Aspirin Therapy in Ischemic Heart Disease and Diabetes PIP
2008 Care Coordinator Q & A
How often are the risk lists sent to Care Coordinators?
o Risk lists are sent to Care Coordinators every month.
o SCHA sends the risk lists to the CRMTs, who then share the risk lists with their
respective care coordinators.
Are members in assisted living facilities and nursing homes included in the
project?
o This intervention is intended for MSHO and MSC+ members in all living
situations except nursing homes. All members in assisted living or similar
facilities are included in the target group and will be included on your risk lists. If
possible, work with whoever is responsible for prescribing medications for them.
If you have patients in nursing homes or others not included on the list who you
feel could benefit from aspirin therapy, feel free to discuss with them and/or their
providers as appropriate. Nursing homes often buy OTC drugs in bulk so
individual pharmacy claims would be difficult to track
Who sends the mailers to members? Are the materials offered in other languages
besides English?
o Each health plan in the Collaborative sends the mailers to eligible members
based on enrollment data.
o The Collaborative team has materials in other languages that reflect their
enrollment populations, including Spanish, Somali and Russian. The project
leads will contact Care Coordinators to notify them of new mailers and materials
in additional formats.
o For SCHA members: Please contact Anne Grimmius via CCM to request
translated materials
What is the best strength of aspirin for low-dose aspirin therapy?
o The dose should depend upon the individual patient and what their primary care
provider determines is best for them.
What is the best-tolerated dose for patients with GI sensitivity?
o The member should discuss dosage and individual health concerns with their
primary care provider to determine the best plan for them.
What is the latest guideline regarding age for diabetics taking aspirin?
o Individual physician guidance may vary depending on patient needs.
o ICSI Guidelines recommend aspirin therapy for people with CAD starting at age
18, and patients with diabetes should begin aspirin therapy at age 40. All
patients should discuss these recommendations with their physician.
Does the use of NSAIDS decrease the benefits of low-dose aspirin therapy?
o Please review your ASA Care Coordinator toolkit; NSAIDs should be viewed as
having the potential to interfere with the anti-platelet effect of aspirin.
How does the Collaborative identify members who are diabetic, have heart disease
or are at risk of bleeding?
o ICD-9 codes, CPT and HEDIS specifications capture the diabetes and heart
disease diagnoses as well as the contraindications such as intracranial bleeding.
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Aspirin Therapy in Ischemic Heart Disease and Diabetes PIP
2008 Care Coordinator Q & A
HEDIS codes also help us identify the diabetes diagnosis by capturing
medications that are used to treat diabetes. NDC codes identify drugs that
exclude the member—anti-platelets and anti-coagulants.
Is there a list of OTCs covered by MSHO?
o Formularies vary by plan so it’s best to refer to the members’ current health plan
formulary.
o For SCHA members: You can view the formulary on SCHA’s website under the
“Our Programs” tab (http://www.mnscha.org/programs.htm). Click on the relevant
product and then “Pharmacy Directory”.
Why do some of the materials mention a co-pay for prescriptions?
o Some of the health plans in the Collaborative have co-pays for certain programs.
Refer to the respective health plan formulary for co-pay information.
o For SCHA members: There is no co-pay for MSHO members. MSC+ members
will have a co-pay of less than $3 (not to exceed the cost of aspirin over-thecounter).
How are the prescription claims coded?
o When a member fills their prescription, the NDC code appears in the pharmacy
claims records.
Is Aspirin covered with a prescription for other things such as a headache?
o Yes. However, the member should discuss aspirin use and individual health
concerns with their primary care provider. Aspirin is only a covered benefit with a
prescription from their provider.
What is the purpose of the “Tips for Working in the Excel Risk List”?
o This document was created to provide suggestions for Care Coordinators for
when they are working with and entering data into the Excel spreadsheet risk
lists, for example when sorting member names alphabetically.
o A “cheat sheet” that describes the information found on the risk list is available
for your reference. For a copy, see SCHA’s website (under the “County
Resources” tab), contact Anne Grimmius via CCM, or talk with your county’s
CRMT.
What information do I need to document for this PIP?
o Please review your ASA Care Coordinator toolkit. The Collaborative asks that
you document member education on ASA in the respective member’s care plan.
If you know of a member who should be excluded from future risk lists (i.e.
member is deceased, has contraindications to aspirin, etc.) please notify the PIP
project lead for your health plan. If a member refuses to change their method of
obtaining aspirin from OTC to prescription, that is their choice; however, the
member will remain on future risk lists for tracking purposes.
o For SCHA members: An “Aspirin PIP” contact type is also available in CCM. This
contact type should also be used to document when a member refuses to
participate in the PIP, has a contraindication to aspirin, or to document any other
information you feel should be noted as it relates to the PIP. Please “CC” Anne
Grimmius when using the Aspirin PIP contact type.
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Aspirin Therapy in Ischemic Heart Disease and Diabetes PIP
2008 Care Coordinator Q & A
Why did you choose to target only Ischemic Vascular Disease when there are so
many other cardiovascular conditions where people could benefit from aspirin
therapy?
o The terminology “Ischemic Vascular Disease” is being used in a general manner
for this intervention. Both diagnostic and procedure codes for many
cardiovascular conditions, as well as Diabetes Mellitus, are included in identifying
patients who could benefit from aspirin therapy. The specific codes were chosen
based on HEDIS specifications for “cholesterol management for those with
cardiovascular conditions.” Our focus is on those members at greatest risk for
heart attack or stroke.
SCHA’s PIP contact information:
Anne Grimmius (Health Promotions Coordinator)
agrimmius@mnscha.org
507-431-6571
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