Targeting preventive care at all visits boosts HEDIS

Printout shows patients, docs, services they need

The proverbial "string around your finger" trick may be the difference between good Health Plan Employer Data and Improvement Set (HEDIS) scores and excellent ones, a California medical group has found. By investing in a computer-based prompting system, The Permanente Medical Group of Northern California expects to improve its HEDIS measures by 6% to 16%.

In fact, that may be a conservative estimate, says Scott Gee, MD, regional associate director for preventive medicine for the 32 clinics based in Oakland, CA.

Kaiser Permanente's Preventive Health Prompting System allows physicians to access a computer-based summary of a patient's preventive health care and determine if any services are due. But in an important change that occurred this spring, patients now receive a receipt when they register for their office visit that contains the preventive care information.

"The key is to make it easy [and] to involve the patients themselves," Gee says. "They want to be a part of their care. It gives them part of the responsibility of getting [the services] done, which is as it should be."

On the slip, patients can learn when they had their last Pap smear or cholesterol screening or other care and when their next one is due. The physician also receives a copy of that receipt and can act on the information immediately, says Gee. The system includes HEDIS and non-HEDIS measures. Physicians frequently were not using the on-line system because it required them to leave the exam room and go to their office computer. The clinics don't have computers in exam rooms.

"Some kids who were behind in their vaccinations had actually been seen by their doctors for illnesses," says Gee, who is also a pediatrician. "The doctors just didn't note the need for immunizations because the vaccine information wasn't readily available. It was a missed opportunity."

With the printed receipts, the Permanente Medical Group saw an immediate jump in preventive care services, says Gee. "The number of tetanus boosters we're giving almost doubled or tripled since we started doing this [in March]," he says.

Patients also have responded favorably to the new system, he says. "Patients really like it because it's their own personal record," he says. "It's hard to remember when those vaccines are due."

Getting complete information to include in the database was a challenge for Gee and his colleagues. Patients may receive preventive care outside the clinic setting. For example, during a trip to the emergency department to care for a cut, a patient may receive a tetanus booster. Another patient may go directly to a mammography center.

"It requires a lot of hard work, looking at all the places the services are provided and trying to get those people to send that information to you so you can put that information in your database," says Gee.

Services such as mammograms and Pap smears can be tracked through claims or encounter data. But physicians must take care to record that they took a patient's blood pressure or performed a breast exam, so it can be included in the database.

By educating physicians and working with other health care providers, Gee now feels confident that he is capturing most of the preventive care his patients need. "You can't do this without good data sources," he says.