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Shared Best Practices (HMOs/PSNs). Presented by Dr. Kamal Hamdan Preferred Medical Plan, Inc January 14, 2009. Introduction. Preferred Medical Plan, Inc. (PMP) is Florida’s oldest independently owned HMO. PMP serves Miami-Dade and Broward counties.
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Shared Best Practices (HMOs/PSNs) Presented by Dr. Kamal Hamdan Preferred Medical Plan, Inc January 14, 2009
Introduction Preferred Medical Plan, Inc. (PMP) is Florida’s 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 %
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.
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.
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.
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.
