Quality improvement initiatives
ODS quality improvement programs are designed for members with asthma, cardiac disease and diabetes. ODS has also developed health education programs to address the importance of childhood immunizations and adult health screenings. ODS quality improvement programs focus on:
- How well we deliver preventive services to members and keep them healthy
- Ensuring that the most up-to-date treatments and interventions are offered for acute episodes of illness and to help improve members’ health
- Assessing the processes we use to deliver care to our members with chronic disease and how well our delivery system helps them manage their illness
- Whether appropriate treatment and testing is being provided to members
For the quality improvement projects listed below, we monitor our Healthcare Effectiveness Data and Information Set (HEDIS) results and analyze our medical and pharmacy claims to regularly measure our progress.
- Adult Tobacco Cessation Program
- ODS Respiratory Care Program
- ODS Cardiac Care Program
- Childhood immunizations
- ODS Diabetes Care Program
- Adult health screenings
Tobacco Cessation Program
The Free & Clear® Quit For Life™ Program is available to individuals age 15 and older. This evidence-based tobacco cessation program is free to most ODS members* and offers the following:
- One-on-one, phone-based sessions scheduled at the patient’s convenience
- Toll-free telephone access to our Quit For Life™ coaches for the duration of the program
- Recommendations for medications such as the nicotine patch, gum, bupropion or Chantix (normal co-pay applies for prescription medication)
- Free delivery of recommended nicotine replacement products, such as the patch, gum or lozenge
- A Quit Guide designed to help patients stay on track between calls
- Interactive Web tools to keep patients engaged with other participants and coaches.
The Quit For Life®Program can help individuals quit tobacco for good. For more details, call 866-784-8454 or visit www.quitnow.net.
*Not all ODS members are eligible for Free & Clear benefits.
Tobacco Cessation clinical guidelines
Screening & Brief Intervention (SBI) This document outlines the purpose and approach to conducting a SBI for youth and adult patients.
ODS Respiratory Care Program
Asthma is a major public health concern. According to the 2008 Behavioral Risk Factor Surveillance System (BRFSS), a survey conducted by the Centers for Disease Control and Prevention, 8.8 percent of the United States population and 8.6 percent of all Oregonians have asthma. According to the 2005 National Health Interview Survey, asthma is associated with 14.7 million doctor visits and 1.8 million ER visits each year.
Outreach
ODS identifies members who are taking more rescue medications than controller medications and provides them with information about how they can better manage their asthma. We offer information for children as well as adults who have the disease. We also send reports to providers to ask for their help in reminding members to take their medications as prescribed.
Respiratory Intervention brochure
ODS Cardiac Care Program
Cardiovascular disease (CVD) is the leading cause of illness and death in the United States. According to the Centers for Disease Control and Prevention, in 2008, the estimated cost of cardiovascular disease and stroke in the United States was more than $400 billion. Although CVD is a costly disease, it is one of the few diseases largely preventable by modifying lifestyle behaviors.
How we help
ODS sends friendly reminders to members who are not refilling their high blood pressure and cholesterol-lowering medications at least 80 percent of the time. The mailing includes materials about why it’s important to take medication as prescribed.
The mailing includes a medication log that helps members keep track of medication information.
Concurrently, ODS sends individual medication adherence reports to these members’ providers to ask for their help in making sure members on high blood pressure and cholesterol-lowering medications fill their prescriptions regularly.
Childhood immunizations
Vaccinations are the easiest way to protect children from infectious diseases. Childhood immunizations continue to be a major focus in public health because they are so effective at preventing illness.
How we help
Since 2002, ODS has sent a newsletter about the importance of immunization to parents of five-month-old children.
In 2009, ODS developed an additional initiative using Oregon Alert Registry data to send member-specific reminders for needed childhood vaccines. The Oregon Alert Registry is a statewide database that keeps immunization records accurate and up-to-date by collecting data from public and private healthcare providers and linking them into one patient record.
ODS sends educational mailings to parents of children age 20 months, reminding them of specific vaccines that are due or that they have missed. Messages in the accompanying newsletter include the importance of immunizations, the risks of not immunizing, common myths, and day-care and school exclusion dates.
In addition to the childhood immunization reminder, ODS members receive important child safety information.
Communicating with people about immunization
- The National Network for Immunization Information provides a comprehensive resource kit to help healthcare providers discuss immunization with their patients.
ODS Diabetes Care Program
According to the 2008 BRFSS survey, 6.9 percent of all Oregonians currently have diabetes. According to Department of Health Services (DHS) data, diabetes hospitalization costs in Oregon were more than $1.1 billion, and total estimated medical costs for diabetes were more than $2 billion. Currently, diabetes has no cure. However, good control of the disease improves health outcomes and can greatly reduce associated health costs. According to current diabetes research, the dramatic rise in type 2 diabetes prevalence among adults and youth is primarily because of unhealthy lifestyle choices. Studies indicate that a healthy diet, with regular physical activity, maintenance of a healthy weight, moderate alcohol consumption and avoidance of sedentary behaviors and smoking, could nearly eliminate type 2 diabetes.
How we help
Members with diabetes, who are due for needed diabetic screenings, such as a dilated eye exam or cholesterol screening, receive a reminder letter and brochure that explains why each screening is important and how often it is recommended. ODS also sends patient reports to providers to help them make sure members receive diabetes-related screenings.
In addition to diabetes screening reminders, ODS sends informational materials to members with diabetes who have not filled a prescription for an ACE inhibitor or ARB medication. These materials convey the American Diabetes Association recommendation for these medications as a first line of defense against high blood pressure and for the protection of the kidneys. The mailing includes educational information about ACE inhibitor and ARB medication.
Adult health screenings
Regular health screenings are the most effective way of detecting cancer early, leading to improved treatment outcomes.
How we help
ODS sends women over 40 and men over 50 a birthday card during their birthday month. The card includes important information about recommended cancer screenings, such as breast and cervical cancer screenings for women, and colorectal cancer screenings for men and women.
How to bill vaccines for children on the Oregon Health Plan
The Vaccines for Children (VFC) Program is a federal program that provides free immunizations for children age 0–18 years.
ODS does not reimburse for the cost of vaccine serums covered by the VFC Program. Providers should bill ODS only for the administration of the vaccines covered under the VFC Program.
Providers should bill the specific immunization CPT code with modifier 26 or SL, which indicates administration only. Providers should not bill for the administration of these vaccines using CPT codes 90465-90474 or 99211 (immunization administration codes).
ODS is unable to reimburse providers who do not participate in the VFC Program for the cost of the serum. Providers not participating with the VFC Program can direct their patients to the County Health Department to receive the vaccines covered under the program. A County Health Department can bill ODS for the administration of the vaccines.
The following CPT codes are covered under the Vaccines for Children Program:
| 90633 | 90634 | 90645 |
| 90647 | 90648 | 90649 |
| 906551 | 906562 | 906571 |
| 906582 | 906604 | 90669 |
| 90680 | 90700 | 90702 |
| 90704-8 | 90710 | 90713 |
| 90714 | 90715 | 90716 |
| 907213 | 90723 | 90732 |
| 90733 | 90734 | 90743 |
| 90744 | 90748 | 90749 |
| S0195 | ||
1 All children ages 6–35 months |
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