- Physicians (does not apply to Cal MediConnect)
- Participating Physician Groups (PPG)
(does not apply to HSP)
This section contains general information about health education services.
The health plan’s Health Education, Cultural & Linguistic Services and Quality Improvement Departments conduct a Population Needs Assessment (PNA) report and action plan annually. The purpose of the PNA is to determine the health education, cultural and linguistic, and quality improvement needs of Health Net and CalViva Health Medi-Cal members. The health plan will use the findings of the PNA, as well as other relevant information, to establish health education programs priorities and appropriate interventions for specific health issues and unmet needs of target populations. In accordance with Department of Health Care Services All Plan Letter 19-011, Health Net will complete a PNA report annually (excluding subcontracted counties) and incorporate updated PNA findings in the plan’s annual work plans.
Printed information for Medi-Cal and Cal MediConnect members must be provided at a sixth-grade (or lower) reading level and must be in an easy-to-read format. Health Net health education brochures and fact sheets for Medi-Cal and Cal MediConnect members are written at this level. Diverse cultural backgrounds are taken into consideration when these materials are created and translated. The Health Net Cultural and Linguistic Services Department reviews these materials for accuracy of translation, cultural content and reading level.
Providers are required to have educational materials available in approved threshold languages. Health Net evaluates member materials with the assistance of experts, community advisory committees, focus groups, and individual and group interviews. For information on threshold language requirements, refer to Access to Care requirements under Compliance and Regulations.
Health Net health education materials may be ordered by mailing or faxing a completed copy of the Provider Order Form for Health Education Materials Health Net Medi-Cal (PDF) or CalViva Health (PDF)) to the Health Net Health Education Department.
Some participating physician groups (PPGs) provide additional health education services for members. Consult the Provider Participation Agreement (PPA) for information on required protocols.
Medi-Cal and Cal MediConnect providers must provide health education materials, services and resources in approved threshold languages and at no cost to Health Net members. Subject matter should address the needs of the general membership population. Information on the following subjects must be available:
- Age-specific anticipatory guidance (Medi-Cal only) - Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
- Alcohol and drug use
- Appropriate use of health care services
- Complementary and alternative care
- Dental health
- Family planning
- Health education services
- HIV and sexually transmitted infection (STI) prevention
- Injury prevention
- Managed health care
- Nutrition, weight control and physical activity
- Obstetrical care
- Perinatal health
- Preventive and primary health care
- Risk reduction and healthy lifestyles
- Substance abuse
- Tobacco prevention and cessation
- Tuberculosis (TB)
- Unintended pregnancy prevention
The Health Net Health Education Department offers no-cost informational materials, programs and other services on a variety of topics to promote healthy lifestyles and health improvement to Health Net members.
Health Net members and providers may call the Health Net Medi-Cal Health Education Department to request educational materials in different languages, information about health education programs available through Health Net, community and national health education programs and services, and to obtain toll-free health information telephone numbers.
Providers are responsible for documenting health education referrals and provision of health education materials in the member's medical record. Health Net uses the following methods to monitor and assess the quality of preventive care and health education services offered by providers and participating physician groups (PPGs):
- Primary care facility site reviews conducted for new providers applying to Health Net to become Medi-Cal managed care or Cal MediConnect providers and recertification reviews conducted for continuing providers
- Health education program evaluations conducted through member satisfaction surveys as a
follow-up to health education material requests and program and class referrals and participation
- Healthcare Effectiveness Data and Information Set (HEDIS®) measures and focused review studies
Health Net provides education to primary care physicians (PCPs) and participating physician groups (PPGs) on Health Net's health education programs and services through the following methods:
- On-site provider education visits - Conducted by Health Net health promotion consultants and the Health Net Facility Site Review (FSR) Compliance Department (Medi-Cal, and Cal MediConnect) nurses, these visits focus on the health education resources available to PCPs and are an opportunity for Health Net to distribute the health education resource material and promote preventive care screenings and education
- Provider Updates - Used to inform providers of new health education policies, programs and services
The Health Net Quality Improvement Department establishes programs to meet the regulatory requirements of the Centers for Medicare and MediCaid Services (CMS), Department of Health Care Services (DHCS) and Department of Managed Health Care (DMHC). These programs include clinical and service quality improvement activities, Healthcare Effectiveness Data and Information Set (HEDIS®) performance measures, member satisfaction and access surveys, Medi-Cal and Cal MediConnect facility site certification, and medical record audits, along with any necessary follow-up quality action plans. This department monitors the results of quality improvement (QI) activities to quantify baseline data, identify opportunities for improvement, develop strong interventions to improve performance, and conduct re-measurements to evaluate effectiveness. The department is also responsible for preparation and implementation of any identified corrective actions based on findings of the CMS, DHCS and DMHC audits and findings identified through quarterly CMS, DHCS and DMHC reviews.
The department is staffed by quality improvement specialists (QIS') who are responsible for ensuring compliance with DHCS standards for facility reviews, medical record audits and quality action plans. The QIS' are responsible for incorporating new accreditation and regulatory standards and implementing new programs to meet those standards. In addition, a QI program manager is responsible for ensuring compliance with all CMS, DHCS and DMHC access to care standards, monitoring processes and access to care action plans.