The Case Studies:

BREAST CANCER SCREENING - Hitting the Road With Screening Programs
Description: After an initial round of awareness and education efforts (newsletter articles, CME program, shower cards outlining how to perform a breast self-examination), this plan provided mobile mammography services at the work sites and office of major employer groups, while continuing direct mail outreach (in the form of birthday card reminders emphasizing the importance of mammography screening).

BREAST CANCER SCREENING - Improving Access and Awareness
Description: While continuing its ongoing outreach efforts, this plan sent birthday reminder cards to women aged 50 or older. The plan also reached women over 50 with reminder calls, which were followed up by a letter from the plan's medical director. Both members (through the member newsletter) and providers received revised preventive health guidelines.

BREAST CANCER SCREENING - Raising Member and Physician Awareness
Description: An increase in the number of breast biopsies and cases of breast cancer prompted this plan to launch a comprehensive education program, which included newsletter articles, support of community activities, distribution of preventive health guidelines and reminder cards for women.

CERVICAL CANCER SCREENING - Improving High-Volume Screening in an Expanding Population
Description: To increase cervical cancer screening rates in its population of females aged 21 to 64-which comprised more than one-third of its total membership-this HMO engaged in an aggressive education campaign. Noncompliant members received targeted mailings, all members received pamphlets and newsletter articles stressing preventive health and physicians were sent preventive care recommendations and guidelines.

CERVICAL CANCER SCREENING - Sticking to the Basics: Outreach and Self-Referral
Description: This organization promoted the need for cervical cancer screening in its member and provider newsletters, and it also mailed preventive health guidelines to all practitioners. In addition, the plan's handbook and schedule of benefits were used to promote the self-referral option for annual Pap tests.

CERVICAL CANCER SCREENING - Turning Plan Awareness Into Action
Description: This plan identified awareness as the primary barrier to receiving a screening for cervical cancer, so it devoted resources to education. An article regarding cervical cancer ran in the member newsletter, and the plan distributed preventive health guidelines to primary care physicians and specialists.

CERVICAL CANCER SCREENING - Understanding Noncompliance
Description: This plan's initiative began with member and provider education through annual newsletter articles, followed by surveys mailed to women who had not received a Pap smear in the past three years. Finally, the plan sought to improve access by sending nurses to conduct cervical cancer screening tests at the sites of two of its largest employers.

CESAREAN SECTION - Peer-Led Quality Improvement
Description: This plan re-examined its cesarean section rate in the face of a Healthy People 2000 goal rate of 15 percent. After review and analysis of C-section documents, C-sections with questionable indicators were flagged, and the plan's OB/GYN committee discussed the delivery with the provider. The plan then distributed vaginal birth after cesarean (VBAC) guidelines to its obstetricians.

CHECK-UPS AFTER DELIVERY - Improving Program Participation
Description: This plan encouraged participation in expectant and new mother outreach programs with newsletter articles, consultation with OB/GYN practices and meetings with the contracted vendor that administered the programs. The plan also offered incentives to OB/GYNs and primary care providers to see women for postpartum visits.

HIGH-RISK PREGNANCY MANAGEMENT - Preventing Prematurity With a Comprehensive Approach
Description: Data from this plan showed that extended hospital stays were more likely related to prematurity than any other diagnosis. With these findings in hand, the plan created a premature delivery prevention program that offered case management, risk assessment services, member education, physician incentives and a new prenatal practice guideline.

HOSPITAL QUALITY PROGRAM: CESAREAN SECTIONS AND LAPAROSCOPIC CHOLECYSTECTOMY - Improving Care for a Hospital Network
Description: For the initial phase of its quality improvement (QI) initiative, this plan implemented a program of sharing guidelines with its hospitals. After re-measuring results, the plan's QI staff and medical directors began conducting annual hospital quality visits to assist the hospitals in developing quality action plans. The plan supported these efforts with educational mailings and seminars.

INITIATION OF PRENATAL CARE - Outreach at Open Enrollment
Description: The plan's goal for this effort was to encourage female members of childbearing age to initiate prenatal care within six weeks of enrollment. In addition to eliminating the referral requirement for obstetrical care, the plan established a program emphasizing regular nurse contacts and educational materials, including prenatal care and breast feeding guides.

PREGNANCY MANAGEMENT - Pursuing Better Care During Pregnancy
Description: Based on the success of related programs for pregnant women, this plan extend pregnancy management to a greater proportion of its members. The program focused on risk assessment and maternal education, and it monitored, implemented and evaluated interventions in complicated pregnancies.

PRENATAL CARE - Collaborating for Community-Wide Improvement
Description: This plan exclusively serves a Medicaid population, and the plan initially responded to ongoing concerns about prenatal care by strengthening existing programs for health education and home care. Subsequent actions included implementation of a lead removal program, case management of high-risk members throughout pregnancy, contracting with a mobile unit and revision of the member OB guide.

VAGINAL BIRTH AFTER CESAREAN SECTION - A MULTIFACETED AND PERSONALIZED APPROACH
Description: Rising C-section rates were the impetus for this organization to revise its maternity management program. New components included a compensation system for reimbursing providers, letters to providers identifying VBAC opportunities, meetings with medical directors for providers with high C-section rates and case management with support for members considering VBAC. Internally, the plan hired an OB/GYN medical director to engage providers in discussions of obstetric care.