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 customer_service@rmhp.org.


HEDIS

HEDIS Information Sheet

RMHP 2014 HEDIS Measures


RMHP CURRENT GUIDELINES

1) ADHD

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

3) Asthma

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

5) Diabetes

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


PREGNANCY PROGRAM

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

Pregnancy Guidelines

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).


SMOKING CESSATION

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


PROVIDER TOOLS

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 customer_service@rmhp.org.