Integrated Health Management Healthy Connections programs help members take a more active role in managing their overall health and enable us to assist physicians in providing the highest quality care. To facilitate patient-provider healthcare decisions, Premera acts as a resource to support those decisions with information and data. Please see our Treatment Guidelines below for examples.
Premera’s Disease Management program is dedicated to improving the quality of life for members who have chronic conditions, including diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease (COPD), and asthma.
The program helps members take a central role in managing their care and fosters responsibility for their own health. Our focus is on identifying conditions as early as possible to slow or prevent their progression.
Premera members eligible for these programs are identified through claims analysis, physician referral or self-referral. This program is completely voluntary and complies with all federal and state regulations, including the Health Insurance Portability and Accountability Act (HIPAA).
Disease Management services include:
For additional information, visit Wellness Resources.
Our Health Awareness Education Programs offer health and lifestyle resources and materials to members. We encourage and remind members to take actions that promote health and prevent disease.
Program activities support healthy lifestyle choices, regular health assessments and early detection of disease.
All health awareness education and reminder programs are based on nationally recognized guidelines for Preventive Health Services, which have been adopted by Premera.
Health Awareness Education services include:
For this program, Premera works withVivacity, an independent provider that offers wellness solutions to deliver integrated, employer-based wellness programs for you.
Personal problems, planning for life events or simply managing daily life can affect your employees’ work. As part of all benefit packages for employers with 1-50 employees and an option for employers with 51 or more employees, our EAP program offers:
For this program, Premera works with Vivacity*, an independent provider that offers wellness solutions to deliver integrated, employer-based wellness programs for you.
Our Health Risk Management programs provide a proactive approach to helping members identify and reduce specific health risk factors, through healthier lifestyle choices.
Groups of 2-199 employees—included in all plans
Online personal health assessment
Confidential personal health report for members
Aggregate management reports to help you identify programs or benefits that can help improve the health of your employees (available when 50 or more employees participate)
Tobacco Cessation (for groups of at least 200 employees)
We can help you harness your employees’ desire to stop smoking, and turn it into a positive health outcome for them and your company. We’ve partnered with the American Cancer Society (ACS) to give your employees access to ACS’s highly-successful Quit for Life®. These supportive, scheduled counseling calls—by trained tobacco cessation counselors—help your employees stay on track.
The program provides Nicotine Replacement Therapy (NRT) for those eligible counseling participants who are medically qualified to receive it.
Biometric Screening Services (for groups of at least 200 employees)
To complement corporate wellness efforts, Premera can partner with you to provide workplace biometrics screenings. Medical professionals come to your site and conduct quick and easy screenings that enable your employees to learn key indicators of their health status.
*Vivacity is a member of the Premera family of companies
Consistent and complete documentation in the medical record is an essential component of high-quality patient care. The following standards and guidelines describe our expectations for primary care medical record documentation and information management. You may also download our Medical Records Flow Sheets, or call 1-800-422-0032 (ext. 85995) for copies.
Note: * Identifies Core Standards of critical importance.
+ Identifies Monitoring Status for new standards not included in the scoring for medical record documentation review.
The Primary Care Practitioner's office has an organized medical record keeping system and standards for the availability of medical records.
Guideline: The office is able to locate and make available records requested for review. Records are assembled in an organized manner to facilitate location of specific information.
The medical record has the patient's name or ID number on every page.
Guideline: Each page, or screen, of the medical record contains the patient's name or ID number.
The medical record contains personal or biographical data.
Guideline: Personal or biographical data, such as address, employer, and home and work telephone numbers are included in the medical record.
The medical record has the date on all entries made at the clinic.
Guideline: All entries in the medical record that are made by office personnel (e.g., progress notes and phone interactions) are dated with month, day and year of encounter.
The medical record has author identification for each entry.
Guideline: All entries in the medical record made by office personnel (e.g., progress notes and phone interactions) have the author or recorder's name, initials or identification mark.
The medical record is legible to healthcare providers other than the writer.
Guideline: The legibility of the entries in the medical record is determined by the reviewer. Photocopies of illegible record pages are reviewed by a second reviewer.
The medical record includes a current problem list.
Guideline: Significant illnesses and medical conditions are documented in the medical record. If a problem list is used, it is current. If a chart notation method is used, it is consistent. Significant is defined as requiring follow-up beyond a two-month time frame.
The medical record notes medication allergies and adverse reactions or absence of allergies (NKDA).
Guideline: Allergies or absence of allergies are easily identified and found in a consistent place in the medical record. Allergy notations are not necessary for children less than one year of age.
The medical record contains a past medical history.
Guideline: A past medical history, including serious accidents, operations and illnesses, is in the medical record of patients seen three or more times. A past medical history for children, age 18 years or younger, may include prenatal care, birth records, operations and childhood illnesses.
The medical record addresses the patient's personal habits regarding tobacco, alcohol and other substance use.
Guideline: A notation is made in the medical record concerning the use of tobacco, alcohol and other addictive substances for patients 14 years and older.
The medical record has a history and physical examination documented for presenting complaints.
Guideline: The subjective and objective information pertinent to the patient's presenting complaint is noted in the medical record.
The medical record reflects evidence that laboratory and other studies are ordered appropriately.
Guideline: Lab work, imaging and other studies ordered are based on the subjective and objective findings of the history and physical exam.
The medical record shows a working diagnosis for presenting complaints.
Guideline: A working diagnosis is recorded in the medical record that is consistent with the subjective and objective findings for the visit.
The medical record has treatment plans consistent with the diagnosis.
Guideline: A plan of treatment is recorded in the medical record that is consistent with the working diagnosis. Interventions, treatment plans or options and appropriate member instruction/education are documented.
The medical record has documentation of a return visit date or other follow-up plan for each encounter.
Guideline: A plan for follow-up is recorded in the medical record, including when the patient should return to the office or next actions. The specific time of return is noted in weeks, months or as needed.
The medical record shows that unresolved problems from previous visits are addressed in subsequent visit(s).
Guideline: Unresolved health issues and ongoing medical conditions are reassessed at subsequent visits.
The medical record reflects evidence of continuity and coordination of care between primary care practitioners and specialty medical care providers or behavioral healthcare providers.
Guideline: There is a consultant report filed in the medical record for requested consultations and referrals for care.
The medical record shows evidence that consultations and abnormal lab and imaging reports have been reviewed by the primary care practitioner.
Guideline: There is indication in the report of the practitioner's review of the outcome of the report. Review by professionals other than the PCP, such as a nurse practitioner or physician assistant, do not meet this requirement. Abnormal results have a notation of follow-up plan either on the report or in the progress notes.
The medical record contains an up-do-date immunization record.
Guideline: There is documentation of immunization status for pediatric patients age 10 and under. Adult patient records note age-appropriate vaccines such as tetanus, influenza or pneumonia vaccination.
The medical record indicates that preventive screening and services are offered.
Guideline: Age-appropriate preventive services are documented. Preventive services are based on the Premera Blue Cross Preventive Health Guideline. Examples for children include immunizations, well-child examinations and anticipatory guidance. Examples for adults include weight, blood pressure, mammograms and Pap examinations.
The medical record shows evidence that the practitioner has discussed advance directives with the patient.
Guideline: There is documentation of discussion of end of life decisions for patients age 18 and older. Documentation may be in the progress notes or in a check box on a flow sheet. Sharing literature about advance directives is considered the same as discussion.
The medical record includes a current medication list.
Guideline: All prescription drugs, vitamins, herbs and other over-the-counter medications used routinely by the patient are listed in one place in the medical record.