Shared Best Practices (HMOs/PSNs) - PowerPoint PPT Presentation

1 / 9
About This Presentation
Title:

Shared Best Practices (HMOs/PSNs)

Description:

Shared Best Practices (HMOs/PSNs) Presented by Dr ... Tahoma Arial Wingdings Calibri Teamwork puzzle design template 1_Teamwork puzzle design template Shared ... – PowerPoint PPT presentation

Number of Views:481
Avg rating:3.0/5.0
Slides: 10
Provided by: kham169
Category:

less

Transcript and Presenter's Notes

Title: Shared Best Practices (HMOs/PSNs)


1
Shared Best Practices (HMOs/PSNs)
  • Presented by Dr. Kamal Hamdan
  • Preferred Medical Plan, Inc
  • January 14, 2009

2
Introduction
  • Preferred Medical Plan, Inc. (PMP) is Floridas
    oldest independently owned HMO. PMP serves
    Miami-Dade and Broward counties.
  • PMP has showed a steady improvement in LDL-C
    screening for many years
  • 2003 62
  • 2004 77.53
  • 2005 78.80
  • 2006  58.6 (Drop)
  • 2007 73.94
  • 2007 (Reform) 90.91

3
Causal/Barrier AnalysisIdentified Barriers
4
Interventions
  • Providers
  • Ongoing Record review by QI Analysts.
  • Provider incentives for certain HEDIS
    measurements.
  • Provider education in HEDIS measurements and the
    importance of data reporting.
  • Data benchmarking between providers.
  • Providers are given a list of their members who
    are due for screenings.
  • CAP with lab provider, and obtain data
    electronically.

5
Interventions cont.
  • Members
  • Member education through Members newsletter,
    new designed outreach materials geared toward DM.
  • Member incentives.
  • Welcome call to all new members within 30 days of
    enrollments to conduct HRA.
  • Individualized care planning and education
    materials for members identified with chronic
    disease including DM.

6
Interventions-cont.
  • Health Plan
  • Develop a home grown Disease Management Database.
  • Identified members who were due for screening
    through LAB, HRA, Case Coordination, pharmacy,
    provider referrals, pre-auth-referrals, claims,
    and inpatient data.
  • Ongoing case coordination to the identified
    members to educate them on the importance of
    preventive screening and guidelines.
  • System change, new IS system.

7
Interventions-cont.
  • Develop a PIP in Diabetes Mellitus.
  • Report data and outcomes to the QIC on quarterly
    basis.
  • Develop a team to contact members after hours to
    conduct HRA. Develop individualized care planning
    and member education.
  • Develop a new outreach program (mailing,
    e-mailing educational materials to our members)
    AHCA approved materials.

8
Linking Interventions together to improve HEDIS
scores
9
Thank You
Write a Comment
User Comments (0)
About PowerShow.com