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Utah Children's Care Coordination Network

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The Utah Children’s Care Coordination Network (UCCCN) was formed in late 2014 to be a source of information, resources, tools, expert advice, and peer learning and support for pediatric and family practice staff members who help coordinate the care of patients. The UCCCN evolved from a Medical Home Demonstration project*, led by the Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ) and the Medical Home Portal, and is a partnership with the Utah Utah Maternal and Child Health Bureau (UDHHS) and Utah Family Voices at the Utah Parent Center** with support from the Department of Pediatrics at the University of Utah.
The UCCCN is coordinated by Mindy Tueller, MS, MCHES, also Director of Operations for the Medical Home Portal, and supported by Eric Christentsen, MPH, (Program Manager, Integrated Service Program at the UT DoH), Gabi Baraghoshi, MPH, RN and Heidi Bates, MHL, RN (UPIQ Practice Coaches), Tina Persels (Family Consultant at Utah Family Voices), and Michelle Redfield, Admin Assistant. Each of us will be available to provide advice and support to your care coordination staff and your practice.

UCCCN Meetings

UCCCN meetings are held every 3rd Wednesday of the month from 8:30 to 10:00 am. From Meetings are currently all online using Zoom. To participate, contact Mindy Tueller (mindy.tueller@hsc.utah.edu) or Michelle Redfield (michelle.redfield@hsc.utah.edu).
Meetings engage Network members in:
  • Education about coordinating care for children, with an emphasis on those with chronic conditions and special health care needs and the family- and patient-centered Medical Home approach
  • Learning about local specialty and other service providers and other health-related resources for children and their families
  • Sharing challenging cases, great ideas, unique resources, and lessons learned
  • Using tools and techniques that will help your practice care for patients with special needs more efficiently and effectively, including new features that will soon be available on the Medical Home Portal.
The UCCCN also offers its members an email listserv to seek answers to questions, share ideas, and find support between meetings. For practices, the UCCCN can assist with job descriptions, guidelines related to care coordination, and finding tools and other resources. There are no charges for participation.

Topics & Presenters

Topics & Presenters 2017 through 2022:
UCCCN 2017 to 2022

Meeting Summaries & Resources of the Month

You can find meeting summaries, which include cases and helpful resources on our Resources of the Month pages:
Meeting recordings can be found on the UCCCN YouTube Channel.

UCCCN Learning Sessions

UCCCN learning sessions are half-day meetings designed primarily for individuals involved in coordinating care for pediatric patients but could be of value for clinicians, administrators, and other staff from primary care and specialty practices, insurers, and other health care organizations.
The first UCCCN learning session in October 2016 focused on “Improving Outcomes of Pediatric Care through Care Coordination,” with panels on implementing & improving care coordination, as well as funding it.
A second learning session in March 2017 focused on "Collaborating on Care Coordination," with representatives from SelectHealth, Healthy U, Health Choice, Molina, Regence, and Primary Specialty Services.
The third learning session was held in March 2018 addressing "Care Coordination: What do Families Value?" and included a panel of 6 parents of children with special needs and a panel of 5 clinicians consisting of primary care, mental health, and sub-specialists.
Our 2019 Learning Session was held on Wednesday, March 20th, 2019 at the SLCC Miller Conference Center in Sandy. The topic was “Legal Issues and Services for Families with Children and Youth with Special Health Care Needs.”

Support for UCCCN

Noel Taxin, Bureau Chief, CSHCN, Utah DOH: "UCCCN is a well coordinated community who works to coordinate care and share resources. In Utah, the UCCCN has filled a void which was present over the years. The group meets regularly, they share challenges, successes and learn new ways to be more effective. This group is much needed and feedback received from participants is it helps them be better care coordinators in serving individuals throughout Utah. UCCCN is an effective forum to support HRSA Block Grant NPM 11 and 12 medical home and transition efforts."

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* funded by a CHIPRA Quality Demonstrations grant from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, awarded to the Utah Medicaid Program
** funded by a State Implementation Grant for Enhancing the System of Services for Children and Youth with Special Health Care Needs from the Health Resources and Services Administration, Maternal and Child Health Bureau

Resources

Information & Support

For Professionals

UCCCN 2015 Pediatric Care Coordination Survey summary (PDF Document 126 KB)
Questions and summarized responses of 39 UCCCN participants to questions on what care coordination-related activities their practices are currently doing.

Chronic Care Management Services Billing (PDF Document 84 KB)
A scenario to bill for CPT 99490 - Chronic Care Management (care coordination) services.

CMS Chronic Care Management Services Changes for 2017 (PDF Document 521 KB)
Chronic Care Management (CCM) services by a physician or non-physician practitioner and their clinical staff, per calendar month, for patients with two or more chronic conditions expected to last at least 12 months.

2022 Coding and Payment Tip Sheet for Transition from Pediatric to Adult Health Care (PDF Document 509 KB)
Thirty-two page booklet of CPT coding options for the provision of transition-related services; from Got Transition and the American Academy of Pediatrics.

Tools

Utah Pediatric Care Coordination Information Checklist (PDF Document 171 KB)
To be used as an assessment tool and in conjunction with the Utah Pediatric Shared Plan of Care.

Utah Pediatric Shared Plan of Care template (Word Document 72 KB)
To be used with the Care Coordination Information Checklist to coordinate care with all members of the care team, including families.

Authors & Reviewers

Initial publication: September 2015; last update/revision: January 2022
Current Authors and Reviewers:
Author: Medical Home Team