Sunday, December 17, 2017

OCMA Blog

CalOptima Ranked Top Medi-Cal Plan in California

National Committee for Quality Assurance (NCQA) honor recognizes CalOptima’s overall quality of care for more than 600,000 Orange County residents

ORANGE, Calif. (September 18, 2014) — CalOptima is California’s top-ranked Medi-Cal health plan, according to the NCQA’s Medicaid Health Insurance Plan Rankings 2014–2015.

CalOptima is 1st in the state and 29th nationwide among the 136 Medicaid plans that were ranked. The NCQA rankings are based on standardized, third-party-audited data regarding health care quality and customer satisfaction, as well as NCQA accreditation scores. CalOptima’s ranking is due to a Board of Directors and executive leadership decision last year to collect and share the full set of NCQA measures so nationwide comparison would be possible in 2014.

“CalOptima’s commitment to quality for our members is reflected in the NCQA recognition,” said Mark Refowitz, Chairman of the CalOptima Board of Directors. “Our ranking is confirmation that Orange County’s most vulnerable residents are healthier because of CalOptima and our provider partners. We share this honor with the thousands of dedicated doctors, health care providers, hospitals and other facilities that deliver care to our members daily.” 

CalOptima CEO Michael Schrader said that the 2014–2015 NCQA rankings of Medicaid plans come at an important time of expanded access to such plans for low-income people across the nation. In Orange County through CalOptima, nearly 200,000 people have gained health coverage since January 2014, he said. “Our new members can rely on CalOptima and feel confident that the care they receive is among the best in the state,” Schrader said. “CalOptima is a mission-driven organization focused on providing all members with access to quality health care delivered in a cost-effective and compassionate manner. The NCQA ranking affirms that we are truly living our mission.”

NCQA assesses plan quality based on 46 clinical measures related to both preventive care and treatments. Preventive measures report whether members are getting services to keep them healthy, such as well-child visits, immunizations, nutrition counseling and breast cancer screenings. Treatment measures gauge whether members are receiving appropriate care and medications in response to acute illnesses and chronic diseases, including diabetes and high blood pressure. NCQA also evaluates plan quality based on 11 customer satisfaction dimensions, such as getting care quickly and how well doctors communicate. Further, CalOptima is NCQA accredited with “commendable” status through 2015, which also contributes to the agency’s new high ranking in California.  

Orange County Supervisor and CalOptima Board Member Janet Nguyen, whose supervisorial district has the highest concentration of Medi-Cal members in the county, said: “All of the efforts we have engaged in are paying off, resulting in better services for members. I am proud of our staff, nurses and doctors for the fine work they have done to earn CalOptima the distinction of being the top-ranked Medi-Cal plan in California.” 

CalOptima is nearing its 20th anniversary, with the first members served in October 1995.  Founding Board Member Peter Anderson, M.D., an emergency physician in Fountain Valley, sees the NCQA ranking as reward for the efforts invested by the community at the beginning and still today. “CalOptima was founded in response to difficulties in providing local Medi-Cal members with consistent access to quality care,” Dr. Anderson said. “The NCQA ranking proves that CalOptima has more than met that challenge. It has risen to new heights in serving our community. I congratulate all the CalOptima team members for achieving this lofty goal.”
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About CalOptima
A county organized health system, CalOptima provides publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, Calif. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. In total, CalOptima serves more than 600,000 members with a network of more than 6,600 primary care doctors and specialists, as well as 30 hospitals. Learn more about CalOptima in this video here.

About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. Learn more about the NCQA rankings here.


OC In+Care Newsletter

Beginning in August 2014, the Orange County Health Care Agency (OCHCA) will be taking a closer look at the medical visit frequency of PLWHD in Orange County. OCHCA is interested in increasing the percentage of HIV-positive clients who are maintained in continuous medical care. It is important for patients to stay in continuous care and see their doctor(s) regularly because it may lead to suppressed viral loads and ultimately overall better health outcomes2. In April 2014, the HIV/AIDS Bureau (HAB) published quality management performance measures and recommended that all individuals living with HIV disease should see their medical provider at least once every six months.

Orange County has a goal to increase the percent of PLWHD who are in continuous HIV medical care. Currently 83% of HIV-positive clients in Ryan White–funded medical care are seeing their doctor regularly. Only 60% of all HIV-positive clients in Orange County are maintained in continuous care3. With the implementation of the Affordable Care Act, more clients will access medical care outside the Ryan White system; therefore, the goal is to increase the percentage of HIV-positive clients in continuous medical care for Orange County to 72% by the end of 2015.

The following table provides an overview of the percent in continuous care compared to the 2015 goal.

In Medical Care  Ryan White  All OC 
2010  79%  N/A
2013  83%  60%
2015 (goal)  84%  72%

Orange County-Wide Quality Improvement Goal

Maintenance in medical care is the primary goal of the Ryan White program and all services provided should help ensure HIV medical care adherence. In order to meet the 2015 goal for Orange County, all service providers should ask their clients “When was the last time you saw your doctor?” and “When is your next doctor’s appointment?” Whether you are a mental health provider, or a case manager, food bank provider, or other service provider, you should be asking your clients about their medical care and help them make it to their medical appointments, as appropriate. This quality improvement activity intends to engage patients in HIV medical care from all points of access.

Providers are also encouraged to create their own quality improvement activities to increase retention in care. For example, medical providers can try different reminder alerts to remind clients of their appointment. Case managers may use a strength-based approach to assist clients in attending their next medical appointment.

It is very important to have a good relationship between case managers and doctors. A good relationship allows for better coordination of care between providers. A client’s case manager and medical provider should be communicating about the client’s care on a regular basis.

From PLWHD
Each client is unique and has different needs and different views of what they would like to see from their doctor. See “My Doctor is the Best Because” box for some of the things clients look for in a medical provider.

How to engage PLWHD
  • Ask them if there are any barriers to attending medical appointments. Link them to support services, if applicable.
  • Acknowledge their personal strengths and help them apply it to their treatment plan.
  • Show that you care about their general well-being.
  • Listen to their concerns and respond to their questions.
  • Encourage clients to ask questions.
  • Create a quality improvement activity to retain clients in care.
  • Use posters, brochures, reminder cards to help clients remember to attend their medical appointment.
  • Explain how important it is to attend medical visits even if they are feeling healthy so they can monitor changes in their health, get their medications and review their CD4 and Viral Load.

OC In+Care is a project of the Orange County HIV Quality Management Committee. The HIV Quality Management Committee works to increase the quality of Ryan White services. For more information about the committee, please call (714) 834-8063. If you have feedback or topic suggestions for future newsletters, please contact Mindy He at Mhe@ochca.com.


OC Health Care Agency Mumps Advisory

Mumps Advisory

September 12, 2014

An adult male living in Anaheim has been diagnosed with mumps. The case has no recent history of international travel or exposure to a known case of mumps. Orange County has 0-3 cases of mumps reported each year, and a mumps case occurring without a history of travel or known contact to a mumps case is unusual.

Providers should consider the diagnosis of mumps in patients with an appropriate clinical presentation, particularly in those with a history of international travel. Providers should notify Orange County Public Health Epidemiology at 714-834-8180 with any suspect cases. The incubation period is usually 16 to 18 days, but cases may occur 12 to 25 days after exposure. Prodromal symptoms are nonspecific and may include myalgia, anorexia, malaise, headache and low-grade fever. The most common manifestation is unilateral or bilateral swelling of one or more of the salivary glands, usually the parotid glands (parotitis). Parotitis tends to occur within the first 2 days and may be first noted as earache and tenderness on palpation of the angle of the jaw. Symptoms tend to decrease after 1 week and usually resolve after 10 days.

Complications include orchitis (testicular swelling), which may occur in as many as 50% of postpubertal males. 10% have symptoms of aseptic meningitis. Treatment is supportive care.

Laboratory Testing
Testing for the mumps virus can be performed by sending serum for mumps IgM and IgG and buccal swab specimens for mumps polymerase chain reaction (PCR) and virus culture to Orange County Public Health Laboratory. Mumps IgM response may be absent or short lived in immunized patients. Orange County Public Health can help coordinate testing of patients.

Infection Control
Mumps virus is transmitted by exposure to respiratory secretions or droplets of infected persons, and is generally transmitted via face-to-face contact. Communicability is probably highest from 2 days before to 5 days after onset of parotitis; the virus has been isolated in saliva from 7 days before through 9 days after onset of swelling. Suspect cases should be cared for using standard and droplet precautions.

Vaccination
Mumps vaccine is given as part of measles, mumps and rubella (MMR) vaccine. All children are recommended to receive a first dose of MMR at 12-15 months and a second dose at 4-6 years of age. Post-licensure data estimate the effectiveness of one dose of mumps vaccine at approximately 80% and two doses at 90%. Health care providers can be presumed to be immune with any of the following evidence: documented administration of 2 doses of MMR vaccine, birth before 1957, positive serum mumps IgM, or laboratory confirmed disease.

See http://ochealthinfo.com/phs/about/dcepi/epi/disease/mumps or www.cdc.gov/mumps/prev-control-settings/index.html for further information.


Physician Advocate Tip of the Month: How To Collect Deductibles On Covered CA Health Plans

September Tip:

How To Collect Deductibles On Covered California Health Plans

There are four plan types (Bronze, Silver, Gold and Platinum) and not all plans and benefits are subject to deductibles. To prevent patient confusion and frustration, OCMA recommends all front office staff:

1.   Download the Covered CA Standard Benefits Summary for 2014 here.
 
2.   Be familiar with which plans have a deductible and which benefits are subject to the deductible.
 
3.   Learn how to confirm whether the patient has met their deductible through their plan's website.

 
For more information, see the Covered CA Standard Benefit Plan Designs.


OCMA Board Member talks with radio station about Joan Rivers' death and administering anesthesia to the elderly

Based on the news of Joan Rivers' death, CSA President and OCMA Board member Paul Yost, MD talked with KFI AM 640 about the risks and considerations for administering anesthesia to elderly patients.

Listen here: 
http://youtu.be/VGJOw24opMY


Your Input is Needed: Susan G. Komen Breast Health Needs Assessment

OCMA is partnering with Susan G. Komen® in order to help disseminate a survey regarding Orange County's needs assessment for the 2015 Community Profile on Breast Cancer and Breast Health. The goal and purpose of the Community Profile is to communicate the status of breast health and breast cancer in the Orange County community, as well as to inform planning of programs and grants for the next several years.
 
As part of the data gathering process, Susan G Komen® has developed a brief provider survey to identify existing gaps and barriers to service as well as patients' beliefs and attitudes towards breast health services. Physicians should answer these questions based on their day-to-day interaction/experience with their patients. The survey should take no more than 20 minutes to complete, and all responses to the survey will be kept confidential. As an incentive, providers who complete the survey will have the opportunity to win a $100 gift card.
 
The last day to complete this survey is Friday, September 19, 2014.
 
Please follow the survey link below to participate in the survey:
https://www.surveymonkey.com/s/breasthealthneeds

 
Thank you in advance for your participation.

Arpan Global Charities Mission Moshi, Tanzania

August 10-17, 2014

At the foothills of Mount Kilimanjaro in Tanzania, Arpan Global Charities 16th volunteer medical mission was held in the town of Moshi. This mission was unique for a few reasons: a) there was a relatively smaller team totaling 10 volunteers, including one anesthesiologist, one dentist, two thoracic surgeons, one pediatric orthopedic surgeon, one ophthalmologist, two pediatricians, one nurse and one non-medical volunteer. Of the10 total team members, 5 were from St Joseph Hospital in Orange. b) The team members came from 3 different hospitals, including St Joseph Hospital, Kibosho Eye and ENT Hospital and Machame Lutheran Hospital. The team stayed at Torchbearer Lodge run by Mama Lynn Elliott, who at the same campus also runs a non-profit organization, the Light in Africa, where 166 orphans are cared for. All the children at this orphanage receive shelter, meals, education and treatment for various underlying medical conditions including cerebral palsy, HIV and other acute as well chronic conditions.

During one week at Moshi our team members saw about 650 patients at different locations, including 3 hospitals in Moshi. Masai patients were seen and treated in remote areas in the bush. A total of 55 surgical procedures were performed including 17 eye surgeries, 16 general surgical and pediatric orthopedic procedures and 22 dental procedures. We delivered gifts from the sisters of St. Joseph Hospital in Orange to sister Leiymo of St Joseph Hospital in Soweto Moshi. In addition, our team members also delivered new clothes donated by St. John’s Friendship Quilters in Orange to the orphans at the Light in Africa. Our team dentist donated hundreds of toothbrushes and toothpaste to the local underserved population.


Overall, Mission Moshi in Tanzania was another successful mission for Arpan Global Charities, fulfilling its mission to bring health and hope to the medically underserved population around the world, while providing humanitarian assistance and medical education to those who need it the most.

For more information on Arpan Global Charities, visit http://www.arpanglobal.org/


New guidance from CDC on Ebola

Below message is from the Orange County HCA / Epidemiology & Assessment

Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries (August 25, 2014) 
http://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html

From Dr. Erin Epson, Assistant Chief / Public Health Medical Officer of the CDPH Healthcare-Associated Infections Program:
CDC has issued Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus, available at: http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html. Although the role of the environment in transmission of Ebola virus has not been established, in this guidance CDC recommends higher levels of precaution to reduce the potential risk posed by contaminated surfaces in the patient care environment “given the apparent low infectious dose, potential of high virus titers in the blood of ill patients, and disease severity.” Disinfection products with higher potency than what is normally required for an enveloped virus such as Ebola are therefore now recommended. Such products include Environmental Protection Agency-registered hospital disinfectants with a label claim for a non-enveloped virus (e.g. norovirus, rotavirus, adenovirus, poliovirus), and would also include bleach solution. In addition, the new guidance recommends that porous surfaces that cannot be made single use (e.g. carpeting, upholstered furniture and curtains) should be avoided in rooms of suspect Ebola virus disease (EVD) patients, and that potentially contaminated textiles (e.g. linens, non-fluid-impermeable pillows or mattresses, and privacy curtains) be discarded as regulated medical waste. This guidance regarding appropriate disinfection products and management of potentially contaminated textiles is different and replaces the environmental infection control elements of the previously issued Infection Prevention and Control Recommendations for Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals.

CDC has also updated a poster depicting the sequence for putting on and removing personal protective equipment (PPE), available at: http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf. This updated poster emphasizes guidance to perform hand hygiene between steps if hands become contaminated, in addition to immediately after removing all PPE. 

There are multiple acceptable sequences and methods for removing PPE. Regardless of the sequence or method used, the important principles are that the most contaminated items are removed first, and that the person removing PPE does not contaminate themselves or others during the process. If two pairs of gloves are used, the most contaminated outer gloves can be removed first and the inner gloves last, in order to limit additional contamination of remaining PPE during removal.  Performing hand hygiene between steps, and especially prior to removal of a mask or respirator, can help prevent contaminating one’s eyes and/or mucous membranes while removing the mask or respirator. Healthcare personnel should familiarize themselves and practice methods of donning and removal of any PPE used, in advance of the time when PPE will be needed. 

Availability of PPE supplies, hand hygiene, and appropriate waste containers at the point needed can be facilitated by placing any suspect EVD patient in a room with an anteroom.  An anteroom is particularly helpful if airborne isolation is implemented and respirators must be removed after leaving the patient room and closing the door. If a room with an anteroom is unavailable, a suspect EVD patient can be placed in a room that is spatially separated from other occupied patient rooms in a low traffic area (e.g., at the end of a hallway), with a designated area for hand hygiene and waste containers outside the room and separate from other patient care areas.

If you have any comments or questions or would like to be added to the distribution list, please email us at epi@ochca.com.


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