CMO Corner:

The Community Health Network of Connecticut, Inc. (CHNCT) quality improvement program employs objective and systematic measurement and monitoring tools to identify opportunities and strategies for improvement and maintenance of member health outcomes. Based on an analysis of data and in alignment with current healthcare concerns, CHNCT selects three indicators annually for quality improvement initiatives. Reducing potentially harmful imaging-related radiation doses in HUSKY Health members is one of the initiatives that has been selected for 2017. Other initiatives include projects related to hepatitis C and chronic obstructive pulmonary disease (COPD). . . read more

Americans are exposed to increasing amounts of ionizing radiation as medical imaging technology becomes more prevalent. Fluoroscopy, nuclear medicine imaging, positron emission tomography (PET) scans, and computed tomography (CT) scans, like all medical procedures, present both benefits and risks. While these imaging procedures have enhanced the ability to diagnose and treat many diseases, they also expose individuals to ionizing radiation which may increase a person’s lifetime risk of developing cancer. Individuals who have been exposed to greater than 100 millisieverts (mSv) of ionizing radiation have an increased lifetime risk of developing cancer. Currently there are 283 HUSKY Health members, 18 years or older, who have been exposed to over 100 mSv, and 2,305 whose exposure ranges between 50-100 mSv.

For many adult members, high levels of radiation exposure are related to the use of CT scans. Based on HUSKY Health data, the rate of potential lifetime CT-related cancer cases (LTCC) for calendar year (CY) 2015 for adults is 4.99 per 10,000 CT scans and in CY 2016, 5.63 per 10,000 CT scans. The goal for this quality improvement initiative is to reduce the rate below 5.63.

Actions to achieve a reduction in radiation exposure include:

  • Outreaching to members who have been exposed to 50-100+ mSv to provide education on radiation exposure
  • Encouraging members to discuss radiation exposure and diagnostic imaging with their provider
  • Promoting “Choosing Wisely,” an American Board of Internal Medicine initiative, that encourages patients and providers to choose care that is necessary, free from harm, supported by evidence, and non-duplicative
  • Promoting “Image Gently,” a campaign dedicated to improving the safe and effective imaging of children worldwide
  • Providing Primary Care Providers (PCPs) with a list of their HUSKY Health patients at risk from high levels of radiation exposure
  • Offering a webinar to educate providers on available alternatives to high dose imaging
  • Collaborating with the Connecticut Hospital Association (CHA) on a statewide radiation dose management repository

References:

http://www.imagegently.org/

http://www.choosingwisely.org/

Attention PCPs: Cancer Screening 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 the 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 regarding their gaps in care, admissions and discharges, ED utilization, and much more. . . read more

Cancer screening reports provide you with information on patients who are due for colorectal, cervical, and breast cancer screenings. These reports enable you, as the provider, to engage the member in preventive care in a timely fashion. You can also see if your member is currently enrolled in the HUSKY Health Intensive Care Management (ICM) program.

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.” 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.

Low-Dose Computed Tomography (LDCT) for Lung Cancer Screening

Age, total cumulative exposure to tobacco smoke, and years since quitting smoking are the most important risk factors for lung cancer. LDCT has high sensitivity and acceptable specificity for detecting lung cancer in high-risk persons, and is the only currently recommended screening test for lung cancer1. . . read more

An annual LDCT scan for lung cancer screening is clinically indicated in adults who:

  • Are between 55 and 80 years of age;
  • Are asymptomatic (no signs or symptoms of lung cancer) and are able and willing to undergo curative lung surgery;
  • Currently smoke tobacco products or have quit within the last 15 years; and
  • Have a cigarette smoking history of at least 30 pack-years.

Healthcare Common Procedure Coding System (HCPCS) code G0297 – LDCT for lung cancer screening has been added to the Department of Social Services (DSS) physician radiology and independent radiology fee schedules effective July 1, 2017. Providers are reminded to use code G0297 when requesting authorization and billing for this service

References:

1 U.S. Preventive Services Task Force. Screening for Lung Cancer. December 2013. Available at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening Accessed August 11, 2017.

Guiding Members to Self-Health Management by ICM

Our focus in Intensive Care Management (ICM) is to optimize the health and quality of life for HUSKY Health members and promote self-empowerment. ICM care managers assist members in different ways, such as providing coaching and specific interventions based on the member’s current needs. . . read more

ICM staff helps connect members to community-based support groups, peer groups, and self-management health tools from nationally recognized associations. ICM helps members find Primary Care Providers (PCPs) to assist them with preventive screenings. We encourage members to make appointments following emergency department (ED) visits or inpatient stays, and we assist as needed since post follow-up care is important.

ICM’s approach is non-prescriptive. Our ICM nurses support the provider’s plan of care and share the member-centered plan of care with the identified provider.

Community Health Network of Connecticut, Inc. (CHNCT) conducts a variety of health promotion and reminder automated calls to the HUSKY Health population to help them improve self-management. Call campaigns include wellness calls for adults and children, as well as cancer screening reminders and PCP selection. Other automated calls are directed toward members with diabetes, ED utilization, and post-admission discharge follow-up visit reminders. These calls serve to encourage members to choose and visit their PCP, maintain their wellness exams, and provide reminders for members to help manage their condition.

CHNCT recognizes the growth and popularity of social media avenues and we have developed various ways to reach HUSKY Health members in the most convenient and effective ways possible. CHNCT offers important diabetes health education messages through Facebook® and Twitter®. Messages are posted monthly to provide members with information about finding a PCP, advocacy programs, and evidence-based resources.

ICM has the ability to provide video conferencing to enable members to take a more active role in their care. ICM acknowledges that decisions most affecting the health and well-being of members are made by the members themselves. Members who are interested in using these technologies are coached on the availability to safely access health tools to promote self-management.

ICM staff will continue to assist members to identify interventions needed to overcome barriers to self-management. Regular use of self-assessment tools allow members to monitor their progress in achieving desired health outcomes. If you have patients that would benefit from the additional support provided by ICM, call 1.800.440.5071 x2024, or fax a completed ICM Referral Form to 866.361.7242.

Missed Appointment Referrals

Effective January 1, 2018, the HUSKY Health program will no longer accept 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 will be accepted electronically through the HUSKY Health secure provider portal after January 1, 2018. CHNCT will notify you by email when you can begin submitting referrals electronically. 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 offers. The Provider Collaborative is CHNCT’s program to educate providers on the ways that we can help providers as they participate in the CMAP program and manage their HUSKY Health members.

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 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 – The State of Connecticut offers a unique Person-Centered Medical Home (PCMH) program which both incentivizes primary care practices for their 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 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, you should not update your address through the DSS Provider Portal. 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 (effective 1/1/18)

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