Author: MM_ADMIN

Upper Respiratory Infection – Appropriate Treatment for Children With Upper Respiratory Infection . The percentage of children 3 months–18 years of age who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription. *The measure is reported as an inverted rate [1 – (numerator/eligible population)]. A higher rate indicates appropriate treatment of children with URI (i.e., the proportion for whom antibiotics were not prescribed).

Further reading –

https://providers.optimahealth.com/clinicalreference/Pages/Avoidance-of-Antibiotic-Use.aspx

Prenatal and Postpartum Care – The percentage of deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care. • Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester or within 42 days of enrollment in the organization. Postpartum Care- The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.

Further reading –

https://www.medicaid.gov/medicaid/quality-of-care/downloads/strategies-to-improve-postpartum-care.pdf

Managed behavioral healthcare organizations (MBHO) can be independent organizations, can be part of a health plan or can be supported by health care providers. All have a common focus: deliver value. Key strategies for accomplishing this include network development, performance measurement, managing utilization, coordinating care and setting payment rates. Managed behavioral healthcare organizations (MBHO) can be independent organizations, can be part of a health plan or can be supported by health care providers. All have a common focus: deliver value.
Key strategies for accomplishing this include network development, performance measurement, managing utilization, coordinating care and setting payment rates.

Further reading –

https://prezi.com/0vo1evondfjr/managed-behavioral-healthcare-organizations-mbho/

Immunizations for Adolescents – The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine and one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) or one tetanus, diphtheria toxoids vaccine (Td) by their 13th birthday.

Further reading –

http://www.ncqa.org/portals/0/Immunizations%20for%20Adolescents.pdf

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment – The percentage of adolescent and adult members with a new episode of alcohol or other drug (AOD) dependence who received the following.

• Initiation of AOD Treatment. The percentage of members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.

• Engagement of AOD Treatment. The percentage of members who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit.

Further reading –

https://www.mhswi.com/content/dam/centene/MHSWI/Providers/PDFs/WI_Medicaid_(IET)_Provider_03_31_17%20BRIEF%20FINAL.pdf

Follow-Up After Hospitalization for Mental Illness – The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Two rates are reported: • The percentage of discharges for which the member received follow-up within 7 days of discharge.

Further reading –

http://www.ncqa.org/portals/0/Follow-Up%20After%20Hospitalization%20for%20Mental%20Illness.pdf

Disease management programs are increasingly being utilized by state Medicaid programs to provide better care while reducing costs, particularly for individuals with chronic conditions. Early research has shown that while disease management programs are relatively new, there can be substantial reductions in health care service use and expenditures. Disease management programs have been developed and implemented largely by managed care plans. Programs for diabetes, asthma, hypertension, depression and congestive heart failure are the most common. Health plans and Medicaid agencies generally contract with disease management organizations to provide services, although some choose to operate the program themselves.

Further reading –

http://www.aafp.org/dam/AAFP/documents/advocacy/coverage/medicaid/ES-MedicaidDiseaseManagementPrograms-121305.pdf

Potentially Harmful Drug-Disease Interactions in the Elderly – Potentially Harmful Drug-Disease Interactions in the Elderly: Assesses adults 65 and older who have a specific disease or condition (i.e., chronic renal failure, dementia, history of falls) and were dispensed a prescription for a medication that could exacerbate that condition.

Use of High-Risk Medications in the Elderly: Assesses adults 65 and older who received at least one high-risk medication or who received at least two different high-risk medications.

Prescription drug use by the elderly can often result in adverse drug events that contribute to hospitalization, increased duration of illness, nursing home placement, falls and fractures. Despite widely accepted medical consensus that certain drugs increase the risk of harm to the elderly, 1 these drugs continue to be prescribed. Because older adults are more likely to take multiple medications for multiple conditions, they are also at higher risk of potentially harmful drug-disease interactions. Avoiding the use of high-risk drugs is an important, simple and effective strategy in reducing medication-related problems and adverse drug events in older adults.2

Further reading –

http://passporthealthplan.com/wp-content/uploads/2017/01/Potentially-Harmful-Drug-Disease-Interactions-in-the-Elderly.pdf