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What are the objectives of the program?
Improved care coordination, Reduced avoidable utilization
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Please provide a brief description of the program:
The Interdisciplinary Model of Care (IMOC) describes how the members of the healthcare team work together to provide care for inpatients and families. The goal of the IMOC is, through rounding, to drive consistency and efficiencies across the following stages of care: hospitalization decision, unit admission, care delivery, discharge transition, care coordination/transition planning, patient & family engagement. This program is operational for hospital inpatients, in MedStar Healths 7 Maryland hospitals.
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Is this program operated as part of HSCRC's Care Redesign Amendment?
No
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Which Center for Medicare and Medicaid Innovation (CMMI) category does (or would) the program fall under? Choose the best match.
Initiatives_to_Speed_the_Adoption_of_Best_Practices
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What are the major components of the program?
Care coordination/management, Patient assessment tools, Care transitions, Patient education/coaching/self-management, Multidisciplinary care teams, Patient care plans
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What types of organizations participate in the program?
Hospital/health system, Home health care
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Which population(s) does the program target?
Medicare/older adults, Medicaid, Dual eligibles (Medicare-Medicaid enrollees), Privately insured, Individuals with multiple chronic conditions, Frail/disabled, Younger adults, Children
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How many patients have participated in the program to date?
Innumerable, since all inpatients are subject to IMOC
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In what Maryland jurisdictions do participating patients reside?
Anne Arundel, Baltimore, Baltimore City, Harford, Howard, Montgomery, Prince Georges, Saint Marys, Participation also includes non-Maryland residents
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Briefly describe the staffing resources required to operate the program:
The core interdisciplinary care team for each patient is comprised of: direct care nurse, charge nurse, therapists (PT/OT/SP), attending physician, resident physicians, RN case manager, social worker, patient & family. Additional team members, based upon patient needs, may include: psychologist, pharmacist, nutritionist, consulting physicians/specialty nurses, palliative care.
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Briefly describe the key initial steps to implementation:
The successful implementation of the Interdisciplinary Model of Care (IMOC) across MedStar Health required two distinct bodies of work: 1) Standardization of specific activities within each stage of care along the acute patient journey 2)Development of IMOC solutions that span across the stages of care and have an impact on roles, processes, technology, and key performance indicators when implemented. This was accomplished through the efforts of a broad-based multidisciplinary team, supplemented by others as needed to complete tasks. Implementation began on a small scale, per unit, per hospital, until expanded throughout the MedStar hospitals.
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Are incentive payments to health care providers part of the program?
False
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What are/were the expected results in improved outcomes, population health, and cost savings?
Decreased Length of Stay (LOS) to risk-adjusted/expected LOS; anticipating patients will have experienced improved care coordination for their discharge
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Have expected results for improving outcomes and population health been met?
Results are expected but not yet achieved
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Please briefly explain your answer to Question 25, and describe any results for improved population health achieved to date:
Premature to report on outcomes in this phase of our process, Results are expected but not yet achieved
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Please briefly explain your answer to Question 27, and describe any cost savings results achieved to date:
Premature to report on cost savings in this phase of our process