NCQA Recognizes ODS with
ODS is pleased to announce the National Committee for
Quality Assurance (NCQA) has awarded us with its highly coveted accreditation
status of Excellent. This is the highest rating possible and is awarded only to
those health plans with well-established programs for both service and clinical
quality. ODS received this award based on our commitment, our focus on quality
in all areas of our business, and our interactions with our customers. Two
criteria were significant: clinical effectiveness measures and member
The hard work and dedication that goes into meeting all
of the rigorous criteria required for receiving this accreditation is truly for
you, our loyal customers. We take pride in giving you confidence, security and
satisfaction in your health care. ODS was first accredited by the NCQA in 2009
at the commendable level; since then we have made strides to be the best, and
to deserve being called excellent.
The fact that member satisfaction rates played a
significant part in receiving this award is most important to us; it signifies
we are meeting and exceeding your expectations. We thank you for setting the
bar high, pushing us to work hard and recognizing our commitment to customer
service. It makes receiving this award all the more gratifying.
ODS met or exceeded a
rigorous set of more than 60 standards and reported on its performance in more
than 40 areas to achieve NCQA's seal of Excellence. "We strongly believe in the
NCQA accreditation process," says Robert Gootee, President & CEO of
ODS. "We know it recognizes that we serve our customers well."
|Spine & Joint Care Program|
On March 31, ODS members became eligible to
participate in the new Spine & Joint Care Program, a musculoskeletal and
pain management coaching benefit.
ODS takes a highly integrated approach
to medical management, leveraging cross-referrals from Care Coordination, Case
Management and Behavioral Health to identify members who may benefit from
health coaching. We also use medical and pharmacy claims data as part of our
multi-faceted approach. We work closely with ODS internal stakeholders,
including representatives from Marketing, Pharmacy, Professional Relations,
Claims and Customer Service to facilitate the best possible care and provide
the best coaching for our members.
As the newest addition to the suite of ODS
Care Programs, the Spine & Joint Care Program offers members
condition-specific outreach, including e-mail and telephone-based "health coaching"
from a multidisciplinary team of clinicians who focus on the following spine
and joint topics:
health coaches work actively with ODS members to help them understand spine and
joint anatomy and create a plan of modified, joint-sparing activities
and techniques to perform at home and work. The program emphasizes the
member working with his or her healthcare provider on interventions, including stretching
and strengthening exercises, relaxation techniques, diet and weight management,
smoking cessation and medication management.
both patient activation measures and motivational interviewing techniques,
one-on-one coaching helps members make realistic and meaningful decisions that
reflect their personal needs and values. We identify members needing higher
levels of support based on the member's knowledge, skills and confidence in
managing his or her health condition. These members may be offered care
coordination and case management services.
communicate with the member's healthcare provider when necessary to
discuss treatment plans and goals. As with other ODS Care Programs, coaches
screen patients for depression, making referral recommendations to the
healthcare provider when appropriate.
For more information
marketing representative if you have any questions about the ODS Spine &
Joint Care Program.
|Preventing a Mouth Malady|
USC School of Dentistry study is among the
first to acknowledge correlation between common osteoporosis medications and
jawbone death by Beth
to a recent study by researchers at the University of Southern California (USC)
School of Dentistry, even short-term use of common oral osteoporosis drugs may
leave the jaw vulnerable to devastating necrosis, or death of the jawbone.
study, which appeared in the Jan. 1, 2009, issue of The Journal of the American
Dental Association, is the first large institutional study in the United States
to investigate the relationship between oral bisphosphonate use and jawbone
death, says principal investigator Parish Sedghizadeh, assistant professor of
clinical dentistry at the USC School of Dentistry.
controlling for referral bias and other health factors, nine of 208 School of
Dentistry patients who take or have taken Fosamax for any length of time were
diagnosed with osteonecrosis of the jaw (ONJ). Fosamax is the most widely
prescribed oral bisphosphonate for people with osteoporosis.
are typically used to reduce the risk of bone fracture and to increase bone
mass in people with osteoporosis. Other negative side effects have been
reported in the past, including unusual fractures of the thigh bone,
inflammatory eye disease and increased risk of atrial fibrillation-a type of
abnormal heart rhythm.
study's results are in contrast to drug makers' prior assertions that
bisphosphonate-related ONJ risk is noticeable only with intravenous use of the
drugs, not oral usage, Sedghizadeh says.
been told that the risk with oral bisphosphonates is negligible, but 4 percent
is not negligible," he says. "This is more frequent than everybody would like
to think it is."
characterized by pain, soft-tissue swelling, infection, loose teeth and exposed
doctors who have prescribed bisphosphonates have not told patients about any
oral health risks associated with the use of the drugs, despite even short-term
usage, which poses a risk due to the drug's tenacious 10-year half-life in bone
Macwilliams of Los Angeles said no one told her about the risk posed by her
three years of Fosamax usage until she became a patient of Sedghizadeh's at the
School of Dentistry.
surprised," she says. "My doctor who prescribed the Fosamax didn't tell me
about any possible problems with my teeth."
was especially at risk for complications because she was to have three teeth
extracted. The danger for infection is especially pronounced with procedures
that directly expose the jawbone, such as tooth extractions and other oral
surgery. This is because the infection is a result of a biofilm bacterial
process. The bacteria infecting the mouth and jaw tissues reside within a slimy
matrix that protects the bacteria from many conventional antibiotic treatments,
and bisphosphonate use may make the infection more aggressive in adhering to
the jaw, Sedghizadeh says.
her extractions, two of the three extraction sites had difficulty healing due
to infection, Macwilliams says. Luckily, with treatment as well as the rigorous
oral hygiene regimen that USC dentists developed especially for patients with a
history of bisphosphonate usage, the remaining sites slowly but fully healed.
took about a year to heal," she said, "but it's doing just fine now."
hopes to have other researchers confirm his findings and thus encourage more
doctors and dentists to talk with patients about the oral health risks
associated with the widely used drugs. The results confirm the suspicions of
many in the oral health field, he says.
at the School of Dentistry, we're getting two or three new patients a week that
have bisphosphonate-related ONJ," he says, "and I know we're not the only ones
Sedghizadeh says they now screen every patient
for bisphosphonate use and treat accordingly. "We put patients on
anti-microbial, anti-fungal rinse one week pre-operatively or
post-operatively," he says. "If they have been on bisphosphonates six months or
a year or longer, then we have a prevention protocol which has been very, very
Reprinted with permission from USC HealthNow
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access to all resources or tools referenced in this newsletter. Please
your member handbook, or call your ODS marketing representative for
ODS Adopts Milliman Care Guidelines
As part of our ongoing commitment to promote
quality care, patient safety and the most appropriate use of healthcare
resources, effective Thursday, April 22, ODS has adopted the evidence-based
Milliman Care Guidelines®. Specifically, we will use the Care Guidelines
Initial and ongoing
goal length of stay for admissions to:
including medical and behavioral health
Long-term acute care
acupuncture and massage services
The Milliman Care Guidelines are developed
using the industry's most rigorous evidence-based methodology. All content is
reviewed annually and updated as necessary by doctors and nurses who cite more
than 15,000 unique references, including peer review journals, in the current
seven-product Care Guidelines series. Milliman Care Guidelines epidemiologists
then examine databases that cover a significant portion of the United States
population to validate that these published research results are achievable in
If you have any
questions about the Milliman Care Guidelines, please contact your marketing