Advantage Health Solutions

• Care-ADVANTAGE
  • Asthma
  • Coronary Artery Disease
  • Congestive Heart Failure
  • Diabetes
  • High Blood Pressure
  • Migraines
  • Case-Management
  • Baby-On-Board (pregnancy program)
  • Tobacco Education
  • Weight Management
• Quality Improvement
  • Preventive Health Guidelines
  • What is HEDIS?
  • CAHPS
  • Clinical Practice Guidelines
  • Immunization Schedule
• Interactive Health Tools
• Mountain of Wellness
• Wellness Within

• Today's Health News
• Health Zone Library
• Other Health Zones
• Weekly Spotlight

Quality Improvement at ADVANTAGE Health Solutions, Inc.

Quality healthcare means getting the gold standard of care you need when you need it. Our Quality Improvement Program addresses this by following the Institute of Medicine recommendations stating that medical care in the 21st century needs to focus on;

• Safety
• Effectiveness
• Patient Centeredness
• Timeliness
• Efficiency
• Equitability

ADVANTAGE Health Solutions, Inc. was awarded "Excellent Accreditation" status by the National Committee for Quality Assurance (NCQA) in 2006. NCQA awards its highest accreditation status of Excellent to organizations with programs for service and clinical quality that meet or exceed rigorous requirements for consumer protection and quality improvement. HEDIS results are in the highest range of national performance.

Preventive Health Guidelines

ADVANTAGE Health Solutions, Inc has developed the Preventive Health Guidelines for both pediatrics and adults. These guidelines are based on nationally recognized standards of care and are provided to our members to ensure they remain updated on maintaining their own personal health through recommended preventative practices. The Preventive Health Guidelines include recommendations for yearly screenings as well as education and counseling with your physician.

Each year the Preventive Health Guidelines are updated and approved by our Physicians Advisory Committee (PAC) in late February. This committee is made up of practicing physicians that work within our health care networks to help establish an overall standard of excellence for your health care needs. If changes occur during the year, they will be updated appropriately throughout the year.

Preventative Health Guidelines

What is a screening?
A screening is looking for a problem before a person has any symptoms.

Breast Cancer Screening:
If you are a woman and between 40-69 years old, you need to get a mammogram to screen for breast cancer at least once every two years.

Colorectal Screening:
If you are between the ages 50-80, you need to get one or more of the following colorectal screenings; Fecal occult blood test yearly, flexible sigmoidoscopy every five years, double contrast barium enema every five years, colonoscopy every 10 years. Please speak with your doctor to find out which screening is right for you!

Cervical Cancer Screening:
If you are a woman between the ages 21-64 years old, you need to be screened for cervical cancer at least every three years. This screening is called a 'Pap smear' and requires a visit to your doctor's office. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

Glaucoma Screening:
If you are 65 or older, you need to be screened for glaucoma. Studies have shown that early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease.

Please view our Preventative Health Guidelines for a complete list of age appropriate screenings and education/counseling.

What is HEDIS?

Healthcare Effectiveness Data and Information Set - So what it is really?

HEDIS was developed by NCQA so they could have a way to measure how effective a health plan is at providing its members with standard of care. These measures include; preventative health screenings and immunizations, appropriate treatment for acute and chronic conditions and monitoring and follow up on care given. These measures are used by 90% of America's health plans so they are a good indicator of how we are doing.

These measures are collected annually and reflect how well we ensure you receive the highest standard of care possible! As you can see, ADVANTAGE has scored consistently above the 50th percentile. This means that of all the health plans in the United States, we are above average in assuring the care required for these measures are completed.

HEDIS 2008 Measurement Guide

Preventative Health	Care needed
Childhood Immunizations The series must be completed by the second birthday	4 DTaP/DT 3 IPV 1MMR 3 HiB 3 hepatitis 1 VZV, or documented chicken pox 4 pneumococcal conjugate
Well Child exams Ages 0-15 months	6 well care visits (at least 2 weeks apart) with PCP
Well Child exams Ages 3-6 years	Annual well care visit with PCP each year
Well Child exams Ages 2-21 years	Annual well care visit with PCP
Chlamydia Screening Age 16-25 and sexually active	Screening for Chlamydia annually
Cervical Cancer Women ages 21-64	PAP test every 3 years
Breast Cancer Screening Women ages 40-69 years	Mammogram every 2 years
Colorectal Cancer Ages 50 - 80 years	One or more of the following screenings Fecal occult blood test yearly Flexible sigmoidoscopy every 5 years Double contrast barium enema every 5 years Colonoscopy every 10 years
Glaucoma screening Ages 65 and older	Glaucoma screening annually
Treatment	Care needed
Treatment of children with upper respiratory infection	Prescription of antibiotic NOT dispensed
Appropriate testing of children with pharyngitis	Children diagnosed with pharyngitis were prescribed an antibiotic and also received a group A streptococcus test 3 days before or 3 days after the prescription
Follow up care for children with ADD/ADHD medication	Children who received medication for ADD/ADHD received At least one follow up visit with prescriber within 30 days of initiation Remained on medication for at least 210 days and in addition to initiation visit, had at least two visit between 4 weeks and 9 months
Pre-natal and post partum care	Prenatal visit within first trimester (or within 42 days of enrollment) Post partum visit between 21 and 56 days after delivery
Adult access to preventative and ambulatory care	Annual ambulatory or preventative visit
Inappropriate antibiotic treatment for adults with acute bronchitis Ages 18-64	Adults diagnosed with acute bronchitis who received an antibiotic prescription on or within 3 days of diagnosis- A lower rate represents better performance!
Annual monitoring for patients on persistent medications Ages 18 or older	Patients on persistent medications who received annual monitoring
Initiation and engagement of alcohol and other drug dependence treatment Ages 13 and older	Patients diagnosed with alcohol and other drug dependence who: Initiate treatment within 14 days Receive two additional AOD [a1]  services within 30 days of initiation
Use of appropriate medication for people with asthma	Children and adults identified with asthma who have received a prescription for long term controller medication for asthma
Persistence of beta blocker treatment after a heart attack	Patients who had a heart attack and were ordered a beta blocker for 6 months after
Cholesterol management for patients with cardiovascular condition Ages 18-75	Patients who had a diagnosis of; acute myocardial infarction, ischemic vascular disease or who had coronary artery bypass graft or percutaneous transluminal coronary angioplasty Screening for LDL-C ('bad cholesterol') Maintain level < 100
Controlling high Blood Pressure Age 18-85	Control is < 140/90
Use of spirometry testing in the assessment and diagnosis of COPD Adults 40 and older	Adults who are newly diagnosed with COPD using spirometry reading
Pharmacotherapy management of COPD exacerbation Adults age 40 and older	Adults who have had a hospitalization or ER visit with diagnosis of COPD who were put on; Systemic corticosteroid within 14 days of discharge Bronchodilator within 30 days of discharge
Comprehensive Diabetes Care	Yearly screening of the following: HbA1c testing HbA1c result > 9.0 = poor control HbA1c result < 7.0 = good control LDL-C LDL-C result < 100 Retinal Eye Exam Nephropathy screening test or evidence of nephropathy Blood pressure collected as 2 measures < 140/90 < 130/80
Osteoporosis management in women who had a fracture	Women who received the following after a fracture; Bone mineral density test Prescription for a drug to treat or prevent osteoporosis six months after fracture
Medical assistance with smoking cessation	Current smokers were seen and; Received advice to quit Cessation medications were recommended Cessation methods were recommended or discussed
Antidepressant mediation management	Newly diagnosed depression treated with an antidepressant swho received: Optimal practitioner contacts ; 3 follow up contacts with in 12 weeks of the original event Effective acute phase; filled sufficient number of prescriptions to allow for 84 days of continuous therapy Effective continuation phase; filled sufficient number of prescription to allow for 180 days of continuous therapy
Follow up after hospitalization for mental illness	Patients discharged from an inpatient mental health admission and receive; One follow up encounter with a mental health provider on the date of discharge or up to 30 days after discharge

CAHPS

What is CAHPS?
Consumer Assessment of Healthcare Providers and Systems - So what is CAHPS really?

The term CAHPS refers to standardized survey that asks you as a consumer and patient to evaluate the interpersonal aspects of health care. Health plans across the United States use CAHPS to monitor how well you are satisfied with the care and service you receive from your health plan and from your healthcare provider.

This survey is completed annually. We hope that if you receive a survey you will participate and answer honestly. By reviewing this information and making the necessary improvements we are striving to be the best health plan in Indiana!

Clinical Practice Guidelines

Clinical Practice Guidelines (CPG) are systematically developed standards to assist the practitioner and patient in making decisions about appropriate health care for specific conditions. The CPG's are developed by organizations that use rigorous review, analysis of peer reviewed research and the use of expert teams. Advantage Health Solutions (AHS) Physician Advisory Committee (PAC) is charged with reviewing and adopting CPG's regarding our Care-ADVANTAGE programs: Asthma, CHF, Diabetes, Hypertension, Migraine, Coronary Artery Disease. They have also reviewed CPG's for COPD and Pregnancy. The PAC is a peer review committee consisting of multi disciplinary team of practitioners.

To encourage the implementation of CPG's and thereby assisting in meeting the strategic plan of Advantage Health Solutions, the PAC has reviewed and approved these CPG's:

ADHD

Asthma Guidelines

Congestive Heart Failure (CHF) Guidelines

COPD Guidelines

Coronary Artery Disease (CAD) Guidelines

Diabetes Guidelines

Hypertension Guidelines

Hypertension Guidelines for Peds

Major Depression

Migraine Guidelines

Pregnancy Guidelines

Immunization Schedule

As part of the ADVANTAGE Immunization Schedule, we have adopted and combined both the Childhood and Adult Immunization schedule into one document for your convenience. This schedule indicates the recommended ages for routine administration of currently licensed vaccines for children through age 18 years and adults. ADVANTAGE Health Solutions, Inc adopts the most current immunization schedule approved by the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP). Additional vaccines may be licensed and recommended during the year, in which ADVNATAGE will update our Immunization Schedule accordingly. This schedule is reviewed yearly in conjunction with many U.S. Government Organizations including the Centers for Disease Control (CDC) and the U.S. Department of Health & Human Services (HHS).

Please feel free to view these immunization practices to assure your child is receiving proper age appropriate vaccinations.

ADVANTAGE Child & Adult Immunization Schedule

This information is not a description of benefits. Please refer to your benefits description materials for the terms, limitations, and exclusions of your coverage. Use this as a guide in scheduling routine care appointments for your family. Your physician can make more specific recommendations based on your health risks.