|Articles|December 2, 2016

Women’s health Q&A: Two specialists discuss top issues

Two experts discuss top-of-mind women’s healthcare issues in managed care.

In this Q&A with Managed Healthcare Executive(MHE), Susan Robertson, MD, a practicing primary care physician at Broomfield Family Practice, in Broomfield, Colorado, and Barbara Nabrit-Stephens, MD, MBA, FAAP, medical director at Health Integrated, discuss how managed care organizations can improve women’s health, help control Zika, and address the rise of consumerism.

MHE: What are the most important things that MCOs should do to more positively influence women’s health issues?

RobertsonRobertson: One of the biggest drivers in women’s health right now is the industry’s push toward wellness/preventive medicine. Requiring payers to cover aspects of women’s wellness visits, including Pap tests, mammograms, birth control, osteoporosis screenings, immunizations, etc., has increased positive utilization as well as access to women’s healthcare.

Additionally, these visits are helping providers identify conditions such as cardiovascular disease in women. In Colorado, we have seen a dramatic reduction in teenage pregnancy due to increased access and no cost for birth control and intrauterine devices.

Our MCO, Physician Health Partners (PHP), focuses on two areas to improve adherence to annual wellness visits (AWVs) among women: provider adherence and patient education.

For providers, we focus on education around the importance of AWVs and the benefits of thorough and complete wellness visits. If the provider completes a thorough AWV, it can result in:

• Identifying other behavioral or physical needs of the patient, resulting in early diagnosis, education opportunities, and preventive measures;

• Documenting all diagnoses properly;

• Achieving quality measures;

• Providing more patient-centered care; and

• Enhancing patient engagement in their health.

PHP helps providers with AWV action plans, patient intake and follow-up templates, and resources to provide to patients once any issues are identified, such as behavioral health, chronic conditions, or social needs.

For patients, PHP focuses on patient outreach and care coordination to help educate about the importance of annual wellness visits. This outreach includes mail, telephonic, and face-to-face education. PHP has a team of clinical social workers and nurses who provide patient outreach and education via home visits, facility visits, or practice colocation.

One downside for patients as they come in for AWVs is when we find something that requires follow-up or treatment. This can lead to costs for the patient. For example, if we have a patient who has an irregular mammogram and we refer them for an ultrasound, they are now responsible for out-of-pocket costs (based on their coverage). This may deter them from seeking the care they need in the future.

Nabrit-StephensNabrit-Stephens: One way MCOs could be a more positive influence on women’s health would be to decrease the number of prior authorizations needed to cover services. For example, not requiring prior authorization for a mammogram for a woman who fits the nationally accepted screening guidelines. Another would be making contraceptives available without prior authorization.

MCOs could also be more prompt in providing preventive health information to women. Guidelines change all the time but most MCOs only distribute quarterly member newsletters. Disseminating updates sooner would be very helpful.

 

 

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