Making Prevention Easier for Providers September-October 2011.

Making Prevention Easier for Providers

September-October 2011

TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. HS0910x004x0211 2

Welcome

One of the major initiatives this year for Health Net Federal Services, LLC (Health Net) is to improve cancer prevention and diabetes care screening rates.

• Our Goal: Improve the rates by three to five percent.• Our Purpose: Help beneficiaries stay healthy.• Our Reason: TRICARE network beneficiaries across the country

have lower screening rates than the national average.

In an effort to accomplish our goal, we are partnering with network physicians and reaching out in various ways to beneficiaries, which are highlighted in this presentation.


Today’s Goals

Upon completion of today’s presentation, you should be able to:

1) Identify the preventive screenings being targeted and measured by Health Net.

2) Access online tools for both beneficiaries and providers.

3) Identify three evidence-based interventions to improve prevention screenings.


A Screening Story

“Recently, my doctor informed me during a regular check-up it was time for my routine mammogram. He wrote a script and handed it to me. Before I left the office, the assistant handed me a flyer that described the test and provided some general information. After that, I carried around the script and flyer, of course intending to make the appointment but somehow, with work and dealing with everyday life events, I just never got around to it.

Isn't it ironic that I work in the Preventive Care Services department promoting the importance of getting screened, and here I was not current in my preventive screenings?

A little over three weeks after the appointment with my doctor, I received a call from the doctor's office. The assistant said they had not yet received the results from my mammogram and wanted to make sure I had gone for my screening.

It was this call that did it. This call, and the reminder I could schedule my appointment online with only a few clicks. If my doctor cares enough to check up on me, how could I not get my mammogram?

And so it was that I got my screening.”


Why Preventive Screenings

• Screenings save lives.

• Screenings detect illnessfor earlier intervention.

• Preventive care is coveredunder TRICARE.

• Healthy patients rate higher satisfaction with their care and providers.

• Improving screening rates is one of Health Net’s key initiatives.


Diabetes Screening Guidelines* (Applies to Diabetics Only)[American Diabetic Association]

Cholesterol (LDL-C blood test) Annually

HbA1c blood test 2x/year

Retinal eye exam Annually

Cancer Screening Guidelines

Mammography[American College of Radiology]

Every year starting at age 40

Pap smear[American Congress of Obstetrics and Gynecology]

Every 2-3 years starting at age 21(TRICARE benefit is one per 12 months)

Colorectal Cancer Screening Guidelines (One of the Following)[American College of Gastroenterology Recommendations]

FOBT Every year starting at age 50

Flexible Sigmoidoscopy Every 5 years starting at age 50(TRICARE benefit is one every 3 years)

Colonoscopy Every 10 years starting at age 50

Which screenings are a focus?

TRICARE benefits match the above guidelines except where noted.

*Diabetes screenings are not covered under preventive care benefits. A beneficiary cost-share applies.

Other widely accepted clinical guidelines exist that may recommend screenings at different frequencies.


What are the targets?

Type of ScreeningNCQA 2010

National Commercial HMO Average (for CY 2009)

Colorectal Screening 60.7%

Breast Cancer Screening 71.3%

Cervical Cancer Screening 77.3%

Diabetic HbA1c Testing 89.2%

Diabetic LDL-C Testing 85.0%

Diabetic Retinal Eye Exam 56.5%


What does it take?

According to Yarnell et al., it would take a primary care physician 7.4 hours per day to satisfy the U.S. Preventive Services Task Force recommendations on preventive screenings.

In other words, if a primary care physician is going to deliver preventive services adequately, the health plan needs to assist.

Yarnell et al. Primary care: Is there enough time for prevention? American Journal of Public Health (2003), 93(4), 635-641.


About Patients and Prevention

Patient Perception on Prevention: Three Groups

Group 1: Eager to be screened• The challenge is preventing overuse and misuse.

Group 2: Need a little nudge• A physician recommendation is sufficient.

Group 3: Unwilling or unable• More than a recommendation is needed.

• Multilevel interventions such as reminders and tracking, and community-based approaches are needed.

These groups challenge the resources of the average practice.

Health Net can help.From a presentation by Chyke Doubeni, MD, at the 2011 Dialog for Action on Colorectal Cancer ScreeningDoubeni. Ann FamMed. eLetters, Jul 22, 2010CuzickJ, et al. Statistics in Medicine. 1997;16(9):1017-29


Predictors of Screening Compliance

• Having a primary care physician

• Getting a recommendation to obtain screening from a primary care physician

• Having a connection to a primary care practice (if not a single, consistent physician)

Donald Neace, Jr., MD, Dialog for Action, March 2010.


Evidence-Based Interventions

1. RecommendYour recommendation is the single most influential factor in persuading patients to be screened or tested.

2. Create an office policy about preventionMake sure all office staff are aware of the policy and know how to implement it, including identification of local resources.

3. Have a reminder systemReminder systems can include electronic flags, chart prompts or labels, audits, ticklers/logs and staff assignments.

Reminders can target patients, providers and office staff.


Evidence-Based Interventions

4. EducateConsider patient preferences and stage of readiness.

Use educational tools: handouts, videos, websites.

5. Reduce barriers Make it easy for patients to schedule appointments.

• Provide lists of convenient sites/providers.• Make phone calls to arrange services.• Allow patients to make appointments via the Internet.

For additional information on evidence-based interventions for cancer screenings, see www.thecommunityguide.org/cancer.


Tools

Free Health Net phone-based education classes for TRICARE beneficiaries

• Topics: diabetes, smoking cessation, asthma, heart failure

• Promotional materials available

Patient overdue screening notification template letter• Download and use with your own stationery and signature

Patients can sign up for automatic reminders via Internet

• American Cancer Society for mammography (www.cancer.com, click Stay Healthy, Tools & Calculators, Reminders)

• MyHealthTestReminder.com for colorectal screening, Pap smear, mammography and other exam reminders

Patient handouts, posters and articles on:

• Mammography• Pap smear• Colorectal cancer screening• www.hnfs.com, Provider,

Wellness, Resources, Toolkits

Teleclass Postcard

Template Letter for Patients

http://www.cancer.com/

http://www.hnfs.com/


Health Net’s Website – www.hnfs.com


Health Net’s Website – Resources for Providers


Health Net’s Website – Impact Provider

Impact Provider offers: • Online access to patient diagnoses, procedures, medications,

and specialty referrals/care • Ability to view individual patient summaries including utilization

and pharmacy information, concurrent providers and care opportunities

• Visibility of patient compliance with refilling ordered medications• Quality profile for civilian network providers, showing overall

completion rates for preventive screening measures• Printable information for placement in patients’ charts • Online training module

Impact Provider is an online tool that uses administrative information from claims and encounter data to give providers access to their TRICARE patients’ diagnoses, tests, medications and more. This information is organized in a user-friendly way intended to help providers proactively manage their patients and administer optimal care.


Impact Provider

The link to Impact Provider can be found under Resources on www.hnfs.com.

Note: Registration on www.hnfs.com is required to access Impact Provider.


Impact Provider – Patient Summary


Impact Provider – Quality Profile


Are you interested?

• Join Health Net’s effort to raise screening rates.

• Receive a quarterly spreadsheet identifying all of your TRICARE beneficiaries overdue for screenings.

• Receive tools to enhance your screening processes.

• Communicate directly with Health Net’s Clinical Quality staff.


Summary

• The primary care provider and practice have the most influence on whether beneficiaries obtain preventive screenings.

• Have the conversation.

• Recommend, use reminders, reduce barriers and share screening stories.

• Follow up.

• Let us know how we can help you and your practice be more effective.


Health Net Preventive Screening Contacts

Laura Benson, RN, MSN, CPHQ571-227-6499

[email protected]

Kimberly Komar571-227-6496

[email protected]

Provider Network Management Contract Representative or PRO (Provider Relations Outreach Specialist)

Market Manager (reach through local TSC)


Questions and Answers

Making Prevention Easier for Providers September-October 2011.

Documents

Transcript of Making Prevention Easier for Providers September-October 2011.