Health promotion/disease prevention guideline development: process and results.
As part of its strategic plan, Physician Plus Insurance Corp. (PPIC), an 80,000-enrollee, provider-owned, network-model, prepaid insurance plan has targeted improvement in enrollee and community health. Health promotion/disease prevention (HP/DP) guidelines were developed as one tool to promote health screening and to close identified gaps between desired and actual rates of health screening. Additional efforts within the health plan have focused on identifying barriers to health screening and on identifying and implementing solutions to overcome these barriers. Opportunities in health screening are identified from in-house data: mammography, Pap smear, cholesterol screening, immunization rates, and the like. Note that these screening topics are among those that the Health Plan Employer Data and Information Set (HEDIS) has selected. This article will describe the processes to develop HP/DP guidelines, obtain provider participation, obtain buy-in from providers, and educate enrollees and employers. It will also show the results that have been obtained in the form of HP/DP Guidelines and outcomes measures.
Mischler
N E
NE
Milliman and Robertson, Inc., Brookfield, WI, USA.
D005568:Forms and Records Control; D006125:Group Practice, Prepaid / Q000458:organization & administration / Q000592:standards*; D006293:Health Promotion / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D010934:Planning Techniques; D017410:Practice Guidelines as Topic; D011315:Preventive Medicine / Q000458:organization & administration / Q000592:standards*; D014481:United States