Blue Shield of California Promise Health Plan
Completing a timely Initial Health Assessment (IHA) provides an opportunity for members to establish a relationship with their PCP and obtain necessary health care and preventative services, which can lead to positive health outcomes and improvement in their overall health status. All newly enrolled members must receive an Initial Health Assessment (IHA) within 120 days of enrollment (DHCS Policy Letter 08-003) . A minimum of three documented attempts must be made to schedule the timey IHA, with at least one phone call and one letter.
The IHA consists of a comprehensive health history (medical, social, family, etc), physical exam, including a review of systems, and the completion of the Staying Healthy Assessment. This visit should include, but is not limited to, immunizations (ACIP Guidelines ) counseling including Tobacco Cessation, medical testing and treatment, review of Preventative Services ( USPSTF ). Although there is no specific form, complete documentation of this visit is required to be kept in the patient’s medical record (age appropriate physical evaluation templates). Provision of the assessment or that of a comparable comprehensive assessment needs to be documented in the patient's medical chart.
During their Initial Health Assessment, members need to complete an IHEBA in the appropriate age category for them. The IHEBA can help you identify risky health behavior in order to promote positive lifestyle changes. Download the forms that are listed below.
In our efforts to coordinate with our providers, Blue Shield of California Promise Health Plan conducts outreach to all new members to ensure timely access to the IHA. Members receive phone calls and letters notifying them of the available service and encouraging them to call their PCP to make an IHA appointment within 120 days of enrollment. Blue Shield of California Promise Health Plan also sends a letter to the PCPs notifying them of their newly assigned member and reminding them of the requirements to conduct a timely IHA. We will follow-up with the PCP to verify if member outreach was conducted or effective follow up was done to schedule the IHA. Please be advised your office may be randomly selected to participate in the IHA Medical Record Review utilizing the IHA Audit Tool.
Blue Shield of California Promise Health Plan and/or your contracted Medical Group/IPA sends contracted PCPs a list of new members who are due for an IHA on a monthly basis. There are multiple ways to receive this information such as a secure document exchange site, website portal, secure email or mail. Please contact your contracted Medical Group/IPA for assistance or call our Blue Shield of California Promise Health Plan Provider Relations at 800-468-9935.
DHCS recently released the new Staying Healthy Assessment via Policy Letter 13-001 "Requirements for the Staying Healthy Assessment". The new forms are dated 12/13 and must be implemented by April 1, 2014. For implementation and documentation requirements please view or download the following narrated provider training presentation. DHCS expects 100% participation from all provider offices.
We ask for your commitment in helping us educate patients about appropriate use of the ER. The following materials can help facilitate your discussion with your patients.
Download the following documents or brochures to stay up-to-date with the latest facts & procedures.
See the list of available health topics in video, animation, handout and web site links from Krames on Demand: