Preferredone Community Health Plan

THE MISSION OF PREFERREDONE COMMUNITY HEALTH PLAN (PCHP) IS TO MAKE AVAILABLE TO THE RESIDENTS OF THE STATE OF MINNESOTA COMPREHENSIVE HEALTH MAINTENANCE SERVICES THAT ARE ACCESSIBLE, ACCEPTABLE, AND DELIVERED IN A MANNER CONGRUENT WITH THE ECONOMIC AND SOCIAL NEEDS OF THE COMMUNITY. THE HEALTH PLAN WILL ADVOCATE FOR IMPROVEMENTS IN THE DELIVERY, QUALITY AND COVERAGE OF HEALTH CARE SERVICES AND PURSUE HEALTH CARE PROGRAMS TO MEET COMMUNITY NEEDS.

THE MISSION OF THE QUALITY MANAGEMENT (QM) PROGRAM IS TO IDENTIFY AND ACT ON OPPORTUNITIES THAT IMPROVE THE QUALITY, SAFETY, VALUE OF CARE, AND SERVICE PROVIDED TO ALL PREFERREDONE MEMBERS, WORKING BOTH INDEPENDENTLY AND COLLABORATIVELY WITH CONTRACTED PRACTITIONERS AND COMMUNITY EFFORTS. AS PART OF THE ORGANIZATION'S MISSION, PREFERREDONE ADVOCATES FOR IMPROVEMENTS IN THE DELIVERY, QUALITY, AND COVERAGE OF HEALTH CARE SERVICES, AND PURSUES HEALTH CARE PROGRAMS TO MEET COMMUNITY NEEDS. IN 2021, PREFERREDONE COMMUNITY HEALTH PLAN MAINTAINED ITS ACCREDITATION STATUS OF ACCREDITED FROM THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA), A PRIVATE, NONPROFIT ORGANIZATION THAT EVALUATES AND REPORTS ON HEALTH CARE QUALITY. NCQA ACCREDITATION RECOGNIZES THE COMMITMENT OF OUR ORGANIZATION TO PROVIDE QUALITY HEALTH CARE TO OUR MEMBERS AND DEMONSTRATES THAT WE HAVE INCORPORATED QUALITY IMPROVEMENT INTO THE FABRIC OF OUR BUSINESS. OUR ACCREDITATION STATUS WAS AWARDED AFTER RIGOROUS EVALUATION BY NCQA OF ALL ASPECTS OF OUR PLAN, INCLUDING PREVENTIVE HEALTH SERVICES, MEMBER SATISFACTION, PHYSICIAN CREDENTIALING AND QUALITY IMPROVEMENT. PARTICIPATION IN COLLABORATIVE AND COMMUNITY PROJECTS IN AN EFFORT TO POOL RESOURCES, CREATE CONSISTENCY AMONG PROVIDER NETWORKS IN OUR COMMUNITY AND IMPROVE THE DELIVERY OF HEALTH CARE TO OUR MEMBERS PREFERREDONE PARTICIPATES IN SEVERAL COLLABORATIVE ACTIVITIES. * MINNESOTA COMMUNITY MEASUREMENT (MNCM) IS A COLLABORATION AMONG HEALTH PLANS AND PROVIDER GROUPS WHOSE MISSION IS TO ACCELERATE THE IMPROVEMENT OF HEALTH BY PUBLICLY REPORTING HEALTH CARE INFORMATION. THE VISION OF MN COMMUNITY MEASUREMENT IS: - BE THE PRIMARY TRUSTED SOURCE FOR HEALTH DATA SHARING AND MEASUREMENT - DRIVE CHANGE THAT IMPROVES HEALTH, PATIENT EXPERIENCE, COST AND EQUITY OF CARE FOR EVERYONE IN OUR COMMUNITY - BE A RESOURCE USED BY PROVIDERS AND PATIENTS TO IMPROVE CARE - PARTNER WITH OTHERS TO USE OUR INFORMATION TO CATALYZE SIGNIFICANT IMPROVEMENTS IN HEALTH PREFERREDONE IS ONE OF SEVEN HEALTH PLAN FOUNDING MEMBERS OF MNCM. THE STATE MEDICAL ASSOCIATION, STATE HOSPITAL ASSOCIATION, PARTICIPATING MEDICAL GROUPS, CONSUMERS, BUSINESSES, HEALTH PLANS, AND STATE HEALTH AGENCIES ARE ALL REPRESENTED ON THE ORGANIZATION'S BOARD OF DIRECTORS IN EITHER A VOTING OR NON-VOTING CAPACITY. DATA IS SUPPLIED BY PARTICIPATING HEALTH PLANS ON AN ANNUAL BASIS FOR USE IN DEVELOPING THEIR ANNUAL HEALTH CARE QUALITY REPORT. * CENTER FOR COMMUNITY HEALTH (CCH) IS A COLLABORATIVE WITH HEALTH PLANS, HOSPITALS, AND PUBLIC HEALTH AGENCIES IN THE SEVEN-COUNTY METROPOLITAN AREA IN MINNESOTA WHO MISSION IS TO SHARE DATA AND PROCESSES TO IDENTIFY HEALTH NEEDS AND IMPLEMENT INNOVATIVE APPROACHES TO ADVANCE COMMUNITY HEALTH, WELL-BEING, AND EQUITY. THE GUIDING PRINCIPLES OF THE CCH INCLUDE: - OUR WORK WILL FOCUS ON WHAT CAN BE DONE ACROSS ALL THREE SECTORS - OUR LEVEL OF ENGAGEMENT WILL REFLECT OUR RESPECTIVE PRIORITIES AND CAPACITY - MEMBERS WILL BE CLEAR ABOUT WHO THEY ARE REPRESENTING WHEN CONTRIBUTING OPINIONS AND IDEAS - OUR WORK WILL BE DATA DRIVEN - WE WILL STRIVE FOR EFFICIENCY AND AVOID ADDED WORK - OUR EFFORTS SHOULD ADD VALUE TO OUR WORK - WE WILL AVOID AREAS THAT MIGHT RAISE ANTITRUST CONCERNS, SUCH AS REIMBURSEMENT MATTERS AND PAYOR/PROVIDER RELATIONSHIPS - MEMBERSHIP IN THE CCH DOES NOT PRECLUDE MEMBERS FROM DOING INDIVIDUAL WORK IN THEIR OWN SECTORS, AND - WE WILL STRIVE TO CREATE/ACHIEVE HEALTH EQUITY THE VISION OF THE CCH IS A HEALTHY AND THRIVING TWIN CITIES METRO AREA POPULATION ACHIEVED THROUGH COLLABORATION, DATA SHARING, AND COLLECTIVE ACTION. ORGANIZATIONAL SUPPORT FOR EMPLOYEE VOLUNTEER EVENTS PREFERREDONE SUPPORTS COMMUNITY INVOLVEMENT THROUGHOUT THE ORGANIZATION. EVENTS ARE EMPLOYEE-DRIVEN, WITH THE ORGANIZATION ENABLING OR PROVIDING EMPLOYEE TIME AND/OR FINANCIAL SUPPORT TO ENCOURAGE VOLUNTEERISM. EXAMPLES INCLUDE: - UNITED WAY - COMMUNITY HEALTH CHARITIES - SECOND HARVEST HEARTLAND OTHER CONDITION-SPECIFIC EDUCATION AND SUPPORT PROGRAMS COMPLEX CASE MANAGEMENT COMPLEX CASE MANAGEMENT IS THE COORDINATION OF CARE AND SERVICES PROVIDED TO MEMBERS WHO HAVE EXPERIENCED A CRITICAL EVENT OR DIAGNOSIS THAT REQUIRES THE EXTENSIVE USE OF RESOURCES AND WHO NEED HELP NAVIGATING THE SYSTEM TO FACILITATE APPROPRIATE DELIVERY OF CARE AND SERVICES. THE GOAL OF COMPLEX CASE MANAGEMENT IS TO HELP MEMBERS REGAIN OPTIMUM HEALTH OR IMPROVED FUNCTIONAL CAPABILITY, IN THE RIGHT SETTING AND IN A COST-EFFECTIVE MANNER. IT INVOLVES COMPREHENSIVE ASSESSMENT OF THE MEMBER'S CONDITION; DETERMINATION OF AVAILABLE BENEFITS AND RESOURCES; AND DEVELOPMENT AND IMPLEMENTATION OF A CASE MANAGEMENT PLAN WITH PERFORMANCE GOALS, MONITORING AND FOLLOW UP. IN 2021 THE COMPLEX CASE MANAGEMENT PROGRAM IDENTIFIED 8,990 MEMBERS WHO COULD BENEFIT FROM CASE MANAGEMENT SERVICES.

CHRONIC ILLNESS MANAGEMENT PREFERREDONE'S CHRONIC ILLNESS MANAGEMENT PROGRAM IS AVAILABLE TO MEMBERS WHO ARE DIAGNOSED WITH ANY OF THE FOLLOWING CHRONIC CONDITIONS: * DIABETES * CORONARY HEART DISEASE * CONGESTIVE HEART FAILURE * CHRONIC OBSTRUCTIVE PULMONARY DISEASE * ASTHMA (ADULT AND JUVENILE) * RARE CONDITIONS (ULCERATIVE COLITIS, CROHN'S DISEASE, RHEUMATOID ARTHRITIS, MULTIPLE SCLEROSIS, SICKLE CELL, CYSTIC FIBROSIS, LUPUS, PARKINSONS, MYASTHENIA GRAVIS, HEMOPHILIA, SCLERODERMA, DERMATOMYOSITIS, MYOSITIS, POLYMYOSITIS, CIDP, ALS, AND GAUCHER DISEASE) THE GOALS OF THE CHRONIC ILLNESS MANAGEMENT PROGRAM ARE TO PROMOTE SELF-MANAGEMENT OF CHRONIC CONDITIONS, IMPROVE ADHERENCE TO TREATMENT PLANS WITH AN EMPHASIS ON MEDICATION THERAPY, REDUCE OR DELAY DISEASE PROGRESSION AND COMPLICATIONS, REDUCE HOSPITALIZATIONS AND EMERGENCY ROOM VISITS AND IMPROVE QUALITY OF LIFE. IN 2021 THE CHRONIC ILLNESS MANAGEMENT PROGRAM IDENTIFIED 14,487 MEMBERS WHO COULD BENEFIT FROM DISEASE MANAGEMENT SERVICES. QUIT FOR LIFE PREFERREDONE PARTNERS WITH OPTUM FOR ITS QUIT FOR LIFE TOBACCO CESSATION PROGRAMMING (FORMERLY ALERE/FREE & CLEAR). THIS IS A 6-MONTH TELEPHONIC, WEB AND TEXT-BASED TOBACCO COUNSELING PROGRAM AVAILABLE AT NO CHARGE TO PREFERREDONE MEMBERS AGE 13 YEARS OR OLDER. (AGE 13-17 YEARS NOT ELIGIBLE FOR TEXTING). USES INBOUND AND OUTBOUND TELEPHONE SUPPORT TO SYSTEMATICALLY MOVE PARTICIPANTS TOWARD A SUCCESSFUL QUIT. THE CORE COMPONENTS OF THE QUIT FOR LIFE PROGRAM INCLUDE: - INDIVIDUALIZED COUNSELING WITH A QUIT COACH - PRINTED SELF-PACED MATERIALS (THE QUIT GUIDE) - TEXT TO QUIT (AGE 18+) - WEB COACH/ONLINE COMMUNITY FOR QUIT SUPPORT - INFORMATION AND GUIDANCE ON QUITTING AIDS (NRT SUBJECT TO PLAN BENEFITS) - 24/7 ACCESS TO THE PROGRAM WEBSITE - LIVE VAPE FREE ONLINE RESOURCES FOR VAPING USERS AND THEIR PARENTS QUIT FOR LIFE IS A SYSTEMATIC AND SOLID SCIENTIFIC EVIDENCE BASED BEHAVIOR CHANGE PROGRAM THAT HELPS TOBACCO USERS QUIT. CLINICAL TRIAL RESULTS INDICATE THAT TELEPHONE COUNSELING, ALONG WITH SELF-HELP MATERIALS, INCREASES QUIT RATES. THE QUIT RATE FOR PREFERREDONE PARTICIPANTS IN 2021 WAS 38%. IN 2021, 16 PREFERREDONE MEMBERS ENROLLED IN THE QUIT FOR LIFE SMOKING CESSATION PROGRAM. HEALTH RISK ASSESSMENT (HRA) PREFERREDONE OFFERS AN HRA THROUGH WELLSOURCE TO ALL MEMBERS AND THEIR DEPENDENTS AGE 18 YEARS OR OLDER. THE HRA IS ACCESSED ONLINE THROUGH THE PREFERREDONE MEMBER WEBSITE (WWW.PREFERREDONE.COM) AND CAN BE COMPLETED ONCE PER CALENDAR YEAR. PREFERREDONE SUBSIDIZES THE COST OF THE HRA SO THERE IS NO COST TO THE EMPLOYEE OR THEIR EMPLOYER. PREFERREDONE ENCOURAGES MEMBERS TO PRINT THEIR INDIVIDUAL RESULTS AND TO SHARE WITH THEIR PHYSICIAN IF THEY DESIRE ADVICE OR DIRECTION TO IMPROVE THEIR LIFESTYLE. ALL HRA REPORTS COMPLETED ARE SAVED IN THE MEMBER'S ACCOUNT SO THEY CAN COMPARE THEIR RESULTS FROM YEAR TO YEAR. THE EMPLOYER GROUP CAN PURCHASE A REPORTING AND HEALTH COACHING PACKAGE, WHICH PROVIDES THEM WITH AGGREGATE REPORTING ON THE HRA RESULTS FOR THE GROUP AS A WHOLE. A TOTAL OF 1,093 PREFERREDONE MEMBERS COMPLETED THE HRA IN 2021. PATIENT SAFETY PREFERREDONE DEMONSTRATES A COMMITMENT TO PATIENT SAFETY BY INCORPORATING SAFETY INTO EXISTING QM ACTIVITIES AND TAKING PATIENT SAFETY INTO CONSIDERATION WHEN EXAMINING TRENDS AND DATA FOR POSSIBLE QUALITY IMPROVEMENT ACTIVITIES. PREFERREDONE ALWAYS IMPLEMENTS PROCESSES WITH OVERALL PATIENT CARE OUTCOMES AND SAFETY AS COMPONENTS OF QUALITY IMPROVEMENT ACTIVITIES. ELEMENTS OF PATIENT SAFETY ARE FOUND IN OUR EXISTING QUALITY IMPROVEMENT PROCESSES THAT INCLUDE, BUT ARE NOT LIMITED TO: * IDENTIFYING AND IMPLEMENTING PROCESSES FOR TRANSITIONS OF CARE FOR CONTINUITY AND SAFETY * IMPLEMENTING CARE MANAGEMENT PROGRAMS THAT INCLUDE FOLLOW-UP SYSTEMS TO ENSURE THAT CARE IS RECEIVED IN A RELIABLE AND TIMELY MANNER * IMPLEMENTING PHARMACEUTICAL MANAGEMENT PRACTICES AND POLICIES THAT INCLUDE SAFEGUARDS TO ENHANCE PATIENT SAFETY, INCLUDING AN EMERGING THERAPEUTIC ISSUES PROGRAM IN WHICH MEMBERS AND/OR PHYSICIANS ARE NOTIFIED OF SIGNIFICANT SAFETY ISSUES WITH PRODUCTS COVERED UNDER THE PHARMACY BENEFIT (INCLUDING PRESCRIPTION DRUGS AND CERTAIN MEDICAL DEVICES) * INCORPORATING ADVERSE EVENT REPORTING INTO THE CREDENTIALING PROCESS * TRACKING AND TRENDING ADVERSE EVENT REPORTING TO IDENTIFY SYSTEMS AND/OR NETWORK ISSUES THAT MAY COMPROMISE SAFETY * ANALYZING AND TAKING ACTION ON MEMBER AND PRACTITIONER COMPLAINTS AND SATISFACTION DATA THAT RELATE TO SAFETY * COLLECTING AND PROVIDING INFORMATION ON PROVIDER AND PRACTITIONER SAFETY AND QUALITY, INCLUDING ACTIVITIES ON PROVIDERS ACTIONS TO IMPROVE PATIENT SAFETY AND TO MAKE PERFORMANCE DATA PUBLICLY AVAILABLE FOR MEMBERS AND PRACTITIONERS. CONTINUITY AND COORDINATION OF CARE PREFERREDONE DEVELOPS A WORK PLAN TO SPECIFICALLY ADDRESS ISSUES RELATED TO CONTINUITY AND COORDINATION OF CARE WITHIN OUR NETWORK FOR OUR MEMBERS. DATA FROM VARIOUS SOURCES ARE USED TO IDENTIFY OPPORTUNITIES FOR IMPROVEMENT AND DEVELOP PROGRAMS TO ADDRESS THESE OPPORTUNITIES, AS NECESSARY. POTENTIAL OPPORTUNITIES FOR IMPROVEMENT UNDER CONSIDERATION INCLUDE * SITE OF CARE (SOC) INITIATIVE (INCREASE HHC INFUSION THERAPY UTILIZATION VERSUS HOSPITAL BASED) * MEDICAL INPATIENT FOLLOW-UP * ADMISSION / DISCHARGE / TRANSFER FEED WORK FOLLOWING ED VISIT * OPIOID POLYPHARMACY (TO REDUCE MULTIPLE ER VISITS) * MEDICATION THERAPY MANAGEMENT * EXCHANGE OF INFORMATION * APPROPRIATE DIAGNOSIS, TREATMENT AND REFERRAL FOR BEHAVIORAL HEALTH SEEN IN A PRIMARY SETTING * SPECIAL NEEDS FOR MEMBERS WITH SEVERE AND PERSISTENT MENTAL ILLNESS * APPROPRIATE USE OF PSYCHOTROPIC MEDICATIONS * MANAGEMENT OF TREATMENT ACCESS AND FOLLOW-UP FOR MEMBERS WITH COEXISTING MEDICAL AND BEHAVIORAL DISORDERS * PRIMARY OR SECONDARY PREVENTIVE BEHAVIORAL HEALTHCARE PROGRAM IMPLEMENTATION SERVING A CULTURALLY AND LINGUISTICALLY DIVERSE MEMBERSHIP PREFERREDONE INCORPORATES INTO ITS ANNUAL WORK PLAN EFFORTS TO BETTER SERVE OUR CULTURALLY AND LINGUISTICALLY DIVERSE MEMBERSHIP; PROVIDES INFORMATION AND TOOLS TO STAFF AND NETWORK PRACTITIONERS TO SUPPORT CULTURALLY APPROPRIATE CARE AND FACILITATE EFFECTIVE COMMUNICATION; AND PROVIDES THESE SERVICES THROUGH LANGUAGELINE SOLUTIONSSM, ANNUALLY COMMUNICATING THEIR SERVICE AVAILABILITY TO MEMBERS.