Practice Resources
Incentive Information
ACP Metrics, Guidelines and Links
Also see the most updated Key Contact List for each Health Plan.
And the Archives for any old information as provided by the Health Plans.
CPC+
- Comprehensive Primary Care Plus Baseline Learning Assessment
- CPC Care Delivery Model
- CPC Primary Care Functions and Graphics
- Depression Self-Management Goal Setting
- Waiting Room Poster Template
Provider Delivered Care Management (PDCM)
The following resources have been made available to assist offices in delivery of Care Management Services by a Care Manager, working with a Physician and Care Team, in the Primary Care or Specialist Office:
- FAQs produced by BCBSM
- PDCM Billing Guidelines produced by BCBSM
- PDCM Employer Group Exception List
- PDCM Employer Group Exception List - MA
- Provider Delivered Care Management and Blue Distinction Total Care Presentation by Lori Boctor of BCBSM on 6/20/2018
- Self-Management Action Plans
OPNS Physician Matrix
- OPNS Employee Key Contact List
- Alphabetic Directory
- Specialty Directory
- Primary Care, Nurse Practitioner, and Physician Assistant Alphabetic Directory
- SCP only Alphabetic Directory
- Physician Specialty Key
Affordable Care Act- Discrimination Rule
The following linked Discrimination Rule Document provides information to remain compliant with an updated law from the Department of Health and Human Services.
Reference the links within the document for additional information.
OPNS Shareholder Information
OPNS Corporate Bylaws:
OPNS Newsletter
2024
2023
- 1st Quarter Newsletter 2023
- 2nd Quarter Newsletter 2023
- 3rd Quarter Newsletter 2023
- 4th Quarter Newsletter 2023
2022
- 1st Quarter Newsletter 2022
- No 2nd Quarter Newsletter 2022
- 3rd Quarter Newsletter 2022
- 4th Quarter Newsletter 2022
2021
- 1st Quarter Newsletter 2021
- 2nd Quarter Newsletter 2021
- 3rd Quarter Newsletter 2021
- No 4th Quarter Newsletter 2021
2020
- 1st Quarter Newsletter 2020
- 2nd Quarter Newsletter 2020
- 3rd Quarter Newsletter 2020
- 4th Quarter Newsletter 2020
2019
- 1st Quarter Newsletter 2019
- 2nd Quarter Newsletter 2019
- 3rd Quarter Newsletter 2019
- 4th Quarter Newsletter 2019
Tips and Tools
- Advanced Care Planning
- Asthma Action Plan
- Diabetic Fax Back Form
- Extended Access
- Fall Risk Assessment Form
- Mammogram Tracking
- Orthopedic Referral Process
- Orthopedic Referral Form
- Transitions of Care
- Tracking Labs and Procedures
- Tracking Office Appointments
- PD Focus eConsult Tool - Referrals
BCBSM Tip Sheets
Choosing Wisely
The American Board of Internal Medicine (ABIM) Foundation created the initiative known as Choosing Wisely® to educate physicians and patients on the overuse of unnecessary tests and procedures.
OPNS promotes Choosing Wisely® throughout its practices as part of a continuous effort to improve the quality of treatment while efficiently decreasing medical costs. The link below was provided by Choosing Wisely® to explain what the initiative involves.
Community Resources
OPNS has developed a comprehensive list of community resources that may be helpful in providing services to your patients. Information contained in the Community Resource Guide is updated on a semiannual basis or as new information/resources become available. Please refer to the Table of Contents at the beginning of the Guide for a complete listing of service categories.
Cardiac Rehab Brochure
The OPNS Cardiac Rehab brochure provides information regarding:
- What is Cardiac Rehabilitation?
- How Cardiac Rehabilitation will help the patient
- The three (3) phases of Cardiac Rehabilitation
- Who qualifies for Cardiac Rehabilitation
Cardiac Rehabilitation Brochure
Diabetes / PreDiabetes
Diabetes
PreDiabetes / Prevention
Pharmacy
Looking for additional educational tools to address common pharmacy issues?
- Pain Management Agreement
- Save More at the Pharmacy
- Tips to Help You Remember to Take Your Medication
HPV Information / Vaccination
Here are some posters you may want to make available in your office(s) regarding HPV:
- HPV - Don't Wait to Vaccinate (Produced by American Cancer Society)
- HPV - Just the Facts for Parents (Produced by American Cancer Society)
- Protecting Our Children From HPV Cancer (produced by American Cancer Society)
- If There Were a Vaccine Against Cancer... (produced by Centers for Disease Control and Prevention)
- Tips for HPV Vaccination Success (produced by Centers for Disease Control and Prevention)
- Talking to Parents about HPV (produced by Centers for Disease Control and Prevention)
Order free immunization materials at:
http://www.hpclearinghouse.org/
Antibiotic Use
- When Children Need Them (Produced by Choosing Wisely)
- When You Need Them and When You Don't (Produced by Choosing Wisely)
- 5 Things Physicians and Patients Should Question (Produced by Choosing Wisely)
- Alternative to Antibiotics - Mini Handouts (Produced by Oakland Physician Network Services)
- Preventing and Treating Bronchitis (Produced by Centers for Disease Control and Prevention)
OPNS IT Assessment Survey
Health Plan Incentive 2024 at a Glance
The 2024 Incentive Matrix provides the rewards associated to the quality metrics by Health plan.
Advance Care Planning in Everyday Clinical Practice
OPNS Video Series
To view the Video Series on the Trinity Health network and claim CME credits, viewers must first create a CME tracker profile. Viewers may have a CME tracker profile if they have claimed credits for Trinity Health programs in the past.
To access the videos and create a profile, click on the link or QR code below to access the “OnDemand” section of the tracker. Click on the video you want to watch. You will be instructed to register and provide your password or create a new user profile.
cmetracker.net/THLMI/Publisher?page=pubOpen#/enduring
Video 1 – ACP 101- ACP 101 Event # 67485
Video 1 Power Point Presentation Slides
Video 2 - ACP 102 - Having the Conversation Event #73661
Video 2 Power Point Presentation Slides
Video 3 – ACP 103 - Strategies for Incorporating ACP in the Medical Office Event # 7384
Video 3 Power Point Presentation Slides
Video 4– ACP 104 - ACP Billing and Coding Tips and Telemedicine Options Event #
Video 4 Power Point Presentation Slides
Michigan Controlled Substance Laws
Opioid Management Toolkit
Several Resources and links are offered to assist office to improve communication between patients and medical staff regarding the benefits and risks of opioid therapy as well as information on the treatment of opioid use disorder. Also provided are the FAQs regarding current Michigan Opioid Laws.
Documents include:
Preventing Fatal Overdose (naloxone)
Produced by Prescribe to Save Lives
Opioid Safety and how to use naloxone - Patient Handout
Produced by the San Francisco Department of Public Health
CDC Developed Tools for Healthcare Providers (Shared through the Oakland County Health Division):
- CDC Guideline for Prescribing Opioids for Chronic Pain - At a Glance
- CDC Guideline for Prescribing Opioids for Chronic Pain - Factsheet
- Non Opioid Treatments for Chronic Pain
- Checklist for Prescribing Opioids for Chronic Pain
- Turn The Tide - Prescribing Opioids for Chronic Pain Pocket Guide (also available printed at OPNS)
- Tapering Opioids for Chronic Pain Pocket Guide (also available printed at OPNS)
- CDC Developed Toolkit on Opioid Prescribing
Implementing CDC's Opioid Prescribing Guideline into Clinical Practice
Produced by the Centers for Disease Control and Prevention
Determining Whether to Initiate Opioids for Chronic Pain
Produced by the Centers for Disease Control and Prevention
Checklist for Prescribing Opioids for Chronic Pain
Produced by the Centers for Disease Control and Prevention
Guideline for Prescribing Opioids for Chronic Pain
Produced by the U.S. Department of Health and Human Services
Free Customizable Brochures for Download; Facts, Disposal, Talking to Your Doctor and Pain Control
Produced by the Michigan Opioid Prescribing Engagement Network (OPEN)
Additional Opioid Informational Links
CDC Website
https://www.cdc.gov/drugoverdose/opioids/index.html
Michigan Department of Health and Human Services
https://www.michigan.gov/mdhhs/0,5885,7-339-71550_2941_4871_79584---,00.html
Michigan State Medical Society
https://www.msms.org/resources/quality-patient-safety/reversing-the-opioid-epidemic
End of Life Planning
Advance Care Planning (ACP)
OPNS hosted a Town Hall on Advanced Care Planning on April 11th, 2019!
Click here for the Power Point presentation
OPNS has compiled an Advanced Care Planning Toolkit containing materials designed to provide information and guide you as you discuss Advanced Care Planning with your patients, ensuring that both you and your patients are most comfortable.
ACP Toolkit
Specific documents include:
An ACP Pamphlet and A Palliative Care Brochure
To give to your patients to introduce them to what Advanced Care Planning and Pallaitive Care are all about.
A Sample Advanced Care Plan Discussion Script
To guide you in your talk with your patients regarding End-of-Life wishes.
Information On Choosing A Patient Advocate
A person appointed to make health care decisions for a patient when he/she is no longer able to make these decisions for themselves.
To strategically place in your office so that patients can be made aware of Advanced Care Planning.
Billing and Coding Information Sheet
Advance Care Planning Bbilling coding information to help you meeting insurance requirements.
Advance Directive Forms
Sample Advanced Care Directive Forms can be obtained from working with an attorney or websites including www.agingwithdignity.org. This website offers forms for both adults and pediatric offices.
In addition, OPNS provides an Advanced Directive (PDF)(Word) that you may choose to use with your patients.
* Please note that a living will by itself is not yet recognized as a legal document in the state of Michigan. It must be accompanied by an Advanced Directive.
** Whoever is designated as the patient advocate must sign an acceptance form in order to be legally recognized as such. The acceptance form must be witnessed by someone other than the patient's family member or Physician.
Palliative Care
“Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” The World Health Organization (WHO)
What is Palliative Care Brochure
Patient introduction brochure to introduce them to Palliative Care.
Palliative Care Lunch and Learn Presentation Slides 2024
Patient Identification and Assessment Tools
“Patient assessment is a critical step in identifying palliative care needs in patients with life-limiting illnesses including metastatic cancers, end stage organ failure, and advanced degenerative neurological conditions. Assessment should address prognosis, current and anticipated symptoms, distress, and the availability and support need of family and caregivers.” MICMT- “Introduction to Palliative Care”
The following categories of PALLIATIVE CARE ASSESSMENT TOOLS may be downloaded, reproduced, and utilized by physicians and office staff to assess the need for Palliative Care Interventions.
Physical/Performance Status Assessment Screens
- Edmonton_symptom_assessment_scale (ESAS)
- Assesses symptoms and complaints on a scale of 1 -10
- Assesses severity of symptoms over time
- Frailty Score
- Assesses physical status and indicators of frailty
- Karnofsky_performance_scale
- Classifies patients as to their functional impairment
- Addresses activities of daily living, selfcare and ability to work
- Memorial_symptom_assessment_scale
- Assesses recent (past week) frequency and severity of common symptoms/complaints such as fatigue, pain, nausea/vomiting etc
- Palliative_Performance_Scale1 (PPS v 2)
- Evaluates ambulation, activity level, selfcare, intake and consciousness level on a scale ranging from full ability to total bed bound status
Psychological/Emotional Symptoms Assessment Screens
- Generalized Anxiety Disorders – 7 Item Scale (GAD-7): GAD-7-anxiety-screen
- Assesses the presence of anxiety symptoms
- Patient Health Questionnaire: PHQ-9
- Assesses the presence of depression symptoms
Social Determinates of Health (SDOH) Assessment Screen
- SDOH Tool
- Identifies and assesses social situations impacting health such as living conditions, finances, transportation needs etc
Spiritual Distress Symptom Assessment Screen
- FICA Spiritual History Tool 32
- 4 questions to assess spiritual needs
Caregiver and Family Stress Assessment Screen
- Caregiver Strain Index
- Assess caregiver stress and need for intervention
Hospice Care
Message from Hospice of Michigan
Here is a video from the Executive Medical Director, Michael Paletta, MD that may provide suport to individuals and families you serve:
Many visit the website hom.org to use the free (to anyone in the community) bereavement services include the Virtual Support Self-Care: Coping with Fear, Isolation and Adversity Group - this brief weekly virtual meeting will provide education, guidance on specific techniques, provide interactive activities and allow sharing. All are welcome. Led by the Hospice of Michigan Grief Counselors. Every Thursday from 2pm-2:45pm.
Behavioral Health Toolkit
OPNS is pleased to provide a Behavioral Health Toolkit which includes information and resources that may be helpful in addressing the behavioral health of your patients including adherence to anti-depressant medications.
Specific documents include:
Adult Screening for Depression Tools (PHQ-2 and PHQ-9)
Pediatric Screening for Depression Tool (Bright Futures)
Depression Self-Management Goal Setting
Tracking and Follow Up of Behavioral Health Services
Molina - Behavioral Health Provider Toolkit
Call Your Doctor First
Call First Poster and Wallet Card
Low Back Pain Toolkit
The following information has been aggregated for use in your office to help with the high costs of unnessesary imaging for Low Back Pain.
Specific documents include:
American College of Radiology (ACR) Appropriateness Criteria
Last reviewed 2021
Quick Reference - Clinical Practice Guidelines: Acute Phase
Produced by the Michigan Quality Improvement Consortium (MQIC)
Quick Reference - Clinical Practice Guidelines: Sub-Acute / Chronic Phases
Produced by MQIC
Acute Low Back Pain Discharge Instructions
Sourced by WebMD
Produced by the Vanderbilt University Medical Center
Produced by CBI Health Group
Produced by BCBSM
Imaging Tests for Low Back Pain
Produced by Choosing Wisely
Produced by Choosing Wisely
Don't Recommend Advanced Imaging Within First 6 Weeks...
Produced by Choosing Wisely
Radiology Toolkit
In recent years, there has been significant press regarding radiation exposure from diagnostic imaging use. The following resources are provided to increase both physician and patient awareness regarding radiation exposure during common radiological tests and procedures:
Specific documents include:
Produced by www.radiologyinfo.org that offers comparisons of effective radiation dose with background radiation exposure for several radiological procedures.
Helpful websites for Radiology Information/Management
Diagnostic Imaging Discussion Script
Calculated Risk From Radiation Exposure
By using a web based calculator offered by www.xrayrisk.com. Patients can also record their imaging procedures received on the My Medical Imaging History booklet.
Reduce Your Risk of X-Ray Exposure Poster
Help to educate your patients by posting in a conspicuous location.
STAT Add-On Process for Outpatient CT and MRI