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Clinical Practice Guidelines at RMHP

Clinical Practice Guidelines at RMHP

These Clinical Practice Guidelines (“Guidelines”) are not meant to replace the clinical judgment of a Member’s physician or other professional health care provider (collectively, “Providers”). As such, these Guidelines do not establish a standard of care or practice, or replace appropriate clinical decision-making. These Guidelines must always be used in the context of a health care Provider's clinical judgment in the care of a particular patient. For that reason, Guidelines may be viewed as an educational tool to provide information and assist Members and Providers in choosing appropriate health care for specific clinical conditions and diagnoses. Deviations from the Guidelines may be necessary and appropriate in certain individual circumstances. These Guidelines were developed by RMHP based on evidence-based clinical guidelines from nationally recognized sources and best practices that were available at the time of publication. More recent information, evidence and practice standards may be available; therefore, persons reviewing these Guidelines should always use independent judgment in their interpretation. Publication of these Guidelines is not a promise or guarantee of coverage. Individuals should review their coverage documents or contact RMHP Customer Service @ 800-346-4643 or customer_service@rmhp.org to determine what health care services are covered benefits and if other conditions or limits of coverage apply.

Clinical Practice Guidelines

 
 

Social Needs Screening Position Statement

Rocky Mountain Health Plans recognizes the growing evidence that non-medical factors drive up to 80% of health outcomes . Rocky Mountain Health Plans is committed to supporting strategies to address the non-medical needs of Members including food insecurity, housing, transportation, utilities, interpersonal violence, social isolation and others as a key way to drive meaningful improvements in the health and wellbeing of Members.

Therefore, in alignment with the American Academy of Physicians , American College of Physicians the American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women , Medicare yearly “wellness” visits , the Centers for Medicare and Medicaid Innovation Accountable Health Communities Model and the Colorado Hospital Transformation Program , Rocky Mountain Health Plans has adopted the following social needs screening position statement.

Rocky Mountain Health Plans encourages all network providers to administer universal social needs screening and to provide patients with information on community resources to address those needs. Social needs screening and community referral can improve health by:

  • ensuring clinical care plans account for patient social constraints (for example, patients without transportation don’t have a plan that requires regular transportation);
  • connecting patients to care coordination;
  • increasing patient awareness of social resource; and,
  • reducing stigma around accessing social resources.

The evolution towards value-based payment models tied to improved health outcomes requires the health system to continue to increase the focus on those non-medical factors that drive health outcomes.

Social Needs Screening Tools

Rocky Mountain Health Plans recommends that network providers use a recognized, validated and widely used screening tool, such as one of the following:

Social Needs Screening Protocols

In order to ensure that social needs screening has the intended impact of improving health, Rocky Mountain Health Plans encourages all network providers to adopt the following high-priority best practices:

  • Train all staff: Clinical and non-clinical staff may have varying knowledge and experience in addressing social determinants of health. All staff should be provided with adequate training to feel comfortable discussing social needs in a supportive strengths-based manner with patients.
  • Implement Universal Screening: Social needs screening should be administered to all patients (for example, all well visits orall new patients in order to avoid exacerbating health inequities or social stigma.
  • Provide Resources: Clinical sites should provide and/or connect patients with a list of community resources at the time of screening. Ideally the clinical site would also have a workflow to connect patients with in-house care coordination or local community based organizations.
  • Assess for Safety: Many social needs screening tools identify safety risks. Clinical sites should have clear workflows for privately assessing patient’s safety needs before the patient leaves the clinical site and what to do if the assessment suggests the patient is at risk.
  • Incorporate Screening Results into the Clinical Care Plan: Social needs screening may indicate potential barriers to complying with the medical or behavioral health care plan. If possible, social needs screening should be recorded in a manner that allows the clinician to see the results and adapt the clinical care plan as needed. RMHP care management staff may be able to help if social needs (or other needs) are identified.

RMHP staff are available to assist any network provider in implementing social needs screening. Please contact us for additional information and resources.