Health Education Program

  • Docx File 71.21KByte



Policy/Procedure Number: MPHP8001 (previously MPCD2004, CD100204) Lead Department: Health ServicesPolicy/Procedure Title: Health Education Program?External Policy ? Internal PolicyOriginal Date: 09/25/1994Next Review Date:03/11/2021Last Review Date:03/11/2020Applies to:? Medi-Cal? EmployeesReviewing Entities:? IQI? P & T? QUAC? OPerations? Executive? Compliance? DepartmentApproving Entities:? BOARD? COMPLIANCE? FINANCE? PAC? CEO? COO? Credentialing? DEPT. DIRECTOR/OFFICERApproval Signature: Robert Moore, MD, MPH, MBAApproval Date: 03/11/2020RELATED POLICIES: MCQP1021 - Initial Health Assessment and Behavioral Risk Assessment MPQD1001 - Quality and Performance Improvement Program DescriptionMCLP7002 - Cultural and Linguistic ServicesCMP36 – Delegation and Oversight MonitoringIMPACTED DEPTS: Health ServicesMember ServicesProvider RelationsDEFINITIONS: IHEBA – Individual Health Education Behavioral Assessment is a series of age specific questions designed to evaluate a member’s risk factors for developing preventable illness, injury, disability and major diseases. Member Incentives (MI) are non-monetary tools, resources, or products used to motivate and encourage PHC members’ engagement and/or improve their health outcomes. As applicable, MIs are not collected from the member after the program is complete. The Staying Healthy Assessment is the Department of Health Care Services (DHCS) approved tool.ATTACHMENTS: Approval Process for Member IncentivesDHCS Member Incentive Request FormDHCS Member Incentive Evaluation FormDHCS Focus Group Incentive Request FormDHCS Focus Group Incentive Evaluation FormTargeted Disease Behavior CodeApproval Process for All Member Facing MaterialsPURPOSE:The Partnership HealthPlan of California (PHC) Health Education Program is designed to develop, implement, and maintain a member health education system to assist members to improve their health and manage illnesses.POLICY / PROCEDURE: Partnership HealthPlan of California (PHC) members have a right to health education services that meet DHCS health education standards in alignment with APL 18-016.PHC promotes self-care and wellness among health plan members. The health education staff works closely with all PHC Departments to assess member needs and to evaluate and improve established programs/activities and develop and implement new programs/activities. In addition, the health education staff obtains information to assess member health care needs and barriers to care by consulting regularly with the Consumer Advisory Committee (CAC), the Family Advisory Committee (FAC), community organizations, community outreach, healthy living tool, PHC’s Chief Medical Officer and through analysis of PHC’s data. Interventions led or facilitated by the Quality and Performance Improvement Department are intended to assist members to improve their health, properly manage illness, and avoid preventable illnesses.PHC’s health education program reflects evidence-based practices and clinical practice guidelines as appropriate. PHC’s health education program includes programs that are appropriate for the member population and can affect behavioral change for improved health outcomes. These include, but are not limited to:Educational interventions designed to assist members to effectively access the managed health care system, preventive and primary healthcare services, obstetrical care and health education services; and to appropriately use complementary and alternative care.Education regarding health promotion to include risk reduction and healthy lifestyles via the member portal/healthy living tool on the PHC website.Educational interventions designed to assist members to learn and follow self-care regimens and treatment therapies for existing medical conditions, chronic disease or health conditions including, but not limited to, prenatal care, asthma, diabetes, and hypertension. Other required health education interventions include, but are not limited to:Tobacco use and smoking cessationAlcohol and drug useFamily PlanningPrevention of sexually transmitted diseasesInjury Prevention ImmunizationsNutritionParentingPhysical ActivityPromotion of the availability of local social service resources and health care programs on the community resource page on the PHC website.Per DHCS All Plan Letter (APL) 16-005 Revised, non-monetary member incentives (MI) may be used in conjunction with or as a component of PHC education programs to motivate members to adopt heathy behaviors and enhance health education activities including focus groups. As described by DHCS APL 16-005 Revised, MI program components include, but are not limited to: Non-monetary member incentives may have a value range from $10 to $100 depending on health education program. Appropriate non-monetary incentives may include gift cards, products, and monthly membership fees. Required completion of an evaluation form thirteen (13) months after the program start date. Intention of increasing member participation, learning and motivation to effectively use health care services including preventive and primary care services. Review by the qualified Health Educator and Regulatory Affairs, then submitted to DHCS for final review and approval prior to implementing new MI programs or focus groups. MI programs may focus on, but are not limited to:Quitting smokingLosing weightTimely prenatal and post-partum careTimely immunizationsTimely well child visitsAppropriate services may be provided through individual classes, group classes, workshops, support groups, peer education programs, patient-centered management programs, educational materials and member newsletters.PHC Providers may refer members to programs within the health education network, or members may self-refer. Health education materials and programs are designed to reflect cultural diversity. PHC ensures that all materials visually recognize and display this diversity. Cultural issues are important variables in understanding health beliefs and practices.PHC members have equal access to all programs within the PHC Health Education Network. Programs will not discriminate against PHC members for any reason.Health Educators participate in PHC’s internal committees, address quality and compliance with PHC’s programs, and ensure that all health education programs and materials are appropriate for members of varying demographics, including but not limited to: language, age, race, ethnicity, national origin, disability, sex and gender. [per Section 1557 of the Patient Protection and Affordable Care Act (ACA 1557)]PHC’s Cultural & Linguistic Services policy (MCLP7002) covers the requirements for the translation of member materials. PHC ensures provisions are made for members who have limited English proficiency and/or low health literacy by assessing health education materials for readability and suitability with special attention to cultural and linguistic appropriateness, concept, density, tone, key messages, including format, page design and graphics. Health education materials are made available in PHC’s threshold languages and in any of California’s top 16 non-English languages upon the request of the member. The Health Education & Cultural and Linguistic Population Needs Assessment (PNA) is required by DHCS to assess the health education and cultural and linguistic needs of PHC members. The PNA is conducted every year; the full report is submitted electronically to DHCS upon completion on or before June 30th. Findings from the PNA, as well as other internal and external data sources, are utilized to guide the development and implementation of health education interventions. It is required annually to submit the Health Education & Cultural and Linguistic Action plan and action plan update table electronically with the full PNA report on or before June 30th. A copy is kept on file at the health plan for DHCS to review upon request. PHC members are not charged enrollment/attendance fees, co-payments or materials fees for health education programs. Primary Care Providers (PCPs) are responsible for the screening and identification of members with specific health educational needs and make referrals to the appropriate health education programs.If a health education need is identified by the PCP, he/she is responsible for providing the information or referring the member and/or the caregiver to PHC’s Population Health Department for assessment of appropriate health education activities or materials. PCPs are responsible for following-up on referrals from the individual health education behavioral assessment, (IHEBA), Staying Healthy Assessment, and providing anticipatory guidance. Provider education and training on health education services include the following:Health Education and Cultural & Linguistic Population Needs Assessment (PNA) findingsIndividual Health Education Behavioral Assessment (IHEBA) and Staying Healthy Assessment (SHA), and Seniors and Persons with Disabilities (SPD) Sensitivity Awareness trainingsTechniques to enhance the effectiveness of provider/patient interactionEducational tools, modules, materials and staff resourcesPlan specific resources and referral informationHealth Education requirements, standards, guidelines and monitoringPHC ensures that administrative oversight, direction, management, and supervision of the health education program is maintained by a full-time qualified health educator. Health education staff serves as an information resource center to providers, provider staff, PHC staff and communities. This includes providing resource information, educational materials, and other program resources to assist contracted medical providers in providing and accessing health education services for members. This is accomplished through provider newsletters, posting materials on PHC’s website, attending Community health fairs and making materials available upon request.PHC uses national standards to establish goals. Health education interventions are based on national preventive care guidelines, professional experts, peers, best practices, published research findings, HEDIS studies, findings from the PNA, community outreach activities, and results of program evaluation measures. In accordance with DHCS APL 18-016, all health education materials are provided to members at a sixth grade or lower reading level. To ensure all health education materials are in a format that is easily understood, the qualified Health Educator and Communications Department will review all documents. Health education materials are designed to assist members to modify personal health behaviors, achieve and maintain healthy lifestyles, and promote positive health outcomes. Materials include updates on current health conditions, management of health conditions, and self-care. PHC will use a readability formula that is most appropriate and reliable for the type of materials and target audience.All written health education materials developed, adapted, purchased, or obtained free-of-charge for use by members must comply with requirements set forth in the DHCS APL18-016. Health plans can approve written member health education materials as long as the following conditions are met:Materials purchased to distribute for member health education are from a DHCS approved company. The Health Education team will maintain a list of approved companies as these are updated by DHCS throughout each year.Materials are field-tested to ensure written health education materials are understood by the target audience. The qualified Health Educator will provide oversight of the field-testing of all materials. Field-testing may include community focus groups, key informant interviews, surveys, and/or review during Consumer Advisory Committee and Family Advisory Committee meetings. The health education team will review the results and adapt materials as needed. Materials are assessed and approved using the Readability and Suitability Checklist, (Attachment C) and all required elements or items have been met.The signed/approved Readability and Suitability Checklist, along with the approved health education material, must be kept (electronic file or hard copy) by the health plan and made available to DHCS for auditing/monitoring purpose upon request.The assessment and approval process must be conducted by a qualified health educator/health education specialist with the equivalent training and background required by DHCS for their Health Education Consultants. For the purposes of the MMCD All Plan Letter 18-016, a qualified health educator is defined as a health educator with one of the following qualifications:Master of Public Health (MPH) degree with a specialization in health education or health promotion, from a program of study accredited by the Council on Education for Public Health, sanctioned by the American Public Health Association.MCHES (Master Certified Health Education Specialist) awarded by the National Commission for Health Education Credentialing, Inc.Health plan staff assigned health education duties who do not meet the definition of a “qualified health educator” as listed above may not approve health education materials for the health plan. If a Plan does not have a qualified health educator (as defined above) on staff to assess and approve health education materials, the Plan will be required to submit health education materials to the Managed Care Quality and Monitoring Division (MCQMD) of DHCS for review and prior approval. A completed Readability and Suitability Checklist must accompany all materials submitted to MCQMD for review and approval. All required sections of the checklist must be completed except for section H (Health Education Certification and Signature). This section will be completed by a MCQMD health education consultant.PHC’s Internal Quality Improvement Committee (IQI) and Quality/Utilization Advisory Committee (Q/UAC) will review the Health Education & Cultural & Linguistic Work Plan annually for a description of required activities, a timeline with milestones and identification of responsible individuals. Final approval of the work plan will be by the Physician Advisory Committee (PAC).Delegation Oversight and MonitoringPHC delegates some functions related to the health education program.A formal agreement is maintained and inclusive of all delegated functions. PHC conducts an audit not less than annually to ensure the appropriate policy and procedures are in place.Results from Oversight and Monitoring activities shall be presented to the Delegation Oversight Review Sub-Committee (DORS) for review and approval.REFERENCES: DHCS/MMCD All Plan Letter (APL) 19-011 Health Education and Cultural and Linguistic Population Needs Assessment (09/30/2019)DHCS/MMCD All Plan Letter (APL) 18-016 Readability and Suitability of Written Health Education Materials (10/05/2018)Document A (APL 18-016): Review and Approval Guidance for Written Health Education and Member Information MaterialsDocument B (APL 18-016): Readability and Suitability Checklist for Written Health Education materialsDHCS/MMCD All Plan Letter (APL) 16-005 Revised Requirements for Use of Non-Monetary Member Incentives for Incentive Programs, Focus Groups, and Member Surveys (11/23/2016)Section 1557 of the Patient Protection and Affordable Care Act (ACA 1557) DISTRIBUTION: PHC Department DirectorsPHC Provider ManualPOSITION RESPONSIBLE FOR IMPLEMENTING PROCEDURE: Senior Director, Health ServicesREVISION DATES: Medi-Cal07/08/96; 10/10/97 (name change only); 06/21/00, 12/19/01, 01/15/03; 04/20/05; 02/20/08; 04/21/10; 04/20/11; 11/16/11; 03/20/13; 10/15/14; 02/18/15; 01/20/16; 02/15/17; *03/14/18; 04/10/19; 03/11/20*Through 2017, Approval Date reflective of the Quality/Utilization Advisory Committee meeting date.?Effective January 2018, Approval Date reflects that of the Physician Advisory Committee’s meeting date. PREVIOUSLY APPLIED TO:Healthy Kids (Healthy Kids program ended 12/01/2016)KK CC403 – 04/21/10MPHP8001 – 11/16/11; 03/20/13; 10/15/14; 02/18/15; 01/20/16 to 12/01/2016PartnershipAdvantagePA CC202 - 06/21/2006 to 02/20/2008MPCD2004 – 02/20/2008 to 11/16/2011MPHP8001 – 11/16/2011 to 01/01/2015Healthy FamiliesMPHP8001 – 04/20/2011 to 03/01/2013 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Online Preview   Download