Clinical Quality Improvement at Rocky Mountain Health Plans
The objective of the RMHP Quality Improvement Program is to monitor, measure, and take effective actions on identified opportunities to improve the quality and safety of health care and services through the cycle of objective evaluation, intervention, and reevaluation. These activities are the summation of efforts by several departments including Quality Improvement, Care Management, Pharmacy, Provider Network Management, Customer Service, Health Promotions, Claims, Home Health, Member Administration, Marketing, Information Technologies, and effective professional peer review. Pertinent activities from all of these processes are reported and integrated into the QI Program.
The goals of the RMHP QI Program are to:
Improve the quality of all categories of health care, including behavioral health care and chronic illness care, provided to the entire population of RMHP Members.
Promote clinical care and services that are delivered in a safe, timely, efficient, effective, equitable, and patient-centered manner.
Respond to the needs and expectations of RMHP internal and external customers by evaluating clinical and service performance relative to meeting those needs and expectations.
Encourage and engage in effective professional peer review.
Support and facilitate health care entities in geographically distinct areas in coordinating the collection and utilization of quality improvement information.
Evaluate and improve the effectiveness of the QI Program by developing action plans based on measured outcomes.
Report results of quality improvement efforts.
Ensure compliance with statutory requirements and accreditation standards.
Additional information about our Quality Improvement Program is available upon request. Please contact our customer service to request this information at 800-346-4643 or e-mail us at email@example.com.
HEDIS Information Sheet
RMHP 2014 HEDIS Measures
RMHP CURRENT GUIDELINES
ADHD Abstract Summary
AAP Clinical Practice Guideline for ADHD
2) Adult Preventive Care
USPSTF Adult Preventive Care Guidelines
USPSTF Guide to Clinical Preventive Services, 2014
Recommended Adult Immunization Schedule
NHLBI Asthma Guideline
GINA Pocketguide for Asthma Management and Prevention
Stepwise Approach for Managing Asthma
4) Cardiovascular Disease
2013 ACC AHA Guideline Assessment of Cardiovascular Risk
2013 ACCF AHA Guideline for the Management of ST-Elevation Myocardial Infarction
2014 AHA ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes
2016 Abridged-SOC Diabetes
6) Major Depression
Guideline for the Treatment of Patients with Major Depression
7) Pediatric Preventive Care
AAP Pediatric Preventive Care Guidelines
Recommended Pediatric Immunization Schedule
8) Perinatal Care
Perinatal Care Guideline
9) Special Health Care Needs - Adults
Adults with Special Health Care Needs
10) Special Health Care Needs - Children
Children with Special Health Care Needs
RMHP offers pregnant members a screening to determine if they might be at risk of delivering early and personalized help for those who are at risk. Our nurses work with delivering physicians to provide education and support on such issues as multiple gestation, premature labor, bed rest, breast feeding, and gestational diabetes.
If you have an RMHP Member who is pregnant please use the Pregnancy Notification/Procedure Form to let us know about the pregnancy, or contact the RMHP Obstetrical Prenatal Care Coordinator listed below:
Obstetrical (OB) Prenatal Care Coordinator 970-248-8718 or 1-800-793-1339
Click on the links below for helpful information and self-management tools:
Improving Pregnancy Outcomes Order Form
Pregnancy Resource List English | Español
Prenatal Care Checklist English | Español
Reducing Chances of Preterm Labor English | Español
Treating Nausea and Vomiting English | Español
Congratulations - You are in the third trimester of your pregnancy! English | Español
Domestic Violence Questionnaire
Edinburgh Depression Scale English | Español
Congratulations! Your Baby is Here English | Español
Rocky Mountain Health Plans encourages our Members to stop using tobacco. Find information on a Tobacco Cessation and Secondhand Smoke using the five A’s approach (Ask, Advise, Assess, Assist, Arrange) and the stages of change. You can also link to Colorado QuitNet, a free professional telephone counseling/support service or call the Colorado Quitline at 800-639-QUIT (7848).
Rocky Mountain Health Plans encourages our members to stop using tobacco. Find information on Tobacco Cessation and Secondhand Smoke using the 5 A’s approach (Ask, Advise, Assess, Assist, Arrange).You can also link to Colorado QuitNet, a free professional telephone counseling/support service or call the Colorado Quitline at 800-639-QUIT (7848).
Guideline for Tobacco Cessation and Secondhand Smoke Exposure
Helping our members maintain a healthy lifestyle is a primary goal for Rocky Mountain Health Plans. We encourage our members to have regular well-care visits, to keep track of key health indicators, and receive preventive care. Below you will find:
- Well-care guidelines for infants, children and adolescents, and adults.
- Screening guidelines for breast cancer, Pap smears, prostate cancer, and colorectal cancer.
- Guidelines for influenza vaccine, pneumococcal vaccine, and childhood immunization.
Rocky Mountain Health Plans participates in the Colorado Immunization Registry. Click here to go to their website: http://coloradoimmunizations.info/ciis/index.htm.
Click on the links below for helpful information and self-management tools: CDC Recommended Childhood Immunization Schedule
CDC Recommended Adult Immunization Schedule Colorado Immunization Registry Clinical Preventive Health Recommendations for the General Adult and Targeted Populations Adult Preventive Care Flowsheet Immunize for Good Staying Healthy at Any Age
Vaccines: Your Best Shot at Good Health
Recovering from a Fracture A Health Reminder for You (Spirometry) Feel Better without Antibiotics Detection is Your Best Protection, Colorectal Detection is Your Best Protection, Eye Exam Adult Obesity Action Plan, Tool Kit
Suggestions for Taking a Sexual History for Teenage Girls Chlamydia Fact Sheet Chlamydia: What You Don't Know May Hurt You BMI Calculators: Child, Teen, and Adult Boys birth to 36 months growth chart Girls birth to 36 months growth chart
Boys 2-20 yrs growth chart Girls 2-20 yrs growth chart Diabetes Foot Evaluation Diabetes Flowsheet Spirometry for Health Care Providers
DISEASE MANAGEMENT PROGRAM
Evidence-based guidelines and tools will help you develop a treatment plan for your patients who have a heart attack. RMHP encourages our Members to manage their chronic condition by following their doctor’s treatment plan, becoming educated about their disease, and learning what affects their condition.
If you have an RMHP Member with diabetes or heart disease that you would like to refer for Disease Management, contact an RN Health educator at 1-800-847-6466.
Case Management Program
To get the most successful health care treatment possible, you need:
- the right care
- from the right provider
- at the right time
- in the right setting
- understand a diagnosis and consider your treatment options
- deal with chronic conditions and complex medical situations
- find information and support for yourself and your family
- understand how your RMHP plan benefits work
- coordinate your health care services in the hospital, doctor’s office, and home
If you have a Rocky Mountain Health Plans Member who you would like to refer, call RMHP Case Management at 800-793-1339 and ask for a care management evaluation. You can also email them at firstname.lastname@example.org