Beneficiary Centered Care

Overview

Beneficiary and Family Centered Care focuses on QIO statutorily mandated case review activities as well as on interventions to promote responsiveness to the beneficiary and family needs. CFMC will work with beneficiaries, providers, physicians, and other practitioners to promote beneficiary and family centered care approaches in multiple health care delivery settings.

CFMC will use information gathered from individual experiences to improve Medicare's entire system of health care as well as provide resources needed for beneficiary and caregivers in decision-making. Beneficiary and family concerns provide an excellent opportunity to explore root causes and to develop an alternative approach to improving care. Engagement and activation of the beneficiary/family members are needed to improve their experiences with the health care system and to ensure best possible outcomes of care.

Primary Case Review Activities include:

  • Quality of Care
  • Emergency Medical Treatment and Labor Act (EMTALA)
  • Higher-Weighted Diagnosis-Related Group
  • Provider Discharge/Service Terminations
  • Hospital Admission Denials
    As directed by the Centers for Medicare & Medicaid Services (CMS)
  • Assistants at Cataracts
  • Physician Acknowledgement Monitoring

CFMC provides technical assistance to beneficiaries, providers, physicians, and practitioners when performing reviews by using findings from case review activities to identify needs for technical assistance related to CMS measures across provider settings. Promotion of evidence-based medical practice, development of interventions that address confirmed concerns, and sharing of best practices improve effectiveness, efficiency, and quality of services for Medicare beneficiaries and all patients.

Quality Measures

CFMC will meet CMS review standards in the following categories:

  • Timeliness of Reviews- Beneficiary Complaints and Other Quality of Care Reviews
  • Timeliness of Discharge/Service Termination Reviews
  • Timeliness of Other Review Types
  • Beneficiary Experience with the Quality of Care and Appeal Reviews
  • Quality of Review: Inter-Rater Reliability

Contact Information

Colorado Foundation for Medical Care (CFMC), the Medicare quality improvement organization for Colorado, prepared this material under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS Policy.