Community Collaboratives Sample Clauses

Community Collaboratives. Local implementation of the State’s Blueprint for Health requires the participation of a wide array of community partners and stakeholders to:  Operate community health team(s) (CHTs)  Coordinate health information technology (HIT) connectivity  Support the development of a learning health system  Participate in regional ACO planning and other health reform activities The Contractor shall work directly with ACO(s) within the HSA to facilitate the formation and maintenance of a Community Collaborative (CC) to align quality improvement initiatives and care coordination activities, to strengthen Vermont’s community health infrastructure, and to help the ACO provider networks within each community meet their organizational goals. The CCs shall promote the cohesive integration of health and human services addressing both the medical and non-medical needs that impact measurement results and outcomes, including social, economic, and behavioral factors. The CC structure, with administrative support locally from the Blueprint and the ACOs, will result in more effective health services as measured by:  Improved results for priority measures of quality  Improved results for priority measures of health status  Improved patterns of services utilization (preventive services, unnecessary care)  Improved access and patient experience of care The CC structure includes three (3) basic elements: (1) Leadership Team (Governance)

Community Collaboratives. Local and regional convenings of county agencies, community-based organizations, nonprofits, Members, relatives/ natural supports, health care Providers, and peers that meet regularly to identify and address community needs through coordinated efforts and system planning. Community Integration Plan (CIP): A planning document completed as part of the diversion process that documents that community integration planning occurred and indicates which residential option and other services were chosen by the Member and/or their relatives or guardian. Compatible Medicaid NCCI Methodologies: The six (6) NCCI Methodologies used in the Medicare Part B program and determined by CMS as compatible methodologies for claims filed in Medicaid: (1) a methodology with procedure-to procedure edits for practitioner and ambulatory surgical center services; (2) a methodology with procedure-to-procedure edits for outpatient services in hospitals (including emergency department, observation, and hospital laboratory services); (3) a methodology with procedure-to-procedure edits for durable medical equipment; (4) a methodology with medically unlikely edits for practitioner and ambulatory surgical center services; (5) a methodology with medically unlikely edits for outpatient services in hospitals; and (6) a methodology with medically unlikely edits for durable medical equipment. Although the Medicare methodologies are compatible for Medicaid, the actual edits used are not identical between programs. Conflict of Interest: Impermissible actual situations or circumstances through which the PIHP, or entities or individuals closely affiliated with the PIHP, will derive, or reasonably may be perceived as deriving, direct financial or other pecuniary benefit from its performance of this Contract other than through the compensation received according to the Contract for performance of the Contract, or that might impair, or reasonably be perceived as impairing, the PIHP’s ability to perform this Contract in the best interests of the State.

Community Collaboratives. Local implementation of the State’s Blueprint for Health requires the participation of a wide array of community partners and stakeholders to:  Operate community health team(s) (CHTs)  Coordinate health information technology (HIT) connectivity  Support the development of a learning health system  Participate in regional ACO planning and other health reform activities The Contractor shall work directly with ACO(s) within the HSA to facilitate the formation and maintenance of a Community Collaborative (CC) (may be called by a different name in the local health service area) to align quality improvement initiatives and care coordination activities, to strengthen Vermont’s community health infrastructure, and to help the ACO provider networks within each community meet their organizational goals. The CCs shall promote the cohesive integration of health and human services addressing both the medical and non-medical needs that impact measurement results and outcomes, including social, economic, and behavioral factors. The CC structure, with administrative support locally from the Blueprint and the ACOs, will result in more effective health services as measured by:  Improved results for priority measures of quality  Improved results for priority measures of health status  Improved patterns of services utilization (preventive services, unnecessary care)  Improved access and patient experience of care The CC structure includes three (3) basic elements: (1) Leadership Team (Governance)

Community Collaboratives. Community Health Team (CHT) Staffing and Design