Problem Statement

Objective

Proposed Strategies

Action Plan

Additional Resources

Status 10/23

Difficulty Obtaining Dust Mite Barriers

1A) PA & payment

1B) Patient access

1C) Provider knowledge of appropriate use of covers.

1A) Streamline administrative system.

1B) Improve Pt access to covers.

1C) Educate health providers of administrative process, use of covers as `best practice'.

1A) Create billing code for the item that all MCO's can use.

1B) Create Pilot for covers distribution at a clinic site.

1C) Using data from pilot, other centers, work with MCO's, Provider Academies to inform providers of streamlined administrative process, best practices.

1D) CHNCT mails covers to clients -? Consider by other plans.

1A) Dr. Harper (HN), Dr. Geertsma & DSS create a billing code.

1B) Dr. Harper, SMH develop a pilot when 1A is complete, evaluate cost, use.

1C) To be identified after 1A & B are in place.

1D) CHNCT plans to evaluate the efficacy of this approach.

None

1B) SMH bulk purchase of covers, submit claim form to MCO for reimbursement.

1A) *BCFP is now internally reviewing the revised PA criteria.

*MCO provide PA guidelines to WG for provider information.

*MCO's will individually/collectively manage billing codes with local vendors, plan internal tracking.

of use.

1B,1C), Wait for survey of NH & Wtrbry.

1D) ? future comment of evaluation from CHNCT

Providers Unable to obtain approval for Multiple Asthma Prescriptions at one time

1A) Pharmacy vendors wil1 accept prescription

1B) Clarify administrative process.

!A) Use Dr. Cloutier's process of writing specific prescription for med. for specific places( i. e. home, school, grandmother)

1B) Inform health providers on how to order multiple prescriptions.

1A) Health Plans need to agree to this, inform their PBM who will inform their pharmacy vendors of process.

1B)* MCO's will inform providers through the provider newsletter.

*AAP inform members.

Staff will request all MCO's and (their PBM) to be prepared to have a decision by Jan. 17^th meeting

Pt difficulty in obtaining emergent asthma med, DME off hours.

Improve ready access to emergent meds, equipment.

*Urban ED's have 2 pulmonades to give to child seen in ED for Asthma.

*Rural Pharmacies with 24 HR service have supplies on hand for emergent needs

MCO's to discuss this strategy internally, bring back to group for action plan development

*Staff to arrange including this on the CHA ED Directors agenda: several MCO Med. Dir and providers present issue & request ED's consideration of having emergency equipment for asthma child seen after hours.

*Arrange similar meeting with CT Pharmacy Assoc. to address rural 24-HR pharmacies.

Patient access to asthma equipment from a single site is not available in all areas, decreasing pt. treatment adherence.

Improve access to meds, spacers, pulmonade, dust covers at one site,

*MCO/PBM encourage pharmacies within geographic areas to stock asthma `package'

* Develop communication process with HUSKY providers for Phar/DME and separate vendors within provider's area & updates on local vendor changes.

*Better inform pharmacies of MCO coverage policies.

10/12: MCO's agreed to 2 city survey: change in report time to Dec, rather than Nov.

10/23:

Dr. Smith (CHNCT) has developed a reporting format that will be sent to the other 3 MCO's for use.

Survey Plan:

*MCO obtain local vendor info by 12/6, ideally by 11/30.

For convenience, can email to M. McCourt: *Will send this on to Dr. Cloutier @CCMC. She will organize the info.

*Email vendor/city info to WG for comment.

*Report to the Council 12/14.