Healthcare services

Health conditions can be challenging. That's why we offer a variety of specialized care programs designed to help members get one-on-one attention from a Moda Health health coach who provides customized guidance.

Moda Health members have access to care programs that help them manage medical conditions:

  • Health Coaching Programs. This flyer provides a summary of the care programs offered to Moda Health members.
  • Health Coaching FAQ. This flyer provides answers to frequently asked questions about the Moda Health care programs.
  • Cardiac Care. Members enrolled in the Cardiac Care Program take a personal risk assessment that aids the health coach in managing specific conditions.
  • Diabetes Care. Health coaches help reduce the complications associated with diabetes, set and achieve goals, and track progress toward improved health.
  • Dental Care.Dental health coaches work with members to identify risks for dental diseases, set goals, and track progress toward a healthy mouth and wellbeing using a whole-body approach.
  • Dental Care FAQ.
  • Depression Care. Health coaches guide members through self-awareness and better management of depression symptoms.
  • Respiratory Care. Health coaches work with members to identify asthma triggers, set goals, track progress and help provide the support needed to feel better and breathe easier.
  • Maternity Care. Expectant mothers get the support and information they need both during and after pregnancy. Specialized guidance is available to members experiencing a high-risk pregnancy.
  • Women’s Health & Maternity Care. Expectant mothers get the support and information they need both during and after pregnancy. Specialized guidance is available to members experiencing a high-risk pregnancy.
  • Spine & Joint Care. Coaches create a plan of modified or joint-sparing activities and techniques to use at home or work. We partner with members as they work with you, their providers, on stretching and strengthening exercises, relaxation techniques, and management of their diet, weight and medication.
  • Lifestyle Coaching. Our health coaches work with members on a number of topics including nutrition, stress, sleep, physical activity and more.
  • Weight Management Our health coaches will work with members to help them control their weight and track their progress to better health. (This plan is not available to all members; members should refer to their Member Handbook for specific plan benefits.)

Participants in Moda Health care programs will:

  • Work one-on-one with a trained health coach over the phone or via email
  • Set goals and learn how to achieve them
  • Learn how to effectively manage their conditions
  • Receive educational materials, answers to questions and self-management tools
  • Track progress to better health
  • Receive incentives for participation
  • Receive mailings with screening reminders, health education and information about medications

Patient Activation Measures

Moda Health staff is trained in the use of motivational interviewing techniques – informed by the insight gained from the Patient Activation Measures (PAM) tool – which allows them to focus on helping participants develop confidence in managing their health (depending on their activation level) rather than on encouraging behaviors they may not be ready to achieve.

PAM is a dynamic assessment and coaching tool that assesses an individual’s knowledge, skills and confidence around managing their health and healthcare. The measure is used at the individual member level to tailor interventions and to serve as the outcome measure to assess change, and track the shift from lower to higher levels of activation. The data shows that small increases in activation have significant impacts on medication adherence, treatment compliance, reductions in ER utilization and acute care readmissions.

Based on responses to the survey, each member is assigned an activation score and level. By understanding participants’ “activation levels” Moda Health staff can better tailor coaching to the individual’s level of activation, helping them identify and overcome barriers. The behaviors encouraged for each activation level are based on empirical data indicating what is realistic at a particular level.

Clinical guidelines

The guidelines below are not intended to direct clinical care in any specific circumstances. They are intended to communicate either evidence-based or generally accepted approaches to care. These clinical guidelines are available for download.

All guidelines can be obtained from the National Guidelines Clearinghouse.

Clinical practice guidelines may include treatment that is not covered by a member's Moda Health benefits. Benefit information can be obtained by calling Moda Health Customer Service using the phone number printed on the back of the member's identification card.

Clinical tools

Obesity

Moda Health encourages all providers to screen for obesity using validated tool such as:

Moda Health would like your support for our Weight Management health coaching program. In an effort to address and combat overweight and obesity, we have begun to identify obese and overweight members based on medical ICD-9 codes included on medical claims. Based on our claims search, we tailor educational outreach to members and refer them to health tools and resources.

When billing for a routine health exam or physical, which includes a screening and assessment of your patient's body mass index (BMI), please include ICD-9 medical codes V85.00–V85.54 (body mass index descriptors1) as well as medical code 278.00 (overweight and obesity1) as ancillary ICD-9 codes.

1Source: ICD-9-CM Volumes 1 through 3, American Academy of Professional Coders, 2010

Preconception and maternity

Moda Health encourages all providers to offer preconception counseling to women who are actively attempting or planning pregnancy. Below are recommended tools to use with patients.

Asthma and pregnancy

Managing a chronic illness such as asthma during pregnancy can be difficult and confusing. Our asthma and pregnancy flyer help women identify triggers and timing as well as help them manage their symptoms.

Preconception

There are many reliable online tools available to women who are trying to get pregnant. Some examples of these tools include ovulation calculators, steps women can take to ensure a healthy pregnancy and a pregnancy quiz to test a women’s knowledge. Many of these tools are available to Moda Health members in their myModa account. If you have a patient who is actively trying to get pregnant, refer them to the Moda Health Maternity Care section of myModa. Members can access myModa by visiting www.modahealth.com/members.

SBIRT - Screening, Brief Intervention, and Referral to Services

SBIRT is an evidence-based, effective method to intervene in alcohol and drug misuse.

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Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

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