Although February is National Children s Dental Health Month, CareFlorida promotes oral health all year long.

Transcription

1 Although February is National Children s Dental Health Month, CareFlorida promotes oral health all year long. According to the Kaiser Family Foundation, tooth decay is the most common chronic illness among children. Difficulty in obtaining dental care is especially prevalent among low-income and minority children. About one half of low-income children age 2-11 have cavities in their primary teeth, compared with about one-third of children in families with income at or above twice the federal poverty level. 1 CareFlorida is committed to improving the state of our enrollee s overall health. This includes their oral health. Please remind the parents or caregivers of your CareFlorida patients age 2-21 to schedule a clinical oral exam for their child at least once a year. If your CareFlorida patients in this age group do not have a network dental provider, please direct their parents or caregiver to the Argus Dental Member Services Department at , Monday through Friday from 8 am to 8 pm. Thank you for supporting this very important initiative. 1 The Kaiser Commission on Medicaid and the Uninsured. Dental Coverage and Care for Low-Income Children: The Role of Medicaid and SCHIP; July 2008 Prevention Spotlight Our preventive care services are designed to help your CareFlorida patients live longer, lead more productive lives. CareFlorida strives to promote high-value, safe and effective health care. One way we do so is through the provision of preventive care services designed to reduce risk factors. These evidence-based interventions include: u Screening tests to detect disease in asymptomatic patients u Behavioral counseling to reduce the prevalence of risk factors that can lead to chronic disease u Pharmaceutical therapy (chemoprophylaxis) to prevent heart disease, stroke or cancer u Immunizations to control infectious agents Please encourage your CareFlorida patients to participate in a preventive care program. For more information on CareFlorida s preventive services, visit our website at: mypreferredprovider.com/medicaid/en/provider-resources/forms-and-documents.aspx.

2 Prevention Spotlight (continued) The U.S. Preventive Services Task Force (USPSTF) makes recommendations to help primary care clinicians determine which preventive services are best for their patients. Following a rigorous review of existing peer-reviewed evidence, the Task Force assigns a letter grade to each recommendation. This letter grade describes the recommendation s strength. They are as follows: Grade A B C Definition The USPSTF recommends the service. There is high certainty that the net benefit is substantial. The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. The USPSTF recommends selectively offering (or providing) this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. Suggestions for Provider Offer or provide this service. Offer or provide this service. Offer or provide this service for selected patients depending on individual circumstances. D The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. Discourage the use of this service. I The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms. BEST PRACTICE HEDIS & Performance Measurement Definitions The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of the nation s health plans to compare how well the plans perform in a variety of categories. These categories include quality of care, access to care and member satisfaction with the health plan and providers. Altogether, HEDIS consists of 75 measures and 8 domains of care. Here are nineteen measures, and their definitions, most commonly used to measure CareFlorida s performance in accordance with HEDIS and the National Committee for Quality Assurance (NCQA) guidelines: Measure Well-Child Visits in the First 15 Months of Life Well-Child visits in the Third, Fourth, Fifth and Sixth Year of Life Adolescent Well-Care Visits Definition Percentage of members who turned 15 months old during the measurement year and who had 6 or more well-child visits with a primary care provider during their first 15 months of life. Percentage of members who were three, four, five or six years of age who received one or more well-child visits with a primary care provider during the measurement year. Percentage of members years of age who had at least one comprehensive well-care visit with a PCP or OB/GYN during the measurement year.

3 HEDIS & Performance Measurement Definitions (continued) Lead Screening in Children Childhood Immunizations by their 2 nd Birthday Percentage of children 2 years of age who had one or more capillary or venous lead blood tests for lead poisoning by their second birthday. Percentage of children 2 years of age who had four DTaP, three IPV, one MMR, three H influenza type B, three hepatitis B, one chickenpox vaccine (VZV), four pneumococcal conjugate, two hepatitis A, two or three rotavirus, and two influenza vaccines by their second birthday. Immunizations for Adolescents Percentage of adolescents 13 years of age who had one dose of meningococcal vaccine and one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) or one tetanus, diphtheria toxoids vaccine (Td) by their 13 th birthday. Appropriate Testing for Children with Pharyngitis Percentage of children 2-18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test; 3 days before diagnosis, the day of diagnosis or 3 days after diagnosis. Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Percentage of members 3-17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year. Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value. Annual Dental Visits Percentage of members 2-21 years of age who had at least one dental visit during the measurement year. (This measure applies only if dental care is a covered benefit in the organization s Medicaid contract.) Chlamydia Screening in Women Percentage of women years of age who were identified as sexually active and who had at least one test for Chlamydia during the measurement year. Use of Appropriate Medications for People with Asthma Percentage of members 5-50 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year. Prenatal Care Percentage of deliveries that received a prenatal care visit in the first trimester or within 42 days of enrollment. Postpartum Care The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery. Adult s Access to Preventive Care Percentage of members 20 years and older who had an ambulatory or preventive care visit. Antidepressant Medication Management Percentage of members 18 years of age and older with a diagnosis of major depression and were newly treated with antidepressant medication, and who remained on an antidepressant medication treatment. Adult BMI Assessment Percentage of members years of age who had an outpatient visit and whose body mass index (BMI) was documented.

4 HEDIS & Performance Measurement Definitions (continued) Breast Cancer Screening Cervical Cancer Screening Percentage of members years of age who had a mammogram to screen for breast cancer. Percentage of women years of age who received one or more Pap tests to screen for cervical cancer. Comprehensive Diabetes Care Follow-Up Care for Children Prescribed ADHD Medication Percentage of members years of age with diabetes (type 1 and type 2) who had each of the following: Hemoglobin A1c testing, HbA1c poor control, HbA1c control, Eye exam performed, LDL-C screening, LDL-C control, Medical attentions for nephropathy, and BP control. Percentage of children newly prescribed attention-deficit/ hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was 30 days of when the first ADHD medication was dispensed Follow-Up After Hospitalization for Mental Illness Percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental health disorders and who had an outpatient visit, an intensive outpatient, encounter or partial hospitalization with a mental health practitioner. Frequency of Ongoing Prenatal Care Percentage of Medicaid deliveries between November 6 of the year prior to the measurement year and November 5 of the measurement year that had the following number of expected prenatal visits: <21%, 21-40%, 41-60%, 61-80% or >81% of expected visits. Why HEDIS is Important to Providers. Although health plans rely on HEDIS to measure quality of care and service to members, HEDIS also helps providers. By proactively managing your CareFlorida patients care in accordance with HEDIS guidelines, you may be able to better monitor their health and identify any potential health issues before they become problematic. Please remind your CareFlorida patients to schedule their preventive exams and to follow up with ordered tests. If you have any questions about HEDIS, please call the CareFlorida Network Management Services department at HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Source: HEDIS 2011 Volume 2 Technical Specifications PRACTICE POINTERS CareFlorida strives to make the business of health care and health insurance as easy as possible for network providers. We are pleased to let you know that the following forms and documents can be downloaded from our Medicaid Provider Portal at: com/medicaid/en/provider-resources/forms-and-documents.aspx u Appointment of Representative u Child Health Check-Up Program (CHCUP) Reference Card u Claim Review Request u Drug Evaluation Review u Florida Patient s Bill of Rights and Responsibilities u Member Incident Report u No Authorization Reference Guide u OBGYN Medical Record Review u PHI Privacy Incident Report u Pre-Certification Form u Pregnancy Notification Form u Provider Appeal Request u Provider Domestic Violence Assessment u Provider Statement of Grievance u Quality Investigation Request u Quick Reference Guide for Clinicians Smoking Cessation

5 Update: ICD-10 Implementation CMS has announced the final rule on ICD-10 Implementation. The compliance date has been moved to October 1, This new date affords physicians and facilities more time to prepare before mandatory implementation. Please visit for more information. YOU CAN HELP YOUR CAREFLORIDA PEDIATRIC PATIENTS STAY CAVITY-FREE. REMIND THEM TO HAVE AT LEAST ONE DENTAL VISIT EVERY YEAR. Attention Broward County Providers: You Still Have Time to Return Your CareFlorida Satisfaction Survey! CareFlorida wants to ensure that you are receiving the best service possible. Your insight and feedback will help us do so. If you haven t done so already, please complete this year s Survey online at: Survey before February 28th. You can also return your Survey via fax at If you have a CareFlorida patient who has recently visited a hospital emergency room, please let us know. Our Case Managers are available to work with you to help CareFlorida enrollees stay healthy. Please call or Thank you. We offer special prenatal Case Management services to facilitate healthy pregnancies. Please help us make your CareFlorida patients aware of this and notify us about any pregnant enrollees. Please call or Thank you. CHCUP UPDATE Update on Blood Lead Levels in Children In January 2012, a committee of experts recommended that the Centers for Disease Control and Prevention (CDC) change it blood lead level of concern. This recommendation was based on scientific studies that show that even low blood lead levels can cause lifelong health effects. This new level is based on the population of children aged 1-5 years in the U.S. who are in the top 2.5% of children when tested for lead in their blood. Currently, that is 5 micrograms per deciliter of lead in blood. Prior to January 2012, CDC s blood level of concern had been 10 micrograms per deciliter. Lead exposure can affect nearly every system in the body and frequently goes unrecognized. We recommend that you conduct a lead screening test during the first visit following enrollment for all CareFlorida enrollees under the age of six. Upon completion of the screening, please fax the results to our Case Management department at Thank you.