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COPD Member and Physician Interventions

The physician and patient can collaborate together, to take proactive steps in addressing and managing Chronic Obstructive Pulmonary Disease (COPD).

Interventions Based on Stratification

The HealthPlus Risk Stratification method is based on condition eligibility criteria, clinical and financial data, predictive modeling and self-reported information. Stratification is a dynamic process and the stratification level can change as the member’s condition changes.

Eligible members are categorized into four levels of risk, where Intense represents the highest level of risk and Low indicates the lowest level of risk.

Member Interventions

HealthPlus provides the following interventions and resources to members, caregivers, or guarians to address COPD issues.The COPD patient or the caregiver or guardian may provide the following interventions to address COPD issues.

Intervention

Risk Level

 

Low

Moderate

High

Intense

Introductory letter and program packet informing how member was identified, how to use the services and how to opt out

Once initially

Once initially

Once initially

Once initially

Welcome call

Once initially

Once initially

Once initially

Once initially

Health Appraisal (includes depression screen)

Every two years

Every two years

Every two years

Every two years

Disease-specific newsletter (includes lifestyle issues, smoking cessation, etc.)

2x/year

2x/year

2x/year

2x/year

Educational materials

4-6x /year

4-6x /year

4-6x /year

4-6x /year

Special equipment (e.g., nebulizer)

As needed

As needed

As needed

As needed

Web-based support and education (Krames Online /disease-specific videos)

Available

Available

Available

Available

Seminars (e.g., nutrition)

2x /year

2x /year

2x /year

2x /year

Tobacco cessation

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Weight management

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Behavioral health referral

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Member satisfaction survey

Annually

Annually

Annually

Annually

General standards of care reminder message (automated phone/mail)

Annually

Annually

Annually

Annually

Missed services reminders (automated phone/mail)

3x/year

3x/year

3x/year

3x/year

Polypharmacy review

 

Monthly

Monthly

Monthly

Care Counseling RN monitoring and assessment calls (includes SOC & PHQ2)

 

 

Monthly

 

Case Management telephonic assessment for standards of care compliance after ER visit twice within 6 months

 

 

 

Monthly

Case Management discharge telephonic assessment for standards of care compliance after 2 or more inpatient admission for CVC in the past 30 days within the past 182 days

 

 

 

Each Discharge

  • Assessment/enrollment for case management after current admission for condition within the last 30 days or
 

 

 

 

Each Discharge

  • Predictive Modeling Score of Resource Utilization Band (RUB) equal to five with a PRS > 7 and trending up at least 15% within past 30 days.
 

 

 

 

Monthly

Physician/Provider Support

The medical practitioner may be provided the following interventions to address COPD issues.

Intervention

Frequency

Program fax back form to get provider input on High Strat members and the appropriateness for monthly RN care counseling calls

At least annually

Provider manual introduction to programs

Once initially

Notification of disease management program information in Provider Plus newsletter

Annually

Educational tools for offices

As needed

Exception list of primary and secondary services

Monthly

Patient Chronic Care Profile identifying potential missed services and co-morbid conditions

Semi-annually

HEDIS® compliance reports with academic detailing (with benchmark and peer comparative analysis) to PCPs

At least annually

Lunch and Learn by RN disease management coordinators

Offered

Educational review on pharmacy utilization for practitioners with members with poly-pharmacy Moderate strata (all members eligible)

Monthly

Nurse medical record review for individualized performance and feedback, and education for physicians with members in Moderate-High-Intensive risk stratification

As needed

Office staff educational forums provided by HealthPlus

At least annually

Office Care Improvement

  • Audit, feedback
  • Tools, materials
  • Office staff education
 

As needed

Web-based support including access to patient education tools, clinical guidelines and forms to promote electronic exchange of information. (Provider can request mail option)

Ongoing

Physician/Provider satisfaction survey

Annually

Tobacco cessation program materials

Telephonic / Fax Referral / Print Materials / Website

Depression screening materials

Print Tools/Website

Weight management program

Telephonic / Fax Referral / Print Materials / Website

Disease Management follow-up after ER visit

As needed

Web-based KRAMES Online patient education materials and disease specific videos

Available as needed

Save Your Breath COPD Program offered to physician offices

Ongoing

Advise the Quit Plus Program offered to physician offices

Ongoing

HealthPlus employs and tracks performance measures for each Disease Management program.

Each measurement:

  • Addresses a relevant process or outcome
  • Produces a quantitative result
  • Is population based
  • Uses data and methodology that are valid for the process or outcome measured
  • Has been analyzed in comparison to a benchmark or goal

HEDIS® Measures

Current measures include spirometry testing and Pharmacotherapy Management of COPD Exacerbation (PCE).

Spirometry Testing:

HEDIS® specifications include the percentage of members, 40 years of age and older, with a new diagnosis of active COPD and who received appropriate spirometry testing to confirm the diagnosis.

Data Elements for Reporting 

  • Measurement year
  • Data collection methodology (administrative data)
  • Eligible population
  • Numerator events by administrative data
  • Reported rate
  • Lower 95% confidence interval
  • Upper 95% confidence interval

Pharmacotherapy Management of COPD Exacerbation (PCE):

The percentage of COPD exacerbations for members 40 years of age and older, who had an acute inpatient discharge or ED encounter between January 1 and November 30 of the measurement year and who were dispensed appropriate medications, there are 2 rates that are reported:

  1. Dispensed a systemic corticosteroid within 14 days of the event
  2. Dispensed a bronchodilator within 30 days of the event

Data Elements for Reporting 

  • Measurement year
  • Data collection methodology (administrative data)
  • Eligible population
  • Exclusions based on direct transfers to another facility
  • Exclusions based on readmissions
  • Numerator events by administrative data
  • Reported rate Lower 95% confidence interval
  • Upper 95% confidence interval

Additional Measures/Outcomes

  • Member satisfaction:  HealthPlus establishes, annually, satisfaction by evaluating member survey results, member inquiries and complaints.
  • Physician satisfaction:  HealthPlus establishes, annually, satisfaction by evaluating physician survey results.
  • Health care cost reduction
  • Health care utilization (in-patient, emergency department and pharmacy)
  • Annual member participation rates

For more information about the HealthPlus Disease Management Program, please contact a HealthPlus Disease Management Coordinator at (800) 345-9956, ext. 8050, or by e-mail to dismgmt@healthplus.org.

Additional Resources: