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Letter From the Medical Director
Dear Providers,
I am writing this the day after healthcare reform passed; it is a day to celebrate. It will be a challenging four years between now and full implementation, but for the first time our country has made healthcare coverage a right, not a privilege.
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Improving Patient Experience Pilots
One of our key initiatives at the San Francisco Health Plan is improving our patients’ experiences with care. Our HEDIS scores are consistently high in our clinical measures, but our patient experience scores, as measured through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, show room for improvement in the areas of access and provider communication.
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HEDIS Season is HERE!
HEDIS is an acronym for Healthcare Effectiveness Data and Information Set. HEDIS is designed to inform providers and health plans about the quality of care and services provided to the members we serve. Doing well on the HEDIS measures is a key indicator that SFHP providers are providing exceptional care to members and SFHP has a great provider network and partnership.
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Pharmacy FAQs
Q: How should I manage a patient with frequent migraines?
A: Please click here and refer to the Institute for Clinical Systems Improvement’s Migraine Prophylactic Treatment Algorithm (page 10).
Q: For Medi-Cal members, what is the prior authorization process for obtaining antipsychotics and anti-retroviral medications for the treatment of AIDS/HIV?
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April Is National Austim Awareness Month
Autism spectrum disorders (ASDs) are a group of developmental disabilities characterized by atypical development in socialization, communication, and behavior. The symptoms of ASDs typically present before age 3 years and often are accompanied by abnormalities in cognitive functioning, learning, attention, and sensory processing.
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2010 Well Adolescent Raffle
During 2009, twenty provider offices and clinics participated in our Well Adolescent Provider Outreach Incentive Program. This program offers providers a $20 cash incentive for each comprehensive annual exam given to adolescents 12-21 years of age. Members also receive an incentive of either two free AMC movie tickets or a $15 gift card to iTunes, Walgreens, or Ross.
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Free Webinar Training Resources on Patient Centered Medical Home
In January, HealthSciences Institute launched an exciting new chronic care improvement community featuring free, noncommercial monthly Continuing Education (CE) webinars. These webinars are designed to help nurses, care managers, health coaches, physicians, pharmacists, and other medical home team members put chronic care and medical home models into practice.
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SFHP Network Operations Manual
The Network Operations Manual is designed to assist providers and medical groups navigate SFHP policies, benefits and programs. The manual is updated periodically and the most current version can be found on the SFHP Website under Provider Resources.
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Revision of Criteria for Breast Cancer Screening
The SFHP Physician Advisory Group reviewed the revised criteria for breast cancer screening. The link below contains the criteria used for Community Health Network and UCSF medical groups (SFHP does not review authorizations for other medical groups). Highlights include:
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Health Care Reform Passes!
As you are no doubt aware, on March 21st, the U.S. House of Representatives passed the Senate health care reform bill, HR 3590 (the Patient Protection and Affordable Care Act) by a vote of 219 to 212. The passage by the House is a huge step forward toward meaningful health care reform, and the outlook from here looks very positive.
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Formulary Updates
- Updates from January 2010 P&T Committee for Medi-Cal, Healthy Families and Healthy Kids
- Drug Class Reviewed- Ophthalmic Agents
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