El Paso Health | About Your Health | Fall 2018

3 stay informed H HSC implements a medical Pay-for-Quality (P4Q) program that creates incentives and disincentives for managed care organizations based on their performance on quality measures. The current iteration of the P4Q program began in January 2018 and holds up to 3 percent of our capitation rate at risk. HHSC recently announced that the P4Q program will be extended through CY 2019. For your reference, following are the quality measures that are included in the P4Q program by STAR and CHIP product lines. STAR and CHIP: Reduction of Potentially Preventable Emergency Department Visits (PPVs): Emergency department treatment provided for a condition that could be provided in a nonemergency setting. HEDIS Appropriate Treatment for Children with Upper Respiratory Infection (URI): Percentage of children 3 months to 18 years of age who were diagnosed with a URI and were not dispensed an antibiotic prescription. STAR only: HEDIS Prenatal and Postpartum Care (PPC): Percentage of deliveries that received a prenatal care visit in the first trimester or within 42 days of enrollment and percentage of deliveries that had a postpartum visit between 21 and 56 days after delivery. HEDIS Well Child Visits in the First 15 Months of Life (W15): Percentage of members who turned 15 months who have completed 6 or more Well-Child visits. CHIP only: HEDIS Weight Assessment and Counseling for Nutrition and Physical Activity (WCC): Percentage of members 3 to 17 years of age who had an outpatient visit with a Primary Care Provider (PCP) who had evidence of counseling for nutrition and physical activity. HEDIS Adolescent Well Care (AWC): Percentage of members 12 to 21 years of age who had at least 1 comprehensive well-care visit with a PCP during the calendar year. Thanks to your help, El Paso Health performs very well on these quality measures. We look to continue our collaboration with our network Providers in 2019 to aim even higher on quality care. Pay for Quality HOW DOES IT WORK? When members call FIRSTCALL Medical Advice Infoline, they will speak to a health-care professional who will ask them basic questions, such as “Why are you calling?” “What is your medical condition?” and “What medications are you taking?” Depending on their answers, the health-care professional will be able to assist and provide the member with the appropriate advice. HOW CAN FIRSTCALL MEDICAL ADVICE INFOLINE HELP? A nurse or pharmacist will answer specific questions about the member’s medical condition. The health-care professional will help members decide what kind of care is needed. They may recommend that members do 1 or more of the following: ■  ■ Stay at home. ■  ■ Go see their doctor the next day. ■  ■ Go to an after-hours or night clinic. ■  ■ Go to an emergency department. ■  ■ Call 911. WHO CAN I CALL IF I NEED MORE INFORMATION? Call El Paso Health at 915-532-3778 or toll-free at 1-877-532-3778 for more information.