![Page 1: Baseline Assessments / Swim Lane Diagrams Presented by: Helen C. Burch, MBA Managed Care Advisors, Inc](https://reader035.vdocument.in/reader035/viewer/2022062421/56649d1b5503460f949f0d33/html5/thumbnails/1.jpg)
Baseline Assessments / Swim Lane Diagrams
Presented by:Helen C. Burch, MBAManaged Care Advisors, Inc.
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Presentation Overview
Process Assessment Assessment Criteria Business Process Mapping
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Process Assessment
Research environment Interview stakeholders Collect documents Review data sources Verify information systems capabilities Document existing processes – swim
lanes
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Assessment Criteria
Core Measures Case Management Measures Data Measures
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Core Measures
Accountability & Structure Regulatory Compliance Documentation Compliance Stakeholder Communication Clinical Services
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Accountability & Structure
Philosophy, goals, objectives Organizational structure Committees
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Regulatory Compliance
Reporting File maintenance Staff responsibilities
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Documentation Compliance
Accuracy Completeness
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Civilian Communications
Documents Correspondence Forms
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Clinical Services
Installation services Community services
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Case Management Measures Information Systems Staffing Patient Protections Client Choice Identification & Assignment Client Disclosure Client Assessment Case Management Plan Requirements Complaints Discharge & Termination Return to Work
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Information Systems
Systems integration Access Tools
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Staffing
Job descriptions Credentials Caseloads Performance standards Physician expertise Staff development and management
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Patient Protections
Confidentiality Security
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Client Choice
Client rights Provider selection
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Identification & Assignment
Selection Case Manager assignment Integration with third parties
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Client Disclosure
Communications to client
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Client Assessment
Evaluation
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Case Management Plan
Plan development Review and updating Decision making
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Complaints
Management and referral
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Discharge & Termination
Case closure Discharge and termination
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Return to Work
Vocational rehabilitation Modified and restricted duty Independent Medical Examinations (IMEs) Transition to work
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Data Measures - Metrics
Program outcomes - frequency and cost Case Manager performance
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Business Process Mapping
Swim Lane Diagram Technique for mapping organizational
structure to processes Delineates ownership of all activities and
processes within swim lanes
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Swim Lane ExampleSwimlane Process Mapping of Initial Stages of Non-Emergent Employee Injury
Em
ploy
eeS
uper
viso
rH
ealth
Pro
vide
r
Sustains injury
Reports injury to
supervisor
Provide Form CA-16 to employee
Determine appropriate site
for care
Provide initial evaluation and
treatment
Access care
Determine work status
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Now What?
Assimilate and record all information Review with stakeholders Identify leakage points Design and implement strategies for
improvement Monitor progress