GULF SOUTH HEALTH PLANS WAS RECOGNIZED BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE FOR ITS OUTSTANDING PREVENTIVE HEALTH SERVICES

PREVENTIVE HEALTH / DISEASE MANAGEMENT PROGRAMS

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2000 Immunization Schedule

2000 Preventive Health Guidelines

Peptic Ulcers: It's Not Just Stress Anymore

Asthma Quality Initiative

• program developed to improve the status of ambulatory care provided to members with moderate to severe asthma and improve their quality of life
• interventions include targeted mailings, Asthma Self Management Program (ASMP), case management, "Entry Zone" mailings to members, provider lectures, member education
• treatment programs established with NIH clinical practice guidelines

Cervical Cancer

• program implemented to monitor compliance rate for Pap tests for women age 21 to 64 using reminder cards for Pap smears
• 1995, 86.9 % of women in target age group received Pap tests; exceeds reported NCQA national average of 73.7%

Diabetes Case Management Program

Diabetes Center established in 1986

• risk stratification by low, moderate and high risk
• interventions include targeted mailings, case management, member education classes and home health services as indicated, and provider lectures and education
• average glycohemoglobin recently measured at 7.2 (<8 is desirable); average on completion of diabetes program
• treatment programs established with ADA clinical practice guidelines for Type I & II diabetes

Joint Replacement

• clinical redesign including design of case management interventions and clinical pathways completed September 1996
• data analysis on first program participants indicated a 32% decrease in length of hospitalization and improvement of 31% in the Physical Function Score, (SF-12) indicating better outcomes for patients with quicker recovery

Childhood Immunizations

• program developed to achieve immunization rate of greater than 80%,
• provided education, member reminder postcards, and ongoing quality monitoring
• 1995 results indicate 75% compliance rate

Post Hospitalization for Mental Illness

Psychiatric Related Diagnosis identified as one of the top 20 diagnosis groups

• discharge protocol redesigned to ensure proper follow-up after hospitalization for mental illness
• 1995 measurement indicated 88% of members were seen on an ambulatory follow-up basis within 30 days of discharge showing a 9% improvement from 1994

Eye Exams for diabetic patients

• diabetes in known to be a leading cause of blindness and impacts nearly 3% of the population
• diabetes retinal examination has been identified as a HEDIS measure
• interventions include practitioner education, dissemination of AAO guidelines, practitioner notification with a list of at-risk members in need of examination, articles in both member and provider newsletters and collaboration with a capitated eye care group
• HEDIS trending has documented a 90% improvement rate in diabetic retinal examination from 1994 to 1997 which surpasses the National Quality Compass benchmark

Hepatitis B

Mammography

• program implemented to achieve a mammogram compliance rate of 90% or better by the year 2000
• program includes member education, primary care physician education and identification of non-compliant members, member reminder postcards, and continuous quality monitoring
• 1997 results indicated a 69% compliance rate; NCQA quality compass benchmark is 69.1%
• clinical practice guidelines established with monitoring of diagnosis and treatment timeframes