ECM Intake and CHW Workflow Notes

Purpose of discussion: clarify processes for ECM vs CHW intake, eligibility-list leads, consent/forms, and how behavioral health screening is handled within the ECM intake flow.

1) Eligibility-based intake: ECM vs CHW, and leads

When a member comes from the eligibility list and is a lead, we do not send ROI forms. The key task is to confirm whether they should be in ECM (ECM intake) or CHW.
For CHW: HIPAA forms and Assignment of Benefits (AOB) are typically required.
For ECM intake: no consent forms need to be signed.
The team notes this is simpler for this health plan because it’s an ACM/ECM intake scenario with no consent workflow.
If a member is from the eligibility list, the process is to perform the ECM intake first. CHW cases used to require building a patient case, but now that step is not always necessary; HIPAA forms may be sufficient if CHW services are needed.
Final caveat mentioned: confirmations may vary by health plan, so checking with Kayla for Santa Clara specifics is advised.

2) ECM vs CHW in practice (leads and assignments)

For leads, we don’t send ROI forms; we determine ECM vs CHW by intake context.
There was discussion about whether to re-route to CHW if ECM isn’t needed; historically, Santa Clara intakes were per ECM eligibility, with CHW leads as exceptions. The group agreed to confirm plan-specific rules with Kayla.
Summary stance: when from the eligibility list, proceed with ECM intake; CHW assignments only when appropriate for the specific plan and lead or explicit CHW need.

3) Behavioral health screening: Green Space and Athena

Tools used for behavioral health questions during ECM intake: Green Space and Athena.
Access and setup for Green Space:
- Access must be granted to Green Space; you may need to share your screen to teach the workflow.
- Steps to add a patient:
- Log in and click "Add patient".
- Do not fill provider field unless required.
- Add a tag: "behavioral health screening" and select the language (English or Spanish) for the screening.
- Option to send the screening link via email or text before the appointment.
- Create the patient at the bottom of the form.
- After creation, complete the screening questions.
The questions include two questionnaires:
- Depression: a PHQ-9-like assessment (depression) with a score that contributes to a total out of 20.
- Anxiety: a GAD-7-like assessment (anxiety) with a score that also contributes to a total out of 20.
Scoring details and thresholds (based on the team discussion):
- Depression threshold: ext{Depression score} \,\ge\, 10 \quad(\text{out of 20 for both combined})
- Anxiety threshold: ext{Anxiety score} \,\ge\, 7 \quad(\text{out of 20 for both combined})
- Total score is the sum of the two: \text{Total score} = \text{Depression score} + \text{Anxiety score} \quad (\le 20)
If thresholds are met or exceeded, you should offer a behavioral health referral:
- Behavioral health providers to schedule with: Adriana, Ara, and Maria Crow (note: roster mentions these names; other names may appear as well—confirm the exact provider list in the roster).
- The appointment type for BH is typically a new patient behavioral health appointment.
- Scheduling workflow: once BH is indicated, schedule and post the patient details in the Behavioral Health Slack channel with the patient ID and assigned provider/date.
If the patient declines behavioral health after screening, you should document the decline and consider reevaluation at the next intake.
Behavioral health screening workflow notes:
- Use both Athena questions and Green Space questions for screening; they are not exclusive to one portal.
- The “green space” BH questions are self-reported; the combination helps trigger a BH referral when scores meet thresholds.
- The two required BH questions (depression and anxiety) have separate cutoff points, but a high score in either domain triggers referral discussion.
Example flow after screening:
- If Depression score >= 10 or Anxiety score >= 7: offer BH referral to the patient.
- If patient accepts: schedule with one of the BH providers; inform via Slack channel with patient ID and appointment details; use appointment type such as "new patient behavioral health." If patient declines: document and plan a re-evaluation at a future intake.

4) Access and roles: Green Space and BH team roster

Access to Green Space discussed; the user explains login and navigation steps, including how to locate the patient and administer screening.
Behavioral health roster considerations:
- BH providers mentioned: Adriana, Ara, and Maria Crow; there is some cross-reference with Alliance coverage in the roster; confirm which providers are actually available and assigned.
- Appointment entries and provider matching rely on the roster and scheduling system; ensure you select the correct provider when scheduling.
Slack integration for BH scheduling:
- After scheduling, you should post in the Behavioral Health Slack channel with the patient ID and provider/date.

5) PDS assignments and ECM for Santa Clara

PDS assignments (ECM for Santa Clara) discussed:
- Stacy and Daniela Moreno Lopez were identified as PDS for ECM Santa Clara (roster check recommended to confirm current assignments).
- Temporary staff listed for Santa Clara: Vanessa Castillo and Mirelli (noted as Santa Clara temp).
- Daniela (Daisy Daniela) mentioned as new; there is discussion about whether she is a PDS now; the roster indicated changes around 08/25 and that Daniela might have been newly assigned.
- Other notes: Meryl is assigned to Santa Clara, but she is expected to be away for two weeks; a note should be added to the roster to reflect her absence.
Action item: verify current PDS assignments for ECM Santa Clara (Stacy, Daniela Moreno Lopez) and confirm temporary/roster changes (Vanessa, Mirelli, Daisy Daniela, Meryl) with the roster and supervisor, especially around the 08/25 effective date.

6) Billing units and plan-specific notes

Billing units for intakes:
- For this health plan (Santa Clara/ECM eligibility flow), intakes are billed at 2 units (not 4 units as seen in some other plans).
- For Family Health/eligibility-list cases, billing is performed; this means the ECM intake from the eligibility list may involve billing, but the standard unit count remains 2 for these scenarios.
Important nuance: some details may vary by health plan; always verify plan-specific billing rules with the billing team or plan administrator.

7) Practical tips and reminders

When in doubt about ECM vs CHW for a member from the eligibility list, confirm with Kayla or the plan administrator to ensure correct routing.
For CHW, ensure HIPAA and AOB forms are prepared and signed if CHW services are engaged.
For ECM, expect no consent forms to be signed during intake.
Ensure access to Green Space is granted before attempting to use the Behavioral Health screening; if access is missing, obtain it from the appropriate administrator.
Keep a running note of roster changes and PDS assignments when scheduling, especially for Santa Clara, where staffing may include temporary workers.
If a member is screened and scores meet thresholds, be prepared to initiate BH scheduling and notify the team via Slack for coordination.
Document any deviations or plan-specific caveats (e.g., if a plan requires a CHW intake despite an eligibility-list ECM lead).

8) Quick glossary

ECM: Emergency Case Management (ECM) intake process for eligible members.
CHW: Community Health Worker intake process; may require HIPAA forms and AOB.
HIPAA: Health Insurance Portability and Accountability Act; governs patient information privacy and consent forms.
AOB: Assignment of Benefits; form used to authorize third-party billing/claims.
PDS: Primary Designated Specialist (roster assignment for cases).
Green Space: Behavioral health screening tool with two questionnaires (depression and anxiety) used during intake.
Athena: Portal used to administer health questionnaires, including BH screening questions.
BH: Behavioral Health.
Lead: A potential member from the eligibility list awaiting assignment to ECM or CHW.
SLACK: Communication channel used to coordinate scheduling and provider assignments for BH.
Total score: The sum of Depression score and Anxiety score, reported as a score out of 20 for screening purposes.

9) Example thresholds and formulas (summary)

Depression threshold: ext{Depression score} \ge 10
Anxiety threshold: ext{Anxiety score} \ge 7
Total screening score: ext{Total score} = ext{Depression score} + ext{Anxiety score}, \text{Total score} \le 20
Action rule: if either threshold is met, offer a BH referral; schedule with BH providers; otherwise continue with ECM intake steps.