Download Gaps in Care Outreach Delegate

Secure Blue (MSHO) Preventive Care Report
MEMBER NAME:
DOB:
MEMBER ID:
DELEGATE NAME:
SCREENING*
DATE OF LAST SCREENING (based on
claims through December, 2015)
SCREENING
NEEDED IN
2016?*
Breast Cancer Screening
Colorectal Cancer Screening
Diabetes Care - Eye Exam
Diabetes Care - Kidney Exam
Diabetes Care - A1C Screening
Diabetes Care - LDL Screening
*See p.2 for adult guidelines for preventive screenings and additional information about the content in
column 3 of the table
How to Use this Report: The information in the above table is based on Blue Plus claims data
received through December, 2015. We hope you find it helpful when talking with members
about the importance of regular preventive screenings for maintaining health.
 Please address the above screenings, as applicable, during the member’s next
annual or six-month assessment.
 Please help facilitate appointments for applicable screenings based on the date
of the member’s last screening, if known. For example, if a member had a fecal
occult blood test (stool test) to screen for colorectal cancer in October, 2015,
then s/he should schedule another colorectal cancer screening test for October,
November or December of 2016. Most clinics can schedule appointments at
least one year in advance.
 The recommended screenings are based on national clinical guidelines. Blue
Plus recognizes that it is the member’s choice whether to complete a
recommended screening and that there are reasons why a member may choose
not to do so (e.g., would not pursue treatment, frailty, advanced dementia). We
recommend members make those decisions together with their doctors.
Please email the Star Ratings Center of Excellence mailbox at [email protected] if you
discover either of the following during your discussion with a member:
 The member notes the report does not list his/her most recent screening. In
this scenario, please include in the email:
o the date the member received the screening (month and year, if possible);
and
o the name of the clinic or facility where the member received the screening
 Suspected issues with the data in the report (e.g., report indicates the member
needs diabetic screenings but the member is not diabetic)
Secure Blue (MSHO) Preventive Care Report
Adult Guidelines for Preventive Screenings
Below are general recommendations for the preventive screenings included in this report. How
often and what kind of preventive care services a member needs will depend on age, gender,
health and family history.
Breast Cancer Screening (mammogram). General recommendation is a mammogram every two
years for women age 50 – 74 years. Some women may start earlier and/or have mammograms
more frequently depending on risks. Members should discuss personal risks with their provider.
Colorectal Cancer Screening (stool test, sigmoidoscopy, colonoscopy). General
recommendation is to start colorectal cancer screening at age 50 and continue until age 75.
Screening frequency depends on the type of test and risk factors. A colonoscopy is not the only
option for colorectal cancer screening. General recommendations for healthy adults are:
 annual stool test (fecal occult blood test or FOBT); or
 sigmoidoscopy every five years; or
 colonoscopy every 10 years
Diabetes Care – Eye Exam. General recommendation is that persons with type 1 or type 2
diabetes should have an annual diabetic eye exam by an optometrist or ophthalmologist.
Regular eye exams are important to monitor for diabetic retinal disease.
Diabetes Care – Kidney Disease Monitoring. General recommendation is that persons with type
1 or type 2 diabetes should be screened for kidney disease on an annual basis. Screening can be
done with a urine microalbumin test.
Diabetes Care – A1C Screening. General recommendation is that persons with type 1 or type 2
diabetes should have an A1C screening annually.
Diabetes Care – LDL Screening. General recommendation is that persons with type 1 or type 2
diabetes should have their LDL cholesterol measured at least annually.
*Note: If the table on page 1 indicates a member does not need a particular screening in 2016
(e.g., it says “NO” in the column titled “SCREENING NEEDED IN 2015?”), that means Blue Cross
data indicates the member is up to date on that screening. If the member is up to date on all of
the identified screenings (i.e., the report has all “NOs”), that is a good opportunity to reinforce
what the member is doing to take care of his/her health. No other specific action is needed
related to those screenings – the information provided is for your reference.