Case Studies - COPE Health Solutions

US Family Health Plan Cuts Readmission Rate for High-Risk Members to 11% By Upgrading Medical Management Programs

Challenge: Frequent regulatory and plan requirement changes, coupled with the need to adapt to pandemic challenges, prompted Uniformed Services Family Health Plan to find a partner to undertake a thorough review and restructuring of its medical management program. US Family Health Plan, a TRICARE Prime® military health care option serving military families in New […]

Building a Medicare Advantage Network

Background The Health Plan is a not-for-profit health plan in the Northeast that services more than 280,000 members, offering Medicaid, Medicare and Children’s Health Insurance Program (CHIP) plans. The plan has consistently ranked high on the National Committee for Quality Assurance’s (NCQA) quality metrics but had a relatively small footprint in its target markets, despite […]

Leveraging Care Navigators to Deliver Impact Medicare Compliance

Background Starting in 2011, the Center of Medicare and Medicaid Services (CMS) has required health care systems to deliver the Important Message from Medicare (IM) to all Medicare beneficiaries who are hospital inpatients. This admission notice provides beneficiaries and representatives a written notice about their hospital discharge appeal rights. CMS regulation dictates that IM delivery […]

Leveraging DSRIP to Improve Clinical Outcomes and Shift Toward Value-Based Payment

Background In 2013, the Texas Legislature created The University of Texas Rio Grande Valley (UTRGV) to increase educational opportunities in the surrounding Rio Grande Valley area, located at the state’s southernmost point along the Mexican border.1 The Rio Grande Valley has an estimated population of about 1.5 million residents.2 In conjunction with the school’s founding, […]

Improving Access and Quality in Post-Acute Care: Building a System-Wide Network of Skilled Nursing Facilities at One of the Nation’s Largest Public Hospital Systems

Introduction Hospital and health systems that strive toward value-based payment as their primary payor engagement strategy become more accountable for costs and health outcomes after a patient leaves an acute care facility. Medicare has already made this accountability a fact of life for all hospitals serving Medicare members through the value-based payment and re-admissions penalties […]

Improving Post-Discharge Phone Call Rates Using Health Scholars

Background: Benefits of a Post-Discharge Phone Program Hospitals have improved patient outcomes and patient satisfaction scores via implementation of a successful post-discharge phone call program to achieve: Improved patient outcomes: Patients receiving a post-discharge call were 23.1% less likely to be readmitted compared to patients who did not receive a call1. Early detection of adverse […]

Related Services : Health Care Talent Innovations

Implementing Medicaid’s 1115 Waiver for Texas’ JPS Health Network

The Problem: John Peter Smith (JPS) Health Network is a major public health care delivery system in Fort Worth, Texas and is the anchor entity for Region 10’s Regional Healthcare Partnership (RHP), part of Texas’ 1115 Medicaid waiver. The Delivery System Reform Incentive Payment (DSRIP) funding pool of the waiver allows providers that participate […]

Related Services : Policy Analysis

St. Mary Medical Center Improves Post-Discharge Phone Call Process

Background: The period following discharge as a patient transitions from hospital to home can be a vulnerable time for patients, especially those who are at high risk for hospital readmission. Preventable hospital readmissions often stem from a discontinuity in a patient’s care plan due to confusion surrounding discharge instructions, changes to medication regimen, or […]

Making Post-Discharge Calls Sustainable in High-Volume Patient Care Environments

Background: Post-discharge phone calls are an empirically supported best practice for improving the patient experience and reducing readmissions in hospitals1. The Agency for Healthcare Research and Quality (AHRQ) recommends that follow-up calls be made to patients within 48-72 hours of discharge2. To meet industry standards and stay connected with their patients, providers are working […]

Related Services : Health Care Talent Innovations

Comparing DSRIP in Texas and New York

Overview: Delivery System Reform Incentive Payment (DSRIP) providers in Texas have been closely following the proposed extension to the Texas State Section 1115 Waiver as HHSC prepares to submit an extension application to the Centers for Medicaid and Medicare Services (CMS). A main goal of the extension is to align the waiver with Medicaid […]

Related Services : State Waivers

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