Welcome to the Patient Assessment Form (PAF) and the Healthcare Quality Patient Assessment Form (HQPAF) Programs for 2015. We thank and appreciate all returning provider offices - and welcome all new provider offices - to the program.
A comprehensive health assessment is one of the best ways for older adults to manage their health. Seeing a physician or certified health care practitioner on an annual basis helps close gaps in care and promotes early detection and management of chronic illnesses. Claims data indicates that only a small percentage of Medicare Advantage members currently receive this type of visit.
An annual wellness visit and the recommended preventative services can close up to 25 HEDIS/Star Ratings measures. The annual wellness visit and recommended preventive services can often catch health problems early when they may be easier and less expensive to treat. All Medicare Advantage members should receive a free annual wellness visit, with no out-of-pocket costs, that includes a schedule of recommended preventive services.
Twenty five clinical and medication adherence quality measures can be addressed when a member completes an annual wellness visit and the recommended preventative services. Targeted HEDIS/Star Ratings Measures*
C01 – Breast Cancer Screening |
C16 – Diabetes, Kidney Disease |
C02 – Colorectal Cancer Screening |
C17 – Diabetes, Blood Sugar |
C03 – Cardiovascular, Cholesterol Screen |
C18 – Diabetes, Cholesterol |
C04 – Diabetes, Cholesterol Screen |
C19 – Controlling Blood Pressure |
C05 – Glaucoma Testing |
C20 – Rheumatoid Arthritis |
C07 – Physical Health |
C21 – Improving Bladder Control |
C08 – Mental Health |
C22 – Reducing the Risk of Falling |
C09 – Monitoring Physical Activity |
C24 – Getting Needed Care |
C10 – Adult BMI Assessment |
C25 – Getting Appointments and Care Quickly |
C11 – Special Needs Plan, Medication Review |
D15 – Diabetes Treatment |
C12 – Special Needs Plan, Functional Assessment |
D16 – Medication Adherence, Diabetes |
12 – Special Needs Plan, Functional Assessment |
D16 – Medication Adherence, Diabetes |
C13 – Special Needs Plan, Pain Screening |
D17 – Medication Adherence, Hypertension |
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D18 – Medication Adherence, Cholesterol |
* The Centers of Medicare & Medicaid Services (CMS) can change the measures and methodology as part of the Star Ratings program. The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by health plans to measure performance on important dimensions of care and services.
For additional information as well as publications and products available for HEDIS, please visit the National Committee for Quality Assurance (NCQA) website at ncqa.org.
Optum wants to encourage and support your success with the HQPAF/PAF program. Talk to your local Optum Healthcare Advocate for additional tools on the PAF and HQPAF program. This includes the HQPAF Provider Instructions and the HQPAF Provider brochure.
For questions, please contact the Optum Provider Support Center at 1-877-751-9207, or contact your local Healthcare Advocate.
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