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PREVENTIVE CARE - Overview |
Primary and secondary prevention are certainly critical
activities for any successful managed care organization,
and are at the core of the philosophy of managed care
itself. The idea that it is better for the patient, as
well as for the fiscal health of an organization, to prevent
illness or detect and treat it at an early stage is fundamental
to the concept of the HMO. This tenet is still central
to the thinking of policy makers, insurers, employers
and public health professionals concerned with extracting
the most value from our nation's health care dollars.
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The Case Studies:
CHILDHOOD
IMMUNIZATIONS - Building on an Automated System
Description: This plan distributed monthly
profiles with immunization rates to each primary
care physician, adding pediatric immunizations
to physician incentive programs, developing a
procedure for assessing immunization status at
all office visits and calling the parents of members
who did not make or keep immunization appointments.
CHILDHOOD IMMUNIZATIONS - Identifying and Addressing
Specific Barriers
Description: After identifying an initial set
of barriers to children receiving timely immunizations
(such as inadequate supply of vaccines), the plan
conducted a telephone survey of parents that uncovered
additional barriers. To address these barriers, the
plan distributed information on immunization guidelines
through several channels, including the member newsletter,
member handbook and new member materials. As a follow-up,
the plan launched a reminder card program; cards were
timed to be received four weeks prior to an immunization
due date.
CHILDHOOD IMMUNIZATIONS - Stressing Education and
Documentation
Description: While this plan's rate of complete
childhood immunizations was not low by normal standards,
there was considerable room for improvement. To boost
results, the plan first mailed immunization records
to all parents, followed by an article about immunizations
in the member newsletter and regular reminders to
parents and primary care providers. The plan subsequently
incorporated their initiatives into a comprehensive
health promotion and education program.
CHILDHOOD IMMUNIZATIONS - Tailoring Interventions
with Analysis and Feedback
Description: The plan boosted immunization
rates in two-year-olds by targeting practitioners.
Practitioners received a tool kit that included, among
other items, standards of practice, a self-assessment
test and an immunization tracking sheet for the medical
record; this was followed by monthly lists of patients
due for immunizations.
FLU SHOTS FOR OLDER ADULTS - Collaborating to Reduce
Missed Opportunities
Description: The plan sought to raise flu vaccination
rates in seniors through an information campaign.
Members received articles in the member newsletter,
reminder postcards and follow-up letters; primary
care providers received information packages that
included posters, buttons and chart stickers.
FLU SHOTS FOR OLDER ADULTS - Measuring the Effect
of Specific Interventions
Description: To achieve the same goal, this
plan implemented a program that encouraged members
to receive preventive care; all members aged 65 and
older received a reminder of the need for a flu shot.
The plan's primary care providers received a fact
sheet outlining the billing and coding of flu shots
and a method for implementing an influenza immunization
program in the office.
INFLUENZA VACCINATION FOR SENIORS - Access and
Awareness: Dedicated Flu Clinics and Member Outreach
Description: This initiative was conducted
in conjunction with a statewide effort to immunize
seniors, which allowed this plan to use data and educational
materials that the cooperative project had accumulated.
The plan's other key focus was on reducing barriers,
which was achieved by establishing and promoting free
vaccination clinics.
INFLUENZA VACCINATION FOR SENIORS - Removing Financial
and Geographic Barriers to Access
Description: This plan's multi-tiered QI effort
offered alternate sites for vaccinations, waived the
office visit co-pay for influenza vaccinations during
the vaccination season and provided comprehensive
education through newsletter articles and reminder
mailings.
PREVENTIVE SERVICES AND COUNSELING - Keeping Members
Well with Information and Incentives
Description: Rather than create initiatives
to address individual services, such as mammography
and Pap smears, this plan incorporated these and other
services into a comprehensive effort at improving
preventive care. The plan provided preventive counseling
by telephone, provided medical groups with lists of
"at risk" members for further outreach, and revised
an existing incentive program for medical groups to
include mammography, smoking cessation and cervical
cancer screening.
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