Welcome to Provider's Corner! This section of our website is customized to meet your needs and will include useful tips and ideas for practices and procedures you need to complete for NCQA, Buckeye and Ohio Department of Medicaid requirements. The intent is to create an easy-to-use, one-stop shop with helpful specifics around Quality measures, such as HEDIS, CAHPS and clinical processes you can use to meet the criteria for these requirements. Be sure to bookmark this page to make it easy to return when you need to reference content. We hope you find this helpful and are open to topics you’d like discussed on the site.
Understanding How We Grasp Our Members' Experience
The primary focus of member experience is the satisfaction and engagement of our health plan members. It is important to understand the unique needs of our members, provide a positive member experience, identify the health plans strengths and areas for improvement. Buckeye contracts with vendors to collaborate, field and manage the annual member surveys to assess member satisfaction for each of our markets in accordance with state regulatory and accreditation requirements. Below is an overview of the surveys that we are currently administrating at our health plan and how you as the provider can help us reach customers satisfaction.
The Medallia Program is a post care survey that administers a digital survey to members to obtain timely feedback with actionable insights to improve their experiences as they access care and use their benefits. A member's overall satisfaction with their healthcare experience (OSAT) and CAHPS performance related to Access, Care Coordination, Pharmacy, Rating of Health Care Quality and Doctor Communication is measured.
We use the survey to assist with giving the patients the help they need and to Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions. (FMC)
The FMC measure assesses the percentage of emergency department (ED) visits between January 1 and December 24 of the measurement year for members ages 18 and older who have multiple high-risk chronic conditions and who had a follow-up service within seven days of the ED visit (eight days total).
Tips for Best Practice:
- Contact members as soon as discharge notification is received and schedule follow-up visit.
- Discuss the discharge summary; verify understanding of instructions and verify if all new prescriptions were filled.
- Complete a thorough medication reconciliation with the members and/or caregiver.
- Conduct outreach to members after their ED visit to schedule a post-ED follow-up visit within 2-5 days after discharge. The follow-up visit can be on the same day as the ED visit.
- Educate members on the importance of regular follow up with their primary health care provider to regularly manage their chronic condition.
- Submit claims timely and includes the appropriate codes for diagnoses, health conditions and the services provided.
- Keep appointments open so patients with an ED visit can be seen within seven days of their discharge. In addition to an office visit, a follow-up could be provided via a telehealth, telephone, e-visit or virtual visit.
- Encourage patients to call primary care physician’s (PCP’s) office/after-hours line when condition changes (weight gain, medication changes, high/low blood sugar readings).
Sometimes patients need a little help and guidance to achieve better healthcare results.
The Centers for Medicare and Medicaid Services (CMS), in collaboration with the National Committee for Quality Assurance (NCQA), is committed to monitoring the quality of care provided by Medicare Advantage Organizations (MAOs) and their providers. The Medicare Health Outcomes Survey (HOS) measures WellCare’s success in improving and maintaining the functional status of our members for a select period. HOS evaluates members aged 65 and older each year to collect a baseline measurement and then surveys again two years later to measure the change in health over time. The survey includes questions that address physical/mental health, social/physical functioning and quality of life.
The HOS survey will start fielding in July and will use the following Measure/Categories:
Management of Urinary Incontinence in Older Adults the Management of Urinary Incontinence and have discussed their urinary leakage problem with a healthcare provider.
Improving and Maintaining Mental Health measure assesses the percentage of patients who spoke with a doctor about emotional wellbeing and caring for their mental health.
Improving and Maintaining Physical Activity in Older Adults measure assesses the percentage of patients who spoke with a doctor or other health provider about their level of exercise or physical activity or received advice to start, increase or maintain their level of exercise or physical activity.
The Fall Risk Management measure assesses the percentage of patients who discussed falls or problems with balance or walking with their current practitioner.
Connect with your patients by asking:
- Have you had a fall in the past year?
- Have you felt dizzy or had problems with balance or walking in the past year?
- Do you have any vision problems? Have you had a recent eye exam?
- Do you have a lot of energy?
- Do you exercise regularly or take part in physical exercise?
- Have you felt depressed or anxious?
- Have you experienced leakage of urine?
Initiating conversations with your patients can help them achieve better health outcomes in their overall health and improve their active daily living (ADLs).
For more information: HEDIS Medicare Health Outcomes Survey - NCQA and Health Outcomes Survey (HOS) | CMS
The Outpatient Mental Health Survey is a standardized tool developed by AHRQ to assess patient experiences with mental health and substance use disorder services over the past six months. Created by the CAHPS research team, this survey replaces the BH ECHO Survey and focuses on treatment and counseling experiences, including access to help between appointments and barriers to care. Results help identify strengths and areas for improvement. It can be used by mental health providers, hospitals, health systems, health plans, and state agencies. The survey target audience is adults or children who have received mental health or substance use disorder services in the previous six months and will begin fielding in July.
This survey generates the following composite measures, single-item measures, and rating measures:
- Getting Appointments for Prescription Medicines
- Getting Mental Health Counseling
- Communication with Mental Health Counselor
- Goal Setting
- Getting Help Between Appointments
- Rating of Mental Health Counselor
- Unmet Need for Mental Health Services
- Financial Barriers to Mental Health Services
The survey helps identify areas where outpatient mental health services can be enhanced, leading to better patient outcomes and more effective treatment plans for our members.
For more information: CAHPS Mental Health Surveys | Agency for Healthcare Research and Quality
- Flu Season
- HEDIS Measures
- CAHPS
- Annual Wellness Visits
- Colorectal Cancer Awareness
- Provider Appointment Standards
- Heart and Nutrition
- Telehealth
- Osteoporosis
- HEDIS/CAHPS Measures: Kidney Health, Eye Exam for Patient with Diabetes, Childhood Immunization Status
- Men's Health Screenings
- Medication Errors: Critical Findings and Critical Interventions
Patient Experience Video Series
What is CAHPS and HEDIS and
Why is the Patient Experience Important to you?
We are thrilled to launch our new Patient Experience Video Series! This month we begin with 'What is CAHPS and HEDIS and Why is the Patient Experience Important to you'.
Each month our Buckeye Medical Directors will share their thoughts and ideas as one clinician to another in these brief videos. We hope you find these valuable in our partnership to make the Patient Experience the best possible outcome.
Coming Soon:
- July: Where to Start When Focusing on Patient Experience?
- August: Care Coordination and Ways to Improve Outcomes
- September: How to Help Patients Get the Care They Need
- October: Barriers to Healthcare Access and How to Overcome Them