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Managed behavioral healthcare organizations (MBHO) can be independent organizations, can be part of a health plan or can be supported by health care providers. All have a common focus: deliver value. Key strategies for accomplishing this include network development, performance measurement, managing utilization, coordinating care and setting payment rates. Managed behavioral healthcare organizations (MBHO) can be independent organizations, can be part of a health plan or can be supported by health care providers. All have a common focus: deliver value.
Key strategies for accomplishing this include network development, performance measurement, managing utilization, coordinating care and setting payment rates.

Further reading –

https://prezi.com/0vo1evondfjr/managed-behavioral-healthcare-organizations-mbho/

Immunizations for Adolescents – The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine and one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) or one tetanus, diphtheria toxoids vaccine (Td) by their 13th birthday.

Further reading –

http://www.ncqa.org/portals/0/Immunizations%20for%20Adolescents.pdf

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment – The percentage of adolescent and adult members with a new episode of alcohol or other drug (AOD) dependence who received the following.

• Initiation of AOD Treatment. The percentage of members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.

• Engagement of AOD Treatment. The percentage of members who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit.

Further reading –

https://www.mhswi.com/content/dam/centene/MHSWI/Providers/PDFs/WI_Medicaid_(IET)_Provider_03_31_17%20BRIEF%20FINAL.pdf

Follow-Up After Hospitalization for Mental Illness – The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Two rates are reported: • The percentage of discharges for which the member received follow-up within 7 days of discharge.

Further reading –

http://www.ncqa.org/portals/0/Follow-Up%20After%20Hospitalization%20for%20Mental%20Illness.pdf

Disease management programs are increasingly being utilized by state Medicaid programs to provide better care while reducing costs, particularly for individuals with chronic conditions. Early research has shown that while disease management programs are relatively new, there can be substantial reductions in health care service use and expenditures. Disease management programs have been developed and implemented largely by managed care plans. Programs for diabetes, asthma, hypertension, depression and congestive heart failure are the most common. Health plans and Medicaid agencies generally contract with disease management organizations to provide services, although some choose to operate the program themselves.

Further reading –

http://www.aafp.org/dam/AAFP/documents/advocacy/coverage/medicaid/ES-MedicaidDiseaseManagementPrograms-121305.pdf

Potentially Harmful Drug-Disease Interactions in the Elderly – Potentially Harmful Drug-Disease Interactions in the Elderly: Assesses adults 65 and older who have a specific disease or condition (i.e., chronic renal failure, dementia, history of falls) and were dispensed a prescription for a medication that could exacerbate that condition.

Use of High-Risk Medications in the Elderly: Assesses adults 65 and older who received at least one high-risk medication or who received at least two different high-risk medications.

Prescription drug use by the elderly can often result in adverse drug events that contribute to hospitalization, increased duration of illness, nursing home placement, falls and fractures. Despite widely accepted medical consensus that certain drugs increase the risk of harm to the elderly, 1 these drugs continue to be prescribed. Because older adults are more likely to take multiple medications for multiple conditions, they are also at higher risk of potentially harmful drug-disease interactions. Avoiding the use of high-risk drugs is an important, simple and effective strategy in reducing medication-related problems and adverse drug events in older adults.2

Further reading –

http://passporthealthplan.com/wp-content/uploads/2017/01/Potentially-Harmful-Drug-Disease-Interactions-in-the-Elderly.pdf

Appropriate Treatment for Children with Pharyngitis – The percentage of children 2–18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. A higher rate represents better performance (i.e., appropriate testing).

Further reading –

http://www.ncqa.org/portals/0/Appropriate%20Testing%20for%20Children%20With%20Pharyngitis.pdf

NCQA’s Credentials Verification Organization (CVO) Certification Program evaluates credentials verification operations and the processes that the CVO uses to continuously improve the services it provides to its managed care clients. CVO certification is available to organizations that conduct credentials verification, report the credentialing information to clients and have systems in place to protect the confidentiality and integrity of the information.

The NCQA Certification Survey includes rigorous onsite and offsite evaluations conducted by a survey team that includes at least one CR surveyor and one administrative surveyor. A Review Oversight Committee (ROC) of physicians analyzes the team’s findings and assigns a certification status based on the CVO’s performance against core standards and the requirements within applicable certification options.

Further reading –

http://www.ncqa.org/programs/certification/credentials-verification-organization-cvo

Childhood Immunization Status . The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates.

Further reading –

http://www.ncqa.org/portals/0/Childhood%20Immunization%20Status.pdf