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As an APRN, you are serving in the capacity as the executive director of an office that proudly holds commercial contracts with health plans all over the country to provide DM and CM services to their members

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As an APRN, you are serving in the capacity as the executive director of an office that proudly holds commercial contracts with health plans all over the country to provide DM and CM services to their members. In approximately 40 different contracts, some large and some small, your site houses a telephone call center that employs over 40 RNs, “on call” with patients in health plans across the country. Your leadership team is made up of a full-time medical director, six supervisors in both clinical and nonclinical roles, and another 40 people who serve various administrative and nonclinical functions. You have access to claims data for every contract and a fully functioning EMR for your DM and CM documentation. Most of your contracts are 3-year contracts.

• Brainstorm at least three metrics for each of the four categories that we’ve discussed in this chapter.

• Consider goal setting. What will you set for annual goals for clinical quality outcome measures selected in the previous question?

• How will you track your nurses’ progress on the core business process measures?

• What resources will you consider using to capture data on customer satisfaction?

• Your contracts are, for the most part, 3 years in length. At the end of the first year, describe where you’d like to go with HEDIS measures when compared to the rest of the commercial PPO (preferred provider organization) and HMO (health maintenance organization) patients? The second year? The third year?