Health promotion/disease prevention guideline development: process and results.

Area of Science:

• Health Services Research
• Preventive Medicine
• Health Insurance Management

Background:

• Physician Plus Insurance Corp. (PPIC), a provider-owned, network-model health plan with 80,000 enrollees, aims to enhance enrollee and community health.
• Health promotion and disease prevention (HP/DP) are key components of PPIC's strategic plan to improve health outcomes.
• Existing health screening rates revealed gaps between desired and actual performance.

Purpose of the Study:

• To develop and implement Health Promotion/Disease Prevention (HP/DP) guidelines within a prepaid insurance plan.
• To identify and address barriers to health screening among enrollees.
• To improve health screening rates for key preventive services.

Main Methods:

• Development of HP/DP guidelines based on in-house data and Health Plan Employer Data and Information Set (HEDIS) metrics.
• Strategies to obtain provider participation, buy-in, and enrollee/employer education.
• Analysis of opportunities in health screening, including mammography, Pap smears, cholesterol screening, and immunizations.

Main Results:

• Successful development of HP/DP guidelines tailored to the health plan's population.
• Implementation of processes to engage providers and educate enrollees.
• Establishment of outcome measures to track the impact of HP/DP guidelines on screening rates.

Conclusions:

• HP/DP guidelines serve as an effective tool for promoting health screening and closing performance gaps.
• A systematic approach involving provider engagement and enrollee education is crucial for successful implementation.
• The initiative demonstrates a commitment to improving preventive care within a managed care setting.