Key points
To improve health and control costs, ÐÇ¿ÕÓéÀÖ¹ÙÍø is prioritizing these six high-burden health conditions and effective interventions.
Prevention Unintended Pregnancy
- Reimburse providers for the full range of contraceptive services (e.g., screening for pregnancy intention; counseling; insertion, removal, replacement, or reinsertion of long-acting reversible contraceptives, and follow-up) for women of childbearing age.
- Reimburse providers for the actual cost of FDA-approved contraceptive methods.
- Unbundle payment for long-acting reversible contraceptives from other postpartum services.
- Remove administrative barriers to receipt of contraceptive services (e.g., pre-approval step therapy restriction, barriers to high acquisition and stocking costs).
Control High Blood Pressure
- Implement strategies that improve adherence to anti-hypertensive and lipid-lowering prescription medications via expanded access to:
- low cost medication copayments, fixed dose medication combinations, and extended medication fills;
- innovative pharmacy packaging;
- improved care coordination using standardized protocols, primary care teams, medication therapy management programs, and self-monitoring of blood pressure with clinical support.
- low cost medication copayments, fixed dose medication combinations, and extended medication fills;
- Provide home blood pressure monitors to patients with high blood pressure and reimburse for the clinical support services required for self-measured blood pressure monitoring.
Reduce Tobacco Use
- Increase access to tobacco cessation treatments, including individual, group, and telephone counseling, and Food and Drug Administration-approved cessation medications (in accordance with the 2008 Public Health Service Clinical Practice Guidelines and the 2015 U.S. Preventive Services Task Force recommendations).
- Remove barriers that impede access to covered cessation treatments, such as cost-sharing and prior authorization.
- Promote increased use of covered treatment benefits by tobacco users.
Control Asthma
- Use the 2007 National Asthma Education and Prevention Program as clinical practice guidelines.
- Promote strategies that improve access and adherence to asthma medications and devices.
- Expand access to intensive self-management education by licensed professionals or qualified lay health workers for patients whose asthma is not well-controlled with medical management.
- Expand access to home visits by licensed professionals or qualified lay health workers to provide intensive self-management education and reduce home asthma triggers for patients whose asthma is not well-controlled with medical management and self-management education.
Improve Antibiotic Use
- Require antibiotic stewardship programs in all hospitals and skilled nursing facilities, in alignment with ÐÇ¿ÕÓéÀÖ¹ÙÍø's Core Elements of Hospital Antibiotic Stewardship Programs and The Core Elements of Antibiotic Stewardship for Nursing Homes.
- Improve outpatient antibiotic prescribing by incentivizing providers to follow ÐÇ¿ÕÓéÀÖ¹ÙÍø's Core Elements of Outpatient Antibiotic Stewardship.