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.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is an annual survey sent to members/patients to measure satisfaction with their providers and healthcare systems. The goal of CAHPS is to capture accurate and complete information about the member-reported experiences.
The CAHPS survey measures how well healthcare providers coordinate care among different services and specialists. The survey measures timely follow-up, management of care and provider awareness. Care coordination is essential to patients receiving effective care and can aid in avoiding complications, decreases hospital readmission and improve the overall patient experience.
Tips to help patients coordinate their care:
- Ensure that there are open appointments for patients recently discharged from facility.
- Review patient’s medical records for other specialty practices they have visited.
- Assist patients with scheduling tests.
- Call patients post-visit to ensure that they are scheduled for test or specialist visits.
- Encourage patients to contact the health plan to see if they qualify for a Case Manager to help navigate the coordination of their health care.
Care Coordination for members leads to better disease management, fewer medical errors, and reduces hospital readmissions. Patients experience a smooth transition in their healthcare journey with a reduction of waiting times and easier access to necessary services.
For more information on Care Coordination, visit Behavioral Health | Buckeye Health Plan and review our Coordination of Care Tip Sheet.
Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standard performance measures developed by the National Committee for Quality Assurance (NCQA), which allows direct, objective comparison of quality across health plans. NCQA develops HEDIS measures through a committee represented by purchasers, consumers, health plans, providers and policy makers. This allows for standardized measurement, reporting and accurate, objective side-by-side comparisons.
The BPD: Blood Pressure Control for Patients with Diabetes HEDIS Measure tracks the percentage of adult members ages 18–75 with diabetes (types 1 and type 2) whose blood pressure was adequately controlled (140/90 mmHg) in the measurement year.
HEDIS Improvement Tips:
- If the member’s initial blood pressure is high, repeat the blood pressure later in the visit. You may use the lowest systolic and diastolic blood pressure results for the visit to represent that day’s visit BP results.
- Do not include BP reading taken at an inpatient or ED visit, diagnostic test/procedure or by the member using manual BP cuff and stethoscope.
- BP reading can be used from a common low-intensity or preventative procedure such as vaccinations, TB test, IUD insertion, eye exam with dilating agents, wart removal, injections (e.g. allergy, steroid, Depo-Provera).
- Ensure member is relaxed and have time to sit after transferring to an exam room, not speaking during reading, patients’ legs are uncrossed, and their feet are flat on the floor. Be sure the patient’s arm is resting at chest height, on a table or supported in some way.
- Educate patients on medication adherence, maintaining a log of at-home blood pressure reading and bringing to each visit.
The BPD measure is important for complication prevention, serves as key performance indicator in healthcare assessment, encourages better management practices, and emphasizes patient education about the importance of healthy lifestyle choices to achieve better overall health outcomes.
For More Information about HEDIS, For more information, please review our HEDIS | Buckeye Health Plan website page and view our HEDIS Provider Reference Guide.
- Flu Season
- 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's Advocacy Program
- Video #2 Where to Start When Focusing on Patient Experience?
- Why Is Patient Engagement Important in Healthcare?
- Maximize the Power of an Annual Preventive Visit.
- World Patient Safety Day: Patient Safety from the Start
- Nurses Drive Meaningful Healthcare Outcomes for Patients
- Monthly CAHPS Tips: Rating of all Health Care Quality
- Monthly HEDIS® Tips: Breast Cancer Screening
Patient Experience Video Series
Breaking Barriers to Healthcare
This month's Patient Experience video briefly shares with our clinicians excellent tips on ways to make yourself more accessible to members.
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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?
- August: Video #3 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