Oregon MCOs launch 22 pilots to find ways to improve delivery of preventive services
Oregon MCOs Launch Pilot
Managed care plans in Oregon have set up 22 pilot studies to find ways to improve the delivery of preventive services to the Medicaid population. Plans in Oregon’s Medicaid program will be meeting in March to exchange best practices from Project: PREVENTION! on mammograms, tobacco cessation and prenatal care and other areas of preventive care.
"In contrast to a commercial population, you have to really encourage [Medicaid enrollees] to come in. They have a backlog of health needs and they may not have the healthy habits that a commercial population may have," says Carole Romm, health services manager for CareOregon, a Medicaid plan with about 26,000 enrollees. "You have to really gear your programs toward them."
Some states are discovering that demand for preventive services has not been as high as expected under Medicaid managed care. In Tennessee, for example, The Prudential is conducting a study to identify and overcome barriers to early prenatal care for women enrolled in TennCare. With the new Medicaid version of HEDIS (Health Plan Employer Data and Information Set) placing heavy emphasis on measuring and assessing the delivery of preventive services, preventive care will become more important for states with Medicaid managed care programs; plans are required to submit those data in 1997.
The Oregon Office of Medical Assistance Programs (OMAP) launched Project: PREVENTION! last summer after an external quality review report indicated that, while overall service delivery to Medicaid recipients under managed care was good, several areas in preventive care such as immunization and mammography could stand improvement, according to OMAP Director Hersch Crawford.
The 22 pilot projects cover tobacco cessation (four); diabetic management (two); early intervention during pregnancy (one); mammograms for women over 50 (six); systems to track prevention practices (one); Pap screening (three); risk reduction counseling (one); pre-term birth prevention (one) and facesheets (three). (A facesheet is a one-page document that becomes part of the medical record and provides physicians with an easy-to-read summary of the patient’s health status and needs.)
All Medicaid plans must participate in Project: PREVENTION!, says Marlene Haugland, OMAP quality improvement coordinator and staff leader for the project, and they must conduct at least one six-month pilot study, which may be expanded if successful.
Some pilots dovetail with quality improvement efforts already in place at the plans. All of the studies are designed to address not only clinical issues, but also other issues such as outreach to culturally distinct populations.
Under CareOregon’s project on tobacco cessation, primary care providers get bonuses for checking their patients’ medical records to see if they have been asked if they smoke. "We want to know what the smoking rate is among our members, which is very hard to learn from claims data," Ms. Romm says. Smoking cessation interventions will be available to plan members identified as high-risk for health problems. The effectiveness of the interventions will then be evaluated.
Ms. Romm notes that the tobacco cessation project is part of a larger quality-of-care initiative at CareOregon that provides financial incentives to providers for quality care in prenatal care, preventive care for diabetes, well-child exams, immunization, Pap smears and mammograms.
Evergreen/FamilyCare, Inc., which serves about 14,000 Medicaid recipients, is evaluating a new health screen facesheet which asks for information about each patient’s demographic characteristics, social history, health habits, screening history, chronic medications, chronic diseases and other factors. The goal of the facesheet is to give doctors a simple tool that will help them remember to keep their patients up to date on preventive services such as mammograms, immunizations and Pap smears. Evergreen/FamilyCare, Inc. is targeting rural providers who lack other assessment tools, says Beverly Day, director of education and quality for the two plans. Information from the facesheets will be compared against patient medical records to verify the data, Ms. Day says.
Another facet of Project: PREVENTION! is that plans must participate in Oregon’s statewide immunization registry, which uses state-of-the-art barcode technology to record and track immunization data. Each patient has a barcode identifier. Immunization ALERT, which went on line last fall, offers providers round-the-clock access to up-to-date immunization information via telephone or fax.
Ms. Haugland believes that by focusing on preventive care, OMAP ultimately will improve delivery of services to Medicaid enrollees — and save money by avoiding the need for acute care services.
—Mary Darby
Contact Ms. Haugland at 503-945-5936; Ms. Day at 503-222-3205; Ms. Romm at 503-306-5900; and Mr. Crawford at 503-945-5767.
Oregon MCOs launch 22 pilots to find ways to improve delivery of preventive services
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