Outcomes

VAAACares® delivers measurable results and positive outcomes. We have a proven track record and our team is focused on achieving goals for you and your members.

Our experienced staff has delivered care transitions since 2013 to over 45,000 Medicare and Medicaid patients, effectively reducing 30-day readmissions. Prior to the pandemic, we utilized the Care Transitions Intervention® model pioneered by Dr. Eric Coleman. We now follow the Transitional Care Support model, which can be customized to meet clients’ requirements with telephonic and telehealth options.

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Services delivered in the home and community to address transportation issues, food insecurity, housing, and social isolation, as well as programs to manage chronic disease, prevent falls, and more, are proven supports that maximize independence and allow older adults to age in place.

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Transitional Care Support and Care Coordination empower patients, equipping them with the skills and insight needed to better manage their conditions. A survey of patients found that confidence in managing health problems, on a scale of 1 to 10, increased from 5.02 at the beginning of the intervention to 7.88 after completing the program.

VAAACares® Care Coordinators demonstrate consistent and successful member outreach and engagement completing MCO Member Health Screening (MMHS) assessments.

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VAAACares® has achieved member engagement rates from 76% to 100% depending on the member population served.

VAAACares® monitors and evaluates compliance with all Virginia Department of Medical Assistance Services (DMAS) contractual regulations. In a shared risk model with an MCO, VAAACares demonstrated compliance at a rate of 96-100% for the following performance measures:

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Completion of comprehensive assessments and plan of care development within 30 calendar days of enrollment for waiver recipients and 60 calendar days of enrollment for members residing in nursing facilities, with updates in accordance with DMAS contractual requirements and upon any member hospitalization or change in condition.

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Member plans of care documented and demonstrated implementation of individualized member care goals.

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Completion of member reassessments and plan of care reviews in accordance with DMAS contractual requirements.

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Assessment and identification of members who are appropriate to transition from institutional placement into the community setting. Transition coordination planning demonstrated to begin within 24 hours of notification or member identification as capable of returning to the community setting.

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MCO notification within 2 business days of any member identified as not receiving waiver services for 30 calendar days.

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Reporting of serious reportable events within 24 hours to the MCO.

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Escalation of grievances or complaints within 1 business day to the MCO.

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Entering authorization for waiver services into the MCO management platform within 2 business days of receipt of the service request.

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Entering expedited authorization requests within 24 hours of receipt (or sooner) of the request for services, should the member’s health condition require it.

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Maintenance of 24-hour access to on-call care management, 24 hours a day, 7 days per week.

VAAACares® is headquartered at Bay Aging, a nonprofit 501(c)(3) Area Agency on Aging established in 1978. Bay Aging has extensive experience in care coordination and health screening, and pioneered care transitions in Virginia through the VAAACares® network. Bay Aging’s Case Management for Long-Term Services and Supports program is accredited by NCQA.

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Get In Touch! Contact us at 1-804-758-2386