Please use the provided talking points to encourage patients to get their flu vaccine during their next appointment.

Greeting: Hello, this is [Staff Member Name] from [Provider’s Office]. I’m calling to confirm your upcoming appointment on [Date].

Ask About Flu Vaccine: While we’re confirming your visit, I wanted to let you know that flu season is here, and we are encouraging patients to get their flu vaccine as soon as possible. It’s one of the best ways to keep you and your family safe from getting sick.

For Buckeye Health Plan Members: Plus, Buckeye Health Plan members earn reward dollars just for getting the flu vaccine. You can arrange a free ride to your appointment too by calling 1-866-531-0615 at least 48 hours in advance.

• Can we plan to give you your flu vaccine on [Date]?

If  Yes: That’s great! I will add the flu vaccination to your visit. Feel free to bring any family members along who need their flu vaccination too.  

If No or Hesitant: If you have any questions about the flu
vaccination or concerns, we’re here to help. Please let us know if you change your mind—we want to keep you as healthy as possible this flu season.

• Designate a “flu lead” to plan and implement strategies.
• Be sure all staff knows to use sick visits as an opportunity to immunize and under what circumstances patients should be vaccinated.
• Encourage staff to use every interaction to promote the flu vaccine.
• Prior to the first patient of the day, generate a list of scheduled patients who still need a flu vaccine.
• Use prompts/flags to remind clinicians when patients are due for a vaccine.
• Encourage medical assistants to use routing slips or other reports to remind physicians to offer the flu vaccine to patients.
• Consider co-administering with the current COVID-19 vaccine.
• Start scheduling flu shot appointments early; prioritize high-risk patients and children who may need two doses.

Over the last several years, NCQA has added the option to report the ECDS (Electronic Clinical Data Systems) reporting standard for several existing HEDIS measures alongside traditional HEDIS reporting.

NCQA has announced the transition of several measures to ECDS-only.  The major reporting change to be aware of is that traditional hybrid measures (COL, CIS, IMA, CCS, COL, BCS, ADD, and APM) that transition to ECDS-only will no longer use the annual chart retrieval process to demonstrate compliance. All compliance from medical records must be processed through prospective supplemental data. The data sources for ECDS are Electronic Health Records, Health Information Exchanges, Case Management Systems, and Administrative Claims.  See ECDS External Link for more information and the data allowed for compliance. ECDS measures can be identified with an -E after the measure abbreviation.

What to expect:

• Records from your office may be requested for dates of service in 2024 or prior for measures not already captured by claims. Your cooperation is greatly appreciated as our health plan may need to either visit your office or request records via fax, mail, or electronic medical record (EMR). 
• Our health plan will be contacting you in the first quarter of 2025, if you are part of our Hybrid sample, for any records that may be needed. 
• Your timeliness in response to medical record requests will assist with a successful HEDIS 2024 Hybrid season. Thank you for your continued assistance and commitment to the quality of care you provide for our members.

• Claim/encounter data is the most clean and efficient way to report HEDIS. Submit claim/encounter data for each and every service rendered.
• Chart documentation must reflect services billed.
• Accurate and timely submission of claim/encounter data will positively reduce the number of medical record reviews required for HEDIS rate calculation. All providers must bill (or report by encounter submission) for services delivered, regardless of contract status. If services are not billed or not billed accurately, they are not included in the calculation.
• Consider including CPT II codes to reduce medical record requests. These codes provide details currently only found in the charts such as lab results.
• Avoid missed opportunities by taking advantage of sick-care visits; combine well visit components and use a modifier and proper codes to bill for both the sick and well visit.
• Use the member list provided by Buckeye to contact patients in need of a visit.
• Routinely schedule a member’s next appointment while in the office for a visit.

For more information, please review our HEDIS | Buckeye Health Plan website page and view our HEDIS Provider Reference Guide.

CAHPS surveys allow patients to evaluate the aspects of care delivery that matter the most to them. At Buckeye Health Plan, we are committed to partnering with our providers to deliver outstanding patient experience. And as a provider, you are the most critical component of that experience. We want to ensure you know how your patients are evaluating your care and how to receive the highest score possible. 

Measure: Getting Needed Care

Assesses the ease with which patients received their care, tests or treatment. It also assesses how often patients were able to get specialist appointments scheduled when needed.

How to positively impact the patient experience:

• Office staff should help coordinate specialty appointments for urgent cases.
• Encourage patients to register for access to their member portal, where they can view their lab results with follow-up instructions from their provider.

Measure: Getting Appointments and Care Quickly

This measure assesses how often patients got the care they needed as soon as they needed it, and how often appointment wait times exceeded 15 minutes.

How to positively impact the patient experience:

• Ensure that a few appointments each day are available to accommodate urgent visits.
• Offer appointments with a nurse practitioner or physician assistant for short-notice appointments.
• Maintain an effective triage system to ensure that frail and/or very sick patients are seen right away or provide alternate care via phone and urgent care.
• Make information around “drop-in” hours available and accessible to your patients. Include this information in visit summary forms.

Measure: Care Coordination

This measure assesses providers’ assistance with managing the disparate and confusing healthcare system, including access to medical records, timely follow-up on test results and education on prescription medications.

How to positively impact the patient experience:

• Ensure there are open appointments for patients recently discharged from a facility.
• Integrate PCP and specialty practices through EMR or fax to get reports promptly.
• Ask patients if they have seen any other providers; discuss visits to specialty care as needed.

Measure: Rating of Health Care Quality

The CAHPS survey asks patients to rate the overall quality of their healthcare on a 0-10 scale.

Incorporate the following into your daily practice:

• Encourage patients to make their routine appointments for checkups or follow-up visits as soon as they can — weeks or even months in advance.
• Ensure that open care gaps are addressed during each patient visit.

For more information on why CAHPS is important to you, please visit our website: https://www.buckeyehealthplan.com/providers/quality-improvement/cahps.html

• Update patient’s medical record: including demographics, other treating providers and family history.
• Conduct a Social Determinants of Health assessment.
• Discuss Advanced Care planning.
• Screen for cognitive impairment, including depression, mental wellness and emotional Health.
• Conduct medication reconciliation and extend day fill opportunities (mail order or 90 days at retail)
• Complete pain and functional assessments; including use of Durable Medical Equipment (DME)
• Assess bladder leakage and care options.
• Create a preventative screening schedule and refer members for tests, labs, X-rays (eye exams, colonoscopy, mammograms), counseling and care programs.
• Complete the health risk assessment, including functional abilities, ADLS, instrumental ADLs and create an action plan.
• Create patient’s list of balance/fall risk factors and conditions, including interventions and treatment options.
• Check routine measurements: height, weight, blood pressure, etc.
• Review current opioid prescription and screen for potential Substance Use Disorders (SUDs)
• Review Health History and Vital Signs: Heart, lung, head/neck, abdominal, neurological, dermatological, Vital signs extremities and gender specific exam.

As Needed:

• Osteoporosis screening and management after fracture

• Annual diabetic retinal eye exam
• Review adherence of diabetes medications (Consider 90-day fills for maintenance medications) and evaluate the addition of a statin to help prevent heart and blood vessel diseases.
• Blood pressure monitoring
• Testing and control of HbA1c
• Kidney function tests
• Medical attention for nephropathy

• Colon cancer screening (Colonoscopy, Fit DNA test, Cologuard)
• Breast cancer screening
• Prostate cancer screening
• Lung cancer screening

• Medication review and reconciliation by physician
• Functional status assessment
• Pain assessment
• Advance care planning
• Depression screening

• COVID-19 – initial and follow-up
• Influenza – yearly
• Pneumococcal – one time (may need booster)
• Meningococcal
• Tetanus, diphtheria, pertussis (Td/Tdap)
• Zoster (shingles)
• Hepatitis A
• Hepatitis B