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Shared Best Practices (HMOs/PSNs)

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9 diapositives · 237 Views · Sep 24, 2014

Join Dr. Kamal Hamdan from Preferred Medical Plan, Inc., Florida's oldest independently owned HMO, as he presents best practices for improving HEDIS scores through effective disease management strategies. This presentation, delivered on January 14, 2009, highlights key interventions like ongoing record review, provider education, member outreach, and individualized care planning which have led to improved LDL-C screening rates over the years. This evidence-based approach demonstrates how coordinated efforts among providers and members can enhance healthcare outcomes.

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  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 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 %

  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