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AAPHP Preventive Services Toolkit

AAPHP Preventive Services Toolkit. Planning -- selecting problems to address -- selecting interventions. Teaching Objectives. Address preventive services from a policy perspective Understand how best to select problems to address and select packages of interventions

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AAPHP Preventive Services Toolkit

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  1. AAPHP Preventive Services Toolkit Planning -- selecting problems to address -- selecting interventions AAPHP PSTK Planning

  2. Teaching Objectives • Address preventive services from a policy perspective • Understand how best to select problems to address and select packages of interventions • Understand coding and reimbursement for clinical preventive services • List and locate software and other tools for planning and evaluation • Understand how statistical approaches to planning and evaluation differ from research AAPHP PSTK Planning

  3. Policy and Management Issues from a Healthcare Perspective - 1 • Many preventive services are considered social or educational – not medical services • Counseling services are often seen as “soft” and ineffective • Some preventive services not reimbursed as clinical services • Most are unrelated to current chief complaints AAPHP PSTK Planning

  4. Policy and Management Issues from a Healthcare Perspective -2 • Some are best provided on a community, rather than clinical, basis • Benefits may be indirect and therefore difficult to quantify • Benefits may only accrue to a percentage of recipients, and therefore be difficult for staff to recognize • Return on investment (both health-related and fiscal) are often delayed AAPHP PSTK Planning

  5. Benefits of Preventive Services • Improve health outcomes • Improve compliance with regulatory and accreditation guidelines • Reduce healthcare costs • Reduce absenteeism • Improve job performance (of patients) • Increase satisfaction by all stakeholders • Improve the community’s perception of the local healthcare system AAPHP PSTK Planning

  6. Initiating a Preventive Services Plan • Acceptance of bright ideas, innovations, local preference or opportunity   • Analysis of  practice diagnosis-specific treatment data • Regulatory and accreditation guidelines  • Community Diagnosis per outcome of COPC process AAPHP PSTK Planning

  7. Implementing Preventive Services • Select the problem and/or the intervention • Select population(s) to be served • Consider the Evidence • Define the • Package of interventions • Baselines and benchmarks • Secure authorization and resources • Advocate, Implement, Evaluate AAPHP PSTK Planning

  8. Accreditation • Immunization – child, adolescent, adult • Cancer screening – breast and colon • Chlamydia screening • Smoking cessation • Prenatal and postnatal care AAPHP PSTK Planning

  9. Evidence Based Interventions • High Priority Health Conditions • Diabetes • Obesity • Heart Disease and Stroke • Asthma • Cancer • Physical Inactivity and Poor Nutrition • Tobacco Use\Youth Risk Taking AAPHP PSTK Planning

  10. Planning Datasets • Demographics and other data from state and local health departments • Billing data • Medical records data • Opinion/perception data • Focus-group-like sessions with patients and staff • COPC process • Newly gathered statistical data – interviews and survey techniques AAPHP PSTK Planning

  11. Establish Baselines, Benchmarks and Objectives By Sub-Population • Define sub-populations • Determine baselines from local data • Identify benchmarks from reference documents • Determine health outcome goals and objectives AAPHP PSTK Planning

  12. Coding and Reimbursement - 1 • Some clinical preventive services are reimbursable, others are not • Which ones are reimbursable varies with health plan • Many physicians and administrators not aware available codes to secure Medicare and other reimbursement AAPHP PSTK Planning

  13. Coding and Reimbursement – 2CPT Codes for Preventive Individual Counseling CPT Code Approximate Duration 99401 15 minutes 99402 30 minutes 99403 45 minutes 99404 60 minutes AAPHP PSTK Planning

  14. Coding and Reimbursement – 3CPT Codes for Comprehensive Preventive Evaluations CPT Codes Age Range Initial Evaluation Periodic Reevaluation 99381 99391 Under 1 year 99382 99392 1-4 99383 99393 5-11 99384 99394 12-17 99385 99395 18-39 99386 99396 40-64 99387 99397 65 and over AAPHP PSTK Planning

  15. Tracking – Evaluation and Data Systems - 1 • Quarterly and annual tracking • Software • Agency data warehouse  • Excel • Access • Epi Info • GIS for health and hospital systems AAPHP PSTK Planning

  16. Tracking – Evaluation and Data Systems - 2 • Guides for community health agencies • NACCHO guidance documents • Model Practices Program. • APEXPH program  • Strategic decisions about Partnerships. • MAPP • National Public Health Performance Standards Toolkit • Map-It • BMJ -- Socio-Economic Determinants of Health AAPHP PSTK Planning

  17. Statistical Data • Baselines and trends • p<0.2 is “statistically meaningful” for planning and evaluation • (statistical significance at p<0.05 impossible to achieve and maintain for most state, local and healthcare facility preventive services) AAPHP PSTK Planning

  18. Final Comments • Instructor’s Manual with supplemental materials • http://www.aaphp.org • Under “Preventive Services ToolKit • Q & A AAPHP PSTK Planning

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