Frequently Asked Questions

Managed Care Performance Monitoring

Questions About Data Submissions

What is the definition of case management?
What is the definition of screening mechanisms?
Do health fairs or special events count as screening mechanisms?
Does the member have to fill the prescription or just receive the written prescription
   at time of discharge? (Beta-Blocker Treatment After a Heart Attack)
What is MOHSAIC (Missouri Health Strategic Architecture and Information Cooperative)
   and how can an HMO access the data?

What is the definition of case management?
Case management is a protocol where case managers work with providers and physicians to coordinate the medical care that patients with complex or chronic illnesses need to receive, Case managers help patients take care of themselves and make sure they get the right specialists, equipment and medications.

What is the definition of screening mechanisms?

Screening mechanisms for a specific condition means:

1. There is an established protocol for the plan's entire membership;
2. This protocol is available through the PCP's or personal physician's daily practice; and
3. The screening is proactively targeted to persons at risk for the condition.

Do health fairs or special events count as screening mechanisms?
Health fairs or special events do not qualify under DHSS definition of screening mechanisms. Traditionally, health fairs are utilized as a marketing promotions targeting a particular product or service. They do not specifically identifying or target current members of an organization in identifying those who might be at risk.

Does the member have to fill the prescription or just receive the written prescription at time of discharge? (Beta-Blocker Treatment After a Heart Attack)
The prescription needs to be ordered and not necessarily filled for the Beta Blocker measure. This can be noted in MRR or the hospital MRR as discharge instructions. Also, the ambulatory portion refers to medications filled at a retail pharmacy or in the hospital pharmacy as an outpatient prescription.

What is MOHSAIC (Missouri Health Strategic Architecture and Information Cooperative) and how can an HMO access the data?
The MOHSAIC process.