation will review the steps involved from the initial working group to the final assembly of participants. Goals were set to improve transitional care processes and 30-day readmission rates, and five additional goals were established to focus on improving care transitions and creating infrastructure for larger strategic initiatives and integration. Specific goals and performance data will also be shared.



Learning Objectives:
  1. Identify and evaluate SNFs for collaboration beyond using Star Ratings
  2. Determine the process to set mutually beneficial goals and performance metrics
  3. Discern best practices to engage stakeholders and implement strategies to improve transitional care across the healthcare continuum

E7 - Improving Outcomes for COPD Patients Through Clinical Consensus | Participant Level – Intermediate 1 CE
Practice Setting:  

4:30 PM - 5:30 PM

Pam Foster, LCSW, MBA, ACM-SW

Nina Shah, D.O.

Faculty Biography:
Pam currently serves as the Associate Vice President for Care Management at the HonorHealth system in Phoenix/Scottsdale, AZ. She received her B.A. from Hillsdale College and her Master's in Social Work from Arizona State University. She also received a Master's in Business Administration from the University of Phoenix and attained her ACM-SW in 2008. Pam has 25 years of experience in case management and has lead multiple process improvement teams to improve the practice of case management. She is the current immediate past president for ACMA.

Dr. Shah currently serves as the Network Medical Director of Clinical Effectiveness for the HonorHealth system in Phoenix/Scottsdale, AZ. She is also the Chief Medical Officer at the Deer Valley Medical Center, one of the HonorHealth hospitals. Dr. Shah received her B.S. and B.A. from the University of California, Berkeley and her D.O. from the Western University of Health Sciences. She completed a residency in Internal Medicine at the Santa Clara Valley Medical Center in Santa Clara, California. Following that, she completed a fellowship in Pulmonary and Critical Care Medicine at Stanford University School of Medicine in Stanford, California. Dr. Shah has extensive experience in leading quality initiatives and clinical consensus projects to improve patient outcomes.

Abstract:

COPD is a leading cause of mortality and morbidity, causing the death of more than 150,000 Americans each year. More than 20% of hospitalized patients over the age of 40 have COPD, and readmissions of COPD patients cost Medicare $475 million each year. Improving the inpatient management of COPD patients through well-designed, evidence-based care pathways can improve patient outcomes, reduce functional decline and decrease the likelihood of readmission. In addition, there are positive implications for Medicare cost per beneficiary by implementing pathways that reduce unnecessary consultations and medications. This presentation will explore one health system’s journey of bringing multiple clinical stakeholders together to build a pathway through a unique, physician-lead clinical consensus process. The pathway includes: appropriate triage, admission status, medication regimens, triggers for pulmonary consultation, vaccinations, smoking cessation, patient education and transition planning. It will explore case management’s integral role in building and executing the pathway and will share positive outcomes on the length of stay, readmissions and cost per episode.



Learning Objectives:
  1. Recognize the implications for poor COPD management on patients, health systems, and payers
  2. Explain the importance and value of evidence-based clinical pathways for chronic disease management
  3. Describe the process of bringing multiple clinical stakeholders together to build a pathway through the clinical consensus process

E8 - Longitudinal Care: TOC Roundtable Discussion | Participant Level – Advanced 1 CE
Practice Setting:  

4:30 PM - 5:30 PM

William Dombi, Esq.

Daren Giberson, RN, MSN, ACM-RN

Faculty Biography:
Bill is the President of the National Association for Home Care & Hospice. He previously served as the Vice President for Law at NAHC beginning in 1987. As a key part of his responsibilities, Bill specializes in legal, legislative, and regulatory advocacy on behalf of patients and providers of home health and hospice care. With nearly 40 years of experience in health care law and policy, Bill has been involved in virtually all legislative and regulatory efforts affecting home care and hospice since 1975, including the expansion of the Medicare home health benefit in 1980, the formation of the hospice benefit in 1983, the institution on Medicare PPS for home health in 2000, and the national health care reform legislation in 2010. With litigation, Bill was lead counsel in the landmark lawsuit that reformed the Medicare home health services benefit, challenges to HMO home care cutbacks for high-tech home care patients, lawsuits against Medicaid programs for inadequate payment rates, along with current lawsuits challenging the Medicare home health face-to-face encounter rule and the Department of labor changes to the overtime rules under the Fair Labor Standards Act. In addition to litigation, Bill offers extensive community and professional educational services through lectures, publications, teleconferences, and videos. His lectures include market trends in home care, compliance, risk management, patient rights, fraud and abuse, health care reimbursement, legislative and regulatory reforms, and legal issues in telehealth services.

Daren has 20+ years’ experience working in case management, with the bulk of the time being spent in the ambulatory setting. He has extensive experience working the transition of care model that his case management program has continued to modify over the past 9 years, and this includes touch-points by multiple disciplines post discharge. He was the RN Case Manager for the 2 year Patient Centered Medical Home pilot, and he has taken those lessons learned and applied to process improvement within the program. Daren has been an ACMA member since 2011 and has been an active participant serving on committees as well as speaking on care transitions at a past ACMA conference in Napa. He completed his Masters in Nursing Leadership & Management in 2014, and is now in his 3rd year as Director of Ambulatory Case Management.

Abstract:

During this session common care coordination challenges encountered within various care delivery sites will be reviewed. Best practices will be shared though interactive audience group discussion providing audience members with networking opportunities and ideas to apply within their settings.



Learning Objectives:
  1. Review common longitudinal care planning challenges
  2. Discuss best practices to resolve common barriers
  3. Apply innovative ideas within various practice settings

Sunrise
Tuesday, April 16, 2019

SR1 - Sunrise 1: Engaging Physicians in Care Management Initiatives | Participant Level – Intermediate 1 CE
Practice Setting:  

6:45 AM - 7:45 AM

Marijke (May) McAnally, RN, BSN

Pat Metzger, RN, BSN, MSA, ACM-RN, FABC

Faculty Biography:
May has over 25 years of experience in healthcare and currently serves as the regional director for CHI St. Luke’s Health in the Memorial market. She has responsibility for an acute care facility and two critical access hospitals and works closely with the hospitalist teams and her physician advisors to support care management efforts. May was a founding member and past president of te ARK-LA-TEX Chapter of CMSA and was nominated for the Board Member at large position with ACMA in 2008 and 2009.

Pat is a registered nurse with over 35 years of healthcare experience. She holds a Bachelor’s Degree in Nursing and a Master’s Degree in Healthcare Administration. She is a Fellow of The Advisory Board. She has served as a Chief Nursing Officer, as well as a Chief Operating Officer. She is currently the Vice President of Care Management CHI St. Luke's Health, Texas Division. In this role, she provides support and case management direction to the division’s 17 hospitals, and its community case management operations. Prior to this, Pat served as the Chief of Care Management for Memorial Hermann Health System in Houston, Texas. Pat carried the Care Management program at Memorial Hermann to national recognition with Memorial Hermann being awarded the Franklin Award of Distinction in Case Management in 2011. Prior to joining Memorial Hermann, Ms. Metzger served as a Principal in the Healthcare Consulting Practice of Ernst and Young. She has authored numerous articles and published The Case Manager’s Training Manual with Aspen Publications. She is a contributor to Peter Kongstevedt’s work, The Essentials of Managed Care. She has served as adjunct faculty in the Masters’ in Nursing Program at Ursuline College, in Cleveland, Ohio and has served a National Board Member with the American Case Management Association.

Abstract:

Physician partnerships are critical to facilitate efficient, effective care. The care management team must engage physician partners to coordinate care, plan for early discharge, review performance metrics and develop strategies to address areas of opportunity. During this session, panelists will share tools and strategies they successfully applied to promote early discharges, length of stay reduction and denial avoidance.



Learning Objectives:
  1. Identify three strategies to engage physicians in care facilitation
  2. Compare physician and case management leader’s perspectives and role in operationalizing initiatives to achieve desired outcomes
  3. Discuss and apply collaborative approaches to achieve length of stay reduction, early discharges and denial avoidance

SR2 - Sunrise 2: Increase Appropriate Admission Authorizations for Pediatric Short Stays | Participant Level – Intermediate 1 CE
Practice Setting:  

6:45 AM - 7:45 AM

Kimberly Littell, BSN, MPA, ACM-RN

Faculty Biography:
Kim is an accomplished leader with a record of achievements in Case Management. Her experience encompasses 20 years in Utilization Management, Transitions of Care and Denial Management. Kim’s greatest interest is identifying process improvement opportunities and collaborating with others in various disciplines to achieve successful outcomes. Kim received her Bachelor in Nursing from University of Pittsburgh and Masters in Public Administration from Cleveland Stay University. Kim is an accredited Case Manager from ACMA and has recently obtained her LEAN certification. Kim is currently a Data Integrity Analyst for UM for 13 hospitals that are part of University Hospitals in Cleveland.

Abstract:

Increasing denials on inpatient claims for short stays indicated that process changes were necessary at this pediatric hospital. Physician and case management undertook a multifaceted approach including chart review, physician education, medical necessity criteria application review and UM process updates. This co-led effort resulted in decreased denials with increased appropriate inpatient claims and an increase from 18–22% in observation status patients.



Learning Objectives:
  1. Describe approaches to assign and justify appropriate level of care status
  2. Review strategies to manage status and appropriately utilize observation and one day inpatient stays
  3. Identify strategies to improve payer reviews and avoid denials

SR3 - Sunrise 3: Public Policy | Participant Level – Intermediate 1 CE
Practice Setting:  

6:45 AM - 7:45 AM

Max Perkins, BA

Suzanne Wilson, RN, MBA, ACM-RN

Faculty Biography:
Max began his career on Capitol Hill in 2008 as a non-partisan staffer for the U.S. Senate Committee on Rules and Administration. While serving the Rules Committee, he worked under the direction of distinguished leaders in Congress, such as Senator Dianne Feinstein (D-CA) and current Senate Minority Leader Charles Schumer (D-NY), as well as former-Senator Robert Bennett (R-UT). Max’s responsibilities at the Committee included research and analysis of Senate rules and procedure, including legal research of the Senate’s filibuster rules; assisting in the management of Committee operations, serving as a staff liaison to Senators assigned to the Committee; and coordinating and moderating the annual Summer Intern Lecture Series, which brings high-profile lecturers from politics and pop culture to Capitol Hill. He fondly recalls successful engagements with former Defense Secretary Robert Gates, Supreme Court Justices Sonia Sotomayor and Ruth Bader Ginsburg, U.S. Army General (Ret.) Colin Powell, famed political prognosticator Charlie Cook, political journalist Cokie Roberts, and MSNBC Political Contributor Chris Cillizza. As Lobbyit’s newest team member, Mr. Perkins serves a diverse client roster, including industry associations, professional societies, municipal governments, non-profits, and privately-owned corporations. He brings a non-partisan approach to advocacy; seeking to build lasting relationships in government for his clients. Mr. Perkins offers strategic intelligence and advise that allows Lobbyit’s partners to successfully navigate the often-treacherous waters of the Federal City. Mr. Perkins is especially honored to have had the unique opportunity to serve as a Staff Assistant to the Joint Congressional Committee on Inaugural Ceremonies in preparation of the 2009 swearing-in ceremony of President Barak Obama. He was trusted with organizing and coordinating over 100 volunteers on inauguration day and will forever remember spending time that day with Barbara Bush, Henry and Jenna Hager, and former Heavyweight Champion Muhammed Ali. Mr. Perkins received his Bachelor of Arts in Political Science from The Catholic University of America in Washington, D.C., and lives in Alexandria, VA with his wife, Caitlyn, son, Luke, and daughter, Violet.

Suzanne is the Assistant Vice President, Post-Acute Services/Continuing Care at ANMED Health in Anderson, South Carolina. She is responsible for providing direction and leadership to Care Coordination, community Skilled Nursing Network, AnMed Heath Home Care Services, Supportive Care Services and AnMed Rehabilitation Hospital. She has over 30 years of healthcare experience and has served in leadership roles within provider services, care management, quality assurance, trustee services, care coordination, resource management and supportive care. Suzanne received her Bachelor of Business Administration and Associate in Science of Nursing from Marshall University in Huntington, West Virginia and her Masters of Business Administration from Clemson University in Clemson, South Carolina. She is currently serving on the Anderson University Human Services Advisory Board and a member of the American College of Healthcare executives, as well as the ACMA National Public Policy Committee and Chapter Advisory Council.

Abstract:

ACMA Public Policy Committee strives to inform the membership of current and relevant legislation that impacts the practice of case management. This session will provide an overview of legislation that is currently being monitored for ACMA advocacy, and also give an update on the ACMA Public Policy focus and activity.



Learning Objectives:
  1. Review identified top legislative priorities for case management and the American Case Management Association for 2019
  2. Discuss strategies for impactful advocacy for key priorities for case management, including activities at the Chapter and National level
  3. Report ACMA Public Policy recommendations and action items

MAIN CONFERENCE DAY 2 INDIVIDUAL SESSIONS
Tuesday, April 16, 2019

General Session: The Future of Health Care | Participant Level – Intermediate 1 CE
8:00 AM - 9:15 AM

Martin Makary, MD, M.P.H., F.A.C.S.

Faculty Biography:
Dr. Makary is health care futurist writing in The Wall Street Journal and USA Today. He is the New York Times Bestselling author of Unaccountable, which was turned into the TV medical series THE RESIDENT which aired on Fox in January 2018. His newest book, The Price We Pay, describes how the disruptors of health care are restoring medicine to its mission. Dr. Makary is a Johns Hopkins cancer surgeon and serves jointly as a professor of health policy & management at the Johns Hopkins School of Public Health. He has published over 250 scientific articles, including the landmark articles on the surgical checklist, frailty as a predictor of surgical outcome, a survey to measure hospital safety culture, and contributions to surgical technique. Dr. Makary performed the world’s first series of laparoscopic pancreatectomies with islet auto transplantation and is the recipient of the Nobility in Science Award of the National Pancreas Foundation. At the W.H.O., Dr. Makary led the technical workgroup on measuring surgical quality worldwide and served in leadership with Atul Gawande on the W.H.O. Surgery Checklist committee—work that later became disseminated in the book The Checklist Manifesto. Dr. Makary has been elected to the National Academy of Medicine and named one of America’s most influential people in health care by Health Leaders Magazine. His current research focuses on vulnerable populations and medical billing. He has grants from the Robert Wood Johnson Foundation and the Gordon and Betty Moore Foundation to study health care costs and develop new measures of high-value care. Dr. Makary currently serves as the executive director of Improving Wisely, a national project to reduce unnecessary care and lower health care costs in America.

Abstract:

Dr. Martin Makary is a surgeon, New York Times bestselling author and Johns Hopkins health policy expert. He is the author of Unaccountable and The Price We Pay, creator of the Surgery Checklist and former leader of the W.H.O. work-group to create global measures of surgical quality. Makary has written for The Wall Street Journal, TIME, Newsweek, and appears as a medical commentator on NBC, CNN and Fox News.
A leading voice on patient safety and quality, Dr. Makary describes the current health care marketplace and new trends that represent a disruption in the industry and the hope of a more patient-centered, value base with accountable care. Finding the best care and navigating the system can be a challenge, even for the most educated consumer. In his presentation, he describes a new movement as American health care seeks to make medical care safer, more transparent and patient-centric.



Learning Objectives:
  1. Discuss the current health care environment and triple aim for quality care
  2. Describe health care disruption necessary to support patient centric care
  3. Identify opportunities to apply data and question processes to create a culture of accountable care

General Session: TOC Standards of Practice | Participant Level – Intermediate 1 CE
1:30 PM - 2:30 PM

Debra McElroy, MPH, RN

Faculty Biography:
Deb is the Senior Vice President for Practice Development for the American Case Management Association (ACMA). Her operational focus for ACMA is on case management education and practice at the regional and national level, as well as new initiatives which include the newly developed Transitions of Care Standards, the ACMA Advanced Care Transition Simulations (ACTS) program and the Association for Physician Leadership in Care Management (APLCM). Deb is the former national nursing leader for the largest national health care improvement organization and healthcare collaborative, where she had responsibility for programs and data products supporting nursing leaders and inter-professional practice across the country. She has extensive experience in the community and public health sector, previously directing healthcare coalitions and federally funded initiatives that established infrastructure for medical homes. Deb holds a master’s degree in public health and a bachelor’s degree in nursing. Her publications include topics related to chronic disease, nurse residency and advanced practice.

Abstract:

Currently the term “transitions of care” is used widely by regulators, providers, payers and community agencies – yet there is wide variability across the service components, minimal standards of service, and the skillsets of people managing care transitions. It is well understood that poorly managed transitions impact health care quality and costs. According to the Centers for Medicare and Medicaid Services (CMS), the cost of poor care transitions of Medicare patients from acute care alone is $26 billion per year as of 2016.

This session will describe standards that will bring clarity to the practice of care transitions and assist providers, payers and all health care organizations in establishing processes for seamless coordination across the entire continuum of care, with the goal of achieving the best health outcomes.



Learning Objectives:
  1. Provide an overview of the opportunities to assure efficient, successful and cost- effective care transitions between settings and levels of care delivery
  2. Present and explain the ACMA Transition of Care standards developed by national health care leaders from all segments of care delivery
  3. Describe metrics associated with Transitions of Care and address opportunities for measurement to drive standardization across the care continuum

Closing General Session: How to Deal with Fear in the Creative Process | Participant Level – Intermediate 1 CE
4:00 PM - 5:00 PM

Erik C. Wahl

Faculty Biography:
Erik Wahl is an internationally recognized artist, TED speaker, and No. 1 bestselling author. His breakthrough experience as an artist and entrepreneur has translated into making him into one of the most sought-after corporate speakers on the circuit today.On stage, Erik’s keynote experience creates a dynamic multidimensional metaphor for how to systematically embrace innovation and risk. His message: disruption is the new normal and businesses must embrace creativity in a wholesale fashion, or risk being left behind. Erik’s presentation inspires organizations to be increasingly agile and outlines how to use disruption as a competitive advantage. Some companies will be disrupted others will choose to be the disruptor. Choose wisely. His breakthrough thinking has earned praise from the likes of top influencers in both art and business. Erik’s previous book, a bestseller called Unthink was hailed by Forbes Magazine as The blueprint to actionable creativity, and by Fast Company Magazine as “provocative with a purpose.” The Warhol of Wall Street, the Renoir of ROI, The Picasso of Productivity, the Jobs of … Well, Jobs. Erik discovered an alarming truth early in his career as a partner in a corporate firm: organizations that encouraged the mental discipline of creativity did better than those that did not put innovation as a priority mission. So he set out to challenge companies to change their way of thinking. In the meantime, inspired by street art, he became an acclaimed graffiti artist—though he has since stopped selling his works for personal gain, and instead uses his art to raise money for charities. His keynote is where his passion for business growth and art converge into a fascinating performance.

Abstract:

Back by popular demand, Erik Wahl will be joining us for this third ACMA Conference.
Wahl is an internationally recognized artist, TED speaker, and No. 1 bestselling author. His breakthrough experience as an artist and entrepreneur has translated into making him into one of the most sought-after corporate speaker.

In his presentation, Wahl will share with us that the awareness of fear is the key to controlling it, and he explains how to use fear in a healthy way.

Wahl will also be joining us at the Closing Party where he will be on hand to sign his book Unchain The Elephant.



Learning Objectives:
  1. Discuss common barriers to achieving optimal potential and attaining goals
  2. Review strategies to reframe situations and unveil new opportunities
  3. Apply strategies to maximize personal strengths and overcome fear

Breakout Session F
Tuesday, April 16, 2019

F01 - Breakout Session F1 (ACUTE Center for Eating Disorders): Medical Complications of Anorexia Nervosa, ARFID, and Bulimia | Participant Level – Intermediate 1 CE
9:30 AM - 10:30 AM

Philip S. Mehler, MD, FACP, FAED, CEDS
Founder & Medical Director
ACUTE Center for Eating Disorders
Denver Health Medical Center - Denver, CO

Faculty Biography:
Philip Mehler, MD, FACP, FAED, CEDS, President, ERC and Executive Medical Director of ACUTE Center for Eating Disorders at Denver Health as President of Eating Recovery Center, Dr. Philip Mehler is the designated head of medical services across Eating Recovery Center’s full National treatment spectrum. Dr. Mehler began his career at Denver Health more than 30 years ago and was formerly its Chief of Internal Medicine. He was Denver Health’s Chief Medical Officer (CMO) for 10 years until he was promoted to its Medical Director, a position he held until his retirement in 2014. He is also the Glassman Professor of Medicine at the University of Colorado School of Medicine and has conducted research into the optimal medical treatment of the most severe cases of Anorexia Nervosa and Bulimia. He founded ACUTE at Denver Health, the country’s center of excellence for those with the most extreme forms of Anorexia Nervosa and continues to serve as its Executive Medical Director. Dr. Mehler has authored 425 scientific publications, including 3 textbooks, Medical Complications of Eating Disorders, published by Johns Hopkins University Press and is now in its third edition. His newest book was just released in November 2017. Dr. Mehler was the recipient of the Academy of Eating Disorders 2012 Outstanding Clinician Award, has been recognized among the “Best Doctors in America” for the past 22 years in a row, and was voted the “Top Internal Medicine physician in Denver” multiple times by 5280 Magazine. Dr. Mehler is a member and fellow of the Eating Disorders Research Society and the Academy of Eating Disorders, as well as a member of the editorial board of the International Journal of Eating Disorders. He has lectured extensively on a national and international level as the leading medical expert on the topic of the medical complications of eating disorders.

Abstract:
Anorexia Nervosa and Bulimia Nervosa are associated with high mortality and morbidity. Much of this is directly attributable to the litany of medical complications associated with these eating disorders. In this workshop the medical complications of Anorexia Nervosa, Bulimia Nervosa and ARFID will be described in detail along with the recommended treatments for them. In addition, recent medical research will be reviewed to help inform and optimize the medical treatments of patients with eating disorders.

Learning Objectives:
  1. Identify medical problems related to bulimia nervosa, and how to manage them
  2. Identify medical problems related to anorexia nervosa, and how to manage them
  3. Identify medical problems related to ARFID, and how to manage them

F02 - Breakout Session F2 (Angel MedFlight) - Patient Targeted Googling: Professional Boundaries in the Internet Age
9:30 AM - 10:30 AM

Rebecca Brashler, LCSW
Director
Global Patient Services
Shirley Ryan AbilityLab - Chicag, IL

Faculty Biography:
Rebecca Brashler, LCSW directs Global Patient Services at Shirley Ryan AbilityLab. Formerly known as the Rehabilitation Institute of Chicago, the Shirley Ryan AbilityLab has been ranked the #1 Rehabilitation Hospital by US News and World Report since 1991. Ms. Brashler is an Assistant Professor of Physical Medicine and Rehabilitation at Northwestern University’s Feinberg School of Medicine. She is a former Illinois ACMA Board Member and served on the National Editorial Board of Collaborative Case Management from 2003 – 2006.

Abstract:
Searching for information on-line has become an everyday activity for health professionals attempting to keep up with ever-changing medical developments, the complex array of community services and the barrage of new information we need to digest every day. But, is there a difference between on-line searches to gather medical/community information and patient-targeted googling activity? Participants will analyze a case, review current regulations/guidelines and explore their own beliefs about professional boundaries.

Learning Objectives:
  1. Define ethical concerns related to patient-targeted web searches.
  2. Apply current recommendations regarding on-line searches from a variety of professional sources to their own practice settings.
  3. Recognize how the internet and 21st Century communication patterns can intrude on traditional therapeutic relationships/goals.

F03 - Breakout Session F3 (Appeal Masters):
9:30 AM - 10:30 AM

Abstract:
Information coming soon...


F04 - Breakout Session F4 (Change Healthcare): Medical Necessity Denials: a Focus on Prevention | Participant Level – Intermediate 1 CE
9:30 AM - 10:30 AM

Laura McIntire, RN, BSN, MA
AVP
Customer Experience
Change Healthcare - Newton, MA

Faculty Biography:
Laura McIntire is the AVP of Customer Experience at Change Healthcare with responsibility for helping healthcare organizations optimize their utilization and care management programs with InterQual. In her previous role as Director of Product Management for InterQual clinical content, she brought the voice of the customer to enhance the InterQual suite of content products as well as new content initiatives. In her 14+ years at Change Healthcare, Laura has held various roles in clinical product management and clinical development. She has conducted evidence-based literature research and developed clinical algorithms for case management, disease management, and acute care clinical decision-support products. She has been a guest speaker at the American Healthcare Quality Association, Case Management Society of America, and CMS’s Quality Net conferences, among others. Prior to Change Healthcare, Laura worked for 13 years as a clinical nurse in a range of care settings, including Intensive care, medical/surgical, and home health. Laura is a registered nurse with a Bachelor of Science degree in nursing and a Master of Arts in Health Care Administration.

Abstract:
Over the past year, Laura McIntire, RN, BSN, MA has conducted hundreds of chart audits throughout the United States. It is no surprise that the number one issue healthcare organization seek assistance with is their denial rate. As a result of conducting these audits, she has identified where time and time again organization are falling short and how the implementation of small changes can have a big impact right off the bat. The focus of this presentation is best practices for preventing medical necessity denials. Laura will discuss the steps your organization can take upfront to establish medical necessity and avoid the need to manage denials on the backend. Strategies include adopting the mindset of creating every medical review as if you will need to defend it, along with tips and tricks of how to paint a complete and accurate picture of your patient’s issues to strengthen your case. As we all know, we don’t live in a perfect world where all cases will never be challenged, so Laura will conclude the presentation with an overview with key strategies on how to manage denials.

Learning Objectives:
  1. Identify areas where your organization may be falling short in the medical review process which are increasing your risk of being denied due to lack of medical necessity.
  2. Establish strategies your organization can implement on the front end to prevent denials on the back end.
  3. Recognize simple steps that you can take to manage denials when they do occur.

F05 - Breakout Session F5 (GoodRx):
9:30 AM - 10:30 AM

Abstract:
Information coming soon...


F06 - Breakout Session F6 (MCG): Unexplained Variation in Clinical Decision-Making | Participant Level – Beginner 1 CE
9:30 AM - 10:30 AM

William Rifkin M.D. FACP
Managing Editor
MCG Health, LLC - Seattle, WA

Faculty Biography:
Dr. Rifkin oversees research, guideline writing, and other content development focused on hospital-based care (medical and surgical) for MCG. Before joining MCG in 2009, he was an Associate Professor of Clinical Medicine and the Director of the Internal Medicine Residency Program at Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York. Prior to that, he was an academic hospitalist and Associate Residency Program Director at two other New York hospitals and at the Yale Primary Care Internal Medicine Residency Program in New Haven, Connecticut. He has published research in the areas of hospital medicine and quality of clinical care. He graduated from the State University of New York Stony Brook School of Medicine, completed his internal medicine training at Lenox Hill Hospital in New York, and is board-certified in internal medicine.

Abstract:
Numerous studies have found that care provided to patients varies beyond what can be explained by clinical factors, such as age, and severity of illness. This variation includes clinical interventions that can carry significant risk and are costly, such as hospitalization rates for a given condition, how often a procedure is performed, and how often a specific procedure is performed on an inpatient vs. outpatient basis. Significant unexplained variation is seen between geographic regions, between provider groups or hospitals, and even between clinicians practicing in the same environment side by side. This session will highlight prominent examples of variation, discuss the clinical significance of these variations, and review some of the benchmark measures by which variation can be detected. In addition, the role of interventions, such as evidence-based guideline application, will be discussed.

Learning Objectives:
  1. Describe unexplained clinical variation and why it is important
  2. List prominent examples of clinical variation
  3. Discuss the role of benchmarking and evidence-based guidelines in reducing unexplained clinical variation

F07 - Breakout Session F7 (MexCare): Unfunded Latin American Nationals - Placement, Care, and Best Practices for Optimal Outcomes | Participant Level – Intermediate 1 CE
9:30 AM - 10:30 AM

Juan Carlos Sanchez, JD
Attorney
Law Offices of Horacio Barraza - San Diego, CA

Faculty Biography:
Juan Carlos Sanchez, JD has been an attorney for over 20 years, both in Mexico and the US. Throughout his career, he has worked in politics, family and accident law, and healthcare law. In addition to his regular practice, Juan Carlos works with MexCare, LLC where he assists patients and healthcare facilities with repatriation services in Latin American countries.

Abstract:
Case Managers face challenges in finding safe discharge solutions for the care of undocumented patients. This session will offer strategies, methodologies and best practices used daily by your peers to assist and guide you in arranging quality healthcare for these patients. This session will also provide a step by step process used to develop a timely and cost-effective plan to ensure a safe transition to their country of origin.

Learning Objectives:
  1. Assess quick ways to identify and solve the internal and external issues surrounding the discharge of undocumented patients
  2. Analyze best practices used by the Case Management to facilitate the transfer, discharge and placement of undocumented patients
  3. Reduce length of stay in your hospital while providing quality care and a safe discharge for the patient in their home country.

F08 - Breakout Session F8 (naviHealth): The Tools, Traits and Technologies for Case Managers to Succeed in the New Order of Value-Based Healthcare | Participant Level – Intermediate 1 CE
9:30 AM - 10:30 AM

Cheri Bankston, MSN
Senior Director
Clinical Advisory Services
naviHealth - Newton, MA

Colleen O'Rourke, PT, MBA
Senior Vice President
Clinical & Network Solutions
naviHealth - Newton, MA

Faculty Biography:
Cheri Bankston brings more than 30 years of nursing experience - both inside and outside of hospitals - to her role as Senior Director of Clinical Advisory Services at naviHealth (www.naviHealth.com). Cheri consults with hundreds of hospitals across the country about transition management assessment, clinical redesign and automation workflows, and uses her clinical expertise to help hospital leaders maximize their investment in automated transition solutions.

Colleen O'Rourke serves as Senior Vice President of Clinical & Network Solutions and drives the integrated business and clinical strategies of the company across an extensive portfolio of clinical services and solutions. A seasoned expert in post-acute care management and operations, Colleen in responsible for the development, monitoring and analysis of comprehensive provider performance data to support overall marketing operations and leads the development and continuous enhancement of the company's clinical model. Colleen has been a practicing Physical Therapist in the Northeast for 25 years; her primary role during that time serving as Director of Rehabilitation Services in a wide variety of post-acute settings, most notably in sub-acute rehabilitation. She has also specialized in CMS reimbursement and management, JCAHO accreditation and DPH compliance and has served as a litigation consultant as a subject matter expert, in Rehabilitative Long-term Care Regulations.

Abstract:
Value-based care is replacing fee-for-service to provide better quality care to patients at a lower cost. But this transition creates administrative headwinds for case managers who already are juggling a host of responsibilities. In this session, seasoned case management and clinical professionals, will outline the current and future landscape of value-based care, and educate case managers on how they can swiftly adapt to new clinical and payment models, such as the Bundled Payments for Care Improvement (BPCI) Advanced program, implemented this year. Specifically, they will demonstrate how case managers’ roles will be impacted by these new models, whether in an acute or post-acute setting, empower them to optimize discharge planning and care transitions (two keys to success), and provide inspirational real-world examples of case managers who are driving success with a value-based mindset.

Learning Objectives:
  1. Assess current state of value-based care, how it will change in the future, and how it is and will impact case managers.
  2. Recognize how to prepare for and embrace value-based care, including the skillsets and attributes case managers need to be successful.
  3. Identify how to measure the impact of value-based care programs through data, technology and qualitative insights to ensure patients are receiving more efficient, cost-effective care without compromising quality or outcomes.

F09 - Breakout Session F9 (Optum): Evolution of Utilization Review and the Role of Physician Advisors | Participant Level – Intermediate 1 CE
9:30 AM - 10:30 AM

Ralph Wuebker, MD, MBA
Chief Medical Officer
Optum360 - Newtown Square, MA

Darren P. Anderson, MSN, RN, ACM-RN
Director
Clinical Denials Management
Vidant Health - Greenville, NC

Faculty Biography:
provides clinical leadership within the organization and works closely with hospital leaders to ensure strong revenue cycle, utilization management (UM) and compliance programs. Dr. Wuebker also provides trained and resourced physician advisors on site for client hospitals to help improve collaboration working with UM departments and across the medical staff. An expert in CMS regulations, medical necessity compliance, utilization review, denials management, and program integrity efforts, Dr. Wuebker also serves as an industry thought leader and editorial advisor to the media. Throughout his career, Dr. Wuebker served as a hospitalist and instructor of medicine at Washington University School of Medicine and St. Louis Children’s Hospital. Prior to joining the organization, he served as Medical Director for the Midwest Region of Great-West Healthcare (now part of Cigna) providing medical necessity case reviews. Dr. Wuebker earned his medical degree and a bachelor’s degree in biology from the University of Missouri-Kansas City School of Medicine and Master of Business Administration degree from Washington University in St. Louis, MO.

Darren Anderson is Director Clinical Denials Management for Vidant Health. Darren is responsible for the overall clinical denials management process for an 8-hospital health system in eastern North Carolina. Evaluating processes to ensure efficiency in managing and preventing clinical denials across the health system. Darren has more than 20 years practical experience in the acute care hospital environment which includes 7 years’ experience of revenue cycle management in the areas of medical necessity and denials management. He received a Master of Science in Nursing (Leadership) and Bachelor of Science in Nursing at East Carolina University, Greenville, NC.

Abstract:
In 2017, medical necessity grew to account for 20% of all denials, a 66% growth. Meanwhile, providers are only successful in appealing commercial denials 45% of the time, a decline of 19.6%. This changing commercial landscape has made effective utilization review more important than ever, and hospital leaders are increasingly viewing utilization review as a vital function with significant implications for the entire revenue cycle. UR teams must increasingly look for ways to improve performance and financial outcomes. New UR paradigms can help improve efficiency and accuracy by ensuring that the right resources and knowledge are applied at the right time in the process. Re-envisioned roles for both case managers and physician advisors can help streamline processes, keeping them focused on the areas where they can be most effective. Cutting edge technology is changing UR in ways that adjustments to operations cannot. Clinically aware artificial intelligence revolutionizes utilization review by mining patient records for vital information. AI can then use this information to both identify the cases needing a physician advisor review and empower physician advisors to conduct those reviews quickly. The result is greater efficiency and accuracy, and significant time-savings to both physician advisors and case managers. In this session, Darren Anderson from Vidant Health and Ralph Wuebker from Optum360 will explore the challenges involved in elevating the effectiveness of utilization review. Attendees will learn how to rethink UR processes and leverage artificial intelligence to apply expertise at the most appropriate points in the UR process, achieving appropriate reimbursement and avoiding clinical denials.

Learning Objectives:
  1. Identify leading practices for organizing a high-performing utilization review department to achieve proper reimbursement.
  2. Determine ways to avoid pitfalls that lead to clinical denials.
  3. Discover the role technology can play to help streamline utilization review processes.

F10 - Breakout Session F10 (R1 RCM): 2019 Medicare and Medicare Advantage Update | Participant Level – Intermediate 1 CE
9:30 AM - 10:30 AM

Ronald Hirsch, MD, FACP, CHCQM
Vice President
Regulations and Education Group
R1 RCM, Inc - Chicago, IL

Faculty Biography:
Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at R1 RCM Inc. He received his medical degree from the Chicago Medical School in North Chicago, IL, and completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA. Dr. Hirsch was a general internist and HIV specialist and practiced at Signature Medical Associates, a multispecialty practice located in Elgin, IL. He was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012, where he was Chairman of the Medical Records Committee from 1995 to 2012, and also served on the Medical Executive Committee. He also served on the Sherman Home Care Board of Directors from 1999 to 2012 He was Chairman of the Board of Health for the City of Elgin, IL from 1997 to 2012 and was medical director at two area nursing facilities in the 1990’s. Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, is on the advisory board of the National Association of Healthcare Revenue Integrity, on the Advisory Board of the American College of Physician Advisors, the editor of the ACPA monthly newsletter, on the editorial board of RACmonitor.com, a weekly guest on the Monitor Monday national webcast, a Fellow of the American College of Physicians, and a member of the American Case Management Association. He is the co-author of The Hospital Guide to Contemporary Utilization Review, with the second edition published in 2018.

Abstract:
Keeping up with Medicare regulations is a full-time job, and improperly implementing regulatory changes at your facility can have compliance and financial consequences. Since the last ACMA National meeting we have faced an increasing number of RAC audits, the expansion of MAC targeted probe audits, continued confusion over the removal of total knee replacement from the inpatient only list, and the continued onslaught of MA plan audits. In this session, the speaker will discuss the latest regulatory issues facing hospitals, both new and old, and provide guidance to enhance compliance and avoid denials with a proactive approach.

Learning Objectives:
  1. Demonstrate understanding of the RAC audit program and daily steps that can be taken to avoid denials
  2. Interpret the latest guidance from CMS on admission determinants for joint replacement surgery
  3. Formulate plans to ensure inpatient admission criteria are met

F11 - Breakout Session F11 (Sound Advisory Services):
9:30 AM - 10:30 AM

Abstract:
Information coming soon...


F12 - Breakout Session F12 (XSOLIS):
9:30 AM - 10:30 AM

Abstract:



Breakout Session G
Tuesday, April 16, 2019

G1 - Hospital and Health Plan Partnership for Discharge Planning and Transitions of Care | Participant Level – Intermediate 1 CE
Practice Setting:  

2:45 PM - 3:45 PM

Stephanie Bowen, RN, MSN, ACM-RN

Yvonne Chan, RN, MSN, GCNS-BC, NE-BC, CCM

Faculty Biography:
Stephanie currently serves as the Director of Care Coordination at Mills Peninsula Medical Center in Burlingame, California. In this role, she has operational responsibility for a team of 30 case managers and social workers. Stephanie has worked in healthcare for 8 years after obtaining her Master of Nursing in Case Management from Samuel Merritt University, in Oakland, CA. Her past roles also include adjunct nursing professor and performance improvement management.

Yvonne is the program manager for the Peninsula Circle of Care program and an expert in transitions of care. Yvonne has a diverse background in inpatient, outpatient, and community nursing. With a passion to work with older adults, she obtained her Masters of Nursing in Geriatric Clinical Nurse Specialist and Nursing Education. Her prior work involved designing, implementing and evaluating a heart failure transition of care program. Her past roles range from charge nurse, hospice case manager, advanced practice nurse, and adjunct nursing professor.

Abstract:

This session will detail a unique partnership between a community not-for-profit hospital and a local non-profit health plan for the care coordination of the managed Medicare and Medicaid patient population. The context and makeup of the partnership, keys to senior stakeholder involvement, model development and evolution will all be covered from both partners’ perspective. Pre-partnership and post-partnership results will be reviewed including avoidable days, readmission rate, length of stay and overall health care utilization, including Quality Measurement standards. Considerations and implications for replicating the model for complex patients will be discussed.



Learning Objectives:
  1. Describe the approach and methodologies used in creation of the partnership
  2. Explain the roles and purpose of each transitions of care program outlined
  3. Identify opportunities and strategies for applying the model

G2 - Physician Advisor Workflow and Metrics | Participant Level – Beginner 1 CE
Practice Setting:  

2:45 PM - 3:45 PM

Yvette Coronado-Castellanos, BSN, RN, ACM-RN

Leah Low, MD

Faculty Biography:
Yvette currently serves as a Supervisor for Utilization Review and Emergency Department Care Management at the University of Texas Medical Branch in Galveston, Texas. She has worked at the University of Texas for 14 years in various roles including: Utilization Review Supervisor, Care Management Nurse Program Coordinator and Care Manager. Yvette is a certified Case Manager and a Certified Chronic Care Professional. She serves as resource to her team sharing her clinical expertise related to utilization, criteria and guidelines.

Leah is a Physician and Assistant Professor in the Department of Internal Medicine at the University of Texas Medical Branch in Galveston. She currently serves as the