Welcome to Provider's Corner! This section of our website is customized to meet your needs and will include useful tips and ideas for practices and procedures you need to complete for NCQA, Buckeye and Ohio Department of Medicaid requirements. The intent is to create an easy-to-use, one-stop shop with helpful specifics around Quality measures, such as HEDIS, CAHPS and clinical processes you can use to meet the criteria for these requirements. Be sure to bookmark this page to make it easy to return when you need to reference content. We hope you find this helpful and are open to topics you’d like discussed on the site.
Did you know that our Patient Care (PCA) Advocates Program can assist provider groups with the mutual goal of closing gaps in care for Medicare Patients? The PCA team’s goal is too close HEDIS care gaps for APV, COL, BCS, GSD, EED, KED, CBP, OSW, OMW, and FMC measures for our Medicare members. Our trained team outreaches to Medicare members to discuss open care gaps and educates the members on the importance of preventive care, provides education on member reward programs associated with recommended care, and coordinates with providers to get the members scheduled for addressing these care gaps.
What Does the PCA Team Do for Members:
- Coordinates annual wellness visits, blood pressure checks for members that have recently had elevated blood pressure readings, and schedules members for EED, GSD, KED, OMW, and mammograms.
- Requests members be seen when indicated for bone mineral density screenings and obtains referrals for mammograms.
- Discuss COL testing options with the provider and ask that the office schedulers make notes if the member needs COA measures completed.
- Follows up with members with chronic conditions that have been in the ER to ensure they are getting an appointment to be seen within the seven-day window of time for the FMC measure.
- If a member is scheduled for a quick follow up appointment, but needs an annual Medicare wellness exam, the PCA team might ask if that provider has time to do the annual wellness on the date of the already scheduled appointment. If not, we may ask the office scheduler to schedule a time when the provider can complete the annual wellness for the member.
- Educates members on member rewards and over-the-counter benefits.
- Assists with scheduling transportation.
- Sets up referrals for members to case management and referrals for any social determinants of health needs.
- The Health Plan makes getting needed care easy for our membership by doing the following:
- We often make a three-way call to the provider’s offices with the member, or we may call independently to get an appointment scheduled upon the member’s request.
- The PCA team establishes relationships with PCP’s and specialists for members who prefer the health plan’s assistance in getting the appointments needed, screenings and testing completed.
How can physician offices help the health plan make getting needed care easy for patients?
- Educate office staff, schedulers, and front desk personnel about our PCA program so they can work together on the behalf of patients.
- Allow our PCA teams to visit your office to perform outreach from your office and utilize the land line phone to schedule appointments for your assigned members. This practice is linked to a higher rate of success when reaching members over the phone from a familiar phone number.
When the health plan, the physician and office staff work together, they achieve greater health outcomes for our members and make it easier for patients to get the care they need.
If you would like to contact the PCA team or have any questions regarding the Patient Care Advocates Program, contact your provider engagement administrator or quality practice advisor. For more information on HEDIS Measures, please refer to our 2025 HEDIS Provider Reference Guide: HEDIS | Buckeye Health Plan
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- HEDIS Measures
- CAHPS
- Annual Wellness Visits
- Colorectal Cancer Awareness
- Provider Appointment Standards
- Heart and Nutrition
- Telehealth
- Osteoporosis
- HEDIS/CAHPS Measures: Kidney Health, Eye Exam for Patient with Diabetes, Childhood Immunization Status
- Men's Health Screenings
- Medication Errors: Critical Findings and Critical Interventions
- Understanding How We Grasp Our Members' Experience
- Medallia Program
- Patient Experience Video Series - Video #1
What is CAHPS and HEDIS and Why is the Patient Experience Important to you? - Outpatient Mental Health Survey
- HOS Medicare Health Outcomes
Patient Experience Video Series
Where to Start When Focusing on Patient Experience?
We are thrilled to launch our new Patient Experience Video Series! This month we begin with 'What is CAHPS and HEDIS and Why is the Patient Experience Important to you'.
Each month our Buckeye Medical Directors will share their thoughts and ideas as one clinician to another in these brief videos. We hope you find these valuable in our partnership to make the Patient Experience the best possible outcome.
- June: Video #1 What is CAHPS and HEDIS and Why is the Patient Experience Important to You?
- July: Video #2 Where to Start When Focusing on Patient Experience?
Coming Soon:
- August: Care Coordination and Ways to Improve Outcomes
- September: How to Help Patients Get the Care They Need
- October: Barriers to Healthcare Access and How to Overcome Them