Focus on Prevention for Quality Improvement | A Quarterly Plan

April 25, 2017

Health plans can focus on prevention to improve their quality scores and impact the health of their members. Prevention can include any number of interventions and can range from primary prevention such as exercise programs to secondary and tertiary prevention, such as immunizations and cancer screenings. Prevention also includes case management to make sure people with high-risk conditions are receiving needed care and can also include home visits post hospitalization.

One strategy is to plan several interventions quarterly, which will leave time to assess impact. By choosing a primary, secondary, and tertiary intervention, health plan professionals can plan and budget annually. Examples of planned quarterly interventions are as follows:

Quarter One

Mailed information on exercise programs, including plan-sponsored programs such as Silver Sneakers; reminder cards when immunizations are due, and where to access; and mailings or contacts with members with Type 2 Diabetes, reminding them to see the ophthalmologist for a Diabetic Retinopathy Examination annually or when due.

Quarter Two

Send nutrition reminders, such as coupons for the local farmer's market or information on local grocery stores that deliver; how to make sure exercise shoes fit, foot care for diabetics, including reminder cards for podiatry appointments and nail care; encouragement for members with congestive heart failure to monitor weight regularly, and guidelines for reporting rapid weight change to primary care doctor. Information on alternative approaches to pain control may benefit members.

Quarter Three

Outdoor exercise safety tips; reminder cards to have Vitamin D screening done; information on depression and when to seek help; information on which supplements to avoid if taking aspirin, coumadin, or other blood thinners. Information on incontinence, when to talk to primary care, and which incontinence devices are covered under insurance. Notes for women on signs of UTI, including confusion and lightheadedness.

Quarter Four

How to use the new fit monitors or a pedometer to measure steps; coupon for pedometer or fit monitor. Information on salt and the relationship to blood pressure; a reminder to have blood pressure checked and when to call primary care doctor. Reminder cards for members with diabetes to have their A1C and kidney function checked, and to see primary care every 3 months. Include OTC diet supplements to avoid.

High-risk populations can also be offered interventions on a rolling basis. Women's health can include osteoporosis screenings, breast cancer screening, falls prevention through tai chi classes, access to water aerobics, and a screening survey of transportation needs for those who no longer are able to drive. Referrals to social services can be made as needed. Those with cognitive impairments can receive information and assistance on how to access social services in the community. They can also receive information on how to access caregivers when the time comes.

Coordinating efforts with social services in the local community can form partnerships that benefit members. The local senior center can provide meals, socialization, transportation, dance and chair yoga classes. 

Of special concern is the re-hospitalization of members who have just been discharged. It is critical to use home visits to assist in falls prevention, nutrition, and transportation for follow up. Medication review and reconciliation are also critical to avoid errors at a time when sleep problems and pain can affect concentration. Durable medical equipment delivery, set-up, and use can cause problems for frail members just out of the hospital. On a home visit, make sure the needed equipment is present, working, and the member can use it without harm, such as tripping over oxygen tubing or cords. Some equipment, such as canes and walkers, can make things worse if members are not shown how to use them properly.

Focus on prevention can improve member engagement, health quality scores, and provides a virtually endless supply of opportunities to interact with members to positively impact their health.

For more information on using prevention to improve quality performance, please contact us.


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