Providernewsletter2009winterDelaware Physicians Care Named One of Top Medicaid Plans in the Nation by U.S.News & World Report/ NCQAProvider Volume 4, Number 1Winter 2009Mission StatementDPCI and Schaller Anderson, an Aetna company, strive for value, integrity and compassion in health care management and consulting.VisionThe vision of DPCI and Schaller Anderson, an Aetna company, is to be recognized as the nations foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.Inside This IssueDPCI Provider Relations TeamDPCI - National Finalist in URAC Awards2008 CAHPS Medicaid Member Satisfaction Surveys ResultsHEDIS CornerDelaware Health AdvisorySpecialty Pharmacy Authorization FormFrom Stans CornerMaking Your Job EasierPrimary Care Provider Panel Size Attestation ProcessProvider Orientation SessionsGlobal SurgeryWe Want You to KnowClaims Reconsideration Process vs.Provider Appeal ProcessDPCI Medical DirectorsDPCI Sponsors the Annual Dr.Martin Luther King, Jr.Day of CelebrationProvider Physicians Care a National Finalist in URAC Best Practices in Health Care AwardsHealth Plans text messaging program for diabetics recognizedDelaware Physicians Cares innovative text messaging program for diabetics has led to the plans selection as one of QDWLRQDOQDOLVWVLQ85&VBest Practices in Health Care Consumer Empowerment and Protection Awards competition.The competition drew entries from across the nation.
name winners of the awards during the 2009 Best Practices Conference & Exhibit, April 1-2, 2009 in Orlando, Fla.
Delaware Physician Cares pilot program using text messaging to remind members who have diabetes of the need to schedule regular blood tests was so successful with members that the plan recently began a second program, reminding pregnant moms of their prenatal and postnatal appointments.
The plan found in the diabetes pilot that after six months, the percentage of patients receiving a necessary test rose from 52.3 percent to 70.5 percent when members received text messages.Furthermore, the results were much higher than the 45.4 percent rate for members of a control group of diabetes patients who did not receive text messages.The Best Practices Awards and Conference provide a unique opportunity for leaders in health care management to learn what premier companies are doing to advance consumer protection and a one-of-a kind conference, designed to inspire the industry as a whole to rapidly adopt proven practices that advance patient safety and empower consumers with improved decision-making tools.We are very pleased to receive this recognition for our program, said Dr.Stanley Lynch, Delaware Physicians Care chief medical of their patients, leading to a decrease in no-show , but also from having ready access to information about their disease. DPCI Provider Relations TeamMike McGarrigleDirector, Provider Relations(302) BruetteHospitals and Out-of-State Providers(302) BattallioNew Castle County (302) FreemanKent County, DE & Cecil County, MD(302) ChristianSussex County, DE & Worcester County, MD(302) FieldsBehavioral Health and Ancillary Providers(302) Taylor-OrossCredentialing Manager(302) StubbsCredentialing Specialist(302) WalshCommunications(302) CHILD MEMBER SATISFACTION SURVEY SUMMARY*2008 CSS Multi-Plan Average How Well Doctors Physicians Care, Incorporated (DPCI) is committed to ensuring the delivery of high quality care and services to our membership.The DPCI Consumer Assessment of Healthcare Providers and Systems (CAHPS 3.0H) is conducted annually on behalf of Schaller Anderson, an Aetna company by the Center for the Study of Services (CSS), Healthcare Effectiveness Data and Information Set (HEDIS) audit.
The CAHPS surveys adult members and parents of children and are reported separately.
Members are randomly selected and surveyed using a mixed survey methodology (mail and telephone) during a four month period (February to May 2008).
Information obtained from the surveys allows DPCI to measure how well they are meeting their members expectations.
In addition, the surveys satisfy NCQA requirements for MCOs to gather information at least annually regarding member satisfaction.
We are pleased to share our results, which have either met or exceeded most of our benchmarks.
The results assist with identifying the plans strengths and opportunities for improvement in collaboration with our providers.
Below is a snapshot of our 2008 results
Enabling Direct Access Testing (dat) With Lab Portal Software
9DAT only one facet of larger phenomenon of consumer- ... Phenomenon in the Lab World ... through LabCorp to market tests downstream to physicians (delawarephysicianscare.com)
If you have any questions or comments about these results or suggestions for improvement, please contact our Quality Management Department at 2008 CAHPS Medicaid Member Satisfaction Surveys ResultsDPCI demonstrated improved rates from CY 2007 to CY CY 2007 to CY 2008:Getting Needed CareGetting Care of Health CareRating of Health PlanDPCI met or exceeded 2008 Plan goals in three areas:Getting Care QuicklyRating of Health CareRating of Health 2008 CSS Child Medicaid Average of Child Medicaid Plans surveyed by CSS were:Rating of Health CareRating of Health Rating of Health Plan:Getting care as soon as wanted Rating of personal doctor or nurse Doctor showed respect for what member says Doctor listened carefully to member Finding or understanding written materialsProvider ADULT MEMBER SATISFACTION SURVEY SUMMARYPlan Average*Compass- Adult Mean ScoreRating of All Health CareHow Well Doctors CommunicateOther Content AreasAdvising Smokers to Quit (Rolling Averages)(Rolling Averages)Averages)2008 CSS Adult Medicaid Average of Adult Medicaid Plans surveyed by CSS**The methodology for calculating the Customer Service composite changed in 2008.The 2007 Customer Service composite score was re-calculated using the new methodology.This is not the calculation that was used for HEDIS demonstrated improved rates from CY 2007 to CY 2008 in six areas
Dat labportalfeb03Bruce A.Friedman, M.D.Enabling Direct Access Testing (DAT) with Lab Portal Software-Overhead 2-Goals and Objectives for this LectureDiscuss direct access testing (DATDirect Access Testing as a New Line of Business Enabled by the Web and Lab Portal Software-Overhead 4-What Is Direct Access Testing and What Accounts for Sudden Surge of Interest?DAT enables consumer to order a menu of high-quality lab tests via the web without using a physician intermediaryAlthough concept not new, web-mediated OE/RR has taken this new this lab product line into homes of all consumersDAT not a new form of alternate healthcare but rather a new approach to case-finding and wellness-monitoringDAT only one facet of larger phenomenon of consumer-controlled selection & utilization of healthcare servicesSurge of media interest prompted by keen interest on part of readers in new web initiatives and connection to healthcare-Overhead 5-care and more on self-care health-related products and servicest; attractive new market for labsr direct access testing (DAT)are -Overhead 6-Direct Access Testing Not a New Phenomenon in the Lab WorldMisguided to view DAT as a new phenomenon; really a web-enabled variant of older widely available testing servicesKit-testing and home-testing (glucose monitors, pregnancy ) are common examples of DATMall testing has been available for decades; testing performed in malls in cooperation with service organizationsDAT opponents focus on DAT misinterpretation & false-so apply to home/kit testingCurrent DAT model differs from these older examples in scale/scope; testing now performed by major reference labs-Overhead 7-www.questest.com) has validated Quest also pushing the envelope by using political lobbying in Warning labelson DAT web sites directing customers to seek T today is that the process -Overhead 8-Direct access testing has potential Such patients could order appropriate tests themselves, using -Overhead 9-Hospital-owned insurance plans may offer lab accountsfor Defined benefit health insurance planslike Lumenosmedicine and wellness expendituresDAT could potentially fall into these categories-Overhead 10-DAT would seem to be a free lunchin that the cost of -Overhead 11-offers a DNA prescription drug reaction profilereport directly to consumersgenomic/proteomic testing directly to the publicr control over test marketing, and test branding when they own the test patentsReview Value Proposition from the Perspective of Consumers, Hospital Labs, Reference Labs, and DAT Test Brokers on the Web-Overhead 13-iently compelling on part of at this time i.e., risk of takingans provide as subscriber benefit-Overhead 14-for continuous testingnot want family physician to MD with test results in-handDesire to gamethe system; available in traditional channels or -Overhead 15-For health systems & their owned insurance/ managed care Some hospital labs insufficiently entrepreneurial to launch -Overhead 16-market; may be pursing more high-enddirection for testingmay be thin, so need volume business to prosperMarketing challenge for Quest will be to develop their DAT line without alienating their physician office customersOne of Quests goals may be to convert patient service centers (PSCs) to consumer health serv-Overhead 17-consumers and labs; actual drawing/testing outsourced Basic Components of Lab Portal Software; HowThese Systems Will Evolve-Overhead 19-via a browser for test ordering, reConnectivityDSL office hookupOffice web hostingOffice web browsingApplicationsction by preference/payor, rules development/ : bar-coded label, packing slip, lab Result-reporting features: reference ranges, interpretive reporting, organ system : patient/physician, electronic medical about Links to other quality Test result transfer to.
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