Office Visit

EmblemHealth and ConnectiCare have an unwavering commitment to ensuring our members receive quality care. As part of that commitment, we work with our network providers to improve their capabilities around meeting state and federal quality measures. We also provide resources, both online and in the community, that providers can use to identify opportunities for improved care. Here are some of those resources:

Medicare Health Outcomes Survey (HOS) Tip Sheet: Every year, the Centers for Medicare & Medicaid Services (CMS) sends the Health Outcomes Survey (HOS) to a random sample of Medicare members in the summer. Those same members are then surveyed again to look at changes in their self-reported health outcomes.

We published tip sheets for both ConnectiCare and EmblemHealth to assist your practice with enhancing your Medicare patients’ health care outcomes. Review the tip sheets to see how you play a vital role in this process.

Social Determinants of Health (SDOH): EmblemHealth is committed to addressing Social Determinants of Health (SDOH) through a critical collaboration between health plan sponsors, providers, and our community. SDOH are the non-medical factors that influence health outcomes including environmental, geographical, occupational, educational, and nutritional needs.

Watch our webinar where we discuss what SDOH are, why they are important, and their impact on individual health. The webinar also outlines how to address barriers by implementing programs focused on SDOH, how to advance your program, and the future of this work.

We published a new provider guide to Social Determinants of Health (SDOH). This guide includes a list of assessment tools, strategies for our providers to use in their offices, coding guidance, and a section on how EmblemHealth can help you and your patients.

Helpful guides like these are housed in the Quality Improvement sections of our EmblemHealth and ConnectiCare websites. We encourage you to visit these pages and dig into the many resources we’ve collected for your use. We also invite you to read about SDOH in our Population Health MD Perspectives by Dr. Lama El Zein, MD.

Our provider portal offers robust information about member eligibility. You can see both the member’s current active plan as well as their prior plans. We do this so you can see which benefit plan applies to each date-of-service.

To identify the current plan, look for the newest “Coverage Start Date” for the right Coverage Type, (Medical vs. Dental) and:

• Status = “Active”
• Coverage End Date Year = “12/31/9999”

Summer is a great time to get your young patients up to date on their vaccines, immunizations, and boosters as they come in to comply with school or daycare requirements. Be sure to refer your patients for dental care, too.

Here are some helpful tips to engage with parents and help improve immunization rates:

• Review and ensure accurate and thorough chart prep before the appointment.
• Review chart for immunizations gaps.
• Proactively outreach parents to schedule appointments for their children.
• Educate your care teams about scheduling visits within the guideline time frames.
• Continue to ensure at each appointment (even sick visits), that immunization records are reviewed and encourage the opportunity to catch up on missed immunizations.
• Advise parents on the importance of completing each vaccine series timely.

Provide handouts on the diseases/illnesses that the vaccines prevent.

As you know, the Centers for Disease Control and Prevention (CDC) recommends immunizations at specific ages.  

Follow the guidelines for ages 7 to 18 and 6 and under and see more information and resources on childhood immunizations and health activities on the CDC website. Your influence is key in the development, health, and well-being of children.

This is a quality measure based on the American Academy of Pediatrics Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents (published by the National Center for Education in Maternal and Child Health).