Attachment E - PMR Template_02_24_26 v2.pdf
PDF 403 KB Posted
- Attached to
- Q201--CCN-Next Gen Medical
- Solicitation number
- 36C10G26R0003
About this file
This document is a template for Program Management Review (PMR) presentations for the Integrated Veteran Care CCN Next Generation program under the U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Integrated Veteran Care. The template is designed to be submitted at least 15 days prior to PMR meetings and contains two versions—one for dental networks and one for medical networks.
The template provides a comprehensive structure for reporting program performance across multiple operational areas. For dental networks, the template includes sections on work and progress summaries (task summaries, schedule summaries, activities, corrective actions, medical documentation compliance, program integrity site visit findings, patient safety reports, and referral trends), risk status and registers, operations support activities, network adequacy outcomes (including provider corrective actions and continuous query monitoring compliance), customer service outcomes (performance summaries and provider satisfaction survey results), and claims processing outcomes (including fraud and abuse reporting). The medical network version includes additional sections on value-based care reporting. Both versions require supporting attachments including the Integrated Master Schedule, project risk registers, continuous query monitoring results, provider satisfaction survey results, key metrics and fraud/abuse reports, and clinical quality and patient safety issues reports. The template is designed as a presentation framework with placeholder sections for customization by presenters to address specific network performance metrics, compliance activities, and operational updates relevant to their reporting period.
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Text version
Integrated Veteran Care
CCN Next Generation Program Management Review
Monday, Month XX, 202X
Presented by
[PRESENTER NAME]
[Presenter Organization] [Presenter Title]
THIS DOCUMENT AND CORRESPONDING ATTACHMENTS WILL BE SUBMITTED AT LEAST 15 DAYS PRIOR TO THE PMR MEETING.
Work and Progress Summary
• Task Summary
• Schedule Summary
• Summary of Activities
• Planned Activities
• Self-Identified Corrective Actions and
Improvements
• Medical Documentation Return Compliance
• Program and Payment Integrity Site Visit
Findings
• Patient Safety Reports
• Referral Trends
Risks Status
• Risk Register Summary
Operations Support Activities
• Operation Support Activities Summary
Network Adequacy Outcomes
• Adequacy Outcomes Summary
• Provider Corrective Actions
• Continuous Query (CQ) Monitoring Compliance
Customer Service Outcomes
• Customer Service Performance Summary
• Provider Satisfaction Survey Results
Claims Processing Outcomes
• Claims Processing Performance Summary
• Fraud and Abuse Summary Report
Other
DENTAL NETWORK PMR
Table of Contents
This section focuses on the information contained in the Monthly Progress Reviews for the most recent quarter.
Integrated Veteran Care 4
Task Summary
Summarizes the work that is being performed
Integrated Veteran Care 5
Schedule Summary
Summary of schedule elements specific to this reporting period from the quarterly updated IMS
Integrated Veteran Care 6
Summary of Activities
Summary of activities completed during the reporting period
Integrated Veteran Care 7
Planned Activities
Summary of activities to be completed during the upcoming period
Integrated Veteran Care 8
Self-Identified Corrective Actions and Improvements
This is a categorized narrative listing of the operational corrective actions and improvements that were executed
Integrated Veteran Care 9
Medical Documentation Return Compliance
This is a summary of the Medical Documentation Return Compliance Report Attachment
Integrated Veteran Care 10
Program and Payment Integrity Site Visit Findings
This is a summary of the Program and Payment Integrity Site Visit Findings and actions based on the feedback
Integrated Veteran Care 11
Patient Safety Reports Overview
This is a summary of the Clinical Quality and Patient Safety Issues Report Attachment
In addition to the above report, at minimal, the following information should be reported:
• Reporting VAMC and VISN (i.e., Dental or Medical)
• Category of care
• Network Provider NPI
• Referral/request for service/authorization number
• Type of issue
• Severity of harm level
• Date issues/event identified and resolved
• Resolution status
• Report to PRC (Y/N)
• PRC final recommendation
• Network provider and/or organizational tally with previous 12 months and flag trends
Integrated Veteran Care 12
Referral Trends
Provide results from referral audits and key referral data and trends
Risks and Issues This section addresses all risks and issues, including but not limited to the Risk Register during the reporting period.
Integrated Veteran Care 14
Risk Register Summary
This is a summary of the Project Risk Register Attachment
Operations Support Activities
Integrated Veteran Care 16
Operation Support Activities Summary
This is a summary of VISN operational support and VAMC community care operations
Network Adequacy Outcomes This section includes an assessment of overall network adequacy, provider corrective actions, and the continuous query monitoring compliance during this reporting period.
Integrated Veteran Care 18
Network Adequacy Outcomes Summary
This is a summary of network adequacy outcomes, including any identified network inadequacies
Integrated Veteran Care 19
Provider Corrective Actions
This is a summary of the Provider Corrective Actions Attachment
Integrated Veteran Care 20
Continuous Query Monitoring Compliance
This is a summary of the Continuous Query Monitoring Compliance Attachment
Customer Service Outcomes This section includes results of customer service quality reviews, customer service availability statistics, and provider satisfaction survey results.
Integrated Veteran Care 22
Customer Service Performance Summary
This is a summary of customer service quality reviews and customer service availability statistics
Integrated Veteran Care 23
Provider Satisfaction Survey Results
This is a summary of the Provider Satisfaction Survey Results Attachment and an action plan to improve the results of any negative trends or results
Claims Processing Outcomes This section includes an overview of claims processing outcomes and fraud and abuse during the reporting period.
Integrated Veteran Care 25
Claims Processing Performance Summary
This is a summary of the claims processing key metrics and outcomes
Integrated Veteran Care 26
Fraud and Abuse Summary Report
This is a summary of the Fraud and Abuse Summary Report Attachment and any actions that will take place in the upcoming period
Other Title and populate this section with other topics you wish to discuss and/or highlight. Delete this section slide if not used.
Email Your Email Address
Questions
Thank you For more information contact -
Integrated Veteran Care 30
DENTAL NETWORK PMR
Attachments
The following attachments are provided as part of the PMR review and when appropriate, are in alignment with the Schedule of Deliverables Table requirements:
• Integrated Master Schedule (IMS)
• Project Risk Register
• Continuous Query (CQ) Monitoring Results
• Provider Satisfaction Survey Results
• Key Metrics and Fraud and Abuse Summary Report
• Clinical Quality and Patient Safety Issues Reports
• Task Summary
• Schedule Summary
• Summary of Activities
• Planned Activities
• Self-Identified Corrective Actions and
Improvements
• Medical Documentation Return Compliance
• Program and Payment Integrity Site Visit Findings
• Patient Safety Reports Overview
• Value-Based Care Report
• Referral Trends
Risks Status
• Risk Register Summary
Operations Support Activities
• Operation Support Activities Summary
Network Adequacy Outcomes
• Adequacy Outcomes Summary
• Provider Corrective Actions
• Continuous Query (CQ) Monitoring Compliance
Customer Service Outcomes
• Customer Service Performance Summary
• Provider Satisfaction Survey Results
Claims Processing Outcomes
• Claims Processing Performance Summary
• Fraud and Abuse Summary Report
Other
MEDICAL NETWORK PMR
Table of Contents – Medical Network
This section focuses on the information contained in the Monthly Progress Reviews for the most recent quarter.
Integrated Veteran Care 33
Task Summary
Summarizes the work that is being performed
Integrated Veteran Care 34
Schedule Summary
Summary of schedule elements specific to this reporting period from the quarterly updated IMS
Integrated Veteran Care 35
Summary of Activities
Summary of activities completed during the reporting period
Integrated Veteran Care 36
Planned Activities
Summary of activities to be completed during the upcoming period
Integrated Veteran Care 37
Self-Identified Corrective Actions and Improvements
This is a categorized narrative listing of the operational corrective actions and improvements that were executed
Integrated Veteran Care 38
Medical Documentation Return Compliance
This is a summary of the Medical Documentation Return Compliance Report Attachment
Integrated Veteran Care 39
Program and Payment Integrity Site Visit Findings
This is a summary of the Program and Payment Integrity Site Visit Findings and actions based on the feedback
Integrated Veteran Care 40
Patient Safety Reports Overview
This is a summary of the Clinical Quality and Patient Safety Issues Report Attachment
In addition to the above report, at minimal, the following information should be reported:
• Reporting VAMC and VISN (i.e., Dental or Medical)
• Category of care
• Network Provider NPI
• Referral/request for service/authorization number
• Type of issue
• Severity of harm level
• Date issues/event identified and resolved
• Resolution status
• Report to PRC (Y/N)
• PRC final recommendation
• Network provider and/or organizational tally with previous 12 months and flag trends
Integrated Veteran Care 41
Value-Based Care Report
This is a summary of the Value-Based Care Report Attachment
Integrated Veteran Care 42
Referral Trends
Provide results from referral audits and key referral data and trends
Risks Status This section addresses all risks and issues, including but not limited to the Risk Register during the reporting period.
Integrated Veteran Care 44
Risk Register Summary
This is a summary of the Project Risk Register Attachment
Operations Support Activities This section includes activities during this reporting period.
Integrated Veteran Care 46
Operations Support Activities Summary
This is a summary of VISN operational support and VAMC community care operations
Network Adequacy Outcomes This section includes an assessment of overall network adequacy, provider corrective actions, and the continuous query monitoring compliance during this reporting period.
Integrated Veteran Care 48
Network Adequacy Outcomes Summary
This is a summary of network adequacy outcomes, including any identified network inadequacies
Integrated Veteran Care 49
Provider Corrective Actions
This is a summary of the Provider Corrective Actions Attachment
Integrated Veteran Care 50
Continuous Query Monitoring Compliance
This is a summary of the Continuous Query Monitoring Compliance Attachment
Customer Service Outcomes This section includes results of customer service quality reviews, customer service availability statistics, and provider satisfaction survey results.
Integrated Veteran Care 52
Customer Service Performance Summary
This is a summary of customer service quality reviews and customer service availability statistics
Integrated Veteran Care 53
Provider Satisfaction Survey Results
This is a summary of the Provider Satisfaction Survey Results Attachment and an action plan to improve the results of any negative trends or results
Claims Processing Outcomes This section includes an overview of claims processing outcomes and fraud and abuse during the reporting period.
Integrated Veteran Care 55
Claims Processing Performance Summary
This is a summary of the claims processing key metrics and outcomes
Integrated Veteran Care 56
Fraud and Abuse Summary Report
This is a summary of the Fraud and Abuse Summary Report Attachment and any actions that will take place in the upcoming period
Other Title and populate this section with other topics you wish to discuss and/or highlight. Delete this section slide if not used.
Questions
Thank you For more information contact -
Integrated Veteran Care 60
MEDICAL NETWORK PMR
Attachments
The following attachments are provided as part of the PMR review and when appropriate, are in alignment with the Schedule of Deliverables Table requirements:
• Integrated Master Schedule (IMS)
• Project Risk Register
• Continuous Query (CQ) Monitoring Results
• Provider Satisfaction Survey Results
• Key Metrics and Fraud and Abuse Summary Report
• Clinical Quality and Patient Safety Issues Reports
• Value-Based Care Report
| CCN Next Generation �Program Management Review |
| Table of Contents |
| Work and Progress Summary |
| Task Summary |
| Schedule Summary |
| Summary of Activities |
| Planned Activities |
| Self-Identified Corrective Actions and Improvements |
| Medical Documentation Return Compliance |
| Program and Payment Integrity Site Visit Findings |
| Patient Safety Reports Overview |
| Referral Trends |
| Risks and Issues |
| Risk Register Summary |
| Operations Support Activities |
| Operation Support Activities Summary |
| Network Adequacy Outcomes |
| Network Adequacy Outcomes Summary |
| Provider Corrective Actions |
| Continuous Query Monitoring Compliance |
| Customer Service Outcomes |
| Customer Service Performance Summary |
| Provider Satisfaction Survey Results |
| Claims Processing Outcomes |
| Claims Processing Performance Summary |
| Fraud and Abuse Summary Report |
| Other |
| Questions |
| Thank you |
| Attachments |
| Table of Contents – Medical Network |
| Work and Progress Summary |
| Task Summary |
| Schedule Summary |
| Summary of Activities |
| Planned Activities |
| Self-Identified Corrective Actions and Improvements |
| Medical Documentation Return Compliance |
| Program and Payment Integrity Site Visit Findings |
| Patient Safety Reports Overview |
| Value-Based Care Report |
| Referral Trends |
| Risks Status |
| Risk Register Summary |
| Operations Support Activities |
| Operations Support Activities Summary |
| Network Adequacy Outcomes |
| Network Adequacy Outcomes Summary |
| Provider Corrective Actions |
| Continuous Query Monitoring Compliance |
| Customer Service Outcomes |
| Customer Service Performance Summary |
| Provider Satisfaction Survey Results |
| Claims Processing Outcomes |
| Claims Processing Performance Summary |
| Fraud and Abuse Summary Report |
| Other |
| Questions |
| Thank you |
| Attachments |
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