Carefirst 2019 individual application virginia residents

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In , providers were in established compacts. Utilized committees to assure oversight for our key partners. We worked collaboratively with Sharecare, Medtronic, and CVS to align their programs with our clinical programs.

Community providers, hospitals, and specialists were engaged in the development of these enhancements. CareFirst partnered with national specialty organizations in the development of clinical programs. This system is used to document Member health history, current health status, and progress toward meeting goals. SearchLight reports are available to practitioners, practices, and at the panel levels to evaluate aggregate performance and utilize data to identify attributed Members needing support.

Practice Consultants assist PCMH panels in data analysis and identify potential opportunities for increased cost savings and improved quality. LCCs reinforced the availability and functionality of portal tools for PCPs to assist with population management. CareFirst offered PCP cost data for specialists to help them make informed referrals. Assess the race, ethnicity, language, interpreters, cultural competency, gender identity, and sexual orientation needs of our diverse populations while considering such diversity in the analysis of data and implementation of intervention to reduce health disparities, improve network adequacy and improve cultural competency in materials and communications; Spanish is the predominant non-English language within our region and CareFirst offers multiple avenues to reach a diverse Membership.

The Language Line provides interpreters, at no cost to Members and providers. The Disease Management and Wellness programs offer printed educational materials in English and Spanish with multi-lingual nurses staffing call centers. The Health Risk Assessment is available in Spanish online, and in printed format. Within care plans, Members are queried as to cultural and ethnic preferences. Through CareFirst Commitment, in funds were provided to community organizations to reduce or eliminate racial disparities and improve the quality and safety of care in the regions we serve.

These individuals are familiar with the local health care systems and support and tailor care plans to the populations they serve. The following functions were delegated: quality improvement, utilization management, case management, pharmaceutical safety, disease management, credentialing, networks, wellness, and Member connections. The Delegation Oversight Committee DOC plays an active role in monitoring activities based on delegation agreements and compliance requirements. Audits and corrective action are taken when needed to ensure delegates serve member needs and comply with state, federal and regulatory requirements.

Develop and maintain a high-quality network of health care practitioners and providers meeting the needs and preferences of its membership by maintaining a systematic monitoring and evaluation process.

Also, providers are required by CAQH to attest to the accuracy of the data every days. CareFirst receives an electronic transmission with updated provider information. CareFirst continues to grow the Behavioral Health network, with 9, behavioral health providers contracted in-network. Operate a QI Program that is compliant with responsive to federal, state, and local public health goals, and requirements of plan sponsors, regulators and accrediting bodies; In , CareFirst submitted its renewal application to National Committee for Quality Assurance NCQA and was granted 3-year accreditation status next submission is scheduled for July Provide insight based on Searchlight data to increase the knowledge base of the Medical Panels in the evaluation of their outcome measures; CareFirst used the comprehensive provider reporting tool SearchLight to have nearly 2, meetings with providers in Insights from specialist data available within SearchLight promoted improved referral patterns.

Support quality improvement principles throughout the organization; acting as a resource in process improvement activities; The QI team continues to focus on quality improvement initiatives throughout the organization, using our Quality Improvement Committee QIC as the platform to present and discuss quality improvement projects and concerns.

These improvements are documented through committee minutes to demonstrate actions taken to address specific areas of concern. Create an awareness for social determinants of health; including what they are and how they affect member abilities to fulfill health goals; While improving health outcomes requires an accessible and high-quality health care delivery system, CareFirst also recognize that this includes addressing root causes of poor health outcomes, or social determinants of health, to truly drive change.

CareFirst has also supported programmatic efforts such care coordination, medically tailored meals, and culturally competent language services. Profile Score. Support and promote all aspects of the CareFirst Patient Centered Medical Home PCMH program and the Clinical programs to improve quality of care, safety, access, efficiency, coordination, and service;. High adoption of the Core Target by providers. In-area medical trend adjusted for rebates, excluding Affordable Care Act was 3.

Implement methods, tracking, monitoring, and oversight processes for all Clinical Programs to measure their value and impact for appropriate patients with complex healthcare needs;. A program management and accountability structure was in place for each Clinical program.

Promote the provision of quality and cost data and support to clinicians to promote evidence-based clinical practice and informed referral choices and Members to use their benefits to their fullest;. Maintain a systematic process to continuously identify, measure, assess, monitor, and improve the quality, safety, and efficiency of clinical care medical and behavioral health , and quality of services;.

Assess the race, ethnicity, language, interpreters, cultural competency, gender identity, and sexual orientation needs of our diverse populations while considering such diversity in the analysis of data and implementation of intervention to reduce health disparities, improve network adequacy and improve cultural competency in materials and communications;.

Spanish is the predominant non-English language within our region and CareFirst offers multiple avenues to reach a diverse Membership. Operate a QI Program that is compliant with responsive to federal, state, and local public health goals, and requirements of plan sponsors, regulators and accrediting bodies;.

Provide insight based on Searchlight data to increase the knowledge base of the Medical Panels in the evaluation of their outcome measures;. Mandatory school closings can challenge working parents and guardians. Additionally, many school children depend on school for meals. According to Johns Hopkins University, social distancing is a public health practice that aims to prevent sick people from coming in close contact with healthy people in order to reduce opportunities for disease transmission.

Here are some resources you can share with friends and family. Proper handwashing can keep you safe and covering your cough can keep others safe. Learn more here:. There are a lot of medical and health insurance definitions flying around these days.

They are the number one resource for any and all coronavirus-related news. Visit their website and social media pages frequently to stay informed. The World Health Organization is a specialized agency of the United Nations that is concerned with world public health.

Check out the WHO's coronavirus updates. Skip Navigation. Login Register. Have questions about health insurance? Explore our Insurance Basics pages. Need Insurance? Log In or Register. Expand All Collapse All individuals-families. Need Health Insurance? Sign up here D. Residents D. Virginia Residents Virginia residents may enroll in individual coverage at Healthcare.

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Have questions about health insurance? Explore our Insurance Basics pages. Need Insurance? Log In or Register. Choosing a health plan for you—or your family—is an important decision. Whether you know what coverage you need or want to explore your options, CareFirst offers a range of plans for Northern Virginia residents. Get a Quote. Dental Insurance Plans of Virginia We offer several affordable dental care plans to help protect your smile, health and budget.

CareFirst funding will support c 3 or c 6 non-profit organizations in Maryland, Washington, DC, Northern Virginia located north and east of route , including portions of Fairfax, Alexandria, and Arlington Counties , and Charleston, West Virginia.

Through this multi-year funding opportunity, CareFirst seeks to invest in initiatives that target at-risk youth e. Special considerations will be given to organizations serving Black, Indigenous, People of Color BIPOC , disconnected youth, persons experiencing homelessness, populations with limited English proficiency LEP , structurally disinvested communities, justice-involved individuals, LGBTQ populations, low-income communities, rural communities, and other marginalized communities.

The application window for this RFP is now closed. Applicants will be notified about the status of their request in Q3. Out of sight, out of mind — behavioral and developmental care for rural children.

The New England Journal of Medicine ; 14 : — Widening rural-urban disparities in youth suicides, United States, — JAMA Pediatrics ; 5 : —

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