TA to Identify and Manage High-Risk Patients During COVID-19
The COVID-19 pandemic required immediate changes to how we deliver services to ACO/CP high-risk populations. As we worked on the front lines and supported our population health teams during this crisis, we observed that population health teams did not have a readily available system to manage care for high risk populations: How many patients/members/clients do we have with asthma? How many home-bound elders? How many with physical or cognitive or behavioral limitations? Developing a population management system would allow the ACO/CP to communicate with and proactively manage care for populations – an important efficiency in a crisis. This engagement will support your team in identifying population segments, quantifying how many of your members/patients/clients are in each group, developing a working registry based on your existing tools, and developing forward-thinking strategies to (re-)engage high risk populations in the context of the challenging and changing realities as we adjust to adapting to COVID.
TA consists of two informational meetings and 10 coaching calls over three months in 2020. CHS is happy to customize this TA opportunity in any of a variety of ways. This could certainly lend itself to ongoing strategic and technical advisement and performance improvement coaching. We always look to serve at the largest scale possible, and this offering would be great to customize for collaborations with multiple ACOs and/or CPs.