Skip to Main Content

Quality Snapshot

 

Stay informed and aligned with the latest Quality priorities through our collection of articles designed for providers and internal teams. This page serves as a centralized resource for various topics such as: best practices, regulatory guidance, and performance insights that support quality improvement initiatives. You’ll find helpful, actionable content to help enhance patient outcomes, ensure compliance, and drive consistent, high-quality care for our members, your patients.

A fracture in an older adult, especially of the hip, spine, wrist, or shoulder, may be an early warning sign of osteoporosis. Without appropriate evaluation and treatment, patients who experience a fracture are at significantly higher risk for future fractures, which can lead to chronic pain, reduced mobility, loss of independence, hospitalization, and increased healthcare costs.

The OMW measure focuses on women ages 67–85 who have experienced a fracture. To meet the measure, patients must receive either a bone mineral density (BMD) test or osteoporosis treatment within 6 months (180 days) of the fracture. 
A referral or order alone does not close the gap—the test must be completed or medication dispensed within the timeframe.  

Our Patient Care Advocacy Team Can Supports Your Practice

Our Patient Care Advocate (PCA) team partners with your office to help close care gaps by: 

  • Providing lists of patients due for post-fracture follow-up 
  • Assisting with scheduling bone mineral density testing and coordinating care 
  • Conducting member outreach to encourage completion and address barriers 
  • Following up with your office to support timely documentation and closure  

  How You Can Help Close:

  • Ensure BMD testing is completed after a fracture 
  • Educate the members on the importance of following through with the testing after an order is provided 
  • Prescribe or initiate osteoporosis treatment when appropriate 

Providers play an important role in closing care gaps by assessing fracture history, ordering bone density testing when appropriate, discussing fracture risk with patients, and initiating or coordinating osteoporosis treatment. Educating patients about bone health, fall prevention, nutrition, physical activity, and medication adherence can further help reduce future fracture risk and improve long-term outcomes.

Your partnership is essential to closing HEDIS® Transitions of Care (TRC) gaps and ensuring timely follow-up for patients following an inpatient discharge.  

Buckeye Health Plan is taking several steps to support providers in meeting the NCQA HEDIS® Transitions of Care requirements; however, action is needed by your office to ensure these opportunities are successfully documented and closed.  

Buckeye Health Plan sends Admission and Discharge Notifications to your office to alert you when a member has experienced an inpatient admission or discharge. 

Action Needed from Your Office:

To support compliance with the NCQA HEDIS® Transitions of Care (TRC) measure, please: 

  • Review and scan admission/discharge fax notifications into the patient's medical record.  The fax notification may serve as supporting documentation for the Notification of Admission and/or Discharge component of the TRC measure. 
  • Schedule and complete a post-discharge follow-up visit within 30 days of discharge.  Timely follow-up care is a key requirement of the TRC measure and helps ensure continuity of care for your patients. 
  • Complete and document medication reconciliation.  When billing for medication reconciliation, include CPT II code 1111F on the claim.   
  • Bill CPT II code 1111F with a charge amount of $0.01.  Wellcare will reimburse the claim, allowing the medication reconciliation service to be captured appropriately and supporting closure of the TRC measure.  
  • Submission of 1111F helps ensure the service is recognized during claims processing and reduces the risk of the code being omitted from reporting.  

We encourage you to share this information with staff responsible for: 

  • Processing incoming faxes 
  • Scheduling patient appointments 
  • Care coordination and transitional care management 
  • Coding and claims submission 

Together, we can improve care transitions, support better patient outcomes, and close important NCQA HEDIS® Transitions of Care gaps.  Thank you for your continued partnership in delivering high-quality care to Buckeye Health Plan members.  

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

TRC Flyer

Buckeye Health Plan is committed to improving member outcomes through strong provider partnerships and focused care gap closure efforts. As noted in recent quality initiatives and provider communications, collaboration between Buckeye and our provider network is key to identifying and addressing care gaps and improving overall quality performance. 

Providers interested in partnering with Buckeye Health Plan to close care gaps are encouraged to submit a request for collaboration. Our team can provide resources, data insights, and targeted support to help enhance care delivery and improve patient outcomes. 

To express interest, please contact BuckeyeQualityImprovement@CENTENE.COM

Preventable surgical harm remains a significant patient safety concern and an ongoing priority for high-quality care. Buckeye Health Plan is committed to partnering with providers to support consistent, evidence-based surgical practices that improve outcomes across care settings.

The need for continued focus on surgical safety is well established. The World Health Organization (WHO) reports that complications following inpatient surgery occur in up to 25% of patients, and at least half of these events may be preventable.

In the United States, preventable “never events” continue to occur despite established safeguards. A systematic review published in JAMA Surgery found median rates of 0.09 wrong-site surgeries and 1.32 retained surgical items per 10,000 procedures. Additionally, The Joint Commission reported 112 wrong surgeries and 110 unintended retained foreign objects in 2023, underscoring the importance of sustained vigilance and adherence to safety protocols.

Consistent use of standardized surgical safety practices remains critical. Providers are encouraged to reinforce:

  • Preoperative verification processes
  • Surgical site marking
  • Surgical time-outs
  • Instrument and sponge counts
  • Postoperative debriefing
  • Ongoing surgeon and team-based education

Evidence shows that structured safety programs, such as those supported by the Agency for Healthcare Research and Quality (AHRQ), can help reduce surgical complications and improve adherence to best practices through team training and standardized workflows.

Buckeye Health Plan supports provider efforts to strengthen surgical safety through education, quality initiatives, and alignment with national best practices. By working together to reinforce standardized protocols and continuous learning, we can reduce preventable harm and improve health care outcomes for our members.

References & Resources