2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Preventive Health Care GuidelinesAmerican Academy of Family Physicians(AAFP)American Congress of Obstetricians andGynecologistsNational Cancer InstitutePresbyterian expects that providers provide thefollowing preventive screenings for allasymptomatic members within six months ofenrollment or within six months of a change inscreening standards, as necessary:Screening for breast cancerScreening for cervical cancerScreening for colorectal cancerBlood pressure measurementSerum cholesterol measurementScreening for obesityScreening for elevated lead levelsScreening for tuberculosisScreening for rubellaScreening for chlamydiaScreening for Type 2 diabetesPrenatal screeningNewborn screeningTot-to-Teen health checksPresbyterian has adopted immunization guidelinesapproved by the AAP, the Advisory Committee onImmunization Practices, and the AAFP. ThePreventive Healthcare Guidelines for Children,published by the AAP, were adopted byPresbyterian for members from birth through age20. All preventive health care guidelines arereviewed at least every two years and are updatedwhen clinically appropriate.All member households receive preventive healthcare guidelines as part of their member handbooks,which are available online. The guidelines are alsodistributed annually in the member newsletters.Presbyterian’s Preventive Health CareGuidelinesPresbyterian also informs providers of updates tothe preventive health care guidelines through theNetwork Connection provider newsletter. Writtencopies of the preventive health care guidelines areavailable upon request. For more information,please seehttp://docs.phs.org/idc/groups/public/@phs/@php/documents/phscontent/wcmdev1001475.pdf.Measurement ActivitiesPresbyterian conducts measurement activities atleast annually based on the National Committee forQuality Assurance (NCQA) HealthcareEffectiveness Data and Information Set (HEDIS ® ),and other clinically based measurement rules.Measures are collected from claims and other datasources made available to Presbyterian, such aslab results and medical record reviews.This data provides feedback on the preventivehealth and health maintenance services membersreceive. Presbyterian uses these measurementresults to identify members with or at risk forspecific health problems, and to inform theirproviders that prevention and treatment servicesmay be needed. For selected measures,5-22014 Practitioner and Provider Manual - Ver. 3