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PO#
#TBA03072
Payment Status
Paid
PO Created Date
2024-08-15 19:47:15
Paid Date
2024-08-15 19:47:45
Competition
2024
Season
2
Entry ID
TBE103417
Entry Submission Date
2024-08-15 19:39:31
Member's Name
Gokul Ramadoss
Member's Email
gokul1248@gmail.com
Entry Level
Information Technology
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IT24000 - Information Technology / Other:___
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Project Description
The project includes the full migration process from MSIS to TMSIS, encompassing data migration, system integration, customization, user training, and ongoing support. The goal is to ensure a smooth transition with minimal disruption to transportation operations and to fully leverage the capabilities of TMSIS for improved efficiency and compliance. AmeriHealth Caritas is a prominent organization in the managed care industry, focusing on providing comprehensive healthcare services to Medicaid, Medicare, and other publicly funded populations. The management team in AmeriHealth Caritas' medical management division plays a critical role in ensuring that members receive high-quality, cost-effective care
Project Description for Judges
The project includes the full migration process from MSIS to TMSIS, encompassing data migration, system integration, customization, user training, and ongoing support. The goal is to ensure a smooth transition with minimal disruption to transportation operations and to fully leverage the capabilities of TMSIS for improved efficiency and compliance.
Question 1 : Provide a brief description / background of your nominated organizational, departmental, team, or individual circumstance. (Your response to this question will be used for public display if your entry is awarded.)
AmeriHealth Caritas is a prominent organization in the managed care industry, focusing on providing comprehensive healthcare services to Medicaid, Medicare, and other publicly funded populations. The management team in AmeriHealth Caritas' medical management division plays a critical role in ensuring that members receive high-quality, cost-effective care The Medical Management team at AmeriHealth Caritas has made significant achievements in improving healthcare delivery, member outcomes, and operational efficiency. Here are some notable accomplishments1. Improved Care Quality and Outcomes Enhanced Member Health: Through comprehensive care management programs, AmeriHealth Caritas has successfully improved chronic disease management and preventive care. For example, their diabetes management programs have led to improved HbA1c control among members, with documented improvements in glycemic control and reduced complications. Quality Metrics: The team has achieved high scores in various quality metrics such as HEDIS (Healthcare Effectiveness Data and Information Set) measures, which include rates of childhood immunizations, breast cancer screening, and diabetes care. 2. Advanced Utilization Management Efficient Resource Use: Implementation of advanced utilization management strategies has led to more efficient use of healthcare resources. For example, the use of evidence-based guidelines and predictive analytics has helped reduce unnecessary hospital admissions and readmissions. Reduced Costs: Through effective utilization management, AmeriHealth Caritas has realized cost savings by minimizing unnecessary procedures and optimizing care pathways. This has contributed to lowering overall healthcare costs while maintaining high-quality care.
Question 2 : Outline your nominated organizational, departmental, team, or individual achievements, dated 1-3 years prior, based on your selected categories.
Integration with Crozer Health: Amerihealth caritas implemented IT solutions for Crozer Health members in 2022. This implementation focused on managing the Chronic Members in their Care Management portal and monitoring their Care Plans. The member population was managed in the platform using Member Centric View functionality in JIVA. The Members were care managed by an effective Care Coordination team who performed Health Risk assessments using predictive Modeling. Integration of SDOH Platform in JIVA: The SDOH module was introduced in late 2022 which focused on the 5 social determinants of Health ie. Education, Food, Transportation, Economic Stability and Social outreach. The members were risk stratified based on these 5 factors and Health risk assessments were performed based on the questionnaire created. The SDOH members claims Data was integrated with the Care management platform and Care programs were designed based on the same.
Question 3 : Provide examples of the strategies / plans you have introduced, in order to attain your nominated organizational, departmental, team, or individual achievements. Explain why the highlighted achievements are significant / unique.
1. Big Data Analytics: I was responsible for introducing the analytics platform in the team to manage large volumes of data coming in from external vendors and integrate them with the cloud platform. 2. Monitoring: Continuously monitor the effectiveness of integrated systems and processes. Evaluate how well they address SDOH and improve health outcomes by using Power BI dashboards. 3. Feedback Mechanism: Establish AGILE based mechanisms for collecting feedback from stakeholders by conducting SPRINT retrospective meetings and users to identify areas for improvement. 4. Implement Batch and Real-Time APIs for Claims, Enrollment and Pharmacy data to enable real-time data exchange and integration between Care management platform and Health portals.
Optional Context for Judges (Not for publication. This section is solely for judges' evaluation.)
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