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UDS Training 2019

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Quarterly Claims and Operations

2018 IQIN Face-to-Face Meeting Highlights
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IQIN 2018 Face-to-Face Highlights

The Indiana Quality Improvement Network (IQIN) Face-to-Face Meeting on October 4th, 2018 featured Candace Chitty, Quality Heatlh First Consulting Services. The purpose of the event was to give participants an understanding of the systems and tools necessary to work successfully with population health models, processes, staffing, training, patient engagement, and reporting. This new model of care will require health center personnel acquire the knowledge and skills necessary to move from an episodic orientation to a population health model. This event covered the essentials of PHM: managing transitions of care, managing high-risk complex populations, engaging patients in self-care, and measuring performance. Skills required to achieve these goals include but are not limited to cultural change, coaching, empowerment, motivating behavior change, advocacy, and mastering continuous quality improvement principles. Other presenters included Azara Healthcare and Purdue Healthcare Advisors.

Speaker Presentations and Materials

Candace Chitty, Quality Health First Consulting: Population Health Management Principles & Practices

Candace Chitty Handouts:

       Risk Stratification Action Planning

       Example Risk-Based Interventions

       Care Transitions Interventions

       Chronic Care Business Requirement Assessment

       Patient Self-Management Agreement

LuAnn Kimker, Azara Healthcare: Risk Algorithms for Predictive & Pragmatic PHM 

Allison Bryan-Jungels, Purdue Healthcare AdvisorsImplementing Medicare CCM in FQHCs


Tools to Support Risk Stratification: 

       Behavioral Risk Factor Surveillance System (BRFSS) Questionnaire


       Diabetes Distress Scale

       NACHC Risk Stratification Action Guide

       AAFP Risk Stratified Care Management Rubric

       SF-12 Questionnaire

       Patient Activation Measure (PAM)

Additional Resources: 

       Resources for Population Health Management