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ForwardPCMH Southeastern PA Learning Session 5.24.23
The activity will provide a follow up for the PCMH Healthcare teams who have initiated Social Determinants of Health screenings and are now progressing into improving their processes and follow up, particularly educating patients and providers.
Agenda
8:30 a.m. to 8:45 a.m. – Welcome & Overview – Suzanne Cohen, MPH, Senior Director of Population Health, The Health Federation of Philadelphia
8:45am – 9am Networking
⦁ Introductions: name, affiliation.
⦁ Identify the organizations at your table.
⦁ What are your burning questions related to SDOH for your colleagues and MCO representatives today? Pick your two questions.
9am – 9:30am Update on PA NAVIGATE
Presenter: Bill Marella, HealthShare Exchange
9:30 – 10:15am MCO Panel: Representatives Discuss SDOH Data and Needs
Panel: Health Partners Plans, Keystone First, United Healthcare, UPMC For YOU
Questions include:
⦁ What SDOH data are you receiving from the PCMH practices? Are you getting Z codes and G codes? Just one or the other? Or are you getting these data in any other way?
⦁ How is your MCO using the SDOH data it receives? Are they going into risk algorithms? Informing programs?
⦁ What types of SDOH needs are the PCMH practices reporting?
⦁ What SDOH data is your MCO getting through your own outreach to members?
⦁ Are you looping practices in on the data that you are collecting?
⦁ What are the main needs that the PCMH and the MCO data show?
⦁ What are the rates of screening that you are seeing in the PCMH practices?
⦁ How many PCMHs are submitting G-codes with Z-codes (by quarter or year)?
⦁ What changes in frequency and type of G-codes and Z-codes have you observed?
BREAK
10:30am – 12pm PCMH Panel 1: SDOH Screening and Coding
Panel: Janine Gibbons, Delaware Valley Health Network, Mitali Desai, Temple Physicians, Inc.
Breakouts
Topics:
1 A. EPIC documentation and coding – B. other EHR documentation and coding?
2 Training staff on how to ask questions/screen
3 Patient entered data: Using portal/tablets
12pm – 1pm LUNCH & NETWORKING
1pm – 2:30pm PCMH Panel 2: SDOH Referrals and Follow-up
Panel:
Katie McPeake, CHOP, Nancy McGlaughlin, Penn Medicine, Jennifer Lydic, PHMC
Breakouts:
Topics:
1- Referral workflow and documentation
2- Working w/CBO partners
3- Use of electronic platforms
4- People’s choice
2:30pm – 3:00pm Action planning for Addressing SDOH
⦁ Work in practice groups to synthesize discussions and decide on next steps (action planning)
3:00pm Evaluation and Wrap-Up
Target Audience
Nurse
Physician
Social Worker
Learning Objectives
● Describe what the MCOs are learning about their members’ social needs through PCMH screening and coding, as well as their own member outreach, and how they are using this information.
● Discuss tactical, how-to information on SDOH screenings, coding, and follow-up best practices .
● Describe the state’s initiative for resources and referrals: PA Navigate.
Additional Information
| Attachment | Size |
|---|---|
 Audience Disclosure slides (005.5).pptx | 459.3 KB |
 Temple Health - MDesai - SDOH Presentation .pdf | 631.5 KB |
| PHMC Presentation - JLydic - SDOH Screening.pdf | 568.8 KB |
| Penn Medicine - NMcGlaughlin - SDOH presentation.pdf | 689.64 KB |
| Delaware Valley Community Health - JGibbons - SDOH Presentation.pdf | 598.86 KB |
| CHOP - McPeake - SDOH Screening.pdf | 1.06 MB |
 PCMH SE 5.24.23 Agenda.docx | 521.91 KB |
The activity will provide a follow up for the PCMH Healthcare teams who have initiated Social Determinants of Health screenings and are now progressing into improving their processes and follow up, particularly educating patients and providers.
Agenda
8:30 a.m. to 8:45 a.m. – Welcome & Overview – Suzanne Cohen, MPH, Senior Director of Population Health, The Health Federation of Philadelphia
8:45am – 9am Networking
⦁ Introductions: name, affiliation.
⦁ Identify the organizations at your table.
⦁ What are your burning questions related to SDOH for your colleagues and MCO representatives today? Pick your two questions.
9am – 9:30am Update on PA NAVIGATE
Presenter: Bill Marella, HealthShare Exchange
9:30 – 10:15am MCO Panel: Representatives Discuss SDOH Data and Needs
Panel: Health Partners Plans, Keystone First, United Healthcare, UPMC For YOU
Questions include:
⦁ What SDOH data are you receiving from the PCMH practices? Are you getting Z codes and G codes? Just one or the other? Or are you getting these data in any other way?
⦁ How is your MCO using the SDOH data it receives? Are they going into risk algorithms? Informing programs?
⦁ What types of SDOH needs are the PCMH practices reporting?
⦁ What SDOH data is your MCO getting through your own outreach to members?
⦁ Are you looping practices in on the data that you are collecting?
⦁ What are the main needs that the PCMH and the MCO data show?
⦁ What are the rates of screening that you are seeing in the PCMH practices?
⦁ How many PCMHs are submitting G-codes with Z-codes (by quarter or year)?
⦁ What changes in frequency and type of G-codes and Z-codes have you observed?
BREAK
10:30am – 12pm PCMH Panel 1: SDOH Screening and Coding
Panel: Janine Gibbons, Delaware Valley Health Network, Mitali Desai, Temple Physicians, Inc.
Breakouts
Topics:
1 A. EPIC documentation and coding – B. other EHR documentation and coding?
2 Training staff on how to ask questions/screen
3 Patient entered data: Using portal/tablets
12pm – 1pm LUNCH & NETWORKING
1pm – 2:30pm PCMH Panel 2: SDOH Referrals and Follow-up
Panel:
Katie McPeake, CHOP, Nancy McGlaughlin, Penn Medicine, Jennifer Lydic, PHMC
Breakouts:
Topics:
1- Referral workflow and documentation
2- Working w/CBO partners
3- Use of electronic platforms
4- People’s choice
2:30pm – 3:00pm Action planning for Addressing SDOH
⦁ Work in practice groups to synthesize discussions and decide on next steps (action planning)
3:00pm Evaluation and Wrap-Up
Suzanne Cohen, MPH, Senior Director of Population Health, The Health Federation of Philadelphia
Bill Marella, HealthShare Exchange
Janine Gibbons, Delaware Valley Health Network
Mitali Desai, Temple Physicians, Inc.
Katie McPeake, CHOP
Nancy McGlaughlin, Penn Medicine
Jennifer Lydic, PHMC
In support of improving patient care, this activity has been planned and implemented by the University of Pittsburgh and The Jewish Healthcare Foundation. The University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
As a Jointly Accredited Organization, University of Pittsburgh is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. University of Pittsburgh maintains responsibility for this course. Social workers completing this course receive 5.5 continuing education credits.
Physician (CME)
The University of Pittsburgh designates this live activity for a maximum of 5.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nursing (CNE)
The maximum number of hours awarded for this Continuing Nursing Education activity is 5.5 contact hours.
Social Work (ASWB)
The maximum number of hours awarded for this Continuing Social Work Education activity is 5.5 contact hours.
Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
Available Credit
- 5.50 AMA PRA Category 1 Credit™The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
- 5.50 ANCCUPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
- 5.50 ASWB
- 5.50 Attendance