SPRING 2012 
  In This Issue:

Medicare and Medicaid Updates

Introducing Care360

EmblemHealth Injectable Drug Utilization Management Program Begins

Claims Corner

Utilization Review Criteria Update

Medical Director Availability After an Adverse Determination

Member Rights and Responsibilities

Provider Advisory Webinars a Success

CAHPS Member Satisfaction Surveys Are in the Field!

Behind the Scenes

Colorectal Cancer Screening

Medication Adherence for Chronic Conditions

Medical Management of COPD

Dental Hygiene Is Important

How to Help Your Patient With ADHD

Your Role in Slowing the Obesity Epidemic

Health and Wellness Programs

What Is a Health Outcome Survey?

Clinical Corner

News&Notes Archive

What Is a Health Outcome Survey?

The Medicare Health Outcome Survey (HOS) was the first outcomes measure used to gather valid health status data in Medicare managed care patients for use in quality improvement activities, plan accountability, public reporting and improving health.

This patient-reported confidential survey also assesses a plan's ability to maintain or improve the physical and mental health functioning of Medicare patients, and to develop action plans to improve patient satisfaction with a plan and provider.

The HOS contains questions about socio-demographics, activities of daily living, chronic medical conditions, health symptoms, number of unhealthy days in the past 30 days, depression risk, as well as height and weight categories used for calculation of body mass index. Four Healthcare Effectiveness Data and Information Set (HEDIS®) measures are included to evaluate management of urinary incontinence, physical activity, osteoporosis testing and fall risk management.

Recent results received from CMS suggest opportunities to address members' concerns. Given that communication between patient and doctor is an important part of any medical encounter, patients who are comfortable with their doctors may be more likely to acknowledge health problems, understand their treatment options, modify their behavior and follow medication schedules. Back pain, being short of breath when sitting or resting, problems with balance/walking, urinary incontinence, depression, falling in the past year, hypertension, arthritis, diabetes and heart conditions remain issues for EmblemHealth respondents.

Collaboratively educating members and assisting them to access services under the physician’s direction may result in addressing improved member health and mental health outlook.

The HOS survey begins in April. EmblemHealth has contracted with a vendor to survey our Medicare members. Please be aware that receipt of this survey may encourage EmblemHealth members enrolled in our Medicare programs to contact you regarding their needs.

*HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


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