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Health Education Program

Provider Type

  • Participating Physician Groups (PPG)

Health Net encourages participating physician groups (PPGs) to provide health education and disease management programs to their members based on identified risks and Healthcare Effectiveness Data and Information Set (HEDIS®) standards.

PPGs should offer health education programs at each PPG delivery site (including satellites) with 5,000 or more Health Net members. Each PPG plans health education programs based on the recommended program criteria and protocols included in the Health Education Program subtopic.

Providing health education programs is part of the contractual agreement between Health Net and the PPG. The PPG is responsible for planning, implementing and evaluating its health education programs.

Health Education Program Offerings

All PPGs should recommend the following core topics: diabetes management, early prenatal education, baby care basics, and for Health Net Medicare Advantage (MA) members, a senior-specific health education or disease management program. Health Net encourages PPGs to provide additional program topics that reflect the breadth and depth of their members' needs. This includes efforts to identify members who smoke and to refer them to appropriate programs.

PPGs may select additional topics from the following list. PPGs are encouraged to select additional topics based on demographic and diagnostic data specific to their members.

Category

Examples

Maternal, infant and child health

VBAC, childbirth preparation, breastfeeding

Circulatory

hypertension, hypercholesterolemia

Respiratory

COPD, asthma

Musculoskeletal

back care, arthritis, osteoporosis

Weight management

adults, adolescents, children

Advisory Committee

Participating physician groups (PPGs) should designate a standing health education advisory committee, including at least one physician and the health education coordinator, to be involved in program planning, evaluation, internal communication, and promotion. This committee can be the same as the PPG Quality Improvement Committee (QIC). The health education advisory committee is responsible for:

  • Meeting at least once a quarter.
  • Maintaining written records of the advisory committee.

Health Net recommends that PPGs:

  • Select advisory committee members to achieve a wide representation of departments in the PPG or geographic locations in a PPG.
  • Distribute meeting minutes widely within the PPG so that staff are kept informed about the program.
  • Develop a supportive, enthusiastic advisory committee. This helps to ensure a quality program and win support from other physicians and staff.

Health Education Coordinator

PPGs should designate a health education coordinator responsible for coordination and delivery of the health education programs, including PPG staff program orientation and record keeping.

Health education coordinators should spend the following number of hours per week coordinating the health education programs based on the PPG's Health Net membership.

PPG Membership

Hours Per Week

Fewer than 5,000 members

15

5,000 to 10,000 members

15 to 25

10,000 to 20,000 members

25 to 40

20,000 or more members

40 hours or more

The health education coordinator's responsibilities are to:

  • Direct members into health education programs based on referrals from Health Net care managers or health risk assessment (HRA) results.
  • Be accessible to Health Net members seeking information, suggestions and problem solving.
  • Coordinate satellite programs (unless another coordinator is designated to do this).
  • Maintain all program records and make them available for the site evaluation.

Health Net recommends that:

  • Health education coordinators have one of the following credentials: masters of public health (MPH), certified health education specialist (CHES), registered nurse (RN), physician assistant (PA), family nurse practitioner (FNP), registered dietitian (RD), or a Masters or Bachelors degree in health education, nutrition or exercise physiology.
  • Health education coordinators receive administrative and medical staff support.

Health education program protocols are recommendations for success when providing classes on diabetes, early prenatal education and baby care basics. Program protocols also include disease-specific education programs and smoking cessation for participating physicians groups (PPGs).

All diabetes education programs should encourage an active partnership between the member, the member's family and the health care provider. Such partnerships can improve member adherence to treatment plans and enable families to better support efforts to control the member's diabetes.

It is also important that all diabetes education programs emphasize the concept of self-management of diabetes rather than teaching individual skills.

The following topics are required for all diabetes education programs:

  • Understanding diabetes:
    • Basic definition and facts about diabetes
      • Normal and abnormal glucose metabolism
      • Classifications: Type I and Type II
    • Factors in the development of Type I and Type II diabetes
    • Signs and symptoms of diabetes
    • Chronic complications
      • Retinopathy
      • Neuropathy
      • Nephropathy
      • Cardiovascular disease
      • Sexual dysfunction/impotence
  • Medications (as indicated):
    • Oral medication
    • Insulin use
      • Review of insulin's action
      • Injection techniques
      • Dosage
      • Insulin reaction (hypoglycemia)
      • Hyperglycemia
  • Strategies to control diabetes:
    • Blood glucose monitoring and interpretation of results
    • Nutrition and meal planning
    • Exercise and activity
    • Routine tests to measure control
      • Annual retinal examination
      • Glycosylated hemoglobin (HbgA1c) screening every three months
      • Annual microalbumin creatinine urine screening
      • Blood pressure screening at every visit
      • Cholesterol screening once a year
      • Foot examination at every visit
  • Living with diabetes:
    • Preventing, detecting and treating complications
      • Skin, eye and dental care
      • Immunizations
      • Infections
      • Foot and leg care
      • "Sick day" rules
      • Identification (such as MedicAlert)
    • Psychological adjustment
    • Lifestyle considerations (nutrition, physical activity and smoking cessation)
    • Family involvement
    • Community resources
  • Patient self-care:
    • Behavior change strategies
    • Goal setting
    • Risk factor reduction
    • Problem-solving

    Adapted from the Journal of Clinical and Applied Research and Education, Diabetes Care, American Diabetes Association, Volume 38: Supplement 1, January 2015.

Frequency

One-to-one counseling should be offered on an ongoing, as-needed basis. Health Net recommends that participating physician groups (PPGs) also offer seminars or classes at least monthly. The diabetes education program may also be a one-session class, multiple-session classes, one-to-one counseling, or any combination of these modes. The recommended minimum length for group programs is three to four sessions, each two hours in length. Classes and seminars should be followed by a one-hour, one-to-one follow-up appointment to develop individualized care plans.

Participant Tracking

PPGs should give documented feedback regarding a member's program attendance to the physician for him or her to include in the member's medical chart.

It is important that all disease-specific education programs encourage an active partnership between the patient, the patient's family, and the health care provider. Such partnerships can improve patient adherence to treatment plans and enable families to better support the patient's efforts to manage his or her disease.

Content may be expanded and additional components incorporated as indicated by the specific disease or condition.

All disease or condition-specific education programs should cover the following topics, as applicable:

  • Understanding the disease:
    • Basic definition of the disease and affected physiological processes
    • Causes of the disease
    • Signs and symptoms of the disease
  • Medications (if applicable):
    • Different types of medications
    • Purpose of medications and how they work
    • Common side-effects and coping strategies
    • Importance of medication compliance
    • Methods of maintaining compliance with the medication regimen
  • Living with the disease:
    • Treatment of the disease:
      • Development of treatment/care plan
      • Routine medical visits and tests
      • Avoiding, detecting and treating complications, if applicable
  • Lifestyle considerations:
    • Nutrition
    • Exercise
    • Other considerations specific to the disease
    • When to call a medical professional immediately
    • Psychosocial issues
    • Importance and role of family/caregivers
  • Patient self-care:
    • Importance of patient compliance with treatment/care plan
    • Self-monitoring, as appropriate
    • Behavior change strategies
    • Individual goal setting

 

Frequency

 

One-to-one counseling should be offered on an ongoing, as-needed basis and should be at least one hour in length. Health Net recommends that participating physician groups (PPGs) offer seminars or classes, which are at least two hours in length, at least monthly. Programs may be offered as a combination of quarterly group programs with one-to-one counseling available in the other two months, as long as both programs are equally available to members.

Participant Tracking

PPGs should document feedback regarding a member's program attendance to be given to the physician for him or her to include in the member's medical chart.

Patient health education is the effort to keep members fully informed about the availability and use of participating physician group (PPG) facilities and services.

PPGs must offer patient health education as a covered service to members in two main areas:

  • Proper use of Health Net and PPG services.
  • Health maintenance and improvement, including personal health care measures and counseling.

Health Net has developed an enrollment packet, which includes a plan overview that explains to members how to use Health Net and PPG services. This enrollment packet is distributed to members, along with identification (ID) cards and the member's Schedule of Benefits. Members are directed to contact their PPGs if they have questions.

PPG Responsibilities

PPGs must make an effort to keep members fully informed about the availability and use of PPG facilities and services. New member interviews, letters of introduction and the Health Net Member Services Department provide sources of ongoing education and information.

Health education services, including educational activities and publications that contain instructions on achieving and maintaining physical and mental health and preventing illness or injury, should be developed by the PPG.

Health Net's Pre-recorded Health Information

Health Net offers a library of pre-recorded information on a variety of health topics to all Health Net members through the AudioHealth Library®. Members may access the library by contacting the Health Net Member Services Department.

Program Delivery Site

Participating physician groups (PPG) and its participating providers should dedicate and maintain a physical environment or setting conducive to the delivery of health education programs and optimal learning and ensure that is appropriate for its Health Net membership. Specifically:

  • Member education must not occur in an examination or a waiting room during clinic hours.
  • All programs should be conducted onsite or at an appropriate offsite location.
  • The sites must be accessible to individuals who have physical limitations.

Program Evaluation and Tracking

Health Net recommends that groups evaluate all classes and seminars using a written participant evaluation form. The evaluation form should include an overall satisfaction question using a five-point rating scale, such as:

5

4

3

2

1

Extremely Satisfied

Very Satisfied

Satisfied

Not Very Satisfied

Extremely Dissatisfied

Written participant evaluation forms are not required for one-to-one counseling sessions.

PPGs should conduct follow-up telephone calls or use other means to evaluate the quality of one-to-one counseling sessions.

Program Promotion

PPGs should promote all programs to Health Net members and PPG staff. Health Net encourages PPGs to mail promotional materials to Health Net members at least once per year to promote all health education programs. Suggested promotional activities include:

  • Flyers and posters in waiting areas.
  • Medical group newsletters via direct mail.
  • Telephone recordings.

PPGs may not use the Health Net corporate logo on material without Health Net's permission.

Record-keeping Responsibilities

PPGs should use and maintain appropriate medical and non-medical records (for example, attendance lists, evaluation forms, patient education sign-in sheets, and documentation of feedback to physicians).

Specifically, PPGs should maintain the following documentation:

  • Attendance records or one-to-one education sign-in sheets identifying Health Net members.
  • Written program evaluations for all programs (except one-on-one counseling).
  • A system to document smoker identification and referrals to a smoking cessation program.
  • Minutes from advisory committee meetings.
  • A physician feedback system of participant attendance and progress in the diabetes and early prenatal programs, which provides a link between the referring physician, patient, and health education program:
    • Attendance feedback is documented in the member's medical record or in a central file.
    • A random sampling of medical records or copies of feedback records may be reviewed during the annual site evaluation.

    PPGs may also document the member's progress, response to education and attendance in other programs and share this information with the member's physician.

Participation in Health Net's Speakers Bureau program is optional. Participating physician groups (PPGs) are asked periodically to provide presentations or screenings to Health Net employer groups.

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Last Updated: 10/31/2019