Encouraging Medicare Patients to Improve Health Outcomes Older patients are at a higher risk for falls, incontinence, emotional health issues, and problems with medication management. To improve patients’ well-being and encourage continued open discussion about their health status, we recommend focusing on the following items:

  • Conducting annual wellness visits with your patients, especially those who are Medicare Advantage members. Encourage patients to schedule their visit for the following year before they leave.

  • Screening patients for fall risk and developing a fall risk reduction plan for patients who screen positive.

  • Documenting the screening (and fall risk reduction plan if applicable) and including the appropriate CPT II code on your claim.

  • Asking patients if they have experienced urinary incontinence, and providing information and resources that can help them.

  • Checking in on patients’ emotional health and referring them to appropriate resources.

  • Having direct conversations about starting, increasing, or maintaining physical activity with patients.

  • Conducting medication reconciliation for appropriate usage with patients.

  • Encouraging patients to stay up to date on health care visits and screening opportunities, while notifying their care team regarding any changes in their health status.

Additional Resources

Highmark has created the Care Conversation video series to encourage members to discuss fall risk and bladder control with their health care providers. If you’d like to view these videos and share them with your patients, click the links below:

Highmark members may also have programs available through their health plan to support their physical and mental health. They can get additional information by contacting Member Service at the number on the back of their member ID card.

How are these outcomes measured?

The Medicare Health Outcomes Survey (HOS) is an annual survey — administered from July through November by the Centers for Medicare and Medicaid Services (CMS) — to a random sample of Medicare Advantage (MA) members.

Every year, a new cohort of MA patients receives a baseline survey; then two years later, those same respondents are surveyed again. HOS measures members’ perceptions of their physical and mental health, and how their health has changed over time.

HOS includes five Healthcare Effectiveness Data and Information Set (HEDIS®) measures that contribute to the health plan’s Medicare Star Rating:

  • Monitoring physical activity
  • Reducing the risk of falling
  • Improving bladder control
  • Improving or Maintaining Physical Health
  • Improving or Maintaining Mental Health

Survey responses are confidential and may be completed by MA patients or their designated representatives. Initiating discussions about the HOS topics may lead to better health outcomes for your patients. Such conversations also help support gap closure programs.

Highmark does not recommend particular treatments or health care services. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should determine the appropriate treatment and follow-up with your patient. Coverage of services is subject to the terms of each member’s benefit plan. Additionally, state laws and regulations governing health insurance, health plans and coverage may apply and will vary from state to state.

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.


 

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