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Quality

WellCare of New York wants to ensure quality, cost-effective health care solutions for our members. Our Quality Improvement (QI) Program aims to advance patient safety and care so our members can stay healthy and manage chronic health problems.

CAHPS: An Important Message to our Valued Providers
Your patients, our members, will be receiving the New York State, Medicaid CAHPS surveys very soon. Are you and your office staff doing what it takes to ensure your patients are satisfied with their health care services? Do you know what your patients have already been saying? To stay up-to-date and informed on the latest, please take a moment to review some important information.

Million Hearts Action Guide 
The Hypertension Control: Change Package for Clinicians  is a quality improvement tool for ambulatory clinical settings to improve hypertension control. This guide includes change concepts, change ideas, and evidence or practice based tools and resources.

2019 HEDIS Toolkit

HEDIS® (Healthcare Effectiveness Data and Information Set)

2019 HEDIS® AT-A-GLANCE: KEY ADULT MEASURES

Coordination of Care requires proactively identifying the patient’s needs, organizing care and communicating vital information at the right time to the right people.

HEDIS® Guide Adult Quick Tips

HEDIS® Adult Resource Guide

2019 HEDIS® AT-A-GLANCE: KEY BEHAVIORAL MEASURES (18 Years and Older)

This form is to assess care needs for older adults.

Every year CMS or NCQA may ask your patient the following questions. How do you rate?

Important Information on CPT II and HCPCS Codes

The survey is used to measure how the care provided by Medicare Advantage Organizations (MAO) affects the health outcomes of their enrollees.

We’re asking our providers to make sure to use accurate CPT Category II codes to improve efficiencies in closing patient care gaps and in data collection for performance measurement.

2019 HEDIS® AT-A-GLANCE: KEY PEDIATRIC MEASURES

Pediatric and Behavioral Health Measures

What are your patients saying about the care they received? Each year, a child CAHPS survey is conducted to collect information about patient healthcare experience. Studies show patients who are happy with their personal doctor are more compliant to treatment plans and have better health outcomes.

Preventive Health Counseling and Education for Children and Adolescents Ages 3–17 Years

HEDIS® Guide Pediatric Quick Tips

Other Resources

WellCare shall monitor providers against the following standards to ensure members can obtain needed health services within the acceptable appointment time frames, in-office waiting times, and after-hours standards.

New York Confidential Case Report Form

Promoting cultural and linguistic competency self-assessment checklist for personnel providing primary health care services

A form used to order copies of the New York State Health Care Proxy

The documentation standards listed here applies to all medical records

The documentation listed here applies to all obstetrical records

QARR Quick Reference Guide for New York State

The purpose of this letter is to inform you about recently adopted amendments to regulations at 10 NYCRR Subpart 66-1 addressing school immunization requirements.

This tool is designed to be a working record for all WellCare members.

Helpful Information

Case Management

Provide coordination of individualized, timely, cost-effective and integrated services to promote positive clinical outcomes for members. The purpose of WellCare’s Case Management program for our medically compromised population is:

  • Decrease fragmentation of health care service delivery
  • Facilitate appropriate use of available resources
  • Optimize member outcomes through education, care coordination and advocacy services

Disease Management

Provide education and health coaching to empower our members to manage chronic conditions, including asthma, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD), hypertension, depression and human immunodeficiency virus (HIV).

EPSTD Program

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program
Improves the rate of members receiving health assessment screenings and testing. 

Health and Wellness

Helps members stay healthy by providing access to educational materials and health tips.

Vaccines for Children Program

The New York Vaccines for Children program ensures children receive their vaccines in accordance with Advisory Committee on Immunization Practices (ACIP) guidelines and periodicity schedule.

  • Case Management

    Case Management

    Provide coordination of individualized, timely, cost-effective and integrated services to promote positive clinical outcomes for members. The purpose of WellCare’s Case Management program for our medically compromised population is:

    • Decrease fragmentation of health care service delivery
    • Facilitate appropriate use of available resources
    • Optimize member outcomes through education, care coordination and advocacy services
  • Disease Management

    Disease Management

    Provide education and health coaching to empower our members to manage chronic conditions, including asthma, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD), hypertension, depression and human immunodeficiency virus (HIV).

  • EPSTD Program

    EPSTD Program

    Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program
    Improves the rate of members receiving health assessment screenings and testing. 
  • Health and Wellness

    Health and Wellness

    Helps members stay healthy by providing access to educational materials and health tips.

  • Vaccines for Children Program

    Vaccines for Children Program

    The New York Vaccines for Children program ensures children receive their vaccines in accordance with Advisory Committee on Immunization Practices (ACIP) guidelines and periodicity schedule.

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Last Updated On: 2/4/2019