Children’s Medical Services Health Plan 2019 Healthy Behaviors Annual Evaluation The Children’s Medical Services Health Plan, operated by WellCare (CMS Health Plan) did not have an approved Healthy Behaviors Program during this reporting period (July 1, 2018 – June 30, 2019). CMS Health Plan will begin monitoring engagement and utilization of its Healthy Behavior Program once it is approved and implemented. The CMS Health Plan Healthy Behavior measures are: Focus Area Activity Criteria Incentive Eligibility / Target Value Population Medically Approved • Completion of at least three $10 Members, ages 13 and older, Smoking/Tobacco successful interactions with a who have a tobacco/nicotine Cessation Program health coach; or dependency • Provides verification of completing an approved smoking cessation program. Medically Approved • Completion of at least six $10 Members, ages 13 and older, Weight Management successful interactions with a diagnosed as being morbidly Program health coach; or obese and/or diabetic • Provides verification of completing an approved weight loss program. Substance Use • Completion of a successful $10 Members, ages 13 and older, Disorder Program interactions with a health coach who are diagnosed with an and accepts referrals to a alcohol or drug dependency community treatment program; or • Provides verification of completing an approved substance abuse program. Initial Primary Care • Member completes their initial $10 New members are identified Provider (PCP) Visit PCP visit within 90 days of for new member outreach enrollment. utilizing the enrollment files received from the Department. Well-Child: 0-15 • Member engage with their PCP $10 When a member completes Months as their medical home and a visit. establish a relationship thereby encouraging annual wellness exams as recommended by
Bright Futures. (Reward for each visit, up to six visits). Well-Child: 3-6 Years • Member engage and $20 When a member completes completes their visit with their a visit PCP. Annual Primary Care • Member completes their Backpack When a member completes Provider Visit: 5-16 annual PCP visit. Upon their annual PCP visit Years completion of Appointment Annual Adolescent • Member completes their $20 When a member completes Check Up: 12-20 Years annual adolescent visit. their annual adolescent visit Prenatal Care Visits • Member completes their initial $20 Identifying pregnant prenatal visit during their first members are through the trimesters. enrollment files Prenatal Care Visit • Member completes their Choice of a Identifying pregnant second prenatal visit. stroller; members are through the portable enrollment files playpen; car seat; or six pack of diapers. Postpartum Care Visit • Member completes on $20 Care management program postpartum visit 21-56 days after follows the new mom after the birth of their baby. discharge to home Annual Eye Exam • Member completes (ages 18 $20 Member ages 18 and older and older identified with a identified with a diagnosis of diagnosis of diabetes or diabetes or hypertension hypertension and are due) Annual Eye Exam. Annual Hb1A1C • Member completes (ages 18 $20 Member ages 18 and older and older identified with a identified with a diagnosis of diagnosis of diabetes or diabetes or hypertension hypertension and are due) Annual Hb1A1C Screening. Blood Pressure Control • Member completes (ages 18 $20 Member ages 18 and older and older identified with a identified with a diagnosis of diagnosis of diabetes or diabetes or hypertension hypertension and are due) a Blood Pressure Check. Chlamydia Screening • Member completes the $20 Member ages 16 and older screening (ages 16 and older who have not had a who have not had a chlamydia chlamydia screening. screening).
Program Evaluation During the July 1, 2019 – June 30, 2020 Report Period, the CMS Health Plan will assess enrollee engagement/utilization, completion rates, and health benefit outcomes/effectiveness for each Healthy Behavior program offered through the analysis of Care Management data and program utilization data received from CMS Health Plan’s program vendor. Results will be reported into CMS Health Plan’s Quality Improvement Committee and Quality Medical Advisory Committee. These Committees will discuss any identified barriers and possible interventions to increase utilization, if applicable.