We wish you and your staff a wonderful holiday season and a happy new year. For the remainder of 2021, we ask that you engage with your quality nurses and outreach to your patients to ensure they are completing their appropriate screenings and examinations. We will continue to emphasize the importance of these measures in 2022 along with a few more.
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Medicare
Patients |
Commercial PPO
Patients |
| Diabetes – HA1C Testing and Documenting Results |
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| Statin Therapy for Patients with Cardiovascular Disease or Diabetes |
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| High Blood Pressure – Input results in EHR |
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| Breast Cancer Screening |
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| Colorectal Cancer Screening |
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| Depression Screening – using PHQ9 |
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| Well-Care Visit: Children (and proper immunization) |
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| Cervical Cancer Screening |
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Diabetes HA1C Testing and Result: “Left unmanaged, diabetes can lead to serious complications, including heart disease, stroke, hypertension, blindness, kidney disease, diseases of the nervous system, amputations and premature death. Proper diabetes management is essential to control blood glucose, reduce risks for complications and prolong life. With support from health care providers, patients can manage their diabetes with self-care, taking medications as instructed, eating a healthy diet, being physically active and quitting smoking.” – From NCQA Dec 2021
Statin Therapy for Patients with Cardiovascular Disease: “Cardiovascular disease is the leading cause of death in the United States. It is estimated that 92.1 million American adults have one or more types of cardiovascular disease (Benjamin et al., 2017). People with diabetes also have elevated cardiovascular risk, thought to be due in part to elevations in unhealthy cholesterol levels. Having unhealthy cholesterol levels places people at significant risk for developing ASCVD. Statins are a class of drugs that lower blood cholesterol. American College of Cardiology and American Heart Association (ACC/AHA) guidelines state that statins of moderate or high intensity are recommended for adults with established clinical ASCVD. The American Diabetes Association and ACC/AHA guidelines also recommend statins for primary prevention of cardiovascular disease in patients with diabetes, based on age and other risk factors. Guidelines also state that adherence to statins will aid in ASCVD risk reduction in both populations.
- Statin Therapy for Patients with Cardiovascular Disease: Assesses males 21–75 years of age and females 40–75 years of age who have clinical atherosclerotic cardiovascular disease (ASCVD) and who received and adhered to statin therapy.
- Statin Therapy for Patients with Diabetes: Assesses adults 40-75 years of age who have diabetes and who do not have clinical ASCVD, who received and adhered to statin therapy.” – From NCQA Dec 2021
High Blood Pressure: “Known as the silent killer, high blood pressure or hypertension, increases the risk of heart disease and stroke, which are the leading causes of death in the United States. Controlling high blood pressure is an important step in preventing heart attacks, stroke and kidney disease, and in reducing the risk of developing other serious conditions.” It is imperative that patient blood pressure levels are recorded in their EHR records. – From NCQA Dec 2021
Breast Cancer Screening: “Breast cancer is the second most common cancer among American women, regardless of race or ethnicity. Screening can improve outcomes: Early detection reduces the risk of dying from breast cancer and can lead to a greater range of treatment options and lower health care costs.” – From NCQA Dec 2021
Colorectal Cancer Screening: “Treatment for colorectal cancer in its earliest stage can lead to a 90% survival rate after five years. However, more than a third of adults 50–75 do not get recommended screenings. Colorectal cancer screening of asymptomatic adults in that age group can catch polyps before they become cancerous or detect colorectal cancer in its early stages when treatment is most effective.” – From NCQA Dec 2021
Depression Screening with PHQ9: “Major depressive disorder (MDD) is the second leading cause of disability worldwide, affecting an estimated 120 million people. The lifelong prevalence is estimated to range from 10%–15%. In the United States, 16% of people report that at some point in their lifetime they were told by a health care professional that they had depression. Studies have found that patient outcomes improve when there is collaboration between a primary care provider, case manager and a mental health specialist to screen for depression, monitor symptoms, provide treatment and refer to specialty care as needed.” – From NCQA Dec 2021
Well-Child Visits and Immunization: “Assessing physical, emotional and social development is important at every stage of life, particularly with children and adolescents. Behaviors established during childhood or adolescence, such as eating habits and physical activity, often extend into adulthood. Well-care visits provide an opportunity for providers to influence health and development. They are a critical opportunity for screening and counseling. Childhood vaccines protect children from a number of serious and potentially life-threatening diseases such as diphtheria, measles, meningitis, polio, tetanus and whooping cough at a time in their lives when they are most vulnerable to disease. Approximately 300 children in the United States die each year from vaccine-preventable diseases. Immunizations are essential for disease prevention and are a critical aspect of preventable care for children. Vaccination coverage must be maintained in order to prevent a resurgence of vaccine-preventable diseases.” – From NCQA Dec 2021
Cervical Cancer Screening: “Cervical cancer is a disease in which cells in the cervix (the lower, narrow end of the uterus) grow out of control. Cervical cancer was one of the most common causes of cancer death for American women; effective screening and early detection of cervical pre-cancers have led to a significant reduction in this death rate. Screening assesses women who were screened for cervical cancer using any of the following criteria:
- Women 21–64 years of age who had cervical cytology performed within the last 3 years.
- Women 30–64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
- Women 30–64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) cotesting within the last 5 years.” – From NCQA Dec 2021
