Well Care Visits
Well care visit for people 21+?
Adult Well Care
How many days do you have post hospital or post emergency to schedule follow up visit?
7 days
What level of insurance do we support?
Medicaid
How do you verify a members account?
Name (Collected in intro)
Address with zip code
Date of Birth
What is the target audience for the Post Hospital Discharge Follow up?
Adult members who have been recently discharge from an inpatient medical admission and not receiving any additional intervention from the health plan
What services will a PCP provide at a Well Child visit?
•Tests vision and hearing
•Give vaccines (as needed)
•Counsels on weight, diet, and physical activity
•Emotional / developmental health
As age appropriate
•Bullying and violence prevention
•Healthy emotional and physical relationships
Purpose of the Post Hospital Discharge Follow up?
To ensure that the member has a post hospital discharge appointment scheduled with their PCP or specialist within 7 days of discharge
Highmark Wholecare owns what former Health Plan?
Gateway Health Plan
When outreaching to a provider, if hold time is over 1 minute what do you do?
Remind the member of what gaps they will need to schedule and hang up for the next call.
What is the target audience age for Well Baby?
0-15 months
For Well Baby Visits, how many preventative visits should a child have with their pediatrician by age 15 months?
8
What is the target population for the Post ER Visit Follow up?
Members who have been recently seen in the emergency room and not receiving any additional intervention from the health plan
What is a Gap in Care?
A “gap in care” is defined as the discrepancy between recommended best practices (ways to prevent illnesses that most doctors agree upon) and the care that is actually provided. This can manifest itself in several different ways; the most common include:
•Individuals that are missing age-based or annual screenings or vaccines
•Individuals who do not consult with their doctors over a prescribed medication that might not be appropriate for a patient
•Individuals that are not adding a medication to meet evidence-based guidelines
If a member requests to be added to the "Do Not Call List", what should you tell the member?
I am sorry for any inconvenience. I have made that note. Have a good day and thank you for your time.
What is the target age audience for Well Child?
3-21 years old
What preventative measures can be done at a Well Baby visit?
Preventive visits may include:
•A physical exam
•Vision and hearing tests
•Immunizations
•Developmental screening
•Lead tests
***DAILY DOUBLE***
What defines as a intellectual disability?
How many zones in the state of PA does Highmark Wholecare cover?
2
What is the goal of your outreach?
•The goal is to get every member to close their gaps in care, by connecting them to the appropriate providers who can perform that care
•The health plan will then work to outreach to members and help them receive the care, even helping with any barriers to receiving these services (i.e. transportation)
What is the target age range for Childhood Immunization Status?
Children before age of 2 y/o.
Ages include
2 mo, 4, 6, 9, 12 mo, 15, 18 mos
What is the purpose of getting a member to complete their Well Care Visit?
Members who see their PCP on an annual basis complete necessary preventative health screenings and are at lower risk for emergency room visits and inpatient hospitalizations.
Target age range for Post ER Visit Follow up?
Any Age
What is the purpose of the HbA1c campaign?
For members with diabetes to complete up to 2 HbA1c tests per year
What is the order of operation is you contact a parent who has several kids with Gaps in Care?
Start with the oldest kids advising what gaps in care exist, then advise of remaining children gaps...
When outreaching to PCP, if multiple children share a PCP, outreach to that PCP to attempt appointment and provide parent/guardian with other PCP date
Target ages for Immunizations for Adolescents?
before 13th bday