Nova Care: A Case Study

Social Services Meeting: On 11/21/2016, Ms. Medina and her children met with her assigned Case Manager for the family ILP Document Review. Ms. Medina is expected to meet with assigned Case Manage bi-weekly. Ms. Medina’s next ILP Document Review is on 12/05/2016. Case Manager encouraged Ms. Medina to continue attending meetings. Ms. Medina stated that she was a sad and upset, due to that her doctor informed her that she is not going to be able to work as a Home Health Aid due to a back injury. Ms. Medina stated that her doctor recommended that she would benefit from physical therapy and that she should avoid to lift anything heavy until further notice.

SC completed monitoring telephone with Pa’s informal Tressa on 1/28/2016. No new health problem was reported. However Pa’s treatment regimen has change to include radiation therapy due no change in the tumor. No ER visit, hospitalization, or falls were reported by CG. A temporary increase in PAS services was requested due to new medical treatment. Pa's informal, stated Pa is requesting a temporary increase in Pa's aide services so that she can safely remain in her home with assistance. Pa is being treated for cancer and need a more aggressive treatment which includes chemo and radiation 5 days a week. Pa currently gets 6 hours of PAS per week, 4 hours on Wednesday and 3 Saturday agency model PAS via Prestige Home Car. Pa anticipates that

Pa confirmed that there is no duplication of services. Waiver is the payer of last resort for services. Pa reported that his back-up plan that the agency will send a replacement aide if needed has not been utilized, Pa reports that is services are not available, his son, Ralph, will come to assist him, these back up plans remain effective and has never been used per Pa. SC called the Dynamic Home Health Care PAS provider agency and reported that the aide has not shown up for the day and she would the Pa to call out leaving him without proper coverages. The receptionist took SC information and stated that the director of the Waiver service was not in as yet and will have all SC. The called meal site and spoke with Lavern, who resumed Pa’s HMD and set it up for Friday delivery. SC called Theresa the nutritionist at DaVita Dialysis and informed her that the Pa HDM will begin starting 5/13/2016. SC called back Dynamic Home Health Care and spoke with the director of Waiver services. The SC informed her of the Pa’s claims about the aide calling him when she will not be at work instead of the agency so that they can send

SC complete monitoring phone call on 01/20/2016 with Pa's PAS (Cheryl). Pa reports receiving all services as outlined in ISP. He remains satisfied with services and feels that they meet his current needs. No falls, hospitalization, changes in health status or medication reported by Pa. No outstanding follow up needs identified. The day before SC received a phone call from Cheryl reporting that Pa’s is running low on heating oil and has exhausted all other option and would like PCA emergency fund to supple Pa with heating oil. SC completed the paperwork and gave to SDCS to review and submit. At the time of this call retreated that the paperwork has been submitted and Pa will receive the heating oil as long as he is qualified and has not use

JenCare Neighborhood Medical Centers has geriatric facilities in Florida, Kentucky, Virginia, Louisiana, and Georgia. As a subsidiary of Chen Medical they have over 25 years of experience dealing with geriatric care. Their services include primary care, onsite diagnostic tests and prescriptions services, door-to-door transportation, life card, vision, and acupuncture.

Maggie Gill started her career with Memorial University Medical Center (MUMC) in 2004 as the VP of managed care and finance. In 2005, she became MUMC's COO, and then in 2011, she was named CEO and president by the board of directors, once they realized that the ideal candidate for the position, one who had experience in both finance and operations, was already employed by the health care facility.

SP discussed future care with client daughter and advise Cindy that client needs to follow up with doctors as recommended immediately after she is discharged. Cindy also discussed with SP that Mrs. Figueroa may be discharged into the NF for short-term rehab and she wanted to know if this would interfere with her CO waiver or MA. SP explained that no interference would occur with CO waiver and MA if client remains in the NF for less than 30 days. After 30 days, Mrs. Figueroa MA will change from STC to LTC. SP is in the process of requesting additional hours from DHMH since client health is significantly declining, SP is waiting to obtain client discharged summary as medical documentation to support the request for 63 hours of personal assistance

SC completed service coordination task associated with care plan rollover.SC rolled over PPL FMS ongoing monthly service fee, PAS service consumer option model Public Partnership (PPL), receives assistance w/ bathing, dressing, transfers and IADLs 7 days x 4 hours 7-9am and 4-6pm, provider PPL, PAS Taheerah, informal Shirley is informal back up. Pa confirms that she is receiving, type, scope, amount, duration and frequency through Self Directed consumer model. Per Pa, the aide continues to assist the Pa w/ his daily, bathing, grooming, IADLS excluding, money and telephone management. The Pa also, receives 7 frozen dinners weekly from Moms meal to supplement nutritious healthy meals, and Service Coordination via PCA. The Pa's has no informal

Per the Pa services continue to meet his needs and he remains satisfied. Pa is not requesting any change to the service plan. Pa denies changes to her ADLs/IADLs, mobility, cognitive, social, emotional, or financial status. SC reviewed Pa's ISP. Pa confirms that he continues to receive the service plan in ISP in the following type, scope, amount, frequency and duration: as specified in the ISP. The Pa has agency model PAS through Moravia Health Network 4 hrs. daily in a split shift from 9-11am, 4-6pm. His aide provides supervision and hands on help as needed with personal care, grooming and dressings. Pa is able to transfer and walk with his cane, but needs supervision and to be checked on. Aide will prep breakfast and lunch for Pa and meals for Pa to warm up in his microwave and complete all laundry and food shopping. Pa confirmed that this is the amount of support necessary to ensure his health and safety and to meet his needs and goals; Pa reported satisfaction with her current services. SC and the Pa discussed self-directed services. Pa declined and reported that he is satisfied with his current agency and does not wish to make changes. SC discussed transportation and Pa remain satisfied with CCT and Logistic

SC spoke with Pa and CG on 09/30/2015. No falls, hospitalization, changes in health status or medications were reported by Pa or CG. Pa reported that both she and spouse (Travers Russell was not present when SC called; Pa stated he went to the senior center and he’s doing well no unmet needs) are receiving services as outlined in the ISP. Pa’s goals remain unchanged both her and spouse remain satisfied with services and feel that they meeting their current needs. Pa reported that all services are received in the correct type, scope, amount, duration, and frequency as specified in the ISP. Pa self-directed model PAS provide hands on assistance and supervision with bathing, dressing, grooming, toileting, light home support and meal prep; daily

Trinity Community is challenged with two current healthcare trends. The first trend is related to Medicare and how doctors are paid on Medicare claims. Medicare’s primary coverage group is for people older than 65 years of age. Medicare also covers some people under 65 that have certain disabilities as well as people of any age that have End-Stage Renal Disease. Year after year, lawmakers have been trying to fix a part of the Medicare law that would cut payments to doctors. Since the late 1980’s, the cuts would continue to grow annually and eventually exceed a 20% pay cut.

As you know on Tuesday, December 1st, we are scheduled for an all-day clinical demonstrations session at 108 Providence. One of our strategies as a MSO is to provide independent practice management support for those practices that wish to remain independent. For these practices that we, as Novant Health, want to strategically align ourselves with, our first choice is to install and implement Epic via Community Connect as a vehicle to monitor and assess the practice’s daily operations. As our MSO continues to grow outside of Novant Health’s footprint, there will be practices that we choose not to strategically align ourselves with. In these cases, we may offer up a secondary EHR system that will not allow us to implement

It was in 1977 that the United Healthcare United Health group was founded by Richard Burke. The headquarters of the company are in Minnetonka, Minnesota. This organization works towards the betterment of people's health, it help them in living a healthy life by providing them with the kind of health care that would be best for them. The main focus of United Healthcare which is a major division of the United Health group is to provide the people with better health benefits and coverage.

All groups of clients, their families, and the community that surrounds us should feel positive about my agency, Alliance Healthcare Services. The agency was founded in 1983 as a mobile crisis service for the community. This is a service that is provided in part by the state to help people in the community who are experiencing a mental health crisis. My agency truly cares about the people and families in which they serve; this is shown through their mission statement and values. “To improve the health and well-being of the people we serve by ensuring highly effective, community-based support and care, at Alliance our values of Accountability and Integrity, Collaboration, Compassion, Dignity and Respect, and Innovation shape the work we do every day” (Alliance Behavioral Healthcare. (n.d.). (2015).

ABC Medical Center is a general hospital setting that employs a variety of professionals in the medical field, including, but not limited to; Doctors, Physician’s Assistants, Nurses, Aides, Physical Therapy, Occupational Therapy, Nurse Case Managers, and Social Workers.