CMS *STAR* QUALITY INITIATIVES

2013

• 2013 CMS Quality Ratings - Technical Notes
• 2013 Star Ratings
• CMS 5 Stars and The Health Outcomes Survey
• CPT_Category_II_Code_Tip_Sheet CQC
• Annual Wellness Visit
• Annual Wellness Visit Sample Letter
• SCAN Health Guidebook
• Quality Improvement Best Practices

HEDIS

• Attest MRRV Timeline
• HEDIS

Surveys

• CAHPS 2012 MA
• CAHPS 2012
• Group Level Survey/SCAN Group Level Survey
• Health Questionnaire sample
• Sample HQ Provider Letter
• Health Outcomes Survey

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Dear Provider:

SCAN Health Plan is committed to quality of care and member satisfaction. In partnership with our network providers, we have conducted quality improvement programs (QIPs) each year to assure that our members receive timely and appropriate care and services. Ongoing quality programs enable us to achieve excellent quality ratings and satisfy federal and state regulatory requirements. Improvements in our member health and satisfaction reflect the care and attention you provide.

SCAN’s QIPs continue with programs implemented in prior years with addition of clinical measures set forth in the CMS Star Quality Ratings. As SCAN’s primary care provider, you will continue to receive by mail, a member profile with care alerts for preventive and chronic care services due. Please review and determine if your patients need to be seen. If member has already received care, please let us know by faxing back the evidence with your corrections.

We encourage you to visit www.scancme.com for web-based interactive CME modules on COPD, Osteoporosis, Falls and other geriatric specific CME courses.

Lastly, we want to underscore the importance of the Annual Wellness Visit, a comprehensive physical exam which includes assessment of functional status and cognitive impairment as part of routine care for our seniors. You can find more information on the Annual Wellness Visit on SCAN’s HCC University web site or click here.

Your recommendations and advice are critical to achieving our goal of improved health and satisfaction of our members. We value your care, collaboration, and look forward to improved quality outcomes. You can direct your questions, comments and suggestions by e-mail to qualityinitiatives@scanhealthplan.com or by fax to 866-951-6315.

Clinical Quality Interventions

• Spirometry testing for patients with COPD
• Bronchodilator treatment for patients with COPD exacerbations
• Stroke prevention for patients with high risk factors: diabetes, hypertension, dyslipidemia, and atrial fibrillation
• Disease modifying anti-rheumatic drugs (DMARDs) treatment for patients diagnosed with rheumatoid arthritis
• Medications or bone density test for patients who have had fractures to treat or prevent osteoporosis
• Mammograms for women up to age 69
• Colon cancer screening – annual FOBT, sigmoidoscopy (every 5 years) or colonoscopy (10 years).

Clinical Guidelines

Spirometry testing for patients with COPD

• Use of Medications in stable COPD
• Differential Diagnosis of COPD
• Standard for diagnosing COPD
• SCAN Health Plan Continuing Medical Education Program

Stroke Guidelines

• Prevention of Secondary Stroke in Patients With TIA and Ischemic Stroke
• SCAN Health Plan Continuing Medical Education Program

Osteoporosis

• Clinician’s Guide to Prevention and Treatment of Osteoporosis
• Calculate a FRAX® Score
• SCAN Health Plan Continuing Medical Education Program

Rheumatoid Arthritis

• Recommendations for the Use of Nonbiologic and Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis

Breast Cancer Screening

• Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement

Colon Cancer Screening

• Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement

Dementia Screening

• Patient Visit Form: Dementia
• Guildelines for Alzheimer’s Disease Management
• Dementia Screening Tools for the PCP

Also, please visit www.SCANCME.com for web-based performance improvement modules

Patient Education Materials
Below are resources for your patients.
COPD
Stroke
Osteoporosis English Español
Rheumatoid Arthritis English Español
Breast Cancer Screening English Español
Colon Cancer Screening English Español

Direct patients to www.scanhealthplan.com/healthtips