Advanced Medical Home Training
AMH 109 provides key messages for organizations across the state that are supporting Medicaid Advanced Medical Home practices by acting as “Clinically Integrated Networks (CINs) / Other Partners.” This webinar will review the key features of AMH model design and its expectations for contracting between PHPs and AMHs, including the role of CINs and other partners.
AMH 108 provides an in-depth review at the IT and data sharing infrastructure that AMHs will need in order to participate in the AMH program. We will review North Carolina’s care management data strategy and identify the various data feeds that AMHs and their clinically integrated networks (CINs) or other partners will have access to, and discuss how key AMH stakeholders – including prepaid health plans (PHPs), CINs/other partners, and AMHs – will share information with one another. The webinar will conclude with several use cases that detail how AMHs may utilize information from various data sources to meet care management requirements.
The seventh in the series of webinars on North Carolina’s AMHs provides an in-depth review of how AMH Tier 3 practices will provide transitional care management to individuals that have been discharged from the hospital. It details the features of short-term transitional care management, including medication management and tracking patient admission, discharge, and transfer (ADT) alerts. It also addresses some frequently asked questions about the AMH program that have been submitted to the NC Department of Health and Human Services (DHHS).
Description: The sixth in our series of webinars on North Carolina’s Advanced Medical Homes (AMH) provides an in-depth review at how AMH Tier 3 practices will provide care management to beneficiaries identified as “high-need.” This includes a discussion of care management staffing requirements, and an overview of the key features of high-need care management in the AMH program, including the development and maintenance of care plans; the use of admission discharge, and transfer (ADT) feeds; and how these components relate to AMH risk stratification.
This webinar provides an in-depth look at how AMH practices will manage patient assignment, empanelment and assessment processes. The webinar reviews the beneficiary primary care provider (PCP) and Prepaid Health Plan (PHP) selection processes and consider how these relate to AMH practice requirements. It also details AMH Tier 3 risk stratification and the Comprehensive Assessment requirements, and how these processes are linked to the identification of high need beneficiaries in need of care management and inform the development of AMH Care Plans. Finally, it concludes with a set of practice “use cases” that provide examples of how Tier 3 practices may choose to partner and delegate AMH responsibilities to Clinically Integrated Networks (CINs) or other partners.
AMH 104 provides an in-depth look at the roles and responsibilities of Clinically Integrated Networks (CINs) and other partners. The state envisions that many AMHs with work with CINs/other partners in order to support their in-house care management functions, and this webinar will focus on how these arrangements might take shape and how AMHs can get the most use out of CINs/other partners. We review the areas where CINs/other partners may be able to provide support to AMHs, including augmenting staffing and providing care management, providing data management and analytic support, and facilitating contracting with PHPs. The presentation concludes with several CIN “use cases” that will detail a few of the ways that Tier 3 practices may consider partnering and delegating responsibilities to a CIN/other partner in ways that best meet the specific needs of the practice and the Medicaid patients they serve.
AMH 103 provides an in-depth look at the accountability structures built into the program, and provide a practical guide for practices in understanding roles and responsibilities under the AMH program. It provides an overview of North Carolina’s Medicaid Transformation and the AMH program and describe how the State will hold Prepaid Health Plans (PHPs), AMHs, and Clinically Integrated Networks (CINs) and other partners accountable and ensure that the program achieves its goals. We also review other program accountability structures, including the role the State’s AMH certification process plays in approving practices for participation as AMHs; how contracting will define responsibilities, payment amounts, and other terms and conditions between the State, PHPs, AMHs, and CINs; and processes the State, PHPs, and AMHs can use to oversee the ongoing functions of entities (including CINs) that have been designated specified AMH program requirements.
Presentation - Training featured an extended discussion combining elements of the AMH 101 and AMH 102 webinars, including a high-level overview of the AMH program and a more detailed look at the transition from Carolina ACCESS to the AMH program.
The attestation tool for providers to attest to a higher tier level.
- Only currently participating primary care providers wanting to attest to a higher tier need to use the attestation tool. Clinical service delivery and care management requirements for each AMH Tier are outlined in the AMH Provider Manual, located on the AMH webpage under Resources.
- More information on the attestation tool and training is available at: https://www.nctracks.nc.gov/content/public/providers/provider-user-guides-and-training/provider-training.html