CMO Corner: Lawrence Magras, MD, MBA, FHM, FAAPL

Approximately five years ago, the American Board of Internal Medicine, in an effort to promote a national dialogue on avoiding wasteful medical tests, treatments, and procedures, developed an initiative known as Choosing Wisely®, a campaign designed to help providers and patients choose medical care that is supported by evidence, non-duplicative of other tests or procedures already received, free from harm and truly necessary. Community Health Network of Connecticut, Inc. (CHNCT) is proud to announce that we, as an organization, have become members of the Connecticut Choosing Wisely Collaborative (CCWC). . . read more

It is estimated that over 200 billion dollars per year is spent on healthcare services in the U.S. that provide little value to patients. Providers may feel pressure to order testing, medications, and procedures that they may not feel are absolutely necessary believing they should abide by patients’ requests to enhance the provider-patient relationship. Other providers are concerned regarding potential litigious actions if they fail to do “everything” to diagnose and treat. Examples of low-value care include inappropriate use of antibiotics to treat upper respiratory infection, early radiological imaging for complaints of low back pain, and performing non-recommended cervical cancer screenings in adolescent females.

In collaboration with the CCWC, CHNCT will promote the campaign to encourage our members to ask appropriate questions when a test or procedure is ordered to encourage open dialogue between providers and members.

These questions include:

  • Do I really need this test or procedure?
  • What are the risks and side effects?
  • Are there any safer or simpler options?
  • What could happen if I don’t do anything?

It is vital that providers address the concerns of their patients to assure the care is safe, efficacious, and of high-value. Promoting open dialogue between providers and patients is equally constructive in that providers may feel less challenged when questions are asked and can help patients verify that the right questions are being addressed. CHNCT believes that the Choosing Wisely® campaign supports the promotion of high-value care to our members by motivating them to consider important inquiries that endorse involvement so they may actively participate in care decisions. We will be analyzing the results of our efforts, looking for improved healthcare outcomes, and sharing our findings with you.

Reference:

http://www.choosingwisely.org/

Attention PCPs: Asthma Controller Medication Reports are Now Available on the HUSKY Health Secure Provider Portal

As a Primary Care Provider (PCP), we want you to have direct access to data regarding your attributed HUSKY Health members. The HUSKY Health secure provider web portal provides you with a variety of reports on your attributed members gaps in care, admissions and discharges, ED utilization, and much more. . . read more

The asthma controller medication report provides a medication adherence value for your attributed members ages 5 through 64 years of age, based on submitted information from paid pharmacy claims for asthma controller medications. The values displayed in the report are based on a Proportion of Days Covered (PDC) measurement. This is an estimate of the percentage of the time when a member has a supply of medication available for administration. The measurement is a calculation of the number of days in the period that are “covered” by medication, divided by the number of days in the period.

The PDC values are grouped by the following asthma controller therapeutic classes:

  • Adrenergic Bronchodilators
  • Antibody Inhibitors
  • Inhaled Corticosteroids
  • Leukotriene Modifiers
  • Mast Cell Stabilizers
  • Methylxanthines

The report encompasses a one year look-back period, but each patient’s review starts on the date of the first asthma controller prescription filled during that period. Supply of medication extending after the reporting period is not considered.

*Please note: some providers consider a PDC value over 80% as acceptable. The PDC’s utility is as a general tool to help identify potential non-adherence issues, and to monitor changes over time.

To access the reports, you must first set up an account on the HUSKY Health portal by visiting www.ct.gov/husky, clicking “For Providers,” then “Provider Login.” to set up your username and password. Once you have an account, you will be able to request access to your reports. You will be notified via email when your report(s) are available for viewing. To learn more about how to gain access to the Provider Portal Reports, click here.

2018 Quality Management Initiatives

Every year in collaboration with the CT Department of Social Services, Community Health Network of Connecticut, Inc. (CHNCT) develops goals, initiatives, and activities in the following key areas: 1) population health management, including health outcomes measures, utilization management, and cost-effectiveness; 2) access to care; and 3) program satisfaction. For each key area, CHNCT routinely monitors data for trends, patterns, or performance levels to identify areas of opportunity, and develops, implements, and assesses initiatives and interventions. . . read more

In 2018, CHNCT’s quality management program will have a special focus on health outcomes related to emergency department (ED) utilization, inpatient readmissions, diabetes, asthma, hepatitis C screening and medication management, pain management, chronic obstructive pulmonary disease (COPD), cardiovascular disease, surgical care, perinatal care, sickle cell disease, radiation dose reduction related to diagnostic imaging, and wellness and preventive care.

Diabetes: Diabetes is a major health problem that is approaching epidemic proportion globally. Based on a review of CHNCT data, approximately 70,000 HUSKY Health members have been diagnosed with diabetes. CHNCT interventions aim to improve health outcomes for members with diabetes in areas such as maintaining HbA1c control levels, obtaining recommended screenings such as HbA1c testing, eye exams, medical attention for nephropathy and hypertension, and improving the members’ self-management capabilities.

To improve the healthcare outcomes for our members with diabetes, CHNCT’s actions include but are not limited to:

  • Reaching out by phone and e-mail to members who have a noted A1c greater than or equal to 9.0%
  • Providing supportive resources to CHNCT staff, HUSKY Health members, and Connecticut Medical Assistance Program (CMAP) providers regarding changes to the 2018 American Diabetes Association Standards of Medical Care
  • Utilizing CHNCT’s Clinical Pharmacy Specialist to reach out to members to address concerns and barriers that may prevent medication adherence

Asthma: Although asthma cannot be cured, appropriate management can control the disease and enable people to enjoy a good quality of life. CHNCT’s interventions aim to improve health outcomes for members with asthma in areas of medication compliance, medication ratio, ED utilization, inpatient hospitalizations, and readmissions.

To improve the healthcare outcomes for our members with asthma, CHNCT’s actions include but are not limited to:

  • Developing processes for the Clinical Pharmacy Specialist to reach out to those noted to have gaps in the Asthma Medication Ratio (AMR) measure
  • Evaluating AMR scores and coordinating follow-up care with PCPs for members with asthma scoring < 0.5
  • Conducting medication reconciliation, and coaching on use of controller medication and rescue inhaler medications in the cohort of members described
  • Providing individualized member coaching on disease processes, triggers, barriers to proper use of inhalers, and ensuring an asthma action plan is in place
  • For hospitals that provide CHNCT with Admission, Discharge, Transfer (ADT) information, conduct post-discharge phone calls to members who utilized the ED to determine members’ needs and to ensure follow-up care and link to a Primary Care Provider (PCP), if needed

Hepatitis C: For some people, hepatitis C is a short-term illness, but for 70-80% of people who become infected with hepatitis C, it becomes a long-term, chronic infection. Hepatitis C-related deaths have reached an all-time high in recent years, exceeding the combined total number of deaths from 60 other infectious diseases, including human immunodeficiency virus (HIV) and tuberculosis. Hepatitis C is often asymptomatic. Many people infected with hepatitis C are unaware and do not receive care and treatment.

To improve hepatitis C screening rates and healthcare outcomes for members with hepatitis C, CHNCT’s actions include but are not limited to:

  • Notifying members who were either born between 1945-1965, as well as those identified as high-risk, of the importance of hepatitis C screening to raise member awareness and improve member activation regarding the importance of being tested
  • Continuing Intensive Care Management (ICM) outreach to monitor adherence to treatment protocols including maintenance of PCP follow-up appointments
  • Contacting members on medications associated with hepatitis C treatment, stressing adherence, and addressing barriers the member may encounter

Pain Management: The misuse of opioids, a group of drugs that includes heroin and prescription painkillers, has a devastating impact on public health and safety in Connecticut, as well as the rest of the country. According to the Centers for Disease Control and Prevention (CDC), in Connecticut, 971 deaths were related to opioid overdoses in 2016 and opioids were involved in a total of 42,249 deaths in 2016 throughout the country.

To address the epidemic related to the misuse of opioids, CHNCT’s actions include but are not limited to:

  • Making a newly developed opioid tapering toolkit available on the HUSKY Health Pain Management micro-site
  • Continuing ICM outreach for members receiving greater than 550 morphine milligram equivalents (MME) per day
  • Targeting Adult PCP and providers who specialize in pain management to participate in Medication-Assisted Treatment (MAT)
  • Promoting Buprenorphine Training for CMAP providers

Reference:

https://www.cdc.gov/drugoverdose/data/statedeaths.html

Missed Appointment Referrals

As of January 1, 2018, the HUSKY Health program no longer accepts Missed Appointment referral forms via fax. Any faxes received will be returned to you with a request to send the information electronically. Missed Appointment referrals are accepted electronically through the HUSKY Health secure provider portal. Electronic missed appointment referrals will allow you to submit up to 10 member referrals at once. If you do not have access to the secure provider portal, please follow the instructions provided here to create a HUSKY Health secure provider portal account.

When we receive a referral, the HUSKY Health program will follow up with the member via an automated phone call to:

  • Educate on the importance of keeping scheduled appointments
  • Educate on the impact missed appointments have on providers and/or practices
  • Offer assistance with appointment scheduling and transportation

Please contact Provider Engagement Services at 1.800.440.5071, Monday - Friday 8:00 a.m. – 6:00 p.m. with any questions.

Use Our Provider Collaborative to Your Advantage!

Community Health Network of Connecticut, Inc. (CHNCT) offers a comprehensive Provider Collaborative program available to Connecticut Medical Assistance Program (CMAP) providers. As the medical Administrative Services Organization (ASO) for the HUSKY Health program, CHNCT offers a variety of support and services to CMAP providers and HUSKY Health members. . . read more

One of the biggest challenges is ensuring that both providers and members use all of the services that CHNCT and the HUSKY Health program offers. The Provider Collaborative is CHNCT’s program to educate providers on ways we can help you.

At any time, your practice may request a session with any one of CHNCT’s functional areas:

Provider Engagement Services – The first line of support for providers who have questions about managing the administrative requirements of the HUSKY Health program

Member Engagement Services – CHNCT’s representatives are ready and able to help members and providers access benefits and navigate services

Intensive Care Management – Comprehensive care coordination services provided by CHNCT nurse Care Managers to support members with complex and chronic conditions

Community Support Services – CHNCT has Community Health Workers (CHWs) who assess members’ social determinants of health needs and who provide education and coaching to access community resources and care coordination services

Transitional Care – CHNCT’s Transitional Care nurses provide support to members during and after a hospital admission and following an Emergency Department (ED) visit

Prior Authorization – CHNCT is dedicated to providing timely review of medically necessary services requiring prior authorization; our clinical reviewers and non-clinical staff utilize a person-centered approach to the review process

Community Practice Transformation & Network Management (a department within the Population Health Management division) – The State of Connecticut offers a unique Person-Centered Medical Home (PCMH) program which both incentivizes primary care practices for thep participation and provides consultative know-how from well-versed medical home experts at no cost to the practice, while also improving quality of care

Population Health and Quality Management – This department is responsible for data reporting, analysis, and clinical evaluation of health outcomes by implementing provider interventions focused on improving the health of the members we serve

For more information click here or go to www.ct.gov/husky, click “For Providers,” then select “Provider Collaborative” under the “Reports & Resources,” menu item. To leverage the Collaborative for your practice, please call 1.800.440.5071 or email us at provider@chnct.org.

Avoid Payment Interruptions – Keep Your Provider Information Up-to-Date

Has your practice undergone any changes in the last four months? If so, please take the time to update your information with the Department of Social Services (DSS). All demographic changes for you and your practice, including additions and terminations of physicians, nurse practitioners, and physician assistants, need to be made in a timely fashion to ensure the integrity of the provider directory. These updates assist physicians and clinical staff, call center staff, and members when searching for or referring to a provider to access and coordinate care. . . read more

The accuracy of your provider information may: 1) impact the payment of claims; 2) lead to misdirected payments or the loss of provider eligibility; and/or 3) impact the recoupment of previously paid claims.

Any changes in address, licensure, provider specialty, certification, business name or ownership, group/clinic affiliation, and Federal Employer Identification Number (FEIN) of all National Provider Identifier (NPI)/medical providers must be communicated to DXC Technology.

Please review and update your information by logging into the DSS Provider Portal by clicking here or by going to www.ctdssmap.com and clicking “Secure Site,” on the left-hand navigation menu.

More information about managing and updating your provider information is available by accessing the DSS Provider Manual by clicking here or visiting www.ctdssmap.com, clicking “Information,” then “Publications.”

You may also submit any changes, on your letterhead, by mail to:

DXC Technology
P.O. Box 5007
Hartford, CT 06104

PCMH Program Providers Please Note: If you are a provider participating in the DSS PCMH program, please contact your Regional Network Manager directly or call 203.949.4194 to avoid any missed enhanced payments.

Important Reminder — Re-Enrollment Due Dates

Please be aware of your re-enrollment date so that you, DXC Technology (formerly Hewlett Packard Enterprises), and the Department of Social Services (DSS) have ample time to submit, review, and process your re-enrollment. Your timely action will eliminate any possible claim denials.

DXC Technology mails a 180-day and 90-day reminder that re-enrollments are due for all physicians, nurse practitioners, and physician assistants. Accurate provider information is critical to receive re-enrollment reminders and instructions from DXC Technology, so be sure your provider information is up-to-date on the DSS provider web portal.

If you receive a re-enrollment notice, visit the web portal at www.ctdssmap.com to complete your re-enrollment. Simple step-by-step directions are available through an online tool to assist you with this process.

Get to Know Your Provider Engagement Services Representatives

The Community Health Network of Connecticut, Inc. (CHNCT) Provider Engagement Services staff is dedicated to working personally with your practice on site and by phone. Our staff is on the road 4-5 days a week, visiting provider offices to discuss topics such as enrollment/attestation processes, DSS bulletins and policies, HUSKY Health policies and programs, and other important matters. . . read more

Our goal is to establish an open dialogue with you and your practice to promote positive relationships through communication, problem resolution, and education. CHNCT collaborates with our partners at the Department of Social Services (DSS) and DXC Technology (formerly Hewlett Packard Enterprises) to address any and all inquiries as quickly as possible and to facilitate resolutions when necessary.

The CHNCT Provider Engagement Services staff supports and attends several provider conferences held throughout the state each year. When you see us at an event, please stop by to introduce yourself and we will do the same!

To set up an appointment with us or to speak with your local Provider Engagement Services representative, please call your regional contact listed below:

Nancy Esposito

203.949.4163

nesposito@chnct.org

New Haven

Katherine Sullivan

203.949.4064

ksullivan@chnct.org

Fairfield

Kimberly Martin

203.949.4106

kmartin@chnct.org

Greater Hartford/Tolland

David Miller

203.949.4141

dmiller@chnct.org

Hartford/Litchfield

Jennie Pinette

203.949.6140

jpinette@chnct.org

Middlesex/New London/Windham

Important Contact Information

  • Behavioral Health1.877.552.8247

Monday - Friday; 8:00 a.m. - 7:00 p.m.
www.ctbhp.com

  • Dental1.888.445.6665

Monday - Friday; 8:00 a.m. - 5:00 p.m.
www.ctdhp.com

  • Non-Emergency
    Medical Transportation
    1.855.478.7350

Monday - Friday; 7:00 a.m. - 6:00 p.m.

  • Medical1.800.440.5071

Monday - Friday; 8:00 a.m. - 6:00 p.m.
www.ct.gov/husky

  • To check member eligibility1.800.842.8440

Monday - Friday; 8:00 a.m. - 6:00 p.m.
www.ctdssmap.com

  • Pharmacy1.800.842.8440

Monday - Friday; 8:00 a.m. - 5:00 p.m.
www.ctdssmap.com