Provider Procedural Manual - The Health Plan

PROVIDER PROCEDURAL MANUAL 2014The Health Plan Quality Management ProgramWellness & Health Promotion EducationThe Health Plan Quality Improvement Department provides preventive health educationalactivities, which can help reduce the incidence of illness and disease for members. The goal ofour wellness and health promotion interventions is to decrease the health risks of members and toimprove their overall health.Employer and/or School Based Wellness programs can be designed to allow for baseline and remeasurementcomparison for each participant as well as overall, aggregate data results.Our Member Wellness Initiatives, Outreach Education, and Health Promotion programs include:Personal Health Risk Assessment A Health Risk Assessment (HRA) is completed on SecureCare members upon enrollment.Members are referred to catastrophic case management, care management, and diseasemanagement programs based on the results. Reassessment is ongoing; and member-specificrisk-stratified reports are reviewed monthly with referrals to care / case management,pharmacy, social services, and disease management as indicated. All adult Health Plan members can take an on-line Health Risk Assessment. This self-guidedtool provides the member with an overall health risk assessment, including readiness tochange status and ways to improve health. Other risk assessments offered are diabetes andcardiac. (Each on-line test takes no more than 10 minutes to complete).The Health Plan Website @ www.healthplan.org / Wellness Services offers the followingfeatures for members: Information Request Referral where members may request various educational materialsbe mailed to them. Monthly Wellness Information featuring short educational and informative pieces withlinks to various websites on specific topics. Health Risk Assessment (see description above). Interactive Health Tools which include health calculators and health screenings. Preventive Health Guidelines to help ensure members obtain the recommendedpreventive services in the timeframes included.Section 8 / Page 18