Health Programs and Campaigns
Healthchek Provider Reference Guide
Click on this Healthchek/EPSDT video link to watch and listen to Dr. Dennis McCluskey, Buckeye’s Medical Director explain the Healthchek-EPSDT Program.
Buckeye is committed to working with our provider partners to improve the health and quality of life of our youngest members. Managed care plans must ensure that members under the age of 21 have access to services that are available in accordance with federal EPSDT requirements.
1. Buckeye Health Plan provides Healthchek education to all network providers on an annual basis that includes, at a minimum:
- The required components of a Healthchek exam pursuant to OAC rule 5160- 01-14;
- A list of the intervals at which members under the age of 21 should receive screening examinations, as indicated by the most recent version of the document “Recommendations for Preventive Pediatric Health Care" published by Bright Futures/American Academy of Pediatrics;
- A statement that Healthchek includes a range of medically necessary screening, diagnostic, and treatment services; and
- A list of common billing codes and procedures related to the Healthchek services (e.g., immunizations, well child exams, laboratory tests, and screenings).
2. The MCO must provide the above information on the MCO's provider website as specified in Appendix A, General Requirements.
Click here to learn more about Healthchek.
EPSDT HealthChek Provider Reference Guide (PDF)
School Based Services Available Throughout Ohio
The Ohio Department of Medicaid and Buckeye Health Plan encourage the use of school-based services to ensure students are healthy and engaged, which enables a better overall learning experience.
School-based health in Ohio ranges from large school health centers that houses full-time medical staff to smaller, part-time clinics that may only have one staff member. Services include primary care (TB testing, annual and sports physicals, hearing and vision screening, immunizations, etc.), oral health, mental healthcare services, and other wrap-around services to promote health and safety.
For a full listing of services, please visit the Ohio Department of Education’s health care support toolkit
Why Chlamydia Screenings
According to the CDC, adolescent and young women have the highest rates of reported chlamydia infection. Approximately 20 percent of untreated chlamydia infections lead to PID and may cause pregnancy complications such as: preterm labor and passing the infection to the infant during birth, leading to blindness and pneumonia.
The HEDIS measure of chlamydia screening in women looks at the percentage of women aged 16-24 identified as sexually active who had chlamydia testing in the past year. According to the National Chlamydia Coalition, the national 2021 HEDIS rate for this measure for Medicaid recipients was 55.3 percent.
Toolkit
Opt-out Chlamydia Screenings
The CDC recommends routine screening for C. trachomatis infection on an annual basis for all sexually active females aged <25 years. However, many adolescent and young adult females may not be comfortable sharing that information and fall through the cracks. Providers might consider opt-out chlamydia screenings for adolescent and young adult females during any clinical encounter regardless of the reason for the visit -- meaning the patient is notified that testing will be performed unless the patient declines, regardless of reported sexual activity.
- An opt-out, or universal screening approach focuses on policy and protocol, not to the individual patient.
- Practicing opt-out will increase screening rates and lead to early detection and treatment. Education about risks for chlamydia can help prevent infection.
- Reduces the risk of NOT screening someone based on our own biases and/or perceived risk factors leading to improved health equity.
- Cost-effectiveness analyses indicate opt-out screenings might substantially increase the number of women screened, be cost saving, and identify infections among patients who do not disclose sexual behavior.
To learn more about adopting this approach and get resources to help improve chlamydia screening rates in young women at your practice, visit the National Chlamydia Coalition.
Materials
Discussion of opt-out screening with patients and parents of minors perpetuates the thought that the screening is routine. We’ve created these materials and tips to aid in those discussions and increase screening rates.
Adolescent Flyer (PDF) can be shared with patients and parents of minors.
Parents Flyer (PDF) Provides talking points and educates parents on discussions with minors.
Infographic (PDF) Posting flyers or handing out infographic sheets and normalizing language help eliminate stigma.
Parents Letter (PDF) Helps explain the need for privacy when discussing sensitive topics with their children and conveys the reason their child may need chlamydia screening. These can be helpful when handed to a parent upon check-in, so the expectation is set that the testing will occur.
Tips for using normalization language to increase screening and reduce stigma.
-- “I see you are here for your depo shot today and I noticed you haven’t been screened for Chlamydia recently. We routinely screen all our patients to make sure we’re not missing a problem, so I’d like to go ahead and do that today”.
-- “Hi Mrs. Gray. Thank you for bringing your daughter in today for her annual wellness exam. I see she is 16 now and to keep her healthy, I recommend testing for chlamydia. It’s a common infection that usually has no symptoms. We test all our patients through a simple urine test. Do you have any questions for me?”.
-- “We ask all our patients your age if they’ve been tested for chlamydia recently. That test should be done every year. Let’s do that today”.
Special Chlamydia Screening Incentive
All female Buckeye Health Plan Medicaid members (ages 16-24) will earn an extra $50 reward on their My Health Pays card for chlamydia screenings performed now thru 12/31/23, when a claim for chlamydia screening is submitted.
Well-Visit Incentive Reminder
As a reminder, all Buckeye Medicaid members receive a $75 reward for their annual wellness exam. Now they will also receive an additional $25 for their well-visit until 12/31/23.
Flu season is right around the corner, and it’s time for everyone to get up to date on vaccinations. With your patient’s trust and their best interest at heart, it’s up to you to recommend they get their flu vaccine.
What to Do Before Talking With Your Patients
- Create standing orders when you can so that others can vaccinate patients without your direct order.
- Add reminders and follow-ups in patients’ EHR/EMR — both for yourself to remember and to send reminders to your patients.
What to Do When Talking With Your Patients
- Make your recommendation an announcement. A strong, declarative statement that their vaccination is due decreases vaccine hesitation in your patients.
- Use the SHARE method to guide the conversation:
o SHARE why patients should get their flu vaccine based on their age, lifestyle, and other risk factors.
o HIGHLIGHT the positives from your personal experience or from appropriate cases from your practice to reinforce the vaccine’s benefits and strengthen their confidence.
o ADDRESS any questions your patients may have about the vaccine. This may include concerns about side effects, effectiveness, and safety. Recognize that while people who’ve been vaccinated may still get sick, the illness is likely to be less severe.
o REMIND patients that the flu vaccine protects them and their loved ones from serious illness and side effects that can lead to greater health risks.
o EXPLAIN the costs that come with getting sick. Besides the potential health effects, you lose time at work and with family, deal with financial costs, and risk spreading the flu to others.
- Follow up! If your patient didn’t get their vaccine at their last visit, check to see if they have since then. Discuss where and when they’re getting their flu vaccine. Confirm it with them during their next visit.
- Repeat your strong recommendation. Address any questions with facts complemented by compassion.
- Think of a time or event that happens in every appointment where you can check in with your patients about their vaccine status.
There’s always time! Administering the flu vaccine is fast and easy.
Flu Prevention is a Win-Win
There are many advantages to promoting flu prevention:
- Healthier patients.
- Decreased severity of illness for those who do get sick.
- Reduced community spread.
- More satisfied patients to help you achieve your practice’s quality goals.
Remember, you are essential in stopping the flu! Strongly recommend the flu vaccine to all of your patients!
Source: “Make a Strong Influenza Vaccine Recommendation,” CDC
Diabetes Programs
Updates to Diabetes Benefits in 2024 Buckeye and the Ohio Managed Care Organizations (MCOs) are working collaboratively to make diabetes management easier for providers and their patients. Diabetes education and support for the use of continuous glucose monitors (CGMs) have proven to be effective in diabetes care management.To facilitate increased utilization of these enhanced tools, Buckeye and the other MCOs will pay an enhanced rate to providers rendering Diabetes Self-Management Education (DSME) and billing the appropriate codes: G0108 and G0109. In addition, PA is not required for members who receive a covered CGM device through durable medical equipment (DME) providers or through their pharmacy. Providers must use HCPCS codes A4239 and E2103 for CGMs provided through DME.For additional information regarding these updates, including who to contact at each MCO for questions, see the quick reference guide.
All 7 Ohio Managed Care Plans (MCP) are proud to partner with the Ohio Department of Medicaid (ODM) to improve the health and well-being of all Ohio Medicaid members. Now, we’ve established a dedicated initiative to focus on improving the lives of our diabetic members through the Diabetes Self-Management Education (DSME) program covered by all MCPs.
What is DSME?
- Members receive instruction and counseling on:
- Healthy eating habits
- Weight management
- Use of glucose meter
- Insulin pen
- Other tools
- The program utilizes Medicaid approved providers such as physicians, pharmacists, nutritionists or other trained health care providers throughout the state to assist providers and members. You can find one near you by accessing the list of DSME providers on our website.
- This partnership has also made it easier for providers and members to order and receive diabetic supplies. We have agreed upon an easier prior authorization process for glucose meters and standard diabetic supply amounts. The hope of the agreement is members will be more willing to test their blood glucose, which in turn would lead to better glucose control, better health and well-being of the members and lower health care cost.
- Additionally, MCPs can supply support with member outreach for scheduling and home testing kits for members who are hard to reach or have barriers to receiving regular care at provider facilities.
For assistance with resources or more information on any of these services please contact your MCO representative at your convenience.
Good Measures provides clinical coaching, nutrition guidance, and condition management support to Buckeye Health Plan members, through our Diabetes Support Program.
Good Measures is currently supporting Medicaid and Ambetter members with diabetes, with Medicare to launch at the end of 2023. This program is available at no cost to the member.
Eligibility Criteria
The Diabetes Support Program is available to members who have a:
- Diabetes diagnosis (type 1, type 2, or gestational diabetes) and
- Obesity or malnourishment
- Indicator of food insecurity
Program Description
The Good Measures Diabetes Support Program provides support to members with diabetes through one-on-one coaching and access to a mobile app and website over the course of 12-months. Coaches are Registered Dietitians and Certified Diabetes Care and Education Specialists. Good Measures provides whole-person care which includes management and support for co-existing conditions and connecting members with resources available to Buckeye Health Plan members. As part of engaging in the Diabetes Support Program, members are eligible to receive two medically-tailored grocery deliveries at no cost to the member. These deliveries are personalized based on members’ conditions, health profile, and food preferences.
Components of the programs include:
- Improving diabetes self-care through lifestyle modifications to better manage diabetes, lose weight, and increase physical activity,
- Learning how foods, activity, stress, and medicine affect blood sugar,
- Empowering members with self-management strategies,
- Collaboration between member and coach to develop and achieve health goals,
- Educating members on the importance of medication adherence, primary and specialty provider visits, and key exams,
- Tracking food, activity, medications, blood glucose, and weight in the Good Measures app
- Two no-cost medically-tailored grocery deliveries with recipes.
Referrals
Please visit goodmeasures.com/physicians to submit a secure referral. You can find a faxable version of this form at the same link. Fax completed form to 617-507-8576.
Members can sign up directly on the Good Measures landing page.
With the launch of Next Generation, managed care plans offer more care coordination services to help members navigate their care. In addition to our care managers, a new role is now available called Care Guides.
- Care guide assists members with short-term goals and one-time needs.
- Care manager assists members with long-term goals and more complex needs.
Buckeye Health Plan’s Care Guides help members access and navigate community resources for help with needs such as finding a doctor, housing, transportation, and durable medical equipment, among other necessities. They also assist Buckeye members with questions related to their health care, their community involvement, and their overall well-being and ensure members are connected with and receiving resources to which they are entitled. A great aspect of the Care Guide program is that each member is assigned to their own personal care guide and act as liaisons between Buckeye and providers of health care to Buckeye members. Providers can encourage members to reach out to Buckeye directly to learn more about care coordination.
Our member website page includes further information.
Note: this does not apply to MyCare Ohio plans.
Members Empowered to Succeed (METS) is a Behavioral Health clinical program within Buckeye Health Plan that has been successfully supporting Ohio providers and members for two years. Traditionally focused on BH/SMI populations, in January 2024, the METS team began including members with solely substance use diagnoses/services as well.
METS takes a unique approach to member care focusing on the individualized needs to create a recovery roadmap that is personalized to the member. We partner with both the provider and the member to ensure the member achieves the ultimate level of recovery and resiliency. Our Clinical Liaisons are licensed clinicians that work directly with with BH & SUD providers to identify the member’s treatment and supports needed for successful progress in treatment. Our Member Engagement Service Coordinators reach out telephonically to the member to identify needs and resources to meet the member’s behavioral health, social, and medical needs.
Benefits and Outcomes of METS
- Integrated, whole health approach to member’s needs and care including behavioral, health, medical, substance use, therapeutic, pharmacy, and supplemental.
- Cross-care team partnership to ensure coordination of care and collaborative problem solving.
- Coordination of services and treatment between multiple providers.
- Knowledge of covered services such as expanded benefits or new programs and how to access.
- Access to various physicians and specialists to promote diversity among providers and treatment team.
Please know that no release of information is required. PHI that is used or disclosed for purposes of treatment, payment, or healthcare operations is permitted by HIPAA Privacy Rules (45 CFR 164.506) and does not require consent or authorization from the member. For our SUD population, METS falls within parameters of 42 CFR Part 2 and still does not require an ROI unless disclosing information to another provider for care coordination.
The Process
A Members Empowered to Succeed (METS) Clinical Liaison will reach out to you via telephone, email, or fax to arrange a call to discuss any members identified for our program that are receiving services from you. Typically, information such as the member’s most recent treatment plan and assessment are helpful in sharing the member’s current treatment goals and progress. The Clinical Liaison would also like to know any barriers in the member’s treatment and any current needs. We prefer to speak directly with the member’s treating provider to ensure the information needed is accessible during our conversation. Ongoing communication takes place monthly and the member typically remains in the program for 3-9 months.
For questions, please contact Provider Services.
Buckeye Health Plan and Ohio University Partnership Programs
Buckeye Health Plan has partnered with Ohio University to support programs to expand access to healthcare and increase the knowledge base for those administering care in rural areas of Ohio.
Partnering with Visiting Physicians Palliative Care, Buckeye is proud to share that we have created an exciting clinical program affectionately called Harmony Cares.
Harmony Cares provides support to members with chronic illnesses that may need assistance with managing their health within their home and assists with filling care gaps. However, it is not your typical palliative care program that is a precursor to hospice, but rather a program to assist members who would like to have an added level of support from a Nurse Practitioner in their home that works with their Primary Care Provider.
Services offered by the program:
- In home or Telemedicine visits
- Injectable medication to manage acute symptoms
- In-home mobile X-ray & ultrasound services
- In-home lab draws processed by VPA CAP accredited laboratory within 24 hours
- Post hospital visit within 48 hours of an acute admission
- Psychosocial assessment completed by a Licensed Clinical Social worker to address social needs
- Provide appropriate screening and assessments to close HEDIS gaps
- 24/7 patient support to assist with afterhours and weekend clinical questions or requests
- Real-time health information exchange alerts for inpatient admits/discharges or ER visits for members
Service Area
At this time, Buckeye is servicing Cuyahoga County, Lorain County, Lake County and other neighboring counties. If you have a patient/our member that you feel may benefit from having a visit from a Certified Nurse Practitioner through VPA please see the contact information below. Each patient is looked at individually and visits are based on the patient’s need.
Referral Considerations
Here are some things to consider when reviewing your patients for a possible referral. Members:
- With chronic conditions, including but not limited to, the following diagnosis i.e
- Diabetes
- COPD
- Heart Failure
- Chronic Pain
- That have frequent inpatient admissions or ER visits
- Who may not have a great understanding of their disease process and may require more education
- Wiith symptoms that are difficult to manage
If you believe your patient may benefit from this amazing program, please contact:
Luann Mobley, RN CM
Buckeye Health Plan
Harmony Cares Coordinator
330-690-0769
or
Call Visiting Physicians directly at 440-202-1635
Providers, Let’s Partner!
Buckeye Health Plan is looking to partner with participating providers to facilitate care gap closure events. Our recently introduced Buckeye HealthConnect van serves the state of Ohio and rotates from region to region. Buckeye is looking for provider partners to staff the mobile unit with clinical staff to provide clinical services. The van is designed to be multifunctional, allowing us to meet and address multiple member needs and close gaps in care. Examples may include backpack drives and flu vaccinations.
Our van features
- Size: 164” X 98”
- 2 Collapsible Desks
- First Aid Kit
- Fridge
- Sink
- Eye wash station
- Diagnostic Wall System
- Storage Cabinets
- Wifi
- Air conditioning & heat
- Generator
- Outlets
- Rear lift gate
We Can Provide
- Mobile Clinic
- Drivers
- Member outreach
- Assistance with logistics planning
- Data and quality assessments and outcomes
- Supplies and materials
HEDIS Measures and Care Gap Closures
- Support Community Events
- Support Social Interventions
- Access to Preventive/Ambulatory Health Services
- Controlling High Blood Pressure
- Adult BMI Assessment
- Flu Vaccinations/HepB
- Diabetes Control
- Children and Adolescents' Access to Primary Care Practitioners
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
- Childhood Immunization Status
- Immunizations for Adolescents
- Colorectal Screening
Currently Scheduled Locations
- Columbus August – October, 2021
- Cincinnati November – February, 2021 to 2022
- Toledo March – April, 2022
- Cleveland May – July, 2022
Billing Information
- The service code for mobile unit is Place of Service 15
- Buckeye will reimburse for this service code for Buckeye members
- Although Buckeye will focus on identifying members with care gaps, there is not an expectation for outreach and services to only include Buckeye members. Providers can provide services to their patients and community members according to their administrative policies, billing and strategic initiatives.
- Providers will have access to outlets and wifi and can bring their laptops to connect to their EMR system
We are pleased with the response we’ve received from community and provider partners. Partnerships will be prioritized among the mobile unit initiatives, planning and operations. Requests must be made in advance and are subject to availability and capacity
Note: Please be aware that Buckeye reserves the right to deny requests based on schedule conflicts. All requests are reviewed and subject to alignment with our mission and guidelines and agreement to comply with terms and conditions. Submission of a request does not guarantee approval of request. The mobile unit cannot be used to support fundraisers or political activities
Breast cancer is the second most common cause of cancer-related death for Ohio women. But when it’s detected early, most breast cancer can be treated successfully. As part of Buckeye Health Plan’s commitment to improving the health of the community, one person at a time, we’re encouraging all women age 45+ to protect themselves through regular mammograms.
Buckeye helps make it easier
We help our members with no-cost transportation to and from their mammogram — and this is an extra benefit that doesn’t count toward their annual transportation benefit. Plus, Buckeye members ages 50-74 can earn $75 in reward dollars just for getting their mammogram.
NOTE: Providers enrolled in our P4P program get rewarded, too! $10 for every patient who completes their mammogram. If you are interested in enrolling in our P4P program call 866-296-8731 to find out more today!