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ODS quality improvement programs: 2009
Our 2009 quality improvement projects are designed to help our members with asthma, cardiac disease and diabetes. We also have initiatives that address the importance of childhood immunizations and adult health screenings. Our quality improvement projects focus on:
- How well we deliver preventive services and keep our members healthy.
- Whether the most up-to-date treatments and interventions are being offered to treat acute episodes of illness and help our members get better.
- The processes we use to deliver care to our members with chronic disease and how well our delivery system helps members cope with illness.
- Whether appropriate treatment and/or testing was provided to our members.
For the quality improvement projects listed below, we monitor our Healthcare Effectiveness Data and Information Set (HEDIS) results and analyze our medical and pharmacy claims to regularly measure our progress.
Adult Tobacco Cessation Program
The Free & Clear® Quit For Life™ Program is available to many of your adult patients. This is an evidence-based tobacco cessation program that is free to ODS members and offers the following:
- One-on-one phone-based sessions scheduled at the patient’s convenience
- Toll-free telephone access to our Quit For Life™ Coaches for the duration of the program
- Recommendations for medications like the nicotine patch, gum, bupropion or Chantix. Normal co-pay applies for prescription medication.
- Delivery of recommended nicotine replacement products (such as the patch, gum, or lozenge) free of charge
- A Quit Guide designed to help patients stay on track between calls
- Interactive web tools to keep patients engaged with other participants and coaches.
The Quit For Life® Program can help your patients quit tobacco for good.
1.866.QUIT.4.LIFE (1.866.784.8454) or www.quitnow.net
*Not all ODS members are eligible for Free & Clear benefits.
Tobacco Cessation Clinical Guidelines
ODS Respiratory Care Program
According to the 2007 Behavior Risk Factor Surveillance System (BRFSS) conducted by the Centers for Disease Control and Prevention, 9.7 percent of adults in Oregon have asthma.
Outreach
We identify ODS members who are not taking enough controller medications compared to their rescue medications and send them educational material about how to use asthma medications effectively. Our messages are geared toward children as well as adults who have asthma. We also send patient reports to providers to ask for their help in making sure members with asthma are taking their medications appropriately.
ODS Cardiac Care Program
Cardiovascular disease (CVD) is the leading cause of death and illness in the United States. CVD is a costly disease. In 2008, the Centers for Disease Control and Prevention estimated the cost of CVD and stroke in the United States was more than $400 billion. Fortunately, CVD is one of the few diseases largely preventable by modifying lifestyle behaviors.
Outreach
ODS sends friendly reminders to members who are not refilling their high blood pressure and cholesterol-lowering medications at least 80 percent of the time. The mailing includes materials about the importance of taking medication as prescribed and a medication log to help members keep track of medication information.
Concurrently, ODS sends individual medication adherence reports to the providers of these members to ask for their help in making sure members on high blood pressure and cholesterol-lowering medications fill their prescriptions timely.
Click on image for printable pdf
Childhood immunizations
Vaccinations are the easiest way to protect children from infectious diseases. Childhood immunizations continue to be a major focus in public health because they are so effective at preventing illness. ODS met or exceeded the National Committee for Quality Assurance (NCQA) national average for 2008 HEDIS childhood immunization rates that measured the percentage of 2-year-olds who received recommended screenings.
Outreach
ODS sends a newsletter to parents of 5-month-old children. Messages in this newsletter include the importance of immunizations, the risks of not immunizing, common myths and day-care and school exclusion dates. The mailing also includes information about child safety and car-seat safety tips.
Click on image for printable pdf
In addition to the childhood immunization reminder, ODS members receive important child safety information.
Communicating with Patients about Immunization
- The National Network for Immunization Information provides a comprehensive resource kit to help healthcare providers discuss immunization with their patients.
Vaccines for Children Billing (Oregon Health Plan only)
The Vaccines for Children (VFC) Program is a federal program that provides free immunizations for children age 0 – 18 years.
ODS does not reimburse for the cost of vaccine serums covered by the VFC Program. Providers should bill ODS only for the administration of the vaccines covered under the VFC Program.
Providers should bill the specific immunization CPT code with modifier 26 or SL, which indicates administration only. Providers should not bill for the administration of these vaccines using CPT codes 90465-90474 or 99211 (immunization administration codes).
ODS is unable to reimburse providers who do not participate in the VFC Program for the cost of the serum. Providers not participating with the VFC Program can direct their patients to the County Health Department to receive the vaccines covered under the program. A County Health Department can bill ODS for the administration of the vaccines.
The following CPT codes are covered under the Vaccines for Children Program:
| 90633 | 90634 | 90645 |
| 90647 | 90648 | 90649 |
| 906551 | 906562 | 906571 |
| 906582 | 906604 | 90669 |
| 90680 | 90700 | 90702 |
| 90704-8 | 90710 | 90713 |
| 90714 | 90715 | 90716 |
| 907213 | 90723 | 90732 |
| 90733 | 90734 | 90743 |
| 90744 | 90748 | 90749 |
| S0195 | ||
1 All children ages 6-35 months. |
||
ODS Diabetes Care Program
The 2007 BRFSS reported that 6.9 percent of all Oregonians have diabetes. Currently diabetes has no cure. Recent diabetes research indicates that the dramatic rise in type 2 diabetes among adults and youth is due primarily to unhealthy lifestyle choices. Studies indicate that a healthy diet along with regular physical activity, keeping a healthy weight, moderating alcohol consumption and avoiding sedentary behaviors and smoking could nearly eliminate type 2 diabetes. People who have diabetes can improve their health and greatly reduce their health costs if they stay in control of their illness.
Outreach
Members with diabetes who are due for needed diabetic screenings, such as a dilated eye exam or cholesterol screening, receive a reminder letter and brochure explaining the importance of each screening and how often it is recommended. ODS sends patient reports to providers to help them manage their patients with diabetes and make sure they receive diabetes-related screenings.
Adult health screenings
Regular health screenings are the most effective way of detecting cancer early, leading to improved treatment outcomes.
Outreach
ODS sends women over 40 and men over 50 a birthday card in their birthday month. The card includes important information about recommended cancer screenings, such as breast and cervical cancer screenings for women and colorectal cancer screenings for men and women.
