Quality and Performance at Rocky Mountain Health Plans
The objective of the RMHP QI 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 Care Management (CM), Pharmacy Management, Medical Quality Improvement (including Disease Management and Case Management, Credentialing, HEDIS®), Provider Administration (Professional Relations, Contracting), Claims Processing, Customer Service, Member Administration, Marketing, Information Technologies, Home Health 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 healthcare and chronic illness care, provided to the entire population of RMHP members.
- Promote safe clinical care and services that are delivered in a safe, timely, efficient, effective, equitable, and patient-centered manner.
- Encourage 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, and target and steer action plans based on measured outcomes.
- Report results of quality improvement efforts.
- Fulfill RMHP statutory obligations in regards to quality improvement.
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 2011 HEDIS Measures
RMHP CURRENT GUIDELINES
Adult Obesity Guideline
Appropriate use of Antibiotics Guideline
Asthma Care Guidelines
Cardiovascular Disease and Stroke Prevention Guideline
Childhood Obesity Guideline
Chlamydia Screening and Treatment Guideline
Clinical Preventive Health Recommendations for the General Adult and Targeted Populations
Colorectal Screening Guidelines
Depression in Adults: Diagnosis and Treatment
Diabetes Treatment Guidelines
Diabetes Treatment Guideline Addendum 2011
Diabetes - Gestational Diabetes Guidelines
Diabetes - Gestational Diabetes Guidelines - Short Form
Diabetes - Gestational Diabetes Guidelines Addendum 2009
Office Record Guidelines
Osteoporosis Management and Prevention Guideline
Tobacco Cessation and Secondhand Smoke Exposure Guideline
Well-Child Visit Guidelines
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
Pregnancy Resource List (Spanish)
Prenatal Care Checklist
Prenatal Care Checklist (Spanish)
Reducing Chances of Preterm Labor
Reducing Chances of Preterm Labor (Spanish)
Treating Nausea and Vomiting
Treating Nausea and Vomiting (Spanish)
Congratulations - You are in the third trimester of your pregnancy!
Congratulations - You are in the third trimester of your pregnancy! (Spanish)
Gestational Diabetes Guidelines
Gestational Diabetes Guidelines - Short Form
Gestational Guidelines 2009 Addendum
Domestic Violence Questionnaire
Edinburgh Depression Scale
Edinburgh Depression Scale (Spanish)
Congratulations! Your Baby is Here
Congratulations! Your Baby is Here (Spanish)
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 Colorectal Screening Guidelines
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
HEALTH AND DISEASE MANAGEMENT PROGRAMS
Evidence-based guidelines and tools will help you develop a treatment plan for your patients who have asthma, cardiovascular disease, depression, or diabetes. 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. PERSONAL HEALTH MANAGEMENT
If you have an RMHP Member with a chronic condition that you would like to refer for chronic disease health education or case management, contact a health educator at 970-255-5661 or 800-843-0719, ext. 5661
At no additional cost, Rocky Mountain Health Plans offers registered nurses and certified case managers to work one-on-one with your patients to help them in:
- Following your treatment plan
- Understanding their diagnosis and treatment options
- Managing their chronic conditions
- Coordinating their health care services
- Understanding their RMHP benefits
If you have a Rocky Mountain Health Plans member who could use personal health management services, call Rocky Mountain Health Plans Customer Service at 970-248-5036 or 800-854-4558 and ask for a personal health management evaluation