Shared Best Practices (HMOs/PSNs)

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Shared Best Practices (HMOs/PSNs)

• Presented by Dr. Kamal Hamdan
• Preferred Medical Plan, Inc
• January 14, 2009

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Introduction

• Preferred Medical Plan, Inc. (PMP) is Floridas
  oldest independently owned HMO. PMP serves
  Miami-Dade and Broward counties.
• PMP has showed a steady improvement in LDL-C
  screening for many years
• 2003 62
• 2004 77.53
• 2005 78.80
• 2006  58.6 (Drop)
• 2007 73.94
• 2007 (Reform) 90.91

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Causal/Barrier AnalysisIdentified Barriers
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Interventions

• Providers
• Ongoing Record review by QI Analysts.
• Provider incentives for certain HEDIS
  measurements.
• Provider education in HEDIS measurements and the
  importance of data reporting.
• Data benchmarking between providers.
• Providers are given a list of their members who
  are due for screenings.
• CAP with lab provider, and obtain data
  electronically.

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Interventions cont.

• Members
• Member education through Members newsletter,
  new designed outreach materials geared toward DM.
  
• Member incentives.
• Welcome call to all new members within 30 days of
  enrollments to conduct HRA.
• Individualized care planning and education
  materials for members identified with chronic
  disease including DM.

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Interventions-cont.

• Health Plan
• Develop a home grown Disease Management Database.
• Identified members who were due for screening
  through LAB, HRA, Case Coordination, pharmacy,
  provider referrals, pre-auth-referrals, claims,
  and inpatient data.
• Ongoing case coordination to the identified
  members to educate them on the importance of
  preventive screening and guidelines.
• System change, new IS system.

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Interventions-cont.

• Develop a PIP in Diabetes Mellitus.
• Report data and outcomes to the QIC on quarterly
  basis.
• Develop a team to contact members after hours to
  conduct HRA. Develop individualized care planning
  and member education.
• Develop a new outreach program (mailing,
  e-mailing educational materials to our members)
  AHCA approved materials.

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Linking Interventions together to improve HEDIS
scores
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Thank You