April 2010
ODS news
Squares accent

NCQA Recognizes ODS with

Excellent Rating

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 satisfaction rates.

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:
  • Disorders
  • Acute and chronic pain
  • Informed decision support
One-on-one 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.

Applying 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.

Coaches 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

Contact your 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 Dunham
According 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.
The 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.

After 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.

Bisphosphonates 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.
The 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.
"We've 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."

ONJ is characterized by pain, soft-tissue swelling, infection, loose teeth and exposed bone. Most 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 tissue.
Lydia 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.
"I was surprised," she says. "My doctor who prescribed the Fosamax didn't tell me about any possible problems with my teeth."
Macwilliams 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.
After 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.
"It took about a year to heal," she said, "but it's doing just fine now."
Sedghizadeh 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.
"Here 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 seeing it."
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 effective."
Reprinted with permission from USC HealthNow


Not all plans have access to all resources or tools referenced in this newsletter. Please refer to your member handbook, or call your ODS marketing representative for plan-specific information.
Issue: 3
In This Issue
Spine & Joint Care
Osteoporosis Medications & Jawbone Death
Milliman Care Guidelines

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 products for:

Inpatient and outpatient surgeries

Initial and ongoing goal length of stay for admissions to:
  • Inpatient facilities, including medical and behavioral health
  • Skilled nursing facilities
  • Acute inpatient rehabilitation
  • Long-term acute care facilities
  • Outpatient therapies
  • Chiropractic, acupuncture and massage services
  • Durable medical equipment
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 real-life situations.

If you have any questions about the Milliman Care Guidelines, please contact your marketing representative.
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